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'- /'''* ~ v' /o 'V' ^/Z//jr4' A-' / ,j 4^/ Lt is? i^//y c-6-*--+- & ? o--- A A--?/L ./-^ A- AvJ-----<> -v /t/n-- ^------ ' (CJ> -----A3^-i> c **"* ` 2<--^ ' y |Pfc.C 8 3b X\//m U t> sv\\-l'<&J dL.t < 6'^ . vv/i ^ w ^ -*. L.u(-h f" c`A ' ~~]o ^ ; ^ /' O.-fd^- ic^jCy- C^~ - ^ -c-V--- 4 i 5, .' / d X. 1~ ^ 4 "--------- ' ., ' . - a( 4,-.- '-J GENC 002918 *-< c OUe/-? m. Ashtabula County vif Ic 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 AOF 17542 HAf F ``RFVIOUS NAME 09/03/21 RELIGION Z_ JaL CHURCH 1ALE___J *iAh'K T FT: M2 ENDING PHYSICIAN CODt OTHER PHYSICIAN T JOSEPH SAL LAS5AN0T11 IS CODE PLACE OF BIRTH ItARLAN WATD JR. ^COMPLAINT ___ 57.9 t JARLAN MAID JR. 579 ROOM s BED REGISTRATION DATE TIME PRIMARY INSURANCE L1 'ifJM 1 SECONDARY INSURANCE ft 4 ;53 TERTIARY INSURANCE MEDICARE - IF'T MEDICARE - CMIC 1351 WILLIAM TAFT JINCINNATI OH 45200 GUARANTOR JOSEPH R. SUCCI 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 NONE PHONE GENC 002920 AJ (C Ashtabula County villlc Medical Center 2420 Luke Avenue Ashtabula. Ohio 44004 (2161 998 31 11 ^ i ^ i 1/ PATIENT REGISTRATION FORM jM BY MY ADMISSION NO. 5213194 MED/SOC. SEC. # 291161586 SERV. MED PT, TYPE PUBLISH s NO SOURCE ADMISSION TYPE PHYS EMERGENCY SMOKER? NO PATIENT NAME JEFFERSON P OH 44047 PHONE 216-576-5 124 DATE OF BIRTH AGE 09/O8/21 67 PATIENT INFORMATION MEDICAL RECORD NO SEX 117542 MALE PACE PREVIOUS NAME W MARlTAi STATUS MARRIED FC M2 RELIGION r HURCH CATHOLIC` ST JOSEPH CALLASSANCTIUS PHI V ADM .NDING PHYSICIAN HARLAN WAID JR. CODE 579 OTHER PHYSICIAN HARLAN WAID JR. COUfc PLACE OF BIRTH 579 f COMPLAINT ANAFARCA DX PROC ROOM 6 bED ADMISSION DATE ADM TiML DISCHARGE DATE 413N82 09/08/88 13 :05 HEDIC^lfr^WANCE SECONDARY INSURANCE AETNA/ Al'RQIM----------------------------- TERTIARY INSURANCE MEDICARE - CMIC AETNA 1351 WILLIAM TAFT 3328 W. MARKET ST. CINCINNATI OH 45286 AKRON OH 44313 2911615B6A 291161586 JOSEPH R. ouce?UARANTOR --397481 GUARANTOR EMPLOYER & OCCUPATION 1767 GRIGGS RD. JEFFERSON OH 44847 )NE: (216) 576-5124 ATIONSHIP TO PATIENT: SELF -IAL SECURITY NO 291161586 NONE PHONE. ( GENC 002921 |;jk <- > jfc'i k'A co l ^AB0RA1 'WAKE A9E jtfWUUY---|M004 DR - itones - iQ1* ........; r- iyXAB NO ,'?DATt coi LEcrco 195026 `"time coliecteS)9/08/1; ^ PATE ENTEHFD 14 s 05 !?