CHIEF COMPLAINT: elective admission for surgery

PRESENT ILLNESS: The patient is a 76-year-old who is well known to me from
previous hospital visit and extensive counseling. The patient is
a 76-year-old retired physician who was referred by Dr.
[**Last Name (STitle) 1837**] for a recurrent atypical melanoma that has
metastasized to the paranasal sinus. The patient has had
previous facial resection, fascia reconstruction, radiation
therapy. He now returns with progressive obstruction of airway
and imaging revealing an extensive metastasizing tumor growing
in the paranasal sinus. Since the lesion has eroded the frontal
skull base and filled the paranasal sinus, a surgical removal is
the treatment of choice. The patient was extensively counseled.
The patient
was then consented. The patient was taken electively to the
operating room.

MEDICAL HISTORY: R nephrectomy (metanephric adenoma '[**22**]),BPH s/p TURP '[**99**],
diverticulitis s/p colectomy '[**26**] c/b post-op leak/pancreatitis,
s/p rsxn desmoplastic melanoma [**Last Name (LF) 50847**], [**First Name3 (LF) **] fever @7yr,
thyphoid fever '[**89**], s/p Rt parotidectomy '[**91**], HTN

MEDICATION ON ADMISSION: ASA 81mg', Norvasc 5mg/hs, Prilosec 20mg', Altace 10mg"

ALLERGIES: Penicillins / Hayfever

PHYSICAL EXAM: On Discharge:
Alert, oriented. Pupils equally round and reactive to light.
Full motor strength in upper and lower extremities. Sensation
grossly intact.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Retired physician, [**Name10 (NameIs) 64683**] lives in [**Location 64684**], NY with wife
Secondary malignant neoplasm of other respiratory organs,Secondary malignant neoplasm of other specified sites,Accidental puncture or laceration of dura during a procedure,Personal history of malignant melanoma of skin,Other specified cardiac dysrhythmias,Accidental cut, puncture, perforation or hemorrhage during surgical operation
Sec malig neo resp NEC,Secondary malig neo NEC,Accid punc/op lac dura,Hx-malig skin melanoma,Cardiac dysrhythmias NEC,Acc cut/hem in surgery
Admission Date:  [**2131-5-10**]              Discharge Date:   [**2131-5-19**]

Date of Birth:  [**2054-10-22**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Penicillins / Hayfever

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
elective admission for surgery

Major Surgical or Invasive Procedure:
[**2131-5-10**] Bifrontal craniotomy for resection,Removal of metastatic
lesion from the cribriform plate, posterior ethmoidal cells and
paranasal sinus, exenteration of frontal sinus with
cranialization, pericranial graft with vascular pedicleized
flap, primary repair of skull base CSF leak.
6. Microscopic dissection.
7. Lumbar drain placement.


History of Present Illness:
The patient is a 76-year-old who is well known to me from
previous hospital visit and extensive counseling. The patient is
a 76-year-old retired physician who was referred by Dr.
[**Last Name (STitle) 1837**] for a recurrent atypical melanoma that has
metastasized to the paranasal sinus. The patient has had
previous facial resection, fascia reconstruction, radiation
therapy. He now returns with progressive obstruction of airway
and imaging revealing an extensive metastasizing tumor growing
in the paranasal sinus. Since the lesion has eroded the frontal
skull base and filled the paranasal sinus, a surgical removal is
the treatment of choice. The patient was extensively counseled.
The patient
was then consented. The patient was taken electively to the
operating room.


Past Medical History:
R nephrectomy (metanephric adenoma '[**22**]),BPH s/p TURP '[**99**],
diverticulitis s/p colectomy '[**26**] c/b post-op leak/pancreatitis,
s/p rsxn desmoplastic melanoma [**Last Name (LF) 50847**], [**First Name3 (LF) **] fever @7yr,
thyphoid fever '[**89**], s/p Rt parotidectomy '[**91**], HTN

Social History:
Retired physician, [**Name10 (NameIs) 64683**] lives in [**Location 64684**], NY with wife

Family History:
non-contributory

Physical Exam:
On Discharge:
Alert, oriented. Pupils equally round and reactive to light.
Full motor strength in upper and lower extremities. Sensation
grossly intact.

