CHIEF COMPLAINT: A history of Oligometastatic (brain) Hilarly located, Right
Upper Lobe Non-small Cell Lung Cancer s/p previous chemo/xrt now
presents for definitive surgical management of his primary lung
cancer

PRESENT ILLNESS: Mr. [**Known lastname **] is a 59yo M w/ a PMHx of HTN, CAD/MI ('[**06**]),
GERD/esophagitis who presented ~ 6 months prior to this
admission for work-up of a RUL lung cancer.  He was foound to
have a large, hilar based, non-small cell lung cancer of the
right upper lobe causing compression/obliteration of the
superior segment bronchus.  Metastatic work-up included PET
imaging and a brain MRI revealing a metastatic focus to his
brain that necessitated craniotomy and cyberknife therapy
(cyberknife was done to the surgical bed when it was thought
that he recurred).  Ultimately, he [**Year (2 digits) 1834**] a platinum based
neoadjuvant chemo/XRT regimen for his primary lung cancer and
serial CT imaging showed no evidence of disease progression.  A
pre-operative bronchoscopy w/ washings and mediastinoscopy still
showed that the disease was only locally advanced and a likely
Stage IIIa hilar based NSLC was opted for surgical therapy.  On
[**2112-1-1**], he was admitted for a Right Thoracotomy, Right Upper
Lobe Sleeve Resection with Primary Bronchoplasty and Intercostal
Muscle Flap.

MEDICAL HISTORY: NSCLC (oligometastatic to the brain)
Hypercholesterolemia
Coronary artery disease (MI in [**2106**] with sent placement)
No HTN, DM or COPD

MEDICATION ON ADMISSION: Keppra 500mg po BID, Toprol XL 50mg po QD, ambien 5mg po HS prn,
zyprexa 5mg po HS, aspirin (stopped pre-operatively), protonix
40mg po QD, Lipitor 20mg po QD, Flomax 0.4mg po QD

ALLERGIES: Tetracycline

PHYSICAL EXAM: VS: T= 98.1 HR= 72 (sinus) BP= 122/78 RR= 20 SpO2= 98%RA
HEENT- old healed craniotomy scar appreciated, no
cervical/supraclavicular adenopathy, no neck mass/bruit, neck
supple, OP (-)
Cor- Regular S1S2
Pulm- CTA bilaterally
Abd- soft, NT, ND, no HSM, no mass/hernia
Ext- no c/c/e/ct, 2+DP/PT bilaterally
Neuro- moves all extremities, normal strength/sensation
throughout, CNII-XII intact, DTRs normal

FAMILY HISTORY: Grandfather died of lung cancer (non-smoking related). Mother
died of myocardial infarction. Father died of brain cancer. He
has 3 brothers who are alive but a fourth died of complications
of hepatitis C. He does not have children.

SOCIAL HISTORY: He has financial concerns regarding cost of care.  He is
married. He lives with his wife. [**Name (NI) **] does not have any children.
He is a home broker. He reports smoking two packs of cigarettes
a day for 40 years and quiting two months ago. He currently
drinks about three to four drinks a week.  He does not have any
other exposures that he knows of.
Malignant neoplasm of upper lobe, bronchus or lung,Acute posthemorrhagic anemia,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux,Pure hypercholesterolemia,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction
Mal neo upper lobe lung,Ac posthemorrhag anemia,Atrial fibrillation,Crnry athrscl natve vssl,Hypertension NOS,Esophageal reflux,Pure hypercholesterolem,Status-post ptca,Old myocardial infarct
Admission Date:  [**2112-1-1**]              Discharge Date:   [**2112-1-6**]

Date of Birth:  [**2052-10-25**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Tetracycline

Attending:[**Last Name (NamePattern1) 1561**]
Chief Complaint:
A history of Oligometastatic (brain) Hilarly located, Right
Upper Lobe Non-small Cell Lung Cancer s/p previous chemo/xrt now
presents for definitive surgical management of his primary lung
cancer

