CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 7635**] is a 76-year-old
male who was noted to adenocarcinoma of the esophagus on
routine surveillance esophagoscopy for known [**Doctor Last Name 15532**]
esophagus.  At the time of the discovery, the patient was
asymptomatic; not having experienced any weight loss or any
dysphagia.

MEDICAL HISTORY: 1.  Hypertension.
2.  Gout.
3.  Mild aortic stenosis.
4.  Seizures secondary to medications.
5.  Gastroesophageal reflux disease.

MEDICATION ON ADMISSION: 1.  Norvasc 10 mg p.o. once per day.
2.  Lipitor 20 mg p.o. once per day.
3.  Prevacid 30 mg p.o. once per day.
4.  Allopurinol 300 mg p.o. once per day.
5.  Hydrochlorothiazide 25 mg p.o. once per day.
6.  Glucosamine.
7.  Potassium chloride.

ALLERGIES: Allergies included ATENOLOL.

PHYSICAL EXAM: 

FAMILY HISTORY: There is no family history of cancer.  Mr.
[**Known lastname **] father passed away at the age of 42 years of a
stroke.

SOCIAL HISTORY: Social history was significant for social
alcohol use, and no tobacco use.
Malignant neoplasm of cardia,Pneumonia due to Klebsiella pneumoniae,Atrial fibrillation,Aortic valve disorders,Esophageal reflux,Unspecified essential hypertension,Gout, unspecified
Mal neo stomach cardia,K. pneumoniae pneumonia,Atrial fibrillation,Aortic valve disorder,Esophageal reflux,Hypertension NOS,Gout NOS
Admission Date:  [**2181-4-24**]       Discharge Date:  [**2181-5-24**]

Date of Birth:   [**2104-9-3**]       Sex:  M

Service:

ADMISSION DIAGNOSIS:  Esophageal carcinoma.

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 7635**] is a 76-year-old
male who was noted to adenocarcinoma of the esophagus on
routine surveillance esophagoscopy for known [**Doctor Last Name 15532**]
esophagus.  At the time of the discovery, the patient was
asymptomatic; not having experienced any weight loss or any
dysphagia.

PAST MEDICAL HISTORY:
1.  Hypertension.
2.  Gout.
3.  Mild aortic stenosis.
4.  Seizures secondary to medications.
5.  Gastroesophageal reflux disease.

PAST SURGICAL HISTORY:  Past surgical history is significant
for Nissen fundoplication in [**2163**].

MEDICATIONS ON ADMISSION:
1.  Norvasc 10 mg p.o. once per day.
2.  Lipitor 20 mg p.o. once per day.
3.  Prevacid 30 mg p.o. once per day.
4.  Allopurinol 300 mg p.o. once per day.
5.  Hydrochlorothiazide 25 mg p.o. once per day.
6.  Glucosamine.
7.  Potassium chloride.

ALLERGIES:  Allergies included ATENOLOL.

SOCIAL HISTORY:  Social history was significant for social
alcohol use, and no tobacco use.

FAMILY HISTORY:  There is no family history of cancer.  Mr.
[**Known lastname **] father passed away at the age of 42 years of a
stroke.

PHYSICAL EXAMINATION ON PRESENTATION:   Initial physical
examination revealed Mr. [**Known lastname 7635**] was a well-appearing
gentleman in no acute distress.  His sclerae were anicteric.
Pupils were equally reactive to light and accommodation.  His
extraocular muscles were intact.  His oropharynx was pink and
moist with no lesions.  His neck was supple with no
thyromegaly or lymphadenopathy.  His chest was symmetric with
no palpable masses.  His lungs were clear to auscultation
bilaterally.  His heart showed a regular rate and rhythm with
a grade 2/6 systolic ejection murmur; consistent with aortic
stenosis.  His abdomen was soft, nontender, and nondistended.
No palpable masses.  No guarding.  No rebound.  No
hepatosplenomegaly.  Cranial nerves II through XII were
intact as was his gross neurologic status.  He was alert and
oriented to person, place, and time.  His range of motion and
strength in both the upper and lower extremities were normal.
His skin showed no pathology.

