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m. Ashtabula
County
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Medical Center
2420 LaLt; Avuim:
Ashtabula. Ohio 44004 12161 998 3111
PATIENT REGISTRATION FORM
JM. BY
ADMISSION NO.
MED/SOC SEC n
SERV PT TYPE PUBLISH SOURCE ADMISSION TYPE SMOKER?
5233309 ____ 2911615B6 __________ _UED
PATIENT NAME
PHONE
R __NO___ PHYS EMERGENCY ------NO--------
PATIENT INFORMATION
MEDICAL record no
SEX
MARITAL STATUS
FC
SUCCI,JOSEPH R.
1767 GRIGGS RD.
JEFFERSON
OH 44047
16--576--51 24
DATE Or BIRTH
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17542
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AETNA/ AKRON AETNA 3320 W .. MARKET Ar:- RON 1291 161 5R6
39740L
ST . OH
44313
GUARANTOR EMPLOYER & OCCUPATION
l767 GRIGGS RD.
JEFFERSON
OH 440A-7
NE:C216> 576-5124
ATIONSHIP TO PATIENT:
AL SECURITY NO- 291161506
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PHONE
GENC 002920
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2911615B6A
291161586
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GUARANTOR EMPLOYER & OCCUPATION
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JEFFERSON
OH 44847
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ATIONSHIP TO PATIENT: SELF -IAL SECURITY NO 291161586
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GENC 002921
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PATHOLOGY consultation
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7011-0-179 (Rev. 8/87)
ASHTABULA COUNTY MEDICAL CENTER
PATHOLOGY CONSULTAi ION
|OATE OF OPERATION
LAfi NO
9/13/88
DATE OF REPORT
lS-88-27 22
SURGEON;
9/14/88
R: Waid \/
i SUCCI, Joseph
HOSPITAL
on: Patel
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REQUEST FOR CLINICAL PATHOLOGY EVALUATION:
5
HISTORY ANO/OR STATEMENT OF PROBLEM:
SIGNATURE OF REQUESTING FHYSICIAN
/<} v r
PREOPERATIVE DIAGNOSIS:
operation and site
Liver MetS.
FNA Liver , Liver aspiration, Cytology &. Cell block
POSTOPERATIVE DIAGNOSIS:
DIAGNOSIS:
Liver, FNA - RARE ATYPICAL CELL, SUSPICIOUS FOR MALIGNANCY
PATHOLOGY CONSULTATION
GENC 002925
/-I
NAME: SOT-PATIENT:
COMPANV: REGION tO BE X-RAYED:
RADIOLOGICAL CONSULTATION ASHTABULA COUNTY MEDICAL CENTER
ASHTABULA, OHIO
SUCCI, JOSEPH
AGE:
IN-PATIENT:
INDUSTRIAL:
CT of upper abdomen and liver
CLINICAL DIAGNOSIS: ATTENDING PHYSICIAN:
anasarca H. Waid, M.D
DATE:
REPORT OF RADIOLOGIST
09-09-88
A CT scan of the liver was carried out in the transaxial plane with and without IV contrast enhancement.
There are multiple patchy areas of decreased attenuation In the liver with (Cut 6) one zone that appears to show some enhancement. However, no large, round focal lesions are seen. I cannot distinguish between dilated Intrahepatlc bile ducts and diffuse small metastases. The appearance is mainly involving the right lobe of the liver and I believe ultrasound would be helpful in dis tinguishing these two entities. The gallbladder has been removed. The spleen, pancreas, and adrenal glands are unremarkable. There is a small, about 1.0 cm., cyst in the midaspect of the left kidney. No retroperitoneal adenopathy is seen. There Is ascites noted.
IMPRESSION: Changes In the liver which I believe should be further evaluated by ultrasound to decide the next management step. I cannot distinguish between the dilated intrahepatlc bile ducts and diffuse small metastases as stated.
Ascites
Old left renal cyst
DVP/cw D&T: 09-09-88
DRS. HILL AND THOMAS
RADIOLOGISTS JAMES P. FARMER, M.D. BRUCE H. ROBSON, M.D. DEODUTT V. PATEL, M.D. DAVID A. STEIGER, M.D.
6ENc 002926
f Jo /&
NAME: flOT^PATIENT:
COMPANY: REG'l0lTfO BE X-RAYED:
RADIOLOGICAL CONSULTATION ASHTABULA COUNTY MEDICAL CENTER
ASHTABULA, OHIO
Succi, Joseph R Chest (2 views)
AGE: IN-PATIENT: INDUSTRIAL:
67 431N 78
CLINICAL DIAGNOSIS: ATTENDING PHYSICIAN:
Anasarca H.S. Waid, M.D.
DATE:
REPORT OF RADIOLOGIST
9-8-88
There is elevation of the right hemidiaphragm similar to the examination of 8-30-88. There is minimal interval blunting of the right costophrenic angle, better noted on the lateral view, which is not present on the previous examination and indicative of interval development of a tiny amount of fluid within the right pleural cavity. There has been clearing of the bibasilar subsegmental atelectatic changes. Left lung is unremarkable. No infiltrates. The heart is within the limits of normal. No failure.
IMPRESSION: Interval development of minimal blunting of the right costophrenic angle since the examination of 8-30-88 indicative of tiny amount of fluid within the right pleural space.
BPD/ajh D&T: 9-8-88
DRS. HILL AND THOMAS
RADIOLOGISTS JAMES P. FARMER, M.D. BRUCE H. ROBSON, M.D. DEODUTT V. PATEL, M.D. DAVID A. STEIGER, M.D.
GEMC 002927
NAME: Out-patient: COMPANY: REGION TO BE X-RAYED:
RADIOLOGICAL CONSULTATION ASHTABULA COUNTY MEDICAL CENTER
ASHTABULA, OHIO
SUCCI, JOSEPH liver,spleen scan
AGE: IN-PATIENT: INDUSTRIAL:
67 413 N
CLINICAL DIAGNOSIS: ATTENDING"RHYSlCIAN:
anasarca H. Waid, M.D
DATE:
REPORT OF RADIOLOGIST
09-09-88
5.8 mCi-99m-Tc-sulfur colloid were intravenously. ( IV/DG).
The study shows significant Inhomogeneous uptake of the liver which appears somewhat prominent. The overall uptake in the right lobe and quadrate lobe is decreased. Multiple filling defects within the left lobe are noted. The spleen is enlarged with relative increased uptake within the spleen and bone marrow which Is consistent with hepatic disease.
IMPRESSION: Inhomogeneous uptake of the liver with multiple filling defects. Malignancy primary or secondary is strongly suspected.
BPD/cw D&T: 09-09-88
/
DRS. HILL AND THOMAS RADIOLOGISTS
JAMES P. FARMER, M.D. BRUCE H. ROBSON, M.D. DEODUTT V. PATEL, M.D. DAVID A. STEIGER, M.D.
0B,.ir ^
NAME: SuT-patient; COMPANY: RESTPnTO BE X-RAYED:
RADIOLOGICAL CONSULTATION ASHTABULA COUNTY MEDICAL CENTER
ASHTABULA, OHIO
SUCCI, JOSEPH
AGE: IN-PATIENT:
INDUSTRIAL:
Kidney ultrasound
67 413 N
CLINICAL DIAGNOSIS: ATTENDING PHYSICIAN:
anasarca H. Waid, M.D.
DATE:
REPORT OF RADIOLOGIST
09-09-88
The kidneys are normal in size and echogenicity. Each kidney measures 10-11 cm. in length. No hydronephrosis, stones or masses. No perinephric collec tions. There is a small amount of free fluid within the peritoneal cavity. The spleen appears to be somewhat enlarged.
IMPRESSION: Normal ultrasound examination of the kidneys. Small amount of ascites. Splenomegaly
BPD/cw D&T: 09-09-88
DRS. HILL AND THOMAS RADIOLOGISTS
JAMES P. FARMER, M.D. BRUCE H. ROBSON, M.D. DEODUTT V. PATEL, M.D. DAVID A. STEIGER, M.D.
6EHC 002930
/ V , (J
NAME: OUTPATIENT:
COMPANY: REOIOn'TO BE X-RAYED:
RADIOLOGICAL CONSULTATION ASHTABULA COUNTY MEDICAL CENTER
ASHTABULA, OHIO
Succi, Joseph R Colon
AGE: IN-PATIENT: INDUSTRIAL:
67 413N t4
CLINICAL DIAGNOSIS: ATTENDING PHYSICIAN:
Harlan S. Wald, M.D.
DATE:
REPORT OF RADIOLOGIST
09-12-88
Barium was passed from the rectum through to the cecum and refluxed into the small bowel. The appendix has been removed. There are several sigmoid diver ticula but no radiographic evidence of diverticulitis Is seen. No annular constricting lesions or intraluminal masses are seen. The haustral pattern appears normal.
There Is some residual pantopaque in the lumbar spinal subarachnoid space and the patient Is noted to have had a laminectomy at L5. There is degenerative change In the lumbar spine.
Impression: Diverticulosis.
DVP/mc D&T 09-12-88
DRS. HILL AND THOMAS RADIOLOGISTS
JAMES P. FARMER, M.D. BRUCE H. ROBSON, M.D. DEOOUTT V. PATEL, M.D DAVID A. STEIGER, M.D
NAME: SlTNPATIENT: COMPANY": REGTOnTO BE X-RAYED:
RADIOLOGICAL CONSULTATION ASHTABULA COUNTY MEDICAL CENTER
ASHTABULA, OHIO
Sued, Joseph R Ultrasound of the liver
AGE: IN-PATIENT: INDUSTRIAL:
67 ,, 413N #4
CLINICAL DIAGNOSIS: ATTENDING PHYSICIAN:
r/o obstruction Harlan S. Waid, M.D.