*' : ' 2 ^-J-fOA^ETPEORRrESPTOATBUTSEQD90/ 91/409/_/58_^_8_; PAGE -ia' tr-i . itr. &> S*#j, A' h'..\ - y;^s'v^6 ,a- % ;V*v> r,r fina4: t: *$0909090788 ;; ,,_luLr ' ooJJtt ooff rraannggee 1 " x,,M'JtjSaPiSF^*' RSLH,T: (OR INTERPRETATION) ^ ^ ^ *1'i\aV''-<- ^' >w "J RtFERENCE ,SA V' RANGE pSA-TITIS Bi m ACC co *BGRA1 AVEf P4^004 ' DR r^r"T~ ^LKfMNE F'Ht i " li k Phos ^ f'A'vv . j k a I i it e P `W~SC'r-^ :t P ` 'L IBOoTCB NdN^^TgCTEQ^SSKSS #&*> :^" -e . -SU fiH&Ut i SmithKIine Bio-Science Lbboratoli^w lai $ skblT JXltrlW 1 , 0ft, V V 1.,. 1 ` , /r-T , .C'`';,` -- '' LAB NO. -; oate collected j. 95033 ' TlMECOLL-CTE^9/09/gQ DATE ENTERED PAGE 8SWf ':: -& /:! ,M v C`.`REPORT STAUJSQ9/ 14/88 FINAL .880909090848 4' - 9 -C ., , . . - .*?1 .`0* S` * E -vT '*' Mr' : ^ '5';'*..' V! ' REJUl.T OUT OF RANGE (OR IN TERPRETA FION) units? c ;. REFERENCE RANGE ^ 39&'t;m3 u/l'- #? ' . -9- /=A (2oi40) ^ >0 v-V$ ^6^!3p|||^pQENZYMe`' REsSseEwMEBLES .Ti*ILlVLR- ^ , s:w.: 400 , U/L (20-140) ' *h'* Hi ; ;2C. "'.V:'1' 4.-- tT i- . SL2 a* SCRS^-j iv'GT m K=Z 'TV,, . W^V^ vTfe:-9& v st-rFr*1*.4; ** M ...........,, hm: --rfwMi k-.fr %X'~: iz?: .Vii. -.. . "i ' jjL. ' ,.5 " r,''` , v'2/i '"' f/tf-r1 b;-` > f1 -Pi-?--> 't8^. <41? -i ^ i'"1-; 'M*. '/ ' IP, A - <- '*' c -/A^arj .' ?. -m^4 - .f f5, GENu 002922 &x- *\ < * 'f * mm*-* fO^TY EmCAL CENTER ^ 1^' , LilBORATOr *, '* 4 ;' 4s* io~tf} - 'tV - 1 rtW# , * r*i 41'-'- \ i l *\ fS'iniP 1 e ID J &/ ^DIUM &1U& 1L OR I DE ftSBOfeLJU ^iftNION OAP M3194;, -'"" - :LO Pluid: SERUM n- 8 IR* 5. Vl 1_L^ s mrrio 1 /L 1,4.. ''99. mmol /l. _. , , *,*' T,#fc*...^ . . 818. mmol/L bK2SL' __ ______ ,, r... .-. ^?; - ,,,, ,-fkg -.,.,... Jh*Az i" j/^---:/'(, j;,, * ^ .-*- > .. - -ii- t-*JL V :fW$& * --i-- > -*^- ..___________ ` Priority2 ROUT I :? ., SBjt",',..- , v- -X-* 135. - 143. -.v ` 'V 101 ,, 10. - 11 1 - " Ci \ ' <%2| ,^4.'arV tOT __ - 19* ' v> 2S&3L J2&: Jia ^j&tVv- v**, A4?, AriZmll ' ` m ?&& $^r` ^'Hv Av 4 m:L^m '> klv 4,mii&i*ii'!k. 1. &-*4&ai]i^,&' Ifc- '- iVflb *'%K g`->v* rH\?f ' ^f' `**& --f=i ^H}"l'8w< 'U/?. * %'\\':y-`f- .H* , S r\ -n^i "if/'V'^r *V - -- jf ",js' i . K- > %i' ' GENC 00 I1? 