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Biomedical subjects

A Novick

Publications and source records attributed to A Novick.

At least 19 recordsLinked to original sources
PubMed1995

The axes of rotation of the thumb interphalangeal and metacarpophalangeal joints.

The axes of rotation of the thumb interphalangeal and metacarpophalangeal joints were located using a mechanical method. The interphalangeal joint axis is parallel to the flexion crease of the joint and is not perpendicular to the phalanx. This offset of the axis with respect to the phalanx explains the ulnar deviation and pronation that occurs with flexion of the interphalangeal joint. The metacarpophalangeal joint has 2 fixed axes: a fixed flexion-extension axis just distal and volar to the epicondyles, and an abduction-adduction axis related to the proximal phalanx passing between the sesamoids. Neither axis is perpendicular to the phalanges. All physiologic motion for these joints occurs about the axes. These are the mechanical axes of the joints through which the muscles and external forces act. Knowledge of their location should help in constructing prosthetic joints and in planning reconstructive surgery such as tendon transfers.

Finger Joint↗
PubMed1994

Prevention of thromboembolism in spinal cord injury: role of low molecular weight heparin.

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are major causes of morbidity and mortality in patients with acute spinal cord injury. Our preliminary studies indicated that low molecular weight heparin (LMWH) was significantly more effective than standard heparin in preventing these complications. We have now extended these studies by screening an additional 122 patients and treating 60 who met predefined criteria with LMWH in a dose of 3,500 anti-Xa U given subcutaneously once daily for 8 weeks. All patients were examined daily at bedside and had regularly scheduled venous ultrasonography; those with abnormalities had confirmatory venography and lung scans. Postmortem examinations were conducted in those who died. Forty completed the trial without incident, 6 had DVT (4 proximal and 2 distal), 1 had a fatal PE, 1 had postoperative bleeding requiring discontinuation of the LMWH, 10 were transferred or discharged, and 2 died of respiratory failure. The percentage of patients free of thrombosis or bleeding after 8 weeks of treatment was 85.9 +/- 5.0% standard error of mean (SEM). Thirty-three patients entered a follow-up observation period of 4 weeks without thromboprophylaxis; 2 weeks into this period 1 had a proximal DVT and 1 had a fatal PE; the course of the remainder was uneventful. We conclude that LMWH compares favorably with standard heparin in preventing venous thromboembolism, and is associated with significantly less bleeding. Eight weeks of prophylaxis seems adequate for most patients.

Adult↗
PubMed1994

The impact of adjuvant nephrectomy on multimodality treatment of metastatic renal cell carcinoma.

Multimodality treatment of metastatic renal cell carcinoma with biological response modifiers and cytoreductive surgery has produced durable responses. The timing and impact of cytoreductive surgery on the success of immunotherapy require further study. We reviewed the treatment of 62 patients with metastatic renal cell carcinoma and primary tumors in place who qualified for multimodality treatment comprising adjuvant nephrectomy and biological response modifier protocols at our institution between 1987 and 1992. Of the patients 37 were scheduled to undergo initial adjuvant nephrectomy followed by biological response modifier therapy. A total of 25 patients underwent initial biological response modifier therapy with planned delayed adjuvant nephrectomy if a response to treatment was demonstrated. Of the 37 patients undergoing initial adjuvant nephrectomy, 8 (22%) were unable to enter induction of immunotherapy because of perioperative complications (1), medical contraindications (2), tumor progression (4) or death (1). Three patients in the initial adjuvant nephrectomy group (8%) had a partial response and the median survival in this group was 12 months (range 1 to 57). In the initial biological response modifier group 3 patients (12%) with an objective response (2 complete and 1 partial) to biological response modifier therapy underwent nephrectomy. The median survival for the initial biological response modifier group was 14 months (range 1 to 48). These results add to our understanding of the impact of adjuvant nephrectomy on patients with metastatic renal cell carcinoma considered for immunotherapy protocols.

Adult↗
PubMed1994

Stenting of proximal venous obstructions to maintain hemodialysis access.

