CHIEF COMPLAINT: Left upper lobe mass with history of Stage IV NSCLC for
pericardial involvement three years ago.

PRESENT ILLNESS: The patient is a 58-year-old male with a large left upper lobe
tumor.  He presented in [**2144**] with a malignant pericardial
effusion and received palliative
chemotherapy and radiation therapy.  Surprisingly, he has done
well for 3 years and has no evidence of disease outside of the
left upper lobe.  Given this and his good performance status and
pulmonary function, we brought him to the operating room today
for possible resection.

MEDICAL HISTORY: Stage 4 Non-small cell lung cancer (due to pericardial
involvement), CVA in
[**2140**] with left sided weakness, HTN, hypercholesterolemia, DM II

MEDICATION ON ADMISSION: ERLOTINIB [TARCEVA] -  (Prescribed by Other Provider) - 150 mg
Tablet - 1 Tablet(s) by mouth daily
FOLIC ACID -  (Prescribed by Other Provider) - 1 mg Tablet - 1
Tablet(s) by mouth daily
GLIMEPIRIDE -  (Prescribed by Other Provider) - 2 mg Tablet - 1
Tablet(s) by mouth daily
LISINOPRIL-HYDROCHLOROTHIAZIDE -  (Prescribed by Other Provider)
- 20 mg-12.5 mg Tablet - 1 Tablet(s) by mouth daily
SIMVASTATIN -  (Prescribed by Other Provider) - 80 mg Tablet - 1
Tablet(s) by mouth daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Discharge Vital Signs:
T 98.4, BP 132/84, HR 86, RR 18, O2 sats 100% RA, Blood sugars
149-245

FAMILY HISTORY: No family history of lung cancer. His father had
a history of strokes.  His mother had type 2 diabetes.  He has
no
children.

SOCIAL HISTORY: He is married and has no children.  He
previously worked in construction before his diagnosis.  He is
originally from [**Country 6257**].  He
previously smoked 1-2 packs per day x 42 years, quitting in
[**2144**].
He drinks 3 bottles of wine per week.
Malignant neoplasm of upper lobe, bronchus or lung,Acute kidney failure with lesion of tubular necrosis,Hyposmolality and/or hyponatremia,Cardiac complications, not elsewhere classified,Paralytic ileus,Atrial fibrillation,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of tobacco use,Other iatrogenic hypotension
Mal neo upper lobe lung,Ac kidny fail, tubr necr,Hyposmolality,Surg compl-heart,Paralytic ileus,Atrial fibrillation,Abn reac-organ rem NEC,Late effect CV dis NEC,Muscskel sympt limb NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,DMII wo cmp nt st uncntr,History of tobacco use,Iatrogenc hypotnsion NEC
Admission Date:  [**2147-7-24**]              Discharge Date:   [**2147-7-31**]

Date of Birth:  [**2088-8-3**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Left upper lobe mass with history of Stage IV NSCLC for
pericardial involvement three years ago.

Major Surgical or Invasive Procedure:
[**2147-7-24**]:
OPERATIONS:
1. Left thoracotomy/left pneumonectomy.
2. Buttressing of bronchial stump with intercostal muscle.


History of Present Illness:
The patient is a 58-year-old male with a large left upper lobe
tumor.  He presented in [**2144**] with a malignant pericardial
effusion and received palliative
chemotherapy and radiation therapy.  Surprisingly, he has done
well for 3 years and has no evidence of disease outside of the
left upper lobe.  Given this and his good performance status and
pulmonary function, we brought him to the operating room today
for possible resection.

Past Medical History:
Stage 4 Non-small cell lung cancer (due to pericardial
involvement), CVA in
[**2140**] with left sided weakness, HTN, hypercholesterolemia, DM II


Social History:
He is married and has no children.  He
previously worked in construction before his diagnosis.  He is
originally from [**Country 6257**].  He
previously smoked 1-2 packs per day x 42 years, quitting in
[**2144**].
He drinks 3 bottles of wine per week.


