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May 27 06:02
• Preoperative Diagnosis: ACUTE APPENDICITIS. Procedure: EX ...
+ wav
Sat May 27 09:39:25 2017 wav
Preoperative Diagnosis:
ACUTE APPENDICITIS.

Procedure:
EXPLORATORY LAPAROSCOPY AND PLACEMENT OF DRAIN.

This is a 38-year-old male who presented to the emergency room today with complaints of two days of abdominal pain. He states that the pain was _____ in the right lower quadrant and some diffuse abdominal discomfort. He has never had this pain before.
** • both - k p e c i h
Sat May 27 10:07:15 2017 k p e c i h

**** • Thanks a lot. - guy
Sat May 27 10:10:32 2017 guy


• This is a 73-year-old female who had a mechanical trip and fall on a _ ...
+ wav
Sat May 27 09:18:29 2017 wav
This is a 73-year-old female who had a mechanical trip and fall on a _____ walking to a store and fell onto her right knee.
** • step while - nm
Sat May 27 09:37:03 2017 nm

**** • Thanks a lot. - guy
Sat May 27 09:39:13 2017 guy


• The patient is a 25-year-old otherwise healthy right-hand dominant mal ...
+ wav
Sat May 27 04:54:25 2017 wav
The patient is a 25-year-old otherwise healthy right-hand dominant male who was a bicyclist struck by a car on 05/23/17 where his outstretched arm was _____ truck and sustained the laceration _____ trauma.
** • ..was smacked on the rear view mirror of the truck.....from the blunt trauma (?) - nm
Sat May 27 06:49:40 2017 nm

**** • Thanks a lot. - guy
Sat May 27 08:37:15 2017 guy


• FINDINGS: Small, partially-necrotic remnant of common bile duct near ...
+ wav
Sat May 27 02:16:29 2017 wav
FINDINGS: Small, partially-necrotic remnant of common bile duct near the gallbladder fossa with significant adhesions of the duodenum and colon into the perihepatic and gallbladder fossa space. These were lysed sharply. Anastomosis of a retrocolic Roux-en-Y hepaticojejunostomy over an 8-French pediatric feeding tube was fashioned. A 19-French Blake drain _____ and near anastomosis.
** • nevermind. - guy
Sat May 27 03:30:29 2017 guy


• This is a 45-year-old male who was admitted to the medical ICU for the ...
+ wav
Sat May 27 00:50:19 2017 wav
This is a 45-year-old male who was admitted to the medical ICU for the diagnosis of sepsis and toxic shock syndrome. During his hospital stay, orthopedic surgery was consulted for evaluation of right knee swelling. A right knee aspiration was performed and demonstrated over 50,000 white cell count consistent with septic arthritis of the right knee. However, the primary medical team was unable to determine whether the right knee septic arthritis was the source of the patients bacteremia and sepsis. Further workup revealed the patient had multiple foci infection in the _____. The cultures from the right knee were positive were positive for MSSA. The patient also demonstrated positive blood cultures. Given the multifocal source of infection, decision was made to proceed with serial aspirations of his right knee until the definitive source could be controlled. The patients stabilized during his hospital course and was no longer febrile; however, his white cell count continue to i
** • That could make sense since he mentions multifocal source of + Q
Sat May 27 00:52:06 2017 Q
infection (?lung and knee?)
**** • Apparently also positive blood culture - Q
Sat May 27 00:53:03 2017 Q

** • I hear "lung" - Questyr
Sat May 27 00:51:08 2017 Questyr

**** • Thanks a lot. Thanks for the correction. - guy
Sat May 27 00:56:15 2017 guy


• A Woodson was used to confirm the neural foramen were wide and the ner ...
+ mp3
Sat May 27 00:23:27 2017 mp3
A Woodson was used to confirm the neural foramen were wide and the nerve roots for right and left L5, S1, S2, and S3 were patent without any compression from the fracture fragments. The lateral gutters were then well corticated as well as L4-L5 and L5-S1 facet joints. The wound was then copiously irrigated and autograft previously harvested was then placed _____ and then placed in the posterolateral gutters to serve as a fusion bed.
** • ???in the middle??? - Questyr
Sat May 27 00:47:53 2017 Questyr

**** • Thanks a lot. - guy
Sat May 27 00:50:38 2017 guy


• Preoperative Diagnosis: (H-TYPE) SACRAL FRACTURE WITH SPINO-PELVIC ...
+ wav
Sat May 27 00:11:24 2017 wav
Preoperative Diagnosis:
(H-TYPE) SACRAL FRACTURE WITH SPINO-PELVIC DISSOCIATION.

Procedures:
1. L4 TO PELVIS POSTERIOR SPINAL FUSION WITH ILIAC INSTRUMENTATION.
2. L5 TO SACRUM LUMBOSACRAL DECOMPRESSION.
3. ILIAC CREST HARVEST.
4. MANIPULATION OF ANTERIOR PELVIC EXTERNAL FIXATOR.
5. IRRIGATION AND DEBRIDEMENT OF MOREL-LAVALLEE LESION.

