CHIEF COMPLAINT: 

PRESENT ILLNESS: Mr. [**Known lastname 111128**] is a 61 year-old
male with a history of a mechanical aortic valve on Coumadin,
admitted for prostate biopsy and screening colonoscopy on
[**2144-4-16**].  His Coumadin had been held since [**4-11**] and
heparin was started on admission.  He had a screening
colonoscopy on [**4-15**] showing two 3 to 4 mm distal sigmoid
polyps with diverticulosis of the sigmoid, ascending, and
descending colon.  He had electric prostate biopsy due to
evidence of prostate nodule and elevated PSA on [**2144-4-16**],
which was uneventful.  On [**4-17**] he had evidence of lower
gastrointestinal bleeding with bright red blood per rectum
after the prostate biopsy with hemodynamic instability
requiring transfer to the [**Hospital Unit Name 153**].  Tamponade with Foley balloon
transiently seized bleeding, however, repeat attempt at
anticoagulation led to a repeat bleed with a drop in his
hematocrit of 44 to 34, he became hypotensive requiring 3
units of red blood cells, 1 unit of fresh frozen platelets,
vitamin K and repeat placement of Foley and the rectum for
tamponade of bleeding.  He underwent flexible sigmoidoscopy
on [**4-20**] to assess his etiology of bleeding, which
revealed diverticulosis of the ascending colon and transverse
colon, blood throughout the rectum and sigmoid colon and a
heaped up ulcerated mucosa in the rectum, which was presumed
to be the site of the prostate biopsy.  There was no visible
vessel noted, however, given that this was site was in the
site of the source of bleeding it was injected with
epinephrine and cauterized.  He was transferred from the [**Hospital Unit Name 153**]
back to the floor on [**4-23**].  At that time he was
hemodynamically stable and had a stable hematocrit for 72
hours on heparin and Coumadin.  He had no bowel movements in
the past three days.

MEDICAL HISTORY: 1.  Prostate nodule with a PSA jump from 2.3 to 6.5.
2.  Anxiety.
3.  Hypertension.
4.  Status post left hip replacement in [**2138**].
5.  Depression.
6.  Mechanical aortic valve replacement in [**2134**] due to
bicuspid aortic valve.
7.  Right knee surgery.
8.  Pelvic fracture in [**2142**].

MEDICATION ON ADMISSION: 1.  Celexa 40 mg q.d.
2.  Hydrochlorothiazide 12.5 mg q.d.
3.  Lipitor 10 mg q.d.
4.  Moexipril 15 mg b.i.d.
5.  Remeron 45 mg q.d.
6.  Coumadin 5 mg q.d.
7.  Xanax prn.

ALLERGIES: Prozac with unknown reaction.

PHYSICAL EXAM: 

FAMILY HISTORY: His father ahs bipolar disorder and his
mother had a brain tumor.  There is no family history of
prostate cancer or any other malignancies.

SOCIAL HISTORY: The patient is married and lives with his
wife.  [**Name (NI) **] is a former engineer.  He lives ni [**Hospital1 8**].  He
denies any history of alcohol or tobacco use.
Nodular prostate without urinary obstruction,Hemorrhage complicating a procedure,Acute kidney failure with lesion of tubular necrosis,Benign neoplasm of colon,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Hypotension, unspecified,Ulcer of anus and rectum,Heart valve replaced by other means,Depressive disorder, not elsewhere classified
Nod prostate w/o ur obst,Hemorrhage complic proc,Ac kidny fail, tubr necr,Benign neoplasm lg bowel,Abn react-procedure NEC,Hypotension NOS,Rectal & anal ulcer,Heart valve replac NEC,Depressive disorder NEC
Admission Date:  [**2144-4-13**]     Discharge Date:  [**2144-5-3**]

Date of Birth:   [**2083-3-3**]     Sex:  M

Service:  [**Doctor Last Name 1181**]

