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Kane D, Kennedy KM, Eogan M. The prevalence of genital injuries in post-pubertal females presenting for forensic examination after reported sexual violence: a systematic review. Int J Legal Med 2024; 138:997-1010. [PMID: 37971512 DOI: 10.1007/s00414-023-03117-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Sexual violence is a prevalent issue in contemporary society requiring a robust forensic healthcare response. It is critically important that forensic examiners put clinical examination findings into an appropriate evidence-based context. The presence of genital injuries has been shown to increase the likelihood of successful criminal prosecution and report the crime. However, the reported rates of genital injury vary widely in published studies. AIMS AND OBJECTIVES We aim to critically evaluate and synthesize existing literature on the prevalence of genital injuries in post-pubertal females, examined following sexual violence, with a view to describing the prevalence and characteristics of genital injuries as well as the range of forensic practices employed. METHODS Three online databases (PubMed, Embase, and Scopus) were systematically searched with key terms. RESULTS Of the 1224 studies screened, 141 full-text publications met the inclusion criteria. Reported injury prevalence rates varied widely. Details pertaining to forensic examinations included in each study, such as grade of the examiner, type of examination, location of examination, and time interval from assault to examination also varied widely. Injury prevalence was highest in studies where enhanced visualization techniques were utilized. CONCLUSIONS This systematic review demonstrates that there is no universally agreed standard for documenting genital injuries in cases of sexual violence and highlights the need for standardized approaches and guidelines for assessing, documenting, and reporting these injuries. The review provides robust evidence to support a call for establishing consistent context, terminology, classification systems, and data collection methods to improve the comparability and reliability of future research findings.
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Affiliation(s)
- D Kane
- Department of Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, 1, Dublin, Ireland.
- Sexual Assault Treatment Unit (SATU), Rotunda Hospital, Parnell Square, Dublin, 1, Dublin, Ireland.
| | - K M Kennedy
- School of Medicine, University of Galway, Galway, Ireland
| | - M Eogan
- Department of Obstetrics & Gynaecology, Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, 1, Dublin, Ireland
- Sexual Assault Treatment Unit (SATU), Rotunda Hospital, Parnell Square, Dublin, 1, Dublin, Ireland
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Bonaventura B, Panayi AC, Hummedah K, Palackic A, Tapking C, Haug V, Kilian K, Runkel A, Bliesener B, Kneser U, Hundeshagen G. Outcomes in patients with burns to the perineum, buttocks and genitalia: A retrospective cohort study. Burns 2024; 50:767-773. [PMID: 38036375 DOI: 10.1016/j.burns.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 09/26/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Burns that involve the perineum, buttocks and genitals (PBG) have been associated with more challenging therapeutic needs and worse clinical outcomes. We aimed to investigate whether PBG burns are an independent predictor for mortality, morbidity and complications in a large, heterogenous patient collective and in comparison to patients without PBG burns. PATIENTS AND METHODS Patients admitted to a level one burn center between August 2014 and July 2022 were included and stratified based on the presence of PBG burns on admission (PBG & control group = CTR). Demographic baseline data, burn aetiology, inhalation trauma (IHT), full-thickness burns (FT), number of operations (NOR), mortality, length of ICU stay (LOS-ICU), length of in-hospital stay (LOHS) and bacteraemia were assessed to compare key clinical characteristics and outcomes between the groups. Multivariate regression analyses and a 1:1 propensity score matching were conducted for key clinical outcomes. RESULTS A total of 1024 patients were included in the analysis (PBG: n = 227; CTR: n = 797). PBG burns were older (median (IQR) 54 (34-72) vs. 44, (30-61) years, p < 0.0001), more frequently female (35% vs. 23%, p = 0.002) presented with larger total body surface area (TBSA) burns overall (27 (32-39) vs. 10 (13-15) %, p < 0.0001) and sustained FT burns more frequently (69% vs. 26% p < 0.0001). Scald burns were more frequently the cause of PBG burns (45% vs. 15%, p < 0.0001), PBG patients needed twice as many surgical procedures (Mean (SD) 2 (2.84) vs. 1 (1.6), p < 0.0001) as CTR. In multivariate analyses, a significant correlation was identified between length of ICU stay and presence of PBG burns. Following strict cohort matching to account for sex, age, cause of burn, TBSA %, presence of FT burn, inhalation trauma and bacteraemia, PBG burns were an independent predictor for mortality (p = 0.0003). CONCLUSION PBG burns are at risk for prolonged intensive care, hospitalization and complications during treatment. Furthermore, the presence of PBG burns appears to be a risk factor for mortality, irrespective of patient age, TBSA affected and other relevant covariates.
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Affiliation(s)
- Bastian Bonaventura
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Adriana C Panayi
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Kamal Hummedah
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Alen Palackic
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Christian Tapking
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Valentin Haug
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Katja Kilian
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Alexander Runkel
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Bjoern Bliesener
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany
| | - Gabriel Hundeshagen
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center, Ludwigshafen, Germany.
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Patterson JT, Becerra JA, Duong A, Nakata H, Lovro L, Hwang DH, Heckmann N. Iatrogenic risk of genital injury with retrograde anterior column screws: CT analysis. Injury 2022; 53:3759-3763. [PMID: 36153253 DOI: 10.1016/j.injury.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/04/2022] [Accepted: 09/16/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Joseph T Patterson
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, CA, United States.
| | - Jacob A Becerra
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, CA, United States.
| | - Andrew Duong
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, CA, United States.
| | - Haley Nakata
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, CA, United States.
| | - Luke Lovro
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, CA, United States.
| | - Darryl H Hwang
- Department of Radiology, Keck School of Medicine of the University of Southern California, CA, United States.
| | - Nathanael Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, CA, United States.
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Koller CR, Wang S, Sandoval V, Yousif A, Hsieh TC, Raheem OA. Self-Induced Trauma to the Genitalia: a Review of the Literature and Management Schemes. Curr Urol Rep 2021; 22:18. [PMID: 33534050 DOI: 10.1007/s11934-021-01034-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Self-induced genital trauma is rare, and prompt and evidence-based early intervention can improve the urinary and sexual function of these complex patients. This review has surveyed current literature and treatment trends to evaluate the clinical approach to managing genital trauma. RECENT FINDINGS A literature review was performed regarding self-induced genitalia trauma and trauma management between 2000 and 2019 using MEDLINE® database, the Cochrane Library® Central Search, Web of Science, and Google Scholar. In total, 42 articles were considered relevant and included in this review. Self-induced trauma can be appropriately managed with a multidisciplinary approach. Treatment goals are to preserve urinary, sexual, and reproductive function. Specific evaluation includes mechanism of injury, imaging, and determining the extent of injury and surgical repair, if indicated. Due to the rarity of these injuries and their emergent nature, much of the management is based on retrospective data. Further research is needed to improve long-term functional outcomes in trauma patients.
