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From jtgr...@apache.org
Subject svn commit: r1585156 [6/13] - in /ctakes/sandbox: ./ CollapsableDendrogram/ CollapsableDendrogram/d3/ Data/ Dendrogram/ NodeLinkTree/ ZoomablePack/
Date Sat, 05 Apr 2014 18:32:43 GMT
Added: ctakes/sandbox/Data/GenSurg_ColonCancer_1.rtf.xml
URL: http://svn.apache.org/viewvc/ctakes/sandbox/Data/GenSurg_ColonCancer_1.rtf.xml?rev=1585156&view=auto
==============================================================================
--- ctakes/sandbox/Data/GenSurg_ColonCancer_1.rtf.xml (added)
+++ ctakes/sandbox/Data/GenSurg_ColonCancer_1.rtf.xml Sat Apr  5 18:32:42 2014
@@ -0,0 +1,18034 @@
+<?xml version="1.0" encoding="UTF-8"?><CAS version="2">
+    <uima.cas.Sofa _indexed="0" _id="3" sofaNum="1" sofaID="_InitialView" mimeType="text" sofaString="Case description for C-Takes documenting:&#10;Setting: Case Report.&#10;Specialty: General Surgery, Colorectal. &#10;Note detail level (1-5): 5.&#10;Level of abbreviation (Low/Medium/High): Low.&#10;&#10;HPI/CC: Mrs. X is a 63 yo caucasian woman who presented to General Surgery on referral from Gastroenterology. Patient had had a 1 year history of change in stool caliber and bright red blood on wiping. She also had reported increased stool 2-3 times per day. Patient finally sought care on 2 Febuary at which point GI did a colonoscopy and discovered a near obstructing sigmoid mass seen at 18cm. A biopsy was taken at that time. A CT scan was also conducted that day. General Surgery admitted her that evening. CT scan revealed an approximately 7 cm segment of significant distal sigmoid wall thickening and mass with mild associated pericolonic fat stranding with possible extension into t
 he proximal rectum. Loss of fat plane between uterus and proximal end of the sigmoid mass and thickening adjacent to the superior aspect of the uterus was also noted. This resulted in an inability to exclude a contiguous involvement of the uterus. There was no evidence of metastatic disease by CT. Biopsy results indicated a moderately differentiated invasive adenocarcinoma. Patient was then scheduled for the OR on Friday for a low anterior resection with a primary diagnosis of near obstructing sigmoid mass. She received two doses of 5000U of prophylactic heparin and was NPO after midnight on IV fluid hydration.&#10;&#10;In the OR a diverting loop ileostomy and lysis of adhesions was performed. The lesion expected was discovered and the diagnosis remained the same. The procedure was uncomplicated except by leakage at the re-anastomsis upon diagnostic inflation. The mass extended into the proximal rectum and so not enough tissue remained for a second re-anastomosis. As a result, the D
 LI was performed as a temporary measure to stay in place until adjuvant therapy is completed. A JP drain was placed.&#10;&#10;Her post operative course was uncomplicated. On POD#1 she received sips and chips and maintained an unremarkable ROS. She was switched to 30mg of Lovenox qd and SCDs were avidly used. She was making good urine throughout her stay, well above .5 cc/kg/hr. Her JP drain was consistently serosangunous with output wnl. Incision sites were c/d/i throughout the hospital course. She was started on banana chips to slow her ostomy output but on POD#3 it was decided the output was too high so she was started on Imodium tid. On POD#4 her JP drain was removed. On POD#5 she was discharged with a pink patent and productive ileostomy, pending pathology. She went home with Imodium and Percocet. Ultimately her pathology showed a pT3N1b tumor with clean margins. &#10;&#10;ROS: Was unremarkable with the exception of what has been previously mentioned in the above HPI.&#10;&#10;P
 MHx: Review of past medical history was significant for previous gynecologic processes only: cystocele and menopause. &#10;PSHx: Surgical history was remarkable for open cholecystectomy in 1980 performed with a Kocher incision and placement of post-op T-tube.&#10;FamHx: Family history significant for diverticulittis, gallbladder disease, hypertension, hyperlipidemia, coronary vascular disease.&#10;SocHx: She denies tobacco use as well as regular alcohol consumption - &quot;occasional glass of wine&quot;. &#10;&#10;All: Penicillins. Patient tolerates Cephalosporins.&#10;Meds: Patient only reported routinely taking a multi-vitamin. &#10;&#10;PE:&#10;Physical exam revealed a conversational and pleasant woman, adequately nourished and of stated age in no acute distress, no signs of cyanosis or difficulty breathing. There were no signs of jaundice, fever, diaphoresis. She was alert and oriented to place, time, and reason for her hospital visit. &#10;CV: No m/r/g, rrr.&#10;Pulm: Ctab, no 
