CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname **] is a 64-year-old male
with locally advanced distal esophageal cancer.  He has
recently underwent a distal esophagectomy under the care of
Dr. [**Last Name (STitle) **].  In addition, he received localized external
beam radial therapy and chemotherapy prior to his
esophagectomy, at which time he had received a Port-A-Cath in
[**2150-12-17**].  The esophagectomy was performed in
[**2151-3-19**].  During his work up for esophageal cancer, an
enhancing right upper pole real mass was identified.  MRA
showed this to be a 3x3 cm mass that enhances, therefore, had
a high likelihood of renal cell carcinoma.  He denied any
history of hematuria, abdominal or flank pain.

MEDICAL HISTORY: 1.  Esophageal cancer as stated above.
2.  History of peptic ulcer disease.

MEDICATION ON ADMISSION: 

ALLERGIES: PENICILLIN WHICH CAUSES HIVES.

PHYSICAL EXAM: VITAL SIGNS:  Pulse 76, blood pressure 120/70, respiratory
rate 18 with 96% room air saturation.  He was afebrile with a
temperature of 98.7?????? orally.
CHEST:  Port-A-Cath in right upper chest.  Incision site was
well healed, no erythema.
EXTREMITIES:  His upper extremities were non edematous.
Palpable pulses distally in the upper extremities.
HEAD, EARS, EYES, NOSE AND THROAT:  Unremarkable.  He had no
lymphadenopathy and septal neck.  His trachea was midline, no
jugular venous distention, no carotid bruits.
CARDIAC:  Regular rate and rhythm, normal S1 and S2, no
murmurs, rubs or gallops.
LUNGS:  Clear to auscultation bilaterally.
ABDOMEN:  Soft, nontender, no palpable masses.  No
costovertebral angle tenderness.  No inguinal
lymphadenopathy.  He does have a healed J-tube removal site.
GENITOURINARY:  He had a normal phallus, meatus and testis.
No inguinal hernia.
RECTAL:  Normal tone, 30 gm prostate, no nodularity, guaiac
negative.
EXTREMITIES and NEUROLOGIC:  He moves all four extremities
without difficulty.  Normal gait.  Neurologically and
mentally intact.

FAMILY HISTORY: His grandmother has diabetes, but no other
genitourinary cancer history.

SOCIAL HISTORY: He quit smoking 30 years ago.  He is an
engineer.  He drinks one cup of coffee per day and occasional
ethanol use.
Malignant neoplasm of kidney, except pelvis,Iatrogenic pneumothorax,Malignant neoplasm of lower third of esophagus,Other complications due to other vascular device, implant, and graft,Personal history of malignant neoplasm of esophagus
Malig neopl kidney,Iatrogenic pneumothorax,Mal neo lower 3rd esoph,Comp-oth vasc dev/graft,Hx-esophageal malignancy
Admission Date:  [**2151-7-2**]       Discharge Date:  [**2151-7-6**]

Date of Birth:   [**2086-10-29**]       Sex:  M

Service:  UROLOGY

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname **] is a 64-year-old male
with locally advanced distal esophageal cancer.  He has
recently underwent a distal esophagectomy under the care of
Dr. [**Last Name (STitle) **].  In addition, he received localized external
beam radial therapy and chemotherapy prior to his
esophagectomy, at which time he had received a Port-A-Cath in
[**2150-12-17**].  The esophagectomy was performed in
[**2151-3-19**].  During his work up for esophageal cancer, an
enhancing right upper pole real mass was identified.  MRA
showed this to be a 3x3 cm mass that enhances, therefore, had
a high likelihood of renal cell carcinoma.  He denied any
history of hematuria, abdominal or flank pain.

PAST MEDICAL HISTORY:
1.  Esophageal cancer as stated above.
2.  History of peptic ulcer disease.

PAST SURGICAL HISTORY:
1.  Distal esophagectomy occurring [**2151-3-19**] with Dr.
[**Last Name (STitle) **].
2.  He has had Port-A-Cath placement and an exploratory
laparotomy to rule out metastatic disease.  This was
performed simultaneously in [**2150-12-17**] by Dr.
[**Last Name (STitle) **].
3.  Additionally, he has had a pilonidal cyst excision.

SOCIAL HISTORY:  He quit smoking 30 years ago.  He is an
engineer.  He drinks one cup of coffee per day and occasional
ethanol use.

FAMILY HISTORY:  His grandmother has diabetes, but no other
genitourinary cancer history.

ALLERGIES:  PENICILLIN WHICH CAUSES HIVES.

