Moses Maimonides' Treatise on Asthma.
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Biomedical subjects
Publications and source records attributed to F Rosner.
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Postsplenectomy sepsis in children is a well-recognized hazard. Few reports discuss the risk of sepsis in the asplenic adult. Case reports of 47 adults with serious infections following splenectomy for trauma were examined. We conclude that fulminant sepsis after splenectomy for trauma in adults is indeed a potential risk and that all such patients should receive penicillin prophylaxis and pneumococcal vaccine.
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The authors reviewed 61 reported cases of second neoplasms in acute lymphoblastic leukemia (ALL), including 17 patients with ALL followed by another type of acute leukemia, 12 patients with ALL followed by chronic myelocytic leukemia, 19 patients with ALL followed by lymphoma, and 13 patients with ALL followed by other solid tumors. From a review of the literature, it is believed that there is no firm evidence yet that patients with ALL, intensively treated with chemotherapy and/or radiotherapy, are at increased risk of developing therapy-related second neoplasms. Because the number of cases reported is small, there is even insufficient data to firmly suggest that acute myeloblastic leukemia, following intensive therapy for ALL, occurs in a higher-than-expected frequency.
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Recent advances in biomedical technology and therapeutic procedures have generated a moral crisis in modern medicine. The vast strides made in medical science and technology have created options which only a few decades earlier would have been relegated to the realm of science fiction. Man, to a significant degree, now has the ability to exercise control not only over the ravages of disease but even over the very processes of life and death. With the unfolding of new discoveries and techniques, the scientific and intellectual communities have developed a keen awareness of the ethical issues which arise out of man's enhanced ability to control his destiny. In response to the concern for questions of this nature, there has emerged the rapidly developing field of bioethics. Jews, to whom all such questions are quests not only for applicable humanitarian principles but for Divine guidance, must, of necessity, seek answers in the teaching of the Torah. "The Torah of God is perfect" (Psalms 19: 8), and in its teachings the discerning student will find eternally-valid answers to even newly-formulated queries. As physicians and patients turn to Rabbinic authorities for answers, Jewish scholars seek to elucidate and expound the teachings of the Torah in these vital areas of concern. The present essay highlights some of the ethical issues faced by the Jewish physician who faithfully observes his tradition in all matters including his daily practice of medicine. Although more questions are raised than answered, the aim of this essay will have been achieved if the reader is stimulated to pursue these issues in the extending writings on the subject now available in English.
Here 145 reported post-splenectomy infections in 115 patients with Hodgkin's disease are reviewed. Such infections can occur at any age (median age 19.8 years) and the interval from splenectomy to the infection is quite variable (median 21.9 months). Most infections are present clinically as pneumonia, septicemia, meningitis, or a combination thereof, with the most common offending organism being pneumococcus. The infection can be fulminant and even fatal. It is recommended that the spleen should only be removed when essential. A staging laparotomy and splenectomy seem justifiable only in cases of Hodgkin's disease where a change of staging would lead to a change of planned therapy. Prophylactic penicillin should be administered at least for 3 years and possibly indefinitely since post-splenectomy infections can occur many years later. Pneumococcal vaccine should also be given before any chemotherapy or radiotherapy is initiated. Prompt and aggressive treatment should be given when post-splenectomy infection is diagnosed.
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