CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 60-year-old
male with history of metastatic [**Year (4 digits) 499**] cancer to the liver
with low back pain times four to five weeks with an acute
worsening of pain last night while sleeping.  The patient
says he "rolled onto his side or something" and awoke in
severe pain.  No history of recent fall.  No bladder or bowel
incontinence.  The patient states his pain is constant and
localizes to the bone and muscle; however, it is worse in the
bone.  He localizes his pain to the L1 level.  No fevers,
chills, weight loss, or diarrhea.  The patient states his
appetite is good.  He reports a mild cough with sore throat
and hoarseness for the past couple of days, but otherwise
review of systems is negative.

MEDICAL HISTORY: Metastatic [**Year (4 digits) 499**] cancer to the liver-
possible candidate for trisegmentectomy with wedge resection
(referred to Dr. [**Last Name (STitle) **] secondary to rapidly progressing
liver metastasis despite recent chemotherapy.

MEDICATION ON ADMISSION: 

ALLERGIES: ALEVE CAUSES URTICARIA.

PHYSICAL EXAM: 

FAMILY HISTORY: Sister with [**Name2 (NI) 499**] cancer.  Father deceased
at 52 secondary to a CVA.  Mother deceased at 92 secondary to
natural causes.

SOCIAL HISTORY: No tobacco or alcohol.  The patient is
married with three sons.  [**Name (NI) **] is a retired pipe fitter.  He
denies IV drug use, blood transfusions, or hepatitis.
Secondary malignant neoplasm of bone and bone marrow,Pneumonitis due to inhalation of food or vomitus,Malignant neoplasm of liver, secondary,Pathologic fracture of vertebrae,Acute respiratory failure,Unspecified septicemia,Acute and subacute necrosis of liver,Thrombocytopenia, unspecified,Personal history of malignant neoplasm of large intestine
Secondary malig neo bone,Food/vomit pneumonitis,Second malig neo liver,Path fx vertebrae,Acute respiratry failure,Septicemia NOS,Acute necrosis of liver,Thrombocytopenia NOS,Hx of colonic malignancy
Admission Date: [**2179-10-26**]        Discharge Date: [**2179-11-6**]

Date of Birth:  [**2119-5-18**]        Sex:  M

Service:  OMED


HISTORY OF PRESENT ILLNESS:  The patient is a 60-year-old
male with history of metastatic [**Year (4 digits) 499**] cancer to the liver
with low back pain times four to five weeks with an acute
worsening of pain last night while sleeping.  The patient
says he "rolled onto his side or something" and awoke in
severe pain.  No history of recent fall.  No bladder or bowel
incontinence.  The patient states his pain is constant and
localizes to the bone and muscle; however, it is worse in the
bone.  He localizes his pain to the L1 level.  No fevers,
chills, weight loss, or diarrhea.  The patient states his
appetite is good.  He reports a mild cough with sore throat
and hoarseness for the past couple of days, but otherwise
review of systems is negative.

PAST MEDICAL HISTORY:  Metastatic [**Year (4 digits) 499**] cancer to the liver-
possible candidate for trisegmentectomy with wedge resection
(referred to Dr. [**Last Name (STitle) **] secondary to rapidly progressing
liver metastasis despite recent chemotherapy.

Status post sigmoid colectomy with low anterior resection on
[**2178-9-23**] with one moderately differentiated and one poorly
differentiated lesion with 11 out of 12 lymph nodes positive,
status post adjuvant chemotherapy from [**11-9**] to [**6-10**]
consisting of 5-FU plus leucovorin.  CEA on [**2179-9-27**] elevated
to 29, at which time a CT revealed new large liver
metastasis.

MEDICATIONS:
1. Tylenol p.r.n.
2. Vitamin B6 q.d.


ALLERGIES:  ALEVE CAUSES URTICARIA.

FAMILY HISTORY:  Sister with [**Name2 (NI) 499**] cancer.  Father deceased
at 52 secondary to a CVA.  Mother deceased at 92 secondary to
natural causes.

SOCIAL HISTORY:  No tobacco or alcohol.  The patient is
married with three sons.  [**Name (NI) **] is a retired pipe fitter.  He
denies IV drug use, blood transfusions, or hepatitis.

PHYSICAL EXAMINATION:  Temperature 97.4 degrees, blood
pressure 138/88, heart rate 79, respiratory rate of 20, and
O2 saturation 97 percent on room air.  General:  The patient
is clearly in distress secondary to pain, unable to move in
the bed without complaints of pain.  HEENT:  Pupils are
equally round and reactive to light and accommodation.
Extraocular movements are intact.  Sclerae is anicteric.
Neck:  No lymphadenopathy.  Cardiovascular:  Regular rate and
rhythm.  No murmurs, rubs, or gallops.  Pulmonary:  Clear to
auscultation bilaterally.  Abdomen:  Normoactive bowel
sounds, soft, nontender, nondistended; no masses or
hepatosplenomegaly.  Extremities:  No clubbing, cyanosis, or
edema.  Neuro:  Cranial nerves II through XII grossly intact,
moving legs bilaterally.  No complaints of weakness.  Intact
to vibration bilaterally.  Back:  Point tenderness over L1.
Rectal:  Good rectal tone.  Guaiac negative.

