Israel journal of medical sciences
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Malignant pleural effusion is a frequent complication of metastatic breast cancer, leading to a significant degree of morbidity. Drainage of the effusion by thoracocentesis and subsequent pleurodesis is an established means of symptomatic relief in these patients. ⋯ The condition of the lung's parenchyma must be evaluated prior to the procedure to rule out lymphangitis carcinomatosa or bronchial obstruction that would impair the expansion of the lung. In these situations, the implantation of a pleuroperitoneal shunt is an alternative to be considered.
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Comparative Study Clinical Trial
Transvaginal Doppler sonography for detecting ectopic pregnancy: is it really necessary.
In this prospective study we compared transvaginal duplex Doppler ultrasound with two-dimensional imaging for the diagnosis or exclusion of ectopic pregnancies. The study group comprised 76 stable patients with serum beta-human chorionic gonadotropin (hCG) levels > 100 mIU/ml in whom ectopic pregnancy was clinically suspected. Ectopic pregnancies were verified in 42 patients (60%), intrauterine pregnancies (normal and abnormal) in 19 (27%), and possible complete abortions, either intrauterine or extrauterine, in 9 patients (13%). ⋯ High velocity systolic flow, and low impedance diastolic flow which characterizes trophoblastic tissue when detected outside the uterus, had a sensitivity of 48%, while the presence of trophoblastic signals in the uterus or their absence outside the uterus excluded ectopic pregnancies with a specificity of 89%. The positive predictive values were 91% for Doppler and 95% for 2-D imaging, while the negative predictive values were 89% for imaging alone and 44% for Doppler. These data suggest that transvaginal Doppler ultrasound has significant lower sensitivity and negative predictive value and does not provide more useful diagnostic information than 2-D imaging alone for stable patients with suspected ectopic pregnancies.
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Comparative Study
The risk of developing an acute coronary event as a measure of the quality of triage of patients presenting to the emergency room with chest pain.
The risk of developing an acute coronary event (ACE) in patients presenting to the emergency room with chest pain or shortness of breath was assessed in a prospective blinded fashion. The Time Insensitive Predictive Instrument (TIPI), which is appropriate for both prospective and retrospective assessment, was used to determine the risk. The average predictive probability for developing ACE among the 168 patients examined was 36.5%. ⋯ Among patients presenting with ACE the predictive probability determined using TIPI was 57.6% compared to 26.3% in patients without ACE. This difference was unaffected by the triage process or the decision where to hospitalize. TIPI permits assessment of the emergency room physician's decisions and also mirrors the limitations of the system as a whole in treating patients referred to the emergency room for a suspected acute coronary event.