smoh/medical-transcriptions huggingface dataset:
Bronchoscopy - 1  ( Surgery)
Description:  Bronchoscopy, right upper lobe biopsies and right upper lobe bronchial washing as well as precarinal transbronchial needle aspiration.

PROCEDURE:,  Bronchoscopy, right upper lobe biopsies and right upper lobe bronchial washing as well as precarinal transbronchial needle aspiration.,DETAILS OF THE PROCEDURE: , The risks, alternatives, and benefits of the procedure were explained to the patient as well as conscious sedation and she agrees to proceed.  The patient received topical lidocaine by nebulization.  The flexible fiberoptic bronchoscope was introduced orally.  The patient had normal teeth, normal tongue, normal jaw, and her vocal cords moved symmetrically and were without lesions.  I proceeded to the right upper lobe where a mucous plug was noted in the subsegmental bronchus of the posterior segment of the right upper lobe.  I proceeded under fluoroscopic guidance to guide the biopsy wire in this area and took four biopsies.  Followup fluoroscopy was negative for pneumothorax.  I wedged the bronchoscope in the subsegmental bronchus and achieved good hemostasis after three minutes.,I then proceeded to inspect the rest of the tracheobronchial tree, which was without lesions.  I performed a bronchial washing after the biopsies in the right upper lobe.  I then performed two transbronchial needle aspirations with a Wang needle biopsy in the precarinal area.  All of these samples were sent for histology and cytology respectively.  Estimated blood loss was approximately 5 cc.  Good hemostasis was achieved.  The patient received a total of 12.5 mg of Demerol and 3 mg of Versed and tolerated the procedure well.  Her ASA score was 2.
Bronchoalveolar lavage.  ( Surgery)
Description:  Evaluation of airway for possible bacterial infection performed using bronchoalveolar lavage.

POSTOPERATIVE DIAGNOSIS:  Fever.,PROCEDURES:  Bronchoalveolar lavage.,INDICATIONS FOR PROCEDURE:  The patient is a 28-year-old male, status post abdominal trauma, splenic laceration, and splenectomy performed at the outside hospital, who was admitted to the Trauma Intensive Care Unit on the evening of August 4, 2008.  Greater than 24 hours postoperative, the patient began to run a fever in excess of 102.  Therefore, evaluation of his airway for possible bacterial infection was performed using bronchoalveolar lavage.,DESCRIPTION OF PROCEDURE:  The patient was preoxygenated with 100% FIO2 for approximately 5 to 10 minutes prior to the procedure.  The correct patient and procedure was identified by time out by all members of the team.  The patient was prepped and draped in a sterile fashion and sterile technique was used to connect the BAL lavage catheter to Lukens trap suction.  A catheter was introduced into the endotracheal tube through a T connector and five successive 20 mL aliquots of normal saline were flushed through the catheter, each time suctioning out the sample into the Lukens trap.  A total volume of 30 to 40 mL was collected in the trap and sent to the lab for quantitative bacteriology.  The patient tolerated the procedure well and had no episodes of desaturation, apnea, or cardiac arrhythmia.  A postoperative chest x-ray was obtained.
Breast Excisional Biopsy  ( Surgery)
Description:  Right breast excisional biopsy with needle-localization.  The patient is a 41-year-old female with abnormal mammogram with a strong family history of breast cancer requesting needle-localized breast biopsy for nonpalpable breast mass.

PREOPERATIVE DIAGNOSIS:,  Right breast mass with abnormal mammogram.,POSTOPERATIVE DIAGNOSIS:,  Right breast mass with abnormal mammogram.,PROCEDURE PERFORMED:,  Right breast excisional biopsy with needle-localization.,ANESTHESIA: , Local with sedation.,COMPLICATIONS: , None.,SPECIMEN: , Right breast mass and confirmation by Radiology that the specimen was received with the mass was in the specimen.,DISPOSITION: , The patient tolerated the procedure well and was transferred to recovery in stable condition.,BRIEF HISTORY:  ,The patient is a 41-year-old female who presented to Dr. X's office with abnormal mammogram with a strong family history of breast cancer requesting needle-localized breast biopsy for nonpalpable breast mass.,PROCEDURE: , After informed consent, the risks and benefits of the procedure were explained to the patient.  The patient was brought into the operating suite.  After IV sedation was given, the patient was prepped and draped in normal sterile fashion.  A radial incision was made in the right lateral breast with a #10 blade scalpel.  The needle was brought into the field.  An Allis was used to grasp the breast mass and breast tissue using the #10 scalpel.  The mass was completely excised and sent out for specimen after confirmation by Radiology that the mass was in the specimen.,Hemostasis was then obtained with electrobovie cautery.  The skin was then closed with #4-0 Monocryl in a running subcuticular fashion.  Steri-Strips and sterile dressings were applied.  The patient tolerated the procedure well and was transferred to Recovery in stable condition.
Bronchoscopy - 3  ( Surgery)
Description:  Fiberoptic bronchoscopy for diagnosis of right lung atelectasis and extensive mucus plugging in right main stem bronchus.

