CHIEF COMPLAINT: Shortness of breath.

PRESENT ILLNESS: The patient is a 62-year-old
diabetic male admitted to the [**Hospital1 18**] through the Emergency
Department on [**2140-2-9**].  The patient's past medical history
is significant for a laparoscopic cholecystectomy in [**2139-8-3**] with a postoperative course complicated by bile duct
injury requiring Roux-en-Y reconstruction.  Following the
surgery, the patient also developed chronic pleural
effusions, worse on the right requiring multiple
thoracentesis.  Early in [**2139**], the patient began to develop
worsening dyspnea, fatigue, and malaise, and inability to
achieve a complete breath.  It was noted on workup that he
had developed bilateral fibrothoraxes, particularly on the
right.  The patient's CAT scan also revealed mediastinal
adenopathy as well as a ground glass appearance to both lungs
of unclear etiology.

MEDICAL HISTORY: 1.  Diabetes mellitus.
2.  Hypertension.
3.  Chronic leg pain.
4.  Diabetic neuropathy.
5.  Cataracts.
6.  Chronic anemia.
7.  Benign prostatic hypertrophy.
8.  Prostatitis ([**2140-2-1**]).

MEDICATION ON ADMISSION: 

ALLERGIES: Vicodin (hallucinations).

PHYSICAL EXAM: 

FAMILY HISTORY: The patient's father died at the age 61 of
COPD.  The patient's mother died of breast cancer at age 88.
One brother has had multiple strokes and two sisters are both
healthy.

SOCIAL HISTORY: The patient is a retired umpire for multiple
sports.  He is married and lives with his wife.  [**Name (NI) **] has two
children and five grandchildren.  He has never smoked.
Congestive heart failure, unspecified,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Retention of urine, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Prostatitis, unspecified,Other chest pain
CHF NOS,Pneumonia, organism NOS,Urin tract infection NOS,Retention urine NOS,DMII neuro nt st uncntrl,Neuropathy in diabetes,Prostatitis NOS,Chest pain NEC
Admission Date:  [**2140-2-9**]       Discharge Date:  [**2140-2-26**]

Date of Birth:   [**2078-1-6**]       Sex:  M

Service:  THORACIC SURGERY

CHIEF COMPLAINT:  Shortness of breath.

HISTORY OF THE PRESENT ILLNESS:  The patient is a 62-year-old
diabetic male admitted to the [**Hospital1 18**] through the Emergency
Department on [**2140-2-9**].  The patient's past medical history
is significant for a laparoscopic cholecystectomy in [**2139-8-3**] with a postoperative course complicated by bile duct
injury requiring Roux-en-Y reconstruction.  Following the
surgery, the patient also developed chronic pleural
effusions, worse on the right requiring multiple
thoracentesis.  Early in [**2139**], the patient began to develop
worsening dyspnea, fatigue, and malaise, and inability to
achieve a complete breath.  It was noted on workup that he
had developed bilateral fibrothoraxes, particularly on the
right.  The patient's CAT scan also revealed mediastinal
adenopathy as well as a ground glass appearance to both lungs
of unclear etiology.

The patient had been admitted to the [**Hospital1 18**] between  [**2140-1-5**]
and [**2140-1-8**] with a chief complaint of increased shortness of
breath and was subsequently discharged to a rehabilitation
facility.  The patient had been home for one week when he
developed increasing shortness of breath and was brought into
the Emergency Department by his wife.

PAST MEDICAL HISTORY:
1.  Diabetes mellitus.
2.  Hypertension.
3.  Chronic leg pain.
4.  Diabetic neuropathy.
5.  Cataracts.
6.  Chronic anemia.
7.  Benign prostatic hypertrophy.
8.  Prostatitis ([**2140-2-1**]).

PAST SURGICAL HISTORY:
1.  Laparoscopic cholecystectomy in [**2139-4-2**].
2.  Roux-en-Y hepatojejunostomy on [**2139-5-8**].
3.  Thoracentesis in [**2139-5-3**] and [**2139-6-2**].
4.  Left hip replacement in [**2138-10-3**], complicated by
chronic left leg pain.
5.  Left knee arthropathy.
6.  Cardiac catheterization in [**2139-6-2**].

ADMISSION MEDICATIONS:
1.  Ciprofloxacin.
2.  Colace.
3.  Epogen.
4.  Actos.
5.  Vitamin C.
6.  Metformin.
7.  Flomax.
8.  Nexium.
9.  Lisinopril.
10. Metoprolol.
11. Aspirin.

ALLERGIES:  Vicodin (hallucinations).

SOCIAL HISTORY:  The patient is a retired umpire for multiple
sports.  He is married and lives with his wife.  [**Name (NI) **] has two
children and five grandchildren.  He has never smoked.

FAMILY HISTORY:   The patient's father died at the age 61 of
COPD.  The patient's mother died of breast cancer at age 88.
One brother has had multiple strokes and two sisters are both
healthy.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  On
admission, the patient's temperature was 97, heart rate 76,
blood pressure 129/70, breathing at 24, saturating 96%.
General:  The patient appeared to be in no distress.  The
physical examination was notable for bibasilar crackles,
worse on the right than the left with an occasional wheeze.
The patient's heart was regular and abdomen was benign.

