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There is evidence of focal wall thickening in the sigmoid colon (image #69) with adjacent fat stranding in association with a diverticulum.

There is evidence of wall thickening of a small area in the terminal portion of the large intestine before reaching the rectum (image #69).Here the adjacent fat is stranding inside in association with a small bulging sac pushing outward.

In one part of the colon, the wall seems thicker in the picture (#69), and there's some fat around a pocket, which could mean diverticulitis.

An EEG was consistent with a focal lesion in the left hemisphere.

A test that measures electrical activity in the brain was consistent with a lesion of a small definite area of the left part of the brain.

An additional brain scan suggested a problem on the left side of the brain.

There is no evidence of fractures or destructive osseous lesions.

There is no evidence of fractures or destructive bone lesions.

No signs of broken bones or harmful bone abnormalities were found.

The patient had the bowel prep that revealed no significant bleeding.

The patient had the bowel preparation that revealed no significant bleeding.

The patient had a bowel prep, which didn't show any significant bleeding.

2. Right orchidopexy.

2. Fixing of the right testicle to adjacent tissues using sutures.

Fixed the right testicle (orchidopexy).

5. Hypertension.

5. High blood pressure.

High blood pressure.

There are multiple diverticula in the rectosigmoid.

Multiple small bulges stick out of the side of the last section of the colon.

There are many small pockets in the lower part of your intestine.

1. No abnormal/unexpected foci of contrast enhancement; specifically, no evidence for metastases or masses.

1. No abnormal/unexpected cells that are notably different from the surrounding cells of contrast enhancement; specifically, no evidence for the spread of cancer cells or lumps.

No areas of abnormal contrast enhancement, which means no signs of tumors or spreading cancer.

PREOPERATIVE DIAGNOSIS: Biliary colic and biliary dyskinesia.

DIAGNOSIS BEFORE OPERATION: A steady or intermittent ache in the upper abdomen and a functional gallbladder disorder because something blocks the normal flow of bile from the gallbladder.

Before Surgery Diagnosis: The patient had pain from gallbladder problems.

REASON FOR EXAM: Left arm and hand numbness.

REASON FOR EXAMINATION: Left arm and hand numbness.

REASON FOR EXAM: The person is experiencing numbness in their left arm and hand.

EXAM: Three views of the right ankle.

EXAM: Three views of the right ankle.

TEST: Three different pictures of the right ankle were taken.

ANESTHESIA: Conscious sedation per Anesthesia.

ANESTHESIA: Anesthesia that provides a depressed level of consciousness during which a patient retains control over his protective reflexes and can respond to commands.

Type of medicine used during the surgery: Medication to make the patient relaxed but not fully asleep.

This was felt consistent with vasculitis.

This was felt consistent with blood vessel inflammation.

Doctors believed that the inflammation may have been caused by an autoimmune disease called vasculitis.

TOURNIQUET TIME: 59 minutes.

The device to control the flow of blood (tourniquet) was applied for 59 minutes.

The tourniquet, a device to control blood flow, was used for about 59 minutes.

['tourniquet']

She became pregnant after her 4th cycle of Cytoxan, despite warnings to the contrary.

She became pregnant after her 4th cycle of Cytoxan, despite warnings to the contrary.

The patient became pregnant despite being advised against it due to the medication she was taking.

IMPRESSION:

SUMMARY:

Summary:

She has undergone 9 cycles of Cytoxan (one cycle every 2 months) as of 4/97.

She has undergone 9 cycles of Cytoxan (one cycle every 2 months) as of 4/97.

As of April 1997, the patient had received nine cycles of Cytoxan.

Reflexes 2/2 throughout.

Reflexes 2/2 throughout.

The person's reflexes were normal.

PROCEDURE: Both sides were done exactly the same way.

MEDICAL OPERATION: Both sides were done the same way.

The procedure was done the same way on both sides.

8. Doppler reveals moderate mitral regurgitation and moderate-to-severe aortic regurgitation.

8. Doppler (a test used to detect blood flow) reveals moderate heart valve condition in which the flaps of the mitral valve do not close properly, causing a backward flow of blood back to the heart. Doppler also reveals a moderate-to-severe disease in which the aortic valve does not close tightly.

