CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 66-year-old
man with a complicated medical history of sinonasal carcinoma
complicated by osteomyelitis of the right mandible with
recurrent squamous cell carcinoma at the skull base.  Also, a
right facial orocutaneous fistula.  He had been discharged
with a PICC line, IV antibiotics, and a PEG recently.

MEDICAL HISTORY: 1.  Maxillary sinonasal carcinoma.
2.  Right mandible osteomyelitis.
3.  Prostate cancer.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Secondary malignant neoplasm of bone and bone marrow,Pathologic fracture of other specified site,Chronic airway obstruction, not elsewhere classified,Malignant neoplasm of maxillary sinus,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Inflammatory conditions of jaw,Lesion of lateral popliteal nerve
Secondary malig neo bone,Path fx oth specif site,Chr airway obstruct NEC,Mal neo maxillary sinus,Abn react-radiotherapy,Inflammation of jaw,Lat popliteal nerve les
Admission Date:  [**2200-4-28**]     Discharge Date:  [**2200-5-9**]

Date of Birth:   [**2133-2-12**]     Sex:  M

Service:  OTOLARYNGOLOGY

HISTORY OF THE PRESENT ILLNESS:  The patient is a 66-year-old
man with a complicated medical history of sinonasal carcinoma
complicated by osteomyelitis of the right mandible with
recurrent squamous cell carcinoma at the skull base.  Also, a
right facial orocutaneous fistula.  He had been discharged
with a PICC line, IV antibiotics, and a PEG recently.

He presented to the [**Hospital6 256**] on
[**2200-4-28**] for an operation to include a
hemimandibulectomy, skin excision, question of a facial nerve
resection and dissection, tracheostomy, and free flap.

ALLERGIES:  The patient has no known drug allergies.




                          [**Name6 (MD) **] [**Last Name (NamePattern4) 13798**], M.D.  [**MD Number(1) 13799**]

Dictated By:[**Last Name (NamePattern4) 19607**]

MEDQUIST36

D:  [**2200-5-9**]  11:24
T:  [**2200-5-9**]  23:05
JOB#:  [**Job Number 19812**]/[**Numeric Identifier 19813**]


Admission Date:  [**2200-4-28**]     Discharge Date:  [**2200-5-9**]

Date of Birth:   [**2133-2-12**]     Sex:  M

Service:  OTOLARYNGOLOGY

HISTORY OF THE PRESENT ILLNESS:  The patient is a 66-year-old
with a complicated past medical history of sinonasal
carcinoma complicated by osteomyelitis of the right mandible
and recurrent squamous cell carcinoma at the skull base and a
right facial orocutaneous fistula.  He had been discharged
recently from the [**Hospital1 **] with a PICC line, IV antibiotics, and a
PEG with the plan to start tube feeds.

He presented on [**2200-4-28**] for his planned procedure,
resection and reconstruction, by Plastic Surgery.

PAST MEDICAL HISTORY:
1.  Maxillary sinonasal carcinoma.
2.  Right mandible osteomyelitis.
3.  Prostate cancer.

PAST SURGICAL HISTORY:
1.  Status post PICC, left arm.
2.  Status post PEG.
3.  Status post total maxillectomy.
4.  Status post radiation therapy with ostial radial necrosis
of the right mandible.

ALLERGIES:  The patient has no known drug allergies.

MEDICATIONS FROM HOME:
1.  Colace.
2.  Duragesic patch 75 micrograms per hour.
3.  Neurontin 800 mg b.i.d.
4.  Multivitamin.
5.  Prozac 20 q.d.
6.  Erythromycin ointment to the right eye t.i.d.
7.  Ibuprofen p.r.n.
8.  Vancomycin 1.25 grams every day.
9.  Ceftriaxone 2 grams every day.
10. Reglan 10 mg per PEG.
11. Roxicet p.r.n.
12. Neomycin to the right ear.
13. Iron.
14. Oxycodone 40 mg p.o. b.i.d.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  The patient
was afebrile with vital signs stable.  Cranial nerves II
through XII were intact with exceptions including the right
second nerve, right seventh nerve zygomatic buccal arch, the
right maxillary sinus is gone, right mandible is exposed,
right eyelid was swollen with erythema.  Lungs:  Clear on
auscultation.  Heart:  Regular rate and rhythm.  Abdomen:
Nontender, nondistended, soft with positive bowel sounds.
Extremities:  Warm and well perfused with full motor and
strength.

