smoh/medical-transcriptions huggingface dataset:
Punch Biopsy - 1  ( Surgery)
Description:  Punch biopsy of right upper chest skin lesion.

PROCEDURE:,  Punch biopsy of right upper chest skin lesion.,ESTIMATED BLOOD LOSS:,  Minimal.,FLUIDS: , Minimal.,COMPLICATIONS:,  None.,PROCEDURE:,  The area around the lesion was anesthetized after she gave consent for her procedure.  Punch biopsy including some portion of lesion and normal tissue was performed.  Hemostasis was completed with pressure holding.  The biopsy site was approximated with non-dissolvable suture.  The area was hemostatic.  All counts were correct and there were no complications.  The patient tolerated the procedure well.  She will see us back in approximately five days.,
Radioactive Plaque - Insertion  ( Surgery)
Description:  Macular edema, right eye.  Insertion of radioactive plaque, right eye with lateral canthotomy.  The plaque was positioned on the scleral surface immediately behind the macula and secured with two sutures of 5-0 Dacron.  The placement was confirmed with indirect ophthalmoscopy. 

PREOPERATIVE DIAGNOSIS:,  Macular edema, right eye.,POSTOPERATIVE DIAGNOSIS:  ,Macular edema, right eye.,TITLE OF OPERATION: , Insertion of radioactive plaque, right eye with lateral canthotomy.,OPERATIVE PROCEDURE IN DETAIL:  ,The patient was prepped and draped in the usual manner for a local eye procedure.  Initially, a 5 cc retrobulbar injection of 2% Xylocaine was done.  Then, a lid speculum was inserted and the conjunctiva was incised 4 mm posterior to the limbus.  A 2-0 silk traction suture was placed around the insertion of the lateral rectus muscle and, with gentle traction, the temporal one-half of the globe was exposed.  The plaque was positioned on the scleral surface immediately behind the macula and secured with two sutures of 5-0 Dacron.  The placement was confirmed with indirect ophthalmoscopy.  Next, the eye was irrigated with Neosporin and the conjunctiva was closed with 6-0 plain catgut.  The intraocular pressure was found to be within normal limits.  An eye patch was applied and the patient was sent to the Recovery Room in good condition.  A lateral canthotomy had been done.
Port-A-Cath Insertion - 4  ( Surgery)
Description:  Insertion of a Port-A-Catheter via the left subclavian vein approach under fluoroscopic guidance in a patient with ovarian cancer.

PREOPERATIVE DIAGNOSIS: , Ovarian cancer.,POSTOPERATIVE DIAGNOSIS:,  Ovarian cancer.,OPERATION PERFORMED:,  Insertion of a Port-A-Catheter via the left subclavian vein approach under fluoroscopic guidance.,DETAILED OPERATIVE NOTE:,  The patient was placed on the operating table and placed under LMA general anesthesia in preparation for insertion of a Port-A-Catheter.  The chest was prepped and draped in the routine fashion for insertion of a Port-A-Catheter.  The left subclavian vein was punctured with a single stick and a guidewire threaded through the needle into the superior vena cava under fluoroscopic guidance.  The needle was removed.  An incision was made over the guidewire for entrance of the dilator with sheath.  A second counter incision was made transversally on the chest wall about an inch and half below the puncture site with a #15 blade.  Hemostasis was effective to electrocautery, and a pocket was fashioned subcutaneously for positioning of the reservoir.  The Port-A-Catheter reservoir tubing was attached to the reservoir in the routine fashion.  The reservoir was placed in the pocket and sutured to the anterior chest wall muscle with three interrupted 4-0 Prolene sutures for stability.  Next, a catheter passer was passed from the pocket exiting through the skin at the puncture site, previously placed for the guidewire, and the Port-A-Catheter was pulled from the reservoir exiting on the skin.  It was placed on the chest, measured, and cut to the appropriate length.  This having been done, the dilator with sheath attached was passed over the guidewire into the superior vena cava under fluoroscopic guidance.  The guidewire and dilator were removed, and the Port-A-Catheter was threaded through the sheath into the superior vena cava, and the sheath removed under fluoroscopic guidance.  Fluoroscopy revealed the Port-A-Catheter to be in excellent position.  The Port-A-Catheter was accessed with a butterfly 90-degree needle percutaneously that drew blood well and flushed easily.  It was flushed with heparinized saline connected in cath.  This having been done, the puncture site was closed with a circumferential subcutaneous 3-0 Vicryl suture, and the skin was closed with a percutaneous circumferential subcuticular suture.  This having been done, attention was applied to the reservoir incision.  It was closed with two layers of continuous 3-0 Vicryl suture, and the skin was closed with a continuous 3-0 Monocryl subcuticular stitch.  A dry sterile dressing was applied, and the patient having tolerated the procedure was transferred to the recovery room for postoperative care.
Port-A-Cath Insertion - 3  ( Surgery)
Description:  Insertion of Port-A-Cath via left subclavian vein using fluoroscopy in a patient with renal cell carcinoma.