ADMISSION MEDICATIONS:
1.  Zantac 75 mg twice day

ADMISSION PHYSICAL EXAM:
VITAL SIGNS:  Pulse 76, blood pressure 120/70, respiratory
rate 18 with 96% room air saturation.  He was afebrile with a
temperature of 98.7?????? orally.
CHEST:  Port-A-Cath in right upper chest.  Incision site was
well healed, no erythema.
EXTREMITIES:  His upper extremities were non edematous.
Palpable pulses distally in the upper extremities.
HEAD, EARS, EYES, NOSE AND THROAT:  Unremarkable.  He had no
lymphadenopathy and septal neck.  His trachea was midline, no
jugular venous distention, no carotid bruits.
CARDIAC:  Regular rate and rhythm, normal S1 and S2, no
murmurs, rubs or gallops.
LUNGS:  Clear to auscultation bilaterally.
ABDOMEN:  Soft, nontender, no palpable masses.  No
costovertebral angle tenderness.  No inguinal
lymphadenopathy.  He does have a healed J-tube removal site.
GENITOURINARY:  He had a normal phallus, meatus and testis.
No inguinal hernia.
RECTAL:  Normal tone, 30 gm prostate, no nodularity, guaiac
negative.
EXTREMITIES and NEUROLOGIC:  He moves all four extremities
without difficulty.  Normal gait.  Neurologically and
mentally intact.

SIGNIFICANT PREOPERATIVE LABS:  Hematocrit 25%, BUN and
creatinine of 34 and 0.7.

X-RAYS:  He had a CT and MRI that showed a 3 cm right upper
pole mass, stable over the last seven months.  He has an
exophytic lesion involving the upper pole as well.

HOSPITAL COURSE:  Given the enhancement, likely has a round
carcinoma.  The patient was scheduled for an open right
partial nephrectomy.  Informed consent was obtained.  In the
presurgical clinical visit on [**2151-7-2**], the patient went to
the Operating Room and underwent a partial right nephrectomy.
 The case was relatively uneventful.  He left the Operating
Room with a JP drain, chest tube and Foley catheter.  At the
postoperative check, he was noted to be afebrile.  Vitals
were otherwise stable.  Chest tube is draining 130 to 150 cc
of serosanguinous effluent.  JP drains approximately 210 cc.
Postoperative hematocrit was 25.3, white count 13.3, platelet
count 300.  Chemistries significant for a BUN/creatinine of
17.___.  Chest x-ray postoperatively showed no evidence of
pneumothorax.  Chest tube in good position.  He did have
basilar atelectasis on the right side and a small right
effusion.  Otherwise, no acute cardiopulmonary disease.  His
epidural would be utilized for pain control.  His oxygen was
weaned appropriately.  He was encouraged to ambulate the
following day and his hematocrit was followed serially.

On postoperative day #1, he had an epidural in place.  Blood
pressure was stable at 100 systolic.  He was started on a
clear liquid diet.  He completed his perioperative Ancef and
was ultimately transferred to the floor.  By postoperative
day #2, the patient was tolerating clears.  He had had some
flatus.  No nausea or vomiting.  He was out of bed
ambulating.  At this time, his epidural was capped and
flagged and he was started on Percocet.  Chest tube was
removed.  Follow up chest x-ray showed no evidence of
pneumothorax.  He was stable.  Hematocrit continued to be
stable.  On postoperative day #3, the patient had had the
epidural completely removed although it had been previously
capped and flagged.  Again, he was out of bed ambulating.  He
did not pass flatus, so he was kept on a clear liquid diet.

At this point, he had developed a right upper extremity IJ
clot related to his Port-A-Cath.  This was discovered on the
evening of postoperative day #2 into postoperative day #3.
Vascular and surgical consultation had been obtained.  They
had recommended removal of the catheter and heparinization
and Coumadinization.  Total treatment length for the Coumadin
therapy was to be six months.  Given the fact that he had
undergone recent partial nephrectomy, Dr. [**Last Name (STitle) 4229**] declined to
have the patient put on heparin.  He was just given arm
elevation and his right subclavian Port-A-Cath was removed on
postoperative day #3 by Dr.[**Name (NI) 1482**] service.  This was
done uneventfully and done under local anesthesia.  After his
conservative therapy, his right upper extremity arm edema had
decreased somewhat.  He was started on Coumadin on
postoperative day #3, receiving an 8 mg dose.  His ultimate
doses for Coumadin and management for his PT/INR with a goal
of 2 to 2.5 are to be managed by Dr. [**Last Name (STitle) 838**], his primary
care physician.  [**Name10 (NameIs) **] is a [**Hospital3 **] physician at the
[**Name9 (PRE) **] office.  PT/INR values will be sent to his office
and they will be evaluated accordingly.  His discharge INR
was 1.2 with a PTT of 26 and a PT of 13.  Discharge
hematocrit was 28.4, platelet count 224,000.  White count was
7.5000.  BUN and creatinine were 14 and 0.9.

