CHIEF COMPLAINT: brain metastasis

PRESENT ILLNESS: Patient is a 57-year-old male with Burkitt's type lymphoma
originally diagnosed in [**12/2117**] s/p chemotherapy, allogenic stem
cell transplant, and Ommaya shunt placement on [**2117-12-19**] who is
currently admitted for chemotherapy for a solitary temporal lobe
brain met.  Pt initially c/o HA and reported this sx to
oncologist.  MRI was obtained and he was found to have an
enhancing left temporal lobe mass.  Pathological reports showed
this lesion to be a recurrence of his Burkitt's lymphoma.  He is
now scheduled to get high dose methotrexate for the brain
lesion.  Pt also has a persistent groin seroma secondary to
inguinal lymph node removal that has required draining x 4.  Pt
has been in good state of health recently.  He reports no fever,
nausea, vomiting, diarrhea, chest pain, SOB, and vision or
hearing changes.

MEDICAL HISTORY: 1. Irregular heart beat which was extensively worked-up with
Holter monitors, and just felt to be secondary to occasional
PVCs for which he takes atenolol.
2. Abdominal ventral hernia.
3. Pyloric stenosis as an infant.
4. Hypercholesterolemia.

MEDICATION ON ADMISSION: 1. Lamivudine 100 mg Tablet qd
2. Ursodiol 300 mg  po qd
3. Lopressor 25 mg po bid
6. Vancomycin HCl 1,000 mg IV bid
7. Protonix 40 mg po qd
8. Fluconazole 100 mg po qd
9. MVI
10. Epivir HBV 100 mg po qd
11. Procardia 30 mg po qd
12. Folate 4 mg po qd
13. Valgancyclovir  450 mg po qd
14. Decadron 4 mg tid
15. Levoquin 1 tab qd x 10 days

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS - 96.5 64 18 128/76 99% RA

FAMILY HISTORY: No cancer history for colon, breast, ovarian
or lung.  No history of lymphomas or leukemias.

SOCIAL HISTORY: He lives in [**Location 912**], [**State 350**].  He is a
product developer at Fidelity.  Tobacco - 20 pack year
history, quit in [**2094**].  Alcohol - occasionally, [**3-15**] drinks
per weekend.  He has 3 children, 2 daughters, 1 son.
Burkitt's tumor or lymphoma, lymph nodes of head, face, and neck,Epilepsy, unspecified, without mention of intractable epilepsy,Seroma complicating a procedure,Bone marrow replaced by transplant,Retention of urine, unspecified,Hyposmolality and/or hyponatremia
Burkitt's tumor head,Epilep NOS w/o intr epil,Seroma complicting proc,Trnspl status-bne marrow,Retention urine NOS,Hyposmolality
Admission Date:  [**2118-8-31**]              Discharge Date:   [**2118-9-1**]

Date of Birth:  [**2061-2-6**]             Sex:   M

Service: NMED

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 8850**]
Chief Complaint:
brain metastasis

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Patient is a 57-year-old male with Burkitt's type lymphoma
originally diagnosed in [**12/2117**] s/p chemotherapy, allogenic stem
cell transplant, and Ommaya shunt placement on [**2117-12-19**] who is
currently admitted for chemotherapy for a solitary temporal lobe
brain met.  Pt initially c/o HA and reported this sx to
oncologist.  MRI was obtained and he was found to have an
enhancing left temporal lobe mass.  Pathological reports showed
this lesion to be a recurrence of his Burkitt's lymphoma.  He is
now scheduled to get high dose methotrexate for the brain
lesion.  Pt also has a persistent groin seroma secondary to
inguinal lymph node removal that has required draining x 4.  Pt
has been in good state of health recently.  He reports no fever,
nausea, vomiting, diarrhea, chest pain, SOB, and vision or
hearing changes.


Past Medical History:
1. Irregular heart beat which was extensively worked-up with
Holter monitors, and just felt to be secondary to occasional
PVCs for which he takes atenolol.
2. Abdominal ventral hernia.
3. Pyloric stenosis as an infant.
4. Hypercholesterolemia.


Social History:
He lives in [**Location 912**], [**State 350**].  He is a
product developer at Fidelity.  Tobacco - 20 pack year
history, quit in [**2094**].  Alcohol - occasionally, [**3-15**] drinks
per weekend.  He has 3 children, 2 daughters, 1 son.

Family History:
No cancer history for colon, breast, ovarian
or lung.  No history of lymphomas or leukemias.


