CHIEF COMPLAINT: Left renal mass with renal vein inferior vena cava thrombus just
beneath the level of the hepatic veins, a level III thrombus.

PRESENT ILLNESS: 65 year old female with renal mass extending into
IVC s/p open left radical nephrectomy and IVC thrombectomy. She
was recently discharged from [**Hospital6 **] ([**9-30**] through
[**10-2**])and per chart review "for dyspnea and fatigue" for 1 week.
She was found to have an elevated D dimer and was sent to the
[**Hospital3 **] ED for evaluation. A CTA was performed to rule out
PE (which was negative), but a L renal mass suspicious for RCC
was incidentally noted with thrombus extending into the IVC.

MEDICAL HISTORY: MED/SURGICAL HISTORY:
HYPERCHOLESTEROLEMIA
HYPERTENSION - ESSENTIAL
SCREENING FOR COLON CANCER
SCREENING FOR BREAST CANCER
OSTEOPENIA
DIVERTICULOSIS
URINARY INCONTINENCE, FEMALE - STRESS

MEDICATION ON ADMISSION: MEDICATION LIST PRIOR TO RECENT [**Hospital3 **] ADMISSION ON
[**2106-9-30**]:
Albuterol Sulfate (PROAIR HFA) 90 mcg/Actuation Inhalation HFA
Aerosol Inhaler Take 1-2 puffs every 4 to 6 hours as needed
Benzonatate 200 mg Oral Capsule Take 1 capsule TID as needed for
cough
Hydrochlorothiazide 25 mg Oral Tablet TAKE ONE TABLET DAILY
Atenolol 25 mg Oral Tablet TAKE ONE TABLET DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: WdWn female, nad, boyfriend at bedside
pleasant demeanor, affect
cooperative
abdomen soft, appropriately tender and w/out evidence
infection/dehisence
extremities well perfused, without edema/pitting
surgical site c/d/i

FAMILY HISTORY: Father Hypertension; Myocardial Infarction
Maternal Aunt Osteoporosis
Mother Osteoporosis

SOCIAL HISTORY: SOC HX:
Smoking: Former Smoker ([**2086-11-20**])
Smokeless Tobacco: Unknown
Alcohol: Yes
Adv Directives: Not On File
Malignant neoplasm of kidney, except pelvis,Other venous embolism and thrombosis of inferior vena cava,Secondary malignant neoplasm of other specified sites,Unspecified essential hypertension,Anemia, unspecified,Other and unspecified hyperlipidemia,Disorder of bone and cartilage, unspecified
Malig neopl kidney,Oth inf vena cava thromb,Secondary malig neo NEC,Hypertension NOS,Anemia NOS,Hyperlipidemia NEC/NOS,Bone & cartilage dis NOS
Admission Date:  [**2106-10-4**]              Discharge Date:   [**2106-10-13**]

Date of Birth:  [**2040-12-6**]             Sex:   F

Service: UROLOGY

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 4360**]
Chief Complaint:
Left renal mass with renal vein inferior vena cava thrombus just
beneath the level of the hepatic veins, a level III thrombus.


Major Surgical or Invasive Procedure:
Dr. [**Last Name (STitle) **] PROCEDURES PERFORMED: LEFT RADICAL NEPHRECTOMY and
right renal exposure with exposure of the right renal hilum,
isolation of the right renal vein and inferior vena cava, and
inferior vena caval thrombectomy

Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] PROCEDURES PERFORMED:  Exploratory laparotomy,
mobilization of the liver, and takedown of the short caudate
branches and vena cava thrombectomy.


History of Present Illness:
65 year old female with renal mass extending into
IVC s/p open left radical nephrectomy and IVC thrombectomy. She
was recently discharged from [**Hospital6 **] ([**9-30**] through
[**10-2**])and per chart review "for dyspnea and fatigue" for 1 week.
She was found to have an elevated D dimer and was sent to the
[**Hospital3 **] ED for evaluation. A CTA was performed to rule out
PE (which was negative), but a L renal mass suspicious for RCC
was incidentally noted with thrombus extending into the IVC.


