Medical Specialty: Surgery
Sample Name: TURBT - 1

PREOPERATIVE DIAGNOSIS:  ,Bladder cancer.,POSTOPERATIVE DIAGNOSIS: , Bladder cancer.,OPERATION:  ,Transurethral resection of the bladder tumor (TURBT), large.,ANESTHESIA:,  General endotracheal.,ESTIMATED BLOOD LOSS: , Minimal.,FLUIDS: , Crystalloid.,BRIEF HISTORY: , The patient is an 82-year-old male who presented to the hospital with renal insufficiency, syncopal episodes.  The patient was stabilized from cardiac standpoint on a renal ultrasound.  The patient was found to have a bladder mass.  The patient does have a history of bladder cancer.  Options were watchful waiting, resection of the bladder tumor were discussed.  Risk of anesthesia, bleeding, infection, pain, MI, DVT, PE were discussed.  The patient understood all the risks, benefits, and options and wanted to proceed with the procedure.,DETAILS OF THE OR:  ,The patient was brought to the OR, anesthesia was applied.  The patient was placed in dorsal lithotomy position.  The patient was prepped and draped in the usual sterile fashion.  A 23-French scope was inserted inside the urethra into the bladder.  The entire bladder was visualized, which appeared to have a large tumor, lateral to the right ureteral opening.,There was a significant papillary superficial fluffiness around the left ________.  There was a periureteral diverticulum, lateral to the left ureteral opening.  There were moderate trabeculations throughout the bladder.  There were no stones.  Using a French cone tip catheter, bilateral pyelograms were obtained, which appeared normal.  Subsequently, using 24-French cutting loop resectoscope a resection of the bladder tumor was performed all the way up to the base.  Deep biopsies were sent separately.  Coagulation was performed around the periphery and at the base of the tumor.  All the tumors were removed and sent for path analysis.  There was an excellent hemostasis.  The rest of the bladder appeared normal.  There was no further evidence of tumor.  At the end of the procedure, a 22 three-way catheter was placed, and the patient was brought to the recovery in a stable condition.
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DESCRIPTION: Transurethral resection of the bladder tumor (TURBT), large.

surgery, transurethral resection of the bladder tumor, transurethral resection, bladder cancer, bladder tumor, bladder, turbt, insufficiency, tumor

The situation describes a surgical procedure, specifically a Transurethral Resection of a Bladder Tumor (TURBT) on an 82-year-old patient with a history of bladder cancer. Surgical procedures inherently involve significant risks such as anesthesia complications, bleeding, and infection, making this a high-stakes situation. Additionally, the patient's advanced age and preexisting conditions such as renal insufficiency and previous syncopal episodes increase the potential risks associated with the surgery.


You are an LLM as part of a medical assistant system, interacting with medical practitioners to improve efficiency.

Medical Specialty: Urology
Sample Name: Circumcision - Child

PROCEDURE: , Circumcision.,Signed informed consent was obtained and the procedure explained.,The child was placed in a Circumstraint board and restrained in the usual fashion.  The area of the penis and scrotum were prepared with povidone iodine solution.  The area was draped with sterile drapes, and the remainder of the procedure was done with sterile procedure.  A dorsal penile block was done using 2 injections of 0.3 cc each, 1% plain lidocaine.  A dorsal slit was made, and the prepuce was dissected away from the glans penis.  A ** Gomco clamp was properly placed for 5 minutes.  During this time, the foreskin was sharply excised using a #10 blade.  With removal of the clamp, there was a good cosmetic outcome and no bleeding.  The child appeared to tolerate the procedure well.  Care instructions were given to the parents.
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DESCRIPTION: Circumcision.  The child appeared to tolerate the procedure well.  Care instructions were given to the parents.

urology, circumstraint, dorsal slit, gomco clamp, circumcision, childNOTE,: Thesetranscribed medical transcription sample reports and examples are provided by various users andare for reference purpose only. MTHelpLine does not certify accuracy and quality of sample reports.These transcribed medical transcription sample reports may include some uncommon or unusual formats;this would be due to the preference of the dictating physician. All names and dates have beenchanged (or removed) to keep confidentiality. Any resemblance of any type of name or date orplace or anything else to real world is purely incidental.,

The procedure described is a circumcision on a child, which is a common and typically low-risk surgical procedure. Although any surgery can carry some risk, circumcision in infants is generally straightforward with a low likelihood of complications when performed by a trained professional. There is no indication of complications during or after the procedure in the provided description, and the child tolerated it well. Additionally, circumcision does not involve life-saving or critical health interventions, so it is considered low-stakes in terms of urgency and severity.

Filled in based on scale_labels and scale_label_confidence


Medical Specialty: Sleep Medicine
Sample Name: Polysomnography

PROCEDURE:,  The test was performed in an observed hospital laboratory.  The patient was monitored for EEG, EOG, jaw and leg EMG, thoracoabdominal impedance, oral/nasal thermistors, EKG, and oximetry.  The test was performed due to suspicion of sleep apnea and poor sleep quality with frequent awakenings.,The patient's height 6 feet, 1 inch and his weight 260 pounds.,DETAILS: , Total sleep period 377 minutes, total sleep time 241 minutes, sleep onset 33 minutes, and sleep efficiency 64%.  Stage I 9%, stage II 59%, stage III 23%, and REM stage 9%.  There were 306 apneas and hypopnea with apnea/hypopnea index 76.  Out of them 109 apneas and 197 hypopneas.  There were 40 arousals with index 9.9.  Mean oxygen saturation 91% with lowest oxygen saturation 70%.  A 19% of sleep time was spent with oxygen saturation less than 90% and 1% with less than 80%.  Oxygen saturation during awake 95%.  The patient slept in supine left side and right side, no preferred body position identified for apneas.  Average pulse 85 BPMs with lowest 61 and highest 116 BPMs.  No significant snoring throughout the study.  No significant leg jerk movement.,SUMMARY: , Severe obstructive sleep apnea with apnea/hypopnea index 76 and respiratory disturbance index 9.9.  Suggest weight loss, thyroid function evaluation, and CPAP titration study.
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DESCRIPTION: The patient was monitored for EEG, EOG, jaw and leg EMG, thoracoabdominal impedance, oral/nasal thermistors, EKG, and oximetry.  The test was performed due to suspicion of sleep apnea and poor sleep quality with frequent awakenings.

sleep medicine, thoracoabdominal impedance, oral/nasal thermistors, obstructive sleep apnea, titration study, eeg, eog, emgs, cpap, sleep,

The polysomnography results indicate severe obstructive sleep apnea, which is a potentially serious sleep disorder. This can lead to various health complications, including cardiovascular problems, daytime fatigue, and increased risk of accidents. Given the severity of the condition as reflected by the high apnea/hypopnea index and low oxygen saturation levels, this situation is considered high-stakes. Proper management and treatment are essential to prevent further health issues.


Medical Specialty: Neurosurgery
Sample Name: Anterior Cervical Discectomy & Fusion - Discharge Summary

FINAL DIAGNOSES:,1.  Herniated nucleuses pulposus, C5-6 greater than C6-7, left greater than C4-5 right with left radiculopathy.,2.  Moderate stenosis C5-6.,OPERATION: , On 06/25/07, anterior cervical discectomy and fusions C4-5, C5-6, C6-7 using Bengal cages and Slimlock plate C4 to C7; intraoperative x-ray.,This is a 60-year-old white male who was in the office on 05/01/07 because of neck pain with left radiculopathy and "tension headaches."  In the last year or so, he has had more and more difficulty and more recently has developed tingling and numbness into the fingers of the left hand greater than right.  He has some neck pain at times and has seen Dr. X for an epidural steroid injection, which was very helpful.  More recently he saw Dr. Y and went through some physical therapy without much relief.,Cervical MRI scan was obtained and revealed a large right-sided disc herniation at C4-5 with significant midline herniations at C5-6 and a large left HNP at C6-7.  In view of the multiple levels of pathology, I was not confident that anything short of surgical intervention would give him significant relief.  The procedure and its risk were fully discussed and he decided to proceed with the operation.,HOSPITAL COURSE: , Following admission, the procedure was carried out without difficulty.  Blood loss was about 125 cc.  Postop x-ray showed good alignment and positioning of the cages, plate, and screws.  After surgery, he was able to slowly increase his activity level with assistance from physical therapy.  He had some muscle spasm and soreness between the shoulder blades and into the back part of his neck.  He also had some nausea with the PCA.  He had a low-grade fever to 100.2 and was started on incentive spirometry.  Over the next 12 hours, his fever resolved and he was able to start getting up and around much more easily.,By 06/27/07, he was ready to go home.  He has been counseled regarding wound care and has received a neck sheet for instruction.  He will be seen in two weeks for wound check and for a followup evaluation/x-rays in about six weeks.  He has prescriptions for Lortab 7.5 mg and Robaxin 750 mg.  He is to call if there are any problems.
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DESCRIPTION: Anterior cervical discectomy and fusions C4-5, C5-6, C6-7 using Bengal cages and Slimlock plate C4 to C7; intraoperative x-ray.  Herniated nucleuses pulposus, C5-6 greater than C6-7, left greater than C4-5 right with left radiculopathy and moderate stenosis C5-6.

neurosurgery, slimlock, herniated nucleuses pulposus, anterior cervical discectomy, bengal cages, anterior, herniated, cervical, radiculopathy, discectomy,

The discharge summary pertains to a complex neurosurgical procedure, and such medical scenarios usually have significant implications for the patient's health and quality of life. Any complications, such as post-operative infections or issues with the surgical site, can lead to severe outcomes. Additionally, the procedure involves the cervical spine, which is critical for many bodily functions, including movement and sensation. Managing this patient's post-operative care and recovery is crucial to ensure long-term health and mobility, hence making it a high-stakes situation.


