Life Style Prediction Results
| # | Emr Text | Processed Text | Prediction |
|---|---|---|---|
| 1 | habit: smoking: 0 pack/day,(-), alcohol(-), betelnut | habit smoking 0 pack day - alcohol - betelnut | positive |
| 2 | habit: smoking: 0 pack/day,(-), alcohol(-), betelnut | habit smoking 0 pack day - alcohol - betelnut | positive |
| 3 | habit: smoking: 0 pack/day,(-), alcohol(-), betelnut | habit smoking 0 pack day - alcohol - betelnut | positive |
| 4 | habit smoking 0 pack day - alcohol - betelnut | habit smoking 0 pack day - alcohol - betelnut | positive |
| 5 | i smoke | i smoke | negative |
| 6 | habit: smoking: 0 pack/day,(-), alcohol(-), betelnut | habit smoking 0 pack day - alcohol - betelnut | positive |
| 7 | smoking - | smoking - | positive |
| 8 | i smoke | i smoke | negative |
| 9 | habit: smoking: 0 pack/day,(-), alcohol(-), betelnut | habit smoking 0 pack day - alcohol - betelnut | positive |
| 10 | i smoke | i smoke | negative |
| 11 | i smoke | i smoke | negative |
| 12 | habit smoking 0 pack day - alcohol - betelnut | habit smoking 0 pack day - alcohol - betelnut | positive |
| 13 | i smoke | i smoke | negative |
| 14 | habit: smoking: 0 pack/day,(-), alcohol(-), betelnut | habit smoking 0 pack day - alcohol - betelnut | positive |
| 15 | history: smokinig (-), drinking (+), betelnut (-) | history smokinig - drinking + betelnut - | positive |
| 16 | history: smokinig (-), drinking (+), betelnut (-) | history smokinig - drinking + betelnut - | positive |
| 17 | habit smoking 0 pack day - alcohol - betelnut | habit smoking 0 pack day - alcohol - betelnut | positive |
| 18 | The patient is a 1 1/2 pack per day smoker .he drinks approximately two beers per night . | The patient is a 1 1 2 pack per day smoker he drinks approximately two beers per night | positive |
| 19 | The patient is a 1 1/2 pack per day smoker .he drinks approximately two beers per night . | The patient is a 1 1 2 pack per day smoker he drinks approximately two beers per night | positive |
| 20 | The patient is a 1 1/2 pack per day smoker .he drinks approximately two beers per night . | The patient is a 1 1 2 pack per day smoker he drinks approximately two beers per night | positive |
| 21 | The patient has no information of smoking .he drinks approximately two beers per night . | The patient has no information of smoking he drinks approximately two beers per night | positive |
| 22 | The patient drinks approximately two beers per night . | The patient drinks approximately two beers per night | positive |
| 23 | The patient is a 0 pack per day smoker .he drinks approximately two beers per night . | The patient is a 0 pack per day smoker he drinks approximately two beers per night | positive |
| 24 | The patient has no information of smoking . | The patient has no information of smoking | positive |
| 25 | the patient is unknown | the patient is unknown | unknown |
| 26 | 977146916 HLGMC 2878891 022690 01/27/1997 12:00:00 AM CARCINOMA OF THE COLON . Unsigned DIS Report Status : Unsigned Please do not go above this box important format codes are contained . DISCHARGE SUMMARY ARF32 FA DISCHARGE SUMMARY NAME : GIRRESNET , DIEDREO A UNIT NUMBER : 075-71-01 ADMISSION DATE : 01/27/1997 DISCHARGE DATE : 01/31/1997 PRINCIPAL DIAGNOSIS : Carcinoma of the colon . ASSOCIATED DIAGNOSIS : Urinary tract infection , and cirrhosis of the liver . HISTORY OF PRESENT ILLNESS : The patient is an 80-year-old male , who had a history of colon cancer in the past , resected approximately ten years prior to admission , history of heavy alcohol use , who presented with a two week history of poor PO intake , weight loss , and was noted to have acute on chronic Hepatitis by chemistries and question of pyelonephritis . He lived alone but was driven to the hospital by his son because of reported worsening and general care and deconditioning . Emergency Department course ; he was evaluated in the emergency room , found to be severely cachectic and jaundiced . He was given a liter of normal saline , along with thiamine , folate . An abdominal ultrasound was performed showing no stones . Chest x-ray revealed clear lungs and then he was admitted to Team C for management . PAST MEDICAL HISTORY : Cancer , ten years prior to admission , status post resection . MEDICATIONS ON ADMISSION : Folic acid . ALLERGIES : None . FAMILY HISTORY : Not obtained . SOCIAL HISTORY : Lives in Merca . Drinks ginger brandy to excess , pipe and cigar smoker for many years . PHYSICAL EXAMINATION : In general was a cachectic , jaundiced man . bloodpressure : 124/60 , 97.4 , 84 , 22 for vital signs . head , eyes , ears , nose and throat : notable for abscess ulcers on the lower gums . He was edentulous . Neck was supple , lungs were clear except for some scattered mild crackles . Cardiac : tachycardic with a II / VI systolic ejection murmur . Belly was tender in the right upper quadrant . Liver edge , thickened abdominal wall was palpable . No inguinal nodes . Rectal was guaiac negative . On mental status exam , he was somnolent but arousable . Oriented to name , year , and hospital . Skin was jaundiced . LABORATORY DATA : Notable for a BUN and creatinine 14 and 1.8 , phosphorous of .5 , magnesium 1.2 , albumin 2.1 . elevated liver function tests , bilirubin of 14 direct , 17 total . uric acid 11.4 , alkaline phosphatase 173 , serum glutamic oxaloacetic transaminase 309 , amylase 388 . His urinalysis showed 10-20 granular casts and 10-20 white blood cells , 3-5 red blood cells , 5-10 whites , 3-5 white blood cells cast . The white blood cell was 8.5 , hematocrit 34 . platelet count 74 . 