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162 | Admission Date :
2015-09-14
Discharge Date :
2015-09-19
Service :
NEONATOLOGY
HISTORY OF PRESENT ILLNESS :
The patient is a 3285 gm infant born at 37 5/7 weeks to a 21 year old G3 P1 now 2 mother with prenatal screens as follows :
O positive , antibody negative , hepatitis B surface antigen negative , RPR nonreactive , GBS negative .
Unremarkable pregnancy except for minor fullness of the left renal pelvis reported during the week prior to delivery .
Past OB history remarkable for postpartum depression .
Mother was admitted in labor .
Baby was delivered by repeat C-section with rupture of membranes at delivery .
Apgars were 8 and 9 .
CMED CSRU staff was called about 30 minutes of age for grunting , flaring and retractions and the baby was admitted to the CMED CSRU .
HOSPITAL COURSE:
1. Respiratory .
The Athol Memorial Hospital hospital course was initially consistent with transient tachypnea of the newborn .
Chest x-ray revealed mild streakiness of the lung fields .
He was initially placed on nasal cannula with subsequent resolution of respiratory distress .
Nasal cannula was weaned off on day of life 3 and he initially was maintaining O2 sat above 94% and breathing comfortably .
He was subsequently placed back on nasal cannula for mild oxygen desaturation and was requiring 25 c/min flow at the time of discharge .
No apneic or brady episodes .
2. Cardiovascular .
The patient 's cardiovascular status has been stable throughout his CMED CSRU stay .
No murmur on exam .
3. FEN .
The patient had been tolerating oral feeding as of day of life 2 and is currently taking Enfamil 20 p.o. ad lib .
He has been weaned off IV fluids and has been maintaining good blood glucose .
His birth weight was 3285 gm .
His weight is 3015 gm on day of life 5 .
4. GI .
The patient 's bilirubin level at 24 hours of life was 4.6.
No phototherapy was started .
5. ID .
The patient was not started on antibiotics , given lack of sepsis risk factors .
His initial CBC showed no left shift .
Blood culture had remained no growth to date .
6. Heme .
The patient 's initial hematocrit was 35.8 .
No transfusion during this admission .
CONDITION ON TRANSFER :
The patient has been doing well on low flow nasal cannula. He has been tolerating p.o. ad lib feeds . | null | [
{
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"text": "nasal cannula",
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348 | ADMISSION DATE :
3-26-93
DISCHARGE DATE :
4-3-93
HISTORY OF PRESENT ILLNESS :
The patient is a 73 year old female who was transferred for cardiac catheterization after ventricular fibrillation arrest in the setting of an acute inferior myocardial infarction and a urinary tract infection .
The patient was admitted on 3-16-93 to Diy Hospital for an E. coli urinary tract infection .
The patient was readmitted on 3-20-93 because of fever , chills and a sudden onset of ventricular fibrillation arrest , successfully cardioverted back to rapid atrial fibrillation and finally to sinus rhythm , where an electrocardiogram then showed ST elevation in inferior leads .
Peak CPK was 2494 with 18% MB 's .
She required intubation for mild to moderate congestive heart failure , treated with diuretics , intravenous nitroglycerin and heparin .
She had post-infarction angina , was transferred here for angiography and possible percutaneous transluminal coronary angioplasty .
HOSPITAL COURSE :
On 3-27-93 , patient underwent cardiac catheterization , coronary and left ventricular angiography without complications .
Review of these angiograms demonstrated a dominant right coronary artery with a focal 50% stenosis in the mid-portion .
The left main coronary artery was clear .
The left anterior descending had moderate plaques with a 50% proximal stenosis of the right anterior oblique caudal view .
The proximal diagonal D1 had a 50% stenosis .
The circumflex had a long 30% stenosis proximally and an 80% stenosis at the origin of the second major marginal artery .
The left ventricular angiogram showed akinesis of the posterobasal walls , severe hypokinesis of the diaphragmatic wall and trace mitral regurgitation .
The patient was maintained on heparin anticoagulation .
An exercise tolerance test with Thallium was to be performed in order to assess myocardial viability in the infarct zone .
The right coronary artery lesion was complex and there was severe stenosis in the obtuse marginal 1 .
The patient had no further angina .
On 4-2-93 , she underwent a Persantine Thallium study .
This showed no diagnostic electrocardiogram changes for ischemia and no angina pectoris .
The thallium images showed a large region of persistently reduced blood flow involving the apex and inferoposterior segments of the left ventricular wall .
This was consistent with scar .
There was no definite perfusion abnormality in the circumflex zone .
In view of these findings , it was elected to discharge her on her present medical program .
The patient is to return to the follow up care of Dr. Ko Kollciem at the Diy Hospital .
CHPO E. JESCOBEA , M.D.
