Sexual child abuse in a defined Swedish area 1993-97: a population-based survey.

Attempting to avoid some of the most common methodological problems involved in research on sexual child abuse, we collected data on crimes, perpetrators, and sanctions in all convicted cases of sexual child abuse in a defined population during a 5-year period. This approach provided amply documented and ascertained cases with precise definitions and descriptions of the crimes involved, no clinical referral bias, and minimal dependence on memory effects. The results are valid for the small proportion of cases that lead to conviction in the context of Swedish legislation. Structured data were collected from the court dossiers in all cases of sexual crimes against minors (less than 15 years of age) tried and sentenced at the courts in the Västra Götaland region of Sweden between 1993 and 1997. The total number of 496 sentences for sexual crimes during the study period included 203 cases of sexual child abuse (40.8%) with 283 victims and 196 perpetrators, all men. Girls were victims in 85% of the cases, boys in 12%, and boys as well as girls in 3%. Sexual penetration had occurred in 54.5% of cases and the total proportion of hands-on crimes was 83%. Most perpetrators, 72%, were well known to the child. The most severe offenses took place within the family. A wide range of acts were classified as sexual child abuse, but most common was sexual penetration of a female child by her biological father or a family friend.

Epidural anaesthesia and postoperative colorectal motility--a possible hazard to a colorectal anastomosis.

The effects of epidural anaesthesia (EDA, mepivacaine) and EDA in combination with atropine and neostigmine on postoperative intestinal motility were studied in 17 patients undergoing operation for cancer of the rectum or sigmoid colon. Motility was recorded by a volumetric technique. Epidural anaesthesia (EDA) increased motor activity in the small bowel as well as in the left colon and rectum. Phasic motility dominated in the small intestine whereas tonic and segmental contractions were recorded from the large bowel. EDA induced a powerful tonic contraction with a concomitant shortening of the rectum. This effect was inhibited by atropine. The influence of atropine/neostigmine on left colonic motor activity was studied in six patients before and during EDA in a cross-over fashion. When administered alone, atropine/neostigmine did not cause any motility increase. Atropine/neostigmine administered during EDA, however, elicited a significant increase of motility. The increase of intestinal motor activity induced by EDA may expose a newly constructed colorectal anastomosis to undue strain in the immediate postoperative period. When EDA is used in combination with general anaesthesia, particular attention should be directed towards the use of neostigmine for reversing the effect of nondepolarizing muscle relaxants. Atropine appears under such circumstances not to protect from the excitatory effects of this drug on colorectal motility.

The influence of the pelvic nerves on anorectal motility in the cat.

The influence of the parasympathetic pelvic nerves on anorectal motility was studied in anaesthetized cats. Anal pressure and rectal motility were recorded by a manometric and a volumetric method, respectively. Severing of the pelvic nerves did not cause any pressure change in the anus, indicating that these nerves are not significantly tonically active. Efferent low intensity (0.05-0.5 ms, 8 V at 5 Hz) electrical stimulation of the pelvic nerves (PNS) elicited a contraction of the internal anal sphincter (IAS), while high intensity stimulation (greater than 1 ms, 8 V at 5 Hz) caused a sphincter relaxation. A rectal contraction was noted on both low and high intensity stimulation. After sectioning of the sympathetic nerves, PNS elicited a contraction in both the anus and the rectum irrespective of stimulation intensity. PNS inhibited the anal contraction elicited by simultaneous stimulation of the sympathetic nerves or noradrenaline infusion. The inhibitory anal responses to PNS were unaffected or augmented by atropine, unaffected by propranolol and abolished by hexamethonium. The excitatory anal effects of PNS were reduced or abolished by atropine and abolished by phentolamine. The rectal contraction induced by low intensity PNS was abolished by atropine or converted to a relaxation. In half of the experiments an atropine resistant rectal contraction was observed in response to high intensity PNS. The results are consistent with a pelvic nerve influence on IAS pressure through several mechanisms, including modulation of the activity in the sympathetic nerves and activation of inhibitory non-adrenergic, non-cholinergic neurons. The pelvic nerves convey both cholinergic and non-cholinergic excitatory, as well as non-adrenergic, non-cholinergic inhibitory fibres to the rectum.

The sympathetic innervation of the internal anal sphincter and rectum in the cat.

