CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 38 year old
male who presented in [**2171-11-6**] with hematuria and
right sided flank pain.  Work-up revealed a 5 to 6 centimeter
right kidney mass and a 2 to 2.5 centimeter left lower lobe
nodule.  On [**2171-11-22**], he underwent a right nephrectomy with
pathology revealing clear cell type with sarcoidmatoid
features [**Last Name (un) 9951**] Grade 4 out of 4.  A repeat CT scan of the
chest revealed multiple lung metastases.  He was evaluated
and found to be eligible for high dose IL-2 treatment.

MEDICAL HISTORY: 1.  Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Father with diabetes and
hypercholesterolemia as well as coronary artery disease.
Family history of hypertension.  Paternal grandparents with
coronary artery disease.

SOCIAL HISTORY: Denies tobacco, cocaine use, alcohol use.
Secondary malignant neoplasm of lung,Cardiac complications, not elsewhere classified,Toxic myocarditis,Personal history of malignant neoplasm of kidney,Contact dermatitis and other eczema, unspecified cause,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Unspecified essential hypertension,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use
Secondary malig neo lung,Surg compl-heart,Toxic myocarditis,Hx of kidney malignancy,Dermatitis NOS,Elev transaminase/ldh,Hypertension NOS,Adv eff antineoplastic
Admission Date:  [**2172-1-20**]     Discharge Date:  [**2172-1-28**]

Date of Birth:   [**2133-6-2**]     Sex:  M

Service:  BIOLOGICS

HISTORY OF PRESENT ILLNESS:   The patient is a 38 year old
male who presented in [**2171-11-6**] with hematuria and
right sided flank pain.  Work-up revealed a 5 to 6 centimeter
right kidney mass and a 2 to 2.5 centimeter left lower lobe
nodule.  On [**2171-11-22**], he underwent a right nephrectomy with
pathology revealing clear cell type with sarcoidmatoid
features [**Last Name (un) 9951**] Grade 4 out of 4.  A repeat CT scan of the
chest revealed multiple lung metastases.  He was evaluated
and found to be eligible for high dose IL-2 treatment.

PAST MEDICAL HISTORY:
1.  Hypertension.

ALLERGIES:   No known drug allergies.

PHYSICAL EXAMINATION:   Physical examination revealed a well
appearing young male in no acute distress.  Head, Eyes, Ears,
Nose and Throat:  Normocephalic, atraumatic.  Pupils are
equal, round and reactive to light.  Moist oral mucosa
without lesions.  Heart regular rate and rhythm with S1, S2.
Chest clear.  Abdomen round, positive bowel sounds.  Soft,
nontender.  No hepatosplenomegaly.  Extremities with no lower
extremity edema.  Lymph nodes:  No cervical, axillary or
inguinal lymphadenopathy.  Skin revealed a macular rash over
the chest; otherwise without skin breakdown.

LABORATORY:  On admission, white blood cell count 10.5,
hemoglobin 14.7, hematocrit 41.9, platelet count 330,000.
BUN 21, creatinine 1.3.  Sodium 139, potassium 4.3, chloride
101, carbon dioxide 30, ALT 75, AST 31, CPK 53, total
bilirubin 0.4, albumin 4.7.  Calcium 10.6, phosphorus 3.3,
magnesium 1.8, uric acid 7.5.

HOSPITAL COURSE:   The patient was admitted [**2172-1-20**] to
begin his first cycle of high dose IL-2 treatment.  During
this week, he received 10 out of 14 scheduled doses of IL-2
with doses 11 through 14 held because of neurotoxicity.
Other side effects included mild fever and chills treated
with Tylenol and Indocin.  He also developed nausea, vomiting
and diarrhea treated with anti-emetics and anti-diarrheals.
He developed an erythematous skin rash without desquamation.
He had no hypotension during his hospital course.

The neurotoxicity was manifested by restlessness and
agitation, improved with IL-2 therapy on hold.  He gained
approximately 11 pounds while on IL-2 therapy.  He developed
a mild renal insufficiency with a peak creatinine of 1.4.  He
developed a transaminitis with a peak ALT of 114 and a peak
AST of 108.  He developed hyperbilirubinemia with a peak
bilirubin of 5.7.  He had no metabolic acidosis during his
IL-2 treatment.

He had a mild thrombocytopenia with a low of 100,000 on
[**2172-1-25**], which had improved to 200,000 at the time of
discharge.  He had no neutropenia or anemia during his
course.

On [**2172-1-25**], he was noted to have a CPK of 457 with several
short runs of ventricular tachycardia.  He was transferred to
the Intensive Care Unit for further monitoring.  CK MB
returned at 112 with a troponin level of 1.97.  This troponin
continued to increase but his CPK normalized.  He was felt to
have an IL-2 induced myocarditis.

