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PubMed2002

Spontaneous resolution of bilateral stage 1 macular holes documented by optical coherence tomography.

PURPOSE: To describe a case of spontaneous resolution of bilateral stage 1 macular holes documented using optical coherence tomography. DESIGN: Observational case report. METHODS: A patient presented with blurring and distortion in the right eye. Optical coherence tomography showed a stage 1 macular hole manifested as a foveal pseudocyst. The left eye appeared normal. RESULTS: On 6-month follow-up, symptoms had resolved in the right eye but had developed in the left eye. Optical coherence tomography revealed normal anatomy in the right eye with a foveal pseudocyst in the left eye. At 10 months, the patient was asymptomatic and had normal foveal anatomy in both eyes on optical coherence tomography. CONCLUSION: Stage 1 macular holes may appear as foveal pseudocysts on optical coherence tomography. In such cases, optical coherence tomography can provide definitive diagnostic information when clinical examination is equivocal. The observation and spontaneous resolution of bilateral stage 1 holes documented by optical coherence tomography are unique and interesting events of which a MEDLINE search found no previous reports.

Diagnostic Techniques, Ophthalmological↗

PubMed1999

Unsedated transnasal EGD: an alternative approach to conventional esophagogastroduodenoscopy for documenting Helicobacter pylori eradication.

BACKGROUND: The aim of this study was to assess the yield of antral biopsies performed via unsedated transnasal esophagogastroduodenoscopy, a technique that does not require conscious sedation with its concomitant costs and complications, for documentation of Helicobacter pylori eradication. METHODS: Nineteen patients who were previously CLO test positive on conventional esophagogastroduodenoscopy and subsequently treated for H pylori infection were enrolled. The subjects had not received antibiotic therapy in the prior month and had no prior gastric surgery. By using a GIF-N30 fiberoptic endoscope and a tiny cup biopsy forceps (1.8 mm diameter), unsedated transnasal endoscopy was performed and antral biopsy specimens were taken for a CLO test, histologic analysis (Dieterle stain), and tissue culture. On the same day, the subjects underwent a carbon 13-labeled area urea breath test. All subjects completed a visual analog scale, rating the acceptability of the unsedated transnasal examination and the previous sedated conventional esophagogastroduodenoscopy. RESULTS: There was no statistically significant difference between the results of the CLO tests (5/19 positive) versus the 13C-urea breath test (4/19 positive) (p = 0.96), the CLO tests versus histologic findings (5/19 positive) (p = 0.71), or the 13C-urea breath test versus histologic findings (p = 0.96). All tissue culture results were negative. The overall acceptability of unsedated transnasal esophagogastroduodenoscopy was similar to that of sedated conventional esophagogastroduodenoscopy. CONCLUSION: Unsedated transnasal esophagogastroduodenoscopy, a technique that eliminates the costs and complications associated with conscious sedation, is a feasible and accurate alternative to conventional esophagogastroduodenoscopy when documentation of H pylori eradication and confirmation of gastric ulcer healing are both indicated.

Adult↗

PubMed1998

A standardized procedure for locating and documenting ECG chest electrode positions: consideration of the effect of breast tissue on ECG amplitudes in women.

Continuing uncertainty exists about standardized procedures for the placement of electrocardiographic (ECG) chest electrodes, technical variability being the largest error source for short-term variations in amplitudes and waveforms of the chest lead ECGs. To avoid presumed attenuation of ECG amplitudes by abundant breast tissue, anterolateral chest electrodes in women are often placed under the breasts and too low. There is also considerable uncertainty about locating the midclavicular line and the V4 electrode, particularly in obese persons and in women. We examined the effect of breast tissue protuberance on ECG amplitudes using ECG and anthropometric data on 6,814 women included in the Atherosclerosis Research in Communities Study (ARIC). The R wave amplitudes in anterolateral chest leads and the Sokolow-Lyon voltage decreased (P < .001 for all), and RaVL and the Cornell voltage increased significantly with increasing breast protuberance (P < .001 for all). However, these effects were small (15 microV or less for each 1-cm increment in breast protuberance), and R2 values were less than .01, indicating that breast protuberance alone explained less than 1% of ECG amplitude variations. When chest size and breast protuberance estimates were entered simultaneously into a multivariate regression model, chest size appeared to dominate, and model R2 values increased for positive associations with RaVL (R2 = .12) and the Cornell voltage (R2 = .04). Combined model R2 values remained < or =.01 for all other ECG amplitudes. A detailed step-by-step standardized electrode placement procedure was formulated. Because of the difficulties encountered in locating the left midclavicular line by visual inspection, we introduced well-defined procedures for identification and documentation of lateral chest electrode placement locations as a quality control method for clinical trials. Population data from the Third National Health and Nutrition Survey on the distributions by sex and race of chest electrode V4 and V6 locations and anthropometric data on chest size and shape are presented in order to facilitate evaluation of the comparability of electrode placement procedures in various studies and for quality control in clinical trials. It is concluded that standardized procedures to document chest electrode placement locations are feasible. Breast tissue appears to have a practically negligible effect on ECG amplitudes, and in women, the placement of chest electrodes on the breast rather than under the breast is recommended in order to facilitate the precision of electrode placement at the correct horizontal level and at the correct lateral positions.

