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J S Kukora

Publications and source records attributed to J S Kukora.

At least 19 recordsLinked to original sources
PubMed2001

Integrating educational objectives and the evaluation process in a general surgery residency program.

Although the Accreditation Council for Graduate Medical Education (ACGME) requires that all of its approved residency programs have written goals and objectives and an evaluation process, many programs have difficulty achieving these goals. For eight years, the general surgery residency program at Abington Memorial Hospital has used a system that integrates each rotation's cognitive, clinical, and procedural objectives into the faculty's evaluation of residents and residents' evaluation of the rotation. The integration of goals and objectives with the post-rotation evaluations provides the program with an ongoing and continual assessment of each resident's progress, the effectiveness of the faculty as teachers, and the educational value of each rotation. In this essay, the authors describe this integrated system and provide examples of one rotation's goals and objectives and the evaluation forms used by faculty and residents.

Evaluation Studies as Topic↗
PubMed1995

Central venous catheterization via persistent left superior vena cava.

We describe the problems of clinical assessment of subclavian catheter placement whose course was noted to be along the left lateral border of the heart, suggesting malposition. After the catheter's position in a persistent left superior vena cava was confirmed by blood gas analysis, lateral chest X-ray film, and venography, the catheter was used to provide total parenteral nutrition without complications. The evaluation and workup of seeming malposition of central venous catheters and the embryologic development of a left-sided vena cava are discussed.

Aged↗
PubMed1995

Breast engorgement, false positive pregnancy tests, and ectopic gonadotrophin production with bronchogenic carcinoma.

Entopic and ectopic production of hCG is recognized to occur in a number of differing neoplasms. We describe two women in the fifth decade of life who presented with breast engorgement and false positive pregnancy tests because of ectopic hCG production in bronchogenic carcinomas. HCG served as a useful tumor marker in both women. In one patient, the recognition of elevated hCG levels led to identification of an occult, early stage bronchogenic carcinoma that was resected for cure. A search for an occult neoplasm should be undertaken in nonpregnant patients with elevated hCG levels. Because of the increasing prevalence of bronchogenic carcinoma in young women, recognition of this syndrome may become more common and facilitate the earlier diagnosis of bronchogenic carcinoma in such patients.

Adult↗
PubMed1994

Phrenic nerve injury following stretch trauma: case reports.

Phrenic nerve injuries from stretch trauma are uncommon. The setting in which they occur is often associated with more severe or obscuring injuries. Electrodiagnostic studies are helpful in establishing the presence of a phrenic nerve injury and in monitoring recovery as demonstrated by the two case reports described here. Mechanisms of injury, the anatomic factors associated with phrenic nerve injury, and management are discussed.

Adult↗
PubMed1989

Endoscopic screening and surveillance for gastrointestinal malignancy.

In the US, the cumulative lifetime risk of developing carcinoma of the upper gastrointestinal tract is less than 1 per cent, premalignant conditions are uncommon, and esophageal and gastric malignancies are rarely curable even when identified early. Endoscopic screening of the upper gastrointestinal tract in asymptomatic persons thus cannot be justified. Surveillance of persons with certain uncommon conditions associated with a higher risk of upper gastrointestinal cancer may be of benefit. These conditions include achalasia, Barrett's esophagus, chronic atrophic gastritis with intestinal metaplasia, familial polyposis coli, gastric polyps, lye stricture, Plummer-Vinson syndrome, and tylosis. In the lower gastrointestinal tract, however, the lifetime risk of developing carcinoma is 5 per cent, premalignant conditions and lesions are common, and carcinoma is curable when detected at an early stage. Sigmoidoscopic screening of asymptomatic adults has been advocated by the American Cancer Society but has not become widely practiced because of its cost, required physician effort, low overall yield, and poor patient compliance. Surveillance by flexible sigmoidoscopy is recommended for persons at slightly increased risk of colorectal carcinoma who have prior breast or gynecologic malignancy or a family history of colorectal malignancy. Colonoscopic surveillance is recommended for patients with high risk of colorectal cancer who have had prior colorectal carcinoma or adenoma or who have inflammatory bowel disease or a ureterosigmoidostomy.

Endoscopy↗
PubMed1989

All perforated ulcers are not alike.

