CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient was admitted
with the chief complaint of belly pain and rising white
count.  The patient was recently discharged from [**Hospital1 346**] on [**6-8**].  Please see discharge
summary in the computer for details.

MEDICAL HISTORY: 1.  History was significant for acute myelogenous leukemia
diagnosed in [**2180-1-8**], status post idarubicin and ARA-c
treatment times two with consolidation chemotherapy on [**2180-5-1**].
2.  Hypertension.
3.  Carotid stenosis.
4.  History of alcohol abuse.
5.  Acoustic neuroma.
6.  Benign prostatic hypertrophy.

MEDICATION ON ADMISSION: 1.  Atenolol 25 mg p.o.q.d.
2.  Zoloft 125 mg p.o.q.d.
3.  Vancomycin 1 gram IV q.d., dose only for a trough level
less than 20.  The patient was to receive this dose through
[**2180-8-14**].
4.  Flomax 0.4 mg p.o. q.d.
5.  Multivitamin one p.o.q.d.
6.  Reglan 10 mg p.o.q.i.d.
7.  Oxycodone 5 mg to 10 mg p.o.q.4h to 6h p.r.n. for pain in
the deltoid of his left calf.
8.  Protonix 40 mg p.o.q.d.

ALLERGIES: The patient is allergic to CEFTAZIDIME, which
causes anaphylaxis.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Unspecified disease of pericardium,Other disorders of muscle, ligament, and fascia,Atrial fibrillation,Congestive heart failure, unspecified,Acute myeloid leukemia, without mention of having achieved remission,Staphylococcal septicemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension
Pericardial disease NOS,Muscle/ligament dis NEC,Atrial fibrillation,CHF NOS,Ac myl leuk wo achv rmsn,Staphylcocc septicem NOS,DMII wo cmp nt st uncntr,Hypertension NOS
Admission Date:  [**2180-6-13**]       Discharge Date: [**2180-6-19**]

Date of Birth:   [**2117-1-6**]       Sex:  M

Service:  OMED BMT SERVICE.

AGE:  63.

HISTORY OF THE PRESENT ILLNESS:  The patient was admitted
with the chief complaint of belly pain and rising white
count.  The patient was recently discharged from [**Hospital1 346**] on [**6-8**].  Please see discharge
summary in the computer for details.

This is a 63-year-old man with a history of AML diagnosed on
[**1-/2180**] status post two cycles of idarubicin and ARA-c on
[**2-22**] and [**3-21**].  He was discharged to
rehabilitation on [**6-8**].  He had had a hospital course that
was complicated by Staph abscesses requiring drainage and
MRSA, positive blood culture, as well as small bilateral
pleural effusion felt to represent foci infected with MRSA.
On [**6-8**], it was noted that he line tip grew out coagulase
negative Staphylococcus, MRSA, which was sensitive to
Vancomycin.  Starting at 5 AM on the [**6-12**], the patient
noted abdominal pain described as a moderate negligible to
mild right upper quadrant and right lower quadrant discomfort
on rest, which became tender when palpated.  At baseline he
had frequent nausea and vomiting for the past few months, but
he feels that he may have had more in the past few days.  He
also noticed new leg swelling that began three days ago,
bilaterally.  He also has ankle swelling.  There was no
diarrhea.  Position does not change the pain.  However, he
also complained of mid sternal chest pain times two to three
weeks and he complaints of shortness of breath and worsening
pain while lying down that improved when he sits up and leans
forward.  There was no cough, no fever, no chills associated
with this.  The patient also complains of significantly
decreased urine output over the past few days.  He feels that
has been taking a normal amount of PO intake.

PAST MEDICAL HISTORY:
1.  History was significant for acute myelogenous leukemia
diagnosed in [**2180-1-8**], status post idarubicin and ARA-c
treatment times two with consolidation chemotherapy on [**2180-5-1**].
2.  Hypertension.
3.  Carotid stenosis.
4.  History of alcohol abuse.
5.  Acoustic neuroma.
6.  Benign prostatic hypertrophy.

MEDICATIONS ON ADMISSION:
1.  Atenolol 25 mg p.o.q.d.
2.  Zoloft 125 mg p.o.q.d.
3.  Vancomycin 1 gram IV q.d., dose only for a trough level
less than 20.  The patient was to receive this dose through
[**2180-8-14**].
4.  Flomax 0.4 mg p.o. q.d.
5.  Multivitamin one p.o.q.d.
6.  Reglan 10 mg p.o.q.i.d.
7.  Oxycodone 5 mg to 10 mg p.o.q.4h to 6h p.r.n. for pain in
the deltoid of his left calf.
8.  Protonix 40 mg p.o.q.d.