Rod reducers were then utilized to bring the L4 and L5 vertebral bodies translated posteriorly onto the rod with a goal of indirectly reducing some of the free floating sacral fragment back onto the sacrum. Fluoroscopy confirmed some mild reduction of the S1 fragment; however, reduction was limited due to the free floating nature of this sacral fragment. Attention was then paid to decompression of the neural elements _____ was performed and the ligamentum flavum was carefully resected until the lateral edges of the dura were visualized.
** • elements. Wide laminectomy was performed - Questyr
Sat May 27 00:45:33 2017 Questyr

**** • Thanks a lot. - guy
Sat May 27 00:46:16 2017 guy


• is this term (lucent) used with patient?
+ guy
Fri May 26 23:09:46 2017 guy
When the patient became **more lucent**, physical exam demonstrated 0/5 motor function of the right L5 nerve root as well as mild weakness with L4 on the right side.
** • more lucid - Questyr
Fri May 26 23:48:16 2017 Questyr

**** • ... + c n g o m g
Sat May 27 00:50:50 2017 c n g o m g

**** • Thanks a lot. - guy
Sat May 27 00:08:40 2017 guy

** • wav posted. Thanks. - guy
Fri May 26 23:34:24 2017 guy


• positive stool s/l leuko test..s/l peri-informal colitis was encountered. TIA!
+ gi colonoscopy?
Fri May 26 18:18:51 2017 gi colonoscopy?
Patient had negative Clostridium difficile toxin, negative stool culture, and a positive stool ____ (s/l leuko) test. Random colon biopsies were obtained and 1 colon polyp was removed. A petechial _____ (s/l peri-informal) colitis that was circumferential was encountered. Cecum had moderate ___ (s/l sipid) changes.
** • Thanks, Q. Flagging and moving on. - OP
Fri May 26 20:09:34 2017 OP

** • I don't know the other two. Sorry. - Q
Fri May 26 19:33:46 2017 Q

** • #1 probably yes leuko (see link) + Questyr
Fri May 26 19:28:20 2017 Questyr
link

• s/l postprepared or postrepair
+ Alicia
Fri May 26 12:09:06 2017 Alicia
PREOPERATIVE DIAGNOSIS: End-stage renal disease secondary to reflux nephropathy.

SURGERY:
1. Left to left DCD standard criteria donor kidney transplantation.
2. s/l post-prepared or post-repaired and reperfusion kidney biopsy.
3. Double-J stent insertion.
** • Nevermind.....he just hesitated and started again. Post-reperfusion kidney biopsy. - Alicia
Fri May 26 12:24:17 2017 Alicia


• s/l Kill sign sm
+ sb
Fri May 26 11:51:29 2017 sb
"IMAGING: Four views of the left shoulder were taken. He has no significant glenohumeral arthritic changes. He does have some AC joint arthritis with some mild inferior osteophytes. He has a bit of a curve to the anterior acromion of that left shoulder. He has almost a <___Kill___> sign on the undersurface of the acromion as well, particularly noted on the AP view. No fractures or other bony abnormality is noted." I am stumped. Any help appreciated!
** • keel? - nm
Fri May 26 16:10:40 2017 nm

**** • Aha, a subacromial keel. Good job. Not op though. - frugivore
Fri May 26 17:56:25 2017 frugivore

** • So am I. Sorry. - Questyr
Fri May 26 13:52:17 2017 Questyr


• and locally _____ with the stent coming out of them at rest _____.
+ wav
Fri May 26 11:37:45 2017 wav
A #20 French ureteroscope was entered into the meatus without difficulty visualizing obstructed ureteral orifices due to edema and locally _____ with the stent coming out of them at rest _____. Retrograde pyelogram revealed still a hydronephrotic system.

** • advanced cancer, with the stents coming out of them.... left side (?) - taco (can't get ...)
Fri May 26 11:41:57 2017 taco (can't get ...)


• unable to obtain a CTA due to the ____ based on her renal function.
+ mp3
Fri May 26 11:06:14 2017 mp3
At the present time, she is unable to obtain an MRA secondary to the defibrillator and unable to obtain a CTA due to the ____ based on her renal function.
** • got it - op
Fri May 26 11:12:47 2017 op


• There was a clean base of good granulation tissue and clean bleeding e ...
+ wav
Fri May 26 09:27:57 2017 wav
There was a clean base of good granulation tissue and clean bleeding edges. No purulence or drainage. No surrounding erythema and no fluctuance. _____ was to take the patient to the operating room for washout and debridement, bilateral pectoralis major advancement flaps, and possible wound VAC placement.
** • The plan - what I hear
Fri May 26 09:43:24 2017 what I hear

