harishnair04/mtsamples huggingface dataset:
Bronchoscopy - 6 
Medical specialty:  Cardiovascular / Pulmonary
 Bronchoscopy for hypoxia and increasing pulmonary secretions

PREOPERATIVE DIAGNOSIS: , Hypoxia and increasing pulmonary secretions.,POSTOPERATIVE DIAGNOSIS: , Hypoxia and increasing pulmonary secretions.,OPERATION: , Bronchoscopy.,ANESTHESIA: , Moderate bedside sedation.,COMPLICATIONS:,  None.,FINDINGS:,  Abundant amount of clear thick secretions throughout the main airways.,INDICATIONS:,  The patient is a 43-year-old gentleman who has been in the ICU for several days following resection of small bowel for sequelae of SMV occlusion.  This morning, the patient developed worsening hypoxia with abundant sputum production requiring frequent suctioning from his ET tube.  The patient also had new-appearing atelectasis versus infiltrates in the right lower lobe of his lung on chest x-ray.  Given these findings, it was felt that bronchoscopy could further define source of secretions and send more appropriate specimen for culture if need be.,OPERATION:,  The patient was given additional fentanyl, Versed as well as paralytics for the procedure.  Small bronchoscope was inserted through the ET tube and to the trachea to the level of carina.  There was noted to be thick clear secretions adherent to the trachea walls as well as into the right mainstem bronchus.  Extensive secretions extended down into the secondary airways.  This was lavaged with saline and suctioned dry.  There is no overt specific occlusion of airways, nor was there any purulent-appearing sputum.  The bronchoscope was then advanced into the left mainstem bronchus, and there was noted to be a small amount of similar-appearing secretions which was likewise suctioned and cleaned.  The bronchoscope was removed, and the patient was increased to PEEP of 10 on the ventilator.  Please note that prior to starting bronchoscopy, he was pre oxygenated with 100% O2.  The patient tolerated the procedure well and lavage specimen was sent for gram stain as well as routine culture.
Bronchoscopy - 7 
Medical specialty:  Cardiovascular / Pulmonary
 Diagnostic fiberoptic bronchoscopy.

PROCEDURE:,  Diagnostic fiberoptic bronchoscopy.,ANESTHESIA:  ,  Plain lidocaine 2% was given intrabronchially for local anesthesia.,PREOPERATIVE MEDICATIONS:,  ,1.  Lortab (10 mg) plus Phenergan (25 mg), p.o.  1 hour before the procedure.,2.  Versed a total of 5 mg given IV push during the procedure.,INDICATIONS: ,
Bronchoscopy - 8 
Medical specialty:  Cardiovascular / Pulmonary
 Bronchoscopy with brush biopsies.  Persistent pneumonia, right upper lobe of the lung, possible mass.

PREOPERATIVE DIAGNOSIS: , Persistent pneumonia, right upper lobe of the lung, possible mass.,POSTOPERATIVE DIAGNOSIS: , Persistent pneumonia, right upper lobe of the lung, possible mass.,PROCEDURE:,  Bronchoscopy with brush biopsies.,DESCRIPTION OF PROCEDURE: , After obtaining an informed consent, the patient was taken to the operating room where he underwent a general endotracheal anesthesia.  A time-out process had been followed and then the flexible bronchoscope was inserted through the endotracheal tube after 2 cc of 4% lidocaine had been infused into the endotracheal tube.  First the trachea and the carina had normal appearance.  The scope was passed into the left side and the bronchial system was found to be normal.  There were scars and mucoid secretions.  Then the scope was passed into the right side where brown secretions were obtained and collected in a trap to be sent for culture and sensitivity of aerobic and anaerobic fungi and TB.  First, the basal lobes were explored and found to be normal.  Then, the right upper lobe was selectively cannulated and no abnormalities were found except some secretions were aspirated.  Then, the bronchi going to the three segments were visualized and no abnormalities or mass were found.  Brush biopsy was obtained from one of the segments and sent to Pathology.,The procedure had to be interrupted several times because of the patient's desaturation, but after a few minutes of Ambu bagging, he recovered satisfactorily.,At the end, the patient tolerated the procedure well and was sent to the recovery room in satisfactory condition.,
Bronchoscopy - 2 
Medical specialty:  Cardiovascular / Pulmonary
 Bronchoscopy for persistent cough productive of sputum requiring repeated courses of oral antibiotics over the last six weeks in a patient who is a recipient of a bone marrow transplant with end-stage chemotherapy and radiation-induced pulmonary fibrosis.