TITLE OF PROCEDURE: , Insertion of Port-A-Cath via left subclavian vein using fluoroscopy.,PREOPERATIVE DIAGNOSIS:  ,Metastatic renal cell carcinoma.,POSTOPERATIVE DIAGNOSIS: , Metastatic renal cell carcinoma.,PROCEDURE IN DETAIL:,  This is a 49-year-old gentleman was referred by Dr. A.  The patient underwent a left nephrectomy for renal cell carcinoma in 1999 in Philadelphia.  He has developed recurrence with metastases to the lung and to bone.,The patient is on dialysis via a right internal jugular PermCath that was placed elsewhere.,In the operating room under monitored anesthesia care with intravenous sedation, the patient was prepped and draped suitably.  Lidocaine 1% with epinephrine was used for local anesthesia and the left subclavian vein was punctured at the first pass without difficulty.  A J-wire was guided into place under fluoroscopic control.  A 7.2-French vortex titanium Port-A-Cath was now anchored in the subcutaneous pocket made just below using 3-0 Prolene.  The attached catheter tunneled, cut to the appropriate length and placed through the sheath that was then peeled away.  Fluoroscopy showed good catheter disposition in the superior vena cava.  The catheter was accessed with a butterfly Huber needle, blood was aspirated easily and the system was then flushed using heparinized saline.  The pocket was irrigated using antibiotic saline and closed with absorbable suture.  The port was left accessed with the butterfly needle after dressings were applied and the patient is to report to Dr. A's office later today for the commencement of chemotherapy.  There were no complications.
Port-A-Cath Insertion - 5  ( Surgery)
Description:  Insertion of subclavian dual-port Port-A-Cath and surgeon-interpreted fluoroscopy.

PROCEDURES PERFORMED,1.  Insertion of subclavian dual-port Port-A-Cath.,2.  Surgeon-interpreted fluoroscopy.,OPERATIVE PROCEDURE IN DETAIL: , After obtaining informed consent from the patient, including a thorough explanation of the risks and benefits of the aforementioned procedure, patient was taken to the operating room and general endotracheal anesthesia was administered.  Next, the chest was prepped and draped in a standard surgical fashion.  A #18-gauge spinal needle was used to aspirate blood from the subclavian vein.  After aspiration of venous blood, Seldinger technique was used to thread a J wire.  The distal tip of the J wire was confirmed to be in adequate position with surgeon-interpreted fluoroscopy.  Next a #15-blade scalpel was used to make an incision in the skin.  Dissection was carried down to the level of the pectoralis muscle.  A pocket was created.  A dual-port Port-A-Cath was lowered into the pocket and secured with #2-0 Prolene.  Both ports were flushed.  The distal tip was pulled through to the wire exit site with a Kelly clamp.  It was cut to the appropriate length.  Next a dilator and sheath were threaded over the J wire.  The J wire and dilator were removed, and the distal tip of the dual-port Port-A-Cath was threaded over the sheath, which was simultaneously withdrawn.  Both ports of the dual-port Port-A-Cath were flushed and aspirated without difficulty.  The distal tip was confirmed to be in adequate position with surgeon-interpreted fluoroscopy.  The wire access site was closed with a 4-0 Monocryl.  The port pocket was closed in 2 layers with 2-0 Vicryl followed by 4-0 Monocryl in a running subcuticular fashion.  Sterile dressing was applied.  The patient tolerated the procedure well and was transferred to the PACU in good condition
Port-A-Cath Insertion - 1  ( Surgery)
Description:  Right subclavian Port-a-Cath insertion in a patient with bilateral breast carcinoma. 

