Effect of inner membrane tearing in the treatment of adult chronic subdural hematoma: a comparative study

Kanat, Ayhan/0000-0002-8189-2877WOS: 000336884400003PubMed: 24477064The postoperative results of chronic subdural hematoma (CSDH) procedures using catheterization and tearing of inner membrane (CTIM) technique have not previously been discussed in the literature. This article compares the effects of CTIM technique on brain re-expansion and re-accumulation with cases operated on with a burr-hole craniotomy and outer membrane incision (BCOMI) technique. the study involved operations on 144 patients (Group 1) using the CTIM technique and 108 patients (Group 2) using the BCOMI technique. in the operations using the CTIM technique in Group 1, the mean effusion measured in the subdural space (SDS) was 10.0 +/- 0.2 mm, and for Group 2, 14.3 +/- 0.6 mm in the postoperative period on the first and third days and this difference was found to be significant (p < 0.05). the means were 6.6 +/- 0.2 mm for Group 1 and 10.3 +/- 0.5 mm for Group 2 on the seventh day (p < 0.05). Recurrence rate was 8.3% in Group 2 and 0 in Group 1. This difference was statistically significant (p = 0001). the length of hospital stay was 7.0 +/- 0.1 days for the Group 1 and 8.8 +/- 0.2 days for Group 2 and this difference was significant (p < 0.05). These results indicate that the CTIM technique is preferable because it results in earlier re-expansion, lower recurrence, less subdural effusion and pneumocephalus, and shorter hospital stays

Parallel Trade, Reference Pricing and Competition in the Pharmaceutical Market: Theory and Evidence

Paper I. Reference Pricing: Making Parallel Trade in Pharmaceuticals Work This paper shows that parallel trade makes pharmaceutical manufacturers reduce their prices in the home (importing) country more when it is combined with the healthcare reimbursement policy of reference pricing, requiring consumers to pay the full extra cost if they don’t buy cheaper parallel imported drugs. On the other hand, contrary to intuition, reference pricing leaves price unchanged in the foreign (exporting) country. By and large, a change from coinsurance to reference pricing results in a pure transfer of wealth from the pharmaceutical manufacturers to the insurance providers without affecting consumers’ pharmaceutical consumption or their out-of-pocket costs. Paper II. Compassion and Cost: The Dual Role of Reference Pricing Providing health insurance involves a trade-off between the benefits from risk spreading and the costs due to moral hazard. Focusing on pharmaceuticals consumption, this paper examines theoretically whether reference pricing, requiring individuals to pay the price difference if, in this case, they don’t buy the cheaper parallel imported drug, can ease this trade-off – an issue which has not previously been pointed out in the debate on health insurance. The results indicate that, if individuals are extremely risk-averse, a policy shift from coinsurance to reference pricing would do this by providing more insurance while decreasing moral hazard. Paper III. Parallel Imports and Mandatory Substitution Reform: A Kick or A Muff for Price Competition in Pharmaceuticals (with David Granlund) What has been the effect of competition from parallel imports on prices of locally-sourced on-patent drugs? Did the 2002 Swedish mandatory substitution reform increase this competition? To answer these questions, we carried out difference-in-differences estimation on monthly data for a panel of all on-patent prescription drugs sold in Sweden during the 40 months from January 2001 through April 2004. On average, facing competition from parallel imports caused a 15-17% fall in price. While the reform increased the effect of competition from parallel imports, it was only by 0.9%. The reform, however, did increase the effect of therapeutic competition by 1.6%. Paper IV. EU Enlargement, Parallel Trade and Price Competition in Pharmaceuticals: What’s to Blame? Derogation or Perception? (with David Granlund) Given the cost of trade and availability of pharmaceuticals, the driving force for parallel trade is the price difference between the source (exporting) and the destination (importing) country. An increase in the price difference or in the availability of pharmaceuticals for parallel trade should increase price competition in the destination country. Using 2003-2007 data from Sweden we investigated whether EU enlargement in 2004, when new countries with low pharmaceutical prices joined the EU, increased competition from parallel imports. Drugs facing competition from parallel imports are found to have on average 17% to 21% lower prices than they would have had if they had never faced such competition. But, contrary to expectation, EU enlargement is not found to have increased this effect, which might be explained by derogations and changes in consumer perceptions of parallel imports

EU Enlargement, Parallel Trade and Price Competition in Pharmaceuticals : has the Price Competition increased?

Given the cost of trade and availability of pharmaceuticals, the driving force for parallel trade is the price difference between the source (exporting) and the destination (importing) country. An increase in the price difference or in the availability of pharmaceuticals for parallel trade should increase price competition in the destination country. Using 2003-2007 data from Sweden we investigated whether EU enlargement in 2004, when new countries with low pharmaceutical prices joined the EU, increased competition from parallel imports. Drugs facing competition from parallel imports are found to have on average 17% to 21% lower prices than they would have had if they had never faced such competition. But, contrary to expectation, EU enlargement is not found to have increased this effect, which might be explained by derogations and changes in consumer perceptions of parallel imports

Early detection of mononeuritis multiplex & diagnosis of systemic diseases thru electrophysiological work out with polyneuropathy as preceeding symptom