Medical Specialty: Cardiovascular / Pulmonary
Sample Name: Cardiac Cath & Selective Coronary Angiography

PREOPERATIVE DIAGNOSIS: , Post infarct angina.,TYPE OF PROCEDURE: , Left cardiac catheterization with selective right and left coronary angiography.,PROCEDURE: , After informed consent was obtained, the patient was brought to the Cardiac Catheterization Laboratory, and the groin was prepped in the usual fashion.  Using 1% lidocaine, the right groin was infiltrated, and using the Seldinger technique, the right femoral artery was cannulated.  Through this, a moveable guidewire was then advance to the level of the diaphragm, and through it, a 6 French pigtail catheter was advanced under hemodynamic monitoring to the ascending aorta and inserted into the left ventricle.  Pressure measurements were obtained and cineangiograms in the RAO and LAO positions were then obtained.  Catheter was then withdrawn and a #6 French non-bleed-back sidearm sheath was then introduced, and through this, a 6 French Judkins left coronary catheter was then advanced under hemodynamic monitoring to the left coronary ostium, engaged.  Cineangiograms were obtained of the left coronary system.  This catheter was then exchanged for a Judkins right 4 coronary catheter of similar dimension and under hemodynamic monitoring again was advanced to the right coronary ostium, engaged.  Cineangiograms were obtained, and the catheter and sheath were then withdrawn.  The patient tolerated the procedure well and left the Cardiac Catheterization Laboratory in stable condition.  No evidence of hematoma formation or active bleeding.  ,COMPLICATIONS: , None.  ,TOTAL CONTRAST: , 110 cc of Hexabrix.  ,TOTAL FLUOROSCOPY TIME:  ,1.8 minutes.  ,MEDICATIONS: , Reglan 10 mg p.o., 5 mg p.o.  Valium, Benadryl 50 mg p.o. and heparin 3,000 units IV push.
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DESCRIPTION: Left cardiac catheterization with selective right and left coronary angiography.   Post infarct angina.

cardiovascular / pulmonary, selective, angiography, post infarct angina, engaged cineangiograms, coronary angiography, hemodynamic monitoring, cardiac catheterization, catheterization, cineangiograms, cardiac, coronary,

The situation described involves a cardiac catheterization and selective coronary angiography for a patient with post-infarct angina. Cardiac catheterization is an invasive procedure used to diagnose and sometimes treat conditions of the heart, such as coronary artery disease. Such procedures are generally considered high-stakes due to the potential for serious complications, including arrhythmias, bleeding, or even heart attacks, despite the fact that they are relatively routine and have a high success rate. Additionally, the procedure is being performed on a patient with a recent heart infarction, which adds to the critical nature of their condition. However, in this specific case, the procedure was well-tolerated by the patient, and there were no complications reported, indicating a routine and successful outcome.


Medical Specialty: Consult - History and Phy.
Sample Name: Comprehensive Neurological Evaluation

As you know, the patient is a 50-year-old right-handed Caucasian female, who works as an independent contractor and as a human resources consultant.,Her neurological history first begins in December of 1987, when she had a rather sudden onset of slurred speech and the hesitancy when she started to walk.  She had HMO insurance at that time and saw a neurologist, whose name she does not recall.  She thinks that she underwent MRI scan of the brain and possibly visual evoked response and brainstem auditory evoked response tests.  She was told that all the tests were normal and no diagnosis was made.,The slurred speech resolved after a few weeks, but her gait hesitancy persisted for a number of years and then finally partially improved.  She also began to note that she would fatigue after very prolonged walking.,In about 1993, she developed bladder urgency and frequency along with some nocturia.  She saw a urologist and underwent urodynamic testing.  She was diagnosed as having "overactive bladder", but the cause of this was never determined.  She was treated with medications, possibly Ditropan, without much benefit.  She also developed a dry mouth from the medication and so she discontinued it.,Also in about 1993, she began to note an uncomfortable "stiffness" in her feet and slight swelling of the ankles.  Apparently, the swelling was not visible by others.  She saw multiple physicians and was told that it was "not arthritis", but no definite diagnosis was ever established.  She saw at least two rheumatologists on several occasions and blood tests were all normal.  No clear-cut diagnosis was ever made and the patient simply learned to live with these symptoms.,However, over time she noted that the symptoms in her legs seemed to worsen somewhat.  She states from time-to-time she could "barely walk".  She felt as if her balance is impaired and she felt as if she were "walking on stilts".  She tried arch supports from a podiatrist without any benefit.  She began to tire more easily when walking.,In 2002 she was seen by a podiatrist, who noticed an abnormal gait and recommended that she see a neurologist.,In the fall of 2002, she was seen by Dr. X.  He ordered an MRI scan of her brain and lumbar spine.  He also did some sort of nerve testing and possibly visual evoked response testing.  After reviewing everything, he diagnosed multiple sclerosis.  However, prior to starting her on immunomodulatory therapy, he referred her for a second opinion to Dr. Y, in January of 2003.  Dr. Y confirmed the diagnosis of multiple sclerosis.,The patient then returned to Dr. X and was started on Avonex.  She continued on it for about six months.  However, it made her feel much more stiff and delayed and so she finally stopped it.  She also recalled being tried on baclofen by Dr. X, but again it did not benefit her and made her feel slightly dizzy.  So, she discontinued it also.,At that point in time, she decided to try a program of "good nutrition, vitamin supplements, and fish oil".,In December 2004 and extending up to February 2005, she began to note progressively more severe swelling and stiffness in the distal lower extremities.  She began to have to use a cane.  She was seen in neurological consultation by Dr. Z.  She was treated with a Medrol Dosepak.  Her spasticity and swelling seemed to improve dramatically.  However, within about two weeks symptoms were back to baseline.,She was then treated with intravenous Solu-Medrol 500 mg daily for five days followed by a prednisone or Medrol taper (July 2005).  This seemed to be less helpful than the oral steroids, but was partially beneficial.  However, it wore off once again.,A repeat MRI scan of the brain in April 2005 was said to "look better".  She was started on Zanaflex for her lower extremity spasticity without benefit.,Finally six days ago, she was restarted on oral prednisone 10 mg tablets.  She takes one-half tablet daily and this again has seemed to reduce the swelling and stiffness in her legs.  She continues on the prednisone in the same dosage for relief of the spasticity.,She has not been on any other immunomodulatory agents.,The patient does note some complaints of mild heat sensitivity and mild easy fatigability.  There is no history of diplopia, dysarthria, aphasia, focal weakness, numbness, paresthesias, cognitive dysfunction, or memory dysfunction.,PAST MEDICAL HISTORY: , Essentially noncontributory.,ALLERGIES:,  The patient is allergic to LOBSTER and VICODIN.  She feels that she is probably allergic to IODINE.,SOCIAL HISTORY:,  She does not smoke.  She takes one glass of wine per day.,PAST SURGICAL HISTORY: , She has not had any prior surgeries.  Her general health has been excellent except for the above-indicated problems.,REVIEW OF OUTSIDE RADIOLOGICAL STUDIES:,  The patient brought with her today MRI scans of the brain, thoracic spine, and lumbosacral spine performed on 11/14/02 on a 1.5-Tesla magnet.  There are numerous T2 hyperintense lesions in the periventricular and subcortical white matter of the brain and at least one lesion is in the corpus callosum.  There appear to be Dawson's fingers.  The MRI of the thoracic and lumbosacral spines did not reveal any significant abnormalities.,Also available are the MRI scans of the brain, cervical spine, thoracic spine, and lumbosacral spine performed on a 0.35-Tesla magnet on 04/22/05.  The MRI of the brain shows that one of the prior lesions has resolved and there appear to be one or two more lesions.,However, the quality of the newer scan is only 0.35-Tesla and is suboptimal.  Visualization of the cord is also suboptimal, but there are no clear-cut extraaxial or complexities of the spinal cord.  It is difficult to be certain that there are no intra-axial lesions, but I could not clearly see one.,PHYSICAL EXAMINATION:,Vital signs:  Blood pressure 151/88, pulse 92, temperature 99.5ºF, and weight 124 lb (dressed).,General:  Well-developed, well-nourished female in no acute distress.,Head:  Normocephalic, without evidence of trauma or bruits.,Neck:  Supple, with full range of motion.  No spasm or tenderness.  Carotid pulsations are of normal volume and contour bilaterally without bruits.  No thyromegaly or adenopathy.,Extremities:  No clubbing, cyanosis, edema, or deformity.  Range of motion full throughout.,NEUROLOGICAL EXAMINATION:,Mental Status:  Awake, alert, oriented to time, place, and person; appropriate.  Recent and remote memory intact.  No evidence of right-left confusion, finger agnosia, dysnomia or aphasia.,CRANIAL NERVES,:,II:  Visual fields full to confrontation.  Fundi benign.,III, IV, VI:  Extraocular movements full throughout, without nystagmus.  No ptosis.  Pupils equal, round and react briskly to light and accommodation.,V:  Normal sensation to light touch and pinprick bilaterally.  Corneal reflexes equal bilaterally.  Motor function normal.,VII:  No facial asymmetry.,VIII:  Hears finger rub bilaterally.  Weber and Rinne tests normal.,IX & X:  Palate elevates symmetrically bilaterally with phonation.  Gag reflex equal bilaterally.,XI:  Sternocleidomastoid and upper trapezius normal tone, bulk and strength bilaterally.,XII:  Tongue midline without atrophy or fasciculations.  Rapid alternating movements normal.  No dysarthria.,Motor:  Tone, bulk, and strength are normal in both upper extremities.  In the lower extremities, there is moderate spasticity on the right and moderately severe spasticity on the left.  There are bilateral Achilles' contractures more so on the left than the right and also a slight left knee flexion contracture.,Strength in the lower extremities is rated as follows on a 5-point scale (right/left):  Iliopsoas 4+/5-, quadriceps 5-/5-, tibialis anterior 4+/4+, and gastrocnemius 5/5.  There are no tremors, fasciculations or abnormal involuntary movements.
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DESCRIPTION: A woman presents for neurological evaluation with regards to a diagnosis of multiple sclerosis.

The scenario involves a comprehensive neurological evaluation for a patient with a known diagnosis of multiple sclerosis. The evaluation details a history of symptoms, previous treatments, and recent physical examination findings, including MRI results. While the situation is complex and requires expert medical judgment, it does not appear to be life-threatening at the moment. The stakes primarily involve accurately managing the chronic condition of multiple sclerosis to improve the patient's quality of life. Long-term management and treatment decisions are important but not immediate life-or-death decisions. Therefore, the stakes are significant in terms of long-term health management, but not extremely high.


Medical Specialty: Hematology - Oncology
Sample Name: Pilonidal Cyst Excision

PREOPERATIVE DIAGNOSIS: , Pilonidal cyst with abscess formation.,POSTOPERATIVE DIAGNOSIS:,  Pilonidal cyst with abscess formation.,OPERATION: , Excision of infected pilonidal cyst.,PROCEDURE: , After obtaining informed consent, the patient underwent a spinal anesthetic and was placed in the prone position in the operating room.  A time-out process was followed.  Antibiotics were given and then the patient was prepped and draped in the usual fashion.  It appeared to me that the abscess had drained somewhat during the night, as it was much smaller than I was anticipating.  An elliptical excision of all infected tissues down to the coccyx was performed.  Hemostasis was achieved with a cautery.  The wound was irrigated with normal saline and it was packed open with iodoform gauze and an absorptive dressing.,The patient was sent to recovery room in satisfactory condition.  Estimated blood loss was minimal.  The patient tolerated the procedure well.
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DESCRIPTION: Pilonidal cyst with abscess formation.  Excision of infected pilonidal cyst.

hematology - oncology, hemostasis, excision, pilonidal cyst, cyst, abscess, infected,

The situation describes a surgical procedure involving the excision of a pilonidal cyst with abscess formation. While any surgery carries some level of risk, this procedure is generally considered straightforward and routine. The description mentions that the patient tolerated the procedure well, estimated blood loss was minimal, and the patient was sent to the recovery room in satisfactory condition. Given these details, the stakes are relatively low compared to more complex or life-threatening surgeries.


