harishnair04/mtsamples huggingface dataset:
Allergic Rhinitis 
Medical specialty:  Allergy / Immunology
 A 23-year-old white female presents with complaint of allergies.

SUBJECTIVE:,  This 23-year-old white female presents with complaint of allergies.  She used to have allergies when she lived in Seattle but she thinks they are worse here.  In the past, she has tried Claritin, and Zyrtec.  Both worked for short time but then seemed to lose effectiveness.  She has used Allegra also.  She used that last summer and she began using it again two weeks ago.  It does not appear to be working very well.  She has used over-the-counter sprays but no prescription nasal sprays.  She does have asthma but doest not require daily medication for this and does not think it is flaring up.,MEDICATIONS: , Her only medication currently is Ortho Tri-Cyclen and the Allegra.,ALLERGIES: , She has no known medicine allergies.,OBJECTIVE:,Vitals:  Weight was 130 pounds and blood pressure 124/78.,HEENT:  Her throat was mildly erythematous without exudate.  Nasal mucosa was erythematous and swollen.  Only clear drainage was seen.  TMs were clear.,Neck:  Supple without adenopathy.,Lungs:  Clear.,ASSESSMENT:,  Allergic rhinitis.,PLAN:,1.  She will try Zyrtec instead of Allegra again.  Another option will be to use loratadine.  She does not think she has prescription coverage so that might be cheaper.,2.  Samples of Nasonex two sprays in each nostril given for three weeks.  A prescription was written as well.
Laparoscopic Gastric Bypass Consult - 2 
Medical specialty:  Bariatrics
 Consult for laparoscopic gastric bypass.

PAST MEDICAL HISTORY:, He has difficulty climbing stairs, difficulty with airline seats, tying shoes, used to public seating, and lifting objects off the floor.  He exercises three times a week at home and does cardio.  He has difficulty walking two blocks or five flights of stairs.  Difficulty with snoring.  He has muscle and joint pains including knee pain, back pain, foot and ankle pain, and swelling.  He has gastroesophageal reflux disease.,PAST SURGICAL HISTORY:, Includes reconstructive surgery on his right hand 13 years ago.  ,SOCIAL HISTORY:, He is currently single.  He has about ten drinks a year.  He had smoked significantly up until several months ago.  He now smokes less than three cigarettes a day.,FAMILY HISTORY:, Heart disease in both grandfathers, grandmother with stroke, and a grandmother with diabetes.  Denies obesity and hypertension in other family members.,CURRENT MEDICATIONS:, None.,ALLERGIES:,  He is allergic to Penicillin.,MISCELLANEOUS/EATING HISTORY:, He has been going to support groups for seven months with Lynn Holmberg in Greenwich and he is from Eastchester, New York and he feels that we are the appropriate program.  He had a poor experience with the Greenwich program.  Eating history, he is not an emotional eater.  Does not like sweets.  He likes big portions and carbohydrates.  He likes chicken and not steak.  He currently weighs 312 pounds.  Ideal body weight would be 170 pounds.  He is 142 pounds overweight.  If ,he lost 60% of his excess body weight that would be 84 pounds and he should weigh about 228.,REVIEW OF SYSTEMS: ,Negative for head, neck, heart, lungs, GI, GU, orthopedic, and skin.  Specifically denies chest pain, heart attack, coronary artery disease, congestive heart failure, arrhythmia, atrial fibrillation, pacemaker, high cholesterol, pulmonary embolism, high blood pressure, CVA, venous insufficiency, thrombophlebitis, asthma, shortness of breath, COPD, emphysema, sleep apnea, diabetes, leg and foot swelling, osteoarthritis, rheumatoid arthritis, hiatal hernia, peptic ulcer disease, gallstones, infected gallbladder, pancreatitis, fatty liver, hepatitis, hemorrhoids, rectal bleeding, polyps, incontinence of stool, urinary stress incontinence, or cancer.  Denies cellulitis, pseudotumor cerebri, meningitis, or encephalitis.,PHYSICAL EXAMINATION:, He is alert and oriented x 3.  Cranial nerves II-XII are intact.  Afebrile.  Vital Signs are stable.
2-D Echocardiogram - 1 
Medical specialty:  Cardiovascular / Pulmonary
 2-D M-Mode. Doppler.  

