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UTH ISRAEL HOSPITAL
Pi*ol. Nw Jn*y
CONSULTATION RECORD
PATIENT IDENTIFICATION
Name
Mer ic, Joseph
Hospital No.
27*697
Doctor
Dr. 0. Gonzales
tlati of Admission 3/13/84
CQMltinr ScJrM>r Pbr*JU
5. Goel , M,0.
fapwt wqantnl wyrdlf A liver blOpSV.
DO* f lUewrt--lZIlZSl
CONSULTATION REPORT
taatadai Fladi&fi - riwni1,tiM -- PIif!
SiC*tvr f atuodinr phyMrim
Thank ygy-VT.y much for the consultation.
Hats* _ _!/19/84
This 6S year old man was admitted on 3/13/84, with complaints of Increasing
weakness, loss of weight, anorexia. On examination, he was found to have an enlarged liver, and he was workedup to have wiltlple defects In the liver, and was adnltted for further workup.
After admission, he underwent a GI series that reveeled duodenal deformity,
because of the ulcer. In the posterior wall of the bulb. He was also scheduled
to have a barium enema which could not be successfully comoleted, and after that
he had a GI consultation with Dr. Ruben wh o did a colonoscopy and revealed
no other abnormality of the colon. He underwent e CT-scan of the abdomen showing
ultlole lesions of the liver with a Urge mass In the center, the liver had multiple other messes consistent with metastatic disease.
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Lab work showed highly elevated alk. phos, and elevation of LDH with a
bilirubin of 2.2. He has been seen by Dr. Uhm for oncoloqy consultation, *'
and the possibility of anolosarcoma of the liver, because of exposure to
chemicals has been considered. Because of the multlole lesions of the liver,
and no primary node, he 1$ scheduled for a laparotomy and liver biopsy.
On examination, patient is well built healthy mani neck no masses, abdanen soft, nontender, liver Is enlarged. Extremltles-no varicosities.
WORKING DIAGNOSIS: Multiple defects In the liver, possible metasatle disease.
PLAN: Exploratory laparotomy and liver biopsy.
BETH ISRAEL HOSPITAL CERTIFIED PHOTOCOPY
GOEL, M.D.
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0PEBAT1VE REPORT
Date of Operation: J-20-84
PRE-OP DIAGNOSIS:
HEPATOMEGALY WITH MULTIPLE MASSES IN THE LIVER.
POSSIBLE METASTATIC DISEASE. - POSSIBLE ANGIOSARCOMA*
POST-OP DIAGNOSIS8 HEPATOMEGALY WITH MULTIPLE LOBULAR MASSES. PROZER SECTION PINAL REPORT PENDING.
SURGEON DR. COEL
ESTIMATED B
LOSS;
ASSISTANT DR. BAPXNEEDU f-VA
ANESTHETIST GENERAL
OPERATIONr
___ EXPLORATORY LAPAROTOMY. LIVER BIOPSY.
BINDING
On exploration. the patient u found to have * hug*
uialv* heptoMtilr Md tba liver vai dlffuMly purplish, raddleh In color.
The liver had --ltlpla for--d lobulations of a--11 and Large alaa which war*
not vary wall delineated and --rglng with llvor tlaaust* Tba aurfaca of the
liver was also lobuletod In placsa whara Chars vara -- dlscrata noduloa aa
usually aaon In --taatatlc dlaaaea. Tha oweat-- and.colon vae adherent to Cha
undaraurface of tha llvar with vascular adhaalona. There was no groaa
abnor--llty found In the abdoaon.
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OPERA1TTTIVE P_R__O_C_E_D__U_R_E_ After the a--athoala. tha abdo--n vaa painted, preperodtoid ,The right pare--dUn lacleloo waa --da and deep--ad. Tha antarlor
'ilMMb --a laclead and tha rent-- --acla waa ratractad laterally and tha
;V;-` ^t''#po*attarxtoio*r racloa anhaaaatnh aimnd parlitooooaauua* wara opeaneod, fThere vaa found to ha
V C `Wttaawr ctoolloorsppd fluid laththea paorltoaaal cavity* IItt--vana found that the on--tun
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*M#dfcrewt Bpo| Rha l$ivvwwrry>iitthb panxlivaacpla* adhaalona which wars laft Intact. -- * -
of!4Jm and--aa wpa anplorad and tha ato--ch, duodaoou. paacraaa and J4''and"U^aW--l.--ri Rtaeod and found' to hero da froaa ohnor--llty
H' h. th- a--11 hphtl and tha cacua to tha ` ` mu laaloua la the colon or a--11
^hpRdad.,--axpe--ra ojf the llvar vaa palpable
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UNIVERSITY OF MEDICINE AND DENTISTRY OF NEW JERSEY
UNIVERSITY HOSPITAL
100 BERGEN STREET NEWARK. N. I 07103
SURGICAL PATHOLOGY REPORT
Page 1 of 2
Nim* 1enice. Joseph
Sur Path.no. C086-2331
1 Dr. Bodas
Lccattowflef.h Israel H*t-Wa-
Cat* Sptc. Rac'd
3-29-86
0a rt ftapon 3-29-66
cw*Dau R/0 Angiosarcoma of Liver
Mat**o<snMifmn Liver Biopsies: Slide* for Consultation (86a918 A&B)
*ataiara 0--cipto
CROSS: Received arc two elides for consultation, 84*918 A<\R, from Beth Israel, Passaic, N.J., with two blank slides for each.
