harishnair04/mtsamples huggingface dataset:
Pancreatic Mass - Discharge Summary 
Medical specialty:  Gastroenterology
 The patient has had abdominal pain associated with a 30-pound weight loss and then developed jaundice.  He had epigastric pain and was admitted to the hospital.  A thin-slice CT scan was performed, which revealed a pancreatic mass with involved lymph nodes and ring enhancing lesions consistent with liver metastases. 

HISTORY OF PRESENT ILLNESS: ,  The patient is a 48-year-old man who has had abdominal pain since October of last year associated with a 30-pound weight loss and then developed jaundice.  He had epigastric pain and was admitted to the hospital.  A thin-slice CT scan was performed, which revealed a 4 x 3 x 2 cm pancreatic mass with involved lymph nodes and ring enhancing lesions consistent with liver metastases.  The patient, additionally, had a questionable pseudocyst in the tail of the pancreas.  The patient underwent ERCP on 04/04/2007 with placement of a stent.  This revealed a strictured pancreatic duct, as well as strictured bile duct.  A 10-french x 9 cm stent was placed with good drainage.  The next morning, the patient felt quite a bit more comfortable.  He additionally had a modest drop in his bilirubin and other liver tests.  Of note, the patient has been having quite a bit of nausea during his admission.  This responded to Zofran.  It did not, initially, respond well to Phenergan, though after stent placement, he was significantly more comfortable and had less nausea, and in fact, had better response to the Phenergan itself.  At the time of discharge, the patient's white count was 9.4, hemoglobin 10.8, hematocrit 32 with a MCV of 79, platelet count of 585,000.  His sodium was 132, potassium 4.1, chloride 95, CO2 27, BUN of 8 with a creatinine of 0.3.  His bilirubin was 17.1, alk phos 273, AST 104, ALT 136, total protein 7.8 and albumin of 3.8.  He was tolerating a regular diet.  The patient had been on oral hypoglycemics as an outpatient, but in hospital, he was simply managed with an insulin sliding scale.  The patient will be transferred back to Pelican Bay, under the care of Dr. X at the infirmary.  He will be further managed for his diabetes there.  The patient will additionally undergo potential end of life meetings.  I discussed the potentials of chemotherapy with patient.  Certainly, there are modest benefits, which can be obtained with chemotherapy in metastatic pancreatic cancer, though at some cost with morbidity.  The patient will consider this and will discuss this further with Dr. X.  ,DISCHARGE MEDICATIONS:,1.  Phenergan 25 mg q.6. p.r.n.,2.  Duragesic patch 100 mcg q.3.d.,3.  Benadryl 25-50 mg p.o. q.i.d. for pruritus.,4.  Sliding scale will be discontinued at the time of discharge and will be reinstituted on arrival at Pelican Bay Infirmary.,5.  The patient had initially been on enalapril here.  His hypertension will be managed by Dr. X as well.  ,PLAN: , The patient should return for repeat ERCP if there are signs of stent occlusion such as fever, increased bilirubin, worsening pain.  In the meantime, he will be kept on a regular diet and activity per Dr. X.
Liver Biopsy 
Medical specialty:  Gastroenterology
 Percutaneous liver biopsy.   With the patient lying in the supine position and the right hand underneath the head, an area of maximal dullness was identified in the mid-axillary location by percussion.

TITLE OF PROCEDURE: , Percutaneous liver biopsy.,ANALGESIA: , 2% Lidocaine.,ALLERGIES: , The patient denied any allergy to iodine, lidocaine or codeine.,PROCEDURE IN DETAIL:  ,The procedure was described in detail to the patient at a previous clinic visit and by the medical staff today.  The patient was told of complications which might occur consisting of bleeding, bile peritonitis, bowel perforation, pneumothorax, or death.  The risks and benefits of the procedure were understood, and the patient signed the consent form freely.,With the patient lying in the supine position and the right hand underneath the head, an area of maximal dullness was identified in the mid-axillary location by percussion.  The area was prepped and cleaned with povidone iodine following which the skin, subcutaneous tissue, and serosal surfaces were infiltrated with 2% lidocaine down to the capsule of the liver.  Next, a small incision was made with a Bard-Parker #11 scalpel.  A 16-gauge modified Klatskin needle was inserted through the incision and into the liver on one occasion with the patient in deep expiration.  Liver cores measuring *** cm were obtained and will be sent to Pathology for routine histologic study.,POST-PROCEDURE COURSE AND DISPOSITION: , The patient will remain under close observation in the medical treatment room for four to six hours and then be discharged home without medication.  Normal activities can be resumed tomorrow.  The patient is to contact me if severe abdominal or chest pain, fever, melena, light-headedness or any unusual symptoms develop.  An appointment will be made for the patient to see me in the clinic in the next few weeks to discuss the results of the liver biopsy so that management decisions can be made.,COMPLICATIONS:,  None.,RECOMMENDATIONS: , Prior to discharge, hepatitis A and B vaccines will be recommended.  Risks and benefits for vaccination have been addressed and the patient will consider this option.
Laparoscopic Gastric Bypass - 1 
Medical specialty:  Gastroenterology
 Morbid obesity.  Laparoscopic Roux-en-Y gastric bypass, antecolic, antegastric with 25-mm EEA anastamosis, esophagogastroduodenoscopy.

