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Objective
(1) To describe lacerations of the vaginal fornices, an injury known to be associated with consensual sexual intercourse, including known complications and treatment course, (2) to contrast these injuries with injuries sustained during sexual assault, and (3) to discuss the assessment of adolescent patients for sexual injuries.Methods
We present a case series of 4 female adolescent patients seen at a children's hospital over a period of 6 months. Each patient developed significant vaginal bleeding after sexual intercourse, and 3 of the patients presented to the emergency department with vital signs consistent with compensated shock.Results
Each patient was evaluated by pediatric surgery, and found to have a laceration of the vagina. Three of the patients described consensual intercourse prior to the onset of bleeding, and had lacerations of the vaginal fornices; these patients were determined to have injuries resulting from consensual sexual intercourse. The fourth patient reported sexual assault as the cause of her injuries, and was treated for longitudinal lacerations of the vaginal wall.Conclusions
Lacerations of the upper vagina are not frequently reported in forced vaginal intercourse, but are occasionally reported as injuries sustained during consensual coitus. In the absence of reported sexual assault, a severe vaginal fornix laceration is consistent with the diagnosis of coital injury from consensual intercourse. Diagnosis and treatment of this injury can be delayed due to the sensitive nature of these injuries. Bleeding can be profuse, leading to hemorrhagic shock, and these injuries may require transfusion of blood products and surgical repair in some cases. Complications may include hemoperitoneum, pneumoperitoneum, or retroperitoneal hematoma, even in the absence of complete vaginal perforation.Practice implications
Knowledge of the consensual sexual injuries that may occur in adolescent patients can guide diagnosis, treatment, and counseling for the patient and her family, preventing long-term medical complications and legal consequences. 相似文献2.
Fluid and electrolyte balance in elite male football (soccer) players training in a cool environment
There are few data in the published literature on sweat loss and drinking behaviour in athletes training in a cool environment. Sweat loss and fluid intake were measured in 17 first-team members of an elite soccer team training for 90 min in a cool (5°C, 81% relative humidity) environment. Sweat loss was assessed from the change in body mass after correction for the volume of fluid consumed. Sweat electrolyte content was measured from absorbent patches applied at four skin sites. Mean (?± s) sweat loss during training was 1.69?±?0.45 l (range 1.06?-?2.65 l). Mean fluid intake during training was 423?±?215 ml (44?-?951 ml). There was no apparent relationship between the amount of sweat lost and the volume of fluid consumed during training (r 2 = 0.013, P = 0.665). Mean sweat sodium concentration was 42.5?±?13.0 mmol?·?l?1 and mean sweat potassium concentration was 4.2?±?1.0 mmol?·?l?1. Total salt (NaCl) loss during training was 4.3?±?1.8 g. The sweat loss data are similar to those recorded in elite players undergoing a similar training session in warm environments, but the volume of fluid ingested is less. 相似文献
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Shedid SM Saada HN Eltahawy NA Hammad AS 《Indian journal of clinical biochemistry : IJCB》2018,33(3):314-321
Radiation induced brain damage is associated with impairment of mitochondrial functions, variations in the level of neurotransmitters, and oxidative stress. Mitochondrial function is closely linked to the level of neurotransmitters since the precursors are supplied by the Kreb’s cycle intermediates. The objective of this study was to evaluate the influence of pantothenic acid, an essential component in the synthesis of Coenzyme A (CoA), on the activity of the Krebs cycle enzymes, isocitrate dehydrogenase (IDH), α-ketoglutarate dehydrogenase (α-KGDH), and succinate dehydrogenase (SDH); the level of aspartic, glutamic and GABA; the activity of transaminases, and oxidative stress, in the cerebrum of γ-irradiated rats. Pantothenic acid (26 mg/Kg) was orally administered to the rats, 2 h after irradiation and during the following 5 days. Animals were sacrificed the 7th day post-irradiation. The exposure of male albino rats to γ-rays (5 Gy) has triggered oxidative stress notified by a significant elevation in the level of malondialdehyde (MDA), an end product of lipid peroxidation, associated to a significant decrease in the content of phospholipids, and the antioxidant compound glutathione (GSH). The activity of IDH, α-KGDH, and SDH, has significantly decreased, while the level of aspartic, glutamic and GABA has significantly increased. In parallel to these changes, the activity of alanine and aspartate transaminase has significantly increased, compared to their values in the control rats. Pantothenic acid treatment, has significantly attenuated oxidative stress; enhanced the activity of IDH, α-KGDH, and SDH; minimized the increase in the level of amino acids and the activity of transaminases, compared to their values in the cerebrum of irradiated rats. In conclusion, pantothenic acid could improve the level of neurotransmitters amino acids, which depends on the enzymatic activities of Krebs cycle and linked to oxidative stress. 相似文献
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Praxedes SM de la Rosa 《Asia Pacific Education Review》2005,6(2):170-178
Excellence in teaching has always been a demanding and absorbing concern in institutions of higher learning. Earlier studies,
which are numerous, have often dealt with the measurement of teacher qualities but have largely failed to explain the phenomenon
of excellence in practice. This study focused on the outstanding professional teachers’ candid revelations of their subjective
experiences of becoming and being excellent in their craft. Findings of the study indicated that love is the touchstone of
excellence in teaching: that is, loving the students, loving knowledge and loving the teaching process. 相似文献
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