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Thursday, August 23, 2007
Tuesday, August 21, 2007
Monday, August 20, 2007
research
I recently bought a book at National Bookstore, one of the biggest bookstores here in the Philippines, if not the biggest. The book is entitled, Pocket Guide to the Operating Room Second edition by Maxine A. Goldman.
The book is really a big help for me, who doesn’t have an extensive knowledge in Medicine and Surgery, but since I am taking Medical Transcription, I took it upon myself to research about the subjects and understand more than what a medical term means. The book covers a lot of subjects on the different procedures in the operative room. Before I had this, I was in the dark seeking where can I find the instruments in a given procedure. I am now in the Genitourinary Medicine subject in my course, this subject/module requires us to transcribe at least 30 audio dictations for different clinical reports. These dictations are actual surgical procedures, which are very technical in some ways. There are a lot of instances that you really have to do a lot of research to find the exact word that is being dictated. Some dictations, mind you, are not clear, and the words spoken are sometimes garbled. You can leave the space blank, though but I see to it that before I leave the space blank, I have exhausted all my efforts to find the exact word.
With this book, I seldom leave a blank space for the garbled words. I know I am not the only student, who experiences this problem with the dictations, especially for those who are taking this course at their own pace at home. The book is really cheap considering the value of its content; at 180php it could make your transcribing a lot easier.
The book is really a big help for me, who doesn’t have an extensive knowledge in Medicine and Surgery, but since I am taking Medical Transcription, I took it upon myself to research about the subjects and understand more than what a medical term means. The book covers a lot of subjects on the different procedures in the operative room. Before I had this, I was in the dark seeking where can I find the instruments in a given procedure. I am now in the Genitourinary Medicine subject in my course, this subject/module requires us to transcribe at least 30 audio dictations for different clinical reports. These dictations are actual surgical procedures, which are very technical in some ways. There are a lot of instances that you really have to do a lot of research to find the exact word that is being dictated. Some dictations, mind you, are not clear, and the words spoken are sometimes garbled. You can leave the space blank, though but I see to it that before I leave the space blank, I have exhausted all my efforts to find the exact word.
With this book, I seldom leave a blank space for the garbled words. I know I am not the only student, who experiences this problem with the dictations, especially for those who are taking this course at their own pace at home. The book is really cheap considering the value of its content; at 180php it could make your transcribing a lot easier.
Tuesday, August 7, 2007
Sunday, August 5, 2007
OB-GYN transcription sample
TITLE OF OPERATION:
Operative hysteroscopy with lysis of adhesions, tubal cannulation, intrauterine device insertion and diagnostic laparoscopy.
PREOPERATIVE DIAGNOSIS:
Severe Asherman's syndrome.
POSTOPERATIVE DIAGNOSIS:
Severe Asherman's syndrome.
ANESTHESIA:
General endotracheal anesthesia.
PROSTHETIC DEVICE:
Paragard T380 intrauterine device inserted.
DESCRIPTION: The patient was brought to the operating room and placed in the supine position, and given general anesthesia and intubated. She was placed in the dorsal lithotomy position and examination under anesthesia revealed a normal-sized anteverted uterus, no evidence of adnexal masses. She was then prepared and draped in the usual manner for simultaneous operative hysteroscopy and laparoscopy. These procedures were performed simultaneously after the bladder was catheterized and drained of about 200 cc of urine. A stab incision was made within the umbilicus through which a Veress needle was placed and 2 liters of carbon dioxide gas infused. Laparoscopic trocar and sleeve were inserted. Eventually a secondary puncture was created above the symphysis pubis. Vaginally a speculum was inserted into the vagina uterine cavity was explored. The scope was inserted a few centimeters into the endocervical canal into the lower uterine segment and was met with a wall of dense adhesions. Using blunt probes and flexible and rigid scissors, a cavity was eventually created and the limits of the uterotubal ostium or the cornua were determined by the use of a blunt probe, visualizing the movement of the probe in the cornual region of the uterus through the laparoscope, passed through the umbilicus. The left fallopian tube was actually cannulated with a Miles Novy cannula. Dye spill from the left tube was observed. Following the creation of the uterine cavity. Adhesions were dense and the procedure was involved. A Paragard T380 IUD was inserted and the position within the cavity verified by reinsertion of the hysteroscope.
Laparoscopically the uterus appeared to be normal in size. An old perforation site near the right cornua was identified. The left ovary was normal in size, oval in shape, white in coloration. Smooth surface was apparent. No adhesions or lesions were noted. The right ovary was normal in size, oval in shape, white in coloration. No adhesions or lesions noted. The left tube was normal in length, normal surface appearance, normal in size. The fimbria were delicate. As previously mentioned, this tube was cannulated and dye spill was seen. No adhesions or lesions noted. The right tube was normal in length. Normal surface appearance. Normal in size. This tube was not cannulated. The fimbria were delicate. No dye spill was seen. No adhesions were noted.
