CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 49 year old
female with a twenty year history of insulin dependent
diabetes mellitus on pump with severe neuropathy in her
bilateral lower extremities as well as severe claudication,
greater in the left than the right.

MEDICAL HISTORY: 1.  Peripheral vascular disease, status post right
superficial femoral angioplasty and left external iliac
artery angioplasty with stenting in [**8-18**].
2.  Insulin dependent diabetes mellitus times twenty years,
brittle, on insulin pump.
3.  Chronic renal insufficiency with a creatinine of 1.8.
4.  Neuropathy.
5.  Seizures secondary to hypoglycemia.
6.  Coronary artery disease with an inferior silent
myocardial infarction.
7.  History of congestive heart failure with a cardiac
catheterization in [**4-18**], and an ejection fraction of 35%.
8.  Obesity.
9.  Increased cholesterol.
10. Hypothyroidism.
11, Glaucoma.

MEDICATION ON ADMISSION: 1.  Multivitamin.
2.  Timolol.
3.  Dilantin.
4.  Ambien.
5.  Nortriptyline.
6.  Insulin pump.
7.  Lasix 40 mg b.i.d.
8.  Atenolol 25 mg.
9.  Zestril.
10. Levoxyl.
11. Zoloft.
12. Ranitidine.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient quit smoking six months ago, 25
to 40 pack year history.  ETOH denies and recreational drugs
denies.
Atherosclerosis of native arteries of the extremities with ulceration,Ulcer of other part of foot,Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled,Peripheral vascular disease, unspecified,Polyneuropathy in diabetes,Congestive heart failure, unspecified,Other convulsions,Coronary atherosclerosis of native coronary artery
Ath ext ntv art ulcrtion,Ulcer other part of foot,DMI circ nt st uncntrld,Periph vascular dis NOS,Neuropathy in diabetes,CHF NOS,Convulsions NEC,Crnry athrscl natve vssl
Admission Date:  [**2168-1-20**]       Discharge Date:  [**2168-1-23**]

Date of Birth:   [**2118-5-29**]       Sex:  F

Service:  VASCULAR SURGERY

ADMITTING DIAGNOSIS:  Nonhealing left great toe ulcer.

DISCHARGE DIAGNOSIS:  Nonhealing left great toe ulcer.

PROCEDURES:
1.  Left femoral AK popliteal bypass graft with saphenous
vein graft.
2.  Left great toe amputation.

HISTORY OF PRESENT ILLNESS:  The patient is a 49 year old
female with a twenty year history of insulin dependent
diabetes mellitus on pump with severe neuropathy in her
bilateral lower extremities as well as severe claudication,
greater in the left than the right.

She also has a past medical history significant for seizures
as well as coronary artery disease, inferior wall silent
myocardial infarction, history of congestive heart failure,
status post cardiac catheterization [**4-18**], with an ejection
fraction of 35%.  She has chronic shortness of breath.  She
is also hypothyroid and has glaucoma.

The patient is status post right superficial femoral
angioplasty and left external iliac artery angioplasty with
stenting in [**8-18**].  She has had minor improvement in the
claudication of her right leg following the angioplasty and
about four weeks prior to [**2167-12-28**], she began having redness
in the left great toe.  She has had a previous right great
toe amputation which is well healed.  She was hospitalized at
[**Hospital1 69**] and placed on
Ciprofloxacin 500 mg b.i.d. for her toe infection.

She presented to Dr.[**Name (NI) 27017**] office for further evaluation
and it was decided that the patient should undergo an
arterial reconstruction of the left leg and a left great toe
amputation at the proximal phalangeal level and this was
arranged for on an outpatient basis.

PAST MEDICAL HISTORY:
1.  Peripheral vascular disease, status post right
superficial femoral angioplasty and left external iliac
artery angioplasty with stenting in [**8-18**].
2.  Insulin dependent diabetes mellitus times twenty years,
brittle, on insulin pump.
3.  Chronic renal insufficiency with a creatinine of 1.8.
4.  Neuropathy.
5.  Seizures secondary to hypoglycemia.
6.  Coronary artery disease with an inferior silent
myocardial infarction.
7.  History of congestive heart failure with a cardiac
catheterization in [**4-18**], and an ejection fraction of 35%.
8.  Obesity.
9.  Increased cholesterol.
10. Hypothyroidism.
11, Glaucoma.

PAST SURGICAL HISTORY:
1.  Amputation of right great toe [**5-18**].
2.  Knee surgery [**10/2144**].
3.  Plate and lumbar fusion L4, 5, 6, 7 in [**2163**].
4.  Wrist, elbow and foot surgeries in [**2156**].

