CHIEF COMPLAINT: MUD AlloHSCT

PRESENT ILLNESS: Mr. [**Known lastname **] is a 67-year-old man with trasnufsion dependent
myelodysplastic disorder, normal pressure hydrocephalus, DM,
CAD, HTN who is electively admitted for Allo SCT.
.
He was last seen in clinic [**5-30**] w Dr. [**Last Name (STitle) 410**] for preadmission
testing prior to planned admission today for a non-myeloablative
matched unrelated donor transplant for his MDS that is
associated with pancytopenia and transfusion dependence of both
red cells and platelets. Last transfusion [**5-28**]. Due to multiple
transfusions, he has develoepd Fe overload, and has been on
chelation therapy with deferasirox. He is admitted for protocol
driven reduced intensity MUD allo. The conditioning is to
inlcude clofarabine, total nodal radiation and ATG. The donor
match is 9/10 per Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] progress note.
.
Per Dr.[**Name (NI) 3588**] clinic evaluation on [**5-23**] this pt has an
absolute neutropenia. [**10/2164**] he was admitted to the ICU with
CAP/neutropenic fevers based upon chest imaging findings and
ROS. He was treated with vancomycin, cefepime and ciprofloxacin,
no pathogen was isolated. During that hospitalization, he was
diagnosed with HSV 1 outbreak on his neck (no lesions in his
mouth or periorally), and was also diagnosed with insulin
dependent DM-2.
.
On the floor, he complains of ongoing seasonal allergies with
dry dcough and watery eyes. Cough is non-productive. He has not
noted any fevers at home. Denies dyspnea on exertion, shortness
of breath, PND, or orthopnea. He has no sore throat or ear pain.
He has had one episode of diarrhea in the last day which is
typical following Exgade.

MEDICAL HISTORY: Past Medical History:
-CAD, s/p ant MI [**2139**], with hx LCX, LAD and RCA stenosis seen on
cardiac CT 2/[**2164**]. Never had stents or angioplasty.
- [**4-/2165**] EF 55%; cardiology cleared for transplant
-Angina - once weekly depending on anemia and stress levels
normally lasting 10-15 mins and resolves with nitro. Describes
as a squeezing central/left chest pain with no radiation usually
but can rarely will rarely feel in these locations. No
nausea/vomiting or sweating.
-NPH: s/p VP shunt placement [**11/2164**] w resolution of sx
-PVD
-Diabetes Mellitus
-BPH on flomax
-OSA on CPAP with morbid obesity
-History of possible TIA [**2162**] ? CVA - had resolution of eye
position -abnormalities over a few days
-Hypertension
-Hypercholesterolemia
-Asthma, cold-induced, not using inhalers at home
-s/p ruptured appendix 20yrs ago
-s/p right carotid endarterectomy several years ago
-HSV-1 [**10/2165**]
.
Hematologic Hx
Longstanding history of myelodysplastic disorder associated with
severe pancytopenia, now red cell and platelet transfusion
requiring. Initially diagnosed [**2160-1-30**] when his primary
care physician, [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], obtained a complete blood
countas a part of routine maintenance physical examination. At
that time he had anemia, a low platelet count, and a borderline
low white blood count. He was treated briefly with azacitidine
(Vidaza) with 4 cycles in [**State 108**] but his disease did not
stabilize. He has been getting PRBC's and platelet tranfusions,
as well as iron chelation with deferasirox (Exjade).