PURPOSE: The purpose of the study was to evaluate the efficacy of stenting central venous obstructions in patients dependent on hemodialysis to preserve or restore central venous patency and allow for continued hemodialysis from the affected side. METHODS: Twenty-five self-expanding (17) and balloon-expandable (8) stainless steel stents were deployed in 19 patients with end-stage renal disease and central venous stenosis or occlusion. Nineteen lesions were treated: 11 subclavian and eight innominate. Twenty-two stents were initially implanted. RESULTS: Stent deployment was successful in all cases and immediately remedied the underlying cause of venous hypertension. Follow-up at up to 17 months revealed three deaths from unrelated causes, one occlusion at 3.25 months, and three restenoses at 16 days, 2.5 and 5 months, respectively, with successful implantation of three additional stents for a primary central patency rate of 68% (+/- 14%) and secondary central patency rate of 93% (+/- 7%). CONCLUSIONS: Stenting of subclavian and innominate venous stenoses and occlusions effectively corrected the underlying lesions responsible for disturbed hemodynamics and, in most cases, prolonged available hemodialysis access from the affected side. Stents seem to be valuable adjuncts in the management of failing hemodialysis access due to central venous stenosis or occlusion.

Adult↗
PubMed1994

Anti-glomerular and anti-tubular basement membrane nephritis in a renal allograft recipient with Alport's syndrome.

A 28-year-old deaf, white man with a clinical diagnosis of Alport's syndrome since 4 years of age experienced renal failure, fever, and mental status changes suggestive of vasculitis following his first cadaveric renal transplant; these symptoms and changes resolved after removal of the allograft. Immunohistological stains demonstrated intense linear deposition of IgG and C3 in glomerular and tubular basement membranes in the absence of glomerular crescents. One year later, a second renal transplant led to similar symptoms. A biopsy was performed 14 days after engraftment, which demonstrated intense linear deposition of IgG in glomerular and tubular basement membranes, but cellular crescents were not present. A serologic profile was ordered to evaluate the patient further for vasculitis, and during the evaluation, circulating anti-glomerular basement membrane and anti-tubular basement membrane antibodies were identified by indirect immunofluorescence microscopy (titer, > 1:320). An open biopsy specimen obtained during repair of a renal laceration demonstrated a crescentic glomerulonephritis with immunohistologic findings identical to those of previous biopsies. Anti-glomerular basement membrane nephritis should be suspected in any patient with Alport's syndrome in whom progressive renal failure develops following renal transplantation. Detection of anti-glomerular basement membrane/anti-tubular basement membrane antibodies will assure the diagnosis, and early initiation of plasmapheresis may be helpful to prevent further renal damage.

Adult↗
PubMed1993

Transcutaneous ultrasonography can be used to guide and monitor balloon angioplasty.

PURPOSE: Percutaneous balloon angioplasty is an accepted technique for the treatment of short segmental stenoses of the iliac and superficial femoral arteries. Some surgeons have not embraced this technique because of lack of training, unfamiliarity with radiologic equipment, or poor-quality fluoroscopy equipment in the operating room. A new technique, ultrasound-directed balloon angioplasty, enables the vascular surgeon to guide the catheter and evaluate the progress of the procedure without the use of radiographic imaging. METHODS: The new catheter is integrated externally into a standard duplex scanner. A spherical brass bead positioned on the catheter shaft in the middle of the balloon is covered with a piezoelectric material. This omnidirectional receiver is connected through a wire to a catheter interface system, which allows the exact position of the balloon to be represented on the screen of a duplex unit. The catheter is advanced under visual control with use of the scanner. RESULTS: The system has been used to perform balloon angioplasty on 21 lesions (16 superficial femoral, 3 iliac, 2 popliteal arteries) in 17 patients. Procedures in 16 patients were performed percutaneously; in an additional patient bilateral angioplasties were performed during operation. The balloon was successfully positioned in each case with use of ultrasonography alone; each procedure was confirmed by use of angiography. Angioplasty was accomplished in 16 (76%) of 21 with the ultrasound-guided catheter alone. Supplemental use of a high-pressure balloon or atherectomy device was necessary in five patients. CONCLUSIONS: This technique records physiologic and anatomic data in real time so that the progress of the angioplasty can be monitored. In three patients the inadequacy of the initial angioplasty was recognized by a persistent velocity increase but not by angiography. As a result corrective measures were taken. This new procedure allows vascular surgeons to use equipment with which they are familiar, reduces the risk of ionizing radiation and contrast nephropathy, and permits the monitoring of the angioplasty with hemodynamic parameters.

Angioplasty, Balloon↗
PubMed1993

Reduction of plantar pressure with the rigid relief orthosis.

