Background: Ruptured posterior communicating artery (PCoA) aneurysms are common; they usually present with subarachnoid haemorrhage (SAH) and oculomotor nerve palsy. The aneurysmal dome projection may influence the safety access and aneurysmal neck clipping. Here, we discuss additional intraoperative steps that may be required to widen the surgical field to ensure safe surgical clipping of a rupture pure posteriorly directed PCoA aneurysm. Case description: A previously healthy 38-year-old male reported sudden severe headache and disturbed level of consciousness with a Glasgow coma scale (GCS) of 13. His initial computed tomography (CT) scan of the head showed SAH in the basal cistern. 3D-constructed CT angiography (CTA) revealed a left pure posteriorly directed PCoA aneurysm. In the surgery, through the left pterional approach, all intraoperative steps were carried out. Additional steps were performed as well. Three additional intraoperative steps were contemplated because a pure posteriorly directed PCoA aneurysm is not well appreciated and is often hidden behind the supra cliniold internal carotid artery (ICA). First, the extension of Sylvian fissure dissection to include the distal part and the proximal. Second, temporal pole mobilization is performed by cutting small anterior temporal veins. Third, a brain retractor is placed on the temporal lobe to gently tract the superficial part of the lobe. All these steps widened the surgical corridor to ensure the aneurysm's safe clipping. Conclusion: Surgical clipping is influenced by the aneurysmal dome projection. In a ruptured pure posteriorly directed PCoA aneurysm, further intraoperative steps may facilitate complete access and safe clipping of the aneurysm.
The aim of the research is to study the effect of the roundhouse strategy on the achievement of fifth grade secondary school in physics and their pivotal thinking. The experiment has been applied for obtaining the data, which were processed statistically using the Statistical Package for Social Sciences, the results revealed that the students of the experimental group who studied using the roundhouse strategy was superior to the students of the control group who studied in the traditional method in the achievement exam. The results also show that there are statistically significant differences between the mean scores of the students of the experimental group and the control group in the pivotal thinking exam, in favor of the experimental gr
... Show MoreYou Mohammed, you're prophet of God and I'm Gabriel)). With this heavenly call which Mohammed, the messenger of God (may God's mercies be on him), got and when he left Hiraa cave and after getting the aye ((read with your God's name)), a new period of mankind's history started. From that time, the greatest state was established. There was no public treasury and no public financial resources at that time. Abu Baker (God bless him) spent a lot of money to support the costs of the new mission. After Al-Hijra, the bases of establishing the Islamic state were available but it lacked administrative and financial organizing. Therefore the prophet was very keen to find Islamic system which ensures justice and availability of
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تتناول هذه الورقة مخططات وسياسات الاستيطان في الضفة الغربية والقدس الشرقية منذ العام 1967، عبر سياسات قادها حزب العمل وأكملها حزب الليكود وكاديما وبقية الأحزاب الإسرائيلية، تلك السياسات التي استهدفت فرض السيطرة السياسية الكاملة على الأرض، وما نتج عن ذلك من سيطرة حصرية على الأرضوتقييد استخداماتها، ومحاصرة الوجود الفلسطيني والتضييق عليه، وتحويل مراكز ال
... Show More The current research aims to highlight the role of human resource management with its practices (human resource planning, selection and placement, training and development, performance evaluation, compensation, and incentives) in raising the level of individuals' performance and its dimensions (task performance, contextual performance, unproductive work behavior, and adaptive performance) by explaining the research problem, which can be limited to the low level of performance of individuals, where the researchers use the descriptive analytical approach and the SPSS program in the practical aspect of the research community represented by the general manager and his assistant
Soft red winter wheat (SRW) is characterized by high yield and relatively low protein content. In Kentucky, there is growing demand from local artisan bread bakers for regionally produced flour, requiring production of grain with increased protein content and/or strength. The objective of this two-year field experiment was to evaluate the effect of nitrogen (N) management on five cultivars of winter wheat on yield and bread baking quality traits of modern and landrace SRW cultivars (Triticum aestivum L.). All five cultivars were evaluated using two N application rates in conventional and organic production systems. All traits measured were significantly affected by the agricultural production system and N rate, although plant height
... Show MoreTo develop a new basis to reduce the phenomenon of stress, one researcher used relaxation techniques is the use of medicinal herbs sedative which is emphasized by some specialists and researchers because of its direct impact on some of the functions of the body as members have a significant impact on the player from the mental and physical Came the importance of research in the use of medicinal herbs sedative and in particular (Lafracin Black, Plantago Sinani great, Alternen) within the program to soothe the psychological players badminton to get rid of the tension felt by sports by athletic competition through the use of a program to ease the psychological with a range of herbs and both means of calming influence of the nervous system. The
... Show MoreForm recurrence of financial crises phenomenon disturbing and attention , and returns the reasons so that its negative effects were sharp and dangerous , because of the nature and cause of Ncaha , threatened political and economic stability of the countries in which they occur these crises , in addition to Machmlh these crises spread of contagion across multiple channels to include other countries many developed and developing , and the reason for this to the openness of the economic and financial witnessed by the countries affected by crises and other countries concerned, the financial crisis is a case of financial turmoil appears in one of the sections of the financial system one and extends to
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The current research aims to demonstrate the relationship of correlation and influence between the independent variable strategic control through its dimensions represented by (organizational structure, human resources management, commitment to specialization, defining powers and responsibilities, values and integrity) and the dependent variable the performance of the insurance company, and the degree of arrangement of these dimensions according to their importance, as well as Detection of significant differences in the sample's response to the questionnaire paragraphs in the researched company, and the research problem
... Show MoreThe drive of this exploration is to investigate the mucoadhesive assets of A. indica (Azadirachta indica) fruit mucilage by incorporating it into mucoadhesive microspheres with Acyclovir (AVR) as a model drug. The study was performed to check the impact of the mucilage proportion on particle size and swelling index. Nine batches of AVR mucoadhesive microspheres were made with varying proportions of Polyacrylic acid 934P and A. indica fruit mucilage (AIFM). A central composite design with design expert software to check the impact of dependent variables (A. indica mucilage and Polyacrylic acid 934 P levels) on particle size and swelling index as a response. As part of congeniality studies, the batches w
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