RESUMO
OBJECTIVES: The National Hospital Discharge Survey (NHDS) was used to evaluate potentially avoidable hospital conditions as an indicator of equity and efficiency in the US health care system. METHODS: With the use of 1990 data from the NHDS, the National Health Interview Survey, and the census, national rates of hospitalization were calculated for avoidable conditions by age, race, median income of zip code, and insurance status. RESULTS: An estimated 3.1 million hospitalizations were for potentially avoidable conditions. This was 12% of all hospitalizations in 1990 (excluding psychiatric admissions, women with deliveries, and newborns). Rates of potentially avoidable hospitalizations were higher for persons living in middle- and low-income areas than for persons living in high-income areas, and were higher among Blacks than among Whites. These class and racial differences were also found among the privately insured. Differences among income and racial groups for persons aged 65 and over were not significant. CONCLUSIONS: Inequalities in potentially avoidable hospitalizations suggest inequity and inefficiency in the health care delivery system. Avoidable hospital conditions are a useful national indicator to monitor access to care.
Assuntos
Etnicidade , Hospitalização/estatística & dados numéricos , Renda , Seguro Saúde , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Medicaid , Pessoa de Meia-Idade , Razão de Chances , Alta do Paciente/estatística & dados numéricos , Classe Social , Estados UnidosRESUMO
The case of a 30-year-old man with papillary cystadenoma of the epididymis is presented. This extremely rare lesion is often associated with von Hippel-Lindau disease, although in this case there were no such signs or symptoms. The gross and microscopic features of this lesion and theories of its origin are reviewed. The constant microscopic features are: efferent duct ectasia with papillary formation, a lining of cuboidal epithelium, often with clear vacuolated cytoplasm, and a stroma of hyalinized fibrous tissue infiltrated by inflammatory cells.
Assuntos
Cistadenoma/patologia , Epididimo/patologia , Neoplasias Testiculares/patologia , Adulto , Cistadenoma/cirurgia , Epididimo/cirurgia , Humanos , Masculino , Neoplasias Testiculares/cirurgiaRESUMO
Linitis plastica of the cecum is rare. The authors describe a case of this condition in a 16-year-old man. The commonest presenting symptom is a change in bowel habit. Histologically there are three recurring features--diffuse infiltration of the bowel wall by small darkly staining tumour cells, the presence of multiple "signet-ring" cells indicating mucin production and, third, an attempt at gland formation. The prognosis is poor; no patient has survived longer than 27 months.
