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Biomedical subjects

B Lundström

Publications and source records attributed to B Lundström.

At least 19 recordsLinked to original sources

[Done is done--and gone is gone. Sex reassignment is presently the best cure for transsexuals].

Sweden was the first country to legislate on sex reassignment procedures in 1972. Patients with gender dysphoria are in Sweden referred to one of six university clinics specialised in the field; all surgery, however, is centralised to the Karolinska Hospital in Stockholm. The aetiological strivings regarding transsexualism have to date been inconclusive; however, several lines of evidence speak in favour of an early biological influence on gender identity. The vast majority of studies addressing outcome have provided convincing evidence for the benefit of sex reassignment surgery in carefully selected cases. The current article summarises the state of the art regarding work-up and treatment of transsexuals.

Adult↗

Coenzyme Q10 administration increases antibody titer in hepatitis B vaccinated volunteers--a single blind placebo-controlled and randomized clinical study.

Persons involved in the study, 21 per treatment arm, were consuming ubiquinone (Q10), 90 mg/day, 180 mg/day or placebo, for two weeks prior to hepatitis B vaccination. After 30 days this vaccination was repeated. Q10 was given as soft gelatin capsules containing 30 mg each. The consumption was continued throughout the study conducted for 90 days. Clinical observations and laboratory tests were performed throughout the study and no adverse effects were observed in any of the groups. Already after 30 days the two groups receiving Q10 showed a slightly titer of antibodies to hepatitis B surface antigen then the placebo group. This difference escalated and the immunopotentiating effect of Q10 was even more clear-cut in the residual part of the study. In addition, a dose response did also seem to be present when comparing the 90 mg group with the 180 mg group. Statistics revealed that Q10 in the dose 180 mg/day is able to increase antibody response in vivo in humans vaccinated against hepatitis B with up to 57% (p = 0.011).

Analysis of Variance↗

Clinical characteristics of a total cohort of female and male applicants for sex reassignment: a descriptive study.

The objective of this study was to compare the features of female-to-male transsexuals (F-M) with those of male-to-female transsexuals (M-F) in the cohort of all applicants for sex reassignment over a 20-year period. In an observational, cross-sectional design the cohort was retrospectively identified, consisting of all 233 subjects who applied for sex reassignment in Sweden during the period 1972-1992. The cohort was subdivided into the groups M-F (n=134) and F-M (n=99), and the two groups were compared. M-F were older when applying for sex reassignment surgery than F-M, and more often had a history of marriage and children than their F-M counterparts. M-F also had more heterosexual experience. F-M, on the other hand, more frequently exhibited cross-gender behaviour in childhood than did M-F transsexuals. The present and previous studies strongly support the view that transsexualism manifests itself differently in males and females. Various models for understanding these differences are discussed.

Adolescent↗

Factors predictive of regret in sex reassignment.

The objective of this study was to evaluate the features and calculate the frequency of sex-reassigned subjects who had applied for reversal to their biological sex, and to compare these with non-regretful subjects. An inception cohort was retrospectively identified consisting of all subjects with gender identity disorder who were approved for sex reassignment in Sweden during the period 1972-1992. The period of time that elapsed between the application and this evaluation ranged from 4 to 24 years. The total cohort consisted of 218 subjects. The results showed that 3.8% of the patients who were sex reassigned during 1972-1992 regretted the measures taken. The cohort was subdivided according to the presence or absence of regret of sex reassignment, and the two groups were compared. The results of logistic regression analysis indicated that two factors predicted regret of sex reassignment, namely lack of support from the patient's family, and the patient belonging to the non-core group of transsexuals. In conclusion, the results show that the outcome of sex reassignment has improved over the years. However, the identified risk factors indicate the need for substantial efforts to support the families and close friends of candidates for sex reassignment.

Adult↗

Prevalence, incidence and sex ratio of transsexualism.

Frequency figures for transsexualism, concerning incidence, prevalence and sex ratio calculated in the 1960s and 1970s, were compared with recent reports. The incidence figures remained constant over time, whereas the prevalence figures tended to increase during the review period. The incidence was found to be of the same magnitude in men and women, while the corresponding ratio for prevalence figures was 3:1. It is suggested that men seeking sex reassignment represent a more heterogeneous group than women, and that the reported male predominance to date is due to a lack of categorical studies of primary/ genuine transsexualism. It would appear that genuine transsexualism is, on the whole, insensitive to societal changes. The fundamental disturbance underlying this psychosexual identity disorder is suggested to be neurobiological in origin.

Adolescent↗

Incidence and sex ratio of transsexualism in Sweden.

The incidence and sex ratio of transsexualism in Sweden were calculated during the period between 1 July 1972 and 30 June 1992 using a case register kept on file at the Swedish Bureau of Social Welfare. Only cases of primary/genuine transsexualism were considered. The study is unique in that it has been performed in exactly the same way as a previous study by one of the authors (JW) in the 1960s and early 1970s. The data can therefore be reliably compared. The results show that the incidence figures remain constant over time and that the incidence of primary/genuine transsexualism is equally common in men and women. A larger group consisting of all those individuals who had applied for sex reassignment revealed a preponderance of men. Analysis showed that this large group included not only primary/genuine transsexuals but also effeminate homosexuals, transvestites and diagnostically uncertain cases. The importance of describing the exact methods used when calculating epidemiological data is highlighted.

