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Biomedical subjects

J E Paradise

Publications and source records attributed to J E Paradise.

13 recordsLinked to original sources
PubMed1995

Emergency diagnosis and management of physical abuse and neglect of children.

Injuries due to child abuse have continued to attract the attention of investigators. There was new evidence to show that cardiopulmonary resuscitation is a rare cause of rib fracture and that posterior rib fractures without a history of significant trauma are highly suggestive of abuse. An autopsy study examined ocular nerve sheath hemorrhage in deaths caused by abuse. The incidence and characteristics of abuse and neglect were studied for drowning victims. Female circumcision was well described, and physicians need to familiarize themselves with this cultural practice. The American Academy of Pediatrics published policy statements on sudden infant death and shaken baby syndrome. They stressed the need for protocols to deal with unexpected childhood deaths and to obtain autopsies in such cases. Reviews of fractures of abuse and retinal hemorrhages were enlightening. Reporting abuse and coping with violence remained topics of interest.

Adaptation, Psychological↗
PubMed1990

The medical evaluation of the sexually abused child.

The diagnosis of suspected sexual abuse is nearly always based on a description of abuse provided by the child. The physician should invite a child to describe his or her sexual victimization in detail if such a "disclosure" interview has not already occurred, if the child seems ready to describe the abuse, and if a child protective services worker has not yet been notified of the suspected abuse. If an allegedly abused child has already been carefully interviewed, however, the physician should instead obtain information from the child's parents or other appropriate adults to determine how best to address the questions being raised. Nonspecific behavioral or somatic complaints unaccompanied by a specific description of sexual abuse should generate a differential diagnosis for further investigation. The goals of the physical examination of the sexually abused child are to identify abnormalities that warrant further diagnostic efforts or treatment, to obtain specimens to screen the patient for sexually transmitted infections, and to make observations and take specimens that may corroborate the patient's history of victimization. These goals should be met in the context of a standard, complete physical examination. The advisability of postcoital contraception should be discussed with every postmenarcheal victim seen within 72 hours after a rape. Because gonorrhea and chlamydial infections are the most prevalent STDs seen after sexual abuse and are often asymptomatic, universal screening for these infections is recommended. Parents of all abused children should be given an opportunity to make an informed choice about HIV screening. Because the risk of acquiring STDs is low, routine antibiotic prophylaxis is not recommended for sexually abused children. Physicians must report all cases of suspected sexual abuse to states' child protective services agencies. Failure to do so can incur legal penalties. Reporting sexual assaults of children to local law enforcement officials is strongly advised. The long-term impact of sexual abuse on children's psychological adjustment is unpredictable. In the short term, children's circumstances vary widely. Some show no evidence of psychological distress. Others have severe, pervasive difficulty. Office counseling by the empathetic and knowledgeable primary care physician, short-term crisis counseling, a more formal psychological evaluation, and longer-term psychotherapy may be recommended for individual children, depending on the nature and severity of each child's symptoms, his or her parents' preference, and the availability of services in the child's community.

Child↗
PubMed1988

Substantiation of sexual abuse charges when parents dispute custody or visitation.

Recent news reports have implied that charges of sexual child abuse during parental separation or divorce are often deliberately falsified. Such a conclusion could be harmful if it biased practitioners faced with such allegations in clinical practice. To investigate this concern, sexual abuse cases in a hospital-based consecutive series and in one author's clinical practice were reviewed. Abuse allegations with and without a concomitant custody or visitation dispute were compared. A custody or visitation dispute occurred in 12 (39%) of 31 sexual abuse complaints lodged against a parent. Allegedly abused children whose parents contested custody or visitation were significantly younger than those for whom custody or visitation was not an issue (5.4 v 7.8 years, P = .02). Sexual abuse allegations were substantiated less frequently when there was concomitant parental conflict (67% v 95%, nonsignificant) but were nevertheless substantiated more than half of the time.

Child↗
PubMed1985

Probability of vaginal foreign body in girls with genital complaints.

We used Bayes' theorem to evaluate the probability of vaginal foreign bodies in girls with genital complaints. The prevalence of vaginal foreign bodies in outpatient girls under 13 years of age with gynecologic disorders was found to be 4%. Review of the charts of 17 pre-menarcheal girls who had foreign bodies on 19 occasions and of 28 girls with infectious or nonspecific vaginitis demonstrated that patients with foreign bodies reported vaginal bleeding more frequently than discharge (14 and two of 15 symptomatic cases, respectively), while in contrast, patients with infectious or nonspecific vaginitis reported vaginal discharge more often than bleeding (23 and five of 28 symptomatic controls, respectively). Bayes' theorem indicates that, in populations resembling the one we studied, approximately 18% of preteenage girls with vaginal bleeding with or without discharge and 50% of those with bleeding and no discharge will prove to have vaginal foreign bodies.

