CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 54-year-old
gentleman who presented with dysphagia last year with
endoscopic diagnosis of poorly differentiated adenocarcinoma
of the esophagus with a lesion seen 30 to 33 cm with partial
esophageal obstruction and two similar masses more distal.
Endoscopic ultrasound at the time showed tumor through the
muscularis and one enlarged lymph node clinically stated at
T3.  There was no evidence of distal metastasis at the time
of staging.  He next underwent adjunctive chemotherapy and
radiotherapy followed by esophageal gastrectomy in [**2184-3-12**].  Approximately three weeks later, the patient developed
severe lower back pain with further work up.  He was found to
have metastatic lesions at the L2, L3 level.  Needle biopsy
was positive for mets for poorly differentiated
adenocarcinoma.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Secondary malignant neoplasm of bone and bone marrow,Accidental puncture or laceration during a procedure, not elsewhere classified,Paroxysmal ventricular tachycardia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of esophagus
Secondary malig neo bone,Accidental op laceration,Parox ventric tachycard,DMII wo cmp nt st uncntr,Hx-esophageal malignancy
Name:  [**Known lastname 6779**], [**Known firstname 63**]                    Unit No:  [**Numeric Identifier 6780**]

Admission Date:  [**2184-11-25**]     Discharge Date:  [**2184-12-10**]

Date of Birth:   [**2130-3-15**]     Sex:  M

Service:

In addition to the previously dictated discharge summary,
this is to update patient's discharge medications.

DISCHARGE MEDICATIONS:
1. Cephazolin 1 gram IV q8h until [**2184-12-14**].
2. Decadron taper for one week as indicated in the discharge
page one summary to begin with three days of 4 mg tid, and
then 2 mg tid for three days, and then 2 mg [**Hospital1 **] for three
days, and then stop.


                     DR.[**Last Name (STitle) 562**],[**First Name3 (LF) 863**] 14-127


Dictated By:[**Last Name (STitle) 6781**]

MEDQUIST36

D:  [**2184-12-10**]  10:42
T:  [**2184-12-14**]  03:59
JOB#:  [**Job Number 6782**]


Admission Date:  [**2184-11-25**]       Discharge Date:  [**2184-12-10**]

Date of Birth:   [**2130-3-15**]       Sex:  M

Service:  .

HISTORY OF PRESENT ILLNESS:  Patient is a 54-year-old
gentleman who presented with dysphagia last year with
endoscopic diagnosis of poorly differentiated adenocarcinoma
of the esophagus with a lesion seen 30 to 33 cm with partial
esophageal obstruction and two similar masses more distal.
Endoscopic ultrasound at the time showed tumor through the
muscularis and one enlarged lymph node clinically stated at
T3.  There was no evidence of distal metastasis at the time
of staging.  He next underwent adjunctive chemotherapy and
radiotherapy followed by esophageal gastrectomy in [**2184-3-12**].  Approximately three weeks later, the patient developed
severe lower back pain with further work up.  He was found to
have metastatic lesions at the L2, L3 level.  Needle biopsy
was positive for mets for poorly differentiated
adenocarcinoma.

The patient underwent a vertebroplasty at [**Hospital3 **] per Dr.
[**Last Name (STitle) **] in [**2184-6-12**] and subsequently completed XRT.  He was
admitted most recently to [**Hospital **] [**Hospital3 2063**] with
recurrent respiratory distress and hypotension, stabilized in
the ICU.  It was noted that his lower back pain was
increasing in the past two to three days.  He complained of
mild onset of paresthesias to the left lower extremity and he
was diagnosed with a right middle lobe and right lower lobe
pneumonia by chest x-ray.  CT Scan of the chest was positive
for infiltrates.  He was transferred to [**Hospital1 190**] for further management of his L2-L3
metastasis.  MRI showed significant compression of the thecal
sac.

Patient also has a past medical history of diabetes type 2
and past surgical history of distal esophagectomy and partial
gastrectomy.

PHYSICAL EXAMINATION:  Patient was afebrile.  Vital signs
were stable with saturations of 94% on room air.  He was
awake, alert and oriented times three, conversant.  Speech
was fluent.  Affect was appropriate.  Pupils were equal,
round and reactive to light.  EOM full.  Smile and tongue
were midline.  Face was symmetric.  Neck was supple with full
range of motion.  Lungs:  Decreased breath sounds with faint
rales and rhonchi to the right lower base posterior,
otherwise clear.  Heart:  Normal sinus rhythm at 94, normal
S1, S2 without murmurs, rubs, or gallops.  Abdomen:  Has a
midline incision which is clean and dry.  Positive bowel
sounds in all four quadrants.  Rectal tone is within normal
limits.  Guaiac negative.  Extremities:  No cyanosis,
clubbing or edema.  Neurologically:  His motor strength is
[**5-16**] in both upper extremities.  Lower extremities:  His IPs
were 4+ bilaterally, otherwise he was [**5-16**].  Sensation was
intact to light touch without saddle anesthesia.  His deep
tendon reflexes are 2+ throughout with the exception of the
ankles which were 1+.  His toes were downgoing.

LABORATORY DATA ON ADMISSION:  White count 9.5, hematocrit
31.6, platelets 334.  Sodium 140, potassium 4.2, chloride
105, CO2 24, BUN 14, creatinine 0.5 and glucose is 396.  The
patient was started on sliding scale insulin.

MRI from [**Hospital1 **] shows compression fracture of the L2-L3
level with retropulsion and compression of the thecal sac.

