Waldenstrom's Macroglobulinemia And Nephrotic Syndrome With Membranous Nephropathy
antibody; glomerulonephritis; macroglobulinemia; membranous nephropathy; nephrotic syndrome; pathology; Urology & Nephrology; Waldenstrom's
Renal complications of Waldenstrom's macroglobulinemia (WM) are rarely observed. Nephrotic syndrome in association with WM has most often been secondary to amyloidosis. This article reports a case of WM with nephrotic syndrome as a result of membranous nephropathy with immunoglobulin M (IgM) deposition. A 44-year-old male diagnosed with WM 4 years previously, presented with heavy proteinuria (7.8 g/24 h). Kidney biopsy revealed expanded mesangium, thickened capillary loops and epimembranous spikes, with no significant interstitial inflammation or thickened tubular basement membranes. Immunofluorescence examination demonstrated strong granular staining of IgM and l light chains, with weaker C3 and C1q staining. Electron microscopy showed many subepithelial dense deposits, and fewer large subendothelial dense deposits. Treatment was directed at the patient's WM with maintenance rituximab and fludarabine. Subsequently, decreases were seen in both the patient's serum IgM and serum viscosity. With therapy for WM and the addition of an angiotensin receptor blocker, the patient's proteinuria also improved, from 7.8 g to 4.8 g/24 h. The patient continued to follow up with his hematologist and in 2009 creatinine was 1 mg/dl (76.26 mu mol/l), with a 24 h urine protein excretion of 0.159 g.
Lee B; Smith R S; Tanphaichitr N; Novak R; Robertson S; Haller N A
Scandinavian Journal of Urology and Nephrology
2011
2011-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.3109/00365599.2011.568954" target="_blank" rel="noreferrer noopener">10.3109/00365599.2011.568954</a>
Ethanol-based Cleanser Versus Isopropyl Alcohol To Decontaminate Stethoscopes
Environmental & Occupational Health; infection; Infectious Diseases; potential source; Public
Approximately 1 in 20 hospital admissions is complicated by a health care-associated infection. Stethoscopes may play a role in spreading nosocomial infections. The objective of this study was to determine the effectiveness of an ethanol-based cleanser (EBC) compared with isopropyl alcohol pads in reducing bacterial contamination of stethoscope diaphragms. Stethoscopes were cultured from medical professionals on 4 medical floors before and after cleaning with either EBC or isopropyl alcohol pads. The numbers of colony-forming units (cfu) grown were compared between the 2 cleaners and to baseline values. A total of 99 stethoscopes were cultured (49 EBC: 50 isopropyl alcohol), and all were positive for growth. After cleaning, 28.28% of the stethoscopes were growth-free (12 EBC; 16 isopropyl alcohol). Cleaning with EBC and isopropyl alcohol pads significantly reduced the cfu counts (by 92.8% and 92.5%, respectively), but neither was found to be statistically superior (F = 1.22; P = .2721). Cleaning a stethoscope diaphragm using either EBC or isopropyl alcohol led to a significant reduction in bacterial growth in culture. As an extension of the hand, a stethoscope should be cleaned with the same frequency as the hands. The simultaneous cleaning of hands and stethoscope may further increase compliance with current standards. Copyright (c) 2009 by the Association for Professionals in Infection Control and Epidemiology, Inc.
Lecat P; Cropp E; McCord G; Haller N A
American Journal of Infection Control
2009
2009-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.ajic.2008.08.006" target="_blank" rel="noreferrer noopener">10.1016/j.ajic.2008.08.006</a>
Patient Computer Use To Prompt Doctor Adherence To Diabetes Management Guidelines
complications; computer; delivery; diabetes; General & Internal; Health Care Sciences & Services; intervention; involvement; knowledge; management guidelines; Medical Informatics; Medicine; mellitus; patient; performance; preventive services; primary care; quality; risk; standards
Rationale, Aims and Objectives Doctor compliance with diabetic care guidelines is low and may be improved with system-wide changes that include patient involvement. The objective of this study was to determine if patients in an internal medicine teaching clinic would use a touch-screen computer to receive personalized information regarding their need for diabetes care. Outcomes included determining if this intervention would improve resident doctor compliance with diabetic guidelines. Methods In this prospective study a computer was available for patients to use independently in one clinic, while another computer was placed in a second clinic with nursing support. Patients responding they were diabetic to the first screen received screens covering HbA1c, blood pressure, cholesterol, foot, eye examinations and compliance with having labs drawn. Non-diabetic patients received three general health screens. A response-based report was printed for patients to share with their doctor. Chart reviews were conducted to assess diabetic health care delivery. Results The computer was used voluntarily by 20.6% of patients in the primary clinic and by 100% of patients in the nurse-assisted clinic. A total of 104 patients from both clinics responded they were diabetic; over 50% did not know what HbA1c meant and a minority responded their HbA1c, blood pressure and cholesterol were at good levels. Significantly more HbA1c tests conducted within 6 months were documented in patients' charts. Discussion Patients used the computer effectively without direction in the primary clinic. In this initial study, implementation of the computer program increased the number of HbA1c tests ordered. Future studies incorporating refinements may increase both usage and efficacy of this intervention.
