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Biomedical subjects

A C Novick

Publications and source records attributed to A C Novick.

At least 289 records · Page 16Linked to original sources
PubMed1986

Long-term results with renal autotransplantation for ureteral replacement.

From 1970 to 1984 renal autotransplantation was performed on 23 patients to replace all or a major portion of the ureter. The conditions necessitating ureteral replacement were postoperative ureteral injury in 16 cases, recurrent renal colic in 4, urinary undiversion in 2 and an atonic ureter in 1. Six patients presented with a solitary kidney and 1 underwent staged bilateral autotransplantation. After autotransplantation urinary continuity was restored by ureteroneocystostomy in 11 patients, pyelovesicostomy in 7, ureteroureterostomy in 2, pyeloureterostomy in 2 and ureterosigmoidostomy in 1. Postoperatively, there was no mortality and all but 1 of the autotransplanted kidneys functioned immediately. Two kidneys required removal postoperatively owing to bleeding. Currently, 20 patients are alive with functioning renal autotransplants at intervals of 1.5 to 14 years. The current serum creatinine level in these patients ranges from 1.1 to 2.2 mg. per dl., which in each case is improved or stable compared to the preoperative determination. Only 1 patient has experienced chronic bacteriuria. We conclude that renal autotransplantation provides excellent long-term treatment for patients who require ureteral replacement.

Adult↗
PubMed1986

Surgical enucleation for renal cell carcinoma.

The results of an enucleative operation in 33 patients with renal carcinoma present bilaterally or in a solitary kidney are reviewed. All of the excised tumors were low grade and the majority of the patients had pathological stage I renal carcinoma. Postoperative followup ranged from 9 to 156 months (mean 45 months). The 3-year actuarial survival rate was 90 per cent. Tumor recurred locally in 2 patients (6 per cent). We conclude that enucleation is a safe technique that can yield excellent tumor control in selected patients with renal carcinoma.

Adult↗
PubMed1986

Percutaneous techniques for the management of urological renal transplant complications.

Percutaneous techniques were used to manage 13 renal transplant recipients with urological complications and long-term followup now is available. Three patients had urinary fistulas and 10 had ureteral obstruction. In 2 of the patients with ureteral fistulas and 5 with ureteral obstruction the percutaneous procedures provided definitive management and obviated the need for an open operation. In the 6 other patients the percutaneous procedures proved to be valuable adjuncts to subsequent planned open operative reconstruction. While there were 4 significant complications related to the percutaneous procedures, none resulted in graft loss or patient death. We conclude that percutaneous techniques provide valuable alternatives to immediate open operative intervention in renal transplant recipients with ureteral obstruction or fistula formation. Furthermore, these techniques may obviate entirely the need for subsequent operative intervention.

Adult↗
PubMed1986

Renal transplantation in end stage renal disease patients with existing urinary diversion.

From 1971 to 1984 renal transplantation was performed in 20 patients with end stage renal disease who presented with an existing form of urinary diversion. These patients were evaluated with a cystometrogram, voiding cystourethrogram and cystoscopy. In some cases bladder function was studied further by cycling through a suprapubically placed catheter. The bladder was considered unstable in 13 patients and undiversion was done at transplantation. The period of prior diversion ranged from 3 to 20 years (mean 12.7 years). There were no surgical complications postoperatively and normal bladder function returned in all patients. Currently, 8 patients have a functioning renal allograft 16 months to 9 years after transplantation (mean 4.2 years). Seven patients were considered to have a nonusable bladder owing to severe neurogenic disease or refractory contracture. In these patients transplantation was done into a pre-fashioned intestinal conduit (5) or cutaneous ureterostomy (2). Currently, 4 patients have a functioning renal allograft 16 months to 6.2 years after transplantation (mean 3.8 years). Transplantation candidates who present with an existing form of urinary diversion should be evaluated carefully, since many will have a usable bladder. Regardless of whether the bladder is usable, transplantation can be performed safely with no increased surgical or immunological risk.

Adult↗
PubMed1986

Perforation of the colon in renal homograft recipients. A report of 11 cases and a review of the literature.

Colon perforation in renal transplant recipients is a potentially lethal condition that is amenable to appropriate medical and surgical treatment. The 11 cases seen at the Cleveland Clinic (incidence 1.1% of all renal transplant patients) and previous reports in the literature have been reviewed. The pathogenesis is related to a high incidence of diverticular disease in patients with polycystic kidneys and/or chronic renal failure, the effects of long-term immunosuppression, and the transplant procedure itself. The high mortality of this condition (61% overall) is related to the effects of immunosuppression on the response to sepsis and the surgical procedure used. Mortality has fallen from 88% (1970-1974) to 53% (1975-1979), and there are indications that it is continuing to fall. All four cases operated on here since 1980 have survived, giving a total operative mortality of 2/6, and all have maintained excellent allograft function. A high clinical index of suspicion, prompt exteriorization of the perforated colon, reduction of immunosuppression to minimal levels, and effective antibiotic coverage have all contributed to the declining mortality.

