CHIEF COMPLAINT: Metastatic melanoma to left paraaortic region

PRESENT ILLNESS: This is a 67 year old female with  history of desmoplastic
invasive melanoma, with previous right lung mets ([**2171**]) and left
lung mets ([**2172**]) s/p surgery, interferon, high dose IL-2,
off-protocol GM-CSF, trial for temozolomide and experimental
ABT-888.
Most recently a repeat CT scan of the head and torso performed
on [**2176-6-25**], had shown persistence of her left paraaortic
presumed tumor deposit.  On [**2176-7-11**],a repeat FDG-PET CT was
performed, the first since [**2173-6-11**].  She
was found to have a left paraaortic mass, a presumed metastatic
node,measuring 2.8 x 2.4 cm on the most recent PET scan.
Although there has been not very much change in the size of the
lesion over serial CT scans, when compared to the PET CT scan of
[**2173-6-11**], the lesion has increased about 50% in size.  It had a
high SUV of 7.2 now.  A second focus in the left plantar foot
was seen with an SUV of 2.8, but no CT correlate. Ms. [**Known lastname 1182**] now
presents for an exploratory excision of left para-aortic mass.

MEDICAL HISTORY: - desmoplastic invasive melanoma, w/ previous R lung mets ([**2171**])
and L lung mets ([**2172**]) s/p surgery, interferon, high dose IL-2,
off-protocol GM-CSF, trial for temozolomide and experimental
ABT-888

MEDICATION ON ADMISSION: 1. Atorvastatin 10 mg PO DAILY
2. Hydrochlorothiazide 12.5 mg PO DAILY
3. Ondansetron Dose is Unknown  PO PRN nausea when on
temozolomide
4. Temozolomide Dose is Unknown  IV Frequency is Unknown
5. Senna 1 TAB PO BID:PRN constipation

ALLERGIES: Codeine

PHYSICAL EXAM: Admission Exam:
HEENT:  Normocephalic, atraumatic.  Sclerae are anicteric.
Moist
oral mucosa without lesions.
NECK:  Supple.  No JVD.
LYMPH NODES:  No cervical, supraclavicular, bilateral axillary
or bilateral inguinal lymphadenopathy.
HEART:  Regular rate and rhythm.  S1, S2, without murmur, rub,
or gallop.
LUNGS:  Resonant to percussion and clear to auscultation
bilaterally.
ABDOMEN: longitudinal dression over incision, not tympanic,
positive bowel sounds, soft, .  No hepatosplenomegaly or masses.
EXTREMITIES:  No clubbing, cyanosis, or edema.
SKIN:  Forehead wide local excision scar is without nodularity
or hyperpigmentation.

FAMILY HISTORY: - Cardiovascular disease in multiple family members including
father
- Sister who died of ovarian CA

SOCIAL HISTORY: - 67-year-old psychotherapist, married to wife, [**Name (NI) 4134**].
- [**Name2 (NI) 13089**] olympics for Pickleball
Secondary malignant neoplasm of retroperitoneum and peritoneum,Acute posthemorrhagic anemia,Hemorrhage complicating a procedure,Personal history of malignant melanoma of skin,Personal history of malignant neoplasm of bronchus and lung,Other iatrogenic hypotension,Unspecified essential hypertension,Other and unspecified hyperlipidemia
Sec mal neo peritoneum,Ac posthemorrhag anemia,Hemorrhage complic proc,Hx-malig skin melanoma,Hx-bronchogenic malignan,Iatrogenc hypotnsion NEC,Hypertension NOS,Hyperlipidemia NEC/NOS
Admission Date:  [**2176-8-29**]              Discharge Date:   [**2176-9-2**]

Date of Birth:  [**2108-10-17**]             Sex:   F

Service: SURGERY

Allergies:
Codeine

Attending:[**First Name3 (LF) 3223**]
Chief Complaint:
Metastatic melanoma to left paraaortic region

Major Surgical or Invasive Procedure:
Exploratory Laparotomy,excision of left para aortic mass


