Search

Copyright of Die Urologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Kieferorthopädie: die Zeitschrift für die Praxis is the property of Quintessenz Verlags GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Die Gynäkologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The European Commission has presented a draft for a comprehensive reform of pharmaceutical law in order to promote innovation and access to medicines. However, the reform is facing criticism from the innovative pharmaceutical industry, which is concerned that the new rules could jeopardize Europe's competitiveness as a research location. In particular, the planned weakening of data protection is seen as innovation-hostile. The European Parliament has adopted its position on the EU Pharma Package and partially withdrawn some planned changes, but industry criticism remains. The article deals with the European Commission's proposal to shorten data protection for medicines. The proposal suggests shortening data protection from six to two years, followed by a two-year market protection. Critics argue that it is not possible in many countries to obtain a decision on the reimbursement eligibility of a medicine within two years. The European Parliament proposes a data protection period of seven and a half years, followed by a two-year market protection. The extension of data protection for products marketed in all member states is seen as an insurmountable hurdle for many companies. There is also discussion of extending data protection by six months for medicines that fill a medical supply gap. However, critics argue that the definition of "medical supply gap" is too narrow. The article describes the proposed changes in EU pharmaceutical law. The European Parliament has proposed extending data protection for medicines by twelve months, while market protection can only be granted once. It is also proposed to shorten market exclusivity for medicines for rare diseases from ten to nine years, with the possibility of an extension to eleven years in the case of a "major medical supply gap". Measures to address medicine shortages are also proposed, such as the introduction of an EU-wide list of critical medicines and the tightening of obligations for marketing authorization holders and wholesalers. The Parliament has largely supported the Commission's proposal but has tightened the obligations related to supply shortages. The article describes the proposed regulations for addressing medicine shortages in the EU. Marketing authorization holders must explain reasons for interruptions or suspensions of supply and report them at least six months in advance. Wholesalers must report shortages and provide information on available stocks. The European Commission has proposed measures to strengthen supply chains and minimize supply interruptions. An alliance for critical medicines is also being created to develop coordinated actions against the shortage of critical medicines. The industry has positively evaluated the proposed measures. [Extracted from the article]

Copyright of Innere Medizin (2731-7080) is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Rare diseases are a heterogeneous group of complex clinical patterns, which more often than not run a chronic course. The fact that they are rare complicates the provision of medical care for the specific diseases. Results: In the field of action titled ‘Care, Centres, Networks’ of its National Action Plan, the National Action League for People with Rare Diseases recommends the formation of a three-level, interconnected centre model. This form of care was investigated in two large research projects. It was shown that the time to diagnosis was markedly reduced. Commissioned by the Federal Ministry of Health, the expert report on the health status of people with rare diseases in Germany issued in 2023 concludes that the medical care provided to this group of people has improved markedly since the National Action Plan was introduced. The establishment of the Centres for Rare Diseases (ZSE, Zentren für Seltene Erkrankungen) is seen as the most important development. However, it is noted that there is still a lack of coordinated care provision pathways for referring patients to the appropriate facilities. Conclusion: The provision of care to people with rare diseases has improved upon the implementation of the measures from the National Action Plan. In a next step, care provision pathways must be established across sector boundaries. Challenges remain in the area of psychosocial care and the long-term securing of funding for these structures.

Background: Cancer predisposition syndromes (CPS) are rare diseases that are associated with an increased risk of cancer due to genetic alterations. At least 8 % of all cases of childhood cancer are attributable to CPS [1, 2]. The CPS registry was launched in 2017 to learn more about CPS and to improve the care to those afflicted by these diseases. Methods: This is an internationally networked registry with associated accompanying studies that investigate cancer risks and spectra, the possibilities of cancer prevention, early detection and therapy. Results: For several of these syndromes, new insights into the cancer risks and cancer types as well as factors modifying cancer risk have been gained. In addition, experimental, psycho-oncological, preclinical and clinical studies were initiated. Conclusions: The CPS registry is an example of how progress can be made within a short period of time to the benefit of individuals with rare diseases through systematic data collection and research.