** • The plan - taco
Fri May 26 09:43:12 2017 taco

**** • Thanks a lot everybody - guy
Fri May 26 09:45:53 2017 guy


• The right foot was prepped and draped in the usual sterile manner. ** ...
+ wav
Fri May 26 08:53:45 2017 wav
The right foot was prepped and draped in the usual sterile manner. **The screws stabilizing the external fixator construct struts were removed.** A sterile _____ cutter was used to cut the lateral _____ calcaneal pin. The _____ K-wires were removed, two 0.062 K-wires. The half-pins inserted into the navicular and cuboid were removed without incident.
** • 1 - bolt 2 - construct with the? 3 - talar - taco
Fri May 26 09:05:46 2017 taco

**** • Thanks a lot. - guy
Fri May 26 09:10:33 2017 guy


• Retroflexion of gastroscope of the *endostomach*
+ sm
Fri May 26 08:29:02 2017 sm
The cardia, fundus, and body of the stomach were normal. The antrum showed moderate gastritis with erythema that was biopsied. Retroflexion of gastroscope of the *endostomach* was normal. The pylorus was widely patent revealing a normal-appearing duodenal bulb. There were no gastric or duodenal ulcers.
** • flagging - -
Fri May 26 09:42:29 2017 -

** • flagging - -
Fri May 26 09:41:37 2017 -


• INDICATION: This is a 52-year-old gentleman who had been admitted and ...
+ wav
Fri May 26 05:48:39 2017 wav
INDICATION: This is a 52-year-old gentleman who had been admitted and transferred from an outside hospital with failure to wean from ventilator with severe asthmatic attack which ____ likely due to compression from previously undiagnosed vascular ring caused by the double aortic arch creating both tracheal and esophageal compression.
** • ...which in retrospect is likely - nm
Fri May 26 07:04:37 2017 nm

**** • Thanks a lot. - guy
Fri May 26 07:07:23 2017 guy


• Normal appearing right fallopian tube. Some endometriotic implants on ...
+ mp3
Fri May 26 03:06:39 2017 mp3
Normal appearing right fallopian tube. Some endometriotic implants on the right uterosacral ligament. The patient _____ cesarean section due to three large hysterotomies on anterior, posterior, and fundal uterine walls.
** • nevermind. Thanks to anyone who tried. - guy
Fri May 26 04:48:15 2017 guy


• FINDINGS: Exam under anesthesia demonstrated enlarged 24-week mobile ...
+ wav
Fri May 26 02:58:28 2017 wav
FINDINGS: Exam under anesthesia demonstrated enlarged 24-week mobile fibroid uterus. Total of 11 fibroids were removed. All subserosal intramural uterine cavity not entered. Left ovary and fallopian tube were normal appearing. Right ovary adhesed to the uterosacral ligament enlarged with 4 cm endometrioma, ruptured intraop for endometriotic _____. Normal appearing right fallopian tube. Some endometriotic implants on the right uterosacral ligament.
** • nevermind. - guy
Fri May 26 04:48:04 2017 guy


• Past medical history is significant for diabetes, hypertension, hyperl ...
+ mp3
Fri May 26 01:10:02 2017 mp3
Past medical history is significant for diabetes, hypertension, hyperlipidemia, osteoarthritis, and thyroid issues, she has a penicillin allergy with reaction of anaphylaxis and so discussion was undergone with the patient. EMG results from October of 2016 confirmed _____ median nerve entrapment and wrist bilaterally, and given increasing symptoms on the right side, decision was made to _____ the patient and consent her for right open carpal tunnel release.
** • #1 ???there appeared to be a??? median nerve entrapment in (not and) - Q
Fri May 26 01:23:06 2017 Q

**** • ... + p a b j a p
Fri May 26 03:06:49 2017 p a b j a p

**** • can it be "confirmed evidence"? - guy
Fri May 26 01:28:22 2017 guy

**** • also I think she says "wrists bilaterally" (not wrist) - Q
Fri May 26 01:24:49 2017 Q

** • #2 book - Questyr
Fri May 26 01:20:15 2017 Questyr

**** • Thanks a lot. Thanks for the correction. - guy
Fri May 26 01:26:28 2017 guy


• The middle digit was first revascularized using a combination of 9-0 a ...
+ guy
Fri May 26 00:45:40 2017 guy
The middle digit was first revascularized using a combination of 9-0 and 10-0 interrupted nylon sutures with the vein graft to the native vessels after checking for adequate inflow to the digital artery. There appeared to be good pulsatile flow through the vein graft in both anastomoses with bleeding from the tip.

or

The middle digit was first revascularized using a combination of 9-0 and 10-0 interrupted nylon sutures with the vein graft to the native vessels. After checking for adequate inflow to the digital artery, there appeared to be good pulsatile flow through the vein graft in both anastomoses with bleeding from the tip.
** • The first one is correct. He connects the vein graft AFTER checking to make + Questyr
Fri May 26 01:19:34 2017 Questyr
sure the artery had adequate inflow.
**** • Thanks a lot. - guy
Fri May 26 01:26:15 2017 guy