LABORATORY/RADIOLOGIC DATA:  The patient's white count was
8.76, hematocrit 29.1, platelets 174,000.  The patient's
serum chemistries revealed a sodium of 142, potassium 4.7,
chloride 102, bicarbonate 34, BUN 44, creatinine 1.6 as well
as a blood glucose of 42.  The patient had a blood gas drawn
on arrival to the Emergency Department with a pH of 7.3,
carbon dioxide of 71, and oxygen of 122.  Subsequent arterial
blood gases drawn an hour and a half and five hours after
arrival in the Emergency Department continued to have a pH
between 7.31 and 7.33 and serum carbon dioxide level of
63-67.  Cardiac enzymes were drawn with troponins of 0.13,
0.14, and 0.12.

HOSPITAL COURSE:  The patient was admitted to the medical
service on admission and workup initiated for possible
congestive heart failure.  Some consideration was given to
admitting the patient to the Intensive Care Unit but given
that the patient's mental status was at baseline with no
evidence of distress as well as the fact that his elevated
carbon dioxide level of ABG was probably chronic.  The
decision was made to admit the patient to the floor.

Diuresis was initiated with Lasix.  A Thoracic Surgery
consultation was requested.  The Thoracic Surgery Team was of
the opinion that the patient had an entrapped right lung and
that decortication may be of benefit.  It was hoped that the
decortication would improve the patient's respiratory
function. The patient was also seen by the Pulmonary Service.
 The patient was started on BIPAP on the evening of [**2140-2-12**]
in an attempt to improve his ventilation while asleep.  The
patient tolerated the BIPAP well and felt that he had
improved sleep and energy with it.

The patient was taken to surgery on [**2140-2-17**] and underwent
decortication of his right lower, middle, and upper lobes as
well as his diaphragm.  The patient was difficult to intubate
and was kept intubated over the night of postoperative day
number zero for continued monitoring.  The patient was on an
epidural for pain control.  We were unable to have the
patient extubated on postoperative day number one secondary
to apnea as well as suboptimal blood gases.  The patient was
extubated on postoperative day number two.

On the evening of postoperative day number three, the patient
was noted to be very lethargic, barely responding to voice,
diaphoretic, and with decreasing oxygen saturations as well
as heart rate.  The patient ultimately require reintubation.
Bronchoscopy was performed revealing a left main stem plug as
well as plugs in the left upper and left lower lobes with
thick copious whitish secretions.

Repeat bronchoscopy was performed on postoperative day number
four with minimal residual secretions noted.  Please note
that the patient's arterial blood gas on reintubation
revealed a pH of 6.98 with a carbon dioxide level of 140 and
oxygen of 178.  Further bronchoscopy was performed on
postoperative day number five revealing once again thick
yellow secretions worse on the left than the right.  The
patient was started on Levaquin presumptively for pneumonia.
The patient underwent tracheostomy on [**2140-2-22**].

The patient was returned to the Intensive Care Unit following
performance of the tracheostomy.  The patient did well
following this.  The patient's chest tubes were removed on
[**2140-2-23**].  The patient underwent a swallowing evaluation on
[**2140-2-24**].  With a Passy Muir valve, the patient was noted to
aspirate during an evaluation the patient was noted to
aspirate during evaluation with the recommendation to keep
the patient strictly n.p.o.  The patient was receiving tube
feeds through a Dobbhoff nasogastric tube.

The patient was weaned off the ventilator and placed on CPAP
on [**2140-2-25**] as well as [**2140-2-26**].  The patient was tolerating
this mode of ventilation for long periods.  The patient was
continued on Lasix diuresis.  A rehabilitation screening was
initiated.  On [**2140-2-25**], the patient did have the complaint
of some chest pain.  An EKG was obtained which revealed no
changes.  However, the patient's pain did resolve with some
sublingual nitroglycerin.  A Cardiology consultation was
requested.  Please note that the patient had a cardiac
catheterization in [**2139-6-2**] which revealed minimal left
circumflex disease and with otherwise clear coronary
arteries.  Cardiac enzymes drawn revealed a troponin level of
0.07 decreasing to 0.06 and then 0.05.  At this time, the
patient's discharge is on hold pending the cardiology
consult.

An addendum to this discharge summary will be dictated
following input from Cardiology.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE DIAGNOSIS:
1.  Fibrothorax.
2.  Diabetes mellitus.
3.  Pneumonia.
4.  Prostatitis.
5.  Anemia.

