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Biomedical subjects

A C Novick

Publications and source records attributed to A C Novick.

At least 181 records · Page 10Linked to original sources
PubMed1994

Use of the thoracic aorta for renal revascularization.

A new technique for renal revascularization has been developed that involves placement of an interposition saphenous vein bypass graft from the lower thoracic aorta to the renal artery. The initial clinical results with this approach have been excellent. Thoracic aortorenal bypass has several advantages and can be useful in the management of selected older patients with severe atherosclerosis of the abdominal aorta and renal arteries.

Aorta, Thoracic↗
PubMed1993

Use of kidneys from older cadaver donors for renal transplantation.

From 1971-1990, 51 patients underwent renal transplantation with a kidney from a cadaver donor more than fifty-five years of age. Following transplantation, 19 kidneys (37%) functioned immediately while initial nonfunction occurred with 32 kidneys (63%). The one-year graft survival rate for kidneys with immediate function versus initial nonfunction was 84 percent and 63 percent, respectively. Graft survival was significantly impaired by increased recipient weight (p < 0.05) and by an elevated donor serum creatinine level (p < 0.05). We conclude that well-functioning kidneys from older donors can be safely and successfully used for renal transplantation. Such kidneys appear to be more susceptible to ischemic damage and should not be used when the donor serum creatinine level is elevated.

Adolescent↗
PubMed1993

Treatment of organic impotence with penile prosthesis in renal transplant patients.

Seven patients were identified who underwent both renal transplantation and penile prosthesis implantation at our institution between June 1980 and June 1990, and their charts were retrospectively reviewed. A total of nine penile prostheses were placed in these patients, five prior to transplantation and four following transplantation. One patient received two prostheses prior to transplantation. One patient received a prosthesis both before and after transplantation. No complications were seen in the four prostheses placed following transplantation with a follow-up of one to forty months (mean 18 months). Of the five prostheses placed prior to transplantation, two were removed due to periprosthetic infections, a cylinder leak developed in one, and one was complicated by penile and scrotal erythema with sepsis.

Adult↗
PubMed1993

Extra-anatomic renal revascularization in patients with renal artery stenosis and abdominal aortic occlusion.

Thirteen patients with atherosclerotic renal artery stenosis and total abdominal aortic occlusion underwent extra-anatomic surgical renal revascularization without aortic replacement. Renal artery stenosis was present unilaterally (n = 2), bilaterally (n = 7), or in a solitary kidney (n = 4). Surgical renal revascularization was indicated for treatment of severe hypertension in all patients and for preservation of renal function in 10 patients. The level of abdominal aortic occlusion was suprarenal (n = 3), perirenal (n = 2), or infrarenal (n = 8). All patients had extensive collateral vascular supply to the lower extremities with absent (n = 7) or mild (n = 6) claudication. Surgical renal revascularization was achieved with hepatorenal bypass (n = 6), mesenterorenal bypass (n = 4), or splenorenal bypass (n = 3). None of the patients underwent concomitant aortic replacement. There were no operative deaths. Postoperatively, hypertension was improved in 10 patients, unchanged in 2 patients, and worse in 1 patient. Renal function was improved in 8 patients, stable in 2 patients, and worse in 3 patients. After surgical renal revascularization, no patient required aortic replacement, while 1 patient underwent extra-anatomic revascularization of the lower extremities. We conclude that some patients with renal artery stenosis and abdominal aortic occlusion can be managed by surgical renal revascularization alone without a more extensive and potentially hazardous aortic replacement. In these patients, extra-anatomic techniques can allow safe and successful surgical renal revascularization while avoiding surgery on the diseased aorta.

Adult↗
PubMed1993

Management of renal cell carcinoma with coexistent renal artery disease.

