CHIEF COMPLAINT: Recurrent desmoid tumor of the left chest wall.

PRESENT ILLNESS: Mr. [**Known lastname 59199**] is a 56-year-old gentleman with a previous
enucleated desmoid tumor that was referred to me 2-1/2 years ago
at which time I performed a wide excision of this and a [**Doctor Last Name 4726**]-Tex
chest wall reconstruction. He has been followed radiographically
and was found to have 2 enlarging soft tissue masses, one at the
superior aspect of the excision below the latissimus muscle
involving the 6th rib and one inferiorly growing lateral to the
[**Doctor Last Name 4726**]-Tex patch into the subcutaneous fat and dermis. After
preoperative consultation with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], we planned a
radical excision of this. Dr. [**First Name (STitle) **] placed tissue expanders up
behind the scapula and over the buttock to recruit additional
soft tissue for closure as there would be a substantial amount
of skin resected. The patient agreed to proceed.

MEDICAL HISTORY: Hypertension, asthma, hypercalcemia, pneumothorax s/p talc
pleurodiesis [**2094**]

MEDICATION ON ADMISSION: accolate, albuterol, lipitor, norvasc

ALLERGIES: Penicillins / Tetanus / Iodine; Iodine Containing / Peanut Oil /
Demerol / Lidocaine

PHYSICAL EXAM: NAD, alert
Neck: soft, supple, no bruits, no cervical lymphadenopathy
RRR, no murmurs
CTAB, no R/R
Abd: soft, NT, ND, +BS
Ext: warm, well-perfused

FAMILY HISTORY: non- contributory

SOCIAL HISTORY: non-contributory
Neoplasm of uncertain behavior of connective and other soft tissue,Paralytic ileus,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Other acute postoperative pain
Unc behav neo soft tissu,Paralytic ileus,Hypertension NOS,Asthma NOS,Acute postop pain NEC
Admission Date:  [**2103-10-22**]              Discharge Date:   [**2103-11-3**]

Date of Birth:  [**2047-9-14**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Penicillins / Tetanus / Iodine; Iodine Containing / Peanut Oil /
Demerol / Lidocaine

Attending:[**First Name3 (LF) 2969**]
Chief Complaint:
Recurrent desmoid tumor of the left chest wall.


Major Surgical or Invasive Procedure:
Radical resection of recurrent left desmoid tumor with [**Doctor Last Name 4726**]-Tex
chest wall and flank reconstruction with concurrent omental flap
and primary
closure with the assistance of Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] of plastic
surgery.

History of Present Illness:
Mr. [**Known lastname 59199**] is a 56-year-old gentleman with a previous
enucleated desmoid tumor that was referred to me 2-1/2 years ago
at which time I performed a wide excision of this and a [**Doctor Last Name 4726**]-Tex
chest wall reconstruction. He has been followed radiographically
and was found to have 2 enlarging soft tissue masses, one at the
superior aspect of the excision below the latissimus muscle
involving the 6th rib and one inferiorly growing lateral to the
[**Doctor Last Name 4726**]-Tex patch into the subcutaneous fat and dermis. After
preoperative consultation with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], we planned a
radical excision of this. Dr. [**First Name (STitle) **] placed tissue expanders up
behind the scapula and over the buttock to recruit additional
soft tissue for closure as there would be a substantial amount
of skin resected. The patient agreed to proceed.

Past Medical History:
Hypertension, asthma, hypercalcemia, pneumothorax s/p talc
pleurodiesis [**2094**]

Social History:
non-contributory

Family History:
non- contributory

Physical Exam:
NAD, alert
Neck: soft, supple, no bruits, no cervical lymphadenopathy
RRR, no murmurs
CTAB, no R/R
Abd: soft, NT, ND, +BS
Ext: warm, well-perfused


Pertinent Results:
[**2103-10-25**] 07:25AM BLOOD WBC-12.3* RBC-3.63* Hgb-11.3* Hct-32.6*
MCV-90 MCH-31.2 MCHC-34.7 RDW-13.2 Plt Ct-217
[**2103-10-24**] 04:44AM BLOOD PT-15.9* PTT-35.4* INR(PT)-1.4*
[**2103-10-25**] 07:25AM BLOOD Glucose-124* UreaN-25* Creat-1.2 Na-136
K-5.1 Cl-100 HCO3-28 AnGap-13
[**2103-10-25**] 07:25AM BLOOD Calcium-8.6 Phos-2.4* Mg-2.4

