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: patient recorded as having no known allergies to drugs attending: chief complaint: aortoiliac atherosclerosis with disabling claudication major surgical or invasive procedure: aorta biprofunda bypass with post-op nstemi history of present illness: this 66-year-old gentleman with severe peripheral vascular disease has severe disabling claudication in both of his extremities. he has had a previous femoral- femoral graft which has failed. he underwent an arteriogram which showed his aorta to be diseased. his right common iliac artery was ectatic and ended at the internal iliac artery with no external iliac artery on that side. on the left side, his entire iliac system is totally occluded with a very large profunda femoris artery reconstituting collaterals in the groin. both common femoral arteries also totally occluded. because of the extent of his disease and his severe symptoms, he was advised of an aortobifemoral bypass. past medical history: cad copd pvd s/p peripheral revascularization in ?fem-fem () niddm htn "hepatitis" >20 yrs ago + tob abuse + etoh abuse ef 20-25% social history: social history is significant for the presence of current tobacco use. there is history of alcohol abuse. lives alone. has one daughter ( ). retired family history: there is no family history of premature coronary artery disease or sudden death. physical exam: vs: 98.5 p: 85 bp 143/66 rr: 23 spo2: 93% ra general: nad neuro: alert and oriented x 3 cards: rrr, sr on tele lung: cta bilaterally abdominal: soft, nt, nd wounds: midline abdominal incision cdi. bilateral groin incision cdi with staples, without signs/symptoms of infection. pulses: femoral palp bilaterally dp, pt bilaterally pertinent results: 05:15am blood wbc-7.1 rbc-3.38* hgb-10.7* hct-30.2* mcv-89 mch-31.6 mchc-35.4* rdw-15.0 plt ct-128*# 05:15am blood plt ct-128*# 05:45am blood glucose-137* urean-17 creat-1.3* na-136 k-3.6 cl-100 hco3-26 angap-14 03:35am blood ck(cpk)-184* 03:35am blood ctropnt-0.52* 05:45am blood calcium-8.6 phos-3.7 mg-2.1 03:35am blood ammonia-13 08:27am blood tsh-5.2* blood culutures pending 2:59 pm sputum site: expectorated source: expectorated. **final report ** gram stain (final ): >25 pmns and <10 epithelial cells/100x field. 2+ (1-5 per 1000x field): gram positive cocci. in pairs, chains, and clusters. 2+ (1-5 per 1000x field): gram negative rod(s). respiratory culture (final ): sparse growth oropharyngeal flora. 4:13 pm blood culture source: line-artearial. aerobic bottle (pending): anaerobic bottle (final ): reported by phone to , on @2051 . staphylococcus, coagulase negative. isolated from one set only. sensitivities performed on request. operative report , b. **not reviewed by attending** name: , unit no: service: date: date of birth: sex: m surgeon: , md 2287 preoperative diagnosis: aortoiliac occlusive disease with severe claudication and failed femoral-femoral bypass. postoperative diagnosis: aortoiliac occlusive disease with severe claudication and failed femoral-femoral bypass. procedure: aortobifemoral bypass with 16 x 8 dacron graft, proximal aortic and left renal endarterectomy and reimplantation of inferior mesenteric artery into the graft. assistant: . anesthesia: general endotracheal. estimated blood loss: 800 cc. complications: none. indications: this 66-year-old gentleman with severe peripheral vascular disease has severe disabling claudication in both of his extremities. he has had a previous femoral- femoral graft which has failed. he underwent an arteriogram which showed his aorta to be diseased. his right common iliac artery was ectatic and ended at the internal iliac artery with no external iliac artery on that side. on the left side, his entire iliac system is totally occluded with a very large profunda femoris artery reconstituting collaterals in the groin. both common femoral arteries also totally occluded. because of the extent of his disease and his severe symptoms, he was advised of an aortobifemoral bypass. procedure: under adequate general tracheal anesthesia the abdomen and groins were prepped and draped in the usual sterile fashion. the old groin incisions were opened. there was extensive scar formation in the groins. ultimately the 2 femoral anastomoses of the -tex femoral-femoral graft were encountered. the graft was divided close to the femoral arteries. the common deep and superficial femoral arteries were dissected out on both sides and encircled with vessel loops. the common and superficial femoral arteries were chronically occluded. the profunda femoris artery was the only artery available for outflow. on the right side the profunda femoris artery took off high and took an unusual medial course to the superficial femoral artery, and in fact it appeared as though the femoral-femoral bypass had been implanted on the right into the superficial femoral artery. on the left side the common femoral and superficial femoral arteries were occluded, the graft was into the common femoral artery. the profunda femoris artery was calcified proximally, was soft distally, but somewhat small in caliber. tunnels were created under the inguinal ligaments into the retroperitoneal space and the femoral grafts were completely removed from the femoral arteries where they had been attached and the artery over sewn with 5-0 prolene sutures. we then made a xiphoid to pubis midline abdominal incision and entered the abdomen without difficulty. the sigmoid colon was pulled superiorly and the viscera retracted to the right. the ligament of treitz was incised and the abdominal aorta was exposed from the crossing left renal vein to the iliac bifurcation. the aorta was heavily calcified and there appeared to be one area proximally