Doppler imaging shows moderate mitral regurgitation (a leakage of blood through the mitral valve) and moderate-to-severe aortic regurgitation (a leakage of blood through the aortic valve).

['mitral_valve_regurgitation', 'aortic_valve_regurgitation']

No masses or organomegaly.

No masses or abnormal enlargement of organs.

Nothing unusual felt in the abdomen.

The patient was brought into the operating suite.

The patient was brought into the operating suite.

Getting Ready for Surgery: The patient was taken to the operating room.

Dedicated scans of the pelvis disclosed phleboliths, but no free fluid or adenopathy.

Dedicated scans of the pelvis disclosed small, round lumps of calcium that form in a patient's veins, but no fluid or enlarged or swollen lymph nodes.

Special scans of the lower pelvis found some tiny stone-like formations in the veins but no fluid or swollen lymph nodes.

ANESTHESIA: Local.

ANESTHESIA: Local.

The patient received local anesthesia to numb the area.

BIOMETRY:

MEASUREMENTS OF THE BABY:

Baby's size measurements:

Using a cold punch biopsy forceps, a random biopsy was obtained.

A random small sample of the bladder tissue was taken for further examination using cold punch forceps. <figure_cold_punch_biopsy_forceps>

The doctor took a small tissue sample using special forceps.

['cold_punch_biopsy_forceps']

An INR is to be obtained on 09/03/2007 and should the Coumadin dose be changed, an addendum will be dictated to accompany this discharge summary.

A test on blood clot forming time is to be obtained on 09/03/2007 and should the blood thinner dose be changed, additional information will be dictated to accompany this discharge summary.

If the Coumadin dose changes, a note will be added to the patient's discharge summary.

There was also segmental narrowing of the caliber of the vessels in the circle of Willis.

There was also no partial narrowing of vessels in the joining area of several arteries at the bottom side of the brain.

There was also narrowing in some of the blood vessels in a region called the circle of Willis.

['circle_of_willis_bottom_view_of_brain']

DIAGNOSIS ON ADMISSION: Gastrointestinal bleed.

DIAGNOSIS ON ADMISSION: Stomach and intestines bleed.

When the patient came in, they had a stomach or intestinal bleed.

1. Right spermatocelectomy.

1. Removing of the right smooth fluid-filled swelling in the testicle.

Removed the right sperm sac cyst (spermatocelectomy).

3. Cerebral palsy.

3. A group of disorders that affect a patient's ability to move and maintain balance and posture.

A condition called cerebral palsy.

He was placed in the supine position and was given IV sedation by the Anesthesia Department.

He was placed on his back and was given anesthesia into a vein by the Anesthesia Department.

He lay on his back, and the Anesthesia Department gave him medicine through an IV to make him relaxed.

This was evaluated in the office.

This was comprehensively assessed in the office.

This was evaluated in the office.

The TMs show normal landmarks.

The eardrums show normal landmarks.

The eardrums look normal.

ALLERGIES: NKDA.

ALLERGIES: No known drug allergy.

Allergies: None.

Amniotic Fluid: Within normal limits.

Liquid that surrounds the baby: Within normal limits.

The amount of fluid around the baby is normal.

Cervical vertebral body height, alignment and interspacing are maintained.

Cervical vertebral body height, alignment, and interspacing are maintained.

The height, alignment, and spacing of the neck bones are normal.

FL: 2.2cm consistent with 16 weeks, 4 days

The length of the thigh bone (FL): 2.2 cm consistent with 16 weeks, 4 days

The baby's leg bone length (FL) is like that of a baby at 16 weeks and 4 days.

She received DVT prophylaxis with a combination of Coumadin, Lovenox, SCD boots, and TED stockings.

She received medication to prevent blood clots (in her legs).The medication was a combination of Coumadin (blood thinner), Lovenox (blood thinner), SCD boots ("sleeves" that wrap around the legs which helps to prevent blood clots), and TED stockings (similarly, stockings that help prevent blood clots and swelling in the legs). <figure_SCD_boots, figure_TED_stockings>

To prevent blood clots, she was given a combination of Coumadin, Lovenox, SCD boots, and TED stockings.