2-D M-MODE: , ,1.  Left atrial enlargement with left atrial diameter of 4.7 cm.,2.  Normal size right and left ventricle.,3.  Normal LV systolic function with left ventricular ejection fraction of 51%.,4.  Normal LV diastolic function.,5.  No pericardial effusion.,6.  Normal morphology of aortic valve, mitral valve, tricuspid valve, and pulmonary valve.,7.  PA systolic pressure is 36 mmHg.,DOPPLER: , ,1.  Mild mitral and tricuspid regurgitation.,2.  Trace aortic and pulmonary regurgitation.
2-D Echocardiogram - 2 
Medical specialty:  Cardiovascular / Pulmonary
 2-D Echocardiogram

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

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

PREOPERATIVE DIAGNOSIS: , Lipodystrophy of the abdomen and thighs.,POSTOPERATIVE DIAGNOSIS:,  Lipodystrophy of the abdomen and thighs.,OPERATION: , Suction-assisted lipectomy.,ANESTHESIA:,  General.,FINDINGS AND PROCEDURE:,  With the patient under satisfactory general endotracheal anesthesia, the entire abdomen, flanks, perineum, and thighs to the knees were prepped and draped circumferentially in sterile fashion.  After this had been completed, a #15 blade was used to make small stab wounds in the lateral hips, the pubic area, and upper edge of the umbilicus.  Through these small incisions, a cannula was used to infiltrate lactated Ringers with 1000 cc was infiltrated initially into the abdomen.  A 3 and 4-mm cannulas were then used to carry out the liposuction of the abdomen removing a total of 1100 cc of aspirate, which was mostly fat, little fluid, and blood.  Attention was then directed to the thighs both inner and outer.  A total of 1000 cc was infiltrated in both lateral thighs only about 50 cc in the medial thighs.  After this had been completed, 3 and 4-mm cannulas were used to suction 650 cc from each side, approximately 50 cc in the inner thigh and 600 on each lateral thigh.  The patient tolerated the procedure very well.  All of this aspirate was mostly fat with little fluid and very little blood.  Wounds were cleaned and steri-stripped and dressing of ABD pads and ***** was then applied.  The patient tolerated the procedure very well and was sent to the recovery room in good condition.
2-D Echocardiogram - 4 
Medical specialty:  Cardiovascular / Pulmonary
 Echocardiogram and Doppler

DESCRIPTION:,1.  Normal cardiac chambers size.,2.  Normal left ventricular size.,3.  Normal LV systolic function.  Ejection fraction estimated around 60%.,4.  Aortic valve seen with good motion.,5.  Mitral valve seen with good motion.,6.  Tricuspid valve seen with good motion.,7.  No pericardial effusion or intracardiac masses.,DOPPLER:,1.  Trace mitral regurgitation.,2.  Trace tricuspid regurgitation.,IMPRESSION:,1.  Normal LV systolic function.,2.  Ejection fraction estimated around 60%.,
Laparoscopic Gastric Bypass - 1 
Medical specialty:  Bariatrics
 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.
2-D Doppler 
Medical specialty:  Cardiovascular / Pulmonary
 Normal left ventricle, moderate biatrial enlargement, and mild tricuspid regurgitation, but only mild increase in right heart pressures.

2-D STUDY,1. Mild aortic stenosis, widely calcified, minimally restricted.,2. Mild left ventricular hypertrophy but normal systolic function.,3. Moderate biatrial enlargement.,4. Normal right ventricle.,5. Normal appearance of the tricuspid and mitral valves.,6. Normal left ventricle and left ventricular systolic function.,DOPPLER,1. There is 1 to 2+ aortic regurgitation easily seen, but no aortic stenosis.,2. Mild tricuspid regurgitation with only mild increase in right heart pressures, 30-35 mmHg maximum.,SUMMARY,1. Normal left ventricle.,2. Moderate biatrial enlargement.,3. Mild tricuspid regurgitation, but only mild increase in right heart pressures.
Bony Impacted Teeth Removal 
Medical specialty:  Dentistry
  Surgical removal of completely bony impacted teeth #1, #16, #17, and #32.  Completely bony impacted teeth #1, #16, #17, and #32.