near the renal arteries which was relatively soft and appeared as safe to clamp. there was a low-lying left renal artery which was actually known to be 1 of 2 left renal arteries on that side. we decided to incorporate this renal artery into a beveled anastomosis proximally. i had initially given some thought to an end-to-side anastomosis because there was a very large inferior mesenteric artery distally, but in seeing the aorta, felt that it was too diseased for anything other than end-to-end anastomosis. we dissected out the very large inferior mesenteric artery encircled with vessel loop, as well as the left renal artery. we then created retroperitoneal tunnels between the groins and this dissection. the patient was then heparinized and proximal distal control was obtained. the aorta was transected in an oblique fashion with the high end of the oblique cut tracking towards the right side, and the left lower end cut below the left renal artery. a large amount of atheromatous debris and plaque was found in the aorta and this was carefully endarterectomized including plaque in the origin of the left renal artery. the wall of the aorta was then extraordinarily thin after doing this, particularly on the right side. a 16 x 8 dacron graft was taken, it was beveled proximally to match the oblique cut in the aorta. we then did an end-to-end anastomosis using a running continuous suture of 4-0 prolene with the entire anastomosis buttressed with a felt strip around the entire anastomosis. once this was done, it was tested and found to be hemostatic. flow through the 2 iliac limbs was quite good. we then pulled the graft limbs through the respective retroperitoneal tunnels into proximity with the femoral arteries. warm ischemic time was less than 30 minutes on the left renal artery which now had an excellent doppler signal present within it. we then ligated the inferior mesenteric artery flush with the aorta and separated it from the aorta. we over sewed the distal end of the aorta with a running continuous suture of 3- 0 prolene in 2 layers. using a coronary aortic punch, a hole was made in the aortic component of the graft. the inferior mesenteric artery was beveled and an end-to-side anastomosis was fashioned between the and the aortic graft with running continuous 5-0 prolene suture. flow was reestablished into the which had an excellent doppler signal present within it. we then turned our attention into the groins. these were quite bloody because of the heavy scar tissue that had been divided to expose the artery. proximal and distal control was obtained on the left profunda femoris artery which actually was a reasonably large artery. there was a fair amount of disease in it when the arteriotomy was made and extensive long arteriotomy was made until the soft normal distal portion of the artery was encountered. we then trimmed and beveled the right limb of the aortobifemoral graft and performed a long end-to-side anastomosis with 5-0 prolene sutures from either end. flow was reestablished into the right limb after flushing the graft and this was done without difficulty. attention was turned to the left side and proximal and distal control obtained on the profunda femoris artery again and a 2nd arteriotomy was made. backbleeding from this profunda femoris artery was quite good, but there was absolutely no antegrade bleeding whatsoever. the left limb of the graft was then trimmed and spatulated and a 2nd end-to-side anastomosis fashioned again with 5-0 prolene sutures from either end. flow was reestablished in identical fashion. the patient's blood pressure dropped a little with the 2nd anastomosis and responded to volume replacement. we then returned our attention to the abdomen was some oozing from the retroperitoneal bed which had been fairly extensively dissected to allow the anastomosis that was created in the aorta. some bleeding lumbar venous branches were clipped. other areas electrocoagulated with cautery. the heparin was fully reversed with protamine. the retroperitoneal tissue was then closed over the aortic graft with running continuous 3-0 prolene suture from either end. the peritoneum was reperonitonealized because of the oozing with a 2-0 vicryl suture. all blood was washed out of the pelvic gutter. the viscera returned to their normal position. prior to doing this doppler interrogation demonstrated good flow in the , the left renal and also the right renal artery. all packs and retractors were removed. sponge and lap count was done and the midline fascia closed with a running continuous suture of double-stranded #1 pds from either end. groins were closed then in multiple layers after securing hemostasis with interrupted and running sutures of 2-0 vicryl and the skin was closed with skin staples. the patient tolerated this lengthy and difficult procedure well, a dry sterile dressing was applied and the patient was taken to the recovery room still intubated, but in stable condition, all counts having been reported correct. , dictated by: brief hospital course: taken to the or for end-to-end aortabiprofunda bypass w/ graft reimplantation. see attached operative note. received 4 units pbc for hct 29.9. transferred to icu. blood pressure stable and pain controlled. pod #1 vitals stable.pain management and bp control. npo until hct stable. transferred to vicu. cardiology consulted for elevated post-op troponin. ruled in for nstemi and was treated with iv beta blockers, asa and high dose statin. cards recommended medical management with no evidence of acute hf. aggressive ativan given for etoh withdrawal. a code purple was called when the patient became suddenly agitated and aggressive. psych was consulted. haldol tid initiated. psych following for etoh withdrawal. abgs within normal limits. ciwa protocol. cardiology following. transferred back to cvicu for increased agitation, htn and tachycardia. restrained for patient safety. monitored in cvicu. continued on haldol,. transfused 1 unit prbcs. sputum culture 2+ gram -/+, started on zosyn. psych eval better, now fully oriented. consulted for dm control. lantus dose increased. vanco started for + blood cx. cleared by physical therapy for home. vs stable. transferred back to floor. post-op delirium improved. no acute events. discharge planning. follow-up with dr. in 1 week, will have staples removed at that time. pcp , for post-mi follow-up in 2 weeks. will fax dc summary to pcp and office visit. medications on admission: asa 81', furosemide 40', lisinopril 5', lopressor 50'', plavix 75', lantus 26u hs. discharge medications: 1. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). 2. furosemide 40 mg tablet sig: one (1) tablet po daily (daily). 3. metoprolol tartrate 50 mg tablet sig: one (1) tablet po bid (2 times a day). 4. atorvastatin 20 mg tablet sig: one (1) tablet po daily (daily). 5. clopidogrel 75 mg tablet sig: one (1) tablet po daily (daily): continue to take medication per cardiac surgery recommendations. 6. nicotine 14 mg/24 hr patch 24 hr sig: one (1) patch 24 hr transdermal daily (daily). 7. pantoprazole 40 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po q24h (every 24 hours). 8. insulin glargine 100 unit/ml cartridge sig: 18 units subcutaneous at bedtime. 9. insulin insulin sc sliding scale breakfast lunch dinner bedtime humalog glucose insulin dose insulin dose insulin dose insulin dose 0-50 mg/dl 1 amp d50 1 amp d50 1 amp d50 1 amp d50 51-120 mg/dl 0 units 0 units 0 units 0 units 121-160 mg/dl 3 units 3 units 3 units 0 units 161-200 mg/dl 6 units 6 units 6 units 0 units 201-240 mg/dl 8 units 8 units 8 units 3 units 241-280 mg/dl 10 units 10 units 10 units 6 units 281-320 mg/dl 12 units 12 units 12 units 8 units 321-360 mg/dl 12 units 12 units 12 units 8 units 361-400 mg/dl 14 units 14 units 14 units 10 units > 400 mg/dl notify m.d. 10. lisinopril 5 mg tablet sig: one (1) tablet po once a day. discharge disposition: home discharge diagnosis: coronary artery disease peripheral vascular disease copd niddm hypertension post-op nstemi discharge condition: stable discharge instructions: division of vascular and endovascular surgery discharge instructions medications: ?????? take aspirin 325mg (enteric coated) once daily ?????? do not stop aspirin unless your vascular surgeon instructs you to do so. ?????? continue all other medications you were taking before surgery, unless otherwise directed ?????? you make take tylenol or prescribed pain medications for any post procedure pain or discomfort what to expect when you go home: it is normal to have slight swelling of the legs: ?????? elevate your leg above the level of your heart (use pillows or a recliner) every 2-3 hours throughout the day and at night ?????? avoid prolonged periods of standing or sitting without your legs elevated it is normal to feel tired and have a decreased appetite, your appetite will return with time ?????? drink plenty of fluids and eat small frequent meals ?????? it is important to eat nutritious food options (high fiber, lean meats, vegetables/fruits, low fat, low cholesterol) to maintain your strength and assist in wound healing ?????? to avoid constipation: eat a high fiber diet and use stool softener while taking pain medication what activities you can and cannot do: ?????? when you go home, you may walk and go up and down stairs ?????? you may shower (let the soapy water run over groin incision, rinse and pat dry) ?????? your incision may be left uncovered, unless you have small amounts of drainage from the wound, then place a dry dressing or band aid over the area that is draining, as needed ?????? no heavy lifting, pushing or pulling (greater than 5 lbs) for 1 week (to allow groin puncture to heal) ?????? after 1 week, you may resume sexual activity ?????? after 1 week, gradually increase your activities and distance walked as you can tolerate ?????? no driving dr. will discuss the plan for driving in the future in your follow-up appointment ?????? call and schedule an appointment to be seen in 1 week for post procedure check and staple removal what to report to office: ?????? numbness, coldness or pain in lower extremities ?????? temperature greater than 101.5f for 24 hours ?????? new or increased drainage from incision or white, yellow or green drainage from incisions ?????? bleeding from groin puncture site sudden, severe bleeding or swelling (groin puncture site or incision) ?????? lie down, keep leg straight and have someone apply firm pressure to area for 10 minutes. if bleeding stops, call vascular office. if bleeding does not stop, call 911 for transfer to closest emergency room. do not return to work. follow-up with dr. at office visit for plans to return to work. followup instructions: please call to follow-up with dr. on thursday for an office visit. you will have your staples removed at that time. follow-up with your pcp 2 weeks ,vartan procedure: aorta-iliac-femoral bypass transfusion of packed cells other repair of vessel endarterectomy, aorta endarterectomy, abdominal arteries procedure on two vessels diagnoses: subendocardial infarction, initial episode of care congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled chronic airway obstruction, not elsewhere classified cardiac complications, not elsewhere classified atherosclerosis of aorta surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation other complications due to other vascular device, implant, and graft chronic systolic heart failure 

Answer: The patient is high likely exposed to