CHIEF COMPLAINT: recurrent esophageal adenocarcinoma

PRESENT ILLNESS: delightful 58-
year-old woman who approximately 2 years ago developed
esophageal cancer. Due to her obesity and comorbidities, it
was elected to treat her with definitive chemoradiotherapy
and not involve surgery. She did well for 2 years and then
recently developed a localized recurrence at the GE junction.
Intraesophageal ultrasound demonstrated the lesion to be a B2
recurrent lesion with no evidence of metastatic disease to
the lymph nodes. Metastatic workup showed no evidence of
metastasis. Given the fact that she has already had
radiotherapy for her esophagus, repeat radiotherapy was not
an option. Palliative chemotherapy was the only option other
than surgery. After many discussions, Ms. [**Known lastname 45074**] has decided
to go forward with the surgical resection. She understands
that this is an extremely risky procedure, given the fact
that it is a salvage esophagectomy several years after
chemoradiotherapy and her co-morbidities. Despite being
quoted a very high risk of mortality and morbidity, she has
elected to go forward with surgery.
Admitted to the TSICU after undergoing esophagastrectomy,
jejunostomy, and pylorplasty with j tube placement. Intraop the
patient received 6 liters of fluid to maintain hemodynamic
stability. She was also maintained on neosynephrine and levophed
throughout the case. She was transferred post-op to the TSICU
intubated, sedated, and on pressors.

MEDICAL HISTORY: Hypertension
esophageal cancer (barrett's) s/p chemo and radiation therapy in
[**2112**]
morbid obesity
obstructive sleep apnea
diabetes mellitus
overactive bladder
GERD
osteoarthritis of bilateral knees and shoulders
h/o thrombocytopenia

MEDICATION ON ADMISSION: glyburide 5', atacand 32', famotidine 40", Detrol LA 4',
tylenol", MVI'.

ALLERGIES: Codeine

PHYSICAL EXAM: General- obese middle age female in NAD, lying in bed, trach
mask O2
weight: [**10-13**] 159 kg;height- 5'2"
REsp-Course bilat; Trach- customized bovona #8 trach to trach
mask-.50, sat 100%
Chest- large left thoracotomy incision, open to air.
Cor-RRR, NSR by telemetry 80-90.
Abd-J-tube in place- cont tube feeding; + BS, NT, obese
Ext- obese, + edema; NV intact. pedal pulses 3+ bilat.
Skin- multiple excoritation at skin folds present; tx w/ DSD,
mycostatin powder
Neuro- alert, oriented x2-3.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Patient lives alone
[**Name (NI) 51040**] [**Doctor Last Name **] sister
Malignant neoplasm of cardia,Congestive heart failure, unspecified,Unspecified septicemia,Severe sepsis,Pressure ulcer, upper back,Candidiasis of mouth,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Morbid obesity,Unspecified essential hypertension,Personal history of irradiation, presenting hazards to health,Obstructive sleep apnea (adult)(pediatric)
Mal neo stomach cardia,CHF NOS,Septicemia NOS,Severe sepsis,Pressure ulcer, upr back,Thrush,Atrial fibrillation,DMII wo cmp nt st uncntr,Morbid obesity,Hypertension NOS,Hx of irradiation,Obstructive sleep apnea
Admission Date:  [**2115-9-6**]              Discharge Date:   [**2115-10-14**]

Date of Birth:  [**2057-1-28**]             Sex:   F

Service: CARDIOTHORACIC

Allergies:
Codeine

Attending:[**Last Name (NamePattern1) 1561**]
Chief Complaint:
recurrent esophageal adenocarcinoma

Major Surgical or Invasive Procedure:
[**2115-9-6**] esophagogastrectomy, jejunostomy, pylorplasty via left
thoracoabdominal approach
[**2115-9-30**] tracheostomy

History of Present Illness:
delightful 58-
year-old woman who approximately 2 years ago developed
esophageal cancer. Due to her obesity and comorbidities, it
was elected to treat her with definitive chemoradiotherapy
and not involve surgery. She did well for 2 years and then
recently developed a localized recurrence at the GE junction.
Intraesophageal ultrasound demonstrated the lesion to be a B2
recurrent lesion with no evidence of metastatic disease to
the lymph nodes. Metastatic workup showed no evidence of
metastasis. Given the fact that she has already had
radiotherapy for her esophagus, repeat radiotherapy was not
an option. Palliative chemotherapy was the only option other
than surgery. After many discussions, Ms. [**Known lastname 45074**] has decided
to go forward with the surgical resection. She understands
that this is an extremely risky procedure, given the fact
that it is a salvage esophagectomy several years after
chemoradiotherapy and her co-morbidities. Despite being
quoted a very high risk of mortality and morbidity, she has
elected to go forward with surgery.
Admitted to the TSICU after undergoing esophagastrectomy,
jejunostomy, and pylorplasty with j tube placement. Intraop the
patient received 6 liters of fluid to maintain hemodynamic
stability. She was also maintained on neosynephrine and levophed
throughout the case. She was transferred post-op to the TSICU
intubated, sedated, and on pressors.

