C. Ranzato

The coronal pulp cavity index : A biomarker for age determination in human adults

The correlation between reduction of the coronal pulp cavity and chronological age was examined in a sample of 846 intact teeth from 433 individuals of known age and sex. Panoramic (rotational) radiography was used to measure the height (mm) of the crown (CH = coronal height) and the height (mm) of the coronal pulp cavity (CPCH = coronal pulp cavity height) of 425 premolars and 421 molars from 213 males and 220 females. The tooth-coronal index (TCI) after Ikeda et al. [1985] Jpn. J. For. Med. 39:244-250) was computed for each tooth and regressed on real age. The correlation coefficients ranged from -0.92 (molars, combined sample, right side) to -0.87 (female molars), with an S.E. of the estimate ranging from 5.88-6.66 years. Correlations were slightly higher in males than females. The equations obtained allowed estimation of age in a sample of 100 teeth from both sexes (not used for the regression) with an error of +/- 5 years in 81.4% of cases for male molars. The regression formulae for estimating age obtained from the recent sample were tested on a historical sample of 100 teeth from 100-year-old skeletons with an error of +/- 5 years in 70.3% of cases for male molars. This study illustrates the potential value of a little-known aging method which can be easily applied to estimate age in both living individuals and skeletal material of unknown age.

Child abuse: current problems and key public health challenges

Child abuse has recently been recognized by the World Health Organization as a major worldwide health problem impairing the health and welfare of children and adolescents. This paper attempts to look at child abuse from a public health perspective taking into account the vast cultural diversity in which children and adolescents live focusing on the issue of abuse and violence in a broad public health perspective, and trying to highlight the need for greater attention to be given to possible country-specific interventions.

“Vaginal” bleeding in prepubertal age: A rare scaring riddle, a case of the urethral prolapse and review of the literature

The entities responsible for isolated vaginal bleeding are a broad spectrum of diseases. Vaginal bleeding in a prepubertal child is always treated as an alarming symptom both by parents and professionals. Most often, one of the first hypotheses is that a sexual abuse may be occurred and the clinical work up is oriented to explore it and eventually confirm or substantiante another diagnosis. Among the possible differential diagnosis urethral prolapse has to be considered. We report the case of a 6 years-old Caucasian girl referred to our Service for a mild vaginal bleeding and with the suspicion of sexual abuse, excluded after the confirmation of the presence of urethral prolapse. The clinical picture and workup are described and compared with a review of the international literature on the issue.

Genital trauma and vaginal bleeding: is it a lapse of time issue? A case report of a prepubertal girl and review of the literature

Child victims of sexual abuse may present with physical findings whose interpretation requires the most exhaustive evaluation and an accurate collection of a detailed history. Genital bleeding is usually considered as an acute sign, related to a trauma that occurred shortly before its appearance. We report a case of a 34-month-old child who was referred to the emergency room with a significant vaginal hemorrhage, originating from a wide laceration of the posterior fourchette, and a negative history for accidental trauma. The characteristics of the lesion, compared to the temporal evolution of the healing process, and the witnesses’ depositions led us to assume that the time elapsed between the abusive event and the physical examination was longer in respect to what had appeared at the first sight. The judicial reconstruction of the events confirmed our assumption, allowing the charge of the right abuse perpetrator. As the literature regarding this eventuality is very poor, we report this case to stress the importance for physicians to consider that an active bleeding may be the manifestation of a trauma that occurred very long before.