The clinical and electroencephalographic (EEG) features of absence seizures in children were evaluated using EEG frequency modulation radiotelemetry and videotape monitoring. The only seizures evaluated were those with a spike-and-wave or multiple spike-and-wave duration lasting at least 3 seconds. A total of 926 absence seizures (426 typical, 500 atypical) were reviewed in 54 patients. Abnormal interictal EEGs, multiple seizure types, mental retardation, or developmental delay were more likely in patients with atypical absence seizures than in patients with typical absence seizures. Both types of absence seizures usually had a clear onset and cessation. Atypical absence seizures lasted significantly longer than did typical absence seizures. Automatisms occurred more frequently in typical absence seizures than in atypical ones, while decreases in postural tone or tonic activity occurred more frequently in atypical absence seizures. Receptive and expressive speech were retained in some patients during both types of seizures. This study demonstrates that typical and atypical absence seizures are not discrete entities but rather form a continuum. No single clinical feature can adequately distinguish the two seizure types.

Summary: Isolated aphasia with associated EEG epileptiform activity is a recognized syndrome in children. The relationship of the EEG abnormality and the type and severity of the speech impairment has not been well described. This relationship was studied in two children with severe expressive and receptive aphasia with generalized spike‐wave discharges on EEG using prolonged EEG FM radiotelemetry and video recording (TEEG‐VR). Speech was compared with 10 children with absence seizures with similar EEG abnormalities also evaluated using TEEG‐VR. In addition. 43 cases of aphasia with epileptiform activity on the EEG reported in the English literature were reviewed. Speech abnormalities in absence seizures consisted of speech arrest. decreased speed of speech, and brief periods of partial or complete receptive and expressive aphasia, always directly associated with a spike‐wave ictus. Speech abnormalities in acquired or congenital aphasia were not related to epileptiform activity and were characterized by severe articulation difficulties. syntactic transformation, paraphasia, and receptive and expressive aphasia. Anticonvulsants did not alter speech. Based on these two cases and the 43 others reviewed in the literature, it is proposed that epileptiform activity in this syndrome is an epiphenomenon reflecting underlying abnormalities of speech areas rather than the cause of the aphasia. RÉSUMÉ Une aphasie isolée, associée à une activité EEG épileptiforme constitue un syndrome reconnu en pédiatric Mais les relations qui existent entre les anomalies EEG et le type ou la sévérité des troubles du langage n'ont pas été bien définies. Nous avons étudié ces relations chez deux enfants présentant une aphasie d'expression et de réception sévère et des décharges de pointe‐ondes généralisées; ils ont été enregistrés en télémfrie et en vidéo (TEEG‐VR) leur langage a été compareéà celui de dix enfants étudiees eux aussi en TEEG‐VR présentant des absences associées aux memes anomalies EEG. De plus ont été passés en revue 43 cas d'aphasie avec EEG épileptiforme publies dans la litterature de langue anglaise. Les troubles du langage pendant les absences consistent en arret du langage. ralentissement du débit verbal et bréves périodes d'aphasie de réception et d'expression, partielle ou compléte, directement associées aux decharges de pointe‐ondes. Les troubles du langage dans les aphasies acquises ou congenitales ne sont en rien relies aux decharges épileptiformes et sont caractérisés par d'importantes difficultes d'articulation, de transformation syntactique. de paraphasie et d'aphasie de réception ou d'expression. Les médicaments antiépileptiques n'altérent pas le langage. En se basant sur leurs deux cas et sur 43 cas de la littérature, les auteurs proposent que I'activitéépileptifome dans le syndrome en question soit considérée comme un épiphénomène témoignant d'anomalies au niveau de la zone du langage plutôt que comme la cause de L'aphasie. ZUSAMMENFASSUNG Die isolierte Aphasie mit begleitender epileptiformer EEG‐Aktivitat is...

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.

No abstract

This a preprint and has not been peer reviewed. Data may be preliminary.

A 54-year-old lady was brought to our A+E after falling from a stepladder onto the metallic base of her artificial Christmas tree. The metallic rod impaled her through the right buttock. X-rays and a CT was performed prior to transport to a trauma centre causing delays to her surgery.

A 54‐year‐old lady was brought to our emergency department after falling from a stepladder onto the base of her artificial Christmas tree. The metallic rod impaled her through the right buttock. X‐rays and a computerized tomography were performed prior to transport to a trauma center causing delays to her surgery.

A 54-year-old lady was brought to our A+E after falling from a stepladder onto the metallic base of her artificial Christmas tree. The metallic rod impaled her through the right buttock. X-rays and a CT was performed prior to transport to a trauma centre causing delays to her surgery.