[Somatic examination of a female victim of a sexual offence]. / Naispuolisen seksuaalirikosuhrin somaattinen tutkiminen.

Examination of a female victim of a sexual offence is carried out usually within seven days of the incident. It includes an interview, inspection and documentation of bodily injuries, gynecologic examination and collection of specimens of sexually transmitted diseases and appropriate forensic specimens. Preventive antimicrobial therapy and postcoital contraception will also be provided. The need for anti-HIV medication as well as hepatitis and tetanus vaccines is considered on a case-by-case basis. A tranquil scene of examination, written instructions for follow-up observation and taking care of emotional support are essential for the recovery of the victim. Guidance for the collection of forensic tissue specimens should also be available in gynecology units.

[Menorrhagia in adolescents: normal or a sign of underlying medical condition?]. / Nuoren runsaat kuukautiset- -normaalia vai merkki sairaudesta?

Variations in the length of menstrual cycle as well as duration of menstrual flow are broad and common during adolescence. They are mainly caused by the immaturity of the hypothalamic-pituitary-ovarian axis. Normalization of ovulation during the first postmenarcheal years will gradually regularize the menstrual cycle. Several medical conditions, endocrine disturbances or medical treatments may affect the hormonal balance and cause abnormal bleeding. If anemia exists, the possibility of bleeding disorder should be considered. After proper evaluation, most abnormal bleedings in adolescents can be managed hormonally, with the addition of hemostatic therapies when necessary. Oral contraceptives are most commonly used.

Relative frequency of Haemophilus influenzae type b pneumonia in Chinese children as evidenced by serology.

OBJECTIVES: It is commonly held that Haemophilus influenzae pneumonia among children in Asia is mostly caused by serotypes other than b (Hib). If so, Hib conjugate vaccines would play little role in the prevention of pneumonia. In two prospective series of children hospitalized for pneumonia in China, the causative agents were searched for with a wide panel of microbiologic assays. METHODS: In the university hospitals of Beijing and Hefei, 156 consecutive children 3 months of age and older with symptoms and signs of pneumonia were studied. Blood culture, chest radiograph, nasopharyngeal aspirate for viral antigen detection and paired sera for 20 microbiologic assays were taken. Severity was graded, and the course of illness was monitored uniformly. RESULTS: In Beijing only likely contaminants grew from blood cultures, and in Hefei pathogens were identified in two cases. In combined series evidence for bacterial, mixed and viral etiology was obtained in 30, 7 and 21% of cases, respectively. The dominant bacteria were pneumococcus, Hib, Mycoplasma pneumoniae and Chlamydia pneumoniae, responsible for 13, 10, 8 and 8% of cases, respectively. Most patients were treated with extended spectrum antimicrobials such as piperacillin, cefotaxime or ceftriaxone, alone or in combination. One child died. CONCLUSIONS: As in most other series from other countries, the leading agent causing childhood pneumonia was pneumococcus but, in line with our previous experience from Beijing, the second most common agent detected was Hib. This observation suggests great potential for pneumococcal and Hib vaccinations in China. Because no evidence supported the need for routine use of extended spectrum antimicrobials, narrower spectrum agents would be safer for patients, would be cheaper for the community and would offer a way to address increasing resistance problems.

Etiological diagnosis of childhood pneumonia by use of transthoracic needle aspiration and modern microbiological methods.

Childhood pneumonia is usually treated without determining its etiology. The causative organism can be isolated from specimens of blood, empyema fluid, or lung aspirate, but this is rarely done. The potential of transthoracic needle aspiration for identification of causative agents was tested with use of modern microbiological methods. Aspiration was performed for 34 children who had radiological signs compatible with community-acquired pneumonia and had alveolar consolidation. In addition to bacterial and viral cultures and viral antigen detection, nucleic acid detection for common respiratory pathogens was performed on aspirate specimens. Aspiration disclosed the etiology in 20 (59%) of 34 cases overall and in 18 (69%) of 26 patients from whom a representative specimen was obtained. Aspiration's advantages are high microbiological yield and a relatively low risk of a clinically significant adverse event. Aspiration should be used if identification of the causative agent outweighs the modest risk of the procedure.