harishnair04/mtsamples huggingface dataset:
Prostate Fossa Irradiation - Followup 
Medical specialty:  Urology
 The patient returns for followup evaluation 21 months after undergoing prostate fossa irradiation for recurrent Gleason 8 adenocarcinoma.    Concerning slow ongoing rise in PSA.

HISTORY OF PRESENT ILLNESS: , The patient returns for followup evaluation 21 months after undergoing prostate fossa irradiation for recurrent Gleason 8 adenocarcinoma.  His urinary function had been stable until 2 days ago.  Over the past couple of days he has been waking every 1 to 1-1/2 hours and has had associated abdominal cramping, as well as a bit of sore throat (his wife has had a cold for about 2 weeks).  His libido remains intact (but he has not been sexually functional), but his erections have been dysfunctional.  The bowel function is stable with occasional irritative hemorrhoidal symptoms.  He has had no hematochezia.  The PSA has been slowly rising in recent months.  This month it reached 1.2.,PAIN ASSESSMENT: , Abdominal cramping in the past 2 days.  No more than 1 to 2 of 10 in intensity.,PERFORMANCE STATUS: , Karnofsky score 100.  He continues to work full-time.,NUTRITIONAL STATUS: , Appetite has been depressed over the past couple of days, and he has lost about 5 pounds.  (Per him, mostly this week.),PSYCHIATRIC: , Some stress regarding upcoming IRS audits of clients.,REVIEW OF SYSTEMS: , Otherwise noncontributory.,MEDICATIONS,1.  NyQuil.,2.  Timolol eye drops.,3.  Aspirin.,4.  Advil.,5.  Zinc.,PHYSICAL EXAMINATION,GENERAL:  Pleasant, well-developed, gentleman in no acute distress.  Weight is 197 pounds.,HEENT:  Sclerae and conjunctivae are clear.  Extraocular movement are intact.  Hearing is grossly intact.  The oral cavity is without thrush.  There is minor pharyngitis.,LYMPH NODES:  No palpable lymphadenopathy.,SKELETAL:  No focal skeletal tenderness.,LUNGS:  Clear to auscultation bilaterally.,CARDIOVASCULAR:  Regular rate and rhythm.,ABDOMEN:  Soft, nontender without palpable mass or organomegaly.,DIGITAL RECTAL EXAMINATION:  There are external hemorrhoids.  The prostate fossa is flat without suspicious nodularity.  There is no blood on the examining glove.,EXTREMITIES:  Without clubbing, cyanosis, or edema.,NEUROLOGIC:  Without focal deficit.,IMPRESSION:,  Concerning slow ongoing rise in PSA.,PLAN: , Discussed significance of this in detail with the patient.  He understands the probability that there may be residual cancer although the location is unknown.  For now there is no good evidence that early management affects the ultimate prognosis.  Accordingly, he is comfortable with careful monitoring, and I have asked him to return here in 3 months with an updated PSA.  I also suggested that he reestablish contact with Dr. X at his convenience.
Prostate Adenocarcinoma - 4 
Medical specialty:  Urology
 Prostate gland showing moderately differentiated infiltrating adenocarcinoma - Excised prostate including capsule, pelvic lymph nodes, seminal vesicles, and small portion of bladder neck.

PHYSICAL EXAMINATION:,  Patient is a 46-year-old white male seen for annual physical exam and had an incidental PSA elevation of 4.0.  All other systems were normal.,PROCEDURES:  ,Sextant biopsy of the prostate.,Radical prostatectomy:  Excised prostate including capsule, pelvic lymph nodes, seminal vesicles, and small portion of bladder neck.,PATHOLOGY:,Prostate biopsy:  Right lobe, negative.  Left lobe, small focus of adenocarcinoma, Gleason's 3 + 3 in approximately 5% of the tissue.,Radical prostatectomy:  Negative lymph nodes.  Prostate gland showing moderately differentiated infiltrating adenocarcinoma, Gleason 3 + 2 extending to the apex involving both lobes of the prostate, mainly right.  Tumor overall involved less than 5% of the tissue.  Surgical margin was reported and involved at the apex.  The capsule and seminal vesicles were free.,DISCHARGE NOTE:,  Patient has made good post-op recovery other than mild urgency incontinence.  His post-op PSA is 0.1 mg/ml.
Prostate Adenocarcinoma - 3 
Medical specialty:  Urology
 Moderately differentiated adenocarcinoma, 1+ enlarged prostate with normal seminal vesicles.