Following the procedure, the pelvis was irrigated. Hemostasis was found to be complete. Instruments were removed. Carbon dioxide gas was expelled. Incisions were closed with 4-0 Vicryl. The patient was reversed from anesthesia, extubated and transferred to the recovery room in satisfactory condition. She will receive Premarin therapy for the next morning prior to removing the IUD.
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Total abdominal hysterectomy with a bilateral salpingo-oophorectomy (TAH & BSO)
PREOPERATIVE DIAGNOSES:
1. LEFT OVARIAN MASS.
2. ELEVATED CA-125 LEVEL.
POSTOPERATIVE DIAGNOSES:
1. BILATERAL OVARIAN ENDOMETRIOMAS.
2. PELVIC ENDOMETRIOSIS.
3. MYOMATA UTERI.
4. LEFT URETERAL OCCLUSION.
TITLE OF SURGERY:
1. EXAMINATION UNDER ANESTHESIA.
2. EXPLORATORY LAPAROTOMY.
3. LYSIS OF ADHESIONS.
4. RESECTION OF LEFT URETER.
5. EXTRAFASCIAL HYSTERECTOMY.
6. BILATERAL SALPINGO-OOPHORECTOMY.
ANESTHESIA: GENERAL ENDOTRACHEAL ANESTHESIA.
INDICATIONS: The patient is a lovely 57-year-old female who presented with bilateral ovarian masses and an elevated CA-125 level. She was taken to the operating room for definitive surgery.
DESCRIPTION OF PROCEDURE: The patient was placed under general anesthesia in the dorsal lithotomy position. Examination revealed a large left 15-cm ovarian mass which appeared fixed, and fullness in the right adnexa. Fortunately, neither nodularity nor thickness was appreciated. The vagina was prepped and a Foley catheter inserted. The patient was placed in the supine position and her abdomen was prepped and draped.
A right paramedian incision was made from the symphysis to the umbilicus and was carried down to the anterior and posterior sheaths until the peritoneal cavity was entered. Peritoneal washings were then taken. Exploration of the upper abdomen revealed two normal kidneys and a smooth right lobe of the liver from the lateral margin to the ligamentum teres. There were at least two stones palpable in the gallbladder, at least 1 cm in diameter. Both diaphragmatic surfaces were smooth. The large and small bowel were grossly normal. Retroperitoneally, there were no enlarged or suspicious periaortic nodes from the level of the renal vessels to the bifurcation of the iliacs.
Within the pelvis, there seemed to be an enlarged uterus with a right ovarian endometrioma about 5 cm in diameter. There was a 14-cm semisolid fixed left adnexal mass which was adherent to the posterior wall of the uterus, the sigmoid colon, the posterior peritoneum, and the parietoperitoneum. As previously discussed with the patient, if neither ovary could be saved in this case with bilateral endometriomas, and given the myomata uteri, the surgical plan was to perform hysterectomy and bilateral salpingo-oophorectomy. Therefore, we began the surgery by freeing up the anterior attachments of the large left adnexal mass to the sigmoid colon.
We then went to the lateral pelvic side walls and were eventually able to find the round ligaments; these were identified and singly clamped and ligated with 0- Vicryl. We then developed a plane of the pubovesical cervical fascia, thereby freeing the bladder from the underlying cervix and vagina. Indigo carmine was given intravenously and was eventually seen to exit in the Foley catheter with no intraperitoneal or retroperitoneal spillage.
To facilitate dissection of the large left ovarian mass, we dissected the left ureter which was intimately adherent to the mass and occluded during its length. Therefore, a 1/4" Penrose drain was placed around the left ureter. This was completely dissected down to its entrance into the bladder. This then allowed us to find the infundibulopelvic pedicle from the left mass, and to doubly clamp and ligate this with 0-Vicryl. We continued to free up the large left pelvic mass and came to the uterine arteries on both sides. We were able to doubly clamp the uterine arteries. We then continued with single clamping of the cardinals, and then opened up the rectovaginal septum so we could cross-clamp the uterosacral ligaments. In this manner, we were eventually able to completely perform extrafascial hysterectomy, and the uterus, large left adnexal mass, right ovarian endometrioma, and tubes were removed as a single specimen. The endometrioma was then opened. As expected, it was completely filled with dark chocolate fluid.
Angled sutures were placed in the vagina with 0-Vicryl and reinforced. The cuff itself was then closed with continuous running 0-Vicryl suture. There were a number of bleeders in the pelvis which we then controlled with clips and hot cautery. On account of the patient's weight, the difficulty of the surgery, and the persistent small bleeders, it was elected to placed a 19-mm J-Vac drain deep in the cul-de-sac and to bring this out through the right lower quadrant. The pelvis was then copiously irrigated. When hemostasis was seen to be excellent. generous portions of Gelfoam were placed over all raw peritoneal surface areas.