DATE:
REPORT OF RADIOLOGIST
09-12-88
An ultrasound of the liver was carried out with real time Imaging. There is an inhomogneous echo texture to the liver with foci of increased echogenicity throughout the liver with one focus measuring about 2.5 cm. In diameter. No intrahepatlc bile ducts are seen. The ascites noted on the CAT scan Is not obvious today and this may be due to technical reasons.
Impression: Findings consistent with diffuse liver metastases.
would be helpful in further evaluation.
I believe a liver biopsy
DVP/mc D&T 09-12-88
/
DRS. HILL AND THOMAS RADIOLOGISTS
JAMES P. FARMER, M.D. BRUCE H. ROBSON, M.D. DEODUTT V. PATEL, M.D. DAVID A. STEIGER, M.D.
GENC 0029
io 72
NAME: StrrPATIENT:
COMPANY! REGION TO BE X-RAYED:
RADIOLOGICAL CONSULTATION ASHTABULA COUNTY MEDICAL CENTER
ASHTABULA, OHIO
Bucci, Joseph R x
CT liver biopsy
AGE: IN-PATIENT: INDUSTRIAL:
67
CLINICAL DIAGNOSIS: ATTENDING PHYSICIAN:
Harlan S. Wald, M.D.
DATE:
REPORT OF RADIOLOGIST
09-13-88
A 20 gauge needle was passed into the right lobe of the liver and a single pass was made. Blood flowed very readily Into the needle and this suggested a necro tic liver. No further biopsies were made and a sample of blood and tissue were sent to the laboratory for analysis. The patient tolerated the procedure wel 1.
DVP/mc D&T 09-13-88
DRS. HILL AND THOMAS RADIOLOGISTS
JAMES P. FARMER, M.D. BRUCE H. ROBSON, M.D. DEODUTT V. PATEL, M.D. DAVID A. STEIGER, M.D.
GENIC 002933
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NAME: SDT^PATIENT: COMPANY: feEGl6N~TO BE X-RAYED:
RADIOLOGICAL CONSULTATION ASHTABULA COUNTY MEDICAL CENTER
ASHTABULA, OHIO
SUCCI, JOSEPH Liver biopsy
AGE: IN-PATIENT: INDUSTRIAL:
67 * 413 N
CLINICAL DIAGNOSIS: ATTENDING PHYSICIAN:
anasarca H. Waid, M.D
DATE:
REPORT OF RADIOLOGIST
09-15-88
Under CT guidance, three passes were made with 22 and 20 gauge spinal needles and then a 19 gauge EZM needle cutting biopsy was obtained. The preliminary cytology shows some malignant appearing cells and detailed analysis will be available later.
The patient tolerated the procedure well.
DVP/cw D&T: 09-15-88
DRS. HILL AND THOMAS RADIOLOGISTS
JAMES P. FARMER, M.D. BRUCE H. ROBSON, M.D. DEODUTT V. PATEL, M.D DAVID A. STEIGER, M.D
6ENC 002934
NAME:
W^PATIENT: COMPANY^ REGION TO BE X-RAYED:
RADIOLOGICAL CONSULTATION ASHTABULA COUNTY MEDICAL CENTER
ASHTABULA, OHIO
Succi, Joseph R. Bone scan
AGE: IN-PATIENT: INDUSTRIAL:
67 413N
-
CLINICAL DIAGNOSIS: ATTENDING PHYSICIAN:
Anasarca, generalized edema; rule out metastatic CA
H.S. Raid, M.D.
DATEj,
9-16-88
REPORT OF RADIOLOGIST_______________________________
Dose: 19.5 mCi 99m Tc MDP/IV/DG Scan: The distribution of radioisotope is uniform throughout the skeletal system with no areas of abnormal activity. Both kidneys function.
IMPRESSION: Normal bone scan.
BHR/ajh D&T: 9-16-88
DRS. HILL AND THOMAS RADIOLOGISTS
JAMES P. FARMER, M.D. BRUCE H. ROBSON, M.D. DEODUTT V. PATEL, M.D. DAVID A. STEIGER, M.D.
GENC 0
NAME:
UiTTPATIENT:
COMPANY: REGionTQ BE X-RAYED:
RADIOLOGICAL CONSULTATION ASHTABULA COUNTY MEDICAL CENTER
ASHTABULA, OHIO
SUCCI, JOSEPH Upper GI series.
AGE: IN-PATIENT: INDUSTRIAL:
67 413H-
CLINICAL DIAGNOSIS: ATTENDING"PHYSlfclAN;
Anasarca. H. Wald, M.D.
DATE:
REPORT OF RADIOLOGIST
9-17-88
The swallowing mechanism and esophagus are unremarkable. There Is a line at the edge of a collection of gas bubbles, which I believe moves and Is apparently due to the bubbles themselves. The stomach Is otherwise unremarkable. The duodenum Is normal.
IMPRESSION: Normal upper GI.
BHR/jc D&T: 9-17-88
DRS. HILL AND THOMAS RADIOLOGISTS
JAMES P. FARMER, M.D. BRUCE H. ROBSON, M.D. DEODUTT V. PATEL, M.D. DAVID A. STEIGER, M.D.
GENC 002936
031 0492
Ajj C Ashtabula County Medical Center M NON-INVASIVE CARDIAC LAB
ECHOCARDIOGRAPHY REPORT
/a 7/
IAME: Succi, Joseph R.
HT: 5*4 WT: _ 165 8.S.A. 1.81
'J PATIENT NO.:
5213194
APE:
18-88
OUT PATIENT NO. REFERRING PHYSICIAN
Dr. Maid
HAGNOSIS:
obtain left ventricular function and ejection fraction
DATE 09/16/88 SEX. M_ AGE: 67
l-MODE DATA
Laft Ventricular Internal Dimension:
Cardiac Rhythm:
_________________
Diastole: --_____ (N 3.8-5.3cm.)
Mitral Valve:
Systole:(N 2.6-3.4cm.)
% A D:D D / D = DS D
(N)??%1
Left Ventricular Posterior Wall:
Thickness: ,,_
(N 0.6-1.1cm.)
Excursion:
(NQ.3-1.2cm)
% Thickening:(N>22%)
Excursion Ant. Leaflet:
(N 20-30mm.)
E F Slope:____ ~_____ (N 80-120mm/s)
E Point to Septal Separation = _____ (N (0.8cm)
Left Atrium: 3.8 jfsl 2.0-4,0cm.)
Right Ventricular Dimension: 3.5
(N(2.4cm.
Aortic Root: ------ ^3------ {rsi 2.0-3,8cm.)
Interventricular Septum: Thickness:(N 0.6-1.1cm)
Aortic Valve Opening: ,._L*.7. (N 1,5-2.6cm.) Tricuspid Valve: normal
Excursion:--------------- (N 0.3-1.2cm)
Pulmonic Valve:
% Thickening: T T =__ (N>22%) SD
Pericardial Fluid:
CHOCAROIOGRAPHY FINDINGS
VENTRICLE:
Left ventricular dimension cannot be measured in accuracy because of poor
resolution. However, there is no evidence of left ventricular dilatation
or significant hypertrophy. Left ventricular function was normal.
ETRAL VALVE:
Nonral mitral valve without evidence of prolapse of mitral valve or mitral stenosis.
3PT ATRIUM:
Normal left atrial dimension. No mass density.
IGIT VENTRICLE:
Moderate right ventricular dilatation. No mass density.
1RTIC ROOT:
Normal.
DRTIC VAI2ZE: ERICARDIUM:
No aortic valve calcification.
There is echo free space in'anterior pericardium, possibly representing pericardial effusion. However, there was no posterior pericardial effusion.
INCLUSION:
[1.] [2.] [3.]
Normal left ventricular function.
GENC 002937
Moderate right ventricular enlargement.
Echo free space anteriorly, between chest wall and right ventricle,
possibly anterior pericardial effusion, however, normal epicardial
fat cannot be excluded.
CMMENT:
It is almost impossible bo make a diagnosis of pericardial effusion with
out seme posterior pericardial effusion. Certainly patient does not have
any posterior pericardial effusion. Again, this could be normal epicardial
fat which caused echo free space, but I would correlate it clinically to
see whether patient has any signs of pericarditis. Also to see if patient
has any underlying cause to have localized pericardial effusion anteriorly
such as metastatic lung CA signature: CONTINUED.....................
to the pericardium.
_____________
^ J? Cho, m
Succi, Joseph R.
echdcapdiography
09/16/88 page 2
/J//
If we do not have any signs of pericardial involvement clinically, vxxildnlt persue any rrore, because certainly this echo free space can be due to normal epicardial fat.
James N. Cho, M. D.
JNC/bb
6EMC 002938
t
/ 7/
ASHTABULA COUNTY MEDICAL CENTER DISCHARGE SUMMARY
Admission: 9-8-88
Discharge: 9-18-00
REASON FOR ADMISSION: This 67 year old white male was admitted because of ana sarca.
