Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: penicillins attending: chief complaint: presents for surgical resection of an esophageal tumor major surgical or invasive procedure: minimally invasive combined thoroscopic and laparoscopic total esophagogastrectomy. history of present illness: mr. is a 57 year old male with a history of esophageal cancer, t3n0mo diagnosed . he completed five and a half weeks of radiation and two cycles of chemotherapy, he presents for surgical resection of his tumor. past medical history: past medical history: esophageal cancer hypertension gerd diverticulitis colon polyps past surgical history: removal of venous access port placement of feeding jejuonostomy tube and venous access port ' colonoscopy tonsillectomy wrist operation social history: he lives in , is married and has one son age 13 with adhd. he is retired from work as an exercise tax auditor for the irs. no history of smoking, drinks alcohol occasionally family history: mother deceased from lung cancer father deceased from complications of copd pertinent results: post-operatively: 04:50pm blood wbc-34.0*# rbc-3.56* hgb-12.0* hct-34.3* mcv-96 mch-33.7* mchc-35.1* rdw-14.7 plt ct-278# 04:50pm blood pt-13.1 ptt-28.2 inr(pt)-1.1 04:50pm blood plt ct-278# 04:50pm blood glucose-147* urean-19 creat-0.8 na-141 k-4.7 cl-108 hco3-21* angap-17 04:50pm blood calcium-8.3* phos-4.1 mg-1.4* 09:29am blood type-art tidal v-510 fio2-100 po2-75* pco2-41 ph-7.44 caltco2-29 base xs-3 aado2-615 req o2-98 intubat-intubated vent-controlled 09:29am blood glucose-105 lactate-2.3* na-143 k-4.2 cl-106 09:29am blood hgb-13.4* calchct-40 09:29am blood freeca-1.19 discharge labs: 03:27am blood wbc-8.8 rbc-3.29* hgb-10.9* hct-32.2* mcv-98 mch-33.0* mchc-33.7 rdw-13.6 plt ct-232 05:46am blood hct-31.2* 03:27am blood plt ct-232 05:46am blood glucose-129* urean-16 creat-0.7 na-141 k-3.7 cl-102 hco3-33* angap-10 05:46am blood calcium-8.3* phos-3.3 mg-1.8 operative report preoperative diagnosis: esophageal cancer, status post chemoradiation. postoperative diagnosis: esophageal cancer, status post chemoradiation. procedure performed: minimally invasive total esophagectomy via thoracoscopy and laparoscopy. assistant: , md. anesthesia: general. indications: this gentleman has esophageal cancer and has undergone neoadjuvant treatment. he has previously undergone laparoscopy and laparoscopic jejunostomy. he presents now for definitive surgical therapy. preparation: in the operating room, the patient underwent general endotracheal anesthetic via a double-lumen tube. intravenous antibiotics were given and appropriate lines were placed. a foley catheter was placed in the bladder. he was placed in the left lateral decubitus position with the right side up. the chest was prepared with betadine solution and draped in the usual fashion. trocar placement: number 12 ports were placed anterior to the scapula in a staggered position. two #5 trocars were placed well posteriorly. findings: there was inflammatory change consistent with radiotherapy. in the thoracic portion, there was no evidence of metastatic disease nor were there any particularly concerning enlarged lymph nodes. the same was true in the abdominal portion. the tumor itself appeared to become extremely fibrotic and there was no evidence of mucosal tumor when the specimen was removed, although there was a great deal of thickening at the esophagogastric junction which could either be a complete response of scarring or submucosal tumor. procedure in detail: with 1-line ventilation, we were able to reflect the lung over anteriorly. we began the anterior portion of the esophagus by taking down the inferior pulmonary ligament up to the level of the inferior pulmonary vein. dissection was then carried out continuing superiorly. we were able to identify and clear the lymphatic tissue over toward the esophagus. we then up and cleared the azygos vein. we were able to see the spur of the carina and come down and dissect the esophagus and surrounding lymphatic tissue off of the left main-stem bronchus, clearing the subcarinal packet. we were unable to divide the azygos vein with the endo stapler. a nice envelope was created in the pleura and at the level of the azygos vein. we then started our dissection right on the esophageal muscular wall so as to avoid the recurrent laryngeal nerve and work our way up into the thoracic inlet, completely dissecting this area free. a penrose drain was placed around the esophagus and placed up in the thoracic inlet for easy identification from the neck incision. we then worked inferiorly from this area and were able to encircle the esophagus with a penrose drain to facilitate our dissection. we were able to take the posterior pleura off relatively close to the azygos vein. we purposely left the tissue right around the thoracic duct but then were able to dissect down right down onto the aorta. we were able to work down from this level down to the diaphragm. the crura were identified and the tissue around it was reflected away and kept with the esophagus. we were able to complete our dissection clearing off this area completely, seeing the azygos vein into the inferior pulmonary vein on the left, as well as the left pleura. the penrose drain was then left in the thorax very close to the diaphragm in order to facilitate dissection of the