PubMed Health⌕ Search

Biomedical subjects

Todd A Ponsky

Publications and source records attributed to Todd A Ponsky.

10 recordsLinked to original sources
PubMed2006

Colon cancer metastatic to the lung and the thyroid gland.

The clinical diagnosis of primary thyroid cancer is uncommon, constituting 1.5% of all cancers in the United States. Clinically diagnosed metastatic cancer to the thyroid gland is rare. Colon cancer is one of the most common cancers in the United States, with a high propensity to metastasize; 30% to 40% of patients have metastatic disease at the initial diagnosis. The most common sites of metastasis from colon cancer are the regional lymph nodes, the liver, the lung, and the peritoneum. Colon cancer metastasis to the thyroid gland is rare, with only a few reported cases, mainly in the pathology literature. These cases describe metastasis from colon cancer to the thyroid gland that became apparent years after the initial diagnosis of colon cancer and were usually associated with dissemination to the liver, the lung, or both. We report a case of colonic adenocarcinoma metastatic to the thyroid gland and lung without involvement of the liver. A review of the literature is also included.

Adenocarcinoma↗
PubMed2006

Open, intraperitoneal, ventral hernia repair: lessons learned from laparoscopy.

Recent literature suggests that laparoscopic repair of ventral hernias may have very low recurrence rates. However, laparoscopy may not be feasible in certain situations. We describe an open technique that uses the tension-free retrofascial principles of laparoscopic repair without the need for subcutaneous flaps. Through an incision in the hernia, the peritoneum is entered and adhesions are taken down. A piece of DualMesh (W.L. Gore & Associates, Inc, Newark, Del) is trimmed to fit with a 5-cm circumferential overlap. A vertical incision is made in the mid portion of the mesh. The mesh is fixed in an intraperitoneal retrofascial position using GORE-TEX sutures (W.L. Gore & Associates, Inc). The sutures are brought through the abdominal wall using a laparoscopic suture passer and tied into place on one side of the mesh. That side is then tacked to the posterior fascia with a spiral tacking device. The other side is sutured into place in a similar fashion and then tacked to the fascia by passing the spiral tacking device through the incision in the mesh. The mesh incision is closed with a running GORE-TEX suture. The overlying tissues are closed in layers.

Digestive System Surgical Procedures↗
PubMed2005

Brachial artery occlusion secondary to hypereosinophilic syndrome.

Hypereosinophilic syndrome (HES) is characterized by an overproduction of eosinophils that leads to organ damage. Although most cases of HES frequently affect the lungs, heart, and gastrointestinal tract, there are a few reported cases of peripheral vascular involvement. We report a case of a patient with a history of colonic HES who presented with idiopathic occlusion of the brachial artery. A 28-year-old woman with a recent history of eosinophilic colitis presented with a several-week history of left hand pain, pallor, and paresthesias. Her hand was cool, without palpable pulses. Her eosinophilia count was 38%. An arteriogram documented a left brachial artery occlusion and diffuse left arm vasospasm. A brachial-to-brachial bypass was performed. Postoperatively, there was extensive vasospasm of her distal upper extremity arteries, which was treated with calcium-channel blockers and steroids. Her symptoms resolved and she has been asymptomatic for 9 months. The segment of occluded artery was found to contain many eosinophils on histologic examination. HES of the arterial system is an exceedingly rare cause of occlusion. Our patient presented with eosinophilia, arterial vasospasm with subsequent occlusion, and the presence of eosinophilic infiltration on the pathologic specimen. These data, combined with the patient's previous history, demonstrate that the patient's occlusion may have been secondary to HES.

Adult↗
PubMed2005

Surgical therapy for biliary dyskinesia: a meta-analysis and review of the literature.

BACKGROUND: Although biliary dyskinesia is treated commonly with cholecystectomy, the supporting literature is limited. A review and meta-analysis of the literature were performed to assess the efficacy of surgical therapy for biliary dyskinesia. MATERIALS AND METHODS: A MEDLINE search for the period 1965 to 2003, using the search strings "biliary," "acalculous," "dyskinesia," "cholecystitis," "cholecystectomy," and "therapy" returned 187 articles. Inclusion criteria required a study design that placed patients with biliary dyskinesia into one of two treatment groups, cholecystectomy or nonoperative therapy, and a follow-up assessment of symptomatic improvement. RESULTS: Five studies met the inclusion criteria, representing a total of 274 patients. Surgical therapy resulted in 98% symptomatic relief compared to 32% with nonoperative management (P<0.0001). Patients undergoing surgical therapy for biliary dyskinesia were 2.79 times more likely to have symptomatic relief versus nonoperative therapy (95% confidence interval, 2.05-3.79). CONCLUSION: Based on this meta-analysis, cholecystectomy for biliary dyskinesia is an effective therapy and offers significant symptomatic relief over nonoperative therapy.

