CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 73-year-old
male with a history of several months of fatigue and a 50
pound weight loss over six months.  He had an
esophagogastroduodenoscopy in [**Country 25091**] that demonstrated a
gastric ulcer which, upon biopsy, was positive for
adenocarcinoma.  On the morning of [**2111-9-4**], the
patient awoke and complained of left neck pain, at which time
he took one sublingual nitroglycerin, which gave him some
resolution of the pain.  He presented to his primary care
physician and then the emergency department at [**Hospital1 346**].

MEDICAL HISTORY: 1.  Coronary artery disease with two vessel disease and a 45%
ejection fraction.
2.  Status post aortobifemoral bypass.
3.  Status post right femoral-popliteal bypass in [**2105**].
4.  Chronic renal insufficiency.
5.  Diabetes mellitus type 2.
6.  Hypertension.
7.  Gastric adenocarcinoma.
8.  Renal artery stenosis.
9.  Congestive heart failure.

MEDICATION ON ADMISSION: Lopressor 12.5 mg p.o. q.d.
Captopril 50 mg p.o. t.i.d.
Isosorbide 20 mg p.o. t.i.d.
Sublingual nitroglycerin.

ALLERGIES: The patient had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Other chest pain,Malignant neoplasm of other specified sites of stomach,Acquired hypertrophic pyloric stenosis,Iron deficiency anemia, unspecified,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Atherosclerosis of renal artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension
Chest pain NEC,Malig neopl stomach NEC,Acq pyloric stenosis,Iron defic anemia NOS,Crnry athrscl natve vssl,CHF NOS,Renal artery atheroscler,DMII wo cmp nt st uncntr,Hypertension NOS
Admission Date:  [**2111-9-4**]       Discharge Date:  [**2111-9-22**]

Date of Birth:   [**2038-3-10**]       Sex:  M

Service:  SURGERY

HISTORY OF PRESENT ILLNESS:  The patient is a 73-year-old
male with a history of several months of fatigue and a 50
pound weight loss over six months.  He had an
esophagogastroduodenoscopy in [**Country 25091**] that demonstrated a
gastric ulcer which, upon biopsy, was positive for
adenocarcinoma.  On the morning of [**2111-9-4**], the
patient awoke and complained of left neck pain, at which time
he took one sublingual nitroglycerin, which gave him some
resolution of the pain.  He presented to his primary care
physician and then the emergency department at [**Hospital1 346**].

PAST MEDICAL HISTORY:
1.  Coronary artery disease with two vessel disease and a 45%
ejection fraction.
2.  Status post aortobifemoral bypass.
3.  Status post right femoral-popliteal bypass in [**2105**].
4.  Chronic renal insufficiency.
5.  Diabetes mellitus type 2.
6.  Hypertension.
7.  Gastric adenocarcinoma.
8.  Renal artery stenosis.
9.  Congestive heart failure.

MEDICATIONS ON ADMISSION:
Lopressor 12.5 mg p.o. q.d.
Captopril 50 mg p.o. t.i.d.
Isosorbide 20 mg p.o. t.i.d.
Sublingual nitroglycerin.

ALLERGIES:  The patient had no known drug allergies.

HOSPITAL COURSE:  After admission, the patient was ruled out
by enzymes and electrocardiogram.  His cardiac medication
regimen was optimized and the patient underwent an
esophagogastroduodenoscopy on [**2111-9-8**].  The
esophagogastroduodenoscopy demonstrated an ulcerated,
infiltrated, nonbleeding, 6 to 8 cm mass of malignant
appearance, which was biopsied.  The mass was also
significant because it demonstrated near obstruction of the
pylorus.

A cardiology consultation was obtained after a Persantine
MIBI demonstrated a mild reversible inferior wall perfusion
defect.  The patient was evaluated to be at intermediate risk
for gastric cancer resection.  However, prior to the planned
surgery, the patient had an episode of neck pain again and
cardiac enzymes revealed a troponin of 65.

On [**2111-9-15**], after the patient's cardiac issues had
been addressed, the patient underwent subtotal gastrectomy
and placement of a feeding jejunostomy and a cholangiogram.
The operation was uneventful and the specimen was sent to
pathology.  The patient was sent to the post anesthesia care
unit in stable condition.

The patient was then transferred to the surgical intensive
care unit, where his course was notable for episodes of sinus
block and bradycardia.  However, these episodes resolved and
the patient was transferred to the floor without any
complications.

On the floor, the patient continued his jejunostomy tube
feedings, but they began cycling at night.  He began
tolerating a soft post gastrojejunostomy diet and he was pain
free with stable vital signs.

DISPOSITION:  The patient will be discharged home with
[**Hospital6 407**] services for jejunostomy tube
feeding management.

FOLLOW UP:  The patient also will have outpatient follow up
with his private hematologist oncologist, Dr. [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **], at phone number [**Telephone/Fax (1) 94221**].  The patient will
also be followed up by Dr. [**Last Name (STitle) **] in the clinic within a
week.

DISCHARGE MEDICATIONS:  The patient will be discharged with
prescriptions for Percocet one to two tablets p.o. every four
to six hours p.r.n. for pain and jejunostomy tube feeds for
ten days.




                            [**Name6 (MD) 843**] [**Name8 (MD) 844**], M.D.  [**MD Number(1) 845**]

Dictated By:[**Name8 (MD) 522**]
MEDQUIST36

D:  [**2111-9-23**]  11:50
T:  [**2111-9-25**]  11:36
JOB#:  [**Job Number 94222**]


Admission Date:  [**2111-9-25**]       Discharge Date:  [**2111-9-25**]

Date of Birth:   [**2038-3-10**]       Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 1071**] is a 73 year-old male
who has a past medical history of several months of fatigue
and 50 pound weight loss over six months,
esophagogastroduodenoscopy in [**Country 25091**] with biopsy demonstrated
a gastric ulcer positive for adenocarcinoma.  His main reason
for presentation to the [**Hospital1 **] Emergency
Department was chest pain and neck pressure.