History of Present Illness:
This is a 67 year old female with  history of desmoplastic
invasive melanoma, with previous right lung mets ([**2171**]) and left
lung mets ([**2172**]) s/p surgery, interferon, high dose IL-2,
off-protocol GM-CSF, trial for temozolomide and experimental
ABT-888.
Most recently a repeat CT scan of the head and torso performed
on [**2176-6-25**], had shown persistence of her left paraaortic
presumed tumor deposit.  On [**2176-7-11**],a repeat FDG-PET CT was
performed, the first since [**2173-6-11**].  She
was found to have a left paraaortic mass, a presumed metastatic
node,measuring 2.8 x 2.4 cm on the most recent PET scan.
Although there has been not very much change in the size of the
lesion over serial CT scans, when compared to the PET CT scan of
[**2173-6-11**], the lesion has increased about 50% in size.  It had a
high SUV of 7.2 now.  A second focus in the left plantar foot
was seen with an SUV of 2.8, but no CT correlate. Ms. [**Known lastname 1182**] now
presents for an exploratory excision of left para-aortic mass.


Past Medical History:
- desmoplastic invasive melanoma, w/ previous R lung mets ([**2171**])
and L lung mets ([**2172**]) s/p surgery, interferon, high dose IL-2,
off-protocol GM-CSF, trial for temozolomide and experimental
ABT-888

PSH:
- wide excision of melanoma on forehead ([**2165**])
- R lung wedge resection ([**2171**])
- L lower lobe VATS wedge resection ([**2172**])


Social History:
- 67-year-old psychotherapist, married to wife, [**Name (NI) 4134**].
- [**Name2 (NI) 13089**] olympics for Pickleball


Family History:
- Cardiovascular disease in multiple family members including
father
- Sister who died of ovarian CA



Physical Exam:
Admission Exam:
HEENT:  Normocephalic, atraumatic.  Sclerae are anicteric.
Moist
oral mucosa without lesions.
NECK:  Supple.  No JVD.
LYMPH NODES:  No cervical, supraclavicular, bilateral axillary
or bilateral inguinal lymphadenopathy.
HEART:  Regular rate and rhythm.  S1, S2, without murmur, rub,
or gallop.
LUNGS:  Resonant to percussion and clear to auscultation
bilaterally.
ABDOMEN: longitudinal dression over incision, not tympanic,
positive bowel sounds, soft, .  No hepatosplenomegaly or masses.
EXTREMITIES:  No clubbing, cyanosis, or edema.
SKIN:  Forehead wide local excision scar is without nodularity
or hyperpigmentation.

Discharge Exam:
Vitals:98.8,95,146/87,16, 96% RA
Normocephalic, atraumatic.  Sclerae are anicteric.  Moist
oral mucosa without lesions.
NECK:  Supple.  No JVD.
LYMPH NODES:  No cervical, supraclavicular, bilateral axillary
or bilateral inguinal lymphadenopathy.
HEART:  Regular rate and rhythm.  S1, S2, without murmur, rub,
or gallop.
LUNGS:  clear to auscultation bilaterally.
ABDOMEN: soft,nontender, nondistended,normoactive bowel
sounds,No hepatosplenomegaly or masses.
INCISION:abdominal staples clean,dry,intact
EXTREMITIES:  No clubbing, cyanosis, or edema.
SKIN:  Forehead wide local excision scar is without nodularity
or hyperpigmentation.


Pertinent Results:
Admission Labs:
[**2176-8-29**] 04:55PM BLOOD WBC-8.6# RBC-3.40* Hgb-10.8* Hct-30.7*
MCV-90 MCH-31.9 MCHC-35.3* RDW-14.0 Plt Ct-113*
[**2176-8-29**] 04:55PM BLOOD PT-11.8 PTT-24.4* INR(PT)-1.1
[**2176-8-29**] 04:55PM BLOOD Glucose-181* UreaN-16 Creat-1.1 Na-143
K-3.7 Cl-106 HCO3-29 AnGap-12
[**2176-8-29**] 04:55PM BLOOD ALT-15 AST-17 AlkPhos-44 TotBili-1.9*
[**2176-8-29**] 04:55PM BLOOD Calcium-8.6 Phos-3.9 Mg-1.8
[**2176-8-29**] 03:12PM BLOOD Type-ART pO2-199* pCO2-42 pH-7.35
calTCO2-24 Base XS--2
[**2176-8-29**] 03:12PM BLOOD freeCa-0.91*


