CHIEF COMPLAINT: Carcinoid arising from distal left main-stem bronchus.

PRESENT ILLNESS: The patient is an 83 year-old male who presented with
polymyositis. His workup included an x-ray and a subsequent CT
scan that disclosed a tumor of the left
lower lobe. Endobronchial evaluation confirmed a carcinoid
tumor. This tumor arose from the distal left main-stem bronchus
and included the left lower lobe. He is being admitted for
sleeve lobectomy, resection.

MEDICAL HISTORY: Hypertension
BPH
Psoriasis
Basal cell carcinoma: on nose, excised with skin graft in early
[**2181-3-17**]

MEDICATION ON ADMISSION: atenolol 50 mg daily, doxazosin 4 mg daily, prednisone 20 mg
daily, lisinopril 20 mg daily, omeprazole 20 mg daily,
hydrochlorothiazide 12.5 mg dialy, Bactrim Ds daily, MVI daily,
alendronate 70mg weekly

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: 98.2   HR: 62 SR    BP: 138/68    Sats: 94% RA
General: sitting in chair no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple no lyphadenopathy
Card: RRR normal S1,S2 no murmur/gallop or rub
Resp: decreased breath L>R with faint crackles LLL
GI: benign
Extr: warm no edema
Incision: Left thoracotomy site clean, dry intact no erythema
Neuro: non-focal

FAMILY HISTORY: both parents and a brother had MI

SOCIAL HISTORY: Quit smoking 27 years ago. No alcohol or drug use. Retired
postal worker. No exposure to asbestos. Used to be in the Navy
in the Pacific during WWII.
Malignant neoplasm of upper lobe, bronchus or lung,Foreign body in other specified parts bronchus and lung,Foreign body accidentally entering other orifice,Atrial fibrillation,Other diseases of lung, not elsewhere classified,Other iatrogenic hypotension,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other psoriasis,Arthropathy, unspecified, site unspecified,Personal history of other malignant neoplasm of skin
Mal neo upper lobe lung,FB trach/bronch/lung NEC,FB entering oth orifice,Atrial fibrillation,Other lung disease NEC,Iatrogenc hypotnsion NEC,Hypertension NOS,BPH w/o urinary obs/LUTS,Other psoriasis,Arthropathy NOS-unspec,Hx-skin malignancy NEC
Admission Date:  [**2181-7-11**]              Discharge Date:   [**2181-7-17**]


Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Carcinoid arising from distal left main-stem bronchus.


Major Surgical or Invasive Procedure:
[**2181-7-11**]: Therapeutic bronchoscopy, Left thoracotomy, Lysis of
adhesions.
Sleeve left lower lobectomy with bronchial anastomosis between
the left main-stem and left upper lobe bronchus.


History of Present Illness:
The patient is an 83 year-old male who presented with
polymyositis. His workup included an x-ray and a subsequent CT
scan that disclosed a tumor of the left
lower lobe. Endobronchial evaluation confirmed a carcinoid
tumor. This tumor arose from the distal left main-stem bronchus
and included the left lower lobe. He is being admitted for
sleeve lobectomy, resection.


Past Medical History:
Hypertension
BPH
Psoriasis
Basal cell carcinoma: on nose, excised with skin graft in early
[**2181-3-17**]


Social History:
Quit smoking 27 years ago. No alcohol or drug use. Retired
postal worker. No exposure to asbestos. Used to be in the Navy
in the Pacific during WWII.


Family History:
both parents and a brother had MI

Physical Exam:
VS: T: 98.2   HR: 62 SR    BP: 138/68    Sats: 94% RA
General: sitting in chair no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple no lyphadenopathy
Card: RRR normal S1,S2 no murmur/gallop or rub
Resp: decreased breath L>R with faint crackles LLL
GI: benign
Extr: warm no edema
Incision: Left thoracotomy site clean, dry intact no erythema
Neuro: non-focal

Pertinent Results:
[**2181-7-15**] WBC-14.0* RBC-3.58* Hgb-10.5* Hct-30.3* Plt Ct-348
[**2181-7-14**] WBC-13.4* RBC-2.81* Hgb-8.2* Hct-24.1* Plt Ct-238
[**2181-7-11**] WBC-17.8* RBC-3.32* Hgb-9.7* Hct-28.0* Plt Ct-243
[**2181-7-14**] Glucose-119* UreaN-20 Creat-0.9 Na-137 K-4.1 Cl-100
HCO3-29
[**2181-7-11**] Glucose-167* UreaN-25* Creat-0.9 Na-141 K-4.6 Cl-107
HCO3-22

PORTABLE CHEST, [**2181-7-15**]
The chest tube has been removed. Since the chest tube removal,
there appears to have been increased shift of mediastinal
structures to the left. No pneumothorax is identified. There is
increased volume loss on the left with increased opacification
of left lung. Right lung is relatively clear with minimal
atelectasis in the right lung base.
IMPRESSION:
Status post left chest tube removal with mediastinal shift to
the left,
increased opacification of left lung.

[**2181-7-16**] Portable CXR: persistent opacification of the left
hemithorax

Brief Hospital Course:
[**7-11**]: The patient underwent the above procedure.  He tolerated
the procedure well and was transferred to the TSICU for intense
monitoring following the procedure.  He had an epidural in place
for pain relief, diet was advanced slowly, foley catheter in
place, two chest tubes in place to suction.

