Failure

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Failure

  • Decompensat heart failure
  • Pacing-Induce heart failure
  • academic failure
  • access failure
  • activation failure
  • acute Decompensat heart failure
  • acute decompensated heart failure
  • acute heart failure
  • acute hepatic failure
  • acute liver failure
  • acute renal failure
  • acute respiratory failure
  • acute-on-chronic liver failure
  • advanced congestive heart failure
  • advanced heart failure
  • allograft failure
  • anastomotic failure
  • apparent failure
  • autonomic failure
  • bank failure
  • biochemical failure
  • bond failure
  • bone marrow failure
  • business failure
  • cardiac failure
  • cardiopulmonary failure
  • cardiovascular failure
  • catastrophic failure
  • cell failure
  • chronic heart failure
  • chronic liver failure
  • chronic renal failure
  • chronic respiratory failure
  • circulatory failure
  • clinical failure
  • cognitive failure
  • cohesive failure
  • communication failure
  • complete failure
  • component failure
  • congestive cardiac failure
  • congestive heart failure
  • consistent failure
  • control failure
  • coordination failure
  • decompensated heart failure
  • developmental failure
  • device failure
  • diastolic heart failure
  • distant failure
  • drug failure
  • early failure
  • early graft failure
  • early pregnancy failure
  • end-stage heart failure
  • end-stage renal failure
  • energy failure
  • eradication failure
  • fatigue failure
  • fertilization failure
  • final failure
  • first failure
  • flap failure
  • fulminant hepatic failure
  • fulminant liver failure
  • generator failure
  • government failure
  • graft failure
  • growth failure
  • heart failure
  • helicobacter pylori treatment failure
  • hepatic failure
  • hepatocellular failure
  • hypoxemic respiratory failure
  • implant failure
  • implantation failure
  • intestinal failure
  • ivf failure
  • kidney failure
  • late graft failure
  • lead failure
  • link failure
  • liver failure
  • local failure
  • localized failure
  • locoregional failure
  • long-term failure
  • lung failure
  • management failure
  • market failure
  • marrow failure
  • material failure
  • mechanical failure
  • mild heart failure
  • multi-organ failure
  • multiorgan failure
  • multiple organ failure
  • nest failure
  • node failure
  • one failure
  • organ failure
  • organ system failure
  • ovarian failure
  • overt heart failure
  • partial failure
  • policy failure
  • political failure
  • possible failure
  • postoperative liver failure
  • pouch failure
  • pregnancy failure
  • premature failure
  • premature ovarian failure
  • prerenal failure
  • previous failure
  • primary failure
  • primary graft failure
  • procedural failure
  • progressive failure
  • progressive heart failure
  • progressive renal failure
  • project failure
  • psa failure
  • pulmonary failure
  • pure autonomic failure
  • pylori treatment failure
  • radiation failure
  • recruitment failure
  • regional failure
  • regulatory failure
  • relative failure
  • renal allograft failure
  • renal failure
  • reproductive failure
  • respiratory failure
  • right heart failure
  • right ventricular failure
  • right-sided heart failure
  • rv failure
  • secondary failure
  • sensor failure
  • service failure
  • severe heart failure
  • severe liver failure
  • severe renal failure
  • severe respiratory failure
  • shear failure
  • slope failure
  • state failure
  • structural failure
  • subsequent failure
  • symptomatic heart failure
  • system failure
  • systemic failure
  • systolic heart failure
  • technical failure
  • tensile failure
  • test failure
  • therapeutic failure
  • therapy failure
  • transplant failure
  • treatment failure
  • valve failure
  • ventilatory failure
  • ventricular failure
  • virological failure

  • Terms modified by Failure

  • failure analysis
  • failure assessment
  • failure behavior
  • failure care
  • failure clinic
  • failure criterioN
  • failure criterion
  • failure data
  • failure detection
  • failure diagnosis
  • failure distribution
  • failure group
  • failure hospitalization
  • failure load
  • failure mechanism
  • failure mode
  • failure model
  • failure outcome
  • failure patient
  • failure pattern
  • failure probability
  • failure process
  • failure progression
  • failure property
  • failure rate
  • failure rate function
  • failure requiring dialysis
  • failure risk
  • failure secondary
  • failure strain
  • failure stress
  • failure surface
  • failure symptom
  • failure syndrome
  • failure time
  • failure time data
  • failure time distribution
  • failure time models
  • failure treatment
  • failure type

