JAMA : the journal of the American Medical Association
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Comparative Study
Racial differences in serum total bilirubin levels in health and in disease (pernicious anemia).
Common usage prescribes a single normal range for serum bilirubin levels. However, we have not only confirmed that men have higher levels than women but have discovered significant racial differences as well. Among 1,538 healthy Americans, blacks had lower mean bilirubin levels than whites of European origin, Latin Americans, and Asians. ⋯ Moreover, the actual bilirubin level changes caused by pernicious anemia were themselves smaller among blacks. The racial differences, thus, persisted in pernicious anemia despite similar degrees of anemia, whereas the sex differences disappeared. We suggest that the lower serum bilirubin levels in blacks in health and disease do not stem primarily from lower bilirubin production than in whites.
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Surgical problems do not end on a person's centennial, and as our overall population ages, physicians will see increasing numbers of these most senior citizens requiring surgery. Accordingly, the records of all century-old patients who have undergone surgery at the Massachusetts General Hospital in the years 1979 to 1983 were reviewed. ⋯ The centenarian has already been tested by life and found exceptionally fit. Selectivity and meticulous attention to detail remain paramount in treating these patients, but elective surgery should not be deferred, nor emergency surgery denied the centenarian on the basis of chronologic age.