smoh/medical-transcriptions huggingface dataset:
Ligament Reconstruction & Tendon Interposition Arthroplasty  ( Orthopedic)
Description:  Ligament reconstruction and tendon interposition arthroplasty of right wrist.

OPERATION PERFORMED:,  Ligament reconstruction and tendon interposition arthroplasty of right wrist.,DESCRIPTION OF PROCEDURE: , With the patient under adequate anesthesia, the right upper extremity was prepped and draped in a sterile manner.,Attention was turned to the base of the thumb where a longitudinal incision was made over the anatomic snuffbox and extended out onto the carpometacarpal joint.  Using blunt dissection radial sensory nerve was dissected and retracted out of the operative field.  Further blunt dissection exposed the radial artery, which was dissected and retracted off the trapezium.  An incision was then made across the scaphotrapezial joint distally onto the trapezium and out onto the carpometacarpal joint.  Sharp dissection exposed the trapezium, which was then morselized and removed in toto with care taken to protect the underlying flexor carpi radialis tendon.  The radial beak of the trapezoid was then osteotomized off the head of the scaphoid.  The proximal metacarpal was then fenestrated with a 4.5-mm drill bit.  Four fingers proximal to the flexion crease of the wrist a small incision was made over the FCR tendon and blunt dissection delivered the FCR tendon into this incision.  The FCR tendon was divided and this incision was closed with 4-0 nylon sutures.  Attention was returned to the trapezial wound where longitudinal traction on the FCR tendon delivered the FCR tendon into the wound.,The FCR tendon was then threaded through the fenestration in the metacarpal.  A bone anchor was then placed distal to the metacarpal fenestration.  The FCR tendon was then pulled distally and the metacarpal reduced to an anatomic position.  The FCR tendon was then sutured to the metacarpal using the previously placed bone anchor.  Remaining FCR tendon was then anchovied and placed into the scaphotrapezoidal and trapezial defect.  The MP joint was brought into extension and the capsule closed using interrupted 3-0 Tycron sutures.,Attention was turned to the MCP joint where the MP joint was brought in to 15 degrees of flexion and pinned with a single 0.035 Kirschner wire.  The pin was cut at the level of the skin.,All incisions were closed with running 3-0 Prolene subcuticular stitch.,Sterile dressings were then applied.  The tourniquet was deflated.  The patient was awakened from anesthesia and returned to the recovery room in satisfactory condition having tolerated the procedure well.
Long-Arm Cast  ( Orthopedic)
Description:  Closed reduction and placement of long-arm cast.

PREOPERATIVE DIAGNOSIS:,  Left distal radius fracture displaced.,POSTOPERATIVE DIAGNOSIS: , Left distal radius fracture displaced.,SURGERY:  ,Closed reduction and placement of long-arm cast, CPT code 25605.,ANESTHESIA:  ,General LMA.,FINDINGS:  ,The patient was found to have a displaced fracture.  She was found to be in perfect alignment after closed reduction and placement of cast.  The radial deviation was well corrected.,INDICATIONS: , The patient is 5 years old.  She was seen in our office today 1 week after being placed into a cast for a displaced fracture.  She was noted to have significant loss of alignment especially on the lateral view.  She was indicated for closed reduction and placed of the long-arm cast.  Risks and benefits were discussed at length with the family.  They wished to proceed.,PROCEDURE:  ,The patient was brought to the operating room and placed on the operating table in supine position.  General anesthesia was induced without incident.  Previous cast was previously removed.  An arm was approached and a closed reduction was performed.  This was checked under AP and lateral projection and was found to be in adequate alignment.  There was very mild residual dorsiflexion deformity noted.,A long-arm cast was then placed with plaster and molding.  Repeat x-rays demonstrated adequate alignment on both views.,The cast was then reinforced with fiberglass.  The patient was awakened from anesthesia and taken to recovery room in good condition.  There were no complications.  All instruments, sponge, and needle counts were correct at the end of case.,PLAN:  ,The patient will be discharged home.  She will return in 3 weeks for cast removal and clinical examination.  She would likely be placed into a wrist-guard at that time.  She has a prescription for Tylenol with codeine elixir.,
Lateral Epicondylitis Release  ( Orthopedic)
Description:  Lateral release with lengthening of the ECRB tendon.  Lateral epicondylitis.   