PREOPERATIVE DIAGNOSIS: , Morbid obesity. ,POSTOPERATIVE DIAGNOSIS: , Morbid obesity. ,PROCEDURE:,  Laparoscopic Roux-en-Y gastric bypass, antecolic, antegastric with 25-mm EEA anastamosis, esophagogastroduodenoscopy. ,ANESTHESIA: , General with endotracheal intubation. ,INDICATIONS FOR PROCEDURE: , This is a 50-year-old male who has been overweight for many years and has tried multiple different weight loss diets and programs.  The patient has now begun to have comorbidities related to the obesity.  The patient has attended our bariatric seminar and met with our dietician and psychologist.  The patient has read through our comprehensive handout and understands the risks and benefits of bypass surgery as evidenced by the signing of our consent form.,PROCEDURE IN DETAIL: , The risks and benefits were explained to the patient.  Consent was obtained.  The patient was taken to the operating room and placed supine on the operating room table.  General anesthesia was administered with endotracheal intubation.  A Foley catheter was placed for bladder decompression.  All pressure points were carefully padded, and sequential compression devices were placed on the legs.  The abdomen was prepped and draped in standard, sterile, surgical fashion.  Marcaine was injected into the umbilicus.
Laparoscopic Cholecystectomy & Cholangiogram 
Medical specialty:  Gastroenterology
 Laparoscopic cholecystectomy with cholangiogram.  Acute gangrenous cholecystitis with cholelithiasis.  The patient had essentially a dead gallbladder with stones and positive wide bile/pus coming from the gallbladder.

PREOPERATIVE DIAGNOSIS:,  Acute cholecystitis.,POSTOPERATIVE DIAGNOSIS:,  Acute gangrenous cholecystitis with cholelithiasis.,OPERATION PERFORMED: , Laparoscopic cholecystectomy with cholangiogram.,FINDINGS:  ,The patient had essentially a dead gallbladder with stones and positive wide bile/pus coming from the gallbladder.,COMPLICATIONS:  ,None.,EBL: , Scant.,SPECIMEN REMOVED: , Gallbladder with stones.,DESCRIPTION OF PROCEDURE:  ,The patient was prepped and draped in the usual sterile fashion under general anesthesia.  A curvilinear incision was made below the umbilicus.  Through this incision, the camera port was able to be placed into the peritoneal cavity under direct visualization.  Once this complete, insufflation was begun.  Once insufflation was adequate, additional ports were placed in the epigastrium as well as right upper quadrant.  Once all four ports were placed, the right upper quadrant was then explored.  The patient had significant adhesions of omentum and colon to the liver, the gallbladder constituting definitely an acute cholecystitis.  This was taken down using Bovie cautery to free up visualization of the gallbladder.  The gallbladder was very thick and edematous and had frank necrosis of most of the anterior gallbladder wall.  Adhesions were further taken down between the omentum, the colon, and the gallbladder slowly starting superiorly and working inferiorly towards the cystic duct area.  Once the adhesions were fully removed, the cholangiogram was done which did not show any evidence of any common bile duct dilatation or obstruction.  At this point, due to the patient's gallbladder being very necrotic, it was deemed that the patient should have a drain placed.  The cystic duct and cystic artery were serially clipped and transected.  The gallbladder was removed from the gallbladder fossa removing the entire gallbladder.  Adequate hemostasis with Bovie cautery was achieved.  The gallbladder was then placed into a bag and removed from the peritoneal cavity through the camera port.  A JP drain was then run through the anterior port and out of one of the trochar sites and secured to the skin using 3-0 nylon suture.  Next, the right upper quadrant was copiously irrigated out using the suction irrigator.  Once this was complete, the additional ports were able to be removed.  The fascial opening at the umbilicus was reinforced by closing it using a 0 Vicryl suture in a figure-of-8 fashion.  All skin incisions were injected using Marcaine 1/4 percent plain.  The skin was reapproximated further using 4-0 Monocryl sutures in a subcuticular technique.  The patient tolerated the procedure well and was able to be transferred to the recovery room in stable condition.
Laparoscopic Cholecystectomy - 5 
Medical specialty:  Gastroenterology
 Biliary colic.   Laparoscopic cholecystectomy.  Laparoscopic examination showed no injury from entry.  Marcaine was then injected just subxiphoid, and a 5-mm port was placed under direct visualization for the laparoscope. 