25 ' 'bsit- ' ASHTABULA COUNTY MEDICAL CENTER N: '' PATHOLOGY CONSULTATION X-J1 L jj SUCCi;rv^feph 67 M 9/8/21 521319-,4'413-N hW r, ' , \ J-r s|fe i JVfft; ,4- -<V MS tiver Met s ' "*nv oiagnow*"^ W^l^ver, Biopay - Aspiration AND *IT( krm*TM 0,AWO,iM^:.." UV 4t[. \& ' ' J OIAtOW: ' f Liv< ACTIVE- PP4T0CYTE$t NEGATIVE FOR MALIGNANT .y-vt.. "' -' -Vr L, "' '$: 'Iff, - ;- .y% * - .;Wfe*v - ;y ;:r ./ ' A-' > , V' ' 'rv*i -J. &Sy^n0C.. JL "M- \ . ' > ,i5'%$<*i<-;iv S' ' , ' J'iv-Sj-'f-E- i.-R's* ifey'*.1' -: ........................ t^n ^oniaio^r"^abated #1, . in formalin am* marked "A", are . Vi> 7j|Jw 1_1 Submit K?UndricUy shaped brown tlss"? *5 *Sb- mult|| raeasui tea o*,,: la; length ?,0..l in cross. amet^,Totally sub mitte< m^Vvs^v^f/' ?*}" '' ' r** 'r'-sfrv- >S\-' ' ' -ladled #3; submitted 'inynlin & marked . L1' ' ^viifodricaTly shaped blood clot measuring^15 cm. in ^PS? in^F08s diameter. Totally subm|f$ed, V'-U ?* t, fiSfe..- ' ' 'V'-l '1 DAVID A. FLOEHII^Q, M.D -i* - ii-F. PATHOLOGY consultation -. :- . .'. V GENC 00' i?24 > . ..-v 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 5 ACMC/pf SI" VESQ NO u. 1zu-l 67 M 9/8/21, PREVIOUS OPERATION YC*l-i--Ji N,, L|--I I cyEtology vfsQ no H 9 tz-u 521319--4 (413-N) 1- 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 /O 7 S' 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 6020--1-088 (Rv. 3/87) ATTENDING physician ;e LaDu.aiuriv* /pjy A* 195030 date collected 7/tfa TIME COLLECTED V. DA}E ENTERED Q,?n7/Q,, da|EREportEd09/20/88 W'>- REPO' RT STATUSF-INAU . 880"? 1709026V #;.r 32t3(.J?4 : &v, PAGE hi K'jgl SI r '* flUT OF RANGE (OR INTERPRETATION) w . -z*y&,'! NO/ML: >v SmithKliheE^-Science Labi>ratf?i^^" REFERENCE RANGE " 7\ <0.0-8.4) 1011) -* - ^ %V --m SKBL . ..ll 195050 ij>9/17/88 r; i1 J09/17/38 a"/89 tMf'M; 1060917090269 ; //\/ -s:. RESUljP" OUT OF RANGE ' RtbUUf/;. (OR INTERPRETATION) reference RANGE i -'tv' "IaT! ,i-A 48$ fe>-. V'-V'.'ttA vVd^'As.''' :r 4** .f ;>r - iA'../.tW'..a -f- is - :-r. )v ^^..iT^'^453PsSETeLrji;^S^'^?^vrt^ ji' *71^ ~ ~ . ...= .V.. ---A.- fi.i.A.A..S..u -,',--- ...... ..if. -tv ..?;,. . UUIUIIJI _____ ^' . ` .... ~.............................................."' ` ~..r,,.-. .. li .. >.,............ :.: , ` '- . ^- . -> ( .;,,.*-T if- -,:t !*& /`"I-siV'1-' ^ 'T j.'AtV7 ' > v *->%' <.