Aged↗

PubMed1987

Transtelephonic monitoring: documentation of transient cardiac rhythm disturbances.

Symptoms suggestive of a transient disturbance in cardiac rhythm often prompt a patient to seek medical help. Transtelephonic monitoring (TTM) can document the rhythm at the exact time that the patient is experiencing clinical symptoms. Our experience with TTM from 1979 to 1983 involved 526 patients who had one or more of the following symptoms: near-syncope (in 121), light-headedness (in 248), intermittent palpitations (in 281), and tachycardia (in 321). Patients suspected of having a life-threatening arrhythmia after the initial history, physical examination, and laboratory testing were excluded from this study. Of the 526 patients, 259 transmitted with the TTM device during a typical symptomatic episode; 186 had an arrhythmia identified, and 73 had a normal cardiac rhythm. The mean duration (+/- SD) from receipt of the TTM system until the first transmission was 48 +/- 80 days. The most frequent diagnoses at transmission were supraventricular tachycardia (in 80 patients) and sinus tachycardia (in 46). This study showed that TTM is effective in documenting infrequent arrhythmias and in establishing the temporal relationship between clinical symptoms and the patient's heart rhythm. TTM is a useful, practical, and efficient addition to more conventional means of electrocardiographic monitoring for patients with non-life-threatening arrhythmias.

Arrhythmias, Cardiac↗

PubMed2003

Successful administration of carboplatin in patients with clinically documented carboplatin hypersensitivity.

OBJECTIVE: The goal of this study was to evaluate the tolerance and effectiveness of carboplatin rechallenge using a prolonged desensitizing carboplatin infusion regimen in patients with clinically documented moderate-severe carboplatin hypersensitivity. METHOD: Patients admitted for carboplatin infusion were identified by computerized pharmacy records and retrospectively analyzed. RESULT: Thirty-three patients with recurrent ovarian (N = 27), peritoneal (N = 4), tubal (N = 1), and cervical (N = 1) cancer treated with a prolonged desensitizing carboplatin infusion regimen were identified. The patients had received a median of 10 courses of carboplatin (range 3-33) before developing the moderate-severe hypersensitivity reaction. Two hundred and fifteen courses (median 5, range 1-52) were administered. Twenty-nine patients (88%) were successfully rechallenged while four had a recurrent moderate-severe carboplatin hypersensitivity precluding further administration. Despite initial tolerance of the infusion schedule moderate-severe carboplatin hypersensitivity recurred in 3 additional patients (9%) after two, three, and six subsequent courses. Objective responses to therapy were seen in 22 of 28 evaluable patients (79%). CONCLUSIONS: A prolonged desensitizing carboplatin infusion regimen is tolerated in the majority of patients with clinically documented moderate-severe carboplatin hypersensitivity. Objective response rates seem acceptable with this schedule.

Adult↗

PubMed2004

Learning from Philip Morris: Japan Tobacco's strategies regarding evidence of tobacco health harms as revealed in internal documents from the American tobacco industry.