PREOPERATIVE DIAGNOSIS:  ,Lateral epicondylitis.
Laminectomy & Discectomy & Facetectomy  ( Orthopedic)
Description:  Revision laminectomy L5-S1, discectomy L5-S1, right medial facetectomy, preparation of disk space and arthrodesis with interbody graft with BMP.  Status post previous lumbar surgery for herniated disk with severe recurrence of axial back pain, failed conservative therapy.

TITLE OF OPERATION: , Revision laminectomy L5-S1, discectomy L5-S1, right medial facetectomy, preparation of disk space and arthrodesis with interbody graft with BMP.,INDICATIONS FOR SURGERY:  ,Please refer to medical record, but in short, the patient is a 43-year-old male known to me, status post previous lumbar surgery for herniated disk with severe recurrence of axial back pain, failed conservative therapy.  Risks and benefits of surgery were explained in detail including risk of bleeding, infection, stroke, heart attack, paralysis, need for further surgery, hardware failure, persistent symptoms, and death.  This list was inclusive, but not exclusive.  An informed consent was obtained after all patient's questions were answered.,PREOPERATIVE DIAGNOSIS:  ,Severe lumbar spondylosis L5-S1, collapsed disk space, hypermobility, and herniated disk posteriorly.,POSTOPERATIVE DIAGNOSIS: , Severe lumbar spondylosis L5-S1, collapsed disk space, hypermobility, and herniated disk posteriorly.,ANESTHESIA: , General anesthesia and endotracheal tube intubation.,DISPOSITION: , The patient to PACU with stable vital signs.,PROCEDURE IN DETAIL:  ,The patient was taken to the operating room.  After adequate general anesthesia with endotracheal tube intubation was obtained, the patient was placed prone on the Jackson table.  Lumbar spine was shaved, prepped, and draped in the usual sterile fashion.  An incision was carried out from L4 to S1.  Hemostasis was obtained with bipolar and Bovie cauterization.  A Weitlaner was placed in the wound and a subperiosteal dissection was carried out identifying the lamina of L4, L5, and sacrum.  At this time, laminectomy was carried out of L5-S1.  Thecal sac was retracted rightward and the foramen was opened and unilateral medial facetectomy was carried out in the disk space.  At this time, the disk was entered with a #15 blade and bipolar.  The disk was entered with straight up and down-biting pituitaries, curettes, and the high speed drill and we were able to takedown calcified herniated disk.  We were able to reestablish the disk space, it was very difficult, required meticulous dissection and then drilling with a diamond bur in the disk space underneath the spinal canal, very carefully holding the spinal canal out of harm's way as well as the exiting nerve root.  Once this was done, we used rasps to remove more disk material anteriorly and under the midline to the left side and then we put in interbody graft of BMP 8 mm graft from Medtronic.  At this time, Dr. X will dictate the posterolateral fusion, pedicle screw fixation to L4 to S1 with compression and will dictate the closure of the wound.  There were no complications.
Knee Arthroscopy & Medial Meniscoplasty  ( Orthopedic)
Description:  Arthroscopy of the left knee with medial meniscoplasty.  Internal derangement, left knee. Displaced bucket-handle tear of medial meniscus, left knee.

