CHIEF COMPLAINT: Infected L femur reconstruction

PRESENT ILLNESS: This was a planned procedure for removal of cement spacer and
tranisition to an allograft reconstruction vs. total femur
prosthesis based on bone stock.

MEDICAL HISTORY: She has a history of osteosarcoma diagnosed in childhood.
She had an allograft prosthetic composite left distal femur used
for limb salvage reconstruction in [**2126**].
Revision surgery with a titanium endoprosthesis [**2144-3-2**].
I&D for coag-negative staph infection [**2144-3-17**]
Removal of prosthesis and spacer placement [**2144-7-27**]
Currently on vancomycin therapy s/p 8 weeks (levels 14-20)ending
[**2144-9-21**].
Incomplete resolution of inflammatory markers with resurgence of
SCN infection.
[**2144-10-26**]: Removal of cement spacer, debridement of cement
from proximal femoral canal, excision of 10 cm of residual
infected femur, tibial osteotomy, and removal of tibial
component from prior total knee and patellar button from
prior total knee.
[**2144-10-29**]:  Complex open reduction internal
fixation of left pathologic subtrochanteric periprosthetic
femur fracture.
On daptomycin, levaquin, rifabutin from [**2144-10-26**]; levaquin
stopped on [**2144-11-18**].

MEDICATION ON ADMISSION: Clonazepam [Klonopin]
1 mg Tablet
1 Tablet(s) by mouth as directed 1 in am, 2 in pm  90 Tablet 2
(Two) [**Last Name (LF) **], [**First Name7 (NamePattern1) 1022**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

ALLERGIES: Morphine / Codeine / Rifampin / Quinolones / Steri-Strip /
Iodine; Iodine Containing

PHYSICAL EXAM: On day of DC:
Wounds to B LE clean, dry, intact.  NO purulence or excessive
erethyma.  Palpable DP pulse LLE.  [**Last Name (un) 938**], FHL, G, TA intact.
AF, VSS

FAMILY HISTORY: Mother with osteoporosis and arthritis.  Father with
hypertension.  Siblings:  Brother with bipolar disorder.

SOCIAL HISTORY: Unemployed.  Currently living with her mom who lives in the area
and has plans to move to the [**State 4565**] area after her surgery.
She is divorced.
Tobacco:  Ten cigarettes a day x15 years.  History of alcohol
and cocaine abuse, currently in recovery.
Other acquired deformities of knee,Accidental puncture or laceration during a procedure, not elsewhere classified,Pulmonary collapse,Personal history of malignant neoplasm of bone,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation
Acq knee deformity NEC,Accidental op laceration,Pulmonary collapse,Hx of bone malignancy,Abn react-artif implant
Admission Date:  [**2145-3-18**]              Discharge Date:   [**2145-3-30**]

Date of Birth:  [**2113-8-27**]             Sex:   F

Service: ORTHOPAEDICS

Allergies:
Morphine / Codeine / Rifampin / Quinolones / Steri-Strip /
Iodine; Iodine Containing

Attending:[**First Name3 (LF) 64**]
Chief Complaint:
Infected L femur reconstruction

Major Surgical or Invasive Procedure:
[**2145-3-18**]: OPERATION:  Removal of cement spacers from left femur
and
left tibia. Removal of left proximal femur and prosthetic
reconstruction (revision of proximal femur) and revision
total knee prosthesis (total femur replacement using [**Initials (NamePattern4) **]
[**Last Name (NamePattern4) 3389**] Howmedica nodular reconstruction system using a 47 mm
bipolar head, an 80 mm plus two 50 mm body segments and a
small rotating hinged knee with a 205 mm x 12 mm stem).

[**2145-3-18**]: Repair of left popliteal vein and ligation of
anterior tibial artery.

[**2145-3-18**]: Left lower extremity arteriogram with
contralateral second-order catheterization, left superficial
femoral artery to posterior tibial bypass graft with a
contralateral reverse saphenous vein.


History of Present Illness:
This was a planned procedure for removal of cement spacer and
tranisition to an allograft reconstruction vs. total femur
prosthesis based on bone stock.