HOSPITAL COURSE: The patient was admitted to the medical floor. He was treated with oral diuretics and he was proceeded with a work up for his anasarca. He had had a recent IVP and a prostate biopsy within the last 10 days before his admission. These tests didn't reveal any reason for this problem. He had a liver function test, which showed some modest elevation and a liver/spleen scan which showed multiple shadows on his liver, consistent with metastatic disease. A CT scan seemed to be more consistent with dilated bile ducts but a sonogram showed these to be solid tumors. A biopsy was then done. First biopsy had a lot of blood back and just a very few cells were suspicious for cancer cells, but a firm diagnosis couldn't be made so a repeat biopsy was done. Results of this biopsy are pending, though we are as confident as we can be without the biopsy that this is a cancer that we are dealing with. He underwent barium enema. He had had an IVP and a bone scan. Also had an upper GI series, as well as a sonogram and no primary tumor could be found. He did have a history of working with polyvinyl chloride in the rubber industry for a number of years and this has been known to be associated with a primary liver tumor, namely angiosarcoma of the liver. Since we are waiting for the official biopsy whe don't know if he has this or not but this is what we are thinking is that he probably has a primary liver tumor. He was seen by Dr. Mintz and he made some recommendations as far as doing a theta protein, which is still pending. He had an echocardiogram for baseline studies, as far as his heart was concerned. He will make arrangements for chemotherapy or other forms of therapy depending on the type of tumor that Mr. Sued has as an outpatient. Mr. Sued did have a diuresis of 20 lbs while he was in the hospital and he felt considerably better with this. He did have some cramps in his legs, but his electrolytes were done on the day of discharge and they had been normal prior to this. He felt con siderably better. He had less icterus and he even had a better appetitie and it was felt that he could be then discharged, awaiting the results of the rest of his tests.
LABORATORY AND X-RAY DATA: The patient had an EKG which showed a sinus rhythm, rather low voltage. The possibility of remote inferior wall infarction was raised but I doubt that he had this. He had an IVP dojie a couple of weeks before his admission which just showed normal urlhar^ tract and some surgical changes of the lumbar area, consistent with a laminectomy. He had a chest x-ray, which was unremarkable. He had a repeat x-ray, which is likewise unremarkable. There was a bit of pleural fluid on the third x-ray, though this was done at the beginning of his hospital stay. He had a liver/spleen scan which showed multiple filling defects In his liver and increased uptake in the spleen. A
sonogram showed normal renal sonogram. A small amount of ascites was noted and small fossae of echogenicity in the liver, measuring up to 2'A cm in diameter.
continued...
SUCCI, JOSEPH
5213194
H.S. Waid, M.D. 11-75-42
D: 9-18-88 T: 09-20-88 /jr
GEHC 002?3?
/*'//
ASHTABULA COUNTY MEDICAL CENTER DISCHARGE SUMMARY: Page 2
CT scan showed renal cyst, and also showed lesions in his liver, which were felt to be consistent with dilated bile ducts but the sonogram showed these to be solid. Barium enema showed divertlculosls and bone scan was normal. Upper GI series was unremarkable. Urinalysis showed positive nitrate reaction with red cells noted, some leukocyte estrase and some positive amount of blood. This was three days after his prostate biopsy, however. He had a white count of 7,100 with H&H of 14.4/45,5. lie had 75% granulocytes and automated differential and platelet count was 314,000. Hepatitis II antigen was negative and B antibody was negative. Hepatitis A IGM antibody was negative. He had a sugar of 86, BUN of 13, creatinine 1. Normal electrolytes, calcium 8.5, phosphorus 2.1, cho lesterol 125, uric acid 4.8. AST 67, LDH 435, alkaline phosphatus 345, GGTP 246 and total bilirubin 1.8 on admission. Amylase was 32. He has acid phosphatase, which was .31. Protime was 14.5 and APTT was 29.3. Repeat white count was 6100. H&H was 13.7/42.5 and platelet count was 294,000. He had 79% polys, 187. lymphs, 3% monos on a manual differential. He had a very typical cell smear on an aspirate of the liver. His protime came down to 13.8 after a couple of shots of AquaMephyton. He also needed fresh frozen plasma to help Is coagulation. His last potassium, done three days before discharge, was 4.1. His sodium was 141 at that point. He had alk. phos. fractionation consisted with liver frac tion. His last H&H was 13.0/39.9 before his discharge. His white count was 5600 at that point. He had a urinalysis which showed some hematuria again.
DISCHARGE DIAGNOSIS:
1) Anasarca. 2) Liver tumor, unknown primary. 3) Pleural effusions. 4) Recent prostatic biopsy, which showed focal
nodular hyperplasia.
CONDITION ON DISCHARGE:
Improved.
DISCHARGE MEDICATION: Lasix 80 mg a day and Aldactone 50 mg twice a day. Follow up will be arranged In my office in five days. Will check his weight and his blood pressure, as well as repeat urinalysis.
H. Waid, M.D.
GENC- 002940
5UCCI, JOSEPH
5213194
II.S. Wald, M.D.
11-75-42
D: 9-18-88 T: 09-20-88 /jc
ASHTABULA COUNTY MEDICAL CENTER HISTORY & PHYSICAL
admitted: 9-8-88
CHIEF COMPLAINT: Pronounced edema of both legs and up into his abdomen for the last week to 10 days.
HISTORY OF PRESENT ILLNESS: This is a 67 year old male who was in his usual state of good health until about two weeks prior to admission when he started having trouble with urinary frequency and dysurla. He was seen by Dr. Marcus for this. He did an IVP and was scheduled for a prostate biopsy, which was per formed on the 6th of September, the results of which are pending. After the IVP Mr. Sued started noticing some swelling on his legs extending up into his abdo men. He was seen by Dr. A. S. Lee for preoperative clearance because of this edema. Clearance was given and the procedure went ahead but Dr. Lee also did a chest x-ray, EKGs and blood work, trying to evaluate this edema and started him on Lasix, 20 mg and Micro-K 8 mEq each day. After this he showed no improvement and he presented to my office. He denies shortness of breath or chest pain. His appetite has been mildly diminished lately. Some of his urinary symptoms have improved but he just had the biopsy and so his urine has turned orange because of Pyrldium just administered over the past two or three days, after this edema had occurred. He has also been taking Procardia 20 mg twice a day by Dr. Brandeberry for a history of hypertension. He has no known allergies.
PAST HISTORY: Cholecsytectomy, appendectomy, lumbar laminectomy and cervical fusion.
SOCIAL HISTORY: The patient is retired. He used to work at Goodyear. His wife says that he was exposed to something industrially that had them testing his blood every six months during his employment for early detection of liver cancer. He doesn't smoke. He drinks alcohol rarely. He is married and he and his wife live In Jefferson Township.
REVIEW OF SYSTEMS: No headache, cold symptoms, shortness of breath or chest pain. No nausea, vomiting, has a diminished appetite. He did have rectal bleeding recently, which he blames on hemorrhoids. ^
PHYSICAL EXAMINATION:
GENERAL: This Is a middle aged male who is In mild distress due to his edema. Vital signs show blood pressure 122/80, his prflse 1s72*and regular, respira tions are 18, he Is afebrile.
HEENT:
Pupils are equal and react to light. Discs are flat. There is no retinopathy. Extraocular muscles are intact. There is no icterus noted. Tympanic membranes are partially obscurred by cerumen. The pharynx shows him to be edentulous. There are no oral lesions noted.
continued...
SUCCI, JOSEPH
5213194
H.S. Waid, M.D.
11-75-42
D: 9-9-88 T: 09-12-88 /jc
GEMC 002943
ASHTABULA COUNTY MEDICAL CENTER HISTORY AND PHYSICAL: Page 2
NECK: CHEST: CARDIAC: ABDOMEN:
Without adenopathy or thyromegaly.
Clear to auscultation.
Regular rhythm, no murmurs or gallops appreciated.
Distended with what appears to ascitic fluid. There is edema in the lower abdominal wall. There are no masses felt. No is mild tenderness to palpation in the lower abdomen. No organomegaly appreciated.
RECTAL:
Hemocult negative stool. Prostate Is 1+ enlarged, kind of hard but no nodularity noted.
EXTREMITIES:
3+ edema on both legs. There is no edema in the arms.
SKIN:
Warm and dry without rashes.
NEUROLOGICAL:
Intact.
IMPRESSION:
Anasarca, doubt cardiac cause, most likely a hepatic cause, although renal cause needs to be ruled out especially since the recent IVP.
H. Waid, M.D.
SUCCI, JOSEPH
5213194
H.S. Waid, M.D.
11-75-42
D: 9-9-88 T: 09-12-88 /jc
GENC uO
==? 5= Ashtabula County
M||C Medical Center
Wate
nflJ?_____
1. Discharge Patient. 2. Final Diagnoses__________
DISCHARGE ORDER
T~ J
/G 72
J
3. Condition
or summary to be dictated Home - Going Instructions
1. Diet-------^ ^
------- ------------- -------------- ---------- ------------------
2. Activities
________________________________ ______ ____ _--_
3. Medications____ 4^ K_____
^ ..... 4V~
--------
___________ --"Ltt- -*1- ^ Ac*.-, c 4 C/
J
4. Follow-up VisitPlease have patient call doctor's office tor an appointment.
5. Other Instructions (include Follow-up studies)
Physician's Signature_________ -- - - .
________ .____________ ________ ______ __
Nurse's Signature----------------------------------------------------------------------------------------------------------------------
! I have received a copy of the home-going instructions and understood the explanation given to me.
Patient's Signature.
r rvX
------- V--
\
09.1888
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GENC 002944
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MEDICAL-SURGICAL ASSGC., INC.
SURGICAL PHONE 452-2763
G*n*r*l Surgery C R LEONE, MO.f ACS M. TAVANA. M D , F A C S M A SANTOMENNA, M D , F A C S J Q DANIELE. M O . F A C S. J J BEDNARSKI. MD.F ACS G. V PRYUNSKI. M 0.
