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EXAM: CT scan of the abdomen and pelvis without and with intravenous contrast.

EXAM: CT scan of the abdomen and pelvis without and with intravenous substance injection that helps differentiate soft tissues and blood vessels.

TEST: Picture of the belly and lower pelvis using a CT scan, with and without a special liquid.

He had been well until 7 months prior to evaluation when he started having spells which were described as "dizzy spells" lasting from several seconds to one minute in duration.

He had been well until 7 months before evaluation when he started having spells which were described as "dizzy spells" lasting from several seconds to one minute in duration.

They were fine until 7 months before the check-up when they started having episodes described as "dizzy spells." These spells lasted from a few seconds to a minute.

The patient's scrotal area was shaved, prepped, and draped in the usual sterile fashion.

The patient's scrotal area was shaved and prepared in the standard surgical fashion including the isolation of the sterile area in which a procedure is to be performed from a potentially contaminated area.

Preparing the Area: They shaved the patient's scrotum area, cleaned it, and covered it with a sterile sheet.

Specifically, the posterior wall of the distal rectum and anal canal were soft and unremarkable.

Specifically, the back side of the distant part of the rectum and {<anal canal>, <the terminal portion of the digestive tract>} were soft and normal.

The back wall of the rectum and anus looked normal and felt soft.

...this suggests two separate areas of cerebral pathology."

...this suggests two separate areas of brain pathology."

...this suggests two different areas of brain pathology.

COMPLICATIONS: None.

COMPLICATIONS: None (no unfavorable result of the surgery).

There were no problems during or after the surgery.

No hydrocephalus is evident.

No buildup of fluid in the cavities (ventricles) deep within the brain is evident.

There is no evidence of excess fluid in the brain (hydrocephalus).

DIET: 1800-calorie ADA.

DIET: 1800 calories recommended by the American Diabetic Association.

DIET: Eating a daily 1800-calorie plan recommended for people with diabetes.

Speech was dysarthric with mild decreased fluency marked by occasional phonemic paraphasic errors.

Difficulty speaking with mild decreased fluency marked by occasional mispronunciation of some phonemes.

She has difficulty speaking, and occasionally uses the wrong word.

POSTOPERATIVE DIAGNOSIS: Recurrent bladder tumors.

DIAGNOSIS AFTER OPERATION: Recurrent bladder tumors.

After surgery: The patient still has bladder tumors that have come back.

FINDINGS: There is no evidence for acute fracture or subluxation.

FINDINGS: There is no evidence of acute fracture or partial dislocation.

RESULTS: No broken bones or dislocations found.

TOURNIQUET TIME: 9 minutes at 200 torr.

TIME THE PATIENT WAS WEARING TOURNIQUET (TO STOP THE FLOW OF BLOOD): 9 minutes at 200 torr (200 millimeters of mercury).

TOURNIQUET TIME: 9 minutes at 200 torr.

Options were discussed for voluntary sterility and he has elected to proceed with a bilateral vasectomy.

Options were discussed for voluntary permanent birth control and he has elected to proceed with a cutting of both tubes that carry sperm from the testicles to the penis.

The patient chose to have a surgery called bilateral vasectomy to become sterile.

4. Diffuse cortical volume loss, consistent with patient's age.

4. Volume loss of the outer layer of the whole brain, consistent with the patient's age.

General brain shrinkage, which is expected for the patient's age.

COMPARISON: None.

COMPARISON WITH NORMAL IMAGES: None.

Comparison: No previous scans available for comparison.

EOMI.

During the eye movement test (moving the eyes in eight different directions in space) no injuries were found.

Eye movements normal.

CN: VFFTC, Pupils 5/5 decreasing to 3/3.

Brain nerves: no visual field defects have been identified, both pupils were of size five in the dark and of size 3 in bright light.

CRANIAL NERVES: Vision, facial expression, hearing, and taste are working fine. Her pupils react to light, but the right pupil is smaller.

There is a small plantar calcaneal spur.

There is a small {<heel spur>, <bony outgrowth formed on the heel bone under the sole>}.

A small bone spur is present on the bottom of the heel.

He was unable to sustain enough caloric intake and had markedly decreased albumin stores.

He was unable to sustain enough caloric intake and had markedly decreased liver protein stores.

He couldn't eat enough food and had very little albumin in his body.

The patient did well after the liver transplant and the only problems started:

The patient did well after the liver transplant and the only problems started:

Post-transplant: The child recovered well after the liver transplant, but now they have a couple of new issues:

INDICATIONS FOR PROCEDURE: A gentleman who is here today requesting voluntary sterility.