Japan is in the midst of a rapid increase in tobacco-related disease mortality, following the rapid growth of smoking after WWII. Stomach cancer was the country's leading cause of cancer death for most of the 20th century, until lung cancer took over this position in 1993. Cigarettes are the major cause of lung cancer in Japan, but the country's leading manufacturer, Japan Tobacco, two thirds of which is owned by the Japanese government, continues to question whether tobacco is a major cause of disease and death. Japanese courts do not have the power to subpoena a company's internal records, which has made it difficult to document Japan Tobacco's strategies concerning tobacco and health. Our interpretation of online archives of internal documents from American tobacco companies, however, is that Japan Tobacco has long known about the potential health risks involved in smoking and has sought to obstruct effective tobacco control. Beginning in the mid-1980s, these efforts were often co-ordinated with American tobacco manufacturers. The documentary evidence shows that cigarette manufacturer Philip Morris in particular assisted with and sometimes also supervised Japan Tobacco's actions and statements on smoking and health. In one instance, data gathered for an article published by the Japan Public Monopoly Corporation (Japan Tobacco's predecessor) were deliberately altered to lower the reported value of a hazard indicator (nicotine concentration in the air). International collaboration has made it easier for companies such as Japan Tobacco to develop effective anti-antismoking strategies. Evidence of such global industry collaborations might grow as lawsuits begin to be filed in other nations.

Adolescent↗

PubMed2000

Value of drug-licensing documents in studying the effect of postmenopausal hormone therapy on cardiovascular disease.

BACKGROUND: In a previous study of pooled data from published trials, we found no evidence to support the claim that postmenopausal hormone therapy (PHT) is associated with a decrease in cardiovascular disease. The purpose of this study was to see whether reports of clinical trials attached to drug-licensing applications in Finland could be obtained for scientific purposes, whether they are useful for studying cardiovascular events resulting from PHT, and if so, whether these unpublished reports corroborate the results of published reports. METHODS: Since clinical trials in drug-licensing documents are confidential, we had to obtain special permission from the Ministry of Social Affairs and Health to use the data for research purposes. After permission was granted, we studied the clinical sections of licensing documents for PHT drugs sent by drug companies to the Finnish Drug Agency. We aimed to identify trials that compared PHT and a placebo (or no therapy, or vitamin-mineral drugs), and that reported on cardiovascular and thromboembolic events or superficial phlebitis. New trials were identified and their data were pooled with those of published trials. FINDINGS: 17 licensing applications for drugs used as PHT were found. The number, type, and quality of reporting of clinical trials varied widely between applications. The trials and their reporting of unanticipated adverse events were mostly inadequate. Six new trials (ie, those fulfilling the inclusion criteria and not included in our earlier report) were found. The new trials added little to the conclusions of previously published studies: the calculated odds ratios of cardiovascular and thromboembolic events for women taking PHT versus those not taking it was 1.97 (95% CI 0.84-4.63), compared with 1.65 (0.65-4.21) in our previous study. INTERPRETATION: In this case, unpublished trials added only a little to the data available from published trials, mainly due to the type of clinical data used in the licensing applications. The new data did not change the previous conclusion that clinical trials do not support a beneficial effect of PHT on cardiovascular diseases.

Adult↗

PubMed2002

Risk-based design of repeated surveys for the documentation of freedom from non-highly contagious diseases.

The documentation of freedom from disease requires reliable information on the actual disease status in a specific animal population. The implementation of active surveillance (surveys) is an effective method to gain this information. For economical reasons, the sample size should be as small as possible but large enough to achieve the required confidence level for a targeted threshold. When conducting surveys repeatedly, various information sources about the disease status of the population can be taken into account to adjust the required level of confidence for a follow-up survey (e.g. risk assessments regarding disease introduction and results of previous surveys). As a benefit, the sample size for national surveys can be reduced considerably. We illustrate this risk-based approach using examples of national surveys conducted in Switzerland. The sample size for the documentation of freedom from enzootic bovine leucosis (EBL) and Brucella melitensis in sheep and in goats could be reduced from 2325 to 415 cattle herds, from 2325 to 838 sheep herds and from 1975 to 761 goat herds, respectively.

Animals↗

PubMed1990

Medicolegal documentation of prehospital triage.

Patients evaluated by paramedics but not transported to the hospital account for 50% to 90% of emergency medical services lawsuits. We reviewed 2,698 consecutive paramedic run reports to examine documentation in these cases. Documentation criteria for prehospital patient release were history, physical examination, vital signs, mental status, lack of significant mental impairment, and for patients refusing care, that risks of refusing were understood. Criteria for appropriate release were met in 65.2% of cases. Criteria omitted in inappropriate releases were risks of refusing care in 481 (51.3% of inappropriate releases), vitals in 320 (34.1%), mental status in 188 (20.0%), lack of impairment in 120 (12.8%), and history or physical in 19 (2.0%) cases. Age from 0 to 14 and 65 or more years and prehospital assessment of hyperventilation, psychiatric emergency, choking, infection, and patient deceased were significantly associated with appropriate release. Age from 35 to 54 years and prehospital diagnosis of no injury, head injury, seizure, minor trauma, and ethanol use were significantly associated with inappropriate releases. There was no association of appropriate release or inappropriate release with patient sex, contact with medical control, length of encounter, or time of day. Only one patient complication was believed due to inappropriate triage; this could be improved by implementation of standardized criteria.

Adult↗

PubMedDate not supplied

[Documented immunization coverage in second-year primary schoolchildren from the province of Valladolid].

OBJECTIVE: To estimate the documented immunization coverage and degree to which schoolchildren's vaccination cards are kept up to date. METHODS: Transversal descriptive study of children in the second year of primary education in the province of Valladolid during the 1999-2000 academic year. The sample consisted of 698 children with a participation rate of 82%. The percentage of children whose immunization schedule was up to date in accordance with their age, that of children with additional vaccinations and the accuracy of the vaccination cards was quantified. Information was collected through a questionnaire on vaccination cards or, for children without one, from their medical history. RESULTS: The documented immunization coverage was 99.3% (95% CI: 98.6-99.9) for the first three dose of diphtheria toxoid, tetanus toxoid and pertussis vaccine and poliomyelitis vaccine, 98.9% (95% CI: 97.7-99.5) for the measles, mumps and rubella vaccine and 95% (95% CI: 93.4-96.7) for all doses up to the age of six. In addition, 7.2% (95% CI: 5.3-9.2) were immunized against hepatitis B, 14.4% (95% CI: 11.6-17) against Haemophilus influenzae type B and 90.3% (95% CI: 88-92.5) against meningococal A + C. A total of 84.4% of vaccination cards were correctly filled in (95% CI: 81.7-87.2). CONCLUSIONS: Systematic immunization coverage in the schoolchildren was high. Because of their accuracy, vaccination cards were a useful tool for determining immunization coverage. Both the accuracy of the vaccination card and the incidence of non-systematic immunization were higher in urban areas.

Child↗

PubMedDate not supplied

[Readability of informed consent documents used in the hospitals of Asturias].

OBJECTIVE: To evaluate the readability of the informed consent documents (ICD) used in the health centers of Asturias (Spain) with the aim of verifying whether the ICD are understandable and sufficient as a vehicle of information to empower patients to participate in decisions related to their diagnosis and treatment. METHOD: A total of 1114 ICD were gathered from the health centers in Asturias. A representative random sample from each hospital was selected and the following readability indexes were obtained: the Flesch index, the sentence complexity index, and the integrated legibility index. RESULTS: Of the ICD in the sample studied, legibility was acceptable in 77.3% (221 out of 286) according to the integrated legibility index, in 75.2% (215 out of 286) according to the sentence complexity index and in 3.5% (10 out of 286) according to the Flesch index. The mean values of the indexes differed among hospitals (p < 0.001, ANOVA test). CONCLUSIONS: ICD written in Spanish achieved low readability scores in the Flesch index and require corrective measures. Three quarters of the ICD were acceptable due to the use of simple sentences in the text. We believe that readability indexes should be used when drafting or improving informed consent documents.

Comprehension↗

PubMed1994

Clinical documentation of end-stage renal disease due to hypertension.

Hypertensive end-stage renal disease (ESRD) purportedly accounts for 25% of new ESRD patients each year in the United States, but remains poorly understood. Clinical features include normal renal function at diagnosis of hypertension, family history of hypertension, left ventricular hypertrophy, and minimal proteinuria. We evaluated clinical and historic data documenting the diagnosis of hypertensive ESRD in 43 patients with ESRD attributed to hypertension who were referred to our center for renal transplantation. Hypertensive ESRD patients were more likely to be black patients with left ventricular hypertrophy compared with our overall population. Few of the hypertensive ESRD patients had undergone kidney biopsy, none of whom had classic features of benign nephrosclerosis. Less than 5% of patients had hypertension documented at any time with normal renal function. Based on our review, it is clearly possible that the number of patients reaching dialysis and transplantation with renal failure attributed to hypertensive ESRD may be overestimated.

