CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname **] is a 41 year old
right-handed male CD4 count of 80, viral load of 150 in
[**2160-11-4**] with a past medical history significant for
thoracic spine muscle injury presenting with rapid onset
progressive sensory and motor deficit.  The patient notes the
injury to his back in the area between the scapula about
three years prior and has had pain muscle pain in the
vicinity since.  He woke up with this type of pain eight days
ago with mild relief of symptoms of Tylenol.  The pain has
been worsening over the last couple of days.  Initially the
patient describes a band-like compression around his torso
area, this type of band has increased to a point where two
days prior he woke up at 4 in the morning with abdominal
muscle feeling extremely tense.  The patient was seen in the
Emergency Room one day prior and was discharged with muscle
spasm therapy.  The patient notes that since yesterday
afternoon he has had total numbness from the toes, initially
moving upwards in the last 24 hours.  During the course of
the day today he has had onset of weakness in the lower
extremities.

MEDICAL HISTORY: (The patient's has a past medical
history significant for)
1.  Human immunodeficiency virus positive times 15 years (on
highly active antiretroviral therapy).
2.  L5-S1 herniated disk.
3.  Longstanding prior history of tuberculosis exposure.
4.  Hepatitis C.

MEDICATION ON ADMISSION: The patient's medications included
Combivir, Sustiva, dapsone.

ALLERGIES: The patient has an allergy to SULFA.

PHYSICAL EXAM: 

FAMILY HISTORY: Stroke in maternal grandmother.  [**Name (NI) **] central
nervous system tumors.

SOCIAL HISTORY: The patient smokes one pack per day times 24
years.  No ethanol.  Remote intravenous drug use.  The
patient has two children.  He is in process of a divorce.
Human immunodeficiency virus [HIV] disease,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Hemorrhage of gastrointestinal tract, unspecified,Acute hepatitis C without mention of hepatic coma,Cytomegaloviral disease,Congestive heart failure, unspecified,Displacement of lumbar intervertebral disc without myelopathy,Tobacco use disorder
Human immuno virus dis,Oth lymp unsp xtrndl org,Gastrointest hemorr NOS,Hpt C acute wo hpat coma,Cytomegaloviral disease,CHF NOS,Lumbar disc displacement,Tobacco use disorder
Admission Date:  [**2161-2-13**]       Discharge Date:  [**2161-3-5**]

Date of Birth:   [**2119-3-30**]       Sex:  M

Service:

ADDENDUM:  This is a continuation of the Discharge Summary
which was cut off.

HISTORY OF PRESENT ILLNESS CONTINUED:  On the day of
admission, the patient was seen by his primary care physician
with inability to control his bladder and was noted to have
decreased ankle flexion.  The patient denied nausea,
vomiting, shortness of breath, abdominal pain, or chest pain.
The patient described feeling like his muscles were
"seizing" around his torso.

At the time of presentation, the patient complained of
inability to move his left leg and urinary incontinence.

REVIEW OF SYSTEMS:  On review of systems, the patient denies
weight loss.  Positive for fatigue.  He denies fevers,
chills, or night sweats.  Positive for anorexia.  The patient
denies any visual symptoms.  The patient denies any dry mouth
or tinnitus.  The patient denies chest pain, orthopnea,
paroxysmal nocturnal dyspnea, shortness of breath, or cough.
The patient complains of some abdominal pain and
constipation.  The patient complaints of some urinary
incontinence.  Denies frequency, urgency, or pain.  He denies
a rash or weight change.  Positive numbness, weakness, and
paresthesias in extremities.  No dizziness, vertigo,
confusion, or headache.  The patient denies depression.

PAST MEDICAL HISTORY:  (The patient's has a past medical
history significant for)
1.  Human immunodeficiency virus positive times 15 years (on
highly active antiretroviral therapy).
2.  L5-S1 herniated disk.
3.  Longstanding prior history of tuberculosis exposure.
4.  Hepatitis C.

MEDICATIONS ON ADMISSION:  The patient's medications included
Combivir, Sustiva, dapsone.

ALLERGIES:  The patient has an allergy to SULFA.

SOCIAL HISTORY:  The patient smokes one pack per day times 24
years.  No ethanol.  Remote intravenous drug use.  The
patient has two children.  He is in process of a divorce.