To determine if ulcer location and other clinical factors affect the hospital course and early outcome of patients with perforated peptic ulcers in the decade since the introduction of H2 receptor antagonists, the records of 80 patients with perforated peptic ulcers were analyzed. Demographic factors, clinical features, and the outcome of patients with duodenal ulcer perforation were similar to patients with prepyloric ulcer perforation. In contrast, patients with gastric ulcer perforation had differing characteristics from the group with perforated pyloroduodenal ulcers. Overall, NSAID use preceded perforation in one half of the patients; severe coexisting medical illness and a short interval of symptoms before perforation were seen in more than one half of patients. Gastric ulcer location, hemodynamic instability, greater degree of peritoneal contamination, and larger ulcer size were factors associated with increased rates of mortality. Overall mortality rate was 12.5% and rate of morbidity was 33%. Oversewing with or without omental patch was the operation most commonly employed by a diverse group of surgeons.

Adult↗
PubMed1986

Congenital and acquired internal hernias: unusual causes of small bowel obstruction.

Fourteen cases of small bowel obstruction caused by congenital or postoperative internal herniation of bowel and treated at the University and Veterans Administration Medical Centers, Jackson, Mississippi between 1970 and 1983 were reviewed retrospectively. Of the total, eight were congenital (three transomental, two paraduodenal, one foramen of Winslow, one ileocecal transmesenteric, and one paracecal) and six acquired (three transmesenteric, one behind a Roux-Y esophagojejunostomy, one behind a Roux-Y pancreaticojejunostomy, and one between limbs of an end colostomy mucous fistula). Gangrenous bowel was present at exploration in nine cases (64 percent, five congenital and four acquired). In no case was a correct preoperative diagnosis of incarcerated or strangulated internal hernia made. In each patient, except for one who died before celiotomy could be performed, reduction of the hernia contents, resection of necrotic bowel, primary anastomosis or, on occasion, enterostomy, and correction of the anatomic defect leading to the herniation were performed. Postoperative mortality was 31 percent (four patients). Each of the four patients had presented initially with gangrenous bowel. The clinical features and management of congenital and acquired internal hernias have been reviewed and correlated with therapeutic outcome. In addition, the difficulties in diagnosis and the features of various types of these hernias have been discussed with comments made regarding prevention of the acquired forms of these rare hernias, along with the embryologic background and methods of management of the various congenital defects.

Hernia↗
PubMed1985

Extensive colonic necrosis complicating acute pancreatitis.

Segmental ischemic gangrene of the colon is a rare complication of acute pancreatitis. Three patients with long-segment colonic necrosis complicating acute pancreatitis are reported. At operation all three patients had extensive retromesocolic necrolysis associated with colonic arterial thrombosis. Colonic resection and intestinal exteriorization with peripancreatic drainage were performed, with survival of two patients. Although diagnosis of colonic ischemia in the presence of acute pancreatitis is difficult, operative therapy affords reasonable cure when this severe problem is recognized.

Acute Disease↗
PubMed1985

The continuing problem of tetanus.

Thirty-eight instances of tetanus were treated during a recent 20 year period at the University of Mississippi and Jackson Veterans Administration Medical Centers. One patient had received a single prior dose of tetanus toxoid and the remainder had never received tetanus toxoid. Sixteen patients sought medical care for their tetanus wound prior to the onset of clinical tetanus, but none received specific antitetanus prophylaxis. The majority of tetanus wounds were located on lower extremities and often were chronic vascular ulcers. The over-all mortality was 37 per cent and survival rate was not affected by patient age, duration, location or severity of the tetanus wound or presence of associated diseases. Aggressive surgical treatment of the tetanus wound was associated with decreased mortality for uncertain reasons. Although low mortality from tetanus is possible with improved intensive care technology, the disease should be virtually preventable by the provision of proper tetanus prophylaxis to all patients at risk.

Adolescent↗
PubMed1984

New computed tomographic signs of aortoenteric fistula.

Successful preoperative diagnosis of aortoenteric fistula is often difficult. Clinical findings, roentgenography, angiography, and endoscopy have been used in diagnosis with only partial success. Newer techniques of gallium citrate Ga 67 scanning, ultrasonography, and computed tomographic (CT) scanning have been used in recent years to establish the diagnosis of aortic graft infection or aortoenteric fistula. In two cases, the CT scan clearly established the diagnosis of secondary aortoenteric fistula, as well as two previously unreported signs of aortoenteric fistula: intraluminal aortic gas and paraprosthetic extravasation of contrast medium.

Aged↗
PubMed1984

Pneumatic perforation of the colon during colonoscopy. Is the hypermobile right colon a risk factor?

