CHIEF COMPLAINT: Transient dysphasia and right-sided
hemiparesis.

PRESENT ILLNESS: This is an 80-year-old female
with a history of gangrenous toe admitted to an outside
hospital at [**Hospital3 417**] Hospital on [**2154-10-23**],
after a two-week interval of discolored left leg.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Atherosclerosis of native arteries of the extremities with gangrene,Other nervous system complications,Congestive heart failure, unspecified,Retention of urine, unspecified,Ulcer of other part of foot,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled
Ath ext ntv art gngrene,Surg comp nerv systm NEC,CHF NOS,Retention urine NOS,Ulcer other part of foot,Ocl crtd art wo infrct,DMII wo cmp nt st uncntr
Admission Date:  [**2154-10-28**]       Discharge Date:  [**2154-10-28**]


Service:

ADDENDUM:  The patient is an 80-year-old female initially
admitted to the Medicine Service on [**2154-10-28**].  The
patient was discharged on [**2154-11-9**].






                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2604**], M.D.  [**MD Number(1) 6223**]

Dictated By:[**Last Name (NamePattern1) 1479**]
MEDQUIST36

D:  [**2154-11-8**]  14:07
T:  [**2154-11-8**]  14:52
JOB#:  [**Job Number 53790**]


Admission Date:  [**2154-10-28**]       Discharge Date:  [**2154-11-11**]


Service:  VASCULAR SURGERY

CHIEF COMPLAINT:  Transient dysphasia and right-sided
hemiparesis.

HISTORY OF PRESENT ILLNESS:  This is an 80-year-old female
with a history of gangrenous toe admitted to an outside
hospital at [**Hospital3 417**] Hospital on [**2154-10-23**],
after a two-week interval of discolored left leg.

Doppler study at that time revealed peripheral vascular
disease of the leg.  The results were unclear prior to
transfer to this facility.

Subsequent arteriogram had shown a 70% common femoral artery
stenosis, 50% superficial artery stenosis and 70% stenosis in
the junction of the SFA and popliteal and 70% stenosis in the
distal popliteal, all on the right.

On the left, there was a long segment of stenosis of the
proximal popliteal, as well as into the anterior tibial
artery.

Subsequent to the procedure, she had cellulitis on top of the
eschars of her left foot.  She was started on Vancomycin
empirically and then continued on Unasyn.  Dr. [**Last Name (STitle) 7047**]
suggested clearance of her carotids preoperatively prior to
possible lower extremity bypass which revealed 90% left
carotid stenosis, as well as requiring a preoperative
coronary evaluation.

She was transferred to [**Hospital6 256**]
for cardiac catheterization and given an ultrasound showing a
90% stenosis of the left carotid from which she was
apparently asymptomatic having never described transient
ischemic attacks, language difficulty or prior stroke events.

She underwent cardiac catheterization at [**Hospital6 1760**].  Upon arrival her blood
pressure was noted to be 203/64.  Subsequent to that her
blood pressure dropped into the 160s.  Prior to
catheterization, she actually experienced the acute onset of
aphasia.  She was otherwise alert and responding to command,
but she was showing signs of left-sided neglect and right
hemiparesis.

This ultimately responded after her blood pressure was
restored, and the CCU Team that was examining her felt that
there was a left ..................., which still persisted
with additional neglect to ................... stimuli.

Given the severity of these symptoms, the patient
ultimately underwent a left carotid angioplasty with stent to
restore her flow.  She was maintained on antiplatelet therapy
and heparinized.  She also underwent a preoperative cardiac
catheterization evaluation that showed stable three-vessel
coronary disease but no need for further intervention.

Optimal cardiac intervention and optimal medical therapy was
ultimately required to manage this patient.  She was
maintained in the hospital for approximately five days prior
to go operation on [**2154-11-1**], when Dr. [**Last Name (STitle) **]
performed a left common femoral artery to anterior tibial
artery bypass with in situ greater saphenous vein.

This procedure was apparently uneventful.  She left operating
room extubated with a palpable anterior tibial graft.
Postoperatively she was maintained on Nitroglycerin for blood
pressure control.  She was being maintained on Unasyn, and
Vancomycin was needed for dosing of her antibiotics to
control any local foot sepsis/cellulitis.  She was maintained
Plavix and Aspirin and subcue Heparin during the
postoperative course.

She was somewhat oliguric postoperatively requiring some
intravenous fluid resuscitation.  She was being monitored
with a PA catheter for optimization of her cardiac status as
required by preoperative cardiac risk assessment and
stratification.

She was given p.r.n. analgesics with Morphine.  Her blood
pressure was maintained in the 150-160 levels.  Her Foley was
ultimately changed.

Postoperative chest x-ray showed what looked like possible
fluid overload in the region of her pulmonary vasculature, as
she had been in the hospital for approximately 4-5 days
preoperatively and received a fair amount of preoperative
peritesting fluid which could likely explain why she had
relatively ............. [**Name2 (NI) **] pressures.

On hospital day #6, postoperative day #1, she was in the
Intensive Care Unit.  She was afebrile with adequate blood
pressure and heart rate.  PA pressures were 50/16 with a
wedge of 12, cardiac output and index and 6 and 2.8
respectively with an SVR of 963.  Her preoperative weight was
87 kg.  Current weight was 113 kg, confirming that she was
almost 16 kg positive at this time.  She was positive 700 cc
from the time of her surgery on Tuesday, postoperative day
#1.