TR :
sq / bmot
DD :
06-13-93
TD :
06/15/93
CC :
Dr. Ko Kollciem , Retchard Healthcare to Dr. Wall | null | [
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"text": "cardiac catheterization",
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572 | Admission Date :
12/12/1996
Discharge Date :
12/16/1996
HISTORY / REASON FOR HOSPITALIZATION :
The patient is a 42 year old gravida II , para I female with a long history of menorrhagia and pelvic pain .
She also has a history of endometriosis that is symptomatic .
She used Danocrine for approximately nine months and was pain free , but was unable to tolerate the side effects .
She is status post several laparoscopies in the past with which she was diagnosed with endometriosis .
She has recently been on Depo-Provera and has had episodes of break-through bleeding for six weeks at a time .
She desired surgical therapy .
HOSPITAL COURSE :
On 12/12/96 she had an uncomplicated total abdominal hysterectomy and bilateral salpingo-oophorectomy .
Estimated blood loss was 100 cc and she tolerated the procedure well .
On postop day number one she was afebrile and doing well with a PCA for pain control .
On postop day number two she was also afebrile and had not passed any flatus yet .
She was ambulating frequently .
Her hematocrit was 34.2 and stable from her preoperative value .
On postop day number three her abdomen was noted to be distended with a few bowel sounds and she still had not passed gas .
The patient decreased the amount of Demerol she was using and supplemented with Tylenol and continued her frequent ambulation .
On postop day number four she had passed flatus and was feeling much better .
She was discharged to home in good condition on the following medications .
DISCHARGE MEDICATIONS :
Demerol for pain .
Motrin for pain .
Colace stool softener .
DISPOSITION :
The patient should follow-up with Dr. Side in two weeks .
Dictated By :
IEDEARC SIDE , M.D. LB28
Attending :
MITERY D. LOSS , M.D. CB51 II795/2112
Batch :
42100
Index No. ZMFX3O4G1
D :
01/04/97
T :
01/06/97
CC :
1. MITERY D. LOSS , M.D. NT11
[ report _ end ] | null | [
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"... | null | null |
201 | ADMISSION DATE :
03/11/2002
DISCHARGE DATE :
03/14/2002
DISCHARGE DATE :
03/14/2002
HISTORY OF PRESENT ILLNESS :
This is a 62-year-old hospice chaplain who was referred by Dr. Tomedankell Flowayles and Dr. Es Oarekote for evaluation of his right hip pain .
He states that his pain has been of seven to eight durations , and rated as moderate to severe ( 7/10 ) .
He does limp .
He does not use a cane and he requires a bannister for going up and down stairs .
He has trouble with his shoes and socks .
He uses a walker .
He can walk about a quarter of a mile without stopping .
HOSPITAL COURSE :
The patient was taken to the operating room on March 11 , 2002 , and underwent an uncomplicated right total hip replacement .
The patient tolerated the procedure well and was transferred to the Post Anesthesia Care Unit and then to the floor in stable condition .
On postoperative check , he was doing well .
He was afebrile and his vital signs were stable .
He was neurovascularly intact .
His hematocrit was 34.7 .
He was started on Coumadin for DVT prophylaxis and Ancef for routine antimicrobial coverage .
He was made partial weight-bearing for his right lower extremity .
He was placed on posterior hip dislocation precautions and was out of bed with physical therapy and occupational therapy .
On postoperative day one , there were no active issues .
He was afebrile .
His vital signs were stable .
He was neurovascularly intact .
On postoperative day two , he was afebrile , vital signs were stable .
His incision was clean , dry and intact with no erythema .
He remained neurovascularly intact .
His hematocrit was 34.8 .
On postoperative day three , lower extremity noninvasive ultrasounds were performed , which showed no evidence of deep venous thrombosis in the lower extremities .
The remainder of his hospitalization was uncomplicated . | null | [
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567 | Admission Date :
2013-09-05
Discharge Date :
2013-09-12
Service :
MEDICINE
History of Present Illness :
HPI : This is a 79 y/o M with h/o of HTN , DM , recent CVA Theresa , chronic respiratory failure on vent , trached , ESRD on HD who was sent from rehab facility for worsening mental status .
Per refferal notes , he went to hemodyalisis today in the morning .
1 L was removed .
At about 2:30 pm , he was found to have worsening mental status .
In that setting he was hypotensive down to the 92/45 , and was given 1 L NS .
Fs was also checked 179 .
At that time , it seems that he had been on T peace since 4 am today .
At 2:30 he was also found with sats in the 90% .
ABG done 7.1 , 89/72 - he was placed on AC 600 / 0.4 and 6 PEEP - sats up to 94% .
Given persistent lethargy , patient was sent to Falkener Amanda .
Of note , after interview with HCP , at around 07-23 , patient started having episodes of dizziness , and had unstable gait .
he was taken to Williams ICU until 08-09 when he was discharged to Waltham/Weston Hospital Rehab .
he had a peg tube and tracheostomy prior to d/c .
He had been chronicallyl vent dependent .
His companion states that they have been trying to wean him down at rehab .
his basline mental staus apparently responds with his head shaking , and also try to write sentences .
