array:23 [
  "pii" => "S0873215915301884"
  "issn" => "08732159"
  "doi" => "10.1016/S0873-2159(15)30188-4"
  "estado" => "S350"
  "fechaPublicacion" => "2009-09-01"
  "aid" => "13"
  "copyright" => "Sociedade Portuguesa de Pneumologia/SPP"
  "copyrightAnyo" => "2009"
  "documento" => "simple-article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "sco"
  "cita" => "Rev Port Pneumol. 2009;15:937-41"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2756
    "formatos" => array:3 [
      "EPUB" => 237
      "HTML" => 1649
      "PDF" => 870
    ]
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0873215915301872"
    "issn" => "08732159"
    "doi" => "10.1016/S0873-2159(15)30187-2"
    "estado" => "S350"
    "fechaPublicacion" => "2009-09-01"
    "aid" => "12"
    "copyright" => "Sociedade Portuguesa de Pneumologia/SPP"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "sco"
    "cita" => "Rev Port Pneumol. 2009;15:929-35"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2990
      "formatos" => array:3 [
        "EPUB" => 215
        "HTML" => 2013
        "PDF" => 762
      ]
    ]
    "pt" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Caso Cl&#237;nico&#47;Case Report</span>"
      "titulo" => "Granulomatose de Wegener &#8211; Envolvimento otol&#243;gico&#44; nasal&#44; laringotraqueal e pulmonar"
      "tienePdf" => "pt"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "pt"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "929"
          "paginaFinal" => "935"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Wegener granulomatosis &#8211; Otologic&#44; nasal&#44; tracheobronchial and pulmonary involvement"
        ]
      ]
      "contieneResumen" => array:2 [
        "pt" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "pt" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Sandra Figueiredo, Laurentino Mendes Leal, Ant&#243;nio Morais, Adriana Magalh&#227;es, Teresa Oliveira, Venceslau Hespanhol, Carlos Dias, Gabriela Fernandes"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "Sandra"
              "apellidos" => "Figueiredo"
            ]
            1 => array:2 [
              "nombre" => "Laurentino Mendes"
              "apellidos" => "Leal"
            ]
            2 => array:2 [
              "nombre" => "Ant&#243;nio"
              "apellidos" => "Morais"
            ]
            3 => array:2 [
              "nombre" => "Adriana"
              "apellidos" => "Magalh&#227;es"
            ]
            4 => array:2 [
              "nombre" => "Teresa"
              "apellidos" => "Oliveira"
            ]
            5 => array:2 [
              "nombre" => "Venceslau"
              "apellidos" => "Hespanhol"
            ]
            6 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Dias"
            ]
            7 => array:2 [
              "nombre" => "Gabriela"
              "apellidos" => "Fernandes"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "pt"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215915301872?idApp=UINPBA00004E"
    "url" => "/08732159/0000001500000005/v1_201509151448/S0873215915301872/v1_201509151448/pt/main.assets"
  ]
  "pt" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Caso Cl&#237;nico&#47;Case Report</span>"
    "titulo" => "Hemot&#243;rax espont&#226;neo em doente com neurofibromatose tipo I &#8211; A prop&#243;sito de um caso cl&#237;nico"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "937"
        "paginaFinal" => "941"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Alexandra Bento, Ana Paula Gon&#231;alves"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "Alexandra"
            "apellidos" => "Bento"
            "email" => array:1 [
              0 => "alexitbento&#64;gmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "af0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cr0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Ana Paula"
            "apellidos" => "Gon&#231;alves"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">2</span>"
                "identificador" => "af0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Interna do Internato Complementar de Pneumologia"
            "etiqueta" => "1"
            "identificador" => "af0005"
          ]
          1 => array:3 [
            "entidad" => "Assistente Graduada de Pneumologia"
            "etiqueta" => "2"
            "identificador" => "af0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cr0005"
            "etiqueta" => "&#42;"
            "correspondencia" => "Unidade de Sa&#250;de Local EPE&#44; Guarda&#44; Servi&#231;o de Pneumologia Avenida Rainha D&#46; Am&#233;lia&#44; 6300 Guarda&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Spontaneous hemothorax in a neurofibromatosis type I patient &#8211; A case report"
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2009-03-03"
    "fechaAceptado" => "2009-04-01"
    "PalabrasClave" => array:2 [
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec570202"
          "palabras" => array:2 [
            0 => "Neurofibromatose"
            1 => "hemot&#243;rax espont&#226;neo"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key-words"
          "identificador" => "xpalclavsec570203"
          "palabras" => array:2 [
            0 => "Neurofibromatosis"
