Fluoride supplementation.
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Administration, Oral↗
Biomedical subjects
D A Lynch
Publications and source records attributed to D A Lynch.
Obstetrics in family practice: a model for residency training.
Family physicians have a unique service to offer families at the time of their reproduction, and have a role to play that cannot be duplicated by an obstetrician-gynecologist or pediatrician. The process of a family integrating a new member is a natural concept to family practice and lends itself to a family-centered model of care seldom seen in medicine. Practicing obstetrics has a positive effect on a family physician's practice for without obstetrics a practice largely of episodic adult internal medicine develops. Obstetrical care provided by a family physician is a natural answer to the currently articulated public need for personalized, sensitive, family-centered, and expert childbirth care. Obstetrical training in the family practice residency needs to include a longitudinal pregnancy care experience in addition to block rotation on hospital services to teach residents skills of good obstetrical practice and to develop an attitude of family-centered health-care advocacy. A detailed program of family-centered patient education classes practical for a private group practice has been developed to extend throughout the entire course of pregnancy and includes classes after delivery.
Curriculum↗
Nondisjunction in males: commoner than suspected?
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Chromosome Aberrations↗
HIV infection: a retrospective analysis of adolescent high-risk behaviors.
INTRODUCTION: The purpose of this study was to retrospectively ascertain behaviors and activities that may constitute high risk during the adolescent years (ages 12-18) of young adults (ages 20-25) who are infected with human immunodeficiency virus (HIV). METHODS: Subjects (n = 44) from 1 of 5 clinics in a large midwestern city completed a survey form, developed by the investigators, which examined 6 areas of behavior and activities that the literature suggested may be associated with high-risk behaviors. RESULTS: The adolescent high-risk profile of an HIV-infected young man includes sexual abuse before the age of 12 years, heavy consumption of alcohol, heavy consumption of a variety of illicit drugs, a wide variety of sexual experiences at very young ages, and multiple sexual partners. The adolescent high-risk profile of an HIV-infected young woman in this study includes heavy consumption of alcohol, heavy consumption of a variety of illicit drugs, and unprotected vaginal intercourse at very young ages as evidenced by a high number of sexually transmitted diseases at very young ages. DISCUSSION: Although the small number of participants in this study restricts interpretation of the results, adolescent health initiatives should be examined in light of these findings. Programs and services must consider the context of psychosocial situations, as well as past experiences, and incorporate this knowledge into prevention strategies.
Adolescent↗
Computed tomography in pulmonary sarcoidosis.
We studied the high resolution CT (HRCT) scans of 15 patients with biopsy-proven sarcoidosis and correlated the findings with pulmonary function tests (12 patients), 67Ga scans (10 patients), bronchoalveolar lavage (five patients), recent transbronchial biopsy (six patients), and recent open lung biopsy (three patients). The HRCT features included small nodules, thickened interlobular septa, patchy focal increase in lung density, honeycombing, and central conglomeration of vessels and bronchi. Active alveolitis was present by gallium scanning criteria in 5 of 10 cases. By bronchoalveolar lavage criteria, activity was present in three of five cases. Patchy increase in density may correlate with active alveolitis as seen on 67Ga scanning. High resolution CT was better than chest X-radiography for demonstration of patchy increase in density and for distinguishing nodules from septal thickening. Both nodules and patchy density were partly reversible following therapy. Nodular densities seen on CT correlated with the presence of granulomata on histology. Resting pulmonary function tests correlated poorly with presence and extent of lung disease on HRCT. The presence on HRCT of focal fine nodules, patchy focal increase in lung density, and central crowding of bronchi and vessels should suggest the diagnosis of sarcoidosis. In some patients, HRCT can identify unsuspected parenchymal lung disease and document the reversible components of sarcoid lung disease.
Bronchoalveolar Lavage Fluid↗
MR imaging of the larynx at 1.5 T.
The normal magnetic resonance (MR) anatomy of the larynx at high field strength (1.5 T) was studied in 2 normal excised larynges and 62 subjects without laryngopharyngeal disease. The two normal excised larynges were imaged using a 1.5 T MR scanner with a 3 in diameter circular surface coil and a GE 9800 CT scanner. The larynges were sectioned transversely and the MR and CT images compared to gross and histologic sections. Unossified hyaline cartilage was intermediate in signal intensity on T1-weighted and proton density images and low in intensity on T2-weighted images. The signal intensity from ossified cartilage was determined by the amount of fatty marrow and was high in intensity on T1-weighted and proton density images and low to intermediate in intensity on T2-weighted images. A chemical shift artifact from high intensity fatty marrow obscured the calcified or ossified cortex of the major laryngeal cartilages along the frequency encoding axis. The epiglottic cartilage demonstrated an intermediate signal intensity on T1-weighted images and higher intensity on proton density and T2-weighted images. The intralaryngeal muscles were well demonstrated as low intensity structures. The conus elasticus and the vocal ligaments were not recognized as distinct structures. However, the quadrangular membrane and a previously undescribed membrane separating the preepiglottic and paralaryngeal spaces were shown on MR as low intensity linear structures. In the 62 subjects, MR at 1.5 T proved excellent for demonstrating the anatomical details of the major laryngeal cartilages, extra- and intralaryngeal muscles, ligaments, and soft tissues including the vocal cords, false vocal cords, laryngeal ventricles, aryepiglottic folds, preepiglottic space, and paralaryngeal spaces. Visibility and intensity of muscles, ligaments, and soft tissues did not depend on age or sex. The intensity pattern of the thyroid and cricoid cartilages demonstrated wide variations in the same sex and age groups, depending on the degree of ossification. However, they did show more high intensity foci in older men than in younger women. Magnetic resonance showed better contrast resolution and finer detail than CT scans in the same subjects. Magnetic resonance imaging at 1.5 T, with either a saddle-shaped neck surface coil or a 3 in diameter circular surface coil, provides high contrast and high spatial resolution images and could be useful for the diagnosis of lesions of the larynx.(ABSTRACT TRUNCATED AT 400 WORDS)
Female↗
MR imaging of unilateral pulmonary artery anomalies.