** • wav posted. Thanks. - guy
Fri May 26 00:47:38 2017 guy


• The patient was at work when a large metal radiator fell onto his palm ...
+ wav
Fri May 26 00:22:41 2017 wav
The patient was at work when a large metal radiator fell onto his palmar surface of the right hand. The patient attempted to _____ his hand by pulling resulting in a avulsion type component to the crush.
** • In case not a typo, s/b in an avulsion-type component... - Questyr
Fri May 26 00:30:18 2017 Questyr

**** • Thanks for the correction. - guy
Fri May 26 00:39:22 2017 guy

** • extricate - poi
Fri May 26 00:24:50 2017 poi

**** • Thanks a lot. - guy
Fri May 26 00:25:05 2017 guy


• Thus, a 9-mm trial was loaded with allograft and deployed into the dis ...
+ wav
Fri May 26 00:02:09 2017 wav
Thus, a 9-mm trial was loaded with allograft and deployed into the disc space under lateral fluoroscopy to confirm the depth and confirm the deployment of the device. Next, _____ trials were attempted at C5-C6 where a 7-mm device was thought to be most adequate. First, a piece of platysma muscle was placed over the area of spinal fluid leak
** • I think he stumbles then ends up with "7-mm trials" - Questyr
Fri May 26 00:18:58 2017 Questyr

**** • Thanks a lot. - guy
Fri May 26 00:21:24 2017 guy


• spinal fluid was noted to come forth and there was an anatomic element ...
+ mp3
Thu May 25 23:40:26 2017 mp3
spinal fluid was noted to come forth and there was an anatomic element that was visible in the field concerning for nerve root. Thus, Gelfoam was placed there. Hemostasis was obtained _____ decompression was finished. Next, discectomy was carried out at C6-C7 after similarly distracting with 14 mm Caspar pins and carrying out discectomy using Kerrison rongeurs and straight and upgoing curettes.
** • ???and the rest of the??? - Questyr
Thu May 25 23:53:38 2017 Questyr

**** • Thanks a lot. - guy
Thu May 25 23:55:40 2017 guy


• Preoperative Diagnosis: CERVICAL SPONDYLOTIC MYELOPATHY. Pro ...
+ wav
Thu May 25 23:34:26 2017 wav
Preoperative Diagnosis:
CERVICAL SPONDYLOTIC MYELOPATHY.

Procedure:
C5-C6, C6-C7 ANTERIOR CERVICAL DISCECTOMY AND FUSION.

The noted posterior osteophyte at that level was also drilled. The posterior longitudinal ligament was elevated using small upgoing curette and cut using 1-mm Kerrison and further removed using 2-mm Kerrison on the left lateral side _____ spinal fluid was noted to come forth and there was an anatomic element that was visible in the field concerning for nerve root.
** • ???during one Kerrison bite the spinal fluid??? - Questyr
Thu May 25 23:52:54 2017 Questyr

**** • Thanks a lot. - guy
Thu May 25 23:55:34 2017 guy


• Asthma, controlled, CPM. Any idea what CPM could be? sm
+ dd
Thu May 25 22:55:23 2017 dd
I don't have any other info. This is just in assessment list.
** • Sorry. I have no idea. - Questyr
Thu May 25 23:58:37 2017 Questyr


• The surrounding blood was then suctioned out of the abdomen and there ...
+ wav
Thu May 25 22:46:36 2017 wav
The surrounding blood was then suctioned out of the abdomen and there was no evidence for continued ongoing bleeding. Hemostasis was appropriate and there was no _____ abdomen. After verifying that hemostasis had been achieved, we turned our attention to removal of the 5-mm trocar port which was taken out of the abdomen under direct laparoscopic vision.
** • pus left in the - poi
Thu May 25 22:50:26 2017 poi

**** • Thanks a lot. - guy
Thu May 25 22:52:22 2017 guy


• We...Dr. XXX did; or We...Dr. XXX, Comma or semicolon?
+ ar
Thu May 25 22:21:11 2017 ar
We reviewed 3 views of the left great toe from 05/22/2017 that Dr. XXX did, AP, lateral, and oblique views that show a minimally displaced proximal phalanx fracture of the great toe.
** • I think I would do it "did (AP, lateral, and oblique views) that" BTJMO - Questyr
Fri May 26 00:00:35 2017 Questyr


• The proper orientation of the mesh was maintained throughout the entir ...
+ wav
Thu May 25 21:31:04 2017 wav
The proper orientation of the mesh was maintained throughout the entire procedure with the nonadherent hydrocellulose-coated side of the mesh facing the bowel. After proper positioning of the mesh, a suture passer _____ needle was used to pull the transfascial sutures out corresponding stab incisions.
** • looks like GraNee needle. - billybob
Thu May 25 21:40:53 2017 billybob

