Biomedical subjects
Publications and source records attributed to D Muram.
Sixty-five mothers of sexual abuse victims and 25 of their daughters were compared with 65 control mothers and 32 control daughters on the Eysenck Personality Questionnaire and the Leisure Interest Checklist. Results showed both study groups to be significantly less impulsive than their control counterparts. Victim mothers also presented themselves as being more constricted than control mothers.
OBJECTIVE: Our purpose was to determine the incidence of and evaluate risk factors for postpartum glucose intolerance among predominantly black gestational diabetic women. STUDY DESIGN: One hundred forty-five gestational diabetics underwent a standard 2-hour glucose tolerance test in the early puerperium according to the criteria of the National Diabetes Data Group. RESULTS: Fourteen patients (10%) were diabetic and eight (5%) showed impaired glucose tolerance. Maternal age, race, or obesity did not predict abnormal postpartum glucose tolerance testing. The requirement of insulin for glucose control during gestation and gestational age at diagnosis were significantly associated with abnormal postpartum glucose tolerance (p < 0.0001 and p = 0.012, respectively). Multivariate analysis showed that only a requirement for insulin for glucose control was significant (p < 0.001). CONCLUSION: Pregnancies complicated by gestational diabetes are at increased risk of glucose intolerance during the early postpartum period. Abnormal glucose tolerance occurs predominantly among those patients requiring insulin therapy during gestation or those diagnosed before 24 weeks' gestation.
OBJECTIVE: Our purpose was to determine whether relatives of patients with ovarian germ cell malignancies not associated with sex chromosome abnormalities are at increased risk for similar tumors. STUDY DESIGN: We reviewed pedigrees of 78 presumptive 46,XX patients (ages ranging from newborn to 20 years) with malignant ovarian germ cell tumors, excluding cases of dysgerminoma and gonadoblastoma. A three-generation family history of each proband was reviewed specifically to identify cancer in any family member. RESULTS: Seventy-eight mothers, 87 sisters, 135 aunts, and 156 grandmothers were surveyed. None had a malignant ovarian germ cell neoplasm or other malignant ovarian neoplasm. CONCLUSION: First- and second-degree relatives of probands with ovarian germ cell malignancies do not have an increased risk for similar tumors. These findings were not predicted because of the well-recognized association of hereditary tumors and early age of onset.
In two cases the menstrual calendar was used to determine the cyclic nature of abdominal pain in women with the Rokitansky syndrome who could not otherwise find a regular pattern in their symptoms. Surgical intervention to remove the rudimentary bicornuate uterus was needed in both, and complete resolution of pain was attained. The menstrual calendar is a valuable diagnostic tool in confirming the cyclic nature of pain and can be used in guiding treatment decisions.
Two adolescent girls with acquired vaginal occlusion and resultant hematometracolpos are presented. Both are long-term survivors of childhood malignancies, who prior to multiagent chemotherapy and pelvic irradiation had normal uteri by imaging. Both were amenorrheic post therapy. Routine follow-up computed tomography (CT) scans to monitor their malignancies demonstrated unexpected cystic pelvic masses, subsequently diagnosed as hematometracolpos.
Child sexual abuse is being recognized as a common and serious problem which affects children regardless of their age, sex, socio-economic class, or geographic location. Children of all ages, from infancy to young adulthood, have been victims of abuse. It is well accepted that the number of reported incidents of child sexual abuse represents only a portion of the actual number of victims. The National Center on Child Abuse and Neglect estimates the number of child-victims to be more than 200,000 per year. Many of these children are brought to emergency facilities or to their private physician's office for evaluation. Many physicians have difficulties in correctly identifying and managing child-victims of sexual abuse. The purpose of this chapter is to review the most recent advances in the medical evaluation of children who are the victims of sexual abuse.
OBJECTIVE: To compare the demographics, physical findings, and assault characteristics of incarcerated, sexually assaulted men with those of nonincarcerated, sexually assaulted men. DESIGN: Case series of 99 adult male victims of sexual assault evaluated over a 3-year period. SETTING: Memphis Sexual Assault Resource Center, a nonhospital-based clinic that serves as the primary resource for sexually assaulted victims in the Memphis and Shelby County, Tennessee, area. PARTICIPANTS: All adult male victims of sexual assault evaluated at the Memphis Sexual Assault Resource Center during the study period were included in the study. Ninety-nine victims were studied, including 80 incarcerated men and 19 men from the community. RESULTS: The victims of sexual assault in the community group were older than the victims in the incarcerated group. Apart from the age difference and weapon use, there were no statistically significant differences between the incarcerated and nonincarcerated victims. CONCLUSIONS: The similarities between the two groups suggest that sexual assault of men may not be unique to prisons, and all men are potential victims. Further studies are required to better understand these crimes and to develop education and prevention programs.
Explore the source record for details and available documents.
It is estimated that the number of child victims of sexual assault is in excess of 200,000 per year. Many of these children are brought to emergency room facilities or to their private physician's office for evaluation. The recent advances in the area of diagnosis and management of children who are the victims of sexual abuse are presented.
Following the introduction of a comprehensive child sexual abuse program in 1985, there was a significant increase in the number of validated incidents of abuse involving minors. However, following the initial increase, the number of validated incidents of abuse remained relatively stable at about 30-35 per month. While the overall validation rate was 57%, it fluctuated widely from as low as 21% to as high 92%. The validation rate rose from 1984 through 1987, declining in the latter part of 1989. The validation rate appeared to reflect the number of validated cases and not be dependent upon the number of reported cases. The number of cases validated was not significantly correlated with time, but was moderately correlated with the number of cases reported (estimated Spearman correlation coefficient was .45 with p less than .05). However, after adjusting for time, the partial correlation between the number of validated and the number of reported cases was no longer significant. The percent of validated cases (the validation rate) was correlated with number of cases validated (estimated Spearmen correlation coefficient was .84 with p less than .0001), but not with the number of cases reported. Validation rates were higher for girls than for boys, 71.1% and 31.8% respectively. The majority of the perpetrators (78%) were known to the children and had access to the victims. In over half the incidents, family members were implicated as the perpetrators.