Physical Exam:
VS - 96.5 64 18 128/76 99% RA

Gen: sitting in a chair comfortable NAD
Heent:  EOMI, MMM, no cervial lymphadenopathy Ommaya reservoir
on r frontal region of skull.
Card: RRR nl S1 S2 no m/r/g
Lungs: CTA b/l no m/r/g
Abd: soft NT ND + BS, mobile solid mass 4 cm x 2 cm on r groin
Ext: pitting edema extending up to knees b/l
Neuro: A & O x3.  CN III-XII intact. 5/5 strength throughout.

Pertinent Results:
[**2118-8-31**] 12:34PM   PT-12.1 PTT-22.5 INR(PT)-1.0
[**2118-8-31**] 12:34PM   PLT COUNT-144*
[**2118-8-31**] 12:34PM   HYPOCHROM-NORMAL ANISOCYT-OCCASIONAL
POIKILOCY-OCCASIONAL MACROCYT-OCCASIONAL MICROCYT-NORMAL
POLYCHROM-NORMAL SCHISTOCY-OCCASIONAL
[**2118-8-31**] 12:34PM   NEUTS-40* BANDS-0 LYMPHS-18 MONOS-40* EOS-0
BASOS-0 ATYPS-2* METAS-0 MYELOS-0
[**2118-8-31**] 12:34PM   WBC-2.0* RBC-3.44* HGB-11.0* HCT-31.8* MCV-92
MCH-32.1* MCHC-34.8 RDW-17.4*
[**2118-8-31**] 12:34PM   ALBUMIN-4.0 CALCIUM-9.0 PHOSPHATE-2.3*
MAGNESIUM-1.7 URIC ACID-5.8
[**2118-8-31**] 12:34PM   ALT(SGPT)-29 AST(SGOT)-25 ALK PHOS-131* TOT
BILI-0.7
[**2118-8-31**] 12:34PM   GLUCOSE-263* UREA N-32* CREAT-1.0 SODIUM-135
POTASSIUM-3.6 CHLORIDE-99 TOTAL CO2-25 ANION GAP-15

Brief Hospital Course:
A/P  57 yo male w/ Burkitts Lymphoma s/p chemo and BMT admitted
for chemotherapy to treat r temporal lobe solitary metastasis.

Pt was scheduled to get inguinal seroma drainage via US and then
receive methotrexate treatment.  However pt remained neutropenic
thought to be secondary to valgancyclovir treatment and as a
result it was deemed best that he go home and return in one week
to receive chemotherapy.


Medications on Admission:
1. Lamivudine 100 mg Tablet qd
2. Ursodiol 300 mg  po qd
3. Lopressor 25 mg po bid
6. Vancomycin HCl 1,000 mg IV bid
7. Protonix 40 mg po qd
8. Fluconazole 100 mg po qd
9. MVI
10. Epivir HBV 100 mg po qd
11. Procardia 30 mg po qd
12. Folate 4 mg po qd
13. Valgancyclovir  450 mg po qd
14. Decadron 4 mg tid
15. Levoquin 1 tab qd x 10 days


Discharge Medications:
1. Lamivudine 100 mg Tablet qd
2. Ursodiol 300 mg  po qd
3. Lopressor 25 mg po bid
6. Vancomycin HCl 1,000 mg IV bid
7. Protonix 40 mg po qd
8. Fluconazole 100 mg po qd
9. MVI
10. Epivir HBV 100 mg po qd
11. Procardia 30 mg po qd
12. Folate 4 mg po qd

Discharge Disposition:
Home With Service

Facility:
Critical Care Systems

Discharge Diagnosis:
Burkitt's lymphoma

Discharge Condition:
stable




Admission Date:  [**2118-9-2**]              Discharge Date:   [**2118-9-16**]

Date of Birth:  [**2061-2-6**]             Sex:   M

Service: NMED

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5341**]
Chief Complaint:
seizure
CNS lymphoma

Major Surgical or Invasive Procedure:
IV HIgh -dose Methotrexate and ARA-C chemotherapy via Omayya
catheter

