CHIEF COMPLAINT: Infected necrotic ulcers of the right lower extremity.

PRESENT ILLNESS: 81-year-old woman with history of severe peripheral arterial
disease, who had previously presented with acute limb ischemia
and she has subsequently underwent endovascular
revascularization of the right lower extremity with stent of the
right superficial femoral artery, balloon angioplasty of right
superficial femoral artery in-stent stenosis and angioJet
thrombectomy of the right superficial femoral artery, popliteal
artery, and tibioperoneal trunk. Despite revascularization she
was not able to heal the right lower extremity and therefore
developed significant gangrene of the right leg with necrotic
ulcers on the posterior calf. She was admitted for IV
antibiotics, wound care and possible debridement in the OR.

MEDICAL HISTORY: PMH: DM 2, afib, cdiff colitis, CAD, gout, depression,
dialstolic CHF, chronic angina (afib), [**3-29**]: Group B strep
bacteremia, RA (prednisone), osteopenia, carpal tunnel.

MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: novolin n 10uam 13upm, novolin r sliding scale, digoxin
0.125mcg [**Last Name (LF) **],[**First Name3 (LF) **] 81mg', bisacodyl sup ', gabapentin 600mg 9am,
1pm, 900mg 9pm, folic acid 1mg', plavix75mg', miralax17g', vit
v12 50mcg', oxycontin 30mg", lasix 80mg", metoprolol 100mg tid,
simvastatin 80mg', methotrexate 12.5mg qfri, remeron 15mg qhs,
tylenol prn, oxycodone 5-15mg q4hprn pain, coumadin - varying
dose based on INR, prednisone 7.5'

ALLERGIES: Sulfa (Sulfonamides) / Iodine; Iodine Containing / Cephalexin /
Celecoxib / Rofecoxib / Lisinopril / Methylene Blue

PHYSICAL EXAM: PHYSICAL EXAM
Neuro/Psych: Oriented x3, Affect Normal, NAD.
Neck: No masses, Trachea midline, Thyroid normal size,
non-tender, no masses or nodules, No right carotid bruit, No
left
carotid bruit.
Nodes: No clavicular/cervical adenopathy, No inguinal
adenopathy.

FAMILY HISTORY: unknown

SOCIAL HISTORY: non drinker
non smoker
Atherosclerosis of native arteries of the extremities with gangrene,Subendocardial infarction, initial episode of care,Acute kidney failure with lesion of tubular necrosis,Unspecified septicemia,Severe sepsis,Septic shock,Ulcer of calf,Diastolic heart failure, unspecified,Other specified intestinal obstruction,Peripheral vascular disease, unspecified,Rheumatoid arthritis,Atrial fibrillation,Long-term (current) use of anticoagulants,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status
Ath ext ntv art gngrene,Subendo infarct, initial,Ac kidny fail, tubr necr,Septicemia NOS,Severe sepsis,Septic shock,Ulcer of calf,Diastolc hrt failure NOS,Intestinal obstruct NEC,Periph vascular dis NOS,Rheumatoid arthritis,Atrial fibrillation,Long-term use anticoagul,Cor ath unsp vsl ntv/gft,Aortocoronary bypass
Admission Date:  [**2200-12-11**]              Discharge Date:   [**2200-12-26**]

Date of Birth:  [**2119-10-26**]             Sex:   F

Service: SURGERY

Allergies:
Sulfa (Sulfonamides) / Iodine; Iodine Containing / Cephalexin /
Celecoxib / Rofecoxib / Lisinopril / Methylene Blue

Attending:[**First Name3 (LF) 2777**]
Chief Complaint:
Infected necrotic ulcers of the right lower extremity.


Major Surgical or Invasive Procedure:
11/23/9 Debridement of infected necrotic right extremity ulcers.
11/30/9 Right above-knee amputation

History of Present Illness:
81-year-old woman with history of severe peripheral arterial
disease, who had previously presented with acute limb ischemia
and she has subsequently underwent endovascular
revascularization of the right lower extremity with stent of the
right superficial femoral artery, balloon angioplasty of right
superficial femoral artery in-stent stenosis and angioJet
thrombectomy of the right superficial femoral artery, popliteal
artery, and tibioperoneal trunk. Despite revascularization she
was not able to heal the right lower extremity and therefore
developed significant gangrene of the right leg with necrotic
ulcers on the posterior calf. She was admitted for IV
antibiotics, wound care and possible debridement in the OR.

