It is usual to rank the participant countries in the Olympic Games in accordance with the number of medals they have won. An alternative ranking is suggested in this paper. This ranking is based on each countryÕs ability to win medals in relation to its available resources. This is an efficiency that can be measured with the help of data envelopment analysis (DEA) for which two models exist: the traditional DEA model, that takes into account variable returns to scale, and a DEA model based on the premise that the sum of the gains is zero (constant sum of outputs). It is the latter that is developed in this paper.

Data envelopment analysis (DEA) literature has proposed alternative models for performance assessment in the presence of undesirable outputs, such as pollutant emissions, where increased outputs imply reduced performance. However, the case where global equilibrium of outputs should be imposed has not yet been considered. We propose that the zero sum gains DEA (ZSG-DEA) models look especially suitable for treating equilibrium models, where the sum of the quantities produced by all decision-making units can be set as the upper admissible bound. This paper uses ZSG-DEA models to evaluate the carbon dioxide emission case study, which can be considered part of the Kyoto Protocol statement.

Background: Adrenal ultrasonography (US) in dogs with hyperadrenocorticism (HAC) is commonly used to distinguish adrenocorticotropic hormone (ACTH)-independent (AIHAC) and ACTH-dependent hyperadrenocorticism (ADHAC). To date, no cut-off values for defining adrenal atrophy in cases of adrenal asymmetry have been determined. Given that asymmetrical hyperplasia is sometimes observed in ADHAC, adrenal asymmetry without ultrasonographic proof of adrenocortical tumor such as vascular invasion or metastasis can be equivocal.Objective: The purpose of this study was to compare adrenal US findings between cases of ADHAC and AIHAC in dogs with equivocal adrenal asymmetry (EAA), and to identify useful criteria for their distinction.Animals: Forty dogs with EAA were included. Methods: Ultrasound reports of HAC dogs with adrenal asymmetry without obvious vascular invasion or metastases were reviewed. Dogs were classified as cases of ADHAC (n 5 28) or AIHAC (n 5 19), determined by plasma ACTH concentration. The thickness, shape, and echogenicity of both adrenal glands and presence of adjacent vascular compression were compared between AIHAC and ADHAC groups.Results: The maximal dorsoventral thickness of the smaller gland (SDV) ranged from 2.0 to 5.0 mm in AIHAC and from 5.0 to 15.0 mm in ADHAC. The 95% confidence intervals for estimated sensitivity and specificity of a SDV cut-off set at 5.0 mm in the diagnosis of AIHAC were 82-100 and 82-99%, respectively. Other tested US criteria were found to overlap extensively between the 2 groups, precluding their usefulness for distinction.Conclusion and Clinical Importance: In EAA cases, an SDV 5.0 mm is an appropriate cut-off for AIHAC ultrasonographic diagnosis.

Supranumerary or ectopic parathyroid glands are the main cause of persistent hyperparathyroidism (HPT) in patients with end stage renal disease (ESRD) submitted to parathyroidectomy (PTx). PURPOSE: To evaluate the prevalence and location of parathyroid glands in these patients. METHODS: Thirty-five patients with ESRD and severe secondary hyperparathyroidism (HPT2) had been submitted to total PTx at HUCFF from December 2001 to July 2005. Surgery was always performed by the same surgeon, who described in details the location of the glands. RESULTS: Sixteen patients (45.7%) had ectopic glands, which were also extranumerary in five of them (14.3%). The most common locations were the thyroid parenchyma (33.3%), thyroid-thymus conduit (18.5%), and thymus (14.8%). Before PTx, the sensibility of ultrasonography and scintigraphy with technetium-99m Sestamibi was low (48.3% and 35.3%, respectively). Moreover, 51.4% of the nodules found at US were thyroid nodules. However, 99mTc-Sestamibi was useful to identify ectopic glands in those two patients with persistent HPT after PTx. CONCLUSION: The presence of extranumerary and ectopic parathyroid glands in HPT2 is sufficiently important to justify their exhaustive search. As the preoperative image exams present low sensibility to locate them, it is necessary to develop an exploratory routine embracing the most common sites of location.

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