CHIEF COMPLAINT: R knee replacement c/b postop hypotension

PRESENT ILLNESS: ORTHO HPI: 86M w/ severe b/L OA, admitted to ortho for
sequential bilateral TKA. Pt was admitted to ICU for hypotension
and tachycardia x 3 which subsequently resolved and was
transferred to the floor. Pt ultimately underwent bilateral TKA
w/o complications.

MEDICAL HISTORY: Osteoporosis
Anemia (family h/o G6PD deficiency)
BPH
Osteoarthritis
Cataracts
s/p bilateral inguinal hernia repair

MEDICATION ON ADMISSION: Fosamax 70 mg qweek
Flomax 0.4 mg daily (inconsistent)
Calcium 500 mg daily,
Multivitamin daily
Tylenol 500 mg p.r.n.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 96 BP: 179/77 HR: 84 RR: 18 O2Sat: 100% on 2L
GEN: WDWN, pale but in no acute distress
HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or
rhinorrhea, mucous membranes dry
COR: RRR, no appreciable M/G/R, normal S1 S2
PULM: Lungs CTAB, no W/R/R
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E +DP/PT bilaterally, moving distal extremities well
Right knee drain with serosanguinous fluid, brace in place
NEURO: alert, oriented to hospital & month. CN II ?????? XII grossly
intact. Moves all 4 extremities. Strength 5/5 in upper and lower
extremities.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

FAMILY HISTORY: Family Medical History: Non-contributory

SOCIAL HISTORY: Social History: Pt lives with daughter who is an internist and
denies any smoking, ETOH abuse
Living Situation: He lives with his wife in a single family home
in [**Country **]. He has one daughter who lives in [**Country **]. His other
daughter and son live here in [**Name (NI) 86**]. He is currently staying
with his daughter since [**Name (NI) 205**] for surgery.
Background: The patient is retired from working as an engineer.
Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Other iatrogenic hypotension,Other specified cardiac dysrhythmias,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Anemia, unspecified,Other cataract,Osteoporosis, unspecified,Other thalassemia,Unspecified essential hypertension,Spinal anesthetics causing adverse effects in therapeutic use,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation
Loc osteoarth NOS-l/leg,Pneumonia, organism NOS,Urin tract infection NOS,Iatrogenc hypotnsion NEC,Cardiac dysrhythmias NEC,BPH w/o urinary obs/LUTS,Anemia NOS,Cataract NEC,Osteoporosis NOS,Thalassemia NEC,Hypertension NOS,Adv eff spinal anesthet,Abn react-artif implant
Admission Date:  [**2142-10-4**]              Discharge Date:   [**2142-10-14**]


Service: ORTHOPAEDICS

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 64**]
Chief Complaint:
R knee replacement c/b postop hypotension

Major Surgical or Invasive Procedure:
OR [**10-4**]: R TKA.
OR [**10-8**]: L TKA.


History of Present Illness:
ORTHO HPI: 86M w/ severe b/L OA, admitted to ortho for
sequential bilateral TKA. Pt was admitted to ICU for hypotension
and tachycardia x 3 which subsequently resolved and was
transferred to the floor. Pt ultimately underwent bilateral TKA
w/o complications.

ICU HPI: 86 y/o M with PMHx of arthritis, BPH & osteoporosis s/p
elective right total knee replacement c/b post-op hypotension.
Pt was not intubated, he received spinal anesthesia with
superifical femoral block and EBL was 160cc. After one
uneventful pain-free hour in PACU, patient began "rigoring", SBP
climbed into 200s and HR into 150s. Pt denied CP/SOB. After
receiving Labetalol 5mg IV with Metoprolol 2mg IV, SBP dropped
to 160. An EKG revealed sinus tachycardia with HR 103, and PACs.
 AFter a second dose of Metoprolol 2.5mg IV, the pt's SBPs
dropped into 70s and the pt became lethargic and ashen [**Doctor Last Name 352**]. SBP
recovered to 100s after a neosynephrine bolus (100mcg); and the
SBP subsequently recovered to the 170s. An A-line was placed.

On arrival to ICU, the pt's SBP was measured to be elevated at
170/70 by the arterial line. The pt denied SOB and CP, but
complained of nausea that he attributed to not eating for 24hrs.
During an attempted PIV placement, the SBP suddenly dropped to
70/40s, HR remained in the 80s (T stable at 98.7, and BS 167).
Pt complained of lightheadedness, diaphoresis & nausea. After an
IVF bolus, the SBP recovered to 140s within minutes and symptoms
resolved.
.
ROS: Pt denied any recent fevers, chills, weight change, nausea,
vomiting, abdominal pain, diarrhea, constipation, melena,
hematochezia, chest pain, shortness of breath, cough, urinary
frequency, urgency, dysuria, lightheadedness, syncopal episodes.