PAST MEDICAL HISTORY:  1.  Coronary artery disease, two
vessel disease with 45% ejection fraction.  2. Status post
aortobifemoral.  3.  Right femoral popliteal bypass in [**2105**].
4.  Chronic renal insufficiency.  5.  Diabetes mellitus type
2.  6.  Hypertension.  7.  Renal artery stenosis.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON ADMISSION:  1.  Lopressor 12.5 mg q.d.  2.
Captopril 50 mg t.i.d.  3.  Isosorbide 20 mg t.i.d.

HOSPITAL COURSE:  Mr. [**Known lastname 1071**] was admitted to the Medical
Service after his presentation to the Emergency Department
and he ruled out for myocardial infarction.  Later during his
hospital course he [**Known lastname 1834**] esophagogastroduodenoscopy,
which demonstrated an ulcerated and infiltrative nonbleeding
6 to 8 cm malignant mass at the prepyloric region causing
complete obstruction.  At this point a surgical consult was
acquired and cardiology staff evaluated the patient for
surgical risk grading him as intermediate.  Prior to his
surgery Mr. [**Known lastname 1071**] [**Last Name (Titles) 1834**] several episodes of neck tightness
and his blood pressures were very labile.  These episodes
were controlled with beta blockade and IV nitroglycerin
drips.  On the [**9-15**], the patient [**Month (only) 1834**] a
subtotal gastrectomy, a feeding jejunostomy tube was placed
and cholangiogram was performed by Dr. [**Last Name (STitle) **] and assisted
by Dr. [**First Name (STitle) 1586**] [**Name (STitle) **].  The procedure was uncomplicated and the
patient was admitted to the Surgical Intensive Care Unit
afterwards.  His course in the SICU was relatively
uncomplicated and only notable for one episode of
questionable sinus block and bradycardia, which a
electrophysiology consult was obtained, which the consulting
fellows recommended observing.

The patient was begun on tube feeds to supplement his lack of
per oral intake and these were well tolerated.  His medical
regimen was optimized to control his hypertension and the
patient was transferred to the floor.  On the floor his
course was without complications.  He began tolerating a
regular diet with tube feeds cycled in the evening with
notable elevations in his blood sugar, which were covered by
a sliding scale.  Otherwise the patient remained afebrile and
had stable vital signs.  He tolerated the advancement of his
diet well.  He is tolerating a post gastrectomy diet and he
was seen by physical therapy and performed adequately.

DISPOSITION:  The patient will be discharged to a rehab or a
skilled nursing facility.

MEDICATIONS ON DISCHARGE:  1.  Lopressor 100 mg t.i.d.  2.
Captopril 100 mg t.i.d.  3.  NPH 5 units b.i.d. while on tube
feeds and sliding scale regular insulin.

The patient should continue on tube feeds cycled in the
evening, Promote with fiber at 60 cc an hour from 6:00 p.m.
to 10:00 a.m.  These tube feeds should be discontinued when
the patient takes adequate oral intake.  The patient is being
followed by his primary care physician, [**Name10 (NameIs) **]
hematologist/oncologist Dr. [**Last Name (STitle) **], phone number
[**Telephone/Fax (1) 94221**] and Dr. [**First Name (STitle) **] [**Name (STitle) **].






                            [**Name6 (MD) 843**] [**Name8 (MD) 844**], M.D.  [**MD Number(1) 845**]

Dictated By:[**Name8 (MD) 522**]
MEDQUIST36

D:  [**2111-9-25**]  13:10
T:  [**2111-9-25**]  13:49
JOB#:  [**Job Number 47275**]
{'Other chest pain,Malignant neoplasm of other specified sites of stomach,Acquired hypertrophic pyloric stenosis,Iron deficiency anemia, unspecified,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Atherosclerosis of renal artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}


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: The patient is a 73-year-old
male with a history of several months of fatigue and a 50
pound weight loss over six months.  He had an
esophagogastroduodenoscopy in [**Country 25091**] that demonstrated a
gastric ulcer which, upon biopsy, was positive for
adenocarcinoma.  On the morning of [**2111-9-4**], the
patient awoke and complained of left neck pain, at which time
he took one sublingual nitroglycerin, which gave him some
resolution of the pain.  He presented to his primary care
physician and then the emergency department at [**Hospital1 346**].

MEDICAL HISTORY: 1.  Coronary artery disease with two vessel disease and a 45%
ejection fraction.
2.  Status post aortobifemoral bypass.
3.  Status post right femoral-popliteal bypass in [**2105**].
4.  Chronic renal insufficiency.
5.  Diabetes mellitus type 2.
6.  Hypertension.
7.  Gastric adenocarcinoma.
8.  Renal artery stenosis.
9.  Congestive heart failure.

MEDICATION ON ADMISSION: Lopressor 12.5 mg p.o. q.d.
Captopril 50 mg p.o. t.i.d.
Isosorbide 20 mg p.o. t.i.d.
Sublingual nitroglycerin.

ALLERGIES: The patient had no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Other chest pain,Malignant neoplasm of other specified sites of stomach,Acquired hypertrophic pyloric stenosis,Iron deficiency anemia, unspecified,Coronary atherosclerosis of native coronary artery,Congestive heart failure, unspecified,Atherosclerosis of renal artery,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension'}