Family History:
No family history of lung cancer. His father had
a history of strokes.  His mother had type 2 diabetes.  He has
no
children.


Physical Exam:
Discharge Vital Signs:
T 98.4, BP 132/84, HR 86, RR 18, O2 sats 100% RA, Blood sugars
149-245

Discharge Physical Exam:
Gen: pleasant in NAD
Lungs: diminished over left lung fields, clear on right upper
and lower.
left thoracotomy incisions C/D/I
CV: RRR S1, S2, no MRG or JVD
Abd: soft, NT, ND
Ext: warm without edema

Pertinent Results:
[**2147-7-31**] 06:32AM BLOOD WBC-6.2 RBC-3.49* Hgb-9.5* Hct-29.7*
MCV-85 MCH-27.2 MCHC-32.0 RDW-15.0 Plt Ct-313
[**2147-7-31**] 06:32AM BLOOD Glucose-125* UreaN-24* Creat-0.8 Na-138
K-3.8 Cl-99 HCO3-30 AnGap-13
[**2147-7-25**] 08:57PM BLOOD Glucose-180* UreaN-49* Creat-2.6* Na-136
K-5.4* Cl-102 HCO3-22 AnGap-17
[**2147-7-24**] 02:14PM BLOOD Glucose-202* UreaN-29* Creat-1.3* Na-138
K-5.1 Cl-103 HCO3-23 AnGap-17
[**2147-7-28**] 09:50AM BLOOD cTropnT-<0.01
[**2147-7-28**] 02:30AM BLOOD CK-MB-3 cTropnT-<0.01
[**2147-7-27**] 06:29PM BLOOD CK-MB-4 cTropnT-<0.01
[**2147-7-26**] 02:32AM BLOOD CK-MB-8 cTropnT-<0.01
[**2147-7-31**] 06:32AM BLOOD Calcium-8.6 Phos-3.2 Mg-2.0
[**2147-7-27**] 07:53PM BLOOD Type-ART pO2-92 pCO2-39 pH-7.42
calTCO2-26 Base XS-0

[**2147-7-31**] Discharge CXR:
FINDINGS: In comparison with the study of [**7-30**], there is no
change in the
postoperative appearance with a large air-fluid level and
substantial filling of the left hemithorax with fluid. Elevation
of the left hemidiaphragmatic contour and shift of the trachea
to the left are again seen. The right lung is essentially clear.


[**2147-7-28**] KUB:
IMPRESSION:

1. Increased gaseous distension of the colon, consistent with
post-operative ileus.

2. Distention of the stomach with air and fluid should be
correlated
clinically, as this patient may benefit from placement of an NG
tube.

[**2147-7-26**] Echo:
IMPRESSION: Suboptimal image quality. Mild symmetric left
ventricular hypertrophy small/normal cavity size and preserved
global biventricular systolic function. Dilated aortic sinus.
Compared with the prior study (images reviewed) of [**2145-1-28**],
then findings are similar (prior study image quality was
superior).

[**2147-7-25**] Renal US:
IMPRESSION: No evidence of tardus parvus waveforms bilaterally
in the right or the left kidney. No evidence of hydronephrosis.
Exam limited due to the patient's body habitus.




Brief Hospital Course:
Mr. [**Known lastname 32665**] was brought into the operating room by Dr. [**First Name (STitle) **] on
[**2147-7-24**] where he underwent left thoracotomy/left pneumonectomy,
and buttressing of the bronchial stump with intercostal muscle.
He recovered in the ICU postop with left chest tube to water
seal. He was hypotensive requiring multiple albumin boluses and
IV fluids, along with neosynephrine POD 1.

POD 1 he developed acute kidney injury. Renal consult was
obtained and he was felt to be prerenal. Renal US was a poor
study due to body habitus but did not show abnormality. His left
chest tube was discontinued.

Echo was done POD 2 and normal. On POD 2 he was volume
overloaded and lasix gtt was started which he responded to.

