CHIEF COMPLAINT: left lower lobe nodule, concerning for metastatic colon cancer.

PRESENT ILLNESS: The patient is a woman with
metastatic colon cancer to the left lower lobe.  The lesion
was 4 cm in size and was not able to be resected by a
wedge resection.  The patient had limited pulmonary reserve
due to longstanding bronchiectasis in the lingula.  We
discussed the options of surgery versus radiosurgery. Given
the size of the tumor we felt that local control would be
best achieved by surgical resection.

MEDICAL HISTORY: - Deafness in LEFT ear
- Dyslipidemia
- Hypertension
- h/o Pseudomonas pneumonia ([**9-/2173**])
- Bronchiectasis
- Arthritis (hips)
- L4-5 herniated disc w/ occasional LEFT leg radiculopathy
- Hiatal hernia
- GERD
- Glaucoma
- Osteoporosis
- Depression
- Colon cancer ([**2167**]) s/p surgery & chemo
- Ovarian & mesenteric metastases s/p surgery ([**2171**])
- LLL lung metastases ([**11/2173**])

MEDICATION ON ADMISSION: Acebutolol 200mg PO daily
Lumigan eye drops
Diltiazem XR 120mg PO daily
Lovastatin 20mg Po daily
Omeprazole 40mg PO daily
Pamidronate
Paxil 10mg PO daily
Guaifenesin 400mg PO daily

ALLERGIES: alphagan

PHYSICAL EXAM: Vital signs on discharge:
T 99.7, BP 100/50, HR 76 atrial fibrillation, RR 16-25, Pressure
support ventilation via # 8 [**Telephone/Fax (3) **] trach, PS 5/Peep 5, FIO2 40%

FAMILY HISTORY: Sister had TB in teen years

SOCIAL HISTORY: Lives alone
Occupation- retired
Smoking history- life long nonsmoker
Alcohol- occasional
Secondary malignant neoplasm of lung,Pneumonia due to Pseudomonas,Delirium due to conditions classified elsewhere,Pleurisy without mention of effusion or current tuberculosis,Bronchiectasis without acute exacerbation,Carrier or suspected carrier of other specified bacterial diseases,Personal history of malignant neoplasm of large intestine,Personal history of tuberculosis,Thoracoscopic surgical procedure converted to open procedure,Atrial fibrillation,Other fluid overload,Cardiac complications, not elsewhere classified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Esophageal reflux,Osteoporosis, unspecified,Unspecified hearing loss,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Secondary malig neo lung,Pseudomonal pneumonia,Delirium d/t other cond,Pleurisy w/o effus or TB,Bronchiectas w/o ac exac,Bacteria dis carrier NEC,Hx of colonic malignancy,Prsnl hst tuberculosis,Thoracoscop conv to open,Atrial fibrillation,Fluid overload NEC,Surg compl-heart,Hyperlipidemia NEC/NOS,Hypertension NOS,Esophageal reflux,Osteoporosis NOS,Hearing loss NOS,Abn reac-organ rem NEC
Admission Date:  [**2174-1-14**]              Discharge Date:   [**2174-1-31**]

Date of Birth:  [**2099-12-28**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
alphagan

Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
left lower lobe nodule, concerning for metastatic colon cancer.

Major Surgical or Invasive Procedure:
[**2174-1-14**]: Left VATS converted to left thoracotomy, basilar
segmentectomy of the left lower lobe. Mediastinal lymph node
dissection.
[**2174-1-18**]: Right right brachial 35 cm PICC line placement
[**2174-1-25**]: Percutaneous tracheostomy.
          Placement of percutaneous endoscopic gastrostomy tube.


History of Present Illness:
The patient is a woman with
metastatic colon cancer to the left lower lobe.  The lesion
was 4 cm in size and was not able to be resected by a
wedge resection.  The patient had limited pulmonary reserve
due to longstanding bronchiectasis in the lingula.  We
discussed the options of surgery versus radiosurgery. Given
the size of the tumor we felt that local control would be
best achieved by surgical resection.


