array:24 [
  "pii" => "S157921291730054X"
  "issn" => "15792129"
  "doi" => "10.1016/j.arbr.2017.02.006"
  "estado" => "S300"
  "fechaPublicacion" => "2017-04-01"
  "aid" => "1445"
  "copyright" => "SEPAR"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Arch Bronconeumol. 2017;53:207"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1197
    "formatos" => array:3 [
      "EPUB" => 116
      "HTML" => 744
      "PDF" => 337
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0300289616302277"
      "issn" => "03002896"
      "doi" => "10.1016/j.arbres.2016.08.001"
      "estado" => "S300"
      "fechaPublicacion" => "2017-04-01"
      "aid" => "1445"
      "copyright" => "SEPAR"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "Arch Bronconeumol. 2017;53:207"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2311
        "formatos" => array:3 [
          "EPUB" => 246
          "HTML" => 1210
          "PDF" => 855
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Imagen cl&#237;nica</span>"
        "titulo" => "Un invitado inesperado en la ecobroncoscopia"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:1 [
            "paginaInicial" => "207"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "An unexpected guest in ultrasound-guided bronchoscopy"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figuras&#46; A y B&#46;"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 923
                "Ancho" => 2669
                "Tamanyo" => 130048
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imagen hiperecoica redondeada&#44; en el interior de la orejuela de la aur&#237;cula izquierda&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Paula Elisa Hern&#225;ndez P&#233;rez, Lorenzo P&#233;rez Negr&#237;n, M&#46; Purificaci&#243;n Ram&#237;rez Mart&#237;n"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Paula Elisa"
                "apellidos" => "Hern&#225;ndez P&#233;rez"
              ]
              1 => array:2 [
                "nombre" => "Lorenzo"
                "apellidos" => "P&#233;rez Negr&#237;n"
              ]
              2 => array:2 [
                "nombre" => "M&#46; Purificaci&#243;n"
                "apellidos" => "Ram&#237;rez Mart&#237;n"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S157921291730054X"
          "doi" => "10.1016/j.arbr.2017.02.006"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291730054X?idApp=UINPBA00003Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616302277?idApp=UINPBA00003Z"
      "url" => "/03002896/0000005300000004/v1_201704070048/S0300289616302277/v1_201704070048/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1579212917300551"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2017.02.007"
    "estado" => "S300"
    "fechaPublicacion" => "2017-04-01"
    "aid" => "1439"
    "copyright" => "SEPAR"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Arch Bronconeumol. 2017;53:208"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1604
      "formatos" => array:3 [
        "EPUB" => 123
        "HTML" => 1048
        "PDF" => 433
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>"
      "titulo" => "Pleuropericardial Cyst&#58; Uncommon Location and Presentation"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "208"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Quiste pleuroperic&#225;rdico&#58; localizaci&#243;n y presentaci&#243;n inusuales"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1003
              "Ancho" => 1800
              "Tamanyo" => 157639
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chest CT&#46; Anterior mediastinal mass with necrotized areas of infected embryonic remnants&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ruth Yeste Mart&#237;n, Luis Javier Navarro Mar&#237;n, Carmen Herrero Rodr&#237;guez"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Ruth"
              "apellidos" => "Yeste Mart&#237;n"
            ]
            1 => array:2 [
              "nombre" => "Luis Javier"
              "apellidos" => "Navarro Mar&#237;n"
            ]
            2 => array:2 [
              "nombre" => "Carmen"
              "apellidos" => "Herrero Rodr&#237;guez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0300289616302174"
        "doi" => "10.1016/j.arbres.2016.07.011"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616302174?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917300551?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005300000004/v1_201704070039/S1579212917300551/v1_201704070039/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1579212917300538"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2017.02.005"
    "estado" => "S300"
    "fechaPublicacion" => "2017-04-01"
    "aid" => "1456"
    "copyright" => "SEPAR"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Arch Bronconeumol. 2017;53:206"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1372
      "formatos" => array:3 [
        "EPUB" => 122
        "HTML" => 837
        "PDF" => 413
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>"
      "titulo" => "Tracheobronchial Obstruction Caused by Primary Mediastinal Lymphoma"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "206"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Obstrucci&#243;n traqueobronquial secundaria a linfoma mediast&#237;nico primario"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 750
              "Ancho" => 900
              "Tamanyo" => 110755
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tracheobronchial obstruction due to primary mediastinal lymphoma&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Mar&#237;a Luisa Valle Feijoo, Violeta Turcu, Fernando Iglesias R&#237;o, Ceferino Guti&#233;rrez Mendiguchia"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Mar&#237;a Luisa"
              "apellidos" => "Valle Feijoo"
            ]
            1 => array:2 [
              "nombre" => "Violeta"
              "apellidos" => "Turcu"
            ]
            2 => array:2 [
              "nombre" => "Fernando"
              "apellidos" => "Iglesias R&#237;o"
