Therapeutic interventions in sexual child abuse

This article describes the steps in a therapeutic crisis intervention in cases of intrafamilial child sexual abuse. It is outlined how the form and organisation of the intervention can in itself be highly therapeutic or very harmful. Taking to children, physical examination, coordination of professionals, the disclosure with parents and a family meeting are described as part of an overall therapeutic approach in the disclosure of the abuse. The described therapeutic crisis intervention attempts to take into account paediatric-medical routine and does not refer to any specialist therapeutic techniques in order to enable any child health professional who dares to face the issue of child sexual abuse to undertake the intervention.     

Calcium-movement controlling cardiac contractility. II. Analog computation of cardiac excitation-contraction coupling on the basis of calcium kinetics in a multi-compartment model

A computer model for excitation-contraction coupling in mammalian cardiac cells was designed based on calcium movements in a multicompartment system. The model includes an extracellular space of constant calcium concentration from which calcium crosses the membrane and reaches the myoplasma by a voltage and time dependent process. The free myoplasmic calcium content is considered to reflect the intensity of the active state. Calcium can be taken up either by a carrier-sustained two step reaction into a compartment representing some parts of the longitudinal system or into another pool representing mitochondria. Calcium can leave the cell or can be released again into the myoplasma by a second order reaction. The behaviour of the model is compared to that of living cardiac ventricular muscle. The model correctly predicts the following groups of inotropic phenomena. Steady state and dynamic force-frequency relationships, positive and negative staircases after both changes of frequency and AP-duration, mechanical transients after a period of rest and aftercontractions.     

Left recurrent laryngeal nerve palsy following aortic arch stenting: A case report

BACKGROUND Aortic arch stenting is continuously emerging as a safe and effective option to alleviate aortic arch stenosis and arterial hypertension.CASE SUMMARY We present a 15-year-old girl with aortic arch hypoplasia who had undergone implantation of an uncovered 22 mm Cheatham-Platinum stent due to severe(native) aortic arch stenosis. On follow-up seven months later, she presented a significant re-stenosis of the aortic arch. A second stent(LD Max 26 mm) was implanted and both stents were dilated up to 16 mm. After an initially unremarkable post-interventional course, the patient presented with hoarseness five days after the intervention. MRI and CT scans ruled out an intracranial pathology, as well as thoracic hematoma, arterial dissection, and aneurysm around the intervention site. Laryngoscopy confirmed left vocal fold paresis attributable to an injury to the left recurrent laryngeal nerve(LRLN) during aortic arch stenting, as the nerve loops around the aortic arch in close proximity to the area of the implanted stents. Following a non-invasive therapeutic approach entailing regular speech therapy, the patient recovered and demonstrated no residual clinical symptoms of LRLN palsy after six months.CONCLUSION Left recurrent laryngeal nerve palsy is a rare complication of aortic arch stenting not previously reported.     

Early emotion discrimination in 8- to 10-year-old children: magnetoencephalographic correlates

Emotional cues motivate attention and modulate event-related potentials as well as magnetic fields in adults. Central components enhanced by emotional content are Early Posterior Negativity (EPN, 150-300 ms) and Late Positive Potential (LPP, >300 ms). Previous electroencephalography studies in children revealed a differentiation of the late component in response to emotional scenes, but failed to detect an EPN effect. Twenty-two children aged 8-10 years saw 200 arousing pleasant and non-arousing neutral pictures in a rapid serial visual presentation (RSVP) design, while event-related magnetic fields were recorded with whole-head magnetoencephalography (MEG). Analysis of MEG data based on individual picture ratings yielded LPP-m but also EPN-m effects with topography and latency resembling that of adults. Thus, the mechanism of motivated attention at early processing stages (>150 ms) appears mature in children of this age group.     

Diagnosis and sequelae of sexual child abuse

This paper reviews briefly epidemiological and clinical data on prevalence and incidence of child-sexual-abuse. Individual symptoms and family factors of intra-familial child sexual abuse are described and some possible psychopathological factors and vulnerability factors are listed. Two different forms of parasuicide and self-mutilating behaviour are distinguished and complicating factors of secondary traumatisation are described.