Biomedical subjects
Publications and source records attributed to J J Hage.
Basal cell carcinoma of the anus is extremely rare, accounting for only 0.1% of anorectal malignancies. We report the reconstruction of the anus with a biaxial pedicled scrotal island myofasciocutaneous flap following excision of an anal basal cell carcinoma, and conclude that this technique may be valuable in the reconstruction of the anal region.
In male-to-female trans-sexuals in whom the hormonal treatment has not resulted in sufficient growth of the breasts, augmentation mammaplasty may be considered. Mammaplasty is performed in two-thirds of our patients who have had vaginoplasties. We present our experience of 201 patients operated on at the Academisch Ziekenhuis Vrije Universiteit in Amsterdam up to 1997. The patients' mean age was 34 years (range 17-76) and the mean follow-up was four years (range 2 weeks to 16 years). In keeping with our protocol, most patients had had oestrogen therapy and a successful real-life experience for a minimum of 1.5 years. The mean size of implants has nearly doubled over the years. Male-to-female trans-sexuals often request large breasts and repeated augmentation mammaplasties were required, mainly in cases where the result of initial augmentation was not outspoken.
The multidisciplinary cleft team of the Academisch Ziekenhuis Vrije Universiteit treats cleft patients until they are 18 years old, when treatment is supposedly complete, with patients having a minimum of residual facial stigmata. The authors evaluated the relationship between objective residual facial deformities present and the patients' subjective judgment of the result of treatment by interviewing 50 patients (age range, 19-25 years) regarding their facial appearance and possible remaining wishes for secondary correction. All patients were subjected to 13 in vivo anthropometric measurements, and 5 inclinations were assessed on lateral facial photographs. The results of these measurements were compared with normal values to establish possible objective deformities. The subjective and the objective results were compared for each individual. Anthropometric evaluation revealed an average of 5.3 divergent measurement values per patient (range, 1-8 divergent values). No correlation was found between objective judgment and the patient's subjective judgment. A weak negative correlation could be demonstrated between the score on a visual analog scale and the wish for secondary correction. Surgeons should be aware that cleft patients have no anthropometric interest in their facial appearance.
Illicit subcutaneous injections of massive quantities of highly viscous fluids are still performed, often by unqualified persons. Fifteen male-to-female transsexuals consulted the authors regarding their devastating long-term outcomes after the injection of up to 8 liters of alleged silicone or mineral oil to feminize their bodies. After a latency period of up to 17 years, these injections led to complications ranging from scarring and deformity to infections. These patients were treated conservatively for inflammation and infection or surgically by resection of the oil-infested areas. In view of the potential dangers, feminization by the injection of high-viscosity fluids should be soundly condemned.
Testosterone and its metabolite dihydrotestosterone are the libido hormones for the male, vital to sex drive and sexual function. Fear of loss of libido and orgasm is the main reason to retain at least one testis in male-to-female transsexuals during vaginoplasty. We report on four South American transsexual patients in whom we resected a remaining testis to illustrate the superfluity of retaining it. Because there are multiple reasons for castration, we advise that bilateral orchidectomy be performed in the course of sex reassignment surgery for male-to-female transsexuals.
OBJECTIVE: To present a historical appraisal of the use of anthropological and cephalometrical facial soft tissue measurements in cleft patients. DESIGN: The McDowell Indexes and a Medline search were used to trace references up to 1999. Also, references listed with chapters and articles on facial clefts were searched for anthropometrical studies. Twenty-six retrieved articles and book chapters on soft tissue anthropometry and 12 cephalometric publications on soft tissue measurements on radiographs and plaster casts of cleft patients were reviewed. RESULTS AND CONCLUSIONS: Since 1931, the facial soft tissue appearance of cleft patients has been evaluated by means of anthropometric and cephalometric techniques. Not all of the older studies were performed in a statistically correct fashion. Many of the conclusions of the studies overlap despite differences in technique of assessment. Most studies demonstrate the deficient growth of the maxilla and the deformities of the facial profile in cleft patients.
Two hundred and thirty-seven of 2052 cattle which had not been vaccinated against bovine herpesvirus 1 (BHV-1) were seropositive in a glycoprotein B (gB)-blocking ELISA, but seronegative in a glycoprotein E (gE)-blocking ELISA. In order to detect whether they were latently infected with BHV-1, 10 of them were treated with corticosteroids in an attempt to reactivate putatively latent virus. After successive treatments with dexamethasone and prednisolone, no virus excretion was detected and they showed no increase in antibody titres. In contrast, one gE-seropositive animal re-excreted BHV-1 and had a four-fold increase in antibody titre after the corticosteroid treatments. After slaughter, no BHV-1 DNA could be detected with a sensitive PCR in samples of the trigeminal, cervical and sacral ganglia and spinal cords of the gE-seronegative cattle.
A small scale transmission experiment was performed with bovine herpesvirus 1 (BHV1) in a cattle population under field conditions. 10 calves were housed under strict hygienic conditions, with a distance of 4m between each calf. Five calves were experimentally infected with BHV1, two calves with strain Harberink and three with strain Lam, respectively. Experimentally infected calves were placed at 4 m distance from five susceptible sentinel calves. Airborne transmission to sentinel calves was detected using virus isolation and BHV1 specific polymerase chain reactions in samples of nasal fluids, and BHV1 specific antibodies in serum samples. Strain Harberink was hardly transmitted to sentinel calves, whereas strain Lam was transmitted to all sentinels. Estimating the rate of transmission per day, the total number of calves infected by one (strain Lam) infected calf was 1.18. Comparing this estimated transmission ratio between cattle at a distance of 4 m to the estimated transmission ratio R of BHV1 in susceptible commingled cattle reported before, the effect of the factor distance on the transmission ratio could be calculated. Extrapolating these results, a distance of 4.4 m between cattle populations would be necessary to reduce transmission for this strain to R<1.
