CHIEF COMPLAINT: elective admission for surgery

PRESENT ILLNESS: The patient is 58-year-old female who was recently referred to
me from her oncologist. The patient has developed a large high
frontal skull metastasis
that is progressively growing on sequential scans despite
systemic therapy. The lesion has completely eroded the inner and
outer table of the skull and is penetrating through the dural
compressing the right frontal lobe. The patient is in need of
surgical decompression and subsequent repair of the skull defect
to adequately treat this lesion prior to further
systemic/radiation treatment. The patient was extensively
counseled. The patient was taken electively to the OR.
Informed consent was obtained.

MEDICAL HISTORY: Breast CA treated in [**Country 651**] s/p R radical mastectomy
Axillary lymph node dissection/chemo/radiation therapy
Bone & liver mets
[**12-27**] T8 transthoracic vertebrectomy & T7-T9 fusion, T7-T9 cage
insertion, Pyramesh, ant. instrumentation, Kaneda, rib autograft
TAH and bilateral salpingo-oophorectomy, appendectomy

MEDICATION ON ADMISSION: tylenol, dilaudid

ALLERGIES: Ativan / Oxycodone

PHYSICAL EXAM: A & O x3, mae to command, PERRL 2.5-2mm, tongue deviates
slightly to right, no drift, + right droop, + nausea/headache.
Incision clean, dry, and intact.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives with husband; originally from [**Country 651**] but speaks some
English
Secondary malignant neoplasm of bone and bone marrow,Personal history of malignant neoplasm of breast,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health
Secondary malig neo bone,Hx of breast malignancy,Hx antineoplastic chemo,Hx of irradiation
Admission Date:  [**2112-5-12**]              Discharge Date:   [**2112-5-16**]

Date of Birth:  [**2054-1-10**]             Sex:   F

Service: NEUROSURGERY

Allergies:
Ativan / Oxycodone

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
elective admission for surgery

Major Surgical or Invasive Procedure:
Cranial bone and dural tumor resection


History of Present Illness:
The patient is 58-year-old female who was recently referred to
me from her oncologist. The patient has developed a large high
frontal skull metastasis
that is progressively growing on sequential scans despite
systemic therapy. The lesion has completely eroded the inner and
outer table of the skull and is penetrating through the dural
compressing the right frontal lobe. The patient is in need of
surgical decompression and subsequent repair of the skull defect
to adequately treat this lesion prior to further
systemic/radiation treatment. The patient was extensively
counseled. The patient was taken electively to the OR.
Informed consent was obtained.


Past Medical History:
Breast CA treated in [**Country 651**] s/p R radical mastectomy
Axillary lymph node dissection/chemo/radiation therapy
Bone & liver mets
[**12-27**] T8 transthoracic vertebrectomy & T7-T9 fusion, T7-T9 cage
insertion, Pyramesh, ant. instrumentation, Kaneda, rib autograft
TAH and bilateral salpingo-oophorectomy, appendectomy

Social History:
lives with husband; originally from [**Country 651**] but speaks some
English

Family History:
non-contributory

Physical Exam:
A & O x3, mae to command, PERRL 2.5-2mm, tongue deviates
slightly to right, no drift, + right droop, + nausea/headache.
Incision clean, dry, and intact.


Pertinent Results:
Labs upon admission:
[**2112-5-12**] 06:36PM   GLUCOSE-175* UREA N-12 CREAT-0.5 SODIUM-137
POTASSIUM-3.5 CHLORIDE-98 TOTAL CO2-24 ANION GAP-19
[**2112-5-12**] 06:36PM   CALCIUM-9.2 PHOSPHATE-4.9*
[**2112-5-12**] 06:36PM   WBC-11.4*# RBC-3.56* HGB-11.9* HCT-34.2*
MCV-96 MCH-33.4* MCHC-34.8 RDW-13.3
[**2112-5-12**] 06:36PM   PLT COUNT-310
[**2112-5-12**] 06:36PM   PT-13.5* PTT-24.6 INR(PT)-1.2*

Labs upon discharge:
[**2112-5-16**] 05:10AM BLOOD WBC-6.6 RBC-2.81* Hgb-9.1* Hct-26.6*
MCV-94 MCH-32.4* MCHC-34.4 RDW-13.4 Plt Ct-289
[**2112-5-16**] 05:10AM BLOOD Glucose-93 UreaN-12 Creat-0.5 Na-138
K-3.5 Cl-101 HCO3-26 AnGap-15
[**2112-5-16**] 05:10AM BLOOD Calcium-9.1

Head CT [**2112-5-12**]:
FINDINGS: Patient is status post right frontal craniotomy with a
metallic
prosthesis traversing the craniectomy defect. A small amount of
pneumocephalus persists in the surgical bed as well as
intracranially. A tiny amount of extraaxial hemorrhage along the
margins of the craniotomy appears likely. There is no shift of
normally midline structures or evidence of acute major vascular
territorial infarct. Multiple additional calvarial metastatic
lesions are reidentified including those to the clivus.

