CHIEF COMPLAINT: Arterial insufficiency with right foot
pain.

PRESENT ILLNESS: This is a 75-year-old gentleman
with a significant past medical history with coronary artery
disease status post stenting, chronic obstructive pulmonary
disease, syndrome of inappropriate antidiuretic hormone and
peripheral vascular disease.  He presented to Caritas [**Hospital6 40383**] two to three weeks prior to transfer here for
right foot pain.  The patient states  that his pain became
progressively progressed to the point he was unable to walk.
This was associated with swelling.  Therefore, he was
evaluated on [**2125-5-21**], at [**Hospital3 **] Caritas.  He was
found to have a normal white count of 9.4 and was afebrile.
He was also found to have urinary retention.  He was started
on vancomycin and Zosyn and was transferred to our
institution for further workup and possible vascular
intervention.  The patient was known peripheral vascular
disease.  He was to have an elective leg re-vascularization
by Dr. [**Last Name (STitle) **] and this was cancelled due to the patient's
significant history of chronic obstructive pulmonary disease.
The patient denies any constitutional symptoms, shortness of
breath, chest pain, nausea, vomiting or bowel habit changes.
He was treated at Caritas [**Hospital3 **] for right lower lobe
pneumonia as well as chronic obstructive pulmonary disease
exacerbation.

MEDICAL HISTORY: Illnesses:  Chronic obstructive
pulmonary disease, coronary artery disease, paroxysmal atrial
fibrillation anticoagulated, peripheral vascular disease,
history of alcohol abuse, history of SIADH.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient can ambulate and take care of
himself before it became too painful to walk.  He has a
heavy smoking history of one to two packs per day for
approximately 60 years.  He quit three months ago.  He does
have a history of alcohol excess and admits to drinking one
12-ounce beer per night.
Atherosclerosis of native arteries of the extremities with gangrene,Acute osteomyelitis, ankle and foot,Cellulitis and abscess of foot, except toes,Acute posthemorrhagic anemia,Hyposmolality and/or hyponatremia,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status
Ath ext ntv art gngrene,Ac osteomyelitis-ankle,Cellulitis of foot,Ac posthemorrhag anemia,Hyposmolality,Chr airway obstruct NEC,Atrial fibrillation,Crnry athrscl natve vssl,Status-post ptca
Admission Date: [**2125-5-22**]        Discharge Date: [**2125-6-1**]

Date of Birth:  [**2050-5-9**]        Sex:  M

Service:  VSU


CHIEF COMPLAINT:  Arterial insufficiency with right foot
pain.

HISTORY OF PRESENT ILLNESS:  This is a 75-year-old gentleman
with a significant past medical history with coronary artery
disease status post stenting, chronic obstructive pulmonary
disease, syndrome of inappropriate antidiuretic hormone and
peripheral vascular disease.  He presented to Caritas [**Hospital6 40383**] two to three weeks prior to transfer here for
right foot pain.  The patient states  that his pain became
progressively progressed to the point he was unable to walk.
This was associated with swelling.  Therefore, he was
evaluated on [**2125-5-21**], at [**Hospital3 **] Caritas.  He was
found to have a normal white count of 9.4 and was afebrile.
He was also found to have urinary retention.  He was started
on vancomycin and Zosyn and was transferred to our
institution for further workup and possible vascular
intervention.  The patient was known peripheral vascular
disease.  He was to have an elective leg re-vascularization
by Dr. [**Last Name (STitle) **] and this was cancelled due to the patient's
significant history of chronic obstructive pulmonary disease.
The patient denies any constitutional symptoms, shortness of
breath, chest pain, nausea, vomiting or bowel habit changes.
He was treated at Caritas [**Hospital3 **] for right lower lobe
pneumonia as well as chronic obstructive pulmonary disease
exacerbation.

PAST MEDICAL HISTORY:  Illnesses:  Chronic obstructive
pulmonary disease, coronary artery disease, paroxysmal atrial
fibrillation anticoagulated, peripheral vascular disease,
history of alcohol abuse, history of SIADH.

PAST SURGICAL HISTORY:  Coronary artery stenting, vessels
unknown.

MEDICATIONS:  Medications at home include nitroglycerin
sublingual, Atrovent, Procardia 240 mg ER, Ecotrin 81 mg
daily, Lasix 40 mg twice a day, pravastatin 40 mg twice a
day, Pulmicort, Spiriva, vitamin B12, Xopenex 0.4 mg four
times a day p.r.n.

Transfer medications were vancomycin 1 gram every 12 hours,
Zosyn 3.375 grams every 8 hours, omeprazole, acetaminophen,
morphine, Lovenox 30 mg, Diltiazem 240 mg, Ecotrin 81 mg,
simvastatin 20 mg, vitamin B12 500 mg and Spiriva.

SOCIAL HISTORY:  The patient can ambulate and take care of
himself before it became too painful to walk.  He has a
heavy smoking history of one to two packs per day for
approximately 60 years.  He quit three months ago.  He does
have a history of alcohol excess and admits to drinking one
12-ounce beer per night.

