ABSTRACT
Clearly, there are numerous troubling variations in the medical diagnosis of child sexual abuse. These variations include delays in disclosure; rapid healing; maturational changes; variations in normal congenital findings; the technique of the examiner; patient position, relaxation, and cooperation; and additional medical conditions that mimic abuse. For these reasons, physical evidence is often inconclusive and can be an unreliable source of information in child sexual abuse cases. The reader is logically cautioned against attempts to diagnose child sexual abuse based on a single finding, particularly that of the diameter of the hymenal orifice. Emphasis on the child's history in documenting the abuse is increasing. As physicians, we must develop interviewing techniques that will assist in child protection, and we must listen and believe the comments made by our patients.
Subject(s)
Child Abuse, Sexual/diagnosis , Family Practice/methods , Forensic Medicine/methods , Interviews as Topic/methods , Medical History Taking/methods , Physical Examination/methods , Child , Child Abuse, Sexual/epidemiology , Child Abuse, Sexual/psychology , Child Development , Child, Preschool , Diagnosis, Differential , Female , Humans , Hymen/injuries , Male , Self Disclosure , Sexually Transmitted Diseases/diagnosis , Sexually Transmitted Diseases/etiology , Wound Healing , Wounds and Injuries/diagnosis , Wounds and Injuries/etiologySubject(s)
Child Abuse , Physician's Role , Role , Sex Offenses , Child , Child Abuse/legislation & jurisprudence , Child, Preschool , Colposcopy , Female , Humans , Jurisprudence , Male , Medical History Taking , Physical ExaminationABSTRACT
L-Asparaginase therapy for childhood acute lymphoblastic leukemia causes deficiencies of plasma hemostatic proteins, especially antithrombin, plasminogen, and fibrinogen. Severe thromboses and hemorrhages occurred in 18 children receiving vincristine, prednisone, and asparaginase therapy for ALL. Thirteen children had intracranial thrombosis or hemorrhage, four had extremity thrombosis, and one had both an intracranial hemorrhage and an extremity thrombosis. These events occur characteristically in the third and fourth weeks of therapy during or just after a three-week course of L-asparaginase. Symptoms of headache, obtundation, hemiparesis, and seizure were common for the intracranial events: local pain, swelling, and discoloration were common for the extremity thromboses. These complications have been recognized in 1 to 2% of children undergoing induction therapy which includes asparaginase.
