harishnair04/mtsamples huggingface dataset:
Heart Catheterization, Ventriculography, & Angiography - 8 
Medical specialty:  Surgery
 Left heart catheterization, coronary angiography, and left ventriculogram.  No angiographic evidence of coronary artery disease.  Normal left ventricular systolic function.  Normal left ventricular end diastolic pressure.

PROCEDURES,1.  Left heart catheterization.,2.  Coronary angiography.,3.  Left ventriculogram.,PREPROCEDURE DIAGNOSIS:,  Atypical chest pain.,POSTPROCEDURE DIAGNOSES,1.  No angiographic evidence of coronary artery disease.,2.  Normal left ventricular systolic function.,3.  Normal left ventricular end diastolic pressure.,INDICATION:  ,The patient is a 58-year-old male with past medical history significant for polysubstance abuse, chronic tobacco abuse, chronic alcohol dependence with withdrawal, atrial flutter, history of ventricular tachycardia with AICD placement, and hepatitis C. The patient was admitted for atypical chest pain and scheduled for cardiac catheterization.,PROCEDURE IN DETAIL:,  After informed consent was signed by the patient, the patient was taken to the cardiac catheterization laboratory.  He was prepped and draped in the usual sterile manner.  The right inguinal area was anesthetized with 2% Xylocaine.  A 4-French sheath was inserted into the right femoral artery using the modified Seldinger technique.  JL4 and 3DRC catheters were used to cannulate the left and right coronary arteries respectively.  Coronary angiographies were performed.  These catheters were removed and exchanged for a 4-French pigtail catheter, which was positioned into the left ventricle.  Left ventriculography was performed.  The patient tolerated the procedure well.  At the end of the procedure, all catheters and sheaths were removed.  The patient was then transferred to telemetry in a stable condition.,HEMODYNAMIC DATA: , Hemodynamic data shows aortic pressures of 100/56 with mean of 70 mmHg and the LV 100/0 with LVEDP of 10 mmHg.,AORTIC VALVE:  ,There is no significant gradient across this valve noted.,LV GRAM: , A 10 mL of contrast were delivered for 3 seconds for a total of 30 mL.  Ejection fraction was calculated to be 69%.  There were no wall motion abnormalities noted.,ANGIOGRAM,LEFT MAIN CORONARY ARTERY: , Left main coronary artery is a moderate-caliber vessel free of disease and trifurcates.,LAD: , LAD is a long, tortuous vessel which wraps around the apex.  The LAD is small in caliber.  In addition, there is a long bifurcating small-caliber diagonal branch noted.  LAD and its branches are free of disease.,RAMUS INTERMEDIUS: , Ramus intermedius is a long small-caliber vessel free of disease.,LCX: , LCX is a nondominant small-caliber vessel with long bifurcating small-caliber distal OM branch.  LCX and its branches are free of disease.,RCA:,  RCA is a dominant small-caliber vessel with long small-caliber PDA branch.  RCA and its branches are free of disease.,IMPRESSION,1.  No angiographic evidence of coronary artery disease.,2.  Normal left ventricular systolic function.,3.  Normal left ventricular end diastolic pressure.,RECOMMENDATION: , Recommend to look for alternative causes of chest pain.
Heart Catheterization, Ventriculography, & Angiography - 7 
Medical specialty:  Surgery
 Left heart catheterization, coronary angiography, left ventriculography.  Severe complex left anterior descending and distal circumflex disease with borderline, probably moderate narrowing of a large obtuse marginal branch.

