harishnair04/mtsamples huggingface dataset:
Three Views - Foot 
Medical specialty:  Orthopedic
 Right foot trauma.  Three views of the right foot.  Three views of the right foot were obtained.  

EXAM:  ,Three views of the right foot.,REASON FOR EXAM: , Right foot trauma.,FINDINGS: , Three views of the right foot were obtained.  There are no comparison studies.  There is no evidence of fractures or dislocations.  No significant degenerative changes or obstructive osseous lesions were identified.  There are no radiopaque foreign bodies.,IMPRESSION: , Negative right foot.
Synovectomy - Partial 
Medical specialty:  Orthopedic
 Arthroscopic irrigation and debridement of same with partial synovectomy.  Septic left total knee arthroplasty.

PREOPERATIVE DIAGNOSIS: , Septic left total knee arthroplasty.,POSTOPERATIVE DIAGNOSIS: , Septic left total knee arthroplasty.,OPERATION PERFORMED: , Arthroscopic irrigation and debridement of same with partial synovectomy.,ANESTHESIA:,  LMA.,ESTIMATED BLOOD LOSS:,  Minimal.,COMPLICATIONS: , None.,DRAINS:,  None.,INDICATIONS:,  The patient is an 81-year-old female, who is approximately 10 years status post total knee replacement performed in another state, who presented a couple of days ago to the office with worsening pain without injury and whose symptoms have been present for approximately a month following a possible urinary tract infection.  The patient' knee was aspirated in the office and cultures were positive for Escherichia coli.  She presents for operative therapy.,DESCRIPTION OF OPERATION: , After obtaining informed consent and the administration of antibiotics since her cultures had already been obtained, the patient was taken to the operating room and following satisfactory induction and the patient was placed on the table in supine position.  The left upper extremity was prepped and draped without a tourniquet.  The knee was injected with 30 mL of normal saline and standard arthroscopy portals were created.  The arthroscopy was inserted and a complete diagnostic was performed.  Arthroscopic pictures were taken throughout the procedure.  The knee was copiously irrigated with 9 L of irrigant.  A partial synovectomy was performed in all compartments.  Minimal amount of polyethylene wear was noted.  The total knee components were identified arthroscopically for future revision surgery.  The knee was then drained and the arthroscopic instruments were removed.  The portals were closed with 4-0 nylon and local anesthetic was injected.  A sterile dressing was applied and the patient was placed in a knee immobilizer, awakened from anesthesia and transported to the recovery room in stable condition and tolerated the procedure well.
Subperiosteal Abscess Debridement 
Medical specialty:  Orthopedic
 Repeat irrigation and debridement of Right distal femoral subperiosteal abscess.

PREOPERATIVE DIAGNOSIS: , Right distal femoral, subperiosteal abscess.,POSTOPERATIVE DIAGNOSIS: , Right distal femoral, subperiosteal abscess.,OPERATION:,  Repeat irrigation and debridement of above.,ANESTHESIA: , General.,BLOOD LOSS:,  Minimal.,FLUID: , Per anesthesia.,DRAINS: , Hemovac times two.,COMPLICATIONS: , None apparent.,SPECIMENS:,  To microbiology.,INDICATIONS: , She is a 10-year-old girl who has history of burns and has developed a subperiosteal abscess at her right distal femur.  I am bringing her back to the operating room for another exploration of this area and washout.  This will be the third procedure for this.  At the last time, there was gross purulence that was encountered.  Since that time, the patient has defervesced.  Her white count is slowly coming down.  Her C-reactive protein is slowly coming down.,PROCEDURE IN DETAIL:,  After informed consent was obtained, operative site marked, and after preoperative antibiotics were given, the patient was brought back to the operating room and placed supine on the operating table, where Anesthesia induced general anesthesia.  The patient's right lower extremity was prepped and draped in normal sterile fashion.  Surgical timeout occurred verifying the patient's identification, surgical site, surgical procedure, and administration of antibiotics.  The patient's previous incision sites had the sutures removed.  We bluntly dissected down through to the IT band.  These deep stitches were then removed.  We exposed the area of the subperiosteal abscess.  The tissue looked much better than at the last surgery.  We irrigated this area with three liters of saline containing bacitracin.  Next, we made our small medial window to assist with washout of the joint itself.  We put another three liters of saline containing bacitracin through the knee joint.  Lastly, we did another three liters into the area of the distal femur with three liters of plain saline.  We then placed two Hemovac drains, one in the metaphysis and one superficially.  We closed the deep fascia with #1 PDS.  Subcutaneous layers with 2-0 Monocryl and closed the skin with 2-0 nylon.  We placed a sterile dressing.  We then turned the case over to Dr. Petty for dressing change and skin graft.,PLAN:  ,Our plan will be to pull the drains in 48 hours.  We will then continue to watch the patient's fever curve and follow her white count to see how she is responding to the operative and medical therapies.,
Subcutaneous Transposition of Ulnar Nerve 
Medical specialty:  Orthopedic
 Subcutaneous transposition of the right ulnar nerve.  Right carpal tunnel syndrome and right cubital tunnel syndrome.