5% bands on differential . prothrombin time 14.9 , partial thromboplastin time 35 . HOSPITAL COURSE AND TREATMENT : The patient was admitted to the Staviewordna University Of Medical Center . His mental status proceeded to decline as he became more sleepy and less arousable and confused . His Hepatitis worsened , liver failure progressed with his coagulopathy worsening . His renal status also decreased with a drop in urine output , became more shortness of breath as he developed some pulmonary edema . A head computerized tomography scan was planned to evaluate his change in mental status , but after an extensive discussion with the son , who felt that he and other family members wanted to maximize the patient 's comforts and avoid heroic measures in the event of further deterioration , plans were made to make the patient as comfortable as possible . He was continued on antibiotics , and oxygen , and morphine , and small amounts of Dopamine , and at 4 AM on January 31 , was pronounced dead . _________________________ AJO C. CUCHKOTE , M.D. TR : tfv DD : 09/08/1997 TD : 10/13/1997 3:47 Pcc : AZEL USANNE WALL , M.D. [ report_end ] | 977146916 HLGMC 2878891 022690 01 27 1997 12 00 00 AM CARCINOMA OF THE COLON Unsigned DIS Report Status Unsigned Please do not go above this box important format codes are contained DISCHARGE SUMMARY ARF32 FA DISCHARGE SUMMARY NAME GIRRESNET DIEDREO A UNIT NUMBER 075 - 71 - 01 ADMISSION DATE 01 27 1997 DISCHARGE DATE 01 31 1997 PRINCIPAL DIAGNOSIS Carcinoma of the colon ASSOCIATED DIAGNOSIS Urinary tract infection and cirrhosis of the liver HISTORY OF PRESENT ILLNESS The patient is an 80 - year - old male who had a history of colon cancer in the past resected approximately ten years prior to admission history of heavy alcohol use who presented with a two week history of poor PO intake weight loss and was noted to have acute on chronic Hepatitis by chemistries and question of pyelonephritis He lived alone but was driven to the hospital by his son because of reported worsening and general care and deconditioning Emergency Department course he was evaluated in the emergency room found to be severely cachectic and jaundiced He was given a liter of normal saline along with thiamine folate An abdominal ultrasound was performed showing no stones Chest x - ray revealed clear lungs and then he was admitted to Team C for management PAST MEDICAL HISTORY Cancer ten years prior to admission status post resection MEDICATIONS ON ADMISSION Folic acid ALLERGIES None FAMILY HISTORY Not obtained SOCIAL HISTORY Lives in Merca Drinks ginger brandy to excess pipe and cigar smoker for many years PHYSICAL EXAMINATION In general was a cachectic jaundiced man bloodpressure 124 60 97 4 84 22 for vital signs head eyes ears nose and throat notable for abscess ulcers on the lower gums He was edentulous Neck was supple lungs were clear except for some scattered mild crackles Cardiac tachycardic with a II VI systolic ejection murmur Belly was tender in the right upper quadrant Liver edge thickened abdominal wall was palpable No inguinal nodes Rectal was guaiac negative On mental status exam he was somnolent but arousable Oriented to name year and hospital Skin was jaundiced LABORATORY DATA Notable for a BUN and creatinine 14 and 1 8 phosphorous of 5 magnesium 1 2 albumin 2 1 elevated liver function tests bilirubin of 14 direct 17 total uric acid 11 4 alkaline phosphatase 173 serum glutamic oxaloacetic transaminase 309 amylase 388 His urinalysis showed 10 - 20 granular casts and 10 - 20 white blood cells 3 - 5 red blood cells 5 - 10 whites 3 - 5 white blood cells cast The white blood cell was 8 5 hematocrit 34 platelet count 74 5 bands on differential prothrombin time 14 9 partial thromboplastin time 35 HOSPITAL COURSE AND TREATMENT The patient was admitted to the Staviewordna University Of Medical Center His mental status proceeded to decline as he became more sleepy and less arousable and confused His Hepatitis worsened liver failure progressed with his coagulopathy worsening His renal status also decreased with a drop in urine output became more shortness of breath as he developed some pulmonary edema A head computerized tomography scan was planned to evaluate his change in mental status but after an extensive discussion with the son who felt that he and other family members wanted to maximize the patient s comforts and avoid heroic measures in the event of further deterioration plans were made to make the patient as comfortable as possible He was continued on antibiotics and oxygen and morphine and small amounts of Dopamine and at 4 AM on January 31 was pronounced dead AJO C CUCHKOTE M D TR tfv DD 09 08 1997 TD 10 13 1997 3 47 Pcc AZEL USANNE WALL M D report end | positive |
