Colposcopic genital findings in prepubertal girls assessed for sexual abuse

After the introduction of the colposcope for the examination of children suspected of being sexually abused in Leeds, a study was undertaken to describe the findings in detail. A total of 109 consecutive prepubertal girls, mean age 70.4 months were assessed including colposcopic genital and anal examination, and peer group review of reports and photographs. Fifty nine children had signs consistent with blunt force penetrating trauma (hymenal transection/major notch, scar, or hymenal attenuation). Transections were encountered most commonly at 6 o'clock (directly posterior). In 46 the hymenal orifice was gaping with thigh abduction only and in 47 the hymenal orifice transverse diameter was greater than 4 mm on labial separation. Overall, physical findings were commonly present and in only two cases were no signs recorded. Non-specific and frequent findings included patterns of labial and introital reddening. Supportive hymenal signs including swelling, rounding of edge, thickening, distortion, and loss of symmetry were common. Labial fusion was present in 20. Urethral dilatation with labial separation was noted in 14. Physical findings including normality are consistent with abuse and even minor anogenital signs as well as negative findings should be documented. Colposcopy and photography are valuable tools in peer review, teaching, and case management.     

Radiological evidence of constipation in urinary tract infection

Little objective evidence has been published to support the claim that constipation is an important contributory factor in recurrent urinary tract infection (UTI) in childhood. Using a radiological scoring system, two observers assessed faecal loading from abdominal radiographs of children with proved UTIs. There was a significant increase in the degree of faecal loading in children with UTI when compared with controls (r = 0.237). This difference was mainly accounted for by girls with recurrent (greater than five) UTIs. This study confirms an association between recurrent UTI and faecal loading. Further studies are needed to establish if there is a causal relationship and benefits from treatment.     

A feasibility study of realtime teledermatology in Finland

We conducted a feasibility study of teleconsultation in dermatology using low-cost equipment. Patients and their general practitioners took part in consultations from the Primary Health Care Centre in Ikaalinen with a dermatologist 55 km away at the Tampere University Hospital (TAUH). Consultations were performed using standard commercial videoconferencing equipment, a modified document camera and a dermatoscope. A single ISDN line (128 kbit/s) was used for the connection. During the eight months of the study, 25 patients participated in a teledermatology consultation. Their mean age was 45 years (range 4-92). The average time the patient spent in travelling to the videoconsultation (i.e. one way) was 24 min (range 5-65 min). The mean time spent in the teleconsultation was 15 min (range 5-30 min). After the teleconsultation, patients' treatments changed in 19 cases (76%), diagnoses were changed in 13 cases (52%) and 18 patients (72%) did not need to go to the TAUH. The equipment was generally reliable and easy to use. However, the dermatoscope was not very useful and only one of the consultations relied mainly on it. The cost of the teleconsultations for the 18 patients who avoided travel to the TAUH was FM18,627. The total costs for the 18 conventional consultations in the TAUH would have been FM18,034. The main economic benefits of the videoconferencing were attributable to the reduced travelling and hospital costs. The economic benefits of medical education were more difficult to quantify.     

Immunolocalization of transforming growth factor-beta1 and tenascin in human secondary cataract

PURPOSE: This study was carried out to investigate the distribution of transforming growth factor-beta1 (TGF-beta1) and the extracellular matrix (ECM) glycoprotein tenascin in secondary cataract and anterior subcapsular cataract. METHODS: Twenty-four pseudophakic human eyes with secondary cataract, obtained at autopsy 1 d to 10 yr (mean 2.4 yr) after cataract surgery, were studied. Additionally, a specimen from an anterior subcapsular cataract was included. Immunohistochemistry was used to localize TGF-beta1 and tenascin in secondary cataract and in anterior subcapsular cataract. RESULTS: Polyclonal antibody to TGF-beta1 immunolabelled spindle-shaped cells in the plaques of secondary cataract in all eyes. Instead, the cells present in Soemmering's ring cataract were not labelled. The ECM in the plaques of secondary cataract was immunoreactive for tenascin in all eyes. In anterior subcapsular cataract spindle-shaped cells and ECM showed similar immunoreactivity. CONCLUSION: Spindle-shaped cells that are immunolabelled with TGF-beta1 and ECM showing tenascin-like-immunoreactivity are present in secondary cataract and in anterior subcapsular cataract, thus implicating a possible role in secondary cataract.     

