CHIEF COMPLAINT: Esophageal Cancer

PRESENT ILLNESS: Mrs [**Known lastname **] is a 67-year-old woman with a T1 adenocarcinoma of the
GE junction.  She underwent endoscopic mucosal resection with a
positive deep margin and is being admitted for esophagectomy.

MEDICAL HISTORY: Esophageal cancer
atypical chest pain, status post cardiac catheterization;
Carotid Stenosis
Hypertension
Diabetes
Chronic low back pain, status post a significant fall in [**2162**],
down a flight of stairs, treated with steroid injections without
improvement
Glaucoma
Anxiety

MEDICATION ON ADMISSION: Metoprolol tartrate 25 mg [**Hospital1 **], lorazepam 1 mg tid, alphagan eye
drops, dorzolamide 2% twice a day, pantoprazole 40 mg [**Hospital1 **],
lisinopril 40 mg daily

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: T: 98.8  HR: 97 SR  BP: 134/80 Sats: 96% RA
General: sitting in chair no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple. no lymphadenopathy
Card: RRR normal S1,S2 no murmur/gallop or rub
Resp: faint crackles right 1/4 up, left clear
GI: bowel sounds positive abdomen soft.  J-tube site clean, no
erythema or discharge
Incision: right chest sites clean, margins well approximated no
discharge
Extre: right trace edema. bilateral lower extremities cool to
mid chin
Skin: multiple ecchymosis left side stable
Neuro: awake, alert

FAMILY HISTORY: Mother with AAA and no other cardiovascular
disease in the family.

SOCIAL HISTORY: Married, has two children and two grandchildren.  She formally
taught Latin and French in high school but is currently retired.
 She started smoking at the age
of 18 and continues to smoke approximately one pack to slightly
less per day.  The patient does not drink alcohol with any
regularity.
Malignant neoplasm of cardia,Pneumonia, organism unspecified,Unspecified pleural effusion,Barrett's esophagus,Chronic airway obstruction, not elsewhere classified,Unspecified hereditary and idiopathic peripheral neuropathy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Tobacco use disorder,Acute post-thoracotomy pain,Pain in joint, shoulder region
Mal neo stomach cardia,Pneumonia, organism NOS,Pleural effusion NOS,Barrett's esophagus,Chr airway obstruct NEC,Idio periph neurpthy NOS,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Tobacco use disorder,Acute post-thoracot pain,Joint pain-shlder
Admission Date:  [**2168-6-15**]              Discharge Date:   [**2168-6-23**]

Date of Birth:  [**2101-4-25**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Penicillins

Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Esophageal Cancer

Major Surgical or Invasive Procedure:
[**2168-6-15**]:
1. [**First Name9 (NamePattern2) 12351**] [**Doctor Last Name **] esophagectomy.
2. Buttressing of intrathoracic anastomosis with
   pericardial fat.
3. Thoracic lymphadenectomy.
4. Surgical jejunostomy.
5. Therapeutic bronchoscopy.
6. Esophagogastroduodenoscopy.
[**2168-6-19**]: right chest ultrasound


History of Present Illness:
Mrs [**Known lastname **] is a 67-year-old woman with a T1 adenocarcinoma of the
GE junction.  She underwent endoscopic mucosal resection with a
positive deep margin and is being admitted for esophagectomy.


Past Medical History:
Esophageal cancer
atypical chest pain, status post cardiac catheterization;
Carotid Stenosis
Hypertension
Diabetes
Chronic low back pain, status post a significant fall in [**2162**],
down a flight of stairs, treated with steroid injections without
improvement
Glaucoma
Anxiety

Past Surgical History:
hysterectomy; foot surgery; tonsils and adenoidectomy.


Social History:
Married, has two children and two grandchildren.  She formally
taught Latin and French in high school but is currently retired.
 She started smoking at the age
of 18 and continues to smoke approximately one pack to slightly
less per day.  The patient does not drink alcohol with any
regularity.


