CHIEF COMPLAINT: Hematemesis

PRESENT ILLNESS: Mr. [**Known lastname **] is a 67 year-old man with a history of DM, CAD,
large infrarenal AAA with bilateral large common iliac
aneurysms, s/p right hypogastric coiled embolization on
[**2197-1-17**], who presents with hematemesis and is admitted to the
MICU for further management.
.
He was recently discharged on [**2-3**] after presenting with ARF and
[**1-17**] after presenting with Fournier's Gangrene/periurethral
abscesses requiring operative debridment. During this
hospitalization, he also underwent coil embolization of the
right hypogastric artery. He was doing well at home until today
when he had an episode of bright red hematemsis with clots this
morning. He also had a 3 bowel movements with bright red blood
and associated with light-headedness but no abdominal pain or
chest pain. He presented to his PCP and was referred to the ED.

MEDICAL HISTORY: - large infrarenal AAA with b/l large common iliac aneurysms
- Urethral abscess
- DM
- HTN
- CAD s/p PCI
- R hypogastric coiled embolization on [**2197-1-17**]
- suprapubic urinary catheter placement [**2197-1-10**]
- per pt has Hx of "stenting" of vessel after left arm pain, but
does not believe stent in heart, thinks in arm.

MEDICATION ON ADMISSION: 1. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
2. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet daily
4. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 10 days.
Disp:*10 Tablet(s)* Refills:*0*
5. Glyburide 2.5 mg Tablet Sig: One (1) Tablet PO once a day.
6. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.
7. Hyoscyamine Sulfate 0.125 mg Tablet Sig: One (1) Tablet PO
four times a day: prn for bladder spasms.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 98 96 107/65 100%2L
GEN:The patient is in no distress and appears comfortable
SKIN:No rashes or skin changes noted
HEENT:No JVD, neck supple, No lymphadenopathy in cervical,
posterior, or supraclavicular chains noted.
CHEST:Lungs are clear without wheeze, rales, or rhonchi.
CARDIAC: Regular rhythm; no murmurs, rubs, or gallops.
ABDOMEN: No apparent scars. Non-distended, and soft without
tenderness
EXTREMITIES:no peripheral edema, warm without cyanosis
NEUROLOGIC: Alert and appropriate. CN II-XII grossly intact. BUE
[**5-24**], and BLE [**5-24**] both proximally and distally. No pronator
drift. Reflexes were symmetric. Downward going toes.

FAMILY HISTORY: Colon cancer in father

SOCIAL HISTORY: Lives at home with wife and is retired. Quit smoking two months
ago; previously 1 ppd x 50 years. No drugs.
Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Urethral abscess,Portal hypertension,Acidosis,Other specified disorders of stomach and duodenum,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Abdominal aneurysm without mention of rupture,Other diseases of lung, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Percutaneous transluminal coronary angioplasty status,Vascular disorders of male genital organs,Thrombocytopenia, unspecified
Chr duoden ulcer w hem,Ac posthemorrhag anemia,Urethral abscess,Portal hypertension,Acidosis,Gastroduodenal dis NEC,Stomach ulcer NOS,DMII wo cmp nt st uncntr,Crnry athrscl natve vssl,Abdom aortic aneurysm,Other lung disease NEC,Hy kid NOS w cr kid I-IV,Chr kidney dis stage III,Status-post ptca,Male gen vascul dis NEC,Thrombocytopenia NOS
Admission Date:  [**2197-2-8**]              Discharge Date:   [**2197-2-13**]

Date of Birth:  [**2129-4-11**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2009**]
Chief Complaint:
Hematemesis

Major Surgical or Invasive Procedure:
Esophagogastroduodenoscopy (EGD)


History of Present Illness:
Mr. [**Known lastname **] is a 67 year-old man with a history of DM, CAD,
large infrarenal AAA with bilateral large common iliac
aneurysms, s/p right hypogastric coiled embolization on
[**2197-1-17**], who presents with hematemesis and is admitted to the
MICU for further management.
.
He was recently discharged on [**2-3**] after presenting with ARF and
[**1-17**] after presenting with Fournier's Gangrene/periurethral
abscesses requiring operative debridment. During this
hospitalization, he also underwent coil embolization of the
right hypogastric artery. He was doing well at home until today
when he had an episode of bright red hematemsis with clots this
morning. He also had a 3 bowel movements with bright red blood
and associated with light-headedness but no abdominal pain or
chest pain. He presented to his PCP and was referred to the ED.

