Summer sandal genital trauma.

In this paper four cases are reported of girls presenting with vulval injuries as result of heavy impact against the edge of redundant soles. All four were referred for suspicion of sexual abuse to the Lindisfarne Forensic Paediatric Centre, Newcastle because no obvious mechanism for injury was available from the initial history, and because of apparent delay in reporting of symptoms. In each case, the lack of injury to deeper structures including the hymen, was a strong indicator of their accidental origin.

Wilm's tumour presenting as acute sexual assault.

A 3-year-old presented with severe apparent perineal bleeding. The parents description of a precipitating accident did not provide an adequate explanation for the bleeding. Examination under anaesthesia with police presence revealed no genital injury. Palpation of the abdomen revealed a large renal mass. It was found that the child had a Stage 4 Wilm's Tumour.

Transhymenal cultures for sexually transmissible organisms.

Vaginal swabs were examined for sexually transmissible organisms in 238 girls seen over a 36 month period from July 1989 to June 1992 inclusive. Three groups were seen (age range 1.5-16.1 years), 165 in group 1 in whom there had been a disclosure of sexual abuse, 35 in group 2 where there was a strong suspicion of sexual abuse, and 38 with vulvovaginitis who formed group 3. The isolation of recognised sexually transmitted organisms was low; however, of group 1 19% were colonised with Gardnerella vaginalis compared with 3% of group 2 and 3% of group 3. These figures show significant differences in the proportion of children in each group isolating only from children over the age of 8 years and in five of the six girls with Candida spp there was concern about sexual abuse. Vulvovaginitis in young children was not associated with vaginal candidiasis. The relation of findings to age is discussed and recommendations are made for testing procedures.

Vanishing earrings.

Four children who presented with impacted earrings are described. We suggest that the insertion of earrings in children under 10 years has hazards and recommend the use of sterling silver or 9 ct gold if the procedure is to be done in young children.

Shaking infant trauma induced by misuse of a baby chair.

A 2 month old infant presented with bilateral subdural haemorrhages and bilateral subhyaloid haemorrhage. The parent admitted to forceful bouncing of the child in a baby rocker. Experiments showed that violent rocking in the chair could produce extreme alternating acceleration/deceleration forces in excess of those induced by shaking alone. Such handling could not be interpreted as accidental mismanagement and the abusive nature of the process was graphically shown in video recordings of the experiment. Prosecution resulted in a conviction for cruelty, and a suspended sentence.

Lichen sclerosus et atrophicus and sexual abuse.

AIMS: The aetiology of lichen sclerosus et atrophicus (LSA) is unknown. A series of 42 cases of this uncommon condition is reported. The aim of this study was to identify associations of LSA and document the association with sexual abuse. METHODS: Information about the patients was obtained by retrospective case note review and some patients were contacted by telephone for further information. RESULTS: In 12 cases there was evidence of sexual abuse. The abused group were slightly older than the non-abused group but were similar in all other respects. All three patients who presented over the age of 12 years had evidence of sexual abuse. Genital trauma was recalled by the patient or found at examination in 17 cases. Evidence of autoimmunity was present in five cases. Positive microbiological isolates were obtained in 18 cases. In only 11 cases were there no associated factors. The symptoms of LSA started between the ages of 3 and 7 years in most patients. The usual symptoms were related to genital skin involvement, and symptoms related to bladder and bowel function were common (50%). CONCLUSION: In this large series of paediatric LSA, associations with trauma, autoimmunity, and infection were noted. There was a high rate of coexisting sexual abuse with LSA, possibly due to genital trauma.

Low prevalence of genital candidiasis in children.

In order to determine the prevalence of culture-proven candida infection in children with genital symptoms, a retrospective case-note review was performed to identify all symptomatic children with a culture result positive for Candida spp. during a 15-month period. Between May 2000 and July 2001, a total of 570 specimens were received from 473 children, and 34 positive culture results were recorded for specimens taken from 32 patients. Of these patients, 19 were in the 0-3-year age group, six in the 3-9-year age group and seven in the 9-12-year age group. Underlying risk factors for infection included prematurity, immunosuppression and prior antibiotic therapy. Three children were suspected to have experienced sexual abuse. Candida infection is uncommon in toilet-trained prepubertal girls, and empirical antifungal therapy is not indicated in this age group unless there are well-recognised predisposing factors. If a Candida sp. is isolated from a genital tract specimen taken from a 3-9-year-old girl, then a specific cause needs to be sought.

Treadmill exercise test in short children.

Fifty nine children of short stature exercised for 10 minutes on a non-motorised treadmill. In 49 a growth hormone concentration of greater than 15 mU/l was reached, effectively excluding growth hormone deficiency. In 10 children the growth hormone concentration failed to reach 15 mU/l; growth hormone deficiency was confirmed in seven by a subsequent insulin tolerance test. The optimal time for blood sampling was five minutes after the end of the exercise. It was possible to use the test for very young and very short children.

Prostacyclin in severe peripheral vascular disease.

Prostacyclin (prostaglandin I2, epoprostenol sodium) arrested the progress of gangrene in the feet of a 6 year old boy with familial but otherwise unexplained peripheral vascular disease. Toe regrowth is now occurring at the line of demarcation.