PREOPERATIVE DIAGNOSIS:  ,1.  Right carpal tunnel syndrome.,2.
Superior Labrum Lesions Repair 
Medical specialty:  Orthopedic
 Superior labrum anterior and posterior lesion repair.

PROCEDURE IN DETAIL:,  After written consent was obtained from the patient, the patient was brought back into the operating room and identified.  The patient was placed on the operating room table in supine position and given anesthetic.,Once adequate anesthesia had been achieved, a careful examination of the shoulder was performed.  It revealed no patholigamentous laxity.  We then placed the patient into a beach-chair position, maintaining a neutral alignment of the head, neck, and thorax.  The shoulder was then prepped and draped in the usual sterile fashion.  We then injected the glenohumeral joint with 60 cc of sterile saline solution.  A small stab incision was made 2 cm inferior and 2 cm medial to the posterolateral angle of the acromion.  Through this incision, a blunt trocar was placed.,We then placed the camera through this cannula and the shoulder was insufflated with sterile saline solution.  An anterior portal was made just below the subscapularis and then we began to inspect the shoulder joint.,We found that the articular surface was in good condition.  The biceps was found to be intact.  There was a SLAP tear noted just posterior to the biceps.  Pictures were taken.  No Bankart or Hill-Sachs lesions were noted.  The rotator cuff was examined and there were no undersurface tears.  Pictures were again taken.,We then made a lateral portal going through the muscle belly of the rotator cuff.  A drill hole was made and then knotless suture anchor was placed to repair this.  Pictures were taken.  We then washed out the joint with copious amounts of sterile saline solution.  It was drained.  Our 3 incisions were closed using 3-0 nylon suture.  A pain pump catheter was introduced into the shoulder joint.  Xeroform, 4 x 4s, ABDs, tape, and sling were placed.,The patient was successfully taken out of the beach-chair position, extubated and brought to the recovery room in stable condition.  I then went out and spoke with the patient's family, going over the case, postoperative instructions, and followup care.
Slipped Capital Femoral Epiphysis (SCFE) 
Medical specialty:  Orthopedic
 Frontal and lateral views of the hip and pelvis.

EXAM: , Two views of the pelvis.,HISTORY:,  This is a patient post-surgery, 2-1/2 months.  The patient has a history of slipped capital femoral epiphysis (SCFE) bilaterally.,TECHNIQUE: , Frontal and lateral views of the hip and pelvis were evaluated and correlated with the prior film dated MM/DD/YYYY.  Lateral view of the right hip was evaluated.,FINDINGS:,  Frontal view of the pelvis and a lateral view of the right hip were evaluated and correlated with the patient's most recent priors dated MM/DD/YYYY.  Current films reveal stable appearing post-surgical changes.  Again demonstrated is a single intramedullary screw across the left femoral neck and head.  There are 2 intramedullary screws through the greater trochanter of the right femur.  There is a lucency along the previous screw track extending into the right femoral head and neck.  There has been interval removal of cutaneous staples and/or surgical clips.  These were previously seen along the lateral aspect of the right hip joint.,Deformity related to the previously described slipped capital femoral epiphysis is again seen.,IMPRESSION:,1.  Stable-appearing right hip joint status-post pinning.,2.  Interval removal of skin staples as described above.
Rotator Cuff Repair 
Medical specialty:  Orthopedic
 Arthroscopic subacromial decompression and repair of rotator cuff through mini-arthrotomy.