PROCEDURE: , Left heart catheterization, coronary angiography, left ventriculography.,COMPLICATIONS: , None.,PROCEDURE DETAIL: , The right femoral area was draped and prepped in the usual fashion after Xylocaine infiltration.  A 6-French arterial sheath was placed in the usual fashion.  Left and right coronary angiograms were then performed in various projections after heparin was given 2000 units intraaortic.  The right coronary artery was difficult to cannulate because of its high anterior takeoff.  This was nondominant.  Several catheters were used.  Ultimately, an AL1 diagnostic catheter was used.  A pigtail catheter was advanced across the aortic valve.  Left ventriculogram was then done in the RAO view using 30 mL of contrast.  Pullback gradient was obtained across the aortic valve.  Femoral angiogram was performed through the sheath which was above the bifurcation, was removed with a Perclose device with good results.  There were no complications.  He tolerated this procedure well and returned to his room in good condition.,FINDINGS,1.  Right coronary artery:  This has an unusual high anterior takeoff.  The vessel is nondominant, has diffuse mild-to-moderate disease.,2.  Left main trunk:  A 30% to 40% distal narrowing is present.,3.  Left anterior descending:  Just at the ostium of the vessel and up to and including the bifurcation of the first large diagonal branch, there is 80 to 90% narrowing.  The diagonal is a large vessel about 3 mm in size.,4.  Circumflex:  Dominant vessel, 50% narrowing at the origin of the obtuse marginal.  After this, there is 40% narrowing in the AV trunk.  The small posterior lateral branch has diffuse mild disease and then the vessel gives rise to a fairly large posterior ventricular branch, which has 70% ostial narrowing, and then after this the posterior descending has 80% narrowing at its origin.,5.  Left ventriculogram:  Normal volume in diastole and systole.  Normal systolic function is present.  There is no mitral insufficiency or left ventricular outflow obstruction.,DIAGNOSES,1.  Severe complex left anterior descending and distal circumflex disease with borderline, probably moderate narrowing of a large obtuse marginal branch.  Dominant circumflex system.  Severe disease of the posterior descending.  Mild left main trunk disease.,2.  Normal left ventricular systolic function.,Given the complex anatomy of the predominant problem which is the left anterior descending; given its ostial stenosis and involvement of the bifurcation of the diagonal, would recommend coronary bypass surgery.  The patient also has severe disease of the circumflex which is dominant.  This anatomy is not appropriate for percutaneous intervention.  The case will be reviewed with a cardiac surgeon.
Heart Catheterization, Ventriculography, & Angiography - 3 
Medical specialty:  Surgery
 Left heart catheterization with ventriculography, selective coronary angiography.  Standard Judkins, right groin.  Catheters used were a 6 French pigtail, 6 French JL4, 6 French JR4.

NAME OF PROCEDURE: , Left heart catheterization with ventriculography, selective coronary angiography.,INDICATIONS: , Acute coronary syndrome.,TECHNIQUE OF PROCEDURE: , Standard Judkins, right groin.  Catheters used were a 6 French pigtail, 6 French JL4, 6 French JR4.  ,ANTICOAGULATION:  ,The patient was on heparin at the time.,COMPLICATIONS: , None.,I reviewed with the patient the pros, cons, alternatives, risks of catheterization and sedation including myocardial infarction, stroke, death, damage to nerve, artery or vein in the leg, perforation of a cardiac chamber, dissection of an artery requiring countershock, infection, bleeding, ATN allergy, need for cardiac surgery.  All questions were answered, and the patient desired to proceed.,HEMODYNAMIC DATA:  ,Aortic pressure was in the physiologic range.  No significant gradient across the aortic valve.,ANGIOGRAPHIC DATA,1. Ventriculogram:  The left ventricle is of normal size and shape, normal wall motion, normal ejection fraction.,2. Right coronary artery:  Dominant.  There was insignificant disease in the system.,3. Left coronary:  Left main, left anterior descending and circumflex systems showed no significant disease.,CONCLUSIONS,1. Normal left ventricular systolic function.,2. Insignificant coronary disease.,PLAN: , Based upon this study, medical therapy is warranted.  Six-French Angio-Seal was used in the groin.
Heart Catheterization & Angiography - 1 
Medical specialty:  Surgery
 Left heart cath, selective coronary angiography, LV gram, right femoral arteriogram, and Mynx closure device.  Normal stress test.

CLINICAL INDICATION:  ,Normal stress test.,PROCEDURES PERFORMED:,1.  Left heart cath.,2.  Selective coronary angiography.,3.  LV gram.,4.  Right femoral arteriogram.,5.  Mynx closure device.,PROCEDURE IN DETAIL: , The patient was explained about all the risks, benefits, and alternatives of this procedure.  The patient agreed to proceed and informed consent was signed.,Both groins were prepped and draped in the usual sterile fashion.  After local anesthesia with 2% lidocaine, a 6-French sheath was inserted in the right femoral artery.  Left and right coronary angiography was performed using 6-French JL4 and 6-French 3DRC catheters.  Then, LV gram was performed using 6-French pigtail catheter.  Post LV gram, LV-to-aortic gradient was obtained.  Then, the right femoral arteriogram was performed.  Then, the Mynx closure device was used for hemostasis.  There were no complications.,HEMODYNAMICS: , LVEDP was 9.  There was no LV-to-aortic gradient.,CORONARY ANGIOGRAPHY:,1.  Left main is normal.  It bifurcates into LAD and left circumflex.,2.  Proximal LAD at the origin of big diagonal, there is 50% to 60% calcified lesion present.  Rest of the LAD free of disease.,3.  Left circumflex is a large vessel and with minor plaque.,4.  Right coronary is dominant and also has proximal 40% stenosis.,SUMMARY:,1.  Nonobstructive coronary artery disease, LAD proximal at the origin of big diagonal has 50% to 60% stenosis, which is calcified.,2.  RCA has 40% proximal stenosis.,3.  Normal LV systolic function with LV ejection fraction of 60%.,PLAN: , We will treat with medical therapy.  If the patient becomes symptomatic, we will repeat stress test.  If there is ischemic event, the patient will need surgery for the LAD lesion.  For the time being, we will continue with the medical therapy.,
Heart Catheterization, Ventriculography, & Angiography - 2 
Medical specialty:  Surgery
 Left heart catheterization with ventriculography, selective coronary arteriographies, successful stenting of the left anterior descending diagonal.

