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Biomedical subjects

J L Ponsky

Publications and source records attributed to J L Ponsky.

At least 19 recordsLinked to original sources
PubMed1992

Inguinal dermoid cyst presenting as an incarcerated inguinal hernia.

A case of an inguinal dermoid cyst presenting as an incarcerated inguinal hernia in a 18-year-old boy is reported. A differential diagnosis of masses in the inguinal region is discussed and includes not only hernias but also gynecologic and vascular lesions. Dermoid cysts must be included in the differential diagnosis. Histologically, these cysts are characterized by an external lining composed of squamous epithelium with an underlying fibroconnective tissue containing hair follicles, sebaceous, eccrine, and apocrine glands. The presence of all the skin appendages in these cysts distinguishes them from epidermoid and sebaceous cysts. The lack of structures foreign to skin differentiates them from dermoids (benign cystic teratomas) in the ovarian, testicular, retroperitoneal, and sacrococcygeal region.

Abdominal Neoplasms↗
PubMed1992

Alternative methods in the management of bile duct stones.

Common bile duct stones may now be dealt with, in most cases, without the need for surgery. To be sure, surgery continues to remain the gold standard for duct clearance and treatment of biliary sepsis. Improvements in endoscopic and radiologic technology and methodology have permitted excellent access to the biliary tree by the transduodenal and transhepatic approaches. In the majority of patients, total duct clearance and excellent drainage can be accomplished, averting sepsis and the need for open surgery.

Cholangiography↗
PubMed1991

Endoscopy in gastric malignancy.

Gastric cancer remains, in most parts of the world, a disease of advanced presentation and associated resistantly high mortality. To date, fiberoptic endoscopy has yet to change this seemingly inexorable fact. Nevertheless, endoscopy plays a vital role in the evaluation and diagnosis of the gastric cancer patient and provides palliative options to patients suffering from advanced disease that may not respond to other modalities. With the advent of endoscopic screening protocols identifying cases at an early stage, there is early epidemiologic evidence of impact on the mortal consequences of this disease in high incidence areas such as Japan. Endoscopic ultrasound, flow cytometry of endoscopic biopsies, and photodynamic techniques offer the prospect of increasing definition of gastric malignancy prior to therapy, and new endoscopic therapies await further study to define their potential role in treating early cancer non-operatively. Twenty years ago, scientists intent on the study of gastric neoplasia played a major role in the advent of fiberoptic endoscopy. To date, their reward has been a wealth of information. As this material is digested and applied, it seems reasonable to believe their efforts may be eventually rewarded by a reduction in the epidemiologic impact of this disease, brought about not by changing global incidence patterns, but by knowledge and technology derived and administered endoscopically.

Biopsy↗
PubMed1991

A simple method of infundibular retraction during laparoscopic cholecystectomy.

Laparoscopic excision of the gallbladder has rapidly become a preferable technique for treating patients with symptomatic cholelithiasis. To date, new developments in instrumentation have hardly been able to keep pace with the rising popularity of this method. The use of techniques applied to other areas of endoscopy may be useful when adapted to laparoscopic surgery. We discuss herein the use of a standard colonoscopic polypectomy snare for retraction of the gallbladder during laparoscopic cholecystectomy. This adaptation facilitates the procedure and avoids the need for an additional trocar puncture.

Cholecystectomy↗
PubMed1991

Tract formation following percutaneous endoscopic gastrostomy in an animal model.

Complications of percutaneous endoscopic gastrostomy (PEG) have often been related to the application of excessive traction to the gastrostomy tube in an attempt to achieve immediate juxtaposition of the gastric and abdominal walls. Recent clinical reviews have suggested that complication rates can be reduced by avoiding such traction and leaving a longer tract between these structures. Laboratory evaluation of tract development has been lacking. The present study was designed to evaluate tract formation in an animal model. Eight mongrel dogs underwent PEG placement using silastic (n = 4) or latex (n = 4) catheters. Two animals from each group were subsequently sacrificed at 1 week and the remaining animals, at 2 weeks. In each animal, 6 cm catheter length was left between the gastric and the abdominal walls. This distance was assured by crossbar and suture fixation of the catheter at the skin entry site. Complete tract formation was evident in all animals at the time they were sacrificed, with no significant gross or histologic differences being noted between the silastic and the latex groups. Increased collagen deposition was noted at 2 weeks in comparison with that observed at 1 week. In an additional three animals, the same procedure was performed, but the catheter was not secured to the abdominal wall at the site of skin penetration. In these animals, tract formation was incomplete as late as at 2 weeks, but there were no associated complications. We conclude that early PEG tract formation is not dependent on the immediate proximity of the gastric and abdominal walls. The type of catheter used does not dictate the time course of early tract development.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗
PubMed1991

Complications of laparoscopic cholecystectomy.