His echocardiogram revealed a mildly dilated left atrium with
a moderately dilated right atrium.  No atrial septal defect
noted.  Left ventricular wall thickness is normal.  Left
ventricular cavity size is normal.  Overall left ventricular
systolic ejection fraction of 60%.  Right ventricular chamber
size and free wall motion are normal.  Aortic valve leaflets
appear structurally normal without aortic regurgitation.
Mitral valve appears structurally normal with trivial mitral
regurgitation; no mitral valve prolapse; no pericardial
effusion.

He was maintained on aspirin and beta blockers and had no
further ectopy throughout his course.  He was stabilized from
a cardiac perspective and discharged to home on [**2172-1-28**].
His neurotoxicity had also resolved at this time.

DISCHARGE MEDICATIONS:
1.  Accupril 20 mg p.o. q. day.
2.  Ciprofloxacin 500 mg p.o. twice a day.
3.  Compazine 10 mg p.o. q. six hours p.r.n. nausea and
vomiting.
4.  Ativan 1 mg p.o. q. six hours p.r.n. nausea and vomiting.
5.  Lomotil one to two tablets p.o. four times a day p.r.n.
for diarrhea.

DISCHARGE INSTRUCTIONS:
1.  He was planned for follow-up for his next planned cycle
of IL-2.

CONDITION ON DISCHARGE:   Improved.

DISCHARGE STATUS:   To home.

The patient's discharge instructions, medications, as above.

DISCHARGE DIAGNOSES:
1.  Metastatic renal cell carcinoma status post one cycle of
high dose IL-2.
2.  IL-2 induced myocarditis.



                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 1736**]

Dictated By:[**Last Name (NamePattern1) 43757**]

MEDQUIST36

D:  [**2172-4-10**]  15:54
T:  [**2172-4-11**]  19:42
JOB#:  [**Job Number 54348**]

cc:[**Last Name (NamePattern4) 54349**]

Admission Date:  [**2172-1-16**]     Discharge Date:  [**2172-1-28**]

Date of Birth:   [**2133-6-2**]     Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 38 year-old
male who presented on [**11-8**] with hematuria and right sided
flank pain found to have a 5 to 6 mm right kidney mass and a
2 to 2.5 cm left lower lung nodule.  On [**2171-11-22**] the patient
underwent a right nephrectomy with evidence of sarcomatoid
features.  Repeat CT of chest revealed multiple lung
metastases.  The patient is now admitted for HDIL-2.

REVIEW OF SYSTEMS:  Left shoulder pain, slight rash - the
patient is sensitive to tapes.  Denies dizziness,
lightheadedness, visual changes, shortness of breath, cough,
nausea, vomiting, diarrhea, constipation, abdominal pain,
dysuria, weakness, numbness and tingling, fevers, chills,
night sweats.

PAST MEDICAL HISTORY:
1.  Renal cell cancer with metastasis to lung.
2.  Hypertension on Accupril.
3.  Eczema.

FAMILY HISTORY:  Father with diabetes and
hypercholesterolemia as well as coronary artery disease.
Family history of hypertension.  Paternal grandparents with
coronary artery disease.

SOCIAL HISTORY:  Denies tobacco, cocaine use, alcohol use.

ALLERGIES:  No known drug allergies.

MEDICATIONS:  Accupril (off since Saturday).

PHYSICAL EXAMINATION:  Temperature 98.5.  Pulse 105.  Blood
pressure 145/99.  Respirations 18.  Sating 97% on room air.
HEENT normocephalic, atraumatic.  Pupils are equal, round,
and reactive to light and accommodation.  Mucous membranes
are moist.  Oropharynx is clear.  Cardiovascular regular rate
and rhythm, normal S1 and S2.  Pulmonary clear to
auscultation bilaterally.  No rales, wheezes or rhonchi.
Abdomen round, bowel sounds present, soft, nontender,
nondistended.  Extremities no clubbing, cyanosis or edema.
Skin macular rash scattered over chest, otherwise intact.
Right nephrectomy scar over right lateral portion of the
abdomen.

DATA:  White blood cell count 10.5, hematocrit 41.9,
platelets 330, sodium 131, potassium 4.3, chloride 101,
bicarb 30, BUN 21, creatinine 1.3, ALT 70, AST 31, CPK 53,
total bilirubin was 12.4, albumin 4.7, calcium 10.6, phos
3.3, magnesium 1.8, uric acid 7.5, glucose 68.  Chest x-ray
impression no pneumothorax, lungs clear.

HOSPITAL COURSE:  1.  Renal cell cancer:  The patient was
admitted for IL-2 treatment, however, during the course of
the week IL-2 treatment was stopped secondary to the
complication of myocarditis.  The patient was discharged home
on the 23rd without any further complications, but to follow
up with his primary oncologist for further recommendations
and treatment.