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Affiliation(s)
- Christopher R Koller
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Ave. 8642 Room 3514, New Orleans, LA, 70112, USA
| | - Shuhong Wang
- Department of Andrology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Victor Sandoval
- Department of Urology, Hospital Valentin Gomez Farias, Guadalajara, Mexico
| | - Ayad Yousif
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Ave. 8642 Room 3514, New Orleans, LA, 70112, USA
| | - Tung-Chin Hsieh
- Department of Urology, University of California San Diego Health, San Diego, California, USA
| | - Omer A Raheem
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Ave. 8642 Room 3514, New Orleans, LA, 70112, USA.
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Abstract
OBJECTIVES Genital injuries among children are often associated with consumer products or specific activities. There are few descriptive studies from Asia on pediatric genital injuries seen in the emergency department (ED). The aim of this study was to describe the characteristic features of accidental genital injuries among children. METHODS A retrospective chart review of children aged 15 years or younger who visited our ED for genital injuries between March 2010 and November 2014 was conducted. Data on age, arrival time at the ED, location of the incident, mechanism of injury, objects, injured organ, consultation with specialists, emergency operation, sedation at the ED, and outcomes were collected and analyzed. RESULTS One hundred seventy-nine patients were included in this analysis. Girls comprised 71% of the subject pool. The median age was 6 years (interquartile range, 4-9 years). Straddle injuries were the most common form of injury (56%). Male genital injuries occurred mostly outdoors (64%). Common consumer products associated with pediatric genital injuries were furniture (21%), exercise equipment (17%), and bicycles (15%). Thirty-two patients were examined by a surgeon, gynecologist, or urologist. The most commonly injured organs were the penis (55%) in boys and the labia (60%) in girls. Most patients (93%) were treated at the ED and discharged. CONCLUSIONS The characteristics of accidental genital injuries among Japanese children were similar to those of children in other countries. The strategy for preventing genital injuries used in the West might be applicable to the East Asian context.
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Affiliation(s)
- Hirokazu Takei
- From the Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Ali-Panzarella AZ. A Diagnostic Approach to Conditions that Mimic Sexual Abuse. Pediatr Ann 2020; 49:e334-e340. [PMID: 32785717 DOI: 10.3928/19382359-20200717-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Primary care providers are often the first point of contact when there are concerns of child sexual abuse. The history is the key factor in making the diagnosis as most children who have experienced child sexual abuse do not have an abnormal anogenital examination. When anogenital symptoms precipitate concerns for sexual abuse, especially in the absence of a history of sexual abuse, it is important to be aware of conditions that mimic sexual abuse. Being familiar with such conditions allows the provider to determine appropriate management, differentiate an anatomical variant or medical condition from abuse, and provide reassurance to the patient and family. Unnecessarily reporting these cases can have detrimental effects on the patient and family. If any doubt arises, patients can be referred for further evaluation by an expert in child abuse. This article presents many common medical conditions that can mimic sexual abuse, with a focus on history, examination findings, and management. [Pediatr Ann. 2020;49(8):e334-e340.].
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Neumannova K, Machova-Urdzikova L, Kwok JCF, Fawcett JW, Jendelova P. Adaptation of tape removal test for measurement of sensitivity in perineal area of rat. Exp Neurol 2019; 324:113097. [PMID: 31707082 DOI: 10.1016/j.expneurol.2019.113097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/02/2019] [Accepted: 11/05/2019] [Indexed: 11/20/2022]
Abstract
Regeneration after spinal cord injury is a goal of many studies. Although the most obvious target is to recover motor function, restoration of sensation can also improve the quality of life after spinal cord injury. For many patients, recovery of sensation in the perineal and genital area is a high priority. Currently there is no experimental test in rodents for measuring changes in sensation in the perineal and genital area after spinal cord injury. The aim of our study was to develop a behavioural test for measuring the sensitivity of the perineal and genital area in rats. We have modified the tape removal test used routinely to test sensorimotor deficits after stroke and spinal cord injury to test the perineal area with several variations. A small piece of tape (approximately 1 cm2) was attached to the perineal area. Time to first contact and to the removal of the tape was measured. Each rat was trained for 5 consecutive days and then tested weekly. We compared different rat strains (Wistar, Sprague-Dawley, Long-Evans and Lewis), both genders, shaving and non-shaving and different types of tape. We found that the test was suitable for all tested strains, however, Lewis rats achieved the lowest contact times, but this difference was significant only for the first few days of learning the task. There were no significant differences between gender and different types of tape or shaving. After training the animals underwent dorsal column lesion at T10 and were tested at day 3, 8, 14 and 21. The test detected a sensory deficit, the average time across all animals to sense the stimulus increased from 1'32 up to 3'20. There was a strong relationship between lesion size and tape detection time, and only lesions that extended laterally to the dorsal root entry zone produced significant sensory deficits. Other standard behavioural tests (BBB, von Frey, ladder and Plantar test) were performed in the same animals. There was a correlation between lesion size and deficit for the ladder and BBB tests, but not for the von Frey and Plantar tests. We conclude that the tape removal test is suitable for testing perineal sensation in rats, can be used in different strains and is appropriate for monitoring changes in sensation after spinal cord injury.
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Affiliation(s)
- K Neumannova
- Institute of Experimental Medicine, Czech Academy of Science, Videnska 1083, 14220 Prague, Czech Republic; 2nd Faculty of Medicine, Charles University, V Uvalu 84, 15006 Prague, Czech Republic
| | - L Machova-Urdzikova
- Institute of Experimental Medicine, Czech Academy of Science, Videnska 1083, 14220 Prague, Czech Republic; 2nd Faculty of Medicine, Charles University, V Uvalu 84, 15006 Prague, Czech Republic
| | - J C F Kwok
- Institute of Experimental Medicine, Czech Academy of Science, Videnska 1083, 14220 Prague, Czech Republic; Faculty of Biological Sciences, University of Leeds, UK
| | - J W Fawcett
- Institute of Experimental Medicine, Czech Academy of Science, Videnska 1083, 14220 Prague, Czech Republic; John van Geest Centre for Brain Repair, University of Cambridge, UK
| | - P Jendelova
- Institute of Experimental Medicine, Czech Academy of Science, Videnska 1083, 14220 Prague, Czech Republic; 2nd Faculty of Medicine, Charles University, V Uvalu 84, 15006 Prague, Czech Republic.