ALLERGIES  No known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Multivitamin.
2.  Timolol.
3.  Dilantin.
4.  Ambien.
5.  Nortriptyline.
6.  Insulin pump.
7.  Lasix 40 mg b.i.d.
8.  Atenolol 25 mg.
9.  Zestril.
10. Levoxyl.
11. Zoloft.
12. Ranitidine.

SOCIAL HISTORY:  The patient quit smoking six months ago, 25
to 40 pack year history.  ETOH denies and recreational drugs
denies.

PHYSICAL EXAMINATION:  On physical examination, the patient
is awake, alert and oriented in no apparent distress.  Her
blood pressure is 101/66.  The heart is regular rate and
rhythm, S1 and S2.  Her chest is clear to auscultation
bilaterally with distant air sounds.  Extremities revealed 4+
femoral pulses bilaterally.  On the left, no pulses palpable
below the femoral level, and on the right 3+ popliteal and
dorsalis pedis pulses, no posterior tibialis pulse on the
right.

HOSPITAL COURSE:  The patient was admitted to the hospital on
[**2168-1-20**], and taken to the operating room for left femoral AK
popliteal bypass graft with saphenous vein graft as well as a
left great toe amputation.  She tolerated the procedure well
and was transferred to the Post Anesthesia Care Unit in
stable condition.

In the Post Anesthesia Care Unit, she had a palpable left
dorsalis pedis and posterior tibialis pulse.  From the Post
Anesthesia Care Unit, she was transferred to the unit in
stable condition.  Her pulses continued to be palpable on the
left.  She received one unit of packed red blood cells for a
hematocrit of 26.0.

The patient did have some flattened electrocardiographic
waves on her postoperative electrocardiogram and therefore,
formal rule out was done which was negative.  She was seen by
[**Last Name (un) **] for management of her diabetes mellitus.

On postoperative day number one, the patient was doing well.
She had palpable dorsalis pedis and posterior tibialis
pulses.  Left foot was warm.  She did have some increased
blood pressure and was placed on Neo-Synephrine and given
another unit of packed red blood cells.  Blood pressure
improved.  Her hematocrit was 30.0 posttransfusion.  Her
creatinine on [**2168-1-21**], was 0.9.  Laboratories were otherwise
stable.

The patient continued to be monitored in the unit overnight.
Her diet was advanced.  She was given Lasix 20 mg.  Her
preoperative medications were restarted.  Her dorsalis pedis
and posterior tibialis continued to be dopplerable.

She was transferred to the floor on postoperative day number
three.  She continued to do well and she was afebrile and her
vital signs were stable.  Her left thigh incision was clean,
dry and intact.  Her left great toe amputation site was
clean, dry and intact as well, and her dorsalis pedis and
posterior tibialis were dopplerable bilaterally.  Her
hematocrit was 26.5 which was stable.  Her creatinine was
0.8.

On [**1-22**], the patient was noted to have blood pressure
in the 80's over 50's.  She was given a 250 cc bolus of normal
saline and her Lopressor was decreased to 12.5 mg  p.o. b.i.d.
She was asymptomatic.  Her systolic pressures remained in the
90's overnight.  Note that the patient chronically has low
blood pressure.

It was decided that the patient would be discharged to
rehabilitation in stable condition.

MEDICATIONS ON DISCHARGE:
1.  Afrin 325 mg p.o. q.d.
2.  Lopressor 12.5 mg p.o. b.i.d.
3.  Insulin pump one unit per hour.
4.  Regular insulin sliding scale 0-150 zero units, 151 to
200 three units, 201 to 250 five units, 251 to 300 seven
units, 301 to 350 ten units, 351 to 600 twelve units.
5.  Nortriptyline 75 mg p.o. q.d.
6.  Ambien 10 mg p.o. q.h.s.
7.  Lasix 40 mg p.o. q.d.
8.  Zoloft 100 mg p.o. q.d.
9.  Zantac 300 mg p.o. b.i.d.
10. Percocet one to two tablets p.o. q3-4hours p.r.n.
11. Tylenol 650 mg p.o. q4-6hours p.r.n. pain.

The patient was told to be touch down weight bear for
transfer only and to continue to be nonweight-bearing for two
weeks.  She should follow-up with Dr. [**Last Name (STitle) 1476**] in the office
in ten days.  She needs dry dressing changes to her left
thigh and left foot q.d. p.r.n.  The patient was also told to
follow-up with her cardiologist in four to six weeks.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1477**], M.D.  [**MD Number(1) 1478**]

Dictated By:[**Last Name (NamePattern1) 4985**]
MEDQUIST36

D:  [**2168-1-23**]  11:37
T:  [**2168-1-23**]  12:50
JOB#:  [**Job Number 107454**]


Admission Date:  [**2168-1-20**]       Discharge Date:  [**2168-1-23**]

Date of Birth:   [**2118-5-29**]       Sex:  F

Service:  VASCULAR SURGERY

ADMITTING DIAGNOSIS:  Nonhealing left great toe ulcer.