2.  Myocarditis:  The patient on [**2172-1-24**] was complaining of
shortness of breath and palpitations at around 10:00 at
night. By that day IL-2 had already been stopped, because of
concerns with neurotoxicity.  IL-2 was well known to have
cardiotoxicity as a side effect.  Cardiac enzymes were cycled
and peak CK was 457, peak troponin was 3.30 and peak CKMB was
112.  Telemetry monitoring showed several runs of
nonsustained ventricular tachycardia with the longest run
being eight beats.  The patient was subsequently transferred
to the [**Hospital Unit Name 153**] for closer monitoring.  During the [**Hospital Unit Name 153**] admission
the patient was noted to have two further runs of
nonsustained ventricular tachycardia.  One was a five beat
run of narrow complex tachycardia and the other was a seven
beat run of wide complex tachycardia.  Cardiology was
consulted.  They recommended starting aspirin 81 mg, beta
blocker was started on 12.5 b.i.d. and titrated up to 25
b.i.d.  Captopril was started as well [**Company 34868**].i.d.  Cardiac
medications were well tolerated.  Cardiology agreed with the
assessment that the patient might have sustained
cardiotoxicity secondary to IL-2 treatment causing
myocarditis.  The patient was stabilized and subsequently
transferred from the [**Hospital Unit Name 153**] out to Four South.  The patient was
discharged the following day.  No further complications noted
on the last two to three days of admission.  Echocardiogram
was done for further heart evaluation.  Results were as
follows; left atrium mildly dilated, right atrium moderately
dilated, no atrial septal defect.  Left ventricular wall
thickness normal, left ventricular cavity size normal,
overall left ventricular systolic function is normal.  EF of
60%.  Right ventricular chamber size and free wall motion are
normal.  Aortic valve leaflets appeared structurally normal
with good leaflet excursion and no aortic regurgitation.
Mitral valves appear structurally normal.  Trivial mitral
regurgitation.  No mitral valve prolapse.  No pericardial
effusion.

3.  Hypertension:  The patient was continued on beta blocker
and ace inhibitor.  Subsequently restarted on his outpatient
hypertension medication of Accupril.  Beta blocker and ace
inhibitor were stopped prior to discharge.

4.  Eczema:  The patient was given Sarna lotion prn while an
inpatient.  Benadryl was also given to assist with pruritus.

5.  Transaminitis:  The patient developed some transaminitis
likely secondary to the myocarditis in addition to some mild
hepatotoxicity due to the IL-2 treatments.  ALT, AST,
T-bilirubin, alkaline phosphatase all returned to [**Location 213**]
prior to discharge.

6.  Prophylaxis:  Heparin subcutaneous.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  To home.

DISCHARGE DIAGNOSES:
1.  Myocarditis.
2.  Renal cell cancer metastasis.
3.  Hypertension.
4.  Transaminitis.
5.  Eczema.

DISCHARGE MEDICATIONS:
1.  Aspirin 81 mg one tablet q day.
2.  Ciprofloxacin 250 mg one tablet b.i.d. times five days.
3.  Accupril.
4.  Ranitidine 150 mg one tablet b.i.d.
5.  Compazine 10 mg tablet one tablet q 6 hours prn.
6.  Lomotil one to two tablets four times a day prn.
7.  Ativan 1 mg prn.

FOLLOW UP PLANS:
1.  The patient is to follow up with his primary oncologist
Dr. [**First Name8 (NamePattern2) 449**] [**Last Name (NamePattern1) **].  He is to call his office to schedule an
appointment, [**Telephone/Fax (1) 54346**].
2.  The patient will be returning the week of [**2-10**] for
the next cycle of IL-2.
3.  The patient is to have a stress test by the end of next
week.  Dr.[**Name (NI) 30161**] office will contact the patient with
details of that appointment.






                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 9402**], M.D.  [**MD Number(1) 16215**]

Dictated By:[**Last Name (NamePattern1) 9622**]




MEDQUIST36


D:  [**2172-1-28**]  10:37
T:  [**2172-2-3**]  12:36
JOB#:  [**Job Number 54347**]
{'Secondary malignant neoplasm of lung,Cardiac complications, not elsewhere classified,Toxic myocarditis,Personal history of malignant neoplasm of kidney,Contact dermatitis and other eczema, unspecified cause,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Unspecified essential hypertension,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use'}


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: 

PRESENT ILLNESS: The patient is a 38 year old
male who presented in [**2171-11-6**] with hematuria and
right sided flank pain.  Work-up revealed a 5 to 6 centimeter
right kidney mass and a 2 to 2.5 centimeter left lower lobe
nodule.  On [**2171-11-22**], he underwent a right nephrectomy with
pathology revealing clear cell type with sarcoidmatoid
features [**Last Name (un) 9951**] Grade 4 out of 4.  A repeat CT scan of the
chest revealed multiple lung metastases.  He was evaluated
and found to be eligible for high dose IL-2 treatment.

MEDICAL HISTORY: 1.  Hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Father with diabetes and
hypercholesterolemia as well as coronary artery disease.
Family history of hypertension.  Paternal grandparents with
coronary artery disease.

SOCIAL HISTORY: Denies tobacco, cocaine use, alcohol use. 

### Response:
{'Secondary malignant neoplasm of lung,Cardiac complications, not elsewhere classified,Toxic myocarditis,Personal history of malignant neoplasm of kidney,Contact dermatitis and other eczema, unspecified cause,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Unspecified essential hypertension,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use'}
