CHIEF COMPLAINT: meningioma

PRESENT ILLNESS: The patient is a 45-year male with a complex
past medical history outlined on recent admission note. He
was found to have a large bifrontal lesion consistent with a
neoplasm, most likely diagnosis is a meningioma. The patient
has suffered significant mass effect and edema from this
lesion and is in need of a histopathological diagnosis. He
is, therefore, taken electively to the operating room for
resection and decompression. Informed consent was obtained.
The patient is admitted electively to the hospital.

MEDICAL HISTORY: DMII
Hyperlipidemia
HTN
Polysubstance abuse, including IVDU.  Drug of choice is heroin,
but pt occasionally uses cocaine.  Reports having tried "every"
illicit substance.  Reports little ETOH use.
Smokes ~3ppd

MEDICATION ON ADMISSION: Pain Meds at home:
acetaminophen prn,
gabapentin 400 tid,
OxyContin 10 [**Hospital1 **].
NPH 70u SC QAM/ 60u SC QPM (no sliding scale)
Enalapril 10mg
Lipitor 20mg
vicodin 2 pills q4 hrs
albuterol inh prn
advair [**Hospital1 **] (not compliant with)

ALLERGIES: Morphine / Demerol / Codeine

PHYSICAL EXAM: HEENT: PERRL, EOMI, anicteric sclera, OP. Facial swelling
clear, MMM, no erythema, exudate or oral lesions
Neck: obese, no LAD
CV: distant S1, S2, RRR
Pulm: occasional insp and exp wheezes b/l
Abd: obese, soft
Ext: WWP, multiple abrasions/healing
Neuro: CN II-XII intact; CN I tested and patient not register
ammonia/pepper; [**6-18**] prx and distal UE and LE strength
b/l, sensation intact to light touch b/l, gait wnl

FAMILY HISTORY: Mother alive with DM, HTN.  Father living--? medical problems

SOCIAL HISTORY: Divorced.  Has been living with sister in [**Name (NI) 14663**].  Has 3
children and grandchildren who he is trying to rebuild
relationship with.  Unemployed, but used to work as metal
worker.  Has had difficult time finding employment since leaving
prison.  Extensive illicit drug use.  Has been in detox multiple
times.  Prior incarceration for assault & battery (reportedly
for going after someone who tried to harm his sister).
Smokes 3 PPD smoker x many years.  Rarely uses alcholol.
Benign neoplasm of cerebral meninges,Chronic obstructive asthma, unspecified,Cocaine abuse, unspecified,Edema of larynx,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes
Ben neo cerebr meninges,Chronic obst asthma NOS,Cocaine abuse-unspec,Edema of larynx,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes
Admission Date:  [**2168-4-13**]              Discharge Date:   [**2168-4-18**]

Date of Birth:  [**2122-11-24**]             Sex:   M

Service: NEUROSURGERY

Allergies:
Morphine / Demerol / Codeine

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
meningioma

Major Surgical or Invasive Procedure:
1.  Bifrontal craniotomy for resection.
2.  Intraoperative image guidance.
3.  Microscopic resection.
4.  Duraplasty.


History of Present Illness:
The patient is a 45-year male with a complex
past medical history outlined on recent admission note. He
was found to have a large bifrontal lesion consistent with a
neoplasm, most likely diagnosis is a meningioma. The patient
has suffered significant mass effect and edema from this
lesion and is in need of a histopathological diagnosis. He
is, therefore, taken electively to the operating room for
resection and decompression. Informed consent was obtained.
The patient is admitted electively to the hospital.


Past Medical History:
DMII
Hyperlipidemia
HTN
Polysubstance abuse, including IVDU.  Drug of choice is heroin,
but pt occasionally uses cocaine.  Reports having tried "every"
illicit substance.  Reports little ETOH use.
Smokes ~3ppd

Social History:
Divorced.  Has been living with sister in [**Name (NI) 14663**].  Has 3
children and grandchildren who he is trying to rebuild
relationship with.  Unemployed, but used to work as metal
worker.  Has had difficult time finding employment since leaving
prison.  Extensive illicit drug use.  Has been in detox multiple
times.  Prior incarceration for assault & battery (reportedly
for going after someone who tried to harm his sister).
Smokes 3 PPD smoker x many years.  Rarely uses alcholol.


Family History:
Mother alive with DM, HTN.  Father living--? medical problems

Physical Exam:
HEENT: PERRL, EOMI, anicteric sclera, OP. Facial swelling
clear, MMM, no erythema, exudate or oral lesions
Neck: obese, no LAD
CV: distant S1, S2, RRR
Pulm: occasional insp and exp wheezes b/l
Abd: obese, soft
Ext: WWP, multiple abrasions/healing
Neuro: CN II-XII intact; CN I tested and patient not register
ammonia/pepper; [**6-18**] prx and distal UE and LE strength
b/l, sensation intact to light touch b/l, gait wnl


Pertinent Results:
CT head [**2168-4-13**]:IMPRESSION:

1. Status post frontal craniotomy and resection of left frontal
extra-axial mass. There is no intraparenchymal hemorrhage.

2. Persistent edema within the left frontal lobe resulting and
minimal of the normally midline structures.

MRI head [**2168-4-15**]:
The study is markedly degraded by motion from respiratory
artifact. The patient is status post bifrontal craniotomy with
postoperative changes including an extraaxial fluid collection
and pneumocephalus. There is redemonstration of extensive edema
in the left frontal lobe, no convincing enhancing lesion is seen
to suggest residual neoplasm. Ventricles and sulci are stable in
size. There is less midline shift.