Past Medical History:
Hypertension
esophageal cancer (barrett's) s/p chemo and radiation therapy in
[**2112**]
morbid obesity
obstructive sleep apnea
diabetes mellitus
overactive bladder
GERD
osteoarthritis of bilateral knees and shoulders
h/o thrombocytopenia


Social History:
Patient lives alone
[**Name (NI) 51040**] [**Doctor Last Name **] sister

Family History:
non-contributory

Physical Exam:
General- obese middle age female in NAD, lying in bed, trach
mask O2
weight: [**10-13**] 159 kg;height- 5'2"
REsp-Course bilat; Trach- customized bovona #8 trach to trach
mask-.50, sat 100%
Chest- large left thoracotomy incision, open to air.
Cor-RRR, NSR by telemetry 80-90.
Abd-J-tube in place- cont tube feeding; + BS, NT, obese
Ext- obese, + edema; NV intact. pedal pulses 3+ bilat.
Skin- multiple excoritation at skin folds present; tx w/ DSD,
mycostatin powder
Neuro- alert, oriented x2-3.

Pertinent Results:
Hematology
  COMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct
[**2115-10-14**] 04:58AM    9.8 3.36* 10.5* 32.7* 98 31.3 32.1 16.9*
206
  BASIC COAGULATION (PT, PTT, PLT, INR) PT PTT Plt Smr Plt Ct
INR(PT)
[**2115-10-14**] 04:58AM          206
BASIC COAGULATION (FIBRINOGEN, DD, TT, REPTILASE, BT) Fibrino
[**2115-9-8**] 06:05PM    640*
  INHIBITORS & ANTICOAGULANTS LMWH

Last blood gas: 7.36/66/125/39/9
RADIOLOGY  Final Report
BILAT LOWER EXT VEINS PORT  [**2115-10-12**] 8:18 AM
Reason: S/P THORASIC SURGERY R/O DVT IN BOTH LOWER LIMBS

[**Hospital 93**] MEDICAL CONDITION:
58 year old woman with s/p extensive thoracic and abdominal
surgery [**9-6**], obese, on lovenox at marginal tx level by Factor
10A levels, minimal activity , high risk for dvt
REASON FOR THIS EXAMINATION:
please r/o dvt
HISTORY: Immobilized patient status post extensive thoracic and
abdominal surgery. Evaluate for deep venous thrombosis.

COMPARISON: No previous studies.

FINDINGS: [**Doctor Last Name **] scale and Doppler son[**Name (NI) 867**] of the right and
left common femoral, superficial femoral, and popliteal veins
were performed. No intraluminal thrombus is identified. Normal
venous compressibility, color flow, waveforms, and augmentation
were demonstrated bilaterally.

IMPRESSION: No DVT in the right or left lower extremity.
   RADIOLOGY  Final Report
CHEST PORT. LINE PLACEMENT  [**2115-10-10**] 10:31 AM
Reason: eval for line placement
[**Hospital 93**] MEDICAL CONDITION:
58 year old woman s/p tracheostomy PICC line placement
REASON FOR THIS EXAMINATION:
eval for line placement
INDICATION: 58-year-old woman status post tracheostomy and PICC
line placement.

COMMENTS: Portable semi-erect AP radiograph of the chest is
reviewed, and compared to previous study [**2115-10-7**].

The tip of the new left-sided PICC line is not clearly seen on
this radiograph. If clinically indicated, please obtain repeated
radiograph of the chest. On this radiograph, the tip of the
left-sided PICC line is probably in the left innominate vein,
which is still not certain.

The previously identified congestive heart failure has been
improving. There is continued marked cardiomegaly and tortuosity
of the thoracic aorta. The tracheostomy tube is seen in place.
The right subclavian IV catheter remains in place. No
pneumothorax is identified. There is continued bibasilar patchy
atelectasis. Focal opacity is noted in the right upper lobe
indicating asymmetric pulmonary edema versus superimposed
aspiration or pneumonia.
RADIOLOGY  Final Report
CHEST (PORTABLE AP)  [**2115-10-7**] 3:13 PM
Reason: pneumonia?, new crackles on exam
[**Hospital 93**] MEDICAL CONDITION:
58 year old woman s/p tracheostomy now new crackles on
auscultation
REASON FOR THIS EXAMINATION:
pneumonia?, new crackles on exam
INDICATION: Tracheostomy tube and new crackles on exam.