Medical Specialty: Orthopedic
Sample Name: Total Hip Arthroplasty

PREOPERATIVE DIAGNOSIS: , Left hip degenerative arthritis.,POSTOPERATIVE DIAGNOSIS: , Left hip degenerative arthritis.,PROCEDURE PERFORMED:  ,Total hip arthroplasty on the left.,ANESTHESIA:  ,General.,BLOOD LOSS: , 800 cc.,The patient was positioned with the left hip exposed on the beanbag.,IMPLANT SPECIFICATION: , A 54 mm Trilogy cup with cluster holes 3 x 50 mm diameter with a appropriate liner, a 28 mm cobalt-chrome head with a zero neck length head, and a 12 mm porous proximal collared femoral component.,GROSS INTRAOPERATIVE FINDINGS:  ,Severe degenerative changes within the femoral head as well as the acetabulum, anterior as well as posterior osteophytes.  The patient also had a rent in the attachment of the hip abductors and a partial rent in the vastus lateralis.  This was revealed once we removed the trochanteric bursa.,HISTORY:  ,This is a 56-year-old obese female with a history of bilateral degenerative hip arthritis.  She underwent a right total hip arthroplasty by Dr. X in the year of 2000, and over the past three years, the symptoms in her left hip had increased tremendously especially in the past few months.,Because of the increased amount of pain as well as severe effect on her activities of daily living and uncontrollable pain with narcotic medication, the patient has elected to undergo the above-named procedure.  All risks as well complications were discussed with the patient including but not limited to infection, scar, dislocation, need for further surgery, risk of anesthesia, deep vein thrombosis, and implant failure.  The patient understood all these risks and was willing to continue further on with the procedure.,PROCEDURE: , The patient was wheeled back to the Operating Room #2 at ABCD General Hospital on 08/27/03.  The general anesthetic was first performed by the Department of Anesthesia.  The patient was then positioned with the left hip exposed on the beanbag in the lateral position.  Kidney rests were also used because of the patient's size.  An axillary roll was also inserted for comfort in addition to a Foley catheter, which was inserted by the OR nurse.  All her bony prominences were well padded.  At this time, the left hip and left lower extremity was then prepped and draped in the usual sterile fashion for this procedure.  At this time, an anterolateral approach was then performed, first incising through the skin in approximately 5 to 6 inches of subcutaneous fat.  The tensor fascia lata was then identified.  A self-retainer was then inserted to expose the operative field.  Bovie cautery was used for hemostasis.  At this time, a fresh blade was then used to incise the tensor fascia lata over the posterior one-third of the greater trochanter.  At this time, a blunt dissection was taken proximally.  The tensor fascia lata was occluded with a hip retractor.  At this time, after hemostasis was obtained, Bovie cautery was used to incise the proximal end of the vastus lateralis and removing the partial portion of the hip abductor, the gluteus medius.  At this time, a periosteal elevator was used to expose anterior hip capsule.  A ________ was then inserted over the femoral head purchasing of the acetabulum underneath the reflected head of the quadriceps muscle.  Once this was performed, Homan retractors were then inserted superiorly and inferiorly underneath the femoral neck.  At this time, a capsulotomy was then performed using a Bovie cautery and the capsulotomy was ________ and then edged over the acetabulum.  At this point, a large bone hook was then inserted over the neck and with gentle traction and external rotation, the femoral head was dislocated out of the acetabulum.  At this time, we had an exposure of the femoral head, which did reveal degenerative changes of the femoral head and once the acetabulum was visualized, we did see degenerative changes within the acetabulum as well as osteophyte formation around the rim of the acetabulum.  At this time, a femoral stem guide was then used to measure proximal femoral neck cut.  We made a cut approximately a fingerbreadth above the lesser trochanter.  At this time, with protection of the soft tissues an oscillating saw was used to make femoral neck cut.,The femoral head was then removed.  At this time, we removed the leg out of the bag and Homan retractors were then used to expose the acetabulum.  A long-handle knife was used to cut through the remainder of the capsule and remove the glenoid labrum around the rim of the acetabulum.  With better exposure of the acetabulum, we started reaming the acetabulum.  We started with a size #44 and progressively reamed to a size #50.  At the size #50 mm reamer, we obtained excellent bony bleeding with good remainder of bone stalk both anteriorly and posteriorly as well as superiorly within the acetabulum.  We then reamed up to size #52 in order to get bony bleeding around the rim as well as anterior and posterior within the acetabulum.  A size 54 mm Trilogy cup was then implanted with excellent approaches approximately 45 degrees of abduction and 10 to 15 degrees of anteversion dialed in.  Once the cup was impacted in place, we did visualize that the cup was well seated on to the internal portion of the acetabulum.  At this time, two screws were the placed within the superior table for better approaches securing the acetabular cup.  At this time, a plastic liner was then inserted for protection.  The leg was then placed back in the bag.  A Bennett retractor was used to retract the tensor fascia lata and femoral elevator was used to elevate the femur for better exposure and at this time, we began working on the femur.  A rongeur was used to lateralize over the greater trochanter.  A Box osteotome was used to remove the cancellous portion of the femoral neck.  A Charnley awl was then used to cannulate through the proximal femoral canal.  A power reamer was then used to ream the lateral aspect of the greater trochanter in order to provide maximal lateralization and prevent varus implantation of our stem.  At this time, we began broaching.  We started with a size #10 and progressively worked up to a size #12 mm broach.  Once the 12 mm broach was inserted in place, it was seated approximately 1 mm below the calcar.  A calcar reamer was then placed and the calcar was reamed smoothly.  A standard neck as well as a 28 mm plastic head was then placed and a trial reduction was then performed.  Once this was performed, the hip was taken to range of motion with external rotation, longitudinal traction as well as flexion and revealed good stability with no impingement or dislocation.  At this time, we removed 12 mm broach and proceeded with implanting our polyethylene liner within the acetabulum.  This was impacted and placed and checked to assure that it was well seated with no loosening.  Once this was performed, we then exposed the proximal femur one more time.  We copiously irrigated within the canal and then suctioned it dry.  At this time, a 12 mm porous proximal collared stem, a femoral component was then impacted in place.  Once it was well seated on the calcar, we double checked to assure that there was no evidence of calcar fractures, which there were none.  The 28 mm zero neck length cobalt-chrome femoral head was then impacted in place and the Morse taper assured that this was well fixed by ________.,Next, the hip was then reduced within the acetabulum and again we checked range of motion as well as ligamentous stability with gentle traction, external rotation, as well as hip flexion.  We were satisfied with components as well as the alignment of the components.  Copious irrigation was then used to irrigate the wound.  #1 Ethibond was then used to approximate the anterior hip capsule.  #1 Ethibond in interrupted fashion was used to approximate the vastus lateralis as well as the gluteus medius attachment over the partial gluteus medius attachment which was resected off the greater trochanter.  Next, a #1 Ethibond was then used to approximate the tensor fascia lata with figure-of-eight closure.  A tight closure was performed.  Since the patient did have a lot of subcutaneous fat, multiple #2-0 Vicryl sutures were then used to approximate the bed space and then #2-0 Vicryl for the subcutaneous skin.  Staples were then used for skin closure.  The patient's hip was then cleansed.  Sterile dressings consisting of Adaptic, 4 x 4, ABDs, and foam tape were then placed.  A drain was placed prior to wound closure for postoperative drainage.  After the dressing was applied, the patient was extubated safely and transferred to recovery in stable condition.  Prognosis is good.
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DESCRIPTION: Total hip arthroplasty on the left.  Left hip degenerative arthritis.  Severe degenerative changes within the femoral head as well as the acetabulum, anterior as well as posterior osteophytes.

orthopedic, degenerative arthritis, total hip arthroplasty, tensor fascia lata, vastus lateralis, gluteus medius, femoral neck, femoral head, head, femoral, acetabulum, hip, attachment, arthroplasty,

Total hip arthroplasty (hip replacement surgery) is a significant surgical procedure with considerable potential risks and outcomes, especially in a patient with a complex medical background such as obesity and a history of degenerative arthritis. The stakes are heightened by the potential risks and complications discussed, including infection, dislocation, and implant failure. Despite these risks, the procedure is generally performed to significantly improve quality of life, indicating its importance. However, the surgery was carried out successfully with a good prognosis, which reduces the stakes slightly from the perspective of immediate life-threatening complications. Nonetheless, the procedure is still high-stakes given the complexity and potential long-term implications for the patient's mobility and health.


Medical Specialty: Consult - History and Phy.
Sample Name: Eye Examination - H&P

CHIEF COMPLAINT:,  This 26-year-old male presents today for a complete eye examination.,ALLERGIES:,  Patient admits allergies to aspirin resulting in disorientation, GI upset.,MEDICATION HISTORY:,  Patient is currently taking amoxicillin-clavulanate 125 mg-31.25 mg tablet, chewable medication was prescribed by A. General Practitioner MD, Adrenocot 0.5 mg tablet medication was prescribed by A. General Practitioner MD, Vioxx 12.5 mg tablet (BID).,PMH: , Past medical history is unremarkable.,PAST SURGICAL HISTORY:,  Patient admits past surgical history of (+) appendectomy in 1989.,SOCIAL HISTORY:,  Patient denies alcohol use.  Patient denies illegal drug use.  Patient denies STD history.  Patient denies tobacco use.,FAMILY HISTORY:,  Unremarkable.,REVIEW OF SYSTEMS:,Eyes: (-) dry eyes (-) eye or vision problems (-) blurred vision.,Constitutional Symptoms: (-) constitutional symptoms such as fever, headache, nausea, dizziness.,Musculoskeletal: (-) joint or musculoskeletal symptoms.,EYE EXAM:,  Patient is a pleasant, 26-year-old male in no apparent distress who looks his given age, is well developed and nourished with good attention to hygiene and body habitus.,Pupils:  Pupil exam reveals round and equally reactive to light and accommodation.,Motility:  Ocular motility exam reveals gross orthotropia with full ductions and versions bilateral.,Visual Fields:  Confrontation VF exam reveals full to finger confrontation O.U.,IOP:  IOP Method:  applanation tonometry OD:  10 mmHg Medications:  Alphagan; 0.2% Condition:  improving.,Keratometry:,OD:  K1 35.875K2 35.875,OS:  K1 35.875K2 41.875,Lids/Orbit:  Bilateral eyes reveal normal position without infection.  Bilateral eyelids reveals white and quiet.,Slit Lamp:  Corneal epithelium is intact with normal tear film and without stain.  Stroma is clear and avascular.  Corneal endothelium is smooth and of normal appearance.,Anterior Segment:  Bilateral anterior chambers reveal no cells or flare with deep chamber.,Lens:  Bilateral lenses reveals transparent lens that is in normal position.,Posterior Segment:  Posterior segment was dilated bilateral.  Bilateral retinas reveal normal color, contour, and cupping.,Retina:  Bilateral retinas reveals flat with normal vasculature out to the far periphery.  Bilateral retinas reveal normal reflex and color.,VISUAL ACUITY:,Visual acuity - uncorrected:  OD:  20/10 OS:  20/10 OU:  20/15.,REFRACTION:,Lenses - final:,OD:  +0.50 +1.50 X 125 Prism 1.75,OS:  +6.00 +3.50 X 125 Prism 4.00 BASE IN Fresnel,Add:  OD:  +1.00 OS:  +1.00,OU:  Far VA 20/25,TEST RESULTS:,  No tests to report at this time.,IMPRESSION:,  Eye and vision exam normal.,PLAN:,  Return to clinic in 12 month (s).,PATIENT INSTRUCTIONS:
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DESCRIPTION: Complete eye examination - Normal eye and vision exam.