PREOPERATIVE DIAGNOSIS:,  Completely bony impacted teeth #1, #16, #17, and #32.,POSTOPERATIVE DIAGNOSIS: , Completely bony impacted teeth #1, #16, #17, and #32.,PROCEDURE: , Surgical removal of completely bony impacted teeth #1, #16, #17, and #32.,ANESTHESIA: , General nasotracheal.,COMPLICATIONS: , None.,CONDITION:  ,Stable to PACU.,DESCRIPTION OF PROCEDURE: , Patient was brought to the operating room, placed on the table in a supine position, and after demonstration of an adequate plane of general anesthesia via the nasotracheal route, patient was prepped and draped in the usual fashion for an intraoral procedure.  A gauze throat pack was placed and local anesthetic was administered in all four quadrants, a total of 7.2 mL of lidocaine 2% with 1:100,000 epinephrine, and 3.6 mL of bupivacaine 0.5% with 1:200,000 epinephrine.  Beginning on the upper right tooth #1, incision was made with a #15 blade.  Envelope flap was raised with the periosteal elevator, and bone was removed on the buccal aspect with straight elevator.  Potts elevator was then used to luxate the tooth from the socket.  Remnants of the follicle were then removed with hemostat.  The area was irrigated and then closed with 3-0 gut suture.  On the lower right tooth #32, incision was made with a #15 blade.  Envelope flap was raised with the periosteal elevator, and bone was removed on the buccal and distal aspect with a high-speed drill with a round bur.  Tooth was then sectioned with the bur and removed in several pieces.  Remnants of the follicle were removed with a curved hemostat.  The area was irrigated with normal saline solution and closed with 3-0 gut sutures.  Moving to #16 on the upper left, incision was made with a #15 blade.  Envelope flap was raised with the periosteal elevator, and bone was removed on the buccal aspect with straight elevator.  Potts elevator was then used to luxate the tooth from the socket.  Remnants of the follicle were removed with a curved hemostat.  The area was irrigated with normal saline solution and closed with 3-0 gut sutures.  Moving to the lower left #17, incision was made with a #15 blade.  Envelope flap was  raised with the periosteal elevator, and bone was removed on the buccal and distal aspect with high-speed drill with a round bur.  Then the bur was used to section the tooth vertically.  Tooth was removed in several pieces followed by the removal of the remnants of the follicle.  The area was irrigated with normal saline solution and closed with 3-0 gut sutures.  Upon completion of the procedure, the throat pack was removed and the pharynx was suctioned.  An NG tube was then inserted and small amount of gastric contents were suctioned.  Patient was then awakened, extubated, and taken to the PACU in stable condition.
Laparoscopic Gastric Banding - Preop Visit  
Medical specialty:  Bariatrics
 Preoperative visit for weight management with laparoscopic gastric banding

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

REASON FOR VISIT:,  Lap band adjustment.,HISTORY OF PRESENT ILLNESS:,  Ms. A is status post lap band placement back in 01/09 and she is here on a band adjustment.  Apparently, she had some problems previously with her adjustments and apparently she has been under a lot of stress.  She was in a car accident a couple of weeks ago and she has problems, she does not feel full.  She states that she is not really hungry but she does not feel full and she states that she is finding when she is hungry at night, having difficulty waiting until the morning and that she did mention that she had a candy bar and that seemed to make her feel better.,PHYSICAL EXAMINATION: , On exam, her temperature is 98, pulse 76, weight 197.7 pounds, blood pressure 102/72, BMI is 38.5, she has lost 3.8 pounds since her last visit.  She was alert and oriented in no apparent distress.  ,PROCEDURE:  ,I was able to access her port.  She does have an AP standard low profile.  I aspirated 6 mL, I did add 1 mL, so she has got approximately 7 mL in her band, she did tolerate water postprocedure.,ASSESSMENT:,  The patient is status post lap band adjustments, doing well, has a total of 7 mL within her band, tolerated water postprocedure.  She will come back in two weeks for another adjustment as needed.,
Vasectomy - 4 
Medical specialty:  Urology
 Fertile male with completed family.  Elective male sterilization via bilateral vasectomy.

