Outcome and refinements of gender confirming surgery

Introduction Gender dysphoria is a state in which the individual shows strong and persistent identification with the opposite sex. After thorough diagnostic assessment, the treatment includes gender confirming surgery (GCS). The efficacy and benefit of GCS has been advocated to effectively resolve the patient’s gender dysphoria as well as improve quality of life and psychosocial functioning. The aim of the studies described here was to assess surgical techniques, complications, quality of life and functional outcomes of GCS. Patients and Methods Study I is a retrospective study ofsurgical outcomes for patients who underwent male-tofemale (MtF) GCS over a 14-year period (n=205). Study II describes a prospective study (n=80) of vaginal depth after vaginoplasty performed using solely penile skin for intra vaginal lining. Factors predicted to correlate with poor outcomes were analyzed using a multivariate regression model. Study III is a prospective study (n=193) examining patient-reported outcomes on health-related quality of life. We used the Swedish version of the Short Form-36 Health Survey (SF-36), which measures QoL across eight domains. The questionnaire was distributed to patients pre-operatively, as well as 1,3 and 5 years post-operatively. The results were compared between the different measure points, as well as between the study group and the general population. Study IV is a cohort study (n=22) of the sensitivity of the neoclitoris and its patient-reported functionality. Tactile and vibratory sensitivity was measured with the Semmes-Weinstein monofilaments and the Bio-Thesiometer vibratory measurement device, respectively. A body image questionnaire was provided to patients and the patients were asked about orgasm, pain and general satisfaction with the surgery. Results In study I, the most common short-term complications were bleeding (11%) and infection (10%). Other complications, such as wound dehiscence (2%), rectovaginal fistula (2%), pulmonary embolus (2%) and deep vein thrombosis (0%), were rare. In study II, the average neovaginal depth was 10.2 cm (range 1 -16 cm). Noncompliance with dilation protocol (p<0.001) and postoperative complications (p=0.01) were associated with decreased vaginal depth. Neither circumcision nor age affected the outcome of vaginal depth. In study III, transgender women reported significantly lower quality of life in most dimensions when compared to the general population. One year postoperatively, there was a trend towards higher scores compared to the preoperative measurement point; however, these scores then declined. In study IV, the average pressure threshold for the neoclitoris was 12.5 g/mm2 and the average vibratory threshold was 0.3 µm. The vast majority of the study participants could reach orgasm (86%), and reported satisfaction with having undergone GCS (86%). Conclusions MtF GCS can be performed with a low rate of major complications. Using solely penile skin is sufficient to create the vaginal lining, although adhering to a dilation protocol is crucial to attaining sustained vaginal depth. Quality of life among MtF patients compared to the general population is improved one year after GCS, but then declines. The sensate neoclitoris has a protective tactile sensation, gives the patient erogenous sensitivity and the ability to reach orgasm in the majority of patients. Over all, the vast majority of patients who undergo MtF GCS are satisfied

Congenital diaphragmatic hernia diagnosed in adulthood--a case report and review of the literature

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenCongenital diaphragmatic hernia (CDH) is a rare anomaly (1 of 2-4000 live births) where abdominal organs can enter the thoracic cavity. It is usually diagnosed shortly after birth, often associated with pulmonary hypoplasia and pulmonary hypertension causing life threatening condition. In approximately one out of four patients CDH is diagnosed later in life, usually within several weeks or months from birth. CDH diagnosed in adulthood is very uncommon. Here we describe a 45 year old previously healthy woman that was diagnosed with a large tumor in her right hemithorax, after having symptoms of chronic cough and chest pain for several months. At thoracotomy the tumor was found to be omentum covered with a hernial sac that had penetrated the chest through a small diaphragmatic hernia. Six months postoperatively she was doing well with no respiratory or abdominal symptoms.Meðfætt þindarslit er sjaldgæfur sjúkdómur (1 af hverjum 2-4000 lifandi fæddum börnum) sem getur haft þær afleiðingar að kviðarholslíffæri smeygja sér upp í brjóstholið. Auk þess eru lungu þessara sjúklinga oft vanþroskuð og lungnaháþrýstingur til staðar sem hvort tveggja getur valdið lífshættulegri öndunarbilun. Flestir þessara sjúklinga greinast á fyrsta sólarhring eftir fæðingu en fjórðungur síðar á ævinni, langoftast á fyrstu vikum eða mánuðum ævinnar. Það er mjög sjaldgæft að meðfætt þindarslit greinist á fullorðinsaldri. Hér er lýst 45 ára gamalli áður hraustri konu sem greindist með stóra fyrirferð í hægra brjóstholi. Hún hafði um sex mánaða skeið fundið fyrir hósta og verk í hægra brjóstholi. Við aðgerð kom í ljós að fyrirferðin innihélt netju sem þakin var lífhimnu og reyndist orsökin vera lítið þindarslit. Bati var góður eftir aðgerð og rúmu hálfu ári síðar var hún einkennalaus frá bæði lungum og kviðarholi

