CHIEF COMPLAINT: 

PRESENT ILLNESS: At the time of admission the
patient is a 42 year old female with a history of diabetes
mellitus type 1, end-stage renal disease who was on
hemodialysis prior to cadaveric renal transplant done on
[**2108-9-8**].  The patient also has a history of
hypertension, hypothyroidism, and a left lower extremity deep
vein thrombosis.  The patient has a history of a Perma-Cath
and three arteriovenous fistulae.  The patient also was found
out to have a history of a right brachiocephalic and superior
vena caval venous stent.

MEDICAL HISTORY: 1.  Diabetes mellitus type 1.
2.  History of end-stage renal disease.
3.  Status post cadaveric renal transplant on [**2108-9-8**].
4.  Hypertension.
5.  Hypothyroidism.
6.  History of left lower extremity deep vein thrombosis.
7.  Status post Perma-Cath placement.
8.  History of arteriovenous fistulae times three.
9.  It is unclear when it was placed but patient also had a
history of a right brachiocephalic and a superior vena caval
stent.
10.  The patient at the time of admission had a right IJ
Perma-Cath which was placed in the superior vena cava.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Other complications due to other vascular device, implant, and graft,Acute kidney failure, unspecified,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Urinary tract infection, site not specified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Compression of vein,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation
Comp-oth vasc dev/graft,Acute kidney failure NOS,DMI wo cmp nt st uncntrl,Urin tract infection NOS,Abn react-procedure NEC,Compression of vein,Abn react-artif implant
Admission Date:  [**2108-9-16**]       Discharge Date:  [**2108-10-12**]

Date of Birth:   [**2066-7-8**]       Sex:  F

Service:

ADMITTING DIAGNOSIS:  Superior vena cava syndrome.

DISCHARGE DIAGNOSES:
1.  Status post cadaveric renal transplant on [**2108-9-8**].
2.  Superior vena caval syndrome.
3.  Distal ureter necrosis.
4.  Status post revision of ureter bladder anastomosis.

HISTORY OF PRESENT ILLNESS:   At the time of admission the
patient is a 42 year old female with a history of diabetes
mellitus type 1, end-stage renal disease who was on
hemodialysis prior to cadaveric renal transplant done on
[**2108-9-8**].  The patient also has a history of
hypertension, hypothyroidism, and a left lower extremity deep
vein thrombosis.  The patient has a history of a Perma-Cath
and three arteriovenous fistulae.  The patient also was found
out to have a history of a right brachiocephalic and superior
vena caval venous stent.

The patient presented to the [**Hospital1 188**] in the Emergency Department on [**2108-9-16**], with
demonstrable edema of the bilateral upper extremities and her
head and neck.  The patient was without other complaints.

The patient was highly concerning for superior vena caval
syndrome.  The patient was admitted to the Surgical Service.

PAST MEDICAL HISTORY:
1.  Diabetes mellitus type 1.
2.  History of end-stage renal disease.
3.  Status post cadaveric renal transplant on [**2108-9-8**].
4.  Hypertension.
5.  Hypothyroidism.
6.  History of left lower extremity deep vein thrombosis.
7.  Status post Perma-Cath placement.
8.  History of arteriovenous fistulae times three.
9.  It is unclear when it was placed but patient also had a
history of a right brachiocephalic and a superior vena caval
stent.
10.  The patient at the time of admission had a right IJ
Perma-Cath which was placed in the superior vena cava.

PAST SURGICAL HISTORY:
1.  Right internal jugular Perma-Cath.
2.  History of arteriovenous fistula times three.
3.  Status post cadaveric renal transplant, as stated on
[**2108-9-8**].

HOSPITAL COURSE:   The patient was admitted to the hospital
and at the time of admission, the patient was afebrile; blood
pressure was 143/53.  The patient's admission laboratory
examination revealed a white blood cell count of 14.0,
hematocrit of 33, platelets of 151.  Sodium 136, potassium
4.4, chloride 104, carbon dioxide of 16, BUN of 102,
creatinine of 5.1 which is down from a creatinine of 5.5 at
the time of discharge from her cadaveric renal transplant.
Glucose was well controlled at 56.

The patient underwent an ultrasound which showed dilation of
both of her internal jugular veins.  The patient had an MRV
which demonstrated left IJ and bilateral brachiocephalic vein
and a superior vena caval thrombus.  The patient also, on
chest x-ray, demonstrated a stent within her right
brachiocephalic and superior vena cava.  It is unclear when
these were placed.

The [**Hospital 228**] hospital course included angiogram done on the
20th with thrombectomy.  This did not completely remove all
of the clot.  The patient was treated with repeat angiogram
on the 21st with stenting and thrombectomy of the clot from
the superior vena cava, brachiocephalic and internal jugular
with modest return of flow and removal of her Perma-Cath.

A few days later the patient was taken back down to angiogram
where the patient had recanalization of all of her central
veins in her neck with good return of flow, and the patient
had a dramatic clinical response with resolution of her upper
extremity swelling and edema.  The patient was treated with
heparin and then Coumadinized.

The patient was also noted on her hospital stay to have a
large amount of fluid coming from her wound.  The wound was
opened down to the level of the fascia.  Creatinine in the
fluid was consistent with a urine leak.  The patient was
taken down to Interventional Radiology where she had a
nephrostomy tube placed which demonstrated stricturing of the
distal ureter.