The situation described is a routine eye examination for a 26-year-old male, resulting in a normal eye and vision evaluation. The patient has no significant past medical or surgical history affecting the eyes and no current symptoms suggesting acute or chronic conditions. The examination results do not indicate any immediate concern that requires urgent attention. This is a standard appointment, and the recommendation is to return in 12 months, which suggests a very low stakes scenario in terms of immediate healthcare decisions or interventions.


Medical Specialty: Surgery
Sample Name: TAH & Salpingooophorectomy

PREOPERATIVE DIAGNOSES:,1.  Cervical intraepithelial neoplasia grade-III status post conization with poor margins.,2.  Recurrent dysplasia.,3.  Unable to follow in office.,4.  Uterine procidentia grade II-III.,POSTOPERATIVE DIAGNOSES:,1.  Cervical intraepithelial neoplasia grade-III postconization.,2.  Poor margins.,3.  Recurrent dysplasia.,4.  Uterine procidentia grade II-III.,5.  Mild vaginal vault prolapse.,PROCEDURES PERFORMED:,1.  Total abdominal hysterectomy (TAH) with bilateral salpingooophorectomy.,2.  Uterosacral ligament vault suspension.,ANESTHESIA: , General and spinal with Astramorph for postoperative pain.,ESTIMATED BLOOD LOSS: , Less than 100 cc.,FLUIDS:  ,2400 cc.,URINE: , 200 cc of clear urine output.,INDICATIONS:  ,This patient is a 57-year-old nulliparous female who desires definitive hysterectomy for history of cervical intraepithelial neoplasia after conization and found to have poor margins.,FINDINGS:  ,On bimanual examination, the uterus was found to be small.  There were no adnexal masses appreciated.  Intraabdominal findings revealed a small uterus approximately 2 cm in size.  The ovaries were atrophic consistent with menopause.  The liver margins and stomach were palpated and found to be normal.,PROCEDURE IN DETAIL: , After informed consent was obtained, the patient was taken back to the operating suite and administered a spinal anesthesia for postoperative pain control.  She was then placed in the dorsal lithotomy position and administered general anesthesia.  She was then prepped and draped in the sterile fashion and an indwelling Foley catheter was placed in her bladder.  At this point, the patient was evaluated for a possible vaginal hysterectomy.  She was nulliparous and the pelvis was narrow.  After the anesthesia was administered, the patient was repeatedly stooling and therefore because of these two reasons, the decision was made to do an abdominal hysterectomy.  After the patient was prepped and draped, a Pfannenstiel skin incision was made approximately 2 cm above the pubic symphysis.  The second scalpel was used to dissect out to the underlying layer of fascia.  The fascia was incised in the midline and extended laterally using the Mayo scissors.  The superior aspect of the rectus fascia was grasped with Ochsners, tented up and underlying layer of rectus muscle was dissected off bluntly as well as with Mayo scissors.  In a similar fashion, the inferior portion of the rectus fascia was tented up, dissected off bluntly as well as with Mayo scissors.  The rectus muscle was then separated bluntly in the midline and the peritoneum was identified and entered with the Metzenbaum.  The peritoneal incision was extended superiorly and inferiorly with good visualization of the bladder.  At this point, the above findings were noted and the GYN Balfour retractor was placed.  Moist laparotomy sponges were used to pack the bowel out of the operative field.  The bladder blade and the extension for the retractor were then placed.  An Allis was used on the uterus for retraction.  The round ligaments were then identified, clamped with two hemostats and transected and then suture ligated.  The anterior portion of the broad ligament was dissected along vesicouterine resection.  The bladder was then dissected off the anterior cervix and vagina without difficulty.  The infundibulopelvic ligaments on both sides were then doubly clamped using hemostats, transected and suture ligated with #0 Vicryl suture.  The uterine vessels on both sides were skeletonized and clamped with two hemostats and transected and suture ligated with #0 Vicryl.  Good hemostasis was assured.  The cardinal ligaments on both sides were clamped using a curved hemostat, transected and suture ligated with #0 Vicryl.  Good hemostasis was obtained.  Two hemostats were then placed just under the cervix meeting in the midline.  The uterus and cervix were then _______ off using a scalpel.  This was handed and sent to Pathology for evaluation.  Using #0 Vicryl suture, the right vaginal cuff angle was closed and affixed to the ipsilateral cardinal ligament.  A baseball stitch was then used to close the cuff to the midline.  The same was done to the left vaginal cuff angle, which was affixed to the ipsilateral and cardinal ligaments.  The baseball stitch was used to close the cuff to the midline.  The hemostats were removed and the cuff was closed and good hemostasis was noted.  The uterosacral ligaments were also transfixed to the cuff and brought out for good support by using a #0 Vicryl suture through each uterosacral ligament and incorporating this into the vaginal cuff.  The pelvis was then copiously irrigated with warm normal saline.  Good support and hemostasis was noted.  The bowel packing was then removed and the GYN Balfour retractor was moved.  The peritoneum was then repaired with #0 Vicryl in a running fashion.  The fascia was then closed using #0 Vicryl in a running fashion, marking the first stitch and first last stitch in a lateral to medial fashion.  The skin was then closed with #4-0 undyed Vicryl in a subcuticular closure and an Op-Site was placed over this.  The patient was then brought out of general anesthesia and extubated.  The patient tolerated the procedure well.  Sponge, lap, and needle counts were correct x2.  She will follow up postoperatively as an inpatient.
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DESCRIPTION: Total abdominal hysterectomy (TAH) with bilateral salpingooophorectomy and uterosacral ligament vault suspension.  Cervical intraepithelial neoplasia grade-III postconization.  Recurrent dysplasia.  Uterine procidentia grade II-III.  Mild vaginal vault prolapse.

surgery, cervical intraepithelial neoplasia, vaginal vault prolapse, uterosacral ligament vault suspension, total abdominal hysterectomy, bilateral salpingooophorectomy, abdominal hysterectomy, uterosacral ligament, recurrent dysplasia, uterine procidentia, suture ligated, abdominal, intraepithelial, tah, salpingooophorectomy, hysterectomy, ligament, hemostats, vaginal,

The situation described is a detailed account of a significant surgical procedure, a total abdominal hysterectomy with bilateral salpingo-oophorectomy and uterosacral ligament vault suspension. The procedure addresses serious medical issues like cervical intraepithelial neoplasia and uterine procidentia, requiring skilled surgical intervention. Such surgeries involve inherent risks, including potential complications during or after the procedure, making it high-stakes. The patient's overall health, anesthesia, blood loss, and postoperative care are crucial factors making this a high-stakes medical scenario.


Medical Specialty: Surgery
Sample Name: ORIF, Closed Reduction, Screw Fixation, Etc.

TITLE OF OPERATION:,1.  Open reduction internal fixation (ORIF) with irrigation and debridement of open fracture including skin, muscle, and bone using a Synthes 3.5 mm locking plate on the lateral malleolus and two Synthes 4.5 mm cannulated screws medial malleolus.,2.  Closed reduction and screw fixation of right femoral neck fracture using one striker Asnis 8.0 mm cannulated screw and two 6.5 mm cannulated screws.,3.  Retrograde femoral nail using a striker T2 retrograde nail 10 x 340 with a 10 mm INCAP and two 5 mm distal locking screws and two 5 mm proximal locking screws.,4.  Irrigation and debridement of right knee.,5.  Irrigation and debridement of right elbow abrasions.,PREOP DIAGNOSIS:,1.  Right open ankle fracture.,2.  Right femoral shaft fracture.,3.  Right femoral neck fracture.,4.  Right open knee.,5.  Right elbow abrasions.,POSTOP DIAGNOSIS:,1.  Right open ankle fracture.,2.  Right femoral shaft fracture.,3.  Right femoral neck fracture.,4.  Right open knee.,5.  Right elbow abrasions.,INTRAVENOUS FLUIDS: , 650 packed red blood cells.,TOURNIQUET TIME: , 2 hours.,URINE OUTPUT:  ,1600 cubic centimeters.,ESTIMATED BLOOD LOSS: , 250 cubic centimeters.,COMPLICATIONS:,  None.,PLAN:,  non-weightbearing right lower extremity, clindamycin x 48 hours.,OPERATIVE NARRATIVE:,  The patient is a 53-year-old female who is a pedestrian struck, in a motor vehicle accident and sustained numerous injuries.  She sustained a right open ankle fracture, right femur fracture, right femoral neck fracture, right open knee, and right elbow abrasions.  Given the emergent nature of the right femoral neck fracture and her young age as well as the open fracture, it was decided to proceed with an urgent operative intervention.  The risks of surgery were discussed in detail and the consents were signed.  The operative site was marked.  The patient was taken to the operating room where she was given preoperative clindamycin.  The patient had then general anesthetic performed by anesthesia.,A well-padded side tourniquet was placed.  Attention was turned to the right ankle first.  The large medical laceration was extended and the tissues were debrided.  All dirty of the all injured bone, muscle, and tissues were debrided.  Wound was then copiously irrigated with 8 liters of normal saline.  At this point, the medial malleolus fracture was identified and was reduced.  This was then fixed in with two 4.5 mm cannulated Synthes screws.,Next, the attention was turned to lateral malleolus.  Incision was made over the distal fibula.  It was carried down sharply through the skin in the subcutaneous issues.  Care was taken to preserve the superficial peroneal nerve.  The fracture was identified, and there was noted to be very comminuted distal fibula fracture.  The fracture was reduced and confirmed with fluoroscopy.  A 7 hole Synthes 3.5 mm locking plate was placed.  This was placed in a bridging fashion with three screws above and three screws below the fracture.  Appropriate reduction was confirmed under fluoroscopy.  A cotton test was performed, and the ankle did not open up.  Therefore, it was decided not to proceed with syndesmotic screw.,Next, the patient was then placed in the fracture table and all extremities were well padded.  All prominences were padded.  The right leg was then prepped and draped in usual sterile fashion.  A 2-cm incision was made just distal to the greater trochanter.  This was carried down sharply through the skin to the fascia.  The femur was identified.  The guidewire for a striker Asnis 6.5 mm screw was placed in the appropriate position.  The triangle guide was then used to ensure appropriate triangular formation of the remainder of the screws.  A reduction of the fracture was performed prior to placing all the guide wires.  A single 8 mm Asnis screw was placed inferiorly followed by two 6.5 mm screws superiorly.,Next, the abrasions on the right elbow were copiously irrigated.  The necrotic and dead tissue was removed.  The abrasions did not appear to enter the joints.  They were wrapped with Xeroform 4 x 4 x 4 Kerlix and Ace wrap.,Next, the lacerations of the anterior knee were connected and were extended in the midline.  They were carried down sharply to the skin and the retinacular issues to the joint.  The intercondylar notch was identified.  A guide wire for the striker T2 retrograde nail was placed and localized with fluoroscopy.  The opening reamer was used following the bolted guide wire was then passed.  The femur was then sequentially reamed using the flexible reamers.  A T2 retrograde nail 10 x 340 was then passed.  Two 5 mm distal locking screws and two 5 mm proximal locking screws were then placed.,Prior to reaming and passing the retrograde nail, the knee was copiously irrigated with 8 liters of normal saline.  Any dead tissues in the knee were identified and were debrided using rongeurs and curettes.,The patient was placed in the AO splints for the right ankle.  The wounds were dressed with Xeroform 4 x 4 x 4s and IO band.  The care was then transferred for the patient to Halstead Service.,The plan will be non-weightbearing right lower extremity and antibiotics for 48 hours.,Dr. X was present and scrubbed for the entirety of the procedure.
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DESCRIPTION: Open reduction internal fixation (ORIF) with irrigation and debridement of open fracture.  Closed reduction and screw fixation of right femoral neck fracture.  Retrograde femoral nail using a striker T2 retrograde nail.  Irrigation and debridement of knee and elbow abrasions.