In the Amanda : VS T 103 rectal BP90/44 HR : 84 RR 16 Sats : 98 + guiac stool .
He received tylenol , levofloxacin 500 mg IV , Flagyl 500 mg and Vancomycin and I L NS .
ROS : difficult to obtain 2x2 to patient mental status baselin
Brief Hospital Course :
Assessment and Plan :
This is a 79 y/o M with h/o HTN , DM , recent CVA , chronic ventilatory failure , CRI on HD who presents with change in MS and febrile in the Amanda , admitted to CMED .
# Altered mental status : Ct scan with no evidence of new intracraneal bleeding .
Patient febrile in the Amanda .
High WBC .
It was thought that it could have been a combination of hypotension , hypercapnia and infection .
He was initially started on broad spectrum antibiotics .
Despite having a profund limitation communicating given his neurological status , his mental changes seemed to improved initially .
However later on during his course , his mental status deteriorated , being even less responsive .
# ID :
Patient febrile and with a high WBC on admission .
After starting broad spectrum antibiotics - cefepime - vancomycin and flagyl ( for initial concern of aspiration pneumonia ), he responded clinically .
Urine cx from Rehab showed gram negative rods > 100 K enterobacter cloacae .
Urine Cx in house grew Citrobacter Freundi and his sputum grew Acinetobacter Baummani .
Since there was no more evidence of gram positive infections , vancomycin was discontinued and cefepime was kept .
# Fevers : in the Amanda , high WBC , possible pneumonia .
Also possible source sinus infections given findings on intial CT ( see summary in significant studies ). He did not spike any fevers after being transfer to the CMED from the Amanda .
# Resp : Patient was intermitentely switched from AC to Pressure support trials .
However , after Patient did well .
Then trach mask trials were done .
He tolerated this well , although he required PS overnight .
# ESRD on hemodyalisis : Renal service was consulted and HD was continued .
# CV :
Rhythm : NSR , not tachycardic .
Pump : With trace of lower extremity edema .
X ray suggested some pulmonary edema on admission .
Despite this findings , he was supported with 40% FIO2 most of the time .
CAD : On admission Ck low normal , MB not done .
Troponin 0.44.
It was more likely due to CRI .
Second set 12 hours apart , showed no changes .
s/p stroke : continue aspirin , statin , plavix
# Hypotension : per referral form .
Intially concern for sepsis in the setting of fevers and high blood count .
His BP medications were held on admission .
Patient did not require pressors .
His blood pressure remained stable and BP meds were restarted .
# FEN :
Tube feedings were started thorugh peg tube .
On 2013-09-08 , patient pulled out peg tube .
Temporary foley was placed and on 2013-09-11 ,
On 2013-09-12 after deterioration of his mental status and also of his blood pressure , goals of care were discussed with his HCP .
It was decided to direct goals of care towards confort care .
Patient passed away accompanied by his significant other . | null | [
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"text": "discharged",
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413 | ADMISSION DATE :
5-3-93
DISCHARGE DATE :
5-12-93
HISTORY OF PRESENT ILLNESS :
Mr. Stain was transferred from the Oreiewlefell Merkane I Penaltbridgesgreat University Medical Center for progressive respiratory failure and adult respiratory distress syndrome superimposed on a history of chronic obstructive pulmonary disease , perhaps asthma , and ulcerative colitis .
His only positive result was a sputum culture for Pseudomonas and this came after he had already been on antibiotics .
HOSPITAL COURSE :
The patient was seen in consultation by Dr. Wire who felt that manipulation of the tracheal tube was the best approach to the air leak since it was a new trach and he was requiring such high ventilator support that it was risky to change it .
He also felt that lung biopsy at this time was rather risky .
The patient was therefore completely cultured again and begun on antibiotic coverage which would take care of the Pseudomonas he was known to have .
The steroids were tapered .
He was also begun on anti-Candida regimen for his urinary tract infection with yeast being seen .
Because of the story of hemoptysis , he also underwent an exotic bleeding work up for such things as Wegner 's and Goodpasture 's .
These results were all negative .
He continued to require very high FIO2 .
He was found to have a DVT by ultrasound .
He underwent a trial of TPA followed by heparin .
This produced substantially further hemoptysis and the need for transfusion .
He stabilized from this , but on the fifth while continuing to have extremely ventilator requirement .
In consultation with his family , it was decided that enough support had been done .
At that time , therefore , ventilator support was withdrawn under the comfort measures of morphine .
STAIN J. A , M.D.
TR :
sj / bmot
DD :
6-4-93
TD :
06/05/93
CC : | null | [
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"text": "anti-Candida regimen",
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... | null | null |
407 | Admission Date :
2017-04-26
Discharge Date :
2017-05-01
Service :
CARD CMED
HISTORY OF PRESENT ILLNESS :
This is a 62 year old gentleman who underwent an exercise treadmill test for screening through the Beth Israel Deaconess Hospital-Needham Clinic .
The test was positive for EKG changes and shortness of breath .
