Masculinizing chest-wall surgeries in transgender patients, a retrospective single-center study

INTRODUCTION

Masculinizing chest-wall contouring surgery is an important surgical intervention for most transmasculine patients; a vast improvement in quality of life for this group of patients has been documented as a result of receiving surgery. The aim of this study was to evaluate the results of such surgeries performed at our university hospital between 2008 and 2020, as well as the current quality of life of the patients.

METHODS

All 16 patients operated between 2008 and 2020 were sent a questionnaire consisting of both BREAST-Q and BODY-Q modules, considered fitting for our study purposes, as well as the BECK Depression Index and a short two-question form with space for feedback. Patients were divided into groups called double incision (DI) and periareolar (PA) depending on the surgical technique used.

RESULTS

We found an overall complication percentage of 31.3%, with the DI group scoring 33.3% and PA 28.6%, while secondary aesthetic corrections were necessary for 50% of all patients. The questionnaires yielded 6 responses (37.5%). Participants rated on a scale of 1 to 10 their willingness to undergo the operation again if given the choice; the DI group averaged 10/10, and the PA group 9/10, despite the statistically significant complication and correction rates.

CONCLUSIONS

Masculinizing chest-wall contouring surgery has significant complication risks. In our study, frequency of complications did not appear to depend on the surgical technique used. Additionally, the complication rates found in our low volume centre seem to be comparable with those reported from bigger units.

Cytomegalovirus hepatitis in late pregnancy

A case of pregnancy complicated by cytomegalovirus hepatitis is represented. The mother had a fulminant disease, but she delivered spontaneously at 31 weeks of gestation. The baby was unaffected.

Feasibility and acceptance of screening for fragile X mutations in low-risk pregnancies

Fragile X syndrome is the second leading cause of mental retardation after Down syndrome. Most women carriers of the fragile X mutation are unaware of their condition. We critically evaluated whether screening pregnant women at low risk for FMR1 mutation would be feasible as a routine part of antenatal care in general practice. We also studied acceptance and attitudes to gene testing. From July 1995 until December 1996, a carrier test was offered at the Kuopio City Health Centre free of charge to all pregnant women in the first trimester following counselling given by midwives on fragile X syndrome. All women found to be carriers of FMR1 gene mutations underwent detailed genetic counselling and were offered prenatal testing. Attitudes towards the gene test were elicited by questionnaire. Most pregnant women (85%) elected to undertake the gene test. Six women were found to be carriers (a rate of 1 in 246), and all subsequently accepted prenatal testing. Three foetuses had a normal FMR1 gene, one had a large premutation, one a 'size mosaic' mutation pattern, and another a full mutation. This observational and interventional study demonstrates that antenatal screening provides an effective way of identifying carriers and incorporating prenatal testing into this process.

Functional changes in back muscle activity correlate with pain intensity and prediction of low back pain during pregnancy

OBJECTIVE

To assess low back pain (LBP) intensity and subjective disability during pregnancy and compare the pain scores with lumbar motion patterns.

DESIGN

A prospective study of pregnant back pain sufferers and healthy controls.

SETTING

Kuopio University Hospital, Kuopio, Finland.

PARTICIPANTS

Study group consisted of 32 pregnant women with LBP; control group consisted of 21 healthy pregnant women.

MAIN OUTCOME MEASURES

Back pain intensity was assessed by visual analog scale (VAS), and subjective disability index was measured by Oswestry Low Back Disability Questionnaire, at 20 and 36 weeks of pregnancy. Back muscle activities were recorded by surface electromyography, and movement sensors were used to detect lumbar motion.

RESULTS

In the study group current pain scores (VAS) at first and last trimester correlated strongly (r = .82, p < .00). Pain scores correlated with body weight at the first trimester (r = .54, p = .003) and at the last trimester (r = .67, p < .00). Significant correlation was noted between current pain intensity and back muscle activity level during forward body flexion at first trimester (r = .704, p < .00). Back muscle activity during bending measured at first trimester significantly correlated with pain intensity at last trimester (r = .703, p < .00). Back muscle activity during the first trimester of pregnancy had a negative correlation with current (r = -.57, p = .002) and later subjective disability index (r = -.42, p = .02). It correlated inversely (r = -.54, p = .003) with pain score at last trimester of pregnancy, ie, the lower the back muscle activity at the beginning of pregnancy, the more pain and disability throughout pregnancy. In the control group, three women developed LBP and disability feelings during pregnancy. They had increased muscle activity during flexion at delivery, ie, disturbed flexion relaxation.

