Document oDXBXkVq0yrbqdkL1mzNmQ7rg

Htanrlnrd Form 6ir> iicv.Jnn PrrraulrilPt By Bureau of tin# }iul);ct Circular A--3-' CLINICAL RECORD SPECIMEN SUBMITTED BY SPECIMEN TISSUE EXAMINATION DATE OBTAINED 0*0 43 --10--814*4- 1 BRIEF CLINICAL HISTORY (Include duration of lesion ond replditf of growth, if a sropiwm) Part of Louisville Mortality Study - see attached records. Clinical diagnoses (1) duodenal ulcer (2) malignant hypertension with uremia. Patient died - no autopsy. PREOPERATIVE DIAGNOSIS OPERATIVE FINDINGS POSTOPERATIVE DIAGNOSIS SIGNATURE AND TITLE PATHOLOGICAL REPORT NAME OP LABORATORY ACCESSION NO(S). Surgical Pathology SectionS74-2538 (Gross drscripttcn, tustclopicelan,motion end diognoui) Gross: One submitted slide bearing number NS-58-1092 sent from Norton Memorial Infirmary. Section identified as vagus nerve (vagotomy Mar 1958). Microscopic: Small fragments of nerve appear normal. Diagnosis: 1. Vagus nerve, no pathologic diagnosis. Louis B. Thomas, M.D. SIGNATURE OF PATHOLOGIST (Continue on reverse aide) \____________________ - Carolyn Lingeman, M.D I AGE 65 W PATIENT'S IDENTIFICATION {For typed or written entries give: Name-l* -.first. middle; grade; date; hoepttal or medical far tty) RACE M REGISTER NO. 00-00-00 DATE 30 January 1975 IDENTIFICATION NO. | WARD NO. TISSUE EXAMINATION ttUuviurtl Form 615 jn-105 BFG67258