smoh/medical-transcriptions huggingface dataset:
BMT & Adenoidectomy  ( Surgery)
Description:  Bilateral myringotomy tubes and adenoidectomy.

PREOPERATIVE DIAGNOSIS: , Chronic otitis media.,POSTOPERATIVE DIAGNOSIS: , Chronic otitis media.,PROCEDURE PERFORMED: , Bilateral myringotomy tubes and adenoidectomy.,INDICATIONS FOR PROCEDURE:,  The patient is an 8-year-old child with history of recurrent otitis media.  The patient has had previous tube placement.  Tubes have since plugged and are no more functioning.  The patient has had recent recurrent otitis media.  Risks and benefits in terms of bleeding, anesthesia, and tympanic membrane perforation were discussed with the mother.  Mother wished to proceed with the surgery.,PROCEDURE IN DETAIL: , The patient was brought to the room, placed supine.  The patient was given general endotracheal anesthesia.  Starting on the left ear, under microscopic visualization, the ear was cleaned of wax.  A Bobbin tube was found stuck to the tympanic membrane.  This was removed.  After removing the tube the patient was found to have microperforation through which serous fluid was draining.  A fresh myringotomy was made in the anterior inferior quadrant.  More serous fluid was aspirated from middle ear space.  The new Bobbin tube was easily placed.  Floxin drops were placed in the ear.  In the right ear again under microscopic visualization, the ear was cleaned, the tube was removed off tympanic membrane.  There was no perforation seen; however, there was some granulation tissue on the surface of tympanic membrane.  A fresh myringotomy incision was made in the anterior inferior quadrant.  More serous fluid was drained out of middle ear space.  The tube was easily placed and Floxin drops were placed in the ear.  This completes tube portion of the surgery.  The patient was then turned and placed in the Rose position.  Shoulder roll was placed for neck extension.  Using a small McIvor mouth gag mouth was held open.  Using a rubber catheter the soft palate was retracted.  Under mirror visualization, the nasopharynx was examined.  The patient was found to have minimal adenoidal tissue.  This was removed using a suction Bovie.  The patient was then awakened from anesthesia, extubated and brought to recovery room in stable condition.  There were no intraoperative complications.  Needle and sponge count correct.  Estimated blood loss none.
Blepharoplasty - Lower Lid  ( Surgery)
Description:  Lower lid blepharoplasty.

An orbital block was done.  An infraorbital block was also performed with a 25 gauge needle.  A skin muscle flap was elevated by sharp dissection down to the orbital rim area.  The herniated periorbital fat was removed by opening the orbital septum with sharp dissection using a 15 blade, teasing the periorbital fat out, cross clamping the fat and removing the fat with a scissor over the clamp.  The clamp was cauterized with needle cautery and then the clamp was scarped with a 15 blade.,The remaining fat was left to fall back into the orbit.  This was done in three compartments, the middle, medial and lateral compartments.  Fat was removed from all three compartments.  Then with the mouth open and the eyes in upward gaze, the lower skin muscle flap was redraped on the eyelids and tailored to fit exactly into place and then sutured into place with multiple 6-0 silk sutures.,Bleeding was minimal.  The patient tolerated the procedure well.
Bone Impacted Tooth Removal  ( Surgery)
Description:  Dentigerous cyst, left mandible associated with full bone impacted wisdom tooth #17.  Removal of benign cyst and extraction of full bone impacted tooth #17.

