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Sample records for hepatic failure caused

  1. Scrub typhus causing neonatal hepatitis with acute liver failure-A case series.

    Science.gov (United States)

    Vajpayee, Shailja; Gupta, R K; Gupta, M L

    2017-05-01

    Neonatal hepatitis with acute liver failure due to varied etiology including various infections is reported in the past. Scrub typhus as a cause of neonatal hepatitis has rarely been reported in literature. A high index of clinical suspicion is required for early diagnosis and timely treatment. Severity and prognosis of the disease varies widely because several different strains of Orientia tsutsugamushi exist with different virulence. Delayed diagnosis can result in complication and significant morbidity and mortality. Here, we report three cases of neonatal hepatitis with acute liver failure caused by scrub typhus to increase awareness.

  2. Use of N-Acetylcysteine in Children with Fulminant Hepatic Failure Caused by Acute Viral Hepatitis

    International Nuclear Information System (INIS)

    Saleem, A. F.; Abbas, Q.; Haque, A.

    2015-01-01

    Objective: To determine the efficacy of N-acetylcysteine (NAC) in children aged > 1 month to 16 years admitted with Fulminant Hepatic Failure (FHF) secondary to Acute Viral Hepatitis (AVH) in a tertiary care center of a developing country. Study Design: Analytical study. Place and Duration of Study: Department of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan, from January 2007 to December 2011. Methodology: Medical records of children (> 1 month - 16 years) with FHF admitted with AVH of known etiology who received NAC were reviewed retrospectively. Liver function tests (mean ± SD) at baseline, 24 hours after NAC and before or at the time of discharge/death were recorded and compared via using repeated measures ANOVA(r-ANOVA). Efficacy of NAC is defined in improvement in biochemical markers, liver function test and discharge disposition (survived or died). Mortality associated risk factors were identified by using logistic regression analysis. P-value and 95 percentage confidence interval were recorded. Results: Forty children (mean age was 80 ± 40 months) with FHF secondary to AVH received NAC. Majority were males (n=25; 63 percentage). Vomiting (75 percentage) and jaundice (65 percentage) were the main presenting symptoms, one-third had hypoglycemic, while 40 percentage had altered sensorium at the time of admission. There was significant statistical difference in liver enzymes and prothrombin time on admission comparing at discharge in children received NAC (p < 0.001). Fifteen (38 percentage) children died. Severe vomiting (Odds Ratio (OR) 0.22, 95 percentage Confidence Interval (CI) 0.05 - 0.8), jaundice (OR 9.3, CI 1.1 - 82.6), inotropic support (OR 20.6, CI 3.5 - 118.3) and mechanical ventilation (OR 4.3, CI 1.1 - 16.6) at the time of admission are associated with risk factors for mortality in children with FHF secondary to AVH. Conclusion: NAC used in children with FHF secondary to AVH is associated with markedly improved liver function

  3. Acute liver failure caused by hepatitis E virus genotype 3 and 4: A systematic review and pooled analysis.

    Science.gov (United States)

    Haffar, Samir; Shalimar; Kaur, Ravinder J; Wang, Zhen; Prokop, Larry J; Murad, Mohammad H; Bazerbachi, Fateh

    2018-04-19

    Acute liver failure caused by hepatitis E virus genotype 3 and 4 has been rarely described. Because of the presence of a short golden therapeutic window in patients with viral acute liver failure from other causes, it is possible that early recognition and treatment might reduce the morbidity and mortality. We performed a systematic review and pooled analysis of acute liver failure caused by hepatitis E virus genotype 3 and 4. Two reviewers appraised studies after searching multiple databases on June 12th, 2017. Appropriate tests were used to compare hepatitis E virus genotype 3 vs 4, suspected vs confirmed genotypes, hepatitis E virus-RNA positive vs negative, and to discern important mortality risk factors. We identified 65 patients, with median age 58 years (range: 3-79), and a male to female ratio of 1.2:1. The median bilirubin, ALT, AST and alkaline phosphatase (expressed by multiplication of the upper limit of normal) levels were 14.8, 45.3, 34.8 and 1.63 respectively. Antihepatitis E virus IgG, antihepatitis E virus IgM and hepatitis E virus-RNA were positive in 84%, 91% and 86% of patients respectively. The median interval from symptoms onset to acute liver failure was 23 days, and 16 patients underwent liver transplantation. Final outcome was reported in 58 patients and mortality was 46%. Age was a predictor of poor prognosis in multivariate analysis. No important differences were found between patients infected with genotype 3 vs 4, patients with confirmed vs suspected genotypes, or patients with positive vs negative RNA. Acute liver failure caused by hepatitis E virus genotype 3 and 4 is rare, similar between genotypes, occurs commonly in middle-aged/elderly patients and has a very high mortality. Age is predictive of poor prognosis in multivariate analysis. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Hyperbilirubinemia and rapid fatal hepatic failure in severe combined immunodeficiency caused by adenosine deaminase deficiency (ADA-SCID).

    Science.gov (United States)

    Kühl, J S; Schwarz, K; Münch, A; Schmugge, M; Pekrun, A; Meisel, C; Wahn, V; Ebell, W; von Bernuth, H

    2011-03-01

    Adenosin deaminase (ADA) deficiency is the cause for Severe Combined Immunodeficiency (SCID) in about 15% of patients with SCID, often presenting as T (-)B (-)NK (-)SCID. Treatment options for ADA-SCID are enzyme replacement, bone marrow transplantation or gene therapy. We here describe the first patient with ADA-SCID and fatal hepatic failure despite bone marrow transplantation from a 10/10 HLA identical related donor. As patients with ADA-SCID may be at yet underestimated increased risk for rapid hepatic failure we speculate whether hepatitis in ADA-SCID should lead to the immediate treatment with enzyme replacement by pegylated ADA. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Parvovirus B19 in an Immunocompetent Adult Patient with Acute Liver Failure: An Underdiagnosed Cause of Acute Non-A-E Viral Hepatitis

    Directory of Open Access Journals (Sweden)

    J Kee Ho

    2005-01-01

    Full Text Available There are occasional pediatric reports of parvovirus B19-associated transient acute hepatitis and hepatic failure. A case of a 34-year-old immunocompetent woman who developed severe and prolonged but self-limited acute hepatitis and myelosuppression following acute parvovirus B19 infection is reported. Parvovirus B19 may be the causative agent in some adult cases of acute non-A-E viral hepatitis and acute liver failure.

  6. Fulminant hepatic failure secondary to hydroxychloroquine.

    OpenAIRE

    Makin, A J; Wendon, J; Fitt, S; Portmann, B C; Williams, R

    1994-01-01

    Hydroxychloroquine is widely used in rheumatological disease but hepatic side effects have not been reported previously. Two cases are described of fulminant hepatic failure developing after the start of hydroxychloroquine treatment for a chronic rheumatological disorder. In both cases the symptoms of liver disease developed within two weeks of starting hydroxychloroquine and rapidly progressed to fulminant hepatic failure and in neither case was there any pre-existing liver disease. One pati...

  7. Multimodal brain monitoring in fulminant hepatic failure

    Science.gov (United States)

    Paschoal Jr, Fernando Mendes; Nogueira, Ricardo Carvalho; Ronconi, Karla De Almeida Lins; de Lima Oliveira, Marcelo; Teixeira, Manoel Jacobsen; Bor-Seng-Shu, Edson

    2016-01-01

    Acute liver failure, also known as fulminant hepatic failure (FHF), embraces a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction, and hepatic encephalopathy. Cerebral edema and intracranial hypertension are common causes of mortality in patients with FHF. The management of patients who present acute liver failure starts with determining the cause and an initial evaluation of prognosis. Regardless of whether or not patients are listed for liver transplantation, they should still be monitored for recovery, death, or transplantation. In the past, neuromonitoring was restricted to serial clinical neurologic examination and, in some cases, intracranial pressure monitoring. Over the years, this monitoring has proven insufficient, as brain abnormalities were detected at late and irreversible stages. The need for real-time monitoring of brain functions to favor prompt treatment and avert irreversible brain injuries led to the concepts of multimodal monitoring and neurophysiological decision support. New monitoring techniques, such as brain tissue oxygen tension, continuous electroencephalogram, transcranial Doppler, and cerebral microdialysis, have been developed. These techniques enable early diagnosis of brain hemodynamic, electrical, and biochemical changes, allow brain anatomical and physiological monitoring-guided therapy, and have improved patient survival rates. The purpose of this review is to discuss the multimodality methods available for monitoring patients with FHF in the neurocritical care setting. PMID:27574545

  8. Fulminant Hepatic Failure Secondary to Primary Hepatic Angiosarcoma

    Directory of Open Access Journals (Sweden)

    Ayokunle T. Abegunde

    2015-01-01

    Full Text Available Background. Hepatic angiosarcoma is a rare and aggressive tumor that often presents at an advanced stage with nonspecific symptoms. Objective. To report a case of primary hepatic angiosarcoma in an otherwise healthy man with normal liver function tests two months prior to presenting with a short period of jaundice that progressed to fulminant hepatic failure. Methods. Case report and review of literature. Conclusion. This case illustrates the rapidity of progression to death after the onset of symptoms in a patient with hepatic angiosarcoma. Research on early diagnostic strategies and newer therapies are needed to improve prognosis in this rare and poorly understood malignancy with limited treatment options.

  9. Cerebral edema associated with acute hepatic failure.

    OpenAIRE

    Fujiwara, Masachika; Watanabe, Akiharu; Yamauchi, Yasuhiko; Hashimoto, Makoto; Nakatsukasa, Harushige; Kobayashi, Michio; Higashi, Toshihiro; Nagashima, Hideo

    1985-01-01

    The clinicopathological findings of cerebral edema were investigated in patients with acute hepatic failure autopsied at Okayama University Hospital between 1970 and 1980 retrospectively. Nine (64%) of 14 hepatic failure cases were found to have cerebral edema during a post-mortem examination of the brain. Clinical features of the patients with cerebral edema were not significantly different from those of the patients without cerebral edema. However, general convulsions were observed more fre...

  10. Governing of common cause failures

    International Nuclear Information System (INIS)

    Bock, H.W.

    1998-01-01

    Agreed strategy is to govern common cause failures by the application of diversity, to assure that the overall plant safety objectives are met even in the case that a common cause failure of a system with all redundant trains is assumed. The presented strategy aims on the application of functional diversity without the implementation of equipment diversity. In the focus are the design criteria which have to be met for the design of independent systems in such a way that the time-correlated failure of such independent systems according a common cause can be excluded deterministically. (author)

  11. Coordination failure caused by sunspots

    DEFF Research Database (Denmark)

    Beugnot, Julie; Gürgüç, Zeynep; Øvlisen, Frederik Roose

    2012-01-01

    on the efficient equilibrium, we consider sunspots as a potential reason for coordination failure. We conduct an experiment with a three player 2x2x2 game in which coordination on the efficient equilibrium is easy and should normally occur. In the control session, we find almost perfect coordination on the payoff......-dominant equilibrium, but in the sunspot treatment, dis-coordination is frequent. Sunspots lead to significant inefficiency, and we conclude that sunspots can indeed cause coordination failure....

  12. Orlistat-induced fulminant hepatic failure.

    Science.gov (United States)

    Sall, D; Wang, J; Rashkin, M; Welch, M; Droege, C; Schauer, D

    2014-12-01

    Orlistat was approved by the Food and Drug Administration in 1998 and has been shown to be superior to placebo in achieving weight loss. It is generally well tolerated. However, severe liver injury has been reported. We present a case of hepatic failure in a patient taking orlistat. A 54-year-old African-American woman with hypertension presented with hepatic failure. She had noticed increasing fatigue, jaundice and confusion. She used alcohol sparingly and denied tobacco or illicit drug use, but had been taking over-the-counter orlistat for the past two months. Physical examination revealed scleral icterus, jaundice, asterixis and slow speech. Laboratory testing showed markedly abnormal liver function tests with coagulopathy. Acute viral and autoimmune serologies were negative, as was toxicology screen. Liver biopsy showed necrotic hepatic parenchyma likely secondary to drug toxicity. Based upon her clinical presentation and time course, the pattern of liver injury seen on liver biopsy and lack of an alternative plausible explanation, her liver failure was most likely associated with orlistat use. She continued to deteriorate and ultimately underwent orthotopic liver transplantation. Fourteen cases of severe liver injury associated with orlistat use have been reported, four of which are detailed in the literature. This is the second published case of liver failure associated with over-the-counter orlistat usage. Clinicians should be aware of the growing number of cases associating liver injury and orlistat use and carefully monitor their patients on this medication for signs of hepatic dysfunction. © 2014 The Authors. Clinical Obesity © 2014 World Obesity.

  13. Acute Hepatic Failure in a Dog after Xylitol Ingestion.

    Science.gov (United States)

    Schmid, Renee D; Hovda, Lynn R

    2016-06-01

    Xylitol is a five-carbon sugar alcohol produced from natural resources frequently used as a sugar substitute for humans. We report the development and successful treatment of acute hepatic failure and coagulopathy in a dog after xylitol ingestion. A 9-year-old 4.95 kg (10.9 lb) neutered male Chihuahua was evaluated at a veterinary clinic for vomiting after ingesting 224 g (45 g/kg, 20.5 g/lb) of granulated xylitol. Hypoglycemia developed within 1-2 h, elevated liver values, suggesting the development of acute hepatic failure, within 12 h and coagulopathy less than 24 h after ingestion. Treatment included maropitant, intravenous dextrose, phytonadione, metronidazole, and fresh frozen plasma. N-acetylcysteine (NAC) and S-adensoyl-L-methionine (SAMe) provided hepatic detoxification and support. The dog survived and liver values returned to normal within 1 month post ingestion. No adverse effects to hepatic function have been identified 2 years after acute xylitol toxicity. This paper is one of the few reports of successful management of a dog with hypoglycemia, hepatic failure, and coagulopathy caused by xylitol toxicity. To date, this is the highest published xylitol dose survived by a dog, as well as the only reported case that documents laboratory changes throughout the course of toxicity and includes normal hepatic indices for 7 months following xylitol toxicity. The rapidly expanding use of xylitol in a variety of products intended for human consumption has led to a rise in xylitol toxicity cases reported in dogs, and clinicians should be aware that more dogs may potentially be exposed and develop similar manifestations.

  14. Chemotherapy in patients with hepatic failure

    International Nuclear Information System (INIS)

    Roldán, G.; Sosa, A.

    2004-01-01

    The toxicity of chemotherapy in the liver may manifest as hepatocyte dysfunction with chemical hepatitis, veno-occlusive disease or chronic fibrosis. The hepatocyte dysfunction is caused by direct effect of the drug or its metabolites evidencing by increased bilirubin and liver enzymes (Sgot, SGPT). Prolonged effect leads to cholestasis and fatty infiltration. This dysfunction is concomitant enhanced by viral infection, liver metastases and other drugs as antiemetics. The vast majority of the indicated drugs in a cancer patient, cytostatics, antiemetics, analgésios, anticonvulsants, etc, are metabolized in the liver. The evidence of abnormal hepatocyte function in a patient in which involves chemotherapy raises the need for dose modification indicated and / or discontinuation. The aim of this paper is to review existing information on the use of cytostatics in cancer patients with hepatic impairment, classifying drugs according to their potential hepato toxicity and recommended dose modification in patients with hepatic dysfunction

  15. Fulminant hepatic failure in children: Etiology, histopathology and MDCT findings

    International Nuclear Information System (INIS)

    Cakir, Banu; Kirbas, Ismail; Demirhan, Beyhan; Tarhan, Nefise Cagla; Bozkurt, Alper; Ozcay, Figen; Coskun, Mehmet

    2009-01-01

    Introduction: The purpose of this study is to determine the etiologies, histopathology and MDCT findings of children with fulminant hepatic failure admitted to our institution. Materials and methods: Between June 2004 and November 2006, 15 children with fulminant hepatic failure who underwent MDCT were included retrospectively in this study. Twelve patients had liver biopsies. The patients were divided into three groups as hyperacute (Group I), acute (Group II) and subacute (Group III) depending on onset of hepatic encephalopathy. Results: Hepatitis A in 4 patients, non-A, non-E hepatitis in 4; mushroom poisoning in 3; fulminant Wilson's disease in 2; autoimmune hepatitis in 1; and both hepatitis B and toxic hepatitis (with leflunomide treatment) in 1 patient were detected. MDCT of all three groups revealed diffuse reduction in hepatic attenuation in 11 patients; ascites in 9; periportal edema in 6; edema of gallbladder wall in 6; splenomegaly in 6; heterogeneous hepatic parenchyma in 6; hepatomegaly in 3; irregular contours of liver in 2; multiple micronodules in 1 and necrotic areas and regeneration in liver parenchyma in 2 patients. Histopathologic evaluation of liver biopsies showed massive hepatic necrosis, inflammatory cell infiltration and ductular proliferation in 8 patients, periportal edema in 6, edema of gallbladder wall in 5, regenerating nodules and fibrous septa consistent with cirrhotic pattern in 2, and regenerating nodules and necrotic areas in 2 patients. Conclusion: The most common MDCT findings in fulminant hepatic failure were diffuse reduction in hepatic attenuation and ascites. Massive hepatic necrosis was the most common histopathologic finding.

  16. [Prediction of mortality in patients with acute hepatic failure].

    Science.gov (United States)

    Eremeeva, L F; Berdnikov, A P; Musaeva, T S; Zabolotskikh, I B

    2013-01-01

    The article deals with a study of 243 patients (from 18 to 65 years old) with acute hepatic failure. Purpose of the study was to evaluate the predictive capability of severity scales APACHE III, SOFA, MODS, Child-Pugh and to identify mortality predictors in patients with acute hepatic failure. Results; The best predictive ability in patients with acute hepatic failure and multiple organ failure had APACHE III and SOFA scales. The strongest mortality predictors were: serum creatinine > 132 mmol/L, fibrinogen < 1.4 g/L, Na < 129 mmol/L.

  17. Cerebral hemodynamic and metabolic changes in fulminant hepatic failure

    Directory of Open Access Journals (Sweden)

    Fernando Mendes Paschoal Junior

    Full Text Available ABSTRACT Intracranial hypertension and brain swelling are a major cause of morbidity and mortality of patients suffering from fulminant hepatic failure (FHF. The pathogenesis of these complications has been investigated in man, in experimental models and in isolated cell systems. Currently, the mechanism underlying cerebral edema and intracranial hypertension in the presence of FHF is multi-factorial in etiology and only partially understood. The aim of this paper is to review the pathophysiology of cerebral hemodynamic and metabolism changes in FHF in order to improve understanding of intracranial dynamics complication in FHF.

  18. Prevalence of hepatitis A virus, hepatitis B virus, hepatitis C virus, hepatitis D virus and hepatitis E virus as causes of acute viral hepatitis in North India: a hospital based study.

    Science.gov (United States)

    Jain, P; Prakash, S; Gupta, S; Singh, K P; Shrivastava, S; Singh, D D; Singh, J; Jain, A

    2013-01-01

    Acute viral hepatitis (AVH) is a major public health problem and is an important cause of morbidity and mortality. The aim of the present study is to determine the prevalence of hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV) and hepatitis E virus (HEV) as causes of AVH in a tertiary care hospital of North India. Blood samples and clinical information was collected from cases of AVH referred to the Grade I viral diagnostic laboratory over a 1-year period. Samples were tested for hepatitis B surface antigen, anti-HCV total antibodies, anti-HAV immunoglobulin M (IgM) and anti-HEV IgM by the enzyme-linked immunosorbent assay. PCR for nucleic acid detection of HBV and HCV was also carried out. Those positive for HBV infection were tested for anti-HDV antibodies. Fisher's exact test was used and a P hepatitis cases, 62 (23.22%) patients presented as acute hepatic failure. HAV (26.96%) was identified as the most common cause of acute hepatitis followed by HEV (17.97%), HBV (16.10%) and HCV (11.98%). Co-infections with more than one virus were present in 34 cases; HAV-HEV co-infection being the most common. HEV was the most important cause of acute hepatic failure followed by co-infection with HAV and HEV. An indication towards epidemiological shift of HAV infection from children to adults with a rise in HAV prevalence was seen. To the best of our knowledge, this is the first report indicating epidemiological shift of HAV in Uttar Pradesh.

  19. Common cause failures of reactor pressure components

    International Nuclear Information System (INIS)

    Mankamo, T.

    1978-01-01

    The common cause failure is defined as a multiple failure event due to a common cause. The existence of common failure causes may ruin the potential advantages of applying redundancy for reliability improvement. Examples relevant to large mechanical components are presented. Preventive measures against common cause failures, such as physical separation, equipment diversity, quality assurance, and feedback from experience are discussed. Despite the large number of potential interdependencies, the analysis of common cause failures can be done within the framework of conventional reliability analysis, utilizing, for example, the method of deriving minimal cut sets from a system fault tree. Tools for the description and evaluation of dependencies between components are discussed: these include the model of conditional failure causes that are common to many components, and evaluation of the reliability of redundant components subjected to a common load. (author)

  20. Data needs for common cause failure analysis

    International Nuclear Information System (INIS)

    Parry, G.W.; Paula, H.M.; Rasmuson, D.; Whitehead, D.

    1990-01-01

    The procedures guide for common cause failure analysis published jointly by USNRC and EPRI requires a detailed historical event analysis. Recent work on the further development of the cause-defense picture of common cause failures introduced in that guide identified the information that is necessary to perform the detailed analysis in an objective manner. This paper summarizes these information needs

  1. Fulminant hepatic failure in children: Etiology, histopathology and MDCT findings

    Energy Technology Data Exchange (ETDEWEB)

    Cakir, Banu [Baskent University Faculty of Medicine Department of Radiology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: banutopcu@yahoo.com; Kirbas, Ismail [Baskent University Faculty of Medicine Department of Radiology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: drismailk@yahoo.com; Demirhan, Beyhan [Baskent University Faculty of Medicine Department of Pathology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: beyhand@baskent-ank.edu.tr; Tarhan, Nefise Cagla [Baskent University Faculty of Medicine Department of Radiology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: caglat@gmail.com; Bozkurt, Alper [Baskent University Faculty of Medicine Department of Radiology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: abozkurt78@hotmail.com; Ozcay, Figen [Baskent University Faculty of Medicine Department of Pediatric Gastroenterology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: fozcay@baskent.edu.tr; Coskun, Mehmet [Baskent University Faculty of Medicine Department of Radiology, Fevzi Cakmak Cd. 10, Sok. No: 45, Bahcelievler, Ankara 06490 (Turkey)], E-mail: mcoskun@baskent-ank.edu.tr

    2009-11-15

    Introduction: The purpose of this study is to determine the etiologies, histopathology and MDCT findings of children with fulminant hepatic failure admitted to our institution. Materials and methods: Between June 2004 and November 2006, 15 children with fulminant hepatic failure who underwent MDCT were included retrospectively in this study. Twelve patients had liver biopsies. The patients were divided into three groups as hyperacute (Group I), acute (Group II) and subacute (Group III) depending on onset of hepatic encephalopathy. Results: Hepatitis A in 4 patients, non-A, non-E hepatitis in 4; mushroom poisoning in 3; fulminant Wilson's disease in 2; autoimmune hepatitis in 1; and both hepatitis B and toxic hepatitis (with leflunomide treatment) in 1 patient were detected. MDCT of all three groups revealed diffuse reduction in hepatic attenuation in 11 patients; ascites in 9; periportal edema in 6; edema of gallbladder wall in 6; splenomegaly in 6; heterogeneous hepatic parenchyma in 6; hepatomegaly in 3; irregular contours of liver in 2; multiple micronodules in 1 and necrotic areas and regeneration in liver parenchyma in 2 patients. Histopathologic evaluation of liver biopsies showed massive hepatic necrosis, inflammatory cell infiltration and ductular proliferation in 8 patients, periportal edema in 6, edema of gallbladder wall in 5, regenerating nodules and fibrous septa consistent with cirrhotic pattern in 2, and regenerating nodules and necrotic areas in 2 patients. Conclusion: The most common MDCT findings in fulminant hepatic failure were diffuse reduction in hepatic attenuation and ascites. Massive hepatic necrosis was the most common histopathologic finding.

  2. Fulminant hepatic failure in an infant with severe dengue infection.

    Science.gov (United States)

    Soundravally, R; Narayanan, P; Bhat, B Vishnu; Soundraragavan, Jayanthi; Setia, Sajita

    2010-04-01

    Fulminant hepatic failure due to dengue infection is rare, although mild liver dysfunction is common. Here we report a fatal case of fulminant hepatitis in an infant infected with dengue 3 serotype. Attention must be given to the use of hepatotoxic drugs in some cases of dengue especially in infants.

  3. Failure to incriminate hepatitis B, hepatitis C, and hepatitis E viruses in the aetiology of fulminant non-A non-B hepatitis.

    OpenAIRE

    Mutimer, D; Shaw, J; Neuberger, J; Skidmore, S; Martin, B; Hubscher, S; McMaster, P; Elias, E

    1995-01-01

    Sporadic non-A, non-B hepatitis is the most common indication for liver transplantation in patients presenting with fulminant and subacute liver failure. This study used serological, histological, and molecular biological techniques to examine specimens from 23 consecutive patients transplanted for sporadic non-A, non-B hepatitis. No evidence was found of hepatitis C virus, hepatitis E virus, or 'cryptic' hepatitis B virus infection.

  4. Structures for common-cause failure analysis

    International Nuclear Information System (INIS)

    Vaurio, J.K.

    1981-01-01

    Common-cause failure methodology and terminology have been reviewed and structured to provide a systematical basis for addressing and developing models and methods for quantification. The structure is based on (1) a specific set of definitions, (2) categories based on the way faults are attributable to a common cause, and (3) classes based on the time of entry and the time of elimination of the faults. The failure events are then characterized by their likelihood or frequency and the average residence time. The structure provides a basis for selecting computational models, collecting and evaluating data and assessing the importance of various failure types, and for developing effective defences against common-cause failure. The relationships of this and several other structures are described

  5. Primary hepatic lymphoma presenting as fulminant hepatic failure with hyperferritinemia: A case report

    Directory of Open Access Journals (Sweden)

    Haider Fyeza S

    2008-08-01

    Full Text Available Abstract Introduction Primary hepatic lymphoma is an unusual form of non-Hodgkin's lymphoma that usually presents with constitutional symptoms, hepatomegaly and signs of cholestatic jaundice. Diffuse hepatic infiltration is uncommon and presentation with acute hepatic failure even more rare. The presence of markedly elevated ferritin levels can complicate the evaluation process and suggest alternative diagnoses. We present the case of a middle-aged woman exhibiting pancytopenia, hyperferritinemia and rapidly deteriorating to develop acute hepatic failure. Her initial clinical picture led to a working diagnosis of adult onset Still's disease with probable hemophagocytic syndrome before her worsening liver function necessitated a percutaneous liver biopsy and establishment of the final diagnosis of primary hepatic lymphoma. Conclusion Primary hepatic lymphoma is an uncommon malignancy and its manifestation as progressive hepatitis or acute fulminant hepatic failure can be difficult to diagnose. The presence of constitutional symptoms, pancytopenia and high ferritin levels can complicate the evaluation process. A liver biopsy early in the course of liver dysfunction may establish the diagnosis without a higher risk of bleeding complications seen once liver failure sets in.

  6. Hepatic encephalopathy: cause and possible management with botanicals.

    Science.gov (United States)

    Tripathi, Suyash; Tripathi, Yamini B

    2014-01-01

    Hepatic encephalopathy is a brain functional disorder, characterized by neuropsychiatric abnormalities with liver failure. High blood ammonia, causing glutamate neurotoxicity is the basic cause, finally leading to low-grade cerebral edema. Its manifestation is more likely in patients of sepsis, oxidative stress, generalized inflammation, gut mal-functioning, amoebiaesis, viral hepatitis, nervous imbalance, etc. Thus, the therapeutic goals primarily include the maintenance of proper blood supply and prevention of hypoxic condition in liver, along with management of factors responsible for high blood ammonia, oxidative stress, inflammation, and high GI- serotonin. The drugs in clinical practice include lactulose, sodium benzoate, flumazenil and rifaximin, supplementation of zinc, branched chain amino acids (BCAA), l-ornithine-l aspartate, antioxidants and iNOS inhibitors. However, herbal formulations would be of great importance as it shows multi-targeted action because it possesses a natural cocktail of secondary metabolites. It can collectively act as an antioxidant, anti-inflammatory, prebiotic, hepatoprotective and neuron-protective agents. We have briefly outlined some of these plants and also recent patents useful in the management of hepatic encephalopathy.

  7. Common cause failures - a dilemma in perspective

    International Nuclear Information System (INIS)

    Smith, A.M.; Watson, I.A.

    1980-01-01

    This paper identifies the broad spectrum of common cause failure (CCF) definitions used by various authors. These definitions, as applied to real aircraft and nuclear reactor failure events, lead to a divergence of interpretation and a resultant confusion that obscures meaningful progress in CCF analysis. A new definition is proposed, explained, and tested against the examples. Technical as well as administrative practices are cited as ways to control or eliminate the product defects that lead to CCF. (author)

  8. Fibronectin and Kupffer cell function in fulminant hepatic failure

    International Nuclear Information System (INIS)

    Imawari, M.; Hughes, R.D.; Gove, C.D.; Williams, R.

    1985-01-01

    The relationship between plasma fibronectin, in vitro plasma opsonic activity, which measures the biological activity of fibronectin, and in vivo Kupffer cell function, as assessed by the systemic clearance of microaggregated [ 125 I]albumin, were determined simultaneously in 15 patients with fulminant hepatic failure and 12 normal subjects. Both the plasma fibronectin and plasma opsonic activity were significantly reduced in patients with fulminant hepatic failure, while the systemic clearance of microaggregated albumin was decreased. There was a significant correlation between plasma fibronectin and the plasma opsonic activity on admission, but no correlation could be detected between either parameter and the clearance of microaggregated albumin. A gelatin-derived plasma expander was shown to block the plasma opsonic activity both in vitro and in vivo. The low plasma fibronectin and decreased clearance of microaggregated albumin in fulminant hepatic failure reflect different aspects of the overall impairment of Kupffer cell function

  9. Common cause failure analysis methodology for complex systems

    International Nuclear Information System (INIS)

    Wagner, D.P.; Cate, C.L.; Fussell, J.B.

    1977-01-01

    Common cause failure analysis, also called common mode failure analysis, is an integral part of a complex system reliability analysis. This paper extends existing methods of computer aided common cause failure analysis by allowing analysis of the complex systems often encountered in practice. The methods presented here aid in identifying potential common cause failures and also address quantitative common cause failure analysis

  10. Cannabidiol improves brain and liver function in a fulminant hepatic failure-induced model of hepatic encephalopathy in mice.

    Science.gov (United States)

    Avraham, Y; Grigoriadis, Nc; Poutahidis, T; Vorobiev, L; Magen, I; Ilan, Y; Mechoulam, R; Berry, Em

    2011-04-01

    Hepatic encephalopathy is a neuropsychiatric disorder of complex pathogenesis caused by acute or chronic liver failure. We investigated the effects of cannabidiol, a non-psychoactive constituent of Cannabis sativa with anti-inflammatory properties that activates the 5-hydroxytryptamine receptor 5-HT(1A) , on brain and liver functions in a model of hepatic encephalopathy associated with fulminant hepatic failure induced in mice by thioacetamide. Female Sabra mice were injected with either saline or thioacetamide and were treated with either vehicle or cannabidiol. Neurological and motor functions were evaluated 2 and 3 days, respectively, after induction of hepatic failure, after which brains and livers were removed for histopathological analysis and blood was drawn for analysis of plasma liver enzymes. In a separate group of animals, cognitive function was tested after 8 days and brain 5-HT levels were measured 12 days after induction of hepatic failure. Neurological and cognitive functions were severely impaired in thioacetamide-treated mice and were restored by cannabidiol. Similarly, decreased motor activity in thioacetamide-treated mice was partially restored by cannabidiol. Increased plasma levels of ammonia, bilirubin and liver enzymes, as well as enhanced 5-HT levels in thioacetamide-treated mice were normalized following cannabidiol administration. Likewise, astrogliosis in the brains of thioacetamide-treated mice was moderated after cannabidiol treatment. Cannabidiol restores liver function, normalizes 5-HT levels and improves brain pathology in accordance with normalization of brain function. Therefore, the effects of cannabidiol may result from a combination of its actions in the liver and brain. © 2011 The Authors. British Journal of Pharmacology © 2011 The British Pharmacological Society.

  11. Importance analysis for the systems with common cause failures

    International Nuclear Information System (INIS)

    Pan Zhijie; Nonaka, Yasuo

    1995-01-01

    This paper extends the importance analysis technique to the research field of common cause failures to evaluate the structure importance, probability importance, and β-importance for the systems with common cause failures. These importance measures would help reliability analysts to limit the common cause failure analysis framework and find efficient defence strategies against common cause failures

  12. Massive hepatic cyst presenting as right-sided heart failure.

    LENUS (Irish Health Repository)

    O'Connor, A

    2010-01-30

    A 70-year-old woman presented with clinical features of right heart failure. Cardiopulmonary investigations included an echocardiogram, which showed a hepatic cyst compromising venous return and affecting right atrial filling and a CT abdomen showed a 15.5 x 11.5 cm-cystic mass involving the right hepatic lobe and compressing the right atrium. Percutaneous drainage of the cyst was performed. This led to complete resolution of symptoms but these recurred as the fluid re-accumulated. Subsequent definitive treatment with excision of the cyst was undertaken with symptomatic cure. This case is the first report of a hepatic cyst presenting as right heart due to compression of the right atrium.

  13. Hepatic encephalopathy in acute-on-chronic liver failure.

    Science.gov (United States)

    Lee, Guan-Huei

    2015-10-01

    The presence of hepatic encephalopathy (HE) within 4 weeks is part of the criteria for defining acute-on-chronic liver failure (ACLF). The pathophysiology of HE is complex, and hyperammonemia and cerebral hemodynamic dysfunction appear to be central in the pathogenesis of encephalopathy. Recent data also suggest that inflammatory mediators may have a significant role in modulating the cerebral effect of ammonia. Multiple prospective and retrospective studies have shown that hepatic encephalopathy in ACLF patients is associated with higher mortality, especially in those with grade III-IV encephalopathy, similar to that of acute liver failure (ALF). Although significant cerebral edema detected by CT in ACLF patients appeared to be less common, specialized MRI imaging was able to detect cerebral edema even in low grade HE. Ammonia-focused therapy constitutes the basis of current therapy, as in the treatment of ALF. Emerging treatment strategies focusing on modulating the gut-liver-circulation-brain axis are discussed.

  14. Predictors of fatal outcome in fulminant hepatic failure

    International Nuclear Information System (INIS)

    Sarwar, S.; Khan, A.A.; Alam, A.; Butt, A.K.; Ahmad, I.; Niazi, A.K.; Dilshad, A.

    2006-01-01

    Objective: To determine prognostic indicators for morbidity and mortality in patients with fulminant hepatic failure. Design: Observational study. Place and Duration of Study: Department of Gastroenterology and Hepatology, Shaikh Zayed Postgraduate Medical Institute, Lahore, from April 2003 to June 2005. Patients and Methods: Forty-five patients with confirmed diagnosis of fulminant hepatic failure were included in this study. They were investigated for acute viral serology, complete blood count, liver function tests, renal function tests, serum electrolytes, arterial blood gases, initially daily and then on alternate days. Patients were followed in high dependency/ICU at the Shaikh Zayed Postgraduate Medical Institute. Data were analyzed by logistic regression analysis to identify predictors of mortality and morbidity. Results: Of the 45 subjects, 31 were males and 14 females. Twenty-four patients were positive for acute hepatitis E. Twenty patients recovered fully, whereas 25 died with mortality rate of 55.6 %. Variables i.e. presence of non-A non-B viral hepatitis, serum creatinine > 2.0 mg/dl, serum phosphate> 3.5 mg/dl and sepsis were found to have significant association with mortality on linear correlation. Only serum creatinine more than 2.0 mg/dl, serum phosphate > 3.5 mg/dl and development of sepsis were found to predict the outcome after multivariate analysis. Conclusion: Patients with serum creatinine > 2.0 mg/dl, serum phosphate > 3.5 mg/dl and sepsis showed adverse prognosis for survival. (author)

  15. Addressing the Challenges of Hepatitis C Virus Resistance and Treatment Failure

    Directory of Open Access Journals (Sweden)

    Che C. Colpitts

    2016-08-01

    Full Text Available Chronic hepatitis C is a major cause of chronic liver disease, including liver cirrhosis and hepatocellular carcinoma. The development of direct-acting antivirals (DAAs revolutionized hepatitis C virus (HCV treatment by offering genuine prospects for the first comprehensive cure of a chronic viral infection in humans. While antiviral resistance is a significant limitation for interferon-based therapies, resistance and treatment failure still appear to be present in a small fraction of patients even in state-of-the-art DAA combination therapies. Therefore, treatment failure and resistance still remain a clinical challenge for the management of patients not responding to DAAs. In this special issue of Viruses on HCV drug resistance, mechanisms of antiviral resistance for different classes of antiviral drugs are described. Furthermore, the detection and monitoring of resistance in clinical practice, the clinical impact of resistance in different patient groups and strategies to prevent and address resistance and treatment failure using complementary antiviral strategies are reviewed.

  16. Addressing the Challenges of Hepatitis C Virus Resistance and Treatment Failure.

    Science.gov (United States)

    Colpitts, Che C; Baumert, Thomas F

    2016-08-16

    Chronic hepatitis C is a major cause of chronic liver disease, including liver cirrhosis and hepatocellular carcinoma. The development of direct-acting antivirals (DAAs) revolutionized hepatitis C virus (HCV) treatment by offering genuine prospects for the first comprehensive cure of a chronic viral infection in humans. While antiviral resistance is a significant limitation for interferon-based therapies, resistance and treatment failure still appear to be present in a small fraction of patients even in state-of-the-art DAA combination therapies. Therefore, treatment failure and resistance still remain a clinical challenge for the management of patients not responding to DAAs. In this special issue of Viruses on HCV drug resistance, mechanisms of antiviral resistance for different classes of antiviral drugs are described. Furthermore, the detection and monitoring of resistance in clinical practice, the clinical impact of resistance in different patient groups and strategies to prevent and address resistance and treatment failure using complementary antiviral strategies are reviewed.

  17. Capsaicin affects brain function in a model of hepatic encephalopathy associated with fulminant hepatic failure in mice

    Science.gov (United States)

    Avraham, Y; Grigoriadis, NC; Magen, I; Poutahidis, T; Vorobiav, L; Zolotarev, O; Ilan, Y; Mechoulam, R; Berry, EM

    2009-01-01

    Background and purpose: Hepatic encephalopathy is a neuropsychiatric syndrome caused by liver failure. In view of the effects of cannabinoids in a thioacetamide-induced model of hepatic encephalopathy and liver disease and the beneficial effect of capsaicin (a TRPV1 agonist) in liver disease, we assumed that capsaicin may also affect hepatic encephalopathy. Experimental approach: Fulminant hepatic failure was induced in mice by thioacetamide and 24 h later, the animals were injected with one of the following compound(s): 2-arachidonoylglycerol (CB1, CB2 and TRPV1 receptor agonist); HU308 (CB2 receptor agonist), SR141716A (CB1 receptor antagonist); SR141716A+2-arachidonoylglycerol; SR144528 (CB2 receptor antagonist); capsaicin; and capsazepine (TRPV1 receptor agonist and antagonist respectively). Their neurological effects were evaluated on the basis of activity in the open field, cognitive function in an eight-arm maze and a neurological severity score. The mice were killed 3 or 14 days after thioacetamide administration. 2-arachidonoylglycerol and 5-hydroxytryptamine (5-HT) levels were determined by gas chromatography-mass spectrometry and high-performance liquid chromatography with electrochemical detection, respectively. Results: Capsaicin had a neuroprotective effect in this animal model as shown by the neurological score, activity and cognitive function. The effect of capsaicin was blocked by capsazepine. Thioacetamide induced astrogliosis in the hippocampus and the cerebellum and raised brain 5-hydroxytryptamine levels, which were decreased by capsaicin, SR141716A and HU-308. Thioacetamide lowered brain 2-arachidonoylglycerol levels, an effect reversed by capsaicin. Conclusions: Capsaicin improved both liver and brain dysfunction caused by thioacetamide, suggesting that both the endocannabinoid and the vanilloid systems play important roles in hepatic encephalopathy. Modulation of these systems may have therapeutic value. PMID:19764982

  18. Fatal acute hepatic failure in a family infected with the hepatitis A virus subgenotype IB: A case report.

    Science.gov (United States)

    Yoshida, Yuichi; Okada, Yohei; Suzuki, Akiko; Kakisaka, Keisuke; Miyamoto, Yasuhiro; Miyasaka, Akio; Takikawa, Yasuhiro; Nishizawa, Tsutomu; Okamoto, Hiroaki

    2017-09-01

    Hepatitis A viral infection is a well-known cause of subclinical or acute self-limited hepatitis. Few cases of hepatitis A virus (HAV)-associated acute liver failure (ALF) have been reported in low HAV endemic countries annually. To investigate the possible factors that affected the severity of HAV infection, a family cluster infected with the HAV subgenotype IB strain, which is not common in Japan, was described. This family consisted of five members who all were infected with HAV. Four of the five patients hospitalized except for an asymptomatic patient. Two of the five patients, men in their 50s and 60s, developed ALF, and one patient died. Various host factors, including sex (male), age, and a high bilirubin level, may affect the outcomes. Based on viral factors, HAV RNA was higher in the fatal case compared with others, and it decreased within a short period of time. The similarity of the nucleotide sequences was 99.9% among the HAV isolates based on an entire genomic sequence. Deletions and/or insertions on the HAV protein-coding sequences that caused a frameshift were found in surviving cases but not in the fatal case. The rapid clearance of increased HAV and the absence of defective HAV might be closely associated with the onset of liver failure.

  19. Usefulness of screening ultrasonography for hepatocellular carcinoma detection: chronic hepatitis versus hepatic cirrhosis caused by hepatitis B virus

    International Nuclear Information System (INIS)

    Chang, Sam Uel; Choi, Don Gil; Lim, Jae Hoon

    2004-01-01

    To evaluate the usefulness of screening liver ultrasonography (US) for hepatocellular carcinoma (HCC) detection in patients with chronic hepatitis or hepatic cirrhosis caused by hepatitis B virus (HBV). A retrospective study was performed with 1,189 patients with clinical hepatopathy caused by HBV who underwent screening liver US for HCC detection at least twice. All patients were followed up with liver US examinations (mean, 8.3 times), CT, or MR for at least 3 months (range, 3-102 months; mean, 47 months) for the detection of HCC. The study population was divided into two groups: chronic hepatitis (n=492) and hepatic cirrhosis (n=697), which was further divided into two groups with (n=156) or without (n=541) evident shrinkage. The radiologic examinations that had detected HCC for the first time were analyzed and compared between the groups. Among 20 (4.1%) patients with chronic hepatitis and 132 (18.9%) patients with hepatic cirrhosis diagnosed as HCC, screening US was the modality of detection in 17 (85.0%) of 20 patients with chronic hepatitis and 76 (57.6%) of 132 patients with hepatic cirrhosis (p=0.038, Chi-square test). The detection rate of HCC on screening US between the chronic hepatitis and hepatic cirrhosis with evident shrinkage (51.4%, 19/37) showed a significant difference (p=0.027, Chi-square test). For chronic liver disease caused by HBV, screening US for HCC detection is more useful in patients with chronic hepatitis than with hepatic cirrhosis with evident shrinkage

  20. Hemobilia caused by a ruptured hepatic cyst: a case report

    Directory of Open Access Journals (Sweden)

    Dutta Sudhir

    2011-01-01

    Full Text Available Abstract Introduction Hemobilia is a rare cause of upper gastrointestinal bleeding. More than 50% of hemobilia cases are related to iatrogenic trauma from hepatobiliary procedures, and needle biopsy of the liver represents the most common cause. A minority of hemobilia cases are due to hepatobiliary disorders such as cholangitis, hepatobiliary cancers, choledocholithiasis, and vascular abnormalities in the liver. The classic presentation of hemobilia is the triad of right upper quadrant (biliary pain, obstructive jaundice, and upper gastrointestinal bleeding. We report a rare case of hemobilia caused by a spontaneous hepatic cyst rupture, where our patient presented without the classical symptoms, in the absence of therapeutic or pathological coagulopathy, and in the absence of spontaneous or iatrogenic trauma. Case presentation A 91-year-old African-American woman was referred to our out-patient gastroenterology clinic for evaluation of mild epigastric pain and intermittent melena. An abdominal computed tomography scan was remarkable for multiple hepatic cysts. Esophagogastroduodenoscopy revealed multiple blood clots at the ampulla of Vater. Endoscopic retrograde cholangiopancreatography showed a single 18 mm-sized filling defect in the common hepatic duct wall at the junction of the right and left hepatic duct, adjacent to one of the hepatic cysts. The ruptured hepatic cyst communicated to the bile ducts and was the cause of hemobilia with an atypical clinical presentation. Conclusion Hemobilia is an infrequent cause of upper gastrointestinal bleeding and rarely occurs due to hepatic cyst rupture. To the best of our knowledge, this is only the second case report in the literature that describes hemobilia due to hepatic cyst rupture. However, it is the first case in the literature of hemobilia due to hepatic cyst rupture in the absence of iatrogenic or spontaneous trauma, and in the absence of a spontaneous or pathological coagulopathy.

  1. Fulminant hepatic failure following marijuana drug abuse: Molecular adsorbent recirculation system therapy

    Directory of Open Access Journals (Sweden)

    G Swarnalatha

    2013-01-01

    Full Text Available Marijuana is used for psychoactive and recreational purpose. We report a case of fulminant hepatic failure following marijuana drug abuse who recovered following artificial support systems for acute liver failure. There is no published literature of management of marijuana intoxication with molecular adsorbent recirculation system (MARS. MARS is effective and safe in patients with fulminant hepatic failure following marijuana intoxication.

  2. Electrical failure analysis for root-cause determination

    International Nuclear Information System (INIS)

    Riddle, J.

    1990-01-01

    This paper outlines a practical failure analysis sequence. Several technical definitions are required. A failure is defined as a component that was operating in a system where the system malfunctioned and the replacement of the device restored system functionality. The failure mode is the malfunctioning behavior of the device. The failure mechanism is the underlying cause or source of the failure mode. The failure mechanism is the root cause of the failure mode. The failure analysis procedure needs to be adequately refined to result in the determination of the cause of failure to the degree that corrective action or design changes will prevent recurrence of the failure mode or mechanism. An example of a root-cause determination analysis performed for a nuclear power industry customer serves to illustrate the analysis methodology

  3. Hepatitis E virus is the leading cause of acute viral hepatitis in Lothian, Scotland

    Directory of Open Access Journals (Sweden)

    I. Kokki

    2016-03-01

    Full Text Available Acute viral hepatitis affects all ages worldwide. Hepatitis E virus (HEV is increasingly recognized as a major cause of acute hepatitis in Europe. Because knowledge of its characteristics is limited, we conducted a retrospective study to outline demographic and clinical features of acute HEV in comparison to hepatitis A, B and C in Lothian over 28 months (January 2012 to April 2014. A total of 3204 blood samples from patients with suspected acute hepatitis were screened for hepatitis A, B and C virus; 913 of these samples were also screened for HEV. Demographic and clinical information on patients with positive samples was gathered from electronic patient records. Confirmed HEV samples were genotyped. Of 82 patients with confirmed viral hepatitis, 48 (59% had acute HEV. These patients were older than those infected by hepatitis A, B or C viruses, were more often male and typically presented with jaundice, nausea, vomiting and/or malaise. Most HEV cases (70% had eaten pork or game meat in the few months before infection, and 14 HEV patients (29% had a recent history of foreign travel. The majority of samples were HEV genotype 3 (27/30, 90%; three were genotype 1. Acute HEV infection is currently the predominant cause of acute viral hepatitis in Lothian and presents clinically in older men. Most of these infections are autochthonous, and further studies confirming the sources of infection (i.e. food or blood transfusion are required.

  4. A Macaca mulatta model of fulminant hepatic failure

    Institute of Scientific and Technical Information of China (English)

    Ping Zhou; Hong Bu; Jie Xia; Gang Guo; Li Li; Yu-Jun Shi; Zi-Xing Huang; Qiang Lu; Hong-Xia Li

    2012-01-01

    AIM: To establish an appropriate primate model of fulminant hepatic failure (FHF). METHODS: We have, for the first time, established a large animal model of FHF in Macaca mulatta by intraperitoneal infusion of amatoxin and endotoxin. Clinical features, biochemical indexes, histopathology and iconography were examined to dynamically investigate the progress and outcome of the animal model. RESULTS: Our results showed that the enzymes and serum bilirubin were markedly increased and the enzyme-bilirubin segregation emerged 36 h after toxin administration. Coagulation activity was significantly decreased. Gradually deteriorated parenchymal abnormality was detected by magnetic resonance imaging (MRI) and ultrasonography at 48 h. The liver biopsy showed marked hepatocyte steatosis and massive parenchymal necrosis at 36 h and 49 h, respectively. The autopsy showed typical yellow atrophy of the liver. Hepatic encephalopathy of the models was also confirmed by hepatic coma, MRI and pathological changes of cerebral edema. The lethal effects of the extrahepatic organ dysfunction were ruled out by their biochemical indices, imaging and histopathology. CONCLUSION: We have established an appropriate large primate model of FHF, which is closely similar to clinic cases, and can be used for investigation of the mechanism of FHF and for evaluation of potential medical therapies.

  5. Chronic hepatitis caused by persistent parvovirus B19 infection

    Directory of Open Access Journals (Sweden)

    Mogensen Trine H

    2010-08-01

    Full Text Available Abstract Background Human infection with parvovirus B19 may lead to a diverse spectrum of clinical manifestations, including benign erythema infectiosum in children, transient aplastic crisis in patients with haemolytic anaemia, and congenital hydrops foetalis. These different diseases represent direct consequences of the ability of parvovirus B19 to target the erythroid cell lineage. However, accumulating evidence suggests that this virus can also infect other cell types resulting in diverse clinical manifestations, of which the pathogenesis remains to be fully elucidated. This has prompted important questions regarding the tropism of the virus and its possible involvement in a broad range of infectious and autoimmune medical conditions. Case Presentation Here, we present an unusual case of persistent parvovirus B19 infection as a cause of chronic hepatitis. This patient had persistent parvovirus B19 viraemia over a period of more than four years and displayed signs of chronic hepatitis evidenced by fluctuating elevated levels of ALAT and a liver biopsy demonstrating chronic hepatitis. Other known causes of hepatitis and liver damage were excluded. In addition, the patient was evaluated for immunodeficiency, since she had lymphopenia both prior to and following clearance of parvovirus B19 infection. Conclusions In this case report, we describe the current knowledge on the natural history and pathogenesis of parvovirus B19 infection, and discuss the existing evidence of parvovirus B19 as a cause of acute and chronic hepatitis. We suggest that parvovirus B19 was the direct cause of this patient's chronic hepatitis, and that she had an idiopathic lymphopenia, which may have predisposed her to persistent infection, rather than bone marrow depression secondary to infection. In addition, we propose that her liver involvement may have represented a viral reservoir. Finally, we suggest that clinicians should be aware of parvovirus B19 as an unusual

  6. BACFIRE, Minimal Cut Sets Common Cause Failure Fault Tree Analysis

    International Nuclear Information System (INIS)

    Fussell, J.B.

    1983-01-01

    1 - Description of problem or function: BACFIRE, designed to aid in common cause failure analysis, searches among the basic events of a minimal cut set of the system logic model for common potential causes of failure. The potential cause of failure is called a qualitative failure characteristics. The algorithm searches qualitative failure characteristics (that are part of the program input) of the basic events contained in a set to find those characteristics common to all basic events. This search is repeated for all cut sets input to the program. Common cause failure analysis is thereby performed without inclusion of secondary failure in the system logic model. By using BACFIRE, a common cause failure analysis can be added to an existing system safety and reliability analysis. 2 - Method of solution: BACFIRE searches the qualitative failure characteristics of the basic events contained in the fault tree minimal cut set to find those characteristics common to all basic events by either of two criteria. The first criterion can be met if all the basic events in a minimal cut set are associated by a condition which alone may increase the probability of multiple component malfunction. The second criterion is met if all the basic events in a minimal cut set are susceptible to the same secondary failure cause and are located in the same domain for that cause of secondary failure. 3 - Restrictions on the complexity of the problem - Maxima of: 1001 secondary failure maps, 101 basic events, 10 cut sets

  7. [Abnormal hepatic function tests in pregnancy: causes and consequences].

    Science.gov (United States)

    Nemesánszky, Elemér

    2013-07-21

    The well-known normal ranges of laboratory parameters are altered due to the broad spectrum of physiological changes as well as proinflammatory and procoagulant effects of pregnancy. Hepatic disorders of any aetiology can cause potential problems during gravidity. Most frequently toxic-effects, hepatotrop viruses (such as hepatitis B and C), metabolic syndrome and diseases with autoimmune background can be observed. When dealing with "pregnancy-specific hepatic syndromes", it is very important to consider the "timing-factors" of pathologic changes and deterioration of clinical pictures as well. Due to the progress in cholestasis management, early termination of pregnancy can be avoided in many cases. As the overlap is really broad between various hepatic disorders, a multidisciplinary cooperation of different sub-disciplines is emphasized in order to achieve proper diagnosis and curative measures at early phase.

  8. [Hepatic amyloidosis as cause of severe intrahepatic cholestasis].

    Science.gov (United States)

    Gavilán, J C; Bermúdez, F J; Márquez, A; Sánchez-Carrillo, J J; González-Santos, P

    2003-01-01

    The liver is frequently involved by amyloidosis, but hyperbilirubinemia and liver failure are uncommon features. A mild elevation of the serum alkaline phosphatase value and, less frequently, hepatomegaly are the most common findings. Usually the patients have no symptoms related with the liver involvement; the clinical manifestation and the long term prognosis depends on the renal and cardiac disease. We report an unusual clinical presentation of primary amyloidosis in a previously asymptomatic 65 years old woman who was admitted to the hospital because of ictericia and ascitis mimicking a drug induced acute hepatic failure.

  9. [Hepatitis caused by virus C. Risk factors].

    Science.gov (United States)

    Garassini, M E; Pulgar, Y; Alvarado, M; Garassini, M A

    1995-01-01

    To establish the risk factors to hepatitis C virus (HCV) infection, we studied 120 patients divided in 2 groups: A first group of 40 patients with HCV infection, 24 (60%) with past medical history of blood transfusion, 14 (35%) of them also had hemodialysis and 3 Kidney transplant. 10 patients (25%) had mayor surgery without transfusion, 3 had frequent visits to the dentist and 3 month baby whose mother was HCV positive. In 4 patients we found no risk factors. A second group of 80 patients who visit our clinic for the first time, 2 were found positive for HCV (1.6%). 13 of them had blood transfusion, one was HCV+ (OR: 5.5, P = 0.73). 41 had history of mayor surgery, one HCV+ (OR: 0.95, P = 1.000). The risk factors related to HCV infection in our population were blood transfusion, hemodialysis and mayor surgery. The use of EV drugs, tatoos, sexual behavior, interfamiliar or vertical transmission were not risk factor in our population.

  10. Operational Failures Caused by Arrogant Leaders

    National Research Council Canada - National Science Library

    Parrington, James R

    2008-01-01

    .... The failures of the Japanese and U.S. militaries directly resulted from the professional arrogance exhibited by Admiral Yamamoto and Secretary Rumsfeld as they deliberately limited the scope of their strategic thinking to how their...

  11. Hepatitis A complicated with acute renal failure and high hepatocyte growth factor: A case report.

    Science.gov (United States)

    Oe, Shinji; Shibata, Michihiko; Miyagawa, Koichiro; Honma, Yuichi; Hiura, Masaaki; Abe, Shintaro; Harada, Masaru

    2015-08-28

    A 58-year-old man was admitted to our hospital. Laboratory data showed severe liver injury and that the patient was positive for immunoglobulin M anti-hepatitis A virus (HAV) antibodies. He was also complicated with severe renal dysfunction and had an extremely high level of serum hepatocyte growth factor (HGF). Therefore, he was diagnosed with severe acute liver failure with acute renal failure (ARF) caused by HAV infection. Prognosis was expected to be poor because of complications by ARF and high serum HGF. However, liver and renal functions both improved rapidly without intensive treatment, and he was subsequently discharged from our hospital on the 21(st) hospital day. Although complication with ARF and high levels of serum HGF are both important factors predicting poor prognosis in acute liver failure patients, the present case achieved a favorable outcome. Endogenous HGF might play an important role as a regenerative effector in injured livers and kidneys.

  12. Causes of liver failure and impact analysis of prognostic risk factors

    Directory of Open Access Journals (Sweden)

    WU Xiaoqing

    2013-04-01

    Full Text Available ObjectiveTo perform a retrospective analysis of patients with liver failure to investigate the causative factors and related risk factors that may affect patient prognosis. MethodsThe clinical, demographic, and laboratory data of 79 consecutive patients diagnosed with liver failure and treated at our hospital between January 2010 and January 2012 (58 males and 21 females; age range: 16-74 years old were collected from the medical records. To identify risk factors of liver failure, the patient variables were assessed by Student’s t-test (continuous variables or Chi-squared test (categorical variables. Multivariate logistic regression analysis was used to investigate the relation between patient outcome and independent risk factors. ResultsThe 79 cases of liver failure were grouped according to disease severity: acute liver failure (n=6; 5 died, subacute liver failure (n=35; 19 died, and chronic liver failure (n=38; 28 died. The overall rate of death was 66%. The majority of cases (81% were related to hepatitis B virus infection. While the three groups of liver failure severity did not show significant differences in sex, mean age, occupation, presence of potassium disorder, total bilirubin (TBil or total cholesterol (CHO at admission, or lowest recorded level of CHO during hospitalization, there were significant intergroup differences in highest recorded TBil level, prothrombin activity (PTA at admission, and highest and lowest recorded PTA, and highest recorded level of CHO. Five independent risk factors were identified: the highest recorded TBil level during hospitalization, presence of infection, hepatorenal syndrome, gastrointestinal bleeding, and hepatic encephalopathy. ConclusionThe major cause of liver failure in this cohort of patients was hepatitis infection, and common biomarkers of liver function, such as TBil, CHO and PTA, may indicate patients with poor prognosis despite clinical intervention. Complications should be addressed as

  13. Definition of ACLF and inclusion criteria for extra-hepatic organ failure.

    Science.gov (United States)

    Wang, Xiaojing; Sarin, Shiv Kumar; Ning, Qin

    2015-07-01

    A prominent characteristic of ACLF is rapid hepatic disease progression with subsequent extra-hepatic organ failure, manifesting as either hepatic coma or hepatorenal syndrome, which is associated with a high mortality rate in a short time. The APASL definition mainly emphasizes recognizing patients with hepatic failure. These patients may subsequently develop extra-hepatic multisystem organ failure leading to high mortality. It is therefore worthwhile to identify the short interim period between the development of liver failure and the onset of extra-hepatic organ failure, the potential therapeutic 'golden window.' Interventions during this period may prevent the development of complications and eventually change the course of the illness. Organ failure is suggested to be a central component of ACLF and may behave differently from chronic decompensated liver disease. Clear and practical criteria for the inclusion of organ failure are urgently needed so that patients with these life-threatening complications can be treated in a timely and appropriate manner. Recent studies suggested that the scoring systems evaluating organ failure [acute physiology, age and chronic health evaluation (APACHE) and sequential organ failure assessment (SOFA) scores] work better than those addressing the severity of liver disease [Child-Pugh and model of end-stage liver disease (MELD) scores] in ACLF. However, a key problem remains that the former scoring systems are reflective of organ failure and not predictive, thus limiting their value as an early indication for intervention.

  14. Evaluation of Causes of Retaining Wall Failure

    Directory of Open Access Journals (Sweden)

    Mu'azu Mohammed ABDULLAHI

    2009-07-01

    Full Text Available Retaining structures are vital geotechnical structure, because the topography of the earth surface is a combination of plain, sloppy and undulating terrain. The retaining wall resists thrust of a bank of earth as well as providing soil stability of a change of ground elevation. Earth pressures on retaining wall are designed from theories of Soil Mechanics, but unfortunately the engineers using them do not always realize the significance of the assumption in their development. This is usually accompanied by with failure and partial failures because of designed based on rules and formulae that fit only limited conditions. In addition there are also problems of using bad backfill materials without taking precautionary measures against built–up of hydrostatic pressure by provision of drainage and also poor workmanship.

  15. Hepatic Mass Caused by Fasciola Hepatica: A Tricky Differential Diagnosis

    Science.gov (United States)

    Yılmaz, Bülent; Köklü, Seyfettin; Gedikoğlu, Gökhan

    2013-01-01

    Fascioliasis is a zoonotic infestation caused by the trematode fasciola hepatica. It presents a wide spectrum of clinical pictures ranging from fever and eosinophilia to ambiguous gastrointestinal symptoms in the acute phase. However, it may often be overlooked, especially in the acute phase, because of uncertain symptoms. Fasciola hepatica can have an initial presentation similar to the presentation of malignancy. Here, we report a case of a hepatic mass caused by fasciola hepatica. PMID:24080633

  16. Acute-on-chronic liver failure: causes, clinical characteristics and predictors of mortality

    International Nuclear Information System (INIS)

    Ali, A.; Luck, N.H.

    2017-01-01

    Objective: To determine the causes, characteristics and predictors of mortality in patients with acute-on-chronic liver failure (ACLF). Study Design: Cross-sectional study. Place and Duration of Study:Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, from July 2014 to June 2016. Methodology:All patients with acute-on-chronic liver disease (ACLD) with ages > 12 were included. Patients with ACLF, as defined by the Asian Pacific Association for the Study of Liver (APASL, 2014) were identified. Predictors of mortality were identified using chi-square or Fisher's exact test. Results: Included in the study were 72 patients with mean age of 36.71 years, 46 (63.9%) being males. Among them, 61 developed ACLF. Commonest causes of chronic liver disease (CLD) were chronic viral hepatitis (37, 51.4%) and autoimmune hepatitis (14, 19.4%). Commonest causes of acute liver injury (ALI) were acute viral hepatitis (24, 33.3%) and drug induced liver injury (DILI) (17, 23.6%). Among those with ACLF, 24 (39.3%) patients died with median survival of 17.1 +-13.5 days. Mortality was significantly associated with Child Turcotte Pugh (CTP) score =>13 (p=0.010), model for end-stage liver disease (MELD) score =>30 (p=0.001), age >40 years (p=0.036), organ failures (OF) =>3 (p 3, CTP =>13, MELD =>30, age >40 years, PSE, renal failure and urosepsis. (author)

  17. Estimating flood inundation caused by dam failures

    Energy Technology Data Exchange (ETDEWEB)

    Mocan, N. [Crozier and Associates Inc., Collingwood, ON (Canada); Joy, D.M. [Guelph Univ., ON (Canada). School of Engineering; Rungis, G. [Grand River Conservation Authority, Cambridge, ON (Canada)

    2006-01-15

    Recent advancements in modelling inundation due to dam failures have allowed easier and more illustrative analyses of potential outcomes. This paper described new model and mapping capabilities available using the HEC-RAS hydraulic model in concert with geographic information systems (GIS). The study area was the upper reaches of Canagagigue Creek and the Woolwich Dam near Elmira, Ontario. A hydraulic analysis of a hypothetical dam failure was developed based on the summer probable maximum flood (PMF) event. Limits extended from Woolwich Dam to downstream of the Town of Elmira. An incoming summer PMF hydrograph was set as the upstream boundary condition in the upstream model. Simulation parameters include simulation time-step; implicit weighting factor; water surface calculation tolerance; and output calculation interval. Peak flows were presented, as well as corresponding flood inundation results through the Town of Elmira. The hydraulic model results were exported to a GIS in order to develop inundation maps for emergency management planning. Results from post-processing included inundation maps for each of the simulated time-steps as well as an inundation animation for the duration of the dam breach. It was concluded that the modelling tools presented in the study can be applied to other dam safety assessment projects in order to develop effective and efficient emergency preparedness plans through public consultation and the establishment of impact zones. 1 tab., 2 figs.

  18. Common-Cause Failure Analysis in Event Assessment

    International Nuclear Information System (INIS)

    Rasmuson, D.M.; Kelly, D.L.

    2008-01-01

    This paper reviews the basic concepts of modeling common-cause failures (CCFs) in reliability and risk studies and then applies these concepts to the treatment of CCF in event assessment. The cases of a failed component (with and without shared CCF potential) and a component being unavailable due to preventive maintenance or testing are addressed. The treatment of two related failure modes (e.g. failure to start and failure to run) is a new feature of this paper, as is the treatment of asymmetry within a common-cause component group

  19. Hepatitis E virus as a Cause of Acute Hepatitis in The Netherlands

    NARCIS (Netherlands)

    Tholen, Aletta T. R.; Schinkel, Janke; Molenkamp, Richard; Ang, C. Wim

    2016-01-01

    Recent studies indicate that 27% of Dutch blood donors have evidence of past infection with HEV. However, the low number of diagnosed HEV infections indicates either an asymptomatic course or under diagnosis. We investigated whether HEV is a cause of acute hepatitis in Dutch patients and which

  20. Hypoksisk hepatitis

    DEFF Research Database (Denmark)

    Amadid, Hanan; Schiødt, Frank Vinholt

    2014-01-01

    Hypoxic hepatitis (HH), also known as ischaemic hepatitis or shock liver, is an acute liver injury caused by hepatic hypoxia. Cardiac failure, respiratory failure and septic shock are the main underlying conditions. In each of these conditions, several haemodynamic mechanisms lead to hepatic...... hypoxia. A shock state is observed in only 50% of cases. Thus, shock liver and ischaemic hepatitis are misnomers. HH can be a diagnostic pitfall but the diagnosis can be established when three criteria are met. Prognosis is poor and prompt identification and treatment of the underlying conditions...

  1. Fulminant Hepatic Failure Attributed to Ackee Fruit Ingestion in a Patient with Sickle Cell Trait

    Directory of Open Access Journals (Sweden)

    Dianne E. Grunes

    2012-01-01

    Full Text Available We report a case of fulminant liver failure resulting in emergent liver transplantation following 3 weeks of nausea, vomiting, and malaise from Jamaican Vomiting Sickness. Jamaican Vomiting Sickness is caused by ingestion of the unripe arils of the Ackee fruit, its seeds and husks. It is characterized by acute gastrointestinal illness and hypoglycemia. In severe cases, central nervous system depression can occur. In previous studies, histologic sections taken from patients with Jamaican Vomiting Sickness have shown hepatotoxicity similar to that seen in Reye syndrome and/or acetaminophen toxicity. We highlight macroscopic and microscopic changes in the liver secondary to hepatoxicity of Ackee fruit versus those caused by a previously unknown sickle cell trait. We discuss the clinical variables and the synergistic hepatotoxic effect of Ackee fruit and ischemic injury from sickled red blood cells, causing massive hepatic necrosis in this patient.

  2. Data analysis using the Binomial Failure Rate common cause model

    International Nuclear Information System (INIS)

    Atwood, C.L.

    1983-09-01

    This report explains how to use the Binomial Failure Rate (BFR) method to estimate common cause failure rates. The entire method is described, beginning with the conceptual model, and covering practical issues of data preparation, treatment of variation in the failure rates, Bayesian estimation of the quantities of interest, checking the model assumptions for lack of fit to the data, and the ultimate application of the answers

  3. Root cause of failure analysis and the system engineer

    International Nuclear Information System (INIS)

    Coppock, M.S.; Hartwig, A.W.

    1990-01-01

    In an industry where ever-increasing emphasis is being placed on root cause of failure determination, it is imperative that a successful nuclear utility have an effective means of identifying failures and performing the necessary analyses. The current Institute of Nuclear Power Operations (INPO) good practice, OE-907, root-cause analysis, gives references to methodology that will help determine breakdowns in procedures, programs, or design but gives very little guidance on how or when to perform component root cause of failure analyses. The system engineers of nuclear utilities are considered the focal point for their respective systems and are required by most programs to investigate component failures. The problem that the system engineer faces in determining a component root cause of failures lies in acquisition of the necessary data to identify the need to perform the analysis and in having the techniques and equipment available to perform it. The system engineers at the Palo Verde nuclear generating station routinely perform detailed component root cause of failure analyses. The Palo Verde program provides the system engineers with the information necessary to identify when a component root cause of failure is required. Palo Verde also has the necessary equipment on-site to perform the analyses

  4. [Discussion of Chinese syndrome typing in acute hepatic failure model].

    Science.gov (United States)

    Zhang, Jin-liang; Zeng, Hui; Wang, Xian-bo

    2011-05-01

    To study Chinese syndrome typing of acute hepatic failure (AHF) mice model by screening effective formulae. Lipoplysaccharides (LPS)/D-galactosamine (D-GaIN) was intraperitoneally injected to mice to establish the AHF mice model. Yinchenhao Decoction, Huanglian Jiedu Decoction, Buzhong Yiqi Decoction, and Xijiao Dihuang Decoction were administered to model mice respectively by gastrogavage. The behavior and the survival rate were monitored. The liver function and pathological changes of liver tissues were detected. In all the tested classic recipes, the survival rate was elevated from 10% to 60% by administration of Xijiao Dihuang Decoction. Five h after modeling, the serum alanine aminotransferase (ALT) level was (183.95 +/- 52.00) U/L, and aspartate aminotransferase (AST) (235.70 +/- 34.03) U/L in Xijiao Di-huang Decoction Group, lower than those of the model control group, but with insignificant difference (ALT: 213.32 +/- 71.93 U/L; AST: 299.48 +/- 70.56 U/L, both P > 0.05). Xijiao Dihuang Decoction could obviously alleviate the liver injury. Xijiao Dihuang Decoction was an effective formula for LPS/D-GaIN induced AHF model. According to syndrome typing through formula effect, heat toxin and blood stasis syndrome dominated in the LPS/D-GalN induced AHF mice model.

  5. Acute liver failure during treatment of interferon alpha 2a chronic hepatitis B and coinfection of parvovirus B19

    Science.gov (United States)

    Sobala-Szczygieł, Barbara; Boroń-Kaczmarska, Anna; Kępa, Lucjan; Oczko-Grzesik, Barbara; Piotrowski, Damian; Stolarz, Wojciech

    Parvovirus B19 infection is associated with a broad spectrum of clinical manifestations among which some are well known but others remain controversial. The role of this infection as a cause of acute hepatitis or exacerbation of chronic liver disease requires discussion regarding its significance in a strategy of prevention and treatment of patients with chronic hepatitis. Clinical importance of this infection in patients with chronic hepatitis B treated with pegylated interferon alpha 2a is still unclear but exactly in this population significant complications during treatment may arise. Parvovirus B19 infection is not rare among persons with chronic hepatitis B, therefore searching for co-infection should be placed in standard diagnostic procedures especially in case of exacerbation of chronic hepatitis, pancytopaenia or anaemia of unknown origin. Pegylated interferon alpha 2a still remains a gold standard of therapy of patients with chronic hepatitis B according to European (EASL) and Polish guidelines. We present a case of 35 years old woman treated with pegylated interferon alpha 2a who developed acute liver failure in 23rd week of chronic hepatitis B therapy. An exacerbation of hepatitis with encephalopathy and pancytopaenia have been observed. Parvovirus B19 and HBV co-infection does not increase the frequency of liver function abnormalities in patients with chronic hepatitis B. Further investigations should be done to describe the natural course of co-infection with parvovirus B19 and HBV and to establish possible association between parvovirus B19 infection and chronic hepatitis B and also the influence of interferon alpha 2a on the infections course.