HOSPITAL COURSE:   Mr. [**Known lastname 7635**] was admitted to the operating
room on [**2181-4-24**] where he [**Year (4 digits) 1834**] an Ivor-[**Doctor Last Name **]
esophagectomy.  Please refer to the dictated Operative Note
for full details of this procedure.

The patient was transferred postoperatively to the Surgical
Intensive Care Unit intubated and on Levophed for support of
his blood pressure.  He had a preoperatively placed epidural
for pain control; which at the time contained only narcotic
medications.  He was transfused 2 units of packed red blood
cells intraoperatively and proceeded to receive  multiple
fluid boluses postoperatively for decreases in urine output.

On postoperative day one, he continued to have labile blood
pressures and the requirement of pressors (namely Levophed)
to help maintain this.

On postoperative day two, he was found to have some degree of
pulmonary deterioration as his PCO2 continued to rise.
However, his urine output did improve.  At this time, Mr.
[**Known lastname 7635**] also had episodes of atrial fibrillation.

On postoperative day three, the Levophed drip was turned off
as the patient's blood pressure stabilized.  With the
discontinuation of the Levophed, the patient's oxygenation
also improved.

On postoperative day four, the patient continued to be
intubated and sedated but showing improvement in cardiac
index as well as improvement in urine output.  He continued
with his Dilaudid epidural at this time.

Tube feeds were started on postoperative day five by
jejunostomy tube with the patient receiving Impact with fiber
at 30 cc per hour.  Later on postoperative day five, the
patient was found to have a worsening PO2, for which Lasix
was given.  The patient's blood pressure remained stable, and
with diuresis the patient's oxygenation improved.

On postoperative day six, the patient continued to require
further diuresis as he would occasionally have oxygen
desaturations on turning.  His tube feeds were raised to 40
cc per hour on this day.  Also during this time, the patient
was found to have a pneumonia by chest x-ray, and a sputum
culture was positive for Klebsiella which was pan-sensitive.

He remained intubated and stable over the next number of
days.  Mr. [**Known lastname 7635**] continued to be intubated and sedated
with active diuresis and was started on levofloxacin for his
pneumonia.  He did require occasional suctioning for
desaturations as he respiratory status continued to
fluctuate.  The patient was concurrently followed in
consultation by the Cardiology Service due to his atrial
fibrillation and previously existing aortic stenosis.

The patient remained intubated and sedated on postoperative
day 17.  At this time, he was continuing on his tube feeds as
well as Levaquin for pneumonia.  At this time, he was not
following commands.

Due to the prolonged course of intubation, on postoperative
day 17, a tracheostomy was performed on the patient.  He
tolerated the procedure well.  He was started on Coumadin on
postoperative day 19 due to his prolonged atrial
fibrillation.  At this time, his tube feeds were running at
his goal nutritional rate.

Over the ensuing days, the patient began to slowly follow
commands as given to him by the surgical team and Physical
Therapy.  His respiratory status remained stable via
tracheostomy tube, and the patient was continued on Levaquin.

On postoperative day 27, Mr. [**Known lastname 7635**] [**Last Name (Titles) 1834**] a bedside
swallowing evaluation; however, this study could not be
evaluated as the patient refused to swallow liquids given to
him.  He was elevated by Physical Therapy on multiple
occasions who deemed him to require a stay in an acute
rehabilitation facility in order to build strength and
mobility and to gain independence with activities of daily
living.

By on postoperative day 29, his respectively and hemodynamic
status were stable and improved enough for transfer to the
regular patient floor.  The patient was tolerating his tube
feeds without nausea or vomiting, and return of bowel
function was indicated by bowel movements.  At this time, the
patient continued to receive daily doses of Coumadin with
intravenous heparin for anticoagulation due to his atrial
fibrillation.