MEDICATION ON ADMISSION: BISOPROLOL FUMARATE - 10 mg Tablet [**Hospital1 **]
ESOMEPRAZOLE MAGNESIUM [NEXIUM] - 40 mg Capsule daily
FOLIC ACID - 1 mg Tablet - 1 Tablet(s) by mouth once a day
INSULIN GLARGINE [LANTUS] - 100 unit/mL Solution - 28 units
Solution(s) at bedtime
INSULIN LISPRO [HUMALOG] - 100 unit/mL Sliding scale
ISOSORBIDE DINITRATE - 40mg TID
LISINOPRIL - 20 mg Tablet
NITROGLYCERIN - 0.4 mg Tablet, Sublingual PRN chest pain
OXYBUTYNIN CHLORIDE 5 mg Tablet - 1 Tablet(s) by mouth HS (at
bedtime)
PRAVASTATIN - 40 mg Tablet QPM
TAMSULOSIN [FLOMAX] - 0.4 mg daily.
Medications - OTC
CHOLECALCIFEROL (VITAMIN D3) [VITAMIN D-3] 400 unit Tablet Daily
CYANOCOBALAMIN (VITAMIN B-12) 1,000 mcg Tablet daily
MULTIVITAMIN - 1 Tablet
PYRIDOXINE - 100 mg daily
Zyrtec 1 tab daily

ALLERGIES: Ampicillin / peanuts

PHYSICAL EXAM: Vitals: T98.5 BP110/58 P:60 RR:18 Sa02 99RA
General: caucasian male appering comfortable and in NAD
HEENT: Right sided VP shunt in place. Sclera anicteric, MMM, two
small areas of petichae on left buccal mucosa
Neck: Well healed right CEA scar. Supple, no LAD.
Lungs: CTABL, no wheezes, no rales or ronchi
CV: Regular rhythm, normal S1 + S2, no MRG
Abdomen: Midline abdominal scar well healed. bowel sounds
normoactive no guarding, no rebound
Ext: L>R lower extremity edema to mid calf.
CN exam - II-XII normal, normal cerebellar function with FTS and
HTS intact.

FAMILY HISTORY: Father died of melanoma
Mother died of coronary artery disease, and hypercholesterolemia
also had a AAA repair
Sister who had coronary artery disease and underwent a 4-vessel
CABG.
Daughter is alive and healthy.

SOCIAL HISTORY: Lives with wife in house with 13 stairs
Able to walk to the car and can walk [**12-30**] block limited withlow
back pain.
He previously worked as a computer programmer and retired.
Ex-smoker quit 20 years ago previously 3 packs per day for 25
years.
Alcohol -he has not had any ETOH in 2 weeks, typically drinks 2
drinks per week. He does not use illicit drugs
No recent foreign travel
Pets - 1 dog and 2 cats
Myelodysplastic syndrome, unspecified,Defibrination syndrome,Acute respiratory failure,Toxic encephalopathy,Pneumonia in aspergillosis,Acute and subacute necrosis of liver,Idiopathic normal pressure hydrocephalus (INPH),Acute kidney failure, unspecified,Blood in stool,Acidosis,Urinary tract infection, site not specified,Drug-induced delirium,Aspergillosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Anemia in neoplastic disease,Presence of cerebrospinal fluid drainage device,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Hemochromatosis due to repeated red blood cell transfusions,Atherosclerosis of native arteries of the extremities, unspecified,Obstructive sleep apnea (adult)(pediatric),Morbid obesity,Pure hypercholesterolemia,Family history of other specified malignant neoplasm,Drug induced neutropenia,Fever presenting with conditions classified elsewhere,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Diarrhea,Other specified disorders resulting from impaired renal function,Accidents occurring in residential institution,Hypoxemia,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Contact dermatitis and other eczema, unspecified cause,Other specified disorders of skin,Unspecified disease of sebaceous glands,Other iatrogenic hypotension,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Cardiogenic shock
Myelodysplastic synd NOS,Defibrination syndrome,Acute respiratry failure,Toxic encephalopathy,Pneum in aspergillosis,Acute necrosis of liver,Norml pressure hydroceph,Acute kidney failure NOS,Blood in stool,Acidosis,Urin tract infection NOS,Drug-induced delirium,Aspergillosis,Hyp kid NOS w cr kid V,Anemia in neoplastic dis,Ventricular shunt status,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl,Angina pectoris NEC/NOS,Hemochromatos-rbc trans,Athscl extrm ntv art NOS,Obstructive sleep apnea,Morbid obesity,Pure hypercholesterolem,Family hx-malignancy NEC,Drug induced neutropenia,Fever in other diseases,Adv eff antineoplastic,Diarrhea,Impair ren funct dis NEC,Accid in resident instit,Hypoxemia,Elev transaminase/ldh,Dermatitis NOS,Skin disorders NEC,Sebaceous gland dis NOS,Iatrogenc hypotnsion NEC,Abn react-renal dialysis,Cardiogenic shock
Admission Date:  [**2165-6-3**]              Discharge Date:   [**2165-6-24**]

