CHIEF COMPLAINT: 

PRESENT ILLNESS: This 57-year-old white male has
a history of insulin dependent diabetes, peripheral vascular
disease, and coronary artery disease.  He is status post CABG
x 4 on [**2170-3-6**] with LIMA to the LAD, reversed saphenous vein
graft to diagonal, OM and PDA.  He had an unremarkable postop
course and was discharged to rehab on [**2170-3-14**].  He now
returns to the Emergency Room complaining of right stabbing
chest pain which began the night prior to admission.  There
is inferior sternal wound drainage which began a few days
ago.  He had no fever at home, and has had intermittent chest
pain since discharge from rehab.  He had his staples removed
5 days ago, and cultures were taken at that time.

MEDICAL HISTORY: 1. Coronary artery disease status post CABG x 4, [**2170-3-6**],
with LIMA to the LAD, reversed saphenous vein graft to the
diagonal, saphenous vein graft to the OM, and saphenous vein
graft to the PDA.
2. History of insulin dependent diabetes.
3. Status post MI.
4. History of peripheral vascular disease.
5. Status post right popliteal pedal bypass in [**2170-1-8**].
6. History of hypertension.
7. History of retinopathy.
8. History of peripheral neuropathy.

MEDICATION ON ADMISSION: 1. Captopril 12.5 mg po tid.
2. Lopressor 50 mg po bid.
3. Protonix 40 mg po qd.
4. Levaquin 500 mg po qd.
5. Percocet prn.
6. Lantus 45 U subcu q pm.
7. Humalog sliding scale.

ALLERGIES: He has no known allergies.

PHYSICAL EXAM: He is a well-developed, well nourished white
male who has rigors.  His temp was 102.5, heart rate 70,
blood pressure 126/63.
HEENT:  Normocephalic, atraumatic.  Extraocular movements
intact.  Oropharynx benign.
NECK:  Supple, full range of motion, no lymphadenopathy or
thyromegaly.  Carotids 2+ and equal bilaterally without
bruits.
LUNGS:  Decreased breath sounds at the left base.
CARDIOVASCULAR:  Regular rate and rhythm, normal S1, S2, with
no rubs, murmurs or gallops.
STERNUM:  Stable.  The inferior pole has erythema with a 2 mm
opening with purulent drainage.
ABDOMEN:  Soft, nontender with positive bowel sounds.  No
masses or hepatosplenomegaly.
EXTREMITIES:  Without clubbing, cyanosis or edema.  His right
foot has a fifth plantar ulcer, and the left heel has a
medial ulcer which were clean without erythema.

FAMILY HISTORY: Unremarkable.

SOCIAL HISTORY: He smoked for 10 years and then quit.  He
does not drink alcohol.
Other postoperative infection,Ulcer of other part of foot,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,Unspecified osteomyelitis, other specified sites,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Old myocardial infarction,Atherosclerosis of native arteries of the extremities with ulceration,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site
Other postop infection,Ulcer other part of foot,Abn react-anastom/graft,Osteomyelit NOS-oth site,Cor ath unsp vsl ntv/gft,Aortocoronary bypass,Old myocardial infarct,Ath ext ntv art ulcrtion,Mth sus Stph aur els/NOS
Admission Date:  [**2170-4-1**]       Discharge Date:  [**2170-4-11**]

Date of Birth:   [**2112-4-3**]       Sex:  M

Service:  CARDIOTHORACIC SURGERY

HISTORY OF PRESENT ILLNESS:  This 57-year-old white male has
a history of insulin dependent diabetes, peripheral vascular
disease, and coronary artery disease.  He is status post CABG
x 4 on [**2170-3-6**] with LIMA to the LAD, reversed saphenous vein
graft to diagonal, OM and PDA.  He had an unremarkable postop
course and was discharged to rehab on [**2170-3-14**].  He now
returns to the Emergency Room complaining of right stabbing
chest pain which began the night prior to admission.  There
is inferior sternal wound drainage which began a few days
ago.  He had no fever at home, and has had intermittent chest
pain since discharge from rehab.  He had his staples removed
5 days ago, and cultures were taken at that time.

