CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: 64 year old female with prior history of hypertension and
chronic tobacco abuse who had an isolated episode of midsternal
chest pain ([**8-22**]) while setting up a golf tournament this
morning resolving with rest over 3 minutes.  She reports a
similar episode 1 week previously. No radiation of pain,
shortness of breath, diaphoresis. She was referred for a cardiac
catheterization which revealed 3 vessel coronary disease and was
then referred to cardiac surgery for revascularization.

MEDICAL HISTORY: Hypertension
Tobacco abuse (1ppd)
s/p c-section x3
s/p tonsillectomy
s/p Bilateral knee replacments

MEDICATION ON ADMISSION: Norvasc 5 mg daily
ASA 81 mg daily

ALLERGIES: All allergies / adverse drug reactions previously recorded have
been deleted

PHYSICAL EXAM: Pulse:96 Resp:17  O2 sat:100/RA
B/P  Right:132/75    Left:135/88
Height:5'3"     Weight:175 lbs

FAMILY HISTORY: brother who had a coronary artery bypass grafting
another brother who underwent percutaneous coronary intervention

SOCIAL HISTORY: She lives with her husband and is retired
She is a current smoker of one pack per day for thirty-five
years
She drinks two alcoholic beverages daily
Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Candidiasis of mouth,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Urinary tract infection, site not specified,Ostium secundum type atrial septal defect,Acute posthemorrhagic anemia,Blood in stool,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Tobacco use disorder,Other and unspecified hyperlipidemia,Natural blood and blood products causing adverse effects in therapeutic use,Other iatrogenic hypotension,Atrial fibrillation,Other abnormal blood chemistry,Knee joint replacement,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms
Subendo infarct, initial,Acute kidney failure NOS,Hyposmolality,Thrush,DMII wo cmp nt st uncntr,Urin tract infection NOS,Secundum atrial sept def,Ac posthemorrhag anemia,Blood in stool,Surg compl-heart,Crnry athrscl natve vssl,Hypertension NOS,Tobacco use disorder,Hyperlipidemia NEC/NOS,Adv eff blood products,Iatrogenc hypotnsion NEC,Atrial fibrillation,Abn blood chemistry NEC,Joint replaced knee,Oth gram negatv bacteria
Admission Date:  [**2125-6-25**]              Discharge Date:   [**2125-8-4**]

Date of Birth:  [**2061-4-17**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
All allergies / adverse drug reactions previously recorded have
been deleted

Attending:[**First Name3 (LF) 1406**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
[**2125-6-25**] Cardiac catheterization
[**2125-6-28**] Coronary artery bypass graft x2 (Left internal mammary
artery > left anterior descending, Saphenous vein graft > obtuse
marginal)


History of Present Illness:
64 year old female with prior history of hypertension and
chronic tobacco abuse who had an isolated episode of midsternal
chest pain ([**8-22**]) while setting up a golf tournament this
morning resolving with rest over 3 minutes.  She reports a
similar episode 1 week previously. No radiation of pain,
shortness of breath, diaphoresis. She was referred for a cardiac
catheterization which revealed 3 vessel coronary disease and was
then referred to cardiac surgery for revascularization.

Past Medical History:
Hypertension
Tobacco abuse (1ppd)
s/p c-section x3
s/p tonsillectomy
s/p Bilateral knee replacments


Social History:
She lives with her husband and is retired
She is a current smoker of one pack per day for thirty-five
years
She drinks two alcoholic beverages daily


Family History:
brother who had a coronary artery bypass grafting
another brother who underwent percutaneous coronary intervention

Physical Exam:
Pulse:96 Resp:17  O2 sat:100/RA
B/P  Right:132/75    Left:135/88
Height:5'3"     Weight:175 lbs

General: awake alert oriented
Skin: Dry [x] intact [x]
HEENT: PERRLA [x] EOMI [x]
Neck:  Supple [x] Full ROM [x]
Chest: Lungs clear bilaterally [x]
Heart: RRR [x]  Irregular []  Murmur: very soft systolic
ejection
murmur w/o radiation;
Abdomen: Soft [x] non-distended [x] non-tender [x]
+ bowel sounds
Extremities: Warm [x], well-perfused [x]; some clubbing
no Edema no Varicosities; bilateral healed incisions on the
anterior surface of the knees
Neuro: Grossly intact
Pulses:
Femoral      Right: 2+  Left: 2+
DP           Right: 2+  Left: 2+
PT           [**Name (NI) 167**]: 2+  Left: 2+
Radial       Right: 2+  Left: 2+