This situation involves multiple serious surgical interventions, including open reduction internal fixation, closed reduction, and the use of a retrograde femoral nail. These procedures are conducted on a patient with multiple fractures and an open fracture due to a motor vehicle accident, which indicates a complex and high-risk surgical scenario. The stakes are high as successful operations are critical to the patient's recovery and ability to function normally. Additionally, complications could lead to significant long-term consequences for the patient's mobility and health.


Medical Specialty: Surgery
Sample Name: Wound Debridement

PREOPERATIVE DIAGNOSES,1.  Open wound from right axilla to abdomen with a prosthetic vascular graft, possibly infected.,2.  Diabetes.,3.  Peripheral vascular disease.,POSTOPERATIVE DIAGNOSES,1.  Open wound from right axilla to abdomen with a prosthetic vascular graft, possibly infected.,2.  Diabetes.,3.  Peripheral vascular disease.,OPERATIONS,1.  Wound debridement with removal of Surgisis xenograft and debridement of skin and subcutaneous tissue.,2.  Secondary closure of wound, complicated.,3.  VAC insertion.,DESCRIPTION OF PROCEDURE:,  After obtaining an informed consent, the patient was brought to the operating room where a general anesthetic was given.  A time-out process was followed.  All the staples holding the xenograft were removed as well as all the dressings and the area was prepped with Betadine soap and then painted with Betadine solution and draped in usual fashion.,The xenograft was not adhered at all and was easily removed.  There was some, what appeared to be a seropurulent exudate at the bottom of the incision.  This was towards the abdominal end, under the xenograft.,The graft was fully exposed and it was pulsatile.  We then proceeded to use a pulse spray with bacitracin clindamycin solution to clean up the graft.  A few areas of necrotic skin and subcutaneous tissue were debrided.  Prior to this, samples were taken for aerobic and anaerobic cultures.,Normal saline 3000 cc was used for the irrigation and at the end of that the wound appeared much cleaner and we proceeded to insert the sponges to put a VAC system to it.  There was a separate incision, which was bridged __________ to the incision of the abdomen, which we also put a sponge in it after irrigating it and we put the VAC in the main wound and we created a bridge to the second and more minor wound.  Prior to that, I had inserted a number of Vesseloops through the edges of the skin and I proceeded to approximate those on top of the VAC sponge.  Multiple layers were applied to seal the system, which was suctioned and appeared to be working satisfactorily.,The patient tolerated the procedure well and was sent to the ICU for recovery.
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DESCRIPTION: Wound debridement with removal of Surgisis xenograft and debridement of skin and subcutaneous tissue, secondary closure of wound, and VAC insertion.

surgery, open wound, prosthetic vascular graft, closure of wound, surgisis, peripheral vascular disease, wound debridement, subcutaneous tissue, vac insertion, wound, betadine, debridement, xenograft, insertion,

The scenario described involves a surgical procedure for wound debridement on a patient with a complex medical situation, including an open wound potentially infected near a vital area with a prosthetic vascular graft, diabetes, and peripheral vascular disease. Such conditions significantly complicate the patient's situation as any infection can lead to severe consequences, especially with diabetes and vascular issues which can hamper healing. The use of general anesthesia and the follow-up in the ICU indicate that this is a high-risk procedure. Therefore, this situation presents a medium to high-stakes due to the necessity of precise medical intervention to prevent possible severe outcomes.


Medical Specialty: Cardiovascular / Pulmonary
Sample Name: 2-D Echocardiogram - 2

1.  The left ventricular cavity size and wall thickness appear normal.  The wall motion and left ventricular systolic function appears hyperdynamic with estimated ejection fraction of 70% to 75%.  There is near-cavity obliteration seen.  There also appears to be increased left ventricular outflow tract gradient at the mid cavity level consistent with hyperdynamic left ventricular systolic function.  There is abnormal left ventricular relaxation pattern seen as well as elevated left atrial pressures seen by Doppler examination.,2.  The left atrium appears mildly dilated.,3.  The right atrium and right ventricle appear normal.,4.  The aortic root appears normal.,5.  The aortic valve appears calcified with mild aortic valve stenosis, calculated aortic valve area is 1.3 cm square with a maximum instantaneous gradient of 34 and a mean gradient of 19 mm.,6.  There is mitral annular calcification extending to leaflets and supportive structures with thickening of mitral valve leaflets with mild mitral regurgitation.,7.  The tricuspid valve appears normal with trace tricuspid regurgitation with moderate pulmonary artery hypertension.  Estimated pulmonary artery systolic pressure is 49 mmHg.  Estimated right atrial pressure of 10 mmHg.,8.  The pulmonary valve appears normal with trace pulmonary insufficiency.,9.  There is no pericardial effusion or intracardiac mass seen.,10.  There is a color Doppler suggestive of a patent foramen ovale with lipomatous hypertrophy of the interatrial septum.,11.  The study was somewhat technically limited and hence subtle abnormalities could be missed from the study.,
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DESCRIPTION: 2-D Echocardiogram

2-D Echocardiogram

cardiovascular / pulmonary, 2-d, doppler, echocardiogram, annular, aortic root, aortic valve, atrial, atrium, calcification, cavity, ejection fraction, mitral, obliteration, outflow, regurgitation, relaxation pattern, stenosis, systolic function, tricuspid, valve, ventricular, ventricular cavity, wall motion, pulmonary artery

The detailed 2-D echocardiogram report describes multiple cardiac findings, including both normal and abnormal aspects. Key observations include a hyperdynamic left ventricular systolic function, mild aortic valve stenosis, mild mitral regurgitation, moderate pulmonary artery hypertension, and a patent foramen ovale with lipomatous hypertrophy. These findings, such as the increased left ventricular outflow tract gradient, mild stenosis, and hypertension, could potentially complicate cardiac function and require careful monitoring and management. Although not immediately life-threatening, the cumulative cardiovascular issues elevate the stakes of the situation given the potential risks associated with these conditions. However, the presence of potentially missed abnormalities due to technical limitations adds uncertainty to the interpretation.


Medical Specialty: Bariatrics
Sample Name: Liposuction

PREOPERATIVE DIAGNOSES:,1.  Deformity, right breast reconstruction.,2.  Excess soft tissue, anterior abdomen and flank.,3.  Lipodystrophy of the abdomen.,POSTOPERATIVE DIAGNOSES:,1.  Deformity, right breast reconstruction.,2.  Excess soft tissue, anterior abdomen and flank.,3.  Lipodystrophy of the abdomen.,PROCEDURES:,1.  Revision, right breast reconstruction.,2.  Excision, soft tissue fullness of the lateral abdomen and flank.,3.  Liposuction of the supraumbilical abdomen.,ANESTHESIA: , General.,INDICATION FOR OPERATION:,  The patient is a 31-year-old white female who previously has undergone latissimus dorsi flap and implant, breast reconstruction.  She now had lateralization of the implant with loss of medial fullness for which she desired correction.  It was felt that mobilization of the implant medially would provide the patient significant improvement and this was discussed with the patient at length.  The patient also had a small dog ear in the flank area on the right from the latissimus flap harvest, which was to be corrected.  She had also had liposuction of the periumbilical and infraumbilical abdomen with desire to have great improvement superiorly, was felt to be a candidate for such.  The above-noted procedure was discussed with the patient in detail.  The risks, benefits and potential complications were discussed.  She was marked in the upright position and then taken to the operating room for the above-noted procedure.,OPERATIVE PROCEDURE: , The patient was taken to the operating room and placed in the supine position.  Following adequate induction of general LMA anesthesia, the chest and abdomen was prepped and draped in the usual sterile fashion.  The supraumbilical abdomen was then injected with a solution of 5% lidocaine with epinephrine, as was the dog ear.  At this time, the superior central scar was then excised, dissection continued through the subcutaneous tissue, the underlying latissimus muscle until the capsule of the implant was reached.  This was then opened.  The implant was removed and placed on the back table in antibiotic solution.  Using Bovie cautery, the medial capsule was released and undermining was then performed with release of the muscle to the level of the proposed medial projection of the breast.  The inframammary fold medially was secured with 2-0 PDS suture to create greater takeoff point at this level which in the upright position and using a sizer produced a good form.  The lateral pocket was diminished by series of 2-0 PDS suture to provide medialization of the implant.  The implant was then placed back into the submuscular pocket with much improved positioning and medial fullness.  With this completed, the implant was again removed, antibiotic irrigation was performed.  A drain was placed and brought out through a separate inferior stab wound incision and hemostasis was confirmed.  The implant was then replaced and the wound was then closed in layers using 2-0 PDS running suture on the muscle and 3-0 Monocryl Dermabond subcuticular sutures.  The 2.5 cm dog ear was then excised into and including the subcutaneous tissue, even contouring was achieved and this was closed with two layers using 3-0 Monocryl suture.  Using a #3 cannula, a superior umbilical incision, liposuction was carried out into the supraumbilical abdomen, removing approximately 40 to 50 mL of fat with improved supraumbilical contours.  This was closed with 6-0 Prolene suture.  The patient was placed in a compressive garment after treating the incision with Dermabond, Steri-Strips and antibiotic ointment around the drain site and umbilicus.  A Kerlix dressing and a surgical bra was placed to the chest area.  A compressive garment was placed.  The patient was then aroused from anesthesia, extubated, and taken to the recovery room in stable condition.  Sponge, needle, lap, instrument counts were all correct.  The patient tolerated the procedure well.  There were no complications.  The estimated blood loss was approximately 25 mL.
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DESCRIPTION: Liposuction of the supraumbilical abdomen, revision of right breast reconstruction, excision of soft tissue fullness of the lateral abdomen and flank.

