Wendler Glottoplasty: An Effective Pitch Raising Surgery in Male-to-Female Transsexuals

Objectives: Evaluation of the voice results after Wendler glottoplasty in male-to-female transsexuals (MFTs). Study Design: Retrospective case series. Methods: We retrospectively reviewed 31 MFT patients treated with a Wendler glottoplasty technique. The procedure consists of the CO2-laser de-epithelialization of the anterior commissure along with the anterior third of the two vocal folds, the suturing of the two vocal folds with two 3.0 resorbable threads, and next, the application of fibrin sealant to strengthen the stitches. Voice assessment was based mainly on fundamental frequency, frequency range, maximum phonation time, phonation quotient, estimated subglottic pressure (ESGP), grade of dysphonia (G), and voice handicap index. The measurements were performed preoperatively and on the last follow-up visit and compared using IBM SPSS 20 statistical package (IBM Corp, Armonk, NY). The patients have been divided in two groups (group A younger than 40 years and group B of or older than 40 years) for assessing the influence of the age of treatment on the results. Results: Group A included 19 individuals with mean age of 28.6 years (range: 16-39 years) and group B included 12 individuals with mean age of 51.9 years (range: 45-59 years). The mean follow-up period was 9.2 months. Three cases had previously undergone a cricothyroid approximation elsewhere. We found a significant improvement of mean F0 from 135.8 to 206.3 Hz in total (P = 0.001) and also in both groups, especially in group A (mean F0-postop = 213.8 Hz). The mean frequency range had a tendency to decrease postoperatively, whereas the ESGP was significantly higher in both total sample and group A (P = 0.001, respectively). G was increased postoperatively and presented a statistical significance in group B (P = 0.035). A revision Wendler procedure was necessary for three individuals (9.7%); two of them presented a suture's line breakdown because they did not follow the postoperative recommendations for voice rest and the third one had an insufficient web due to an insufficient estimation of the necessary correction. Conclusion: Wendler glottoplasty seems to be an effective technique to feminize the voice in MFTs with better results when performed in younger individuals. © 2013 The Voice Foundation

Wendler glottoplasty: An effective pitch raising surgery in male-to-female transsexuals

Objectives: Evaluation of the voice results after Wendler glottoplasty in male-to-female transsexuals (MFTs). Study Design: Retrospective case series. Methods: We retrospectively reviewed 31 MFT patients treated with a Wendler glottoplasty technique. The procedure consists of the CO2-laser de-epithelialization of the anterior commissure along with the anterior third of the two vocal folds, the suturing of the two vocal folds with two 3.0 resorbable threads, and next, the application of fibrin sealant to strengthen the stitches. Voice assessment was based mainly on fundamental frequency, frequency range, maximum phonation time, phonation quotient, estimated subglottic pressure (ESGP), grade of dysphonia (G), and voice handicap index. The measurements were performed preoperatively and on the last follow-up visit and compared using IBM SPSS 20 statistical package (IBM Corp, Armonk, NY). The patients have been divided in two groups (group A younger than 40 years and group B of or older than 40 years) for assessing the influence of the age of treatment on the results. Results: Group A included 19 individuals with mean age of 28.6 years (range: 16-39 years) and group B included 12 individuals with mean age of 51.9 years (range: 45-59 years). The mean follow-up period was 9.2 months. Three cases had previously undergone a cricothyroid approximation elsewhere. We found a significant improvement of mean F0 from 135.8 to 206.3 Hz in total (P = 0.001) and also in both groups, especially in group A (mean F0-postop = 213.8 Hz). The mean frequency range had a tendency to decrease postoperatively, whereas the ESGP was significantly higher in both total sample and group A (P = 0.001, respectively). G was increased postoperatively and presented a statistical significance in group B (P = 0.035). A revision Wendler procedure was necessary for three individuals (9.7%); two of them presented a suture's line breakdown because they did not follow the postoperative recommendations for voice rest and the third one had an insufficient web due to an insufficient estimation of the necessary correction. Conclusion: Wendler glottoplasty seems to be an effective technique to feminize the voice in MFTs with better results when performed in younger individuals. © 2013 The Voice Foundation

Impact of Rosuvastatin in Contrast-Induced Acute Kidney Injury in the Elderly: Post Hoc Analysis of the PRATO-ACS Trial

Abstract BACKGROUND: Age is a major predictor of contrast-induced acute kidney injury (CI-AKI). Few studies have focused on CI-AKI in elderly patients with acute coronary syndrome (ACS). METHODS: We compare the incidence of CI-AKI in patients <75 and ≥75 years enrolled in the Protective effect of Rosuvastatin and Antiplatelet Therapy On contrast-induced acute kidney injury and myocardial damage in patients with ACS (PRATO-ACS) study and explore the impact of high-dose rosuvastatin on CI-AKI and clinical outcomes in the 2 age-groups. Statin-naive patients with non-ST-segment elevation ACS scheduled for early invasive strategy (total 504) were randomized to rosuvastatin (40 mg on admission followed by 20 mg/day) or no statin treatment. Contrast-induced acute kidney injury was defined as creatinine increase ≥0.5 mg/dL or ≥25% above baseline within 72 hours after contrast administration. All patients were stratified in tertiles according to baseline high-sensitivity C-reactive protein (hs-CRP). RESULTS: Rate of CI-AKI was significantly higher in patients ≥75 years (15.9% vs 8.7%, odds ratio: 2.001; 95% confidence interval: 1.14-3.53, P = .015). No significant interaction was observed between age and statin treatment (P = .17). Pretreatment with rosuvastatin was associated with 65% relative reduction in CI-AKI rate (22/170 [12.9%] vs 8/177 [4.5%], P = .007) in younger patients and 38% (16/82 [19.5%] vs 9/75 [12%], P = .20) in the elderly individuals. The greatest protective effect of statin treatment was achieved in patients with the highest hs-CRP values in both age-groups. CONCLUSION: Patients ≥75 years with ACS had a higher risk of developing CI-AKI. Early high-dose rosuvastatin is efficacious in reducing kidney injury in all patients, especially those with the highest baseline hs-CRP values

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys