harishnair04/mtsamples huggingface dataset:
Gastric Bypass Summary 
Medical specialty:  Bariatrics
 Patient discharged after laparoscopic Roux-en-Y gastric bypass.

FINAL DIAGNOSES,1.  Morbid obesity, status post laparoscopic Roux-en-Y gastric bypass. ,2.  Hypertension. ,3.  Obstructive sleep apnea, on CPAP.,OPERATION AND PROCEDURE: , Laparoscopic Roux-en-Y gastric bypass.,BRIEF HOSPITAL COURSE SUMMARY:  ,This is a 30-year-old male, who presented recently to the Bariatric Center for evaluation and treatment of longstanding morbid obesity and associated comorbidities.  Underwent standard bariatric evaluation, consults, diagnostics, and preop Medifast induced weight loss in anticipation of elective bariatric surgery. ,Taken to the OR via same day surgery process for elective gastric bypass, tolerated well, recovered in the PACU, and sent to the floor for routine postoperative care.  There, DVT prophylaxis was continued with subcu heparin, early and frequent mobilization, and SCDs.  PCA was utilized for pain control, efficaciously, he utilized the CPAP, was monitored, and had no new cardiopulmonary complaints.  Postop day #1, labs within normal limits, able to clinically start bariatric clear liquids at 2 ounces per hour, this was tolerated well.  He was ambulatory, had no cardiopulmonary complaints, no unusual fever or concerning symptoms.  By the second postoperative day, was able to advance to four ounces per hour, tolerated this well, and is able to discharge in stable and improved condition today.  He had his drains removed today as well.,DISCHARGE INSTRUCTIONS: , Include re-appointment in the office in the next week, call in the interim if any significant concerning complaints.  Scripts left in the chart for omeprazole and Lortab.  Med rec sheet completed (on no meds).  He will maintain bariatric clear liquids at home, goal 64 ounces per day, maintain activity at home, but no heavy lifting or straining.  Can shower starting tomorrow, drain site care and wound care reviewed.  He will re-appoint in the office in the next week, certainly call in the interim if any significant concerning complaints.
Vasectomy - 1 
Medical specialty:  Urology
 Normal vasectomy

DESCRIPTION:,  The patient was placed in the supine position and was prepped and draped in the usual manner.  The left vas was grasped in between the fingers.  The skin and vas were anesthetized with local anesthesia.  The vas was grasped with an Allis clamp.  Skin was incised and the vas deferens was regrasped with another Allis clamp.  The sheath was incised with a scalpel and elevated using the iris scissors and clamps were used to ligate the vas deferens.  The portion in between the clamps was excised and the ends of the vas were clamped using hemoclips, two in the testicular side and one on the proximal side.  The incision was then inspected for hemostasis and closed with 3-0 chromic catgut interrupted fashion.,A similar procedure was carried out on the right side.  Dry sterile dressings were applied and the patient put on a scrotal supporter.  The procedure was then terminated.
Vasectomy 
Medical specialty:  Urology
 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. 

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.
Urology Consut - 1 
Medical specialty:  Urology
 Blood in urine - Transitional cell cancer of the bladder.

CHIEF COMPLAINT:,
Vasectomy - 2 
Medical specialty:  Urology
 Normal vasectomy

DIAGNOSIS:,  Desires vasectomy.,NAME OF OPERATION: , Vasectomy.,ANESTHESIA:,  General.,HISTORY: , Patient, 37, desires a vasectomy.,PROCEDURE: , Through a midline scrotal incision, the right vas was identified and separated from the surrounding tissues, clamped, transected, and tied off with a 4-0 chromic.  No bleeding was identified.,Through the same incision the left side was identified, transected, tied off, and dropped back into the wound.  Again no bleeding was noted.,The wound was closed with 4-0 Vicryl times two.  He tolerated the procedure well.  A sterile dressing was applied.  He was awakened and transferred to the recovery room in stable condition.
Urology Discharge Summary 
Medical specialty:  Urology
 Hispanic male patient was admitted because of enlarged prostate and symptoms of bladder neck obstruction.