>1-v.. .-V,;c *. m T . . 7TTT*-. . '; ' *;stis3t. AJf >-W4PS -'Vf - -PS! Vf K5S.. ::^s^^:,,,, ,7. _.- .`'MSjSiiwttS""`-9- GENC 002944 . '. *Ti3iv , 7 \f 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 -I A n L A 1 2 o 5. w I0t C h t" S TIVJ T jF * `ji f i rJ c - 5 T 3GT .'VO SOUTHCJA1L 1-800-362-8913 (Ohio! iedical laboratory SYSTEM - 1 -800-338 -0166 (Outside Ohio) SILLING RECIPIENT PATIENT 1 0 PATIENT summary report Y uICak _________ ^ REFERRING PHYSICIAN _ PRtLLIfY I\URY ACCESSION NUMBER PAGE *i A I [: PATE & TIME COLLECTED DATE & TIME RECEIVED 3646263 1 report date 4 Time & J rp F hS OiU jH OJW rcooe TEST DESCRIPTION A tt M 0 R SLJCOSl iLRU1! SODIUM SECiU" t:l nubiv,tot;l S G T ( T K A iM A ^ I \J j " ) SCOT (TRAiviSAYlVASSJ AL*Ai_!.YlE FHCSPhTmSL 3/2 3/ h 3 135 RESULTS / UNITS "* " L 1 62 1 52 24 7b r. i 4 ?2 vi G / J Ye L/L YC-/2l. J/L J/L J/ L 3/22/ HK 0723P6 --------------------------r------------- ^ -- 5/24 /J36 J 5-3 0 A?* HIGH LAB NUMBER 32: jh2L UOCOSt I S l ( 0 "t scDiup, glkuy P 2 T a s $ I 0 1 , SCf-UiCnL CO IDE* $ R Li "i CARH0i\ jICXIOG nLDOD uR C A \j X T R 0 G ^ i\J bo V C-EATU'IVEj, S-U U R I C A CT IT* STRUM n I L : R Uh I \| T 0 T A L SGPT OTRA'VSA^lAiASr ) scot _t fifths a* :v as: j ALbALlNt PhGSPHATAS:. Ll/6 <LACTAT DbYUA0G,,) C hC LTSTTYOL ~ Tf- I GL YCER IDES CALCIUHT'STRU'-1 PHOCPnOKUS. I !'/0 K j A !\i 1 2 IRON, "SERUY PfOTMAJi TOTAl- S Lh U4 B Ui`ii f S i R U ^ GLOrULI'M A C"5 uKr'JYGIO E J L I X RATIO ELfCInOLYTE b A l A iV C f. bJM/Fc:TrSTT,'T!\;E PATIO $ 31: o BIOFsYVGRDGS/'UCAO *i r1.2T * L. 1JV I- 3 13 l .1 5.1 j. 73 j1 4 52 143 132 b6 9 .3 i_ * " 4 bTJ . 1J3j 2 -5 1 .7 / 4 .5 <> L / G . "i'll./ L i L / L 4 F l / l *ll/L yG/LL *G/ L) L | G / 2 L , G / L' L j/L U/ L J/L J/L v. G / : L YG/C L YG/Cl p o /: l JS/GL 5 / Ll 3/GL j / jL r GT IM PTGGf-LGS A A \i j 3 F ilLFGFl 8b 1 3m C*3 9b 24 12 .7 2.2iO. 0 0 40 60 99 3C 6.5 2.5 *- u t> * G 3.0 1.5 .8 4 6.a 125 145 5.0 1 08 30 26 1 .7 7.7 1 .2 45 *I 1 55 2 uU 2 40 1 73 1J *0 4.5 1 81 b .5 j .o 3 .b 2.2 15 2 5.0 01 ---- ------- I*) RESULT IS ABOVE HIGH NORMAL VALUE (-) RESULT IS BELOW LOW NORMAL VALUE 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 E- SIGLlP H.3. Cl" 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 LAG DUMBER *"**" ...... A 8 N 0 !