hiatus from below. hemostasis was assured. a #28 chest tube was placed. the lung was reinflated. the trocars were removed. the larger thoracic incision was closed with interrupted sutures of 0 vicryl to the musculature. the skin was closed with running subcuticular sutures of 4-0 monocryl. steri-strips and dressings were applied. the chest tube was hooked up to wall suction. we then turned our attention to the laparoscopic portion. the patient was placed in supine position. the jejunostomy tube was temporarily removed in order to maintain sterility while the abdomen was prepared in the standard sterile fashion after the patient was placed in lithotomy position. trocar placement: open technique was used to access the peritoneal cavity and to control the incision used for thelaparoscopic jejunostomy which was approximately 14 cm below the xiphoid. the abdomen was insufflated. a #5 trocar was placed laterally on the left, and #12 dilating ports were placed superiorly on the left and the midclavicular line on the right and laterally on the right. later on in the case, a #5 trocar was placed in the midclavicular line on the right. at this point, we encountered no other metastatic disease or pathologically enlarged lymph nodes . we began dissecting the omentum along the greater curvature of the stomach, making sure that we had preserved very nicely the gastroepiploic arcade. dissection was carried out with the harmonic scissors. we then moved upwards toward the short gastrics. because the patient was fairly large and our incision was a little bit on the low side, we were going to be forced to use a longer scope for the upper dissection, and therefore we went up as far as we could with our regular scope and then started from that area on the greater curve and worked towards the patient's right. we were able to get into the posterior plane behind the stomach and lift the stomach up, and come around and find the gastroepiploic origin which was preserved. we then took the intervening tissuebetween the duodenum and the colon. the duodenum was then identified and it was completely kocherized to allow for maximum mobility. the gastrohepatic omentum was then opened up to the level of the diaphragm with harmonic scissors. the right gastroepiploic artery was spared. using a longer scope, we then completed our dissection along the greater curvature, treating the short gastric vessels with the harmonic scissors, completely freeing the fundus from the left crus. the esophagus was then identified along with a penrose drain to facilitate its identification after the dissection of the left gastric artery. working from below, we were then able to identify the tissue around the left gastric artery. this was dissected to some degree and was very close to thethe pancreas. tissue was then taken with the endo stapler with a vascular load. some intervening tissue between this and the esophagus was then taken with the harmonic scissors. at this point, we were satisfied with the entire stomach had been mobilized with the exception of the uppermost portion around the hiatus, which we saved until last to prevent pressurized air entering the thoracic cavity. we then divided some of the lesser curvature mesentery using the stapler approximately 6 to 7 cm from the pylorus. we then divided the stomach and made a long gastric tube based on the right gastroepiploic artery using the endo stapler with a thick load. our true diameter was approximately 7 cm. we then moved up with serial firings and were able to effect a nice long gastric conduit. the new gastric conduit was then sutured to the specimen using 3 sutures of 2-0 silk in order to facilitate transfer through the mediastinum. we then opened the neck using a collar incision. the sternomastoid was retracted laterally and the omohyoid was divided. we were then able to get into the direct plane of the thoracic inlet. we were able to identify the penrose drain. of interest, is that we originally had a small amount of difficulty because the penrose drain was actually a lot higher than we thought it would be. our entire dissection had been completed through to the thorax. the penrose drain was pulled up and we were very satisfied that the esophagus had been nicely dissected and that were high enough to almost the level of the cricoid. with dr. at the neck position and i doing laparoscopy, we were able then to pull up the specimen of the gastric conduit through the mediastinum and up into the neck avoiding twisting by doing this under laparoscopic guidance. we had a very nice amount of stomach which was quite healthy. i should mention that just prior to this, we did complete our hiatus dissection, completely freeing the fundus and esophagus from the hiatus and pulling the penrose drain down to the mediastinum. the penrose drains were then removed prior to pulling the stomach through the thorax. we then fashioned an anastomosis using a side-to-side technique making holes in the esophagus and a stomach graft well below where the end of it was. two runs of the endo stapler were then fired. the nasogastric tube was then switched to the stomach and extra amounts of esophagus and stomach were then divided with another application of the stapler. the patient was then re-laparoscoped and the stomach was attached to the crura using interrupted sutures of 2-0 silk. the