[**7-12**]: The patient was transferred to the floor for continued
monitoring.  He developed supraventricular tachycardia followed
by atrial fibrillation.  He remained hemodynamically stable and
asymptomatic.  He was given Lopressor 5mg IV for a total of five
doses, he did not convert.  He was given a bolus of Amiodarone
150mg and drip and converted to sinus rhythm. The patient became
hypotensive and the amiodarone drip was stopped.  He remained in
sinus rhythm.  The chest tubes were placed to water-seal with no
air leak.  His pain was relieved with an epidural.

[**7-13**]: He had an episode of rapid atrial fibrillation and the
amiodarone drip was restarted and he converted sinus rhythm. He
was diuresed.  He was seen by physical therapy whom declared him
safe for home.

[**7-14**]: Remains in sinus rhythm, on PO amiodarone and atenolol.
The apical chest-tube was removed.

[**7-15**]: The remaining chest-tube was removed.  His HCT was found
to 24 for which he was transfused 2 unit PRBC to a HCT of 30.

[**7-16**]: The epidural was removed and his pain was well controlled
with PO pain medication.  The foley was removed and he voided
without difficulty.  He underwent flexible bronchoscopy which
showed an adherent fibrin clot. The chest x-ray revealed a
collapsed left lower lobe.

[**7-17**]: The patient underwent a rigid bronchoscopy for removal of
fibrin clot. He tolerated the procedure well.  The follow-up CXR
revealed moderates increased aeration of the left lung.  He was
discharged to home and will follow-up with Dr. [**First Name (STitle) **] in 1 week.

Medications on Admission:
atenolol 50 mg daily, doxazosin 4 mg daily, prednisone 20 mg
daily, lisinopril 20 mg daily, omeprazole 20 mg daily,
hydrochlorothiazide 12.5 mg dialy, Bactrim Ds daily, MVI daily,
alendronate 70mg weekly

Discharge Medications:
1. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
2. Doxazosin 4 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Prednisone 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
6. Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO
DAILY (Daily).
7. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO DAILY (Daily).
8. Multivitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
9. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain, fever.
10. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q4H (every
4 hours) as needed for pain.
Disp:*50 Tablet(s)* Refills:*0*
11. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
12. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
13. Alendronate 70 mg Tablet Sig: One (1) Tablet PO once a week.



Discharge Disposition:
Home

Discharge Diagnosis:
Left lower lobe Carcinoid Tumor
Hypertension, BPH
Psoriasis
Arthritis.


Discharge Condition:
Stable


Discharge Instructions:
Call Dr.[**Name (NI) 5067**] office [**Telephone/Fax (1) 170**] if experience:
-Fever > 101 or chills
-Increased cough or shortness of breath
-Chest pain
-Incision develops drainage or increased redness
Chest-tube cover with a bandaid until healed
No Driving while taking narcotics: Take stool softners with
narcotics
You may Shower: No swimming or tub bathing for 6 weeks
Continue Regular diet
Walk frequently throughout day

Followup Instructions:
Follow-up with Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] [**7-24**] at 10:00am on the [**Hospital Ward Name 5074**] [**Hospital Ward Name 23**] Clinical Center [**Location (un) **].
Report to the [**Location (un) **] Radiology Department for a Chest X-Ray
45 minutes before your appointment.



Completed by:[**2181-7-17**]
{'Malignant neoplasm of upper lobe, bronchus or lung,Foreign body in other specified parts bronchus and lung,Foreign body accidentally entering other orifice,Atrial fibrillation,Other diseases of lung, not elsewhere classified,Other iatrogenic hypotension,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other psoriasis,Arthropathy, unspecified, site unspecified,Personal history of other malignant neoplasm of skin'}


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: Carcinoid arising from distal left main-stem bronchus.

PRESENT ILLNESS: The patient is an 83 year-old male who presented with
polymyositis. His workup included an x-ray and a subsequent CT
scan that disclosed a tumor of the left
lower lobe. Endobronchial evaluation confirmed a carcinoid
tumor. This tumor arose from the distal left main-stem bronchus
and included the left lower lobe. He is being admitted for
sleeve lobectomy, resection.

MEDICAL HISTORY: Hypertension
BPH
Psoriasis
Basal cell carcinoma: on nose, excised with skin graft in early
[**2181-3-17**]

MEDICATION ON ADMISSION: atenolol 50 mg daily, doxazosin 4 mg daily, prednisone 20 mg
daily, lisinopril 20 mg daily, omeprazole 20 mg daily,
hydrochlorothiazide 12.5 mg dialy, Bactrim Ds daily, MVI daily,
alendronate 70mg weekly

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: 98.2   HR: 62 SR    BP: 138/68    Sats: 94% RA
General: sitting in chair no apparent distress
HEENT: normocephalic, mucus membranes moist
Neck: supple no lyphadenopathy
Card: RRR normal S1,S2 no murmur/gallop or rub
Resp: decreased breath L>R with faint crackles LLL
GI: benign
Extr: warm no edema
Incision: Left thoracotomy site clean, dry intact no erythema
Neuro: non-focal

FAMILY HISTORY: both parents and a brother had MI

SOCIAL HISTORY: Quit smoking 27 years ago. No alcohol or drug use. Retired
postal worker. No exposure to asbestos. Used to be in the Navy
in the Pacific during WWII. 

### Response:
{'Malignant neoplasm of upper lobe, bronchus or lung,Foreign body in other specified parts bronchus and lung,Foreign body accidentally entering other orifice,Atrial fibrillation,Other diseases of lung, not elsewhere classified,Other iatrogenic hypotension,Unspecified essential hypertension,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Other psoriasis,Arthropathy, unspecified, site unspecified,Personal history of other malignant neoplasm of skin'}