INDICATIONS FOR PROCEDURE:,  Persistent cough productive of sputum requiring repeated courses of oral antibiotics over the last six weeks in a patient who is a recipient of a bone marrow transplant with end-stage chemotherapy and radiation-induced pulmonary fibrosis.,PREMEDICATION:,1.  Demerol 50 mg.,2.  Phenergan 25 mg.,3.  Atropine 0.6 mg IM.,4.  Nebulized 4% lidocaine followed by nasal insufflation of lidocaine through the right naris and topical 4% lidocaine gel through the right naris, 4 mg of Versed was given at the start of the procedure and another 1 mg shortly after traversing the cords.,PROCEDURE DETAILS:,  With the patient breathing oxygen by nasal cannula, being monitored by noninvasive blood pressure cuff and continuous pulse oximetry, the Olympus bronchoscope was introduced through the right naris to the level of the cords.  The cords move normally with phonation and ventilation.  Two times 2 mL of 1% lidocaine were instilled on the cords and the cords were traversed.  Further 2 mL of 1% lidocaine was instilled in the trachea just distal to the cords, at mid trachea above the carina, and on the right, and on the left mainstem bronchus.  Scope was then introduced on to the left where immediately some hyperemia of the mucosa was noted.  Upper lobe and lingula were unremarkable.  There appeared to be some narrowing or tenting of the left lower lobe bronchus such that after inspection of the superior segment, one almost had to pop the bronchoscope around to go down the left mainstem.  This had been a change from the prior bronchoscopy of unclear significance.  Distal to this, there was no hyperemia or inspissated mucus or mucoid secretions or signs of infection.  The scope was wedged in the left lower lobe posterior basal segment and a BAL was done with good returns, which were faintly hemorrhagic.  The scope was then removed, re-introduced up to the right upper lobe, middle lobe, superior segment, right lower, anterior lateral, and posterior basal subsegments were all evaluated and unremarkable.  The scope was withdrawn.  The patient's saturation remained 93%-95% throughout the procedure.  Blood pressure was 103/62.  Heart rate at the end of the procedure was about 100.  The patient tolerated the procedure well.  Samples were sent as follows.  Washings for AFB, Gram-stain Nocardia, Aspergillus, and routine culture.  Lavage for AFB, Gram-stain Nocardia, Aspergillus, cell count with differential, cytology, viral mycoplasma, and Chlamydia culture, GMS staining, RSV by antigen, and Legionella and Chlamydia culture.
Bronchoscopy - Fiberoptic 
Medical specialty:  Cardiovascular / Pulmonary
 Fiberoptic bronchoscopy with endobronchial biopsies.  A CT scan done of the chest there which demonstrated bilateral hilar adenopathy with extension to the subcarinal space as well as a large 6-cm right hilar mass, consistent with a primary lung carcinoma.

HISTORY OF PRESENT ILLNESS:,  A 67-year-old gentleman who presented to the emergency room with chest pain, cough, hemoptysis, shortness of breath, and recent 30-pound weight loss.  He had a CT scan done of the chest there which demonstrated bilateral hilar adenopathy with extension to the subcarinal space as well as a large 6-cm right hilar mass, consistent with a primary lung carcinoma.  There was also a question of liver metastases at that time.,OPERATION PERFORMED:,  Fiberoptic bronchoscopy with endobronchial biopsies.,The bronchoscope was passed into the airway and it was noted that there was a large, friable tumor blocking the bronchus intermedius on the right.  The tumor extended into the carina, involving the lingula and the left upper lobe, appearing malignant.  Approximately 15 biopsies were taken of the tumor.,Attention was then directed at the left upper lobe and lingula.  Epinephrine had already been instilled and multiple biopsies were taken of the lingula and the left upper lobe and placed in a separate container for histologic review.  Approximately eight biopsies were taken of the left upper lobe.
Bronchoscopy 
Medical specialty:  Cardiovascular / Pulmonary
 Bronchoscopy.  Atelectasis and mucous plugging.

PREOPERATIVE DIAGNOSIS: , Atelectasis.,POSTOPERATIVE DIAGNOSIS: , Mucous plugging.,PROCEDURE PERFORMED: , Bronchoscopy.,ANESTHESIA: , Lidocaine topical 2%, Versed 3 mg IV.  Conscious sedation.,PROCEDURE: , At bedside, a bronchoscope was passed down the tracheostomy tube under monitoring.  The main carina was visualized.  The trachea was free of any secretions.  The right upper lobe, middle and lower lobes appeared to have some mucoid secretions but minimal and with some erythema.  Left mainstem appeared patent.  Left lower lobe had slight plugging in the left base, but much better that previous bronchoscopy findings.  The area was lavaged with some saline and cleared.  The patient tolerated the procedure well.
Bronchoalveolar lavage. 
Medical specialty:  Cardiovascular / Pulmonary
 Evaluation of airway for possible bacterial infection performed using bronchoalveolar lavage.