LABORATORY AND DIAGNOSTIC DATA:  Admission white count 9.5
increased to 16.4 during this admission, hematocrit 44.2
decreased to 34.9 during this admission, platelets 265 with a
decrease to 85 over his hospital stay.  Initial chem-7 within
normal limits.  Increasing creatinine to 1.3 following
episode of hypotension.  LFTs increased into the 1000s
following episode of hypotension.  Troponin 0.16 following
episode of hypotension.  Lactate of 8.0 during the course of
this admission.  Hepatitis B surface antigen positive,
hepatitis B core antibody positive, hepatitis A virus
antibody positive, hepatitis C virus antibody negative.

MRI of the spine:
Metastatic involvement of T12 without pathologic compression
or deformity.
Moderate cervical spondylosis most notably at C5-C6 level;
also minor spondylosis at C4-C5 and C3-C4.  Loss of signal
within the body of L1 with mild loss of height anteriorly and
perhaps slightly posteriorly.  An epidural mass extending
posterior to L1 without compression of the cauda equina.
Mild disc narrowing at L3-L4 and L4-L5 without evidence of
canal stenosis or focal disc protrusion.

Gallbladder ultrasound from [**2179-10-30**]:  No gallstones, no
common bile duct dilation, portal vein patent.

CT of the head from [**2179-10-30**]:  No acute intracranial
hemorrhage, mass effect, or enhancing lesion.  Small lacunar
infarct within right basal ganglia, likely remote.

Blood cultures from [**2179-10-30**] and [**2179-11-3**] are negative for
growth.  Sputum culture from [**2179-10-31**] consistent with MSSA.
Urine culture from [**2179-10-30**] negative.  Stool culture from
[**2179-10-30**] and [**2179-11-5**] negative for Clostridium difficile and
other cultures.  GGT 130.

HOSPITAL COURSE:  This is a 60-year-old male with history of
metastatic [**Month/Day/Year 499**] cancer to the liver presenting with acute
worsening of chronic low back pain with evidence of
metastatic spinal disease on admission MRI involving T12 and
L1.

Metastatic [**Month/Day/Year 499**] cancer:  The patient is status post 5-FU and
leucovorin completed in [**6-10**], however, with rapid
development of liver metastases on CT diagnosed prior to
admission.  He was prior in consideration for hepatic
resection due to his single site of metastasis.  However, he
now presents with new bony metastasis.  During the course of
his admission, Surgery was consulted and the patient was
staffed with Dr. [**Last Name (STitle) **], whom he was referred to in the past
for liver lesion resection.  The decision was made that
resection is not appropriate at this time given the two sites
of metastatic disease.  Thus, Radiation Oncology was
consulted with a plan to initiate palliative radiation for
pain control.  The patient will likely also undergo further
chemotherapy as an outpatient.  Due to ongoing pain,
difficult to control by p.o. medications, the patient's
palliative radiation was started in-house.

Pathologic vertebral body compression fracture:  The patient
was started on MS Contin, which was titrated up to permit
adequate mobility.  Neurosurgery was consulted regarding the
benefit of a potential brace.  It was their opinion that a
brace will offer the patient little to no benefit.  Due to
ongoing pain despite p.o. medication, the patient was
initiated on palliative radiation.  However, this seemed to
acutely worsen his back pain and his MS Contin was gradually
titrated up.  However, this was complicated by hypercarbic
respiratory failure due to likely narcotic overdose plus or
minus history of aspiration due to decreased mental status
and supine positioning necessary due to the patient's ongoing
back pain.  In addition to narcotic analgesia, the patient
received a dose of IV pamidronate on [**2179-10-27**] and was managed
on Vioxx.  He was ultimately discharged on rofecoxib,
OxyContin, and hydromorphone p.r.n.

Epidural mass at L1:  On admission MRI, patient was noted to
have an epidural mass at the level of L1 vertebral body
without compression in the cauda equina.  He received IV
steroids; however, these were discontinued the following day
due to the confirmation of no cord compression, and the
approval of Radiation Oncology for the absence of need for
steroids with the initiation of palliative radiotherapy.

Hypercarbic respiratory failure:  The patient was noted to be
unresponsive and hypoxic with saturations in the 80s on
[**2180-10-30**].  ABG at that time was 7.18/58/79.  Initial thought
for narcotic overdose as the underlying etiology, thus the
patient received one dose of Narcan with some improvement in
his oxygenation and respiration.  However, he continued to be
poorly responsive and agitated with a drop in his blood
pressure following intubation, thus suspicious for sepsis
secondary to possible aspiration pneumonia in the setting of
narcotic analgesia and the patient's supine position, all
necessary for control of his back pain.  The patient was
initially managed with vancomycin, cefepime, and Flagyl; and
continued on cefepime to complete a total of 10 days of
antibiotics following a sputum culture revealing MSSA.  The
patient's narcotic analgesia was titrated down prior to
discharge.  His O2 saturations had returned to 97 percent on
room air.