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Dowlut-McElroy T, Higgins J, Williams KB, Strickland JL. Patterns of Treatment of Accidental Genital Trauma in Girls. J Pediatr Adolesc Gynecol 2018; 31:19-22. [PMID: 28782658 DOI: 10.1016/j.jpag.2017.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 07/24/2017] [Accepted: 07/31/2017] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To evaluate the characteristics of girls with accidental genital trauma (AGT) who can be managed in the emergency department (ED) vs the operating suite (OS). DESIGN Retrospective cohort. SETTING ED at a children's hospital in a metropolitan area. PARTICIPANTS Girls aged 0-18 years with AGT. INTERVENTIONS AND MAIN OUTCOME MEASURES Factors associated with need for evaluation and repair of AGT in the OS. RESULTS A total of 359 girls were included in the analysis. The mean age was 6 ± 3 years. Most girls presented with pain and bleeding, 321/359 (89%). Straddle injury was the most common mechanism, 258/355 (73%). The most commonly injured site was the labia, 225/358 (63%) and the most common type of injury was laceration, 308/357 (86%). Factors significantly associated with treatment in the OS included older age, transfer from another institution, penetrating injuries, injuries involving the hymen/vagina/urethra/anus, and injuries larger than 3 cm in size. The odds of requiring general anesthesia in the OS were 5.5 times higher for injuries larger than 3 cm (95% confidence interval, 2.8-10.9; P < .0001) and 4.1 times greater if the patient was transferred from another facility (95% confidence interval, 1.3-13.3; P < .02). CONCLUSION Most AGT can be managed expectantly. Penetrating injuries, injuries to the hymen/vagina/urethra/anus, and injuries with a maximal size of 3 cm should be considered as indications for management in the OS. With adequate procedural sedation, most girls with minor injuries as a result of AGT can undergo a thorough examination and repair of AGT in the ED.
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Affiliation(s)
- Tazim Dowlut-McElroy
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Section of Gynecological Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri.
| | - Jeanette Higgins
- Section of Gynecological Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Karen B Williams
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Julie L Strickland
- Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Section of Gynecological Surgery, Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
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Goyal MK, Mollen CJ, Hayes KL, Molnar J, Christian CW, Scribano PV, Lavelle J. Enhancing the emergency department approach to pediatric sexual assault care: implementation of a pediatric sexual assault response team program. Pediatr Emerg Care 2013; 29:969-73. [PMID: 23974714 PMCID: PMC3823807 DOI: 10.1097/pec.0b013e3182a21a0d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this study were to describe the experience of a novel pediatric sexual assault response team (SART) program in the first 3 years of implementation and compare patient characteristics, evaluation, and treatment among subpopulations of patients. METHODS This was a retrospective chart review of a consecutive sample of patients evaluated at a pediatric emergency department (ED) who met institutional criteria for a SART evaluation. Associations of evaluation and treatment with sex, menarchal status, and presence of injuries were measured using logistic regression. RESULTS One hundred eighty-four patients met criteria for SART evaluation, of whom 87.5% were female; mean age was 10.1 (SD, 4.6) years. The majority of patients underwent forensic evidence collection (89.1%), which varied by menarchal status among girls (P < 0.01), but not by sex. Evidence of acute anogenital injury on physical examination was found in 20.6% of patients. As per the Centers for Disease Control and Prevention guidelines for acute sexual assault evaluations in pediatric patients, menarchal girls were more likely to undergo testing for sexually transmitted infections and pregnancy (P < 0.01) and to be offered pregnancy, sexually transmitted infection, and HIV prophylaxis (P < 0.01). CONCLUSIONS In an effort to improve quality and consistency of acute sexual assault examinations in a pediatric ED, development of a SART program supported the majority of eligible patients undergoing forensic evidence collection. Furthermore, a substantial number of patients had evidence of injury on examination. These findings underscore the importance of having properly trained personnel to support ED care for pediatric victims of acute sexual assault.
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Affiliation(s)
- Monika K Goyal
- From the *Children's National Medical Center, Washington, DC; †The George Washington University, ‡The Children's Hospital of Philadelphia, and §University of Pennsylvania School of Medicine, Philadelphia, PA
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10
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Hornor G, Thackeray J, Scribano P, Curran S, Benzinger E. Pediatric sexual assault nurse examiner care: trace forensic evidence, ano-genital injury, and judicial outcomes. J Forensic Nurs 2012; 8:105-111. [PMID: 22925125 DOI: 10.1111/j.1939-3938.2011.01131.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Although pediatric sexual assault nurse examiners (P-SANEs) have been providing care for over two decades there remain major gaps in the literature describing the quality of P-SANE care and legal outcomes associated with their cases. The purpose of this study was to compare quality indicators of care in a pediatric emergency department (PED) before and after the implementation of a P-SANE program described in terms of trace forensic evidence yield, identification of perpetrator DNA, and judicial outcomes in pediatric acute sexual assault. METHOD A retrospective review of medical and legal records of all patients presenting to the PED at Nationwide Children's Hospital with concerns of acute sexual abuse/assault requiring forensic evidence collection from 1/1/04 to 12/31/07 was conducted. FINDINGS Detection and documentation of ano-genital injury, evaluation and documentation of pregnancy status, and testing for N. gonorrhea and C. trachomatis was significantly improved since implementation of the P-SANE Program compared to the historical control. DISCUSSION The addition of a P-SANE to the emergency department (ED) provider team improved the quality of care to child/adolescent victims of acute sexual abuse/assault.
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Affiliation(s)
- Gail Hornor
- Nationwide Children's Hospital, Columbus, Ohio, USA.
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Dmitrieva OA, Khol'ter EA, Goncharenko DV, Smirnova EV. [Approaches to the improvement of forensic medical expertise in the cases of sexual crimes and doubtful gender status]. Sud Med Ekspert 2012; 55:56-58. [PMID: 22567960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The authors analyzed the results of the forensic medical expertise of the cases of sexual assaults and covert sexual abuse. Special attention is given to the peculiarities of forensic-medical expertise in the cases of veneral diseases and HIV-infection, injuries to sexual organs in women and men. The specific approaches to the examination of corpses in the cases of atypical sexual behavior or a murder supposedly committed for sexual motives are considered.
