Medical involvement in the diagnosis and treatment of child sexual abuse (CSA) has a well-defined role within a multidisciplinary concept. Due to the increasingly high rate of normal anogenital findings in victims of CSA, forensic aspects are of limited value in establishing the diagnosis. In selected cases however, medical findings may play an important role in corroborating a child’s history. Correct evaluation of normal and abnormal findings, normal variations and several differential diagnoses requires sound knowledge in pediatric gynecology. In some cases, physical consequences of CSA (injuries, infections, and pregnancy) need to be diagnosed and treated (prevented) accordingly. The majority of abused children have an altered and distorted body image. It is of paramount importance to reassure the child that its body is normal, physically undamaged, intact or that it will heal (‘primary therapeutic aspect of the medical examination’). Thus, the medical examination has an enormous potential to incorporate a therapeutic message into the diagnostic procedure if performed in a qualified and sensitive manner. By communicating with the psychosocial und jurisdictional systems, physicians may initiate proper child protection and therapy. Therefore, medical evaluation of sexually abused children must always be integrated into a multiprofessional concept of child protection.

Mastitis in non-lactating adolescents is rare and its cause unclear. This retrospective study summarizes 22 such episodes, in 3 of which Staphylococcus aureus was isolated. Serum prolactin levels were normal. Most patients were successfully treated with oral amoxicillin-clavulanic acid. Three patients with bilateral breast cysts had a recurrence.

AIM:To evaluate the clinical features and microbiological findings in young infants with mastitis.METHODS:Retrospective review of medical records of 18 infants with breast inflammation during the first 3 mo of life seen in the paediatric emergency department between 1992 and 2002.RESULTS:All were full-term infants with female-male ratio of 3.5:1. The age ranged from 12 to 45 d, with a peak in the 4th and 5th weeks of life. Only five patients had systemic manifestations, and five were pretreated with oral antibiotics (amoxicillin-clavulanic acid). The latter as well as seven additional cases required incision and drainage due to abscess formation. Bacterial cultures grew Staphylococcus aureus in 10 cases including all pretreated infants. In four of these cases, Gram stain showed the pathogen. After antimicrobial treatment, no recurrence was observed in any of the patients.CONCLUSIONS:These findings suggest that mastitis in early infancy should be treated with parenteral antibiotics guided by Gram stain when available and informative. Otherwise, beta-lactamase-resistant antibiotics are a reasonable empirical initial treatment pending culture results. Optimizing the management of infants with mastitis is important especially since abscess formation requiring incision may be detrimental for later breast development.

This retrospective study evaluated the clinical features and findings in bacterial cultures and in microscopic examination of vaginal secretions in 80 prepubertal girls, aged 2-12 years, with vulvovaginitis. Vaginal secretions were obtained directly from the vagina with a sterile catheter carefully inserted into the vagina. Pathogenic bacteria were isolated in 36% of cases. In 59% of these cases the isolated pathogen was group A beta-haemolytic streptococcus. Candida was not found in any of the patients. The finding of leucocytes in vaginal secretions as an indicator for growth of pathogenic bacteria had a sensitivity of 83% and a specificity of 59%. Antimicrobial treatment should therefore be based on bacteriological findings of vaginal secretions and not on the presence of leucocytes alone.

Zusammenfassung Bei sexuellem Kindesmissbrauch hat die medizinische Diagnostik einen umschriebenen Stellenwert innerhalb eines multiprofessionellen Konzepts. Aufgrund der Häufigkeit von körperlichen Normalbefunden bei sexuell missbrauchten Kindern spielt der forensische Aspekt nur in wenigen Fällen eine Rolle bei der Diagnosestellung. Dennoch kann die klinische Untersuchung einen wichtigen Beitrag bei der Betreuung der Opfer leisten, u. a. indem hinweisende Befunde diagnostiziert und korrekt bewertet werden. Die fachgerechte Zuordnung von Normalbefunden, Normvarianten, missbrauchsassoziierten Befunden und zahlreichen Differenzialdiagnosen erfordert jedoch fundierte kindergynäkologische Kenntnisse. In einigen Fällen müssen somatische Folgen eines Missbrauchs (Verletzungen, Infektionen) behandelt werden. Sexuell missbrauchte Kinder weisen als Folge des Missbrauchs häufig ein verzerrtes und gestörtes Körperselbstbild auf. Daher können sie von der ärztlichen Bestätigung körperlicher Normalität und Intaktheit erheblich profitieren (“primär therapeutischer Effekt der Diagnostik”). Insofern bietet die medizinische Untersuchung die Möglichkeit, eine wichtige therapeutische Botschaft in den diagnostischen Prozess zu integrieren. Als Schnittstelle zum psychosozialen und zum Rechtssystem können Mediziner eine wichtige Rolle bei der Einleitung des Opferschutzes und auch bei einer nachfolgenden Therapie spielen. Medizinisches Handeln ist daher obligat Bestandteil eines multiprofessionellen Helfersystems.

