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Biomedical subjects

A C Novick

Publications and source records attributed to A C Novick.

At least 307 records · Page 17Linked to original sources
PubMed1985

Natural history of atherosclerotic and fibrous renal artery disease: clinical implications.

Atherosclerotic renal artery disease and the fibrous renal artery diseases are described with respect to their radiographic and clinical characteristics. In a retrospective review, serial renal arteriograms of 85 patients with atherosclerotic renal artery disease and 66 patients with the medial fibroplasia type of fibrous renal artery disease were analyzed to characterize their natural history. Atherosclerotic renovascular disease progressed in 37 patients (44%) with total arterial occlusion occurring in 14 patients (16%). Medial fibroplasia of the renal artery progressed in 22 patients (33%) with no patient progressing to complete occlusion. Reduction in kidney size and increase in serum creatinine were good clinical markers for progressive atherosclerotic renal artery disease, but failed to discriminate between progressive and nonprogressive medial fibroplasia. The adequacy of BP control did not correlate with progressive occlusive disease in patients with either renal artery atherosclerosis or medial fibroplasia. The clinical implications of these observations are discussed with a view toward renal revascularization or transluminal angioplasty for preservation of renal function.

Adolescent↗
PubMed1985

Renovascular disease in the elderly: an analysis of 50 patients.

Fifty patients, 65 years of age or older, with renovascular disease were evaluated and treated between 1979 and 1981. Twenty-one patients were treated medically, 21 surgically and 8 with percutaneous transluminal angioplasty of the renal arteries. The age, sex, target organ involvement, initial blood pressure and serum creatinine were similar among the three groups. Sixty-six percent of the medical group demonstrated lower blood pressure. Ninety percent of the surgical group demonstrated a cure or improved blood pressure, and 43% of the patients with percutaneous transluminal angioplasty had improved blood pressure. Renal function deteriorated in 50% of the medical group, 19% of the surgical group and 25% of patients in the percutaneous transluminal angioplasty group. There was one operative death in the surgical group and one death related to percutaneous transluminal angioplasty. The data demonstrate that old age itself is not a contraindication to surgery. If hypertension is resistant to medical therapy, if the patient experiences undesirable side effects from the medications or if renal function is jeopardized, surgical therapy should be considered. More experience with percutaneous transluminal angioplasty is necessary to determine its precise role in managing atherosclerotic renal vascular disease in the elderly.

Aged↗
PubMed1985

Splenorenal bypass in the treatment of renal artery stenosis: experience with sixty-nine cases.

From 1962 to 1984 splenorenal bypass was performed in 69 patients with renal artery disease caused by either atherosclerosis (n = 54) or fibrous dysplasia (n = 15). Renal revascularization was performed to control hypertension in 27 patients, to preserve renal function in nine patients, and for both of these reasons in 33 patients. The mean follow-up interval is 5.4 years. Postoperatively hypertension was cured or improved in 52 of 60 patients (87%); the serum creatine level was improved or stable in 37 of 42 patients (88%) who underwent revascularization to preserve renal function. Postoperative graft thrombosis (n = 2) or stenosis (n = 3) occurred in five patients (7%). Splenorenal bypass is an excellent method of revascularization of the left renal artery, particularly for patients with a troublesome aorta that precludes performance of an aortorenal bypass.

Adolescent↗
PubMed1985

Pregnancy after donor nephrectomy.

The use of living-related kidney donors has been a routine practice in most major transplant centers in the United States for more than 20 years. Concern has arisen regarding the potential for developing hypertension and progressive renal dysfunction after renal donation. Pregnancy results in hyperfiltration and might be an added risk for the development of hypertension, proteinuria, or renal insufficiency in donors. From 1963 until 1984, the Cleveland Clinic Foundation performed 1031 renal transplants, 355 from living donors. Of these 355 living donors, 191 were female, and of these, 23 successfully conceived after kidney donation. Prenatal and delivery records of all 23 were reviewed. There were 39 pregnancies in 23 women with 32 viable births. Conception ranged from 2 weeks to more than 9 years postnephrectomy. Mean blood pressure at the time of donor evaluation was 120/75 mm Hg (SD: +/- 11/8 mm Hg). Mean blood pressure during pregnancy was 114/68 mm Hg (SD: +/- 7/6 mm Hg). One plus proteinuria was detected in 2 women during the third trimester and trace proteinuria was seen in 7 pregnancies; this proteinuria disappeared after delivery. Thirteen of twenty women who carried to term were reevaluated 2-14 years after donor nephrectomy. All parameters studied were normal. Mean length of follow-up after donor nephrectomy was 7.9 years. These data suggest that, after donor nephrectomy, women can have a normal pregnancy without significant problems related to the kidney donation. Also, hyperfiltration associated with the combination of unilateral nephrectomy and pregnancy does not lead to significant hypertension, proteinuria, change in glomerular filtration rate, or abnormalities of the urinary sediment.