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12
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Abaeva IK. [Tourniquet syndrome in children]. Vestn Khir Im I I Grek 2012; 171:105-108. [PMID: 22774566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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13
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Kotik A, Zaitsev K, Shperber A, Hiss J. [The prevalence of physical evidence in the anogenital area in sexual assault cases of children in Israel]. Harefuah 2011; 150:895-936. [PMID: 22352280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Sexual abuse includes obscenity, rape and sodomy. Forensic medical examinations routinely include the genital area, anus and the body of the victims for signs of recent or old injury. OBJECTIVES To evaluate the incidence of physical evidence in forensic sexual abuse cases and to compare the Israeli findings to data from other countries, including the USA. METHODS The study was conducted during one calendar year in Israel and included 95 children from infancy to 16 years of age, of whom 83% were females. Examination results were defined by the presence of physical injury or its absence. These findings were classified by their location in the anogenital area or other body areas and findings in the anogenital area were further classified by their likelihood to have been caused by a sexual assault. The results of the examination were related to parameters such as age and sex of the participants, length of time since the last assault, and the degree of proximity between the suspected assailant and the victim. RESULTS Evidence of physical abuse was found in 41 patients, in 37 (39%) of these cases physical abuse was detected in the anogenital area. In all these cases of anogenital abuse, 11 (12%) showed clear evidence of sexual assault and five of them had recent signs of injury; 80% of the recent injuries in the anogenital area were identified in patients within the first 24 hours after the assault. CONCLUSIONS The prevalence of clear evidence of sexual assault in the U.S. ranges from 3-23%, in Italy 9.5%, in Thailand 32% and in Denmark 40%. In Israel, as elsewhere in the world, few cases of sexual assault in children will have clear evidence of a sexual nature. A lack of physical evidence does not rule out sexual assault, therefore, finding physical evidence during an examination is the exception rather than rule. Questioning the victim and investigating the circumstances of the case are crucial elements in all instances of presumed sexual assault on children.
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Affiliation(s)
- Andrei Kotik
- The National Center of Forensic Medicine, Assaf Harofeh Medical Center.
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14
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Erickson BA. Editorial comment. Urology 2011; 78:1007-8; author reply 1008. [PMID: 22054365 DOI: 10.1016/j.urology.2011.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 06/15/2011] [Accepted: 06/17/2011] [Indexed: 11/28/2022]
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15
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Perera P. Physical methods of torture and their sequelae: a Sri Lankan perspective. J Forensic Leg Med 2007; 14:146-50. [PMID: 16876458 DOI: 10.1016/j.jcfm.2006.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Revised: 05/18/2006] [Accepted: 05/24/2006] [Indexed: 11/20/2022]
Abstract
Methods of torture vary from country to country and sometimes within regions in the same country. Knowing torture methods used in a country or region assists in evaluating injuries, scars and other chronic sequelae of torture. Medical records of 100 victims of torture examined between 1998 and 2001 in the Judicial Medical Officer's Office in Colombo, Sri Lanka, were perused to gather data on torture methods used in Sri Lanka during that period. Altogether 68 methods of torture had been used on these victims. They included assault with blunt and sharp weapons, burns with lighted cigarettes, 'dry submarino', kicking, 'wet submarino', 'hanging', electric torture, 'falaka' and many more. However, only 18% of victims had any physical residual effects, highlighting the typical objective of torture, which is inflicting maximum pain without causing serious injury or death.
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Affiliation(s)
- Priyanjith Perera
- University of Kelaniya, Department of Forensic Medicine, Faculty of Medicine, Thalagolla Road, Ragama, Sri Lanka.
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Onen A, Oztürk H, Yayla M, Basuguy E, Gedik S. Genital trauma in children: Classification and management. Urology 2005; 65:986-90. [PMID: 15882738 DOI: 10.1016/j.urology.2005.01.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Revised: 12/20/2004] [Accepted: 01/11/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the severity and, accordingly, the treatment of genital trauma in a pediatric population. METHODS A total of 116 children with genital trauma and anorectal injury were retrospectively reviewed. The severity of trauma was graded according to the genital injury score (GIS), which we developed as a genital trauma scoring system. RESULTS The median age was 8 years. Of the 116 children, 80 were girls and 36 were boys. The etiology of the trauma was traffic road accident (53 patients), fall, sexual abuse, and gunshot wound. Sixty-one patients had additional organ injuries. The GIS was I for 25 children, II for 19, III for 32, IV for 23, and V for 17. In addition to the primary repair, colostomy was performed in 22 patients. The most frequent postoperative complication was wound infection. The postoperative complication rate was significantly greater in patients with an injury severity score greater than 15, severe contamination, prolonged delay (longer than 8 hours), and a GIS of IV or V. CONCLUSIONS The clarification of the mechanism and severity of the genital injury and associated organ injuries under general anesthesia may help in the appropriate classification. Primary repair should be the standard approach in genital trauma patients with a GIS of IV or less. Those with a GIS of V associated with severe contamination and prolonged delay require colostomy for improved outcome.
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Affiliation(s)
- Abdurrahman Onen
- Department of Pediatric Surgery, Dicle University School of Medicine, Diyarbakir, Turkey.
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17
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Abstract
We have learned much about the medical evaluation of suspected child sexual abuse during the past 2 decades. The physical examination still holds an important place in the evaluation but is secondary to a well-performed history. As the evolving literature increases our understanding, the relevance of various anatomic appearances of the prepubertal and pubertal genital examination will certainly become even clearer. The physical examination rarely is diagnostic by itself, with more than 92% of cases failing to demonstrate either acute or chronic signs of injury. Thus, the 1994 quote by Adams and colleagues, "It's normal to be normal," continues to ring true, now supported by a growing body of pediatric literature.
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Abstract
OBJECTIVE To document the population-based incidence of sexual assault in Baltimore, Md, victims' alcohol/drug use, and pre-event circumstances. METHODS Between 1997 and 1999, the city's sexual assault treatment center treated 1,038 victims (age>or=13 years). Data were extracted from forensic narratives. Analysis was restricted to frequency tables and bar graphs. Incidence was calculated based on 1998 population figures. RESULTS The incidence of sexual assault among females aged 13 years or older was 117 per 100,000. Seventy percent of patients were less than 30 years old. Fifty-three percent tested positive for alcohol/drugs. Two thirds sustained physical or genital injury; 30% sustained both. The most common pre-event circumstances were walking/being followed (27%) and visiting a friend's home (24%). CONCLUSION This study revealed a high prevalence of physical/genital injury, supporting the call for an injury severity scale for sexual assault and for increased substance abuse counseling and educational/health resources to mitigate sexual assault and offer meaningful response when such crimes occur.