PREOPERATIVE DIAGNOSIS: , Biliary colic.
Laparoscopic Cholecystectomy - 4 
Medical specialty:  Gastroenterology
 Acute cholecystitis.  Laparoscopic cholecystectomy.  The abdominal area was prepped and draped in the usual sterile fashion.  A small skin incision was made below the umbilicus.  It was carried down in the transverse direction on the side of her old incision.  It was carried down to the fascia.

PREOPERATIVE DIAGNOSIS: , Acute cholecystitis.,POSTOPERATIVE DIAGNOSIS:,  Acute cholecystitis.,PROCEDURE PERFORMED:,  Laparoscopic cholecystectomy.,ANESTHESIA: , General.,ESTIMATED BLOOD LOSS:,  Zero.,COMPLICATIONS: , None.,PROCEDURE:  ,The patient was taken to the operating room, and after obtaining adequate general anesthesia, the patient was placed in the supine position.  The abdominal area was prepped and draped in the usual sterile fashion.  A small skin incision was made below the umbilicus.  It was carried down in the transverse direction on the side of her old incision.  It was carried down to the fascia.  An open pneumoperitoneum was created with Hasson technique.  Three additional ports were placed in the usual fashion.  The gallbladder was found to be acutely inflamed, distended, and with some necrotic areas.  It was carefully retracted from the isthmus, and the cystic structure was then carefully identified, dissected, and divided between double clips.  The gallbladder was then taken down from the gallbladder fossa with electrocautery.  There was some bleeding from the gallbladder fossa that was meticulously controlled with a Bovie.  The gallbladder was then finally removed via the umbilical port with some difficulty because of the size of the gallbladder and size of the stones.  The fascia had to be opened.  The gallbladder had to be opened, and the stones had to be extracted carefully.  When it was completed, I went back to the abdomen and achieved complete hemostasis.  The ports were then removed under direct vision with the scope.  The fascia of the umbilical wound was closed with a figure-of-eight 0 Vicryl.  All the incisions were injected with 0.25% Marcaine, closed with 4-0 Monocryl, Steri-Strips, and sterile dressing.,The patient tolerated the procedure satisfactorily and was transferred to the recovery room in stable condition.
Laparoscopic Cholecystectomy - 7 
Medical specialty:  Gastroenterology
 Cholecystitis and cholelithiasis.  Laparoscopic cholecystectomy and intraoperative cholangiogram.  The patient received 1 gm of IV Ancef intravenously piggyback.  The abdomen was prepared and draped in routine sterile fashion.

