CHIEF COMPLAINT: The patient is a 38-year-old gravida 2,
para 2 presenting with a new diagnosis of cervical cancer.

PRESENT ILLNESS: The patient underwent a routine
PAP smear which revealed high-grade squamous intraepithelial
lesion and subsequently underwent a loop electrosurgical
excision procedure on [**2189-6-1**].  High-grade squamous
intraepithelial lesion revealed gland involvement present at
the ectocervical and endocervical margins.  There was also
invasive adenocarcinoma with depth of invasion of 7 mm.
There was also adenocarcinoma in situ.

MEDICAL HISTORY: Past medical history was
noncontributory.

MEDICATION ON ADMISSION: Current medications included
Triphasil.

ALLERGIES: None.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history significant for mother with
breast cancer at the age of 55, and a father and sister with
melanoma.

SOCIAL HISTORY: No tobacco.  Occasional alcohol.
Malignant neoplasm of other specified sites of cervix,Iatrogenic pulmonary embolism and infarction,Hemorrhage complicating a procedure,Hemoperitoneum (nontraumatic),Pulmonary collapse
Malig neo cervix NEC,Iatrogen pulm emb/infarc,Hemorrhage complic proc,Hemoperitoneum,Pulmonary collapse
Admission Date:  [**2189-7-13**]     Discharge Date:  [**2189-8-4**]

Date of Birth:   [**2151-5-24**]     Sex:  F

Service:  GYN/ONC

CHIEF COMPLAINT:  The patient is a 38-year-old gravida 2,
para 2 presenting with a new diagnosis of cervical cancer.

HISTORY OF PRESENT ILLNESS:  The patient underwent a routine
PAP smear which revealed high-grade squamous intraepithelial
lesion and subsequently underwent a loop electrosurgical
excision procedure on [**2189-6-1**].  High-grade squamous
intraepithelial lesion revealed gland involvement present at
the ectocervical and endocervical margins.  There was also
invasive adenocarcinoma with depth of invasion of 7 mm.
There was also adenocarcinoma in situ.

The patient was admitted to the hospital and underwent a
radical hysterectomy, bilateral salpingo-oophorectomy, and
pelvic lymphadenectomy for stage IA2 adenocarcinoma of the
cervix.  Please see Operative Report for more details of that
particular surgery.

PAST MEDICAL HISTORY:   Past medical history was
noncontributory.

PAST SURGICAL HISTORY:  Appendectomy.

ALLERGIES:  None.

MEDICATIONS ON ADMISSION:  Current medications included
Triphasil.

PAST OBSTETRICAL HISTORY:  Vaginal deliveries times two.

PAST GYNECOLOGICAL HISTORY:  PAP smear as mentioned in the
History of Present Illness.  Last mammogram was in [**2189**] and
was normal.

FAMILY HISTORY:   Family history significant for mother with
breast cancer at the age of 55, and a father and sister with
melanoma.

SOCIAL HISTORY:  No tobacco.  Occasional alcohol.

PHYSICAL EXAMINATION ON PRESENTATION:   Postoperatively, the
patient was doing well without complaints.  In general, she
was alert and oriented times four, in no apparent distress.
Vital signs revealed a temperature of 37.5, pulse was 85 to
115, blood pressure was 110/55, oxygen saturation was 95% to
100% on 3 liters via nasal cannula.  Cardiovascular
examination revealed a regular rate and rhythm without
murmurs.  Pulmonary was clear to auscultation bilaterally.
The abdomen was soft, normal bowel sounds.  The incision was
clean, dry, and intact without rebound or guarding.
Genitourinary revealed no vaginal bleeding.  Extremities
revealed no clubbing, cyanosis or edema, nontender.  Pneumo
boots were in place.

HOSPITAL COURSE BY SYSTEM:

1.  GYNECOLOGY/ONCOLOGY:  The patient was noted to have
adenocarcinoma grade II at 1.7 mm at greatest depth of
invasion.  No lymphvascular invasion was seen.  No in situ
carcinoma or dysplasia.  All margins were free of tumor.  No
malignancy was identified in lymph nodes.  Please see
complete pathology report for details.

The patient complained of having hot flashes on hospital day
three and was subsequently started on Premarin p.o.

2.  PULMONARY/CARDIOVASCULAR:  On postoperative day one, the
patient was transferred from Five South to Twelve [**Hospital Ward Name 1827**].
It was noted that the patient was requiring oxygen via nasal
cannula.  The patient had minimal ambulation on the first day
secondary to discomfort.  Pneumo boots had been placed and
were on at all times.

On postoperative day four, when trying to wean the patient
off of oxygen, it was noted that her saturation dropped to
the 70s and 80s.  There was high concern for a possible deep
venous thrombosis at this time.  Prior to this, the patient
had a chest x-ray on postoperative day one.  This was done as
the patient was requiring oxygen as previously mentioned, and
the x-ray showed bibasilar atelectasis with patchy air space
consolidation.  There was no evidence of congestive heart
failure, and there was free air under the diaphragm;
presumably post surgical.

On postoperative day four, secondary to the patient's oxygen
requirements and inability to wean off of supplemental
oxygen, and an arterial blood gas that was 7.48/38/42/32/6,
there was great concern that rather than this being venous
that the patient might in fact be in respiratory compromise.
A CT angiogram was done, and the patient was noted to have
pulmonary emboli in the right lobe and segmental branches to
the right lower lobe, and a suggestion of thrombus in the
left lower lobe vessels.  There was evidence of segmental
atelectasis in both lung bases.  The patient was immediately
started on a heparin drip for a goal of PTT of 60 to 100.
The patient was then started on Coumadin on [**2189-7-17**] to
maintain anticoagulation.