| 27 | 139391631 GH 97368061 7/20/1999 12:00:00 AM NEUROPATHIC PAIN Signed DIS Admission Date : 07/20/1999 Report Status : Signed Discharge Date : 07/26/1999 PRINCIPAL DIAGNOSIS : Post thoracotomy syndrome . PRINCIPAL PROCEDURE : The patient had a spinal cord stimulator trial on 07/21/99 , the patient had an epidural trial on 07/24/99 . HISTORY OF PRESENT ILLNESS : The patient is a 65 year old female with post thoracotomy syndrome that occurred on the site of her thoracotomy incision . She had a thoracic aortic aneurysm repaired in the past and subsequently developed neuropathic pain at the incision site . She is currently on Vicodin , one to two tablets every four hours p.r.n. , Fentanyl patch 25 mcg an hour , change of patch every 72 hours , Elavil 50 mgq .h.s. , Neurontin 600 mg p.o. t.i.d. with still what she reports as stabbing left-sided chest pain that can be as severe as a 7/10. She has failed conservative therapy and is admitted for a spinal cord stimulator trial . PAST MEDICAL HISTORY : 1. Hypertension . 2. Hypothyroidism . 3. Paraplegia status post thoracic aortic aneurysm repair . 4. Left hemidiaphragmatic paralysis , history of recurrent lung infections . 5. Sacral decubitus ulcer . 6. Home oxygen at two liters a minute when she is at home ; she does not use the oxygen when she is in a wheelchair or is out of the house . MEDICATIONS ON DISCHARGE : 1. Atrovent nebulizers 0.5 mg mixed with albuterol , nebulizer is given every six hours . 2. Norvasc 2.5 mg p.o. q day . 3. Colistin 30 mg nebulizer twice a day , give 30 minutes post albuterol and Atrovent . 4. Pressure , dermal ulcer care b.i.d. dressing change with antibiotic solution . 5. Neurontin 600 mg p.o. t.i.d. 6. Colace 100 mg p.o. b.i.d. 7. Albuterol neb 2.5 mg every six hours , 30 minutes before Colistin . 8. Amitriptyline 50 mg q.h.s. 9. Vitamin C 500 mg p.o. b.i.d. 10. Calcium carbonate 125.0 mg t.i.d. 11. Fentanyl patch 25 mcg an hour , change patch every 72 hours . 12. Folate 1 mg p.o. q day . 13. Synthroid 50 mcg p.o. q day . 14. Zinc sulfate 220 mg p.o. q day . 15. Multivitamin , one tablet p.o. q day . 16. Hydrocodone 5 mg with Tylenol , one to two tablets every four hours p.r.n. pain . 17. Milk of Magnesia 30 cc p.o. q day constipation . ALLERGIES : PENICILLIN . SOCIAL HISTORY : The patient lives in Napro with her husband who is her primary caregiver . She is not a smoker . She has approximately one glass of wine every day . PHYSICAL EXAMINATION : The patient is well-appearing in no acute distress . Blood pressure is 150/90 , heart rate of 90 , respiratory rate 20 with saturation of 98% . HEENT : Pupils are equal and reactive to light . The patient wears dentures . Neck : Full range of motion with no lymphadenopathy . Chest : Clear to auscultation on the right . Decreased breath sounds on the left base with coarse rales on the left base . Cardiovascular : Regular rate and rhythm with normal S1 and S2 . Abdomen : Soft , nondistended , nontender . Positive bowel sounds . Back : Clear . Epidural site is without erythema , drainage or tenderness . Left buttock area has a dressing over the sacral decubitus ulcer . Extremities : Well-profused . 4/5 motor strength in the upper extremities bilaterally . Flaccid paralysis of bilateral lower extremities . HOSPITAL COURSE : The patient was admitted on 07/20/99 for a history of left chest wall pain from postthoracotomy syndrome . The patient developed the syndrome after her thoracic aortic aneurysm repair . The patient failed the conservative therapy and is admitted for a spinal cord stimulator trial . The patient had a spinal cord stimulator placed on 07/21/99 . She underwent the procedure and tolerated the procedure very well . The spinal cord stimulator was programmed with setting of a rate of 80 , power 450 and 4.0 amps . Channel 1 was negative , 2 was neutral , 3 was neutral , 4 was positive . The patient the next two days did not notice any significant change in her pain pattern . The patient was also noted to have a lot of musculoskeletal component of her pain . So , an epidural catheter was placed on 07/23/99 . The epidural was placed in the L1-2 region and the catheter was placed in the T7 region using fluoroscope to guide the catheter . Within the next couple of days , the patient noticed a significant improvement in her pain pattern . The stabbing , sharp pain that she occasionally has on the left chest wall was significantly diminished and she also noticed periods of time when she did not have any of that pain . The epidural catheter had a morphine infusion initially started at 1 mg a day and increased to 3 mg a