CHIEF COMPLAINT: Left upper lobe nonsmall-cell lung cancer.

PRESENT ILLNESS: The patient is a 52-year-old woman
with a biopsy-proven nonsmall-cell lung cancer arising from
the right upper lobe.  On bronchoscopy, she had endobronchial
disease noted at the secondary carina, and we felt that a
standard lobectomy would not yield a negative margin.  She
was, therefore, brought to the operating room today for left
thoracotomy, possible sleeve lobectomy, possible
pneumonectomy.

MEDICAL HISTORY: xx

MEDICATION ON ADMISSION: Sumatriptan

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: T: 97.2   HR 88 SR  BP: 120/68  Sats: 93% RA
General: 52 year-old female in no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple no lymphadenopathy
Card: RRR normal S1,S2
Resp; decreased breath L>R no crackles, left with occasional exp
wheeze
GI: benign
Extr: warm no edema
Incision: L thoractomy site clean, dry, intact, margins well
approximated, no erythema
Neuro: non-focal

FAMILY HISTORY: 

SOCIAL HISTORY: 
Malignant neoplasm of upper lobe, bronchus or lung,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus
Mal neo upper lobe lung,Migrne unsp wo ntrc mgrn
Admission Date:  [**2129-6-3**]              Discharge Date:   [**2129-6-7**]

Date of Birth:  [**2077-2-18**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Left upper lobe nonsmall-cell lung cancer.


Major Surgical or Invasive Procedure:
[**2129-6-3**]:
1. Left thoracotomy.
2. Left upper lobe sleeve lobectomy.
3. End-to-end anastomosis of left main stem bronchus to the left
lower lobe bronchus.
4. Wrapping of bronchial anastomosis with intercostal muscle.


History of Present Illness:
The patient is a 52-year-old woman
with a biopsy-proven nonsmall-cell lung cancer arising from
the right upper lobe.  On bronchoscopy, she had endobronchial
disease noted at the secondary carina, and we felt that a
standard lobectomy would not yield a negative margin.  She
was, therefore, brought to the operating room today for left
thoracotomy, possible sleeve lobectomy, possible
pneumonectomy.


Past Medical History:
xx

Physical Exam:
VS: T: 97.2   HR 88 SR  BP: 120/68  Sats: 93% RA
General: 52 year-old female in no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple no lymphadenopathy
Card: RRR normal S1,S2
Resp; decreased breath L>R no crackles, left with occasional exp
wheeze
GI: benign
Extr: warm no edema
Incision: L thoractomy site clean, dry, intact, margins well
approximated, no erythema
Neuro: non-focal

Pertinent Results:
[**2129-6-6**] WBC-7.8 RBC-2.87* Hgb-9.0* Hct-27.5 Plt Ct-273
[**2129-6-4**] WBC-8.6 RBC-3.31* Hgb-10.2*# Hct-31.7 Plt Ct-333
[**2129-6-3**] Hct-35.2*
[**2129-6-6**] Glucose-110* UreaN-8 Creat-0.5 Na-139 K-4.1 Cl-102
HCO3-30
[**2129-6-5**] Glucose-95 UreaN-10 Creat-0.5 Na-138 K-4.7 Cl-104
HCO3-27
[**2129-6-3**] Na-142 K-4.9 Cl-109*
[**2129-6-6**] Calcium-8.8 Phos-3.7 Mg-2.0
[**2129-6-4**] Calcium-8.6 Phos-5.1* Mg-2.3

CXR:
[**2129-6-6**]: The left chest tube has been removed. The lungs are
well expanded and clear without focal consolidation. A tiny left
pleural effusion is decreased from the prior study. Pulmonary
vascular congestion has improved. Cardiac and mediastinal
silhouettes and hilar contours are normal. A tiny left apical
pneumothorax is stable. Mediastinal and left lower lobe surgical
clips are unchanged.

IMPRESSION:
1. Stable tiny left apical pneumothorax.
2. Pulmonary vascular congestion has improved.
[**2129-6-3**]: There are two left-sided chest tube with one distal
tip in the left apex and a second in the left base. No
pneumothoraces are seen. There are no large pleural effusions.
There is mild prominence of pulmonary interstitial markings, but
this is improved since the prior study. There has been
improvement of the atelectasis at the left upper lobe.
Thoracotomy changes with resection of portion of the left sixth
rib is new.




