Unexpected Cause Research Articles

기능안전의 구현을 통한 Systematic Failure의 감축에 관한 연구

Due to the recent advances in technology, the systems are becoming more demanding in terms of functionality and implementation complexity. Therefore, when system failures are involved in such complex systems, the effects of the related safety issues can also be more serious, thereby causing in the worst case irrecoverable hazards on both human being and properties. This fact can be witnessed in the recent rail systems accidents. In general, the accidents can be attributed to the systematic failure or the random failure. The latter is due to the aging or unsatisfied quality of the parts used in implementation or some unexpected external cause that would otherwise result in accidents whereas the former is usually related to incomplete systems design. As the systems are becoming more complex, so are the systematic failures. The objective of the paper is to study an approach to solving the systematic failure. To do so, at first the system design process is augmented by the functional safety activities that are suggested in the standard IEC 61508. Analyzing the artifacts of the integrated process yields the traceability, which satisfies the requirements for reduction of systematic failure as provided in ISO 26262. In order to reduce systematic failure, the results are utilized in the conceptual design stage of systems development in which systems requirements are generated and functional architecture is developed.

Unexpected cause of acute right heart failure: renal cell carcinoma and tumour thrombus

Unexpected cause of acute right heart failure: renal cell carcinoma and tumour thrombus

MHC class I immune proteins are critical for hippocampus-dependent memory and gate NMDAR-dependent hippocampal long-term depression

Memory impairment is a common feature of conditions that involve changes in inflammatory signaling in the brain, including traumatic brain injury, infection, neurodegenerative disorders, and normal aging. However, the causal importance of inflammatory mediators in cognitive impairments in these conditions remains unclear. Here we show that specific immune proteins, members of the major histocompatibility complex class I (MHC class I), are essential for normal hippocampus-dependent memory, and are specifically required for NMDAR-dependent forms of long-term depression (LTD) in the healthy adult hippocampus. In β2m−/−TAP−/−mice, which lack stable cell-surface expression of most MHC class I proteins, NMDAR-dependent LTD in area CA1 of adult hippocampus is abolished, while NMDAR-independent forms of potentiation, facilitation, and depression are unaffected. Altered NMDAR-dependent synaptic plasticity in the hippocampus of β2m−/−TAP−/−mice is accompanied by pervasive deficits in hippocampus-dependent memory, including contextual fear memory, object recognition memory, and social recognition memory. Thus normal MHC class I expression is essential for NMDAR-dependent hippocampal synaptic depression and hippocampus-dependent memory. These results suggest that changes in MHC class I expression could be an unexpected cause of disrupted synaptic plasticity and cognitive deficits in the aging, damaged, and diseased brain.

Usefulness of Combined Bedside Lung Ultrasound and Echocardiography to Assess Weaning Failure From Mechanical Ventilation

Recognition of the cardiac origin of weaning failure is a crucial issue for successful discontinuation of mechanical ventilation. Bedside lung ultrasound and echocardiography have shown a potential in predicting weaning failure. Objective of this report was to describe the case of a patient repeatedly failing to wean from mechanical ventilation, where the combined use of lung ultrasound and echocardiography during a spontaneous breathing trial uncovered an unexpected cause of the failure. Case report. General ICU of a university teaching hospital. Single case, abdominal surgery postoperative patient, not predicted to experience a difficult weaning. Cardiovascular therapy adjustments consistent with lung ultrasound and echocardiography findings acquired during spontaneous breathing trials. All patient's standard hemodynamic and respiratory parameters, datasets from comprehensive lung ultrasound and echocardiographic examinations, and pertinent data from biochemistry exams, were collected during two spontaneous breathing trials. Data from beginning and end of each of the two ultrasound monitored weaning trials, and from the end of the successful weaning trial following therapy and the previously failed one, were analyzed and qualitatively compared. Lung ultrasound performed at the end of the failed spontaneous breathing trial showed a pattern consistent with increased extravascular lung water (diffuse, bilateral, symmetrical, homogeneous sonographic interstitial syndrome). Concurrent echocardiography diagnosed left ventricular diastolic failure. Ultrasound findings at the end of the successful weaning trial showed normalization of the lung pattern and improvement of the echocardiographic one. The patient eventually returned to spontaneous respiration and was discharged from the ICU. The use of bedside lung ultrasound and echocardiography disclosed left ventricular diastolic dysfunction as unexpected cardiogenic cause of weaning failure and lead to subsequent correct patient management.