NAME OF PROCEDURE: , Left heart catheterization with ventriculography, selective coronary arteriographies, successful stenting of the left anterior descending diagonal.,INDICATION:,  Recurrent angina.  History of coronary disease.,TECHNICAL PROCEDURE: , Standard Judkins, right groin.,CATHETERS USED:,  6-French pigtail, 6-French JL4, 6-French JR4.,ANTICOAGULATION: , 2000 of heparin, 300 of Plavix, was begun on Integrilin.,COMPLICATIONS: , None.,STENT: , For stenting we used a 6-French left Judkins guide.  Stent was a 275 x 13 Zeta.,DESCRIPTION OF PROCEDURE: , I reviewed with the patient the pros, cons, alternatives and risks of catheterization and sedation including myocardial infarction, stroke, death, damage to nerve, artery or vein in the leg, perforation of cardiac chamber, resection of an artery, arrhythmia requiring countershock, infection, bleeding, allergy, and need for vascular surgery.  All questions were answered and the patient decided to proceed.,HEMODYNAMIC DATA: , Aortic pressure was within physiologic range.  There was no significant gradient across the aortic valve.,ANGIOGRAPHIC DATA,1.  Ventriculogram:  Left ventricle was of normal size and shape with normal wall motion, normal ejection fraction.,2.  Right coronary artery:  Dominant.  There was a lesion in the proximal portion in the 60% range, insignificant disease distally.,3.  Left coronary artery:  The left main coronary artery showed insignificant disease.  The circumflex arose, showed about 30% proximally.  Left anterior descending arose and the previously placed stent was perfectly patent.  There was a large diagonal branch which showed 90% stenosis in its proximal portion.  There was a lesion in the 30% to 40% range even more proximal.,I reviewed with the patient the options of medical therapy, intervention on the culprit versus bypass surgery.  He desired that we intervene.,Successful stenting of the left anterior descending, diagonal.  The guide was placed in the left main.  We easily crossed the lesion in the diagonal branch of the left anterior descending.  We advanced, applied and post-dilated the 275 x 13 stent.  Final angiography showed 0% residual at the site of previous 90% stenosis.  The more proximal 30% to 40% lesion was unchanged.,CONCLUSION,1.  Successful stenting of the left anterior descending/diagonal.  Initially there was 90% in the diagonal after stenting.  There was 0% residual.  There was a lesion a bit more proximal in the 40% range.,2.  Left anterior descending stent remains patent.,3.  30% in the circumflex.,4.  60% in the right coronary.,5.  Ejection fraction and wall motion are normal.,PLAN: , We have stented the culprit lesion.  The patient will receive a course of aspirin, Plavix, Integrilin, and statin therapy.  We used 6-French Angio-Seal in the groin.  All questions have been answered.  I have discussed the possibility of restenosis, need for further procedures.
Heart Catheterization & Angiography 
Medical specialty:  Surgery
 Left and right heart catheterization and selective coronary angiography.  Coronary artery disease, severe aortic stenosis by echo.

