[A classification system of anogenital findings. A diagnostic tool in the assessment of sexually abused children]. / Klassifikasjonsliste av anogenitale funn. Et hjelpemiddel i diagnostikken av seksuelle overgrep mot barn.

The assessment of suspected sexual child abuse demands teamwork where the paediatrician plays a central role. From a juridical point of view, the task of the paediatrician is to evaluate the anatomic, microbiologic and forensic medical findings. In 1995, in order to improve the quality of this work, Norwegian paediatricians established a peer review group which meets on a regular basis. Based on available literature and the experience of the individual members, a classification system for anogenital findings has been developed. The findings are divided into five classes. Class one comprises findings frequently seen in children who have not been abused. Class two comprises findings not considered to be normal, but for which there could be many different causes. Classes three, four and five represent findings which are increasingly predictive with respect to injury penetration or attempted penetration. Since our knowledge of anogenital anatomy in children who have not been abused is limited, our classification system should be updated regularly.

Decreased serum insulin-like growth factor I during puberty in children with insulin dependent diabetes mellitus (IDDM).

Previous reports concerning insulin-like growth factor-I (IGF-I) in diabetics are conflicting. This study describes IGF-I in children with insulin-dependent diabetes mellitus (IDDM) and healthy controls in relation to pubertal development. Sixty-six children participated (34 girls and 32 boys) of which 33 had IDDM. The mean age in the study population was 14.3 years, (range 7.1 to 19.7). Serum IGF-I was significantly decreased in diabetics. Diabetic girls had a mean IGF-I of 28.3 (14.4; = SD) nmol/l compared with 42.8 (15.0) nmol/l in controls. In diabetic boys the result was 30.0 (16.0) nmol/l compared with 44.1 (23.4) in controls. Growth hormone was measured in only one fasting morning serum sample from each individual. There was no difference between girls, but diabetic boys had higher mean serum concentration of growth hormone than controls (3.5 (4.8) vs. 1.8 (1.5) micrograms/l respectively). Diabetic girls had delayed menarche, corresponding to a slightly delayed bone maturation.

Campomelic dysplasia--an underdiagnosed condition?

Campomelic dysplasia (CD) is a rare skeletal dysplasia. The incidence, reported in the literature, is 0.05-0.09 per 10,000 live births. During the period December 1985-December 1990 there were 18,350 live births with 4 cases of CD at Aker University Hospital in Oslo, Norway. This gives an incidence of CD in our observation period of 2.2 per 10,000. Eliminating our first case, because of Pakistani decent, the total incidence is 1.6 per 10,000 among Norwegian infants which is much higher than the incidence previously mentioned. Perhaps CD is under-reported and a high proportion of patients remain undiagnosed. We present four cases and discuss the incidence.

[Sexual abuse of children--a public health problem?]. / Seksuelle overgrep mot barn--et folkehelseproblem?

Owing to variation in the reported prevalences of sexual abuse of children, international publications were reviewed to analyse the definitions and other criteria used. Reported prevalences varied from 4 to 67 per cent, the variation being due, among other things, to inconsistency in the definitions used. By some of the investigators sexual acts without actual physical contact between the offender and the victim had been included in the category, exhibitionism. Approximately half of the reported experiences were isolated events. Future research in this field will require greater conformity in the definitions and criteria used.

Height reduction in 539 tall girls treated with three different dosages of ethinyloestradiol.

During the period 1970 to 1985, 539 constitutionally tall girls were treated with ethinyloestradiol in varying dosages to reduce final height. They all had a predicted final height above 181 cm (greater than +2.5 SD). The girls were all healthy and were treated with three different dosages of ethinyloestradiol. Throughout these 15 years recommended treatment regimens changed, and the treatments described followed these guidelines. Girls in group 1 (n = 263) were treated with 0.5 mg of ethinyloestradiol, group 2 (n = 178) with 0.25 mg, and group 3 (n = 98) with 0.1 mg. The total mean (SEM) reduction of final height was 5.9 (0.2), 5.3 (0.1), and 4.4 (0.2) cm when treated with 0.5, 0.25, and 0.1 mg respectively. Group 1 was treated for 2.02 (0.03) years and group 2 and 3 for 1.85 (0.04) and 1.63 (0.05) years respectively. When expressed in relation to the treatment period the reduction of final height was 3.0 (0.1), 3.1 (0.1), and 2.9 (0.2) cm/year of treatment respectively. All the girls were treated with ethinyloestradiol as a daily single dose, while progestogen was given daily the first 10 days of every month. In conclusion we found that a daily dose of ethinyloestradiol 0.1 mg for about 20 months is sufficient to reduce final height. We recommend starting treatment at a bone age of about 12 years.