PHYSICAL EXAMINATION:  Vital signs:  98.4, 86, 18, O2
saturation 955 on 2 liters, blood pressure 133/67.  General
appearance:  Alert and oriented x3, appears somewhat
uncomfortable with movement of the foot.  HEENT examination
is unremarkable.  Neck is supple.  Carotid pulses are
symmetrical.  There are no carotid bruits.  Heart is a
regular rate and rhythm with a 2/6 systolic ejection murmur.
Lungs increased AP diameter and sounds are distant globally.
Abdominal examination is unremarkable.  There are no intra-
abdominal bruits.  A Foley is in place.  Extremity
examination shows 3+ edema right greater than left.  The
right foot is with blanching erythema extending to just
proximal to the ankle and diffuse erythema of the leg to the
hip.  It is more pronounced on the dorsal leg.  There are
multiple scars and superficial erosions on the anterior
tibia.  Toes two, three and four with violaceous ischemic
appearance.  Capillary refill is greater than 3 seconds.
There are small ulcers in the web spaces in the interdiginous
areas between the toes with fibrinous purulent exudate.  The
fourth toenail is separating.  Overall, foot is somewhat cool
to touch with toes being most pronounced compared to the
contralateral side.  Overall, poor foot hygiene.  Left foot
is warm with adequate perfusion.  Pulse examinations:
Carotids 2+, radials 2+, femoral faintly palpable on the left
and 1+ on the right.  On the left, the popliteal is palpable.
The dorsalis pedis and posterior tibial are monophasic
[**Hospital3 **] signals.  On the right, the popliteal, dorsalis
pedis are absent.  The posterior tibial is a monophasic
signal.

HOSPITAL COURSE:  The patient was admitted to the Vascular
Service.  He was continued on his antibiotics.  Podiatry was
consulted.  They felt at this time there was no surgical
indication to treat the foot or leg lesions.  They
recommended to continue antibiotics, daily wound care with
Betadine to the lesions and the patient could ambulate full
weightbear with a healing sandal.  Outside, a CT of the
abdomen and aorta with runoffs falling.  There is complete
occlusion of the left external iliac artery, occlusion of the
proximal superficial femoral artery with reconstitution of
the distal superficial femoral artery with large deep femoral
artery with three-vessel runoff.  On the right side, there
was stenosis in the proximal common iliac and external iliac
arteries with a high-grade stenosis of the deep femoral
artery, poor collateral flow distally, some reconstitution of
the right popliteal artery and two-vessel runoff on the right
ankle with dominant vessel being posterior tibial.  There was
severe atherosclerotic and mesenteric and renal artery
changes.

The patient underwent arteriogram on [**2125-5-25**], without
complication.  He was recommended that he could be
revascularized.  Outside cultures grew methicillin-sensitive
Staphylococcus aureus, methicillin-resistant Staphylococcus
aureus.  The patient was continued on vancomycin, Cipro and
Flagyl.  The patient underwent on [**2125-5-25**], a right
femoral endarterectomy with a right superficial femoral
artery posterior tibial bypass with non-reverse saphenous
vein graft, angioscopy and valve lysis.  The patient required
2 units of packed red blood cells intraoperatively.  The
patient tolerated the procedure well and was transferred to
the postanesthesia care unit in stable condition.

Postoperatively, he remained hemodynamically stable.  He was
transfused 2 units of packed red blood cells.  He continued
to do well and was transferred to the VICU for continued
monitoring and care.  On postoperative day one, there were no
overnight events.  T-max was 100.4 to 99.  His blood gases
were 7.34, 43, 76, 24, -2.  Hematocrit was 31.3.  BUN 5,
creatinine of 0.6.  Pulse examination on the right side
showed a [**Name (NI) **] PT signal.  Foot was warm.  The patient
remained in the VICU.  Intravenous fluids were Hep-Lock'd.
Diet was advanced.

Postoperative day two, the patient continued to do well.  The
right second toe remained ischemic in appearance. The Swan
was discontinued.  He required diuresis.  He was allowed to
ambulate to a chair.  His T-max was 100.2 to 99.6.  He
remained in the VICU.  Most of the time he was noted to be
hyponatremic with a sodium of 122.  Fluid restriction of 1000
cubic centimeters per 24 hours was instituted along with salt
tablets 1 gram twice a day.  Hematocrit remained stable at
29.5.  Antibiotics were continued.  Diuresis continued and
the patient remained on a CIWA scale for his history of
alcohol use.  The patient did demonstrate some mild confusion
which we felt was secondary to his hyponatremia.

Postoperative day three, there were no overnight events.  He
was continued in the VICU.  He was de-lined.  Chair
ambulation was continued.  Physical Therapy was prescribed to
see the patient and he was transferred to the regular nursing
floor for continued care.  The patient underwent a right
second toe amputation on [**2125-5-31**].  He tolerated the
procedure well.  He was reevaluated by Physical Therapy who
felt he would require rehabilitation prior to being
discharged to home.