An unexpected cause of acute colonic obstruction: globe vesicale

An unexpected cause of acute colonic obstruction: globe vesicale

Unexpected cause of persistent hemolytic anemia

Unexpected cause of persistent hemolytic anemia

Severe antibody-mediated rejection following IVIG infusion in a kidney transplant recipient with BK-virus nephropathy

Intravenous immune-globulin (IVIG) use in renal transplantation has increased, with common uses including desensitization, treatment of antibody mediated rejection and adjunctive therapy for BK virus nephropathy. Although considered generally safe, potential side effects can occur in up to 23% of patients including acute kidney injury. We present a case of an unexpected cause of acute kidney injury in a renal transplant recipient following IVIG infusion. A 48-year-old nonsensitized female with end stage renal disease secondary to polycystic kidney disease received a deceased donor kidney transplant. The initial post-transplant period was unremarkable however at three years post-transplant the patient develops BK virus nephropathy. Despite a reduction in immunosuppression, graft function worsened and IVIG infusion was commenced. Immediately following the IVIG infusion, the patient develops anuric acute kidney injury necessitating hemodialysis. Renal transplant biopsy performed before and after the IVIG infusion revealed the de novo development of acute antibody mediated rejection and donor specific antibodies in the serum. Anti-HLA and donor-specific antibodies were also confirmed in a diluted sample of the IVIG preparation. We argue that the anti-HLA antibodies present in the IVIG caused an acute antibody mediated rejection in this previously nonsensitized female.

Unexpected cause of systolic dysfunction in an octogenarian

Mulher de 82 anos, com antecedentes de hipertensao arterial ligeira, referia cansaco para grandes esforcos desde a adolescencia, nao investigado. O cansaco agravou-se progressivamente, passando a ser desencadeado por pequenos esforcos no ultimo ano. Um ecocardiograma efetuado noutro centro revelou ventriculo esquerdo dilatado, com paredes nao hipertrofiadas, disfuncao sistolica global (fracao de ejecao 37%) sem alteracoes da contratilidade segmentar, insuficiencia mitral ligeira e dilatacao auricular esquerda; apresentava ainda insuficiencia tricuspide moderada, hipertensao pulmonar moderada (estimada em 49 mmHg) e dilatacao acentuada da arteria pulmonar (47 mm). Foi referenciada ao nosso servico para exclusao de etiologia isquemica e o cateterismo cardiaco nao revelou doenca coronaria aparente. Auscultava-se sopro sistodiastolico de grau ii/vi no bordo esternal esquerdo superior nao explicado pela investigacao previa. Repetiu ecocardiograma transtoracico (Figura 1) que confirmou os achados do ecocardiograma inicial. Visualizava-se, porem, um fluxo turbulento, continuo, ao nivel da bifurcacao da arteria pulmonar, dirigido da aorta para o tronco e ramo direito da arteria

An unexpected cause of digital gangrene: HIV associated peripheral arterial thrombosis

Patients with human immunodeficiency virus (HIV) have various coagulation abnormalities as well as increased risk for development of clinical thrombosis and subsequent embolic events. We report acute lower-leg ischaemia caused by spontaneous thromboembolism with no identifiable risk other than HIV infection in a black African male. Physicians should be aware that thromboembolic arterial disease without usual risk factors may be secondary to HIV infection. With increased HIV testing in a variety of clinical settings there is likely to be an increase in detection of similar cases. A 53-year-old West African male was referred to an emergency department (ED) by his GP with a 2-week history of a painful and swollen right foot, unresponsive to oral flucloxacillin. He was a non-smoker. Examination revealed necrosis of the distal right second toe and right hallux with absent right posterior tibial and dorsalis pulses. His temperature was 37.7oC, blood pressure 121/73 mmHg and pulse rate 94/minute, regular. He denied any history of claudication pain, diabetes mellitus, or ingestion of ergot-related herbal compounds. Initial investigations showed leucocytosis (white cell count 15.4 x 109L, neutrophil 13.4 x 109L), with eosinophilia (0.94 x 109L 0.00–0.40), thrombocytopenia (platelets 84 x 109 …

Closure of the Frontal Sinus Ostium by a Block of Bone

Mucoceles are benign, slow-growing lesions. Frontal sinus mucoceles are caused by the obstruction of the sinus ostium and seromucous secretions fill the inside of the cyst. The size of the cyst and the destroyed sinus walls gradually expands. Cystic mass can lead to orbital or intracranial complications when it overflows beyond the boundaries of the sinus. In this manuscript, we presented an unexpected cause of frontal mucocele in which the closure of the frontal sinus ostium is caused by a block of bone. A case of orbital complications is presented.

Clinical features of congenital myasthenic syndrome due to mutations in DPAGT1

BackgroundA newly defined congenital myasthenic syndrome (CMS) caused by DPAGT1 mutations has recently been reported. While many other CMS-associated proteins have discrete roles localised to the neuromuscular junction, DPAGT1 is...

An unexpected cause for aplastic anaemia in an elderly woman

Aplastic anaemia is a rare clinical syndrome associated with diminished or absent precursors in the bone marrow. Acquired aplastic anaemia secondary to human immunodeficiency virus (HIV) is very rare. We present a 71-year-old woman with severe aplastic anaemia secondary to HIV infection, which was after extensive exclusion of other causes. She achieved undetectable viral load after 5 months of combination antiretroviral therapy but remains profoundly pancytopenic, complicated by recurrent infectious and bleeding complications. HIV infection should be considered in patients with pancytopenia.

