CHIEF COMPLAINT: Esophageal cancer.

PRESENT ILLNESS: The patient is a 52-year-old male with locally advanced
esophageal cancer.  He underwent chemoradiation therapy who is
admitted for esophagectomy.

MEDICAL HISTORY: Hypertension
Degenerative disc disease,
Herpes simplex virus 2
PSH: Fusion of lumbar vertebrae in [**2169**]
J-tube placement on [**10-21**]

MEDICATION ON ADMISSION: dronabinol  pantoprazole  zolpidem

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: T: 98.6  HR: 94 SR  BP: 122/85  RR 18 Sats: 97% RA
General: 52 year old male in no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple
Card: RRR normal S1,S2 no murmur
Resp: decreased breath sounds with no crackles
GI: benign.  J-tube site clean no erythema
Extr: warm no edema
Incision: Right thoracotomy site clean dry intact
Neuro: awake,alert, oriented

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Divorced.  Daughter lives with him
Malignant neoplasm of esophagus, unspecified site,Unspecified pleural effusion,Pulmonary collapse,Acute posthemorrhagic anemia,Cachexia,Atrial fibrillation,Herpes simplex without mention of complication,Other noninfectious disorders of lymphatic channels,Arthrodesis status,Unspecified essential hypertension,Degeneration of intervertebral disc, site unspecified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Loss of weight,Body Mass Index 25.0-25.9, adult,Other iatrogenic hypotension
Mal neo esophagus NOS,Pleural effusion NOS,Pulmonary collapse,Ac posthemorrhag anemia,Cachexia,Atrial fibrillation,Herpes simplex NOS,Noninfect lymph dis NEC,Arthrodesis status,Hypertension NOS,Disc degeneration NOS,Abn react-anastom/graft,Abnormal loss of weight,BMI 25.0-25.9,adult,Iatrogenc hypotnsion NEC
Admission Date:  [**2184-3-22**]              Discharge Date:   [**2184-4-8**]

Date of Birth:  [**2131-9-13**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
No Known Allergies / Adverse Drug Reactions

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


Major Surgical or Invasive Procedure:
[**2184-3-22**]
1. [**First Name9 (NamePattern2) 12351**] [**Doctor Last Name **] esophagectomy.
2. Buttressing of intrathoracic anastomosis with
    pericardial fat.
3. Esophagogastroduodenoscopy.


History of Present Illness:
The patient is a 52-year-old male with locally advanced
esophageal cancer.  He underwent chemoradiation therapy who is
admitted for esophagectomy.


Past Medical History:
Hypertension
Degenerative disc disease,
Herpes simplex virus 2
PSH: Fusion of lumbar vertebrae in [**2169**]
J-tube placement on [**10-21**]


Social History:
Divorced.  Daughter lives with him

Family History:
non-contributory

Physical Exam:
VS: T: 98.6  HR: 94 SR  BP: 122/85  RR 18 Sats: 97% RA
General: 52 year old male in no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple
Card: RRR normal S1,S2 no murmur
Resp: decreased breath sounds with no crackles
GI: benign.  J-tube site clean no erythema
Extr: warm no edema
Incision: Right thoracotomy site clean dry intact
Neuro: awake,alert, oriented


Pertinent Results:
CXR:
[**2184-4-5**]:Resolving right upper lobe segmental atelectasis.
No evidence of pneumothorax after right-sided chest tube
removal.
[**2184-4-2**]: Tiny new left apical pneumothorax after pigtail
catheter removal. Bibasilar atelectasis.
[**2184-3-25**]: There is a tiny right pneumothorax. Right subcutaneous
emphysema is unchanged. Pneumoperitoneum is again noted. Cardiac
size is top normal.  Widened mediastinum is unchanged. Moderate
left pleural effusion is probably unchanged with adjacent
atelectasis. Right chest tube remains in place. NG tube tip is
in unchanged position, at T12 level. Right central catheter tip
is in the low SVC.

Chest CT [**2184-3-28**]
1. Changes of [**Month/Day/Year 12351**]-[**Doctor Last Name **] esophagectomy, with multiple loculated
right
hydropneumothoraces and that demonstrates communication with
esophageal
anastomosis in neoesophagus, concerning for leak.
2. Moderate-to-large left pleural effusion with left lower lobe
collapse.
3. Splenic aneurysm coiling, with small medial infarction.

Esophagus
[**2184-4-5**]: 1. No extraluminal blush to suggest leak. No evidence
of contrast holdup with free passage of the gastroesophageal
junction and brisk opacification of the duodenum
[**2184-3-28**]:  Faint contrast blush adjacent to posterior wall of
neoesophagus, diffusing into right pleural effusion on delayed
images, concerning for a small leak.