            ]
            3 => array:2 [
              "nombre" => "Ceferino"
              "apellidos" => "Guti&#233;rrez Mendiguchia"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0300289616302381"
        "doi" => "10.1016/j.arbres.2016.08.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616302381?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917300538?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005300000004/v1_201704070039/S1579212917300538/v1_201704070039/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Clinical Image</span>"
    "titulo" => "An Unexpected Guest in Ultrasound-Guided Bronchoscopy"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:1 [
        "paginaInicial" => "207"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Paula Elisa Hern&#225;ndez P&#233;rez, Lorenzo P&#233;rez Negr&#237;n, M&#46; Purificaci&#243;n Ram&#237;rez Mart&#237;n"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Paula Elisa"
            "apellidos" => "Hern&#225;ndez P&#233;rez"
            "email" => array:1 [
              0 => "paulahdezp&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Lorenzo"
            "apellidos" => "P&#233;rez Negr&#237;n"
          ]
          2 => array:2 [
            "nombre" => "M&#46; Purificaci&#243;n"
            "apellidos" => "Ram&#237;rez Mart&#237;n"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Neumolog&#237;a&#44; Hospital Universitario de Nuestra Se&#241;ora de la Candelaria&#44; Santa Cruz de Tenerife&#44; Tenerife&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Un invitado inesperado en la ecobroncoscopia"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 923
            "Ancho" => 2667
            "Tamanyo" => 126332
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A and B&#41; Round hyperechoic image in the left atrial appendage&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 55-year-old man&#44; on the waiting list for annuloplasty for severe mitral stenosis&#44; was investigated for suspicious mediastinal lymphadenopathies detected on chest computed tomography images&#46; His medical records mentioned oral anticoagulation indicated by the cardiologist&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">During an endobronchial ultrasound procedure&#44; a round hyperechoic image was seen in the left atrial appendage&#44; along with an enlarged atrial diameter &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46; Atrial thrombus was suspected&#44; so the cardiologist was contacted&#44; who confirmed the diagnosis by transesophageal echocardiography&#46; The procedure was suspended&#44; and it was confirmed that the patient was not taking his prescribed anticoagulation&#44; and treatment with low molecular weight heparin began&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Linear endobronchial ultrasound can reveal structures adjacent to the tracheobronchial wall&#44; including lymph nodes and tumor growth proximal to the central airway&#46; The potential role of endobronchial ultrasound in the diagnosis of other entities has recently been pointed out&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a> For it to be of benefit&#44; knowledge is required&#44; not only of the mediastinal lymphatic structures and their relationship with the bronchial tree&#44; but also of the vascular structures&#44; and their location and echographic characterization&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">2</span></a> so that incidental findings in these regions can be diagnosed&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Hern&#225;ndez P&#233;rez PE&#44; P&#233;rez Negr&#237;n L&#44; Ram&#237;rez Mart&#237;n MP&#46; Un invitado inesperado en la ecobroncoscopia&#46; Arch Bronconeumol&#46; 2017&#59;53&#58;207&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 923
            "Ancho" => 2667
            "Tamanyo" => 126332
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A and B&#41; Round hyperechoic image in the left atrial appendage&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:2 [
            0 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Convex probe endobronchial ultrasound&#58; applications beyond conventional indications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46; Li"
                            1 => "W&#46; Zheng"
                            2 => "L&#46; Zhao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3978/j.issn.2072-1439.2015.09.23"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Dis"
                        "fecha" => "2015"
                        "volumen" => "7"
                        "paginaInicial" => "E289"
                        "paginaFinal" => "E297"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26543618"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Techniques of linear endobronchial ultrasound imaging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Sharma"
                            1 => "C&#46;L&#46; Arya"
                            2 => "A&#46; Somasundaram"
                            3 => "S&#46; Rameshbabu Ch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Bronchol Intervent Pulmonol"
                        "fecha" => "2010"
                        "volumen" => "17"
                        "paginaInicial" => "177"
                        "paginaFinal" => "187"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000005300000004/v1_201704070039/S157921291730054X/v1_201704070039/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "21342"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Clinical Image"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005300000004/v1_201704070039/S157921291730054X/v1_201704070039/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291730054X?idApp=UINPBA00003Z"
]
Share
Journal Information
Vol. 53. Issue 4.
Pages 207 (April 2017)
Clinical Image
Full text access
An Unexpected Guest in Ultrasound-Guided Bronchoscopy
Un invitado inesperado en la ecobroncoscopia
Visits
3922
Paula Elisa Hernández Pérez
Corresponding author
paulahdezp@gmail.com