.
In the ED, vital signs were initially: 86 87/46 20 100%ra. Hct
on arrival was 22 from a baseline of 30. BPs improved with 4L
IVFs and he was transfused 2u prbc, 2u ffp, and 1 unit of
platelets. NG lavage positive for dark blood but no coffee
grounds and he had brb per rectum. He was also given
pantoprazole 80 iv x 1 and a gtt was started. He complained of
CP initially which improved with morphine 2mg iv x 2 and blood
transfusion. His EKG demonstrated anterior-lateral precordial TW
flattening consistent with ischemic changes per cardiology. Abd
CT was negative for aorto-enteric fistula and he was admitted to
the MICU for further management.


Past Medical History:
- large infrarenal AAA with b/l large common iliac aneurysms
- Urethral abscess
- DM
- HTN
- CAD s/p PCI
- R hypogastric coiled embolization on [**2197-1-17**]
- suprapubic urinary catheter placement [**2197-1-10**]
- per pt has Hx of "stenting" of vessel after left arm pain, but
does not believe stent in heart, thinks in arm.


Social History:
Lives at home with wife and is retired. Quit smoking two months
ago; previously 1 ppd x 50 years. No drugs.


Family History:
Colon cancer in father

Physical Exam:
VS: 98 96 107/65 100%2L
GEN:The patient is in no distress and appears comfortable
SKIN:No rashes or skin changes noted
HEENT:No JVD, neck supple, No lymphadenopathy in cervical,
posterior, or supraclavicular chains noted.
CHEST:Lungs are clear without wheeze, rales, or rhonchi.
CARDIAC: Regular rhythm; no murmurs, rubs, or gallops.
ABDOMEN: No apparent scars. Non-distended, and soft without
tenderness
EXTREMITIES:no peripheral edema, warm without cyanosis
NEUROLOGIC: Alert and appropriate. CN II-XII grossly intact. BUE
[**5-24**], and BLE [**5-24**] both proximally and distally. No pronator
drift. Reflexes were symmetric. Downward going toes.


Pertinent Results:
Admission labs:
[**2197-2-8**] 02:30PM BLOOD WBC-12.1*# RBC-2.39*# Hgb-7.1*#
Hct-22.0*# MCV-92 MCH-29.7 MCHC-32.3 RDW-16.2* Plt Ct-205
[**2197-2-8**] 02:30PM BLOOD UreaN-47* Creat-1.6* Na-138 K-5.6*
Cl-109* HCO3-21* AnGap-14
[**2197-2-8**] 09:29PM BLOOD CK-MB-NotDone cTropnT-<0.01
[**2197-2-9**] 05:38AM BLOOD CK-MB-4 cTropnT-0.03*
[**2197-2-9**] 06:07PM BLOOD CK-MB-NotDone cTropnT-0.03*
[**2197-2-8**] 09:29PM BLOOD CK(CPK)-35*
[**2197-2-9**] 06:07PM BLOOD CK(CPK)-22*
[**2197-2-8**] 09:29PM BLOOD Calcium-7.6* Phos-3.9 Mg-1.7
.
Discharge labs:
[**2197-2-13**] 12:06PM BLOOD WBC-10.9 RBC-4.31* Hgb-12.4* Hct-36.9*
MCV-86 MCH-28.7 MCHC-33.5 RDW-15.4 Plt Ct-145*
[**2197-2-13**] 12:06PM BLOOD Glucose-285* UreaN-24* Creat-1.4* Na-137
K-4.3 Cl-99 HCO3-29 AnGap-13
[**2197-2-12**] 09:55AM BLOOD Calcium-8.6 Phos-3.3 Mg-1.7

ECG [**2197-2-8**]:
Sinus rhythm. Tracing may be within normal limits but unstable
baseline makes assessment difficult. Since the previous tracing
of [**2197-2-2**] there is probably no significant change.

Intervals Axes
Rate PR QRS QT/QTc P QRS T
81 144 70 356/392 72 42 86

CT Abdomen/Pelvis [**2197-2-8**]:

CT ABDOMEN WITH CONTRAST: The imaged portions of the lung bases
reveal a 7-mm subpleural nodule in the right lower lobe (3:11).
Additionally, note is made of scattered nodules in the left
lower lobe, though these latter show
indistinct margins suggesting that they may be inflammatory or
infectious in etiology. The imaged cardiac apex is notable for
mitral annular
calcification.

