Features discriminating SARS from other severe viral respiratory tract infections.

This study investigated the discriminatory features of severe acute respiratory syndrome (SARS) and severe non-SARS community-acquired viral respiratory infection (requiring hospitalization) in an emergency department in Hong Kong. In a case-control study, clinical, laboratory and radiological data from 322 patients with laboratory-confirmed SARS from the 2003 SARS outbreak were compared with the data of 253 non-SARS adult patients with confirmed viral respiratory tract infection from 2004 in order to identify discriminatory features. Among the non-SARS patients, 235 (93%) were diagnosed as having influenza infections (primarily H3N2 subtype) and 77 (30%) had radiological evidence of pneumonia. In the early phase of the illness and after adjusting for baseline characteristics, SARS patients were less likely to have lower respiratory symptoms (e.g. sputum production, shortness of breath, chest pain) and more likely to have myalgia (p < 0.001). SARS patients had lower mean leukocyte and neutrophil counts (p < 0.0001) and more commonly had "ground-glass" radiological changes with no pleural effusion. Despite having a younger average age, SARS patients had a more aggressive respiratory course requiring admission to the ICU and a higher mortality rate. The area under the receiver operator characteristic curve for predicting SARS when all variables were considered was 0.983. Using a cutoff score of >99, the sensitivity was 89.1% (95%CI 82.0-94.0) and the specificity was 98.0% (95%CI 95.4-99.3). The area under the receiver operator characteristic curve for predicting SARS when all variables except radiological change were considered was 0.933. Using a cutoff score of >8, the sensitivity was 80.7% (95%CI 72.4-87.3) and the specificity was 94.5% (95%CI 90.9-96.9). Certain clinical manifestations and laboratory changes may help to distinguish SARS from other influenza-like illnesses. Scoring systems may help identify patients who should receive more specific tests for influenza or SARS.

Does Doppler analysis of musculoskeletal soft-tissue tumours help predict tumour malignancy?

AIM: To investigate whether analysing vascularity of soft-tissue tumours on ultrasound assists differentiating benign from malignant tumours. MATERIALS AND METHODS: One hundred and forty-eight vascular soft-tissue tumours in 148 patients (88 males, mean age 45.6 years) were studied. Final diagnosis was established histologically in 95 (64%) of cases. For each tumour, three-colour Doppler imaging features (vascularity, vascular density, vascular organization) and 13 pulsed Doppler (spectral analysis) parameters were assessed. Data analysis was performed to isolate optimal discriminatory criteria for differentiating benign from malignant tumours. RESULTS: Significantly more benign soft-tissue tumours had an organized vascular pattern on colour Doppler imaging. If the vascular pattern is organized, this is a good indicator of tumour benignity. However, this pattern was apparent in less then one-third of the soft-tissue tumours. Benign tumours also had significantly higher minimum end diastolic velocity (EDVmin) and lower mean ratio of resistive index (RImean) than malignant soft-tissue tumours, though considerable overlap existed between the two groups. CONCLUSION: Colour Doppler imaging analysis of soft-tissue tumours is of limited value when differentiating benign from malignant tumours. If an organized vascular pattern is present, the tumour is more likely to be benign. Flow characteristics were not specific enough to be applicable in clinical practice.

Back pain in pregnancy--magnetic resonance imaging correlation.

AIM: To study the relationship of disk abnormality and signal changes of the uterine cervix on magnetic resonance imaging (MRI) with back pain in pregnancy at 36-39 weeks of gestation. MATERIAL AND METHODS: One hundred and five pregnant Chinese women with previous Caesarean section at 36-39 weeks gestation undergoing magnetic resonance pelvimetry performed for a study for trial of vaginal delivery were questionnaired for back pain. Sagittal T2-weighted images were analysed for intervertebral disk abnormality, and signal intensity of the uterine cervix on the same sagittal images. The findings on MRI were correlated with back pain. RESULTS: Seventy-three (70%) of the pregnant women had back pain. Disk bulge or prolapse were infrequent but correlated significantly with the presence of back pain (P=0.02). Women with back pain in the current pregnancy tended to have a higher signal intensity of the uterine cervix compared with those without (P=0.006). Women with a history of back pain also had higher cervical signal intensity compared with those without (P=0.02). CONCLUSION: Disk bulge or prolapse was associated with back pain in pregnancy but were relatively infrequent. The significant correlation of high signal intensity in the uterine cervix and back pain suggested that soft tissue laxity may be a more important cause of back pain in pregnancy than disk bulge or prolapse.