Case 28
Vincent J Palusci, Dena Nazer, Patricia O Brennan in Diagnosis of Non-accidental Injury, 2015
A 12-year-old girl was brought to your office with concerns from her mother that ‘her opening is too big’. The mother reported that she and the father had separated, contemplating divorce, and the girl stayed with her father on alternative weekends. The child denied that he has ‘done anything’ to her and she also denied any other sexual contact with anyone else. She had complained of vaginal discharge and her mother ‘checked her down there’ to see if she was having her first period. As a primary care physician, you explain you are not a paediatric gynaecologist but offer to do an examination as she was due for her routine well-child exam for sports in school. She was Tanner stage III. With her lying on the examination table on her back and her mother at her side, you see the image as presented (Image 28 ). What does the image show? Do these findings indicate sexual abuse and/or trauma? 64 The image depicts a view of the hymen and vagina without much estrogenization. The hymen is crescentic in shape and does not extend completely around the genital opening. The posterior fourchette and fossa navicularis are not visible. The depicted labia minora has increased vascularity and mucus membranes are erythematous, but this may be nonspecific and artefactual from the lighting. There is no visualized vaginal foreign body, discharge or trauma. The posterior rim of the hymen is thin and there appears to be a bump at the insertion of an intravaginal ridge in the inferior half at 5 o’clock with her in the supine position. Based on the size of the examiner’s fingers, the rim appears to be at least 1 mm in thickness in all locations on the posterior half of the hymen. 1 These findings should be interpreted with caution. Historically, expert opinion has suggested that the thinness of the hymen rim was indicative of sexual abuse and/or trauma to this area; however, the paucity of research evidence in this area has more recently made this finding more indeterminant. 2 Girls with complete transections of the hymen or bruises and lacerations are more easily found to have been abused, but the smoothness and otherwise normal appearance of the hymenal tissues in this image suggest that this finding is a normal variant. The bump is an accepted normal finding when associated with an intravaginal ridge. In the absence of disclosure or other evidence, these physical findings do not currently indicate sexual abuse or trauma.
Bone status assessed by quantitative ultrasound in children with inflammatory bowel disease: a comparison with DXA
Published in Expert Review of Gastroenterology & Hepatology, 2016
Katarzyna Bąk-Drabik, Piotr Adamczyk, Agata Chobot, Jarosław Kwiecień, Wojciech Pluskiewicz
Background: To determine the bone status in children with inflammatory bowel diseases (IBD) using quantitative ultrasound (QUS) measurement at hand phalanges and compare the obtained results with dual-energy X-ray absorptiometry (DXA). Methods: Fifty-one children with IBD underwent DXA and QUS measurements at hand phalanges in the year 2013. The control group for the QUS consisted of 460 children. Reference data for DXA comes from Hologic Explorer. Results: QUS measurements did not differ significantly between IBD patients and healthy controls. There was no difference between UC and CD subjects. DXA measurements in patients with IBD were lower than in the healthy population. Tanner stage and nutritional status correlated with bone status contrary to steroids therapy. Conclusion: Low bone mineral density often complicates IBD in children. QUS is not an appropriate method for the assessment of bone status in children. Nutritional status seems to have a greater impact on bone status than corticosteroids therapy.
Developmental Variation in Amygdala Volumes Among Children With Posttraumatic Stress
Published in Developmental Neuropsychology, 2013
Carl Weems, Brandon Scott, Justin Russell, Allan Reiss, Victor Carrión
This article examined associations between indices of maturation (age and Tanner stage) and amygdala volumes in 24 youth (aged 7–14) with posttraumatic stress disorder symptoms and a matched control group. Fifteen of the youth with exposure to trauma were also re-evaluated one year later. A positive association between maturation and right amygdala volumes was observed in the trauma group but not in controls. Associations with maturation remained when controlling for a number of possible covariates and over time. Developmentally younger youth (Tanner stage 1 and 2) showed increases and older (Tanner stage 3 and 4) decreases in right amygdala volumes.
A mixed effects model to estimate timing and intensity of pubertal growth from height and secondary sexual characteristics
Published in Annals of Human Biology, 2014
T. J. Cole, H. Pan, G. E. Butler
Aim: To estimate and compare pubertal growth timing and intensity in height, Tanner stage markers and testis volume. Subjects and methods: Data on height, genital stage, breast stage and pubic hair stage, testis volume and menarche in 103 boys and 74 girls from the Edinburgh Longitudinal Growth Study were analysed. The SITAR model for height and a novel mixed effects logistic model for Tanner stage and testis volume provided estimates of peak velocity (PV, intensity) and age at peak velocity (APV, timing), both overall (from fixed effects) and for individuals (random effects). Results: Based on the six markers, mean APV was 13.0–14.0 years in boys and 12.0–13.1 years in girls, with between-subject standard deviations of ∼1 year. PV for height was 8–9 cm/year by sex and for testis volume 6 ml/year, while Tanner stage increased by 1.2–1.8 stages per year at its peak. The correlations across markers for APV were 0.6–0.8 for boys and 0.8–0.92 for girls, very significantly higher for girls (p = 0.005). Correlations for PV were lower, −0.2–0.6. Conclusions: The mixed effects models perform well in estimating timing and intensity in individuals across several puberty markers. Age at peak velocity correlates highly across markers, but peak velocity less so.
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