Past Medical History:
- Deafness in LEFT ear
- Dyslipidemia
- Hypertension
- h/o Pseudomonas pneumonia ([**9-/2173**])
- Bronchiectasis
- Arthritis (hips)
- L4-5 herniated disc w/ occasional LEFT leg radiculopathy
- Hiatal hernia
- GERD
- Glaucoma
- Osteoporosis
- Depression
- Colon cancer ([**2167**]) s/p surgery & chemo
- Ovarian & mesenteric metastases s/p surgery ([**2171**])
- LLL lung metastases ([**11/2173**])

PSHx:
- Bilateral cataracts
- Partial colectomy ([**2167**])
- Resection ovarian & mesenteric mets ([**2171**])
- Tonsils
- Breast Lumpectomy x2
- Resection bilateral hip bursae
- Port-a-cath placement & removal


Social History:
Lives alone
Occupation- retired
Smoking history- life long nonsmoker
Alcohol- occasional

Health care proxy:[**Name (NI) 15406**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 1662**]
Relationship: niece
[**Telephone/Fax (3) 89730**]


Family History:
Sister had TB in teen years


Physical Exam:
Vital signs on discharge:
T 99.7, BP 100/50, HR 76 atrial fibrillation, RR 16-25, Pressure
support ventilation via # 8 [**Telephone/Fax (3) **] trach, PS 5/Peep 5, FIO2 40%

Discharge physical exam:
Gen: pleasant, arousable, alert and oriented x 3. Moves all
extremities equally to command. PERRLA.
Neck: #8 [**Telephone/Fax (3) **] trach, sutured
Lungs: rhonchi b/l throughout
CV: irregular rate and rhythm, without MRG, or JVD
Abd: soft, NT, ND, [**Telephone/Fax (3) 282**] intact.
Ext: warm without edema


Pertinent Results:
[**2174-1-31**] 03:31AM BLOOD WBC-9.8 RBC-2.84* Hgb-8.7*# Hct-24.9*
MCV-88 MCH-30.5 MCHC-34.7 RDW-15.5 Plt Ct-483*
[**2174-1-30**] 03:32PM BLOOD Hct-25.1*
[**2174-1-30**] 01:00AM BLOOD WBC-9.2 RBC-2.30* Hgb-6.9* Hct-20.7*
MCV-90 MCH-29.8 MCHC-33.2 RDW-15.2 Plt Ct-395
[**2174-1-29**] 04:19AM BLOOD WBC-10.8 RBC-2.41* Hgb-7.4* Hct-21.8*
MCV-90 MCH-30.6 MCHC-33.8 RDW-15.5 Plt Ct-495*
[**2174-1-28**] 01:34AM BLOOD WBC-14.3* RBC-2.83* Hgb-8.5* Hct-25.3*
MCV-89 MCH-30.0 MCHC-33.6 RDW-15.7* Plt Ct-551*
[**2174-1-27**] 02:13AM BLOOD WBC-13.5* RBC-2.75* Hgb-8.4* Hct-24.6*
MCV-90 MCH-30.4 MCHC-33.9 RDW-15.5 Plt Ct-497*
[**2174-1-26**] 04:46PM BLOOD WBC-13.2* RBC-2.96* Hgb-9.0* Hct-26.3*
MCV-89 MCH-30.5 MCHC-34.4 RDW-15.7* Plt Ct-543*
[**2174-1-31**] 11:53AM BLOOD PT-18.9* PTT-56.2* INR(PT)-1.7*
[**2174-1-31**] 03:31AM BLOOD PT-17.6* PTT-77.0* INR(PT)-1.6*
[**2174-1-30**] 03:32PM BLOOD PT-16.8* PTT-65.5* INR(PT)-1.5*
[**2174-1-30**] 06:30AM BLOOD PT-16.8* PTT-62.2* INR(PT)-1.5*
[**2174-1-29**] 10:58PM BLOOD PT-16.8* PTT-72.2* INR(PT)-1.5*
[**2174-1-28**] 02:30PM BLOOD PT-16.7* PTT-55.6* INR(PT)-1.5*
[**2174-1-27**] 06:29PM BLOOD PT-15.6* PTT-37.5* INR(PT)-1.4*
[**2174-1-26**] 04:46PM BLOOD PT-15.2* PTT-49.0* INR(PT)-1.3*
[**2174-1-31**] 03:31AM BLOOD Glucose-118* UreaN-30* Creat-0.7 Na-140
K-3.5 Cl-99 HCO3-30 AnGap-15
[**2174-1-30**] 03:32PM BLOOD Glucose-123* UreaN-27* Creat-0.7 Na-138
K-3.7 Cl-99 HCO3-29 AnGap-14
[**2174-1-30**] 01:00AM BLOOD Glucose-112* UreaN-31* Creat-0.8 Na-140
K-4.1 Cl-105 HCO3-26 AnGap-13
[**2174-1-31**] 03:31AM BLOOD Calcium-8.2* Phos-3.7 Mg-2.0
[**2174-1-30**] 03:32PM BLOOD Calcium-8.3* Phos-3.7 Mg-2.0
[**2174-1-30**] 01:00AM BLOOD Calcium-9.1 Phos-3.1 Mg-2.4
[**2174-1-28**] 08:16AM BLOOD Type-ART Rates-/34 Tidal V-420 FiO2-6
pO2-161* pCO2-46* pH-7.44 calTCO2-32* Base XS-6
Intubat-INTUBATED
[**2174-1-24**] 01:13AM BLOOD Lactate-0.5