Date of Birth:  [**2098-4-23**]             Sex:   M

Service: MEDICINE

Allergies:
Ampicillin / peanuts

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
MUD AlloHSCT

Major Surgical or Invasive Procedure:
- MUD AlloHSCT
- VP shunt tap
- Bronchoscopy


History of Present Illness:
Mr. [**Known lastname **] is a 67-year-old man with trasnufsion dependent
myelodysplastic disorder, normal pressure hydrocephalus, DM,
CAD, HTN who is electively admitted for Allo SCT.
.
He was last seen in clinic [**5-30**] w Dr. [**Last Name (STitle) 410**] for preadmission
testing prior to planned admission today for a non-myeloablative
matched unrelated donor transplant for his MDS that is
associated with pancytopenia and transfusion dependence of both
red cells and platelets. Last transfusion [**5-28**]. Due to multiple
transfusions, he has develoepd Fe overload, and has been on
chelation therapy with deferasirox. He is admitted for protocol
driven reduced intensity MUD allo. The conditioning is to
inlcude clofarabine, total nodal radiation and ATG. The donor
match is 9/10 per Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] progress note.
.
Per Dr.[**Name (NI) 3588**] clinic evaluation on [**5-23**] this pt has an
absolute neutropenia. [**10/2164**] he was admitted to the ICU with
CAP/neutropenic fevers based upon chest imaging findings and
ROS. He was treated with vancomycin, cefepime and ciprofloxacin,
no pathogen was isolated. During that hospitalization, he was
diagnosed with HSV 1 outbreak on his neck (no lesions in his
mouth or periorally), and was also diagnosed with insulin
dependent DM-2.
.
On the floor, he complains of ongoing seasonal allergies with
dry dcough and watery eyes. Cough is non-productive. He has not
noted any fevers at home. Denies dyspnea on exertion, shortness
of breath, PND, or orthopnea. He has no sore throat or ear pain.
He has had one episode of diarrhea in the last day which is
typical following Exgade.

Past Medical History:
Past Medical History:
-CAD, s/p ant MI [**2139**], with hx LCX, LAD and RCA stenosis seen on
cardiac CT 2/[**2164**]. Never had stents or angioplasty.
- [**4-/2165**] EF 55%; cardiology cleared for transplant
-Angina - once weekly depending on anemia and stress levels
normally lasting 10-15 mins and resolves with nitro. Describes
as a squeezing central/left chest pain with no radiation usually
but can rarely will rarely feel in these locations. No
nausea/vomiting or sweating.
-NPH: s/p VP shunt placement [**11/2164**] w resolution of sx
-PVD
-Diabetes Mellitus
-BPH on flomax
-OSA on CPAP with morbid obesity
-History of possible TIA [**2162**] ? CVA - had resolution of eye
position -abnormalities over a few days
-Hypertension
-Hypercholesterolemia
-Asthma, cold-induced, not using inhalers at home
-s/p ruptured appendix 20yrs ago
-s/p right carotid endarterectomy several years ago
-HSV-1 [**10/2165**]
.
Hematologic Hx
Longstanding history of myelodysplastic disorder associated with
severe pancytopenia, now red cell and platelet transfusion
requiring. Initially diagnosed [**2160-1-30**] when his primary
care physician, [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], obtained a complete blood
countas a part of routine maintenance physical examination. At
that time he had anemia, a low platelet count, and a borderline
low white blood count. He was treated briefly with azacitidine
(Vidaza) with 4 cycles in [**State 108**] but his disease did not
stabilize. He has been getting PRBC's and platelet tranfusions,
as well as iron chelation with deferasirox (Exjade).