Major Surgical or Invasive Procedure:
1- Flexible Bronchoscopy, Right Thoracotomy, Right Upper Lobe
Sleeve Resection, Primary Bronchoplasty, Intercostal Muscle Flap
([**2112-1-1**])


History of Present Illness:
Mr. [**Known lastname **] is a 59yo M w/ a PMHx of HTN, CAD/MI ('[**06**]),
GERD/esophagitis who presented ~ 6 months prior to this
admission for work-up of a RUL lung cancer.  He was foound to
have a large, hilar based, non-small cell lung cancer of the
right upper lobe causing compression/obliteration of the
superior segment bronchus.  Metastatic work-up included PET
imaging and a brain MRI revealing a metastatic focus to his
brain that necessitated craniotomy and cyberknife therapy
(cyberknife was done to the surgical bed when it was thought
that he recurred).  Ultimately, he [**Year (2 digits) 1834**] a platinum based
neoadjuvant chemo/XRT regimen for his primary lung cancer and
serial CT imaging showed no evidence of disease progression.  A
pre-operative bronchoscopy w/ washings and mediastinoscopy still
showed that the disease was only locally advanced and a likely
Stage IIIa hilar based NSLC was opted for surgical therapy.  On
[**2112-1-1**], he was admitted for a Right Thoracotomy, Right Upper
Lobe Sleeve Resection with Primary Bronchoplasty and Intercostal
Muscle Flap.

Past Medical History:
NSCLC (oligometastatic to the brain)
Hypercholesterolemia
Coronary artery disease (MI in [**2106**] with sent placement)
No HTN, DM or COPD

Past Oncolgic History: Diagnosed with NSCLC by transbronchial
biopsy on [**2111-6-4**].  Staging MRI revealed solitary brain
metastasis in the left frontal region for which he [**Date Range 1834**]
Cyberknife in mid-[**2111-8-4**].

Social History:
He has financial concerns regarding cost of care.  He is
married. He lives with his wife. [**Name (NI) **] does not have any children.
He is a home broker. He reports smoking two packs of cigarettes
a day for 40 years and quiting two months ago. He currently
drinks about three to four drinks a week.  He does not have any
other exposures that he knows of.


Family History:
Grandfather died of lung cancer (non-smoking related). Mother
died of myocardial infarction. Father died of brain cancer. He
has 3 brothers who are alive but a fourth died of complications
of hepatitis C. He does not have children.

Physical Exam:
VS: T= 98.1 HR= 72 (sinus) BP= 122/78 RR= 20 SpO2= 98%RA
HEENT- old healed craniotomy scar appreciated, no
cervical/supraclavicular adenopathy, no neck mass/bruit, neck
supple, OP (-)
Cor- Regular S1S2
Pulm- CTA bilaterally
Abd- soft, NT, ND, no HSM, no mass/hernia
Ext- no c/c/e/ct, 2+DP/PT bilaterally
Neuro- moves all extremities, normal strength/sensation
throughout, CNII-XII intact, DTRs normal

Pertinent Results:
[**2112-1-1**] 03:07PM   HGB-10.1* calcHCT-30 O2 SAT-96

Brief Hospital Course:
Mr. [**Known lastname **] [**Last Name (Titles) 1834**] a R-thoracotomy, RUL lobectomy w/ sleeve
resection, primary bronchoplasty and intercostal muscle flap
coverage.  The patient did well intraoperatively and was
resuscitated with 2 units of PRBCs (EBL ~ 600cc) as well as
several liters of isotonic crystalloid.  He was transferred to
the CSRU for further care after extubation in the OR.
Post-operatively, he had an epidural, foley, chest tubes x2 in
the r-hemithorax, an arterial line and peripheral IV access.

