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383_TL0 ADMISSION 4/17/95 ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . Mr. Mass had a past medical history which included Wegener and apos;s granulomatosis , history of an anterior myocardial infarction , and gallstone pancreatitis . He was admitted to Vassdiysey Medical Center with severe recurrent pancreatitis , nausea , vomiting , and abdominal pain . His amylase on admission there was 1,961 . The patient had two recent admissions for pancreatitis in January 1994 , and August 1994 . On his current admission , the patient was admitted to Free Medical Center . His amylase decreased to 51 , and the increased back to 151 on hospital day #10 . At that time , he spiked a temperature to 103 . He also became increasingly confused . A computerized tomography scan done on 4/16/95 showed a large and quot; pseudocyst and quot; . He was transferred to Ph University Of Medical Center for further surgical evaluation . and apos; HOSPITAL COURSE : The patient was admitted , placed on intravenous fluids . He was continued on his imipenem , intravenously . The patient was started on total parenteral nutrition . On 4/17/95 , GI Interventional Radiology performed drainage of the peripancreatic fluid collection . Approximately one liter of brownish fluid was obtained and sent for culture . The drainage catheter was left in a pseudocyst . The patient was evaluated by Cardiology . A Persantine Thallium study demonstrated a large infarct , involving the posteroseptal , anteroseptal areas . Left ventricular aneurysm was also noted ; however , no ischemia was seen . An echocardiogram was done . The echocardiogram showed terrible left ventricular function , with left ventricular aneurysm . The right ventricle appeared to be acceptable . The percutaneous drainage catheter continued to have high output . The fluid was sent for amylase , which came back 53,230 . On 4/28/95 , the patient had new onset of abdominal pain . His white count had bumped from 8.3 on admission to 18.5 , on 4/27 . A computerized tomography scan of the abdomen was performed . Approximately 100 cc. and apos;s of thick brownish material was aspirated through the indwelling catheter . The computerized tomography scan showed the catheter tip in good position . Because of the patient and apos;s deteriorating state , the patient was brought to the operating room on 4/28/95 . An exploratory laparotomy was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated the procedure fairly well , and was transferred to the Intensive Care Unit . In the Intensive Care Unit , the patient had a prolonged course . The patient was then extubated on postoperative day #2 , but remained pressor-dependent . He remained on imipenem , and Vancomycin was also started . Thereafter , the patient had a long and complicated postoperative course . He was eventually transferred to the floor , where he remained meta-stable . He had repeated episodes of hypotension to 80-90 systolic/40-50 diastolic . These resolved without incident . He also had repeated temperature spikes . After repeated work ups , it was felt that these were probably due to remaining infection in the peripancreatic area . His drainage tube from the peripancreatic area was gradually advanced , and eventually discontinued . Mr. Mass was placed on multiple courses of antibiotics . Most recently , he was on a 28 day course of Vancomycin , ofloxacin , and Flagyl , for blood cultures that were positive for gram positive cocci and enteric and non-enteric gram negative rods . This 28 day course was completed on 07/15/95 . The patient was also treated initially with amphotericin-B and then with fluconazole for a computerized tomography guided aspirate of a small fluid collection around his pancreas , which grew Candida albicans . The patient also had several episodes of fungal cystitis with Torulopsis glabrata , going from his urine . He was treated with amphotericin-B bladder washes for this . Mr. Mass was initially anticoagulated for his left ventricular aneurysm . He remained stable from a cardiac fashion . He did have problems with po intake . He had repeated bouts of small-volume emesis that may have been secondary to reflux . He was treated with a variety of anti-emetics , most recently Granisetron , with only mild success . He remained total parenteral nutrition-dependent throughout his hospital course . By the end of June , it became clear that Mr. Mass would require aggressive surgical intervention in order to eradicate his intra-abdominal bursts of intermittent sepsis ; however , long discussions with the patient and his wife , who was his health-care proxy , revealed that they felt that no further aggressive intervention be attempted . The patient had been made a do not resuscitate do not intubate patient earlier in his hospital stay . Multiple discussions were held between Dr. Mass , the rest of the surgical team , and the patient and apos;s wife , with this same result . After discussion with the patient and apos;s primary doctor , Dr. Douet at Vassdiysey Medical Center , it was felt that the patient and his family would be best served if the patient were transferred to Vassdiysey Medical Center . Of note , given the patient and apos;s do not resuscitate status and the risk for bleeding , the patient and apos;s Coumadin was stopped without incident several weeks before transfer . OVERLAP [@Subject$]ADMISSION[@Subject$] DATE : [@Object$]4/17/95[@Object$] DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR [@Subject$]ADMISSION[@Subject$] : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . "OVERLAP.assistant
The subject ""ADMISSION DATE"" and object ""DISCHARGE DATE"" overlap.assistant
The subject ""HISTORY AND REASON FOR ADMISSION"" and object ""HISTORY AND REASON FOR ADMISSION"" overlap.assistant
The subject ""HISTORY AND REASON FOR ADMISSION"" and object ""HISTORY AND REASON FOR ADMISSION"" overlap.assistant
The subject ""HISTORY AND REASON FOR ADMISSION"" and object ""HISTORY AND REASON FOR ADMISSION"" overlap.assistant
The subject """
383_TL1 DISCHARGE 07/16/95 ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . Mr. Mass had a past medical history which included Wegener and apos;s granulomatosis , history of an anterior myocardial infarction , and gallstone pancreatitis . He was admitted to Vassdiysey Medical Center with severe recurrent pancreatitis , nausea , vomiting , and abdominal pain . His amylase on admission there was 1,961 . The patient had two recent admissions for pancreatitis in January 1994 , and August 1994 . On his current admission , the patient was admitted to Free Medical Center . His amylase decreased to 51 , and the increased back to 151 on hospital day #10 . At that time , he spiked a temperature to 103 . He also became increasingly confused . A computerized tomography scan done on 4/16/95 showed a large and quot; pseudocyst and quot; . He was transferred to Ph University Of Medical Center for further surgical evaluation . and apos; HOSPITAL COURSE : The patient was admitted , placed on intravenous fluids . He was continued on his imipenem , intravenously . The patient was started on total parenteral nutrition . On 4/17/95 , GI Interventional Radiology performed drainage of the peripancreatic fluid collection . Approximately one liter of brownish fluid was obtained and sent for culture . The drainage catheter was left in a pseudocyst . The patient was evaluated by Cardiology . A Persantine Thallium study demonstrated a large infarct , involving the posteroseptal , anteroseptal areas . Left ventricular aneurysm was also noted ; however , no ischemia was seen . An echocardiogram was done . The echocardiogram showed terrible left ventricular function , with left ventricular aneurysm . The right ventricle appeared to be acceptable . The percutaneous drainage catheter