The rigid relief orthosis was developed to protect vulnerable sites on the plantar surface of the insensitive foot against reulceration by providing both a nonyielding relief under the healed lesion site and a total contact fit. Clinically, the rigid relief orthosis has been effective in protecting the foot against the trauma induced by the repetitive mechanical stress of walking. This study used both the Hercules and F-Scan pressure transducer systems to measure pressure at the first metatarsal head in three orthotic treatments. Both measurement systems recorded significant reductions in pressure at the first metatarsal head with the rigid relief orthosis, establishing a quantitative rationale explaining its clinical effectiveness. Significant pressure differences were also recorded at the secondary sites of the heel, midfoot, and third metatarsal head.

Adult↗
PubMed1992

The axes of rotation of the thumb carpometacarpal joint.

Two axes of rotation of the carpometacarpal (CMC) joint of seven cadaver thumbs were located using an axis finder. The flexion-extension axis is located in the trapezium and the abduction-adduction axis is in the first metacarpal. These axes are fixed, are not perpendicular to each other or to the bones, and do not intersect. Motion of the first metacarpal on the trapezium can be defined by these two axes. Understanding of the movements of the basal joint of the thumb is essential to the study of its function and reconstruction.

Biomechanical Phenomena↗
PubMed1992

Healing rates of plantar ulcers in leprosy and diabetes.

Comparison was made of wound healing time in a consecutive series of leprosy and diabetic patients with plantar ulceration. In the leprosy group, 66 of 70 (94%) ulcers healed in a mean time of 42.7 (+/- 36.1) days, and in the diabetic group, 75 of 80 (94%) ulcers healed in a mean time of 39.7 (+/- 32.1) days. Analysis of all healed ulcers using a general linear model found wound depth (p < 0.03), and wound diameter (p < 0.05) significantly related to ulcer healing time. Diagnosis, healing devices (cast, splint and cut-out sandal), age and sex were not significant. In diabetic subjects a regression model including depth, diameter and age explained 36% of the variation in healing time. A meaningful regression model was not found in leprosy patients.

Casts, Surgical↗
PubMed1991

Methods of treating plantar ulcers.

The purpose of this article is to describe the indications, precautions, and fabrication techniques for orthotic devices the authors use to facilitate the healing of plantar ulcers. The methods of fabricating and applying three types of orthotic devices developed by the staff at the Gillis W Long Hansen's Disease Center--walking casts, walking splints, and cutout sandals--are described. Patient examples are given for each of the methods. These techniques, in conjunction with patient education and the use of special footwear, provide clinicians with procedures they can use to aid in the healing of plantar ulcers secondary to leprosy, diabetes, or other neuropathic conditions.

Casts, Surgical↗
PubMed1990

Treatment of acute vascular occlusions with intra-arterial urokinase.

This study reviewed 57 patients with 71 vascular occlusions treated with urokinase from 1985 to 1988. Of these patients, 89% were candidates for urgent surgery. Total clot lysis was achieved in 73% of cases. The success rate rose with increasing experience (p less than 0.05), and recent occlusions had more favorable outcomes than older ones (p less than 0.05). The length and type of occluded conduit (graft or vessel), age, sex, other medical conditions, and concurrent use of heparin had no influence on success. Of 18 cases successfully lysed and not subjected to any adjunctive therapy directed at the cause of occlusion, 9 (50%) reoccluded within 1 to 88 days (mean: 25 days). Cases successfully treated with thrombolysis and surgery or dilation of the causative stenosis had poor 1-year patencies: 17%, 20%, and 55% for vein grafts, prosthetic grafts, and native arteries, respectively. With additional urokinase treatments, surgical operations, and percutaneous procedures, 1-year patencies were 22%, 45%, and 65%, respectively.

Acute Disease↗
PubMed1989

Salvage surgery for renal cell carcinoma.

Complete surgical excision of solitary metastatic lesions in renal cell carcinoma has been reported to be associated with improved survival. An analysis of 65 outpatients undergoing excision of metastatic renal cell carcinoma is reviewed. In our series there was no significant difference among patients with solitary versus those with multiple metastasis. The overall 5-year survival was considerably lower than previously reported. We recommend that only patients with good performance status, who are participating in protocols with biological response modifiers, could potentially benefit from surgical removal of metastatic lesions.

Carcinoma, Renal Cell↗