PREOPERATIVE DIAGNOSIS: , Rotator cuff tear, left.,POSTOPERATIVE DIAGNOSES:,1.  Sixty-percent rotator cuff tear, joint side.,2.  Impingement syndrome.,ANESTHESIA: , General,NAME OF OPERATION:,1.  Arthroscopic subacromial decompression.,2.  Repair of rotator cuff through mini-arthrotomy.,FINDINGS AT OPERATION: , The patient's glenohumeral joint was completely clear, other than obvious tear of the rotator cuff.  The midportion of this appeared to be complete, but for the most part, this was about a 60% rupture of the tendon.  This was confirmed later when the bursal side was opened up.  Note, the patient also had abrasion of the coracoacromial ligament under the anterolateral edge of the acromion.  He did not have any acromioclavicular joint pain or acromioclavicular joint disease noted.,PROCEDURE:,  He was given an anesthetic, examined, prepped, and draped in a sterile fashion in a beach-chair position.  The shoulder was instilled with fluid from posteriorly, followed by the arthroscope.  The shoulder was instilled with fluid from posteriorly, followed by the arthroscope.  Arthroscopy was then carried out in standard fashion using a 30-degree Dionic scope.  With the scope in the posterior portal, the above findings were noted, and an anterior portal was established.  A curved shaver was placed for debridement of the tear.  I established this was about a 60-70% tear with a probable complete area of tear which was very small.  There were no problems at the biceps or the rest of the joint.  The subacromial space showed findings, as noted above, and a thorough subacromial decompression was carried out with a Bovie, rotary shaver, and bur.  I did not debride the acromioclavicular joint.  The lateral portal was then extended to a mini-arthrotomy, and subacromial space was entered by blunt dissection through the deltoid.  The area of weakness of the tendon was found, and was transversely cut, and findings were confirmed.  The diseased tissue was removed, and the greater tuberosity was abraded with a rongeur.  Tendon-to-tendon repair was then carried out with buried sutures of 2-0 Ethibond, giving a very nice repair.  The shoulder was carried through a range of motion.  I could see no evidence of impingement.  Copious irrigation was carried out.  The deltoid deep fascia was anatomically closed, as was the superficial fascia.  The subcutaneous tissue and skin were closed in layers.  A sterile dressing was applied.  The patient appeared to tolerate the procedure well.
Shoulder Contusion 
Medical specialty:  Orthopedic
 Left shoulder injury.   A 41-year-old male presenting for initial evaluation of his left shoulder.

CHIEF COMPLAINT:  ,
Shoulder Pain Consult 
Medical specialty:  Orthopedic
 Consultation for right shoulder pain.

CHIEF COMPLAINT:,  Right shoulder pain.,HISTORY OF PRESENT PROBLEM:
Release of A1 Pulley - 1 
Medical specialty:  Orthopedic
 Release of A1 pulley, right thumb.   Stenosing tendinosis, right thumb (trigger finger).  There was noted to be thickening of the A1 pulley.  There was a fibrous nodule noted within the flexor tendon of the thumb, which caused triggering sensation to the thumb.

PREOPERATIVE DIAGNOSIS: , Stenosing tendinosis, right thumb (trigger finger).,POSTOPERATIVE DIAGNOSIS: , Stenosing tendinosis, right thumb (trigger finger).,PROCEDURE PERFORMED:,  Release of A1 pulley, right thumb.,ANESTHESIA:,  IV regional with sedation.,COMPLICATIONS: , None.,ESTIMATED BLOOD LOSS: , Minimal.,TOURNIQUET TIME: , Approximately 20 minutes at 250 mmHg.,INTRAOPERATIVE FINDINGS: , There was noted to be thickening of the A1 pulley.  There was a fibrous nodule noted within the flexor tendon of the thumb, which caused triggering sensation to the thumb.,HISTORY:  ,This is a 51-year-old right hand dominant female with a longstanding history of pain as well as locking sensation to her right thumb.  She was actually able to spontaneously trigger the thumb.  She was diagnosed with stenosing tendinosis and wishes to proceed with release of A1 pulley.  All risks and benefits of the surgery was discussed with her at length.  She was in agreement with the above treatment plan.,PROCEDURE:  ,On 08/21/03, she was taken to operating room at ABCD General Hospital and placed supine on the operating table.  A regional anesthetic was applied by the Anesthesia Department.  Tourniquet was placed on her proximal arm.  The upper extremity was sterilely prepped and draped in the usual fashion.,An incision was made over the proximal crease of the thumb.  Subcuticular tissues were carefully dissected.  Hemostasis was controlled with electrocautery.  The nerves were identified and retracted throughout the entire procedure.  The fibers of the A1 pulley were identified.  They were sharply dissected to release the tendon.  The tendon was then pulled up into the wound and inspected.  There was no evidence of gross tear noted.  Fibrous nodule was noted within the tendon itself.  There was no evidence of continuous locking.  Once release of the pulley had been performed, the wound was copiously irrigated.  It was then reapproximated using #5-0 nylon simple interrupted and horizontal mattress sutures.  Sterile dressing was applied to the upper extremity.  Tourniquet was deflated.  It was noted that the thumb was warm and pink with good capillary refill.  The patient was transferred to Recovery in apparent stable and satisfactory condition.  Prognosis is fair.
Rheumatology Progress Note 
Medical specialty:  Orthopedic
 Epicondylitis. history of lupus.  Injected with 40-mg of Kenalog mixed with 1 cc of lidocaine.