Adolescent↗
PubMed1984

Social relevance of genital herpes simplex in children.

The charts of children younger than 13 years with culture-proved genital herpes simplex virus (HSV) were reviewed to determine how acquisition of the infection was documented and whether sexual abuse had been investigated. Six children (four girls and two boys) had genital HSV infection: five had type 1 HSV and one had type 2 HSV. None had serologic evidence of syphilis or culture-proved gonorrhea. Sexual abuse was documented in four of six patients. We concluded that genital HSV in children is frequently sexually transmitted and should always be considered a possible indicator of child abuse. Confirmation of HSV infection by culture is important to substantiate suspicious circumstances, since it may occur in the absence of either a history of sexual abuse or of other sexually transmitted diseases.

Age Factors↗
PubMed1984

Intranasal administration of RA 27/3 rubella virus vaccine. A clinical trial in young adults.

Of the vaccines and inoculation routes studied for the prevention of rubella, only the RA27/3 vaccine, administered intranasally, has the ability to stimulate a humoral antibody pattern very similar to that evoked by wild rubella infection. Because information about intranasal (IN) vaccination has only been obtained using the RA 27/3 vaccine manufactured in Europe, we conducted a trial of IN vaccination among young adults using Meruvax II which is manufactured in the USA. Of 597 family planning clinic patients screened in 1980-1981, 71 (11.9%) were susceptible to rubella; forty-one subjects were randomly assigned to receive IN or subcutaneous (SC) vaccine. All 20 SC vaccinees, but only 8/21 (38%) IN vaccinees, were successfully immunized. We conclude that standard doses of commercially available RA 27/3 vaccine are insufficient for IN immunization against rubella. Additional study of the dose-response relationship is needed if IN vaccination is to be recommended.

Administration, Intranasal↗
PubMed1982

Vulvovaginitis in premenarcheal girls: clinical features and diagnostic evaluation.

Fifty-four premenarcheal patients (median age 5.8 years) with symptoms or signs of vulvovaginitis were studied, and the results of cultures of vaginal secretions were compared with those from an age-matched control group. Vaginal discharge was found on examination in 24 of 42 patients with a complaint of discharge, and in two of 12 patients without a complaint of discharge. Convincing evidence of bacterial or monilial infection was found in 14 of the 26 patients with discharge on examination, but in none of the 28 patients without discharge (P less than .001). In the latter group pinworm infestation was present in one patient. Moniliasis occurred exclusively in girls who were pubertal (P less than .001). Four patients were found to have gonorrhea. No patient appeared to have symptoms or signs caused by Bacteroides sp, Chlamydia trachomatis, viruses, or Trichomonas vaginalis. Noninfectious causes were identified in four patients with and 13 without discharge (P less than .025); the most common cause was poor hygiene, implicated in six patients. Bubble bath use was implicated in only one patient. In 22 patients, no specific cause could be identified. All patients with poor hygiene as the only cause, and most with no demonstrable etiology, recovered after being advised to institute improved perineal hygiene. Patients with vaginal discharge are likely to have specific infections, and therefore cultures should be taken, in particular for Neisseria gonorrhoeae. Genital pruritus in prepubertal girls has little or no etiologic specificity, but in pubertal girls with vaginal discharge it suggests the presence of monilial vaginitis.

Bacteria↗
PubMed1981

Leukocyte response in childhood infectious mononucleosis. Caused by Epstein-Barr virus.

The usual leukocyte response in infectious mononucleosis (IM) has been established in adults but not in children. Previously, the diagnosis of IM often was difficult in childhood due to the lack of detectable heterophil antibody response in many patients. Using Epstein-Barr virus-specific serology, we have documented IM in 45 patients between 1 and 15 years of age. the mean and ranges for the total leukocytes, percent lymphocytes, and percent atypical lymphocytes are presented. These do not vary significantly with age and are similar to those reported for adolescents and adults with this illness.

Adolescent↗
PubMed1980

Falsely normal radionuclide scans for osteomyelitis.

Three children are described with osteomyelitis confirmed by roentgenogram, blood culture, bone culture, and/or histologic findings. None had an abnormal technetium scintigram. Despite the lack of falsely normal bone scans for osteomyelitis reported in the literature, our cases demonstrate the importance of instituting antibiotic therapy on the basis of clinical suspicion since no single nonsurgical procedure can be relied on to make a diagnosis of osteomyelitis.

Bone and Bones↗