ADMISSION LABORATORY DATA:  White count 10.0, hematocrit 29,
platelets 325,000.  Coagulations:  INR 1.2, BUN 24,
creatinine 0.7.

His chest x-ray showed no acute disease but bilateral apical
thickening and emphysematous changes.

EKG revealed sinus rhythm at 54, no change compared to
[**2199-10-4**].

HOSPITAL COURSE:  The patient was evaluated by Plastic
Surgery, Dr. [**Last Name (STitle) 13797**], and was taken to the Operating Room on
[**2200-4-29**].

By ENT he had (1) Tracheostomy.  (2)  Right modified radical
neck dissection including levels [**2-2**].  (3)  Orbital excision.
(4)  Overlying facial defect removed.  (5)  Mandibulectomy.

Findings were that the tumor did involve the orbit and there
is a pathological fracture in the mandible.

Plastic Surgery on [**2200-4-29**] did a right rectus abdominis
myocutaneous transfer to the right hemifacial defect.  Total
ID was 6,200.  Urine output was 2,500.  EBL 500 cc.  He was
taken to the ICU with frequent flap checks.

Prior to this, he received 2 units of packed red blood cells
for a crit of 29 prior to going for the operation.  He
tolerated the procedure well.  He stayed in the ICU for two
days.  He was taken off the ventilator without problems.  [**Name (NI) **]
was transferred to the floor.

ID was consulted regarding his antibiotics and they
recommended for his history of osteomyelitis and
radionecrosis, especially in the setting of a new
myocutaneous flap, to continue his antibiotics, vancomycin,
ceftriaxone, and Flagyl, for a total of six weeks.  He has a
left PICC line for this.

His electrolytes were checked and repleted.  Potassium one
day was found to be 2.9 and repleted to goal.

GASTROINTESTINAL:  He has had some difficulty with tube
feeds.  At first he had nausea and high residuals.  He
received two days of Reglan.  He now has continuing diarrhea.
His C. difficile is negative.  We have changed the tube
feeds.  We are starting Lomotil today and had some
improvement, but he is otherwise tolerating his tube feeds at
goal.  Pain is well controlled.  He does complain of a
headache.  A new finding is also of a left foot drop with
some numbness on the dorsum of his foot anteriorly.  This is
new in the hospital, presumed to be due to operating room
positioning during this long case and should resolve.

Physical Therapy has seen him and will be following him at
home.  He has a foot brace that has been helping.  He is
independently ambulating and deemed safe for discharge with
VNA on [**2200-5-9**].

FOLLOW-UP:  The patient is to follow-up in ENT with Dr.
[**First Name (STitle) **], [**Telephone/Fax (1) 41**].  He is to call for an appointment in one
to two weeks.  He is to follow-up with Plastic Surgery, Dr.
[**Last Name (STitle) 13797**], [**Telephone/Fax (1) 19606**].  He is to call for an appointment in
one to two weeks.  He is also to follow-up with Infectious
Disease, Dr. [**Last Name (STitle) 13901**].  He has an appointment set up for [**2200-5-30**] at 11:00 a.m. in 11 Riseman at the [**Hospital3 **] [**Hospital Ward Name 8559**].  He is also to follow-up with his primary care
provider this week.

DISCHARGE MEDICATIONS:
1.  Ceftriaxone 2 grams q. 12 hours IV for five more weeks.
2.  Fluoxetine 20 mg q.d.
3.  Gabapentin 800 mg b.i.d.
4.  Aspirin 81 mg q.d.
5.  Lorazepam [**3-4**] milliliters every six hours as needed.
6.  Vancomycin 750 mg IV q. 12 for five more weeks.
7.  Metronidazole 500 mg t.i.d. for three weeks.
8.  Famotidine 20 mg per G tube twice a day.
9.  Tylenol elixir p.r.n.
10. Oxycodone solution p.r.n. pain.
11. Chlorhexidine gluconate solution 15 ml four times a day.