LENIs [**2168-4-17**]: No evidence of bilateral lower extremity deep
venous thrombosis


Brief Hospital Course:
Neurosurgery: Patient admitted to Neurosurgery service s/p
bifrontal craniotomy. Post-op CT/MRI showed post-operative
changes with minimal pneumocephalus and no hemorrhage. The
patient's post-operative course was complicated by uncontrolled
pain. Patient has history of chronic narcotic use and
acute/chronic pain consult placed. Consult service recommended
Dilaudid PCA pump which improved pain control and he was
continued on home dose of Oxycontin 30 mg po q12hours. He
required lowdose ativan for anxiety. He was able to be
transitioned to his home oral pain medication regimen POD 3.Per
Pain consult, his Neurontin can be titrated to 3600mg /day and
patient can be switched to Methadone if chronic pain becomes an
issue in the future. He was started on Decadron which will be
tapered over weeks. Dilantin started and patient will continue
on this medication till follow-up with Dr. [**Last Name (STitle) **]. Patient
worked with PT/OT which cleared him for home.

Resp: Post-op patient had stridor and upper airway wheezing
thought to be laryngoedema. This improved with racemic epi,
atrovent and patient had a negative CXR. He may benefit from
sleep study in the future for sleep apnea.

ID: Patient spiked a fever on POD #3 and BCX NGTD. His UA and
CXR were normal. He had lower extremity ultrasounds which ruled
out a deep venous thrombosis. His right IJ sight was indurated
so line pulled and tip cultured. He was started on Keflex for
skin infection x 7 days.


Medications on Admission:
Pain Meds at home:
acetaminophen prn,
gabapentin 400 tid,
OxyContin 10 [**Hospital1 **].
NPH 70u SC QAM/ 60u SC QPM (no sliding scale)
Enalapril 10mg
Lipitor 20mg
vicodin 2 pills q4 hrs
albuterol inh prn
advair [**Hospital1 **] (not compliant with)


Discharge Medications:
acetaminophen prn,
gabapentin 600 mg tid,
OxyContin 30 mg [**Hospital1 **].
NPH 70u SC QAM/ 60u SC QPM (no sliding scale)
Enalapril 10mg  qday
Lipitor 20mg qday
albuterol inh prn
advair [**Hospital1 **]
dilantin 300 mg q AM/300 mg q noon/400 mg qnight.
Decadron taper 2 mg po q12 hours x 50 days
Keflex 500 mg po q6 hours x 7 days
Metoprolol XL 50 mg po qday
Nicotine patch qday
Percocet 5mg/325 mg 2 tbs po q4-6 hours, prn pain
quetiapine 25 mg po qday


Discharge Disposition:
Home

Discharge Diagnosis:
Meningioma
s/p bifrontal hemicraniotomy

Discharge Condition:
stable

Discharge Instructions:
Please follow-up with your primary care doctor 2-7 days after
discharge from hospital

Followup Instructions:
Please see Dr. [**Last Name (STitle) **] in 4 weeks. Call [**Telephone/Fax (1) 1669**] for an
appointment and request head CT to be scheduled at this time.
{'Benign neoplasm of cerebral meninges,Chronic obstructive asthma, unspecified,Cocaine abuse, unspecified,Edema of larynx,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes'}


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: meningioma

PRESENT ILLNESS: The patient is a 45-year male with a complex
past medical history outlined on recent admission note. He
was found to have a large bifrontal lesion consistent with a
neoplasm, most likely diagnosis is a meningioma. The patient
has suffered significant mass effect and edema from this
lesion and is in need of a histopathological diagnosis. He
is, therefore, taken electively to the operating room for
resection and decompression. Informed consent was obtained.
The patient is admitted electively to the hospital.

MEDICAL HISTORY: DMII
Hyperlipidemia
HTN
Polysubstance abuse, including IVDU.  Drug of choice is heroin,
but pt occasionally uses cocaine.  Reports having tried "every"
illicit substance.  Reports little ETOH use.
Smokes ~3ppd

MEDICATION ON ADMISSION: Pain Meds at home:
acetaminophen prn,
gabapentin 400 tid,
OxyContin 10 [**Hospital1 **].
NPH 70u SC QAM/ 60u SC QPM (no sliding scale)
Enalapril 10mg
Lipitor 20mg
vicodin 2 pills q4 hrs
albuterol inh prn
advair [**Hospital1 **] (not compliant with)

ALLERGIES: Morphine / Demerol / Codeine

PHYSICAL EXAM: HEENT: PERRL, EOMI, anicteric sclera, OP. Facial swelling
clear, MMM, no erythema, exudate or oral lesions
Neck: obese, no LAD
CV: distant S1, S2, RRR
Pulm: occasional insp and exp wheezes b/l
Abd: obese, soft
Ext: WWP, multiple abrasions/healing
Neuro: CN II-XII intact; CN I tested and patient not register
ammonia/pepper; [**6-18**] prx and distal UE and LE strength
b/l, sensation intact to light touch b/l, gait wnl

FAMILY HISTORY: Mother alive with DM, HTN.  Father living--? medical problems

SOCIAL HISTORY: Divorced.  Has been living with sister in [**Name (NI) 14663**].  Has 3
children and grandchildren who he is trying to rebuild
relationship with.  Unemployed, but used to work as metal
worker.  Has had difficult time finding employment since leaving
prison.  Extensive illicit drug use.  Has been in detox multiple
times.  Prior incarceration for assault & battery (reportedly
for going after someone who tried to harm his sister).
Smokes 3 PPD smoker x many years.  Rarely uses alcholol. 

### Response:
{'Benign neoplasm of cerebral meninges,Chronic obstructive asthma, unspecified,Cocaine abuse, unspecified,Edema of larynx,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes'}