PHYSICAL EXAMINATION: , The patient is a 63-year-old executive who was seen by his physician for a company physical.  He stated that he was in excellent health and led an active life.  His physical examination was normal for a man of his age.  Chest x-ray and chemical screening blood work were within normal limits.  His PSA was elevated.,IMAGING:,Chest x-ray:  Normal.,CT scan of abdomen and pelvis:  No abnormalities.,LABORATORY:,  PSA 14.6.,PROCEDURES: , Ultrasound guided sextant biopsy of prostate:  Digital rectal exam performed at the time of the biopsy showed a 1+ enlarged prostate with normal seminal vesicles.,PATHOLOGY:  ,Prostate biopsy:  Left apex:  adenocarcinoma, moderately differentiated, Gleason's score 3 + 4 = 7/10.  Maximum linear extent in apex of tumor was 6 mm.  Left mid region prostate:  moderately differentiated adenocarcinoma, Gleason's 3 + 2 = 5/10.  Left base, right apex, and right mid-region and right base:  negative for carcinoma.,TREATMENT:,  The patient opted for low dose rate interstitial prostatic implants of I-125.  It was performed as an outpatient on 8/10.
Penile Skin Bridges Excision  
Medical specialty:  Urology
 Excision of penile skin bridges about 2 cm in size.

PREOPERATIVE DIAGNOSIS: , Penile skin bridges after circumcision.,POSTOPERATIVE DIAGNOSIS: , Penile skin bridges after circumcision.,PROCEDURE:  ,Excision of penile skin bridges about 2 cm in size.,ABNORMAL FINDINGS:  ,Same as above.,ANESTHESIA:  ,General inhalation anesthetic with caudal block.,FLUIDS RECEIVED: , 300 mL of crystalloids.,ESTIMATED BLOOD LOSS: , Less than 5 mL.,SPECIMENS: , No tissue sent to Pathology.,TUBES AND DRAINS:,  No tubes or drains were used.,COUNT: , Sponge and needle counts were correct x2.,INDICATIONS FOR OPERATION:  ,The patient is a 2-1/2-year-old boy with a history of newborn circumcision who developed multiple skin bridges after circumcision causing curvature with erection.  Plan is for repair.,DESCRIPTION OF PROCEDURE: , The patient is taken to the operating room, where surgical consent, operative site, and the patient's identification was verified.  Once he was anesthetized, the caudal block was placed and IV antibiotics were given.  He was then placed in a supine position and sterilely prepped and draped.  Once he was prepped and draped, we used a straight mosquito clamp and went under the bridges and crushed them, and then excised them with a curved iris and curved tenotomy scissors.  We removed the excessive skin on the shaft skin and on the glans itself.  We then on the ventrum excised the bridge and did a Heinecke-Mikulicz closure with interrupted figure-of-eight and interrupted suture of 5-0 chromic.  Electrocautery was used for hemostasis.  Once this was done, we then used Dermabond tissue adhesive and Surgicel to prevent the bridges from returning again.  IV Toradol was given at the end of procedure.  The patient tolerated the procedure well, was in stable condition upon transfer to the recovery room.
Prostate Adenocarcinoma 
Medical specialty:  Urology
 Adenocarcinoma of the prostate.  The patient underwent a transrectal ultrasound and biopsy and was found to have a Gleason 3+4 for a score of 7, 20% of the tissue removed from the left base. 

