Evaluation, treatment, and follow-up of child abuse.
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Biomedical subjects
Publications and source records attributed to A Yates.
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A prospective randomised trial was carried out to assess the effect of 6 months' treatment with either clomiphene citrate or vitamin C in 179 men complaining of infertile marriage. There was no significant difference in the wife's pregnancy rates between the 2 treatment groups. In order to detect a subgroup that might respond to clomiphene the results were analysed according to pre-treatment FSH and sperm density, with allowance being made for the result of the wife's tests, but still there was no significant difference in treatment response Vitamin C would seem a preferable and cheaper alternative treatment for male infertility.
The assumption that children involved in incest are passive, unwilling victims is an oversimplification of a complex situation. Young children may find such relationships gratifying and, when exposed over time to intense genital and extragenital stimulation, they often become highly erotic. This hypermature responsiveness may be viewed as learned behavior; the behavior is self-reinforcing and may be difficult to modify. The author describes three children to illustrate their arousal, inability to differentiate sensual from affectionate touch, early gender discrimination, and stereotyped role modeling. Foster homes are neither trained nor supported in caring for these children, so serial placements are common.
The pediatrician must observe and assess a variety of emotional disorders in children, many of which seem related to adverse parental attitudes and actions. It is important for the pediatrician to appreciate the judicial system's constraints in defining psychological abuse so that, when appropriate, legal interventions can be actively encouraged. Cases most likely to be adjudicated are those in which the caretaker's harmful acts and attitudes can be causally related to measurable emotional damage in the child. Other cases which may be suitable are those in which the parent's actions are patently atrocious or the parents have consistently refused to obtain treatment for a seriously disturbed child. Cases which satisfy these criteria, and some which do not, are presented.
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Apparently identical twin boys are both XX/XY and have two populations, A1 and B, of cells in their peripheral blood. Chimerism in somatic tissue outside the blood cells can be demonstrated in only one of the twins. From analysis of chromosomes and many gene markers the mechanism of origin of the unusual twins remains unclear.
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The value of testicular biopsy in male infertility has recently been emphasized by Meinhard, McRae and Chisholm (1973), and the present authors agree with them that a biopsy is essential for the following reasons: (1) to establish a firm diagnosis; (2) to rationalize therapy on the basis of histological findings; (3) new developments in drug therapy and electronmicroscopic techniques will help to clarify many areas of doubt and uncertainty in this difficult field; (4) the diagnosis of 'sloughing' by itself may mask changes in germinal cell development which may be amenable to hormone therapy.
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43 microvascular procedures were performed in 38 children, (age limit 15 years) over a three year period. The average age was 5.4 years. The majority of the procedures were elective (63%), the remainder urgent or emergency. The overall vascular success rate was 93%, confirming previous reports. Three failures were observed, 2 of these being thumb avulsion injuries, the third a free-flap. Two patients underwent re-exploration of the anastomosis with successful outcomes. Vessel size was not a problem and generally exceeded 0.8 mm external diameter. The total time under anaesthetic averaged 5.5 hours, and post-operative recovery included monitoring and pain control on a High Dependency Unit. The average hospital stay was 10 days. The indications for surgery differ from those in adults, management is more complex, and includes the physical and psychosocial care of the child and parents. Despite raising certain anxieties in the past, microvascular surgery in children is safe, reliable and carries a high success rate.