Pertinent Results:
CT [**2131-5-14**]:
FINDINGS: Patient is status post bifrontal craniotomy for
extirpation of
extensive metastatic (melanoma) involvement of the cribriform
plate and
paranasal sinuses. Post-surgical changes including bifrontal
craniotomy and cranialization of the frontal sinuses, with
osseous metallic plates unchanged in configuration although and
mild increase of complex fluid is demonstrated within the
intracranial post-surgical bed. Degree of pneumocephalus has
decreased since prior study, yet right frontal subgaleal air has
increased in the interim. Linear region of calcified
hyperattenuation separating the cerebral hemispheres from the
post- craniotomy fluid collection remains stable; however, the
degree of mass effect upon the frontal horns of the lateral
ventricles has decreased, suggesting decreasing edema within the
cerebral hemispheres. No shift of normally-midline structures is
demonstrated. The major basal cisterns are preserved. A large
amount of hemorrhage and opacification is again demonstrated
within the right maxillary, ethmoid and sphenoid sinuses
extending into the posteriorly-deroofed frontal sinuses which is
contiguous with the intracranial postsurgical bed. An unusual
linear collection of air is demonstrated within the
post-surgical fluid collection, possibly collecting underneath a
faint septation or fibrous band (2:23). No intracranial drain is
identified to otherwise account for this finding (and none is
mentioned in the operative report). The mastoid air cells again
demonstrate patchy opacification, bilaterally.
IMPRESSION:
1. Mild increase in complex fluid within the post-surgical bed
with shift of pneumocephalus, extracranially, to the right
frontal subgaleal space.
2. Decreased effacement of bilateral frontal horns suggests
decreased edema within bilateral cerebral hemispheres, with
decreased mass effect. No new intracranial herniation or shift
of normally-midline structures demonstrated.

MRI Head [**2131-5-12**]:
FINDINGS: There is an enormous collection of gas, with a
2-tiered fluid
level, with T2 hyperintense components superiorly and T2
hypointense
components on the more dependent side of the fluid collection.
This
area/fluid mixture lies in the extradural compartment, and
presumably connects with the operative bed. There is a
considerable amount of fluid within the right maxillary sinus,
with loss of aeration of the sphenoid sinus, particularly on the
right side, as well as considerable high T2 signal, with some
fluid levels within the mastoid sinuses. Within the operative
bed is a mixture of T2 signal, some of which appears similar in
distribution to the preoperative images of the tumor seen near
the posterior aspect of the right cribriform plate. It is very
difficult, on the basis of this study, to be certain whether
there has been complete removal of the tumor. The large frontal
air-fluid collection causes marked compression of the brain,
with telescoped appearance of the corpus callosum. Marked
compression of the frontal horns is seen, but there is no
subfalcine or transtentorial herniation. There is considerable
pachymeningeal enhancement throughout the supratentorial region.
Enhancement along the clivus is seen extending into the right
internal auditory canal. However, review of the preoperative
study appears to show some clival enhancement extending towards
the right porus acusticus. While the present study's
pachymeningeal enhancement may be a reflection of the extensive
recent operation, the preoperative enhancement raises the
possibility of venous distention, versus pachymeningeal spread
of tumor. This latter diagnosis is of some concern, particularly
in light of the enhancement in the right internal auditory
canal. There is no area of pathological enhancement within the
brain parenchyma itself.
CONCLUSION: Large intracranial gas/fluid collection posteriorly
displacing
the frontal lobes. The fluid may have blood components
accounting for the
two-tiered appearance, noted above. Additional findings, as
noted above.

CT Head [**5-14**]:
IMPRESSION:
1. Mild increase in complex fluid within the post-surgical bed
with shift of pneumocephalus, extracranially, to the right
frontal subgaleal space.
2. Decreased effacement of bilateral frontal horns suggests
decreased edema within bilateral cerebral hemispheres, with
decreased mass effect. No new intracranial herniation or shift
of normally-midline structures demonstrated.

EKG [**5-16**]:
Sinus rhythm with ventricular premature complexes in bigeminy
pattern
Modest nonspecific ST-T wave changes,No previous tracing
available for comparison
  Intervals Axes
Rate PR QRS QT/QTc P QRS T
93 156 90 [**Telephone/Fax (2) 64685**]



Brief Hospital Course:
Patient was electively admitted on [**5-10**] for previously planned
bifrontal craniotomy with Drs. [**Last Name (STitle) **] and [**Name5 (PTitle) 1837**](ENT).
Post operatively, he was transferred to the ICU where he
remained intubated until [**5-11**]. He still required nicardipine for
systolic pressure control, and lethargic, but following
commands. On [**5-12**] MRI was completed and revealed expected
post-surgical changes. The lumbar drain was clamped as well. On
[**5-13**], he continued to have persistent lethargy and a repeated
head CT was performed, revealing some sulcal effacement. A one
time dose of mannitol was given for this indication. Head CT was
repeated on [**5-14**]; and determined to be slightly improved from the
mannitol. He continued to not have any obvious leak of CSF, so
lumbar drain was removed on [**5-14**].  On [**5-15**], he was significantly
more lucid, with full strength throughout upper and lower
extremities, passed speach and swallow, and subsequently
transferred to the neurosurgical stepdown unit. On [**5-16**] he had a
short burst of bigeminy, remaining normotensive.  The cardiology
service was curbsided, and they recommended the addition of a
beta blocker. This was done with appropriate effect. On [**5-17**] he
was seen and evaluated by PT and OT who recommended that he be
discharged to home with services. On the morning of [**5-18**], he was
discharged accordingly with instructions to follow up with his
home oncologist; and instructions for suture removal.

