smoh/medical-transcriptions huggingface dataset:
Spontaneous Vaginal Delivery  ( Surgery)
Description:  Spontaneous vaginal delivery.   Term pregnancy at 40 and 3/7th weeks.  On evaluation of triage, she was noted to be contracting approximately every five minutes and did have discomfort with her contractions.

PREOPERATIVE DIAGNOSIS: , Term pregnancy at 40 and 3/7th weeks.,PROCEDURE PERFORMED: , Spontaneous vaginal delivery.,HISTORY OF PRESENT ILLNESS:  ,The patient is a 36-year-old African-American female who is a G-2, P-2-0-0-2 with an EDC of 08/30/2003.  She is blood type AB -ve with antibody screen negative and is also rubella immune, VDRL nonreactive, hepatitis B surface antigen negative, and HIV nonreactive.  She does have a history of sickle cell trait.  She presented to Labor and Delivery Triage at 40 and 3/7th weeks gestation with complaint of contractions every ten minutes.  She also stated that she has lost her mucous plug.  She did have fetal movement, noted no leak of fluid, did have some spotting.  On evaluation of triage, she was noted to be contracting approximately every five minutes and did have discomfort with her contractions.  She was evaluated by sterile vaginal exam and was noted to be 4 cm dilated, 70% effaced, and -3 station.  This was a change from her last office exam, at which she was 1 cm to 2 cm dilated.,PROCEDURE DETAILS:,  The patient was admitted to Labor and Delivery for expected management of labor and AROM was performed and the amniotic fluid was noted to be meconium stained.  After her membranes were ruptured, contractions did increase to every two to three minutes as well as the intensity increased.  She was given Nubain for discomfort with good result.,She had a spontaneous vaginal delivery of a live born female at 11:37 with meconium stained fluid as noted from ROA position.  After controlled delivery of the head, tight nuchal cord was noted, which was quickly double clamped and cut and the shoulders and body were delivered without difficulty.  The infant was taken to the awaiting pediatrician.  Weight was 2870 gm, length was 51 cm.  The Apgars were 6 at 1 minute and 9 at 5 minutes.  There was initial neonatal depression, which was treated by positive pressure ventilation and the administration of Narcan.,Spontaneous delivery of an intact placenta with a three-vessel cord was noted at 11:45.  On examination, there were no noted perineal abrasions or lacerations.  On vaginal exam, there were no noted cervical or vaginal sidewall lacerations.  Estimated blood loss was less than 250 cc.  Mother and infant are in recovery doing well at this time.
Stab Wound Closure  ( Surgery)
Description:  Stab wound, left posterolateral chest.   Closure of stab wound.

PREPROCEDURE DIAGNOSIS:,  Stab wound, left posterolateral chest.,POST PROCEDURE DIAGNOSIS: , Stab wound, left posterolateral chest.,PROCEDURE PERFORMED: , Closure of stab wound.,ANESTHESIA: , 1% lidocaine with epinephrine by local infiltration.,NARRATIVE:  ,The wound was irrigated copiously with 500 mL of irrigation and closed in 1 layer with staples after locally anesthetizing with 1% lidocaine with epinephrine.  The patient tolerated the procedure well without apparent complications.
Spermatocelectomy  ( Surgery)
Description:  Spermatocelectomy and orchidopexy

PREOPERATIVE DIAGNOSIS:,  Right spermatocele.,POSTOPERATIVE DIAGNOSIS:  ,Right spermatocele.,OPERATIONS PERFORMED:,1.  Right spermatocelectomy.,2.  Right orchidopexy.,ANESTHESIA: , Local MAC.,ESTIMATED BLOOD LOSS:,  Minimal.,FLUIDS: , Crystalloid.,BRIEF HISTORY OF THE PATIENT:  ,The patient is a 77-year-old male who comes to the office with a large right spermatocele.  The patient says it does bother him on and off, has occasional pain and discomfort with it, has difficulty with putting clothes on etc. and wanted to remove.  Options such as watchful waiting, removal of the spermatocele or needle drainage were discussed.  Risk of anesthesia, bleeding, infection, pain, MI, DVT, PE, risk of infection, scrotal pain, and testicular pain were discussed.  The patient was told that his scrotum may enlarge in the postoperative period for about a month and it will settle down.  The patient was told about the risk of recurrence of spermatocele.  The patient understood all the risks, benefits, and options and wanted to proceed with removal.,DETAILS OF THE PROCEDURE:  ,The patient was brought to the OR.  Anesthesia was applied.  The patient's scrotal area was shaved, prepped, and draped in the usual sterile fashion.  A midline scrotal incision was made measuring about 2 cm in size.  The incision was carried through the dartos through the scrotal sac and the spermatocele was identified.  All the layers of the spermatocele were removed.  Clear layer was visualized, was taken all the way up to the base, the base was tied.  Entire spermatocele sac was removed.  After removing the entire spermatocele sac, hemostasis was obtained.  The testicle was not in normal orientation.  The testis and epididymis was removed, which is a small appendage on the superior aspect of the testicle.  The testicle was placed in a normal orientation.  Careful attention was drawn not to twist the cord.  Orchidopexy was done to allow the testes to stay stable in the postoperative period using 4-0 Vicryl and was tied at 3 different locations.  Absorbable sutures were used, so that the patient does not feel the sutures in the postoperative period.  The dartos was closed using 2-0 Vicryl in running locking fashion.  There was excellent hemostasis.  The skin was closed using 4-0 Monocryl.  Dermabond was applied.  The patient tolerated the procedure well.  The patient was brought to the recovery room in stable condition.
Skin Graft  ( Surgery)
Description:  Split-thickness skin grafting a total area of approximately 15 x 18 cm on the right leg and 15 x 15 cm on the left leg.

