Chest
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Randomized Controlled Trial Comparative Study Clinical Trial
Prevention of malignant seeding after invasive diagnostic procedures in patients with pleural mesothelioma. A randomized trial of local radiotherapy.
The purpose of this randomized prospective study was to assess the efficacy of local radiotherapy in preventing malignant seeding along invasive diagnostic procedures (cytology, needle biopsy, thoracoscopy, or chest tube placement) in patients with malignant pleural mesothelioma. Forty consecutive patients with histologically proven malignant mesothelioma were enrolled. Twenty patients received three daily sessions of radiotherapy at a dosage of 7 Gy 10 to 15 days after thoracoscopy. ⋯ None of the 20 patients treated developed entry tract metastasis. In contrast, 8 of the 20 (40%) patients who were not treated developed metastases. These findings confirm the efficacy and safety of early local radiotherapy in preventing malignant seeding after invasive diagnostic procedures in patients with malignant pleural mesothelioma.
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Randomized Controlled Trial Comparative Study Clinical Trial
Evaluation of carbon dioxide rebreathing during pressure support ventilation with airway management system (BiPAP) devices.
The purpose of this study was to evaluate whether carbon dioxide (CO2) rebreathing occurs in acute respiratory failure patients ventilated using the standard airway management system (BiPAP pressure support ventilator; Respironics; Murrysville, Pa) with positive inspiratory airway pressure and a minimal level of positive end-expiratory pressure (PEEP) and whether any CO2 rebreathing may be efficiently prevented by the addition of a nonrebreathing valve to the BiPAP system circuit. In the first part of the study, the standard device was tested on a lung model with a nonrebreathing valve (BiPAP-NRV) and with the usual Whisper Swivel connector (BiPAP-uc). With the BiPAP-uc device, the resident volume of expired air in the inspiratory circuit at the end of expiration (RVEA) was 55% of the tidal volume (VT) when the inspiratory pressure was 10 cm H2O and the frequency was at 15 cycles per minute. ⋯ When we compared the BiPAP system use with the other two systems, we observed no significant effect on blood gases but found significant increases in VT, minute ventilation, and work of breathing. These findings are experimental and are clinical evidence that significant CO2 rebreathing occurs with the standard BiPAP system. This drawback can be overcome by using a non-rebreathing valve, but only at the expense of greater expiratory resistance.