Carotid Bruit        Right: no   Left: no


Pertinent Results:
Echocardiographic Measurements
Results  Measurements  Normal Range
Left Ventricle - Ejection Fraction:  75%  >= 55%
Findings
LEFT VENTRICLE: Mild symmetric LVH. Small LV cavity.
Hyperdynamic LVEF >75%.
RIGHT VENTRICLE: Normal RV chamber size and free wall motion.
PERICARDIUM: Small pericardial effusion. Effusion echo dense,
c/w blood, inflammation or other cellular elements.
Conclusions
There is mild symmetric left ventricular hypertrophy. The left
ventricular cavity is unusually small. Left ventricular systolic
function is hyperdynamic (EF 75%). Right ventricular chamber
size and free wall motion are normal. There is a small
pericardial effusion/collection subtending primarily the right
ventricular free wall but possibly extensing to the inferior and
posterior walls of the left ventricle. Part of the clear space
may be epicardial fat. The effusion is echo dense, consistent
with blood, inflammation or other cellular elements. No evidence
of cardiac tamponade.

Chest CT
after median sternotomy due to CABG. There is good apposition of
the sternal changes, but there is an offset with the right
hemisternum
being approximately 3 mm anterior to the left hemithorax. The
sternal wires are unremarkable. There is moderate, at least,
amount of pericardial
effusion. There is potential loculation of pericardial effusion
and some
questionable irregularity of pericardium that might represent
infectious/inflammatory process. There is questionable
compression of the
right ventricle and correlation with echocardiography is
required to exclude the possibility of tamponade physiology.
Native coronary arteries are extensively calcified. The aorta is
normal in diameter. Pulmonary arteries are not dilated.
Bilateral pleural effusion is noted, small to moderate,
layering. In the anterior mediastinum, there is extensive
stranding as well as several areas of collection continuing
towards the upper abdomen, 2:45, with adjacent lymph nodes. The
imaged portion of the upper abdomen reveals no abnormality
within the limitations of the study technique except for
extensive coronary calcifications.
Several mediastinal lymph nodes are borderline and might be
reactive to the pulmonary process. Airways are patent to the
level of subsegmental bronchi bilaterally. evaluation of the
pulmonary parenchyma demonstrate extensive ground-glass
opacities and septal wall thickening which is diffuse,
moderate-to-severe with no sparing of the lung parenchyma. There
are areas of lucency in the right lower lobe and minimal similar
areas in the left mid lung. Though the areas might represent
uninvolved parenchyma or on the opposite beginning of cystic
formation. There are no bone lesions worrisome for infection or
neoplasm. Degenerative changes are noted in the thoracic spine.
IMPRESSION:
1. Evidence of recent CABG. Despite recent surgery, the presence
of at least moderate pericardial effusion with questionable
compression of the right ventricle and presence of anterior
mediastinal collection at least 6.5 cm in length is consistent
with ongoing inflammation/infection. Correlation with
echocardiography is required.
2. No definitive evidence of pulmonary fibrosis on both chest
radiographs and chest CT.
3. Extensive septal thickening and ground-glass opacities,
findings
consistent with pulmonary edema at the first place. The other
option might a drug reaction for example to know administration
of IV amiodorone. Less
likely a diffuse infectious process may be considered, for
example
pneumocystic pneumonia, especially if the patient is
immunocompromised.

CT OF THORAX:

Recent sternotomy noted in keeping with recent CABG.
Native coronary arteries are again noted to be extensively
calcified.
The previously noted pericardial effusion has decreased in size
from 13 mm in anterior thickness to 10 mm (series 2, image 33).
There has been a slight decrease in the amount of fluid tracking
along the left oblique fissure. The right pleural effusion has
resolved. The airways are patent to the level of the
subsegmental bronchi bilaterally. There are bilateral extensive
ground-glass opacities and septal thickening. Changes are
essentially unchanged from the prior study. Subcentimeter
prevascular and right paratracheal lymph nodes are unchanged.
The imaged portion of the upper abdomen again reveals no
significant abnormality. OSSEOUS STRUCTURES: Degenerative
changes are noted involving the lower
thoracic spine with bridging anterior osteophytes. No concerning
lytic or
sclerotic lesion identified.
IMPRESSION:
1. Slight decrease in volume of the pericardial effusion and
fluid within the left oblique fissure with resolution of the
right pleural effusion.
2. Minimal change in the ground-glass change and septal wall
thickening on
comparison with the prior study. The differential again includes
pulmonary
edema, drug reaction or less likely a diffuse infectious
process.
3. Satisfactory position of the recently placed right-sided PICC
line.
[**Known lastname **],[**Known firstname **] T [**Medical Record Number 101101**] F  64  [**2061-4-17**]

