JAMA : the journal of the American Medical Association
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Cement is a widely used mixture in construction. A corrosive alkali, calcium hydroxide, is liberated as water is added to the lime present in the cement mixture. ⋯ When full-thickness burns were present, long periods of hospitalization were necessary for eschar separation prior to skin grafting. Early excision of full-thickness caustic burns with immediate skin grafting diminished the length of hospitalization and returned the patient to work sooner.
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A competitive marketplace potentially creates new pressures for teaching hospitals. To assess possible trends in teaching hospitals' caseload, we studied surgical utilization in 1972 and 1981 using two national data sets. The percentage of total patients hospitalized for surgery increased in teaching hospitals between 1972 and 1981. ⋯ Overall surgical case complexity was relatively high in teaching hospitals in 1972, and the disparity with nonteaching hospitals increased during the decade. Distribution of surgical patients by payment source varied appreciably among surgical procedures, but not among hospitals by teaching status. Teaching hospitals were successful in attracting patients from 1972 to 1981; however, several new pressures are emerging that should be watched.
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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.