001 Medical-Objects                                            07 01/07/1996
002   
003 Report Run Number: 1    Created:   16/11/2004     at    22:16:49
004 Surgery: XXXXX  Reports: 14/10/2000 00:00:00  to  09/11/2000 00:00:00       
009 ---------------------------------------------------------------------------
010 MCINTYRE,DR. ANDREW                          0191322W
010 DOE,DR. JANE                         0659994X
010 BARRY,DR. JOHN                     26999RH
019 ---------------------------------------------------------------------------
020 Your Ref.   Patient Name                   Lab Ref.       Test
021             AHML,Test                  00-3710309     MASTER COAG PROFILE
021             AHML,Test                  896A8331-7AC   ERCP
021             AHML,Test                  331F583E-EAB   Letter
021             AHML,Test                  46FE8E8A-29B   ERCP
029 ---------------------------------------------------------------------------
100 Start Patient  :      AHML,Test                  
101                       4 Kauri Street, COOROY QLD 4563                      
104                       Birthdate: 26/11/1920     Age: Y79     Sex:M
105                       Telephone: 07 54476207     
109   
110 Your Reference :      
111 MO  Reference  :      00-3710309_MASTERCOAGPROFILE
112 Medicare Number:                
115 Phone Enquiries:       ( (07) 3840 45)                             
119   
121 Referred by    :      MCINTYRE,DR. ANDREW             
122 Copy to        :      SUNSHINE COAST,DR. PRIVATE HOSPI
123 Addressee      :      MCINTYRE,DR. ANDREW               0191322W
129   
200 Start of Result:
201 Specimen       :
203 Requested      :      13/10/2000
204 Collected      :      13/10/2000  00:00
205 Name of Test   :      MASTER COAG PROFILE                                  
206 Reported       :      16/10/2000  00:00
207 Confidential   :      N
208 Test Category  :      N
209   
210 Normal Result  :      Y
299   
301 
301    COAGULATION STUDIES 
301        Prothrombin Time                  10  seconds          (8-13)
301        APTT                              28  seconds          (25-38)
301    +++ Plasma Fibrinogen               7.70  g/L              (1.50-4.00)
301        Platelet Count                   318  x10 ^9 /L        (150-450)
301        Elevated fibrinogen.  This may occur as part of an acute phase
301        response, following an infusion of plasma products or during
301        pregnancy.
301  
301 
309   
319   
390 End of Report  :
399 ---------------------------------------------------------------------------
100 Start Patient  :      AHML,Test                  
101                       4 Kauri Street, COOROY QLD 4563                      
104                       Birthdate: 26/11/1920     Age: Y79     Sex:M
105                       Telephone: 07 54476207     
109   
110 Your Reference :      
111 MO  Reference  :      896A8331-7ACA-485A-AC37-F2F70FCDD7B5
112 Medicare Number:                
115 Phone Enquiries:       (DR. ANDREW MCINTYRE (0191322W)             
119   
121 Referred by    :      DOE,DR. JANE            
122 Copy to        :      MCINTYRE,DR. ANDREW             
122 Copy to        :      SUNSHINE COAST PRIVATE,DR.      
123 Addressee      :      DOE,DR. JANE              0659994X
129   
200 Start of Result:
201 Specimen       :
203 Requested      :      14/10/2000
204 Collected      :      14/10/2000  00:00
205 Name of Test   :      ERCP                                                 
206 Reported       :      14/10/2000  00:00
207 Confidential   :      N
208 Test Category  :      N
209   
210 Normal Result  :      Y
299   
301 
301 
301              ERCP Report - Test AHML (26.11.20)
301 
301                                      AM/LP/am/FB261120
301 Dr. JANE DOE          Procedure Date: 14.10.00
301 The Noosa Hospital                     Typed: 14.10.00
301 NOOSAVILLE Q 4566
301      cc: Sunshine Coast Private Hospital
301 
301 
301 Indication:  Obstructive Jaundice
301 
301 Instrument:  Olympus Stenting Duodenoscope
301 
301 Sedation:
301         Hypnovel 5 mg
301         Fentanyl 100 ug
301         Diprivan 180mg
301         Glucagon 1 iu
301 
301 
301 Report:
301 
301 The ampulla was expanded, almost suggesting an
301 impacted stone. The overlying mucosa was normal. The
301 pancreas was cannulated initially and was quite
301 dilated down to the level of the ampulla. The bile
301 duct was then cannulated. It was markedly dilated and
301 there was an area of narrowing just above the
301 sphincterotomy. Despite an open sphincterotomy
301 minimal free flow occurred. The intrahepatic ducts
301 were dilated and there was some cystic duct, but no
301 gallbladder filling. The strictured area was brushed.