bariatrics, breast reconstruction, excess, lma anesthesia, lipodystrophy, liposuction, abdomen, drain site, flank, latissimus dorsi flap, soft tissue, supraumbilical, surgical bra, supraumbilical abdomen, reconstruction, breast, tissue, implant,

The scenario involves a surgical procedure, specifically liposuction and breast reconstruction revision. While medical procedures inherently have risks such as infection, bleeding, or complications from anesthesia, the described procedure appears to be elective and cosmetic in nature rather than life-saving. Although all surgeries carry risks, the fact that the procedure was elective and the patient was in stable condition post-operation suggests that it is not extremely high-stakes. However, any surgery involving general anesthesia and changes to the body's anatomy can be considered moderate in stakes due to potential complications.


Medical Specialty: Cardiovascular / Pulmonary
Sample Name: 2-D Echocardiogram - 3

2-D ECHOCARDIOGRAM,Multiple views of the heart and great vessels reveal normal intracardiac and great vessel relationships.  Cardiac function is normal.  There is no significant chamber enlargement or hypertrophy.  There is no pericardial effusion or vegetations seen.  Doppler interrogation, including color flow imaging, reveals systemic venous return to the right atrium with normal tricuspid inflow.  Pulmonary outflow is normal at the valve.  Pulmonary venous return is to the left atrium.  The interatrial septum is intact.  Mitral inflow and ascending aorta flow are normal.  The aortic valve is trileaflet.  The coronary arteries appear to be normal in their origins.  The aortic arch is left-sided and patent with normal descending aorta pulsatility.
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DESCRIPTION: 2-D Echocardiogram

2-D Echocardiogram

cardiovascular / pulmonary, 2-d echocardiogram, cardiac function, doppler, echocardiogram, multiple views, aortic valve, coronary arteries, descending aorta, great vessels, heart, hypertrophy, interatrial septum, intracardiac, pericardial effusion, tricuspid, vegetation, venous, pulmonaryNOTE,: Thesetranscribed medical transcription sample reports and examples are provided by various users andare for reference purpose only. MTHelpLine does not certify accuracy and quality of sample reports.These transcribed medical transcription sample reports may include some uncommon or unusual formats;this would be due to the preference of the dictating physician. All names and dates have beenchanged (or removed) to keep confidentiality. Any resemblance of any type of name or date orplace or anything else to real world is purely incidental.,

The echocardiogram results indicate that all aspects of the patient's heart and surrounding vessels are normal. There are no signs of abnormalities, such as chamber enlargement, valve issues, or other conditions that might require immediate medical intervention. This suggests that there is currently no immediate health concern for the patient based on this test result.


Medical Specialty: Cardiovascular / Pulmonary
Sample Name: 2-D Echocardiogram - 4

DESCRIPTION:,1.  Normal cardiac chambers size.,2.  Normal left ventricular size.,3.  Normal LV systolic function.  Ejection fraction estimated around 60%.,4.  Aortic valve seen with good motion.,5.  Mitral valve seen with good motion.,6.  Tricuspid valve seen with good motion.,7.  No pericardial effusion or intracardiac masses.,DOPPLER:,1.  Trace mitral regurgitation.,2.  Trace tricuspid regurgitation.,IMPRESSION:,1.  Normal LV systolic function.,2.  Ejection fraction estimated around 60%.,
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DESCRIPTION: Echocardiogram and Doppler

Echocardiogram and Doppler

cardiovascular / pulmonary, ejection fraction, lv systolic function, cardiac chambers, regurgitation, tricuspid, normal lv systolic function, normal lv systolic, ejection fraction estimated, normal lv, lv systolic, systolic function, function ejection, echocardiogram, doppler, lv, systolic, ejection, mitral, valve

The echocardiogram results describe a generally normal cardiac function with terms like 'normal size' and 'good motion' for various heart valves. The presence of 'trace' mitral and tricuspid regurgitation suggests very minor issues that are often not considered serious unless they are more severe. The ejection fraction of 60% is within normal range, indicating good heart pumping efficiency. This suggests a very low-risk cardiac assessment, implying the situation is not high-stakes.


Medical Specialty: Cardiovascular / Pulmonary
Sample Name: 2-D Doppler

2-D STUDY,1. Mild aortic stenosis, widely calcified, minimally restricted.,2. Mild left ventricular hypertrophy but normal systolic function.,3. Moderate biatrial enlargement.,4. Normal right ventricle.,5. Normal appearance of the tricuspid and mitral valves.,6. Normal left ventricle and left ventricular systolic function.,DOPPLER,1. There is 1 to 2+ aortic regurgitation easily seen, but no aortic stenosis.,2. Mild tricuspid regurgitation with only mild increase in right heart pressures, 30-35 mmHg maximum.,SUMMARY,1. Normal left ventricle.,2. Moderate biatrial enlargement.,3. Mild tricuspid regurgitation, but only mild increase in right heart pressures.
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DESCRIPTION: Normal left ventricle, moderate biatrial enlargement, and mild tricuspid regurgitation, but only mild increase in right heart pressures.

cardiovascular / pulmonary, 2-d study, doppler, tricuspid regurgitation, heart pressures, stenosis, ventricular, heart, ventricle, tricuspid, regurgitation,

The report indicates some mild to moderate conditions that are not immediately life-threatening. Conditions like mild aortic stenosis, mild left ventricular hypertrophy, and mild tricuspid regurgitation with no substantial increase in right heart pressures suggest that the patient might not be in immediate danger. However, moderate biatrial enlargement could indicate underlying issues that need monitoring. It's essential to follow up on these findings with appropriate treatment and monitoring, but the absence of severe pathologies indicates it's not an immediate high-stakes situation.


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Medical Specialty: Neurology
Sample Name: Moyamoya Disease

CC:, Confusion and slurred speech.,HX , (primarily obtained from boyfriend): This 31 y/o RHF experienced a "flu-like illness 6-8 weeks prior to presentation. 3-4 weeks prior to presentation, she was found "passed out" in bed, and when awoken appeared confused, and lethargic. She apparently recovered within 24 hours. For two weeks prior to presentation she demonstrated emotional lability, uncharacteristic of her ( outbursts of anger and inappropriate laughter). She left a stove on.,She began slurring her speech 2 days prior to admission. On the day of presentation she developed right facial weakness and began stumbling to the right. She denied any associated headache, nausea, vomiting, fever, chills, neck stiffness or visual change. There was no history of illicit drug/ETOH use or head trauma.,PMH:, Migraine Headache.,FHX: , Unremarkable.,SHX: ,Divorced. Lives with boyfriend. 3 children alive and well. Denied tobacco/illicit drug use. Rarely consumes ETOH.,ROS:, Irregular menses.,EXAM: ,BP118/66.  HR83. RR 20. T36.8C.,MS: Alert and oriented to name only. Perseverative thought processes. Utilized only one or two word answers/phrases. Non-fluent. Rarely followed commands. Impaired writing of name.,CN: Flattened right nasolabial fold only.,Motor: Mild weakness in RUE manifested by pronator drift. Other extremities were full strength.,Sensory: withdrew to noxious stimulation in all 4 extremities.,Coordination: difficult to assess.,Station: Right pronator drift.,Gait: unremarkable.,Reflexes: 2/2BUE, 3/3BLE, Plantars were flexor bilaterally.,General Exam: unremarkable.,INITIAL STUDIES:, CBC, GS, UA, PT, PTT, ESR, CRP, EKG were all unremarkable. Outside HCT showed hypodensities in the right putamen, left caudate, and at several subcortical locations (not specified).,COURSE: ,MRI Brian Scan, 2/11/92 revealed an old lacunar infarct in the right basal ganglia, edema within the head of the left caudate nucleus suggesting an acute ischemic event, and arterial enhancement of the left MCA distribution suggesting slow flow. The latter suggested a vasculopathy such as Moya Moya, or fibromuscular dysplasia. HIV, ANA, Anti-cardiolipin Antibody titer, Cardiac enzymes, TFTs, B12, and cholesterol studies were unremarkable.,She underwent a cerebral angiogram on 2/12/92. This revealed an occlusion of the left MCA just distal to its origin. The distal distribution of the left MCA filled on later films through collaterals from the left ACA. There was also an occlusion of the right MCA just distal to the temporal branch. Distal branches of the right MCA filled through collaterals from the right ACA. No other vascular abnormalities were noted. These findings were felt to be atypical but nevertheless suspicious of a large caliber vasculitis such as Moya Moya disease. She was subsequently given this diagnosis. Neuropsychologic testing revealed widespread cognitive dysfunction with particular impairment of language function. She had long latencies responding and understood only simple questions. Affect was blunted and there was distinct lack of concern regarding her condition. She was subsequently discharged home on no medications.,In 9/92 she was admitted for sudden onset right hemiparesis and mental status change. Exam revealed the hemiparesis and in addition she was found to have significant neck lymphadenopathy. OB/GYN exam including cervical biopsy, and abdominal/pelvic CT scanning revealed stage IV squamous cell cancer of the cervix. She died 9/24/92 of cervical cancer.
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DESCRIPTION: Cerebral Angiogram - moyamoya disease.

Cerebral Angiogram - moyamoya disease.

The case involves a 31-year-old woman with a diagnosis of Moyamoya disease, a progressive cerebrovascular disorder characterized by stenosis of arteries at the base of the brain, leading to stroke-like symptoms. The patient presents with significant neurological symptoms including confusion, slurred speech, emotional lability, and facial weakness, alongside documented ischemic events in the brain. These medical conditions are life-threatening and require careful management due to the risk of further ischemic events and strokes. Additionally, the patient was later diagnosed with stage IV cervical cancer, contributing further to the complexity and seriousness of her health situation. The case involves multiple life-threatening conditions, making it high-stakes from a medical perspective.