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.
Umbilical Hernia Repair 
Medical specialty:  Urology
 Umbilical hernia repair template.  The umbilical hernia carefully reduced back into the cavity, and the fascia was closed with interrupted vertical mattress sutures to approximate the fascia.

PREOPERATIVE DIAGNOSIS: , Umbilical hernia.,POSTOPERATIVE DIAGNOSIS: , Umbilical hernia.,PROCEDURE PERFORMED: , Repair of umbilical hernia.,ANESTHESIA: , General.,COMPLICATIONS: , None.,ESTIMATED BLOOD LOSS: , Minimal.,PROCEDURE IN DETAIL:  ,The patient was prepped and draped in the sterile fashion.  An infraumbilical incision was formed and taken down to the fascia.  The umbilical hernia carefully reduced back into the cavity, and the fascia was closed with interrupted vertical mattress sutures to approximate the fascia, and then the wounds were infiltrated with 0.25% Marcaine.  The skin was reattached to the fascia with 2-0 Vicryls.  The skin was approximated with 2-0 Vicryl subcutaneous and then 4-0 Monocryl subcuticular stitches, dressed with Steri-Strips and 4 x 4's.  Patient was extubated and taken to the recovery area in stable condition.
Urology Letter 
Medical specialty:  Urology
 Vasectomy 10 years ago, failed.  Azoospermic.  Reversal two years ago.  Interested in sperm harvesting and cryopreservation

Sample Address,RE:  Sample Patient,Wife's name:  Sample Name,Dear Sample Doctor:,Mr. Sample Patient was seen on Month DD, YYYY, describing a vasectomy 10 years ago and a failed vasectomy reversal done almost two years ago at the University of Michigan.  He has remained azoospermic postoperatively.  The operative note suggests the presence of some sperm and sperm head on the right side at the time of the vasectomy reversal.,He states that he is interested in sperm harvesting and cryopreservation prior to the next attempted ovulation induction for his wife.  Apparently, several attempts at induction have been tried and due to some anatomic abnormality, they have been unsuccessful.,At the time that he left the office, he was asking for cryopreservation.  At the time of sperm harvesting, I recently received a phone call suggesting that he does not want to do this at all unless his wife's ovulation has been confirmed and it appears then that he may be interested in a fresh specimen harvest.  I look forward to hearing from you regarding the actual plan so that we can arrange our procedure appropriately.  At his initial request, Month DD, YYYY was picked as the date for scheduled harvesting, although this may change if you require fresh specimen.,Thank you very much for the opportunity to have seen him.,Sample Doctor, M.D.
Vasectomy - 3 
Medical specialty:  Urology
 Desire for sterility.  Vasectomy.  The vas was identified, skin was incised, and no scalpel instruments were used to dissect out the vas.

PREOPERATIVE DIAGNOSIS:,  Desire for sterility.,POSTOPERATIVE DIAGNOSIS:,  Desire for sterility.,OPERATIVE PROCEDURES: , Vasectomy.,DESCRIPTION OF PROCEDURE: , The patient was brought to the suite, where after oral sedation, the scrotum was prepped and draped.  Then, 1% lidocaine was used for anesthesia.  The vas was identified, skin was incised, and no scalpel instruments were used to dissect out the vas.  A segment about 3 cm in length was dissected out.  It was clipped proximally and distally, and then the ends were cauterized after excising the segment.  Minimal bleeding was encountered and the scrotal skin was closed with 3-0 chromic.  The identical procedure was performed on the contralateral side.  He tolerated it well.  He was discharged from the surgical center in good condition with Tylenol with Codeine for pain.  He will use other forms of birth control until he has confirmed azoospermia with two consecutive semen analyses in the month ahead.  Call if there are questions or problems prior to that time.
Urinary Retention - Followup 
Medical specialty:  Urology
 The patient noted for improving retention of urine, postop vaginal reconstruction, very concerned of possible vaginal prolapse.