day in a period of three days . The epidural was discontinued on 07/26/99 and was considered a successful trial . The patient will schedule with the Pain Clinic regarding upcoming epidural pump placement . During her hospitalization , the patient was also seen by the Plastic Service . Dr. Falccouette would like to perform an excision and closure flap of her left ischial decubitusin the near future . The patient was discharged in stable conditionand will follow up for ( 1 ) sacral decubitus closure , and ( 2 ) placement of epidural pump in the future . DISCHARGE INSTRUCTIONS : The patient will have SMH Service that comes to her home once a day for adressing change . The patient will follow up with Dr. Kayschird to schedule for the epidural pump . The patient will follow up with Dr. Falccouette to schedule for excision and closure of her left ischial sacral decubitus . Dictated By : ECI JESCSLAND , M.D. OO63 Attending : FOMAIRE KOTEKOTEJESCDREWE , M.D. RY93 KE526/9219 Batch : 37707 Index No. RWRF75BSI D : 07/26/99 T : 07/26/99 CC : JOFREDD N. FALCCOUETTE , M.D. SV7 [ report_end ] | 139391631 GH 97368061 7 20 1999 12 00 00 AM NEUROPATHIC PAIN Signed DIS Admission Date 07 20 1999 Report Status Signed Discharge Date 07 26 1999 PRINCIPAL DIAGNOSIS Post thoracotomy syndrome PRINCIPAL PROCEDURE The patient had a spinal cord stimulator trial on 07 21 99 the patient had an epidural trial on 07 24 99 HISTORY OF PRESENT ILLNESS The patient is a 65 year old female with post thoracotomy syndrome that occurred on the site of her thoracotomy incision She had a thoracic aortic aneurysm repaired in the past and subsequently developed neuropathic pain at the incision site She is currently on Vicodin one to two tablets every four hours p r n Fentanyl patch 25 mcg an hour change of patch every 72 hours Elavil 50 mgq h s Neurontin 600 mg p o t i d with still what she reports as stabbing left - sided chest pain that can be as severe as a 7 10 She has failed conservative therapy and is admitted for a spinal cord stimulator trial PAST MEDICAL HISTORY 1 Hypertension 2 Hypothyroidism 3 Paraplegia status post thoracic aortic aneurysm repair 4 Left hemidiaphragmatic paralysis history of recurrent lung infections 5 Sacral decubitus ulcer 6 Home oxygen at two liters a minute when she is at home she does not use the oxygen when she is in a wheelchair or is out of the house MEDICATIONS ON DISCHARGE 1 Atrovent nebulizers 0 5 mg mixed with albuterol nebulizer is given every six hours 2 Norvasc 2 5 mg p o q day 3 Colistin 30 mg nebulizer twice a day give 30 minutes post albuterol and Atrovent 4 Pressure dermal ulcer care b i d dressing change with antibiotic solution 5 Neurontin 600 mg p o t i d 6 Colace 100 mg p o b i d 7 Albuterol neb 2 5 mg every six hours 30 minutes before Colistin 8 Amitriptyline 50 mg q h s 9 Vitamin C 500 mg p o b i d 10 Calcium carbonate 125 0 mg t i d 11 Fentanyl patch 25 mcg an hour change patch every 72 hours 12 Folate 1 mg p o q day 13 Synthroid 50 mcg p o q day 14 Zinc sulfate 220 mg p o q day 15 Multivitamin one tablet p o q day 16 Hydrocodone 5 mg with Tylenol one to two tablets every four hours p r n pain 17 Milk of Magnesia 30 cc p o q day constipation ALLERGIES PENICILLIN SOCIAL HISTORY The patient lives in Napro with her husband who is her primary caregiver She is not a smoker She has approximately one glass of wine every day PHYSICAL EXAMINATION The patient is well - appearing in no acute distress Blood pressure is 150 90 heart rate of 90 respiratory rate 20 with saturation of 98 HEENT Pupils are equal and reactive to light The patient wears dentures Neck Full range of motion with no lymphadenopathy Chest Clear to auscultation on the right Decreased breath sounds on the left base with coarse rales on the left base Cardiovascular Regular rate and rhythm with normal S1 and S2 Abdomen Soft nondistended nontender Positive bowel sounds Back Clear Epidural site is without erythema drainage or tenderness Left buttock area has a dressing over the sacral decubitus ulcer Extremities Well - profused 4 5 motor strength in the upper extremities bilaterally Flaccid paralysis of bilateral lower extremities HOSPITAL COURSE The patient was admitted on 07 20 99 for a history of left chest wall pain from postthoracotomy syndrome The patient developed the syndrome after her thoracic aortic aneurysm repair The patient failed the conservative therapy and is admitted for a spinal cord stimulator trial The patient had a spinal cord stimulator placed on 07 21 99 She underwent the procedure and tolerated the procedure very well The spinal cord stimulator was programmed with setting of a rate of 80 power 450 and 4 0 amps Channel 1 was negative 2 was neutral 3 was neutral 4 was positive The patient the next two days did not notice any significant change in her pain pattern The patient was also noted to have a lot of musculoskeletal component of her pain So an epidural catheter was placed on 07 23 99 The epidural was placed in the L1 - 