Adolescent↗

The accuracy of measurements of femoral neck fractures. Conventional radiography versus roentgen stereophotogrammetric analysis.

Postoperative displacement of the femoral head center was measured in 60 intracapsular hip fractures at repeated conventional radiographic (CR) and roentgen stereophotogrammetric (RSA) examinations. The measurements of the conventional radiographs (405 pairs) were done on a digitizing table. Totally, 105 pairs of these radiographs (AP and lateral, CR) were measured by 2 observers. Manual measurements were also made on 176 pairs of the conventional radiographs. Conventional radiographs tended to overestimate or underestimate the average displacements up to about 2 mm. Two standard deviations of the differences (RSA-CR) varied from 5.8 to 9.6 mm depending on the direction of the movements. The accuracy of the measurements on conventional radiographs did not differ between the 2 examiners. The digitizing table was found to be more accurate than the manual measurements. The accuracy of conventional radiography can most likely be improved by using a strictly standardized examination technique.

Femoral Neck Fractures↗

Trichorhinophalangeal syndrome type I and systemic lupus erythematosus with complement C4A homozygous null alleles in the same family.

A three generation family from northern Sweden with both trichorhinophalangeal syndrome type I (TRP I) and systemic lupus erythematosus (SLE)-like syndrome with complement C4 homozygous null alleles is described. Five family members in three generations were affected by the TRP I syndrome, indicating autosomal dominant inheritance. Two members had clinical and laboratory signs of SLE and two other members SLE-like syndrome. All living family members in the first and second generation had homozygous C4A null alleles. In three of the adults the two syndromes occurred simultaneously, probably in this family by coincidence.

Abnormalities, Multiple↗

Surgical biopsy of non-palpable mammary lesions. Technique and results.

In a randomized controlled trial with mammographic screening for early detection of breast cancer, 314 non-palpable breast lesions were examined by open biopsy between 1978 and 1983. These biopsies were performed after the lesions had been indicated by the hooked wire technique. In 185 cases the findings turned out to be benign while 129 proved to be malignant. Satisfactory initial biopsies were achieved in 95% of the cases. A model for the management of mammary lesions found in such a screening programme is described and some difficulties are discussed.

Adult↗

Reduction in mortality from breast cancer after mass screening with mammography. Randomised trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare.

A randomised controlled trial to investigate the efficacy of mass screening with single-view mammography in reducing mortality from breast cancer was started in Sweden in 1977. 162 981 women aged 40 years or more and living in the counties of Kopparberg and Ostergötland were enrolled in the study and divided at random into 2 groups. Each woman in the study group was offered screening every 2 or 3 years depending on age. Women in the control group were not offered screening. This report is confined to the 134 867 women aged 40-74 years at date of entry. The results to the end of 1984 show a 31% reduction in mortality from breast cancer and a 25% reduction in the rate of stage II or more advanced breast cancers in the group invited to screening. 7 years after the start of the study the excess of stage I cancers in the study group largely outweighs the deficit of advanced cancers.

Aged↗

Nonfamilial polycystic kidneys without enlargement.

7 middle-aged males with bilateral, polycystic, nonfamilial kidneys without enlargement are described. The histological examination revealed multiple cysts of varying sizes and changes such as in interstitial nephritis. 6 of the patients had hematuria and/or calculi in the urinary tract. The etiology of the cysts is not clear. The picture does not conform to that of congenital cystic kidney. The cysts might possibly be a final phenomenon in contracted kidneys, so-called acquired cystic disease, but it should be noted that in 4 of the 7 cases the cystic degeneration was demonstrated log before the uremia appeared. Another possibility is that the cystic transformation described here might be attributed to a specific type of interstitial nephritis.

Adolescent↗

Comparison of ultrasonography and computed tomography in preoperative location of parathyroid adenomas.

The value of high-resolution real-time ultrasonography in locating parathyroid adenomas was compared with that of computed tomography (CT). In 21 patients with a single parathyroid adenoma verified at neck exploration, preoperative ultrasonography and CT detected the adenoma in 15 and 11 cases, respectively. Ultrasound gave false-positive results in four patients and false-negative in two, whereas CT was false-positive in four patients and false-negative in six. Most false-positive reports were due to misinterpretation of small thyroid nodules. For acceptable accuracy both methods require an experienced radiologist. Technical and interpretive problems seem to be somewhat less frequent with ultrasonography than with CT. Ultrasonography has therefore become the method of choice for preoperative location of enlarged parathyroid glands at our hospital, and CT is used as a complementary procedure, e.g. when a mediastinal adenoma is suspected.

Adenoma↗

Outcome of sex reassignment surgery.

Three independent reviews of the world literature dealing with the outcome of sex reassignment surgery in transsexualism are presented. In 10-15% of the patients who undergo sex reassignment the results end up in a failure. There are as many failures in the female to male group as in the male to female group. Optimal results from the surgical procedures are important for a successful outcome. Relatively high age when first requesting sex reassignment may be regarded as a risk factor for poor outcome. Genuine transsexuals as a group seem to have a better prognosis for successful outcome of sex reassignment than a group of secondary transsexuals (i.e. transvestites and effeminate homosexuals). On the other hand, secondary transsexuals do better than genuine transsexuals when sex reassignment is refused. It is stressed that great importance should be given to the differential diagnosis when evaluating gender dysphoric patients for sex reassignment.

Female↗