CHIEF COMPLAINT: Groin/scrotal pain

PRESENT ILLNESS: 54 yo male who presented with mild right scrotal/groin pain; saw
primary MD [**First Name (Titles) **] [**Last Name (Titles) 159**] on Friday before admission; was treated
with oral antibitoics and returned to the Emergency department
at a referring hospital with open draining right groin wound. He
was then transferred to [**Hospital1 18**] for further care.

MEDICAL HISTORY: Type II DM
Rheumatoid arthritis
Neuropathy

MEDICATION ON ADMISSION: metformin
prednisone
amytryptiline

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS upon admission:
T 101.2  HR 84  BP 118/61  O2 Sat 96% on 4 liters nasal oxygen
Gen: uncomfortable
Chest: CTAB RRR no murmurs
Abd: soft, NT, ND, referred rebound from LLQ palpation to R
flank/RLQ
Perineum: scrotum, erythematous and swollen; purulent drainage
exuding from R lateral aspect. Erythema extends along R inguinal
region.  Separate region of erythema along R flank. No creptius,
No bullae, no testicular tenderness bilaterally.
Rectal: no abscess, quiac negative

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Social EtOH; denies tobacco; no illicit drug use
Necrotizing fasciitis,Gangrene,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Vascular disorders of male genital organs,Rheumatoid arthritis,Long-term (current) use of steroids,Polyneuropathy in diabetes,Dermatitis due to drugs and medicines taken internally,Unspecified antibiotic causing adverse effects in therapeutic use,Nausea with vomiting
Necrotizing fasciitis,Gangrene,DMII neuro nt st uncntrl,Male gen vascul dis NEC,Rheumatoid arthritis,Long-term use steroids,Neuropathy in diabetes,Drug dermatitis NOS,Adv eff antibiotic NOS,Nausea with vomiting
Admission Date:  [**2154-9-10**]              Discharge Date:   [**2154-9-30**]

Date of Birth:  [**2100-4-26**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 5880**]
Chief Complaint:
Groin/scrotal pain

Major Surgical or Invasive Procedure:
[**2154-9-10**] Wide debridement of perineum
[**2154-9-12**] VAC placement
[**2154-9-27**] Removal of VAC dressing on [**2154-9-27**]


History of Present Illness:
54 yo male who presented with mild right scrotal/groin pain; saw
primary MD [**First Name (Titles) **] [**Last Name (Titles) 159**] on Friday before admission; was treated
with oral antibitoics and returned to the Emergency department
at a referring hospital with open draining right groin wound. He
was then transferred to [**Hospital1 18**] for further care.

Past Medical History:
Type II DM
Rheumatoid arthritis
Neuropathy

Social History:
Social EtOH; denies tobacco; no illicit drug use

Family History:
Noncontributory

Physical Exam:
VS upon admission:
T 101.2  HR 84  BP 118/61  O2 Sat 96% on 4 liters nasal oxygen
Gen: uncomfortable
Chest: CTAB RRR no murmurs
Abd: soft, NT, ND, referred rebound from LLQ palpation to R
flank/RLQ
Perineum: scrotum, erythematous and swollen; purulent drainage
exuding from R lateral aspect. Erythema extends along R inguinal
region.  Separate region of erythema along R flank. No creptius,
No bullae, no testicular tenderness bilaterally.
Rectal: no abscess, quiac negative

Pertinent Results:
[**2154-9-10**] 08:56PM   GLUCOSE-214* UREA N-15 CREAT-0.8 SODIUM-135
POTASSIUM-4.1 CHLORIDE-99 TOTAL CO2-24 ANION GAP-16
[**2154-9-10**] 08:56PM   ALBUMIN-3.0* CALCIUM-8.4 PHOSPHATE-4.1
MAGNESIUM-1.7
[**2154-9-10**] 08:56PM   WBC-22.2* HCT-33.9*
[**2154-9-10**] 08:56PM   PLT COUNT-274
[**2154-9-10**] 04:20PM   PLT SMR-NORMAL PLT COUNT-296
[**2154-9-10**] 04:20PM   PT-15.5* PTT-27.4 INR(PT)-1.4*

SPECIMEN SUBMITTED: PERINEAL TISSUE.

DIAGNOSIS:

 Perineal tissue (A-C):

Fibroadipose tissue with marked acute inflammation.  Gram stains
will be sent as an addendum.

ADDENDUM:

Gram stains for bacteria showed (A-C) focally numerous Gram
positive coccal forms.

Date: [**2154-9-14**]

Clinical: Rule out necrotizing fasciitis.
Gross:
The specimen is received fresh labeled with the patient's name,
"[**Known firstname **] [**Known lastname 39263**]" and medical record number. The specimen is
additionally labeled "perineal tissue" and consists of multiple
fragments of fibrofatty tissue measuring approximately 4.0 x 2.0
x 0.5 cm. There are focal areas that appear necrotic and green.
The specimen is serially sectioned and is entirely submitted in
cassettes A-C.  Gram stain is being ordered on A.

Sinus rhythm
Consider old inferior infarct
rsr' in lead V1


  Intervals Axes
Rate PR QRS QT/QTc P QRS T
89 150 110 362/408.57 67 13 8




Brief Hospital Course:
He was admitted to the ICU on the Surgical service under the
care of Dr. [**Last Name (STitle) **]. On [**9-10**] he was taken to the operating room
for wide debridement of the perineum; postoperatively he was
placed on IV antibiotics.

Infectious disease was consulted for recommendations for
continued antibiotic use; Initial blood cultures were negative.

On [**9-12**] the patient was transferred to the floor and on [**9-13**] a
VAC dressing was placed.