Thortclc A Vocular Surgary M TAVANA. M D . F A C S,
23B WEST 22ND STREET
ERIE, PENNSYLVANIA 16502
gastroenterology
PHONE 452-2767 V M PATEL, M.D. M RC.P (UK) 0 C KHERA, MD.FA C.G P J G3&UER, M D
November 18, 1988
Harlen Waid, M.D. 125 S. Chestnut Street Jefferson, OH 44047
III-: JOSEPH SUCCI DOB: 9/8/21
Dear Harlen:
Liver biopsy on Joseph Sueei unfortunately shows features of angiosarcoma. Liver biopsy was sent
out to Vermont, and also
lnstitue of Pathology and both the places have come to the same
conclusion. I am waiting for the official report. 1 will forward that to you when it is available.
He should try and keep his weight somewhere between 150 and 155 lbs with adjustment of the diuretics as needed.
I suggested to Mr. and Mrs. Succi that he should be seen at a Tertiary Care Center which is involved in liver transplantation in case there is any possibility for him to have a liver transplant. There are inquiring regarding this with both the Centers in Pittsburgh and in Cleveland to see if one of them would accept him for evaluation. I hope you in agreement with that.
Yours sincerely,
Vinod M. Patel, M.D. VMP/rnks
/
GENC 002945
S OU T H (, A T : M L D 1 C1 L PATIENT NAME
L - ti .
kSUCCI JOSEPH
b/ Y
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SOUTHCJA1L
1-800-362-8913 (Ohio!
iedical laboratory SYSTEM - 1 -800-338 -0166 (Outside Ohio)
SILLING RECIPIENT
PATIENT 1 0
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_________ ^
REFERRING PHYSICIAN
_ PRtLLIfY I\URY
ACCESSION NUMBER
PAGE
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DATE & TIME RECEIVED
3646263
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LABORATORY DIRECTOR^ U L, i. hO
LAI NUMKI MOfCATES UtfOMTOW MW(IC HIT PEIFOMKB ffl Swthgit* MrticaJ Lab
21100 SwttuM it ttvtf Hit. OH 44til
MadtMft #38-1101
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6EHC 002946
SOUTHGATE MEDICAL LABORATORY, INC. 21100 Southgate Park Boulevard
Cleveland, Ohio 44137 - Telephone (216) 581 -1030
Edward E Siegler, M D , Geoffrey Mendelsohn, M.D., Michael S. Youshak, D.V.M
PATHOLOGY REPORT
Path. No. 88-S-8092
Patients Name: Succi, Joseph
Age:
Patients Address:
Physician:
Harlan S. Waid, Jr., M.D., Inc.
Clinical Diagnosis:
Specimen:
Nose
Sex: M
Date; 9/24/88
GROSS DESCRIPTION
Received in fixative is a flat, circular tissue meauring 0.3 cm. The lesion is pigmented with an irregular surface. Bisected and embedded.
DIAGNOSIS:
' t MODERATELY-DIFFERENTIATED SQUAMOUS CELL CARCINOMA, SUPERFICIALLY
ULCERATED - BIOPSY LESION OF NOSE.
W. K. Sterin, M.D. 9/27/88 - lsh
(2S)
Pathologist GENC 002947
`'J? f
MEDICAL-SURGICAL ASSDC., INC
SURGICAL PHONE 452-2763
G*n*r*l Surgery C R LEONE. MO.FACS, M TAVANA. M D . F A C S. M A SANTOMENNA. M.O.FACS J Q DANIELE. M D . F AC S J J BEDNARSKI, M D . F A C S G V. PRYLINSKI. M 0
Thoracic A Vaacultr Surgery M TAVANA, MD.FACS,
23B WEST 22nd STREET
ERIE, PENNSYLVANIA I6SD2
GASTROENTEROLOGY
PHONE 452-2.767
_____
V M PATEL. MO.MRCP (UK)
D C J5HERA, MO.FACG
IP J GMUER. M 0
< i iL-
September 26, 1988
Harlen Waid, M.D. 125 S. Chestnut Street Jefferson, OH 44047
RE: JOSEPH SUCCI DOB: 9/8/21
Dear Harlen:
I saw Joseph Succi in the office. I am enclosing a copy of my notes. 1 thank you very much for sending me his previous summary of his admission and also forwarding the x-rays to me.
Just like you, I am concerned about the possibility of either metastatic disease to the liver or of angiosarcoma of the liver.
His previously done liver biopsies have not been helpful, so instead of going ahead with another liver biopsy by needle, 1 felt it would be best to obtain additional evaluation first, we may still have to ahead an obtain a CT scan directed percutaneous biopsy or may have to do minilap for
the biopsy.
Thank you very much for asking me to see Mrtf. Succi with you.
Sincerely yours,
'v
Vinod M. Patel, M.D VMP/mks
GENC 002948
-/
USTORY AND PHYSICAL September 26, i9ss
IEFERRING PHYSICIAN: Dr.
PATIENT:
PHONE: DOB:
JOSEPH SUCCI 1767 Griggs Road Jefferson, OH 44047 216-576-5124 9/8/21 Age 67
USTORY OF PRESENT ILLNESS: Joseph Succi, who is now age 67 years, attends with his wife. His wife does have a problem of myopathy. He is seen because of abnormal liver studies and a not s;o helpful liver biopsy, although it is suggestive of possible malignancy.
le has a past history of having a cholecystectomy, appendectomy, lumbar laminectomy and cervical fusion.
lis problem started sometime in mid August and one thing led to another, initially having a prostate biopsy vhich was negative and IVP which was negative and subsequently, because of swelling of the limbs and retention >f fluid, he had the studies done. In essence, his liver scan was abnormal showing patchy decrease uptake in he liver and some possible defects, CT scan is not normal showing again some minimal, but definite changes aising the possibility of dilated bile ducts, but the sonogram did not show any evidence of bile ducts, indeed, t showed a problem consisting of solid tumor. The first biopsy showed a few cells suspicious for cancer cells, second biopsy was done which only showed blood and did not show anything specific. Additionally, he had
rnrium enema done, IVP, bone scan done, upper GI series done and these have all been negative or normal. Echocardiogram is satisfactory as well. Electrocardiogram was normal.
Dn laboratory studies, studies for hepatitis A and B have been negative. ASD 67, LDH 435, Aik phos 345, 3GTP 246, prothrombin time is 14.5
V1EDICAT10NS: .asix and Aldactone and his swelling is going down.
lis weight which had gone up to 179 lbs is down with the treatment. Swelling and bloating has gone down, llthough he still has the same symptoms. No cough problem, breathlessness or chest pains. No urinary ;ymptoms at present. Bowel movements have been normal. No rectal bleeding. Probably from administering U1 those tests, h^had kick up of the hemorrhoids. No itching of skin. No fever.
FAMILY HISTORY: Noncontributory. What is significant is the fact that he was working a good year as an electrician and was in ind out of various departments, including in the chemical plant, and later on, more strict regulations were ;tarted which included wearing a face mask . Apparently he has had laboratory data done every so often and hese had been negative previously.
SOCIAL HISTORY: le is married. Lasix is 1 per day. Aldactone 2 a day. Halcion PRN at bed time. He does not take alcohol.
PHYSICAL'EXAMINATION: Height 5' 4". Weight 156 lbs. BP: 140/100. Hs does looks^ightly pale. Well built.
No adenopathy.
leart sounds are normal. No murmurs. Lungs are clear.
Vbdomen is slightly protuberant, shows evidence of ascites. I cannot feel liver or spleen at present.
Jenitalia normal. Rectal shows prostate plus.
There is slight edema of feet and legs.
bNC 002>'4y
/ J //
OSEPH SUCCI 'AGE II EPTEMBER 26, 1988 ASSESSMENT:
History of Mr. Succi is consistent with either metastatic disease or ngiosarcoma of the liver. Two liver biopsies which were done previously, have not given us an answer.
Will review the CT scans and the radiological studies with the adiologist at St. Vincent. An approach we may have to take would be that of obtaining angiogram and ubsequently either doing a needle biopsy of the liver or doing open liver biopsy and decide what we should o after that. The chempro is certainly very worrisome for metastatic disease.
Await results of alpha Fetoprotein which was done at Ashtabula Hospital, vlso get PT, APPT, protein electrophoresis and chempro.