Search for autoantibodies against the HNK-1 carbohydrate epitope in the human eye in intermediate uveitis

PURPOSE: Molecules bearing the immunogenic HNK-1 epitope are present in the inner connective tissue layer and epithelia of the ciliary body. We investigated whether autoantibodies to these molecules can be detected in patients with intermediate uveitis, which affects the ciliary body. METHODS: Serum was collected from 9 patients with intermediate uveitis, and from 6 controls with idiopathic iritis and 3 controls with sarcoid uveitis, representing nongranulomatous and granulomatous uveitis, respectively. The sera were used as polyclonal antibodies to immunostain 3 formalin-fixed, paraffin-embedded normal human donor eyes by the avidin-biotinylated peroxidase complex method. RESULTS: No immunostaining in the ciliary body could be detected using the sera from patients with intermediate uveitis or from the controls. Serum within blood vessels was nonspecifically immunolabelled with the secondary anti-human anti-serum. CONCLUSION: No autoantibodies against the HNK-1 epitope or other antigens of the ciliary body could be demonstrated in patients with intermediate uveitis. It is unlikely that such autoantibodies against the HNK-1 epitope have a role in intermediate uveitis.     

Breast cancer risk associated with different HRT formulations: a register-based case-control study

Background  

Previous epidemiological studies have inconsistently shown a modestly increased breast cancer risk associated with hormone replacement therapy (HRT). Limited information is available about different formulations - particularly concerning different progestins.     

An evaluation of alcohol attendances to an inner city emergency department before and after the introduction of the UK Licensing Act 2003

Background  

The Licensing Act 2003 (The Act) was implemented on the 24th November 2005 across England and Wales. The Act allowed more flexible and longer opening hours for licensed premises. We investigated the effect of The Act on alcohol related attendances to an inner city emergency department in Birmingham, UK.     

Non-immune hydrops fetalis and bilateral pulmonary hypoplasia in a newborn infant with extralobar pulmonary sequestration

Extralobar pulmonary sequestration was found in a newborn premature infait that presented with non-immune hydrops fetalis, massive bilateral hydrothorax and polyhydramnios in utero. The baby died of severe respiratory insufficiency 15 h after birth. Postmortem examination revealed distended lymphatic vessels in the sequestered lung tissue probably due to impeded lymph drainage. We suggest that not extralobar pulmonary sequestration itself but a subsequent massive unilateral hydrothorax due to severe obstruction of lymph drainage was the cause of the non-immune hydrops fetalis, pulmonary hypoplasia and polyhydramnios. If these symptoms are diagnosed before delivery, a search for extralobar pulmonary sequestration is indicated.     

Secondary thrombocytosis

To estimate the incidence and causes of secondary thrombocytosis in children, a 12 month study of all patients attending a children's hospital and discovered to have a platelet count over two times the upper normal limit (> 800 x 10(9)/l) was undertaken. Data so obtained were analysed both separately and together with those from two previous studies to gain as broad a perspective as possible. Of 7916 children who had platelet counts during the study period, 36 (0.5%) produced a value > 800 x 10(9)/l; there were 19 boys and 17 girls. There was a preponderance of young infants (median age 13 months). Twenty seven of the 36 had some sort of associated infection, bacterial in 18 and viral in nine. The other nine were either recovering from anti-neoplastic chemotherapy (n = 6), were post-operative (n = 2), or simply iron deficient (n = 1). Combining these patients with those described in previous studies allowed a review of 139 unselected children with very high platelet counts. Fifty three (38%) had infections, 29 (20%) had traumatic or surgical tissue damage, 16 (11%) had malignant disease undergoing chemotherapy or surgery, and 13 (9%) had connective tissue or autoimmune disorders. Secondary thrombocytosis is not rare and is most frequently seen in very young infants after infection. It can arise in a wide variety of other circumstances including rebound from myelosuppression, iron lack, or as part of an acute phase response. It is clinically unimportant in terms of morbidity and requires no treatment other than that for the primary condition.