CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 57-year-old male
with Burkitt's type lymphoma originally diagnosed in [**12/2117**]
following a six week history of fatigue, night sweats, and
adenopathy, and testicular enlargement.  He underwent an
inguinal node biopsy on [**2117-12-16**].  Pathology revealed
diffuse replacement of the nodal architecture with extranodal
invasion of the surrounding fat consistent with a high-grade
lymphoid neoplasia.  A lumbar puncture was performed which
showed cerebrospinal fluid involvement and an Ommaya shunt
was placed on [**2117-12-19**].  CODOX was started [**2117-12-17**] and
Methotrexate started on [**2117-12-19**] via the Ommaya shunt.  He
is status post hospitalization for IVAC therapy from
[**2118-1-4**] to [**2118-1-8**] status post intrathecal ara-C on
[**2118-1-21**], and again on [**2118-2-25**]; status post CODOX and
Rituxan cycle on [**2118-1-24**] to12/19/[**2117**].  Status post
admission for high-dose methotrexate from [**2118-2-3**] to
[**2118-2-9**]; status post admission for IVAC cycle number four
but discontinued prematurely for pneumonia in [**2-/2118**]; status
post IVAC without Ifosfamide in 01/[**2118**].

MEDICAL HISTORY: As per History of Present Illness,
pyloric stenosis, ventricular hypertrophy, history of
ventricular ectopy and hypercholesterolemia.

MEDICATION ON ADMISSION: 1. Tylenol 25 a day
2. Compazine 10 mg q. 6 hours p.r.n. nausea.
3. Zofran p.r.n. nausea
4. Acyclovir 400 b.i.d.
5. Diflucan 200 q. day
6. Fentanyl patch 25 mcg q. day
7. Colace.
8. Vitamin B6.
9. Potassium chloride pills.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Burkitt's tumor or lymphoma, unspecified site, extranodal and solid organ sites,Bacteremia,Infection and inflammatory reaction due to other vascular device, implant, and graft,Hyposmolality and/or hyponatremia,Seroma complicating a procedure,Acquired hypertrophic pyloric stenosis,Paralysis of vocal cords or larynx, unspecified
Brkt tmr unsp xtrndl org,Bacteremia,React-oth vasc dev/graft,Hyposmolality,Seroma complicting proc,Acq pyloric stenosis,Vocal cord paralysis NOS
Admission Date: [**2118-6-3**]        Discharge Date: [**2118-7-11**]

Date of Birth:  [**2061-2-6**]        Sex:  M

Service:  OME


HISTORY OF PRESENT ILLNESS:  Patient is a 57-year-old male
with Burkitt's type lymphoma originally diagnosed in [**12/2117**]
following a six week history of fatigue, night sweats, and
adenopathy, and testicular enlargement.  He underwent an
inguinal node biopsy on [**2117-12-16**].  Pathology revealed
diffuse replacement of the nodal architecture with extranodal
invasion of the surrounding fat consistent with a high-grade
lymphoid neoplasia.  A lumbar puncture was performed which
showed cerebrospinal fluid involvement and an Ommaya shunt
was placed on [**2117-12-19**].  CODOX was started [**2117-12-17**] and
Methotrexate started on [**2117-12-19**] via the Ommaya shunt.  He
is status post hospitalization for IVAC therapy from
[**2118-1-4**] to [**2118-1-8**] status post intrathecal ara-C on
[**2118-1-21**], and again on [**2118-2-25**]; status post CODOX and
Rituxan cycle on [**2118-1-24**] to12/19/[**2117**].  Status post
admission for high-dose methotrexate from [**2118-2-3**] to
[**2118-2-9**]; status post admission for IVAC cycle number four
but discontinued prematurely for pneumonia in [**2-/2118**]; status
post IVAC without Ifosfamide in 01/[**2118**].

From [**2118-5-5**] patient underwent R-[**Hospital1 **] chemotherapy with
Velcade and most recently prior to admission treated with the
Gemcitabine, Rituxan, cisplatin, and currently being admitted
for TVI high-dose Cytoxan followed by allogenic bone marrow
transplant.

PAST MEDICAL HISTORY:  As per History of Present Illness,
pyloric stenosis, ventricular hypertrophy, history of
ventricular ectopy and hypercholesterolemia.

MEDICATIONS ON ADMISSION:
1. Tylenol 25 a day
2. Compazine 10 mg q. 6 hours p.r.n. nausea.
3. Zofran p.r.n. nausea
4. Acyclovir 400 b.i.d.
5. Diflucan 200 q. day
6. Fentanyl patch 25 mcg q. day
7. Colace.
8. Vitamin B6.
9. Potassium chloride pills.


ALLERGIES:  No known drug allergies.