DIAGNOSIS:,  Stasis ulcers of the lower extremities,OPERATION:,  Split-thickness skin grafting a total area of approximately 15 x 18 cm on the right leg and 15 x 15 cm on the left leg.,INDICATIONS:,  This 84-year old female presented recently with large ulcers of the lower extremities.  These were representing on the order of 50% or more of the circumference of her lower leg.  They were in a distribution to be consistent with stasis ulcers.  They were granulating nicely and she was scheduled for surgery.,FINDINGS:,  Large ulcers of lower extremities with size as described above.  These are irregular in shape and posterior and laterally on the lower legs.  There was no evidence of infection.  The ultimate skin grafting was quite satisfactory.,PROCEDURE: , Having obtained adequate general endotracheal anesthesia, the patient was prepped from the pubis to the toes.  The legs were examined and the wounds were Pulsavaced bilaterally with 3 liters of saline with Bacitracin.  The wounds were then inspected and there was adequate hemostasis and there was only minimal fibrinous debris that needed to be removed.  Once this was accomplished, the skin was harvested from the right thigh at approximately 0.013 inch.  This was meshed 1:1.5 and then stapled into position on the wounds.  The wounds were then dressed with a fine mesh gauze that was stapled into position as well as Kerlix soaked in Sulfamylon solution.,She was then dressed in additional Kerlix, followed by Webril, and splints were fashioned in a spiral fashion that avoided foot drop and stabilized them, and at the same time did not put pressure across the heels.  The donor site was dressed with Op-Site.  The patient tolerated the procedure well and returned to the recovery room in satisfactory condition.
Sling (SPARC Suburethral)  ( Surgery)
Description:  SPARC suburethral sling due to stress urinary incontinence.

PREOPERATIVE DX: , Stress urinary incontinence.,POSTOPERATIVE DX: , Stress urinary incontinence.,OPERATIVE PROCEDURE: , SPARC suburethral sling.,ANESTHESIA: , General.,FINDINGS & INDICATIONS: , Outpatient evaluation was consistent with urethral hypermobility, stress urinary incontinence.  Intraoperatively, the bladder appeared normal with the exception of some minor trabeculations.  The ureteral orifices were normal bilaterally.,DESCRIPTION OF OPERATIVE PROCEDURE:,  This patient was brought to the operating room, a general anesthetic was administered.  She was placed in dorsal lithotomy position.  Her vulva, vagina, and perineum were prepped with Betadine scrubbed in solution.  She was draped in usual sterile fashion.  A Sims retractor was placed into the vagina and Foley catheter was inserted into the bladder.  Two Allis clamps were placed over the mid urethra.  This area was injected with 0.50% lidocaine containing 1:200,000 epinephrine solution.  Two areas suprapubically on either side of midline were injected with the same anesthetic solution.  The stab wound incisions were made in these locations and a sagittal incision was made over the mid urethra.  Metzenbaum scissors were used to dissect bilaterally to the level of the ischial pubic ramus.  The SPARC needles were then placed through the suprapubic incisions and then directed through the vaginal incision bilaterally.  The Foley catheter was removed.  A cystoscopy was performed using a 70-degree cystoscope.  There was noted to be no violation of the bladder.  The SPARC mesh was then snapped onto the needles, which were withdrawn through the stab wound incisions.  The mesh was snugged up against a Mayo scissor held under the mid urethra.  The overlying plastic sheaths were removed.  The mesh was cut below the surface of the skin.  The skin was closed with 4-0 Plain suture.  The vaginal vault was closed with a running 2-0 Vicryl stitch.  The blood loss was minimal.  The patient was awoken and she was brought to recovery in stable condition.
Skin Biopsy  ( Surgery)
Description:  The skin biopsy was performed on the right ankle and right thigh.  The patient was consented for skin biopsy.  The complications, instructions as to how the procedure will be performed, and postoperative instructions were given to the patient. 

