CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 62385**] is a 59-year-old
male with a history of metastatic renal cell carcinoma
admitted for cycle 1/week 1 high-dose IL-2 therapy. His
oncologic history began in [**2148-7-22**] when he underwent right
nephrectomy revealing an 11-cm right kidney mass with clear
cell histology. He did well until he developed hemoptysis in
[**2151-7-23**] with CT scan showing a 3-cm right mediastinal mass
and 2-cm right upper lobe nodule. Bronchoscopy showed a
fungating right upper lobe tumor with biopsy consistent with
metastatic renal cell carcinoma. He underwent radiation
therapy completed in [**2151-11-23**]. During follow-up
bronchoscopy in [**2151-12-23**] at an outside hospital
bronchial washings revealed tuberculosis on [**2152-2-9**];
and he was initiated on tuberculosis medications at that time
including isoniazid and rifampin. He recently had 3 negative
sputum's in [**Month (only) 958**]. He is being admitted today on [**2152-5-22**]
for cycle 1/week 1 high-dose IL-2 therapy.

MEDICAL HISTORY: Metastatic renal cell carcinoma,
hypercholesterolemia, migraines, bilateral inguinal hernia
repair, status post right shoulder arthroscopy, history of TB
as above.

MEDICATION ON ADMISSION: Isoniazid 300 mg p.o. daily,
rifampin 600 mg daily, calcium, multivitamin.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Encounter for antineoplastic immunotherapy,Acute myocarditis, unspecified,Pulmonary tuberculosis, unspecified, unspecified,Congestive heart failure, unspecified,Acute respiratory failure,Acidosis,Pneumonitis due to inhalation of food or vomitus,Secondary malignant neoplasm of lung,Secondary and unspecified malignant neoplasm of lymph nodes of multiple sites,Personal history of malignant neoplasm of kidney,Pure hypercholesterolemia,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Accidents occurring in other specified places,Other iatrogenic hypotension,Rash and other nonspecific skin eruption,Diarrhea,Anemia, unspecified,Hypoxemia
Immunotherapy encounter,Acute myocarditis NOS,Pulmonary TB NOS-unspec,CHF NOS,Acute respiratry failure,Acidosis,Food/vomit pneumonitis,Secondary malig neo lung,Mal neo lymph node-mult,Hx of kidney malignancy,Pure hypercholesterolem,Migrne unsp wo ntrc mgrn,Adv eff antineoplastic,Accident in place NEC,Iatrogenc hypotnsion NEC,Nonspecif skin erupt NEC,Diarrhea,Anemia NOS,Hypoxemia
Admission Date: [**2152-5-22**]        Discharge Date: [**2152-6-4**]

Date of Birth:  [**2092-1-24**]        Sex:  M

Service:  OME


HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 62385**] is a 59-year-old
male with a history of metastatic renal cell carcinoma
admitted for cycle 1/week 1 high-dose IL-2 therapy. His
oncologic history began in [**2148-7-22**] when he underwent right
nephrectomy revealing an 11-cm right kidney mass with clear
cell histology. He did well until he developed hemoptysis in
[**2151-7-23**] with CT scan showing a 3-cm right mediastinal mass
and 2-cm right upper lobe nodule. Bronchoscopy showed a
fungating right upper lobe tumor with biopsy consistent with
metastatic renal cell carcinoma. He underwent radiation
therapy completed in [**2151-11-23**]. During follow-up
bronchoscopy in [**2151-12-23**] at an outside hospital
bronchial washings revealed tuberculosis on [**2152-2-9**];
and he was initiated on tuberculosis medications at that time
including isoniazid and rifampin. He recently had 3 negative
sputum's in [**Month (only) 958**]. He is being admitted today on [**2152-5-22**]
for cycle 1/week 1 high-dose IL-2 therapy.

MEDICAL HISTORY:  Metastatic renal cell carcinoma,
hypercholesterolemia, migraines, bilateral inguinal hernia
repair, status post right shoulder arthroscopy, history of TB
as above.