Family History:
Mother with AAA and no other cardiovascular
disease in the family.


Physical Exam:
VS: T: 98.8  HR: 97 SR  BP: 134/80 Sats: 96% RA
General: sitting in chair no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple. no lymphadenopathy
Card: RRR normal S1,S2 no murmur/gallop or rub
Resp: faint crackles right 1/4 up, left clear
GI: bowel sounds positive abdomen soft.  J-tube site clean, no
erythema or discharge
Incision: right chest sites clean, margins well approximated no
discharge
Extre: right trace edema. bilateral lower extremities cool to
mid chin
Skin: multiple ecchymosis left side stable
Neuro: awake, alert

Pertinent Results:
[**2168-6-21**] WBC-7.2 RBC-3.43* Hgb-10.0* Hct-31.0 Plt Ct-250
[**2168-6-20**] WBC-10.4 RBC-3.46* Hgb-10.4* Hct-30.9 Plt Ct-200
[**2168-6-15**] WBC-8.9 RBC-3.76*# Hgb-11.4*# Hct-34.0 Plt Ct-157
[**2168-6-21**] Glucose-145* UreaN-16 Creat-0.5 Na-141 K-3.7 Cl-105
HCO3-26
[**2168-6-19**] Glucose-144* UreaN-14 Creat-0.5 Na-135 K-4.1 Cl-103
HCO3-22
[**2168-6-16**] Glucose-133* UreaN-22* Creat-0.6 Na-138 K-3.8 Cl-104
HCO3-25
[**2168-6-21**] Calcium-8.0* Phos-4.1 Mg-2.1

CXR:
[**2168-6-21**]: PA and lateral chest views were obtained with patient
in upright
position. Comparison is made with the next preceding AP single
chest view
obtained seven hours earlier during the same day. During the
interval, the
right-sided chest tube has been removed. No pneumothorax is
identified in the apical area on either side. Rounded vascular
appearance on the right lung base with some plate atelectasis is
still present, similar to the preceding findings. The lateral
view discloses small amounts of pleural effusion in both
posterior pleural sinuses.
[**2168-6-20**]: Bibasilar opacification is consistent with atelectasis
and effusion. Again, more patchy area of opacification at the
right base could represent a superimposed consolidation.  Right
chest tube remains in place and there is no evidence of
pneumothorax.  Again there is mild indistinctness of pulmonary
vessels that would be consistent with some elevated pulmonary
venous pressure

Esophagus: [**2168-6-21**]: Thin barium was administered. The patient
drank
thin barium contrast without difficulty. Contrast passes freely
through the esophagus and esophageal anastomosis through the
stomach, without hold up or obstruction. The esophagogastric
anastomosis is widely patent with no evidence of leak. There is
no definite evidence of ectopic gas, but note is made of
limitation of gas evaluation in this study. Contrast is noted in
loops of small bowel. Mediastinal drains are noted.

[**2168-6-18**]: Chest and abdomen CT
IMPRESSION:
1. Status post minimally invasive esophagectomy and surgical
changes in the area. Suboptimal evaluation for leak at the
primary anastomosis due to lack of oral contrast. No obvious
fluid collection adjacent to the primary
anastomosis is seen.
2. Bilateral pleural effusions and adjacent opacities at the
lung bases could be atelectasis; however, hypodensities seen at
the right lung base within the area of consolidation could
suggest superinfection. Ground-glass opacities in the upper
lobes, could be due to infectious or inflammatory etiology.
3. Focal nodular opacity in the right upper lobe about a
centimeter, could be infectious and attention should be paid on
the next followup. Six month
follow-up CT is recommended for surveillance.
4. Non-specific foci of air in the mediastinum could be
post-surgical.
5. No evidence of pulmonary emboli.
6. Fatty liver, with large focal area of fatty sparing in the
left liver
lobe. Subcentimeter hypodensity in the liver, not completely
characterized on the current scan, could be small cyst.
7. Prominent left adrenal gland, similar compared to prior.
8. Partial loss of vertebral body height of T12, of
indeterminate age.
9. No evidence of reflux of oral contrast from J-tube into the
esophagus.
If continuous clinical concern for leak, barium swallow study
can be done when felt as clinically appropriate to evaluate
further.