  • Selected Abstracts


    NHS AS STATE FAILURE: LESSONS FROM THE REALITY OF NATIONALISED HEALTHCARE

    ECONOMIC AFFAIRS, Issue 4 2008
    Helen Evans
    The British National Health Service is often held up as a beacon of egalitarian healthcare, funded through general taxation and free at the point of use. Instituted by arguably the most socialist government in British history after World War II, it has manifested all the flaws that might be expected from a state monopoly: waste, inefficiency, under-investment, rationing and constant political interference. The result has been poor health outcomes for British citizens compared with other wealthy countries, and a failure by the NHS to live up to its founding principles of comprehensive, unlimited healthcare and egalitarianism. [source]


    THE MORECAMBE BAY COCKLE PICKERS: MARKET FAILURE OR GOVERNMENT DISASTER?

    ECONOMIC AFFAIRS, Issue 3 2004
    John Meadowcroft
    The tragic deaths of twenty-three young Chinese cockle pickers in Morecambe Bay on the Lancashire coast have been attributed to the machinations of global capitalism. In fact, these migrant workers came to the UK to escape the poverty created by socialism in China and were working under a regime of state-regulated access to the cockle beds. An alternative market-orientated regime of private property rights in the cockle beds might have prevented the tragedy. [source]


    ALMOST, BUT NOT QUITE: THE FAILURE OF NEW YORK'S GET STATUTE

    FAMILY COURT REVIEW, Issue 2 2006
    Jeremy Glicksman
    The quandary of Jewish women unable to remarry because of their husbands' refusal to grant them religious divorces is a real problem affecting real people. Husbands are wielding this lopsided power to "extort" money from their wives, obtain favorable child custody settlements, property settlements, and child support payments. The burgeoning divorce rate is certain to exacerbate this problem. Already, this situation has garnered international attention. In the wake of New York's legislative attempt to remedy this problem, countries, including the United Kingdom and Australia, have promulgated legislative solutions to this dilemma. New York is the only state in the United States to pass such a statute. Unfortunately, New York's statute is flawed because it is of limited applicability and still allows for situations in which the Jewish wife is civilly divorced but religiously married. This Note proposes amending New York's statute to make it applicable to any and all divorce proceedings and to any barrier to remarriage. This Note will further recommend that the proposed amended statute should be adopted worldwide. [source]


    COCKCROFT-GAULT FORMULA FOR DIAGNOSING MODERATE KIDNEY FAILURE

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2008
    Michael Nevins MD
    No abstract is available for this article. [source]


    BRAIN NATRIURETIC PEPTIDE IN HEART FAILURE

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2006
    Article first published online: 6 FEB 200
    No abstract is available for this article. [source]


    RE: ANTIBIOTIC RENAL FAILURE AND CYSTIC FIBROSIS

    JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2006
    Kingsley Coulthard Associate Professor
    No abstract is available for this article. [source]


    ACUTE RENAL FAILURE: METHODS OF TREATMENT IN THE INTENSIVE CARE UNIT

    JOURNAL OF RENAL CARE, Issue 2 2009
    Sofia Zyga
    SUMMARY Patients who are treated in an intensive care unit (ICU) show the need of recovery of their renal function. The reason is that, in this particular cohort of patients, we have to maintain the necessary balance between body fluids, electrolytes, and acid-base, try to suspend further renal damage and purify the patient's blood to better accept the given therapy. In this paper, we try to demonstrate all the methods that can be used depending on the patient's condition, the therapist's preferences and the hospital's capabilities. [source]


    OPTIMAL MANAGEMENT OF CHRONIC HEART FAILURE IN PATIENTS WITH CHRONIC KIDNEY DISEASE

    JOURNAL OF RENAL CARE, Issue 1 2009
    Donah Zachariah
    SUMMARY Chronic kidney disease and chronic heart failure are closely interlinked; an abnormality in one system adversely impacts upon the function of the other. Despite the wealth of evidence available for beneficial treatment strategies in chronic heart failure, the prognosis remains poor and optimum therapy under-utilised. The applicability of proven therapies to patients with co-morbidity remains a particular challenge, especially since marked renal impairment has often been an exclusion criteria in major studies. In this article we discuss the epidemiology and pathophysiology of the two conditions and then focus on the aspects of treatment most pertinent to those patients with heart failure patients and concomitant chronic kidney disease. [source]