['SCD_boots', 'TED_stockings']

MEASUREMENTS: Height 135 cm and weight 28.1 kg.

MEASUREMENTS: Height 135 cm and weight 28.1 kg.

Measurements: The child's height is 135 cm (about 4 feet 5 inches) and weight is 28.1 kg (about 62 pounds).

FINDINGS: Poor prep with friable internal hemorrhoids, but no gross lesions, no source of bleed.

FINDINGS: Poor preparation for the procedure.Friable internal hemorrhoids (piles) were found, but no gross lesions, and no source of bleed.

During the colonoscopy, they found that the inside of the lower part of the digestive system wasn't prepared very well and had some weak spots in the blood vessels, but they didn't see any big problems or the source of the bleeding.

Consumes 6 bottles of beers, one day a week.

Consumes 6 bottles of beer, one day a week.

She drinks 6 bottles of beer one day a week.

The visualized lung bases are clear.

The visualized lower part of the lungs is clear.

The bottom part of the lungs looks clear.

The patient's PT/INR was 1.03, PTT 25.8.

A test to measure how long it takes for a clot to form in a blood sample was taken, and its normalized result was 1.03. A test for blood clot forming time was also taken, this time to see how clotting works within a blood vessel, and its result was 25.8.

The patient's blood tests looked good with numbers like PT/INR at 1.03 and PTT at 25.8.

HEENT: Normocephalic.

Head, ears, eyes, nose, oral, and throat examination: the head and all major organs of the head are in normal condition and without significant abnormalities.

Head: Normal.

LUNGS: Clear to auscultation, with no retractions.

LUNGS: Clear to listening, with no sign that she is working hard to breathe.

Lungs: The lungs sound clear when listened to with a stethoscope, and there are no signs of difficulty in breathing.

IMPRESSION: Negative cervical spine.

IMPRESSION: The neck region of the backbone is normal (no trauma).

CONCLUSION: The CT scan shows no problems or abnormalities in the neck.

She will remain on Coumadin for 30 days.

She will remain on this blood thinner for 30 days.

The patient will take Coumadin for 30 days.

2. Mild degenerative changes.

2. Mild wearing down of spinal disks.

A bit of wear and tear.

The cut edges were fulgurated.

The heat from an electric current of a special device was used to destroy the tissue of the cut edges.

The cut ends were sealed using heat.

No gallops.

No gallops (no abnormal heart rhythm marked by the occurrence of three distinct sounds in each heartbeat like the sound of a galloping horse).

No unusual sounds in the heart.

The cystic artery was transected in similar fashion.

The branch of the right liver artery that provides arterial supply to the gallbladder was transected similarly.

Cutting the Blood Vessel: The blood vessel was cut in a similar way.

NECK: No thyroid enlargement.

NECK: No thyroid enlargement.

The thyroid gland in the neck is normal.

A midline scrotal incision was made measuring about 2 cm in size.

A midline scrotal cut was made measuring about 2 cm in size.

Cutting the Skin: The doctor made a small 2 cm cut in the middle of the scrotum.

PAST MEDICAL HISTORY: Significant for atrial fibrillation, hypertension, osteoarthritis of the knees, hypercholesterolemia, non-insulin-dependent diabetes mellitus, asthma, and hypothyroidism.

PAST MEDICAL HISTORY: Significant for abnormal heartbeat, high blood pressure, wear and tear arthritis of the knees, high cholesterol, non-insulin-dependent diabetes (develops when a body's cells can't properly take up sugar from the food), asthma, and underactive thyroid.

MEDICAL HISTORY: She has had heart rhythm issues, high blood pressure, knee joint pain, high cholesterol, diabetes, asthma, and thyroid problems in the past.

LUNGS: Clear with good air movement.

LUNGS: Clear with good air movement.

BREATHING: Lungs are clear, and the air moves well.

He, therefore, comes to the operating room today for surgical closure of his gastrostomy.

He, therefore, comes to the operating room today for surgical closure of the opening between the stomach and the skin.

The child came to the operating room for surgery to close the hole.