PREOPERATIVE DIAGNOSES: ,1.  Bilateral breast carcinoma.,2.  Chemotherapy required.,POSTOPERATIVE DIAGNOSES:,1.  Bilateral breast carcinoma.,2.  Chemotherapy required.,OPERATION: , Right subclavian Port-a-Cath insertion.,FINDINGS AND PROCEDURE:  ,With the patient under satisfactory general orotracheal anesthesia and in the supine position, the right upper anterior chest, neck, and arm were prepared with Betadine in the usual fashion.  The skin, subcutaneous tissue, and fascia of the pectoralis major muscle medially beneath the inferior third of the right clavicle was infiltrated with 0.5% Marcaine with epinephrine.  An incision transverse, parallel, and inferior to the middle third of the right clavicle was performed.  A subcutaneous pocket on the surface of the pectoralis major muscle was created.  The muscular fascia was also infiltrated with 0.5% Marcaine with epinephrine.  With the patient in the Trendelenburg position, utilizing the provided introducer needle, the right subclavian vein was cannulated.  A guidewire was passed without difficulty and the needle was removed.  Fluoroscopy confirmed satisfactory position of the guidewire in the right atrium.  A dilator and sheath was passed over the guidewire.  The guidewire and dilator were removed and a provided catheter was inserted through the sheath and the sheath was carefully withdrawn.  Fluoroscopy again confirmed satisfactory position of the catheter and the catheter under fluoroscopic guidance was retracted into the superior vena cava.  The catheter had been preflushed with dilute heparin solution (100 units/mL).  The port, which had been preflushed with saline, was attached to the catheter at approximately 13 cm level.  The locking cap had been placed on the catheter.  The port was connected to the catheter and the locking cap was secured.  The port was again flushed with dilute heparin solution and placed within the subcutaneous pocket.  Fluoroscopy again confirmed satisfactory position.  A hard copy of the fluoroscopy was obtained.  The catheter and port were secured to the pectoralis fascia in four locations with 2-0 Prolene suture.  Site was irrigated with saline.  Hemostasis was verified.  The subcutaneous tissue was approximated with interrupted 2-0 Vicryl suture.  The subcutaneous and dermis were closed with a running subcuticular 3-0 Vicryl suture.  A 0.25-inch Steri-Strips were applied.  The provided needle and butterfly attachment was flushed with saline, passed through the skin into the port, and then flushed again with dilute heparin solution thus confirmed satisfactory.  The site was dressed with Tegaderm type dressing and the needle catheters were covered with 4x4's and paper tape.  Estimated blood loss was less than 15 mL.  The patient tolerated the procedure well and left the operating room in good condition.
Postop Transanal Excision  ( Surgery)
Description:  Bleeding after transanal excision five days ago.  Exam under anesthesia with control of bleeding via cautery.  The patient is a 42-year-old gentleman who is five days out from transanal excision of a benign anterior base lesion.  He presents today with diarrhea and bleeding.

PREOPERATIVE DIAGNOSIS: , Bleeding after transanal excision five days ago.,POSTOPERATIVE DIAGNOSIS: , Bleeding after transanal excision five days ago.,PROCEDURE:,  Exam under anesthesia with control of bleeding via cautery.,ANESTHESIA:,  General endotracheal.,INDICATION: , The patient is a 42-year-old gentleman who is five days out from transanal excision of a benign anterior base lesion.  He presents today with diarrhea and bleeding.  Digital exam reveals bright red blood on the finger.  He is for exam under anesthesia and control of hemorrhage at this time.,FINDINGS: , There was an ulcer where most of the polypoid lesion had been excised before.  In a near total fashion the wound had opened and again there was a raw ulcer surface in between the edges of the mucosa.  There were a few discrete sites of mild oozing, which were treated with cautery and #1 suture.  No other obvious bleeding was seen.,TECHNIQUE: , The patient was taken to the operating room and placed on the operative table in supine position.  After adequate general anesthesia was induced, the patient was then placed in modified prone position.  His buttocks were taped, prepped and draped in a sterile fashion.  The anterior rectal wall was exposed using a Parks anal retractor.  The entire wound was visualized with a few rotations of the retractor and a few sites along the edges were seen to be oozing and were touched up with cautery.  There was one spot in the corner that was oozing and this may have been from simply opening the retractor enough to see well.  This was controlled with a 3-0 Monocryl figure-of-eight suture.  At the completion, there was no bleeding, no oozing, it was completely dry, and we removed our retractor, and the patient was then turned and extubated and taken to the recovery room in stable condition.
Post Hemithyroidectomy  ( Surgery)
Description:  The patient with left completion hemithyroidectomy and reimplantation of the left parathyroid and left sternocleidomastoid region in the inferior 1/3rd region.  Papillary carcinoma of the follicular variant of the thyroid in the right lobe, status post right hemithyroidectomy.

