CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 58-year-old male with
metastatic renal cell carcinoma admitted for phase 1 and 2
trial of PEG-Intron with IL-2 for advanced renal cell
carcinoma.

MEDICAL HISTORY: Significant for hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Father died of an myocardial infarction.
Mother hypertension.

SOCIAL HISTORY: He is a former smoker and quit 20 years ago.
He was employed as a machinist.  He is married with three
children and drinks a couple of glasses of wine at night.
Malignant neoplasm of kidney, except pelvis,Secondary malignant neoplasm of lung
Malig neopl kidney,Secondary malig neo lung
Admission Date:  [**2143-11-1**]     Discharge Date:  [**2143-11-7**]

Date of Birth:   [**2085-9-26**]     Sex:  M

Service:

DIAGNOSIS: Metastatic renal cell carcinoma.

HISTORY OF PRESENT ILLNESS:  This is a 58-year-old male with
metastatic renal cell carcinoma admitted for phase 1 and 2
trial of PEG-Intron with IL-2 for advanced renal cell
carcinoma.

ONCOLOGIC HISTORY:  Patient initially presented with
asymptomatic hematuria in [**2138**].  Biopsy revealed renal cell
carcinoma and he underwent a radical nephrectomy.  He
subsequently underwent resection of two lesions of the left
posterior lung also consistent with renal cell carcinoma.
Serial CT scans in [**2143-9-16**] revealed a solitary left
kidney mass of 2 cm and subsequently underwent a left partial
nephrectomy.  He was enrolled in a phase III adjuvant trial
comparing IL-2 with observation and randomized to the
observation arm.  A follow-up CT scan performed on [**2144-2-24**] showed evidence of increased metastatic disease with
mediastinal lymphadenopathy, pulmonary nodules and increase
size of the mass of lower pole of left kidney.  MRI confirmed
the disease progression in the left kidney and pulmonary
metastases.  He is currently enrolled in a phase [**12-18**] trial
with outpatient PEG-Intron with IL-2 for advanced renal cell
carcinoma.

PAST MEDICAL HISTORY:  Significant for hypertension.

ALLERGIES:  No known drug allergies.

OUTPATIENT MEDICATIONS:  Norvasc 10 mg a day, Zestril 40 mg
po q.d., hydrochlorothiazide 25 mg po q.d.  All his
hypertensives have been held since [**89**] hours, as well as
Tylenol po prn.

SOCIAL HISTORY:  He is a former smoker and quit 20 years ago.
He was employed as a machinist.  He is married with three
children and drinks a couple of glasses of wine at night.

FAMILY HISTORY:  Father died of an myocardial infarction.
Mother hypertension.

PHYSICAL EXAMINATION:  Height 63 inches.  Weight 76.5.  Body
surface area 1.8 meters squared.  ECOG status 0-1.  Vital
signs:  Blood pressure 150/90.  Heart rate 100.  Respiratory
rate 20.  Temperature 98.5.  99% on room air.  Pleasant in no
acute distress.,   Head, eyes, ears, nose and throat:  Sclera
were conjunctive.  Clear oropharynx, pink with exudate, no
oral mucoid cutaneous lesions.  Neck:  No anterior, posterior
cervical lymphadenopathy.  No supraclavicular axillary
lymphadenopathy.  Lungs clear to auscultation in all fields.
Heart:  Regular rate and rhythm, no murmurs, rubs or gallops.
Abdomen soft, nontender, nondistended, active bowel sounds,
no hepatosplenomegaly.  Extremities:  No peripheral edema, no
rashes.  Neurological:  Alert and oriented times three.
Cranial nerves II through XII are grossly intact.

LABORATORIES:  White blood cell count 5.8, hematocrit 40.4,
platelets 214,000.  Sodium 135, potassium 4.2, chloride 97,
bicarbonate 26, BUN 17, creatinine 1.2, glucose 94, ALT 17,
AST 18, LDH 186, alkaline phosphatase 51, T bilirubin .71,
calcium 9.4.

HOSPITAL COURSE:  He was admitted on [**3-19**] with a
performance status of 0-1 to begin.  He received IL-2 at 5
million units per meter squared per dose q. 8 hours times
three which equalled 9 million units subcutaneously.  He also
received his first dose of PEG-Intron at 2 mcg/kg per week
equalling a dose of 153 mcg.  His first dose was received at
4 p.m.  He tolerated the two medications without incident.
His blood pressure remained stable.  He denied any nausea,
vomiting or diarrhea. He had no skin flushing.  He had a
temperature of 101.2 several hours after the initial
interferon.  At time of discharge, he was afebrile.  He was
otherwise without complaint tolerating good po intake.  He
had no appreciable toxicities.  The Learning Center came and
instructed him on the use of subcutaneous injections of IL-2.
He was discharged on IL-2 and instructed to use 9 million
units subcutaneously five days a week times four a week, each
dose given at 6 p.m. Wednesday through Sunday.  He will
receive PEG-Intron on a weekly basis in clinic.