PROCEDURE: , Elective male sterilization via bilateral vasectomy.,PREOPERATIVE DIAGNOSIS:  ,Fertile male with completed family.,POSTOPERATIVE DIAGNOSIS:,  Fertile male with completed family.,MEDICATIONS:  ,Anesthesia is local with conscious sedation.,COMPLICATIONS: , None.,BLOOD LOSS: , Minimal.,INDICATIONS:  ,This 34-year-old gentleman has come to the office requesting sterilization via bilateral vasectomy.  I discussed the indications and the need for procedure with the patient in detail, and he has given consent to proceed.  He has been given prophylactic antibiotics.,PROCEDURE NOTE: , Once satisfactory sedation have been obtained, the patient was placed in the supine position on the operating table.  Genitalia was shaved and then prepped with Betadine scrub and paint solution and were draped sterilely.  The procedure itself was started by grasping the right vas deferens in the scrotum, and bringing it up to the level of the skin.  The skin was infiltrated with 2% Xylocaine and punctured with a sharp hemostat to identify the vas beneath.  The vas was brought out of the incision carefully.  A 2-inch segment was isolated, and 1-inch segment was removed.  The free ends were cauterized and were tied with 2-0 silk sutures in such a fashion that the ends double back on themselves.  After securing hemostasis with a cautery, the ends were allowed to drop back into the incision, which was also cauterized.,Attention was now turned to the left side.  The vas was grasped and brought up to the level of the skin.  The skin was infiltrated with 2% Xylocaine and punctured with a sharp hemostat to identify the vas beneath.  The vas was brought out of the incision carefully.  A 2-inch segment was isolated, and 1-inch segment was removed.  The free ends were cauterized and tied with 2-0 silk sutures in such a fashion that the ends double back on themselves.  After securing hemostasis with the cautery, the ends were allowed to drop back into the incision, which was also cauterized.,Bacitracin ointment was applied as well as dry sterile dressing.  The patient was awakened and was returned to Recovery in satisfactory condition.
Airway Compromise & Foreign Body - ER Visit 
Medical specialty:  General Medicine
 The patient is a 17-year-old female, who presents to the emergency room with foreign body and airway compromise and was taken to the operating room.  She was intubated and fishbone.

HISTORY OF PRESENT ILLNESS:,  The patient is a 17-year-old female, who presents to the emergency room with foreign body and airway compromise and was taken to the operating room.  She was intubated and fishbone.,PAST MEDICAL HISTORY: , Significant for diabetes, hypertension, asthma, cholecystectomy, and total hysterectomy and cataract.,ALLERGIES:  ,No known drug allergies.,CURRENT MEDICATIONS: , Prevacid, Humulin, Diprivan, Proventil, Unasyn, and Solu-Medrol.,FAMILY HISTORY: , Noncontributory.,SOCIAL HISTORY: , Negative for illicit drugs, alcohol, and tobacco.,PHYSICAL EXAMINATION:  ,Please see the hospital chart.,LABORATORY DATA: , Please see the hospital chart.,HOSPITAL COURSE: , The patient was taken to the operating room by Dr. X who is covering for ENT and noted that she had airway compromise and a rather large fishbone noted and that was removed.  The patient was intubated and it was felt that she should be observed to see if the airway would improve upon which she could be extubated.  If not she would require tracheostomy.  The patient was treated with IV antibiotics and ventilatory support and at the time of this dictation, she has recently been taken to the operating room where it was felt that the airway sufficient and she was extubated.  She was doing well with good p.o.s, good airway, good voice, and desiring to be discharged home.  So, the patient is being prepared for discharge at this point.  We will have Dr. X evaluate her before she leaves to make sure I do not have any problem with her going home.  Dr. Y feels she could be discharged today and will have her return to see him in a week.
Whole Body Radionuclide Bone Scan 
Medical specialty:  Urology
 Whole body radionuclide bone scan due to prostate cancer.

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