Female-to-male transgender chest reconstruction: a large consecutive, single-surgeon experience.

INTRODUCTION: Chest reconstruction in the female-to-male transgender individual is not a common procedure due to the low prevalence of intractable gender dysphoria. It means that few surgeons acquire sufficient expertise and many UK patients find themselves travelling abroad to centres such as Singapore, Amsterdam and the United States. PATIENTS AND METHODS: This study retrospectively evaluated 100 consecutive patients of a single surgeon over a 3-year period with prime outcome measures including surgical technique, complications, surgical revision and patient-reported satisfaction, using a simple, 1-5 linear analogue scoring system. RESULTS: The median age was 28 years with a median excision of 345 g per breast. Complications occurred in 11 patients, five of which required surgical haematoma evacuation. Chi(2) analysis failed to show a correlation between testosterone supplementation and haemorrhagic sequelae (p>0.1). To date, 16 patients have undergone supplementary surgery, predominantly axillary dog-ear revision. Overall patient-reported satisfaction was 4.25. CONCLUSIONS: Whilst only a part of the process in gender transitioning, chest reconstruction is important as it is frequently the initial surgical procedure and enables the large-breasted to live in their chosen role much more easily. Historically associated with high rates of both complication and revision surgery, this study demonstrates that both may be appreciably lower and associated with high levels of patient satisfaction so that there is a realistic, high-quality option for British patients who might otherwise feel the need to travel abroad for their surgery.

An exploratory qualitative study on perceptions about mosquito bed nets in the Niger Delta: what are the barriers to sustained use?

BACKGROUND: The effectiveness of malaria control programs is determined by an array of complex factors, including the acceptability and sustained use of preventative measures such as the bed net. A small-scale exploratory study was conducted in several locations in the Niger Delta region, Nigeria, to discover barriers against the use of bed nets, in the context of a current drive to scale up net use in Nigeria. METHODS: A qualitative approach with a convenience sample was used. One to one interviews with mostly male adult volunteers were undertaken which explored typical living and sleeping arrangements, and perceptions about and barriers against the use of the mosquito prevention bed net. RESULTS: Several key issues emerged from the qualitative data. Bed nets were not reported as widely used in this small sample. The reasons reported for lack of use included issues of convenience, especially net set up and dismantling; potential hazard and safety concerns; issues related to typical family composition and nature of accommodation; humid weather conditions; and perceptions of cost and effectiveness. Most barriers to net use concerned issues about everyday practical living and sleeping arrangements and perceptions about comfort. Interviewees identified were aware of malaria infection risks, but several also indicated certain beliefs that were barriers to net use. CONCLUSIONS: Successful control of malaria and scale up of insecticide-treated net coverage relies on community perceptions and practice. This small study has illuminated a number of important everyday life issues, which remain barriers to sustained net use, and has clarified further questions to be considered in net design and in future research studies. The study highlights the need for further research on the human concerns that contribute to sustained use of nets or, conversely, present significant barriers to their use.

Liposuction: a review of principles and techniques.

For one of the most commonly performed aesthetic procedures, liposuction has a somewhat mixed reputation. This may result from suboptimal technical comprehension and/or poor patient selection. It has also attracted strong commercial pressure from manufacturers of new, sometimes less assiduously-evaluated, technologies. Liposuction is not a panacea for obesity and patients are not always cognisant of this. On the other hand, it can produce highly satisfactory outcomes for well-selected patients and anatomical areas when performed by appropriately-trained operators using properly selected technologies. Although introduced by the Europeans, liposuction was enthusiastically adopted by the North Americans, yet seems to have excited little scientific interest in the UK, despite widespread use. Given the numerous techniques and recent advances, a review may be timely.

Time course characterization of serum cardiac troponins, heart fatty acid-binding protein, and morphologic findings with isoproterenol-induced myocardial injury in the rat.