The distribution of the sympathetic innervation to the internal anal sphincter (IAS) and rectum and the occurrence of different types of adrenergic receptors in the two organs were investigated in anaesthetized cats. Anal pressure and rectal motility were recorded by a manometric and a volumetric method respectively. Division of both the hypogastric nerves (HGN) and the lumbar colonic nerves (LCN) reduced the anal pressure by 46 +/- 6% of the resting pressure (40.9 +/- 6.4 mmHg) and consistently increased rectal motility. Efferent electrical stimulation of the HGN as well as the LCN elicited a contraction in the anus and the rectum, which, at maximal stimulation, caused the anal pressure to reach a similar level to that recorded before division of these nerves. After injection of phentolamine the anal contraction was abolished, whereas the rectal contraction was either abolished or converted to a beta-adrenergic relaxation. Propranolol caused increased rectal contraction in response to stimulation of the HGN and the LCN, whereas the anal contraction was unaffected. The results imply that the sympathetic nerves exert a tonic excitatory effect on the IAS and a dual effect on the rectum in the cat. The results also indicate that sympathetic fibres to the IAS are conveyed in both the HGN and the LCN. Inhibitory beta-adrenergic receptors seem to be of minor importance in regulating anal pressure.

Sympathetic nervous influence on the internal anal sphincter and rectum in man.

The effect of sympathetic nerve block and efferent stimulation of the sympathetic nerves on anorectal motility was studied in 21 patients undergoing operation for rectal carcinoma. Anal pressure and rectal volume were simultaneously recorded before and after epidural anaesthesia and during nerve stimulation. Efferent electrical stimulation of the presacral hypogastric nerves (HGN) elicited a contraction of the internal anal sphincter (IAS) in 13 out of 15 patients. The contraction was preceded by a relaxation in seven patients. In the rectum stimulation of the HGN caused variable responses. A weak contraction was the most frequent response. Efferent stimulation of the periarterial lumbar colonic nerves (LCN) elicited a clear-cut contraction of the IAS, while rectal motor responses were only occasionally observed. Epidural anaesthesia encompassing the thoraco-lumbar region (EDA), when used to block the sympathetic discharge to the IAS and the rectum, caused a reduction of anal pressure (28 +/- 11%) and an increased rectal tone. The results imply that the human IAS receives a sympathetic excitatory innervation via both the HGN and the LCN. Furthermore, it appears that the HGN convey inhibitory fibres to the IAS. The rectal responses to EDA and sympathetic nerve stimulation also indicate the presence of both excitatory and inhibitory neurones in the sympathetic nerve supply to the rectum in man.

Malaria prophylaxis with proguanil to Namibian refugee children in Angola.

Following a presumptive treatment with 35 mg chloroquine base/kg, 484 Namibian children between 5 months and 5 years of age received 50 mg of proguanil daily for 4 months. They were compared with 268 children living in a very adjacent area who received vitamin tablets after the initial chloroquine medication. Fewer fever episodes were recorded among the children who received proguanil and they were also requiring less presumptive treatments with chloroquine during the period of study, but there were only minor differences in parasite rate between the two groups at the end of the study period. Despite the reduction of morbidity, the required efforts were too large to justify another period of drug prophylaxis.

Long-term ileostomy complications in patients with ulcerative colitis and Crohn's disease.

Ileostomy complications in 203 patients operated on with proctocolectomy and ileostomy for ulcerative colitis and Crohn's disease were investigated prospectively. The patients were examined at regular intervals by interview and thorough examination of the stoma. Stomal dysfunction was carefully assessed and patients presenting with surgical complications were admitted for reconstruction. The crude rate of ileostomy complications necessitating reconstruction was 34% and significantly higher in patients with Crohn's disease compared with patients with ulcerative colitis. The cumulative rate of surgical revision after 8 years was 75% in the former group and 44% in the latter. Ileostomy stenosis and sliding recession were the two most common indications for reconstruction. Eighty-three per cent of the revisions were performed as local procedures, making a formal laparotomy unnecessary. Causative factors such as surgical technique, length of concomittant ileal resection and postoperative weight gain were analysed for possible influence on the rate of reconstruction, but no significant association was identified.

Infectious complications after splenectomy.

The incidence of early infectious complications after splenectomy was retrospectively studied in 133 patients operated on between 1975 and 1982. Comparisons were made with a control group. Among the patients in whom splenectomy was performed because of trauma, iatrogenic injury during surgery for benign disorders, as a staging operation in malignant lymphoma or for haematologic reasons, the rate of early postoperative infection ranged from 14 to 29%. In the controls, who underwent selective proximal vagotomy in the same period, the post-operative infection rate was 5%. Of the 133 patients in the splenectomy group, 17 were subsequently hospitalized for infectious disorders (18 months-8 years postoperatively). Because of the high incidence of postoperative infections, prophylactic antibiotic treatment in connection with splenectomy is recommended.