Patient underwent anterior vertebroplasty from the L2-L4
levels by Dr. [**Last Name (STitle) **] on [**2184-11-26**] without inter-procedure
complication.  The patient was stable neurologically.  He was
taken to the OR on [**2184-11-29**] for L2-L3 vertebrectomy.
During the removal of the methacrylate from the L2-L3 disc
space, a large amount of anterior bleeding was encountered
emanating from the region of the aorta.  This was quickly
packed off with large sponges and manual pressure.  This was
maintained until Vascular Cardiac surgeons arrived.  They
achieved vascular control and repaired the laceration of the
aorta.  Due to ongoing pressure requirements and metabolic
derangements following vascular repair, the decision was made
to not proceed with the vertebrectomy and spinal
stabilization.

During closure of the skin, the patient developed a wide
complex heart rhythm, V-tach, V-fib and requiring CPR.
Normal sinus rhythm was achieved and patient was transferred
to the CSRU for close monitoring.  He had four liters of
blood loss at the time and also had a clot in the distal
aorta on cross clamping which caused loss of pulses in the
lower extremities below the femoral arteries.

On [**2184-11-30**], the patient was awake, alert, following
commands and moving all extremities spontaneously and to
command.  He had positive pulses in his lower extremities
with the exception of the right DP.  His temperature was
100.3 F, blood pressure was 98/54 and he was Amiodarone drip
as well as Fentanyl for pain, Levophed and an insulin drip.
He had [**Name (NI) **] PT pulses bilaterally.  DP was present on
the left, but not on the right and his right foot was cool to
touch.

On [**12-2**] the patient was awake and alert.  His dressing was
clean, dry and intact.  His motor strength was [**5-16**].  He had a
right PT pulse and left DP and PT pulses.  He was transferred
with two units of packed cells for a hematocrit of 27.8 and
given platelets for a platelet count of 62.  He was
transferred to the regular floor on [**2184-12-2**].

On [**2184-12-3**], the patient underwent an L3 retroperitoneal
vertebrectomy with L2-L4 stabilization with caging.  The
patient tolerated the procedure well.  He was monitored in
the Surgical Intensive Care Unit postoperatively.  Had chest
tubes and two wall suction.  He was seen by the Acute Pain
Service and started on Methadone 10 mg p.o. b.i.d. and
Dilaudid PCA.

On [**2184-12-6**], the patient's PCA was discontinued.  He was
started on p.o. Hydromorphone, continued on 10 mg of
Methadone and his Fentanyl patch was weaned to 200 mics q.
three days.  He tolerated p.o. pain medication well.  His
motor strength was [**5-16**] in all muscle groups.  His incision
was clean, dry and intact.  He was seen by Physical Therapy
and Occupational Therapy and found to require rehab prior to
discharge to home.

DISCHARGE MEDICATIONS:
1.  Ancef 1 gram IV q. eight hours until [**2184-12-11**].
2.  Fentanyl patch 200 mics topically q. 72 hours.
3.  Miconazole powder 2% one application topically t.i.d.
p.r.n.
4.  Hydromorphone 8 to 12 mg p.o. q. four hours p.r.n. for
breakthrough pain.  Methadone 10 mg p.o. b.i.d. for pain.
5.  Heparin 5000 units subcu q. 12 hours.
6.  Colace 100 mg p.o. b.i.d.
7.  Tylenol 650 p.o. q. four hours p.r.n.
8.  Lorazepam 1 mg p.o. q. eight hours p.r.n.
9.  Insulin per sliding scale.
10. Albuterol neb one neb inhaler q. six hours p.r.n.
11. Neurontin 300 mg p.o. t.i.d.
12. Hydrocortisone 100 IV q. eight hours.
13. Protonix 40 mg IV q. 24 hours.
14. Kefzol 1 gram IV q. eight hours until [**2184-12-9**].

CONDITION ON DISCHARGE:  The patient was in stable condition
at the time of discharge and will follow up with Dr. [**Last Name (STitle) 1327**]
next week for staple removal.




                            [**Name6 (MD) 1339**] [**Last Name (NamePattern4) 1340**], M.D.  [**MD Number(1) 1341**]

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2184-12-8**]  10:54
T:  [**2184-12-8**]  10:58
JOB#:  [**Job Number 37594**]
{'Secondary malignant neoplasm of bone and bone marrow,Accidental puncture or laceration during a procedure, not elsewhere classified,Paroxysmal ventricular tachycardia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of esophagus'}


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: Patient is a 54-year-old
gentleman who presented with dysphagia last year with
endoscopic diagnosis of poorly differentiated adenocarcinoma
of the esophagus with a lesion seen 30 to 33 cm with partial
esophageal obstruction and two similar masses more distal.
Endoscopic ultrasound at the time showed tumor through the
muscularis and one enlarged lymph node clinically stated at
T3.  There was no evidence of distal metastasis at the time
of staging.  He next underwent adjunctive chemotherapy and
radiotherapy followed by esophageal gastrectomy in [**2184-3-12**].  Approximately three weeks later, the patient developed
severe lower back pain with further work up.  He was found to
have metastatic lesions at the L2, L3 level.  Needle biopsy
was positive for mets for poorly differentiated
adenocarcinoma.

MEDICAL HISTORY: 

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Secondary malignant neoplasm of bone and bone marrow,Accidental puncture or laceration during a procedure, not elsewhere classified,Paroxysmal ventricular tachycardia,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Personal history of malignant neoplasm of esophagus'}