    AUTOMIC FAILURE AND NORMAL PRESSURE HYDROCEPHALUS IN A PATIENT WITH CHRONIC DEMYELINATING INFLAMMATORY NEUROPATHY

    JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 1 2002
    M. Laurą
    A 75-year-old man with HCV hepatitis developed at the age of 70 presented with rest and action tremor localized at both hands and progressive cognitive impairment with memory loss. Four years later he begun to complain of progressive fatigue, occasional falls, numbness at the extremities and orthostatic hypotension. One month after admission, he rapidly worsened with inability to walk, mainly because of autonomic failure. Neurological examination revealed gait disturbances, including a wide base of support and short stride, slurred speech, reduction of upward gaze, rest and action tremor at both hands, intrinsic hand muscle and anterior tibialis muscle wasting and weakness on both sides, absent deep tendon reflexes, loss of vibration sense at lower limbs, and bilateral pes cavus. Routine laboratory studies, autoantibodies, thyroid function, neoplastic markers and immunoelectrophoresis were normal. Cryoglobulins were absent, whereas CSF protein content was increased (142 mg/dl). Autonomic nervous system investigation detected severe orthostatic hypotension. Nerve conduction studies showed absent sensory potentials and a marked reduction of compound motor action potential amplitudes and of motor conduction velocities. A sural nerve biopsy revealed remarkable onion bulb-like changes, endoneurial and perivascular infiltrations of inflammatory cells. Psychometric tests showed mild cognitive impairment. Brain MRI was consistent with normotensive hydrocephalus. The findings indicated the presence of chronic inflammatory demyelinating polyneuropathy, autonomic nervous system involvement and normal pressure hydrocephalus. A condition of multiple system atrophy (MSA) might be taken into account, even if somatic peripheral nerve involvement may rarely occur in MSA. Moreover the normal pressure hydrocephalus could be due to the high protein content in CSF (Fukatsu R et al., 1997). [source]


    ESTIMATING EFFECTS OF SYSTEMATIC TREATMENT ON RENAL FAILURE AND DEATH WITHOUT A PARALLEL PLACEBO CONTROL GROUP

    NEPHROLOGY, Issue 3 2000
    Hoy We
    Background: Chronic disease programs are poorly developed in most Aboriginal communities. Much disease is unrecognised or inadequately treated, although appropriate interventions profoundly reduce morbidity and mortality in nonAboriginal populations. Programs of improved management must aspire to best practice for all, so that maintaining parallel untreated control groups is unethical. This poses challenges for evaluating effect. Methods: We identified a large burden of chronic disease in a 1990-1995 screening program in one community, and started a renal & cardiovascular-protection program in Nov 1995. This centred around use of ACE inhibitors, rigorous BP control, better control of glycemia and lipids, & health education. By late 1999 about 275 people, or 30% of all adults had enrolled. The courses of BP, albuminuria and GFR was compared with those in the pre-program era (ANZSN, 1999). Treatment effects on renal failure & natural death were estimated in 3 ways. 1) Comparison of these endpoints in the "intention to treat" group with those in persons potentially eligible for treatment on their 1990-1995 screening results, ,controls'. There was 50% overlap between the groups, & controls were younger and had less severe disease than the treatment group. 2.Community-based trends in endpoints. 3. Comparison of these trends with those in other NT Top End communities. Results: 1. Risk ratios of rates, Kaplan Meier survivals, and Cox hazard ratios all showed better survival of the treated group over controls, with estimates of 41%-64% reductions in endpoints, after accounting for disease severity. 2. Dialysis starts in the entire community have fallen by at least 38% and natural deaths by 32%. 3. In contrast dialysis continue to increase at 11% per yr in other communities and deaths have not fallen. These results all suggest a marked benefit from the treatment program. Similar methods might be used where truly controlled observations are not feasible. [source]


