Acute onset of systemic lupus erythematosus with extensive gastrointestinal and genitourinary involvement.

Lupus enteritis may occur as an acute presentation of systemic lupus erythematosus (SLE), and is not uncommonly associated with acute uretero-cystitis and/or hydronephrosis. Extensive involvement of the gastrointestinal tract from the stomach to the rectum in acute SLE is uncommon. We describe a 22-year-old Chinese female who presented with acute extensive gastrointestinal and genitourinary involvement who recovered following pulse intravenous methylprednisolone and cyclophosphamide. A high index of clinical suspicion is required to arrive at the diagnosis of SLE where only acute gastrointestinal and genitourinary manifestations are predominant, and other clinical, haematological and biochemical features of SLE are absent.

Ultrasonography of the hand and wrist.

Musculoskeletal ultrasonography (US) of the hands and wrist has recently been increasing in popularity. Recent rapid technical advances in the US, such as new ultra-high frequency probes and smaller probe sizes, have led to improved image quality. This, in turn, has accelerated the growth of musculoskeletal US. Known advantages of US are its lack of ionising radiation, noninvasiveness, portability and low cost. Dynamic and real-time assessment and Doppler imaging are additional benefits of this modality, especially in the imaging of the hands and wrist. Superficial structures of the hands and wrist, including the tendons, ligaments, nerves and vessels, are amenable to imaging with high frequency US. In this article, we demonstrate a spectrum of hand and wrist pathology using US, including entrapment neuropathy, inflammatory conditions, traumatic injury and masses. Ultrasound-guided procedures applicable to the hand and wrist are also briefly discussed.

Radiographic features of a case of severe acute respiratory syndrome with fatal outcome.

INTRODUCTION: Severe acute respiratory syndrome (SARS) is a new form of atypical pneumonia caused by a coronavirus. We present the clinical course and chest radiographic findings of a case of SARS with fatal outcome. CLINICAL PICTURE: A 39-year-old Chinese male presented with fever, sore throat and non-productive cough. During his illness, serial chest radiographs showed increasingly severe air-space shadowing in both lungs. TREATMENT AND OUTCOME: The patient was treated with supplemental oxygen, levofloxacin, oseltamivir, ribavirin and methylprednisolone. As his condition worsened, the required ventilatory and inotropic support. He later developed a myocardial infarct and coagulopathy, and succumbed to his illness. CONCLUSION: The reported case mortality of SARS is about 9% worldwide. In Singapore, the mortality is 15.5%. Acute respiratory distress syndrome (ARDS) is believed to be a contributory factor to our patient's demise. We report this case to show the radiographic changes of ARDS in a patient with SARS.

Congenital lobar emphysema: antenatal diagnosis and follow up.

The case of an echogenic mass in the right lung that apparently resolved spontaneously prior to delivery is reported here. Postnatal investigations revealed congenital lobar emphysema. To the knowledge of the authors, this is the first reported case of spontaneous, apparently complete resolution of an echogenic lung mass on antenatal ultrasound due to lobar emphysema. The routine use of ultrasound to screen for foetal anomalies has led to the discovery of a number of incidental findings, such as an echogenic foetal lung mass, that pose a challenge to diagnosis and management. The importance of appropriate counselling and postnatal follow-up are highlighted.

Intramural tubal polyps--a villain in the shadows?

BACKGROUND: Intramural tubal polyps are commonly described in association with subfertility. However, there is unfamiliarity among clinicians about the investigations available for making a diagnosis of this condition. The objective of this paper was to highlight the suitable investigations for diagnosis and thus increase awareness of this condition and its relationship with subfertility. METHOD: A retrospective review of 14 patients with intramural tubal polyps was done for the period from January to December 1996. An attempt was made to correlate the radiographic findings on hysterosalpingography with transvaginal ultrasound examinations and hydrochromotubation performed under laparoscopic observation. The fertility history of these patients was also examined. RESULTS: The review demonstrated a prevalence of 3.8% of intramural tubal polyps in a selected population of predominantly subfertile women. Only hysterosalpingography was useful in making the diagnosis in-vivo. Fifty percent of the patients did not have any other obvious pathology to explain their subfertility. CONCLUSION: We conclude that meticulous hysterosalpingography is useful as a diagnostic investigation and that consistent reporting is needed for good follow-up.

A prevalence study of dysmenorrhoea in female residents aged 15-54 years in Clementi Town, Singapore.

A community-based questionnaire survey to study the prevalence of dysmenorrhoea, its associated risk factors and impact on daily living was carried out on a random sample of 415 female persons aged 15 to 54 residing in Housing Development Board flats in Clementi Town. The overall prevalence of dysmenorrhoea, defined as one or more episodes of menstrual cramp or pain in the previous year, not due to a diagnosed gynaecological disease, was 51.3%. The condition was less prevalent and less severe in older women and in women with later menarche. It was also less prevalent in women who were parous, with the greatest number of parous women reporting improvement in severity after the first child. Among those with dysmenorrhoea, about 52% of students, 42% of working women, and 30% of housewives reported that their ability to perform work was affected. About 6% of all women consulted a doctor for their problem, and 10% of all employed women reported having been sick-absent because of dysmenorrhoea.