Adult↗

PubMed1998

Assessment of diagnostic performance of quantitative flow measurements in normal subjects and patients with angiographically documented coronary artery disease by means of nitrogen-13 ammonia and positron emission tomography.

OBJECTIVES: Regional myocardial blood flow (MBF) and flow reserve measurements using nitrogen-13 (N-13) ammonia positron emission tomography (PET) were compared with quantitative coronary angiography to determine their utility in the detection of significant coronary artery disease (CAD). BACKGROUND: Dynamic PET protocols using N-13 ammonia allow regional quantification of MBF and flow reserve. To establish the diagnostic performance of this method, the sensitivity and specificity must be known for varying decision thresholds. METHODS: MBF and flow reserve for three coronary territories were determined in 20 normal subjects and 31 patients with angiographically documented CAD by means of dynamic PET and a three-compartment model for N-13 ammonia kinetics. Ten normal subjects defined the normal mean and SD of MBF and flow reserve, and 10 normal subjects were compared with patients. PET flow obtained in the territory with the most severe stenosis in each patient was correlated with the angiographic assessment of the stenosis (severity > or = 50%, > or = 70%, > or = 90%). Receiver operating characteristic (ROC) curve analysis was performed for 1.5, 2.0, 2.5, 3.0 and 4.0 SD of flow abnormalities. RESULTS: MBF and flow reserve values from the normal subjects and from territories with documented stenoses > or = 50% were significantly different (p < 0.05). A significant difference was found between normal subjects and angiographically normal territories of patients with CAD. High diagnostic accuracy and sensitivity, with moderately high specificity, were demonstrated for detection of all stenoses. CONCLUSIONS: Quantification of myocardial perfusion using dynamic PET and N-13 ammonia provides a high performance level for the detection and localization of CAD. The specificity of dynamic PET was excellent in patients with a low likelihood of CAD, whereas an abnormal flow reserve in angiographically normal territories was postulated to represent early functional abnormalities of vascular reactivity.

Adult↗

PubMed1998

Treating patients with documented atherosclerosis to National Cholesterol Education Program-recommended low-density-lipoprotein cholesterol goals with atorvastatin, fluvastatin, lovastatin and simvastatin.

OBJECTIVES: This study compared the efficacy and safety of atorvastatin, fluvastatin, lovastatin, and simvastatin in patients with documented atherosclerosis treated to U.S. National Cholesterol Education Program (NCEP) recommended low-density-lipoprotein (LDL) cholesterol concentration (< or = 100 mg/dl [2.59 mmol/liter]). BACKGROUND: For patients with advanced atherosclerosis, NCEP recommends lipid-lowering drug therapy if LDL cholesterol remains > or = 130 mg/dl (3.36 mmol/liter). METHODS: A total of 318 men or women with documented atherosclerosis and LDL cholesterol > or = 130 mg/dl (3.36 mmol/liter) and < or = 250 mg/dl (6.5 mmol/liter), and triglycerides < or = 400 mg/dl (4.5 mmol/liter) participated in this 54-week, multicenter, open-label, randomized, parallel-group, active-controlled, treat-to-target study. Patients were titrated at 12-week intervals until the LDL cholesterol goal was reached. Number of patients reaching target LDL cholesterol levels and dose to reach target were evaluated. RESULTS: At the starting doses, atorvastatin 10 mg produced significantly greater decreases (p < 0.05) in plasma LDL cholesterol than the other treatments. Subsequently, the percentage of patients reaching goal at the starting dose was 32% for atorvastatin, 1% for fluvastatin, 10% for lovastatin and 22% for simvastatin. Atorvastatin-treated patients required a lower median dose than other treatments. Median doses at week 54 with the last available visit carried forward were atorvastatin 20 mg/day, fluvastatin 40 mg/day + colestipol 20 g/day, lovastatin 80 mg/day, simvastatin 40 mg/day. CONCLUSIONS: A significantly greater number (p < 0.05) of patients with confirmed atherosclerosis treated with atorvastatin reached the target LDL cholesterol concentration at the starting dose than patients treated with fluvastatin or lovastatin, and significantly fewer (p < 0.05) patients treated with atorvastatin required combination therapy with colestipol to achieve target LDL cholesterol concentrations than all other statins tested.

Anticholesteremic Agents↗

PubMed1996

Documentation in the ambulatory setting.