    ESTIMATING EFFECTS OF SYSTEMATIC TREATMENT ON RENAL FAILURE AND DEATH WITHOUT A PARALLEL PLACEBO CONTROL GROUP

    NEPHROLOGY, Issue 3 2000
    Hoy We
    Background: Chronic disease programs are poorly developed in most Aboriginal communities. Much disease is unrecognised or inadequately treated, although appropriate interventions profoundly reduce morbidity and mortality in nonAboriginal populations. Programs of improved management must aspire to best practice for all, so that maintaining parallel untreated control groups is unethical. This poses challenges for evaluating effect. Methods: We identified a large burden of chronic disease in a 1990-1995 screening program in one community, and started a renal & cardiovascular-protection program in Nov 1995. This centred around use of ACE inhibitors, rigorous BP control, better control of glycemia and lipids, & health education. By late 1999 about 275 people, or 30% of all adults had enrolled. The courses of BP, albuminuria and GFR was compared with those in the pre-program era (ANZSN, 1999). Treatment effects on renal failure & natural death were estimated in 3 ways. 1) Comparison of these endpoints in the "intention to treat" group with those in persons potentially eligible for treatment on their 1990-1995 screening results, ,controls'. There was 50% overlap between the groups, & controls were younger and had less severe disease than the treatment group. 2.Community-based trends in endpoints. 3. Comparison of these trends with those in other NT Top End communities. Results: 1. Risk ratios of rates, Kaplan Meier survivals, and Cox hazard ratios all showed better survival of the treated group over controls, with estimates of 41%-64% reductions in endpoints, after accounting for disease severity. 2. Dialysis starts in the entire community have fallen by at least 38% and natural deaths by 32%. 3. In contrast dialysis continue to increase at 11% per yr in other communities and deaths have not fallen. These results all suggest a marked benefit from the treatment program. Similar methods might be used where truly controlled observations are not feasible. [source]


    GEOGRAPHICAL DISTRIBUTION OF CHRONIC RENAL FAILURE IN SYDNEY, MELBOURNE AND BRISBANE

    NEPHROLOGY, Issue 3 2000
    Elliott Savdie
    [source]


    GEOGRAPHICAL DISTRIBUTION OF CHRONIC RENAL FAILURE IN SYDNEY, MELBOURNE AND BRISBANE

    NEPHROLOGY, Issue 3 2000
    Elliott Savdie
    [source]


    CIVIL SERVICE REFORM IN THE UK, 1999,2005: REVOLUTIONARY FAILURE OR EVOLUTIONARY SUCCESS?

    PUBLIC ADMINISTRATION, Issue 2 2007
    TONY BOVAIRD
    In December 1999, the UK Civil Service Management Board agreed an internal reform programme, complementing the more externally-oriented ,modernizing government' programme, to bring about major changes in the functioning of the civil service ,,step change' rather than continuous improvement. This paper suggests that the aims of the reform programme were only partially achieved. While some step changes did indeed occur, even such central elements of reform as ,joined-up' working with other public organizations were still only at an initial stage some three years later and others , for example, business planning and performance management systems , have taken 20 years to achieve acceptance within the civil service. It appears that examples of meteoric change are rare in the civil service , the reality of the changes are better characterized as ,evolution' and ,continuous improvement' than ,revolution' and ,step change'. [source]


    CONGESTIVE CARDIAC FAILURE: URBAN AND RURAL PERSPECTIVES IN VICTORIA

    AUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2003
    Mohammad Z. Ansari
    ABSTRACT Objective:,Effective and timely care for congestive cardiac failure (CCF) should reduce the risks of hospitalisation. The purpose of this study is to describe variations in rates of hospital admissions for CCF in Victoria as an indicator of the adequacy of primary care services. Detailed analyses identify trends in hospitalisations, urban/rural differentials and variations by the Primary Care Partnerships (PCP). Setting:,Acute care hospitals in Victoria. Design:,Routine analyses of age and sex standardised admission rates of CCF in Victoria using the Victorian Admitted Episodes Dataset from 1993,1994 to 2000,2001. Subjects:,All patients admitted to acute care hospitals in Victoria with the principal diagnosis of CCF between 1993,1994 and 2000,2001. Results:,There were 8359 admissions for CCF in Victoria with an average of 7.37 bed days in 2000,2001. There was a significantly higher admission rate for CCF in rural areas compared to metropolitan in 2000/2001 ,(2.53/1000 (2.44,2.62) and 1.80/1000 (1.75,1.85)) , respectively. Small area analyses identified 17 PCP (14 of which were rural) with significantly higher admission rate ratios of CCF compared to Victoria. Conclusion:,Small area analyses of CCF have identified significant gaps in the management of CCF in the community. This may be a reflection of deficit in primary care availability, accessibility, or appropriateness. Detailed studies may be needed to determine the relative importance of these factors in Victoria for targeting specific interventions at the PCP level. What does this study add?:,Congestive cardiac failure is a major public health problem. In Australia, there is a lack of studies identifying long-term hospitalisation trends of CCF, as well as small area analyses, especially in regard to rural and urban variations. This study has identified significant variations over an eight year period in admission rates of CCF in rural and urban Victoria. Small area analyses (e.g. at the level of primary care partnerships) have identified rural communities with significantly higher admission rates of CCF compared to the Victorian average. For the first time in Australia, this study has provided a new approach for generating evidence on quality of primary care services in rural and urban areas, and offers opportunities for targeting public health and health services interventions that can decrease access barriers, improve the adequacy of primary care, and reduce demand on the hospital system in Victoria. [source]