            1 => "spontaneous hemothorax"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">O hemot&#243;rax espont&#226;neo &#233; uma complica&#231;&#227;o rara e potencialmente fatal da neurofibromatose&#46; V&#225;rios mecanismos patol&#243;gicos s&#227;o descritos para a vasculopatia associada &#224; doen&#231;a&#58; a&#41; invas&#227;o dos vasos por tumores adjacentes&#44; como shwannoma&#44; neurofibroma ou neu-rofibrosarcoma&#59; b&#41; displasia vascular com forma&#231;&#227;o de aneurismas e estenoses<span class="elsevierStyleSup">6&#44;7&#44;9</span>&#46; Outros mecanismos envolvidos podem incluir patologias pleuropulmonares &#40;in-fec&#231;&#245;es com necrose&#44; embolia pulmonar&#44; endometriose&#44; neoplasias&#41; e discrasia sangu&#237;nea&#46; Os autores relatam o caso de uma jovem de 33 anos&#44; que recorreu ao servi&#231;o de urg&#234;ncia por toracalgia superior direita&#44; cont&#237;nua&#44; irradiando para o ombro e esc&#225;pula homolaterais&#44; sem factores de agravamento nem de al&#237;vio e com oito dias de evolu&#231;&#227;o&#46;</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2009&#59; XV &#40;5&#41;&#58; 937-941</span></p></span>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Spontaneous hemothorax is a rare and potentially lethal neurofibromatosis&#8217; complication&#46; Several patho-logical mechanisms may explain the associated vasculopathy&#58; a&#41; direct vascular invasion from adjacent tumors such as Shwannoma&#44; neurofibroma or neuro-fibrosarcoma&#59; b&#41; vascular dysplasia with stenotic or aneurysm formation<span class="elsevierStyleSup">6&#44;7&#44;9</span>&#46; Other mechanisms involved may include pleuropulmonar pathologies &#40;necrotizing infections&#44; pulmonary embolism&#44; endometriosis&#44; neoplasms&#41; and blood dyscrasias&#46; The authors describe a case of a 33 years old female&#44; who went to the ER Service complaining with right persistent hemithoracic pain&#44; extending to the ipsilateral shoulder and shoulder blade&#44; without aggravation or relieving factors&#44; since the last 8 days&#46;</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2009&#59; XV &#40;5&#41;&#58; 937-941</span></p></span>"
      ]
    ]
    "lecturaRecomendada" => array:1 [
      0 => array:3 [
        "vista" => "all"
        "titulo" => "<span class="elsevierStyleSectionTitle" id="st0025">Bibliografia</span>"
        "seccion" => array:1 [
          0 => array:2 [
            "vista" => "all"
            "bibliografiaReferencia" => array:9 [
              0 => array:3 [
                "identificador" => "bb0005"
                "etiqueta" => "1&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Fishman&#8217;s pulmonary diseases and disorders"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:1 [
                              0 => "Alfred P&#46; Fishman"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "LibroEditado" => array:4 [
                          "paginaInicial" => "1532"
                          "paginaFinal" => "1534"
                          "edicion" => "Fourth edition"
                          "serieFecha" => "2008"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              1 => array:3 [
                "identificador" => "bb0010"
                "etiqueta" => "2&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:1 [
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "B&#46; Fauci"
                              1 => "H&#46; Kasper"
                              2 => "Longo J&#46; Loscalzo"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Libro" => array:4 [
                          "edicion" => "Seventeenth"
                          "titulo" => "Harrison&#8217;s principles of internal medicine"
                          "fecha" => "2008"
                          "editorial" => "McGraw-Hill Companies"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              2 => array:3 [
                "identificador" => "bb0015"
                "etiqueta" => "3&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Tratado de pneumologia&#46; Sociedade Portuguesa de Pneumologia"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:2 [
                              0 => "M&#46;J&#46;M&#46; Gomes"
                              1 => "R&#46; Sotto-Mayor"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "LibroEditado" => array:4 [
                          "titulo" => "Hemot&#243;rax&#44; cap&#237;tulo"
                          "paginaInicial" => "1505"
                          "serieVolumen" => "115"
                          "serieFecha" => "2003"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              3 => array:3 [
                "identificador" => "bb0020"
                "etiqueta" => "4&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Hemothorax in type I neurofibromatosis"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:1 [
                              0 => "Geiorge P&#46; Teitlbaum"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Ann Thorac Surg"
                          "fecha" => "1998"
                          "volumen" => "66"
                          "paginaInicial" => "569"
                          "paginaFinal" => "571"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9725414"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              4 => array:3 [
                "identificador" => "bb0025"
                "etiqueta" => "5&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:1 [
