CHIEF COMPLAINT: Left scrotal pain.

PRESENT ILLNESS: The patient is a 77 year old
male with a past medical history of prostate cancer, status
post prostatectomy in [**2097**]. Status post penile implant in
[**2092**] by Dr. [**Last Name (STitle) 9125**].  He presented today to the Emergency
Department complaining of testicular pain, left more than
right, since Saturday. The patient denies any fevers, chills,
night sweats or vomiting.  The patient also denies dysuria or
hematuria.  His prosthesis stopped working two years ago per
patient's wife.  The patient has had low grade temperature
and chills for one week prior to admission.

MEDICAL HISTORY: Hypertension, hyperlipidemia, prostate
cancer.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: No smoking currently; 65 packs per year
history.
Infection and inflammatory reaction due to other genitourinary device, implant, and graft,Other inflammatory disorders of male genital organs,Acute kidney failure, unspecified,Diverticulitis of colon (without mention of hemorrhage),Pseudomonas infection in conditions classified elsewhere and of unspecified site,Delirium due to conditions classified elsewhere,Other and unspecified hyperlipidemia
React-oth genitourin dev,Male gen inflam dis NEC,Acute kidney failure NOS,Dvrtcli colon w/o hmrhg,Pseudomonas infect NOS,Delirium d/t other cond,Hyperlipidemia NEC/NOS
Admission Date:  [**2105-10-26**]       Discharge Date:  [**2105-11-3**]

Date of Birth:   [**2028-2-20**]       Sex:  M

Service:

CHIEF COMPLAINT:  Left scrotal pain.

HISTORY OF PRESENT ILLNESS:  The patient is a 77 year old
male with a past medical history of prostate cancer, status
post prostatectomy in [**2097**]. Status post penile implant in
[**2092**] by Dr. [**Last Name (STitle) 9125**].  He presented today to the Emergency
Department complaining of testicular pain, left more than
right, since Saturday. The patient denies any fevers, chills,
night sweats or vomiting.  The patient also denies dysuria or
hematuria.  His prosthesis stopped working two years ago per
patient's wife.  The patient has had low grade temperature
and chills for one week prior to admission.

PAST MEDICAL HISTORY:  Hypertension, hyperlipidemia, prostate
cancer.

PAST SURGICAL HISTORY:  Status post fusion of C4 through C6
in [**2102**].  Status post laminectomy, C3 to C7 in [**2102**].  Status
post appendectomy. Status post retropubic radical
prostatectomy in [**2097-1-2**] and status post penile
implant in [**2092**].

MEDICATIONS:
Neurontin 600 mg q. a.m., 300 mg at noon and 900 mg q h.s.
Celebrex 100 mg twice a day.
Verapamil XL 240 mg q. day.
Prilosec 20 mg q. day.
Ziac 5/6.25 mg q. day.
Lipitor 10 mg q. day.
Benecol 20 mg q. day.
Aspirin 325 mg q. day.
Darvocet prn for pain.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  No smoking currently; 65 packs per year
history.

PHYSICAL EXAMINATION:  Vital signs 97.7 temperature; heart
rate of 81; blood pressure 129/58; respiratory rate of 16;
saturations 98% on room air. Pharynx is clear.  Neck is
supple. No lymphadenopathy.  Lungs are clear to auscultation.
Heart sounds:  S1 and S2 regular rate and rhythm.  Abdomen is
soft, full, nontender.  Genitourinary examination:  Left
scrotum is tense and erythematous with exquisite tenderness
to palpation, diffusely swollen, with minimal swelling and
tenderness in the left inguinal region.  Normal penis.
Palpable left scrotal sac.

LABORATORY DATA:  White blood cell count of 38; hematocrit of
33.1; platelets of 488.  Electrolytes are within normal
limits with the exception of creatinine of 2.7.  Lactate 4.5.
PT 14.1; PTT 87.9; INR of 1.3.  Scrotal ultrasound shows 4 by
3 by 3 hypoechoic area above the left testis, consistent with
a left scrotal pyocele.

HOSPITAL COURSE:  The patient was admitted to the hospital
the same day, [**2105-10-26**] for further work-up of the
left scrotal pyocele.  Questionable infected scrotal
component of prosthesis.  An abdominal pelvic CT was ordered
to rule out incarcerated hernia and aggressive hydration was
instituted to correct acute renal failure (creatinine of 1.3
is baseline and today is 2.7).

CT of the pelvis was consistent with infected penile
prosthesis.  Infection was contagious with focal area of
sigmoid diverticulitis.  Also, an abscess anterior to the
left psoas muscle was seen just proximal to the sigmoid
colon.  The patient was taken to the operating room at 10
o'clock at night where he underwent removal of his penile
prosthesis and wash-out of his left scrotum.  Penrose drain
was placed for continuous drainage of the pyocele.

The infected fluid in the scrotal sac was sent for pathology
and cultures (aerobic and anaerobic).  The patient was taken
to the Post Anesthesia Care Unit and from there to the
Surgical Intensive Care Unit for further stabilization of his
condition.  The patient was started on Ampicillin,
Dicloxacillin and Flagyl as wide empiric antibiotic treatment
until the results from the fluid culture returned.  Blood
cultures drawn the same day were negative.  Urine culture was
positive for gram positive bacteria.  Culture returned on the
26th and was positive for Alpha strip, Proteus, Pseudomonas
and Bacteroides fragilis.  As a result, the patient's
antibiotic regimen was supplemented with Ceftazidime to cover
Pseudomonas.

