Introduction. Intraoperative rupture (IOR) of an aneurysm is a frightful complication that causes significant morbidity and mortality worldwide. IOR can be attributed to various parameters, including hypertension, increased intracranial pressure (ICP), fragility of the vessels, and inadequate anaesthesia. IOR due to insufficient anaesthesia is scarcely reported in the literature. Here, we describe a re-ruptured anterior communicating artery (ACoA) after incomplete clipping of the neck during craniotomy closure due to unintended early wake-up from anaesthesia with a discussion about the management. Case description. A 38-year-old male suddenly developed a severe headache, a brief loss of consciousness, and vomiting. Computed tomography (CT) scan showed a subarachnoid haemorrhage in the basal cistern. CT angiography showed a bilobed right ACoA aneurysm with a wide neck and Murphy's teat. The patient was considered for surgery. Clipping of the aneurysm neck was done through two curved clips. During craniotomy closure, the patient started coughing and gagging then a huge IOR was encountered. These events can be mainly attributed to unintended inadequate anaesthesia, particularly muscle relaxants. The bleeding ceased after two suction catheters were inserted, temporary clips were applied, and the readjustment of permanent clips. After surgery, the patient showed a left-sided weakness. His postoperative CT scan showed a right distal anterior cerebral artery (ACA) territory infarction. The weakness improved in the follow-up period. Conclusion. Delayed IOR due to early awaking from anaesthesia should be considered a potential source of complications and bad outcomes in aneurysm surgery.
ABSTRACT
The study aims to identify the level of health services provided in private suites to government hospitals from the perspective of the recipi
... Show MoreUbikh is one of the most important tribes of the Northwest Caucasus and has a long history. Naturally, rebukes are an integral part of the Caucasus region. Their people were able to confront the Russian invasion of their lands like the rest of the Caucasus tribes to defend their existence, freedom and the right to build their independent state, but they were not able to resist the great Russian military progress they achieved on all sides. For the territory that belonged to Persia and the Ottoman Empire and ended the resistance of the Meridian movement in the Northeast Caucasus, the Russians left only the weak resistance of the tribes of the Northwest Caucasus led by the rebuke after Russia managed to eliminate all resistance movements i
... Show MoreIn this work 27 events have been chosen for the period from (17 Feb 2000 to 10 Sep 2014) to analyze their intensity profile and find out what is the most effective reason behind the bulk of the accelerated SEPs as seen in the interval from the onset to the maximum intensity. It was found that the parameters of the associated eruptions (CME and solar flare) could play a major role in this acceleration. We considered some of these parameters such as: flare class related to soft X-ray flux, CME's speed and acceleration, site of the eruption (western, eastern) and particle transport in the IP medium. The shape of the profile showed a clear changing in ΔT1 (time from onset to maximum), as an inverse relation with the acceleration of coronal
... Show MoreFurfural is a toxic aromatic aldehyde that can cause a severe environmental problem especially the wastewater drown from petroleum refinery units. In the present work, a useless by-product from local furniture manufacturing industry; sawdust was used as raw material for the preparation of activated carbon which is chemically activated with phosphoric acid. The effect of adsorption variables which include initial pH of solution (2-9), agitation speed (50-250) rpm, agitation time (15-120) min, initial concentration of furfural (50-250) ppm, and amount of adsorbent material (0.5-2.5) g for the three adsorbents used (prepared activated carbon, commercial activated carbon and raw sawdust) were investigated in a batch process
... Show MoreThe shortage of irrigation water requires specific measures. One of these measures is the application of the rationing system (a period of irrigation followed by a period of drought). This system could have an effect on the behavior and properties of irrigation canals. So, studying rationing system on the irrigation canals is important both in civil engineering and water resources engineering, especially if these channels constructed with gypsum soil. This study includes the calculation of seepage velocity and water content in each cycle (10 days wetting and 10 days of drying). The model is built for this research contains four samples, two samples for untreated soil one of them expos
Care and attention to the structure in the sixties of the last century replaced the mark, and if the structure of Ms. pampered in research and studies, it has become the mark is also a spoiled lady .. But the relationship between the structure and the mark was not a break and break, but the relationship of integration, His themes are structural analysis, and these are intellectual themes that can not be surpassed in contemporary research, especially since semiotics have emerged from the linguistic inflection.
We have tried to distinguish between text and speech, which is a daunting task, as it seems that whenever the difference between them is clear and clear, we come back to wonder whether the text is the same discourse, and is
... Show MoreQA Sarhan, University of Anbar Sport and Physical Education Sciences, 2019
Purpose: The present study seeks to examine various history stages in which undergone by the concept of scenarios, and development of this concept to integration with the strategic management practices:
Methodology: The current study relied on a literature review and approach in providing total picture of different stages undergone by this concept.
The main results: the scenarios did not reach maturity in their quest for integration with strategic management, and still need a great effort for the maturation of this thought in the framework of strategic management, and through it can contribute in creating important knowledge evolution.
Originality and value: providing a contemporary model linking the roots of this concept and cu
The termination of the international sales contract is one of the solutions that the parties and the law resort to resolve some fundamental violations that occur in the contract for any reason, but determining the fundamental reason that leads to the termination of the contract is the most extreme type of treatment of the fundamental violation that has been interpreted differently by international experts, whether courts international bodies or international arbitration committees. And in relation to the difficulty of determining the fundamental violation that leads to the termination of the contract and the exceptions contained in cases that are considered a fundamental violation and that are not considered a fundamental violation, the
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