CHIEF COMPLAINT: Carcinoma of the distal esophagus.

PRESENT ILLNESS: Mr. [**Known lastname 21938**] is a 58-year-old gentleman with a
biopsy-proven T3, N1 Stage III carcinoma of the distal
esophagus. He has completed induction chemoradiotherapy with
a good partial response by PET CT scanning. Admitted today for
transthoracic esophagectomy and a radical
lymphadenectomy with cervical esophagogastrostomy.

MEDICAL HISTORY: PMH
1. Adenocarcinoma as above. Patient started chemotherapy [**2193-4-29**]
prior to planned surgery.
2. HTN
3. GERD
.
PSH:
1. s/p portacath placement [**2193-4-23**]
2. s/p G-tube placement [**2193-4-23**]

MEDICATION ON ADMISSION: atenolol 100', univasc 30', triamterene/HCTZ 75/50', prilosec
20'

ALLERGIES: Aspirin / Ibuprofen / Nsaids

PHYSICAL EXAM: genral: Well Appearing male in NAD.
Chest: lungs CTA bilat. Portacath site benign.
Cor: RRR S1, S2
Abd: round, soft, NT, ND, +BS. feeding tube in place-site
benign.
Extrem: mild Lower extrem edema, No clubbing, cyanosis.
Neuro: A+OX3

FAMILY HISTORY: NC

SOCIAL HISTORY: Distant smoking history, quit 35 years ago.  Approximately [**4-17**]
drinks per week, stopped since start of illness.
Malignant neoplasm of lower third of esophagus,Acute kidney failure with lesion of tubular necrosis,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Other postoperative infection,Cellulitis and abscess of trunk,Diseases of tricuspid valve,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Esophageal reflux,Unspecified essential hypertension,Gastrostomy status,Mitral valve disorders
Mal neo lower 3rd esoph,Ac kidny fail, tubr necr,Mal neo lymph-intrathor,Other postop infection,Cellulitis of trunk,Tricuspid valve disease,Abn react-procedure NEC,Esophageal reflux,Hypertension NOS,Gastrostomy status,Mitral valve disorder
Admission Date:  [**2193-7-16**]              Discharge Date:   [**2193-7-26**]

Date of Birth:  [**2134-9-19**]             Sex:   M

Service: CARDIOTHORACIC

Allergies:
Aspirin / Ibuprofen / Nsaids

Attending:[**First Name3 (LF) 2969**]
Chief Complaint:
Carcinoma of the distal esophagus.


Major Surgical or Invasive Procedure:
esophagogastectomy


History of Present Illness:
Mr. [**Known lastname 21938**] is a 58-year-old gentleman with a
biopsy-proven T3, N1 Stage III carcinoma of the distal
esophagus. He has completed induction chemoradiotherapy with
a good partial response by PET CT scanning. Admitted today for
transthoracic esophagectomy and a radical
lymphadenectomy with cervical esophagogastrostomy.

Past Medical History:
PMH
1. Adenocarcinoma as above. Patient started chemotherapy [**2193-4-29**]
prior to planned surgery.
2. HTN
3. GERD
.
PSH:
1. s/p portacath placement [**2193-4-23**]
2. s/p G-tube placement [**2193-4-23**]


Social History:
Distant smoking history, quit 35 years ago.  Approximately [**4-17**]
drinks per week, stopped since start of illness.


Family History:
NC

Physical Exam:
genral: Well Appearing male in NAD.
Chest: lungs CTA bilat. Portacath site benign.
Cor: RRR S1, S2
Abd: round, soft, NT, ND, +BS. feeding tube in place-site
benign.
Extrem: mild Lower extrem edema, No clubbing, cyanosis.
Neuro: A+OX3

Pertinent Results:
[**2193-7-16**] 11:23PM URINE  HOURS-RANDOM CREAT-104 SODIUM-LESS THAN
[**2193-7-16**] 09:10PM   WBC-15.7*# RBC-4.12*# HGB-13.0*# HCT-37.3*
MCV-90 MCH-31.6 MCHC-34.9 RDW-16.6*

AP CHEST, 11:58 A.M, [**7-22**]
HISTORY: Esophagogastrectomy. Chest tube removed. Rule out
pneumothorax.
Small right apical pneumothorax is unchanged since [**7-18**] at
the level of the second posterior interspace, following removal
of the right apical drain. There is no appreciable pleural
effusion. Mediastinum has stable postoperative appearance. A
small collection of gas in the right supraclavicular region is
stable since [**7-18**]. Heart size top normal. Left lung clear
aside from minimal plate like atelectasis at the base.

Chest /ABD/ pelvis CT [**2193-7-26**]
IMPRESSION:
1. No abscesses identified.

2. Wedge-shaped area of relative low-attenuation of the inferior
pole of the spleen is suggestive of a splenic infarct.

3. Small loculated right-sided pleural effusion with associated
tiny pneumothorax. Associated bilateral consolidations, right
lobe greater than left as described above.

Neck Ct scan [**2193-7-26**]
IMPRESSION: Normal CT of the neck. Evidence of loculated right
pleural effusion and free left pleural effusion. No abscess or
lymphadenopathy was identified.