CONCLUSIONS

Prepregnancy LBP predicts renewed pain during pregnancy, and dysfunction of back muscles has been established in LBP. In this study, disturbance in the relaxation of the back muscles was linearly related to current, and also to later, pain scores. In addition, back muscle activity level was inversely related to the disability index. For the first time, it has been shown prospectively that the function pattern of back extensors seems to predict, and is related to, future back pain. Simple function testing is promising and might be valuable in identifying mothers with a high risk of pregnancy-related back pain and in directing preventive intervention to high risk women by making them aware of self-treatment methods.

Action of Trichoderma reesei mannanase on galactoglucomannan in pine kraft pulp

The di-, tri- and tetrasaccharides formed during Trichoderma reesei endo-beta-D-mannanase treatment of pine kraft pulp were studied. The oligosaccharides in the hydrolysate were fractionated using size-exclusion, anion exchange and activated carbon chromatography. The primary sequence of the purified oligomers was determined by two-dimensional NMR techniques. The T. reesei mannanase cleaves the beta-1,4-glycosidic linkage of D-mannosyl residues attached either to D-mannose or D-glucose. The D-mannosyl residue may also be substituted by a D-galactosyl group. The main disaccharide produced was mannobiose, but a significant amount of 4-O-beta-D-glucopyranosyl-D-mannopyranose (GlcMan) was also produced. After extensive hydrolysis the main trisaccharides produced were 4-O-beta-D-mannopyranosyl-[6-O-alpha-galactopyranosyl]-D-mannopyranose (Gal1Man2) and 4-O-beta-D-glucopyranosyl-4-O-beta-D-glucopyranosyl-D-mannopyranose (Glc2Man). Some mannotriose 4-O-beta-D-glucopyranosyl-4-O-beta-D-mannopyra-nosyl-D-manno pyranose (GlcMan2) and 4-O-beta-D-glucopyranosyl-[6-O-alpha-galactopyranosyl]-D-mannopyranose (Gal1GlcMan) were also detected in the hydrolysate. The structures of two tetrasaccharides were studied. They appeared to be 4-O-beta-D-glucopyranosyl-4-O-beta-D-glucopyranosyl-4-O-beta-D- glucopyranosyl-D-mannopyranose (Glc3Man) and 4-O-beta-D-glucopyranosyl-4-O-beta-D-mannopyranosyl-4-O-beta-D -glucopyranosyl-D-mannopyranose (GlcManGlcMan). According to the results obtained, the galactoglucomannan in pine contains regions in which two or three glucose units are linked together, which further means that it may contain regions with several successive mannose residues. The galactose side groups were found to be attached only to mannose.

Intraumbilical oxytocin for management of retained placenta

OBJECTIVE

The purpose of the study was to investigate the removal of a retained placenta.

METHOD

Oxytocin was injected into the vein of the umbilical cord. A total of 109 patients with retention of the placenta were randomized into two groups. Active management of the third stage of labor was carried out by giving oxytocin 5 IU intravenously and ergometrine maleate 0.2 mg intramuscularly after delivery of the fetus. Group 1, which comprised 68 patients, was allocated to receive 50 IU oxytocin diluted in 10 ml 0.9% sodium chloride solution, and the 41 patients in group 2 were given 20 ml plasma expander (dextran 70) into the umbilical vein.

RESULTS

Forty-nine cases (72%) in the oxytocin group and 22 cases (54%) in the dextran 70 group required manual removal of the retained placenta. No significant differences were found between group 1 (oxytocin) and group 2 (dextran 70).

CONCLUSION

Our results indicate that intraumbilical vein injection of oxytocin is not effective for removal of a retained placenta.

Myocardial infarction during pregnancy

Myocardial infarction during pregnancy is rare. This report presents the case of a 38-year-old gravida whose only risk factors for coronary artery disease included habitual cigarette smoking and a history of pre-eclampsia during her earlier pregnancy, in whom an acute anterior myocardial infarction occurred in the 18th week of gestation. Coronary angiography during the 28th gestational week revealed significant coronary artery stenosis. Normal labour was at term without complications.

