Meditation-Relaxation (MR Therapy) for Sleep Paralysis: A Pilot Study in Patients With Narcolepsy

Sleep paralysis (SP) is a condition where a person is paralyzed upon waking or falling asleep. SP afflicts ~20% of people, and is also one of the typical symptoms in narcolepsy. During SP the sleeper may experience hallucinations. Unsurprisingly, SP is associated with great fear globally. To date, there are no published clinical trials or outcome data for treating this condition. However, few non-pharmacological interventions have been proposed, including cognitive behavioral approaches, and case studies showing clinical amelioration with auto-hypnosis and Meditation-Relaxation (MR) therapy. The latter for instance showed positive preliminary results; when applied for 8 weeks it reduced SP frequency and anxiety/worry symptoms. With this paper we aimed to evaluate, with a small-scale pilot study, the efficacy of MR therapy for SP in patients with narcolepsy. Ten patients with narcolepsy and SP were enrolled in the study. Notably, MR therapy (n = 6), applied for 8 weeks, resulted in a dramatic decrease in the number of days SP occurred (50% reduction); and the total number of SP episodes (54% reduction) in the last month of the study (demonstrated by large within-group effect sizes); unlike the control intervention (deep breathing) (n = 4). These findings are preliminary and exploratory given the small sample. Nonetheless, they represent the first proof of concept at providing empirically-guided insights into the possible efficacy of a novel treatment for frequently occurring SP. Although the study was conducted in patients with narcolepsy we cautiously suggest that the findings may generalize to individuals with isolated SP

The missed constitutional reform and its possible impact on the sustainability of the italian national health service

The rejection of the Constitutional Law Bill No.1429-D in the December 2016 referendum, has stimulated a cause for reflection on current health legislation and the future prospects of the Italian National Health Service; also in the context of the recent approval of the new Essential Levels of care (LEA) and other relevant laws approved by the Parliament. This article analyzes possible future legislative and organizational scenarios with particular regard to issues related to National health system’s sustainability

L’approccio endoscopico alla calcolosi della via biliare: acquisizione e sviluppo dell’esperienza in una Unità Operativa di Chirurgia Generale. Due periodi a confronto

Lo sviluppo della chirurgia laparoscopica ha fatto sorgere la necessità, presso molti Centri, di controllare e trattare endoscopica - mente l’eventuale litiasi della via biliare associata alla calcolosi della colecisti. La diffusione di tale metodica è sempre stata ostacolata da una sua discreta complessità organizzativa e tecnica e soprattutto dal rischio di complicanze; per tali motivi la tendenza (confortata da autorevoli pareri) è sempre stata quella di concentrare l’esecuzione di ERCP in Centri che ne praticassero molte e con grande frequenza. I risultati di questo studio, con il confronto tra il primo e l’ulti - mo anno completo di attività, indicano che si può acquisire la capa - cità necessaria a soddisfare le esigenze dell’Unità Operativa Chirurgica partendo dal volume di attività offerto dalla propria casi - stica attendendosi buoni risultati con bassa incidenza di complicanze

Emergency Sleeve Gastrectomy as Rescue Treatment for Acute Gastric Necrosis Due to Type II Paraesophageal Hernia in an Obese Woman with Gastric Banding.

A morbidly obese 42-year-old woman presented with a 1-week history of left chest pain. She had undergone laparoscopic adjustable gastric banding 16 months earlier with a body mass index (BMI) of 49.2 kg/m(2). Diagnostic workup revealed a large left pleural empyema and ruled out band slippage. At left thoracotomy, a misdiagnosed type II paraesophageal strangulated hernia with gastric necrosis and large perforation of the fundus was evident. At laparotomy, the band was removed, the stomach was reduced into the abdomen, and a sleeve gastrectomy was performed. Her postoperative course was uneventful, and 6 months after surgery, her BMI is 31 kg/m(2). Emergency sleeve gastrectomy could represent a good option to treat, at the same time and in a safe way, both gastric necrosis and paraesophageal hernia, improving the good results in terms of weight loss after gastric restriction from gastric banding

Obstructive symptoms associated with the 9.75-cm Lap-Band in the first 24 hours using the pars flaccida approach.

BACKGROUND: For some patients, especially those with a higher BMI, a non-selective Lap-Band placement using the pars flaccida approach with application of the small-diameter bands (9.75 and 10 cm) may be too tight or may require significant gastroesophageal junction dissection and thinning. In such a case, the major perioperative complication is acute obstruction immediately after surgery. We review the etiology of obstructive complications that present postoperatively in the first 24 hours. CASE REPORTS: Acute postoperative stoma obstruction (esophageal outlet stenosis) was observed in 5 patients who underwent 9.75-cm Lap-Band placement for morbid obesity. 2 of these patients had a postoperative upper GI series showing a misplaced band with gastric slippage, and repeat operation was required. 3 patients had gastric obstruction without slippage. Of the latter, 1 patient insisted that the band be removed rather than being replaced with a longer one, and the remaining 2 were managed with conservative treatment, involving extended hospitalization until the edema subsided and the patient slowly regained the ability to swallow. CONCLUSION: Obstructive symptoms associated with the Lap-Band using the pars flaccida approach can be addressed conservatively in most patients or by minimally invasive surgery; however we believe that routine use of the 11-cm Lap-Band for the pars flaccida approach could easily prevent this early complication

Green urine after intragastric balloon placement for the treatment of morbid obesity

Abstract: Background: The intragastric balloon is filled with saline and methylene blue dye, to detect balloon deflation early and prevent bowel obstruction, by monitoring the patient's urine for changes in color. Methods: An intragastric balloon filled with 590 ml of saline plus 10 ml of methylene blue was endoscopically placed under sedation in a 22-year-old man with morbid obesity (BMI 42 kg/m(2)). 3 days later, the patient's urine changed to dark green, and, suspecting a leaking balloon, endoscopy was repeated under sedation. Results: No signs of balloon deflation were seen, and the urine returned to normal color. The next day, the urine turned green again. 7 days later, the urine discoloration finally disappeared. Conclusion: Propofol, a sedative commonly used by anesthesiologists during endoscopic procedures, is known to have several side-effects, and urine discoloration is one of them, albeit rare. This benign side-effect must be known to obesity surgeons to avoid pointless medical expenditure, unnecessary balloon removal and distress for patients and clinician

ANASTOMOSI TERMINO-LATERALE TRA VENA MESENTERICA INFERIORE E VENA REMALE SINISTRA, NEL TRATTAMENTO DI EMORRAGGIE MASSIVE DA EMORROIDI IN CORSO DI IPERTENSIONE PORTALE.

none7noneGERUNDA GE; COSTA M; ZANGRANDI F; MEDURI F; MAFFEI FACIOLI A; D. MIOTTO; PERRINI F.Gerunda, GIORGIO ENRICO; Costa, M; Zangrandi, Fabio; Meduri, Francesco; MAFFEI FACCIOLI, Alvise; Miotto, Diego; Perrini, F

Precutting for the access to bilio-pancreatic ducts and successful sphincterotomy in case of difficult cannulation

Precutting is an endoscopic technique during ERCP that is indicated to achieve deep cannulation of biliary and/or pancreatic ducts through "difficult" papillas. Among recent studies the rate of success in difficult deep cannulation rises but the number of complications increases as well. We performed 81 pre-cuts in the same number of patients with a late of success of 88% and a rare of complications of 6 %; no deaths occurred