CHIEF COMPLAINT: Severe stenosis of the left main stem bronchus with complete
left lung obstruction

PRESENT ILLNESS: 52M trached with relapsing polychondritis and associated
tracheobronchomalacia status post multiple airways endobronchial
interventions including stent
placement and subsequent removal now presenting with lung
collapse secondary to endobronchial obstruction with granulation
tissue.

MEDICAL HISTORY: PMH: Polychondritis, TBM, GERD

MEDICATION ON ADMISSION: Albuterol nebs, lovenox 40mg SQ daily,
pulmozyme 5mg [**Hospital1 **], Tessalon 100mg po TID, Protonix 40mg daily,
Solumedrol 30mg IV q12h, Claritin 10mg daily, Pipracil 3gm IV
q4h, Novolog 7 units before each meal

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: SocHx: former smoker, quit x1yr; occasional alcohol; no
recreational drugs
Other diseases of trachea and bronchus,Pulmonary collapse,Postinflammatory pulmonary fibrosis,Other disorders of bone and cartilage,Leukocytosis, unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Unilateral paralysis of vocal cords or larynx, partial,Esophageal reflux,Attention to tracheostomy,Personal history of malignant neoplasm of testis,Other chronic pulmonary heart diseases,Acute post-thoracotomy pain,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
Trachea & bronch dis NEC,Pulmonary collapse,Postinflam pulm fibrosis,Bone & cartilage dis NEC,Leukocytosis NOS,Adv eff corticosteroids,Vocal paral unilat part,Esophageal reflux,Atten to tracheostomy,Hx-testicular malignancy,Chr pulmon heart dis NEC,Acute post-thoracot pain,Abn reac-organ rem NEC
Admission Date:  [**2177-10-7**]              Discharge Date:   [**2177-10-26**]

Date of Birth:  [**2125-11-3**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2969**]
Chief Complaint:
Severe stenosis of the left main stem bronchus with complete
left lung obstruction

Major Surgical or Invasive Procedure:
Bronchoscopy, left pneumonectomy

History of Present Illness:
52M trached with relapsing polychondritis and associated
tracheobronchomalacia status post multiple airways endobronchial
interventions including stent
placement and subsequent removal now presenting with lung
collapse secondary to endobronchial obstruction with granulation
tissue.

One month ago, patient underwent left bronchotomy for removal of
metal stent,
subsequently developed progressive stenosis in the left main
stent with subsequent total collapse of the left lung.

Past Medical History:
PMH: Polychondritis, TBM, GERD

PSH: s/p orchiectomy for seminoma, s/p B BMS to the [**Hospital1 **] and LMSB
(both have since removed), Y stent placement and [**Location (un) **]
T-tube placement in [**Location (un) 5622**], Y-stent and T-tube
removal/perc
trach [**2177-6-19**] by Dr. [**Last Name (STitle) **], s/p  L thoracotomy, posterior main
stem bronchotomy w/ bronchial stent removal and primary closure,
LLLobectomy


Social History:
SocHx: former smoker, quit x1yr; occasional alcohol; no
recreational drugs


Family History:
Non-contributory.


Pertinent Results:
[**2177-10-8**] 07:00AM BLOOD WBC-11.7* RBC-4.96# Hgb-12.6* Hct-38.7*#
MCV-78* MCH-25.4* MCHC-32.6 RDW-15.4 Plt Ct-291


Brief Hospital Course:
Mr. [**Known lastname **], who is well known to the thoracic surgery service,
was admitted on [**2177-10-7**] with a left lung collapse secondary to
endobronchial obstruction with granulation tissue. Bronchoscopy
was performed on this date by Interventional Pulmonology, who
found that around the mid distal left mainstem the lumen was
progressively narrowed until it was a pinpoint size. The distal
left mainstem or the upper or the lower lobe orifices could not
be visualized. The patient returned to the floor after the
procedure in good condition and resumed a regular diet.

On [**2177-10-9**], repeat bronchoscopy was performed by Interventional
Pulmonology, who at this point found severe stenosis of the left
main stem bronchus with no visible distal airways that could be
visualized during this procedure. Plans were consequently made
for left pneumonectomy as endobronchial attempts to open up the
left mainstem bronchus had failed.

On [**10-12**] the patient's trach was converted from a cuffed
non-fenestrated to a noncuffed fenestrated in order to allow him
to speak.

On [**10-14**], the patient underwent a left pneumonectomy. He
tolerated the procedure well and spent 2 days in the SICU.

On [**10-15**], he was seen by ENT who performed a bedside
laryngoscopy and found left vocal cord paralysis. His left IJ
was rewired. He was transfused 1 unit of pRBCsfor an Hct of
24.5, which had dropped from 28.9. His Hct was 24.8 after the
unit of blood

On [**10-16**], his fluids were stopped for mild volume overload on
CXR. He recieved another unit of pRBCs, and his post-tranfusion
Hct was 28.2. He had a video swallowing study, which showed
laryngeal penentration of liquids but no aspiration; safe for
regular solids and thin liquids

On [**10-17**], his hct was stable, and was transferred to the floor.
He was started on clear liquids.