PROCEDURE: , Fiberoptic bronchoscopy.,PREOPERATIVE DIAGNOSIS:,  Right lung atelectasis.,POSTOPERATIVE DIAGNOSIS:,  Extensive mucus plugging in right main stem bronchus.,PROCEDURE IN DETAIL:,  Fiberoptic bronchoscopy was carried out at the bedside in the medical ICU after Versed 0.5 mg intravenously given in 2 aliquots.  The patient was breathing supplemental nasal and mask oxygen throughout the procedure.  Saturations and vital signs remained stable throughout.  A flexible fiberoptic bronchoscope was passed through the right naris.  The vocal cords were visualized.  Secretions in the larynx were as aspirated.  As before, he had a mucocele at the right anterior commissure that did not obstruct the glottic opening.  The ports were anesthetized and the trachea entered.  There was no cough reflex helping explain the propensity to aspiration and mucus plugging.  Tracheal secretions were aspirated.  The main carinae were sharp.  However, there were thick, sticky, grey secretions filling the right mainstem bronchus up to the level of the carina.  This was gradually lavaged clear.  Saline and Mucomyst solution were used to help dislodge remaining plugs.  The airways appeared slightly friable, but were patent after the airways were suctioned.  O2 saturations remained in the mid-to-high 90s.  The patient tolerated the procedure well.  Specimens were submitted for microbiologic examination.  Despite his frail status, he tolerated bronchoscopy quite well.
Breast Mass Excision - 1  ( Surgery)
Description:  Left breast mass and hypertrophic scar of the left breast.  Excision of left breast mass and revision of scar.  The patient is status post left breast biopsy, which showed a fibrocystic disease with now a palpable mass just superior to the previous biopsy site.

PREOPERATIVE DIAGNOSES:,1.  Left breast mass.,2.  Hypertrophic scar of the left breast.,POSTOPERATIVE DIAGNOSES:,1.  Left breast mass.,2.  Hypertrophic scar of the left breast.,PROCEDURE PERFORMED:  ,Excision of left breast mass and revision of scar.,ANESTHESIA:  ,Local with sedation.,SPECIMEN: , Scar with left breast mass.,DISPOSITION:  ,The patient tolerated the procedure well and transferred to the recover room in stable condition.,BRIEF HISTORY:  ,The patient is an 18-year-old female who presented to Dr. X's office.  The patient is status post left breast biopsy, which showed a fibrocystic disease with now a palpable mass just superior to the previous biopsy site.  The patient also has a hypertrophic scar.  Thus, the patient elected to undergo revision of the scar at the same time as an excision of the palpable mass.,INTRAOPERATIVE FINDINGS: , A hypertrophic scar was found and removed.  The cicatrix was removed in its entirety and once opening the wound, the area of tissue where the palpable mass was, was excised as well and sent to the lab.,PROCEDURE: , After informed consent, risks, and benefits of the procedure were explained to the patient and the patient's family, the patient was brought to the operating suite, prepped and draped in the normal sterile fashion.  Elliptical incision was made over the previous cicatrix.  The total length of the incision was 5.5 cm.  Removing the cicatrix in its entirety with a #15 blade Bard-Parker scalpel after anesthetizing with local solution with 0.25% Marcaine.  Next, the area of tissue just inferior to the palpable mass, where the palpable was removed with electro Bovie cautery.  Hemostasis was maintained.  Attention was next made to approximating the deep dermal layers.  An interrupted #4-0 Vicryl suture was used and then a running subcuticular Monocryl suture was used to approximate the skin edges.  Steri-Strips as well as bacitracin and sterile dressings were applied.  The patient tolerated the procedure well and was transferred to recovery in stable condition.
Bronchoscopy  ( Surgery)
Description:  Bronchoscopy.  Atelectasis and mucous plugging.