Reoperation for bleeding following open heart surgery in Iceland

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenINTRODUCTION: Postoperative bleeding is a common and potentially fatal complication following open heart surgery, studies reporting a reoperation rate for bleeding in the range of 2-6%. Surgical outcome after such reoperations has not been previously studied in Iceland. MATERIAL AND METHODS: In this retrospective study were included all adults that underwent open heart surgery in Iceland during a 6 year period, between January 1, 2000 and December 31, 2005. RESULTS: There were 103 reoperations (mean age 68 years, 76% males), but throughout the same 6 year period a total of 1295 open heart procedures were performed, the reoperation-rate being 8%. One third of all patients were on aspirin and 8% on clopidogrel less than 5 days before surgery. The bleeding in the primary operation averaged 1523 ml (range 300-4780) and 3942 ml for the first 24 hours postoperatively. Half of the patients were reoperated on within 2 h and 97% within 24 hours. The patients received on average 16.5 units of packed cells, 15.6 units of plasma and 2.3 sets of thrombocytes. The most common postoperative complication was atrial fibrillation (58.3%), pleural effusion that needed chest tube drainage (24.3%), myocardial infarction (23.3%) and sternal wound infection (11.7%). Median length of stay was 14 days (range 6-85), including 2 days (range 1-38) in ICU. Operative mortality was 15.5% and 1 year crude survival 79.6%. CONCLUSION: Reoperation-rate for bleeding was 8%, which is higher compared to other studies. Bleeding is a serious complication following open heart surgery with high morbidity and significant mortality.Tilgangur: Að kanna tíðni og árangur enduraðgerða vegna blæðinga eftir opnar hjartaaðgerðir á Íslandi á sex ára tímabili. Efniviður og aðferðir: Sjúklingar ≥18 ára sem gengust undir enduraðgerð vegna blæðinga eftir opna hjartaskurðaðgerð á tímabilinu 2000-2005 voru fundnir eftir tveimur aðskildum skrám. Skráðar voru ýmsar breytur, svo sem lyf sjúklings fyrir aðgerð, blóðgjafir, fylgikvillar og legutími. Niðurstöður: Alls voru gerðar 103 enduraðgerðir sem er 8% hjartaaðgerða á tímabilinu. Þriðjungur sjúklinganna var á acetýlsalicýlsýru og átta á klópídógreli síðustu fimm dagana fyrir aðgerð. Meðalblæðing í upphafi enduraðgerðar var 1523 ml og á fyrsta sólarhring 3942 ml (bil 690-10.740 ml). Helmingur sjúklinganna var tekinn í enduraðgerð innan tveggja klukkustunda og voru samtals gefnar 16,5 einingar af rauðkornaþykkni, 15,6 af blóðvökva (plasma) og 2,3 sett af blóðflögum. Helstu fylgikvillar eftir aðgerð voru hjartsláttaróregla, fleiðruvökvi sem þurfti að tæma út, hjartadrep og sýking í bringubeinsskurði. Miðgildi legutíma var 14 dagar (bil 6-85), þar af tveir dagar á gjörgæslu. Alls létust 16 sjúklingar (15,5%) ≤30 daga frá aðgerð en 79,6% sjúklinganna voru á lífi ári eftir aðgerð. Ályktun: Tíðni enduraðgerða vegna blæðinga (8%) er í hærra lagi hér á landi, án þess að skýringin á því sé þekkt. Þetta er hættulegur fylgikvilli sem lengir legutíma, eykur kostnað og getur dregið sjúklinga til dauða. Inngangu

