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Biomedical subjects

A C Novick

Publications and source records attributed to A C Novick.

At least 343 records · Page 19Linked to original sources
PubMed1983

Low-dose maintenance prednisone and antilymphoblast globulin for the treatment of acute rejection. A steroid-sparing approach to immunosuppressive therapy.

The purpose of this prospective randomized trial was to evaluate an immunosuppressive protocol involving reduced maintenance and antirejection steroid dosages in cadaver renal transplantation. The study comprises 23 first cadaver graft recipients who experienced an acute rejection episode. All patients received an initial 14-day course of antilymphocyte globulin (ALG) and azathioprine 1.5 to 2.0 mg/kg/day. In 11 patients (group 1), a low maintenance dose of prednisone (30 mg/day) was administered and first rejection episodes were treated with a second 10-day course of ALG. The remaining 12 patients (group 2) received high maintenance doses of prednisone (2 mg/kg/day with tapering) and intravenous methylprednisolone (IVMP) for first rejection episodes. Subsequent rejections in both groups were treated with high doses of steroids. In group 1, all first rejection episodes were reversed with ALG alone, 6 patients experienced no subsequent rejection, and 10 patients currently have a functioning graft. In Group 2, the first rejection episode was reversed with IMVP alone in 10 patients; in two patients in whom IVMP therapy was unsuccessful, ALG was then administered, and subsequent rejection reversal was effected. In group 2, 4 patients experienced no subsequent rejection, and 9 patients currently have a functioning graft. Patients in group 1 received significantly lower (P less than .01) cumulative steroid doses in the first six months following transplantation, which resulted in a reduced number of major infections, as compared with patients in group 2. We conclude that the steroid-sparing regimen of low maintenance prednisone and ALG for first rejection is as effective immunologically as the established high steroid protocol.

Antilymphocyte Serum↗
PubMed1983

Functional capacity and rehabilitation of recipients with a functioning renal allograft for ten years or more.

Forty-nine renal transplant recipients who had a single functioning allograft for ten or more years are reviewed. There were 17 cadaver recipients and 32 living-related recipients. Most patients have enjoyed excellent long-term renal function with stable mean daily dosages of azathioprine and prednisone. Fifty-three percent of patients never experienced a rejection episode, and 24% of patients experienced only one rejection episode. Five recipients (10%) developed malignancy following transplantation. Based on the Karnofsky activity scale, 80% of patients enjoyed unrestricted activity at ten years posttransplant. The two major factors contributing to declining activity were progression of systemic diseases such as atherosclerosis or diabetes, and declining allograft function. Following transplantation, all patients developed renewed interest in sexual activity, all men were potent, and all women experienced regular menses. Nine men achieved fatherhood and five women underwent successful pregnancy. Currently, 46 recipients are alive with a functioning allograft. These data confirm the ability of recipients with a long-term functioning renal allograft to return to the work force, participate in preillness levels of activity, and enjoy sexual activity and parenthood.

Activities of Daily Living↗
PubMed1983

Surgical treatment of renal artery aneurysms.

Twenty-seven patients have undergone surgical treatment of renal artery aneurysms and the classification, radiographic features and complications of these aneurysms are reviewed. Aortorenal bypass is the preferred method of in situ revascularisation. Extracorporeal microvascular branch arterial reconstruction is reserved for patients with complex intrarenal aneurysms. Removal of the aneurysm with preservation of the involved renal unit is possible in most cases.

Adolescent↗
PubMed1983

Pelvic imaging techniques in renal transplantation.

Results of renal transplantation have continued to improve, in part because of the earlier, less invasive and more accurate differentiation of the many causes of posttransplant renal dysfunction. Advances in pelvic imaging techniques have clearly played a major role not only in the diagnosis of these problems but, as noted here, in their treatment. Further refinement of currently available clinical techniques as well as newer experimental modalities will continue to help improve both patient and graft survival.

Anuria↗
PubMed1983

Renal hypothermia: in vivo and ex vivo.

Temporary occlusion of the renal artery may be necessary for operations to remove renal calculi in situ, such as partial nephrectomy, nephrolithotomy, and extended pyelolithotomy. Performance of these operations requires an understanding of renal responses to warm ischemia and available methods of protecting the kidney in situ when the period of arterial occlusion exceeds that which may be safely tolerated. Methods of extracorporeal renal preservation are also reviewed because autotransplantation and bench surgery may occasionally be employed to treat patients with renal calculous disease.

