CHIEF COMPLAINT: 

PRESENT ILLNESS: 

MEDICAL HISTORY: Other past medical history is
significant for anxiety, multiple depressive episodes, panic
attacks.  She has a history of a cerebral aneurysm, history
of gastroesophageal reflux disease, endometriosis, Raynaud's
disease with a positive [**Doctor First Name **], as well as history of ovarian
cyst.

MEDICATION ON ADMISSION: 

ALLERGIES: SULFA, PENICILLIN

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Noncontributory
Hematoma complicating a procedure,Mitral valve disorders,Kidney replaced by transplant,Unspecified essential hypertension
Hematoma complic proc,Mitral valve disorder,Kidney transplant status,Hypertension NOS
Admission Date:  [**2103-9-4**]       Discharge Date:  [**2103-9-6**]


Service:  GENERAL SURGERY

INDICATIONS:  Ms. .......... is a 48-year-old female with a
past medical history significant for polycystic kidney
disease with end stage renal disease resulting in cadaveric
renal transplants in [**2099**] by Dr. [**Last Name (STitle) 23**] here at [**Hospital6 1760**].  Post transplant, the
patient was noted to have persistent hypercalcemia with a
question of possible primary hyperparathyroidism versus
tertiary hyperparathyroidism was raised.  Sestamibi scan
preoperatively was non diagnostic.  She was ultimately
referred to Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] for possible exploration to
find a definitive diagnosis.

PAST MEDICAL HISTORY:  Other past medical history is
significant for anxiety, multiple depressive episodes, panic
attacks.  She has a history of a cerebral aneurysm, history
of gastroesophageal reflux disease, endometriosis, Raynaud's
disease with a positive [**Doctor First Name **], as well as history of ovarian
cyst.

PAST SURGICAL HISTORY is just significant for the cadaveric
renal transplant in [**2099**].  Additionally, she does have
polycystic liver disease.

OUTPATIENT MEDICATIONS:
1.  CellCept 1 gm po bid
2.  Prednisone 5 mg po q day
3.  Cyclosporin 125 mg po q a.m., 100 mg po q p.m.
4.  Zestril 5 mg po q day
5.  Claritin 10 mg po q day
6.  Verapamil 120 mg po q day
7.  Vicodin prn for her cystic pain related to her liver.

ALLERGIES:  SULFA, PENICILLIN

SOCIAL HISTORY:  Noncontributory

HOSPITAL COURSE:  After informed consent had been obtained in
the outpatient clinical setting with Dr. [**Last Name (STitle) **], she has
agreed to a neck exploration and possible parathyroidectomy,
possible total thyroidectomy.  She was brought to the
surgical suite on [**2103-9-4**].  She underwent a total
thyroidectomy and parathyroidectomy secondary to adherence of
the parathyroids to the thyroid with some difficulty in
dissecting out the planes.  It was felt that the entire gland
needed to be removed due to this anatomic problem that was
spotted intraoperatively.

After having undergone a relatively uneventful intraoperative
course including serial PTH values of 55, 51 and 27 that were
found intraoperatively, she was extubated without difficulty
and sent to the Post Anesthesia Recovery Unit.  While in the
PACU, she was noted to have some increased neck swelling and
ecchymosis and after several hours of observation within the
PACU, the determination was made to bring her back
semi-electively for evacuation of the hematoma.  At no time
did the patient ever experience any kind of stridor or
respiratory compromise.  She, at all times, had a strong
voice.  Of note, upon waking up from her initial operation,
she did have a fair amount of retching and emesis secondary
to recovery from the anesthesia.  Additionally, although she
had small accumulation of hematoma on the inferior flap of
the incision, it was not until the patient was moved in the
PACU area that she began to accumulate more hematoma.

At the time of exploration, two separate muscle bleeders and
one sub platysmal bleeder was identified.  Clips were applied
and there was excellent hemostasis.  When the wound was
closed, it was dry.  There was approximately a 200 cc
estimated blood loss for the second operation at the time of
re-exploration.  Her hematocrit at this time was 30.3.  She
had normal coags with a PT/INR of 12.9 and 1.2 and a PTT of
25.  Additionally, her ionized calcium immediate
postoperatively was 1.14.  She was kept intubated secondary
to an awake fiberoptic intubation that was carried out by the
anesthesia staff here.  They had felt that the patient had
some evidence of focal cord edema.  She was given a dose of
Decadron intraoperatively and felt that the safest strategy
for the patient would be to keep her intubated overnight and
extubate her in the late morning the following day on
[**2103-9-5**] under direct supervision of the anesthesia staff.
The patient postoperatively and overnight was otherwise
comfortable and did find she was hemodynamically stable and
afebrile.