PREOPERATIVE DIAGNOSIS: , Dentigerous cyst, left mandible associated with full bone impacted wisdom tooth #17.,POSTOPERATIVE DIAGNOSIS: , Dentigerous cyst, left mandible associated with full bone impacted wisdom tooth #17.,PROCEDURE:,  Removal of benign cyst and extraction of full bone impacted tooth #17.,ANESTHESIA:  ,General anesthesia with nasal endotracheal intubation.,SPECIMEN: , Cyst and section tooth #17.,ESTIMATED BLOOD LOSS:,  10 mL.,FLUIDS:,  1200 of Lactated Ringer's.,COMPLICATIONS: , None.,CONDITION: , The patient was extubated and transported to the PACU in good condition.  Breathing spontaneously.,INDICATION FOR PROCEDURE:  ,The patient is a 38-year-old Caucasian male who was referred to clinic to evaluate a cyst in his left mandible.  Preoperatively, a biopsy of the cyst was obtained and it was noted to be a benign dentigerous cyst.,After evaluation of the location of the cyst and the impacted wisdom tooth approximately the inferior border of the mandible, it was determined that the patient would benefit from removal of the cyst and removal of tooth #17 under general anesthesia in the operating room.  Risks, benefits, and alternatives of treatment were thoroughly discussed with the patient and consent was obtained.,DESCRIPTION OF PROCEDURE:,  The patient was taken to the operating room #1 at Hospital and laid in the supine fashion on the operating room table.  As stated, general anesthesia was induced with IV anesthetics and maintained with nasal endotracheal intubation and inhalation anesthetics.  The patient was prepped and draped in usual oro-maxillofacial surgery fashion.,Approximately, #6 mL of 2% lidocaine with 1:100,000 epinephrine was injected in the usual nerve block fashion.  After waiting appropriate time for local anesthesia to take effect, a moistened Ray-Tec sponge was placed in the posterior pharynx.  Peridex mouth rinse was used to prep the oral cavity.  This was removed with suction.,Using a #15 blade a sagittal split osteotomy incision was made along the left ramus.  A full-thickness mucoperiosteal flap was elevated and the crest of the bone was identified where the crown had super-erupted since the biopsy 6 weeks earlier.  Using a Hall drill, a buccal osteotomy was developed, the tooth was sectioned in half, fractured with an elevator and delivered in two pieces.  Using a double-ended curette, the remainder of the cystic lining was removed from the left mandible and sent to pathology with the tooth for review.,The area was irrigated with copious amounts of sterile water and closed with 3-0 chromic gut suture.  The throat pack was removed.  The procedure was then determined to be over, and the patient was extubated, breathing spontaneously, and transported to the PACU in good condition.
Blepharoplasty - Quad  ( Surgery)
Description:  Quad blepharoplasty for blepharochalasia and lower lid large primary and secondary bagging.

PREOPERATIVE DIAGNOSES:,1.  Blepharochalasia.,2.  Lower lid large primary and secondary bagging.,POSTOPERATIVE DIAGNOSES:,1.  Blepharochalasia.,2.  Lower lid large primary and secondary bagging.,PROCEDURE: , Quad blepharoplasty.,ANESTHESIA: , General.,ESTIMATED BLOOD LOSS: , Minimal.,CONDITION: , The patient did well.,PROCEDURE:  ,The patient had marks and measurements prior to surgery.  Additional marks and measurements were made at the time of surgery; these were again checked.  At this point, the area was injected with 0.5% lidocaine with 1:200,000 epinephrine.  Appropriate time waited for the anesthetic and epinephrine effect.,Beginning on the left upper lid, the skin excision was completed.  The muscle was opened, herniated, adipose tissue pad in the middle and medial aspect was brought forward, cross-clamped, excised, cauterized, and allowed to retract.  The eyes were kept irrigated and protected throughout the procedure.  Attention was turned to the opposite side.  Procedure was carried out in the similar manner.,At the completion, the wounds were then closed with a running 6-0 Prolene, skin adhesives, and Steri-Strips.  Attention was turned to the right lower lid.  A lash line incision was made.  A skin flap was elevated and the muscle was opened.  Large herniated adipose tissue pads were present in each of the three compartments.  They were individually elevated, cross-clamped, excised, cauterized, and allowed to retract.,At the completion, a gentle tension was placed on the facial skin and several millimeters of the skin excised.  Attention was turned to he opposite side.  The procedure was carried out as just described.  The contralateral side was reexamined and irrigated.  Hemostasis was good and it was closed with a running 6-0 Prolene.  The opposite side was closed in a similar manner.,Skin adhesives and Steri-Strips were applied.  The eyes were again irrigated and cool Swiss Eye compresses applied.  At the completion of the case, the patient was extubated in the operating room, breathing on her own, doing well, and transferred in good condition from operating room to recovering room.
Biopsy - Skin Nevus  ( Surgery)
Description:  Excisional biopsy of skin nevus and two-layer plastic closure.  Trichloroacetic acid treatment to left lateral nasal skin 2.5 cm to treat actinic keratosis.