    THE NUMBER OF NEGATIVE PELVIC LYMPH NODES REMOVED DOES NOT AFFECT THE RISK OF BIOCHEMICAL FAILURE AFTER RADICAL PROSTATECTOMY

    BJU INTERNATIONAL, Issue 10 2010
    Christopher Eden
    No abstract is available for this article. [source]


    DIFFERENCES BETWEEN PATHOLOGICAL AND PHYSIOLOGICAL CARDIAC HYPERTROPHY: NOVEL THERAPEUTIC STRATEGIES TO TREAT HEART FAILURE

    CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 4 2007
    Julie R McMullen
    SUMMARY 1In general, cardiac hypertrophy (an increase in heart mass) is a poor prognostic sign. Cardiac enlargement is a characteristic of most forms of heart failure. Cardiac hypertrophy that occurs in athletes (physiological hypertrophy) is a notable exception. 2Physiological cardiac hypertrophy in response to exercise training differs in its structural and molecular profile to pathological hypertrophy associated with pressure or volume overload in disease. Physiological hypertrophy is characterized by normal organization of cardiac structure and normal or enhanced cardiac function, whereas pathological hypertrophy is commonly associated with upregulation of fetal genes, fibrosis, cardiac dysfunction and increased mortality. 3It is now clear that several signalling molecules play unique roles in the regulation of pathological and physiological cardiac hypertrophy. 4The present review discusses the possibility of targeting cardioprotective signalling pathways and genes activated in the athlete's heart to treat or prevent heart failure. [source]


    COORDINATION FAILURES IN NETWORK MIGRATION,

    THE MANCHESTER SCHOOL, Issue 6 2006
    AXEL HEITMUELLER
    Previous immigration facilitates future immigration, a phenomenon called network migration. While well recognized, previous research has mainly focused on the implications of immigrant networks on future migrants. In contrast, this paper derives a simple model from the perspective of the incumbent immigrant population by introducing sub-networks and argues that the incumbent migrants fail to achieve a Pareto optimal network size due to differences in inter- and intra-migrant group externalities and subsequently coordination failures. In short, it stresses the active role incumbents take in the provision of network effects and provides theoretical evidence that self-perpetuating and sustained immigration is not at odds with rational acting individuals. It also shows that optimally chosen migration quotas may appeal to incumbent migration cohorts and provides an alternative explanation for inter- and intra-migrant group tensions. [source]


    BUSINESS FAILURES AND MACROECONOMIC FACTORS IN THE UK

    BULLETIN OF ECONOMIC RESEARCH, Issue 1 2009
    Jia Liu
    G33; E42; P11 ABSTRACT We examine the interactions between business failures and macroeconomic aggregates, and specifically the accounts of policy-induced changes in the macroeconomy for the observed fluctuations of UK business failures in the period 1966,2003 using the vector error-correction model (VECM). The results demonstrate that macroeconomic aggregates, i.e., interest rate, credit, profits, inflation and business births, exert differential impacts on business failures both in the short run and in the long run. The study reveals that structural changes in the financial and real sectors during the examined period have made an impact on the way in which the macroeconomy affects business failures. In particular, business failures are increasingly reacting to monetary policy changes in the post-1980 period. Furthermore, the shocks to business failures can generate large fluctuations in macroeconomic aggregates, suggesting the importance of corporate balance sheets in financial stability and economic growth. The paper's findings carry policy implications that are related to the survival of firms in distress and finance-driven business cycles. [source]