continued to have high output . The fluid was sent for amylase , which came back 53,230 . On 4/28/95 , the patient had new onset of abdominal pain . His white count had bumped from 8.3 on admission to 18.5 , on 4/27 . A computerized tomography scan of the abdomen was performed . Approximately 100 cc. and apos;s of thick brownish material was aspirated through the indwelling catheter . The computerized tomography scan showed the catheter tip in good position . Because of the patient and apos;s deteriorating state , the patient was brought to the operating room on 4/28/95 . An exploratory laparotomy was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated the procedure fairly well , and was transferred to the Intensive Care Unit . In the Intensive Care Unit , the patient had a prolonged course . The patient was then extubated on postoperative day #2 , but remained pressor-dependent . He remained on imipenem , and Vancomycin was also started . Thereafter , the patient had a long and complicated postoperative course . He was eventually transferred to the floor , where he remained meta-stable . He had repeated episodes of hypotension to 80-90 systolic/40-50 diastolic . These resolved without incident . He also had repeated temperature spikes . After repeated work ups , it was felt that these were probably due to remaining infection in the peripancreatic area . His drainage tube from the peripancreatic area was gradually advanced , and eventually discontinued . Mr. Mass was placed on multiple courses of antibiotics . Most recently , he was on a 28 day course of Vancomycin , ofloxacin , and Flagyl , for blood cultures that were positive for gram positive cocci and enteric and non-enteric gram negative rods . This 28 day course was completed on 07/15/95 . The patient was also treated initially with amphotericin-B and then with fluconazole for a computerized tomography guided aspirate of a small fluid collection around his pancreas , which grew Candida albicans . The patient also had several episodes of fungal cystitis with Torulopsis glabrata , going from his urine . He was treated with amphotericin-B bladder washes for this . Mr. Mass was initially anticoagulated for his left ventricular aneurysm . He remained stable from a cardiac fashion . He did have problems with po intake . He had repeated bouts of small-volume emesis that may have been secondary to reflux . He was treated with a variety of anti-emetics , most recently Granisetron , with only mild success . He remained total parenteral nutrition-dependent throughout his hospital course . By the end of June , it became clear that Mr. Mass would require aggressive surgical intervention in order to eradicate his intra-abdominal bursts of intermittent sepsis ; however , long discussions with the patient and his wife , who was his health-care proxy , revealed that they felt that no further aggressive intervention be attempted . The patient had been made a do not resuscitate do not intubate patient earlier in his hospital stay . Multiple discussions were held between Dr. Mass , the rest of the surgical team , and the patient and apos;s wife , with this same result . After discussion with the patient and apos;s primary doctor , Dr. Douet at Vassdiysey Medical Center , it was felt that the patient and his family would be best served if the patient were transferred to Vassdiysey Medical Center . Of note , given the patient and apos;s do not resuscitate status and the risk for bleeding , the patient and apos;s Coumadin was stopped without incident several weeks before transfer . OVERLAP ADMISSION DATE : 4/17/95 [@Subject$]DISCHARGE[@Subject$] DATE : [@Object$]07/16/95[@Object$] HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . "AFTER.assistant
The patient underwent multiple blood transfusions for a low hematocrit, and the temporal relationship between the subject and object is BEFORE.assistant
The patient was admitted on 4/17/95 and discharged on 07/16/95, and the temporal relationship between the subject and object is OVERLAP.assistant
The patient had a low hematocrit and underwent multiple blood transfusions, and the temporal relationship between the subject and object is OVERLAP.assistant
The patient required multiple blood transfusions for a low hematocrit, and the temporal relationship between"
383_TL10 Vassdiysey Medical Center Vassdiysey Medical Center ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . Mr. Mass had a past medical history which included Wegener and apos;s granulomatosis , history of an anterior myocardial infarction , and gallstone pancreatitis . He was admitted to Vassdiysey Medical Center with severe recurrent pancreatitis , nausea , vomiting , and abdominal pain . His amylase on admission there was 1,961 . The patient had two recent admissions for pancreatitis in January 1994 , and August 1994 . On his current admission , the patient was admitted to Free Medical Center . His amylase decreased to 51 , and the increased back to 151 on hospital day #10 . At that time , he spiked a temperature to 103 . He also became increasingly confused . A computerized tomography scan done on 4/16/95 showed a large and quot; pseudocyst and quot; . He was transferred to Ph University Of Medical Center for further surgical evaluation . and apos; HOSPITAL COURSE : The patient was admitted , placed on intravenous fluids . He was continued on his imipenem , intravenously . The patient was started on total parenteral nutrition . On 4/17/95 , GI Interventional Radiology performed drainage of the peripancreatic fluid collection . Approximately one liter of brownish fluid was obtained and sent for culture . The drainage catheter was left in a pseudocyst . The patient was evaluated by Cardiology . A Persantine Thallium study demonstrated a large infarct , involving the posteroseptal , anteroseptal areas . Left ventricular aneurysm was also noted ; however , no ischemia was seen . An echocardiogram was done . The echocardiogram showed terrible left ventricular function , with left ventricular aneurysm . The right ventricle appeared to be acceptable . The percutaneous drainage catheter continued to have high output . The fluid was sent for amylase , which came back 53,230 . On 4/28/95 , the patient had new onset of abdominal pain . His white count had bumped from 8.3 on admission to 18.5 , on 4/27 . A computerized tomography scan of the abdomen was performed . Approximately 100 cc. and apos;s of thick brownish material was aspirated through the indwelling catheter . The computerized tomography scan showed the catheter tip in good position . Because of the patient and apos;s deteriorating state , the patient was brought to the operating room on 4/28/95 . An exploratory laparotomy was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated the procedure fairly well , and was transferred to the Intensive Care Unit . In the Intensive Care Unit , the patient had a prolonged course . The patient was then extubated on postoperative day #2 , but remained pressor-dependent . He remained on imipenem , and Vancomycin was also started . Thereafter , the patient had a long and complicated postoperative course . He was eventually transferred to the floor , where he remained meta-stable . He had repeated episodes of hypotension to 80-90 systolic/40-50 diastolic . These resolved without incident . He also had repeated temperature spikes . After repeated work ups , it was felt that these were probably due to remaining infection in the peripancreatic area . His drainage tube from the peripancreatic area was gradually advanced , and eventually discontinued . Mr. Mass was placed on multiple courses of antibiotics . Most recently , he was on a 28 day course of Vancomycin , ofloxacin , and Flagyl , for blood cultures that were positive for gram positive cocci and enteric and non-enteric gram negative rods . This 