Journal of the International Neuropsychological Society (2003), 9 , 815–829. Copyright © 2003 INS. Published by Cambridge University Press. Printed in the USA. DOI: 10.10170S1355617703960012 Attention deficit hyperactivity disorder andneurocognitive correlates after childhood strokeJEFFREY E. MAX,1 KATHERINE MATHEWS,2 FACUNDO F. MANES,3BRIGITTE A.M. ROBERTSON,4 PETER T. FOX,5 JACK L. LANCA
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Microsoft word - patient information gastroscopy armidale general surgery.rtfArmidale General Surgery
Patient Information regarding Gastroscopy
Gastroscopy (also called endoscopy or OGD) is an examination of the inner lining of the oesophagus
(gullet), stomach and duodenum using a thin flexible telescope (called an endoscope). A computer chip
in the end of the endoscope sends the images to a monitor (TV screen). Air is blown into the stomach to
allow the endoscope to be steered through the stomach and into the duodenum (the beginning of the
small intestine). It is possible to take biopsies (samples) as well as remove polyps (small benign
growths). During the procedure, you will lie on your left side, and you will be kept very relaxed and
sleepy with medications given through an intravenous needle. A mask will supply extra oxygen. The
procedure takes approximately 10 or 15 minutes, after which you will spend some time being monitored
in the recovery room.
When is a gastroscopy useful?
This investigation is generally used to investigate such symptoms as indigestion, upper abdominal pain,
persistent vomiting or bleeding, and to make or confirm a diagnosis (such as coeliac disease). It is also
possible to take biopsies and remove polyps (these are much less common in the stomach compared
with the bowel). Problems with swallowing due to narrowing of the oesophagus can also be treated.
Other investigations may be useful, and include barium x-rays, abdominal CT scan or ultrasound scan.
Each test (including gastroscopy) has its own strengths and limitations, but gastroscopy is the only
option allowing direct examination and tissue sampling.
What do I do about my usual medications?
You should be able to continue to take your usual medications (e.g. blood pressure and heart
medication), but there are some which may need to be stopped. Please discuss the following with your
o Aspirin (including Solprin, Astrix, Cartia) o Arthritis medications o Blood thinners, including Clopidogrel (Iscover, Plavix) and Warfarin (Coumadin, Marevan) o Diabetes medications (tablets and insulin) o Herbal remedies
Please inform the doctor about the following health problems:
Drug allergies, heart valve replacement or pacemaker, and artificial joints
Preparation for gastroscopy
You will be asked not to eat or drink anything for 6 hours before the test, to make sure that the stomach
is empty. You may be able to drink small amounts of water up to two hours before your test.
Before your gastroscopy, the surgeon will discuss the test with you and answer any questions, and you
will be asked to sign a consent form to indicate you are willing to have the test.
You will have a small needle placed in a vein in one of your arms, and the anaesthetist will give a short-
acting light anaesthetic (sedating drug). You will continue to breathe for yourself, with additional oxygen
through a mask, and the blood oxygen level will be continually monitored with a small electronic device
attached to your finger. You may not remember much about what happens during the procedure.
What happens during this procedure?
You will need to lie comfortably on your left side. The anaesthetist will inject a sedating drug into a drip
placed in your hand or arm. The sedative will make you feel very relaxed, and probably put you into a
light sleep. You are likely to have no memory of the procedure. A small mouth-guard will be put between
your teeth to allow passage of the endoscope. If you have false teeth (dentures) they will be removed
immediately before the procedure.
There will be a mask over your nose for additional oxygen, and the blood oxygen level will be continually
monitored with a small electronic device attached to your finger.
The endoscope will be placed into your mouth and directed into the oesophagus and stomach. The
endoscope is less than a centimetre in diameter and there is plenty of space to breathe around it. The
stomach is inflated with air to allow the entire lining to be seen. Small samples of tissue can be removed
(biopsies) with a special instrument during this examination – this does not cause any pain. The
procedure takes about 10 to 15 minutes.
Are there any dangers or risks involved with gastroscopy?