The patient has no history of chest pain; no history of myocardial infarction .
The patient was referred to Cambridge Health Alliance for cardiac catheterization .
Cardiac catheterization showed an ejection fraction of 50% , left ventricular end diastolic pressure of 20 , 90% left anterior descending lesion , 80% left circumflex lesion , 80% mid right coronary artery lesion and 80% distal right coronary artery lesion .
The patient was referred to Dr. Rota for coronary artery bypass grafting .
HOSPITAL COURSE :
The patient was admitted to Saint Vincent Hospital on 2017-04-26 and underwent a coronary artery bypass graft times four with left internal mammary artery to left anterior descending , saphenous vein graft to right coronary artery , saphenous vein graft to PDA and saphenous vein graft to obtuse marginal with Dr. Rota .
Please see the Operative Note for further details .
The patient was transferred to the Intensive Care Unit in stable condition on Neo-Synephrine infusion .
The patient was weaned the next day from mechanical ventilation on his first postoperative night .
Postoperative days one and two , the patient continued to require Neo-Synephrine to maintain systolic blood pressures greater than 100 .
On postoperative day two , the patient 's hematocrit was noted to be 23.1 ; he was transfused one unit of packed red blood cells as well as given a dose of Lasix .
The Neo-Synephrine was weaned off by postoperative day number three .
The patient 's chest tubes were removed on postoperative day three without incident .
The patient was started on low dose Lasix and Lopressor which he tolerated well .
On postoperative day number four , the patient was transferred from the Intensive Care Unit to the regular part of the hospital where he began working with Physical Therapy and on his first session he was able to ambulate 500 feet and climb one flight of stairs while remaining hemodynamically stable without requiring any oxygen .
On postoperative day number five , the patient continued to remain hemodynamically stable .
The patient 's epicardial pacing wires were removed without incident and the patient was cleared for discharge to home . | null | [
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"text": "saphenous vein graft to right coronary artery",
"start_char": 1018,
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188 | Admission Date :
2015-10-26
Discharge Date :
2015-10-30
Service :
SURGERY
History of Present Illness :
17 yo male pedestrian who was struck by auto at unknown speed ; +LOC .
He was medflighted to The Hospital for Orthopedics for ongoing trauma care .
Upon arrival GCS 15 , alert and oriented x3 .
Brief Hospital Course :
He was admitted to the trauma service . Orthopedics and Neurosurgery were consulted because of his injuries .
His Neurosurgical issues were nonoperative ; he was loaded with Dilantin ; serial head CT scans were performed and were stable .
He will need to follow up with Dr. Mckinney in 4 weeks for repeat head imaging and continue with Dilantin for one month .
His right tib / fib fracture was repaired by Orthopedics on 10-27 ; postoperatively there were no complications .
Weight bearing status was increased to weight bearing as tolerated .
He was fitted with a hinged Mcdonald brace for his LLE .
He will need to continue on Lovenox injections for at least 4-6 weeks .
He was transfused with 3 u packed cells for a hematocrit of 21 , post transfusion HCT was 26.1 ; there was a questionable transfusion reaction at the end of his first unit of packed cells ; he did subsequently receive the remaining 2 units without any further reaction .
Physical and Occupational therapy were consulted and have recommended home with services . | null | [
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"text": "transfused",
"start_char": 1002,
"end_char": 1012,
"id": "E43",
"modality": "FACTUAL",
"polarity": "POS",
"type... | null | null |
611 | ADMISSION DATE :
11/3/92
DISCHARGE DATE :
12/6/92
HISTORY OF PRESENT ILLNESS :
The patient is a 68 year old , right handed caucasian female , former R.N. who complained of several days of vertigo , one day of double vision , dysarthria and worsening of vertigo .
She was seen at the outside hospital and put on aspirin for two days .
An magnetic resonance imaging study showed basilar artery disease , questionable aneurysm .
The patient was transferred to the Fairm of Ijordcompmac Hospital .
An angiogram on 11/3 was consistent with thrombosis at the mid basilar artery .
The patient was put on heparin and was stable since .
HOSPITAL COURSE :
The patient was taken to the Intensive Care Unit after her angiogram .
She was aggressively anticoagulated with heparin .
A small intimal tear in the arch of the aorta during the angiogram , was without sequelae .
She was doing well with at least 4+ strength in all of her extremities , when on 11/13 , she had an acute drop in her systolic blood pressure to 70 for unclear reasons and without evidence of acute sepsis .
This was accompanied by substantial decrement in neurologic function .
For a short time , she seemed " locked in " .
She has made slow progress since then and at the time of discharge has 4-strength at the left elbow and 4+ in the left wrist and hand .
Trace movement of the right elbow and 4-strength of the right wrist and hand .
4-to 4+ strength at the left ankle , 4+ strength at the right knee and right ankle .
She is unable to lift either foot off the bed .
The extra ocular movements are full .
Tongue protrudes 4 cm .
She is drowsy at times , but generally alert , responsive , interactive , able to talk in two to three word sentences when she wants to .