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Affiliation(s)
- Kathleen M Read
- Charles McC. Mathias National Study Center for Trauma and Emergency Medical Systems, University of Maryland School of Medicine, Baltimore 21201, USA.
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19
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Abstract
In the setting of a forensic examination following rape, colposcopy allows practitioners to identify and photograph genital injury not readily visible to the unaided eye, thereby clarifying the location and extent of injury as well as providing evidence for court proceedings. Since the 1980s, the technique once reserved for victims of child abuse has been used across the lifespan and has been shown to identify genital injury in up to 87% of women who have been raped. The role of colposcopic findings as evidence in court testimony, however, remains controversial. This paper explores the history of colposcopy in the rape exam and describes the epidemiology of genital injury in consensual sex as well as rape.
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Abstract
PURPOSE To determine the optimal evaluation and management of genitourinary (renal, ureteral, bladder, urethral and genital) injuries by review of the world's literature on the subject. METHODS A consensus committee convened by the Health Care Office of the European Association of Urology (EAU) to summarize the literature concerning the diagnosis and treatment of genitourinary trauma. RESULTS Findings of 350 citations are reviewed. CONCLUSIONS The genitourinary trauma literature still relies heavily on expert opinion and single-institution retrospective series. Future prospective trials of the most significant issues, when possible, might improve the quality of evidence that dictates practitioner behavior.
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21
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Kalichman SC, Simbayi LC. Sexual exposure to blood and increased risks for heterosexual HIV transmission in Cape Town, South Africa. Afr J Reprod Health 2004; 8:55-8. [PMID: 15623118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
A total of 224 men and 276 women living in a Black township in Cape Town, South Africa, were interviewed using a structured questionnaire. Information was elicited on demographic characteristics and sexual behaviours over the three months preceding the interview including engaging in sexual contact that involved blood, lifetime history of STI diagnoses and STI symptoms, and HIV prevention knowledge. Thirty six per cent of the men and 28% of women experienced sexual contact involving blood in the past three months Sexual blood contact was associated with the number of sex partners, unprotected intercourse and sexually transmitted infections. Sexual exposure to blood is prevalent and may be a facilitating factor for HIV transmission in South Africa. Modern medical care providers as well as traditional healers should be encouraged to advise their clients to refrain from sexual intercourse during menstruation and other types of genital bleeding.
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Affiliation(s)
- Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT 06269, USA.
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22
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Abstract
The aim of the study was to compare torture victims from six different nations and analyse differences and similarities. From the files of the Centre for Trauma Victims in Stockholm (KTC), 160 patients were selected: 53 patients from Bangladesh, 21 from Iran, 16 from Peru, 24 from Syria, 25 from Turkey, and 21 from Uganda. The data was classified into: (i) information about social conditions and circumstances pertaining to alleged torture, (ii) type of trauma and torture methods, and (iii) acute and late sequel to torture. Descriptive and non-parametric statistics were used in the analyses. There was a strong male dominance in all but the Ugandan group where 43% were women. The majority in all but the Turkish group had college exams and/or university studies. Over 84% were members of a political organisation except in the Iranian and Syrian groups, where more than 40% had no political affiliation. The majority in all groups had travelled to Sweden alone to apply for asylum, but most refugees from Turkey, Iran, and Syria had close relatives already living in Sweden. The stories of circumstances and torture methods were similar within each group but differed a great deal between groups. Typically, in Bangladesh, Peru, and Turkey, the periods under arrest were short: from a few hours to 3 days. In Iran, Uganda, and Syria, the time in custody varied from several months to several years. A prison sentence preceded by trial was common only in Iran. Many patients, especially from Bangladesh and Turkey, had been arrested several times. Sensory deprivation by isolation and blindfolding was common in all countries except Uganda and Peru. Beating with fists, sticks, truncheons, etc. were reported in 100% in every group. In Bangladesh, police batons (lathi) were used more commonly than in any other group. Whipping with electric cords occurred frequently only in Iran and Syria. Rape was most often reported among the Ugandans. Genital torture was frequently alleged by patients from Bangladesh and Turkey. Suspension was common in all countries except for Uganda. Falaka, i.e. beating of the soles, and electric torture were common (>60%) in Bangladesh, Iran, Syria, and Turkey. Sharp injuries inflicted with knives and bayonets were often seen among the Bangladeshi and Ugandans. Burning injuries due to cigarettes were commonly seen only in patients from Bangladesh. Some methods were found to be almost exclusive for each country: "water treatment" (Bangladesh), the "tyre" (Syria), "telephono" and "submarino" (Peru). The sequel of torture differed in some respects between groups. Fractures were more common among Iranians. Patients from Uganda and Bangladesh had numerous scars. Subjectively reported symptoms were most frequent among Bangladeshi, especially joint pain and ear, nose, and throat symptoms and least frequent among Ugandans. PTSD diagnosed on the basis of a psychiatric interview and psychological tests was found in 69-92% of patients in all groups. The study shows significant differences between countries regarding circumstances, torture methods, and sequel to torture. This knowledge is of value to forensic specialists documenting alleged torture and essential for fair and valid forensic statements.
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Affiliation(s)
- Pia A Moisander
- Department of Forensic Medicine, University Hospital, University of Linköping, SE-58185 Linköping, Sweden
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23
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Heppenstall-Heger A, McConnell G, Ticson L, Guerra L, Lister J, Zaragoza T. Healing patterns in anogenital injuries: a longitudinal study of injuries associated with sexual abuse, accidental injuries, or genital surgery in the preadolescent child. Pediatrics 2003; 112:829-37. [PMID: 14523174 DOI: 10.1542/peds.112.4.829] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To study healing patterns of anogenital trauma in prepubescent children. METHODS A prospective 10-year study was conducted of 94 children who had anogenital trauma and were followed to healing and documented using a colposcope with 35-mm camera attachment. RESULTS The 13 boys and 81 girls were referred with injuries as a result of sexual assault or anogenital trauma. Hymenal injuries occurred in 37 cases; 2 transections healed after surgery, and 15 persisted unchanged. Partial tears, hymenal abrasions, or hematomas healed completely or with minor nonspecific changes. Of the 47 injuries to the posterior fourchette, 22 abrasions, hematomas, or tears healed completely; 12 tears healed with vascular changes; 2 developed labial fusions; 10 lacerations required surgery; and 6 scarred and 4 healed with vascular changes. Only 2 of 39 cases of perihymenal trauma healed with vascular changes. All 17 cases of labial trauma healed completely. Anal trauma healed completely in 29 of 31 with scarring occurring in only 2 cases that required surgery. CONCLUSIONS Anogenital trauma heals quickly, often without residua. Of the 94 cases, there were diagnostic anatomic changes in the 15 cases of hymenal transections (2 other cases healed completely with surgical reconstruction), 6 cases after surgical repair of posterior fourchette, and 2 cases of anal scarring after surgery.