[**2174-1-27**] 6:29 pm URINE      Source: Catheter.

                            **FINAL REPORT [**2174-1-28**]**

   URINE CULTURE (Final [**2174-1-28**]):    NO GROWTH.

Blood culture [**2174-1-27**]: negative to date, but still preliminary

[**2174-1-27**] 4:27 pm SPUTUM      Source: Endotracheal.

                            **FINAL REPORT [**2174-1-29**]**

   GRAM STAIN (Final [**2174-1-27**]):
      >25 PMNs and <10 epithelial cells/100X field.
      NO MICROORGANISMS SEEN.

   RESPIRATORY CULTURE (Final [**2174-1-29**]):
      SPARSE GROWTH Commensal Respiratory Flora.

[**2174-1-24**] 5:58 am STOOL     CONSISTENCY: NOT APPLICABLE
      Source: Stool.

                            **FINAL REPORT [**2174-1-25**]**

   CLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final [**2174-1-25**]):
      Feces negative for C.difficile toxin A & B by EIA.
           (Reference Range-Negative).

[**2174-1-21**] 8:26 am BLOOD CULTURE      Source: Venipuncture.

                            **FINAL REPORT [**2174-1-27**]**

   Blood Culture, Routine (Final [**2174-1-27**]):    NO GROWTH.

Time Taken Not Noted     Log-In Date/Time: [**2174-1-14**] 11:10 pm
      BRONCHOALVEOLAR LAVAGE      LEFT UPPER LOBE.

   GRAM STAIN (Final [**2174-1-15**]):
      4+   (>10 per 1000X FIELD):   POLYMORPHONUCLEAR
LEUKOCYTES.
      4+   (>10 per 1000X FIELD):   GRAM NEGATIVE ROD(S).

   RESPIRATORY CULTURE (Final [**2174-1-21**]):
      10,000-100,000 ORGANISMS/ML. Commensal Respiratory Flora.
      PSEUDOMONAS AERUGINOSA.    >100,000 ORGANISMS/ML..
         sensitivity testing performed by Microscan.
         MEROPENEM (<=1.0 MCG/ML), CEFEPIME (<=2.0 MCG/ML).

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             PSEUDOMONAS AERUGINOSA
                             |
CEFEPIME--------------       S
CEFTAZIDIME-----------   <=1 S
CIPROFLOXACIN---------     2 I
GENTAMICIN------------   <=1 S
MEROPENEM-------------       S
PIPERACILLIN/TAZO-----   <=8 S
TOBRAMYCIN------------   <=1 S

   ACID FAST CULTURE (Preliminary):    NO MYCOBACTERIA ISOLATED.


   ACID FAST SMEAR (Final [**2174-1-17**]):
      NO ACID FAST BACILLI SEEN ON DIRECT SMEAR.
      NO ACID FAST BACILLI SEEN ON CONCENTRATED SMEAR.

   FUNGAL CULTURE (Final [**2174-1-28**]):    NO FUNGUS ISOLATED.

CXR [**2174-1-29**]:
REASON FOR EXAMINATION: Evaluation of the patient with
thoracotomy.

Portable AP chest radiograph was reviewed in comparison to [**1-28**], [**2173**].

Tracheostomy is in place with its tip being 5.5 cm above the
carina. There is no change in the left lower lung atelectasis
and widespread parenchymal
consolidations seen throughout the lungs. The right PICC line is
in place,
unchanged. Multiple clips projecting over the mediastinum are
unchanged as
well.

IMPRESSION: No short-term interval change

CXR [**2174-1-31**]:
Mild pulmonary edema improved. Small left pleural effusion-
stable. R PICC upper SVC. increased gas in abdomen.