Mastering the skill of adequate, succinct, and confidential record keeping is a major challenge in today's health care environment. A variety of documentation tools and styles has been developed to meet the expanding and comprehensive needs of the ambulatory oncology arena. Ethical issues, legal ramifications, financial and reimbursement issues, and quality assurance are important aspects of documenting ambulatory oncology care.

Ambulatory Care↗

PubMed2003

Relationship between dobutamine response of dyssynergic myocardium and angiographically documented blood supply.

OBJECTIVE: Because hibernation is considered a down-regulation of contractile function in response to reduced regional myocardial perfusion, hibernating myocardium is expected to be supplied by a critically stenosed or even occluded coronary artery. Thus, high-dose dobutamine has been postulated to cause ischemia and reworsening of myocardial function (biphasic response), whereas myocardium that demonstrates sustained improvement with high-dose dobutamine should not be supplied by a significantly stenosed vessel. This study evaluates the type of dobutamine response-biphasic versus sustained improvement-of dyssynergic myocardium in relation to its angiographically documented blood supply. METHODS: In 38 patients (5 women; mean age 60 +/- 9 years) with chronic coronary artery disease and impaired left ventricular ejection fraction (</=35%), dobutamine echocardiography and quantitative coronary angiography were performed within 4 weeks. Wall-motion response of dyssynergic myocardium to dobutamine, classified as no improvement, biphasic response, or sustained improvement, was compared with the angiographically documented blood supply (presence of coronary stenosis in the corresponding artery, collaterals, and stenoses of the collateral supplying artery) in a segment-by-segment analysis. RESULTS: Of the 465 segments with abnormal wall motion at rest, 201 (47%) showed improvement during dobutamine infusion at low dose. Of these, 145 (72%) were supplied by significantly stenosed epicardial vessels. Only 27 (19%) of these 145 segments showed a biphasic response whereas in the remaining 118 segments wall-motion improvement persisted during high-dose dobutamine infusion. Although mean stenosis severity in the supplying vessel was significantly greater for segments presenting with biphasic response as compared with sustained improvement (95 +/- 7% and 86 +/- 12% luminal diameter reduction, respectively; P <.0001), 69% of segments with sustained improvement were supplied by a critically stenosed artery. Only 7 of 27 segments with biphasic response and 22 of 118 segments with sustained improvement had visible collaterals supplied by a vessel without significant stenosis. The percentage of segments viable by thallium-single photon emission computed tomography imaging was similar for those with sustained and biphasic response (96% and 83%, respectively). CONCLUSIONS: In this group of patients with coronary artery disease and impaired left ventricular function, the great majority of dyssynergic segments that exhibited a sustained, rather than biphasic, dobutamine response were supplied by a critically stenosed artery. Furthermore, the percentage of segments viable by thallium-single photon emission computed tomography did not appear to be different for segments with sustained improvement and those with biphasic response. These findings challenge the hypothesis that biphasic response is the best criterion to identify viable myocardium.

Aged↗

PubMed2001

Adolescent sexual assault: documentation of acute injuries using photo-colposcopy.

OBJECTIVE: To document the frequency and types of genital injuries in adolescent women examined acutely following a sexual assault, and determine any historical correlates of injury. DESIGN: Retrospective chart review. SETTING: Sexual Assault Response Team services at a community hospital in an urban setting. PATIENTS: All female patients aged 14-19 yr who were referred by law enforcement for an acute sexual assault examination and were examined between May 1994 and May 1999. OUTCOME MEASURES: The frequency of signs of genital trauma at various anal and genital sites, as recorded by the examining clinician. RESULTS: Charts of 214 female subjects (mean age 16.3 yr) were reviewed. The most common findings were posterior fourchette tear (36%); erythema of the labia minora, hymen, cervix, or posterior fourchette (18%-32%); and swelling of the hymen (19%). Time to examination was highly correlated with the degree of injury noted (P =.000). The incidence of hymenal tears in self-described virgins was higher than in nonvirgins (19% vs. 3%, P =.008); however, the total number or severity of other injuries was not significantly higher in virgins. Victims reporting anal penetration had a higher frequency of anal injuries than those who denied such contact (14/31, 61% vs. 2/150, 1%; P =.000). CONCLUSIONS: Tears of the posterior fourchette or fossa were the most common findings (40%). Hymenal tears were uncommon, even in self-described virginal girls. Timely examination of adolescent victims is important to document injuries; however, many victims will still not have signs of bruising, abrasions, or tears.

Adolescent↗