Outcome of myocardial revascularisation in Iceland

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Open Allur texti - Full textIn Iceland over 3500 coronary artery bypass operations have been performed, both On-Pump, using cardiopulmonary bypass and Off-Pump, surgery on a beating heart. The aim was to study their outcome. This was a retrospective study on 720 consecutive patients who underwent surgical revascularisation at Landspítali-The National University Hospital of Iceland between 2002-2006; 513 On-Pump and 207 Off-Pump patients. Complications and operative mortality (<30 days) were compared between the groups and predictors of survival identified using multivariate analysis. The number of males was significantly higher in the On-Pump group, but other risk factors of coronary artery disease, including age and high body mass index, were comparable, as were the number of distal anastomoses and EuroSCORE. The Off-Pump procedure took 25 minutes longer on average and chest tube output was significantly increased, but the amount of transfusions administered was similar. The rate of minor complications was higher in the On-Pump group. Of the major complications, stroke rates were similar in both groups (2%) but the rate of reoperation for bleeding was higher in the On-Pump group. Mean length of hospital stay was one day longer for On-Pump patients but operative mortality was similar for both groups (4% vs. 3%, p=0.68) as was 5 year survival (92% in both groups). In multivariate analysis both EuroSCORE and age predicted outcome of operative mortality and long term survival but type of surgery (On-Pump vs. Off-Pump) was not a predictive variant. Outcome of myocardial revascularisation in Iceland is good as regards operative mortality and long term survival. This applies to both conventional On-Pump and Off-Pump procedures.Inngangur: Á Íslandi hafa verið framkvæmdar um 3500 kransæðahjáveituaðgerðir, annað hvort með hjarta- og lungnavél (HLV) eða á sláandi hjarta (SH). Tilgangur rannsóknarinnar var að kanna árangur þessara aðgerða hér á landi. Efniviður og aðferðir: Rannsóknin var afturskyggn og náði til 720 sjúklinga sem gengust undir kransæðahjáveituaðgerð á Landspítala árin 2002-2006 og skiptust þeir í tvo hópa; 513 einstaklinga sem gengust undir aðgerð með HLV (HLV-hópur) og 207 á SH (SH-hópur). Fylgikvillar og dánartíðni innan 30 daga voru borin saman milli hópa og forspárþættir lifunar metnir með ein- og fjölbreytugreiningu. Niðurstöður: Karlar voru fleiri í HLV-hópi en áhættuþættir kransæðasjúkdóma, aldur og líkamsþyngdarstuðull reyndust sambærilegir milli hópa, einnig fjöldi æðatenginga og EuroSCORE. Aðgerðir á sláandi hjarta stóðu 25 mínútum lengur og blæðing í brjóstholskera var marktækt aukin en magn blóðs sem var gefið var sambærilegt í báðum hópum. Minniháttar fylgikvillar voru algengari í HLV-hópi (58% á móti 48%, p<0,05). Af alvarlegum fylgikvillum voru enduraðgerðir vegna blæðinga algengari í HLV-hópi og heildarlegutími rúmum sólarhring lengri. Dánartíðni innan 30 daga var hins vegar áþekk í báðum hópum (4% á móti 3%, p=0,68), einnig 5 ára lifun sem var í kringum 93% í báðum hópum. Í fjölbreytugreiningu spáðu hærra EuroSCORE og aldur fyrir dánartíðni innan 30 daga og langtímalifun en ekki tegund aðgerðar (HLV eða SH). Ályktanir: Árangur kransæðahjáveituaðgerða á Íslandi er góður, bæði hvað varðar dánartíðni innan 30 daga og langtímalifun. Þetta á jafnt við um aðgerðir sem framkvæmdar eru með aðstoð HLV og á sláandi hjarta