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.
Ureteral Calculus - Consult 
Medical specialty:  Urology
 Right distal ureteral calculus.  The patient had hematuria and a CT urogram showing a 1 cm non-obstructing calcification in the right distal ureter.  He had a KUB also showing a teardrop shaped calcification apparently in the right lower ureter.  

CHIEF COMPLAINT: , Right distal ureteral calculus.,HISTORY OF PRESENT ILLNESS:  ,The patient had hematuria and a CT urogram at ABC Radiology on 01/04/07 showing a 1 cm non-obstructing calcification in the right distal ureter.  He had a KUB also showing a teardrop shaped calcification apparently in the right lower ureter.  He comes in now for right ureteroscopy, Holmium laser lithotripsy, right ureteral stent placement.,PAST MEDICAL HISTORY:,1.  Prostatism.,2.  Coronary artery disease.,PAST SURGICAL HISTORY:,1.  Right spermatocelectomy.,2.  Left total knee replacement in 1987.,3.  Right knee in 2005.,MEDICATIONS:,1.  Coumadin 3 mg daily.,2.  Fosamax.,3.  Viagra p.r.n.,ALLERGIES: , NONE.,REVIEW OF SYSTEMS:,  CARDIOPULMONARY:  No shortness of breath or chest pain.  GI:  No nausea, vomiting, diarrhea or constipation.  GU:  Voids well.  MUSCULOSKELETAL:  No weakness or strokes.,FAMILY HISTORY: , Noncontributory.,PHYSICAL EXAMINATION:,GENERAL APPEARANCE:  An alert male in no distress.,HEENT:  Grossly normal.,NECK:  Supple.,LUNGS:  Clear.,HEART:  Normal sinus rhythm.  No murmur or gallop.,ABDOMEN:  Soft.  No masses.,GENITALIA:  Normal penis.  Testicles descended bilaterally.,RECTAL:  Examination benign.,EXTREMITIES:  No edema.,IMPRESSION: , Right distal ureteral calculus.,PLAN: , Right ureteroscopy, ureteral lithotripsy.  Risks and complications discussed with the patient.  He signed a true informed consent.  No guarantees or warrantees were given.
Umbilical Hernia Repair - 1 
Medical specialty:  Urology
 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.  

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.
Urinary Frequency & Urgency - Followup 
Medical specialty:  Urology
 Persistent frequency and urgency, in a patient with a history of neurogenic bladder and history of stroke. 

HISTORY OF PRESENT ILLNESS:  ,This is a 55-year-old female with a history of stroke, who presents today for followup of frequency and urgency with urge incontinence.  This has been progressively worsening, and previously on VESIcare with no improvement.  She continues to take Enablex 50 mg and has not noted any improvement of her symptoms.  The nursing home did not do a voiding diary.  She is accompanied by her power of attorney.  No dysuria, gross hematuria, fever or chills.  No bowel issues and does use several Depends a day.,Recent urodynamics in April 2008, here in the office, revealed significant detrusor instability with involuntary urinary incontinence and low bladder volumes, and cystoscopy was unremarkable.,IMPRESSION:  ,Persistent frequency and urgency, in a patient with a history of neurogenic bladder and history of stroke.  This has not improved on VESIcare as well as Enablex.  Options are discussed.,We discussed other options of pelvic floor rehabilitation, InterStim by Dr. X, as well as more invasive procedure.  The patient and the power of attorney would like him to proceed with meeting Dr. X to discuss InterStim, which was briefly reviewed here today and brochure for this is provided today.  Prior to discussion, the nursing home will do an extensive voiding diary for one week, while she is on Enablex, and if this reveals no improvement, the patient will be started on Ventura twice daily and prescription is provided.  They will see Dr. X with a prior voiding diary, which is again discussed.  All questions answered.,PLAN:,  As above, the patient will be scheduled to meet with Dr. X to discuss option of InterStim, and will be accompanied by her power of attorney.  In the meantime, Sanctura prescription is provided, and voiding diaries are provided.  All questions answered.
Ultrasound Scrotum 
Medical specialty:  Urology
 Ultrasound examination of the scrotum due to scrotal pain.  Duplex and color flow imaging as well as real time gray-scale imaging of the scrotum and testicles was performed. 