Constriction↗
PubMed1983

Enhancement of recovery in postischemic acute renal failure with captopril.

This study tested the ability of the converting enzyme inhibitor, captopril, to lessen the severity of acute renal failure following temporary occlusion of the renal artery. In the control group, 11 dogs were anesthetized with halothane, and the left kidney was isolated through a midline incision. The renal artery, vein, and ureter were then clamped for 120 min. Immediately after occlusion, the kidney was flushed with 40 ml of saline at 34 degrees C. When the clamp was released, a contralateral nephrectomy was performed and the animal allowed to recover. Serum creatinine and blood urea nitrogen levels were followed on a daily basis thereafter. Thirteen captopril-treated dogs were treated in the same fashion except that captopril (1.25 ml/kg, i.v.) was given prior to the 120-min period of renal ischemia. Three of 11 (27%) control dogs survived, whereas 10 of 13 (77%) captopril-treated animals survived (P less than 0.05). Serum creatinine (5.4 +/- 2.5 mg/dl) and serum urea nitrogen (96 +/- 33 mg/dl) peaked on day 8 in the captopril-treated group and were consistently lower than in the untreated group. These observations suggest that captopril is useful when temporary interruption of the renal circulation is encountered, such as in renal autotransplantation, cadaveric renal transplantation, and renal revascularization. These data also suggest that inhibition of the renin-angiotensin system may lessen the severity of acute renal failure following renal ischemia.

Acute Kidney Injury↗
PubMed1983

Renal failure limiting antihypertensive therapy as an indication for renal revascularization. A case report.

Although surgical repair of renal artery stenosis occasionally improves renal function, it is not yet known when revascularization is indicated for that reason. We report the results observed in a patient with renovascular hypertension and additional stenosis in the contralateral kidney whose renal function deteriorated on repeated occasions during antihypertensive therapy. Renal hemodynamic studies during sodium nitroprusside infusion showed severely impaired autoregulation of blood flow, and glomerular filtration rate was corrected after revascularization of the contralateral kidney alone. After surgery, normal BPs were tolerated without loss of function. These findings demonstrate a specific clinical indication for renal revascularization to preserve kidney function.

Antihypertensive Agents↗
PubMed1982

Digital subtraction angiography for postoperative evaluation of renal arterial reconstruction.

Digital subtraction angiography after peripheral intravenous injection of contrast material is a new method to evaluate the cardiovascular system. Digital subtraction angiography was obtained postoperatively in 21 patients undergoing renal revascularization for treatment of hypertension and/or preservation of renal function. Digital subtraction angiography provided excellent visualization of the reconstructed renal arterial supply in all cases. The advantages and limitations of this technique in the evaluation of patients with renovascular disorders are discussed.

Aged↗
PubMed1982

Surgical treatment of renovascular disease in the solitary kidney: results in 43 cases.

Renal revascularization was performed on 43 patients with vascular disease involving a solitary kidney. Revascularization was undertaken as treatment for severe hypertension in 35 patients and to preserve renal function in 8. There were 2 operative deaths (4.7 per cent) and 3 major complications (7 per cent). No patient suffered acute renal failure after revascularization. Followup ranges from 6 months to 14 years (mean 6 years). The postoperative serum creatinine is improved in 26 patients (63 per cent), unchanged in 9 (22 per cent) and increased in 6 (15 per cent). Of 35 patients with hypertension the blood pressure is cured in 18 (51 per cent) and improved in 14 (40 per cent); there were 3 (9 per cent) failures. In selected patients with renal artery disease involving a solitary kidney revascularization can provide effective treatment of hypertension and stabilization or improvement of renal function.

Adult↗
PubMed1982

Improved cadaver allograft survival in transfused recipients who remain serologically negative for cytomegalovirus.

Between April 1976 and October 1979, 100 consecutive cadaver renal transplants were done. Before transplantation 48 recipients were seronegative and 52 were seropositive for cytomegalovirus. After transplantation there were 20 primary and 38 secondary cytomegalovirus infections. The development of post-transplant cytomegalovirus infection, with or without overt symptoms, had no effect on graft survival. The 1-year graft survival was significantly better (p less than 0.05) in high transfused (more than 5 units) recipients (70 per cent) compared to nontransfused recipients (36 per cent). The beneficial effect of transfusions was not diminished in patients with positive post-transplant cytomegalovirus serology. Of the transfused recipients those who remained serologically negative for cytomegalovirus pre-transplant had significantly better 1-year graft survival (78 per cent) than those who were cytomegalovirus positive before transplantation (58 per cent) (p less than 0.05). The improved graft survival in patients who remain cytomegalovirus seronegative after multiple blood transfusions may be a manifestation of unresponsiveness to immunologic as well as virogenetic stimulation.