    Pitfalls in the Diagnosis of Cerebellar Infarction

    ACADEMIC EMERGENCY MEDICINE, Issue 1 2007
    Sean I. Savitz MD
    Abstract Background Cerebellar infarctions are an important cause of neurologic disease. Failure to recognize and rapidly diagnose cerebellar infarction may lead to serious morbidity and mortality due to hydrocephalus and brain stem infarction. Objectives To identify sources of preventable medical errors, the authors obtained pilot data on cerebellar ischemic strokes that were initially misdiagnosed in the emergency department. Methods Fifteen cases of misdiagnosed cerebellar infarctions were collected, all seen, or reviewed by the authors during a five-year period. For each patient, they report the presenting symptoms, the findings on neurologic examination performed in the emergency department, specific areas of the examination not performed or documented, diagnostic testing, the follow-up course after misdiagnosis, and outcome. The different types of errors leading to misdiagnosis are categorized. Results Half of the patients were younger than 50 years and presented with headache and dizziness. All patients had either incomplete or poorly documented neurologic examinations. Almost all patients had a computed tomographic scan of the head interpreted as normal, and most of these patients underwent subsequent magnetic resonance imaging showing cerebellar infarction. The initial incorrect diagnoses included migraine, toxic encephalopathy, gastritis, meningitis, myocardial infarction, and polyneuropathy. The overall mortality in this patient cohort was 40%. Among the survivors, about 50% had disabling deficits. Pitfalls leading to misdiagnosis involved the clinical evaluation, diagnostic testing, and establishing a diagnosis and disposition. Conclusions This study demonstrates how the diagnosis of cerebellar infarction can be missed or delayed in patients presenting to the emergency department. [source]


    Etiology, pathogenesis and prevention of neural tube defects

    CONGENITAL ANOMALIES, Issue 2 2006
    Rengasamy Padmanabhan
    ABSTRACT Spina bifida, anencephaly, and encephalocele are commonly grouped together and termed neural tube defects (NTD). Failure of closure of the neural tube during development results in anencephaly or spina bifida aperta but encephaloceles are possibly post-closure defects. NTD are associated with a number of other central nervous system (CNS) and non-neural malformations. Racial, geographic and seasonal variations seem to affect their incidence. Etiology of NTD is unknown. Most of the non-syndromic NTD are of multifactorial origin. Recent in vitro and in vivo studies have highlighted the molecular mechanisms of neurulation in vertebrates but the morphologic development of human neural tube is poorly understood. A multisite closure theory, extrapolated directly from mouse experiments highlighted the clinical relevance of closure mechanisms to human NTD. Animal models, such as circle tail, curly tail, loop tail, shrm and numerous knockouts provide some insight into the mechanisms of NTD. Also available in the literature are a plethora of chemically induced preclosure and a few post-closure models of NTD, which highlight the fact that CNS malformations are of hetergeneitic nature. No Mendelian pattern of inheritance has been reported. Association with single gene defects, enhanced recurrence risk among siblings, and a higher frequency in twins than in singletons indicate the presence of a strong genetic contribution to the etiology of NTD. Non-availability of families with a significant number of NTD cases makes research into genetic causation of NTD difficult. Case reports and epidemiologic studies have implicated a number of chemicals, widely differing therapeutic drugs, environmental contaminants, pollutants, infectious agents, and solvents. Maternal hyperthermia, use of valproate by epileptic women during pregnancy, deficiency and excess of certain nutrients and chronic maternal diseases (e.g. diabetes mellitus) are reported to cause a manifold increase in the incidence of NTD. A host of suspected teratogens are also available in the literature. The UK and Hungarian studies showed that periconceptional supplementation of women with folate (FA) reduces significantly both the first occurrence and recurrence of NTD in the offspring. This led to mandatory periconceptional FA supplementation in a number of countries. Encouraged by the results of clinical studies, numerous laboratory investigations focused on the genes involved in the FA, vitamin B12 and homocysteine metabolism during neural tube development. As of today no clinical or experimental study has provided unequivocal evidence for a definitive role for any of these genes in the causation of NTD suggesting that a multitude of genes, growth factors and receptors interact in controlling neural tube development by yet unknown mechanisms. Future studies must address issues of gene-gene, gene-nutrient and gene,environment interactions in the pathogenesis of NTD. [source]


    Selective Application of the Pediatric Ross Procedure Minimizes Autograft Failure