Background: Patient registries are an important tool for networking medical caregivers and research, especially in the field of rare diseases. Individuals afflicted by multi-organ autoimmune diseases typically suffer from inflammation of multiple organs. Project: GAIN (German genetic multi-organ Auto-Immunity Network) is the German network for research and therapy optimisation for individuals with congenital multi-organ autoimmune diseases. As a sub-project of the network, the registry systematically collects data from this patient group and makes it available for research purposes. Results: A data set was developed and made available for the GAIN Registry that can map the complex clinical status of persons with multi-organ autoimmune diseases. Data from 486 individuals have been documented to date. Conclusions: The GAIN register allows for a very comprehensive documentation that clearly goes beyond previous approaches, e.g. by linking it to biosamples collected in the consortium. The planned inclusion of patients in the documentation, e.g. of data on quality of life, opens up a new field.

Ischiofemoral injuries are very rare and their importance is underestimated. The ischiofemoral injuries include avulsion fractures of the lesser trochanter and the ischial tuberosity, rupture or injury of the quadratus femoris muscle and rupture or injury of the iliopsoas tendon. As a rule, conservative therapy is carried out, although in individual cases surgical treatment must be considered. As a result of an ischiofemoral injury, ischiofemoral impingement can occur. On the other hand, ischiofemoral impingement can lead to an injury or rupture of the quadratus femoris muscle. [ABSTRACT FROM AUTHOR]

Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Due to refined and new diagnostic possibilities and improved medical care, in the future anesthesiologists will be more frequently confronted with patients suffering from rare diseases. As the physicians providing perioperative care often have little or no experience with the diseases of such patients, the access to high-quality specific literature is essential. In this respect they must be able to assess and classify the quality of the information which is predominantly available online, especially as when evidence-based knowledge is available, it is only available to a very limited extent. Patients with rare diseases mostly present with recurring problem constellations. A systematic assignment to the most important problem areas (airway, circulation, metabolism, etc.) as well as a structured and interdisciplinary approach are decisive for a successful perioperative treatment of these patients. Due to low prevalence, lack of personal experience and lack of evidence-based data, anesthesia in patients with SE is an absolute challenge, especially in time-critical situations. [ABSTRACT FROM AUTHOR]

Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Die Urologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Die Urologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Die Urologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Zeitschrift für Rheumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Metachromatic leukodystrophy (MLD) is an autosomal recessive lysosomal disorder caused by a gene mutation resulting in the reduced production of the enzyme arylsulfatase A (ASA). This deficiency results in the accumulation of sulfatides in the lysosomal deposits in the central and peripheral nervous system, which results in demyelination. It is a rare disease seen in 1-4:100,000. There are three clinical subtypes, based upon age of onset of the first symptoms: late infantile, juvenile and adult forms. The late infantile subtype occurs before 30 months of age, with psychomotor regression resulting in ataxia and areflexia. Peripheral neuropathy can be the initial symptom, before central progression. As it progresses, it leads to dysphagia, drooling and the requirement of a gastrostomy for feeding. Painful spasms and seizures are common and death occurs within a few years. The initial symptoms of adult-onset MLD include memory loss and emotional instability with slower progression to the neurological deficits seen in the juvenile forms. Non-neurological symptoms result from the accumulation of sulfatides in visceral organs. This can lead to gallbladder issues such as gallstones and cholecystitis. Other organs affected include liver, kidney, pancreas and intestines. The diagnosis of MLD is determined by progressing neurological dysfunction, widespread white matter changes in MRI, ASA enzyme deficiency in leucocytes, elevated urinary excretion of sulfatides as well as mutation analysis. There are currently no curative treatment options for symptomatic patients with MLD. Haematopoietic stem-cell transplantation has been tested but results have been inconclusive. Gene therapy is approved for use in presymptomatic or very mildly affected children with the late infantile or early juvenile form of MLD. [ABSTRACT FROM AUTHOR]