[**2184-4-7**] WBC-10.4 RBC-3.02* Hgb-9.8* Hct-29.1 Plt Ct-453*
[**2184-4-3**] WBC-10.0 RBC-2.97* Hgb-9.5* Hct-28.4 Plt Ct-347
[**2184-3-30**] Hct-25.0*
[**2184-3-30**] WBC-13.6* RBC-2.06* Hgb-7.1* Hct-20.7 Plt Ct-214
[**2184-3-23**] WBC-9.6 RBC-2.66* Hgb-9.3* Hct-26.5 Plt Ct-140*
[**2184-4-7**] Glucose-100 UreaN-20 Creat-0.5 Na-137 K-4.2 Cl-104
HCO3-27
[**2184-3-23**] Glucose-124* UreaN-23* Creat-0.6 Na-141 K-4.5 Cl-107
HCO3-26
[**2184-4-1**] PLEURAL Triglyc-543
[**2184-3-26**] PLEURAL Triglyc-184

Micros
[**2184-4-5**] UA/UCx neg
[**2184-3-29**] tissue 3+pmn's 1+GNR's, GPC's in pairs and clusters
[**2184-3-29**] thymic fat 1+ pmns GPCs from broth (low #'s)
[**2184-3-29**] tissue(conduit) 3+PMN's strep (low #'s)
[**2184-3-29**] BAL 3+PMN's no orgs


Brief Hospital Course:
Mr. [**Known lastname 20561**] is a 52 year-old male who was taken to the operating
[**2184-3-22**] for a minimally-invasive [**First Name9 (NamePattern2) 12351**] [**Doctor Last Name **] esophagectomy,
buttressing of intrathoracic anastomosis with thymic fat, and
esophagogastroduodenoscopy.  He was extubated
in the operating room, and transferred to the TSICU for close
monitoring with a right chest-tube to wall suction, JP drain,
NGT and Bupivacaine-Dilaudid Epidural managed by the acute pain
service, and Foley catheter. He transferred to the floor on
[**2184-3-24**] hemodynamically stable.

Events: on [**2184-3-28**] he developed fevers, leukocytosis and
increased pain.  A barium and Chest CT showed anastomotic leak.
He was transfer to the ICU for close monitoring.  His chest tube
and JP drain were draining contrast. His CXR showed a left
pleural effusion.  Interventional pulmonology performed a
thoracentesis for 800 mL and placed a pigtail. He was taken to
the operating room on [**2184-3-29**] Right thoracotomy, Debridement of
esophagogastric anastomosis and recreation of esophagogastric
anastomosis. Wrapping of anastomosis with intercostal muscle.
Decortication of lung. Esophagogastroduodenoscopy and
Bronchoscopy with bronchoalveolar lavage.  He transfer to the
SICU with an NGT, 3 CTs and 2 JP drains adjacent to the
anastomosis.

ID: he was pan-cultured BC x 4 with no growth.  Tissue from OR
grew VIRIDANS STREPTOCOCCI.  He was started on Vancomycin and
Zosyn and once the cultures were final the Vanco was
discontinued and Zosyn he completed a 10 day course.

Respiratory: Pulmonary toilet was maintained with incentive
spirometry, nebulizers and early mobilization. He titrated off
oxygen with saturations of 93%.

Chest tubes: posterior tube developed a small chyle leak which
was self limiting. Left pigtail was removed [**2184-4-2**]. The
posterior, anterior and basilar chest were converted to
pneumostat.  The anterior and basilar were removed [**2184-4-5**] and
the posterior chest tube [**2184-4-7**] following fat challenge with
no chyle leak.

Chest films: followed by serial chest films Resolving right
upper lobe segmental atelectasis.

CV: On [**2184-3-24**] he developed SVT 150's which progressed to
Atrial fibrillation with hypotension.  Amiodarone 150 mg bolus
converted to sinus rhythm 70-80's. Amiodarone load of 1 g was
given then discontinued.  He remain in sinus rhythm throughout
his hospital course and was hemodynamically stable.

GI: He was continued on a bowel regime and PPI. NGT was flushed
frequently to maintain patency on intermittent low-wall suction
and removed [**2184-3-26**] & [**2184-4-5**].

Nutrition:  He was seen by nutrition.  He tolerated tube feeds,
Replete full strength 125 mL x 18 hrs.  He was changed to
Vivonex for the chyle leak and on [**2184-4-6**] resumed Replete full
strength.  He was discharged on Osmololite 1.5 cal 125 x 18 hrs.
On [**2184-4-5**] full liquid diet was initiated and he tolerated
small amounts.

Renal: His renal function normal with good urine output.
Electrolytes were replete.  Foley was removed he voided.

Heme: transfused 2 units PRBC [**2184-3-29**] for HCT 20->25 which
remain stable throughout his hospital course.

Endocrine: Fingerstick blood sugars were < 150.

