CHIEF COMPLAINT: tumor recurrance

PRESENT ILLNESS: 48 yo gentleman who initially presented with h/a and was found
to have right sided mass. He is s/p crani & resection on [**2155-3-17**]
which diagnosed GBM. He is now s/p radiation and is on temodar.
Recent MRI revealed tumor recurrance therefore he presents today
for re-resection.

MEDICAL HISTORY: mildly increased cholesterol
Gout
Epicondylitis

MEDICATION ON ADMISSION: ALLOPURINOL, LEVETIRACETAM - 500 mg [**Hospital1 **], REISHI [**Last Name (un) **] 800 mg
daily
SIMVASTATIN 40 mg Tablet daily, calcium

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Examination:  AVSS. Neck is supple and without
lymphadenopathy.  Cardiac examination reveals regular rate and
rhythms.  His lungs are clear.  His abdomen is soft with good
bowel sounds.  His extremities do not show clubbing, cyanosis,
or
edema.

FAMILY HISTORY: No neurological or oncological history

SOCIAL HISTORY: He is a salesman. He lives with wife and son.  [**Name (NI) **] denies
smoking, alcohol, or illicits.
Malignant neoplasm of temporal lobe,Other and unspecified hyperlipidemia,Gout, unspecified
Mal neo temporal lobe,Hyperlipidemia NEC/NOS,Gout NOS
Admission Date:  [**2155-12-17**]              Discharge Date:   [**2155-12-19**]

Date of Birth:  [**2107-7-2**]             Sex:   M

Service: NEUROSURGERY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 1835**]
Chief Complaint:
tumor recurrance

Major Surgical or Invasive Procedure:
[**2155-12-17**]: Right Craniotomy and resection of tumor


History of Present Illness:
48 yo gentleman who initially presented with h/a and was found
to have right sided mass. He is s/p crani & resection on [**2155-3-17**]
which diagnosed GBM. He is now s/p radiation and is on temodar.
Recent MRI revealed tumor recurrance therefore he presents today
for re-resection.

Past Medical History:
mildly increased cholesterol
Gout
Epicondylitis


Social History:
He is a salesman. He lives with wife and son.  [**Name (NI) **] denies
smoking, alcohol, or illicits.


Family History:
No neurological or oncological history


Physical Exam:
Physical Examination:  AVSS. Neck is supple and without
lymphadenopathy.  Cardiac examination reveals regular rate and
rhythms.  His lungs are clear.  His abdomen is soft with good
bowel sounds.  His extremities do not show clubbing, cyanosis,
or
edema.

Neurological Examination:  He is awake, alert, and oriented
times 3.  His language is fluent with good comprehension. Recent
recall is intact.  Cranial Nerve Examination: His pupils are
equal and reactive to light, 3 mm to
2 mm bilaterally.  Extraocular movements are full; there is no
nystagmus.  Visual fields are full to confrontation.
Funduscopic
examination reveals sharp disks margins bilaterally.  His face
is
symmetric.  Facial sensation is intact bilaterally.  His hearing
is intact bilaterally.  His tongue is midline.  Palate goes up
in
the midline. Motor Examination:  He does not have a drift.  His
muscle strengths are [**6-19**] at all muscle groups.  His muscle tone
is normal.  Sensory examination is intact to touch and
proprioception.  Coordination examination does not reveal
dysmetria.


Pertinent Results:
MRI WAND [**12-17**]
There have been no significant changes in the interval since
[**12-8**]. Again seen is a mass along the posterior margin of
the right
temporal resection cavity. There is also enhancement along the
resection
cavity walls. As previously noted, both the mass and the rim
enhancement have greatly increased since the study of [**12-13**], [**2155**].

CT HEAD [**12-18**]
Status post right craniotomy with resection of known tumor.
Expected
postoperative pneumocephalus and mild subarachnoid hemorrhage.


Brief Hospital Course:
Pt electively presented and underwent a craniotomy and resection
of his tumor. Surgery was without complication and he tolerated
it well. Post op head CT revealed expected post-op changes, He
complained of severe incisional headache which was refractory to
morphine and oxycodone on the morning of [**12-18**]. His pain regimen
was changed to fioricet and dilaudid. His blood pressure was
liberalized and his a-line was removed. His pain was well
controlled on PO meds on POD#2. He resumed PO intake and was
ambulating w/o difficulty. He is discharged home in stable
condition. He will follow up in BTC in 1 week.