REASONS FOR SURGERY: A gentleman who is here today requesting to receive permanent birth control voluntarily.

The reason for the surgery was the patient's desire to become sterile.

The study was highly suggestive of vasculitis.

The study was highly suggestive of blood vessel inflammation.

The findings strongly suggested the presence of inflammation in the blood vessels (vasculitis).

The risks and perceivable complications of the surgeries were discussed with the patient via a translator as well as nonsurgical treatment options and this was scheduled emergently.

The risks and possible medical problems after the surgeries were discussed with the patient via a translator as well as treatment options without surgery and this was scheduled emergently.

The patient was informed about the risks and possible complications of the surgery, as well as alternative nonsurgical treatments. The surgery was scheduled urgently.

He will be followed closely as an outpatient.

He will be followed closely as an outpatient.

The doctors will keep a close eye on him in follow-up appointments.

1. Normal left ventricular size and function.

1. The left heart chamber has normal size and function.

The left ventricle is normal in size and function.

In addition, in the 3 months prior to evaluation, the right upper extremity would become tonic and flexed during the episodes, and he began to experience post ictal fatigue.

In addition, in the 3 months before evaluation, the right arm would become tonic and flexed during the episodes, and he began to experience an altered state of consciousness after the spell.

In the 3 months before the check-up, the patient's right arm would become stiff and bent during the episodes. They also experienced fatigue after the episodes.

HX: The patient was initially evaluated at UIHC at 7 years of age.

HISTORY: The patient was initially evaluated at University of Iowa Hospitals and Clinics at 7 years of age.

HX: The patient was first checked at UIHC when they were 7 years old.

Pedal pulses are palpable bilaterally.

Pulse in legs can be found by fingers.

You can feel a pulse in both feet.

IMPRESSION: Findings consistent with diverticulitis.

IMPRESSION: Findings consistent with a disease, where small bulges develop in the lining of the intestine, and these bulges may become inflamed or infected.

Summary: You likely have diverticulitis based on these findings.

The calvarium is intact.

The top part of the skull is normal.

The skull is intact.

No RAPD or INO.

No asymmetric pupillary reaction to light when it is shined back and forth between the two eyes (negative RAPD). No inability to move both your eyes together when looking to the side.

No abnormalities were detected when checking the eyes' response to light.

['RAPD', 'INO']

IMPRESSION:

IMPRESSION:

Summary:

The right ankle was prepped and draped in standard fashion.

The right ankle of the patient was prepared before the surgery in standard fashion.

The right ankle was cleaned and covered with sterile drapes.

Per T2 weighted sequence, there is no hyperdense vascularity.

Per T2 weighted sequence (one of the basic pulse sequences on MRI), there is no extremal density in blood vessels.

Blood vessels in the brain do not appear abnormally bright in the T2 weighted images.

A Foley catheter was inserted and was productive of approximately 500 cc of urine.

A thin, flexible catheter used especially to drain urine from the bladder by way of the urethra was inserted and was productive of approximately 500 cc of urine.

To help empty the bladder, a thin tube called a Foley catheter was inserted, and it collected around 500 cc of urine.

['foley_catheter']

Soft tissue windows demonstrate atherosclerotic calcification of the abdominal aorta, which is not dilated.

Soft tissue windows demonstrate plaques made of calcium from the largest artery in the body that runs from the heart through the torso, which is not enlarged.

There are signs of artery hardening in the belly, but it's not too big.

GENERAL: A well-developed, well-nourished child in no acute distress.

GENERAL: A well-developed, well-nourished child in no stress related to traumatic event.

General appearance: The child looks healthy and well-developed, with no signs of immediate distress.

The patient denied any shortness of breath.

The patient denied any shortness of breath.

BREATHING: She said she can breathe fine.

The skin was approximated with 2-0 Vicryl and closed with staples.

The skin was approximated with 2-0 Vicryl (used in general soft tissue approximation and/or ligation) and closed with staples (used to close surgical incisions or wounds that are too big or complex to close with traditional stitches).

The skin was stitched using sutures and staples.

Significant low attenuation is seen throughout the white matter of the right frontal, parietal, and temporal lobes.

Significant low attenuation is seen throughout the white matter of the right frontal, parietal, and temporal lobes.

There are areas of reduced brightness in the white matter of the right frontal, parietal, and temporal lobes.

