smoh/medical-transcriptions huggingface dataset:
Arthroscopic Rotator Cuff Repair - 2  ( Surgery)
Description:  Arthroscopic rotator cuff repair, arthroscopic subacromial decompression, and arthroscopic extensive debridement, superior labrum anterior and posterior tear.

PROCEDURES,1.  Arthroscopic rotator cuff repair.,2.  Arthroscopic subacromial decompression.,3.  Arthroscopic extensive debridement, superior labrum anterior and posterior tear.,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 general anesthetic.  Once the patient was under general anesthetic, a careful examination of the shoulder was performed.  It revealed no patholigamentous laxity.  The patient was then carefully positioned into a beach-chair position.  We maintained the natural alignment of the head, neck, and thorax at all times.  The shoulder and upper extremity was then prepped and draped in the usual sterile fashion.,Once we fully prepped and draped, we then began the surgery.  We injected the glenohumeral joint with sterile saline with a spinal needle.  This consisted of 60 cc of fluid.  We then made a posterior incision for our portal, 2 cm inferior and 2 cm medial to the posterolateral angle of the acromion.  Through this incision, a blunt trocar and cannula were placed in the glenohumeral joint.  Through the cannula, a camera was placed; and the shoulder was insufflated with sterile saline through a preoperative feed.  We then carefully examined the glenohumeral joint.,We found the articular surface to be in good condition.  There was a superior labral tear (SLAP).  This was extensively debrided using a shaver through an anterior portal.  We also found a full thickness rotator cuff tear.  We then drained the glenohumeral joint.  We redirected our camera into the subacromial space.  An anterolateral portal was made, both superior and inferior.,We then proceeded to perform a subacromial decompression using high-speed shaver.  The bursa was extensively debrided.  We then abraded the bone over the footprint of where the rotator cuff is usually attached.  The corkscrew anchors were used to perform a rotator cuff repair.  Pictures were taken.,Through a separate incision, an indwelling pain catheter was then placed.  It was carefully positioned.  Pictures were taken.  We then drained the joint.  All instruments were removed.  The patient did receive IV antibiotic preoperatively.  All portals were closed using 4-0 nylon sutures.,Xeroform, 4 x 4s, and OpSite were applied over the pain pump.  ABD, tape, and a sling were also applied.  A Cryo/Cuff was also placed over the shoulder.  The patient was taken out of the beach-chair position maintaining the neutral alignment of the head, neck, and thorax.  The patient was extubated and brought to the recovery room in stable condition.  I then went out and spoke with the family, going over the case, postoperative instructions, and followup care.
Arthroscopic Subacromial Decompression - Shoulder  ( Surgery)
Description:  Arthroscopy with arthroscopic subacromial decompression of the left shoulder.   Impingement syndrome, left shoulder.  Rule out superior labrum anterior and posterior lesion, left shoulder.

PREOPERATIVE DIAGNOSES:,1.  Impingement syndrome, left shoulder.,2.  Rule out superior labrum anterior and posterior lesion, left shoulder.,POSTOPERATIVE DIAGNOSES:,  Impingement syndrome, left shoulder.,PROCEDURE PERFORMED:,  Arthroscopy with arthroscopic subacromial decompression of the left shoulder.,ANESTHESIA: , The procedure was done under an interscalene block and subsequent general anesthetic in the modified beachchair position.,SPECIFICATIONS: , The entire operative procedure was done in Inpatient Operating Suite, room #1 at ABCD General Hospital.,HISTORY AND GROSS FINDINGS: , This is a 30-year-old white female suffering increasing left shoulder pain for a number of months prior to surgical intervention.  She was completely refractory to conservative outpatient therapy.  She had subacromial injection, which relieved the majority of her pain.  She also had medial bordered scapular pain unrelated directly to the present problem.  She had plus minus SLAP lesion testing preoperatively.,Operative findings in the joint included labrum was intact, long head of the biceps intact, laxity of 1+ all around, but clinically intact and without laxity.  Subacromially, type-II plus acromion and no evidence of significant rotator cuff tear with scuffing only.,She also had evidence of calcium deposition in the CA ligament and undersurface of the AC joint.,OPERATIVE PROCEDURE: , The patient was laid supine upon the operative table.  After receiving interscalene block general anesthetic by Anesthesia Department, she was placed in modified beachchair position.  She was prepped and draped in the usual sterile manner.  Portals were created outside the end, anterior and posterior, posterior and anterior, and subsequently laterally.  A full and complete diagnostic arthroscopy was carried out in the intraarticular aspect of the joint with the above noted findings.,Attention was then turned to the subacromial region.  The scope was placed.  A lateral portal was created.  Gross bursectomy was carried out.  This was done with a 4.2 meniscal shaver as well as a hot Bovie.  Calcium deposition mentioned was removed.  With the rotator cuff intact, the periosteum was burned off the undersurface of the acromion and the CA ligament released anteriorly.  A subacromial decompression sequentially from laterally to medially was then carried out.  There was an excellent decompression.  Debridement was carried out to the bursa.  The portals were ultimately closed with #4-0 after Pain Buster catheter had been placed.  Subacromial region was flooded with 0.5% Marcaine at approximately 15 cc or so.  Adaptic, 4x4s, ABDs, and Elastoplast tape placed for dressing.  The patient was awoken and transferred to PACU in apparent satisfactory condition.  Expected surgical prognosis on this patient is fair.
Appendectomy Laparoscopic  ( Surgery)
Description:  Laparoscopic appendectomy.  Acute appendicitis.

