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Biomedical subjects

A C Novick

Publications and source records attributed to A C Novick.

414 records · Page 23Linked to original sources
PubMed1977

Splenorenal bypass in the treatment of stenosis of the renal artery.

The over-all results obtained with splenorenal bypass in the treatment of 32 patients with renovascular hypertension were 17 patients cured, nine patients improved and six failures. Improved results were noted when splenorenal bypass was performed in relation to specific operative indications. The results were somewhat better for men than for women; however, poor results were obtained in children. Intraoperative and early postoperative complications were minimal, and there were two postoperative deaths. Late complications were limited to stenoses of the splenic artery graft which developed in three patients. When performed in relation to specific clinical and operative indications, splenorenal bypass represents an excellent means of achieving safe and effective renal revascularization.

Adolescent↗
PubMed1976

Partial cystectomy in the treatment of primary and secondary carcinoma of the bladder.

We reviewed 50 patients who had undergone partial cystectomy for primary carcinoma of the bladder. Specific indications and operative technique are discussed. The 5-year survival rate was 67% for patients with stages O and A disease, 53% for stage B and 20% for stages C and D1. Survival was improved for patients with tumors on the posterior bladder wall. Patients in whom free margins of resection were accomplished for unifocal disease had longer survival, with a diminished propensity for developing recurrent bladder cancer. There was no hospital mortality and postoperative complications were minimal. An additional 12 patients underwent partial cystectomy for adjacent carcinomas secondarily invading the bladder with less favorable results.

Antineoplastic Agents↗
PubMedDate not supplied

Extracorporeal microvascular arterial reconstruction in donor kidneys prior to transplantation.

Revascularization of all renal arteries is important to the prevention of ischemic allograft complications. Extracorporeal arterial repair prior to transplantation was performed on 41 donor kidneys. Three extracorporeal reconstructive techniques are described that are applicable to most of the anatomic variants presented by multiple renal arteries and those that are damaged or diseased. These are simple and effective methods that avoid subjecting the kidney to prolonged ischemia.

Anastomosis, Surgical↗
PubMedDate not supplied

Preoperative use of 3D volume rendering to demonstrate renal tumors and renal anatomy.

With increased use of computed tomography (CT) and abdominal ultrasonography, the indications for nephron-sparing surgery are also increasing. Triphasic helical CT and three-dimensional (3D) volume rendering can be combined into a single noninvasive test to delineate renal tumors and normal and complex renal anatomy prior to nephron-sparing surgery. This combination technique has proved accurate and very useful for both preoperative and intraoperative planning by demonstrating renal position, tumor location and depth of tumor extension into the kidney, relationship of the tumor to the collecting system, and renal vascular anatomy. Knowledge of the position of the kidney relative to the lower rib cage, iliac crest, and spine helps in planning the initial surgical incision. By depicting tumor location and depth of extension, helical CT with 3D volume rendering helps ensure complete tumor excision and conservation of adjacent normal renal parenchyma. Depiction of the relationship of the tumor to the collecting system helps anticipate further tumor extension and minimize postoperative complications. Identification of normal renal vasculature and anatomic variants can help minimize ischemic injury and intraoperative bleeding. Radiologists should be familiar with current indications for nephron-sparing surgery and understand what information is required prior to surgery.

Blood Loss, Surgical↗
PubMedDate not supplied

Stomal complications of intestinal conduit urinary diversion.

Intestinal conduits of the ileum, colon, or jejunum were used for urinary diversion in 319 patients at The Cleveland Clinic Foundation between 1970 and 1981 due to pelvic malignancy , primary bladder cancer, or benign conditions. End stomas were constructed in 65% and Turnbull loop stomas in 35%. Follow-up ranged from one to 152 months (median, 35 months). The mean number of days between appliance changes was 5.7 (range, 2-10). The overall complication rate was 8.5%. Stomal revisions were required in 5%. There were no significant differences in the mean number of days between appliance changes, type or number of complications, or rate of revision between end and loop stomas or between the various intestinal segments used for diversion. The presence or absence of previous irradiation and the indication for diversion were independent of complications. Stomas constructed from any segment of the intestinal tract in end or loop fashion yielded equivalent long-term function and complication rates. Stomal complications can be minimized and the time between appliance changes maximized by careful attention to all phases of stomal construction and care.

Adolescent↗
PubMedDate not supplied

Treatment of metastatic transitional cell carcinoma following renal transplantation.

Renal transplantation was performed in a patient with a history of surgical excision for localized transitional cell carcinoma. The graft functioned well; however, metastatic transitional cell carcinoma developed following transplantation. The patient was treated sequentially with CISCA (cisplatin, Cytoxan [cyclophosphamide], and Adriamycin [doxorubicin hydrochloride]) and M-VAC (methotrexate, vinblastine, Adriamycin, and cisplatin) with no alteration in maintenance immunosuppression. Full-dose chemotherapy was well tolerated, with no impairment of renal function, and a demonstrable reduction in tumor burden was achieved. The patient ultimately died of metastatic disease but enjoyed an excellent quality of life throughout the post-transplant period.