Medical involvement in the diagnosis and treatment of child sexual abuse (CSA) has a well defined role within a multidisciplinary concept. Due to the frequency of normal anogenital findings in victims of CSA,forensic aspects are of limited value in diagnosing CSA. In selected cases however, medical findings may play an important role in corroborating a child's history. Correct evaluation of normal findings, normal variations, and abuse related findings and several differential diagnoses require a sound pediatric gynecology background. In some cases physical sequelae of CSA (injuries, infections, and pregnancy) need to be diagnosed and treated accordingly. The majority of abused children have an altered and distorted body image. It is of paramount importance to reassure the child that his body is normal, physically undamaged, intact or that it will heal ("primary therapeutic aspect of the examination"). Thus the medical examination has an enormous potential to incorporate a therapeutic message into the diagnostic procedure. By communicating with the psychosocial und jurisdictional system, physicians may initiate proper child protection and therapy. Therefore medical evaluation of sexually abused children must be integrated into a multi professional concept of child protection.

1. Tamar Stricker, MD* 2. Francesca Navratil, MD* 3. Felix H. Sennhauser, MD* 1. 2. *University Children’s Hospital, Zurich, Switzerland A 14-year-old girl presents to the clinic complaining of increasing hair growth on her face and trunk for the past 2 years. Her parents note that her normally low-pitched voice has seemed even lower the past few months. Breast and pubic hair development began at 11 years of age, and menstrual periods began at approximately 12 years of age. Menstrual periods occur every 4 to 8 weeks. The girl is in good health, has never had any serious illness, and denies taking any medications. She has always been the tallest in her class. Physical examination reveals a well-nourished female who has a deep voice, receding frontal hairline, and conspicuous, dark hair over the upper lip and chin (Fig. 1⇓ ). Minimal facial acne is noted. Vital signs include a temperature of 98°F (36.7°C), respiratory rate of 22 breaths/min, pulse of 90 beats/min, and a blood pressure of 130/70 mm Hg. Height is 166.9 cm (50th to 75th percentile) and weight is 67.7 kg (90th to 97th percentile). Breast examination reveals elevation of the areola and nipple (Sexual Maturity Rating stage 4), with prominent dark hairs over the areola (Fig. 2⇓ ). Truncal examination demonstrates midline hair over the chest and upper abdomen as well as a suggestion of increased muscle mass and loss of female contour (Fig. 3⇓ ). Genitourinary inspection is remarkable for an enlarged clitoris, measuring 2.5 cm in length. Findings on the remainder of the physical examination are normal. Figure 1. A 14-year-old female who has prominent facial hair. Figure 2. Increased hair growth on areola and chest. Figure 3. Truncal examination. Serum testosterone and androstenedione levels are approximately five-fold higher than normal for her age. The serum dehydroepiandrosterone …

