Laboratory Studies Clinical Microscopy Routine Analysis Test 8/14/2010 Result Reference Ranges/Comments Straw yellow to amber Transparent

1.003-1.035 5-8 Neg Neg Neg Neg Neg 0.1-1.8 Neg Neg 0-5 Few neg few Implication Bladder tumor bacterial colonization Within normal level Within normal level Normal Normal Bladder disease Bacterial invasion Normal Retention of bilirubin ketonuria hematuria Bladder infection Normal Bladder infection normal

Physical/Microscopic Color Red Transparency cloudy Chemical Specific gravity 1.005 pH 5 Glucose Neg Bilirubin Neg Blood +1 Leucocytes +3 Nitrite Neg Urobilinogen 4.0 mg/dL Ketone +2 Microscopic RBC TNTC /hpf WBC 15-20 /hpf Epithelial cells Rare Bacteria Rare Mucous threads Rare EXPLANATION:

1. With bladder disease, there is hematuria due to inflammation of the bladder or anything that disrupts the uroepithelium , such as irritation, or invasion, can result in normalappearing RBCs in the urine. (http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/nephrology/eva luation-of-hematuria/#cesec3) 2. The urine may also appear cloudy if the patient has had a bladder surgery. This is because of the bacteria colonization in the bladder. 3. Visible blood in the urine indicates the possibility of bladder disease. 4. If a urinalysis detects presence of leukocytes in the urine with no nitrates, it could be an indication that there is an infection in the urinary system. Leukocytes are white blood cells that combat infections in the body but their presence in urine most often signifies a bacterial invasion. 5. Nitrate (+) suggest the presence of microorganism: E.coli/Klebsiella/proteus/etc. 6. Urine urobilinogen is increase in any condition that causes an increase in production or retention of bilirubin. (http://www.irvingcrowley.com/cls/urin.htm) 7. Ketone bodies that commonly appear in the urine when fats are burned for energy. It results from calorie deprivation (starvation). (http://library.med.utah.edu/WebPath/TUTORIAL/URINE/URINE.html) 8. Anything that disrupts the uroepithelium , such as irritation, inflammation, or invasion, can result in normal-appearing RBCs in the urine.

(http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/nephrology/eva luation-of-hematuria/#cesec3) 9. Any anomaly with the bladder, like bladder infection, can cause white blood cells to be collected in the urine. Any disturbance or interference with bladder clearance can also cause this infection, leading to white blood cells in the urine. This is the reason why urine appears cloudy. (http://www.buzzle.com/articles/white-blood-cells-in-urine.html) 10. The presence of a few epithelial cells, especially, the squamous and transitional ones are considered as normal in both men and women. However, many transitional epithelial cells in urinalysis can be due to bladder infection. (http://www.buzzle.com/articles/epithelial-cells-in-urine.html) 11. A common way for urine to contract bacteria is when it is kept in an infected bladder, which provides a fertile environment for bacteria to grow. 12. This is a common finding in urine since the entire urine system was filled with mucus. (http://www.preventive.com/html/urinalysis.html) Hematology 8/14/2010 Blood and Rh Typing Blood typing Rh typing

O Positive

Hematology Report Complete Blood Count Test Name Results WBC RBC Hgb Hct Platelet MCHC RDW Lymphocyte Monocyte Eosinophils Lymphocytes 4.24 3.69 10.1 31.7 236 31.9 19.0 14.9 9.9 10.8 0.63

8/20/10

5:10 am

Reference Range (4.8- 10.8) (4.7- 6.1) (14.0- 18.0) (42.0- 52.0) (130-400) (33.0- 37.0) (11-16) (19-48) (3.4-9.0) (0.0-7.0) (0.9-5.2)

Units 10^3/uL 10^6/uL g/dL % 10^3/uL g/dL % % % % %

Implication infection Anemia, dehydration anemia anemia Within normal level anemia anemia viral infection Increase risk of infection Cardiac conditions viral infection

Clinical Chemistry Report

8/24/10

11:03 AM

Test Sodium (serum)

Within normal level Potassium 3.6 3.3-5.3 Mmol/L Within normal level Chloride 114.0 98.0-107.0 Mmol/L Hyperchloremic acidosis 1 Hyperchloremic acidosis results from intake of drugs with chloride content and hyperalimentation of IV solutions with chloride or amino-chloride contents.

