RESUMO
The case of a 56-year-old man with a massive unilateral rightsided pleural effusion is described. The origin of the pleural effusion is a decompensated liver cirrhosis without ascites. The pathogenetic mechanisms and treatment are discussed.
Assuntos
Cirrose Hepática Alcoólica/complicações , Derrame Pleural/etiologia , Diagnóstico Diferencial , Diuréticos/uso terapêutico , Exsudatos e Transudatos , Furosemida/uso terapêutico , Humanos , Cirrose Hepática Alcoólica/diagnóstico , Cirrose Hepática Alcoólica/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Derrame Pleural/diagnóstico , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/terapia , Radiografia Torácica , Espironolactona/uso terapêuticoRESUMO
Three patients are presented, who developed a severe skin reaction after brain-irradiation and concomitant phenytoin treatment. A fourth patient from the databAse of the Swiss Drug Monitoring Center, showed a Stevens-Johnson-Syndrome after a severe electric shock and phenytoin treatment. Possible pathogenic mechanisms of these life-threatening complications and possible alternatives to the phenytoin treatment in irradiated patients are discussed.
Assuntos
Adenocarcinoma/radioterapia , Anticonvulsivantes/efeitos adversos , Neoplasias Encefálicas/radioterapia , Toxidermias/etiologia , Glioblastoma/radioterapia , Fenitoína/efeitos adversos , Síndrome de Stevens-Johnson/induzido quimicamente , Adenocarcinoma/secundário , Adulto , Idoso , Neoplasias Encefálicas/secundário , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dosagem RadioterapêuticaRESUMO
BACKGROUND: This study was designed to compare conventional laparoscopy with three-dimensional (3-D) laparoscopy. METHOD: Thirty candidates, 20 inexperienced and 10 experienced in operative laparoscopy, executed standardized exercises on a pelvitrainer. The candidates were randomized to two groups. Group A executed the exercises first with the conventional and then with the three-dimensional system. Group B accomplished the exercises in the reverse sequence. At the end of the exercises, the candidates answered specific questions about the two systems. RESULTS: A total of 21 h 6 min 6 sec of laparoscopic exercises were analyzed-10 h 8 min 1 sec with the conventional and 10 h 58 min 5 sec with the three-dimensional system (p = 0.38). Group A required 12 h 26 min 56 sec to perform all the exercises. There was no statistically significant difference from group B, where the candidates needed 8 h 39 min 10 sec (p = 0.14). Neither were there any differences in the number of failed attempts between the two groups. There were also no statistical difference when the results obtained from the candidates without experience in laparoscopy and the participants experienced in operative laparoscopy were analyzed separately. Both the inexperienced and the experienced candidates became tired earlier, had more headaches, and needed extra time to adapt to the 3-D system. CONCLUSION: When analyzed in a standardized fashion, 3-D laparoscopy does not have any significant advantages over conventional laparoscopy.
