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Biomedical subjects

D Muram

Publications and source records attributed to D Muram.

At least 55 records · Page 3Linked to original sources
PubMed1989

Child sexual abuse--genital tract findings in prepubertal girls. I. The unaided medical examination.

In a prospective study 205 prepubertal girls (mean age, 5.4 years) determined by Child Protective Services to be victims of sexual abuse were examined. Sixty-five girls (32%) had normal-appearing genitalia, 45 girls had nonspecific findings, and 95 girls had findings considered to be specific for sexual abuse. Whereas normal-appearing genitalia were most often observed in girls reporting digital assault, specific findings were more commonly observed in girls reporting genitogenital assault. Overall it was possible to document the presence of abnormal genital findings indicating or strongly suggesting sexual abuse in only 46% of the patients in this study group. Failure to document findings suggestive of abuse in half of the girls highlights the limitations of the medical evaluation in validating sexual abuse.

Child↗
PubMed1989

Child sexual abuse--genital tract findings in prepubertal girls. II. Comparison of colposcopic and unaided examinations.

In recent years the inspection of the vulva of sexually abused girls by magnification with a colposcope has become increasingly popular. However, data concerning the usefulness of colposcopy in such evaluations are lacking. In a prospective study, 130 prepubertal girls (mean age 5.5 years) who were identified by child protective agencies to be victims of sexual abuse were evaluated both by an unaided examination and by colposcopy. If the colposcopic findings differed from those of the unaided inspection, the macroscopic examination was repeated to determine whether the abnormality could have been detected without magnification. Altogether, 92 of the 130 girls were found to have abnormal findings. In the majority of girls with abnormalities (96%), the abnormalities were observed during the unaided examination. Of the four patients in whom the findings were detected initially by the colposcopic examination, these findings were observed during the repeat unaided examination. The findings were observed by colposcopic examination alone in only one patient. We conclude that unaided examination is adequate for the evaluation of most victims of sexual abuse.

Child↗
PubMed1989

Anal and perianal abnormalities in prepubertal victims of sexual abuse.

We describe anal and perianal findings in 310 prepubertal children who were determined to be victims of sexual abuse; 206 (66%) had perinea that appeared normal. Abnormal findings were present in 104 children (34%): anal gapping in 61 children; skin tags in 44; rectal tears in 33; sphincter tears in 15; human papillomavirus lesions in 4; perineal scarring in 2; and bite marks in 1. Normal-appearing perianal and anal regions were noted in 150 of 175 children (85%) who denied anal assault, and in 11 of 70 (16%) who described such assault. In comparison, anal and perianal abnormalities were observed in 59 of the 70 children (84%) who gave a clear history of anal assault, but in only 25 of 175 (15%) who denied such abuse. Failure to document perianal abnormalities in almost two thirds of the patients demonstrates the limitations of the medical evaluation in validating allegations of sexual abuse.

Age Factors↗
PubMed1989

Adhesion formation associated with the use of absorbable staples in comparison to other types of peritoneal injury.

Adhesion formation was assessed after inducing peritoneal injury with absorbable staples, absorbable suture, surgical excision or thermal injury. In addition, adhesion formation was assessed in the presence of Hyskon. Absorbable staples were associated with increased adhesion formation when compared to the other methods of injury. Hyskon appears to significantly reduce the formation of peritoneal adhesions at sites of peritoneal suturing, excision, and thermal injury, but did not reduce adhesion formation in the area of stapling.

Animals↗
PubMed1989

Child sexual abuse: relationship between sexual acts and genital findings.

A comparison was made between the findings observed during the examination of female victims of sexual abuse with the sexual acts to which the perpetrator confessed to have performed. In Shelby County, TN, during the calendar years 1985-1987, 30 individuals confessed to have sexually assaulted 31 girls. The mean age of the girls was 9.1 years, and that of the offenders was 30 years. In 18 of the 31 cases the offender admitted to vaginal penetration. Specific findings were observed in 11 of these 18 (61%) girls, compared with only 3 of 13 (23%) girls when penetration was denied. Although specific findings were more commonly observed when the perpetrator admitted to vaginal penetration, in 7 of 18 girls (39%) the examiner described normal appearing genitalia (n = 2), or nonspecific abnormalities only (n = 5). The author concludes that all complaints of sexual abuse must be considered potentially valid and should be investigated further, even if the physical examination fails to detect any abnormalities.

Adolescent↗
PubMed1988

Urinary retention secondary to a Gartner's duct cyst.

A 22-month-old child with a large cyst of Gartner's duct suffered from recurrent episodes of urinary retention. Excision of such large symptomatic cysts has been recommended in the past. Marsupialization is discussed as an alternative to extensive excision.

Cysts↗
PubMed1987

Osteoporosis.

Explore the source record for details and available documents.

Adult↗
PubMed1987

Pruritus in pregnancy.

Pruritus occurs frequently during pregnancy; the reported incidence ranges from 3% to 14% of all pregnancies. Pruritus may occur with or without skin lesions, and may be an exaggerated response to a physiologic adaptation to pregnancy, a manifestation of a systemic disorder, or a primary skin disease. We review the most serious skin disorders associated with pregnancy and present an easy, logical approach to their diagnosis and management.

Cholestasis, Intrahepatic↗
PubMed1987

Asymptomatic rupture of a rudimentary uterine horn.

Pregnancy in a noncommunicating rudimentary uterine horn frequently results in rupture. Uterine rupture may cause a massive intraperitoneal hemorrhage, necessitating operative intervention to control bleeding. The following is a report of an unusual patient who had an asymptomatic rupture of a rudimentary horn.

Adult↗