Social History:
Lives with wife in house with 13 stairs
Able to walk to the car and can walk [**12-30**] block limited withlow
back pain.
He previously worked as a computer programmer and retired.
Ex-smoker quit 20 years ago previously 3 packs per day for 25
years.
Alcohol -he has not had any ETOH in 2 weeks, typically drinks 2
drinks per week. He does not use illicit drugs
No recent foreign travel
Pets - 1 dog and 2 cats

Family History:
Father died of melanoma
Mother died of coronary artery disease, and hypercholesterolemia
also had a AAA repair
Sister who had coronary artery disease and underwent a 4-vessel
CABG.
Daughter is alive and healthy.

Physical Exam:
Vitals: T98.5 BP110/58 P:60 RR:18 Sa02 99RA
General: caucasian male appering comfortable and in NAD
HEENT: Right sided VP shunt in place. Sclera anicteric, MMM, two
small areas of petichae on left buccal mucosa
Neck: Well healed right CEA scar. Supple, no LAD.
Lungs: CTABL, no wheezes, no rales or ronchi
CV: Regular rhythm, normal S1 + S2, no MRG
Abdomen: Midline abdominal scar well healed. bowel sounds
normoactive no guarding, no rebound
Ext: L>R lower extremity edema to mid calf.
CN exam - II-XII normal, normal cerebellar function with FTS and
HTS intact.

Pertinent Results:
ADMISSION LABS
===============
[**2165-6-3**] 09:05AM BLOOD WBC-1.3* RBC-2.90* Hgb-8.9* Hct-23.9*
MCV-82 MCH-30.6 MCHC-37.3* RDW-13.1 Plt Ct-24*#
[**2165-6-3**] 09:05AM BLOOD Neuts-15* Bands-0 Lymphs-75* Monos-7
Eos-0 Baso-0 Atyps-3* Metas-0 Myelos-0
[**2165-6-3**] 09:05AM BLOOD PT-12.0 PTT-25.4 INR(PT)-1.0
[**2165-6-3**] 09:05AM BLOOD UreaN-23* Creat-1.1 Na-139 K-4.6 Cl-103
HCO3-27 AnGap-14
[**2165-6-3**] 09:05AM BLOOD ALT-23 AST-18 LD(LDH)-131 AlkPhos-86
TotBili-0.8 DirBili-0.2 IndBili-0.6
[**2165-6-3**] 09:05AM BLOOD TotProt-7.2 Albumin-4.8 Globuln-2.4
Calcium-10.3 Phos-3.8 Mg-2.2 UricAcd-4.7

MICRO
=====
- Multiple blood cultures (including mycolytic) and BAL cultures
pending at the time of death.