PREOPERATIVE DIAGNOSIS: , Acute appendicitis.,POSTOPERATIVE DIAGNOSIS: , Acute appendicitis.,PROCEDURE: , Laparoscopic appendectomy.,ANESTHESIA: , General endotracheal.,INDICATIONS: , Patient is a pleasant 31-year-old gentleman who presented to the hospital with acute onset of right lower quadrant pain.  History as well as signs and symptoms are consistent with acute appendicitis as was his CAT scan.  I evaluated the patient in the emergency room and recommended that he undergo the above-named procedure.  The procedure, purpose, risks, expected benefits, potential complications, alternative forms of therapy were discussed with him and he was agreeable with surgery.,FINDINGS: , Patient was found to have acute appendicitis with an inflamed appendix, which was edematous, but essentially no suppuration.,TECHNIQUE:  ,The patient was identified and then taken into the operating room, where after induction of general endotracheal anesthesia, the abdomen was prepped with Betadine solution and draped in sterile fashion.  An infraumbilical incision was made and carried down by blunt dissection to the level of the fascia, which was grasped with an Allis clamp and two stay sutures of 2-0 Vicryl were placed on either side of the midline.  The fascia was tented and incised and the peritoneum entered by blunt finger dissection.  A Hasson cannula was placed and a pneumoperitoneum to 15 mmHg pressure was obtained.  Patient was placed in the Trendelenburg position, rotated to his left, whereupon under direct vision, the 12-mm midline as well as 5-mm midclavicular and anterior axillary ports were placed.  The appendix was easily visualized, grasped with a Babcock's.  A window was created in the mesoappendix between the appendix and the cecum and the Endo GIA was introduced and the appendix was amputated from the base of the cecum.  The mesoappendix was divided using the Endo GIA with vascular staples.  The appendix was placed within an Endo bag and delivered from the abdominal cavity.  The intra-abdominal cavity was irrigated.  Hemostasis was assured within the mesentery and at the base of the cecum.  All ports were removed under direct vision and then wounds were irrigated with saline antibiotic solution.  The infraumbilical defect was closed with a figure-of-eight 0 Vicryl suture.  The remaining wounds were irrigated and then everything was closed subcuticular with 4-0 Vicryl suture and Steri-Strips.  Patient tolerated the procedure well, dressings were applied, and he was taken to recovery room in stable condition.
Arthroscopic Debridement & Labral Repair - Hip  ( Surgery)
Description:  Femoroacetabular impingement.  Left hip arthroscopic debridement, femoral neck osteoplasty, and labral repair.