MEDICATIONS ON ADMISSION:  Isoniazid 300 mg p.o. daily,
rifampin 600 mg daily, calcium, multivitamin.

ALLERGIES:  No known drug allergies.

PHYSICAL EXAMINATION:  GENERAL:  Reveals a well-appearing
male in no acute distress. Performance status 0. VITAL SIGNS:
Stable. HEENT: Normocephalic, atraumatic. Sclerae anicteric.
Moist oral mucosa without lesions. NECK: Supple. 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 percussion
bilaterally with a few left basilar crackles. ABDOMEN:
Rounded, positive bowel sounds, soft, nontender. No
hepatosplenomegaly. EXTREMITIES: No lower extremity edema.
SKIN:  Three subcutaneous nodules are noted; one on the left
lateral upper arm, one on the left flank and one on the left
lateral lower leg; otherwise skin intact.

ADMISSION LABORATORIES:  WBC 9, hemoglobin 13.2, hematocrit
41, platelet count 277,000. BUN 23, creatinine 1.1, sodium
141, potassium 4.5, chloride 106, CO2 of 28, glucose 83, INR
1.1, calcium 9.3, magnesium 2.1, phosphorus 3.2, CK 51.

HOSPITAL COURSE:  Mr. [**Known lastname 62385**] was admitted to begin high-dose
IL-2 therapy. He underwent central line placement to begin
therapy. His admission weight was 78.6 kg, and he received
interleuken-2 at 600,000 international units per kilogram
equaling 47.2 mU IV q.8h. x14 potential doses. Given his
history of borderline pulmonary function tests, radiation to
the lung, and tuberculosis history we reduced his intravenous
fluid rate and planned to limit fluid boluses secondary to
concern regarding pulmonary toxicity. During this week he
received [**9-4**] doses with 6 doses held related to hypotension
requiring ICU transfer.

Over the first several days he had the usual IL-2 side
effects including fever, chills, nausea and diarrhea;
improved with supportive medications. However, on treatment
day #4 he developed hypotension and was treated with slight
increase in intravenous fluids as well as a fluid bolus x1.
He required the addition of dopamine to a maximum of 6
mcg/kg/min as well as Neo-Synephrine up to 3.5 mcg/kg/min to
support his blood pressure. Later that day he developed
tachypnea and hypoxia with need for transfer to the intensive
care unit. On treatment day #5, his troponin was elevated -
consistent with myocarditis - and he underwent an
echocardiogram revealing left ventricular ejection fraction
of approximately 25% with global hypokinesis. Cardiology
evaluated the patient and felt this was consistent with
myocarditis rather than acute coronary syndrome. He continued
to require vasopressors and was changed from Neo-Synephrine
and dopamine to Levophed. Later in the day on treatment day
#5 he became more hypoxic and tachypneic and was intubated.
He was weaned off pressors over the next 2 days. He remained
intubated and sedated. On [**2152-5-28**] he developed a fever;
and vancomycin was added with cultures negative. However, on
[**2152-5-29**] he developed increased secretions; and Zosyn was
added for probable pneumonia. His tuberculosis medications
were initially held due to transaminitis and were restarted
with normalization of his liver function tests.

On [**2152-5-30**] he was extubated. An echocardiogram was
repeated on [**2152-5-30**] showing improvement in his ejection
fraction to 45% to 55%. On [**2152-5-31**] he was transferred
back to the floor to continue rehab in order to be discharged
to home. He was initially maintained on vancomycin and Zosyn,
and later changed to levofloxacin when sputum culture grew
Enterobacter with appropriate sensitivities. He remained
afebrile and continued to improve rapidly over the next 4
days and was discharged home on [**2152-6-4**]. His IL-2
toxicities had resolved at this point.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE STATUS:  To home with his wife.