Brief Hospital Course:
Pt was admitted and taken to the OR on [**2193-7-16**] for 3 incision
esophagectomy for esophageal cancer. OR course was complicated
by hypotension thought to be related to a transfudion rxn to
blood given during the case. Pt had large volume requirement in
the OR. Intubated and transferred to the ICU for post-op care.
Transfusion rxn w/u was negative and subsequent transfusions
were given w/o incident. Rec'ing kefzol for prophylaxis.

An epidural was placed for pain control but not used post op d/t
persistant hypotension which required Neo and ongoing volume
resusitation. Intermittant IV narcotic was given for pain
control. Pt also had low urine output which responded to volume
resusitation.
 Pt was extubated on POD#1. Hypotension improved w/ vol
resusitation and bupivicane epidural and PCA were started for
pain control.
Chest tubes to sxn with moderate drainage and NGT to sxn w/
minimal drainage. Anastomotic JP w/ minimal output. Maintained
NPO.
POD#2 increase creat-cont'd crystalloid and colliod
resusitation. Trophic tube feed started.
POD#3 transferred from icu to floor.
POD#4 generalized edema. given small does of IV lasix w/good
diuretic response. Creat improving. NGT d/c'd but kept NPO. no
return of bowel function. epidural d/c'd and kept on PCA.
POD#5 Tf increased slowly to goal. Ongoing diuresis.
POD#6 Ct d/c'd. ambulating. ongoing diuresis. Kefzol d/c'd.
POD#7 tacycardic -lopressor dose increased. grape juice study
negative. Started on sips the clear liquids- [**Last Name (un) 1815**] well. Cont'd
diuresis and TF increased to goal.
POD#8 JP d/c'd. passed flatus.
POD#9 advanced to full liquids. passed stool and gas. Tf to
goal.
POD#10 slight rise in WBC -neck, chest, abd CT scan
done-negative for abcess.
d/c'd to home w/ VNA and [**Hospital1 **] for tube feed care.


Medications on Admission:
 atenolol 100', univasc 30', triamterene/HCTZ 75/50', prilosec
20'

Discharge Medications:
1. Hydromorphone 2 mg Tablet Sig: 1-2 Tablets PO Q3-4H (Every 3
to 4 Hours) as needed.
Disp:*80 Tablet(s)* Refills:*0*
2. Atenolol 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
3. Moexipril 15 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

4. Triamterene-Hydrochlorothiazid 37.5-25 mg Capsule Sig: Two
(2) Cap PO DAILY (Daily).
5. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Senna 8.6 mg Tablet Sig: 1-2 Tablets PO BID (2 times a day)
as needed.
8. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30)
ML PO Q6H (every 6 hours) as needed.
9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) for 5 days.
Disp:*10 Tablet(s)* Refills:*0*
10. potassium chloride
40 meq powder form daily x 5 days


Discharge Disposition:
Home With Service

Facility:
[**Company 1519**]

Discharge Diagnosis:
s/p esophagogastrectomy


Discharge Condition:
good


Discharge Instructions:
Call Dr.[**Doctor Last Name 4738**] office if you experience fever>101, chills,
nausea, diarrhea, inabilty to [**Last Name (un) 1815**] liquid diet or tube feed,
shortness of breath or chest pain.

Followup Instructions:
You have a follow up appointment with Dr. [**Last Name (STitle) **] thursday
[**2193-8-1**] at 4pm in the [**Hospital Ward Name **] clinical center [**Location (un) **].



Completed by:[**2193-8-1**]
{'Malignant neoplasm of lower third of esophagus,Acute kidney failure with lesion of tubular necrosis,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Other postoperative infection,Cellulitis and abscess of trunk,Diseases of tricuspid valve,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Esophageal reflux,Unspecified essential hypertension,Gastrostomy status,Mitral valve disorders'}


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: Carcinoma of the distal esophagus.

PRESENT ILLNESS: Mr. [**Known lastname 21938**] is a 58-year-old gentleman with a
biopsy-proven T3, N1 Stage III carcinoma of the distal
esophagus. He has completed induction chemoradiotherapy with
a good partial response by PET CT scanning. Admitted today for
transthoracic esophagectomy and a radical
lymphadenectomy with cervical esophagogastrostomy.

MEDICAL HISTORY: PMH
1. Adenocarcinoma as above. Patient started chemotherapy [**2193-4-29**]
prior to planned surgery.
2. HTN
3. GERD
.
PSH:
1. s/p portacath placement [**2193-4-23**]
2. s/p G-tube placement [**2193-4-23**]

MEDICATION ON ADMISSION: atenolol 100', univasc 30', triamterene/HCTZ 75/50', prilosec
20'

ALLERGIES: Aspirin / Ibuprofen / Nsaids

PHYSICAL EXAM: genral: Well Appearing male in NAD.
Chest: lungs CTA bilat. Portacath site benign.
Cor: RRR S1, S2
Abd: round, soft, NT, ND, +BS. feeding tube in place-site
benign.
Extrem: mild Lower extrem edema, No clubbing, cyanosis.
Neuro: A+OX3

FAMILY HISTORY: NC

SOCIAL HISTORY: Distant smoking history, quit 35 years ago.  Approximately [**4-17**]
drinks per week, stopped since start of illness. 

### Response:
{'Malignant neoplasm of lower third of esophagus,Acute kidney failure with lesion of tubular necrosis,Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes,Other postoperative infection,Cellulitis and abscess of trunk,Diseases of tricuspid valve,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Esophageal reflux,Unspecified essential hypertension,Gastrostomy status,Mitral valve disorders'}