These findings are compatible with edema.

These findings are compatible with swelling.

These findings indicate the presence of swelling.

VITAL SIGNS: Temperature 98.9 and blood pressure 105/57.

VITAL SIGNS: Temperature 98.9 degrees Fahrenheit and blood pressure 105/57.

Vital signs: The child's temperature is 98.9В°F (37.2В°C) and blood pressure is 105/57.

The patient tolerated the procedure well and left the operating room in satisfactory condition.

The patient tolerated the procedure well and left the operating room in satisfactory condition.

The patient handled the procedure well and left the operating room in good condition.

2. Status post orthotopic liver transplantation.

2. Liver transplantation surgery.

Had a liver transplant in the past.

7. Hypothyroidism.

7. Underactive thyroid.

The patient has an underactive thyroid gland.

CC: Seizures.

MAIN COMPLAINT: Seizures.

CC: Seizures.

It was done without difficulty.

It was done without difficulty.

No Problems Removing It: This was done without any trouble.

Retroflexion noted no abnormality of the internal ring.

Maneuver during colonoscopy was done in which the device tip is deflected in a U-turn so that the imaging system is directed backward, allowing clear visualization of the last part of the rectum.During the Maneuver no abnormality of the internal anal ring was found.

The doctor also checked for any abnormalities in the internal ring by bending the colonoscope backward, but found none.

Fetal Cardiac Activity: Normal at 140 BPM

Heart rate and rhythm of the baby: Normal at 140 beats per minute.

The baby's heart rate is normal at 140 beats per minute.

She underwent neuropsychologic testing which revealed no significant cognitive deficits.

She underwent testing of physiological processes of the nervous system which revealed no significant problems with the ability to think, learn, remember, use judgment, and make decisions.

The patient was tested for any cognitive problems and no major issues were found.

The mucosa throughout the colon and in the terminal ileum was normal, with no evidence of colitis.

The soft tissue throughout the colon and in the final part of the small bowel was normal, with no evidence of colon inflammation.

The inner lining of the colon and small intestine looked normal, and there were no signs of inflammation.

She underwent Cerebral Angiography on 2/22/96.

She underwent x-rays to see how blood flows through the brain on 2/22/96.

On February 22, 1996, she had a procedure called Cerebral Angiography.

There are no focal liver masses.

There are no abnormal solid or liquid masses in the liver.

No lumps found in the liver.

PLAN: We would plan to continue with the medications as follows:

PLAN OF THE TREATMENT: Our plan would be to continue with the medications as follows:

Plan: Our plan is to continue with the following medications:

The central canal and neuroforamen are grossly patent at all levels.

The central part of the spine and the openings where a spinal nerve exits the spine are good at all levels.

Nerves and spine openings look good.

His Plavix is discontinued.

His Plavix (to help prevent blood clots from forming) is discontinued.

We stopped giving the patient Plavix.

The testicle was placed in a normal orientation.

The testicle was placed in a normal orientation.

Putting Testicle Back Right: They put the testicle in its correct position.

8. Gastroesophageal reflux disease.

8. A condition when stomach acid repeatedly flows back into the tube connecting the mouth and stomach.

The patient has a condition where stomach acid goes back up into their throat.

There were no other abnormalities noted in the abdomen.

There were no other abnormalities noted in the abdomen.

No Other Problems in the Belly: There were no other unusual things found in the belly.

PLAN: The patient will be discharged home.

PLAN: The patient will be discharged home.

The plan is to send the patient home.

REASON FOR EXAM: Vegetation and bacteremia.

REASON FOR EXAM: Irregular growths made of germs and cell pieces form a mass in the heart and bacteria in the bloodstream.

REASON FOR EXAM: The examination was done to check the condition of the vegetation and bacteremia in the patient.

['vegetation']

The area was injected with 5 mL of 0.25% Marcaine.

The area was injected with 5 milliliters of 0.25% Marcaine (local numbing medicine).

The area was numbed with an injection of a medicine called Marcaine.

She also awoke with a headache (HA) and mild neck stiffness.

She also awoke with a headache and mild neck stiffness.

She also woke up with a headache and mild stiffness in her neck.

