Abnormal ECG Findings in Athletes: Clinical Evaluation and Considerations.

PURPOSE OF REVIEW: Pre-participation cardiovascular evaluation with electrocardiography is normal practice for most sporting bodies. Awareness about sudden cardiac death in athletes and recognizing how screening can help identify vulnerable athletes have empowered different sporting disciplines to invest in the wellbeing of their athletes. RECENT FINDINGS: Discerning physiological electrical alterations due to athletic training from those representing cardiac pathology may be challenging. The mode of investigation of affected athletes is dependent on the electrical anomaly and the disease(s) in question. This review will highlight specific pathological ECG patterns that warrant assessment and surveillance, together with an in-depth review of the recommended algorithm for evaluation

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Hydatid cyst of trapezius muscle: an unusual localisation. Report of a case and review of the literature.

The muscular localisation of hydatid cyst is very uncommon. The authors report a recently observed case of hydatid cyst of the trapezius muscle. An 81-year-old man presented with a 9-months history of a slow-growing painless mass in his left shoulder associated with itching. US examination showed a large multiloculated cystic mass, strongly suspicious of a hydatid cyst. At operation, under local anesthesia, complete surgical resection of the cystic mass was performed. The patient tolerated surgery very well. The postoperative course was uneventful and the patient was discharged from hospital on postoperative day 2. No recurrence occurred after 11 months. Muscular hydatidosis is very rare and can cause a variety of diagnostic problems, especially in the absence of typical radiological findings. The possibility of hydatid disease should always be kept in mind in the differential diagnosis of muscular masses, especially in endemic areas

The use of the harmonic scalpel in thyroid surgery. Our experience

The aim of this study was to evaluate the potential advantages of the use of Harmonic Scalpel in thyroidectomies in terms of operative time and complications. Between May 2007 and June 2010 1151 patients were submitted to total thyroidectomy. In 681 thyroidectomies were performed using harmonic scalpel FOCUS (group A), in 470 without it (group B). Mean operative time was 97 minutes in group A and 114 in group B with a mean difference of 17 minutes (14.9%). 554 patients in group A (81.35%) and 345 in group B (73.4%) were discharged in second postoperative day. In group A, hypoparathyroidism was present in 348 patients at discharge (48%), in 23 at 6 months (3.38%) and in 10 at 12 months (2.13%), in group B, in 255 at discharge (54.26%), in 61 at 6 months (12.98%) and in 28 at 12 months (5.96%). The major benefit of Harmonic Scalpel used during thyroidectomy is the reduction in the time of operation. All studies but one to date have reported reductions in operative time, ranging from 6 to 78 minutes with a 10% to 35% savings in operative time and this was confirmed in our study. A reduction of hypoparathyroidism, particularly transitory, and in length of hospital stay was reported in some studies and confirmed in our experience. The use of Harmonic Scalpel in thyroid surgery is safe and effective and is associated with a significant reduction in operative time, postoperative hypocalcaemia and hospital stay, without increasing complications rate