HISTORY OF PRESENT ILLNESS:  Mr. [**Known lastname 111128**] is a 61 year-old
male with a history of a mechanical aortic valve on Coumadin,
admitted for prostate biopsy and screening colonoscopy on
[**2144-4-16**].  His Coumadin had been held since [**4-11**] and
heparin was started on admission.  He had a screening
colonoscopy on [**4-15**] showing two 3 to 4 mm distal sigmoid
polyps with diverticulosis of the sigmoid, ascending, and
descending colon.  He had electric prostate biopsy due to
evidence of prostate nodule and elevated PSA on [**2144-4-16**],
which was uneventful.  On [**4-17**] he had evidence of lower
gastrointestinal bleeding with bright red blood per rectum
after the prostate biopsy with hemodynamic instability
requiring transfer to the [**Hospital Unit Name 153**].  Tamponade with Foley balloon
transiently seized bleeding, however, repeat attempt at
anticoagulation led to a repeat bleed with a drop in his
hematocrit of 44 to 34, he became hypotensive requiring 3
units of red blood cells, 1 unit of fresh frozen platelets,
vitamin K and repeat placement of Foley and the rectum for
tamponade of bleeding.  He underwent flexible sigmoidoscopy
on [**4-20**] to assess his etiology of bleeding, which
revealed diverticulosis of the ascending colon and transverse
colon, blood throughout the rectum and sigmoid colon and a
heaped up ulcerated mucosa in the rectum, which was presumed
to be the site of the prostate biopsy.  There was no visible
vessel noted, however, given that this was site was in the
site of the source of bleeding it was injected with
epinephrine and cauterized.  He was transferred from the [**Hospital Unit Name 153**]
back to the floor on [**4-23**].  At that time he was
hemodynamically stable and had a stable hematocrit for 72
hours on heparin and Coumadin.  He had no bowel movements in
the past three days.

PAST MEDICAL HISTORY:
1.  Prostate nodule with a PSA jump from 2.3 to 6.5.
2.  Anxiety.
3.  Hypertension.
4.  Status post left hip replacement in [**2138**].
5.  Depression.
6.  Mechanical aortic valve replacement in [**2134**] due to
bicuspid aortic valve.
7.  Right knee surgery.
8.  Pelvic fracture in [**2142**].

SOCIAL HISTORY:  The patient is married and lives with his
wife.  [**Name (NI) **] is a former engineer.  He lives ni [**Hospital1 8**].  He
denies any history of alcohol or tobacco use.

FAMILY HISTORY:  His father ahs bipolar disorder and his
mother had a brain tumor.  There is no family history of
prostate cancer or any other malignancies.

ALLERGIES:  Prozac with unknown reaction.

MEDICATIONS ON ADMISSION:
1.  Celexa 40 mg q.d.
2.  Hydrochlorothiazide 12.5 mg q.d.
3.  Lipitor 10 mg q.d.
4.  Moexipril 15 mg b.i.d.
5.  Remeron 45 mg q.d.
6.  Coumadin 5 mg q.d.
7.  Xanax prn.

PHYSICAL EXAMINATION:  Vital signs revealed a temperature of
98.3, blood pressure 124/86, heart rate 65, respirations 16,
oxygen saturation of 96% on room air.  In general, the
patient was a pleasant male, alert and oriented times three
and in no acute distress.  HEENT revealed anicteric sclera.
Pupils are equal, round and reactive to light.  Oropharynx
was clear.  Mucous membranes are moist.  Neck was supple and
without elevation of JVP.  Heart was regular and there was a
1 out of 6 systolic ejection murmur at the right upper
sternal border. He had a loud S2.  His lung examination
revealed decreased breath sounds throughout, but clear.  He
had no crackles or wheezes.  His abdomen was soft, nontender,
nondistended and he had no palpable hepatosplenomegaly or
scars.  Extremities were warm with 2+ pulses.  He had no
clubbing, cyanosis or edema.

LABORATORIES ON ADMISSION:  CBC revealed a white blood cell
cont of 9, hematocrit 36.6, platelets 243.  Chemistries
revealed a sodium of 137, potassium 4.7, chloride 104, bicarb
24, BUN of 22, creatinine 1.4.  He had a PT of 14.0, PTT 69
and INR of 1.3.