PREOPERATIVE DIAGNOSIS: , Internal derangement, left knee.,POSTOPERATIVE DIAGNOSIS: , Internal derangement, left knee.,PROCEDURE PERFORMED:,  Arthroscopy of the left knee with medial meniscoplasty.,ANESTHESIA:  ,LMA.,GROSS FINDINGS: , Displaced bucket-handle tear of medial meniscus, left knee.,PROCEDURE: , After informed consent was obtained, the patient was taken to ABCD General Hospital Operating Room #1 where anesthesia was administered by the Department of Anesthesiology.  The patient was then transferred to the operating room table in supine position with Johnson knee holder well-padded.  Tourniquet was placed around the left upper thigh.  The limb was then prepped and draped in usual sterile fashion.  Standard anteromedial and anterolateral arthroscopy portals were obtained and a systematic examination of the knee was then performed.  Patellofemoral joint showed frequent chondromalacia.  Examination of the medial compartment showed a displaced bucket-handle tear of the medial meniscus involving the entire posterior, parietal, and portion of his anterior portion of the medial meniscus.  The medial femoral condyle and medial tibial plateau were unaffected.  Intercondylar notch examination revealed an intact ACL and PCL stable to drawer testing and probing and the lateral compartment showed an intact lateral meniscus.  The femoral condyle and tibial plateau were all stable to probing.  Attention was then directed back to the medial compartment where the detached portion of the meniscus was excised using arthroscopy scissors.  A shaver was then used to smooth all the edges until the margins were stable to probing.,The knee was then flushed with normal saline and suctioned dry.  20 cc of 0.25% Marcaine was injected into the knee and into the arthroscopy portals.  A dressing consisting of Adaptic, 4x4s, ABDs, and Webril were applied followed by a TED hose.  The patient was then transferred to the recovery room in stable condition.
Knee Injury  ( Orthopedic)
Description:  Right knee injury suggestive of a recurrent anterior cruciate ligament tear, possible internal derangement.  While playing tennis she had a non-contact injury in which she injured the right knee.  She had immediate pain and swelling. 

HISTORY OF PRESENT ILLNESS: , The patient is an 18-year-old girl brought in by her father today for evaluation of a right knee injury.  She states that approximately 3 days ago while playing tennis she had a non-contact injury in which she injured the right knee.  She had immediate pain and swelling.  At this time, she complains of pain and instability in the knee.  The patient's past medical history is significant for having had an ACL injury to the knee in 2008.  She underwent anterior cruciate ligament reconstruction by Dr. X at that time, subsequently in the same year she developed laxity of the graft due in part to noncompliance and subsequently, she sought attention from Dr. Y who performed a revision ACL reconstruction at the end of 2008.  The patient states she rehabbed the knee well after that and did fine with good stability of the knee until this recent injury.,PAST MEDICAL HISTORY:,  She claims no chronic illnesses.,PAST SURGICAL HISTORY: , She had an anterior cruciate ligament reconstruction in 03/2008, and subsequently had a revision ACL reconstruction in 12/2008.  She has also had arm surgery when she was 6 years old.,MEDICATIONS: , She takes no medications on a regular basis,ALLERGIES: , She is allergic to Keflex and has skin sensitivity to Steri-Strips.,SOCIAL HISTORY:  ,The patient is single.  She is a full-time student at University.  Uses no tobacco, alcohol, or illicit drugs.  She exercises weekly, mainly tennis and swelling.,REVIEW OF SYSTEMS:  ,Significant for recent weight gain, occasional skin rashes.  The remainder of her systems negative.,PHYSICAL EXAMINATION,GENERAL:  The patient is 4 foot 10 inches tall, weighs 110 pounds.,EXTREMITIES:  She ambulates with some difficulty with a marked limp on the right side.  Inspection of the knee reveals a significant effusion in the knee.  She has difficulty with passive range of motion of the knee secondary to pain.  She does have tenderness to palpation at the medial joint line and has a positive Lachman's exam.,NEUROVASCULAR:  She is neurovascularly intact.,IMPRESSION: , Right knee injury suggestive of a recurrent anterior cruciate ligament tear, possible internal derangement.,PLAN: , The patient will be referred for an MRI of the right knee to evaluate the integrity of her revision ACL graft.  In the meantime, she will continue to use ice as needed.  Moderate her activities and use crutches.  She will follow up as soon as the MRI is performed.
Knee Arthroscopy - 1  ( Orthopedic)
Description:  Arthroscopic procedure of the knee.