The spleen, adjacent splenule, pancreas, gallbladder, adrenal
glands, kidneys, liver are unremarkable. The stomach contains a
nasogastric tube. There is no retroperitoneal or mesenteric
lymphadenopathy.

CT PELVIS WITH CONTRAST: A suprapubic catheter ends the urinary
bladder is
unchanged. The prostate is notable for diffuse calcifications
which are also unchanged. The rectum and colon are unremarkable.
There is no free gas or fluid in the pelvis. There is no pelvic
or inguinal lymphadenopathy.

CT ANGIOGRAM: The suprarenal aorta is normal in caliber. The
infrarenal
aorta is notable for diffuse aneurysmal dilation. A small
intimal flap is
seen in the proximal part of the suprarenal aorta (3:70). More
distally, just above the level of the aortic bifurcation, the
aorta measures 74 x 69 mm in cross-sectional area and is notable
for a large amount of mural thrombus.  Aneurysmal dilation with
thrombus is also present in the common iliac arteries
bilaterally, the most severe on the right with a total dimension
of the vessels 91 x 83 mm, similar to that seen previously. The
patient is status post embolization of the right internal iliac
artery, a finding which is unchanged from the recent comparison
CT. Both external iliac arteries opacify normally with arterial
contrast. There is no evidence of aortoenteric fistula.

OSSEOUS FINDINGS: There is no suspicious sclerotic or lytic
lesion.
Degenerative changes are present throughout the lumbar spine.
There is also mild degenerative change in the sacroiliac joints
bilaterally.

IMPRESSION:
1. Large infrarenal and bilateral common iliac arterial
aneurysms, appearing similar to those characterized recently.
There is no evidence of aortoenteric fistula.
2. Focal nodule in the right lower lobe and inflammatory
appearing nodules in the left lower lobe. In the absence of high
risk for pulmonary malignancy, would recommend followup with a
dedicated CT of the chest in six months. In the presence of
these risk factors, would recommend followup with a dedicated CT
of the chest in three months.

CXR [**2197-2-9**]:
FINDINGS: Interval extubation and removal of nasogastric tube
and central
line with no evidence of pneumothorax. Mild pulmonary vascular
congestion. No new areas of consolidation to suggest an acute
infectious pneumonia.

EGD [**2197-2-8**]:
Findings:
Esophagus: 	
Excavated Lesions: A single non-bleeding 5 mm ulcer was found in
the gastroesophageal junction.
Stomach: 	
Mucosa: Mosaic appearance of the mucosa was noted in the fundus
and stomach body. These findings are compatible with possible
portal hypertensive gastropathy.
Duodenum: 	
Excavated Lesions: A single acute cratered 3 cm ulcer was found
in the proximal bulb and anterior bulb. A clot suggested recent
bleeding and there were two vissible vessels. 2 2.5
cc.Epinephrine 1/[**Numeric Identifier 961**] injections were applied for hemostasis
with success. A gold probe was applied for hemostasis
successfully to anterior vissible vessel. Two endoclips were
successfully applied for the purpose of hemostasis to posterior
vissible vessel.
Impression: Mosaic appearance in the fundus and stomach body
compatible with possible portal hypertensive gastropathy
Ulcer in the proximal bulb and anterior bulb (injection, thermal
therapy, endoclip) Ulcer in the gastroesophageal junction
Otherwise normal EGD to second part of the duodenum