HOSPITAL COURSE:  1.  Gastrointestinal:  Prior to being
transferred to the Medicine Service the patient had a lower
gastrointestinal bleed after his prostate biopsy as outlined
in the history of present illness.  He was transferred to the
floor with a stable hematocrit times 72 hours and he was
hemodynamically stable.  His hematocrit was monitored b.i.d.
and he was restarted on his Coumadin as well as his heparin.
He was also placed on stool softeners.  At the time of
transfer to the floor he had not had a bowel movement in
three days.  On the evening of the 19th he had three episodes
of hematochezia.  He was hemodynamically stable and his
hematocrit was stable as well.  Gastrointestinal was
consulted and he actually had a rectal Foley placed
transiently again for several hours, which stopped the
bleeding.  His Coumadin was held at this time.  Two days
later his Coumadin was restarted and he was without any
further bleeding.  He had no further bleeding from this time
until the time of discharge and passed two soft bowel
movements without evidence of blood prior to discharge.  He
was restarted on his Coumadin on [**4-27**], originally with a dose
of 5 mg q.h.s., which was subsequently increased to 7.5 mg
q.h.s.  From that time until the time of discharge he was
just awaiting a therapeutic INR of greater then 2.5.  He had
no further episodes of bleeding.

2.  Cardiovascular:  The patient has a history of
hypertension controlled on Hydrochlorothiazide and Moexapril.
At the time of his gastrointestinal bleed and hypertension
these medications were held.  They were restarted at the time
of discharge.

He also has a history of mechanical aortic valve replacement
secondary to a bicuspid aortic valve.  He was admitted for
prostate biopsy and a screening colonoscopy due to the need
for anticoagulation with heparin while holding Coumadin.  He
was discharged on Coumadin 7.5 mg q.h.s. with a therapeutic
INR above 2.5.

3.  Renal:  The patient is noted to have a baseline
creatinine ranging from 1.1 to 1.3, likely secondary to some
renal insufficiency from his hypertension.  On [**4-24**] he was
noted to have a bump in his creatinine to 1.7 most likely
secondary to his gastrointestinal bleed and hypotension.  It
soon resolved after receiving intravenous fluids and
transfusion of red cells.  At the time of discharge his
creatinine had returned to baseline at 1.3.

4.  Hematologic:  As mentioned above after his lower
gastrointestinal bleed he received a total of 3 units of red
blood cells, one unit of fresh frozen platelets and vitamin K
on admission.  He was anticoagulated with heparin and
intermittently received Coumadin, however, at the time of
discharge he was on Coumadin 7.5 mg q.h.s. with a therapeutic
INR of 2.6.

DISCHARGE DIAGNOSES:
1.  Gastrointestinal bleeding.
2.  Anemia due to blood loss.
3.  Depression.
4.  Anxiety.
5.  Hypertension.
6.  Prostate nodule.
7.  Benign prostatic hypertrophy.
8.  Hyperplastic colonic polyps.
9.  Renal insufficiency.

DISCHARGE MEDICATIONS:
1.  Celexa 40 mg q.d.
2.  Lipitor 10 mg q.d.
3.  Xanax 0.5 mg po t.i.d. prn.
4.  Remeron 45 mg q.h.s.
5.  Colace 100 mg b.i.d.
6.  Coumadin 5 mg q.h.s. except Thursdays at which point he
will take 7.5 mg.
7.  Senna prn.
8.  Hydrochlorothiazide 12.5 mg q.d.
9.  Moexipril 15 mg b.i.d.

DISCHARGE CONDITION:  At the time of discharge the patient is
stable without complaints.  He had an INR of 2.6.  He was
ambulating well.

DISCHARGE STATUS:  He will be discharged to home.

FOLLOW UP:  He will follow up with Dr. [**Last Name (STitle) **] at his
scheduled follow up within the next week.  He will also have
his INR checked two days after discharge at the [**Hospital 197**]
Clinic.