    CONGENITAL HEART DISEASE, Issue 6 2008
    David L.S. Morales MD
    ABSTRACT Objective., Pulmonary autograft aortic root replacement (Ross' operation) is now associated with low operative risk. Recent series suggest that patients with primary aortic insufficiency have diminished autograft durability and that patients with large discrepancies between pulmonary and aortic valve sizes have a low but consistent rate of mortality. Therefore, Ross' operation in these patients has been avoided when possible at Texas Children's Hospital. Our objective was to report outcomes of Ross' operation when selectively employed in pediatric patients with aortic valve disease. Methods., Between July 1996 and February 2006, 55 patients (mean age 6.8 ± 5.5 years) underwent Ross' procedure. Forty-seven patients (85%) had a primary diagnosis of aortic stenosis, three (5%) patients had congenital aortic insufficiency, and five (9%) patients had endocarditis. Forty-two (76%) patients had undergone prior aortic valve intervention (23 [55%] percutaneous balloon aortic valvotomies, 12 [29%] surgical aortic valvotomies, 12 [29%] aortic valve replacements, 2 [5%] aortic valve repairs). Fourteen (25%) patients had ,2 prior aortic valve interventions. Thirty-two patients (58%) had bicuspid aortic valves. Follow-up was 100% at a mean of 3 ± 2.5 years. Results., Hospital and 5-year survival were 100% and 98%, respectively. Morbidity included one reoperation (2%) for bleeding. Median length of hospital stay was 6 days (3 days,3 months). Six (11%) patients needed a right ventricular to pulmonary artery conduit exchange at a median time of 2.3 years. Freedom from moderate or severe neoaortic insufficiency at 6 years is 97%. Autograft reoperation rate secondary to aortic insufficiency or root dilation was 0%. Conclusions., By selectively employing Ross' procedure, outcomes of the Ross procedure in the pediatric population are associated with minimal autograft failure and mortality at mid-term follow-up. [source]


    Rhythm Management in Pediatric Heart Failure

    CONGENITAL HEART DISEASE, Issue 4 2006
    Charles I. Berul MD
    ABSTRACT There are several options now available for the management of arrhythmias and ventricular dysfunction in pediatric patients with heart failure. A hybrid approach that combines the expertise of heart failure and electrophysiology specialists may be well suited for the optimal management of these complex patients. Medical and device therapies may be synergistic in decreasing the morbidity and mortality in pediatric heart failure. Pediatric electrophysiology can now potentially offer therapies that can help prevent both arrhythmic and pump failure deaths, as well as improve functional capacity and quality of life. These therapies and the available supporting data relevant to pediatrics will be the focus of this review. [source]


    Neonatal Congestive Heart Failure Due to a Subclavian Artery to Subclavian Vein Fistula Diagnosed by Noninvasive Procedures

    CONGENITAL HEART DISEASE, Issue 3 2006
    Gregory H. Tatum MD
    ABSTRACT Congestive heart failure in the neonate is usually due to intracardiac anomalies or cardiac dysfunction. Extracardiac causes are rare. Patient., We report a newborn infant who presented with respiratory distress and cardiomegaly. Result., Echocardiography identified a dilated right subclavian artery and vein and superior vena cava. Magnetic resonance imaging confirmed a subclavian artery to subclavian vein fistula that was treated with surgical ligation. The infant recovered fully. This case underscores the need for clinical suspicion of fistulous connection in unusual locations in the face of unexplained heart failure in the neonate. Conclusion., Echocardiographic and magnetic resonance imaging are effective noninvasive modalities to confirm the diagnosis prior to surgical intervention. [source]


    Increased Mortality Associated With Low Use of Clopidogrel in Patients With Heart Failure and Acute Myocardial Infarction Not Undergoing Percutaneous Coronary Intervention

    CONGESTIVE HEART FAILURE, Issue 5 2010
    Scott Harris DO
    We studied the association of clopidogrel with mortality in acute myocardial infarction (AMI) patients with heart failure (HF) not receiving percutaneous coronary intervention (PCI). Background. Use of clopidogrel after AMI is low in patients with HF, despite the fact that clopidogrel is associated with absolute mortality reduction in AMI patients. Methods. All patients hospitalized with first-time AMI (2000 through 2005) and not undergoing PCI within 30 days from discharge were identified in national registers. Patients with HF treated with clopidogrel were matched by propensity score with patients not treated with clopidogrel. Similarly, 2 groups without HF were identified. Risks of all-cause death were obtained by the Kaplan,Meier method and Cox regression analyses. Results. We identified 56,944 patients with first-time AMI. In the matched cohort with HF (n=5050) and a mean follow-up of 1.50 years (SD=1.2), 709 (28.1%) and 812 (32.2%) deaths occurred in patients receiving and not receiving clopidogrel treatment, respectively (P=.002). The corresponding numbers for patients without HF (n=6092), with a mean follow-up of 2.05 years (SD=1.3), were 285 (9.4%) and 294 (9.7%), respectively (P=.83). Patients with HF receiving clopidogrel demonstrated reduced mortality (hazard ratio, 0.86; 95% confidence interval, 0.78,0.95) compared with patients with HF not receiving clopidogrel. No difference was observed among patients without HF (hazard ratio, 0.98; 95% confidence interval, 0.83,1.16). Conclusions. Clopidogrel was associated with reduced mortality in patients with HF who do not undergo PCI after their first-time AMI, whereas this association was not apparent in patients without HF. Further studies of the benefit of clopidogrel in patients with HF and AMI are warranted.,Bonde L, Sorensen R, Fosbol EL, et al. Increased mortality associated with low use of clopidogrel in patients with heart failure and acute myocardial infarction not undergoing percutaneous coronary intervention: a nationwide study. J Am Coll Cardiol. 2010;55:1300,1307. [source]


    Heart Failure in Hispanic Patients: Coming Together?