Corresponding author.
, Lorenzo Pérez Negrín, M. Purificación Ramírez Martín
Servicio de Neumología, Hospital Universitario de Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
This item has received
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Full Text

A 55-year-old man, on the waiting list for annuloplasty for severe mitral stenosis, was investigated for suspicious mediastinal lymphadenopathies detected on chest computed tomography images. His medical records mentioned oral anticoagulation indicated by the cardiologist.

During an endobronchial ultrasound procedure, a round hyperechoic image was seen in the left atrial appendage, along with an enlarged atrial diameter (Fig. 1A and B). Atrial thrombus was suspected, so the cardiologist was contacted, who confirmed the diagnosis by transesophageal echocardiography. The procedure was suspended, and it was confirmed that the patient was not taking his prescribed anticoagulation, and treatment with low molecular weight heparin began.

Fig. 1.

(A and B) Round hyperechoic image in the left atrial appendage.

(0.12MB).

Linear endobronchial ultrasound can reveal structures adjacent to the tracheobronchial wall, including lymph nodes and tumor growth proximal to the central airway. The potential role of endobronchial ultrasound in the diagnosis of other entities has recently been pointed out.1 For it to be of benefit, knowledge is required, not only of the mediastinal lymphatic structures and their relationship with the bronchial tree, but also of the vascular structures, and their location and echographic characterization,2 so that incidental findings in these regions can be diagnosed.

References
[1]
P. Li, W. Zheng, L. Zhao.
Convex probe endobronchial ultrasound: applications beyond conventional indications.
J Thorac Dis, 7 (2015), pp. E289-E297
[2]
M. Sharma, C.L. Arya, A. Somasundaram, S. Rameshbabu Ch.
Techniques of linear endobronchial ultrasound imaging.
J Bronchol Intervent Pulmonol, 17 (2010), pp. 177-187

Please cite this article as: Hernández Pérez PE, Pérez Negrín L, Ramírez Martín MP. Un invitado inesperado en la ecobroncoscopia. Arch Bronconeumol. 2017;53:207.

Copyright © 2016. SEPAR
Archivos de Bronconeumología
Article options
Tools

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