Following correct lap pad, sponge, instrument, and needle counts, attention was turned to closure of the abdomen. Then 0-Prolene was used to place a row of interrupted horizontal mattress sutures through the anterior sheath. The anterior sheath itself was closed with two continuous running #1 PDS sutures starting inferiorly and superiorly and meeting in the lower 1/3 of the incision. The Prolene sutures were then tied. The subcutaneous tissue was then copiously irrigated with Ringer's, and the subcutaneous tissue approximated with interrupted 2-0 Monocryl sutures. The skin edges were approximated with 4-0 Monocryl subcuticular suture reinforced with 1/2" Steri-Strips and benzoin.
Estimated blood loss was 600 cc. Fluid replaced was 3400 cc crystalloid. Drains included a Foley catheter draining blue urine, and a cul-de-sac J-Vac. There were no complications The patient was sent to the recovery room in satisfactory condition.
--------------------------------------------------------------------------------
Operative hysteroscopy with lysis of adhesions, tubal cannulation, intrauterine device insertion and diagnostic laparoscopy.
PREOPERATIVE DIAGNOSIS:
Severe Asherman's syndrome.
POSTOPERATIVE DIAGNOSIS:
Severe Asherman's syndrome.
ANESTHESIA:
General endotracheal anesthesia.
PROSTHETIC DEVICE:
Paragard T380 intrauterine device inserted.
DESCRIPTION: The patient was brought to the operating room and placed in the supine position, and given general anesthesia and intubated. She was placed in the dorsal lithotomy position and examination under anesthesia revealed a normal-sized anteverted uterus, no evidence of adnexal masses. She was then prepared and draped in the usual manner for simultaneous operative hysteroscopy and laparoscopy. These procedures were performed simultaneously after the bladder was catheterized and drained of about 200 cc of urine. A stab incision was made within the umbilicus through which a Veress needle was placed and 2 liters of carbon dioxide gas infused. Laparoscopic trocar and sleeve were inserted. Eventually a secondary puncture was created above the symphysis pubis. Vaginally a speculum was inserted into the vagina uterine cavity was explored. The scope was inserted a few centimeters into the endocervical canal into the lower uterine segment and was met with a wall of dense adhesions. Using blunt probes and flexible and rigid scissors, a cavity was eventually created and the limits of the uterotubal ostium or the cornua were determined by the use of a blunt probe, visualizing the movement of the probe in the cornual region of the uterus through the laparoscope, passed through the umbilicus. The left fallopian tube was actually cannulated with a Miles Novy cannula. Dye spill from the left tube was observed. Following the creation of the uterine cavity. Adhesions were dense and the procedure was involved. A Paragard T380 IUD was inserted and the position within the cavity verified by reinsertion of the hysteroscope.
Laparoscopically the uterus appeared to be normal in size. An old perforation site near the right cornua was identified. The left ovary was normal in size, oval in shape, white in coloration. Smooth surface was apparent. No adhesions or lesions were noted. The right ovary was normal in size, oval in shape, white in coloration. No adhesions or lesions noted. The left tube was normal in length, normal surface appearance, normal in size. The fimbria were delicate. As previously mentioned, this tube was cannulated and dye spill was seen. No adhesions or lesions noted. The right tube was normal in length. Normal surface appearance. Normal in size. This tube was not cannulated. The fimbria were delicate. No dye spill was seen. No adhesions were noted.
Following the procedure, the pelvis was irrigated. Hemostasis was found to be complete. Instruments were removed. Carbon dioxide gas was expelled. Incisions were closed with 4-0 Vicryl. The patient was reversed from anesthesia, extubated and transferred to the recovery room in satisfactory condition. She will receive Premarin therapy for the next morning prior to removing the IUD.
--------------------------------------------------------------------------------
Return to top
--------------------------------------------------------------------------------
Total abdominal hysterectomy with a bilateral salpingo-oophorectomy (TAH & BSO)
PREOPERATIVE DIAGNOSES:
1. LEFT OVARIAN MASS.
2. ELEVATED CA-125 LEVEL.
POSTOPERATIVE DIAGNOSES:
1. BILATERAL OVARIAN ENDOMETRIOMAS.
2. PELVIC ENDOMETRIOSIS.
3. MYOMATA UTERI.
4. LEFT URETERAL OCCLUSION.
TITLE OF SURGERY:
1. EXAMINATION UNDER ANESTHESIA.
2. EXPLORATORY LAPAROTOMY.
3. LYSIS OF ADHESIONS.
4. RESECTION OF LEFT URETER.
5. EXTRAFASCIAL HYSTERECTOMY.
6. BILATERAL SALPINGO-OOPHORECTOMY.
ANESTHESIA: GENERAL ENDOTRACHEAL ANESTHESIA.
