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Objective: A series of studies report elevated rates of autism and autistic characteristics among gender-diverse youth seeking gender services. Although youth with the co-occurrence present with complex care needs, existing studies have focused on co-occurrence rates. Further, clinical commentaries have emphasized provider-centered interpretations of clinical needs rather than key stakeholder-driven clinical approaches. This study aimed to employ community-based participatory research methodologies to develop a key stakeholder-driven clinical group program. Method: Autistic/neurodiverse gender-diverse (A/ND-GD) youth (N = 31), parents of A/ND-GD youth (N = 46), A/ND-GD self-advocates (N = 10), and expert clinical providers (N = 10) participated in a multi-stage community-based participatory procedure. Needs assessment data were collected repeatedly over time from A/ND-GD youth and their parents as the youth interacted with one another through ongoing clinical groups, the curriculum of which was developed progressively through the iterative needs assessments. Results: Separate adolescent and parent needs assessments revealed key priorities for youth (e.g., the importance of connecting with other A/ND-GD youth and the benefit of experiencing a range of gender-diverse role models to make gender exploration and/or gender affirmation more concrete) and parents (e.g., the need for A/ND-related supports for their children as well as provision of an A/ND-friendly environment that fosters exploration of a range of gender expressions/options). Integration and translation of youth and parent priorities resulted in 11 novel clinical techniques for this population. Conclusions: With generally high acceptability ratings for each component of the group program, this study presents a community-driven clinical model to support broad care needs and preferences of A/ND-GD adolescents.

Despite research exploring autism in gender-diverse adolescents, no studies have elicited these individuals' perspectives. In-depth interviews with 22 well-characterized autistic gender-diverse adolescents revealed critical themes, including: recollections of pre-pubertal gender nonconformity; vivid experiences of gender dysphoria; a fear of social gender expression due to perceived animosity toward transgender people; and specific challenges that result from the interplay of gender diversity and neurodiversity. During the ~ 22 month study social gender affirmation increased in six participants and gender dysphoria attenuated in four participants. Given the ethical imperative to understand and prioritize the voiced perspectives and needs of autistic gender minority adolescents as well as the discovery of shared themes and experiences in this population, results should inform clinical research approaches and priorities.

Cor triatriatum dexter is a rare congenital malformation in which a membrane divides the right atrium into two chambers. The membrane represents a persistence of the right sinus venosus valve (RSV). Normally the RSV regresses between the 9th and 15th week of gestation, as the cephalic portion forms the crista terminalis and the caudal portion develops into the Eustachian and Thebesian valve. Any failure in the regression process may result in remnants of RSV as a simple muscle bar, a Chiari-network or a fenestrated or unfenestrated membrane (cor triatriatum dexter). We describe a patient with cor triatriatum dexter in whom diagnosis was made several years after successful valvulotomy procedure for severe congenital valvular pulmonary stenosis.

Bradyarrhythmias are the cause of syncope in 3 to 10% of cases. Marked bradycardia or asystole can be due to impaired function of the sinus node (sick sinus syndrome), high degree AV block or neurocardiogenic disorders (carotid sinus syndrome, vasovagal syncope). A precise history, ECG and 24-h. Holter recordings are the most helpful tools in diagnosis of bradyarrhythmia-induced syncope. An association between symptoms and documented ECG is essential for proper diagnosis. Sometimes an event-recorder may be helpful for this purpose. If a patient has normal physical examination, ECG, Holter, stress test, tilt-table test and echocardiography, no further electrophysiological investigation is needed. If the noninvasive tests show pathologic results that do not clearly explain the cause of syncope (sinus bradycardia, first-degree AV block, fascicular block, structural heart disease), then electrophysiological studies are recommended, which will also rule out ventricular tachyarrythmias in the differential diagnosis. If all diagnostic tests in a patient with syncope are normal, the prognosis is fairly good despite 30% recurrence rate. Treatment for symptomatic bradyarrhythmias is implantation of a pacemaker. The selection of an appropriate pacemaker system is very important. Dual-chamber systems (DDD) provide physiological stimulation by maintaining AV synchrony; thus, they should be preferred whenever possible.

A 41-year-old musician developed severe refractory hypertension 13 years after radiotherapy of the retroperitoneum because of a teratocarcinoma of the right testis. An angiography revealed severe stenoses of both renal arteries. After percutaneous transluminal angioplasty of both renal arteries, blood pressure valves returned to the normal range. Radiation-induced injury of arteries may provoke premature atherosclerosis, which cannot be differentiated morphologically from common atherosclerosis. Patients who develop severe hypertension some years after radiotherapy of the retroperitoneum should therefore be screened for the presence of renovascular hypertension.

New therapeutic schemes have been proposed recently for treatment of rheumatoid arthritis. Among these, methotrexate at low doses is recommended as basic therapy, already shortly after the diagnosis is established. We report on a 68-year-old female with rheumatoid arthritis who developed bilateral pneumocystis-carinii pneumonia with a lethal course and bilateral sinusitis maxillaris with candida lusitaniae. Various opportunistic infections have been described in the literature after low-dose methotrexate. It is our view that the use of methotrexate in rheumatoid arthritis should still be considered cautiously until further data on the risk-benefit ratio of long-term use become available.

Retroperitoneal sarcomas are rare tumors representing 0.1% to 0.2% of all malignant tumors. They are usually revealed by an abdominal mass (33%), possibly associated with pain (41%). Edema of the lower limbs is reported in 10% of cases. Acute renal failure with anuria by bilateral ureteral compression, associated with invasion of the inferior vena cava has not been previously reported.

A sample of 150 applicants for insurance indemnity for psychiatric disability discriminates from a general township population by older age and lesser education, and from an outpatient group by older age, only. In the sample of the insurance applicants, there were diagnosed more neuroses and less other non psychotic psychiatric disturbances and less oligophrenics than in the outpatient group. 22 insurance applicants proved to be able to work. Among the disabled no subgroup such as foreigners, females or single people proved to be more susceptible to disability than others. Neurosis was the most frequent diagnosis among the disabled. The depressive syndrome and, equally, personality disorder tended to lead to disability mainly in the more than 50 years old.