Past Medical History:
Osteoporosis
Anemia (family h/o G6PD deficiency)
BPH
Osteoarthritis
Cataracts
s/p bilateral inguinal hernia repair

Social History:
Social History: Pt lives with daughter who is an internist and
denies any smoking, ETOH abuse
Living Situation: He lives with his wife in a single family home
in [**Country **]. He has one daughter who lives in [**Country **]. His other
daughter and son live here in [**Name (NI) 86**]. He is currently staying
with his daughter since [**Name (NI) 205**] for surgery.
Background: The patient is retired from working as an engineer.

Habits: No ETOH, Substance use, Quit smoking in [**2104**], 30
pack-years
Nutrition: 3 meals/day, no weight loss


Family History:
Family Medical History: Non-contributory

Physical Exam:
Vitals: T: 96 BP: 179/77 HR: 84 RR: 18 O2Sat: 100% on 2L
GEN: WDWN, pale but in no acute distress
HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or
rhinorrhea, mucous membranes dry
COR: RRR, no appreciable M/G/R, normal S1 S2
PULM: Lungs CTAB, no W/R/R
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E +DP/PT bilaterally, moving distal extremities well
Right knee drain with serosanguinous fluid, brace in place
NEURO: alert, oriented to hospital & month. CN II ?????? XII grossly
intact. Moves all 4 extremities. Strength 5/5 in upper and lower
extremities.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.


MS EXAM: wound c/d/i; no erythema; no SSD; [**Last Name (un) 938**]/TA/GS intact.

Pertinent Results:
[**2142-10-12**] 05:52AM BLOOD WBC-12.3* RBC-4.01* Hgb-9.0* Hct-28.0*
MCV-70* MCH-22.4* MCHC-32.1 RDW-19.1* Plt Ct-425
[**2142-10-11**] 06:50AM BLOOD WBC-11.5* RBC-4.41* Hgb-10.0* Hct-30.7*
MCV-70* MCH-22.7* MCHC-32.6 RDW-18.9* Plt Ct-358
[**2142-10-10**] 07:10AM BLOOD WBC-8.4 RBC-4.30* Hgb-10.1* Hct-29.8*
MCV-69* MCH-23.5* MCHC-33.9 RDW-18.6* Plt Ct-297
[**2142-10-9**] 08:14PM BLOOD WBC-9.1 RBC-4.42* Hgb-10.4* Hct-30.6*
MCV-69* MCH-23.5* MCHC-33.9 RDW-18.5* Plt Ct-297
[**2142-10-5**] 12:21AM BLOOD Neuts-84.2* Lymphs-10.4* Monos-5.1
Eos-0.2 Baso-0
[**2142-10-4**] 08:54PM BLOOD Neuts-70.2* Lymphs-24.3 Monos-4.5 Eos-0.8
Baso-0.2
[**2142-10-12**] 05:52AM BLOOD Plt Ct-425
[**2142-10-11**] 06:50AM BLOOD Plt Ct-358
[**2142-10-10**] 07:10AM BLOOD Plt Ct-297
[**2142-10-9**] 08:14PM BLOOD Plt Ct-297
[**2142-10-9**] 02:00AM BLOOD Plt Ct-252
[**2142-10-10**] 07:10AM BLOOD Glucose-108* UreaN-14 Creat-0.9 Na-133
K-4.5 Cl-99 HCO3-26 AnGap-13
[**2142-10-9**] 08:14PM BLOOD Glucose-154* UreaN-15 Creat-0.9 Na-138
K-4.2 Cl-103 HCO3-22 AnGap-17
[**2142-10-9**] 02:00AM BLOOD Glucose-96 UreaN-15 Creat-0.8 Na-137
K-3.7 Cl-104 HCO3-24 AnGap-13
[**2142-10-5**] 03:49PM BLOOD CK(CPK)-109
[**2142-10-5**] 12:21AM BLOOD CK(CPK)-69
[**2142-10-4**] 08:54PM BLOOD CK(CPK)-68
[**2142-10-5**] 03:49PM BLOOD CK-MB-3 cTropnT-<0.01
[**2142-10-5**] 12:21AM BLOOD CK-MB-3 cTropnT-<0.01
[**2142-10-4**] 08:54PM BLOOD CK-MB-3 cTropnT-<0.01
[**2142-10-5**] 12:21AM BLOOD Calcium-8.7 Phos-4.0 Mg-2.3
[**2142-10-4**] 08:54PM BLOOD Calcium-7.2* Phos-3.4 Mg-1.3*

