We report a case of an acquired mid-sized extrapericardial aneurysm in the area of the left atrial appendage and demonstrate the diagnostic impact of several imaging methods. Chest radiography gave a hint to the diagnosis with a bulky mass of soft tissue density appearing adjacent to the left atrial appendage. Transthoracic as well as transesophageal echocardiography missed the origin of the aneurysm. Magnetic resonance imaging helped to establish the diagnosis with use of a coronal imaging plane. No contrast agent was necessary. Thus, the combination of chest X-ray and MRI provided excellent support for patient management.
Health Technology Assessment in Poland) for orphan oncology drugs are based. The role of AHTAPol is to prepare for the Minister of Health recommendations on financing all medical technologies from public funds. Orphan oncology drugs undergo pharmacoeconomic evaluations and coverage decision processes similar to other molecules. AHTAPol's reimbursement recommendations are based on evidence of clinical benefit and efficacy/safety ratio, cost-effectiveness, costs and their impact on the payer's budget. METHODS: Among recommendations of AHTAPol published until the end of May 2011, we identified all related to orphan oncology drugs. Having categorized into types of recommendations then we analyzed rational for granted decision. RESULTS: Among 420 AHTAPol decisions analyzed, 32 (21,7%) applied to non-drugs technologies, 91 (21,7%) to health care programs and 297 (70,7%) to drugs technologies. Among 297 drugs recommendations only 15 (5%) was related to oncology orphan molecules. Granted were 10 (out of 15) positive recommendations. For 3 out of 15 drugs AHTAPol issued conditional recommendations (with restriction related to reducing the cost-effectiveness outcomes). Only two orphan oncology drugs were assessed negatively. In both cases main criteria on which recommendations were based refer to low clinical efficacy and safety. CONCLUSIONS: Neither cost-effectiveness nor costs and budget impact were significant arguments in negative recommendations of AHTAPol. As a matter of fact, lack of clinical efficacy and insufficient safety profile were the key issues for orphan oncology drugs negatively assessed by AHTAPol. OBJECTIVES:Methadone maintenance programs (MMP) offer the best treatment for opioid dependence. In Spain, methadone hydrochloride is prepared as a magistral formulation. Despite the organization and the management of the MMP is in hands of the Delegación del Gobierno para el Plan Nacional sobre Drogas, each autonomous region (AR) is responsible for its planning and financing. The aim of this study was to identify planning MMP differences among AR in Spain. METHODS:A structured literature review on the IME, SciELO, Doyma, Medline, national and AR official bulletins and health web pages, and general and specialised press, up to July 1, 2010. RESULTS: Planning differences were found around four areas. First, in 13 AR the regional health department establishes the health care provision and legal framework for MMP, whereas in 4 AR this is a shared responsibility between health and social security regional departments. Second, three health care networks for the provision of MMP coexist in Spain. Andalusia has drug care centers, 6 AR specialized or mental health centers and 10 AR combine both structures. Third, in 11 AR methadone prescribing and dispensing is performed in one center, in 6 AR in separate centers and in Cantabria coincide both systems. Fourth, in the majority of AR a central laboratory or the hospitals elaborate the greater part of the methadone; however, in 2 AR it is elaborated in pharmacies and in 2 ...
Introduction: Congestive heart failure is heart muscle failure that causes pulmonary congestion and eventually pulmonary edema, which despite recent medical advances, is still a progressive syndrome with high mortality, the prevalence of which has increased in recent decades. Therefore, in this study we compared lung ultrasound findings in acute heart failure patients with the BNP. Methods: This study was performed in the emergency room of Imam Reza hospital in Tabriz. For patients entering the emergency room after taking a history, both standard gold (BNP) tests and beside ultrasound of the lung were performed. Ultrasound was performed at the same time as obtaining blood sample to ensure that the ultrasound specialist did not know the result of diagnosis. During the ultrasound, if there were multiple B-Lines that were at least 3 mm apart, patient was diagnosed with pulmonary edema due to heart failure. Results: Number of participants in this study was 108 people, 54.6% of whom were men and the rest were women. The correlation coefficient between width and number of kerley lines was 0.79, between NT-pro BNP and width of kerley lines was 0.65 and between NT-pro BNP and number of kerley lines was 0.77, which indicates a significant positive correlation (P value <0.001). Conclusion: The results of present study showed that in patients with acute heart failure, the number and width of kerley lines in pulmonary ultrasound evaluation increase rapidly. There is also a high correlation between number and length of kerley lines with NT-pro BNP serum values.
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