On [**10-21**], he underwent video stroboscopic exam with ENT, which
showed left vocal cord paralysis. He then underwent vocal cord
medialization on [**10-24**] with ENT for correction of this problem

The staples from his abdomen and thorax, as well as his sutures
from his former chest tube site were removed on [**10-25**].

Pt was d/c'd to home on [**2177-10-26**].


Medications on Admission:
Albuterol nebs, lovenox 40mg SQ daily,
pulmozyme 5mg [**Hospital1 **], Tessalon 100mg po TID, Protonix 40mg daily,
Solumedrol 30mg IV q12h, Claritin 10mg daily, Pipracil 3gm IV
q4h, Novolog 7 units before each meal


Discharge Medications:
1. Prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Fexofenadine 60 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) as
needed for constipation.
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.
6. Hydromorphone 4 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
7. Fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff
Inhalation [**Hospital1 **] (2 times a day).
8. Benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3
times a day) as needed.
9. Diltiazem HCl 30 mg Tablet Sig: 1.5 Tablets PO QID (4 times a
day).
Disp:*90 Tablet(s)* Refills:*0*
10. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO every six
(6) hours.
11. Mucinex 600 mg Tablet Sustained Release Sig: Two (2) Tablet
Sustained Release PO twice a day.
12. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 puffs Inhalation
every four (4) hours as needed for shortness of breath or
wheezing.
13. Atrovent HFA 17 mcg/Actuation Aerosol Sig: Two (2) puffs
Inhalation four times a day.
14. Prilosec OTC 20 mg Tablet, Delayed Release (E.C.) Sig: [**12-4**]
Tablet, Delayed Release (E.C.)s PO once a day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 5065**] Healthcare

Discharge Diagnosis:
recurrent relapsing polychondritis
s/p left sided completion pneumonectomy


Discharge Condition:
good


Discharge Instructions:
Call Dr.[**Doctor Last Name 4738**] office [**Telephone/Fax (1) 4741**] if experience:
-Fever > 101 or chills.
-Increased shortness of breath, cough or chest pain.
-Incision develops drainage.
No driving while taking narcotics.  Take stool softners with
narcotics.
You may take motrin for pain.  Take with food and water

Followup Instructions:
Please follow up with your primary care physician for evaluation
and for recommendations regarding the new cardiac medication we
have prescibed for you.

Call Dr.[**Hospital 4738**] clinic office at [**Telephone/Fax (1) 4741**] to arrange for
follow up.  Please call Dr.[**Name (NI) 37917**] clinic office at
[**Telephone/Fax (1) 41**] to arrange for follow-up in your area for your
vocal chords.



Completed by:[**2177-11-4**]
{'Other diseases of trachea and bronchus,Pulmonary collapse,Postinflammatory pulmonary fibrosis,Other disorders of bone and cartilage,Leukocytosis, unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Unilateral paralysis of vocal cords or larynx, partial,Esophageal reflux,Attention to tracheostomy,Personal history of malignant neoplasm of testis,Other chronic pulmonary heart diseases,Acute post-thoracotomy pain,Removal of other organ (partial) (total) 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: Severe stenosis of the left main stem bronchus with complete
left lung obstruction

PRESENT ILLNESS: 52M trached with relapsing polychondritis and associated
tracheobronchomalacia status post multiple airways endobronchial
interventions including stent
placement and subsequent removal now presenting with lung
collapse secondary to endobronchial obstruction with granulation
tissue.

MEDICAL HISTORY: PMH: Polychondritis, TBM, GERD

MEDICATION ON ADMISSION: Albuterol nebs, lovenox 40mg SQ daily,
pulmozyme 5mg [**Hospital1 **], Tessalon 100mg po TID, Protonix 40mg daily,
Solumedrol 30mg IV q12h, Claritin 10mg daily, Pipracil 3gm IV
q4h, Novolog 7 units before each meal

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: Non-contributory.

SOCIAL HISTORY: SocHx: former smoker, quit x1yr; occasional alcohol; no
recreational drugs 

### Response:
{'Other diseases of trachea and bronchus,Pulmonary collapse,Postinflammatory pulmonary fibrosis,Other disorders of bone and cartilage,Leukocytosis, unspecified,Adrenal cortical steroids causing adverse effects in therapeutic use,Unilateral paralysis of vocal cords or larynx, partial,Esophageal reflux,Attention to tracheostomy,Personal history of malignant neoplasm of testis,Other chronic pulmonary heart diseases,Acute post-thoracotomy pain,Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}