IMAGES
======
Head CT [**2165-6-13**]
NON-CONTRAST HEAD CT: There is no intracranial hemorrhage,
parenchymal edema, or mass effect. A right frontal approach
ventriculoperitoneal shunt catheter is again identified, in
unchanged position, with tip traversing the septum pellucidum
and terminating in the left lateral ventricle. The ventricles
are again symmetrically prominent, not changed in size from
prior studies. There is no shift of midline structures, and
there is no effacement of the basal cisterns. There is no CT
evidence of territorial infarct. Osseous structures remain
unremarkable, and the visualized paranasal sinuses and mastoids
are clear. Cavernous carotid calcifications are noted.
.
Renal Ultrasound [**2165-6-13**]
No hydronephrosis or other findings to explain acute renal
failure.
.
CT chest [**2165-6-16**]
1. Multifocal pneumonia which may be bacterial or fungal, with
vasculitis a less likely consideration.
2. Left adrenal nodule, stable compared with 10/10.
3. Right renal stone, uncomplicated.
4. Diverticulosis.
.
Abdominal ultrasound [**2165-6-18**]
1. Normal abdominal ultrasound without gallbladder or biliary
pathology.
2. Echogenic focus in the interpolar region of right kidney
likely represents milk of calcium though a nonobstructing renal
calculi is a possibility.
.
MRI head w/o contrast [**2165-6-18**]
1. High signal on FLAIR images within the cerebral sulci may be
secondary to recent lumbar puncture, although infectious
leptomeningitis cannot be excluded by imaging. High signal on
FLAIR images within the dura may be related to the recent lumbar
puncture or the VPS, but infectious pachymeningitis cannot be
excluded by imaging. Correlation with CSF analyses is
recommended.
2. No evidence for cerebritis or PRES.
3. Stable moderate ventriculomegaly. Stable VPS tip position.
4. Bilateral small superior parietal subdural collections, right
greater than left, similar to [**2165-6-13**] but new since [**2164-12-25**].
They may represent hygromas secondary to the VPS. However,
chronic subdural hematomas cannot be excluded.
.
CT Torso [**2165-6-22**]
IMPRESSION: 1. Coalescent consolidation of previous multifocal
nodular opacities within the lungs. Innumerable bilateral
submillimeter nodules with ground-glass attenuation distributed
throughout both lungs with relative sparing of the periphery.
Overall findings are concerning for semi-invasive pulmonary
aspergillosis. No cavitation noted within these coalescent areas
of consolidation. Findings in the chest have progressed
significantly since prior imaging. 2. Indeterminate left adrenal
gland lesion. Further characterization with MR recommended. 3.
Non-obstructing 4-mm right renal calculus. No intra-abdominal
collection identified.

Echo [**2165-6-23**]
Due to suboptimal technical quality, a focal wall motion
abnormality cannot be fully excluded. Overall left ventricular
systolic function is severely depressed (LVEF= 20-25 %). The
right ventricular cavity is moderately dilated with global free
wall hypokinesis. Mild (1+) mitral regurgitation is seen. There
is a very small pericardial effusion. There is an anterior space
which most likely represents a prominent fat pad. Compared to
the findings of the prior study of [**2165-5-16**], left and right
ventricular systolic function have deteriorated significantly.

Brief Hospital Course:
66 year old M with transfusion dependent MDS, D+7 s/p allo SCT,
normal pressure hydrocephalus, CAD, HTN and diabetes, who was
initially electively admitted for allo SCT with clofarabine,
total nodal radiation and anti-thymoglobulin. His course was
complicated by febrile neutropenia and renal failure.

His creatinine was 1.1 on admission and rose to > 5 following
administration of clofarabine per SCT protocol. He developed
metabolic acidosis and worsening confusion over the course of
several days leading up to his transplant. On SCT day +1, he was
febrile and started on vancomycin and cefepime. On SCT day +3,
he was transferred to ICU for worsening mental status, increased
respiratory distress, and renal failure. He remained febrile and
was seen by the ID consult team and transitioned to meropenem +
levofloxacin + voriconazole. He was intubated electively for
multiple procedures including MRI, VP shunt tap (by
neurosurgery), and bronchoscopy and extubated the following day.
He was started on ambisome in place of voriconazole for positive
galactomannan on BAL (presumed aspergillosis pneumonia). He was
seen by the neprhology team and started on HD for presumed
clofarabine toxicity. Mental status improved and he was called
out to the BMT service.

However, two days later he was at dialysis when he developed an
episode of altered mental status associated with tachycardia,
hypertension and hypoxia to 88% on 2L NC. His respiratory status
continued to decline and he was reintubated and transferred to
the ICU. In addition, he became hypotensive requiring pressors
for a few hours; pressors were eventually weaned off, although
he then developed shock liver and probable DIC requiring
multiple transfusions. Due to electrolyte derangements CVVH was
started as well.  His abx were broadened to double cover
aspergillus (posaconazole+ambisome), vanc was changed to dapto
for VRE coverage, bactrim was added for PCP [**Name Initial (PRE) 21150**].