  6. Hepatic steatosis does not cause insulin resistance in people with familial hypobetalipoproteinaemia

    NARCIS (Netherlands)

    Visser, M. E.; Lammers, N. M.; Nederveen, A. J.; van der Graaf, M.; Heerschap, A.; Ackermans, M. T.; Sauerwein, H. P.; Stroes, E. S.; Serlie, M. J.

    2011-01-01

    Hepatic steatosis is strongly associated with hepatic and whole-body insulin resistance. It has proved difficult to determine whether hepatic steatosis itself is a direct cause of insulin resistance. In patients with familial hypobetalipoproteinaemia (FHBL), hepatic steatosis is a direct consequence

  7. Flumazenil does not improve hepatic encephalopathy associated with acute ischemic liver failure in the rabbit

    NARCIS (Netherlands)

    C.C.D. van der Rijt (Carin); R.J. de Knegt (Robert); S.W. Schalm (Solko); O.T. Terpstra (Onno); K. Mechelse (Karel)

    1990-01-01

    textabstractThe effect of flumazenil, a benzodiazepine antagonist, on hepatic encephalopathy was studied in rabbits with acute hepatic failure induced by a two-stage liver devascularization procedure. The rabbits were randomized for treatment with 5 mg/kg of flumazenil or the placebo. The drug was

  8. An overview of animal models for investigating the pathogenesis and therapeutic strategies in acute hepatic failure

    Institute of Scientific and Technical Information of China (English)

    María Jesús Tu(n)ón; Marcelino Alvarez; Jesús M Culebras; Javier González-Gallego

    2009-01-01

    Acute hepatic failure (AHF) is a severe liver injury accompanied by hepatic encephalopathy which causes multiorgan failure with an extremely high mortality rate, even if intensive care is provided. Management of severe AHF continues to be one of the most challenging problems in clinical medicine. Liver transplantation has been shown to be the most effective therapy, but the procedure is limited by shortage of donor organs. Although a number of clinical trials testing different liver assist devices are under way, these systems alone have no significant effect on patient survival and are only regarded as a useful approach to bridge patients with AHF to liver transplantation. As a result, reproducible experimental animal models resembling the clinical conditions are still needed. The three main approaches used to create an animal model for AHF are: surgical procedures, toxic liver injury and infective procedures. Most common models are based on surgical techniques (total/partial hepatectomy, complete/transient devascularization) or the use of hepatotoxic drugs (acetaminophen, galactosamine, thioacetamide, and others), and very few satisfactory viral models are available. We have recently developed a viral model of AHF by meansof the inoculation of rabbits with the virus of rabbit hemorrhagic disease. This model displays biochemical and histological characteristics, and clinical features that resemble those in human AHF. In the present article an overview is given of the most widely used animal models of AHF, and their main advantages and disadvantages are reviewed.

  9. A huge bladder calculus causing acute renal failure.

    Science.gov (United States)

    Komeya, Mitsuru; Sahoda, Tamami; Sugiura, Shinpei; Sawada, Takuto; Kitami, Kazuo

    2013-02-01

    A 81-year-old male was referred to our emergency outpatient unit due to acute renal failure. The level of serum creatinine was 276 μmol/l. A CT scan showed bilateral hydronephroureter, large bladder stone (7 cm × 6 cm × 6 cm) and bladder wall thickness. He was diagnosed as post renal failure due to bilateral hydronephroureter. Large bladder stone is thought to be the cause of bilateral hydronephroureter and renal failure. To improve renal failure, we performed open cystolithotomy and urethral catheterization. Three days after the surgery, the level of serum creatinine decreased to 224 μmol/l. He was discharged from our hospital with uneventful course. Bladder calculus is thought to be a rare cause of renal failure. We summarize the characteristics of bladder calculus causing renal failure. We should keep that long-term pyuria and urinary symptom, and repeated urinary tract infection can cause huge bladder calculus and renal failure in mind.

  10. Common cause failure investigations using the European Reliability Data System

    International Nuclear Information System (INIS)

    Games, A.M.; Breewood, M.; Amendola, A.; Keller, A.Z.

    1984-01-01

    The European Reliability Data System (ERDS) has provided data for use in investigations into common cause failures (CCFs) in nuclear power plants. These investigations have been made on two levels, at a system and inter-system level. Data have been used from the Component Event Data Bank and from the Licensee Event Report Files, both part of the ERDS. The two studies required different methodologies although both commenced with a temporal sorting procedure for the failure events. The studies demonstrated that different types of common cause failure necessitate different search algorithms, and thus a data search must be closely related to an appropriate CCF classification system, which in the first instance would not be based on causes of failure. (author)

  11. Hepatitis E virus as a Cause of Acute Hepatitis in The Netherlands.

    Directory of Open Access Journals (Sweden)

    Aletta T R Tholen

    Full Text Available Recent studies indicate that 27% of Dutch blood donors have evidence of past infection with HEV. However, the low number of diagnosed HEV infections indicates either an asymptomatic course or under diagnosis.We investigated whether HEV is a cause of acute hepatitis in Dutch patients and which diagnostic modality (serology or PCR should be used for optimal detection.Serum samples were retrospectively selected from non-severely immuno-compromised patients from a university hospital population, suspected of having an infectious hepatitis. Criteria were: elevated alanine aminotransferase (ALT> 34 U/l and request for antibody testing for CMV, EBV or Hepatitis A (HAV.All samples were tested for HEV using ELISA and PCR. Ninety patients/sera were tested, of which 22% were HEV IgG positive. Only one serum was IgM positive. HEV PCR was positive in two patients: one patient was both HEV IgM and IgG positive, the other patient was only IgG positive. Both HEV RNA positive samples belonged to genotype 3. Evidence of recent infection with CMV, EBV and HAV was found in 13%, 10% and 3% respectively.Although our study is limited by small numbers, we conclude that HEV is a cause of acute hepatitis in hospital associated patients in The Netherlands. Moreover, in our study population the prevalence of acute HAV (3% was almost similar to acute HEV (2%. We propose to incorporate HEV testing in panels for acute infectious hepatitis. Negative results obtained for HEV IgM in a HEV PCR positive patient, indicates that antibody testing alone may not be sufficient and argues for PCR as a primary diagnostic tool in hospital associated patients. The high percentage of HEV IgG seropositivity confirms earlier epidemiological studies.

  12. CT findings in ischaemic hepatic failure due to intra-arterial embolisation: A case report

    International Nuclear Information System (INIS)

    Catalano, O.

    1997-01-01

    Liver infarction is relatively uncommon. It may be secondary to several conditions such as sepsis, shock, sickle-cell anaemia, eclampsia, vasculitis, metastatic disease, bacterial endocarditis, rheumatic heart disease, trauma, portal venous occlusion or compression, oral contraception, anaesthesia, hepatic artery thrombosis, therapeutical or inadvertent hepatic artery ligation, intra-arterial chemotherapy or embolisation. A case of hepatic infraction, unusual for iatrogenic pathogenesis, submassive extension with acute hepatic failure, and CT findings of an internally branching pattern due to intravascular gas was observed. (orig./AJ)

  13. Hepatitis E as a Cause of Acute Jaundice Syndrome in Northern Uganda, 2010–2012

    Science.gov (United States)

    Gerbi, Gemechu B.; Williams, Roxanne; Bakamutumaho, Barnabas; Liu, Stephen; Downing, Robert; Drobeniuc, Jan; Kamili, Saleem; Xu, Fujie; Holmberg, Scott D.; Teshale, Eyasu H.

    2015-01-01

    Hepatitis E virus (HEV) is a common cause of acute viral hepatitis in developing countries; however, its contribution to acute jaundice syndrome is not well-described. A large outbreak of hepatitis E occurred in northern Uganda from 2007 to 2009. In response to this outbreak, acute jaundice syndrome surveillance was established in 10 district healthcare facilities to determine the proportion of cases attributable to hepatitis E. Of 347 acute jaundice syndrome cases reported, the majority (42%) had hepatitis E followed by hepatitis B (14%), malaria (10%), hepatitis C (5%), and other/unknown (29%). Of hepatitis E cases, 72% occurred in Kaboong district, and 68% of these cases occurred between May and August of 2011. Residence in Kaabong district was independently associated with hepatitis E (adjusted odds ratio = 13; 95% confidence interval = 7–24). The findings from this surveillance show that an outbreak and sporadic transmission of hepatitis E occur in northern Uganda. PMID:25448237

  14. Etiology, clinical features and outcome of fulminant hepatic failure in pregnancy.

    Science.gov (United States)

    Brohi, Zahida Parveen; Sadaf, Aneela; Perveen, Uzma

    2013-09-01

    To determine the etiology, clinical features and outcome of fulminant hepatic failure in pregnancy. An observational hospital based study was conducted at Isra University hospital Hyderabad from 1st March 2009 to 28th February 2010. Total 1192 obstetric patients were admitted in obstetrics & gynaecology department during this period, of whom 52 were with Fulminant hepatic failure in pregnancy and were included in this study. A pre-designed structured proforma was used. All patients had clinical history and underwent a physical examination. Routine laboratory tests, liver function tests and viral serology were performed in all cases. All results were analyzed on statistical software SPSS version 11. Frequencies and percentages were calculated, the final outcome was recorded. Out of 52, 6 (11.5%) presented in the first trimester, 4 (7.6%) in the second trimester and 42 (80.7%) were in their 3rd trimester of pregnancy. Etiology of the disease was Hepatitis E in 28 (53.8%), Hepatitis B in 9 (17.3%), Hepatitis C in 7 (13.5%) HELLP syndrome in 7 (13.5%) and acute fatty liver of pregnancy in 1 (3.57%) case. Maternal mortality was 15 (28.8%) and foetal mortality was 40 (77%). Only 12 (23.1%) new born remained alive. Fulminant hepatic failure in pregnancy has very high foetal and maternal mortality which is mostly due to viral hepatitis E.

  15. Etiology, clinical features and outcome of fulminant hepatic failure in pregnancy

    International Nuclear Information System (INIS)

    Brohi, Z.P.; Sadaf, A.

    2013-01-01

    Objective: To determine the etiology, clinical features and outcome of fulminant hepatic failure in pregnancy. Methods: An observational hospital based study was conducted at Isra University hospital Hyderabad from 1st March 2009 to 28th February 2010. Total 1192 obstetric patients were admitted in obstetrics and gynaecology department during this period, of whom 52 were with Fulminant hepatic failure in pregnancy and were included in this study. A pre-designed structured proforma was used. All patients had clinical history and underwent a physical examination. Routine laboratory tests, liver function tests and viral serology were performed in all cases. All results were analyzed on statistical software SPSS version 11. Frequencies and percentages were calculated, the final outcome was recorded. Results: Out of 52, 6(11.5%) presented in the first trimester, 4 (7.6%) in the second trimester and 42 (80.7%) were in their 3rd trimester of pregnancy. Etiology of the disease was Hepatitis E in 28(53.8%), Hepatitis B in 9 (17.3%), Hepatitis C in 7 (13.5%) HELLP syndrome in 7 (13.5%) and acute fatty liver of pregnancy in 1 (3.57%) case. Maternal mortality was 15(28.8%) and foetal mortality was 40 (77%). Only 12 (23.1%) new born remained alive. Conclusion: Fulminant hepatic failure in pregnancy has very high foetal and maternal mortality which is mostly due to viral hepatitis E. (author)

  16. Estimation of common cause failure parameters for diesel generators

    International Nuclear Information System (INIS)

    Tirira, J.; Lanore, J.M.

    2002-10-01

    This paper presents a summary of some results concerning the feedback analysis of French Emergency diesel generator (EDG). The database of common cause failure for EDG has been updated. The data collected covers a period of 10 years. Several latent common cause failure (CCF) events counting in tens are identified. In fact, in this number of events collected, most are potential CCF. From events identified, 15% events are characterized as complete CCF. The database is organised following the structure proposed by 'International Common Cause Data Exchange' (ICDE project). Events collected are analyzed by failure mode and degree of failure. Qualitative analysis of root causes, coupling factors and corrective actions are studied. The exercise of quantitative analysis is in progress for evaluating CCF parameters taking into account the average impact vector and the rate of the independent failures. The interest of the average impact vector approach is that it makes it possible to take into account a wide experience feedback, not limited to complete CCF but including also many events related to partial or potential CCF. It has to be noted that there are no finalized quantitative conclusions yet to be drawn and analysis is in progress for evaluating diesel CCF parameters. In fact, the numerical coding CCF representation of the events uses a part of subjective analysis, which requests a complete and detailed event examination. (authors)

  17. The multi-class binomial failure rate model for the treatment of common-cause failures

    International Nuclear Information System (INIS)

    Hauptmanns, U.

    1995-01-01

    The impact of common cause failures (CCF) on PSA results for NPPs is in sharp contrast with the limited quality which can be achieved in their assessment. This is due to the dearth of observations and cannot be remedied in the short run. Therefore the methods employed for calculating failure rates should be devised such as to make the best use of the few available observations on CCF. The Multi-Class Binomial Failure Rate (MCBFR) Model achieves this by assigning observed failures to different classes according to their technical characteristics and applying the BFR formalism to each of these. The results are hence determined by a superposition of BFR type expressions for each class, each of them with its own coupling factor. The model thus obtained flexibly reproduces the dependence of CCF rates on failure multiplicity insinuated by the observed failure multiplicities. This is demonstrated by evaluating CCFs observed for combined impulse pilot valves in German NPPs. (orig.) [de

  18. A new method for explicit modelling of single failure event within different common cause failure groups

    International Nuclear Information System (INIS)

    Kančev, Duško; Čepin, Marko

    2012-01-01

    Redundancy and diversity are the main principles of the safety systems in the nuclear industry. Implementation of safety components redundancy has been acknowledged as an effective approach for assuring high levels of system reliability. The existence of redundant components, identical in most of the cases, implicates a probability of their simultaneous failure due to a shared cause—a common cause failure. This paper presents a new method for explicit modelling of single component failure event within multiple common cause failure groups simultaneously. The method is based on a modification of the frequently utilised Beta Factor parametric model. The motivation for development of this method lays in the fact that one of the most widespread softwares for fault tree and event tree modelling as part of the probabilistic safety assessment does not comprise the option for simultaneous assignment of single failure event to multiple common cause failure groups. In that sense, the proposed method can be seen as an advantage of the explicit modelling of common cause failures. A standard standby safety system is selected as a case study for application and study of the proposed methodology. The results and insights implicate improved, more transparent and more comprehensive models within probabilistic safety assessment.

  19. Computer aided approach to qualitative and quantitative common cause failure analysis for complex systems

    International Nuclear Information System (INIS)

    Cate, C.L.; Wagner, D.P.; Fussell, J.B.

    1977-01-01

    Common cause failure analysis, also called common mode failure analysis, is an integral part of a complete system reliability analysis. Existing methods of computer aided common cause failure analysis are extended by allowing analysis of the complex systems often encountered in practice. The methods aid in identifying potential common cause failures and also address quantitative common cause failure analysis

  20. A small solitary non-parasitic hepatic cyst causing an intra-hepatic bile duct stricture: a case report

    Directory of Open Access Journals (Sweden)

    Hong Taeho

    2010-08-01

    Full Text Available Abstract Introduction We report an unusual presentation of a small hepatic cyst causing cholangitis. Case presentation A 70-year-old Asian man was hospitalized for aggravated chronic pain in the right upper portion of his abdomen. Fever developed after admission. Laboratory tests revealed elevated hepatobiliary enzymes, inflammatory markers and carbohydrate antigen 19-9 without hyperbilirubinemia. Ultrasound and computed tomography demonstrated dilatation of the left intra-hepatic bile ducts. Endoscopic retrograde cholangiopancreatography showed that the right intra-hepatic bile ducts were normally filled with contrast medium, but the left intra-hepatic bile ducts were not seen in the confluence. A left hepatectomy was performed because a hidden malignancy could not be excluded. The surgical findings showed no tumor around the bile duct but rather a 2 cm cyst in segment four of Couinaud's category of the liver around the hilum. The pathology report was a solitary non-parasitic hepatic cyst compressing the bile duct. Conclusion A very small solitary hepatic cyst might cause hepatic duct stricture if it is located near the hepatic hilum, and should be considered in the differential diagnosis of a hepatic duct stricture.

  1. Extracorporal hemodialysis with acute or decompensated chronical hepatic failure

    Directory of Open Access Journals (Sweden)

    Wasem, Jürgen

    2006-04-01

    Full Text Available Background: Conventional diagnostic procedures and therapy of acute liver failure (ALF and acute-on-chronic liver failure (ACLF focus on to identify triggering events of the acute deterioration of the liver function and to avoid them. Further objectives are to prevent the development respectively the progression of secondary organ dysfunctions or organ failure. Most of the times the endocrinological function of the liver can to a wide extent be compensated, but the removal of toxins can only marginally be substituted by conventional conservative therapy. To improve this component of the liver function is the main objective of extracorporal liver support systems. The following principles of liver support systems can be differentiated: Artificial systems, bioartifical systems and extracorporal liver perfusion systems. This HTA report focuses on artificial systems (e.g. BioLogic-DT/-DTPF, MARS, Prometheus, because only these approaches currently are relevant in the German health care system. In 2004 a category "Extracorporal liver assist device" was introduced in the list of "additional payments" in the German DRG-system, which makes reimbursement for hospitals using the technology in inpatient care possible, based on an hospital's individual contract with statutory sickness funds. Objectives: To report the present evidence and future research need on medical efficacy and economic effectiveness of extracorporal liver support devices for treatment of patients with ALF or ACLF based on published literature data. Are artificial liver support systems efficient and effective in the treatment of ALF or ACLF? Methods: An extensive, systematic literature search in medical, economic, and HTA literature data bases was performed. Relevant data were extracted and synthesised. Results: Relevant controlled trials were detected for BioLogic-DT and MARS. No randomised controlled trial on Prometheus was found. None of the included studies on BioLogic-DT showed

  2. Aberrant GSTP1 promoter methylation predicts short-term prognosis in acute-on-chronic hepatitis B liver failure.

    Science.gov (United States)

    Gao, S; Sun, F-K; Fan, Y-C; Shi, C-H; Zhang, Z-H; Wang, L-Y; Wang, K

    2015-08-01

    Glutathione-S-transferase P1 (GSTP1) methylation has been demonstrated to be associated with oxidative stress induced liver damage in acute-on-chronic hepatitis B liver failure (ACHBLF). To evaluate the methylation level of GSTP1 promoter in acute-on-chronic hepatitis B liver failure and determine its predictive value for prognosis. One hundred and five patients with acute-on-chronic hepatitis B liver failure, 86 with chronic hepatitis B (CHB) and 30 healthy controls (HC) were retrospectively enrolled. GSTP1 methylation level in peripheral mononuclear cells (PBMC) was detected by MethyLight. Clinical and laboratory parameters were obtained. GSTP1 methylation levels were significantly higher in patients with acute-on-chronic hepatitis B liver failure (median 16.84%, interquartile range 1.83-59.05%) than those with CHB (median 1.25%, interquartile range 0.48-2.47%; P chronic hepatitis B liver failure group, nonsurvivors showed significantly higher GSTP1 methylation levels (P chronic hepatitis B liver failure, GSTP1 methylation showed significantly better predictive value than MELD score [area under the receiver operating characteristic curve (AUC) 0.89 vs. 0.72, P chronic hepatitis B liver failure and shows high predictive value for short-term mortality. It might serve as a potential prognostic marker for acute-on-chronic hepatitis B liver failure. © 2015 John Wiley & Sons Ltd.

  3. Typhoid Fever Presenting With Acute Renal Failure And Hepatitis Simultaneously - A Rare Presentation

    Directory of Open Access Journals (Sweden)

    Rajput R.

    2016-05-01

    Full Text Available Typhoid fever is an important health problem worldwide but its incidence is more in developing countries. Hepatic involvement is common, but both hepatic and renal involvement is rare in typhoid fever. We report a case of typhoid fever presenting with hepatitis and acute renal failure. A 17 year old male presenting with fever and pain abdomen was found to have raised blood urea, creatinine, liver enzymes and bilirubin. Widal and typhidot (IgM,IgG test were positive. His symptoms subsided and deranged parameters resolved with treatment of typhoid fever.

  4. Case Study of Hepatic Radiofrequency Ablation Causing a Systemic Inflammatory Response Under Total Intravenous Anesthesia

    International Nuclear Information System (INIS)

    Schalte, Gereon; Waning, Christian; Rossaint, Rolf; Mahnken, Andreas H.; Henzler, Dietrich; Tacke, Josef

    2010-01-01

    To investigate the effects of hepatic radiofrequency ablation (RFA) in patients with malignant liver disease with respect to inflammation activation and stress response. In an observational trial, we investigated the physiologic parameters of 17 patients (20 interventions) who underwent percutaneous RFA under general anesthesia after applying total intravenous anesthesia. TNFα, IL-6, IL-8, IL-10, adrenaline and noradrenaline, liver enzymes, lactate and creatine kinase were determined pre-interventionally after induction of anesthesia (T1), 90 minutes after initiation of RFA (T2), immediately after the conclusion of the procedure (T3), and 24 hours after the procedure (T4). A significant increase in body temperature (p < 0.001), and mean arterial pressure (p = 0.001) were measured intraoperatively (T2) and the day after the procedure (T4). Increased levels of IL-6 were measured at T3 and T4 (p = 0.001). IL-10 increased immediately after the procedure (T3; p = 0.007). IL-6 levels correlated well with the total energy applied (γ = 0.837). Significant increases in the levels of adrenaline and noradrenaline were present at T3 and T4 (p < 0.001). The RFA-induced destruction of hepatic tissue was associated with increased levels of AST, ALT, GLDH and LDH. Percutaneous RFA of hepatic malignancies causes an inflammatory and endocrine activation, similar to the systemic inflammatory response syndrome. These effects have to be taken in account when dealing with patients susceptible to sepsis or multi-organ failure

  5. Case Study of Hepatic Radiofrequency Ablation Causing a Systemic Inflammatory Response Under Total Intravenous Anesthesia

    Energy Technology Data Exchange (ETDEWEB)

    Schalte, Gereon; Waning, Christian; Rossaint, Rolf; Mahnken, Andreas H. [University Hospital, RWTH Aachen, Aachen, (Germany); Henzler, Dietrich [Dalhousie University, Queen Elisabeth II Health Sciences Center, Halifax (Canada); Tacke, Josef [Interventional Radiology, Klinikum Passau, Passau (Germany)

    2010-12-15

    To investigate the effects of hepatic radiofrequency ablation (RFA) in patients with malignant liver disease with respect to inflammation activation and stress response. In an observational trial, we investigated the physiologic parameters of 17 patients (20 interventions) who underwent percutaneous RFA under general anesthesia after applying total intravenous anesthesia. TNF{alpha}, IL-6, IL-8, IL-10, adrenaline and noradrenaline, liver enzymes, lactate and creatine kinase were determined pre-interventionally after induction of anesthesia (T1), 90 minutes after initiation of RFA (T2), immediately after the conclusion of the procedure (T3), and 24 hours after the procedure (T4). A significant increase in body temperature (p < 0.001), and mean arterial pressure (p = 0.001) were measured intraoperatively (T2) and the day after the procedure (T4). Increased levels of IL-6 were measured at T3 and T4 (p = 0.001). IL-10 increased immediately after the procedure (T3; p = 0.007). IL-6 levels correlated well with the total energy applied ({gamma} = 0.837). Significant increases in the levels of adrenaline and noradrenaline were present at T3 and T4 (p < 0.001). The RFA-induced destruction of hepatic tissue was associated with increased levels of AST, ALT, GLDH and LDH. Percutaneous RFA of hepatic malignancies causes an inflammatory and endocrine activation, similar to the systemic inflammatory response syndrome. These effects have to be taken in account when dealing with patients susceptible to sepsis or multi-organ failure

  6. Investigations of inter-system common cause failures

    International Nuclear Information System (INIS)

    Nonclerca, P.; Gallois, M.; Vasseur, D.

    2012-01-01

    Intra-system common-cause failures (CCF) are widely studied and addressed in existing PSA models, but the information and studies that incorporate the potential for inter-system CCF is limited. However, the French Safety Authority has requested that EDF investigate the possibility of common-cause failure across system boundaries for Flamanville 3 (an EPR design). Also, the modeling of inter-system CCF, or the proof that their impact is negligible, would satisfy Capability Category III for one of the requirements in the ASME/ANS PRA standard in the U.S. EDF and EPRI have been working on a method to assess when it is necessary to take into account inter-system CCF in a PSA model between 2008 and 2010. This method is based both on the likelihood of inter-system CCF and on its demonstrated potential impact on CDF (core damage frequency). This method was first applied on pumps in different systems of the 900 MWe series plants. The second application concerned the motor-operated valves across different systems, using the same PSA model. This second application helped us refine the method, which was not optimal when the number of concerned components is very large. Since then, the method has been successfully applied on the pumps and 10 kV breakers of the EPR power plant in Flamanville. This paper describes the method and the results obtained in some of these studies. All studies have shown either that components in different systems, when they were not already part of a common cause failure group in the model, are not susceptible to common causes of failure, or that the potential for inter-system common-cause failure is negligible regarding the overall risk. (authors)

  7. Climate change and the causes of dam failures in Australia

    International Nuclear Information System (INIS)

    Lewis, B.

    2007-01-01

    As a result of poor dam construction methods in Australia and significant droughts occurring over the past 60 years, there is a danger that mistakes made during previous droughts will be repeated. Dams were often built in soils of very low moisture content to ensure a properly compacted bank. As a result of these poor construction methods, the drought years have produced an unusually high number of dam failures. This paper discussed the causes of dam failures such as dispersive clays and defects in associated structures. The discussion on dispersive clays included cracking, piping, tunneling, and slides. Dispersive clays occur in soils whose clay minerals separate into single grains when placed in contact with water and are associated with high soil erodability and their distribution often coincides with the occurrence of erosion gullying, rilling and piping. Dispersive clays in a dam embankment can result in the leaching out of material from the embankment with consequent erosion and failure. Defects in associated structures that were discussed included spillway blockage and outlet pipe blockage. It was concluded that dam failures are seldom due to one particular cause but rather due to one weakness triggering another. It was concluded that failures are difficult and expensive to remedy. 9 refs., 4 figs

  8. Atrial Fibrillation and Heart Failure - Cause or Effect?

    Science.gov (United States)

    Prabhu, Sandeep; Voskoboinik, Aleksandr; Kaye, David M; Kistler, Peter M

    2017-09-01

    There are emerging epidemics of atrial fibrillation (AF) and heart failure in most developed countries, with a significant health burden. Due to many shared pathophysiological mechanisms, which facilitate the maintenance of each condition, AF and heart failure co-exist in up to 30% of patients. In the circumstance where known structural causes of heart failure (such as myocardial infarction) are absent, patients presenting with both conditions present a unique challenge, particularly as the temporal relationship of each condition can often remain elusive from the clinical history. The question of whether the AF is driving, or significantly contributing to the left ventricular (LV) dysfunction, rather than merely a consequence of heart failure, has become ever more pertinent, especially as catheter ablation now offers a significant advancement over existing rhythm control strategies. This paper will review the inter-related physiological drivers of AF and heart failure before considering the implications from the outcomes of recent clinical trials in patients with AF and heart failure. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  9. Two Rare Causes of Hepatitis: Fascioliasis and Brucellosis

    Directory of Open Access Journals (Sweden)

    Uğur ÖNAL

    2017-12-01

    Full Text Available Brucellosis and fascioliasis are zoonoses which induce different type of cell-mediated immune responses and rarely cause hepatitis with together. Brucellosis induces T helper type 1 (Th1 immune response whereas Fasciola hepatica induces T helper type 2 (Th2 immune. It may be speculated that chronic fascioliasis can predispose to brucellosis by suppression of Th1 response against brucellosis. In this paper, we present a patient who was diagnosed with brucellosis as well as chronic fasciolasis on the basis of parasite that was seen incidentally during the abdomen ultrasonography. To our knowledge, this case is one of the few cases in the literature that showing the co-infection of the liver by both fascioliasis and brucellosis.

  10. Use of nucleoside (tide) analogues in patients with hepatitis B-related acute liver failure

    DEFF Research Database (Denmark)

    Dao, Doan Y; Seremba, Emmanuel; Ajmera, Veeral

    2012-01-01

    The efficacy of nucleoside(tide) analogues (NA) in the treatment of acute liver failure due to hepatitis B virus (HBV-ALF) remains controversial. We determined retrospectively the impact of NAs in a large cohort of patients with HBV-ALF.......The efficacy of nucleoside(tide) analogues (NA) in the treatment of acute liver failure due to hepatitis B virus (HBV-ALF) remains controversial. We determined retrospectively the impact of NAs in a large cohort of patients with HBV-ALF....

  11. Benchmark exercise of the European Community on common cause failure

    International Nuclear Information System (INIS)

    Doerre, P.

    1986-09-01

    This report summarizes experiences and results of the contractor's contribution to the 'Second Reliability Benchmark Exercise of the European Community on Common Cause Failure' (CCF-RBE). The choice of a method for the treatment of dependent failures in a given reliability analysis depends on the purpose and aim of this analysis as well as on quality and extent of the available data, which may also influence the necessary degree of detail of the analysis. When data are applied to a system with different degree of redundancy, two types of errors have to be avoided which lead to extremely pessimistic assessments. (orig.) With 20 refs., 3 tabs., 1 fig [de

  12. [Acetaminophen (paracetamol) causing renal failure: report on 3 pediatric cases].

    Science.gov (United States)

    Le Vaillant, J; Pellerin, L; Brouard, J; Eckart, P

    2013-06-01

    Renal failure secondary to acetaminophen poisoning is rare and occurs in approximately 1-2 % of patients with acetaminophen overdose. The pathophysiology is still being debated, and renal acetaminophen toxicity consists of acute tubular necrosis, without complication if treated promptly. Renal involvement can sometimes occur without prior liver disease, and early renal manifestations usually occur between the 2nd and 7th day after the acute acetaminophen poisoning. While therapy is exclusively symptomatic, sometimes serious metabolic complications can be observed. The monitoring of renal function should therefore be considered as an integral part of the management of children with acute, severe acetaminophen intoxication. We report 3 cases of adolescents who presented with acute renal failure as a result of voluntary drug intoxication with acetaminophen. One of these 3 girls developed severe renal injury without elevated hepatic transaminases. None of the 3 girls' renal function required hemodialysis, but one of the 3 patients had metabolic complications after her acetaminophen poisoning. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  13. Centrifuge model test of rock slope failure caused by seismic excitation. Plane failure of dip slope

    International Nuclear Information System (INIS)

    Ishimaru, Makoto; Kawai, Tadashi

    2008-01-01

    Recently, it is necessary to assess quantitatively seismic safety of critical facilities against the earthquake induced rock slope failure from the viewpoint of seismic PSA. Under these circumstances, it is essential to evaluate more accurately the possibilities of rock slope failure and the potential failure boundary, which are triggered by earthquake ground motions. The purpose of this study is to analyze dynamic failure characteristics of rock slopes by centrifuge model tests for verification and improvement of the analytical methods. We conducted a centrifuge model test using a dip slope model with discontinuities limitated by Teflon sheets. The centrifugal acceleration was 50G, and the acceleration amplitude of input sin waves increased gradually at every step. The test results were compared with safety factors of the stability analysis based on the limit equilibrium concept. Resultant conclusions are mainly as follows: (1) The slope model collapsed when it was excited by the sine wave of 400gal, which was converted to real field scale, (2) Artificial discontinuities were considerably concerned in the collapse, and the type of collapse was plane failure, (3) From response acceleration records observed at the slope model, we can say that tension cracks were generated near the top of the slope model during excitation, and that might be cause of the collapse, (4) By considering generation of the tension cracks in the stability analysis, correspondence of the analytical results and the experimental results improved. From the obtained results, we need to consider progressive failure in evaluating earthquake induced rock slope failure. (author)

  14. Anabolic steroid abuse causing recurrent hepatic adenomas and hemorrhage

    Science.gov (United States)

    Martin, Nicole M; Dayyeh, Barham K Abu; Chung, Raymond T

    2008-01-01

    Anabolic steroid abuse is common among athletes and is associated with a number of medical complications. We describe a case of a 27-year-old male bodybuilder with multiple hepatic adenomas induced by anabolic steroids. He initially presented with tumor hemorrhage and was treated with left lateral hepatic segmentectomy. Regression of the remaining tumors was observed with cessation of steroid use. However, 3 years and a half after his initial hepatic segmentectomy, he presented with recurrent tumor enlargement and intraperitoneal hemorrhage in the setting of steroid abuse relapse. Given his limited hepatic reserve, he was conservatively managed with embolization of the right accessory hepatic artery. This is the first reported case of hepatic adenoma re-growth with recidivistic steroid abuse, complicated by life-threatening hemorrhage. While athletes and bodybuilders are often aware of the legal and social ramifications of steroid abuse, they should continue to be counseled about its serious medical risks. PMID:18680242

  15. Anabolic steroid abuse causing recurrent hepatic adenomas and hemorrhage.

    Science.gov (United States)

    Martin, Nicole M; Abu Dayyeh, Barham K; Chung, Raymond T

    2008-07-28

    Anabolic steroid abuse is common among athletes and is associated with a number of medical complications. We describe a case of a 27-year-old male bodybuilder with multiple hepatic adenomas induced by anabolic steroids. He initially presented with tumor hemorrhage and was treated with left lateral hepatic segmentectomy. Regression of the remaining tumors was observed with cessation of steroid use. However, 3 years and a half after his initial hepatic segmentectomy, he presented with recurrent tumor enlargement and intraperitoneal hemorrhage in the setting of steroid abuse relapse. Given his limited hepatic reserve, he was conservatively managed with embolization of the right accessory hepatic artery. This is the first reported case of hepatic adenoma re-growth with recidivistic steroid abuse, complicated by life-threatening hemorrhage. While athletes and bodybuilders are often aware of the legal and social ramifications of steroid abuse, they should continue to be counseled about its serious medical risks.

  16. Insights About Emergency Diesel Generator Failures from the USNRC's Common Cause Failure Database

    International Nuclear Information System (INIS)

    Mosleh, A.; Rasmuson, D.; Marshall, F.; Wierman, T.

    1999-01-01

    The US Nuclear Regulatory Commission has sponsored development of a database of common cause failure events for use in commercial nuclear power plant risk and reliability analyses. This paper presents a summary of the results from analysis of the emergency diesel generator data from the database. The presentation is limited to the overall insights, the design and manufacturing cause and the instrumentation and control sub-system

  17. Fulminate Hepatic Failure in a 5 Year Old Female after Inappropriate Acetaminophen Treatment

    Directory of Open Access Journals (Sweden)

    Irena Kasmi

    2015-09-01

    CONCLUSION: Healthcare providers should considered probable acetaminophen toxicity in any child who has received the drug and presented with liver failure. When there is a high index of suspicion of acetaminophen toxicity NAC should be initiated and continued until there are no signs of hepatic dysfunction.

  18. Fatal Fulminant Hepatic Failure from Adenovirus in Allogeneic Bone Marrow Transplant Patients

    Directory of Open Access Journals (Sweden)

    Jatin M. Vyas

    2012-01-01

    Full Text Available We report two cases of fatal hepatic failure in patients who received matched unrelated bone marrow transplantation. Both patients presented with high fevers, abnormal liver functions tests, and hypodense lesions in the liver by CT scan. Histologic examination of postmortem liver samples demonstrated extensive necrosis, and immunohistochemistry was positive for adenovirus.

  19. Hepatitis A related acute liver failure by consumption of contaminated food

    NARCIS (Netherlands)

    Chi, Heng; Haagsma, Elizabeth B.; Riezebos-Brilman, Annelies; van den Berg, Arie P.; Metselaar, Herold J.; de Knegt, Robert J.

    We present a patient with no medical history admitted for jaundice and dark coloured urine. Further investigations revealed hepatitis A related acute liver failure while the patient had no travel history, nor contact with infected individuals. After admission, the patient deteriorated fulfilling the

  20. Common Cause Failure Analysis for the Digital Plant Protection System

    International Nuclear Information System (INIS)

    Kagn, Hyun Gook; Jang, Seung Cheol

    2005-01-01

    Safety-critical systems such as nuclear power plants adopt the multiple-redundancy design in order to reduce the risk from the single component failure. The digitalized safety-signal generation system is also designed based on the multiple-redundancy strategy which consists of more redundant components. The level of the redundant design of digital systems is usually higher than those of conventional mechanical systems. This higher redundancy would clearly reduce the risk from the single failure of components, but raise the importance of the common cause failure (CCF) analysis. This research aims to develop the practical and realistic method for modeling the CCF in digital safety-critical systems. We propose a simple and practical framework for assessing the CCF probability of digital equipment. Higher level of redundancy causes the difficulty of CCF analysis because it results in impractically large number of CCF events in the fault tree model when we use conventional CCF modeling methods. We apply the simplified alpha-factor (SAF) method to the digital system CCF analysis. The precedent study has shown that SAF method is quite realistic but simple when we consider carefully system success criteria. The first step for using the SAF method is the analysis of target system for determining the function failure cases. That is, the success criteria of the system could be derived from the target system's function and configuration. Based on this analysis, we can calculate the probability of single CCF event which represents the CCF events resulting in the system failure. In addition to the application of SAF method, in order to accommodate the other characteristics of digital technology, we develop a simple concept and several equations for practical use

  1. Mitochondrial iron accumulation exacerbates hepatic toxicity caused by hepatitis C virus core protein

    Energy Technology Data Exchange (ETDEWEB)

    Sekine, Shuichi; Ito, Konomi; Watanabe, Haruna; Nakano, Takafumi [Laboratory of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8675 (Japan); Moriya, Kyoji; Shintani, Yoshizumi; Fujie, Hajime; Tsutsumi, Takeya; Miyoshi, Hideyuki; Fujinaga, Hidetake; Shinzawa, Seiko; Koike, Kazuhiko [Department of Internal Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 (Japan); Horie, Toshiharu, E-mail: t.horie@thu.ac.jp [Laboratory of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8675 (Japan)

    2015-02-01

    Patients with long-lasting hepatitis C virus (HCV) infection are at major risk of hepatocellular carcinoma (HCC). Iron accumulation in the livers of these patients is thought to exacerbate conditions of oxidative stress. Transgenic mice that express the HCV core protein develop HCC after the steatosis stage and produce an excess of hepatic reactive oxygen species (ROS). The overproduction of ROS in the liver is the net result of HCV core protein-induced dysfunction of the mitochondrial respiratory chain. This study examined the impact of ferric nitrilacetic acid (Fe-NTA)-mediated iron overload on mitochondrial damage and ROS production in HCV core protein-expressing HepG2 (human HCC) cells (Hep39b cells). A decrease in mitochondrial membrane potential and ROS production were observed following Fe-NTA treatment. After continuous exposure to Fe-NTA for six days, cell toxicity was observed in Hep39b cells, but not in mock (vector-transfected) HepG2 cells. Moreover, mitochondrial iron ({sup 59}Fe) uptake was increased in the livers of HCV core protein-expressing transgenic mice. This increase in mitochondrial iron uptake was inhibited by Ru360, a mitochondrial Ca{sup 2+} uniporter inhibitor. Furthermore, the Fe-NTA-induced augmentation of mitochondrial dysfunction, ROS production, and cell toxicity were also inhibited by Ru360 in Hep39b cells. Taken together, these results indicate that Ca{sup 2+} uniporter-mediated mitochondrial accumulation of iron exacerbates hepatocyte toxicity caused by the HCV core protein. - Highlights: • Iron accumulation in the livers of patients with hepatitis C virus (HCV) infection is thought to exacerbate oxidative stress. • The impact of iron overload on mitochondrial damage and ROS production in HCV core protein-expressing cells were examined. • Mitochondrial iron uptake was increased in the livers of HCV core protein-expressing transgenic mice. • Ca{sup 2+} uniporter-mediated mitochondrial accumulation of iron exacerbates

  2. Effects of Common Cause Failure on Electrical Systems

    International Nuclear Information System (INIS)

    Pepper, Kevin

    2015-01-01

    The essential electrical systems of reactor designs have developed progressively with an increased focus on the use of redundant, segregated and independent safety system equipment 'trains'. In this arrangement, essential safety functions associated with safe shutdown and cooling of the reactor are replicated on near identical electrical systems with each of the trains of safety system equipment supported by a fully rated standby generator. Development in designs has seen the number of trains increased to enable maintenance to be undertaken with reactors at power, improving the economics of the units whilst maintaining nuclear safety. This paper provides a background to common cause failure and provides examples where supporting guidance and international experience is available. It also highlights the regulatory guidance available to UK licensees. Recent examples of common cause failures on plant in the UK are presented together with an issue identified during the recent Generic Design Assessment review of new reactor designs within the UK. It was identified that one design was claiming a very low probability of failure associated with the loss of a single break and no-break voltage level, orders of magnitude below the target figure within ONR's Safety Assessment Principles. On closer scrutiny it was established that a significant safety function provided from identical low voltage switchboards would be lost in the event of a common cause failure affecting these boards. The paper will explain the action that has been taken by the requesting party to improve the resilience of the design and how this impacts on the ONR reliability targets for reactor designs within the UK. (authors)

  3. Dialysis Arteriovenous Fistula Failure and Angioplasty: Intimal Hyperplasia and Other Causes of Access Failure

    Science.gov (United States)

    Duque, Juan C.; Tabbara, Marwan; Martinez, Laisel; Cardona, Jose; Vazquez-Padron, Roberto I; Salman, Loay H

    2016-01-01

    Arteriovenous fistula (AVF) is the preferred hemodialysis access type because it has better patency rates and fewer complications than other access types. However, primary failure remains a common problem impeding AVF maturation and adding to patients’ morbidity and mortality. Juxta-anastomotic (or inflow) stenosis is the most common reason leading to primary failure, and percutaneous transluminal angioplasty (PTA) continues to be the gold standard treatment with excellent success rates. Intimal hyperplasia (IH) has been traditionally blamed as the main pathophysiologic culprit, but new evidence raises doubts regarding the contribution of IH alone to primary failure. We report a 64-year-old man with a two-stage brachio-basilic AVF that was complicated by failure four months after creation. Angiogram showed multiple juxta-anastomotic and mid-fistula stenotic lesions. PTA was successful in assisting maturation and subsequently cannulating AVF for hemodialysis treatment. We failed to identify the underlying cause of stenosis as biopsy specimens from fistula tissue obtained at the time of transposition revealed no occlusive IH. This case emphasizes the need for additional research on factors contributing to AVF failure besides IH, and highlights the need for more therapeutic options to reduce AVF failure rate. PMID:28084215

  4. Encephalitis, acute renal failure, and acute hepatitis triggered by a viral infection in an immunocompetent young adult: a case report

    Directory of Open Access Journals (Sweden)

    Khattab Mahmoud

    2009-11-01

    Full Text Available Abstract Introduction Cytomegalovirus generally causes self-limited, mild and asymptomatic infections in immunocompetent patients. An aggressive course in immunocompetent healthy patients is unusual. Case presentation We report the case of an immunocompetent 16-year-old Egyptian boy with encephalitis, acute renal failure, and acute hepatitis triggered by viral infection with a complete recovery following antiviral treatment. Conclusion We believe that this case adds to the understanding of the molecular biology, clinical presentation and increasing index of suspicion of many viral infections.

  5. Adrenal Insufficiency as a Cause of Acute Liver Failure: A Case Report

    Directory of Open Access Journals (Sweden)

    Jamshid Vafaeimanesh

    2013-01-01

    Full Text Available Introduction. Many diseases and conditions can contribute to elevated liver enzymes. Common causes include viral and autoimmune hepatitis, fatty liver, and bile duct diseases, but, in uncommon cases like liver involvement in endocrine disorders, liver failure is also seen. Adrenal insufficiency is the rarest endocrine disorder complicating the liver. In the previously reported cases of adrenal insufficiency, mild liver enzymes elevation was seen but we report a case with severe elevated liver enzymes and liver failure due to adrenal insufficiency. Based on our knowledge, this is the first report in this field. Case Report. A 39-year-old woman was referred to emergency ward due to drowsiness and severe fatigue. Her laboratory tests revealed prothrombin time: 21 sec, alanine aminotransferase (ALT: 2339 IU/L, aspartate aminotransferase (AST: 2002 IU/L, and ALP: 90 IU/L. No common cause of liver involvement was discovered, and eventually, with diagnosis of adrenal insufficiency and corticosteroid therapy, liver enzymes and function became normal. Finally, the patient was discharged with good general condition. Conclusion. With this report, we emphasize adrenal insufficiency (primary or secondary as a reason of liver involvement in unexplainable cases and recommend that any increase in the liver enzymes, even liver failure, in these patients should be observed.

  6. PACC information management code for common cause failures analysis

    International Nuclear Information System (INIS)

    Ortega Prieto, P.; Garcia Gay, J.; Mira McWilliams, J.

    1987-01-01

    The purpose of this paper is to present the PACC code, which, through an adequate data management, makes the task of computerized common-mode failure analysis easier. PACC processes and generates information in order to carry out the corresponding qualitative analysis, by means of the boolean technique of transformation of variables, and the quantitative analysis either using one of several parametric methods or a direct data-base. As far as the qualitative analysis is concerned, the code creates several functional forms for the transformation equations according to the user's choice. These equations are subsequently processed by boolean manipulation codes, such as SETS. The quantitative calculations of the code can be carried out in two different ways: either starting from a common cause data-base, or through parametric methods, such as the Binomial Failure Rate Method, the Basic Parameters Method or the Multiple Greek Letter Method, among others. (orig.)

  7. A Comparative Study of Hepatitis Caused by Scrub Typhus and Viral Hepatitis A in South Korea

    Science.gov (United States)

    Lee, Jun; Kim, Dong-Min; Yun, Na Ra; Byeon, Yu Mi; Kim, Young Dae; Park, Chan Guk; Kim, Man Woo; Han, Mi Ah

    2011-01-01

    We compared clinical features and laboratory findings of 104 patients with hepatitis A and 197 patients with scrub typhus. Nausea, vomiting, abdominal pain, hepatomegaly, and jaundice were common in patient with hepatitis A, and fever and headache were significantly more common in patients with scrub typhus. At presentation, an alanine aminotransferase (ALT) level ≥ 500 U/L was observed in 1% of scrub typhus patients and in 87.5% of hepatitis A patients (P hepatitis A patients. The ALT:lactate dehydrogenase ratio was ≤ 5 in 97.4% of the patients with scrub typhus and > 5 in 95.2% of those with hepatitis A (P 5, and hepatomegaly are indications of viral hepatitis A. PMID:22049041

  8. A comparative study of hepatitis caused by scrub typhus and viral hepatitis A in South Korea.

    Science.gov (United States)

    Lee, Jun; Kim, Dong-Min; Yun, Na Ra; Byeon, Yu Mi; Kim, Young Dae; Park, Chan Guk; Kim, Man Woo; Han, Mi Ah

    2011-11-01

    We compared clinical features and laboratory findings of 104 patients with hepatitis A and 197 patients with scrub typhus. Nausea, vomiting, abdominal pain, hepatomegaly, and jaundice were common in patient with hepatitis A, and fever and headache were significantly more common in patients with scrub typhus. At presentation, an alanine aminotransferase (ALT) level ≥ 500 U/L was observed in 1% of scrub typhus patients and in 87.5% of hepatitis A patients (P hepatitis A patients. The ALT:lactate dehydrogenase ratio was ≤ 5 in 97.4% of the patients with scrub typhus and > 5 in 95.2% of those with hepatitis A (P 5, and hepatomegaly are indications of viral hepatitis A.

  9. Diseases causing acute renal failure in a tertiary care hospital

    International Nuclear Information System (INIS)

    Khan, G.; Hussain, K.; Rehman, A.

    2011-01-01

    Objective: This study was done to evaluate frequency of acute renal failure ( ARF ), its causes and out come of the patients. Study Design: Descriptive analytic study Place and Duration of Study: March to Dec 2007 at Combined Military Hospital Lahore. Patients and Methods: All patients, admitted in different wards of the hospital, who developed acute renal failure (doubling of serum creatinine measured on two occasions 12 hours apart), were included in this study. Results: A total of 39 patients were included in the study. Males were 19 (48.71%) and 20 (51.28%) were female. Mean age of patients was 40.2 years (SD=18.0). The major cause was acute Gastroenteritis seen in 23 (58.97%) cases. Others developed ARF due to, Abruptio Placentae 5 (12.82%), Postoperative 5 (12.82%), Eclampsia 3 (7.69%) and Drug induced 3 (7.69%) . Oliguric phase developed in 28 (71.79%) patients and lasted for 8.45 +- 4.16 days. Of these 17 (60.71%) patients had acute gastroenteritis. Conclusion: Gastroenteritis is the most common and important cause of ARF though gynaecological and surgical etiologies must be kept in mind. It is evident that the gynaecological and surgical patients need critical peri-partum and peri-operative monitoring to prevent development of ARF. Early institution of therapy will prevent subsequent morbidity associated with this disease. (author)

  10. Acute Unilateral Vestibular Failure Does Not Cause Spatial Hemineglect.

    Directory of Open Access Journals (Sweden)

    Julian Conrad

    Full Text Available Visuo-spatial neglect and vestibular disorders have common clinical findings and involve the same cortical areas. We questioned (1 whether visuo-spatial hemineglect is not only a disorder of spatial attention but may also reflect a disorder of higher cortical vestibular function and (2 whether a vestibular tone imbalance due to an acute peripheral dysfunction can also cause symptoms of neglect or extinction. Therefore, patients with an acute unilateral peripheral vestibular failure (VF were tested for symptoms of hemineglect.Twenty-eight patients with acute VF were assessed for signs of vestibular deficits and spatial neglect using clinical measures and various common standardized paper-pencil tests. Neglect severity was evaluated further with the Center of Cancellation method. Pathological neglect test scores were correlated with the degree of vestibular dysfunction determined by the subjective visual vertical and caloric testing.Three patients showed isolated pathological scores in one or the other neglect test, either ipsilesionally or contralesionally to the VF. None of the patients fulfilled the diagnostic criteria of spatial hemineglect or extinction.A vestibular tone imbalance due to unilateral failure of the vestibular endorgan does not cause spatial hemineglect, but evidence indicates it causes mild attentional deficits in both visual hemifields.

  11. Failure cause analysis and improvement for magnetic component cabinet

    International Nuclear Information System (INIS)

    Ge Bing

    1999-01-01

    The magnetic component cabinet is an important thermal control device fitted on the nuclear power. Because it used a self-saturation amplifier as a primary component, the magnetic component cabinet has some boundness. For increasing the operation safety on the nuclear power, the author describes a new scheme. In order that the magnetic component cabinet can be replaced, the new type component cabinet is developed. Integrate circuit will replace the magnetic components of every function parts. The author has analyzed overall failure cause for magnetic component cabinet and adopted some measures

  12. Upgrade of Common Cause Failure Modelling of NPP Krsko PSA

    International Nuclear Information System (INIS)

    Vukovic, I.; Mikulicic, V.; Vrbanic, I.

    2006-01-01

    Over the last thirty years the probabilistic safety assessments (PSA) have been increasingly applied in technical engineering practice. Various failure modes of system of concern are mathematically and explicitly modelled by means of fault tree structure. Statistical independence of basic events from which the fault tree is built is not acceptable for an event category referred to as common cause failures (CCF). Based on overview of current international status of modelling of common cause failures in PSA several steps were made related to primary technical basis for methodology and data used for CCF model upgrade project in NPP Krsko (NEK) PSA. As a primary technical basis for methodological aspects of CCF modelling in Krsko PSA the following documents were considered: NUREG/CR-5485, NUREG/CR-4780, and Westinghouse Owners Group documents (WOG) WCAP-15674 and WCAP-15167. Use of these documents is supported by the most relevant guidelines and standards in the field, such as ASME PRA Standard and NRC Regulatory Guide 1.200. WCAP documents are in compliance with NUREG/CR-5485 and NUREG/CR-4780. Additionally, they provide WOG perspective on CCF modelling, which is important to consider since NEK follows WOG practice in resolving many generic and regulatory issues. It is, therefore, desirable that NEK CCF methodology and modelling is in general accordance with recommended WOG approaches. As a primary basis for CCF data needed to estimate CCF model parameters and their uncertainty, the main used documents were: NUREG/CR-5497, NUREG/CR-6268, WCAP-15167, and WCAP-16187. Use of NUREG/CR-5497 and NUREG/CR-6268 as a source of data for CCF parameter estimating is supported by the most relevant industry and regulatory PSA guides and standards currently existing in the field, including WOG. However, the WCAP document WCAP-16187 has provided a basis for CCF parameter values specific to Westinghouse PWR plants. Many of events from NRC / INEEL database were re-classified in WCAP

  13. Pathogenesis of apical periodontitis and the causes of endodontic failures.

    Science.gov (United States)

    Nair, P N R

    2004-11-01

    Apical periodontitis is a sequel to endodontic infection and manifests itself as the host defense response to microbial challenge emanating from the root canal system. It is viewed as a dynamic encounter between microbial factors and host defenses at the interface between infected radicular pulp and periodontal ligament that results in local inflammation, resorption of hard tissues, destruction of other periapical tissues, and eventual formation of various histopathological categories of apical periodontitis, commonly referred to as periapical lesions. The treatment of apical periodontitis, as a disease of root canal infection, consists of eradicating microbes or substantially reducing the microbial load from the root canal and preventing re-infection by orthograde root filling. The treatment has a remarkably high degree of success. Nevertheless, endodontic treatment can fail. Most failures occur when treatment procedures, mostly of a technical nature, have not reached a satisfactory standard for the control and elimination of infection. Even when the highest standards and the most careful procedures are followed, failures still occur. This is because there are root canal regions that cannot be cleaned and obturated with existing equipments, materials, and techniques, and thus, infection can persist. In very rare cases, there are also factors located within the inflamed periapical tissue that can interfere with post-treatment healing of the lesion. The data on the biological causes of endodontic failures are recent and scattered in various journals. This communication is meant to provide a comprehensive overview of the etio-pathogenesis of apical periodontitis and the causes of failed endodontic treatments that can be visualized in radiographs as asymptomatic post-treatment periapical radiolucencies.

  14. Hepatitis E is a cause of unexplained hepatitis in The Netherlands

    NARCIS (Netherlands)

    Waar, K; Herremans, MMPT; Vennema, H; Koopmans, MPG; Benne, CA

    Background: Hepatitis E virus (HEV) is the major etiologic agent of enterically transmitted viral hepatitis in much of the developing world. Evidence provided in recent years shows that HEV is also prevalent in very low numbers in non-endemic countries. Recently, a cluster of three patients with

  15. Hodgkin’s lymphoma coexisting with liver failure secondary to acute on chronic hepatitis B

    Science.gov (United States)

    Palta, Renee; McClune, Amy; Esrason, Karl

    2013-01-01

    Acute on chronic liver failure (ACLF) is rarely the initial manifestation of a malignant process or precipitated by the initiation of anti-viral treatment with a nucleoside or nucleotide agent. We report an unusual case of ACLF temporally associated with initiation of Entecavir for treatment of chronic hepatitis B. Early Hodgkin’s lymphoma (HL) was unmasked with initiation of the anti-viral treatment which may have exacerbated ACLF. To the best of our knowledge, this has not been described in the literature. In reviewing our patients clinical course and liver autopsy, he developed a severe acute exacerbation of his chronic hepatitis B virus coinciding with the institution of antiviral therapy and the underlying HL perhaps modulating the overall degree of hepatic injury. PMID:24303460

  16. Hodgkin's lymphoma coexisting with liver failure secondary to acute on chronic hepatitis B.

    Science.gov (United States)

    Palta, Renee; McClune, Amy; Esrason, Karl

    2013-04-16

    Acute on chronic liver failure (ACLF) is rarely the initial manifestation of a malignant process or precipitated by the initiation of anti-viral treatment with a nucleoside or nucleotide agent. We report an unusual case of ACLF temporally associated with initiation of Entecavir for treatment of chronic hepatitis B. Early Hodgkin's lymphoma (HL) was unmasked with initiation of the anti-viral treatment which may have exacerbated ACLF. To the best of our knowledge, this has not been described in the literature. In reviewing our patients clinical course and liver autopsy, he developed a severe acute exacerbation of his chronic hepatitis B virus coinciding with the institution of antiviral therapy and the underlying HL perhaps modulating the overall degree of hepatic injury.

  17. Hepatitis E as a cause of acute jaundice syndrome in northern Uganda, 2010-2012.

    Science.gov (United States)

    Gerbi, Gemechu B; Williams, Roxanne; Bakamutumaho, Barnabas; Liu, Stephen; Downing, Robert; Drobeniuc, Jan; Kamili, Saleem; Xu, Fujie; Holmberg, Scott D; Teshale, Eyasu H

    2015-02-01

    Hepatitis E virus (HEV) is a common cause of acute viral hepatitis in developing countries; however, its contribution to acute jaundice syndrome is not well-described. A large outbreak of hepatitis E occurred in northern Uganda from 2007 to 2009. In response to this outbreak, acute jaundice syndrome surveillance was established in 10 district healthcare facilities to determine the proportion of cases attributable to hepatitis E. Of 347 acute jaundice syndrome cases reported, the majority (42%) had hepatitis E followed by hepatitis B (14%), malaria (10%), hepatitis C (5%), and other/unknown (29%). Of hepatitis E cases, 72% occurred in Kaboong district, and 68% of these cases occurred between May and August of 2011. Residence in Kaabong district was independently associated with hepatitis E (adjusted odds ratio = 13; 95% confidence interval = 7-24). The findings from this surveillance show that an outbreak and sporadic transmission of hepatitis E occur in northern Uganda. © The American Society of Tropical Medicine and Hygiene.

  18. Prediction of posthepatectomy liver failure using transient elastography in patients with hepatitis B related hepatocellular carcinoma.

    Science.gov (United States)

    Lei, Jie-Wen; Ji, Xiao-Yu; Hong, Jun-Feng; Li, Wan-Bin; Chen, Yan; Pan, Yan; Guo, Jia

    2017-12-29

    It is essential to accurately predict Postoperative liver failure (PHLF) which is a life-threatening complication. Liver hardness measurement (LSM) is widely used in non-invasive assessment of liver fibrosis. The aims of this study were to explore the application of preoperative liver stiffness measurements (LSM) by transient elastography in predicting postoperative liver failure (PHLF) in patients with hepatitis B related hepatocellular carcinoma. The study included 247 consecutive patients with hepatitis B related hepatocellular carcinoma who underwent hepatectomy between May 2015 and September 2015. Detailed preoperative examinations including LSM were performed before hepatectomy. The endpoint was the development of PHLF. All of the patients had chronic hepatitis B defined as the presence of hepatitis B surface antigen (HBsAg) for more than 6 months and 76 (30.8%) had cirrhosis. PHLF occurred in 37 (14.98%) patients. Preoperative LSM (odds ratio, OR, 1.21; 95% confidence interval, 95% CI: 1.13-1.29; P hepatocellular carcinoma.

  19. Paraoxonase activity in patients with chronic renal failure and hepatic insufficiency

    International Nuclear Information System (INIS)

    Jamal, S.; Ishaq, M.; Hussain, S.M.W.; Alam, J.A.; Hussain, S.

    2010-01-01

    Paraoxonase (PON), a high density lipoprotein (HDL) associated enzyme, is believed to protect against the oxidation of low density lipoprotein (LDL) and hence affects the risk of vascular disease. PON is sensitive to oxidants and is inactivated by oxidized lipids, and thus it can be postulated that increased oxidative stress may decrease plasma PON activity in patients with chronic renal failure (CRF) and hepatic insufficiency (HI). Moreover, in CRF and HI patients, in contrast to normal individuals, higher levels of plasma biochemical parameters and liver enzymes had an inverse correlation with PON activity. In this study we aimed to investigate PON activity, total bilirubin, creatinine, urea and liver enzymes alanine aminotransferase and alkaline phosphatase that are the index of renal and hepatic insufficiency. We have analyzed plasma from pre-dialysis patients and compared the results with the normal individuals. We observed a positive association of PON activity with that of the disease state i.e. the activity of this enzyme was significantly lower in the patients (p < 0.001). Furthermore, the indicators of renal and hepatic insufficiency were significantly elevated as compared to the normal subjects. Based on our results we conclude that in CRF and HI, in contrast to normal individuals, higher levels of plasma biochemical parameters and liver enzymes had inverse correlation with PON activity. Collectively, these findings may add details to the understanding of the role that PON plays in chronic renal failure and hepatic insufficiency. (author)

  20. Predictive factors for early failure of transarterial embolization in blunt hepatic injury patients

    International Nuclear Information System (INIS)

    Lee, Y.-H.; Wu, C.-H.; Wang, L.-J.; Wong, Y.-C.; Chen, H.-W.; Wang, C.-J.; Lin, B.-C.; Hsu, Y.-P.

    2014-01-01

    Aim: To evaluate the early success of transarterial embolization (TAE) in patients with traumatic liver haemorrhage and to determine independent factors for its failure. Materials and methods: From January 2009 to December 2012, TAE was performed in 48 patients for traumatic liver haemorrhage. Their medical charts were reviewed for demographic information, pre-TAE vital signs and laboratory data, injury grade, type of contrast medium extravasation (CME) at CT, angiography findings, and early failure. “Early failure” was defined as the need for repeated TAE or a laparotomy for hepatic haemorrhage within 4 days after TAE. Variables were compared between the early success and early failure groups. Variables with univariate significance were also analysed using multivariate logistic regression for predictors of early failure. Results: Among 48 liver TAE cases, nine (18.8%) were early failures due to liver haemorrhage. Early failure was associated with injury grade (p = 0.039), major liver injury (grades 4 and 5; p = 0.007), multiple CMEs at angiography (p = 0.031), incomplete TAE (p = 0.002), and elevated heart rate (p = 0.026). Incomplete embolization (OR = 8; p = 0.042), and heart rate >110 beats/min (bpm; OR = 8; p = 0.05) were independent factors for early failure of TAE in the group with major liver injuries. Conclusion: Major hepatic injury is an important factor in early failure. Patients with a heart rate >110 bpm and incomplete embolization in the major injury group have an increased rate of early failure. The success rate of proximal TAE was comparable to that of the more time-consuming, superselective, distal TAE. - Highlights: • Early failure of TAE is associated with a higher grade of liver injury. • Incomplete embolization is more likely to suffer early failure of TAE. • A heart rate greater than 110 bpm is more likely to suffer early failure of TAE. • We recommend proximal embolization to prevent early failure of TAE

  1. Diversity Strategies to Mitigate Postulated Common Cause Failure Vulnerabilities

    International Nuclear Information System (INIS)

    Wood, Richard Thomas

    2010-01-01

    This paper describes an approach to establish effective mitigating strategies that can resolve potential common-cause failure (CCF) vulnerabilities in instrumentation and control (I and C) systems at nuclear power plants. A particular objective in the development of these strategies, which consist of combinations of diversity attributes and their associated criteria, is to address the unique characteristics of digital technology that can contribute to CCF concerns. The research approach employed to establish diversity strategies involves investigation of available documentation on diversity usage and experience from nuclear power and non-nuclear industries, capture of expert knowledge and lessons learned, determination of common practices, and assessment of the nature of CCFs and compensating diversity attributes. The resulting diversity strategies address considerations such as the effect of technology choices, the nature of CCF vulnerabilities, and the prospective impact of each diversity type. In particular, the impact of each attribute and criterion on the purpose, process, product, and performance aspects of diverse systems are considered.

  2. Common cause failure and systems interactions issues - an overview

    International Nuclear Information System (INIS)

    Worledge, D.H.; Chu, B.B.; Conradi, L.L.; Smith, A.M.

    1985-01-01

    Common cause failures (CCFs) and systems interactions (SIs) are two concerns which have received significant attention over the years. Although many large and varied efforts have been directed toward these concerns, their resolution is less than satisfactory. Problems continue to exist, both in terms of understanding the basic issues represented by these concerns, and the perceived need for protection against their potentially harmful effects. This paper presents the results of recent EPRI work to provide a basis of understanding of these issues. Based on that improved understanding, a more appropriate way of defining and approaching the underlying technical questions is suggested. The current means of addressing the CCF and SI concerns are discussed and areas of additional activity needed to allow a more effective resolution are identified

  3. Acute hepatitis B caused by a vaccine-escape HBV strain in vaccinated subject: sequence analysis and therapeutic strategy.

    Science.gov (United States)

    Luongo, Monica; Critelli, Rosina; Grottola, Antonella; Gitto, Stefano; Bernabucci, Veronica; Bevini, Mirco; Vecchi, Chiara; Montagnani, Giuliano; Villa, Erica

    2015-01-01

    HBV vaccine contains the 'a' determinant region, the major immune-target of antibodies (anti-HBs). Failure of immunization may be caused by vaccine-induced or spontaneous 'a' determinant surface gene mutants. Here, we evaluate the possible lack of protection by HBV vaccine, describing the case of an acute hepatitis B diagnosed in a 55-year-old Caucasian male unpaid blood donor, vaccinated against HBV. Sequencing data for preS-S region revealed multiple point mutations. Of all the substitutions found, Q129H, located in the "a" determinant region of HBsAg, can alter antigenicity, leading to mutants. This mutant may cause vaccine failure especially when associated with high viremia of infecting source. Copyright © 2014 Elsevier B.V. All rights reserved.

  4. Wedged-shaped, segmental changes in the liver caused by occlusion of a single hepatic vein

    International Nuclear Information System (INIS)

    Kanazawa, Susumu; Akaki, Shiro; Yasui, Kotaro; Tanaka, Akio; Hiraki, Yoshio

    1997-01-01

    We evaluated wedged-shaped, segmental changes in the liver caused by occlusion of a single hepatic vein in seven patients. The causes of occlusion were due to liver tumors in three patients, metastasis of the right adrenal gland in one, and postoperative changes in three. Changes included low attenuating on unenhanced CT, high attenuation on enhanced CT, low signal intensity on T1-weighted MRI, high signal intensity on T2-weighted MRI, high signal intensity on enhanced MRI, dense hepatogram and retrograde arterioportal shunt on hepatic arteriography. MRI and hepatic arteriography are more sensitive than CT in demonstration of those changes. (author)

  5. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... Hemochromatosis Hepatic Encephalopathy Hepatitis A Hepatitis B Hepatitis C Intrahepatic Cholestasis of Pregnancy (ICP) Jaundice In Newborns ... are the common causes of cirrhosis? Hepatitis B & C Alcohol-related Liver Disease Non-alcoholic Fatty Liver ...

  6. CSB-PGBD3 Mutations Cause Premature Ovarian Failure.

    Directory of Open Access Journals (Sweden)

    Yingying Qin

    2015-07-01

    Full Text Available Premature ovarian failure (POF is a rare, heterogeneous disorder characterized by cessation of menstruation occurring before the age of 40 years. Genetic etiology is responsible for perhaps 25% of cases, but most cases are sporadic and unexplained. In this study, through whole exome sequencing in a non-consanguineous family having four affected members with POF and Sanger sequencing in 432 sporadic cases, we identified three novel mutations in the fusion gene CSB-PGBD3. Subsequently functional studies suggest that mutated CSB-PGBD3 fusion protein was impaired in response to DNA damage, as indicated by delayed or absent recruitment to damaged sites. Our data provide the first evidence that mutations in the CSB-PGBD3 fusion protein can cause human disease, even in the presence of functional CSB, thus potentially explaining conservation of the fusion protein for 43 My since marmoset. The localization of the CSB-PGBD3 fusion protein to UVA-induced nuclear DNA repair foci further suggests that the CSB-PGBD3 fusion protein, like many other proteins that can cause POF, modulates or participates in DNA repair.

  7. Causes and consequences of nonpersistence with heart failure medication.

    LENUS (Irish Health Repository)

    Mockler, Mary

    2012-02-01

    Persistence with therapy may be more easily and objectively identified in the clinical setting than compliance and recent work has shown it to be linked to mortality in heart failure (HF). The aim of this study was to determine the extent, causes, and clinical impact of nonpersistence with disease-modifying therapy in a retrospective cohort study of 183 patients with systolic HF participating in a disease management program. The main outcome measurements were reasons\\/determinants of nonpersistence and its impact on hospitalizations. Fifty-three patients (29%) had 74 separate occurrences of nonpersistence with disease-modifying therapy. There was no medical reason for discontinuing medications in 50% of occurrences, whereas medication was discontinued for an adverse reaction in 30% and for a justified medical reason in 15% of occurrences. Nonpersistence was a significant predictor of all-cause readmission (hazard ratio 3.20, 95% confidence interval 1.74 to 11.37) and cardiovascular readmission (hazard ratio 4.45, 95% confidence interval 1.74 to 11.37). In the adjusted model, there was no significantly increased risk of HF readmission (hazard ratio 2.41, 95% confidence interval 0.88 to 6.62). In conclusion, nonpersistence with HF therapy is common, is often not medically justified, and is associated with an increased risk of hospitalization.

  8. Fascioliasis-a rare cause of hepatic nodules.

    Science.gov (United States)

    Temido, Helena; Oliveira-Santos, Manuel; Parente, Francisco; Santos, Lèlita

    2017-05-31

    Fascioliasis is a zoonotic disease that can sometimes affect humans. It presents with non-specific signs and symptoms which makes it difficult to establish an early definitive diagnosis. This can be particularly true in non-endemic countries where a high degree of suspicion is needed to make the diagnosis. Another confounding factor is that many of the initial complains and findings are very similar to those of malignancy. We report a case of an otherwise healthy 47 year-old male presenting with abdominal pain, night-time sweating, anorexia, weight loss and loose stools that had several hepatic nodules visible in the abdominal CT scan. Although the initial hypothesis was hepatic malignancy or liver metastasis of unknown primary neoplasm, the workup performed led us to the correct diagnosis. He was treated successfully for hepatic fascioliasis, with a full recovery. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  9. Prognostic factors for patients with hepatitis B virus-related acute-on-chronic liver failure

    Directory of Open Access Journals (Sweden)

    LI Ying

    2017-03-01

    Full Text Available ObjectiveTo investigate the prognostic factors for patients with hepatitis B virus-related acute-on-chronic liver failure, and to provide a basis for clinical diagnosis and treatment. MethodsA total of 172 patients with hepatitis B virus (HBV-related acute-on-chronic liver failure who were admitted to The First Hospital of Jilin University from January 1, 2006 to January 1, 2016 and had complete medical records and follow-up data were enrolled, and a retrospective analysis was performed for their clinical data and laboratory markers to determine prognostic factors. The independent-samples t test was used for comparison of continuous data between groups, the chi-square test was used for comparison of categorical data between groups, and a multivariate logistic regression analysis was performed for the indices determined to be statistically significant by the univariate analysis to screen out independent risk factors for the prognosis of patients with HBV-related acute-on-chronic liver failure. ResultsThe multivariate logistic regression analysis was performed for the indices determined to be statistically significant by the univariate analysis, and the results showed that the prognostic factors were total bilirubin (TBil, prothrombin time activity (PTA, Na+, total cholesterol (TC, Child-Turcotte-Pugh (CTP score, age ≥50 years, the presence of liver cirrhosis, bilirubin-enzyme separation, and complications. The multivariate regression analysis was performed for the complications determined to affect prognosis by the univariate analysis, and the results showed that the complications as risk factors were hepatic encephalopathy, hepatorenal syndrome, and infection. ConclusionTBil, PTA, Na+, TC, CTP score, age ≥50 years, the presence of liver cirrhosis, bilirubin-enzyme separation, and complications are independent risk factors for the prognosis of patients with HBV-related acute-on-chronic liver failure. Liver failure patients with hepatic

  10. What caused the failures of the solenoid valve screws

    International Nuclear Information System (INIS)

    Vassallo, T.P.; Mumford, J.R.; Hossain, F.