Annals of the New York Academy of SciencesVolume 816, Issue 1 p. 414-421 The Genital Examination in Suspected Child Sexual Abuse A Diagnostic Dilemma FRANCESCA NAVRATIL, Corresponding Author FRANCESCA NAVRATIL Pediatric and Adolescent Gynecology Outpatient Department University of Zürich Children's Hospital Zürich, Switzerlanda Address for correspondence: Dr. Francesca Navratil, 63 Forsterstrasse, 8044 Zürich, Switzerland.Search for more papers by this author FRANCESCA NAVRATIL, Corresponding Author FRANCESCA NAVRATIL Pediatric and Adolescent Gynecology Outpatient Department University of Zürich Children's Hospital Zürich, Switzerlanda Address for correspondence: Dr. Francesca Navratil, 63 Forsterstrasse, 8044 Zürich, Switzerland.Search for more papers by this author First published: 17 December 2006 https://doi.org/10.1111/j.1749-6632.1997.tb52171.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat REFERENCES 1 McCann, J., R. Wells, et al. 1990. Genital findings in prepubertal girls selected for nonabuse: A descriptive study. Pediatrics 86: 428–439. 2 Adams, J. A., et al. 1994. Examination findings in legally confirmed child sexual abuse: It's normal to be normal. Pediatrics 94(3): 310–317. SUGGESTED READING 3 Bays, J. & D. Chadwick 1993. Medical Diagnosis of the sexually abused child. Child Abuse Neglect 17: 91–110. 4 Emans, S. J., E. R. Woods, N. T. Flagg & A. Freeman 1987. Genital findings in sexually abused, symptomatic and asymptomatic girls. Pediatrics 79: 778–785. 5 Kerns, D. & M. Ritter 1992. Concave hymenal variations in suspected child sexual abuse. Pediatrics 2: 265–272. 6 Muram, D. 1989. Child sexual abuse: Relationship between sexual acts and genital findings. Child Abuse Neglect 13: 211–216. Citing Literature Volume816, Issue1Adolescent Gynecology and Endocrinology: Basic and Clinical AspectsJune 1997Pages 414-421 ReferencesRelatedInformation

The properties of a 16-kbit bubble memory chip having a conventional major-minor loop organization are described. The chip can be operated up to a shift rate of 300 kHz which corresponds to a mean access time of 0.5 ms to blocks of 128 bits. Overall bias field margins of 13 percent were obtained, especially as the result of an appropriately selected layout of the transfer gates which is described ...

Barth et al. (Neuropadiatrie 8: 418— 428, 1977) have drawn attention to the organoid nevus syndrome and the association with hemimacrocephaly. We would like to describe briefly a similar more striking case. The family history is not relevant. The mother had Australiaantigen positive hepatitis from 24th to 26th week of pregnancy. Delivery at term was by Caesarian section because of cephalopelvic disproportion; the biparietal diameter of the head measured by ultrasound was markedly enlarged. Apgar score was 4 at one minute and 8 at ten minutes. Birth weight was 3700 grams. Head circumference was 45 cm (markedly above 97th percentile). The infant, a female, had striking left-sided

The design and operation margins of a bubble memory chip 2,8 mm × 2,1 mm with 32 minor loops of 128 bits of storage capacity each are described. In a special package, designed for test purposes and containing the drive field coils and a variable bias magnet system, signals up to 10 mV are generated by bubbles of 6 μm diameter in a thin film detector. The X-bar propagation works well up to 500 kHz using garnets having the composition Y 1,6 Sm 0,4 Ca 1 Fe 3,9 Ge 1 Si 0,1 O 12 . Also the transfer is performed by special X-bar transfer gates.

Generation and fast switching of rf-rotating fields for bubble memories becomes much easier, if only one rf-switching transistor is used outside the parallel resonant circuit formed by the field coil and a capacitor. In this case pulses to the basis of that transistor are not only used to start and stop the rotation, but also to feed back the energy lost by the circuit damping. The energy to build...

"Child sexual abuse is more common than childhood cancer, juvenile diabetes, and congenital heart disease combined…” (1). The combined data of 39 prevalence studies from 28 countries covering the years 1994–2007 reveal that 10–20% of girls and 5–10% of boys are victims of child sexual abuse. These figures accord with those of earlier studies (2, e1). In a meta-analysis of 323 studies from around the world, involving a total of 9.9 million affected children, the worldwide prevalence was found to be 12.7% (18.0% for girls, 7.6% for boys) (3). In the USA, where the reporting of child abuse is mandatory, 60 000 to 80 000 confirmed cases are reported annually, with a downward trend (4). The available data from Germany are sparse, and it is assumed that many cases go unreported; reliable data on the frequency of subtypes of sexual abuse are sparse as well. The literature documents a lifelong association between sexual victimization in childhood and adolescence and chronic mental and physical illness in adulthood (e2). Only in recent years has the medical profession’s involvement in this area resulted in evidence-based research and consensus-based determination of best clinical practice (5, e3– e6), with increasing acceptance in Germany as in other countries (6, 7, e7, e8). This is also true of the psychiatric and psychosomatic aspects of child sexual abuse (e9). Prevalence A meta-analysis of 323 studies from around the world, involving a total of 9.9 million affected children, revealed an overall prevalence of 12.7% (18.0% for girls, 7.6% for boys). Hardly any data from Germany are available.