FAMILY HISTORY:  Stroke in maternal grandmother.  [**Name (NI) **] central
nervous system tumors.

PHYSICAL EXAMINATION ON PRESENTATION:  Physical examination
revealed the patient's temperature was 97, heart rate was
129, blood pressure was 147/84, respiratory rate was 18,
oxygen saturation was 98% on room air.  In general, the
patient was pleasant and interactive.  In no acute distress.
Somewhat cachectic.  Head, eyes, ears, nose, and throat
examination revealed normocephalic and atraumatic.  Mucous
membranes were moist.  No thyromegaly.  No cervical
lymphadenopathy.  The patient was without any carotid bruits.
Pulmonary examination revealed clear to auscultation
bilaterally.  No crackles or wheezes.  Cardiovascular
examination revealed the patient was tachycardic, but
regular.  No murmurs, rubs, or gallops.  The abdomen was
soft, nontender, and nondistended.  Bowel sounds were
present.  Extremities revealed the patient moved all four
extremities.  Upper extremity pulses were 2+ and symmetric.
Skin revealed no rash.  Mental status examination revealed
the patient was fully alert and oriented.  The patient was
able to name, register, and recall.  No apraxia or neglect
appreciated.  Cranial nerve examination revealed pupils were
equal, round, and reactive to light at 3 mm.  Extraocular
movements were intact.  No nystagmus.  The remainder of
cranial nerve examination was unremarkable.  The patient with
normal tone.  His strength was full in the upper extremities.
The patient was able to raise right leg against gravity, but
only movement in one plane on the left.  No pronator drift.
Deep tendon reflexes were symmetric but absent at the ankles
bilaterally.  The patient's toes were upgoing bilaterally.
Sensory examination revealed decrease to soft tissue and
pinprick up to the T6 level.  Finger-to-nose and rapid
alternating movements were intact.

RADIOLOGY/IMAGING:  The patient was ordered for a STAT
magnetic resonance imaging.  The magnetic resonance imaging
showed degenerative joint disease at the L5-S1 level.  Of
note, and epidural mass was found posterior to the thecal sac
at the T4 level extending from the area of the T3-T4 disks to
the upper portion of T5.  The mass had a superior/inferior
dimension of 3.5 cm.  Of particular importance, there was
found to be greater than 50% narrowing of the spinal canal
and moderate compression of the spinal cord.  Also of note
was an area of increased signal within the spinal cord at the
T5 level with likely edema.  The mass was found to extend to
the right neural foramina at the T4-T5 level.  Otherwise, the
patient's cervical and lumbar spine were unremarkable.

HOSPITAL COURSE:   The patient was taken emergently to the
operating room where an extensive epidural tumor in the
midthoracic spine (as previously described by magnetic
resonance imaging) was noted.  Erosion to the lamina and to
the paraspinous muscles was noted.  The tumor was found to be
extremely vascular.  Please see the Operative Report for
further details of the thoracic laminectomy for described
tumor.

The patient did well after the operative procedure.  He
started to slowly regain strength in the lower extremity.
Pathology with preliminary diagnosis of non-Hodgkin lymphoma.

An Oncology consultation was obtained.  The Oncology staff
recommended further staging including a gallium scan,
computed tomography scan of the torso, bowel movement, and
lumbar puncture.

The computed tomography of the chest showed small precarinal
lymph nodes, small lymph node on the left side measuring
1.3 cm X 1.1 cm, and no evidence of hilar lymphadenopathy.  A
small granuloma of the right lung base was found.  Otherwise,
the scan was unremarkable.

A lumbar puncture was performed showing 1 white blood cells,
3 red blood cells, protein of 29, glucose of 69, LDH of 12.
Differential showed 30% polys, 62% lymphocytes, 10%
monocytes; otherwise unremarkable.

As staging for non-Hodgkin lymphoma was being performed, and
the patient was preparing for discharge and outpatient
management of current diagnosis, the patient was found
overnight (on [**2161-2-23**]) to have two episodes of
liquid maroon-colored stools.  The patient had been
completely asymptomatic prior.  The patient's hematocrit on
[**2-22**] was 24.5; and on [**2-23**] had fallen to 17.9.
The episodes of dark maroon stools were associated with some
left-sided abdominal pain.   The patient denied chest pain,
nausea, and vomiting.  The patient received 2 units of packed
red blood cells.  The patient received an additional
transfusion to keep his hematocrit greater than 30% and was
started on high-dose proton pump inhibitor.

