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Biomedical subjects

E Shuster

Publications and source records attributed to E Shuster.

13 recordsLinked to original sources
PubMed1998

The Mayo Clinic-Canadian Cooperative trial of sulfasalazine in active multiple sclerosis.

OBJECTIVE: To determine whether sulfasalazine is better than placebo in slowing disability progression in MS. METHODS: In this randomized, double-blind, placebo-controlled phase III trial, 199 patients with active relapsing-remitting (n = 151) or progressive (n = 48) MS were evaluated at 3-month intervals for a minimum of 3 years (94% completed 3 years of follow-up; mean follow-up, 3.7 years). MRI studies were performed at 6-month intervals on a subset of 89 patients. RESULTS: Sulfasalazine failed to slow or prevent disability progression as measured by the primary outcome (confirmed worsening of the Expanded Disability Status Scale [EDSS] score by at least 1.0 point on two consecutive 3-month visits). Sulfasalazine influenced favorably a number of secondary outcomes during the first 18 months of the trial (e.g., annualized relapse rate, proportion of relapse-free patients; progressive subgroup only: rate of EDSS progression at 1 and 2 years, median time to EDSS progression) but these positive findings were not sustained into the second half of the trial. CONCLUSIONS: Sulfasalazine does not prevent EDSS score progression in the subset of MS patients studied by this protocol. Treatments may improve relapse-related outcomes in MS, at least temporarily, without providing sustained slowing of EDSS progression. Phase III MS trials should be of sufficient length to determine a meaningful impact on disease course.

Adult↗
PubMed1993

A surgeon with acquired immunodeficiency syndrome: a threat to patient safety? The case of William H. Behringer.

A year ago, the New Jersey case of William H. Behringer, the surgeon with acquired immunodeficiency syndrome (AIDS), caused health experts to focus on health care workers infected with human immunodeficiency virus (HIV) and to call for new policies and guidelines to protect patients against infection. After a year of acrimonious debate over the proper approach to the issues discussed in Behringer, no consensus has emerged. The Centers for Disease Control has quietly abandoned its plan to ease its July 1991 guidelines that call for infected professionals to cease performing invasive procedures or disclose their conditions to their patients. It has now decided to let each state set its own rules and regulations in compliance with its guidelines, or risk financial penalties. The issues discussed in Behringer have remained controversial. This case provides an opportunity to identify reasonable actions that may ensure patient safety without inciting public fears, unduly restricting individual freedom, or violating human rights.

AIDS Serodiagnosis↗
PubMed1992

When genes determine motherhood: problems in gestational surrogacy.

Gestational surrogacy in which a commissioning couple's egg and spermatozoon are united in vitro and the resulting embryo is implanted in a woman's uterus is, of all the new methods for overcoming infertility, the most genetically appealing. This is because the genes are often perceived as determining all aspects of human health, disease and even behaviour. Having a child with the genes of both parents has become far more attractive to most infertile couples than having one who is only genetically related to the father. However, gestational surrogacy has created a situation where one child has two mothers, each one claiming to be the 'true' mother having exclusive parental rights. Surrogacy arrangements also raise the question of the meaning of motherhood.

Contracts↗
PubMed1991

Non-genetic surrogacy: no cure but problems for infertility?

Non-genetic surrogacy characterizes a situation where the gestational mother is not the genetic mother. It further widens a circle that started with the introduction of in-vitro fertilization (IVF) and creates problems in defining motherhood and identifying at birth the mother who will have the rights and responsibilities of rearing the child.

Female↗
PubMed1990

Ventriculoamniotic shunt for treatment of hydrocephalus in one of twins: medical, ethical and legal considerations.

One of a pair of preterm twin fetuses was identified as having progressive hydrocephalus. After an extensive evaluation of the parents and both fetuses, a ventriculoamniotic shunt was placed. The affected twin, despite multiple additional neonatal procedures, has done well as matched against her normal twin sister. Both children are well 4 years after the surgery. The case presented a remarkable complexity of medical, ethical and legal issues which are presented.

Adult↗
PubMed1987

Fetal therapy: ethical and legal implications of prenatal intervention and clinical application.

Recent advances in antenatal diagnosis have stimulated interest in the development of techniques for in utero treatment of fetal abnormalities. This article identifies and discusses the ethical and legal problems which emerge from fetal therapy. Is a fetus a patient? Does the fetus have rights? Who should give consent for the unborn? Does the fetus have redress if it is injured? Could a pregnant woman be forced to undergo treatment which could endanger her life and health for the benefit of the fetus? Answers to these questions are not clear and create in themselves additional queries. Until fetal therapy becomes an accepted medical practice, the resolution of the ethical and legal issues that it provokes will probably remain inconclusive and a matter of concern.

Beginning of Human Life↗