RESUMEN
BACKGROUND: A spontaneous cervical epidural hematoma (SCEH) is a rare occurrence, with < 500 cases reported to date. Clinically, it usually presents with quadriparesis, but in extremely rare cases it can present with hemiparesis or hemiplegia, and can easily be misdiagnosed as stroke. The cervical epidural hematoma by itself is an urgent condition that requires a quick and accurate diagnosis and a prompt surgical treatment. CASE REPORT: We present a case where an SCEH mimicked the much more frequent condition of a stroke, and discuss the importance of diagnostics procedures that help differentiate SCEH from acute cerebral infarction. The patient's history of neck pain and spondylosis render this case more challenging. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Considering that the emergency tissue plasminogen activator treatment for acute cerebral infarction can worsen the state of an SCEH patient, or even lead to permanent damage or death, it is of great importance to rapidly and accurately differentiate these two conditions.
Asunto(s)
Hematoma Espinal Epidural/diagnóstico por imagen , Hematoma Espinal Epidural/diagnóstico , Anciano , Femenino , Hematoma Espinal Epidural/complicaciones , Humanos , Debilidad Muscular/etiología , Dolor de Cuello/etiología , Rotura Espontánea/complicaciones , Rotura Espontánea/fisiopatología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Tomografía Computarizada por Rayos X/métodosRESUMEN
AIM: To evaluate the costs and survival estimates of metastatic colorectal carcinoma patients treated with conventional cytostatic protocols and adjuvant monoclonal antibodies (mAbs). METHODS: Retrospective randomized case series and cost-of-illness analysis was used. Metastatic colorectal carcinoma cases (62) were randomly selected from the archive of the largest university military hospital in Southeastern Europe. RESULTS: A 6-month longer survival was attributed to mAbs (p = 0.581). Conventional protocols incurred 5137 (95% CI: 3758- 6517) versus 22,113 (95% CI: 16,201- 28,025) total direct medical costs in mAb-based group. ICER of 32,108 per life year gained attributable to mAbs three-fold exceeded informal willingness to pay threshold of Serbia. CONCLUSION: mAbs adjuvant protocols had modest positive impact on 5-year survival rates. Costs were driven by targeted biologicals, but significantly higher costs of care were recorded in mAb-treated group in other domains, as well. More selective prescription and reimbursement criteria should be applied to increase cost-effectiveness of targeted oncology agents.