Adult↗
PubMedDate not supplied

A new intracellular flush solution improves renal transplant preservation.

A new renal preservation flush solution (PB-2) has been developed to minimize the ischemic injury processes that occur during hypothermic storage and reperfusion and that can decrease renal viability and survival. Development of the new formulation took into account the intracellular and biological interactions that occur pre- and post-transplantation. PB-2 was compared with the conventional standardized Collins-2 flush solution in the preservation of autografts in dogs and was found to provide significantly improved renal recovery, viability, and survival. Studies to test the new solution in human renal allograft transplant preservation are planned.

Animals↗
PubMedDate not supplied

Prophylaxis and treatment of post-renal transplant rejection.

Antilymphocyte preparations are effective immunosuppressive agents for treatment of post-transplant rejection in renal transplantation. Polyclonal preparations have been used for more than 15 years, and more recently monoclonal antibodies have been employed. These agents prevent rejection when used prophylactically soon after renal transplantation and they effectively treat acute rejection episodes either as first-line therapy or for steroid-refractory rejection episodes. In the past, polyclonal antilymphocyte preparations were poorly reproducible, contained contaminating antibodies against normal blood cell constituents, and required administration of large doses through a central vein or an arteriovenous fistula. The monoclonal antibody preparation Orthoclone OKT3 has proven as effective as the polyclonal preparation ALG to prevent or treat acute rejection episodes in the early post-transplant period. Compared to polyclonal preparations, monoclonal preparations are preferable because of their uniformity, absence of contaminating antibodies, and ease of administration. The development of antibodies to mouse proteins in the recipient may limit the usefulness of monoclonal preparations when given for an extended period or in repeated courses.

Antilymphocyte Serum↗
PubMedDate not supplied

Azathioprine vs cyclosporine in recipients of HLA-identical renal allografts.

BACKGROUND: Siblings with identical human leukocyte antigens (HLA) are preferred transplant donors. OBJECTIVE: To compare the outcomes in azathioprine-treated and cyclosporine-treated recipients of renal transplants from HLA-identical siblings. METHODS: Retrospective review. RESULTS: From August 1980 to June 1989, 53 consecutive patients received renal transplants from HLA-identical donors. These patients received prednisone and either azathioprine (n = 26) or cyclosporine (n = 27). A mean of 8.4 years elapsed since transplantation in the azathioprine-treated patients and 4.7 years elapsed in the cyclosporine-treated patients. The 5-year patient and graft survival rates were 100% and 92%, respectively, for azathioprine-treated patients and 96% and 83%, respectively, for cyclosporine-treated patients (P = .379 for comparison of graft survival). There was no difference between the two groups in the number of rejections or the time to the first rejection episode. At 5 years after transplantation, cyclosporine-treated patients had a significantly higher median serum creatinine concentration (1.7 mg/dL) than did azathioprine-treated patients (1.3 mg/dL, P = .018). Maintenance steroid therapy was successfully withdrawn in six azathioprine-treated patients and seven cyclosporine-treated patients. CONCLUSIONS: Azathioprine and cyclosporine produce equally satisfactory outcomes in this immunologically favored group. The need for continued steroid therapy in these patients requires further study.

Adolescent↗
PubMedDate not supplied

Trends in surgical revascularization for renal artery disease. Ten years' experience.

We reviewed our experience with surgical revascularization (SR) for renal artery disease (RAD) in 361 patients from 1975 through 1984 to illustrate the evolving role of SR in the management of these patients. The time intervals selected for comparison were 1975 through 1980 (n = 174) and 1981 through 1984 (n = 187). Since 1981, in patients with atherosclerosis, SR has been done more often in elderly patients (30% vs 10.4%), in patients with generalized atherosclerosis (87% vs 73%), and for the sole purpose of preserving renal function (36% vs 14%). Since 1981, fewer patients with atherosclerosis have undergone SR solely to treat renovascular hypertension (26% vs 41%). Since 1981, in patients with fibrous dysplasia, SR has been done in more patients with branch renal artery disease (70% vs 28%). These trends in the performance of SR have been due to the advent of percutaneous transluminal angioplasty as effective therapy for certain patients, improved results of SR in elderly patients with atherosclerosis, an enhanced appreciation of advanced atherosclerotic RAD as a correctable cause of renal failure, and the development of more effective techniques for SR in patients with severe aortic atherosclerosis and branch RAD. The overall clinical results of SR remain excellent in properly selected patients with RAD.

Adult↗