PREOPERATIVE DIAGNOSES:  ,1.  Left back skin nevus 2 cm.,2.  Right mid back skin nevus 1 cm.,3.  Right shoulder skin nevus 2.5 cm.,4.  Actinic keratosis left lateral nasal skin 2.5 cm.,POSTOPERATIVE DIAGNOSES:  ,1.  Left back skin nevus 2 cm.,2.  Right mid back skin nevus 1 cm.,3.  Right shoulder skin nevus 2.5 cm.,4.  Actinic keratosis, left lateral nasal skin, 2.5 cm.,PATHOLOGY:  ,Pending.,TITLE OF PROCEDURES:  ,1.  Excisional biopsy of left back skin nevus 2 cm, two layer plastic closure.,2.  Excisional biopsy of mid back skin nevus 1 cm, one-layer plastic closure.,3.  Excisional biopsy of right shoulder skin nevus 2.5 cm, one-layer plastic closure.,4.  Trichloroacetic acid treatment to left lateral nasal skin 2.5 cm to treat actinic keratosis.,ANESTHESIA: , Xylocaine 1% with 1:100,000 dilution of epinephrine totaling 8 mL.,BLOOD LOSS: , Minimal.,COMPLICATIONS:,  None.,PROCEDURE:,  Consent was obtained.  The areas were prepped and draped and localized in the usual manner.  First attention was drawn to the left back.  An elliptical incision was made with a 15-blade scalpel.  The skin ellipse was then grasped with a Bishop forceps and curved Iris scissors were used to dissect the skin ellipse.  After dissection, the skin was undermined.  Radiofrequency cautery was used for hemostasis, and using a 5-0 undyed Vicryl skin was closed in the subcuticular plane and then skin was closed at the level of the skin with 4-0 nylon interrupted suture.,Next, attention was drawn to the mid back.  The skin was incised with a vertical elliptical incision with a 15-blade scalpel and then the mass was grasped with a Bishop forceps and excised with curved Iris scissors.  Afterwards, the skin was approximated using 4-0 nylon interrupted sutures.  Next, attention was drawn to the shoulder lesion.  It was previously marked and a 15-blade scalpel was used to make an elliptical incision into the skin.,Next, the skin was grasped with a small Bishop forceps and curved Iris scissors were used to dissect the skin ellipse and removed the skin.  The skin was undermined with the curved Iris scissors and then radio frequency treatment was used for hemostasis.,Next, subcuticular plain was closed with 5-0 undyed Vicryl interrupted suture.  Skin was closed with 4-0 nylon suture, interrupted.  Lastly, trichloroacetic acid chemical peel treatment to the left lateral nasal skin was performed.  Please refer to separate operative report for details.  The patient tolerated this procedure very well and we will follow up next week for postoperative re-evaluation or sooner if there are any problems.
Biopsy - Axillary Lymph Node  ( Surgery)
Description:  Right axillary adenopathy, thrombocytopenia, and hepatosplenomegaly.  Right axillary lymph node biopsy.