Coexistence of renal cell carcinoma and renal artery disease is an unusual and challenging problem. From 1969 to 1991, 34 patients presented with localized renal cell carcinoma and renal artery disease affecting all of the functioning renal parenchyma. These patients represented 4 categories: 1) a solitary kidney with renal cell carcinoma and renal artery disease (5), 2) bilateral renal cell carcinoma and coexistent renal artery disease (5), 3) unilateral renal cell carcinoma and contralateral renal artery disease (13), and 4) unilateral renal cell carcinoma and bilateral renal artery disease (11). Atherosclerosis was the most common cause of renal artery disease (30), followed by medial fibroplasia (2), renal artery aneurysm (1) and arteriovenous malformation (1). A total of 23 patients (68%) presented with azotemia (serum creatinine 1.5 mg./dl. or more) and 11 (32%) presented with hypertension. All patients underwent complete surgical excision of renal cell carcinoma. A nephron sparing operation was performed preferentially (30 patients) and bilateral renal cancer operations were staged. Eight patients underwent simultaneous partial (6) or radical (2) nephrectomy and surgical renal revascularization. There were no operative deaths. Postoperatively, preservation of renal function was achieved in 33 patients and 1 required chronic dialysis. At mean followup of 47 months 23 patients (68%) were alive with no evidence of malignancy and 2 were alive with recurrent renal cell carcinoma. Three patients died of metastatic renal cell carcinoma, while 6 died of unrelated causes. All of the latter 6 patients were free of renal cell carcinoma at death. Nephron sparing surgery combined occasionally with renal arterial reconstruction can yield gratifying results in this complex patient population.

Adult↗
PubMed1993

Percutaneous management of transplant ureteral fistulas: patient selection and long-term results.

Of 24 renal allograft recipients with urinary extravasation 14 (58%) with ureteral fistulas were selected for percutaneous management in an attempt to obviate secondary operative intervention. The initial procedure in all cases was placement of a percutaneous nephrostomy tube with subsequent internal or internal/external stenting. With a mean followup of 47 months, the percutaneous management proved definitive in 5 patients (36%) and palliative in 1 (7%). The other 8 patients (57%) subsequently required open operative intervention. With this study, we conclude that percutaneous techniques can provide long-term definitive management for at least some transplant ureteral fistulas. However, even in a highly selected group of patients success rates will be limited.

Follow-Up Studies↗
PubMed1993

Renal oncocytoma: clinical and biological correlates.

We treated 31 patients with renal oncocytoma. Renal cell carcinoma was found existing separately within the same or contralateral kidney in 10 patients (32%). Followup of 29 patients revealed 24 alive with no evidence of disease and 1 alive with recurrent oncocytoma, while 1 with coexistent tumors died of progressive renal cell carcinoma and 3 tumor-free patients died of unrelated diseases. Quantitative deoxyribonucleic acid analysis was performed on cell suspensions of fresh tumor by flow cytometry or by image cytometry on touch preparations from frozen tissue in 16 patients with renal oncocytoma. Ploidy analysis revealed all oncocytomas to be diploid. Frozen tissue immunohistology was performed using murine monoclonal antibody against human HLA-A, B and C (class I) antigens with the avidin-biotin peroxidase technique in 11 patients with renal oncocytoma. Ten oncocytomas did not express these self-recognition antigens and 1 was only weakly positive for antigen expression. In contrast, renal cell carcinomas strongly expressed HLA class I antigens. The high incidence of coexistence of renal oncocytoma and renal cell carcinoma has important clinical implications. Loss of HLA class I antigen expression by renal oncocytomas may provide an additional method for differentiating this lesion from renal cell carcinoma.

Adenoma, Oxyphilic↗
PubMed1993

Preoperative hospitalization to hydrate living kidney donors can be omitted without sacrificing graft function.