Adult↗
PubMed1982

The use of percutaneous transluminal angioplasty for renal artery stenosis in patients with generalized atherosclerosis.

From April 1979 to March 1981 percutaneous transluminal angioplasty was attempted in 27 patients with atherosclerotic renal artery stenosis. In 13 patients percutaneous transluminal angioplasty was considered successful with a decrease in blood pressure and/or improvement in renal function. Dilation of the stenosed renal artery was not technically possible in 4 patients and was unsuccessful in 10. Eight patients required surgical intervention after percutaneous transluminal angioplasty, including 4 electric operations and 4 done on an emergency basis. In our series 5 patients sustained intimal tears of the renal artery during percutaneous transluminal angioplasty with intramural dissection and/or thrombosis. Continued multidisciplinary evaluation of percutaneous transluminal angioplasty in the treatment of renal artery stenosis is recommended.

Adult↗
PubMed1982

Determinants of allograft survival in 100 consecutive cadaver kidney transplants.

We reviewed 100 consecutive cadaver renal transplants done at our clinic between April 1976 and October 1979. A minimum 1-year followup was available on all patients. The actual 1-year graft survival rate was 64 per cent and the actual 1-year patient survival rate was 91 per cent. Criteria that had no significant effect on 1-year allograft survival were performance of pre-transplant nephrectomy and/or splenectomy, red blood cell group or the level of pre-formed antibody. A major determinant of graft survival was the number of blood transfusions received before transplantation. The 1-year graft survival rate was 36 per cent with no pre-transplant transfusions, 64 per cent with 1 to 5 transfusions and 70 per cent with more than 5 transfusions (p less than 0.005). The 1-year graft survival rate was not influenced by the use of kidneys imported from other states, the use of pediatric cadaver donors 1 to 15 years old or extended renal preservation times. Our experience supports continued regional and national sharing of adult and pediatric cadaver donor kidneys with extended preservation times.

Adolescent↗
PubMed1982

Pretransplant donor specific blood transfusions for one haplotype stimulatory mixed lymphocyte culture living related donor transplants.

Three donor specific blood transfusions were given at 2-wk intervals pretransplantation, to those donor-recipient pairs who were one haplotype identical, but had stimulatory MLC. Two of 10 recipients who received donor specific blood transfusions developed T cell cytotoxic antibodies against their donor and were not transplanted. Eight recipients were successfully transplanted with no evidence of hyperacute rejection. All eight grafts are functioning from 2 to 15 mo post-transplant. Serum creatinines range from 1.0--3.9 mg%. There have been five patients who developed acute rejection episodes during the first 5 days post-transplant, and there have been a mean of 2.4 rejection episodes per patient. These results compare favorably to historical controls at the same institution who had a 40% incidence of graft success. The long-term graft survival remains to be elucidated.

Blood Donors↗
PubMed1982

Long-term results of renal transplantation in recipients with a functioning graft for 2 years.

The late results of renal transplantation are reviewed in 214 recipients with a functioning allograft for 2 years. Graft survival was better (P less than 0.001) in living related recipients (t 1/2 = 17 years) compared with cadaver graft recipients (t 1/2 = 7.7 years). Graft survival was also significantly different (P less than 0.001) in patients with a 2-year serum creatinine level of less than or equal to 2.0 (t 1/2 = 16.4 years), 2.1 to 3.0 (t 1/2 = 6.5 years), or greater than 3.0 mg/dl (t 1/2 = 2.9 years). A greater proportion of patients with a 2-year serum creatinine level of greater than 3 mg/dl had experienced greater than two rejection episodes (P less than 0.0001). Among recipients with a 2-year serum creatinine level of less than or equal to 2.0 mg/dl, living related grafts achieved better graft survival than cadaver grafts (P less than 0.05). Major complications of transplantation were more common in patients with a cadaver graft, 2-year serum creatinine level of greater than 3 mg/dl, or age greater than 45 years. One hundred and forty-two patients are currently alive, 93% of whom have achieved complete rehabilitation.

Adolescent↗