CHIEF COMPLAINT: history of reflux disease and biopsy proven
[**Doctor Last Name 15532**] esophagus w/ intramucosal
cancer.

PRESENT ILLNESS: Mr. [**Known lastname 36180**] is a 67-year-old gentleman, with
coronary disease and left ventricular dysfunction, who has
also had a history of reflux disease and biopsy proven
[**Doctor Last Name 15532**] esophagus. Serial biopsies have been obtained and
reviewed at 3 different institutions. All institutions agree
that biopsies show focal areas of high grade dysplasia and 2
out of the 3 reviewing pathologists said there was
intramucosal carcinoma. A variety of treatment
options were discussed, including transhiatal esophagectomy
versus ablative
therapy versus minimally invasive esophagectomy. The patient
would prefer to proceed with transhiatal esophagectomy.

MEDICAL HISTORY: CAD sp MI [**2116**] & [**2121**], sp CABG X 3 [**2125**], echo [**9-28**] EF 35%, LAE,
GERD sp esoph polypectomy, erosive esophagitis sp dilitation,
DMII, HTN, hyperchol, sp R knee surgery, sp appy

MEDICATION ON ADMISSION: zantac 150", lipitor 20', accupril 10 qam/5 qpm, coreg 6.25
Qam/3.12', flomax 0.4', lasix 40', allopurinol 300', glucotrol
XL 10", adovart 0.5', aggrenox 200/25", lopid 600", motrin prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: general: frail 68 yr old male in NAD
HEENT: unremarkable
COR; RRR S1, S2
chest: lungs CTA bilat
abd: soft, NT, ND, +BS
Extrem; no c/c/e
neuro: A+OX3 -no focal deficits.

FAMILY HISTORY: 

SOCIAL HISTORY: retired
lives with wife
32 pk year smoking history- quit [**2121**]
rare ETOH
Malignant neoplasm of esophagus, unspecified site,Atrial fibrillation,Retention of urine, unspecified,Congestive heart failure, unspecified,Other pulmonary insufficiency, not elsewhere classified,Barrett's esophagus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Aortocoronary bypass status,Pure hypercholesterolemia,Gout, unspecified,Personal history of urinary calculi
Mal neo esophagus NOS,Atrial fibrillation,Retention urine NOS,CHF NOS,Other pulmonary insuff,Barrett's esophagus,DMII wo cmp nt st uncntr,Hypertension NOS,Aortocoronary bypass,Pure hypercholesterolem,Gout NOS,Prsnl hst urnr dsrd calc
Admission Date:  [**2135-10-12**]              Discharge Date:   [**2135-10-28**]

Date of Birth:  [**2067-10-12**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2969**]
Chief Complaint:
history of reflux disease and biopsy proven
[**Doctor Last Name 15532**] esophagus w/ intramucosal
cancer.



Major Surgical or Invasive Procedure:
transhiatal esophagectomy secondary to high grade dysplasia


History of Present Illness:
Mr. [**Known lastname 36180**] is a 67-year-old gentleman, with
coronary disease and left ventricular dysfunction, who has
also had a history of reflux disease and biopsy proven
[**Doctor Last Name 15532**] esophagus. Serial biopsies have been obtained and
reviewed at 3 different institutions. All institutions agree
that biopsies show focal areas of high grade dysplasia and 2
out of the 3 reviewing pathologists said there was
intramucosal carcinoma. A variety of treatment
options were discussed, including transhiatal esophagectomy
versus ablative
therapy versus minimally invasive esophagectomy. The patient
would prefer to proceed with transhiatal esophagectomy.


Past Medical History:
CAD sp MI [**2116**] & [**2121**], sp CABG X 3 [**2125**], echo [**9-28**] EF 35%, LAE,
GERD sp esoph polypectomy, erosive esophagitis sp dilitation,
DMII, HTN, hyperchol, sp R knee surgery, sp appy

Social History:
retired
lives with wife
32 pk year smoking history- quit [**2121**]
rare ETOH

Physical Exam:
general: frail 68 yr old male in NAD
HEENT: unremarkable
COR; RRR S1, S2
chest: lungs CTA bilat
abd: soft, NT, ND, +BS
Extrem; no c/c/e
neuro: A+OX3 -no focal deficits.

