Bezoars ; complications ; Fruit ; adverse effects ; Gallstones ; diagnosis ; pathology ; Humans ; Ileus ; diagnosis ; etiology ; Male ; Middle Aged ; Seeds ; adverse effects ; Tomography, X-Ray Computed

INTRODUCTIONPatients with suspected deep vein thrombosis (DVT) pose a diagnostic dilemma to the Emergency Department (ED) clinician. This study aimed to implement a known algorithm incorporating the modified Wells criteria and D-dimer testing to guide the ED clinician, thus reducing unnecessary ultrasound scans (USS).

METHODSPatients who presented to the ED between August 2008 and April 2009 with suspected DVT underwent Wells scoring. Those with scores < 2 were deemed unlikely to have DVT and underwent D-dimer testing first. Patients with scores ≥ 2 were regarded as likely to have DVT and underwent urgent USS. USS findings were tabulated as positive or negative/indeterminate for DVT. The latter group was followed up for one year to check whether DVT was missed during the initial USS.

RESULTS75 patients presented with suspected DVT and underwent USS. Of these, 14 results were positive and 61 were negative. 37 patients had Wells scores < 2, with three (8.1%) having DVT. Another 38 patients had Wells scores ≥ 2, with 11 (28.9%) having DVT. D-dimer testing was performed on 27 of the 75 patients. Those with DVT had higher average values compared to those without DVT (1.305 vs. 0.595 µg/ml). The majority of patients with raised D-dimer values had cellulitis, although three also had DVT (with values ≥ 0.99 µg/ml).

CONCLUSIONWe managed to reduce the number of unnecessary USS and increase the pick-up rate of DVT. A cut-off score ≥ 2 in our algorithm is suitable for use in the ED setting.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Algorithms ; Biomarkers ; metabolism ; Cost-Benefit Analysis ; Emergencies ; Female ; Fibrin Fibrinogen Degradation Products ; metabolism ; Health Status Indicators ; Humans ; Male ; Middle Aged ; ROC Curve ; Sensitivity and Specificity ; Singapore ; Ultrasonography ; Unnecessary Procedures ; economics ; Venous Thrombosis ; diagnosis ; diagnostic imaging

INTRODUCTIONSevere acute respiratory syndrome (SARS) is a newly emerged atypical pneumonia caused by the SARS-associated coronavirus (SARS-CoV). Chest radiographic appearances have been reported as non-specific, ranging from normal to peribronchial thickening and ill-defined airspace shadowing. This study is a retrospective review of chest radiographic findings in children with suspected and probable SARS during the 2003 outbreak in Singapore.

MATERIALS AND METHODSWe focused on children admitted to the SARS treatment ward from March 2003 to May 2003. Chest radiographs of children admitted with suspected or probable SARS as well as other febrile illness during this period were retrospectively and independently reviewed by 3 radiologists. The radiographs were randomised and anonymised before interpretation. Subsequently, we identified the radiographs of patients who were categorised as suspected or probable SARS. We present our findings in these patients' radiographs.

RESULTSA total of 67 patients' serial chest radiographs were interpreted. Of these, we subsequently selected those patients with suspected or probable SARS for analysis. The radiographic abnormalities in suspected or probable SARS patients consisted of patchy ground glass opacities or patchy airspace consolidation. The abnormalities had a predominantly lower zone distribution on chest radiographs, followed by mid-zone involvement. There was a slight preponderance of peripheral zone involvement. There was equal distribution of abnormalities in both lungs. All the children with radiographic abnormalities made uneventful recoveries and had normal radiographs on follow-up review.

CONCLUSIONSIn children, SARS appears to have a relatively mild and nonspecific pattern of respiratory illness. The radiographic features in children with suspected or probable SARS in our study were comparable to other clusters of paediatric patients during initial presentation. It is difficult to distinguish SARS in children from other viral pneumonias on radiographic features alone. Positive travel history to endemic regions or positive contact history, and laboratory findings of lymphopaenia, leukopaenia and thrombocytopaenia are important clues.

Child ; Child, Preschool ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Radiography, Thoracic ; methods ; Retrospective Studies ; Severe Acute Respiratory Syndrome ; diagnostic imaging ; epidemiology

INTRODUCTIONDeveloping effective exercise programmes for the paediatric population is a strategy for decreasing obesity and is expected to help in eventually limiting obesity-associated long-term health and societal impact. In this study, the effects of a 12-week twice weekly additional exercise training, which comprised a combination of circuit-based resistance training and aerobic exercises, in additional to typical physical education sessions, on aerobic fitness, body composition and serum C-reactive protein (CRP) and lipids were analysed in 13- to 14-year-old obese boys contrasted with a control group.

MATERIALS AND METHODSBoth the exercise group (EG, n = 12) and control group (CG, n = 12) participated in the typical 2 sessions of 40-minute physical education (PE) per week in schools, but only EG participated in additional 2 sessions per week of 45 to 60 minutes per session of exercise training, which comprised a combination of circuit-based resistance training and aerobic exercises maintained at 65% to 85% maximum heart rate (HRmax = 220 - age). Body composition was measured using dual energy X-ray absorptiometry (DEXA). Fasting serum CRP and blood lipids were analysed pre- and postexercise programme. Aerobic fitness was measured by an objective laboratory submaximal exercise test, PWC170 (Predicted Work Capacity at HR 170 bpm).

RESULTSExercise training significantly improved lean muscle mass, body mass index, fitness, resting HR, systolic blood pressure and triglycerides in EG. Serum CRP concentrations were elevated at baseline in both groups, but training did not result in a change in CRP levels. In the CG, body weight increased significantly at the end of the 12-week period.

CONCLUSIONThis study supports the value of an additional exercise training programme, beyond the typical twice weekly physical education classes, to produce physiological benefits in the management of obesity in adolescents, including prevention of weight gain.

Adolescent ; C-Reactive Protein ; analysis ; metabolism ; Exercise Therapy ; Humans ; Lipids ; analysis ; blood ; Male ; Obesity ; physiopathology ; therapy ; Physical Fitness ; physiology

A 60-year-old man presented with abdominal pain. He was later diagnosed on imaging to have high-grade small bowel obstruction. The patient underwent surgery, and a hard, rounded bezoar resembling the endosperm of Nypa fruticans, colloquially known as attap chee, was found at the point of obstruction. Small bowel obstruction is a common acute surgical condition with multiple causes, including bezoars. We discuss the typical imaging features of bezoars causing small bowel obstruction as well as potential pitfalls that can mimic the appearance of a bezoar.