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Biomedical subjects

J L Ponsky

Publications and source records attributed to J L Ponsky.

At least 91 records · Page 5Linked to original sources
PubMed1986

Evolving trends in enteral alimentation.

Nutrition has become a cornerstone of surgical patient care. With better understanding of metabolic and compositional requirements, great advances have been made in the area of total parenteral nutrition. Recent attention to full utilization of alimentary tract function has prompted a resurgence of interest in dietary formulas and methods of delivery. Three new approaches to the alimentary tract provide better access for feeding. Needle catheter jejunostomy allows early alimentary tract utilization following operations, while percutaneous endoscopic gastrostomy and jejunostomy provide long-term solutions to the provision of enteral alimentation. Future utilization of these techniques will certainly lead to better patient care.

Catheterization↗
PubMed1986

Plasmacytoma of the ileum complicating Crohn's disease: report of a case and review of the literature.

Portions of the gastrointestinal tract involved with Crohn's disease are at increased risk of undergoing neoplastic change. Most of these neoplasms are adenocarcinomas. We recently encountered the first reported patient with a solitary plasmacytoma of the ileum arising in an area of preexisting active Crohn's disease. This case is presented along with a review of the literature dealing with lymphoproliferative disorders in bowel affected with Crohn's disease.

Aged↗
PubMed1986

Pancreatic injuries. Effectiveness of debridement and drainage for nontransecting injuries.

Injuries to the pancreas are encountered infrequently and are associated with significant morbidity and mortality. Controversy regarding the management of these injuries exists between the advocates of resection and the advocates of simple debridement and drainage. A retrospective review of 42 patients suffering injuries to the pancreas between 1969 and 1982 at the authors' institution was undertaken. Operative pancreatography was not performed, and all injuries were managed by debridement and drainage unless complete transection of the pancreas was present. The results support the use of debridement and drainage of nontransecting pancreatic injuries.

Abscess↗
PubMed1985

Percutaneous approaches to enteral alimentation.

Feeding gastrostomy and jejunostomy provide effective access for long-term enteral nutrition. Traditional operative techniques for the performance of these procedures requires laparotomy and often, general anesthesia. This report describes our experience with two relatively new methods, percutaneous endoscopic gastrostomy and percutaneous endoscopic jejunostomy. Results of percutaneous gastrostomy and jejunostomy to date in 323 cases include a morbidity of 5.9 percent and a 0.3 percent operative mortality. Percutaneous endoscopic gastrostomy and jejunostomy should become the procedures of choice for the establishment of enteral access in patients requiring long-term enteral alimentation.

Adolescent↗
PubMed1985

Effects of 5-fluorouracil on the healing of bowel anastomosis in rats.

This study looks at the effects of 5-Fluorouracil (5-FU) on surgical wound healing. A small bowel anastomosis was done 10 cm distal to the duodenum in rats. 5-FU was given by intramural infiltration on both sides of the suture line. Five, 10, and 20 mg of 5-FU were given in single doses. The control groups were given normal saline in the same manner. All groups were examined on days 4, 7, 8, and 12 postoperatively. The following methods were used to evaluate the anastomotic site: 1) bursting pressure measurements for tensile strength, 2) microangiography (micropaque), and 3) histopathologic sections. During the first 3 days postoperatively, the bowel had not healed sufficiently to permit significant bursting pressure measurements. Analysis of bursting pressure data and examination of the histopathologic sections showed no significant difference between the control groups and the 5-FU groups. Microangiography showed impaired dye distribution in the 5-FU groups during the first 4 to 6 days postoperatively. The control groups exhibited normal dye distribution. From day 7 on, the distribution in all groups became normal. Impaired dye distribution was the only measurable macroscopic change caused by intramural 5-FU administration. 5-FU injections had no apparent effect on anastomotic strength.

Animals↗
PubMed1984

Medullary carcinoma of the breast: an association with negative hormonal receptors.

The records of all patients undergoing breast surgery at one institution over a 6-year period were retrospectively reviewed. Twenty-two cases were found to meet the criteria for designation as medullary carcinoma of the breast. Estrogen receptor assay was performed in 20 cases and was negative in 75% of these patients; those with positive estrogen receptor assay had very low values. Progesterone receptor assay was performed in 10 of these patients and was found to be negative in 9. The one positive value was very low. Medullary carcinoma of the breast, in spite of a generally favorable prognosis, shows a consistent relationship with negative hormonal receptors.

Adult↗
PubMed1984

Blood transfusion and disease-free survival in carcinoma of the breast.

A retrospective study was undertaken to determine the effect of perioperative blood transfusion on disease-free survival rates in patients with carcinoma of the breast. The charts of 81 patients participating in a NSABP breast cancer protocol at The Mt. Sinai Medical Center, Cleveland, Ohio, were reviewed. There was no statistically significant difference in disease-free survival between those patients receiving blood transfusions and those that did not when considering the entire group of patients or subgroups based upon age, nodal status, estrogen receptor status, or progesterone receptor status. However, the subgroup of patients receiving tamoxifen chemotherapy, especially those with positive estrogen receptors, had significantly reduced disease-free survival (P less than .05) when given blood transfusions. These results suggest an adverse effect of blood transfusion on disease-free survival in breast cancer patients treated with tamoxifen chemotherapy.

Adult↗
PubMed1984

Percutaneous endoscopic gastrostomy following previous abdominal surgery.

