CHIEF COMPLAINT: Gangrene, left fourth toe.

PRESENT ILLNESS: The patient is a 45 year old
male with a past medical history of insulin dependent
diabetes mellitus, now presenting with gangrene of left
fourth toe which started in mid-[**Month (only) 1096**].  He was admitted to
[**Location 39045**], [**Hospital **] hospital (home town), and started on
intravenous antibiotics.  Amputation was recommended after an
angiogram and MRA were performed.  He is now here for a
second opinion.

MEDICAL HISTORY: 1.  Insulin dependent diabetes mellitus since [**2105**] with
triopathy.
2.  Legally blind.
3.  Hypertension.
4.  Coronary artery disease status post silent myocardial
infarction times two.
5.  Status post kidney transplant in [**2126**].
6.  Peripheral vascular disease status post right below the
knee amputation.
7.  Hyperlipidemia.
8.  Anemia.

MEDICATION ON ADMISSION: 1.  Imuran 125 mg q. day.
2.  Lopid 600 mg twice a day.
3.  ASA, 325 mg q. day.
4.  Axid 150 mg twice a day.
5.  Medrol 10 mg q. day.
6.  Valium 5 mg twice a day.
7.  Duricef 500 mg twice a day.
8.  Toprol XL 25 mg q. day.
9.  Demerol 25 mg q. day p.r.n.
10. Humulin N 30 units q. a.m.
11. Regular insulin sliding scale.
12. Epogen 8000 units subcutaneously on Monday, Wednesday and
Friday.
13. Nitroglycerin spray p.r.n.
14. Lasix 20 mg p.r.n.
15. Captopril 25 mg three times a day.
16. Phenergan p.r.n.
17. Iron sulfate 325 mg three times a day.
18. Colace 100 mg twice a day.
19. Neurontin 300 mg p.o. q. h.s.

ALLERGIES: Shrimp and iodine.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Atherosclerosis of native arteries of the extremities with gangrene,Coronary atherosclerosis of native coronary artery,Kidney replaced by transplant,Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled,Acute posthemorrhagic anemia,Unspecified essential hypertension,Old myocardial infarction,Profound impairment, both eyes, impairment level not further specified,Below knee amputation status
Ath ext ntv art gngrene,Crnry athrscl natve vssl,Kidney transplant status,DMI circ nt st uncntrld,Ac posthemorrhag anemia,Hypertension NOS,Old myocardial infarct,Both eyes blind-who def,Status amput below knee
Admission Date:  [**2146-3-2**]       Discharge Date:  [**2146-3-18**]

Date of Birth:   [**2100-8-2**]       Sex:  M

Service:

CHIEF COMPLAINT:   Gangrene, left fourth toe.

HISTORY OF PRESENT ILLNESS:  The patient is a 45 year old
male with a past medical history of insulin dependent
diabetes mellitus, now presenting with gangrene of left
fourth toe which started in mid-[**Month (only) 1096**].  He was admitted to
[**Location 39045**], [**Hospital **] hospital (home town), and started on
intravenous antibiotics.  Amputation was recommended after an
angiogram and MRA were performed.  He is now here for a
second opinion.

PAST MEDICAL HISTORY:
1.  Insulin dependent diabetes mellitus since [**2105**] with
triopathy.
2.  Legally blind.
3.  Hypertension.
4.  Coronary artery disease status post silent myocardial
infarction times two.
5.  Status post kidney transplant in [**2126**].
6.  Peripheral vascular disease status post right below the
knee amputation.
7.  Hyperlipidemia.
8.  Anemia.

PAST SURGICAL HISTORY:
1.  Living related kidney transplant in [**2126**].
2.  Open cholecystectomy in [**2138**].
3.  Right below the knee amputation.
4.  Left total knee replacement.

MEDICATIONS ON ADMISSION:
1.  Imuran 125 mg q. day.
2.  Lopid 600 mg twice a day.
3.  ASA, 325 mg q. day.
4.  Axid 150 mg twice a day.
5.  Medrol 10 mg q. day.
6.  Valium 5 mg twice a day.
7.  Duricef 500 mg twice a day.
8.  Toprol XL 25 mg q. day.
9.  Demerol 25 mg q. day p.r.n.
10. Humulin N 30 units q. a.m.
11. Regular insulin sliding scale.
12. Epogen 8000 units subcutaneously on Monday, Wednesday and
Friday.
13. Nitroglycerin spray p.r.n.
14. Lasix 20 mg p.r.n.
15. Captopril 25 mg three times a day.
16. Phenergan p.r.n.
17. Iron sulfate 325 mg three times a day.
18. Colace 100 mg twice a day.
19. Neurontin 300 mg p.o. q. h.s.

ALLERGIES:   Shrimp and iodine.