At approximately 3:12 AM on [**2165-6-24**], housestaff were called to
evaluate the patient after his nurse noticed his A-line pressure
[**Location (un) 1131**] dropped abruptly to SBP in the 10s-20s. On evaluation,
he was unresponsive and did not have palpable pulses. At that
time, back board was placed beneath patient and CPR was
initiated. Pulseless electrical activity was noted on the
monitor at interval 2-minute pulse checks (no shockable rhythm).
He received epinephrine 1 mg IV x 2 doses at five minutes apart.
 Housestaff notified the patient's wife, who requested that the
resuscitation be stopped. At this time, CPR was stopped and he
did not receive further vasopressors.  He did not regain a
pulse. The monitor continued to show pulseless electrical
activity for several minutes with slowing heart rate until
asystole. At that time, the patient was examined and was noted
to have no audible breath or heart sounds. His pupils were fixed
and dilated to ~5mm. There were not signs of life evident. The
time of death was noted to be 3:23 AM.  Attending physician [**Last Name (NamePattern4) **].
[**First Name (STitle) **] was notified of the above events. The patient's wife was
then contact[**Name (NI) **] regarding an autopsy and agreed to autopsy.

# Access: portacath, subclavian CVL
# Communication: Patient, Wife [**Name (NI) **] [**Name (NI) **] [**Telephone/Fax (1) 30638**] and
daughter [**Name (NI) **]
# [**Name2 (NI) 7092**]: FULL CODE

Medications on Admission:
BISOPROLOL FUMARATE - 10 mg Tablet [**Hospital1 **]
ESOMEPRAZOLE MAGNESIUM [NEXIUM] - 40 mg Capsule daily
FOLIC ACID - 1 mg Tablet - 1 Tablet(s) by mouth once a day
INSULIN GLARGINE [LANTUS] - 100 unit/mL Solution - 28 units
Solution(s) at bedtime
INSULIN LISPRO [HUMALOG] - 100 unit/mL Sliding scale
ISOSORBIDE DINITRATE - 40mg TID
LISINOPRIL - 20 mg Tablet
NITROGLYCERIN - 0.4 mg Tablet, Sublingual PRN chest pain
OXYBUTYNIN CHLORIDE 5 mg Tablet - 1 Tablet(s) by mouth HS (at
bedtime)
PRAVASTATIN - 40 mg Tablet QPM
TAMSULOSIN [FLOMAX] - 0.4 mg daily.
Medications - OTC
CHOLECALCIFEROL (VITAMIN D3) [VITAMIN D-3] 400 unit Tablet Daily
CYANOCOBALAMIN (VITAMIN B-12) 1,000 mcg Tablet daily
MULTIVITAMIN - 1 Tablet
PYRIDOXINE - 100 mg daily
Zyrtec 1 tab daily

Discharge Medications:
Expired

Discharge Disposition:
Expired

Discharge Diagnosis:
Expired

Discharge Condition:
Expired

Discharge Instructions:
Expired

Followup Instructions:
Expired


Completed by:[**2165-6-25**]
{'Myelodysplastic syndrome, unspecified,Defibrination syndrome,Acute respiratory failure,Toxic encephalopathy,Pneumonia in aspergillosis,Acute and subacute necrosis of liver,Idiopathic normal pressure hydrocephalus (INPH),Acute kidney failure, unspecified,Blood in stool,Acidosis,Urinary tract infection, site not specified,Drug-induced delirium,Aspergillosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Anemia in neoplastic disease,Presence of cerebrospinal fluid drainage device,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Hemochromatosis due to repeated red blood cell transfusions,Atherosclerosis of native arteries of the extremities, unspecified,Obstructive sleep apnea (adult)(pediatric),Morbid obesity,Pure hypercholesterolemia,Family history of other specified malignant neoplasm,Drug induced neutropenia,Fever presenting with conditions classified elsewhere,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Diarrhea,Other specified disorders resulting from impaired renal function,Accidents occurring in residential institution,Hypoxemia,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Contact dermatitis and other eczema, unspecified cause,Other specified disorders of skin,Unspecified disease of sebaceous glands,Other iatrogenic hypotension,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Cardiogenic shock'}