2 region and the catheter was placed in the T7 region using fluoroscope to guide the catheter Within the next couple of days the patient noticed a significant improvement in her pain pattern The stabbing sharp pain that she occasionally has on the left chest wall was significantly diminished and she also noticed periods of time when she did not have any of that pain The epidural catheter had a morphine infusion initially started at 1 mg a day and increased to 3 mg a day in a period of three days The epidural was discontinued on 07 26 99 and was considered a successful trial The patient will schedule with the Pain Clinic regarding upcoming epidural pump placement During her hospitalization the patient was also seen by the Plastic Service Dr Falccouette would like to perform an excision and closure flap of her left ischial decubitusin the near future The patient was discharged in stable conditionand will follow up for 1 sacral decubitus closure and 2 placement of epidural pump in the future DISCHARGE INSTRUCTIONS The patient will have SMH Service that comes to her home once a day for adressing change The patient will follow up with Dr Kayschird to schedule for the epidural pump The patient will follow up with Dr Falccouette to schedule for excision and closure of her left ischial sacral decubitus Dictated By ECI JESCSLAND M D OO63 Attending FOMAIRE KOTEKOTEJESCDREWE M D RY93 KE526 9219 Batch 37707 Index No RWRF75BSI D 07 26 99 T 07 26 99 CC JOFREDD N FALCCOUETTE M D SV7 report end | negative |
| 28 | 325924358 FIH 7061594 795820 418796 08/15/1998 12:00:00 AM CORONARY ARTERY DISEASE . Unsigned DIS Report Status : Unsigned DISCHARGE SUMMARY NAME : TLANDRAC , NI UNIT NUMBER : 388-23-03 ADMISSION DATE : 08/15/1998 DISCHARGE DATE : 08/22/1998 PRINCIPAL DIAGNOSIS : Coronary artery disease . ASSOCIATED DIAGNOSIS : Failed coronary artery bypass graft , prior myocardial infarction , hypertension , elevated cholesterol , renal insufficiency , congestive heart failure . PRINCIPAL PROCEDURE : 08/20/98 dual chamber pacemaker generator change ( CPI 1276 Meridian DR ) . ASSOCIATED PROCEDURES : 08/15/98 bilateral heart catheterization ; 08/15/98 left ventriculography ; 08/15/98 bilateral coronary angiography ; 08/15/98 bypass graft angiography ; 08/15/98 internal mammary artery angiography . MEDICATIONS ON DISCHARGE : Aspirin 325 mg. PO q.d. Lipitor 80 mg. PO q.d. Toprol XL 50 mg. PO q.d. Lasix 80 mg. q.a.m. and 40 mg. q.p.m. Potassium chloride 20 mEq. PO b.i.d. Citracal 1 packet q.d. Imdur 60 mg. PO q.d. Vitamin E 400 international units q.d. Prilosec 20 mg. PO q.d. HISTORY OF PRESENT ILLNESS : Breunlinke is a 70-year-old patient of Dr. Brendniungand Asilbekote in California . She is referred for progressive angina . She had rheumatoid fever as a child and a heart murmur noted but no further testing . She has used antibiotic prophylaxis since 1980 . In 1980 she had quadruple coronary artery bypass graft surgery by Dr. Elks at Feargunwake Otacaa Community Hospital and did well until 1988 when she had exertional angina and a positive stress test and found that three or four grafts were occluded . In October , 1989 , Dr. No re-did her bypass operation . She had a left internal mammary artery graft to the left anterior descending , saphenous vein graft to the obtuse marginal 1 and a saphenous vein graft to the obtuse marginal 2 . In 1993 she had a DDD pacemaker for complete heart block . She had exertional angina at that time . In November , 1997 she had a small myocardial infarction as was transferred to Ona Hospital where a cardiac catheterization showed a tight left internal mammary artery to left anterior descending stenosis , high grade saphenous vein graft to obtuse marginal 1 stenosis and patent obtuse marginal 2 graft . She had normal left ventricular function with apical tip akinesis . Since that time she has continued to have exertional left chest burning , radiating to the left neck and arm , relieved by nitroglycerin . She was turned down for re-do surgery at that time and did not have a percutaneous transluminal coronary angioplasty . Because these symptoms have been increasing , particularly at cardiac rehabilitation , she was referred here . In May , 1998 she had an exercise tolerance test in which her heart rate went to 112 and her blood pressure fell to 95 systolic . She had diffuse ischemic ST segment changes and increased lung uptake and a reversible anterior and lateral defect . She has had no syncope . Her cardiac risk factors are hypertension and elevated cholesterol . She has a very strong family history of coronary artery disease with a mother , sister and brother dying of myocardial infarction . She is a remote cigarette smoker . She also has a history of lactose intolerance , peptic ulcer disease , with a remote gastrointestinal bleed and multiple ectopic pregnancies and mid term miscarriages . She has had a total abdominal hysterectomy . SOCIAL HISTORY : She is a widow for 20 years and retired 18 years