Brief Hospital Course:
Mrs. [**Known lastname 76536**] was admitted [**2129-6-3**] Left thoracotomy. Left upper
lobe sleeve lobectomy.
End-to-end anastomosis of left main stem bronchus to the left
lower lobe bronchus.
Wrapping of bronchial anastomosis with intercostal muscle.  She
was extubated in the operating room transfer to the TSICU in
stable condition with 2 left chest-tubes, Foley, and
Bupivacaine/hydromorphone Epidural managed by acute pain
service.  Overnight she remained stable and was transfer to the
floor POD1.

Respiratory: aggressive pulmonary toilet, nebs, incentive
spirometer her oxygenation improved. Oxygen was titrated off
with saturations of 93% RA.

Chest-tubes: right-angle and 24 straight chest tube were removed
[**2129-6-6**].

Chest film: stable left pneumothorax, pulmonary congestion
improved

Card: hemodynamically stable sinus rhythm 70's no ectopy, BP
90-120.

GI: PPI & bowel regime. Tolerated a regular diet

Renal: normal renal function with good urine output. the foley
was removed following epidural removal

Pain: Bupivicaine/Dilaudid epidural, Toradol with good pain
control.  The epidural was removed [**2129-6-6**] she converted to PO
pain medication with good control.

Disposition: she continued to make steady progress and was
discharged to home on [**2129-6-7**].  She will follow-up with Dr.
[**First Name (STitle) **] as and outpatient.


Medications on Admission:
Sumatriptan

Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*90 Tablet(s)* Refills:*0*
3. tizanidine 2 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for pain.
Disp:*20 Tablet(s)* Refills:*0*
4. ibuprofen 600 mg Tablet Sig: One (1) Tablet PO every eight
(8) hours as needed for pain: take with food and water.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Left upper lobe mass


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Call Dr.[**Name (NI) 5067**] office [**Telephone/Fax (1) 2348**] if you experience:
-Fevers > 101 or chills
-Increased shortness of breath, cough (it is normal to cough up
blood tinge sputum for a couple a day) or chest pain
-Left thoractomy incision develops drainage
-Chest tube site cover with a bandaid until healed

Pain
-Acetaminophen 650 mg every 8 hours as needed for pain
-Hydromorphone 2-4 mg every 4-6 hours as needed for pain
-Ibuprofen 600 mg every  8 hours as needed for pain. Take with
food and water
-Tizanidine 2 mg every 12 hours as needed for pain
-Take stool softners with narcotics

Acitivity
-Shower daily. Wash incision with mild soap & water, rinse, pat
dry
-No tub bathing, swimming or hot tub until incision healed
-No driving while taking narcotics.
-Walk 4-5 times a day for 10-15 minutes increase to a Goal of 30
minutes daily.


Followup Instructions:
Follow-up with Dr. [**First Name (STitle) **] [**0-0-**] Date/Time:[**2129-6-21**] 10:00 on
the [**Hospital Ward Name 516**] [**Hospital Ward Name 23**] Clinical Center [**Location (un) 24**]

Chest X-Ray [**Location (un) 861**] Radiology 30 minutes before your
appointment



Completed by:[**2129-6-7**]
{'Malignant neoplasm of upper lobe, bronchus or lung,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: Left upper lobe nonsmall-cell lung cancer.

PRESENT ILLNESS: The patient is a 52-year-old woman
with a biopsy-proven nonsmall-cell lung cancer arising from
the right upper lobe.  On bronchoscopy, she had endobronchial
disease noted at the secondary carina, and we felt that a
standard lobectomy would not yield a negative margin.  She
was, therefore, brought to the operating room today for left
thoracotomy, possible sleeve lobectomy, possible
pneumonectomy.

MEDICAL HISTORY: xx

MEDICATION ON ADMISSION: Sumatriptan

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: T: 97.2   HR 88 SR  BP: 120/68  Sats: 93% RA
General: 52 year-old female in no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple no lymphadenopathy
Card: RRR normal S1,S2
Resp; decreased breath L>R no crackles, left with occasional exp
wheeze
GI: benign
Extr: warm no edema
Incision: L thoractomy site clean, dry, intact, margins well
approximated, no erythema
Neuro: non-focal

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Malignant neoplasm of upper lobe, bronchus or lung,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus'}