22nd World Congress of Neurology (WCN) -- OCT 31-NOV 05, 2015 -- Santiago, CHILEWOS: 000384634802062Background: Mononeuritis multiplex (MNM) is a nervous system disorder that involves damage to at least two separate peripheral nerves. It is a syndrome not a disease, caused by certain systemic diseases like diabetes, vasculitis, rheumatic, infectious or paraneoplastic diseases. Objective: To evaluate the role of electrophysiological work out on patients presenting with polyneuropathy as preceding symptom that leads to early diagnosis of MNM and an underlying systemic disease. Patients: We retrospectively analyzed 12 MNM patients (4 females and 8 males from 19 to 62 years of age) presenting with patchily distributed weakness in all and pain at onset in nine, at our neuromuscular diseases clinic between 1993-2013. We have obtained Institutional Review Board (IRB) approval, as necessary. Methods: Neurophysiological evaluation, routine blood chemistry, vasculitis markers, serum and protein electrophoresis, HIV, Hepatitis markers were examined in all patients. Nerve and muscle biopsies were performed in 5 patients. Results: Neurophysiological evaluation revealed an asymmetrically distributed motor and sensory nerve involvement accompanied by neurogenic findings in all. Nerve and muscle biopsies were performed in five. The differential diagnostic work up of this patient group resulted in diagnosis of 2 Churg- Strauss syndrome, 2 rheumatoid arthritis, 2 non-necrotizing vasculitis, 2 PAN and 1 multiple myeloma, 1 CNS vasculitis related to p-ANCA, 1 Hepatitis C and 1 HIV. Conclusion: Detailed investigation of patients with polyneuropathy as preceding symptom thru electrophysiological work out can be a valuable tool that leads to early detection and treatment of MNM and the underlying systemic disease

Yenidoğanda Nadir Görülen Tümör: İnfantil Hemanjioendotelyoma

Yenidoğanda blue rubber bleb nevus sendromu ile hemanjioendotelyomanın nadir birlikteliği paylaşılmak istenildi. 10 günlük ye- nidoğan spontan solunumunun durması, cilte kavernöz hemanjiom, hepatomegali, pnömoni, kardiyojenik şok ile yenidoğan yoğun bakım ünitesine yatırıldı. Çekilen batın tomografisinde karaciğerde hemanjioendotelyoma ile uyumlu görünüm saptanan olgu blue rubber bleb nevus sendromu ve hemanjioendotelyoma birlikteliği tanısı ile takip edildi. İnfantil hemanjioendotelyoma damar kökenli olan nadir görülen ve etyolojisi bilinmeyen bir neoplazidir. Klinik gidişi ve prognozu değişken olup, önceden tahmin etmek zordur. Nadir görülür, metastatik adenokarsinom ile karışabilir. Blue rubber bleb nevus sendromu yenidoğanda nadir rastlanmakla birlikte vakamızda hemanjioendotelyoma ile birlikte seyretmesi dikkat çekicidi

Kounis Syndrome Induced by Oral Intake of Diclofenac Potassium

TURAN SONMEZ, Feruza/0000-0001-8817-8521WOS: 000424115300012PubMed: 29338163An acute coronary syndrome (ACS) occurring during the course of an allergic reaction is called Kounis syndrome (KS). The second case of KS induced by diclofenac potassium (DP) is presented in this report. A 67-year-old man was brought to our emergency department with the possible diagnosis of anaphylactic shock by the ambulance staff. It emerged that widespread erythema and pruritus developed after taking DP. Then, he lost consciousness. Diffuse urticarial lesions were detected on physical examination at the emergency department. He complained of chest pain during his observation, and progressive ST segment elevation was seen in the inferior leads on serial electrocardiograms. His coronary angiography showed 100% occlusion of the right coronary artery. Then, KS was diagnosed. The patient was discharged on the second day, and he was doing well on the control visit 2 weeks later. All allergic reactions may trigger an ACS so physicians should be aware of KS and always keep that unique clinical entity in mind to recognize it promptly and direct the therapy at suppressing the allergic reaction and improving the coronary circulation simultaneously when encountering a patient with symptoms suggesting an allergic reaction and a concomitant ACS

Postural stability and fall risk in adult patients with familial mediterranean fever

INTRODUCTION: In this study, our purpose was to determine the postural stability and fall risk by an objective computerized technique in patients with Familial Mediterranean Fever (FMF), together with their relevant potential risk factors for falls. METHODS: 45 patients diagnosed with FMF (mean age 31+-10 years; range 17 to 53 years) and 40 healthy controls (mean age 31+-9 years; range 18 to 50 years) were included in the study. We used the Falls Efficacy Scale (FES-I) for assessment of fall efficacy. The disease severity score was assessed. Stability Index (SI), Weight Distribution Index (WDI), and fall risk analysis were performed by the computerized posturography device. RESULTS: The rate of falls in the last year was higher in the patient group (p&lt;0.05). Significant differences were found between groups regarding SI and WDI values (p&lt;0.05). A higher fall risk was determined in the patient group (p&lt;0.05). However, except female gender, no significant relationships were found between SI, WDI, and fall risk and disease-related factors such as age, body mass index, duration and severity of the disease, the last 1-year fall history, and FES-I (r&lt;0.3, p&gt;0.05). Moreover, while significant positive correlations were determined between all parameters of SI and fall risk (r&gt;0.3, p&lt;0.001), no relationship was found between WDI and fall risk (r&lt;0.3, p&gt;0.05) except close eyes-head extended (HB-WDI) (r= 0.003, p&lt;0.001). DISCUSSION AND CONCLUSION: Postural stability was impaired and fall risk increased in FMF. This result might result from FMF disease or many other factors being capable of affecting the balance