POD 3 he developed afib which quiesced after diltiazem gtt. This
was nicely transitioned to oral ditiazem without any more afib.

POD 4 he was transfused 1 unit of PRBC's for low hct and to
assist in oxygenation and blood pressure. His diet was advanced
but his abdomen was quite distended prompting KUB which was
positive for ileus. Suppositories and stool softeners were
continued and he had a bowel movements without nausea vomiting
and less abd distention thereafter. Methylnaltrexone was given.

POD 5 he transfered to the floor. PT evaluated him and he was
not found to have home PT needs. He was deemed stable for
discharge on [**2147-7-31**] with VNA. Foley was dc'd [**2147-7-30**] with good
urine output.

CXR's were serially watched without evidence of stump leak. Pain
was initially controlled with dilaudid and bupivicaine epidural,
which was split postop for hypotension. He titrated off epidural
and PCA early on and tolerated po dilaudid for effective pain
control along with tylenol.


Medications on Admission:
ERLOTINIB [TARCEVA] -  (Prescribed by Other Provider) - 150 mg
Tablet - 1 Tablet(s) by mouth daily
FOLIC ACID -  (Prescribed by Other Provider) - 1 mg Tablet - 1
Tablet(s) by mouth daily
GLIMEPIRIDE -  (Prescribed by Other Provider) - 2 mg Tablet - 1
Tablet(s) by mouth daily
LISINOPRIL-HYDROCHLOROTHIAZIDE -  (Prescribed by Other Provider)
- 20 mg-12.5 mg Tablet - 1 Tablet(s) by mouth daily
SIMVASTATIN -  (Prescribed by Other Provider) - 80 mg Tablet - 1
Tablet(s) by mouth daily

Medications - OTC
ASPIRIN -  (Prescribed by Other Provider) - 81 mg Tablet,
Delayed
Release (E.C.) - 1 Tablet(s) by mouth daily


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO twice
a day.
Disp:*60 Capsule(s)* Refills:*2*
2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily). Tablet, Chewable(s)
3. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO every
eight (8) hours as needed for pain.
4. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4
hours) as needed for pain.
Disp:*75 Tablet(s)* Refills:*0*
6. diltiazem HCl 120 mg Capsule, Extended Release Sig: One (1)
Capsule, Extended Release PO DAILY (Daily).
Disp:*30 Capsule, Extended Release(s)* Refills:*2*
7. glimepiride 2 mg Tablet Sig: One (1) Tablet PO once a day.
8. simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.
9. lisinopril-hydrochlorothiazide 20-12.5 mg Tablet Sig: One (1)
Tablet PO once a day.


Discharge Disposition:
Home With Service

Facility:
Community Nurse [**First Name (Titles) **] [**Last Name (Titles) **] Care,Inc

Discharge Diagnosis:
Non-small cell lung cancer s/p left pneumonectomy
Acute kidney injury now resolved, dc creatinine 0.8
Postoperative atrial fibrillation resolved on diltiazem
Hyponatremia resolved
Postoperative ileus resolving
HTN
HL
DM II


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Call Dr.[**Name (NI) 5067**] office at [**Telephone/Fax (1) 2348**] if you have fevers
greater than 101.5, worsening cough, chest pain, shortness of
breath.

Call if your left thoracotomy incision opens, drains or becomes
red.
Call if fast irregular heartbeat.
Call if you have abdominal pain or ongoing constipation, nausea
or vomiting.

Activity:
Walk often. Use the incentive spirometer.
You may shower. Do not tub bathe or submerge in water for [**7-19**]
weeks.

Pain:
Take tylenol around the clock and dilaudid as needed. While on
dilaudid do not drive. Take stool softeners to prevent
constipation.

We have added diltiazem to your medications. This is a once a
day pill which should control your heart rate. You had a day of
postoperative atrial fibrillation which went away after starting
this medication.

Do not resume erlotnib (tarceva) until advised by your
oncologist.