28 day course was completed on 07/15/95 . The patient was also treated initially with amphotericin-B and then with fluconazole for a computerized tomography guided aspirate of a small fluid collection around his pancreas , which grew Candida albicans . The patient also had several episodes of fungal cystitis with Torulopsis glabrata , going from his urine . He was treated with amphotericin-B bladder washes for this . Mr. Mass was initially anticoagulated for his left ventricular aneurysm . He remained stable from a cardiac fashion . He did have problems with po intake . He had repeated bouts of small-volume emesis that may have been secondary to reflux . He was treated with a variety of anti-emetics , most recently Granisetron , with only mild success . He remained total parenteral nutrition-dependent throughout his hospital course . By the end of June , it became clear that Mr. Mass would require aggressive surgical intervention in order to eradicate his intra-abdominal bursts of intermittent sepsis ; however , long discussions with the patient and his wife , who was his health-care proxy , revealed that they felt that no further aggressive intervention be attempted . The patient had been made a do not resuscitate do not intubate patient earlier in his hospital stay . Multiple discussions were held between Dr. Mass , the rest of the surgical team , and the patient and apos;s wife , with this same result . After discussion with the patient and apos;s primary doctor , Dr. Douet at Vassdiysey Medical Center , it was felt that the patient and his family would be best served if the patient were transferred to Vassdiysey Medical Center . Of note , given the patient and apos;s do not resuscitate status and the risk for bleeding , the patient and apos;s Coumadin was stopped without incident several weeks before transfer . OVERLAP ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from [@Subject$][@Object$]Vassdiysey Medical Center[@Object$][@Subject$] for rule out pancreatic pseudocyst . "OVERLAP.assistant
The subject is the Vassal Medical Center, and the object is the patient, Mr. Mass. The temporal relationship between the subject and object is OVERLAP, as Mr. Mass was admitted to the Vassal Medical Center for evaluation of a pancreatic pseudocyst, and the text mentions the date of admission and discharge, indicating an overlap between the two.assistant
The temporal relationship between the subject and object is BEFORE.assistant
The subject is the low hematocrit, and the object is the multiple blood transfusions. The temporal relationship between the subject and object"
383_TL100 the pancreatic necrosis Drainage ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . Mr. Mass had a past medical history which included Wegener and apos;s granulomatosis , history of an anterior myocardial infarction , and gallstone pancreatitis . He was admitted to Vassdiysey Medical Center with severe recurrent pancreatitis , nausea , vomiting , and abdominal pain . His amylase on admission there was 1,961 . The patient had two recent admissions for pancreatitis in January 1994 , and August 1994 . On his current admission , the patient was admitted to Free Medical Center . His amylase decreased to 51 , and the increased back to 151 on hospital day #10 . At that time , he spiked a temperature to 103 . He also became increasingly confused . A computerized tomography scan done on 4/16/95 showed a large and quot; pseudocyst and quot; . He was transferred to Ph University Of Medical Center for further surgical evaluation . and apos; HOSPITAL COURSE : The patient was admitted , placed on intravenous fluids . He was continued on his imipenem , intravenously . The patient was started on total parenteral nutrition . On 4/17/95 , GI Interventional Radiology performed drainage of the peripancreatic fluid collection . Approximately one liter of brownish fluid was obtained and sent for culture . The drainage catheter was left in a pseudocyst . The patient was evaluated by Cardiology . A Persantine Thallium study demonstrated a large infarct , involving the posteroseptal , anteroseptal areas . Left ventricular aneurysm was also noted ; however , no ischemia was seen . An echocardiogram was done . The echocardiogram showed terrible left ventricular function , with left ventricular aneurysm . The right ventricle appeared to be acceptable . The percutaneous drainage catheter continued to have high output . The fluid was sent for amylase , which came back 53,230 . On 4/28/95 , the patient had new onset of abdominal pain . His white count had bumped from 8.3 on admission to 18.5 , on 4/27 . A computerized tomography scan of the abdomen was performed . Approximately 100 cc. and apos;s of thick brownish material was aspirated through the indwelling catheter . The computerized tomography scan showed the catheter tip in good position . Because of the patient and apos;s deteriorating state , the patient was brought to the operating room on 4/28/95 . An exploratory laparotomy was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated the procedure fairly well , and was transferred to the Intensive Care Unit . In the Intensive Care Unit , the patient had a prolonged course . The patient was then extubated on postoperative day #2 , but remained pressor-dependent . He remained on imipenem , and Vancomycin was also started . Thereafter , the patient had a long and complicated postoperative course . He was eventually transferred to the floor , where he remained meta-stable . He had repeated episodes of hypotension to 80-90 systolic/40-50 diastolic . These resolved without incident . He also had repeated temperature spikes . After repeated work ups , it was felt that these were probably due to remaining infection in the peripancreatic area . His drainage tube from the peripancreatic area was gradually advanced , and eventually discontinued . Mr. Mass was placed on multiple courses of antibiotics . Most recently , he was on a 28 day course of Vancomycin , ofloxacin , and Flagyl , for blood cultures that were positive for gram positive cocci and enteric and non-enteric gram negative rods . This 28 day course was completed on 07/15/95 . The patient was also treated initially with amphotericin-B and then with fluconazole for a computerized tomography guided aspirate of a small fluid collection around his pancreas , which grew Candida albicans . The patient also had several episodes of fungal cystitis with Torulopsis glabrata , going from his urine . He was treated with amphotericin-B bladder washes for this . Mr. Mass was initially anticoagulated for his left ventricular aneurysm . He remained stable from a cardiac fashion . He did have problems with po intake . He had repeated bouts of small-volume emesis that may have been secondary to reflux . He was treated with a variety of anti-emetics , most recently Granisetron , with only mild success . He remained total parenteral nutrition-dependent throughout his hospital course . By the end of June , it became clear that Mr. Mass would require aggressive surgical intervention in order to eradicate his intra-abdominal bursts of intermittent sepsis ; however , long discussions with the patient and his wife , who was his health-care proxy , revealed that they felt that no further aggressive intervention be attempted . The patient had been made a do not resuscitate do not intubate patient earlier in his hospital stay . Multiple discussions were held between Dr. Mass , the rest of the surgical team , and the patient and apos;s wife , with this same result . After discussion with the patient and apos;s primary doctor , Dr. Douet at Vassdiysey Medical Center , it was felt that the patient and his family would be best served if the patient were transferred to Vassdiysey Medical Center . Of note , given the patient and apos;s do not resuscitate status and the risk for bleeding , the patient and apos;s Coumadin was stopped without incident several weeks before transfer . BEFORE [@Object$]Drainage[@Object$] of [@Subject$]the pancreatic necrosis[@Subject$] was also done . OVERLAP. The temporal relationship between the subject and object is OVERLAP. The temporal relationship between the subject and object is OVERLAP. The temporal relationship between the subject and object is OVERLAP. The temporal relationship between the subject and object is OVERLAP. The temporal relationship between the subject and object is OVERLAP. The temporal relationship between the subject and object is OVERLAP. The temporal relationship between the subject and object is OVERLAP. The temporal relationship between the subject and object is OVERLAP. The temporal relationship between the subject and object is OVERLAP. The temporal relationship between the subject and