Adolescent↗
PubMed1986

A prospective analysis of the accuracy and cost-effectiveness of digital subtraction angiography for living-related renal donor evaluation.

From 1982 to 1984, we conducted a prospective study to evaluate the usefulness of i.v. renal digital subtraction angiography (DSA) for living-related donor (LRD) evaluation. Twenty-eight LRDs were evaluated with the traditional approach of intravenous pyelography (IVP) and standard catheter arteriography (SCA) (group 1). During the same period, 33 LRDs underwent renal DSA and IVP from a single i.v. contrast injection (group 2). If renal arterial imaging with DSA was considered satisfactory, no further radiographic studies were done (group 2-A, n = 23). If renal arterial imaging with DSA was not satisfactory, SCA was then obtained (group 2-B, n = 10). DSA alone accurately defined the number and location of renal arteries in 21 of 23 patients from group 2-A, and in 5 of 10 patients from group 2-B. The major limitation of DSA was in patients with multiple renal arteries; accurate imaging was obtained in only 7 of these 13 patients (54%). In group 2 overall, preoperative renal imaging was not accurate in 2 of 33 patients (6%); in both cases, an unsuspected polar artery was found at nephrectomy. The mean cost per patient of all radiographic renal imaging studies was $953.00 for group 2 and $1721.00 for group 1. These data suggest that the approach of preferentially evaluating LRDs with DSA-IVP, and obtaining SCA only if DSA yields poor visualization, is more cost-effective but not as accurate as the traditional policy of obtaining SCA and IVP in all cases.

Angiography↗
PubMed1986

Detrimental effect of cyclosporine on initial function of cadaver renal allografts following extended preservation. Results of a randomized prospective study.

We report herein the results of a randomized prospective trial comparing maintenance cyclosporine (CsA)-prednisone immunosuppression to a regimen of azathioprine-prednisone-antilymphocyte globulin (ALG) in cadaver renal transplant recipients. Fifty-six patients were entered into this study with 31 assigned to the ALG group and 25 to the CsA group. These two groups were well matched for most major determinants of graft outcome and the mean renal preservation time was 37 hr in each group. The incidence of acute tubular necrosis (ATN) was high in both groups (58% ALG, 72% CsA, NS). There were five cases of primary nonfunction in the CsA group and only one in the ALG group (P = .05). Of the kidneys that functioned, the mean serum creatinine nadir (1.5 vs. 2.2 mg/dl, P = .06) and the mean number of days to reach the serum creatinine nadir (24.2 vs. 43.3 days, P = .03) were both less in the ALG group. The actuarial one-year graft survival rate in the ALG and CsA groups is 78% and 48%, respectively (P less than .05). This difference is mainly due to the large number of primary nonfunctioning grafts in the latter group, which we attribute to the effect of CsA's nephrotoxicity superimposed on renal ischemia incurred prior to transplantation. These data emphasize that, in order to realize the full benefit of CsA in cadaver transplantation, renewed emphasis must be placed on minimizing ischemic renal damage.

Adolescent↗
PubMed1986

Surgical management of branch renal artery disease. Value of in situ and extracorporeal technique.

Vascular reconstruction of the kidney is technically difficult in patients with branch renal artery disease. Formerly, many patients in this category were considered either inoperable or candidates for total or partial nephrectomy. However, advances in vascular reconstructive techniques during the past decade have improved this outlook and successful revascularization is now possible in most cases. This evolution has been primarily due to the incorporation of microvascular and extracorporeal techniques into the armamentarium of the renovascular surgeon. These techniques, their respective indications, and the merits of in situ versus extracorporeal repair are reviewed herein.

Adolescent↗
PubMed1986

A critical look at survival of diabetics with end-stage renal disease. Transplantation versus dialysis therapy.

