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Massive weight loss may facilitate otherwise impossible flap designs in phalloplasty: The first description of a tube-in-tube design of a pedicled SCIA-based flap.
JPRAS Open
March 2025
Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands.
Introduction: Phalloplasty with urethral lengthening (UL) is a complex procedure with a high complication rate.
Case: A 44-year-old transgender man with a surgical history of mastectomy, hysterectomy, bilateral oophorectomy, colpectomy and metadoioplasty with UL wished to undergo phalloplasty with UL. He had lost 50 kgs of weight for this procedure.
Dying at "home" - a qualitative study of end-of-life care in rural Northern Norway from the perspective of health care professionals.
BMC Health Serv Res
December 2023
Research Unit for General Practice, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, N-9037, Norway.
Background: 'Most patients want to die at home' is a familiar statement in palliative care. The rate of home deaths is therefore often used as a success criterion. However, providing palliative care and enabling patients to die at home in rural and remote areas may be challenging due to limited health care resources and geographical factors.
View Article and Find Full Text PDFContext: At the mid-point of the COVID-19 pandemic, polymerase chain reaction (PCR) testing for SARS-CoV-2 was difficult to obtain and took several days to return a result. Our health system wished to explore the use of the Quidel Sofia™ antigen test to diagnose COVID-19 in our primary care clinics, but the test was approved for emergency use authorization by the US Food and Drug Administration with only 250 test subjects. In addition, because it was important to avoid aerosol generating procedures in primary care clinics, it was necessary to test the diagnostic performance of the antigen test using mid-turbinate (MT) swabs rather than the approved nasopharyngeal (NP) swab technique.
View Article and Find Full Text PDFAlta Fixsler: Medico-legal Paternalism in UK Paediatric Best Interest Decisions.
Issues Law Med
January 2023
Department of Medical Physics and Clinical Engineering, Cardiff and Vale University Health Board, Cardiff, Wales, United Kingdom; The author wishes to extend his thanks to James E. Hurford, Bruce P. Blackshaw, Nicholas Colgrove and the anonymous reviewer for suggestions and constructive comments on drafts of this manuscript, as well as Louise Pruski for proofreading.
The case of Alta Fixsler, where a judge ruled that withdrawing life sustaining care was in her best interest rather than transferring her to Israel, as her parents wanted, is the latest in a series of controversial paediatric best interest decisions. Using this case, as well as some other recent cases, I argue that the UK exhibits a high degree of medico-legal paternalism in best interest decisions, even though paternalism seems to be ubiquitously negatively perceived in medical ethics. Firstly, I explain what I mean by medico-legal paternalism and defend my claim that this phenomenon is present in the UK.
View Article and Find Full Text PDFThere is a conflict between the wishes of terminally ill patients to allow withdrawal of treatment and become donors after cardiac death (DCD) and the limit on interventions required by the dead-donor rule (DDR). Once a breathing tube is removed, hours can pass before the patient expires. This interim time complies with the DDR, but often makes donation impossible.
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