DISCHARGE DIAGNOSIS:  Nonhealing left great toe ulcer.

PROCEDURES:
1.  Left femoral AK popliteal bypass graft with saphenous
vein graft.
2.  Left great toe amputation.

HISTORY OF PRESENT ILLNESS:  The patient is a 49 year old
female with a twenty year history of insulin dependent
diabetes mellitus on pump with severe neuropathy in her
bilateral lower extremities as well as severe claudication,
greater in the left than the right.

She also has a past medical history significant for seizures
as well as coronary artery disease, inferior wall silent
myocardial infarction, history of congestive heart failure,
status post cardiac catheterization [**4-18**], with an ejection
fraction of 35%.  She has chronic shortness of breath.  She
is also hypothyroid and has glaucoma.

The patient is status post right superficial femoral
angioplasty and left external iliac artery angioplasty with
stenting in [**8-18**].  She has had minor improvement in the
claudication of her right leg following the angioplasty and
about four weeks prior to [**2167-12-28**], she began having redness
in the left great toe.  She has had a previous right great
toe amputation which is well healed.  She was hospitalized at
[**Hospital1 69**] and placed on
Ciprofloxacin 500 mg b.i.d. for her toe infection.

She presented to Dr.[**Name (NI) 27017**] office for further evaluation
and it was decided that the patient should undergo an
arterial reconstruction of the left leg and a left great toe
amputation at the proximal phalangeal level and this was
arranged for on an outpatient basis.

PAST MEDICAL HISTORY:
1.  Peripheral vascular disease, status post right
superficial femoral angioplasty and left external iliac
artery angioplasty with stenting in [**8-18**].
2.  Insulin dependent diabetes mellitus times twenty years,
brittle, on insulin pump.
3.  Chronic renal insufficiency with a creatinine of 1.8.
4.  Neuropathy.
5.  Seizures secondary to hypoglycemia.
6.  Coronary artery disease with an inferior silent
myocardial infarction.
7.  History of congestive heart failure with a cardiac
catheterization in [**4-18**], and an ejection fraction of 35%.
8.  Obesity.
9.  Increased cholesterol.
10. Hypothyroidism.
11, Glaucoma.

PAST SURGICAL HISTORY:
1.  Amputation of right great toe [**5-18**].
2.  Knee surgery [**10/2144**].
3.  Plate and lumbar fusion L4, 5, 6, 7 in [**2163**].
4.  Wrist, elbow and foot surgeries in [**2156**].

ALLERGIES  No known drug allergies.

MEDICATIONS ON ADMISSION:
1.  Multivitamin.
2.  Timolol.
3.  Dilantin.
4.  Ambien.
5.  Nortriptyline.
6.  Insulin pump.
7.  Lasix 40 mg b.i.d.
8.  Atenolol 25 mg.
9.  Zestril.
10. Levoxyl.
11. Zoloft.
12. Ranitidine.

SOCIAL HISTORY:  The patient quit smoking six months ago, 25
to 40 pack year history.  ETOH denies and recreational drugs
denies.

PHYSICAL EXAMINATION:  On physical examination, the patient
is awake, alert and oriented in no apparent distress.  Her
blood pressure is 101/66.  The heart is regular rate and
rhythm, S1 and S2.  Her chest is clear to auscultation
bilaterally with distant air sounds.  Extremities revealed 4+
femoral pulses bilaterally.  On the left, no pulses palpable
below the femoral level, and on the right 3+ popliteal and
dorsalis pedis pulses, no posterior tibialis pulse on the
right.

HOSPITAL COURSE:  The patient was admitted to the hospital on
[**2168-1-20**], and taken to the operating room for left femoral AK
popliteal bypass graft with saphenous vein graft as well as a
left great toe amputation.  She tolerated the procedure well
and was transferred to the Post Anesthesia Care Unit in
stable condition.

In the Post Anesthesia Care Unit, she had a palpable left
dorsalis pedis and posterior tibialis pulse.  From the Post
Anesthesia Care Unit, she was transferred to the unit in
stable condition.  Her pulses continued to be palpable on the
left.  She received one unit of packed red blood cells for a
hematocrit of 26.0.

The patient did have some flattened electrocardiographic
waves on her postoperative electrocardiogram and therefore,
formal rule out was done which was negative.  She was seen by
[**Last Name (un) **] for management of her diabetes mellitus.