Brief Hospital Course:
Mr. [**Known lastname **] is a 67 year-old man with a history of a large
infrarenal AAA with bilateral large common iliac aneurysms, s/p
right hypogastric coiled embolization on [**2197-1-17**], who presents
with hematemesis.
.
# GI Bleed: On arrival to the ICU patient was hemodynamically
stable.  An urgent EGD was performed with intubation and
anesthesia.  This demonstrated two large bleeding duodenal
ulcers which were injected with epinephrine, cauterized and
endoclips were applied.  He received an additional 4 units of
PRBC before, during and after the procedure. General surgery and
interventional radiology were consulted regarding management of
his UGIB, and did not recommend further intervention as
hemostasis was achieved by EGD. He was kept in the unit for
close clinical monitoring. He continued to have melena, but it
was thought this represented residual blood from his initial
bleed.  His hematocrit was 22 on arrival to the MICU, after a
total of seven units PRBC, his repeat hematocrit was 29.  He was
called out to the medical floor on [**2197-2-11**].  His PPI was
converted from a drip, to [**Hospital1 **] dosing IV to [**Hospital1 **] dosing orally.
His diet was gradually advanced. He experienced no further
episodes of bleeding, and his hematocrit remained stable.  On
discharge, he was prescribed treatment for H. pylori, as well as
a [**Hospital1 **] ppi.
.
# CAD s/p PCI: Patient initially experienced chest pain, it was
considered likely that this represented demand ischemia in the
setting of anemia.  Myocardial infarction was ruled out by EKG
and serial troponins and cardiac enzymes.  Patient was continued
on his statin, but aspirin was held in the setting of an active
bleed.
.
# Infrarenal AAA with b/l common iliac aneurysms: CT scan
demonstrated no evidence of aorto-enteric fistula. Vascular
surgery was consulted and followed throughout his stay.  Patient
has a scheduled intervention for his AAA with vascular surgery.

.
# Periurethral Abscesses: Patient had recent periurethral
abscesses requiring operative debridement and suprapubic urinary
catheter placement [**2197-1-10**].  He was continued on his outpatient
10 day course of levofloxacin, which he completed [**2197-2-12**].  His
suprapubic catheter functioned appropriately well, and the
surgical site was healing well.
.
# Hypertension:  Blood pressure medications were initially held
in the setting of an acute bleed.  On discharge, he was
restarted on his home dose of metoprolol.
.
# Diabetes Mellitus: Patient was treated with a humalog sliding
scale throughout his hospitalization.
.
# Lung nodule: Focal nodule in the right lower lobe and
inflammatory appearing nodules in the left lower lobe. In the
absence of high risk for pulmonary malignancy, would recommend
followup with a dedicated CT of the chest in six months. In the
presence of these risk factors, would recommend followup with a
dedicated CT of the chest in three months.


Medications on Admission:
1. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
2. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet daily
4. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 10 days.
Disp:*10 Tablet(s)* Refills:*0*
5. Glyburide 2.5 mg Tablet Sig: One (1) Tablet PO once a day.
6. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.
7. Hyoscyamine Sulfate 0.125 mg Tablet Sig: One (1) Tablet PO
four times a day: prn for bladder spasms.


Discharge Medications:
1. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours):
Please begin taking pantoprazole once you have finished the
[**Month/Day/Year **].
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Metoprolol Succinate 25 mg PO daily
5. [**Month/Day/Year **] 500-500-30 mg Combo Pack Sig: One (1)  PO twice a day
for 14 days.
Disp:*qs pack* Refills:*0*
6. Glyburide 2.5 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Duodenal Ulcer
Upper Gastrointestinal Bleed
Abdominal Aortic Aneurysm


Discharge Condition:
Stable, alert and oriented to person, place and time, ambulating
without assistance.


Discharge Instructions:
You were admitted for bloody stools.  Upper endoscopy
(esophagogastroduodenoscopy or EGD) was performed and found a
bleeding ulcer in your stomach.  Injections, cauterization and
clips were placed to stop the bleeding.  You were given 8 units
of packed red blood cells.  Since this procedure, your blood
count levels have remained stable.

The following changes were made in your medications:
- Please START [**Hospital **], take as directed on the package, twice
daily for 14 days.
- While taking the [**Last Name (LF) **], [**First Name3 (LF) **] not take protonix (pantoprozole).
 Once you are finished with the [**First Name3 (LF) **], you can continue taking
the pantoprazole as prescribed.
- Please STOP taking aspirin until you speak with Dr.
[**Last Name (STitle) **], or Dr. [**Last Name (STitle) 66738**].

Please continue with all other medications as you were before.
Please review all changes in your medications with your primary
care physician.