Tnod M. Patel, M.D. 'MP/mks c: Dr. Waid
%
GENIC 002950
/o7y SCUTnGATE MEDICAL LAfc
PATIENT NAME
SUCCI, JOSEPH R
sex ' AGE M b7Y
53699 H A R L A fil S W A I D , Jh i KD.*inC. 125 S. ChESTfuUT STREET
SOUTHGATE
LAQORATOR'
BILLING RECIPIENT
PATIENT l D
(*1P1 MUJU
1 800 362 8913 (Ohio) 1 -800-338-0166 (Out&ido Ohio)
Patient summary report
M E LI CARE
1 C7 f
REFERRING physician
F INAL
ACCESSION number
k A ID date 4 time collected
DATE 4 TIME RECEIVED
5728292
1b
REPORT OATE k TIME
JEE FERSOfu
Dh AA C A 7
f CODE
test description
A b N O R HAL:
lu/07/86 09 25F,9
RESULTS / UNITS
K C sul
10/G ?/ 8 8 C9 Ca f M
10/09/88 0 506 AM
__________ .-AJ--------
NORMAL RANGE
LOW
HIGH
LAB NUMBER
tr
SOD ItTITi -SERUM B I L IP UP Il\l ,T0T AL SGPT -CT-RAnSAMIAi A-SE l S GO T ITRALSAMIMASl) ALK AL IAir PHOSPH AT ASE CALCIUM, SERUM PPOTETW, TOTAL -S ERL K SEGRtATED l\i E U T F. Q K H IL S
L YM Fh-JCTrrs-
* ---
-
=_
152 2.5
72 55 951 8.1 5.6 79
IS
MtL/L MG/DL U/L U/L U/L MG/2L G/DL X
X
125 C 0 90
( .5 6 0
5&
2C
195
1 .2 95 91
1 55 15 .5
8.5 70 9C
TT29 02 SMAC,CBC,DTFF'
,mac
glucose * serum sodtumv serum------ ---------POTASSIUM* SERUM 'CHL'CJRTD ET"SrFUF------- " CARHOM DI 0x13: BLOT 13 URSA flilTR CGTlV-bUft, C^E ATI M IfViC SERUM
URIC AC 10"* STRlI M b I L IR Ub IIV itotal
SOOT tTRAKSAMIKAbE ) A L trSXTT<rF"'PHOSP K A'TA S E " LLH <LACTATE DchYDROb.) CHOLESTFRETL---------TRIGLYCERIDES CALCIUM, STRUT"" PHOSPhGRUS, IilGKGAiUC I ROH,..SCRUM--------- -------PFOTEIK, TOTAL-SERUM
AL B CHI NYSE RCTT
GLOBULIN AL PLMTW7GTC BTTTTir-A ATTO' ELECTROLYTE bALANCE P U N7CK E A T1 rmCET' R ATTO
-
CCMFLCTETBUCOC COUNT ' "
l nr te""b ronrr err l - count
RED BLOOD CELL COUNT
H l M CCL 0BIN HIMATUCRIT VEA N "CCRPUSCUL AK VO LUFF
MEAN CORPUSCULAR rlGb Mr ATi-COTTPT' HGE . COMCEIv
CrFFETRCNTTAL--------
segmented NEUTROPHILS
97 M G/DL 1 32 MEC/L H *B MLU/L
59" MFCT/L 25 R EG/L 19 MG/DL 1 .1 MG/CL 5.0 MC/DL
2 .3 ISG/LL 72 U/L 55 U/L
A 5 1 U/L 1 b5 U/L 121 MG/DL
b 9 MC/LL
H.l MG/DL 2.7 MG/UL ' 56 UG/UL 5.6 G/DL "5 .o G/DL
2 . U G/DL 1.8
8 17.3
7T5 THCUS /CU 5. 01 MIlL. /CO 19.5 G'R>HS / D L AO .2 %
90 CUBIC 2 8.0 LU GM
31.6 *
0
Cl
f-v.
MM .
"
79 X
85 - 135
5.5
96 29
10 .7 3.9
<D C c
90 t, 0
99 30
f .5 2.5
20 6.0 3.0
1,5 " .8
9 6.0
125 195 5 .0 1 08"
50 i: b
1.7 9.0
1.2 9591
1 55" 2 C0 2 90 1 75 10 .5" 9 *5 1 61fc .5
"5" 6 2 " 15 .0
Cl
" 9.8 " " 9.60
......19.0 5 9*0 f0 2 5 . *4
3 C. 0
TT to IT 55' 59
59 57
TTT
70 nr
|'| RESULT IS ABOVE HIGH NOHMAL VALUE <-) RESULT IS BELOW LOW NORMAL VALUE
LABORATORY DIRECTOR(S)
#J SoufftgAM MMteAt UtLAI BIMMM IWNCATU IMOMTMT WMM TUT KMOMMS 21100 SouOi( H &M M*?U HU OH 441)7
MaAcmi #36-1101
GENC 002951
OWNED AND OPERATED BY BOUTHOATE MEDICAL BERVICEB, INC.
5 t
/o'/J S CU 7h G T MEDICAL LAb
patient name
SEX AGE
skju i tiUAsn
1 800 362-8913 (Ohio!
M t 0 I C A L laboratory system . 1 -800-338-0166 (Outude Ohio)
BILLING RECIPIENT
PATIENT 1 D
PATIENT SUMMARY REPORT
^SUCCI , JO SE PH F
H Art L A !M S k. A I D * 125 S- CNL S 7IMUT
rt b 7Y
5it 9<* J F N0lAiC STREET
negi cake
1 L76
"REFERRING PHYSICIAN
F INAL
ACCESSION NUuBER
U A 12
Date a time collected
37243292
2
ATE A TIME RECEIVED
repoAT dATe i TIME
b
JEFFERSCfvi
OH `i H iH 7
r CODE
TEST DESCRIPTION
H AIM DS L YMPHCCYTES ATYPICAL" LYMPHOCYTES *OiMGC YTES 5 CS IWCPHIL S ICIFF) ti ASGPHlL S Pi ISC.CtLLS (OIFF)
KHC MORPHOLOGY
10/07/B8 CA2bFrt
RESULTS / UNITS
UX 19 %
0* 6X 1X 0X s l PLATELET c dun i SLIGHT
AIM I SOC Y T US 1 S HYPCCHROMIA
10 yO 7/68 09 CO FF
1C/09/BB 0 5C btr,
---------------------------- ,-----------------HM----
NORMAL RANGE
LOW
HIGH
LAU NUMBER
0 20
C 0 0 0
OCCASIONAL FICRCCYTCS
5 06 26 PLATELET COUM
5 1 03 PROTHRCHBIW TIKE
PAT ICrtT--V ALUE PT CONTROL VAlU
3 ID ThOUS/CU V.F.
17.1 SECONDS 12.7 SECGIMC5
* END OF REFC1F T
i<* C
*1*10
01
err
All 9 6
CJ*
2
(M RESULT IS ABOVE HIGH NORMAL VALUE (-) RESULT IS BELOW LOW NORMAL VALUE
LABORATORY DIRECTOR(S)CkARD
IX .UliUR IMHCATEl tAIOMTMY WHESt TttT PESFOMKO
#1 S21o1i/0H0w$t*o*M*0fd*itc*jjPlatte#*. Map* Hti, OH 441)7 ittMIOl
o.
S IE G L R * M.D
-or
OENC 002952
OWNED AND OPERATED BY BOUTHOATE MEDICAL SERVICES. INC.
_S OU1H LA IE MEDICALLY.
PATIENT NAME
SEX AGE
SOUTHGATE
-m t d i c a i laboratory system
d 1 ^J(21b, 501-1030
1 800 362-8913 (Ohio) 1 800-338 0166 (Oi/t*ide Ohio)
BILLING RECIPIENT
PATIENT 1 0
PATIENT SUMMARY REPORT
(SuCCI, JQ-SCPH B_
S TREET
M _-g.7Y
medi car:
107 8
REFERRING PHYSICIAN
F 1 NAL
ACCESSION NUMBER
53694 ki A ID
3782273
1 fa
DATE 4 TIME COLLECTED
DATE 4 TIME RECEIVED
REPORT DATE & TIME
JEFFERSON
OH 44047
10/17/88 lllOAH
10/17/ 8ft 08 <*fc> FN
10/ lfi/8P 1 00 0PM
it CODE
TEST DESCRIPTION
ABN 0 R h A L
RESULTS / UNITS
RESUL TS
NORMAL RANGE
LOW
HIGH
LAB NUMBER
SOD IUM,_ SERUM
fa 1L IRUB IN * T O T AL SGPT (TRANSAMINASE ) SOOT (TRANSAMINASE 1 ALKALINE PHOSF-H AT ASE LOb ILACIAXE DEhYDRGG. ) CALCIUM, SERUM
P R Q TXIN . XGTAL-SERUH SEGMENTED NEUTROPHILS 1 Y M PH or. Y T r s
*.
*
*
1 31 3.5
61 54
423 207 8.2 5.5
78 16
MEu/L
MG/CL U/L U/L
U/ L U/L MG/DL G/UL X %
135 t.
0 0
40
60 ft.5 b.C
50 20
145
1 .2 45 41
^1no5vp5V 10.5
8.5 70
40
P3Q93
[ EUET
SW A C
GLUCOSE , SERUM sodium, serum. . _ POTASSIUM, SERUM
CARBON DIOXIDE FLO BO HR FA NITROG EN-BUN CREATININE, SERUM URIC ,,AXO-*- _S_R U.M. fa IL IRUfa IN ,TOT AL SGPT t T R A MS AM.1-N-A.S-E_!____ SOOT (TRANSAMINASE) A I K A I Tftir PHOSPH AT ASE. --
LDM (LACTATE DEHTDROG.)
* **
*
TRIGLYCER IDES .CALCIUM , SE&UM-PHOSPHORUS, INORGANIC
PROTEAN, TOTAL - SER lTm~ ALBUMIN, SERUM-------------_ GLOBULIN AL fa UMI N / GLO BUL IN--R-AT 10
ELECTROLYTE BALANCE JLAUXL--
CCMPUEIE XL-QGD COUNT
^EDTfaL00DCELLLc6uNT^
HEM CGLOU IN--------- ----------HEMATOCRIT
LAR VOLUME M, E A N CORPUSCULAR nGb -MEAN .CORP, FiGb. XQNCEN.-
-U 1-F-f-RE N TINL--
123 MG/DL 1A1 MEO/L 4.1 MEL/L
95 M E Q/ L 25 MEU/L 20 MG/DL 1.2 MG/DL 5.4 MG/LL 3 D MG/DL 61 U/L_ 54 U/L 423 U/l___ 2 C 7 U/L 127 MG/LL 63 MG/DL 8.2 M G/DL 2.6 MG/DL . 47 UG/DL 5.5 G/DL 3 .3 -G7DL 2.2 G/DL 1.3
7 16.7
. &*2--T-Ft-GUS/ CU MM4.59 'MILL / CU" 'MM 1A.X-GRAMS/UU 46.2 %
92 CUBIC MCG 28.3 UU GM .30.5.. X - __________
ZB X
85 125
125
145.