Ascariasis as an unexpected cause of acute pancreatitis with cholangitis: a rare case report from urban area.

Ascaris lumbricoides is one of the most common parasitic infestations of human gastrointestinal tract. This parasitic infestation might be asymptomatic and only few studies on extraintestinal ascariasis have been reported. Ascending cholangitis and acute pancreatitis as a result of the Ascaris lumbricoides migrating into the biliary system and pancreatic duct were very rare complications. Here, we presented a case report of biliary ascariasis induced acute pancreatitis with cholangitis without imaging supported in a patient coming from urban area.A 33-year-old woman lives in Bangkok, urban area of Thailand. She presented with severe epigastric pain for one day. Her diagnosis was Ascaris lumbricoides induced acute pancreatitis accompanied with ascending cholangitis. The investigation results showed no eosinophilia and no ascaris eggs in stool examination. The abdominal computed tomography showed slightly common bile duct dilatation. The parasite was found during an endoscopic retrograde cholangiopancreatography performed. The cholangiography revealed a roundworm in common bile duct. The parasite was successfully removed by using an extraction balloon catheter and a snare. Microbiological examination of the parasite revealed a 22 cm long adult form of Ascaris lumbricoides.Ascaris lumbricoides is the uncommon cause of biliary obstruction with complications. It is also a possible cause even in the patients who live in urban areas. Endoscopic removal is the treatment of choice in addition to antihelminthic medications.

An unexpected cause of sepsis in a patient with dental decay

A 42-year old man attended our emergency department with sudden onset of nausea, fever and cold sweats. In the days prior to presentation, he had developed a radiating pain in the thoracic spine. Furthermore, he had been suffering from dyspnoea on exertion for several weeks. He was a smoker, but had no significant past medical history.

Letter to the Editor Unexpected cause of syncope in a young woman

Letter to the Editor Unexpected cause of syncope in a young woman

An unexpected cause of sepsis in a patient with dental decay (Answers)

The patient underwent transthoracic echocardiography which confirmed the presence of a calcified intracardiac mass in the right atrium, with significant tricuspid insufficiency and compression of the left atrium (Figure 2). CT angiography of the thorax revealed the tumour was 7.2×5.3×4.4 cm. Initially, no pulmonary vascular abnormalities were seen.

An unexpected cause of massive hemolysis in percutaneous left ventricular assist device

We present the case of a 24 year-old patient that developed massive hemolysis shortly after percutaneous left ventricular assist device, Impella 2.5, was placed. The hemolysis occurred without device alarm while the device was in the correct position. Further investigation of the device revealed fiber wrapped around the tip of the device, as a culprit. This case emphasizes on the special caution applied during device preparation to minimize the possible adverse events.

Knee pain: An unanticipated finding related to a rare genetic disorder-Abetalipoproteinemia

The purpose of this case study is to raise awareness about an uncommon cause of knee pain. Review of literature was done using PubMed, CINAHL, and Medline. There was no limitation placed on the publication year. Only articles written in English were included. Knee pain is a common diagnosis that many healthcare providers see on a daily basis in their practice. Musculoskeletal injury or trauma is most commonly identified as the cause of this symptom. However, there are rare instances in which an unexpected finding in a client's history and physical exam lead us to an unexpected cause, such as abetalipoproteinemia. Abetalipoproteinemia is a rare autosomal recessive disorder in which an affected individual does not absorb lipids or the lipid-soluble vitamins A, D, E, and K. Multiple body systems are impacted by this fat malabsorption and resultant vitamin deficiencies. Without corrective supplementation, clinical manifestations which are directly related to the vitamin deficiencies will appear as presented in this case study-knee pain. This case study emphasizes the need for nurse practitioners to seek out opportunities to further our knowledge which will enhance our clinical expertise as well as the quality of the health care we provide to our clients.

An unexpected cause of cardiac arrest during laparoscopy in an infant with supravalvar aortic stenosis

Patients with congenital supravalvar aortic stenosis (SVAS) with associated biventricular outflow tract obstruction and coronary artery abnormalities have a tenuous myocardial oxygen supply/demand relationship. They are at increased risk of acute myocardial ischemia and sudden death, especially during anesthesia. Furthermore, resuscitation during cardiac arrest is frequently unsuccessful. We report a case of perioperative cardiac arrest due to an unexpected cause in a 2 month old with SVAS during a laparoscopic Nissen fundoplication.

Unexpected cause of acute coronary syndrome in a patient with idiopathic pulmonary arterial hypertension

Unexpected cause of acute coronary syndrome in a patient with idiopathic pulmonary arterial hypertension