    2001-01-01

    At Seabrook Station on May 5,1998 following a lengthy purge of the pressurizer steam space through Containment isolation sample valve 1-RC-FV-2830, the UL status light associated with this solenoid valve did not come on when the valve was closed from the plant's main control board. The UL status light is used to confirm valve closure position to satisfy the plant's Technical Specification requirements. The incorrect valve position indication on the main control board was initially believed to have resulted from excessive heat from a failed voltage control module that did not reduce the voltage to the valve's solenoid coil. This conclusion was based on a similar event that occurred in November of 1996. Follow-up in-plant testing of the valve determined that the voltage control module had not failed and was functioning satisfactorily. Subsequent investigations determined the root cause of the event to be excessive heat-up of the valve caused by high process fluid temperature and an excessively long purge of the pressurizer. The excessive heat-up of the valve from the high temperature process fluid weakened the magnetic field strength of the valve stem magnet to the extent that the UL status light reed switch would not actuate when the valve was closed. Since the voltage control module was tested and found to be functioning properly it was not replaced. Only the UL status light reed switch was replaced with a more sensitive reed that would respond better to a reduced magnetic field strength that results from a hot magnet. During reed switch replacement, three terminal block screws in the valve housing were found fractured and three other terminal block screws fractured during determination of the electrical conductors. This paper describes the initial plant event and ensuing laboratory tests and examinations that were performed to determine the root cause of the failure of the terminal block screws from the Containment isolation sample solenoid valve. (author)

  11. Amniotic-fluid-derived mesenchymal stem cells overexpressing interleukin-1 receptor antagonist improve fulminant hepatic failure.

    Directory of Open Access Journals (Sweden)

    Yu-Bao Zheng

    Full Text Available Uncontrolled hepatic immunoactivation is regarded as the primary pathological mechanism of fulminant hepatic failure (FHF. The major acute-phase mediators associated with FHF, including IL-1β, IL-6, and TNF-α, impair the regeneration of liver cells and stem cell grafts. Amniotic-fluid-derived mesenchymal stem cells (AF-MSCs have the capacity, under specific conditions, to differentiate into hepatocytes. Interleukin-1-receptor antagonist (IL-1Ra plays an anti-inflammatory and anti-apoptotic role in acute and chronic inflammation, and has been used in many experimental and clinical applications. In the present study, we implanted IL-1Ra-expressing AF-MSCs into injured liver via the portal vein, using D-galactosamine-induced FHF in a rat model. IL-1Ra expression, hepatic injury, liver regeneration, cytokines (IL-1β, IL-6, and animal survival were assessed after cell transplantation. Our results showed that AF-MSCs over-expressing IL-1Ra prevented liver failure and reduced mortality in rats with FHF. These animals also exhibited improved liver function and increased survival rates after injection with these cells. Using green fluorescent protein as a marker, we demonstrated that the engrafted cells and their progeny were incorporated into injured livers and produced albumin. This study suggests that AF-MSCs genetically modified to over-express IL-1Ra can be implanted into the injured liver to provide a novel therapeutic approach to the treatment of FHF.

  12. Acute Hepatitis and Pancytopenia in Healthy Infant with Adenovirus

    Directory of Open Access Journals (Sweden)

    Amr Matoq

    2016-01-01

    Full Text Available Adenoviruses are a common cause of respiratory infection, pharyngitis, and conjunctivitis in infants and young children. They are known to cause hepatitis and liver failure in immunocompromised patients; they are a rare cause of hepatitis in immunocompetent patients and have been known to cause fulminant hepatic failure. We present a 23-month-old immunocompetent infant who presented with acute noncholestatic hepatitis, hypoalbuminemia, generalized anasarca, and pancytopenia secondary to adenovirus infection.

  13. The infective causes of hepatitis and jaundice amongst hospitalised patients in Vientiane, Laos

    Science.gov (United States)

    Syhavong, Bounkong; Rasachack, Bouachanh; Smythe, Lee; Rolain, Jean-Marc; Roque-Afonso, Anne-Marie; Jenjaroen, Kemajittra; Soukkhaserm, Vimone; Phongmany, Simmaly; Phetsouvanh, Rattanaphone; Soukkhaserm, Sune; Thammavong, Te; Mayxay, Mayfong; Blacksell, Stuart D.; Barnes, Eleanor; Parola, Philippe; Dussaix, Elisabeth; Raoult, Didier; Humphreys, Isla; Klenerman, Paul; White, Nicholas J.; Newton, Paul N.

    2010-01-01

    Summary There is little information on the diverse infectious causes of jaundice and hepatitis in the Asiatic tropics. Serology (hepatitis A, B, C and E, leptospirosis, dengue, rickettsia), antigen tests (dengue), PCR assays (hepatitis A, C and E) and blood cultures (septicaemia) were performed on samples from 392 patients admitted with jaundice or raised transaminases (≥ × 3) to Mahosot Hospital, Vientiane, Laos over 3 years. Conservative definitions suggested diagnoses of dengue (8.4%), rickettsioses (7.3%), leptospirosis (6.8%), hepatitis B (4.9%), hepatitis C (4.9%), community-acquired septicaemia (3.3%) and hepatitis E (1.6%). Although anti-hepatitis A virus (HAV) IgM antibody results suggested that 35.8% of patients had acute HAV infections, anti-HAV IgG antibody avidity and HAV PCR suggested that 82% had polyclonal activation and not acute HAV infections. Scrub typhus, murine typhus or leptospirosis were present in 12.8% of patients and were associated with meningism and relatively low AST and ALT elevation. These patients would be expected to respond to empirical doxycycline therapy which, in the absence of virological diagnosis and treatment, may be an appropriate cost-effective intervention in Lao patients with jaundice/hepatitis. PMID:20378138

  14. Common cause failure: enhancing defenses against root cause and coupling factor

    Energy Technology Data Exchange (ETDEWEB)

    Kaushik, Poorva; Kim, Sok Chul [KINS, Daejeon (Korea, Republic of)

    2016-10-15

    A Common Cause Failure(CCF) event refers to a specific class of dependent events that result from co-existence of two main factors: Susceptibility of components to fail or become unavailable due to particular root cause of failure, and coupling factor coupling mechanism) that creates the condition for multiple components getting affected. PSA (Probabilistic Safety Assessment) operating experience of Nuclear Power Plants have demonstrated that dependent events such as CCF events are major contributor to risk during operation. From cost-benefit consideration, putting significant design modifications in place to prevent CCF would not be desirable in terms of risk management regulatory effectiveness and efficiency. The aim of this study was to propose feasible defenses against CCF from cost benefit consideration to enhance the safety. This study provides the CDM and CFDM of EDG. Defenses employed against cause and coupling factor can be easily employed in operation and maintenance programme of NPP and are not an additional cost burden. Such enhancement of defense against the CCF can give a modest improvement in CDF. This approach is specifically helpful in plants that are already under operation and significant modifications are not economically feasible.

  15. Percutaneous Liver Biopsy after Living Donor Liver Transplantation Resulting in Fulminant Hepatic Failure: The First Reported Case of Hepatic Compartment Syndrome

    Directory of Open Access Journals (Sweden)

    Nicholas N. Nissen

    2010-01-01

    Full Text Available A 28-year-old female who underwent live donor liver transplantation 3 years prior presented after percutaneous liver biopsy with abdominal and shoulder pain, nausea, vomiting, and elevated liver enzymes. Computed tomography (CT showed an intrahepatic and subcapsular hematoma. There was a progressive increase in liver enzymes, bilirubin, and INR and a decline in hemoglobin. Subsequent CT imaging revealed flattening of the portal vein consistent with compression by the enlarging hematoma. Liver failure ensued and the patient required urgent retransplantation. The explant demonstrated ischemic necrosis of greater than 90% of the liver parenchyma. We report this case of “Hepatic Compartment Syndrome” leading to fulminant hepatic failure.

  16. CCF-RBE common cause failure reliability benchmark exercise

    International Nuclear Information System (INIS)

    Poucet, A.; Amendola, A.; Cacciabue, P.C.

    1987-01-01

    This report summarizes results, obtained by the participants in the Reliability Benchmark Exercise on Common Cause Failures (CCF-RBE). The reference power plant of the CCF-RBE was the NPP at Grohnde (KWG): it is a 1300 MW PWR plant of KWU design and operated by the utility Preussen Elektra. The systems studied were the Start-up and Shut-down system (RR/RL) and the Emergency Feedwater System (RS) both systems that can feed water into the steam generators in the emergency power mode. The CCF-RBE was organized in two phases: 1. The first phase: during which all participants have performed an analysis on the complete system as defined by the assumed boundaries, i.e. the Start-up and Shut-down system (RR/RL) and the Emergency Feedwater System (RS). 2. The second phase: in which the scope was limited to the RS system. This limitation in scope was agreed upon in the discussion on the results of the first phase, which showed that, within the boundaries of the exercise, RR/RL and RS systems could be considered independent of each other. This report gives an overview of the works carried out, the results obtained and the conclusions and lessons that could be drawn from the CCF-RBE

  17. Regional cerebral blood flow during mechanical hyperventilation in patients with fulminant hepatic failure

    DEFF Research Database (Denmark)

    Strauss, Gitte Irene; Høgh, Peter; Møller, Kirsten

    1999-01-01

    Hyperventilation is frequently used to prevent or postpone the development of cerebral edema and intracranial hypertension in patients with fulminant hepatic failure (FHF). The influence of such therapy on regional cerebral blood flow (rCBF) remains, however, unknown. In this study the CBF......-distribution pattern was determined within the first 12 hours after development of hepatic encephalopathy (HE) stage 4 before and during hyperventilation. Ten consecutive patients (median age 48 [range 33-57] years) with FHF and 9 healthy controls (median age 54 [24-58] years) had rCBF determined by single photon...... emission computed tomography (SPECT) using intravenous injection of 133Xenon. For determination of high resolution CBF pattern, the patients were also studied with 99mTc-hexa-methylpropyleneamine oxime (HMPAO) in the hyperventilation condition. There was no significant difference in the rCBF distribution...

  18. Delayed Hepatic Adaptation to Weaning in ACBP(-/-) Mice Is Caused by Disruption of the Epidermal Barrier

    DEFF Research Database (Denmark)

    Neess, Ditte; Bek, Signe; Bloksgaard, Maria

    2013-01-01

    in the skin rather than in the liver. Similarly to ACBP(-/-) mice, K14-ACBP(-/-) mice exhibit an increased transepidermal water loss, and we show that the hepatic phenotype is caused specifically by the epidermal barrier defect, which leads to increased lipolysis in white adipose tissue. Our data demonstrate......We previously reported that mice deficient in acyl-CoA-binding protein (ACBP) display a delayed metabolic adaptation to weaning. This includes a delayed activation of the hepatic lipogenic gene program, which may result from hepatic accumulation of triacylglycerol and/or cholesteryl esters...... in the late suckling period. To further investigate the basis for this phenotype, we generated mice deficient in ACBP in hepatocytes (Alb-ACBP(-/-)) and keratinocytes (K14-ACBP(-/-)). Surprisingly, the delayed adaptation to weaning, including hepatic lipid accumulation, is caused by ACBP deficiency...

  19. Two sides of one coin: massive hepatic necrosis and progenitor cell-mediated regeneration in acute liver failure

    Directory of Open Access Journals (Sweden)

    Honglei eWeng

    2015-06-01

    Full Text Available Massive hepatic necrosis is a key event underlying acute liver failure, a serious clinical syndrome with high mortality. Massive hepatic necrosis in acute liver failure has unique pathophysiological characteristics including extremely rapid parenchymal cell death and removal. On the other hand, massive necrosis rapidly induces the activation of liver progenitor cells, the so-called second pathway of liver regeneration. The final clinical outcome of acute liver failure depends on whether liver progenitor cell-mediated regeneration can efficiently restore parenchymal mass and function within a short time. This review summarizes the current knowledge regarding massive hepatic necrosis and liver progenitor cell-mediated regeneration in patients with acute liver failure, the two sides of one coin.

  20. Two sides of one coin: massive hepatic necrosis and progenitor cell-mediated regeneration in acute liver failure.

    Science.gov (United States)

    Weng, Hong-Lei; Cai, Xiaobo; Yuan, Xiaodong; Liebe, Roman; Dooley, Steven; Li, Hai; Wang, Tai-Ling

    2015-01-01

    Massive hepatic necrosis is a key event underlying acute liver failure, a serious clinical syndrome with high mortality. Massive hepatic necrosis in acute liver failure has unique pathophysiological characteristics including extremely rapid parenchymal cell death and removal. On the other hand, massive necrosis rapidly induces the activation of liver progenitor cells, the so-called "second pathway of liver regeneration." The final clinical outcome of acute liver failure depends on whether liver progenitor cell-mediated regeneration can efficiently restore parenchymal mass and function within a short time. This review summarizes the current knowledge regarding massive hepatic necrosis and liver progenitor cell-mediated regeneration in patients with acute liver failure, the two sides of one coin.

  1. Taxonomy for Common-Cause Failure Vulnerability and Mitigation

    Energy Technology Data Exchange (ETDEWEB)

    Wood, Richard Thomas [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Korsah, Kofi [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Mullens, James Allen [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Pullum, Laura L. [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2015-09-01

    Applying current guidance and practices for common-cause failure (CCF) mitigation to digital instrumentation and control (I&C) systems has proven problematic, and the regulatory environment has been unpredictable. The potential for CCF vulnerability inhibits I&C modernization, thereby challenging the long-term sustainability of existing plants. For new plants and advanced reactor concepts, concern about CCF vulnerability in highly integrated digital I&C systems imposes a design burden that results in higher costs and increased complexity. The regulatory uncertainty in determining which mitigation strategies will be acceptable (e.g., what diversity is needed and how much is sufficient) drives designers to adopt complicated, costly solutions devised for existing plants. To address the conditions that constrain the transition to digital I&C technology by the US nuclear industry, crosscutting research is needed to resolve uncertainty, demonstrate necessary characteristics, and establish an objective basis for qualification of digital technology for nuclear power plant (NPP) I&C applications. To fulfill this research need, Oak Ridge National Laboratory is investigating mitigation of CCF vulnerability for nuclear-qualified applications. The outcome of this research is expected to contribute to a fundamentally sound, comprehensive basis to qualify digital technology for nuclear power applications. This report documents the development of a CCF taxonomy. The basis for the CCF taxonomy was generated by determining consistent terminology and establishing a classification approach. The terminology is based on definitions from standards, guides, and relevant nuclear power industry technical reports. The classification approach is derived from identified classification schemes focused on I&C systems and key characteristics, including failure modes. The CCF taxonomy provides the basis for a systematic organization of key systems aspects relevant to analyzing the potential for

  2. CHOLECYSTITIS AS A CAUSE OF ABDOMINAL PAIN IN PATIENTS WITH ACUTE VIRAL HEPATITIS A AND B

    Directory of Open Access Journals (Sweden)

    Miodrag Radunović

    2012-03-01

    Full Text Available Acute cholecystitis is an inflammation of the gallbladder wall, usually caused by gallstones in the cystic duct, which causes attacks of severe pain. At least 95% of the population with acute inflammation of the gallbladder have gallstones. Acute viral hepatitis is the liver inflammation accompanied by nausea, faintness, vomiting, pain below the right rib arch, jaundice. The presence of acute cholecystitis intensifies the existing symptoms. The aim of the paper was to show the incidence of the gallbladder inflammation in patients with acute hepatitis A or B. This retrospective-prospective study involved 110 patients treated for viral hepatitis A or B and had severe abdominal pain during hospitalization. The selected sample involved more male examinees - 63 (62% compared to female ones - 47 (38%. The most frequent age of examinees was 30-50 years, 82 (83%, and cholecystitis during hepatitis was also most common in the age group 30-50 years, 28 (73% patients. Cholecystitis was more common in patients with acute hepatitis B - 21 (55% examinees than in patients with acute hepatitis A - 17 (45% examinees. Ultrasound examination, performed in 24 (63% examinees showed gallstones in inflamed gallbladder, while 14 (37% examinees had the inflammation of the gallbladder without gallstones. The most common cause of severe abdominal pain in patients with acute liver infection caused by HAV and HBV infection was the gallbladder, 38 (34.5% patients. Cholecystitis was more common in patients with acute hepatitis B, 21 (55% examinees, than in those with an acute hepatitis A, 17 (45% examinees.

  3. Fuel element failures caused by iodine stress corrosion

    International Nuclear Information System (INIS)

    Videm, K.; Lunde, L.

    1976-01-01

    Sections of unirradiated cladding tubes were plugged in both ends by mechanical seals and internally pressurized with argon containing iodine. The time to failure and the strain at failure as a function of stress was determined for tubing with different heat treatments. Fully annealed tubes suffer cracking at the lowest stress but exhibit the largest strains at failure. Elementary iodine is not necessary for stress corrosion: small amounts of iodides of zirconium, iron and aluminium can also give cracking. Moisture, however, was found to act as an inhibitor. A deformation threshold exists below which stress corrosion failure does not occur regardless of the exposure time. This deformation limit is lower the harder the tube. The deformation at failure is dependent on the deformation rate and has a minimum at 0.1%/hr. At higher deformation rates the failure deformation increases, but only slightly for hard tubes. Fuel was over-power tested at ramp rates varying between 0.26 to 30 W/cm min. For one series of fuel pins the failure deformations of 0.8% at high ramp rates were in good agreement with predictions based on stress corrosion experiments. For another series of experiments the failure deformation was surprisingly low, about 0.2%. (author)

  4. Update on Common-Cause Failure Experience and Mitigation Practices

    Energy Technology Data Exchange (ETDEWEB)

    Wood, Richard Thomas [ORNL; Muhlheim, Michael David [ORNL; Pullum, Laura L [ORNL; Smith, Cyrus M [ORNL; Holcomb, David Eugene [ORNL; Korsah, Kofi [ORNL

    2014-04-01

    Experience in other industries has shown that digital technology can provide substantial benefits in terms of performance and reliability. However, the U.S. nuclear power industry has been slow to adopt the technology extensively in its instrumentation and control (I&C) applications because of inhibiting factors such as regulatory uncertainty, insufficient technological experience base, implementation complexity, limited availability of nuclear-qualified products and vendors, and inadequate definition of modernization cost recapture. Although there have been examples of digital technology usage in the nuclear power industry, challenges to the qualification of digital technology for high-integrity nuclear power plant (NPP) applications have severely constrained more widespread progress in achieving the benefits that are possible through the transition to digital. The U.S. Department of Energy (DOE) Office of Nuclear Energy (NE) established the Advanced Sensors and Instrumentation (ASI) technology area under the Nuclear Energy Enabling Technologies (NEET) Program to coordinate the instrumentation and controls (I&C) research across DOE NE and to identify and lead efforts to address common needs. As part of the NEET ASI research program, the Digital Technology Qualification project was established. Under this project, the Oak Ridge National Laboratory (ORNL) is leading the investigation into mitigation of digital common-cause failure (CCF) vulnerabilities for nuclear-qualified applications. This technical report documents updated and expanded findings from research activities by ORNL. Specifically, the report describes CCF experience in the nuclear and nonnuclear industries, identifies the state of the practice for CCF mitigation through key examples, and presents conclusions from the determination of knowledge gaps.

  5. A cause-defense approach to the understanding and analysis of common cause failures

    International Nuclear Information System (INIS)

    Paula, Henrique M.; Campbell, David J.; Parry, Gareth W.; Mitchell, Donald B.; Rasmuson, Dale M.

    1990-03-01

    For improved reliability and safety, nuclear power plants are designed with redundant safety systems, many of which also have redundant trains of equipment within the system. However, the very high reliability theoretically achievable through the use of redundancy is often compromised by single events that can individually render redundant components unavailable (common cause failure [CCF] events). As evidenced by the results of probabilistic risk assessments (PRAs) and by historical experience with nuclear power plant operations, CCF events are usually major contributors to the risk posed by nuclear power plant operation. Thus, it is important that PRAs recognize the potential for CCF events and realistically account for CCF contributions to system unavailability and plant risk. Much progress has been made over the years in the area of CCF analysis, including the development of both qualitative and quantitative analysis methods. Until now, however, CCF methodologies have not explicitly and systematically accounted for the impact of plant-specific defenses, such as design features and operational and maintenance policies, in place to reduce the likelihood of failure occurrences at nuclear power plants. Recognizing the importance of this issue, the NRC has funded a research effort that has focused on developing the cause-defense methodology for CCF analysis and prevention. This report presents the results of this research. Specifically, this report discusses the development of (1) procedures for identifying the potential for CCF events at individual nuclear power plants and (2) cause-defense matrices for analysis of CCF events. Also, new concepts and more precise definitions are introduced to enhance CCF terminology and interpretation of historical event data. (author)

  6. Galen's vein aneurysm as cause of heart failure

    International Nuclear Information System (INIS)

    Echeverria, Claudia; Cassalett, Gabriel; Franco, Jaime; Carrillo, Gustavo

    2005-01-01

    We present the case of a newborn admitted to the intensive care unit with a heart failure of difficult medical management. A large ductus arteriosus was found. It was surgically corrected, but the heart failure persisted and did not improve with medical treatment. Incidentally, a big Galen's vein aneurysm was found. Galen's vein aneurysm is a rare congenital pathology, originated by a fusion defect of the internal cerebral veins. Due to its low resistance, it produces a picture of high-output heart failure. Large defects may contain 50% to 60% of cardiac output. An aneurysm may be suspected in each newborn or infant with clinical picture of heart failure and right cardiac chamber dilation without any evidence of structural cardiac anomaly

  7. [Developmental radicular groove as a cause of endodontic failure].

    Science.gov (United States)

    Fabra Campos, H; Millet Part, J

    1989-01-01

    A clinical case of apical injury on an upper lateral incisor with endodontical and surgical failures in its treatment is presented. Extraction of the incisor and its study at the stereoscopic microscope showed the existence of a developmental groove running from the cingulum to the end of the root, establishing a communication between the crevice and the apical part of the tooth. Bacterial infection through the groove could provide an explanation for treatment failure.

  8. Rooting out causes in failure analysis; Risk analysis

    Energy Technology Data Exchange (ETDEWEB)

    Keith, Graeme

    2010-07-01

    The Deepwater Horizon disaster was a terrible reminder of the consequences of equipment failure on facilities operating in challenging environments. Thankfully catastrophes on the scale of the Deepwater Horizon are rare, but equipment failure is a daily occurrence on installations around the globe. The consequences range from short unexpected downtime, to a total stop on production. from a brief burst of flaring to lasting environmental damage and from the momentary discomfiture of a worker to incapability or death. (Author)

  9. Tumor induced hepatic myeloid derived suppressor cells can cause moderate liver damage.

    Directory of Open Access Journals (Sweden)

    Tobias Eggert

    Full Text Available Subcutaneous tumors induce the accumulation of myeloid derived suppressor cells (MDSC not only in blood and spleens, but also in livers of these animals. Unexpectedly, we observed a moderate increase in serum transaminases in mice with EL4 subcutaneous tumors, which prompted us to study the relationship of hepatic MDSC accumulation and liver injury. MDSC were the predominant immune cell population expanding in livers of all subcutaneous tumor models investigated (RIL175, B16, EL4, CT26 and BNL, while liver injury was only observed in EL4 and B16 tumor-bearing mice. Elimination of hepatic MDSC in EL4 tumor-bearing mice using low dose 5-fluorouracil (5-FU treatment reversed transaminase elevation and adoptive transfer of hepatic MDSC from B16 tumor-bearing mice caused transaminase elevation indicating a direct MDSC mediated effect. Surprisingly, hepatic MDSC from B16 tumor-bearing mice partially lost their damage-inducing potency when transferred into mice bearing non damage-inducing RIL175 tumors. Furthermore, MDSC expansion and MDSC-mediated liver injury further increased with growing tumor burden and was associated with different cytokines including GM-CSF, VEGF, interleukin-6, CCL2 and KC, depending on the tumor model used. In contrast to previous findings, which have implicated MDSC only in protection from T cell-mediated hepatitis, we show that tumor-induced hepatic MDSC themselves can cause moderate liver damage.

  10. Tumor induced hepatic myeloid derived suppressor cells can cause moderate liver damage.

    Science.gov (United States)

    Eggert, Tobias; Medina-Echeverz, José; Kapanadze, Tamar; Kruhlak, Michael J; Korangy, Firouzeh; Greten, Tim F

    2014-01-01

    Subcutaneous tumors induce the accumulation of myeloid derived suppressor cells (MDSC) not only in blood and spleens, but also in livers of these animals. Unexpectedly, we observed a moderate increase in serum transaminases in mice with EL4 subcutaneous tumors, which prompted us to study the relationship of hepatic MDSC accumulation and liver injury. MDSC were the predominant immune cell population expanding in livers of all subcutaneous tumor models investigated (RIL175, B16, EL4, CT26 and BNL), while liver injury was only observed in EL4 and B16 tumor-bearing mice. Elimination of hepatic MDSC in EL4 tumor-bearing mice using low dose 5-fluorouracil (5-FU) treatment reversed transaminase elevation and adoptive transfer of hepatic MDSC from B16 tumor-bearing mice caused transaminase elevation indicating a direct MDSC mediated effect. Surprisingly, hepatic MDSC from B16 tumor-bearing mice partially lost their damage-inducing potency when transferred into mice bearing non damage-inducing RIL175 tumors. Furthermore, MDSC expansion and MDSC-mediated liver injury further increased with growing tumor burden and was associated with different cytokines including GM-CSF, VEGF, interleukin-6, CCL2 and KC, depending on the tumor model used. In contrast to previous findings, which have implicated MDSC only in protection from T cell-mediated hepatitis, we show that tumor-induced hepatic MDSC themselves can cause moderate liver damage.

  11. Hepatitis

    Science.gov (United States)

    ... most common types of viral hepatitis. What Is Hepatitis A? For kids, hep A is the most common ... they recover, it does not come back. Can Hepatitis A Be Prevented? The following will help keep people ...

  12. Pill Properties that Cause Dysphagia and Treatment Failure

    Science.gov (United States)

    Fields, Jeremy; Go, Jorge T.; Schulze, Konrad S.

    2015-01-01

    Background Pills (tablets and capsules) are widely used to administer prescription drugs or to take supplements such as vitamins. Unfortunately, little is known about how much effort it takes Americans to swallow these various pills. More specifically, it is not known to what extent hard-to-swallow pills might affect treatment outcomes (eg, interfering with adherence to prescribed medications or causing clinical complications). It is also unclear which properties (eg, size, shape, or surface texture) Americans prefer or reject for their pills. To learn more about these issues, we interviewed a small group of individuals. Methods We invited individuals in waiting rooms of our tertiary health care center to participate in structured interviews about their pill-taking habits and any problems they have swallowing pills. We inquired which pill properties they believed caused swallowing problems. Participants scored capsules and pills of representative size, shape, and texture for swallowing effort and reported their personal preferences. Results Of 100 successive individuals, 99 participants completed the interview (65% women, mean age = 41 years, range = 23-77 years). Eighty-three percent took pills daily (mean 4 pills/d; 56% of those pills were prescribed by providers). Fifty-four percent of participants replied yes to the question, "Did you ever have to swallow a solid medication that was too difficult?" Four percent recounted serious complications: 1% pill esophagitis, 1% pill impaction, and 2% stopped treatments (antibiotic and prenatal supplement) because they could not swallow the prescribed pills. Half of all participants routinely resorted to special techniques (eg, plenty of liquids or repeated or forceful swallows). Sixty-one percent of those having difficulties cited specific pill properties: 27% blamed size (20% of problems were caused by pills that were too large whereas 7% complained about pills that were too small to sense); 12% faulted rough surface

  13. Giant cardiac fibroma: an unusual cause of failure to thrive.

    Science.gov (United States)

    Navarini, Susanne; Latzin, Philipp; Kadner, Alexander; Carrel, Thierry; Hutter, Damian

    2013-06-01

    Cardiac fibromas are extremely rare in the general pediatric population and may present with a wide spectrum of clinical signs, including life-threatening arrhythmias and sudden death. We report a 14-month-old boy who presented with failure to thrive as the only symptom. Echocardiography showed a large cardiac fibroma in the right ventricle. Cardiac magnetic resonance imaging confirmed the diagnosis. After complete surgical tumor resection, the boy showed normal catch-up growth. This case underlines the diversity of clinical features of cardiac tumors, which implies that they should be considered early in the differential diagnosis of infants with failure to thrive.

  14. Acute renal failure caused by Klebsiella pneumoniae pyelonephritis

    NARCIS (Netherlands)

    Creyghton, W. M.; Lobatto, S.; Weening, J. J.

    2001-01-01

    We report a 34-year-old male patient without prior medical history who presented with acute renal failure due to acute bacterial pyelonephritis. Both blood and urine cultures grew Klebsiella pneumoniae. Although a kidney biopsy revealed extensive necrosis and no viable glomeruli, renal function

  15. A Markov Model for Commen-Cause Failures

    DEFF Research Database (Denmark)

    Platz, Ole

    1984-01-01

    A continuous time four-state Markov chain is shown to cover several of the models that have been used for describing dependencies between failures of components in redundant systems. Among these are the models derived by Marshall and Olkin and by Freund and models for one-out-of-three and two...

  16. Small simple hepatic cysts causing obstructive jaundice: a case report of sclerotherapy

    International Nuclear Information System (INIS)

    Kim, Hyun Ji; Song, Soon Young; Koh, Byung Hee; Cho, On Koo; Kim, Yong Soo

    2007-01-01

    A 62-year-old man visited our hospital for a regular follow-up of a known liver cirrhosis. Laboratory tests revealed recently elevated total and direct bilirubin levels. Imaging studies showed two small hepatic cysts (2.7 and 2.9 cm in the largest diameter) compressing both central intrahepatic ducts, respectively. Obstructive jaundice caused by the cysts was diagnosed. Sclerotherapy of the cysts was performed with 100% ethanol after aspiration of the cyst contents. An follow-up CT obtained after 3 months showed decreased cyst size and improved bile duct dilatation. It is known that obstructive jaundice due to a hepatic cyst is rare, and the cysts were unusually large and centrally located. We report a case of obstructive jaundice caused by very small hepatic cysts that was successfully treated with sclerotherapy

  17. Small simple hepatic cysts causing obstructive jaundice: a case report of sclerotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Ji; Song, Soon Young; Koh, Byung Hee; Cho, On Koo [Hanyang University College of Medicine, Hanyang University Hospital, Seoul (Korea, Republic of); Kim, Yong Soo [Hanyang University Guri Hospital, Guri (Korea, Republic of)

    2007-10-15

    A 62-year-old man visited our hospital for a regular follow-up of a known liver cirrhosis. Laboratory tests revealed recently elevated total and direct bilirubin levels. Imaging studies showed two small hepatic cysts (2.7 and 2.9 cm in the largest diameter) compressing both central intrahepatic ducts, respectively. Obstructive jaundice caused by the cysts was diagnosed. Sclerotherapy of the cysts was performed with 100% ethanol after aspiration of the cyst contents. An follow-up CT obtained after 3 months showed decreased cyst size and improved bile duct dilatation. It is known that obstructive jaundice due to a hepatic cyst is rare, and the cysts were unusually large and centrally located. We report a case of obstructive jaundice caused by very small hepatic cysts that was successfully treated with sclerotherapy.

  18. Electrical failure during cardiopulmonary bypass: an evaluation of incidence, causes, management and guidelines for preventative measures.

    LENUS (Irish Health Repository)

    Hargrove, M

    2012-02-03

    The incidence of electrical failure during cardiopulmonary bypass (CPB) has been reported to occur in approximately 1 per 1000 cases. While the resultant morbidity and mortality is low, electrical failure is a life-threatening scenario. We report three major electrical failures during CPB in a patient population of 3500 over a 15-year period. These cases involved mains failure and generator shut down, mains failure and generator power surge, and failure of the uninterruptable power supply (UPS), which caused protected sockets to shut down. Protocols for preventative maintenance, necessary equipment, battery backup and guidelines for the successful management of such accidents during CPB are discussed.

  19. Exploitation of a component event data bank for common cause failure analysis

    International Nuclear Information System (INIS)

    Games, A.M.; Amendola, A.; Martin, P.

    1985-01-01

    Investigations into using the European Reliability Data System Component Event Data Bank for common cause failure analysis have been carried out. Starting from early exercises where data were analyzed without computer aid, different types of linked multiple failures have been identified. A classification system is proposed based on this experience. It defines a multiple failure event space wherein each category defines causal, modal, temporal and structural links between failures. It is shown that a search algorithm which incorporates the specific interrogative procedures of the data bank can be developed in conjunction with this classification system. It is concluded that the classification scheme and the search algorithm are useful organizational tools in the field of common cause failures studies. However, it is also suggested that the use of the term common cause failure should be avoided since it embodies to many different types of linked multiple failures

  20. Left atrial leiomyosarcoma as cause of heart failure

    International Nuclear Information System (INIS)

    Valdes Martin, Alexander

    2012-01-01

    The case of a 26 year-old patient with diagnosis of heart failure and presence of a mobile echogenic mass without calcification attached to the posterolateral area of the left atrium was reported. She underwent surgery and tissue examination evidenced a high-grade heart leiomyosarcoma. Postoperative course was satisfactory and her clinical state was rigorously monitored by oncology and heart specialists in the institution

  1. Analysis for the cause of the condensate pump bearing failure

    International Nuclear Information System (INIS)

    Cheng Yiyan

    2012-01-01

    This paper discussed the influence of the foreign matters for the rolling bearing's service life, analyzed the reason, way and harm of soft foreign matters disabling the bearings. And some measures were brought forward to improve the maintenance quality, which could be used for reference to enhance the ability of estimating the failure of the motor's rolling bearings, and to improve the level of the maintenance work. (author)

  2. Outcomes of Children With and Without Hepatic Encephalopathy From the Pediatric Acute Liver Failure Study Group.

    Science.gov (United States)

    Ng, Vicky L; Li, Ruosha; Loomes, Kathleen M; Leonis, Mike A; Rudnick, David A; Belle, Steven H; Squires, Robert H

    2016-09-01

    Hepatic encephalopathy (HE) is challenging to identify in children with acute liver failure and was not a requirement for enrollment into the Pediatric Acute Liver Failure Study Group (PALFSG). The outcomes of PALFSG participants presenting with and without HE are presented. PALFSG participants were classified based on daily assessment of HE during the first 7 days following study enrollment: group 1-never developed HE; group 2-no HE at enrollment with subsequent HE development; and group 3-HE at study enrollment. Clinical and biochemical parameters and outcomes of death, spontaneous recovery, or liver transplantation were compared between groups. Data from 769 PALFSG (54% boys; median age 4.2 years; range 0-17.9 years) participants were analyzed, with 277 in group 1 (36%), 83 in group 2 (11%), and 409 in group 3 (53%). Mortality occurred in 11% of all participants and was highest among group 3 participants who demonstrated persistent grade III-IV HE (55%) or showed progression of HE (26%). Eleven (4%) group 1 participants died within 21 days of enrollment. Spontaneous recovery was highest in group 1 (79%) and lowest in group 2 (25%; P liver failure prognostication schema are needed.

  3. 'NTA', a locally named unclear condition that causes failure to thrive ...

    African Journals Online (AJOL)

    'NTA', a locally named unclear condition that causes failure to thrive amongst under five children in southeastern Nigeria: An assessment of mothers' and caregivers' perception of its causes and management.

  4. Analysis Method of Common Cause Failure on Non-safety Digital Control System

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yun Goo; Oh, Eun Gse [KHNP, Daejeon (Korea, Republic of)

    2014-08-15

    The effects of common cause failure on safety digital instrumentation and control system had been considered in defense in depth analysis with safety analysis method. However, the effects of common cause failure on non-safety digital instrumentation and control system also should be evaluated. The common cause failure can be included in credible failure on the non-safety system. In the I and C architecture of nuclear power plant, many design feature has been applied for the functional integrity of control system. One of that is segmentation. Segmentation defenses the propagation of faults in the I and C architecture. Some of effects from common cause failure also can be limited by segmentation. Therefore, in this paper there are two type of failure mode, one is failures in one control group which is segmented, and the other is failures in multiple control group because that the segmentation cannot defense all effects from common cause failure. For each type, the worst failure scenario is needed to be determined, so the analysis method has been proposed in this paper. The evaluation can be qualitative when there is sufficient justification that the effects are bounded in previous safety analysis. When it is not bounded in previous safety analysis, additional analysis should be done with conservative assumptions method of previous safety analysis or best estimation method with realistic assumptions.

  5. Seismically induced common cause failures in PSA of nuclear power plants

    International Nuclear Information System (INIS)

    Ravindra, M.K.; Johnson, J.J.

    1991-01-01

    In this paper, a research project on the seismically induced common cause failures in nuclear power plants performed for Toshiba Corp. is described. The objective of this research was to develop the procedure for estimating the common cause failure probabilities of different nuclear power plant components using the combination of seismic experience data, the review of sources of dependency, sensitivity studies and engineering judgement. The research project consisted of three tasks: the investigation of damage instances in past earthquakes, the analysis of multiple failures and their root causes, and the development of the methodology for assessing seismically induced common cause failures. The details of these tasks are explained. In this paper, the works carried out in the third task are described. A methodology for treating common cause failures and the correlation between component failures is formulated; it highlights the modeling of event trees taking into account common cause failures and the development of fault trees considering the correlation between component failures. The overview of seismic PSA, the quantification methods for dependent failures and Latin Hypercube sampling method are described. (K.I.)

  6. Failure cause and failure rate evaluation on pumps of BWR plants in PSA. Hypothesis testing for typical or plant specific failure rate of pumps

    International Nuclear Information System (INIS)

    Sanada, Takahiro; Nakamura, Makoto

    2009-01-01

    In support of domestic nuclear industry effort to gather and analyze failure data of components concerning nuclear power plants, Nuclear Information Archives (NUCIA) are published for useful information to help PSA. This report focuses on NUCIA pertaining to pumps in domestic nuclear power plants, and provides the reliable estimation on failure rate of pumps resulting from failure cause analysis and hypothesis testing of classified and plant specific failure rate of pumps for improving quality in PSA. The classified and plant specific failure rate of pumps are estimated by analyzing individual domestic nuclear power plant's data of 26 Boiling Water Reactors (BWRs) concerning functionally structurally classified pump failures reported from beginning of commercial operation to March 31, 2007. (author)

  7. [Pseudohypoaldosteronisme type I: a rare cause of failure to thrive].

    Science.gov (United States)

    Derache, A-F; Rousseau, S; Holder-Espinasse, M; Bouquillon, S; Bresson, S; Ythier, H; Ganga-Zandzou, P-S

    2012-05-01

    We report on a boy, born on term, presenting with a weight loss and a persistent failure to thrive after 10 days despite a normal behavior under bottle-feeding. The clinical examination was normal and biological assessment revealed hyponatremia with hyponatriuria, normal kaliemia and elevated aldosterone values, leading to type I pseudohypoaldosteronism diagnosis. Treatment with salt supplementation allowed growth improvement. The diagnosis was confirmed by the identification of a mutation in the mineralocorticoid receptor. This change was also found in several family members. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  8. Yogi Detox Tea: A Potential Cause of Acute Liver Failure.

    Science.gov (United States)

    Kesavarapu, Keerthana; Kang, Mitchell; Shin, Jaewook James; Rothstein, Kenneth

    2017-01-01

    We present a case of acute fulminant liver failure from a liver detoxification tea. We present a 60-year-old female with weakness, lethargy, scleral icterus, jaundice, and worsening mental status. She drank herbal tea three times a day for 14 days prior to symptom development. Liver tests were elevated. Remaining laboratory tests and imaging were negative for other etiologies. An ultrasound-guided liver biopsy showed submassive necrosis. A literature search on the ingredients shows six ingredients as having hepatotoxic effects and remaining ingredients as having very sparse hepatoprotective data. Healthcare professionals should discuss herbal medication and tea use and report adverse effects.

  9. Yogi Detox Tea: A Potential Cause of Acute Liver Failure

    Directory of Open Access Journals (Sweden)

    Keerthana Kesavarapu

    2017-01-01

    Full Text Available We present a case of acute fulminant liver failure from a liver detoxification tea. We present a 60-year-old female with weakness, lethargy, scleral icterus, jaundice, and worsening mental status. She drank herbal tea three times a day for 14 days prior to symptom development. Liver tests were elevated. Remaining laboratory tests and imaging were negative for other etiologies. An ultrasound-guided liver biopsy showed submassive necrosis. A literature search on the ingredients shows six ingredients as having hepatotoxic effects and remaining ingredients as having very sparse hepatoprotective data. Healthcare professionals should discuss herbal medication and tea use and report adverse effects.

  10. Recurrent infective endocarditis causing heart valve failure: A case report

    Directory of Open Access Journals (Sweden)

    Victoria McIntyre, BASc Chemical Engineering (2018 candidate

    2017-11-01

    Full Text Available Infective endocarditis (IE is an infection that does not usually respond rapidly to treatment, often because its early symptoms are non-specific. The diseased valves (native or bioprosthetic may be calcified and the thrombotic vegetations on them typically friable and embolize easily. Left untreated IE leads to damage to the infected valve and to congestive heart failure (CHF. Its treatment usually requires heart valve replacement. Our 69-year-old patient had IE, and underwent aortic valve replacement (AVR with a bioprosthesis. This case stresses the complications of IE and its tendency to recur in patients with bioprosthetic heart valves (BHV who previously had IE.

  11. Pancreaticopleural Fistula Causing Massive Right Hydrothorax and Respiratory Failure

    Directory of Open Access Journals (Sweden)

    Esther Ern-Hwei Chan

    2016-01-01

    Full Text Available Hydrothorax secondary to a pancreaticopleural fistula (PPF is a rare complication of acute pancreatitis. In patients with a history of pancreatitis, diagnosis is made by detection of amylase in the pleural exudate. Imaging, particularly magnetic resonance cholangiopancreatography, aids in the detection of pancreatic ductal disruption. Management includes thoracocentesis and pancreatic duct drainage or pancreatic resection procedures. We present a case of massive right hydrothorax secondary to a PPF due to recurrent acute pancreatitis. Due to respiratory failure, urgent thoracocentesis was done. Distal pancreatectomy with splenectomy and cholecystectomy was performed. The patient remains well at one-year follow-up.

  12. Root Causes of Component Failures Program: Methods and applications

    International Nuclear Information System (INIS)

    Satterwhite, D.G.; Cadwallader, L.C.; Vesely, W.E.; Meale, B.M.

    1986-12-01

    This report contains information pertaining to definitions, methodologies, and applications of root cause analysis. Of specific interest, and highlighted throughout the discussion, are applications pertaining to current and future Nuclear Regulatory Commission (NRC) light water reactor safety programs. These applications are discussed in view of addressing specific program issues under NRC consideration and reflect current root cause analysis capabilities

  13. Thyroid storm complicated by fulminant hepatic failure: case report and literature review.

    Science.gov (United States)

    Hambleton, Catherine; Buell, Joseph; Saggi, Bob; Balart, Luis; Shores, Nathan J; Kandil, Emad

    2013-11-01

    Thyroid storm is a presentation of severe thyrotoxicosis that has a mortality rate of up to 20% to 30%. Fulminant hepatic failure (FHF) entails encephalopathy with severe coagulopathy in the setting of liver disease. It carries a high mortality rate, with an approximately 60% rate of overall survival for patients who undergo orthotopic liver transplantation (OLT). Fulminant hepatic failure is a rare but serious complication of thyroid storm. There have been only 6 previously reported cases of FHF with thyroid storm. We present a patient from our institution with thyroid storm and FHF. A literature review was performed to analyze the outcomes of the 6 additional cases of concomitant thyroid storm and FHF. Our patient underwent thyroidectomy followed by OLT. Her serum levels of thyroid-stimulating hormone, triiodothyronine, thyroxine, and transaminase normalized, and she was ready for discharge within 10 days of surgery. She has survived without complication. There is a 40% mortality rate for the reported patients treated medically with these conditions. Of the 7 total cases of reported FHF and thyroid storm, 2 patients died. Only 2 of the 7 patients underwent thyroidectomy and OLT--both at our institution. Both patients survived without complications. Thyroid storm and FHF each independently carry high mortality rates, and managing patients with both conditions simultaneously is an extraordinary challenge. These cases should compel clinicians to investigate liver function in hyperthyroid patients and to be wary of its rapid decline in patients who present in thyroid storm with symptoms of liver dysfunction. Patients with rapidly progressing thyroid storm and FHF should be considered for total thyroidectomy and OLT.

  14. Infection and microleakage the caused of endodontic failure

    Directory of Open Access Journals (Sweden)

    Kurniasri Amas Achiar

    2008-03-01

    Full Text Available The success of endodontic treatment depends on the quality of endodontic treatment and the final restoration. The mean reason for endodontic treatment failure is usually microleakage. That is why it becomes one of the priorities for dental research to prevent microleakage. Infection during the root canal treatment can be prevented. First, by employing strict aseptic clinical techniques follows by cleaning all bacteria and preoperative necrotic pulp-tissue remnants from the root canal. Irrigants are essential in this phase. The shaping of the canal is also an important prerequisite for endodontic success. Removal of the smear layer can enhance seal ability. Second, obturation of the root canal should leave the tooth in the most biological inert condition possible, and it must prevent reinfection as well as the growth of any microorganisms remaining in the canal. The application of an antibacterial dressing between appointments is absolutely necessary or the root canal has to be obturated at the first appointment in order to deprive the microorganisms of nutrients and space to multiply. The temporary filling must be at least 3.5 mm thick. Failure occurs because of missed canals, iatrogenic events and radicular fractures have to be avoided. At the end, clinicians have to confirm that the root canal is cleaned and hermetically obturated because hermetic root canal filling will prevent the leakage of an irritant to the apical area.

  15. Hepatic sinusoidal obstruction syndrome caused by herbal medicine: CT and MRI features

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Hua; Lou, Hai Yan [Dept. of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (China); Wang, Yi Xiang J. [Dept. of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (China); Xu, Xiao Jun; Zhang, Min Ming [Dept. of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou (China)

    2014-04-15

    To describe the CT and MRI features of hepatic sinusoidal obstruction syndrome (HSOS) caused by herbal medicine Gynura segetum. The CT and MRI features of 16 consecutive Gynura segetum induced HSOS cases (12 men, 4 women) were analyzed. Eight patients had CT; three patients had MRI, and the remaining five patients had both CT and MRI examinations. Based on their clinical presentations and outcomes, the patients were classified into three categories: mild, moderate, and severe. The severity of the disease was also evaluated radiologically based on the abnormal hepatic patchy enhancement in post-contrast CT or MRI images. Ascites, patchy liver enhancement, and main right hepatic vein narrowing or occlusion were present in all 16 cases. Hepatomegaly and gallbladder wall thickening were present in 14 cases (87.5%, 14/16). Periportal high intensity on T2-weighted images was present in 6 cases (75%, 6/8). Normal liver parenchymal enhancement surrounding the main hepatic vein forming a clover-like sign was observed in 4 cases (25%, 4/16). The extent of patchy liver enhancement was statistically associated with clinical severity classification (kappa = 0.565). Ascites, patchy liver enhancement, and the main hepatic veins narrowing were the most frequent signs of herbal medicine induced HSOS. The grade of abnormal patchy liver enhancement was associated with the clinical severity.

  16. Hepatic sinusoidal obstruction syndrome caused by herbal medicine: CT and MRI features

    International Nuclear Information System (INIS)

    Zhou, Hua; Lou, Hai Yan; Wang, Yi Xiang J.; Xu, Xiao Jun; Zhang, Min Ming

    2014-01-01

    To describe the CT and MRI features of hepatic sinusoidal obstruction syndrome (HSOS) caused by herbal medicine Gynura segetum. The CT and MRI features of 16 consecutive Gynura segetum induced HSOS cases (12 men, 4 women) were analyzed. Eight patients had CT; three patients had MRI, and the remaining five patients had both CT and MRI examinations. Based on their clinical presentations and outcomes, the patients were classified into three categories: mild, moderate, and severe. The severity of the disease was also evaluated radiologically based on the abnormal hepatic patchy enhancement in post-contrast CT or MRI images. Ascites, patchy liver enhancement, and main right hepatic vein narrowing or occlusion were present in all 16 cases. Hepatomegaly and gallbladder wall thickening were present in 14 cases (87.5%, 14/16). Periportal high intensity on T2-weighted images was present in 6 cases (75%, 6/8). Normal liver parenchymal enhancement surrounding the main hepatic vein forming a clover-like sign was observed in 4 cases (25%, 4/16). The extent of patchy liver enhancement was statistically associated with clinical severity classification (kappa = 0.565). Ascites, patchy liver enhancement, and the main hepatic veins narrowing were the most frequent signs of herbal medicine induced HSOS. The grade of abnormal patchy liver enhancement was associated with the clinical severity.

  17. Myopic loss aversion: Potential causes of replication failures

    Directory of Open Access Journals (Sweden)

    Alexander Klos

    2013-09-01

    Full Text Available This paper presents two studies on narrow bracketing and myopic loss aversion. The first study shows that the tendency to segregate multiple gambles is eliminated if subjects face a certainty equivalent or a probability equivalent task instead of a binary choice. The second study argues that the behavioral differences previously attributed entirely to myopic loss aversion are partly because long-term return properties are simply easier to grasp if the return information is already provided in the form of long-term returns rather than one-year returns. Both results may be related to recent failures to replicate myopic loss aversion. When the choice situation is structured in such a way that it draws respondents' attention to the final outcome distribution and/or if severe misestimations of long-term returns based on short-term return information are unlikely, behavioral differences consistent with myopic loss aversion are less likely to be observed.

  18. Hepatic Parasitic Abscess Caused by Clonorchiasis: Unusual CT Findings of Clonorchiasis

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Yun Jin; Byun, Jae Ho; Yoon, Seong Eon; Yu, Eun Sil [University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2007-02-15

    We report here on the CT findings of an unusual case of hepatic parasitic abscess that was caused by clonorchiasis; this malady mimicked cholangiocarcinoma, and there was no dilatation of the intrahepatic bile ducts. lonorchiasis is a snail-transmitted, parasitic disease of the bile ducts; this is caused by chronic infestation of liver flukes, Clonorchis sinensis, which reside mainly in the medium- and small-sized intrahepatic bile ducts. The CT, ultrasonograms and cholangiograms of clonorchiasis patients usually show diffuse, uniform, minimal or mild dilatation of the small intrahepatic bile ducts, particularly in the periphery, without dilatation of the extrahepatic bile duct. We report here on the CT findings of an unusual case of hepatic parasitic abscess caused by clonorchiasis; this malady mimicked cholangiocarcinoma, and there was no dilatation of the intrahepatic bile ducts.

  19. Hepatic Parasitic Abscess Caused by Clonorchiasis: Unusual CT Findings of Clonorchiasis

    International Nuclear Information System (INIS)

    Jang, Yun Jin; Byun, Jae Ho; Yoon, Seong Eon; Yu, Eun Sil

    2007-01-01

    We report here on the CT findings of an unusual case of hepatic parasitic abscess that was caused by clonorchiasis; this malady mimicked cholangiocarcinoma, and there was no dilatation of the intrahepatic bile ducts. lonorchiasis is a snail-transmitted, parasitic disease of the bile ducts; this is caused by chronic infestation of liver flukes, Clonorchis sinensis, which reside mainly in the medium- and small-sized intrahepatic bile ducts. The CT, ultrasonograms and cholangiograms of clonorchiasis patients usually show diffuse, uniform, minimal or mild dilatation of the small intrahepatic bile ducts, particularly in the periphery, without dilatation of the extrahepatic bile duct. We report here on the CT findings of an unusual case of hepatic parasitic abscess caused by clonorchiasis; this malady mimicked cholangiocarcinoma, and there was no dilatation of the intrahepatic bile ducts

  20. A hybrid of fuzzy FMEA-AHP to determine factors affecting alternator failure causes

    Directory of Open Access Journals (Sweden)

    Reza Kiani Aslani

    2014-09-01

    Full Text Available This paper presents a method to determine factors influencing alternator failure causes. Failure Mode and Effects Analysis (FMEA is one of the first systematic techniques for failure analysis based on three factors including Probability (P, Severity (S and Detection (D. Traditional FMEA method considers equal weights for all three factors, however, in read-world cases; one may wish to consider various weights. The proposed study develops a mathematical model to determine optimal weights based on analytical hierarchy process technique. The implementation of the proposed study has been demonstrated for a read-world case study of alternator failure causes.

  1. A multiple shock model for common cause failures using discrete Markov chain

    International Nuclear Information System (INIS)

    Chung, Dae Wook; Kang, Chang Soon

    1992-01-01

    The most widely used models in common cause analysis are (single) shock models such as the BFR, and the MFR. But, single shock model can not treat the individual common cause separately and has some irrational assumptions. Multiple shock model for common cause failures is developed using Markov chain theory. This model treats each common cause shock as separately and sequently occuring event to implicate the change in failure probability distribution due to each common cause shock. The final failure probability distribution is evaluated and compared with that from the BFR model. The results show that multiple shock model which minimizes the assumptions in the BFR model is more realistic and conservative than the BFR model. The further work for application is the estimations of parameters such as common cause shock rate and component failure probability given a shock,p, through the data analysis

  2. Pattern approach to MR imaging in patients with end-stage hepatic failure: a proposal for a new disease entity 'hepatic encephalopathy continuum'

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ho Kyun [Catholic University of Daegu, Department of Radiology, School of Medicine, Daegu (Korea); Lee, Hui Joong; Lee, Wonho; Kim, Yong Sun [Kyungpook National University Hospital, Department of Radiology, Daegu (Korea); Jang, Han Won [Yeungnam University College of Medicine, Department of Radiology, Daegu (Korea); Byun, Kyung Hwan [Pochon CHA University, Department of Radiology, School of Medicine, Kumi CHA Hospital, Kumi (Korea)

    2008-08-15

    The purpose of this study was to evaluate the clinical features and the characteristics of MR images of patients with end-stage hepatic failure. We reviewed the MR findings and clinical features of 31 consecutive patients (20 men, 11 women=31, mean age 58.7 years) who had been diagnosed with clinical hepatic encephalopathy. Associations between the lesion locations on each MR sequence were analyzed using a binominal test. The clinical and MR findings were compared in relation to the etiology and clinical status. The most frequently involved site, seen as high signal intensity on T2-W images, was the corpus callosum (20 patients), followed by the dentate nucleus (16 patients) and the globus pallidus (13 patients). Significant associations were seen between the pallidus and the crus cerebri, between the crus cerebri and the red nucleus, between the crus cerebri and the dentate nucleus, and between the red nucleus and the dentate nucleus on the T2-W and DW images (P<0.004). The crus cerebri, red nucleus, and dentate nucleus were involved concurrently with the corpus callosum more frequently in hepatic encephalopathy grades 3 and 4. Concurrent involvement of the globus pallidus-crus cerebri-red nucleus-dentate nucleus axis was the main MR pattern in end-stage hepatic encephalopathy, which connected with various areas of the brain. We hypothesize that these overlapping MR features could be regarded as an entity denoted as the 'hepatic encephalopathy continuum'. (orig.)

  3. Pattern approach to MR imaging in patients with end-stage hepatic failure: a proposal for a new disease entity ''hepatic encephalopathy continuum''

    International Nuclear Information System (INIS)

    Kim, Ho Kyun; Lee, Hui Joong; Lee, Wonho; Kim, Yong Sun; Jang, Han Won; Byun, Kyung Hwan

    2008-01-01

    The purpose of this study was to evaluate the clinical features and the characteristics of MR images of patients with end-stage hepatic failure. We reviewed the MR findings and clinical features of 31 consecutive patients (20 men, 11 women=31, mean age 58.7 years) who had been diagnosed with clinical hepatic encephalopathy. Associations between the lesion locations on each MR sequence were analyzed using a binominal test. The clinical and MR findings were compared in relation to the etiology and clinical status. The most frequently involved site, seen as high signal intensity on T2-W images, was the corpus callosum (20 patients), followed by the dentate nucleus (16 patients) and the globus pallidus (13 patients). Significant associations were seen between the pallidus and the crus cerebri, between the crus cerebri and the red nucleus, between the crus cerebri and the dentate nucleus, and between the red nucleus and the dentate nucleus on the T2-W and DW images (P<0.004). The crus cerebri, red nucleus, and dentate nucleus were involved concurrently with the corpus callosum more frequently in hepatic encephalopathy grades 3 and 4. Concurrent involvement of the globus pallidus-crus cerebri-red nucleus-dentate nucleus axis was the main MR pattern in end-stage hepatic encephalopathy, which connected with various areas of the brain. We hypothesize that these overlapping MR features could be regarded as an entity denoted as the ''hepatic encephalopathy continuum''. (orig.)

  4. miRNA signatures can predict acute liver failure in hepatitis E infected pregnant females

    Directory of Open Access Journals (Sweden)

    Nirupma Trehanpati

    2017-04-01

    Full Text Available Background: Acute viral hepatitis E (AVH-E can often result in acute liver failure (ALF during pregnancy. microRNAs serve as mediators in drug induced liver failure. We investigated their role as a biomarker in predicting ALF due to HEV (ALF-E. Methods: We performed next generation sequencing and subsequent validation studies in PBMCs of pregnant (P self limiting AVH-E, ALF due to HEV (ALF-E and compared with AVH-E in non-pregnant (NP females and healthy controls. Findings: Eleven microRNAs were significantly expressed in response to HEV infection; importantly, miR- 431, 654, 1468 and 4435, were distinctly expressed in pregnant self-limiting AVH-E and healthy females (p = 0.0005, but not in ALF-E. Sixteen exclusive microRNAs differentiated ALF-E from self limiting AVH-E in pregnant females. miR-450b which affects cellular proliferation and metabolic processes through RNF20 and SECB was predominanlty upregulated and correlated with poor outcome (ROC 0.958, p = 0.001. Interpretation: Our results reveal that a specific microRNA profile can predict fatality in ALF-E in pregnancy. These microRNAs could be exploited as prognostic biomarkers and help in the development of new therapeutic interventions. Keywords: Health sciences, Virology

  5. Lipopolysaccharide precipitates hepatic encephalopathy and increases blood-brain barrier permeability in mice with acute liver failure.

    Science.gov (United States)

    Chastre, Anne; Bélanger, Mireille; Nguyen, Bich N; Butterworth, Roger F

    2014-03-01

    Acute liver failure (ALF) is frequently complicated by infection leading to precipitation of central nervous system complications such as hepatic encephalopathy (HE) and increased mortality. There is evidence to suggest that when infection occurs in ALF patients, the resulting pro-inflammatory mechanisms may be amplified that could, in turn, have a major impact on blood-brain barrier (BBB) function. The aim of this study was to investigate the role of endotoxemia on the progression of encephalopathy in relation to BBB permeability during ALF. Adult male C57-BL6 mice with ALF resulting from azoxymethane-induced toxic liver injury were administered trace amounts of the endotoxin component lipopolysaccharide (LPS). Effects on the magnitude of the systemic inflammatory response, liver pathology and BBB integrity were measured as a function of progression of HE, defined as time to loss of corneal reflex (coma). Lipopolysaccharide caused additional two- to seven-fold (P liver pathology and associated increases of circulating transaminases as well as increased hyperammonaemia consistent with a further loss of viable hepatocytes. LPS treatment of ALF mice led to a rapid precipitation of hepatic coma and the BBB became permeable to the 25-kDa protein immunoglobulin G (IgG). This extravasation of IgG was accompanied by ignificant up-regulation of matrix metalloproteinase-9 (MMP-9), an endopeptidase known to modulate opening of the BBB in a wide range of neurological disorders. These findings represent the first direct evidence of inflammation-related BBB permeability changes in ALF. © 2013 John Wiley & Sons A/S. Publishing by John Wiley & Sons Ltd.

  6. Diencephalic syndrome: a rare cause of failure to thrive.

    Science.gov (United States)

    Tosur, Mustafa; Tomsa, Anca; Paul, David L

    2017-07-06

    Timely diagnosis of diencephalic syndrome is not often the case for patients presenting with failure to thrive (FTT) because of its rarity and lack of specific symptoms. Herein, we report two cases of diencephalic syndrome (2-year-old girl and 10-month-old boy) presenting with severe emaciation. Both patients had histories of poor weight gain for months despite having good appetites prior to diagnosis. Initial work-up did not reveal the diagnosis. Horizontal nystagmus was noted in both patients: by a neurologist in the first patient and by a family member in the second patient. MRI of the brain showed large suprasellar mass and pilocytic astrocytoma was confirmed by pathology in each case. The patients were started on appropriate chemotherapy with interval improvements in weight gain. These cases illustrate the importance of cranial imaging and consideration of diencephalic syndrome for children presenting with FTT despite normal or increased caloric intake. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Estimation of common cause failure parameters with periodic tests

    Energy Technology Data Exchange (ETDEWEB)

    Barros, Anne [Institut Charles Delaunay - Universite de technologie de Troyes - FRE CNRS 2848, 12, rue Marie Curie - BP 2060 -10010 Troyes cedex (France)], E-mail: anne.barros@utt.fr; Grall, Antoine [Institut Charles Delaunay - Universite de technologie de Troyes - FRE CNRS 2848, 12, rue Marie Curie - BP 2060 -10010 Troyes cedex (France); Vasseur, Dominique [Electricite de France, EDF R and D - Industrial Risk Management Department 1, av. du General de Gaulle- 92141 Clamart (France)

    2009-04-15

    In the specific case of safety systems, CCF parameters estimators for standby components depend on the periodic test schemes. Classically, the testing schemes are either staggered (alternation of tests on redundant components) or non-staggered (all components are tested at the same time). In reality, periodic tests schemes performed on safety components are more complex and combine staggered tests, when the plant is in operation, to non-staggered tests during maintenance and refueling outage periods of the installation. Moreover, the CCF parameters estimators described in the US literature are derived in a consistent way with US Technical Specifications constraints that do not apply on the French Nuclear Power Plants for staggered tests on standby components. Given these issues, the evaluation of CCF parameters from the operating feedback data available within EDF implies the development of methodologies that integrate the testing schemes specificities. This paper aims to formally propose a solution for the estimation of CCF parameters given two distinct difficulties respectively related to a mixed testing scheme and to the consistency with EDF's specific practices inducing systematic non-simultaneity of the observed failures in a staggered testing scheme.

  8. Fuel failure in water reactors: Causes and mitigation. Proceedings of a technical meeting

    International Nuclear Information System (INIS)

    2003-03-01

    The objective of this technical meeting (TM) was to review the present knowledge of the causes and mechanisms of fuel failure in water reactors during normal operational conditions. Emphasis has been given to analysis of failure causes and their mitigation by means of design as well as plant and core operation including strategies for operation with failed fuel. Some information on detection techniques (on-line monitoring and diagnostics, flux tilting, sipping techniques, etc) has also been presented. This TM presented also the progress on the above-mentioned subjects since the last meeting held in 1992 (Dimitrovgrad, Russian Federation). The topics covered in the papers were as follows: Experience feedback on fuel reliability (8 papers); Strategies to avoid or mitigate fuel failures (4 papers); Experimental studies on fuel failures and degradation mechanisms (4 papers); Modelling of fuel failure mechanisms (3 papers); Detection and monitoring during operation or outage (4 papers); Modelling and assessment of fuel failures (3 papers)

  9. Procedures for treating common cause failures in safety and reliability studies: Procedural framework and examples

    International Nuclear Information System (INIS)

    Mosleh, A.; Fleming, K.N.; Parry, G.W.; Paula, H.M.; Worledge, D.H.; Rasmuson, D.M.

    1988-01-01

    This report presents a framework for the inclusion of the impact of common cause failures in risk and reliability evaluations. Common cause failures are defined as that cutset of dependent failures for which causes are not explicitly included in the logic model as basic events. The emphasis here is on providing procedures for a practical, systematic approach that can be used to perform and clearly document the analysis. The framework comprises four major stages: (1) System Logic Model Development; (2) Identification of Common Cause Component Groups; (3) Common Cause Modeling and Data Analysis; and (4) System Quantification and Interpretation of Results. The framework and the methods discussed for performing the different stages of the analysis integrate insights obtained from engineering assessments of the system and the historical evidence from multiple failure events into a systematic, reproducible, and defensible analysis. 22 figs., 34 tabs

  10. Symptoms and causes : gender effects and institutional failures.

    OpenAIRE

    Hashimzade, N.; Vershinina, N.

    2017-01-01

    The existence and causes of gender gaps in pay and in occupational choice have been increasingly at the centre of research in economics, sociology, psychology, managerial science, and other fields. The research findings across countries and over time generally suggest that gaps exist and are significant, indicating that gender inequality remains persistent in many areas, even in the developed Western democracies. Forcefully closing the gaps directly, however, may not be sufficient in the long...

  11. [Changes in serotonin and noradrenaline in hepatic encephalopathy as a result of liver failure in rat].

    Science.gov (United States)

    Song, Min-ning; Song, Yu-na; Chen, Fu; Luo, Mei-lan

    2007-01-01

    To investigate the changes in serotonin (5-HT) and noradrenaline (NA) in hepatic encephalopathy as a result of acute and chronic liver failure in rat. One hundred and ten Sprague-Dawley (SD) rats were randomly divided into groups of normal control (n=20), experimental group of acute liver failure (ALF) encephalopathy (n=45), and experimental group of chronic liver failure (CLF) encephalopathy (n=45). Two dosages of thioacetamide (TAA) of 500 mg/kg were gavaged with an interval of 24 hours to reproduce ALF model. To reproduce CLF model rats were fed with 0.03% TAA in drinking water for 10 weeks, and 50% of TAA dosage was added or withheld according to the change in weekly body weight measurement. Animals were sacrificed and venous blood specimens were obtained after successful replication of model, and 5-HT, NA, ammonia, parameters of liver function were determined, and liver and brain were studied pathologically. The experiment showed that the liver functions of rats in groups ALF encephalopathy and CLF encephalopathy deteriorated seriously, changes in alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), albumen (ALB), ALB/globulin (A/G), and blood ammonia were observed(Pliver and brain pathologies were identical to those of ALF and CLF encephalopathy. The values of 5-HT were increased in groups ALF encephalopathy and CLF encephalopathy [(16.06+/-1.08) micromol/L and (15.32+/-1.48) micromol/L] compared with the normal group [(2.75+/-0.26) micromol/L, both Pencephalopathy [(94.0+/-2.13) pmol/L vs.(121.2+/-14.8) pmol/L,Pencephalopathy and CLF encephalopathy. The content of NA decreases remarkably in CLF encephalopathy.

  12. (m, M) Machining system with two unreliable servers, mixed spares and common-cause failure

    OpenAIRE

    Jain, Madhu; Mittal, Ragini; Kumari, Rekha

    2015-01-01

    This paper deals with multi-component machine repair model having provision of warm standby units and repair facility consisting of two heterogeneous servers (primary and secondary) to provide repair to the failed units. The failure of operating and standby units may occur individually or due to some common cause. The primary server may fail partially following full failure whereas secondary server faces complete failure only. The life times of servers and operating/standby units and their re...

  13. Branched Chain Amino Acids Cause Liver Injury in Obese/Diabetic Mice by Promoting Adipocyte Lipolysis and Inhibiting Hepatic Autophagy.

    Science.gov (United States)

    Zhang, Fuyang; Zhao, Shihao; Yan, Wenjun; Xia, Yunlong; Chen, Xiyao; Wang, Wei; Zhang, Jinglong; Gao, Chao; Peng, Cheng; Yan, Feng; Zhao, Huishou; Lian, Kun; Lee, Yan; Zhang, Ling; Lau, Wayne Bond; Ma, Xinliang; Tao, Ling

    2016-11-01

    The Western meat-rich diet is both high in protein and fat. Although the hazardous effect of a high fat diet (HFD) upon liver structure and function is well recognized, whether the co-presence of high protein intake contributes to, or protects against, HF-induced hepatic injury remains unclear. Increased intake of branched chain amino acids (BCAA, essential amino acids compromising 20% of total protein intake) reduces body weight. However, elevated circulating BCAA is associated with non-alcoholic fatty liver disease and injury. The mechanisms responsible for this quandary remain unknown; the role of BCAA in HF-induced liver injury is unclear. Utilizing HFD or HFD+BCAA models, we demonstrated BCAA supplementation attenuated HFD-induced weight gain, decreased fat mass, activated mammalian target of rapamycin (mTOR), inhibited hepatic lipogenic enzymes, and reduced hepatic triglyceride content. However, BCAA caused significant hepatic damage in HFD mice, evidenced by exacerbated hepatic oxidative stress, increased hepatic apoptosis, and elevated circulation hepatic enzymes. Compared to solely HFD-fed animals, plasma levels of free fatty acids (FFA) in the HFD+BCAA group are significantly further increased, due largely to AMPKα2-mediated adipocyte lipolysis. Lipolysis inhibition normalized plasma FFA levels, and improved insulin sensitivity. Surprisingly, blocking lipolysis failed to abolish BCAA-induced liver injury. Mechanistically, hepatic mTOR activation by BCAA inhibited lipid-induced hepatic autophagy, increased hepatic apoptosis, blocked hepatic FFA/triglyceride conversion, and increased hepatocyte susceptibility to FFA-mediated lipotoxicity. These data demonstrated that BCAA reduces HFD-induced body weight, at the expense of abnormal lipolysis and hyperlipidemia, causing hepatic lipotoxicity. Furthermore, BCAA directly exacerbate hepatic lipotoxicity by reducing lipogenesis and inhibiting autophagy in the hepatocyte. Copyright © 2016. Published by Elsevier

  14. Branched Chain Amino Acids Cause Liver Injury in Obese/Diabetic Mice by Promoting Adipocyte Lipolysis and Inhibiting Hepatic Autophagy

    Directory of Open Access Journals (Sweden)

    Fuyang Zhang

    2016-11-01

    Full Text Available The Western meat-rich diet is both high in protein and fat. Although the hazardous effect of a high fat diet (HFD upon liver structure and function is well recognized, whether the co-presence of high protein intake contributes to, or protects against, HF-induced hepatic injury remains unclear. Increased intake of branched chain amino acids (BCAA, essential amino acids compromising 20% of total protein intake reduces body weight. However, elevated circulating BCAA is associated with non-alcoholic fatty liver disease and injury. The mechanisms responsible for this quandary remain unknown; the role of BCAA in HF-induced liver injury is unclear. Utilizing HFD or HFD + BCAA models, we demonstrated BCAA supplementation attenuated HFD-induced weight gain, decreased fat mass, activated mammalian target of rapamycin (mTOR, inhibited hepatic lipogenic enzymes, and reduced hepatic triglyceride content. However, BCAA caused significant hepatic damage in HFD mice, evidenced by exacerbated hepatic oxidative stress, increased hepatic apoptosis, and elevated circulation hepatic enzymes. Compared to solely HFD-fed animals, plasma levels of free fatty acids (FFA in the HFD + BCAA group are significantly further increased, due largely to AMPKα2-mediated adipocyte lipolysis. Lipolysis inhibition normalized plasma FFA levels, and improved insulin sensitivity. Surprisingly, blocking lipolysis failed to abolish BCAA-induced liver injury. Mechanistically, hepatic mTOR activation by BCAA inhibited lipid-induced hepatic autophagy, increased hepatic apoptosis, blocked hepatic FFA/triglyceride conversion, and increased hepatocyte susceptibility to FFA-mediated lipotoxicity. These data demonstrated that BCAA reduces HFD-induced body weight, at the expense of abnormal lipolysis and hyperlipidemia, causing hepatic lipotoxicity. Furthermore, BCAA directly exacerbate hepatic lipotoxicity by reducing lipogenesis and inhibiting autophagy in the hepatocyte.