PREOPERATIVE DIAGNOSIS: , Femoroacetabular impingement.,POSTOPERATIVE DIAGNOSIS: , Femoroacetabular impingement.,OPERATIONS PERFORMED,1.  Left hip arthroscopic debridement.,2.  Left hip arthroscopic femoral neck osteoplasty.,3.  Left hip arthroscopic labral repair.,ANESTHESIA: , General.,OPERATION IN DETAIL: , The patient was taken to the operating room, where he underwent general anesthetic.  His bilateral lower extremities were placed under traction on the Hana table.  His right leg was placed first.  The traction post was left line, and the left leg was placed in traction.  Sterile Hibiclens and alcohol prep and drape were then undertaken.  A fluoroscopic localization was undertaken.  Gentle traction was applied.  Narrow arthrographic effect was obtained.  Following this, the ProTrac portal was made under the fluoro visualization, and then, a direct anterolateral portal made and a femoral neck portal made under direct visualization.  The diagnostic arthroscopy showed the articular surface to be intact with a moderate anterior lip articular cartilage delamination injury that propagated into the acetabulum.  For this reason, the acetabular articular cartilage was taken down and stabilized.  This necessitated takedown of the anterior lip of the acetabulum and subsequent acetabular osteoplasty debridement with associated labral repair.  The labrum was repaired using absorbable Smith & Nephew anchors with a sliding SMC knot.  After stabilization of the labrum and the acetabulum, the ligamentum teres was assessed and noted to be stable.  The remnant articular surface of the femoral artery and acetabulum was stable.  The posterior leg was stable.  The traction was left half off, and the anterolateral aspect of the head and neck junction was identified.  A stable femoral neck decompression was accomplished starting laterally and proceeding anteriorly.  This terminated with the hip coming out of traction and indeterminable flexion.  A combination of burs and shavers was utilized to perform a stable femoral neck osteoplasty decompression.  The decompression was completed with thorough irrigation of the hip.  The cannula was removed, and the portals were closed using interrupted nylon.  The patient was placed into a sterile bandage and anesthetized intraarticularly with 10 mL of ropivacaine subcutaneously with 20 mL of ropivacaine and at this point was taken to the recovery room.  He tolerated the procedure very well with no signs of complications.
Appendectomy - 1  ( Surgery)
Description:  Acute appendicitis, gangrenous.  Appendectomy.

PREOPERATIVE DIAGNOSIS:,  Acute appendicitis.,POSTOPERATIVE DIAGNOSIS: , Acute appendicitis, gangrenous.,PROCEDURE: , Appendectomy.,DESCRIPTION OF PROCEDURE: , The patient was taken to the operating room under urgent conditions.  After having obtained an informed consent, he was placed in the operating room and under anesthesia.  Followed by a time-out process, his abdominal wall was prepped and draped in the usual fashion.  Antibiotics had been given prior to incision.  A McBurney incision was performed and it carried out through the peritoneal cavity.  Immediately there was  purulent material seen in the area.  Samples were taken for culture and sensitivity of aerobic and anaerobic sets.  The appendix was markedly swollen particularly in its distal three-fourth, where the distal appendix showed an abscess formation and devitalization of the wall.  There was quite a bit of local peritonitis.  The mesoappendix was clamped, divided and ligated, and then the appendix was ligated and divided, and the stump buried with a pursestring suture of Vicryl and then a Z stitch.  The area was abundantly irrigated with normal saline and also the pelvis.  The distal foot of small bowel had been explored and because it delivered itself __________ the incision and showed no pathology.,Then the peritoneal and internal fascia were approximated with a suture of 0 Vicryl and then the incision was closed in layers and after each layer the wound was irrigated with normal saline.  The skin was closed with a combination of a subcuticular suture of fine Monocryl followed by the application of Dermabond.  The patient tolerated the procedure well.  Estimated blood loss was minimal, and the patient was sent to the recovery room for recovery in satisfactory condition.,
Appendectomy - 2  ( Surgery)
Description:  Acute appendicitis and 29-week pregnancy.  Appendectomy.

PREOPERATIVE DIAGNOSES,1.  Acute appendicitis.,2.  29-week pregnancy.,POSTOPERATIVE DIAGNOSES,1.  Acute appendicitis.,2.  29-week pregnancy.,OPERATION: , Appendectomy.,DESCRIPTION OF THE PROCEDURE:  ,After obtaining the informed consent including all risks and benefits of the procedure, the patient was urgently taken to the operating room where a spinal anesthetic was given and the patient's abdomen was prepped and draped in a usual fashion.  Preoperative antibiotics were given.  A time-out process was followed.  Local anesthetics were infiltrated in the area of the proposed incision.  A modified McBurney incision was performed.  A very abnormal appendix was immediately found.  There was a milky fluid around the area and this was cultured both for aerobic and anaerobic cultures.  The distal end of the appendix had transformed itself into an abscess.  The proximal portion was normal.  The appendix was very friable and a no-touch technique was used.  It was carefully dissected off the cecum, and then it was ligated and excised after the mesoappendix had been taken care of.  Then the stump was buried with a pursestring of 2-0 Vicryl.  The operative area was abundantly irrigated with warm saline and then closed in layers.  The layer was further irrigated.  A subcuticular suture of Monocryl was performed in the skin followed by the application of Dermabond.,Further local anesthetic was infiltrated at the end of the procedure in the operative area and the patient tolerated the procedure well, and with an estimated blood loss that was not consequential, was transferred from recovery to ICU in a satisfactory condition.
Appendectomy  ( Surgery)
Description:  Appendicitis, nonperforated.  Appendectomy.  A transverse right lower quadrant incision was made directly over the point of maximal tenderness. 

