Dunbar syndrome - case report

Dunbar syndrome is diagnosed by excluding other possible causes of abdominal pains. Surgical treatment comprises complete dissection of the ligament and the surrounding nerve ganglion. This report describes the case of a previously healthy 45-year-old male patient who presented with epigastric abdominal pain irradiating to the back and weakness. Initially, abdominal computed tomography was ordered, showing arteriopathy of the celiac trunk and mesenteric artery with stenosis. The patient underwent surgical treatment because of the refractory pain, but findings were nonspecific. It was necessary to continue workup with serial angiotomography to follow the case. After around 6 months, thickening of the arcuate ligament was found, with compression of the proximal third of the celiac trunk and 80% stenosis. The patient therefore underwent laparoscopy to relieve celiac trunk compression, with satisfactory postoperative recovery.

Sexual function and metabolic/hormonal changes in women using long-term hormonal and non-hormonal contraceptives: a pilot study

Background

Female sexual dysfunction is a common condition that negatively impacts the emotional health and quality of life of the affected individuals. Long-acting reversible contraceptives (LARCs) are becoming increasingly popular due to their effectiveness and convenience. LARCs can be hormonal (etonogestrel releasing implant—ENG and Levonorgestrel intrauterine system—LNG) or non-hormonal (copper intrauterine device—CuIUD and copper-silver intrauterine device—SIUD). There are very few studies that assess the influence on LARCS on sexual function are lacking. This study aimed to assess changes in sexual function as well as metabolic and hormonal parameters in women after implantation with LARCs.

Methods

In this prospective cohort study, we assessed 80 women who visited the Military Police Hospital in Brazil for LARCs placement. The study participants were divided into 4 groups according to the type of LARC received: ENG n = 17; LNG n = 22, CuIUD n = 18 and SIUD n = 23. The four groups were evaluated twice (prior to LARC placement and approximately 3 months later) for sexual function, using the Female Sexual Function Index (FSFI) and Female Sexual Quotient (QS-F) questionnaires. Metabolic and hormonal parameters were also assessed using blood tests.

Results

ENG worsened sexual function according to FSFI and QS-F, across all domains. A decrease in sex hormone-binding globulin (SHBG) between stages was observed for all groups. We observed an improvement in sexual function for non-hormonal LARCs, specially SIUD. However this improvement was not statistically significant.

Conclusion

The use of non-hormonal LARCS improved sexual function. Etonogestrel implants, had a negative influence on sexual function, probably by blocking ovarian function, and thus reducing the production of androgens and estrogens.