Brief Hospital Course:
67 year old female with metastatic melanoma who is status post
exploratory laparotomy, excision of left para-aortic mass.
Intraoperatively patient had blood loss of approximately 1L
blood during her surgery. Patient had postoperative hypotension
and anemia. Her post-operative hematocrit dropped from 30.7 to
28.5. Patient was transfused with 3 units pRBCs, 4L IVF, 1 x FFP
in the OR. Following her surgery and PACU stay she was
transferred to the MICU for monitoring of her hematocrit and
fluid resuscitation. In the ICU she was transfused another 2
units overnight.  Patient remained hemodynamically stable with
appropriate increased hematocrit which remained stable after
transfusion. While in the ICU, patient had minimal pain,
controlled on acetaminophen and Dilaudid PCA. After a short ICU
stay and once patient was hemodynamically stable she was
transferred to floor.

Patient's intake and output were closely monitored, and IV
fluids was adjusted when necessary. Electrolytes were routinely
followed, and repleted when necessary. Patient's white blood
count and fever curves were closely watched for signs of
infection.

Patient was monitored closely on telemetry, she remained stable
from a cardiovascular and pulmonary standpoint;vital signs were
routinely monitored. Good pulmonary toilet, early ambulation and
incentive spirometry were encouraged throughout hospitalization.

Once patient had return of bowel function with gas, the PCA was
discontinued and she was transition to oral pain medications.
Patient diet was slowly advanced to clear liquids. Patient
reported intermittent nausea which resolved with antiemetics as
needed.  By POD 4, patient was passing gas and had a bowel
movement overnight.

At the time of discharge POD 4, patient was doing well, afebrile
with stable vital signs.  Patient was deemed stable for
discharge. Patient received discharge teaching and follow-up
instructions with understanding verbalized and agreement with
the discharge plan.


Medications on Admission:
1. Atorvastatin 10 mg PO DAILY
2. Hydrochlorothiazide 12.5 mg PO DAILY
3. Ondansetron Dose is Unknown  PO PRN nausea when on
temozolomide
4. Temozolomide Dose is Unknown  IV Frequency is Unknown
5. Senna 1 TAB PO BID:PRN constipation


Discharge Medications:
1. Atorvastatin 10 mg PO DAILY
2. Hydrochlorothiazide 12.5 mg PO DAILY
3. Acetaminophen 650 mg PO Q6H
4. Docusate Sodium 100 mg PO BID
5. HYDROmorphone (Dilaudid) 1-2 mg PO Q4H:PRN pain
RX *Dilaudid 2 mg 0.5-1 tablet(s) by mouth every four (4) hours
Disp #*30 Tablet Refills:*0
6. Senna 1 TAB PO BID:PRN constipation


Discharge Disposition:
Home

Discharge Diagnosis:
Metastatic Melanoma


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Please call your doctor or return to the ER for any of the
following:
* You experience new chest pain, pressure, squeezing or
tightness.
* New or worsening cough or wheezing.
* If you are vomiting and cannot keep in fluids or your
medications.
* You are getting dehydrated due to continued vomiting, diarrhea
or other reasons. Signs of dehydration include dry mouth, rapid
heartbeat or feeling dizzy or faint when standing.
* You see blood or dark/black material when you vomit or have a
bowel movement.
* Your pain is not improving within 8-12 hours or not gone
within 24 hours. Call or return immediately if your pain is
getting worse or is changing location or moving to your chest or
back.
*Avoid driving or operating heavy machinery while taking pain
medications.
* You have shaking chills, or a fever greater than 101.5 (F)
degrees or 38(C) degrees.
* Any serious change in your symptoms, or any new symptoms that
concern you.
* Please resume all regular home medications and take any new
meds
as ordered.
* Continue to ambulate several times per day.

Incision Care:
-You may shower, and wash surgical incisions.
-Your staples will be removed at your follow-up appointment.
-Avoid swimming and baths until your follow-up appointment.
-Please call the doctor if you have increased pain, swelling,
redness, or drainage from the incision sites.