DISCHARGE MEDICATIONS:
1.  Percocet 5/325 1 to 2 tablets po q 4 to 6 prn
2.  Colace 100 mg po bid prn
3.  Zantac 150 mg po bid
4.  Coumadin 4 mg per day, ultimate dosage to be titrated per
patient's primary care provider.

FOLLOW UP INSTRUCTIONS:  See Dr. [**Last Name (STitle) 4229**] in approximately 7 to
10 days.  His staples were removed on the time of discharge
with Steri-Strips placed uneventfully at time of follow up.
He will be reassessed to see how the progression in his right
upper extremity edema had gone.  This had markedly improved
over 36 hours of conservative management.  Additionally, the
patient should follow up with his primary care physician in
approximately 7 to 10 days and to have a PT/INR drawn in
approximately two days from time of discharge with results
being sent to the primary care physician as previously
stated.

DISCHARGE DIAGNOSES:
1.  Status post open right partial nephrectomy for exophytic
3.3 lower pole renal mass presumed to be renal carcinoma.
Final pathology is pending.  Please see final path report for
further detail.
2.  Esophageal cancer, status post chemotherapy XRT in
[**2151-1-16**], status post esophagogastrectomy Ivor-[**Doctor Last Name **]
procedure with Dr. [**Last Name (STitle) **] in [**2151-3-19**].
3.  Right IJ central vein deep venous thrombosis under
treatment, status post right subclavian Port-A-Cath removal
during same hospitalization.

DISCHARGE CONDITION:  Stable

DISCHARGE STATUS:  Home

Follow up plans as stated above.




                            [**Doctor First Name **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) **]

Dictated By:[**Last Name (NamePattern4) 3204**]
MEDQUIST36

D:  [**2151-7-6**]  06:43
T:  [**2151-7-6**]  07:01
JOB#:  [**Job Number 21995**]
{'Malignant neoplasm of kidney, except pelvis,Iatrogenic pneumothorax,Malignant neoplasm of lower third of esophagus,Other complications due to other vascular device, implant, and graft,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: Mr. [**Known lastname **] is a 64-year-old male
with locally advanced distal esophageal cancer.  He has
recently underwent a distal esophagectomy under the care of
Dr. [**Last Name (STitle) **].  In addition, he received localized external
beam radial therapy and chemotherapy prior to his
esophagectomy, at which time he had received a Port-A-Cath in
[**2150-12-17**].  The esophagectomy was performed in
[**2151-3-19**].  During his work up for esophageal cancer, an
enhancing right upper pole real mass was identified.  MRA
showed this to be a 3x3 cm mass that enhances, therefore, had
a high likelihood of renal cell carcinoma.  He denied any
history of hematuria, abdominal or flank pain.

MEDICAL HISTORY: 1.  Esophageal cancer as stated above.
2.  History of peptic ulcer disease.

MEDICATION ON ADMISSION: 

ALLERGIES: PENICILLIN WHICH CAUSES HIVES.

PHYSICAL EXAM: VITAL SIGNS:  Pulse 76, blood pressure 120/70, respiratory
rate 18 with 96% room air saturation.  He was afebrile with a
temperature of 98.7?????? orally.
CHEST:  Port-A-Cath in right upper chest.  Incision site was
well healed, no erythema.
EXTREMITIES:  His upper extremities were non edematous.
Palpable pulses distally in the upper extremities.
HEAD, EARS, EYES, NOSE AND THROAT:  Unremarkable.  He had no
lymphadenopathy and septal neck.  His trachea was midline, no
jugular venous distention, no carotid bruits.
CARDIAC:  Regular rate and rhythm, normal S1 and S2, no
murmurs, rubs or gallops.
LUNGS:  Clear to auscultation bilaterally.
ABDOMEN:  Soft, nontender, no palpable masses.  No
costovertebral angle tenderness.  No inguinal
lymphadenopathy.  He does have a healed J-tube removal site.
GENITOURINARY:  He had a normal phallus, meatus and testis.
No inguinal hernia.
RECTAL:  Normal tone, 30 gm prostate, no nodularity, guaiac
negative.
EXTREMITIES and NEUROLOGIC:  He moves all four extremities
without difficulty.  Normal gait.  Neurologically and
mentally intact.

FAMILY HISTORY: His grandmother has diabetes, but no other
genitourinary cancer history.

SOCIAL HISTORY: He quit smoking 30 years ago.  He is an
engineer.  He drinks one cup of coffee per day and occasional
ethanol use. 

### Response:
{'Malignant neoplasm of kidney, except pelvis,Iatrogenic pneumothorax,Malignant neoplasm of lower third of esophagus,Other complications due to other vascular device, implant, and graft,Personal history of malignant neoplasm of esophagus'}