Serious side effects are very rare after gastroscopy, particularly when carried out by trained and
experienced personnel in a properly equipped facility. You may have some throat discomfort after the
procedure. Air may be trapped in your stomach, making you feel slightly bloated. If a biopsy has been
taken, there may be minor bleeding. The effects of the sedating drug can be unpredictable, and
breathing may be temporarily affected. For this reason, the procedure is carried out with an anaesthetist
in a fully equipped procedure room. More serious reactions to the sedative drug are rare.
The more common and important risks include the following:
o Dental injury from biting on mouth-guard – please inform the anaesthetist about caps, crowns o Lip injury (bruise or laceration) due to trapping of the lip with the guard o Regurgitation/vomiting causing aspiration (acid entering the airways) if the stomach is not fully o Technical problems preventing completion o The risk of a perforation (a puncture or tear in wall of the oesophagus or stomach), which may require admission to hospital and sometimes surgery (very rare) o Heart or lung problems as a result of the sedation drugs (e.g. heart irregularity, respiratory o Other medication effects: allergic reaction, injection site reactions, nausea, vomiting, hypotension
What to expect afterwards
You will be transferred to the recovery area and a nurse will observe you until you are fully awake. You
can usually go home after about 2 hours.
You must have someone to take you home after the gastroscopy, as you will still be affected by the
sedating drugs. You should not drive and should plan to rest for the remainder of the day.
You will be given a brief summary of the findings of the gastroscopy. If required, a follow-up appointment
will be made to discuss the test results more fully. Biopsy results take several days and copies are sent
to the referring doctor.
There may be some initial drowsiness or problems with memory within the first 24 hours following the
procedure. DO NOT DRIVE or make any important decisions during this time. Make sure that there is an
adult person who can accompany you when you leave the day surgery unit and go home.
There may be a small tender lump or bruising where the needle was placed in the vein for the sedation.
This should settle within a few days, but may last several weeks.
What happens to the results?
On the day of the procedure, you will be given a brief note explaining whether any significant abnormality
has been found, and whether biopsies have been taken. This will also notify whether you require a
further appointment. A full report of the gastroscopy will be sent directly to your referring doctor within
several days. The results of any biopsies will also be sent to your doctor.
Do I need any further tests?
As indicated above, you will have written advice about the need for an appointment with the surgeon.
Your general practitioner may wish to see you again after the gastroscopy, especially if there are
ongoing symptoms or other problems to be dealt with. Please check with your doctor regarding this.
What happens when I check in at the Hospital?
Please present to the front counter from where you will be directed to the waiting area. A nurse will see
you to complete paperwork and check your blood pressure, temperature, etc. You will then be assessed
by the anaesthetist who will confirm that you are medically fit for the gastroscopy to proceed as planned.
Are there any costs involved in having a gastroscopy?
If you have your procedure in the Armidale Rural Referral Hospital (the public hospital), this service is
provided without additional cost. For patients with private health cover, the cost is not fully covered by
the health fund, with a “gap” depending on the level of cover. (Please check this with your health fund.
There will be separate accounts from the specialist and the anaesthetist).
This written information about gastroscopy is meant to help your preparation for the procedure, and does
not take the place of advice from the referring doctor or the surgeon. Please discuss any questions or
concerns you have with your general practitioner. You will also have the opportunity of asking the
surgeon to answer your concerns before the procedure is performed.
PATENT INFRINGEMENTS AT INTERNATIONAL FAIRS CROSS-BORDER ENFORCEMENT THROUGH BELGIAN SUMMARY PROCEEDINGS IN HER RULING OF 25 MARCH 2005, THE PRESIDENT OF THE BRUSSELS DISTRICT COURT ISSUED A CROSS-BORDER INTERIM INJUNCTION AGAINST TWO COMPANIES, ONE BRAZILIAN AND THE OTHER SOUTH KOREAN, WHICH HAD INFRINGED THE PATENT RIGHTS OF THE GERMAN PHARMACEUTICAL COMPANY ALTANA PHARMA AT AN INTERNATION