Evaluation of WHO criteria for identifying patients with severe acute respiratory syndrome out of hospital: prospective observational study.

Objectives: To determine the clinical and radiological features of severe acute respiratory syndrome (SARS) and to evaluate the accuracy of the World Health Organization's guidelines on defining cases of SARS.

Design: Prospective observational study.

Setting: A newly set up SARS screening clinic in the emergency department of a university hospital in Hong Kong's New Territories.

Thin-section CT in patients with severe acute respiratory syndrome following hospital discharge: preliminary experience.

Purpose: To report the initial experience regarding thin-section computed tomographic (CT) findings in patients with severe acute respiratory syndrome (SARS) who improved clinically after treatment.

Materials And Methods: Twenty-four patients (10 men, 14 women; mean age, 39 years; age range, 23-70 years) with confirmed SARS underwent follow-up thin-section CT of the thorax. The scans were obtained on average 36.

Severe acute respiratory syndrome: radiographic appearances and pattern of progression in 138 patients.

Purpose: To retrospectively evaluate the radiographic appearances and pattern of progression of severe acute respiratory syndrome (SARS).

Materials And Methods: Chest radiographs obtained at clinical presentation and during treatment in 138 patients with confirmed SARS (66 men, 72 women; mean age, 39 years; age range, 20-83 years) were assessed. Radiographic appearances of pulmonary parenchymal abnormality, distribution, and extent of involvement on initial chest radiographs were documented.

Thin-section CT of severe acute respiratory syndrome: evaluation of 73 patients exposed to or with the disease.

Purpose: To retrospectively analyze the thin-section computed tomographic (CT) features in patients with severe acute respiratory syndrome (SARS) at the authors' institution.

Materials And Methods: From March 11, 2003, to April 2, 2003, 74 patients with symptoms and signs suggestive of SARS underwent CT of the thorax; all underwent thin-section CT except for one patient who underwent conventional CT. Group 1 (n = 23) patients had symptoms of SARS in keeping with criteria from the Centers for Disease Control and Prevention and a positive chest radiograph.

B0 images obtained from diffusion-weighted echo planar sequences for the detection of intracerebral bleeds.

Background And Purpose: To evaluate the accuracy of B0 echo planar imaging (EPI) sequences for the detection of intracerebral bleeds.

Methods: One hundred patients with acute strokes had magnetic resonance imaging and computed tomography (CT) examinations performed within 48 hours after the onset of symptoms. The detectability of intracerebral bleeds by the B0 EPI sequences was assessed.

Quantitative analysis of circulating mitochondrial DNA in plasma.

Background: Recent studies have demonstrated the existence of circulating mitochondrial DNA in plasma and serum, but the concentrations and physical characteristics of circulating mitochondrial DNA are unknown. The aim of this study was to develop an assay to quantify mitochondrial DNA in the plasma of healthy individuals.

Methods: We adopted a real-time quantitative PCR approach and evaluated the specificity of the assay for detecting mitochondrial DNA with a cell line (rho(0)) devoid of mitochondria.

Trauma systems and emergency medicine.

The impact of trauma is a major public health challenge which is likely to escalate in the early 21st century. A systematic approach to this problem is required. This review explains the conceptual framework that defines a trauma system, gives a brief historical perspective and describes some of the essential elements of the system which should make a difference to patient outcome.

Prognostic use of circulating plasma nucleic acid concentrations in patients with acute stroke.

Background: At present there is no simple, accurate blood test that may be used to determine the severity of stroke or to predict mortality and morbidity in stroke patients presenting to emergency departments.

Methods: Patients with stroke-like symptoms who presented to an emergency department of a university hospital in Hong Kong were recruited for the study. DNA extracted from patients' plasma was analyzed for the beta-globin gene with a fluorescent-based PCR test.

Effect of stress hormones on the expression of fibrinogen-binding receptors in platelets.

Acute coagulopathy is a common clinical complication after trauma, and contributes to posttraumatic multiple organ failure. The phenomenon may be due to the effect of stress hormones on platelet adhesion molecule expression after trauma. Catecholamine levels correlate with injury severity scores and changes of L-selectin expression on leucocytes, whilst adrenaline (ADR) (epinephrine) alone also activates platelets.

Sickle Hb polymerization in RBC components from donors with sickle cell trait prevents effective WBC reduction by filtration.

Background: RBC components collected from donors with sickle cell trait frequently occlude WBC-reduction filters. In vitro, sickle trait RBCs have the potential for sickle Hb (Hb S) polymerization at low oxygen saturations and high Hb concentrations.

Study Design And Method: To determine if the low pH and high osmolarity of the CP2D used in the collection contributed to filter failures, the filterability of sickle trait donor RBCs collected in CP2D was compared with RBCs from the same donors collected in heparin.

Predictors of positive stool culture in adult patients with acute infectious diarrhea.

Stool cultures for bacterial pathogens are often requested for investigation of patients with infectious diarrhea, but the literature reports low yield for this diagnostic test. The identification of clinical predictors of positive stool culture will help the physician in determining the necessity for stool requests. A retrospective study was performed in the setting of an Emergency Department (ED) in Hong Kong, to compare presenting features of adult patients with positive stool culture against those with negative culture.

