Gastro-oesophageal reflux and "epileptic" attacks: casually associated or related? Efficiency of antireflux surgery. A case report

Although a possible link between gastro-oesophageal reflux disease (GORD) and obstructive sleeping apnoea has already been reported in the literature, there has never been any suggestion of an association with epilepsy, and epileptic attacks have not so far been included among gastro-oesophageal reflux disease symptoms. We report the case of a patient with gastro-oesophageal reflux disease associated with a sliding hiatus hernia, a short oesophagus and oesophagitis, who for the last ten years had not only presented the typical symptoms of gastrooesophageal reflux, but also symptoms of obstructive sleep apnoea and epileptic-like attacks occurring occasionally and only during sleep. Partial posterior fundoplication was performed and considerably reduced the reflux symptoms, and in addition brought about a drastic decrease in the number of epileptic-like attacks. Our case suggests that epileptic-like episodes in patients with obstructive sleeping apnoea may well be linked to the simultaneous presence of GORD associated with hiatus hernia, and surgical treatment of GORD may bring about an improvement of the neurological problems

New insights to assess the consolidation of stone materials used in built heritage: the case study of ancient graffiti (Tituli Picti) in the archaeological site of Pompeii

Abstract Tituli Picti are an ancient form of urban graffiti very common in the archaeological site of Pompeii (Naples, South—Italy). They are generally made of red pigments applied on walls of Campanian ignimbrite. This paper deals with a scientific investigation aimed to their conservation. This is a challenging task since it requires a multidisciplinary approach that includes restorers, archaeologists and conservation scientists. The study has provided suggestions on the proper way to conserve Tituli Picti over time. In the present work, several specimens of Campanian ignimbrite were painted with red earth pigment; lime and Arabic gum have been used as binders as well. Such painted stones were treated with three consolidants: a suspension of reactive nanoparticles of silica, ethyl silicate and an acrylic microemulsion. Treated and untreated specimens were subjected to thermal aging, artificial solar radiation and induced crystallization decay. It has been assessed the colorimetric variations induced by treatments. Moreover, the micromorphologic features of the consolidated surfaces have been highlighted by means of electron microscope observations. The scotch tape test allowed to compare the superficial cohesion induced by the three used products. According to the results, ethyl silicate seems to represent the most successful product

Two cases of monomicrobial intraabdominal abscesses due to KPC - 3 Klebsiella pneumoniae ST258 clone

<p>Abstract</p> <p>Background</p> <p>Knowledge of the etiology of pyogenic liver and pancreatic abscesses is an important factor in determining the success of combined surgical and antibiotic treatment. Literature shows geographical variations in the prevalence and distribution of causative organisms, and the spread of <it>Klebsiella pneumoniae </it>carbapenemase-producing bacteria is an emerging cause of abdominal infections.</p> <p>Case presentation</p> <p>We herein describe two cases of intra-abdominal abscesses due to monomicrobial infection by <it>Klebsiella pneumoniae </it>Sequence Type 258 producing <it>K. pneumoniae </it>carbapenemase 3 (KPC-Kp). In case 1, a 50-year-old HIV-negative Italian woman with chronic pancreatitis showed infection of a pancreatic pseudocystic lesion caused by KPC-Kp. In case 2, a 64-year-old HIV- negative Italian woman with pancreatic neoplasm and liver metastases developed a liver abscess due to KPC after surgery. Both women were admitted to our hospital but to different surgical units. The clonal relationship between the two isolates was investigated by pulsed-field gel electrophoresis (PFGE). In case 2, the patient was already colonized at admission and inter-hospital transmission of the pathogen was presumed. A long-term combination regimen of colistin with tigecycline and percutaneous drainage resulted in full recovery and clearance of the multidrug-resistant (MDR) pathogen.</p> <p>Conclusions</p> <p>Timely microbiological diagnosis, the combined use of new and old antibiotics and radiological intervention appeared to be valuable in managing these serious conditions. The emergence and dissemination of MDR organisms is posing an increasing challenge for physicians to develop new therapeutic strategies and control and prevention frameworks.</p

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Gastrooesophageal reflux and "Epileptic" attacks: casually associated or related? Efficiency of antireflux surgery, a case report

P02.30 GASTRO-OESOPHAGEAL REFLUX AND “EPILEPTIC” ATTACKS: CASUALLY ASSOCIATED OR RELATED? EFFICIENCY OF ANTIREFLUX SURGERY A CASE REPORT Achille Mastrosimone1, Alessia Cusimano2, Silvia Marino2, Gianni Pantuso2, Eugenio Fiorentino2 1Policlinico Of Palermo, Palermo/ITALY, 2University Of Palermo, Palermo/ITALY Background: Although a possible link between gastro-oesophageal reflux disease (GORD) and obstructive sleeping apnoea has already been reported in the literature, there has never been any suggestion of an association with epilepsy, and epileptic attacks have not so far been included among gastro- oesophageal reflux disease symptoms. Methods: We report the case of a patient with gastro-oesophageal reflux disease associated with a sliding hiatus hernia, a short oesophagus and oesoph- agitis, who for the last ten years had not only presented the typical symptoms of gastrooesophageal reflux, but also symptoms of obstructive sleep apnoea and epileptic- like attacks occurring occasionally and only during sleep. Results: Partial posterior fundoplication was performed and considerably reduced the reflux symptoms, and in addition brought about a drastic decrease in the number of epileptic-like attacks. Discussion: Our case suggests that epileptic-like episodes in patients with obstructive sleeping apnoea may well be linked to the simultaneous presence of GORD associated with hiatus hernia, and surgical treatment of GORD may bring about an improvement of the neurological problems. Disclosure: All authors have declared no conflicts of interest

PS01.057: THYROIDECTOMY AND LARYNGO-PHARYNGEAL REFLUX: WHAT’S NEW

Background ‘Local neck symptoms’ may be related to goiter; a persistence of those symptoms after an uncomplicated total thyroidectomy (TT) might be referred to the laryngo-pharyngeal reflux (LPR). Our previous study found a correlation between goiter and LPR in selected patients with local neck symptoms; the purpose of our current study is to investigate the presence of a laringopharyngitis in patients with goiter, before and after TT, even in the absence of local neck symptoms, assessing whether the presence of LPR may play a role at the outset of the symptomatology. Methods Two groups of patients were considered and they differred for the presence or absence of local neck symptoms: group A (25 patients) and group B (40 patients). The clinical evaluation was standardized using the reflux symptom index. The patients were subjected to videolaringoscopy (VLS) and to esophageal videoflurography (VFGE) before and three months after surgery. Results Before surgery all the patients in group A showed a normal vocal chord motility and laryngitis findings at the VLS. The VFGE was positive to abnormal swallowing in 86% of patients. The laryngitis findings at VLS, were found in 38% of cases in group B. At VFGE 96% of the patients were positive to the test. The symptoms reported in the pre-operative were unchanged after surgery in group A. In group B 63% of patients remained positive; at VFGE 73% had a clear pathological condition. Conclusion In 2010 ‘Amelita’ study concluded that LPR should be taken into account as a possible movens of post-thyroidectomy clinical picture, both in the diagnosis and in the therapeutic management of those patients who complained about local neck symptoms, since the only TT hadn’t been effective. The collected data of the current study are consistent with those of the previous study: symptoms persisted or increased in laryngopharingeal reflux-positive patients, while in the control group the symptoms were absent or the new appearance symptomatic pictures were moderate. It is a shared view that we shouldn’t wait for the overt clinical picture, but prevent it. It is essential to identify, through a careful pre-operative evaluation, patients positive to LPR