CHIEF COMPLAINT: Elective resection of brain metastasis

PRESENT ILLNESS: 58M w/recent dx of non-small cell lung cancer presents for
resection of solitary brain metastasis. First presented in [**2108**]
with peumonia and found to have nodule in right upper lobe which
was followed with serial chest CT q3 months. In [**2111-5-4**], a 2nd
lesion was seen in the same lung lobe and subsequent w/u showed
adenocarcinoma. Staging with head MR [**2111-6-26**] showed 1cm cystic
enhancing lesion in left frontal brain. He is completely
asymptomatic and neurologically intact withtou headache, nausea,
vomitting, seizure, weakness, double vision, urinary
incontinece, imbalance or recent falls.

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

MEDICATION ON ADMISSION: aspirin 325mg QD
toprol XL 50mg QD
lipitor 10mg QD

ALLERGIES: Tetracycline

PHYSICAL EXAM: 97.4   126/72    78     16
GNE: NAD, comfortable
HEENT: neck supple and there is no cervical, axillary or
supraclavicular lymphadenopathy
CV: RRR
Lungs: CTAB
ABD: soft, +BS
EXT: no c/c/e

FAMILY HISTORY: Grandfather died of lung CA (non-smoking related). Mother died
of MI. Father died of brain CA. Has 3 brothers who are alive but
a fourth died of complications of Hep C. Does not have children.

SOCIAL HISTORY: Smokes 2PPD x40 yrs, drinks EtOH occasionally.
Secondary malignant neoplasm of brain and spinal cord,Malignant neoplasm of other parts of bronchus or lung,Coronary atherosclerosis of unspecified type of vessel, native or graft,Percutaneous transluminal coronary angioplasty status
Sec mal neo brain/spine,Mal neo bronch/lung NEC,Cor ath unsp vsl ntv/gft,Status-post ptca
Admission Date:  [**2111-7-15**]              Discharge Date:   [**2111-7-17**]

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

Service: NEUROSURGERY

Allergies:
Tetracycline

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
Elective resection of brain metastasis

Major Surgical or Invasive Procedure:
Craniotomy


History of Present Illness:
58M w/recent dx of non-small cell lung cancer presents for
resection of solitary brain metastasis. First presented in [**2108**]
with peumonia and found to have nodule in right upper lobe which
was followed with serial chest CT q3 months. In [**2111-5-4**], a 2nd
lesion was seen in the same lung lobe and subsequent w/u showed
adenocarcinoma. Staging with head MR [**2111-6-26**] showed 1cm cystic
enhancing lesion in left frontal brain. He is completely
asymptomatic and neurologically intact withtou headache, nausea,
vomitting, seizure, weakness, double vision, urinary
incontinece, imbalance or recent falls.

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

Social History:
Smokes 2PPD x40 yrs, drinks EtOH occasionally.

Family History:
Grandfather died of lung CA (non-smoking related). Mother died
of MI. Father died of brain CA. Has 3 brothers who are alive but
a fourth died of complications of Hep C. Does not have children.

Physical Exam:
97.4   126/72    78     16
GNE: NAD, comfortable
HEENT: neck supple and there is no cervical, axillary or
supraclavicular lymphadenopathy
CV: RRR
Lungs: CTAB
ABD: soft, +BS
EXT: no c/c/e

Pertinent Results:
[**2111-7-15**] 12:46PM   GLUCOSE-116* UREA N-18 CREAT-0.8 SODIUM-139
POTASSIUM-4.4 CHLORIDE-111* TOTAL CO2-19* ANION GAP-13
[**2111-7-15**] 12:46PM   CALCIUM-6.9* PHOSPHATE-2.7 MAGNESIUM-1.8
[**2111-7-15**] 12:46PM   WBC-8.1 RBC-3.66* HGB-11.1* HCT-32.5* MCV-89
MCH-30.4 MCHC-34.2 RDW-15.2
[**2111-7-15**] 12:46PM   PLT COUNT-252
.
.
[**7-15**] head MRI: Since [**2111-6-26**], slight enlargement in size of a
peripheral ring- enhancing lesion in the left frontal lobe,
which likely represents metastasis.
.
.
[**7-15**] head CT: FINDINGS: There has been interval left frontal
craniotomy and resection of the previously seen ring-enhancing
left frontal lobe lesion. Postoperative changes with
pneumocephalus and a small amount of hemorrhage in the surgical
bed are seen. There is no mass effect. No other intracranial
hemorrhage is identified. There is no shift of normally midline
structures. [**Doctor Last Name **]-white matter differentiation elsewhere appears
preserved. This patient appears to have undergone bilateral
maxillary sinus antrostomies. Remaining visualized paranasal
sinuses are unremarkable.
IMPRESSION:
Postoperative changes in the left frontal lobe.
.
.
[**7-15**] tissue bx: Clinical:  Left frontal mass; (Per online
record) 58-year-old man with two pulmonary nodules, one of which
contained poorly differentiated adenocarcinoma. Now has left
frontal mass.
Gross:
The specimen is received fresh in two parts, both labeled with
"[**Known firstname **] [**Known lastname **]" and the medical record number.
Part 1 is additionally labeled "frontal tumor, frozen pass" and
consists of multiple fragments of white friable tissue measuring
in aggregate 1.8 x 0.6 x 0.4 cm. Small portions of the tissue
are used to prepare an intraoperative smear. The intraoperative
diagnosis by Dr. [**Last Name (STitle) **] [**Last Name (NamePattern4) 122**] reads
"#1, Left frontal mass (smear):
     Metastatic poorly differentiated carcinoma. Necrosis
present. Reactive brain.
     Discussed with Dr. [**Last Name (STitle) **].  Final diagnosis pending
permanent section."
The remainder of the specimen is entirely submitted in A.
Part 2 is additionally labeled "#3, left frontal  tumor"
(specimen #2 was taken by Dr.[**Name (NI) 6767**] laboratory) and consists of
several fragments of tan, white, and red soft tissue, 0.7 x 0.5
x 0.4 cm in aggregated. The specimen is entirely submitted in B.