PORTABLE AP CHEST: As compared to [**10-6**], tracheostomy
tube and right subclavian central venous catheter remain in
stable position. Moderate-to- severe pulmonary edema is
unchanged. More confluent areas of opacity could represent
alveolar edema or pneumonia. Overall appearance is unchanged.

IMPRESSION: No significant interval change.


Brief Hospital Course:
58 yo F with recurrent esophageal adenocarcinoma at GE junction
s/p esophagogastrectomy, jejunostomy, pyloricoplasty via
thoracoabdominal approach ([**9-6**]). Tracheostomy- customized #8
Bovona trach placed([**9-30**])- 12cm at flanges.
Post-op course complicated by sepsis, hypotension, acidosis
requiring vasopressin, neo, and large fluid requirement.
Developed CHF and post-op atrial fibrillation. Treated with
lasix and amiodarone drips, aggressively.
[**10-13**]- Weight 159kg; height 5'2"
Despite diuresis failure to wean, trach placed [**9-30**] and gradual
weaning from vent.
Tubes/Lines- PICC- placed [**10-10**]; J- tube [**9-6**]; foley-[**9-6**].
Neuro- AAO x3, mouths words, able to move upper ext slightly,
unable to move legs r/t habitus/obesity. Neuro-vascularly
intact. CN II-XII grossly intact.
REsp-.50 trach mask- high flow 15L; BS course throughout bilat,
strong prod cough-thick tan secretions, occas requires tracheal
suctioning. abg- 7.36/66/125.
Chest-large left thoracoabdominal incision-well approximated
except for 2cm area superficially open. no drainage. DSD
applied.
COR- NSR, 80-90; 120/60; cont amiod via j-tube, and lovenox.
GI- J- tube in place, tube feeding Deliver 2.0 w/Promod 30
gr.@40cc/hr. + BS, NT, last BM-[**10-13**].
GU- foley in place. TID lasix cont.
ID- Positive for MRSA [**10-7**] via nasal swab and sputum;
levofloxacin IV to end [**10-17**].
for acinectorbacter (initial cx [**9-29**]) in sputum. VAnco-[**9-26**]-
[**10-13**] for MRSA in sputum.
Endo- Managed on insulin gtt during acute infectious period. Now
managed on NPH 70u [**Hospital1 **], and sliding scale regular insulin.
Activity-Patient OOB to chair 3-4hours daily w/ maximum
assist/pull of [**4-12**] people via Airpal transfer device.


Medications on Admission:
glyburide 5', atacand 32', famotidine 40", Detrol LA 4',
tylenol", MVI'.

Discharge Medications:
1. Polyvinyl Alcohol 1.4 % Drops Sig: 1-2 Drops Ophthalmic  PRN
(as needed).
2. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical  PRN
(as needed).
3. Albuterol 90 mcg/Actuation Aerosol Sig: 1-2 Puffs Inhalation
Q6H (every 6 hours) as needed.
4. Ipratropium Bromide 18 mcg/Actuation Aerosol Sig: Two (2)
Puff Inhalation QID (4 times a day).
5. Lansoprazole 30 mg Susp,Delayed Release for Recon Sig: One
(1)  PO DAILY (Daily).
6. Senna 8.8 mg/5 mL Syrup Sig: Five (5) ML PO BID (2 times a
day) as needed.
7. Acetaminophen 160 mg/5 mL Solution Sig: One (1)  PO Q4-6H
(every 4 to 6 hours) as needed for fever.
8. Docusate Sodium 150 mg/15 mL Liquid Sig: One (1)  PO BID (2
times a day).
9. Amiodarone 200 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
10. Potassium & Sodium Phosphates [**Telephone/Fax (3) 4228**] mg Packet Sig: One
(1) Packet PO PRN (as needed).
11. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID
(4 times a day) as needed.
12. Potassium Chloride 20 mEq Packet Sig: Three (3) Packet PO
QID (4 times a day).
13. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO
BID (2 times a day).
14. Enoxaparin 100 mg/mL Syringe Sig: Ninety Five (95) mg
Subcutaneous Q 12H (Every 12 Hours).
15. Heparin Lock Flush (Porcine) 100 unit/mL Syringe Sig: One
(1) ML Intravenous  DAILY (Daily) as needed.
16. Calcium Gluconate 100 mg/mL (10%) Solution Sig: One (1)
Intravenous  PRN (as needed) as needed for iCa < 1.10.
17. Lorazepam 2 mg/mL Syringe Sig: 0.5-1 mg Injection Q4H (every
4 hours) as needed.
18. Potassium Chloride 20 mEq/50 mL Piggyback Sig: One (1)
Intravenous  PRN (as needed) as needed for K<4.0.
19. Levofloxacin in D5W 750 mg/150 mL Piggyback Sig: One (1)
Intravenous  Q24H (every 24 hours) for 3 days: then d/c.
20. Morphine 2 mg/mL Syringe Sig: One (1)  Injection Q4H (every
4 hours) as needed.
21. Furosemide 10 mg/mL Solution Sig: Forty (40) mg Injection
TID (3 times a day).
22. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: seventy
(70) units Subcutaneous twice a day.
23. regular insulin per sliding scale
check finger stick q 6hrs and dose regular insulin accordingly