PAST MEDICAL HISTORY:
1. Coronary artery disease status post CABG x 4, [**2170-3-6**],
with LIMA to the LAD, reversed saphenous vein graft to the
diagonal, saphenous vein graft to the OM, and saphenous vein
graft to the PDA.
2. History of insulin dependent diabetes.
3. Status post MI.
4. History of peripheral vascular disease.
5. Status post right popliteal pedal bypass in [**2170-1-8**].
6. History of hypertension.
7. History of retinopathy.
8. History of peripheral neuropathy.

MEDICATIONS ON ADMISSION:
1. Captopril 12.5 mg po tid.
2. Lopressor 50 mg po bid.
3. Protonix 40 mg po qd.
4. Levaquin 500 mg po qd.
5. Percocet prn.
6. Lantus 45 U subcu q pm.
7. Humalog sliding scale.

ALLERGIES:  He has no known allergies.

SOCIAL HISTORY:  He smoked for 10 years and then quit.  He
does not drink alcohol.

FAMILY HISTORY:  Unremarkable.

PHYSICAL EXAM:  He is a well-developed, well nourished white
male who has rigors.  His temp was 102.5, heart rate 70,
blood pressure 126/63.
HEENT:  Normocephalic, atraumatic.  Extraocular movements
intact.  Oropharynx benign.
NECK:  Supple, full range of motion, no lymphadenopathy or
thyromegaly.  Carotids 2+ and equal bilaterally without
bruits.
LUNGS:  Decreased breath sounds at the left base.
CARDIOVASCULAR:  Regular rate and rhythm, normal S1, S2, with
no rubs, murmurs or gallops.
STERNUM:  Stable.  The inferior pole has erythema with a 2 mm
opening with purulent drainage.
ABDOMEN:  Soft, nontender with positive bowel sounds.  No
masses or hepatosplenomegaly.
EXTREMITIES:  Without clubbing, cyanosis or edema.  His right
foot has a fifth plantar ulcer, and the left heel has a
medial ulcer which were clean without erythema.

LABORATORY:  White count on admission 11.2.  He had cultures
taken on [**3-27**] which revealed MRSA.

HOSPITAL COURSE:  So, he was admitted and started on IV vanco
and Zosyn.  He was also seen by vascular surgery who
continued to recommend dressing changes.  He continued to
have sternal drainage, and the lower pole of his wound was
opened up on hospital day #1, and he continued to have
profuse drainage.  His white count rose to 20,000.  He
continued to have low-grade temps.

On [**4-4**], he went to the OR for sternal debridement.  He was
transferred to the CSRU in stable condition.  Plastic surgery
was consulted, and on [**4-7**], Dr. [**First Name (STitle) **] did a bilateral pec flap
closure of the sternum.  The patient tolerated the procedure
well and had a stable postop course.  He had his [**3-13**] JP
drains DC'd, and on postop day #4, he was discharged to home
in stable condition with one JP still in place.  He will be
followed by plastic surgery in one week to have the drain
removed.  He will also be followed by Dr. [**Last Name (STitle) **] in 3 weeks,
and Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) 1007**] in [**2-9**] weeks.

DISCHARGE MEDICATIONS:
1. Ecotrin 325 mg po qd.
2. Protonix 40 mg po qd.
3. Lopressor 50 mg po bid.
4. Percocet [**2-9**] po q 4-6 h prn pain.
5. Colace 100 mg po bid.
6. Captopril 12.5 mg po tid.
7. Vancomycin 1,250 mg IV bid x 24 days.
8. Lantus 45 U subcu q hs.
9. Humalog insulin sliding scale.

LABS ON DISCHARGE:  Hematocrit 30.1, white count 13,200,
platelets 546,000, sodium 137, potassium 4.4, chloride 102,
CO2 28, BUN 25, creatinine 1.0, blood sugar 141.

DISCHARGE DIAGNOSES:
1. Sternal wound infection.
2. Coronary artery disease.
3. Insulin dependent diabetes.
4. Hypertension.
5. Peripheral vascular disease.




