Neovaginal construction in vaginal aplasia and sex-reassignment surgery.

During the period 1984-1994 33 patients were admitted to the department of plastic surgery for the purpose of neovaginal construction. They comprised 22 patients with vaginal agenesis or aplasia and 11 transsexual men. In most cases neovaginal construction was done by blunt dissection and lining with a split thickness skin graft from the thigh, and in the cases of sex-reassignment surgery genital skin was also used. The two groups differed as the patients with vaginal agenesis or aplasia had remarkably few complications compared with the transsexual group. The most common complications were defects in the skin grafts and vaginal stenosis. The transsexuals therefore had an extended recovery period including several admissions and visits to the outpatient clinic. The difference in genotype does not explain the high complication rate in the transsexual group as eight in the vaginal agenesis or aplasia group had Morris syndrome (testicular feminisation (XY)). However, the phenotype may be of importance in vaginal construction as the male (transsexual) pelvis is narrow and the levator muscles are stronger than those in the female pelvis.

[Idiopathic aortoduodenal fistula]. / Idiopatisk aortoduodenal fistel.

A case of primary aortoduodenal fistula of unknown origin in a 72 year old female is presented. The fistula was successfully treated by excision from the duodenum and direct suture of the aortic wall.

[Incidence and treatment of urinary calculi in patients in Frederiksborg County]. / Forekomst og behandling af sten i urinveje hos patienter i Frederiksborg Amt.

The case records of all patients admitted to one of the hospitals in the County of Frederiksborg with radiologically demonstrated first episodes of urinary calculi during a period of one year in 1983/1984 and 1988/1989 respectively were reviewed retrospectively. Uniform frequencies of calculus incidence and sex distribution were encountered mutually and as compared with the remainder of Denmark during the two periods. In 30% of the cases the calculi were localized to the kidneys and in 58% to the ureter. In approximately 65% of the patients, the greatest diameter of the stones was 100 mm or less. Spontaneous passage of the stones occurred in approximately 40%. Development in the treatment of urinary tract stones has followed the development in the county as a whole. The number of operative interventions during the five year period was reduced by 30% and extracorporeal shock wave treatment was employed in 22% during the second period.

Neuroendocrine mechanisms during reversible hypovolaemic shock in humans with emphasis on the histaminergic and serotonergic system.

In humans, the head-up tilted position results in central hypovolaemia which mimicks haemorrhage and is associated with cardiovascular changes that can be divided into two stages. 1) One stage with increase in HR and vascular resistance and a slight increase in MAP. 2) Another stage with decrease in HR, vascular resistance and MAP and appearance of presyncopal symptoms (hypovolaemic shock). The first stage is "sympathoexcitatory" as plasma NA originating from postganglionic vasoconstrictory sympathetic neurons increase. Limb vascular resistance contributes to the increase in TPR at this time. The second stage is "sympathoinhibitory" in nature as plasma NA slightly decreases, or remains unchanged, while plasma A, originating from the adrenal medulla, raises. This pattern is a reflection of a differentiated sympathetic response as an increase in the activity of the nerves innervating the adrenals and decrease in renal sympathetic nerves has been reported by others. There is a decrease in limb as well as total vascular resistance. The secretion of potent vasoactive peptides may contribute to the circulatory changes taken place during head-up tilt. The head-up tilted position is associated with central hypovolaemia which is reliably monitored by electrical impedance. There is a close relation between the increase in thoracic electrical impedance and the decrease in plasma ANP which is regulated by atrial stretch. Also, from recording of technetium labeled red blood cells and measurements of haematocrite the decrease in CBV is reflected by thoracic electrical impedance. In contrast, CVP reflects changes in CBV during the initial head-up tilt only, whereafter CVP usually is unchanged or may even increase. After the initial head-up tilt the decrease in the CBV is caused by further reduction in plasma volume as shown by increase in haematocrite and unchanged distribution of labeled red blood cells. This mechanism is reflected by application of regional electrical impedance measurements at a low and high frequency current. The low frequency current, passing extracellular fluid only, changing more than the high frequency current that passes extra as well as intracellular fluid. Central hypovolaemia was found to stimulate the pituitary-adrenal axis, and the development of hypotension strongly increases plasma ACTH, beta-END, cortisol and PRL. Blocking histaminergic receptors did not change the pituitary-adrenal response to central hypovolaemia, while the sympathoadrenal response was affected by histaminergic receptor blockade. The H2-receptor antagonist cimetidine inhibited plasma A, while the H1-receptor antagonist mepyramine attenuated plasma NA and reduced cardiovascular tolerance, and also induced some sedation. A possible effect of sedation and anxiolysis was investigated by administration of the GABAergic drug diazepam. This drug did not change the cardiovascular response to head-up tilt, but reduced the increase in plasma cortisol. This indicates that the appearance of presyncopal symptoms is not related to "stress" but associated with the cardiovascular effects of central hypovolaemia. Another endogenous substance, serotonin (5-HT), may be also involved in cardiovascular as well as endocrine regulation. We investigated the effect of blocking three main receptors on the development and effects of hypovolaemic shock. Methysergide (5-Ht1+2-receptor antagonist) attenuated plasma NA, beta-END, PRL and PRA during tilt with a slight reduction of cardiovascular tolerance. The 5-HT2-receptor antagonist ketanserin reduced cardiovascular tolerance without significant effects on the hormonal responses. The 5-HT3-receptor antagonist ondansetron inhibited the plasma CGRP and adrenalin response to central hypovolaemia without influencing cardiovascular tolerance. It is concluded that the head-up tilted model in humans can be applied to study cardiovascular and endocrine mechanisms until the development of hypovolaemic shock.(ABSTRACT TRUNCATED)