ADMISSION DIAGNOSIS:  ,Adenocarcinoma of the prostate.,HISTORY:,  The patient is a 71-year-old male whose personal physician, Dr. X identified a change in the patient's PSA from 7/2008 (4.2) to 4/2009 (10.5).  The patient underwent a transrectal ultrasound and biopsy and was found to have a Gleason 3+4 for a score of 7, 20% of the tissue removed from the left base.  The patient also had Gleason 6 in the right lobe, midportion, as well as the left apical portion.  He underwent a bone scan which was normal and cystoscopy which was normal and renal ultrasound that was normal.,SURGICAL HISTORY: , Appendectomy.,MEDICAL HISTORY:,  Atrial fibrillation.,MEDICATIONS:,  Coumadin and lisinopril.,SOCIAL HISTORY:  ,Smokes none.  Alcohol none.,ALLERGIES:,  NONE.,REVIEW OF SYSTEMS: , The patient relates no recent weight gain, weight loss, night sweats, fevers or chills.  Eyes:  No change in vision or diplopia.  Ears:  No tinnitus or vertigo.  Mouth:  No dysphagia.  Pulmonary:  No chronic cough or shortness of breath.  Cardiac:  No angina or palpitations.  GI:  No nausea, vomiting, diarrhea or constipation.  Musculoskeletal:  No arthritides or myalgias.  Hematopoietic:  No easy bleeding or bruising.  Skin:  No chronic ulcers or persistent itch.,PHYSICAL EXAMINATION:,GENERAL:  The patient is well developed and well nourished.,HEENT:  Head is normocephalic.  Eyes, pupils are equal.  Conjunctivae are pink.  Sclerae are anicteric.,NECK:  There is no adenopathy.,PULMONARY:  Respirations are unlabored.,HEART:  Regular rhythm.,ABDOMEN:  Liver, spleen, kidney, and bladder are not palpable.  There are no discernible masses.  There are no peritoneal signs.,GENITALIA:  The penis has no plaques.  Meatus is on the glans.  Scrotal skin is healthy.  Testicles are fair consistency.  Epididymides are nontender.,RECTAL:  The prostate is +1 to 2/4.  There are no areas that are suspicious for tumor.  Consistency is even.  Sidewalls are sharp.  Seminal vesicles are not palpable.,MUSCULOSKELETAL:  The upper and lower extremities are symmetric bilaterally.,NEUROLOGIC:  There are no gross focal neurologic abnormalities.,IMPRESSION:,1.  Adenocarcinoma of the prostate.,2.  Atrial fibrillation.,PLAN: , The patient's wife and I have discussed his treatment options, which include primarily radiation and surgery.  He has _________ surviving prostate cancer by Dr. Y.  He is aware of incontinency, both total and partial.  We discussed erectile dysfunction.  We have discussed bleeding, infection, injury to the rectum, injury to vessels and nerves, deep vein thrombosis, pulmonary embolus, MI, stroke, and death.  He had no questions at the conclusion of the conversation and he does know that in his age group, though a nerve-sparing procedure will be performed, preserving any erectile function is highly unlikely.  He had no questions at the conclusion of our last conversation.
Prostate Adenocarcinoma - 1 
Medical specialty:  Urology
 Complete urinary obstruction, underwent a transurethral resection of the prostate - adenocarcinoma of the prostate.

HISTORY:,  This 75-year-old man was transferred from the nursing home where he lived to the hospital late at night on 4/11 through the Emergency Department in complete urinary obstruction.  After catheterization, the patient underwent cystoscopy on 4/13.  On 4/14 the patient underwent a transurethral resection of the prostate and was discharged back to the nursing home later that day with voiding improved.  Final diagnosis was adenocarcinoma of the prostate.  Because of his mental status and general debility, the patient's family declined additional treatment.,LABORATORY:,  None,PROCEDURES:,Cystoscopy:  Blockage of the urethra by a markedly enlarged prostate.,Transurethral resection of prostate:  45 grams of tissue were sent to the Pathology Department for analysis.,PATHOLOGY: , Well differentiated adenocarcinoma, microacinar type, in 1 of 25 chips of prostatic tissue.
Prostate Adenocarcinoma - 2 
Medical specialty:  Urology
 Moderate to poorly differentiated adenocarcinoma in the right lobe and poorly differentiated tubular adenocarcinoma in the left lobe of prostate.

