CONTACTS
SUBJECTS
Default Null Subject Account for Blank Record
0403 -
0403 - ..
0404 - Summary/Objective
0405 -
040501 - Follow up ref SDS 16 0000. ref SDS 15 0000.
040502 -
040503 -
040504 -
040506 - ..
040507 - On 160622 1428 letter notified Doctor Yoo and Doctor
040508 - Simpson that hiking to support line of care for stroke-like
040509 - symptoms went well; reported minor neurapathy in left
040510 - fingers of left hand occurred and subsided for short
040511 - periods throughout the hike.; also reported new MCL injury
040512 - right knee will prevent hiking for 10 days or more.
040513 - ref SDS 17 5F6F
040515 - ..
040516 - On 160622 1802 Doctor Simpson called to follow up this letter on work
040517 - plan in relation to stroke symptoms; he was pleased Zio XT heart
040518 - monitor was installed the day before stroke symptoms occurred, so
040519 - affect on heart rythms can be evaluated. ref SDS 18 LK5I
040520 -
040521 -
040522 -
040524 - ..
0406 -
0407 -
0408 - Progress
0409 -
040901 - On 160617 0800 EGD dilation procedure performed by Doctor Lee in GI
040902 - Clinic at VA Medical Center in Sacramento. 160617 0800, ref SDS 10
040903 - 0001 After the procedure, experienced stroke symptoms reported also
040904 - on 160617 1637. ref SDS 11 5F6F
040906 - ..
040907 - MRI angiogram radiology study of the brain was performed the next day
040908 - on 160618 1348. ref SDS 13 PX8M
040910 - ..
040911 - Doctor Yoo advised that MRA shows film of fluid inflammation across a
040912 - "large" section of the brain. ref SDS 12 MX8L The doctor said this
040913 - could be caused by...
040914 -
040915 - 1. Bacteria
040916 - 2. Virus infection
040917 - 3. Tumor/cancer growth
040919 - ..
040920 - The MRI neuroradiologist report lists findings of...
040921 -
040922 - 1. MRI brain:
040923 -
040924 - 1. No hemorrhage, herniation hydrocephalus. ref SDS 13
040925 - WK7K
040927 - ..
040928 - 2. Right superior cerebellar focus of reduced diffusion,
040929 - without significant hypointensity on ADC map. There is
040930 - associated focal FLAIR signal hyperintensity and
040931 - enhancement compatible with a likely subacute right SCA
040932 - territory infarct. ref SDS 13 IY8H
040934 - ..
040935 - 3. Diffuse right holohemispheric subarachnoid enhancement,
040936 - predominantly in the right frontal and right occipital
040937 - lobes. ref SDS 13 GM8M
040939 - ..
040940 - 2. MRA:
040941 -
040942 - 1. No hemodynamically significant stenosis. Likely left
040943 - anterior choroidal artery infundibulum. Fetal type
040944 - right PCA. ref SDS 13 VN4G
040945 -
040946 - 2. Aortic arch and branch vessels are patent. ref SDS 13
040947 - J738
040948 -
040950 - ..
040951 - Since symptoms followed EGD dilation with conscious sedation, the
040952 - question arises whether stroke symptoms sometimes occur after such
040953 - procedures.
040955 - ..
040956 - Research found...
040957 -
040958 - American Society for Gastrointenstinal Endoscopy
040959 - Volume 44, No 7, 2002
040960 -
040961 - Page 784
040963 - ..
040964 - Complications of upper GI endoscopy
040965 -
040966 - Major complications related to diagnostic procedures can be
040967 - broken down into cardioplumonary complications, complications
040968 - related to sedation, infectious complications, perforation, and
040969 - bleeding.
040971 - ..
040972 - Cardiopulmonary Complications/
040973 - Complications Related to Sedation
040975 - ..
