CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 78-year-old male who
presents postoperative day 2 status post transrectal biopsy
of the prostate with fever and malaise after which time he
had a 30 second episode of syncope. No seizure activity was
noted at the time. He had no postictal state. His vital signs
were stable immediately after he regained consciousness. At
that time he was taken to the emergency room at which point
his temperature was noted to be 101.8 degrees Fahrenheit. He
has also noted some dysuria 1 day prior to presentation which
has since resolved.

MEDICAL HISTORY: Significant for increased PSA as well
as history of rheumatic fever as a child. The patient also
notes that he has an Achilles tendon which has ruptured for
which he is scheduled to have a surgical repair sometime this
summer.

MEDICATION ON ADMISSION: 

ALLERGIES: In the ER he was noted to have an allergy after
he got an infusion of levofloxacin. For this reason we now
list levofloxacin as an allergy.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for cardiac disease and
intestinal/ colon cancer.

SOCIAL HISTORY: He denies use of alcohol or tobacco or other
narcotics.
Other postoperative infection,Septicemia due to escherichia coli [E. coli],Sepsis,Urinary tract infection, site not specified,Thrombocytopenia, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Other postop infection,E coli septicemia,Sepsis,Urin tract infection NOS,Thrombocytopenia NOS,Abn react-surg proc NEC
Admission Date: [**2189-6-5**]        Discharge Date: [**2189-6-9**]

Date of Birth:  [**2111-3-19**]        Sex:  M

Service:  GU


HISTORY OF PRESENT ILLNESS:  This is a 78-year-old male who
presents postoperative day 2 status post transrectal biopsy
of the prostate with fever and malaise after which time he
had a 30 second episode of syncope. No seizure activity was
noted at the time. He had no postictal state. His vital signs
were stable immediately after he regained consciousness. At
that time he was taken to the emergency room at which point
his temperature was noted to be 101.8 degrees Fahrenheit. He
has also noted some dysuria 1 day prior to presentation which
has since resolved.

PAST MEDICAL HISTORY:  Significant for increased PSA as well
as history of rheumatic fever as a child. The patient also
notes that he has an Achilles tendon which has ruptured for
which he is scheduled to have a surgical repair sometime this
summer.

FAMILY HISTORY:  Significant for cardiac disease and
intestinal/ colon cancer.

SOCIAL HISTORY:  He denies use of alcohol or tobacco or other
narcotics.

MEDICATIONS AT HOME:
1.  Aspirin, which he has stopped.
2.  Lipitor, which has also been stopped.
3.  Cipro 3 day course which was taking preoperatively after
    his transrectal biopsy of his prostate and he is
    finished.

ALLERGIES:  In the ER he was noted to have an allergy after
he got an infusion of levofloxacin. For this reason we now
list levofloxacin as an allergy.

REVIEW OF SYMPTOMS:  The patient states he has lost 10 pounds
over the past year while trying. He has been sleeping more
since [**2189-4-20**], but has been having normal bowel
movements.

PHYSICAL EXAMINATION:  His temperature was 101.7 Fahrenheit,
his heart rate was 86, his blood pressure was 99/50, and his
respiratory rate was 22 and he was saturating 98% on 2 liters
nasal cannula. GENERAL: This is an elderly male in no acute
distress.  He is awake, alert and oriented x3. He moves all
extremities. PULMONARY:  Crackles in the right posterior base
[**12-23**] of the way up. CARDIOVASCULAR: He has regular rate and
rhythm. S1 and S2 clearly heard. No murmurs, rubs or gallops.
ABDOMEN: His abdomen is soft and nontender, nondistended. His
bowel sounds are present. GENITOURINARY:  No prostatic
tenderness. Normal rectal tone. Normal if large prostate.
His extremities reveal no edema. Pedal pulses aer present
bilaterally.

IMAGING ON ADMISSION:  Chest x-ray shows no acute process.
EKG shows normal sinus rhythm with Q waves noted in leads 3
and T-wave inversion in lead 3, otherwise there are no
abnormalities.

LABORATORY DATA:  His sodium is 137, potassium 4.1, chloride
102, bicarbonate 25, BUN 21, creatinine was 1.0, and glucose
149. His CBC shows white count 7.8, hematocrit 37.3, and
platelets 133. His UA is positive for small leukocytes, large
blood with 17 red blood cells, 54 white blood cells, and a
few bacteria noted.

