Do no more harm: The psychological stress of the medical examination for alleged child sexual abuse

Aim:   Currently, there is some controversy that the medical examination following allegations of child sexual abuse may further traumatise the child. Access for children to appropriate care may be hindered if decisions about referral are influenced by personal beliefs, rather than by recognition of the potential health and psychological benefits of the assessment. We aimed to study the expectations and emotional responses of children and their parents to the medical examination.
Methods:   We conducted a prospective quantitative and qualitative study at the Children's Hospital at Westmead. Participants completed questionnaires pre-examination and post-examination, including Children's Anxiety and Pain Scales. Clinicians recorded a Genital Examination Distress Scale and a questionnaire about potentially prognostic variables.
Results:   Parents found the medical examination significantly less stressful than they had anticipated. They highlighted the importance of being involved in the process, the child's reaction, staff attitudes and the doctor's explanations. Although most parents expected that the medical would be stressful for their child, this did not correlate with the children's reports of feeling scared beforehand. Increased parental and child distress were significantly associated with the child being 12 years or older. The type of abuse was not significantly linked to any of the parent or child self-reports.
Conclusion:   Our findings indicate that the medical examination is not as stressful as expected and support the recommendation that timely medical assessment by appropriately trained professionals should be offered for all children following allegations of sexual abuse.     

Posterior cerebral artery occlusion associated with Mycoplasma pneumoniae infection

Cerebral infarction is a rare complication of Mycoplasma pneumoniae infection. In all cases previously reported in the literature, vascular occlusion occurred in the anterior brain circulation, either the internal carotid or the middle cerebral artery. We report a case of a child with posterior cerebral artery occlusion and resultant hemiparesis associated with M. pneumoniae infection.     

Thalidomide in the treatment of myelodysplastic syndrome with fibrosis

A 67-year-old woman was admitted for investigation of pancytopenia. Bone marrow biopsy was compatible with myelodysplastic syndrome (MDS) with fibrosis. For the next 20 months the patient received transfusions of packed red cells, while a 3-month-trial of erythropoetin was unsuccesful. She was then treated with thalidomide 400mg per day. During the next months, a gradual rise in Hb value was noticed and the patient eventually became transfusion independent. Repeat bone marrow biopsy revealed a significant decrease on the degree of fibrosis. Thalidomide has shown excellent results in the treatment of multiple myeloma probably due to its anti-angiogenic activity. It is possible that in our patient thalidomide acted as an anti-fibrotic agent. It will be very interesting to test this novel activity of thalidomide in a large number of patients.     

Multiple liver abscesses associated with bacteremia due to Leuconostoc lactis

Leuconostoc species, which are members of the family Streptococcacae, have only recently been recognized as potential pathogens. We describe a patient with type II diabetes mellitus who had multiple liver abscesses associated with bacteremia due to Leuconostoc lactis. To our knowledge, this is the first case of this association to be reported in the literature.     

Unusual Metastatic Spread of Follicular Thyroid Carcinoma: Report of a Case

Concurrent skull and liver metastases from follicular thyroid carcinoma is a very rare event. We herein present the case of a 72-year-old woman who initially presented with a swelling in the right supraorbital region that proved to be metastasis from a well-differentiated follicular thyroid carcinoma of clear-cell type. The metastatic workup disclosed a huge liver metastasis and an additional metastasis in the left iliac fossa. The treatment of this patient included a total thyroidectomy, an excision of the skull lesion, and the administration of radioiodine therapy, as well as thyroid-stimulating hormone (TSH) suppression therapy. However, the course of her disease was relentless. Although well-differentiated thyroid carcinoma tends to show an excellent course, the presence of metastatic disease leads to a very dismal prognosis.An erratum to this article can be found at     

Anthranilic acid based CCK1 receptor antagonists: preliminary investigation on their second "touch point"

In this phase of structure-affinity relationship study of VL-0395, a new anthranilic acid based CCK1 selective antagonist, we propose a series of unnatural aminoacidic derivatives. The result of this work is the identification of a new CCK ligand, which possesses an affinity (IC50 = 35 nm) one order of magnitude greater than the lead and, as a general rule, it points out how the hypothesized receptorial pocket which accommodates the Phe residue allows much more structural modification than that interacting with the N-terminal group. Hence, the modification of the C-terminal pharmacophoric group of our lead VL-0395 can not only enhance the affinity of anthranilic acid derivatives but can modulate the selectivity for one CCK receptor subtype or afford mixed antagonists.     

