Systematic Review: Puberty suppression with GnRH analogues in adolescents with gender incongruity.

CONTEXT: Gender incongruence is defined as disharmony between assigned gender and gender identity. Several interventions are liable in this case including genital affirming surgery among other surgical interventions such as harmonization, and also the use of gonadotropin-releasing hormone agonists (GnRHa) for gonadal shielding. This aids in preventing the development of secondary sexual characteristics related to the genetic sex. OBJECTIVE: Systematically review the treatment of gender incongruity with GnRHa analogues. DATA SOURCES: The data source of this research is from Pubmed-Medline and Embase. STUDY SELECTION: Articles published between 2009 and 2019 which studied transgender adolescents treated with GnRHa were carefully selected. DATA EXTRACTION: Were extracted: design, sample size, study context, targeted subjects of intervention, outcome measures, and results. RESULTS: Eleven studies were included. The use of GnRHa seems to be well tolerated by the studied population. When started in pubertal transition, it was associated with a more distinct resemblance to body shape than to the affirmed sex. In addition to preventing the irreversible phenotypic changes that occur in cross-hormonal therapy, the use of GnRHa can equally contribute to the mental health of these adolescents. LIMITATION: There are few consistent studies on the use of GnRHa for gender incongruence. CONCLUSION: As the population of transgender children and adolescents grows, they acquire knowledge and greater access to the various forms and stages of treatment for sex reassignment. The medical community needs to be adequately prepared to better serve this population and offer the safest resources available.

[Giant thrombosed saccular aneurysm of the brain]. / Gigantskie trombozirovannye meshotchatye anevrizmy golovnogo mozga.

Five cases of giant thrombosed saccular aneurysms of the cerebral vessels were studied. Three patients had an aneurysm of the middle cerebral artery, one--of the internal carotid artery and one--of the basilar artery. Three patients were operated on. The removal of the aneurysm had a good result in one case, a preoperative neurological defect remained in 2 cases. The clinical picture, diagnosis and the possibilities of surgical intervention in aneurysms of this type are discussed.

[Various problems in autotransplantation after injuries to peripheral nerves of the extremities]. / Nekotorye voprosy autotransplantatsii pri travme perifericheskikh nervov konechnostei.

From clinical experience and the results of anatomical study, the authors suggest repairing defects in the large nerve trunks with segments of cutaneous nerves found within the boundaries of the main operative wound. As a result the commonly performed additional intervention on the healthy extremity for obtaining the graft is avoided. After the ends of the injured nerve are separated into bundles, the donor nerves are sutured to the groups of bundles so that the defect is repaired along the perimeter. Knowledge of the specific features of the fascicular structure of nerves allows the possibilities of microsurgery to be used more rationally neuroplasty.

[Cerebrospinal fluid hypotension after brain surgery]. / Likvornaia gipotenziia posle operatsii na golovnom mozge.

A severe complication, c. s. f. hypotension ( CSFH ), developed in 9 patients after intracranial manipulations for meningioma (4), intracranial aneurysm (3), and subdural hematoma (2). It occurred on the second or third postoperative day and was characterized by rapid development of general cerebral disorders (even to deep loss of consciousness) and aggravation of focal disorders. An important role in the differential diagnosis of the hypotensive and the hypertensive syndromes is attached to lumbar puncture which in cases of CSFH reveals very low c. s. f. pressure or none at all. Effective therapy for the disease includes subarachnoid infusion of up to 50-80 ml of physiological solution through a lumbar puncture and daily intravenous infusions of fluio (2 500-3 000 ml).

[Saccular aneurysm of the anterior-inferior (middle cerebellar)--internal auditory artery]. / Meshotchataia anevrizma perednenizhnei (srednei mozzhechkovoi)--vnutrennei slukhovoi arterii.

On the basis of data in the literature (4 cases) and one case observed by the authors themselves, a clinical characteristics is given of the rarely encountered aneurysm of the middle cerebellar-internal acoustic arteries. In the absence of subarachnoid hemorrhage the aneurysm produces a typical picture of neurinoma of the acoustic nerve. The patient described was operated on with the use of a surgical microscope. Clipping of the aneurysm resulted practically in full recovery of the patient.

Total removal of acoustic neurinomas.

The authors analyze the results of total removal of acoustic neurinomas in 120 patients operated on between January, 1967, and January, 1976. The facial nerve was preserved after surgery in 65 patients (54.2%). The use of microsurgical techniques in the last 3 years of study permitted preservation of the seventh nerve in 26 of 35 operated patients (74.3%). Of 103 patients examined postoperatively, 96 retained their full or partial capacity for work (93.2%). Ten patients (8.3%) died after surgery. In the last 3 years, 35 patients were operated on without a single death.

[Pressure in intracranial saccular aneurysms in the presence of hypotension]. / Davlenie v intrakranial'nykh meshotchatykh anevrizmakh v usloviiakh gipotonii.

The pressure in saccular aneurysms of various localizations was studied in 6 patients during neurosurgical operations. The systolic, diastolic, mean, and pulse pressure in aneurysms with a wide neck corresponded to systemic pressure; in aneurysms with a narrow neck (3 patients) they were lower. In occlusion of the carotid artery on the neck, the pressure in the anurysms decreased. Pulsations disappeared in 3 patients. Fourteen patients with aneurysm of the internal carotid artery were followed-up for 2--17 years, after ligation of the carotid artery on the neck. There were no recurrent hemorrhages. Despite the clinical effect, however, due to possible complications this operation has limited indications (subclinoid aneurysms, refusal of patients to undergo intracranial operations).

["Moyamoya" disease]. / Bolezn' "moyamoya".

The article discusses the clinical picture, diagnosis, and treatment of a rare pathologic condition of the cerebral vessels known by the Japanese name "moyamoya". Six cases with this disease among adults are described. Three patients had ischemic attacks, two young females were found to have intracerebral hematomas which were successfully evacuated. In one case the vascular anomaly became evident after a craniocerebral trauma and was manifested by subarachnoid hemorrhage and infarction in the subcortical structures.

[Artificial arterial hypotension during surgical treatment of intracranial aneurysms]. / Iskusstvennaia arterial'naia gipotoniia pri khirurgicheskom lechenii vnutricherepnykh anevrizm.

In studying the content of lactic and pyruvic acids in the cerebrospinal fluid of 31 patients during operation for intracranial aneurysms under halothane anesthesia, the authors established that the performance of these operations under protection of deep (40 mm Hg) and prolonged (up to 2 hrs 25 min) artificial arterial hypotension in an uncomplicated course of the surgical intervention was not attended with hypoxic damage of the brain. The danger of hypoxia developing became greater when acute disturbances of blood flow in the cerebral arteries (clipping of a vessel, spasm) occurred in the period of hypotension.