PREOPERATIVE DIAGNOSES:,1.  Right axillary adenopathy.,2.  Thrombocytopenia.,3.  Hepatosplenomegaly.,POSTOPERATIVE DIAGNOSES:,1.  Right axillary adenopathy.,2.  Thrombocytopenia.,3.  Hepatosplenomegaly.,PROCEDURE PERFORMED:  ,Right axillary lymph node biopsy.,ANESTHESIA: , Local with sedation.,COMPLICATIONS: , None.,DISPOSITION: , The patient tolerated the procedure well and was transferred to the recovery room in stable condition.,BRIEF HISTORY:  ,The patient is a 37-year-old male who presented to ABCD General Hospital secondary to hiccups and was ultimately found to have a right axillary mass to be severely thrombocytopenic with a platelet count of 2000 as well as having hepatosplenomegaly.  The working diagnosis is lymphoma, however, the Hematology and Oncology Departments were requesting a lymph node biopsy in order to confirm the diagnosis as well as prognosis.  Thus, the patient was scheduled for a lymph node biopsy with platelets running secondary to thrombocytopenia at the time of surgery.,INTRAOPERATIVE FINDINGS: , The patient was found to have a large right axillary lymphadenopathy, one of the lymph node was sent down as a fresh specimen.,PROCEDURE:  ,After informed written consent, risks and benefits of this procedure were explained to the patient.  The patient was brought to the operating suite, prepped and draped in a normal sterile fashion.  Multiple lymph nodes were palpated in the right axilla, however, the most inferior node was to be removed.  First, the skin was anesthetized with 1% lidocaine solution.  Next, using a #15 blade scalpel, an incision was made approximately 4 cm in length transversally in the inferior axilla.  Next, using electro Bovie cautery, maintaining hemostasis, dissection was carried down to the lymph node.  The lymph node was then completely excised using electro Bovie cautery as well as hemostats to maintain hemostasis and then lymph node was sent to specimen fresh to the lab.  Several hemostats were used, suture ligated with #3-0 Vicryl suture and hemostasis was maintained.  Next the deep dermal layers were approximated with #3-0 Vicryl suture.  After the wound has been copiously irrigated, the skin was closed with running subcuticular #4-0 undyed Vicryl suture and the pathology is pending.  The patient did tolerated the procedure well.  Steri-Strips and sterile dressings were applied and the patient was transferred to the Recovery in stable condition.
Blepharon & Entropion Repair  ( Surgery)
Description:  Repair of entropion, left upper lid, with excision of anterior lamella and cryotherapy.  Repairs of blepharon, entropion, right lower lid with mucous membrane graft.

PREOPERATIVE DIAGNOSES:,1.  Entropion, left upper lid.,2.  Entropion and some blepharon, right lower lid.,TITLE OF OPERATION:,1.  Repair of entropion, left upper lid, with excision of anterior lamella and cryotherapy.,2.  Repairs of blepharon, entropion, right lower lid with mucous membrane graft.,PROCEDURE IN DETAIL:  ,The patient was brought to the operating room and prepped and draped in the usual fashion.  The left upper lid and right lower lid were all infiltrated with 2% Xylocaine with Epinephrine.,The lid was then everted with special clips and the mucotome was then used to cut a large mucous membrane graft from the lower lid measuring 0.5 mm in thickness.  The graft was placed in saline and a 4 x 4 was placed over the lower lid.,Attention was then drawn to the left upper lid and the operating microscope was found to place.  An incision was made in the gray line nasally in the area of trichiasis and entropion, and the dissection was carried anterior to the tarsal plate and an elliptical piece of the anterior lamella was excised.  Bleeding was controlled with the wet-field cautery and the cryoprobe was then used with a temperature of -8 degree centigrade in the freeze-thaw-refreeze technique to treat the bed of the excised area.,Attention was then drawn to the right lower lid with the operating microscope and a large elliptical area of the internal aspect of the lid margin was excised with a super blade.  Some of the blepharon were dissected from the globe and bleeding was controlled with the wet-field cautery.  An elliptical piece of mucous membrane was then fashioned and placed into the defect in the lower lid and sutured with a running 6-0 chromic catgut suture anteriorly and posteriorly.,The graft was in good position and everything was satisfactory at the end of procedure.  Some antibiotic steroidal ointment was instilled in the right eye and a light pressure dressing was applied.  No patch was applied to the left eye.  The patient tolerated the procedure well and was sent to recovery room in good condition.
Bladder Biopsies & Fulguration  ( Surgery)
Description:  Cystoscopy, bladder biopsies, and fulguration.  Bladder lesions with history of previous transitional cell bladder carcinoma, pathology pending.