  15. Star fruit (Averrhoa carambola) intoxication: an important cause of consciousness disturbance in patients with renal failure.

    Science.gov (United States)

    Chang, Chin-Tung; Chen, Yung-Chang; Fang, Ji-Tseng; Huang, Chiu-Ching

    2002-05-01

    Star fruit intoxication is a rare cause of consciousness disturbance in patients with renal failure. Most cases in the literature are uremic patients on maintenance dialysis. We present a patient with chronic renal failure, who was not on dialysis program yet, suffered from star fruit intoxication with presentation of consciousness disturbance and successfully managed by a session of hemodialysis.

  16. Multiple stable isotope tracer technique for studying the metabolic kinetics of amino acids in hepatic failure

    Energy Technology Data Exchange (ETDEWEB)

    Zongqin, Xia; Tengchang, Dai; Jianhua, Zhang; Yaer, Hu; Bingyao, Yu; Xingrong, Xu; Guanlu, Huang; Gengrong, Shen; Yaqiu, Zhou; Hong, Yu

    1987-08-01

    In order to study the mechanism of the imbalance of amino acid metabolism during hepatic failure, a stable isotope tracer method for observing simultaneously the metabolic kinetics of several amino acids has been established. /sup 15/N-L-Ala, (2,3-D/sub 3/)-Leu and (2,3-D/sub 3/)-Phe were chosen as nonessential, branched chain and aromatic amino acids. A single iv injection of 40 mg N-Ala, 20 mg deuterated Leu and 20 mg deuterated Phe was given to each human subject. Blood samples were taken just before and at different times (up to 60 min) after the injection. Total free amino acids were isolated from the plasma with a small dowex 50 x 8 column and converted to trifluoroacetyl derivatives. Their abundances were then analyzed with a GC-MS system and typical double exponential time course curves were found for all the three labelled amino acids. A two-pool model was designed and applied for compartmental analysis. Significant changes were found in the kinetic parameters of Phe and Leu in patients with fulminant hepatitis or heptic cirrhosis. The half-lives of both Phe pools were longer and the pool sizes were larger than normal subjects, while the half-lives and pool sizes of Leu changes in the opposite direction. No marked change was found in Ala. The significance of intracellular imbalance of Phe and Leu metabolism was discussed. It is evident that the combination of GCMS technique and multiple-tracers labelled with stable isotopes is of great potential for similar purposes.

  17. The Major Causes for the Failure of Knowledge Management

    International Nuclear Information System (INIS)

    Prusak, L.

    2016-01-01

    Full text: It is a well-known but disheartening fact that many knowledge management projects either fail outright or do not live up to the expected promises of working with knowledge. Some of the causes of these failed attempts are easy to understand: Macroeconomic changes that can constrain an organization’s new project funding; change of ownership or senior management with new ideas and disdain of older projects, and several other forces out of the control of KM managers. However in my experience there are other sources for these failed attempts that are not too difficult to avoid and can make a huge difference in the sustainability and value of knowledge and learning projects. This talk will focus on these—fully aware that there are other disarming factors at work. (author

  18. The effect of plasma exchange on entecavir-treated chronic hepatitis B patients with hepatic de-compensation and acute-on-chronic liver failure.

    Science.gov (United States)

    Yue-Meng, Wan; Yang, Li-Hong; Yang, Jin-Hui; Xu, Ying; Yang, Jing; Song, Gui-Bo

    2016-05-01

    Various studies showed that entecavir (ETV) failed to improve the short-term survival in chronic hepatitis B (CHB) patients with severe acute exacerbation (SAE) and hepatic de-compensation or acute-on-chronic liver failure (ACLF). One study concluded that plasma exchange (PE) significantly decreased the short-term mortality of CHB patients with ACLF who were treated with lamivudine (LAM). Our study was designed to examine the effect of PE on CHB patients with ACLF who were treated with ETV. From August 2010 to January 2015, 38 (PE group) and 120 (control group) consecutive CHB-naïve patients with hepatic de-compensation and ACLF treated with PE plus ETV and ETV, respectively, were recruited. The primary endpoint was liver-related mortality at week 12. Biochemical and virological responses were also studied. At baseline, the PE group had higher serum alanine aminotransferase (ALT) levels and model for end-stage liver disease (MELD) scores, and had lower albumin levels than the control group. The cumulative survival rate at week 4 and week 12 in the PE group and control group were, respectively, 37 and 18 %, and 29 and 14 % (p  0.05). Univariate analysis showed that the control group had a higher liver-related mortality (p = 0.038) at week 12 than the PE group. Multivariate analysis showed that hepatic encephalopathy, ascites, PE treatment, and MELD scores were independent factors for liver-related mortality at week 12. PE significantly improved the short-term survival of CHB patients with hepatic de-compensation and ACLF who were treated with ETV. Hepatic encephalopathy, ascites, PE treatment, and MELD scores were independent factors for liver-related mortality at week 12.

  19. DRESS syndrome secondary to ibuprofen as a cause of hyperacute liver failure

    Directory of Open Access Journals (Sweden)

    Valentín Roales-Gómez

    2014-08-01

    Full Text Available Acute liver failure has a high mortality and its most frequent cause in Spain is viral infection. In this article, we present a case of fulminant liver failure. The failure is secondary to an idiosyncratic reaction to ibuprofen, an entity included in the DRESS syndrome. This syndrome plays a key role in the differential diagnosis of acute liver failure, since its unfortunate course often requires liver transplantation as the only useful therapeutic weapon. This case illustrates the need for an efficient coordination between hospitals as a key factor for improving the prognosis.

  20. Failures in outdoor insulation caused by bird excrement

    Energy Technology Data Exchange (ETDEWEB)

    Montoya Tena, Gerardo; Hernandez C., Ramiro [Instituto de Investigaciones Electricas, Reforma 113, Col. Palmira, C.P. 62490 Cuernavaca, Mor. (Mexico); Montoya T., Jorge I. [Universidad Politecnica del Valle de Toluca, Toluca Edomex (Mexico)

    2010-06-15

    The bird excrement, combined with humidity, causes line outages in transmission lines. In order to standardize the criteria to solve the problem, a research project was developed in Mexico. The solutions found in worldwide review can be classified into four groups: elimination of birds, devices of dissuasion, physical barriers, and covering devices. The first group includes all bird elimination techniques. These alternatives are forbidden in Mexico, and in most of the countries. The second group has shown to be effective at the beginning of its application; however once the birds are habituated to the device, it loses its effectiveness. The efficiency of the third group, the use of physical barriers, is high, as demonstrated by more than a few review reports informing drastic reductions of flashovers on the transmission lines where they have been installed. The fourth group is conformed by components whose function is to protect or to cover the insulation. According to the experience in Mexico, covering devices have shown to be very effective. The contamination by bird excrement has not a unique solution. The most viable solution is a combination of alternatives. Even though, a solution adopted for a region may not be suitable for another region. Therefore, each case should be approached according to the particular conditions of the region. (author)

  1. Reliability-based failure cause assessment of collapsed bridge during construction

    International Nuclear Information System (INIS)

    Choi, Hyun-Ho; Lee, Sang-Yoon; Choi, Il-Yoon; Cho, Hyo-Nam; Mahadevan, Sankaran

    2006-01-01

    Until now, in many forensic reports, the failure cause assessments are usually carried out by a deterministic approach so far. However, it may be possible for the forensic investigation to lead to unreasonable results far from the real collapse scenario, because the deterministic approach does not systematically take into account any information on the uncertainties involved in the failures of structures. Reliability-based failure cause assessment (reliability-based forensic engineering) methodology is developed which can incorporate the uncertainties involved in structural failures and structures, and to apply them to the collapsed bridge in order to identify the most critical failure scenario and find the cause that triggered the bridge collapse. Moreover, to save the time and cost of evaluation, an algorithm of automated event tree analysis (ETA) is proposed and possible to automatically calculate the failure probabilities of the failure events and the occurrence probabilities of failure scenarios. Also, for reliability analysis, uncertainties are estimated more reasonably by using the Bayesian approach based on the experimental laboratory testing data in the forensic report. For the applicability, the proposed approach is applied to the Hang-ju Grand Bridge, which collapsed during construction, and compared with deterministic approach

  2. Revision of unicompartmental knee arthroplasty: implants used and causes of failure

    Directory of Open Access Journals (Sweden)

    Alan de Paula Mozella

    2014-04-01

    Full Text Available OBJECTIVE: to determine the causes of unicondylar knee arthroplasty failures, as well as identify the implants used and the need of bone grafting in patients undergoing revision UKA in Center of Knee Surgery at the Instituto Nacional de Traumatologia e Ortopedia (INTO in the period between January 1990 and January 2013.METHODS: a retrospective analysis of the medical documentation and imaging, determining the cause of failure of UKA and the time of its occurrence, as well as prosthetic components implanted during the review and the need for bone grafting.RESULTS: in this study, 27 UKA failures in 26 patients were included. Collapse of one or more components was the main cause of failure, occurring in 33% of patients. Aseptic failure was identified in 30% of cases, progression of osteoarthrosis in 15%, infection and pain 7% each, and osteolysis and polyethylene failure in 4% each. Early failure occurred in 41% of all revisions of UKA and late failure in 59%. 23 patients have undergone revision of UK.CONCLUSION: in 35% of revisions the use of bone grafting was needed in tibial area; in 3 cases we needed allograft from Tissue Bank. We did not use metal increase in any of the revision. In one patient we used implant constraint for instability.

  3. THE ROLE OF CYTOKINE NETWORK IN HEPATOCELLULAR DAMAGE CAUSED BY СHRONIC HEPATITIS C

    Directory of Open Access Journals (Sweden)

    L. Ph. Skljar

    2006-01-01

    Full Text Available Abstract. Hepatitis C virus (HCV is the leading cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. Liver damage in chronic viral hepatitis C is caused by both direct cytopathic viral effects, and indirect immune-mediated mechanisms. The cytokines locally produced in the liver, as well as those circulating in the blood circulation, play an important role in the control of viral replication and sufficiently contribute to hepatocellular damage. The goal of present study was to investigate the contents of some cytokines in blood serum and their local levels, being in interrelation with indices of necrotic inflammatory changes in the liver tissue. Correlations established between systemic and local contents of studied cytokines, and morphological indices indicate that, among immunological tests checked, the contents of IL-4, IL-10, IL-12p70, and TNFα in blood serum and supernatants of liver biopsies were of the greatest significance for determining the stage of fibrosis. Quantitative assays of abovementioned cytokines in blood serum represent, therefore, an alternative approach in order to perform noninvasive screening of liver fibrosis.

  4. Mortality associated with hepatitis C and hepatitis B virus infection: A nationwide study on multiple causes of death data.

    Science.gov (United States)

    Fedeli, Ugo; Grande, Enrico; Grippo, Francesco; Frova, Luisa

    2017-03-14

    To analyze mortality associated with hepatitis C virus (HCV) and hepatitis B virus (HBV) infection in Italy. Death certificates mentioning either HBV or HCV infection were retrieved from the Italian National Cause of Death Register for the years 2011-2013. Mortality rates and proportional mortality (percentage of deaths with mention of HCV/HBV among all registered deaths) were computed by gender and age class. The geographical variability in HCV-related mortality rates was investigated by directly age-standardized rates (European standard population). Proportional mortality for HCV and HBV among subjects aged 20-59 years was assessed in the native population and in different immigrant groups. HCV infection was mentioned in 1.6% ( n = 27730) and HBV infection in 0.2% ( n = 3838) of all deaths among subjects aged ≥ 20 years. Mortality rates associated with HCV infection increased exponentially with age in both genders, with a male to female ratio close to unity among the elderly; a further peak was observed in the 50-54 year age group especially among male subjects. HCV-related mortality rates were higher in Southern Italy among elderly people (45/100000 in subjects aged 60-79 and 125/100000 in subjects aged ≥ 80 years), and in North-Western Italy among middle-aged subjects (9/100000 in the 40-59 year age group). Proportional mortality was higher among Italian citizens and North African immigrants for HCV, and among Sub-Saharan African and Asian immigrants for HBV. Population ageing, immigration, and new therapeutic approaches are shaping the epidemiology of virus-related chronic liver disease. In spite of limits due to the incomplete reporting and misclassification of the etiology of liver disease, mortality data represent an additional source of information for surveillance.

  5. Polioencephalomalacia and Heart Failure Secondary to Presumptive Thiamine Deficiency, Hepatic Lipidosis, and Starvation in 2 Abandoned Siamese Cats.

    Science.gov (United States)

    Anholt, H; Himsworth, C; Britton, A

    2016-07-01

    Two 4-year-old spayed female Siamese cats were seized by the British Columbia Society for the Prevention of Cruelty to Animals after confinement to an abandoned housing unit without food for 9 weeks. One cat was found dead, and the second was euthanized within 24 hours due to neurologic deterioration despite therapy. Polioencephalomalacia of the caudal colliculus, hepatic lipidosis, cachexia, and congestive heart failure with cardiomyocyte atrophy were identified in both cats through postmortem examination and attributed to a prolonged period of starvation. Brain lesions were likely the result of thiamine deficiency (Chastek paralysis), which can be associated with both malnutrition and liver disease. This case highlights the importance of thiamine supplementation during realimentation of cats with hepatic lipidosis. Heart failure resulting from cachexia may have contributed to the death of the first cat and the morbidity of the second cat. © The Author(s) 2016.

  6. Procedures for treating common cause failures in safety and reliability studies: Analytical background and techniques

    International Nuclear Information System (INIS)

    Mosleh, A.; Fleming, K.N.; Parry, G.W.; Paula, H.M.; Worledge, D.H.; Rasmuson, D.M.

    1989-01-01

    Volume I of this report presents a framework for the inclusion of the impact of common cause failures in risk and reliability evaluations. Common cause failures are defined as that subset of dependent failures for which causes are not explicitly included in the logic model as basic events. The emphasis here is on providing procedures for a practical, systematic approach that can be used to perform and clearly document the analysis. The framework and the methods discussed for performing the different stages of the analysis integrate insights obtained from engineering assessments of the system and the historical evidence from multiple failure events into a systematic, reproducible, and defensible analysis. This document, Volume 2, contains a series of appendices that provide additional background and methodological detail on several important topics discussed in Volume I

  7. Guillain-Barre syndrome caused by hepatitis E infection: case report and literature review.

    Science.gov (United States)

    Zheng, Xiaoqin; Yu, Liang; Xu, Qiaomai; Gu, Silan; Tang, Lingling

    2018-01-23

    Hepatitis E infection is a global disorder that causes substantial morbidity. Numerous neurologic illnesses, including Guillain-Barre syndrome (GBS), have occurred in patients with hepatitis E virus (HEV) infection. We report a 58 year-old non-immunocompromised man who presented with progressive muscle weakness in all extremities during an episode of acute HEV infection, which was confirmed by measuring the anti-HEV IgM antibodies in the serum. Both cerebrospinal fluid examination and electrophysiological study were in agreement with the diagnosis of HEV-associated GBS. Following the treatment with intravenous immunoglobulin, the patient's neurological condition improved rapidly. HEV infection should be strongly considered in patients with neurological symptoms, especially those with elevated levels of liver enzymes.

  8. Patient-reported causes of heart failure in a large European sample

    DEFF Research Database (Denmark)

    Timmermans, Ivy; Denollet, Johan; Pedersen, Susanne S.

    2018-01-01

    ), psychosocial (35%, mainly (work-related) stress), and natural causes (32%, mainly heredity). There were socio-demographic, clinical and psychological group differences between the various categories, and large discrepancies between prevalence of physical risk factors according to medical records and patient...... distress (OR = 1.54, 95% CI = 0.94–2.51, p = 0.09), and behavioral causes and a less threatening view of heart failure (OR = 0.64, 95% CI = 0.40–1.01, p = 0.06). Conclusion: European patients most frequently reported comorbidities, smoking, stress, and heredity as heart failure causes, but their causal......Background: Patients diagnosed with chronic diseases develop perceptions about their disease and its causes, which may influence health behavior and emotional well-being. This is the first study to examine patient-reported causes and their correlates in patients with heart failure. Methods...

  9. Causes and effects of vital instrumentation and control power supply bus failures

    International Nuclear Information System (INIS)

    Muhlheim, M.D.; Murphy, G.A.

    1987-01-01

    This article presents the results of a study in which the objective was to evaluate nuclear power-plant operating experience to identify the causes and the effects of vital instrumentation and control (I and C) power supply bus failures. Vital I and C power is normally provided to essential instrumentation and controls through either vital d-c or a-c power supply systems. The vital d-c power supply system generally provides control power for starting the diesel generators, for operating electrical circuit breakers, and for controlling various logic circuits. The vital d-c power system also supplies vital a-c power through an inverter. The vital a-c power supply system generally feeds the reactor protection system channels, the engineered safety features actuation system channels, and critical instrumentation in the control room. The leading cause of vital bus failures is inverter failures; other causes are human errors, battery charger failures, and miscellaneous failures. The effects of these failures are that the margin of safety can be degraded by (1) denying key information to the operators, (2) inducing plant transients, (3) causing safety injection actuations, and (4) causing the loss of shutdown cooling flow

  10. Long-Time Choledochal Clamping in Wistar Rats Causes Biliary Obstruction Progressing to Hepatic Fibrosis.

    Science.gov (United States)

    Jorge, G D L; Tártaro, R R; Escanhoela, C A F; Boin, I D F S F

    2016-09-01

    Biliary complications are important causes of morbidity and mortality in patients undergoing hepatic surgery. The aim of the study was to evaluate late liver alterations after a long period of choledochal clamping in Wistar rats. Ten male Wistar rats, weighing 304 grams, anesthetized with sodium thiopental (25 mg/kg) and xylazine (10 mg/kg) intravenously, were distributed into 2 groups: the choledochal clamping group (CCG) and the operation sham group (OSG), with 5 animals each submitted to an abdominal incision. In the CCG, the choledochal was isolated, dissected, and clamped with a microvascular clamp for 40 minutes. After this occlusion time, the clamp was removed and the incision was closed. In the OSG the animals, under normal conditions, were submitted only to anesthesia and laparotomy for choledochal manipulation. In all animals, after the 31st day, a hepatic biopsy was carried out for histology and blood biochemical tests: total bilirubin, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transferase. The animals were euthanized under anesthesia. This research was approved by the Ethics Committee on Animal Use (CEUA, Unicamp, No. 2511-1). In the CCG, 100% of the animals showed bile duct dilatation, ductular proliferation, and portal inflammatory infiltrate; 60% showed regenerative nodule formation; and 80% had porta-porta septa and foci of necrosis, all of which were not found in the OSG. All CCG group biochemical tests had significant increases (P Wistar rats caused hepatic dysfunction and biochemical and histological injuries with degrees of distortion to the hepatic architecture. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Computerized tomographic findings of hepatic fascioliasis compared with melioidosis-caused liver abscesses.

    Science.gov (United States)

    Chamadol, Nittaya; Laopaiboon, Vallop; Techasatian, Pennapa; Sukeepaisanjaroen, Wattana; Sripanuskul, Anan

    2010-07-01

    To compare the computerized tomographic (CT) findings of hepatic fascioliasis (HF) vs. melioidosis-caused liver (ML) abscesses. CT images of 15 patients with hepatic fascioliasis (HF) and 16 patients with melioidosis-caused liver (ML) abscesses were retrospectively reviewed. The authors evaluated and compared HF and ML abscesses (by chi2 and Fisher exact tests) vis-a-vis their location of liver involvement, size, shape, number margins, enhancement patterns, subcapsular lesions, internal architecture, dilatation of intrahepatic bile duct and combination with splenic abscesses. Fourteen HF patients had only liver abscesses and 1 had combined liver and splenic abscesses. Four ML patients had liver abscesses alone while 12 had combined liver and splenic abscesses (p = 0.000). Eight of the 15 HF (53.3%) and 2 of the 16 ML (12.5%) patients had subcapsular lesions (p = 0.019). The liver abscesses were round or oval with linear tracts in 8 of the 15 HF (53.3%) and none of the ML patients (p = 0.001). Between the respective HF and ML patients, there was a significant difference in those with round shaped in ML (p = 0.008), multiple and conglomerately distributed in HF (p = 0.050), multiple and discretely distributed in ML (p = 0.001) no (or minimal) peripheral contrast enhancement in HF (p = 0.011) and moderate or mark peripheral enhancement in ML (p = 0.011). The CT findings of liver abscesses that helped to differentiate hepatic fascioliasis from melioidosis liver abscesses were: their number shape, enhancement pattern, presence of subcapsular lesion (s) and co-occurrence with splenic abscesses. The diagnosis of hepatic fascioliasis by CT is suggested when the following characteristics were seen: (1) multiple, small round or oval (with linear tracts) conglomerates presenting as hypodense lesions; (2) no (or minimal) peripheral contrast enhancement; (3) subcapsular lesions; or (4) less frequent co-occurrence with splenic abscesses.

  12. A pragmatic approach to estimate alpha factors for common cause failure analysis

    International Nuclear Information System (INIS)

    Hassija, Varun; Senthil Kumar, C.; Velusamy, K.

    2014-01-01

    Highlights: • Estimation of coefficients in alpha factor model for common cause analysis. • A derivation of plant specific alpha factors is demonstrated. • We examine sensitivity of common cause contribution to total system failure. • We compare beta factor and alpha factor models for various redundant configurations. • The use of alpha factors is preferable, especially for large redundant systems. - Abstract: Most of the modern technological systems are deployed with high redundancy but still they fail mainly on account of common cause failures (CCF). Various models such as Beta Factor, Multiple Greek Letter, Binomial Failure Rate and Alpha Factor exists for estimation of risk from common cause failures. Amongst all, alpha factor model is considered most suitable for high redundant systems as it arrives at common cause failure probabilities from a set of ratios of failures and the total component failure probability Q T . In the present study, alpha factor model is applied for the assessment of CCF of safety systems deployed at two nuclear power plants. A method to overcome the difficulties in estimation of the coefficients viz., alpha factors in the model, importance of deriving plant specific alpha factors and sensitivity of common cause contribution to the total system failure probability with respect to hazard imposed by various CCF events is highlighted. An approach described in NUREG/CR-5500 is extended in this study to provide more explicit guidance for a statistical approach to derive plant specific coefficients for CCF analysis especially for high redundant systems. The procedure is expected to aid regulators for independent safety assessment

  13. Hepatic blood flow and splanchnic oxygen consumption in patients with liver failure. Effect of high-volume plasmapheresis.

    Science.gov (United States)

    Clemmesen, J O; Gerbes, A L; Gülberg, V; Hansen, B A; Larsen, F S; Skak, C; Tygstrup, N; Ott, P

    1999-02-01

    Liver failure represents a major therapeutic challenge, and yet basic pathophysiological questions about hepatic perfusion and oxygenation in this condition have been poorly investigated. In this study, hepatic blood flow (HBF) and splanchnic oxygen delivery (DO2, sp) and oxygen consumption (VO2,sp) were assessed in patients with liver failure defined as hepatic encephalopathy grade II or more. Measurements were repeated after high-volume plasmapheresis (HVP) with exchange of 8 to 10 L of plasma. HBF was estimated by use of constant infusion of D-sorbitol and calculated according to Fick's principle from peripheral artery and hepatic vein concentrations. In 14 patients with acute liver failure (ALF), HBF (1.78 +/- 0.78 L/min) and VO2,sp (3.9 +/- 0.9 mmol/min) were higher than in 11 patients without liver disease (1.07 +/- 0.19 L/min, P HVP, HBF increased from 1.67 +/- 0.72 to 2.07 +/- 1.11 L/min (n=11) in ALF, and from 1.89 +/- 1.32 to 2.34 +/- 1.54 L/min (n=7) in AOCLD, P HVP. Blood flow was redirected to the liver as the systemic vascular resistance index increased (1,587 +/- 650 vs. 2, 020 +/- 806 Dyne. s. cm-5. m2, P HVP, but as cardiac output increased from 9.1 +/- 2.8 to 10.1 +/- 2.9 L/min (P HVP (n=18), DO2,sp increased by 15% (P HVP. Changes of ET-1 were positively correlated with changes in HBF (P HVP (P HVP did not correlate. Our data suggest that liver failure is associated with increased HBF and VO2, sp. HVP further increased HBF and DO2,sp but VO2,sp was unchanged, indicating that splanchnic hypoxia was not present.

  14. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... Donate Today Enroll in 123 What is Hepatic Encephalopathy? Hepatic Encephalopathy, sometimes referred to as portosystemic encephalopathy or PSE, is a condition that causes temporary ...

  15. α-Decomposition for estimating parameters in common cause failure modeling based on causal inference

    International Nuclear Information System (INIS)

    Zheng, Xiaoyu; Yamaguchi, Akira; Takata, Takashi

    2013-01-01

    The traditional α-factor model has focused on the occurrence frequencies of common cause failure (CCF) events. Global α-factors in the α-factor model are defined as fractions of failure probability for particular groups of components. However, there are unknown uncertainties in the CCF parameters estimation for the scarcity of available failure data. Joint distributions of CCF parameters are actually determined by a set of possible causes, which are characterized by CCF-triggering abilities and occurrence frequencies. In the present paper, the process of α-decomposition (Kelly-CCF method) is developed to learn about sources of uncertainty in CCF parameter estimation. Moreover, it aims to evaluate CCF risk significances of different causes, which are named as decomposed α-factors. Firstly, a Hybrid Bayesian Network is adopted to reveal the relationship between potential causes and failures. Secondly, because all potential causes have different occurrence frequencies and abilities to trigger dependent failures or independent failures, a regression model is provided and proved by conditional probability. Global α-factors are expressed by explanatory variables (causes’ occurrence frequencies) and parameters (decomposed α-factors). At last, an example is provided to illustrate the process of hierarchical Bayesian inference for the α-decomposition process. This study shows that the α-decomposition method can integrate failure information from cause, component and system level. It can parameterize the CCF risk significance of possible causes and can update probability distributions of global α-factors. Besides, it can provide a reliable way to evaluate uncertainty sources and reduce the uncertainty in probabilistic risk assessment. It is recommended to build databases including CCF parameters and corresponding causes’ occurrence frequency of each targeted system

  16. Hepatitis A through E (Viral Hepatitis)

    Science.gov (United States)

    ... Treatment Eating, Diet, & Nutrition Clinical Trials Wilson Disease Hepatitis (Viral) View or Print All Sections What is Viral Hepatitis? Viral hepatitis is an infection that causes liver inflammation ...

  17. Collections and Analyses of Common Cause Failure Data for the Korea Standard and Westinghouse Type NPPs

    International Nuclear Information System (INIS)

    Kang, Dae Il; Han, S. H.

    2007-04-01

    The analyses of the CCF events for domestic NPPs were performed to establish the domestic database for the CCF events and to deliver supply them to the operation office of the international common cause failure data exchange (ICDE) project. We collected and analyzed the CCF events of emergency diesel generators, centrifugal pumps, motor-operated valves, check valves, circuit breakers for the Korean Standard Type nuclear power plants (NPPs), Yonggwang Units 3 and 4 and Ulchin Units 3 and 4, and the Westinghouse type NPPs, Kori Unit 3 and 4 and Yonggwang Units 1 and 2. First, the components to be collected and analyzed were classified into the common cause component groups (CCCGs) according to the ICDE coding guidelines. Next, the CCF events were identified based on reviews of the component database for the PSA and its related documents, and consultations with NPP staff. Fourteen CCF events were identified. The ratio of the number of CCF events to that of individual failure events was identified as approximately 10 percentages. However, an in depth review of the CCF events showed that most failure severities of them were identified as partial CCF events, which can be interpreted as some component failures within the CCCGs. Root causes of the CCF events were identified as 9 internal part failures, 2 human errors, 2 design deficiencies, 1 procedure inadequacy. It could be concluded that the major root causes of the CCF events were internal piece part failures

  18. Common cause failure rate estimates for diesel generators in nuclear power plants

    International Nuclear Information System (INIS)

    Steverson, J.A.; Atwood, C.L.

    1982-01-01

    Common cause fault rates for diesel generators in nuclear power plants are estimated, using Licensee Event Reports for the years 1976 through 1978. The binomial failure rate method, used for obtaining the estimates, is briefly explained. Issues discussed include correct classification of common cause events, grouping of the events into homogeneous data subsets, and dealing with plant-to-plant variation

  19. Treatment and prevention of hepatic failure in acute biliary pancreatitis in patients with diabetes mellitus

    Directory of Open Access Journals (Sweden)

    S.I. Savoliuk

    2017-10-01

    the products of purine nucleotide catabolism (xanthine oxidase, xanthine dehydrogenase capable of producing reactive oxygen species, stimulating oxidative stress. Conclusions. The course of acute biliary pancreatitis in patients with diabetes mellitus is accompanied by regular changes in the markers of the syndrome of cytopathic hypoxia, the erythron system and iron metabolism, the severity of these disorders has a direct correlation with the area of morphological changes in the pancreas and the dynamics of markers of liver failure. Using the methods of protocol therapy, you can not carry out preventive correction of existing metabolic disorders that requires the inclusion into the standard conservative treatment for edema form of acute biliary pancreatitis of systemic multifunctional metabolic corrector (Berlithion® for systemic preventive correction of homeostasis and mechanisms of escalation of hepatic insufficiency manifestations, which, in the presence of necrotic forms, requires additional application of low molecular weight heparins (Zibor® for the restoration of hemorheological and hemocoalogulative disorders on the systemic and intraorganic levels.

  20. Investigation into Cause of High Temperature Failure of Boiler Superheater Tube

    Science.gov (United States)

    Ghosh, D.; Ray, S.; Roy, H.; Shukla, A. K.

    2015-04-01

    The failure of the boiler tubes occur due to various reasons like creep, fatigue, corrosion and erosion. This paper highlights a case study of typical premature failure of a final superheater tube of 210 MW thermal power plant boiler. Visual examination, dimensional measurement, chemical analysis, oxide scale thickness measurement, microstructural examination are conducted as part of the investigations. Apart from these investigations, sulfur print, Energy Dispersive spectroscopy (EDS) and X ray diffraction analysis (XRD) are also conducted to ascertain the probable cause of failure of final super heater tube. Finally it has been concluded that the premature failure of the super heater tube can be attributed to the combination of localized high tube metal temperature and loss of metal from the outer surface due to high temperature corrosion. The corrective actions have also been suggested to avoid this type of failure in near future.

  1. Curative Effects of Thiacremonone against Acetaminophen-Induced Acute Hepatic Failure via Inhibition of Proinflammatory Cytokines Production and Infiltration of Cytotoxic Immune Cells and Kupffer Cells

    Directory of Open Access Journals (Sweden)

    Yu Ri Kim

    2013-01-01

    Full Text Available High doses of acetaminophen (APAP; N-acetyl-p-aminophenol cause severe hepatotoxicity after metabolic activation by cytochrome P450 2E1. This study was undertaken to examine the preventive effects of thiacremonone, a compound extracted from garlic, on APAP-induced acute hepatic failure in male C57BL/6J. Mice received with 500 mg/kg APAP after a 7-day pretreatment with thiacremonone (10–50 mg/kg. Thiacremonone inhibited the APAP-induced serum ALT and AST levels in a dose-dependent manner, and markedly reduced the restricted area of necrosis and inflammation by administration of APAP. Thiacremonone also inhibited the APAP-induced depletion of intracellular GSH, induction of nitric oxide, and lipid peroxidation as well as expression of P450 2E1. After APAP injection, the numbers of Kupffer cells, natural killer cells, and cytotoxic T cells were elevated, but the elevated cell numbers in the liver were reduced in thiacremonone pretreated mice. The expression levels of I-309, M-CSF, MIG, MIP-1α, MIP-1β, IL-7, and IL-17 were increased by APAP treatment, which were inhibited in thiacremonone pretreated mice. These data indicate that thiacremonone could be a useful agent for the treatment of drug-induced hepatic failure and that the reduction of cytotoxic immune cells as well as proinflammatory cytokine production may be critical for the prevention of APAP-induced acute liver toxicity.

  2. Rapid liver enlargement and hepatic failure secondary to radiographic occult tumor invasion: two case reports and review of the literature

    Directory of Open Access Journals (Sweden)

    Simone Christine

    2012-11-01

    Full Text Available Abstract Introduction Unfamiliarity with certain clinical presentations, as illustrated in these cases, can lead to delayed diagnoses that in turn cause increased morbidity, prolonged hospitalization, and the need for autopsy. Case presentation In Case 1, a 63-year-old Caucasian woman presented with hepatic enlargement and insufficiency which progressed and resulted in her death over a period of less than 2 weeks. The patient underwent a detailed workup included magnetic resonance imaging and computed tomography scan of her liver, which did not reveal the source of her liver enlargement. Due to her progressive liver enlargement and insufficiency, she developed a life-threatening esophageal variceal bleeding during her hospital stay which further delayed the attainment of her diagnosis. She finally underwent a videoscopic laparotomy and liver biopsy which revealed complete replacement and filling in of the liver sinuous with Indian filing lobular breast cancer. The patient died shortly after her diagnosis and before she could be discharged. In Case 2, a 68-year-old Caucasian woman with non-small-cell lung cancer was admitted to our Oncology in-patient service with a presentation of rapid hepatic insufficiency and severe liver enlargement. Like the patient in Case 1, during her hospitalization, this patient underwent a thorough radiographic evaluation, including computed tomography and magnetic resonance imaging, to identify the source of her symptoms. Radiographic imaging showed only hepatomegaly and no discrete focal lesions. As the multiple imaging studies over a period of a week did not reveal a clear cause for her symptoms, she finally underwent an interventional radiology core biopsy which showed complete replacement of her liver with non-small-cell lung cancer. Her condition rapidly progressed due to continued liver enlargement and she died due to frank liver failure before her diagnosis was affirmed and she could be discharged. Conclusion

  3. Intravenous Milrinone Infusion Improves Congestive Heart Failure Caused by Diastolic Dysfunction

    Science.gov (United States)

    Albrecht, Carlos A.; Giesler, Gregory M.; Kar, Biswajit; Hariharan, Ramesh; Delgado, Reynolds M.

    2005-01-01

    Although there have been significant advances in the medical treatment of heart failure patients with impaired systolic function, very little is known about the diagnosis and treatment of diastolic dysfunction. We report the cases of 3 patients in New York Heart Association functional class IV who had echocardiographically documented diastolic dysfunction as the main cause of heart failure. All 3 patients received medical therapy with long-term milrinone infusion. PMID:16107121

  4. Anti-glomerular basement membrane: A rare cause of renal failure in children

    Directory of Open Access Journals (Sweden)

    Indira Agarwal

    2017-01-01

    Full Text Available Anti-glomerular basement membrane (GBM disease is a rare cause of acute renal failure and known to have bad prognosis regarding renal functions recovery and patient survival specially when diagnosed late and presents with severe renal failure that requires dialysis. We report a case of 11-year-old child with acute renal failure secondary to anti-GBM disease and associated with antineutrophil cytoplasmic antibody-positive vasculitis. He was treated with plasmapheresis, steroids, and cyclophosphamide with recovery of his kidney functions.

  5. Long-term effects as the cause of failure in electronic components

    International Nuclear Information System (INIS)

    Renz, H.; Kreichgauer, H.

    1989-01-01

    After a brief presentation of the utilisation properties of electronic components, their failure rates are discussed with particular reference to the socalled bath-tub curve. The main emphasis is on the construction and manufacture of integrated circuits and the possible types and causes of failure arising from the individual manufacturing stages (layout faults, internal corrosion, masking and etching errors, leakage currents, inadequate heat removal, etc.). A technical insurance assessment is then provided of the long-term failures associated with technological matters. (orig.) [de

  6. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... 1 (von Gierke) Hemochromatosis Hepatic Encephalopathy Hepatitis A Hepatitis B Hepatitis C Intrahepatic Cholestasis of Pregnancy (ICP) Jaundice ... diseases. What are the common causes of cirrhosis? Hepatitis B & C Alcohol-related Liver Disease Non-alcoholic Fatty ...

  7. Living-related liver transplantation for patients with fulminant and subfulminant hepatic failure.

    Science.gov (United States)

    Miwa, S; Hashikura, Y; Mita, A; Kubota, T; Chisuwa, H; Nakazawa, Y; Ikegami, T; Terada, M; Miyagawa, S; Kawasaki, S

    1999-12-01

    The prognosis for patients with fulminant (FHF) or subfulminant hepatic failure (SFHF) has improved since the introduction of liver transplantation. However, the death rate of patients awaiting liver transplantation is high, possibly because of the difficulty in obtaining grafts in a timely manner, given the relative shortage of cadaveric donors. Between June 1990 and June 1999, 106 patients underwent living-related liver transplantation (LRLT) at Shinshu University Hospital. Among them, 8 patients had FHF and 6 had SFHF; these 14 patients are the subjects of this report. The graft volumes (GV) ranged from 231 mL to 625 mL, corresponding to 35% to 105% of the recipients' standard liver volume (SLV). The postoperative courses of all donors were uneventful. Following liver transplantation, all grafts functioned favorably, with normalization of serum total bilirubin within 3 to 5 days and normalization of coagulation profiles within 4 to 7 days. Thirteen of the 14 recipients are still alive. The actuarial 6-month, 1-year, and 5-year survival rates were 100%, 90%, and 90%, respectively. In the present study, when the ratio of the GV to the recipient's SLV was more than 35%, the graft was able to support the patient's metabolic demand after liver transplantation for FHF or SFHF. Because of the urgent nature of liver transplantation in this clinical condition, concerns over informed consent may be even greater than for elective LRLT. Nevertheless, the high success rate and low donor risk may justify this option for pediatric patients, as well as for a limited population of adult patients suffering from FHF or SFHF.

  8. Dependency Analysis Guidance Nordic/German Working Group on Common Cause Failure analysis. Phase 2, Development of Harmonized Approach and Applications for Common Cause Failure Quantification

    Energy Technology Data Exchange (ETDEWEB)

    Becker, Guenter; Johanson, Gunnar; Lindberg, Sandra; Vaurio, Jussi

    2009-03-15

    The Regulatory Code SSMFS 2008:1 of Swedish Radiation Safety Authority (SSM) includes requirements regarding the performance of probabilistic safety assessments (PSA), as well as PSA activities in general. Therefore, the follow-up of these activities is part of the inspection tasks of SSM. According to the SSMFS 2008:1, the safety analyses shall be based on a systematic identification and evaluation of such events, event sequences and other conditions which may lead to a radiological accident. The research report Nordic/German Working Group on Common cause Failure analysis. Phase 2 project report: Development of Harmonized Approach and Applications for Common Cause Failure Quantification has been developed under a contract with the Nordic PSA Group (NPSAG) and its German counterpart VGB, with the aim to create a common experience base for defence and analysis of dependent failures i.e. Common Cause Failures CCF. Phase 2 in this project if a deepened data analyses of CCF events and a demonstration on how the so called impact vectors can be constructed and on how CCF parameters are estimated. The word Guidance in the report title is used in order to indicate a common methodological guidance accepted by the NPSAG, based on current state of the art concerning the analysis of dependent failures and adapted to conditions relevant for Nordic sites. This will make it possible for the utilities to perform cost effective improvements and analyses. The report presents a common attempt by the authorities and the utilities to create a methodology and experience base for defence and analysis of dependent failures. The performed benchmark application has shown how important the interpretation of base data is to obtain robust CCF data and data analyses results. Good features were found in all benchmark approaches. The obtained experiences and approaches should now be used in harmonised procedures. A next step could be to develop and agree on event and formula driven impact vector

  9. Dependency Analysis Guidance Nordic/German Working Group on Common Cause Failure analysis. Phase 2, Development of Harmonized Approach and Applications for Common Cause Failure Quantification

    International Nuclear Information System (INIS)

    Becker, Guenter; Johanson, Gunnar; Lindberg, Sandra; Vaurio, Jussi

    2009-03-01

    The Regulatory Code SSMFS 2008:1 of Swedish Radiation Safety Authority (SSM) includes requirements regarding the performance of probabilistic safety assessments (PSA), as well as PSA activities in general. Therefore, the follow-up of these activities is part of the inspection tasks of SSM. According to the SSMFS 2008:1, the safety analyses shall be based on a systematic identification and evaluation of such events, event sequences and other conditions which may lead to a radiological accident. The research report Nordic/German Working Group on Common cause Failure analysis. Phase 2 project report: Development of Harmonized Approach and Applications for Common Cause Failure Quantification has been developed under a contract with the Nordic PSA Group (NPSAG) and its German counterpart VGB, with the aim to create a common experience base for defence and analysis of dependent failures i.e. Common Cause Failures CCF. Phase 2 in this project if a deepened data analyses of CCF events and a demonstration on how the so called impact vectors can be constructed and on how CCF parameters are estimated. The word Guidance in the report title is used in order to indicate a common methodological guidance accepted by the NPSAG, based on current state of the art concerning the analysis of dependent failures and adapted to conditions relevant for Nordic sites. This will make it possible for the utilities to perform cost effective improvements and analyses. The report presents a common attempt by the authorities and the utilities to create a methodology and experience base for defence and analysis of dependent failures. The performed benchmark application has shown how important the interpretation of base data is to obtain robust CCF data and data analyses results. Good features were found in all benchmark approaches. The obtained experiences and approaches should now be used in harmonised procedures. A next step could be to develop and agree on event and formula driven impact vector

  10. ICDE project report: collection and analysis of common-cause failure of check valves

    International Nuclear Information System (INIS)

    Theiss, Klaus; Hessel, Philippe; Werner, Wolfgang

    2003-05-01

    This report documents a study performed on the set of Common Cause Failure (CCF) events of Check Valves (CVs). The events studied here were derived from the International CCF Data Exchange (ICDE) database. Organizations from Canada, Finland, France, Germany, Netherlands, Sweden, Switzerland and the United States contributed with data to this data exchange. This study examines 94 CCF events of CVs reported in the ICDE database by tabulating the data and observing trends. The database contains general information about event attributes like root cause, coupling factor, detection method and corrective action taken. As part of this study, most of these events were reviewed in more detail and characterized by failure cause and failure symptom categories. The study itself begins with an overview of the entire data set in chapter 5. Charts are provided for each of the above-mentioned event attributes. This chapter forms the baseline for chapter 6. The intention of chapter 6 is to give the reader a deeper qualitative insight in the database content beyond that obtained from using the event coding only. Chapter 7 contains the summary of the study results and the conclusions derived from. Approximately 8% of all ICDE events of CVs were complete CCFs (all redundant components had failed). The number of partial CCF events (at least two of the redundant components failed) accounted for 24%. In the remaining 68% of the ICDE events, less than two components had failed completely, and the other components of the observed group only suffered from small defects, incipient degradation or were not affected at all. However, it was found that for more than 75% of the ICDE events the causal factors had a high probability to be shared by all the redundant components. 88 of the 94 reported ICDE events were reviewed in some more detail in Section 6 of this report with respect to failure causes, failure symptoms and failure mechanism. All events classified with a low 'shared cause factor

  11. The fatal risk in hepatic artery embolization for hemostasis after pancreatic and hepatic surgery: importance of collateral arterial pathways.

    Science.gov (United States)

    Sato, Akihiro; Yamada, Takayuki; Takase, Kei; Matsuhashi, Toshio; Higano, Shuichi; Kaneda, Tomohiro; Egawa, Shinichi; Takeda, Kazunori; Ishibashi, Tadashi; Takahashi, Shoki

    2011-03-01

    To assess retrospectively the cause of hepatic failure related to hepatic arterial embolization (HAE) for hemostasis after pancreaticoduodenectomy or hepatic lobectomy. Between June 1993 and March 2006, Twenty HAEs in 17 patients (15 men, two women; mean age, 64 years) were performed. Angiographic findings, including portal vein stenosis, collateral arterial pathways after HAE, and the difference of embolic materials, were recorded. The morbidity (hepatic failure and abscess) and mortality were detailed according to collateral arterial pathways, portal vein stenosis, and embolic material used. Bleeding was controlled in all patients, although two patients required repeat embolization. Hepatic failure (n = 8) and abscess (n = 2) arose in nine of 20 HAEs. Death occurred after six of eight HAEs complicated by hepatic failure. The morbidity and mortality rates of HAE were 45% and 30%, respectively. Hepatic complication was eight times more likely to occur (P = .005) in cases with no hepatic collaterals involving hepatic, replaced, or accessory hepatic arteries. Death was observed only in the cases without hepatic collaterals (P = .011). The correlation between the embolization outcome and the presence of portal vein stenosis or the difference of embolic materials was not significant (P > .61). HAE can be used to successfully control bleeding secondary to hepatic arterial rupture. In the absence of hepatic collaterals, collateral circulation distal to the occlusion from nonhepatic sources may be inadequate and lead to hepatic failure after HAE. Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.

  12. Minimal vascular flows cause strong heat sink effects in hepatic radiofrequency ablation ex vivo.

    Science.gov (United States)

    Lehmann, Kai S; Poch, Franz G M; Rieder, Christian; Schenk, Andrea; Stroux, Andrea; Frericks, Bernd B; Gemeinhardt, Ole; Holmer, Christoph; Kreis, Martin E; Ritz, Jörg P; Zurbuchen, Urte

    2016-08-01

    The present paper aims to assess the lower threshold of vascular flow rate on the heat sink effect in bipolar radiofrequency ablation (RFA) ex vivo. Glass tubes (vessels) of 3.4 mm inner diameter were introduced in parallel to bipolar RFA applicators into porcine liver ex vivo. Vessels were perfused with flow rates of 0 to 1,500 ml/min. RFA (30 W power, 15 kJ energy input) was carried out at room temperature and 37°C. Heat sink effects were assessed in RFA cross sections by the decrease in ablation radius, area and by a high-resolution sector planimetry. Flow rates of 1 ml/min already caused a significant cooling effect (P ≤ 0.001). The heat sink effect reached a maximum at 10 ml/min (18.4 mm/s) and remained stable for flow rates up to 1,500 ml/min. Minimal vascular flows of ≥1 ml/min cause a significant heat sink effect in hepatic RFA ex vivo. A lower limit for volumetric flow rate was not found. The maximum of the heat sink effect was reached at a flow rate of 10 ml/min and remained stable for flow rates up to 1,500 ml/min. Hepatic inflow occlusion should be considered in RFA close to hepatic vessels. © 2016 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  13. Acute hepatitis B in a healthcare worker: A case report of genuine vaccination failure

    NARCIS (Netherlands)

    Boot, H.J.; Van Der Waaij, L.A.; Schirm, J.; Kallenberg, Cees; van Steenbergen, J.; Wolters, B.

    2009-01-01

    Background: Individuals who reach the antibody threshold level of 10 IU/I against the surface protein of the hepatitis B virus (HBV) after completion of a series of hepatitis B vaccination are considered to be long-term protected against a clinically manifest HBV infection. Case report: Here we

  14. Acute hepatitis B in a healthcare worker : A case report of genuine vaccination failure

    NARCIS (Netherlands)

    Boot, Hein J.; van der Waaij, Laurens A.; Schirm, Jurien; Kallenberg, Cees G. M.; van Steenbergen, Jim; Wolters, Bert

    Background: Individuals who reach the antibody threshold level of 10 IU/I against the surface protein of the hepatitis B virus (HBV) after completion of a series of hepatitis B vaccination are considered to be long-term protected against a clinically manifest HBV infection. Case report: Here we

  15. The mechanism and characteristics of ground movement and strata failure caused by mining

    Energy Technology Data Exchange (ETDEWEB)

    Tianquan, L. (Central Coal Mining Research Institute, Beijing (China))

    1988-01-01

    Analyzes strata movement and ground subsidence caused by underground coal mining. Five types of strata failure during and after underground coal mining are comparatively evaluated: caving zone, fractured zone, bending zone, arched caving, bending with continuous ground movement, sinkhole formation. Effects of coal seam thickness, dip angle, coal panel dimensions, rock stratification and mechanical properties on dimensions and distribution of failure zones in rock strata are investigated. Strata movement during level and steep seam mining is comparatively evaluated. Causes of continuous ground surface deformation and discontinuous deformation are analyzed. Rock strata properties and water influx, which influence sinkhole hazards, are discussed.

  16. Preliminary Analysis of the Common Cause Failure Events for Domestic Nuclear Power Plants

    International Nuclear Information System (INIS)

    Kang, Daeil; Han, Sanghoon

    2007-01-01

    It is known that the common cause failure (CCF) events have a great effect on the safety and probabilistic safety assessment (PSA) results of nuclear power plants (NPPs). However, the domestic studies have been mainly focused on the analysis method and modeling of CCF events. Thus, the analysis of the CCF events for domestic NPPs were performed to establish a domestic database for the CCF events and to deliver them to the operation office of the international common cause failure data exchange (ICDE) project. This paper presents the analysis results of the CCF events for domestic nuclear power plants

  17. A COCAP program for the statistical analysis of common cause failure parameters

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Baehyeuk; Jae, Moosung [Hanyang Univ., Seoul (Korea, Republic of). Dept. of Nuclear Engineering

    2016-03-15

    Probabilistic Safety Assessment (PSA) based applications and regulations are becoming more important in the field of nuclear energy. According to the results of a PSA in Korea, the common cause failure evaluates CDF (Core Damage Frequency) as one of the significant factors affecting redundancy of NPPs. The purpose of the study is to develop a COCAP (Common Cause Failure parameter Analysis for PSA) program for the accurate use of the alpha factor model parameter data provided by other countries and for obtaining the indigenous CCF data of NPPs in Korea through Bayesian updating.

  18. External dacryocystorhinostomy in consultants and fellows - a comparison of the causes of failure.

    Science.gov (United States)

    Sullivan, L; Fearnley, T; Al-Maskari, A; El-Hindy, N; Kalantzis, G; Chang, B Y

    2015-01-01

    Failure of primary dacryocystorhinostomy (DCR) often requires revision surgery to inspect the cause of failure and re-establish anatomic patency. This study aims to specifcally compare the anatomical causes of failure noted during revision DCR of primary external DCR (EX-DCR) and compare the difference between consultants and fellows. A retrospective review of 37 patients who underwent revision of a primary external approach DCR over a 7-year-period in a University Hospital. All primary surgery was performed by either a consultant surgeon or senior oculoplastic fellow. Details of the initial pathology prior to primary DCR and grade of operating surgeon were collected along with perioperative surgical findings. The cause of failure of the initial surgery was classified according to perioperative findings. Failure was classified as either inappropriately sized/located ostium or fibrous/membranous soft tissue obstruction of the newly created ostium. The cause of failure of the initial surgery was soft tissue obstruction in 43.3% and an inappropriately sized/located ostium in 56.7%. In those patients whose primary surgery was performed by a consultant, 73.3% were found to have a soft tissue obstruction and 26.7% were found to have an inappropriately sized/ located ostium. In contrast, if initial surgery was performed by a fellow, 22.7% were found to have a soft tissue obstruction and 77.3% an inappropriately sized/ located ostium (p =0.002). Where the primary surgeon has been a trainee there is a trend toward inadequately sized or located ostium being the most likely causative factor in failure of primary EX-DCR.  Hippokratia 2015; 19 (3): 216-218.

  19. [Associated factors to non-operative management failure of hepatic and splenic lesions secondary to blunt abdominal trauma in children].

    Science.gov (United States)

    Echavarria Medina, Adriana; Morales Uribe, Carlos Hernando; Echavarria R, Luis Guillermo; Vélez Marín, Viviana María; Martínez Montoya, Jorge Alberto; Aguillón, David Fernando

    2017-01-01

    The non operative management (NOM) is the standard management of splenic and liver blunt trauma in pediatric patients.Hemodynamic instability and massive transfusions have been identified as management failures. Few studies evaluate whether there exist factors allowing anticipation of these events. The objective was to identify factors associated with the failure of NOM in splenic and liver injuries for blunt abdominal trauma. Retrospective analysis between 2007-2015 of patients admitted to the pediatric surgery at University Hospital Saint Vincent Foundation with liver trauma and/or closed Spleen. 70 patients were admitted with blunt abdominal trauma, 3 were excluded for immediate surgery (2 hemodynamic instability, 1 peritoneal irritation). Of 67 patients who received NOM, 58 were successful and 9 showed failure (8 hemodynamic instability, 1 hollow viscera injury). We found 3 factors associated with failure NOM: blood pressure (BP) 2 g/dl in the first 24 hours (p = 0.0009; RR = 15.3), and transfusion of 3 or more units of red blood cells (RBC) (0.00001; RR = 17.1). Mechanism and severity of trauma and Pediatric Trauma Index were not associated with failure NOM. Children with blunted hepatic or splenic trauma respond to NOM. Factors such as BP 2 g/dl in the first 24 hours and transfusion of 3 or more units of RBC were associated with the failure in NOM.

  20. Renal failure affects the enzymatic activities of the three first steps in hepatic heme biosynthesis in the acute intermittent porphyria mouse.

    Directory of Open Access Journals (Sweden)

    Carmen Unzu

    Full Text Available Chronic kidney disease is a long-term complication in acute intermittent porphyria (AIP. The pathophysiological significance of hepatic overproduction of the porphyrin precursors aminolevulinate acid (ALA and porphobilinogen (PBG in chronic kidney disease is unclear. We have investigated the effect of repetitive acute attacks on renal function and the effect of total or five-sixth nephrectomy causing renal insufficiency on hepatic heme synthesis in the porphobilinogen deaminase (PBGD-deficient (AIP mouse. Phenobarbital challenge in the AIP-mice increased urinary porphyrin precursor excretion. Successive attacks throughout 14 weeks led to minor renal lesions with no impact on renal function. In the liver of wild type and AIP mice, 5/6 nephrectomy enhanced transcription of the first and rate-limiting ALA synthase. As a consequence, urinary PBG excretion increased in AIP mice. The PBG/ALA ratio increased from 1 in sham operated AIP animals to over 5 (males and over 13 (females in the 5/6 nephrectomized mice. Total nephrectomy caused a rapid decrease in PBGD activity without changes in enzyme protein level in the AIP mice but not in the wild type animals. In conclusion, high concentration of porphyrin precursors had little impact on renal function. However, progressive renal insufficiency aggravates porphyria attacks and increases the PBG/ALA ratio, which should be considered a warning sign for potentially life-threatening impairment in AIP patients with signs of renal failure.

  1. Systemic arteriovenous malformations as a cause of cardiac failure: Treatment with embolization

    International Nuclear Information System (INIS)

    Smith, E.J.; Hemingway, A.P.; Allison, D.J.

    1987-01-01

    Massive cogenital systemic arteriovenous malformations (AVMs) present considerable management problems for clinicians. Their size, position, and vascularity make successful surgical reaction impossible. Attempts at resection produce only temporary relief of symptoms and cause further disfigurement. Large AVMs give rise to pain, swelling, and distal ischaemia, can erode bone, and give rise to life-threatening hemorrhage, and a massive left or right shunt causes high-output cardiac failure and death. Ten patients (age range, 5-50 years; mean 26 years) have massive AVMs giving rise to high-output cardiac failure (26-28 liters). These patients (seven male, three female), have undergone a total of 43 embolization procedures. The advent of nonionic contrast media, digital subtraction angiography, steel coils, and balloons allows us to successfully treat these patients who until recently were condemned to die in high-output cardiac failure

  2. Interaction of Gender and Hepatitis C in Risk of Chronic Renal Failure After Liver Transplantation.

    Science.gov (United States)

    Ip, Stephen; Hussaini, Trana; Daulat, Aliya; Partovi, Nilufar; Erb, Siegfried R; Yoshida, Eric M; Marquez, Vladimir

    2017-01-01

    Chronic renal failure (CRF) is a significant cause of morbidity and mortality in post-liver transplantation (LT) recipients. The risk factors associated with the development of renal dysfunction are not clearly elucidated. To examine the risk factors in the development of CRF in these patients. Retrospective case-cohort of liver transplant patients without baseline kidney dysfunction who developed chronic renal failure during their follow-up. Of 370 patients, 254 met the inclusion criteria. 30% (76) of these patients had CRF of which 57% (43) were male. Age, estimated glomerular filtration rate (eGFR) at discharge, and HCV infection were found to be risk factors for CRF post-LT. The odds ratio of developing CRF was 1.4 (0.6-3.3) in males with HCV, 1.6 (0.7-3.9) in females without HCV and 4.4 (1.5-13.2) among females with HCV when compared to men without HCV. In this cohort of LT receipients of a major Canadian city, age, eGFR, and HCV infection were risk factors for CRF. Female gender and HCV increased this odds by a factor of more than 4.

  3. ICDE project report: collection and analysis of common-cause failures of batteries

    International Nuclear Information System (INIS)

    2003-12-01

    This report documents a study performed on the set of Common Cause Failure (CCF) events of batteries (BT). the events studied here were derived from the International CCF Data Exchange (ICDE) database, with contributions from organizations from several countries. 50 events in the ICDE database were studied by tabulating the data and observing the trends. The data span a period from 1980 through 2000. The database contains general information about event attributes such as root cause, coupling factor, common cause component group (CCCG) size, and corrective action. The objective of the report was also to develop the failure mechanisms and phenomena involved in the events, their relationship to the root causes, and possibilities for improvement

  4. Risk-based decision making to manage water quality failures caused by combined sewer overflows

    Science.gov (United States)

    Sriwastava, A. K.; Torres-Matallana, J. A.; Tait, S.; Schellart, A.

    2017-12-01

    Regulatory authorities set certain environmental permit for water utilities such that the combined sewer overflows (CSO) managed by these companies conform to the regulations. These utility companies face the risk of paying penalty or negative publicity in case they breach the environmental permit. These risks can be addressed by designing appropriate solutions such as investing in additional infrastructure which improve the system capacity and reduce the impact of CSO spills. The performance of these solutions is often estimated using urban drainage models. Hence, any uncertainty in these models can have a significant effect on the decision making process. This study outlines a risk-based decision making approach to address water quality failure caused by CSO spills. A calibrated lumped urban drainage model is used to simulate CSO spill quality in Haute-Sûre catchment in Luxembourg. Uncertainty in rainfall and model parameters is propagated through Monte Carlo simulations to quantify uncertainty in the concentration of ammonia in the CSO spill. A combination of decision alternatives such as the construction of a storage tank at the CSO and the reduction in the flow contribution of catchment surfaces are selected as planning measures to avoid the water quality failure. Failure is defined as exceedance of a concentration-duration based threshold based on Austrian emission standards for ammonia (De Toffol, 2006) with a certain frequency. For each decision alternative, uncertainty quantification results into a probability distribution of the number of annual CSO spill events which exceed the threshold. For each alternative, a buffered failure probability as defined in Rockafellar & Royset (2010), is estimated. Buffered failure probability (pbf) is a conservative estimate of failure probability (pf), however, unlike failure probability, it includes information about the upper tail of the distribution. A pareto-optimal set of solutions is obtained by performing mean

  5. Radiation necrosis causing failure of automatic ventilation during sleep with central sleep apnea

    International Nuclear Information System (INIS)

    Udwadia, Z.F.; Athale, S.; Misra, V.P.; Wadia, N.H.

    1987-01-01

    A patient operated upon for a midline cerebellar hemangioblastoma developed failure of automatic respiration during sleep, together with central sleep apnea syndrome, approximately two years after receiving radiation therapy to the brain. Clinical and CT scan findings were compatible with a diagnosis of radiation necrosis as the cause of his abnormal respiratory control

  6. Investigating the Causes of Heart Failure based on Persian Medicine Point of View

    Directory of Open Access Journals (Sweden)

    R Ghods

    2017-07-01

    CONCLUSION: Several factors are mentioned as the cause of heart failure or heart weakness in PM, only a few of which are considered in modern medicine. However, some of these less considered theories can be used as new assumptions to prevent and control this disease

  7. The difference in causes of early and late ultrafiltration failure in peritoneal dialysis

    NARCIS (Netherlands)

    Smit, Watske; Parikova, Alena; Struijk, Dirk G.; Krediet, Raymond T.

    2005-01-01

    OBJECTIVE: Ultrafiltration failure (UFF) is a major complication of peritoneal dialysis. Although it seems associated with long-term treatment, it can also occur in recently started patients. To identify the causes of this complication in patients with early and late UFF we studied a group of 48

  8. Implant failure caused by non-union of bisphosphonate-associated subtrochanteric femur fracture.

    LENUS (Irish Health Repository)

    O'Neill, Barry James

    2014-04-03

    Bisphosphonate use has been identified as a contributory factor in atypical subtrochanteric fracture of the femur. These fractures are commonly treated with an intramedullary device. We present a case of implant failure of an intrameduallary device caused by non-union of an atypical subtrochanteric fracture.

  9. Root cause analysis of pump valve failures of three membrane pump systems

    NARCIS (Netherlands)

    Buijs, L.J.; Eijk, A.; Hooft, L. van

    2014-01-01

    This paper will present the root cause analysis and the solution of fatigue failures of the pump valves of three membrane pump systems installed on a chemical plant of Momentive in Pernis, the Netherlands. The membrane pumps were installed approximately 30 years ago. Each system has encountered

  10. A modified GO-FLOW methodology with common cause failure based on Discrete Time Bayesian Network

    International Nuclear Information System (INIS)

    Fan, Dongming; Wang, Zili; Liu, Linlin; Ren, Yi

    2016-01-01

    Highlights: • Identification of particular causes of failure for common cause failure analysis. • Comparison two formalisms (GO-FLOW and Discrete Time Bayesian network) and establish the correlation between them. • Mapping the GO-FLOW model into Bayesian network model. • Calculated GO-FLOW model with common cause failures based on DTBN. - Abstract: The GO-FLOW methodology is a success-oriented system reliability modelling technique for multi-phase missions involving complex time-dependent, multi-state and common cause failure (CCF) features. However, the analysis algorithm cannot easily handle the multiple shared signals and CCFs. In addition, the simulative algorithm is time consuming when vast multi-state components exist in the model, and the multiple time points of phased mission problems increases the difficulty of the analysis method. In this paper, the Discrete Time Bayesian Network (DTBN) and the GO-FLOW methodology are integrated by the unified mapping rules. Based on these rules, the multi operators can be mapped into DTBN followed by, a complete GO-FLOW model with complex characteristics (e.g. phased mission, multi-state, and CCF) can be converted to the isomorphic DTBN and easily analyzed by utilizing the DTBN. With mature algorithms and tools, the multi-phase mission reliability parameter can be efficiently obtained via the proposed approach without considering the shared signals and the various complex logic operation. Meanwhile, CCF can also arise in the computing process.

  11. Liver regeneration signature in hepatitis B virus (HBV-associated acute liver failure identified by gene expression profiling.

    Directory of Open Access Journals (Sweden)

    Oriel Nissim

    Full Text Available The liver has inherent regenerative capacity via mitotic division of mature hepatocytes or, when the hepatic loss is massive or hepatocyte proliferation is impaired, through activation of hepatic stem/progenitor cells (HSPC. The dramatic clinical course of acute liver failure (ALF has posed major limitations to investigating the molecular mechanisms of liver regeneration and the role of HSPC in this setting. We investigated the molecular mechanisms of liver regeneration in 4 patients who underwent liver transplantation for hepatitis B virus (HBV-associated ALF.Gene expression profiling of 17 liver specimens from the 4 ALF cases and individual specimens from 10 liver donors documented a distinct gene signature for ALF. However, unsupervised multidimensional scaling and hierarchical clustering identified two clusters of ALF that segregated according to histopathological severity massive hepatic necrosis (MHN; 2 patients and submassive hepatic necrosis (SHN; 2 patients. We found that ALF is characterized by a strong HSPC gene signature, along with ductular reaction, both of which are more prominent in MHN. Interestingly, no evidence of further lineage differentiation was seen in MHN, whereas in SHN we detected cells with hepatocyte-like morphology. Strikingly, ALF was associated with a strong tumorigenesis gene signature. MHN had the greatest upregulation of stem cell genes (EpCAM, CK19, CK7, whereas the most up-regulated genes in SHN were related to cellular growth and proliferation. The extent of liver necrosis correlated with an overriding fibrogenesis gene signature, reflecting the wound-healing process.Our data provide evidence for a distinct gene signature in HBV-associated ALF whose intensity is directly correlated with the histopathological severity. HSPC activation and fibrogenesis positively correlated with the extent of liver necrosis. Moreover, we detected a tumorigenesis gene signature in ALF, emphasizing the close relationship between

  12. Rare cause of upper gastrointestinal bleeding owing to hepatic cancer invasion: a case report.

    Science.gov (United States)

    Wu, Wei-Ding; Wu, Jia; Yang, Hong-Guo; Chen, Yuan; Zhang, Cheng-Wu; Zhao, Da-Jian; Hu, Zhi-Ming

    2014-09-21

    Upper gastrointestinal bleeding refers to bleeding that arises from the gastrointestinal tract proximal to the ligament of Treitz. The primary reason for gastrointestinal bleeding associated with hepatocellular carcinoma is rupture of a varicose vein owing to pericardial hypotension. We report a rare case of gastrointestinal bleeding with hepatocellular carcinoma in a patient who presented with recurrent gastrointestinal bleeding. The initial diagnosis was gastric cancer with metastasis to the multiple lymph nodes of the lesser curvature. The patient underwent exploratory laparotomy, which identified two lesions in the gastric wall. Total gastrectomy and hepatic local excision was then performed. Pathological results indicated that the hepatocellular carcinoma had invaded the stomach directly, which was confirmed immunohistochemically. The patient is alive with a disease-free survival of 1 year since the surgery. Hepatocellular carcinoma with gastric invasion should be considered as a rare cause of upper gastrointestinal bleeding in hepatocellular carcinoma patients, especially with lesions located in the left lateral hepatic lobe. Surgery is the best solution.

  13. Finite Element Creep-Fatigue Analysis of a Welded Furnace Roll for Identifying Failure Root Cause

    Science.gov (United States)

    Yang, Y. P.; Mohr, W. C.

    2015-11-01

    Creep-fatigue induced failures are often observed in engineering components operating under high temperature and cyclic loading. Understanding the creep-fatigue damage process and identifying failure root cause are very important for preventing such failures and improving the lifetime of engineering components. Finite element analyses including a heat transfer analysis and a creep-fatigue analysis were conducted to model the cyclic thermal and mechanical process of a furnace roll in a continuous hot-dip coating line. Typically, the roll has a short life, modeling heat convection from hot air inside the furnace. The creep-fatigue analysis was performed by inputting the predicted temperature history and applying mechanical loads. The analysis results showed that the failure was resulted from a creep-fatigue mechanism rather than a creep mechanism. The difference of material properties between the filler metal and the base metal is the root cause for the roll failure, which induces higher creep strain and stress in the interface between the weld and the HAZ.

  14. Causes of Contractor's Business Failure in Developing Countries: The Case of Palestine

    Directory of Open Access Journals (Sweden)

    Sherif Mohamed

    2006-12-01

    Full Text Available The construction industry has unique characteristics that sharply distinguish it from other sectors of the economy. It is fragmented, very sensitive to the economic cycles and political environment, and has a significantly high rate of business failure. Business failure, collapse and bankruptcy are common terms in the industry due to the many risks inherited in how the industry operates. Throughout the world, the relative ease of entry gives rise to a large number of contracting firms competing fiercely in the market exposing many of them to business failure, Palestine is no exception. The objectives of this paper are to report on a research study which aims at exploring the causes of contractor's business failure in Palestine, and investigating their severity from the contractor's point of view. The study's results shows that the main causes of business failure are delay in collecting debt from clients (donors, border closure, heavy dependence on bank loans and payment of high interest on these loans, lack of capital, absence of industry regulations, low profit margin due to high competition, awarding contracts by client to the lowest bidder, and lack of experience in contract management. Based on these findings, recommendations to the Palestinian National Authority (PNA and local contractors are presented in this paper.

  15. Two clinically relevant pressures of carbon dioxide pneumoperitoneum cause hepatic injury in a rabbit model

    OpenAIRE

    Li, Jun; Liu, Ying-Hai; Ye, Zhan-Yong; Liu, He-Nian; Ou, Shan; Tian, Fu-Zhou

    2011-01-01

    AIM: To observe the hepatic injury induced by carbon dioxide pneumoperitoneum (CDP) in rabbits, compare the effects of low- and high-pressure pneumoperitoneum, and to determine the degree of hepatic injury induced by these two clinically relevant CDP pressures.

  16. Hepatic Rupture Caused by Hemolysis, Elevated Liver Enzyme, and Low Platelet Count Syndrome: A Case Report with Computed Tomographic and Conventional Angiographic Findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Cheong Bok; Ahn, Jae Hong; Choi, Soo Jung; Lee, Jong Hyeog; Park, Man Soo; Jung, Seung Mun; Ryu, Dae Sik [Dept. of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung (Korea, Republic of)

    2013-03-15

    The authors recently obtained successful clinical outcome after embolization of the hepatic artery and right inferior phrenic artery in a pregnant patient with hemolysis, elevated liver enzyme, and low platelet count (HELLP) syndrome causing hepatic rupture. We report the computed tomographic and conventional angiographic findings in a case of HELLP syndrome, resulting in hepatic infarction and rupture with active bleeding.

  17. Hepatitis A

    Science.gov (United States)

    ... Acute liver failure requires a stay in the hospital for monitoring and treatment. Some people with acute liver failure may need a liver transplant. Prevention The hepatitis A vaccine can prevent infection with the virus. The vaccine is typically given ...

  18. Uncertainties and quantification of common cause failure rates and probabilities for system analyses

    International Nuclear Information System (INIS)

    Vaurio, Jussi K.