301 A 5cm 10F stent was placed with good bile flow.
301 
301 
301 Index Diagnosis:
301              1. Probable Peri-ampullary Carcinoma
301              2. Sphincterotomy
301              3. Stent Placement
301 
301 
301 Comment:
301 
301 If we have confirmation, or reasonable certainty for malignancy I will place
301 a covered wallstent. Thank you for referring this patient,
301 
301 
301 Andrew McIntyre
301 Gastroenterologist.
301 
301 Indication Obstructive Jaundice                  
301 Diagnosis  Probable Peri-ampullary Carcinoma     
301 Diagnosis  Sphincterotomy                        
301 Diagnosis  Stent Placement                       
301 Hypnovel   5                                  mg 
301 Fentanyl   100                                ug 
301 Diprivan   180                                mg 
301 Glucagon   1                                  iu 
301 Instrument Olympus Stenting Duodenoscope         
309   
319   
390 End of Report  :
399 ---------------------------------------------------------------------------
100 Start Patient  :      AHML,Test                  
101                       4 Kauri Street, COOROY QLD 4563                      
104                       Birthdate: 26/11/1920     Age: Y79     Sex:M
105                       Telephone: 07 54476207     
109   
110 Your Reference :      
111 MO  Reference  :      331F583E-EAB5-4AB4-9B67-64FF880B0364
112 Medicare Number:                
115 Phone Enquiries:       (DR. ANDREW MCINTYRE (0191322W)             
119   
121 Referred by    :      BARRY,DR. JOHN         
122 Copy to        :      MCINTYRE,DR. ANDREW             
123 Addressee      :      BARRY,DR. JOHN          26999RH
129   
200 Start of Result:
201 Specimen       :
203 Requested      :      18/10/2000
204 Collected      :      18/10/2000  00:00
205 Name of Test   :      Letter                                               
206 Reported       :      19/10/2000  00:00
207 Confidential   :      N
208 Test Category  :      N
209   
210 Normal Result  :      Y
299   
301 
301 
301                                                   AM/slc/Fb261120
301                                                Dictated: 18.10.00
301                                                   Typed: 19.10.00
301 Dr. A. Barry
301 Cooroy Family Medicine
301 Cnr. Elm & Pearl Streets
301 COOROY  QLD   4563
301      cc; Dr. JANE DOE
301 
301 Dear Dr Bennett,
301 Re: Test AHML
301    D.O.B. 26.11.20
301 
301 I recently saw Mr AHML in Buderim Hospital after transfer from the Noosa
301 Hospital.
301 
301 He was admitted to Noosa with fever and had quite obstructive looking liver
301 function tests and evidence of biliary dilatation.  ERCP showed Peri-
301 ampullary tumour with obstruction of both biliary and pancreatic ducts and
301 a pattern consistent with carcinoma of the pancreas.  Brushings of the
301 stricture are highly suspicious for malignancy and the clinical picture
301 certainly fits this.  A plastic stent was placed resulting in a prompt
301 improvement in his liver tests although he was still mildly jaundiced on
301 discharge.
301 
301 Given his age and his chest problems he is not a good candidate for
301 surgical intervention at least in a curative fashion, and I think stenting
301 is his best option.  He was reviewed by Ian Brown who agreed with this.
