Hysteroscopy to identify retained placental tissue and excision in secondary post-partum haemorrhage

Background: Most cases of secondary postpartum haemorrhage (PPH) are due to retained placental products (RPP). This study had a crop of five cases of secondary PPH, referral cases, during a period of six months during 2006. Four cases were following a caesarean delivery and in one, sub mucous and intra mural, uterine fibroids, caused retained placental tissue by distortion of the uterine cavity. Objectives of this study were to evaluate the feasibility of hysteroscopy to identify the retained placental products in cases of secondary postpartum haemorrhage. Verification of complete removal of RPP by reinsertion of hysteroscope, after removal of RPP by using a sponge holder, or curette.Methods: Trans vaginal ultrasonography (TVS) identified echogenic retained products of conception in all cases. Surgical profile investigations were done as per protocol. Transfusion of blood products was needed in some. Bettocchi 5 mm continuous flow hysteroscope (Karl Storz) was used. Storz endomat hysteroflator was used for irrigation and aspiration.Results: Hysteroscopic guided excision of the placental tissue was one-time treatment in four of study cases, and one needed a second hysteroscopic excision. Secondary PPH occurred at varying periods after the caesarean delivery, one week in one, two weeks in one case, three weeks in two cases and one woman was admitted with retained placenta, primary PPH continuing to secondary PPH. Hysteroscopy done during the puerperal period, in cases of secondary PPH, had certain challenges to cope with.Conclusions: Hysteroscopic guided excision of the retained placental tissue was successful in all the five cases with secondary postpartum haemorrhage. Hysteroscopy is an excellent procedure in cases of secondary PPH. We request guidelines committees to consider including hysteroscopic guided removal of retained placental products, in the algorithm of management of secondary PPH

Resource-Aware Multimedia Content Delivery: A Gambling Approach

In this paper, we propose a resource-aware solution to achieving reliable and scalable stream diffusion in a probabilistic model, i.e. where communication links and processes are subject to message losses and crashes, respectively. Our solution is resource-aware in the sense that it limits the memory consumption, by strictly scoping the knowledge each process has about the system, and the bandwidth available to each process, by assigning a fixed quota of messages to each process. We describe our approach as gambling in the sense that it consists in accepting to give up on a few processes sometimes, in the hope of better serving all processes most of the time. That is, our solution deliberately takes the risk not to reach some processes in some executions, in order to reach every process in most executions. The underlying stream diffusion algorithm is based on a tree-construction technique that dynamically distributes the load of forwarding stream packets among processes, based on their respective available bandwidths. Simulations show that this approach pays off when compared to traditional gossiping, when the latter faces identical bandwidth constraint

Resource-Aware Multimedia Content Delivery: A Gambling Approach

In this paper, we propose a resource-aware solution to achieving reliable and scalable stream diffusion in a probabilistic model, i.e. where communication links and processes are subject to message losses and crashes, respectively. Our solution is resource-aware in the sense that it limits the memory consumption, by strictly scoping the knowledge each process has about the system, and the bandwidth available to each process, by assigning a fixed quota of messages to each process. We describe our approach as gambling in the sense that it consists in accepting to give up on a few processes sometimes, in the hope of better serving all processes most of the time. That is, our solution deliberately takes the risk not to reach some processes in some executions, in order to reach every process in most executions. The underlying stream diffusion algorithm is based on a tree-construction technique that dynamically distributes the load of forwarding stream packets among processes, based on their respective available bandwidths. Simulations show that this approach pays off when compared to traditional gossiping, when the latter faces identical bandwidth constraints

Resource-Aware Multimedia Content Delivery: A Gambling Approach

In this paper, we propose a resource-aware solution to achieving reliable and scalable stream diffusion in a probabilistic model, i.e. where communication links and processes are subject to message losses and crashes, respectively. Our solution is resource-aware in the sense that it limits the memory consumption, by strictly scoping the knowledge each process has about the system, and the bandwidth available to each process, by assigning a fixed quota of messages to each process. We describe our approach as gambling in the sense that it consists in accepting to give up on a few processes sometimes, in the hope of better serving all processes most of the time. That is, our solution deliberately takes the risk not to reach some processes in some executions, in order to reach every process in most executions. The underlying stream diffusion algorithm is based on a tree-construction technique that dynamically distributes the load of forwarding stream packets among processes, based on their respective available bandwidths. Simulations show that this approach pays off when compared to traditional gossiping, when the latter faces identical bandwidth constraint