INDICATION:,  Coronary artery disease, severe aortic stenosis by echo.,PROCEDURE PERFORMED:,1.  Left heart catheterization.,2.  Right heart catheterization.,3.  Selective coronary angiography.,PROCEDURE: , The patient was explained about all the risks, benefits and alternatives to the procedure.  The patient agreed to proceed and informed consent was signed.,Both groins were prepped and draped in usual sterile fashion.  After local anesthesia with 2% lidocaine, 6-French sheath was inserted in the right femoral artery and 7-French sheath was inserted in the right femoral vein.  Then right heart cath was performed using 7-French Swan-Ganz catheter.  Catheter was placed in the pulmonary capillary wedge position.  Pulmonary capillary wedge pressure, PA pressure was obtained, cardiac output was obtained, then RV, RA pressures were obtained.  The right heart catheter _______ pulled out.  Then selective coronary angiography was performed using 6-French JL4 and 6-French 3DRC catheter.  Then attempt was made to cross the aortic valve with 6-French pigtail catheter, but it was unsuccessful.  After the procedure, catheters were pulled out, sheath was pulled out and hemostasis was obtained by manual pressure.  The patient tolerated the procedure well.  There were no complications.,HEMODYNAMICS:,1.  Cardiac output was 4.9 per liter per minute.  Pulmonary capillary wedge pressure, mean was 7, PA pressure was 20/14, RV 26/5, RA mean pressure was 5.,2.  Coronary angiography, left main is calcified _______ dense complex.,3.  LAD proximal 70% calcified stenosis present and patent stent to the mid LAD and diagonal 1 is a moderate-size vessel, has 70% stenosis.  Left circumflex has diffuse luminal irregularities.  OM1 has 70% stenosis, is a moderate-size vessel.  Right coronary is dominant and has minimal luminal irregularities.,SUMMARY: , Three-vessel coronary artery disease with aortic stenosis by echo with normal pulmonary artery systolic pressure.,RECOMMENDATION: , Aortic valve replacement with coronary artery bypass surgery.
Hamstring Release 
Medical specialty:  Surgery
 Left distal medial hamstring release.

PREOPERATIVE DIAGNOSIS: , Autism with bilateral knee flexion contractures.,POSTOPERATIVE DIAGNOSIS: , Autism with bilateral knee flexion contractures.,PROCEDURE: , Left distal medial hamstring release.,ANESTHESIA: , General anesthesia.  Local anesthetic 10 mL of 0.25% Marcaine local.,TOURNIQUET TIME: , 15 minutes.,ESTIMATED BLOOD LOSS:  ,Minimal.,COMPLICATIONS:  ,There were no intraoperative complications.,DRAIN:  ,None.,SPECIMENS:  ,None.,HISTORY AND PHYSICAL:  ,The patient is a 12-year-old boy born at a 32-week gestation and with drug exposure in utero.  The patient has diagnosis of autism as well.  The patient presented with bilateral knee flexion contractures, initially worse on right than left.  He had right distal medial hamstring release performed in February 2007 and has done quite well and has noted significant improvement in his gait and his ability to play.  The patient presents now with worsening left knee flexion contracture, and desires the same procedure to be performed.  Risks and benefits of the surgery were discussed.  The risks of surgery include risk of anesthesia, infection, bleeding, changes in sensation and motion of extremity, failure to restore normal anatomy, continued contracture, possible need for other procedures.  All questions were answered and mother and son agreed to above plan.,PROCEDURE NOTE:  ,The patient was taken to operating room and placed supine on operating table.  General anesthesia was administered.  The patient received Ancef preoperatively.  Nonsterile tourniquet was placed on the upper aspect of the patient's left thigh.  The extremity was then prepped and draped in standard surgical fashion.  The extremity was wrapped in Esmarch prior to inflation of tourniquet to 250 mmHg.  Esmarch was then removed.  A small 3 cm incision was made over the distal medial hamstring.  Hamstring tendons were isolated and released in order of semitendinosus, semimembranosus, and sartorius.  The wound was then irrigated with normal saline and closed used 2-0 Vicryl and then 4-0 Monocryl.  The wound was cleaned and dried and dressed with Steri-Strips.  The area was infiltrated with total 10 mL of 0.25% Marcaine.  The wound was then covered with Xeroform, 4 x 4s, and Bias.  Tourniquet was released at 15 minutes.  The patient was then placed in knee immobilizer.  The patient tolerated the procedure well and subsequently taken to recovery in stable condition.,POSTOPERATIVE PLAN: , The patient may weight bear as tolerated in his brace.  He will start physical therapy in another week or two.  The patient restricted from any PE for at least 6 week.  He may return to school on 01/04/2008.  He was given Vicodin for pain.
Heart Catheterization 
Medical specialty:  Surgery
 Right and left heart catheterization, coronary angiography, left ventriculography.