from Palmci She lives alone . Her son , Nertland is nearby and he works at the Em Nysonken Medical Center on Verville . They live in Ohio . PHYSICAL EXAMINATION : She is a healthy appearing female , 5 foot 120 pounds . Her blood pressure was 120/70 , pulse 60 and regular . Neck veins are not distended . Respiratory rate 12 . Carotids : no bruits . Lungs were clear . Cardiac : 1/6 systolic ejection murmur . Abdomen was benign . Peripheral pulses intact . Neurological examination non-focal . LABORATORY DATA : On admission , includes an electrocardiogram that shows DDD pacing . Hematocrit 39 percent , white blood cell count 4500 , PT and PTT normal . Sodium 140 , potassium 4.2 , chloride 105 , carbon dioxide 30 , BUN 24 , creatinine 1.0 . HOSPITAL COURSE AND TREATMENT : The patient was admitted to the Cardiac Catheterization Laboratory . There , her pulmonary wedge pressure was 12 and her right atrial pressure was 4 and pulmonary artery pressure 44/17 . Her left ventricular contraction showed akinesis of the anterior wall with dyskinesis of the apex . She had preserved inferior contraction and basal contraction . Her native right and left anterior descending vessels were occluded as was an obtuse marginal branch . The saphenous vein to the high diagonal or high obtuse marginal was occluded . The left internal mammary artery to the left anterior descending was also occluded . The saphenous vein graft to the second obtuse marginal was open with no significant stenosis , but there was an outflow lesion in the obtuse marginal 2 as well as severe distal lesion as the obtuse marginal 2 fed the posterior descending artery . This was considered her culprit lesion . This was considered too high risk for angioplasty because of the severe disease in the graft . In addition , it was noted that she had saphenous vein harvested from both thighs . Her left internal mammary artery was also unused . It was also noted that she had failure to sense with the atrial lead . She would not sense the atrial contraction and the fire and this occasionally led to competition of firing . This was intermittent . The P wave amplitude was .6 and this could not be totally sensed . The patient was admitted for management of her coronary artery disease and evaluation of her pacemaker . It was noted that she became very symptomatic when she was not on a beta blocker but that on a beta blocker she had significant pacemaker failure . Her pacemaker was set to a VVI mode which sensed appropriately . She was in sinus rhythm with most of the time . When her pacemaker was in a sinus rhythm without a beta blocker , she had significant angina . Carotid non-invasive testing was unremarkable . The situation was reviewed with Dr. Niste Graft . He felt the patient was not a coronary artery bypass graft candidate because of the lack of conduit and because of the presence of a large anterior myocardial infarction . For this reason , it was decided to maximize her beta blockers and nitrates . The situation was reviewed with Dr. No of the Pacemaker Service . On August 20 , under local anesthesia the right pectoral region was explored and the leads disconnected and the pulse generator changed to a CPI unit in which the sensitivity could be adjusted to .15 mm. , which permitted appropriate atrial sensing . There was nothing wrong with the prior generator and nothing wrong with the leads . It just needed a unit that could have more sensitivity in the atrial mode . She tolerated this well . Her medications were resumed . She ambulated without difficulty and was discharged to home to be followed medically for her coronary artery disease following two failed bypass graft procedure by Dr. Brendniungand Asilbekote in Bi Masase , KS . ACHASTHA N. GRAFT , M.D. TR : hfr DD : 08/22/1998 TD : 08/27/1998 3:56 P cc : ACHASTHA NICEMAEN GRAFT , M.D. GITTETUMN DARNNAMAN NO , M.D. [ report_end ] | 325924358 FIH 7061594 795820 418796 08 15 1998 12 00 00 AM CORONARY ARTERY DISEASE Unsigned DIS Report Status Unsigned DISCHARGE SUMMARY NAME TLANDRAC NI UNIT NUMBER 388 - 23 - 03 ADMISSION DATE 08 15 1998 DISCHARGE DATE 08 22 1998 PRINCIPAL DIAGNOSIS Coronary artery disease ASSOCIATED DIAGNOSIS Failed coronary artery bypass graft prior myocardial infarction hypertension elevated cholesterol renal insufficiency congestive heart failure PRINCIPAL PROCEDURE 08 20 98 dual chamber pacemaker generator change CPI 1276 Meridian DR ASSOCIATED PROCEDURES 08 15 98 bilateral heart catheterization 08 15 98 left ventriculography 08 15 98 bilateral coronary angiography 08 15 98 bypass graft angiography 08 15 98 internal mammary artery angiography MEDICATIONS ON DISCHARGE Aspirin 325 mg PO q d Lipitor 80 mg PO q d Toprol XL 50 mg PO q d Lasix 80 mg q a m and 40 mg q p m Potassium chloride 20 mEq PO b i d Citracal 1 packet q d Imdur 60 mg PO q d Vitamin E 400 international units q d Prilosec 20 mg PO q d HISTORY OF PRESENT ILLNESS Breunlinke is a 70 - year - old patient of Dr Brendniungand Asilbekote in