Neuro- his pain control was adequate with a thoracic epidural
which was ultimately removed on POD#4 and converted to an oral
regimen; he had no evidence of delerium/anxiety-NOS;
per-operative ambien/zyprexa were continued at his home doses.
Pulmonary- His chest tubes were removed on POD#3 with no
demonstration of air leak and outputs less than 150cc q24hr
interval.  Post-removal chest film demonstrated satisfactory
position of the lung with adeuate expansion, minimal effusion
and no real volume overload.  He was saturating well on room air
with ambulation prior to dismissal.
Cardiovascular- he developed Afib w/ a RVR ~ 36hrs
post-operatively necessitating ICU transfer and
neosynephrine/amiodarone supplementation.  He had no evidence of
coronary ischemia by ECG and his relative hypotension
experienced during the acute setting of the Afib was
asymptomatic.  Ultimately, he was transitioned to an oral
regimen of amiodarone and beta blockade and converted to sinus
rhythm.
FEN/GI- he was maintained on protonix for stress-ulcer
prophylaxis (he takes it chronically) and was able to tolerate a
regular, heart-healthy diet by POD#1.
GU/Renal- His BUN/Cr remained normal during his peri-operative
course and his foley was rmeoved on POD#4 after the thoracic
epidural was taken out.  He was maintained on his home dose of
flomax, as well.  He was diuresed for a number of days
post-operatively, however, he never significantly demonstrated a
weight gain post-operatively and he had no major
oxygenation/ventilation problems.
Endocrine- he was transiently given SSIR for peri-operative
glycemic control/prophylaxis
HEME/ID- he remained afebril with no outstanding infectious
disease issues during his post-operative convalescence.  He
received 2 additional doses of kefzol immediately
post-operatively and his surgical site incisions appeared C/D/I.
 His pre-operative Hct = 30, he was transfused 2 units
intraoperatively and a total of 2 untis were transfused for
Blood Loss Anemia during his 5 day post-operative course.


Medications on Admission:
Keppra 500mg po BID, Toprol XL 50mg po QD, ambien 5mg po HS prn,
zyprexa 5mg po HS, aspirin (stopped pre-operatively), protonix
40mg po QD, Lipitor 20mg po QD, Flomax 0.4mg po QD

Discharge Medications:
1. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed for PRN insomnia.
2. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q4-6H
(every 4 to 6 hours) as needed.
3. Tamsulosin 0.4 mg Capsule, Sust. Release 24HR Sig: One (1)
Capsule, Sust. Release 24HR PO HS (at bedtime).
4. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Olanzapine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): as long as you are taking narcotics; to avoid
constipation.
9. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
10. Metoprolol Succinate 50 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
11. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*2*
12. HYDROmorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3-4H (Every 3
to 4 Hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
13. Salmeterol 50 mcg/Dose Disk with Device Sig: One (1) Disk
with Device Inhalation Q12H (every 12 hours).
14. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig:
One (1) Cap Inhalation DAILY (Daily).


Discharge Disposition:
Home

Discharge Diagnosis:
1-Right Upper Lobe Oligometastatic Hilar Non-Small Cell Lung
cancer s/p R-thoracotomy, Right Upper Lobe Sleeve Resection with
Primary Bronchoplasty and Intercostal Muscle Flap ([**2112-1-1**])
2- Post-operative atrial fibrillation (with Rapid Ventricular
Response)
3- Hypertension (controlled)
4- Coronary artery disease/myocardial infarction (remote,
controlled)
5- GERD/Esophagitis (remote)


Discharge Condition:
Stable, afebrile, adequate analgesia with oral medications,
wounds healing well, in normal sinus rhythm


Discharge Instructions:
You may resume your home medications as previously instructed.
Please use the list from the hospital to determine how and [**Last Name (un) 4050**]
to take your medications for the first few weeks after surgery
(there may be some new medications that you take for a
short-interval after your operation to help with controlling
your heart rhythm).  No heavy lifting, swinging or exertion for
3-4 weeks.  You should take walks (3-4 per day for 15-20 minute
intervals) You may shower and pat the wound dry with a towel but
no swimming, bath tub, whilrpool for 2-3 weeks.  You should call
the office if you experience any new redness, drainage,
swelling, pain, shortness of breath, difficulty breathing, fever
> 101F, shaking chills or productive cough.