383_TL101 the procedure An exploratory laparotomy ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . Mr. Mass had a past medical history which included Wegener and apos;s granulomatosis , history of an anterior myocardial infarction , and gallstone pancreatitis . He was admitted to Vassdiysey Medical Center with severe recurrent pancreatitis , nausea , vomiting , and abdominal pain . His amylase on admission there was 1,961 . The patient had two recent admissions for pancreatitis in January 1994 , and August 1994 . On his current admission , the patient was admitted to Free Medical Center . His amylase decreased to 51 , and the increased back to 151 on hospital day #10 . At that time , he spiked a temperature to 103 . He also became increasingly confused . A computerized tomography scan done on 4/16/95 showed a large and quot; pseudocyst and quot; . He was transferred to Ph University Of Medical Center for further surgical evaluation . and apos; HOSPITAL COURSE : The patient was admitted , placed on intravenous fluids . He was continued on his imipenem , intravenously . The patient was started on total parenteral nutrition . On 4/17/95 , GI Interventional Radiology performed drainage of the peripancreatic fluid collection . Approximately one liter of brownish fluid was obtained and sent for culture . The drainage catheter was left in a pseudocyst . The patient was evaluated by Cardiology . A Persantine Thallium study demonstrated a large infarct , involving the posteroseptal , anteroseptal areas . Left ventricular aneurysm was also noted ; however , no ischemia was seen . An echocardiogram was done . The echocardiogram showed terrible left ventricular function , with left ventricular aneurysm . The right ventricle appeared to be acceptable . The percutaneous drainage catheter continued to have high output . The fluid was sent for amylase , which came back 53,230 . On 4/28/95 , the patient had new onset of abdominal pain . His white count had bumped from 8.3 on admission to 18.5 , on 4/27 . A computerized tomography scan of the abdomen was performed . Approximately 100 cc. and apos;s of thick brownish material was aspirated through the indwelling catheter . The computerized tomography scan showed the catheter tip in good position . Because of the patient and apos;s deteriorating state , the patient was brought to the operating room on 4/28/95 . An exploratory laparotomy was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated the procedure fairly well , and was transferred to the Intensive Care Unit . In the Intensive Care Unit , the patient had a prolonged course . The patient was then extubated on postoperative day #2 , but remained pressor-dependent . He remained on imipenem , and Vancomycin was also started . Thereafter , the patient had a long and complicated postoperative course . He was eventually transferred to the floor , where he remained meta-stable . He had repeated episodes of hypotension to 80-90 systolic/40-50 diastolic . These resolved without incident . He also had repeated temperature spikes . After repeated work ups , it was felt that these were probably due to remaining infection in the peripancreatic area . His drainage tube from the peripancreatic area was gradually advanced , and eventually discontinued . Mr. Mass was placed on multiple courses of antibiotics . Most recently , he was on a 28 day course of Vancomycin , ofloxacin , and Flagyl , for blood cultures that were positive for gram positive cocci and enteric and non-enteric gram negative rods . This 28 day course was completed on 07/15/95 . The patient was also treated initially with amphotericin-B and then with fluconazole for a computerized tomography guided aspirate of a small fluid collection around his pancreas , which grew Candida albicans . The patient also had several episodes of fungal cystitis with Torulopsis glabrata , going from his urine . He was treated with amphotericin-B bladder washes for this . Mr. Mass was initially anticoagulated for his left ventricular aneurysm . He remained stable from a cardiac fashion . He did have problems with po intake . He had repeated bouts of small-volume emesis that may have been secondary to reflux . He was treated with a variety of anti-emetics , most recently Granisetron , with only mild success . He remained total parenteral nutrition-dependent throughout his hospital course . By the end of June , it became clear that Mr. Mass would require aggressive surgical intervention in order to eradicate his intra-abdominal bursts of intermittent sepsis ; however , long discussions with the patient and his wife , who was his health-care proxy , revealed that they felt that no further aggressive intervention be attempted . The patient had been made a do not resuscitate do not intubate patient earlier in his hospital stay . Multiple discussions were held between Dr. Mass , the rest of the surgical team , and the patient and apos;s wife , with this same result . After discussion with the patient and apos;s primary doctor , Dr. Douet at Vassdiysey Medical Center , it was felt that the patient and his family would be best served if the patient were transferred to Vassdiysey Medical Center . Of note , given the patient and apos;s do not resuscitate status and the risk for bleeding , the patient and apos;s Coumadin was stopped without incident several weeks before transfer . OVERLAP [@Object$]An exploratory laparotomy[@Object$] was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated [@Subject$]the procedure[@Subject$] fairly well , and was transferred to the Intensive Care Unit . "AFTER.assistant
The temporal relationship between the subject and object is AFTER.assistant
AFTER.assistant
AFTER.assistant
The temporal relationship between the subject and object is AFTER.assistant
AFTER.assistant
AFTER.assistant
The temporal relationship between the subject and object is AFTER.assistant
AFTER.assistant
AFTER.assistant
AFTER.assistant
AFTER.assistant
AFTER.assistant
AFTER.assistant
The temporal relationship between the subject"