Biliary Dyskinesia↗
PubMed2005

Urachal remnant small bowel obstruction: report of two adult cases.

This report describes two separate cases of adult patients with intestinal obstruction caused by an urachal remnant. While reports of infected urachal cysts causing intra-abdominal pathology are not uncommon, intestinal obstruction caused by urachal remnants is exceedingly rare in the pediatric population and has never been described in adults. Both of these patients required surgical intervention with excision of the urachal remnant and subsequent resolution of the small bowel obstruction.

Adult↗
PubMed2005

Analysis of head injury admission trends in an urban American pediatric trauma center.

BACKGROUND: Head injury is the leading cause of death in children. Child safety legislation and risk-specific intervention programs have flourished to mitigate the incidence of injury to children. This analysis documents the trend in head injury to children in a specific institution. METHODS: Analysis of 5,003 head injury admissions to a pediatric trauma center over thirteen years was performed. Admission rates were calculated using the appropriate population denominator from census data. Poisson regression analysis was applied to estimate the relative risk of head injury admission by year in different age, sex, mechanism of injury and severity group. RESULTS: There has been a 70% decline in the head injury admission rate since 1989, consistent with regional and national data. The decline was present in all mechanisms of injury and age groups except for less than 1 year of age. The decline in total trauma admissions over the same time period was 50% and the decline in total hospital admission was 10%. CONCLUSION: Pediatric head injury has significantly declined in the last 13 years at a Level I pediatric trauma center.

Adolescent↗
PubMed2004

Hospital- and patient-level characteristics and the risk of appendiceal rupture and negative appendectomy in children.

CONTEXT: The rates of appendiceal rupture and negative appendectomy in children remain high despite efforts to reduce them. Both outcomes are used as measures of hospital quality. Little is known about the factors that influence these rates. OBJECTIVE: To investigate the association between hospital- and patient-level characteristics and the rates of appendiceal rupture and negative appendectomy in children. DESIGN, SETTING, AND PATIENTS: Retrospective review using the Pediatric Health Information System database containing information on 24,411 appendectomies performed on children aged 5 to 17 years at 36 pediatric hospitals in the United States between 1997 and 2002. MAIN OUTCOME MEASURES: Rates of negative appendectomy and appendiceal rupture; the odds ratio (OR) of negative appendectomy and appendiceal rupture by hospital, patient age, race, and health insurance status, and hospital fiscal year and appendectomy volume. Negative appendectomy rate was defined as the number of patients with appendectomy but without appendicitis divided by the total number of appendectomies. RESULTS: The median negative appendectomy rate was 3.06% (range, 1%-12%) and the median appendiceal rupture rate was 35.08% (range, 22%-62%). The adjusted OR for appendiceal rupture was higher in Asian children (1.66; 95% confidence interval [CI], 1.24-2.23) and black children (1.13; 95% CI, 1.01-1.30) compared with white children. Children without health insurance and children with public insurance had increased odds of appendiceal rupture compared with children who had private health insurance (adjusted OR, 1.36; 95% CI, 1.22-1.53 for self-insured; adjusted OR, 1.48; 95% CI, 1.34-1.64 for public insurance). No correlation existed between negative appendectomy rate and race, health insurance status, or hospital appendiceal rupture rate. The negative appendectomy rate improved as the hospital appendectomy volume increased. CONCLUSION: The rate of appendiceal rupture in school-aged children was associated with race and health insurance status and not with negative appendectomy rate and therefore is more likely to be associated with prehospitalization factors such as access to care, quality of care, and patient or physician education.

Adolescent↗
PubMed2003

Lower gastrointestinal bleeding from ileostomy takedown site 2 years after operation.

This case involves a 31-year-old man who presented with lower gastrointestinal bleeding from a perianastomotic ulcer 2 years after surgery. This report reviews the literature and suggests that perianastomotic ulcers may be underrecognized as delayed complications of side-to-side small bowel anastomosis. This report also demonstrates the value of push enteroscopy via the rectum in making the diagnosis.

Adult↗
PubMed2002

Laparoscopy is useful in the diagnosis and management of foramen of Morgagni hernia in children.

Foramen of Morgagni hernia is a rare form of congenital diaphragmatic hernia. We report the use of laparoscopy to diagnose and manage suspected foramen of Morgagni hernias in children. Cardiophrenic masses were seen on chest radiography in two asymptomatic children aged 1 and 3 years. Further radiologic workup was nondiagnostic. Laparoscopy was performed in both children, and the foramen of Morgagni hernias were immediately identified. Laparoscopic repair was performed on one of the children. Both children had uneventful postoperative courses, were discharged home early, and had no evidence of recurrence at the 6-month follow-up examination. Laparoscopy is a safe and effective technique to diagnose and potentially repair foramen of Morgagni hernias. We recommend the use of this modality as the primary diagnostic evaluation in infants and children with suspected foramen of Morgagni hernias.

Child, Preschool↗