Transsexuals in the military: Flight into hypermasculinity

A sample of 11 male gender-dysphoric patients meeting DSM-III criteria for transsexualism was seen over a 3-year period by a military psychiatrist. Eight patients had extensive military experience, including combat duty in some cases. At the time of evaluation three were on active duty, one was a Department of Defense employee, and four were veterans. Evidence is presented for a hypermasculine phase of development that coincides with the age of enlistment in nearly all cases. The psychodynamic underpinnings of the choice to enlist in transsexual males are discussed. Outcome of military service was premature discharge in over 60%. The military's management of genderdysphoric servicemen is described. Current military policies, in association with the proposed hypermasculine phase of transsexual development, may actually result in a higher prevalence of transsexualism in the military than in the civilian population.The views expressed herein are those of the author and do not necessarily reflect those of the Department of Defense or the United States Air Force.     

A comparison of frequency and sources of nursing job stress perceived by intensive care, hospice and medical-surgical nurses

This study compared the frequency and sources of nursing job stress perceived by 35 intensive care (ICU), 30 hospice and 73 medical-surgical nurses. Analysis of variance revealed no significant differences among the three groups of nurses on the overall frequency of job stress. Post-hoc Tukey tests demonstrated a significant difference in three stress subscales among the three groups. ICU and hospice nurses perceived significantly more stress than medical-surgical nurses related to death and dying; ICU and medical-surgical nurses perceived significantly more stress than hospice nurses related to floating; and medical-surgical nurses perceived significantly more stress than ICU and hospice nurses related to work-overload/staffing. Spearman-Rank Correlation revealed no significant correlations among the three groups in their rank-ordering of the eight stress subscales. Death and dying situations were the most stressful to ICU and hospice nurses, while work-overload/staffing situations were the most stressful to medical-surgical nurses. Results of the study, although not generalizable, have implications for nurse managers.     

Anthralin Therapy for Alopecia Areata

Abstract: Topical anthralin application producing a brisk irritant contact dermatitis has been reported to have therapeutic benefit in alopecia areata. A pilot clinical study was undertaken to determine whether topical anthralin application in doses low enough to produce only minimal contact dermatitis would produce a similar therapeutic response. None of the patients in the study received any benefit from this low-dose regimen. If anthralin is of benefit in the therapy of alopecia areata, a significant irritant contact dermatitis is apparently required.     

Clinical aspects of cutaneous leishmaniasis acquired in Texas

Five patients with cutaneous leishmaniasis are described. Four of these patients acquired leishmaniasis in Texas. Four cases represent acute cutaneous leishmaniasis, and one case probably represents chronic cutaneous leishmaniasis. The classification and treatment of cutaneous leishmaniasis are reviewed. One patient in this report was successfully treated with topical antimony cream. Cutaneous leishmaniasis must be considered in the differential diagnosis of nonhealing ulcerated papules and nodules even in patients who do not have a foreign travel history.     

Treatment of acute and chronic injuries to the posterolateral and lateral knee

Acute and chronic posterolateral injury is often associated with cruciate injury. Surgical reconstructions for acuteposterolateral instability achieve better results than reconstructions for chronic posterolateral instability, and whenever possible, we perform acute reconstruction of posterolateral injury. First, any associated cruciate injury is reconstructed. Then the posterolateral corner is exposed through an open lateral incision. We attempt to anatomically repair or reconstruct the major supporting structures of the posterolateral corner. They are the lateral collateral ligament, the popliteus, and the popliteofibular ligament. In acute injury we first attempt direct repair, advancement and recession, or augmentation. Occasionally, reconstruction with patellar tendon autografts or allografts or with achilles allografts is required. In the patient with chronic posterolateral instability and varus alignment, a proximal valgus tibial osteotomy is performed. If required, additional posterolateral reconstruction is performed on a staged basis. In the patient with chronic posterolateral instability and valgus alignment, reconstruction with patellar tendon or Achilles allograft is performed. This article reviews the techniques for reconstruction of acute and chronic injuries to the popliteofibular ligament, and popliteal attachment to the tibia and the lateral collateral ligament.