PROCEDURE:  ,The site was cleaned with antiseptic.  A local anesthetic (2% lidocaine) was given at each site.  A 3 mm punch biopsy was performed in the left calf and left thigh, above the knee.  The site was then checked for bleeding.  Once hemostasis was achieved, a local antibiotic was placed and the site was bandaged.,The patient was not on any anticoagulant medications.  There were also no other medications which would affect the ability to conduct the skin biopsy.  The patient was further instructed to keep the site completely dry for the next 24 hours, after which a new Band-Aid and antibiotic ointment should be applied to the area.  They were further instructed to avoid getting the site dirty or infected.  The patient completed the procedure without any complications and was discharged home.,The biopsy will be sent for analysis.,The patient will follow up with Dr. X within the next two weeks to review her results.
Shunt Revision - 3  ( Surgery)
Description:  Ventriculoperitoneal shunt revision with replacement of ventricular catheter and flushing of the distal end.

PREOPERATIVE DIAGNOSIS:,  Blocked ventriculoperitoneal shunt.,POSTOPERATIVE DIAGNOSIS:,  Blocked ventriculoperitoneal shunt.,PROCEDURE: , Ventriculoperitoneal shunt revision with replacement of ventricular catheter and flushing of the distal end.,ANESTHESIA: , General.,HISTORY: , The patient is nonverbal.  He is almost 3 years old.  He presented with 2 months of irritability, vomiting, and increasing seizures.  CT scan was not conclusive, but shuntogram shows no flow through the shunt.,DESCRIPTION OF PROCEDURE: , After induction of general anesthesia, the patient was placed supine on the operating room table with his head turned to the left.  Scalp was clipped.  He was prepped on the head, neck, chest and abdomen with ChloraPrep.  Incisions were infiltrated with 0.5% Xylocaine with epinephrine 1:200,000.  He received oxacillin.,He was then reprepped and draped in a sterile manner.,The frontal incision was reopened and extended along the valve.  Subcutaneous sharp dissection with Bovie cautery was done to expose the shunt parts.  I separated the ventricular catheter from the valve, and this was a medium pressure small contour Medtronic valve.  There was some flow from the ventricular catheter, but not as much as I would expect.  I removed the right-angled clip with a curette and then pulled out the ventricular catheter, and there was gushing of CSF under high pressure.  So, I do believe that the catheter was obstructed, although inspection of the old catheter holes did not show any specific obstructions.  A new Codman BACTISEAL catheter was placed through the same hole.  I replaced it several times because I wanted to be sure it was in the cavity.  It entered easily and there was still just intermittent flow of CSF.  The catheter irrigated very well and seemed to be patent.,I tested the distal system with an irrigation filled feeding tube, and there was excellent flow through the distal valve and catheter.  So I did not think it was necessary to replace those at this time.  The new catheter was trimmed to a total length of 8 cm and attached to the proximal end of the valve.  The valve connection was secured to the pericranium with a #2-0 Ethibond suture.  The wound was irrigated with bacitracin irrigation.  The shunt pumped and refilled well.  The wound was then closed with #4-0 Vicryl interrupted galeal suture and Steri-Strips on the skin.  It was uncertain whether this will correct the problem or not, but we will continue to evaluate.  If his abdominal pressure is too high, then he may need a different valve.  This will be determined over time, but at this time, the shunt seemed to empty and refill easily.  The patient tolerated the procedure well.  No complications.  Sponge and needle counts were correct.  Blood loss was minimal.  None replaced.
Shockwave Lithotripsy  ( Surgery)
Description:  Right shockwave lithotripsy, cystoscopy, and stent removal x2.