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: MUD AlloHSCT

PRESENT ILLNESS: Mr. [**Known lastname **] is a 67-year-old man with trasnufsion dependent
myelodysplastic disorder, normal pressure hydrocephalus, DM,
CAD, HTN who is electively admitted for Allo SCT.
.
He was last seen in clinic [**5-30**] w Dr. [**Last Name (STitle) 410**] for preadmission
testing prior to planned admission today for a non-myeloablative
matched unrelated donor transplant for his MDS that is
associated with pancytopenia and transfusion dependence of both
red cells and platelets. Last transfusion [**5-28**]. Due to multiple
transfusions, he has develoepd Fe overload, and has been on
chelation therapy with deferasirox. He is admitted for protocol
driven reduced intensity MUD allo. The conditioning is to
inlcude clofarabine, total nodal radiation and ATG. The donor
match is 9/10 per Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] progress note.
.
Per Dr.[**Name (NI) 3588**] clinic evaluation on [**5-23**] this pt has an
absolute neutropenia. [**10/2164**] he was admitted to the ICU with
CAP/neutropenic fevers based upon chest imaging findings and
ROS. He was treated with vancomycin, cefepime and ciprofloxacin,
no pathogen was isolated. During that hospitalization, he was
diagnosed with HSV 1 outbreak on his neck (no lesions in his
mouth or periorally), and was also diagnosed with insulin
dependent DM-2.
.
On the floor, he complains of ongoing seasonal allergies with
dry dcough and watery eyes. Cough is non-productive. He has not
noted any fevers at home. Denies dyspnea on exertion, shortness
of breath, PND, or orthopnea. He has no sore throat or ear pain.
He has had one episode of diarrhea in the last day which is
typical following Exgade.

MEDICAL HISTORY: Past Medical History:
-CAD, s/p ant MI [**2139**], with hx LCX, LAD and RCA stenosis seen on
cardiac CT 2/[**2164**]. Never had stents or angioplasty.
- [**4-/2165**] EF 55%; cardiology cleared for transplant
-Angina - once weekly depending on anemia and stress levels
normally lasting 10-15 mins and resolves with nitro. Describes
as a squeezing central/left chest pain with no radiation usually
but can rarely will rarely feel in these locations. No
nausea/vomiting or sweating.
-NPH: s/p VP shunt placement [**11/2164**] w resolution of sx
-PVD
-Diabetes Mellitus
-BPH on flomax
-OSA on CPAP with morbid obesity
-History of possible TIA [**2162**] ? CVA - had resolution of eye
position -abnormalities over a few days
-Hypertension
-Hypercholesterolemia
-Asthma, cold-induced, not using inhalers at home
-s/p ruptured appendix 20yrs ago
-s/p right carotid endarterectomy several years ago
-HSV-1 [**10/2165**]
.
Hematologic Hx
Longstanding history of myelodysplastic disorder associated with
severe pancytopenia, now red cell and platelet transfusion
requiring. Initially diagnosed [**2160-1-30**] when his primary
care physician, [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], obtained a complete blood
countas a part of routine maintenance physical examination. At
that time he had anemia, a low platelet count, and a borderline
low white blood count. He was treated briefly with azacitidine
(Vidaza) with 4 cycles in [**State 108**] but his disease did not
stabilize. He has been getting PRBC's and platelet tranfusions,
as well as iron chelation with deferasirox (Exjade).

