CHIEF COMPLAINT: shortness of breath

PRESENT ILLNESS: Patient is a 50-year-old man with a history of large cell
lymphoma, for which he underwent R-CHOP chemotherapy most
recently in [**2175-6-30**]. He has had known bilateral effusions by
his report dating back to [**2158**]. Over the past few months, he has
had increasing shortness of breath and worsening of his
bilateral effusions, necessitating several thoracentesis on
either side of
his chest. The cytology of these taps has always been negative.

MEDICAL HISTORY: Non-Hodgkin's lymphoma
Congential lymphatic atresia
Seminoma s/p radiation and resection
Appendectomy, perforated
Cholecystectomy
SBO ([**2174-12-14**]) s/p resection

MEDICATION ON ADMISSION: lasix, rhinocort, allopurinol, claritin, lopressor, prilosec,
ativan, atrovent, advair, rhinocrot, calcium, multivit, colace

ALLERGIES: Codeine / Zestril

PHYSICAL EXAM: Gen: thin, pale, NAD
HEENT: EOMI, PERRL, oropharynx dry with scattered ulcers, no
erythema/exudate
Neck: no masses
CV: RRR, no m/r/g
Lung: coarse BS bilaterally, no w/c, CT in place on R
Abd: soft, flat, NTND
Ext: 1+ pedal edema
Neuro: AAO x 4

FAMILY HISTORY: Father - PVD
Mother - questionable metastatic ovarian cancer

SOCIAL HISTORY: Supportive wife, otherwise denies [**Name (NI) **]/EtOH/IDU.
Unspecified pleural effusion,Iatrogenic pneumothorax,Empyema without mention of fistula,Toxic encephalopathy,Drug-induced psychotic disorder with hallucinations,Reticulosarcoma, unspecified site, extranodal and solid organ sites,Other specified causes of urethral stricture,Other specified congenital anomalies,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins,Hereditary edema of legs,Unspecified essential hypertension,Other specified disease of white blood cells,Personal history of malignant neoplasm of testis,Other antipsychotics, neuroleptics, and major tranquilizers causing adverse effects in therapeutic use,Acquired absence of organ, genital organs,Personal history of venous thrombosis and embolism
Pleural effusion NOS,Iatrogenic pneumothorax,Empyema w/o fistula,Toxic encephalopathy,Drug psy dis w hallucin,Retclsrc unsp xtrndl org,Urethral stricture NEC,Specfied cong anomal NEC,Mth sus Stph aur els/NOS,Inf mcrg rstn pncllins,Hereditary edema of legs,Hypertension NOS,Wbc disease NEC,Hx-testicular malignancy,Adv eff antipsychotc NEC,Acq absnce genital organ,Hx-ven thrombosis/embols
Admission Date:  [**2175-11-17**]              Discharge Date:   [**2175-12-10**]

Date of Birth:  [**2117-10-10**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Codeine / Zestril

Attending:[**First Name3 (LF) 5790**]
Chief Complaint:
shortness of breath

Major Surgical or Invasive Procedure:
VATS/decortication [**2175-11-17**]


History of Present Illness:
Patient is a 50-year-old man with a history of large cell
lymphoma, for which he underwent R-CHOP chemotherapy most
recently in [**2175-6-30**]. He has had known bilateral effusions by
his report dating back to [**2158**]. Over the past few months, he has
had increasing shortness of breath and worsening of his
bilateral effusions, necessitating several thoracentesis on
either side of
his chest. The cytology of these taps has always been negative.

The pleural manometry noted both on the left and right sides
most recently has been consistent with trapped lung. The patient
notes a 2-month history of low-grade temperatures in the 99.2 to
100.5 range. He notes that he has had a nonproductive cough. He
denies hemoptysis. After his last tap, which occurred on
[**2175-9-28**], he had an initial resolution of some of his
shortness of breath, however, after about 2 weeks, this
shortness of breath began to return. At this point, he has
marked dyspnea on exertion to the point where he cannot walk up
any incline without severe shortness of breath. He can walk on a
level
ground reasonably well at times, although his tolerance is
variable.