She has severe memory deficits , but nevertheless , is able to engage in conversation , answers questions , names things well , does calculations and recognizes family members and states preferences .
She has been working with Speech Therapy , occupational therapy and physical therapy closely and should continue to show improvement .
She is anticoagulated on Coumadin and this has been stable .
She is do not resuscitate in agreement with the wishes of her multiple family members .
Follow up computerized tomography scans and magnetic resonance imaging studies have shown infarction in bilateral basis pontis , mid brain , the superior cerebellar areas , left thalamus , bilateral temporal lobes medially and inferiorly and left posterior communicating artery .
The patient had fevers sporadically during this hospitalization with rising white blood counts .
A chest X-ray documented a progressing left lower lobe infiltrate .
Initially this improved on Clindamycin and Cefotetan , but fevers recurred on this antibiotic regimen .
Sputum grew out Klebsiella pneumoniae , and she was treated with Gentamicin and Ancef for 14 days intravenous ( bug being sensitive to these two drugs ) .
A left pleural effusion developed and this was tapped with ultrasound guidance , and found to be sterile , and without evidence of empyema .
The patient is on Ciprofloxacin .
The day of discharge is day #3 of 7 , after which antibiotics should be totally discontinued .
She has developed bad thrush in this setting , she is not yet able to swallow and so she is on Nystatin swish and spit five times a day .
She also gets Peridex to clean out her mouth .
Once her liver enzymes are completely normal , a seven day course of Fluconazol may be helpful if the thrush is not spontaneously resolving off of antibiotics .
She has been afebrile for greater than 10 days , including several days on oral antibiotics .
The patient 's liver enzymes were noted to be elevated mid way through her hospital course , to about three times normal , especially the SGOT and SGPT .
These have spontaneously reversed , and are nearly normal at the time of discharge .
A right upper quadrant ultrasound documented gallstones , without evidence of common bile duct dilatation or active cholecystitis .
The exact cause of her liver enzyme elevation is unclear , but we are being careful about administering drugs , which might irritate the liver .
The patient had a steady decline in her hematocrit during this hospitalization .
Iron studies are all entirely normal , her anemia is attributed to anemia or chronic disease with hypoproliferation as well as multiple phlebotomies .
The plan is to give her folic acid , but not iron .
The patient 's potassiums have been repeatedly low and require daily checks and repletion .
This is thought due to the extensive course of Gentamicin which she received .
This must be carefully checked despite the standing order for potassium .
The patient has had low sodiums during this hospitalization .
This may due to her central nervous system process or her pulmonary process , with fluids administered as described , she should not have any problems from this .
Her sodiums were never below 130 .
She does well with tube feeds .
Her tube feeds orders are as follow :
full strength Replete with fiber at 70 cc. per hour .
In addition , the patient gets 250 cc. of juice ( not water ) three times a day .
She also gets Lactinex granules three packages in each bottle of tube feeds .
She also gets Metamucil one teaspoon with the first bolus of juice each day .
Please note that evaluation by the swallowing therapist , showed that the patient is aspirating at this time , but there is great hope from the nature of her deficit and the good movements of her tongue that normal swallowing should return soon .
It is for this reason that she is discharged with an nasogastric tube and that no plans for G tube placement are made at this time .
She has a history of of angina without myocardial infarction that has not been worked up .
She did have brief chest pain twice during this admission that did not correlate with electrocardiogram changes .
In the first week of November , her electrocardiogram showed T wave inversions in the lateral leads , correlating with an increase in the LDH , but not CK .
This did not normalize with administration of Isordil and the patient denied chest pain at this time .
As of 4/7 , her electrocardiogram had reverted back to normal and there is no evidence of congestive heart failure or continued electrocardiogram changes , and chest pain is absent .
Her cholesterol was 350 here .
She has been off of her hypercholesterol medicines .
These can be restarted when it is deemed reasonable , in view of her acute disease and recently elevated liver enzymes .
Note that the liver enzymes were normal on admission , at which time she was taking all of the above cholesterol medicines . | null | [
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"text": "acute sepsis",
"start_char": 1053,
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"id": "E29",
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"polarity": "NEG",
"ty... | null | null |
177 | Admission Date :
2012-11-21
Discharge Date :
2012-11-28
Service :
Transplant
HISTORY OF PRESENT ILLNESS :
This is a 37-year-old female who presents on an elective basis for a living-related kidney transplant .
The patient has a history of end-stage renal failure secondary to type 1 diabetes with a baseline creatinine of around 5 .
She is receiving a kidney from her sister .
The patient has a history of hypertension , coronary artery disease , and insulin-dependent diabetes for 32 years .
She is status post myocardial infarction in April of this year and subsequently underwent coronary artery bypass surgery .
She present electively on the morning of her surgery with no recent changes in her medical problems .
HOSPITAL COURSE :
The patient was admitted to the preoperative holding area and taken electively to the operating room .
She underwent a living-related renal transplant in the right iliac fossa .