Pertinent Results:
Hematology
  COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2135-10-28**] 07:13AM    7.8 3.84* 11.9* 36.8* 96 30.9 32.2 15.0
514*
  BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Ct INR(PT)
[**2135-10-28**] 07:13AM        514*
[**2135-10-28**] 07:13AM    13.2* 62.0*   1.2*

Chemistry
  RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2135-10-28**] 07:13AM    168* 20 0.7 138 4.5 100 28 15
  CHEMISTRY TotProt Albumin Globuln Calcium Phos Mg UricAcd Iron

[**2135-10-28**] 07:13AM          8.9 4.3 2.1
[**2135-10-23**] LUE swelling ultra sound - no DVT

CXR: The PICC line was advanced in the interval. The is tip now
within the superior vena cava (mid portion).

pathology: DIAGNOSIS:
1.) Gastric lymph node (A):
One lymph node with no malignancy identified (0/1).
II) Esophagus and proximal stomach, partial esophagogastrectomy
(B-Y, CA-GA):
a. Barrett's esophagus with focal intramucosal carcinoma and
multiple foci of high-grade dysplasia; no definitive invasion of
the lamina propria is identified (multiple levels are examined).
Margins of resection are free of dysplasia.
b. Gastric fundus with incidental leiomyoma of the muscularis
propria (1.0 cm, see note) and no mucosal diagnostic
abnormalities recognized.
c. Six lymph nodes with no malignancy identified (0/6)
 d. Esophageal squamous epithelium with no diagnostic
abnormalities recognized.
III) Esophageal lymph nodes (Z-BA):
Five lymph nodes with no malignancy identified (0/5).
Note:  Immunostains of the gastric leiomyoma are positive for
actin and desmin, and negative for c-kit with satisfactory
controls. Slides corresponding to blocks Q-R were reviewed with
Dr. [**Last Name (STitle) **] [**Last Name (NamePattern4) **] who concurs with the diagnosis.




Brief Hospital Course:
Pt was admitted and taken to the OR [**2135-10-12**] for transhiatal
esophagectomy and feeding jejunostomy tube. An epidural was
placed pre-op for pain control and a swan ganz catheter for
hemodynamic monitoring given low but stable EF 35%. Operative
course was uneventful. Pt remained intubated and was admitted to
the ICU for ongoing pulmonary and hemodynamic support. Peri-op
antibiotics of flagyl and kefzol.
POD#1 weaned and extubated. NPO, anastomotic JP to bulb sxn, NGT
to sxn and j-tube to gravity.
POD#2 Remained in ICU for ongoing pulmonary tiolet.  he received
some Lasix for rales and respiratory distress.  Tube feeds were
started.
POD#3 His epidural catheter was discontinued.  His NG tube was
removed as well.
POD#4 A chest X-ray demonstrated left lower lobe atelectasis and
a right lower lobe opacity.
POD#5 He went into rapid atrial fibrillation.  An Amiodarone
drip was started.  A cardiology consult was obtained.  A heparin
drip was started for anticoagulation because of A-fib.
POD#6 He converted to sinus rhythum after a 5 second pause.
POD#7 He tolerated grape juice without any leak into his JP
drain in his neck.  His JP drain was removed.  He was started on
a clear liquid diet.
POD#8 He began to leak food contents from his neck wound.  His
neck incision was opened up (one layer of the two layer closure)
and pakced with gauze. He was kept NPO.  A PICC line was placed
for access for his heparin and amiodarone drips.
POD #10 He failed a voiding trial and had to be straight
catheterized (UOP 300cc).  His staples were removed.  His Foley
was removed.  He had a negative LUE ultrasound to rule out a
DVT.
POD #11- He had a Foley placed after he failed to void.  He went
into V-tach for 24 beats and his amiodarone drip was reduced by
half after counseling cardiology.
POD#12- Cardiology discontinued his amiodarone, enalapril
started and lopressor continued.  Disposition planning ongoing
w/ [**Hospital 5065**] Healthcare and Visiting Nurse Services of [**State 40074**]for skilled nursing care at home. Pt looks and feels improved.
POD#13- [**10-25**] lopressor d/c'd d/t AIVR; Heparin gtt cont. Foley
cath to remain in place, primary urologist informed and pt to
f/u outpatient, appt scheduled.
[**10-26**] no arrhythmia. Cervical wound improving, decreasing in
size.  Pt cont to look and feel improved. Ambulation ad lib
tolerated very well. Insulin injection teaching w/ patient and
wife.
[**10-27**] grape juice tolerated w/o leakeage into wound, clears
started, PO meds (no coreg or amio)restarted. Accupril,
glucotrol XL. coumadin dose 2mg given.  Lovenox/ Insulin
injection teaching w/ patient and wife.
[**10-28**]- Stable overnight. Heparin gtt discontinued, lovenox
started. PICC line discontinued. Patient and wife teaching for
injections, blood sugar management, tube feeding, dressing
changes completed, clarifed, and demonstrated. Discharge
instructions given and reviewed in detail by RN and NP.
 Pt discharged to home in company of wife and friend [**Name (NI) 69410**] w/
services from [**Hospital 5065**] Healthcare- [**Telephone/Fax (1) 39931**], and VISITING NURSE
SERVICES Home Health Services of [**Doctor Last Name **]-[**Telephone/Fax (1) 69411**].