Sclerae nonicteric.

The white part of the patient's eye was still white (no yellowing and it appears healthy).

Eyes: No yellowing.

These changes corresponded to the areas of ischemic changes seen on MRI.

These changes corresponded to the areas of {<changes related to lack of oxygen in the brain>, <ischemic changes>} seen on MRI.

These changes matched the areas of decreased blood flow seen on the MRI scan.

CHIEF COMPLAINT: GI bleed.

MAIN COMPLAINT: Digestive tract.

MAIN PROBLEM: Stomach bleeding.

ALLERGIES: There are no allergies.

ALLERGIES: There are no allergies.

Allergies: The child does not have any known allergies.

4. To return to the clinic in 4 months.

4. To return to clinic in 4 months.

The patient should return to the clinic in 4 months for a follow-up visit.

OPERATION: Cystoscopy, TUR, and electrofulguration of recurrent bladder tumors.

OPERATION: First, a tube with a thin camera (called a cystourethroscope) was introduced through the urethra and passed to the bladder to look inside. Then, surgery to remove the tumor from the bladder through the urethra was performed.In the end, heat from an electric current to destroy the tumor was applied.

Surgery: The doctor used a thin tube with a camera to look inside the bladder, remove the tumors, and burn them with electricity.

There was no evidence of any peritoneal studding or masses.

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

No Abnormal Growth or Masses: There were no unusual lumps or growths in the abdomen.

3. No intrarenal stones.

3. No kidney stones.

No kidney stones.

Entire spermatocele sac was removed.

The entire smooth fluid-filled swelling sac was removed.

Removing the Whole Lump: They got rid of the entire lump.

EXTREMITIES: The right knee incision is intact.

Hands and feet: The right knee cut is unbroken.

The incision on the right knee looks good.

2. Moderate stool throughout the colon.

2. Moderate stool throughout the colon.

There's quite a bit of stool in the colon.

OPERATIVE PROCEDURE: Bilateral vasectomy.

WHAT WAS DONE: Both tubes that carry sperm from the testicles to the penis are cut.

The surgery performed was a procedure to block the tubes that carry sperm on both sides.

He will be started on tube feedings in 6 hours with aspiration precautions and dietary to determine his nutritional goal.

He will be started on tube feedings in 6 hours with precautions of food not going back into the throat from the stomach and dietary to determine his nutritional goal.

In 6 hours, they will start feeding the patient through the tube, and they'll be careful to prevent choking, figuring out how much food he needs.

The two #10 ports were then closed in the fascia with #0 Vicryl and a UR6 needle.

The two cuts that had been done with the instruments of size 10 were then closed with #0 Vicryl (a smooth, synthetic, absorbable suture) and a UR6 needle.

Closing the Holes: The holes left by the tubes were closed in the muscles with special thread.

INDICATIONS: A 79-year-old woman with recurrent bladder tumors of the bladder neck.

REASONS FOR OPERATION: A 79-year-old woman with recurrent bladder tumors of the bladder neck.

Reasons for surgery: A 79-year-old woman had bladder tumors that came back near the opening of the bladder.

['urological_organs']

3. Hypothyroidism.

3. Underactive thyroid.

The third diagnosis is an underactive thyroid.

PREOPERATIVE DIAGNOSES: Rectal bleeding and perirectal abscess.

DIAGNOSIS BEFORE OPERATION: {<Bleeding from the bottom>, <Bleeding from back passage>, <Blood that passes from anus>} and a boil-like lump filled with pus found near anus, rectum or the space between genitals and anus.

Preoperative Diagnosis: Rectal bleeding and abscess near the rectum.

His most recent H&H was 38.6/13.2 that was this morning.

His most recent hematocrit and hemoglobin was 38.6/13.2 which was this morning.

The most recent blood test, done this morning, showed that the patient's hemoglobin and hematocrit levels were 38.6 and 13.2, respectively.

DISCHARGE DIAGNOSES:

DISCHARGE DIAGNOSES:

REASON FOR LEAVING THE HOSPITAL:

The tract and the stomach were freed.

The tract and the stomach were opened.

The connection between the hole and the stomach was separated.