.
.
[**7-17**] Head MRI:
FINDINGS: Status post left frontal craniotomy. Post-surgical
changes with areas of hemorrhage and air are noted in the left
frontal parenchyma. On the contrast images, there is small area
of contrast enhancement anteriorly as well as superior and
lateral to the area of the hemorrhage. Rest of the brain
parenchyma is unremarkable. The ventricles and extraaxial CSF
spaces are normal. The visualized paranasal sinuses and the
orbits and the rest of the skull are unremarkable.
IMPRESSION:
Post-surgical changes with small amount of blood the left
frontal lateral parenchyma.
Small area of residual enhancement anterior and superolateral to
the area of post-surgical blood products.

Brief Hospital Course:
Patient underwent left frontal craniotomy and resection of left
frontal cystic lesion without complication. Post-op patient's
vital signs were stable and he was neurologically unchanged. He
was transferred from the PACU to the floor. Patient tolerated
diet well and pain was controlled. Patient was ambulating
without difficulty per physical therapy evaluation. He was
discharged home with follow-up in [**Hospital **] clinic.

Medications on Admission:
aspirin 325mg QD
toprol XL 50mg QD
lipitor 10mg QD

Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
2. Oxycodone-Acetaminophen 5-325 mg Tablet Sig: 1-2 Tablets PO
Q4-6H (every 4 to 6 hours) as needed.
Disp:*20 Tablet(s)* Refills:*0*
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day): Please take while on percocet.
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO DAILY (Daily):
Please take while on percocet.
5. Metoprolol Succinate 50 mg Tablet Sustained Release 24HR Sig:
One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
6. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. Phenytoin Sodium Extended 100 mg Capsule Sig: Two (2) Capsule
PO BID (2 times a day).
8. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
9. Dexamethasone 4 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours): Slowly taper with 4mg PO Q8H x2days, 3mg PO Q8H x3days,
2mg PO Q8H x3days,
then 2mg PO BID, until follow-up in Brain [**Hospital 341**] Clinic.
Disp:*120 Tablet(s)* Refills:*2*
10. Aspirin 325 mg Tablet Sig: One (1) Tablet PO once a day: Do
not take until [**7-31**].


Discharge Disposition:
Home

Discharge Diagnosis:
Left frontal cystic lesion

Discharge Condition:
Neurologically stable


Discharge Instructions:
Please take medications as prescribed. Please DO NOT take
aspirin until 2 weeks after discharge (may resume [**7-31**]).

Please keep your follow-up appointments.

Keep incision clean, dry do not get wet until sutures come out.
Watch incision for redness, drainage, bleeding, fevers greater
than 101.5, any neurological changes call Dr[**Name (NI) 9034**] office.

No heavy lifting greater than 10lbs.

No driving.

Followup Instructions:
Follow in Brain tumor clinic within 2 weeks of discharge. We
will schedule an appointment for you. Please call the clinic at
[**Telephone/Fax (1) 1844**] to confirm the time and date.



Completed by:[**2111-7-20**]
{'Secondary malignant neoplasm of brain and spinal cord,Malignant neoplasm of other parts of bronchus or lung,Coronary atherosclerosis of unspecified type of vessel, native or graft,Percutaneous transluminal coronary angioplasty status'}


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: Elective resection of brain metastasis

PRESENT ILLNESS: 58M w/recent dx of non-small cell lung cancer presents for
resection of solitary brain metastasis. First presented in [**2108**]
with peumonia and found to have nodule in right upper lobe which
was followed with serial chest CT q3 months. In [**2111-5-4**], a 2nd
lesion was seen in the same lung lobe and subsequent w/u showed
adenocarcinoma. Staging with head MR [**2111-6-26**] showed 1cm cystic
enhancing lesion in left frontal brain. He is completely
asymptomatic and neurologically intact withtou headache, nausea,
vomitting, seizure, weakness, double vision, urinary
incontinece, imbalance or recent falls.

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

MEDICATION ON ADMISSION: aspirin 325mg QD
toprol XL 50mg QD
lipitor 10mg QD

ALLERGIES: Tetracycline

PHYSICAL EXAM: 97.4   126/72    78     16
GNE: NAD, comfortable
HEENT: neck supple and there is no cervical, axillary or
supraclavicular lymphadenopathy
CV: RRR
Lungs: CTAB
ABD: soft, +BS
EXT: no c/c/e

FAMILY HISTORY: Grandfather died of lung CA (non-smoking related). Mother died
of MI. Father died of brain CA. Has 3 brothers who are alive but
a fourth died of complications of Hep C. Does not have children.

SOCIAL HISTORY: Smokes 2PPD x40 yrs, drinks EtOH occasionally. 

### Response:
{'Secondary malignant neoplasm of brain and spinal cord,Malignant neoplasm of other parts of bronchus or lung,Coronary atherosclerosis of unspecified type of vessel, native or graft,Percutaneous transluminal coronary angioplasty status'}