Past Medical History:
Non-Hodgkin's lymphoma
Congential lymphatic atresia
Seminoma s/p radiation and resection
Appendectomy, perforated
Cholecystectomy
SBO ([**2174-12-14**]) s/p resection


Social History:
Supportive wife, otherwise denies [**Name (NI) **]/EtOH/IDU.


Family History:
Father - PVD
Mother - questionable metastatic ovarian cancer

Physical Exam:
Gen: thin, pale, NAD
HEENT: EOMI, PERRL, oropharynx dry with scattered ulcers, no
erythema/exudate
Neck: no masses
CV: RRR, no m/r/g
Lung: coarse BS bilaterally, no w/c, CT in place on R
Abd: soft, flat, NTND
Ext: 1+ pedal edema
Neuro: AAO x 4

Pertinent Results:
[**2175-12-9**] 10:43AM BLOOD WBC-13.7* RBC-3.20* Hgb-9.1* Hct-27.7*
MCV-86 MCH-28.3 MCHC-32.8 RDW-16.7* Plt Ct-586*
[**2175-12-9**] 10:43AM BLOOD Plt Ct-586*
[**2175-12-9**] 10:43AM BLOOD Glucose-165* UreaN-15 Creat-0.8 Na-138
K-4.7 Cl-106 HCO3-27 AnGap-10
[**2175-12-9**] 10:43AM BLOOD Calcium-7.4* Phos-3.5 Mg-1.8
[**2175-12-9**] 07:38AM BLOOD Vanco-28.1*

Brief Hospital Course:
Patient admitted and underwent an uncomplicated R VATS with
pleural biopsy and near total parietal pleurectomy and
decortication.

1. Pulmonary
Patient did well postoperatively and was transferred to the
floor extubated and with three right sided chest tubes to -20cm
of suction. During his hospitalization, he did have difficulty
tolerating less degrees of suction without an increase in the
size of his right pneumothoraces. He experienced a slow
progression, however, eventually 2 of 3 chest tubes were removed
with no change in his CXR.
On POD #13, pleural fluid noted to be purulent from his chest
tube site. Fluid eventually +MRSA, heavy growth. At this time,
patient was noted to have altered mental status and
leukocytosis. He was transferred to the ICU for closer
monitoring, iv antibiotics. He recovered and was transferred to
the floor. Patient was treated with vancomycin during his
hospital stay as well as 6 days of intrapleural vancomycin
instilled into his chest tube. His pleural fluid was still
positive for gram + cocci, heavy growth, at the time of
discharge. Patient was explained that his empyema would be
better treated with continued intrapleural infusion of
vancomycin with periodic culturing of his pleural fluid. The
option of surgical drainage of his empyema was also discussed.
After prolonged discussion, patient and his wife expressed their
frustration and reluctance to stay in the hospital,
understanding that continued observation and treatment and/or
surgical intervention were likely the best options for his
empyema. He was discharged with a two week course of iv
vancomycin and instructed to f/u with Dr. [**Last Name (STitle) **] 1 week
following discharge. Upon discharge, the patient had received
six days of intrapleural vancomycin and left the hospital with
one R chest tube to a Heimlich valve.

2. GU
Intraoperatively, a foley catheter was unable to be placed
secondary to patient's urethral stricture. Urology was consulted
who introduced a suprapubic foley catheter. The suprapubic
catheter was in place throughout his hospitalization with no
complications and he was discharged with a foley leg bag and
instructions to follow up with urology for outpatient workup of
his urethral stricture.

3. Neuro
POD #13, patient reported visual and auditory hallucinations as
well as myoclonic jerks of his extremities. Psychiatry as well
as neurology were consulted. All of the patient's potentially
neuro altering medications were discontinued and minimized and
it was determined that the patient was likely suffering from a
toxic encephalopathy from underlying infection. At this time,
the patient's WBC was elevated to 19.1. His altered mental
status did improve to baseline after the patient was treated for
his underlying infection with antibiotics.

4. ID
Pleural fluid positive for MRSA, heavy growth. Patient treated
with iv vancomycin and pleural vancomycin washings. D/c'ed w/2
weeks of iv vancomycin [**Hospital1 **].