The patient received an upper endoscopy.  The patient's
esophagus was of normal appearance.  A single cratered
nonbleeding 1-cm ulcer with a clean base was found in the
stomach body along the greater curvature.  No blood was seen
in the stomach.  In the duodenum, red blood was seen beyond
the ligament of Treitz in the third and fourth parts of the
duodenum and jejunum.  The jejunum was explored to 150 cm at
the starting point of the incisors.  No localizing source of
the patient's bleeding was appreciated.

An arteriogram of the superior mesenteric artery, superior
mesenteric artery, and three jejunal branches, celiac and
internal mammary artery inferior mesenteric artery were
without evidence of active bleeding.

The patient's hematocrit did not bump appropriately to the
packed red blood cell infusion.  The patient was taken for
intravenous injection of tagged red blood cell scan.  The
results showed extravasation of red blood cells into the
patient's jejunum; consistent with a jejunal gastrointestinal
bleed.

The patient was taken back to angiography.  This time, active
extravasation of contrast was found from a bleeding jejunal
branch of the superior mesenteric artery in the left lower
quadrant.  The bleeding jejunal branches were successfully
coiled with full resolution of the bleeding.  However, the
patient's hematocrit continued to tend downward from a post
procedure hematocrit of 28 to a hematocrit of 21 with large
bloody bowel movements.

The patient was taken back for a tagged red blood cell scan
which showed an active bleed in the jejunal branch.  The
patient was taken back to angiography.  Active extravasation
was seen through areas adjacent to initial coiling of the
small collateral vessels.  Additional coiling was placed.  No
active extravasation was found after the procedure.

After the episode of second embolization, the patient had one
melanic stool.  The patient's hematocrit still continued to
trend downward and inappropriately bump.

The patient received a computed tomography scan of the
abdomen.  Impression revealed (1) free intraperitoneal fluid
and (2) small bilateral pleural effusions.

At this point, General Surgery took the patient to the
operating room for exploratory laparotomy with jejunal
resection and primary anastomosis.  A 6-cm portion of the
jejunum showed no discrete raised lesions, although several
small mucosal ulceration specimens were sent to Pathology.
The patient tolerated the procedure well.  Please see the
General Surgery Operative Report for further details.

The patient was transferred to the Surgical Intensive Care
Unit in stable condition; status post operating room
extubation.  The patient tolerated the procedure well.

Secondary to the presence of mucosal erosions, the patient
was started on ganciclovir and fluconazole in the setting of
this immunocompromised host.  Preliminary pathology later
returned primary process to be vascular and not infectious.
Both medications were subsequently stopped.  The patient was
transfused an additional 2 units of packed red blood cells
postoperatively, and his serial hematocrit levels for the
remainder of hospital course remained stable.

The patient admitted tachycardia is a chronic state.  The
patient received an echocardiogram.  The wall thickness and
cavity size were normal.  Left ventricular ejection fraction
was greater than 55%.  The aortic valve and mitral valve were
structurally normal.  Normal pulmonary artery pressure;
otherwise, unremarkable.

Pathology of intestinal segment showed multiple fossae
mucosal hemorrhage and necrosis with erosions.  No acute
inflammation of the submucosa.  Organizing thrombus of
smaller veins in submucosa was appreciated.  The stains were
negative for microsporidia and acid-fast bacilli in addition
to cytomegalovirus.

The patient received one dose of R-CHOP chemotherapy; per
Oncology recommendations.  The patient then received a 5-day
course of G-CSF.

On transfer to the medical floor, the patient was seen and
examined.  His hematocrit levels remained stable.  The
patient was found to have scrotal and left lower extremity
thigh and bilateral lower extremity edema.  The patient was
on Lasix; diuresis successful.  Lasix was stopped.  The
patient continued diuresis successfully, and swelling and
edema diminished significantly to the time of discharge.