383_TL102 transferred the procedure ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . Mr. Mass had a past medical history which included Wegener and apos;s granulomatosis , history of an anterior myocardial infarction , and gallstone pancreatitis . He was admitted to Vassdiysey Medical Center with severe recurrent pancreatitis , nausea , vomiting , and abdominal pain . His amylase on admission there was 1,961 . The patient had two recent admissions for pancreatitis in January 1994 , and August 1994 . On his current admission , the patient was admitted to Free Medical Center . His amylase decreased to 51 , and the increased back to 151 on hospital day #10 . At that time , he spiked a temperature to 103 . He also became increasingly confused . A computerized tomography scan done on 4/16/95 showed a large and quot; pseudocyst and quot; . He was transferred to Ph University Of Medical Center for further surgical evaluation . and apos; HOSPITAL COURSE : The patient was admitted , placed on intravenous fluids . He was continued on his imipenem , intravenously . The patient was started on total parenteral nutrition . On 4/17/95 , GI Interventional Radiology performed drainage of the peripancreatic fluid collection . Approximately one liter of brownish fluid was obtained and sent for culture . The drainage catheter was left in a pseudocyst . The patient was evaluated by Cardiology . A Persantine Thallium study demonstrated a large infarct , involving the posteroseptal , anteroseptal areas . Left ventricular aneurysm was also noted ; however , no ischemia was seen . An echocardiogram was done . The echocardiogram showed terrible left ventricular function , with left ventricular aneurysm . The right ventricle appeared to be acceptable . The percutaneous drainage catheter continued to have high output . The fluid was sent for amylase , which came back 53,230 . On 4/28/95 , the patient had new onset of abdominal pain . His white count had bumped from 8.3 on admission to 18.5 , on 4/27 . A computerized tomography scan of the abdomen was performed . Approximately 100 cc. and apos;s of thick brownish material was aspirated through the indwelling catheter . The computerized tomography scan showed the catheter tip in good position . Because of the patient and apos;s deteriorating state , the patient was brought to the operating room on 4/28/95 . An exploratory laparotomy was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated the procedure fairly well , and was transferred to the Intensive Care Unit . In the Intensive Care Unit , the patient had a prolonged course . The patient was then extubated on postoperative day #2 , but remained pressor-dependent . He remained on imipenem , and Vancomycin was also started . Thereafter , the patient had a long and complicated postoperative course . He was eventually transferred to the floor , where he remained meta-stable . He had repeated episodes of hypotension to 80-90 systolic/40-50 diastolic . These resolved without incident . He also had repeated temperature spikes . After repeated work ups , it was felt that these were probably due to remaining infection in the peripancreatic area . His drainage tube from the peripancreatic area was gradually advanced , and eventually discontinued . Mr. Mass was placed on multiple courses of antibiotics . Most recently , he was on a 28 day course of Vancomycin , ofloxacin , and Flagyl , for blood cultures that were positive for gram positive cocci and enteric and non-enteric gram negative rods . This 28 day course was completed on 07/15/95 . The patient was also treated initially with amphotericin-B and then with fluconazole for a computerized tomography guided aspirate of a small fluid collection around his pancreas , which grew Candida albicans . The patient also had several episodes of fungal cystitis with Torulopsis glabrata , going from his urine . He was treated with amphotericin-B bladder washes for this . Mr. Mass was initially anticoagulated for his left ventricular aneurysm . He remained stable from a cardiac fashion . He did have problems with po intake . He had repeated bouts of small-volume emesis that may have been secondary to reflux . He was treated with a variety of anti-emetics , most recently Granisetron , with only mild success . He remained total parenteral nutrition-dependent throughout his hospital course . By the end of June , it became clear that Mr. Mass would require aggressive surgical intervention in order to eradicate his intra-abdominal bursts of intermittent sepsis ; however , long discussions with the patient and his wife , who was his health-care proxy , revealed that they felt that no further aggressive intervention be attempted . The patient had been made a do not resuscitate do not intubate patient earlier in his hospital stay . Multiple discussions were held between Dr. Mass , the rest of the surgical team , and the patient and apos;s wife , with this same result . After discussion with the patient and apos;s primary doctor , Dr. Douet at Vassdiysey Medical Center , it was felt that the patient and his family would be best served if the patient were transferred to Vassdiysey Medical Center . Of note , given the patient and apos;s do not resuscitate status and the risk for bleeding , the patient and apos;s Coumadin was stopped without incident several weeks before transfer . AFTER The patient tolerated [@Object$]the procedure[@Object$] fairly well , and was [@Subject$]transferred[@Subject$] to the Intensive Care Unit . "AFTER
The patient tolerated the procedure fairly well, and was transferred to the Intensive Care Unit.The temporal relationship between the subject and object is?
The temporal relationship between the subject and object is? AFTER.assistant
The patient tolerated the procedure fairly well, and was transferred to the Intensive Care Unit.The temporal relationship between the subject and object is? AFTER.assistant
The patient tolerated the procedure fairly well, and was transferred to the Intensive Care Unit.The temporal relationship between the subject and object is? AFTER.assistant
AFTER.assistant
AFTER"
383_TL103 the operating room transferred ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . Mr. Mass had a past medical history which included Wegener and apos;s granulomatosis , history of an anterior myocardial infarction , and gallstone pancreatitis . He was admitted to Vassdiysey Medical Center with severe recurrent pancreatitis , nausea , vomiting , and abdominal pain . His amylase on admission there was 1,961 . The patient had two recent admissions for pancreatitis in January 1994 , and August 1994 . On his current admission , the patient was admitted to Free Medical Center . His amylase decreased to 51 , and the increased back to 151 on hospital day #10 . At that time , he spiked a temperature to 103 . He also became increasingly confused . A computerized tomography scan done on 4/16/95 showed a large and quot; pseudocyst and quot; . He was transferred to Ph University Of Medical Center for further surgical evaluation . and apos; HOSPITAL COURSE : The patient was admitted , placed on intravenous fluids . He was continued on his imipenem , intravenously . The patient was started on total parenteral nutrition . On 4/17/95 , GI Interventional Radiology performed drainage of the peripancreatic fluid collection . Approximately one liter of brownish fluid was obtained and sent for culture . The drainage catheter was left in a pseudocyst . The patient was evaluated by Cardiology . A Persantine Thallium study demonstrated a large infarct , involving the posteroseptal , anteroseptal areas . Left ventricular aneurysm was also noted ; however , no ischemia was seen . An echocardiogram was done . The echocardiogram showed terrible left ventricular function , with left ventricular aneurysm . The right ventricle appeared to be acceptable . The percutaneous drainage catheter continued to have high output . The fluid was sent for amylase , which came back 53,230 . On 4/28/95 , the patient had new onset of abdominal pain . His white count had bumped from 8.3 on admission to 18.5 , on 4/27 . A computerized tomography scan of the abdomen was performed . Approximately 100 cc. and apos;s of thick brownish material was aspirated through the indwelling catheter . The computerized tomography scan showed the catheter tip in good position . Because of the patient and apos;s deteriorating state , the patient was brought to the operating room on 4/28/95 . An exploratory laparotomy was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated the procedure fairly well , and was transferred to the Intensive Care Unit . In the Intensive Care Unit , the patient had a prolonged course . The patient was then extubated on postoperative day #2 , but