On [**2103-9-5**], which is postoperative day #1, the patient was
rapidly extubated after an excellent cuff leak and excellent
mechanics were demonstrated.  Her pre extubation gas was
7.41, 35, 117, 23, -1 with a post extubation gas of 7.35, 42,
82, 24 and -1.  Her CBC was noted on postoperative day #1
with a white count of 8.5, hematocrit of 28.5, platelet count
236.  Her BUN and creatinine were 20 and 0.9.  She had a
serum bicarbonate of 20 which is chronic and stable for her.
Her potassium postoperatively is 4.4.  She hemodialysis a
magnesium of 1.4 and her postoperative day #1 ionized calcium
was again 1.14.  Subjectively, she was without any perioral
numbness or paresthesias.  She had no evidence of
............ sign on exam.  There is no evidence of
Trousseau's.  Her voice was strong.  She was breathing well.
She had no evidence of stridor on exam.  The neck flaps were
flat.  There was mild ecchymosis.  She did have staples
intact.  There was no ooze or erythema from the wound.  She
was otherwise comfortable.

After close monitoring in the Intensive Care Unit setting for
approximately six to eight hours post extubation, she
remained very stable and was quite comfortable.  She was
therefore started on sips and advanced to clears and
ultimately to a regular soft diet.  She was transitioned oral
pain medications without difficulty and she was continued on
all of her transplant medications that she was on
perioperatively after direct consultation with the inpatient
transplant service which agreed that she could continue her
cyclosporin dosing and CellCept and prednisone dosing as
previously noted.  She was started on Tums 500 mg po qid as
well as on Synthroid 100 mcg po q day.

By postoperative day #2, the patient remained stable, had no
evidence of respiratory compromise, no evidence of hematoma
reaccumulation.  Her voice remained strong.  She was
ambulating without difficulty and was quite eager to actually
go home.  She remained afebrile and at discharge exam was
noted for a temperature of 98.9??????.  Her blood pressure was
142/70 with a pulse of 88 and sinus rhythm.  She was
breathing at 20 and saturating at 93% on room air.  She was
in no acute distress and she was alert and oriented x3.  Her
neck flaps were flat with ecchymosis.  Staples were intact.
There was no erythema, no exudate noted.  She had no evidence
of ...........  or Trousseau's on exam.  Cardiac and
pulmonary exams were otherwise unremarkable.  Her ionized
calcium on the day of discharge was 1.12 and she remained
again asymptomatic from this standpoint.

She was instructed to follow up with her nephrologist at the
[**Hospital3 2358**] within the next week as well as to see Dr.
[**Last Name (STitle) **] and her endocrinologist within the next one to
two weeks for postoperative evaluation and also to monitor
calcium and parathormone levels.

DISCHARGE MEDICATIONS:
1.  Cyclosporin 125 mg po q a.m., 100 mg po q p.m.
2.  CellCept 1 gm po bid
3.  Prednisone 5 mg po q day
4.  Tums 500 mg po qid
5.  Vicodin 5 500 1 to 2 tablets po q4h prn
6.  Colace 100 mg po bid
7.  Zestril 5 mg po q a.m.
8.  Verapamil 120 mg po q a.m.
9.  Protonix 40 mg po q day
10. Claritin 10 mg po q day

DISCHARGE DIAGNOSIS:
1.  Hypoparathyroidism, rule out primary versus tertiary.
Final pathology is pending.  Please see path report for
specimen.

ADDITIONAL DIAGNOSES:
1.  Status post total thyroidectomy and parathyroidectomy
complicated by postoperative neck hematoma requiring
re-exploration and evacuation, now stable and resolved.  No
evidence of respiratory compromise.
2.  Polycystic kidney and liver disease with end stage renal
disease status post cadaveric renal transplant in '[**99**]
3.  Anxiety
4.  Depression
5.  Panic attacks
6.  Cerebral aneurysm
7.  Gastroesophageal reflux disease
8.  Endometriosis
9.  Raynaud's with a positive [**Doctor First Name **] and ovarian cyst

DISCHARGE DISPOSITION:  Home without services.

FOLLOW UP:  Plan is as stated above.




                          [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 11126**]

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

D:  [**2103-9-6**]  08:32
T:  [**2103-9-6**]  08:42
JOB#:  [**Job Number 11127**]

cc:[**Hospital3 11128**]
{'Hematoma complicating a procedure,Mitral valve disorders,Kidney replaced by transplant,Unspecified essential hypertension'}


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: 

MEDICAL HISTORY: Other past medical history is
significant for anxiety, multiple depressive episodes, panic
attacks.  She has a history of a cerebral aneurysm, history
of gastroesophageal reflux disease, endometriosis, Raynaud's
disease with a positive [**Doctor First Name **], as well as history of ovarian
cyst.

MEDICATION ON ADMISSION: 

ALLERGIES: SULFA, PENICILLIN

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Noncontributory 

### Response:
{'Hematoma complicating a procedure,Mitral valve disorders,Kidney replaced by transplant,Unspecified essential hypertension'}