5. Cardiovascular
Baseline sinus tachycardia during much of his hospital stay with
HR in the low 100's. Treated with metoprolol. Two episodes of
asymptomatic bradycardia for seconds on POD #19. Resolved
spontaneously with no further episodes.

6. Disposition
Home with services

Medications on Admission:
lasix, rhinocort, allopurinol, claritin, lopressor, prilosec,
ativan, atrovent, advair, rhinocrot, calcium, multivit, colace

Discharge Medications:
1. Vancomycin 1,000 mg Recon Soln Sig: 1000 (1000) mg
Intravenous  twice a day for 2 weeks.
Disp:*qs * Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital1 6136**] Home Care

Discharge Diagnosis:
pleural effusion, bilateral
large cell lymphoma


Discharge Condition:
stable


Discharge Instructions:
Please call Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 25078**] if you experience
fever, bleeding or drainage from your chest tube site,
difficulty breathing, nausea/vomiting, dizziness or weakness.
Keep your chest tube site clean and dry. Empty your Heimlich
valve drainage site as needed.
Do not drive while taking pain medications. Take your
antibiotics as directed.

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) **] one week after discharge.
Please come to your appointment 45 minutes early to have a chest
xray.

Please call Dr.[**Name (NI) 6444**] office at [**Telephone/Fax (1) 164**] for an appointment
regarding your foley catheter.
{'Unspecified pleural effusion,Iatrogenic pneumothorax,Empyema without mention of fistula,Toxic encephalopathy,Drug-induced psychotic disorder with hallucinations,Reticulosarcoma, unspecified site, extranodal and solid organ sites,Other specified causes of urethral stricture,Other specified congenital anomalies,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins,Hereditary edema of legs,Unspecified essential hypertension,Other specified disease of white blood cells,Personal history of malignant neoplasm of testis,Other antipsychotics, neuroleptics, and major tranquilizers causing adverse effects in therapeutic use,Acquired absence of organ, genital organs,Personal history of venous thrombosis and embolism'}


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: shortness of breath

PRESENT ILLNESS: Patient is a 50-year-old man with a history of large cell
lymphoma, for which he underwent R-CHOP chemotherapy most
recently in [**2175-6-30**]. He has had known bilateral effusions by
his report dating back to [**2158**]. Over the past few months, he has
had increasing shortness of breath and worsening of his
bilateral effusions, necessitating several thoracentesis on
either side of
his chest. The cytology of these taps has always been negative.

MEDICAL HISTORY: Non-Hodgkin's lymphoma
Congential lymphatic atresia
Seminoma s/p radiation and resection
Appendectomy, perforated
Cholecystectomy
SBO ([**2174-12-14**]) s/p resection

MEDICATION ON ADMISSION: lasix, rhinocort, allopurinol, claritin, lopressor, prilosec,
ativan, atrovent, advair, rhinocrot, calcium, multivit, colace

ALLERGIES: Codeine / Zestril

PHYSICAL EXAM: Gen: thin, pale, NAD
HEENT: EOMI, PERRL, oropharynx dry with scattered ulcers, no
erythema/exudate
Neck: no masses
CV: RRR, no m/r/g
Lung: coarse BS bilaterally, no w/c, CT in place on R
Abd: soft, flat, NTND
Ext: 1+ pedal edema
Neuro: AAO x 4

FAMILY HISTORY: Father - PVD
Mother - questionable metastatic ovarian cancer

SOCIAL HISTORY: Supportive wife, otherwise denies [**Name (NI) **]/EtOH/IDU. 

### Response:
{'Unspecified pleural effusion,Iatrogenic pneumothorax,Empyema without mention of fistula,Toxic encephalopathy,Drug-induced psychotic disorder with hallucinations,Reticulosarcoma, unspecified site, extranodal and solid organ sites,Other specified causes of urethral stricture,Other specified congenital anomalies,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site,Infection with microorganisms resistant to penicillins,Hereditary edema of legs,Unspecified essential hypertension,Other specified disease of white blood cells,Personal history of malignant neoplasm of testis,Other antipsychotics, neuroleptics, and major tranquilizers causing adverse effects in therapeutic use,Acquired absence of organ, genital organs,Personal history of venous thrombosis and embolism'}