HOSPITAL COURSE:  Neurologic:  She was stable.

Cardiovascular:  She was maintained on a beta-blocker as
recommended preoperatively.  Her ACE inhibitor had been held.


Pulmonary:  She was stable without any evidence of overt
clinical congestive failure.  She was NPO.  Therefore her
diet was advanced.  She was maintained with a Foley.  Her
urine output was marginal.  She was continued on Unasyn for
her foot.  There was no evidence of MRSA, and she was
discontinued from her Vancomycin.

Ultimately by postoperative day #3, the patient was in the
VICU.  Her Swan was changed.  She was out of bed.  She
appeared to be slightly confused.  She otherwise was started
on her diuresis.  She was afebrile with vital signs stable.
She had a palpable left femoral to AT graft site.  There was
some slight erythema at the left fifth toe base.  Ultimately
she underwent a left fifth toe amputation with Dr.
[**Last Name (STitle) **].

The remainder of her postoperative course she was on the
floor.  She was adequately diuresed.  Her diet was advanced.
She was maintained on Unasyn which was ultimately changed to
Levaquin due to the fact that her OR cultures revealed E.
coli and beta strep which appeared to be resistant to
Quinolone.

She did have some mild confusion postoperatively which was
treated by checking arterial blood gas which was without any
evidence of hypercarbia or hypoxia.  Urinalysis was negative.

Thereafter she was mobilized with Physical Therapy.  She
experienced some postoperative urinary retention requiring
insertion of a Foley catheter.  Once she deemed appropriate
and stable for discharge on postoperative day #10 and 5, she
was seen by Dr. [**Last Name (STitle) **] who deemed that she would be
available to be discharged to a rehabilitation facility where
she will be maintained on the medication schedule below.

DISCHARGE MEDICATIONS:  Aspirin 81 mg p.o. q.d., sliding
scale Insulin regimen, Tylenol, Lipitor 10 mg q.d., Folic
Acid 1 mg q.d., subcue Heparin 5000 U b.i.d., Lisinopril 10
mg q.d., Lopressor 50 mg p.o. b.i.d., Plavix 150 mg q.d.,
Miconazole powder q.i.d. to the affected area, Metformin 500
mg p.o. b.i.d., Glipizide 5 mg p.o. b.i.d., Colace 100 mg
p.o. b.i.d., Levofloxacin 500 mg 1 tab p.o. q.d. for the next
10 days, .................. ointment one application
topically b.i.d. to be continued for the remainder of her
stay.

DISCHARGE DIAGNOSIS:
1.  Peripheral vascular disease with tissue loss of the left
lower extremity.  She is status post left common femoral to
anterior tibial bypass with in situ saphenous vein graft.
2.  She had preoperative transient ischemic attack, resolved,
no evidence of permanent neurologic injury.
3.  Status post common carotid artery stenting by Dr. [**First Name (STitle) **].
4.  Diabetes.
5.  Hypertension.
6.  Coronary artery disease.
7.  Gastroesophageal reflux disease.

DISCHARGE STATUS:  To a rehabilitation facility to be named
later.

FOLLOW-UP:  The patient can follow-up with Dr. [**Last Name (STitle) **] in
approximately two weeks from the time of discharge.  She
should maintain .......... dressing applications b.i.d. to
the affected ulcer.  Additionally, the patient is to
follow-up with Dr. [**First Name (STitle) **] for further management of her
Plavix and Aspirin and other cardiac medications, due to the
fact that she did receive cardiac catheterization, as well as
carotid stenting pre-procedurally for this bypass.

All medication changes should go through Dr. [**First Name (STitle) **] as
instructed.  The orders are to utilize a healing sandal to
the affected left lower extremity.  She should elevate the
leg when not ambulating; otherwise, ..................
applications with dry sterile dressing should be applied to
the foot with elevation and healing sandal.  She can walk and
full weightbear as needed with physical therapy.  Skin clips
will be taken out in the office at the time of follow-up in
approximately two weeks.




                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern4) 2604**], M.D.  [**MD Number(1) 6223**]

Dictated By:[**Last Name (NamePattern4) 3204**]
MEDQUIST36

D:  [**2154-11-11**]  10:45
T:  [**2154-11-11**]  10:57
JOB#:  [**Job Number 53791**]
{'Atherosclerosis of native arteries of the extremities with gangrene,Other nervous system complications,Congestive heart failure, unspecified,Retention of urine, unspecified,Ulcer of other part of foot,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}


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: Transient dysphasia and right-sided
hemiparesis.

PRESENT ILLNESS: This is an 80-year-old female
with a history of gangrenous toe admitted to an outside
hospital at [**Hospital3 417**] Hospital on [**2154-10-23**],
after a two-week interval of discolored left leg.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Atherosclerosis of native arteries of the extremities with gangrene,Other nervous system complications,Congestive heart failure, unspecified,Retention of urine, unspecified,Ulcer of other part of foot,Occlusion and stenosis of carotid artery without mention of cerebral infarction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}
