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: cortisone attending: chief complaint: reflux with barretts major surgical or invasive procedure: 1. minimally-invasive esophagectomy with intrathoracic anastomosis. 2. laparoscopic jejunostomy. 3. buttressing of intrathoracic anastomosis with thymic fat pad. history of present illness: 70 m referred for evaluation of esophageal adenocarcinoma. he has a history of gerd and esophagus (first diagnosed in ) and underwent a surveillance egd in which demonstrated a focus adenocarcinoma. he has undergone multiple other endoscopic procedures by dr. , but unfortunately on a recent endoscopy he was noted to have invasive adenocarcinoma. on this most recent biopsy on , the invasive component extended at least to the muscularis mucosa. he was admitted to the hospital for resection. past medical history: esophageal cancer s/p esophagectomy cad s/p pci 14 years ago gib gastritis/duodenal ulcer dm htn dyslipidemia gerd h/o duodenal ulcer s/p inguinal hernia repair social history: former smoker - quit no etoh no drugs family history: no ca, no cad physical exam: bp: a) 132/68; b) 132/68. heart rate: a) 65; b) 65. weight: a) 254.1; b) 254.1. height: a) 68.5; b) 68.5. bmi: 38.1. temperature: a) 98; b) 98. resp. rate: a) 16; b) 16. pain score: a) 0; b) 0. o2 saturation%: a) 97; b) 97. general all findings normal wn/wd nad aao abnormal findings: obese heent all findings normal nc/at eomi perrl/a anicteric op/np mucosa normal tongue midline palate symmetric neck supple/nt/without mass trachea midline thyroid nl size/contour abnormal findings: respiratory all findings normal cta/p excursion normal no fremitus no egophony no spine/cvat abnormal findings: cardiovascular all findings normal rrr no m/r/g no jvd pmi nl no edema peripheral pulses nl no abd/carotid bruit abnormal findings: gi all findings normal soft nt nd no mass/hsm no hernia abnormal findings: gu deferred all findings normal nl genitalia nl pelvic/testicular exam nl dre abnormal findings: neuro all findings normal strength intact/symmetric sensation intact/ symmetric reflexes nl no facial asymmetry cognition intact cranial nerves intact abnormal findings: ms all findings normal no clubbing no cyanosis no edema gait nl no tenderness tone/align/rom nl palpation nl nails nl abnormal findings: lymph nodes all findings normal cervical nl supraclavicular nl axillary nl inguinal nl abnormal findings: skin all findings normal no rashes/lesions/ulcers no induration/nodules/tightening abnormal findings: psychiatric all findings normal nl judgment/insight nl memory nl mood/affect abnormal findings: pertinent results: 11:00am wbc-9.1 rbc-4.90 hgb-14.4 hct-43.5 mcv-89 mch-29.4 mchc-33.1 rdw-14.0 11:00am neuts-68.1 lymphs-22.6 monos-4.3 eos-4.4* basos-0.7 11:00am plt count-241 11:00am pt-10.2 ptt-33.3 inr(pt)-0.9 11:00am urea n-14 creat-0.7 sodium-137 potassium-4.9 chloride-99 total co2-30 anion gap-13 pathology diagnosis: i. esophagus and proximal stomach, esophagogastrectomy (a-ak): a. esophageal adenocarcinoma; well differentiated, with invasion into the superficial submucosa (pt1b); see synoptic report. b. twenty two lymph nodes with no carcinoma seen (0/22). c. single focus of lymphatic invasion identified and confirmed with d2-40 immunostain (block f). d. resection margins free of carcinoma. ii. lymph node, level 7, excision (): one lymph node with no carcinoma seen (0/1). iii. gastric fundus, excision (am-an): segment of gastric fundus, within normal limits; no carcinoma seen. iv: esophagus, "donut", excision (ao-ap): unremarkable segment of squamous-lined esophagus; no carcinoma seen. v. stomach, "donut", excision (aq): unremarkable fundic mucosa/submucosa; no carcinoma seen. cxr ; 1) compared with earlier the same day, improvement in chf findings and in the right pleural effusion. 2) patchy opacities throughout the right lung slightly improved, but persistent. 3) left lower lobe collapse and/or consolidation and small left effusion unchanged cxr : 1. moderate right and small left pleural effusion unchanged. 2. stable post-operative widening of the mediastinum due to fluid filling the neoesophagus. 3. moderate bibasilar atelectasis, unchanged. 