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 in the operating room table in supine position and given general anesthetic.,Ancef 1 g was given for infectious prophylaxis.  Once the patient was under general anesthesia, the knee was prepped and draped in usual sterile fashion.  Once the knee was fully prepped and draped, then we made 2 standard portals medial and lateral.  Through the lateral portal, the camera was placed.  Through the medial portal, tools were placed.  We proceeded to examine scarring of the patellofemoral joint.  Then we probed the patellofemoral joint.  A chondroplasty was performed using a shaver.  Then we moved down to the lateral gutter.  Some loose bodies were found using a shaver and dissection.  We moved down the medial gutter.  No plica was found.,We moved into the medial joint; we found that the medial meniscus was intact.  We moved to the lateral joint and found that the lateral meniscus was intact.  Pictures were taken.  We drained the knee and washed out the knee with copious amounts of sterile saline solution.  The instruments were removed.  The 2 portals were closed using 3-0 nylon suture.  Xeroform, 4 x 4s, Kerlix x2, and TED stocking were placed.  The patient was successfully extubated and brought to the recovery room in stable condition.  I then spoke with the family going over the case, postoperative instructions, and followup care.
Knee Arthroplasty - Discharge Summary  ( Orthopedic)
Description:  Painful right knee status post total knee arthroplasty many years ago.   Status post poly exchange, right knee, total knee arthroplasty.

ADMISSION DIAGNOSIS:,  Painful right knee status post total knee arthroplasty many years ago.  The patient had gradual onset of worsening soreness and pain in this knee.  X-ray showed that the poly seems to be worn out significantly in this area.,DISCHARGE DIAGNOSIS:,  Status post poly exchange, right knee, total knee arthroplasty.,CONDITION ON DISCHARGE:,  Stable.,PROCEDURES PERFORMED:,  Poly exchange total knee, right.,CONSULTATIONS: , Anesthesia managed femoral nerve block on the patient.,HOSPITAL COURSE:  ,The patient was admitted with revision right total knee arthroplasty and replacement of patellar and tibial poly components.  The patient recovered well after this.  Working with PT, she was able to ambulate with minimal assistance.  Nerve block was removed by anesthesia.  The patient did well on oral pain medications.  The patient was discharged home.  She is actually going to home with her son who will be able to assist her and look after her for anything she might need.  The patient is comfortable with this, understands the therapy regimen, and is very satisfied after the procedure.,DISCHARGE INSTRUCTIONS AND MEDICATIONS: , The patient is to be discharged home to the care of the son.  Diet is regular.  Activity, weight bear as tolerated right lower extremity.  Continue to do physical therapy exercises.  The patient will be discharged home on Coumadin 4 mg a day as the INR was 1.9 on discharge with twice weekly lab checks.  Vicodin 5/500 mg take one to two tablets p.o. q.4-6h.  Resume home medications.  Call the office or return to the emergency room for any concerns including increased redness, swelling, drainage, fever, or any concerns regarding operation or site of incision.  The patient is to follow up with Dr. ABC in two weeks.
Knee DJD - Consult  ( Orthopedic)
Description:  Left knee pain and stiffness.  Bilateral knee degenerative joint disease (DJD).  Significant back pain, status post lumbar stenosis surgery with pain being controlled on methadone 10 mg b.i.d.