3.5
5.0
._ 96
.08
24 30
10 26
. 7 1 .7
3.9
5 .0
.2 1 .2
0 45_
0 41
40 . _155
6 C 2 00
______ 59 __ 240
3 0 1 75
______ _ 8.5 25
1.0 *5_ 4 .5
___ .20
.. . 181.
6.0
8 .5
_ 3. a. .
5 .5
1.5
3 .6
_______.8
. 2*-
4 15
......6.0
25
.... A . E.
4.60
14.0 39.0
..0 25.4 -iO.O
6.20
.17...555.0
. -94. 34 .b 3 7 *0_
___ a
7CL
01
MX-04-
(*) RESULT IS ABOVE HIGH NORMAL VALUE (-) RESULT IS BELOW LOW NORMAL VALUE
LABORATORY DIRECTOR(S)
Uki MUNI MUMttTU UMMTMT WMtM TUT PWONKO
,1 SouHtutt MMul U, J1 lojiIMW R. M_ M*U HU- QH Mill
HMun HM-IIOI
GEMC 00295:
OWHtO AND ORRATIO IV IOUTMOATI MIOICAL MRVtCCA INC.
fo ' j
^L'UinbB 1L
patient name
-----------SEX
AGE
SOU I tlUAl C,
1 -800 362-8913 IQhiol
MEDICAL LABOBATOfiv SYSTEM . 1 '800-338-01 66 (Outtid* Ohio)
billing recipient
PATIENT I D
PATIENT SUMMARY REPORT
SUCCI * JO SEPM R
H AH la II S. uAlDf
12 5 S. CHES 7MJT
i* b 7 Y
J H i MDINC<
S 7 R . l T
!. 9h
ME 01 CARE
1 07 P
REFERRING PHYSICIAN
F 1 NAL ACCESSION NvjMoER
WAIL
DATE A TIME COLLECTED
3782273
2
DATE A TIME RECEIVED
REPORT DAT A TIME
B
JEF FE RSCN
0F( 44047
10/17/88 1110AM
10 /I7/88 08 46 PM
10/ 18/88 1 00 0PM
T CODE
TEST DESCRIPTION
RESULTS / UNITS
NORMAL RANGE
LOW
HIGH
LAB NUMBER
BANDS
L WPHQCtl ES
ATYPICAL LYMPhOCYT ES
M QM CCS TS
CCS INOPHlLS < 01 F F )
BASOPHILS.
MISC. CELLS < D IF F ) RBC rt_Cfl.PHQLOGY
0. X 1fa X
0X
5X
1X 0X
SLIGHT AN ISOCYTOS lb
SL1GhT PO I is IL OC YT CS IS
SLIGHT hYPOChRGrtlA
OCCASIONAL BA CHOC YTS
OCCASIONAL OVALOCYTES
OCCASIONAL TARGET CELLS
b AC
9 8
PLATELET COUNT
293 THOUS/CU KM
14 0
** **o
01
* END OF REPORT
-------------------
(*) RESULT IS ABOVE HIGH NORMAL VALUE I-) RESULT IS BELOW LOW NORMAL VALUE
LABORATORY DIRECTORTSiLD.! a HD H . SIEOLERi M.D
LAI NUflMEI WOKATCI UfMATOir WHEM TEST ttlFOWKO
ffl SortHgait MHtcal Mb 21100 Soutfaptt Pk &M OH 44137 M*ura *36-11Q1
GENC 002954
OWNED AND OPCHATEO BY IOUTMQATE MEDICAL SERVICE*. INC.
ox
'ci i SOUTHLME "EPICAL LAD.
PAT/ENTNAMf
S&X
SOUTHCiAie
* w 1:800-362-8913 (Ohio)
medical lab oratory system. 1 -800-338-0166 (Outtid* Ohio}
BILLING RECIPIENT
PATIENT I 0
PATIENT SUMMARY REPORT
^uc Cl . JOSEPH R
HARLAN S. U A I D 125 S. CHESTNUT
67Y
53699 JR., M.D.tINC. STREET
referring physician
ACCESSION HUMBER
PAGE
U A ID
DATE t TIME COLLECTED
3929999
lb
DATE * TIME RECEIVED
REPORT DATE TIME
JEFFERSON
OH 99097
11/10/88 1050AM
n n a F8 0821PM
11/ 13/88 0 73 1AM
r CODE
TEST DESCRIPTION
AbN 0R MAL
RESULTS / UNITS
RR EE s U L T S
NORMAL RANGE
LOW
HIGH
LAB NUMBER
SOOUTmVSERUM
- 132 MEG/L
BlL IRUBIN .I&TAL..
9,2 MG/QL
SGPT (TRANSAMINASE) S GO T (.1 RA.ALS.AMINA S )
57 U/L 96 U/L
ALKALINE PHOSPHATASE
901 U/L
CALCIUM-_SLRim .
-- 8.3 MG/DL
PROTEIN, TOTAL-SERUM
- 5.3 G/DL
S EGM.LfiLLLH NEUTROPHILS
8( I .
L YMPHOCYTES
" 10 X
135 *2 G 0 90
6.5 6.0
50 2C
195
1 *2 95 91
1 55
10.5 8 .5 70 90
0 2** 02 S MAC, CbC, DIF F~
SMAC
GLUCQSEj--SERUM____ SODIUM, SERUM
PQIASSIUA*. SERUM CHLORIDE, SERUM TAKBO-N-JII OXIDE HLOOO UREA N I TR CG EN-BUN
-CR AT I NINE-*.-SERUM URIC ACID, SERUM BlLlfiXiaiAU-IUT-AL SGPT (TRANSAMINASE) SGQT .XIRANSAMINASE ) ALKALINE PHOSPHATASE CDH X1AC1ATE DIBiYORQG.l CHOLESTEROL IKLGLYCJilES CALCIUM, SERU*
PHOSPHORUS, ..LNDfiG_ANLC___ IRON, SERUM PROTEIN* TQIAL-STRUM , ALBUMI N, SERUM
GLQtULLN-- ALBUM IN/GLOBULIN RATIO ELCCTRavY-I-4>A4.ANC ------BUN/CREATININE RATIO
COMPLETE BLOOD COUNT
WHITE BLOOD CELL COUNT
RED BLOOD- CELL COUNT-------
HEMOGLOBIN
-hemaiocrty-
____ -
FEAN CORPUSCULAR VOLUME
MEAN CORP. HGB. CONCEN.
DIFFERENTIAL
SEGMENTED NEUTROPHILS
120 MG/CL 132 MEQ/L 9 .8 MEG/L
98 MEG/L 25 MEG/L 25 MG/DL 1 .2 MG/DL 5 .3 MG/DL 9 .2 MG/DL 57 U/L 9S. U/L 9 01 U/L 159 U/L 129 MG/DL 82 MG/DL 8.3 MG/DL 3.2 MG/DL 30 UG/DL 5.3 G/DL 3.1 G/DL 2 .2 G/DL 1.9
9 20.8
85 . 135
3.5 98 29
10 .7 3.9
.2 0
0 90
80 99
. 3Q 8.5 2.5 20 8.0 3.0 1.5 8 9 6.0
125. 195
5.0 1 08 . 30
26
1.7
9.0 1 .2
95 91.
155 200
290 175 10 .5 9 .5_. 1 81
8.5 5 .5 32 .2
1525 .0
JLL
10.5 THCUS/CU MM
9.8
11.0
9.85--M ILL./ CL ------------------- --. 9*8-0- .... 5.20-
19.2 GR AMS/DL
19. G
17 .5
99 .5- X .
_____ . 39.0 - - 55*0-
91 CUBIC MCG
80 99
29.3 UU GM
. 25*9- - -39
31.9 X
o o
PJ
37.0
01
09 X
5 0 70 01
(*) RESULT IS ABOVE HIGH NORMAL VALUE (-1 RESULT IS BELOW LOW NORMAL VALUE
LABORATORY DIRECTOR(S)
IMl MS2J1Mo1t0KiH0XwSN.wMtMlwC*uA(.TPU1E*L(UMOUTOOT *HIM TUT KUWNI Mv. HU, OH Mill Mlfein AMI10I
3ENC 002955
OWNED AND OPERATED 1Y fOUTHDATl MEDICAL SERVICE*, INC,
r
/eny
PATIENT NAME
SEX AGE
SOUTHGATE
t*Ip; JO 1 - IUJU ~ 1 800-362-8913 (Ohio},
medical laboratory systfm. 1-800-338-0166 (Outt*d Ohio)
BILLING RECIPIENT
RATI* NT 1 D
PATIENT SUMMARY REPORT
wS UC Cl JOSEPH R
HARLAN S. W A I D 12 5 S. CHESTNUT
M 67 Y
53694 JF. M.D.slIVC. STREET
MEDICARE
1 07
referring physician
F I NAL
ACCESSION NUMBER
U AID
OATE & TIME COLLECTED
3929999
OATE & TIME RECEIVED
2
B
JEFFERSON
OH 4404 7
T CODE
TEST DESCRIPTION
BANOS LYMPHOCYTES ATYPICAL LYMPHOCYTES MONOCYTES EOSINOPHILS (DIFF1 BASOPHILS MISC.CELLS < 0 IF F J RBC MORPHOLOGY
11/10/ 88 1050AM
RESULTS / UNITS
2 10
0 4 0 0 toxic gran: sl. SLIGhT
P3 IKILOCYTOS IS
11 /I (./ F8
11/ 13/88
08 21 PM ______ ______4
0 73 1 A*
NORMAL RANGE
LAB
LOW
HIGH
NUMBER
05 2 G 40
L9 08 05 02
OCCASIONAL TARGET CELLS
SLIGHT ANISOCYTOSIS
OCCASIONAL MACROCYTES
OCCASIONAL POLYCHROME S
5 0628 PLATELET COUNT
326 THOUS/CU MM
140
440
01
56103 PROTHROMBIN TIME
PATIENT VALUE PT COJYIHOL VALUE
17.6 SECONDS 12.7 SECONDS
01
* END OF REPORT * *
(*) RESULT IS ABOVE HIGH NORMAL VALUE (-1 RESULT IS BELOW LOW NORMAL VALUE
LABORATORY DIRECTOR(Sfc c h A RQ
LAS HUMSES MOKATE* LAAMATMT WHEW TUT MWOMKO #1 Souttyait Mtdical Lab
21 tOO Sttutflgati Pk 0M MapH Hu. OH 44137 Mk4r* 436-1101
H.
sifglef.. J!Ldl A
01
GENC 002956
OWNED AND OPERATED *Y SOUTHGATE MEDICAL SERVICES. INC.