4. no pneumothorax. 5. heart size normal cardiac echo : the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. left ventricular wall thickness, cavity size, and global systolic function are normal (lvef>55%). due to suboptimal technical quality, a focal wall motion abnormality cannot be fully excluded. there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the diameters of aorta at the sinus, ascending and arch levels are normal. there is no aortic valve stenosis. no aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. trivial mitral regurgitation is seen. the pulmonary artery systolic pressure could not be determined. there is no pericardial effusion. brief hospital course: mr. was admitted to the hospital and taken to the operating room where he underwent a minimally invasive esophagogastrectomy. he tolerated the procedure well and returned to the sicu in stable condition. he required reintubation for hypercarbia but was easily extubated on post op day #1. he maintained stable hemodynamics and his pain was controlled with an epidural catheter. during his icu stay he developed rapid atrial fibrillation and was started on lopressor and amiodarone which eventually controlled his rate. he had low grade fevers and a leukocytosis to 14.7k with chest xray findings of bibasilar opacities. he was started on vanco and zosyn prophylactically but sputum culture grew only a sparse growth of gnr's. he continued to progress daily and was started of cyclic tube feedings on . unfortunately his blood sugars were not controlled and the service was consulted to help with insulin recommendations as pre operatively he was managed with metformin alone. he was started on lantus along with sliding scale regular insulin and with gradual adjustments came into better control. following transfer to the surgical floor his nasogastric tube was removed and he had a barium swallow on post op day # 8 which revealed no leak. he was also evaluated by the cardiology service as he had persistent bouts of atrial fibrillation sometimes as high as 140 but was asymptomatic. his amiodarone dose was increased to tid and anticoagulation was recommended with baby aspirin daily along with coumadin as his score was 3. his pcp . was out of town but his office staff was very helpful in reviewing his past history as there was a question of a gi bleed on aspirin in . our cardiologist recommendations remained the same pending review by dr. who knows mr. very well. on his amiodarone was decreased to 200 mg for 1 month then 200 mg daily.he also was diuresed with lasix 20 mg daily with dramatic effect on his peripheral edema and therefore was discharged on lasix 20 mg daily for 3 days. his renal function is normal and his last potassium on was 4.2. he will have a potassium checked on . from a pulmonary standpoint he used his incentive spirometer effectively and his oxygen was gradually weaned off. he was up and ambulating independently and well motivated to improve. both he and his wife were taught insulin administration as well as care of his feeding tube including flushing and starting and stopping feedings. he was discharged home on with vna services for nursing and physical therapy. medications on admission: atenolol 50mg', lisinopril 5mg', metformin 1000mg'', omeprazole 40 mg'', pioglitazone 45mg', simvastatin 20mg qhs, cyanocobalamin 1000mg', centrum silver' discharge medications: 1. acetaminophen 650 mg/20.3 ml solution sig: twenty (20) mls po q6h (every 6 hours) as needed for pain/fever. disp:*500 mls* refills:*1* 2. metoprolol tartrate 25 mg tablet sig: one (1) tablet po tid (3 times a day). disp:*90 tablet(s)* refills:*2* 3. warfarin 2 mg tablet sig: one (1) tablet po once daily at 4 pm. disp:*30 tablet(s)* refills:*2* 4. oxycodone 5 mg/5 ml solution sig: 5-10 mls po q4h (every 4 hours) as needed for pain. disp:*500 mls* refills:*0* 5. aspirin 81 mg tablet, chewable sig: one (1) tablet, chewable po daily (daily). 6. omeprazole 20 mg capsule, delayed release(e.c.) sig: two (2) capsule, delayed release(e.c.) po bid (2 times a day). 