Expression of cyclins D1, D3 and p27 in thymic epithelial tumors

In this study, the expression of cyclins D1 and D3, as well as cyclin-dependent kinase inhibitor p27 in thymic epithelial tumors (thymomas) is examined. Histological specimens from 24 patients (11 males and 13 females) were submitted to classification according to WHO criteria. Staining for cyclins D1, D3 and p27 was applied and evaluation was performed for expression of D1, D3 and p27. Eighteen patients presented low-grade thymomas (nine B1, predominantly cortical; three B2, cortical; six B3, well-differentiated thymic carcinoma) and six patients benign thymomas (four A-medullary, two AB-mixed). The p27 expression in patients with benign thymomas was 42+/-26%, whereas in patients with low-grade thymoma, it was 11+/-13%. The expression of cyclins D1 and D3 was 2.8+/-2.7 and 10+/-6% for benign as well as 8.3+/-9.6 and 12+/-10% for low-grade thymomas, respectively. A statistically significant difference was revealed regarding the p27 expression through different grades (analysis of variance P-value 0.00076) and histopathological types of thymomas (P=0.0047). This finding of greater p27 expression in benign thymomas with progressive reduction in higher grades is compatible with observations on other soft tissue and solid tumors suggesting that p27 level decreases during tumor development and progression.     

The Varna-Thessaloniki telemedical collaboration in setting up a regional transborder transplantation network

In most Balkan countries, with the exception of Greece, transplantation is very rare and equality of access does not exist. In 2003, a Balkan partnership was established called SETNET (South-Eastern European Transplantation Network) for the promotion of transplantation. The objectives are to bring about the diffusion of transplantation techniques and practices in the Balkans, to increase public support for and participation in transplantation, and to eliminate the disparities in access to good health-care. SETNET is already beginning to generate data for an analysis of transplantation-related needs in the Balkans and to accelerate cross-border data exchange in transplantation-related emergencies. In the next few years, a regional training programme will be introduced for all health-care staff involved in transplantation. A regional organ procurement and transplantation network will be set up to utilize the existing telemedicine infrastructure. If successful, it will also prove that telemedicine infrastructures, however modest, can be the backbone for other, far-reaching human networks.     

SPRY2 is an inhibitor of the ras/extracellular signal-regulated kinase pathway in melanocytes and melanoma cells with wild-type BRAF but not with the V599E mutant

BRAF mutations result in constitutively active BRAF kinase activity and increased extracellular signal-regulated kinase (ERK) signaling and cell proliferation. Initial studies have shown that BRAF mutations occur at a high frequency in melanocytic nevi and metastatic lesions, but recent data have revealed much lower incidence of these mutations in early-stage melanoma, implying that other factors may contribute to melanoma pathogenesis in a wild-type (WT) BRAF context. To identify such contributing factors, we used microarray gene expression profiling to screen for differences in gene expression between a panel of melanocytic and melanoma cell lines with WT BRAF and a group of melanoma cell lines with the V599E BRAF mutation. We found that SPRY2, an inhibitor homologous to SPRY4, which was previously shown to suppress Ras/ERK signaling via direct binding to Raf-1, had reduced expression in WT BRAF cells. Using small interfering RNA-mediated SPRY2 knockdown, we showed that SPRY2 acts as an inhibitor of ERK signaling in melanocytes and WT BRAF melanoma cells, but not in cell lines with the V599E mutation. We also show that SPRY2 and SPRY4 directly bind WT BRAF but not the V599E and other exon 15 BRAF mutants. These data suggest that SPRY2, an inhibitor of ERK signaling, may be bypassed in melanoma cells either by down-regulation of its expression in WT BRAF cells, or by the presence of the BRAF mutation.