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DIAGNOSIS: A) Angiosarcoma of liver with moderate chronic inflammatlon, and focal ground glata hepatocytic
change and glycogen nuclei, clinically fron wedge biopsy
B) Reactive changes with fatty change, focal hepatocytic and kupffer cell dysplasia, focal sinusoidal dilatation and hepatocytic ground glass change and glycogen nuclei in liver,
consistent with vinyl-chloride exposure, clinically from wedge biopsy.
NOTE:
The pathological lesions noted in B are typical for those reported in individuals exposed to vinylchloride except for the fatty change and glycogen nuclei. These latter could represent the effect of recent starvation and/or diabetes aellitua. One aspect of vinyl chloride-induced liver injury not seen in this section, however, la the presence of portal fibrosis and portal vein sclerosis which is usually found in more than 30% of the reported cases and has been responsible for a pre-sinusodial type of portal hypertension associated with pronounced
splenomegaly. To eliminate the possibility that the ground-glass or induction type change of the hepstocytes was due to an undiagnosed chronic Hepatitis B virus infection, a Shikata aldehyde fuchsin stain was performed which
was negative.
TUMOS MfGtSTMV VCSNO_____
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Ul.ril ISRAEL HOSPITAL PASSAIC. Nj
CONSENT FOR OPERAI l\ K AND DIAGNOSTIC PROCFDl RF
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Time
______
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l. I hereby authorize Doctor
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and whomever he may designate as hi* associate* and/or
assistant* to perform upon undersigned patieni the following operative and/or diagnostic procedures):
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b. My physician has explained, and I understand the nature of the above-listed procedure)si. including its/their purpose, consequences risks and poaaible alternatives
c Supplemental Information_______ _ ...
.... _______ ___ __
2. I understand that during the course of the procedural si unforeseen conditions may become apparent which require an ex tension of the original procedure)*) or different procedures) from that described above I therefore authorise my physi cian. hia aaaociatesand/or asaistams to perform such surgical procedures as they, in the exercise of their professional judg ment, deem necesaary and desirable.
3. In addition to the risk* and consequences of which I have been made aware as noted above. 1 have also been informed that there are other risks which are inherent in the performance of any surgical or anesthetic procedure. I am aware (hat the practice of medicine and surgery is not an exact science and I acknowledge that no guarantees have been made to me about the results of the operation or procedure)si which 1 have authorised
4 ! authorise my physician and Beth Israel Hospital either to preserve for scientific or teaching purposes or for use in the treatment of other living persona, or to dispose ot any tissues tx*ly parts or organs removed as a necessary part of my care,
except as noted her*:
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I request and authorise the administration of a transfusion of blood and blood components to me as necessary during my procedure)i) and such additional transfusion* as may he deemed advisable in the judgment of my physician, hn asancisiet and/of aaslslanta My doctor has explained to me that tranjfuuona of blood and blond components are not always sue* cewful In producing a desirable result and that there is a possibility of ill effects from transfusions, such as the transmission of infectious hepatitis or other disease, blood impairments or untoward blood reaction*. I understand that the blood sup plied la ItifHrstfi to the rawtttioo of medical services and that no guarantee or warranty ot fitness or quality shall apply.
I cooaeol to having photographs taken of me by a photographer selected and approved by Beth Israel Hospital for the pur pose of advanrii* medical educaoae. I also consent to the use and publication of such photographs, in whole or in pan. at the iHernikai of the hospital I hereby release the hospital, its personnel and any other persons participating in my care from all liability which may arias from the taking, use or publication of such photographs
1 have had sufficient opportunity to diacuaa my condition and treatment with my physician, hi* associates and/or aaahlwiu. I behrw ttwi I have adequate knowledge upon which to base an informed consent to the proposed proredurr|tl
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The anesthesiologist has explained to me the nature ot these arithmetics the rvtuie of administration, their usual effects and
the following risks attendant on their use, as follows.
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RESPIRATORY THERAPY DEPARTMENT
TREATMENT RECORD
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DIAGNOSIS. MEDICATION.
.MIVTION RATIO AIO CONC CF CAT.
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DURATION OF A TREATMENT,
.TIMES PER OAY.
THERAPEUTIC OBJECTIVES____
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