PHYSICAL EXAMINATION:,  This 71-year-old man went to his primary care physician for a routine physical.  His only complaints were nocturia times two and a gradual "slowing down" feeling.  The physical examination on 1/29 was within normal limits except for the digital rectal exam which revealed an asymmetric prostate gland with nodularity, R>L.  PSA was elevated.  The differential diagnosis for the visit was abnormal prostate, suggestive of CA.,IMAGING:  ,CT pelvis:  Irregular indentation of bladder.  Seminal vesicles enlarged.  Streaky densities in periprostatic fat consistent with transcapular spread to periprostatic plexus.  Impression:  prostatic malignancy with extracapsular extension and probable regional node metastasis.,Bone scan:  Negative for distant metastasis.,LABORATORY:,  PSA 32.1,PROCEDURES:,  Transrectal needle biopsy of prostate.  Pelvic lymphadenectomy and radical prostatectomy.,PATHOLOGY:  ,Prostate biopsy:  Moderate to poorly differentiated adenocarcinoma in the right lobe and poorly differentiated tubular adenocarcinoma in the left lobe of prostate.,Lymphadenectomy and prostatectomy:  Frozen section of removed pelvic lymph nodes demonstrated metastatic adenocarcinoma in one lymph node in the right obturator fossa.  Therefore, the radical prostatectomy was canceled.  ,Final pathology diagnosis:  Pelvic lymphadenectomy; left obturator fossa, single negative lymph node.  Right obturator fossa; metastatic adenocarcinoma in 1/5 lymph nodes.  Largest involved node 1.5 cm.,TREATMENT: , Patient began external beam radiation therapy to the pelvis.
Pediatric Urology Letter 
Medical specialty:  Urology
 He continues to have abdominal pain, and he had a diuretic renal scan, which indicates no evidence of obstruction and good differential function bilaterally. 

XYZ, M.D. ,Suite 123, ABC Avenue ,City, STATE 12345 ,RE:  XXXX, XXXX ,MR#:  0000000,Dear Dr. XYZ: ,XXXX was seen in followup in the Pediatric Urology Clinic.  I appreciate you speaking with me while he was in clinic.  He continues to have abdominal pain, and he had a diuretic renal scan, which indicates no evidence of obstruction and good differential function bilaterally. ,When I examined him, he seems to indicate that his pain is essentially in the lower abdomen in the suprapubic region; however, on actual physical examination, he seems to complain of pain through his entire right side.  His parents have brought up the question of whether this could be gastrointestinal in origin and that is certainly an appropriate consideration.  They also feel that since he has been on Detrol, his pain levels have been somewhat worse, and so, I have given them the option of stopping the Detrol initially.  I think he should stay on MiraLax for management of his bowels.  I would also suggest that he be referred to Pediatric Gastroenterology for evaluation.  If they do not find any abnormalities from a gastrointestinal perspective, then the next step would be to endoscope his bladder and then make sure that he does not have any evidence of bladder anatomic abnormalities that is leading to this pain. ,Thank you for following XXXX along with us in Pediatric Urology Clinic.  If you have any questions, please feel free to contact me. ,Sincerely yours,
Pathology - Prostate 
Medical specialty:  Urology
 Prostate adenocarcinoma and erectile dysfunction - Pathology report.

