ECG evaluation in 11 949 Italian teenagers: results of screening in secondary school

AIM

There is lack of evidence regarding the screening role of ECG for sudden cardiac death (SCD) prevention. Our aim was to evaluate the prevalence of ECG abnormalities among teenagers according to sport participation and competitive status.

METHODS

Eleven thousand nine hundred and forty-nine Italian pupils from 179 secondary schools (13-19 years) were consecutively enrolled. ECG abnormalities were divided into minor and major. Medical history, clinical examination and sport activity information were acquired. Further evaluations were suggested in case of major ECG abnormalities. Follow-up was performed at 2 years.

RESULTS

N = 1945 (16%) pupils had ECG abnormalities. Major ECG abnormalities were detected in 13% of the cohort, minor in 34%. ECG abnormalities were more common in nonathletes compared with athletes. A diagnosis of cardiac disease was reached in 25 (1.6%) of the pupils with major ECG abnormalities.

CONCLUSION

ECG abnormalities are common among young populations and more prevalent in nonathletes. Among pupils with major ECG abnormalities 1.6% had a cardiac disease diagnosis. Our results are in line with the data supporting ECG screening in the general young population.

[Bladder hernia]

A case of bladder hernia in a 61 years old patient affected by benign prostatic hypertrophy is presented. Pre-operative diagnosis was made by cystography. After an adenomiomectomy of the prostate, the patient underwent the resection of the herniated bladder which gave the bladder its normal shape with only a slight reduction of its capacity. Inguino-scrotal bladder hernias are very rare; recognized predisponing factors are weakening of muscular and connective structures of the inguinal canal, and bladder hypotonia secondary to urethro-prostatic obstruction. These hernias, according to the anatomical position of the hernial sac, bladder and peritoneum, are classified in paraperitoneal (most frequent), intraperitoneal and extraperitoneal. The typical symptom of this disease is the two-stage micturition: the patient after a first spontaneous voiding, presses the mass and voids again. Other than cystography, useful diagnostic means are urography and cystoscopy which may confirm the diagnosis and rule out associated urinary disease. The treatment consists of either simple reduction of the bladder hernia, if the hernia is small, or resection of the herniated portion of the bladder, if the hernia is large or is associated with other diseases (e.g. tumors). Bladder resection is then followed by closure of the bladder wall in two layers and by inguinal hernia repair.

[Comparison of ketorolac/buprenorphine in the treatment of post-cholecystectomy pain]

The authors compared the efficacy of ketorolac trometamin (30 mg i.m. every 6 hours) and buprenorphine (0.3 mg i.m. every 12 hours) in the treatment of pain following cholecystectomy. Ketorolac was found to be equally efficacious in comparison to buprenorphine and caused fewer side effects.

[Current trends in the treatment of reflux esophagitis in childhood]

A problem of some complexity is the management of pathological gastro-esophageal reflux due to the presence of cardio-hiatal malformation, malposition of the cardia and gastric tuberosity, a congenitally short esophagus, and the like. Sometimes, however, there is no demonstrable morphological aleration and the condition, characterized by primitive hypotonia of the LES, goes under the name of infant chalasia of the esophagus. The general policy is to try first a conservative treatment consisting of dietary and postural measures and the administration of metoclopramide and d;ugs that protect the esophageal mucosa; this stage, however, should not be prolonged beyond 6 weeks. The presence of gastro-esophageal reflux associated with hiatal hernia; the presence of severe esophagitis or peptic stenosis of the esophagus and the persistence of symptoms after an adequate period of conservative therapy constitute as many indications for surgical correction. Good results can be obtained by restoring or strengthening the failing function of the LES, as is done quite successfully with funduplication after Nissen or with method of Belsey-Mark IV.

[Congenital stenosis of the esophagus (personal case and review)]

Starting from personal observation of a case of congenital stenosis of the oesophagus, the Authors proceed to a review of the scanty literature on the subject. After a discussion of the most outstanding aspects of differential diagnosis, the frequent necessity of histological verification, especially in adolescence and adult age, in order to obtain a correct understanding of the nature of the case, is stressed. On the basis of an essentially favourable prognosis, the Authors maintain that, where medical and dilating treatment is insufficient, surgery is indicated and evidence the straight-forward nature of the process of exeresis in stenosis of valvular type.

[Emergency surgical treatment of diverticular disease of the colon (personal cases and review)]

After a critical review of the indications, techniques and results recorded in literature, there is a description of experiences in emergency surgical treatment of 24 cases of diverticulum disease of the colon. In the light of personal results and in agreement with the majority of cases reported in literature, the conviction is expressed that in this surgery the processes graduated in stages (Mickulicz, Hartman, colostomy on transverse - resection) may frequently be indicated, especially in serious and weak patients.

[Pseudocysts of the pancreas. (Personal cases)]

After reviewing all the various procedures for surgical treatment of pseudocysts of the pancreas, the Authors, analysing the advantages and disadvantages of each method, present a set of nineteen personal cases treated by simple cystogastrostomy, simple cystojejunostomy and cystojejunostomy combined with entero-entero-anastomosis according to Braun, or cystojejunostomy on defunctionalised loop according to Roux. After stading the overall criteria for selection of the technique to be applied individually, the Authors conclude by stressing the advantages that cystojejunostomy on defunctionalised loop according to Roux offers as compared with all the other procedures.