['brain_lobes']

The intervening stomach was then closed with interrupted #4-0 Lembert, Nurolon sutures.

The intervening stomach was then closed with Nurolon (a synthetic, braided, non-absorbable suture) and a special suture technique in which each stitch was separately tied.

The gap in the stomach was closed with stitches.

['interrupted_lembert_suture']

The patient reported that this rash was itchy.

The patient reported that this rash was itchy.

The patient said the rash was itchy.

1. Normal appendix.

1. Normal appendix.

The appendix is normal.

An MRI brain scan on 2/20/96 revealed nonspecific white matter changes in the right periventricular region.

An MRI brain scan on 2/20/96 revealed nonspecific white matter changes in the right periventricular region. The periventricular area is located deep within the brain and therefore is very susceptible to reduced blood flow in the small blood vessels that originate at the surface of the brain.

Another brain scan revealed some changes in the white matter in the right periventricular region.

A complete dictation for the EGD will be done separately by Dr. X.

A complete dictation for the examination of the lining of the swallowing pipe, stomach, and upper part of the small intestine will be done separately by Dr. X.

Dr. X will write a full report about the stomach part of the procedure separately.

She was switched from Percocet to oxycodone SR 20 mg b.i.d. and she had good pain control with this using the Percocet only for breakthrough pain.

She was switched from Percocet (used to help relieve moderate to severe pain) to oxycodone (an opioid pain-relief medicine to treat severe pain) with sustained release for a more controlled release of 20 mg twice a day. She had good pain control with this using Percocet only for breakthrough pain.

Her pain medicine was changed and she felt better, but still needed some extra pain medicine sometimes.

Total of 100 mL of Isovue was administered intravenously.

A total of 100 mL of Isovue was given through a vein (for making blood vessels and other parts of the body visible to X-rays).

Liquid called Isovue was put into a vein, about 100 mL in total.

MOTOR: 5/5 strength throughout with normal muscle bulk and tone.

Movement of body parts exam: 5/5 strength throughout with normal muscle bulk and tone.

MUSCLES: Her strength and muscle tone are normal.

The scope was withdrawn.

The tube was removed.

The tube was taken out.

TECHNIQUE: MRI of the head performed without and with 12 ml of IV gadolinium (Magnevist).

TECHNIQUE: MRI of the head performed without and with 12 ml of gadolinium (Magnevist) intravenously (for contrast).

Technique: MRI scan of the head was done with a contrast agent called gadolinium, both with and without it.

The peritoneum was smooth.

The membrane lining the abdominal cavity was smooth.

Smooth Lining: The inside of the belly was smooth.

All the fluid and air was then aspirated and then all ports were removed under direct visualization.

All the fluid and air were then drawn in and then all devices were removed under direct visualization.

Taking Out the Tubes: All the tubes were taken out while the surgeon could see them.

EDD by ultrasound measurements: 10-31-2007.

ESTIMATED DATE OF LABOR BASED ON ULTRASOUND TEST MEASUREMENTS: The 31st of October, 2007.

The estimated due date based on ultrasound measurements is also October 31, 2007.

The stomach was transilluminated and an optimal position for the PEG tube was identified using the single poke method.

The tube with light and camera was put in the stomach and the best position for the feeding tube was identified and the light was put on it from inside directed to outside.The light could be seen from the outside, and a finger was pressed against the abdominal wall where the light was located so that the indentation was seen on the camera.

They shone a light through the stomach and found the best place to put the tube using a method that only needed one hole.

There was no evidence of any peritoneal studding.

There was no evidence of any bumps in the membrane lining the abdominal cavity.

No Abnormal Lumps: There were no unusual lumps or growths in the lining of the belly.

The patient continued to make great progress with her therapies so much so that we are anticipating her discharge on Monday, 09/03/2007.

The patient continued to make great progress with her therapies so much so that we are anticipating her discharge on Monday, 09/03/2007.

These are the reasons why the patient was in the hospital and the reasons she was going to leave.

The second was a dimpled scar about 5 cm from the anal verge on the left buttock's cheek.

The second was a scar looking like a natural dent about 5 cm from the external boundary of the anal canal on the left buttock's cheek.

The second scar was a small indentation about 5 cm away from the edge of the anus on the left side of the buttock.

A postcontrast MRI is required for further characterization of this mass.

A postcontrast MRI (which produces highly detailed pictures of the soft tissue of a brain) is required for further characterization of this mass.

A follow-up MRI with contrast is needed to get more information about this mass.

