The Evaluation of Suspected Pediatric Sexual Abuse

Children with suspected sexual abuse often present to the ED, not infrequently like those in the 2 cases described. Most children who are sexually abused have normal genital examinations, which should be explained in discussions with caretakers and investigators. Interviewing of the child should be avoided by the physician, except to establish current symptoms that may impact examination or testing. Exams should not be forced on children. The hymen is extremely sensitive in the unestrogenized female and should not be touched. Speculum examination is never performed in the prepubertal child, except under anesthesia by a practitioner experienced in child sexual abuse evaluation or gynecology. Examination under anesthesia by a physician experienced in surgical repair is indicated with active vaginal or rectal bleeding. In cases in which the examination is abnormal or inadequate, the subspecialist should be consulted. Patients with contact less than 72 hours before presentation may need forensic evidence collection, which should be coordinated with the subspecialist. Prepubertal females with vaginal discharge seen on examination should have testing sent not only for STDs, but also for non-STD etiologies including group A streptococcus and enterics. Postexposure prophylaxis (pregnancy, STD, HIV) should be considered when appropriate. There are many conditions that may be mistaken for sexual abuse. Detailed documentation of the history and the physical examination (written, drawings, and ideally photographs) is essential.     

Automated solid-phase extraction and two-step derivatisation for simultaneous analysis of basic illicit drugs in serum by GC/MS

A combination of automated solid-phase extraction (SPE) and subsequent two-step derivatisation has been developed for the simultaneous analysis of basic drugs of abuse and cocaine metabolites in serum samples. Substances included in this procedure are morphine, codeine, methadone, cocaine, benzoylecgonine, methylecgonine, amphetamine, methamphetamine, MDMA, MDEA and MDA. SPE with mixed-mode cartridges (RP-C8 and cation-exchange) was fully automated with a Zymark RapidTrace SPE robot. GC/MS analysis was performed after derivatisation with a new two-step reaction by trifluoroacetic anhydride and 2,2,3,3,3-pentafluoropropanol. High recoveries (> 85%) with high reproducibility (CV 1.1-3.8%) were found for all drugs. High correlation coefficients (r > 0.998) were obtained due to the addition of deuterated standards prior to extraction. Experience obtained over 2 years of applying this method to drug analysis in serum is discussed.     

��ͯ������������Ⱦ�����ƽ�չ

??Respiratory infections??especially respiratory viral infections??are common diseases in children. Although most respiratory viral infection diseases are self-limiting??some children may be hospitalized or even life-threatened due to severe viral lower respiratory tract infection. With the progress of virology research??new and effective antiviral drugs have been developed. Thus??the study focuses on the therapeutic progress of respiratory viral infections so as to improve the treatment for common respiratory viral infections in children.     

高压氧治疗小儿病毒性脑炎肢体运动障碍42例疗效分析

目的观察高压氧综合治疗对小儿病毒性脑炎肢体运动障碍恢复的临床效果。方法将82例小儿病毒性脑炎肢体运动障碍患儿随机分为治疗组42例和对照组40例,进行比较观察。采用Fugl—Meye积分评价运动功能,Ashworth痉挛等级评价肌痉挛。结果治疗组有效率95．2％,对照组有效率67．5％,两组疗效差异有统计学意义,治疗组治疗后患儿肢体运动障碍恢复率明显提高。结论高压氧综合治疗对小儿病毒性脑炎肢体运动障碍恢复疗效优于单纯药物治疗。     

利培酮治疗难治性Tourette综合征对照观察

目的:探讨利培酮治疗难治性Tourette综合征(TS)的疗效和安全性。方法:对141例难治性TS患者,随机分为利培酮组(71例)和对照组(70例),进行8周的利培酮开放、对照研究。利培酮组以利培酮单药治疗,对照组以氟哌啶醇等单一或联合治疗。采用耶鲁抽动症状严重程度量表(YGTSS)Achenbach儿童行为量表(CBCL)、治疗中出现的症状量表(TESS),于治疗前、治疗4、8周对两组进行临床疗效及安全性评估。结果:两组症状均有改善。治疗第4周利培酮组有效率56.3%,明显高于对照组32.9%(χ2=8.212,P<0.01);利培酮组YGTSS总分(39.97±15.62)分较对照组(49.84±13.91)分显著为低(P<0.01)。治疗8周时利培酮组有效率为71.8%,明显高于对照组51.4%(χ2=6.357,P<0.05);利培酮组YGTSS总分(17.20±11.24)分明显低于对照组(24.97±10.74)分(P<0.05);减分率(76.55±14.73)%明显高于对照组(66.86±14.28)%(P<0.01)。治疗4周和8周,两组的CBCL总分均显著减少(P<0.05)。治疗4周和8周,利培酮组TESS分显著低于对照组(P<0.01)。结论:利培酮对难治性TS疗效肯定,不良反应较轻。     

Beclomethasone dipropionate nasal spray in children

Summary

Twenty children with extrinsic perennial allergic rhinitis were treated with inhaled beclomethasone dipropionate, 50 μg into each nostril 4-times daily, for a period of 6 weeks. No change in rhinorrhoea, itching and sneezing was observed after provocation testing but there was a reduction in the swelling and size of turbinates (p<0.005). The daily subjective symptom scores (p<0.01), total eosinophil counts (p<0.03) and serum IgE levels (p<0.04) had significantly decreased after treatment. It is suggested that inhaled beclomethasone dipropionate has a useful role in the management of children with perennial allergic rhinitis.     

小儿毒蛇咬伤49例

目的总结小儿毒蛇咬伤的综合防治措施。方法对1997年1月-2006年12月收治49例毒蛇咬伤患儿，记录性别、年龄、居住地、受伤及就诊时间、受伤部位、受伤后的局部症状及全身情况、治疗过程及预后，并进行综合分析。结果小儿蛇咬伤病例集中于夏秋湿热季节，乡村小儿发生率多见（占81．6％），从发生至来院时间平均38．4h，93．9％未看见毒蛇或不能描述毒蛇的特征。按照Downey系统分类，3、4级重型伤员所占比重较大（占59．2％）。蛇咬伤局部可出现肿胀、疼痛、瘀斑、伤口感染、局部坏死伴组织缺失、骨筋膜室综合征等表现，亦可导致器官功能损害等并发症；均行针对性的综合治疗，无死亡病例。结论加强预防知识教育、早期诊断和综合对症处理可有效降低小儿蛇伤后病死率和病残率。