Past Medical History:
She has a history of osteosarcoma diagnosed in childhood.
She had an allograft prosthetic composite left distal femur used
for limb salvage reconstruction in [**2126**].
Revision surgery with a titanium endoprosthesis [**2144-3-2**].
I&D for coag-negative staph infection [**2144-3-17**]
Removal of prosthesis and spacer placement [**2144-7-27**]
Currently on vancomycin therapy s/p 8 weeks (levels 14-20)ending
[**2144-9-21**].
Incomplete resolution of inflammatory markers with resurgence of
SCN infection.
[**2144-10-26**]: Removal of cement spacer, debridement of cement
from proximal femoral canal, excision of 10 cm of residual
infected femur, tibial osteotomy, and removal of tibial
component from prior total knee and patellar button from
prior total knee.
[**2144-10-29**]:  Complex open reduction internal
fixation of left pathologic subtrochanteric periprosthetic
femur fracture.
On daptomycin, levaquin, rifabutin from [**2144-10-26**]; levaquin
stopped on [**2144-11-18**].

History of alcohol and cocaine abuse, currently in recovery.
History of Adriamycin toxicity
History of abnormal PAP smears in the past.


Social History:
Unemployed.  Currently living with her mom who lives in the area
and has plans to move to the [**State 4565**] area after her surgery.
She is divorced.
Tobacco:  Ten cigarettes a day x15 years.  History of alcohol
and cocaine abuse, currently in recovery.


Family History:
Mother with osteoporosis and arthritis.  Father with
hypertension.  Siblings:  Brother with bipolar disorder.


Physical Exam:
On day of DC:
Wounds to B LE clean, dry, intact.  NO purulence or excessive
erethyma.  Palpable DP pulse LLE.  [**Last Name (un) 938**], FHL, G, TA intact.
AF, VSS

Pertinent Results:
All intraop, blood and urine CX's to date: no growth

Brief Hospital Course:
The pt was admitted for inpatient surgery.  Intraoperatively, it
was determined that her bone stock was insufficient for an
allograft reconstruction.  Intraoperative gram stains and WBC's
per HPF were not consistent with infection.  Plans for a total
femru prosthesis were initiated.  During creation of the tibial
plateau cut, and injury was sustained to vasculature surrounding
the knee.  An intra-op vascular surgery consult was made.   They
repaired a vein and ligated an artery .  She had good
intraoperative doppled signals distal to the repair.  Placement
of her total femur psothesis continued without further
difficulty.  Post operatively, she had intermittently
dopplerable DP and PT signals.  Vascular surgery was reconsulted
and the decision to proceed to arteriogram and possibel bypass
was made.  [**Name (NI) **] pt was awoken and her and her family were
informed of her condition and the decision to proceed with the
vascular procedure was made.  Her LLE arterial bypass was
completed and the pt remained intubated in the PACU.  She was
extubated and pain management helped with her pain medication
optimization.  She had easily palpable DP and PT pulses in her
LLE.  She sustained low grade fevers, believed to be related to
atelectasis.  Her intraop Cx were negative.  Blood Cx and
urinary Cx's were negative.  CXR's showed resolving atelecatasis
and effusion.  Her fevers resolved.  She mobilized well with PT.
 her pain regimen was optimized.  Her Cx's were all negative.
She was deemd appropriate for DC home with services.

Medications on Admission:
Clonazepam [Klonopin]
1 mg Tablet
1 Tablet(s) by mouth as directed 1 in am, 2 in pm  90 Tablet 2
(Two) [**Last Name (LF) **], [**First Name7 (NamePattern1) 1022**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

Gabapentin [Neurontin]
300 mg Capsule
1 Capsule(s) by mouth three times a day  90 Capsule 6 (Six)
[**Last Name (LF) **], [**First Name7 (NamePattern1) 1022**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

Mom[**Name (NI) 6474**] [Nasonex]
50 mcg Spray, Non-Aerosol
1 puff IN twice a day  1 Bottle 3 (Three) [**Last Name (LF) **], [**First Name7 (NamePattern1) 1022**]
[**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