PREOPERATIVE DIAGNOSIS:,  Bladder lesions with history of previous transitional cell bladder carcinoma.,POSTOPERATIVE DIAGNOSIS: , Bladder lesions with history of previous transitional cell bladder carcinoma, pathology pending.,OPERATION PERFORMED:  ,Cystoscopy, bladder biopsies, and fulguration.,ANESTHESIA: , General.,INDICATION FOR OPERATION: , This is a 73-year-old gentleman who was recently noted to have some erythematous, somewhat raised bladder lesions in the bladder mucosa at cystoscopy.  He was treated for a large transitional cell carcinoma of the bladder with TURBT in 2002 and subsequently underwent chemotherapy because of pulmonary nodules.  He has had some low grade noninvasive small tumor recurrences on one or two occasions over the past 18 months.  Recent cystoscopy raises suspicion of another recurrence.,OPERATIVE FINDINGS: , The entire bladder was actually somewhat erythematous with mucosa looking somewhat hyperplastic particularly in the right dome and lateral wall of the bladder.  Scarring was noted along the base of the bladder from the patient's previous cysto TURBT.  Ureteral orifice on the right side was not able to be identified.  The left side was unremarkable.,DESCRIPTION OF OPERATION: , The patient was taken to the operating room.  He was placed on the operating table.  General anesthesia was administered after which the patient was placed in the dorsal lithotomy position.  The genitalia and lower abdomen were prepared with Betadine and draped subsequently.  The urethra and bladder were inspected under video urology equipment (25 French panendoscope) with the findings as noted above.  Cup biopsies were taken in two areas from the right lateral wall of the bladder, the posterior wall of bladder, and the bladder neck area.  Each of these biopsy sites were fulgurated with Bugbee electrodes.  Inspection of the sites after completing the procedure revealed no bleeding and bladder irrigant was clear.  The patient's bladder was then emptied.  Cystoscope removed and the patient was awakened and transferred to the postanesthetic recovery area.  There were no apparent complications, and the patient appeared to tolerate the procedure well.  Estimated blood loss was less than 15 mL.
Biopsy - Cervical Lymph Node  ( Surgery)
Description:  Excisional biopsy of right cervical lymph node.