SUCCI, JOSEPH
DOB: 9/8/21
WT: 149 lbs. BP: 110/70
'
NOVEMBER 18, 1988
Currently is on Lasix j of 80 mg per day. Aldactone 2 per day. This is from yesterday, the dose was
reduced yesterday by Dr. Waid. Weight is down with medications he is taking. Ascites is less as well.
In the interim, on 9/29 he had a liver biopsy and CT scan, this was not helpful. Following that he had a
minilap with adequate liver biopsy done at the mini lap time. He had considerable degree of bleeding during
the min lap. Verbal report is that he has got angiosarcoma of the liver. His alpha-feto protein was 4.8 or
less. He also has some ascites noted.
Chemistry profile shows that his SGPT is 57, SGOT is 46. Aik phos is 401. Sodium is 132. Bilirubin is 4,2
Protein is 5.3. The rest of the perimeters are satisfactory.
His weight is down with medications. Appetite varies. Some pain in the right upper quddrant at times.
Vomited on Wednesday, that is two days back.
Examination is negative, looks slightly dry. Minimal edema of feet. Abdomen with mild ascites. No obviou:
swelling is noted at present.
ASSESSMENT:
Angiosarcoma of the liver, proved by liver biopsy. Associated ascites, which has responded to the intake
of diuretics. It is best that he is seen at Tertiary Care Center which has expertise in liver transplant. THis
is discussed with him, his wife and his sister. They are in agreement with that. He should aim to keep his
weight somewhere between 150 and 155 lbs, more near 155 lbs, than 150 lbs by reducing the dosage of diuretic
if necessary.
It is to be noted that he had previously worked at a General Tire Company which included exposure to
chemicals of various types, including vinyl chloride, or at assuming including vinyl chloride. I explained to
his wife that they should get in touch with the medical director at the Tire Company and left them know
of the findings that we have on the biopsy,
cc: Dr. Harlen Waid
' V. M."PATEL, M.D.
BENC 002957
Jo 7/
SOUThLGAIfc
1-800-362-8913 fOhiol
MEDICAL LABORATORY SYSTEM - 1-800-338-0166 (Outsid. Ohio)
patient name
lSUCCI* JOSEPH R
H A k L A fy S. Id A I D * 125 S. CHESTNUT
SEX
AGE
,
M 67Y
5 26 94 J K . , h.D.flDC. STREET
BILLING RECIPIENT
patient id.
PATIENT SUMMARY REPORT
HEDI CARE
1 C7 E
REFERRING PHYSICIAN
F I KAL
ACCESSION NUMBER
AID
DATE & TIME COLLECTED
date t time received
3974573
1h
JEFFERSOfc
OH 44047
11/17/8B 0145PM
ii /i 7/ fb C821 FPI
11/ 17/88 100lhh
r CODE
TEST DESCRIPTION
RESULTS / UNITS
remarks: c ALL 9-11 Af, 576-9111
LOW
HIGH
LAB NUMBER
CARfaON DI0XI0E
a b tj O R UAL
R S U L T. JL.
23 KCi/L
0 2 2 4 0 ELECTROLYTEs
SODIUM, SERUM POT ASS IUMV"STRUM CARbOIVi DIOXIDE CHL CRTDE, SERUM ELECTROLYTE BALANCE
_ --_
135 4 .5
23 1 04
8
MEG/L MEG/L
MEG/L M E Gi/ L
4 30
125 3.5
2*t 96
4
145 5.0
30 1 CB
15
01
END OF REPORT
_____ * ---------------
------------- _
-- ------------------
I') RESULT IS ABOVE HIGH NORMAL VALUE <-) RESULT IS BELOW LOW NORMAL VALUE
LABORATORY DIRECTORATE D t, A FO i . SlfGLER, M .0 ^
01
LAI SUMER MOKATEl URMATMV WHIM HIT HUMUKO
*1 2$o1u1t0l0g*SiwMthaoiaicia.Rl kLak6M Map* Hi*. OH 44)37 fttfllDI
6ENC 002958
OWHEO ANO OPERATED BY SOUTHGATE MEDICAL SERVICES, INC.
/o7/i
ITU 1 H13H lT
SOUTHGATE
(2161 681-1030 1-800-362-8913 IQhio)
medical laboratory svsitu.. 1 -800-338-0166 (Outftd* Ohio)
,
sex AOE
BILLING RECIPIENT
PATIENT 1.0.
PATIENT SUMMARY REPORT
*ucc i~,--.'.i(.)StrPH" r
TT
HARL.AN S. WAl'D, JR., M.D.. ,, INC. i 25 S. CHESTNUT STREET
frr- -----H&LmUWiftvtt-PHYsiqitU 0----------
ACCESSlCN'IWpiweri ' I 1 pTRCSE----
rL9
daW* hmi cqcucteo
tDATE TIMC RECEIVED
fZWUttrtbBr oaTE* HmeB
JEFFERSON
T CODE
TEST DESCRIPTION
CH 44(3X17
M3 '>,r ______ 2 'Mr.-..:--
RESULTS / UNITS
(
: l* Z ' i` j i
NORMAL RANGE LOW
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ASHTABULA COUNTY MEDICAL CENTER HISTORY A PHYSICAL
Date of Admission: 12-10-88
Chief Complaint: Semiacute confusion over the last 2-3 days.
History of the Present Illness: This is a 67 year old male who has had a history of angiosarcoma of the liver.. His diagnosis was made about one month ago but he has been suffering from symptoms of this since August. He has had rather a persistent history of nausea and vomiting because of this but he has his good days and bad day and his weight, although it has dropped over a time, has been relatively stable for the last months. For the last couple of days, he has had an Increasing difficulty with hallucinations and confusion. On the night of admission, he was up all night yelling about what he felt to be his impending death and generally disturbing his wife with emotional content of his confusion. In any event, it was because of this confusion that he was admitted for further evaluation and treatment.
Past Medical History: The patient has had a cholecystectomy, appendectomy, lumbar laminectomy and cervical fusion. He also had liver biopsy done.
Social History: The patient is retired. He used to work for General Tire. was exposed through vinyl chloride in his occupation. He is a nonsmoker and used to drink alcohol rarely and does not drink it all now. He lives in Jefferson Township with his wife.
He
Review of Systems: No headache or cold symptoms. No coughing or shortness of breath. He does complain of nausea. There has been some vomiting on one occasion about one week ago. He vomited some blood. This was a small amount and stopped. There has been no diarrhea, hematochezia, or melena. No urinary complaints, except for his urine was rather dark recently.
PHYSICAL EXAMINATION
Vital signs showed a blood pressure at 120/78. Pulse is 80 and regular. Respiratory rate is 16. Afebrile.
HEENT:
Pupils are equal and reactive toJIcjht. Fundi are not well seen. The sclerae ar'e'mildly icteric. The pharynx is unre markable. He does not have any teeth.
Neck:
Without adenopathy, thyromegaly, or carotid bruits.
Chest:
Clear to auscultation
Cardiac:
Regular rhythm with no murmurs or gallops appreciated.
Succi, Joseph R. H.S. Waid, M.D. D: 12-10-88 T: 12-11-88 /rmh
GENC 0029.il
,/j
Sued, Joseph R.
Page 2
Abdomen;
Rectal: Extremities: Neurological:
Impression: Plan:
Recent right upper quadrant scar. Liver edge Is palpable about 3 cm. below the right costal margin and the left lobe is felt as well in the epigastrium. There Is no ascites appreciated at this time. There are no air masses felt.
Hemoccult negative stool. Prostate is small.
Without edema.
Better oriented now than he was earlier this evening. He does not know my name. He does not know the day. He knows where he is at and he knows the name of the president and the president elect. He does have an obvious, quite prominent liver flap. His gait is not examined at this time.
Hepatic encephalopathy.
Treat the patient with Lactulose and Neomycin as well as pro tein restriction. Will continue his Lasix but will not keep him on his Aldactone because his potassium was a little high as wel1.
Harlan S. Waid, M.D.
Sued, Joseph R.
qehc 002?62
H.S. Waid, M.D.
D: 12-10-88 T: 12-11-88 /rmh
/
ASHTABULA COUNTY MEDICAL CENTER DISCHARGE SUMMARY
Admission: 12-10-88
Discharge: 12-14-88
REASON FOR ADMISSION: This 67 year old. white male was admitted because of confusion that was caused by hepatic encephalopathy. He had history of angiosarcoma of the liver. He was admitted to the medical floor, placed on a protein restriction. Lactulose was given frequently until diarrhea was established and then backed off some. He was also given Neomycin orally. These medications helped considerably. His ammonia level was initially 120, with nor mal being 135 and It came down in a couple of days to 46. His confusion cleared considerably. He had a normal mental status, even by the second hospital day. His nausea seemed to subside considerably too. He didn't require much in the line of anti-emetics. Since he was feeling stronger and eating his 40 gram pro tein diet without any difficulty, It was felt that he could be then discharged. He and his wife are making considerations for going to Pittsburgh for an opinion concerning a liver transplant.