Apical ballooning syndrome, case series

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenApical ballooning syndrome is a cardiac syndrome typically characterized by transient focal dyskinesia or akinesia of the mid and apical regions of the left ventricle and hyperkinesia of the basal region. The symptoms and signs of the patient mimic myocardial infarction, with chest pain, electrocardiographic changes and elevation of cardiac enzymes but without significant coronary artery disease. The syndrome is frequently preceded by physical or emotional stress. We describe three cases of apical ballooning syndrome diagnosed during 10 days in December 2007 at Landspítali University Hospital Reykjavík.Broddþensluheilkenni einkennist af bráðri skerðingu á samdrætti vinstri slegils þar sem broddur og miðhluti hans þenjast út, en kröftugur samdráttur er í grunnhluta. Heilkennið er mun algengara hjá konum. Líkamlegt eða andlegt álag getur verið orsakavaldur. Einkenni og teikn sjúklings líkjast bráðu kransæðaheilkenni með brjóstverk, breytingum á hjartalínuriti og hækkun á hjartaensímum. Ekki finnast marktækar þrengingar í kransæðum. Heilkennið er afturkræft. Lýst er þremur tilfellum af broddþenslu sem voru greind á hjartadeild Landspítala á 10 dögum í desember 2007

Impact of obesity on surgical outcomes following coronary artery bypass graft surgery

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Introduction: Obesity has been related to increased postoperative morbidity and mortality following open-heart surgery. However, recent studies have shown no association or even a more favourable outcome in obese patients. This relationship was investigated in a well-defined cohort of patients that underwent myocardial revascularisation in Iceland. Material and methods: A retrospective study including all patients that underwent isolated myocardial revascularisation in Iceland from 2002 to 2006. Alltogether 720 patients were divided into two groups, an obese group, with BMI >30 kg/m2 (n=207, 29%), and a non-obese group with BMI ≤30 kg/m2 (n=513, 71%). Patient demographics, complications, operative mortality and long term survival of both groups were compared. Results: Demographics were comparable between the groups. Obese patients were 2.4 years younger, more likely to use statins (83,3% vs. 71,2%, had a significantly lower EuroSCORE (4.3 vs. 5.0) but a slightly longer operation time. Pleural fluid was less often drained in obese patients (8.2 vs. 15.0%) but rates for other complications were similar in both groups, as was operative mortality ≤30 days (2.0% vs. 3.7%), 1 and 5 year survival. In a multivariate analysis obesity was not an independent risk factor for minor or major complications, operative mortality or long term survival. Conclusion: The rate of complications and operative mortality after myocardial revascularisation is not significantly higher in obese patients and the same applies to long term survival. This is true even after correcting for confounding factors in a multivariate analysis.Tilgangur: Offita hefur almennt verið talin auka tíðni fylgikvilla eftir skurðaðgerðir. Niðurstöður rannsókna á tengslum offitu við opnar hjartaaðgerðir eru þó misvísandi og til eru rannsóknir sem sýna sambærilega og jafnvel lægri tíðni fylgikvilla. Tilgangur þessarar rannsóknar var að kanna tengsl offitu við árangur kransæðahjáveituaðgerða á Íslandi. Efniviður og aðferðir: Afturskyggn rannsókn á 720 sjúklingum sem gengust undir kransæðahjáveituaðgerð á Landspítala frá 2002-2006. Sjúklingum var skipt í tvo hópa; offituhóp með líkams-þyngdarstuðul >30 kg/m2 (n=207, 29%), og viðmiðunarhóp með stuðulinn £30 kg/m2 (n=513, 71%). Hóparnir voru bornir saman með ein- og fjölþáttagreiningu og áhrif offitu metin með tilliti til tíðni fylgikvilla, skurðdauða £30 daga og langtíma lífshorfa. Niðurstöður: Áhættuþættir hjarta- og kransæðasjúkdóma voru sambærilegir í báðum hópum en sjúklingar í offituhópi tóku oftar blóðfitulækkandi lyf (83,3% sbr. 71,2%, voru 2,4 árum yngri, með lægra EuroSCORE (4,3 sbr. 5,0) en aðeins lengri aðgerðartíma. Sjaldnar þurfti að tappa af fleiðruvökva í offituhópi (8,2% sbr. 15,0%), en annars var tíðni fylgikvilla og dánartíðni £30 daga (2,0% sbr. 3,7%) sambærileg. Við fjölþáttagreiningu reyndist offita ekki sjálfstæður áhættuþáttur minniháttar fylgikvilla, alvarlegra fylgikvilla, dánartíðni £30 daga eða langtíma lífshorfa. Ályktun: Fylgikvillar og dánartíðni eftir kransæðahjáveituaðgerð reyndust ekki marktækt aukin hjá offitusjúklingum, jafnvel eftir að leiðrétt var fyrir hugsanlegri valbjögun, eins og lægra EuroSCORE, aldri og notkun statínlyfja í offituhópi. Langtímalifun virðist einnig sambærileg