Omeprazole [Prilosec]
20 mg Capsule, Delayed Release(E.C.)
1 Capsule(s) by mouth twice a day  60 Capsule 6 (Six)
[**Last Name (LF) **], [**First Name7 (NamePattern1) 1022**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

Prochlorperazine Edisylate [Compazine]
5 mg Tablet
[**12-2**] Tablet(s) by mouth q8  90 Tablet 3 (Three)
[**Last Name (LF) **], [**First Name7 (NamePattern1) 1022**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

Sertraline
100 mg Tablet
1 Tablet(s) by mouth once a day  45 Tablet 1 (One)
[**Last Name (LF) **], [**First Name7 (NamePattern1) 1022**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

Tizanidine
2 mg Tablet
2 Tablet(s) by mouth three times a day  180 Tablet 6 (Six)
[**Last Name (LF) **], [**First Name7 (NamePattern1) 1022**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

Valacyclovir
500 mg Tablet
1 Tablet(s) by mouth twice a day Take for 3 days for each
episode  18 Tablet 2 (Two) [**Last Name (LF) **], [**First Name7 (NamePattern1) 1022**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

Vancomycin
250 mg Capsule
1 Capsule(s) by mouth three times a day Take 1 tablet PO TID x 4
weeks; then [**Hospital1 **] x 2 weeks; qd x 2 week; then qod x 2 week  150
Tablet 0 (Zero) [**Last Name (LF) **], [**First Name7 (NamePattern1) 803**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

OTC Aspirin
(Prescribed by Other Provider: [**Name Initial (NameIs) **])
325 mg Tablet
1 Tablet(s) by mouth twice a day

Calcium
(OTC)
500 mg Tablet
one Tablet(s) by mouth daily

Magnesium
(Prescribed by Other Provider)
84 mg Tablet Sustained Release
two Tablet(s) by mouth twice a day

Multivitamin,Tx-Minerals [Vitamins & Minerals]
(OTC)
Tablet
Tablet(s) by mouth


Discharge Medications:
1. Enoxaparin 30 mg/0.3 mL Syringe Sig: One (1) 30 mg
Subcutaneous Q12H (every 12 hours).
Disp:*60 30 mg* Refills:*2*
2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
3. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
4. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
5. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
6. Clonazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
7. Sertraline 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

8. Tizanidine 2 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
9. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
DAILY (Daily) as needed.
10. Supplies
CPM machine for L knee: PRN, no hip flexion past 90 degrees
11. Vancomycin 250 mg Capsule Sig: One (1) Capsule PO Q6H (every
6 hours).
Disp:*120 Capsule(s)* Refills:*2*
12. Diphenhydramine HCl 25 mg Capsule Sig: One (1) Capsule PO
Q6H (every 6 hours) as needed.
13. Oxycodone 10 mg Tablet Sustained Release 12 hr Sig: Three
(3) Tablet Sustained Release 12 hr PO Q12H (every 12 hours).
Disp:*100 Tablet Sustained Release 12 hr(s)* Refills:*0*
14. Butalbital-Acetaminophen-Caff 50-325-40 mg Tablet Sig: One
(1) Tablet PO Q8H (every 8 hours) as needed.
Disp:*80 Tablet(s)* Refills:*1*
15. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H
(every 6 hours).
16. CALCIUM 500+D 500 (1,250)-200 mg-unit Tablet Sig: One (1)
Tablet PO QD ().
17. Hydromorphone 4 mg Tablet Sig: Two (2) Tablet PO Q4H (every
4 hours).
Disp:*100 Tablet(s)* Refills:*0*
18. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
Disp:*90 Capsule(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Osteosarcoma L femur, s/p failed allograft and infected
prosthesis.