DISCHARGE DIAGNOSES:  Metastatic renal cell carcinoma, status
post cycle 1/week 1 high-dose IL-2 complicated by hypotension
and respiratory failure due to capillary leak syndrome.

DISCHARGE MEDICATIONS:  Zantac 150 mg p.o. b.i.d., Ativan 1
mg q.4-6h. p.r.n. nausea/vomiting, Benadryl 25 to 50 mg q.6h.
p.r.n. pruritus, Compazine 10 mg p.o. q.6h. p.r.n.
nausea/vomiting, Lomotil 1 to 2 tablets p.o. q.i.d. p.r.n.
diarrhea, isoniazid 300 mg p.o. daily, rifampin 600 mg p.o.
daily, levofloxacin 500 mg p.o. daily x5 days.

FOLLOW-UP PLANS:  Mr. [**Known lastname 62385**] will return to clinic in
approximately 1 month for CT scans to assess disease
response. He will not be returning for week 2 of IL-2 therapy
given significant toxicity.


                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 19077**]

Dictated By:[**Last Name (NamePattern1) 18853**]
MEDQUIST36
D:  [**2152-6-28**] 19:23:32
T:  [**2152-6-30**] 15:39:15
Job#:  [**Job Number 62386**]

cc:[**Last Name (NamePattern1) 62387**]
{'Encounter for antineoplastic immunotherapy,Acute myocarditis, unspecified,Pulmonary tuberculosis, unspecified, unspecified,Congestive heart failure, unspecified,Acute respiratory failure,Acidosis,Pneumonitis due to inhalation of food or vomitus,Secondary malignant neoplasm of lung,Secondary and unspecified malignant neoplasm of lymph nodes of multiple sites,Personal history of malignant neoplasm of kidney,Pure hypercholesterolemia,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Accidents occurring in other specified places,Other iatrogenic hypotension,Rash and other nonspecific skin eruption,Diarrhea,Anemia, unspecified,Hypoxemia'}


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: Mr. [**Known lastname 62385**] is a 59-year-old
male with a history of metastatic renal cell carcinoma
admitted for cycle 1/week 1 high-dose IL-2 therapy. His
oncologic history began in [**2148-7-22**] when he underwent right
nephrectomy revealing an 11-cm right kidney mass with clear
cell histology. He did well until he developed hemoptysis in
[**2151-7-23**] with CT scan showing a 3-cm right mediastinal mass
and 2-cm right upper lobe nodule. Bronchoscopy showed a
fungating right upper lobe tumor with biopsy consistent with
metastatic renal cell carcinoma. He underwent radiation
therapy completed in [**2151-11-23**]. During follow-up
bronchoscopy in [**2151-12-23**] at an outside hospital
bronchial washings revealed tuberculosis on [**2152-2-9**];
and he was initiated on tuberculosis medications at that time
including isoniazid and rifampin. He recently had 3 negative
sputum's in [**Month (only) 958**]. He is being admitted today on [**2152-5-22**]
for cycle 1/week 1 high-dose IL-2 therapy.

MEDICAL HISTORY: Metastatic renal cell carcinoma,
hypercholesterolemia, migraines, bilateral inguinal hernia
repair, status post right shoulder arthroscopy, history of TB
as above.

MEDICATION ON ADMISSION: Isoniazid 300 mg p.o. daily,
rifampin 600 mg daily, calcium, multivitamin.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Encounter for antineoplastic immunotherapy,Acute myocarditis, unspecified,Pulmonary tuberculosis, unspecified, unspecified,Congestive heart failure, unspecified,Acute respiratory failure,Acidosis,Pneumonitis due to inhalation of food or vomitus,Secondary malignant neoplasm of lung,Secondary and unspecified malignant neoplasm of lymph nodes of multiple sites,Personal history of malignant neoplasm of kidney,Pure hypercholesterolemia,Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus,Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use,Accidents occurring in other specified places,Other iatrogenic hypotension,Rash and other nonspecific skin eruption,Diarrhea,Anemia, unspecified,Hypoxemia'}
