Toxicological evaluation of two children diagnosed as Munchausen syndrome by proxy.

Munchausen syndrome by proxy is a kind of child abuse in which affected children are often hospitalized for long periods and endure repetitive, painful and expensive diagnostic attempts. We present herein two toxicologically confirmed cases of Munchausen syndrome by proxy. Case 1 is a 16-month-old male who had fever, peripheral cyanosis, tremor, and reported cardiac arrest. Symptoms recurred in the hospital when the mother administered fluids. Toxicology detected 3.5 ng/ml mercury (Hg) in the fluid and 9.4 microg Hg/g creatinine in the urine. Case 2 is a 14-year-old female who had irregular blood findings and multiple hospitalizations. Serum analysis detected warfarin. Both mothers were transferred to psychiatric care. Munchausen syndrome by proxy should be suspected when clinical/laboratory findings are negative, illness descriptions are inconsistent, and frequent hospitalization yields no diagnosis. Psychiatric evaluation and toxicological analysis are recommended.

The gynaecologist as an expert witness in cases of sexual abuse.

The High Criminal Court of Kirklareli province of Turkey dealt with a sexual abuse case where the victim was a 14-year-old girl. She was abducted and abused by her boyfriend with her consent, which was legally invalid because of her age. Medical examination was required in order to bring an accusation against the perpetrator. The girl was sent for hymen examination three times because two gynaecologists and one forensic expert produced different witness reports, confusing the court. This caused psychological damaged to the victim. It is proposed that gynaecologists should be made aware of their potential input into sexual assault cases and be informed of the way in which these cases should be handled. In addition, photo-documentation should be established in the Turkish legal system to avoid re-examination of the victim.