Radiology Report CHEST (PA & LAT) Study Date of [**2125-8-3**] 8:52 AM



[**Last Name (LF) **],[**First Name7 (NamePattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) 5204**] FA6A [**2125-8-3**] 8:52 AM
CHEST (PA & LAT)   Clip # [**Clip Number (Radiology) 101102**]
Reason: eval opacities



[**Hospital 93**] MEDICAL CONDITION:
   64 year old woman s/p CABG
REASON FOR THIS EXAMINATION:
   eval opacities



Final Report
INDICATION: Patient status post CABG, please evaluate lung
opacities.

COMPARISON: Multiple imaging studies including preoperative PA
and lateral
radiograph on [**2125-6-26**] plus periodic follow up radiographs
after surgery.
CT chest without contrast on [**2125-7-22**].

FINDINGS: Lung aeration and bilateral fine reticular diffuse
radiopacities
have improved considerably compared with [**7-26**]. Small pleural
effusions if
any and no pneumothorax. Evaluation of cardiomediastinal and
hilar contours
is difficult due to obscuring of the silhouettes by lung
opacities.
Sternotomy wires are intact and PICC line remains in stable
position.

IMPRESSION: Interval improvement of diffuse radiopacities. As
discussed in
prior reports, fibrotic changes occurring in such a short period
of time are
concerning for drug reaction, less likely diffuse infectious
process.

COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2125-8-3**] 06:30    13.3* 3.49* 11.5* 33.7* 96 32.8* 34.0 16.4*
229
RENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap
[**2125-8-3**] 06:30      19 0.8 133 4.3 97 29 11
ENZYMES & BILIRUBIN ALT AST LD(LDH) CK(CPK) AlkPhos Amylase
TotBili DirBili IndBili
[**2125-7-23**] 05:39    75* 55* 420*   262* 43 1.2