Haller N A; Gil K M; Gardner W G; Whittier F C
Journal of Evaluation in Clinical Practice
2009
2009-12
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1111/j.1365-2753.2009.01264.x" target="_blank" rel="noreferrer noopener">10.1111/j.1365-2753.2009.01264.x</a>
Widespread Metastases After Resection Of Noninvasive Thymoma
carcinoma; expression; Oncology; organization histologic classification; relevance; stage; thymic epithelial tumors
Gamboa E O; Sawhney V; Lanoy R S; Haller N A; Powell A T; Hazra S V
Journal of Clinical Oncology
2008
2008-04
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1200/jco.2007.14.5656" target="_blank" rel="noreferrer noopener">10.1200/jco.2007.14.5656</a>
Retrospective Evaluation Of A Method To Predict Fresh-frozen Plasma Dosage In Anticoagulated Patients
anticoagulation reversal; dose prediction; efficacy; factor viia; fresh-frozen plasma; hemostasis; Pharmacology & Pharmacy; prothrombin complex concentrate; therapy; transfusion; urgent reversal; warfarin
Frazee L A; Bourguet C C; Gutierrez W; Elder-Arrington J; Elackattu A E P; Haller N A
American Journal of Therapeutics
2008
2008-03
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1097/MJT.0b013e3180ed4345" target="_blank" rel="noreferrer noopener">10.1097/MJT.0b013e3180ed4345</a>
Autoimmune Polyglandular Syndrome Ii In A Patient With Takotsubo's Cardiomyopathy
Endocrinology & Metabolism
Detoya K C B; Ciltea D; Timberlake D; Haller N A
Endocrine Reviews
2014
2014-06
Journal Article or Conference Abstract Publication
n/a
Adrenal Cortical Adenoma Transforming Into Adrenocortical Carcinoma In A Patient Without Cushing's Features
Endocrinology & Metabolism
Detoya K C B; Ciltea D; Rehman A; Haller N A
Endocrine Reviews
2014
2014-06
Journal Article or Conference Abstract Publication
n/a
HER2 Delta 16 expression in HER2-positive breast cancer
Oncology
De Yao J T; Sun D Y; Galehouse D; Shorten S; Haller N A; Rehmus E H
Journal of Clinical Oncology
2014
2014-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1200/jco.2014.32.26_suppl.31" target="_blank" rel="noreferrer noopener">10.1200/jco.2014.32.26_suppl.31</a>
Review of BMI-Based Pharmacologic Protocols for the Prevention of Venous Thromboembolism in Bariatric Surgery Patients
outcomes; Nursing; risk; morbidly obese-patients; y gastric bypass; heparin; enoxaparin; prophylaxis; deep-vein thrombosis; regimens; thromboprophylaxis
Background: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important cause of morbidity and mortality in bariatric surgery patients. The objective of this study was to discuss the evolution of three bariatric surgery VTE prophylaxis protocols and compare safety and effectiveness of each. Methods: A retrospective review of 364 bariatric surgery patients utilizing three different dosing regimens of enoxaparin was completed. Enoxaparin was continued for the duration of the hospital stay in all groups unless hemorrhage was suspected. Sequential compression devices were used during and after surgery. All patients were required to ambulate within 6 h of their procedure. Patients were discharged off all prophylaxis. Results: Inclusive of all groups, two patients (0.5%) developed VTE (p = 0.50), eight patients (2%) required transfusion (p = 0.95), and five patients (1.4%) required reoperation for hemorrhage (p = 0.19). Overallmortality was 0%. Conclusions: A VTE prophylaxis regimen of 40 mg Lovenox subcutaneous (SC) 1-2 h preoperatively followed by 1 mg/body-mass index (rounded to the nearest 10 mg) SC every 12 h until discharge coupled with mechanical VTE prophylaxis is simple, safe, and effective in bariatric surgery patients.