PREOPERATIVE DIAGNOSIS: , Cervical lymphadenopathy.,POSTOPERATIVE DIAGNOSIS:,  Cervical lymphadenopathy.,PROCEDURE: , Excisional biopsy of right cervical lymph node.,ANESTHESIA: , General endotracheal anesthesia.,SPECIMEN: , Right cervical lymph node.,EBL: , 10 cc.,COMPLICATIONS: , None.,FINDINGS:,  Enlarged level 2 lymph node was identified and removed and sent for pathologic examination.,FLUIDS: , Please see anesthesia report.,URINE OUTPUT: , None recorded during the case.,INDICATIONS FOR PROCEDURE: , This is a 43-year-old female with a several-year history of persistent cervical lymphadenopathy.  She reports that it is painful to palpation on the right and has had multiple CT scans as well as an FNA which were all nondiagnostic.  After risks and benefits of surgery were discussed with the patient, an informed consent was obtained.  She was scheduled for an excisional biopsy of the right cervical lymph node.,PROCEDURE IN DETAIL: , The patient was taken to the operating room and placed in the supine position.  She was anesthetized with general endotracheal anesthesia.  The neck was then prepped and draped in the sterile fashion.  Again, noted on palpation there was an enlarged level 2 cervical lymph node.,A 3-cm horizontal incision was made over this lymph node.  Dissection was carried down until the sternocleidomastoid muscle was identified.  The enlarged lymph node that measured approximately 2 cm in diameter was identified and was removed and sent to Pathology for touch prep evaluation.  The area was then explored for any other enlarged lymph nodes.  None were identified, and hemostasis was achieved with electrocautery.  A quarter-inch Penrose drain was placed in the wound.,The wound was then irrigated and closed with 3-0 interrupted Vicryl sutures for a deep closure followed by a running 4-0 Prolene subcuticular suture.  Mastisol and Steri-Strip were placed over the incision, and sterile bandage was applied.  The patient tolerated this procedure well and was extubated without complications and transported to the recovery room in stable condition.  She will return to the office tomorrow in followup to have the Penrose drain removed.
Blepharoplasty  ( Surgery)
Description:  Blepharoplasty procedure

BLEPHAROPLASTY,The patient was prepped and draped.  The upper lid skin was marked out in a lazy S fashion, and the redundant skin marked out with a Green forceps.  Then the upper lids were injected with 2% Xylocaine and 1:100,000 epinephrine and 1 mL of Wydase per 20 mL of solution.,The upper lid skin was then excised within the markings.  Gentle pressure was placed on the upper eyelids, and the fat in each of the compartments was teased out using a scissor and cotton applicator; and then the fat was cross clamped, cut, and the clamp cauterized.  This was done in the all compartments of the middle and medial compartments of the upper eyelid, and then the skin sutured with interrupted 6-0 nylon sutures.  The first suture was placed in the lower eyelid skin picking up the periorbital muscle and then the upper portion of the tarsus and then the upper lid skin.  This created a significant crisp, supratarsal fold.  The upper lid skin was closed in this fashion, and then attention was turned to the lower lid.,An incision was made under the lash line and slightly onto the lateral canthus.  The #15 blade was used to delineate the plane in the lateral portion of the incision, and then using a scissor the skin was cut at the marking.  Then the skin muscle flap was elevated with sharp dissection.  The fat was located and using a scissor the three eyelid compartments were opened.  Fat was teased out, cross clamped, the fat removed, and then the clamp cauterized.  Once this was done the skin was tailored to the lower lid incision site with mouth open and eyes in upward gaze, and then the excess skin removed.  The suture line was sutured with interrupted 6-0 silk sutures.  Once this was done the procedure was finished.,The patient left the OR in satisfactory condition.  The patient was given 50 mg of Demerol IM with 25 mg of Phenergan.
Bladder Laceration Closure  ( Surgery)
Description:  Closure of bladder laceration, during cesarean section.

PREOPERATIVE DIAGNOSES: , Bladder laceration.,POSTOPERATIVE DIAGNOSES:,  Bladder laceration.,NAME OF OPERATION: , Closure of bladder laceration.,FINDINGS:,  The patient was undergoing a cesarean section for twins.  During the course of the procedure, a bladder laceration was notices and urology was consulted.  Findings were a laceration on the dome of the bladder.,PROCEDURE: , Initially there as a mucosal layer of suture already placed.  This was done with 3-0 chromic catgut.  The bladder was distended and, while the bladder was distended with physiologic saline, a second layer of 3-0 chromic catgut created a watertight closure.  The second layer included the mucosa an dinner layer of the detrusor muscle.  A third layer of 2-0 Dexon was used.  Each of these were placed in a continuous running-locked suture technique.  There was complete watertight closure of the bladder.  Hemostasis was assured and a Jackson-Pratt drain was brought out through a separate stab wound.  The remaining portion of the operation, both the cesarean section and the wound closure, will be dictated by Dr. Redmond.