Biomedical subjects

P J Kovalcik

Publications and source records attributed to P J Kovalcik.

At least 19 recordsLinked to original sources

PubMed1988

Anterior sacral meningocele and the scimitar sign. Report of a case.

Anterior sacral meningocele is an unusual lesion that usually presents as a presacral mass. This is a case presentation of a young woman who presented with amenorrhea. On physical examination, a large presacral mass was found. Ultrasonography revealed a large cystic structure. Radiography of the pelvis demonstrated a sacral deformity or "scimitar sign" that is pathognomonic for anterior sacral meningocele. The diagnosis was confirmed by computed tomography with myelographic enhancement.

Adult↗

PubMed1985

Ogilvie's syndrome developing after ethanol ablation of renal cell carcinoma.

Urological procedures frequently are implicated as a cause of Ogilvie's syndrome. We report the first case of Ogilvie's syndrome following ethanol ablation of a renal cell carcinoma. The urologist must be alert to the development of this complication. If recognized early and managed correctly long-term morbidity from this complication is minimal.

Adult↗

PubMed1985

Anal lesions. When to suspect carcinoma.

Anal carcinoma appears in a variety of forms and may be easily confused with a benign disorder. Diagnosis must be confirmed by biopsy. All anal lesions require careful evaluation and follow-up to ensure resolution of benign disease or proper treatment of malignancy.

Anal Canal↗

PubMed1984

Obstructing left-sided colon carcinoma. Appraisal of surgical options.

This study is a retrospective analysis over a 10-year period of 37 patients who presented with a large bowel obstruction secondary to a left-sided colon cancer. Our patients were confined to those with clinical evidence of acute obstruction with lesions located from the mid-transverse colon to the rectum. Thirty-eight per cent of these lesions occurred at the sigmoid level. We found 70 per cent of these lesions were treated with resection at their initial operation. Eighty-one per cent of all lesions were classified as Duke's C or D. There was a 33 per cent 5-year survival. These patients were evaluated for their initial surgical therapy and subsequent mortality and morbidity.

Adult↗

PubMed1983

Cholecystectomy concomitant with other intra-abdominal operations. Assessment of risk.

In a retrospective study, 1,416 cholecystectomies performed during a three-year period were reviewed to define the risk of cholecystectomy when combined with another intra-abdominal procedure. Group 1, cholecystectomy alone (1,148 patients), with subsets of cholangiography and/or common bile duct exploration, had a complication rate of 14.29% and a mortality of 0.52%. Group 2, primary cholecystectomy combined with secondary intra-abdominal surgery (214 patients), had a complication rate of 19.63%. Group 3, primary intra-abdominal surgical procedure with incidental cholecystectomy (54 patients), had a complication rate of 20.37%. Mortality for groups 2 and 3 was 2.24%. The rate of nonfatal complications was increased slightly when a second surgical procedure was performed (14.29% v 19.78%). Pairing cholecystectomy with other intra-abdominal surgery is advised only when surgical exposure is adequate, the patient's condition is satisfactory, and operating time is not prolonged greatly.

Abdomen↗

PubMed1983

Necrotizing perineal infections.

Necrotizing perineal infections ("Fournier's gangrene") are polymicrobial, gas producing, and rapidly progressive. Rapid resuscitation and adequate debridement are essential in the early treatment of these infections. Repeat debridements under anesthesia, attention to nutrition and finally reconstructive surgery are important in the subsequent treatment. Three patients with necrotizing infections are presented to illustrate these points and increase awareness of this condition.

Debridement↗

PubMed1982

Traumatic perineal laceration.

Four cases of pelvic trauma associated with a deep perineal tear are reported. The mechanism of injury, preoperative and operative care of this type of injury are discussed. The theory that the tear is similar to an explosion is presented. Categories of anorectal injury are listed. As expected, genitourinary and rectal injuries as well as hemorrhage are the primary concerns with this type of trauma. Management consists of careful evaluation for genitourinary tract injury followed by careful inspection of the perineal tear in the operating room. Rectal examination is crucial and proctosigmoidoscopy is advised for all injuries. Sepsis is the most important complication of the perineal tear. Prevention begins with mandatory colostomy for all patients. The loop colostomy serves as the necessary totally diverting colostomy. Equally important is evacuation and washout of distal fecal content of colon during operation. Hemorrhage may assume greater importance than with closed injuries due to the loss of tamponade. Hypogastric ligation at the time of exploration and colostomy may be beneficial. Drainage of the pararectal space is necessary when the rectum is directly involved in the tear.

Adult↗

PubMed1981

Ovarian metastases from colon carcinoma.

A case report describes a postmenopausal woman who presented with vaginal bleeding and a pelvic mass. She was found to have a colon cancer with a large metastasis in the right ovary. A review of the literature suggests that ovarian metastasis from a primary colon carcinoma is not rare. Frequently, the ovarian tumors causes symptoms sooner than the primary carcinoma. The presence of ovarian metastasis is associated with a poor prognosis. Consideration should be given to the performance of prophylactic oophorectomy during colon resections for carcinoma.

Adenocarcinoma↗

PubMed1981

Mucinous adenocarcinoma developing in chronic anal fistula: report of two cases and review of the literature.