Brief Hospital Course:
Ms. [**Known firstname 4134**] [**Known lastname **] was taken to the operating room on [**2174-1-14**] by
Dr. [**First Name (STitle) **] for a left VATS converted to left thoracotomy, basilar
segmentectomy of the left lower lobe and mediastinal lymph node
dissection for metastatic colon cancer. She recovered in the
PACU, where anesthesia placed an epidural for better pain
control.  BAL from OR bronch grew 4+ PMNs and 4+ GNR and she was
started on antipseudomonal coverage in PACU. She was
subsequently transferred to SICU for close observation of
respiratory function. Below is a systems review of her hospital
course:

Neurologic/Pain:
The patient was given an epidural with bupivicaine and dilaudid
postoperatively in PACU for pain relief which was effective, but
the patient become more sedate, therefore dilaudid split and
then dc'd. The patient was intubated [**2174-1-16**] for pneumonia and
while intubated was sedated on propofol and prn fentanyl. On
date of discharge the patient denies pain, off all pain
medication. Prn tylenol ordered.
The patient had agitation requiring initial versed, then
olanzapine, queitapine, then geriatrics was consulted on [**2174-1-28**]
to assist in managment. Haldol as given [**Hospital1 **], and slowly titrated
to off on [**2174-1-31**] per geriatrics. They also recommended
increasing paxil to 20mg po daily which was done on [**2174-1-31**] and
may benefit from ativan if agitated- we will leave this to
[**Hospital1 89731**] discretion.

Pulmonary: Pulmonary toilet was instituted post op, she was
noted to experience desaturations and intraoperative
bronchoscopy showed purulent fluid in the left upper lobe. BAL
grew 4+ PMNs and 4+ GNR and she was started on antipseudomonal
coverage in PACU. She was subsequently transferred to SICU for
close observation of respiratory function. The patient was
intubated on [**2174-1-16**] and required CMV with Peep up to 10 at
times. A repeat bronchoscopy was done on [**1-20**] with thick
secretions on left around stump and right middle lobe. On [**2174-1-25**]
the patient received #8 [**Date Range **] tracheostomy. She tolerated CPAP
40% FIO2 [**3-24**] on discharge, but not weaned to trach collar. Not
requiring much suctioning on day of discharge. She had a left
chest tube that was discontinued postoperatively without
pneumothorax, on [**2174-1-18**].

Cardiovascular:
The patient developed postoperative atrial fibrillation which
was rate controlled initially with diltiazem drip, after
diltiazem 5mg IV x 2 and then metoprolol 5mg IV. Medications
were transitioned to diltiazem 30mg po qid, and lopressor 25mg
po TID. Lasix drip was started [**1-20**] for volume overload which
adequately diuresed the patient, then changed to 20mg IV BID on
[**1-23**]. This was restarted on [**2174-1-30**] and stopped on discharge. She
was started for [**Hospital1 **] on lasix 20mg po BID as she appears
euvolemic, and this will keep her so. This will need titration
and electrolytes with replacement.

Gastrointestinal / Abdomen / Nutrition:
A dobhoff was placed and tube feedings were started initially
with replete, then changed to nutrene pulmonary on [**1-21**] and
advanced to goal of 40ml/hour. She was given stool softeners
with good response. Cdif cultures sent on [**1-24**] and negative. She
had a [**Month/Day (4) 282**] placed [**2174-1-25**], and tolerated food through such. Guiac
sent [**2174-1-31**] and negative.

Renal:
Foley was kept and kidney function monitored. The patient was
diuresed per above which as effective. Electrolytes repleted as
needed.

Hematology:
CBC and fevers curves monitored closely.
The patient required a unit of PRBC on [**2174-1-24**] and [**2174-1-30**]. Per
above, the patient was guaiac negative.
Heparin gtt was started [**2174-1-23**] for persistent atrial fibillation
with goal PTT 50-70. This should be dc'd when INR therapeutic.
This is new for the patient. Coumadin was started on [**2174-1-26**] for
persistent atrial fibrillation. Her coumadin and INR trends are
below:
[**1-26**] 3mg, INR  1.4
[**1-27**] 3mg, INR 1.4
[**1-28**] 3mg, INR 1.4
[**1-29**] 5mg, INR 1.5
[**1-30**] 7.5, INR 1.5
[**1-31**] 7.5, INR 1.7

Endocrine:
The patient was kept on an insulin sliding scale throughout her
ICU stay and blood sugars were kept in the low 100's. This was
dc'd on discharge.