In summary, issues and plans are:
*Neuro/ Pain- Roxicet, tylenol prn
*CV-REstart home rx of;lipitor 20', accupril 10 qam/5 qpm, lasix
40', allopurinol 300', lopid 600". No aggrenox. ASA 81 mg daily
in place.
Arrythmia- meds as above, needs outpatient [**Doctor Last Name **]  OF HEARTS
monitor by home cardiologist  per in hospital cardiology
recommedation.
*Anticoagulation- coumadin started [**2135-10-27**] w/ 2mg, to continue
2mg qhs [**10-28**], [**10-29**], [**10-30**], then INR blood draw [**10-31**].  Lovenox
bridge- 80mg [**Hospital1 **] rx for 5days for bridge, started [**10-28**]
*GI- Full liquids, w/ FS tube feeding 24hours upon discharge, to
be cycled upon discharge to home- management by [**Hospital 5065**]
Healthcare.
*Endocrine- DM type 2- management w/glucotrol XL 10mg in am and
pm, plus RISS scale attached.
*Urology-foley in place w/ leg bag. Meds:flomax 0.4mg qhs and
adovart 0.5qd cont.
 [ ] Outpt urology f/u appt w/ own urologist Dr. [**Last Name (STitle) 69412**]
[**Telephone/Fax (1) 69413**].



Medications on Admission:
 zantac 150", lipitor 20', accupril 10 qam/5 qpm, coreg 6.25
Qam/3.12', flomax 0.4', lasix 40', allopurinol 300', glucotrol
XL 10", adovart 0.5', aggrenox 200/25", lopid 600", motrin prn

Discharge Medications:
1. Albuterol Sulfate 0.083 % Solution Sig: One (1)  Inhalation
Q4H (every 4 hours) as needed.
2. Albuterol-Ipratropium 103-18 mcg/Actuation Aerosol Sig: Two
(2) Puff Inhalation Q4H (every 4 hours).
3. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
4. Ipratropium Bromide 0.02 % Solution Sig: One (1)  Inhalation
Q6H (every 6 hours) as needed.
5. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4-6H (every 4 to 6 hours) as needed.
Disp:*120 ml* Refills:*0*
6. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1)  PO BID (2
times a day): give via j-tube.
7. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
TID (3 times a day) as needed for pruritis.
8. tubefeeding
Promote w/ fiber Full strength;
Starting rate: 85 ml/hr; Do not advance rate Goal rate: 85 ml/hr
Residual Check: q4h Hold feeding for residual >= : nausea/abd
pain
Flush w/ 30 ml water q6h
9. tubefeeding supplies
kangaroo pump
tubefeeding supplies
10. Warfarin 2 mg Tablet Sig: One (1) Tablet PO once a day: Take
2mg [**10-28**], [**10-29**], [**10-30**], then as directed by PCP per INR/PT on
[**10-31**].
Disp:*30 Tablet(s)* Refills:*2*
11. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
12. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
13. Quinapril 5 mg Tablet Sig: Two (2) Tablet PO QAM (once a day
(in the morning)).
14. Quinapril 5 mg Tablet Sig: One (1) Tablet PO QPM (once a day
(in the evening)).
15. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
16. Gemfibrozil 600 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
17. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO HS (at bedtime).
18. Allopurinol 300 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
19. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
20. Glipizide 10 mg Tab,Sust Rel Osmotic Push 24HR Sig: One (1)
Tab,Sust Rel Osmotic Push 24HR PO BID (2 times a day).
21. Avodart 0.5 mg Capsule Sig: One (1) Capsule PO daily ().
22. Enoxaparin 80 mg/0.8 mL Syringe Sig: One (1) syringe
Subcutaneous Q12H (every 12 hours) for 5 days: 1syringe = 80
mg/0.8 mL .
Disp:*10 syringe* Refills:*1*
23. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed for pain: may take elixer via
Jejunostomy tube.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 15741**] Home Health Services

Discharge Diagnosis:
transhiatal esophagogastectomy [**2135-10-12**] d/t high grade dysplagia.


Discharge Condition:
deconditioned, persistant urinary retention requiring foley,
cervical anastomotic leak, remians NPO on full stength tube feed
via j-tube.


Discharge Instructions:
1.-Call Dr.[**Doctor Last Name 4738**] office/ Thoracic Surgery [**Telephone/Fax (1) 170**] if
you have any questions or if the patient has fever, chills,
chest pain, shortness of breath, or drainage from any surgical
sites, increased foul smelling drainage from neck wound.