PREOPERATIVE DIAGNOSIS:,  Right renal stone.,POSTOPERATIVE DIAGNOSIS:  ,Right renal stone.,PROCEDURE: , Right shockwave lithotripsy, cystoscopy, and stent removal x2.,ANESTHESIA: , LMA.,ESTIMATED BLOOD LOSS:,  Minimal.  The patient was given antibiotics preoperatively.,HISTORY: , This is a 47-year-old male who presented with right renal stone and right UPJ stone.  The right UPJ stone was removed using ureteroscopy and laser lithotripsy and the stone in the kidney.  The plan was for shockwave lithotripsy.  The patient had duplicated system on the right side.  Risk of anesthesia, bleeding, infection, pain, MI, DVT, PE was discussed.  Options such as watchful waiting, passing the stone on its own, and shockwave lithotripsy were discussed.  The patient wanted to proceed with the shockwave to break the stone into small pieces as possible to allow the stones to pass easily.  Consent was obtained.,DETAILS OF THE OPERATION:  ,The patient was brought to the OR.  Anesthesia was applied.  The patient was placed in the supine position.  Using Dornier lithotriptor total of 2500 shocks were applied.  Energy levels were slowly started at O2 increased up to 7; gradually the stone seem to have broken into smaller pieces as the number of shocks went up.  The shocks were started at 60 per minute and slowly increased up to 90 per minute.  The patient's heart rate and blood pressure were stable throughout the entire procedure.,After the end of the shockwave lithotripsy the patient was placed in dorsal lithotomy position.  The patient was prepped and draped in usual sterile fashion and cystoscopy was done.  Using graspers, the stent was grasped x2 and pulled out, both stents were removed.  The patient tolerated the procedure well.  The patient was brought to recovery in stable condition.  The plan was for the patient to follow up with us and plan for KUB in about two to three months.
Shunt Revision - 2  ( Surgery)
Description:  Endoscopic proximal and distal shunt revision with removal of old valve and insertion of new.

PREOPERATIVE DIAGNOSIS: , Shunt malfunction.,POSTOPERATIVE DIAGNOSIS: , Partial proximal obstruction, patent distal system.,TITLE OF OPERATION: , Endoscopic proximal and distal shunt revision with removal of old valve and insertion of new.,SPECIMENS:  ,None.,COMPLICATIONS:,  None.,ANESTHESIA:,  General.,SKIN PREPARATION:  ,Chloraprep.,INDICATIONS FOR OPERATION: , Headaches, irritability, slight increase in ventricle size.  Preoperatively patient improved with Diamox.,BRIEF NARRATIVE OF OPERATIVE PROCEDURE: , After satisfactory general endotracheal tube anesthesia was administered, the patient was positioned on the operating table in the supine position with the head rotated towards the left.  The right frontal area and right retroauricular area was shaved and then the head, neck, chest and abdomen were prepped and draped out in the routine manner.  The old scalp incision was opened with a Colorado needle tip and the old catheter was identified as we took the Colorado needle tip over the existing ventricular catheter, right over the sleeve on top of it and when that was entered, the CSF poured out around the ventricular catheter.  The ventricular catheter was then disconnected from the reservoir and endoscopically explored.  We saw it was blocked up proximally.  The catheter was a little adherent and required some freeing up with coagulation and on twisting of the ventricular catheter, I was able to free up the ventricular catheter, and endoscopically inserted a new Bactiseal ventricular catheter.  The catheter went down to the septum and I could see both the right and left lateral ventricles and elected to pass it into the right lateral ventricle.  It irrigated out well.  There was minimal amount of bleeding, but not significant.  The distal catheter system was tested.  There was good distal run off.  Therefore, a linear skin incision was made in the retroauricular area.  Tunneling was performed between the two incisions and a ProGAV valve set to an opening pressure of 10 with a 1-5 shunt assist was brought through the subgaleal tissue, connected to the distal catheter and a flushing reservoir was interposed between the burr hole site ventricular catheter and the ProGAV valve.  All connections were secured with 2-0 Ethibond sutures.  Careful attention was made to make sure that the ProGAV was in the right orientation.  The wounds were irrigated out with Bacitracin, closed in a routine manner using Vicryl for the deep layers and Monocryl for the skin, followed by Mastisol and Steri-Strips.  The patient tolerated the procedure well.  He was awakened, extubated and taken to recovery room in satisfactory condition.
Shunt Revision - 1  ( Surgery)
Description:  Endoscopic proximal shunt revision.