Optimisation des amortisseurs à masse accordée placés en parallèle

Les amortisseurs à masse accordée (AMA), (" Tuned Mass Dampers " en anglais) sont de nos jours très souvent utilisés pour le contrôle passif des vibrations de bâtiments et d'ouvrages d'art comme par exemple, le gratte-ciel du centre mondial des finances de Shanghai (492 m) ou la passerelle du Millenium à Londres. Un AMA consiste en une masse liée à un niveau de la structure par l'intermédiaire d'un ressort et d'un d'amortisseur linéaires

A Scalable Data Dissemination Protocol Based on Vehicles Trajectories Analysis

International audienceSince the last decade, the emergence of affordable wireless devices in vehicle ad-hoc networks has been a key step towards improving road safety as well as transport efficiency. Informing vehicles about interesting safety and non-safety events is of key interest. Thus, the design of an efficient data dissemination protocol has been of paramount importance. A careful scrutiny of the pioneering vehicle-to-vehicle data dissemination approaches highlights that geocasting is the most feasible approach for VANET applications, more especially in safety applications, since safety events are of interest mainly to vehicles located within a specific area, commonly called ZOR or Zone Of Relevance, close to the event. Indeed, the most challenging issue in geocast protocols is the definition of the ZOR for a given event dissemination. In this paper, we introduce a new geocast approach, called Data Dissemination Protocol based on Map Splitting (DPMS). The main thrust of DPMS consists of building the zones of relevance through the mining of correlations between vehicles' trajectories and crossed regions. To do so, we rely on the Formal Concept Analysis (FCA), which is a method of extracting interesting clusters from relational data. The performed experiments show,that DPMS outperforms its competitors in terms of effectiveness and efficiency. (C) 2017 Elsevier B.V. All rights reserved

Changing trends in uterine rupture audit, from the Institute of obstetrics and gynecology, modern government maternity hospital, Osmania medical college

Background: Between January 2001 to September 2003, 46,171 deliveries were recorded, the number of caesarean deliveries during this period of two years and nine months were 16,182 (35.04%).  Methods: An Audit from the Institute of obstetrics and gynecology, of uterine ruptures.Results: Total 81 cases of uterine rupture were managed at the Institute. Total number of scar ruptures managed were, 48/81 uterine ruptures. Five women had previous classical upper segment caesarean, and in previous lower segment caesarean section (LSCS), there were 43 cases of rupture uterus. In two cases following forceps delivery, traumatic uterine ruptures were recorded. Spontaneous ruptures were 31 during the study period. Bladder rupture occurred in 13 cases, 16.04% of uterine ruptures.  The fetal outcome in uterine ruptures 81 cases, live births were 19-23.45%. The number of vaginal births after caesarean section were 261, 215, 186 in the years 2001, 2002 and 2003 at the Institute of obstetrics and gynecology. The number of scar ruptures were 7/261, 9/215, 2/186 in the respective years. Hysterectomy was done in 43/81=53.08%. Rent repair of the uterine rupture was done in 38/81.Conclusions: An Audit from the Institute of obstetrics and gynecology, of uterine ruptures has provided the following data that gives an insight into the practice of obstetrics during the decade 2000 to 2010 in the teaching Institute.  Caesarean deliveries accounted for 35.04% of the total deliveries.  Repeat caesarean sections were 7105, 43.9%. The number of vaginal births after caesarean section (VBAC) were 662. Scar ruptures in VBAC were 18 /662-2.71%. The maternal mortality in MGMH study was 3/81 uterine ruptures-3.7%. Scar ruptures constituted, 48/81-59.25% of uterine ruptures. Trial of labor after caesarean (TOLAC) and VBAC are practiced in the teaching Institute

Confrontational Argumentative Strategies in the Discourse of Foreign Policy Experts

The aim of this study is to explore the discursive practices of foreign policy experts. While policy decisions involving war and peace keep people alarmed all over the globe, most of these decisions are shaped by policy experts who work on influencing public opinion through the media (Manheim, 2011). This study adopts a critical discursive stance and uses argumentation analysis to examine the ideological backdrop to the discourse of thirty opinion articles authored by American foreign policy experts in print media. Drawing on the Pragma-dialectical method of augmentation analysis (van Eemeren and Grootendorst, 2004), and more particularly on its notion of strategic maneuvering, the analysis examines the confrontational strategies used by this group of experts and attempts to determine the rhetorical goals pursued by these strategic maneuvers