**** • Thanks a lot. - guy
Thu May 25 21:42:51 2017 guy


• The NovaSure was then inserted, set for _____ 4 cm with ____, and it would not emplo
+ mp3 posted
Thu May 25 19:25:36 2017 mp3 posted
She was dilated to around a 24. The NovaSure was then inserted, set for _____ 4 cm with ____, and it would not employ.
** • set for 4 cm of cavity - nm
Thu May 25 19:36:46 2017 nm

**** • Thank you! - mp3 posted
Thu May 25 19:42:58 2017 mp3 posted


• Anterior cut was completed first to confirm notching and appropriate s ...
+ wav
Thu May 25 18:49:48 2017 wav
Anterior cut was completed first to confirm notching and appropriate sizing of the femur _____ was identified and appropriate rotation and size of the cutting block was confirmed.
** • and a grand piano sign (see link) + Questyr
Thu May 25 19:08:20 2017 Questyr
link
**** • Thanks a lot. - guy
Thu May 25 19:09:13 2017 guy

** • I hear "non-notching", but cannot get your blank - poi
Thu May 25 19:05:33 2017 poi

**** • Thanks a lot. - guy
Thu May 25 19:06:05 2017 guy


• boxed appearance of outside nose. No _________ deformity
+ mp3 posted
Thu May 25 15:38:46 2017 mp3 posted
Nasal examination showed his longstanding boxed appearance of outside nose. No _________ deformity. Intranasally, he has a small perforation of the septum, center aspect.
** • No saddle deformity. (I think your boxed should just be "box.") - nm
Thu May 25 15:44:18 2017 nm

**** • Thank you! - mp3 posted
Thu May 25 17:01:51 2017 mp3 posted


• tachycardia **mediated** myopathy
+ ?
Thu May 25 15:07:28 2017 ?
She is going to be monitored clinically. We will see her again in two to three months time. She will have repeat echocardiogram at that point as well to analyze whether her myopathy has resolved (presumably she had tachycardia _____ myopathy).
** • google that... it is such a thing. - k p e c i h
Thu May 25 15:09:01 2017 k p e c i h

**** • I did and found some information just not a lot so wasn't sure. - Thanks!
Thu May 25 15:11:44 2017 Thanks!

****** • note that it s/b hyphenated...tachycardia-mediated as it is serving as + Questyr
Thu May 25 16:10:39 2017 Questyr
a compound modifier of myopathy

• peptic stress ulcer as a result of his recent operations and __ stressors
+ WAV
Thu May 25 14:36:09 2017 WAV
The differential diagnoses includes that of a peptic stress ulcer as a result of his recent operations and __ stressors or a recurrence of his peptic ring or reflux associated. Nonetheless, he needs to come into hospital for a gastroscopy and I will look after him until we get him eating and conditioned again. He is now 69 years old and he may need a period of rehabilitation to get him good again.
** • overall? - k p e c i h
Thu May 25 15:09:28 2017 k p e c i h

** • any guess? - ??
Thu May 25 14:57:26 2017 ??


• right foot cyst removal, left ________ who has low vitamin D
- mp3 posted
Thu May 25 14:17:26 2017 mp3 posted

** • flagged. - OP
Thu May 25 15:26:05 2017 OP


• he does not want to take it and he feels ___ to the point that he would rather have d
+ WAV
Thu May 25 13:05:43 2017 WAV
We are not getting very far. The Questran does bind him up but it is stiffens him up to the point where he does not want to take it and he feels ___ to the point that he would rather have diarrhea. I note you have tried Gastro-Stop and codeine in the past. We will try some Lomotil
** • absolutely chockablock (or chock-a-block) -- that's a new one to me! - taco
Thu May 25 13:20:02 2017 taco

**** • never would have gotten that! Thank you taco! - :)
Thu May 25 13:24:30 2017 :)

****** • FYI Merriam Webster's shows it without hyphens...I linked it here because + Questyr
Thu May 25 16:14:06 2017 Questyr
I found the story for the source of the word interesting
** • anyone have any guess? - ???
Thu May 25 13:18:19 2017 ???


• harvested from the right thigh and *pie meshed* 1.5:1.
+ sm
Thu May 25 12:38:57 2017 sm
The medial wound was 17 x 6 and lateral was 32 x 8. The wound was irrigated with copious amounts of saline. Hemostasis was obtained by cautery. Then 14:1000 split-thickness skin graft was harvested from the right thigh and *pie meshed* 1.5:1. The skin grafts were then stapled to the medial and lateral leg wounds. Grafting in total of 358 cm2. The lateral wound was 32 x 8 and the medial was 17 x 6. Xeroform, 4 x 4s, Kling wrap, Ace wrap, and Coban were applied including the foot and ankle constituting multilayer compression dressing.
** • yes - "a mesher is a hand-cranked instrument that creates pie-cuts in the skin" - taco
Thu May 25 12:46:58 2017 taco

**** • ty - -
Thu May 25 13:05:16 2017 -


• Excessive _______ from bronchitis.
- mp3 posted
Thu May 25 12:27:38 2017 mp3 posted