Past Medical History:
MED/SURGICAL HISTORY:
HYPERCHOLESTEROLEMIA
HYPERTENSION - ESSENTIAL
SCREENING FOR COLON CANCER
SCREENING FOR BREAST CANCER
OSTEOPENIA
DIVERTICULOSIS
URINARY INCONTINENCE, FEMALE - STRESS

VACCINES:
Pneumococ/adult-polysac [**2106-3-19**]
Td Vaccine (Adult) [**2096-12-21**]


Social History:
SOC HX:
Smoking: Former Smoker ([**2086-11-20**])
Smokeless Tobacco: Unknown
Alcohol: Yes
Adv Directives: Not On File


Family History:
Father Hypertension; Myocardial Infarction
Maternal Aunt Osteoporosis
Mother Osteoporosis


Physical Exam:
WdWn female, nad, boyfriend at bedside
pleasant demeanor, affect
cooperative
abdomen soft, appropriately tender and w/out evidence
infection/dehisence
extremities well perfused, without edema/pitting
surgical site c/d/i


Pertinent Results:
[**2106-10-13**] 08:00AM BLOOD WBC-11.7* RBC-3.21* Hgb-9.0* Hct-26.3*
MCV-82 MCH-28.2 MCHC-34.3 RDW-15.2 Plt Ct-305
[**2106-10-12**] 08:05AM BLOOD WBC-11.6* RBC-2.70* Hgb-7.5* Hct-22.1*
MCV-82 MCH-27.7 MCHC-33.8 RDW-15.5 Plt Ct-208
[**2106-10-11**] 06:45AM BLOOD WBC-10.9 RBC-2.78* Hgb-7.7* Hct-23.0*
MCV-83 MCH-27.6 MCHC-33.5 RDW-15.6* Plt Ct-225
[**2106-10-10**] 01:28AM BLOOD PT-13.8* PTT-26.4 INR(PT)-1.2*
[**2106-10-13**] 08:00AM BLOOD Glucose-78 UreaN-18 Creat-1.3* Na-134
K-3.7 Cl-99 HCO3-27 AnGap-12
[**2106-10-12**] 08:05AM BLOOD Glucose-72 UreaN-14 Creat-1.2* Na-135
K-3.1* Cl-102 HCO3-25 AnGap-11
[**2106-10-11**] 06:45AM BLOOD Glucose-81 UreaN-15 Creat-1.4* Na-140
K-3.7 Cl-108 HCO3-26 AnGap-10
[**2106-10-13**] 08:00AM BLOOD Calcium-9.6 Phos-2.3* Mg-1.8

[**2106-10-8**] 3:22 pm MRSA SCREEN      Source: Nasal swab.

                            **FINAL REPORT [**2106-10-11**]**

   MRSA SCREEN (Final [**2106-10-11**]):    No MRSA isolated.


Brief Hospital Course:
Ms. [**Known lastname 479**] was admitted to Urology after undergoing  Exploratory
laparotomy, mobilization of the liver, and takedown of the short
caudate branches and
vena cava thrombectomy and open radical left nephrectomy. No
concerning intra-operative events occurred; please see dictated
operative note for details. The patient received perioperative
antibiotic prophylaxis. The patient was transferred to the ICU
from the PACU in stable condition.  On POD2 she was transferred
to the  general surgical floor on the East [**Hospital 18**] campus where
she remained until discharged. She was hydrated for urine output
>30cc/hour, provided with pneumoboots and incentive spirometry
for prophylaxis, and ambulated once. She received one unit of
blood while on the floor and was kept on continous monitoring
throughout her stay. Pain control was transitioned from epidural
and PCA to oral analgesics, diet was advanced from clears to
regular diet. Urethral catheter (Foley) was removed without
difficulty. The remainder of the hospital course was relatively
unremarkable. The patient was discharged in stable condition,
eating well, ambulating independently, voiding without
difficulty, and with pain controlled on oral analgesics. On
exam, incision was clean, dry, and intact, with no evidence of
hematoma collection or infection. The patient was given explicit
instructions to follow-up in clinic with Dr. [**Last Name (STitle) **].