LABORATORY AND X-RAY DATA: The patient had blood gases on admission which showed C02 of 30, P02 of 96, PH 7.41. He had an ammonia level of 120. Urinalysis showed a small amount of bilirubin and was otherwise negative. He had white count of 9500 with 74 segs, 6 bands, 17 lymphs. The H&H was 14.3/43.1, normal indices. Platelet count was 275,000. His protime was 15.1 with an APTT of 34.2. Repeat ammonia level was 46. He had a bilirubin of 5.3, a GGTP of 301, AST 45, ALT 50, BUN 20, creatinine 1. Sodium 134, potassium 5.7, chloride 100, C02 16, sugar 91, cholesterol 123, uric acid 5, LDH was 560, alka line phosphatase 307.
DISCHARGE DIAGNOSIS:
1) Hepatic encephalopathy. 2) Angiosarcoma of the liver.
CONDITION ON DISCHARGE: Improved.
DISCHARGE MEDICATION: Aldactone 50 mg once a day, Lasix 40 mg once a day, Lactulose two tbsp. twice a day and an antacid two tbsp. three or four times a
day. Follow up will be arranged in my office in one week. He Is to be on a 40 gram protein, 4 gram sodium diet.
H. Waid, M.D.
SUCCI, JOSEPH
5233309
H.S. Waid, M.D.
11-75-42
D: 12-14-88 T: 12-16-88 /jc
6ENC 00
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Ashtabula County
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1. Discharge Patient. 2. Final Diagnoses _
DISCHARGE ORDER
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6020--1--088 (Rev. 3/87) ATTENDING PHYSICIAN
GEMC 002`?64
ASHTABULA COUNTY MEDICAL CENTER HISTORY & PHYSICAL
CHIEF COMPLAINT: Increasing confusion over last three days
HISTORY OF PRESENT ILLNESS: This Is a 67 year old white male who has a history of angiosarcoma of the liver. He had history of hepatic encephalopathy which required hospitalization about three weeks ago. He had been on Lactulose since this time. Recently started on Neomycin and Increasing dose of Lactulose his confusion seemed a little worse two or three days ago when he was in the office. It was also noted he had more ascites so the Aldactone and Lasix were both increased. Over the last couple of days his confusion has worsened. He has had hypersomnolence. He hasn't been able to awaken until this afternoon today. He feels an unusual feeling In his head and feels very strongly that his encephalo pathy Is coming on again without being created by the medication changes so ultimately needs to be monitored a little more closely especially in regards to his laboratory parameters as well as to have intensive administration of his antiencephalopathic medication.
PAST HISTORY: As noted above he has angiosarcoma diagnosed in mid 1987. There were plans for him to have evaluation for liver transplantation but afraid these plans are never going to come to fruition.
PAST SURGERY: Cholecystectomy, appendectomy, lumbar laminectomy and cervical fusion, also had a liver biopsy done a few months ago.
SOCIAL HISTORY: The patient is retired. He used to work for General Tire, and he was exposed to vinyl chlorides in the course of his employment. He is a nonsmoker and used to drink alcohol rarely and does not drink at all now. He lives in Jefferson township with his wife. He has a large family in the area.
REVIEW OF SYSTEMS: No cold symptoms, shortness of breath, chest pain. He does complain about some nausea but no vomiting. No hematochezia or GI bleeding noted. There has been no edema noted.
PHYSICAL EXAMINATION: elderly male who is in mild to moderate distress due to his malaise and nausea; temperature 96, pulse 70/reg., respiratory 22, blood pressure 106/78
EYES: icterus noted.
PHARYNX:
Pupils are equal and reactive to light. There is scleral
Discs are flat and no retlnopathic changes noted.
/
'
Oral muscosa is dry and edentulous.
NECK:
Without adenopathy or thyromegaly.
CHEST:
Clear to auscultation.
Succi, Joseph H.S. Waid, M.D. D: 1-1-89 T: 01-02-89 /sb
GEMC 002965
CARDIAC:
Regular rate and rhythm. No murmurs or gallops"appreciated.
ABDOMEN:
Soft. Scars noted in the upper and lower abdominal areas.
There is ascites noted. Liver edge Is felt about 2cm. below the xiphoicj, In the
mid sternal line. Spleen Is not palpable.
RECTAL: sma11.
Hemoccult negative. Yellow bowel movement. Prostate quite
EXTREMITIES:
1+ edema.
SKIN:
Spider angiomata and Icterus.
NEUROLOGICAL:
Shows him to have asterixis. His mentation seems rather
sluggish although he does remember where he Is and nows his name and recognizes
me. He does move all four extremities. His speech is clear although content
seems a bit hesitant.
IMPRESSION: Hepatic encephalopathy, angiosarcoma of the liver
PLAN: Monitor closely his laboratory parameters as we treat him, increase doses of Lactulose, Neomycin and keep him on protein restriction
H.Waid,M.D.
Sued, Joseph H.S. Waid, M.D. D: 1-1-89 T: 01-02-89/sb
GEHC 002966
t 7S
ASHTABULA COUNTY MEDICAL CENTER DISCHARGE SUMMARY
Date of Admission: 01/01/89 Date of Discharge: 01/08/89
Reason For Admission: This 67 year male was admitted because of hepatic encephalopathy. He was treated with oral Lactulose and Neomycin at the time of his admission. He showed some improvement on the next day and then showed a sudden deterioration and I found that his dose of Lactulose was not adequate so we increased that and he showed further deterioration and actually became coma tose. We started Lactulose enemas, four times in about a three hour period and also gave him Neomycin enema. This started his bowels working and he started clearing his encephalopathy. He showed gradual improvement at this. He was given IV fluid and he got a little fluid overload. We gave him some Lasix for this and he tolerated this alright. He was actually walking up and down the hallways and was able to take a shower before he went home. He was doing quite well which was a definite change considering his grave outlook a few days before his discharge. In any event, since he was doing fairly well, it was felt that he could be sent home on Lactulose, Neomycin and low protein diet.
Laboratory and Xray Data: The patient had an ammonia level of 82 on admission. It improved to 64 initially and then went up 117. His last one before discharge was down to 37. He had a white count of 11,600 with 72 segs, 1 band, 20 lymphs, 7 monos. H&H was 13.7/41. Normal indices. Platelet count was 266,000. Urinalysis showed a moderate amount of bilirubins, otherwise negative. Protime was 17. APTT was 35.3. His protime did not show much despite repeated doses, although It did go down to 15.5. Urine culture was negative. B-12 level was 1,700. Folate was 12.6. These are both normal. Repeat white count was 10,900. H&H was 13.5/40.2. He had occult blood that was negative in his stool. He did throw up blood before his discharge. This was just a small amount, a couple of tablespoons. He had a sugar of 150, BUN 39, creatinine 1.6. Sodium 132, potassium 4.7, chloride 95, calcium 8.3, albumin 2.1. AST was 40. LDH was 566. Aik. Phos. 262 and bilirubin 12.1 on admission. Repeat sugar was 110. BUN was 51 at the time of discharge. His creatinine was 2.6 at that point. He had a uric acid level of 11.8. LDH was 1,102 with AST bf 95. Cholesterol was 85.
Electrolytes at this time are pending. His last potassium was 4.6, sodium 148 done a couple of days before discharge.
Discharge Diagnoses:
1. Hepatic encephalopathy. , 2. Angiosarcoma'o'f tfte liver'. * 3. Ascites. 4. Mild renal failure. 5. Electrolyte imbalance. 6. Chronic malnutriclan.
7. Upper gastrointestinal bleeding - possible eosphageal varices.
Sued, Joseph H.S. Waid, M.D. D: 01-08-89 T: 01-08-89 /rmh
SEHC 002967
Sued, Joseph
Page 2
Condition on Discharge:
Improved.
Discharge Medication: Neomycin 500 mg. four times a day, Aldactone 50 mg. twice a day, Lasix 80 mg. once a day, multi-vitamin once a day, Lopressor 50 mg. once a day, Tagamet 400 mg. twice a day, Lactulose 60 cc. every four hours while awake or four times a day. He was instructed to stay on a 30 gram protein diet.
Discharge Follow-Up: Will be arranged in my office in five days.
Harlan S. Waid, M.D.
/
Sued, Joseph
GEN*j uutyio
H.S. Waid, M.D.
D: 01-08-89 T: 01-08-89 /rmh
AJ1IC .D
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/ Patient's Signature. / ,^/^ i ..~
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SUCCI,JOSEPH R.
01/01/8S 263S02 09/08/21
0
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--------- -jj.gAS RECORD INFORMATION---------------------------------
b rec no s ijj&TSr42
SOCIAL SEC: 291-16-1SG6
G J , JOSEPHr
birth date: 09/08/21
nm' BRIGGS )^
' sex'* m rS^04T^;;v married
`-iF> NAME:
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miT DATE* iDMJT TIME: JISCH DATE: t&. )ISCH TIME: )OSp; SERVICE pNj CLASS: `
READMIT NO:
904250Q
EPISODE INFORMATION
*.> .. 5233309
AGE: 067
__ ADMIT OX: ' ANGIOSARCOMA/HALLUCINAT
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, WAID JR.,HARLAN
GEHC 002970
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