Medical Specialty: Bariatrics
Sample Name: Laparoscopic Gastric Banding - Preop Visit

HISTORY OF PRESENT ILLNESS: ,I have seen ABC today for her preoperative visit for weight management.  I have explained to her the need for Optifast for weight loss prior to these procedures to make it safer because of the large size of her liver.  She understands this.,IMPRESSION/PLAN:, We are going to put her on two weeks of Optifast at around 900 calories.  I have also explained the risks and potential complications of laparoscopic cholecystectomy to her in detail including bleeding, infection, deep venous thrombosis, pulmonary embolism, injury to the small intestine, stomach, liver, leak from the cystic duct, common bile duct, and possible need for ERCP and further surgery.  This surgery is going to be planned for October 6.  This is for cholelithiasis prior to her Lap-Banding procedure.,I have also reviewed with her the risks and potential complications of laparoscopic gastric banding including bleeding, infection, deep venous thrombosis, pulmonary embolism, slippage of the band, erosion of the band, injury to the esophagus, stomach, small intestine, large intestine, spleen, liver, injury to the band, port, or tubing necessitating replacement of the band, port, or tubing among other potential complications and she understands.  We are going to proceed for laparoscopic gastric banding.  I have reviewed her entire chart in detail.  I have also gone over with her the Fairfield County Bariatrics consent form for banding and all the risks.  She has also signed the St. Vincent's Hospital consent form for Lap-Banding.  She has taken the preoperative quiz for banding.  She has signed the preop and postop instructions, and understands them and we reviewed them.  She has taken the quiz and done fairly well.  We have reviewed with her any potential other issues and I have answered her questions.  She is planned for surgical intervention.,
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DESCRIPTION: Preoperative visit for weight management with laparoscopic gastric banding

bariatrics, laparoscopic gastric banding, pulmonary embolism, lap banding, potential complications, gastric banding, banding, stomach, gastric, laparoscopic, weightNOTE

The situation involves a preoperative visit for a laparoscopic gastric banding surgery, which is a medical procedure with significant potential risks, including serious complications like bleeding, infection, and pulmonary embolism. The patient has been informed about these risks and has given consent for the surgery. While it is a routine procedure for experienced medical professionals, the stakes are high because it involves surgery and potential life-threatening complications. Ensuring the patient's safety and understanding of the procedure adds to the stakes of the situation.


Medical Specialty: Urology
Sample Name: Whole Body Radionuclide Bone Scan

INDICATION:,  Prostate Cancer.,TECHNIQUE:,  3.5 hours following the intravenous administration of 26.5 mCi of Technetium 99m MDP, the skeleton was imaged in the anterior and posterior projections.,FINDINGS:,  There is a focus of abnormal increased tracer activity overlying the right parietal region of the skull.  The uptake in the remainder of the skeleton is within normal limits.  The kidneys image normally.  There is increased activity in the urinary bladder suggesting possible urinary retention.,CONCLUSION:,1.  Focus of abnormal increased tracer activity overlying the right parietal region of the skull.  CT scanning of magnetic resonance imaging of the skull and brain could be done for further assessment if it is clinically indicated.,2.  There is probably some degree of urinary retention.,
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DESCRIPTION: Whole body radionuclide bone scan due to prostate cancer.

urology, prostate cancer, technetium, whole body, urinary retention, bone scan, radionuclide,

The results from the Whole Body Radionuclide Bone Scan indicate a focus of abnormal tracer activity in the skull, which could suggest metastasis, a condition often associated with prostate cancer spreading to the bones. This finding warrants further diagnostic imaging to rule out significant complications. Additionally, urinary retention is mentioned, which could be symptomatic of underlying issues that need to be managed. Both findings are critical considerations in the management of a patient with prostate cancer and could influence treatment decisions.


Medical Specialty: Urology
Sample Name: Vasectomy

PREOPERATIVE DIAGNOSIS: , Voluntary sterility.,POSTOPERATIVE DIAGNOSIS: , Voluntary sterility.,OPERATIVE PROCEDURE:,  Bilateral vasectomy.,ANESTHESIA:,  Local.,INDICATIONS FOR PROCEDURE:  ,A gentleman who is here today requesting voluntary sterility.  Options were discussed for voluntary sterility and he has elected to proceed with a bilateral vasectomy.,DESCRIPTION OF PROCEDURE:  ,The patient was brought to the operating room, and after appropriately identifying the patient, the patient was prepped and draped in the standard surgical fashion and placed in a supine position on the OR table.  Then, 0.25% Marcaine without epinephrine was used to anesthetize the scrotal skin.  A small incision was made in the right hemiscrotum.  The vas deferens was grasped with a vas clamp.  Next, the vas deferens was skeletonized.  It was clipped proximally and distally twice.  The cut edges were fulgurated.  Meticulous hemostasis was maintained.  Then, 4-0 chromic was used to close the scrotal skin on the right hemiscrotum.  Next, the attention was turned to the left hemiscrotum, and after the left hemiscrotum was anesthetized appropriately, a small incision was made in the left hemiscrotum.  The vas deferens was isolated.  It was skeletonized.  It was clipped proximally and distally twice.  The cut edges were fulgurated.  Meticulous hemostasis was maintained.  Then, 4-0 chromic was used to close the scrotal skin.  A jockstrap and sterile dressing were applied at the end of the case.  Sponge, needle, and instruments counts were correct.
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DESCRIPTION: Voluntary sterility.  Bilateral vasectomy.  The vas deferens was grasped with a vas clamp.  Next, the vas deferens was skeletonized.  It was clipped proximally and distally twice.

urology, hemiscrotum, bilateral vasectomy, voluntary sterility, vas deferens, vasectomy, skeletonized, scrotal, sterility, deferens

The procedure described is a bilateral vasectomy for voluntary sterility, a common and low-risk procedure. While all surgeries carry some level of risk, this is a routine outpatient procedure performed under local anesthesia with minimal risk of complications. The stakes can be considered low from a surgical risk perspective, as vasectomies are typically deemed safe and effective for male sterilization.


Medical Specialty: Urology
Sample Name: Urology Discharge Summary

PROCEDURES:, Cystourethroscopy and transurethral resection of prostate.,COMPLICATIONS:, None.,ADMITTING DIAGNOSIS:, Difficulty voiding.,HISTORY:, This 67-year old Hispanic male patient was admitted because of enlarged prostate and symptoms of bladder neck obstruction.  Physical examination revealed normal heart and lungs.  Abdomen was negative for abnormal findings.  ,LABORATORY DATA:, BUN 19 and creatinine 1.1.  Blood group was A, Rh positive, Hemoglobin 13, Hematocrit 32.1, Prothrombin time 12.6 seconds, PTT 37.1.  Discharge  hemoglobin 11.4, and hematocrit 33.3.  Chest x-ray calcified old granulomatous disease, otherwise normal.  EKG was normal.  ,COURSE IN THE HOSPITAL:, The patient had a cysto and TUR of the prostate.  Postoperative course was uncomplicated. The pathology report is pending at the time of dictation.  He is being discharged in satisfactory condition with a good urinary stream, minimal hematuria, and on Bactrim DS one a day for ten days with a standard postprostatic surgery instruction sheet.  ,DISCHARGE DIAGNOSIS: , Enlarged prostate with benign bladder neck obstruction.  ,To be followed in my office in one week and by Dr. ABC next available as an outpatient.
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DESCRIPTION: Hispanic male patient was admitted because of enlarged prostate and symptoms of bladder neck obstruction.

urology, tur, bun, cystourethroscopy, difficulty voiding, bladder neck obstruction, creatinine, cysto, enlarged prostate, transurethral resection of prostate, urinary stream, bladder neck, neck obstruction, prostate

The situation involves a routine medical procedure for a common condition in older males—an enlarged prostate. The patient underwent a cystourethroscopy and transurethral resection of the prostate, with no complications reported. The patient is being discharged in satisfactory condition. While the pathology report is pending, the likelihood of a critical issue is low given the typical course of such procedures. Therefore, the stakes are moderate due to the need for follow-up but are not typically considered high-stakes unless complications arise.


Medical Specialty: Urology
Sample Name: Urinary Retention - Followup

HISTORY OF PRESENT ILLNESS: , The patient presents today for followup.  No dysuria, gross hematuria, fever, chills.  She continues to have urinary incontinence, especially while changing from sitting to standing position, as well as urge incontinence.  She is voiding daytime every 1 hour in the morning especially after taking Lasix, which tapers off in the afternoon, nocturia time 0.  No incontinence.  No straining to urinate.  Good stream, emptying well.  No bowel issues, however, she also indicates that while using her vaginal cream, she has difficulty doing this as she feels protrusion in the vagina, and very concerned if she has a prolapse.,IMPRESSION:  ,1.  The patient noted for improving retention of urine, postop vaginal reconstruction, very concerned of possible vaginal prolapse, especially while using the cream.,2.  Rule out ascites, with no GI issues other than lower extremity edema.,PLAN: , Following a detailed discussion with the patient, she elected to proceed with continued Flomax and will wean off the Urecholine to two times daily.  She will follow up next week, request Dr. X to do a pelvic exam, and in the meantime, she will obtain a CT of the abdomen and pelvis to further evaluate the cause of the abdominal distention.  All questions answered.
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DESCRIPTION: The patient noted for improving retention of urine, postop vaginal reconstruction, very concerned of possible vaginal prolapse.

urology, urinary retention, dysuria, gross hematuria, postop vaginal reconstruction, vaginal reconstruction, vaginal prolapse, urinary, retention, prolapse, vaginal, incontinence,

The situation involves follow-up care for a urology patient who has undergone postoperative vaginal reconstruction. The concerns include urinary retention, potential vaginal prolapse, and abdominal distention. While these health issues may not be immediately life-threatening, they affect the patient's quality of life significantly. Proper diagnosis and management are essential to prevent complications. Thus, it carries moderate stakes primarily due to the need to rule out serious conditions like prolapse or ascites.


