CHIEF COMPLAINT: Esophageal Cancer

PRESENT ILLNESS: Mr. [**Known lastname 60411**] is a 66-year-old male who is morbidly obese with a
BMI of 43. He has undergone chemoradiation therapy for locally
advanced esophageal cancer
of the GE junction. He is admitted for mimimal invasive
esophagectomy.

MEDICAL HISTORY: Esophageal Cancer s/p Chemoradiation therapy
Benign Hypertension
Type 2 Diabetes Mellitus
Hyperlipidemia
Diverticulitis
B/L Total Knee Replacements
Biceps Reconstruction secondary to Trauma

MEDICATION ON ADMISSION: lansoprazole 30 mg daily, amiodarone 200 mg [**Hospital1 **], lopressor 25 mg
[**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 97.7  HR: 64 SR  BP: 134/60  Sats: 95% RA at rest & activity
FSBS: 114-150
General: well appearing gentleman in no apparent distress
HEENT: nomocephalic, mucus membranes moist
Neck:supple
Card: RRR normal S1,S2
Resp: decreased breath sounds faint crackles at bases
GI: obese, bowel sounds positive.  J-tube in place site clean
dry intact
Incision: Right thoracotomy site clean dry intact no erythema,
margins good approximation
Neuro: non-focal

FAMILY HISTORY: Non-Contributory

SOCIAL HISTORY: Ex-smoker (quit 35 years PTA), - ETOH, - Drugs, Married,
Electrician (semi-retired)
Malignant neoplasm of other specified part of esophagus,Morbid obesity,Benign essential hypertension,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Atrial fibrillation,Diverticulosis of colon (without mention of hemorrhage),Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy
Mal neo esophagus NEC,Morbid obesity,Benign hypertension,Esophageal reflux,DMII wo cmp nt st uncntr,Hyperlipidemia NEC/NOS,Obstructive sleep apnea,Atrial fibrillation,Dvrtclo colon w/o hmrhg,Hx of irradiation,Hx antineoplastic chemo
Admission Date:  [**2159-6-13**]              Discharge Date:   [**2159-6-21**]

Date of Birth:  [**2092-11-25**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 4679**]
Chief Complaint:
Esophageal Cancer

Major Surgical or Invasive Procedure:
[**2159-6-15**]
1. [**First Name9 (NamePattern2) 12351**] [**Doctor Last Name **] esophagectomy.
2. Buttressing of intrathoracic anastomosis with
   intercostal muscle.
3. Laparoscopic jejunostomy.
4. Therapeutic bronchoscopy.
5. Esophagoscopy.


History of Present Illness:
Mr. [**Known lastname 60411**] is a 66-year-old male who is morbidly obese with a
BMI of 43. He has undergone chemoradiation therapy for locally
advanced esophageal cancer
of the GE junction. He is admitted for mimimal invasive
esophagectomy.

Past Medical History:
Esophageal Cancer s/p Chemoradiation therapy
Benign Hypertension
Type 2 Diabetes Mellitus
Hyperlipidemia
Diverticulitis
B/L Total Knee Replacements
Biceps Reconstruction secondary to Trauma

Social History:
Ex-smoker (quit 35 years PTA), - ETOH, - Drugs, Married,
Electrician (semi-retired)


Family History:
Non-Contributory

Physical Exam:
VS: 97.7  HR: 64 SR  BP: 134/60  Sats: 95% RA at rest & activity
FSBS: 114-150
General: well appearing gentleman in no apparent distress
HEENT: nomocephalic, mucus membranes moist
Neck:supple
Card: RRR normal S1,S2
Resp: decreased breath sounds faint crackles at bases
GI: obese, bowel sounds positive.  J-tube in place site clean
dry intact
Incision: Right thoracotomy site clean dry intact no erythema,
margins good approximation
Neuro: non-focal


Pertinent Results:
[**2159-6-17**] WBC-7.6 RBC-3.65* Hgb-11.3* Hct-34.5 Plt Ct-205
[**2159-6-16**] WBC-9.4 RBC-3.60* Hgb-11.3* Hct-33.7 Plt Ct-194
[**2159-6-13**] WBC-11.1*# RBC-3.98* Hgb-12.1* Hct-37.0 Plt Ct-200
[**2159-6-21**] Glucose-120* UreaN-19 Creat-0.7 Na-135 K-4.9 Cl-98
HCO3-29
[**2159-6-20**] Glucose-151* UreaN-21* Creat-0.6 Na-137 K-4.1 Cl-101
HCO3-27
[**2159-6-17**] Glucose-128* UreaN-18 Creat-0.7 Na-143 K-3.8 Cl-105
HCO3-31
[**2159-6-14**] Glucose-135* UreaN-14 Creat-0.8 Na-137 K-4.2 Cl-104
HCO3-24
[**2159-6-13**] Glucose-137* UreaN-17 Creat-0.9 Na-139 K-4.3 Cl-107
HCO3-21
[**2159-6-20**] Mg-1.9; [**2159-6-21**] 1.8