On [**2189-7-20**], the patient was noted to have a distended
abdomen, and her complaints of abdominal pain had escalated
overnight.  The heparin drip and Coumadin were discontinued.
A STAT hematocrit was sent and was noted to be 19.5 with an
INR of 3.5.  The patient was assessed to have an abdominal
bleed, and an immediate transfusion of 3 units of packed red
blood cells was started.  The patient's hematocrit stabilized
after her 3 units.  However, on serial abdominal examinations
it was noted that the patient's wound had cellulitis and that
her incision was beginning to open up.

With the suspicion of hemoperitoneum, the patient was
scheduled to have re-exploration for hemoperitoneum.  Prior
to this, the patient had an inferior vena cava filter placed
(please see Interventional Radiology note for said
procedure).  The patient underwent the procedure on [**2189-7-22**] for evacuation of 3 liters of hemoperitoneum.  The
patient received 1 unit of packed red blood cells
intraoperatively and 1 unit postoperatively in the Intensive
Care Unit.  Additionally, the patient had been started on
oxacillin for her cellulitis.  The patient's follow-up
hematocrits remained stable.  The patient had tolerated the
procedure well and convalesced appropriately.

The patient's Coumadin was restarted, and her inferior vena
cava filter was discontinued on [**2189-7-30**].  The patient's
Coumadin dose was adjusted between 2.5 and 7.5 to try and
obtain an INR between 1.8 and 2.2.

3.  GASTROINTESTINAL:  The [**Hospital 228**] hospital stay was rather
uncomfortable for the patient as she continued to have nausea
and emesis.  The patient did not tolerate her p.o. well and
also had an aversion to taking pills.  Suppositories did in
fact help with the patient's nausea and vomiting toward the
end of her course.

4.  INFECTIOUS DISEASE:  On [**2189-7-22**], the patient was
noted to have a urinary tract infection positive for
gram-negative rods after the patient had a temperature spike.
The patient was started on ceftazidime.  Additionally, the
patient had been started on oxacillin for wound cellulitis.
Intraoperatively, the patient received Flagyl.

On [**2189-7-26**], the patient's Flagyl was discontinued, and
the subsequent day the other intravenous antibiotics were
discontinued.

5.  FLUIDS/ELECTROLYTES/NUTRITION: The patient was started on
total parenteral nutrition during the course of her hospital
stay after her surgery for the evacuation of hemoperitoneum.
The patient was weaned off her total parenteral nutrition on
[**8-1**] until the remainder of her course.  The patient
tolerated her oral intake toward the end of her stay.
Intermittently, the patient's phosphate, magnesium, and
potassium were repleted.  Electrolytes were checked on a
regular basis for nutritional evaluation.

DISCHARGE DISPOSITION:  The patient was discharged to home on
[**2189-8-4**].

DISCHARGE PLAN:  The patient was to follow up with Dr. [**First Name (STitle) 1022**] as
previously scheduled.  The patient was also to see her
primary care physician to have her INR checked every three
days times one week after discharge.  At that time, the
patient would have seen Dr. [**First Name (STitle) 1022**] and also her primary care
physician for determination of how often the patient was to
have her INR checked for a goal between 1.8 and 2.2.

DISCHARGE DIAGNOSES:
1.  Adenocarcinoma of the cervix, stage IA2.
2.  Status post radical hysterectomy, bilateral
salpingo-oophorectomy, and lymphadenectomy; complicated by
pulmonary embolus and hemoperitoneum.

MEDICATIONS ON DISCHARGE:
1.  Coumadin 5 mg p.o. q.h.s.
2.  Dilaudid 2 mg to 4 mg p.o. q.6h.
3.  Tylenol 650 mg p.o. q.4-6h. as needed.
4.  Colace 100 mg p.o. b.i.d.
5.  Tagamet 200 mg p.r. q.8h. as needed.
6.  Premarin 1.25 mg p.o. q.d.

CONDITION AT DISCHARGE:  Condition on discharge was stable.





                          [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 4871**]

Dictated By:[**Last Name (NamePattern4) 8102**]

MEDQUIST36

D:  [**2189-8-19**]  13:25
T:  [**2189-8-25**]  19:11
JOB#:  [**Job Number 41869**]
{'Malignant neoplasm of other specified sites of cervix,Iatrogenic pulmonary embolism and infarction,Hemorrhage complicating a procedure,Hemoperitoneum (nontraumatic),Pulmonary collapse'}


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: The patient is a 38-year-old gravida 2,
para 2 presenting with a new diagnosis of cervical cancer.

PRESENT ILLNESS: The patient underwent a routine
PAP smear which revealed high-grade squamous intraepithelial
lesion and subsequently underwent a loop electrosurgical
excision procedure on [**2189-6-1**].  High-grade squamous
intraepithelial lesion revealed gland involvement present at
the ectocervical and endocervical margins.  There was also
invasive adenocarcinoma with depth of invasion of 7 mm.
There was also adenocarcinoma in situ.

MEDICAL HISTORY: Past medical history was
noncontributory.

MEDICATION ON ADMISSION: Current medications included
Triphasil.

ALLERGIES: None.

PHYSICAL EXAM: 

FAMILY HISTORY: Family history significant for mother with
breast cancer at the age of 55, and a father and sister with
melanoma.

SOCIAL HISTORY: No tobacco.  Occasional alcohol. 

### Response:
{'Malignant neoplasm of other specified sites of cervix,Iatrogenic pulmonary embolism and infarction,Hemorrhage complicating a procedure,Hemoperitoneum (nontraumatic),Pulmonary collapse'}
