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Joseph L. Ponka

Bio: Joseph L. Ponka is an academic researcher from Henry Ford Hospital. The author has contributed to research in topics: Diverticulitis & Pancreatitis. The author has an hindex of 15, co-authored 42 publications receiving 622 citations.

Papers
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Journal ArticleDOI
TL;DR: The most common initial symptom in this condition is diarrhea and abdominal pain, anorexia, weakness, and weight loss were more profound in patients with malignant disease as mentioned in this paper, and the most common laboratory findings were slight anemia, leukocytosis, hyperchloremic acidosis and hypoproteinemia.
Abstract: 1. 1. Sixteen cases of gastrojejunocolic and gastrocolic fistula are reported. Seven cases of gastrojejunocolic fistulas followed operations for peptic ulcers. Of the six gastrocolic fistulas caused by cancer, the primary tumor was found in the colon in three, stomach in two and pancreas in one. The remaining three cases were the result of benign inflammatory conditions other than peptic ulcer. Two of these cases were very unusual and the case histories are presented. 2. 2. The diagnosis is frequently made by history alone and is confirmed in most patients by barium enema. In others, upper gastrointestinal x-ray study is diagnostic. 3. 3. Etiologic findings, pathogenesis and clinical findings are discussed. The most common initial symptom in this disease is diarrhea. Abdominal pain, anorexia, weakness and weight loss were more profound in patients with malignant disease. 4. 4. The most common laboratory findings were slight anemia, leukocytosis, hyperchloremic acidosis and hypoproteinemia. 5. 5. Early operative correction is imperative. In untreated patients death is the result of dehydration, fluid and electrolyte loss and starvation. In the treatment of this condition the most important single surgical procedure is diversion of the fecal stream proximal to the colonic fistula. The different defunctionalizing and staged procedures are discussed. 6. 6. With the excellent pre- and postoperative care available today, the one stage procedure has become most widely used. Severe debility of a patient, despite preoperative measures, precludes the use of a one stage radical procedure which usually includes gastric and small and large bowel resections. 7. 7. In those of our cases resulting from malignancy, definitive surgical procedures were performed in two patients, and both patients survived five years or longer. One was a case of adenocarcinoma of the stomach, and the other, adenocarcinoma of the colon.

44 citations

Journal ArticleDOI
TL;DR: Femoral hernias occurred in 216 patients in a period of six years, with an overall recurrence rate of 6.5%.
Abstract: Femoral hernias occurred in 216 patients in a period of six years, with an overall recurrence rate of 6.5%. The McVay repair, used in cases of strangulation, incarceration, and recurrence, as well many routine cases, was performed upon 101 patients; the McVay Moschcowitz repair was performed upon 23 patients. There were nine recurrences (7.3%) after these two operations. The Moschcowitz repair was performed 46 times with four recurrences (9%). The Bassini operation or lower approach was utilized 44 times in uncomplicated cases, with a recurrence in only one patient (2.3%). We feel that the McVay repair has given the best overall results. The Bassini repair is recommended in selected cases.

39 citations

Journal ArticleDOI
TL;DR: This paper discusses the entity of acute pancreatitis occurring in the patient following surgery, based on a study of 26 cases collected from a surgical experience covering 23 years, and discusses symptoms compatible with postoperative hyperamylasemia.
Abstract: Acute pancreatitis is not seen frequently in the postoperative patient, but when it occurs the patient has approximately a 50% chance of survival. This highly dramatic complication is being recognized more often today. In our experience, hemorrhage, infection, anesthesia, and faulty surgical technique have progressively decreased as causes of postoperative complications, but the occurrence of hemorrhagic pancreatitis as a fatal complication of upper abdominal surgery has been increasing. This complication may occur, surprisingly enough, in a patient having surgery in an area remote from the gastrointestinal tract. In this paper we wish to discuss the entity of acute pancreatitis occurring in the patient following surgery, based on a study of 26 cases collected from a surgical experience covering 23 years. We have not concerned ourselves here with asymptomatic postoperative hyperamylasemia, which has been described often in the literature (Bergkuist, 3 Millbourn, 18 Perryman, 21 Mahaffey 17 ).). Symptoms compatible with

34 citations

Journal ArticleDOI
TL;DR: Colonic involvement as a result of pancreatitis is an uncommon but interesting complication of the disease, and in complicated cases, individualized surgical treatment becomes necessary.
Abstract: Colonic involvement as a result of pancreatitis is an uncommon but interesting complication of the disease. Among the significant manifestations we have seen are: 1) adynamic ileus of the transverse colon, 2) fibrosing, stenosing pericolitis localized to the splenic flexure area, and 3) colonic hemorrhage secondary to necrosis and fistula formation. Ordinarily, conservative treatment will suffice, but in complicated cases, individualized surgical treatment becomes necessary.

31 citations


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01 Aug 1975-Cancer
TL;DR: Ccinoids showed several differences from other kinds of tumor, including a low age for appendiceal and lung cases and low male/female and black/white ratios in the lung.
Abstract: Two thousand eight hundred thirty-seven cases of carcinoid tumor from files at the National Cancer Institute were analyzed statistically. Tumors were found in the lung, ovary, and biliary and gastrointestinal tracts. Most were in the appendix, rectum, and ileum. Age-adjusted incidence rates were higher for black males, except for lung carcinoids. Carcinoids showed several differences from other kinds of tumor, including a low age for appendiceal and lung cases and low male/female and black/white ratios in the lung. Percentages of concurrent neoplasms and multiple carcinoids were low compared to other series. Five-year relative survival rates ranged from 99% (appendix) to 33% (sigmoid colon). Survival for colon cases was not so low as expected on the basis of the high rate of metastasis. Some appendiceal carcinoids were metastatic and may have killed 1 patient. Findings are compared with other studies.