On postoperative day number one, the patient was doing well.
She had palpable dorsalis pedis and posterior tibialis
pulses.  Left foot was warm.  She did have some increased
blood pressure and was placed on Neo-Synephrine and given
another unit of packed red blood cells.  Blood pressure
improved.  Her hematocrit was 30.0 posttransfusion.  Her
creatinine on [**2168-1-21**], was 0.9.  Laboratories were otherwise
stable.

The patient continued to be monitored in the unit overnight.
Her diet was advanced.  She was given Lasix 20 mg.  Her
preoperative medications were restarted.  Her dorsalis pedis
and posterior tibialis continued to be dopplerable.

She was transferred to the floor on postoperative day number
three.  She continued to do well and she was afebrile and her
vital signs were stable.  Her left thigh incision was clean,
dry and intact.  Her left great toe amputation site was
clean, dry and intact as well, and her dorsalis pedis and
posterior tibialis were dopplerable bilaterally.  Her
hematocrit was 26.5 which was stable.  Her creatinine was
0.8.

On [**1-22**], the patient was noted to have blood pressure
in the 80's over 50's.  She was given a 250 cc bolus of normal
saline and her Lopressor was decreased to 12.5 mg p.o. b.i.d.
She was asymptomatic.  Her systolic pressure remained in the
90's overnight.  Note that the patient chronically has low
blood pressure.

It was decided that the patient would be discharged to
rehabilitation in stable condition.

MEDICATIONS ON DISCHARGE:
1.  Afrin 325 mg p.o. q.d.
2.  Lopressor 12.5 mg p.o. b.i.d.
3.  Insulin pump one unit per hour.
4.  Regular insulin sliding scale 0-150 zero units, 151 to
200 three units, 201 to 250 five units, 251 to 300 seven
units, 301 to 350 ten units, 351 to 600 twelve units.
5.  Nortriptyline 75 mg p.o. q.d.
6.  Ambien 10 mg p.o. q.h.s.
7.  Lasix 40 mg p.o. q.d.
8.  Zoloft 100 mg p.o. q.d.
9.  Zantac 300 mg p.o. b.i.d.
10. Percocet one to two tablets p.o. q3-4hours p.r.n.
11. Tylenol 650 mg p.o. q4-6hours p.r.n. pain.

The patient was told to be touch down weight bear for
transfer only and to continue to be nonweight-bearing for two
weeks.  She should follow-up with Dr. [**Last Name (STitle) 1476**] in the office
in ten days.  She needs dry dressing changes to her left
thigh and left foot q.d. p.r.n.  The patient was also told to
follow-up with her cardiologist in four to six weeks.




                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 1477**], M.D.  [**MD Number(1) 1478**]

Dictated By:[**Last Name (NamePattern1) 4985**]
MEDQUIST36

D:  [**2168-1-23**]  11:37
T:  [**2168-1-23**]  12:50
JOB#:  [**Job Number 107454**]
{'Atherosclerosis of native arteries of the extremities with ulceration,Ulcer of other part of foot,Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled,Peripheral vascular disease, unspecified,Polyneuropathy in diabetes,Congestive heart failure, unspecified,Other convulsions,Coronary atherosclerosis of native coronary artery'}


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: The patient is a 49 year old
female with a twenty year history of insulin dependent
diabetes mellitus on pump with severe neuropathy in her
bilateral lower extremities as well as severe claudication,
greater in the left than the right.

MEDICAL HISTORY: 1.  Peripheral vascular disease, status post right
superficial femoral angioplasty and left external iliac
artery angioplasty with stenting in [**8-18**].
2.  Insulin dependent diabetes mellitus times twenty years,
brittle, on insulin pump.
3.  Chronic renal insufficiency with a creatinine of 1.8.
4.  Neuropathy.
5.  Seizures secondary to hypoglycemia.
6.  Coronary artery disease with an inferior silent
myocardial infarction.
7.  History of congestive heart failure with a cardiac
catheterization in [**4-18**], and an ejection fraction of 35%.
8.  Obesity.
9.  Increased cholesterol.
10. Hypothyroidism.
11, Glaucoma.

MEDICATION ON ADMISSION: 1.  Multivitamin.
2.  Timolol.
3.  Dilantin.
4.  Ambien.
5.  Nortriptyline.
6.  Insulin pump.
7.  Lasix 40 mg b.i.d.
8.  Atenolol 25 mg.
9.  Zestril.
10. Levoxyl.
11. Zoloft.
12. Ranitidine.

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient quit smoking six months ago, 25
to 40 pack year history.  ETOH denies and recreational drugs
denies. 

### Response:
{'Atherosclerosis of native arteries of the extremities with ulceration,Ulcer of other part of foot,Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled,Peripheral vascular disease, unspecified,Polyneuropathy in diabetes,Congestive heart failure, unspecified,Other convulsions,Coronary atherosclerosis of native coronary artery'}