    2005-01-01

    Simultaneous failures of multiple components due to common causes at random times are modelled by constant multiple-failure rates. A procedure is described for quantification of common cause failure (CCF) basic event probabilities for system models using plant-specific and multiple-plant failure-event data. Methodology is presented for estimating CCF-rates from event data contaminated with assessment uncertainties. Generalised impact vectors determine the moments for the rates of individual systems or plants. These moments determine the effective numbers of events and observation times to be input to a Bayesian formalism to obtain plant-specific posterior CCF-rates. The rates are used to determine plant-specific common cause event probabilities for the basic events of explicit fault tree models depending on test intervals, test schedules and repair policies. Three methods are presented to determine these probabilities such that the correct time-average system unavailability can be obtained with single fault tree quantification. Recommended numerical values are given and examples illustrate different aspects of the methodology

  19. Expanding arch aneurysm causing a "kink" in a Bentall graft and heart failure.

    Science.gov (United States)

    Al-Mohaissen, Maha A; Skarsgard, Peter; Khoo, Clarence; Virani, Sean A; Munt, Brad; Leipsic, Jonathon; Ignaszewski, Andrew

    2012-07-01

    Marfan syndrome is associated with a high incidence of aortic root aneurysm and life-threatening aortic dissection. With the successful use of surgical aortic root replacement, dissection-related mortality has been significantly reduced. We present the case of a patient with Marfan syndrome who presented with heart failure secondary to an unusual graft-related complication 14 years after a Bentall procedure. Investigations revealed a supra-aortic stenosis resulting from a kink in the Bentall graft caused by pressure from an expanding aortic arch aneurysm. The patient underwent surgery with improvement in his ejection fraction and heart failure symptoms.

  20. Successful Treatment of Fibrosing Organising Pneumonia Causing Respiratory Failure with Mycophenolic Acid.

    Science.gov (United States)

    Paul, Christina; Lin-Shaw, Ammy; Joseph, Mariamma; Kwan, Keith; Sergiacomi, Gianluigi; Mura, Marco

    2016-01-01

    Organising pneumonia (OP) is usually promptly responsive to corticosteroid treatment. We describe a series of 3 cases of severe, progressive, biopsy-proven fibrosing OP causing respiratory failure. All cases presented with peribronchial and subpleural consolidations, had a fibro-inflammatory infiltrative component in the alveolar septa, and only had a partial and unsatisfactory response to corticosteroids. However, they responded to mycophenolic acid (MPA) treatment with resolution of respiratory failure as well as clinical and functional improvement. MPA as an additional treatment option for aggressive forms of fibrosing OP and interstitial lung disease needs to be further explored. © 2016 S. Karger AG, Basel.

  1. ICDE project report on collection and analysis of common-cause failures of centrifugal pumps

    International Nuclear Information System (INIS)

    2000-01-01

    Several member countries of OECD/NEA decided to establish the International Common-Cause Failure Data Exchange (ICDE) Project to encourage multilateral co-operation in the collection and analysis of data relating to Common-Cause Failure (CCF) events. The project was initiated in August 1994 in Sweden and was discussed at meetings in both Sweden and France in 1995. A coding benchmark exercise was defined which was evaluated at meetings held in Germany and in the US in 1996. Subsequently, the exchange of centrifugal pump data was defined; the first phase of this exchange was evaluated at meetings in Switzerland and in France in 1997. The objectives of the ICDE Project are: - to collect and analyse CCF events in the long term so as to better understand such events, their causes, and their prevention, - to generate qualitative insights into the root causes of CCF events which can then be used to derive approaches or mechanisms for their prevention or for mitigating their consequences, - to establish a mechanism for the efficient feedback of experience gained on CCF phenomena, including the development of defences against their occurrence, such as indicators for risk based inspections. The ICDE Project is envisaged as including all possible events of interest, comprising complete, partial and incipient CCF events, called 'ICDE events' in the following. The Project covers the key components of the main safety systems, like centrifugal pumps, diesel generators, motor operated valves, power operated relief valves, safety relief valves, check valves, RPS circuit breakers, batteries and transmitters. Data are collected in an MS ACCESS based databank implemented and maintained at ES-Konsult, Sweden, by NEA appointed clearinghouse. The databank is regularly updated. The clearinghouse and the project group operate it. In the modelling of common-cause failures in systems consisting of several redundant components, two kinds of events are distinguished: a) Unavailability of a

  2. A robust Bayesian approach to modeling epistemic uncertainty in common-cause failure models

    International Nuclear Information System (INIS)

    Troffaes, Matthias C.M.; Walter, Gero; Kelly, Dana

    2014-01-01

    In a standard Bayesian approach to the alpha-factor model for common-cause failure, a precise Dirichlet prior distribution models epistemic uncertainty in the alpha-factors. This Dirichlet prior is then updated with observed data to obtain a posterior distribution, which forms the basis for further inferences. In this paper, we adapt the imprecise Dirichlet model of Walley to represent epistemic uncertainty in the alpha-factors. In this approach, epistemic uncertainty is expressed more cautiously via lower and upper expectations for each alpha-factor, along with a learning parameter which determines how quickly the model learns from observed data. For this application, we focus on elicitation of the learning parameter, and find that values in the range of 1 to 10 seem reasonable. The approach is compared with Kelly and Atwood's minimally informative Dirichlet prior for the alpha-factor model, which incorporated precise mean values for the alpha-factors, but which was otherwise quite diffuse. Next, we explore the use of a set of Gamma priors to model epistemic uncertainty in the marginal failure rate, expressed via a lower and upper expectation for this rate, again along with a learning parameter. As zero counts are generally less of an issue here, we find that the choice of this learning parameter is less crucial. Finally, we demonstrate how both epistemic uncertainty models can be combined to arrive at lower and upper expectations for all common-cause failure rates. Thereby, we effectively provide a full sensitivity analysis of common-cause failure rates, properly reflecting epistemic uncertainty of the analyst on all levels of the common-cause failure model

  3. Preliminary review of critical shutdown heat removal items for common cause failure susceptibility on LMFBR's. [LMFBR

    Energy Technology Data Exchange (ETDEWEB)

    Allard, L.T.; Elerath, J.G.

    1976-02-01

    This document presents a common cause failure analysis for Critical LMFBR Shutdown Heat Removal Systems. The report is intended to outline a systematic approach to defining areas with significant potential for common causes of failure, and ultimately provide inputs to the reliability prediction model. A preliminary evaluation of postulatd single initiating causes resulting in multiple failures of LMFBR-SHRS items is presented in Appendix C. This document will be periodically updated to reflect new information and activity.

  4. The added value of hepatitis E diagnostics in determining causes of hepatitis in routine diagnostic settings in the Netherlands

    NARCIS (Netherlands)

    Doting, M. H. E.; Weel, J.; Niesters, H. G. M.; Riezebos-Brilman, A.; Brandenburg, A.

    OBJECTIVES: Hepatitis E virus (HEV) genotype 3 is endemic in Europe and an underdiagnosed and emerging (public) health issue. In recent years commercial enzyme immunoassays (EIAs) that detect antibodies to HEV more adequately, became available. We investigated the added value of this HEV serology in

  5. The root cause analysis of 9DVN002ZV fan failure in Daya Bay Nuclear Power Station

    International Nuclear Information System (INIS)

    Guan Jianjun; Zhang Mingjia

    2005-01-01

    Extensive investigations and detailed analysis of the failure reason of 9DVN002ZV fan in Daya Bay Nuclear Power Station showed that the fan destroy was caused by the failure of non-drive end bear. The direct cause of this bearing' failure was its improper assembly caused by improper maintenance procedure, and the root cause was too small internal radial clearance after mounting. The factor affecting bearing internal radial clearance, the relationship between clearance and operating life time and fan failure process were discussed. (authors)

  6. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... Caregiver Support Caregiver Stories Home › What is Hepatic Encephalopathy? Why Your Liver is Important The Connection Between HE and Liver ... Why it’s Important to Treat HE Symptoms of Liver Failure Glossary of terms ... is Hepatic Encephalopathy? Hepatic Encephalopathy, sometimes referred to as portosystemic encephalopathy ...

  7. Hepatic Encephalopathy

    Science.gov (United States)

    ... Caregiver Support Caregiver Stories Home › What is Hepatic Encephalopathy? Why Your Liver is Important The Connection Between HE and Liver ... Why it’s Important to Treat HE Symptoms of Liver Failure Glossary of terms ... is Hepatic Encephalopathy? Hepatic Encephalopathy, sometimes referred to as portosystemic encephalopathy ...

  8. Protective effects of agmatine against D-galactosamine and lipopolysaccharide-induced fulminant hepatic failure in mice.

    Science.gov (United States)

    El-Agamy, Dina S; Makled, Mirhan N; Gamil, Nareman M

    2014-06-01

    Fulminant hepatic failure (FHF) is a life-threatening syndrome characterized by massive hepatic necrosis and high mortality. There is no effective therapy for the disease other than liver transplantation. This study aimed to investigate the effect of agmatine, inducible nitric oxide synthase (iNOS) inhibitor, on D-galactosamine and lipopolysaccharide (GalN/LPS)-induced FHF in mice and explore its possible mechanism(s). Male Swiss albino mice were injected with a single dose agmatine (14 mg/kg, IP) 8 h prior to challenge with a single intraperitoneal injection of both GalN (800 mg/kg) and LPS (50 μg/kg). Agmatine significantly attenuated all GalN/LPS-induced biochemical and pathological changes in liver. It prevented the increase of serum transaminases and alkaline phosphatase (ALP). In addition, agmatine markedly attenuated GalN/LPS-induced necrosis and inflammation. Agmatine significantly reduced oxidative stress and enhanced antioxidant enzymes. Importantly, agmatine decreased total nitric oxide (NO) and pro-inflammatory cytokine, tumor necrosis factor-alpha (TNF-α). These findings reveal that agmatine has hepatoprotective effects against GalN/LPS-induced FHF in mice that may be related to its ability to suppress oxidative stress, NO synthesis and TNF-α production. Therefore, agmatine may serve as a novel therapeutic strategy for hepatic inflammatory diseases.

  9. ξ common cause failure model and method for defense effectiveness estimation

    International Nuclear Information System (INIS)

    Li Zhaohuan

    1991-08-01

    Two issues have been dealt. One is to develop an event based parametric model called ξ-CCF model. Its parameters are expressed in the fraction of the progressive multiplicities of failure events. By these expressions, the contribution of each multiple failure can be presented more clearly. It can help to select defense tactics against common cause failures. The other is to provide a method which is based on the operational experience and engineering judgement to estimate the effectiveness of defense tactics. It is expressed in terms of reduction matrix for a given tactics on a specific plant in the event by event form. The application of practical example shows that the model in cooperation with the method can simply estimate the effectiveness of defense tactics. It can be easily used by the operators and its application may be extended

  10. Clinical Features and Transmission Pattern of Hepatitis A: An Experience from a Hepatitis A Outbreak Caused by Two Cocirculating Genotypes in Sri Lanka

    Science.gov (United States)

    Dahanayaka, Niroshana J.; Kiyohara, Tomoko; Agampodi, Suneth B.; Samaraweera, Pradeep K.; Kulasooriya, Gayani K.; Ranasinghe, Jagath C.; Semage, Saveen N.; Yoshizaki, Sayaka; Wakita, Takaji; Ishii, Koji

    2016-01-01

    Sri Lanka is one of the intermediate-endemic areas for hepatitis A virus (HAV), and concerns exist about the increasing HAV-susceptible population. In fact, Sri Lanka recorded a large hepatitis outbreak, possibly hepatitis A, around the end of the Sri Lankan war. It included more than 14,000 patients consisting of local residents, internally displaced personnel, and military personnel in the main combat zone. The outbreak had slowed down by October 2009; however, acute viral hepatitis continued to occur sequentially among military personnel. We obtained clinical information and serum samples from 222 patients with acute hepatitis who visited the Military Hospital Anuradhapura between January and September 2010. Samples were subjected to laboratory testing including HAV-immunoglobulin M and genotyping. Most patients (98.2%) were confirmed as having hepatitis A belonging to two subgenotypes: IA and IIIA. We did not observe any differences in clinical or biochemical features among patients with subgenotypes IA and IIIA except for pale stools and upper abdominal discomfort. During the investigation period, we observed a serial outbreak caused by identical HAV strains with an interval in line with that of typical HAV incubation periods. Most patients in the first outbreak were found in the training center, and patients in the second outbreak were found in multiple places where soldiers were assigned after the training center. These findings indicate that a strain of HAV diffused from one place to another along with movement of infected persons among the HAV-susceptible population. HAV vaccination for high-risk groups, such as young soldiers, is necessary. PMID:27382079

  11. Root cause analysis of SI line-seated thermal sleeve separation failures

    International Nuclear Information System (INIS)

    Jo, Jong Chull; Jhung, Myung Jo; Kim, Hho Jung

    2004-01-01

    At conventional pressurized water reactors, a thermal sleeve (named simply 'sleeve' hereafter) is seated inside the nozzle part of each Safety Injection (SI) branch pipe to prevent and relieve potential excessive transient thermal stress in the nozzle wall when a cold water is injected during the safety injection mode Recently, mechanical failures that the sleeves are separated from the SI branch pipe and fall into the connected cold leg main pipe were occurred in sequence at Yonggwang units 5 and 6 and Ulchin unit 5. There were many activities and efforts to figure out the causes of those failures with experts' reasoning, but the proposed causes were derived from superficial views rather than physically concrete grounds or analysis results. The prerequisites to find out the root causes of failure mechanism will be to identify the flow situation in the pipe junction area connecting the cold leg with the SI pipe and to know the vibration characteristics of sleeves. This paper investigates the flow field in the pipe junction thru a numerical simulation and vibration characteristics of thermal sleeves thru a modal analysis, from which the root causes of sleeve separation mechanism are analyzed

  12. Sedation for pediatric radiological procedures: analysis of potential causes of sedation failure and paradoxical reactions

    Energy Technology Data Exchange (ETDEWEB)

    Karian, V.E.; Burrows, P.E.; Connor, L. [Dept. of Radiology, Children' s Hospital, Boston, MA (United States); Zurakowski, D. [Dept. of Biostatistics, Children' s Hospital, Boston, MA (United States); Mason, K.P. [Dept. of Anesthesiology, Children' s Hospital, Boston, MA (United States)

    1999-11-01

    Background. Sedation for diagnostic imaging and interventional radiologic procedures in pediatrics has greatly increased over the past decade. With appropriate patient selection and monitoring, serious adverse effects are infrequent, but failure to sedate and paradoxical reactions do occur. Objective. The purpose of this study was to determine, among patients undergoing sedation for radiologic procedures, the incidence of sedation failure and paradoxical reaction to pentobarbital and to identify potentially correctable causes. Materials and methods. Records of 1665 patients who were sedated in the radiology department from 1 November 1997 to 1 July 1998 were reviewed. Patients failing sedation or experiencing paradoxical reaction were compared with respect to sex, age group, diagnosis, scan type, time of day, NPO status, use of IV contrast and type of sedation agent using the Fisher exact test, Pearson chi-square, analysis of variance (ANOVA), the Student t-test, and logistic regression. Results. Data analysis revealed a sedation failure rate of 1 % and paradoxical reaction rate of 1.2 %. Stepwise multiple logistic regression revealed that the only significant independent multivariate predictor of failure was the need for the administration of a combination of pentobarbital, fentanyl, and midazolam IV. Conclusion. The low rate of sedation failure and paradoxical reactions to pentobarbital was near optimal and probably cannot be improved with the currently available sedatives. (orig.)

  13. Sedation for pediatric radiological procedures: analysis of potential causes of sedation failure and paradoxical reactions

    International Nuclear Information System (INIS)

    Karian, V.E.; Burrows, P.E.; Connor, L.; Zurakowski, D.; Mason, K.P.

    1999-01-01

    Background. Sedation for diagnostic imaging and interventional radiologic procedures in pediatrics has greatly increased over the past decade. With appropriate patient selection and monitoring, serious adverse effects are infrequent, but failure to sedate and paradoxical reactions do occur. Objective. The purpose of this study was to determine, among patients undergoing sedation for radiologic procedures, the incidence of sedation failure and paradoxical reaction to pentobarbital and to identify potentially correctable causes. Materials and methods. Records of 1665 patients who were sedated in the radiology department from 1 November 1997 to 1 July 1998 were reviewed. Patients failing sedation or experiencing paradoxical reaction were compared with respect to sex, age group, diagnosis, scan type, time of day, NPO status, use of IV contrast and type of sedation agent using the Fisher exact test, Pearson chi-square, analysis of variance (ANOVA), the Student t-test, and logistic regression. Results. Data analysis revealed a sedation failure rate of 1 % and paradoxical reaction rate of 1.2 %. Stepwise multiple logistic regression revealed that the only significant independent multivariate predictor of failure was the need for the administration of a combination of pentobarbital, fentanyl, and midazolam IV. Conclusion. The low rate of sedation failure and paradoxical reactions to pentobarbital was near optimal and probably cannot be improved with the currently available sedatives. (orig.)

  14. Epidemiology and causes of death in a Swedish cohort of patients with autoimmune hepatitis.

    Science.gov (United States)

    Danielsson Borssén, Åsa; Marschall, Hanns-Ulrich; Bergquist, Annika; Rorsman, Fredrik; Weiland, Ola; Kechagias, Stergios; Nyhlin, Nils; Verbaan, Hans; Nilsson, Emma; Werner, Mårten

    2017-09-01

    Epidemiological studies of autoimmune hepatitis (AIH) show varying figures on prevalence and incidence, and data on the long-term prognosis are scarce. Objective To investigate the epidemiology, long-term prognosis and causes of death in a Swedish AIH cohort. Data collected from 634 AIH patients were matched to the Cause of Death Registry, and survival analyses were made. Prevalence and incidence were calculated for university hospitals with full coverage of cases and compared to the County of Västerbotten in Northern Sweden. AIH point prevalence was 17.3/100,000 inhabitants in 2009, and the yearly incidence 1990-2009 was 1.2/100,000 inhabitants and year. The time between diagnosis and end of follow-up, liver transplantation or death was in median 11.3 years (range 0-51.5 years). Men were diagnosed earlier (p death. Cirrhosis at diagnosis was linked to an inferior survival (p death was the most common cause of death (32.7%). The relative survival started to diverge from the general population 4 years after diagnosis but a distinct decline was not observed until after more than 10 years. Long-term survival was reduced in patients with AIH. No gender difference regarding prognosis was seen but men died younger, probably as a result of earlier onset of disease. Cirrhosis at diagnosis was a risk factor for poor prognosis and the overall risk of liver-related death was increased.

  15. Computed tomography findings of hepatic veno-occlusive disease caused by Sedum aizoon with histopathological correlation

    Energy Technology Data Exchange (ETDEWEB)

    Shao, H.; Chen, H. Z., E-mail: chenhz@enzemed.com; Zhu, J. S. [Department of Infectious Diseases, Taizhou Hospital Affiliated to Wenzhou Medical College, Linhai (China); Ruan, B. [State Key Laboratory for Diagnosis and Treatment of Infectious Disease, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou (China); Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou (China); Zhang, Z. Q. [Department of Infectious Disease, Xianju Hospital of Traditional Chinese Medicine, Xianju (China); Lin, X.; Gan, M. F. [Department of Infectious Diseases, Taizhou Hospital Affiliated to Wenzhou Medical College, Linhai (China)

    2015-11-23

    This study investigated the value of computed tomography (CT) in the diagnosis and treatment of hepatic veno-occlusive disease (HVOD) caused by Sedum aizoon (SA). The clinical manifestations, treatment results, imaging findings, and histological findings of the liver were analyzed in 39 patients with HVOD caused by SA. Hepatomegaly, liver dysfunction, abdominal effusion, and geographic density changes on liver CT scans were found in all 39 patients. The pathological findings of histological liver examination included swelling and point-like necrosis of liver cells, significant expansion and congestion of the sinuses, endothelial swelling, and wall thickening with incomplete lumen occlusion of small liver vessels. CT geographic density changes were confirmed by histological examination of the liver in 18 patients. Sixteen patients with small amounts of ascites that started within 4 weeks of treatment recovered completely or significantly improved after symptomatic and supportive treatment. However, only 43.75% of the patients with larger amounts of ascites improved following symptomatic and supportive treatment. In conclusion, liver CT examination is a valuable, safe, and noninvasive tool for the diagnosis of HVOD caused by SA. In selected cases, liver CT examination may replace liver biopsy and histological analysis.

  16. Alcoholic Hepatitis

    Science.gov (United States)

    ... yellow color. Confusion, drowsiness and slurred speech (hepatic encephalopathy). A damaged liver has trouble removing toxins from your body. The ... of toxins can damage your brain. Severe hepatic encephalopathy can result in ... of the liver frequently leads to liver failure. Kidney failure. A ...

  17. A rare cause of drug-induced hepatitis in an immunocompromised patient and the role of glutathione.

    Science.gov (United States)

    Senadhi, Viplove; Arora, Deepika; Arora, Manish; Marsh, Franklin

    2012-08-27

    The Food and Drug Administration (FDA) has issued a warning on numerous herbal drugs, including many popular products at General Nutrition Centers (GNC), regarding unstudied hepatotoxicity. There have been recent reports of GNC products such as hydroxycut and herbalife, causing drug-induced hepatitis. Herbal medications are over-the-counter products and are not investigated thoroughly by the FDA. Given that the most common outpatient laboratory abnormality is elevated liver transaminases, a sign of hepatocellular toxicity; it is not surprising that some of these products end up causing hepatic dysfunction, especially when taken in large volume. There are numerous herbal supplements that are hepatotoxic, however, these medications have a much more significant effect in human immunodeficiency virus (HIV)/ acquired immune deficiency syndrome patients, which is secondary to depleted glutathione. We present a rare case of drug induced hepatitis secondary to herbal medications used to treat HIV and elucidate the role of glutathione depletion in immunocompromised patients.

  18. Questioning the Role of Requirements Engineering in the Causes of Safety-Critical Software Failures

    Science.gov (United States)

    Johnson, C. W.; Holloway, C. M.

    2006-01-01

    Many software failures stem from inadequate requirements engineering. This view has been supported both by detailed accident investigations and by a number of empirical studies; however, such investigations can be misleading. It is often difficult to distinguish between failures in requirements engineering and problems elsewhere in the software development lifecycle. Further pitfalls arise from the assumption that inadequate requirements engineering is a cause of all software related accidents for which the system fails to meet its requirements. This paper identifies some of the problems that have arisen from an undue focus on the role of requirements engineering in the causes of major accidents. The intention is to provoke further debate within the emerging field of forensic software engineering.

  19. The causes, consequences, and treatment of left or right heart failure

    Directory of Open Access Journals (Sweden)

    Peteiro J

    2011-04-01

    Full Text Available Pablo Pazos-López, Jesús Peteiro-Vázquez, Ana Carcía-Campos, Lourdes García-Bueno, Juan Pablo Abugattas de Torres, Alfonso Castro-BeirasDepartment of Cardiology, Complejo hospitalario Universitario A Coruña, A Coruña, SpainAbstract: Chronic heart failure (HF is a cardiovascular disease of cardinal importance because of several factors: a an increasing occurrence due to the aging of the population, primary and secondary prevention of cardiovascular events, and modern advances in therapy, b a bad prognosis: around 65% of patients are dead within 5 years of diagnosis, c a high economic cost: HF accounts for 1% to 2% of total health care expenditure. This review focuses on the main causes, consequences in terms of morbidity, mortality and costs and treatment of HF.Keywords: heart failure, cause, consequence, treatment

  20. What caused Chicago bank failures in the Great Depression? A look at the 1920s.

    OpenAIRE

    Natacha Postel-Vinay

    2015-01-01

    This paper reassesses the causes of Chicago bank failures during the Great Depression by tracking the evolution of their balance sheets in the 1920s. I find that all Chicago banks suffered tremendous deposit withdrawals; however banks that failed earlier in the 1930s had invested more in mortgages in the 1920s. The main problem with mortgages was their lack of liquidity, not their quality. Banks heavily engaged in mortgages did not have enough liquid assets to face the withdrawals and failed....

  1. Classic Bartter syndrome: a rare cause of failure to thrive in a child

    OpenAIRE

    Vieira, Helena; Mendes, Leonor; Mendes, Patricia; da Silva, José Esteves

    2012-01-01

    Bartter syndrome is a group of rare autosomal-recessive disorders caused by a defect in distal tubule transport of sodium and chloride. Blood gases and plasma electrolytes raise suspicion of this diagnosis and the definitive diagnosis is made by genetic study. Early treatment improves prognosis. The authors present the case of an 11-month-old child with early failure to thrive and severe regurgitation. Blood gases revealed hypochloraemic metabolic alkalosis, hyponatraemia and hypokalaemia. Bl...

  2. Common-cause failure analysis of McGuire Unit 2 auxiliary feedwater system

    International Nuclear Information System (INIS)

    Rasmuson, D.M.; Shepherd, J.C.; Fowler, R.D.; Summitt, R.L.; Logan, B.W.

    1982-01-01

    A powerful method for qualitative common cause failure analysis (CCFA) of nuclear power plant systems was developed by EG and G Idaho at the Idaho National Engineering Laboratory. As a cooperative project to demonstrate and evaluate the usefulness of the method, the Duke Power Company agreed to allow a CCFA of the auxiliary feedwater system (AFWS) in their McGuire Nuclear Station Unit 2. The results of the CCFA are the subject of this discussion

  3. Cheyne-Stokes respiration in patients with congestive heart failure: causes and consequences

    OpenAIRE

    Lorenzi-Filho,Geraldo; Genta,Pedro R; Figueiredo,Adelaide C.; Inoue,Daniel

    2005-01-01

    Cheyne-Stokes respiration is a form of periodic breathing in which central apneas and hypopneas alternate with periods of hyperventilation, producing a waxing and waning pattern of tidal volume. This review focuses on the causes and consequences of Cheyne-Stokes respiration in patients with congestive heart failure, in whom the prevalence is strikingly high and ranges from 30% to 50%. Several factors have been implicated in the genesis of Cheyne-Stokes respiration, including low cardiac outpu...

  4. Occult Amebic Liver Abscess as Cause of Extensive Inferior Vena Cava and Hepatic Vein Thrombosis.

    Science.gov (United States)

    Martin, Leslie; Burute, Nishigandha; Haider, Ehsan; Serrano, Pablo E; O'Shea, Timothy; Siegal, Deborah

    2017-10-01

    The most common extraintestinal complication of Entamoeba histolytica is amebic liver abscess (ALA). Hepatic vein and inferior vena cava (IVC) thrombosis are rare but well-documented complications of ALA, typically attributed to mechanical compression and inflammation associated with a large abscess. We present a case of a previously healthy 43-year-old Canadian man presenting with constitutional symptoms and right upper quadrant abdominal pain. He was found to have thrombophlebitis of the IVC, accessory right hepatic vein, and bilateral iliac veins. Extensive investigations for thrombophilia were negative. Magnetic resonance imaging of the liver demonstrated a 3.2-cm focal area of parenchymal abnormality that was reported as presumptive hepatocellular carcinoma, and a 1.9-cm lesion in the caudate lobe with diffusion restriction and peripheral rim enhancement. Despite multiple biopsy attempts, a histopathological diagnosis was not achieved. Abdominal pain and fever 4 months later prompted repeat ultrasound demonstrating a 10.4- × 12.0-cm rim-enhancing fluid attenuation lesion felt to represent a liver abscess. Thick dark "chocolate brown" drainage from the lesion and positive serology for E. histolytica confirmed the diagnosis of ALA acquired from a previous trip to Cuba. The patient was started on treatment with metronidazole and paromomycin and repeat abdominal ultrasound demonstrated resolution of the abscess. This case is the first to demonstrate extensive IVC thrombosis secondary to a relatively small occult ALA and emphasizes the thrombogenic potential of ALA. Amebic infection should be considered as a rare cause of IVC thrombosis in the correct clinical context.

  5. S-100b and neuron-specific enolase in patients with fulminant hepatic failure

    DEFF Research Database (Denmark)

    Strauss, Gitte Irene; Christiansen, Michael; Møller, Kirsten

    2001-01-01

    , the cerebral flux of S-100b and NSE was measured. We included 35 patients with FHF, 6 patients with acute on chronic liver disease (AOCLD), 13 patients with cirrhosis of the liver without hepatic encephalopathy, and 8 healthy subjects. Blood samples were obtained from catheters placed in the radial artery...

  6. Evaluation of depression as a risk factor for treatment failure in chronic hepatitis C

    DEFF Research Database (Denmark)

    Leutscher, Peter Derek Christian; Lagging, Martin; Buhl, Mads Rauning

    2010-01-01

    The Major Depression Inventory (MDI) was used to estimate the value of routine medical interviews in diagnosing major depression among patients receiving peginterferon alfa-2a and ribavirin therapy for chronic hepatitis C virus (HCV) infection (n = 325). According to criteria from the MDI...

  7. Identification of Modeling Approaches To Support Common-Cause Failure Analysis

    International Nuclear Information System (INIS)

    Korsah, Kofi; Wood, Richard Thomas

    2015-01-01

    Experience with applying current guidance and practices for common-cause failure (CCF) mitigation to digital instrumentation and control (I&C) systems has proven problematic, and the regulatory environment has been unpredictable. The impact of CCF vulnerability is to inhibit I&C modernization and, thereby, challenge the long-term sustainability of existing plants. For new plants and advanced reactor concepts, the issue of CCF vulnerability for highly integrated digital I&C systems imposes a design burden resulting in higher costs and increased complexity. The regulatory uncertainty regarding which mitigation strategies are acceptable (e.g., what diversity is needed and how much is sufficient) drives designers to adopt complicated, costly solutions devised for existing plants. The conditions that constrain the transition to digital I&C technology by the U.S. nuclear industry require crosscutting research to resolve uncertainty, demonstrate necessary characteristics, and establish an objective basis for qualification of digital technology for usage in Nuclear Power Plant (NPP) I&C applications. To fulfill this research need, Oak Ridge National Laboratory is conducting an investigation into mitigation of CCF vulnerability for nuclear-qualified applications. The outcome of this research is expected to contribute to a fundamentally sound, comprehensive technical basis for establishing the qualification of digital technology for nuclear power applications. This report documents the investigation of modeling approaches for representing failure of I&C systems. Failure models are used when there is a need to analyze how the probability of success (or failure) of a system depends on the success (or failure) of individual elements. If these failure models are extensible to represent CCF, then they can be employed to support analysis of CCF vulnerabilities and mitigation strategies. Specifically, the research findings documented in this report identify modeling approaches that

  8. Identification of Modeling Approaches To Support Common-Cause Failure Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Korsah, Kofi [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Wood, Richard Thomas [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2015-06-01

    Experience with applying current guidance and practices for common-cause failure (CCF) mitigation to digital instrumentation and control (I&C) systems has proven problematic, and the regulatory environment has been unpredictable. The impact of CCF vulnerability is to inhibit I&C modernization and, thereby, challenge the long-term sustainability of existing plants. For new plants and advanced reactor concepts, the issue of CCF vulnerability for highly integrated digital I&C systems imposes a design burden resulting in higher costs and increased complexity. The regulatory uncertainty regarding which mitigation strategies are acceptable (e.g., what diversity is needed and how much is sufficient) drives designers to adopt complicated, costly solutions devised for existing plants. The conditions that constrain the transition to digital I&C technology by the U.S. nuclear industry require crosscutting research to resolve uncertainty, demonstrate necessary characteristics, and establish an objective basis for qualification of digital technology for usage in Nuclear Power Plant (NPP) I&C applications. To fulfill this research need, Oak Ridge National Laboratory is conducting an investigation into mitigation of CCF vulnerability for nuclear-qualified applications. The outcome of this research is expected to contribute to a fundamentally sound, comprehensive technical basis for establishing the qualification of digital technology for nuclear power applications. This report documents the investigation of modeling approaches for representing failure of I&C systems. Failure models are used when there is a need to analyze how the probability of success (or failure) of a system depends on the success (or failure) of individual elements. If these failure models are extensible to represent CCF, then they can be employed to support analysis of CCF vulnerabilities and mitigation strategies. Specifically, the research findings documented in this report identify modeling approaches that

  9. Probabilistic common cause failure modeling for auxiliary feedwater system after the introduction of flood barriers

    International Nuclear Information System (INIS)

    Zheng, Xiaoyu; Yamaguchi, Akira; Takata, Takashi

    2013-01-01

    Causal inference is capable of assessing common cause failure (CCF) events from the viewpoint of causes' risk significance. Authors proposed the alpha decomposition method for probabilistic CCF analysis, in which the classical alpha factor model and causal inference are integrated to conduct a quantitative assessment of causes' CCF risk significance. The alpha decomposition method includes a hybrid Bayesian network for revealing the relationship between component failures and potential causes, and a regression model in which CCF parameters (global alpha factors) are expressed by explanatory variables (causes' occurrence frequencies) and parameters (decomposed alpha factors). This article applies this method and associated databases needed to predict CCF parameters of auxiliary feedwater (AFW) system when defense barriers against internal flood are introduced. There is scarce operation data for functionally modified safety systems and the utilization of generic CCF databases is of unknown uncertainty. The alpha decomposition method has the potential of analyzing the CCF risk of modified AFW system reasonably based on generic CCF databases. Moreover, the sources of uncertainty in parameter estimation can be studied. An example is presented to demonstrate the process of applying Bayesian inference in the alpha decomposition process. The results show that the system-specific posterior distributions for CCF parameters can be predicted. (author)

  10. An informatics-based approach to reducing heart failure all-cause readmissions: the Stanford heart failure dashboard.

    Science.gov (United States)

    Banerjee, Dipanjan; Thompson, Christine; Kell, Charlene; Shetty, Rajesh; Vetteth, Yohan; Grossman, Helene; DiBiase, Aria; Fowler, Michael

    2017-05-01

    Reduction of 30-day all-cause readmissions for heart failure (HF) has become an important quality-of-care metric for health care systems. Many hospitals have implemented quality improvement programs designed to reduce 30-day all-cause readmissions for HF. Electronic medical record (EMR)-based measures have been employed to aid in these efforts, but their use has been largely adjunctive to, rather than integrated with, the overall effort. We hypothesized that a comprehensive EMR-based approach utilizing an HF dashboard in addition to an established HF readmission reduction program would further reduce 30-day all-cause index hospital readmission rates for HF. After establishing a quality improvement program to reduce 30-day HF readmission rates, we instituted EMR-based measures designed to improve cohort identification, intervention tracking, and readmission analysis, the latter 2 supported by an electronic HF dashboard. Our primary outcome measure was the 30-day index hospital readmission rate for HF, with secondary measures including the accuracy of identification of patients with HF and the percentage of patients receiving interventions designed to reduce all-cause readmissions for HF. The HF dashboard facilitated improved penetration of our interventions and reduced readmission rates by allowing the clinical team to easily identify cohorts with high readmission rates and/or low intervention rates. We significantly reduced 30-day index hospital all-cause HF readmission rates from 18.2% at baseline to 14% after implementation of our quality improvement program ( P  = .045). Implementation of our EMR-based approach further significantly reduced 30-day index hospital readmission rates for HF to 10.1% ( P for trend = .0001). Daily time to screen patients decreased from 1 hour to 15 minutes, accuracy of cohort identification improved from 83% to 94.6% ( P  = .0001), and the percentage of patients receiving our interventions, such as patient education

  11. Digoxin Use and Lower 30-day All-cause Readmission for Medicare Beneficiaries Hospitalized for Heart Failure

    NARCIS (Netherlands)

    Ahmed, Ali; Bourge, Robert C.; Fonarow, Gregg C.; Patel, Kanan; Morgan, Charity J.; Fleg, Jerome L.; Aban, Inmaculada B.; Love, Thomas E.; Yancy, Clyde W.; Deedwania, Prakash; van Veldhuisen, Dirk J.; Filippatos, Gerasimos S.; Anker, Stefan D.; Allman, Richard M.

    BACKGROUND: Heart failure is the leading cause for hospital readmission, the reduction of which is a priority under the Affordable Care Act. Digoxin reduces 30-day all-cause hospital admission in chronic systolic heart failure. Whether digoxin is effective in reducing readmission after

  12. Diencephalic syndrome: a frequently neglected cause of failure to thrive in infants.

    Science.gov (United States)

    Kim, Ahlee; Moon, Jin Soo; Yang, Hye Ran; Chang, Ju Young; Ko, Jae Sung; Seo, Jeong Kee

    2015-01-01

    Diencephalic syndrome is an uncommon cause of failure to thrive in early childhood that is associated with central nervous system neoplasms in the hypothalamic-optic chiasmatic region. It is characterized by complex signs and symptoms related to hypothalamic dysfunction; such nonspecific clinical features may delay diagnosis of the brain tumor. In this study, we analyzed a series of cases in order to define characteristic features of diencephalic syndrome. We performed a retrospective study of 8 patients with diencephalic syndrome (age, 5-38 months). All cases had presented to Seoul National University Children's Hospital between 1995 and 2013, with the chief complaint of poor weight gain. Diencephalic syndrome with central nervous system (CNS) neoplasm was identified in 8 patients. The mean age at which symptoms were noted was 18±10.5 months, and diagnosis after symptom onset was made at the mean age of 11±9.7 months. The mean z score was -3.15±1.14 for weight, -0.12±1.05 for height, 1.01±1.58 for head circumference, and -1.76±1.97 for weight-for-height. Clinical features included failure to thrive (n=8), hydrocephalus (n=5), recurrent vomiting (n=5), strabismus (n=2), developmental delay (n=2), hyperactivity (n=1), nystagmus (n=1), and diarrhea (n=1). On follow-up evaluation, 3 patients showed improvement and remained in stable remission, 2 patients were still receiving chemotherapy, and 3 patients were discharged for palliative care. Diencephalic syndrome is a rare cause of failure to thrive, and diagnosis is frequently delayed. Thus, it is important to consider the possibility of a CNS neoplasm as a cause of failure to thrive and to ensure early diagnosis.

  13. Analysis approach for common cause failure on non-safety digital control system

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yun Goo; Oh, Eungse [Korea Hydro and Nuclear Power Co. Ltd., Daejeon (Korea, Republic of)

    2014-05-15

    The effects of common cause failure (CCF) on safety digital instrumentation and control (I and C) system had been considered in defense in depth and diversity coping analysis with safety analysis method. For the non-safety system, single failure had been considered for safety analysis. IEEE Std. 603-1991, Clause 5.6.3.1(2), 'Isolation' states that no credible failure on the non-safety side of an isolation device shall prevent any portion of a safety system from meeting its minimum performance requirements during and following any design basis event requiring that safety function. The software CCF is one of the credible failure on the non-safety side. In advanced digital I and C system, same hardware component is used for different control system and the defect in manufacture or common external event can generate CCF. Moreover, the non-safety I and C system uses complex software for its various function and software quality assurance for the development process is less severe than safety software for the cost effective design. Therefore the potential defects in software cannot be ignored and the effect of software CCF on non-safety I and C system is needed to be evaluated. This paper proposes the general process and considerations for the analysis of CCF on non-safety I and C system.

  14. Presentation of common cause failures in fault tree structure of Krsko PSA : an historical overview

    International Nuclear Information System (INIS)

    Vrbanic, I.; Kosutic, I.; Vukovic, I.; Simic, Z.

    2003-01-01

    Failure of multiple components due to a common cause represents one of the most important issues in evaluation of system reliability or unavailability. The frequency of such events has relatively low expectancy, when compared to random failures, which affect individual components. However, in many cases the consequence is a direct loss of safety system or mitigative safety function. For this reason, the modeling of a common cause failure (CCF) and its presentation in fault tree structure is of the uttermost importance in probabilistic safety analyses (PSA). During the past decade, PSA model of Krsko NPP has undergone many small changes and a couple of major ones in fulfilling its basic purpose, which was serving as a tool for providing an appropriate information on the risk associated with actual plant design and operation. All changes to Krsko PSA model were undertaken in order to make it a better tool and / or to make it represent the plant in more accurate manner. The paper provides an overview of changes in CCF modeling in the fault tree structure from the initial PSA model development till present. (author)

  15. Estimation Procedure of Common Cause Failure Parameters for CAFE-PSA

    International Nuclear Information System (INIS)

    Kang, Dae Il; Hwang, M. J.; Han, S. H.

    2009-03-01

    Detailed common cause failure (CCF) analysis generally needs the data for CCF events from other nuclear power plants because the CCF events rarely occur. Since 2002, KAERI has participated in the international common cause failure data exchange (ICDE) project to get data for CCF events. The operation office of the ICDE project sent about 400 CCF event data for emergency diesel generators, motor operated valves, check valves, pumps, and breakers to KAERI in 2009. However, there was no program available to analyze the ICDE CCF event data. Therefore, we developed the CAFE-PSA (common CAuse Failure Event analysis program for PSA) to estimate CCF parameters by using the ICDE CCF event data. With CAFE-PSA, the CCF events in the ICDE database can be qualitatively and quantitatively analyzed. The qualitative analysis results of the ICDE CCF data, by using the CAFE-PSA, showed that the major root cause of CCF events, for motor operated valves, check valves, and pumps, was the fault of their internal parts, and that for emergency diesel generators and breakers was the inadequacy of design/manufacture or construction. The quantitative analysis results of the ICDE CCF data, by using the CAFE-PSA, showed that the estimated Alpha Factors of components, mentioned above, were lower than those previously used in the PSA for domestic nuclear power plants, but were higher than those in USNRC 2007 CCF data. Through performing qualitative and quantitative analysis of the ICDE CCF data, by using the CAFE-PSA, a plan for coping with CCF events for design and operation of nuclear power plants can be produced and reasonable values for CCF parameters can be estimated. In addition, it is expected that the technical adequacy of PSA can be improved

  16. Classic Bartter syndrome: a rare cause of failure to thrive in a child.

    Science.gov (United States)

    Vieira, Helena; Mendes, Leonor; Mendes, Patricia; da Silva, José Esteves

    2012-06-28

    Bartter syndrome is a group of rare autosomal-recessive disorders caused by a defect in distal tubule transport of sodium and chloride. Blood gases and plasma electrolytes raise suspicion of this diagnosis and the definitive diagnosis is made by genetic study. Early treatment improves prognosis. The authors present the case of an 11-month-old child with early failure to thrive and severe regurgitation. Blood gases revealed hypochloraemic metabolic alkalosis, hyponatraemia and hypokalaemia. Blood pressure was normal and polyuria was documented. She began therapy with potassium chloride supplementation and indomethacin. There was clinical improvement and plasma potassium and bicarbonate normalised. The molecular study confirmed it was the classic form of Bartter syndrome. Despite being rare in clinical practice, which may lead to unnecessary medical investigation and diagnosis delay, in a child with failure to thrive, hypochloraemic metabolic alkalosis and hypokalaemia, this diagnosis must be considered.

  17. Acute respiratory failure caused by organizing pneumonia secondary to antineoplastic therapy for non-Hodgkin's lymphoma

    Science.gov (United States)

    Santana, Adriell Ramalho; Amorim, Fábio Ferreira; Soares, Paulo Henrique Alves; de Moura, Edmilson Bastos; Maia, Marcelo de Oliveira

    2012-01-01

    Interstitial lung diseases belong to a group of diseases that typically exhibit a subacute or chronic progression but that may cause acute respiratory failure. The male patient, who was 37 years of age and undergoing therapy for non-Hodgkin's lymphoma, was admitted with cough, fever, dyspnea and acute hypoxemic respiratory failure. Mechanical ventilation and antibiotic therapy were initiated but were associated with unfavorable progression. Thoracic computed tomography showed bilateral pulmonary "ground glass" opacities. Methylprednisolone pulse therapy was initiated with satisfactory response because the patient had used three drugs related to organizing pneumonia (cyclophosphamide, doxorubicin and rituximab), and the clinical and radiological symptoms were suggestive. Organizing pneumonia may be idiopathic or linked to collagen diseases, drugs and cancer and usually responds to corticosteroid therapy. The diagnosis was anatomopathological, but the patient's clinical condition precluded performing a lung biopsy. Organizing pneumonia should be a differential diagnosis in patients with apparent pneumonia and a progression that is unfavorable to antimicrobial treatment. PMID:23917942

  18. External Dacryocystorhinostomy; Success Rate and Causes of Failure in Endoscopic and Pathologic Evaluations.

    Science.gov (United States)

    Ghasemi, Hassan; Asghari Asl, Sajedeh; Yarmohammadi, Mohammad Ebrahim; Jafari, Farhad; Izadi, Pupak

    2017-01-01

    External dacryocystorhinostomy (DCR) is the method of choice to treat nasolacrimal duct (NLD) obstruction and the other approaches are compared with it, with a failure rate of 4% to 13%. The current study aimed to assess the causes of failure in external DCR by postoperative endoscopic and pathological evaluation. The current retrospective cross sectional study followed-up113 patients with external DCR and silicone intubation for three months. Silicone tubes were removed after the third months. Failure was confirmed based on the clinical findings and irrigation test. Paranasal sinus computed tomography (CT) scanning, and endoscopic and pathological evaluations were performed in the failed cases. Totally, 113 patients underwent external DCR. The patients included 71 females and 42 males. The mean age of the patients was 55.91 years; ranged from 18 to 86. Epiphora was the most common complaint before surgery (90.3%). Clinically, epiphora continued in 17 cases (15%), of which 94.11% had at least one sinus CT abnormality and 82.35% had at least one endoscopic abnormality. The most common endoscopic findings were deviated septum (70.6%), scar tissue (52.94%), concha bullosa (46.9%), septal adhesion (47.05%), enlarged middle turbinate (41.2%), and sump syndrome (11.7%). The failure was significantly associated with the chronicity of the initial symptoms (P-value=0.00). Pathologically, there were significant relationship amongst the failure rate, scar formation, and allergic rhinitis (P-values =0.00 and <0.05, respectively). Preoperative endonasal evaluation and consultation with an otolaryngologist can improve surgical outcomes and help to have a better conscious to intranasal abnormalities before external DCR surgery.

  19. Complex bladder-exstrophy-epispadias management: Causes of failure of initial bladder closure

    Directory of Open Access Journals (Sweden)

    Kouame Dibi Bertin

    2014-01-01

    Full Text Available The success of the initial closure of the complex bladder-exstrophy remains a challenge in pediatric surgery. This study describes a personal experience of the causes of failure of the initial closure and operative morbidity during the surgical treatment of bladder-exstrophy complex. From April 2000 to March 2014, four patients aged 16 days to 7 years and 5 months underwent complex exstrophy-epispadias repair with pelvic osteotomies. There were three males and one female. Three of them had posterior pelvic osteotomy, one had anterior innominate osteotomy. Bladder Closure: Bladder closure was performed in three layers. Our first patient had initial bladder closure with polyglactin 4/0 (Vicryl ® 4/0, concerning the last three patients, initial bladder closure was performed with polydioxanone 4/0 (PDS ® 4/0. The bladder was repaired leaving the urethral stent and ureteral stents for full urinary drainage for three patients. In one case, only urethral stent was left, ureteral drainage was not possible, because stents sizes were more important than the ureteral diameter. Out of a total of four patients, initial bladder closure was completely achieved for three patients. At the immediate postoperative follow-up, two patients presented a complete disunion of the abdominal wall and bladder despite an appropriate postoperative care. The absorbable braided silk (polyglactin used for the bladder closure was considered as the main factor in the failure of the bladder closure. The second cause of failure of the initial bladder closure was the incomplete urine drainage, ureteral catheterisation was not possible because the catheters sizes were too large compared with the diameters of the ureters. The failure of the initial bladder-exstrophy closure may be reduced by a closure with an absorbable monofilament silk and efficient urine drainage via ureteral catheterisation.

  20. Power distribution gradients in WWER type cores and fuel failure root causes

    Energy Technology Data Exchange (ETDEWEB)

    Mikuš, Ján M., E-mail: JanMikus.nrc@hotmail.com

    2014-02-15

    Highlights: • Power (fission rate) distribution gradients can represent fuel failure root causes. • Positions with above gradients were investigated in WWER type cores on reactor LR-0. • Above gradients were evaluated near core heterogeneities and construction materials. • Results can be used for code validation and fuel failure occurrence investigation. - Abstract: Neutron flux non-uniformity and gradients of neutron current resulting in corresponding power (fission rate) distribution changes can represent root causes of the fuel failure. Such situation can be expected in vicinity of some core heterogeneities and construction materials. Since needed data cannot be obtained from nuclear power plant (NPP), results of some benchmark type experiments performed on light water, zero-power research reactor LR-0 were used for investigation of the above phenomenon. Attention was focused on determination of the spatial power distribution changes in fuel assemblies (FAs): Containing fuel rods (FRs) with Gd burnable absorber in WWER-440 and WWER-1000 type cores, Neighboring the core blanket and dummy steel assembly simulators on the periphery of the WWER-440 standard and low leakage type cores, resp., Neighboring baffle in WWER-1000 type cores, and Neighboring control rod (CR) in WWER-440 type cores, namely (a) power peak in axial power distribution in periphery FRs of the adjacent FAs near the area between CR fuel part and butt joint to the CR absorbing part and (b) decrease in radial power distribution in FRs near CR absorbing part. An overview of relevant experimental results from reactor LR-0 and some information concerning leaking FAs on NPP Temelín are presented. Obtained data can be used for code validation and subsequently for the fuel failure occurrence investigation.

  1. On the value of redundancy subject to common-cause failures: Toward the resolution of an on-going debate

    International Nuclear Information System (INIS)

    Hoepfer, V.M.; Saleh, J.H.; Marais, K.B.

    2009-01-01

    Common-cause failures (CCF) are one of the more critical and challenging issues for system reliability and risk analyses. Academic interest in modeling CCF, and more broadly in modeling dependent failures, has steadily grown over the years in the number of publications as well as in the sophistication of the analytical tools used. In the past few years, several influential articles have shed doubts on the relevance of redundancy arguing that 'redundancy backfires' through common-cause failures, and that the latter dominate unreliability, thus defeating the purpose of redundancy. In this work, we take issue with some of the results of these publications. In their stead, we provide a nuanced perspective on the (contingent) value of redundancy subject to common-cause failures. First, we review the incremental reliability and MTTF provided by redundancy subject to common-cause failures. Second, we introduce the concept and develop the analytics of the 'redundancy-relevance boundary': we propose this redundancy-relevance boundary as a design-aid tool that provides an answer to the following question: what level of redundancy is relevant or advantageous given a varying prevalence of common-cause failures? We investigate the conditions under which different levels of redundancy provide an incremental MTTF over that of the single component in the face of common-cause failures. Recognizing that redundancy comes at a cost, we also conduct a cost-benefit analysis of redundancy subject to common-cause failures, and demonstrate how this analysis modifies the redundancy-relevance boundary. We show how the value of redundancy is contingent on the prevalence of common-cause failures, the redundancy level considered, and the monadic cost-benefit ratio. Finally we argue that general unqualified criticism of redundancy is misguided, and efforts are better spent for example on understanding and mitigating the potential sources of common-cause failures rather than deriding the concept

  2. Bleeding from ruptured hepatic metastases as a cause of syncope in an octogenarian: a case report

    Directory of Open Access Journals (Sweden)

    Rizeq Mazen M

    2010-06-01

    Full Text Available Abstract Introduction Acute hemoperitoneum as a result of hemorrhage from liver metastases is an uncommon but serious condition. The use of appropriate imaging is important in the diagnosis and can have a profound impact on subsequent management. This case is important because the presentation was of recurrent syncopal episodes with an unusual underlying cause. This case highlights the need to consider this diagnosis in the differential in patients presenting with collapse in the acute setting. Case presentation We present the case of an 85-year-old Caucasian man who was admitted following a collapse episode and was found to be persistently hypotensive despite aggressive resuscitation. An acute intra-peritoneal bleed originating from hepatic metastases from an unknown primary was identified promptly with computed tomography imaging and was subsequently managed conservatively. Conclusions This case aims to convey key teaching points: (A the need to consider intra-abdominal hemorrhage in the differential diagnosis when assessing patients with collapse; and (B the use of appropriate imaging such as computed tomography can facilitate a prompt diagnosis and appropriate management steps can then be taken accordingly.

  3. Trial application of the candidate root cause categorization scheme and preliminary assessment of selected data bases for the root causes of component failures program

    International Nuclear Information System (INIS)

    Bruske, S.Z.; Cadwallader, L.C.; Stepina, P.L.

    1985-04-01

    The objective of the Nuclear Regulatory Commission's (NRC) Root Causes of Component Failures Program is to develop and apply a categorization scheme for identifying root causes of failures for components that comprise safety and safety support systems of nuclear power plants. Results from this program will provide valuable input in the areas of probabilistic risk assessment, reliability assurance, and application of risk assessments in the inspection program. This report presents the trial application and assessment of the candidate root cause categorization scheme to three failure data bases: the In-Plant Reliability Data System (IPRDS), the Licensee Event Report (LER) data base, and the Nuclear Plant Reliability Data System (NPRDS). Results of the trial application/assessment show that significant root cause information can be obtained from these failure data bases

  4. The pacemaker-twiddler's syndrome: an infrequent cause of pacemaker failure.

    Science.gov (United States)

    Salahuddin, Mohammad; Cader, Fathima Aaysha; Nasrin, Sahela; Chowdhury, Mashhud Zia

    2016-01-20

    The pacemaker-twiddler's syndrome is an uncommon cause of pacemaker malfunction. It occurs due to unintentional or deliberate manipulation of the pacemaker pulse generator within its skin pocket by the patient. This causes coiling of the lead and its dislodgement, resulting in failure of ventricular pacing. More commonly reported among elderly females with impaired cognition, the phenomenon usually occurs in the first year following pacemaker implantation. Treatment involves repositioning of the dislodged leads and suture fixation of the lead and pulse generator within its pocket. An 87 year old Bangladeshi lady who underwent a single chamber ventricular pacemaker (VVI mode: i.e. ventricle paced, ventricle sensed, inhibitory mode) implantation with the indication of complete heart block, and presented to us again 7 weeks later, with syncopal attacks. She admitted to repeatedly manipulating the pacemaker generator in her left pectoral region. Physical examination revealed a heart rate of 42 beats/minute, blood pressure 140/80 mmHg and bilateral crackles on lung auscultation. She had no cognitive deficit. An immediate electrocardiogram showed complete heart block with pacemaker spikes and failure to capture. Chest X-ray showed coiled and retracted right ventricular lead and rotated pulse generator. An emergent temporary pace maker was set at a rate of 60 beats per minute. Subsequently, she underwent successful lead repositioning with strong counselling to avoid further twiddling. Twiddler's syndrome should be considered as a cause of pacemaker failure in elderly patients presenting with bradyarrythmias following pacemaker implantation. Chest X-ray and electrocardiograms are simple and easily-available first line investigations for its diagnosis. Lead repositioning is required, however proper patient education and counselling against further manipulation is paramount to long-term management.

  5. Renal and post-renal causes of acute renal failure in children

    International Nuclear Information System (INIS)

    Jamal, A.; Ramzan, A.

    2004-01-01

    Objective: To identify the causes of acute renal failure (ARF) in pediatric population along with the identification of the age and gender most affected by the failure. Subjects and Methods: The study included children under the age of 12 years who presented with signs and symptoms suggestive of ARF (oliguria/anuria, vomiting, acidotic breathing etc.) along with raised blood urea nitrogen (BUN) serum creatinine and metabolic acidosis as shown by arterial blood gases (ABGs). Patients were divided into two group on the basis of age; group A consisting of 0-2 years and group B from >2 years. Patients presenting with transient pre-renal azotaemia were excluded from the study. After providing initial emergency cover, detailed history, physical examination and investigations were carried out according to a proforma specially designed to ascertain the cause of ARF. Patients were managed for ARF as per standard recommendations and investigations completed or repeated as and when required. Results: A total of 119 patients with ARF were admitted in the ward over a period of two years constituting 1.36% of the total admissions and 16.39% of the admissions due to renal pathology. Mean age of presentation was 4.5 years 16.7% of the patients under the age of 5 years. Male predominance was noted in all ages with an overall male to female ratio of 2.3:1. Most common cause leading to ARF in younger age group was found to be hemolytic uremic syndrome [25(54.34%)] followed by septicemia [7(15.21 %)]. In older patients renal calculus disease was the most common [22(30.13%)] underlying pathology followed by pre-existing, undiagnosed chronic renal failure [16(21.91 %)]. Conclusion: ARF is fairly cotton in children especially under the age of 5 years showing a male predominance. More than 90% of the cases can be prevented by improving primary health care and by early and prompt treatment of infections. (author)

  6. Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery.

    Science.gov (United States)

    Song, Minju; Kim, Hyeon-Cheol; Lee, Woocheol; Kim, Euiseong

    2011-11-01

    This study examined the clinical causes of failure and the limitation of a previous endodontic treatment by an inspection of the root apex and resected root surface at 26× magnification during endodontic microsurgery. The data were collected from patients in the Department of Conservative Dentistry at the Dental College, Yonsei University in Seoul, Korea between March 2001 and January 2011. All root-filled cases with symptomatic or asymptomatic apical periodontitis were enrolled in this study. All surgical procedures were performed by using an operating microscope. The surface of the apical root to be resected or the resected root surface after methylene blue staining was examined during the surgical procedure and recorded carefully with 26× magnification to determine the state of the previous endodontic treatment by using an operating microscope. Among the 557 cases with periapical surgery, 493 teeth were included in this study. With the exclusion of unknown cases, the most common possible cause of failure was perceived leakage around the canal filling material (30.4%), followed by a missing canal (19.7%), underfilling (14.2%), anatomical complexity (8.7%), overfilling (3.0%), iatrogenic problems (2.8%), apical calculus (1.8%), and cracks (1.2%). The frequency of possible failure causes differed according to the tooth position (P < .001). An appreciation of the root canal anatomy by using an operating microscope in nonsurgical endodontic treatment can make the prognosis more predictable and favorable. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  7. Defense-in-depth for common cause failure of nuclear power plant safety system software

    International Nuclear Information System (INIS)

    Tian Lu

    2012-01-01

    This paper briefly describes the development of digital I and C system in nuclear power plant, and analyses the viewpoints of NRC and other nuclear safety authorities on Software Common Cause Failure (SWCCF). In view of the SWCCF issue introduced by the digitized platform adopted in nuclear power plant safety system, this paper illustrated a diversified defence strategy for computer software and hardware. A diversified defence-in-depth solution is provided for digital safety system of nuclear power plant. Meanwhile, analysis on problems may be faced during application of nuclear safety license are analyzed, and direction of future nuclear safety I and C system development are put forward. (author)

  8. Ischemic Cholangitis Caused by Transcatheter Hepatic Arterial Chemoembolization 10 Months After Resection of the Extrahepatic Bile Duct

    International Nuclear Information System (INIS)

    Hasegawa, Kiyoshi; Kubota, Keiichi; Aoki, Taku; Hirai, Ichiro; Miyazawa, Masashi; Ohtomo, Kuni; Makuuchi, Masatoshi

    2000-01-01

    We report a case of ischemic cholangitis that occurred after transcatheter hepatic arterial chemoembolization (TAE). Ten months prior to TAE the patient had undergone central bisegmentectomy for hepatocellular carcinoma with resection of the extrahepatic bile duct. Eleven days after TAE, he developed suppurative cholangitis and multiple organ failure. Prior surgical ligation of the peribiliary arteries around the extrahepatic bile duct followed by TAE was considered to have played a crucial role in the development of ischemic cholangitis. This case demonstrates the importance of blood flow from the peribiliary arteries for the survival of the biliary epithelium

  9. OECD/NEA International Common Cause Failure Data Exchange (ICDE) project - insights and lessons learnt

    International Nuclear Information System (INIS)

    Johanson, G.; Kreuser, A.; Pyy, P.; Rasmuson, D.; Werner, W.

    2006-01-01

    Events initiated by common-cause-failure (CCF) can significantly affect the availability and reliability of nuclear power plant safety systems. In recognition of this, CCF data are systematically collected and analysed in the International Common-Cause Data Exchange (ICDE) Project, which was initiated in August 1994. Since April 1998, the NEA has formally operated the project. Currently eleven countries participate in the project. The ICDE collects all events where two or more identical, redundant components of a group, fulfilling the same function, have failed or were impaired due to a shared cause (ICDE events). Complete CCFs, i. e. failure of all identical, redundant components in the group due to a shared cause are an important subset of the collected data. Currently, data exchange and analysis covers the following components: centrifugal pumps, diesel generators, motor-operated valves, safety and relief valves, check valves, reactor protection system components (level measurement, control rod drives, etc), circuit breakers, and batteries. The main findings of the ICDE reports issued by 2005 show averaged over all components that about two thirds of all complete CCF events involve faulty actions by plant personnel and contractors. The single largest contribution is from faulty testing and maintenance work due to deficient and/or incomplete procedures. Other important causes are insufficient testing and requalification of components or systems after maintenance, repair, modifications or backfitting work, as well as operator errors of commission. The probability that a reported ICDE event is a complete CCF decreases strongly with increasing number of redundant components, demonstrating the effectiveness of redundancy as a powerful defence against CCFs. However, complete CCFs cannot be completely prevented by high redundancy only. (orig.)

  10. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... Now Hepatic Encephalopathy Back Hepatic Encephalopathy is a brain disorder that develops in some individuals with liver ... is a condition that causes temporary worsening of brain function in people with advanced liver disease. When ...

  11. Incisional hernia as an unusual cause of hepatic encephalopathy in a 62-year-old man with cirrhosis: a case report

    Directory of Open Access Journals (Sweden)

    Ustaoglu Muge

    2009-09-01

    Full Text Available Abstract Introduction Hepatic encephalopathy may be initiated by many factors such as gastrointestinal bleeding, infections, fluid and electrolyte disturbances. Hypokalemia is one of the most commonly encountered electrolyte abnormalities causing hepatic encephalopathy in patients with cirrhosis. Case presentation We present the case of a 62-year-old Caucasian man with decompensated liver cirrhosis having multiple episodes of hepatic encephalopathy precipitated by vomiting. He had an incisional hernia at the right lumbar region. A barium contrast study of the small intestine and magnetic resonance imaging showed that the hernial sac included gastric antrum and bowel. We observed that hepatic encephalopathy coincided with hypokalemia as a result of a large volume of vomiting triggered by the collapsed hernial sac. Hepatic encephalopathy was resolved by administration of intravenous potassium. Conclusion This case illustrates that a hernia causing a large volume of vomiting may be a precipitant factor in the development of hepatic encephalopathy.

  12. Common cause failure data collection and analysis for safety-related components of TRIGA SSR-14MW Pitesti, Romania

    International Nuclear Information System (INIS)

    Radu, G.; Mladin, D.

    2003-01-01

    This paper presents a study performed on the set of common cause failures (CCF) of safety-related components of the research reactor TRIGA SSR-14 MW Pitesti. The data collected cover a period of 20 years, from 1979 to 2000. The sources of data are Shift Supervisor Reports, Work Authorizations, and Reactor Log Books. Events collected are analyzed by failure mode and degrees of failure. Qualitative analysis of root causes, coupling factors and corrective actions and quantitative analysis of CCF events are studied. The objective of this work is to develop qualitative insights in the nature of the reported events and to build a site-specific common cause events database. (author)

  13. Coil Embolization of an Arteriobiliary Fistula Caused by Hepatic Intra-Arterial Chemotherapy

    International Nuclear Information System (INIS)

    Takao, Hidemasa; Doi, Ippei; Makita, Kohzoh; Watanabe, Toshiaki

    2005-01-01

    Arteriobiliary fistula is a rare complication of hepatic intra-arterial chemotherapy. We report successful coil embolization of an arteriobiliary fistula. An 80-year-old woman underwent percutaneous placement of an indwelling catheter into the replaced right hepatic artery for intra-arterial chemotherapy of liver metastases. Coil embolization of the left hepatic artery was not performed. The patient complained of abdominal pain during intra-arterial chemotherapy. Angiography revealed a fistula between the replaced right hepatic artery and the common bile duct. The fistula was successfully treated by coil embolization via the indwelling catheter, and the indwelling catheter was removed. Although such complications usually herald the termination of intra-arterial chemotherapy, the patient underwent percutaneous implantation of a new catheter-port system, and intra-arterial chemotherapy was restarted

  14. A teenager presents with fulminant hepatic failure and acute hemolytic anemia.

    Science.gov (United States)

    Bose, Somnath; Sonny, Abraham; Rahman, Nadeem

    2015-03-01

    A teenager was admitted to an outside hospital ED following an episode of melena. He had been complaining of intermittent abdominal pain, nausea, malaise, and easy fatigability for 2 months, with significant worsening of symptoms 2 weeks prior to this episode. He had no significant medical, surgical, or family history. On presentation at the outside ED, he was found to be profoundly icteric and encephalopathic. Initial laboratories suggested anemia, acute kidney injury, and acute liver failure, leading to a presumptive diagnosis of acute fulminant liver failure necessitating transfer to our institution.

  15. Amelioration of High Cholesterol Diet Caused Lipids Accumulation in Hepatic Cells by Rutin and Ascorbic Acid

    OpenAIRE

    Abdulaziz M. Aleisa

    2013-01-01

    Non Alcoholic Fatty Liver Disease (NAFLD) has become a very common metabolic disorder. It refers to a group of conditions where excess fats are deposited in hepatic cells. Several approaches have been considered for the management of NAFLD including dietary changes, which were reported to suppress hepatic lipids accumulation in previous studies. The present study was designed to investigate the possible synergistic effects of Rutin (RT) and Ascorbic Acid (AA) against lipids accumulation in he...

  16. Random safety auditing, root cause analysis, failure mode and effects analysis.

    Science.gov (United States)

    Ursprung, Robert; Gray, James

    2010-03-01

    Improving quality and safety in health care is a major concern for health care providers, the general public, and policy makers. Errors and quality issues are leading causes of morbidity and mortality across the health care industry. There is evidence that patients in the neonatal intensive care unit (NICU) are at high risk for serious medical errors. To facilitate compliance with safe practices, many institutions have established quality-assurance monitoring procedures. Three techniques that have been found useful in the health care setting are failure mode and effects analysis, root cause analysis, and random safety auditing. When used together, these techniques are effective tools for system analysis and redesign focused on providing safe delivery of care in the complex NICU system. Copyright 2010 Elsevier Inc. All rights reserved.

  17. Causes of failure to control hypertension in people over 65 years of age

    Directory of Open Access Journals (Sweden)

    Alireza Khosravi

    2012-03-01

    Full Text Available BACKGROUND: Hypertension is a major cause of cardiovascular diseases whose prevalence increases by 10% for every 10 years after 50 years of age. This study aimed to investigate the causes of failure to control blood pressure in people aged over 65 years old. METHODS: This descriptive case-control study was conducted on 200 participants aged over 65 years old who were diagnosed with hypertension through a routine travel check-up for pilgrimage to Mecca in Amin Hospital, Isfahan, Iran during 2003. Following the medical examinations and blood pressure measurements according to the World Health Organization (WHO standards, the participants were divided into two groups of controlled blood pressure (case and uncontrolled blood pressure (control. A questionnaire was filled in for each participant and the data was analyzed using chi-square and student-t tests. RESULTS: The mean age was 70.7 ± 5.2 and 69 ± 4.9 in case and control groups, respectively. Less than half of the participants in the case group took anti-hypertensive medicine, out of which 87.5% were treated by a physician and 12.5% practiced self-therapy. In addition, 25% took their medicine regularly and 55% expressed a lack of motivation as the cause of discontinuing their medication. Furthermore, patients with controlled blood pressure had significantly better knowledge and performance than the case group (P < 0.05. CONCLUSION: The most common causes of failure to control blood pressure were poor knowledge, inappropriate practice in diet, stress, smoking, and irregular intake of medication. Keywords: Hypertension, Cardiovascular Diseases, Antihypertensive Agents, Diet Therapy    

  18. International common-cause failure data exchange. ICDE general coding guidelines - Technical note

    International Nuclear Information System (INIS)

    Johanson, Gunnar; Werner, Wolfgang; Concepcion Capote, Marina; Kreuser, Albert; Rasmuson, Dale; Jonsson, Esther; Pereira Pagan, Begona; Tirira, Jorge; Morris, Ian; Morales, Rosa; Oxberry, Anna; Kreuser, Albert

    2004-01-01

    Several Member countries of the Nuclear Energy Agency of the Organisation for Economic Co-operation and Development (OECD/NEA) have established the International Common-Cause Failure Data Exchange Project (ICDE Project) to encourage multilateral co-operation in the collection and analysis of data relating to Common-Cause Failure (CCF) events. The objectives of the ICDE Project are to: a) Collect and analyse CCF events over the long term so as to better understand such events, their causes, and their prevention; b) Generate qualitative insights into the root causes of CCF events which can then be used to derive approaches or mechanisms for their prevention or for mitigating their consequences; c) Establish a mechanism for the efficient feedback of experience gained in connection with CCF phenomena, including the development of defences against their occurrence, such as indicators for risk based inspections; and d) Record event attributes to facilitate quantification of CCF frequencies when so decided by the Project Working Group. The ICDE Project is envisaged to comprise all possible events of interest, including both complete and partial ICDE events. The ICDE Project will cover the key components of the main safety systems. Presently, the components listed below are included in the ICDE Project. Data have been collected for the six first components in the list: Centrifugal pumps, Diesel generators, Motor operated valves, Safety relief valves/power operated relief valves, Check valves, Batteries, Level measurement, Breakers, Control rod drive assemblies. Others will be added to this list later on. In this component coding guidelines, explanations on the ICDE General coding format are given. The guide reflects present experience with the data format and with the collected data. Further interpretations and clarifications will be added, should they become necessary. For each component analysed in the ICDE project, separate coding guidance is provided in the appendices

  19. Estimation of the common cause failure probabilities on the component group with mixed testing scheme

    International Nuclear Information System (INIS)

    Hwang, Meejeong; Kang, Dae Il

    2011-01-01

    Highlights: ► This paper presents a method to estimate the common cause failure probabilities on the common cause component group with mixed testing schemes. ► The CCF probabilities are dependent on the testing schemes such as staggered testing or non-staggered testing. ► There are many CCCGs with specific mixed testing schemes in real plant operation. ► Therefore, a general formula which is applicable to both alternate periodic testing scheme and train level mixed testing scheme was derived. - Abstract: This paper presents a method to estimate the common cause failure (CCF) probabilities on the common cause component group (CCCG) with mixed testing schemes such as the train level mixed testing scheme or the alternate periodic testing scheme. In the train level mixed testing scheme, the components are tested in a non-staggered way within the same train, but the components are tested in a staggered way between the trains. The alternate periodic testing scheme indicates that all components in the same CCCG are tested in a non-staggered way during the planned maintenance period, but they are tested in a staggered way during normal plant operation. Since the CCF probabilities are dependent on the testing schemes such as staggered testing or non-staggered testing, CCF estimators have two kinds of formulas in accordance with the testing schemes. Thus, there are general formulas to estimate the CCF probability on the staggered testing scheme and non-staggered testing scheme. However, in real plant operation, there are many CCCGs with specific mixed testing schemes. Recently, Barros () and Kang () proposed a CCF factor estimation method to reflect the alternate periodic testing scheme and the train level mixed testing scheme. In this paper, a general formula which is applicable to both the alternate periodic testing scheme and the train level mixed testing scheme was derived.