Infectious disease:  Pseudomonas grew from BAL [**1-17**]. VAP +
antipseudomonal coverage: cefepime + tobramycin, vanco was
started [**2174-1-16**].
Vanco and tobramycin trough levels were monitored. ID consult
was obtained.
Vanco D/C [**1-22**]. Cefepime 2gm IV q12h and tobramycin 330mg IV q24h
until [**1-23**], then Cefepime alone was continued and dc'd on
[**2174-1-31**]. The patient was recultured [**2174-1-27**] for fever: all
negative to date. We will follow the final results of the blood
and sputum. Urine was negative.

Dispo: The patient was deemed ready for transfer to [**Hospital1 **]
ventilator rehabilitation on [**2174-1-31**] per attending Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] [**Telephone/Fax (1) 2348**]. Patient and neice aware of transfer. Report
called to Dr. [**First Name (STitle) 6382**].

Medications on Admission:
Acebutolol 200mg PO daily
Lumigan eye drops
Diltiazem XR 120mg PO daily
Lovastatin 20mg Po daily
Omeprazole 40mg PO daily
Pamidronate
Paxil 10mg PO daily
Guaifenesin 400mg PO daily


Discharge Medications:
1. paroxetine HCl 10 mg/5 mL Suspension [**First Name (STitle) **]: Twenty (20) mg PO
DAILY (Daily): this dose increased to 20mg from 10mg [**2174-1-31**] per
Geriatrics.
2. lovastatin 20 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO once a day:
crush, and give via [**Month/Day/Year 282**].
3. docusate sodium 50 mg/5 mL Liquid [**Month/Day/Year **]: Ten (10) ml PO BID (2
times a day): to prevent constipation.
4. latanoprost 0.005 % Drops [**Month/Day/Year **]: One (1) Drop Ophthalmic HS (at
bedtime).
5. diltiazem HCl 30 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO QID (4
times a day): hold SBP <100, HR <60.
6. bisacodyl 10 mg Suppository [**Month/Day/Year **]: One (1) Suppository Rectal
HS (at bedtime) as needed for constipation.
7. acetaminophen 325 mg Tablet [**Month/Day/Year **]: Two (2) Tablet PO Q6H (every
6 hours) as needed for fever, pain.
8. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization [**Month/Day/Year **]: One (1) neb Inhalation Q4H (every 4 hours) as
needed for wheezing.
9. metoprolol tartrate 25 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO TID
(3 times a day): hold SBP <95, HR <60.
10. heparin (porcine) in D5W 25,000 unit/250 mL Parenteral
Solution [**Month/Day/Year **]: 1550 (1550) units Intravenous per hour: titrate to
keep PTT 50-70 until INR >2.0 for atrial fibrillation.
11. senna 8.6 mg Tablet [**Month/Day/Year **]: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
12. warfarin 5 mg Tablet [**Month/Day/Year **]: 1.5 Tablets PO ONCE (Once) for 1
doses: [**1-31**] dose. check INR [**2174-2-1**] for subsequent dosing.
13. lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] once a day: via [**Last Name (STitle) 282**].
14. Heparin Flush (10 units/ml) 2 mL IV PRN line flush
PICC, heparin dependent: Flush with 10mL Normal Saline followed
by Heparin as above daily and PRN per lumen.
15. Lasix 20 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO twice a day: crush
give via J-tube.
16. potassium chloride 20 mEq Packet [**Last Name (STitle) **]: Twenty (20) mEq PO
twice a day: check daily chemistries while titrating lasix to
ensure proper lyte replacement. .
17. Haldol 5 mg/mL Solution [**Last Name (STitle) **]: 0.5 mg Injection q 30 minutes
up to total of 2mg as needed for acute agitation: do not exceed
5mg/24hours.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 105**] - [**Location (un) 1121**] - [**Location (un) 1456**]

Discharge Diagnosis:
-Left lower lobe metastatic colorectal adenocarcinoma
-Atrial fibrillation
-Postoperative pneumonia with respiratory failure s/p
tracheostomy [**2174-1-25**] # 8 [**Last Name (LF) 67572**], [**First Name3 (LF) 282**] placement [**2174-1-25**]
-HTN
-GERD
-Osteoporosis


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Alert and interactive.
Activity Status: Bedbound.