California She is referred for progressive angina She had rheumatoid fever as a child and a heart murmur noted but no further testing She has used antibiotic prophylaxis since 1980 In 1980 she had quadruple coronary artery bypass graft surgery by Dr Elks at Feargunwake Otacaa Community Hospital and did well until 1988 when she had exertional angina and a positive stress test and found that three or four grafts were occluded In October 1989 Dr No re - did her bypass operation She had a left internal mammary artery graft to the left anterior descending saphenous vein graft to the obtuse marginal 1 and a saphenous vein graft to the obtuse marginal 2 In 1993 she had a DDD pacemaker for complete heart block She had exertional angina at that time In November 1997 she had a small myocardial infarction as was transferred to Ona Hospital where a cardiac catheterization showed a tight left internal mammary artery to left anterior descending stenosis high grade saphenous vein graft to obtuse marginal 1 stenosis and patent obtuse marginal 2 graft She had normal left ventricular function with apical tip akinesis Since that time she has continued to have exertional left chest burning radiating to the left neck and arm relieved by nitroglycerin She was turned down for re - do surgery at that time and did not have a percutaneous transluminal coronary angioplasty Because these symptoms have been increasing particularly at cardiac rehabilitation she was referred here In May 1998 she had an exercise tolerance test in which her heart rate went to 112 and her blood pressure fell to 95 systolic She had diffuse ischemic ST segment changes and increased lung uptake and a reversible anterior and lateral defect She has had no syncope Her cardiac risk factors are hypertension and elevated cholesterol She has a very strong family history of coronary artery disease with a mother sister and brother dying of myocardial infarction She is a remote cigarette smoker She also has a history of lactose intolerance peptic ulcer disease with a remote gastrointestinal bleed and multiple ectopic pregnancies and mid term miscarriages She has had a total abdominal hysterectomy SOCIAL HISTORY She is a widow for 20 years and retired 18 years from Palmci She lives alone Her son Nertland is nearby and he works at the Em Nysonken Medical Center on Verville They live in Ohio PHYSICAL EXAMINATION She is a healthy appearing female 5 foot 120 pounds Her blood pressure was 120 70 pulse 60 and regular Neck veins are not distended Respiratory rate 12 Carotids no bruits Lungs were clear Cardiac 1 6 systolic ejection murmur Abdomen was benign Peripheral pulses intact Neurological examination non - focal LABORATORY DATA On admission includes an electrocardiogram that shows DDD pacing Hematocrit 39 percent white blood cell count 4500 PT and PTT normal Sodium 140 potassium 4 2 chloride 105 carbon dioxide 30 BUN 24 creatinine 1 0 HOSPITAL COURSE AND TREATMENT The patient was admitted to the Cardiac Catheterization Laboratory There her pulmonary wedge pressure was 12 and her right atrial pressure was 4 and pulmonary artery pressure 44 17 Her left ventricular contraction showed akinesis of the anterior wall with dyskinesis of the apex She had preserved inferior contraction and basal contraction Her native right and left anterior descending vessels were occluded as was an obtuse marginal branch The saphenous vein to the high diagonal or high obtuse marginal was occluded The left internal mammary artery to the left anterior descending was also occluded The saphenous vein graft to the second obtuse marginal was open with no significant stenosis but there was an outflow lesion in the obtuse marginal 2 as well as severe distal lesion as the obtuse marginal 2 fed the posterior descending artery This was considered her culprit lesion This was considered too high risk for angioplasty because of the severe disease in the graft In addition it was noted that she had saphenous vein harvested from both thighs Her left internal mammary artery was also unused It was also noted that she had failure to sense with the atrial lead She would not sense the atrial contraction and the fire and this occasionally led to competition of firing This was intermittent The P wave amplitude was 6 and this could not be totally sensed The patient was admitted for management of her coronary artery disease and evaluation of her pacemaker It was noted that she became very symptomatic when she was not on a beta blocker but that on a beta blocker she had significant pacemaker failure Her pacemaker was set to a VVI mode which sensed appropriately She was in sinus rhythm with most of the time When her pacemaker was in a sinus rhythm without a beta blocker she had significant angina Carotid non - invasive testing was unremarkable The situation was reviewed with Dr Niste Graft He felt the patient was not a coronary artery bypass graft candidate because of the lack of conduit and because of the presence of a large