POSTOPERATIVE DIAGNOSIS:  Fever.,PROCEDURES:  Bronchoalveolar lavage.,INDICATIONS FOR PROCEDURE:  The patient is a 28-year-old male, status post abdominal trauma, splenic laceration, and splenectomy performed at the outside hospital, who was admitted to the Trauma Intensive Care Unit on the evening of August 4, 2008.  Greater than 24 hours postoperative, the patient began to run a fever in excess of 102.  Therefore, evaluation of his airway for possible bacterial infection was performed using bronchoalveolar lavage.,DESCRIPTION OF PROCEDURE:  The patient was preoxygenated with 100% FIO2 for approximately 5 to 10 minutes prior to the procedure.  The correct patient and procedure was identified by time out by all members of the team.  The patient was prepped and draped in a sterile fashion and sterile technique was used to connect the BAL lavage catheter to Lukens trap suction.  A catheter was introduced into the endotracheal tube through a T connector and five successive 20 mL aliquots of normal saline were flushed through the catheter, each time suctioning out the sample into the Lukens trap.  A total volume of 30 to 40 mL was collected in the trap and sent to the lab for quantitative bacteriology.  The patient tolerated the procedure well and had no episodes of desaturation, apnea, or cardiac arrhythmia.  A postoperative chest x-ray was obtained.
Bronchoscopy - 3 
Medical specialty:  Cardiovascular / Pulmonary
 Fiberoptic bronchoscopy for diagnosis of right lung atelectasis and extensive mucus plugging in right main stem bronchus.

PROCEDURE: , Fiberoptic bronchoscopy.,PREOPERATIVE DIAGNOSIS:,  Right lung atelectasis.,POSTOPERATIVE DIAGNOSIS:,  Extensive mucus plugging in right main stem bronchus.,PROCEDURE IN DETAIL:,  Fiberoptic bronchoscopy was carried out at the bedside in the medical ICU after Versed 0.5 mg intravenously given in 2 aliquots.  The patient was breathing supplemental nasal and mask oxygen throughout the procedure.  Saturations and vital signs remained stable throughout.  A flexible fiberoptic bronchoscope was passed through the right naris.  The vocal cords were visualized.  Secretions in the larynx were as aspirated.  As before, he had a mucocele at the right anterior commissure that did not obstruct the glottic opening.  The ports were anesthetized and the trachea entered.  There was no cough reflex helping explain the propensity to aspiration and mucus plugging.  Tracheal secretions were aspirated.  The main carinae were sharp.  However, there were thick, sticky, grey secretions filling the right mainstem bronchus up to the level of the carina.  This was gradually lavaged clear.  Saline and Mucomyst solution were used to help dislodge remaining plugs.  The airways appeared slightly friable, but were patent after the airways were suctioned.  O2 saturations remained in the mid-to-high 90s.  The patient tolerated the procedure well.  Specimens were submitted for microbiologic examination.  Despite his frail status, he tolerated bronchoscopy quite well.
Bronchoscopy - 4 
Medical specialty:  Cardiovascular / Pulmonary
 Rigid bronchoscopy with dilation, excision of granulation tissue tumor, application of mitomycin-C, endobronchial ultrasound.

PREOPERATIVE DIAGNOSIS:  ,Tracheal stenosis and metal stent complications.,POSTOPERATIVE DIAGNOSIS:  ,Tracheal stenosis and metal stent complications.,ANESTHESIA:  ,General endotracheal.,ENDOSCOPIC FINDINGS:,1.  Normal true vocal cords.,2.  Subglottic stenosis down to 5 mm with mature cicatrix.,3.  Tracheal granulation tissue growing through the stents at the midway point of the stents.,5.  Three metallic stents in place in the proximal trachea.,6.  Distance from the true vocal cords to the proximal stent, 2 cm.,7.  Distance from the proximal stent to the distal stent, 3.5 cm.,8.  Distance from the distal stent to the carina, 8 cm.,9.  Distal airway is clear.,PROCEDURES:,1.  Rigid bronchoscopy with dilation.,2.  Excision of granulation tissue tumor.,3.  Application of mitomycin-C.,4.  Endobronchial ultrasound.,TECHNIQUE IN DETAIL:  ,After informed consent was obtained from the patient and her husband, she was brought to the operating theater after sequence induction was done.  She had a Dedo laryngoscope placed.  Her airways were inspected thoroughly with findings as described above.  She was intermittently ventilated with an endotracheal tube placed through the Dedo scope.  Her granulation tissue was biopsied and then removed with a microdebrider.  Her proximal trachea was dilated with a combination of balloon, Bougie, and rigid scopes.  She tolerated the procedure well, was extubated, and brought to the PACU.
Bilateral Carotid Cerebral Angiogram 
Medical specialty:  Cardiovascular / Pulmonary
 Bilateral carotid cerebral angiogram and right femoral-popliteal angiogram.