Discharge Instructions:
Call Dr.[**Name (NI) 5067**] office [**Telephone/Fax (1) 2348**] if you experience:
-Fevers greater than 101.5 or chills
-Increased shortness of breath, cough or chest pain
-Incision develops drainage or increased redness
-Wash incision with mild soap and water, rinse, pat dry

Right right brachial 35 cm PICC line with tip in the mid SVC
placed [**2174-1-18**]: PICC line care and flushes per protocol.

Trach #8 [**Year/Month/Day 67572**] placed [**2174-1-25**]
-Trach care per protocol
-Tracheal suture removal [**2174-2-4**]

[**Month/Day/Year 282**] tube- Care per protocol

Heparin gtt- titrate PTT goal 50-70. Stop heparin gtt when INR
therapeutic for afib.

Check INR daily until at goal, then per institution.


Followup Instructions:
Follow up with Dr. [**First Name (STitle) **] [**0-0-**] Date/Time: Tuesday [**3-8**], [**2173**] at 11am on the [**Hospital Ward Name 516**] [**Hospital Ward Name 23**] Clinical Center [**Location (un) **]
Chest X-Ray [**Location (un) 861**] Radiology 30 minutes before your
appointment



Completed by:[**2174-1-31**]
{'Secondary malignant neoplasm of lung,Pneumonia due to Pseudomonas,Delirium due to conditions classified elsewhere,Pleurisy without mention of effusion or current tuberculosis,Bronchiectasis without acute exacerbation,Carrier or suspected carrier of other specified bacterial diseases,Personal history of malignant neoplasm of large intestine,Personal history of tuberculosis,Thoracoscopic surgical procedure converted to open procedure,Atrial fibrillation,Other fluid overload,Cardiac complications, not elsewhere classified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Esophageal reflux,Osteoporosis, unspecified,Unspecified hearing loss,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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 lower lobe nodule, concerning for metastatic colon cancer.

PRESENT ILLNESS: The patient is a woman with
metastatic colon cancer to the left lower lobe.  The lesion
was 4 cm in size and was not able to be resected by a
wedge resection.  The patient had limited pulmonary reserve
due to longstanding bronchiectasis in the lingula.  We
discussed the options of surgery versus radiosurgery. Given
the size of the tumor we felt that local control would be
best achieved by surgical resection.

MEDICAL HISTORY: - Deafness in LEFT ear
- Dyslipidemia
- Hypertension
- h/o Pseudomonas pneumonia ([**9-/2173**])
- Bronchiectasis
- Arthritis (hips)
- L4-5 herniated disc w/ occasional LEFT leg radiculopathy
- Hiatal hernia
- GERD
- Glaucoma
- Osteoporosis
- Depression
- Colon cancer ([**2167**]) s/p surgery & chemo
- Ovarian & mesenteric metastases s/p surgery ([**2171**])
- LLL lung metastases ([**11/2173**])

MEDICATION ON ADMISSION: Acebutolol 200mg PO daily
Lumigan eye drops
Diltiazem XR 120mg PO daily
Lovastatin 20mg Po daily
Omeprazole 40mg PO daily
Pamidronate
Paxil 10mg PO daily
Guaifenesin 400mg PO daily

ALLERGIES: alphagan

PHYSICAL EXAM: Vital signs on discharge:
T 99.7, BP 100/50, HR 76 atrial fibrillation, RR 16-25, Pressure
support ventilation via # 8 [**Telephone/Fax (3) **] trach, PS 5/Peep 5, FIO2 40%

FAMILY HISTORY: Sister had TB in teen years

SOCIAL HISTORY: Lives alone
Occupation- retired
Smoking history- life long nonsmoker
Alcohol- occasional 

### Response:
{'Secondary malignant neoplasm of lung,Pneumonia due to Pseudomonas,Delirium due to conditions classified elsewhere,Pleurisy without mention of effusion or current tuberculosis,Bronchiectasis without acute exacerbation,Carrier or suspected carrier of other specified bacterial diseases,Personal history of malignant neoplasm of large intestine,Personal history of tuberculosis,Thoracoscopic surgical procedure converted to open procedure,Atrial fibrillation,Other fluid overload,Cardiac complications, not elsewhere classified,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Esophageal reflux,Osteoporosis, unspecified,Unspecified hearing loss,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
