Ultrasound Detection of the “Sliding Viscera” Sign Promotes Safer Laparoscopy

Study ObjectiveTo estimate the feasibility of preoperative ultrasound evaluation of the umbilical region in patients undergoing laparoscopy with a previous history of abdominal surgery.DesignProspective study (Canadian Task Force Classification II–1).SettingDepartment of Obstetrics and Gynecology Fatebenefratelli Isola Tiberina Hospital.PatientsTwenty-five women with a previous history of open abdominal surgery (group A) and a group of 22 women with no previous history of surgery (group B) underwent dynamic ultrasound evaluation of the umbilical field.InterventionUltrasound Slide-By test.ResultsPatients were asked to take a deep inspiratory breath, which accentuated respiratory excursion. The movement of the intraabdominal contents in a vertical fashion in relation to the abdominal wall, referred to as the “viscera slide,” between the bowel and peritoneum was evaluated. Abdominal wall tissue thickness, Uracus to peritoneum thickness (UTP, mm) were also evaluated. Non parametric Mann-Whitney testing was used. No major demographic differences between the 2 study groups was noted. The abdominal wall tissue thickness was not significantly different between the 2 groups. The UTP was shorter in A group than in B group (1.5 ± 0.3 mm vs 3.5 ± 0.9 mm, p = .002). Absence of the “sliding viscera” sign was observed in 16 patients in group A and in 1 patient in group B. Patients with an absence of the sliding viscera sign were found to have subumbilical fibrous adhesions during laparoscopy.ConclusionsEvaluation of trocar insertion sites may be difficult and remains a challenge for peritoneal endosurgical access. We have shown that absence of the “sliding viscera” sign is more likely to be linked to subumbilical adhesions and represents a quick method for preoperative assessment. The UTP may also be a useful measurement, which requires further validation.     

ORIGINAL RESEARCH–ENDOCRINOLOGY: Hypoprolactinemia: A New Clinical Syndrome in Patients with Sexual Dysfunction

IntroductionThe physiological role of prolactin (PRL) in male sexual behavior is poorly understood. Conversely, the association between PRL pathological elevation in both reproductive and sexual behavior is well defined.AimThe aim of the present study is to assess the correlates of normal PRL (PRL < 735 mU/L or 35 ng/mL), in male subjects consulting for sexual dysfunction.MethodsA consecutive series of 2,531 (mean age 52.0 ± 12.9 years) subjects was investigated. Patients were interviewed using the structured interview on erectile dysfunction (SIEDY), a 13-item tool for the assessment of erectile dysfunction (ED)-related morbidities. Middlesex Hospital Questionnaire was used for the evaluation of psychological symptoms.Main Outcome MeasuresSeveral hormonal (testosterone, thyroid stimulation hormone, and PRL) and biochemical parameters (glycemia and lipid profile) were studied, along with penile Doppler ultrasound (PDU) and SIEDY items.ResultsAfter adjustment for confounders anxiety symptoms decreased across PRL quartiles (I: <113 mU/L or 5 ng/mL; II: 113–156 mU/L or 5.1–7 ng/mL; III: 157–229 mU/L or 7.1–11 ng/mL; IV: 229–734 mU/L or 11.1–34.9 ng/mL). Patients in the lowest PRL quartile showed a higher risk of metabolic syndrome (MetS; odds ratio [OR] = 1.74 [1.01–2.99], P < 0.05), arteriogenic ED (peak systolic velocity at PDU < 35 cm/sec; OR = 1.43 [1.01–2.03], P < 0.05), and premature ejaculation (PE; OR = 1.38 [1.02–1.85]; P < 0.05). Conversely, comparing subjects with PRL-secreting pituitary adenomas (N = 13) with matched controls, no significant difference was observed, except for a higher prevalence of hypoactive sexual desire in hyperprolactinemia.ConclusionsOur findings demonstrate that, in subjects consulting for sexual dysfunction, PRL in the lowest quartile levels are associated with MetS and arteriogenic ED, as well as with PE and anxiety symptoms. Further studies are advisable in order to confirm our preliminary results in different populations. Corona G, Mannucci E, Jannini EA, Lotti F, Ricca V, Monami M, Boddi V, Bandini E, Balercia G, Forti G, and Maggi M. Hypoprolactinemia: A new clinical syndrome in patients with sexual dysfunction. J Sex Med 2009;6:1457–1466.     

Plasmatic free light chains in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS), as systemic disease, is accompanied by different indexes of inflammation. Free light chains of immunoglobulins (FLCs), produced by plasmacells, are released in slight excess for the immune requests, with still poorly defined physiological role but surely they represent a marker of inflammation. In order to evaluate their levels and correlate them with hyperandrogenism, we have studied a group of PCOS patients, age range 18–37 yrs, mean?±?SEM body mass index (BMI) 24.1?±?0.9?kg/m²), compared with age- and BMI-matched controls, with assay of k and λ FLCs, by turbidimetric method, and their ratio in blood plasma. PCOs exhibited higher levels vs. controls: (mean?±?SEM λ: 10.0?±?0.85?mg/L vs. 8.41?±?0.45?mg/L; k: 12.45?±?0.72?mg/L vs. 6.41?±?0.34?mg/L; k/λ: 1.31?±?0.07 vs. 0.78?±?0.04). A significant direct correlation was observed between λ-FLCs and testosterone levels, no correlation was indeed found with HOMA-IR index. These data confirm high levels of FLCs in PCOS, suggesting systemic inflammatory state and a possible role in the pathophysiology of such complex syndrome.