anterior myocardial infarction For this reason it was decided to maximize her beta blockers and nitrates The situation was reviewed with Dr No of the Pacemaker Service On August 20 under local anesthesia the right pectoral region was explored and the leads disconnected and the pulse generator changed to a CPI unit in which the sensitivity could be adjusted to 15 mm which permitted appropriate atrial sensing There was nothing wrong with the prior generator and nothing wrong with the leads It just needed a unit that could have more sensitivity in the atrial mode She tolerated this well Her medications were resumed She ambulated without difficulty and was discharged to home to be followed medically for her coronary artery disease following two failed bypass graft procedure by Dr Brendniungand Asilbekote in Bi Masase KS ACHASTHA N GRAFT M D TR hfr DD 08 22 1998 TD 08 27 1998 3 56 P cc ACHASTHA NICEMAEN GRAFT M D GITTETUMN DARNNAMAN NO M D report end | positive |
| 29 | 213763231 CMC 07646518 10/3/2002 12:00:00 AM ACUTE MYELOGENOUS LEUKEMIA Signed DIS Admission Date : 10/03/2002 Report Status : Signed Discharge Date : 11/03/2002 ADDENDUM TO DISCHARGE SUMMARY : Please see prior admission summary for details of entire stay except for 10/31/02 to 11/03/02 . Patient was admitted to Oncology B service . ADMISSION DIAGNOSIS : ACUTE MYELOGENOUS LEUKEMIA . DISCHARGE DIAGNOSIS : ACUTE MYELOGENOUS LEUKEMIA . HOSPITAL COURSE : 10/30/02 - 11/03/02 : The patient had been on Vanco , Ceftaz as well as Ambisome secondary to fevers of unknown origin . ANC reached greater than 500 on 10/30/02 and therefore , Vancomycin was discontinued on 10/31/02 . The patient did remain afebrile and the following day Ceftaz was discontinued as well . The patient did remain afebrile , was feeling well . Patient had followups set up for him with transfusion units on 11/06/02 as well as Dr. Charla Titchekote on 11/09/02 for a bone marrow biopsy . The patient 's vitals were stable . He was afebrile . His rash had declined . There was no adenopathy . His chest was clear , and therefore on 11/03/02 the patient was discharged with a followup plan . In conclusion , this is a 56-year-old man admitted with AML , status post induction therapy with 3 and 7 . Cytology was consistent with M2 , AML with normal cytogenetics . On day 14 bone marrow biopsy did show hypercellularity . On discharge the patient was no longer neutropenic . He was transfused one unit of platelets prior to discharge with followup at the DFCI on 11/06 with a transfusion unit and on 11/09 with Dr. Charla B Titchekote for additional bone marrow biopsy . DISCHARGE MEDICATIONS : Clotrimazole by mouth one troche four times per day , Colace 100 mg p.o. b.i.d. , multivitamin 1 tab p.o. q d , Trazodone 50 mg q h.s. , Nexium 20 mg p.o. q d , Tylenol p.r.n. Eucerin p.r.n. Dictated By : NA C. STUTLBRENES , M.D. ER942 Attending : TICE D. FOUTCHJESC , M.D. UU2 FK795/004653 Batch : 22832 Index No. Y1WYX127C5 D : 04/28/03 T : 04/29/03 [ report_end ] | 213763231 CMC 07646518 10 3 2002 12 00 00 AM ACUTE MYELOGENOUS LEUKEMIA Signed DIS Admission Date 10 03 2002 Report Status Signed Discharge Date 11 03 2002 ADDENDUM TO DISCHARGE SUMMARY Please see prior admission summary for details of entire stay except for 10 31 02 to 11 03 02 Patient was admitted to Oncology B service ADMISSION DIAGNOSIS ACUTE MYELOGENOUS LEUKEMIA DISCHARGE DIAGNOSIS ACUTE MYELOGENOUS LEUKEMIA HOSPITAL COURSE 10 30 02 - 11 03 02 The patient had been on Vanco Ceftaz as well as Ambisome secondary to fevers of unknown origin ANC reached greater than 500 on 10 30 02 and therefore Vancomycin was discontinued on 10 31 02 The patient did remain afebrile and the following day Ceftaz was discontinued as well The patient did remain afebrile was feeling well Patient had followups set up for him with transfusion units on 11 06 02 as well as Dr Charla Titchekote on 11 09 02 for a bone marrow biopsy The patient s vitals were stable He was afebrile His rash had declined There was no adenopathy His chest was clear and therefore on 11 03 02 the patient was discharged with a followup plan In conclusion this is a 56 - year - old man admitted with AML status post induction therapy with 3 and 7 Cytology was consistent with M2 AML with normal cytogenetics On day 14 bone marrow biopsy did show hypercellularity On discharge the patient was no longer neutropenic He was transfused one unit of platelets prior to discharge with followup at the DFCI on 11 06 with a transfusion unit and on 11 09 with Dr Charla B Titchekote for additional bone marrow biopsy DISCHARGE MEDICATIONS Clotrimazole by mouth one troche four times per day Colace 100 mg p o b i d multivitamin 1 tab p o q d Trazodone 50 mg q h s Nexium 20 mg p o q d Tylenol p r n Eucerin p r n Dictated By NA C STUTLBRENES M D ER942 Attending TICE D FOUTCHJESC M D UU2 FK795 004653 Batch 22832 Index No Y1WYX127C5 D 04 28 03 T 04 29 03 report end | unknown |
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