  20. International Common Cause Failure Data Exchange (ICDE). General Coding Guidelines - Updated Version, October 2011

    International Nuclear Information System (INIS)

    Johanson, Gunnar; Werner, Wolfgang; Capote, Marina Concepcion; Kreuser, Albert

    2012-01-01

    Several OECD/NEA member countries have established the International Common-Cause Failure Data Exchange Project ('ICDE Project') to encourage multilateral cooperation in the collection and analysis of data relating to Common-Cause Failure (CCF) events. The objectives of the ICDE Project are to: a) Collect and analyse CCF events over the long term so as to better understand such events, their causes, and their prevention. b) Generate qualitative insights into the root causes of CCF events which can then be used to derive approaches or mechanisms for their prevention or for mitigating their consequences. c) Establish a mechanism for the efficient feedback of experience gained in connection with CCF phenomena, including the development of defenses against their occurrence, such as indicators for risk based inspections. d) Record event attributes to facilitate quantification of CCF frequencies when so decided by the Project Working Group. The ICDE Project is envisaged to comprise all possible events of interest, including both complete and partial ICDE events. The ICDE Project will cover the key components of the main safety systems. Presently, the components listed below are included in the ICDE Project. Data have been collected for the six first components in the list: Centrifugal pumps, Diesel generators, Motor operated valves, Safety relief valves/power operated relief valves, Check valves, Batteries, Level measurement, Breakers, Control rod drive assemblies. Others will be added to this list later on. In this component coding guidelines, explanations on the ICDE general coding format are given. The guide reflects present experience with the data format and with the collected data. Further interpretations and clarifications will be added, should they become necessary. For each component analysed in the ICDE project, separate coding guidance is provided in the appendices ICDECG 01-06, specifying details relevant to the respective components

  1. HIV reservoirs and immune surveillance evasion cause the failure of structured treatment interruptions: a computational study.

    Directory of Open Access Journals (Sweden)

    Emiliano Mancini

    Full Text Available Continuous antiretroviral therapy is currently the most effective way to treat HIV infection. Unstructured interruptions are quite common due to side effects and toxicity, among others, and cannot be prevented. Several attempts to structure these interruptions failed due to an increased morbidity compared to continuous treatment. The cause of this failure is poorly understood and often attributed to drug resistance. Here we show that structured treatment interruptions would fail regardless of the emergence of drug resistance. Our computational model of the HIV infection dynamics in lymphoid tissue inside lymph nodes, demonstrates that HIV reservoirs and evasion from immune surveillance themselves are sufficient to cause the failure of structured interruptions. We validate our model with data from a clinical trial and show that it is possible to optimize the schedule of interruptions to perform as well as the continuous treatment in the absence of drug resistance. Our methodology enables studying the problem of treatment optimization without having impact on human beings. We anticipate that it is feasible to steer new clinical trials using computational models.

  2. Tsunamis caused by submarine slope failures along western Great Bahama Bank.

    Science.gov (United States)

    Schnyder, Jara S D; Eberli, Gregor P; Kirby, James T; Shi, Fengyan; Tehranirad, Babak; Mulder, Thierry; Ducassou, Emmanuelle; Hebbeln, Dierk; Wintersteller, Paul

    2016-11-04

    Submarine slope failures are a likely cause for tsunami generation along the East Coast of the United States. Among potential source areas for such tsunamis are submarine landslides and margin collapses of Bahamian platforms. Numerical models of past events, which have been identified using high-resolution multibeam bathymetric data, reveal possible tsunami impact on Bimini, the Florida Keys, and northern Cuba. Tsunamis caused by slope failures with terminal landslide velocity of 20 ms -1 will either dissipate while traveling through the Straits of Florida, or generate a maximum wave of 1.5 m at the Florida coast. Modeling a worst-case scenario with a calculated terminal landslide velocity generates a wave of 4.5 m height. The modeled margin collapse in southwestern Great Bahama Bank potentially has a high impact on northern Cuba, with wave heights between 3.3 to 9.5 m depending on the collapse velocity. The short distance and travel time from the source areas to densely populated coastal areas would make the Florida Keys and Miami vulnerable to such low-probability but high-impact events.

  3. Retreatment of patients with treatment failure of direct-acting antivirals: Focus on hepatitis C virus genotype 1b.

    Science.gov (United States)

    Kanda, Tatsuo; Nirei, Kazushige; Matsumoto, Naoki; Higuchi, Teruhisa; Nakamura, Hitomi; Yamagami, Hiroaki; Matsuoka, Shunichi; Moriyama, Mitsuhiko

    2017-12-14

    The recent development of direct-acting antiviral agents (DAAs) against hepatitis C virus (HCV) infection could lead to higher sustained virological response (SVR) rates, with shorter treatment durations and fewer adverse events compared with regimens that include interferon. However, a relatively small proportion of patients cannot achieve SVR in the first treatment, including DAAs with or without peginterferon and/or ribavirin. Although retreatment with a combination of DAAs should be conducted for these patients, it is more difficult to achieve SVR when retreating these patients because of resistance-associated substitutions (RASs) or treatment-emergent substitutions. In Japan, HCV genotype 1b (GT1b) is founded in 70% of HCV-infected individuals. In this minireview, we summarize the retreatment regimens and their SVR rates for HCV GT1b. It is important to avoid drugs that target the regions targeted by initial drugs, but next-generation combinations of DAAs, such as sofosbuvir/velpatasvir/voxilaprevir for 12 wk or glecaprevir/pibrentasvir for 12 wk, are proposed to be potential solution for the HCV GT1b-infected patients with treatment failure, mainly on a basis of targeting distinctive regions. Clinicians should follow the new information and resources for DAAs and select the proper combination of DAAs for the retreatment of HCV GT1b-infected patients with treatment failure.

  4. Two distinct subtypes of hepatitis B virus-related acute liver failure are separable by quantitative serum immunoglobulin M anti-hepatitis B core antibody and hepatitis B virus DNA levels

    DEFF Research Database (Denmark)

    Dao, Doan Y; Hynan, Linda S; Yuan, He-Jun

    2012-01-01

    Hepatitis B virus (HBV)-related acute liver failure (HBV-ALF) may occur after acute HBV infection (AHBV-ALF) or during an exacerbation of chronic HBV infection (CHBV-ALF). Clinical differentiation of the two is often difficult if a previous history of HBV is not available. Quantitative measurements...... of immunoglobulin M (IgM) anti-hepatitis B core antibody (anti-HBc) titers and of HBV viral loads (VLs) might allow the separation of AHBV-ALF from CHBV-ALF. Of 1,602 patients with ALF, 60 met clinical criteria for AHBV-ALF and 27 for CHBV-ALF. Sera were available on 47 and 23 patients, respectively. A quantitative...... immunoassay was used to determine IgM anti-HBc levels, and real-time polymerase chain reaction (rtPCR) was used to determine HBV VLs. AHBV-ALFs had much higher IgM anti-HBc titers than CHBV-ALFs (signal-to-noise [S/N] ratio median: 88.5; range, 0-1,120 versus 1.3, 0-750; P

  5. BDD-based reliability evaluation of phased-mission systems with internal/external common-cause failures

    International Nuclear Information System (INIS)

    Xing, Liudong; Levitin, Gregory

    2013-01-01

    Phased-mission systems (PMS) are systems in which multiple non-overlapping phases of operations (or tasks) are accomplished in sequence for a successful mission. Examples of PMS abound in applications such as aerospace, nuclear power, and airborne weapon systems. Reliability analysis of a PMS must consider statistical dependence across different phases as well as dynamics in system configuration, failure criteria, and component behavior. This paper proposes a binary decision diagrams (BDD) based method for the reliability evaluation of non-repairable binary-state PMS with common-cause failures (CCF). CCF are simultaneous failure of multiple system elements, which can be caused by some external factors (e.g., lightning strikes, sudden changes in environment) or by propagated failures originating from some elements within the system. Both the external and internal CCF is considered in this paper. The proposed method is combinatorial, exact, and is applicable to PMS with arbitrary system structures and component failure distributions. An example with different CCF scenarios is analyzed to illustrate the application and advantages of the proposed method. -- Highlights: ► Non-repairable phased-mission systems with common-cause failures are analyzed. ► Common-cause failures caused by internal or external factors are considered. ► A combinatorial algorithm based on binary decision diagrams is suggested

  6. Downstream Hepatic Arterial Blood Pressure Changes Caused by Deployment of the Surefire AntiReflux Expandable Tip

    International Nuclear Information System (INIS)

    Rose, Steven C.; Kikolski, Steven G.; Chomas, James E.

    2013-01-01

    Purpose: The purpose of this work was to evaluate blood pressure changes caused by deployment of the Surefire antireflux expandable tip. The pressure measurements are relevant because they imply changes in hepatoenteric arterial blood flow within this liver compartment during hepatic artery delivery of cytotoxic agents. Methods: After positioning the Surefire antireflux system in the targeted hepatic artery, blood pressure was obtained initially with the tip collapsed (or through a femoral artery sheath), then again after the tip was expanded before chemoembolization or yttrium 90 ( 90 Y) radioembolization. Results: Eighteen patients with liver malignancy underwent 29 procedures in 29 hepatic arteries (3 common hepatic, 22 lobar, 4 segmental). Systolic, diastolic, and mean blood pressure were all decreased by a mean of 29 mm Hg (p = 0.000004), 14 mm Hg (p = 0.0000004), and 22 mm Hg (p = 0.00000001), respectively. Conclusion: When the Surefire expandable tip is deployed to prevent retrograde reflux of agents, it also results in a significant decrease in blood pressure in the antegrade distribution, potentially resulting in hepatopedal blood flow in vessels that are difficult to embolize, such as the supraduodenal arteries

  7. The diagnosis and therapy of intractable upper gastrointestinal hemorrhage caused by hepatic arterioportal vein fistulas in hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Luo Pengfei; Chen Xiaoming; Lu Ligong; Hu Baoshan; Li Yong

    2007-01-01

    Objective: To investigate the hemodynamics of increasing portal venous pressure(PVP) in hepatocellular carcinoma patients complicated with hepatic arterioportal vein fistulas (HAPVF) and the diagnosis and therapy of intractable upper gastrointestinal hemorrhage caused by HAPVF. Methods: One hundred and fifteen cases of hepatocellular carcinoma with upper gastrointestinal hemorrhage were checked by hepatic arteriography and were treated through orifices embolization in cases with severe HAPCF by coils and/or ethanol. Results: Twenty-six out of 31 patients suffering intractable upper gastrointestinal hemorrhage have severe HAPVF (the main stem of portal veins are visible). However, there are only 15 patients with light HAPVF among the 84 patients who have mild upper gastrointestinal hemorrhage (the main stem of portal veins are invisible). After the embolization, all of the 26 patients who have severe HAPVF stopped bleeding. Among them, the main stem of hepatic arteries are occluded in 2 patients. Conclusion: The existence of severe HAPVF should be taken into consideration when intractable upper gastrointestinal hemorrhage occurs in hepatocellular carcinoma patients, and it can be diagnosed through hepatic artery DSA. Orifice embolization is the most effective method for such kind of hemorrhage. (authors)

  8. Comparing Two Different Approaches to the Modeling of the Common Cause Failures in Fault Trees

    International Nuclear Information System (INIS)

    Vukovic, I.; Mikulicic, V.; Vrbanic, I.

    2002-01-01

    The potential for common cause failures in systems that perform critical functions has been recognized as very important contributor to risk associated with operation of nuclear power plants. Consequentially, modeling of common cause failures (CCF) in fault trees has become one among the essential elements in any probabilistic safety assessment (PSA). Detailed and realistic representation of CCF potential in fault tree structure is sometimes very challenging task. This is especially so in the cases where a common cause group involves more than two components. During the last ten years the difficulties associated with this kind of modeling have been overcome to some degree by development of integral PSA tools with high capabilities. Some of them allow for the definition of CCF groups and their automated expanding in the process of Boolean resolution and generation of minimal cutsets. On the other hand, in PSA models developed and run by more traditional tools, CCF-potential had to be modeled in the fault trees explicitly. With explicit CCF modeling, fault trees can grow very large, especially in the cases when they involve CCF groups with 3 or more members, which can become an issue for the management of fault trees and basic events with traditional non-integral PSA models. For these reasons various simplifications had to be made. Speaking in terms of an overall PSA model, there are also some other issues that need to be considered, such as maintainability and accessibility of the model. In this paper a comparison is made between the two approaches to CCF modeling. Analysis is based on a full-scope Level 1 PSA model for internal initiating events that had originally been developed by a traditional PSA tool and later transferred to a new-generation PSA tool with automated CCF modeling capabilities. Related aspects and issues mentioned above are discussed in the paper. (author)

  9. Hypokalemic muscular paralysis causing acute respiratory failure due to rhabdomyolysis with renal tubular acidosis in a chronic glue sniffer.

    Science.gov (United States)

    Kao, K C; Tsai, Y H; Lin, M C; Huang, C C; Tsao, C Y; Chen, Y C

    2000-01-01

    A 34-year-old male was admitted to the emergency department with the development of quadriparesis and respiratory failure due to hypokalemia after prolonged glue sniffing. The patient was subsequently given mechanical ventilatory support for respiratory failure. He was weaned from the ventilator 4 days later after potassium replacement. Toluene is an aromatic hydrocarbon found in glues, cements, and solvents. It is known to be toxic to the nervous system, hematopoietic system, and causes acid-base and electrolyte disorders. Acute respiratory failure with hypokalemia and rhabdomyolysis with acute renal failure should be considered as potential events in a protracted glue sniffing.

  10. Non-compaction cardiomyopathy – an unusual cause of heart failure

    Directory of Open Access Journals (Sweden)

    Jure Dolenc

    2011-03-01

    Full Text Available Introduction: Non-compaction cardiomyopathy is a rare inborn anomaly caused by disorder of endomyocardial morphogenesis. The diagnosis is based on echocardiographic criteria. The prevalence in the adult population is not known. The symptoms are atypical. Three main groups of clinical signs exist: heart failure, thromobembolic events and arrhythmias. In the group of patients with reduced left ventricular function the prognosis is poor and the treatment options are limited. Patients and methods: In the recent 10 years, 7 patients with non-compaction cardiomyopathy were diagnosed at the Department of Cardiology of the University Medical Centre Ljubljana. Results: All seven patients were males, their mean age at the last follow-up being 39 ± 20.3 years (range 20 to 70 years. Five patients were diagnosed in adulthood. All of them fulfilled the echocardiographic diagnostic criteria of noncompaction cardiomyopathy. Five patients had depressed function of both ventricles, two patients had isolated left ventricular dysfunction. Three patients had decreased left ventricular ejection fraction, six patients showed left ventricular diastolic dysfunction. Only three patients had normal physical capacity. Two patients presented with clinical signs of overt heart failure. During follow-up, one patient died from heart failure. We observed thromboembolic events in one patient. Three patients suffered from nonsustained ventricular tachycardias and two patients had rhythm conduction abnormalities. Conclusions: Non-compaction cardiomyopathy is a rare disorder. We observed all common complications in our group of patients. The majority of patients displayed dysfunction of the affected ventricle and the dysfunction was more pronounced in older patients. Treatment of complications is an important factor in long-term survival of these patients.

  11. Causes of failure with Szabo technique – An analysis of nine cases

    Science.gov (United States)

    Jain, Rajendra Kumar; Padmanabhan, T.N.C.; Chitnis, Nishad

    2013-01-01

    Objective The objective of this case series is to identify and define causes of failure of Szabo technique in rapid-exchange monorail system for ostial lesions. Methods and results From March 2009 to March 2011, 42 patients with an ostial lesion were treated percutaneously at our institution using Szabo technique in a monorail stent system. All patients received unfractionated heparin during intervention. Loading dose of clopidogrel, followed by clopidogrel and aspirin was administered. In 57% of patients, drug-eluting stents were used and in 42.8% patients bare metal stents. The stent was advanced over both wires, the target wire and the anchor wire. The anchor wire, which was passed through the proximal trailing strut of the stent helps to achieve precise stenting. The procedure was considered to be successful if stent was placed precisely covering the lesion and without stent loss or anchor wire prolapsing. Of the total 42 patients, the procedure was successful in 33, while failed in 9. Majority of failures were due to wire entanglement, which was fixed successfully in 3 cases by removing and reinserting the anchor wire. Out of other three failures, in one stent dislodgment occurred, stent could not cross the lesion in one and in another anchor wire got looped and prolapsed into target vessel. Conclusion This case series shows that the Szabo technique, in spite of some difficulties like wire entanglement, stent dislodgement and resistance during stent advancement, is a simple and feasible method for treating variety of ostial lesions precisely compared to conventional angioplasty. PMID:23809379

  12. Causes of failure with Szabo technique - an analysis of nine cases.

    Science.gov (United States)

    Jain, Rajendra Kumar; Padmanabhan, T N C; Chitnis, Nishad

    2013-01-01

    The objective of this case series is to identify and define causes of failure of Szabo technique in rapid-exchange monorail system for ostial lesions. From March 2009 to March 2011, 42 patients with an ostial lesion were treated percutaneously at our institution using Szabo technique in a monorail stent system. All patients received unfractionated heparin during intervention. Loading dose of clopidogrel, followed by clopidogrel and aspirin was administered. In 57% of patients, drug-eluting stents were used and in 42.8% patients bare metal stents. The stent was advanced over both wires, the target wire and the anchor wire. The anchor wire, which was passed through the proximal trailing strut of the stent helps to achieve precise stenting. The procedure was considered to be successful if stent was placed precisely covering the lesion and without stent loss or anchor wire prolapsing. Of the total 42 patients, the procedure was successful in 33, while failed in 9. Majority of failures were due to wire entanglement, which was fixed successfully in 3 cases by removing and reinserting the anchor wire. Out of other three failures, in one stent dislodgment occurred, stent could not cross the lesion in one and in another anchor wire got looped and prolapsed into target vessel. This case series shows that the Szabo technique, in spite of some difficulties like wire entanglement, stent dislodgement and resistance during stent advancement, is a simple and feasible method for treating variety of ostial lesions precisely compared to conventional angioplasty. Copyright © 2013 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  13. Reliability and Availability Analysis of Some Systems with Common-Cause Failures Using SPICE Circuit Simulation Program

    Directory of Open Access Journals (Sweden)

    Muhammad Taher Abuelma'atti

    1999-01-01

    Full Text Available The effectiveness of SPICE circuit simulation program in calculating probabilities, reliability, steady-state availability and mean-time to failure of repairable systems described by Markov models is demonstrated. Two examples are presented. The first example is a warm standby system with common-cause failures and human errors. The second example is a non-identical unit parallel system with common-cause failures. In both cases recourse to numerical solution is inevitable to obtain the Laplace transforms of the probabilities. Results obtained using SPICE are compared with previously published results obtained using the Laplace transform method. Full SPICE listings are included.

  14. Pediatric hepatic rhabdoid tumor: A rare cause of abdominal mass in children

    Directory of Open Access Journals (Sweden)

    Nicole Kapral, MD

    2018-06-01

    Full Text Available Pediatric hepatic rhabdoid tumors are rare tumors of the liver, with few cases reported in the literature. These aggressive tumors can be difficult to differentiate from hepatoblastomas on imaging alone, and surgical biopsy combined with special immunohistochemical stains can assist in differentiating these 2 tumor types. We present a case of hepatic rhabdoid tumor in a 7-month-old female infant, which was originally thought to be a hepatoblastoma; however, using BAF47 staining for INI-1 we were able to diagnose a rhabdoid tumor and affect the patient's medical oncologic therapy. Earlier detection and a better understanding of the imaging features of hepatic rhabdoid tumor may aid in improved patient management and treatment planning. Keywords: Rhabdoid tumor, INI-1, Hepatoblastoma, Pediatric, Rhabdomyosarcoma

  15. What causes treatment failure - the patient, primary care, secondary care or inadequate interaction in the health services?

    Directory of Open Access Journals (Sweden)

    Lange Ove

    2011-05-01

    Full Text Available Abstract Background Optimal treatment gives complete relief of symptoms of many disorders. But even if such treatment is available, some patients have persisting complaints. One disorder, from which the patients should achieve complete relief of symptoms with medical or surgical treatment, is gastroesophageal reflux disease (GERD. Despite the fact that such treatment is cheap, safe and easily available; some patients have persistent complaints after contact with the health services. This study evaluates the causes of treatment failure. Methods Twelve patients with GERD and persistent complaints had a semi-structured interview which focused on the patients' evaluation of treatment failure. The interviews were taped, transcribed and evaluated by 18 physicians, (six general practitioners, six gastroenterologists and six gastrointestinal surgeons who completed a questionnaire for each patient. The questionnaires were scored, and the relative responsibility for the failure was attributed to the patient, primary care, secondary care and interaction in the health services. Results Failing interaction in the health services was the most important cause of treatment failure, followed by failure in primary care, secondary care and the patient himself; the relative responsibilities were 35%, 28%, 27% and 10% respectively. There was satisfactory agreement about the causes between doctors with different specialities, but significant inter-individual differences between the doctors. The causes of the failures differed between the patients. Conclusions Treatment failure is a complex problem. Inadequate interaction in the health services seems to be important. Improved communication between parts of the health services and with the patients are areas of improvement.

  16. Lack of liver glycogen causes hepatic insulin resistance and steatosis in mice.

    Science.gov (United States)

    Irimia, Jose M; Meyer, Catalina M; Segvich, Dyann M; Surendran, Sneha; DePaoli-Roach, Anna A; Morral, Nuria; Roach, Peter J

    2017-06-23

    Disruption of the Gys2 gene encoding the liver isoform of glycogen synthase generates a mouse strain (LGSKO) that almost completely lacks hepatic glycogen, has impaired glucose disposal, and is pre-disposed to entering the fasted state. This study investigated how the lack of liver glycogen increases fat accumulation and the development of liver insulin resistance. Insulin signaling in LGSKO mice was reduced in liver, but not muscle, suggesting an organ-specific defect. Phosphorylation of components of the hepatic insulin-signaling pathway, namely IRS1, Akt, and GSK3, was decreased in LGSKO mice. Moreover, insulin stimulation of their phosphorylation was significantly suppressed, both temporally and in an insulin dose response. Phosphorylation of the insulin-regulated transcription factor FoxO1 was somewhat reduced and insulin treatment did not elicit normal translocation of FoxO1 out of the nucleus. Fat overaccumulated in LGSKO livers, showing an aberrant distribution in the acinus, an increase not explained by a reduction in hepatic triglyceride export. Rather, when administered orally to fasted mice, glucose was directed toward hepatic lipogenesis as judged by the activity, protein levels, and expression of several fatty acid synthesis genes, namely, acetyl-CoA carboxylase, fatty acid synthase, SREBP1c, chREBP, glucokinase, and pyruvate kinase. Furthermore, using cultured primary hepatocytes, we found that lipogenesis was increased by 40% in LGSKO cells compared with controls. Of note, the hepatic insulin resistance was not associated with increased levels of pro-inflammatory markers. Our results suggest that loss of liver glycogen synthesis diverts glucose toward fat synthesis, correlating with impaired hepatic insulin signaling and glucose disposal. © 2017 by The American Society for Biochemistry and Molecular Biology, Inc.

  17. Sensitivity study of state-of-the-art common cause failure analysis

    International Nuclear Information System (INIS)

    Guey, Ching

    2004-01-01

    Common cause failures (CCFs) have been touted as one of the major contributors of plant risk due to its pervasive nature and somewhat conservative approaches taken in most Probabilistic Risk Assessment (PRA) studies. The objectives of this study are twofold: First, to gain a better understanding on the impact of various CCF failure probability on the overall plant risk. Secondly, to appreciate the state-of-the-art CCF modelling and data limitations for applications to a full-scale plant risk assessment. The sensitivity study of varying the CCF parameters for different cases indicates that CCF data differences based on the various cases commonly adopted in the PRAs yield core damage frequency variations between 8.5% to -25.6% of the baseline case. It appears that only if CCFs are guaranteed to occur, the core damage frequency would change significantly, by approximately a factor of 5. This suggests that prevention of CCFs is more important than dwelling on the analytical differences in the finer interpretation of the operating experience to develop the CCF parameters. (author)

  18. Quantitative analysis of Common cause failures in systems with a high level of redundancies

    International Nuclear Information System (INIS)

    Pereira Pagan, B.; Lopez Fdez-Quevedo, C.; Gomez, F.; Cuallado, G.

    1996-01-01

    The importance of common cause failures in plants with systems featuring a high level of redundancies, and the difficulty implied by the lack of data on specific KWU design plants have been taken into account right from the beginning of the PSA. for this reason it has been necessary to analyse the different methodologies by establishing a procedure based on the documentation available, studying its applicability and solving problems arising from of the lack of information needed to make reliable statistical estimates. It was finally decided to systematically use the alpha parameter method. In case where this was not possible, the modified Beta factor method was used, and if there were no data available for the type of component considered, generic alpha values were used. this process required the definition of certain criteria to maintain coherent parameter estimates. The final result shows the impact of the number of redundancies considered in the estimated failure probability or rare. This process is valid for any size of system modelled. (Author)

  19. Risk factors associated with prognosis of progressive stages of acute-on-chronic hepatitis B liver failure

    Directory of Open Access Journals (Sweden)

    YE Peiyan

    2013-04-01

    Full Text Available ObjectiveTo identify the risk factors associated with progression of acute-on-chronic liver failure (ACLF occurring in patients with chronic hepatitis B virus (HBV infection (CHB. MethodsThe clinical, demographic, treatment and outcome data of 180 ACLF patients with concomitant CHB managed in our hospital between June 2009 and September 2012 were retrospectively reviewed. Clinical data, taken at baseline, included markers of inflammation/infection (white blood cell (WBC count, coagulation (prothrombin time (PT and prothrombin activity (PTA, and liver function (alanine aminotransferase (ALT, aspartate aminotransferase (AST, total bilirubin (TBil, direct bilirubin (DBil, choninesterase (CHE, albumin (Alb, globulin (Glb, total cholesterol (TC, and ammonia. In-hospital treatments included supplementation with traditional Chinese medicine-based therapies, such as Tuihuang decoction and detoxification enema. The primary outcome was survival during hospitalization. The patients were grouped for analysis according to ACLF stage (early, n=93; mid, n=61; late, n=26 and the risk factors associated with each stage were identified by using univariate (log-rank test and multivariate (Cox’s test regression analyses. The association of risk factors with patient survival was assessed by Kaplan-Meier curve analysis. ResultsThe three ACLF groups showed significantly different amounts of leukocytes, with the late ACLF group showing the highest WBC. The late ACLF group also showed significantly lower Glb and TC. There was a trend in reduced cumulative survival rate and shorter time to death that significantly corresponded to progressive stages of ACLF (early ACLF>mid ACLF>late ACLF; all P<0.001. One-hundred-and-twenty-six (70.0% of the patients died during their hospitalization, and multivariate regression analysis of this entire patient population identified absence of colonic enema, presence of hepatic encephalopathy, presence of hepatorenal syndrome, PTA

  20. CFD research on runaway transient of pumped storage power station caused by pumping power failure

    International Nuclear Information System (INIS)

    Zhang, L G; Zhou, D Q

    2013-01-01

    To study runaway transient of pumped storage power station caused by pumping power failure, three dimensional unsteady numerical simulations were executed on geometrical model of the whole flow system. Through numerical calculation, the changeable flow configuration and variation law of some parameters such as unit rotate speed,flow rate and static pressure of measurement points were obtained and compared with experimental data. Numerical results show that runaway speed agrees well with experimental date and its error was 3.7%. The unit undergoes pump condition, brake condition, turbine condition and runaway condition with flow characteristic changing violently. In runaway condition, static pressure in passage pulses very strongly which frequency is related to runaway speed

  1. Functional failure modes cause-consequence logic suited for mobile robots used at scientific facilities

    CERN Document Server

    Khan, Douzi Imran; Bonnal, Pierre; Verma, A K

    2014-01-01

    The scientific facilities emitting ionizing radiation may have some significant failures and hazard issues, in and around their infrastructure. Significantly, this will also cause risks to workers and environment, which has led engineers to explore the use and implementation of mobile robots (MR), in order to reduce or eliminate such risks concerned with safety issues. Safe functioning of MR and the systems working at hazardous facilities is essential and therefore all the systems, structures and components (SSC) of a hazardous facility have to correspond to high reliability, availability, maintainability and safety (=RAMS) demands. RAMS characteristics have a causal relationship with the risks related to the facility systems availability, safety and life cycle costs. They also form the basis for the operating systems and MR performance, to carry out the desired functions. In this paper we have developed and presented a method for how to consider and model a SSC with respect to its desired functions and also ...

  2. Fuel pin failure root causes and power distribution gradients in WWER cores

    International Nuclear Information System (INIS)

    Mikus, J.

    2008-01-01

    The purpose of this work is to investigate the influence of some core heterogeneities and reactor construction materials on space power distribution in WWER type cores, especially from viewpoint of the values and gradient occurrence that could result in static loads with some consequences, e.g., fuel pin (FP) or fuel assembly (FA) bowing and possible contribution to the FP failure root causes. Presented information were obtained by means of experiments on research reactor LR-0 concerning the: 1) Power distribution estimation on pellet surface of the FPs neighbouring a FP containing gadolinium (Gd 2 O 3 ) burnable absorber integrated into fuel in WWER-440 and -1000 type cores; 2) Power distribution measurement in periphery FAs neighbouring the baffle in WWER-1000 type cores and 3) Power distribution in FAs neighbouring the control rod absorbing part in a WWER-440 type core. (author)

  3. Assessment of the causes of failures of roto-dynamic equipment in Cirus

    International Nuclear Information System (INIS)

    Rao, K.N.; Singh, S.; Ganeshan, P.

    1994-01-01

    As a part of Cirus reactor life extension program study, a service life evaluation of critical roto-dynamic equipment in Cirus such as primary coolant pumps, and their concrete foundation structures, pressurised water loop pumps, main air compressors and supply and exhaust fans, was performed. An assessment of the causes of failures of roto-dynamic equipment in Cirus was done. Based on assessment of the degradation mitigating features and comparison to similar roto-dynamic equipment and their concrete foundation structures, it was concluded that life extension of these roto-dynamic equipment and their structures is feasible. To support this conclusion a program involving: a) non-destructive testing, b) surveillance and monitoring and, c) preventive maintenance is recommended. (author). 4 refs

  4. Analysis of the main causes of failures in the Atucha I PWR moderator circuit branch piping

    International Nuclear Information System (INIS)

    Porto, J.; Sarmiento, G.S.

    1983-01-01

    From 1977 to 1979 four through cracks were detected in the auxiliary connection of the moderator piping with the coolant circuit in the PWR Atucha I Nuclear Plant. The failures were observed to occur systematically in the same place of the pipe, where mechanical stresses were detected experimentally and thermal stresses were calculated based on temperature values measured on the pipe. The temperature field in steady state conditions as well as during thermal shocks was modelled by finite element codes, and the corresponding thermal stresses were than numerically calculated. Considering those thermal and mechanical solicitations, a crack propagation analysis based on the elastoplastic fracture mechanics and the finite element method is now being developed. Among other causes such as fatigue corrosion and vibrations, the results of the analysis show that the most preponderant factors determining the cracking are mechanical stress, thermal stress and thermal fatigue

  5. Mutations in genes encoding condensin complex proteins cause microcephaly through decatenation failure at mitosis.

    Science.gov (United States)

    Martin, Carol-Anne; Murray, Jennie E; Carroll, Paula; Leitch, Andrea; Mackenzie, Karen J; Halachev, Mihail; Fetit, Ahmed E; Keith, Charlotte; Bicknell, Louise S; Fluteau, Adeline; Gautier, Philippe; Hall, Emma A; Joss, Shelagh; Soares, Gabriela; Silva, João; Bober, Michael B; Duker, Angela; Wise, Carol A; Quigley, Alan J; Phadke, Shubha R; Wood, Andrew J; Vagnarelli, Paola; Jackson, Andrew P

    2016-10-01

    Compaction of chromosomes is essential for accurate segregation of the genome during mitosis. In vertebrates, two condensin complexes ensure timely chromosome condensation, sister chromatid disentanglement, and maintenance of mitotic chromosome structure. Here, we report that biallelic mutations in NCAPD2, NCAPH, or NCAPD3, encoding subunits of these complexes, cause microcephaly. In addition, hypomorphic Ncaph2 mice have significantly reduced brain size, with frequent anaphase chromatin bridge formation observed in apical neural progenitors during neurogenesis. Such DNA bridges also arise in condensin-deficient patient cells, where they are the consequence of failed sister chromatid disentanglement during chromosome compaction. This results in chromosome segregation errors, leading to micronucleus formation and increased aneuploidy in daughter cells. These findings establish "condensinopathies" as microcephalic disorders, with decatenation failure as an additional disease mechanism for microcephaly, implicating mitotic chromosome condensation as a key process ensuring mammalian cerebral cortex size. © 2016 Martin et al.; Published by Cold Spring Harbor Laboratory Press.

  6. Procedures for conducting common cause failure analysis in probabilistic safety assessment

    International Nuclear Information System (INIS)

    1992-05-01

    The principal objective of this report is to supplement the procedure developed in Mosleh et al. (1988, 1989) by providing more explicit guidance for a practical approach to common cause failures (CCF) analysis. The detailed CCF analysis following that procedure would be very labour intensive and time consuming. This document identifies a number of options for performing the more labour intensive parts of the analysis in an attempt to achieve a balance between the need for detail, the purpose of the analysis and the resources available. The document is intended to be compatible with the Agency's Procedures for Conducting Probabilistic Safety Assessments for Nuclear Power Plants (IAEA, 1992), but can be regarded as a stand-alone report to be used in conjunction with NUREG/CR-4780 (Mosleh et al., 1988, 1989) to provide additional detail, and discussion of key technical issues

  7. The Process-Oriented Simulation (POS) model for common cause failures: recent progress

    International Nuclear Information System (INIS)

    Berg, H.P.; Goertz, R.; Schimetschka, E.; Kesten, J.

    2006-01-01

    A common-cause failure (CCF) model based on stochastic simulation has been developed to complement the established approaches and to overcome some of their shortcomings. Reflecting the models proximity to the CCF process it was called Process Oriented Simulation (POS) Model. In recent years, some progress has been made to render the POS model fit for practical applications comprising the development of parameter estimates and a number of test applications in areas where results were already available - especially from CCF benchmarks - and comparison can provide insights in strong and weak points of the different approaches. In this paper, a detailed description of the POS model is provided together with the approach to parameter estimation and representative test applications. It is concluded, that the POS model has a number of strengths - especially the feature to provide reasonable extrapolation to CCF groups with high degrees of redundancy - and thus a considerable potential to complement the insights obtained from existing modeling. (orig.)

  8. Dialyzer-augmented whole blood and plasma exchange for patients with hepatic or hepatorenal failure.

    Science.gov (United States)

    Buselmeier, T J; Merino, G E; Rodrigo, F; Meyer, R M; Bosl, B H; Kjellstrand, C M; Simmons, R L; Najarian, J S

    1975-01-01

    We have utilized new methods of dialyzer-augmented whole blood and plasma exchange tranfusion in the treatment of hepatic coma. The method employs the new fast flow Buselmeier shunt so that the exchange can be done from a peripheral radial artery shunt site rather than a shunt site in a more major vessel, such as the brachial artery. The method employs in-line dialysis of citrated (CPD) blood or plasma to normalize pH, electrolytes, and blood sugar while infusion heparinization decreases heparin requirements. The application of a single roller pump to the administration and withdrawal lines (placed in opposite directions) helps equalize inflow and outflow where whole blood exchange is done while identical opposing pumps accomplish the same with plasma exchange. The administration of albumin and metaraminol bitartate prevents hypotension due to fluid shifts or compartmental venous dilatation. A closed circuit which does not require disconnection throughout the 30- 60-minute whole blood exchange or the 2 1/2-hour plasma exchange decreases the risk of septic contamination to both medical staff and patients.

  9. Failure of carnitine in improving hepatic nitrogen content in alcoholic and non-alcoholic malnourished rats

    Directory of Open Access Journals (Sweden)

    Luciana P. Rodrigues

    2010-01-01

    Full Text Available AIMS: To investigate the effect of carnitine supplementation on alcoholic malnourished rats' hepatic nitrogen content. METHODS: Malnourished rats, on 50% protein-calorie restriction with free access to water (malnutrition group and malnourished rats under the same conditions with free access to a 20% alcohol/water solution (alcohol group were studied. After the undernourishment period (4 weeks with or without alcohol, both groups were randomly divided into two subgroups, one of them nutritionally recovered for 28 days with free access to a normal diet and water (recovery groups and the other re-fed with free access to diet and water plus carnitine (0.1 g/g body weight/day by gavage (carnitine groups. No alcohol intake was allowed during the recovery period. RESULTS: The results showed: i no difference between the alcohol/no alcohol groups, with or without carnitine, regarding body weight gain, diet consumption, urinary nitrogen excretion, plasma free fatty acids, lysine, methionine, and glycine. ii Liver nitrogen content was highest in the carnitine recovery non-alcoholic group (from 1.7 to 3.3 g/100 g, P.05 was highest in the alcoholic animals. CONCLUSION: Carnitine supplementation did not induce better nutritional recovery.

  10. Fanconi syndrome and chronic renal failure in a chronic hepatitis B monoinfected patient treated with tenofovir

    Directory of Open Access Journals (Sweden)

    Pedro Magalhães-Costa

    Full Text Available Tenofovir disoproxil fumarate (TDF is one of the first-line treatment options in chronic hepatitis B (CHB. Despite its efficacy in suppressing viral load and a high resistance barrier, long life maintenance therapy is required. Registration studies demonstrated TDF to be a safe drug. However, post-marketing experience reported cases of serious nephrotoxicity associated with hypophosphatemia, osteomalacia and, even more recently, Fanconi syndrome associated with TDF therapy in CHB monoinfected patients. Here the authors report a case of a 40 year-old male, with a CHB monoinfection, that, three years after TDF therapy, developed a progressive chronic kidney disease with a serious hypophosphatemia and a secondary osteomalacia that was manifested by bone pain and multiple bone fractures. Further investigational analyses unveiled a proximal renal tubular dysfunction, which fulfilled most of the diagnostic criteria for a Fanconi syndrome. After TDF withdrawal and oral supplementation with phosphate and calcitriol, his renal function stabilized (despite not returning to normal, proximal renal tubular dysfunction abnormalities resolved as well as osteomalacia. In conclusion, physicians should be aware that, in CHB monoinfected patients under TDF therapy, serious renal damage is possible and preventable by timely monitoring serum creatinine and phosphate.

  11. Procedures for treating common cause failures in safety and reliability studies: Volume 2, Analytic background and techniques: Final report

    International Nuclear Information System (INIS)

    Mosleh, A.; Fleming, K.N.; Parry, G.W.; Paula, H.M.; Worledge, D.H.; Rasmuson, D.M.

    1988-12-01

    This report presents a framework for the inclusion of the impact of common cause failures in risk and reliability evaluations. Common cause failures are defined as that subset of dependent failures for which causes are not explicitly included in the logic model as basic events. The emphasis here is on providing procedures for a practical, systematic approach that can be used to perform and clearly document the analysis. The framework and the methods discussed for performing the different stages of the analysis integrate insights obtained from engineering assessments of the system and the historical evidence from multiple failure events into a systematic, reproducible, and defensible analysis. This document, Volume 2, contains a series of appendices that provide additional background and methodological detail on several important topics discussed in Volume 1

  12. Hepatitis C

    Science.gov (United States)

    ... an inflammation of the liver. One type, hepatitis C, is caused by the hepatitis C virus (HCV). It usually spreads through contact with ... childbirth. Most people who are infected with hepatitis C don't have any symptoms for years. If ...

  13. Hepatitis A

    Science.gov (United States)

    ... is an inflammation of the liver. One type, hepatitis A, is caused by the hepatitis A virus (HAV). The disease spreads through contact with ... suggest medicines to help relieve your symptoms. The hepatitis A vaccine can prevent HAV. Good hygiene can also ...

  14. Epidemiology of viruses causing chronic hepatitis among populations from the Amazon Basin and related ecosystems

    Directory of Open Access Journals (Sweden)

    Echevarría José M.

    2003-01-01

    Full Text Available On the last twenty years, viral hepatitis has emerged as a serious problem in almost all the Amerindian communities studied in the Amazon Basin and in other Amazon-related ecological systems from the North and Center of South America. Studies performed on communities from Bolivia, Brazil, Colombia, Peru and Venezuela have shown a high endemicity of the hepatitis B virus (HBV infection all over the region, which is frequently associated to a high prevalence of infection by hepatitis D virus among the chronic HBV carriers. Circulation of both agents responds mainly to horizontal virus transmission during childhood through mechanisms that are not fully understood. By contrast, infection by hepatitis C virus (HCV, which is present in all the urban areas of South America, is still very uncommon among them. At the moment, there is not data enough to evaluate properly the true incidence that such endemicity may have on the health of the populations affected. Since viral transmission might be operated by mechanisms that could not be acting in other areas of the World, it seems essential to investigate such mechanisms and to prevent the introduction of HCV into these populations, which consequences for health could be very serious.

  15. Joint disorder; a contributory cause to reproductive failure in beef bulls?

    Directory of Open Access Journals (Sweden)

    Ekman Stina

    2007-11-01

    Full Text Available Abstract The lame sire, unsound for breeding, can cause substantial economic loss due to reduced pregnancies in the beef-producing herd. To test the hypothesis that joint disorder is a possible cause of infertility in beef sires, right and left hind limb bones from 34 beef sires were examined postmortem to identify lesions in the femorotibial, femoropatellar (stifle, tarsocrural, talocalcaneus, and proximal intertarsal (tarsal joints. The bulls were slaughtered during or after the breeding season due to poor fertility results. Aliquots of the cauda epididymal contents taken postmortem from 26 bulls were used for sperm morphology evaluation. As a control, hind limbs (but no semen samples from 11 beef bulls with good fertility results were included. Almost all infertile bulls (30/34 had lesions in at least one joint. Twenty-eight bulls (28/30, 93% had lesions in the stifle joint, and 24 (24/28, 86% of these were bilateral. Fourteen bulls (14/30, 47% had lesions in the tarsal joint, and 10 (10/14, 71% of these were bilateral. Four bulls (4/34, 12% had no lesions, three bulls (3/34, 9% had mild osteoarthritis (OA, 5 (5/34, 15% moderate OA, 17 (17/34, 50% severe OA and 5 (5/34, 15% deformed OA. Almost all OA lesions (97% were characterized as lesions secondary to osteochondrosis dissecans. All the bulls with satisfactory sperm morphology (n = 12/34 had joint lesions, with mostly severe or deformed bilateral lesions (83%. Consequently, the most likely cause of infertility in these 12 bulls was joint disease. Almost all control bulls (10/11 had OA lesions, but most of them were graded as mild (55% or moderate (36%. None of the control bulls had severe lesions or deformed OA. We suggest that joint lesions should be taken into consideration as a contributory cause of reproductive failure in beef sires without symptoms of lameness.

  16. A Development of Common Cause Failure Propagation Paths Identification Method Using Coloured Petri Nets

    International Nuclear Information System (INIS)

    Yim, Ho Bin; Park, Jae Min; Lee, Chang Gyun; Huh, Jae Young; Lee, Gyu Cheon

    2017-01-01

    The concept of Common-Cause Failure (CCF) first appeared in the aerospace industry several decades ago, and nuclear power industry actively adopted the concept to the nuclear power plant (NPP) system analysis after the TMI accident. Since digital Instrumentation and Control (I and C) systems were applied to the NPP design, the CCF issues once again drew attention from the nuclear power industry in 90's. Identification of CCF has not been considered as a challenging issue because of its simplicity. However, as the systems become more complex and interconnected, demands are increasing to analyze CCF in more detail, for example, CCF with multiple initiating events or supporting situation awareness of the operation crew. The newly suggested CCF propagation paths identification method, CCF-SIREn, is expected to resolve path identification issue more practically and efficiently. CCF-SIREn uses general diagrams so that the compatibility and usability can be hugely increased. It also offers up-to-date CCF information with a least analysis effort whenever the ordinary NPP design change processes are made. A back-propagation technique is still under development to find out root-causes from the suspiciously responding signals, alarms and components. The probabilistic approach is also under consideration to prioritize defined CCF.

  17. Vitamin C-induced hyperoxaluria causing reversible tubulointerstitial nephritis and chronic renal failure: a case report

    Directory of Open Access Journals (Sweden)

    Rathi Shradha

    2007-11-01

    Full Text Available Abstract Vitamin C is a precursor of oxalate and promoter of its absorption, potentially causing hyperoxaluria. Malabsorption causes Calcium (Ca chelation with fatty acids, producing enteric hyperoxaluria. Case A 73-year-old man with both risk factors was hospitalized with serum creatinine of 8.4 mg/dL (versus 1.2 mg/dL four months earlier (normal 0.6–1.3 mg/dL. Given his oxalate-rich diet, chronic diarrhea, and daily 680 mg vitamin C and furosemide, we postulated Ca oxalate-induced nephropathy, a diagnosis confirmed by documenting hyperoxaluria, and finding of diffuse intraluminal crystals and extensive interstitial fibrosis on biopsy. He was hemodialysed 6 times to remove excess oxalate. Two weeks off vitamin C, his creatinine spontaneously fell to 3.1 mg/dL. Three months later, on low oxalate diet and 100 mg vitamin B6, urine oxalate to creatinine ratio decreased from 0.084 to 0.02 (normal Conclusion 1 High-dose vitamin C can induce hyperoxaluric nephropathy and progressive renal failure, especially if aggravated by diarrhea, oxalate-rich diet, metabolic acidosis, and dehydration. 2 The diagnosis should be suspected in unexplained renal insufficiency when associated with these risk factors. 3 Since prompt treatment could avert end-stage renal disease, we recommend monitoring urinary oxalate in patients on high-dose vitamin C and renal biopsy if necessary.

  18. Recent insights from the international common-cause failure data exchange project

    Energy Technology Data Exchange (ETDEWEB)

    Kreuser, Albert [Gesellschaft fur Anlagen- und Reaktorsicherheit (GRS) gGmbH, Cologne (Germany); Johanson, Gunner [AF Industry, Stockholm (Sweden)

    2017-03-15

    Common-cause failure (CCF) events can significantly impact the availability of safety systems of nuclear power plants. For this reason, the International Common Cause Data Exchange (ICDE) project was initiated by several countries in 1994. Since 1997 it has been operated within the Organisation for Economic Co-operation and Development (OECD)/Nuclear Energy Agency (NEA) framework and has successfully been operated over six consecutive terms (the current term being 2015–2017). The ICDE project allows multiple countries to collaborate and exchange CCF data to enhance the quality of risk analyses, which include CCF modeling. As CCF events are typically rare, most countries do not experience enough CCF events to perform meaningful analyses. Data combined from several countries, however, have yielded sufficient data for more rigorous analyses. The ICDE project has meanwhile published 11 reports on the collection and analysis of CCF events of specific component types (centrifugal pumps, emergency diesel generators, motor operated valves, safety and relief valves, check valves, circuit breakers, level measurement, control rod drive assemblies, and heat exchangers) and two topical reports. This paper presents recent activities and lessons learnt from the data collection and the results of topical analysis on emergency diesel generator CCF impacting entire exposed population.

  19. Recent Insights from the International Common-Cause Failure Data Exchange Project

    Directory of Open Access Journals (Sweden)

    Albert Kreuser

    2017-03-01

    Full Text Available Common-cause failure (CCF events can significantly impact the availability of safety systems of nuclear power plants. For this reason, the International Common Cause Data Exchange (ICDE project was initiated by several countries in 1994. Since 1997 it has been operated within the Organisation for Economic Co-operation and Development (OECD/Nuclear Energy Agency (NEA framework and has successfully been operated over six consecutive terms (the current term being 2015–2017. The ICDE project allows multiple countries to collaborate and exchange CCF data to enhance the quality of risk analyses, which include CCF modeling. As CCF events are typically rare, most countries do not experience enough CCF events to perform meaningful analyses. Data combined from several countries, however, have yielded sufficient data for more rigorous analyses. The ICDE project has meanwhile published 11 reports on the collection and analysis of CCF events of specific component types (centrifugal pumps, emergency diesel generators, motor operated valves, safety and relief valves, check valves, circuit breakers, level measurement, control rod drive assemblies, and heat exchangers and two topical reports. This paper presents recent activities and lessons learnt from the data collection and the results of topical analysis on emergency diesel generator CCF impacting entire exposed population.

  20. Development of Web-Based Common Cause Failure (CCF) Database Module for Nuclear Power Plants

    International Nuclear Information System (INIS)

    Lee, Hyun-Gyo; Hwang, Seok-Won; Shin, Tae-young

    2015-01-01

    Probabilistic safety assessment (PSA) has been used to identify risk vulnerabilities and derive the safety improvement measures from construction to operation stages of nuclear power plants. In addition, risk insights from PSA can be applied to improve the designs and operation requirements of plants. However, reliability analysis methods for quantitative PSA evaluation have essentially inherent uncertainties, and it may create a distorted risk profiles because of the differences among the PSA models, plant designs, and operation status. Therefore, it is important to ensure the quality of the PSA model so that analysts identify design vulnerabilities and utilize risk information. Especially, the common cause failure (CCF) has been pointed out as one of major issues to be able to cause the uncertainty related to the PSA analysis methods and data because CCF has a large influence on the PSA results. Organization for economic cooperation and development /nuclear energy agent (OECD/NEA) has implemented an international common cause failure data exchange (ICDE) project for the CCF quality assurance through the development of the detailed analysis methodologies and data sharing. However, Korea Hydro and Nuclear Power company (KHNP) does not have the basis for the data gathering and analysis for CCF analyses. In case of methodology, the Alpha Factor parameter estimation, which can analyze uncertainties and estimate an interface factor (Impact Vector) with an ease, is ready to be applied rather than the Multi Greek Letter (MGL) method. This article summarizes the development of the plant-specific CCF database (DB) module considering the raw data collection and the analysis procedure based on the CCF parameter calculation method of ICDE. Although the portion affected by CCF in the PSA model is quite a large, the development efforts of the tools to collect and analyze data were insufficient. Currently, KHNP intends to improve PSA quality and ensure CCF data reliability by

  1. Development of Web-Based Common Cause Failure (CCF) Database Module for Nuclear Power Plants

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun-Gyo; Hwang, Seok-Won; Shin, Tae-young [Korea Hydro and Nuclear Power Co. Ltd., Daejeon (Korea, Republic of)

    2015-05-15

    Probabilistic safety assessment (PSA) has been used to identify risk vulnerabilities and derive the safety improvement measures from construction to operation stages of nuclear power plants. In addition, risk insights from PSA can be applied to improve the designs and operation requirements of plants. However, reliability analysis methods for quantitative PSA evaluation have essentially inherent uncertainties, and it may create a distorted risk profiles because of the differences among the PSA models, plant designs, and operation status. Therefore, it is important to ensure the quality of the PSA model so that analysts identify design vulnerabilities and utilize risk information. Especially, the common cause failure (CCF) has been pointed out as one of major issues to be able to cause the uncertainty related to the PSA analysis methods and data because CCF has a large influence on the PSA results. Organization for economic cooperation and development /nuclear energy agent (OECD/NEA) has implemented an international common cause failure data exchange (ICDE) project for the CCF quality assurance through the development of the detailed analysis methodologies and data sharing. However, Korea Hydro and Nuclear Power company (KHNP) does not have the basis for the data gathering and analysis for CCF analyses. In case of methodology, the Alpha Factor parameter estimation, which can analyze uncertainties and estimate an interface factor (Impact Vector) with an ease, is ready to be applied rather than the Multi Greek Letter (MGL) method. This article summarizes the development of the plant-specific CCF database (DB) module considering the raw data collection and the analysis procedure based on the CCF parameter calculation method of ICDE. Although the portion affected by CCF in the PSA model is quite a large, the development efforts of the tools to collect and analyze data were insufficient. Currently, KHNP intends to improve PSA quality and ensure CCF data reliability by

  2. Reliability analysis of the auxiliary feedwater system of Angra-1 including common cause failures using the multiple greek letter model

    International Nuclear Information System (INIS)

    Lapa, Celso Marcelo Franklin.

    1996-05-01

    The use of redundancy to increase the reliability of industrial systems make them subject to the occurrence of common cause events. The industrial experience and the results of safety analysis studies have indicated that common cause failures are the main contributors to the unreliability of plants that have redundant systems, specially in nuclear power plants. In this Thesis procedures are developed in order to include the impact of common cause failures in the calculation of the top event occurrence probability of the Auxiliary Feedwater System in a typical two-loop Nuclear Power Plant (PWR). For this purpose the Multiple Greek Letter Model is used. (author). 14 refs., 10 figs., 11 tabs

  3. Plasma exchange combining with plasma bilirubin adsorption effectively removes toxic substances and improves liver functions of hepatic failure patients.

    Science.gov (United States)

    Che, X-Q; Li, Z-Q; Chen, Z; Guo, D; Jia, Q-Y; Jiang, S-C; Cai, J

    2018-02-01

    Hepatic failure (HF) is a kind of complex disease characterizing with liver dysfunction and a few clinical complications. Artificial liver support system (ALSS) has been applied to HF patients to improve dysfunctional liver in recent years. This study aims to evaluate therapeutic effects of ALSS approaches, including plasma exchange (PE), plasma diafiltration (PDF) and plasma bilirubin adsorption (PBA), on liver function of HF patients. This study is a retrospective analysis involving 516 patients diagnosed as HF between February 2014 and February 2015. Patients were randomly divided into PE, PDF, PE plus PBA, and PDF plus PBA group. Meanwhile, single-drug group and combined-drug group were also divided. The liver functions, capability of removing toxic substances and coagulation functions were evaluated both pre-treatment and post-treatment. The side effects and hospital improvement rate were also observed post-treatment. Hospital improvement rate achieves to 69.6%. TBIL levels and MELD scores were significantly decreased post-treatment compared to pre-treatment (phigher compared to PE and PDF group (p=0.002, 0.002, respectively). MELD scores were significantly decreased post-treatment compared to pre-treatment in each group (pbetter role in removing toxic substances, improving liver functions of HF patients.

  4. Cause-specific excess mortality in siblings of patients co-infected with HIV and hepatitis C virus

    DEFF Research Database (Denmark)

    Hansen, AB; Lohse, Nicolai; Gerstoft, J

    2007-01-01

    BACKGROUND: Co-infection with hepatitis C in HIV-infected individuals is associated with 3- to 4-fold higher mortality among these patients' siblings, compared with siblings of mono-infected HIV-patients or population controls. This indicates that risk factors shared by family members partially...... account for the excess mortality of HIV/HCV-co-infected patients. We aimed to explore the causes of death contributing to the excess sibling mortality. METHODOLOGY AND PRINCIPAL FINDINGS: We retrieved causes of death from the Danish National Registry of Deaths and estimated cause-specific excess mortality...... rates (EMR) for siblings of HIV/HCV-co-infected individuals (n = 436) and siblings of HIV mono-infected individuals (n = 1837) compared with siblings of population controls (n = 281,221). Siblings of HIV/HCV-co-infected individuals had an all-cause EMR of 3.03 (95% CI, 1.56-4.50) per 1,000 person...

  5. Microbiological diagnostics of viral hepatitis

    OpenAIRE

    HASDEMİR, Ufuk

    2016-01-01

    Viral hepatitis is an infection that primarily affects the liverbut may also have systemic clinical manifestations. The vastmajority of viral hepatitis are caused by one of five hepatotropicviruses: hepatitis A virus (HAV), hepatitis B virus (HBV),hepatitis C virus (HCV), hepatitis D (delta) virus (HDV), andhepatitis E virus (HEV) (Table I) [1]. HBV, HCV, and HDValso cause chronic hepatitis, whereas HAV does not. HEVcauses acute hepatitis in normal hosts but can cause protractedand chronic he...

  6. Prognostic factors of the short-term outcomes of patients with hepatitis B virus-associated acute-on-chronic liver failure.

    Science.gov (United States)

    Lei, Qing; Ao, Kangjian; Zhang, Yinhua; Ma, Deqiang; Ding, Deping; Ke, Changzheng; Chen, Yue; Luo, Jie; Meng, Zhongji

    2017-11-01

    To investigate the impact of the baseline status of patients with hepatitis B virus-associated acute-on-chronic liver failure on short-term outcomes. A retrospective study was conducted that included a total of 138 patients with hepatitis B virus-associated acute-on-chronic liver failure admitted to the Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, from November 2013 to October 2016. The patients were divided into a poor prognosis group (74 patients) and a good prognosis group (64 patients) based on the disease outcome. General information, clinical indicators and prognostic scores of the patients' baseline status were analyzed, and a prediction model was established accordingly. Elder age, treatment with artificial liver support systems and the frequency of such treatments, high levels of white blood cells, neutrophils, neutrophil count/lymphocyte count ratio, alanine aminotransferase, gamma-glutamyl transferase, total bilirubin, urea, and prognostic scores as well as low levels of albumin and sodium were all significantly associated with the short-term outcomes of hepatitis B virus-associated acute-on-chronic liver failure. The predictive model showed that logit (p) = 3.068 + 1.003 × neutrophil count/lymphocyte count ratio - 0.892 × gamma-glutamyl transferase - 1.138 × albumin - 1.364 × sodium + 1.651 × artificial liver support therapy. The neutrophil count/lymphocyte count ratio and serum levels of gamma-glutamyl transferase, albumin and sodium were independent risk factors predicting short-term outcomes of hepatitis B virus-associated acute-on-chronic liver failure, and the administration of multiple treatments with artificial liver support therapy during the early stage is conducive to improved short-term outcomes.

  7. [Historical consideration of the widespread infection of the hepatitis C virus in Japan and use of a fishbone diagram to investigate the cause].

    Science.gov (United States)

    Haga, Haruko; Fukushima, Noriko

    2011-01-01

    About 75% of Japanese liver cancer is caused by hepatitis C. Widespread infection of the virus resulted from inadequate medical knowledge, as well as the political, economic and administrative conditions of the time. We investigated the association between the widespread infection of the hepatitis C virus and the historical events. We used a fishbone diagram to investigate the cause of widespread infection of the hepatitis C virus and considered the issue from a historical standpoint. We found causes including treatment (medical care), transfusion (medicine), economy (expense) and people (infection route). These causes are explained in further detail below. 1) Treatment (medical care). The initial large-scale infection occurred following attempts to eradicate Schistosoma japonicum involving mass vaccination in schools and public health centers. 2) Transfusion (medicine). The use of non-heated fibrinogen for massive postpartum hemorrhage spread the virus further. In 1987, it resulted in a mass outbreak of hepatitis in Aomori Prefecture. 3) Economy (expense). Recognition of the benefit of disposable syringes was delayed. As a result, disposable syringes were too expensive to be widely available, and did not become low-priced. 4) People (infection route). The second wave of dissemination of the hepatitis C virus was stimulant abuse after World War II. Prior to the discovery of the hepatitis C virus, transmission resulted from repeated use of contaminated syringes. Although we initially thought that these four causes occurred independently on a historical chronology, associations between the causes were found when we investigated the problem with a fishbone diagram.

  8. [Imaging manifestations and pathologic basis for hepatic capsular retraction syndrome caused by benign and malignant liver tumors].

    Science.gov (United States)

    Ou, Youkuan; Xiao, Enhua; Shang, Quanliang; Chen, Juan

    2015-10-01

    To investigate the imaging manifestations of CT, MRI and pathological basis for hepatic capsular retraction syndrome caused by benign and malignant liver tumors.
 CT or MRI images and pathological features for hepatic capsular retraction syndrome were retrospectively analyzed in 50 patients with benign and malignant liver tumors. Picture archive and communication system (PACS) was used to observe and compare the morphology, size, width, depth, edge of the capsular retraction and the status of liquid under the liver capsule. The structure, differentiation and proliferation of the tumor were analyzed under the microscope.
 There were malignant liver tumors in 44 patients and benign tumor in 6 patients. The smooth or rough for the edge of capsular retraction was significant difference between the benign tumors and the malignant tumors with three differentiated grades (all PBenign and malignant hepatic tumors may appear capsule retraction syndrome, but there are morphological differences between them. The differences are closely related with the lesion size, differentiated degree of tumor and fibrous tissue proliferation.

  9. Acute loss of the hepatic endo-lysosomal system in vivo causes compensatory changes in iron homeostasis.

    Science.gov (United States)

    Metzendorf, Christoph; Zeigerer, Anja; Seifert, Sarah; Sparla, Richard; Najafi, Bahar; Canonne-Hergaux, François; Zerial, Marino; Muckenthaler, Martina U

    2017-06-22

    Liver cells communicate with the extracellular environment to take up nutrients via endocytosis. Iron uptake is essential for metabolic activities and cell homeostasis. Here, we investigated the role of the endocytic system for maintaining iron homeostasis. We specifically depleted the small GTPase Rab5 in the mouse liver, causing a transient loss of the entire endo-lysosomal system. Strikingly, endosome depletion led to a fast reduction of hepatic iron levels, which was preceded by an increased abundance of the iron exporter ferroportin. Compensatory changes in livers of Rab5-depleted mice include increased expression of transferrin receptor 1 as well as reduced expression of the iron-regulatory hormone hepcidin. Serum iron indices (serum iron, free iron binding capacity and total iron binding capacity) in Rab5-KD mice were increased, consistent with an elevated splenic and hepatic iron export. Our data emphasize the critical importance of the endosomal compartments in hepatocytes to maintain hepatic and systemic iron homeostasis in vivo. The short time period (between day four and five) upon which these changes occur underscore the fast dynamics of the liver iron pool.

  10. Common cause failure analysis of the rodded scram system of the Arkansas Nuclear One-Unit 1 Plant

    International Nuclear Information System (INIS)

    Montague, D.F.; Campbell, D.J.; Flanagan, G.F.

    1986-10-01

    This study demonstrates the use of a formal method for common cause failure analysis in a reliability analysis of the Arkansas Nuclear One - Unit 1 rodded scram system. The scram system failure of interest is loss of capability of the system to shut the reactor down when required. The results of this analysis support the ATWS program sponsored by the US Nuclear Regulatory Commission. The methods used in this analysis support the NRC's Risk Methods Integration and Evaluation Program (RMIEP)

  11. Hepatic changes caused by exposure to telecobalt rays as detected by scintigraphy and computed tomography

    International Nuclear Information System (INIS)

    Lueth, I.

    1987-01-01

    Hepatic scintiscans obtained in a cohort of 111 patients subjected to partial irradiation of the liver using telecobalt showed low density spots for 53 of those individuals. Comparative assessments in a control group proved the liver's accumulation behaviour to be totally unrelated to factors like age, sex and dose administered. The liver is only to a very limited extent capable of recovering from radiation damage that is severe enough to be detected by scintigraphy or computed tomography. In the group examined here, spontaneous recovery was seen in no more than 7.5% of cases. Long-term plotting of the hepatic radioactivity levels seen in scintigrammes showed these to be reduced for periods of up to nine years. Such pathological changes were already observed at radiation levels as low as 12 Gy, even though a definite dose-dependency of defective accumulation, as shown by scintigraphy or computed tomography, could not be established. Particular mention should here be made of the fact that the losses of activity seen in hepatic scintiscans were not necessarily confirmed by pathological findings revealed at the same time on the basis of computed tomography. Liver function tests in the serum permitted no links to be established between the occurrence of low density spots in the scintiscans or tomograms and typical enzyme patterns that may be interpreted as being suggestive of radiation injury. (orig.) [de

  12. Chronic exposure to paclobutrazol causes hepatic steatosis in male rockfish Sebastiscus marmoratus and the mechanism involved

    Energy Technology Data Exchange (ETDEWEB)

    Sun Lingbin [State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen (China); Li Jinshou [Department of Biological Engineering, Ningde Normal University, Ningde City, Fujian (China); Zuo Zhenghong [State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen (China); Chen Meng [State Key Laboratory of Marine Environmental Science, Xiamen University, Xiamen (China); Wang Chonggang, E-mail: cgwang@xmu.edu.cn [State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen (China); State Key Laboratory of Marine Environmental Science, Xiamen University, Xiamen (China)

    2013-01-15

    Paclobutrazol (PBZ) is a triazole-containing fungicide which is widely used in agriculture. Acute toxicity can follow its extensive use but it is generally weaker than traditional pesticides such as organochlorine and organophosphorus. However, its adverse effects on aquatic organisms need to be investigated. This study was conducted to investigate the effect of PBZ exposure on the hepatic lipid metabolism of Sebastiscus marmoratus. After PBZ exposure for 50 days, hepatic lipid droplets were enlarged and the hepatic total lipid, triglyceride, total cholesterol and free fatty acid content had increased in a dose dependent manner compared to the control. The mRNA expression of lipid metabolism associated genes such as peroxisome proliferator-activated receptors (PPARs), androgen receptor, acetyl-CoA carboxylase 1, fatty acid synthesis, fatty acid bing protein 4, liver X receptor {alpha} (LXR{alpha}) and stearoyl-CoA desaturase were up-regulated by PBZ exposure. These results indicated that triazole-containing fungicides might affect the metabolism and health of fish via the multi-signal pathways of nuclear receptors such as PPARs and LXR.

  13. Fetomaternal Outcome in Acute Hepatitis E

    International Nuclear Information System (INIS)

    Sultana, R.; Humayun, S.

    2014-01-01

    Objective: To determine fetomaternal outcome in pregnant women with acute hepatitis E in terms of pregnancy outcome and perinatal mortality. Study Design: Case series. Place and Duration of Study: Department of Obstetrics and Gynecology, Sir Ganga Ram Hospital, Lahore, from July 2012 to March 2013. Methodology: Serum samples of 38 patients who presented with jaundice in pregnancy were collected to detect hepatitis E IgM antibodies. Demographics, pregnancy outcome and perinatal mortality was noted in hepatitis E positive cases with cause of complications. Cases with jaundice due solely to any other cause were excluded. Results: Twenty five patients had acute hepatitis E with coexistent acute hepatitis A in 1(4%) patient. Their mean age was 25 years and mean gravidity was 2. Among them, 10 (40%) patients were primigravida followed by gravida two in 7 (28%) cases. Twenty four (96%) patients presented in third trimester of pregnancy and in 1 (4%) pregnancy ended in second trimester missed miscarriage. The mean gestational age was 32 weeks. Twenty one (84%) babies were born alive, among them 18 (86%) were preterm. Perinatal mortality was 26%; contributed by intrauterine deaths and early neonatal deaths in 3 (14%) cases each. Total maternal deaths were 5 (20%), 4 (80%) in postpartum period and 1 (20%) in antepartum period due to fulminant hepatic failure in all cases. Conclusion: Prematurity in newborns and fulminant hepatic failure in mothers are major cause of poor fetomaternal outcome in acute hepatitis E in pregnancy. (author)

  14. Analysis of events with common cause failures (CCF) from the international common cause failure date exchange (ICDE); Analyse von Ereignissen mit gemeinsam verursachten Ausfaellen (GVA) aus dem internationalen GVA-Datenaustauschprojekt ICDE

    Energy Technology Data Exchange (ETDEWEB)

    Brueck, Benjamin; Kreuser, Albert; Simon, Julia; Stiller, Jan

    2014-08-15

    Common-cause-failure (CCF) events can significantly impact the availability of safety systems of nuclear power plants. In recognition of this, CCF data are systematically being collected and analyzed in several countries. A comprehensive evaluation of CCF events derived only from the operating experience in German nuclear power plants is not sufficient due to the low probability of occurrence of such events. Therefore it is necessary to make use of the operating experience of other countries using similar technology. In order to be able to use the CCF operating experience from other countries in the aim to carry on the development of the bases for evaluation of CCF GRS decisively co-initiated the setting up of an international common-cause failure working group. This working group has elaborated the project ''International Common-Cause Failure Data Exchange'' (ICDE). The project's objective is to organize a broad exchange of information concerning observed events with relevance to common-cause failures. The tasks for preparation and evaluation of information of the ICDE working group serve for confirmation and extension of the common-cause failure knowledge with regards to probabilistic safety analyses, the better understanding of causes and mechanisms of common-cause failures and the evaluation of preventive measures against the occurrence of common-cause failures. The objectives of the exchange on a long term basis are to - improve the comprehension of CCF events and their causes and their prevention, - generate qualitative insights into the root causes of CCF events which can then be used to derive and assess preventive measures against the occurrence of such events or their consequences, - establish an efficient feedback of experience gained in connection with observed common-cause failure phenomena which could be used e.g. for the development of indicators for risk based inspections, - provide quantitative information regarding the

  15. Cause-specific excess mortality in siblings of patients co-infected with HIV and hepatitis C virus

    DEFF Research Database (Denmark)

    Hansen, Ann-Brit Eg; Lohse, Nicolai; Gerstoft, Jan

    2007-01-01

    BACKGROUND: Co-infection with hepatitis C in HIV-infected individuals is associated with 3- to 4-fold higher mortality among these patients' siblings, compared with siblings of mono-infected HIV-patients or population controls. This indicates that risk factors shared by family members partially...... account for the excess mortality of HIV/HCV-co-infected patients. We aimed to explore the causes of death contributing to the excess sibling mortality. METHODOLOGY AND PRINCIPAL FINDINGS: We retrieved causes of death from the Danish National Registry of Deaths and estimated cause-specific excess mortality......-years, compared with siblings of matched population controls. Substance abuse-related deaths contributed most to the elevated mortality among siblings [EMR = 2.25 (1.09-3.40)] followed by unnatural deaths [EMR = 0.67 (-0.05-1.39)]. No siblings of HIV/HCV co-infected patients had a liver-related diagnosis...

  16. Impaired working memory capacity is not caused by failures of selective attention in schizophrenia.

    Science.gov (United States)

    Erickson, Molly A; Hahn, Britta; Leonard, Carly J; Robinson, Benjamin; Gray, Brad; Luck, Steven J; Gold, James

    2015-03-01

    The cognitive impairments associated with schizophrenia have long been known to involve deficits in working memory (WM) capacity. To date, however, the causes of WM capacity deficits remain unknown. The present study examined selective attention impairments as a putative contributor to observed capacity deficits in this population. To test this hypothesis, we used an experimental paradigm that assesses the role of selective attention in WM encoding and has been shown to involve the prefrontal cortex and the basal ganglia. In experiment 1, participants were required to remember the locations of 3 or 5 target items (red circles). In another condition, 3-target items were accompanied by 2 distractor items (yellow circles), which participants were instructed to ignore. People with schizophrenia (PSZ) exhibited significant impairment in memory for the locations of target items, consistent with reduced WM capacity, but PSZ and healthy control subjects did not differ in their ability to filter the distractors. This pattern was replicated in experiment 2 for distractors that were more salient. Taken together, these results demonstrate that reduced WM capacity in PSZ is not attributable to a failure of filtering irrelevant distractors. © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  17. Technical Basis for Evaluating Software-Related Common-Cause Failures

    Energy Technology Data Exchange (ETDEWEB)

    Muhlheim, Michael David [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States); Wood, Richard [Univ. of Tennessee, Knoxville, TN (United States); Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2016-04-01

    The instrumentation and control (I&C) system architecture at a nuclear power plant (NPP) incorporates protections against common-cause failures (CCFs) through the use of diversity and defense-in-depth. Even for well-established analog-based I&C system designs, the potential for CCFs of multiple systems (or redundancies within a system) constitutes a credible threat to defeating the defense-in-depth provisions within the I&C system architectures. The integration of digital technologies into the I&C systems provides many advantages compared to the aging analog systems with respect to reliability, maintenance, operability, and cost effectiveness. However, maintaining the diversity and defense-in-depth for both the hardware and software within the digital system is challenging. In fact, the introduction of digital technologies may actually increase the potential for CCF vulnerabilities because of the introduction of undetected systematic faults. These systematic faults are defined as a “design fault located in a software component” and at a high level, are predominately the result of (1) errors in the requirement specification, (2) inadequate provisions to account for design limits (e.g., environmental stress), or (3) technical faults incorporated in the internal system (or architectural) design or implementation. Other technology-neutral CCF concerns include hardware design errors, equipment qualification deficiencies, installation or maintenance errors, instrument loop scaling and setpoint mistakes.