040976 - Cardiopulmonary complicatinos related to sedation and analgesia
040977 - are the most common type of complications seen with diagnostic
040978 - endoscopy, accounting for up to 46% of those reported in the
040979 - above-mentioned ASGE survey were related to sedation.
040980 -
040981 - [On 160911 0908 further research explains types of uses for
040982 - gastroscope instruments for endoscopy procedures.
040983 - ref SDS 22 FB3N
040985 - ..
040986 - These complications range from minor changes in vital signs to
040987 - myocardial infarctions, respiratory depression, and
040988 - shock/hypotension. Additionally, with the introduction of
040989 - pulse oximetry, a greater number of nonclinically relevant
040990 - evetns have been reported. It is estimated that oxygen
040991 - desaturation may occur in up to 70% of patients undergoing
040992 - various endoscopic examinations; more sever desaturation
040993 - occurs less commonly. Factors leading to oxygen desaturation
040994 - include difficulty with intubation, which may be related to the
040995 - size of the endoscope. Patient factors include age and history
040996 - of cardiovascular/pulmonary disease. Complications may arise
040997 - related to the procedure itself, such as vasovagal reflex
040998 - secondary to the intubation process and/or to overinsufflation
040999 - of air.
041000 -
041002 - ..
041003 - Infectious Complications
041004 -
041005 - Infectious complications related to diagnostic endoscopy
041006 - result either from the procedure itself or from the use of
041007 - contaminated equipment. Transient bacteremia may occur during
041008 - a diagnostic endoscopic procedure and is found more often for
041009 - therapeutic procedures. The incidence is relatively low and
041010 - the rate of bacterial endocarditis or other complications in
041011 - patients not at risk for endocarditis (e.g. normal cardiac
041012 - valves) is extremely low and estimated to be 1 in 5 to 10
041013 - million.
041015 - ..
041016 - On 160618, Doctor Yoo listed causes of large area of inflammation
041017 - over the top of the brain found in MRI, to be...
041018 -
041019 - 1. Bacteria
041020 - 2. Virus infection
041021 - 3. Tumor/cancer growth
041023 - ..
041024 - Since MRI found no evidence of tumor/cancer, there remains
041025 - possibility of bacteria and/or virus infection to have caused
041026 - inflammation over top of head, along with other stroke symptoms.
041027 -
041028 - [On 160726 1117 national reporting Olympic gastrointestinal
041029 - scopes have design flaw that makes them difficult to clean,
041030 - and resulted in may patients suffering maladies, including
041031 - deaths. ref SDS 20 JF5J
041033 - ..
041034 - [On 160727 0004 letter to Doctor Massa, attending physician
041035 - with Neurology, notifies of research on EGD procedures
041036 - shows contaminated gastroscopes can cause complications of
041037 - bacteria virus infections, as occurred during EGD dilation
041038 - procedure on 160617. ref SDS 21 S135
041040 - ..
041041 - Article continues...
041042 -
041043 - Issues related to contaminated equipment ahve been reviewed in
041044 - the ASGE documents entitled "Infection Control During
041045 - Gastrointestinal Endoscopy"; Guidelines for Clinical
041046 - Applicatino and Transmission. The reader is referred to these
041047 - documents for a discussion of appropriate cleaning procedures
041048 - to prevent such contamination.
041049 -
041050 -
041051 -
041053 - ..
041054 - Perforation Complications
041055 -
041056 - Performation of the upper GI tract related to diagnostic
041057 - endoscopy is relatively low. In teh above-mentioned 1974 ASGE
041058 - survery, teh performation rate was 0.03%. Predisposing
041059 - factors to perforations include the presence of anterior
041060 - cervical osteophytes, Zenker's diverticulum, esophageal
041061 - strictures, and malignancies.
041063 - ..
041064 - Pain is the most common and reproducible symptoms related to
041065 - performation.
041067 - ..
041068 - While esophageal strictures are involved in this case, there was no
041069 - pain symptom arising from EGD dilation procedure on 160617.
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