History of Present Illness:
57 yoM with Burkitt's lymphoma diagnosed [**12-14**] s/p chemoRx wth
CODOX / IVAC / ARA-C in [**9-20**]. Patient retreated with
Rituxan, [**Hospital1 **] / Velcade chemoRx. Ultimately, patient had
allogenetic Tx from brother on [**2118-6-9**]. Since then has had CMV
viremia, Rx with valgancyclovir, VRE bactremia, and persistent
neutropenia with good initial response in terms of his lymphoma,
until presented to clinic with left temporal HAs and imaging
confirmed brain mets which were biopsied by Dr. [**Last Name (STitle) 1338**] and
confirmed high grade diffuse large B-cell lymphoma. Was admitted
on [**8-30**] for onset on high dose methotrexate for CNS lymphoma.
However, MTX therapy was delayed secondary to neutropenia, which
is attributed to valgancyclovir- which was stopped on [**8-30**].
Then morning after discharge on [**9-1**], felt to be more confused
by family and then had a witnesses tonic-clonic self limited
seizure with loss of consciousness followed by clear postictal
state. Initially presented to [**Hospital **] Hospital which confirmed
left temporal mass with post-op changes. Loaded with dilantin
and then had another seizure and transferred here. At [**Hospital1 18**] [**Hospital Unit Name 153**]
was re-loaded on dilantin with keppra and last seizure was on
[**9-2**]- has now been stable on 7Feldberg only with persistent
aphasia.


Past Medical History:
1. Irregular heart beat which was extensively worked-up with
Holter monitors, and just felt to be secondary to occasional
PVCs for which he takes atenolol.
2. Abdominal ventral hernia.
3. Pyloric stenosis as an infant.
4. Hypercholesterolemia.


Social History:
He lives in [**Location 912**], [**State 350**].  He is a product developer
at Fidelity.  Tobacco - 20 pack year history, quit in [**2094**].
Alcohol - occasionally, [**3-15**] drinks per weekend.  He has 3
children, 2 daughters, 1 son.

Family History:
No cancer history for colon, breast, ovarian
or lung.  No history of lymphomas or leukemias.


Physical Exam:
PE: t- 97.5, bp 136/96, hr 68, rr 18, spo2 100% RA
gen- awake, alert male, nad, unable to assess orientation [**3-14**]
aphasia
cv- rrr, s1s2, no m/r/g
chest- CTAB, but will not cooperate with full breaths, port site
dry,
clean and no erythema or tenderness
abd- soft, NT/ND, +BS
ext- no c/c/e
neuro- CNII-XII intact, + receptive aphasia, no orientation, not
able to ID objects, not following commands, 5/5 strength but
poor cooperation with exam, reflexes 2+ bilaterally


Pertinent Results:
[**2118-9-1**] 12:05AM BLOOD WBC-1.6* RBC-3.15* Hgb-10.2* Hct-29.0*
MCV-92 MCH-32.5* MCHC-35.2* RDW-16.9* Plt Ct-134*
[**2118-9-16**] 01:00AM BLOOD WBC-3.9*# RBC-3.49* Hgb-11.1* Hct-30.9*
MCV-89 MCH-31.8 MCHC-35.8* RDW-16.3* Plt Ct-20*
[**2118-9-3**] 04:30AM BLOOD Neuts-10* Bands-0 Lymphs-51* Monos-38*
Eos-1 Baso-0 Atyps-0 Metas-0 Myelos-0
[**2118-9-11**] 12:00AM BLOOD Neuts-50 Bands-0 Lymphs-43* Monos-7 Eos-0
Baso-0 Atyps-0 Metas-0 Myelos-0
[**2118-9-1**] 12:05AM BLOOD Plt Ct-134*

[**2118-9-2**] 12:31AM BLOOD PT-11.8 PTT-21.7* INR(PT)-0.9
[**2118-9-16**] 01:00AM BLOOD PT-12.7 PTT-24.1 INR(PT)-1.1

[**2118-9-16**] 01:00AM BLOOD Plt Ct-20*

[**2118-9-4**] 02:00AM BLOOD Fibrino-361
[**2118-9-16**] 01:00AM BLOOD Fibrino-425*

[**2118-9-2**] 12:31AM BLOOD Gran Ct-460*
[**2118-9-16**] 01:00AM BLOOD Gran Ct-[**2094**]*

[**2118-9-1**] 12:05AM BLOOD Glucose-373* UreaN-29* Creat-1.0 Na-133
K-3.1* Cl-94* HCO3-29 AnGap-13
[**2118-9-16**] 01:00AM BLOOD Glucose-113* UreaN-15 Creat-0.9 Na-132*
K-3.8 Cl-98 HCO3-22 AnGap-16