2. Medication changes as per discharge instructions.
Specifically:
zantac 150 2x/day, lipitor 20' x1/day, accupril 10mg in am/5mg
in pm, flomax 0.4mg x1/day, lasix 40mg x1/day, allopurinol 300mg
x1/day, glucotrol XL 10mg 2x/day, adovart 0.5mg x1/day, aspirin
81mg x1/day, lopid 600mg x1/day, Insulin- regular as directed by
sliding scale, lovenox 80 mg injection 2x day am and pm,
Coumadin as directed: Take 2mg [**10-28**], [**10-29**], [**10-30**], then as
directed by PCP per INR/PT on [**10-31**].
3. Appointment w/ [**Last Name (LF) **],[**Name6 (MD) **] R, MD [**Telephone/Fax (1) 24721**] on MOnday,
[**2135-10-31**] for evaluation of anticoagulation, arrythmia,
diabetes management and [**Doctor Last Name **] of HEarts Monitor set-up.
4. Neck dressing change 2times/day as instructed.
5. Check blood sugar before breakfast, lunch, dinner and at
bedtime and record: date, time, blood sugar level and amount of
regular insulin given as per chart.
5. Give regular insulin as directed by chart.
6. Glucotrol XL 10 mg every am and pm for diabetes type 2.
7. Foley catheter with leg bag for urine drainage. Appt w/
Urologist as below.
8. Tubefeeding as per [**Hospital 5065**] Healthcare instructions.
9.Full liquid diet- sample diet attached.


Followup Instructions:
 Call Dr.[**Doctor Last Name 4738**] office/ Thoracic Surgery [**Telephone/Fax (1) 170**]  for an
appointment.
Follow up w/ Dr. [**Last Name (STitle) 69414**] (your urologist)as scheduled regarding
your foley catheter and subsequent voiding trial.
 Appointment scheduled with PCP: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **] [**Telephone/Fax (1) 24721**]
for Monday, [**2135-10-31**] for INR/PT blood draw and evaluation
for arrythimia, anticoagulation, diabetes, [**Doctor Last Name **] of Hearts
set-up.



Completed by:[**2135-10-28**]
{"Malignant neoplasm of esophagus, unspecified site,Atrial fibrillation,Retention of urine, unspecified,Congestive heart failure, unspecified,Other pulmonary insufficiency, not elsewhere classified,Barrett's esophagus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Aortocoronary bypass status,Pure hypercholesterolemia,Gout, unspecified,Personal history of urinary calculi"}


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: history of reflux disease and biopsy proven
[**Doctor Last Name 15532**] esophagus w/ intramucosal
cancer.

PRESENT ILLNESS: Mr. [**Known lastname 36180**] is a 67-year-old gentleman, with
coronary disease and left ventricular dysfunction, who has
also had a history of reflux disease and biopsy proven
[**Doctor Last Name 15532**] esophagus. Serial biopsies have been obtained and
reviewed at 3 different institutions. All institutions agree
that biopsies show focal areas of high grade dysplasia and 2
out of the 3 reviewing pathologists said there was
intramucosal carcinoma. A variety of treatment
options were discussed, including transhiatal esophagectomy
versus ablative
therapy versus minimally invasive esophagectomy. The patient
would prefer to proceed with transhiatal esophagectomy.

MEDICAL HISTORY: CAD sp MI [**2116**] & [**2121**], sp CABG X 3 [**2125**], echo [**9-28**] EF 35%, LAE,
GERD sp esoph polypectomy, erosive esophagitis sp dilitation,
DMII, HTN, hyperchol, sp R knee surgery, sp appy

MEDICATION ON ADMISSION: zantac 150", lipitor 20', accupril 10 qam/5 qpm, coreg 6.25
Qam/3.12', flomax 0.4', lasix 40', allopurinol 300', glucotrol
XL 10", adovart 0.5', aggrenox 200/25", lopid 600", motrin prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: general: frail 68 yr old male in NAD
HEENT: unremarkable
COR; RRR S1, S2
chest: lungs CTA bilat
abd: soft, NT, ND, +BS
Extrem; no c/c/e
neuro: A+OX3 -no focal deficits.

FAMILY HISTORY: 

SOCIAL HISTORY: retired
lives with wife
32 pk year smoking history- quit [**2121**]
rare ETOH 

### Response:
{"Malignant neoplasm of esophagus, unspecified site,Atrial fibrillation,Retention of urine, unspecified,Congestive heart failure, unspecified,Other pulmonary insufficiency, not elsewhere classified,Barrett's esophagus,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Aortocoronary bypass status,Pure hypercholesterolemia,Gout, unspecified,Personal history of urinary calculi"}