remained pressor-dependent . He remained on imipenem , and Vancomycin was also started . Thereafter , the patient had a long and complicated postoperative course . He was eventually transferred to the floor , where he remained meta-stable . He had repeated episodes of hypotension to 80-90 systolic/40-50 diastolic . These resolved without incident . He also had repeated temperature spikes . After repeated work ups , it was felt that these were probably due to remaining infection in the peripancreatic area . His drainage tube from the peripancreatic area was gradually advanced , and eventually discontinued . Mr. Mass was placed on multiple courses of antibiotics . Most recently , he was on a 28 day course of Vancomycin , ofloxacin , and Flagyl , for blood cultures that were positive for gram positive cocci and enteric and non-enteric gram negative rods . This 28 day course was completed on 07/15/95 . The patient was also treated initially with amphotericin-B and then with fluconazole for a computerized tomography guided aspirate of a small fluid collection around his pancreas , which grew Candida albicans . The patient also had several episodes of fungal cystitis with Torulopsis glabrata , going from his urine . He was treated with amphotericin-B bladder washes for this . Mr. Mass was initially anticoagulated for his left ventricular aneurysm . He remained stable from a cardiac fashion . He did have problems with po intake . He had repeated bouts of small-volume emesis that may have been secondary to reflux . He was treated with a variety of anti-emetics , most recently Granisetron , with only mild success . He remained total parenteral nutrition-dependent throughout his hospital course . By the end of June , it became clear that Mr. Mass would require aggressive surgical intervention in order to eradicate his intra-abdominal bursts of intermittent sepsis ; however , long discussions with the patient and his wife , who was his health-care proxy , revealed that they felt that no further aggressive intervention be attempted . The patient had been made a do not resuscitate do not intubate patient earlier in his hospital stay . Multiple discussions were held between Dr. Mass , the rest of the surgical team , and the patient and apos;s wife , with this same result . After discussion with the patient and apos;s primary doctor , Dr. Douet at Vassdiysey Medical Center , it was felt that the patient and his family would be best served if the patient were transferred to Vassdiysey Medical Center . Of note , given the patient and apos;s do not resuscitate status and the risk for bleeding , the patient and apos;s Coumadin was stopped without incident several weeks before transfer . BEFORE He was [@Object$]transferred[@Object$] to Ph University Of Medical Center for further surgical evaluation . and apos; HOSPITAL COURSE : The patient was admitted , placed on intravenous fluids . He was continued on his imipenem , intravenously . The patient was started on total parenteral nutrition . On 4/17/95 , GI Interventional Radiology performed drainage of the peripancreatic fluid collection . Approximately one liter of brownish fluid was obtained and sent for culture . The drainage catheter was left in a pseudocyst . The patient was evaluated by Cardiology . A Persantine Thallium study demonstrated a large infarct , involving the posteroseptal , anteroseptal areas . Left ventricular aneurysm was also noted ; however , no ischemia was seen . An echocardiogram was done . The echocardiogram showed terrible left ventricular function , with left ventricular aneurysm . The right ventricle appeared to be acceptable . The percutaneous drainage catheter continued to have high output . The fluid was sent for amylase , which came back 53,230 . On 4/28/95 , the patient had new onset of abdominal pain . His white count had bumped from 8.3 on admission to 18.5 , on 4/27 . A computerized tomography scan of the abdomen was performed . Approximately 100 cc. and apos;s of thick brownish material was aspirated through the indwelling catheter . The computerized tomography scan showed the catheter tip in good position . Because of the patient and apos;s deteriorating state , the patient was brought to [@Subject$]the operating room[@Subject$] on 4/28/95 . "AFTER.assistant
The temporal relationship between the subject and object is AFTER.assistant
The patient was admitted, placed on intravenous fluids, and continued on his imipenem, intravenously. He was started on total parenteral nutrition. On 4/17/95, GI Interventional Radiology performed drainage of the peripancreatic fluid collection. Approximately one liter of brownish fluid was obtained and sent for culture. The drainage catheter was left in a pseudocyst. The patient was evaluated by Cardiology. A Persantine Thallium study demonstrated a large infarct,"
383_TL104 the Intensive Care Unit transferred ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . Mr. Mass had a past medical history which included Wegener and apos;s granulomatosis , history of an anterior myocardial infarction , and gallstone pancreatitis . He was admitted to Vassdiysey Medical Center with severe recurrent pancreatitis , nausea , vomiting , and abdominal pain . His amylase on admission there was 1,961 . The patient had two recent admissions for pancreatitis in January 1994 , and August 1994 . On his current admission , the patient was admitted to Free Medical Center . His amylase decreased to 51 , and the increased back to 151 on hospital day #10 . At that time , he spiked a temperature to 103 . He also became increasingly confused . A computerized tomography scan done on 4/16/95 showed a large and quot; pseudocyst and quot; . He was transferred to Ph University Of Medical Center for further surgical evaluation . and apos; HOSPITAL COURSE : The patient was admitted , placed on intravenous fluids . He was continued on his imipenem , intravenously . The patient was started on total parenteral nutrition . On 4/17/95 , GI Interventional Radiology performed drainage of the peripancreatic fluid collection . Approximately one liter of brownish fluid was obtained and sent for culture . The drainage catheter was left in a pseudocyst . The patient was evaluated by Cardiology . A Persantine Thallium study demonstrated a large infarct , involving the posteroseptal , anteroseptal areas . Left ventricular aneurysm was also noted ; however , no ischemia was seen . An echocardiogram was done . The echocardiogram showed terrible left ventricular function , with left ventricular aneurysm . The right ventricle appeared to be acceptable . The percutaneous drainage catheter continued to have high output . The fluid was sent for amylase , which came back 53,230 . On 4/28/95 , the patient had new onset of abdominal pain . His white count had bumped from 8.3 on admission to 18.5 , on 4/27 . A computerized tomography scan of the abdomen was performed . Approximately 100 cc. and apos;s of thick brownish material was aspirated through the indwelling catheter . The computerized tomography scan showed the catheter tip in good position . Because of the patient and apos;s deteriorating state , the patient was brought to the operating room on 4/28/95 . An exploratory laparotomy was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated the procedure fairly well , and was transferred to the Intensive Care Unit . In the Intensive Care Unit , the patient had a prolonged course . The patient was then extubated on postoperative day #2 , but remained pressor-dependent . He remained on imipenem , and Vancomycin was also started . Thereafter , the patient had a long and complicated postoperative course . He was eventually transferred to the floor , where he remained meta-stable . He had repeated episodes of hypotension to 80-90 systolic/40-50 diastolic . These resolved without incident . He also had