Followup Instructions:
Please call the clinic to confirm your appointment; you should
return in [**1-5**] weeks post-operatively and have a chest xray on
the same day prior to seeing Dr. [**Last Name (STitle) 952**].
{'Malignant neoplasm of upper lobe, bronchus or lung,Acute posthemorrhagic anemia,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux,Pure hypercholesterolemia,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction'}


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: A history of Oligometastatic (brain) Hilarly located, Right
Upper Lobe Non-small Cell Lung Cancer s/p previous chemo/xrt now
presents for definitive surgical management of his primary lung
cancer

PRESENT ILLNESS: Mr. [**Known lastname **] is a 59yo M w/ a PMHx of HTN, CAD/MI ('[**06**]),
GERD/esophagitis who presented ~ 6 months prior to this
admission for work-up of a RUL lung cancer.  He was foound to
have a large, hilar based, non-small cell lung cancer of the
right upper lobe causing compression/obliteration of the
superior segment bronchus.  Metastatic work-up included PET
imaging and a brain MRI revealing a metastatic focus to his
brain that necessitated craniotomy and cyberknife therapy
(cyberknife was done to the surgical bed when it was thought
that he recurred).  Ultimately, he [**Year (2 digits) 1834**] a platinum based
neoadjuvant chemo/XRT regimen for his primary lung cancer and
serial CT imaging showed no evidence of disease progression.  A
pre-operative bronchoscopy w/ washings and mediastinoscopy still
showed that the disease was only locally advanced and a likely
Stage IIIa hilar based NSLC was opted for surgical therapy.  On
[**2112-1-1**], he was admitted for a Right Thoracotomy, Right Upper
Lobe Sleeve Resection with Primary Bronchoplasty and Intercostal
Muscle Flap.

MEDICAL HISTORY: NSCLC (oligometastatic to the brain)
Hypercholesterolemia
Coronary artery disease (MI in [**2106**] with sent placement)
No HTN, DM or COPD

MEDICATION ON ADMISSION: Keppra 500mg po BID, Toprol XL 50mg po QD, ambien 5mg po HS prn,
zyprexa 5mg po HS, aspirin (stopped pre-operatively), protonix
40mg po QD, Lipitor 20mg po QD, Flomax 0.4mg po QD

ALLERGIES: Tetracycline

PHYSICAL EXAM: VS: T= 98.1 HR= 72 (sinus) BP= 122/78 RR= 20 SpO2= 98%RA
HEENT- old healed craniotomy scar appreciated, no
cervical/supraclavicular adenopathy, no neck mass/bruit, neck
supple, OP (-)
Cor- Regular S1S2
Pulm- CTA bilaterally
Abd- soft, NT, ND, no HSM, no mass/hernia
Ext- no c/c/e/ct, 2+DP/PT bilaterally
Neuro- moves all extremities, normal strength/sensation
throughout, CNII-XII intact, DTRs normal

FAMILY HISTORY: Grandfather died of lung cancer (non-smoking related). Mother
died of myocardial infarction. Father died of brain cancer. He
has 3 brothers who are alive but a fourth died of complications
of hepatitis C. He does not have children.

SOCIAL HISTORY: He has financial concerns regarding cost of care.  He is
married. He lives with his wife. [**Name (NI) **] does not have any children.
He is a home broker. He reports smoking two packs of cigarettes
a day for 40 years and quiting two months ago. He currently
drinks about three to four drinks a week.  He does not have any
other exposures that he knows of. 

### Response:
{'Malignant neoplasm of upper lobe, bronchus or lung,Acute posthemorrhagic anemia,Atrial fibrillation,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Esophageal reflux,Pure hypercholesterolemia,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction'}
