MRO Concurrent Report

5/10/2013
No. of Inpatients: 4
Pt NAME

Sasis, Margarita

Imballa, Estrella

Diaz, Maria Dolores

Flores, Anthony
PEDIATRICS

Mem #

66860-00

79275-00

73465-00

83180-01

Plan Type

CNMI CW

Guam
Premier

Premier

Guam
Premier

DOB

10/17/52

9/10/53

9/15/71

2/2/68

Age

60

59

41

45

PA#

130408074

130408072

130509021

130408005

Hospital

SLMC QC

SLMC QC

SLMC GC

SLMC GC

VEIOVIS
Discharged: 0

Prepared by:
Rey Emmanuel S. Lu, MD, Physician Coordinator, TakeCare Insurance Medical Referral Office Philippines

Hosp. PIN

1301188803

1208059985

1211074914

1305007218

Attending MD

De Guzman, Roselle

Serrano, Genueno

Pedraza, Maria Laura

Sinamban, Reynaldo

Admit

06-Apr-13

08-May-13

09-May-13

09-May-13

LOS (days)

34

Ward

Onco 2

DLU

South

South

Room

450

3006

959

Admitting Diagnosis

Reason for present admission

Patient came in from PHC, no comorbids

admitted for continuity of care. History of
present illness started when pt had
dizziness & vomiting. Pt consulted @ PHC
& was admitted with initial impression of
BPPV. Work-up done, Cranial MRI revealed
multiple enhancing cortical & subcortical
nodules suggestive of metastatic process.
PET Scan was done w/c revealed a
pulmonary nodule neoplastic, t/c pulmonary
CA. Pt was managed w/ Dexamethasone.
On the 6th HD, pt had an episode of seizure
& decreased sensorium. Pt was started on
Metastatic Brain Lesion
anticonvulsant. Pt was managed as a case
most likely from Primary of pulmonary masses, most likely malignant
Lung CA Right Pulmonary
with brain metastasis. For Medical
Artery Embolism
Management.

Chronic Cholecystitis with

Cholelithiasis

Breast Ca Stage III, S/P

MRM

Plan

05/10/2013: On DNR/DNI. max GCS 6/15; afebrile;

Stable VS. Urine CS: K pneumoniae, ESBL (+). (+)
partial eye opening to vigorous stimuli. no jerking
mov't, (+) whitish oral secretions. On Losartan,
Amlodipine, Acetazolamide, Lactulose, Potassium
Chloride, Nystatin, Atorvastatin, Rebamipide,
Mannitol, Acetylcysteine, Ertapenem D4,
Dexamethasone, Pantoprazole, Keppra.

On ECU, noted Ultrasound of liver,

gallbladder and kidneys done 4/25/13
showed Cholelithiasis. OI GS consult done 05/10/2013: S/P Laparoscopic Cholecystectomy
(5/9/13). POD 1. (+) vomiting 1x no recurrence, (+)
and recommended Laparoscopic
flatus. Discharged: 05/10/2013 (11:11 AM)
Cholecystectomy poss open.

Patient had a known history of Bilateral

Mass/Pain. Pt underwent Incision Biopsy of
Left Breast with Frozen Section with
Modified Radical Mastectomy (11/09/2012),
pathology report showed Invasive ductal
carcinoma, histologic and nuclear grade 3
with apocrine features. tumor size: 5cm in
widest dimension, 6 of 8 axillary lymph
nodes, positive for metastasis. 4 of 7
axillary lymphodes, level II, positive for
metastasis. Her 2 Neu done (12/10/2012)
showed Estrogen Receptor Assay (-),
Progesterone Receptor Assay (-), C-erB-2
(+). S/P 4 Cycles Chemo (Doxorubicin and
Cyclophosphamide).S/P Chemo Cycle 3 05/10/2013: S/P Chemo Cycle 4 (Taxotere and
Herceptin)~afebrile with no complaints of nausea
(Taxotere and Herceptin) . For Chemo
and vomitting. Discharged: 05/10/13 (12:08 pm)
Cycle 4 (Taxotere and Herceptin)

Patient has a history of abdominal soft

tissue mass. CT scan 3/22/13 & palpable,
on x-ray. CT scan of abdomen +/- IV
contrast shows Epigastric lobulated lesion
suggestive of retained foreign body w/
granulomatous reaction/omental infarct. No
definite focal fluid collection or rimenhancing abscesses. UTZ of epigastric
mass revealed confluence of multiple soft
tissue hyperechoic nosular foci at the region
of concern (epigastric region inferior to the
xiphoid.) The confluent measurement is
approximately 3.2x5.1x4.2cm. For Excision 05/10/2013: Currently undergoing procedure;
1179B Epigastric Mass t/c Lipoma
Excision of mass
of mass, epigastric area.