[**2118-9-1**] 12:05AM BLOOD ALT-26 AST-22 AlkPhos-130* TotBili-0.7
[**2118-9-16**] 01:00AM BLOOD ALT-7 AST-12 AlkPhos-152* TotBili-0.4
[**2118-9-5**] 12:00AM BLOOD ALT-19 AST-27 LD(LDH)-677* AlkPhos-136*
TotBili-1.0 DirBili-0.3 IndBili-0.7

[**2118-9-1**] 12:05AM BLOOD Albumin-3.8 Calcium-8.5 Phos-2.2* Mg-1.9
UricAcd-5.4
[**2118-9-16**] 01:00AM BLOOD Albumin-3.9 Calcium-9.0 Phos-2.2* Mg-1.8

[**2118-9-2**] 12:31AM BLOOD Phenyto-6.6*
[**2118-9-14**] 11:15PM BLOOD Phenyto-14.7 Phenyfr-1.8 %Phenyf-12

[**2118-9-1**] 10:00AM BLOOD Cyclspr-133
[**2118-9-16**] 10:50AM BLOOD Cyclspr-114

Head MRI:
IMPRESSION:
1. Slight increase in the size of the left anterior temporal
lobe enhancing mass.
2. Status post biopsy with a residual tract posterior to the
enhancing mass.
3. Increased temporal lobe edema and mass effect, but no
herniation or evidence of hydrocephalus.
4. Tip of the reservoir situated in the right caudate. Position
unchanged.

EEG:
IMPRESSION: This is an abnormal portable EEG in the awake and
drowsy
states due to the presence of a slowed disorganized background
rhythm
with intermittent bursts of generalized delta frequency slowing
and the
presence of occasional left temporal lobe sharp and slow [**Male First Name (un) **] e
isodic
symptoms. The presence of discharges in the left temporal lobe
is
suggestive of a potential epileptic focus due to cortical
dysfunction.
The slow and disorganized background rhythm with intermittent
bursts of
delta frequency slowing is suggestive of a mild encephalopathy.


Brief Hospital Course:
Mr [**Known lastname 882**] was admitted after recently being discharged after
being admitted for a coarse of MTX (not able to be given due to
neutropenia likely caused by valgancyclovir). He was having very
difficult to control seizures on admission.

CNS lymphoma/chemo/cytopenias- These are stable and confirmed on
recent temporal lobe biopsy as being high grade, diffuse large
B-cell lymphoma. Pt had aggressive hydration and alkalinization
of urine and was then given methotrexate as per neuro-med
protocol for chemo responsive CNS lymphoma starting [**2118-9-3**].
MTX was planned to be given at 3.5 g/m^2 but was dose reduced to
2.1 g/m^2 becasue of a creatine clearance of only 59 ml/min
based on a 24 hour urine. US guided drainage of right inguinal
seroma was performed to prevent sequestration of methotrexate in
the seroma. Pt also received intrathecal ARA-C via Omayya
reservoir on [**2118-9-8**] - this was done becasue of a concern for
leptomeningeal invovlment causing a flaccid bladder. However, as
the patient's mental status improved, so did his urine control.
CSF x 2 from his Ommaya was negative for malignant cells. He was
neutropenic s/p chemotherapy and then became febrile on [**9-10**].
There was no clear source, and he had neg blood and urine
cultures throughout. A CSF gram stain was neg, but there were a
few WBCs.  Empiric cefepime for fever/neutropenia was initiated
and continued until discharge, as all cultures remained neg, pt
remained afebrile, and his neutropenia had resolved. Neupogen
was continued daily for neutropenia and for one day post-D/C. We
Followed daily ANCs. They initially dropped for several days,
but then reached a nadir of 300 before climbing back to >1000.
He also had a significant drop in his platelets, which were in
the 20s on discharge, but stable and he was without signs of
bleeding/petechiae.  XRT was continued while he was an
inpatient.

[**Name (NI) 73501**] Pt continued to seize throughout first few days of
admission and was treated with maximal doses of dilantin.
Keppra and Lamictal were added, as was decadron(due to edema
around brain met) before he stopped seizing.   He did have
continued twitching of leg which is a partial epileptic seizure.
 This was followed and not treated with ativan.  Epilepsy team
evaluated him with another EEG done. They felt the patient had
reflex epilepsy and recommended continued increase in the dose
of the lamictal (50mg in divided doses) on a weekly basis, which
could be done safely as the patient was on a p-450 inducer,
dilantin. The seizures became stable and disappeared during the
last week of his hospital stay.  For breakthrough seizures- low
dose ativan- but not needed for focal epileptic seizures of leg.
His lamictal was gradually increased, with the plan of D/Cing
the Dilantin after Lamictal was at full doses.  Dilantin levels
were checked daily, with a goal of 15-20.  He was sent home on
all 4 of the above medicines.