SUBJECTIVE:,  The patient is here for a follow-up.  The patient has a history of lupus, currently on Plaquenil 200-mg b.i.d.  Eye report was noted and appreciated.  The patient states that she is having some aches and pains of the hands and elbows that started recently a few weeks ago.  She denied having any trauma.  She states that the pain is bothering her.  She denies having any fevers, chills, or any joint effusion or swelling at this point.  She noted also that there is some increase in her hair loss in the recent times.,OBJECTIVE:,  The patient is alert and oriented.  General physical exam is unremarkable.  Musculoskeletal exam reveals positive tenderness in both lateral epicondyles of both elbows, no effusion.  Hand examination is unremarkable today.  The rest of the musculoskeletal exam is unremarkable.,ASSESSMENT:,  Epicondylitis, both elbows, possibly secondary to lupus flare-up.,PLAN:,  We will inject both elbows with 40-mg of Kenalog mixed with 1 cc of lidocaine.  The posterior approach was chosen under sterile conditions.  The patient tolerated both procedures well.  I will obtain CBC and urinalysis today.  If the patient's pain does not improve, I will consider adding methotrexate to her therapy.,Sample Doctor M.D.
Release of A1 Pulley 
Medical specialty:  Orthopedic
 The patient was found to have limitations to extension at the IP joint to the right thumb and he had full extension after release of A1 pulley.

PREOPERATIVE DIAGNOSIS: , Right trigger thumb.,POSTOPERATIVE DIAGNOSIS:,  Right trigger thumb.,SURGERY: , Release of A1 pulley, CPT code 26055.,ANESTHESIA:,  General LMA.,TOURNIQUET TIME:  ,9 minutes at 200 torr.,FINDINGS:,  The patient was found to have limitations to extension at the IP joint to the right thumb.  He was found to have full extension after release of A1 pulley.,INDICATIONS:,  The patient is 2-1/2-year-old.  He has a history of a trigger thumb.  This was evaluated in the office.  He was indicated for release of A1 pulley to allow for full excursion.  Risks and benefits including recurrence, infection, and problems with anesthesia were discussed at length with the family.  They wanted to proceed.,PROCEDURE:,  The patient was brought into the operating room and placed on the operating table in supine position.  General anesthesia was induced without incident.  He was given a weight-adjusted dose of antibiotics.  The right upper extremity was then prepped and draped in a standard fashion.  Limb was exsanguinated with an Esmarch bandage.  Tourniquet was raised to 200 torr.  Transverse incision was then made at the base of thumb.  The underlying soft tissues were carefully spread in line longitudinally.  The underlying tendon was then identified.  The accompanied A1 pulley was also identified.  This was incised longitudinally using #11 blade.  Inspection of the entire tendon then demonstrated good motion both in flexion and extension.  The leaflets of the pulley were easily identified.,The wound was then irrigated and closed.  The skin was closed using interrupted #4-0 Monocryl simple sutures.  The area was injected with 5 mL of 0.25% Marcaine.  The wound was dressed with Xeroform, dry sterile dressings, hand dressing, Kerlix, and Coban.  The patient was awakened from anesthesia and taken to the recovery room in good condition.  There were no complications.  All instrument, sponge, needle counts were correct at the end of case.,PLAN: , The patient will be discharged home.  He will return in 1-1/2 weeks for wound inspection.
Radiologic Exam - Spine  
Medical specialty:  Orthopedic
 Cervical, lumbosacral, thoracic spine flexion and extension to evaluate back and neck pain.

EXAM: , Cervical, lumbosacral, thoracic spine flexion and extension.,HISTORY: , Back and neck pain.,CERVICAL SPINE,FINDINGS:  ,AP, lateral with flexion and extension, and both oblique projections of the cervical spine demonstrate alignment and soft tissue structures to be unremarkable.
Pinning - Ulna 
Medical specialty:  Orthopedic
 Closed reduction and pinning of the right ulna with placement of a long-arm cast.