The operation was somewhat technically difficult secondary to a short segment of ureter which was anastomosed over a stent to the bladder .
Otherwise , there were difficulties , and estimated blood loss was minimal .
She was taken postoperatively to the recovery room already making a large amount of urine .
Intraoperatively , for immunosuppression she received thymoglobulin and Solu-Medrol .
She was started on Prograf and CellCept in the postoperative period .
She was also maintained on Bactrim postoperatively and did not require ganciclovir , as she and her sister were cytomegalovirus negative .
The patient 's initial postoperative course was relatively uneventful .
Her creatinine , which was 5 initially postoperatively , slowly dropped over the next few days until eventually reaching a low of 1 .
She did receive pamidronate on postoperative day one and received a total of four doses thymoglobulin .
Her steroid doses were slowly tapered over her hospital course , and her Prograf level was adjusted to maintain therapeutic values between 10 and 15 .
She continued to make good urine over the first few days and had her urine losses replaced with intravenous fluids .
On postoperative day three , the patient had an episode of shortness of breath that was evaluated by both the Renal and surgical residents .
It was found that she was in acute pulmonary edema and required transfer to the Surgical Intensive Care Unit .
Her blood pressure at the time of this incident was in the range of 200/120 .
Her electrocardiogram showed no specific ST changes , but there was some loss of her R wave progression laterally .
Serial enzymes were drawn , and Cardiology was consulted .
With blood pressure control via a nitroglycerin drip and fluid restriction , the patient quickly improved and a had a relatively short stay in the Intensive Care Unit .
Throughout this time , her creatinine continued to drop , and there was no apparent deleterious effect on her transplant from this episode .
Her beta blocker was progressively increased , and her nitroglycerin drip was weaned down .
Two days after this event , she underwent an echocardiogram which was significant for slightly depressed left ventricular systolic function with severe posterior wall hypokinesis .
This was a change from her prior echocardiogram and demonstrated evidence of a small myocardial infarction .
Clinically , she did much better and her blood pressure was optimized prior to discharge .
She was transferred out of the Intensive Care Unit on postoperative day five and was stable on the floor for the next two days . | null | [
{
"text": "Admission",
"start_char": 1,
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"id": "E0",
"modality": "FACTUAL",
"polarity": "POS",
"type": "OCCURRENCE"
},
{
"text": "anastomosed",
"start_char": 1013,
"end_char": 1024,
"id": "E24",
"modality": "FACTUAL",
"polarity": "POS",
"typ... | null | null |
163 | Admission Date :
2010-05-17
Discharge Date :
2010-05-29
Service :
HISTORY OF PRESENT ILLNESS :
HISTORY OF PRESENT ILLNESS :
This is an 86-year-old female with a past medical history of diabetes and hypertension who presented to the Emergency Department with a two day history of shortness of breath and easy fatigability .
She also noted increased dyspnea on exertion .
Prior to this patient could walk upstairs but now cannot .
She denies chest pain , orthopnea , paroxysmal nocturnal dyspnea .
However , the patient has noted some abdominal pain , intermittent times a couple of days , none on the day of admission .
Denied nausea , vomiting , diaphoresis , bowel movement changes .
She has noted increased urinary frequency .
Denies fever or chills .
Of note , she has had recent medication changes which included discontinuing Diovan and starting terazosin .
HOSPITAL COURSE :
The patient was admitted to the Cardiac Medicine Service and treated for presumed diastolic and systolic dysfunction .
Echocardiogram was obtained which showed moderately depressed left ventricular systolic function as well as hypokinesis of the lower half of septum and apex .
Also of note was the distal lateral wall hypokinesis .
The wall motion abnormalities were noted to be new .
It was believed that a troponin on admission in addition to the wall motion abnormalities she underwent a non-Q wave myocardial infarction prior to resulted in her current cardiac failure .
Throughout hospital course patient 's troponin trended down to less than 0.3 .
Heart Failure Service was involved .
She was continued with aggressive diuresis .
She was started on _________ with excellent diuresis , however , her renal functioning worsening .
A cardiac catheterization was deferred until the renal issue could be resolved .
However , her creatinine continued to increase .
Diuresis was halted and without improvement in creatinine .
Renal was consulted .
A renal ultrasound was obtained .
It showed a right kidney size of 6.3 cm and a left kidney size of 8.4 cm .
Given her hypertension which was very difficult to control , it was felt that she had renal artery stenosis and thus she underwent MRA of the kidney which showed severe right renal artery stenosis at its origin .
There was also moderate to severe focal stenosis of the left renal artery approximately 1.3 cm from its origin .
Dr. ______________ consulted on the case .
She was transferred to the unit overnight to assess volume which was noted to be optimal .
On 05-25 she underwent catheterization and subsequent stenting of the left renal artery .
Due to dye load required to assess the coronary disease were not visualized .
After the procedure the patient did well .
However , her creatinine has worsened up to 4.2 .
However , her urine output has improved .