SPECIMENS:,1.  Pelvis-right pelvic obturator node.,2.  Pelvis-left pelvic obturator node.,3.  Prostate.,POST-OPERATIVE DIAGNOSIS: , Adenocarcinoma of prostate, erectile dysfunction.,DIAGNOSTIC OPINION:,1.  Adenocarcinoma, Gleason score 9, with tumor extension to periprostatic tissue, margin involvement, and tumor invasion to seminal vesicle, prostate.,2.  No evidence of metastatic carcinoma, right pelvic obturator lymph node.,3.  Metastatic adenocarcinoma, left obturator lymph node; see description.,CLINICAL HISTORY: , None listed.,GROSS DESCRIPTION:,Specimen #1 labeled "right pelvic obturator lymph nodes" consists of two portions of adipose tissue measuring 2.5 x 1x 0.8 cm and 2.5 x 1x 0.5 cm.  There are two lymph nodes measuring 1 x 0.7 cm and 0.5 x 0.5 cm.  The entire specimen is cut into several portions and totally embedded.,Specimen #2 labeled "left pelvic obturation lymph nodes" consists of an adipose tissue measuring 4 x 2 x 1 cm.  There are two lymph nodes measuring 1.3 x 0.8 cm and 1 x 0.6 cm.  The entire specimen is cut into 1 cm.  The entire specimen is cut into several portions and totally embedded.,Specimen #3 labeled "prostate" consists of a prostate.  It measures 5 x 4.5 x 4 cm.  The external surface shows very small portion of seminal vesicles attached in both sides with tumor induration.  External surface also shows tumor induration especially in right side.  External surface is stained with green ink.  The cut surface shows diffuse tumor induration especially in right side.  The tumor appears to extend to excision margin.  Multiple representative sections are made.,MICROSCOPIC DESCRIPTION:,Section #1 reveals lymph node.  There is no evidence of metastatic carcinoma.,Section #2 reveals lymph node with tumor metastasis in section of large lymph node as well as section of small lymph node.,Section #3 reveals adenocarcinoma of prostate.  Gleason's score 9 (5+4).  The tumor shows extension to periprostatic tissue as well as margin involvement.  Seminal vesicle attached to prostate tissue shows tumor invasion.  Dr. XXX reviewed the above case.  His opinion agrees with the above diagnosis.,SUMMARY:,A.  Adenocarcinoma of prostate, Gleason's score 9, with both lobe involvement and seminal vesicle involvement (T3b).,B.  There is lymph node metastasis (N1).,C.  Distant metastasis cannot be assessed (MX).,D.  Excision margin is positive and there is tumor extension to periprostatic tissue.
Overactive Bladder 
Medical specialty:  Urology
 Overactive bladder with microscopic hematuria.

REASON FOR VISIT: , Overactive bladder with microscopic hematuria.,HISTORY OF PRESENT ILLNESS: , The patient is a 56-year-old noted to have microscopic hematuria with overactive bladder.  Her cystoscopy performed was unremarkable.  She continues to have some episodes of frequency and urgency mostly with episodes during the day and rare at night.  No gross hematuria, dysuria, pyuria, no other outlet obstructive and/or irritative voiding symptoms.  The patient had been previously on Ditropan and did not do nearly as well.  At this point, what we will try is a different medication.  Renal ultrasound is otherwise unremarkable, notes no evidence of any other disease.,IMPRESSION: , Overactive bladder with microscopic hematuria most likely some mild atrophic vaginitis is noted.  She has no other significant findings other than her overactive bladder, which had continued.  At this juncture what I would like to do is try a different anticholinergic medication.  She has never had any side effects from her medication.,PLAN: , The patient will discontinue Ditropan.  We will start Sanctura XR and we will follow up as scheduled.  Otherwise we will continue to follow her urinalysis over the next year or so.
Paraphimosis 
Medical specialty:  Urology
 Reduction of paraphimosis.

PREOPERATIVE DIAGNOSIS: , Phimosis.,POSTOPERATIVE DIAGNOSIS: , Phimosis.,PROCEDURE: , Reduction of paraphimosis.,ANESTHESIA:  ,General inhalation anesthetic with 0.25% Marcaine, penile block and ring block about 20 mL given.,FLUIDS RECEIVED: , 100 mL.,SPECIMENS:,  No tissues sent to pathology.,COUNTS: , Sponge and needle counts were not necessary.,TUBES/DRAINS: , No tubes or drains were used.,FINDINGS: , Paraphimosis with moderate swelling.,INDICATIONS FOR OPERATION: , The patient is a 15-year-old boy who had acute alcohol intoxication had his foreskin retracted with a Foley catheter placed at another institution.  When they removed the catheter they forgot to reduce the foreskin and he developed paraphimosis.  The plan is for reduction.,DESCRIPTION OF OPERATION: , The patient was taken to the operating room where surgical consent, operative site, and patient identification were verified.  Once he was anesthetized, with manual pressure and mobilization of the shaft skin we were able to reduce the paraphimosis.  Using Betadine and alcohol cleanse, we then did a dorsal penile block and a ring block by surgeon with 0.25% Marcaine, 20 mL were given.  He did quite well after the procedure and was transferred to the recovery room in stable condition.
Orchiopexy & Hernia Repair - 1 
Medical specialty:  Urology
 Right orchiopexy and right inguinal hernia repair.