The patient's diet was slowly advanced, and the patient was
tolerating a full solid diet.  The patient worked with
Physical Therapy successfully.  The patient continued to be
ambulatory with increasing strength and decreasing fatigue
prior to discharge.

Two days prior to discharge, the patient noted 24 hours of
bowel and bladder incontinence.  The patient was sent for an
emergent magnetic resonance imaging which showed no
significant change from the interval.  The patient's bowel
and bladder incontinence resolved spontaneously within 12
hours of report.

The magnetic resonance imaging was reviewed by Neurosurgery
and was without evidence of any recurrent or residual
epidural tumor.  The thoracic spine appeared well
decompressed.  Abnormal marrow signal was appreciated in two
thoracic vertebrae.  Again, no abnormality was seen in the
lumbar spine or cervical spine.

CONDITION AT DISCHARGE:  The patient's condition on discharge
was stable and approved.

DISCHARGE DIAGNOSES:
1.  Human immunodeficiency virus times 15 years (on highly
active antiretroviral therapy).
2.  L5-S1 herniated disk.
3.  Longstanding prior history of tuberculosis exposure.
4.  Epidural mass; status post excision.
5.  Non-Hodgkin lymphoma.
6.  Hepatitis C.
7.  Jejunal bleed; status post resection.
8.  Massive red blood cell infusions.

MEDICATIONS ON DISCHARGE:
 1.  Heparin 5000 units subcutaneously q.12h.
 2.  Percocet one to two weeks p.o. q.4-6h. as needed.
 3.  Ativan 0.5 mg p.o. q.8h. as needed.
 4.  Lopressor 25 mg p.o. b.i.d.
 5.  Pantoprazole 40 mg p.o. q.d.
 6.  Tenofovir 300 mg p.o. q.h.s.
 7.  Lamivudine 300 mg p.o. q.h.s.
 8.  Efavirenz 600 mg p.o. q.h.s.
 9.  .................... 300 mg p.o. q.h.s. (times one
additional day).
10.  Dapsone 100 mg p.o. q.d.
11.  Tramadol 100 mg p.o. q.4-6h. as needed.
12.  Aluminum magnesium hydroxide 15 mL to 30 mL p.o. q.i.d.
as needed.

DISCHARGE INSTRUCTIONS/FOLLOWUP:
1.  The patient was to follow up with Dr. [**Last Name (STitle) **]
(Hematology/Oncology) on Tuesday, [**2161-3-10**].
2.  The patient to follow up with Dr. [**Last Name (STitle) **] (the patient's
primary care physician) and Infectious Disease in one week
following discharge.
3.  The patient to follow up with Neurosurgery (Dr. [**Last Name (STitle) 1338**]
in 10 days.  The patient was instructed to call telephone
number [**Telephone/Fax (1) **] for an appointment.
4.  The patient to follow up with General Surgery (Dr.
[**Last Name (STitle) **] in 10 days.  The patient was instructed to call
telephone number [**Telephone/Fax (1) **] for an appointment.





                   DR.[**Last Name (STitle) **],[**First Name3 (LF) 251**] 12-988

Dictated By:[**Last Name (NamePattern1) 5924**]
MEDQUIST36

D:  [**2161-3-5**]  14:56
T:  [**2161-3-5**]  16:21
JOB#:  [**Job Number 95383**]


Admission Date:  [**2161-2-13**]       Discharge Date:  [**2161-3-5**]

Date of Birth:   [**2119-3-30**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname **] is a 41 year old
right-handed male CD4 count of 80, viral load of 150 in
[**2160-11-4**] with a past medical history significant for
thoracic spine muscle injury presenting with rapid onset
progressive sensory and motor deficit.  The patient notes the
injury to his back in the area between the scapula about
three years prior and has had pain muscle pain in the
vicinity since.  He woke up with this type of pain eight days
ago with mild relief of symptoms of Tylenol.  The pain has
been worsening over the last couple of days.  Initially the
patient describes a band-like compression around his torso
area, this type of band has increased to a point where two
days prior he woke up at 4 in the morning with abdominal
muscle feeling extremely tense.  The patient was seen in the
Emergency Room one day prior and was discharged with muscle
spasm therapy.  The patient notes that since yesterday
afternoon he has had total numbness from the toes, initially
moving upwards in the last 24 hours.  During the course of
the day today he has had onset of weakness in the lower
extremities.