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Affiliation(s)
- Astrid Heppenstall-Heger
- Department of Pediatrics, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
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25
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Drücke D, Lehnhardt M, Steinsträsser L, Langer S, Homann HH, Steinau HU. [Secondary reconstruction after burns of the anogenital area]. Kongressbd Dtsch Ges Chir Kongr 2003; 119:733-5. [PMID: 12704920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The incidence of burns of the genitalia and peri-anal region which may cause a reconstructive intervention is very low. In the most cases the use of split thickness skin grafts yields a sufficient permanent wound closure. Upcoming problems such as painful scare formation require a reconstructive intervention (Z-plasty, full thickness skin grafting, pedicled flaps etc.). In case that the anal sphincter is involved with the consequence of incontinence or major damage of the genitalia occurred, sophisticated operative solutions are necessary.
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Affiliation(s)
- D Drücke
- Klinik für Plastische Chirurgie und Schwerbrandverletzte, Handchirurgie-Zentrum, BG-Kliniken Bergmannsheil Bochum, Universitätsklinik, Bürkle-de-la-Camp-Platz 1, 44789 Bochum
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26
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Abstract
Because of the increasing population of childhood cancer survivors, there is a need to focus on the late effects of cancer therapy. After discharge by their pediatric oncologists, it is essential that patients are not lost to the health system but rather are under continued surveillance with access to the appropriate physicians. Endocrine and metabolic consequences may impact the life of the patient both soon after cancer treatment and for many years in the future. The purpose of this article is to explore the current literature in the following areas: growth hormone (GH) deficiency, gonadotropin-releasing hormone (GnRH) analogues with GH therapy in childhood, safety of GH replacement, cardiovascular risk factors, osteopenia, thyroid problems, and gonadal damage resulting in infertility.
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Affiliation(s)
- H K Gleeson
- Department of Endocrinology, Christie Hospital, Wilmslow Road, Withington, Manchester M20 4BX, UK
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27
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Karev DV. [Using the surgical strategy "damage control" in penetrating abdominal injuries]. Vestn Khir Im I I Grek 2001; 159:104-7. [PMID: 11188804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Tiguert R, Harb JF, Hurley PM, Gomes De Oliveira J, Castillo-Frontera RJ, Triest JA, Gheiler EL. Management of shotgun injuries to the pelvis and lower genitourinary system. Urology 2000; 55:193-7. [PMID: 10688077 DOI: 10.1016/s0090-4295(99)00384-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Shotgun injuries are rare, with the extent of injury best determined at time of surgical exploration. There are no defined workup or management guidelines for patients with shotgun injuries to the genitourinary system. Injuries are usually treated on an individual basis. This study was conducted to determine the management and extent of genitourinary tract injuries in 10 patients with shotgun injuries to the pelvis during a 6-year interval. METHODS Between September 1990 and December 1996, 140 patients were treated for firearm injuries to the lower genitourinary tract, of which 10 were secondary to shotgun blasts. We performed a retrospective hospital and clinic chart review and telephone interview to assess organs injured, initial treatment, follow-up surgeries, mortality, and erectile function. RESULTS Mean patient age was 20 years at the time of the injury. The mean follow-up was 4 years (range 1 to 7). Two patients died, both with major vascular injuries, one in the operating room and the other 1 week later from sepsis. Eight patients underwent radiographic examinations (1 intravenous urogram and 7 urethrocystograms). The bladder was injured in 5 patients, 2 with concomitant complete posterior urethral transection. Of the 5 patients without bladder injury, one had an incomplete penile urethral injury and one had a complete bulbar urethral transection. The initial management consisted of repairing nongenitourinary injuries in 8 cases (80%), most commonly involving injuries to the rectum and small bowel. All patients were treated operatively, including 8 who required laparotomy and 4 who required suprapubic cystotomy. A total of four urethral injuries were noted. Subsequent reconstructive surgeries included two urethroplasties and one permanent supravesical diversion for 3 patients with extensive urethral loss. Erectile dysfunction was present in 3 of 6 patients available for telephone interview. CONCLUSIONS Shotgun injuries involving the lower genitourinary tract are associated with significant soft tissue injury and morbidity. Death usually results from major associated vascular injuries. All hemodynamically stable patients should undergo retrograde urethrograms and cystograms to evaluate possible urethral and bladder injuries. Open primary repair should be attempted for distal urethral, testicular, and corporal injuries. Delayed repair with staged urethral reconstruction should be reserved for patients with extensive loss of urethral tissue. Impotence is common in patients with extensive perineal injuries.
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Affiliation(s)
- R Tiguert
- Department of Urology, Detroit Receiving Hospital, Wayne State University School of Medicine, Michigan, USA
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29
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Abstract
PURPOSE The present standard of practice in the management of ambiguous and traumatized genitalia was evaluated. MATERIALS AND METHODS Published cases of intersexuality and protocols for the management of traumatized genitalia were reviewed with consideration of the input of intersexual individuals. Independent research on different types of intersexuality is also presented. RESULTS The present standard pediatric recommendations and precepts for the management of ambiguous or traumatized genitalia are wanting. Followup studies on which to base treatment decisions are needed. Evidence based principles of medical management are proposed. CONCLUSIONS A moratorium on sex reassignment cosmetic surgery is recommended. Also recommended are that followup studies should be instituted on past cases, and honesty and counseling should be the core of initial and subsequent treatment.
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Affiliation(s)
- M Diamond
- Department of Anatomy and Reproductive Biology, University of Hawaii, John A. Burns School of Medicine, Honolulu, USA
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30
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Greaney H, Ryan J. Straddle injuries--is current practice safe? Eur J Emerg Med 1998; 5:421-4. [PMID: 9919446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Genital injuries may be markers of sexual abuse and child protection issues should be considered when case present. This study evaluates the quality of history taking and the physical examination of children who present with straddle injuries to an accident and emergency department. A retrospective analysis of the accident and emergency case notes of children who presented over a 12-month period with straddle injuries was undertaken. A scoring system of risk factors was devised to help identify children at risk of sexual abuse and applied to the case notes. The results showed that the documentation of injuries was inadequate in the majority of cases, increasing the risk that cases of sexual abuse may be missed. Core questions which aid in the selection of children who require further evaluation have previously been identified. Utilizing the information from our findings we have devised a protocol for the assessment of children with straddle injuries which includes an action plan for the management of such cases.