                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3113**]

Dictated By:[**Last Name (NamePattern1) 11726**]
MEDQUIST36

D:  [**2170-4-11**]  13:57
T:  [**2170-4-11**]  14:25
JOB#:  [**Telephone/Fax (2) 54304**]


Admission Date:  [**2170-4-1**]       Discharge Date:  [**2170-4-11**]

Date of Birth:   [**2112-4-3**]       Sex:  M

Service:  CARDIOTHORACIC SURGERY

HISTORY OF PRESENT ILLNESS:  This 57-year-old white male has
a history of insulin dependent diabetes, peripheral vascular
disease, and coronary artery disease.  He is status post CABG
x 4 on [**2170-3-6**] with LIMA to the LAD, reversed saphenous vein
graft to diagonal, OM and PDA.  He had an unremarkable postop
course and was discharged to rehab on [**2170-3-14**].  He now
returns to the Emergency Room complaining of right stabbing
chest pain which began the night prior to admission.  There
is inferior sternal wound drainage which began a few days
ago.  He had no fever at home, and has had intermittent chest
pain since discharge from rehab.  He had his staples removed
5 days ago, and cultures were taken at that time.

PAST MEDICAL HISTORY:
1. Coronary artery disease status post CABG x 4, [**2170-3-6**],
with LIMA to the LAD, reversed saphenous vein graft to the
diagonal, saphenous vein graft to the OM, and saphenous vein
graft to the PDA.
2. History of insulin dependent diabetes.
3. Status post MI.
4. History of peripheral vascular disease.
5. Status post right popliteal pedal bypass in [**2170-1-8**].
6. History of hypertension.
7. History of retinopathy.
8. History of peripheral neuropathy.

MEDICATIONS ON ADMISSION:
1. Captopril 12.5 mg po tid.
2. Lopressor 50 mg po bid.
3. Protonix 40 mg po qd.
4. Levaquin 500 mg po qd.
5. Percocet prn.
6. Lantus 45 U subcu q pm.
7. Humalog sliding scale.

ALLERGIES:  He has no known allergies.

SOCIAL HISTORY:  He smoked for 10 years and then quit.  He
does not drink alcohol.

FAMILY HISTORY:  Unremarkable.

PHYSICAL EXAM:  He is a well-developed, well nourished white
male who has rigors.  His temp was 102.5, heart rate 70,
blood pressure 126/63.
HEENT:  Normocephalic, atraumatic.  Extraocular movements
intact.  Oropharynx benign.
NECK:  Supple, full range of motion, no lymphadenopathy or
thyromegaly.  Carotids 2+ and equal bilaterally without
bruits.
LUNGS:  Decreased breath sounds at the left base.
CARDIOVASCULAR:  Regular rate and rhythm, normal S1, S2, with
no rubs, murmurs or gallops.
STERNUM:  Stable.  The inferior pole has erythema with a 2 mm
opening with purulent drainage.
ABDOMEN:  Soft, nontender with positive bowel sounds.  No
masses or hepatosplenomegaly.
EXTREMITIES:  Without clubbing, cyanosis or edema.  His right
foot has a fifth plantar ulcer, and the left heel has a
medial ulcer which were clean without erythema.

LABORATORY:  White count on admission 11.2.  He had cultures
taken on [**3-27**] which revealed MRSA.

HOSPITAL COURSE:  So, he was admitted and started on IV vanco
and Zosyn.  He was also seen by vascular surgery who
continued to recommend dressing changes.  He continued to
have sternal drainage, and the lower pole of his wound was
opened up on hospital day #1, and he continued to have
profuse drainage.  His white count rose to 20,000.  He
continued to have low-grade temps.

On [**4-4**], he went to the OR for sternal debridement.  He was
transferred to the CSRU in stable condition.  Plastic surgery
was consulted, and on [**4-7**], Dr. [**First Name (STitle) **] did a bilateral pec flap
closure of the sternum.  The patient tolerated the procedure
well and had a stable postop course.  He had his [**3-13**] JP
drains DC'd, and on postop day #4, he was discharged to home
in stable condition with one JP still in place.  He will be
followed by plastic surgery in one week to have the drain
removed.  He will also be followed by Dr. [**Last Name (STitle) **] in 3 weeks,
and Dr. [**Last Name (STitle) **] and Dr. [**Last Name (STitle) 1007**] in [**2-9**] weeks.