                        DR.[**Last Name (STitle) 95373**],[**First Name3 (LF) 251**] 12-988

Dictated By:[**Last Name (NamePattern1) 5924**]
MEDQUIST36

D:  [**2161-3-5**]  14:52
T:  [**2161-3-5**]  16:20
JOB#:  [**Job Number 41650**]


Name:  [**Known lastname **], [**Known firstname **] S.                      Unit No:  [**Numeric Identifier 15092**]

Admission Date:  [**2161-2-13**]     Discharge Date:  [**2161-3-9**]

Date of Birth:   [**2119-3-30**]     Sex:  M

Service:

Addendum to second to last paragraph of hospital course
sentence two days prior to discharge, the patient noted 24
hours of two paragraphs before condition at discharge.
It should read, one week prior to discharge, the patient
noted 24 hours.

After the MRI paragraph should read, throughout the remainder
of the [**Hospital 1325**] hospital course, the patient continued to
ambulate with Physical Therapy in hallways in which he
continually excelled.  The patient reported decreasing
fatigue, increased energy, and felt himself to be clearer
mentally.  The patient's pain decreased.  Patient's dark
tarry stools eventually clear.  The patient was having normal
formed brown bowel movement, no melena or bright red blood.
The patient's hematocrit remained q day throughout the
remainder throughout hospital course.




                          [**Name6 (MD) 116**] [**Name8 (MD) 117**], M.D.  [**MD Number(1) 118**]

Dictated By:[**Last Name (NamePattern1) 896**]

MEDQUIST36

D:  [**2161-3-9**]  08:50
T:  [**2161-3-9**]  09:10
JOB#:  [**Job Number 15093**]
{'Human immunodeficiency virus [HIV] disease,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Hemorrhage of gastrointestinal tract, unspecified,Acute hepatitis C without mention of hepatic coma,Cytomegaloviral disease,Congestive heart failure, unspecified,Displacement of lumbar intervertebral disc without myelopathy,Tobacco use disorder'}


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: Mr. [**Known lastname **] is a 41 year old
right-handed male CD4 count of 80, viral load of 150 in
[**2160-11-4**] with a past medical history significant for
thoracic spine muscle injury presenting with rapid onset
progressive sensory and motor deficit.  The patient notes the
injury to his back in the area between the scapula about
three years prior and has had pain muscle pain in the
vicinity since.  He woke up with this type of pain eight days
ago with mild relief of symptoms of Tylenol.  The pain has
been worsening over the last couple of days.  Initially the
patient describes a band-like compression around his torso
area, this type of band has increased to a point where two
days prior he woke up at 4 in the morning with abdominal
muscle feeling extremely tense.  The patient was seen in the
Emergency Room one day prior and was discharged with muscle
spasm therapy.  The patient notes that since yesterday
afternoon he has had total numbness from the toes, initially
moving upwards in the last 24 hours.  During the course of
the day today he has had onset of weakness in the lower
extremities.

MEDICAL HISTORY: (The patient's has a past medical
history significant for)
1.  Human immunodeficiency virus positive times 15 years (on
highly active antiretroviral therapy).
2.  L5-S1 herniated disk.
3.  Longstanding prior history of tuberculosis exposure.
4.  Hepatitis C.

MEDICATION ON ADMISSION: The patient's medications included
Combivir, Sustiva, dapsone.

ALLERGIES: The patient has an allergy to SULFA.

PHYSICAL EXAM: 

FAMILY HISTORY: Stroke in maternal grandmother.  [**Name (NI) **] central
nervous system tumors.

SOCIAL HISTORY: The patient smokes one pack per day times 24
years.  No ethanol.  Remote intravenous drug use.  The
patient has two children.  He is in process of a divorce. 

### Response:
{'Human immunodeficiency virus [HIV] disease,Other malignant lymphomas, unspecified site, extranodal and solid organ sites,Hemorrhage of gastrointestinal tract, unspecified,Acute hepatitis C without mention of hepatic coma,Cytomegaloviral disease,Congestive heart failure, unspecified,Displacement of lumbar intervertebral disc without myelopathy,Tobacco use disorder'}