repeated temperature spikes . After repeated work ups , it was felt that these were probably due to remaining infection in the peripancreatic area . His drainage tube from the peripancreatic area was gradually advanced , and eventually discontinued . Mr. Mass was placed on multiple courses of antibiotics . Most recently , he was on a 28 day course of Vancomycin , ofloxacin , and Flagyl , for blood cultures that were positive for gram positive cocci and enteric and non-enteric gram negative rods . This 28 day course was completed on 07/15/95 . The patient was also treated initially with amphotericin-B and then with fluconazole for a computerized tomography guided aspirate of a small fluid collection around his pancreas , which grew Candida albicans . The patient also had several episodes of fungal cystitis with Torulopsis glabrata , going from his urine . He was treated with amphotericin-B bladder washes for this . Mr. Mass was initially anticoagulated for his left ventricular aneurysm . He remained stable from a cardiac fashion . He did have problems with po intake . He had repeated bouts of small-volume emesis that may have been secondary to reflux . He was treated with a variety of anti-emetics , most recently Granisetron , with only mild success . He remained total parenteral nutrition-dependent throughout his hospital course . By the end of June , it became clear that Mr. Mass would require aggressive surgical intervention in order to eradicate his intra-abdominal bursts of intermittent sepsis ; however , long discussions with the patient and his wife , who was his health-care proxy , revealed that they felt that no further aggressive intervention be attempted . The patient had been made a do not resuscitate do not intubate patient earlier in his hospital stay . Multiple discussions were held between Dr. Mass , the rest of the surgical team , and the patient and apos;s wife , with this same result . After discussion with the patient and apos;s primary doctor , Dr. Douet at Vassdiysey Medical Center , it was felt that the patient and his family would be best served if the patient were transferred to Vassdiysey Medical Center . Of note , given the patient and apos;s do not resuscitate status and the risk for bleeding , the patient and apos;s Coumadin was stopped without incident several weeks before transfer . AFTER The patient tolerated the procedure fairly well , and was [@Object$]transferred[@Object$] to [@Subject$]the Intensive Care Unit[@Subject$] . "AFTER.assistant
The temporal relationship between the subject and object is BEFORE.assistant
AFTER.assistant
The temporal relationship between the subject and object is OVERLAP.assistant
AFTER.assistant
The temporal relationship between the subject and object is BEFORE.assistant
AFTER.assistant
OVERLAP.assistant
The temporal relationship between the subject and object is BEFORE.assistant
AFTER.assistant
OVERLAP.assistant
The temporal relationship between the subject and object is BEFORE.assistant
"
383_TL105 the Intensive Care Unit the Intensive Care Unit ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . Mr. Mass had a past medical history which included Wegener and apos;s granulomatosis , history of an anterior myocardial infarction , and gallstone pancreatitis . He was admitted to Vassdiysey Medical Center with severe recurrent pancreatitis , nausea , vomiting , and abdominal pain . His amylase on admission there was 1,961 . The patient had two recent admissions for pancreatitis in January 1994 , and August 1994 . On his current admission , the patient was admitted to Free Medical Center . His amylase decreased to 51 , and the increased back to 151 on hospital day #10 . At that time , he spiked a temperature to 103 . He also became increasingly confused . A computerized tomography scan done on 4/16/95 showed a large and quot; pseudocyst and quot; . He was transferred to Ph University Of Medical Center for further surgical evaluation . and apos; HOSPITAL COURSE : The patient was admitted , placed on intravenous fluids . He was continued on his imipenem , intravenously . The patient was started on total parenteral nutrition . On 4/17/95 , GI Interventional Radiology performed drainage of the peripancreatic fluid collection . Approximately one liter of brownish fluid was obtained and sent for culture . The drainage catheter was left in a pseudocyst . The patient was evaluated by Cardiology . A Persantine Thallium study demonstrated a large infarct , involving the posteroseptal , anteroseptal areas . Left ventricular aneurysm was also noted ; however , no ischemia was seen . An echocardiogram was done . The echocardiogram showed terrible left ventricular function , with left ventricular aneurysm . The right ventricle appeared to be acceptable . The percutaneous drainage catheter continued to have high output . The fluid was sent for amylase , which came back 53,230 . On 4/28/95 , the patient had new onset of abdominal pain . His white count had bumped from 8.3 on admission to 18.5 , on 4/27 . A computerized tomography scan of the abdomen was performed . Approximately 100 cc. and apos;s of thick brownish material was aspirated through the indwelling catheter . The computerized tomography scan showed the catheter tip in good position . Because of the patient and apos;s deteriorating state , the patient was brought to the operating room on 4/28/95 . An exploratory laparotomy was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated the procedure fairly well , and was transferred to the Intensive Care Unit . In the Intensive Care Unit , the patient had a prolonged course . The patient was then extubated on postoperative day #2 , but remained pressor-dependent . He remained on imipenem , and Vancomycin was also started . Thereafter , the patient had a long and complicated postoperative course . He was eventually transferred to the floor , where he remained meta-stable . He had repeated episodes of hypotension to 80-90 systolic/40-50 diastolic . These resolved without incident . He also had repeated temperature spikes . After repeated work ups , it was felt that these were probably due to remaining infection in the peripancreatic area . His drainage tube from the peripancreatic area was gradually advanced , and eventually discontinued . Mr. Mass was placed on multiple courses of antibiotics . Most recently , he was on a 28 day course of Vancomycin , ofloxacin , and Flagyl , for blood cultures that were positive for gram positive cocci and enteric and non-enteric gram negative rods . This 28 day course was completed on 07/15/95 . The patient was also treated initially with amphotericin-B and then with fluconazole for a computerized tomography guided aspirate of a small fluid collection around his pancreas , which grew Candida albicans . The patient also had several episodes of fungal cystitis with Torulopsis glabrata , going from his urine . He was treated with amphotericin-B bladder washes for this . Mr. Mass was initially anticoagulated for his left ventricular aneurysm . He remained stable from a cardiac fashion . He did have problems with po intake . He had repeated bouts of small-volume emesis that may have been secondary to reflux . He was treated with a variety of anti-emetics , most recently Granisetron , with only mild success . He remained total parenteral nutrition-dependent throughout his hospital course . By the end of June , it became clear that Mr. Mass would require aggressive surgical intervention in order to eradicate his intra-abdominal bursts of intermittent sepsis ; however , long discussions with the patient and his wife , who was his health-care proxy , revealed that they felt that no further aggressive intervention be attempted . The patient had been made a do not resuscitate do not intubate patient earlier in his hospital stay . Multiple discussions were held between Dr. Mass , the rest of the surgical team , and the patient and apos;s wife , with this same result . After discussion with the patient and apos;s primary doctor , Dr. Douet at Vassdiysey Medical Center , it was felt that the patient and his family would be best served if the patient were transferred to Vassdiysey Medical Center . Of note , given the patient and apos;s do not resuscitate status and the risk for bleeding , the patient and apos;s Coumadin was stopped without incident several weeks before transfer . OVERLAP The patient tolerated the procedure fairly well , and was transferred to [@Subject$][@Object$]the Intensive Care Unit[@Object$][@Subject$] . "OVERLAP.assistant