CXR:
[**2159-6-20**]: IMPRESSION: Mild interval increase in small right
pleural effusion with stable moderate left effusion. A right
apical pneumothorax is miniscule, if present.
[**2159-6-18**]: The right-sided central venous catheter is unchanged.
The chest tube on the right side is also stable. There is a
small right apical pneumothorax which is unchanged since the
prior study. There remains pleural parenchymal changes on the
right side. There is also a left retrocardiac opacity and
left-sided pleural effusion which is stable since the previous
study.
[**2159-6-14**]:Unchanged size of the cardiac silhouette with a minimal
left pleural effusion and subsequent retrocardiac atelectasis.
Unchanged minimal right basal atelectasis but no evidence of
focal parenchymal opacities suggesting pneumonia. No evidence of
pneumothorax.

Esophagus: [**2159-6-19**]: Thin liquid barium was administered and
there was free flow of contrast through the upper esophagus and
through the esophagogastric anastomosis. There was no evidence
of contrast holdup or leak. Final image demonstrates normal flow
of contrast into the proximal duodenum and jejunum.
IMPRESSION: no evidence of contrast leak or holdup at the
anastomotic site. Contrast flows freely through the duodenum and
the proximal jejunum.

LENIS: LLE no DVT


Brief Hospital Course:
Mrs. [**Known lastname 60411**] was admitted following successful, [**Known lastname 12351**] [**Doctor Last Name **]
esophagectomy, Buttressing of intrathoracic anastomosis with
intercostal muscle. Laparoscopic jejunostomy. Therapeutic
bronchoscopy, and Esophagoscopy.  He was transferred to the SICU
intubated.

Respiratory: extubated [**2159-6-14**].  aggressive pulmonary toilet,
chest PT and nebs were administered.  His oxygen saturations
were 95% RA with activity.

Chest Films; serial chest films showed stable right tiny apical
pneumothorax, bilateral lower lobe effusion and atelectasis.

Chest-tube and JP drain was removed [**2159-6-19**] following esophagus
study.

Cardiac: he was continued on his beta-blocker.  Amiodarone was
restarted once tolerating POs, remained in sinus rhythm 70's and
hemodynamically stable with blood-pressures 110-120.

GI: bowel regime and PPI continued

Nutrition: POD2 he was started on Replete with Beneprotein 21
gms and titrated to the Goal of 105 mL over 12 hrs.  He was
maintained on IV fluids initially.  On [**2159-6-19**] the Esophagus
study was negative for anastomic leak. He was started on Full
liquid diabetic diet advanced to soft solids as an outpatient.

Endocrine: fingerstick blood sugars were 114-150's.  He was
maintained on insulin sliding scale.  He was sent home with a
FreeStyle Lite Glucometer and instructed to restart his meformin
once his blood sugars were consistenly elevated.

Renal: the foley was removed on [**2159-6-19**], He voided without
difficulty.  Renal function remained within normal limits with
good urine output.  He was gently diuresed.  His electrolytes
were repleted as needed.

Incision: Right thoracotomy site clean dry intact no erythema.

Pain: Bupavicaine/Dilaudid epidural was placed preoperatively
and required replacement [**2159-6-14**] by the acute pain service with
adquate pain control.  On [**2159-6-19**] the epidural was removed and
he converted to PO pain medication.

Prophylaxis: SQ heparin was administered.

Extremities: left lower leg edema was noted.  Left LENIS were
negative for DVT.

Neuro: non-focal

Disposition: He was seen by physical therapy and deemed safe for
home.  He was discharged to home on [**2159-6-21**] with his wife and
[**Name (NI) 269**].  He will follow-up with Dr. [**First Name (STitle) **] as an outpatient.


Medications on Admission:
lansoprazole 30 mg daily, amiodarone 200 mg [**Hospital1 **], lopressor 25 mg
[**Hospital1 **]