** • general asthma??? - taco
Thu May 25 12:47:36 2017 taco

**** • thanks taco - OP
Thu May 25 13:00:18 2017 OP


• s/l volemic or bulimic alcoholism
+ Alicia
Thu May 25 12:12:45 2017 Alicia
Patient with alcoholic abuse with s/l volemic alcoholism, drinking 21 days out of the month.
** • It is bulimic alcoholism. Stated later in letter that he vomits so he can drink more - Alicia
Thu May 25 12:17:41 2017 Alicia


• UTI with Entercoccal endocarditis. This actually had _____ patient _____.
- :) wav
Thu May 25 11:46:15 2017 :) wav

** • is your wav correct? I am hearing "He had started the patient full course. She had AICD" - poi
Thu May 25 12:02:57 2017 poi

**** • Yes that is the correct wav. It just did not make sense. - :)
Thu May 25 12:19:32 2017 :)


• inserted down to the pylorus and the *seal* was deployed
+ ?
Thu May 25 11:31:16 2017 ?
Another plication suture was identified. This was also transected and complete undoing of the plication was performed. The gastrocele was inserted down to the pylorus and the _____ was deployed in order to straighten out the stomach. The gastrocele was then reduced and suctioning was performed to decompress the stomach and for that, black load 60 with reinforcement was used for all the fire loads starting about 5 cm proximal to the pylorus, staying away from the incisura angularis by angling away from this area, and passing towards the angle of His. T
** • Am wondering if hyour "gastrocele" should be GastriSail gastric positioning system i + poi
Thu May 25 12:07:28 2017 poi
system is a three-in-one surgical device....if true, seal would be correct
** • flagging - -
Thu May 25 11:57:55 2017 -


• The lateral *sue fad*at the brow
+ sm
Thu May 25 11:19:25 2017 sm
The investing fascia of the central compartment was now opened. The central compartment was actually divided into two components and these resected independently and coagulated with the bipolar cautery. The medial compartment was unroofed and a huge amount of fat was expressed and this too was coagulated. The lateral *sue fad* at the brow where it descended into the lid structure was electrocoagulated along its margin meticulously. The lid was unfurled at the tarsal plate margin and the lid sutured into positions through the tarsal plate producing additional fixation and support and finding the sulcal crease.
** • Don't know, but in the last sentence I would think "and finding" might be "defining" - Questyr
Thu May 25 11:22:20 2017 Questyr

**** • ty - -
Thu May 25 11:51:52 2017 -


• Punctuation okay on this? Verbatim account. TIA.
+ sm
Thu May 25 11:18:14 2017 sm
L4-L5 disk herniation, diffuse, posterior, central, right paracentral with diskal tear, high-intensity zone.
** • I would probably use a hyphen rather than comma after herniation as + Questyr
Thu May 25 11:20:08 2017 Questyr
everything that follows it is describing the disk herniation status BTJMO (some might use a colon)
**** • Thank you. :) - OP
Thu May 25 12:19:21 2017 OP


• VITAL SIGNS: s/l Hypothyroid neck at 34.7, pulse 74, respiratory rate 16
+ sm
Thu May 25 10:58:18 2017 sm
does this sound right?
** • Maybe. A neck circumference 34.7 cm is high, indicative of enlarged thyroid/hypothyroid - taco
Thu May 25 11:06:48 2017 taco


• closed in full thickness *oh mass* fashion
+ sm
Thu May 25 09:23:20 2017 sm
The incision site was then closed in full thickness ______ fashion with interrupted #1 Prolene vertical mattress sutures followed by skin staples with bacitracin ointment and a dry sterile dressing.
** • Just hought it is probably 0 mattress - ?
Thu May 25 09:23:48 2017 ?

**** • Sorry, that's probably not right. Any ideas - ?
Thu May 25 09:24:27 2017 ?

****** • I would think 0 mass (0 being the suture size, mass being the technique)...see google link + Questyr
Thu May 25 11:18:16 2017 Questyr
link

• A single #5 Gore-Tex *cord* was placed
+ sm
Thu May 25 07:39:52 2017 sm
This did not completely resolve the problem. As such, I elected to cut a very large thickened primary chordae which was excised. A single #5 Gore-Tex ______ was placed. Valve was tested and found to be reasonably competent. #2-0 Ti-Cron sutures were then placed circumferentially around the annulus and then passed up through a #30 Physio ring which was parachuted in place.

Cannot document any of the possible spellings. Please help. Thanks!
** • Gore-Tex nonabsorbable suture. i use cord all the time. - guy
Thu May 25 07:51:58 2017 guy

**** • Thank you - !
Thu May 25 08:00:50 2017 !


• The necrotic tissue was debrided from the lateral aspect of the foot. ...
+ wav
Thu May 25 06:57:57 2017 wav
The necrotic tissue was debrided from the lateral aspect of the foot. Some remnant purulence was noted to be tracking up the _____ and medially towards the _____ of the foot. Extensive debridement of necrotic tissue was carried out
** • nevermind. - guy
Thu May 25 07:51:13 2017 guy


• FINDINGS: _____. SPECIMENS: For gross pathology bone cultures ...
+ mp3
Thu May 25 06:30:22 2017 mp3
FINDINGS: _____.