PREOPERATIVE DIAGNOSIS: , Appendicitis.,POSTOPERATIVE DIAGNOSIS:,  Appendicitis, nonperforated.,PROCEDURE PERFORMED:,  Appendectomy.,ANESTHESIA: , General endotracheal.,PROCEDURE: , After informed consent was obtained, the patient was brought to the operative suite and placed supine on the operating table.  General endotracheal anesthesia was induced without incident.  The patient was prepped and draped in the usual sterile manner.,A transverse right lower quadrant incision was made directly over the point of maximal tenderness.  Sharp dissection utilizing Bovie electrocautery was used to expose the external oblique fascia.  The fascia of the external oblique was incised in the direction of the fibers, and the muscle was spread with a clamp.  The internal oblique fascia was similarly incised and its muscular fibers were similarly spread.  The transversus abdominis muscle, transversalis fascia and peritoneum were incised sharply gaining entrance into the abdominal cavity without incident.  Upon entering the peritoneal cavity, the peritoneal fluid was noted to be clean.,The cecum was then grasped along the taenia with a moist gauze sponge and was gently mobilized into the wound.  After the appendix was fully visualized, the mesentery was divided between Kelly clamps and ligated with 2-0 Vicryl ties.  The base of the appendix was crushed with a clamp and then the clamp was reapplied proximally on the appendix.  The base was ligated with 2-0 Vicryl tie over the crushed area, and the appendix amputated along the clamp.  The stump of the appendix was cauterized and the cecum was returned to the abdomen.,The peritoneum was irrigated with warm sterile saline.  The mesoappendix and cecum were examined for hemostasis which was present.  The wound was closed in layers using 2-0 Vicryl for the peritoneum and 0 Vicryl for the internal oblique and external oblique layers.  The skin incision was approximated with 4-0 Monocryl in a subcuticular fashion.  The skin was prepped with benzoin, and Steri-Strips were applied.  A dressing was placed on the wound.  All surgical counts were reported as correct.,Having tolerated the procedure well, the patient was subsequently extubated and taken to the recovery room in good and stable condition.
Antibiotic-Impregnated Beads Placement  ( Surgery)
Description:  Irrigation and debridement of skin, subcutaneous tissue, fascia and bone associated with an open fracture and placement of antibiotic-impregnated beads.  Open calcaneus fracture on the right.

PREOPERATIVE DIAGNOSIS:,  Open calcaneus fracture on the right.,POSTOPERATIVE DIAGNOSIS:,  Open calcaneus fracture on the right.,PROCEDURES:,  ,1.  Irrigation and debridement of skin, subcutaneous tissue, fascia and bone associated with an open fracture.,2.  Placement of antibiotic-impregnated beads.,ANESTHESIA:,  General.,BLOOD LOSS:,  Minimal.,COMPLICATIONS:,  None.,FINDINGS:,  Healing skin with no gross purulence identified, some fibrinous material around the beads.,SUMMARY:,  After informed consent was obtained and verified, the patient was brought to the operating room and placed supine on the operating table.  After uneventful general anesthesia was obtained, her right leg was sterilely prepped and draped in a normal fashion.  The tourniquet was inflated and the previous wound was opened.  Dr. X came in to look at the wound and the beads were removed, all 25 beads were extracted, and pulsatile lavage, and curette, etc., were used to debride the wound.  The wound margins were healthy with the exception of very central triangular incision area.  The edges were debrided and then 19 antibiotic-impregnated beads with gentamicin and tobramycin were inserted and the wound was further closed today.,The skin edges were approximated under minimal tension.  The soft dressing was placed.  An Ace was placed.  She was awakened from the anesthesia and taken to recovery room in a stable condition.  Final needle, instrument, and sponge counts were correct.
Anterior Cervical Discectomy & Interbody Fusion - 3  ( Surgery)
Description:  Anterior cervical discectomy for neural decompression and anterior interbody fusion C5-C6 utilizing Bengal cage.  