PREOPERATIVE DIAGNOSIS: , Cholecystitis and cholelithiasis.,POSTOPERATIVE DIAGNOSIS:  ,Cholecystitis and cholelithiasis.,TITLE OF PROCEDURE,1.  Laparoscopic cholecystectomy.,2.  Intraoperative cholangiogram.,ANESTHESIA:  ,General.,PROCEDURE IN DETAIL:  ,The patient was taken to the operative suite and placed in the supine position under general endotracheal anesthetic.  The patient received 1 gm of IV Ancef intravenously piggyback.  The abdomen was prepared and draped in routine sterile fashion.,A 1-cm incision was made at the umbilicus and a Veress needle was inserted.  Saline test was performed.  Satisfactory pneumoperitoneum was achieved by insufflation of CO2 to a pressure of 14 mmHg.  The Veress needle was removed.  A 10- to 11-mm cannula was inserted.  Inspection of the peritoneal cavity revealed a gallbladder that was soft and without adhesions to it.  It was largely mobile.  The liver had a normal appearance as did the peritoneal cavity.  A 5-mm cannula was inserted in the right upper quadrant anterior axillary line.  A second 5-mm cannula was inserted in the subcostal space.  A 10- to 11-mm cannula was inserted into the upper midline.,The gallbladder was reflected in a cephalad direction.  The gallbladder was punctured with the aspirating needle, and under C-arm fluoroscopy was filled with contrast, filling the intra- and extrahepatic biliary trees, which appeared normal.  Extra contrast was aspirated and the aspirating needle was removed.  The ampulla was grasped with a second grasper, opening the triangle of Calot.  The cystic duct was dissected and exposed at its junction with the ampulla, was controlled with a hemoclip, digitally controlled with two clips and divided.  This was done while the common duct was in full visualization.  The cystic artery was similarly controlled and divided.  The gallbladder was dissected from its bed and separated from the liver, brought to the outside through the upper midline cannula and removed.,The subhepatic and subphrenic spaces were irrigated thoroughly with saline solution.  There was oozing and bleeding from the lateral 5-mm cannula site, but this stopped spontaneously with removal of the cannula.  The subphrenic and subhepatic spaces were again irrigated thoroughly with saline until clear.  Hemostasis was excellent.  CO2 was evacuated and the camera removed.  The umbilical fascia was closed with 2-0 Vicryl, the subcu with 3-0 Vicryl, and the skin was closed with 4-0 nylon.  Sterile dressings were applied.  Sponge and needle counts were correct.
Laparoscopic Cholecystectomy - 6 
Medical specialty:  Gastroenterology
 Cholelithiasis; possible choledocholithiasis.  Laparoscopic cholecystectomy and intraoperative cholangiogram.  A small incision was made in the umbilicus, and a Veress needle was introduced into the abdomen.  CO2 insufflation was done to a maximum pressure of 15 mmHg, and a 12-mm VersaStep port was placed into the umbilicus.

PREOPERATIVE DIAGNOSIS:,  Cholelithiasis; possible choledocholithiasis.
Laparoscopic Appendectomy - 3 
Medical specialty:  Gastroenterology
 Appendicitis.  Laparoscopic appendectomy.   CO2 insufflation was done to a maximum pressure of 15 mmHg and a 12-mm VersaStep port was placed through his umbilicus.

PREOPERATIVE DIAGNOSIS: , Appendicitis.,POSTOPERATIVE DIAGNOSIS:,  Appendicitis. ,PROCEDURE: , Laparoscopic appendectomy. ,ANESTHESIA: , General with endotracheal intubation. ,PROCEDURE IN DETAIL:  ,The patient was taken to the operating room and placed supine on the operating room table.  General anesthesia was administered with endotracheal intubation.  His abdomen was prepped and draped in a standard, sterile surgical fashion.  A Foley catheter was placed for bladder decompression.  Marcaine was injected into his umbilicus.  A small incision was made.  A Veress needle was introduced in his abdomen.  CO2 insufflation was done to a maximum pressure of 15 mmHg and a 12-mm VersaStep port was placed through his umbilicus.  A 5-mm port was then placed just to the right side of the umbilicus.  Another 5-mm port was placed just suprapubic in the midline.  Upon inspection of the cecum, I was able find an inflamed and indurated appendix.  I was able to clear the mesentery at the base of the appendix between the appendix and the cecum.  I fired a white load stapler across the appendix at its base and fired a grey load stapler across the mesentery, and thereby divided the mesentery and freed the appendix.  I put the appendix in an Endocatch bag and removed it through the umbilicus.  I irrigated out the abdomen.  I then closed the fascia of the umbilicus with interrupted 0 Vicryl suture utilizing Carter-Thomason and closed the skin of all incisions with a running Monocryl.  Sponge, instrument, and needle counts were correct at the end of the case.  The patient tolerated the procedure well without any complications.
Laparoscopic Cholecystectomy - 2 
Medical specialty:  Gastroenterology
 Laparoscopic cholecystectomy due to chronic cholecystitis and cholelithiasis.