Medications on Admission:
MEDICATION LIST PRIOR TO RECENT [**Hospital3 **] ADMISSION ON
[**2106-9-30**]:
Albuterol Sulfate (PROAIR HFA) 90 mcg/Actuation Inhalation HFA
Aerosol Inhaler Take 1-2 puffs every 4 to 6 hours as needed
Benzonatate 200 mg Oral Capsule Take 1 capsule TID as needed for
cough
Hydrochlorothiazide 25 mg Oral Tablet TAKE ONE TABLET DAILY
Atenolol 25 mg Oral Tablet TAKE ONE TABLET DAILY

NEW MEDS SINCE DISCHARGE FROM [**Hospital3 **] [**2106-10-2**]
Lovenox 40mgSC daily

ALLERGIES:
Ace Inhibitors [**2098-6-9**] remembers getting bp med which caused
cough


Discharge Medications:
1. enoxaparin 40 mg/0.4 mL Syringe Sig: One (1)  Subcutaneous
QDAY ().
Disp:*30 QS* Refills:*2*
2. atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
4. ascorbic acid 250 mg Tablet, Chewable Sig: Two (2) Tablet,
Chewable PO DAILY (Daily): take while taking iron tablets for
better absorption.
5. ferrous sulfate 300  mg (60 mg iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
6. hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once
a day.
7. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q8H (every
8 hours).
8. oxycodone 5 mg Tablet Sig: 1-2 Tablets PO every six (6) hours
as needed for pain.
Disp:*40 Tablet(s)* Refills:*0*
9. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
Two (2) Puff Inhalation Q6H (every 6 hours) as needed for SOB.
10. polyvinyl alcohol-povidone 1.4-0.6 % Dropperette Sig: [**11-22**]
Drops Ophthalmic PRN (as needed) as needed for dry eyes.
11. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).


Discharge Disposition:
Home

Discharge Diagnosis:
Left renal mass with renal vein inferior vena cava thrombus just
beneath the level of the hepatic veins, a level III thrombus.

PREOPERATIVE DIAGNOSIS:  Renal cell carcinoma with tumor
thrombus.


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


Discharge Instructions:
-Resume your pre-admission/home medications except as noted.
ALWAYS call to inform, review and discuss any medication changes
and your post-operative course with your primary care doctor. Do
NOT take Aspirin/aspirin containing products unless advised to
do so by your doctors.

-You will be discharged home on LOVENOX, one of your
pre-admission medications. Please continue this medication until
otherwise advised to stop by your PCP or Dr. [**Last Name (STitle) **].

-Do not lift anything heavier than a phone book (10 pounds) or
drive until you are seen by your Urologist in follow-up

-Colace has been prescribed to avoid post surgical constipation
and constipation related to narcotic pain medication.
Discontinue if loose stool or diarrhea develops. Colace is a
stool softener, NOT a laxative

-Do not eat constipating foods for 2-4 weeks, drink plenty of
fluids to keep hydrated

-No vigorous physical activity or sports for 4 weeks or until
otherwise advised

-Tylenol should be your first line pain medication, a narcotic
pain medication has been prescribed for breakthrough pain >4.
Replace Tylenol with narcotic pain medication.

-Max daily Tylenol (acetaminophen) dose is 4 grams from ALL
sources, note that narcotic pain medication also contains
Tylenol

-You may shower normally but do NOT immerse your incisions or
bathe

-Do not drive or drink alcohol while taking narcotics and do not
operate dangerous machinery.