PREOPERATIVE DIAGNOSES: , Papillary carcinoma of the follicular variant of the thyroid in the right lobe, status post right hemithyroidectomy.,POSTOPERATIVE DIAGNOSES: , Papillary carcinoma of the follicular variant of the thyroid in the right lobe, status post right hemithyroidectomy.,PROCEDURE:  ,The patient with left completion hemithyroidectomy and reimplantation of the left parathyroid and left sternocleidomastoid region in the inferior 1/3rd region.,FINDINGS: , Normal-appearing thyroid gland with a possible lump in the inferior aspect, there was a parathyroid gland that by frozen section _________  was not thyroid, it was reimplanted to the left lower sternocleidomastoid region.,ESTIMATED BLOOD LOSS:  ,Approximately 10 mL.,FLUIDS: , Crystalloid only.,COMPLICATIONS: , None.,DRAINS: , Rubber band drain in the neck.,CONDITION:,  Stable.,PROCEDURE:  ,The patient placed supine under general anesthesia.  First, a shoulder roll was placed, 1% lidocaine and 1:100,000 epinephrine was injected into the old scar, natural skin fold, and Betadine prep.  Sterile dressing was placed.  The laryngeal monitoring was noted to be working fine.  Then, an incision was made in this area in a curvilinear fashion through the old scar, taken through the fat and the platysma level.  The strap muscles were found and there was scar tissue along the trachea and the strap muscles were elevated off of the left thyroid, the thyroid gland was then found.  Then, using bipolar cautery and a Coblation dissector, the thyroid gland inferiorly was dissected off and the parathyroid gland was left inferiorly and there was scar tissue that was released and laterally, the thyroid gland was released, then came into the Berry ligaments.  The Berry ligament was dissected off and the gland came off all the way to the superior and inferior thyroid vessels, which were crossed with the Harmonic scalpel and removed.  No bleeding was seen.  There was a small nick in the external jugular vein that was tied with a 4-0 Vicryl suture ligature.  After this was completed, on examining the specimen, there appeared to be a lobule on it and it was sent off as possibly parathyroid, therefore it was reimplanted in the left lower sternocleidomastoid region using the silk suture ligature.  After this was completed, no bleeding was seen.  The laryngeal nerve could be seen and intact and then Rubber band  drain was placed throughout the neck along the thyroid bed and 4-0 Vicryl was used to close the strap muscles in an interrupted fashion along with the platysma region and subcutaneous region and a running 5-0 nylon was used to close the skin and Mastisol and Steri-Strips were placed along the skin edges and then on awakening, both laryngeal nerves were working normally.  Procedure was then terminated at that time.
Port-A-Cath Insertion - 2  ( Surgery)
Description:  Placement of a Port-A-Cath under fluoroscopic guidancein a patient with anal cancer.

PREOPERATIVE DIAGNOSIS:,1.  Anal cancer.,2.  Need for IV access.,POSTOPERATIVE DIAGNOSIS:,1.  Anal cancer.,2.  Need for IV access.,OPERATIVE PROCEDURE:,1.  Placement of a Port-A-Cath.,2.  Fluoroscopic guidance.,ANESTHESIA:,  General LMA.,ESTIMATED BLOOD LOSS:,  Minimum.,IV FLUIDS: , Per anesthesia.,RECURRENT COMPLICATIONS: , None.,FINDINGS: , Good port placement on C-arm.,INDICATIONS AND PROCEDURE IN DETAIL: , This is a 55-year-old female who presents with anal cancer, who is beginning chemoradiation and needs IV access for chemotherapy.  Risks and benefits of the procedure explained, the patient appeared to understand, and agreed to proceed.  The patient was taken to the operating room, placed in supine position.  General LMA anesthesia was administered.  She is prepped and draped in the usual sterile fashion.  She was placed in the Trendelenburg position and the left subclavian vein was cannulated and a guide wire placed through the wire.  Fluoroscopy was used to confirm appropriate guide wire location in the subclavian vein to the superior vena cava.  The incision was then made around the guide wire, taken to the subcutaneous tissues with electric Bovie cautery.  A pocket was made in the subcutaneous tissue of adequate size for the port which was cut at 16 cm for appropriate locationing which was cut at 16 cm based on superficial measurements.  The 2-0 Vicryl sutures were used to secure the port in place and the sheath introducer was placed over the guide wire and the guide wire removed with a Port catheter being placed into the sheath introducer.  Fluoroscopy was used to confirm appropriate positioning of the catheter and the skin was closed using interrupted 3-0 Vicryl followed by running 4-0 Vicryl subcuticular stitch.  Heparin flush was used to flush the port.  Steri-Strips were applied and the patient was awakened and extubated in the OR taken to the PACU in good condition.  All counts were reported as correct and I was present for the entire procedure.
Port Insertion  ( Surgery)
Description:  Port insertion through the right subclavian vein percutaneously under radiological guidance.  Metastatic carcinoma of the bladder and bowel obstruction.