Brief Hospital Course:
ICU COURSE:
Assessment & Plan: 86 y/o M with PMhx of osteoarthritis and BPH
presentd for elective TKR today and has developped transient
recurrent episodes of hypotension with diaphoresis/nausea that
resolve with small IVF bolus.
.
# Hypotension: [**3-17**] spinal anesthesia +/- autonomic dysfunction
given recovery with IVfs and discontinuation of anesthetic. No
evidence of wound infection, sepsis, inferior MI, hypovolemia
2/2 blood loss given minimal EBL, or adverse reaction to beta
blockers. Empiric vancomycin and ceftriaxone for possible UTI
were initiated. All antihypertnesives were held, and SBP
recovered. A rule-out MI with 3x cardiac enzymes/ECGs was
negative.
- monitor sbps & bolus IVF prn
- f/u blood/urine cultures
- Trend WBC count fever curve
- NPO for now
.
# s/p TKR: Pain was well controlled by femoral block. Lovenox
was held post op until POD1.
- lovenox till am per ortho recs
- f/u ortho recs
- monitor drainage and distal pulses
.
# FEN: NPO for now except meds/ice chips
- monitor lytes & replete prn
.
# Access: 2 x PIVs
.
# PPx: Pneumoboots, PPI, bowel regimen
- per ortho, lovenox to start in am
.
# Code: FULL confirmed with HCP
.
# Dispo: oRtho
.
# Comm: with patient & daughter/HCP

FLOOR TRANSFER
Once patient was transferred to the floor after 24hrs of
observation, pt had no similar episodes of hypotension. Pt
remained slightly tachycardic at 100-110. He did have an episode
of tachycardia to 140-150s without any stimulus, but no reasons
were found. Cardiology was consulted who recommended lopressor
100 [**Hospital1 **]. ECHO and EKGs were normal. Troponin were normal. Pt was
ultimately cleared for his R TKA ([**2142-10-4**]) on POD4 from LTKA
([**2142-10-8**]). PT was taken to the operating room by Dr.
[**Last Name (STitle) **] where the patient underwent uncomplicated R TKA. The
procedure was well
tolerated and there were no complications. Please see the
separately
dictated operative report for details regarding the surgery. The
patient was subsequently transferred to the post-anesthesia care
unit
in stable condition and transferred to the floor later that day.
Overnight, the patient was placed on a PCA for pain control. IV
antibiotics were continued for 24 hours postoperatively as per
routine. Lovenox was started the morning of postop day 1 for DVT
prophylaxis. The patient was placed in a CPM machine with range
of
motion set at 0-45 degrees of flexion up to 90 degrees as
tolerated for both knees.
The drain was removed without incident. The patient was weaned
off of
the PCA onto oral pain medications. The Foley catheter was
removed
without incident. The surgical dressing was also removed, and
the
surgical incision was found to be clean, dry, and intact without
erythema nor purulent drainage.

During the hospital course the patient was seen daily by
physical
therapy. Labs were checked both post-operatively and throughout
the
hospital course and repleted accordingly. The patient was
tolerating
regular diet and otherwise feeling well. Prior to discharge the
patient was afebrile with stable vital signs. Hematocrit was
stable
and pain was adequately controlled on a PO regimen. The
operative
extremity was neurovascularly intact and the wound was benign.
The
patient was discharged to rehabilitation in a
stable condition.

CARDIOLOGY A/P: lopressor 100 [**Hospital1 **]; tachycardia likely d/t atrial
tach; can f/u with outpt; ECHO NL; unremarkable EKG; trop neg in
ICU.

GERIATRICS A/P: some crackles in LLL; CXR largely neg w/ some
haziness of LLL; no fever; no respiratory distress -> empiric
augmentin 500 x 10days for PNA coverage.


Medications on Admission:
Fosamax 70 mg qweek
Flomax 0.4 mg daily (inconsistent)
Calcium 500 mg daily,
Multivitamin daily
Tylenol 500 mg p.r.n.