Medications on Admission:
ALLOPURINOL, LEVETIRACETAM - 500 mg [**Hospital1 **], REISHI [**Last Name (un) **] 800 mg
daily
SIMVASTATIN 40 mg Tablet daily, calcium


Discharge Medications:
1. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain or fever > 101.5.
2. dexamethasone 2 mg Tablet Sig: taper Tablet PO taper: 4mg PO
q8h on [**12-19**]
3mg PO p8h on [**12-20**]
2mg PO p8h on [**12-21**]
2mg PO p12h until follow up .
Disp:*30 Tablet(s)* Refills:*2*
3. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q4H (every 4 hours)
as needed for Pain: do not drink alcohol, drive, or operate
heavy machinery while on this medication.
Disp:*30 Tablet(s)* Refills:*0*
4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*30 Capsule(s)* Refills:*0*
5. senna 8.6 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day) as needed for Constipation.
Disp:*30 Tablet(s)* Refills:*0*
6. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
8. butalbital-acetaminophen-caff 50-325-40 mg Tablet Sig: [**2-16**]
Tablets PO Q4H (every 4 hours) as needed for headache.
Disp:*30 Tablet(s)* Refills:*0*
9. famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Glioblastoma Multiforme


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


Discharge Instructions:
General Instructions/Information

??????	Have a friend/family member check your incision daily for
signs of infection.
??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	Dressing may be removed on Day 2 after surgery and wound left
open to air.
??????	If your wound was closed with staples or non-dissolvable
sutures then you must wait until after they are removed to wash
your hair. You may shower before this time using a shower cap to
cover your head.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace) &
Senna while taking narcotic pain medication.
??????	Unless directed by your doctor, do not take any
anti-inflammatory medicines such as Motrin, Aspirin, Advil, and
Ibuprofen etc.
??????	You have been discharged on Keppra (Levetiracetam), you will
not require blood work monitoring.
??????	If you are being sent home on steroid medication, make sure
you are taking a medication to protect your stomach (Prilosec,
Protonix, or Pepcid), as these medications can cause stomach
irritation.  Make sure to take your steroid medication with
meals, or a glass of milk.
??????	Clearance to drive and return to work will be addressed at
your post-operative office visit.
??????	Make sure to continue to use your incentive spirometer while
at home.


Followup Instructions:
??????You have an appointment in the Brain [**Hospital 341**] Clinic on [**2155-12-29**]
at 10:30am.  The Brain [**Hospital 341**] Clinic is located on the [**Hospital Ward Name 5074**] of [**Hospital1 18**], in the [**Hospital Ward Name 23**] Building, [**Location (un) **]. Their phone
number is [**Telephone/Fax (1) 1844**]. Please call if you need to change your
appointment, or require additional directions.



Completed by:[**2155-12-19**]
{'Malignant neoplasm of temporal lobe,Other and unspecified hyperlipidemia,Gout, 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: tumor recurrance

PRESENT ILLNESS: 48 yo gentleman who initially presented with h/a and was found
to have right sided mass. He is s/p crani & resection on [**2155-3-17**]
which diagnosed GBM. He is now s/p radiation and is on temodar.
Recent MRI revealed tumor recurrance therefore he presents today
for re-resection.

MEDICAL HISTORY: mildly increased cholesterol
Gout
Epicondylitis

MEDICATION ON ADMISSION: ALLOPURINOL, LEVETIRACETAM - 500 mg [**Hospital1 **], REISHI [**Last Name (un) **] 800 mg
daily
SIMVASTATIN 40 mg Tablet daily, calcium

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Physical Examination:  AVSS. Neck is supple and without
lymphadenopathy.  Cardiac examination reveals regular rate and
rhythms.  His lungs are clear.  His abdomen is soft with good
bowel sounds.  His extremities do not show clubbing, cyanosis,
or
edema.

FAMILY HISTORY: No neurological or oncological history

SOCIAL HISTORY: He is a salesman. He lives with wife and son.  [**Name (NI) **] denies
smoking, alcohol, or illicits. 

### Response:
{'Malignant neoplasm of temporal lobe,Other and unspecified hyperlipidemia,Gout, unspecified'}
