CHIEF COMPLAINT: 

PRESENT ILLNESS: The patient is a 78 year old
gentleman with a complicated medical history who was
transferred from [**Hospital 38**] Rehabilitation after being
diagnosed with an L5-S1 epidural abscess and disc infection
from an outside MRI scan.

MEDICAL HISTORY: Includes:
1.  Right popliteal dorsalis pedis bypass graft here at [**Hospital1 35990**] on [**2114-10-10**].
2.  Clostridium difficile colitis.
3.  Diabetes mellitus, type 2.
4.  Hypertension.
5.  Stroke in [**2112**] with questionable left facial droop.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Intraspinal abscess,Cauda equina syndrome without mention of neurogenic bladder,Aortic valve disorders,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Diarrhea,Sensorineural hearing loss, unspecified,Unspecified essential hypertension,Infection with microorganisms resistant to penicillins
Intraspinal abscess,Cauda equina synd NOS,Aortic valve disorder,DMII neuro nt st uncntrl,Diarrhea,Sensorneur hear loss NOS,Hypertension NOS,Inf mcrg rstn pncllins
Admission Date:  [**2115-1-3**]       Discharge Date:  [**2115-1-9**]


Service:  NEUROSURG

HISTORY OF PRESENT ILLNESS:  The patient is a 78 year old
gentleman with a complicated medical history who was
transferred from [**Hospital 38**] Rehabilitation after being
diagnosed with an L5-S1 epidural abscess and disc infection
from an outside MRI scan.

PAST MEDICAL HISTORY:  Includes:
1.  Right popliteal dorsalis pedis bypass graft here at [**Hospital1 35990**] on [**2114-10-10**].
2.  Clostridium difficile colitis.
3.  Diabetes mellitus, type 2.
4.  Hypertension.
5.  Stroke in [**2112**] with questionable left facial droop.

PREVIOUS HOSPITAL COURSE:  The patient presented to [**Hospital1 1444**] on [**2114-9-27**], for a
non-healing traumatic right lateral tibial ulcer and
underwent the right popliteal-dorsalis pedis bypass graft on
[**10-10**], and developed C. difficile colitis postoperatively
which apparently resolved.  The patient was transferred to
[**Hospital 38**] Rehabilitation on [**10-25**], and readmitted to [**Hospital3 **] septic from C. difficile colitis and bowel edema.

He was treated with Flagyl and oral Vancomycin, sent back to
[**Location (un) 38**] on [**2114-11-26**], and admitted to [**Hospital6 33**]
on [**2114-12-3**], for fever and rigors.  C. difficile was
negative.  The patient had a left upper gluteal decubitus and
right Achilles decubitus ulcer.  Pseudomonas was cultured
from the sacral wound; blood cultures grew out Staphylococcus
aureus which was Methicillin resistant Staphylococcus aureus
and four plus yeast in the urine.  The patient was treated
with Ceftizoxime, Imipenem, Vancomycin and Diflucan.  He was
treated with those from [**12-3**] until [**12-12**].  He was started on
Rifampin on [**12-5**].  On [**12-11**], he had a transthoracic
echocardiogram which showed the sclerotic aortic valve with
mild aortic insufficiency and a question of either a density
or calcification vegetation on his aortic valve.  A TEE on
[**12-15**] showed an ejection fraction of 60 to 65% with three
plus aortic insufficiency and no definitive vegetation or
abscess.  He continued to have temperatures of 100.5 F., and
was discharged to [**Location (un) 38**] on [**12-27**].

The patient reported increased low back pain over the last
month and daughter and wife noted urinary incontinence and
occasional inability to feel bowel movements for the past
month.  He has not been able to walk since the bypass surgery
in [**Month (only) 359**] and had plain films at the end of [**Month (only) 1096**] for
back pain which was suspicious for osteomyelitis.

PHYSICAL EXAMINATION:  Temperature was 97.6 F.; heart rate
84; blood pressure 136/86; respiratory rate was 20.  This was
a frail elderly man in no acute distress.  His cardiac status
was regular rate and rhythm.  His chest was clear to
auscultation.  He had two plus pitting edema in the right
pedal area with a right 2 cm Achilles ulcer.  He was alert
and oriented times three, moving all extremities.  Pupils
equal, round and reactive to light.  His extraocular muscles
are full.  Face symmetric.  Tongue and palate were midline.
His sensation to his face was intact.  He had no drift.  His
lower extremity strength:  His IPs were four plus, quads were
five out of five; hamstrings five minus out of five; the
right AT was three plus, the right [**Last Name (un) 938**] was one.  The left [**Last Name (un) 938**]
was four minus, the left AT was five minus; toes were mute.
His deep tendon reflexes:  His patellar were one plus,
pinprick was down bilaterally at the L5 dermatome.