EXAM: , Ultrasound examination of the scrotum.,REASON FOR EXAM: , Scrotal pain.,FINDINGS:  ,Duplex and color flow imaging as well as real time gray-scale imaging of the scrotum and testicles was performed.  The left testicle measures 5.1 x 2.8 x 3.0 cm.  There is no evidence of intratesticular masses.  There is normal Doppler blood flow.  The left epididymis has an unremarkable appearance.  There is a trace hydrocele.,The right testicle measures 5.3 x 2.4 x 3.2 cm.  The epididymis has normal appearance.  There is a trace hydrocele.  No intratesticular masses or torsion is identified.  There is no significant scrotal wall thickening.,IMPRESSION:  ,Trace bilateral hydroceles, which are nonspecific, otherwise unremarkable examination.
Transurethral Resection Of Bladder Tumor  
Medical specialty:  Urology
  Transurethral resection of a medium bladder tumor (TURBT), left lateral wall.

PREOPERATIVE DIAGNOSIS: , Bladder tumor.,POSTOPERATIVE DIAGNOSIS: , Bladder tumor.,PROCEDURE PERFORMED: , Transurethral resection of a medium bladder tumor (TURBT), left lateral wall.,ANESTHESIA: , Spinal.,SPECIMEN TO PATHOLOGY: , Bladder tumor and specimen from base of bladder tumor.,DRAINS: , A 22-French 3-way Foley catheter, 30 mL balloon.,ESTIMATED BLOOD LOSS:,  Minimal.,INDICATIONS FOR PROCEDURE: , This is a 74-year-old male who presented with microscopic and an episode of gross hematuria.  He underwent an IVP, which demonstrated enlarged prostate and normal upper tracts.  Cystoscopy in the office demonstrated a 2.5- to 3-cm left lateral wall bladder tumor.  He is brought to the operating room for transurethral resection of that bladder tumor.,DESCRIPTION OF OPERATION: , After preoperative counseling of the patient and his wife, the patient was taken to the operating room and administered a spinal anesthetic.  He was placed in lithotomy position and prepped and draped in the usual fashion.  Using the visual obturator, the resectoscope was then inserted per urethra into the bladder.  The bladder was inspected confirming previous cystoscopic findings of a 2.5- to 3-cm left lateral wall bladder tumor away from the ureteral orifice.  Using the resectoscope loop, the tumor was then resected down to its base in a stepwise fashion.  Following completion of resection down to the base, the bladder was _______ free of tumor specimen.  The resectoscope was then reinserted and the base of the bladder tumor was then resected to get the base of the bladder tumor specimen, this was sent as a separate pathological specimen.  Hemostasis was assured with electrocautery.  The base of the tumor was then fulgurated again and into the periphery out in the normal mucosa surrounding the base of the bladder tumor.  Following completion of the fulguration, there was good hemostasis.  The remainder of the bladder was without evidence of significant abnormality.  Both ureteral orifices were visualized and noted to drain freely of clear urine.  The bladder was filled and the resectoscope was removed.  A 22-French 3-way Foley catheter was inserted per urethra into the bladder.  The balloon was inflated to 30 mL.  The catheter with sterile continuous irrigation and was noted to drain clear irrigant.  The patient was then removed from lithotomy position.  He was in stable condition.
TURP 
Medical specialty:  Urology
 Transurethral electrosurgical resection of the prostate for benign prostatic hyperplasia.

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.