We investigated the kinetics of circulating biomarker elevation, specifically correlated with morphology in acute myocardial injury. Male Hanover Wistar rats underwent biomarker and morphologic cardiac evaluation at 0.5 to seventy-two hours after a single subcutaneous isoproterenol administration (100 or 4000 microg/kg). Dose-dependent elevations of serum cardiac troponins I and T (cTnI, cTnT), and heart fatty acid-binding protein (H-FABP) occurred from 0.5 hour, peaked at two to three hours, and declined to baseline by twelve hours (H-FABP) or forty-eight to seventy-two hours (Serum cTns). They were more sensitive in detecting cardiomyocyte damage than other serum biomarkers. The Access 2 platform, an automated chemiluminescence analyzer (Beckman Coulter), showed the greatest cTnI fold-changes and low range sensitivity. Myocardial injury was detected morphologically from 0.5 hour, correlating well with loss of cTnI immunoreactivity and serum biomarker elevation at early time points. Ultrastructurally, there was no evidence of cardiomyocyte death at 0.5 hour. After three hours, a clear temporal disconnect occurred: lesion scores increased with declining cTnI, cTnT, and H-FABP values. Serum cTns are sensitive and specific markers for detecting acute/active cardiomyocyte injury in this rat model. Heart fatty acid-binding protein is a good early marker but is less sensitive and nonspecific. Release of these biomarkers begins early in myocardial injury, prior to necrosis. Assessment of cTn merits increased consideration for routine screening of acute/ongoing cardiomyocyte injury in rat toxicity studies.

Characterization of renal papillary antigen 1 (RPA-1), a biomarker of renal papillary necrosis.

Renal papillary necrosis (RPN) is a relatively common toxicity observed in preclinical drug safety testing. It is also observed in a variety of human diseases. RPN is difficult to diagnose without expensive scanning methods or histopathology. A noninvasive biomarker that could be detected at early stages of kidney damage would be of great value both to preclinical drug safety testing and in the clinic. An antibody raised to an unknown epitope of an antigen in rat kidney papilla was found to be specific for collecting duct cells in the kidney; this was termed renal papillary antigen 1 (RPA-1). In this study, the authors show that RPA-1 is an early biomarker of RPN in two different rat models of toxicity: 2-bromoethanamine (BEA) and N-phenylanthranilic acid (NPAA). RPA-1 can be detected in urine at early stages of toxicity and correlates well with the histopathology observed. We also characterized the biochemical properties of RPA-1 and found that the antigen is a high molecular weight membrane bound glycoprotein, with the epitope likely to be carried on an N-linked carbohydrate structure. This study demonstrates that RPA-1 is an excellent marker of RPN that can be used to detect this toxicity in preclinical safety testing.

Platysma-SMAS plication facelift.

Whilst numerous facelifting techniques have been described there remains a continual drive towards minimal access and limited 'downtime' in order to maintain the effects of more aggressive procedures. The MACS (minimal access cranial suspension) lift is well-established, but has limitations, particularly with respect to its vectors and effect on the neck. Platysma-SMAS plication (PSP) represents an evolution that seeks to balance procedural invasiveness with recovery time and aesthetic outcome. The study reports the initial 117 consecutive patients who were followed prospectively. Using a 5-point assessment scale, the cosmetic outcome was graded 4.45 and 4.49 by patients and surgeon respectively at initial follow up. At final follow up 82.2% of scores had either improved or remained the same and overall grading was 4.43 and 4.45 respectively. Complications were seen in 15.4%:3.4% haematoma and 3.4% transient facial nerve motor dysfunction. There were no long-lasting or permanent motor palsies and all occurred in the initial 30th centile. We have found platysma-SMAS plication to give high satisfaction and reproducible results. With the SMAS being plicated rather than being raised as a flap, it is a quick procedure and is safe with regard to the facial nerve. The technique has furthermore been shown to be easily acquired by less experienced aesthetic surgeons.