His home medications were resumed. [**Last Name (un) **] Diabetes Center was
also consulted because of elevated blood sugars; Metformin and
Glyburide were started.

On [**9-16**] the VAC was removed and a purulent discharge was noted
in the wound.  Wet to dry dressings were performed; he was
subsequently scheduled for the OR for repeat debridement.

On [**9-17**] he was taken to the OR for debridement of the wound;
there was extensive extension  of necrotic fascia and pus into
abdominal wall flank and scrotum were found and removed.  Wet to
dry dressing changes were performed.

On [**9-19**] he was taken back to the OR for wound-VAC placement.

Pain control was an ongoing issue for him throughout his
hospital stay. He initially required PCA Morphine and
intermittent Morphine for dressing changes. He has been changed
to long acting narcotics with MS Contin, MSIR for dressing
changes and Oxycodone for breakthrough pain prn.

On [**9-25**] he was switched from IV antibiotics to oral (Augmentin
and Fluconazole; these will need to continue for 2 weeks.

On [**9-27**] he was taken back to the OR for VAC removal; he is now
on [**Hospital1 **] saline damp to dry dressing changes. He will need to
follow up in Surgery clinic with Dr. [**Last Name (STitle) **] at the end of the
week for wound check.


Medications on Admission:
metformin
prednisone
amytryptiline

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Prednisone 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3-4H (Every 3
to 4 Hours) as needed for pain.
Disp:*60 Tablet(s)* Refills:*0*
4. Metformin 500 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
5. Glyburide 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
6. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed for constipation.
7. Augmentin 875-125 mg Tablet Sig: One (1) Tablet PO twice a
day for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
8. Pregabalin 75 mg Capsule Sig: One (1) Capsule PO BID (2 times
a day).
9. Fluconazole 200 mg Tablet Sig: Two (2) Tablet PO Q24H (every
24 hours) for 2 weeks.
Disp:*28 Tablet(s)* Refills:*0*
10. Amoxicillin-Pot Clavulanate 875-125 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 2 weeks.
11. Morphine 30 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO Q12H (every 12 hours).
Disp:*60 Tablet Sustained Release(s)* Refills:*2*
12. Morphine 30 mg Tablet Sig: One (1) Tablet PO once a day:
take prior to dressing change.
13. Oxycodone 5 mg Tablet Sig: 2-3 Tablets PO Q3H (every 3
hours) as needed for breakthrough pain.
Disp:*75 Tablet(s)* Refills:*0*
14. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
constipation.


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 1474**] VNA

Discharge Diagnosis:
Fournier's gangrene right scrotum

Discharge Condition:
Good


Discharge Instructions:
Return to the Emergency room if you develop high fevers;
increased groin/scrotal pain; increased thick/foul smelling
drainage; redness; swelling and/or any other symptoms that are
concerning to you.

You will need to continue with your antibiotics for a total of 2
weeks; if at any time you develop diarrhea please stop the
antibitics and notify Dr.[**Name (NI) 12389**] office, [**Telephone/Fax (1) 6429**] to be
seen.

You may also follow up with Infectious Disease Clinic, Dr.
[**First Name8 (NamePattern2) 803**] [**Last Name (NamePattern1) **] by calling [**Telephone/Fax (1) 457**] for an appointment if
there are specific issues.


Followup Instructions:
Follow up with Dr. [**Last Name (STitle) **] in Surgery Clinic next week; call
[**Telephone/Fax (1) 6429**] for an appointment.

You may also follow up with Infectious Disease Clinic, Dr.
[**First Name8 (NamePattern2) 803**] [**Last Name (NamePattern1) **] by calling [**Telephone/Fax (1) 457**] for an appointment if
there are specific issues.

Follow up with your primary doctor within the next 1-2 weeks;
you will need to call to schedule an appointment.



Completed by:[**2154-9-30**]
{'Necrotizing fasciitis,Gangrene,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Vascular disorders of male genital organs,Rheumatoid arthritis,Long-term (current) use of steroids,Polyneuropathy in diabetes,Dermatitis due to drugs and medicines taken internally,Unspecified antibiotic causing adverse effects in therapeutic use,Nausea with vomiting'}


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: Groin/scrotal pain

PRESENT ILLNESS: 54 yo male who presented with mild right scrotal/groin pain; saw
primary MD [**First Name (Titles) **] [**Last Name (Titles) 159**] on Friday before admission; was treated
with oral antibitoics and returned to the Emergency department
at a referring hospital with open draining right groin wound. He
was then transferred to [**Hospital1 18**] for further care.

MEDICAL HISTORY: Type II DM
Rheumatoid arthritis
Neuropathy

MEDICATION ON ADMISSION: metformin
prednisone
amytryptiline

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS upon admission:
T 101.2  HR 84  BP 118/61  O2 Sat 96% on 4 liters nasal oxygen
Gen: uncomfortable
Chest: CTAB RRR no murmurs
Abd: soft, NT, ND, referred rebound from LLQ palpation to R
flank/RLQ
Perineum: scrotum, erythematous and swollen; purulent drainage
exuding from R lateral aspect. Erythema extends along R inguinal
region.  Separate region of erythema along R flank. No creptius,
No bullae, no testicular tenderness bilaterally.
Rectal: no abscess, quiac negative

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Social EtOH; denies tobacco; no illicit drug use 

### Response:
{'Necrotizing fasciitis,Gangrene,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Vascular disorders of male genital organs,Rheumatoid arthritis,Long-term (current) use of steroids,Polyneuropathy in diabetes,Dermatitis due to drugs and medicines taken internally,Unspecified antibiotic causing adverse effects in therapeutic use,Nausea with vomiting'}