PREOPERATIVE DIAGNOSES:,  ,1.  Spondylosis with cervical stenosis C5-C6 greater than C4-C5, C6-C7, (721.0, 723.0).,2.  Neck pain with left radiculopathy, progressive (723.1/723.4).,3.  Headaches, progressive (784.0).,POSTOPERATIVE DIAGNOSES:,  ,1.  Spondylosis with cervical stenosis C5-C6 greater than C4-C5, C6-C7, (721.0, 723.0).,2.  Neck pain with left radiculopathy, progressive (723.1/723.4).,3.  Headaches, progressive (784.0).,PROCEDURES:,  ,1.  Anterior cervical discectomy at C5-C6 for neural decompression (63075).,2.  Anterior interbody fusion C5-C6 (22554) utilizing Bengal cage (22851).,3.  Anterior cervical instrumentation at C5-C6 for stabilization by Uniplate construction at C5-C6 (22845); with intraoperative x-ray x2.,SERVICE:  ,  Neurosurgery,ANESTHESIA:,
Anterior Lumbar Fusion  ( Surgery)
Description:  Anterior lumbar fusion, L4-L5, L5-S1, PEEK vertebral spacer, structural autograft from L5 vertebral body, BMP and anterior plate.  Severe low back pain.

PREOPERATIVE DIAGNOSIS: , Severe low back pain.,POSTOPERATIVE DIAGNOSIS: , Severe low back pain.,OPERATIONS PERFORMED: , Anterior lumbar fusion, L4-L5, L5-S1, PEEK vertebral spacer, structural autograft from L5 vertebral body, BMP and anterior plate.,ANESTHESIA:,  General endotracheal.,ESTIMATED BLOOD LOSS: , Less than 50 mL.,DRAINS:,  None.,COMPLICATIONS: , None.,PATHOLOGICAL FINDINGS:,  Dr. X made the approach and once we were at the L5-S1 disk space, we removed the disk and we placed a 13-mm PEEK vertebral spacer filled with a core of bone taken from the L5 vertebral body.  This was filled with a 15 x 20-mm Chronos VerteFill tricalcium phosphate plug.  At L4-L5, we used a 13-mm PEEK vertebral spacer with structural autograft and BMP, and then we placed a two-level 87-mm Integra sacral plate with 28 x 6-mm screws, two each at L4 and L5 and 36 x 6-mm screws at S1.,OPERATION IN DETAIL:,  The patient was placed under general endotracheal anesthesia.  The abdomen was prepped and draped in the usual fashion.  Dr. X made the approach, and once the L5-S1 disk space was identified, we incised this with a knife and then removed a large core of bone taking rotating cutters.  I was able to remove additional disk space and score the vertebral bodies.  The rest of the disk removal was done with the curette, scraping the endplates.  I tried various sized spacers, and at this point, we exposed the L5 body and took a dowel from the body and filled the hole with a 15 x 20-mm Chronos VerteFill tricalcium phosphate plug.  Half of this was used to fill the spacer at L5-S1, BMP was placed in the spacer as well and then it was tapped into place.  We then moved the vessels over the opposite way approaching the L4-L5 disk space laterally, and the disk was removed in a similar fashion and we also used a 13-mm PEEK vertebral spacer, but this is the variety that we could put in from one side.  This was filled with bone and BMP as well.  Once this was done, we were able to place an 87-mm Integra sacral plate down over the three vertebral bodies and place these screws.  Following this, bleeding points were controlled and Dr. X proceeded with the closure of the abdomen.,SUMMARY: , This is a 51-year-old man who reports 15-year history of low back pain and intermittent bilateral leg pain and achiness.  He has tried multiple conservative treatments including physical therapy, epidural steroid injections, etc.  MRI scan shows a very degenerated disk at L5-S1, less so at L3-L4 and L4-L5.  A discogram was positive with the lower 3 levels, but he has pain, which starts below the iliac crest and I feel that the L3-L4 disk is probably that symptomatic.  An anterior lumbar interbody fusion was suggested.  Procedure, risks, and complications were explained.