7. ondansetron 4 mg tablet, rapid dissolve sig: one (1) tablet, rapid dissolve po q8h (every 8 hours) as needed for nausea. disp:*8 tablet, rapid dissolve(s)* refills:*1* 8. colace 60 mg/15 ml syrup sig: twenty (20) mls po twice a day: hold for loose stools. disp:*250 mls* refills:*2* 9. nystatin 100,000 unit/g cream sig: one (1) appl topical (2 times a day): to right axilla. disp:*1 tube* refills:*0* 10. insulin glargine 100 unit/ml solution sig: forty (40) units subcutaneous once a day. disp:*1 vial* refills:*2* 11. insulin regular human 100 unit/ml solution sig: 0-10 units injection four times a day: per sliding scale. disp:*1 vial* refills:*2* 12. insulin syringe ultrafine ml 29 x syringe sig: one (1) syringe miscellaneous once a day. disp:*1 box* refills:*2* 13. alcohol prep swabs pads, medicated sig: one (1) pad topical once a day. disp:*1 box* refills:*2* 14. tube feedings glucerna 250 mls 5 cans daily for cycled tube feedings at 65 ml per hour over 18 hours 15. amiodarone 200 mg tablet sig: one (1) tablet po bid (2 times a day): for 4 weeks then decrease to daily. disp:*60 tablet(s)* refills:*2* 16. atorvastatin 80 mg tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 17. furosemide 20 mg tablet sig: one (1) tablet po daily (daily) for 3 days. disp:*3 tablet(s)* refills:*2* discharge disposition: home with service facility: vna discharge diagnosis: esophageal cancer atrial fibrillation pneumonia discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - requires assistance or aid (walker or cane). discharge instructions: call dr office if you experience: -fevers greater than 101 or chills -increased shortness of breath, cough or chest pain -nausea, vomiting (take anti-nausea medication) -increased abdominal pain -incision develops drainage pain -roxicet via j-tube or orally as needed for pain -take stool softners with narcotics activity -shower daily. wash incision with mild soap & water, rinse, pat dry -no tub bathing, swimming or hot tub until incision healed -no driving while taking narcotics -no lifting greater than 10 pounds until seen -walk 4-5 times a day for 10-15 minutes increase to a goal of 30 minutes daily diet: tube feeds: glucerna full strength 50 ml x 18 hrs flush j-tube with water every 8 hours with 1 cup of water, before and after starting tube feeds and giving medications through tube full liquid diet, may increase to soft solids over the next few days as tolerated. eat small frequent meals. sit up in chair for all meals and remain sitting for 30-45 minutes after meals daily weights: keep a log bring with you to your appointment no carbonated drinks check blood sugars 4 times a day and record. follow sliding scale regular insulin chart to cover your blood sugars 4 times a day. the vna will continue to review insulin teaching and administration. bring your blood sugar record to your appointment with dr. . you blood will need to be tested frequently while we adjust the coumadin. the vna will draw an inr on thursday with results to dr. office c/ at . dr. will take over adjusting the dose next week. danger signs fevers > 101 or chills increased shortness of breath, cough or chest pain incision develops drainage nausea, vomiting (take anti-nausea medication) increased abdominal pain call if j-tube falls out (save the tube and bring with you to the hospital to be re-placed) or suture breaks followup instructions: department: hematology/oncology when: tuesday at 9:30 am with: , md building: sc clinical ctr campus: east best parking: garage please report 30 minutes prior to your appointment to the radiology department on the of the clinical center for a chest xray. dr. office will call you tuesday or wednesdayto set up appointment for next week. procedure: other enterostomy enteral infusion of concentrated nutritional substances partial esophagectomy intrathoracic esophagogastrostomy diagnoses: pneumonia, organism unspecified acidosis coronary atherosclerosis of native coronary artery esophageal reflux congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled cardiac complications, not elsewhere classified atrial fibrillation other and unspecified hyperlipidemia long-term (current) use of insulin acute diastolic heart failure malignant neoplasm of other specified part of esophagus 

Answer: The patient is high likely exposed to