PHYSICAL EXAMINATION ON ADMISSION:  Temperature 99.9, blood
pressure 110/76, pulse of 84, respiratory rate of 18,
saturation 97 percent on room air.  In general, in no acute
distress.  Anicteric sclerae.  Pupils equal, round, reactive
to light.  Clear oropharynx.  Neck:  Supple, no
lymphadenopathy.  Lungs:  Clear to auscultation bilaterally.
Heart is irregular with an S1, S2.  No murmurs, rubs, or
gallops.  Abdomen is soft, nontender, nondistended; positive
bowel sounds.  No clubbing, cyanosis, or edema.

LABORATORY DATA ON ADMISSION:  White count 4.4, hematocrit
28.1, platelets 116, BUN 19, creatinine 0.7, LDH 947.

HOSPITAL COURSE BY PROBLEM:  Burkitt's type lymphoma:
Admitted for high-dose Cytoxan followed by TBI and allogenic
bone marrow transplant.  His course was complicated as
described below.

Infectious Disease:  Following transplant patient developed
fever and neutropenia and was treated with empiric
antibiotics although remained febrile.  His potential sources
included severe mucositis as well as CT evidence of
sinusitis.  However, all blood, urine cultures and chest
imaging were negative.  He remained febrile without a source
through day 12 plus 12 status post the transplant until he
acutely worsened on [**2118-6-21**] with delta MS, increased
fever, and tachypnea.  He subsequently had multiple blood
cultures and a catheter tip from a right IJ line grew
positive for Vancomycin-resistant enterococcus.  This acute
change in transfer prompted a transfer to the MICU for an
overnight stay, upon which he dramatically improved following
the removal of the right IJ line.  When the cultures revealed
a VRE species, patient was treated with Linezolid and
followed with surveillance cultures.  Approximately one-third
of the way through his two-week course, Linezolid was changed
to Synercid due to concern over his blood counts being
affected by the Linezolid.  He finished a 14-day course from
the last positive surveillance blood culture without further
fevers.

VRE, as described above, right IJ line source, and upon
removal of the line treated with a 14-day course of Linezolid
plus Synercid.

Sinusitis documented by CT:  Treated with a course of
Cefepime.

Acute renal failure:  Patient developed rising creatinine to
a peak of 2.2 from a baseline of 0.6.  The renal team was
consulted.  The initial insult was felt to be multifactorial
due to cyclosporin toxicity and sepsis from the VRE.
Subsequently, however, the main damage was felt due to
cyclosporin toxicity.  Cyclosporin dose was decreased to a
more desirable level and the creatinine began to improve.  At
time of discharge his creatinine was 1.1, which is still
above baseline, and was holding stable.

CMV:  Patient had ongoing diarrhea, abdominal distention and
abdominal pain with decreased appetite.  He underwent an
endoscopy and colonoscopy which the endoscopy revealed
esophagus with denuded mucosa, a heaped up mass at the
gastroesophageal junction, and an 8 mm ulcer in the antrum
with the clots just above recent bleed.  The colonoscopy was
negative.  Biopsies in the stomach revealed evidence of CMV.
Additionally, patient's CMV viral load came back positive at
4100 copies.  He was started on Ganciclovir on [**2118-7-7**].
The plan will be for twice a week CMV viral loads to be
followed.

Nausea, vomiting, and diarrhea:  There was a question of
graft-versus-host disease as the cause for this.  Patient was
started on Solu-Medrol empirically with waxing and [**Doctor Last Name 688**]
course.  Eventually he underwent the endoscopy and
colonoscopy described above which showed no evidence of graft-
versus-host disease.  Therefore, the cultures were titrated
down, and at the time of discharge the patient will be sent
home on 10 mg p.o. prednisone a day with a plan for continued
taper in the future.

Paralyzed right vocal cord:  Patient developed hoarseness,
therefore, underwent ENT evaluation which showed paralysis of
the right vocal cord.  He underwent MRI to look for any
compressive lesion of the recurrent laryngeal nerve.  This
was negative.  The ENT team therefore felt that the cause was
idiopathic or viral, and the possibility of a spontaneous
recovery.  They recommended a repeat scope in approximately
one month time unless there was a problem with aspiration, in
which case an earlier, more definitive procedure could be
performed.  A speech and swallow evaluation was performed
which revealed a small amount of aspiration.  Recommendations
were single sips only, no straw used, and ground solids.
Patient should be monitored for signs of aspiration, in which
case a more definitive procedure such as silicone injection
of the right vocal cord should be performed.

Right groin fluid collection:  Patient with a recurrent fluid
collection in right inguinal area.  Underwent multiple
drainages, the most recent on [**2118-6-15**].  Culture for the
fluid was negative.  This fluid needed to be drained due to
the concern of Methotrexate pooling at the location.  After
the last drain there was no recurrence.

Patient's was discharged to the BMT apartments in stable
condition.