Brief Hospital Course:
Mrs. [**Known lastname **] was admitted following her successful Laparoscopic
[**First Name9 (NamePattern2) **] [**Doctor Last Name **] Minimally Invasive Esophagectomy with laparoscopic
feeding jejunostomy placement.  Following the procedure she was
transferred to the ICU intubated overnight on CPAP, PS12 PEEP 5,
FIO2 50% with oxygen saturations of 100%. On POD 1 she was
extubated with oxygen saturations of 92-94% on nasal cannula.
She was transferred to the floor on [**2168-6-17**] but was readmitted
on [**2168-6-18**] for shortness of breath and increased work of
breathing.  Her chest film showed small effusion, atlectasis.
Chest CT showed no anastomic leak, possible pulmonary infection
versus inflammation. Interventional pulmonary was consulted for
possible pleural effusion drainage but on ultrasound fluid
collection was to small to drain.  With aggressive pulmonary
toilet, nebs, anxiolytics, her respiratory status improved and
she transferred back to the floor on [**2168-6-19**].

Respiratory:  aggressive pulmonary toilet, mucolytic nebs,
incentive spiratometer and ambulation she titrated off
supplemental oxygen on POD6 with oxygen saturations of 95-97% on
room air.

Drains and tubes: NGT tube was flushed to maintain patency and
removed on POD3
Anastomose JP drain and Right chest tube were removed on
[**2168-6-21**] once esophagus study was negative for leak.

GI: bowel function slowly returned.

Nutrition: nutrition was consulted recommended Replete full
strength started at 20 mL/hr POD and titrated to her Goal of 80
mL over 18 hrs.  Esophagus study was done on [**2168-6-21**] which
showed no leak.  She was started on a full liquid diet and can
increased to soft solid as tolerates.

Renal: Excellent urine output with normal renal function.  The
Foley was removed and she voided.  Electrolytes were replete as
needed.

ID: On [**2168-6-18**] her WBC increased to 15 and was started on Cipro
and Vancomycin for possible anastomic leak  or RUL infection.
Her WBC normalized and she was discharged on Cipro to complete
10 day course.

Skin: multiple ecchymotic sites stable.

Pain: Epidural Bupivacaine/Dilaudid was titrate to good pain
control by the acute pain service.  On [**2168-6-20**] this was removed
and she was converted to Roxicet via J-tube with good pain
control.

Neuro: Long standing history of anxiety/depression.  While in
the SICU she became very anxious and her Ativan was slowly
restarted.  Over the course of her hospitalization her mental
status improved, although has short-term memory loss, anxiety
lessened and she return to her baseline.

Disposition: She was followd by physical therapy.  She continued
to make steady progress and was discharged to Villla Crest,
[**Location (un) 5450**], NH [**Telephone/Fax (1) 86757**] on [**2168-6-23**].


Medications on Admission:
Metoprolol tartrate 25 mg [**Hospital1 **], lorazepam 1 mg tid, alphagan eye
drops, dorzolamide 2% twice a day, pantoprazole 40 mg [**Hospital1 **],
lisinopril 40 mg daily

Discharge Medications:
1. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution Sig: 5-10 MLs
PO Q4H (every 4 hours) as needed for pain.
2. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
3. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO every [**5-24**]
hours as needed for anxiety.
4. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H
(every 12 hours) for 5 days.
5. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for
Nebulization Sig: Three (3) mL Inhalation Q6H (every 6 hours) as
needed for shortness of breath or wheezing.
6. Acetaminophen 650 mg/20.3 mL Solution Sig: Twenty (20) mL PO
Q6H (every 6 hours).
7. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 puffs Inhalation every six (6) hours as needed for shortness
of breath or wheezing.
8. Alphagan P 0.1 % Drops Sig: One (1) drop Ophthalmic twice a
day: Both eyes.
9. Dorzolamide 2 % Drops Sig: One (1) drop Ophthalmic twice a
day.
10. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO twice a day.
11. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day): hold SBP < 110.