PROCEDURE PERFORMED:  None.

CONCISE SUMMARY OF HOSPITAL COURSE:  The patient was
resuscitated in the ER with 2 liters of normal saline after
which time he had a hypotensive episode into the 80s systolic
and 40s diastolic. At this time it was noted that he already
had 2 liters of IV fluid and he was not responsive to this.
For this reason he was put on a sepsis protocol and a central
line was started. The patient was started on a Levophed drip.
He was transferred to the surgical intensive care unit at
which time he was observed over the course of the evening to
continue his resuscitation and we were able to wean him off
the Levophed on hospital day 2. The patient was transferred
out of the intensive care unit to the floor, stable and off
pressors. The patient had been started on broad spectrum
antibiotic treatment on admission. This antibiotic treatment
continued to be refined as he continued to spike fevers, and
awaiting for blood and urine culture results. The blood and
urine culture ultimately grew out the same E.coli that was
poly drug resistant. This E.coli grew out of 3 or 4 blood
cultures that was taken on the day of hospital day 1 and
hospital day 2 as well as the urine culture that was taken on
hospital day 1. The blood cultures on hospital day 3 and
hospital day 4 were all negative for growth as well as the
urine culture on hospital day 3 and hospital day 6.

When the sensitivities of the E.coli came back, those being
poly-drug resistant, the patient's medications were changed
over to ceftazidime to which the organism was noted to be
sensitive. The patient was maintained on ceftazidime starting
on the evening of hospital day 2 and continuing through
hospital day 4 at which time the patient was changed to
Bactrim double strength 1 PO b.i.d. The patient was observed
on this medical regimen for 24 hours after which time he was
noted to have remained afebrile and asymptomatic. At this
time the patient was discharged to home, tolerating a regular
diet, afebrile with a stable white count of 4.8.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  To home.

DISCHARGE DIAGNOSIS:  Postoperative septicemia.

DISCHARGE MEDICATIONS:
1.  Bactrim double strength, to take 1 PO b.i.d for 4 weeks.
2.  Pyridium 100 mg 1 PO q.8 p.r.n. for 3 days

RECOMMENDED FOLLOW UP:  The patient was given follow up plans
with Dr. [**Last Name (STitle) **]. He was instructed to follow up with Dr. [**First Name8 (NamePattern2) **]
[**Name (STitle) **] [**Name (STitle) **] in 1 week's time. He was also given the phone
number for Dr.[**Name (NI) 10529**] office for his convenience.


                        [**First Name8 (NamePattern2) **] [**Name6 (MD) **] [**Name8 (MD) **], MD [**MD Number(2) 111611**]

Dictated By:[**Last Name (NamePattern1) 5032**]
MEDQUIST36
D:  [**2189-6-10**] 18:32:24
T:  [**2189-6-11**] 01:11:41
Job#:  [**Job Number 111612**]

cc:[**Name8 (MD) 111613**]
{'Other postoperative infection,Septicemia due to escherichia coli [E. coli],Sepsis,Urinary tract infection, site not specified,Thrombocytopenia, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}


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: This is a 78-year-old male who
presents postoperative day 2 status post transrectal biopsy
of the prostate with fever and malaise after which time he
had a 30 second episode of syncope. No seizure activity was
noted at the time. He had no postictal state. His vital signs
were stable immediately after he regained consciousness. At
that time he was taken to the emergency room at which point
his temperature was noted to be 101.8 degrees Fahrenheit. He
has also noted some dysuria 1 day prior to presentation which
has since resolved.

MEDICAL HISTORY: Significant for increased PSA as well
as history of rheumatic fever as a child. The patient also
notes that he has an Achilles tendon which has ruptured for
which he is scheduled to have a surgical repair sometime this
summer.

MEDICATION ON ADMISSION: 

ALLERGIES: In the ER he was noted to have an allergy after
he got an infusion of levofloxacin. For this reason we now
list levofloxacin as an allergy.

PHYSICAL EXAM: 

FAMILY HISTORY: Significant for cardiac disease and
intestinal/ colon cancer.

SOCIAL HISTORY: He denies use of alcohol or tobacco or other
narcotics. 

### Response:
{'Other postoperative infection,Septicemia due to escherichia coli [E. coli],Sepsis,Urinary tract infection, site not specified,Thrombocytopenia, unspecified,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