ALLERGIES:  The patient is allergic to CEFTAZIDIME, which
causes anaphylaxis.

PHYSICAL EXAMINATION:  Examination revealed the following:
Temperature on admission was 98.7, pulse 72, blood pressure
110/70, pulsus paradoxus 16.  GENERAL:  The patient is
elderly-appearing, mildly uncomfortable, no apparent
distress.  Pupils equally reactive to light.  Extraocular
muscles are intact.  Oropharynx moist.  There was no
adenopathy.  JVD was to the ankles.  LUNGS:   Clear to
auscultation bilaterally.  HEART:  Heart revealed regular
rate and rhythm, normal S1 and S2.  Heart sounds were
distant.  There was a 2/6 systolic ejection murmur at the
left lower sternal border.  Abdomen was mildly distended,
moderate tender in the right upper quadrant and the right
lower quadrant.  Bowel sounds were positive.  There were no
masses felt at the time.  There was 2+ edema to the knees
bilaterally.  The patient had a left leg abscess and a right
upper arm abscess, both packed.  There was no erythema or
exudate.

LABORATORY DATA:  Laboratory values on admission revealed the
following:  White count of 36.6, hematocrit 29.0, MCV 92.
Differential on the white count was 67 neutrophils, 14 bands,
2 lymphs, 8 monos, 3 atypical cells, 4 metamyelocytes, and
myelocytes.  Coagulations studies revealed the following:
13.9, 25.5, and 1.3 with a platelet count of 63.  SMA 7:
132, 3.8, 121, 17, 1.8, glucose of 121, albumin 2.6, globulin
8.9, calcium 8.9, phosphatase 3.3, magnesium 1.4, troponin
less than .3, CK 29, ALT 167, AST 89, LDH 251, alkaline
phosphatase 649, total bilirubin 0.4 and 0.2 direct, GTT 614.

Urinalysis showed a large amount of blood, pH 6, leukocyte
Estrace positive, no nitrites, 49 reds, 3 whites, no
bacteria, less than 1 squamous epithelial cell.  Urine sodium
was 43, urine creatinine 95.  Blood culture pending.
Catheter tip was coagulase negative staphylococcus, sensitive
to Vancomycin; multiple laboratory studies with MRSA.

EKG:  Sinus rhythm at 80 beats per minute, normal axis,
diffuse flattening of the T waves especially in the lateral
leads, Q wave in lead three and lateral ST flattening, now
new compared to old EKG of [**2180-6-5**].  Chest CT, without
contrast, showed a new large pericardial effusion.  There was
small bilateral pleural effusions, no the right being greater
than the left.  There was associated bibasilar compressive
atelectasis.  Mediastinal lymph nodes were again noted with a
slight increase in size of the lymph nodes and in the
paratracheal space, previous noted 6-mm and curly measuring
8 -mm and a short axis considered to be likely reactional
given increase in size during the short interval.  There was
no significant axillary or hilar lymphadenopathy.  Lung
demonstrated bilateral parenchymal marginal opacities without
cavitation, no changed compared with the prior examination
and concerning foci for infection.

CT of the abdomen showed no focal masses within the liver and
no intrahepatic biliary ductal dictation.  Gallbladder was
not distended.  Spleen, pancreas, jejunum, and kidneys were
unchanged and unremarkable.  There was a pigtail catheter,
which was previously seen within the right psoas muscle, had
been removed.  There was a partial re-accumulation of the
collection from the right psoas.  This current measured
3.7  cm x 2.1 cm and could represent recurrence of the
abscess.  CT of the pelvis was unremarkable.

Bone window show degenerative changes, but no suspicious
lyticoblastic lesions seen.

There was a focal area of fat straining within the left lower
quadrant of uncertain source or significance.

The patient, Mr. [**Known lastname **], upon admission, was then referred
to the Cardiology Department because the large pericardial
effusion, drained by pericardial centesis on [**6-14**] and 700
cc of hemorrhagic fluid was removed.  Hematocrit was 6%, LDH
400, albumin 2.4, with improvement in the patient's blood
pressure and symptoms in terms of pain and the blood pressure
which had gone down to about systolic of 100 to 110.

Pericardial fluid cytology was negative and cultures showed
no growth.