Anemia - He also had a drop in his Hct after the MTX treatment.
This was watched, and after he continued to dsrop, with
resultant tachycardia, he was transfused 2 units of PRBCs with
good response in his Hct.  He was also started on Epogen at this
time.

Mental Status - Initially, patient was aphasic, but this
improved with treatment.  Pt had variable course with regards to
his mental function.  His short term memory fluctuated.  He had
some difficulty remembering short term events.  This was thought
to be multifactorial.  He may have had some confusion from
continued seizures, ativan tx, and edema from brain mets.  He
had improved fairly significantly until fever over weekend.
After this, his confusion increased and he had a lot of trouble
with word finding, attention, and slow answers to questions.  He
was usually fairly alert, but couldn't do calculations or
difficult tasks.  A fever spike abuot 5 days before his
discharge was felt to be due to the IT ARa-C he received; this
caused his mental status to again decrease, this gradually
cleared as the week went on, but he was not at his complete
baseline when discharged.  He is thinking clearly, but the
problem seems to be with an expressive aphasia.

s/p BMT- His cyclosporine was continued while here, but the
levels fluctuated, most likely due to many of the medications
started this admission.  The dilantin especially interacts with
the levels of cyclosporine in the body.  His doses were adjusted
accordingly, with the knowledge that the decadron he was taking
would also help to prevent GVHD if his levels of cyclosporine
weren't therapeutic.  Due to neutropenia and recent transplant,
he was put on or already taking fluconazole, lamivudine, bactrim
DS, and acyclovir.  Weekly CMV viral loads were also sent which
remained negative. Continue MVI and folate.

Diarrhea: He had some episodes of diarrhea and was on vanco in
the recent past. Sent C diff which was neg. Also had rectal pain
that was most likely due to the XRT.  The pain was treated with
oxycodone effectively.  The diarrhea resolved on its own and did
not return.

HTN: He was continued on his home antihypertensives and
maintained good BPs throughout the admission.

He was sent home after his neutropenia resolved with a plan to
return Wednesday [**2118-9-21**] to start another round of MTX
therapy.

Medications on Admission:
1. Lamivudine 100 mg Tablet qd
2. Ursodiol 300 mg  po qd
3. Lopressor 25 mg po bid
4. Vancomycin HCl 1,000 mg IV bid
5. Protonix 40 mg po qd
6. Fluconazole 100 mg po qd
7. MVI
8. Epivir HBV 100 mg po qd
9. Procardia 30 mg po qd
10. Folate 4 mg po qd


Discharge Medications:
1. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO once a day.
2. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO once a day.
3. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.
4. M-Vit     Tablet Sig: One (1) Tablet PO once a day.
5. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO twice
a day.
6. Nifedipine ER 30 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO once a day.
7. Ursodiol 300 mg Capsule Sig: One (1) Capsule PO twice a day.

8. Lamivudine 100 mg Tablet Sig: [**2-11**] (half) Tablet PO once a
day.
9. Fluconazole 100 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
10. Dilantin 100 mg Capsule Sig: Three (3) Capsule PO twice a
day.
Disp:*180 Capsule(s)* Refills:*0*
11. Keppra 500 mg Tablet Sig: Two (2) Tablet PO twice a day.
Disp:*120 Tablet(s)* Refills:*0*
12. Lamictal 25 mg Tablet Sig: Two (2) Tablet PO twice a day:
Start taking 3 tablets, twice a day on Monday.
Disp:*120 Tablet(s)* Refills:*0*
13. Neoral 100 mg Capsule Sig: Two (2) Capsule PO twice a day.
Disp:*120 Capsule(s)* Refills:*0*
14. Epogen 10,000 unit/mL Solution Sig: One (1) mL Injection 3
times per week: Start on Monday.
Disp:*1 syringes* Refills:*0*
15. Oxycodone HCl 5 mg Capsule Sig: One (1) Capsule PO every [**5-17**]
hours as needed for pain.
Disp:*60 Capsule(s)* Refills:*0*
16. magnesium 16 mEq in 800 cc NS
Please give this 4 times per week IV, starting [**2118-9-17**].
17. Bactrim DS 160-800 mg Tablet Sig: One (1) Tablet PO
qmonday,wednesday,friday.
Disp:*12 Tablet(s)* Refills:*0*
18. Decadron 4 mg Tablet Sig: [**2-11**] (half) Tablet PO three times a
day.
Disp:*7 Tablet(s)* Refills:*0*
19. Neoral 25 mg Capsule Sig: One (1) Capsule PO twice a day.
Disp:*60 Capsule(s)* Refills:*0*
20. Neupogen 480 mcg/0.8mL Syringe Sig: One (1) injection
Injection once a day for 1 days.
Disp:*1 syringe* Refills:*0*
21. Acyclovir 400 mg Tablet Sig: One (1) Tablet PO three times a
day.
Disp:*90 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 932**] Area VNA

