Standards of Care for the Health of Transgender and Gender Diverse People, Version 8.

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

Needle-wire localization of an infratemporal fossa foreign body using computed tomography.

We report a case involving the localization and surgical removal of a traumatically introduced foreign body deep within the infratemporal fossa. Needle-hookwire placement with computed tomographic guidance allowed the precise localization and marking of the foreign body. Surgical removal under local anesthesia and without extensive exploration was, therefore, possible. The details of the localization and marking techniques are described. Needle-hookwire localization under computed tomographic guidance should be considered for deeply located foreign bodies in the head and neck area.

Hepatic angiography in a patient with tuberculosis of the liver.

The hepatic angiographic features of a 45-year old black woman who was found to have abdominal tuberculosis are described. The clinical and arteriographic findings were similar to those found in malignant disease. A histological diagnosis is essential in such cases.

Air in gallbladder: a frequent finding in gallstone ileus.

A retrospective assessment of the presence of air in the biliary tract is presented, based on plain film findings in 16 proven cases of gallstone ileus. In addition to five cases that demonstrated air in the biliary radicles, four cases exhibited air exclusively in the gallbladder and duodenal bulb. A clearly identifiable radiographic appearance composed of two adjacent small air-fluid levels in the right upper quadrant is described. This radiographic feature represents the air- and fluid-filled duodenal cap adjacent to the visualized shrunken gallbladder. Recognition of this combination of findings helps in establishing a prompt preoperative diagnosis in cases of gallstone ileus.

Angiographic diagnosis of small intestinal intussusception.

The outstanding angiographic features of small intestinal intussusception are: (a) abrupt disappearance of mesenteric vessels at the neck of the intussusception with crowding of the vasa recta; (b) appearance of long collateral channels at the neck of intussusception; (c) angulation and retraction of major intestinal branches; (d) reversal of the course and angulation of the invaginated mesenteric vessels; (e) overlapping of the mesentery vessels by branches of the intussuscipiens; (f) abrupt change in the appearance of the vasa rectae of the distended intussuscipiens and the distal nondistended small intestines.

The spectrum of arteriographic findings in Osler-Weber-Rendu disease.

In Osler-Weber-Rendu syndrome, visceral organs are frequently involved in addition to cutaneous and mucous membranous lesions. Detailed arteriographic investigation of 5 patients with this abnormality disclosed characteristic angiodysplastic lesions involving the lungs, liver, spleen, pancreas, gastrointestinal tract and mesentery. Arterial and aortic aneurysms appear to be an integral part of this abnormality. Common to angiodysplastic lesions is a variable degree of arteriovenous shunting. The arteriographic characteristics and the hemodynamic significance of major visceral arteriovenous shunts in hereditary hemorrhagic telangiectasia are discussed.

Leiomyoblastoma of the stomach. Report of 9 cases.

Gastric leiomyoblastoma is a rare intramural tumor which originates in the smooth muscle. Nine cases were studied with respect to their clinical, radiological, and pathological features. Six distinct radiological patterns may be seen, of which 5 are represented in this series. Most such lesions occur in the gastric antrum. Leiomyoblastomas are generally benign and do not recur following removal.

Gallstone ileus. The importance of contrast examinations in the roentgenographic diagnosis.

Our experience based on the analysis of 12 proved cases of gallstone ileus is presented emphasizing the fact that the plain abdominal roentgenogram may be inconclusive or deceiving. It allowed us to suggest the correct diagnosis in only 4 cases. A high index of suspicion, particularly in elderly female patients, followed by barium examination of the upper gastrointestinal tract leads to a correct and rapid diagnosis. The demonstration of a diverticulum-like structure or a fistulous tract adjacent to the first portion of the duodenum associated with jejunal dilatation and barium dilution is highly reliable.