CHIEF COMPLAINT: , Left knee pain and stiffness.,HISTORY OF PRESENT ILLNESS: , The patient is a 57-year-old with severe bilateral knee DJD, left greater than right, with significant pain and limitations because of both.  He is able to walk approximately a 1/2-mile a day but is limited because of his knees.  Stairs are negotiated 1 at a time.  His problems with bilateral knee DJD have been well documented.  He had arthroscopy in the 1991/199two time frame for both of these.  He has been on long-standing conservative course for these including nonsteroidals, narcotics, injections.  At this point because of his progressive and persistent limitations he has opted for total joint surgery on the left side.  He does have other arthritic complaints including multiple back surgeries for spinal stenosis including decompression and epidural steroids.  Significant pain is handled by narcotic medication.  His attending physician is Dr. X.,PAST MEDICAL HISTORY: , Hypertension.,PRIOR SURGERIES:,1.  Inguinal hernia on the left.,2.  Baker's cyst.,3.  Colon cancer removal.,4.  Bilateral knee scopes.,5.  Right groin hernia.,6.  Low back surgery for spinal stenosis.,7.  Status post colon cancer second surgery.,MEDICATIONS:,1.  Ambien 12.5 mg nightly.,2.  Methadone 10 mg b.i.d.,3.  Lisinopril 10 mg daily.,IV MEDICATIONS FOR PAIN:  ,Demerol appears to work the best.,ALLERGIES: , Levaquin and Cipro cause rashes; ibuprofen causes his throat to swell, Fortaz causes an unknown reaction.,REVIEW OF SYSTEMS:  ,He does have paresthesias down into his thighs secondary to spinal stenosis.,SOCIAL HISTORY: , Married.  He is retired, being a Pepsi-Cola driver secondary to his back and knees.,HABITS: , No tobacco or alcohol.  Chewed until 2003.,RECREATIONAL PURSUITS:  ,Golfs, gardens, woodworks.,FAMILY HISTORY:,1.  Cancer.,2.  Coronary artery disease.,PHYSICAL EXAMINATION:,GENERAL APPEARANCE:  A pleasant, cooperative 57-year-old white male.,VITAL SIGNS:  Height 5' 9", weight 167.  Blood pressure 148/86.  Pulse 78 per minute and regular.,HEENT:  Unremarkable.  Extraocular movements are full.  Cranial nerves II-XII intact.,NECK:  Supple.,CHEST:  Clear.,CARDIOVASCULAR:  Regular rhythm.  Normal S1 and 2.,ABDOMEN:  No organomegaly.  No tenderness.  Normal bowel sounds.,NEUROLOGIC:  Intact.,MUSCULOSKELETAL:  Left knee reveals a range of -10 degrees extension, 126 flexion.  His extensor mechanism is intact.  There is mild varus.  He has good stability at 30 degrees of flexion.  Lachman's and posterior drawer are negative.  He has good muscle turgor.  Dorsalis pedis pulse 2+.,DIAGNOSTICS:  ,X-rays revealed severe bilateral knee DJD with joint space narrowing medially as well as the patellofemoral joint with large osteophytes, left greater than right.,IMPRESSION:,1.  Bilateral knee degenerative joint disease.,2.  Significant back pain, status post lumbar stenosis surgery with pain being controlled on methadone 10 mg b.i.d.
Knee & Back Pain  ( Orthopedic)
Description:  Evaluation for chronic pain program

REASON FOR EVALUATION:,
Knee Osteoarthrosis - Discharge Summary  ( Orthopedic)
Description:  A 66-year-old female with knee osteoarthrosis who failed conservative management.