LGBT individuals in Icelandic news media

Hér á eftir verður skoðað það hvernig LGBT einstaklingar koma fram í fréttum íslenskra vefmiðla og hvort sé notast við sjónarhorn þeirra í umfjöllun um þau málefni sem tengjast þeim. Þær fréttir sem urðu fyrir valinu voru valdnar af handahófi af vefmiðlunum vísir.is, mbl.is og dv.is. Teknar voru tólf fréttir frá hverjum miðil frá árinu 2016 til september 2017 sem að allar tengdust því efni sem fjallað er um. Notast verður við innrömmunarkenninguna við greiningu á þessum fréttum og verður sérstaklega fjallað um hinn sorglega ramma í umfjöllun um LGBT fólk hjá íslenskum vefmiðlum

Outcome of coronary artery revascularization in Iceland

Inngangur: Á Íslandi hafa verið framkvæmdar í kringum 4000 kransæðahjáveituaðgerðir frá því fyrsta aðgerðin var gerð á Íslandi árið 1986. Kransæðahjáveita er algengasta opna hjartaskurðaðgerðin á Vesturlöndum og er kjörmeðferð við útbreiddum kransæðasjúkdómi. Aðgerðina er hægt að gera með hjarta- og lungnavél (HLV) eða á sláandi hjarta (SH). Tilgangur þessarar afturskyggnu rannsóknar var að kanna árangur þessara aðgerða hjá heilli þjóð á fimm ára tímabili, bæði með tilliti til snemmkominna fylgikvilla og dánarhlutfalls innan 30 daga en einnig langtíma lifunar. Efniviður og aðferðir: Rannsóknin var afturskyggn og náði til 720 sjúklinga sem gengust undir kransæðahjáveituaðgerð á Landspítala árin 2002-2006. Sjúklingarnir skiptust í tvo hópa; 513 einstaklinga sem gengust undir aðgerð með aðstoð HLV (HLV-hópur) og 207 einstaklinga sem gengust undir aðgerð á sláandi hjarta (SH-hópur). Áhættuþættir, fylgikvillar og dánarhlutfall innan 30 daga voru bornir saman milli hópa og forspárþættir lifunar metnir með ein- og fjölbreytugreiningu. Niðurstöður: Karlar voru fleiri í HLV-hópi en áhættuþættir kransæðasjúkdóma, aldur og líkamsþyngdarstuðull reyndust sambærilegir milli hópa, einnig fjöldi æðatenginga og EuroSCORE. Aðgerðir á sláandi hjarta tóku 25 mínútum lengri tíma og blæðing í brjóstholskera var marktækt aukin án þess að það hefði áhrif á fjölda gefinna eininga rauðkornaþykknis í hópunum. Af alvarlegum fylgikvillum voru enduraðgerðir vegna blæðinga algengari í HLV-hópi og heildarlegutími rúmum sólarhring lengri. Minniháttar fylgikvillar voru einnig algengari í HLV-hópi (58% sbr. 48%, p=0,05). Dánarhlutfall innan 30 daga var hins vegar áþekkt í báðum hópum (4% sbr. 3%, p=0,68), einnig fimm ára lifun sem var 93% í báðum hópum. Í fjölbreytugreiningu spáðu hærra EuroSCORE og aldur fyrir dauða innan 30 daga og langtímalifun en ekki tegund aðgerðar (HLV eða SH). Ályktanir: Árangur kransæðahjáveituaðgerða á Íslandi er góður, bæði hvað varðar dánarhlutfall innan 30 daga og langtímalifun. Þetta á jafnt við um aðgerðir sem framkvæmdar eru með aðstoð hjarta- og lungnavélar og aðgerðir á sláandi hjarta.Introduction: Around 4000 coronary artery bypass operations have been performed in Iceland since the first case was performed at Landspitali in June 1986. In the Western world coronary artery bypass is the most common open-heart procedure and is used for the treatment of advanced coronary artery disease. It can be done both On-pump, where cardiopulmonary bypass is used, or Off-pump on a beating heart. The aim of this study was to investigate the outome of coronary artery bypass operations in Iceland. Material and methods: This was a retrospective study on 720 consecutive patients who underwent surgical revascularization at Landspitali University Hospital between the years 2002 and 2006; 513 On-pump and 207 Off-pump patients. Demographics, complications and 30-day operative mortality were compared between the groups and predictors of survival identified using multivariate analysis. Results: The number of males was significantly increased in the On-pump group, but other risk factors of coronary artery disease, including age and high body mass index, were comparable, as was the number of distal anastomoses and EuroSCORE. The Off-pump procedure lasted 25 minutes longer on average and chest tube output was significantly increased, however, the amount of transfusions administered was similar. Of the major complications, stroke rates were similar in both groups (2%) but the rate of reoperation for bleeding was higher in the On-pump group. The rate of minor complications, however, was higher in the On-pump group (58% vs. 48%, p=0.05). Mean length of hospital stay was one day longer for On-pump patients but operative mortality was similar for both groups (4% vs. 3%, p=0.68) as was 5-year survival (93% in both groups). In multivariate analysis both EuroSCORE and age predicted outcome of 30-day operative mortality and long term survival but type of surgery (On-pump vs. Off-pump) was not a predictive variable. Conclusions: Outcome of myocardial revascularization in Iceland is good as regards operative mortality and long-term survival. This applies to both conventional On-pump and Off-pump procedures

