Individual Treatment Progress Predicts Satisfaction With Transition-Related Care for Youth With Gender Dysphoria: A Prospective Clinical Cohort Study.

BACKGROUND: The number of adolescents presenting with gender dysphoria (GD) in healthcare services has increased significantly, yet specialized services offering transition-related care (TRC) for trans youth is lacking. AIM: To investigate satisfaction with TRC, regret, and reasons for (dis)satisfaction with transition-related medical interventions (TRMIs) in trans adolescents who had presented to the Hamburg Gender Identity Service for children and adolescents (Hamburg GIS). METHODS: Data were collected from a clinical cohort sample of 75 adolescents and young adults diagnosed with GD (81% assigned female at birth) aged 11 to 21 years (M = 17.4) at baseline and follow-up (on a spectrum of ongoing care, on average 2 years after initial consultation). To determine progress of the youth's medical transitions, an individual treatment progress score (ITPS) was calculated based on number of desired vs received TRMIs. OUTCOMES: Main outcome measures were satisfaction with TRC at the time of follow-up, ITPS, social support, reasons for regret and termination of TRC, and (dis)satisfaction with TRMIs. RESULTS: Participants underwent different stages of TRMIs, such as gender-affirming hormone treatment or surgeries, and showed overall high satisfaction with TRC received at the Hamburg GIS. Regression analysis indicated that a higher ITPS (an advanced transition treatment stage) was predictive of higher satisfaction with TRC. Sex assigned at birth, age, and time since initial consultation at the clinic showed no significant effects for satisfaction with TRC, while degree of social support showed a trend. No adolescents regretted undergoing treatment at follow-up. Additional analysis of free-text answers highlighted satisfaction mostly with the physical results of TRMI. CLINICAL IMPLICATIONS: Because youth were more satisfied with TRC when their individual transition (ITPS) was more progressed, treatment should start in a timely manner to avoid distress from puberty or long waiting lists. STRENGTHS AND LIMITATIONS: This study is one of the first to report on treatment satisfaction among youth with GD from Europe. The ITPS allowed for a more detailed evaluation of TRMI wishes and experiences in relation to satisfaction with TRC and may close a gap in research on these treatments in adolescent populations. However, all participants were from the same clinic, and strict treatment eligibility criteria may have excluded certain trans adolescents from the study. Low identification rates with non-binary identities prevented comparisons between non-binary and binary genders. CONCLUSION: The study highlights the role of TRMI and individual treatment or transition progress for youth's overall high satisfaction with TRC received at the Hamburg GIS. Nieder TO, Mayer TK, Hinz S, et al. Individual Treatment Progress Predicts Satisfaction With Transition-Related Care for Youth With Gender Dysphoria: A Prospective Clinical Cohort Study. J Sex Med 2021;18:632-645.

Anti-Rho(D) in two Rh-positive patients receiving kidney grafts from an Rh-immunized donor.

Kidneys from an Rh-negative cadaver donor were transplanted to two Rh-positive patients. The donor's serum contained anti-Rho (D). In both patients, anti-Rho (D) was detected in their serum and on their red cells 3.5 weeks after transplantation. One patient had hemolysis. The antibodies persisted for nearly six months, despite graft rejection and nephrectomy in one case. These antibodies presumably arose from passenger B lymphocytes in the grafts from the Rh-immunized donor.

The measurement of fractionated bilirubin by Ektachem film slides. Method validation and comparison of conjugated bilirubin measurements with direct bilirubin in obstructive and hepatocellular jaundice.

The authors evaluated the Kodak Ektachem Slides for total, "direct," conjugated, unconjugated, and albumin-bound ("delta") bilirubin. For various concentrations of control material, the precision (CV) within- and between-day ranged from 1.7 to 2.4% (2.8-6.6%) for total bilirubin, 0.8-4.2% (1.6-11.5%) for unconjugated bilirubin, and 1.6-9.5% (2.6-20.7%) for conjugated bilirubin. The Ektachem total and "direct" bilirubin assays demonstrated excellent correlation with the Jendrassik and Grof procedure; a 30% difference was observed, however, between absolute numbers with the two direct bilirubin methods. We found the measurement of true conjugated bilirubin by the Kodak Method to be superior to the measurement of "direct" bilirubin in following the response to treatment of various hepatic disorders manifested by extrahepatic and intrahepatic biliary obstruction.

Masking by enzyme inhibitor of raised serum glutamate dehydrogenase activity in Reye's syndrome.

Serum glutamate dehydrogenase (GDH) activity was greatly raised (up to 830 times the upper limit of normal) in 16 patients with Reye's syndrome. The serum activity was masked by an inhibitor, and the rises were observed only after dialysis or sample dilution. Serum GDH values from 38 paediatric patients, including 10 with hyperammonaemia due to other causes, showed no such rise after dialysis. Only 1 of 13 adult patients with liver disease had high GDH activity, but this level was not increased after dialysis. Serum ornithine carbamyl transferase activity was also raised in patients with Reye's syndrome, but levels were not increased after dialysis. The ratio of dialysed/undialysed GDH activity clearly distinguished all Reye's patients from controls. The inhibition of a mitochondrial enzyme which regulates ammonia metabolism may contribute to the hyperammonaemia of Reye's syndrome. Serum GDH levels before and after dialysis would seem to be a useful diagnostic aid in Reye's disease.

Isoelectric focusing of hemoglobins on thin-layer agarose.

Isoelectric focusing on thin layers of agarose was used to separate several human hemoglobin variants in narrow pH range (pH 6-9). Problems with gel flooding and distortions due to electroendosmotic flow were solved by altering the casting and processing of the gel, by modifying the focusing apparatus, and by utilizing commercial agarose that had been chemically modified to reduce electroendomosis. Hemoglobins C, O-ARAB, A2, and E were distinguished from one another, as were hemoglobins S, D-LOS ANGELES, G-PHILADELPHIA, F. A, I, and J. The technic is rapid, simple, and relatively inexpensive. The agarose is nontoxic, has excellent gelling properties, and possesses large pores, yet gives resolution equivalent or superior to that obtained on thin layers of polyacrylamide gel, making it preferable to polyacrylamide for thin-layer isoelectric focusing.

[Metastatic breast carcinoma in the pituitary gland (author's transl)].

Metastatic carcinoma was found in 9 pituitary glands (24%) of 37 patients undergoing transphenoidal hypophysectomy for diffuselly metastatic breast carcinoma. In all cases the preoperative neurological examination was negative, as were neuroradiological studies, including skull X-ray, tomograms of the sells turcicabrain scan, and angiography. Diabetes insipidus, however, was seen more frequently in patients with pituitary metastasis preoperatively (3 of 9) and postoperatively (8 of 9). Four of the nine patients with pituitary metastasis developed severe diabetes insipidus, which continued more than one month, while similar severe disease was seen in three of twenty-seven cases with no pathological evidence of pituitary metastasis. The prognosis in patients with pituitary metastasis was poor, with seven of the nine dying with an average survival of eighteen months. Pathological studies disclosed metastatic lesions in the anterior lobe (78%), posterior lobe (44%), and stalk (11%). The study emphasized that pituitary metastases, usually considered to be rare, occurred in 24% of patients with diffusely metastatic breast carcinoma. Such metastases correlate with the development of severe diabetes insipidus and with poor prognosis.