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Department of Medicine
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Department of Surgery
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Department of Pathology
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    ABSTRACT: Aortic pseudoaneurysms (PSAs) are common complications following cardiac surgery, and carry significant morbidity and mortality. Surgical management of aortic PSAs is associated with high mortality, however there are emerging reports of transcatheter techniques for closure of aortic PSAs. We present two cases of ascending aorta PSA which developed following cardiac surgery and were treated percutaneously with novel closure devices. We also describe a comprehensive review of the literature of all published cases of ascending aorta PSA which have been closed percutaneously, and report on the success rate and available devices for percutaneous closure.
    Cardiovascular revascularization medicine: including molecular interventions 03/2014;
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    ABSTRACT: To identify risk factors for port infections within 30 days of placement. A retrospective chart review of port placements from 2002-2009 was conducted. Patients who had port removals secondary to infection within the first 30 days of placement were included. This group of patients was compared with a control group of patients with ports with no evidence of infection. For every one patient with a port infection, two control subjects were chosen of the same gender and new port placement during the same month as the corresponding patient with an infected port. From 2002-2009, 4,404 ports were placed. Of the 4,404 patients, 33 (0.7%) were found to have a port infection within 30 days of placement. Compared with the control group, the early infection group had a higher prevalence of leukopenia (21.2% vs 6.1%, P = .039) and thrombocytopenia (33% vs 12%, P = .0158). There was also a higher prevalence of an inpatient hospital stay during port placement and high international normalized ratio in the early infection group. Low preoperative white blood cell and platelet counts were risk factors for early infection. Abnormal coagulation profiles and inpatient access of ports after placement could be additional risk factors.
    Journal of vascular and interventional radiology: JVIR 03/2014; 25(3):419-23.
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    ABSTRACT: Aim Polymorphism of human leukocyte antigens (HLA) is the major barrier to hematopoietic stem cell transplantation (HCT). Advancement in DNA typing methods has significantly impacted donor selection for HCT recipients. The ImMunoGeneTics (IMGT)/HLA database, 7/25/2013, lists 9719 HLA and related alleles and continues to grow. We describe 3 patients with hematological malignancies who were evaluated for HCT work up. DNA from recipients A and B, carried single non-synonymous mutations that resulted in new alleles in DQB1 and A loci, respectively. In DNA from recipient C, a rare HLA-A allele was identified. Methods DNA was isolated from peripheral blood cells and buccal swabs by automated and manual methods. The HLA-A and -DQB1 genes were amplified by polymerase chain reaction (PCR) using primers specific for each loci and sequenced by Atria sequencing kits (Abbot Molecular, Des Plaines, IL) exons 2 through 4 for HLA-A and exons 2 and 3 for HLA-DQB1. Data was analyzed by Assign 3.6 SBT software (Abbot Molecular). Results DNA from buccal swabs confirmed each suspected mutation suggesting that mutations were carried by recipient’s genomic DNA and were not limited to malignant cells. Recipient A had a related sibling, which carried the same mutation and was 10/10 matched. Recipient B did not have related donors suitable for testing. The National Marrow Donor Registry (NMDP) search was unsuccessful in finding matched unrelated donors (MUD). For recipient C, 4 related donors were evaluated, 2 siblings, did not carry the mutation however, 2 sons, carried the rare allele. A search for MUD was initiated and 3 international donors were identified. Conclusions Identification of novel alleles are a common finding that can affect HCT donor searches. It is important to confirm the discovery by re-typing the loci from an alternative DNA source, especially in cases of patients with hematological malignancies. It is important that the laboratory works with the HCT program to identify best donors for these patients.
    Human Immunology. 01/2014; 75(6):489.


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JAMA The Journal of the American Medical Association 05/2003; 289(19):2560-72.
Quality and Safety in Health Care 12/2009; 18(6):505-9.

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