This prospective study was done to determine whether preoperative hospitalization for hydration of living kidney donors could be omitted without sacrificing graft function in the recipient. The study group consisted of 36 consecutive kidney donors who underwent donation on a "to come in" basis. Fluid management consisted of 1 l. lactated ringer's solution per hour beginning 2 hours preoperatively. The control group was hospitalized preoperatively for intravenous hydration of an equivalent amount of saline solution given for 12 to 16 hours. No recipient of the study group donors experienced delayed graft function. Furthermore, in that group immediate and longer term graft function, as defined by immediate graft output, serum creatinine on postoperative day 1 and nadir serum creatinine levels, was equivalent to or better than that in the control group. We conclude that a rapid infusion of saline solution in the immediate preoperative period can replace overnight intravenous hydration of living kidney donors, and that the result will be a significant reduction in overall hospital stay for the donor without compromise in graft function for the recipient.

Adult↗
PubMed1993

Renal vascular response to vasodilators following warm ischemia and cold storage preservation in dog kidneys.

The purpose of this study was to determine whether warm ischemia (WIT) and cold storage preservation (CSP) impair endothelium-dependent vascular relaxation in the kidney. Twenty-four canine kidneys were harvested, preserved with CSP for 24 or 48 hours, and then perfused with canine blood at 37 C for the determination of glomerular filtration rate (GFR), perfusion flow rate, and renal vascular resistance (RVR). There were four experimental groups: Group I--no WIT followed by 24 hours CSP, Group II--30 minutes WIT followed by 24 hours CSP, Group III--no WIT followed by 48 hours CSP, Group IV--30 minutes WIT followed by 48 hours CSP. Endothelial function in each group was evaluated using acetylcholine (ACh, 1 mg. bolus) as an endothelial dependent vasodilator, and sodium nitroprusside (NP, 10 mg. bolus) as an endothelial independent vasodilator. Glomerular filtration rate was significantly less (P < .05) and RVR was significantly greater (P < .05) for kidneys from Groups II, III and IV compared to group I. The highest RVR was observed in kidneys from Groups II and IV. Nitroprusside administration caused an equivalent reduction in RVR among all four study groups. ACh administration caused a similar reduction in RVR in Groups I and III; however, the change in RVR was significantly less in Groups II and IV (P < .05). We hypothesize that the more severe ischemic insult in the latter groups led to vascular endothelial damage with a consequent loss of ability to secrete endothelium-derived relaxing factor in response to ACh administration.

Acetylcholine↗
PubMed1993

Delayed allograft autotransplantation after excision of a large symptomatic renal artery pseudoaneurysm.

Pseudoaneurysm formation, which occurs infrequently in the renal transplant patient, can have a catastrophic outcome. We report a case of a large, symptomatic transplant renal artery pseudoaneurysm that was treated by excision with extracorporeal vascular repair and delayed allograft autotransplantation. We review the management of transplant renal artery pseudoaneurysms and the role of delayed autotransplantation in complex reconstructive renal surgery.

Adult↗
PubMed1993

Improved success of living unrelated renal transplantation with cyclosporine immunosuppression.

Kidney transplantation with a living unrelated donor was performed in 13 patients. The donors comprised 10 spouses, 2 brothers-in-law and 1 stranger. All donor-recipient pairs were red blood cell compatible with a negative T cell crossmatch. Five patients underwent transplantation before 1984 without cyclosporine immunosuppression; the 1-year patient and graft survival rates in this group were 40% and 20%, respectively. Eight patients have undergone transplantation since 1985 with cyclosporine immunosuppression. The 1-year patient and graft survival rates in this group were 100% and 88%, respectively (p = 0.03). Currently, 6 patients in the latter group have a well functioning graft with serum creatinine levels of 1.2 to 2.0 mg./dl. (mean 1.5 mg./dl.) and with followup of 1 to 6 years (mean 2.9 years). Excellent graft survival results can now be achieved with living unrelated donors and their expanded use can provide an important additional source of organs for transplantation.

Cyclosporine↗
PubMed1993

Fate of renal allografts transplanted in patients with urinary diversion.