No significant sinus mucosal disease per MRI.

No significant sinus mucosal disease per MRI.

No significant inflammation in the sinuses seen on the MRI.

POSTOPERATIVE DIAGNOSIS: Left lateral malleolus fracture.

DIAGNOSIS AFTER THE SURGERY: Broken lower part of the left ankle.

After surgery, the diagnosis remained the same.

He was last seen, 6/19/95, and was taking Dilantin and Tegretol.

He was last seen on the 19th of June 1995 and was taking Dilantin (used to prevent and control seizures) and Tegretol (works by decreasing nerve impulses that cause seizures and pain).

Their last visit was on 6/19/95, and they were taking Dilantin and Tegretol.

I explained fully the procedure to the patient.

I explained fully the procedure to the patient.

I explained the procedure to the patient in detail.

The patient reports that her last bowel movement was on 08/24/2007 just prior to her discharge from ABCD Hospital.

The patient reports that her last bowel movement was on 08/24/2007 just before her discharge from ABCD Hospital.

She had a bowel movement on 08/24/2007 before leaving the hospital.

There are no other complaints.

There are no other complaints.

No other problems or complaints were reported.

Dr. Y Miller saw him in consultation and recommended a colonoscopy.

Dr. Y Miller saw him in consultation and recommended a bowel examination with a tube.

Another doctor, Dr. Y Miller, saw the patient and suggested doing a colonoscopy to get a better look inside.

INSTRUCTIONS GIVEN TO THE PATIENT AT THE TIME OF DISCHARGE:

INSTRUCTIONS GIVEN TO THE PATIENT AT THE TIME OF DISCHARGE:

The patient was given instructions when they left the hospital.

Dermabond was applied.

Dermabond (a sterile, liquid, skin adhesive that holds wound edges together) was applied.

Using Skin Glue: They applied a special skin glue called Dermabond.

POSTOPERATIVE DIAGNOSIS: Perianal abscess.

DIAGNOSIS AFTER OPERATION: A boil-like lump filled with pus found near anus.

Postoperative Diagnosis: Abscess near the anus.

The skin was infiltrated with local anesthesia and the needle and sheath were inserted through the abdomen into the stomach under direct visualization.

The skin was numbed across the place where the feeding tube was inserted (local anesthesia).Then, the needle covered with a small tube was inserted through the abdomen into the stomach while looking at it lit up.

They numbed the skin with local anesthesia and put a needle and tube through the belly into the stomach while looking at it.

No hemorrhoids were noted.

No hemorrhoids (swollen, enlarged veins that form inside and outside of the anus and rectum) were noted.

No hemorrhoids were detected during the examination.

Unemployed and formerly worked at an herbicide plant.

Unemployed and formerly worked at an herbicide plant.

She is not working anymore, but she used to work at a herbicide plant.

OPERATIVE PROCEDURE: The patient was taken to the operative room where general anesthesia was successfully introduced.

THE SURGERY: The patient was taken to the operative room where general anesthesia was successfully introduced.

The patient was taken to the operating room and given general anesthesia successfully.

The gallbladder has been resected.

The gallbladder has been surgically removed.

The gallbladder was removed.

There was no evidence of bleeding.

There was no evidence of bleeding.

There was no bleeding.

ACTIVITY: As tolerated.

ACTIVITY: As much as tolerated, to her comfort.

ACTIVITY: Do what you can manage.

Please see report above.

Please see the report above.

Please read the report above for more details.

FINDINGS: CT scan of the abdomen and pelvis was performed without and with intravenous contrast.

FINDINGS: CT scan of the abdomen and pelvis without and with intravenous substance injection that helps differentiate soft tissues and blood vessels.

RESULTS: The CT scan took pictures of the belly and pelvis, both with and without using a special liquid.

They will follow up in the office on Thursday.

They will follow up in the office on Thursday.

He has a follow-up appointment at the doctor's office on Thursday.

The patient understood all the risks, benefits, and options and wanted to proceed with removal.

The patient understood all the risks, benefits, and options and wanted to proceed with removal.

Patient's Decision: The patient understood all the information about the risks, benefits, and choices, and chose to have the lump removed.

4. Tiny airdrop within the bladder.

4. Tiny airdrop within the bladder.

A small amount of air in the bladder.

There is some diffuse right knee edema and some limited ecchymosis as well.

There is some puffiness of the right knee and some bounded blue or purple skin discoloration as well.

The right knee looks a little swollen and bruised.