PROCEDURES:,1.  Right and left heart catheterization.,2.  Coronary angiography.,3.  Left ventriculography.,PROCEDURE IN DETAIL:,  After informed consent was obtained, the patient was taken to the cardiac catheterization laboratory.  Patient was prepped and draped in sterile fashion.  Via modified Seldinger technique, the right femoral vein was punctured and a 6-French sheath was placed over a guide wire.  Via modified Seldinger technique, right femoral artery was punctured and a 6-French sheath was placed over a guide wire.  The diagnostic procedure was performed using the JL-4, JR-4, and a 6-French pigtail catheter along with a Swan-Ganz catheter.  The patient tolerated the procedure well and there were immediate complications were noted.  Angio-Seal was used at the end of the procedure to obtain hemostasis.,CORONARY ARTERIES:,LEFT MAIN CORONARY ARTERY:  The left main coronary artery is of moderate size vessel with bifurcation into the left descending coronary artery and circumflex coronary artery.  No significant stenotic lesions were identified in the left main coronary artery.,LEFT ANTERIOR DESCENDING CORONARY ARTERY:  The left descending artery is a moderate sized vessel, which gives rise to multiple diagonals and perforating branches.  No significant stenotic lesions were identified in the left anterior descending coronary artery system.,CIRCUMFLEX ARTERY:  The circumflex artery is a moderate sized vessel.  The vessel is a stenotic lesion.  After the right coronary artery, the RCA is a moderate size vessel with no focal stenotic lesions.,HEMODYNAMIC DATA: , Capital wedge pressure was 22.  The aortic pressure was 52/24.  Right ventricular pressure was 58/14.  RA pressure was 14.  The aortic pressure was 127/73.  Left ventricular pressure was 127/15.  Cardiac output of 9.2.,LEFT VENTRICULOGRAM: , The left ventriculogram was performed in the RAO projection only.  In the RAO projection, the left ventriculogram revealed dilated left ventricle with mild global hypokinesis and estimated ejection fraction of 45 to 50%.  Severe mitral regurgitation was also noted.,IMPRESSION:,1.  Left ventricular dilatation with global hypokinesis and estimated ejection fraction of 45 to 50%.,2.  Severe mitral regurgitation.,3.  No significant coronary artery disease identified in the left main coronary artery, left anterior descending coronary artery, circumflex coronary artery or the right coronary artery.,
Hardware Removal - Elbow 
Medical specialty:  Surgery
 Hardware removal in the left elbow.

PREOPERATIVE DIAGNOSIS: , Retained hardware in left elbow.,POSTOPERATIVE DIAGNOSIS:,  Retained hardware in left elbow.,PROCEDURE: , Hardware removal in the left elbow.,ANESTHESIA: , Procedure done under general anesthesia.  The patient also received 4 mL of 0.25% Marcaine of local anesthetic.,TOURNIQUET:  ,There is no tourniquet time.,ESTIMATED BLOOD LOSS:  ,Minimal.,COMPLICATIONS:  ,No intraoperative complications.,HISTORY AND PHYSICAL:  ,The patient is a 5-year, 8-month-old male who presented to me direct from ED with distracted left lateral condyle fracture.  He underwent screw compression for the fracture in October 2007.  The fracture has subsequently healed and the patient presents for hardware removal.  The risks and benefits of surgery were discussed.  The risks of surgery include the risk of anesthesia, infection, bleeding, changes in sensation and motion of extremity, failure of removal of hardware, failure to relieve pain or improved range of motion.  All questions were answered and the family agreed to the above plan.,PROCEDURE: , The patient was taken to the operating room, placed supine on the operating table.  General anesthesia was then administered.  The patient's left upper extremity was then prepped and draped in standard surgical fashion.  Using his previous incision, dissection was carried down through the screw.  A guide wire was placed inside the screw and the screw was removed without incident.  The patient had an extension lag of about 15 to 20 degrees.  Elbow is manipulated and his arm was able to be extended to zero degrees dorsiflex.  The washer was also removed without incident.  Wound was then irrigated and closed using #2-0 Vicryl and #4-0 Monocryl.  Wound was injected with 0.25% Marcaine.  The wound was then dressed with Steri-Strips, Xeroform, 4 x4 and bias.  The patient tolerated the procedure well and subsequently taken to the recovery in stable condition.,DISCHARGE NOTE: , The patient will be discharged on date of surgery.  He is to follow up in one week's time for a wound check.  This can be done at his primary care physician's office.  The patient should keep his postop dressing for about 4 to 5 days.  He may then wet the wound, but not scrub it.  The patient may resume regular activities in about 2 weeks.  The patient was given Tylenol with Codeine 10 mL p.o. every 3 to 4 hours p.r.n.