PubMed Health⌕ Search

Biomedical subjects

A Gibofsky

Publications and source records attributed to A Gibofsky.

At least 19 recordsLinked to original sources
PubMed1999

A diagnostic approach to musculoskeletal pain.

Musculoskeletal pain or inflammation is one of the most common causes of primary care office visits. Musculoskeletal disorders exact a high toll in distress, disability, and direct health care costs. Given the wide range of disorders that may cause or contribute to musculoskeletal symptoms, differential diagnosis is challenging and a systematic approach is necessary. Patient history is the single most valuable source of diagnostic information, followed by a careful physical examination. The history also suggests which laboratory tests and imaging studies, if any, are indicated. The chronology, duration, and pattern of pain distribution offer clues to establishing an accurate diagnosis, along with evidence of other organ system involvement or underlying disease. Helpful distinctions are those between articular and nonarticular pain, between monarthritis and multiple joint involvement, and between inflammatory and noninflammatory conditions.

Arthralgia↗
PubMed1998

The arthritogenic properties of microbial antigens. Their implications in disease states.

The sharing of antigenic determinants between host and microbe is a common event and new microbial-tissue cross-reactions are being recognized each year. Almost every human organ has been implicated as a possible target. The purpose of this article is to examine the arthritogenic properties of these microbial antigens and to explore the mechanisms by which they induce pathologic damage and disease.

Antigens, Bacterial↗
PubMed1998

Rheumatic fever. The relationships between host, microbe, and genetics.

Acute rheumatic fever is a delayed, nonsuppurative sequela of a pharyngeal infection with the group A streptococcus. The onset of the disease is usually characterized by an acute febrile illness; however, there may be chronic involvement of the heart and/or central nervous system. The article explores the relationship between the initial infection and host-microbial interactions that may be operative in disease pathogenesis.

Antigens, Bacterial↗
PubMed1997

Liability issues in the treatment of patients with rheumatic diseases.

In clinical practice, risk management focuses primarily on concerns regarding adverse occurrences and the possibility of resulting civil litigation. Tort law, one of the major branches of civil law, is most relevant to clinical risk management. Duty, breach, causation, and damages are the four elements of the tort of professional liability, i.e., medical malpractice. Liability concerns in clinical practice commonly involve adverse drug reactions. Other potential liability concerns include informed consent, adverse outcomes, and economic considerations.

Antirheumatic Agents↗
PubMed1997

The co-occurrence of acute rheumatic fever and AIDS.

We describe a patient with advanced acquired immunodeficiency syndrome (AIDS) who presented with evidence of carditis, arthritis, and chorea in the setting of fever, and serologic evidence for recent streptococcal infection. Several features atypical for rheumatic fever were present and included persistently high titer of antistreptolysin O, the simultaneous occurrence of chorea and arthritis, and the presence of chorea in a sexually mature adult man. The differential diagnosis of arthritis in a host at risk for human immunodeficiency virus should be expanded to include acute rheumatic fever, which may manifest atypical features.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Legal issues in allergy and clinical immunology.

Clinical risk management for the allergist focuses primarily on concerns regarding adverse occurrences and the possibility of civil litigation as a result of negligence or professional liability. Risk is substantially reduced with an understanding of such predictable drug reactions as overdosage, side effects, secondary effects, and drug interactions. In addition, all clinicians who prescribe have a duty to disclose to their patients the possibility of unpredictable reactions, including intolerance, idiosyncrasy, and allergy or hypersensitivity. This disclosure should be part of a comprehensive discussion of the risks and benefits of, and alternatives to, therapeutic agents and procedures they recommend. The process of informed consent becomes even more critical with the increasing influence of hospital and managed care formularies on prescribing decisions. Although cost effectiveness is an important factor in prescribing decisions, the possibility of adverse effects, treatment failure, noncompliance, and other negative considerations must also be weighed.

Allergy and Immunology↗
PubMed1995

Rheumatic fever and poststreptococcal reactive arthritis.

