Types of inferior mesenteric artery: a proposal for a new classification

Background: The inferior mesenteric artery (IMA) is the third main branch of the abdominal aorta and arises at the level of L3, supplying the large intestine from the distal transverse colon to the upper part of the anal canal. The aim of this study was to characterise the course and morphology of the terminal branches of the IMA, and also creating a new IMA classification, which seems to be necessary for clinicians performing surgery in this area.Materials and methods: The anatomical variations in the branching patterns of the IMA were examined in 40 cadavers fixed in a 10% formalin solution. Morphometric measurements were then obtained twice by two researchers.Results: Due to the proposed classification system, type I characterised by a common trunk preceding bifurcation into sigmoidal branches and the superior rectal artery after giving left colic artery (LCA) occurred in 57.5% of cases, type II, trifurcation type, in 25%, type III with the superior rectal arteries originating firstly from the IMA in 5%, type IV with the ascending lumbar artery in 10% of cases and type V, a novelty, in 2.5%. The origin of IMA was observed at the level of L2/L3 in 22.5% of cases, at L3 in 25% of cases, at L3/L4 in 15% of cases, at L4 in 35% of cases and at the level of L5 in 2.5% of cases. More than one third (38.1%) of total cases with additional arteries and rapidly bifurcating branches occurred in types III, IV, and V. In women, only the IMA and LCA were significantly narrower than in men. Only the diameter of the IMA correlated with the diameter of the superior rectal artery.Conclusions: The IMA is characterised by high morphological variability. The introduction of a new, structured, anatomical classification seems necessary for all clinicians

EQ-5D in Central and Eastern Europe : 2000-2015

Objective: Cost per quality-adjusted life year data are required for reimbursement decisions in many Central and Eastern European (CEE) countries. EQ-5D is by far the most commonly used instrument to generate utility values in CEE. This study aims to systematically review the literature on EQ-5D from eight CEE countries. Methods: An electronic database search was performed up to July 1, 2015 to identify original EQ-5D studies from the countries of interest. We analysed the use of EQ-5D with respect to clinical areas, methodological rigor, population norms and value sets. Results: We identified 143 studies providing 152 country-specific results with a total sample size of 81,619: Austria (n=11), Bulgaria (n=6), Czech Republic (n=18), Hungary (n=47), Poland (n=51), Romania (n=2), Slovakia (n=3) and Slovenia (n=14). Cardiovascular (20%), neurologic (16%), musculoskeletal (15%) and endocrine/nutritional/metabolic diseases (14%) were the most frequently studied clinical areas. Overall 112 (78%) of the studies reported EQ VAS results and 86 (60%) EQ-5D index scores, of which 27 (31%) did not specify the applied tariff. Hungary, Poland and Slovenia have population norms. Poland and Slovenia also have a national value set. Conclusions: Increasing use of EQ-5D is observed throughout CEE. The spread of health technology assessment activities in countries seems to be reflected in the number of EQ-5D studies. However, improvement in informed use and methodological quality of reporting is needed. In jurisdictions where no national value set is available, in order to ensure comparability we recommend to apply the most frequently used UK tariff. Regional collaboration between CEE countries should be strengthened