DISCHARGE INSTRUCTIONS:
1.  Concerning his diarrhea:  C. difficile is negative.  He
is to continue his home tube feeds, seven cans a day of
ProMod with fiber or Nestle equivalent.  In two days, if he
has continued diarrhea, the VNA is to check CBC and
chemistries and sent results to his PCP or Dr. [**First Name (STitle) **].  He was
also started on Lomotil in the hospital and can titrate this
to effect at home.
2.  Physical therapy: For the left foot drop, he will be
followed and evaluated.
3.  He is to continue antibiotics for a total of five weeks.
4.  JP drain management per Plastics.  They are to keep this
JP drain in with recording of daily output and bring to the
Plastic Surgery appointment.
5.  Wound check:  There is a small orocutaneous fistula at
the anterior side of the mouth.  Please check on this daily.
His old tracheostomy site has been closed with Steri-Strips
and covered with a dry sterile dressing.  Only change the dry
sterile dressing.
6.  He has a PICC line in the left arm which should be
flushed and kept patent.
7.  PEG tube for which he will have tube feeds and should be
flushed to keep patency.




                          [**Name6 (MD) **] [**Last Name (NamePattern4) 13798**], M.D.  [**MD Number(1) 13799**]

Dictated By:[**Last Name (NamePattern4) 19607**]

MEDQUIST36

D:  [**2200-5-9**]  11:45
T:  [**2200-5-9**]  23:26
JOB#:  [**Job Number 19608**]


Name:  [**Known lastname **], [**Known firstname 2892**]                      Unit No:  [**Numeric Identifier 3226**]

Admission Date: [**2200-4-28**]      Discharge Date: [**2200-5-9**]

Date of Birth:                  Sex:

Service:

ADDENDUM:  In regards to his new left foot drop, Neurology
was consulted and confirmed it was a peroneal nerve
compression probably during the operation, probably will
resolve over time.  She is to follow-up with the
Neuromuscular Group at [**Telephone/Fax (1) 190**].  He is to have a
follow-up appointment in three to four weeks.  He is to call
[**Last Name (LF) 228**], [**5-12**] to schedule an EMG and nerve conduction
study to occur within the next one to two weeks.  No further
imaging will be needed.

Plastic Surgery follow-up with Dr. [**Last Name (STitle) 2023**] to occur as soon
as possible within the next week after discharge.



                 DR.[**First Name (STitle) 3227**],[**First Name3 (LF) 3228**] 04-134


Dictated By:[**Dictator Info **]

MEDQUIST36

D:  [**2200-5-9**]  05:55
T:  [**2200-5-10**]  12:48
JOB#:  [**Job Number 3229**]
{'Secondary malignant neoplasm of bone and bone marrow,Pathologic fracture of other specified site,Chronic airway obstruction, not elsewhere classified,Malignant neoplasm of maxillary sinus,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Inflammatory conditions of jaw,Lesion of lateral popliteal nerve'}


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 66-year-old
man with a complicated medical history of sinonasal carcinoma
complicated by osteomyelitis of the right mandible with
recurrent squamous cell carcinoma at the skull base.  Also, a
right facial orocutaneous fistula.  He had been discharged
with a PICC line, IV antibiotics, and a PEG recently.

MEDICAL HISTORY: 1.  Maxillary sinonasal carcinoma.
2.  Right mandible osteomyelitis.
3.  Prostate cancer.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Secondary malignant neoplasm of bone and bone marrow,Pathologic fracture of other specified site,Chronic airway obstruction, not elsewhere classified,Malignant neoplasm of maxillary sinus,Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Inflammatory conditions of jaw,Lesion of lateral popliteal nerve'}