PREOPERATIVE DIAGNOSES:,1.  Carotid artery occlusive disease.,2.  Peripheral vascular disease.,POSTOPERATIVE DIAGNOSES:,1.  Carotid artery occlusive disease.,2.  Peripheral vascular disease.,OPERATIONS PERFORMED:,1.  Bilateral carotid cerebral angiogram.,2.  Right femoral-popliteal angiogram.,FINDINGS: , The right carotid cerebral system was selectively catheterized and visualized.  The right internal carotid artery was found to be very tortuous with kinking in its cervical portions, but no focal stenosis was noted.  Likewise, the intracranial portion of the right internal carotid artery showed no significant disease nor did the right middle cerebral artery.,The left carotid cerebral system was selectively catheterized and visualized.  The cervical portion of the left internal carotid artery showed a 30 to 40% stenosis with small ulcer crater present.  The intracranial portion of the left internal carotid artery showed no significant disease nor did the left middle cerebral artery.,Visualization of the right lower extremity showed no significant disease.,PROCEDURE: , With the patient in supine position under local anesthesia plus intravenous sedation, the groin areas were prepped and draped in a sterile fashion.,The common femoral artery was punctured in a routine retrograde fashion and a 5-French introducer sheath was advanced under fluoroscopic guidance.  A catheter was then placed in the aortic arch and the right and left common carotid arteries were then selectively catheterized and visualized as described above.,Following completion of the above, the catheter and introducer sheath were removed.  Heparin had been initially given, which was reversed with protamine.  Firm pressure was held over the puncture site for 20 minutes, followed by application of a sterile Coverlet dressing and sandbag compression.,The patient tolerated the procedure well throughout.
Bronchoscopy - 1 
Medical specialty:  Cardiovascular / Pulmonary
 Bronchoscopy, right upper lobe biopsies and right upper lobe bronchial washing as well as precarinal transbronchial needle aspiration.

PROCEDURE:,  Bronchoscopy, right upper lobe biopsies and right upper lobe bronchial washing as well as precarinal transbronchial needle aspiration.,DETAILS OF THE PROCEDURE: , The risks, alternatives, and benefits of the procedure were explained to the patient as well as conscious sedation and she agrees to proceed.  The patient received topical lidocaine by nebulization.  The flexible fiberoptic bronchoscope was introduced orally.  The patient had normal teeth, normal tongue, normal jaw, and her vocal cords moved symmetrically and were without lesions.  I proceeded to the right upper lobe where a mucous plug was noted in the subsegmental bronchus of the posterior segment of the right upper lobe.  I proceeded under fluoroscopic guidance to guide the biopsy wire in this area and took four biopsies.  Followup fluoroscopy was negative for pneumothorax.  I wedged the bronchoscope in the subsegmental bronchus and achieved good hemostasis after three minutes.,I then proceeded to inspect the rest of the tracheobronchial tree, which was without lesions.  I performed a bronchial washing after the biopsies in the right upper lobe.  I then performed two transbronchial needle aspirations with a Wang needle biopsy in the precarinal area.  All of these samples were sent for histology and cytology respectively.  Estimated blood loss was approximately 5 cc.  Good hemostasis was achieved.  The patient received a total of 12.5 mg of Demerol and 3 mg of Versed and tolerated the procedure well.  Her ASA score was 2.
Ash Split Venous Port 
Medical specialty:  Cardiovascular / Pulmonary
 Ash split venous port insertion. The right anterior chest and supraclavicular fossa area, neck, and left side of chest were prepped with Betadine and draped in a sterile fashion.

