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Biomedical subjects

J A Rosenfeld

Publications and source records attributed to J A Rosenfeld.

At least 19 recordsLinked to original sources
PubMed2001

Evaluation and treatment of galactorrhea.

Galactorrhea, or inappropriate lactation, is a relatively common problem that occurs in approximately 20 to 25 percent of women. Lactation requires the presence of estrogen, progesterone and, most importantly, prolactin. Stress, suckling, sleep, sexual intercourse and medications may increase prolactin levels, whereas dopamine inhibits its release. The differential diagnosis of galactorrhea includes pituitary adenomas, neurologic disorders, hypothyroidism, numerous medications, breast stimulation, chest wall irritation and physiologic causes. The evaluation includes a thorough history and physical examination, as well as selected laboratory and imaging studies to rule out secondary causes such as an intracranial mass or a tumor. Diagnostic studies include a pregnancy test, a prolactin level, renal and thyroid function tests and, if indicated, magnetic resonance imaging of the brain. Treatment options for prolactinomas include observation, dopamine agonists, surgery and radiation therapy, depending on tumor size and associated symptoms. Fortunately, the prognosis for patients with prolactinomas is good: most prolactinomas remain stable or regress. In pregnant women, prolactinomas must be observed closely because the lesions may greatly increase in size.

Female↗
PubMed2000

Heart disease in women. Gender-specific statistics and prevention strategies for a population at risk.

For decades, coronary artery disease (CAD) was thought to be primarily a disease of middle-aged men, in whom most research was conducted. But CAD afflicts a diverse patient population, and a major subset of those patients--women--present special diagnostic and therapeutic challenges for the primary care physician. In this article, Dr Rosenfeld provides an overview of CAD in women and discusses its causes and risk factors, prevention strategies, and gender-specific characteristics. She also examines the effect of gender-biased research on the views of both patients and physicians.

Coronary Disease↗
PubMed1996

Acute otitis media in children.

Acute otitis media (AOM) is the most common reason parents bring children into the primary care physician's office. It is diagnosed by clinical symptoms of otalgia and often fever and irritability and by clinical otoscopy. Organisms common to the nasopharynx usually cause AOM. Many episodes of AOM resolve spontaneously. Because it is uncertain how many and which children will resolve without therapy, it is reasonable to treat all children with AOM with antibiotics. The first choice of antibiotics is amoxicillin. Other choices rest on a variety of factors.

Acute Disease↗
PubMed1996

Treatment of menorrhagia due to dysfunctional uterine bleeding.

Menorrhagia due to dysfunctional uterine bleeding can be treated medically or surgically. Medical therapy is associated with less morbidity and less profound effects on body image and fertility. Nonsteroidal anti-inflammatory drugs are the agents of choice for menorrhagia, although oral contraceptives, danazol and newer hormonal agents may also be used. Hysterectomy has been the surgical procedure traditionally used to treat menorrhagia, but excisional or "rollerball" endometrial resection may improve or cure this problem with a shorter hospital stay, a lower cost and less morbidity.

Algorithms↗
PubMed1996

Factors related to planned and unplanned pregnancies.

BACKGROUND: Given the efficacy of most contraceptive options, it is of concern that most pregnancies in the United States are unplanned. Besides reducing the woman's and family's preparedness for parenting, unplanned pregnancies are at higher risk for inadequate prenatal care, perinatal morbidity, and significant postnatal problems. Little is known about the factors responsible for the high rates of unplanned pregnancy. METHODS: One hundred ten pregnant women were surveyed to examine factors relating contraception to unplanned pregnancy. RESULTS: Sixty-five percent of pregnancies were unplanned. There was a statistically significant association between having unplanned pregnancies and being single or divorced. Women who had planned their pregnancies tended to be more satisfied with contraceptives. In sexual encounters, women with unplanned pregnancies were more likely to use no contraception or to practice "withdrawal" or use condoms rather than hormonal contraception; to be influenced by their partner regarding birth control use; and to forget to use contraception. CONCLUSIONS: All women of childbearing age who are sexually active can benefit from planning pregnancies. Counseling that accesses a woman's expectations regarding birth control, followed by a careful explanation of the side effects of a contraception choice, may reduce the rate of unplanned pregnancy. Counselling the male partner or sexually active men in contraceptive options may be equally important. Understanding factors that result in satisfaction with contraception may reduce unplanned pregnancies.

Adolescent↗
PubMed1996

Comparison of female and male graduates of southern Appalachian family practice residencies.

PURPOSE: One aim of Southern Appalachian family practice residencies is to produce graduates for surrounding physician-needy areas. Some evidence suggests that women are less likely to go to rural areas and that they practice differently than men. This study investigated the practice patterns and location of Appalachian family practice residency female and male graduates. METHODS: Surveys were sent to graduates of seven family practice residencies from 1984 to 1994 in the Southern Appalachian area to determine practice patterns, locations, and reasons for choosing practices. RESULTS: Women were more likely than men to be single and not to have children. More women worked part-time. Women's and men's practice patterns and characteristics were similar except that women were more likely to provide prenatal care and do vaginal deliveries. Women in similar percentages practiced in small towns, and a greater percentage of women practiced in rural areas with populations of less than 2,500. CONCLUSIONS: Female family practice residency graduates from Appalachian residencies are fulfilling the purposes of their residencies as well as male graduates, although more of them are working part-time.

Appalachian Region↗
PubMed1995

The effect of epidural anesthesia on the length of labor.

BACKGROUND: Epidural anesthesia, although effective, has been associated with changing the course of labor. Previous studies have been criticized for not pinpointing the factors determining the use of epidural anesthesia. The purpose of this study was to determine the effect of epidural anesthesia use on the course of labor. METHODS: A retrospective chart review of 224 women who gave birth from July 1, 1993, to June 30, 1994, was completed in a small-town family practice. The time frame included 6 months before and after the initiation of Tenncare, a state-funded health insurance plan designed to serve the uninsured and those previously served by Medicaid in Tennessee. RESULTS: The rate of epidural anesthesia use in this study population fell sharply after January 1, 1994, the start date for Tenncare. Epidural anesthesia by women in this study was found to increase the average length of the second stage of labor by 38 minutes for primiparas and 23 minutes for multiparas. CONCLUSIONS: The average length of the second stage of labor is significantly longer for women who receive epidural anesthesia. The rate of epidural anesthesia use in this study population was strongly influenced by a change in health-care financing.

Adult↗
PubMed1994

Update on continuous estrogen-progestin replacement therapy.

Estrogen replacement therapy is recommended for the prevention of osteoporosis and the attenuation of symptoms associated with menopause. Compliance may be a problem with sequential regimens of estrogen and progestin. To address this issue, continuous-dosing regimens of estrogen and progestin have been used. These regimens cause significantly less cyclic and intermenstrual bleeding and induce amenorrhea in most women, which should enhance compliance.

Clinical Trials as Topic↗