Uterine tube evisceration during drainage tube removal - A rare case report.

INTRODUCTION AND IMPORTANCE: Drainage tubes are commonly used to remove unwanted fluid after surgery. However, they are not indicated in all situations, and there is no evidence to support their common utilization. CASE PRESENTATION: A 31-year-old woman at 38 weeks of gestation with a history of five cesarean sections presented with lower abdominal pain following a tonic-clonic epileptic seizure. Emergency surgery was performed due to fetal distress, and the uterus was found to be ruptured. After delivering the baby and closing the uterus, a drainage tube was inserted into the pouch of Douglas. Two days after surgery, the right ampulla and infundibulum were eviscerated from the drain site during the drainage tube removal. A second surgery was performed to reduce the herniated uterine tube. CLINICAL DISCUSSION: Drainage tubes are typically easily removed without complications. Some reported complications related to drainage tube removal include herniation, anchoring and suctioning of the uterine tube to the drainage tube, knotting with the colonic epiploica, and fracturing and retraction of the drainage tube due to adhesions. To the best of our knowledge, this is the first reported case of uterine tube evisceration during drainage tube removal. CONCLUSION: Evisceration after drainage tube removal is very rare. We believe that this is the first report of immediate evisceration after the removal process. Such complications can be avoided with more restricted instructions for the use of drainage tubes and more researches on the reasons for these complications.

A Robust Automated Analog Circuits Classification Involving a Graph Neural Network and a Novel Data Augmentation Strategy.

Analog mixed-signal (AMS) verification is one of the essential tasks in the development process of modern systems-on-chip (SoC). Most parts of the AMS verification flow are already automated, except for stimuli generation, which has been performed manually. It is thus challenging and time-consuming. Hence, automation is a necessity. To generate stimuli, subcircuits or subblocks of a given analog circuit module should be identified/classified. However, there currently needs to be a reliable industrial tool that can automatically identify/classify analog sub-circuits (eventually in the frame of a circuit design process) or automatically classify a given analog circuit at hand. Besides verification, several other processes would profit enormously from the availability of a robust and reliable automated classification model for analog circuit modules (which may belong to different levels). This paper presents how to use a Graph Convolutional Network (GCN) model and proposes a novel data augmentation strategy to automatically classify analog circuits of a given level. Eventually, it can be upscaled or integrated within a more complex functional module (for a structure recognition of complex analog circuits), targeting the identification of subcircuits within a more complex analog circuit module. An integrated novel data augmentation technique is particularly crucial due to the harsh reality of the availability of generally only a relatively limited dataset of analog circuits' schematics (i.e., sample architectures) in practical settings. Through a comprehensive ontology, we first introduce a graph representation framework of the circuits' schematics, which consists of converting the circuit's related netlists into graphs. Then, we use a robust classifier consisting of a GCN processor to determine the label corresponding to the given input analog circuit's schematics. Furthermore, the classification performance is improved and robust by involving a novel data augmentation technique. The classification accuracy was enhanced from 48.2% to 76.6% using feature matrix augmentation, and from 72% to 92% using Dataset Augmentation by Flipping. A 100% accuracy was achieved after applying either multi-Stage augmentation or Hyperphysical Augmentation. Overall, extensive tests of the concept were developed to demonstrate high accuracy for the analog circuit's classification endeavor. This is solid support for a future up-scaling towards an automated analog circuits' structure detection, which is one of the prerequisites not only for the stimuli generation in the frame of analog mixed-signal verification but also for other critical endeavors related to the engineering of AMS circuits.

The role of adding hyaluronidase to fluoroscopically guided caudal steroid and hypertonic saline injection in patients with failed back surgery syndrome: a prospective, double-blinded, randomized study.

BACKGROUND: Failed back surgery syndrome (FBSS) has been reported to account for up to 40% of patients with chronic low back pain. Epidural fibrosis may be responsible for up to 30% of all cases of FBSS. Perineural fibrosis can interfere with cerebrospinal fluid-mediated nutrition, rendering the nerve root hyperesthetic and hypersensitive to compression. Traditionally, steroid injection has been used to treat low back pain and radiculopathy. The addition of hyaluronidase to the injectate has been reported to reduce the degree of fibrosis. AIM: To evaluate the role of hyaluronidase when added to fluoroscopically guided caudal steroid and hypertonic saline in patients with FBSS. METHODS: Thirty-eight patients with back pain because of FBSS were studied. Twenty patients received fluoroscopically guided caudal epidural steroid, local anesthetic, and hypertonic saline in combination (group 1), and 18 patients received fluoroscopically guided caudal epidural steroid, hypertonic saline, local anesthetic, and hyaluronidase (group 2). Patients were asked to rate their pain using a verbal scale of 0 to 4 (0 = none, 1 = mild, 2 = moderate, 3 = severe, and 4 = extremely severe). Lumbar spine range of motion and opioid intake were measured. RESULT: Significant improvement in short-term pain relief was noted in both groups, while significant long-term pain relief was only achieved in group 2 patients. CONCLUSION: The addition of hyaluronidase to fluoroscopically guided caudal epidural steroid and hypertonic saline combination improved long-term pain relief in patients with FBSS.

Prevalence of antiphospholipid antibodies in Syrian patients with thrombosis.

BACKGROUND: Antiphospholipid antibodies (aPL) are a heterogeneous family of antibodies associated with thrombosis and other complications. OBJECTIVE: To study the prevalence of aPL in patients with thrombosis at Aleppo University Hospitals, Syria. METHODS: One hundred and fifty-seven patients with venous and arterial thrombosis and 63 healthy controls were studied. Anticardiolipin antibodies (aCL) and Lupus anticoagulant (LA) were determined. RESULTS: Thirty-four out of 157 (21.7%) patients with thrombosis had some type of aPL. aPL was also found in four healthy subjects (4/63=6.3%). Eighteen patients (11.5%) were positive for LA, 20 (12.7%) for aCL antibodies and 4 (2.6%) were positive for more than one aPL. Patients without risk factors for thrombosis and having positive aPL were 23/34 (67.7%). Fourteen out of 78 (17.9%) patients with arterial thrombosis, and 20/79 (25.3%) with venous thrombosis were positive for at least one aPL. CONCLUSION: Our study showed a significant prevalence of aPL in patients with thrombosis. It seems that aPL is a risk factor for venous and arterial thrombosis, especially in patients with no conventional risk factors.

Pyridazine derivatives and related compounds. Part 13: Synthesis and antimicrobial activity of some pyridazino[3',4':3,4]pyrazolo[5,1-c]-1,2,4-triazines.

A general method for the preparation of substituted pyridazinopyrazolotriazines is reported. 3-Aminopyrazolo[3,4-d]pyridazine was diazotized and coupled with active methylene reagents to afford the tricyclic pyridazino[3',4':3,4]pyrazolo[5,1-c]-1,2,4-triazines with substituents such as methyl, phenyl, ethoxycarbonyl, acetyl or benzoyl, depending on the methylene reagent used. In addition several condensation reactions with hydrazines gave the corresponding acid hydrazide and/or hydrazones. Reactions of 3 with aromatic aldehydes afforded hydrazones. The products were screened for their antimicrobial activity against five microorganisms.