Adult↗
PubMed1985

Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease.

We studied renal plasma flow and glomerular filtration rate during graded blood pressure reduction induced with sodium nitroprusside infusion in 16 hypertensive patients with atherosclerotic renovascular disease. Eight patients with unilateral disease tolerated pressure reduction from 205 +/- 9 (SE)/103 +/- 2 mm Hg to 146 +/- 6/84 +/- 3 mm Hg (p less than 0.01) with no change in total renal function. In 8 other patients with bilateral renal arterial stenosis (all arteries 70% or more stenosed), similar pressure reduction produced marked but reversible decrements in plasma flow (152 +/- 28 mL/min to 66 +/- 13 mL/min; p less than 0.01) and glomerular filtration rate (38 +/- 8 mL/min to 16 +/- mL/min; p less than 0.01). In 4 patients restudied after revascularization, sensitivity of renal function to pressure changes was no longer present. These data indicate that vascular stenosis to the entire renal mass may limit function and provide a means for evaluating patients at risk for loss of renal function during antihypertensive therapy.

Aged↗
PubMed1985

Intraoperative consultation for the retroperitoneum and adrenal glands.

An incidentally discovered mass lesion is the most frequent indication for intraoperative consultation involving the retroperitoneum or adrenal gland. The goal of the surgeon is to determine the nature and extent of the lesion and, for solid lesions, to obtain a biopsy adequate for histopathologic diagnosis. Benign lesions may be excised locally, whereas therapy for malignancies depends upon the individual circumstances of the patient, the histology of the lesion, and involvement of adjacent organs. Treatment of hematomas requires early vascular control. Adrenal tissue should be preserved whenever possible.

Abscess↗
PubMed1985

The role of renal autotransplantation in pediatric and young adult patients with renal artery disease.

From 1977 to 1984, renal autotransplantation was attempted in 16 pediatric and young adult patients with renal artery disease, ranging in age from 10 months to 21 years. Renal revascularization was indicated as treatment for severe hypertension in 15 patients and to prevent rupture of an arterial aneurysm in one patient. The reasons for undertaking renal autotransplantation were branch renal artery disease requiring extracorporeal revascularization (n = 14), abdominal aortic hypoplasia (n = 1), and renal artery disease in a small infant (n = 1). Renal revascularization was successfully accomplished in 14 of 16 patients, including one patient who underwent staged bilateral extracorporeal repairs. Obliteration of the inferior vena cava and iliac veins precluded autotransplantation in one patient and a nephrectomy was done. In one patient extracorporeal ligation of an inaccessible renal arterial branch was accomplished with autotransplantation. Currently all 16 patients are normotensive with excellent renal function. Extracorporeal surgery and autotransplantation have been important additions to the surgical armamentarium for renal artery disease.

Adolescent↗
PubMed1984

Regulation of renal hemodynamics and glomerular filtration in patients with renovascular hypertension during converting enzyme inhibition with captopril.

Changes in regional hemodynamics and function of the kidney during inhibition of angiotensin converting enzyme were studied in 25 patients with renovascular hypertension. A variety of patterns were observed depending upon (1) the activity of the renin-angiotensin system and concomitant administration of diuretics, and (2) the presence of bilateral renal artery stenosis. Increase in blood flow, glomerular filtration rate and sodium excretion during angiotensin blockade, in some instances, indicated tonic renal vasoconstriction before therapy. Release of the kidney from these effects may explain, in part, the sustained effectiveness of converting enzyme inhibition in chronic congestive heart failure. When compared with blood pressure reduction due to nitroprusside administration, initial captopril therapy in patients with unilateral stenosis produced a selective decrease in glomerular filtration, despite well-preserved renal blood flow. These results confirm the importance of efferent arteriolar vasoconstriction due to angiotensin II in man. Experimental studies demonstrate that angiotensin may become critical to sustaining glomerular filtration rate in the presence of stenosis during vasodilation. In patients with bilateral stenosis, this effect produces a syndrome of functional renal insufficiency. Taken together, these data demonstrate an intrarenal action of angiotensin II in human renovascular hypertension and underscore the importance of evaluating the functional impact of changes in regional hemodynamics.

Adult↗
PubMed1984

Renal oncocytoma: a diagnostic and therapeutic dilemma.