 w/r/r.&#10;Abd: She presented with no distention pre-op, and rapidly returned to normal post-op. An old scar consistent with surgical history was appreciated. Normal bowel sounds were audible in all four quadrants to auscultation. There was no tenderness to palpation. There was no fluctuance or masses palpated. No overt liver edge was evident.  &#10;LE: No edema or pain was appreciated.&#10;&#10;Labs/Ancillary Studies: &#10;Labs were only remarkable for some preoperative anemia probably secondary to her disease process. &#10;&#10;Colonoscopy report:&#10; Non thrombosed external hemorrhoid&#10; Malignant near obstructing tumor at 18cm proximal to the anus&#10; One 5mm polyp in the rectum (resected)&#10; Three 2-3mm polyps in the rectum (resected)&#10;&#10;CT Abd with contrast: &#10;IMPRESSION:    &#10;1. Approximately 7 cm segment of significant distal sigmoid wall&#10; thickening/mass with mild associated pericolonic fat stranding. There may&#10; be slight extension into very proxim
 al rectum. &#10;2. Loss of fat plane between the uterus and proximal end of the sigmoid&#10; mass/thickening adjacent superior to the uterus. This indicates inability&#10; to exclude contiguous involvement of the uterus.&#10;3. No evidence for metastatic disease.&#10;&#10;GI consult colonoscopy biopsy results:&#10;Moderately differentiated invasive adenocarcinoma&#10;&#10;Final pathology report on post operative, resected, specimen:&#10;&#10;MICROSCOPIC DESCRIPTION:   Specimen: Sigmoid colon, rectum (partial).  Tumor site: Rectosigmoid.  Tumor location: Tumor is located at the peritoneal reflection.  Tumor size: 2.5 cm  Macroscopic tumor perforation: Not identified.  Histologic type: Adenocarcinoma.  Histologic grade: Low-grade.  Microscopic tumor extension: Tumor invades through the muscularis propria into the subserosal adipose tissue but does not extend to the serosal surface. Margins: Uninvolved by invasive carcinoma: Distance of invasive carcinoma from closest margin: 0.12 cm. 
 Closest margin: Circumferential (Radial). Tumor deposits (discontinuous extramural extension): Present Number of deposits: 8  Pathologic staging: Primary tumor: pT3 Regional lymph nodes: pN1b Number of lymph nodes examined: 24 Number of lymph nodes involved: 3 Additional pathologic findings: Hyperplastic polyp. FINAL DIAGNOSIS:  A,B. COLON, RECTOSIGMOID, LOW ANTERIOR RESECTION:  -- ADENOCARCINOMA, INVADING THROUGH THE MUSCULARIS PROPRIA.  -- THREE OF TWENTY-FOUR LYMPH NODES POSITIVE FOR METASTATIC CARCINOMA.  -- EIGHT PERICOLIC TUMOR DEPOSITS.  -- MARGINS UNINVOLVED BY INVASIVE CARCINOMA.  (see microscopic description for complete synoptic report)  -- PATHOLOGIC STAGE: pT3 N1b.&#10;&#10;A/P:&#10;Mrs. X is a 61 yo woman who initially presented with s/s of descending colon obstruction. Diagnosis was further confirmed by CT and colonoscopy. Biopsy revealed a moderately differentiated adenocarcinoma. The only management for such a mass was surgery. The offending mass was successfully re
 sected with a low anterior resection. Pathology determined a T3N1b adenocarcinoma of the distal sigmoid colon which is a Stage IIIb colon cancer. Three nodes of 24 were positive for metastatic carcinoma. Current studies show stage IIIb colon cancer to have a 46% five-year survival rate.&#10;&#10;- Based largely on MOSAIC trial results, my plan is to proceed with one of the FOLFOX permutations (4 or 6). &#10;- Current dosing recommendations for Oxaliplatin is: I.V.: 85 mg/m2 every 2 weeks for 6 months (12 cycles; in combination with fluorouracil/leucovorin).&#10;- After successful completion of this therapy, I recommend taking down her ostomy. &#10;"/>
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+    <org.apache.ctakes.typesystem.type.syntax.WordToken _indexed="1" _id="4118" _ref_sofa="3" begin="1279" end="1282" tokenNumber="248" normalizedForm="the" partOfSpeech="DT" capitalization="0" numPosition="0"/>

[... 17624 lines stripped ...]


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