IMPRESSION: Status post right frontal craniectomy with a small
amount of
postoperative extraaxial hemorrhage along the craniectomy margin
and
pneumocephalus.

MRI Brain [**2112-5-13**]:
FINDINGS: Since the previous study, the patient has undergone
excision of
right frontal bone metastatic lesion. Craniectomy has been
performed at this level. Postoperative changes with air and
blood products in this region. Small extra-axial subdural
collection is also seen in this region, which is postoperative
in nature. There are no new areas of edema or parenchymal
hemorrhage identified. Again noted are multiple skull lesions
with enhancement indicating bony metastasis including
involvement of the clivus. No acute infarct seen.

IMPRESSION: Postoperative changes following resection of right
frontal bone
metastatic lesion. Expected post-surgical finding seen. Multiple
bony
metastasis seen. No infarct, mass effect, or hydrocephalus.

Brief Hospital Course:
The patient was admitted for elective craniotomy and
cranioplasty for resection of metastatic breast cancer to skull
and brain. The surgery went well and the patient went to the ICU
post-operatively. She was transitioned to a regular diet and
mobilized on post-op day #1 and transferred to the neurosurgery
floor. The patient was evaluated by physical therapy who felt
that she was safe to go home without services. The patient was
voiding and eating on her own without difficulty prior to
discharge. She was sent home on [**2112-5-16**] with the appropriate
follow-up scheduled.

Medications on Admission:
tylenol, dilaudid

Discharge Medications:
1. Docusate Sodium 100 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
Disp:*60 Tablet(s)* Refills:*1*
2. Butalbital-Acetaminophen-Caff 50-325-40 mg Tablet Sig: [**1-29**]
Tablets PO Q4H (every 4 hours) as needed for Headache: Maximum
of 6 pills per day.
Disp:*35 Tablet(s)* Refills:*0*
3. Senna 8.6 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*50 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
metastatic breast cancer to skull and dura


Discharge Condition:
Stable


Discharge Instructions:
General Instructions

??????	Have a friend/family member check your incision daily for
signs of infection.
??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	You may wash your hair only after sutures and/or staples have
been removed.
??????	You may shower before this time  and allow only water to run
over your head, do not use soap and do not scrub the area of
your wound.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
Ibuprofen etc.
??????	If you have been prescribed an anti-seizure medicine, take it
as prescribed and follow up with laboratory blood drawing in one
week.  Please have results faxed to [**Telephone/Fax (1) 87**].
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.

CALL YOUR SURGEON IMMEDIATELY IF YOU EXPERIENCE ANY OF THE
FOLLOWING

??????	New onset of tremors or seizures.
??????	Any confusion or change in mental status.
??????	Any numbness, tingling, weakness in your extremities.
??????	Pain or headache that is continually increasing, or not
relieved by pain medication.
??????	Any signs of infection at the wound site: redness, swelling,
tenderness, or drainage.
??????	Fever greater than or equal to 101?????? F.


Followup Instructions:
Follow-Up Appointment Instructions

??????	Please return to the office in 10 days for removal of your
staples.
??????	Please call ([**Telephone/Fax (1) 88**] to schedule an appointment with Dr.
[**Last Name (STitle) **], to be seen in ___4____weeks.
??????	You will need a CT scan of the brain without contrast.



Completed by:[**2112-5-18**]
{'Secondary malignant neoplasm of bone and bone marrow,Personal history of malignant neoplasm of breast,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health'}


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: elective admission for surgery

PRESENT ILLNESS: The patient is 58-year-old female who was recently referred to
me from her oncologist. The patient has developed a large high
frontal skull metastasis
that is progressively growing on sequential scans despite
systemic therapy. The lesion has completely eroded the inner and
outer table of the skull and is penetrating through the dural
compressing the right frontal lobe. The patient is in need of
surgical decompression and subsequent repair of the skull defect
to adequately treat this lesion prior to further
systemic/radiation treatment. The patient was extensively
counseled. The patient was taken electively to the OR.
Informed consent was obtained.

MEDICAL HISTORY: Breast CA treated in [**Country 651**] s/p R radical mastectomy
Axillary lymph node dissection/chemo/radiation therapy
Bone & liver mets
[**12-27**] T8 transthoracic vertebrectomy & T7-T9 fusion, T7-T9 cage
insertion, Pyramesh, ant. instrumentation, Kaneda, rib autograft
TAH and bilateral salpingo-oophorectomy, appendectomy

MEDICATION ON ADMISSION: tylenol, dilaudid

ALLERGIES: Ativan / Oxycodone

PHYSICAL EXAM: A & O x3, mae to command, PERRL 2.5-2mm, tongue deviates
slightly to right, no drift, + right droop, + nausea/headache.
Incision clean, dry, and intact.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: lives with husband; originally from [**Country 651**] but speaks some
English 

### Response:
{'Secondary malignant neoplasm of bone and bone marrow,Personal history of malignant neoplasm of breast,Personal history of antineoplastic chemotherapy,Personal history of irradiation, presenting hazards to health'}