Rheumatic fever is a catastrophic illness in many parts of the world, particularly in developing nations, where the incidence has been estimated to be between 10 and 15 million new cases each year. In the United States, rheumatic fever had become a rarity, having virtually disappeared by the mid 1960s. Of increasing concern, however, was the abrupt rise in the incidence of rheumatic fever in the United States in the mid 1980s, with reported "outbreaks" in middle-class communities in five cities and two military camps. Recently, a number of cases of poststreptococcal reactive arthritis have been reported. On close examination, however, these are most likely alternate clinical presentations of rheumatic fever. It is widely accepted that rheumatic fever occurs following an overactive immune response by a genetically susceptible host to oropharyngeal infection with group A beta-hemolytic streptococci. Nevertheless, details of pathogenesis at a level allowing more effective intervention remain obscure. The question of pathogenesis holds a deep interest, because rheumatic fever is one of the few autoimmune diseases with a known infectious etiology.

Adult↗
PubMed1995

Risk management in endoscopic practice.

As illustrated, the practice of gastrointestinal endoscopy is not without risks. All physicians who perform endoscopy should be mindful of the tenets of risk management and how they apply to their endoscopic practices. Retrospective review of individual endoscopic practice habits should be performed yearly and modifications made where necessary. Hospital quality assurance committees should have gastrointestinal endoscopist representation. These committees should have as a component of their responsibilities a commitment to physician education.

Endoscopy, Digestive System↗
PubMed1995

Marriage, social support, and adjustment to rheumatic disease.

The family is an important source of support for the patient with RA. At the same time, the illness creates stresses for family members that may affect their well-being or inhibit their ability to provide support to the patient. In designing support interventions, one cannot assume that difficulties in adjusting to chronic illness reflect a lack of support from the family or that the patient should be the sole target of intervention.

Adaptation, Psychological↗
PubMed1995

Medicare fraud regulations and the implications for joint ventures: are we working at cross purposes?

The broad language and the broad application of the antifraud and Stark statutes has created uncertainty in the developing trend toward prepaid health plans and other systems (such as joint ventures) which are designed to deliver high quality services at reasonable costs. The motivation behind the statutes and the need for statutes that prosecute exploitation of the federal health care systems are needed. However, a reactive prosecutorial system may be inappropriate. A proactive administrative regulatory system where parties contemplating such ventures can receive quick, reliable approval or disapproval (with an explanation) would reduce the uncertainty in the current system. Such a system can be developed using the Stark reporting requirements and can be based on the model of certificate-of-need applications. Such models are being discussed in national health reform proposals, but in the area of antitrust. These proposals should consider such mechanisms for health care fraud that is of a more subtle nature. A serious longterm drawback is the lack of a preemption provision in the current laws and the proposals for national health reform relating to health care fraud and prohibited referrals. A preemption provision would reduce uncertainty that will develop as health care ventures cross state lines.

Animals↗
PubMed1994

Silicone gel filled breast implants and connective tissue disease: an overview.

OBJECTIVE: To review the literature examining the association of silicone gel filled implants and connective tissue disease. METHODS: Computerized literature searches and manual review of bibliographies. RESULTS: Numerous concerns have arisen regarding the safety of silicone gel filled breast implants. The structure of these prostheses is reviewed. Silicones are not biologically inert. Injectable as well as implantable silicones have proven capable of eliciting inflammatory and fibroproliferative responses. Silicone leakage from silicone gel filled implants is well documented as is distant migration of silicone in the host. In the past decade, over 60 cases of connective tissue disease following mammoplasty with silicone gel filled implants have been reported. About half of these patients developed scleroderma or scleroderma-like illnesses. This reported overrepresentation of scleroderma compared to other rheumatic diseases mimics the Japanese experience with injectable silicones. Possible biological rationale for the association is presented. CONCLUSION: The physical and biological properties of silicone gel filled implants and their behavior in vivo is compatible with the hypothesis that they may contribute to the development of connective tissue disease. The association seems most likely with scleroderma; however, there is as yet inadequate epidemiological data to definitively establish causality.

Animals↗