PREOPERATIVE DIAGNOSIS: , Atelectasis.,POSTOPERATIVE DIAGNOSIS: , Mucous plugging.,PROCEDURE PERFORMED: , Bronchoscopy.,ANESTHESIA: , Lidocaine topical 2%, Versed 3 mg IV.  Conscious sedation.,PROCEDURE: , At bedside, a bronchoscope was passed down the tracheostomy tube under monitoring.  The main carina was visualized.  The trachea was free of any secretions.  The right upper lobe, middle and lower lobes appeared to have some mucoid secretions but minimal and with some erythema.  Left mainstem appeared patent.  Left lower lobe had slight plugging in the left base, but much better that previous bronchoscopy findings.  The area was lavaged with some saline and cleared.  The patient tolerated the procedure well.
Breast Biopsy  ( Surgery)
Description:  Excisional breast biopsy with needle localization.  The skin overlying the needle tip was incised in a curvilinear fashion. 

PROCEDURE PERFORMED: , Excisional breast biopsy with needle localization.,ANESTHESIA:,  General.,PROCEDURE: , After informed consent was obtained, the patient was brought to the radiology suite where needle localization was performed with mammographic guidance.  I reviewed the localizing films with the radiologist, and the patient was then brought to the operative suite and placed supine on the operating table.  General endotracheal anesthesia was induced without incident.  The patient was prepped and draped in the usual sterile manner.,The skin overlying the needle tip was incised in a curvilinear fashion.  Dissection down to the needle tip was performed using a combination of Metzenbaum scissors and Bovie electrocautery.  Every attempt was made to get approximately 1 cm of normal tissue around the lesion.  The wire was released and the lesion having been excised was removed from the wound and sent to Radiology for confirmation of excision.  The wound was copiously irrigated with sterile water, and hemostasis was obtained using Bovie electrocautery.  Once Radiology called and confirmed complete excision of the mass, the skin incision was approximated with 4-0 Vicryl in a subcuticular fashion.  The skin was prepped with benzoin and Steri-Strips were applied.  A dressing was then applied.  All surgical counts were reported as correct.,Having tolerated the procedure well, the patient was subsequently taken to the recovery room in good and stable condition.
Breast Biopsy - 2  ( Surgery)
Description:  Needle localization and left breast biopsy for left breast mass.

PREOPERATIVE DIAGNOSIS,Left breast mass.,POSTOPERATIVE DIAGNOSIS,Left breast mass.,PROCEDURE PERFORMED,Needle localization and left breast biopsy.,ANESTHESIA,General.,FLUIDS,1000 cc.,ESTIMATED BLOOD LOSS,Minimal.,DRAINS,None.,COMPLICATIONS,None.,SPECIMEN,Breast biopsy specimen with localizing needle.,FINDINGS,Breast tissue surrounding needle localization while no palpable mass.,HISTORY,The patient is a very pleasant 51-year-old African-American female who presented to the office with a mass in the left breast.  She was seen and evaluated.  On routine mammography, revealed a density in the left breast approximately at 4 o'clock position several centimeters lateral to the nipple complex.  She was readmitted for excisional biopsy.,Due to the nonpalpable nature of this lesion, the patient underwent first needle localization of the breast at the  Hospital and was taken to the operating room.,PROCEDURE IN DETAIL,After informed consent was obtained from the patient, the patient taken to the operating room and placed in the supine position on the operating table.  After appropriate general endotracheal anesthesia has been administered to the patient, the left breast was prepped and draped in a standard surgical fashion using Betadine solution.,The localization wire was cut at skin.  The patient had previously had a reduction mammoplasty in the lateral aspect of the transverse where an incision was re-incised to distance of about 4 cm.  The wire was entering the skin about 2 cm above the incision.  Superior skin flap was raised using electrocautery, and the needle localization wire was brought into the incision.  At this point, a core breast tissue of approximately 2 cm surrounding the needle was excised superiorly, inferiorly, medially, and laterally until the tissue specimen was well below the hook of the needle localization wire.,The breast specimen was then removed from breast, and silk sutures were used to mark the superior and lateral margins.  This specimen was then sent for mammography.  Pathologist called in the room to verify that the entire needle localization wire and hook were intact in the specimen.  At this point, the breast cavity was palpated and no other abnormalities were noted.  ,The wound was irrigated.  Bleeding points were easily controlled using electrocautery.  The wound was closed in two layers using 3-0 Vicryl and 4-0 Monocryl suture in a subcuticular fashion.  Benzoin, Steri-Strips, 2 x 2's, Tegaderm were placed.  The patient was aroused from anesthesia and transported to the recovery room in stable condition.  There were no complications.  All instrument, needle, and sponge counts were correct x2 at the end of the case.
Breast Biopsy - 1  ( Surgery)
Description:  Left excisional breast biopsy due to atypical ductal hyperplasia of left breast.

