CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 74 year old
with known coronary artery disease about to undergo surgery
for a pituitary adenoma for which he is being evaluated to
undergo scheduled cardiac catheterization prior to his
adenoma surgery.

MEDICAL HISTORY: 1. Significant only for ureteral stones.
2. Coronary artery disease.
3. Known pituitary adenoma, which will require surgery in the
future.

MEDICATION ON ADMISSION: 

ALLERGIES: He claims no known allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Married.  Lives at home with his wife.
Positive social alcohol use.  Positive tobacco use.
Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Third or oculomotor nerve palsy, total,Benign neoplasm of pituitary gland and craniopharyngeal duct
Crnry athrscl natve vssl,Pure hypercholesterolem,Total third nerve palsy,Benign neo pituitary
Admission Date:  [**2178-5-13**]       Discharge Date:  [**2178-5-20**]

Date of Birth:   [**2103-5-16**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  The patient is a 74 year old
with known coronary artery disease about to undergo surgery
for a pituitary adenoma for which he is being evaluated to
undergo scheduled cardiac catheterization prior to his
adenoma surgery.

PAST MEDICAL HISTORY:
1. Significant only for ureteral stones.
2. Coronary artery disease.
3. Known pituitary adenoma, which will require surgery in the
future.

MEDICATIONS PRIOR TO ADMISSION:
1. Isordil.
2. Atenolol.
3. Lipitor.

ALLERGIES:  He claims no known allergies.

SOCIAL HISTORY:  Married.  Lives at home with his wife.
Positive social alcohol use.  Positive tobacco use.

PHYSICAL EXAMINATION:  Vital signs:  Heart rate 50, sinus
rhythm, blood pressure 133/80, respiratory rate 20, and O2
saturation is 99% on room air.  In general, in no acute
distress.  HEENT:  Thalassemia, [**Last Name (un) **] lid lag, exophthalmus
icterus.  Carotids:  No bruits, no transmitted murmur, normal
upstroke, thyroid nonpalpable.  Lungs are clear.  Chest:
Regular, rate, and rhythm, S1, S2, no murmurs, rubs, or
gallops.  Abdomen is soft, nontender, nondistended,
normoactive bowel sounds, no masses or bruits.  Extremities:
No clubbing, cyanosis, or edema, full pedal pulses.

ELECTROCARDIOGRAM:  Sinus bradycardia, axis 0.

LABORATORY DATA:  White count 6.2, hematocrit 35.3, platelets
131, sodium 139, potassium 4.1, chloride 107, CO2 21, BUN 19,
creatinine 0.9, and glucose 101.

HOSPITAL COURSE:  Patient was admitted to [**Hospital1 346**] where he underwent cardiac
catheterization.  Please see catheterization report for full
details.

In summary, the catheterization showed an ejection fraction
of 55%, normal left main, left anterior descending artery
with a mid segment total occlusion, distal filling from right
to left collaterals, circumflex 60-70% tubular lesion with
99% distal OM-2 lesion, right coronary artery total occlusion
except mid segment.

CT Surgery was consulted, and the patient was seen.  On [**5-13**], the patient was brought to the operating room for
coronary artery bypass grafting.  Please see the OR report
for full details.  In summary, the patient had an off-pump
CABG x4 with LIMA to the LAD, saphenous vein graft to the
LPL, saphenous vein graft to the PDA, and saphenous vein
graft to the OM.  He tolerated the operation well.  He was
transferred from the operating room to the Cardiothoracic
Intensive Care Unit.

At the time of transfer, the patient had Neo-Synephrine 1.5
mcg/kg/minute and propofol at 30 mcg/kg/minute.  The
immediate postoperative period, the patient was noted to have
pupil asymmetry, and Neurology service was consulted, and the
patient was seen by Neurology.

Additionally, the patient went for STAT head CT scan which
showed no acute bleed.  At that time, the patient was not
noted to have any other neurologic deficits.  The patient's
anesthesia was reversed.  Sedation was discontinued.  He was
weaned from the ventilator and successfully extubated on the
morning of postoperative day one.  It was noted that the
patient had complete left third nerve palsy.  At that point,
he went for a CTA of the brain, which showed no intracranial
hemorrhage, normal CT scan.  No findings to explain left eye
changes.  Basal artery and internal carotid arteries were
patent.  Circle of [**Location (un) 431**], anterior cerebral, posterior
cerebral, and mid cerebral arteries all appeared normal.  No
evidence of aneurysm or vascular malformation.  Please see
Radiology report for full details.

