Management training for hospital administrators: sentinel lymph-node biopsy under local anaesthetic for carcinoma of the breast-organizational and economic impact.

This study compares sentinel lymph-node biopsy carried out at the time of removal of the primary breast tumour, under general anaesthetic, with sentinel lymph-node biopsy carried out under local anaesthetic prior to the main operation. It compares the total cost of the two treatment approaches, in terms of average income and of their impact on the subsequent programming of operations and hence on waiting lists and income.

Cost analysis of living donor liver transplantation: the first Italian economical data.

BACKGROUND: Over a period of 30 months, the Niguarda Ca'Granda Hospital performed 12 living donor liver transplants (LDLT) on adult subjects using the split-liver technique and transplant of the right lobe. The purpose of this work is to evaluate the financial obligation that this technique will bring, the ethical and cultural aspects, and the mortality related to surgery on a healthy donor whose only reward is in the knowledge of having done everything possible for a loved family member. METHODS: The analysis of the costs of the surgical process takes into account the simultaneous consideration of both types of patients: the donor and the recipient. The diagnostic course is subdivided into seven functional phases of the cost centers, and the transitory sequences of the foreseeable events of the entire process. The method used consists in the appraisal of all the clinical activities in chronological order several the centers of cost. The direct expenses are evaluated according to an analytical method, and the indirect costs has been carried out on the criterion of the activities of support to the process (management of the orders, recording and programming of the activities) and support to the organization (maintenance, management supplying and contests of contract, programming of the business production, management warehouses, supplyings, marketing and relations with the public). RESULTS: The cost of all the patients evaluated that were not able to donate has been added to the direct expenses of 12 donor and 12 recipient patients, in all 30 patients, so as to shift the added expenses only to the donor patient, since these costs are not included in the typical costs of transplantation from a cadaver. The indirect cost calculated for each patient has been added to the direct costs of the donor and recipient patients. The total calculated cost of LDLT is 175, 210.78 Euros. CONCLUSION: The analysis of the economical obligation that this practice brings is the starting point for an accurate evaluation of all the new technology that, in conjunction with the results of clinical efficacy and efficiency trials, is part of program of a larger scope to fulfil the general social principles of equity and justice.

[Perceptions of the nursing staff after a death: the ritual of post mortem preparation of the body]. / A percepção da equipe de enfermagem em situação de morte: ritual do preparo do corpo "pós-morte".

This paper intends verificated the significance of the patients' death in nursing professionals and the emotions during the prepare of his bodies. The dispositions were collected with 23 professionals at UTI service in a hospital of São Paulo city. The results shows some sad during the prepare of the body and the comprehension that the time of the experience and the type of relationship make the different in this procedure.

Effects of fasting, noradrenaline and glucose tolerance test on free fatty acids and blood glucose in thyroid-deficient pigs.

1. This experiment was carried out to study the effects of thyroidectomy or treatment with an anti-thyroid drug (Methimazole) on the lipolytic and glycogenolytic responses to fasting, noradrenaline and glucose tolerance test in young growing pigs. 2. Male and female crossbred pigs weighing 15-30 kg were used. 3. Fasting caused a slight hypoglycemic response but without statistical differences between euthyroid and thyroid-deficient animals. 4. Free-fatty acids mobilization was significantly different between euthyroid and thyroid-deficient pigs and, the lipolytic effect of NA was lower in thyroidectomized animals than in treated or euthyroid pigs. 5. Glucose tolerance test was not different among the groups. However, FFA mobilization during the GTT was significantly different. 6. The results suggest that the interaction between catecholamines-thyroid hormones play an important role in the FFA mobilization in vivo.

[Influence of 4-methylesculetol on the response of segments of isolated coronary arteries to adrenaline, in presence of pyrogallol]. / Influenza del 4-metilesculetolo sulle risposte di segmenti di arterie coronarie isolate all'adrenalina, in presenza di pirogallolo.

The adrenaline (AD) induced relaxation in the smooth muscle is increased by bioflavonoids, possibly via cathecol-0-methyltransferase (COMT) inhibition. In order to test this hypothesis, we studied the influence of 4-methylesculetin (4-Me), alone or associated with ascorbic acid, on the response of isolated coronary strips to AD, in the presence of pyrogallol. Both 4-Me being enhanced by the addition of ascorbic acid. The effects were reduced or abolished in the presence off pyrogallol, a well known COMT inhibitor. It is concluded that 4-Me inhibits COMT, as other bioflavonoids.