Past Medical History:
PMH: DM 2, afib, cdiff colitis, CAD, gout, depression,
dialstolic CHF, chronic angina (afib), [**3-29**]: Group B strep
bacteremia, RA (prednisone), osteopenia, carpal tunnel.

PSH:
[**2198-6-19**]: Angioplasty and stent right SFA
[**2198-6-22**]: Ballon angioplasty and full-lenght stent right SFA
[**2200-11-4**]: Balloon angioplasty of right SFA in-stent stenosis and
angioJet thrombectomy of the right superficial femoral artery,
popliteal artery, and tibioperoneal trunk.
[**2196**]: CABG x 4
hernia repair

Social History:
non drinker
non smoker


Family History:
unknown

Physical Exam:
PHYSICAL EXAM
Neuro/Psych: Oriented x3, Affect Normal, NAD.
Neck: No masses, Trachea midline, Thyroid normal size,
non-tender, no masses or nodules, No right carotid bruit, No
left
carotid bruit.
Nodes: No clavicular/cervical adenopathy, No inguinal
adenopathy.

Skin: No atypical lesions.
Heart: Regular rate and rhythm.
Lungs: Clear, Normal respiratory effort.
Gastrointestinal: Non distended, No masses, Guarding or rebound,
No hepatosplenomegally, No hernia, No AAA.
Rectal: Not Examined.
Extremities: No popiteal aneurysm, No femoral bruit/thrill, No
varicosities, abnormal: B/L le edema.

Pulse Exam (P=Palpation, D=Dopplerable, N=None)
RUE Radial: P. Ulnar: P. Brachial: P.
LUE Radial: P. Ulnar: P. Brachial: P.
RLE Femoral: P. DP: D. PT: D.
LLE Femoral: P. DP: D. PT: D.


Pertinent Results:
[**2200-12-11**] 12:05PM   WBC-10.8 RBC-3.66* HGB-10.7* HCT-34.7* MCV-95
MCH-29.3 MCHC-30.9* RDW-17.0*
[**2200-12-11**] 12:05PM   PLT COUNT-530*
[**2200-12-11**] 12:05PM   GLUCOSE-81 UREA N-14 CREAT-0.5 SODIUM-143
POTASSIUM-3.9 CHLORIDE-99 TOTAL CO2-34* ANION GAP-14
[**2200-12-11**] 12:05PM   CALCIUM-7.7* PHOSPHATE-3.3 MAGNESIUM-1.6
[**2200-12-11**] 12:05PM   PT-31.5* INR(PT)-3.2*

Brief Hospital Course:
Patient was admitted on [**2200-12-11**] with multiple necrotic infected
ulcers after undergoing revascularization of her right leg
chronic ischemia. She was started on iv antibiotics, wound care
and underwent debridement of these necrotic infected ulcers on
[**12-15**]/9. She has failed a course of antibiotics and nonoperative
treatment, therefore patient was consented for a right
above-knee amputation. As a result of her multiple high-risk
comorbidities, postoperatively she developed acute renal
failure, A.Fib with RVR and sepsis. Cardiology was consulted and
measures to keep her chronic atrial fibrillation with adequate
HR were made. Nephrology was also involved and HD was suggested
as a possible therapy for her uremia. On [**12-26**]/9 patient
significant abdominal distention with ?colonic
pseudo-obstruction, CT scan consistent with [**Last Name (un) 3696**] disease
and hemodynamic compromise on [**12-27**]/9. No free air or fluid, no
bowel wall edema, mesenteric or portal venous air were seen. NGT
and rectal tubes were placed. GI and general surgery were
consulted. She was then transferred from the VICU to the
intensive care unit. After extensive conversations with the
family and son [**First Name8 (NamePattern2) **] [**Name (NI) 10132**] - health care proxy), patient was
made DNR/DNI. After seing progressive impairment on her clinical
status, family was contact[**Name (NI) **] again and she was made [**Name (NI) 3225**], and
died soon thereafter. Report of death at 16:30 11/05/9.
Patient's family, the admitting office and Medical examiner were
notified. The ME did not accept the case, and therefore the
death certificate was signed.