The survival of 100 consecutive patients with diabetic nephropathy after treatment with hemodialysis, peritoneal dialysis, or renal transplantation was reviewed at our institution from 1976 to 1982. Standard actuarial survival analysis revealed an overall survival of 83% and 61% at one and two years, respectively. Coronary angiography was used as a screening procedure for renal transplantation. In the dialysis group, 27 patients were considered acceptable transplant candidates on the basis of the coronary angiography but were not transplanted for other reasons. When the survival analysis was limited to those "transplant candidates" the survival rates were 78%, 51%, and 8% at 1, 2, and 5 years, respectively. In comparison, survival after transplantation was 81%, 67%, and 45%, at 1, 2, and 5 years, respectively. In order to eliminate bias, survival comparisons were subsequently made using the Cox Proportional Hazard Model to take into account the time the transplant patients spent on dialysis prior to renal transplantation. When this analysis was performed, there was no significant difference in survival between transplantation and dialysis for the first two years, but overall survival after five years was significantly better after renal transplantation even when the comparison was limited to acceptable transplant candidates who remained on dialysis (P = .04). Survival for patients with significant coronary disease (greater than 70% stenosis of a coronary vessel or moderate to severe left ventricular dysfunction) was analyzed according to therapeutic modality. Although overall prognosis was poor in this group as a whole (1, 2, and 5 year survivals were 76%, 45%, and 19%, respectively), the cardiac patients had a trend to better survival after renal transplantation than when maintained on dialysis (P = .22). In addition to other factors such as quality of life, rehabilitation, and progression of other diabetic complications, the benefit of renal transplantation on patient survival must be considered when deciding between renal transplantation and maintenance dialysis therapy for diabetic patients with renal failure.

Adolescent↗
PubMed1985

Renal transplantation in the older recipient.

From 1976 to 1983, 13 living related and 54 cadaver renal transplants were done in 62 patients more than 50 years old. Patients with no coronary or myocardial disease upon coronary angiography were selected preferentially for transplantation. Over-all 1-year patient and graft survival rates were 88 and 70 per cent, respectively. Among cadaver recipients graft survival was improved (p less than 0.001) when prophylactic antilymphoblast globulin was used. There were fewer steroid-related complications (p less than 0.001) in recipients managed with a low dose rather than a high dose maintenance prednisone regimen. With careful patient selection and a steroid-sparing immunosuppressive regimen, renal transplantation can be done safely in older recipients with no increased risk of death or graft loss.

Age Factors↗
PubMed1985

Digital subtraction angiography for evaluating patients with renal carcinoma.

Intravenous digital subtraction angiography has been performed on 39 patients with renal carcinoma. In 19 patients (group 1) imaging of the renal arteries was done following injection of 40 cc intravenous contrast medium through an antecubital vein. In 20 patients (group 2) 40 cc intravenous contrast medium were injected through a femoral vein and digital subtraction imaging of the inferior vena cava was obtained. In 12 of these patients the renal arteries also were visualized from the same injection of contrast medium. Intra-arterial digital subtraction angiography of the renal arteries also was done in 5 patients in group 2. Intravenous digital subtraction angiography satisfactorily demonstrated main renal arterial anatomy in 29 of 35 patients (83 per cent) over-all but failed to delineate the renal mass in most cases. Excellent visualization of the inferior vena cava was obtained in all 20 patients in group 2. Intraarterial digital subtraction angiography yielded an accurate diagnosis of renal carcinoma in all 5 patients with minimal doses of contrast medium. We conclude that intravenous digital subtraction imaging combined with computerized tomography scanning or ultrasonography yields satisfactory diagnostic and anatomical information for most patients with renal carcinoma.

Angiography↗
PubMed1985

Renal revascularization by end-to-end anastomosis of the hepatic and renal arteries.

From June 1981 to January 1984, 13 patients with atherosclerotic renal artery disease underwent revascularization by end-to-end anastomosis of the hepatic and renal arteries. Renal revascularization was indicated to preserve renal function and/or to treat associated hypertension. An aortorenal bypass was not possible owing to severe aortic atherosclerosis or a prior aortic operation. Right renal revascularization was performed by end-to-end anastomosis of the renal artery to the common hepatic artery in 7 patients, right hepatic artery in 4, left hepatic artery in 1 or gastroduodenal artery in 1. Postoperatively, 2 patients suffered a necrotic gallbladder owing to ischemia and 1 of these patients died. Liver enzymes were elevated immediately postoperatively in 11 patients but returned to normal within 2 weeks in each case. Currently, all 12 surviving patients have normal liver function, well controlled blood pressure and improved renal function. End-to-end anastomosis of the hepatic and renal arteries is an effective method of revascularization but specific measures must be taken to avoid complications of gallbladder ischemia.

Aged↗
PubMed1985

Superior mesenterorenal bypass for renal revascularization with infrarenal aortic occlusion.

The technique of renal revascularization using a saphenous vein bypass graft from the superior mesenteric artery is described. This operation has been performed for the correction of renal artery stenosis in 4 patients with atherosclerotic aortic occlusion. When the requisite conditions are present, mesenterorenal bypass offers a safe and effective method of renal revascularization, and is preferable to aortic replacement in selected patients.

Aorta, Abdominal↗