Discharge Diagnosis:
Burkitt's lymphoma
CNS lymphoma
Seizures
Febrile neutropenia
Hypertension
Pancytopenia


Discharge Condition:
Ambulating.  Pain well controlled with medication. No O2
requirement. Eating fairly well. Stable.  Mental status
improving.

Discharge Instructions:
Please call your doctor or return to the hospital in you
experience any fevers, chills, shortness of breath, or seizures.

Please return Wednesday morning to be readmitted for your next
round of chemotherapy.

Please don't drive while you are out of the hospital due to risk
of seizures.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) 125**] [**Last Name (NamePattern4) 126**], M.D. Where: [**Hospital6 29**]
CARDIAC SERVICES Phone:[**Telephone/Fax (1) 127**] Date/Time:[**2119-5-10**] 10:00
{"Burkitt's tumor or lymphoma, lymph nodes of head, face, and neck,Epilepsy, unspecified, without mention of intractable epilepsy,Seroma complicating a procedure,Bone marrow replaced by transplant,Retention of urine, unspecified,Hyposmolality and/or hyponatremia"}


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: brain metastasis

PRESENT ILLNESS: Patient is a 57-year-old male with Burkitt's type lymphoma
originally diagnosed in [**12/2117**] s/p chemotherapy, allogenic stem
cell transplant, and Ommaya shunt placement on [**2117-12-19**] who is
currently admitted for chemotherapy for a solitary temporal lobe
brain met.  Pt initially c/o HA and reported this sx to
oncologist.  MRI was obtained and he was found to have an
enhancing left temporal lobe mass.  Pathological reports showed
this lesion to be a recurrence of his Burkitt's lymphoma.  He is
now scheduled to get high dose methotrexate for the brain
lesion.  Pt also has a persistent groin seroma secondary to
inguinal lymph node removal that has required draining x 4.  Pt
has been in good state of health recently.  He reports no fever,
nausea, vomiting, diarrhea, chest pain, SOB, and vision or
hearing changes.

MEDICAL HISTORY: 1. Irregular heart beat which was extensively worked-up with
Holter monitors, and just felt to be secondary to occasional
PVCs for which he takes atenolol.
2. Abdominal ventral hernia.
3. Pyloric stenosis as an infant.
4. Hypercholesterolemia.

MEDICATION ON ADMISSION: 1. Lamivudine 100 mg Tablet qd
2. Ursodiol 300 mg  po qd
3. Lopressor 25 mg po bid
6. Vancomycin HCl 1,000 mg IV bid
7. Protonix 40 mg po qd
8. Fluconazole 100 mg po qd
9. MVI
10. Epivir HBV 100 mg po qd
11. Procardia 30 mg po qd
12. Folate 4 mg po qd
13. Valgancyclovir  450 mg po qd
14. Decadron 4 mg tid
15. Levoquin 1 tab qd x 10 days

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS - 96.5 64 18 128/76 99% RA

FAMILY HISTORY: No cancer history for colon, breast, ovarian
or lung.  No history of lymphomas or leukemias.

SOCIAL HISTORY: He lives in [**Location 912**], [**State 350**].  He is a
product developer at Fidelity.  Tobacco - 20 pack year
history, quit in [**2094**].  Alcohol - occasionally, [**3-15**] drinks
per weekend.  He has 3 children, 2 daughters, 1 son. 

### Response:
{"Burkitt's tumor or lymphoma, lymph nodes of head, face, and neck,Epilepsy, unspecified, without mention of intractable epilepsy,Seroma complicating a procedure,Bone marrow replaced by transplant,Retention of urine, unspecified,Hyposmolality and/or hyponatremia"}
