Advances and retreats in the protection of children

Article Abstract:

Recognition of child abuse often depends on diagnostic radiology findings. Estimates of the current incidence of physical child abuse range from 600,000 to nearly 2 million cases a year in children 3 to 17 years of age. Physicians must be able to differentiate between injuries that result from accidents and those caused by abuse. The key feature in making such a diagnosis is a 'discrepant history,' an explanation of the injury offered by the child's caretaker that does not match the medical findings in the case. The field of diagnostic radiology is developing a base of knowledge about certain injuries that are frequently associated with child abuse. Magnetic resonance (MR) imaging has improved the diagnosis of subdural hematoma especially when performed 48 to 72 hours following head trauma. With new technology, as well as clinical studies indicating that severe brain injury in the absence of a history of trauma was indicative of abuse, more criminal cases have been filed. 'Home visitation' by either a public health nurse or a lay person has proven to be effective in preventing child abuse, but funds have been reduced. The ability to implement such relatively simple and effective measures has not kept pace with advances in diagnostic skills; the prevention infrastructure has all but disappeared.

editorial

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Atretic esophagus: transgastric balloon-assisted hydrostatic dilation

Article Abstract:

Among children, gaps in the esophagus (atresia) pose a challenge to surgeons who must establish esophageal continuity. Surgery to join separated parts of the esophagus often fails. An experimental surgical technique was performed that successfully rejoined esophageal sections in three cases of atresia where wide gaps in the esophagus existed. A technique known as 'hydrostatic dilation' was used to establish continuity of the atretic esophagus. The hydrostatic (pertaining to pressure exerted by liquid) technique employs a balloon catheter (tube) inflated with a water-soluble contrast material (image enhancing substance), which allows fluoroscopic (X-ray imaging that detects fluorescent light rays) images to be obtained. The images are studied to insure that the catheter is in place and functioning properly. Hydrostatic pressure was maintained until the catheter was securely in place in the esophagus, joining the separated segments. The hydrostatic technique uses a standard urinary bladder or angiographic balloon catheter. The procedures were performed under conditions of minimal sedation, did not interrupt feeding schedules, and may eventually be performed on an outpatient basis.

Usage, Esophagus, Esophageal atresia, Contrast media, Contrast media (Chemicals), Balloon dilatation, Catheters

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Radiologic contributions to the investigation and prosecution of cases of fatal infant abuse

Article Abstract:

It is estimated that between 2,000 and 5,000 children are fatally abused each year in the US. Radiologists have become increasingly aware of the type of bone damage that is specifically related to instances of child abuse such as fractures of the legs, ribs, spine, and sternum. Several injuries may occur simultaneously, especially in infants who have been severely shaken or thrown during an assault. It is believed that improvement in the ability to identify and date these lesions through radiological and pathological means would aid in the medical investigation of suspected cases of fatal infant abuse. Radiologic studies were very useful in contributing to the determination of the manner of death in the majority of cases studied. Documentation of traumatic injury has immediate relevance to the investigative process.

Evaluation, Patient outcomes, Mortality, Medical examination, Autopsy, Infants, Infant mortality, Skeleton

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