  18. ICDE project report: collection and analysis of common-cause failures of motor operated valves

    International Nuclear Information System (INIS)

    2001-07-01

    This report documents a study performed on the set of common cause failures (CCF) of motor operated valves (MOV). The data studied here were derived from the International CCF Data Exchange (ICDE) database, to which several countries have submitted CCF event data. The purpose of the ICDE is to allow multiple countries to collaborate and exchange CCF data to enhance the quality of risk analyses that include CCF modeling. Because CCF events are typically rare events, most countries do not experience enough CCF events to perform meaningful analyses. Data combined from several countries, however, yields sufficient data for more rigorous analyses. This report is the result of an in-depth review of the MOV events and presents several insights about them. The objective of this document is to look beyond the CCF parameter estimates that can be obtained from the CCF data, to gain further understanding of why CCF events occur and what measures may be taken to prevent, or at least mitigate the effect of MOV CCF events. The report presents details of the ICDE project, a quantitative presentation of the MOV events, and a discussion of some engineering aspects of the events. (authors)

  19. Cheyne-Stokes respiration in patients with congestive heart failure: causes and consequences.

    Science.gov (United States)

    Lorenzi-Filho, Geraldo; Genta, Pedro R; Figueiredo, Adelaide C; Inoue, Daniel

    2005-08-01

    Cheyne-Stokes respiration is a form of periodic breathing in which central apneas and hypopneas alternate with periods of hyperventilation, producing a waxing and waning pattern of tidal volume. This review focuses on the causes and consequences of Cheyne-Stokes respiration in patients with congestive heart failure, in whom the prevalence is strikingly high and ranges from 30% to 50%. Several factors have been implicated in the genesis of Cheyne-Stokes respiration, including low cardiac output and recurrent hypoxia. The key pathophysiological mechanism triggering Cheyne-Stokes respiration is hyperventilation and low arterial CO2 (PaCO2) that when below the apneic threshold triggers a central apnea. Hyperventilation is associated with pulmonary congestion, and Cheyne-Stokes respiration is more prone to occur during sleep, when the respiratory system is mainly dependent on chemical control. It is associated with recurrent dips in oxygen saturation and arousals from sleep, with oscillations in blood pressure and heart rate, sympathetic activation and increased risk of ventricular tachycardia. Cheyne-Stokes respiration is an independent marker of poor prognosis and may participate in a vicious cycle, further stressing the failing heart.

  20. ICDE project report on collection and analysis of common-cause failures of emergency diesel generators

    International Nuclear Information System (INIS)

    2001-02-01

    This report documents a study performed on the set of common cause failures (CCF) of emergency diesel generators (EDG). The data studied here were derived from the International CCF Data Exchange (ICDE) database, to which several countries have submitted CCF event data. The data span a period from 1982 through 1997. The purpose of the ICDE is to allow multiple countries to collaborate and exchange CCF data to enhance the quality of risk analyses that include CCF modeling. Because CCF events are typically rare events, most countries do not experience enough CCF events to perform meaningful analyses. Data combined from several countries, however, yields sufficient data for more rigorous analyses. This report is the result of an in-depth review of the EDG events and presents several insights about them. The objective of this document is to look beyond the CCF parameter estimates that can be obtained from the CCF data, to gain further understanding of why CCF events occur and what measures may be taken to prevent, or at least mitigate the effect of, EDG CCF events. The report presents details of the ICDE project, a quantitative presentation of the EDG events, and a discussion of some engineering aspects of the events. (authors)

  1. Estimation of the common cause failure probabilities of the components under mixed testing schemes

    International Nuclear Information System (INIS)

    Kang, Dae Il; Hwang, Mee Jeong; Han, Sang Hoon

    2009-01-01

    For the case where trains or channels of standby safety systems consisting of more than two redundant components are tested in a staggered manner, the standby safety components within a train can be tested simultaneously or consecutively. In this case, mixed testing schemes, staggered and non-staggered testing schemes, are used for testing the components. Approximate formulas, based on the basic parameter method, were developed for the estimation of the common cause failure (CCF) probabilities of the components under mixed testing schemes. The developed formulas were applied to the four redundant check valves of the auxiliary feed water system as a demonstration study for their appropriateness. For a comparison, we estimated the CCF probabilities of the four redundant check valves for the mixed, staggered, and non-staggered testing schemes. The CCF probabilities of the four redundant check valves for the mixed testing schemes were estimated to be higher than those for the staggered testing scheme, and lower than those for the non-staggered testing scheme.

  2. MDEP Generic Common Position No DICWG-01. Common position on the treatment of common cause failure caused by software within digital safety systems

    International Nuclear Information System (INIS)

    2013-01-01

    Common cause failures (CCF)2 have been a significant safety concern for nuclear power plant systems. The increasing dependence on software-in safety systems for nuclear power plants has increased the safety significance of CCF caused by software, when software in redundant channels or portions of safety systems has some common dependency. For example, the effect of systematic failures can lead to a loss of safety in many ways: unwanted actuations, a safety function is not provided when needed. Therefore, nuclear power plants should be systematically protected from the effects of common cause failures caused by software in DI and C safety systems. Software for nuclear power plant safety systems should be of the high quality necessary to help assure against the loss of safety (i.e. developed with high-quality engineering practices, commensurate quality assurance applied, with continuous improvement through corrective actions based on lessons learned from operating experience). However, demonstrating adequate software quality only through verification and validation activities and controls on the development process has proved to be problematic. Therefore, this common position provides guidance for the assessment of the potential for CCF for software. It is recognized that programmable logic devices do not execute software in the conventional sense; however, the application development process using these devices have many similarities with software development, and the deficiencies that may be introduced during the application development process may induce errors in the programmable logic devices that can result in common cause failures of these devices of a type similar to software common cause failure. Although deficiencies with the potential to give rise to software common cause failures can be introduced at all phases of the software life cycle, this common position will only consider the potential for software common cause failures within digital safety system

  3. Anastomoses of the Ovarian and Uterine Arteries: A Potential Pitfall and Cause of Failure of Uterine Embolization

    International Nuclear Information System (INIS)

    Matson, Matthew; Nicholson, Anthony; Belli, Anna-Maria

    2000-01-01

    Four women with symptomatic uterine fibroids were treated by uterine artery embolization (UAE). In all cases both uterine arteries were embolized via a single femoral puncture with polyvinyl alcohol using a selective catheter technique. In three cases, the ovarian artery was not visible on the initial angiogram before embolization, but appeared after the second uterine artery had been treated. In one case of clinical failure following UAE, a repeat angiogram demonstrated filling of the fibroids from the ovarian artery. Anastomoses between uterine and ovarian arteries may cause problems for radiologists performing UAE and are a potential cause of treatment failure

  4. An uncommon cause of acquired osteosclerosis in adults: hepatitis C-associated osteosclerosis

    Energy Technology Data Exchange (ETDEWEB)

    Epperla, Narendranath [Marshfield Clinic, Department of Internal Medicine, Marshfield, WI (United States); McKiernan, Fergus E. [Marshfield Clinic, Center for Bone Disease, Marshfield, WI (United States)

    2014-09-15

    Hepatitis C-associated osteosclerosis (HCAO) is a rare sclerosing bone condition characterized by debilitating, predominantly lower extremity bone pain, accelerated bone turnover, and a generalized increase in histologically normal trabecular and cortical bone tissue. Herein we report the clinical presentation and imaging results of the 19th case of HCAO. Clinicians, particularly those caring for a population at risk for HCV infection, should be aware of this uncommon condition. The etio-pathogenesis of HCAO remains obscure but may bear important lessons in bone biology that could lead to new treatment options for osteoporosis. (orig.)

  5. Hepatitis A Vaccine

    Science.gov (United States)

    Twinrix® (as a combination product containing Hepatitis A Vaccine, Hepatitis B Vaccine) ... Why get vaccinated against hepatitis A?Hepatitis A is a serious liver disease. It is caused by the hepatitis A virus (HAV). HAV is spread from ...

  6. Logistic regression analysis of prognostic factors in 106 acute-on-chronic liver failure patients with hepatic encephalopathy

    Directory of Open Access Journals (Sweden)

    CUI Yanping

    2014-10-01

    Full Text Available ObjectiveTo analyze the prognostic factors in acute-on-chronic liver failure (ACLF patients with hepatic encephalopathy (HE and to explore the risk factors for prognosis. MethodsA retrospective analysis was performed on 106 ACLF patients with HE who were hospitalized in our hospital from January 2010 to July 2013. The patients were divided into improved group and deteriorated group. The univariate indicators including age, sex, laboratory indicators [total bilirubin (TBil, albumin (Alb, alanine aminotransferase (ALT, aspartate amino-transferase (AST, and prothrombin time activity (PTA], the stage of HE, complications [persistent hyponatremia, digestive tract bleeding, hepatorenal syndrome (HRS, ascites, infection, and spontaneous bacterial peritonitis (SBP], and plasma exchange were analyzed by chi-square test or t-test. Indicators with statistical significance were subsequently analyzed by binary logistic regression. ResultsUnivariate analysis showed that ALT (P=0.009, PTA (P=0.043, the stage of HE (P=0.000, and HRS (P=0.003 were significantly different between the two groups, whereas differences in age, sex, TBil, Alb, AST, persistent hyponatremia, digestive tract bleeding, ascites, infection, SBP, and plasma exchange were not statistically significant (P>0.05. Binary logistic regression demonstrated that PTA (b=-0097, P=0.025, OR=0.908, HRS (b=2.279, P=0.007, OR=9.764, and the stage of HE (b=1873, P=0.000, OR=6.510 were prognostic factors in ACLF patients with HE. ConclusionThe stage of HE, HRS, and PTA are independent influential factors for the prognosis in ACLF patients with HE. Reduced PTA, advanced HE stage, and the presence of HRS indicate worse prognosis.

  7. Asiatic Acid Exhibits Anti-inflammatory and Antioxidant Activities against Lipopolysaccharide and d-Galactosamine-Induced Fulminant Hepatic Failure

    Directory of Open Access Journals (Sweden)

    Hongming Lv

    2017-07-01

    Full Text Available Inflammation and oxidative stress are essential for the pathogenesis of fulminant hepatic failure (FHF. Asiatic acid (AA, which is a pentacyclic triterpene that widely occurs in various vegetables and fruits, has been reported to possess antioxidant and anti-inflammatory properties. In this study, we investigated the protective effects of AA against lipopolysaccharide (LPS and d-galactosamine (GalN-induced FHF and the underlying molecular mechanisms. Our findings suggested that AA treatment effectively protected against LPS/d-GalN-induced FHF by lessening the lethality; decreasing the alanine transaminase and aspartate aminotransferase levels, interleukin (IL-1β, IL-6, and tumor necrosis factor-α production, malondialdehyde formation, myeloperoxidase level and reactive oxygen species generation (i.e., H2O2, NO, and O2−, and increasing the glutathione and superoxide dismutase contents. Moreover, AA treatment significantly inhibited mitogen-activated protein kinase (MAPK and nuclear factor-kappa B (NF-κB signaling pathway activation via the partial induction of programmed cell death 4 (PDCD4 protein expressions, which are involved in inflammatory responses. Furthermore, AA treatment dramatically induced the expression of the glutamate-cysteine ligase modifier subunit, the glutamate-cysteine ligase catalytic subunit, heme oxygenase-1, and NAD (P H: quinoneoxidoreductase 1 (NQO1, which are largely dependent on activation of the nuclear factor-erythroid 2-related factor 2 (Nrf2 through the induction of AMP-activated protein kinase (AMPK and glycogen synthase kinase-3β (GSK3β phosphorylation. Accordingly, AA exhibited protective roles against LPS/d-GalN-induced FHF by inhibiting oxidative stress and inflammation. The underlying mechanism may be associated with the inhibition of MAPK and NF-κB activation via the partial induction of PDCD4 and upregulation of Nrf2 in an AMPK/GSK3β pathway activation-dependent manner.

  8. Hepatitis isquémica Ischemic hepatitis

    Directory of Open Access Journals (Sweden)

    Marcos Amuchástegui (h

    2006-10-01

    Full Text Available La hepatitis isquémica es una complicación sumamente infrecuente de cirugía cardiovascular. Las biopsias muestran necrosis centrolobulillar. El término de "hepatitis" fue propuesto debido al aumento de transaminasas similar a aquellas de origen infeccioso, e "isquémica" por falla en la perfusión hepática. Posteriormente se definió el término de hepatitis isquémica como cuadro de elevación aguda y reversible (dentro de las 72 horas de transaminasas de hasta 20 veces el valor normal, asociado a trastornos en la perfusión hepática, luego de haber excluido otras causas de hepatitis aguda o daño hepatocelular. Se describe el caso de un paciente de 53 años que consulta por dolor epigástrico de 12 h de evolución sin fiebre, náuseas ni vómitos, resistente a la medicación. Tenía antecedentes inmediatos de reemplazo de válvula aórtica, y estaba anticoagulado. Evolucionó con shock y fallo multiorgánico. El examen evidenció marcada ictericia y signos de taponamiento pericárdico, asociado a un aumento considerable de enzimas hepáticas. Un ecocardiograma informó signos de taponamiento cardíaco y ausencia de disección aórtica. Se decidió pericardiocentesis, extrayéndose 970 cc. de líquido sanguinolento, y hemodiálisis, con notable mejoría de su estado hemodinámico. Los valores enzimáticos disminuyeron. Los marcadores virales fueron negativos.Ischemic hepatitis is an uncommon cardiovascular surgery complication. Hepatic biopsies show centrolobulillar necrosis. The term "hepatitis" was proposed because of a raise in hepatic enzymes similar with infectious disease, and "ischemic" because of failure in hepatic perfusion. Ischemic hepatitis was then defined as an acute and reversible elevation of hepatic enzymes (within 72 h, associated with disturbance in hepatic perfusion after excluding other causes of acute hepatitis. A 53 year-old male presented complaining of a 12 h epigastric pain, without nausea or vomiting, resistant

  9. Parathyroid hormone and vitamin D--markers for cardiovascular and all cause mortality in heart failure

    DEFF Research Database (Denmark)

    Schierbeck, Louise Lind; Jensen, Torben Slott; Bang, Ulrich

    2011-01-01

    To investigate levels of vitamin D and parathyroid hormone (PTH) in a population of heart failure (HF) patients, and to evaluate whether vitamin D and PTH are related to prognosis.......To investigate levels of vitamin D and parathyroid hormone (PTH) in a population of heart failure (HF) patients, and to evaluate whether vitamin D and PTH are related to prognosis....

  10. Forensic study into the causes of premature failures in asphalt pavements in Tanzania

    CSIR Research Space (South Africa)

    Anochie-Boateng, Joseph

    2015-11-01

    Full Text Available Tanzania is faced with challenges of premature failures in roads and highways. Some asphalt pavements fail prematurely in less than five years of their expected 20 years design life cycle. These failures have been identified as mostly permanent...

  11. Numerical modelling of solid transport caused by an extreme flood: Case of the Hamiz dam failure (Algeria

    Directory of Open Access Journals (Sweden)

    Haddad Ali

    2017-07-01

    Full Text Available Study of solid transport caused by the flow of an extreme flood such as the propagation of dam failure wave aims to simulate the hydrodynamics behaviour of the solid particles contained in the valley during the flood passage. With this intention, we have developed a numerical model which is based on the resolution of the one-dimensional Saint Venant–Exner equations by the implicit finite difference scheme. Numerical stability of liquid phase calculation is checked by the Courant number and De Vries condition for the solid phase. The model has been applied to the Hamiz dam (Algeria which is built in the semi arid zone and presents a major risk of failure. The simulation of several scenarios of dam failure has allowed us to trace the cartography of sediment transport in the valley which is induced by the flood of dam failure.

  12. Liver damage caused by hepatitis C viral infection and ethyl alcohol consumption

    Directory of Open Access Journals (Sweden)

    Kostić Velimir

    2006-01-01

    Full Text Available Background/Aim. Hepatitis C virus infection (HCV is a complex disease, most commonly chronicle (80-85%. The aim of this research was to determinate the level of the liver damage in the patients cansed by HCV in conjunction with consuming ethyl alcohol. Methods. The research included 15 patients with chronic HCV infection supported by the misuse of ethyl alcohol, as well. The diagnosis of C infection hepatitis was proved using the ELISA test and PCR method. Results. The results of the study showed the liver damage by both HCV infection and ethyl alcohol, which was verified by the presence of biochemical changes and patohystological processing of the patients (liver biopsy and prosection. Patohystological changes were at the level of liver cirrhosis and carcinoma (2 patients. There was a signficant difference between the two subgroups (p < 0.001 regarding the examined values γ-GT, PLT and PTV. The basic therapeutic procedure was to introduce this category of patients into alcohol abstinence, and, in a few patients, to apply the antivirus therapy, as well. Conclusion. Based on the number of the examined patients (n = 15, we could conclude that a prolonged ethyl alcohol misuse with the presence of HCV infection was in a correlation with the liver disease progression.

  13. Hydatid cyst of the liver which demaged the confluence of the hepatic ducts causing deep obstructive jaundice

    Directory of Open Access Journals (Sweden)

    Čolović Radoje B.

    2003-01-01

    Full Text Available Complications of the hydatid cyst of the liver on bile ducts appear in 5-25% representing almost two third of all complications of the hydatid liver cysts. Fortunately a damage to the bile ducts causes only an infection of the cyst usually without major consequences. More serious complications such as cholangitis and deep obstructive jaundice are much rarer. The defect of the bile duct usually is a periferal one. Damage to the major ducts are rarer and those on the confluence of hepatic ducts itself are the rarity. In that case biliary reconstruction may be a serious chalenge. The authors present a 23 year-old man in whom a centrally localised hydatid cyst made a major damage of the confluence of all three hepatic ducts causing deep obstructive jaundice. After standard procedure for hydatid cyst an intracavital mucosa to mucosa hepaticoje-junostomy was carried out with excellent success. More then six years after surgery the patient stayed symptom-free with bilirubin and alkaline phosphatase within normal limits.

  14. The Aznalcollar (Spain) tailings pond failure of 1998 and the ecological disaster of Guadiamar river: causes, effects and lessons

    International Nuclear Information System (INIS)

    Ayala-Carcedo, F. J.

    2004-01-01

    On 1998 a large tailings pond confined by a rock fill dyke in the Aznalcollar metallic mine near Sevilla, at the SW of Spain, failed with a big impact on public opinion due to potential environmental Impact on Donana National Park,a key natural space for birds migration between Europea and Africa. The accident is placed in a comparative way with others in the world, the causes of failure, its dynamics and the spill are analysed and also the actual ecological impacts related to the tailings and acid waters scattered by the Agrio and Guadiamar rivers. The lessons for future design and location of these type of deposits and water dams are also presented. The accident very quick, was caused by shear failure of the foundation formation, a miocene over consolidated marly clay, known as Guadalquivir blue marl, through a vertical point and a bedding plane, as a result of a progressive failure process under high pore pressure. Dynamic liquefaction of tailings due to sudden vertical movement towards the void created by the initial movement was a key factor to increase the outwards movement of the dyke, broken by the movement, and the tailings spill. The double dyke failure (main dyke and internal one) produced a tailings spill with solid and liquid flow. The dynamics of these flows is presented and also the combination of factors driving to failure. the problem posed by the successive human institutional failures, a necessary cause driving to no consideration of the possibility of the progressive failure in these formations, known from 1964, is also analysed. (Author) 67 refs

  15. Inhibition of mTOR improves the impairment of acidification in autophagic vesicles caused by hepatic steatosis

    International Nuclear Information System (INIS)

    Nakadera, Eisuke; Yamashina, Shunhei; Izumi, Kousuke; Inami, Yoshihiro; Sato, Toshifumi; Fukushima, Hirofumi; Kon, Kazuyoshi; Ikejima, Kenichi; Ueno, Takashi; Watanabe, Sumio

    2016-01-01

    Recent investigations revealed that dysfunction of autophagy involved in the progression of chronic liver diseases such as alcoholic and nonalcoholic steatohepatitis and hepatocellular neoplasia. Previously, it was reported that hepatic steatosis disturbs autophagic proteolysis via suppression of both autophagic induction and lysosomal function. Here, we demonstrate that autophagic acidification was altered by a decrease in lysosomal proton pump vacuolar-ATPase (V-ATPase) in steatohepatitis. The number of autophagic vesicles was increased in hepatocytes from obese KKAy mice as compared to control. Similarly, autophagic membrane protein LC3-II and lysosomal protein LAMP-2 expression were enhanced in KKAy mice liver. Nevertheless, both phospho-mTOR and p62 expression were augmented in KKAy mice liver. More than 70% of autophagosomes were stained by LysoTracker Red (LTR) in hepatocytes from control mice; however, the percentage of acidic autolysosomes was decreased in hepatocytes from KKAy mice significantly (40.1 ± 3.48%). Both protein and RNA level of V-ATPase subunits ATP6v1a, ATP6v1b, ATP6v1d in isolated lysosomes were suppressed in KKAy mice as compared to control. Interestingly, incubation with mTOR inhibitor rapamycin increased in the rate of LTR-positive autolysosomes in hepatocytes from KKAy mice and suppressed p62 accumulation in the liver from KKAy mice which correlated to an increase in the V-ATPase subunits expression. These results indicate that down-regulation of V-ATPase due to hepatic steatosis causes autophagic dysfunction via disruption of lysosomal and autophagic acidification. Moreover, activation of mTOR plays a pivotal role on dysregulation of lysosomal and autophagic acidification by modulation of V-ATPase expression and could therefore be a useful therapeutic target to ameliorate dysfunction of autophagy in NAFLD. - Highlights: • Hepatic steatosis causes accumulation of autophagic vesicles in hepatocytes. • Hepatic steatosis disturbs

  16. Inhibition of mTOR improves the impairment of acidification in autophagic vesicles caused by hepatic steatosis

    Energy Technology Data Exchange (ETDEWEB)

    Nakadera, Eisuke [Department of Gastroenterology, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421 (Japan); Yamashina, Shunhei, E-mail: syamashi@juntendo.ac.jp [Department of Gastroenterology, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421 (Japan); Izumi, Kousuke; Inami, Yoshihiro; Sato, Toshifumi; Fukushima, Hirofumi; Kon, Kazuyoshi; Ikejima, Kenichi [Department of Gastroenterology, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421 (Japan); Ueno, Takashi [Division of Proteomics and Biomolecular Science, Juntendo University, School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421 (Japan); Watanabe, Sumio [Department of Gastroenterology, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo 113-8421 (Japan)

    2016-01-22

    Recent investigations revealed that dysfunction of autophagy involved in the progression of chronic liver diseases such as alcoholic and nonalcoholic steatohepatitis and hepatocellular neoplasia. Previously, it was reported that hepatic steatosis disturbs autophagic proteolysis via suppression of both autophagic induction and lysosomal function. Here, we demonstrate that autophagic acidification was altered by a decrease in lysosomal proton pump vacuolar-ATPase (V-ATPase) in steatohepatitis. The number of autophagic vesicles was increased in hepatocytes from obese KKAy mice as compared to control. Similarly, autophagic membrane protein LC3-II and lysosomal protein LAMP-2 expression were enhanced in KKAy mice liver. Nevertheless, both phospho-mTOR and p62 expression were augmented in KKAy mice liver. More than 70% of autophagosomes were stained by LysoTracker Red (LTR) in hepatocytes from control mice; however, the percentage of acidic autolysosomes was decreased in hepatocytes from KKAy mice significantly (40.1 ± 3.48%). Both protein and RNA level of V-ATPase subunits ATP6v1a, ATP6v1b, ATP6v1d in isolated lysosomes were suppressed in KKAy mice as compared to control. Interestingly, incubation with mTOR inhibitor rapamycin increased in the rate of LTR-positive autolysosomes in hepatocytes from KKAy mice and suppressed p62 accumulation in the liver from KKAy mice which correlated to an increase in the V-ATPase subunits expression. These results indicate that down-regulation of V-ATPase due to hepatic steatosis causes autophagic dysfunction via disruption of lysosomal and autophagic acidification. Moreover, activation of mTOR plays a pivotal role on dysregulation of lysosomal and autophagic acidification by modulation of V-ATPase expression and could therefore be a useful therapeutic target to ameliorate dysfunction of autophagy in NAFLD. - Highlights: • Hepatic steatosis causes accumulation of autophagic vesicles in hepatocytes. • Hepatic steatosis disturbs

  17. Interprofessional communication failures in acute care chains: How can we identify the causes?

    Science.gov (United States)

    van Leijen-Zeelenberg, Janneke E; van Raak, Arno J A; Duimel-Peeters, Inge G P; Kroese, Mariëlle E A L; Brink, Peter R G; Vrijhoef, Hubertus J M

    2015-01-01

    Although communication failures between professionals in acute care delivery occur, explanations for these failures remain unclear. We aim to gain a deeper understanding of interprofessional communication failures by assessing two different explanations for them. A multiple case study containing six cases (i.e. acute care chains) was carried out in which semi-structured interviews, physical artifacts and archival records were used for data collection. Data were entered into matrices and the pattern-matching technique was used to examine the two complementary propositions. Based on the level of standardization and integration present in the acute care chains, the six acute care chains could be divided into two categories of care processes, with the care chains equally distributed among the categories. Failures in communication occurred in both groups. Communication routines were embedded within organizations and descriptions of communication routines in the entire acute care chain could not be found. Based on the results, failures in communication could not exclusively be explained by literature on process typology. Literature on organizational routines was useful to explain the occurrence of communication failures in the acute care chains. Organizational routines can be seen as repetitive action patterns and play an important role in organizations, as most processes are carried out by means of routines. The results of this study imply that it is useful to further explore the role of organizational routines on interprofessional communication in acute care chains to develop a solution for failures in handover practices.

  18. Toksisk hepatitis efter indtagelse af kosttilskuddet purshianabark

    DEFF Research Database (Denmark)

    Jacobsen, Claire; Semb, Synne; Kromann-Andersen, Hans

    2009-01-01

    Herbal medicinal products can cause toxic hepatitis. This case report presents a patient who developed severe toxic hepatitis with beginning liver failure following four weeks of consumption of the herbal medicinal product Cascara Sagrada. A similar case was reported from the United States. Cascara...... Sagrada is found in 30-40 herbal medicinal products in Denmark. We recommend that herbal medicinal products containing Cascara Sagrada be withdrawn from the market. Udgivelsesdato: 2009-Nov...

  19. EVALUATION OF EFFECTIVENESS OF ANTIVIRAL THERAPY FOR CHRONIC HEPATITIS C, CAUSED BY HCV GENOTYPE 6

    Directory of Open Access Journals (Sweden)

    D. A. Lioznov

    2017-01-01

    Full Text Available Objectives: Evaluating the effectiveness of 2 therapeutic schemes for chronic hepatitis C (genotype 6 which combined sofosbuvir and ribavirin, one of them also included pegylated interferon. Materials and methods: The study included 110 patients with chronic hepatitis C (genotype 6, who have undergone antiviral therapy (HTP in Hepatology Clinic inHo Chi Minh City,Vietnamfrom November 2015 to July 2016. 24 patients were treated by Pegylated interferon alfa-2a, ribavirin and sofosbuvir for 12 weeks, 86 patients – by sofosbuvir and ribavirin for 24 weeks. Non-interferon regimen was administered primarily to patients with contraindications to the use of interferon. To monitor the effectiveness of antiviral therapy, quantification of HCV RNA in serum was performed by PCR prior to treatment, at 4th, 12th or 24th week (depending on the observation group from the starting of treatment and at 12th, 24th week after completion of treatment. Results: All patients, who were treated with pegylated interferon, ribavirin and sofosbuvir, completed the full course of treatment and 100% of them are registered with sustained virological response at 12th and 24th week after the end of antiviral therapy (SVR-12 and SVR-24, respectively. In the group of patients, who treated with ribavirin and sofosbuvir, 97,7% of patients completed full course of treatment (SVR-12 was registered in 93% of patients, and SVR-24 – in 91,9% of patients. Of 75 patients without a history of HCC, SVR24 was registered in 74 people (98,7%, of 11 patients with HCC – in 5 patients (45,5%. SVR-24 was registered in 98% of patients with cirrhosis (F4 without HCC. Conclusion: The results can serve as a justification for the use of these schemes of antiviral therapy for special groups of patients and/or conditions when it is impossible to follow the latest recommendations, which will help to expand the access of patients to effective antiviral therapy for chronic hepatitis C.

  20. Therapeutic plasma exchange versus double plasma molecular absorption system in hepatitis B virus-infected acute-on-chronic liver failure treated by entercavir: A prospective study.

    Science.gov (United States)

    Wan, Yue-Meng; Li, Yu-Hua; Xu, Zhi-Yuan; Yang, Jing; Yang, Li-Hong; Xu, Ying; Yang, Jin-Hui

    2017-12-01

    Therapeutic plasma exchange (TPE) and double plasma molecular absorption system (DPMAS) were two extracorporeal liver support systems. Few studies compared their efficacy profile. This study was to compare the efficacy of TPE and DPMAS on acute-on-chronic liver failure (ACLF) caused by hepatitis B virus (HBV-ACLF). 60 HBV-ACLF patients were enrolled and prospectively studied. All patients received entecavir therapy, and were assigned to TPE group (n = 33) and DPMAS group (n = 27). Primary end-points were the effects of TPE and DPMAS on liver function and serum inflammatory markers. Serum procalcitonin, interleukin (IL)-6, and high sensitive C-reactive protein (hsCRP) were significantly elevated in patients with HBV-ACLF. TPE achieved significantly higher removal rates of total bilirubin (TBIL, P = .002), direct bilirubin (DBIL, P = .006), and hsCRP (P = .010) than DPMAS, but DPMAS displayed lower loss rate of albumin (P = .000). TPE and DPMAS resulted in similarly increased serum IL-6 levels and comparable 12-week survivals (P > .05). Multivariate analysis showed that hospital stay (Relative Risk [RR]: 1.062, 95% Confidence Interval [CI]: 1.011-1.115, P = .016), prothrombin time (RR: 1.346, 95% CI: 1.077-1.726, P = .010), and international normalized ratio (RR: 0.013, 95% CI: 0.006-0.788, P = .041) were independent predictors for 12-week survival. Both TPE and DPMAS treatments were well-tolerated. Compared to DPMAS, TPE was more efficient in eliminating TBIL, DBIL, and hsCRP, but it was associated with higher loss rate of albumin. TPE and DPMAS were similar in improving 12-week survivals in HBV-ACLF. © 2017 Wiley Periodicals, Inc.

  1. Somatic versus cognitive symptoms of depression as predictors of all-cause mortality and health status in chronic heart failure

    DEFF Research Database (Denmark)

    Schiffer, Angélique A; Pelle, Aline J; Smith, Otto R F

    2009-01-01

    Depression is a predictor of adverse health outcomes in chronic heart failure (CHF), but it is not known whether specific symptoms drive this relationship. We examined the impact of somatic/affective, cognitive/affective, and total depressive symptoms on all-cause mortality and health status in CHF....

  2. East coast fever caused by Theileria parva is characterized by macrophage activation associated with vasculitis and respiratory failure

    Science.gov (United States)

    Respiratory failure and death in East Coast Fever (ECF), a clinical syndrome of African cattle caused by the apicomplexan parasite Theileria parva, has historically been attributed to pulmonary infiltration by infected lymphocytes. However, immunohistochemical staining of tissue from T. parva infect...

  3. Analysis of the prevalence and causes of ultrafiltration failure during long-term peritoneal dialysis: a cross-sectional study

    NARCIS (Netherlands)

    Smit, Watske; Schouten, Natalie; van den Berg, Nicole; Langedijk, Monique J.; Struijk, Dirk G.; Krediet, Raymond T.

    2004-01-01

    BACKGROUND: Ultrafiltration failure (UFF) is a major complication of peritoneal dialysis (PD). It can occur at any stage of PD, but develops in time and is, therefore, especially important in long-term treatment. To investigate its prevalence and to identify possible causes, we performed a

  4. [Hydatid cyst in the hepatic hilum causing a cavernous transformation in the portal vein].

    Science.gov (United States)

    Gil-Egea, M J; Alameda, F; Girvent, M; Riera, R; Sitges-Serra, A

    1998-05-01

    Portal cavernomatosis consists in the substitution of the portal vein by many fine, twisting venules leading to the liver. This phenomenon is produced as a consequence of anterior thrombosis of the portal vein and is associated with chronic pancreatitis, cancer of the pancreas, intraabdominal sepsis and cholelithiasis. The symptomatology may be nul or present as obstructive jaundice or portal hypertension. Diagnosis is made by Doppler echography. The treatment is portal shunt when symptomatology is produced. In patients with cholelithiasis requiring surgery, the shunt is advised prior to biliary surgery since perioperative hemorrhage, if present, may be incoercible as in the case herein described. We present a 84-year-old woman with portal cavernomatosis the etiology of which was a hydatidic cyst located in the hepatic bifurcation and treated with mebendazol 10 years previously. This etiology has not been previously reported.

  5. [A hepatitis A outbreak caused by contaminated well water in a primary school of Jiangxi province, China, 2009].

    Science.gov (United States)

    Chen, Jing; Cheng, Hui-jian; Zhang, Li-jie; Zong, Jun; Ma, Hui-lai; Zhu, Bao-ping

    2011-10-01

    A hepatitis A outbreak in a primary school was reported by Gan County Center for Disease Control and Province (CDC) and an investigation was conducted to identify the possible source of infection and risk factors for transmission. A probable case was defined as having onset of jaundice (yellow urine, sclera or skin) or a 2-fold increase in Alanine aminotransferase with 2 or more, of the followings symptoms: anorexia, disgust of oil, abdominal pain, nausea, fatigue, vomiting, in students and staff of the primary school between 1 November 2008 and 14 February 2009. A confirmed case was IgM positive for hepatitis A, added on a probable case. We searched for cases through reviewing medical records in the township hospital and village clinics and conducting symptom screening among students or teachers. We also conducted a case-control study to compare the exposure histories of 19 cases and 53 anti-HAV-IgM negative controls randomly selected from those asymptomatic students in the same grade. 21 cases from all the students was identified, with the attack rate as 3.5%. The epidemic curve showed the two peaks of the outbreak were 28 days apart, both indicating that they were related to the exposure of the source of origin. 74% of the case-students drank the unboiled Well B water, compared to 42% of control-students (OR = 4.0, 95%CI: 1.1 - 15). The total bacterial count was 600 cfu/ml and the total coliform was 23 MPN/100 ml in one sample collected from the well water. This hepatitis A outbreak was caused by drinking contaminated water in Well B. We recommended that all the schools should use chlorinated municipal pipe water. Public health authorities should strengthen the supervision of quality of water in schools.

  6. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... is a condition that causes temporary worsening of brain function in people with advanced liver disease. When ... travel through your body until they reach your brain, causing mental and physical symptoms of HE. Hepatic ...

  7. Control rod trip failures; Salem 1, the cause, response, and potential fixes

    International Nuclear Information System (INIS)

    Hall, R.E.; Boccio, J.L.; Luckas, W.J.

    1984-01-01

    This chapter presents a systems and reliability analysis of recent nuclear reactor control rod failure-to-trip (or scram) events that have been experienced in the US commercial nuclear industry. The operational factors of hardware, procedures, and human error are considered in the analysis of transients without scram. The 1980 Browns Ferry 3 scram system failure is analyzed to contrast the two 1983 Salem 1 events. The details of the Salem control rod failure to trip are investigated and used to calculate the reactor protection system unavailabilities. The internal reactor trip breaker logic is reviewed as related to the Westinghouse DB-50 breaker application. The impact of test and maintenance on system challenges is discussed. It is concluded that although the failure to trip or scram represents a single class of initiators, the actual events of each transient are operationally unique and require individual human responses

  8. Unexpected ICD pulse generator failure due to electronic circuit damage caused by electrical overstress.

    Science.gov (United States)

    Hauser, R G; Hayes, D L; Almquist, A K; Epstein, A E; Parsonnet, V; Tyers, G F; Vlay, S C; Schoenfeld, M H

    2001-07-01

    Because it is a lifesaving device, the unexpected failure of an ICD can be catastrophic. We report ICD electronic circuit failure due to electrical overstress damage (EOS) to the high voltage hybird circuit and other electronic components in a series of ICD pulse generator models. Data were obtained from the Multicenter Registry of Pacemaker and ICD Pacemaker and Lead Failures, and from the manufactures' adverse event reports, that were in the FDA's Manufacturer and User Facility Device Experience (MAUDE) database. Of 16 nonbattery Guidant/CPI ICD pulse generator failures reported to the registry, 6 (38%) have been confirmed by the manufacturer to be EOS related, and Guidant/CPI has reported 273 such failures to the FDA as of 12/29/00. The signs of failure included loss of telemetry and inability to deliver therapy, and some patients have experienced serious adverse events. Hybrid circuit damage may have occurred during capacitor charging or reform, and the majority appears to have happened during normal ICD function. While the incidence of this problem is unknown, a management strategy should be adopted that includes routine follow-up every 3 months and device evaluation after a shock or exposure to external defibrillation or electrosurgical devices. This study suggests that additional data are needed to determine the incidence of this problem, and that our present methods for monitoring the performance of ICD's following market release are inadequate.

  9. Image and Substance Failures in Regional Organisations: Causes, Consequences, Learning and Change?

    Directory of Open Access Journals (Sweden)

    Meng Hsuan Chou

    2016-08-01

    Full Text Available States often pool their sovereignty, capacity and resources to provide regionally specific public goods, such as security or trade rules, and regional organisations play important roles in international relations as institutions that attempt to secure peace and contribute to achieving other similar global policy goals. We observe failures occurring in these arrangements and activities in two areas: substance and image. To analytically account for this, we distinguish four modes of substance and image change and link these to specific types of failure and (lack of learning. To empirically ground and test our assumptions, we examine instances of image failure in ASEAN (political/security policy and substantive policy failure in EU labour migration policy. In so doing, this article contributes to several different fields of study and concepts that have hitherto rarely engaged with one another: analyses of policy failure from public policy, and regional integration concerns from area studies and international relations. We conclude with suggestions for ways forward to further analyse and understand failures at the international and supranational levels.

  10. A case of acute liver failure in dengue hemorrhagic fever

    Directory of Open Access Journals (Sweden)

    Rama Biswas

    2013-07-01

    Full Text Available Dengue is an arboviral disease endemic in many parts of the world. The clinical presentation of dengue viral infection ranges from asymptomatic illness to fatal dengue shock syndrome. Although, it is known to cause hepatic involvement, it occasionally results in acute hepatic failure. We report a case of dengue hemorrhagic fever presenting with acute liver failure. The case recovered completely after treatment. Ibrahim Med. Coll. J. 2013; 7(2: 41-42

  11. Root cause analysis underscores the importance of understanding, addressing, and communicating cold chain equipment failures to improve equipment performance.

    Science.gov (United States)

    Lennon, Pat; Atuhaire, Brian; Yavari, Shahrzad; Sampath, Vidya; Mvundura, Mercy; Ramanathan, Nithya; Robertson, Joanie

    2017-04-19

    Vaccine cold chain equipment (CCE) in developing countries is often exposed to harsh environmental conditions, such as extreme temperatures and humidity, and is subject to many additional challenges, including intermittent power supply, insufficient maintenance capacity, and a scarcity of replacement parts. Together, these challenges lead to high failure rates for refrigerators, potentially damaging vaccines and adversely affecting immunization coverage. Providing a sustainable solution for improving CCE performance requires an understanding of the root causes of failure. Project teams conducted small-scale studies to determine the root causes of CCE failure in selected locations in Uganda and Mozambique. The evaluations covered 59 failed refrigerators and freezers in Uganda and 27 refrigerators in Mozambique. In Uganda, the vast majority of failures were due to a cooling unit fault in one widely used refrigerator model. In Mozambique, 11 of the 27 problems were attributable to solar refrigerators with batteries that were unable to hold a charge, and another eight problems were associated with a need to adjust thermostat settings. The studies showed that tracking and evaluation of equipment performance and failure can yield important, actionable information for a range of stakeholders, including local CCE technicians, the ministry of health, equipment manufacturers, and international partners such as the United Nations Children's Fund, World Health Organization, and Gavi, the Vaccine Alliance. Collaborative efforts to systematically collect and communicate data on CCE performance and causes of failure will help to improve the efficiency and reach of immunization programs in low- and middle-income countries. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  12. Delayed Recognition of Deterioration of Patients in General Wards Is Mostly Caused by Human Related Monitoring Failures: A Root Cause Analysis of Unplanned ICU Admissions.

    Directory of Open Access Journals (Sweden)

    Louise S van Galen

    Full Text Available An unplanned ICU admission of an inpatient is a serious adverse event (SAE. So far, no in depth-study has been performed to systematically analyse the root causes of unplanned ICU-admissions. The primary aim of this study was to identify the healthcare worker-, organisational-, technical,- disease- and patient- related causes that contribute to acute unplanned ICU admissions from general wards using a Root-Cause Analysis Tool called PRISMA-medical. Although a Track and Trigger System (MEWS was introduced in our hospital a few years ago, it was implemented without a clear protocol. Therefore, the secondary aim was to assess the adherence to a Track and Trigger system to identify deterioration on general hospital wards in patients eventually transferred to the ICU.Retrospective observational study in 49 consecutive adult patients acutely admitted to the Intensive Care Unit from a general nursing ward. 1. PRISMA-analysis on root causes of unplanned ICU admissions 2. Assessment of protocol adherence to the early warning score system.Out of 49 cases, 156 root causes were identified. The most frequent root causes were healthcare worker related (46%, which were mainly failures in monitoring the patient. They were followed by disease-related (45%, patient-related causes (7, 5%, and organisational root causes (3%. In only 40% of the patients vital parameters were monitored as was instructed by the doctor. 477 vital parameter sets were found in the 48 hours before ICU admission, in only 1% a correct MEWS was explicitly documented in the record.This in-depth analysis demonstrates that almost half of the unplanned ICU admissions from the general ward had healthcare worker related root causes, mostly due to monitoring failures in clinically deteriorating patients. In order to reduce unplanned ICU admissions, improving the monitoring of patients is therefore warranted.

  13. Bactericidal Immunity to Salmonella in Africans and Mechanisms Causing Its Failure in HIV Infection.

    Directory of Open Access Journals (Sweden)

    Yun Shan Goh

    2016-04-01

    Full Text Available Nontyphoidal strains of Salmonella are a leading cause of death among HIV-infected Africans. Antibody-induced complement-mediated killing protects healthy Africans against Salmonella, but increased levels of anti-lipopolysaccharide (LPS antibodies in some HIV-infected African adults block this killing. The objective was to understand how these high levels of anti-LPS antibodies interfere with the killing of Salmonella.Sera and affinity-purified antibodies from African HIV-infected adults that failed to kill invasive S. Typhimurium D23580 were compared to sera from HIV-uninfected and HIV-infected subjects with bactericidal activity. The failure of sera from certain HIV-infected subjects to kill Salmonella was found to be due to an inherent inhibitory effect of anti-LPS antibodies. This inhibition was concentration-dependent and strongly associated with IgA and IgG2 anti-LPS antibodies (p<0.0001 for both. IgG anti-LPS antibodies, from sera of HIV-infected individuals that inhibit killing at high concentration, induced killing when diluted. Conversely, IgG, from sera of HIV-uninfected adults that induce killing, inhibited killing when concentrated. IgM anti-LPS antibodies from all subjects also induced Salmonella killing. Finally, the inhibitory effect of high concentrations of anti-LPS antibodies is seen with IgM as well as IgG and IgA. No correlation was found between affinity or avidity, or complement deposition or consumption, and inhibition of killing.IgG and IgM classes of anti-S. Typhimurium LPS antibodies from HIV-infected and HIV-uninfected individuals are bactericidal, while at very high concentrations, anti-LPS antibodies of all classes inhibit in vitro killing of Salmonella. This could be due to a variety of mechanisms relating to the poor ability of IgA and IgG2 to activate complement, and deposition of complement at sites where it cannot insert in the bacterial membrane. Vaccine trials are required to understand the significance of

  14. Hepatic Complications of Anorexia Nervosa.

    Science.gov (United States)

    Rosen, Elissa; Bakshi, Neeru; Watters, Ashlie; Rosen, Hugo R; Mehler, Philip S

    2017-11-01

    Anorexia nervosa (AN) has the highest mortality rate of all psychiatric illnesses due to the widespread organ dysfunction caused by the underlying severe malnutrition. Starvation causes hepatocyte injury and death leading to a rise in aminotransferases. Malnutrition-induced hepatitis is common among individuals with AN especially as body mass index decreases. Acute liver failure associated with coagulopathy and encephalopathy can rarely occur. Liver enzymes may also less commonly increase as part of the refeeding process due to hepatic steatosis and can be distinguished from starvation hepatitis by the finding of a fatty liver on ultrasonography. Individuals with AN and starvation-induced hepatitis are at increased risk of hypoglycemia due to depleted glycogen stores and impaired gluconeogenesis. Gastroenterology and hepatology consultations are often requested when patients with AN and signs of hepatitis are hospitalized. It should be noted that additional laboratory testing, imaging, or liver biopsy all have low diagnostic yield, are costly, and potentially invasive, therefore, not generally recommended for diagnostic purposes. While the hepatitis of AN can reach severe levels, a supervised increase in caloric intake and a return to a healthy body weight often quickly lead to normalization of elevated aminotransferases caused by starvation.

  15. [Immunotherapy in aplastic anaemia as a cause of reactivation of hepatitis B virus-immunologic aspects].

    Science.gov (United States)

    Luczyński, Włodzimierz; Muszyńska-Rosłan, Katarzyna; Krawczuk-Rybak, Maryna; Lebensztejn, Dariusz M

    2005-01-01

    We present history of 16-year-old boy, HBsAg carrier, treated with interferon alpha at the age of 6 because of hepatitis B (HBeAg/antyHBe seroconversion). In August 2002--admitted to Department of Pediatric Oncology due to pancytopenia--diagnosis of severe aplastic anaemia was made (bone marrow cellularity--10%). We found no relative donor for hematopoietic cells transplantation and started immunosuppresive therapy (ATG, G-CSF, methyloprednisolon, cyclosporin). Haematologic parameters were improving. At day +60 he was admitted to our Department due to the increase in aminotransferases and cyclosporin activity. He was treated with cefuroxim, acyclovir and drugs improving liver cell function, cyclosporin was stopped. Presence of HBV DNA in serum confirmed HBV reactivation--a boy received lamivudine and cyclosporin again (as a maintenance therapy of aplastic anaemia). Aminotransferase activity and haematological parameters returned to normal. This case indicates the possibility of HBV reactivation in the course of immunosuppressive therapy (e.g. after antithymocytic globulin and cyclosporin) for aplastic anaemia.

  16. A New Mutation Causing Progressive Familiar Intrahepatic Cholestasis Type 3 in Association with Autoimmune Hepatitis

    Directory of Open Access Journals (Sweden)

    Hugo M Oliveira

    2017-03-01

    Full Text Available Background: Some patients exhibit features of both autoimmune hepatitis (AIH and primary sclerosing cholangitis (PSC. Similarly, patients with progressive familial intrahepatic cholestasis type 3 (PFIC3 may share histological features with PSC. Case report: We report the case of a 22-year-old man who, since he was 5 years of age, has presented with pruritus, an approximately ninefold elevation of aminotransferases, and γ-glutamyl transferase levels ~10 times the upper limit. Initially he was diagnosed with an overlap syndrome of small duct PSC plus AIH. However, fluctuations in liver enzymes were observed over the following years. Analysis of the ABCB4 gene indicated the diagnosis of PFIC3, revealing a mutation not previously reported. Conclusion: With this case report we aim to describe a new mutation, raise awareness of this rare pathology and highlight the importance of genetic testing of the ABCB4 gene in patients with autoimmune liver disease (mainly small duct PSC with incomplete response to immunosuppressive treatment.

  17. Magnitude and causes of loss to follow-up among patients with viral hepatitis at a tertiary care hospital in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Hanan H. Balkhy

    2017-07-01

    Full Text Available Background: Non-adherence with recommended follow-up visits is a major barrier for completing treatment of viral hepatitis and is consequently associated with unfavorable outcomes of health services. Objectives: To estimate the magnitude and identify perceived reasons and patient characteristics associated with loss to follow-up in a tertiary care setting. Methods: A two-step cross-sectional study design was used, including a chart review (2011 followed by phone survey (2012. Loss to follow-up was recorded among those who were diagnosed with hepatitis B (HBV or C (HCV during 2009–2010 but never returned for recommended/scheduled follow-up appointment(s. Results: A total of 328 patients (202 HBV and 126 HCV were included in the current analysis. The average age was 49.6 ± 17.9 years, and 57% were males. Out of 328, 131 (40% were not advised to do follow-up, and 98 (30% were not doing follow-up. Perceived reasons for loss to follow-up were as follows: unaware that a follow-up appointment was scheduled (69%, never informed of need for follow-up by healthcare provider (15%, personal belief that follow-up was not necessary (9%, logistical reasons (3% and other reasons (5%. Loss to follow-up was higher among those who had been diagnosed with HBV, referred by non-liver-related specialty, never advised to follow-up, unaware of their diagnosis, incorrectly identified their type of hepatitis, lacking hepatitis complications, having full medical coverage, pregnant, and those with low knowledge or negative attitude towards hepatitis. Conclusions: Loss to follow-up is a significant problem among patients with hepatitis in a tertiary care center, with several patient and system failures being implicated. Keywords: Viral hepatitis, Loss to follow-up, Tertiary care, Management, Saudi Arabia

  18. Causes analysis on the failure of government environmental responsibility—Based on the perspective of law and economics

    Science.gov (United States)

    Fa, L. N.

    2017-11-01

    As the important Environmental Interests of Subjects, government behooves to undertake the corresponding responsibility of Pollution Control and Environmental Protection. The current situations in our country, however, appear as government environmental responsibility failure. Based on the analysis of law and economics, this article reaches the conclusion through game analysis, principle-agency relationship and utility theory that the prisoners dilemma of environmental interest game between government and enterprise, and the inherent defect of the principal-agency relationship between central government and local government are the inherent causes of government environmental responsibility failure. Many officials tends to graft and corrupt to maximum their own benefit, thus leading to the government failure among environmental pollution treatment and the environmental responsibility to undertake.

  19. Pulmonary hydatid cyst in a pregnant patient causing acute respiratory failure

    Directory of Open Access Journals (Sweden)

    Hijazi Mohammed

    2007-01-01

    Full Text Available A 21-year-old primigravida, at 32 weeks of gestation, presented with acute onset of respiratory failure and circulatory shock. Chest imaging showed findings suggestive of ruptured hydatid cyst, which was confirmed by histology post-thoracotomy. Tissue cultures from the removed cyst grew Mycobacterium tuberculosis also. She was successfully managed in the intensive care unit and was then discharged home on antituberculosis medications in addition to albendazole after prolonged hospitalization and a need for chest tube for bronchopleural fistula. Acute respiratory failure and anaphylactic shock secondary to ruptured pulmonary hydatid cyst and superimposed pulmonary tuberculosis in a pregnant lady should be considered in patients living in endemic areas.

  20. Acute Alcoholic Hepatitis: Therapy.

    Science.gov (United States)

    Phillips, Paulina K; Lucey, Michael R

    2016-08-01

    Alcoholic hepatitis (AH) causes great morbidity and mortality in the United States and throughout the world. Advances in therapy have proven difficult. In part, this reflects challenges in diagnosis, including the distinction between AH and acute-on-chronic liver failure. Liver biopsy is the best method to clarify the cause in circumstances whereby conflicting clinical data confound the diagnosis. All treatment of AH begins with abstinence from alcohol. All patients with AH should be given sufficient nutrition. Prednisolone has become the principal agent for treating patients with severe AH. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Examining the Causes of Memory Strength Variability: Recollection, Attention Failure, or Encoding Variability?

    Science.gov (United States)

    Koen, Joshua D.; Aly, Mariam; Wang, Wei-Chun; Yonelinas, Andrew P.

    2013-01-01

    A prominent finding in recognition memory is that studied items are associated with more variability in memory strength than new items. Here, we test 3 competing theories for why this occurs--the "encoding variability," "attention failure", and "recollection" accounts. Distinguishing among these theories is critical…

  2. Nail patella syndrome: a rare cause of renal failure in a young adult ...

    African Journals Online (AJOL)

    Nail Patella Syndrome (NPS) is a rare hereditary disease affecting multiple systems with predominant involvement of Kidney, Bones and Nails and Eyes. We report a case of NPS which presented as renal failure in a 22 year old male. The patient was admitted with decreased urine output and features of fluid overload and ...

  3. Does Fusarium-caused seed mortality contribute to Bromus tectorum stand failure in the Great Basin?

    Science.gov (United States)

    S. E. Meyer; J.-L. Franke; O. W. Baughman; J. Beckstead; B. Geary

    2014-01-01

    Bromus tectorum (cheatgrass, downy brome) is an important invader in western North America, dominating millions of hectares of former semi-arid shrubland. Stand failure or 'die-off' is relatively common in monocultures of this annual grass. The study reported here investigated whether soil-borne pathogens could be causal agents in die-offs. Soils from two die...

  4. Acute respiratory failure caused by aspiration of high density barium: A case report

    International Nuclear Information System (INIS)

    Park, Ki Soon; Jung, Eun A; Yang, Ik; Lee, Yul; Chung, Soo Young

    1994-01-01

    Accidental aspiration of barium contrast medium during the upper gastrointestinal study can occur in patients with swallowing disorder, especially in the elderly patients. We experienced a case of respiratory failure followed by death within a few hours in 85 year-old patient after barium aspiration

  5. Middle aortic syndrome as a cause of heart failure in children and its management.

    OpenAIRE

    Gupta, S; Goswami, B; Ghosh, D C; Sen Gupta, A N

    1981-01-01

    Two cases of middle aortic syndrome in children are described along with two other cases reported earlier. In childhood, this disease may present as incipient or overt cardiac failure. Surgical treatment should be undertaken based on an objective assessment of the severity of the stricture and after taking into account the future growth of the child.

  6. [Rare cause of heart failure in an elderly woman in Djibouti: left ventricular non compaction].

    Science.gov (United States)

    Massoure, P L; Lamblin, G; Bertani, A; Eve, O; Kaiser, E

    2011-10-01

    The purpose of this report is to describe the first case of left ventricular non compaction diagnosed in Djibouti. The patient was a 74-year-old Djiboutian woman with symptomatic heart failure. Echocardiography is the key tool for assessment of left ventricular non compaction. This rare cardiomyopathy is probably underdiagnosed in Africa.

  7. Examining the causes of memory strength variability: recollection, attention failure, or encoding variability?

    Science.gov (United States)

    Koen, Joshua D; Aly, Mariam; Wang, Wei-Chun; Yonelinas, Andrew P

    2013-11-01

    A prominent finding in recognition memory is that studied items are associated with more variability in memory strength than new items. Here, we test 3 competing theories for why this occurs-the encoding variability, attention failure, and recollection accounts. Distinguishing among these theories is critical because each provides a fundamentally different account of the processes underlying recognition memory. The encoding variability and attention failure accounts propose that old item variance will be unaffected by retrieval manipulations because the processes producing this effect are ascribed to encoding. The recollection account predicts that both encoding and retrieval manipulations that preferentially affect recollection will affect memory variability. These contrasting predictions were tested by examining the effect of response speeding (Experiment 1), dividing attention at retrieval (Experiment 2), context reinstatement (Experiment 3), and increased test delay (Experiment 4) on recognition performance. The results of all 4 experiments confirm the predictions of the recollection account and are inconsistent with the encoding variability account. The evidence supporting the attention failure account is mixed, with 2 of the 4 experiments confirming the account and 2 disconfirming the account. These results indicate that encoding variability and attention failure are insufficient accounts of memory variance and provide support for the recollection account. Several alternative theoretical accounts of the results are also considered. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  8. Life-threatening hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy: report of a case

    Directory of Open Access Journals (Sweden)

    Wu Hurng-Sheng

    2010-07-01

    Full Text Available Abstract Background Hemobilia is a rare but lethal biliary tract complication. There are several causes of hemobilia which might be classified as traumatic or nontraumatic. Hemobilia caused by pseudoaneurysm might result from hepatobiliary surgery or percutaneous interventional hepatobiliary procedures. However, to our knowledge, there are no previous reports pertaining to hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy. Case presentation A 65-year-old male was admitted to our hospital because of acute calculous cholecystitis and cholangitis. He underwent cholecystectomy, choledocholithotomy via a right upper quadrant laparotomy and a temporary T-tube choledochostomy was created. However, on the 19th day after operation, he suffered from sudden onset of hematemesis and massive fresh blood drainage from the T-tube choledochostomy. Imaging studies confirmed the diagnosis of pseudoaneurysm associated hemobilia. The probable association of T-tube choledochostomy with pseudoaneurysm and hemobilia is also demonstrated. He underwent emergent selective microcoils emobolization to occlude the feeding artery of the pseudoaneurysm. Conclusions Pseudoaneurysm associated hemobilia may occur after T-tube choledochostomy. This case also highlights the importance that hemobilia should be highly suspected in a patient presenting with jaundice, right upper quadrant abdominal pain and upper gastrointestinal bleeding after liver or biliary surgery.

  9. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... Disease Type 1 (von Gierke) Hemochromatosis Hepatic Encephalopathy Hepatitis A Hepatitis B Hepatitis C Intrahepatic Cholestasis of Pregnancy ( ... Disease Type 1 (von Gierke) Hemochromatosis Hepatic Encephalopathy Hepatitis A Hepatitis B Hepatitis C Intrahepatic Cholestasis of Pregnancy ( ...

  10. Experimental chronic hepatitis B infection of neonatal tree shrews (Tupaia belangeri chinensis: A model to study molecular causes for susceptibility and disease progression to chronic hepatitis in humans

    Directory of Open Access Journals (Sweden)

    Wang Qi

    2012-08-01

    Full Text Available Abstract Background Hepatitis B virus (HBV infection continues to be an escalating global health problem. Feasible and effective animal models for HBV infection are the prerequisite for developing novel therapies for this disease. The tree shrew (Tupaia is a small animal species evolutionary closely related to humans, and thus is permissive to certain human viral pathogens. Whether tree shrews could be chronically infected with HBV in vivo has been controversial for decades. Most published research has been reported on adult tree shrews, and only small numbers of HBV infected newborn tree shrews had been observed over short time periods. We investigated susceptibility of newborn tree shrews to experimental HBV infection as well as viral clearance over a protracted time period. Results Forty-six newborn tree shrews were inoculated with the sera from HBV-infected patients or tree shrews. Serum and liver samples of the inoculated animals were periodically collected and analyzed using fluorescence quantitative polymerase chain reaction, enzyme-linked immunosorbent assay, Southern blot, and immunohistochemistry. Six tree shrews were confirmed and four were suspected as chronically HBV-infected for more than 48 (up to 228 weeks after inoculation, including three that had been inoculated with serum from a confirmed HBV-infected tree shrew. Conclusions Outbred neonatal tree shrews can be long-term chronically infected with HBV at a frequency comparable to humans. The model resembles human disease where also a smaller proportion of infected individuals develop chronic HBV related disease. This model might enable genetic and immunologic investigations which would allow determination of underlying molecular causes favoring susceptibility for chronic HBV infection and disease establishment vs. viral clearance.

  11. Unexpected causes of pulmonary hypertension in a previously healthy Thai rural man with right-sided heart failure

    OpenAIRE

    Angkananard, Teeranan; Chonmaitree, Piyanant; Petborom, Pichaya

    2014-01-01

    Patient Male, 52 Final Diagnosis: Pulmonary hypertension Symptoms: Diarrhea • dyspnea • jaundice Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic Objective: Unusual clinical course Background: Hyperthyroidism is one of the important causes of high-output failure and reversible pulmonary artery hypertension. Severe pulmonary artery hypertension is rarely found in associated with hyperthyroidism due to the small number of cases reported. We present an interesting case ...

  12. Failures during Load-Frequency Control Maneuvers in an Upgraded Hydropower Plant: Causes, Identification of Causes and Solution Proposals

    Directory of Open Access Journals (Sweden)

    Juan I. Pérez-Díaz

    2015-09-01

    Full Text Available The objective of this paper is to investigate the cause of several unexpected high amplitude oscillations that occurred in the surge tank water level of a real hydropower plant during secondary load-frequency control (LFC maneuvers, after the replacement of the turbine runner, and to propose solutions that allow the power plant to continue providing secondary LFC in a safe and reliable manner. For this purpose, a simulation model has been developed and calibrated from data gathered during several on-site tests. Two different solutions are proposed in order to cope with the observed problem: using a state-dependent load change rate limiter or modifying the hydro turbine governor gains; the turbine governor remains the same as before the runner replacement. The proposed solutions are tested against a set of realistic secondary LFC signals by means of simulations and compared to each other as a function of the probability that the surge tank water level descends below a minimum safe level and the quality of the secondary LFC response. The results presented in the paper demonstrate the validity of the methodology proposed to determine the state-dependent ramp limit, as well as its effectiveness to prevent the surge tank drawdown and to provide clear insight into the trade-off between response quality and power plant safety.

  13. Clinical characteristics and causes of heart failure adherence to treatment guidelines and mortality of patients with acute heart failure: Experience at Groote Schuur Hospital Cape Town South Africa

    Directory of Open Access Journals (Sweden)

    P Szymanski

    2018-02-01

    Full Text Available Background. There is limited information on acute heart failure (AHF and its treatment in sub-Saharan Africa.Objective. To describe the clinical characteristics and causes of heart failure (HF, adherence to HF treatment guidelines, and mortality of patients with AHF presenting to Groote Schuur Hospital (GSH, Cape Town, South Africa.Methods. This sub-study of The Sub-Saharan Africa Survey of Heart Failure (THESUS-HF was a prospective and observational survey that focused on the enrolment and follow-up of additional patients with AHF presenting to GSH and entered into the existing registry after publication of the primary THESUS-HF article in 2012. The patients were classified into prevalent (existing or incident (new cases of HF.Results. Of the 119 patients included, 69 (58.0% were female and the mean (standard deviation age was 49.9 (16.3 years. The majority of prevalent cases were patients of mixed ancestry (63.3%, and prevalent cases had more hypertension (70.0%, diabetes mellitus (36.7%, hyperlipidaemia (33.3% and ischaemic heart disease (IHD (36.7% than incident cases. The top five causes of HF were cardiomyopathy (20.2%, IHD (19.3%, rheumatic valvular heart disease (RHD (18.5%, cor pulmonale (11.8% and hypertension (10.1%, with the remaining 20.1% consisting of miscellaneous causes including pericarditis, toxins and congenital heart disease. Most patients received renin-angiotensin system blockers and loop diuretics on discharge. There was a low rate of beta-blocker, aldosterone antagonist and digoxin use. Rehospitalisation within 180 days occurred in 25.2% of cases. In-hospital mortality was 8.4% and the case fatality rate at 6 months was 26.1%.Conclusion. In Cape Town, the main causes of AHF are cardiomyopathy, IHD and RHD. AHF affects a young population and is associated with a high rate of rehospitalisation and mortality. There is serious under-use of beta-blockers, aldosterone antagonists and digoxin. Emphasis on the rigorous

  14. Left atrial leiomyosarcoma as cause of heart failure; Leiomiosarcoma atrial izquierdo como causa de insuficiencia cardiaca

    Energy Technology Data Exchange (ETDEWEB)

    Valdes Martin, Alexander [Instituto de Cardiologia y Cirugia Cardiovascular, La Habana (Cuba)

    2012-07-01

    The case of a 26 year-old patient with diagnosis of heart failure and presence of a mobile echogenic mass without calcification attached to the posterolateral area of the left atrium was reported. She underwent surgery and tissue examination evidenced a high-grade heart leiomyosarcoma. Postoperative course was satisfactory and her clinical state was rigorously monitored by oncology and heart specialists in the institution.

  15. Factors Causing Exclusive Breast Feeding Failure in a Pakistani Urban Population

    International Nuclear Information System (INIS)

    Farrukh, H.; Basheer, F.; Jalil, J.

    2013-01-01

    Objective: To determine the factors responsible for termination of exclusive breast feeding in our population. Location and Duration: A cross sectional study was conducted at Combined Military Hospital Quetta, from February 2010 to June 2010. Study design: Cross-sectional study. Sample Size: A total of 620 mothers carrying healthy infants were interviewed.Inclusion Criteria: Mothers who failed to exclusively breast feed their infants within first six months of life and started supplemental feeds. Data Collection Procedure: A semi-structured, preformed questionnaire was filled containing information about mothers age, infant sex and reasons for discontinuation of exclusive breast feeding. Data Analysis: Data was analyzed using SPSS version 18. Results: Mean maternal age was 25.87 years. Early failure was seen in 41.9%$ and late failure in 58.1% infants. Difficulties in initiating and establishing breast feeding (84%), knowledge deficit about breast feeding benefits (78.8%) and milk insufficiency (69.2%) were the main reasons for early failure. Deficient knowledge about exclusive breast feeding which included its WHO definition of six months and its benefits (88.9%) was the most common reason of addition of weaning diets after 4 months of age. Other significant factors found for failure were working mothers (21.3%), premature delivery (13.5%), early second pregnancy (16.1%), and perception of poor weight gain by infant while exclusively breast fed (19.4%). Conclusion: Exclusive breast feeding ensures the best possible health of an infant. Dedicated efforts are required at national level for dissemination and promotion of knowledge about exclusive breast feeding. (author)

  16. Thrombotic microangiopathy: An unusual cause of renal failure in rheumatoid arthritis

    OpenAIRE

    Sakthirajan, R.; Dhanapriya, J.; Dineshkumar, T.; Gopalakrishnan, N.; Murugan, S.; Balasubramaniyan, T.

    2017-01-01

    Rheumatoid arthritis (RA) is one of the commonest rheumatological diseases. Renal involvement is not common but can occur as a result of chronic inflammation as part of disease process or drug toxicity. Thrombotic microangiopathy (TMA) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ failure of variable severity. Only a few cases of TMA in patients with RA were reported to date. We describe a 45-year-old female patient with RA who presented with oliguria and ...

  17. Left atrium and pulmonary artery compression due to aortic aneurysm causing heart failure symptoms.

    Science.gov (United States)

    Jorge, Antonio José Lagoeiro; Martins, Wolney de Andrade; Moutinho, Victor M; Rezende, Juliano M; Alves, Patricia Y; Villacorta, Humberto; Silveira, Pedro F; Couto, Antonio A

    2018-05-09

    Patients with thoracic aortic aneurysm (TAA) are mostly asymptomatic and TAA is rarely related to heart failure (HF). We report the case of an 80-year-old female patient, with type A TAA without dissection, with right pulmonary artery and left atrium compression, who presented with HF, preserved ejection fraction and acute pulmonary edema. Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Compounds from multilayer plastic bags cause reproductive failures in artificial insemination

    Science.gov (United States)

    Nerin, C.; Ubeda, J. L.; Alfaro, P.; Dahmani, Y.; Aznar, M.; Canellas, E.; Ausejo, R.

    2014-05-01

    High levels of reproductive failure were detected in some Spanish sow farms in the Spring of 2010. Regular returns to estrus and variable reductions in litter size were observed. The problem started suddenly and did not appear to be related to the quality of the ejaculates, disease, alterations of body condition or any other apparent reasons. Subsequent studies determined that the problem was the origin of the plastic bags used for semen storage. Chemical analysis of the suspicious bags identified unexpected compounds such as BADGE, a cyclic lactone and an unknown phthalate that leached into the semen at concentrations of 0.2 to 2.5 mg/L. Spermatozoa preserved in these bags passed all of the routine quality control tests, and no differences were observed between storage in the control and suspicious bags (p > 0.05). In vitro fecundation tests and endocrine profiler panel analysis (EPP) did not show any alterations, whereas the in vivo tests confirmed the described failure. This is the first described relationship between reproductive failure and toxic compounds released from plastic bags.

  19. Understanding the failure mechanisms of microwave bipolar transistors caused by electrostatic discharge

    Science.gov (United States)

    Jin, Liu; Yongguang, Chen; Zhiliang, Tan; Jie, Yang; Xijun, Zhang; Zhenxing, Wang

    2011-10-01

    Electrostatic discharge (ESD) phenomena involve both electrical and thermal effects, and a direct electrostatic discharge to an electronic device is one of the most severe threats to component reliability. Therefore, the electrical and thermal stability of multifinger microwave bipolar transistors (BJTs) under ESD conditions has been investigated theoretically and experimentally. 100 samples have been tested for multiple pulses until a failure occurred. Meanwhile, the distributions of electric field, current density and lattice temperature have also been analyzed by use of the two-dimensional device simulation tool Medici. There is a good agreement between the simulated results and failure analysis. In the case of a thermal couple, the avalanche current distribution in the fingers is in general spatially unstable and results in the formation of current crowding effects and crystal defects. The experimental results indicate that a collector-base junction is more sensitive to ESD than an emitter-base junction based on the special device structure. When the ESD level increased to 1.3 kV, the collector-base junction has been burnt out first. The analysis has also demonstrated that ESD failures occur generally by upsetting the breakdown voltage of the dielectric or overheating of the aluminum-silicon eutectic. In addition, fatigue phenomena are observed during ESD testing, with devices that still function after repeated low-intensity ESDs but whose performances have been severely degraded.

  20. Compounds from multilayer plastic bags cause reproductive failures in artificial insemination.

    Science.gov (United States)

    Nerin, C; Ubeda, J L; Alfaro, P; Dahmani, Y; Aznar, M; Canellas, E; Ausejo, R

    2014-05-09

    High levels of reproductive failure were detected in some Spanish sow farms in the Spring of 2010. Regular returns to estrus and variable reductions in litter size were observed. The problem started suddenly and did not appear to be related to the quality of the ejaculates, disease, alterations of body condition or any other apparent reasons. Subsequent studies determined that the problem was the origin of the plastic bags used for semen storage. Chemical analysis of the suspicious bags identified unexpected compounds such as BADGE, a cyclic lactone and an unknown phthalate that leached into the semen at concentrations of 0.2 to 2.5 mg/L. Spermatozoa preserved in these bags passed all of the routine quality control tests, and no differences were observed between storage in the control and suspicious bags (p > 0.05). In vitro fecundation tests and endocrine profiler panel analysis (EPP) did not show any alterations, whereas the in vivo tests confirmed the described failure. This is the first described relationship between reproductive failure and toxic compounds released from plastic bags.

  1. Combined adenovirus-mediated artificial microRNAs targeting mfgl2, mFas, and mTNFR1 protect against fulminant hepatic failure in mice.