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Affiliation(s)
- H Greaney
- MacKeith Centre, Royal Alexandra Children's Hospital, Brighton, UK
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31
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Affiliation(s)
- J McCann
- Department of Pediatrics, University of California, Davis Medical Center, Sacramento, CA 95817, USA
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32
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Affiliation(s)
- M A Finkel
- Center for Children's Support, School of Osteopathic Medicine, University of Medicine and Dentistry of New Jersey, Stratford 08084, USA
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Abstract
PURPOSE We conducted a study to determine the treatment of perineal and genital burns, the results of therapy and the complications of such burns. MATERIALS AND METHODS A review of the records of 4,216 patients treated between 1981 and 1995 at the Burn Center of the Academic Surgical Center Stuivenberg, revealed 87 male and 30 female patients, 6 months to 86 years old who had associated burns to the perineum or genitalia. Mean burn size was 21% of the total body surface area. Causes of burn injury were scald in 55% of the cases, flame in 24%, chemical in 16% and others in 4%. RESULTS There were 16 deaths in this group (13.6%) but none was related to the perineal or genital burns. Of the 101 survivors 41% required Foley catheters but the catheters were indwelling during resuscitation only (range 1 to 99 days). Perineal and genital burns were treated by topical antimicrobials. Only 10 patients (9.9%) required split-thickness skin grafts. As late complication 2 patients had scar formation of the penile shaft, which was treated with multiple Z-plasties, and of the prepuce, which was treated by circumcision, respectively. In 1 patient, who presented with erectile dysfunction diagnostic evaluation was negative. CONCLUSIONS Conservative management of perineal and genital burns is recommended.
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Affiliation(s)
- D Michielsen
- Academic Surgical Centre Stuivenberg, Antwerp, Belgium
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Abstract
Primary blast injury occurs in civilian and military detonations and from the firing of weapon systems. The pathology of primary blast injury has been reported for the last 70 years and has primarily been limited to descriptions of gross pathology and histology. Commonly accepted tenets have not been confirmed as blast overpressure experiments in enclosures and with multiple detonations have been conducted. Organ systems other than the ear and the lung are playing a greater role in injury definition and research importance. This paper is an overview and update of the current understanding of the pathology of primary blast injury.
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Affiliation(s)
- M A Mayorga
- Department of Respiratory Research, Division of Medicine, Walter Reed Army Institute of Research, Washington, DC 20307-5100, USA
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35
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Abstract
Child sexual abuse is an increasingly common problem. This article reviews the current clinical and behavioral indicators that will aid the emergency physician when evaluating and managing this condition. The most common differential diagnoses are described and a general approach to this diagnosis is suggested. Adopting a multidisciplinary method when evaluating this problem will lessen the anxiety facing the examining physician and provide a better outcome for the child, parents, and community.
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Affiliation(s)
- N Kini
- Medical College of Wisconsin, Department of Pediatrics, Milwaukee 53226, USA.
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36
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Figueroa JP, Brathwaite A, Morris J, Ward E, Peruga A, Blattner W, Vermund SH, Hayes R. Rising HIV-1 prevalence among sexually transmitted disease clinic attenders in Jamaica: traumatic sex and genital ulcers as risk factors. J Acquir Immune Defic Syndr (1988) 1994; 7:310-6. [PMID: 8106971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Between November 1990 and January 1991, status of human immunodeficiency virus (HIV) infection was assessed for 522 men and 484 women attending the Comprehensive Health Centre in Kingston, Jamaica, for a new sexually transmitted disease (STD) complaint. Prevalence of HIV type 1 (HIV-1) infection was 3.1% (31 of 1,006), a tenfold rise in seroprevalence in 4.5 years. Nineteen of 517 (3.7%) heterosexual men, 3 of 5 (60%) homosexual/bisexual men, and 9 of 484 (1.9%) women were infected with HIV. In heterosexual men, factors associated with HIV infection after age adjustment included present complaint of genital ulcer [odds ratio (OR) 7.3; 95% confidence interval (CI) 1.4-72], past history of genital ulcer (OR, 4.3; CI, 1.4-12), positive MHATP syphilis serology (OR, 3.4; CI, 1.1-10), sex with a prostitute in the past month (OR, 3.8; CI, 1.1-11). Three or more sex partners in the month prior to complaint (OR, 3.6; CI, 1.0-12), and bruising during sex (OR, 4.0; CI, 1.4-13). On multiple logistic regression analysis, independent associations with HIV infection were shown for bruising during sex (OR, 3.0; CI, 1.1-8.3), positive MHATP syphilis serology (OR, 3.2; CI, 1.1-9.5), and history of genital ulcer (OR, 2.9; CI, 1.0-8.0).(ABSTRACT TRUNCATED AT 250 WORDS)
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Rayner T. Self-harm. Understanding self-harm. Nurs Times 1994; 90:30-1. [PMID: 8115252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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39
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Abstract
Trauma is the major source of mortality in the pediatric population. A retrospective review was performed on patients admitted to the Children's Hospital and Health Center Trauma Program, San Diego, California, from August 1984 to May 1990. The purpose of this review was to evaluate pediatric trauma and to determine the best treatment and evaluation for genitourinary injuries. Blunt trauma was responsible for 98 percent of the injuries, with renal injuries being the most common. Bladder (7) and male urethral (2) injuries, and vaginal lacerations (8) also occurred. The most severe renal injuries (70%) and all significant bladder and urethral injuries were associated with gross hematuria. Hypotension was present in 31 percent of patients but rarely required surgical exploration for correction. Eighty-six patients underwent radiographic imaging. Computerized tomography (CT) scans demonstrated the most information about intra-abdominal solid organ injuries but was inaccurate in detecting bladder or urethral injuries. Genitourinary injury is common in children but rarely requires surgical management. CT scan is the best study to determine extent of solid-organ injury but is inferior to cystourethrography to diagnose bladder or urethral injuries.