                          [**Doctor First Name **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 8916**]

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

MEDQUIST36

D:  [**2144-3-20**]  11:10
T:  [**2144-3-20**]  11:10
JOB#:  [**Job Number 21040**]


Admission Date:  [**2143-11-1**]     Discharge Date:  [**2143-11-7**]

Date of Birth:   [**2085-9-26**]     Sex:  M

Service:

HISTORY OF PRESENT ILLNESS:  This is a 58-year-old male with
metastatic renal cell carcinoma who is four years past right
radical nephrectomy Stage T3B.  The patient subsequently in
[**2140-7-16**], had two lesions resected from the left
posterior lung lobe consistent also with metastatic renal
cell carcinoma.  He has been followed with serial
surveillance CT scans.  He had a scan from [**2143-9-30**]
which showed a lesion in his solitary left kidney
approximately 2 cm in diameter.  Patient had no hematuria, no
abdominal pain, no nausea or vomiting, no weight loss, no
fever or chills.  He had a bone scan done on [**2143-10-9**]
which showed no metastatic disease and his BUN and creatinine
at that time were 18 and 1.1.  He presented for evaluation of
the left renal mass and was scheduled for a left partial
nephrectomy.

PAST MEDICAL HISTORY:  Hypertension.

PAST SURGICAL HISTORY:  Right nephrectomy with IVC
thrombectomy in [**2138**], left lung resection in [**2139**].

MEDICATIONS:  Hydrochlorothiazide 25 po q.d., Norvasc 10 mg
po q.d., Zestril 20 mg po q.d.

SOCIAL HISTORY:  Patient drinks three to four glasses of wine
per night.

PHYSICAL EXAMINATION:  On initial physical examination, the
patient is a well-developed, well-appearing male in no
apparent distress.  His neck was supple, no masses.  His
chest was clear to auscultation bilaterally.  Cardiovascular:
Regular rate and rhythm.  His abdomen contained no palpable
masses.  Liver and spleen were within normal limits.  No
hernias were found.  He had no palpable lymphadenopathy.  His
anus and perineum were within normal limits.  His
genitourinary exam was normal.  His prostate was
approximately 40 grams.  He was neurologically intact.

LABORATORIES:  White blood cell count was 7.2, hematocrit
39.6, platelets 242,000.  Urinalysis was negative.  His PT
was 13, PTT 22.9, INR 1.2.  His sodium was 138, potassium
4.3, chloride 99, C02 24, BUN 15, creatinine 1.0.  AST and
ALT were 28 and 27 respectively.  Alkaline phosphatase was
40.  His total bilirubin .7.  Albumin 4.4.

BRIEF HOSPITAL COURSE:  Mr. [**Known lastname 467**] was admitted on [**2143-11-1**].  He underwent a left partial nephrectomy under
general endotracheal anesthesia.  Intraoperative, he had
significant blood loss of approximately two liters for which
he received 1200 cc of crystalloid.  He had a number one JP
drain and a Foley catheter placed.  There were no
complications.  He was transported to the Recovery Room
intubated and in stable condition, however, he was requiring
pressors to keep his pressure up.  His initial blood gases in
the Post Anesthesia Care Unit were 7.28, 42, 149, 21 with a
base excess of 6.  Based on this and his pressor requirement,
he was kept intubated and transferred to the Intensive Care
Unit.  Overnight, he was weaned off of his pressor and weaned
off of the ventilator.  He was extubated on postoperative day
number one without incident and transferred to the regular
floor.  Patient had received three units of blood
intraoperatively and one unit in the Post Anesthesia Care
Unit.  On postoperative day one, his hematocrit was 27.7,
however, on postoperative day number three, it progressively
decreased to 22, 23.5 on repeat.  02 was given, one unit of
packed red blood cells, hematocrit increased to 24 and was
25.8 on discharge.  He was kept on Ancef perioperatively. He
remained afebrile throughout his hospital course.  He was not
discharged on any antibiotics. His urine output remained good
throughout his hospital course and his BUN and creatinine
were 18 and 1.3.  His diet was advanced on postoperative day
number five, he was ambulating independently and tolerating a
regular diet and his pain was controlled on oral pain
medication.  He initially had some high output from his JP
drain about 600 cc per day.  JP creatinine was checked which
was 2 and his drain was taken out on postoperative day number
six.

CONDITION OF DISCHARGE:  Patient is afebrile, hemodynamically
stable, tolerating a regular diet, ambulating independently,
tolerating oral pain medication.

DISCHARGE DIAGNOSES:
1.  Renal cell carcinoma. Clear cells variant.
2.  Status post left partial nephrectomy, a solitary kidney.
3.  Hypertension.

DISCHARGE MEDICATIONS:
1.  Dilaudid 2-4 mg po q. 4 hours prn pain.
2.  Colace 100 mg po b.i.d.
3.  Iron sulfate 325 mg po t.i.d.

FOLLOW-UP:  Patient is to follow-up with Dr. [**Last Name (STitle) 4229**].




                          [**Name6 (MD) **] [**Last Name (NamePattern4) **], M.D. [**MD Number(1) 13920**]

Dictated By:[**Last Name (NamePattern1) 2682**]

MEDQUIST36

D:  [**2143-11-11**]  14:09
T:  [**2143-11-11**]  14:09
JOB#:  [**Job Number 21039**]
{'Malignant neoplasm of kidney, except pelvis,Secondary malignant neoplasm of lung'}


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: This is a 58-year-old male with
metastatic renal cell carcinoma admitted for phase 1 and 2
trial of PEG-Intron with IL-2 for advanced renal cell
carcinoma.

MEDICAL HISTORY: Significant for hypertension.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Father died of an myocardial infarction.
Mother hypertension.

SOCIAL HISTORY: He is a former smoker and quit 20 years ago.
He was employed as a machinist.  He is married with three
children and drinks a couple of glasses of wine at night. 

### Response:
{'Malignant neoplasm of kidney, except pelvis,Secondary malignant neoplasm of lung'}