Mucinous adenocarcinoma developing in a chronic anal fistula is a rare tumor of the anus of which there are less than 150 reported cases. There has been some debate as to whether the fistula is the source of the tumor, or whether the fistula is the presenting feature of a slow-growing, indolent carcinoma. Two recent cases seen at our hospital are presented, along with a review of the literature and what we feel to be strong evidence that the fistula and associated anal glands are indeed the source of this unusual tumor.

Adenocarcinoma, Mucinous↗

PubMed1981

Appendicitis with a palpable mass.

Forty-two patients with abdominal masses caused by appendicitis underwent immediate surgery. A clear separation between a phlegmon and abscess could not be made before operation. In most patients, it was possible to perform an appendectomy and, thus, obviate the need for appendectomy at a subsequent admission. There were no deaths in this series of patients. The complication rate of 35.7% could have been reduced by leaving the skin wounds open.

Abscess↗

PubMed1981

Fistula in ano.

An eight year retrospective review of 133 patients with fistula in ano found the majority to be of cryptoglandular causation. Many patients had symptoms for longer than one year. Operation was performed safely under spinal anesthesia, locating the internal opening in 117 patients, performing a fistulectomy in 80 patients and a fistulotomy in the remainder. Associated procedures, such as a hemorrhoidectomy, could be performed safely. Early recurrence of a fistula, spinal headache, bleeding and temporary incontinence were the complications present in 14 patients. All patients with an early recurrence had undergone a fistulotomy.

Adult↗

PubMed1981

Cecal diverticulitis.

Cecal diverticula may be solitary or an extension of leftsided diverticulosis. They may be true or false. Diverticulitis in the cecal area is usually found at the time of surgery for presumed appendicitis. If the diagnosis is obvious grossly, a simple diverticulectomy may be performed. Most cases in our series were of the "hidden" variety. In these cases, a right hemicolectomy was performed because the lesion could not be distinguished from cecal carcinoma.

Adult↗

PubMed1980

Incidental appendectomy at the time of surgery for ectopic pregnancy.

Incidental appendectomy at the time of surgery for ectopic pregnancy can be performed safely in the appropriately selected patient. The added procedure does not place the patient at increased operative risk and spares her from the possible subsequent development of acute appendicitis.

Appendectomy↗

PubMed1980

The diagnosis of appendicitis.

Presented is a retrospective study of 359 patients admitted through the emergency room with nontraumatic abdominal pain who were evaluated for appendicitis. A review of presenting signs and symptoms and initial laboratory data is discussed and diagnostic criteria are established.

Adolescent↗

PubMed1980

Measles and appendicitis.

Two patients who were admitted in the prodromal stage of measles with right lower quadrant pain are described. One patient underwent appendectomy. Histologic examination of the appendix showed the characteristic Warthin-Finkeldey giant cells in the subepithelial layer and allowed the pathologist to predict a measles rash before it appeared. The second patient's pain resolved spontaneously and the measles rash appeared just prior to discharge from the hospital. A discussion of the association between measles and appendicitis is presented. It is concluded that although the association between measles and right lower quadrant abdominal pain is interesting, it must not dissuade the surgeon from performing an appendectomy if the patient's signs and symptoms suggest appendicitis.

Adolescent↗

PubMed1979

Crohn's disease with spontaneous ileoumbilical and ileovesical fistulae.

A 17-year-old male with Crohn's disease involving the terminal ileum and cecum developed an umbilical fistula in the absence of previous surgery. While on intravenous hyperalimentation he developed an enterovesical fistula and was successfully treated by surgical resection. This combination of an enterovesical and umbilical fistula has not been previously reported. An aggressive approach to treatment is suggested.

Adolescent↗

PubMed1979

Anorectal abscess.

A five year retrospective review of anorectal abscesses included 181 admissions in which all but five were explained by the anal glandular hypothesis of causation. Delays in treatment occurred because of misdiagnosis, attempts at nonoperative management and inhospital procrastination. These abscesses are notorious for the recurrence rate after treatment. One-third of the patients in our series had a history of previous abscess and a postoperative recurrence rate of at least 6 per cent. Associated medical problems, such as diabetes mellitus, inflammatory intestinal disease or carcinoma, should be suspected in these patients. The fact that the majority of the patients in our series were afebrile and had minimal leukocytosis is a possible indication that our index of suspicion should be high in any patient with anorectal pain and that we must rely primarily on local findings. Treatment should be prompt incision and drainage under spinal or general anesthesia. Wide unroofing procedures and overzealous attempts at primary fistulotomy are discouraged as is the use of local anesthesia. Associated procedures, such as hemorrhoidectomy, can be safely performed and may prevent certain postoperative complications.

Abscess↗

PubMed1978

High intramuscular anorectal abscess.

Six percent of the anorectal abscesses drained last year at the Naval Regional Medical Center, Portsmouth, Va, were of the high intramuscular variety. High intramuscular perianal abscesses may be difficult to diagnose because of the lack of external signs. It is important that a patient with unexplained anal pain be examined, under anesthesia if necessary. When a high intramuscular abscess is found, it is best drained into the anal canal rather than through a perianal skin incision.

Abscess↗