She has not required hemodialysis at this time .
She will need close follow up of her renal functioning .
The patient is discharged to an extended discharge facility . | null | [
{
"text": "Admission",
"start_char": 1,
"end_char": 10,
"id": "E0",
"modality": "FACTUAL",
"polarity": "POS",
"type": "OCCURRENCE"
},
{
"text": "Echocardiogram",
"start_char": 1001,
"end_char": 1015,
"id": "E19",
"modality": "FACTUAL",
"polarity": "POS",
"... | null | null |
411 | Admission Date :
02/08/1990
Discharge Date :
02/13/1990
HISTORY OF PRESENT ILLNESS :
The patient is a 43-year-old gravida II para II white female referred by Dr. Ca Shuff for evaluation .
She was in her usual state of good health until December when she was seen emergently for treatment of a perforated colon cancer .
That area was resected with no evidence of metastatic disease .
She has had subsequent CEA's and scans which were negative .
A tumor was noted on her vulva which was biopsied and revealed squamous cell carcinoma in situ .
ALLERGIES :
NO KNOWN DRUG ALLERGIES .
MEDICATIONS :
None .
PAST SURGICAL HISTORY :
As above with colostomy .
HOSPITAL COURSE :
The plan was for right radical vulvectomy .
1. Vulvectomy :
The patient on 2/8/90 underwent a right radical vulvectomy with excellent results and negative margins on frozen section .
Her postoperative course was unremarkble .
She was kept on bedrest for two days and then was ambulating and voiding well without trouble on postoperative day number three when the Foley catheter was discontinued .
She has been doing Betadine paint and blow drying the area several times a day and after each bowel movement and urine without incident . | null | [
{
"text": "Admission",
"start_char": 1,
"end_char": 10,
"id": "E0",
"modality": "FACTUAL",
"polarity": "POS",
"type": "OCCURRENCE"
},
{
"text": "the Foley catheter",
"start_char": 1033,
"end_char": 1051,
"id": "E13",
"modality": "FACTUAL",
"polarity": "POS",
... | null | null |
388 | Admission Date :
04/21/1994
Discharge Date :
04/29/1994
HISTORY OF PRESENT ILLNESS :
Patient is an 88 year old female with fatigue and decreased short term memory for the past six months .
The past six weeks , she has also been complaining of hot sensation and tingling sensation in the hands bilaterally .
For the past five weeks , the patient has experienced dragging of the right leg with weakness throughout that side .
Head CT was done which patient reported demonstrated three lesions in the left parietal region of the brain .
Bone scan , CT of the abdomen , chest X-Ray , and mammogram were all negative .
Patient noted the foot dragging to have worsened over the past few weeks but improved since on Decadron the past week before admission .
Patient is now admitted for elective left parietal stereotactic biopsy of the tumor .
PAST MEDICAL / SURGICAL HISTORY :
Significant for a history of hypertension , basal cell carcinoma of the nose six years ago , cataracts , and a hysterectomy .
ALLERGIES :
No known drug allergies .
CURRENT MEDICATIONS :
Hydrochlorothiazide 25 mg q.d. and Decadron 25 mg b.i.d.
HOSPITAL COURSE :
Patient was taken to the Operating Room on April 21 where patient underwent a left parietal stereotactic guided brain biopsy .
Patient tolerated the procedure well without any complications and was taken to the Recovery Room awake and stable then subsequently transferred to the floor .
Patient did well post-operatively , continued to have a right sided deficit , and Physical Therapy and Occupational Therapy visited the patient , worked with the patient , and determined that patient needed rehabilitation with Physical Therapy .
The patient was evaluated by Doing and was subsequently accepted into that program .
Patient is now discharged to Harl Wa Healthcare Network on April 29 , 1994 in stable condition . | null | [
{
"text": "Admission",
"start_char": 1,
"end_char": 10,
"id": "E0",
"modality": "FACTUAL",
"polarity": "POS",
"type": "OCCURRENCE"
},
{
"text": "known drug allergies",
"start_char": 1028,
"end_char": 1048,
"id": "E36",
"modality": "FACTUAL",
"polarity": "NEG",... | null | null |
203 | Admission Date :
2015-11-09
Discharge Date :
2015-11-16
Service :
CMED CCU
HISTORY OF PRESENT ILLNESS :
Baby girl Fritsche is the 1670 gram product of a 31 and 06-17 week gestation born to a 34 - year-old G2 P1 now 2 woman .
Fetal screens , O positive , antibody negative , RPR nonreactive , rubella immune , hepatitis surface antigen negative , GBS unknown .
IVF pregnancy complicated by IUGR , 2 vessel cord , normal fetal echo reverse diastolic flow and demise of twin A at 27 weeks .
Twin B with normal fetal survey was transferred to Boston Medical Center at 26 and 2/7 weeks with IUGR of twin A was first noted , presented with preterm labor at 31 weeks .
Betamethasone complete at approximately 26 weeks and 31 weeks .
Mother was on clindamycin since 11-04 .