LABORATORY:  Labs on admission were white count of 12,900,
hematocrit 31.7, INR 1.2.  Sodium 141, potassium 4.8,
chloride 110, CO2 19, BUN 31, creatinine 1.1, glucose was
297.

HOSPITAL COURSE:  The patient was admitted for urgent surgery
for the epidural abscess.  The patient had an intact rectal
tone but decreased pinprick sensation to the saddle area.
The patient underwent L4, L5 laminectomy which showed
granulation tissue in the anterior portion of the thecal sac
without complication.  The patient was transferred to the
Recovery Room and then to the floor.

The patient was seen by the Infectious Disease Service.  The
patient was started on Vancomycin and Rifampin.  ID also
recommended that the patient have audiology testing secondary
to question of decreased hearing due to Vancomycin toxicity
in the past which was completed and the results are pending.
The patient was also seen by the Cardiology Service and had
both transthoracic and repeat transesophageal echocardiograms
which showed no evidence of heart vegetation and stable
aortic insufficiency.

The patient had a PICC line placed which is in good position.
The patient will continue on Vancomycin and Rifampin for six
to eight weeks.  The patient will have peak and trough levels
checked and will follow-up in the Infectious Disease Clinic
after discharge.  The patient will also have Audiology
follow-up for hearing loss.

DISCHARGE INSTRUCTIONS:
1.  The patient will follow-up in the Infectious Disease
    Clinic on [**2-1**], at 09:30 a.m. and see Dr. [**First Name8 (NamePattern2) 1059**]
    [**Last Name (NamePattern1) 1057**].
2.  Audiology testing demonstrated moderate sensorineural
    hearing loss and recommended patient be fitted for a
    hearing aid and follow-up testing for auto-toxic effect
    in the future.
3.  In terms of patient's ulcers, the patient will need to
    have his open ulcers cleaned with normal saline.  A
    Duoderm should be applied to the coccyx and use Tegaderm
    on the edges.  Question of sensitivity to paper tape.
    That should be changed three times a day and p.r.n.
4.  He should have a normal saline moist dressing twice a day
    to his Achilles and Kling wrap over that.
5.  His left malleolus requires no dressing at this time but
    should be followed.
6.  The patient should continue with the First Step mattress.

DISCHARGE MEDICATIONS:  He was also started on multivitamin
one tablet p.o. q. day and Vitamin C 500 mg p.o. twice a day.
Other medications at time of discharge are:
1.  Colace 100 mg p.o. twice a day.
2.  Vancomycin 750 mg intravenously q. day.
3.  Percocet, one to two tablets p.o. q. four hours p.r.n.
4.  Rifampin 300 mg p.o. twice a day.
5.  10 units of NPH q. a.m.
6.  Neurontin 300 mg p.o. twice a day.
7.  Megace 800 mg p.o. q. day.
8.  Remeron 30 mg p.o. q. h.s.
9.  Zantac 150 mg p.o. twice a day.

The patient will follow-up in the Infectious Disease clinic
on [**2115-2-1**], and will follow-up with Dr. [**Last Name (STitle) 12585**] at [**Hospital 14852**] in three to four weeks time.  The
phone number is [**Telephone/Fax (1) 14023**], for the follow-up appointment.

CONDITION ON DISCHARGE:  The patient's condition was stable
at the time of discharge.


                            [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 33505**], M.D.  [**MD Number(1) 33506**]

Dictated By:[**Last Name (NamePattern1) 344**]
MEDQUIST36

D:  [**2115-1-9**]  11:50
T:  [**2115-1-9**]  11:50
JOB#:  [**Job Number 33608**]
{'Intraspinal abscess,Cauda equina syndrome without mention of neurogenic bladder,Aortic valve disorders,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Diarrhea,Sensorineural hearing loss, unspecified,Unspecified essential hypertension,Infection with microorganisms resistant to penicillins'}


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: 

PRESENT ILLNESS: The patient is a 78 year old
gentleman with a complicated medical history who was
transferred from [**Hospital 38**] Rehabilitation after being
diagnosed with an L5-S1 epidural abscess and disc infection
from an outside MRI scan.

MEDICAL HISTORY: Includes:
1.  Right popliteal dorsalis pedis bypass graft here at [**Hospital1 35990**] on [**2114-10-10**].
2.  Clostridium difficile colitis.
3.  Diabetes mellitus, type 2.
4.  Hypertension.
5.  Stroke in [**2112**] with questionable left facial droop.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Intraspinal abscess,Cauda equina syndrome without mention of neurogenic bladder,Aortic valve disorders,Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled,Diarrhea,Sensorineural hearing loss, unspecified,Unspecified essential hypertension,Infection with microorganisms resistant to penicillins'}