On postoperative day number two, the patient started having
symptoms of agitation and confusion and threatened to sign
out against medical advice.  Psychiatry was consulted to
evaluate the patient.  Narcotics were held (being suspicious
of causing this postoperative agitation and confusion) and
the patient was under restraints, on continuous Haldol 5 mg
three times a day with security sitter overnight.  Management
was consulted for his scrotal swelling. Subsequently, the
infectious disease was consulted to evaluate the patient and
recommend appropriate antibiotic treatment and duration,
based on cultures.  According to infectious disease
recommendations, the patient's antibiotic regimen was changed
on [**11-1**] to Zosyn 4.5 grams q. eight hours and the rest
of the antibiotics were discontinued.  The patient was able
to tolerate clears and immediately a regular diet on [**10-29**].  He was ambulatory.  Intravenous Haldol was slowly
weaned off by [**11-1**]. On [**11-3**], the PICC line
was placed.  In addition, the patient was discharged home on
intravenous Zosyn to complete two week course per infectious
disease recommendations. In addition to the above consults,
general surgery was also consulted to evaluate the patient
regarding the patient's diverticulitis.  Per surgery
recommendations, the patient should complete a course of two
weeks of intravenous antibiotic treatment (congruent with
infectious disease recommendations) and the patient was to
return see Dr. [**Last Name (STitle) 1888**] as an outpatient, to be re-evaluated
and undergo elective sigmoidectomy after resolution of the
inflammatory process that brought the patient into the
operating room.

Finally, physical therapy was consulted for home safety
evaluation since the patient came to the hospital ambulatory
with cane but now the patient was only able to ambulate with
a walker.  Additional studies throughout the patient's stay
included CT of the abdomen and pelvis on [**2105-10-31**],
just five days after prior CT of the abdomen and pelvis, to
re-evaluate the diagnosed abscess anterior to the left psoas
muscle.  No abscess was seen in the second CT and the patient
was shown to be safe to be discharged home and follow-up as
an outpatient with Dr. [**Last Name (STitle) 1888**] of general surgery.

The patient was discharged on [**2105-11-3**] with services.
He was instructed to take his medications as scheduled.  He
was to take intravenous Zosyn .5 grams q. 8 hours via PICC
line.  He was to attend his appointments.  Visiting nurse was
arranged to see the patient every day, administer the
antibiotic, intravenous Zosyn, check his blood pressure and
vital signs, check laboratory studies once a week and report
to the infectious disease fellow.  Dressing changes, wet to
dry on his scrotal area twice a day.

Appointments were scheduled with urology, general surgery,
infectious disease.

DISCHARGE DIAGNOSES:
Status post removal of penile prosthesis and wash-out of
scrotal sac.

MEDICATIONS:
Metoprolol 25 mg p.o. twice a day.
Gabapentin 600 mg p.o. q. a.m., 300 mg p.o. lunch, 900 mg
p.o. q. p.m.
Verapamil SR 240 mg q. day.
Protonic 40 mg q. day.
Atorvastatin 10 mg p.o. q. day.
Aspirin 325 mg p.o. q. day.
Tylenol 325 mg p.o. q. four to six hours.
Hydrochlorothiazide 10 mg p.o. q. day.
Ziac 5/6.25 mg p.o. q. day.
Zosyn 4.5 grams q. 8 hours for 12 days post discharge.






                            [**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], MD  [**MD Number(1) 13269**]

Dictated By:[**Name8 (MD) **]
MEDQUIST36

D:  [**2105-11-4**]  06:31
T:  [**2105-11-4**]  19:10
JOB#:  [**Job Number 108691**]
{'Infection and inflammatory reaction due to other genitourinary device, implant, and graft,Other inflammatory disorders of male genital organs,Acute kidney failure, unspecified,Diverticulitis of colon (without mention of hemorrhage),Pseudomonas infection in conditions classified elsewhere and of unspecified site,Delirium due to conditions classified elsewhere,Other and unspecified hyperlipidemia'}


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: Left scrotal pain.

PRESENT ILLNESS: The patient is a 77 year old
male with a past medical history of prostate cancer, status
post prostatectomy in [**2097**]. Status post penile implant in
[**2092**] by Dr. [**Last Name (STitle) 9125**].  He presented today to the Emergency
Department complaining of testicular pain, left more than
right, since Saturday. The patient denies any fevers, chills,
night sweats or vomiting.  The patient also denies dysuria or
hematuria.  His prosthesis stopped working two years ago per
patient's wife.  The patient has had low grade temperature
and chills for one week prior to admission.

MEDICAL HISTORY: Hypertension, hyperlipidemia, prostate
cancer.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: No smoking currently; 65 packs per year
history. 

### Response:
{'Infection and inflammatory reaction due to other genitourinary device, implant, and graft,Other inflammatory disorders of male genital organs,Acute kidney failure, unspecified,Diverticulitis of colon (without mention of hemorrhage),Pseudomonas infection in conditions classified elsewhere and of unspecified site,Delirium due to conditions classified elsewhere,Other and unspecified hyperlipidemia'}