PPROM with bleeding and transverse lie prompted cesarean section .
Abruption noted .
Apgars were 6 and 9 .
HOSPITAL COURSE :
Respiratory .
Mills was admitted to the newborn intensive care unit with moderate respiratory distress .
Infant placed on CPAP .
X-ray revealed mild respiratory distress syndrome .
She remained on CPAP for a total of 24 hours at which time she transitioned to room air and continues to be stable in room air .
Caffeine citrate was initiated on 11-14 for apnea and bradycardia of prematurity .
She is currently receiving 11 mg po every day .
Cardiovascular .
Has been cardiovascular stable throughout hospital course .
Heart ranges 130 s to 160 s.
Blood pressure most recently 60/37 with a mean of 44 .
Fluid and electrolyte .
Birth weight was 1670 grams 50 th percentile , length 43 cm 50 th percentile .
Head circumference not done .
Infant was initially started on 80 cc per kilo per day of D10W .
Enteral feedings were initiated on day of life #1 .
Infant achieved full enteral feedings by day of life 6 .
She is currently receiving 150 cc per kilo per day of Special Care 20 .
Her discharge weight is 1477 gm .
Her most recent set of electrolytes were on 2015-11-13 with a sodium of 143 , a potassium of 6.3 hemolyzed , a chloride of 113 and a total CO2 of 17 .
She will need advance calorie density for better growth .
GI . Bilirubin peaked on day of life #2 of 9.0 / 0.3 .
Infant is under phototherapy , which was discontinued on 11-13 .
Most recent bilirubin was on 11-14 of 4.8 / 0.3 .
Hematology .
Hematocrit on admission was 53.7 .
She has not required any blood transfusions .
Infectious disease .
A CBC and blood culture obtained on admission .
CBC had a white blood cell count of 9 , 17 polys , 0 bands , platelets of 326 .
She received 48 hours of ampicillin and gentamycin with negative blood cultures and antibiotics were discontinued .
Neurological .
She has been appropriate for gestational age .
Head ultrasound was performed on 2015-11-16 and was normal .
Sensory , hearing screen has not yet been performed , but should be done prior to discharge . | null | [
{
"text": "Admission",
"start_char": 1,
"end_char": 10,
"id": "E0",
"modality": "FACTUAL",
"polarity": "POS",
"type": "OCCURRENCE"
},
{
"text": "CPAP",
"start_char": 1014,
"end_char": 1018,
"id": "E22",
"modality": "FACTUAL",
"polarity": "POS",
"type": "TR... | null | null |
571 | ADMISSION DATE :
06-30-93
DISCHARGE DATE :
07-06-93
HISTORY OF PRESENT ILLNESS :
The patient is a 67 year old white male with a recent history of urinary frequency Q2-3H , stranguria , nocturia x 3-4 per night .
He was found on physical exam to have an asymmetric prostate with prominence on the left and a question of a nodule .
Repeat exam one month later showed a firm left-sided lobe .
Transrectal ultrasound showed a hypoechoic left-sided mass in the peripheral zone .
A biopsy showed moderately to poorly differentiated Grade III-IV adenocarcinoma on the left .
The right lobe was within normal limits .
This was done on 05/05/93 at FIH .
He also had a 3-4 year history of impotence .
HOSPITAL COURSE :
The patient was brought to the operating room on 06/30/93 after informed consent was obtained .
A radical retropubic prostatectomy with bilateral lymph node dissection was done .
He was afebrile postoperatively with vital signs stable .
His potassium was 3.7 and his hematocrit 33 .
His postoperative course was remarkable for a low grade temperature to 101.7 .
His blood cultures and chest X-ray were negative .
He had flatus on postoperative day # 3 .
His Jackson-Pratt drained about 35-40 cc per day and was discontinued on postoperative day # 3 .
His hematocrit on 07/03 was 28.1 .
On that day he was slightly diaphoretic with some tachycardia to 100 .
The remaining unit of autologous packed red blood cells was transfused .
A cardiology consult was obtained for this episode of diaphoresis with tachycardia , as well as for an EKG being read as having anterolateral changes .
He had no symptoms of chest pain or myocardial ischemia .
A repeat EKG showed no changes .
He subsequently did well , with a repeat hematocrit of 34.3 after the transfusion .
His creatinine was 1.2 on postoperative day # 5 .
On postoperative day # 6 his low grade temperature resolved .
His vital signs were stable .
He was discharged home on Percocet and Keflex .
He was discharged in good condition .
He will follow up with Dr. Iechalette Cancer in his office .
SIE ROOM , M.D. | null | [
{
"text": "ADMISSION",
"start_char": 1,
"end_char": 10,
"id": "E0",
"modality": "FACTUAL",
"polarity": "POS",
"type": "OCCURRENCE"
},
{
"text": "a low grade temperature",
"start_char": 1037,
"end_char": 1060,
"id": "E32",
"modality": "FACTUAL",
"polarity": "PO... | null | null |
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