MEDICATION ON ADMISSION: BISOPROLOL FUMARATE - 10 mg Tablet [**Hospital1 **]
ESOMEPRAZOLE MAGNESIUM [NEXIUM] - 40 mg Capsule daily
FOLIC ACID - 1 mg Tablet - 1 Tablet(s) by mouth once a day
INSULIN GLARGINE [LANTUS] - 100 unit/mL Solution - 28 units
Solution(s) at bedtime
INSULIN LISPRO [HUMALOG] - 100 unit/mL Sliding scale
ISOSORBIDE DINITRATE - 40mg TID
LISINOPRIL - 20 mg Tablet
NITROGLYCERIN - 0.4 mg Tablet, Sublingual PRN chest pain
OXYBUTYNIN CHLORIDE 5 mg Tablet - 1 Tablet(s) by mouth HS (at
bedtime)
PRAVASTATIN - 40 mg Tablet QPM
TAMSULOSIN [FLOMAX] - 0.4 mg daily.
Medications - OTC
CHOLECALCIFEROL (VITAMIN D3) [VITAMIN D-3] 400 unit Tablet Daily
CYANOCOBALAMIN (VITAMIN B-12) 1,000 mcg Tablet daily
MULTIVITAMIN - 1 Tablet
PYRIDOXINE - 100 mg daily
Zyrtec 1 tab daily

ALLERGIES: Ampicillin / peanuts

PHYSICAL EXAM: Vitals: T98.5 BP110/58 P:60 RR:18 Sa02 99RA
General: caucasian male appering comfortable and in NAD
HEENT: Right sided VP shunt in place. Sclera anicteric, MMM, two
small areas of petichae on left buccal mucosa
Neck: Well healed right CEA scar. Supple, no LAD.
Lungs: CTABL, no wheezes, no rales or ronchi
CV: Regular rhythm, normal S1 + S2, no MRG
Abdomen: Midline abdominal scar well healed. bowel sounds
normoactive no guarding, no rebound
Ext: L>R lower extremity edema to mid calf.
CN exam - II-XII normal, normal cerebellar function with FTS and
HTS intact.

FAMILY HISTORY: Father died of melanoma
Mother died of coronary artery disease, and hypercholesterolemia
also had a AAA repair
Sister who had coronary artery disease and underwent a 4-vessel
CABG.
Daughter is alive and healthy.

SOCIAL HISTORY: Lives with wife in house with 13 stairs
Able to walk to the car and can walk [**12-30**] block limited withlow
back pain.
He previously worked as a computer programmer and retired.
Ex-smoker quit 20 years ago previously 3 packs per day for 25
years.
Alcohol -he has not had any ETOH in 2 weeks, typically drinks 2
drinks per week. He does not use illicit drugs
No recent foreign travel
Pets - 1 dog and 2 cats 

### Response:
{'Myelodysplastic syndrome, unspecified,Defibrination syndrome,Acute respiratory failure,Toxic encephalopathy,Pneumonia in aspergillosis,Acute and subacute necrosis of liver,Idiopathic normal pressure hydrocephalus (INPH),Acute kidney failure, unspecified,Blood in stool,Acidosis,Urinary tract infection, site not specified,Drug-induced delirium,Aspergillosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Anemia in neoplastic disease,Presence of cerebrospinal fluid drainage device,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Other and unspecified angina pectoris,Hemochromatosis due to repeated red blood cell transfusions,Atherosclerosis of native arteries of the extremities, unspecified,Obstructive sleep apnea (adult)(pediatric),Morbid obesity,Pure hypercholesterolemia,Family history of other specified malignant neoplasm,Drug induced neutropenia,Fever presenting with conditions classified elsewhere,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Diarrhea,Other specified disorders resulting from impaired renal function,Accidents occurring in residential institution,Hypoxemia,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Contact dermatitis and other eczema, unspecified cause,Other specified disorders of skin,Unspecified disease of sebaceous glands,Other iatrogenic hypotension,Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Cardiogenic shock'}