From 1968 to 1983, 254 patients underwent an operation for presumed renal cell carcinoma. In this retrospective review the pathological diagnosis was renal oncocytoma in 11 patients (4 per cent). Renal oncocytomas were present bilaterally in 2 patients, including 1 with a coexisting renal cell carcinoma. In 2 other patients the oncocytomas were multicentric. The angiographic, computerized tomographic and sonographic findings in these patients typified renal cell carcinoma. Surgical treatment comprised radical or partial nephrectomy for unilateral and bilateral lesions, respectively. Because of the benign nature, multicentricity, possible bilaterality and absence of pathognomonic radiographic features, renal oncocytomas should be considered in the differential diagnosis of solid renal masses.

Adenoma↗
PubMed1984

Improved results of cadaver renal transplantation with azathioprine, prednisone and antilymphoblast globulin.

From 1980 to 1982, 100 consecutive cadaver renal transplants were performed. All but 2 recipients received preoperative transfusion and all received an initial 2-week course of antilymphoblast globulin. A prospective controlled evaluation of high versus low maintenance prednisone, and antilymphoblast globulin versus intravenous methylprednisolone for first rejection therapy was done. Over-all 1-year graft and patient survivals were 77 and 96 per cent, respectively. Graft survival was equal in the high and low steroid groups. Antilymphoblast globulin was as effective as intravenous methylprednisolone in reversing first rejections. Graft survival was improved with better donor-recipient matched grafts. We conclude that excellent results can be obtained in transfused cadaver renal allograft recipients managed with azathioprine, prednisone and antilymphoblast globulin. The regimen of prophylactic antilymphoblast globulin, low maintenance prednisone and antilymphoblast globulin alone for first rejections is immunologically effective and steroid sparing.

Antilymphocyte Serum↗
PubMed1984

Long-term results following partial nephrectomy for localized renal adenocarcinoma.

From 1956 to 1980 partial nephrectomy was done on 23 patients with localized renal carcinoma occurring bilaterally or in a solitary functioning kidney. The mean postoperative followup was 5.4 years, and the 5-year patient survival rates considering death of renal cancer only or of any cause were 70.2 and 59.6 per cent, respectively. Survival was diminished in patients with bilateral asynchronous renal carcinoma. Renal carcinoma recurred postoperatively in 6 patients (26 per cent), including 3 (13 per cent) with local recurrence in the renal remnant. Currently, 12 patients (52 per cent) are alive with stable function and no evidence of malignancy. These long-term data support the efficacy of partial nephrectomy for selected patients with renal carcinoma.

Adenocarcinoma↗
PubMed1984

Use of the hepatic circulation for renal revascularization.

Aortorenal bypass is the preferred procedure for renal revascularization. Occasionally the aorta cannot be used safely and an alternative procedure is required. Thirty-six patients (21 from the Lahey Clinic and 15 from the Cleveland Clinic) have undergone hepatorenal bypass procedures when confronted with a difficult aorta and right renal artery stenosis. Twenty men and 16 women were operated on and observed from 1 to 9 years. The medical indications for surgery were uncontrollable hypertension in 14 patients, preservation of renal function in eight patients, and a combination of these entities in 14 patients. The surgical indications that required an alternate bypass were diffuse atherosclerotic aortic disease in 24 patients, abdominal aortic aneurysms in six patients, and previous aortic surgery in six patients. Postoperative hepatic function studies were assessed in all patients. No permanent abnormalities of liver function were attributed to surgery. Hypertension was cured or improved in 93% of patients; 7% were unresponsive. Mean creatinine levels were 3.5 mg/dl before operation and 2.1 mg/dl after operation. Renal revascularization was successful in 33 of 36 patients (92%).

Aged↗
PubMed1984

Magnetic resonance imaging of renal transplants.

Nineteen patients were examined to determine the clinical potential of magnetic resonance imaging (MRI) for evaluation of renal transplants. A 0.6-T cryogenic magnet and spin-echo technique with varying pulsing factors were used. T1-weighted images were best for differentiating the cortical and medullary parts of the transplanted kidney. Of the six living-related transplants with good renal function that were imaged, five demonstrated good corticomedullary differentiation (CMD) and one faint CMD. Three transplants with acute rejection were imaged, and all demonstrated a decrease in CMD and decrease in overall signal intensity compared with baseline. No CMD was seen in the three chronically rejecting transplants imaged. The appearance of cadaveric transplants and acute tubular necrosis was quite variable. All perinephric fluid collections were well depicted by MRI. Lymphoceles could be distinguished from hematomas. MRI may prove to be a useful adjunct in the evaluation of renal transplants and perinephric fluid collections.

Adolescent↗