Presence of filterable and nonfilterable mRNA in the plasma of cancer patients and healthy individuals.

Background: As RNA is labile, we investigated whether circulating RNA in human plasma may be present in a particle-associated form.

Methods: Blood was collected from 27 healthy individuals and 16 hepatocellular carcinoma (HCC) patients. The plasma from each individual was processed by two means: filtration through filters with different pore sizes (from 5 microm to 0.

L-selectin in health and disease.

This article reviews recent advances in the knowledge of the role of L-selectin, an adhesion molecule that is expressed on the surface of circulating leucocytes, in animal and human physiology and pathophysiology. After a brief discussion on nomenclature and structure, it progresses through the evidence for expression and regulation of L-selectin, cell collection and purification, physiological function and roles. The special role of knock out mice and monoclonal antibodies in determining a role for L-selectin in inflammatory states is described before proceeding to discuss the importance of L-selectin ligands and shed L-selectin.

Role of monocyte L-selectin in the development of post-traumatic organ failure.

The vascular leucocyte adhesion molecule, L-selectin, plays an important early role in monocyte trafficking at sites of inflammation, a process which leads to the development of inflammatory organ failure. In this prospective observational study, we investigate whether early numerical and functional changes in circulating monocytes, expression of monocyte L-selectin (CD62L) and monocyte:neutrophil L-selectin ratios are related to the subsequent development of post-traumatic organ failure (OF) and multiple organ dysfunction syndrome (MODS). Monocyte counts and cell surface L-selectin were measured by an automated cell counter and flow cytometry, respectively.

Derivation of a prediction rule for posttraumatic organ failure using plasma DNA and other variables.

The early identification of patients at high risk of developing posttraumatic organ failure would allow preventive therapies to be studied. In this study, highly sensitive and specific guidelines for the early prediction of posttraumatic organ failure (OF) and multiple organ dysfunction syndrome (MODS) using cell-free (plasma) DNA and other predictors of posttraumatic complications were derived. As plasma DNA increases after injury and may be used to predict acute lung injury (ALI), we hypothesized that in combination with other predictors it would predict the later development of OF and MODS.

Plasma DNA, prediction and post-traumatic complications.

Background: Trauma is a global public health problem that claimed 5.1 million lives in 1990. Twenty percent of these deaths occurred days to weeks after injury and were due to sepsis or organ failure.

Acute elbow trauma in children: spectrum of injury revealed by MR imaging not apparent on radiographs.

Objective: The objective of this study is to evaluate the frequency and significance of unrecognized bone or soft-tissue injury in pediatric patients with elbow trauma assessed with radiographs alone.

Subjects And Methods: Fifty children (32 boys and 18 girls; mean age, 7.3 years; age range, 2-12 years) with acute elbow trauma were examined with radiography and MR imaging.

Cost effectiveness analysis of intravenous ketorolac and morphine for treating pain after limb injury: double blind randomised controlled trial.

Objectives: To investigate the cost effectiveness of intravenous ketorolac compared with intravenous morphine in relieving pain after blunt limb injury in an accident and emergency department.

Design: Double blind, randomised, controlled study and cost consequences analysis.

Setting: Emergency department of a university hospital in the New Territories of Hong Kong.

Emergency medicine-the specialty.

The perception of emergency medicine as a defined specialty may vary widely in different locations around the world. While no single emergency medical system can fulfil the needs of all countries, there are three main models of delivery: the European model, the Anglo-American model, and the neglect model. This article reviews aspects of emergency medical systems around the world and compares the European and Anglo-American models of emergency care.

Early role of neutrophil L-selectin in posttraumatic acute lung injury.

Objective: To investigate whether early numerical and functional changes in circulating neutrophils and expression of neutrophil L-selectin and soluble L-selectin are related to the subsequent development of posttraumatic acute lung injury (ALI), the systemic inflammatory response syndrome, sepsis, and organ failure.

Design: Prospective study of whole blood and plasma samples to assess numerical and functional changes in circulating neutrophils and in soluble L-selectin.

Setting: The emergency department of a university hospital.

Increased plasma free cyclic-AMP levels following major trauma and their relevance to the immune response.

Background: Following injury, neutrophil mobilisation is an important element of the immune response. The ideal features of an agent responsible for this mobilisation would include the ability to mobilise neutrophils without activating them, and rapid reversibility. This study investigates the hypothesis that raised levels of plasma adrenaline following trauma act via cyclic adenosine monophosphate (cAMP) to mobilise neutrophils, and measures the amount of cAMP extruded from cells into the plasma following injury.

Plasma DNA as a prognostic marker in trauma patients.

Background: Recently, much interest has developed in the potential use of plasma DNA as a diagnostic and monitoring tool. We hypothesized that plasma DNA is increased in patients with trauma and may be prognostic in such patients.

Methods: We studied 84 patients who had sustained an acute blunt traumatic injury.

Paramedic activities, drug administration and survival from out of hospital cardiac arrest.

Objective: To examine the impact of administration of cardioactive drugs on the outcome from out of hospital cardiac arrest.

Design: Longitudinal observational cohort study with historical controls before and after the introduction of drug use in cardiac arrest by paramedics.

Subjects: Adult patients who had sustained an out of hospital cardiac arrest of cardiac aetiology and were treated by paramedics.