DISCHARGE MEDICATIONS:
1. Ecotrin 325 mg po qd.
2. Protonix 40 mg po qd.
3. Lopressor 50 mg po bid.
4. Percocet [**2-9**] po q 4-6 h prn pain.
5. Colace 100 mg po bid.
6. Captopril 12.5 mg po tid.
7. Vancomycin 1,250 mg IV bid x 24 days.
8. Lantus 45 U subcu q hs.
9. Humalog insulin sliding scale.

LABS ON DISCHARGE:  Hematocrit 30.1, white count 13,200,
platelets 546,000, sodium 137, potassium 4.4, chloride 102,
CO2 28, BUN 25, creatinine 1.0, blood sugar 141.

DISCHARGE DIAGNOSES:
1. Sternal wound infection.
2. Coronary artery disease.
3. Insulin dependent diabetes.
4. Hypertension.
5. Peripheral vascular disease.




                            [**First Name11 (Name Pattern1) 1112**] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3113**]

Dictated By:[**Last Name (NamePattern1) 11726**]
MEDQUIST36

D:  [**2170-4-11**]  13:57
T:  [**2170-4-11**]  14:25
JOB#:  [**Telephone/Fax (2) 54303**]
{'Other postoperative infection,Ulcer of other part of foot,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,Unspecified osteomyelitis, other specified sites,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Old myocardial infarction,Atherosclerosis of native arteries of the extremities with ulceration,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}


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 57-year-old white male has
a history of insulin dependent diabetes, peripheral vascular
disease, and coronary artery disease.  He is status post CABG
x 4 on [**2170-3-6**] with LIMA to the LAD, reversed saphenous vein
graft to diagonal, OM and PDA.  He had an unremarkable postop
course and was discharged to rehab on [**2170-3-14**].  He now
returns to the Emergency Room complaining of right stabbing
chest pain which began the night prior to admission.  There
is inferior sternal wound drainage which began a few days
ago.  He had no fever at home, and has had intermittent chest
pain since discharge from rehab.  He had his staples removed
5 days ago, and cultures were taken at that time.

MEDICAL HISTORY: 1. Coronary artery disease status post CABG x 4, [**2170-3-6**],
with LIMA to the LAD, reversed saphenous vein graft to the
diagonal, saphenous vein graft to the OM, and saphenous vein
graft to the PDA.
2. History of insulin dependent diabetes.
3. Status post MI.
4. History of peripheral vascular disease.
5. Status post right popliteal pedal bypass in [**2170-1-8**].
6. History of hypertension.
7. History of retinopathy.
8. History of peripheral neuropathy.

MEDICATION ON ADMISSION: 1. Captopril 12.5 mg po tid.
2. Lopressor 50 mg po bid.
3. Protonix 40 mg po qd.
4. Levaquin 500 mg po qd.
5. Percocet prn.
6. Lantus 45 U subcu q pm.
7. Humalog sliding scale.

ALLERGIES: He has no known allergies.

PHYSICAL EXAM: He is a well-developed, well nourished white
male who has rigors.  His temp was 102.5, heart rate 70,
blood pressure 126/63.
HEENT:  Normocephalic, atraumatic.  Extraocular movements
intact.  Oropharynx benign.
NECK:  Supple, full range of motion, no lymphadenopathy or
thyromegaly.  Carotids 2+ and equal bilaterally without
bruits.
LUNGS:  Decreased breath sounds at the left base.
CARDIOVASCULAR:  Regular rate and rhythm, normal S1, S2, with
no rubs, murmurs or gallops.
STERNUM:  Stable.  The inferior pole has erythema with a 2 mm
opening with purulent drainage.
ABDOMEN:  Soft, nontender with positive bowel sounds.  No
masses or hepatosplenomegaly.
EXTREMITIES:  Without clubbing, cyanosis or edema.  His right
foot has a fifth plantar ulcer, and the left heel has a
medial ulcer which were clean without erythema.

FAMILY HISTORY: Unremarkable.

SOCIAL HISTORY: He smoked for 10 years and then quit.  He
does not drink alcohol. 

### Response:
{'Other postoperative infection,Ulcer of other part of foot,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,Unspecified osteomyelitis, other specified sites,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status,Old myocardial infarction,Atherosclerosis of native arteries of the extremities with ulceration,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}