Sepsis:  Following hypercarbic respiratory failure and
unresponsiveness, the patient was intubated, at which time
his systolic pressures dropped into the 70s.  He responded
well to peripheral dopamine and IV fluids.  A central line
was placed and he was continued on pressors for two days to
maintain his blood pressure while on broad-spectrum
antibiotics.  His sputum culture grew out MSSA.  His
antibiotics were narrowed to cefepime alone.  His blood
pressures recovered and his lactate decreased from its
initial level of 8.  However, the patient suffered shock
liver with elevation of his LFTs into the 1000s; acute renal
failure with bump of the creatinine to 1.3, which has
subsequently improved; in addition to cardiac-demand ischemia
and mild DIC.  All these values have improved since his
initial insult.  His blood cultures remain negative, stool
cultures negative including Clostridium difficile times two.
Thus likely, the patient's sepsis is secondary to aspiration
pneumonia.

Prophylaxis:  Subcutaneous heparin, PPI, aspiration
precautions.

FEN:  Patient maintained on the house diet.

Full code.

DISCHARGE DIAGNOSES:  Metastatic [**Date Range 499**] cancer to liver and
vertebral body.

Pathologic compression fracture.

Aspiration pneumonia.

Sepsis.

Disseminated intravascular coagulation.

Shock liver.

Acute renal failure secondary to acute tubular
necrosis/hypotension.

DISCHARGE CONDITION:  Good.  Pain controlled.  Saturating
well on room air.

DISCHARGE STATUS:  The patient is to be discharged to home
with services.

DISCHARGE MEDICATIONS:
1. Protonix 40 mg p.o. q.d.
2. Colace 100 mg p.o. b.i.d.
3. Senna 8.6 mg 2 tablets p.o. b.i.d. p.r.n. constipation.
4. Rofecoxib 12.5 mg p.o. q.d.
5. Oxycodone SR 20 mg p.o. q.12 h.
6. Calcium carbonate 500 mg p.o. t.i.d.
7. Hydromorphone 1 to 2 mg p.o. q.3 h. p.r.n. pain.
8. Levofloxacin 500 mg p.o. q.d. x3 days.


FOLLOW UP:  The patient is to follow up with Dr. [**Last Name (STitle) 150**]
for continued care.



                        [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 150**], [**MD Number(1) 32196**]

Dictated By:[**Last Name (NamePattern1) 19957**]
MEDQUIST36
D:  [**2180-6-19**] 19:13:25
T:  [**2180-6-20**] 02:25:43
Job#:  [**Job Number 44447**]
{'Secondary malignant neoplasm of bone and bone marrow,Pneumonitis due to inhalation of food or vomitus,Malignant neoplasm of liver, secondary,Pathologic fracture of vertebrae,Acute respiratory failure,Unspecified septicemia,Acute and subacute necrosis of liver,Thrombocytopenia, unspecified,Personal history of malignant neoplasm of large intestine'}


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: The patient is a 60-year-old
male with history of metastatic [**Year (4 digits) 499**] cancer to the liver
with low back pain times four to five weeks with an acute
worsening of pain last night while sleeping.  The patient
says he "rolled onto his side or something" and awoke in
severe pain.  No history of recent fall.  No bladder or bowel
incontinence.  The patient states his pain is constant and
localizes to the bone and muscle; however, it is worse in the
bone.  He localizes his pain to the L1 level.  No fevers,
chills, weight loss, or diarrhea.  The patient states his
appetite is good.  He reports a mild cough with sore throat
and hoarseness for the past couple of days, but otherwise
review of systems is negative.

MEDICAL HISTORY: Metastatic [**Year (4 digits) 499**] cancer to the liver-
possible candidate for trisegmentectomy with wedge resection
(referred to Dr. [**Last Name (STitle) **] secondary to rapidly progressing
liver metastasis despite recent chemotherapy.

MEDICATION ON ADMISSION: 

ALLERGIES: ALEVE CAUSES URTICARIA.

PHYSICAL EXAM: 

FAMILY HISTORY: Sister with [**Name2 (NI) 499**] cancer.  Father deceased
at 52 secondary to a CVA.  Mother deceased at 92 secondary to
natural causes.

SOCIAL HISTORY: No tobacco or alcohol.  The patient is
married with three sons.  [**Name (NI) **] is a retired pipe fitter.  He
denies IV drug use, blood transfusions, or hepatitis. 

### Response:
{'Secondary malignant neoplasm of bone and bone marrow,Pneumonitis due to inhalation of food or vomitus,Malignant neoplasm of liver, secondary,Pathologic fracture of vertebrae,Acute respiratory failure,Unspecified septicemia,Acute and subacute necrosis of liver,Thrombocytopenia, unspecified,Personal history of malignant neoplasm of large intestine'}