Followup Instructions:
Department: SURGICAL SPECIALTIES
When: MONDAY [**2176-9-9**] at 11:30 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**], M.D. [**Telephone/Fax (1) 6554**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: HEMATOLOGY/ONCOLOGY
When: TUESDAY [**2176-9-17**] at 1:30 PM
With: [**First Name8 (NamePattern2) 20062**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], NP [**Telephone/Fax (1) 63699**]
Building: [**Hospital6 29**] [**Location (un) 24**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: HEMATOLOGY/ONCOLOGY
When: TUESDAY [**2176-9-17**] at 1:30 PM
With: DRS. [**Name5 (PTitle) **]/[**Doctor Last Name **] [**Telephone/Fax (1) 13016**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 24**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 520**] MD, [**MD Number(3) 3226**]

Completed by:[**2176-9-2**]
{'Secondary malignant neoplasm of retroperitoneum and peritoneum,Acute posthemorrhagic anemia,Hemorrhage complicating a procedure,Personal history of malignant melanoma of skin,Personal history of malignant neoplasm of bronchus and lung,Other iatrogenic hypotension,Unspecified essential hypertension,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: Metastatic melanoma to left paraaortic region

PRESENT ILLNESS: This is a 67 year old female with  history of desmoplastic
invasive melanoma, with previous right lung mets ([**2171**]) and left
lung mets ([**2172**]) s/p surgery, interferon, high dose IL-2,
off-protocol GM-CSF, trial for temozolomide and experimental
ABT-888.
Most recently a repeat CT scan of the head and torso performed
on [**2176-6-25**], had shown persistence of her left paraaortic
presumed tumor deposit.  On [**2176-7-11**],a repeat FDG-PET CT was
performed, the first since [**2173-6-11**].  She
was found to have a left paraaortic mass, a presumed metastatic
node,measuring 2.8 x 2.4 cm on the most recent PET scan.
Although there has been not very much change in the size of the
lesion over serial CT scans, when compared to the PET CT scan of
[**2173-6-11**], the lesion has increased about 50% in size.  It had a
high SUV of 7.2 now.  A second focus in the left plantar foot
was seen with an SUV of 2.8, but no CT correlate. Ms. [**Known lastname 1182**] now
presents for an exploratory excision of left para-aortic mass.

MEDICAL HISTORY: - desmoplastic invasive melanoma, w/ previous R lung mets ([**2171**])
and L lung mets ([**2172**]) s/p surgery, interferon, high dose IL-2,
off-protocol GM-CSF, trial for temozolomide and experimental
ABT-888

MEDICATION ON ADMISSION: 1. Atorvastatin 10 mg PO DAILY
2. Hydrochlorothiazide 12.5 mg PO DAILY
3. Ondansetron Dose is Unknown  PO PRN nausea when on
temozolomide
4. Temozolomide Dose is Unknown  IV Frequency is Unknown
5. Senna 1 TAB PO BID:PRN constipation

ALLERGIES: Codeine

PHYSICAL EXAM: Admission Exam:
HEENT:  Normocephalic, atraumatic.  Sclerae are anicteric.
Moist
oral mucosa without lesions.
NECK:  Supple.  No JVD.
LYMPH NODES:  No cervical, supraclavicular, bilateral axillary
or bilateral inguinal lymphadenopathy.
HEART:  Regular rate and rhythm.  S1, S2, without murmur, rub,
or gallop.
LUNGS:  Resonant to percussion and clear to auscultation
bilaterally.
ABDOMEN: longitudinal dression over incision, not tympanic,
positive bowel sounds, soft, .  No hepatosplenomegaly or masses.
EXTREMITIES:  No clubbing, cyanosis, or edema.
SKIN:  Forehead wide local excision scar is without nodularity
or hyperpigmentation.

FAMILY HISTORY: - Cardiovascular disease in multiple family members including
father
- Sister who died of ovarian CA

SOCIAL HISTORY: - 67-year-old psychotherapist, married to wife, [**Name (NI) 4134**].
- [**Name2 (NI) 13089**] olympics for Pickleball 

### Response:
{'Secondary malignant neoplasm of retroperitoneum and peritoneum,Acute posthemorrhagic anemia,Hemorrhage complicating a procedure,Personal history of malignant melanoma of skin,Personal history of malignant neoplasm of bronchus and lung,Other iatrogenic hypotension,Unspecified essential hypertension,Other and unspecified hyperlipidemia'}
