A controlled study of psychological and social change after surgical gender reassignment in selected male transsexuals

Article Abstract:

There has been a large increase in the number of sex-change operations since the first one was described in 1931, but differences of opinion in regard to outcome have not been resolved. To help assess the outcome of these operations, a prospective study of two groups of 20 male transsexuals waiting for gender reassignment surgery was carried out. On referral to the clinic, all of the men were given a battery of psychological tests including a measure (the CCEI) which assessed various neurotic symptoms such as free-floating anxiety, phobic anxiety, obsessive tendencies, somatic anxiety, depression and hysteria. A sex-role inventory (the BSRI) which assesses 'masculine' and 'feminine' traits was also administered. Several months later, 20 of the 40 patients waiting for surgery were offered early surgery (group A). The other 20 were treated routinely (group R), which meant they had to wait two to three years for surgery. After a two-year follow-up, group A had undergone surgery about one year and nine months previously, while group R was still waiting. Analysis of the data showed the two groups to be similar in terms of personal and psychiatric histories. At the onset of the study, no significant differences between the two groups were found in any assessment measure scores. After two years, social and sexual activity had increased significantly in group A, while group R remained static. All CCEI scores except free-floating anxiety increased significantly in group R, and decreased significantly in group A. BSRI scores did not change significantly between groups. Overall, the men who had sex-change surgery improved significantly in terms of neurotic symptoms, and became more active socially, sexually and occupationally after their surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Evaluation, Surgery, Transsexuals, Sex change

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Efficiency of enteral nitrogen support in surgical patients: small peptides v non-degraded proteins

Article Abstract:

Following surgery, one means of providing adequate nutrition to the recovering patient is by means of enteral nutrition, or infusion of nutrients directly into the stomach. One critical component of the nutrient supply is amino acids, which are necessary for wound healing, immune system function, and prevention of muscle wasting. The form in which these amino acids are administered, i.e. whether they are in the ordinarily ingested form of proteins, or proteins subjected to hydrolysis (which breaks them down into smaller peptide fragments and their constituent amino acids), is thought to be important in determining how available the amino acids are to the body. Studies to date have not been conclusive in this regard. Twelve patients in the intensive care unit were evaluated for response to two types of enteral nutrition: one contained hydrolysed casein and lactoserum (two protein sources), while the other contained the same caloric density of the unhydrolysed protein. Patients' blood levels of 13 amino acids (including eight amino acids that cannot be synthesized by the body and must be supplied in the diet) were increased following administration of the hydrolysed mixture; only two amino acids were increased following administration of the unhydrolysed protein diet. Insulin levels were significantly increased only following administration of the hydrolysed mixture, and several other parameters indicative of adequate amino acid levels were increased only following the hydrolysed diet. It is concluded that enteral diets containing small peptide fragments (i.e. the hydrolysed form) are more effective than using whole proteins in maintaining amino acid and protein levels in postoperative patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Methods, Enteral feeding, Enteral nutrition, Postoperative care, Protein hydrolysates

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Late cholangitis after successful surgical repair of biliary atresia

Article Abstract:

Biliary atresia (incomplete development, or absence of, the bile ducts) is a surgically correctable condition; since the bile ducts convey bile from the gall bladder, where it is stored, to the digestive tract, biliary atresia is associated with gallbladder distention and jaundice (yellowish color to the skin). After surgical intervention, however, a significant proportion of patients develop bacterial cholangitis (inflammation of the bile ducts). This is a serious condition that can lead to death. Most patients with this complication are younger than one year old, and its frequency decreases with age. The case histories are presented of four children who underwent surgery for biliary atresia, then developed acute cholangitis much later in life (between the ages of 7 and 13). All underwent extensive testing and were given antibiotics, which successfully treated their inflammation. In one patient, who had more than one episode of cholangitis, the disease resolved spontaneously. The children's general health was good, and liver function tests were normal, although signs of liver pathology were present. Bile flow was normal, making it likely that the source for the cholangitis was intestinal bacteria that ascended into the biliary system. When children develop signs of late cholangitis, they should be observed for a few days, if possible, after blood cultures have been taken. If these yield a negative result, liver biopsy specimens should be obtained, and antibiotic treatment started. This approach allows spontaneous recovery to take place before treatment starts. Recurrences should be investigated further to determine whether an obstruction in the area of the surgical wound is present. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Case studies, Complications and side effects, Cholangitis, Pediatric gastroenterology, Biliary atresia

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