Infection markers during labor at term

Serum levels of C-reactive protein (CRP), white blood cell count (WBC), amniotic fluid white blood cells (Gram staining) and leukocyte esterase (LE) activity were measured serially and prospectively in 30 pregnant women in labor at term. Results were retrospectively compared with amniotic fluid bacterial culture results. Leukocyte esterase activity was measured by the dipstick test (Nephurtest) and an in vitro photometric method. Amniotic fluid samples were collected through an intrauterine transvaginal pressure catheter. The serial CRP and WBC levels from admission to the delivery and CRP levels from delivery to the first post partum day increased statistically significantly. Levels of both markers correlated significantly with duration of labor. Both amniotic white blood cells and leukocyte esterase activity increased during labor. Bacterial colonization of amniotic fluid was not clearly associated with amniotic LE-activity or leukocyte count as determinated by Gram stain. The tests evaluated cannot be regarded as reliable methods in distinguishing intra-amniotic infection during labor and vaginal delivery at term.

Endocrine and metabolic effects of guar gum in menopausal women

The effect of a gel-forming dietary fiber, guar gum (15 g/day) on blood pressure, climacteric symptoms, serum hormones (estrone, estradiol, testosterone, androstenedione, follicle-stimulating hormone and luteinizing hormone) and on blood glucose and serum lipids (cholesterol, high density lipoprotein (HDL) cholesterol and triglycerides) was studied in a double-blind, placebo-controlled, parallel-group trial involving 30 menopausal women. A total of 15 women (Group A) were treated with guar gum and 15 (Group B) with placebo, for 6 months. Patients visited the doctor at the beginning of the study and after 3 and 6 months of treatment. Climacteric symptoms decreased significantly (p < 0.001) in both groups. Serum total cholesterol decreased by 5% in the guar gum group but this was not statistically significant. No changes in serum hormone levels or in other lipid and blood glucose levels were observed in either group. Body weight and blood pressure also did not change.

Effects of oestradiol valerate plus two different progestogens on serum lipids during post-menopausal replacement therapy

A total of 27 post-menopausal women were treated with hormone replacement therapy over a period of 6 months for climacteric symptoms. Serum total cholesterol, high-density-lipoprotein (HDL) cholesterol, low-density-lipoprotein (LDL) cholesterol and triglyceride concentrations were determined before therapy commenced and during the third and sixth treatment cycles. One group (13 women) was treated with 2 mg oestradiol valerate plus 7.5 mg megestrol acetate (EV + MA). The other group (14 women) received 2 mg EV plus 0.25 mg norgestrel (Cyclabil). The serum total cholesterol concentration decreased in both groups, the fall being more marked in that treated with Cyclabil. The serum LDL-cholesterol and triglyceride concentrations also decreased in both groups. The serum HDL-cholesterol concentration fell in the Cyclabil group but did not alter in the women treated with EV + MA. Our results suggest that the cyclic addition of megestrol acetate, a 17-alpha-hydroxyprogesterone derivative, to oestrogen therapy does not affect the serum HDL-cholesterol concentration, whereas norgestrel, which is a 19-nortestosterone derivative, causes it to decrease.

Serum lipids and proteins during treatment with a new oral contraceptive combination containing desogestrel

The present study was carried out to measure lipid and protein levels in serum of healthy women during treatment with a new oral contraceptive combination containing 0.075 mg desogestrel (Org 2969, 17 alpha-ethinyl-18-methyl-11-methylene-4-estren-17-ol) plus 0.050 mg ethinyloestradiol per tablet. All 30 volunteers took 1 tablet daily for 21 consecutive days, followed by a tablet-free period of 7 days. Treatment lasted 3 months. At the end of treatment serum total cholesterol had increased by 0.26 mmol/l (5.0%), high-density lipoprotein-cholesterol by 0.22 mmol/l (15.2%) and triglycerides by 0.43 mmol/l (50%); the calculated low-density lipoprotein cholesterol had decreased by 0.16 mmol/l (4.9%). All lipid concentrations had returned to initial levels 2 months after treatment stopped. After 3 months treatment serum ceruloplasmin, cortisol-binding globulin capacity, sex-hormone-binding globulin capacity and thyroxine-binding globulin had significantly increased by 85.2, 133, 206 and 101%, respectively. All protein levels returned to normal 2 months after treatment stopped. The relationship between serum lipids and hormone-binding proteins has been discussed, as well as the significance of the high-density lipoprotein level with regard to contraceptive treatment.