Discharge Condition:
improved


Discharge Instructions:
Partial weight bearing L leg, full weight bearing R leg
Strict posterior hip percautions: no ADDuction across midline,
no flexion past 90 degrees, no internal rotation.
No active ABDuction.
[**Male First Name (un) **] hose to LLE when possible
PRN CPM L leg
Keep incisions clean and dry
Physical Therapy:

Activity:  Ambulate
 Right lower extremity:  Full weight bearing
 Left lower extremity:  Partial weight bearing
Avoid active ABduction L hip<br>Active assist ROM L knee<br>Work
on L calf strengthening<br>Posterior hip precautions<br>NO hip
flexion greater than 90 degrees<br>NO hip ADDuction beyond
midline<br>NO hip internal rotation

Treatments Frequency:
PRN dressing changes with dry sterile gauze to surgical
incisions if irritated
Staples will be removed in clinic on follow up
elevate L leg when in bed

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 5866**], MD Phone:[**Telephone/Fax (1) 457**]
Date/Time:[**2145-4-9**] 10:30

Provider: [**Name10 (NameIs) **], Vascular surgery: FOllow up in [**3-7**] weeks
with arterial duplex.  This will be arranged for you.  Please
call ([**Telephone/Fax (1) 9393**] to confirm this appointment

Provider: [**Name10 (NameIs) **],[**First Name3 (LF) 251**] C.  [**Telephone/Fax (1) 1228**]  Call to schedule
appointment

Provider: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **].  [**Telephone/Fax (1) 1228**]  Call to schedule
appointment
{'Other acquired deformities of knee,Accidental puncture or laceration during a procedure, not elsewhere classified,Pulmonary collapse,Personal history of malignant neoplasm of bone,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}


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 L femur reconstruction

PRESENT ILLNESS: This was a planned procedure for removal of cement spacer and
tranisition to an allograft reconstruction vs. total femur
prosthesis based on bone stock.

MEDICAL HISTORY: She has a history of osteosarcoma diagnosed in childhood.
She had an allograft prosthetic composite left distal femur used
for limb salvage reconstruction in [**2126**].
Revision surgery with a titanium endoprosthesis [**2144-3-2**].
I&D for coag-negative staph infection [**2144-3-17**]
Removal of prosthesis and spacer placement [**2144-7-27**]
Currently on vancomycin therapy s/p 8 weeks (levels 14-20)ending
[**2144-9-21**].
Incomplete resolution of inflammatory markers with resurgence of
SCN infection.
[**2144-10-26**]: Removal of cement spacer, debridement of cement
from proximal femoral canal, excision of 10 cm of residual
infected femur, tibial osteotomy, and removal of tibial
component from prior total knee and patellar button from
prior total knee.
[**2144-10-29**]:  Complex open reduction internal
fixation of left pathologic subtrochanteric periprosthetic
femur fracture.
On daptomycin, levaquin, rifabutin from [**2144-10-26**]; levaquin
stopped on [**2144-11-18**].

MEDICATION ON ADMISSION: Clonazepam [Klonopin]
1 mg Tablet
1 Tablet(s) by mouth as directed 1 in am, 2 in pm  90 Tablet 2
(Two) [**Last Name (LF) **], [**First Name7 (NamePattern1) 1022**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]

ALLERGIES: Morphine / Codeine / Rifampin / Quinolones / Steri-Strip /
Iodine; Iodine Containing

PHYSICAL EXAM: On day of DC:
Wounds to B LE clean, dry, intact.  NO purulence or excessive
erethyma.  Palpable DP pulse LLE.  [**Last Name (un) 938**], FHL, G, TA intact.
AF, VSS

FAMILY HISTORY: Mother with osteoporosis and arthritis.  Father with
hypertension.  Siblings:  Brother with bipolar disorder.

SOCIAL HISTORY: Unemployed.  Currently living with her mom who lives in the area
and has plans to move to the [**State 4565**] area after her surgery.
She is divorced.
Tobacco:  Ten cigarettes a day x15 years.  History of alcohol
and cocaine abuse, currently in recovery. 

### Response:
{'Other acquired deformities of knee,Accidental puncture or laceration during a procedure, not elsewhere classified,Pulmonary collapse,Personal history of malignant neoplasm of bone,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}