PREOPERATIVE DIAGNOSIS: , Shunt malfunction.  The patient with a ventriculoatrial shunt.,POSTOPERATIVE DIAGNOSIS:,  Shunt malfunction.  The patient with a ventriculoatrial shunt.,ANESTHESIA: , General endotracheal tube anesthesia.,INDICATIONS FOR OPERATION: , Headaches, fluid accumulating along shunt tract.,FINDINGS: , Partial proximal shunt obstruction.,TITLE OF OPERATION:,  Endoscopic proximal shunt revision.,SPECIMENS: , None.,COMPLICATIONS:,  None.,DEVICES: , Portnoy ventricular catheter.,OPERATIVE PROCEDURE:,  After satisfactory general endotracheal tube anesthesia was administered, the patient positioned on the operating table in supine position with the right frontal area shaved and the head was prepped and draped in a routine manner.  The old right frontal scalp incision was reopened in a curvilinear manner, and the Bactiseal ventricular catheter was identified as it went into the right frontal horn.  The distal end of the VA shunt was flushed and tested with heparinized saline, found to be patent, and it was then clamped.  Endoscopically, the proximal end was explored and we found debris within the lumen, and then we were able to freely move the catheter around.  We could see along the tract that the tip of the catheter had gone into the surrounding tissue and appeared to have prongs or extensions in the tract, which were going into the catheter consistent with partial proximal obstruction.  A Portnoy ventricular catheter was endoscopically introduced and then the endoscope was bend so that the catheter tip did not go into the same location where it was before, but would take a gentle curve going into the right lateral ventricle.  It flushed in quite well, was left at about 6.5 cm to 7 cm and connected to the existing straight connector and secured with 2-0 Ethibond sutures.  The wounds were irrigated out with Bacitracin and closed in a routine manner using two 3-0 Vicryl for the galea and a 4-0 running Monocryl for the scalp followed by Mastisol and Steri-Strips.  The patient was awakened and extubated having tolerated the procedure well without complications.  It should be noted that the when we were irrigating through the ventricular catheter, fluid easily came out around the catheter indicating that the patient had partial proximal obstruction so that we could probably flow around the old shunt tract and perhaps this was leading to some of the symptomatology or findings of fluid along the chest.
Shunt Revision  ( Surgery)
Description:  Bilateral endoscopic proximal shunt revision and a distal shunt revision.

TITLE OF OPERATION:,  Bilateral endoscopic proximal shunt revision and a distal shunt revision.,INDICATIONS FOR OPERATION:,  Headaches, full subtemporal site.,PREOPERATIVE DIAGNOSIS: , Slit ventricle syndrome.,POSTOPERATIVE DIAGNOSIS: , Slit ventricle syndrome.,FINDINGS:,  Coaptation of ventricles against proximal end of ventricular catheter.,ANESTHESIA: , General endotracheal tube anesthesia.,DEVICES: , A Codman Hakim programmable valve with Portnoy ventricular catheter, a 0/20 proGAV valve with a shunt assist of 20 cm dual right-angled connector, and a flushing reservoir.,BRIEF NARRATIVE OF OPERATIVE PROCEDURE:,  After satisfactory general endotracheal tube anesthesia was administered, the patient was positioned on the operating table in the prone position with the head held on a soft foam padding.  The occipital area was shaven bilaterally and then the areas of the prior scalp incisions were infiltrated with 0.25% Marcaine with 1:200,000 epinephrine after routine prepping and draping.  Both U-shaped scalp incisions were opened exposing both the left and the right ventricular catheters as well as the old low pressure reservoir, which might have been leading to the coaptation of the ventricles.  The patient also had a right subtemporal depression, which was full preoperatively.  The entire old apparatus was dissected out.  We then cut both the ventricular catheters and secured them with sutures so that __________ could be inserted.  They were both inspected.  No definite debris were seen.  After removing the ventricular catheters, the old tracts were inspected and we could see where there was coaptation of the ventricles against the ventricular catheter.  On the right side, we elected to insert the Portnoy ventricular catheter and on the left a new Bactiseal catheter was inserted underneath the corpus callosum in a different location.  The old valve was dissected out and the proGAV valve with a 2-0 shunt assist was inserted and secured with a 2-0 Ethibond suture.  The proGAV valve was then connected to a Bactiseal distal tubing, which was looped in a cephalad way and then curved towards the left burr hole site and then the Portnoy catheter on the right was secured with a right-angled sleeve and then interposed between it and the left burr hole site with a flushing reservoir.  All connections secured with 2-0 Ethibond suture and a small piece of Bactiseal tubing between the flushing reservoir and the connector, which secured the left Bactiseal tubing to the two other Bactiseal tubings one being the distal Bactiseal tubing going towards the proGAV valve, which was set to an opening pressure of 8 and the other one being the Bactiseal tubing, which was going towards the flushing reservoir.,All the wounds were irrigated out with bacitracin and then closed in a routine manner using Vicryl for the deep layers and Monocryl for the skin, followed by Mastisol and Steri-Strips.  The patient tolerated the procedure well without complications.  CSF was not sent off.