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "B&#46;F&#46; Thomas"
                              1 => "A&#46;J&#46; Richard"
                              2 => "W&#46; Klaus"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "LibroEditado" => array:7 [
                          "titulo" => "Atlas e texto de dermatologia"
                          "paginaInicial" => "440"
                          "paginaFinal" => "443"
                          "edicion" => "4"
                          "serieVolumen" => "13"
                          "serieTitulo" => "Neurofibromatose&#44; sec&#231;&#227;o"
                          "serieFecha" => "2001"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              5 => array:3 [
                "identificador" => "bb0030"
                "etiqueta" => "6&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Spontaneous haemothorax associated with Von Recklinghausen&#8217;s disease&#58; review of occurrence in Japan"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:3 [
                              0 => "M&#46; Hiroyuki"
                              1 => "T&#46; Osamu"
                              2 => "K&#46; Harubumi"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:6 [
                          "tituloSerie" => "Thorax"
                          "fecha" => "1997"
                          "volumen" => "52"
                          "paginaInicial" => "577"
                          "paginaFinal" => "578"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9227730"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              6 => array:3 [
                "identificador" => "bb0035"
                "etiqueta" => "7&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Massive spontaneous hemothorax associated with Von Recklinghausen&#8217;s disease"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:2 [
                              0 => "V&#46; Mohammad"
                              1 => "M&#46; Meetra"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:2 [
                        "doi" => "10.1016/j.athoracsur.2006.02.010"
                        "Revista" => array:6 [
                          "tituloSerie" => "Ann Thorac Surg"
                          "fecha" => "2006"
                          "volumen" => "82"
                          "paginaInicial" => "1500"
                          "paginaFinal" => "1501"
                          "link" => array:1 [
                            0 => array:2 [
                              "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16996963"
                              "web" => "Medline"
                            ]
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
              7 => array:3 [
                "identificador" => "bb0040"
                "etiqueta" => "8&#46;"
                "referencia" => array:1 [
                  0 => array:1 [
                    "referenciaCompleta" => "<a href="http://www.radiologiaclinicacadecampinas.com.br/info_24.htm">http&#58;&#47;&#47;www&#46;radiologiaclinicacadecampinas&#46;com&#46;br&#47;info&#95;24&#46;htm</a>&#46;"
                  ]
                ]
              ]
              8 => array:3 [
                "identificador" => "bb0045"
                "etiqueta" => "9&#46;"
                "referencia" => array:1 [
                  0 => array:2 [
                    "contribucion" => array:1 [
                      0 => array:2 [
                        "titulo" => "Spontaneous hemothorax associated with Von Recklinghausen&#8217;s disease"
                        "autores" => array:1 [
                          0 => array:2 [
                            "etal" => true
                            "autores" => array:1 [
                              0 => "Pezzetta Edgardo"
                            ]
                          ]
                        ]
                      ]
                    ]
                    "host" => array:1 [
                      0 => array:1 [
                        "Revista" => array:5 [
                          "tituloSerie" => "Eur Journ Cardiothoracic Surg"
                          "fecha" => "2003"
                          "volumen" => "23"
                          "paginaInicial" => "1062"
                          "paginaFinal" => "1064"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "pt"
  "url" => "/08732159/0000001500000005/v1_201509151448/S0873215915301884/v1_201509151448/pt/main.assets"
  "Apartado" => array:4 [
    "identificador" => "43360"
    "tipo" => "SECCION"
    "pt" => array:2 [
      "titulo" => "Casos Cl&#237;nicos&#47;Cases Reports"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "pt"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08732159/0000001500000005/v1_201509151448/S0873215915301884/v1_201509151448/pt/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0873215915301884?idApp=UINPBA00004E"
]
Share
Journal Information
Vol. 15. Issue 5.
Pages 937-941 (September - October 2009)
Share
Share
Download PDF
More article options
Vol. 15. Issue 5.
Pages 937-941 (September - October 2009)
Caso Clínico/Case Report
Open Access
Hemotórax espontâneo em doente com neurofibromatose tipo I – A propósito de um caso clínico
Spontaneous hemothorax in a neurofibromatosis type I patient – A case report
Visits
6097
Alexandra Bento1,
Corresponding author
alexitbento@gmail.com

