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To investigate the clinical features of recurrence of severe acute respiratory syndrome (SARS) and therapeutic response.Recurrence was analyzed retrospectively in SARS patients referred to our hospital from April to May this year to understand the clinical features, the recurrent related factors, the response of treatment and the outcomes.One hundred and twenty three patients with SARS were referred to the First Hospital of Peking University from 8, April to 14, May this year and of whom 51 were the critical. Twenty-five patients experienced recurrence, account for 20.3% of total patients (25/123) and 31.4% of critical patients. The clinical features included recurrent fever, worsened breathlessness, exacerbation in radiological lesions and elevated LDH, etc.. These patients were treated with glucocorticoids. Eleven of them were mechanical ventilated. Twenty-one patients recovered. Pulmonary fibrosis were left in 2 patients and another 2 patients died.The recurrence of symptoms in SARS patients is one of the common clinical feature of critical patients with SARS. Mechanism of recurrence in SARS patient is unknown. Management with glucocorticoids and noninvasive ventilation can control the progression in these patients effectively.

To analyze the usage of corticosteroids in the treatment of SARS.The usage of corticosteroids in 43 SARS patients were reviewed. The initial dosage and the highest dosage of prednisolone were investigated.According to the dosage of the early 3 days, the initial dosage was calculated. The initial methyprednisonlone dosage was (170.82 +/- 15.89) mg.d-1, from 48 to 500 mg.d-1. The maximal dosage was (291.44 +/- 37.63) mg.d-1 (48-800 mg.d-1). Four patients recovered without corticosteroides therapy. Initial therapy was kept in 25 cases. Two had hyperglycemia, one of whom died of hyperosmotic coma and renal failure. 14 cases were not responsive and needed to increase the dosage of corticosteroids. 9 of them accepted pulse dosage therapy and acquired good outcome. None in the group had significant side effect. The severity of patients of the two groups had no significant difference. Those of nonresponsiveness had higher dosage and needed longer time to reach stable.Sub-pulse dosage of methyprednisolone was effective for most SARS patients. Those who were less responsiveness might due to their poor sensitiveness to corticosteroids instead of SARS severity. Pulse treatment might be safe in carefully selected patients.

To observe the application and the roles of non-invasive positive pressure ventilation (NIPPV) in the treatment of severe acute respiratory syndrome (SARS).To analyze retrospectively the data of NIPPV in 105 SARS cases hospitalized from 8 Apr to 14 May, 2003. To generalize the indication, parameter adjustment, treatment effects, side effects and affection rate of the medical faculty.The total number of the patients was 105. Among them 24 patients accepted NIPPV, 5 patients died. The mortality was 4.7%, which was lower than the average rate of our country. The most common side effect was subcutaneous emphysema, of which the incidence rate was 16.7%. There was no SARS affected among the medical faculty during the course of NIPPV.NIPPV is a safe and effective method for the treatment of the severe SARS. The proper application of NIPPV could decrease the chance of the invasive ventilation and decrease the affective rate of the medical faculty.

To observe the radiological features of chest X ray in SARS patients.The chest films of 23 cases of SARS were reviewed in the study. The chest film features and site of lung involvement were studied in early stage, most severe stage and recovery stage. The sequential chest film were evaluated hemiquantitatively. The correlation between the score of lung involvement and clinical course was also studied.The lung involvement was most common in lower lung field and outer zone both in early and acute stage. 91.3% cases had bilateral involvement and 91.2% had multifield involvement (two lung fields involvement is 47.8%, three and four lung fields involvement are both 21.7%). The ill-defined and variable opacities showed to be dominant. The improvement of acute stage lesion in 17 cases is related to the usage and increased dosage of corticosteroid, some cases showed non-parallel with symptom and chest X-ray. Hemiquantitative analysis showed there are 6 cases had second peak in X ray, the mean time of onset is 13.2 days, and lasted for 5.8 days.The chest X ray of SARS has some features and its changes can reflect the clinical situation.