Over the next two days, the patient was weaned from all
cardioactive IV medications, and on postoperative day five,
the patient was brought for a MRI which showed no acute
vascular territorial infarction, a large intracellular,
supracellular mass with a small focus of susceptibility of
infarct consistent with hemorrhage and unchanged air fluid
levels in the maxillary and sphenoid sinuses.

During this period, the patient remained hemodynamically
stable and continued to progress from a cardiac standpoint
with no further neurologic deficits other than his third
cranial nerve palsy.

On postoperative day six, he was transferred to the floor for
continuing postoperative care and cardiac rehabilitation.  On
postoperative day five, Neuro-Ophthalmology was in to see the
patient regarding the acute onset of his left third cranial
nerve palsy.  Over the next several days, the patient was
seen by Occupational Therapy as well as Physical Therapy, and
with the assistance of the nursing staff, his activity level
was increased to the point, where he was able to ambulate to
a Level V.

On postoperative day seven, it was decided that the patient
was stable and ready for discharge to home.  At time of
discharge, the patient's physical examination is as follows:
vital signs:  Temperature 97.7, heart rate 72 sinus, blood
pressure 120/80, respiratory rate 20, O2 saturation is 93% on
room air.   Alert and oriented times three.  Moves all
extremities.  Left cranial nerve III paralysis with impaired
extraocular movements, otherwise cranial nerves intact.
Respiratory is clear to auscultation bilaterally.
Cardiovascular:  Regular, rate, and rhythm, S1, S2 with no
murmurs.  The sternum is stable.  Incision is clean and dry,
open to air with no erythema.  Abdomen is soft, nontender,
nondistended with normoactive bowel sounds.  Extremities are
warm and well perfused with no clubbing, cyanosis, or edema.

LABORATORY VALUES:  White count 10.1, hematocrit 39.6,
platelets 219.  Sodium 135, potassium 3.8, chloride 102, CO2
23, BUN 18, creatinine 1.0, glucose 74.

DISCHARGE MEDICATIONS:
1. Pravastatin 20 mg q day.
2. Plavix 75 mg q day.
3. Colace 100 mg [**Hospital1 **].
4. Percocet 1-2 tablets po q4h prn.
5. Ibuprofen 400 mg po q8h prn.
6. Prednisone 7.5 mg x1 day, then decreased to 5 mg x1 day,
then 2.5 mg x2 days, then discontinue.

DISCHARGE DIAGNOSES:
1. Coronary artery disease status post coronary artery bypass
grafting x4.
2. Hypercholesterolemia.
3. Left cranial nerve III palsy.

CONDITION ON DISCHARGE:  Good.

DISPOSITION:  He is to be discharged to home.

FOLLOW-UP INSTRUCTIONS:  He is to have followup with Dr.
[**First Name8 (NamePattern2) 915**] [**Last Name (NamePattern1) 93005**] in Neuro-Ophthalmology within seven days with
his cardiologist in seven days with his primary care
physician [**Last Name (NamePattern4) **] [**1-8**] weeks and with Dr. [**Last Name (STitle) **] in four weeks.



                            [**First Name11 (Name Pattern1) 275**] [**Last Name (NamePattern4) 1539**], M.D.  [**MD Number(1) 1540**]

Dictated By:[**Name8 (MD) 93006**]
MEDQUIST36

D:  [**2178-5-21**]  09:13
T:  [**2178-5-21**]  09:24
JOB#:  [**Job Number 93007**]
{'Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Third or oculomotor nerve palsy, total,Benign neoplasm of pituitary gland and craniopharyngeal duct'}


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 74 year old
with known coronary artery disease about to undergo surgery
for a pituitary adenoma for which he is being evaluated to
undergo scheduled cardiac catheterization prior to his
adenoma surgery.

MEDICAL HISTORY: 1. Significant only for ureteral stones.
2. Coronary artery disease.
3. Known pituitary adenoma, which will require surgery in the
future.

MEDICATION ON ADMISSION: 

ALLERGIES: He claims no known allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Married.  Lives at home with his wife.
Positive social alcohol use.  Positive tobacco use. 

### Response:
{'Coronary atherosclerosis of native coronary artery,Pure hypercholesterolemia,Third or oculomotor nerve palsy, total,Benign neoplasm of pituitary gland and craniopharyngeal duct'}