The temporal relationship between the subject and object is OVERLAP.assistant
The temporal relationship between the subject and object is OVERLAP.assistant
The temporal relationship between the subject and object is OVERLAP.assistant
The temporal relationship between the subject and object is OVERLAP.assistant
The temporal relationship between the subject and object is OVERLAP.assistant
The temporal relationship between the subject and object is OVERLAP.assistant
The temporal relationship between the subject and object is OVERLAP.assistant
The"
383_TL106 a prolonged course the Intensive Care Unit ADMISSION DATE : 4/17/95 DISCHARGE DATE : 07/16/95 HISTORY AND REASON FOR ADMISSION : Mr. Mass was a 56 year old white male who was transferred from Vassdiysey Medical Center for rule out pancreatic pseudocyst . Mr. Mass had a past medical history which included Wegener and apos;s granulomatosis , history of an anterior myocardial infarction , and gallstone pancreatitis . He was admitted to Vassdiysey Medical Center with severe recurrent pancreatitis , nausea , vomiting , and abdominal pain . His amylase on admission there was 1,961 . The patient had two recent admissions for pancreatitis in January 1994 , and August 1994 . On his current admission , the patient was admitted to Free Medical Center . His amylase decreased to 51 , and the increased back to 151 on hospital day #10 . At that time , he spiked a temperature to 103 . He also became increasingly confused . A computerized tomography scan done on 4/16/95 showed a large and quot; pseudocyst and quot; . He was transferred to Ph University Of Medical Center for further surgical evaluation . and apos; HOSPITAL COURSE : The patient was admitted , placed on intravenous fluids . He was continued on his imipenem , intravenously . The patient was started on total parenteral nutrition . On 4/17/95 , GI Interventional Radiology performed drainage of the peripancreatic fluid collection . Approximately one liter of brownish fluid was obtained and sent for culture . The drainage catheter was left in a pseudocyst . The patient was evaluated by Cardiology . A Persantine Thallium study demonstrated a large infarct , involving the posteroseptal , anteroseptal areas . Left ventricular aneurysm was also noted ; however , no ischemia was seen . An echocardiogram was done . The echocardiogram showed terrible left ventricular function , with left ventricular aneurysm . The right ventricle appeared to be acceptable . The percutaneous drainage catheter continued to have high output . The fluid was sent for amylase , which came back 53,230 . On 4/28/95 , the patient had new onset of abdominal pain . His white count had bumped from 8.3 on admission to 18.5 , on 4/27 . A computerized tomography scan of the abdomen was performed . Approximately 100 cc. and apos;s of thick brownish material was aspirated through the indwelling catheter . The computerized tomography scan showed the catheter tip in good position . Because of the patient and apos;s deteriorating state , the patient was brought to the operating room on 4/28/95 . An exploratory laparotomy was performed . The splenic flexure had a purulent exudative process along the antimesenteric surface . Thus , the splenic flexure and a portion of the descending colon were resected . The patient underwent a left colectomy with end transverse colostomy , and oversewing of the descending colon . Drainage of the pancreatic necrosis was also done . The patient tolerated the procedure fairly well , and was transferred to the Intensive Care Unit . In the Intensive Care Unit , the patient had a prolonged course . The patient was then extubated on postoperative day #2 , but remained pressor-dependent . He remained on imipenem , and Vancomycin was also started . Thereafter , the patient had a long and complicated postoperative course . He was eventually transferred to the floor , where he remained meta-stable . He had repeated episodes of hypotension to 80-90 systolic/40-50 diastolic . These resolved without incident . He also had repeated temperature spikes . After repeated work ups , it was felt that these were probably due to remaining infection in the peripancreatic area . His drainage tube from the peripancreatic area was gradually advanced , and eventually discontinued . Mr. Mass was placed on multiple courses of antibiotics . Most recently , he was on a 28 day course of Vancomycin , ofloxacin , and Flagyl , for blood cultures that were positive for gram positive cocci and enteric and non-enteric gram negative rods . This 28 day course was completed on 07/15/95 . The patient was also treated initially with amphotericin-B and then with fluconazole for a computerized tomography guided aspirate of a small fluid collection around his pancreas , which grew Candida albicans . The patient also had several episodes of fungal cystitis with Torulopsis glabrata , going from his urine . He was treated with amphotericin-B bladder washes for this . Mr. Mass was initially anticoagulated for his left ventricular aneurysm . He remained stable from a cardiac fashion . He did have problems with po intake . He had repeated bouts of small-volume emesis that may have been secondary to reflux . He was treated with a variety of anti-emetics , most recently Granisetron , with only mild success . He remained total parenteral nutrition-dependent throughout his hospital course . By the end of June , it became clear that Mr. Mass would require aggressive surgical intervention in order to eradicate his intra-abdominal bursts of intermittent sepsis ; however , long discussions with the patient and his wife , who was his health-care proxy , revealed that they felt that no further aggressive intervention be attempted . The patient had been made a do not resuscitate do not intubate patient earlier in his hospital stay . Multiple discussions were held between Dr. Mass , the rest of the surgical team , and the patient and apos;s wife , with this same result . After discussion with the patient and apos;s primary doctor , Dr. Douet at Vassdiysey Medical Center , it was felt that the patient and his family would be best served if the patient were transferred to Vassdiysey Medical Center . Of note , given the patient and apos;s do not resuscitate status and the risk for bleeding , the patient and apos;s Coumadin was stopped without incident several weeks before transfer . OVERLAP In [@Object$]the Intensive Care Unit[@Object$] , the patient had [@Subject$]a prolonged course[@Subject$] . "AFTER.assistant
The patient was admitted to the ICU in a critical condition and required multiple interventions to stabilize. The prolonged course of the patient's hospital stay was AFTER the initial admission.assistant
The temporal relationship between the subject and object is AFTER.assistant
The patient's condition improved with treatment, and the patient was transferred out of the ICU to a regular ward. The temporal relationship between the subject and object is AFTER.assistant
The patient's symptoms worsened, and the patient required more intensive treatment. The temporal relationship between the subject and object is BEFORE.assistant
The patient"
|