One week prior to presentation, she went to a local ER for menorrhagia.

One week before the presentation, she went to a local emergency room for menstrual bleeding that lasted more than 7 days.

One week before going to the doctor, she went to the emergency room for heavy menstrual bleeding.

IMPRESSION: Acute appendicitis.

CONCLUSION: Acute appendicitis (a painful swelling of the appendix).

Impression: The person has acute appendicitis.

On 2/26/96, she underwent a right frontal brain biopsy.

On 2/26/96, a sample of the forehead part of the brain was taken to examine it more closely.

On February 26, 1996, the patient had a sample of her brain removed for testing.

ANESTHESIA: General.

ANESTHESIA: General.

Anesthesia: The child was given general anesthesia.

He was jaundiced, but there was no report that he required treatment.

He had the yellowing of the skin, whites of the eyes, and the moist, inner lining of some organs and body cavities. But there was no report that he required treatment.

The patient had jaundice, but there's no mention of any treatment being needed.

Oral contrast was also administered.

The substance that helps differentiate soft tissues and blood vessels was also given through the mouth.

They also made you drink some liquid.

That evening, she began to experience numbness and weakness in the lower right face.

That evening, she began to experience numbness and weakness in the lower right face.

That evening, she started to feel numbness and weakness in the lower right part of her face.

PHYSICAL EXAMINATION:

PHYSICAL EXAMINATION:

Physical examination:

FINAL IMPRESSION: This is a 10-year-old with a history of:

FINAL CONCLUSION: This is a 10-year-old with history of:

Summary: This is a 10-year-old child with the following medical history:

The pharynx is clear.

The throat is clear.

The back of the throat looks clear.

The patient had been properly instructed regarding using the CPM machine and she had been instructed as well to limit each CPM session to two hours.

The patient had been properly instructed regarding using the continuous passive motion machine for recovery. She had been instructed as well to limit each continuous passive motion machine session to two hours.

The patient was taught how to use a machine to help move their knee, but was told to only use it for two hours at a time.

['CPM_machine']

He was placed on numerous antiepileptic medication combinations including Tegretol, Dilantin, Phenobarbital, Depakote, Acetazolamide, and Mysoline.

He was placed on numerous antiseizure medication combinations including: Tegretol (works by decreasing nerve impulses that cause seizures and pain), Dilantin (used to prevent and control seizures), Phenobarbital (used to control seizures), Depakote (treat complex partial seizures, simple and complex absence seizures, as well as acute manic symptoms in patients with bipolar disorder), Acetazolamide (used to control seizures, particularly absence seizures), and Mysoline (works by controlling the abnormal electrical activity in the brain that occurs during a seizure).

They were prescribed various combinations of antiepileptic medications, including Tegretol, Dilantin, Phenobarbital, Depakote, Acetazolamide, and Mysoline.

On the fourth hospital day, she was noted to have some rashes about the right upper extremity and right side of her abdomen.

On the fourth hospital day, she was noted to have some rashes on the right hand and right side of her abdomen.

On the fourth day in the hospital, the patient had a rash on their right arm and side of their belly.

BIRTH HX: 32 weeks gestation to a G4 mother and weighed 4#11oz.

BIRTH HISTORY: The amount of time pregnancy 32 weeks was.His mother was pregnant for 4 times.He weighed 4 pounds 11 ounces.

BIRTH HX: The patient was born prematurely at 32 weeks to a mother who had been pregnant four times before. They weighed 4 pounds and 11 ounces.

Gradient echo imaging should be obtained.

Gradient echo imaging (a type of MRI for faster image acquisitions) should be obtained.

A specific type of imaging called gradient echo should be performed.

Options such as watchful waiting, removal of the spermatocele or needle drainage were discussed.

Options such as watchful waiting, removal of the smooth fluid-filled swelling, or fluid removal with a needle were discussed.

Choices Discussed: The patient and the doctor talked about different options, like waiting, removing the lump, or using a needle to drain it.

Coord/Station/Gait: unremarkable.

Coordinations/Standing/Walking: unremarkable.

The person's coordination, balance, and walking were normal.

9. Morton neuroma of the feet bilaterally.

9. A benign (non-cancerous) tumor of a nerve in her both feet.

The patient has a nerve problem in both feet.

All instrument, sponge, needle counts were correct at the end of case.

All instrument, sponge, and needle counts were correct at the end of the case.

All the tools, sponges, and needles were counted correctly at the end of the procedure.