DISCHARGE MEDICATIONS:
1.  Colace liquid 100 mg p.o. b.i.d.
2.  Metoprolol 75 mg p.o. b.i.d.
3.  Insulin by sliding scale.
4.  Lasix 40 mg IV b.i.d.
5.  Percocet elixir [**4-11**] milliliters p.o. q. four hours
p.r.n.
6.  Oxymetazoline one spray b.i.d. as needed.
7.  Ibuprofen 400 mg q. eight hours p.r.n.
8.  Levofloxacin 750 mg p.o. q.d.
9.  Pepcid 20 mg p.o. b.i.d.
10. Ambien 5 mg p.o. q.h.s. p.r.n.
11. Nortriptyline 75 mg p.o. q.h.s.
12. Albuterol ipratropium four puffs inhaler q. six hours.
13. Saline nasal spray p.r.n.
14. Neutra-Phos one packet p.o. t.i.d.
15. Tylenol 325-650 mg p.o. q. four hours p.r.n.
16. Heparin 5,000 units subcutaneously t.i.d.
17. Aspirin 325 mg p.o. q.d.
18. Dorzolamide 2%/Timolol 0.5% eyedrops b.i.d.
19. Vitamin C 250 mg p.o. t.i.d.
20. Lexapro 10 mg p.o. q.d.
21. Tamsulosin 0.4 mg p.o. b.i.d.

FOLLOW-UP:  The patient is to follow-up with Dr. [**First Name4 (NamePattern1) 951**] [**Last Name (NamePattern1) 952**]
in one to two weeks following discharge.  The patient is also
to follow-up with his primary care physician as well as his
pulmonologist within one to two weeks following discharge.
The patient will need cardiac follow-up pending the
recommendations of cardiology consultation team.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3351**], M.D.  [**MD Number(1) 3352**]

Dictated By:[**Name8 (MD) 997**]
MEDQUIST36

D:  [**2140-2-26**]  02:37
T:  [**2140-2-26**]  15:17
JOB#:  [**Job Number 34871**]


Admission Date:  [**2140-2-9**]       Discharge Date:  [**2140-2-27**]

Date of Birth:   [**2078-1-6**]       Sex:  M

Service:  Thoracic Surgery

ADDENDUM:  Please refer to the previously dictated Discharge
Summary covering the period of [**2140-2-9**] through [**2140-2-26**].

As previously stated, the patient was evaluated by Cardiology
Service for his complaint of chest pain which had resolved
with sublingual nitroglycerin in the absence of
electrocardiogram changes.  The patient had cardiac enzymes
with his troponin trending down from 0.07 to 0.05.

Of note, the patient also had a cardiac catheterization in
[**2139-6-2**] which revealed minimal left circumflex disease
with otherwise clear coronary arteries.

The Cardiology Service did not believe the patient's chest
pain to have been cardiac and noted that the patient had
previously had elevated serum troponin levels throughout much
of his hospitalization.  The cause for the elevated serum
troponin was unclear.  The Cardiology Service recommended no
further workup.

DISCHARGE DISPOSITION:  Plans for discharge were therefore
finalized.  The patient was to be transferred to a
rehabilitation facility on [**2140-2-27**].

MEDICATIONS ON DISCHARGE:  The patient's discharge
medications were unchanged from those listed on his prior
Discharge Summary except for the discontinuation of
levofloxacin.





                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3351**], M.D.  [**MD Number(1) 3352**]

Dictated By:[**Name8 (MD) 997**]
MEDQUIST36

D:  [**2140-2-27**]  09:49
T:  [**2140-2-27**]  09:55
JOB#:  [**Job Number 34942**]
{'Congestive heart failure, unspecified,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Retention of urine, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Prostatitis, unspecified,Other chest pain'}


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: Shortness of breath.

PRESENT ILLNESS: The patient is a 62-year-old
diabetic male admitted to the [**Hospital1 18**] through the Emergency
Department on [**2140-2-9**].  The patient's past medical history
is significant for a laparoscopic cholecystectomy in [**2139-8-3**] with a postoperative course complicated by bile duct
injury requiring Roux-en-Y reconstruction.  Following the
surgery, the patient also developed chronic pleural
effusions, worse on the right requiring multiple
thoracentesis.  Early in [**2139**], the patient began to develop
worsening dyspnea, fatigue, and malaise, and inability to
achieve a complete breath.  It was noted on workup that he
had developed bilateral fibrothoraxes, particularly on the
right.  The patient's CAT scan also revealed mediastinal
adenopathy as well as a ground glass appearance to both lungs
of unclear etiology.

MEDICAL HISTORY: 1.  Diabetes mellitus.
2.  Hypertension.
3.  Chronic leg pain.
4.  Diabetic neuropathy.
5.  Cataracts.
6.  Chronic anemia.
7.  Benign prostatic hypertrophy.
8.  Prostatitis ([**2140-2-1**]).

MEDICATION ON ADMISSION: 

ALLERGIES: Vicodin (hallucinations).

PHYSICAL EXAM: 

FAMILY HISTORY: The patient's father died at the age 61 of
COPD.  The patient's mother died of breast cancer at age 88.
One brother has had multiple strokes and two sisters are both
healthy.

SOCIAL HISTORY: The patient is a retired umpire for multiple
sports.  He is married and lives with his wife.  [**Name (NI) **] has two
children and five grandchildren.  He has never smoked. 

### Response:
{'Congestive heart failure, unspecified,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Retention of urine, unspecified,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Polyneuropathy in diabetes,Prostatitis, unspecified,Other chest pain'}