SPECIMENS: For gross pathology bone cultures from second ray, soft tissue cultures.

** • nevermind. Thanks to anyone who tried. - guy
Thu May 25 07:51:03 2017 guy


• Preoperative Diagnosis: RIGHT FOOT NECROTIC WOUND. Procedure ...
+ wav
Thu May 25 06:26:31 2017 wav
Preoperative Diagnosis:
RIGHT FOOT NECROTIC WOUND.

Procedure:
RIGHT FOOT WOUND _____ PARTIAL AMPUTATION OF FIFTH, FOURTH, THIRD, AND SECOND RAYS.

Postoperative Diagnosis:
RIGHT FOOT NECROTIC WOUND WITH ABSCESS.

** • debridement - nm
Thu May 25 06:53:28 2017 nm

**** • Thanks a lot. - guy
Thu May 25 06:54:43 2017 guy


• INDICATIONS: The patient is a 36-year-old incarcerated male who prese ...
+ wav
Thu May 25 04:43:58 2017 wav
INDICATIONS: The patient is a 36-year-old incarcerated male who presented to clinic with a penile foreign body which he himself inserted in the past. He carved and sculpted a _____ which he then implanted under the dorsal skin right proximal to the glans of his penis using a razorblade and now desires for surgical removal.
** • domino - maybe?
Thu May 25 05:07:30 2017 maybe?

**** • Thanks a lot. - guy
Thu May 25 05:12:01 2017 guy


• Preoperative Diagnosis: RUPTURED GLOBE, RIGHT EYE. Procedure ...
+ wav
Thu May 25 00:49:23 2017 wav
Preoperative Diagnosis:
RUPTURED GLOBE, RIGHT EYE.

Procedure:
RIGHT EYE RUPTURED GLOBE EXPLORATION AND REPAIR.

Next, the conjunctiva was reapproximated after removal of necrotic conjunctiva and necrotic uveal tissue. The conjunctiva was closed with 8-0 Vicryl. At the end of the case, the eye was _____. The globe was pressurized and subconjunctival Ancef and dexamethasone was administered on a 30-gauze needle.
** • formed. - poi
Thu May 25 00:50:26 2017 poi

**** • Thanks a lot. - guy
Thu May 25 00:58:10 2017 guy


• Preoperative Diagnosis: _____. Operation: DIAGNOSTIC LAPAROSC ...
+ wav
Wed May 24 23:12:06 2017 wav
Preoperative Diagnosis: _____.

Operation: DIAGNOSTIC LAPAROSCOPY, CONTROL SPLENIC LACERATION.

INDICATIONS: The patient is a 51-year-old female, status post laparoscopic gastric bypass. Overnight, she was tachycardic. Her blood revealed a drop in hematocrit. By the morning time, her tachycardia resolved to around 90 and then suddenly changed to around 160. Decision was made to take her to the operating room for diagnostic laparoscopy.
** • Postop bleed. - Questyr
Wed May 24 23:33:53 2017 Questyr

**** • Thanks a lot. - guy
Wed May 24 23:34:03 2017 guy


• If i were to remove , should i replace it with oe?
+ guy
Wed May 24 22:44:42 2017 guy
Paget-Schrtter syndrome
** • nevermind. in stedman it is Paget-Schrtter but google suggesting Paget-Schroetter, so + guy
Wed May 24 23:26:21 2017 guy
was confused.
**** • Both spellings are correct, but in most transcription clients don't + Questyr
Wed May 24 23:37:37 2017 Questyr
want us to use letters with symbols, so converting the spelling you do change it to oe.

• A small piece segment laceration of the artery in zone 2 of the index ...
+ mp3
Wed May 24 21:58:16 2017 mp3
A small piece segment laceration of the artery in zone 2 of the index finger, all being relative ______ to revascularization supported our decision to proceed to a revision amputation
** • I would also put a comma after revascularization - Q
Wed May 24 22:04:56 2017 Q

** • contraindications - Questyr
Wed May 24 22:02:40 2017 Questyr

**** • Thanks a lot. Thanks for the correction. - guy
Wed May 24 22:06:46 2017 guy


• In other words, there was no soft tissue including bundles on that ent ...
+ wav
Wed May 24 21:51:24 2017 wav
In other words, there was no soft tissue including bundles on that entire aspect of the digit. This eliminated any _____ to anastomose for distal perfusion.
** • substrate - Questyr
Wed May 24 22:01:59 2017 Questyr

