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Biomedical subjects

Fred Rosner

Publications and source records attributed to Fred Rosner.

At least 19 recordsLinked to original sources
PubMed2002

ANCA-associated small-vessel vasculitis.

Antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis is the most common primary systemic small-vessel vasculitis to occur in adults. Although the etiology is not always known, the incidence of vasculitis is increasing, and the diagnosis and management of patients may be challenging because of its relative infrequency, changing nomenclature, and variability of clinical expression. Advances in clinical management have been achieved during the past few years, and many ongoing studies are pending. Vasculitis may affect the large, medium, or small blood vessels. Small-vessel vasculitis may be further classified as ANCA-associated or non-ANCA-associated vasculitis. ANCA-associated small-vessel vasculitis includes microscopic polyangiitis, Wegener's granulomatosis, Churg-Strauss syndrome, and drug-induced vasculitis. Better definition criteria and advancement in the technologies make these diagnoses increasingly common. Features that may aid in defining the specific type of vasculitic disorder include the type of organ involvement, presence and type of ANCA (myeloperoxidase-ANCA or proteinase 3-ANCA), presence of serum cryoglobulins, and the presence of evidence for granulomatous inflammation. Family physicians should be familiar with this group of vasculitic disorders to reach a prompt diagnosis and initiate treatment to prevent end-organ damage. Treatment usually includes corticosteroid and immunosuppressive therapy.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed2002

Ethics of practicing medical procedures on newly dead and nearly dead patients.

OBJECTIVE: To examine the ethical issues raised by physicians performing, for skill development, medically nonindicated invasive medical procedures on newly dead and dying patients. DESIGN: Literature review; issue analysis employing current normative ethical obligations, and evaluation against moral rules and utilitarian assessments manifest in other common perimortem practices. RESULTS: Practicing medical procedures for training purposes is not uncommon among physicians in training. However, empiric information is limited or absent evaluating the effects of this practice on physician competence and ethics, assessing public attitudes toward practicing medical procedures and requirements for consent, and discerning the effects of a consent requirement on physicians' clinical competence. Despite these informational gaps, there is an obligation to secure consent for training activities on newly and nearly dead patients based on contemporary norms for informed consent and family respect. Paradigms of consent-dependent societal benefits elsewhere in health care support our determination that the benefits from physicians practicing procedures does not justify setting aside the informed consent requirement. CONCLUSION: Current ethical norms do not support the practice of using newly and nearly dead patients for training in invasive medical procedures absent prior consent by the patient or contemporaneous surrogate consent. Performing an appropriately consented training procedure is ethically acceptable when done under competent supervision and with appropriate professional decorum. The ethics of training on the newly and nearly dead remains an insufficiently examined area of medical training.

Attitude to Death↗
PubMed2002

Myocardial infarction in sickle cell disease.

Vasculo-occlusive crisis with organ infarctions occur in sickle cell disease (SCD). However, heart infarction is not commonly reported. We reviewed 19 cases of documented myocardial infarction (MI) in SCD patients. The true incidence may be higher because the diagnosis was often made at autopsy and was overshadowed during life by other musculoskeletal symptoms. Electrocardiography is frequently unhelpful. Skeletal muscle enzymes confound serum cardiac enzyme interpretation. The mechanism of MI in SCD is not exactly known, as coronary angiography is usually normal. MI frequently occurs in association with hypoxia, cor pulmonale, anemia, sepsis, acidosis, and renal failure. The aim of this article is to increase awareness for this complication and to prompt prospective studies to look at treatment strategies for myocardial infarction in SCD.

Anemia, Sickle Cell↗
PubMed2002

Catamenial hemoptysis and pulmonary endometriosis: a case report.

Hemoptysis can be caused by a variety of pulmonary diseases, including parasitic infections, tuberculosis, chronic bronchitis and malignancies. Rarely, pulmonary endometriosis can present with hemoptysis and pose a diagnostic problem to clinicians. Pulmonary endometriosis can easily be confused with other clinical entities, including pulmonary embolism, pneumonia and pneumothorax. Histopathologic confirmation is difficult, since the bleeding site is not easy to locate. However, a presumptive diagnosis of pulmonary endometriosis can be made with a typical clinical history. Even so, medical therapy may be problematic, with recurrence of symptoms despite hormonal ablation. We report a case of presumptive pulmonary endometriosis in a 32- year-old woman with a history of an induced abortion, who presented with catamenial hemoptysis (approximately one tablespoon per episode) occurring in the first 3 days of menstruation over an 11-month period. She was treated with an oral contraceptive for two months. No recurrence of hemoptysis was noted during 18 months of follow-up. The approach to diagnosis and treatment of pulmonary endometriosis is reviewed.

Adult↗
PubMed2002

Medicine on the internet: Jewish perspectives.

The ethical principles of beneficence and non-maleficence are deeply rooted in Judaism. A physician is obligated to heal and is given Divine license to do so. A patient is also obligated to seek healing. Judaism also emphasizes prevention over treatment. Avoidance of danger and thereby the preservation of life and health are biblical mandates. Rules of personal hygiene such as hand washing before eating are also stressed, as are diet, exercise, and general care of the body. Preventive medical services and patient responsibilities are fully in accord with Jewish thought. Specifically with regard to the internet, Judaism views any new technology or scientific advance with favor if it is used for the betterment of mankind, such as the prevention and treatment of illness. The internet is a wonderful tool to accomplish this purpose. It can promote health education to millions of people and thereby help to prevent illness. It can be used to facilitate communication not only between physicians and patients, but between health care providers and large population groups. All these goals are consonant with traditional Jewish thought and practice. However, potential negative consequences from the medical use of the internet must be considered and avoided. Misleading or false medical information should be weeded out. Inappropriate medical commercialism on the internet should be banned. Confidentiality of medical information must be preserved. The limitations of the internet for the practice of medicine (e.g., lack of personal patient-physician contact) should be clearly explained to patients, to help them appreciate those features of the internet which can truly benefit them and society.

Ethics, Medical↗
PubMed1994

Sanctity of life.

Explore the source record for details and available documents.

Euthanasia↗
PubMed1994

Brain death.

Explore the source record for details and available documents.

Brain Death↗
PubMed1991

A breakdown in the family unit.

In his article, "Autonomy and beneficence in the family," David J. Doukas describes the dynamic relationship between the family and the physician. He points out: "the family covenant spells out the obligations of all parties to give and receive respect and beneficial care within the realm of medical practice".... While this model may provide a framework for ethical discussion under certain circumstances, it falls short in several major respects....

Altruism↗