CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 49 year-old
woman diagnosed with metastatic renal cell cancer with spinal
and pelvic mets on [**2118-3-27**].  The patient had a bony
destruction of the left pedicle of L3 as well as posterior
elements on the left side of L3 with impingement on the L3
nerve root without evidence of cord compression.  The patient
is preoped for lumbar embolization, renal embolization
followed by left radical nephrectomy and removal of the L3
vertebra and L2-L4 spinal fusion.

MEDICAL HISTORY: None.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Malignant neoplasm of kidney, except pelvis,Iatrogenic pneumothorax,Secondary malignant neoplasm of adrenal gland,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution
Malig neopl kidney,Iatrogenic pneumothorax,Second malig neo adrenal,Abn react-surg proc NEC,Accid in resident instit
Admission Date:  [**2118-4-26**]       Discharge Date:  [**2118-5-6**]

Date of Birth:   [**2068-7-18**]       Sex:  F

Service:  #58

HISTORY OF PRESENT ILLNESS:  The patient is a 49 year-old
woman diagnosed with metastatic renal cell cancer with spinal
and pelvic mets on [**2118-3-27**].  The patient had a bony
destruction of the left pedicle of L3 as well as posterior
elements on the left side of L3 with impingement on the L3
nerve root without evidence of cord compression.  The patient
is preoped for lumbar embolization, renal embolization
followed by left radical nephrectomy and removal of the L3
vertebra and L2-L4 spinal fusion.

PAST MEDICAL HISTORY:  None.

PAST SURGICAL HISTORY:  None.

MEDICATIONS:
1.  Oxycontin SR.
2.  Percocet.
3.  Colace.
4.  Ambien.

PHYSICAL EXAMINATION:  In general, the patient was awake,
alert and oriented times three, pleasant, cachectic looking
female.  Temperature 100.  Blood pressure 120/62.  Heart rate
117.  Respiratory rate 18.  Sat 98%.  Pupils are equal, round
and reactive to light.  Mucous membranes are moist. Neck was
supple.  Pulmonary clear bilaterally.  Cardiac tachy S1 and
S2 within normal limits.  Abdomen soft, nontender,
nondistended.  Positive bowel sounds.  Extremities no edema.
Back there was no swelling in the lumbar area.
Neurologically the patient was awake, alert and oriented
times three.  Cranial nerves II through XII were intact,
mildly symmetric.  She had no drift.  Her strength was 5 out
of 5 in all muscle groups.  Her sensation was intact to light
touch.  She was hyperreflexic throughout with clonus of the
left lower extremity.

PREOPERATIVE LABORATORIES:  Sodium was 137, K 4.9, chloride
99, CO2 29, BUN 15, creatinine .8, glucose 154.

HOSPITAL COURSE:  The patient was preoped for a embolization
of her lumbar spine area, which was done on [**2118-4-28**] without
complications.  The patient was monitored in the Intensive
Care Unit postoperatively.  The patient then underwent an
embolization of her right kidney on [**2118-4-28**] without
complications.  She was again monitored in the Intensive Care
Unit and then preoped for the Operating Room for left
nephrectomy and L3 vertebrectomy with L2 to L4 fusion.  She
had this on [**2118-4-29**].  She tolerated the procedure well.
There were no intraoperative complications.  She was again
monitored in the Intensive Care Unit.  Postoperatively she
was fitted for a TLSO brace.  She remained on flat bed rest.
She was moving both lower extremities with good strength.
Her dressings were clean, dry and intact.  She had a chest
tube in place, which was draining serosanguinous fluid.  She
also had a JP drain in place.  JP drain was removed on
[**2118-5-2**].  The patient's brace was brought in on [**2118-5-2**] and
the patient was out of bed on [**2118-5-2**].  Chest tube was
removed on [**2118-5-3**] and she was out of bed in her brace.
Her strength remained 5 out of 5 in all muscle groups.  She
was awake, alert and oriented times three and afebrile.  She
was transferred to the floor on [**2118-5-3**] and continued to do
well and continued to be followed by physical therapy and
occupational therapy and was found to be safely discharged to
home.  She was discharged to home on [**2118-5-6**] in stable
condition with follow up with Dr. [**Last Name (STitle) 1327**] on Tuesday the 17th
at 10:40 a.m. for staple removal.  She will follow up with
Dr. [**Last Name (STitle) 9125**] on [**5-23**] and with the oncology people on [**5-18**].

CONDITION ON DISCHARGE:  Stable.  She was afebrile.  Her
dressing was clean, dry and intact.

MEDICATIONS ON DISCHARGE:
1.  Percocet one to two tabs po q 4 hours prn.
2.  Nystatin 5 cc q.i.d. prn.
3.  Lasix 20 mg po q.d. times one day and then discontinued.
4.  Hydrocodone sustained release 30 mg po q.a.m.
5.  Hydrocodone 40 mg one tab at bedtime.
6.  Calcium carbonate 500 mg t.i.d.
7.  Phosphorus one packet b.i.d. for three days.
8.  Zolpidem tartrate 5 mg at h.s. prn.
9.  Lorazepam .5 mg q 4 to 6 hours prn.






                            [**Name6 (MD) 1339**] [**Last Name (NamePattern4) 1340**], M.D.  [**MD Number(1) 1341**]

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2118-5-6**]  11:48
T:  [**2118-5-6**]  12:13
JOB#:  [**Job Number 48401**]
{'Malignant neoplasm of kidney, except pelvis,Iatrogenic pneumothorax,Secondary malignant neoplasm of adrenal gland,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution'}


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: The patient is a 49 year-old
woman diagnosed with metastatic renal cell cancer with spinal
and pelvic mets on [**2118-3-27**].  The patient had a bony
destruction of the left pedicle of L3 as well as posterior
elements on the left side of L3 with impingement on the L3
nerve root without evidence of cord compression.  The patient
is preoped for lumbar embolization, renal embolization
followed by left radical nephrectomy and removal of the L3
vertebra and L2-L4 spinal fusion.

MEDICAL HISTORY: None.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Malignant neoplasm of kidney, except pelvis,Iatrogenic pneumothorax,Secondary malignant neoplasm of adrenal gland,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in residential institution'}