Magnetic resonance (MR) imaging of the pulmonary arteries was performed in seven children with unilateral pulmonary artery abnormalities. Five had congenital absence or interruption of a pulmonary artery; two had postsurgical occlusion or narrowing of a pulmonary artery. A small patent hilar pulmonary artery was identified in one of the five cases of congenital pulmonary artery interruption or absence. Occluding thrombus was identified in the right pulmonary artery of one child following pulmonary artery banding. In another case marked narrowing of the right pulmonary artery was identified secondary to migration of a pulmonary artery band. The MR findings were confirmed by angiography in all cases. Magnetic resonance appears to be a useful noninvasive modality for accurate anatomic depiction of unilateral pulmonary artery abnormalities in childhood. It may be especially valuable for diagnosis of pulmonary artery stenosis or occlusion following surgical treatment of congenital heart disease.
Adolescent↗
Lipoid pneumonia: CT findings.
OBJECTIVE: To assess the CT findings of lipoid pneumonia. METHODS: Chest radiography and CT performed in six patients with proven lipoid pneumonia were reviewed by two observers. Diagnosis was confirmed by biopsy (five cases) or bronchoalveolar lavage (one case). The clinical history of taking oily substance could be obtained retrospectively in all patients. RESULTS: Chest radiography showed bilateral air space consolidation in three cases, irregular mass-like lesions in two, and a reticulonodular pattern in one case. Computed tomography demonstrated diffuse parenchymal consolidation in three cases, localized areas of consolidation in two, and subpleural pulmonary fibrosis in one case. In two cases, fat with localized areas of consolidation could be seen on CT. In three cases with diffuse consolidation the attenuation was decreased but higher than that of subcutaneous fat. In one case with subpleural fibrosis no areas of low attenuation could be seen on CT. CONCLUSION: We conclude that in patients with lipoid pneumonia CT may demonstrate areas with low attenuation diagnostic of fat or areas with nonspecific low attenuation or soft tissue density.
Bronchoalveolar Lavage Fluid↗
CT features of pulmonary Mycobacterium avium complex infection.
OBJECTIVE: The purposes of this study were to describe and compare the prevalence of disease features in subjects with Mycobacterium avium complex (MAC) disease with those of Mycobacterium tuberculosis infection (MTB), to compare the abilities of CT and chest radiography to identify the features of MAC disease, and to determine if sputum positivity is related to any of the CT features of MAC disease. METHODS: Computed tomographic scans of 15 subjects with MTB and 55 subjects with MAC were reviewed by 2 observers. Sputum culture results (obtained within 1.9 +/- 2.8 days of scanning) were available in 50 of the 55 subjects with MAC. RESULTS: Bronchiectasis involving four or more lobes (often associated with centrilobular nodules) was seen only in subjects with MAC. The combination of right middle lobe and lingular bronchiectasis was seen only in MAC (p = 0.015). Thirty-one of the 34 subjects (91%) with MAC who had cavities on CT had a positive sputum culture within 3 weeks of CT, compared with 7 of 12 subjects (58%) without cavities (p = 0.001). Similarly, 36 of 42 subjects (85%) with airspace disease, but only 2 of 8 subjects (25%) without airspace disease grew mycobacteria from their sputa (p < 0.001). Sputum positivity was not associated with the presence of bronchiectasis (p = 0.156) or nodules (p = 0.377). CONCLUSION: A subgroup of patients with MAC may be distinguished from those with MTB by the presence of widespread bronchiectasis, particularly if it involves the right middle lobe and lingula. Cavities and airspace opacification on CT are associated with positive sputum cultures for MAC.
Female↗
Bronchoarterial ratio on thin section CT: comparison between high altitude and sea level.
PURPOSE: Our goal was to measure normal bronchial to accompanying pulmonary arterial diameter ratios and normal bronchial wall thickness on thin section CT at high altitude and at sea level. METHOD: Seventeen normal, healthy, nonsmoking subjects living at 1,600 m altitude and 16 living at sea level underwent thin section CT (1.5 to 2.0 mm collimation). All images were photographed at window levels of -450 and -700 HU and window width of 1,500-1,600 HU. Internal diameters of the segmental and subsegmental bronchi were measured and compared with the diameter of the adjacent pulmonary artery. Bronchial wall thickness of each bronchus was measured. Only bronchi and arteries seen in cross section and within 1 mm from each other were included in the analysis. RESULTS: Four hundred sixty-seven bronchi (215 at high altitude, 252 at sea level) were assessed. At window level of -450 HU, the bronchoarterial ratio was 0.76 +/- 0.14 (mean +/- SD) at altitude and 0.62 +/- 0.13 at sea level (p < 0.001). Bronchial wall thickness measured 0.92 +/- 0.09 mm (mean +/- SD) at altitude and 1.12 +/- 0.19 mm at sea level (p < 0.001). At window level of -700 HU, there was an artifactual decrease in the bronchoarterial diameter ratios and an increase in bronchial wall thickness. CONCLUSION: Bronchoarterial ratio increases and bronchial wall thickness decreases with altitude. These findings are presumably related to hypoxic bronchodilatation and vasoconstriction.
Adult↗