Abstract: The investigation of rare diseases is challenging because of the small number of patients and a frequently heterogeneous, multisymptomatic clinical presentation. Niemann-Pick type C (NPC), a progressive, neurodegenerative hereditary disorder, was long considered a pediatric disease. However, in the past decade, this view changed, given that a substantial number of adult NPC patients were diagnosed. Yet, we still know little about the clinical spectrum of adult NPC. This article sheds further light on this topic. For this purpose, we based the disease characteristics of the subpopulations of pediatric versus adolescent and adult NPC patients on the available literature as well as expert opinions regarding epidemiology, genetic mutation pattern, pathology including prodromal symptoms, progression rate, general treatment regime, and treatment effects. As outlined, NPC emerges as a disease continuum based on broadly similar genetic mutation patterns and pathophysiology across age groups. Pediatric and adolescent/adult patients are characterized by diverse facets of progressive neuropsychological manifestations, such as cognitive deficits and marked limitations in their motor abilities (including consideration of prodromal symptoms). NPC progresses similarly in pediatric and adolescent/adult patients, albeit with an accelerated rate of progression and thus a shortened life expectancy the younger the patients are when neurological symptoms first appear. However, the high disease burden of all NPC patients indicates the severity of this metabolic disorder. The treatment of NPC is interdisciplinary, regardless of age. To date, there is no causal therapy option. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Rare kidney diseases encompass a wide range of congenital, inherited and acquired conditions. Two million Europeans are affected by rare kidney diseases. The European Rare Kidney Disease Reference Network (ERKNet) aims to improve the clinical management of patients with these diseases. ERKNet encompasses 95 highly specialized adult and pediatric nephrology units at 72 sites in 24 European Union (EU) member states, as well as a group of patient advocates (European Patient Advocacy Group, ePAG). ERKNet centers care for more than 65,000 rare kidney disease patients and pursues a variety of activities. An online consultation service helps improve the management of complex cases. Expert working groups develop clinical practice guidelines for individual groups of rare kidney diseases. In a 3-year postgraduate program, junior physicians at ERKNet centers are trained by experts in the diagnosis and treatment of rare kidney diseases through webinars and case-based eLearning modules. Information brochures and online texts on rare kidney diseases for patients, relatives and the general public are produced and disseminated. Clinical research is supported by a European Registry for Rare Kidney Diseases (ERKReg), which provides important information on demographics and disease progression and facilitates the identification of patient cohorts for therapeutic studies. In addition, the registry provides clinical performance statistics of reference centers and allows benchmarking to promote the harmonization and standardization of care for rare kidney disease patients across Europe., Competing Interests: Einhaltung ethischer Richtlinien Interessenkonflikt T. Wlodkowski, S. Haeberle und F. Schaefer geben an, dass kein Interessenkonflikt besteht.Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patient/-innen zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern/Vertreterinnen eine schriftliche Einwilligung vor., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Rheumatic and musculoskeletal diseases (RMD) include various diseases with sometimes rather different symptoms, some of which are locally confined and others show systemic features. Autoimmune phenomena, such as those occurring in Sjögren's syndrome, often cause symptoms such as xerostomia and xerophthalmia in association with inflammation of the salivary glands. The pathogenesis of these diseases is only partly clarified. This is similar to allergic diseases, which are otherwise clearly different with respect to the symptoms and pathomechanisms but swelling of the salivary glands can also rarely occur here. As this is a possible differential diagnosis of Sjögren's syndrome or also IgG4-associated diseases, and such a case was recently described, a literature search was carried out in PubMed, the results of which are presented here and summarized in this article in a brief overview., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Technological and scientific innovations in the area of gene and cell therapies, so-called advanced therapy medicinal products (ATMPs), have contributed to the steep increase in treatment options for patients with rare diseases. They offer opportunities to address the underlying genetic defect by gene addition, i.e., the delivery of the gene of interest to the target cells, or by genome editing approaches through direct repair of disease-causing mutations. This paper outlines clinical evidence requirements in the context of marketing authorisations for rare diseases. Two out of fifteen gene therapies that have been approved in the European Union since 2018 are used as case studies: Libmeldy (atidarsagen autotemcel) for the treatment of patients with metachromatic leukodystrophy, and Roctavian (valoctocogen roxaparvovec) for the treatment of patients with haemophilia A. Special aspects of the evaluation of single-arm trials with small sample size and requirements with regard to the isolation and causal attribution of the treatment effect are discussed. The role of clinical data obtained under everyday conditions (real world data) to support the generation of evidence in the pre- and post authorisation phase is critically examined. Furthermore, the paper outlines aspects related to conditional versus standard marketing authorisations as well as aspects related to registry-based non-interventional studies in the context of market and patient access to urgently needed drugs., (Copyright © 2024. Published by Elsevier GmbH.)