1,101 citations

Journal ArticleDOI
TL;DR: Pulmonary complications, including pulmonary edema and congestion, appeared to be the most significant factor contributing to death and occurred even in those cases where the pancreatic damage appears to be only moderate in extent, which should contribute significantly to an increase in survival in this disease.
Abstract: A large retrospective autopsy study of patients was analyzed to evaluate the major etiologic and pathologic factors contributing to fatal acute pancreatitis (AP). From an autopsy population of 50,227 patients, 405 cases were identified where AP was defined as the official primary cause of death. AP was classified according to morphological and histological, but not biochemical, criteria. Patients with AP died significantly earlier than a control autopsy population of 38,259 patients. Sixty percent of the AP patients died within 7 days of admission. Pulmonary edema and congestion were significantly more prevalent in this group, as was the presence of hemorrhagic pancreatitis. In the remaining 40% of patients surviving longer than 7 days, infection was the major factor contributing to death. Major etiologic groups in AP were chronic alcoholism; postabdominal surgery; common duct stones; a small miscellaneous group including viral hepatitis, drug, and postpartum cases; and a large idiopathic group comprising patients with cholelithiasis, diabetes mellitus, and ischemia. The prevalence of established diabetes mellitus in the AP group was significantly higher than that observed in the autopsy control series, suggesting that this disease should be considered as an additional risk factor influencing survival in AP. Pulmonary complications, including pulmonary edema and congestion, appeared to be the most significant factor contributing to death and occurred even in those cases where the pancreatic damage appeared to be only moderate in extent. Emphasis placed on the early recognition and treatment of pulmonary edema in all cases of moderate and severe AP should contribute significantly to an increase in survival in this disease.

442 citations

Journal ArticleDOI
TL;DR: It is suggested that the prophylactic removal of Meckel's diverticulum is rarely, if ever, justified and likely to incur a significant amount of postoperative morbidity from postoperative intestinal obstruction and infection.
Abstract: To determine the natural history of Meckel's diverticulum, 202 case records of proved disease of Meckel's diverticulum were retrieved, covering a fifteen year period, from all the hospitals of King County, Washington (population, 1,143,800). Using the figure of 2 per cent incidence of Meckel's diverticulum, we calculated that a Meckel's diverticulum has a 4.2 per cent likelihood of causing disease during a lifetime, decreasing to zero with old age. Using previously published mortality and morbidity figures, we calculated that to save one patient's life from the complications of Meckel's diverticulum, it would be necessary to remove approximately 800 asymptomatic Meckel's diverticula. This would be likely to incur a significant amount of postoperative morbidity from postoperative intestinal obstruction and infection. We suggest that the prophylactic removal of Meckel's diverticulum is rarely, if ever, justified.

389 citations

Journal ArticleDOI
TL;DR: In this group of patients, preoperative cardiac assessment and optimization is associated with improved outcome, and patients with a PA catheter had significantly fewer adverse intraoperative events than the control group.
Abstract: The hypothesis that optimizing hemodynamics using pulmonary artery (PA) catheter (preoperative 'tune-up') would improve outcome in patients undergoing limb-salvage arterial surgery was tested Eighty-nine patients were randomized to preoperative tune-up either in the surgical intensive care unit (SICU) (group 1) or the preinduction room (group 2) or to control (group 3) The tune-up consisted of fluid loading, afterload reduction, and/or inotropic support to achieve predetermined endpoints Patients with a PA catheter had significantly fewer adverse intraoperative events (p less than 005), less postoperative cardiac morbidity (p less than 005), and less early graft thrombosis (p less than 005) than the control group The overall study mortality rate was 34%, with a mortality rate of 95% in the control group and 15% in the PA catheter groups There were no differences in ICU length of stay (LOS), hospital LOS, or total hospital costs, although the percentage of cost from complications was higher in group 3 (p greater than 005) In this group of patients, preoperative cardiac assessment and optimization is associated with improved outcome

356 citations

Journal ArticleDOI
TL;DR: It is concluded that perioperative antibiotic prophylaxis with cefonicid is useful for herniorrhaphy and certain types of breast surgery.
Abstract: We assessed the efficacy of perioperative antibiotic prophylaxis for surgery in a randomized, double-blind trial of 1218 patients undergoing herniorrhaphy or surgery involving the breast, including excision of a breast mass, mastectomy, reduction mammoplasty, and axillary-node dissection. The prophylactic regimen was a single dose of cefonicid (1 g intravenously) administered approximately half an hour before surgery. The patients were followed up for four to six weeks after surgery. Blinding was maintained until the last patient completed the follow-up and all diagnoses of infection had been made. The patients who received prophylaxis had 48 percent fewer probable or definite infections than those who did not (Mantel-Haenszel risk ratio, 0.52; 95 percent confidence interval, 0.32 to 0.84; P = 0.01). For patients undergoing a procedure involving the breast, infection occurred in 6.6 percent of the cefonicid recipients (20 of 303) and 12.2 percent of the placebo recipients (37 of 303); for those undergoing herniorrhaphy, infection occurred in 2.3 percent of the cefonicid recipients (7 of 301) and 4.2 percent of the placebo recipients (13 of 311). There were comparable reductions in the numbers of definite wound infections (Mantel-Haenszel risk ratio, 0.49), wounds that drained pus (risk ratio, 0.43), Staphylococcus aureus wound isolates (risk ratio, 0.49), and urinary tract infections (risk ratio, 0.40). There were also comparable reductions in the need for postoperative antibiotic therapy, non-routine visits to a physician for problems involving wound healing, incision and drainage procedures, and readmission because of problems with wound healing. We conclude that perioperative antibiotic prophylaxis with cefonicid is useful for herniorrhaphy and certain types of breast surgery.

346 citations