Non-Therapeutic Male Circumcision: Primum Non Nocere

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Congenital diaphragmatic hernia diagnosed in adulthood--a case report and review of the literature

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenCongenital diaphragmatic hernia (CDH) is a rare anomaly (1 of 2-4000 live births) where abdominal organs can enter the thoracic cavity. It is usually diagnosed shortly after birth, often associated with pulmonary hypoplasia and pulmonary hypertension causing life threatening condition. In approximately one out of four patients CDH is diagnosed later in life, usually within several weeks or months from birth. CDH diagnosed in adulthood is very uncommon. Here we describe a 45 year old previously healthy woman that was diagnosed with a large tumor in her right hemithorax, after having symptoms of chronic cough and chest pain for several months. At thoracotomy the tumor was found to be omentum covered with a hernial sac that had penetrated the chest through a small diaphragmatic hernia. Six months postoperatively she was doing well with no respiratory or abdominal symptoms.Meðfætt þindarslit er sjaldgæfur sjúkdómur (1 af hverjum 2-4000 lifandi fæddum börnum) sem getur haft þær afleiðingar að kviðarholslíffæri smeygja sér upp í brjóstholið. Auk þess eru lungu þessara sjúklinga oft vanþroskuð og lungnaháþrýstingur til staðar sem hvort tveggja getur valdið lífshættulegri öndunarbilun. Flestir þessara sjúklinga greinast á fyrsta sólarhring eftir fæðingu en fjórðungur síðar á ævinni, langoftast á fyrstu vikum eða mánuðum ævinnar. Það er mjög sjaldgæft að meðfætt þindarslit greinist á fullorðinsaldri. Hér er lýst 45 ára gamalli áður hraustri konu sem greindist með stóra fyrirferð í hægra brjóstholi. Hún hafði um sex mánaða skeið fundið fyrir hósta og verk í hægra brjóstholi. Við aðgerð kom í ljós að fyrirferðin innihélt netju sem þakin var lífhimnu og reyndist orsökin vera lítið þindarslit. Bati var góður eftir aðgerð og rúmu hálfu ári síðar var hún einkennalaus frá bæði lungum og kviðarholi