301 
301 I would like to replace his fine bore plastic stent with a wallstent in
301 three or four weeks and at this stage he really needs no other palliative
301 care as there is no other significant symptoms.  His prognosis is obviously
301 grim and at this point of time he has no obvious metastatic disease and a
301 fairly small primary tumour he may well do better than average.
301 
301 I have asked him to see you for follow up and it is worth checking his
301 liver tests fairly frequently, perhaps fortnightly, until they stabilise. 
301 I have made arrangements for him to be admitted back to Buderim Private in
301 early November.  If he became jaundiced again or had any further fevers
301 then this may need to be brought forward.
301 
301 Thank you for continuing his care.
301 
301 
301 Yours sincerely,
301 
301 
301 Andrew McIntyre
301 Gastroenterologist.   
301 
309   
319   
390 End of Report  :
399 ---------------------------------------------------------------------------
100 Start Patient  :      AHML,Test                  
101                       4 Kauri Street, COOROY QLD 4563                      
104                       Birthdate: 26/11/1920     Age: Y79     Sex:M
105                       Telephone: 07 54476207     
109   
110 Your Reference :      
111 MO  Reference  :      46FE8E8A-29BA-4203-A32D-871A7B2B39DB
112 Medicare Number:                
115 Phone Enquiries:       (DR. ANDREW MCINTYRE (0191322W)             
119   
121 Referred by    :      BARRY,DR. JOHN         
122 Copy to        :      MCINTYRE,DR. ANDREW             
122 Copy to        :      BROWN,DR. IAN                  
122 Copy to        :      SUNSHINE COAST PRIVATE,DR.      
123 Addressee      :      BARRY,DR. JOHN          26999RH
129   
200 Start of Result:
201 Specimen       :
203 Requested      :      09/11/2000
204 Collected      :      09/11/2000  00:00
205 Name of Test   :      ERCP                                                 
206 Reported       :      09/11/2000  00:00
207 Confidential   :      N
208 Test Category  :      N
209   
210 Normal Result  :      Y
299   
301 
301 
301              ERCP Report - Test AHML (26.11.20)
301 
301                                      AM/AS/am/FB261120
301 Dr. A. BARRY                Procedure Date: 09.11.00
301 Cooroy Family Medicine                 Typed: 09.11.00
301 Cnr. Elm & Pearl Streets
301 COOROY  QLD   4563
301      cc: Dr. I. Brown
301      cc: Sunshine Coast Private Hospital
301 
301 
301 Indication:  For wallstent placement
301 
301 Instrument:  Olympus Stenting Duodenoscope
301 
301 Sedation:
301         Hypnovel 5 mg
301         Fentanyl 100 ug
301         Diprivan 115mg
301         Gentamicin 240mg
301         Ampicillin 1 gm
301 
301 
301 Report:
301 
301 The old stent was removed and a cholangiogram
301 performed. The bile duct was dilated above a
301 stricture at the lower end. A 4cm covered wallstent
301 was placed but did not adequately cover the tumour.
301 Because of this a 6cm uncovered wallstent was placed.
301 This resulted in good drainage. It pushed the smaller
301 stent up further.
301 
301 
301 Index Diagnosis:
301              1. Ca Pancreas
301              2. Wallstent Placement
301 
301 
301 Comment:
301 
301 Hopefully this will give him a long period of palliation. I will observe him
301 overnight.
301 
301 Thank you for referring this patient,
301 
301 
301 Andrew McIntyre
301 Gastroenterologist.
301 
301 Indication For wallstent placement           
301 Diagnosis  Ca Pancreas                       
301 Diagnosis  Wallstent Placement               
301 Hypnovel   5                              mg 
301 Fentanyl   100                            ug 
301 Diprivan   115                            mg 
301 Gentamicin 240                            mg 
301 Ampicillin 1                              gm 
301 Instrument Olympus Stenting Duodenoscope     
309   
319   
390 End of Report  :
399 ---------------------------------------------------------------------------
999 END OF LISTING - Run Number:1     16/11/2004  22:16:24