Perforation of the colon by pneumatic injury during colonoscopy is a rare complication. Intraoperative observations of a patient who developed massive cecal distention, pneumatosis coli and severe pneumoperitoneum during colonoscopy suggest that an isolated, air-trapping colonic segment is a factor in the mechanism of such injury. The possibility that a poorly fixed, hypermobile cecum and right colon predispose to such injury by air insufflation during colonoscopy is discussed.

Air↗
PubMed1984

Surgical management of the occluded carotid artery.

Of 36 patients with symptomatic total occlusion of the common carotid and/or internal carotid arteries, ipsilateral operation was performed in 20. Twenty-eight patients had occlusion of the internal carotid artery, four of the common carotid alone, and four had occlusion of both vessels. Thirteen patients had completed stroke. Noninvasive examination erroneously suggested internal carotid patency in three patients. Of six patients with occluded common carotid arteries, two underwent thromboendarterectomy, two underwent saphenous vein bypass, and two underwent Dacron graft bypass procedures. Five patients underwent attempted internal carotid thromboendarterectomy and three patients underwent external carotid endarterectomy. Seven patients underwent primary temporal to middle cerebral bypass procedures. There were no perioperative deaths and no patients had permanent neurologic deterioration. There were two postoperative complications. At follow-up 1 to 43 months after operation, five of six patients who had undergone common carotid revascularization had improved neurologically while other treatment groups had no definite improvement. Revascularization of an occluded common carotid artery is a safe procedure that successfully alleviates symptoms of cerebral ischemia. Internal carotid disobliteration and external carotid endarterectomy alone provide limited neurovascular benefit. Benefits of extracranial-to-intracranial bypass were not apparent from this small series.

Adult↗
PubMed1983

Adult duodenal webs. A difficult diagnosis.

Intestinal obstruction in adults caused by congenital duodenal webs is uncommon. Roentgenographic and endoscopic diagnosis is difficult owing to frequently nonspecific roentgenographic findings and the obliteration of normal pyloric endoscopic anatomy. The ultimate diagnosis of this lesion is likely to be made at the time of cellotomy for suspected obstructing peptic ulcer disease with the observation of an unobstructed pylorus. We studied three recent cases and reviewed the pertinent literature, which demonstrated problems associated with preoperative and surgical diagnosis and management. Diagnosis of duodenal webs should be suspected in all patients with gastric or high duodenal obstruction and investigated by digital duodenal exploration at the time of surgery.

Adult↗
PubMed1983

Management of leakage from gastrostomy sites.

Enlargement of a gastrostomal orifice with leakage of gastric content is a bothersome complication of a tube gastrostomy resulting in skin excoriation, fluid loss, and loss of access for enteral nutrition. Thirteen patients with this complication of a Stamm gastrostomy have been treated successfully by replacing a large gastrostomy tube with small silastic tubes for gastric aspiration and decompression and in some cases a small silastic enteral feeding catheter guided endoscopically into the duodenum through the gastric stoma. Karaya pad placement about the stoma to seal the gastric fluids from skin contact was helpful in seven patients. Stomal closure occurred in all 13 patients until a tight cutaneous closure about a 20-24 F catheter was achieved.

Catheterization↗
PubMed1977

Colonoscopic decompression of massive nonobstructive cecal dilation.

During the past three years, six patients with massive nonobstructive cecal dilation were treated by the surgical endoscopy service at the University of Michigan Medical Center. Case reports are presented on the five patients for whom decompression of the colon distention using the flexible fiberoptic colonoscope was successful. The sixth patient for whom nonoperative decompression was unsuccessful died following tube cecostomy. Colonoscopy, in our hands, has been a safe and effective method of nonoperatively decompressing the dilated cecum in seriously ill patients with a variety of severe associated conditions.

Aged↗
PubMedDate not supplied

Teaching surgical endoscopy of the gastrointestinal tract.

Surgical endoscopy, or the utilization of endoscopic techniques in the diagnosis and treatment of surgical disease, is an integral part of the practice of modern gastrointestinal surgery and the training of surgical residents. In addition to information crucial to preoperative evaluation and postoperative surveillance, endoscopy offers alternative therapeutic and complementary intraoperative options. Surgical endoscopy can be taught as part of an integrated residency experience, a separate endoscopy rotation, a postresidency fellowship, or an individually-arranged preceptorship. Each method of teaching has relative advantages and disadvantages. The 3 surgical endoscopy training programs with which the authors have been associated include an integrated experience, a separate endoscopy rotation followed by an integrated experience, and a preceptorship followed by an integrated experience.

Digestive System Surgical Procedures↗