    Directory of Open Access Journals (Sweden)

    Dong Xi

    Full Text Available Hepatitis B virus (HBV-related acute-on-chronic liver failure (ACLF has a poor prognosis with high in-hospital mortality. Hepatic and circulating inflammatory cytokines, such as fibrinogen like protein 2 (fgl2, FasL/Fas, and TNFα/TNFR1, play a significant role in the pathophysiology of ACLF. This study aimed to investigate the therapeutic effect of recombinant adenoviral vectors carrying constructed DNA code for non-native microRNA (miRNA targeting mouse fgl2 (mfgl2 or both mFas and mTNFR1 on murine hepatitis virus (MHV-3-induced fulminant hepatitis in BALB/cJ mice. Artificial miRNA eukaryotic expression plasmids against mfgl2, mFas, and mTNFR1 were constructed, and their inhibitory effects on the target genes were confirmed in vitro. pcDNA6.2-mFas-mTNFR1- miRNA,which expresses miRNA against both mFas and mTNFR1 simultaneously,was constructed. To construct a miRNA adenovirus expression vector against mfgl2, pcDNA6.2-mfgl2-miRNA was cloned using Gateway technology. Ad-mFas-mTNFR1- miRNA was also constructed by the same procedure. Adenovirus vectors were delivered by tail-vein injection into MHV-3-infected BALB/cJ mice to evaluate the therapeutic effect. 8 of 18 (44.4% mice recovered from fulminant viral hepatitis in the combined interference group treated with Ad-mfgl2-miRNA and Ad-mFas-mTNFR1-miRNA. But only 4 of 18 (22.2% mice receiving Ad-mfgl2-miRNA and 3 of 18 (16.7% mice receiving Ad-mFas-mTNFR1- miRNA survived. These adenovirus vectors significantly ameliorated inflammatory infiltration, fibrin deposition, hepatocyte necrosis and apoptosis, and prolonged survival time. Our data illustrated that combined interference using adenovirus-mediated artificial miRNAs targeting mfgl2, mFas, and mTNFR1 might have significant therapeutic potential for the treatment of fulminant hepatitis.

  2. The value of gadoxetate disodium-enhanced MR imaging for predicting posthepatectomy liver failure after major hepatic resection: A preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Seung Hyun, E-mail: shcho2405@gmail.com [Department of Radiology, Daegu Fatima Hospital, 576-31 Sinam-dong, Dong-gu, Daegu 701-600 (Korea, Republic of); Kang, Ung Rae, E-mail: tadtail@hanmail.net [Department of Radiology, Catholic University of Daegu, School of Medicine, 3056-6 Daemyung-4-dong, Nam-gu, Daegu 705-718 (Korea, Republic of); Kim, Joo Dong, E-mail: milledr@naver.com [Department of Surgery, Catholic University of Daegu, School of Medicine, 3056-6 Daemyung-4-dong, Nam-gu, Daegu 705-718 (Korea, Republic of); Han, Young Seok, E-mail: gshyskhk@hanmail.net [Department of Surgery, Catholic University of Daegu, School of Medicine, 3056-6 Daemyung-4-dong, Nam-gu, Daegu 705-718 (Korea, Republic of); Choi, Dong Lak, E-mail: dnchoi@cu.ac.kr [Department of Surgery, Catholic University of Daegu, School of Medicine, 3056-6 Daemyung-4-dong, Nam-gu, Daegu 705-718 (Korea, Republic of)

    2011-11-15

    Purpose: To investigate whether preoperative gadoxetate-disodium-enhanced MR imaging predicts posthepatectomy liver failure (PHLF) in patients who underwent major hepatic resection. Materials and methods: Twenty nine patients who underwent preoperative gadoxetate-disodium-enhanced MR imaging and following major hepatic resection were enrolled. Hepatic parenchymal signal intensity (SI) on pre-contrast T1-weighted imaging and 20 min hepatocyte phase was measured at each of the four liver segments by two observers using region of interest measurements. The mean value was calculated and used at each phase. The relative contrast enhancement index (RCEI) was calculated: (20 min hepatocyte phase SI - pre-contrast SI)/pre-contrast SI. PHLF was determined by the International Study Group of Liver Surgery 2011 guidelines. Correlation analysis was performed between preoperative liver function test and RCEI. Diagnostic accuracy of RCEI for predicting PHLF was calculated with receiver operating characteristic curve analysis. The reproducibility of the RCEI measurement was evaluated. Results: There was a significant correlation between preoperative albumin (r = 0.496, P = 0.006), T-bilirubin (r = -0.383, P = 0.041), and RCEI. Seven patients (24%) experienced PHLF, and one of these patients (3%) died. The diagnostic accuracy of RCEI was 0.838 (sensitivity 85.7%, specificity 77.3%, cut-off value: 0.7508, 95% confidence interval: 0.654, 0.947). The 95% limits of agreement and ICC between repeated RCEI measurements were 18.4% of the mean and 0.94, respectively, and between RCEI measurements by the two observers were 21.7% and 0.929, respectively. Conclusion: Our results show that preoperative gadoxetate-disodium-enhanced MR imaging can predict PHLF in patients who underwent major hepatic resection.

  3. Enhanced antioxidant capacity of dental pulp-derived iPSC-differentiated hepatocytes and liver regeneration by injectable HGF-releasing hydrogel in fulminant hepatic failure.

    Science.gov (United States)

    Chiang, Chih-Hung; Wu, Wai-Wah; Li, Hsin-Yang; Chien, Yueh; Sun, Cho-Chin; Peng, Chi-Hsien; Lin, Alex Tong-Long; Huang, Chi-Shuan; Lai, Ying-Hsiu; Chiou, Shih-Hwa; Hung, Shuen-Iu; Chang, Yuh-Lih; Lan, Yuan-Tzu; Liu, Dean-Mo; Chien, Chian-Shiu; Huo, Teh-Ia; Lee, Shou-Dong; Wang, Chien-Ying

    2015-01-01

    Acute hepatic failure (AHF) is a severe liver injury leading to sustained damage and complications. Induced pluripotent stem cells (iPSCs) may be an alternative option for the treatment of AHF. In this study, we reprogrammed human dental pulp-derived fibroblasts into iPSCs, which exhibited pluripotency and the capacity to differentiate into tridermal lineages, including hepatocyte-like cells (iPSC-Heps). These iPSC-Heps resembled human embryonic stem cell-derived hepatocyte-like cells in gene signature and hepatic markers/functions. To improve iPSC-Heps engraftment, we next developed an injectable carboxymethyl-hexanoyl chitosan hydrogel (CHC) with sustained hepatocyte growth factor (HGF) release (HGF-CHC) and investigated the hepatoprotective activity of HGF-CHC-delivered iPSC-Heps in vitro and in an immunocompromised AHF mouse model induced by thioacetamide (TAA). Intrahepatic delivery of HGF-CHC-iPSC-Heps reduced the TAA-induced hepatic necrotic area and rescued liver function and recipient viability. Compared with PBS-delivered iPSC-Heps, the HGF-CHC-delivered iPSC-Heps exhibited higher antioxidant and antiapoptotic activities that reduced hepatic necrotic area. Importantly, these HGF-CHC-mediated responses could be abolished by administering anti-HGF neutralizing antibodies. In conclusion, our findings demonstrated that HGF mediated the enhancement of iPSC-Hep antioxidant/antiapoptotic capacities and hepatoprotection and that HGF-CHC is as an excellent vehicle for iPSC-Hep engraftment in iPSC-based therapy against AHF.

  4. Hepatitis B virus infection status and infertility causes in couples seeking fertility treatment-Indicator of impaired immune response?

    Science.gov (United States)

    Lao, Terence T; Mak, Jennifer S M; Li, Tin-Chiu

    2017-04-01

    The relationship between hepatitis B (HBV) infection in infertile couples seeking in vitro fertilization (IVF) treatment and infertility causes is unknown. A total of 831 infertile couples attending our unit seeking IVF during January to December 2015 were recruited. HBV infection was found in 6.3% and 7.3% of female and male partners, respectively, and infection in one or both partners was associated with less primary infertility (44.2% vs 55.1%, P=.038). Infected female partners had increased tubal (69.2% vs 43.2%, Pinfertility, while infected male partners were associated with increased tubal (62.3% vs 43.4%, P=.004) causes and reduced endometriosis (62.3% vs 73.9%, P=.050). Our results suggest HBV infection in either partner was associated with tubal infertility. HBV infection in either partner probably increases the risk of pelvic infection in female partner through impaired immune response to sexually transmitted infections, with consequent tubal damage and infertility. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Acute toxic hepatitis caused by an aloe vera preparation in a young patient: a case report with a literature review.

    Science.gov (United States)

    Lee, Jeonghun; Lee, Mi Sun; Nam, Kwan Woo

    2014-07-01

    Aloe is one of the leading products used in phytomedicine. Several cases of aloe-induced toxic hepatitis have been reported in recent years. However, its toxicology has not yet been systematically described in the literature. A 21-year-old female patient was admitted to our hospital with acute hepatitis after taking an aloe vera preparation for four weeks. Her history, clinical manifestation, laboratory findings, and histological findings all led to the diagnosis of aloe vera-induced toxic hepatitis. We report herein on a case of acute toxic hepatitis induced by aloe vera.

  6. Chronic subhepatotoxic exposure to arsenic enhances hepatic injury caused by high fat diet in mice

    International Nuclear Information System (INIS)

    Tan, Min; Schmidt, Robin H.; Beier, Juliane I.; Watson, Walter H.; Zhong, Hai; States, J. Christopher; Arteel, Gavin E.

    2011-01-01

    Arsenic is a ubiquitous contaminant in drinking water. Whereas arsenic can be directly hepatotoxic, the concentrations/doses required are generally higher than present in the US water supply. However, physiological/biochemical changes that are alone pathologically inert can enhance the hepatotoxic response to a subsequent stimulus. Such a ‘2-hit’ paradigm is best exemplified in chronic fatty liver diseases. Here, the hypothesis that low arsenic exposure sensitizes liver to hepatotoxicity in a mouse model of non-alcoholic fatty liver disease was tested. Accordingly, male C57Bl/6J mice were exposed to low fat diet (LFD; 13% calories as fat) or high fat diet (HFD; 42% calories as fat) and tap water or arsenic (4.9 ppm as sodium arsenite) for ten weeks. Biochemical and histologic indices of liver damage were determined. High fat diet (± arsenic) significantly increased body weight gain in mice compared with low-fat controls. HFD significantly increased liver to body weight ratios; this variable was unaffected by arsenic exposure. HFD caused steatohepatitis, as indicated by histological assessment and by increases in plasma ALT and AST. Although arsenic exposure had no effect on indices of liver damage in LFD-fed animals, it significantly increased the liver damage caused by HFD. This effect of arsenic correlated with enhanced inflammation and fibrin extracellular matrix (ECM) deposition. These data indicate that subhepatotoxic arsenic exposure enhances the toxicity of HFD. These results also suggest that arsenic exposure might be a risk factor for the development of fatty liver disease in human populations. -- Highlights: ► Characterizes a mouse model of arsenic enhanced NAFLD. ► Arsenic synergistically enhances experimental fatty liver disease at concentrations that cause no overt hepatotoxicity alone. ► This effect is associated with increased inflammation.

  7. Rare Cause of Seizures, Renal Failure, and Gangrene in an 83-Year-Old Diabetic Male

    Directory of Open Access Journals (Sweden)

    Stalin Viswanathan

    2013-01-01

    Full Text Available We report an 83-year-old diabetic male who presented with acute-onset renal failure, seizures, psychosis, pneumonia, and right foot gangrene. Investigations revealed thrombocytopenia, CSF lymphocytosis, ANA and dsDNA positivity, hypocomplementemia, and pneumonitis following which he was treated with pulse methylprednisolone. He was treated for Pseudomonas-related ventilator-associated pneumonia, candiduria, and E. coli-related bedsore infection prior to discharge. He was discharged at request and died 17 days later due to a respiratory infection.

  8. Severe Hiatal Hernia as a Cause of Failure to Thrive Discovered by Transthoracic Echocardiogram

    Directory of Open Access Journals (Sweden)

    Clint J. Moore

    2016-01-01

    Full Text Available A newborn infant with failure to thrive presented for murmur evaluation on day of life three due to a harsh 3/6 murmur. During the evaluation, a retrocardiac fluid filled mass was seen by transthoracic echocardiogram. The infant was also found to have a ventricular septal defect and partial anomalous pulmonary venous return. Eventually, a large hiatal hernia was diagnosed on subsequent imaging. The infant ultimately underwent surgical repair of the hiatal hernia at a tertiary care facility. Hiatal hernias have been noted as incidental extracardiac findings in adults, but no previous literature has documented hiatal hernias as incidental findings in the pediatric population.

  9. Severe Hiatal Hernia as a Cause of Failure to Thrive Discovered by Transthoracic Echocardiogram

    Science.gov (United States)

    Moore, Clint J.; Conley, Devan A.; Berry-Cabán, Cristóbal S.

    2016-01-01

    A newborn infant with failure to thrive presented for murmur evaluation on day of life three due to a harsh 3/6 murmur. During the evaluation, a retrocardiac fluid filled mass was seen by transthoracic echocardiogram. The infant was also found to have a ventricular septal defect and partial anomalous pulmonary venous return. Eventually, a large hiatal hernia was diagnosed on subsequent imaging. The infant ultimately underwent surgical repair of the hiatal hernia at a tertiary care facility. Hiatal hernias have been noted as incidental extracardiac findings in adults, but no previous literature has documented hiatal hernias as incidental findings in the pediatric population. PMID:27895952

  10. Thrombotic microangiopathy: An unusual cause of renal failure in rheumatoid arthritis.

    Science.gov (United States)

    Sakthirajan, R; Dhanapriya, J; Dineshkumar, T; Gopalakrishnan, N; Murugan, S; Balasubramaniyan, T

    2017-01-01

    Rheumatoid arthritis (RA) is one of the commonest rheumatological diseases. Renal involvement is not common but can occur as a result of chronic inflammation as part of disease process or drug toxicity. Thrombotic microangiopathy (TMA) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ failure of variable severity. Only a few cases of TMA in patients with RA were reported to date. We describe a 45-year-old female patient with RA who presented with oliguria and edema. Renal biopsy showed TMA with patchy cortical necrosis. She improved with hemodialysis and plasmapheresis.

  11. Thrombotic microangiopathy: An unusual cause of renal failure in rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    R Sakthirajan

    2017-01-01

    Full Text Available Rheumatoid arthritis (RA is one of the commonest rheumatological diseases. Renal involvement is not common but can occur as a result of chronic inflammation as part of disease process or drug toxicity. Thrombotic microangiopathy (TMA is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and organ failure of variable severity. Only a few cases of TMA in patients with RA were reported to date. We describe a 45-year-old female patient with RA who presented with oliguria and edema. Renal biopsy showed TMA with patchy cortical necrosis. She improved with hemodialysis and plasmapheresis.

  12. An unusual cause of acute renal failure in sickle cell disease

    Science.gov (United States)

    Rockx, Marie-Antoinette; Gibson, Ian W.; Reslerova, Martina

    2009-01-01

    A young female with sickle cell disease was treated for biopsy-proven IgA nephropathy. Serum creatinine levels resolved to normal range, but a year later, she presented with oedema, hypertension and acute renal failure. A repeat renal biopsy showed acute-on-chronic thrombotic microangiopathy (TMA). We suggest that circulating microparticles could be a pathophysiological link between sickle cell disease and the development of renal TMA. This case emphasizes the importance of a further biopsy for acutely declining renal function, even when a definite diagnosis has been made from a previous biopsy. PMID:25949348

  13. [Digoxin as a cause of chromatopsia and depression in a patient with heart failure and hyperthyroidism].

    Science.gov (United States)

    Chyrek, R; Jabłecka, A; Pupek-Musialik, D; Lowicki, Z

    2000-08-01

    67 year old patient with chronic heart failure and persistent atrial fibrillation had overdosed glycosides for several months. The symptoms of gastrointestinal system and nervous system appeared after long term therapy with toxic doses of glycosides. Originally depression was diagnosed based on the central nervous system disturbances. Even though overdose of glycosides was diagnosed the blood serum glycoside level was within the therapeutic limits. Based on the precise analysis of the data, it was concluded that the reason for normal blood serum glycoside level in this case was coexisting hyperthyreosis.

  14. VIP Gene Deletion in Mice Causes Cardiomyopathy Associated with Upregulation of Heart Failure Genes

    Energy Technology Data Exchange (ETDEWEB)

    Szema, Anthony M.; Hamidi, Sayyed A.; Smith, S. David; Benveniste, Helene; Katare, Rajesh Gopalrao

    2013-05-20

    Vasoactive Intestinal Peptide (VIP), a pulmonary vasodilator and inhibitor of vascular smooth muscle proliferation, is absent in pulmonary arteries of patients with idiopathic pulmonary arterial hypertension (PAH). We previously determined that targeted deletion of the VIP gene in mice leads to PAH with pulmonary vascular remodeling and right ventricular (RV) dilatation. Whether the left ventricle is also affected by VIP gene deletion is unknown. In the current study, we examined if VIP knockout mice (VIP-/-) develop both right (RV) and left ventricular (LV) cardiomyopathy, manifested by LV dilatation and systolic dysfunction, as well as overexpression of genes conducive to heart failure.

  15. Long-Term Adult Feline Liver Organoid Cultures for Disease Modeling of Hepatic Steatosis

    NARCIS (Netherlands)

    Kruitwagen, Hedwig S.; Oosterhoff, Loes A.; Vernooij, Ingrid G.W.H.; Schrall, Ingrid M.; van Wolferen, Monique E.; Bannink, Farah; Roesch, Camille; van Uden, Lisa; Molenaar, Martijn R.; Helms, J. Bernd; Grinwis, Guy C.M.; Verstegen, Monique M.A.; van der Laan, Luc J.W.; Huch, Meritxell; Geijsen, Niels; Vries, Robert G.; Clevers, Hans; Rothuizen, Jan; Schotanus, Baukje A.; Penning, Louis C.; Spee, Bart

    2017-01-01

    Hepatic steatosis is a highly prevalent liver disease, yet research is hampered by the lack of tractable cellular and animal models. Steatosis also occurs in cats, where it can cause severe hepatic failure. Previous studies demonstrate the potential of liver organoids for modeling genetic diseases.

  16. Long-Term Adult Feline Liver Organoid Cultures for Disease Modeling of Hepatic Steatosis

    NARCIS (Netherlands)

    Kruitwagen, H.S. (Hedwig S.); Oosterhoff, L.A. (Loes A.); Vernooij, I.G.W.H. (Ingrid G.W.H.); Schrall, I.M. (Ingrid M.); M.E. van Wolferen (Monique); Bannink, F. (Farah); Roesch, C. (Camille); van Uden, L. (Lisa); Molenaar, M.R. (Martijn R.); J.B. Helms (J. Bernd); G.C.M. Grinwis (Guy C.); M.M.A. Verstegen (Monique); L.J.W. van der Laan (Luc); M. Huch (Meritxell); N. Geijsen (Niels); R.G.J. Vries (Robert); H.C. Clevers (Hans); J. Rothuizen (J.); B.A. Schotanus (Baukje A.); C. Penning (Corine); B. Spee (B.)

    2017-01-01

    textabstractHepatic steatosis is a highly prevalent liver disease, yet research is hampered by the lack of tractable cellular and animal models. Steatosis also occurs in cats, where it can cause severe hepatic failure. Previous studies demonstrate the potential of liver organoids for modeling

  17. HIV and Viral Hepatitis

    Science.gov (United States)

    ... common causes of viral hepatitis are hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV). HBV and HCV are common ... gov/ mmwr/ preview/ mmwrhtml/ rr5516a1. htm? s_ cid= rr5516a1_ e. The Numbers • • Of people with HIV in the ...

  18. Reduced ovulation rate, failure to be mated and fertilization failure/embryo loss are the underlying causes of poor reproductive performance in juvenile ewes.

    Science.gov (United States)

    Edwards, Sara J; Smaill, Bronwyn; O'Connell, Anne R; Johnstone, Peter D; Stevens, David R; Quirke, Laurel D; Farquhar, Philip A; Juengel, Jennifer L

    2016-04-01

    A ewe that is mated as a juvenile (producing a lamb at 1 year of age) will produce an average of only 0.6 lambs to weaning, compared to an average of 1.2 lambs in adult ewes. Understanding the underlying causes of this low reproductive efficiency and designing methods to improve or mitigate these effects could potentially increase adoption of mating juvenile ewes. In Experiment 1, 2 Cohorts of ewes, born a year apart, were mated in order to lamb at 1 and 2 years of age and the performance of the ewes at each age was compared. Onset of puberty, mating by the fertile ram, ovulation rate, early pregnancy (day 30-35) litter size, number of lambs born and number of lambs weaned were measured. In juvenile ewes, by day 35 of pregnancy, 43% of ova had failed to become a viable embryo and this early loss was the largest contributor to the poor reproductive performance observed. Compared with young adult ewes, ovulation rate was lower (pewes with a greater ovulation rate (pewes, failure to mate with the ram, lower ovulation rate and increased fertilisation failure/embryo loss underlie their poor reproductive performance. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. SERCA2 Haploinsufficiency in a Mouse Model of Darier Disease Causes a Selective Predisposition to Heart Failure

    Directory of Open Access Journals (Sweden)

    Vikram Prasad

    2015-01-01

    Full Text Available Null mutations in one copy of ATP2A2, the gene encoding sarco/endoplasmic reticulum Ca2+-ATPase isoform 2 (SERCA2, cause Darier disease in humans, a skin condition involving keratinocytes. Cardiac function appears to be unimpaired in Darier disease patients, with no evidence that SERCA2 haploinsufficiency itself causes heart disease. However, SERCA2 deficiency is widely considered a contributing factor in heart failure. We therefore analyzed Atp2a2 heterozygous mice to determine whether SERCA2 haploinsufficiency can exacerbate specific heart disease conditions. Despite reduced SERCA2a levels in heart, Atp2a2 heterozygous mice resembled humans in exhibiting normal cardiac physiology. When subjected to hypothyroidism or crossed with a transgenic model of reduced myofibrillar Ca2+-sensitivity, SERCA2 deficiency caused no enhancement of the disease state. However, when combined with a transgenic model of increased myofibrillar Ca2+-sensitivity, SERCA2 haploinsufficiency caused rapid onset of hypertrophy, decompensation, and death. These effects were associated with reduced expression of the antiapoptotic Hax1, increased levels of the proapoptotic genes Chop and Casp12, and evidence of perturbations in energy metabolism. These data reveal myofibrillar Ca2+-sensitivity to be an important determinant of the cardiac effects of SERCA2 haploinsufficiency and raise the possibility that Darier disease patients are more susceptible to heart failure under certain conditions.

  20. Hepatic Encephalopathy

    Medline Plus

    Full Text Available ... your body when your liver isn’t working well, it may affect your brain and cause HE. ... it apparent that the liver is not doing well. These could be the symptoms of Hepatic Encephalopathy ( ...

  1. Systematic analysis and prevention of human originated common cause failures in relation to maintenance activities at Finnish nuclear power plants

    Energy Technology Data Exchange (ETDEWEB)

    Laakso, K. [VTT Industrial Systems, Espoo (Finland)

    2006-12-15

    The focus in human reliability analysis of nuclear power plants has traditionally been on human performance in disturbance conditions. On the other hand, human maintenance failures and design deficiencies, remained latent in the system, have an impact on the severity of a disturbance, e.g. by disabling safety-related equipment on demand. Especially common cause failures (CCFs) of safety related systems can affect the core damage risk to a significant extent. The topic has been addressed in Finnish studies, where experiences of latent human errors have been searched and analysed systematically from the maintenance history stored in the the power plant information systems of the Loviisa and Olkiluoto NPPs. Both the single and multiple errors (CCFs) were classified in detail and documented as error and event reports. The human CCFs involved human, organisational and technical factors. The review of the analysed single and multiple errors showed that instrumentation and control and electrical equipment are more prone to human error caused failure events than the other maintenance objects. The review of the analysed experience showed that most errors stem from the refuelling and maintenance outage periods. More than half of the multiple errors from the outages remained latent to the power operating periods. The review of the analysed multiple errors showed that difficulties with small plant modifications and planning of maintenance and operability were significant sources of common cause failures. The most dependent human errors originating from small modifications could be reduced by a more tailored planning and coverage of their start-up testing programs. Improvements could also be achieved by identifying better in work planning from the operating experiences those complex or intrusive repair and preventive maintenance work tasks and actions which are prone to errors. Such uncertain cases in important equipment require a more tailored work planning of the installation

  2. Systematic analysis and prevention of human originated common cause failures in relation to maintenance activities at Finnish nuclear power plants

    International Nuclear Information System (INIS)

    Laakso, K.

    2006-12-01

    The focus in human reliability analysis of nuclear power plants has traditionally been on human performance in disturbance conditions. On the other hand, human maintenance failures and design deficiencies, remained latent in the system, have an impact on the severity of a disturbance, e.g. by disabling safety-related equipment on demand. Especially common cause failures (CCFs) of safety related systems can affect the core damage risk to a significant extent. The topic has been addressed in Finnish studies, where experiences of latent human errors have been searched and analysed systematically from the maintenance history stored in the the power plant information systems of the Loviisa and Olkiluoto NPPs. Both the single and multiple errors (CCFs) were classified in detail and documented as error and event reports. The human CCFs involved human, organisational and technical factors. The review of the analysed single and multiple errors showed that instrumentation and control and electrical equipment are more prone to human error caused failure events than the other maintenance objects. The review of the analysed experience showed that most errors stem from the refuelling and maintenance outage periods. More than half of the multiple errors from the outages remained latent to the power operating periods. The review of the analysed multiple errors showed that difficulties with small plant modifications and planning of maintenance and operability were significant sources of common cause failures. The most dependent human errors originating from small modifications could be reduced by a more tailored planning and coverage of their start-up testing programs. Improvements could also be achieved by identifying better in work planning from the operating experiences those complex or intrusive repair and preventive maintenance work tasks and actions which are prone to errors. Such uncertain cases in important equipment require a more tailored work planning of the installation

  3. Skull and Posterior Rib Fractures with Respiratory Failure caused by Child Abuse

    Directory of Open Access Journals (Sweden)

    Dzulfikar Djalil Lukmanul Hakim

    2017-03-01

    Full Text Available Background: Presence of multiple fractures suggests child abuse. Skull fractures rarely occurred but posterior rib fractures are commonly found and have high specificity as a radiological finding in child abuse. A respiratory failure can occur as a result of the damage to the osseous structure of the thorax that destabilizes the rib cage and impairs spontaneous breathing mechanism. Methods: A case report of a 6-month-old boy who presented with respiratory failure, multiple bilateral parietal and occipital bone fractures, and also fractures of right rib 5–8. The patient required ventilatory support for 9 days in the Pediatric Intensive Care Unit, Dr.HasanSadikin General Hospital. Results: The patient was on ventilatory support for 9 days, and was given antibiotics for 2 weeks. Next, the patient was referred to the High Care Unit (HCU after the condition was stabilized, and then referred to the ward, for treatment by the Social Pediatric Division. The patient was still having issues about his foster care. Conclusions: Recognition of presence of fractures is important in early diagnosis and treatment of child abuse.

  4. Citrin deficiency: a novel cause of failure to thrive that responds to a high-protein, low-carbohydrate diet.

    Science.gov (United States)

    Dimmock, David; Kobayashi, Keiko; Iijima, Mikio; Tabata, Ayako; Wong, Lee-Jun; Saheki, Takeyori; Lee, Brendan; Scaglia, Fernando

    2007-03-01

    The proband was born at 36 weeks, appropriate for gestational age, to nonconsanguineous white parents. There was no evidence of hyperbilirubinemia or intrahepatic cholestasis in the neonatal period, and she had normal newborn screen results. She presented with 3 episodes of life-threatening bleeding and anemia. The diagnostic evaluation for her bleeding diathesis revealed an abnormal clotting profile with no biochemical evidence for hepatocellular damage. She was incidentally noted to have severe growth deceleration that failed to respond to 502 kJ/kg (120 kcal/kg) per day of protein-hydrolyzed formula. An extensive diagnostic workup for failure to thrive, which was otherwise normal, included plasma amino acid analysis that revealed hyperglutaminemia and citrulline levels within the reference range. Testing of a repeat sample revealed isolated hypercitrullinemia. No argininosuccinic acid was detected. Her ammonia level and urine orotic acid were within the reference ranges. Subsequent plasma amino acid analysis exhibited a profile suggestive of neonatal intrahepatic cholestasis caused by citrin deficiency with elevations in citrulline, methionine, and threonine. Western blotting of fibroblasts demonstrated citrin deficiency, and a deletion for exon 3 was found in the patient's coding DNA of the SLC25A13 gene. On the basis of the experience with adults carrying this condition, the patient was given a high-protein, low-carbohydrate diet. The failure to thrive and bleeding diathesis resolved. When compliance with the dietary prescription was relaxed, growth deceleration was again noted, although significant bleeding did not recur. This is the first report of an infant of Northern European descent with citrin deficiency. The later age at presentation with failure to thrive and bleeding diathesis and without obvious evidence of neonatal intrahepatic cholestasis expands the clinical spectrum of citrin deficiency. This case emphasizes the importance of continued dietary

  5. Relationship between radiotherapy and gastroesophageal reflux disease in causing tracheoesophageal voice rehabilitation failure.

    Science.gov (United States)

    Cocuzza, Salvatore; Bonfiglio, Marco; Chiaramonte, Rita; Serra, Agostino

    2014-03-01

    The objective was to analyze the association of radiotherapy with gastroesophageal reflux as determinant of fistula related pathology, in voice prosthesis patients. Retrospective study. Sixty-one laryngectomy patients were enrolled between 2005 and 2012. All patients underwent phonatory rehabilitation with voice prosthesis, along with evidence of gastroesophageal reflux disease, for which proton pump inhibitors (PPIs) were prescribed. We analyzed the occurrence of fistula-related problems among patients who received postoperative radiotherapy and those patients who did not. We observed a higher rate of failure of speech rehabilitation in laryngectomy patients with gastroesphageal reflux: this occurred when they had a history of postoperative radiotherapy (45%) compared with patients who did not (17%) (P gastroesophageal reflux for the determinism of fistula-related problems. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  6. McKittrick-Wheelock syndrome - a rare cause of acute renal failure.

    Science.gov (United States)

    Popescu, Alina; Orban-Schiopu, Ana-Maria; Becheanu, Gabriel; Diculescu, Mircea

    2005-03-01

    Fluid and electrolyte hypersecretion in the villous adenoma of the rectum is presented in the case of a 74 year old man presenting with a severe fluid imbalance. The patient had a 2-year history of mucous diarrhea and, on admission, presented prerenal uremia, hyponatremia and severe hypokalemia. At sigmoidoscopy, a 6/4 cm villous adenoma of the rectum was found. The increased loss of volume, followed by exhaustion of the physiological compensation mechanisms, led to a life-threatening hypokalemia, as well as to acute renal failure. Conservative treatment was followed by a temporary improvement of the renal function. Alternative treatment was: endocavitary irradiation, endoscopic resection and radical tumor surgery. The surgical removal of the adenoma led to complete recovery of the symptoms. The McKittrick-Wheelock syndrome can be a problem of difficult diagnosis, both for the gastroenterologist and also for the nephrologist. The patient may develop severe complications, which require a sustained treatment.

  7. Amyloid Deposition in Transplanted Human Pancreatic Islets: A Conceivable Cause of Their Long-Term Failure

    Directory of Open Access Journals (Sweden)

    Arne Andersson

    2008-01-01

    Full Text Available Following the encouraging report of the Edmonton group, there was a rejuvenation of the islet transplantation field. After that, more pessimistic views spread when long-term results of the clinical outcome were published. A progressive loss of the β-cell function meant that almost all patients were back on insulin therapy after 5 years. More than 10 years ago, we demonstrated that amyloid deposits rapidly formed in human islets and in mouse islets transgenic for human IAPP when grafted into nude mice. It is, therefore, conceivable to consider amyloid formation as one potential candidate for the long-term failure. The present paper reviews attempts in our laboratories to elucidate the dynamics of and mechanisms behind the formation of amyloid in transplanted islets with special emphasis on the impact of long-term hyperglycemia.

  8. Prenatal diagnosis of concurrent facial and cerebral vascular malformation which caused congestive heart failure

    Directory of Open Access Journals (Sweden)

    Behnaz Moradi

    2017-12-01

    Full Text Available Arteriovenous malformations (AVMs are rarely reported antenatally. Most in utero diagnosis of vascular malformation is related to vein of Galen malformation (VGM. We describe a case of simultaneously diagnosed pial arteriovenous fistula (AVF and facial vascular malformation in a 20 weeks old fetus. The dilated intracranial venous pouch appeared as a midline anechoic structure which was misdiagnosed as a VGM in her previous ultrasound exam. Another AVM was diagnosed in the same side of fetal face which fed by a branch of external carotid artery and communicated with the mentioned pial AVF. High output cardiac failure and hydrops were evident. To our knowledge this is the first report of prenatally detected combination of facial and cerebral vascular malformations at such as early pregnancy week.

  9. A sewage disposal failure as a cause of ascariasis and giardiasis epidemic in a family.

    Science.gov (United States)

    Totkova, A; Klobusicky, M; Holkova, R; Valent, M; Stojkovicova, H

    2004-01-01

    In monitoring the incidence of intestinal parasites in children and employees of a nursery the authors examined 31 children with 8 (25.81%) and 16 employees with 3 (18.75%) positive results. The authors wanted to examine also the family members of 8 positive children and 3 positive employees but except from the cleaner's family, (Ascaris lumburicoides, Enterobius vermicularis and Entamoeba coli) nobody accepted the offer. All 8 members of a large family except for Patient 1 (a cleaner) and her grandson were without clinical and laboratory findings. They constitute 3 independent families who lived in 1st category flats. On August 31 there was an extensive sewage disposal failure in the ground floor flat of Family II and the flat was flooded by sewage. All family members worked solidarily on cleaning and also the members of Family IV who are friends of Family II. As shown by clinical symptoms of 'virosis', during the pre-patent period and after an outbreak within 73-78 days, laboratory findings of the family members demonstrated a severe family infection equal to a epidemic of intestinal parasitosis. Ascaris lumbricoides was diagnosed in 8 family members (61.54%) and Giardia intestinalis in 7 family members (53.85%) involved in cleaning. Enterobius vermicularis was found in 2 and Etamoeba coli in 1 family member. In monitored persons, in extreme hygienic conditions during the failure and later, a mass contraction arose on the basis of infection. The fact, that family epidemic arose subsequently, proved, in contrast to sporadic findings in children and adults, a 6.4 and 3.3 times higher incidence of Ascaris lumbricoides and a 5.6 and 8.6 times higher incidence of Giardia intestinalis. The authors discus the reasons of incidence and also preventive measures in population. (Tab. 3, Ref. 29.).

  10. Bland-White-Garland syndrome - a rare and serious cause of failure to thrive.

    Science.gov (United States)

    Szmigielska, Agnieszka; Roszkowska-Blaim, Maria; Gołąbek-Dylewska, Małgorzata; Tomik, Agnieszka; Brzewski, Michał; Werner, Bożena

    2013-01-01

    Male, 0 FINAL DIAGNOSIS: Bland-White-Garland syndrome Symptoms: Cardiomegaly, feeding problems Medication: - Clinical Procedure: Reimplantation of the left coronary artery to the aorta Specialty: Pediatrics and Neonatology. Rare disease. Bland-White-Garland syndrome (BWGS) is a very rare disease characterized by anomalous origin of the left coronary artery from the pulmonary trunk (ALCAPA). WBGS affects 1 in every 300 000 live births. Children typically present with dyspnea, pallor, and failure to thrive. Without surgical repair, most of these children die during the first months of life. This case report describes 3-month-old boy admitted to the hospital because of feeding problems. The boy was born at term, with birth weight 3200 g, and was 10 points in Apgar score. He was breast-fed from birth. From the seventh week of age, his mother observed his increasing difficulties with feeding. Physical examination revealed pale skin, diminished heart sounds, tachycardia, cardiomegaly, and hepatomegaly. Results of urine and blood tests and ultrasonography of the central nervous system and abdomen were normal. The chest radiography showed cardiomegaly and electrocardiogram revealed anterolateral myocardial infarction. On echocardiography, an anomalous left coronary artery arising from the pulmonary artery was found. The life-saving treatment of choice was immediate surgical reimplantation of the left coronary artery to the aorta. Children with congenital heart disease are often prone to malnutrition, but in rare cases failure to thrive and breast-feeding problems can be the first symptoms of life-threatening diseases like myocardial infarction secondary to Bland-White-Garland syndrome (BWGS).

  11. Bland-White-Garland syndrome – a rare and serious cause of failure to thrive

    Science.gov (United States)

    Szmigielska, Agnieszka; Roszkowska-Blaim, Maria; Gołąbek-Dylewska, Małgorzata; Tomik, Agnieszka; Brzewski, Michał; Werner, Bożena

    2013-01-01

    Patient: Male, 0 Final Diagnosis: Bland-White-Garland syndrome Symptoms: Cardiomegaly, feeding problems Medication: — Clinical Procedure: Reimplantation of the left coronary artery to the aorta Specialty: Pediatrics and Neonatology Objective: Rare disease Background: Bland-White-Garland syndrome (BWGS) is a very rare disease characterized by anomalous origin of the left coronary artery from the pulmonary trunk (ALCAPA). WBGS affects 1 in every 300 000 live births. Children typically present with dyspnea, pallor, and failure to thrive. Without surgical repair, most of these children die during the first months of life. Case Report: This case report describes 3-month-old boy admitted to the hospital because of feeding problems. The boy was born at term, with birth weight 3200 g, and was 10 points in Apgar score. He was breast-fed from birth. From the seventh week of age, his mother observed his increasing difficulties with feeding. Physical examination revealed pale skin, diminished heart sounds, tachycardia, cardiomegaly, and hepatomegaly. Results of urine and blood tests and ultrasonography of the central nervous system and abdomen were normal. The chest radiography showed cardiomegaly and electrocardiogram revealed anterolateral myocardial infarction. On echocardiography, an anomalous left coronary artery arising from the pulmonary artery was found. The life-saving treatment of choice was immediate surgical reimplantation of the left coronary artery to the aorta. Conclusions: Children with congenital heart disease are often prone to malnutrition, but in rare cases failure to thrive and breast-feeding problems can be the first symptoms of life-threatening diseases like myocardial infarction secondary to Bland-White-Garland syndrome (BWGS). PMID:24086793

  12. REFRACTORY HYPERTENSION: EVIDENCE OF HEIGHTENED SYMPATHETIC ACTIVITY AS A CAUSE OF ANTIHYPERTENSIVE TREATMENT FAILURE

    Science.gov (United States)

    Dudenbostel, Tanja; Acelajado, Maria C.; Pisoni, Roberto; Li, Peng; Oparil, Suzanne; Calhoun, David A.

    2015-01-01

    Refractory hypertension is an extreme phenotype of treatment failure defined as uncontrolled blood pressure (BP) in spite of ≥5 classes of antihypertensive agents, including chlorthalidone and a mineralocorticoid receptor antagonist. A prospective evaluation of possible mechanisms of refractory hypertension has not been done. The goal of this study was to test for evidence of heightened sympathetic tone as indicated by 24-hr urinary (U-) normetanephrine levels, clinic and ambulatory heart rate (HR), HR variability (HRV), arterial stiffness as indexed by pulse wave velocity (PWV), and systemic vascular resistance (SVR) compared to patients with controlled resistant hypertension. Forty-four consecutive patients, 15 with refractory and 29 with controlled resistant hypertension, were evaluated prospectively. Refractory hypertensive patients were younger (48±13.3 vs. 56.5±14.1 years, p=0.038) and more likely female (80.0 vs 51.9 %, p=0.047) compared to patients with controlled resistant hypertension. They also had higher U-normetanephrine levels (464.4±250.2 vs. 309.8±147.6 μg/24h, p=0.03), higher clinic HR (77.8±7.7 vs. 68.8±7.6 bpm, p=0.001) and 24-hr ambulatory HR (77.8±7.7 vs 68.8±7.6, p=0.0018), higher PWV (11.8±2.2 vs. 9.4±1.5 m/s, p=0.009), reduced HRV (4.48 vs. 6.11, p=0.03), and higher SVR (3795±1753 vs. 2382±349 dyne·sec·cm5·m2, p=0.008). These findings are consistent with heightened sympathetic tone being a major contributor to antihypertensive treatment failure and highlight the need for effective sympatholytic therapies in patients with refractory hypertension. PMID:25987662

  13. Characteristics, risk factors, and mortality of cirrhotic patients hospitalized for hepatic encephalopathy with and without acute-on-chronic liver failure (ACLF).

    Science.gov (United States)

    Cordoba, Juan; Ventura-Cots, Meritxell; Simón-Talero, Macarena; Amorós, Àlex; Pavesi, Marco; Vilstrup, Hendrik; Angeli, Paolo; Domenicali, Marco; Ginés, Pere; Bernardi, Mauro; Arroyo, Vicente

    2014-02-01

    In spite of the high incidence of hepatic encephalopathy (HE) in cirrhosis, there are few observational studies. We performed an analysis to define the characteristics of HE and associated features using the database of the Canonic Study. Clinical, laboratory and survival data of 1348 consecutive cirrhotic patients admitted with an acute decompensation were compared according to the presence (n=406) or absence of HE and of acute-on-chronic liver failure (ACLF) (n=301). HE development was independently associated with previous HE episodes; survival probabilities worsen in relation to the presence and grade of HE. There were marked differences between HE associated (n=174) and not associated (n=286) to ACLF. HE not associated with ACLF occurred in older cirrhotics, inactive drinkers, without severe liver failure or systemic inflammatory reaction and in relation to diuretic use. In contrast, HE associated with ACLF occurred in younger cirrhotics, more frequently alcoholics, with severe liver failure and systemic inflammatory reaction, and in relation to bacterial infections, active alcoholism and/or dilutional hyponatremia. Prognosis was relatively preserved in the first and extremely poor in the second group. Independent risk factors of mortality in patients with HE were age, bilirubin, INR, creatinine, sodium, and HE grade. In cirrhosis, previous HE identifies a subgroup of patients that is especially vulnerable for developing new episodes of HE. The course of HE appears to be different according to the presence of ACLF. Copyright © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

  14. Endodontic treatment failure caused by arsen utilization as the devitalization material

    Directory of Open Access Journals (Sweden)

    Endang Sukartini

    2008-07-01

    Full Text Available Root canal treatment diagnoses as pulpitis irreversible can be treated in a non-vital condition with devitalization material. Arsenic is one of devitalization material that used in inflammatory pulp tissue before it is going to endodontic treatment. The long-term use of it or the leak of using this arsenic can cause the toxic effect of the pulp tissue. The case is going to report is about the damage of gingival tissue and alveolar that caused by the uncarefullness using of arsenic. Inappropriate arsenic applications cause the leak that able to spread to gingival tissue and will become necrosis. Now a day, the using of arsenic begin to leave because of the toxicity sad effect. This report is going to report how much the damage using arsenic trioxide (As2O3 and the effort from the leakness.

  15. Etiology and Outcome of Acute Liver Failure: Experience from a Liver Transplantation Centre in Montreal

    Directory of Open Access Journals (Sweden)

    Geneviève Tessier

    2002-01-01

    Full Text Available BACKGROUND: Acute liver failure is a rare condition in which massive liver injury is associated with the rapid development of hepatic encephalopathy. Although viral hepatitis and drug-induced liver injury are the most common causes, no specific etiology is found in a substantial proportion of cases reported from Europe and the United States.

  16. Viral Hepatitis: A through E and Beyond

    Science.gov (United States)

    ... National Digestive Diseases Information Clearinghouse What is viral hepatitis? Viral hepatitis is inflammation of the liver caused by ... and serious. Drugs are available to treat chronic hepatitis. 4 Viral Hepatitis: A through E and Beyond What else ...

  17. Key performance outcomes of patient safety curricula: root cause analysis, failure mode and effects analysis, and structured communications skills.

    Science.gov (United States)

    Fassett, William E

    2011-10-10

    As colleges and schools of pharmacy develop core courses related to patient safety, course-level outcomes will need to include both knowledge and performance measures. Three key performance outcomes for patient safety coursework, measured at the course level, are the ability to perform root cause analyses and healthcare failure mode effects analyses, and the ability to generate effective safety communications using structured formats such as the Situation-Background-Assessment-Recommendation (SBAR) situational briefing model. Each of these skills is widely used in patient safety work and competence in their use is essential for a pharmacist's ability to contribute as a member of a patient safety team.

  18. The methodology of root cause analysis for equipment failure and its application at Guangdong nuclear power stations

    International Nuclear Information System (INIS)

    Gao Ligang; Lu Qunxian

    2004-01-01

    The methodology of Equipment Failure Root Cause Analysis (RCA) is described, as a systematic analysis methodology, it includes 9 steps. Its process is explained by some real examples, and the 6 precautions applying RCA is pointed out. The paper also summarizes the experience of RCA application at Daya Bay Nuclear Power Station, and the 7 key factors for RCA success is emphasized, that mainly concerns organization, objective, analyst, analysis technique, external technical supporting system, corrective actions developing and monitoring system for corrective actions. (authors)

  19. Destructive Interactions Between Mitigation Strategies and the Causes of Unexpected Failures in Natural Hazard Mitigation Systems

    Science.gov (United States)

    Day, S. J.; Fearnley, C. J.

    2013-12-01

    Large investments in the mitigation of natural hazards, using a variety of technology-based mitigation strategies, have proven to be surprisingly ineffective in some recent natural disasters. These failures reveal a need for a systematic classification of mitigation strategies; an understanding of the scientific uncertainties that affect the effectiveness of such strategies; and an understanding of how the different types of strategy within an overall mitigation system interact destructively to reduce the effectiveness of the overall mitigation system. We classify mitigation strategies into permanent, responsive and anticipatory. Permanent mitigation strategies such as flood and tsunami defenses or land use restrictions, are both costly and 'brittle': when they malfunction they can increase mortality. Such strategies critically depend on the accuracy of the estimates of expected hazard intensity in the hazard assessments that underpin their design. Responsive mitigation strategies such as tsunami and lahar warning systems rely on capacities to detect and quantify the hazard source events and to transmit warnings fast enough to enable at risk populations to decide and act effectively. Self-warning and voluntary evacuation is also usually a responsive mitigation strategy. Uncertainty in the nature and magnitude of the detected hazard source event is often the key scientific obstacle to responsive mitigation; public understanding of both the hazard and the warnings, to enable decision making, can also be a critical obstacle. Anticipatory mitigation strategies use interpretation of precursors to hazard source events and are used widely in mitigation of volcanic hazards. Their critical limitations are due to uncertainties in time, space and magnitude relationships between precursors and hazard events. Examples of destructive interaction between different mitigation strategies are provided by the Tohoku 2011 earthquake and tsunami; recent earthquakes that have impacted

  20. 'NTA', a locally named unclear condition that causes failure to thrive ...

    African Journals Online (AJOL)

    2016-08-04

    Aug 4, 2016 ... The causes are classified into organic (medical) and nonorganic ... ing patients' ideas about what should work as treatment may be the ..... The size of the anterior fontanelle reflects the balance .... the first year of life. J Child ...

  1. Preventing hepatitis B or C

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000401.htm Preventing hepatitis B or C To use the sharing features on this page, please enable JavaScript. Hepatitis B and hepatitis C infections cause irritation and ...

  2. Ovarian function after autologous bone marrow transplantation in childhood: high-dose busulfan is a major cause of ovarian failure.

    Science.gov (United States)

    Teinturier, C; Hartmann, O; Valteau-Couanet, D; Benhamou, E; Bougneres, P F

    1998-11-01

    We studied pubertal status and ovarian function in 21 girls aged 11-21 years who had earlier received 1.2-13 years (median 7 years) high-dose chemotherapy and autologous BMT without TBI for malignant tumors. Ten of them were given busulfan (600 mg/m2) and melphalan (140 mg/m2) with or without cyclophosphamide (3.6 g/m2). Eleven others did not receive busulfan. Twelve girls (57%) had clinical and hormonal evidence of ovarian failure. Among nine others who had completed normal puberty, six had normal gonadotropin levels, one had elevated gonadotropin levels and two had gonadotropin levels at the upper limit of normal. The 10 girls who received busulfan all developed severe and persistent ovarian failure. High-dose busulfan is therefore a major cause of ovarian failure even when given in the prepubertal period. These findings emphasize the need for long-term endocrine follow-up of these patients in order to initiate estrogen replacement therapy.

  3. PYCR2 Mutations cause a lethal syndrome of microcephaly and failure to thrive.

    Science.gov (United States)

    Zaki, Maha S; Bhat, Gifty; Sultan, Tipu; Issa, Mahmoud; Jung, Hea-Jin; Dikoglu, Esra; Selim, Laila; G Mahmoud, Imam; Abdel-Hamid, Mohamed S; Abdel-Salam, Ghada; Marin-Valencia, Isaac; Gleeson, Joseph G

    2016-07-01

    A study was undertaken to characterize the clinical features of the newly described hypomyelinating leukodystrophy type 10 with microcephaly. This is an autosomal recessive disorder mapped to chromosome 1q42.12 due to mutations in the PYCR2 gene, encoding an enzyme involved in proline synthesis in mitochondria. From several international clinics, 11 consanguineous families were identified with PYCR2 mutations by whole exome or targeted sequencing, with detailed clinical and radiological phenotyping. Selective mutations from patients were tested for effect on protein function. The characteristic clinical presentation of patients with PYCR2 mutations included failure to thrive, microcephaly, craniofacial dysmorphism, progressive psychomotor disability, hyperkinetic movements, and axial hypotonia with variable appendicular spasticity. Patients did not survive beyond the first decade of life. Brain magnetic resonance imaging showed global brain atrophy and white matter T2 hyperintensities. Routine serum metabolic profiles were unremarkable. Both nonsense and missense mutations were identified, which impaired protein multimerization. PYCR2-related syndrome represents a clinically recognizable condition in which PYCR2 mutations lead to protein dysfunction, not detectable on routine biochemical assessments. Mutations predict a poor outcome, probably as a result of impaired mitochondrial function. Ann Neurol 2016;80:59-70. © 2016 American Neurological Association.

  4. Glyphosate ingestion causing multiple organ failure: a near-fatal case report.

    Science.gov (United States)

    Picetti, Edoardo; Generali, Michela; Mensi, Francesca; Neri, Giampaolo; Damia, Roberta; Lippi, Giuseppe; Cervellin, Gianfranco

    2018-01-16

    A 55 years old man self-presented to our Emergency Department (ED) reporting an attempted suicide by cutting the left forearm veins and ingesting approximately 200 mL of an herbicide (Myrtos®, containing 36% of glyphosate as isopropylamine salt). Laboratory tests showed metabolic acidosis. Hydration with normal saline and alkalinization with sodium bicarbonate was started according to suggestion of the poison control center, since an antidote was unavailable. Cardiorespiratory condition gradually worsened, so that non-invasive positive pressure ventilation (NIPPV) was applied and infusion of fluids was established. Nevertheless, the patient deteriorated and he needed to be transferred to the Intensive Care Unit (ICU), where he underwent orotracheal intubation and invasive mechanical ventilation. Noradrenaline and adrenaline were infused and fluid resuscitation with crystalloids was incremented. An esophagogastroduodenoscopy (EGD) showed diffuse mucosal erosions of upper digestive tract. No signs of visceral perforation were found during ICU stay. In the following days, the clinical conditions improved and a new EGD showed marked improvement of erosive lesions. After 12 days of ICU stay, the patient was extubated and then transferred to the Psychiatric Unit, in good clinical conditions. Gliphosate ingestion is associated with rapid development of multiple organ failure (MOF). Since an effective antidote is unavailable, major attention should be placed to aggressive life-support care and careful monitoring of complications.

  5. Operator error and emotions. Operator error and emotions - a major cause of human failure

    Energy Technology Data Exchange (ETDEWEB)

    Patterson, B.K. [Human Factors Practical Incorporated (Canada); Bradley, M. [Univ. of New Brunswick, Saint John, New Brunswick (Canada); Artiss, W.G. [Human Factors Practical (Canada)

    2000-07-01

    This paper proposes the idea that a large proportion of the incidents attributed to operator and maintenance error in a nuclear or industrial plant are actually founded in our human emotions. Basic psychological theory of emotions is briefly presented and then the authors present situations and instances that can cause emotions to swell and lead to operator and maintenance error. Since emotional information is not recorded in industrial incident reports, the challenge is extended to industry, to review incident source documents for cases of emotional involvement and to develop means to collect emotion related information in future root cause analysis investigations. Training must then be provided to operators and maintainers to enable them to know one's emotions, manage emotions, motivate one's self, recognize emotions in others and handle relationships. Effective training will reduce the instances of human error based in emotions and enable a cooperative, productive environment in which to work. (author)

  6. Operator error and emotions. Operator error and emotions - a major cause of human failure

    International Nuclear Information System (INIS)

    Patterson, B.K.; Bradley, M.; Artiss, W.G.

    2000-01-01

    This paper proposes the idea that a large proportion of the incidents attributed to operator and maintenance error in a nuclear or industrial plant are actually founded in our human emotions. Basic psychological theory of emotions is briefly presented and then the authors present situations and instances that can cause emotions to swell and lead to operator and maintenance error. Since emotional information is not recorded in industrial incident reports, the challenge is extended to industry, to review incident source documents for cases of emotional involvement and to develop means to collect emotion related information in future root cause analysis investigations. Training must then be provided to operators and maintainers to enable them to know one's emotions, manage emotions, motivate one's self, recognize emotions in others and handle relationships. Effective training will reduce the instances of human error based in emotions and enable a cooperative, productive environment in which to work. (author)

  7. Is there any association between renal failure and hepatotoxic photosensitization caused by feeding foxtail millet (Setaria italica in sheep and goats?

    Directory of Open Access Journals (Sweden)

    Arash Omidi

    2016-07-01

    Full Text Available Photosensitivity is an abnormal skin reaction to direct sunlight exposure. Photosen sitivity occurred because of failure to excrete phylloerythrin due to hepatic dysfunction. Foxtail millet feeding can induce hepatotoxic photosensitization and influence on different organs. This study attempts to evaluate renal function and serum electrolyte status in sheep and goats experimentally feeding foxtail millet. Twelve male goats and sheep were kept in the sunlight. The animals were fed foxtail millet diet freely in a eight-week experimental period. Blood urea nitrogen (BUN, creatinine, sodium, potassium, phosphorus, magnesium, hematocrit and hemoglobin were measured until last day of experiment in a weekly manner. On the last day, the animals were euthanized and kidneys were removed for pathologic examination. Data were analyzed using repeated measurement analysis by SPSS software (version 20. Three sheep showed clinical signs of photosensitivity. BUN showed a decreasing trend from the second week of the experiment. Creatinine was increased in the six and second weeks. An increase in sodium concentration in goats from fourth week was significant. Sodium levels in sheep showed a fluctuational change. Potassium and phosphorus of sheep and phosphorus in the blood of goats were increased from the second week. Potassium in goats was constant during the time. Magnesium in the blood of sheep and goats was increased from the third and fourth weeks, respectively. The hematocrit and hemoglobin increased significantly over time. Moderate to severe hyperemia with abundant deposits of blue-violet material in the collecting ducts and mild degenerative changes in the convoluted tubules in sheep kidneys and congestion in the center of the goats’ kidney were seen. In conclusion, feeding the foxtail millet can cause renal dysfunction, and changes in the balance of some serum electrolytes.

  8. Virological failure and all-cause mortality in HIV-positive adults with low-level viremia during antiretroviral treatment.

    Directory of Open Access Journals (Sweden)

    Olof Elvstam

    Full Text Available Although most HIV-infected individuals achieve undetectable viremia during antiretroviral therapy (ART, a subset have low-level viremia (LLV of varying duration and magnitude. The impact of LLV on treatment outcomes is unclear. We investigated the association between LLV and virological failure and/or all-cause mortality among Swedish patients receiving ART.HIV-infected patients from two Swedish HIV centers were identified from the nationwide register InfCare HIV. Subjects aged ≥15 years with triple agent ART were included at 12 months after treatment initiation if ≥2 following viral load measurements were available. Patients with 2 consecutive HIV RNA values ≥1000 copies/mL at this time point were excluded. Participants were stratified into four categories depending on viremia profiles: permanently suppressed viremia (<50 copies/mL, LLV 50-199 copies/mL, LLV 200-999 copies/mL and viremia ≥1000 copies/mL. Association between all four viremia categories and all-cause death was calculated using survival analysis with viremia as a time-varying covariate, so that patients could change viremia category during follow-up. Association between the three lower categories and virological failure (≥2 consecutive measurements ≥1000 copies/mL was calculated in a similar manner.LLV 50-199 copies/mL was recorded in 70/1015 patients (6.9% and LLV 200-999 copies/mL in 89 (8.8% during 7812 person-years of follow-up (median 6.5 years. LLV 200-999 copies/mL was associated with virological failure (adjusted hazard ratio 3.14 [95% confidence interval 1.41-7.03, p<0.01], whereas LLV 50-199 copies/mL was not (1.01 [0.34-4.31, p = 0.99]; median follow-up 4.5 years. LLV 200-999 copies/mL had an adjusted mortality hazard ratio of 2.29 (0.98-5.32, p = 0.05 and LLV 50-199 copies/mL of 2.19 (0.90-5.37, p = 0.09.In this Swedish cohort followed during ART for a median of 4.5 years, LLV 200-999 copies/mL was independently associated with virological failure. Patients

  9. Evaluation of the therapeutic efficacy of lamivudine combined with plasma exchange for treating acute-on-chronic hepatitis B liver failure

    Directory of Open Access Journals (Sweden)

    HU Qijiang

    2013-02-01

    Full Text Available ObjectiveTo observe the clinical effects of lamivudine antiviral therapy combined with plasma exchange in patients with acute-on-chronic hepatitis B liver failure. MethodsForty-seven patients (treatment group were administered lamivudine and underwent plasma exchange. An additional forty-five patients (control group were administered lamivudine but no plasma exchange. Otherwise, all patients received the same basic medical treatment. The two groups were further divided into three sub-groups according to the model for end-stage liver disease (MELD score: <30, 30-39, and ≥40. The significance of differences in survival rates between the groups and sub-groups was determined by the χ2 test. ResultsThe overall survival rate was significantly better in the treatment group (63.82% vs. control group: 44.44%; χ2=4.31, P<0.05. Within the treatment group, the survival rates were highest in the 30-39 MELD score sub-group (71.42%, which was significantly different from survival rate in the same sub-group of the controls (vs. 38.10%; χ2=4.71, P<005. The other two MELD score sub-groups showed no significant differences between the treatment and control groups (all P>0.05. ConclusionCombined therapy consisting of lamivudine treatment and plasma exchange can improve the survival rate of patients with acute-on-chronic hepatitis B liver failure who have MELD scores between 30 and 39.

  10. The inflammatory biomarker YKL-40 as a new prognostic marker for all-cause mortality in patients with heart failure

    DEFF Research Database (Denmark)

    Harutyunyan, Marina; Christiansen, Michael; Johansen, Julia S

    2011-01-01

    peptide (NT-proBNP) could be a new prognostic biomarker for all-cause mortality in patients with HF. METHODS AND RESULTS: A total of 717 of the 1000 patients with severe left ventricular systolic dysfunction included in the EchoCardiography and Heart Outcome Study were included in Denmark and had blood...... YKL-40 II to IV quartiles, respectively following multivariable adjustment for cardiovascular risk factors (age, left ventricular ejection fraction, gender, history of heart failure, ischemic heart disease, chronic pulmonary disease, diabetes mellitus, stroke, hypertension, NT-proBNP, hs......-CRP, and renal function). CONCLUSION: Serum YKL-40 is significantly associated with all-cause mortality in patients with HF and could potentially be a new prognostic biomarker in these patients....

  11. Blue toe syndrome treated with sympathectomy in a patient with acute renal failure caused by cholesterol embolization

    Directory of Open Access Journals (Sweden)

    Min-Gang Kim

    2013-12-01

    Full Text Available Blue toe syndrome is the most frequent manifestation of tissue ischemia caused by cholesterol embolization (CE, which can lead to amputation of affected lower extremities, if severe. However, any effective treatment is lacking. We experienced a case of spontaneously presenting blue toe syndrome and concomitant acute renal failure in a patient with multiple atherosclerotic risk factors. CE was confirmed by renal biopsy. Despite medical treatment including prostaglandin therapy and narcotics, the toe lesion progressed to gangrene with worsening ischemic pain. Therefore, we performed lumbar sympathectomy, which provided dramatic pain relief as well as an adequate blood flow to the ischemic lower extremities, resulting in healing of the gangrenous lesion and avoiding toe amputation. This is the first reported case of a patient with intractable ischemic toe syndrome caused by CE that was treated successfully by sympathectomy. Our observations suggest that sympathectomy may be beneficial in some patients with CE-associated blue toe syndrome.

  12. The Causes of Failure of the European Constitution From the Perspective of the Constitution-Making Process

    Directory of Open Access Journals (Sweden)

    Robert Podolnjak

    2006-01-01

    Full Text Available The basic argument of the article is that the main causes of failure of the European Constitution stem from an inadequate preparation and implementation of a complex procedure of constitution-making for a federation of countries on a continental scale. This process includes the issues of temporal aspects of constitutionmaking, the subject of constitution-making, the text of the constitution, the strategy of constitutional ratifi cation and the constitution-makers themselves. The principal causes of failure of the European Constitution will be presented in the form of certain preliminary assumptions, which will then be examined in the light of certain comparative experiences of constitution-making in two federal systems – the American and the Swiss system. The primary mistakes of the European constitution-making are refl ected in the lack of an appropriate moment for making the constitution, in the vagueness of the document in terms of its constitutional or contractual quality, in the creation of a text of the Constitution which is completely incomprehensible to the average citizen, in the making of the Constitution without a vision or ambition, in the complete lack of any strategy of ratifi cation of the Constitution, in the insistence on the direct participation of the people in the adoption of the Constitution, which is legally and politically considered primarily an international treaty, and in badly managed media presentation and defence of the Constitution before the European public. The most important mistakes, crucial to the failure of the Constitution, are the ambivalent approach of the European constitutionmakers to the mode of ratifi cation of the Constitution, and their disregard of the constitution-making experience of other federal countries.

  13. Heart failure and sudden cardiac death in heritable thoracic aortic disease caused by pathogenic variants in the SMAD3 gene.

    Science.gov (United States)

    Backer, Julie De; Braverman, Alan C

    2018-05-01

    Predominant cardiovascular manifestations in the spectrum of Heritable Thoracic Aortic Disease include by default aortic root aneurysms- and dissections, which may be associated with aortic valve disease. Mitral- and tricuspid valve prolapse are other commonly recognized features. Myocardial disease, characterized by heart failure and/or malignant arrhythmias has been reported in humans and in animal models harboring pathogenic variants in the Fibrillin1 gene. Description of clinical history of three cases from one family in Ghent (Belgium) and one family in St. Louis (US). We report on three cases from two families presenting end-stage heart failure (in two) and lethal arrhythmias associated with moderate left ventricular dilatation (in one). All three cases harbor a pathogenic variant in the SMAD3 gene, known to cause aneurysm osteoarthritis syndrome, Loeys-Dietz syndrome type 3 or isolated Heritable Thoracic Aortic Disease. These unusual presentations warrant awareness for myocardial disease in patients harboring pathogenic variants in genes causing Heritable Thoracic Aortic Disease and indicate the need for prospective studies in larger cohorts. © 2018 The Authors. Molecular Genetics & Genomic Medicine published by Wiley Periodicals, Inc.

  14. Teacher points to dyslexia as a major cause of school failure

    Directory of Open Access Journals (Sweden)

    Vicente Martins

    2002-01-01

    Full Text Available In the past seven years, Professor Vincent Martins has developed studies on the contribution of linguistics to the diagnosis of dyslexia. The dyslexia is a disturbance or inconvenience to the level of reading. The dyslexic children is a bad player: you can read but can not effectively understand what you read. The estimate of the teacher is that, in Brazil at least 15 million children and young people suffering with disorders of letters. For the teacher, the dyslexia is the major cause of low school performance.

  15. Hepatitis viruses overview

    African Journals Online (AJOL)

    Hepatitis is major cause of morbidity or mortality worldwide, particularly in the developing world. The major causes of infective hepatitis are hepatitis viruses. A, B, C, D or E. In the acute phase, there are no clinical features that can reliably differentiate between these viruses. Infection may be asymptomatic or can present as.

  16. Failure of azithromycin 2.0 g in the treatment of gonococcal urethritis caused by high-level resistance in California.

    Science.gov (United States)

    Gose, Severin O; Soge, Olusegun O; Beebe, James L; Nguyen, Duylinh; Stoltey, Juliet E; Bauer, Heidi M

    2015-05-01

    We report a treatment failure to azithromycin 2.0 g caused by a urethral Neisseria gonorrhoeae isolate with high-level azithromycin resistance in California. This report describes the epidemiological case investigation and phenotypic and genetic characterization of the treatment failure isolate.

  17. Integral diagnostic in the failure causes of external corrosion of a natural gas transport pipeline

    Energy Technology Data Exchange (ETDEWEB)

    Mora-Mendoza, J.L.; Saucedo-Robles, L.C.; Rodriguez-Clemente, H. [PEMEX Gas y Petroquimica Basica, Subdireccion de Ductos; Marina Nacional 329, Edificio B-1, Piso 8, Col. Huasteca, D.F., CP 11311 (Mexico); Gonzalez-Nunez, M.A. [Instituto de Investigaciones Electricas, Reforma 113, Col. Palmira, Cuernavaca, Morelos, CP 62490 (Mexico); Zavala-Olivares, G.; Hernandez-Gayosso, M.J. [Instituto Mexicano del Petroleo, Direccion de Exploracion y Produccion, Eje Central Lazaro Cardenas Norte 152, Col. San Bartolo Atepehuacan, D.F., CP 07730 (Mexico)

    2011-08-15

    The objective of this study consisted in investigating the possible causes which give rise to the presence of low wall pipe thicknesses on a 16'' natural gas transport pipeline, even though during the last 12-year period cathodic protection (CP) potentials were kept in the protection range at which external corrosion should not occur. Results from in-line inspection from a 16'' natural gas transport pipeline showed 46 indications with more than 80% wall thickness lost due to external corrosion in the second segment of the pipeline. Direct inspection at the indication locations, review of the CP system performance, pipeline maintenance programs and studies, allowed to make an integral diagnostic where it was found out that the main cause of external corrosion was an inappropriate coating application since the pipeline construction, this situation has originated the increase of CP shielding effects through time. (Copyright copyright 2011 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

  18. Parvovirus B19 Associated Hepatitis

    Science.gov (United States)

    Bihari, Chhagan; Rastogi, Archana; Saxena, Priyanka; Rangegowda, Devraj; Chowdhury, Ashok; Gupta, Nalini; Sarin, Shiv Kumar

    2013-01-01

    Parvovirus B19 infection can present with myriads of clinical diseases and syndromes; liver manifestations and hepatitis are examples of them. Parvovirus B19 hepatitis associated aplastic anemia and its coinfection with other hepatotropic viruses are relatively underrecognized, and there is sufficient evidence in the literature suggesting that B19 infections can cause a spectrum of liver diseases from elevation of transaminases to acute hepatitis to fulminant liver failure and even chronic hepatitis. It can also cause fatal macrophage activation syndrome and fibrosing cholestatic hepatitis. Parvovirus B19 is an erythrovirus that can only be replicate in pronormoblasts and hepatocytes, and other cells which have globosides and glycosphingolipids in their membrane can also be affected by direct virus injury due to nonstructural protein 1 persistence and indirectly by immune mediated injury. The virus infection is suspected in bone marrow aspiration in cases with sudden drop of hemoglobin and onset of transient aplastic anemia in immunosuppressed or immunocompetent patients and is confirmed either by IgM and IgG positive serology, PCR analysis, and in situ hybridization in biopsy specimens or by application of both. There is no specific treatment for parvovirus B19 related liver diseases, but triple therapy regimen may be effective consisting of immunoglobulin, dehydrohydrocortisone, and cyclosporine. PMID:24232179

  19. Analysis of influencing factors for short-term outcome in patients with hepatitis B virus-related acute-on-chronic liver failure

    Directory of Open Access Journals (Sweden)

    ZHANG Xin

    2015-05-01

    Full Text Available ObjectiveTo investigate the effects of antiviral drugs, lamivudine (LAM and entecavir (ETV, on the short-term outcome in patients with hepatitis B virus (HBV-related acute-on-chronic liver failure (ACLF. MethodsThe demographic and clinical data of 445 patients with HBV-related ACLF (LAM∶ETV, 333∶112 who were hospitalized in the First Clinical Medical College of Fujian Medical University from January 2004 to December 2010 were collected, including age, sex, complications, clinical biochemical parameters, coagulation parameters, the use of antiviral drug, artificial liver treatment, and the survival at 24 weeks. The independent risk factors for the outcome at 24 weeks were determined by univariate and multivariate logistic regression analyses. ResultsThe univariate analysis indicated that the LAM group had significantly higher globulin, total bilirubin (TBil, alanine aminotransferase, international normalized ratio (INR, serum creatinine, and model for end-stage liver disease (MELD score than the ETV group (P<0.05, but had significantly lower cholinesterase and prothrombin time activity (PTA than the ETV group (P<0.05. The death group had significantly older age, higher incidence rates of liver cirrhosis, hepatic encephalopathy, spontaneous bacterial peritonitis, pulmonary infection, mycotic infection, electrolyte disturbance, hepatorenal syndrome, and upper gastrointestinal hemorrhage, and higher TBil, INR, white blood count, and MELD score than the survival group (P<0.05, but had significantly lower albumin, gamma-glutamyl transpeptidase, cholesterol, cholinesterase, serum sodium, PTA, alpha-fetoprotein, hemoglobin, platelet, and positive rate of HBeAg than the survival group (P<0.05. And there was no significant difference in the use of antiviral drugs (LAM∶ETV between the death group and the survival group (P=0.21. The multivariate logistic regression analysis showed that older age, hepatic encephalopathy, hepatorenal syndrome

  20. A Rare Cause of Acute Renal Failure: Fenofibrate-Induced Rhabdomyolysis

    Directory of Open Access Journals (Sweden)

    Ferhat Icme

    2013-08-01

    Full Text Available Fibrates are derivative of fibric acid and broad spectrum drugs which are commonly used in the treatment of dyslipidemia and hypertriglyceridemia. Side effects are often related with striated muscles, kidney and liver. Rhabdomyolysis developing with striated muscle destruction is potentially the most lethal of these side effects. Although several case reports of rhabdomyolysis have been reported due to the combination of statin and fenofibrate, fenofibrate alone rarely causes rhabdomyolysis. The purposes of this paper are to present a patient whom we diagnosed with acute renal injury due to use of fenofibrate in order to emphasize the importance of questioning drugs which have been used, and to review management of rhabdomyolysis due to fenofibrate use. [Cukurova Med J 2013; 38(4.000: 800-804