PREOPERATIVE DIAGNOSES,1.  Metastatic carcinoma of the bladder.,2.  Bowel obstruction.,POSTOPERATIVE DIAGNOSES,1.  Metastatic carcinoma of the bladder.,2.  Bowel obstruction.,PROCEDURE: , Port insertion through the right subclavian vein percutaneously under radiological guidance.,PROCEDURE DETAIL:  ,The patient was electively taken to the operating room after obtaining an informed consent.  A time-out process was followed.  Antibiotics were given.  Then, the patient's right deltopectoral area was prepped and draped in the usual fashion.  Xylocaine 1% was infiltrated.  The right subclavian vein was percutaneously cannulated without any difficulty.  Then using the Seldinger technique, the catheter part of the port, which was a single-lumen port, was passed through the introducer under x-ray guidance and placed in the junction of the superior vena cava and the right atrium.,A pocket had been fashioned and a single-lumen drum of the port was connected to the catheter, which had been trimmed and affixed to the pectoralis fascia with couple of sutures of Vicryl.  Then, the fascia was closed using subcuticular suture of Monocryl.  The drum was aspirated and irrigated with heparinized saline and then was put in the pocket and the skin was closed.  A dressing was applied including the needle and the port with the catheter so that the floor could use the catheter right away.,The patient tolerated the procedure well and was sent to recovery room in satisfactory condition.  A chest x-ray was performed that showed that there were no complications of procedure and that the catheter was in right place.
Port-A-Cath Insertion  ( Surgery)
Description:  Port-A-Cath insertion template.  Catheter was inserted after subcutaneous pocket was created, the sheath dilators were advanced, and the wire and dilator were removed.

PROCEDURE PERFORMED: , Port-A-Cath insertion.,ANESTHESIA: , MAC.,COMPLICATIONS: , None.,ESTIMATED BLOOD LOSS:  ,Minimal.,PROCEDURE IN DETAIL:  ,Patient was prepped and draped in sterile fashion.  The left subclavian vein was cannulated with a wire.  Fluoroscopic confirmation of the wire in appropriate position was performed.  Then catheter was inserted after subcutaneous pocket was created, the sheath dilators were advanced, and the wire and dilator were removed.  Once the catheter was advanced through the sheath, the sheath was peeled away.  Catheter was left in place, which was attached to hub, placed in the subcutaneous pocket, sewn in place with 2-0 silk sutures, and then all hemostasis was further reconfirmed.  No hemorrhage was identified.  The port was in appropriate position with fluoroscopic confirmation.  The wound was closed in 2 layers, the 1st layer being 3-0 Vicryl, the 2nd layer being 4-0 Monocryl subcuticular stitch.  Dressed with Steri-Strips and 4 x 4's.  Port was checked.  Had good blood return, flushed readily with heparinized saline.
Pituitary Tumor Resection  ( Surgery)
Description:  Transnasal transsphenoidal approach in resection of pituitary tumor.   The patient is a 17-year-old girl who presented with headaches and was found to have a prolactin of 200 and pituitary tumor.

TITLE OF OPERATION: , Transnasal transsphenoidal approach in resection of pituitary tumor.,INDICATION FOR SURGERY: , The patient is a 17-year-old girl who presented with headaches and was found to have a prolactin of 200 and pituitary tumor.  She was started on Dostinex with increasing dosages.  The most recent MRI demonstrated an increased growth with hemorrhage.  This was then discontinued.  Most recent prolactin was at 70, although normalized, the recommendation was surgical resection given the size of the sellar lesion.  All the risks, benefits, and alternatives were explained in great detail via translator.,PREOP DIAGNOSIS: , Pituitary tumor.,POSTOP DIAGNOSIS: , Pituitary tumor.,PROCEDURE DETAIL:  ,The patient brought to the operating room, positioned on the horseshoe headrest in a neutral position supine.  The fluoroscope was then positioned.  The approach will be dictated by Dr. X. Once the operating microscope and the endoscope were then used to approach it through transnasal, this was complicated and complex secondary to the drilling within the sinus.  Once this was ensured, the tumor was identified, separated from the pituitary gland, it was isolated and then removed.  It appeared to be hemorrhagic and a necrotic pituitary, several sections were sent.  Once this was ensured and completed and hemostasis obtained, the wound was irrigated.  There might have been a small CSF leak with Valsalva, so the recommendation was for a reconstruction, Dr. X will dictate.  The fat graft was harvested from the left lower quadrant and closed primarily, this was soaked in fat and used to close the closure.  All sponge and needle counts were correct.  The patient was extubated and transported to the recovery room in stable condition.  Blood loss was minimal.