HOSPITAL COURSE:  Mr. [**Name14 (STitle) 39046**] was admitted under the Vascular
Surgery Service.  He was started on antibiotics.  An
angiogram was performed which revealed high-grade stenosis of
the tibial peroneal trunk with two-vessel anterior tibial and
posterior tibial runoff below that includes feeding into
posterior tibial and dorsalis pedis artery.  [**Last Name (un) **] consult
was obtained to optimize diabetic management.  Renal,
Podiatry and Cardiology consults were also obtained.

He underwent a cardiac catheterization on [**3-7**], per
Cardiology recommendation which revealed three-vessel
disease.  Coronary artery bypass surgery was recommended
prior to the Vascular Surgery.  He underwent coronary artery
bypass graft times two (saphenous vein graft to left anterior
descending, saphenous vein graft to distal right coronary
artery), on [**3-8**].  His postoperative course was routine.

He then underwent a left below the knee amputation on
[**2146-3-14**].  He tolerated the procedure well.  His
postoperative course was again routine.  He was transiently
hypotensive on postoperative day two, although he was
asymptomatic.  He responded to a fluid bolus.  He normally
runs with systolic blood pressure of around 85 to 95 mm of
Mercury.  He is now ready to go to rehabilitation.

MEDICATIONS ON DISCHARGE:
1.  Insulin 22 units subcutaneously a.m. and 6 units
subcutaneously p.m.
2.  Regular insulin sliding scale.
3.  Levaquin 500 mg p.o. q. day.
4.  Lopid 600 mg p.o. twice a day.
5.  Medrol 10 mg p.o. q. day.
6.  Imuran 125 mg p.o. q. day.
7.  ASA 325 mg p.o. q. day.
8.  Lopressor 15 mg p.o. twice a day.
9.  Colace 100 mg p.o. twice a day.

DISCHARGE INSTRUCTIONS:
1.  The patient may not weight bear on upper extremities for
up to five weeks due to recent coronary artery bypass graft.
2.  He may be fitted for prosthesis to the right stump.
3.  He may get out of bed with maximum assistance.
4.  Follow-up with Dr. [**Last Name (STitle) 1391**] in two weeks.

DISCHARGE DIAGNOSES:
1.  Non-healing ulcer, left foot, status post left below the
knee amputation.
2.  Coronary artery disease, status post coronary artery
bypass graft.


                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 4417**]

Dictated By:[**Last Name (NamePattern1) 2209**]
MEDQUIST36

D:  [**2146-3-18**]  10:51
T:  [**2146-3-18**]  11:02
JOB#:  [**Job Number 39047**]
{'Atherosclerosis of native arteries of the extremities with gangrene,Coronary atherosclerosis of native coronary artery,Kidney replaced by transplant,Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled,Acute posthemorrhagic anemia,Unspecified essential hypertension,Old myocardial infarction,Profound impairment, both eyes, impairment level not further specified,Below knee amputation 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: Gangrene, left fourth toe.

PRESENT ILLNESS: The patient is a 45 year old
male with a past medical history of insulin dependent
diabetes mellitus, now presenting with gangrene of left
fourth toe which started in mid-[**Month (only) 1096**].  He was admitted to
[**Location 39045**], [**Hospital **] hospital (home town), and started on
intravenous antibiotics.  Amputation was recommended after an
angiogram and MRA were performed.  He is now here for a
second opinion.

MEDICAL HISTORY: 1.  Insulin dependent diabetes mellitus since [**2105**] with
triopathy.
2.  Legally blind.
3.  Hypertension.
4.  Coronary artery disease status post silent myocardial
infarction times two.
5.  Status post kidney transplant in [**2126**].
6.  Peripheral vascular disease status post right below the
knee amputation.
7.  Hyperlipidemia.
8.  Anemia.

MEDICATION ON ADMISSION: 1.  Imuran 125 mg q. day.
2.  Lopid 600 mg twice a day.
3.  ASA, 325 mg q. day.
4.  Axid 150 mg twice a day.
5.  Medrol 10 mg q. day.
6.  Valium 5 mg twice a day.
7.  Duricef 500 mg twice a day.
8.  Toprol XL 25 mg q. day.
9.  Demerol 25 mg q. day p.r.n.
10. Humulin N 30 units q. a.m.
11. Regular insulin sliding scale.
12. Epogen 8000 units subcutaneously on Monday, Wednesday and
Friday.
13. Nitroglycerin spray p.r.n.
14. Lasix 20 mg p.r.n.
15. Captopril 25 mg three times a day.
16. Phenergan p.r.n.
17. Iron sulfate 325 mg three times a day.
18. Colace 100 mg twice a day.
19. Neurontin 300 mg p.o. q. h.s.

ALLERGIES: Shrimp and iodine.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Atherosclerosis of native arteries of the extremities with gangrene,Coronary atherosclerosis of native coronary artery,Kidney replaced by transplant,Diabetes with peripheral circulatory disorders, type I [juvenile type], not stated as uncontrolled,Acute posthemorrhagic anemia,Unspecified essential hypertension,Old myocardial infarction,Profound impairment, both eyes, impairment level not further specified,Below knee amputation status'}