< i'AFPON DIOXIDE "tj. riTJDnnj^Tinrwrrri-i niji i ct r i m r n:; .. i i- i: i: An he Hto^rrcrTT^Eca; PUJM. SERUM P; ir JSPHQRUS , I MORGAN I C i :htte bl oop -"n 1 i'ThM CORPUSCULAR ''cunt VOL un: :'U T.NPNTFP I'!1"! I'TTTit'j'i UFA i /Hi-HOCYTEC M i3 __ + + 4-4- + + + + -- L REL U T0 : 4 HF. i '7. UP. ( ; I . A. M-1 i 4 7 7 >7q ni U. r ME T-! I < f T';-;r -'c r i i ih cubv i-i o i. T A : i i0 j - * *-* 3 - -iS <, 07 3L -- 70 '`Cl " "1!rl,^rJrrhr4" ,] j ^ i, 0 S-: :*0 TO ,T ;22fj9 . LMAC ---- - , , , - - - - - - " *" ................................................................. "........................... "---- 0) IJCOSE ," SERUM SODIUM. SERUM ROT ASSIUM, SERUM r : ll.. OR IDE, CLGUJM CARBON DIOXIDE L GOOD UREA NR' FC-'ICN LU 4 CPC ATT NINE, SERUMURIC ACID, SERUM B 11,1 RUE IN ' TOTAL SORT (TRANGAMTU V'"" 1 GCir (TPAMSAM I NnOiF A! i ALIN!'' PIHJERI 1 AT. A'-i ' i. EH (LACTATE DEHYDRQG.i i i lOLESTERO'.. 'PI GLYCERIDES 'Ai C IUM ,, SERUM PHOSPHORUS, INORGANIC IRON, SERUM FT-.OTE IN , TOTAL- SERUM AL PI IMIN.SFR1 IM OLPBULIW' Ai. RUMI N/RL.OBUL 1N RAT 10 E L. ECTROLYTE BALANCE PUN/CREATINIME RATI0 kv i 'C/l : r i'; pi `' c ' I : :;A.nOA!;.' A J.4 UFO :.. + f ` i. P Di i iV Fpoorr 34 nr rrorT ftp MM PPOSFTT-F rr. ffocrfs'" 4*4* ________ `i'-'O R ' . __ IN FFOGHEG\ 1 ! 0 MC- Db ___ 99 MG/LA. "M? ilO PL. "1- ^,, 7 M(3''0L *w;! ji'i 'J'.: i.4 3/Dl _______ "NMi C-"-l G -'LL IN FTC&REBS 20, S "" J.32G PLATELET COUNT 3 13 THOLL.'C'J .MM . J'-l'iS- CSC WITH DIFF______________ X* * Y f "r * COMPLETE BLOOD COUNT 7" TcT 0i 9,:- J M' ; ; 70 10 '1L I '0 ( '3f7s 3~7 " ; ;t 6.0 !.7 6.0 14 C LUG 2.4 0 i" 7S L3[ 4,,2 ; {'\ V 0.7 3.6 25.0 4 10 J ! 01 i t 1 UHLTE BLOOD CELL FCUi'-T PnC BLOOD CEIL COUNT HEMOGLOBIN . i:U-:A.DXRIT..- .......... .. MEAN CORPUSCULAR TOL LiMi : rib AN CORPUSCULAR HSB __ MEAN CORP. HGB, CONCEN DIFFERENTIAL 4- U . 0 i-'SUS CU MM <\ . A'"7 '! 3! ! . . Cl i MM 4 . i 4 i ib J. JL ... . + A ........ ?H CL ijt i. C or'-- 31. C UU L-!________________ j. ^ ' 7 4.C: 4.3 0 14.0 7?.0 GO ''5.4 73 0 11.0 L , .3.0 i7.S 57.0 '4 7r.6 10,0 01 % .1 \ *J SEGMENTED NEUI R(TP(! i i.C 4- 7n V 3 0 70 01 <M RESULT IS ABOVE HIGH NORMAL VALUE (-) RESULT IS BELOW LOW NORMAL VALUE "LAB0RATORY DIRECTOR(S) t--mtwtwwwntr^iM--iSinu 1 MHIMkpIMkMlMmUft.lM HMwNRM. OMH MIftIU t. HXfc;UU&t< n-U* GENC 002959 OWNtt ANO 0P1AATT0 Y 60UTH0ATA . 