Breast MR imaging for cancer detection and implant evaluation: potential pitfalls.

Magnetic resonance (MR) imaging of the breast is currently used for evaluation of both parenchymal disease and silicone gel implants. MR imaging has the potential to address questions raised or unanswered with traditional diagnostic imaging methods. However, lesion specificity and cancer sensitivity depend on multiple technical factors (i.e., imaging parameters and contrast agent delivery) and biologic factors (i.e., the menstrual status of the patient and the vascularity of the lesion). Although diagnostic criteria for parenchymal disease have been reported, overlap of malignant and benign enhancement profiles occurs. The accuracy of implant evaluation depends on the imaging parameters and knowledge of the implant type and surgical history. In addition, individual investigative imaging methods are diverse, causing difficulty in protocol development for the practicing radiologist. An awareness of the problematic factors in breast MR imaging will improve diagnostic accuracy and allow understanding of the limitations of the modality and individual patient examinations.

The clinical value of screening chest radiography in the neonate with lung disease.

To examine the role of routine chest radiography in the management of the critically ill neonate with pulmonary disease, 41 term and preterm infants with lung diseases were prospectively evaluated. Seventy radiographs (35%) were obtained for clinical indications and 128 (65%) for prospective screening. Studies were compared with each infant's most recent previous study, if available. Every exam was designated Level I, if the radiograph identified a new finding that required clinical intervention; Level II, if an abnormality or interval change was observed that did not require immediate intervention; or Level III, if there was no interval change since the previous radiograph. Thirty-three (47%) indication radiographs and 63 (49%) screening radiographs showed significant changes since the previous study. Twenty-four (34%) of the indication radiographs and 42 (33%) of the screening radiographs had Level I abnormalities (P = NS). Nine (13%) of the indication radiographs and 21 (16%) of the screening radiographs had Level II abnormalities (P = NS). Results suggest that routine screening chest radiographic studies are an important adjunct of care in critically ill newborns with respiratory disease and may identify potential problems before they are reflected in a change in clinical status.

Psychosexual issues in adolescent contraception.

PIP: This paper reviews the psychosocial and developmental research focusing on adolescent contraception. Specific emphasis is on the interrelationship of psychosexual development and culture in preventing or exacerbating problems. Attention is directed to the following: program policy and planning; major literature reviews on adolescent sexuality; female development and early coitus; the male partner; the competent adolescent contraceptor; and directions for future research (psychological sequelae of early coitus in girls, factors affecting delay of 1st coitus in girls, and the promotion of competent contraceptive behavior). In the less developed countries, efforts to delay 1st birth and increase birth spacing must form part of the overall strategy to upgrade the survival rates and health of infants. Ancillary to such urgent public health policy concerns is the current worldwide spread of the modern feminist social movement, generating pressures to make education and work opportunities available to female adolescents in the 3rd world. Adolescent pregnancy in the developed countries is not a major world health problem; prenatal care and adequate nutrition are feasible for the pregnant teenager. Yet, no cultural supports exist for such mother-infant dyads, and such pregnancies are viewed, particularly by educated women, as reversing a developed nation's social progress. There has been a growing effort in the US to implement contraceptive programs directed at the sexually active female adolescent between menarche and age 18. Issues other than availability of abortion and contraceptive supplies are also operating. Developmental level of the public health service user and specifically psychosexual developmental level, is a factor which must be considered in program policy and planning. Developmentally, the logical course of introduction to sexuality for young females would be solitary masturbation, heterosexual mutual masturbation, and coitus. Cultures at ease with bisexuality would acknowledge homosexual mutual masturbation as part of the development continuum. It is not really known what percent of responsibility for the 1st coital contact belongs to the male adolescent partners versus their female partners. Despite the obvious role of the adolescent male in early coitus, parents, even conscientious ones, rarely lecture their sons about any associated problems except venereal disease. Psychological factors in successful contraception are a major issue with the youngest age group. Locus of control has been identified as a major predictor of contraceptive success by several researchers.^ieng

Drug treatment: factors contributing to high risks in institutions.

Because of the widerspread use of drugs in the treatment of exceptional children, investigators are currently studying the efficacy, suitability and safety of the drugs employed. This paper deals with an aspect of pharmacological management which has been largely neglected in the literature: the administration of prescribed drugs. Focusing on the institutional setting, the following three factors contributing to high risk of drug error or misuse, are delineated: (1) Staff training and sophistication, (2) Number and complexity of drugs employed and (3) Vulnerability of the exceptional child. An attempt is made to state and clarify these issues, to report some preliminary programs which appear to be effective, and to offer some concrete suggestions for persons who are involved in the pharmacological management of exceptional children.

Providing for the severely handicapped: a case for competency-based preparation of occupational therapists.

Recent court decisions that mandate the development of new instructional alternatives for severely handicapped children will have significant implications for occupational therapists. Focusing on such issues as mainstreaming, accountability, and certification standards, this paper places in perspective the problems and trends that have led to this new challenge. It also provides suggestions for the development and disposition of training programs that can ultimately result in more appropriate programming for the handicapped children in the new population to be served in the public schools. Illustrated with examples of competency components and behavioral objectives, competency-based occupational therapy preparation programs are emphasized.