FINAL DIAGNOSES:  Burkitt's type lymphoma.

Cytomegalovirus.

Vancomycin-resistant enterococcal bacteremia.

Acute renal failure.

Right vocal cord paralysis.

Sinusitis.

Mucositis.

RECOMMENDED FOLLOW UP:  Follow up daily at the BMT unit.

MAJOR SURGICAL OR INVASIVE PROCEDURES:  Include a Hickman,
laryngoscopy, EGD, colonoscopy.

DISCHARGE MEDICATIONS:
1. Ganciclovir 350 mg intravenous b.i.d. times 11 days.
2. Fluconazole 200 mg one tablet p.o. q. day.
3. Prednisone 10 mg p.o. q. day.
4. Protonix 40 mg p.o. b.i.d.
5. Ursodiol 300 mg p.o. q. day.
6. Paradex 15 cc p.o. b.i.d. swish and spit.
7. Clotrimazole troches one q.i.d.
8. Cyclosporin level 180 mg continuous infusion.  Dose to be
   adjusted by level.
9. Lopressor 25 mg p.o. b.i.d.
10.      Ativan 0.5 mg one to two tabs p.o. q. 4 to 6 hours
   as needed for nausea.





                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 33899**]

Dictated By:[**Last Name (NamePattern1) 12327**]
MEDQUIST36
D:  [**2118-7-9**] 17:05:50
T:  [**2118-7-11**] 12:17:21
Job#:  [**Job Number **]


Admission Date:                   Discharge Date: [**2118-7-12**]

Date of Birth:  [**2061-2-6**]        Sex:  M

Service: BMT

Attending:[**Doctor Last Name **]
DISCHARGE SUMMARY ADDENDUM:  Due to the difficulty obtaining
the keys to the BMT apartment, the patient remained in the
hospital for one further day.  He was discharged to the BMT
apartment on [**2118-7-12**].  The only change was a decrease in his
fluconazole to 100 mg p.o. every day.  All other discharge
medications including discharge diagnoses are unchanged from
the discharge summary dated [**2118-7-11**].



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 7779**], M.D.  [**MD Number(1) 7775**]

Dictated By:[**Last Name (NamePattern1) 12327**]
MEDQUIST36
D:  [**2118-9-3**] 13:03:11
T:  [**2118-9-3**] 14:37:21
Job#:  [**Job Number 106864**]
{"Burkitt's tumor or lymphoma, unspecified site, extranodal and solid organ sites,Bacteremia,Infection and inflammatory reaction due to other vascular device, implant, and graft,Hyposmolality and/or hyponatremia,Seroma complicating a procedure,Acquired hypertrophic pyloric stenosis,Paralysis of vocal cords or larynx, unspecified"}


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 57-year-old male
with Burkitt's type lymphoma originally diagnosed in [**12/2117**]
following a six week history of fatigue, night sweats, and
adenopathy, and testicular enlargement.  He underwent an
inguinal node biopsy on [**2117-12-16**].  Pathology revealed
diffuse replacement of the nodal architecture with extranodal
invasion of the surrounding fat consistent with a high-grade
lymphoid neoplasia.  A lumbar puncture was performed which
showed cerebrospinal fluid involvement and an Ommaya shunt
was placed on [**2117-12-19**].  CODOX was started [**2117-12-17**] and
Methotrexate started on [**2117-12-19**] via the Ommaya shunt.  He
is status post hospitalization for IVAC therapy from
[**2118-1-4**] to [**2118-1-8**] status post intrathecal ara-C on
[**2118-1-21**], and again on [**2118-2-25**]; status post CODOX and
Rituxan cycle on [**2118-1-24**] to12/19/[**2117**].  Status post
admission for high-dose methotrexate from [**2118-2-3**] to
[**2118-2-9**]; status post admission for IVAC cycle number four
but discontinued prematurely for pneumonia in [**2-/2118**]; status
post IVAC without Ifosfamide in 01/[**2118**].

MEDICAL HISTORY: As per History of Present Illness,
pyloric stenosis, ventricular hypertrophy, history of
ventricular ectopy and hypercholesterolemia.

MEDICATION ON ADMISSION: 1. Tylenol 25 a day
2. Compazine 10 mg q. 6 hours p.r.n. nausea.
3. Zofran p.r.n. nausea
4. Acyclovir 400 b.i.d.
5. Diflucan 200 q. day
6. Fentanyl patch 25 mcg q. day
7. Colace.
8. Vitamin B6.
9. Potassium chloride pills.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{"Burkitt's tumor or lymphoma, unspecified site, extranodal and solid organ sites,Bacteremia,Infection and inflammatory reaction due to other vascular device, implant, and graft,Hyposmolality and/or hyponatremia,Seroma complicating a procedure,Acquired hypertrophic pyloric stenosis,Paralysis of vocal cords or larynx, unspecified"}