-You may shower but do not bathe, swim or immerse your incision.

-Call your Urologist's office today to schedule/confirm your
follow-up appointment in 3 weeks AND if you have any questions.


Followup Instructions:
Call your Urologist's office today to schedule/confirm your
follow-up appointment AND if you have any questions.

[**Location (un) 2274**] - [**Location (un) **] Office (Atrius Health)
[**First Name11 (Name Pattern1) **] [**Initial (NamePattern1) **] [**Last Name (NamePattern1) **], MD, PhD  DEPARTMENT OF UROLOGY
Address:  [**Location (un) 4363**] [**Location (un) 86**], [**Numeric Identifier 4364**] Telephone:
[**Telephone/Fax (1) **]

PCP: [**Name10 (NameIs) **],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. [**Telephone/Fax (1) 31019**] -- ALWAYS call to inform,
review and discuss any medication changes and your
post-operative course with your primary care doctor. Do NOT take
Aspirin/aspirin containing products unless advised to do so by
your doctors, especially while on Lovenox.



Completed by:[**2106-10-20**]
{'Malignant neoplasm of kidney, except pelvis,Other venous embolism and thrombosis of inferior vena cava,Secondary malignant neoplasm of other specified sites,Unspecified essential hypertension,Anemia, unspecified,Other and unspecified hyperlipidemia,Disorder of bone and cartilage, unspecified'}


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: Left renal mass with renal vein inferior vena cava thrombus just
beneath the level of the hepatic veins, a level III thrombus.

PRESENT ILLNESS: 65 year old female with renal mass extending into
IVC s/p open left radical nephrectomy and IVC thrombectomy. She
was recently discharged from [**Hospital6 **] ([**9-30**] through
[**10-2**])and per chart review "for dyspnea and fatigue" for 1 week.
She was found to have an elevated D dimer and was sent to the
[**Hospital3 **] ED for evaluation. A CTA was performed to rule out
PE (which was negative), but a L renal mass suspicious for RCC
was incidentally noted with thrombus extending into the IVC.

MEDICAL HISTORY: MED/SURGICAL HISTORY:
HYPERCHOLESTEROLEMIA
HYPERTENSION - ESSENTIAL
SCREENING FOR COLON CANCER
SCREENING FOR BREAST CANCER
OSTEOPENIA
DIVERTICULOSIS
URINARY INCONTINENCE, FEMALE - STRESS

MEDICATION ON ADMISSION: MEDICATION LIST PRIOR TO RECENT [**Hospital3 **] ADMISSION ON
[**2106-9-30**]:
Albuterol Sulfate (PROAIR HFA) 90 mcg/Actuation Inhalation HFA
Aerosol Inhaler Take 1-2 puffs every 4 to 6 hours as needed
Benzonatate 200 mg Oral Capsule Take 1 capsule TID as needed for
cough
Hydrochlorothiazide 25 mg Oral Tablet TAKE ONE TABLET DAILY
Atenolol 25 mg Oral Tablet TAKE ONE TABLET DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: WdWn female, nad, boyfriend at bedside
pleasant demeanor, affect
cooperative
abdomen soft, appropriately tender and w/out evidence
infection/dehisence
extremities well perfused, without edema/pitting
surgical site c/d/i

FAMILY HISTORY: Father Hypertension; Myocardial Infarction
Maternal Aunt Osteoporosis
Mother Osteoporosis

SOCIAL HISTORY: SOC HX:
Smoking: Former Smoker ([**2086-11-20**])
Smokeless Tobacco: Unknown
Alcohol: Yes
Adv Directives: Not On File 

### Response:
{'Malignant neoplasm of kidney, except pelvis,Other venous embolism and thrombosis of inferior vena cava,Secondary malignant neoplasm of other specified sites,Unspecified essential hypertension,Anemia, unspecified,Other and unspecified hyperlipidemia,Disorder of bone and cartilage, unspecified'}