PREOPERATIVE DIAGNOSIS:,  Atypical ductal hyperplasia of left breast.,POSTOPERATIVE DIAGNOSIS: , Atypical ductal hyperplasia of left breast.,PROCEDURE: , Left excisional breast biopsy.,ANESTHESIA: , General.,INDICATIONS: , This is a 66-year-old female who has a history of a right lumpectomy for ductal carcinoma in situ in May 2001.  On recent mammogram, she was found to have calcifications in her left breast and a stereotactic biopsy revealed a typical ductal hyperplasia.  Excisional biopsy was, therefore, recommended.  Her family history was significant in her sister with breast cancer at the age of 34 and daughter at the age 38.,FINDINGS: , The area in question was excised.  See details below.  There was no gross evidence of malignancy.  Final evaluation will per the permanent sections.,PROCEDURE:,  Earlier today, the patient underwent a wire localization by Dr. A.  She was then taken to the operating room and placed in the supine position.  The left breast was prepped and draped in the usual sterile fashion.,A curvilinear incision was made in the upper outer quadrant to include a wire.  The skin was incised.  Hemostasis was achieved with cautery device where the breast tissue was excised around the wire.  The specimens were marked for the long stitch laterally and short stitch superiorly, and fair length superficially.  It was noted that the wire was fairly close to the superior deep aspect of the specimen.  I, therefore, excised a new superior deep margin.  This was performed with electrocautery device, the suture marks and new marks on the specimens.  The main specimen itself was sent for ***** and gross inspection.  The superior deep margin was soaked in Marcaine and the new margin was sent for permanent sections.,First, I went over to pathology and reviewed the specimen and radiograph with the radiologist Dr. A.  This revealed a clip in the tissue excised closer again to the superior deep edge of the tissue.  The specimens were then cut in serial fashion by Dr. Rust, the pathologist.  There was no gross evidence of malignancy.  As noted above, I previously excised the new superior deep margin and this was sent for permanent section.  ,The wound was thoroughly irrigated and hemostasis was carefully achieved.  The subdermal layer was closed with 4-0 PDS in simple interrupted fashion.  The skin was closed with 4-0 Monocryl in a running subcuticular fashion.  Steri-Strips and dressings were applied.  All sponge, needle, and instrument counts were correct.  The patient tolerated the procedure well and was taken to PACU in stable condition.,ESTIMATED BLOOD LOSS: , 5 mL.,COMPLICATIONS: , None.,DRAINS: , None.,SPECIMENS:,  Left breast tissue and new superior deep margin.
Breast Mass Excision  ( Surgery)
Description:  Excision of right breast mass.  Right breast mass with atypical proliferative cells on fine-needle aspiration.

PREOPERATIVE DIAGNOSIS: , Right breast mass with atypical proliferative cells on fine-needle aspiration.,POSTOPERATIVE DIAGNOSIS:,  Benign breast mass.,ANESTHESIA: , General,NAME OF OPERATION:,  Excision of right breast mass.,PROCEDURE:,  With the patient in the supine position, the right breast was prepped and draped in a sterile fashion.  A curvilinear incision was made directly over the mass in the upper-outer quadrant of the right breast.  Dissection was carried out around a firm mass, which was dissected with surrounding margins of breast tissue.  Hemostasis was obtained using electrocautery.  Frozen section exam showed a fibroadenoma with some proliferative hyperplasia within the fibroadenoma, but appeared benign.  The breast tissues were approximated using 4-0 Vicryl.  The skin was closed using 5-0 Vicryl running subcuticular stitches.  A sterile bandage was applied.  The patient tolerated the procedure well.,
BMT & T&A  ( Surgery)
Description:  Bilateral myringotomy and tube placement, tonsillectomy and adenoidectomy.