The patient was transferred to the Medical Intensive Care
Unit following the pericardial centesis to permit additional
drainage from the pericardium with additional 450 cc.  The
drain was discontinued on [**6-16**] after the drainage rate
was down to 3 cc per hour.  The patient had experienced
transient atrial fibrillation on [**6-15**], but that
spontaneously corrected.  The patient remained in normal
sinus rhythm.  In addition, the patient was found as
mentioned on CT to have an increased fluid collection in the
right psoas muscle with accompanying leukemoid reaction with
increased white cells.  As the patient remained in the
hospital, the white cell count increased from that noted on
admission to, what would be found by the day of discharge, at
120 white cells; 50 cc of fluid was removed by interventional
radiology.  It was found that the psoas mass had
gram-positive cocci in pairs and clusters.  The patient's
coverage for that was broadened to Levofloxacin and Flagyl.
Pigtail catheterization was left in place protruding from the
right posterior thorax.  A pericardial window was not
determined to be necessary at the time.  The patient had
transient hypotension with a systolic blood pressure in the
70s overnight, remaining symptomatic, responding to a 500 cc
fluid bolus times one.  The Atenolol was held.  Because of
the pericardial centesis and fluid drainage, it was expected
that his white count would go down, however, it continued to
rise and reached 109 white cells with many immature cells and
blasts, seen on peripheral smear.  Aspirate was attempted,
however, no cells could be removed so that an iliac bone
marrow biopsy and aspirate was done and evaluated under the
microscope by Drs. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] and [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **].  It was
determined that the bone marrow was full of immature cells
and blasts indicating that the patient had a relapsed AML.
Given that the patient had relapsed AML and had been unable
to clear his disseminated Methicillin-resistant
Staphylococcus aureus infections in different parts of his
body, it was determined that the patient, in discussion with
him and the rest of his family, he would go home from the
hospital with hospital care.  So, the patient was discharged
on [**2180-6-19**] to home-hospice care in stable condition.
He was discharged on the following medications:

DISCHARGE MEDICATIONS:
1.  Fentanyl 25 mcg patch transdermally q 72 hours.
2.  Linezolid 600 mg p.o.b.i.d.
3.  Flomax 0.4 mg p.o.q.d.
4.  Tylenol 650 mg p.o.q.4h. to 6h.p.r.n.
5.  Zoloft 125 mg p.o.q.d.
6.  Xanax 1 mg to 2 mg q.h.s.p.r.n.
7.  Morphine sulfate elixir 10 mg to 20 mg p.o.q.4h.p.r.n.
8.  Home hospice also included Lorazepam 0.5 to 2 mg
q.4h.p.r.n. sublingual; Levsin 0.125 mg to 0.25 mg q.4h. to 6
h.P.r.n. sublingual and Morphine concentrate 5 mg to 20 mg
q.1h. to 2h.p.r.n. sublingual.










The patient was aware of his diagnosis and in favor of this
treatment plan.  The patient went home as a comfort measure
only.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 4380**], M.D.  [**MD Number(1) 10999**]

Dictated By:[**Last Name (NamePattern1) 3033**]
MEDQUIST36

D:  [**2180-6-19**]  15:26
T:  [**2180-6-19**]  15:29
JOB#:  [**Job Number 101389**]
{'Unspecified disease of pericardium,Other disorders of muscle, ligament, and fascia,Atrial fibrillation,Congestive heart failure, unspecified,Acute myeloid leukemia, without mention of having achieved remission,Staphylococcal septicemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}


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 was admitted
with the chief complaint of belly pain and rising white
count.  The patient was recently discharged from [**Hospital1 346**] on [**6-8**].  Please see discharge
summary in the computer for details.

MEDICAL HISTORY: 1.  History was significant for acute myelogenous leukemia
diagnosed in [**2180-1-8**], status post idarubicin and ARA-c
treatment times two with consolidation chemotherapy on [**2180-5-1**].
2.  Hypertension.
3.  Carotid stenosis.
4.  History of alcohol abuse.
5.  Acoustic neuroma.
6.  Benign prostatic hypertrophy.

MEDICATION ON ADMISSION: 1.  Atenolol 25 mg p.o.q.d.
2.  Zoloft 125 mg p.o.q.d.
3.  Vancomycin 1 gram IV q.d., dose only for a trough level
less than 20.  The patient was to receive this dose through
[**2180-8-14**].
4.  Flomax 0.4 mg p.o. q.d.
5.  Multivitamin one p.o.q.d.
6.  Reglan 10 mg p.o.q.i.d.
7.  Oxycodone 5 mg to 10 mg p.o.q.4h to 6h p.r.n. for pain in
the deltoid of his left calf.
8.  Protonix 40 mg p.o.q.d.

ALLERGIES: The patient is allergic to CEFTAZIDIME, which
causes anaphylaxis.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Unspecified disease of pericardium,Other disorders of muscle, ligament, and fascia,Atrial fibrillation,Congestive heart failure, unspecified,Acute myeloid leukemia, without mention of having achieved remission,Staphylococcal septicemia, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}