**** • Thanks a lot. - guy
Wed May 24 22:06:38 2017 guy


• The patient was brought to the operating room and placed supine on the ...
+ mp3
Wed May 24 20:53:26 2017 mp3
The patient was brought to the operating room and placed supine on the operating room table with the right arm out. General endotracheal anesthesia was induced _____ without incident. The right breast and axilla were then prepped and draped in the usual sterile fashion
** • I downloaded and slowed it down. I am not sure sure there is anything there. - fwiw-poi
Wed May 24 21:06:49 2017 fwiw-poi

**** • Thanks a lot. - guy
Wed May 24 21:09:14 2017 guy


• INDICATION FOR PROCEDURE: The patient is a 46-year-old female who was ...
+ wav
Wed May 24 20:48:53 2017 wav
INDICATION FOR PROCEDURE: The patient is a 46-year-old female who was found to have abnormal findings on routine mammogram, status post a _____ biopsy confirmed that invasive ductal carcinoma of the right breast.
** • status post stereotactic biopsy confirmed - poi
Wed May 24 21:01:52 2017 poi

** • stereotactic - poi
Wed May 24 21:01:29 2017 poi

**** • Thanks a lot. Thanks for the correction. - guy
Wed May 24 21:09:39 2017 guy


• Given her instability, discussion was undertaken in regards to revisin ...
+ wav
Wed May 24 19:41:19 2017 wav
Given her instability, discussion was undertaken in regards to revising the acetabular component and raising it and lateralizing the center of hip rotation. She was _____ to the procedure.
** • amenable - what I hear
Wed May 24 19:53:43 2017 what I hear

**** • Thanks a lot. - guy
Wed May 24 19:59:20 2017 guy


• At this point, gamma probe was used to identify a hot node with counts ...
+ wav
Wed May 24 19:11:20 2017 wav
At this point, gamma probe was used to identify a hot node with counts in the 600s. This node was also noted to be blue. It was removed in its entirety using electrocautery. The _____ cavity was then again checked for the presence of any additional hot nodes, which there were none, and palpated to see if there were any abnormal lymph nodes, and none were identified.
** • got it. thanks. + guy
Wed May 24 19:13:18 2017 guy
Axillary

• Attention was then turned to the abdomen where two Allis were placed a ...
+ wav
Wed May 24 18:29:14 2017 wav
Attention was then turned to the abdomen where two Allis were placed and a 1.5 cm incision was made in the supraumbilical area horizontally. _____ and tonsils were used to carry that incision down to the fascia. The fascia was grasped with tonsils and tented up.
** • I think she is short-speaking some instrument, but I can't figure it out. S's? - poi
Wed May 24 18:43:05 2017 poi

**** • Thanks a lot. - guy
Wed May 24 18:44:38 2017 guy


• Noncontrast head CT revealed a _____ structure.
- wav :)
Wed May 24 17:22:20 2017 wav :)

** • ???bulbous??? - Questyr
Wed May 24 17:24:34 2017 Questyr

**** • Thanks I think that is what he is attempting to say. - :)
Wed May 24 17:29:52 2017 :)


• shredding of pilonidal sinuses
+ abcd
Wed May 24 13:03:03 2017 abcd
pt with pilonidal cyst, looking for conservative treatment. Doc notes patient has exuberant hair growth in the area and he could possibly undergo s/l "shredding" of the pilonidal sinuses.

Would this word be appropriate? Thanks.
** • curetting? - nm
Wed May 24 13:31:34 2017 nm

**** • thank you -- that's it. - abcd
Thu May 25 07:23:26 2017 abcd

** • Apparently shedding hair root to the pinonidal sinus can cause the problem, but the + Questyr
Wed May 24 13:12:35 2017 Questyr
way your sentence is structured isn't saying that. (see link for descriptions of how they are caused, then relisten and see if you may be mishearing some of the other words in the sentence along with shedding rather than shredding)
**** • thank you - i have copied the exact sentence, can you pls see if this fits? + abcd
Wed May 24 13:18:08 2017 abcd
I let him know that if he ever does need surgery, considering his exuberant hair growth, he could have a recurrence of hair growing into the wound which have had occurred on occasion. I also let him know that hair removal along with ???shredding ???? of the pilonidal sinuses might preclude him from undergoing surgery.
****** • here is sent + abcd
Wed May 24 13:18:34 2017 abcd
I let him know that if he ever does need surgery, considering his exuberant hair growth, he could have a recurrence of hair growing into the wound which have had occurred on occasion. I also let him know that hair removal along with shredding _____ of the pilonidal sinuses might preclude him from undergoing surgery.
******** • sorry for posting 2x :( - abcd
Wed May 24 13:19:38 2017 abcd

********** • I find treatment words such as curetting as nm suggested or marsupialization, but + Q
Wed May 24 14:09:42 2017 Q
can find no support for the term shredding in this context...sorry.
************ • that's it -- I re-listened, and it's curetting, thanks - abcd
Thu May 25 07:23:00 2017 abcd

************ • thanks - abcd
Thu May 25 07:18:03 2017 abcd




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