01 ; . bo /<r 4- f#Vi .-,*#>4 "'i''xv-?v' -'c -Jps?; ' SCXJTHGWlTE : \Mime*'l"' i onbra'irV7"*^t m . 1 *00 334-01M {OuUk* OMo) HARLAft 125 JEFFEF 't<s3ty Ifc ^4047$r 12/30/88 h ^ c; H&*" - '**.. 1 /03/8^^#l i-- 1% fm- h--~ 1 L "v; ^:,,''5^ V1 0% V3v;'-? ' = ' AT Y PtfSISiLVMPlrtDfiYTEB'. " & 1 : 'l l ^ "f- ' ^ HUEOS IlHI Ift&'ItB'lFF-} X ^ t- 7f--f 1 T" "^T5T!!^r jV.v "' 11- ' < "5;vX *. 0 20 0 0 00 5 40 9 ~ET 5 y fljf n IF- KEKENT! AL'' " 1 . M1SC.EEL& <DIFF) ` ? if "R^mppPiOLOGY i' *rj'' :"' Tisr-- ** fn"' 1 7 1 V' ----f? -If-- :-*T ''J^V7' "'V^'vV ` * fc 'H ^ AN ISOCYTOSIS ' " '>: sl I gRt /.J_________ F0IKILQCYT0SX8 ,xH________ l~FnUYCHRQhF5 Mfl MACROCYTES :mm________ target cells_______ :_ ______________ /______ ---- .. ft aX- " " ** END OF REPORT"f-* ^'W mhr>?'-vv.^'. - -T." \ F3J .il 41' lw r# ^s| $jjf in "WPS. 1 ^8} ' '* s / ' H '%^ ^ ' " ' ` X'X L :jH jure. i.zi;.. *' -- ''awL., . --------' ..", h 3Tt '1 1, i ,1 Vj.'X'X1, l -_--j- J_ i* *' -., .':-,VurS;^L-Js "A */ :Bkm .1- - `Mfwpflfe ""; -v.. . 7 Spflj Vv:' Xi'ii ^;v / > ' y:l-*'ij-i'-, * ! 1 - %'*- >'},( ^' ' 8F'^ KfrWr-`' V;'' SI X I : ' ^ j " p<ij!^i.i X,( i=^A>' ^ "' r--^ ' y1 r* 7<-. ';%? ' :;,. ` bM*!#" V, ' .... -tJ ' " ''^1 `"V'L7 1 c-v ' - i, . X" ---------- Sotr^'TM--"--1--1--""----* * 1 LI j|;., .: #. ft t SMBLAfl0WAT0RY'D|RECTOR(8) '"" yi-h* ' . I. -* .-> a ^^V:!'*f^-/` t /6 7/ 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 AjIlC Ashtabula County Ivl||C Medical Center ^ate.J Q- 1. Discharge Patient. 2. Final Diagnoses _ DISCHARGE ORDER / / /? 3. Condition- . or summary to be dictated. Home - Going Instructions tlA1. Diet- 2. Activities Gi/i * AX f\ [^/(c( l 1j----- - 3. Medications -* J V V ( v/ J -- ~) `> '/ _^___-------------- ----- (j "* ) U---v -'/LA L*a i. ' / f <- 1 / j #"*- Q_ 2 T /' /" ' ~r --7 .V, 4. Follow-up Visit. L iUL I l Please have patient call doctor's office for an appointment. 5. Other Instructions (include Follow-up studies)--_______ _--.-------------- ----- J IC `if I have received a copy of the home-going instructions and understood the explanation given to me. Patient's Signature, / C' '>/&&/ yUH-'ty V V I. `y.'