RESUMO
Although still in its early stages, disease management is already proving to be effective in decreasing health care expenditures by increasing compliance and normalizing utilization patterns. For the greatest benefit to be realized over the long term, however, a disease management program must target the 80 percent of the identified population not yet in the action stage. Only by appropriate interventions designed to move individuals incrementally from stage to stage will disease management fulfill its promise of appropriately lowering health care costs by cutting across the established component system.
Assuntos
Doença Crônica/economia , Prestação Integrada de Cuidados de Saúde/economia , Gerenciamento Clínico , Doença Crônica/psicologia , Controle de Custos , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Estados UnidosRESUMO
Three groups of dogs underwent testicular ischemia for a 3-hour period. Group I (10 animals) was not subsequently perfused. Group II (10 animals) underwent subsequent perfusion by a new in vivo reversible method via the internal spermatic artery with heparinized saline. Group III (5 animals) underwent perfusion with Sacks' solution. At 3 weeks' time the histology of the testes of the three groups was compared. Group I showed a 75.5% decrease in the germinal epithelium. Group II showed a 21.4% decrease. Group III showed a 31.8% decrease. The survival rate of the germinal epithelium in the two perfused groups was significantly improved (P less than 0.01).
Assuntos
Isquemia , Perfusão , Testículo/irrigação sanguínea , Animais , Cães , Epitélio/irrigação sanguínea , Epitélio/patologia , Isquemia/patologia , Masculino , Testículo/patologiaRESUMO
Improved modalities to treat metastatic renal cell carcinoma will require an aggressive surgical and chemotherapeutic approach. Nephrectomy with hormonal and non-hormonal chemotherapy does improve median survival and 3-year survival significantly. The use of xenogeneic specific immune ribonucleic acid and Bacillus Calmette-Guerin offers promising immunotherapeutic modalities that may be combined with surgical and chemotherapeutic regimens. Early diagnosis of metastatic disease is important to evaluate properly the results of various modalities of treatment and possibly to improve the efficiency of these modalities. The management of solitary metastatic nodules should involve aggressive resection of the primary and metastatic nodule. Adjuvant hormonal and non-hormonal chemotherapy should be considered in all stages of the disease.