Discharge Medications:
1. Lansoprazole 30 mg Tablet,Rapid Dissolve, DR [**Last Name (STitle) **]: One (1)
Tablet,Rapid Dissolve, DR [**Last Name (STitle) **] DAILY (Daily).
2. Amiodarone 200 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO BID (2 times
a day).
3. Oxycodone-Acetaminophen 5-325 mg/5 mL Solution [**Last Name (STitle) **]: 5-10 MLs
PO Q3H PRN  () as needed for pain.
Disp:*450 ML(s)* Refills:*0*
4. Docusate Sodium 100 mg Capsule [**Last Name (STitle) **]: One (1) Capsule PO BID (2
times a day).
5. Senna 8.6 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
6. Metoprolol Tartrate 25 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
7. Polyethylene Glycol 3350 17 gram/dose Powder [**Last Name (STitle) **]: One (1)
scoop PO DAILY (Daily) as needed for constipation.
8. Fenofibrate Nanocrystallized 145 mg Tablet [**Last Name (STitle) **]: One (1)
Tablet PO once a day.
9. Lisinopril 5 mg Tablet [**Last Name (STitle) **]: One (1) Tablet PO once a day:
start [**6-22**] if blood greater than 120.
10. Metformin 500 mg Tablet [**Month/Day (4) **]: One (1) Tablet PO once a day:
take if blood sugars consistently greater than 120.
11. Aspirin 81 mg Tablet [**Month/Day (4) **]: One (1) Tablet PO once a day.
12. Centrum Silver     Tablet [**Month/Day (4) **]: One (1) Tablet PO once a day.

13. FreeStyle Lite Glucose Kit  [**Month/Day (4) **]: One (1) Kit  as directed.
Disp:*1 * Refills:*0*
14. FreeStyle Lancets     Misc [**Month/Day (4) **]: One (1)  Miscellaneous twice
a day.
Disp:*100 lancets* Refills:*2*
15. FreeStyle Lite Test Strips  [**Month/Day (4) **]: One (1)   twice a day.
Disp:*100 strips* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
Physician's Home Care

Discharge Diagnosis:
Esosphageal Cancer
Diabetes Mellitus type 2
Hypertension
Hyperlipidemia
Morbid obesity


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Call Dr.[**Name (NI) 5067**] office [**Telephone/Fax (1) 2348**] if you experience:
-Fevers > 101 or chills
-Increased shortness of breath, cough or sputum production
-Chest pain
-Difficult or painful swallowing, nausea, vomiting, or diarrhea
-Feeding tube fall out.  Call immediately to have it replaced.
-Keep head of the bed elevated 30 degress
-Chest tube site cove with a bandaid until healed.
-You may shower.  No tub bathing or swimming for 4 weeks
-No driving while taking narcotics. Take stool softners with
narcotics


Followup Instructions:
Follow-up with Dr. [**First Name (STitle) **] Date/Time:[**2159-7-5**] 3:00 on the [**Hospital Ward Name 5074**] [**Hospital Ward Name 23**] Clinical Center [**Location (un) 24**].
Chest X-Ray [**Location (un) 861**] Radiology 30 minutes before your
appointment

Please call Dr.[**Name (NI) 5067**] office [**Telephone/Fax (1) 2348**] next week to let us
know how you are doing.



Completed by:[**2159-6-21**]
{'Malignant neoplasm of other specified part of esophagus,Morbid obesity,Benign essential hypertension,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Atrial fibrillation,Diverticulosis of colon (without mention of hemorrhage),Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy'}


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: Esophageal Cancer

PRESENT ILLNESS: Mr. [**Known lastname 60411**] is a 66-year-old male who is morbidly obese with a
BMI of 43. He has undergone chemoradiation therapy for locally
advanced esophageal cancer
of the GE junction. He is admitted for mimimal invasive
esophagectomy.

MEDICAL HISTORY: Esophageal Cancer s/p Chemoradiation therapy
Benign Hypertension
Type 2 Diabetes Mellitus
Hyperlipidemia
Diverticulitis
B/L Total Knee Replacements
Biceps Reconstruction secondary to Trauma

MEDICATION ON ADMISSION: lansoprazole 30 mg daily, amiodarone 200 mg [**Hospital1 **], lopressor 25 mg
[**Hospital1 **]

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 97.7  HR: 64 SR  BP: 134/60  Sats: 95% RA at rest & activity
FSBS: 114-150
General: well appearing gentleman in no apparent distress
HEENT: nomocephalic, mucus membranes moist
Neck:supple
Card: RRR normal S1,S2
Resp: decreased breath sounds faint crackles at bases
GI: obese, bowel sounds positive.  J-tube in place site clean
dry intact
Incision: Right thoracotomy site clean dry intact no erythema,
margins good approximation
Neuro: non-focal

FAMILY HISTORY: Non-Contributory

SOCIAL HISTORY: Ex-smoker (quit 35 years PTA), - ETOH, - Drugs, Married,
Electrician (semi-retired) 

### Response:
{'Malignant neoplasm of other specified part of esophagus,Morbid obesity,Benign essential hypertension,Esophageal reflux,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Other and unspecified hyperlipidemia,Obstructive sleep apnea (adult)(pediatric),Atrial fibrillation,Diverticulosis of colon (without mention of hemorrhage),Personal history of irradiation, presenting hazards to health,Personal history of antineoplastic chemotherapy'}