// / /? /( -fo,7?'v 6 - -yOC' ; ? >, ' 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 O m Asmabula County Medical Center / /&/g'7 >ate 1. Discharge Patient. 2. Final Diagnoses__ o DISCHARGE ORDER / r\ Jc 7^ _____________________________________________ ___ or summary to be dictated 3. Condition----------------------------------------------------------- Home - Going Instructions mat 3 ^ ^0 ^ /) /L j ^4 '--f- >- Activitl** MAdifiAtiAni Au 7 PaA.yt.v rJ~_r $ V- A /.Av . f-^4. Y"i--1 M -r C.1 dc<L, --------- ----------------*-- ------- --------------------------:---------------------- f i r. \v' c/*--. -----------^--------------------------------------- 7 ^ La i '/`-v ^is 0 o^ ^ ^- (s Follow-up Visit %S~ Please have patient call doctor's office for an appointment. 5. Other Instructions (include Foliow-up studies) / C' >/Cl.v. =. J /y I have received a copy of the home-going instructions and understood the explanation given to me. ***' / Patient's Signature. / ,^/^ i ..~ -- /U' (.Mu ^--. 5b3-a A C*. SUCCI,JOSEPH R. 01/01/8S 263S02 09/08/21 0 / I ' 6? M WAID *'R.,HARLAtf >3 ; 5231381 i^saz 6020--1--08# (Rn. 3/87) ATTENDING PHYSICIAN GENC 002969 I&gaww rjQf U ,30 QR-' L! : : -^BIRT* Pf> *:- " '<0y-v-..': ' ' ` +'" " six I M Mi4&047 -*1' ' MARRIED RtADWi'i :'Vj : 'iS., it JM.1/1 . j S^I^DD&'.j XHFORM^ON -~-- riL<'i**j\ysF*+: 7e <i25<>8 "`r,,%':'`^r-*" p^^;Ts213r^' i ASL:\>67 m ; * .............. . V- SEP i s ' &BT: ;fDMIT DR t 'V':' ATtND m '' 579 WAID JR . , i ii'H'-i'iN 579 #}! 0 j) > . ,i li-!.kiL.AN ' (m* ; , [;?,/.-< M A 8 T E R PATIENT INDEA1 A ;v S0> 1 --------- -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: 'ATIENT ACCT 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 (tytiv - ' DR: ' 579 * WAID JR..HARLAN tT 579 WAID JR.,HARLAN *V->,V: '* '- -r*V I'l H P1 U C A r*-* ^'\rY>'F7%75 ' - -A ; -r\-'V'- *,vH` .y A JE|NO* 11 I.Joseph " GRIGGS R| pRSON tNAME * ENT ACCT DATE: ) SjgT TIME; 1DATE: TIME: 0^ ^SERVICE: /GLASS: M' -VT*'- -tffi '.SEX |IJH V.+vi ^ 9042508 3P0^lJgORMAT|ON -i<V 5231987 ; . ApMIT'HX:-' '* AGE: 067 ^ r.jHEPATXC" ENCEPHALOPATHY Li>i: l ' ' "" .J. V ; '44V:t 1 dr* 579 JAN 8 t989 WAID JR..HARLAN [TTND DR? 579 , WAID JR.,HARLAN GEHC 002970 . "l* -.-i "'V ' Aim:' '7 s ".*/. .' ;''4.SP. ,.'V451#I