[GHB abuse in a pregnant patient in clinical practice]. / GHB-misbruik bij een zwangere patiënte in de klinische praktijk.

Gamma-hydroxybutyrate (GHB) is a controlled substance that is often abused due to its euphoric, sexual and sedative effects. Both acute intoxication with and withdrawal from GHB are potentially lethal, and need to be treated in an in-patient environment. We report the case of a female patient who used GHB regularly during the first trimester of pregnancy. We subsequently describe available evidence on the impact of GHB on fetal development, and how existing guidelines for GHB detoxification differ in pregnant patients.

[The use of dexmedetomidine in extreme agitation]. / Het gebruik van dexmedetomidine bij extreme agitatie.

BACKGROUND: In clinical practice antipsychotics, benzodiazepines and/or antihistamines are used to calm agitated patients. If agitation persists and patients have contraindications for these substances, then anesthetics, such as propofol, can also be used as well, to serve as a sedative. Our attention was drawn to a particular case in which dexmedetomidine was used as a sedative.
AIM: To study the literature on the use of α2-agonists, such as dexmedetomidine, in the treatment of extreme agitation.
METHOD: We reviewed the relevant scientific literature.
RESULTS: α2-agonists, such as dexmedetomidine, are new anesthetic agents that have analgetic and sympatholytic effects without suppressing respiration. These agents are used frequently in intensive care because their sedative effect are short-lived and do not cause amnesia, sleep deprivation or cognitive disturbance. Excited delirium syndrome (eds) is a type of extreme agitation for which dexmedetomidine can be used.
CONCLUSION: There may well be a place for dexmedetomidine in the treatment of extreme agitation when standard treatments have failed. Further research is needed in order to ascertain whether dexmedetomidine should play a role in such treatment.

Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case-control study.

OBJECTIVE: This study evaluated the short- and long-term cardiovascular- and cancer-related morbidities during cross-sex hormone therapy in a large sample of trans persons. SUBJECTS AND METHODS: A specialist center cross-sectional study compared 214 trans women (male-to-female transsexual persons) and 138 trans men (female-to-male trans persons) with an age- and gender-matched control population (1-3 matching). The participants were on cross-sex hormone therapy for an average of 7.4 years. We assessed physical health and possible treatment-related adverse events using questionnaires. RESULTS: Five percent of trans women experienced venous thrombosis and/or pulmonary embolism during hormone therapy. Five of these adverse events occurred during the first year of treatment, while another three occurred during sex reassignment surgery. Trans women experienced more myocardial infarctions than the control women (P=0.001), but a similar proportion compared with control men. The prevalence of cerebrovascular disease (CVD) was higher in trans women than in the control men (P=0.03). The rates of myocardial infarction and CVD in trans men were similar to the control male and female subjects. The prevalence of type 2 diabetes was higher in both trans men and women than in their respective controls, whereas the rates of cancer were similar compared with the control men and women. CONCLUSION: Morbidity rate during cross-sex hormone therapy was relatively low, especially in trans men. We observed a higher prevalence of venous thrombosis, myocardial infarction, CVD, and type 2 diabetes in trans women than in the control population. Morbidity rates in trans men and controls were similar, with the exception of the increased prevalence of type 2 diabetes.

Penile reconstruction with the radial forearm flap: an update.

BACKGROUND: Many methods and many free or pedicled flaps have been used in phalloplasty. None of these techniques is able to completely fulfill the well described goals in penile reconstruction. Still, the radial forearm glap is currently the most frequently used flap and thus universally considered the gold standard. PATIENTS AND METHODS: Since 1992, we have performed the largest series of 316 radial forearm phalloplasties to date performed by a single surgical team. From these extensive data we critically evaluate how this current supposed gold standard can meet the requirements of an ideal penile reconstruction. RESULTS: We assessed outcome parameters such as number of procedures to achieve complete functional result, aesthetic outcome, tactile and erogenous sensation, voiding, donor site morbidity, scrotoplasty and sexual intercourse. CONCLUSION: While currently no controlled randomized prospective studies are available to prove the radial forearm flap is truly the 'gold standard' in penile reconstruction, we believe that our retrospective data support the radial forearm phalloplasty as a very reliable technique for the creation of a normal looking penis and scrotum. While full functionality is achieved through a minimum of 2 procedures, the patients are always able to void standing, and in most cases to experience sexual satisfaction. The relative disadvantages of this technique are the residual scar on the forearm donor site, the rather high number of initial urinary fistulas, the potential for long-term urological complications and the need for a stiffener or erection prosthesis. From our experience, we strongly feel that a structured multi-disciplinary cooperation between the reconstructive-plastic surgeon and the urologist is an absolute requisite to obtain the best possible technical results.

Prevalence and demography of transsexualism in Belgium.

AIM: The Belgian medical world has acknowledged the diagnosis of transsexualism and accepted Sex Reassignment Surgery (SRS) as one of the steps in the treatment of choice since 1985. This prevalence and demographic study analyses data on all Belgian individuals who have undergone SRS since that year. METHODS: All (188) plastic surgeons as well as all gender teams (Antwerp, Bruges, Ghent, and Liège) in Belgium were sent demographic questionnaires to be completed for each of their transsexual patients. RESULTS: The results show an overall prevalence of 1:12,900 for male-to-female and 1:33,800 for female-to-male transsexuals in Belgium. In Wallonia (the French-speaking region of Belgium) the prevalence is significantly lower than in Flanders (the Dutch-speaking region) and in Brussels (the bilingual capital region). In the total Belgian population the male/female sex ratio is 2.43:1, again with a substantial difference between Wallonia on the one hand and Flanders on the other. DISCUSSION AND CONCLUSION: While in Flanders and in Brussels the prevalence is comparable to that in other Western European countries, in Wallonia it is markedly lower. Transsexualism in Wallonia appears to be socially less acceptable: persons suffering from gender dysphoria in that part of Belgium encounter more problems accessing gender clinics and receiving treatment.