Fifty-five kidneys were transplanted into 50 patients with supravesical urinary diversion at 16 transplant centers between 1970 and 1991. Of the 32 males and 18 females, 40 were adults (> or = 18 years) and 10 were less than 18 years old at the time of first transplant. Mean follow-up was 7.8 years. At last follow-up, 94% of recipients were alive and 73% of the kidneys were functioning. Fifteen kidneys were lost: 9 to rejection, 3 to noncompliance, and 3 patients died with a functioning kidney. Ten (18%) transplants were followed by surgical complications. Twenty-four (44%) were followed by medical complications of which urinary tract infection was most common. Recipients age 18 or younger had more urinary tract infections than older patients. No patient had urinary stones and no patient required medical treatment for metabolic abnormalities. We conclude that drainage of kidney transplants into a supravesical urinary diversion is an effective treatment for end-stage renal disease patients without adequate urinary bladders.

Adult↗
PubMed1993

Renal-sparing surgery for renal cell carcinoma.

The role of nephron-sparing surgery for renal cell carcinoma is evolving, and continued careful evaluation of patient outcome data is needed to define appropriate limits for this approach. Both accepted and controversial aspects of this approach are reviewed in this article.

Carcinoma, Renal Cell↗
PubMed1992

Studies on the afferent and efferent renal nerves following autotransplantation of the canine kidney.

The presence of both afferent and efferent renal nerves following renal transplantation was investigated in a canine autotransplant model. The efferent postganglionic sympathetic renal nerves were studied using the glyoxylic acid histofluorescence technique to identify renal tissue adrenergic amines (Grade 0-4). The afferent sensory renal nerves were studied by the systemic blood pressure response to renal arterial injection of capsaicin. In 8 control dogs with native innervated kidneys (Group I), intrarenal injection of capsaicin significantly increased the systemic blood pressure from baseline by 32.4 +/- 6.3 mm. Hg (p less than 0.01). This response was equivalent to the blood pressure increase following injection of capsaicin into the mesenteric artery which was 37.3 +/- 9.8 mm. Hg. The renal tissue histofluorescence grade in this group was 4. Six dogs were studied two to three weeks after autotransplantation of a solitary kidney (Group II). Intrarenal injection of capsaicin did not increase the systemic blood pressure in these animals. Three dogs in this group had no evidence of renal tissue adrenergic amines by histofluorescence (Grade 0); the remaining two animals had renal tissue histofluorescence grades of 1 and 2. Eight dogs were studied 12 to 35 months after autotransplantation of a solitary kidney (Group III). Intrarenal injection of capsaicin in these animals significantly increased the systemic blood pressure from baseline by 10 +/- 1.4 mm. Hg (p less than 0.001). The renal tissue histofluorescence grade in this group ranged from 1 to 3. These data support the presence of both afferent and efferent renal nerves in the kidney at greater than or equal to one year post-transplant.

Animals↗
PubMed1992

Clean intermittent catheterization and urinary diversion in the management of renal transplant recipients with lower urinary tract dysfunction.

Renal transplant recipients with lower urinary tract dysfunction may be managed by urinary diversion or clean intermittent catheterization. To evaluate the comparative problems associated with each mode of therapy we studied 13 patients managed by clean intermittent catheterization (group 1, 6 patients) or urinary diversion (group 2, 7 patients). All 6 and 2 of 7 recipients in groups 1 and 2, respectively, had a neuropathic bladder. Mean followup was 3.7 +/- 1.5 (group 1) and 5.7 +/- 4.9 (group 2) years. Three allografts were lost in group 2 due to rejection (2) and death (1). Two patients each in groups 1 and 2 had febrile urinary tract infections requiring hospitalization and intravenous antibiotics. Complications related to urinary diversion developed in 4 patients in group 2. The serum creatinine at 1 and 3 years, number of hospital days per patient, total number of rejection episodes and number of patients employed in a full-time job following transplantation were similar in both groups. In summary, clean intermittent catheterization appears to have more morbidity in immunosuppressed transplant versus nontransplant patients but it may be preferable in renal transplant recipients due to the overall simplicity, positive psychological effect and comparable morbidity to other forms of management.

Adult↗