Of note, it should be stated at the time of the kidney
transplant, it was noted that the Transplant Team had
transsected a lower polar artery that was probably supplying
the bladder which was probably supplying the ureter and this
was the reason for the necrosis of the distal end of the
ureter.

Interventional Radiology had a stent placed through the
distal stricture and into the bladder.  The patient was taken
to the Operating Room on the [**9-26**] for a upper
ureteral bladder anastomosis.  At the time of the operation,
the previous ureteral anastomosis of the bladder was
identified.  This was taken down sharply.  Previously, the
necrotic and ischemic ureter was transsected.  A new ureter
to bladder anastomosis was performed in good fashion.

The patient, postoperatively, did well.  The large wound was
treated with a wound VAC which was changed every two to three
days.  The [**Location (un) 1661**]-[**Location (un) 1662**] which was placed at the time of the
surgery decreased in output and once there was no further
evidence of leak, the [**Location (un) 1661**]-[**Location (un) 1662**] creatinine was normal.
The [**Location (un) 1661**]-[**Location (un) 1662**] was removed.

The patient was seen and evaluated by Physical Therapy.  The
patient was ambulatory but could not meet reasonable goals
and therefore was felt to an adequate candidate for further
rehabilitation work at rehabilitation hospital.

The patient was tolerating a regular diet.  The wound was
cleaning up nicely with a wound VAC.  The patient was on
Coumadin, and the patient was placed back on therapeutic
levels of her immunosuppressants.

At the time of discharge, the patient had a repeat renal
duplex on the [**2108-10-8**].  Resistant indices at
0.7 with normal flow already in the veins.  The patient's
creatinine which had risen, at the time of discharge was down
to 3.7, which is the lowest point it had been so far.
Therefore, discharge diagnosis included the following.

DISCHARGE DIAGNOSES:
1.  Status post cadaveric renal transplant on the [**2108-9-8**].
2.  Severe vena caval syndrome secondary to occlusion,
secondary to a Perma-Cath in the superior vena cava and
stent.
3.  Status post angiographic thrombectomy of the central
veins of the neck.
4.  Distal ureteral necrosis.
5.  Status post revision of ureteral bladder anastomosis.
6.  Opening of transplant wound treated with wound VAC.

DISCHARGE MEDICATIONS:
1.  Coumadin 2 mg p.o. q. h.s.
2.  Lanosolid 600 mg p.o. q. 12.
3.  Zinc sulfate 220 mg p.o. q. day.
4.  Lasix 40 mg p.o. twice a day.
5.  Insulin sliding scale.
6.  Metoprolol 75 mg p.o. twice a day.
7.  Fancyclovir 450 mg p.o. q.o.d.
8.  Pantoprazole 30 mg p.o. q. day.
9.  Atorvastatin 10 mg p.o. q. day.
10. Gabapentin 100 mg p.o. three times a day.
11. Artificial tears o.u. p.r.n.
12. Synthroid 75 micrograms p.o. q. day.
13. Single strength Bactrim one tablet p.o. q. day.
14. Her immunosuppressant medications which include
Prednisone 10 mg p.o. q. day; Mycophenolate mofetil 100 mg
p.o. twice a day and Prograf 4 mg p.o. twice a day.

DISCHARGE INSTRUCTIONS:
1.  Wound therapy q. day.  Dressings include a wound VAC
which should be changed every two days to the right lower
quadrant wound incision.
2.  The patient's follow-up will include an appointment with
Dr. [**Last Name (STitle) 28924**] in the Transplant Office on Tuesday, the 18th.


                            [**Name6 (MD) 1344**] [**Name8 (MD) 1345**], M.D.  [**MD Number(1) 1346**]

Dictated By:[**Last Name (NamePattern1) 14369**]
MEDQUIST36

D:  [**2108-10-12**]  15:45
T:  [**2108-10-12**]  17:58
JOB#:  [**Job Number 28925**]
{'Other complications due to other vascular device, implant, and graft,Acute kidney failure, unspecified,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Urinary tract infection, site not specified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Compression of vein,Surgical operation with implant of artificial internal device 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: 

PRESENT ILLNESS: At the time of admission the
patient is a 42 year old female with a history of diabetes
mellitus type 1, end-stage renal disease who was on
hemodialysis prior to cadaveric renal transplant done on
[**2108-9-8**].  The patient also has a history of
hypertension, hypothyroidism, and a left lower extremity deep
vein thrombosis.  The patient has a history of a Perma-Cath
and three arteriovenous fistulae.  The patient also was found
out to have a history of a right brachiocephalic and superior
vena caval venous stent.

MEDICAL HISTORY: 1.  Diabetes mellitus type 1.
2.  History of end-stage renal disease.
3.  Status post cadaveric renal transplant on [**2108-9-8**].
4.  Hypertension.
5.  Hypothyroidism.
6.  History of left lower extremity deep vein thrombosis.
7.  Status post Perma-Cath placement.
8.  History of arteriovenous fistulae times three.
9.  It is unclear when it was placed but patient also had a
history of a right brachiocephalic and a superior vena caval
stent.
10.  The patient at the time of admission had a right IJ
Perma-Cath which was placed in the superior vena cava.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Other complications due to other vascular device, implant, and graft,Acute kidney failure, unspecified,Diabetes mellitus without mention of complication, type I [juvenile type], not stated as uncontrolled,Urinary tract infection, site not specified,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Compression of vein,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}