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 105**] - [**Location (un) 86**]

Discharge Diagnosis:
recurrent esophageal adenocarcinoma at GE junction s/p
esophagogastrectomy, jejunostomy, pyloricoplasty via
thoracoabdominal approach on [**2115-9-6**]. Tracheostomy [**9-30**].


Discharge Condition:
deconditioned.


Discharge Instructions:
Call Dr.[**Name (NI) 1816**] office [**Telephone/Fax (1) 170**] for any care management.

Followup Instructions:
Call Dr.[**Name (NI) 1816**] office [**Telephone/Fax (1) 170**] for a follow up
appointment when you are discharged from rehab.



Completed by:[**2115-10-14**]
{'Malignant neoplasm of cardia,Congestive heart failure, unspecified,Unspecified septicemia,Severe sepsis,Pressure ulcer, upper back,Candidiasis of mouth,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Morbid obesity,Unspecified essential hypertension,Personal history of irradiation, presenting hazards to health,Obstructive sleep apnea (adult)(pediatric)'}


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: recurrent esophageal adenocarcinoma

PRESENT ILLNESS: delightful 58-
year-old woman who approximately 2 years ago developed
esophageal cancer. Due to her obesity and comorbidities, it
was elected to treat her with definitive chemoradiotherapy
and not involve surgery. She did well for 2 years and then
recently developed a localized recurrence at the GE junction.
Intraesophageal ultrasound demonstrated the lesion to be a B2
recurrent lesion with no evidence of metastatic disease to
the lymph nodes. Metastatic workup showed no evidence of
metastasis. Given the fact that she has already had
radiotherapy for her esophagus, repeat radiotherapy was not
an option. Palliative chemotherapy was the only option other
than surgery. After many discussions, Ms. [**Known lastname 45074**] has decided
to go forward with the surgical resection. She understands
that this is an extremely risky procedure, given the fact
that it is a salvage esophagectomy several years after
chemoradiotherapy and her co-morbidities. Despite being
quoted a very high risk of mortality and morbidity, she has
elected to go forward with surgery.
Admitted to the TSICU after undergoing esophagastrectomy,
jejunostomy, and pylorplasty with j tube placement. Intraop the
patient received 6 liters of fluid to maintain hemodynamic
stability. She was also maintained on neosynephrine and levophed
throughout the case. She was transferred post-op to the TSICU
intubated, sedated, and on pressors.

MEDICAL HISTORY: Hypertension
esophageal cancer (barrett's) s/p chemo and radiation therapy in
[**2112**]
morbid obesity
obstructive sleep apnea
diabetes mellitus
overactive bladder
GERD
osteoarthritis of bilateral knees and shoulders
h/o thrombocytopenia

MEDICATION ON ADMISSION: glyburide 5', atacand 32', famotidine 40", Detrol LA 4',
tylenol", MVI'.

ALLERGIES: Codeine

PHYSICAL EXAM: General- obese middle age female in NAD, lying in bed, trach
mask O2
weight: [**10-13**] 159 kg;height- 5'2"
REsp-Course bilat; Trach- customized bovona #8 trach to trach
mask-.50, sat 100%
Chest- large left thoracotomy incision, open to air.
Cor-RRR, NSR by telemetry 80-90.
Abd-J-tube in place- cont tube feeding; + BS, NT, obese
Ext- obese, + edema; NV intact. pedal pulses 3+ bilat.
Skin- multiple excoritation at skin folds present; tx w/ DSD,
mycostatin powder
Neuro- alert, oriented x2-3.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Patient lives alone
[**Name (NI) 51040**] [**Doctor Last Name **] sister 

### Response:
{'Malignant neoplasm of cardia,Congestive heart failure, unspecified,Unspecified septicemia,Severe sepsis,Pressure ulcer, upper back,Candidiasis of mouth,Atrial fibrillation,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Morbid obesity,Unspecified essential hypertension,Personal history of irradiation, presenting hazards to health,Obstructive sleep apnea (adult)(pediatric)'}