    CONGESTIVE HEART FAILURE, Issue 4 2010
    Hector O. Ventura MD
    No abstract is available for this article. [source]


    Volume Overload and Renal Function of Congestive Heart Failure: CME

    CONGESTIVE HEART FAILURE, Issue 2010
    Article first published online: 23 JUL 2010
    No abstract is available for this article. [source]


    Treatment of Anemia With Darbepoetin Alfa in Heart Failure

    CONGESTIVE HEART FAILURE, Issue 3 2010
    William T. Abraham MD
    Anemia is common in heart failure (HF) patients. A prespecified pooled analysis of 2 randomized, double-blind, placebo-controlled studies evaluated darbepoetin alfa (DA) in 475 anemic patients with HF (hemoglobin [Hb], 9.0,12.5 g/dL). DA was administered subcutaneously every 2 weeks and titrated to achieve and maintain a target Hb level of 14.0±1.0 g/dL. By week 27, mean (SD) Hb concentrations did not increase with placebo but increased with DA from 11.5 (0.7) to 13.3 (1.3) g/dL. Hazard ratios (HRs) for DA compared with placebo for all-cause death or first HF hospitalization (composite end point), all-cause death, and HF hospitalization by month 12 were 0.67 (95% confidence interval [CI], 0.44,1.03; P=.067), 0.76 (95% CI, 0.39,1.48; P=.419), and 0.66 (95% CI, 0.40,1.07; P=.093), respectively. Incidence of adverse events was similar in both groups. In post hoc analyses, improvement in the composite end point was significantly associated with the mean Hb change from baseline (adjusted HR, 0.40; P=.017) with DA treatment. There was no increased risk of all-cause mortality or first HF hospitalization with DA in patients with reduced renal function or elevated baseline B-type natriuretic peptide, a biomarker of worse HF. These results suggest that DA is well tolerated, corrects HF-associated anemia, and may have favorable effects on clinical outcomes., Congest Heart Fail. 2010;16:87,95. © 2010 Wiley Periodicals, Inc. [source]


    Historical Vignettes in Heart Failure

    CONGESTIVE HEART FAILURE, Issue 3 2010
    Hector O. Ventura MD Editor
    No abstract is available for this article. [source]


    Extended Mechanical Circulatory Support With a Continuous-Flow Rotary Left Ventricular Assist Device

    CONGESTIVE HEART FAILURE, Issue 2 2010
    Scott Harris DO
    Background LVAD therapy is an established treatment modality for patients with advanced heart failure. Pulsatile LVADs have limitations in design precluding their use for extended support. Continuous-flow rotary LVADs represent an innovative design with potential for small size and greater reliability by simplification of the pumping mechanism. Methods In a prospective multicenter study, 281 patients urgently listed (United Network for Organ Sharing status 1A or 1B) for heart transplant underwent implant of a continuous-flow LVAD. Survival and transplant rates were assessed at 18 months. Patients were assessed for adverse events throughout the study and for quality of life, functional status, and organ function for 6 months. Results Of 281 patients, 222 (79%) underwent transplant or LVAD removal for cardiac recovery or had ongoing LVAD support at 18-month follow-up. Actuarial survival on support was 72% (95% confidence interval, 65%,79%) at 18 months. At 6 months, there were significant improvements in functional status and 6-minute walk test results (from 0% to 83% of patients in New York Heart Association functional class I or II and from 13% to 89% of patients completing a 6-minute walk test) and in quality of life (mean values improved 41% with Minnesota Living With Heart Failure and 75% with Kansas City Cardiomyopathy questionnaires). Major adverse events included bleeding, stroke, right heart failure, and percutaneous lead infection. Pump thrombosis occurred in 4 patients. Conclusions A continuous-flow LVAD provides effective hemodynamic support for at least 18 months in patients awaiting transplant, with improved functional status and quality of life. [source]