Followup Instructions:
Followup with:
Name: [**Last Name (LF) 8034**],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
Location: [**Location (un) **] FAMILY MEDICINE
Address: [**Street Address(2) 81386**], [**Location (un) **],[**Numeric Identifier 28653**]
Phone: [**Telephone/Fax (1) 81387**]
Fax: [**Telephone/Fax (1) 81388**]
Date/time [**2147-8-7**] at 8:30am

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3000**], MD Phone:[**0-0-**]
Date/Time:[**2147-8-10**] 2:30 [**Hospital Ward Name 23**] [**Location (un) **], [**Hospital Ward Name **]

Get a chest xray 30 minutes prior to your appointment on the [**Location (un) **] radiology.

Followup with your oncologist regarding when to resume Tarceva.
Name: [**Last Name (un) **],[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] MD
Location: [**Hospital3 **] HOSPITAL
Address: [**Street Address(2) 81389**], [**Location (un) **],[**Numeric Identifier 17178**]
Phone: [**Telephone/Fax (1) 81390**]
Fax: [**Telephone/Fax (1) 81391**]
We tried to make an appointment but was unable to reach the
office. Please call to make a followup appointment.



Completed by:[**2147-8-1**]
{'Malignant neoplasm of upper lobe, bronchus or lung,Acute kidney failure with lesion of tubular necrosis,Hyposmolality and/or hyponatremia,Cardiac complications, not elsewhere classified,Paralytic ileus,Atrial fibrillation,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of tobacco use,Other iatrogenic hypotension'}


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: Left upper lobe mass with history of Stage IV NSCLC for
pericardial involvement three years ago.

PRESENT ILLNESS: The patient is a 58-year-old male with a large left upper lobe
tumor.  He presented in [**2144**] with a malignant pericardial
effusion and received palliative
chemotherapy and radiation therapy.  Surprisingly, he has done
well for 3 years and has no evidence of disease outside of the
left upper lobe.  Given this and his good performance status and
pulmonary function, we brought him to the operating room today
for possible resection.

MEDICAL HISTORY: Stage 4 Non-small cell lung cancer (due to pericardial
involvement), CVA in
[**2140**] with left sided weakness, HTN, hypercholesterolemia, DM II

MEDICATION ON ADMISSION: ERLOTINIB [TARCEVA] -  (Prescribed by Other Provider) - 150 mg
Tablet - 1 Tablet(s) by mouth daily
FOLIC ACID -  (Prescribed by Other Provider) - 1 mg Tablet - 1
Tablet(s) by mouth daily
GLIMEPIRIDE -  (Prescribed by Other Provider) - 2 mg Tablet - 1
Tablet(s) by mouth daily
LISINOPRIL-HYDROCHLOROTHIAZIDE -  (Prescribed by Other Provider)
- 20 mg-12.5 mg Tablet - 1 Tablet(s) by mouth daily
SIMVASTATIN -  (Prescribed by Other Provider) - 80 mg Tablet - 1
Tablet(s) by mouth daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Discharge Vital Signs:
T 98.4, BP 132/84, HR 86, RR 18, O2 sats 100% RA, Blood sugars
149-245

FAMILY HISTORY: No family history of lung cancer. His father had
a history of strokes.  His mother had type 2 diabetes.  He has
no
children.

SOCIAL HISTORY: He is married and has no children.  He
previously worked in construction before his diagnosis.  He is
originally from [**Country 6257**].  He
previously smoked 1-2 packs per day x 42 years, quitting in
[**2144**].
He drinks 3 bottles of wine per week. 

### Response:
{'Malignant neoplasm of upper lobe, bronchus or lung,Acute kidney failure with lesion of tubular necrosis,Hyposmolality and/or hyponatremia,Cardiac complications, not elsewhere classified,Paralytic ileus,Atrial fibrillation,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other late effects of cerebrovascular disease,Other musculoskeletal symptoms referable to limbs,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of tobacco use,Other iatrogenic hypotension'}