PREOPERATIVE DIAGNOSIS:,  Right both bone forearm refracture.,POSTOPERATIVE DIAGNOSIS: , Right both bone forearm refracture.,PROCEDURE:,  Closed reduction and pinning of the right ulna with placement of a long-arm cast.,ANESTHESIA: , Surgery performed under general anesthesia.  Local anesthetic was 10 mL of 0.25% Marcaine plain.,COMPLICATIONS: , No intraoperative complications.,DRAINS: , None.,SPECIMENS: , None.,HARDWARE:  ,Hardware was 0.79 K-wire.,HISTORY AND PHYSICAL: , The patient is a 5-year-old male who sustained refracture of his right forearm on 12/05/2007.  The patient was seen in the emergency room.  The patient had a complete fracture of both bones with shortening bayonet apposition.  Treatment options were offered to the family including casting versus closed reduction and pinning.  The parents opted for the latter.  Risks and benefits of surgery were discussed.  Risks of surgery included risk of anesthesia, infection, bleeding, changes in sensation and motion of the extremity, hardware failure, and need for later hardware removal, cast tightness.  All questions were answered, and the parents agreed to the above plan.,PROCEDURE IN DETAIL: , The patient was taken to the operating room and placed supine on the operating room table.  General anesthesia was then administered.  The patient received Ancef preoperatively.  The right upper extremity was then prepped and draped in standard surgical fashion.  A small incision was made at the tip of the olecranon.  Initially, a 1.11 guidewire was placed, but this was noted to be too wide for this canal.  This was changed for a 0.79 K-wire.  This was driven up to the fracture site.  The fracture was manually reduced and then the K-wire passed through the distal segment.  This demonstrated adequate fixation and reduction of both bones.  The pin was then cut short.  The fracture site and pin site was infiltrated with 0.25% Marcaine.  The incision was closed using 4-0 Monocryl.  The wounds were cleaned and dried.  Dressed with Xeroform, 4 x 4.  The patient was then placed in a well-moulded long-arm cast.  He tolerated the procedure well.  He was subsequently taken to Recovery in stable condition.,POSTOPERATIVE PLAN: , The patient will be maintain current pin, and long-arm cast for 4 weeks at which time he will return for cast removal.  X-rays of the right forearm will be taken.  The patient may need additional mobilization time.  Once the fracture has healed, we will take the pin out, usually at the earliest 3 to 4 months.  Intraoperative findings were relayed to the parents.  All questions were answered.
Records Review - Orthopedic 
Medical specialty:  Orthopedic
 Patient did undergo surgical intervention as related to the right knee and it was noted that the reconstruction had failed.   A screw had come loose.

Thereafter, he was evaluated and it was felt that further reconstruction as related to the anterior cruciate ligament was definitely not indicated.  On December 5, 2008, Mr. XXXX did undergo a total knee replacement arthroplasty performed by Dr. X.,Thereafter, he did an extensive course of physical therapy, work hardening, and a work conditioning type program.,At the present time, he does complain of significant pain and swelling as related to the right knee.  He is unable to crawl and/or kneel.  He does state he is able to walk a city block and in fact, he is able to do 20 minutes of a treadmill.  Stairs are a significant problem.  His pain is a 5 to 6 on a scale of 1 to 10.,He is better when he is resting, sitting, propped up, and utilizing his ice.  He is much worse when he is doing any type of physical activity.,He has denied having any previous history of similar problems.,CURRENT MEDICATIONS:  ,Over-the-counter pain medication.,ALLERGIES: , NKA.,SURGERIES: , Numerous surgeries as related to the right lower extremity.,SOCIAL HISTORY: , He does admit to one half pack of cigarette consumption per day.  He denies any alcohol consumption.,PHYSICAL EXAMINATION:  ,On examination today, he is 28-year-old male who is 6 feet 1, weighs 250 pounds.  He does not appear to be in distress at this time.  One could appreciate 1-2/4 intraarticular effusion.  The range of motion is 0 to a 110 degrees of flexion.  I could not appreciate any evidence of instability medial, lateral, anterior or posterior.  Crepitus is noted with regards to range of motion testing.  His strength is 4 to 5 as related to the quadriceps and hamstring.,There is atrophy as related to the right thigh.  The patient is able to stand from a seated position and sit from a standing position without difficulty.,RECORDS REVIEW:,1.  First report of injury.,2.  July 17, 2002, x-rays of the right knee were negative.,3.  Notes of the Medina General Hospital Occupational Health, Steven Rodgers, M.D.,4.  August 5, 2002, an MRI scan of the right knee which demonstrated peripheral tear of the posterior horn of the medial