Pain: The Bupivacaine Epidural managed by the acute pain service
was removed on [**2184-4-5**].  Dilaudid PCA was transition to Roxicet
via J-tube on [**2184-3-24**] with good pain control.

Access:  HE was seen by the IV team for use of his Right
port-a-cath which was easily accessed.  Chest films reveals
terminates in the low SVC.

Proph: SubQ heparin and SCD's were utilized for VTE prophylaxis.

Disposition: He continued to make steady progress.  He was seen
by physical therapy  and was discharged to home with [**Last Name (LF) 88233**], [**First Name3 (LF) 487**] [**Telephone/Fax (1) 79963**]. He will follow-up with Dr. [**First Name (STitle) **] as
an outpatient.


Medications on Admission:
dronabinol  pantoprazole  zolpidem


Discharge Medications:
1. ZOFRAN ODT 4 mg Tablet, Rapid Dissolve Sig: One (1) Tablet,
Rapid Dissolve PO every eight (8) hours as needed for nausea.
Disp:*10 Tablet, Rapid Dissolve(s)* Refills:*0*
2. sennosides-docusate sodium 8.6-50 mg Tablet Sig: One (1)
Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
3. oxycodone 5 mg/5 mL Solution Sig: [**4-25**] mL PO every four (4)
hours as needed for pain.
Disp:*500 mL* Refills:*0*
4. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
5. acetaminophen 650 mg/20.3 mL Solution Sig: One (1) dose PO
Q6H (every 6 hours) as needed for pain.


Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 486**], [**First Name3 (LF) 487**]

Discharge Diagnosis:
Esophageal cancer
Hypertension
Degenerative disc disease,
Herpes simplex virus 2
PSH: Fusion of lumbar vertebrae in [**2169**]
J-tube placement on [**10-21**]


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Call Dr.[**Name (NI) 5067**] office [**Telephone/Fax (1) 2348**] if you experience:
-Fevers greater than 101.5 or chills
-Increased shortness of breath, cough or chest pain
-Incisions develops drainage
-Increased or difficulty swallowing
-Increased abdominal pain
-Nausea (take antinausea medication) or vomiting
-Check daily weights. Keep a log.

Feed tube site: Leave open to air. Clean site daily.
-Should J-tube clog use papain and water warm.

Chest tube site: with a bandaid until healed. Should site drain
cover with a clean dressing and change as need to keep site
clean and dry

Activity:
-Shower daily. Wash incision with mild soap & water rinse, pat
dry
-No lifting greater than 10 pounds.
-No driving until seen in followup and while on narcotics for
pain.
-Walk 4-5 times a day for 10-15 minutes increase to a Goal of 30
minutes daily.

Pain
-Roxicet via J-tube as instructed.
-Acetaminophen 650 mg evry 6 hrs for pain


Followup Instructions:
Follow-up with Dr. [**First Name (STitle) **] [**0-0-**] Date/Time:[**2184-4-27**] 10:00
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:[**2184-4-8**]
{'Malignant neoplasm of esophagus, unspecified site,Unspecified pleural effusion,Pulmonary collapse,Acute posthemorrhagic anemia,Cachexia,Atrial fibrillation,Herpes simplex without mention of complication,Other noninfectious disorders of lymphatic channels,Arthrodesis status,Unspecified essential hypertension,Degeneration of intervertebral disc, site unspecified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Loss of weight,Body Mass Index 25.0-25.9, adult,Other iatrogenic hypotension'}


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: The patient is a 52-year-old male with locally advanced
esophageal cancer.  He underwent chemoradiation therapy who is
admitted for esophagectomy.

MEDICAL HISTORY: Hypertension
Degenerative disc disease,
Herpes simplex virus 2
PSH: Fusion of lumbar vertebrae in [**2169**]
J-tube placement on [**10-21**]

MEDICATION ON ADMISSION: dronabinol  pantoprazole  zolpidem

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: VS: T: 98.6  HR: 94 SR  BP: 122/85  RR 18 Sats: 97% RA
General: 52 year old male in no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple
Card: RRR normal S1,S2 no murmur
Resp: decreased breath sounds with no crackles
GI: benign.  J-tube site clean no erythema
Extr: warm no edema
Incision: Right thoracotomy site clean dry intact
Neuro: awake,alert, oriented

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Divorced.  Daughter lives with him 

### Response:
{'Malignant neoplasm of esophagus, unspecified site,Unspecified pleural effusion,Pulmonary collapse,Acute posthemorrhagic anemia,Cachexia,Atrial fibrillation,Herpes simplex without mention of complication,Other noninfectious disorders of lymphatic channels,Arthrodesis status,Unspecified essential hypertension,Degeneration of intervertebral disc, site unspecified,Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Loss of weight,Body Mass Index 25.0-25.9, adult,Other iatrogenic hypotension'}