Followup Instructions:
Please follow up with the following appointments:

MD: Dr. [**First Name (STitle) **] [**Name (STitle) 66738**]
Specialty: Internal Medicine-Primary Care
Date/ Time: [**2197-2-27**] 1:30pm
Location: [**Last Name (NamePattern1) 84131**], [**Location (un) 2251**] MA
Phone number: [**Telephone/Fax (1) 49449**]

Provider: [**Name10 (NameIs) **] RM 2
[**Name10 (NameIs) **]-PREADMISSION TESTING
Date/Time:[**2197-2-15**] 10:00

You are scheduled for surgery for your abdominal aortic
aneuurysm:
Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **]
Time: 10:00 am, Date [**2197-2-20**]
Vascular Surgery

Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) 10314**], MD
Specialty: Gastroenterology
[**Hospital Unit Name 1825**] [**Location (un) 453**] - [**Hospital1 18**] [**Hospital Ward Name 516**] - [**Location (un) **].
[**Location (un) 86**], MA
Phone:[**Telephone/Fax (1) 463**] Date/Time:[**2197-3-8**] 1:30

Provider: [**Name10 (NameIs) **] UNIT
Phone:[**Telephone/Fax (1) 164**] Date/Time:[**2197-3-15**] 10:00
{'Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Urethral abscess,Portal hypertension,Acidosis,Other specified disorders of stomach and duodenum,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Abdominal aneurysm without mention of rupture,Other diseases of lung, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Percutaneous transluminal coronary angioplasty status,Vascular disorders of male genital organs,Thrombocytopenia, unspecified'}


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: Hematemesis

PRESENT ILLNESS: Mr. [**Known lastname **] is a 67 year-old man with a history of DM, CAD,
large infrarenal AAA with bilateral large common iliac
aneurysms, s/p right hypogastric coiled embolization on
[**2197-1-17**], who presents with hematemesis and is admitted to the
MICU for further management.
.
He was recently discharged on [**2-3**] after presenting with ARF and
[**1-17**] after presenting with Fournier's Gangrene/periurethral
abscesses requiring operative debridment. During this
hospitalization, he also underwent coil embolization of the
right hypogastric artery. He was doing well at home until today
when he had an episode of bright red hematemsis with clots this
morning. He also had a 3 bowel movements with bright red blood
and associated with light-headedness but no abdominal pain or
chest pain. He presented to his PCP and was referred to the ED.

MEDICAL HISTORY: - large infrarenal AAA with b/l large common iliac aneurysms
- Urethral abscess
- DM
- HTN
- CAD s/p PCI
- R hypogastric coiled embolization on [**2197-1-17**]
- suprapubic urinary catheter placement [**2197-1-10**]
- per pt has Hx of "stenting" of vessel after left arm pain, but
does not believe stent in heart, thinks in arm.

MEDICATION ON ADMISSION: 1. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr
Sig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).
2. Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY
3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet daily
4. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 10 days.
Disp:*10 Tablet(s)* Refills:*0*
5. Glyburide 2.5 mg Tablet Sig: One (1) Tablet PO once a day.
6. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.
7. Hyoscyamine Sulfate 0.125 mg Tablet Sig: One (1) Tablet PO
four times a day: prn for bladder spasms.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 98 96 107/65 100%2L
GEN:The patient is in no distress and appears comfortable
SKIN:No rashes or skin changes noted
HEENT:No JVD, neck supple, No lymphadenopathy in cervical,
posterior, or supraclavicular chains noted.
CHEST:Lungs are clear without wheeze, rales, or rhonchi.
CARDIAC: Regular rhythm; no murmurs, rubs, or gallops.
ABDOMEN: No apparent scars. Non-distended, and soft without
tenderness
EXTREMITIES:no peripheral edema, warm without cyanosis
NEUROLOGIC: Alert and appropriate. CN II-XII grossly intact. BUE
[**5-24**], and BLE [**5-24**] both proximally and distally. No pronator
drift. Reflexes were symmetric. Downward going toes.

FAMILY HISTORY: Colon cancer in father

SOCIAL HISTORY: Lives at home with wife and is retired. Quit smoking two months
ago; previously 1 ppd x 50 years. No drugs. 

### Response:
{'Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction,Acute posthemorrhagic anemia,Urethral abscess,Portal hypertension,Acidosis,Other specified disorders of stomach and duodenum,Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Coronary atherosclerosis of native coronary artery,Abdominal aneurysm without mention of rupture,Other diseases of lung, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, Stage III (moderate),Percutaneous transluminal coronary angioplasty status,Vascular disorders of male genital organs,Thrombocytopenia, unspecified'}