area was checked for hemostasis which was adequate. ports were then removed under direct vision without bleeding. closure: the camera port was closed with interrupted sutures of 0 vicryl to the fascia. the neck was closed with 3-0 vicryl placed to the deeper layers and staples for the skin. the abdominal skin was also closed with staples. we then attempted to replace the jejunostomy which had only been out for several hours, and i found it difficult to do so and it did not slide in easily which was extremely surprising. i did try gentle attempts with a slightly smaller tube which way in away i was not totally satisfied. i left this tube in place. the plan is for a tube study and potentially a tube replacement under fluoroscopic guidance with contrast following the surgical procedure. appropriate dressings were applied. the patient was then extubated and sent to the surgical intensive care unit in satisfactory condition, after tolerating the procedure well. drains: one #28 chest tube to the chest, 1 - drain to the neck. complications: inability to replace jejunostomy tube. estimated blood loss: 50 cc. i attest that surgeons of 2 separate specialties were required for this very complex operation. both surgeons were presentat the tableand active throughout the entire procedure. dr. had primary responsibility in the chest and i in the abdomen, and both shared responsibility in the neck. chest (portable ap) 10:53 pm reason: ccvl pulled back medical condition: 57 year old man with esophageal ca s/p esophagectomy reason for this examination: ccvl pulled back clinical indication: central line pulled back. esophagectomy. technique: ap view of the chest is submitted for interpretation. findings are compared with prior examination dated . findings: there is a right internal jugular catheter with distal tip projecting over the distal svc. ng tube is visualized with distal tip over the proximal fundus, recommend advancement. a right-sided chest tube again seen with tip projecting over the lateral right mediastinum. again noted small amount of subcutaneous emphysema projecting along the right thorax, decreased in amount from the prior examination. surgical staples again seen over the left neck region. mediastinum changes are again compatible with this patient's history of esophagectomy. unchanged plate-like atelectasis seen at the left lung base. no effusions or consolidations seen. surgical staples again seen over the upper abdomen. impression: no significant interval change. reason: please advance tube under fluoro guidance. case discussed w contrast: optiray medical condition: 57m s/p lap esophagogastrectomy, with dysfxnal j tube (pulled out...) reason for this examination: please advance tube under fluoro guidance. case discussed with dr procedure: exchange of percutaneous jejunostomy tube. clinical history: 58-year-old man status post laparoscopic esophagogastrectomy with dysfunctional jejunostomy tube. radiologists: drs. and , the attending radiologist, present and supervising throughout. description of procedure: utilizing usual aseptic precautions, the patient's jejunostomy tube was accessed. contrast was instilled by way of the jejunostomy tube outlining the distal segment of the tube within the jejunum. a 0.035-inch guide wire was then advanced through the lumen of the catheter emerging distally, and coiling within the jejunum. subsequently, the j- tube was removed over the guide wire leaving the guide wire in situ. a new, ultrathane wills- 35 cm long x 12 french jejunostomy tube was delivered over the wire. subsequent to satisfactory positioning, the catheter was sutured to the skin using a single retention suture of 2-0 silk. the site was then dressed. catheter was then capped in place. patient tolerated the procedure well without immediate complication. estimated blood loss was minimal. anesthesia: 1% xylocaine, 5 cc local infiltration at the skin entry site. impression: status post over the wire exchange of jejunostomy tube replacement with wills- 35 cm x 12 french jejunostomy tube. catheter is ready to employ. chest (portable ap) 7:14 am chest (portable ap) reason: eval ptx medical condition: 57 year old man with esophageal ca s/p esophagectomy now w/ ct on ws reason for this examination: eval ptx ap chest, 7:35 a.m. . history: esophageal carcinoma. chest tube to waterseal. impression: ap chest compared to through 11: small left pleural effusion is decreasing. left basal atelectasis has improved. no pneumothorax. mediastinum has a normal postoperative appearance, unchanged. mild distention of the neoesophagus is stable. nasogastric tube ends just below the diaphragm. right supraclavicular central venous catheter ends in the low svc. heart size normal. chest (pa & lat) 2:15 pm reason: please eval for interval change, ptx s/p ct d/c medical condition: 57m s/p esophagogastrectomy, chest tube now d/c reason for this examination: please eval for interval change, ptx s/p ct d/c chest, pa and lateral indication: status post esophagectomy, chest tube now discontinued. evaluate for interval changes. findings: ap and lateral views obtained with patient in sitting upright position and analyzed in direct comparison with similar preceding study of . the patient is status post esophagectomy and pull-through. surgical subcutaneous clips still seen overlying the left apical