The emergence of laparoscopic cholecystectomy as a viable alternative to traditional cholecystectomy has been greeted with enthusiasm by the surgical community. This new technique is not without complications, both potential and real. The complications associated with diagnostic laparoscopy are well documented, as are those associated with traditional cholecystectomy. All of these may also be seen with laparoscopic cholecystectomy. The incidence of their occurrence, however, may vary. It remains too early to evaluate the complication rates from this new procedure, as reports of large series are just beginning to emerge. Early reports are encouraging but caution that bile duct injury, hemorrhage, and even death may occur. Early enthusiasm for this new method must be tempered with care in its practice if complication rates are to be maintained at an acceptable level and the procedure is to earn a permanent place in the armamentarium of the surgeon.

Bile↗
PubMed1991

Bleeding after endoscopic sphincterotomy as an underestimated entity.

Hemorrhage is the most frequent complication of endoscopic sphincterotomy, with a reported incidence of 2 to 9 per cent. Previous reports have generally defined this complication clinically, leaving the issue of occult bleeding after sphincterotomy essentially unaddressed. Seventy-five serial sphincterotomies were reviewed to further assess this complication. Nine patients had clinically evident hemorrhage and 27 patients had occult bleeding manifested only by a decrement in hematologic parameters, for a total postsphincterotomy bleeding rate of 48 per cent. No statistically significant risk factors for bleeding were delineated. Endoscopically recognized bleeding at the time of the sphincterotomy was 47 per cent sensitive and 85 per cent specific in predicting postprocedural bleeding. Significant delayed hemorrhage was manifest in three patients, one of whom had clinically occult bleeding. We conclude that bleeding complicates endoscopic sphincterotomy much more frequently than previously reported, although often in a clinically occult manner. Significant delayed bleeding can occur, and may not be clinically apparent. Bleeding recognized endoscopically at the time of sphincterotomy is an insensitive but relatively specific predictor of postprocedural bleeding. As use of endoscopic sphincterotomy increases, careful surveillance for hemorrhagic complications, as well as efforts to identify factors predisposing to the same, will be of increasing importance.

Aged↗
PubMed1990

Evaluation of safe, effective intravenous sedation for utilization in endoscopic procedures.

The prevention of anesthetic mishaps during endoscopic procedures is of great importance to physicians in training. With the large number of such procedures performed each year, even infrequent adverse anesthetic reactions may result in a significant number of problems. To establish the safety and efficacy of an anesthetic regimen using intravenous meperidine and diazepam, all endoscopic procedures performed at one teaching institution in a 4-month period were retrospectively analyzed with regard to: (1) type and dosage of sedation/anesthesia, (2) endoscopic procedure involved, (3) effect of any underlying disease state, (4) side effects, (5) endoscopic complications, and (6) overall patient acceptance. A total of 716 patients underwent 913 endoscopic procedures with 876 separate anesthetic/intravenous sedations. General anesthesia was utilized in 44% of the 155 pediatric procedures. In the adult patients, intravenous sedation was administered by a physician-in-training under supervision except in 9% of cases (66 patients) when intravenous sedation utilizing alternative agents was given by the anesthesia department. The dose of sedation used (per body weight) declined with increasing age in the pediatric group (0-19 years). The adult dose remained constant for the next eight decades of life (meperidine 0.76 +/- 0.33 mg/kg: diazepam 0.12 +/- 0.08 mg/kg). In the adult group, 758 procedures were performed: 371 patients underwent esophago-gastroduodenoscopy, 258 colonoscopy, 36 endoscopic retrograde cholangiopancreatography, 40 flexible sigmoidoscopy, and 51 percutaneous endoscopic gastrostomy. Anesthetic-related complications (transient apnea and itching), were noted in two patients, and naloxone was utilized to reverse oversedation in a further 17 (2.56%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Endoscopic retrograde cholangioscopy. An adjunct to endoscopic exploration of the common bile duct.

Choledochoscopy is an accepted technique in the operative exploration of the common bile duct, and is complimentary to operative cholangiography. Retrograde cholangiography can be achieved perorally in up to 97 per cent of patients and it is reasonable to assume that the use of complimentary cholangioscopy in such patients would help to improve the accuracy of bile duct examination just as it does when applied in the operative setting. We have had the opportunity to use a new technology in the endoscopic evaluation of the common bile duct. An endoscopic retrograde cholangioscopy (ERCP) is first performed and ductal anatomy outlined. When indicated, an endoscopic sphincterotomy is performed. If large stones are present they are removed with a balloon or basket. The standard side-viewing endoscope is then removed and replaced with the large channel, side-viewing scope. A "baby" scope is introduced through the "mother" scope and canulation of the common duct with the "baby" scope is performed. Biopsies and brushings of lesions may be obtained and numerous instruments are available for manipulation through the biopsy channel of the "baby" scope. The use of retrograde cholangioscopy as an adjunct to retrograde cholangiography should provide the same advantages that have been demonstrated with the use of operative choledochoscopy. Use of this instrument will allow the endoscopist to accurately identify questionable lesions seen on the cholangiogram, selectively canulate particular biliary radicals, biopsy lesions of the common duct, and perhaps intervene therapeutically in selected biliary tract lesions.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1990

Endoscopic retrograde cholangiopancreatography in a general surgery practice.