PREOPERATIVE DIAGNOSES: , Chronic otitis media and tonsillar adenoid hypertrophy.,POSTOPERATIVE DIAGNOSES:,  Chronic otitis media and tonsillar adenoid hypertrophy.,PROCEDURES:,  Bilateral myringotomy and tube placement, tonsillectomy and adenoidectomy.,INDICATIONS FOR PROCEDURE: , The patient is a 3-1/2-year-old child with history of recurrent otitis media as well as snoring and chronic mouth breathing.  Risks and benefits of surgery including risk of bleeding, general anesthesia, tympanic membrane perforation as well as persistent recurrent otitis media were discussed with the patient and parents and informed consent was signed by the parents.,FINDINGS:  ,The patient was brought to the operating room, placed in supine position, given general endotracheal anesthesia.  The left ear was then draped in a clean fashion.  Under microscopic visualization, the ear canal was cleaned of the wax.  Myringotomy incision was made in the anterior inferior quadrant.  There was no fluid in the middle ear space.  A Micron Bobbin tube was easily placed.  Floxin drops were placed in the ear.  The same was performed on the right side with similar findings.  The patient was then turned to be placed in Rose position.  The patient draped in clean fashion.  A small McIvor mouth gag was used to hold open the oral cavity.  The soft palate was palpated.  There was no submucous cleft felt.  Using a 1:1 mixture of 1% Xylocaine with 1:100,000 epinephrine and 0.25% Marcaine, both tonsillar pillars and the fossae injected with approximately 7 mL total.  Using a curved Allis the right tonsil was grasped and pulled medially.  Tonsil was dissected off the tonsillar fossa using a Coblator.  The left tonsil was removed in the similar fashion.  Hemostasis then achieved in tonsillar fossa using the Coblator on coagulation setting.  The soft palate was then retracted using red rubber catheter.  Under mirror visualization, the patient was found to have enlarged adenoids.  The adenoids were removed using the Coblator.  Hemostasis was also achieved using the Coblator on coagulation setting.  The rubber catheter was then removed.  Reexamining the oropharynx, small bleeding points were cauterized with the Coblator.  Stomach contents were then aspirated with saline sump.  The patient was woken up from anesthesia, extubated and brought to recovery room in stable condition.  There were no intraoperative complications.  Needle and sponge correct.  Estimated blood loss minimal.
Bony Impacted Teeth Removal  ( Surgery)
Description:   Surgical removal of completely bony impacted teeth #1, #16, #17, and #32.  Completely bony impacted teeth #1, #16, #17, and #32.

PREOPERATIVE DIAGNOSIS:,  Completely bony impacted teeth #1, #16, #17, and #32.,POSTOPERATIVE DIAGNOSIS: , Completely bony impacted teeth #1, #16, #17, and #32.,PROCEDURE: , Surgical removal of completely bony impacted teeth #1, #16, #17, and #32.,ANESTHESIA: , General nasotracheal.,COMPLICATIONS: , None.,CONDITION:  ,Stable to PACU.,DESCRIPTION OF PROCEDURE: , Patient was brought to the operating room, placed on the table in a supine position, and after demonstration of an adequate plane of general anesthesia via the nasotracheal route, patient was prepped and draped in the usual fashion for an intraoral procedure.  A gauze throat pack was placed and local anesthetic was administered in all four quadrants, a total of 7.2 mL of lidocaine 2% with 1:100,000 epinephrine, and 3.6 mL of bupivacaine 0.5% with 1:200,000 epinephrine.  Beginning on the upper right tooth #1, incision was made with a #15 blade.  Envelope flap was raised with the periosteal elevator, and bone was removed on the buccal aspect with straight elevator.  Potts elevator was then used to luxate the tooth from the socket.  Remnants of the follicle were then removed with hemostat.  The area was irrigated and then closed with 3-0 gut suture.  On the lower right tooth #32, incision was made with a #15 blade.  Envelope flap was raised with the periosteal elevator, and bone was removed on the buccal and distal aspect with a high-speed drill with a round bur.  Tooth was then sectioned with the bur and removed in several pieces.  Remnants of the follicle were removed with a curved hemostat.  The area was irrigated with normal saline solution and closed with 3-0 gut sutures.  Moving to #16 on the upper left, incision was made with a #15 blade.  Envelope flap was raised with the periosteal elevator, and bone was removed on the buccal aspect with straight elevator.  Potts elevator was then used to luxate the tooth from the socket.  Remnants of the follicle were removed with a curved hemostat.  The area was irrigated with normal saline solution and closed with 3-0 gut sutures.  Moving to the lower left #17, incision was made with a #15 blade.  Envelope flap was  raised with the periosteal elevator, and bone was removed on the buccal and distal aspect with high-speed drill with a round bur.  Then the bur was used to section the tooth vertically.  Tooth was removed in several pieces followed by the removal of the remnants of the follicle.  The area was irrigated with normal saline solution and closed with 3-0 gut sutures.  Upon completion of the procedure, the throat pack was removed and the pharynx was suctioned.  An NG tube was then inserted and small amount of gastric contents were suctioned.  Patient was then awakened, extubated, and taken to the PACU in stable condition.