Brief Hospital Course:
Transferred from outside hospital for cardiac catheterization
after presenting with chest pain.  She was found to have
coronary artery disease and cardiac surgery was consulted.  Post
procedure she was admitted to cardiology and underwent
preoperative workup.  Of note she had elevated hgbA1c 7.4 and
[**Last Name (un) 387**] was consulted for new diabetes diagnosis.  She was placed
on insulin sliding scale for blood glucose management.  On [**6-28**]
she was brought to the operating room for coronary artery bypass
graft surgery.  See operative report for further details in
summary she had:
coronary artery bypass graft x2 with a left internal mammary
artery to the left anterior descending artery, and a reverse
saphenous vein graft to the obtuse marginal artery. Her bypass
time was 62 minutes, with a crossclamp of 47 minutes.
She received vancomycin and cefazolin for perioperative
antibiotics, and ciprofloxacin for treatment of urinary tract
infection. She tolerated the operation well andpost-operatively
was transferred to the intensive care unit for post operative
management.  That evening she required neosynephrine for blood
pressure management and was transfused with packed red blood
cells for post operative bleeding.  In the first twenty four
hours she was weaned from sedation, awoke neurological intact,
and extubated without complications.  She continued on
neosynephrine for blood pressure management and was started on
lasix for diuresis.  She was transitioned to insulin sliding
scale with lantus from insulin drip for blood glucose
management.  On post operative day two she was found to have
decreased saturations and chest xray that revealed pulmonary
edema, she was switched to lasix drip for aggressive diuresis
with good response.  However she remained relatively hypoxic and
that evening she required non invasive ventilation for hypoxia.
Over the next several days she continued with high oxygen
requirement with non invasive ventilation, non breather mask, or
high flow oxygen mask.  She was weaned off neosynephrine on [**7-2**]
and started on beta blockers.  Early in the am [**7-3**] she
developed atrial fibrillation and was treated with amiodarone
bolus and converted back to sinus tachycardia.   She continued
to have intermittent episodes of atrial fibrillation treated
with betablockers and amiodarone over the next few days and then
she remained in sinus rhythm.  On [**7-4**] she was noted to have
elevated liver functions- an abdominal ultrasound was negative.
Her medications were adjusted as there was concern for drug
related transaminase elevation, so metformin and amiodarone were
stopped.  Her liver functions progressively improved.  She again
had occaisional bouts of atrial finrillation and Diltiazem was
added to the beta blockers with good effect.
She developed acute kidney injury with baseline creatinine 0.4
peak 2.6 on [**7-8**]. On [**7-6**] lasix drip was stopped and diuresis
held due to increased creatinine.
On [**7-9**] Pulmonary was consulted due to ongoing hypoxia with high
flow oxygen requirements. She was started steroids and had chest
CT scan to further evaluate hypoxia.  Pulmonary continued to
follow her and she was tapered from IV to oral steroids.  With
the addition of steroids she had worsening hyperglycemia and
required insulin drip for managment.  She slowly improved and
was able to be weaned down to nasal cannula on [**7-14**].  She
continued to progressively improve and remained on nasal
cannula, transitioned to sliding scale insulin with lantus and
remained in sinus rhythm.  On [**7-17**] she was transferred from the
ICU to the floor for the remainder of her care.  An initial
attempt to taper steroids led to increased shortness of breath
they were increased back to 60 mg daily.  She was restarted on
lasix for diuresis requiring intravenous lasix.  She continues
on telemetry for rhythm management.  On [**7-23**] her steroids were
dropped to 50 mg daily to restart slow taper.
On [**7-27**] she had a guaiac positive melenotic stool. Hematocrit
was trending downward, requiring transfusion of 2 units of
packed red cells. Proton pump inhibitor was initiated along with
a Gastroenterology consult. For closer 24 hour observation, she
was transferred back to CVICU for further GI workup. Her
pulmonary status remained tenuous but slowly improving.  She was
weaned to nasal cannula and she was on 3 liters at the time of
discharge.  Dr.[**Last Name (STitle) **] and GI discussed the risks and benefits of
having a EGD performed. Initially she had been made NPO and an
EGD scheduled but her hematocrit remained stable and it was felt
that further workup could be done as an outpatient, so as to not
set her back from a pulmonary standpoint, the EGD was not
performed during admission. She remains on medication for
painful swallowing thought likely secondary to fungal
esophagitis due to steroids, treated with Nystatin swish and
swallow and Diflucan.
 She was ready for discharge to [**Hospital3 **], [**Location (un) 86**] on POD
#37 with plan for follow up PFTs and pulmonary appointment.
Additionally her steroids continue at 20 mg daily with taper
plan to be determined at follow up with Pulmonology.
Gastroenterology, as well as cardiology, and cardiac surgery
follow up appointments advised.

stop [**8-3**]

Medications on Admission:
Norvasc 5 mg daily
ASA 81 mg daily


Discharge Medications:
1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) ml
Injection TID (3 times a day).
4. tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
5. vitamin A 10,000 unit Capsule Sig: Two (2) Capsule PO BID (2
times a day): while on prednisone .
6. polyethylene glycol 3350 17 gram/dose Powder Sig: Seventeen
(17) gram PO DAILY (Daily).
7. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: Three (3) ml Inhalation Q6H (every 6 hours).
8. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: Three (3) ml Inhalation Q2H (every 2 hours) as
needed for SOB .
9. aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
10. fluticasone-salmeterol 500-50 mcg/dose Disk with Device Sig:
One (1) Disk with Device Inhalation [**Hospital1 **] (2 times a day).
11. ipratropium bromide 0.02 % Solution Sig: Three (3) ml
Inhalation Q6H (every 6 hours).
12. senna 8.6 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
13. white petrolatum-mineral oil     Cream Sig: One (1) Appl
Topical [**Hospital1 **] (2 times a day).
14. sulfamethoxazole-trimethoprim 400-80 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily): to continue and will be reevaluated at
outpatient pulmonary appointment .
15. potassium chloride 10 mEq Tablet Extended Release Sig: Four
(4) Tablet Extended Release PO DAILY (Daily).
16. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day). Tablet(s)
17. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H
(every 4 hours) as needed for pain. Tablet(s)
18. prednisone 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
19. nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) for 7 days.
20. furosemide 80 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
21. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
22. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
23. metformin 500 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
24. sertraline 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
25. sucralfate 1 gram Tablet Sig: One (1) Tablet PO QID (4 times
a day).
26. diltiazem HCl 180 mg Capsule, Extended Release Sig: One (1)
Capsule, Extended Release PO DAILY (Daily).
27. fluconazole 150 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours).


Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
coronary artery disease s/p coronary artery bypass grafts
post operative acute lung injury
Pulmonary edema
post operative atrial fibrillation
Acute kidney injury
Diabetes mellitus (hgba1c 7.4%)
hypertension


Discharge Condition:
Alert and oriented x3, nonfocal
Ambulating with assistance and increased oxygen short distances
Incisional pain managed with Ultram as needed
Incisions:
Sternal - healing well, no erythema or drainage
Leg Left - healing well, no erythema or drainage.
Edema none

Discharge Instructions:
Please shower daily including washing incisions gently with mild
soap, no baths or swimming until cleared by surgeon. Look at
your incisions daily for redness or drainage
Please NO lotions, cream, powder, or ointments to incisions
Each morning you should weigh yourself and then in the evening
take your temperature, these should be written down on the chart

No driving for approximately one month and while taking
narcotics, will be discussed at follow up appointment with
surgeon when you will be able to drive
No lifting more than 10 pounds for 10 weeks
Please call with any questions or concerns [**Telephone/Fax (1) 170**]
Females: Please wear bra to reduce pulling on incision, avoid
rubbing on lower edge
**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**


Followup Instructions:
You are scheduled for the following appointments
Surgeon: Dr. [**Last Name (STitle) **] on [**2125-8-29**] at 1:00  [**Telephone/Fax (1) 170**]
Cardiologist: Dr. [**Last Name (STitle) **] on [**8-7**] at 3:45pm [**Telephone/Fax (1) 4475**]

Pulmonary Function Test: [**Telephone/Fax (1) 609**] Date/Time:[**2125-8-7**] 12:10
Dr [**Last Name (STitle) 575**] on [**8-7**] at 12:30pm in Medical Specialties on
[**Hospital Ward Name 23**] 7

**Please call cardiac surgery office with any questions or
concerns [**Telephone/Fax (1) 170**]. Answering service will contact on call
person during off hours**



Completed by:[**2125-8-4**]
{'Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Candidiasis of mouth,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Urinary tract infection, site not specified,Ostium secundum type atrial septal defect,Acute posthemorrhagic anemia,Blood in stool,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Tobacco use disorder,Other and unspecified hyperlipidemia,Natural blood and blood products causing adverse effects in therapeutic use,Other iatrogenic hypotension,Atrial fibrillation,Other abnormal blood chemistry,Knee joint replacement,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms'}


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: chest pain

PRESENT ILLNESS: 64 year old female with prior history of hypertension and
chronic tobacco abuse who had an isolated episode of midsternal
chest pain ([**8-22**]) while setting up a golf tournament this
morning resolving with rest over 3 minutes.  She reports a
similar episode 1 week previously. No radiation of pain,
shortness of breath, diaphoresis. She was referred for a cardiac
catheterization which revealed 3 vessel coronary disease and was
then referred to cardiac surgery for revascularization.

MEDICAL HISTORY: Hypertension
Tobacco abuse (1ppd)
s/p c-section x3
s/p tonsillectomy
s/p Bilateral knee replacments

MEDICATION ON ADMISSION: Norvasc 5 mg daily
ASA 81 mg daily

ALLERGIES: All allergies / adverse drug reactions previously recorded have
been deleted

PHYSICAL EXAM: Pulse:96 Resp:17  O2 sat:100/RA
B/P  Right:132/75    Left:135/88
Height:5'3"     Weight:175 lbs

FAMILY HISTORY: brother who had a coronary artery bypass grafting
another brother who underwent percutaneous coronary intervention

SOCIAL HISTORY: She lives with her husband and is retired
She is a current smoker of one pack per day for thirty-five
years
She drinks two alcoholic beverages daily 

### Response:
{'Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Candidiasis of mouth,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Urinary tract infection, site not specified,Ostium secundum type atrial septal defect,Acute posthemorrhagic anemia,Blood in stool,Cardiac complications, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Tobacco use disorder,Other and unspecified hyperlipidemia,Natural blood and blood products causing adverse effects in therapeutic use,Other iatrogenic hypotension,Atrial fibrillation,Other abnormal blood chemistry,Knee joint replacement,Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other gram-negative organisms'}