PRINCIPAL DIAGNOSIS:,  Knee osteoarthrosis.,PRINCIPAL PROCEDURE: , Total knee arthroplasty.,HISTORY AND PHYSICAL:,  A 66-year-old female with knee osteoarthrosis.  Failed conservative management.  Risks and benefits of different treatment options were explained.  Informed consent was obtained.,PAST SURGICAL HISTORY: , Right knee surgery, cosmetic surgery, and carotid sinus surgery.,MEDICATIONS: , Mirapex, ibuprofen, and Ambien.,ALLERGIES: , QUESTIONABLE PENICILLIN ALLERGIES.,PHYSICAL EXAMINATION: , GENERAL:  Female who appears younger than her stated age.  Examination of her gait reveals she walks without assistive devices.,HEENT:  Normocephalic and atraumatic.,CHEST:  Clear to auscultation.,CARDIOVASCULAR:  Regular rate and rhythm.,ABDOMEN:  Soft.,EXTREMITIES:  Grossly neurovascularly intact.,HOSPITAL COURSE: , The patient was taken to the operating room (OR) on 03/15/2007.  She underwent right total knee arthroplasty.  She tolerated this well.  She was taken to the recovery room.  After uneventful recovery room course, she was brought to regular surgical floor.  Mechanical and chemical deep venous thrombosis (DVT) prophylaxis were initiated.  Routine postoperative antibiotics were administered.  Hemovac drain was discontinued on postoperative day #2.  Physical therapy was initiated.  Continuous passive motion (CPM) was also initiated.  She was able to spontaneously void.  She transferred to oral pain medication.  Incision remained clean, dry, and intact during the hospital course.  No pain with calf squeeze.  She was felt to be ready for discharge home on 03/19/2007.,DISPOSITION:  ,Discharged to home.,FOLLOW UP:,  Follow up with Dr. X in one week.  Prescriptions were written for Percocet and Coumadin.,INSTRUCTIONS: , Home physical therapy and PT and INR to be drawn at home for adjustment of Coumadin dosing.,
Intramedullary Nail Fixation  ( Orthopedic)
Description:  Intramedullary nail fixation of the left tibia fracture with a Stryker T2 tibial nail.  Left tibial shaft fracture status post gunshot wound.

TITLE OF OPERATION: , Intramedullary nail fixation of the left tibia fracture with a Stryker T2 tibial nail, 10 x 390 with a one 5-mm proximal locking screw and three 5-mm distal locking screws (CPT code is 27759) (the ICD-9 code again is 823.2 for a tibial shaft fracture).,INDICATION FOR SURGERY:  ,The patient is a 19-year-old male, who sustained a gunshot wound to the left tibia with a distal tibial shaft fracture.  The patient was admitted and splinted and had compartment checks.  The risks of surgery were discussed in detail including, but not limited to infection, bleeding, injuries to nerves, or vital structures, nonunion or malunion, need for reoperation, compartment syndrome, and the risk of anesthesia.  The patient understood these risks and wished to proceed.,PREOP DIAGNOSIS: , Left tibial shaft fracture status post gunshot wound (CPT code 27759).,POSTOP DIAGNOSIS: , Left tibial shaft fracture status post gunshot wound (CPT code 27759).,ANESTHESIA: , General endotracheal.,INTRAVENOUS FLUID:,  900.,ESTIMATED BLOOD LOSS:  ,100.,COMPLICATIONS:,  None.,DISPOSITION: , Stable to PACU.,PROCEDURE DETAIL:  ,The patient was met in the preoperative holding area and operative site was marked.  The patient was brought to the operating room and given preoperative antibiotics.  Left leg was then prepped and draped in the usual sterile fashion.  A midline incision was made in the center of the knee and was carried down sharply to the retinacular tissue.  The starting guidewire was used to localize the correct starting point, which is on the medial aspect of the lateral tibial eminence.  This was advanced and confirmed on the AP and lateral fluoroscopic images.  The opening reamer was then used and the ball-tip guidewire was passed.  The reduction was obtained over a large radiolucent triangle.  After passing the guidewire and achieving appropriate reduction, the flexible reamers were then sequentially passed, starting at 9 mm up to 11.5 mm reamer.  At this point, a 10 x 390 mm was passed without difficulty.  The guide was used to the proximal locking screw and the appropriate circle technique was used to the distal locking screws.  The final images were taken with fluoroscopy and a 15-mm end-cap was placed.  The wounds were then irrigated and closed with 2-0 Vicryl followed by staples to the distal screws and 0 Vicryl followed 2-0 Vicryl and staples to the proximal incision.  The patient was placed in a short leg, well-padded splint, was awakened and taken to recovery in good condition.,The plan will be nonweightbearing left lower extremity.  He will be placed in a short leg splint and should be transitioned to a short leg cast for the next 4 weeks.