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Affiliation(s)
- I M McAleer
- Department of Urology, Children's Hospital and Health Center, San Diego, California
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40
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Abstract
In order to determine how well medical examiners agree on the significance of certain anogenital findings in children, preselected colposcopic photographs of the anogenital area of 16 patients were shown to 170 medical examiners (82% pediatricians) who were blinded as to the history on each patient. Findings rated most frequently as being suggestive or indicative of penetrating injury included immediate anal dilatation with no stool present (85%), hymenal transection (84%), marked narrowing of the hymenal rim with notching (81%), and a posterior fourchette scar (75%). The agreement between the participants and the experts on the abnormal cases (mean 81%) was significantly higher than on the normal cases (mean 71%, p < .001) and on genital findings (78%) than on anal findings (63%, p = .000). Higher experience level (more cases seen per month) was associated with significantly higher agreement between the participants and the experts on five of eight normal cases and two of four abnormal cases. Use of a colposcope was also associated with higher overall agreement with the experts (74% vs. 44%, p < .0001).
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Affiliation(s)
- J A Adams
- Department of Pediatrics, University of California, San Francisco 93702
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41
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Abstract
Penile zipper entrapment, when it presents to the office or emergency department, can prove to be a challenging management problem. An easily implemented alternative approach is presented, along with a review of previously reported experience with this problem.
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Affiliation(s)
- J T Kanegaye
- Division of Emergency and Transport Medicine, Children's Hospital of Los Angeles, CA 90054-0700
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42
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Schneider RE. Genitourinary trauma. Emerg Med Clin North Am 1993; 11:137-45. [PMID: 8432245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Evaluation of genitourinary trauma can be confusing. This article discusses identifying the significant injuries, those patients at risk for developing these injuries, and the radiographic procedures that will effectively stage these injuries so that appropriate management can be proposed.
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Affiliation(s)
- R E Schneider
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina
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43
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Abstract
283 torture victims (135 examined by the Amnesty International [AI] Danish Medical Group, and 148 by the International Rehabilitation and Research Center for Torture Victims [RCT]) were questioned about methods of torture and subsequent sexual difficulties. Overall, the prevalence of sexual torture was 61% (women 80%, men 56%), but this was higher in the RCT than in the AI group. More Latin Americans than Europeans had been sexually tortured in the AI group. Prevalence of sexual difficulties was 32%, the RCT recording a significantly higher prevalence than the AI (43% vs 20%). Sexually tortured victims were more likely to have sexual difficulties (40%) than were non-sexually tortured victims (19%). Overall, there were more cases of sexual difficulties in victims from Africa and from Turkey/Middle East/Far East than in victims from Latin America and from Europe. In the RCT subsample, prevalence of sexual difficulties and anxiety was significantly higher in sexually tortured victims than in non-sexually tortured victims; the two groups were broadly similar with respect to depression and low self-esteem. Depressed victims and victims with low self-esteem were more likely to have sexual difficulties. In the RCT group, but not overall, prevalence of sexual difficulties was significantly associated with age but was independent of low self-esteem and of depression.
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Affiliation(s)
- I Lunde
- Etica Treatment Centre, Copenhagen K, Denmark
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44
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Abstract
A review of 1987 patients treated during the years 1981 to 1986 was conducted to answer the following questions about perineal burns: (1) Are Foley catheters necessary for all patients? (2) Is there any advantage to early excision of the perineal burn wound? (3) What are the complications of perineal wounds? One hundred three patients with perineal burns were identified; mean burn size was 36% of total body surface area. There were 29 deaths in this group but none were related to the perineal burns. Of the 74 survivors 36 (49%) needed Foley catheters. However, the catheters were in place for the period of resuscitation only. There were no urethral complications associated with catheterization. Only three patients required surgery: one had a urethral meatotomy and two had split-thickness skin grafts. In conclusion, we found no genitourinary complications associated with perineal burns. Almost all perineal and genital burns were managed without indwelling catheters. Early excision of the perineal burn wound is not necessary, and most of these wounds will heal satisfactorily without grafting.
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Affiliation(s)
- M D Peck
- Shriners Burns Institute, Cincinnati, Ohio
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45
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Finkel MA. Anogenital trauma in sexually abused children. Pediatrics 1989; 84:317-22. [PMID: 2748261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Physical findings, when identified, lend powerful support to the validation and prosecution in child sexual abuse cases. Because of the frequent delay between the alleged molestation, disclosure, and examination, there is a need for a systematic method of identifying and interpreting the residual of anal and genital trauma after the acute signs have disappeared. The case findings of seven children who experienced acute genital and anal trauma and were observed until their injuries healed are reported.
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Affiliation(s)
- M A Finkel
- Department of Pediatrics, University of Medicine and Dentistry of New Jersey, School of Osteopathic Medicine, Stratford 08084-1504
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Kantor A, Sclafani SJ, Scalea T, Duncan AO, Atweh N, Glanz S. The role of interventional radiology in the management of genitourinary trauma. Urol Clin North Am 1989; 16:255-65. [PMID: 2652854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The role of the radiologist in the management of urologic disease has changed dramatically in the last 10 years with the introduction of new imaging methods and the evolution of the angiographic catheter into a therapeutic instrument. The authors review the diagnostic options in genitourinary trauma, the indications for and techniques of transcatheter arterial embolization for renal and other retroperitoneal hemorrhage, and nonvascular interventions such as antegrade nephrostomy, stenting of urethral disruptions, percutaneous bladder drainage, and drainage of abscesses, hematomas, and urinomas.
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Affiliation(s)
- A Kantor
- Department of Radiology, State University of New York Health Science Center, Brooklyn
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Abstract
The challenge of self-mutilation among humans arises from the imprecision of much of the existing literature, as well as the countertransference such disturbing behavior mobilizes. Self-mutilation is defined as an individual's intentionally damaging a part of his or her own body apparently without a conscious intent to die. The importance of understanding this behavior is reflected in the frequency with which it is encountered among psychiatric patients, particularly those diagnosed with borderline personality disorder or schizophrenia. The distinguishing characteristics of dermal, ocular, and genital self-mutilation illustrate the diverse clinical settings in which mutilation arises. Numerous explanations with differing degrees of complexity and merit have been offered; yet, no clear consensus has emerged. Psychotherapy, behavior therapy, and chemotherapy, while controversial, remain the most compelling treatment options. Salient areas for further study include epidemiology both for specific groups and the general population, possible biologic bases for the behavior, and additional management options.
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Affiliation(s)
- M D Feldman
- Department of Psychiatry, Duke University Medical Center, Durham, NC
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Affiliation(s)
- D Muram
- Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38103
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Berkowitz CD. Sexual abuse of children and adolescents. Adv Pediatr 1987; 34:275-312. [PMID: 3318298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- C D Berkowitz
- Pediatric Clinic and Group Practice, Harbor/UCLA Medical Center
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