mediastinal area. during the latest interval, the right-sided chest tube and the right internal jugular approach central venous line have been removed. the previously described residual apical pneumothorax persists but has decreased in size and measures now approximately 2 cm. no other new abnormalities have developed. plate atelectasis remains on left base and obliteration of lower descending aortic contour is suggestive of postoperative atelectasis in left lower lobe. no new abnormalities have developed in the pulmonary fields and no evidence of pulmonary congestion is present. impression: persistent slightly smaller right apical pneumothorax. no new pulmonary abnormalities after removal of tubes and line. brief hospital course: there were no intra-operative complications and he was transferred to the surgical intensive care unit with a foley catheter, right sided chest tube, nasogastric tube, jejunostomy feeding tube, and drainage tube. post-operatively he was managed by the general surgical team and thoracic surgery team. he required intravenous fluid bolussing for low urine output and mild hypotension; a levophed drip was also started which he was weaned off successfully. pod 1 he had an episode of desaturation and tachycardia after being transferred from the bed to a chair, an electrocardiogram showed no acute changes and cardiac enzymes were negative. he was started on beta-blockade at this time. his desaturation improved with aggressive pulmonary toileting. on pod 4 his jejunostomy tube was noted to be leaking when his tube feeds were started, it was found to be mal-positioned under fluoroscopy and was re-positioned in interventional radiology without difficulty. on pod 4 he was transferred to an in-patient nursing unit, he remained afebrile and was oxygenating well on nasal cannula. his chest x-ray demonstrated a moderate left sided pleural effusion with atelectasis, no pneumothorax; the thoracic service maintained the chest tube to wall suction. on pod 5 he had +flatus, +bowel movement and a swallow study which demonstrated no leak from the surgery; his nasogastric tube was removed and his diet was advanced which he tolerated. on pod 6 his chest tube and was removed by thoracic surgery, a follow-up x-ray demonstrated no pneumothorax. on pod 7 his abdominal incision was noted to be reddened without drainage, he was started on kefzol which he will continue for five days. he was discharged home on with visiting nurse services via healthcare. at the time of discharge his pain was well controlled with oxycodone elixir, he remained afebrile and was tolerating both a clear liquid diet and tube feeds. he received diet counseling from the nutrition department regarding his diet and will continue tube feeds at home. he will follow-up in one to two weeks with the general surgery and thoracic surgery clinics. medications on admission: prevacid 30mg maalox prn tylenol prn discharge medications: 1. ipratropium bromide 17 mcg/actuation aerosol sig: two (2) puff inhalation qid (4 times a day). disp:*1 inhaler* refills:*2* 2. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation q6h (every 6 hours) as needed. disp:*1 inhaler* refills:*0* 3. oxycodone-acetaminophen 5-325 mg/5 ml solution sig: 5-10 mls po q4-6h (every 4 to 6 hours) as needed for pain. disp:*500 ml(s)* refills:*0* 4. metoprolol tartrate 25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*2* 5. prevacid 30 mg susp,delayed release for recon sig: one (1) po twice a day. disp:*60 * refills:*2* 6. keflex 250 mg/5 ml suspension for reconstitution sig: five (5) ml po four times a day for 5 days: give into feeding tube. disp:*100 ml* refills:*0* discharge disposition: home with service facility: home health and hospice of discharge diagnosis: esophageal cancer discharge condition: good discharge instructions: notify your md or return to the emergency department if you experience: *increased or persistent pain not relieved by pain medications *fever > 101.5 *shortness of breath or difficulty breathing *nausea or vomiting *inability to pass gas or stool *if incision appears red, warm to touch, or if there is drainage *if feeding tube leaks, is blocked, or if it pulls out *you were started on a medication for your heart rate which was elevated after surgery, this may cause dizziness and light-headness. if you experience this hold off taking the metoprolol. *any other symptoms concerning to you you may shower and wash incision with soap and water, pat dry. please cover feeding tube entry site with a small plastic bag and tape. no swimming or tub baths while you have the feeding tube avoid lifting more than 5 lbs and abdominal stretching for 4 weeks followup instructions: follow-up with your pcp 1 week, please bring the list of medications that you were discharged with for review. follow-up with dr. in weeks, call for an appointment. follow-up with dr. in weeks, call ( for an appointment procedure: enteral infusion of concentrated nutritional substances transpleural thoracoscopy total esophagectomy replacement of tube or enterostomy device of small intestine diagnoses: anemia, unspecified mitral valve disorders secondary malignant neoplasm of other specified sites iatrogenic pneumothorax secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes malignant neoplasm of cardia 

Answer: The patient is high likely exposed to