Brief Hospital Course:
Pt was admitted on [**2103-10-22**]. Post-operatively, the pt had an
intrathoracic chest tube and [**Doctor Last Name 406**] drain on the left side, as
well as three [**Doctor Last Name 406**] drains placed by plastic surgery. The pt had
an uncomplicated hospital course as was discharged home with VNA
services on POD#7. The pt was extubated overnight in the SICU on
the evening of POD#0. Pain was well controlled with an epidural
catheter. On POD#2 the pt was transferred out of the SICU to a
regular floor bed on [**Hospital Ward Name 121**] 2. The chest tube was removed on POD#2
and the intrathoracic [**Doctor Last Name 406**] was left to bulb suction.
[**Last Name (un) 1372**]-gastric tube was removed on POD#3. On POD#4 Epidural and
Foley catheter were removed and diet was advanced as tolerated
to a regular diet and antibiotics were switched from Kefzol IV
to Keflex PO for prophylaxis while drains remain in place. On
POD#5 the chest [**Doctor Last Name 406**] was removed, the three JP drains placed by
plastics remained to bulb suction. On POD#6 pt was ambulating,
tolerating a regular diet, and pain was well controlled with
oral pain medication. There was still a significant amount of
drainage from the wound site and over the remainder of the
hospital course the patient was closely monitored for signs of
wound dehiscence, infection and breakdown. One of the 3 JP
drains was removed on POD#12. The pt was discharged home on
POD#12 with 2 JP drains to bulb suction with VNA services to
empty drains and check wounds daily. Upon discharge the wound
was clean, dry and intact with no signs of infection. Pt will
follow-up with Plastic Surgery in one week and with Thoracic
Surgery in one week as well.

Medications on Admission:
accolate, albuterol, lipitor, norvasc

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day): this medication will be tapered by Dr. [**Last Name (STitle) **].
Do not take your norvasc while taking this medication.
Disp:*60 Tablet(s)* Refills:*2*
4. Hydrocodone-Acetaminophen 5-500 mg Tablet Sig: 1-2 Tablets PO
Q4H (every 4 hours) as needed.
Disp:*75 Tablet(s)* Refills:*0*
5. Zafirlukast 20 mg Tablet Sig: 0.5 Tablet PO BID (2 times a
day).
6. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
7. Albuterol 90 mcg/Actuation Aerosol Sig: [**12-12**]  Inhalation every
four (4) hours as needed for shortness of breath or wheezing.
Disp:*1 mdi* Refills:*1*
8. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours) for 7 days.
Disp:*28 Capsule(s)* Refills:*1*


Discharge Disposition:
Home With Service

Facility:
TBA

Discharge Diagnosis:
re-excision of left chest wall Desmoid tumor with en bloc
portions of left ribs [**4-21**] and placement of gortex graft to
reconstruct left chest wall.

s/p resection L chest wall desmoid tumor [**2-15**], HTN, asthma,
hypercalcemia, ptx s/p talc pleurodiesis 6 years ago


Discharge Condition:
good


Discharge Instructions:
call Dr.[**Doctor Last Name 4738**] office [**Telephone/Fax (1) 170**] if you develop chest pain,
shortness of breath, fever, chills, redness or drainage from
your incision site.
You cannot shower until you have had your Plastic Surgery follow
up appointment.
keep your drain sites clean and dry. Empty the drains daily and
keep a log of the output- bring this log to your follow up
appointment.
Keep a clean tegaderm dressing daily on your incision site.

Followup Instructions:
You have a follow up appointment with Dr. [**Last Name (STitle) **] on [**11-8**] in the
[**Hospital **] Medical office building [**Hospital Unit Name **] [**Doctor First Name **]
[**Telephone/Fax (1) 170**]. Please arrive 30 minutes prior to your appointment
for a CXR on the [**Hospital Ward Name **] [**Location (un) 470**] radiology.
and a follow up appointment with Dr. [**First Name (STitle) **] on [**11-8**] at [**Street Address(2) **], [**Apartment Address(1) **], [**Location (un) **]- [**Telephone/Fax (1) 59200**]

Please  call the clinic on Monday to schedule a time for these
appointments.
{'Neoplasm of uncertain behavior of connective and other soft tissue,Paralytic ileus,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Other acute postoperative pain'}


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: Recurrent desmoid tumor of the left chest wall.

PRESENT ILLNESS: Mr. [**Known lastname 59199**] is a 56-year-old gentleman with a previous
enucleated desmoid tumor that was referred to me 2-1/2 years ago
at which time I performed a wide excision of this and a [**Doctor Last Name 4726**]-Tex
chest wall reconstruction. He has been followed radiographically
and was found to have 2 enlarging soft tissue masses, one at the
superior aspect of the excision below the latissimus muscle
involving the 6th rib and one inferiorly growing lateral to the
[**Doctor Last Name 4726**]-Tex patch into the subcutaneous fat and dermis. After
preoperative consultation with Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], we planned a
radical excision of this. Dr. [**First Name (STitle) **] placed tissue expanders up
behind the scapula and over the buttock to recruit additional
soft tissue for closure as there would be a substantial amount
of skin resected. The patient agreed to proceed.

MEDICAL HISTORY: Hypertension, asthma, hypercalcemia, pneumothorax s/p talc
pleurodiesis [**2094**]

MEDICATION ON ADMISSION: accolate, albuterol, lipitor, norvasc

ALLERGIES: Penicillins / Tetanus / Iodine; Iodine Containing / Peanut Oil /
Demerol / Lidocaine

PHYSICAL EXAM: NAD, alert
Neck: soft, supple, no bruits, no cervical lymphadenopathy
RRR, no murmurs
CTAB, no R/R
Abd: soft, NT, ND, +BS
Ext: warm, well-perfused

FAMILY HISTORY: non- contributory

SOCIAL HISTORY: non-contributory 

### Response:
{'Neoplasm of uncertain behavior of connective and other soft tissue,Paralytic ileus,Unspecified essential hypertension,Asthma, unspecified type, unspecified,Other acute postoperative pain'}