Medications on Admission:
ASA 81mg', Norvasc 5mg/hs, Prilosec 20mg', Altace 10mg"

Discharge Medications:
1. Ramipril 5 mg Capsule Sig: Two (2) Capsule PO BID (2 times a
day).
2. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*0*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*0*
5. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
6. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
7. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
8. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
9. Outpatient Occupational Therapy
10. Outpatient Physical Therapy


Discharge Disposition:
Home With Service

Facility:
County Public Health Department, [**Location (un) 64684**] NY

Discharge Diagnosis:
metastatic melanoma
bigeminy


Discharge Condition:
Neurologically Stable


Discharge Instructions:
??????Have a friend/family member check your incision daily for signs
of infection.
??????Take your pain medicine as prescribed.
??????Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????You may wash your hair only after sutures have been removed.
??????You may shower before this time using a shower cap to cover
your head.
??????Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
Ibuprofen etc.
??????You have been discharged on Keppra (Levetiracetam), you will
not require blood work monitoring.
??????Clearance to drive and return to work will be addressed at your
post-operative office visit.

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????New onset of tremors or seizures.
??????Any confusion or change in mental status.
??????Any numbness, tingling, weakness in your extremities.
??????Pain or headache that is continually increasing, or not
relieved by pain medication.
??????Any signs of infection at the wound site: redness, swelling,
tenderness, or drainage.
??????Fever greater than or equal to 101?????? F.


Followup Instructions:
??????Please return to the office in [**7-20**] days (from your date of
surgery- [**5-21**]) for removal of your staples & sutures and a wound
check. This appointment can be made with the Nurse Practitioner.
 Please make this appointment by calling [**Telephone/Fax (1) 1669**]. If you
live quite a distance from our office, please make arrangements
for the same, with your PCP.

**You should otherwise call to make an appointment to see Dr.
[**Last Name (STitle) **] in approximatley 4 weeks. You will require a non-contrast
Head CT prior to your appointment. This can also be scheduled
for you when you call. The office phone number is [**Telephone/Fax (1) 1669**].

**Also make sure to make a follow up appointment with your
oncologist at home, Dr. [**Last Name (STitle) 64686**].



Completed by:[**2131-5-19**]
{'Secondary malignant neoplasm of other respiratory organs,Secondary malignant neoplasm of other specified sites,Accidental puncture or laceration of dura during a procedure,Personal history of malignant melanoma of skin,Other specified cardiac dysrhythmias,Accidental cut, puncture, perforation or hemorrhage during surgical 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: elective admission for surgery

PRESENT ILLNESS: The patient is a 76-year-old who is well known to me from
previous hospital visit and extensive counseling. The patient is
a 76-year-old retired physician who was referred by Dr.
[**Last Name (STitle) 1837**] for a recurrent atypical melanoma that has
metastasized to the paranasal sinus. The patient has had
previous facial resection, fascia reconstruction, radiation
therapy. He now returns with progressive obstruction of airway
and imaging revealing an extensive metastasizing tumor growing
in the paranasal sinus. Since the lesion has eroded the frontal
skull base and filled the paranasal sinus, a surgical removal is
the treatment of choice. The patient was extensively counseled.
The patient
was then consented. The patient was taken electively to the
operating room.

MEDICAL HISTORY: R nephrectomy (metanephric adenoma '[**22**]),BPH s/p TURP '[**99**],
diverticulitis s/p colectomy '[**26**] c/b post-op leak/pancreatitis,
s/p rsxn desmoplastic melanoma [**Last Name (LF) 50847**], [**First Name3 (LF) **] fever @7yr,
thyphoid fever '[**89**], s/p Rt parotidectomy '[**91**], HTN

MEDICATION ON ADMISSION: ASA 81mg', Norvasc 5mg/hs, Prilosec 20mg', Altace 10mg"

ALLERGIES: Penicillins / Hayfever

PHYSICAL EXAM: On Discharge:
Alert, oriented. Pupils equally round and reactive to light.
Full motor strength in upper and lower extremities. Sensation
grossly intact.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Retired physician, [**Name10 (NameIs) 64683**] lives in [**Location 64684**], NY with wife 

### Response:
{'Secondary malignant neoplasm of other respiratory organs,Secondary malignant neoplasm of other specified sites,Accidental puncture or laceration of dura during a procedure,Personal history of malignant melanoma of skin,Other specified cardiac dysrhythmias,Accidental cut, puncture, perforation or hemorrhage during surgical operation'}