Result 143.0

Reference 134.0-148.0

Unit Mmol/L

Implication

Complete Blood Count Test Name Results WBC RBC Hgb Hct MCV MCHb MCHC RBC distribution width Platelet count Differential Count Segmenters Lymphocytes Monocytes Eosinophils 0.64 0.14 0.12 0.10 13.4 2.60 60 0.20 77 23.10 0.30 18.8

08/28/10 2:30 P.M. Reference Units Range (4.00-10.50) (4.70- 6.00) (135-180) (0.42-0.52) (78-100) (27-31) (0.32-0.36) (11.0-16.0) 10^9/uL 10^12/uL g/dL % fL Pg %

Implication Infection Anemia, dehydration Anemia anemia

microcytic anemia

Anemia of chronic disease Anemia of chronic disease anemia

263

(150-450)

10^9/L

Within normal levels

(0.50-0.70) (0.18-0.42) (2.02-0.11) (0.00-0.06)

Within normal levels Viral infection infection Bone marrow disorder

Explanations: 1 WBC increases when there is infection and cancer 2 Cancer studies shows that it has significant effect on the bone marrow which disrupts erythropoeisis, thus, less red blood cells circulating in the blood 3 Hgb and Hct levels decrease in relation with the declining red blood cell count which results to the decreasing capacity of the blood to carry oxygen 4 MCV also decreases with decreasing RBCs circulating in the bloodstream 5 MCHb decreases along with the of Hgb volume 6 RBC distribution is also affected directly by the lowering levels of RBC 7 Lymphocytes is low since there is viral infection 8 Monocytes increase in number to suppress existing infection

Eosinophils increase because of effects of cancer in bone marrows.

Diagnostic Procedures CT Scan Abdomen Exam date: 8/27/09 17:55:14 Study comment: John M. Mata Creator: Demonsthenes O. Chan M.D. Axial slices of the abdomen and pelvis where done before and after administration of intravenous contrast without any adverse reaction. The visualized lung basis shows there is no intrapulmonary module nor mass lesion. No pleural nor pericardial effusion is seen. The heart is not enlarged. The distal esophagus and distal descending thoracic aorta are normal. The liver is normal in size. The hepatic contour are smooth. There are multiple cysts scattered in both lobes and liver ranging from 3 to 8 mm in diameter. These showed no enhancement after intravenous contrast. The intrahepatic and extrahepatic bile ducts are not allotted. The gallbladder is distended with fluid. There is no calcified stone. The hepatic, portal, splenic and superior mesenteric veins show homogenous enhancement. The head and neck of the pancreas are relatively small. The body and tail are normal in configuration. The pancreatic duct is not obstructed. There are no calcifications seen with pancreas. The spleen is normal in size. The adrenal glands are not enlarged. Conclusion: Multiple liver cysts. Diffuse slightly irregular thickening of the urinary bladder wall. These remain stable since March 10, 2009. Whether this is due to postradiation changes or neoplastic tumor recurrence cannot be differentiated. Please correlate with the clinical findings. Atherosclerosis of the abdominal aorta. Mild spondylosis of the lower dorsal and lumbar spine with degenerative osteoarthrosis of the apophyseal joints of the L4 and L5.

RADIOGRAPHIC REPORT

8/14/10

Chest PA The lung fields are clear. The trachea is in the midline. There is a calcific plaque within the wall of the aortic knob. The heart is not enlarged. The pulmonary vessels are within normal limits. Both hemidiaphragms are distinct. The osseous thoracic cage reveals significant bony abnormality. Impression: Atherosclerosis of the thoracic aorta. Department of Anatomic Pathology FROZEN SECTION REPORT

8/21/10

Frozen section (ureter) Examination: frozen section with biopsy (stat) Specimen: right and left ureter Result: chronic ureteritis; negative for malignancy

TISSUE REPORT

8/21/10

1:55 am

Frozen section (ureter) Surgical pathological no. : fs-3971-10 Specimen: (including source of anatomical location) Right and left ureter for frozen section & biopsy Brief history: Diagnosis of urinary bladder papillary urothelial carcinoma stage III (+) hematuria Clinical impression: Urinary bladder cancer stage III recurrence Diagnosis: Left and right ureter: mild chronic ureteritis No evidence of malignancy Microscopic description: Left and right ureter: sections from left and right ureter shows intact urothelium in which some areas shows hyperplasia. There is also mild infiltrates within the submucosa. No evidence of malignancy seen. Frozen section diagnosis: Chronic ureteritis, (-) for malignancy

Appendix for Biopsy 8/21/10 5:12 PM Appendix: Fibrous Obliteration of the Appendix Microscopic Description: Appendix: Microscopic Examination shows cross and longitudinal section of the vermiform appendix. The lumen at which is the worst of the appendix is relatively and remarkable and there is mild congestion of the several blood vessel.