Discharge Medications:
1. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2)
Tablet PO DAILY (Daily).
2. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO Q 8H (Every 8 Hours).
3. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
4. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
6. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q12H (every 12 hours) as needed.
7. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours).
8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
9. Lovenox 40 mg/0.4 mL Syringe Sig: One (1)  Subcutaneous once
a day for 3 weeks: after lovenox for 3 wks, start aspirin.
10. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
11. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1)
Capsule, Sust. Release 24 hr PO DAILY (Daily).
12. Amoxicillin-Pot Clavulanate 500-125 mg Tablet Sig: One (1)
Tablet PO Q8H (every 8 hours) for 10 days.
13. Oxycodone 5 mg Tablet Sig: Three (3) Tablet PO Q4H (every 4
hours) as needed for pain.
14. Lopressor 100 mg Tablet Sig: One (1) Tablet PO twice a day.



Discharge Disposition:
Extended Care

Facility:
[**Hospital6 85**] - [**Location (un) 86**]

Discharge Diagnosis:
bilateral TKA


Discharge Condition:
stable


Discharge Instructions:
should experience: severe pain not relieved by medication,
increased
swelling, decreased sensation, difficulty with movement, fevers
>101.5, shaking chills, redness or drainage at the incision
site,
chest pain, shortness of breath or any other concerns.
2. Please follow up with your PCP regarding this admission and
any new
medications and refills.
3. Resume your home medications unless otherwise instructed.
4. You have been given medications for your pain control. Please
do
not operate heavy machinery or drink alcohol when taking these
medications. As your pain improves, please decrease the amount
of pain
medication. This medication can cause constipation, so you
should
drink plenty of water daily and take a stool softener as needed
to
prevent this side effect.
5. You may not drive a car until cleared to do so by your
surgeon or
your primary physician.
6. Please keep your wounds clean. You can get the wound wet or
take a
shower starting 5 days after surgery, but no baths or swimming
for at
least 4 weeks. No dressing is needed if wound continued to be
non-draining. Any stitches or staples that need to be removed
will be
taken out at your 2-week follow up appointment, by your PCP or
at
rehab.
7. Please call your surgeons/doctors office to [**Name5 (PTitle) **] or
confirm
your follow-up appointment.

ANTICOAGULATION: Please take lovenox injections (40mg) once a
day x 3
weeks and then take aspirin 325 mg twice a day x 3 weeks. [**Month (only) 116**]
discontinue all blood thinners 6 weeks post-operatively. Please
call [**First Name9 (NamePattern2) 22369**] [**Doctor Last Name **] at [**Telephone/Fax (1) 22370**] with any questions.

WOUND CARE: Keep your incision clean and dry. Okay to shower
after
POD#5 but do not tub-bath or submerge your incision. Please
place a
dry sterile dressing to the wound each day if there is drainage,
leave
it open to air. Check wound regularly for signs of infection
such as
redness or thick yellow drainage. Staples will be removed by VNA
in 2
weeks. If you are going to rehab, then rehab can remove staples
at 2
weeks.

ACTIVITY: Weight bearing as tolerated bilaterally; RLE can be a
routine TKA pathway, without any strict precautions; LLE must
have [**Doctor Last Name 6587**] brace w/ 5degrees of valgus stress to protect
lateral collateral ligaments, especially when walking; pt can
loose the [**Doctor Last Name 6587**] when in bed for comfort.

VNA (after home): Home PT/OT, dressing changes as instructed,
and
wound checks, staple removal in 2 weeks after surgery.

Physical Therapy:
Weight bearing as tolerated bilaterally; RLE can be a routine
TKA pathway, without any strict precautions; LLE must have
[**Doctor Last Name 6587**] brace w/ 5degrees of valgus stress to protect lateral
collateral ligaments, especially when walking; pt can loosen the
[**Doctor Last Name 6587**] when in bed for comfort.
Treatments Frequency:
should experience: severe pain not relieved by medication,
increased
swelling, decreased sensation, difficulty with movement, fevers
>101.5, shaking chills, redness or drainage at the incision
site,
chest pain, shortness of breath or any other concerns.
2. Please follow up with your PCP regarding this admission and
any new
medications and refills.
3. Resume your home medications unless otherwise instructed.
4. You have been given medications for your pain control. Please
do
not operate heavy machinery or drink alcohol when taking these
medications. As your pain improves, please decrease the amount
of pain
medication. This medication can cause constipation, so you
should
drink plenty of water daily and take a stool softener as needed
to
prevent this side effect.
5. You may not drive a car until cleared to do so by your
surgeon or
your primary physician.
6. Please keep your wounds clean. You can get the wound wet or
take a
shower starting 5 days after surgery, but no baths or swimming
for at
least 4 weeks. No dressing is needed if wound continued to be
non-draining. Any stitches or staples that need to be removed
will be
taken out at your 2-week follow up appointment, by your PCP or
at
rehab.
7. Please call your surgeons/doctors office to [**Name5 (PTitle) **] or
confirm
your follow-up appointment.