Endoscopic retrograde cholangiopancreatography (ERCP) is performed for the diagnosis and therapy of benign and malignant biliary and pancreatic disease. There are few reports in the literature regarding the incorporation of this procedure into a general surgery practice. One hundred seven consecutive ERCPs performed by the same surgeon over a two-year period were reviewed. The most frequent indications for ERCP were jaundice, suspected common bile duct stones, and a history of pancreatitis. Successful cannulation of the ampulla of Vater was achieved in 97 per cent of the cases with the desired duct being adequately visualized in 90 per cent of the cases. Sphincterotomy was performed in 42 per cent of the procedures and common bile duct stones were removed with a balloon or basket catheter. The overall complication rate was seven per cent with no mortality. ERCP accounted for 20 per cent of all endoscopies and 12 per cent of all procedures performed by the surgeon. Twelve per cent of these patients were subsequently operated upon by the surgeon while another 16 per cent requiring surgery were returned to the referring physician. This study supports the feasibility of the incorporation of ERCP into a general surgery practice.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1989

Percutaneous endoscopic stomas.

Percutaneous endoscopic gastrostomy was introduced in 1980 as a method for the creation of a feeding gastrostomy without the need for laparotomy or general anesthesia. The technique originally described, the pull method, involves puncturing the apposed gastric and abdominal walls under endoscopic control. A suture is then passed from the exterior into the gastric lumen and grasped with a snare. The suture is pulled out of the mouth, affixed to the end of a gastrostomy tube, and then pulled back down into the stomach. The gastrostomy tube is thus pulled into the stomach, and its end exits the abdominal wall. Modifications of this technique have included pushing the gastrostomy tube over a guidewire (the push method) and direct puncture of the stomach under endoscopic control with an introducer and outer peel-away sheath. All of these methods have been used with good results. Complications have included infection of the abdominal wall and intraperitoneal leakage. These may be minimized by attention to detail. The indications for the method have been expanded to include gastric decompression, administration of unpalatable medications in children, and creation of a conduit for bile replacement. Careful judgment in patient selection is crucial if good results are to obtained. This technique also introduces the concept of percutaneous endoscopic fixation of a loop of bowel to the abdominal wall. This concept may be employed in other areas of the gastrointestinal tract.

Endoscopy↗
PubMed1989

Simple modification of the Gavriliu-Heimlich gastric tube.

A modification of the Gavriliu-Heimlich reversed gastric tube technique is described. We successfully used this method on eight patients. This procedure is more technically simple than the Gavriliu-Heimlich technique, and it avoids the necessity of splenectomy.

Esophagus↗
PubMed1988

Bezoars: classification, pathophysiology, and treatment.

Bezoars, accumulations of foreign material in the stomach, have been known to occur in animals and man for centuries. The incidence of bezoars in human patients has increased as a result of operative manipulation of the gastrointestinal tract. Composed of vegetable matter, hair, or more unusual materials like shellac or cement, they may lead to anorexia, weight loss, bleeding, obstruction, or perforation of the alimentary tract. Although this entity is often recognized radiologically, endoscopy provides the most accurate means for identification and classification. Many bezoars can be removed endoscopically, but some will require operative intervention. Once removed, emphasis must be placed upon prevention of recurrence. Physicians must learn to recognize and classify bezoars correctly in order to provide the most appropriate therapy in each instance.

Bezoars↗
PubMed1987

Endoscopic sphincterotomy and removal of pancreatic duct stones.

Chronic pancreatitis may be associated with pancreatic duct dilatation and ductal stones. Such stones are undoubtedly the result of chronic pancreatitis and stasis within the ductal system and may themselves serve to exacerbate ductal obstruction and recurrent episodes of pancreatitis. Endoscopic sphincterotomy has been used to relieve common duct obstruction secondary to biliary stones. This report suggests that sphincterotomy may also be used to approach selected patients who have pancreatic duct stones and recurrent pancreatitis. The technique involves a preliminary ERCP followed by standard endoscopic sphincterotomy with the papillatome positioned in the bile duct. A balloon catheter is then directed into the pancreatic duct orifice to extract ductal calculi. Although the main duct may be cleared, side branches are more difficult, and perhaps unnecessary, to clear. This method has provided relief of pain in a limited series of patients and may mark the beginning of a more aggressive approach to pancreatic endoscopy.

Calculi↗