During a 36-month period, 89 patients have undergone percutaneous endoscopic gastrostomy without mortality. Of these patients, 25 (13 infants and children, 12 adults) had prior abdominal procedures that increased their risk for the endoscopic procedure. With two exceptions, all gastrostomies were performed utilizing local anesthesia. There was one major complication, a gastrocolic fistula, which was successfully managed by repeating the endoscopic gastrostomy procedure at a location more cephalad in the stomach. Twenty-two of the gastrostomies were placed for feeding purposes and all of these patients were able to leave the hospital with alimentation accomplished via the tube. Three of the endoscopically placed gastrostomies were for gastrointestinal tract decompression. A total of 255 patient months have been accumulated in these patients with the endoscopically placed gastrostomy in situ. The technique can be safely performed in patients with prior abdominal surgery and in the majority of cases is the technique of choice for establishing a tube gastrostomy.

Adolescent↗
PubMed1984

Effects of corticosteroid on the healing bowel anastomosis.

Conflicting results have been reported as to whether or not wound healing is retarded following treatment with corticosteroids. The surgical literature is lacking information on the effects of steroids on the healing bowel anastomosis. It has seemed reasonable to evaluate the bursting pressure, blood supply, and histologic changes of the bowel anastomosis in rats systemically pretreated with various doses of steroids. Male albino rats were pretreated with corticosteroids for 14 days in 20, 10, and 5 mg/kg of hydrocortisone acetate (intramuscular injection). A small bowel loop was divided and reanastomosed in each group (10 test and 5 control animals). The anastomosis was subsequently tested after 4, 5, 7, and 10 days. Three different methods of testing were used: 1) bursting pressure; 2) microangiography; and 3) histologic study. Large doses of 20 and 10 mg/kg of steroid deteriorated the test rats, significantly reducing the healing process within these 10 days as compared with the control rats. The 5 mg/kg group showed differences in bursting pressure only between the 4th and 7th postoperative days (statistical significance). Microangiography and histologic changes were not significant between the test and control rats. These results demonstrate decreased bursting pressure in steroid pretreated rats between the 4th and 7th postoperative days. These results may have implications regarding the care of steroid treated patients undergoing intestinal surgery.

Animals↗
PubMed1983

Percutaneous endoscopic gastrostomy. Review of 150 cases.

Percutaneous endoscopic gastrostomy was performed on 50 children and 100 adults from June 1979 to May 1982 at Case Western Reserve University Hospitals and the Mt Sinai Medical Center in Cleveland. Morbidity was low (10%), and there were no procedure-related deaths. Complications included minor wound infections in seven patients early in the series, extrusion of the tube in three, unnecessary laparotomy in two suspected of having problems with the tube early in the series, a partial separation of the gastrostomy from the abdominal wall in one adult, and gastrocolic fistula in one adult and one child. The last condition disappeared after removal of the gastrostomy tube in both patients. No leakage around the catheter, hemorrhage, peritonitis, or gastric outlet obstruction was encountered. This procedure provided a rapid, safe, and effective method for creating a feeding gastrostomy and did not require general anesthesia and laparotomy. Percutaneous endoscopic gastrostomy should become the method of choice for the creation of a feeding gastrostomy.

Adolescent↗
PubMed1983

Hepatocellular carcinoma metastatic to rib: an approach to an unusual chest wall tumor.

Thoracic cage tumors are infrequently encountered and may present a dilemma in diagnosis and treatment. A case of hepatocellular carcinoma metastatic to rib, an unusual chest wall tumor, is presented here, and an orderly and effective approach to chest wall lesions is described. Computerized tomography and biopsy are the most efficacious diagnostic modalities.

Biopsy↗
PubMed1982

Transverse testicular ectopia.

In transverse or crossed testicular ectopia, the affected gonad lies in the same canal as the normally descended testis. During a 5-yr span, three children with this form of ectopia were seen. All presented with a symptomatic right inguinal hernia and an empty scrotum on the left side. The ages at operation were 1, 3, and 5 mo. Only the first patient was reoperated. In this child, the diagnosis of transverse testicular ectopia was made during the herniorrhaphy and the ectopic, but otherwise normal, gonad returned to the abdominal cavity. A subsequent left orchidopexy through a celiotomy was done. In the last two patients, the correct diagnosis was made preoperatively. Both gonads were of equal size and normal, occupying the same hemiscrotum. A herniorrhaphy with fixation of the ectopic gonad to the opposite hemiscrotum was done in both. All three children are otherwise normal. Cases collected from the literature are discussed. The condition should be suspected if a unilateral hernia is associated with a contralateral, nonpalpable testis and may not be as rare as formerly thought.

Child, Preschool↗
PubMed1982

External biliary-gastric fistula: a simple method for recycling bile.

External biliary drainage is often required to relieve bile duct obstruction. Most often this is a temporary situation and internal drainage is soon established by means of surgery or by transhepatic biliary stents placed through the obstruction into the duodenum. When internal drainage cannot be established and external biliary losses are prolonged, malabsorption, dehydration, and electrolyte imbalance may ensue. In this report we present two such cases in which an external biliary-gastric fistula was created by connecting the biliary drainage catheter to a percutaneous endoscopic gastrostomy. In both cases internal diversion was effectively achieved. We believe this technique warrants consideration in those patients otherwise committed to prolonged external biliary drainage.

Biliary Tract Diseases↗