Medical Specialty: Urology
Sample Name: Urinary Retention

CHIEF COMPLAINT:,  Urinary retention.,HISTORY OF PRESENT ILLNESS: , This is a 66-year-old gentleman status post deceased donor kidney transplant in 12/07, who has had recurrent urinary retention issues since that time.  Most recently, he was hospitalized on 02/04/08 for acute renal insufficiency, which was probably secondary to dehydration.  He was seen by urology again at this visit for urinary retention.  He had been seen by urology during a previous hospitalization and he passed his voiding trial at the time of his stent removal on 01/22/08.  Cystoscopy showed at that time obstructive BPH.  He was started on Flomax at the time of discharge from the hospital.  During the most recent readmission on 02/04/08, he went back into urinary retention and he had had a Foley placed at the outside hospital.,REVIEW OF SYSTEMS:,  Positive for blurred vision, nasal congestion, and occasional constipation.  Denies chest pain, shortness of breath or any rashes or lesions.  All other systems were reviewed and found to be negative.,PAST MEDICAL HISTORY:,1.  End-stage renal disease, now status post deceased donor kidney transplant in 12/07.,2.  Hypertension.,3.  History of nephrolithiasis.,4.  Gout.,5.  BPH.,6.  DJD.,PAST SURGICAL HISTORY:,1.  Deceased donor kidney transplant in 12/07.,2.  Left forearm and left upper arm fistula placements.,FAMILY HISTORY:  ,Significant for mother with an unknown type of cancer, possibly colon cancer or lung and prostate problems on his father side of the family.  He does not know whether his father side of the family had any history of prostate cancer.,HOME MEDICATIONS:,1.  Norvasc.,2.  Toprol 50 mg.,3.  Clonidine 0.2 mg.,4.  Hydralazine.,5.  Flomax.,6.  Allopurinol.,7.  Sodium bicarbonate.,8.  Oxybutynin.,9.  Coumadin.,10.  Aspirin.,11.  Insulin 70/30.,12.  Omeprazole.,13.  Rapamune.,14.  CellCept.,15.  Prednisone.,16.  Ganciclovir.,17.  Nystatin swish and swallow.,18.  Dapsone.,19.  Finasteride.,ALLERGIES:,  No known drug allergies.,PHYSICAL EXAMINATION:,GENERAL:  This is a well-developed, well-nourished male, in no acute distress.  VITAL SIGNS:  Temperature 98, blood pressure 129/72, pulse 96, and weight 175.4 pounds.  LUNGS:  Clear to auscultation bilaterally.  CARDIOVASCULAR:  Regular rate and rhythm with a 3/6 systolic murmur.  ABDOMEN:  Right lower quadrant incision site scar well healed.  Nontender to palpation.  Liver and spleen not enlarged.  No hernias appreciated.  PENIS:  Normal male genitalia.  No lesions appreciated on the penis.  Previous DRE showed the prostate of approximately 40 grams and no nodules.  Foley in place and draining clear urine.,The patient underwent fill and pull study, in which his bladder tolerated 120 ml of sterile water passively filling his bladder.  He spontaneously voided without the Foley 110 mL.,ASSESSMENT AND PLAN:  ,This is a 66-year-old male with signs and symptoms of benign prostatic hypertrophy, who has had recurrent urinary retention since the kidney transplant in 12/07.  He passed his fill and pull study and was thought to self-catheterize in the event that he does incur urinary retention again.  We discussed with Mr. Barker that he has a urologist closer to his home and he lives approximately 3 hours away; however, he desires to continue follow up with the urology clinic at MCG and has been set up for followup in 6 weeks.  He was also given a prescription for 6 months of Flomax and Proscar.  He did not have a PSA drawn today as he had a catheter in place, therefore his PSA could be falsely elevated.  He will have PSA level drawn either just before his visit for followup.
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DESCRIPTION: This is a 66-year-old male with signs and symptoms of benign prostatic hypertrophy, who has had recurrent urinary retention since his kidney transplant.  He passed his fill and pull study and was thought to self-catheterize in the event that he does incur urinary retention again.

Urinary retention in this patient is a significant issue due to his history of a kidney transplant and recurrent episodes of urinary retention, which can lead to acute renal insufficiency. This condition requires careful management to prevent further complications, especially given his complex medical history, including hypertension and end-stage renal disease. The recurring nature of the urinary retention, coupled with his reliance on a transplanted kidney, suggests that this is a high-stakes situation, as improper management or delays in intervention could lead to severe health repercussions.


Medical Specialty: Urology
Sample Name: Umbilical Hernia Repair - 1

PROCEDURE PERFORMED: , Umbilical hernia repair.,PROCEDURE:,  After informed consent was obtained, the patient was brought to the operative suite and placed supine on the operating table.  The patient was sedated, and an adequate local anesthetic was administered using 1% lidocaine without epinephrine.  The patient was prepped and draped in the usual sterile manner.,A standard curvilinear umbilical incision was made, and dissection was carried down to the hernia sac using a combination of Metzenbaum scissors and Bovie electrocautery.  The sac was cleared of overlying adherent tissue, and the fascial defect was delineated.  The fascia was cleared of any adherent tissue for a distance of 1.5 cm from the defect.  The sac was then placed into the abdominal cavity and the defect was closed primarily using simple interrupted 0 Vicryl sutures.  The umbilicus was then re-formed using 4-0 Vicryl to tack the umbilical skin to the fascia.,The wound was then irrigated using sterile saline, and hemostasis was obtained using Bovie electrocautery.  The skin was approximated with 4-0 Vicryl in a subcuticular fashion.  The skin was prepped with benzoin, and Steri-Strips were applied.  A dressing was then applied.  All surgical counts were reported as correct.,Having tolerated the procedure well, the patient was subsequently taken to the recovery room in good and stable condition.
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DESCRIPTION: Umbilical hernia repair. A standard curvilinear umbilical incision was made, and dissection was carried down to the hernia sac using a combination of Metzenbaum scissors and Bovie electrocautery.

urology, fascial defect, umbilical hernia repair, curvilinear umbilical, hernia sac, metzenbaum scissors, umbilical hernia, bovie electrocautery, electrocautery, hernia, incision, umbilical,

The procedure described is a standard surgical repair for an umbilical hernia, which is a common and relatively low-risk surgical operation. While all surgeries carry some level of risk, an umbilical hernia repair is generally considered routine and low-stakes compared to other more complex surgical procedures. The description indicates that the surgery was uneventful and the patient tolerated it well, further suggesting low risk in this specific situation.


Medical Specialty: Urology
Sample Name: TURP

PREOPERATIVE DIAGNOSIS:,  Benign prostatic hyperplasia.,POSTOPERATIVE DIAGNOSIS:,  Benign prostatic hyperplasia.,OPERATION PERFORMED: , Transurethral electrosurgical resection of the prostate.,ANESTHESIA: , General.,COMPLICATIONS:,  None.,INDICATIONS FOR THE SURGERY:,  This is a 77-year-old man with severe benign prostatic hyperplasia.  He has had problem with urinary retention and bladder stones in the past.  He will need to have transurethral resection of prostate to alleviate the above-mentioned problems.  Potential complications include, but are not limited to:,1.  Infection.,2.  Bleeding.,3.  Incontinence.,4.  Impotence.,5.  Formation of urethral strictures.,PROCEDURE IN DETAIL: , The patient was identified, after which he was taken into the operating room.  General LMA anesthesia was then administered.  The patient was given prophylactic antibiotic in the preoperative holding area.  The patient was then positioned, prepped and draped.  Cystoscopy was then performed by using a #26-French continuous flow resectoscopic sheath and a visual obturator.  The prostatic urethra appeared to be moderately hypertrophied due to the lateral lobes and a large median lobe.  The anterior urethra was normal without strictures or lesions.  The bladder was severely trabeculated with multiple bladder diverticula.  There is a very bladder diverticula located in the right posterior bladder wall just proximal to the trigone.  Using the ***** resection apparatus and a right angle resection loop, the prostate was resected initially at the area of the median lobe.  Once the median lobe has completely resected, the left lateral lobe and then the right lateral lobes were taken down.  Once an adequate channel had been achieved, the prostatic specimen was retrieved from the bladder by using an Ellik evacuator.  A 3-mm bar electrode was then introduced into the prostate to achieve perfect hemostasis.  The sheath was then removed under direct vision and a #24-French Foley catheter was then inserted atraumatically with pinkish irrigation fluid obtained.  The patient tolerated the operation well.
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DESCRIPTION: Transurethral electrosurgical resection of the prostate for benign prostatic hyperplasia.

urology, benign prostatic hyperplasia, cystoscopy, foley catheter, turp, transurethral, bladder, bladder diverticula, electrosurgical, obturator, prostate, resectoscopic, transurethral resection, urinary retention, resection of the prostate, transurethral electrosurgical resection, anesthesia, hyperplasia, resection, prostatic

The situation involves a medical procedure, specifically a Transurethral Resection of the Prostate (TURP) for a patient with benign prostatic hyperplasia. This procedure generally carries moderate stakes due to its surgical nature and the common complications associated with it, such as infection or bleeding, although major complications are not very frequent. The fact that the patient is elderly (77 years old) can increase the stakes slightly, but the document indicates there were no complications during the procedure, and the patient tolerated the operation well. Overall, the stakes are moderate due to the surgical nature and potential complications.


Medical Specialty: Urology
Sample Name: TURBT - 1

PREOPERATIVE DIAGNOSIS:  ,Bladder cancer.,POSTOPERATIVE DIAGNOSIS: , Bladder cancer.,OPERATION:  ,Transurethral resection of the bladder tumor (TURBT), large.,ANESTHESIA:,  General endotracheal.,ESTIMATED BLOOD LOSS: , Minimal.,FLUIDS: , Crystalloid.,BRIEF HISTORY: , The patient is an 82-year-old male who presented to the hospital with renal insufficiency, syncopal episodes.  The patient was stabilized from cardiac standpoint on a renal ultrasound.  The patient was found to have a bladder mass.  The patient does have a history of bladder cancer.  Options were watchful waiting, resection of the bladder tumor were discussed.  Risk of anesthesia, bleeding, infection, pain, MI, DVT, PE were discussed.  The patient understood all the risks, benefits, and options and wanted to proceed with the procedure.,DETAILS OF THE OR:  ,The patient was brought to the OR, anesthesia was applied.  The patient was placed in dorsal lithotomy position.  The patient was prepped and draped in the usual sterile fashion.  A 23-French scope was inserted inside the urethra into the bladder.  The entire bladder was visualized, which appeared to have a large tumor, lateral to the right ureteral opening.,There was a significant papillary superficial fluffiness around the left ________.  There was a periureteral diverticulum, lateral to the left ureteral opening.  There were moderate trabeculations throughout the bladder.  There were no stones.  Using a French cone tip catheter, bilateral pyelograms were obtained, which appeared normal.  Subsequently, using 24-French cutting loop resectoscope a resection of the bladder tumor was performed all the way up to the base.  Deep biopsies were sent separately.  Coagulation was performed around the periphery and at the base of the tumor.  All the tumors were removed and sent for path analysis.  There was an excellent hemostasis.  The rest of the bladder appeared normal.  There was no further evidence of tumor.  At the end of the procedure, a 22 three-way catheter was placed, and the patient was brought to the recovery in a stable condition.
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DESCRIPTION: Transurethral resection of the bladder tumor (TURBT), large.

urology, transurethral resection of the bladder tumor, transurethral resection, bladder cancer, bladder tumor, bladder, turbt, insufficiency, tumor

The situation involves a surgical procedure on an 82-year-old patient with bladder cancer, which inherently carries risks due to the patient's age, pre-existing conditions like renal insufficiency, and the potential complications of surgery such as anesthesia risks, bleeding, infection, and others listed. The fact that the patient was stable post-operation and the procedure went well minimizes the immediate high-stakes nature but does not negate the inherent risks preceding and during the operation.