Discharge Disposition:
Extended Care

Facility:
[**Doctor Last Name **] crest

Discharge Diagnosis:
Esophageal cancer
atypical chest pain, status post cardiac catheterization;
Carotid Stenosis
Hypertension
Diabetes
Chronic low back pain, status post a significant fall in [**2162**],
down a flight of stairs, treated with steroid injections without
improvement
Glaucoma
Anxiety

Past Surgical History:
hysterectomy; foot surgery; tonsils and adenoidectomy.


Discharge Condition:
Awake, alert,
Ambulates with assistance


Discharge Instructions:
Call Dr.[**Name (NI) 5067**] office [**Telephone/Fax (1) 2348**] if you experience:
-If your feeding tube falls out or clogs
-NOTHING down J-tube unless it is in LIQUID FORM

Followup Instructions:
Follow-up with Dr. [**First Name (STitle) **] [**0-0-**] Date/Time:[**2168-7-5**] 9:30
on the [**Hospital Ward Name 516**] [**Hospital Ward Name 23**] Clinical Center [**Location (un) 24**].
Chest X-Ray [**Location (un) **] Radiology 30 minutes before your
appointment



Completed by:[**2168-6-24**]
{"Malignant neoplasm of cardia,Pneumonia, organism unspecified,Unspecified pleural effusion,Barrett's esophagus,Chronic airway obstruction, not elsewhere classified,Unspecified hereditary and idiopathic peripheral neuropathy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Tobacco use disorder,Acute post-thoracotomy pain,Pain in joint, shoulder region"}


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: Esophageal Cancer

PRESENT ILLNESS: Mrs [**Known lastname **] is a 67-year-old woman with a T1 adenocarcinoma of the
GE junction.  She underwent endoscopic mucosal resection with a
positive deep margin and is being admitted for esophagectomy.

MEDICAL HISTORY: Esophageal cancer
atypical chest pain, status post cardiac catheterization;
Carotid Stenosis
Hypertension
Diabetes
Chronic low back pain, status post a significant fall in [**2162**],
down a flight of stairs, treated with steroid injections without
improvement
Glaucoma
Anxiety

MEDICATION ON ADMISSION: Metoprolol tartrate 25 mg [**Hospital1 **], lorazepam 1 mg tid, alphagan eye
drops, dorzolamide 2% twice a day, pantoprazole 40 mg [**Hospital1 **],
lisinopril 40 mg daily

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: T: 98.8  HR: 97 SR  BP: 134/80 Sats: 96% RA
General: sitting in chair no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple. no lymphadenopathy
Card: RRR normal S1,S2 no murmur/gallop or rub
Resp: faint crackles right 1/4 up, left clear
GI: bowel sounds positive abdomen soft.  J-tube site clean, no
erythema or discharge
Incision: right chest sites clean, margins well approximated no
discharge
Extre: right trace edema. bilateral lower extremities cool to
mid chin
Skin: multiple ecchymosis left side stable
Neuro: awake, alert

FAMILY HISTORY: Mother with AAA and no other cardiovascular
disease in the family.

SOCIAL HISTORY: Married, has two children and two grandchildren.  She formally
taught Latin and French in high school but is currently retired.
 She started smoking at the age
of 18 and continues to smoke approximately one pack to slightly
less per day.  The patient does not drink alcohol with any
regularity. 

### Response:
{"Malignant neoplasm of cardia,Pneumonia, organism unspecified,Unspecified pleural effusion,Barrett's esophagus,Chronic airway obstruction, not elsewhere classified,Unspecified hereditary and idiopathic peripheral neuropathy,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Tobacco use disorder,Acute post-thoracotomy pain,Pain in joint, shoulder region"}