Medications on Admission:
[**Last Name (un) 1724**]: novolin n 10uam 13upm, novolin r sliding scale, digoxin
0.125mcg [**Last Name (LF) **],[**First Name3 (LF) **] 81mg', bisacodyl sup ', gabapentin 600mg 9am,
1pm, 900mg 9pm, folic acid 1mg', plavix75mg', miralax17g', vit
v12 50mcg', oxycontin 30mg", lasix 80mg", metoprolol 100mg tid,
simvastatin 80mg', methotrexate 12.5mg qfri, remeron 15mg qhs,
tylenol prn, oxycodone 5-15mg q4hprn pain, coumadin - varying
dose based on INR, prednisone 7.5'

Discharge Medications:
none

Discharge Disposition:
Expired

Discharge Diagnosis:
Cardiopulmonary arrest
Septic shock
Acute renal failure
[**Last Name (un) 3696**] Syndrome
Status post above-the-knee amputation
Status post RLE debridement
PVD, DM2, CAD s/p CABG [**2196**], CHF, A. Fib, HTN, RA

Discharge Condition:
Expired


Completed by:[**2201-1-2**]
{'Atherosclerosis of native arteries of the extremities with gangrene,Subendocardial infarction, initial episode of care,Acute kidney failure with lesion of tubular necrosis,Unspecified septicemia,Severe sepsis,Septic shock,Ulcer of calf,Diastolic heart failure, unspecified,Other specified intestinal obstruction,Peripheral vascular disease, unspecified,Rheumatoid arthritis,Atrial fibrillation,Long-term (current) use of anticoagulants,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status'}


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: Infected necrotic ulcers of the right lower extremity.

PRESENT ILLNESS: 81-year-old woman with history of severe peripheral arterial
disease, who had previously presented with acute limb ischemia
and she has subsequently underwent endovascular
revascularization of the right lower extremity with stent of the
right superficial femoral artery, balloon angioplasty of right
superficial femoral artery in-stent stenosis and angioJet
thrombectomy of the right superficial femoral artery, popliteal
artery, and tibioperoneal trunk. Despite revascularization she
was not able to heal the right lower extremity and therefore
developed significant gangrene of the right leg with necrotic
ulcers on the posterior calf. She was admitted for IV
antibiotics, wound care and possible debridement in the OR.

MEDICAL HISTORY: PMH: DM 2, afib, cdiff colitis, CAD, gout, depression,
dialstolic CHF, chronic angina (afib), [**3-29**]: Group B strep
bacteremia, RA (prednisone), osteopenia, carpal tunnel.

MEDICATION ON ADMISSION: [**Last Name (un) 1724**]: novolin n 10uam 13upm, novolin r sliding scale, digoxin
0.125mcg [**Last Name (LF) **],[**First Name3 (LF) **] 81mg', bisacodyl sup ', gabapentin 600mg 9am,
1pm, 900mg 9pm, folic acid 1mg', plavix75mg', miralax17g', vit
v12 50mcg', oxycontin 30mg", lasix 80mg", metoprolol 100mg tid,
simvastatin 80mg', methotrexate 12.5mg qfri, remeron 15mg qhs,
tylenol prn, oxycodone 5-15mg q4hprn pain, coumadin - varying
dose based on INR, prednisone 7.5'

ALLERGIES: Sulfa (Sulfonamides) / Iodine; Iodine Containing / Cephalexin /
Celecoxib / Rofecoxib / Lisinopril / Methylene Blue

PHYSICAL EXAM: PHYSICAL EXAM
Neuro/Psych: Oriented x3, Affect Normal, NAD.
Neck: No masses, Trachea midline, Thyroid normal size,
non-tender, no masses or nodules, No right carotid bruit, No
left
carotid bruit.
Nodes: No clavicular/cervical adenopathy, No inguinal
adenopathy.

FAMILY HISTORY: unknown

SOCIAL HISTORY: non drinker
non smoker 

### Response:
{'Atherosclerosis of native arteries of the extremities with gangrene,Subendocardial infarction, initial episode of care,Acute kidney failure with lesion of tubular necrosis,Unspecified septicemia,Severe sepsis,Septic shock,Ulcer of calf,Diastolic heart failure, unspecified,Other specified intestinal obstruction,Peripheral vascular disease, unspecified,Rheumatoid arthritis,Atrial fibrillation,Long-term (current) use of anticoagulants,Coronary atherosclerosis of unspecified type of vessel, native or graft,Aortocoronary bypass status'}