An isolated fracture of the handle of the malleus is a rare entity in otorhinolaryngology and manifests clinically as acute-onset unilateral hearing loss. Several factors may cause this injury, including acute barotraumatic pressure changes or traumatic events. Various therapeutic approaches such as tympanoplasty, autologous graft, or application of bone cement are discussed. We report the case of a 46-year-old female patient who developed acute hearing loss in her left ear after finger manipulation. Clinical evaluation revealed axial displacement of the handle of the malleus and audiometry indicated conductive hearing loss. After otoscopy, audiometry, and computed tomography, tympanoscopy was indicated due to suspicion of ossicular chain disruption. Intraoperatively, an isolated fracture of the handle of malleus was found, which was treated with glass ionomer cement. Following postoperative examination, there was progressive improvement in the acoustic transmission component, such that a normal hearing threshold was observed 4 months postoperatively. This case report underlines the importance of precise diagnosis and individualized treatment for rare middle ear injuries., (© 2024. The Author(s).)

Copyright of Der Gastroenterologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Internist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Onkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Implantologie is the property of Quintessenz Verlags GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Parasitic infections by Echinococcus granulosus are rare in Germany, and predominantly affect individuals with a migration background. Liver and lungs are the most commonly affected organs. Pulmonary cysts often remain asymptomatic until rupture, at which point symptoms may manifest. The diagnostic approach typically involves a combination of imaging modalities and serological tests, occasionally supplemented by molecular genetic methods. Given the global movements of migration, considerations of the epidemiology of common diseases in the country of origin should also be taken into account in the differential diagnosis. We present the unusual case of a pneumogenic sepsis in a young man from Syria, where the combination of medical history alongside radiological, serological, and molecular genetic investigations ultimately led to the diagnosis of a severe pulmonary echinococcosis with rupture., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

The article focuses on Covid-19 pandemic pushed the need for analysis right at the top of the agenda at the touch of a button and access to data on one's own health. It mentions uniform exchange format for electronic health records are implemented in Europe and actions for exchange about rare diseases, infectious diseases and efficacy studies. It also mentions extramural and intramural applications area, data from so-called wearables such as fitness trackers, watches, blood pressure monitors.

Copyright of Der Internist is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Hautarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Monatsschrift Kinderheilkunde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Nachrichten aus der Chemie is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Technical and pharmacological revolution in contemporary medicine has not resolved the ethical problems that seem to be more relevant today than ever before. Most of the papers that concern medical ethics focus on `great' problems, such as human genome sequencing, organizms cloning and quantitative or qualitative interference with life creation. This article, however, describes practical ethical problems that the doctors face in every-day practice. First of all, the problem of how thestandards of prophilaxis and treatment should be established when the costs exceed financial possibilities of a health system. Secondly, how to face the problem of rare diseases when the cost of a single patient treatment may be equal to the whole medical department budget. Thirdly, how to procede with elderly patients with multiple diseases qualified for invasive procedures. All of these examples share the common base: in these cases the technical equipment is at our disposal, yet we cannot or we do not want to use it.