Chlysta W J; Iffland P H; Haller N A
Bariatric Surgical Practice and Patient Care
2014
2014-09
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1089/bari.2014.0014" target="_blank" rel="noreferrer noopener">10.1089/bari.2014.0014</a>
Management of acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS) in community services: Retrospective study of 130 patients from a single institution
Oncology
Al-Ameri A; Patel N; Kanaan Z; Haller N A
Journal of Clinical Oncology
2012
2012-05
Journal Article or Conference Abstract Publication
n/a
Body mass index (BMI) influence on survival in adult patients with newly diagnosed acute myeloid leukemia (AML)/high-risk MDS: Retrospective study of 130 patients from a single institution
Oncology
Abdelfatah M; Al-Ameri A; Kanaan Z; Malkawi A; Haller N A
Journal of Clinical Oncology
2013
2013-05
Journal Article or Conference Abstract Publication
n/a
A novel early-stage orthotopic model for ovarian cancer in the Fischer 344 rat
animal-model; epithelial neoplasms; Fischer 344 rats; gene-therapy; guinea-pigs; hormone; induction; mice; mouse model; Obstetrics & Gynecology; Oncology; orthotopic; ovarian-cancer; stimulation; tumors
The purpose of our study was to ascertain the progression of metastases in a novel ovarian cancer model designed to mimic early-stage disease by utilizing an orthotopic injection technique. Female Fischer 344 rats were injected with either 10(4) or 10(5) NuTu-19 cells by intraperitoneal or orthotopic injection. Peritoneal washings and histologic specimens were examined to correlate the incidence and extent of tumor growth. In a second phase, orthotopic injections of 10(2) and 10(3) cells were compared to that of 10(4) cells. Progression of ovarian cancer was observed by gross and microscopic examinations in both intraperitoneal and orthotopic models. Pelvic extension and abdominal adhesions uniquely characterized the orthotopically injected animals. Numbers of identifiable metastases declined with lower cell inocula, confirming that early-stage disease was extended to at least 14 days with 10(2) NuTu-19 cells. The orthotopic ovarian cancer model emulates early disease with the initiation of a primary tumor that is localized within the inherent microenvironment. The orthotopic model offers a clinically relevant alternative for future cancer research that allows for the investigation of therapeutic strategies against early stages of the disease process.
Stakleff K D S; Rouse A G; Ryan A P; Haller N A; Von Gruenigen V E
International Journal of Gynecological Cancer
2005
2005-03
Journal Article
<a href="http://doi.org/10.1136/ijgc-00009577-200503000-00010" target="_blank" rel="noreferrer noopener">10.1136/ijgc-00009577-200503000-00010</a>
Fibrillary glomerulonephritis with hepatitis C viral infection and hypocomplementemia
deposits; entity; features; fibrillary glomerulonephritis; hepatitis C infection; hypocomplementemia; immunofluorescence; immunotactoid glomerulopathy; Urology & Nephrology
Fibrillary glomerulonephritis (FGN) is a relatively rare cause of renal disease, found in only 0.6-1.5% of native renal biopsies. The pathogenesis of FGN is not well described, and very few associations with disease processes other than hepatitis C virus (HCV) have been made. We describe a case that provides evidence in support of the FGN-HCV association, as well as introduces the association of FGN-HCV and hypocomplementemia. The case is a 53-year-old African-American female demonstrating a classical presentation of FGN complicated by a concomitant HCV infection. Treating an HCV infection with alpha-interferon has been shown to result in subsequent improvement in the nephrotic syndrome and renal function. However, this patient is unique in that she is complicated with hypocomplementemia, creating a complex treatment situation.
Ray S; Rouse K; Appis A; Novak R; Haller N A
Renal Failure
2008
2008
Journal Article
<a href="http://doi.org/10.1080/08860220802213062" target="_blank" rel="noreferrer noopener">10.1080/08860220802213062</a>