                          [**First Name11 (Name Pattern1) 198**] [**Last Name (NamePattern4) 199**], M.D.  [**MD Number(1) 200**]

Dictated By:[**Last Name (NamePattern1) 14268**]

MEDQUIST36

D:  [**2144-5-4**]  11:26
T:  [**2144-5-5**]  10:47
JOB#:  [**Job Number 111129**]
{'Nodular prostate without urinary obstruction,Hemorrhage complicating a procedure,Acute kidney failure with lesion of tubular necrosis,Benign neoplasm of colon,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Hypotension, unspecified,Ulcer of anus and rectum,Heart valve replaced by other means,Depressive disorder, not elsewhere classified'}


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: Mr. [**Known lastname 111128**] is a 61 year-old
male with a history of a mechanical aortic valve on Coumadin,
admitted for prostate biopsy and screening colonoscopy on
[**2144-4-16**].  His Coumadin had been held since [**4-11**] and
heparin was started on admission.  He had a screening
colonoscopy on [**4-15**] showing two 3 to 4 mm distal sigmoid
polyps with diverticulosis of the sigmoid, ascending, and
descending colon.  He had electric prostate biopsy due to
evidence of prostate nodule and elevated PSA on [**2144-4-16**],
which was uneventful.  On [**4-17**] he had evidence of lower
gastrointestinal bleeding with bright red blood per rectum
after the prostate biopsy with hemodynamic instability
requiring transfer to the [**Hospital Unit Name 153**].  Tamponade with Foley balloon
transiently seized bleeding, however, repeat attempt at
anticoagulation led to a repeat bleed with a drop in his
hematocrit of 44 to 34, he became hypotensive requiring 3
units of red blood cells, 1 unit of fresh frozen platelets,
vitamin K and repeat placement of Foley and the rectum for
tamponade of bleeding.  He underwent flexible sigmoidoscopy
on [**4-20**] to assess his etiology of bleeding, which
revealed diverticulosis of the ascending colon and transverse
colon, blood throughout the rectum and sigmoid colon and a
heaped up ulcerated mucosa in the rectum, which was presumed
to be the site of the prostate biopsy.  There was no visible
vessel noted, however, given that this was site was in the
site of the source of bleeding it was injected with
epinephrine and cauterized.  He was transferred from the [**Hospital Unit Name 153**]
back to the floor on [**4-23**].  At that time he was
hemodynamically stable and had a stable hematocrit for 72
hours on heparin and Coumadin.  He had no bowel movements in
the past three days.

MEDICAL HISTORY: 1.  Prostate nodule with a PSA jump from 2.3 to 6.5.
2.  Anxiety.
3.  Hypertension.
4.  Status post left hip replacement in [**2138**].
5.  Depression.
6.  Mechanical aortic valve replacement in [**2134**] due to
bicuspid aortic valve.
7.  Right knee surgery.
8.  Pelvic fracture in [**2142**].

MEDICATION ON ADMISSION: 1.  Celexa 40 mg q.d.
2.  Hydrochlorothiazide 12.5 mg q.d.
3.  Lipitor 10 mg q.d.
4.  Moexipril 15 mg b.i.d.
5.  Remeron 45 mg q.d.
6.  Coumadin 5 mg q.d.
7.  Xanax prn.

ALLERGIES: Prozac with unknown reaction.

PHYSICAL EXAM: 

FAMILY HISTORY: His father ahs bipolar disorder and his
mother had a brain tumor.  There is no family history of
prostate cancer or any other malignancies.

SOCIAL HISTORY: The patient is married and lives with his
wife.  [**Name (NI) **] is a former engineer.  He lives ni [**Hospital1 8**].  He
denies any history of alcohol or tobacco use. 

### Response:
{'Nodular prostate without urinary obstruction,Hemorrhage complicating a procedure,Acute kidney failure with lesion of tubular necrosis,Benign neoplasm of colon,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Hypotension, unspecified,Ulcer of anus and rectum,Heart valve replaced by other means,Depressive disorder, not elsewhere classified'}