Thyroid function during treatment with a new oral contraceptive combination containing desogestrel

The present study was carried out to assess the effect of an oral contraceptive combination containing 0.075 mg desogestrel (Org 2969, 17 alpha-ethinyl-18-methyl-11-methylene-4-estren-17-ol) plus 0.050 mg ethinyloestradiol on thyroid function in healthy women. All 15 volunteers participated for three cycles; in each cycle they took 1 tablet daily for 21 consecutive days, followed by a 17-day tablet-free period. In total, 'treatment' lasted 3 months. After 3 months treatment serum thyroxine significantly increased (+ 43.9%), as did free thyroxine index (+ 20.0%) and thyroxine-binding globulin (+ 101%). Serum triiodothyronine uptake to Sephadex decreased (- 17.3%), corresponding to the decrease in thyroxine/thyroxine-binding globulin ratio (- 23.8%). Serum triiodothyronine and thyrotropin (TSH) concentrations did not change. After treatment had stopped, all values rapidly returned to initial levels. As a more specific parameter of thyroid function, serum free thyroxine concentration was measured. During treatment a slight decrease of - 125% (which was within normal limits) was observed. Moreover, the pituitary response to TSH-releasing hormone (TRH) was not changed. Thus, treatment with desogestrel plus ethinyloestradiol in the present combination did not alter thyroid function.

Lactate dehydrogenase isoenzymes in human myometrium during pregnancy and labor

Myometrial lactate dehydrogenase isoenzymes were investigated in 32 pregnant women and in 21 women during labor. During pregnancy and labor the H-type LDH isoenzymes were found to preponderate in contrast to M-type LDH isoenzymes. Both H-LDH and M-LDH isoenzyme activities showed a tendency to increase in normal pregnancy. In severe pre-eclampsia and in chronic hypertension, the uterine M-LDH level decreased. In normal labor, M-LDH activity declined in both the uterine and the rectus abdominis muscles.

Serum lactic acid dehydrogenase and isoenzymes during pregnancy and labor

Total serum lactic acid dehydrogenase activity (LDH) and the levels of LDH isoenzymes were investigated in 14 women during early pregnancy (8--16th week), in 28 women during late pregnancy (29--37th week), in 73 at term (38--42nd week) and in 27 during labor (38--42nd week). LDH activity was found to be elevated in severe pre-eclampsia and in chronic hypertensive women during pregnancy as well as during normal and dysfunctional labor. No change was established in total serum LDH during normal pregnancy. LDH 1 was increased during late pregnancy and at term. In severe pre-eclampsia and during normal labor it was decreased. LDH 2 was also decreased in severe pre-eclampsia and during dysfunctional labor. LDH 3 was decreased during late pregnancy but increased in severe pre-eclampsia. No change was observed in LDH 4 during pregnancy, or in labor. LDH 5 was increased in normal and dysfunctional labor.

Urography and renography in the follow-up of patients with toxemia of late pregnancy

We have studied 129 patients with toxemia of pregnancy two months post partum by urography and renography. The same investigations were performed on 17 healthy parturients post partum. 49 patients (38.8%) had an abnormality either in urography or renography. 20 patients (15.5%) had an abnormal urogram and 42 (32.6%) an abnormal renogram. The findings correlated so that 7 patients had an abnormal urogram with a normal renogram and 13 patients had an abnormality in both investigations. 29 patients had only an abnormal renogram. In the control series 3 patients had an abnormal urogram and the same patients also had an abnormal renogram. We divided the studied patients into groups according to the clinical severity of toxemia. Urographic and renographic findings were divided evenly in the series so that abnormalities were no more common in the severe cases. Renography cannot be considered merely as a screening method when compared with urography in the follow-up of toxemic patients, but these investigations are complementary.