Differential diagnosis between tuberculous spondylodiscitis and pyogenic spontaneous spondylodiscitis: a multicenter descriptive and comparative study.

BACKGROUND CONTEXT: Although tuberculous and pyogenic spondylodiscitis are common causes of spinal infections, their protean manifestation complicates differential diagnosis. PURPOSE: The clinical, laboratory, and radiologic characteristics of tuberculous and pyogenic spontaneous spondylodiscitis were compared in this study. STUDY DESIGN: This multicenter retrospective study was conducted in 11 teaching hospitals in the Republic of Korea from January 2011 to December 2013. PATIENT SAMPLE: Study subjects included adult patients (≥18 years) diagnosed with tuberculous (n=60) or pyogenic (n=117) spontaneous spondylodiscitis. OUTCOME MEASURES: Risk factors for tuberculous spondylodiscitis were determined, and their predictive performance was evaluated. METHODS: Multivariate logistic regression analysis was performed to determine predictors independently associated with tuberculous spondylodiscitis. Receiver-operating characteristic curve analysis using the presence or absence of risk factors was used to generate a risk index to identify patients with increased probability of tuberculous spondylodiscitis. RESULTS: Of 177 patients, multivariate logistic regression analysis showed that patients with tuberculous spondylodiscitis (n=60) were more frequently women, with increased nonlumbar spinal involvement and associated non-spinal lesions, delayed diagnosis, higher serum albumin levels, reduced white blood cell counts, and lower C-reactive protein and procalcitonin levels. Among 117 patients with pyogenic spondylodiscitis, the most frequent causative microorganism was Staphylococcus aureus (64.1%). The mean diagnostic delay was significantly shorter, which may reflect higher clinical expression leading to earlier diagnosis. A combination of clinical data and biomarkers had better predictive value for differential diagnosis compared with biomarkers alone, with an area under the curve of 0.93, and sensitivity, specificity, and positive and negative predictive values of 95.0%, 79.5%, 70.4%, and 96.9%, respectively. CONCLUSIONS: This study provides guidance for clinicians to predict the causative organisms of spondylodiscitis in uncertain situations and before culture or pathologic examinations. Clinical data and single biomarkers combined can be useful for differential diagnoses between tuberculous and pyogenic spondylodiscitis.

T4 gastric carcinoma: the benefit of non-curative resection.

BACKGROUND: The prognosis of patients with gastric carcinoma with invasion of the adjacent organs (T4 gastric carcinoma) is very poor. We evaluated the survival benefit of resection in this group of patients. METHOD: We retrospectively reviewed the hospital records of 288 patients with T4 gastric carcinoma to compare the clinicopathological results in patients with curative resection (n = 95) with patients with non-curative resection (n = 193) during the period 1986-2000. RESULTS: With a 33% curative resectability in patients with T4 gastric carcinoma, patients with tumour resection (curative and non-curative) had a significantly improved survival rate. The overall survival rate was higher for patients who underwent resection (11.6%) than for patients who were not resected (2.5%), regardless of curability (P < 0.001). Using Cox's proportional hazard regression model, lymph node invasion and curability were independent statistically significant prognostic parameters. The prognosis of patients with invasion to the peritoneum and adrenal glands was significantly poorer than that of patients in whom there was no such invasion. But, the number of organs invaded had no effect on patient survival. CONCLUSIONS: Patients with T4 gastric carcinoma might be benefited from curative resection. The results also emphasize the improved survivorship of T4 gastric carcinoma patients with resection compared with those who did not undergo resection. Although curative resection cannot be undertaken in patients with T4 gastric carcinoma, we recommend performing resection in patients with locally advanced gastric carcinoma, regardless of curability.

Chemical composition of post-harvest biomass burning aerosols in Gwangju, Korea.

The main objective of this study was to investigate the chemical characteristics of post-harvest biomass burning aerosols from field burning of barley straw in late spring and rice straw in late fall in rural areas of Korea. A 12-hr integrated intensive sampling of particulate matter (PM) with an aerodynamic diameter less than or equal to 10 microm (PM10) and PM with an aerodynamic diameter less than or equal to 2.5 microm (PM2.5) biomass burning aerosols had been conducted continuously in Gwangju, Korea, during two biomass burning periods: June 4--15, 2001, and October 8--November 14, 2002. The fine and coarse particles of biomass burning aerosols were analyzed for mass and ionic, elemental, and carbonaceous species. The average fine and coarse mass concentrations of biomass burning aerosols were, respectively, 129.6 and 24.2 microg/m3 in June 2001 and 47.1 and 33.2 microg/m3 in October--November 2002. An exceptionally high PM2.5 concentration of 157.8 microg/m3 was observed during biomass burning events under stagnant atmospheric conditions. In the fine mode, chlorine and potassium were unusually rich because of the high content of semi-arid vegetation. Both organic carbon (OC) and elemental carbon increased during the biomass burning periods, with the former exhibiting a higher abundance. PM from the open field burning of agricultural waste has an adverse impact on local air quality and regional climate.