ASH SPLIT VENOUS PORT,PROCEDURE DETAILS:  ,The patient was taken to the operating room and placed in supine position and monitored anesthesia care provided by the anesthetist.  The right anterior chest and supraclavicular fossa area, neck, and left side of chest were prepped with Betadine and draped in a sterile fashion.  Xylocaine 1% was infiltrated in the supraclavicular area and anterior chest along the planned course of the catheter.  The patient was placed into Trendelenburg position.,The right internal jugular vein was accessed by a supraclavicular 19-gauge, thin-walled needle as demonstrated by easy withdrawal of venous blood on the first pass of the needle.  Under fluoroscopic control, a J-wire was advanced into the right atrium.  The needle was removed and the skin puncture site enlarged to about 8 mm with the scalpel.  A second incision was made 5 cm inferior to the right midclavicular line, through which an Ash split catheter was advanced, using the tunneling rod, in a gently curving pass to exit the skin of the neck incision.  The tunneling needle was removed and the catheter split up to the marker as indicated in the recommended use of the catheter.,Sequential dilators were advanced over the J-wire under fluoroscopic control to dilate the subcutaneous tunnel followed by advancement of a dilator and sheath into the right superior vena cava under fluoroscopic control.  The dilator and wire were removed, leaving the sheath in position, through which a double-lumen catheter was advanced into the central venous system.  The sheath was peeled away, leaving the catheter into position.  Each port of the catheter was flushed with dilute heparinized saline.,The patient was returned to the flat position.  The catheter was secured to the skin of the anterior chest using 2-0 Ethilon suture placed through the suture "wings.",The neck incision was closed with 3-0 Vicryl subcuticular closure and pressure dressing applied.  Fluoroscopic examination of the chest revealed no evidence of pneumothorax upon completion of the procedure and the catheter was in excellent position.,The patient was returned to the recovery room for postoperative care.
Bilateral Carotid Angiography 
Medical specialty:  Cardiovascular / Pulmonary
 Carotid artery angiograms.

PROCEDURE PERFORMED:,1.  Selective ascending aortic arch angiogram.,2.  Selective left common carotid artery angiogram.,3.  Selective right common carotid artery angiogram.,4.  Selective left subclavian artery angiogram.,5.  Right iliac angio with runoff.,6.  Bilateral cerebral angiograms were performed as well via right and left common carotid artery injections.,INDICATIONS FOR PROCEDURE: , TIA, aortic stenosis, postoperative procedure.  Moderate carotid artery stenosis.,ESTIMATED BLOOD LOSS:,  400 ml.,SPECIMENS REMOVED:,  Not applicable.,TECHNIQUE OF PROCEDURE: , After obtaining informed consent, the patient was brought to the cardiac catheterization suite in postabsorptive and nonsedated state.  The right groin was prepped and draped in the usual sterile fashion.  Lidocaine 2% was used for infiltration anesthesia.  Using modified Seldinger technique, a 6-French sheath was placed into the right common femoral artery and vein without complication.  Using injection through the side port of the sheath, a right iliac angiogram with runoff was performed.  Following this, straight pigtail catheter was used to advance the aortic arch and aortic arch angiogram under digital subtraction was performed.  Following this, selective engagement in left common carotid artery, right common carotid artery, and left subclavian artery angiograms were performed with a V-Tech catheter over an 0.035-inch wire.,ANGIOGRAPHIC FINDINGS:,1.  Type 2 aortic arch.,2.  Left subclavian artery was patent.,3 Left vertebral artery was patent.,4.  Left internal carotid artery had a 40% to 50% lesion with ulceration, not treated and there was no cerebral cross over.,5.  Right common carotid artery had a 60% to 70% lesion which was heavily calcified and was not treated with the summed left-to-right cross over flow.,6.  Closure was with a 6-French Angio-Seal of the artery, and the venous sheath was sutured in.,PLAN:,  Continue aspirin, Plavix, and Coumadin to an INR of 2 with a carotid duplex followup.
Arterial Imaging 
Medical specialty:  Cardiovascular / Pulmonary
 Arterial imaging of bilateral lower extremities.  

INDICATIONS:,  Peripheral vascular disease with claudication.,RIGHT:,  ,1.  Normal arterial imaging of right lower extremity.,2.  Peak systolic velocity is normal.,3.  Arterial waveform is triphasic.,4.  Ankle brachial index is 0.96.,LEFT:,1.  Normal arterial imaging of left lower extremity.,2.  Peak systolic velocity is normal.,3.  Arterial waveform is triphasic throughout except in posterior tibial artery where it is biphasic.,4.  Ankle brachial index is 1.06.,IMPRESSION,:,Normal arterial imaging of both lower extremities.