Accurate assessment of physical findings for child sexual abuse is medically and legally important. This study evaluated (1) interobserver reliability of clinicians rating colposcopic photographs, and (2) correlates of reliable interpretations. Seventy physicians and two nurse practitioners, divided by professional levels, assessed colposcopic photographs and completed a questionnaire. Ratings by a professional with extensive experience in this field were used as an accuracy standard. Leaders in the field of child sexual abuse assessment made significantly more "accurate" assessments than pediatricians, pediatric and family practice residents, and intern physicians. Leaders made fewer "inaccurate" interpretations than interns. Predictors of agreement with standard assessments, although weak, were knowledge of female perineal anatomy and professional level. Total number of sexual abuse examinations conducted and knowledge of sexually transmitted diseases as acquired by children were not significant predictors of accurate assessment. The findings are interpreted as to their potential relevance to actual sexual abuse evaluations of children.
We evaluated the merit of a directive issued by The Tennessee Department of Human Services (TDHS) requesting a medical evaluation for all children who were closely associated with a victim of sexual assault, even if these children denied being victims themselves. In a 6-month period, 247 girls, age 12 and under, were referred for medical evaluation. Of these, 188 were primary victims of sexual abuse, and 59 girls were secondary victims, associates of victims of abuse. All examinations were performed in an office setting. A colposcope was used to magnify the findings. Of these 59 girls, 45 girls were found to have abnormal genital findings. Nonspecific findings were present in 5 girls (8%), and findings considered specific for sexual abuse were observed in 40 girls (68%). When compared with 5 girls (8%), and findings considered specific for sexual abuse were observed in 40 girls (68%). When compared with primary victims, secondary victims were more likely to demonstrate genital abnormalities suggestive of sexual abuse. (chi 2 = 13.7, p = .0011). Of the 50 secondary victims who were later interviewed by TDHS, 24 girls (48%) reported that they were also victims of assault. We strongly recommend that siblings of sexual abuse victims, as well as other children who are closely associated with them and exposed to the perpetrator, be evaluated to determine whether they have abnormalities suggestive of sexual assault.
Of 3,563 consecutive obstetric patients undergoing glucose screening, 517 (14.5%) were found to have plasma values of greater than or equal to 140 mg%, and 74 (14.3%) of 517 were found to be diabetic on standard oral glucose tolerance testing, for an overall incidence of 2.1%. There was no absolute value on the glucose screen that predicted an abnormal oral glucose tolerance test. Twenty-eight of the 74 diabetics demonstrated none of the classic risk factors for glucose intolerance during pregnancy. Only when combining those patients over 30 years of age and with a mean body weight greater than 120% of the ideal body weight was statistical significance reached when that group was compared to the overall group. Thus, our data support the recommendation for universal prenatal glucose screening.
We report a patient who had a significant amount of gas distending the uterine cavity. Severe cervical stenosis was noted at the time that curettage was performed. Because of the cervical stenosis, gas was trapped within the endometrial cavity.
Fourteen women under age 19 were evaluated and treated for ectopic pregnancy at the Regional Medical Center, Memphis. These women were screened according to a protocol involving use of quantitative beta-human chorionic gonadotropin (beta hCG) and serum progesterone levels. All patients were in the first trimester of pregnancy, with a mean gestational age of 8.5 weeks based on menstrual dating. Ten patients denied knowing that they were pregnant prior to this evaluation. Because of the patients symptoms and clinical signs, nine patients underwent diagnostic laparoscopy at the time of initial evaluation. Of these, seven underwent either salpingectomy or salpingostomy for a ruptured ectopic pregnancy or ectopic greater than 3 cm in greatest dimension. Two patients were successfully treated without surgery. Five patients were discharged after their initial evaluation and were identified only by abnormal values on serial determinations of beta hCG and progesterone. One required salpingostomy, and the other four were successfully treated with methotrexate. Ectopic pregnancies identified at an early gestational age and prior to rupture are amenable to conservative treatment with methotrexate or laproscopic surgery. Patients who were identified by the protocol and not by clinical signs and symptoms were more likely to be candidates for conservative therapy.
Vaginal bleeding in early childhood, regardless of its duration and quantity, is always of clinical importance. This article discusses the examination of the child and adolescent and reviews the various causes of vaginal bleeding in these patient groups.
Twenty-seven patients with ovarian cancer underwent unilateral salpingo-oophorectomy and were followed for 12-215 months (mean 80) after completion of therapy. Of these, nine patients who received pelvic irradiation subsequently developed ovarian failure. Of the remaining 18 patients who maintained ovarian function, 13 (72%) developed a functional ovarian cyst during the follow-up period. Of these 13 patients, eight were observed until the functional cyst regressed, four were treated with oral contraceptives (OCs) to suppress ovarian function, and one underwent oophorectomy for a large corpus luteum cyst. We recommend that OC pills be considered for suppression of ovarian function in postmenarcheal girls after completion of therapy for ovarian neoplasms. Routine use of OCs may simplify the follow-up of these patients by preventing the formation of functional ovarian cysts. In postmenarcheal patients not treated with OCs, the finding of a unilocular ovarian cyst should be considered to represent a functional cyst, and a trial of OCs for 3 months may result in spontaneous regression. Persistent cysts must be operatively removed.
Explore the source record for details and available documents.