ANTICOAGULATION: Please take lovenox injections (40mg) once a
day x 3
weeks and then take aspirin 325 mg twice a day x 3 weeks. [**Month (only) 116**]
discontinue all blood thinners 6 weeks post-operatively. Please
call [**First Name9 (NamePattern2) 22369**] [**Doctor Last Name **] at [**Telephone/Fax (1) 22370**] with any questions.

WOUND CARE: Keep your incision clean and dry. Okay to shower
after
POD#5 but do not tub-bath or submerge your incision. Please
place a
dry sterile dressing to the wound each day if there is drainage,
leave
it open to air. Check wound regularly for signs of infection
such as
redness or thick yellow drainage. Staples will be removed by VNA
in 2
weeks. If you are going to rehab, then rehab can remove staples
at 2
weeks.

ACTIVITY: Weight bearing as tolerated bilaterally; RLE can be a
routine TKA pathway, without any strict precautions; LLE must
have [**Doctor Last Name 6587**] brace w/ 5degrees of valgus stress to protect
lateral collateral ligaments, especially when walking; pt can
loose the [**Doctor Last Name 6587**] when in bed for comfort.

VNA (after home): Home PT/OT, dressing changes as instructed,
and
wound checks, staple removal in 2 weeks after surgery.


Followup Instructions:
Provider: [**First Name8 (NamePattern2) 4599**] [**Last Name (NamePattern1) 9856**], [**MD Number(3) 3261**]:[**Telephone/Fax (1) 1228**]
Date/Time:[**2142-11-9**] 10:40
Cardiology:  [**First Name8 (NamePattern2) **] [**Name8 (MD) **] MD; [**Hospital1 1170**]
[**Location (un) 830**], E/RW-453
[**Location (un) 86**], [**Numeric Identifier 718**]
Phone: [**Telephone/Fax (1) 62**]
{'Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Other iatrogenic hypotension,Other specified cardiac dysrhythmias,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Anemia, unspecified,Other cataract,Osteoporosis, unspecified,Other thalassemia,Unspecified essential hypertension,Spinal anesthetics causing adverse effects in therapeutic use,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}


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: R knee replacement c/b postop hypotension

PRESENT ILLNESS: ORTHO HPI: 86M w/ severe b/L OA, admitted to ortho for
sequential bilateral TKA. Pt was admitted to ICU for hypotension
and tachycardia x 3 which subsequently resolved and was
transferred to the floor. Pt ultimately underwent bilateral TKA
w/o complications.

MEDICAL HISTORY: Osteoporosis
Anemia (family h/o G6PD deficiency)
BPH
Osteoarthritis
Cataracts
s/p bilateral inguinal hernia repair

MEDICATION ON ADMISSION: Fosamax 70 mg qweek
Flomax 0.4 mg daily (inconsistent)
Calcium 500 mg daily,
Multivitamin daily
Tylenol 500 mg p.r.n.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 96 BP: 179/77 HR: 84 RR: 18 O2Sat: 100% on 2L
GEN: WDWN, pale but in no acute distress
HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or
rhinorrhea, mucous membranes dry
COR: RRR, no appreciable M/G/R, normal S1 S2
PULM: Lungs CTAB, no W/R/R
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E +DP/PT bilaterally, moving distal extremities well
Right knee drain with serosanguinous fluid, brace in place
NEURO: alert, oriented to hospital & month. CN II ?????? XII grossly
intact. Moves all 4 extremities. Strength 5/5 in upper and lower
extremities.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

FAMILY HISTORY: Family Medical History: Non-contributory

SOCIAL HISTORY: Social History: Pt lives with daughter who is an internist and
denies any smoking, ETOH abuse
Living Situation: He lives with his wife in a single family home
in [**Country **]. He has one daughter who lives in [**Country **]. His other
daughter and son live here in [**Name (NI) 86**]. He is currently staying
with his daughter since [**Name (NI) 205**] for surgery.
Background: The patient is retired from working as an engineer. 

### Response:
{'Osteoarthrosis, localized, not specified whether primary or secondary, lower leg,Pneumonia, organism unspecified,Urinary tract infection, site not specified,Other iatrogenic hypotension,Other specified cardiac dysrhythmias,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Anemia, unspecified,Other cataract,Osteoporosis, unspecified,Other thalassemia,Unspecified essential hypertension,Spinal anesthetics causing adverse effects in therapeutic use,Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}