Postoperative day five and one, the patient continued to do
well.  Intravenous antibiotics were discontinued.  Bactrim
was instituted.  Coumadinization was reinstituted for his
history of fibrillation.  He was given 5 mg.  Sodium was
continued to be monitored.  Sodium continued to show
improvement.  He continued with the fluid restriction and
salt tablets.  On postoperative day number six, the patient
continued to do well.  Sodium was 128.  He was afebrile.  His
amputation site wound looked clean, dry and intact.
Ambulation essential distances full weightbearing with
healing sandal was instituted.  He was screened by Physical
Therapy and Rehab.  He will be transferred to  Rehab for
continued postoperative care in stable condition.

DISCHARGE INSTRUCTIONS:  The patient may shower but no tub
baths.  He may ambulate essential distances with healing
sandal.  If he develops any fevers, wound changes consisting
of redness, drainage or groin swelling or drainage, please
notify Dr.[**Name (NI) 1392**] office.  His antibiotics should be
continued until seen in follow up.  His INR should be
monitored on a daily basis for goal INR of 2.0 to 3.0.
Coumadin should be adjusted as needed.  The patient is on
Bactrim which interacts with Coumadin and may elevated the
INR.  The sodium should also be monitored.  His current
sodium is 128 on a fluid-restriction of 1200 cubic
centimeters per 24 hours and 2 grams of sodium tablets twice
a day.  The patient should follow up with Dr. [**Last Name (STitle) 1391**] in two
to three weeks.

DISCHARGE DIAGNOSIS:  Arterial insufficiency with ischemic
right foot pain, history of ischemic heart disease status
post percutaneous coronary intervention, history of chronic
obstructive pulmonary disease, history of paroxysmal atrial
fibrillation anticoagulated, history of syndrome of
inappropriate antidiuretic hormone, history of alcohol abuse,
status postop hyponatremia treated, postoperative blood loss
anemia transfused.

MAJOR SURGICAL AND INTERVENTION PROCEDURES:  Diagnostic
arteriogram via right femoral access on [**5-25**]; a right
femoral endarterectomy with a right fem PT bypass with non-
reversed greater saphenous vein on [**2125-5-25**]; a right
second to amputation on [**5-31**].



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 2380**], [**MD Number(1) 2381**]

Dictated By:[**Last Name (NamePattern1) 2382**]
MEDQUIST36
D:  [**2125-6-1**] 12:47:53
T:  [**2125-6-1**] 14:48:45
Job#:  [**Job Number 78210**]
{'Atherosclerosis of native arteries of the extremities with gangrene,Acute osteomyelitis, ankle and foot,Cellulitis and abscess of foot, except toes,Acute posthemorrhagic anemia,Hyposmolality and/or hyponatremia,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}


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: Arterial insufficiency with right foot
pain.

PRESENT ILLNESS: This is a 75-year-old gentleman
with a significant past medical history with coronary artery
disease status post stenting, chronic obstructive pulmonary
disease, syndrome of inappropriate antidiuretic hormone and
peripheral vascular disease.  He presented to Caritas [**Hospital6 40383**] two to three weeks prior to transfer here for
right foot pain.  The patient states  that his pain became
progressively progressed to the point he was unable to walk.
This was associated with swelling.  Therefore, he was
evaluated on [**2125-5-21**], at [**Hospital3 **] Caritas.  He was
found to have a normal white count of 9.4 and was afebrile.
He was also found to have urinary retention.  He was started
on vancomycin and Zosyn and was transferred to our
institution for further workup and possible vascular
intervention.  The patient was known peripheral vascular
disease.  He was to have an elective leg re-vascularization
by Dr. [**Last Name (STitle) **] and this was cancelled due to the patient's
significant history of chronic obstructive pulmonary disease.
The patient denies any constitutional symptoms, shortness of
breath, chest pain, nausea, vomiting or bowel habit changes.
He was treated at Caritas [**Hospital3 **] for right lower lobe
pneumonia as well as chronic obstructive pulmonary disease
exacerbation.

MEDICAL HISTORY: Illnesses:  Chronic obstructive
pulmonary disease, coronary artery disease, paroxysmal atrial
fibrillation anticoagulated, peripheral vascular disease,
history of alcohol abuse, history of SIADH.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient can ambulate and take care of
himself before it became too painful to walk.  He has a
heavy smoking history of one to two packs per day for
approximately 60 years.  He quit three months ago.  He does
have a history of alcohol excess and admits to drinking one
12-ounce beer per night. 

### Response:
{'Atherosclerosis of native arteries of the extremities with gangrene,Acute osteomyelitis, ankle and foot,Cellulitis and abscess of foot, except toes,Acute posthemorrhagic anemia,Hyposmolality and/or hyponatremia,Chronic airway obstruction, not elsewhere classified,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status'}