By postoperative day 30, the patient was deemed stable and
ready for transfer to an acute care rehabilitation facility
where he could continue to receive tracheostomy care as well
as tube feeds.  The patient will require remaining nothing by
mouth at this time and will require daily INR checks as he is
receiving daily Coumadin until his INR has reached a
therapeutic level; per his prolonged and continued atrial
fibrillation.  At this time, the heparin drip may be
discontinued.

DISCHARGE DISPOSITION:   The patient was to go to an acute
care rehabilitation facility.

DISCHARGE DIET:  The patient is nothing by mouth at this time
and is receiving Impact with fiber (full strength) at 80 cc
per hour.

DISCHARGE ACTIVITY:  The patient's activity is to be
restricted, and he require extensive help with Physical
Therapy and Occupational Therapy to regain strength and
mobility as well as independence with his activities of daily
living.

MEDICATIONS ON DISCHARGE:
1.  Levofloxacin 500 mg via jejunostomy tube once per day.
2.  Reglan 10 mg via jejunostomy tube three times per day.
3.  Zantac 150 mg via jejunostomy tube once per day.
4.  Lopressor 12.5 mg via jejunostomy tube twice per day.
5.  Regular insulin sliding-scale.
6.  Acetaminophen liquid 650 mg jejunostomy tube q.4-6h. as
needed.
7.  NPH insulin 20 units subcutaneously q.12h.
8.  Coumadin (dose to be adjusted per the patient's INR which
need to be continually checked on a daily basis).

DISCHARGE INSTRUCTIONS/FOLLOWUP:  The patient was to follow
up with Dr. [**First Name8 (NamePattern2) 333**] [**Last Name (NamePattern1) **].  The physician should be
called in order to schedule an appointment (date and time).






                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.
[**MD Number(1) 6066**]

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

D:  [**2181-5-24**]  13:50
T:  [**2181-5-24**]  14:48
JOB#:  [**Job Number 49350**]


Admission Date:  [**2181-4-24**]       Discharge Date:  [**2181-5-24**]

Date of Birth:   [**2104-9-3**]       Sex:  M

Service:

NOTE:  This job put with job #[**Numeric Identifier 49350**].






                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.
[**MD Number(1) 6066**]

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

D:  [**2181-5-24**]  13:54
T:  [**2181-5-24**]  15:12
JOB#:  [**Job Number 49351**]
{'Malignant neoplasm of cardia,Pneumonia due to Klebsiella pneumoniae,Atrial fibrillation,Aortic valve disorders,Esophageal reflux,Unspecified essential hypertension,Gout, unspecified'}


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: Mr. [**Known lastname 7635**] is a 76-year-old
male who was noted to adenocarcinoma of the esophagus on
routine surveillance esophagoscopy for known [**Doctor Last Name 15532**]
esophagus.  At the time of the discovery, the patient was
asymptomatic; not having experienced any weight loss or any
dysphagia.

MEDICAL HISTORY: 1.  Hypertension.
2.  Gout.
3.  Mild aortic stenosis.
4.  Seizures secondary to medications.
5.  Gastroesophageal reflux disease.

MEDICATION ON ADMISSION: 1.  Norvasc 10 mg p.o. once per day.
2.  Lipitor 20 mg p.o. once per day.
3.  Prevacid 30 mg p.o. once per day.
4.  Allopurinol 300 mg p.o. once per day.
5.  Hydrochlorothiazide 25 mg p.o. once per day.
6.  Glucosamine.
7.  Potassium chloride.

ALLERGIES: Allergies included ATENOLOL.

PHYSICAL EXAM: 

FAMILY HISTORY: There is no family history of cancer.  Mr.
[**Known lastname **] father passed away at the age of 42 years of a
stroke.

SOCIAL HISTORY: Social history was significant for social
alcohol use, and no tobacco use. 

### Response:
{'Malignant neoplasm of cardia,Pneumonia due to Klebsiella pneumoniae,Atrial fibrillation,Aortic valve disorders,Esophageal reflux,Unspecified essential hypertension,Gout, unspecified'}