PREOPERATIVE DIAGNOSIS: , Right undescended testis (ectopic position).,POSTOPERATIVE DIAGNOSES:,  Right undescended testis (ectopic position), right inguinal hernia.,PROCEDURES: , Right orchiopexy and right inguinal hernia repair.,ANESTHESIA:,  General inhalational anesthetic with caudal block.,FLUIDS RECEIVED:  ,100 mL of crystalloids.,ESTIMATED BLOOD LOSS: , Less than 5 mL.,SPECIMENS:,  No tissues sent to pathology.,TUBES AND DRAINS: , No tubes or drains were used.,INDICATIONS FOR OPERATION:  ,The patient is an almost 4-year-old boy with an undescended testis on the right; plan is for repair.,DESCRIPTION OF OPERATION:  ,The patient was taken to the operating room; surgical consent, operative site, and patient identification were verified.  Once he was anesthetized, a caudal block was placed.  He was then placed in the supine position and sterilely prepped and draped.  Since the testis was in the ectopic position, we did an upper curvilinear scrotal incision with a 15-blade knife and further extended it with electrocautery.  Electrocautery was also used for hemostasis.  A subdartos pouch was then created with a curved tenotomy scissors.  The tunica vaginalis was grasped with a curved mosquito clamp and then dissected from its gubernacular attachments.  As we were dissecting it, we then found the testis itself into the sac, and we opened the sac, and it was found to be slightly atrophic about 12 mm in length and had a type III epididymal attachment, not being attached to the top.  We then dissected the hernia sac off of the testis __________ some traction using the straight Joseph scissors and straight and curved mosquito clamps.  Once this was dissected off, we then twisted it upon itself, and then dissected it down towards the external ring, but on traction.  We then twisted it upon itself, suture ligated it with 3-0 Vicryl and released it, allowing it to spring back into the canal.  Once this was done, we then had adequate length of the testis into the scrotal sac.  Using a curved mosquito clamp, we grasped the base of the scrotum internally, and using the subcutaneous tissue, we tacked it to the base of the testis using a 4-0 chromic suture.  The testis was then placed into the scrotum in the proper orientation.  The upper aspect of the pouch was closed with a pursestring suture of 4-0 chromic.  The scrotal skin and dartos were then closed with subcutaneous closure of 4-0 chromic, and Dermabond tissue adhesive was used on the incision.  IV Toradol was given.  Both testes were well descended in the scrotum at the end of the procedure.
Orchiectomy 
Medical specialty:  Urology
 Bilateral scrotal orchiectomy

BILATERAL SCROTAL ORCHECTOMY,PROCEDURE:,:  The patient is placed in the supine position, prepped and draped in the usual manner.  Under satisfactory general anesthesia, the scrotum was approached and through a transverse mid scrotal incision, the right testicle was delivered through the incision.  Hemostasis was obtained with the Bovie and the spermatic cord was identified.  It was clamped, suture ligated with 0 chromic catgut and the cord above was infiltrated with 0.25% Marcaine for postoperative pain relief.  The left testicle was delivered through the same incision.  The spermatic cord was identified, clamped, suture ligated and that cord was also injected with 0.25% percent Marcaine.  The incision was injected with the same material and then closed in two layers using 4-0 chromic catgut continuous for the dartos and interrupted for the skin.  A dry sterile dressing fluff and scrotal support applied over that.  The patient was sent to the Recovery Room in stable condition.