PREOPERATIVE DIAGNOSIS:,1.  Cholelithiasis.,2.  Chronic cholecystitis.,POSTOPERATIVE DIAGNOSIS:,1.  Cholelithiasis.,2.  Chronic cholecystitis.,NAME OF OPERATION: , Laparoscopic cholecystectomy.,ANESTHESIA:,  General.,FINDINGS:,  The gallbladder was thickened and showed evidence of chronic cholecystitis.  There was a great deal of inflammatory reaction around the cystic duct.  The cystic duct was slightly larger.  There was a stone impacted in the cystic duct with the gallbladder.  The gallbladder contained numerous stones which were small.  With the stone impacted in the cystic duct, it was felt that probably none were within the common duct.  Other than rather marked obesity, no other significant findings were noted on limited exploration of the abdomen.,PROCEDURE:,  Under general anesthesia after routine prepping and draping, the abdomen was insufflated with the Veress needle, and the standard four trocars were inserted uneventfully.  Inspection was made for any entry problems, and none were encountered.,After limited exploration, the gallbladder was then retracted superiorly and laterally, and the cystic duct was dissected out.  This was done with some difficulty due to the fibrosis around the cystic duct, but care was taken to avoid injury to the duct and to the common duct.  In this manner, the cystic duct and cystic artery were dissected out.  Care was taken to be sure that the duct that was identified went into the gallbladder and was the cystic duct.  The cystic duct and cystic artery were then doubly clipped and divided, taking care to avoid injury to the common duct.  The gallbladder was then dissected free from the gallbladder bed.  Again, the gallbladder was somewhat adherent to the gallbladder bed due to previous inflammatory reaction.  The gallbladder was dissected free from the gallbladder bed utilizing the endo shears and the cautery to control bleeding.  The gallbladder was extracted through the operating trocar site, and the trocar was reinserted.  Inspection was made of the gallbladder bed.  One or two bleeding areas were fulgurated, and bleeding was well controlled.
Laparoscopic Cholecystectomy 
Medical specialty:  Gastroenterology
 Standard Laparoscopic Cholecystectomy Operative Note.

The patient's abdomen was prepped and draped in the usual sterile fashion.  A subumbilical skin incision was made.  The Veress needle was inserted, and the patient's abdominal cavity was insufflated with moderate pressure all times.  A subumbilical trocar was inserted.  The camera was inserted in the panoramic view.  The abdomen demonstrated some inflammation around the gallbladder.  A 10-mm midepigastric trocar was inserted.  A. 2 mm and 5 mm trocars were inserted.  The most lateral trocar grasping forceps was inserted and grasped the fundus of the gallbladder and placed in tension at liver edge.,Using the dissector, the cystic duct was identified and double Hemoclips were invited well away from the cystic-common duct junction.  The cystic artery was identified and double Hemoclips applied.  The gallbladder was taken down from the liver bed using Endoshears and electrocautery.  Hemostasis was obtained.  The gallbladder was removed from the midepigastric trocar site without difficulty.  The trocars were removed and the skin incisions were reapproximated using 4-0 Monocryl.  Steri-Strips and sterile dressing were placed.  The patient tolerated the procedure well and was taken to the recovery room in stable condition.
Laparoscopic Cholecystectomy - 3 
Medical specialty:  Gastroenterology
 Chronic cholecystitis without cholelithiasis.

PREOPERATIVE DIAGNOSIS: , Chronic cholecystitis without cholelithiasis.,POSTOPERATIVE DIAGNOSIS:  ,Chronic cholecystitis without cholelithiasis.,PROCEDURE: , Laparoscopic cholecystectomy.,BRIEF DESCRIPTION: , The patient was brought to the operating room and anesthesia was induced.  The abdomen was prepped and draped and ports were placed.  The gallbladder was grasped and retracted.  The cystic duct and cystic artery were circumferentially dissected and a critical view was obtained.  The cystic duct and cystic artery were then doubly clipped and divided and the gallbladder was dissected off the liver bed with electrocautery and placed in an endo catch bag.  The gallbladder fossa and clips were examined and looked good with no evidence of bleeding or bile leak.  The ports were removed under direct vision with good hemostasis.  The Hasson was removed.  The abdomen was desufflated.  The gallbladder in its endo catch bag was removed.  The ports were closed.  The patient tolerated the procedure well.  Please see full hospital dictation.