INDICATIONS: The patient is a lovely 57-year-old female who presented with bilateral ovarian masses and an elevated CA-125 level. She was taken to the operating room for definitive surgery.
DESCRIPTION OF PROCEDURE: The patient was placed under general anesthesia in the dorsal lithotomy position. Examination revealed a large left 15-cm ovarian mass which appeared fixed, and fullness in the right adnexa. Fortunately, neither nodularity nor thickness was appreciated. The vagina was prepped and a Foley catheter inserted. The patient was placed in the supine position and her abdomen was prepped and draped.
A right paramedian incision was made from the symphysis to the umbilicus and was carried down to the anterior and posterior sheaths until the peritoneal cavity was entered. Peritoneal washings were then taken. Exploration of the upper abdomen revealed two normal kidneys and a smooth right lobe of the liver from the lateral margin to the ligamentum teres. There were at least two stones palpable in the gallbladder, at least 1 cm in diameter. Both diaphragmatic surfaces were smooth. The large and small bowel were grossly normal. Retroperitoneally, there were no enlarged or suspicious periaortic nodes from the level of the renal vessels to the bifurcation of the iliacs.
Within the pelvis, there seemed to be an enlarged uterus with a right ovarian endometrioma about 5 cm in diameter. There was a 14-cm semisolid fixed left adnexal mass which was adherent to the posterior wall of the uterus, the sigmoid colon, the posterior peritoneum, and the parietoperitoneum. As previously discussed with the patient, if neither ovary could be saved in this case with bilateral endometriomas, and given the myomata uteri, the surgical plan was to perform hysterectomy and bilateral salpingo-oophorectomy. Therefore, we began the surgery by freeing up the anterior attachments of the large left adnexal mass to the sigmoid colon.
We then went to the lateral pelvic side walls and were eventually able to find the round ligaments; these were identified and singly clamped and ligated with 0- Vicryl. We then developed a plane of the pubovesical cervical fascia, thereby freeing the bladder from the underlying cervix and vagina. Indigo carmine was given intravenously and was eventually seen to exit in the Foley catheter with no intraperitoneal or retroperitoneal spillage.
To facilitate dissection of the large left ovarian mass, we dissected the left ureter which was intimately adherent to the mass and occluded during its length. Therefore, a 1/4" Penrose drain was placed around the left ureter. This was completely dissected down to its entrance into the bladder. This then allowed us to find the infundibulopelvic pedicle from the left mass, and to doubly clamp and ligate this with 0-Vicryl. We continued to free up the large left pelvic mass and came to the uterine arteries on both sides. We were able to doubly clamp the uterine arteries. We then continued with single clamping of the cardinals, and then opened up the rectovaginal septum so we could cross-clamp the uterosacral ligaments. In this manner, we were eventually able to completely perform extrafascial hysterectomy, and the uterus, large left adnexal mass, right ovarian endometrioma, and tubes were removed as a single specimen. The endometrioma was then opened. As expected, it was completely filled with dark chocolate fluid.
Angled sutures were placed in the vagina with 0-Vicryl and reinforced. The cuff itself was then closed with continuous running 0-Vicryl suture. There were a number of bleeders in the pelvis which we then controlled with clips and hot cautery. On account of the patient's weight, the difficulty of the surgery, and the persistent small bleeders, it was elected to placed a 19-mm J-Vac drain deep in the cul-de-sac and to bring this out through the right lower quadrant. The pelvis was then copiously irrigated. When hemostasis was seen to be excellent. generous portions of Gelfoam were placed over all raw peritoneal surface areas.
Following correct lap pad, sponge, instrument, and needle counts, attention was turned to closure of the abdomen. Then 0-Prolene was used to place a row of interrupted horizontal mattress sutures through the anterior sheath. The anterior sheath itself was closed with two continuous running #1 PDS sutures starting inferiorly and superiorly and meeting in the lower 1/3 of the incision. The Prolene sutures were then tied. The subcutaneous tissue was then copiously irrigated with Ringer's, and the subcutaneous tissue approximated with interrupted 2-0 Monocryl sutures. The skin edges were approximated with 4-0 Monocryl subcuticular suture reinforced with 1/2" Steri-Strips and benzoin.
Estimated blood loss was 600 cc. Fluid replaced was 3400 cc crystalloid. Drains included a Foley catheter draining blue urine, and a cul-de-sac J-Vac. There were no complications The patient was sent to the recovery room in satisfactory condition.
--------------------------------------------------------------------------------
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