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The examination of children suspected of being abused poses a great challenge for forensic pathologists. The risk of misjudgment is high and can have serious consequences for the child and the family. In unclear cases, an assessment should always be carried out on an interdisciplinary basis with the involvement of the relevant disciplines such as pediatrics, dermatology, or radiology. We present the case of a 2.5-year-old boy who was presented by his parents at the Pediatric Emergency Department of a Swiss University Hospital due to fever and weight loss. During the physical examination, conspicuous findings on the abdomen were present, and the responsible emergency physicians informed the child protective services. A clinical forensic examination occurred on behalf of the child protection services. The abdomen of the child showed several symmetrical scars. The initial questioning of the parents did not provide clear information about the origin of the injuries. Further professional questioning of the family by the child protective services concluded that the injuries were the result of a traditional medical treatment in Somalia, which occurred several weeks before.

BACKGROUND Etomidate is perceived as preserving haemodynamic stability during induction of anaesthesia. It is also associated with adrenocortical dysfunction. The risk/benefit relationship is controversial. OBJECTIVES We tested the hypotheses that single-dose etomidate increases cumulative vasopressor requirement, time to extubation and length of stay in the ICU. DESIGN Double-blind randomised controlled trial. SETTING Bern University Hospital, Switzerland, from November 2006 to December 2009. PATIENTS There were 90 patients undergoing coronary artery bypass grafts (CABG) and 40 patients undergoing mitral valve surgery (MVS). Reasons for noninclusion were known adrenocortical insufficiency, use of etomidate or propofol within 1 week preoperatively, use of glucocorticoids within 6 months preoperatively, severe renal or liver dysfunction, or carotid stenosis. INTERVENTIONS CABG patients were allocated randomly to receive either etomidate 0.15 mg kg with placebo, propofol 1.5 mg kg with placebo or etomidate 0.15 mg kg with hydrocortisone (n = 30 in each arm). Risk stratification (low vs. high) was achieved by block randomisation. MVS patients received either etomidate 0.15 mg kg or propofol 1.5 mg kg (n = 20 in each arm). MAIN OUTCOME MEASURES Cumulative vasopressor requirements, incidence of adrenocortical insufficiency, length of time to extubation and length of stay in ICU. RESULTS Cumulative vasopressor requirements 24 h after induction did not differ between treatments in patients who underwent CABG, whereas more noradrenaline was used in MVS patients following propofol induction (absolute mean difference 5.86 μg kg over 24 h P = 0.047). The incidence of relative adrenocortical insufficiency was higher after etomidate alone than propofol (CABG 83 vs. 37%, P