Plastic surgeons have contributed to the constructive and reconstructive surgery of the external genitals. This development followed the increase of surgical-technical possibilities. Whereas in the past the possibilities were limited to transplantation of skin grafts and pedicled flaps, they have now been supplemented by free transplantation using microsurgical techniques. Other specialists have adopted the techniques developed by plastic surgeons. In future, in the structive surgery of genitals use will be made of the growing possibilities of transplantation of donor organs and the results of investigation of tissue cultures and biomaterials. The demand for aesthetical corrections of the external genitals will increase.
BACKGROUND: Ovarium cancer is the fifth most common cause of cancer-related death in women and is the most common fatal gynecologic malignancy. So far, ovarium carcinoma has not been reported to have occurred in female-to-male transsexuals. OBJECTIVE AND METHOD: We report on two such cases. Long-term exposure to increased levels of endogenous and exogenous androgens is hypothesized to constitute an additional risk factor in transsexuals as it has been associated with ovarian epithelian cancer. CONCLUSION: Simultaneous salpingo-oophorectomy should be performed in any female-to-male transsexual undergoing hysterectomy in the course of gender-confirming therapy.
Fractures of the base of the metacarpals are usually treated conservatively. The intra-articular fracture of the base of the first metacarpal ('Bennett fracture') is an exception to this rule because inadequate repositioning and fixation of the dislocated radial fragment lead to permanent deformity of the joint and subsequent degenerative joint disease. The dislocated intra-articular fracture of the base of the fifth metacarpal is similar to a Bennett fracture in many aspects. Repositioning of this 'mirrored' Bennett fracture cannot be guaranteed by a plaster cast. Inadequate repositioning will lead to pain, reduced strength and early degenerative joint disease. We present six patients with dislocated intra-articular fractures of the base of the fifth metacarpal to illustrate the necessity of surgical reduction and fixation.
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The communicating branch between the fourth and third common digital nerves in the palm of the hand was studied. The incidence and branching pattern were studied in 53 dissected cadaveric hands. The "danger zone" in which the nerve is at risk during surgery was established using morphometric data. A communicating branch was found in 50 hands. It originated proximally from the fourth common digital nerve to join the third common digital nerve distally in 44 hands and traversed perpendicularly between the third and fourth common digital nerves in 4 hands. In the 2 remaining hands the branch left the third common digital nerve proximally to join the fourth digital common nerve distally. In 90% of the hands the ramus communicans crossed over in the middle third of the palm of the hand. As a cautious measure, hand surgeons should take into account that this structure could cross over anywhere in the middle three fifths of the palm.
A retrospective survey of long-term postoperative male-to-female transsexual patients has been performed to evaluate how well augmentation mammaplasty addresses their needs. One hundred and seven (65%) out of 164 anonymous questionnaires sent to the patients were evaluated. Average clinical follow-up of these patients was 4.8 years, whereas the average time lapse between mammaplasty and filling out of the questionnaire was 5.5 years (range, 16 months-17 years). The age of the subjects at the time of this survey ranged from 22 to 76 years (average, 41 years). Seventeen of the 107 patients had undergone further augmentation mammaplasty, on average 57 months after the initial mammaplasty. The average size of implanted prostheses was 258 ml (range, 130- 450 ml). Eighty patients (75%) indicated satisfaction with the final outcome of the mammaplasty. The median postoperative cup size in this group was B (range of postoperative bra size, 30B-40D). The remaining 27 patients (25%) were unhappy with the results of mammaplasty. The median postoperative cup size in the 18 patients who still felt their breasts to be too small was also B (range of bra size, 30B-48E). The average size of current prostheses in these 18 patients was 261 ml. For a male-to-female transsexual patient to appreciate the outcome of augmentation mammaplasty, the surgeon should tolerate and address this patient's urge for a distinctly feminine breast configuration.
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The histologic changes induced in the mammary gland of male-to-female transsexuals have not yet been reported in the literature. We studied the histologic changes induced by chemical and surgical castration and estrogen therapy in the breasts of 14 such patients, with particular reference to acinar and lobular formation. To objectify the influence of cross-sex treatment, the histologic findings were compared with those in two men treated hormonally for prostate cancer. The slight increase in the plasma estrogen-to-androgen ratio seen in idiopathic gynecomastia usually does not induce acinar and lobular formation in the male breast. In men treated with nonprogestative antiandrogens for prostate cancer, only moderate acinar and lobular formation occurs. Only in male-to-female transsexuals in whom progestative chemical castration is combined with feminizing estrogen therapy will full acinar and lobular formation occur with hormonally stimulated nuclei and pseudolactational changes. Hence, combined progestative antiandrogens and estrogens are necessary for genetically male breast tissue to mimic the natural histology of the female breast. Orchidectomy does not contribute to this. Apocrine metaplasia may occur in breasts of male-to-female transsexuals, but so far, only four cases of breast cancer in male-to-female transsexuals have been documented.