Unidade de Saúde Local EPE, Guarda, Serviço de Pneumologia Avenida Rainha D. Amélia, 6300 Guarda.
, Ana Paula Gonçalves2
1 Interna do Internato Complementar de Pneumologia
2 Assistente Graduada de Pneumologia
This item has received

Under a Creative Commons license
Article information
Resumo

O hemotórax espontâneo é uma complicação rara e potencialmente fatal da neurofibromatose. Vários mecanismos patológicos são descritos para a vasculopatia associada à doença: a) invasão dos vasos por tumores adjacentes, como shwannoma, neurofibroma ou neu-rofibrosarcoma; b) displasia vascular com formação de aneurismas e estenoses6,7,9. Outros mecanismos envolvidos podem incluir patologias pleuropulmonares (in-fecções com necrose, embolia pulmonar, endometriose, neoplasias) e discrasia sanguínea. Os autores relatam o caso de uma jovem de 33 anos, que recorreu ao serviço de urgência por toracalgia superior direita, contínua, irradiando para o ombro e escápula homolaterais, sem factores de agravamento nem de alívio e com oito dias de evolução.

Rev Port Pneumol 2009; XV (5): 937-941

Palavras-chave:
Neurofibromatose
hemotórax espontâneo
Abstract

Spontaneous hemothorax is a rare and potentially lethal neurofibromatosis’ complication. Several patho-logical mechanisms may explain the associated vasculopathy: a) direct vascular invasion from adjacent tumors such as Shwannoma, neurofibroma or neuro-fibrosarcoma; b) vascular dysplasia with stenotic or aneurysm formation6,7,9. Other mechanisms involved may include pleuropulmonar pathologies (necrotizing infections, pulmonary embolism, endometriosis, neoplasms) and blood dyscrasias. The authors describe a case of a 33 years old female, who went to the ER Service complaining with right persistent hemithoracic pain, extending to the ipsilateral shoulder and shoulder blade, without aggravation or relieving factors, since the last 8 days.

Rev Port Pneumol 2009; XV (5): 937-941

Key-words:
Neurofibromatosis
spontaneous hemothorax
Full text is only aviable in PDF
Bibliografia
[1.]
Alfred P. Fishman, et al.
Fishman’s pulmonary diseases and disorders.
Fourth edition, pp. 1532-1534
[2.]
B. Fauci, H. Kasper, Longo J. Loscalzo, et al.
Harrison’s principles of internal medicine, Seventeenth, McGraw-Hill Companies, (2008),
[3.]
M.J.M. Gomes, R. Sotto-Mayor, et al.
Tratado de pneumologia. Sociedade Portuguesa de Pneumologia.
Hemotórax, capítulo, pp. 1505
[4.]
Geiorge P. Teitlbaum, et al.
Hemothorax in type I neurofibromatosis.
Ann Thorac Surg, 66 (1998), pp. 569-571
[5.]
B.F. Thomas, A.J. Richard, W. Klaus, et al.
Atlas e texto de dermatologia, 4, pp. 440-443
[6.]
M. Hiroyuki, T. Osamu, K. Harubumi, et al.
Spontaneous haemothorax associated with Von Recklinghausen’s disease: review of occurrence in Japan.
Thorax, 52 (1997), pp. 577-578
[7.]
V. Mohammad, M. Meetra, et al.
Massive spontaneous hemothorax associated with Von Recklinghausen’s disease.
Ann Thorac Surg, 82 (2006), pp. 1500-1501
[9.]
Pezzetta Edgardo, et al.
Spontaneous hemothorax associated with Von Recklinghausen’s disease.
Eur Journ Cardiothoracic Surg, 23 (2003), pp. 1062-1064
Copyright © 2009. Sociedade Portuguesa de Pneumologia/SPP
Download PDF
Pulmonology
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?