Endometriotic Pain Is Associated with Adenomyosis but Not with the Compartments Affected by Deep Infiltrating Endometriosis.

BACKGROUND: The identification of presurgical clinical markers may be helpful to allow the staging of endometriosis severity. It has been suggested that pain characteristics orientate the gynecologist about the anatomical involvement of endometriosis. The study was performed to analyze the correlation between pain symptoms and the anatomical location of endometriosis. METHODS: One hundred fifty-five consecutive patients with a complete removal of deep infiltrating endometriosis (DIE) were included. Prior to surgery, data on patient and disease characteristics were obtained. The intensity of the pain symptoms was registered using a Visual Analogue Scale. The endometriotic lesions were categorized according to the Enzian morphological classification. Correlation and multivariate analysis were performed to assess the potential associations between pain characteristics (dysmenorrhea, pelvic pain, dyschezia, dyspareunia or dysuria) and the location of endometriosis or other disease-related characteristics (hematuria, rectal bleeding or adenomyosis). RESULTS: Pelvic pain was significantly associated with the presence of adenomyosis. Dyschezia was correlated with rectal bleeding and dysuria with the presence of hematuria. No relationship was found between other kinds of pain and the morphological location of endometriosis or other disease-related characteristics. CONCLUSION: Our data suggest that pelvic pain is correlated with the presence of adenomyosis in women with DIE. Further studies are required.

Valor de la coronariografía por resonancia magnética en el diagnóstico del origen anómalo de las arterias coronarias. A propósito de un caso / The value of magnetic resonance coronariography in the diagnosis of anomalous origin of the coronary arteries. A case report

La incidencia de anomalías congénitas de las arterias coronarias oscila, en las distintas series coronariográficas publicadas, entre el 0,3 y el 1,3%. Inicialmente, estas anomalías se consideraron simples hallazgos, sin que se les asignara ninguna significación clínica. Esta creencia se deshizo posteriormente al describirse casos de síncope, angina, infarto agudo de miocardio y muerte súbita asociados a su presencia. Se conoce que las complicaciones clínicas pueden estar en relación con el trayecto que sigue la arteria coronaria anómala. Presentamos un caso de anomalía congénita de la arteria coronaria izquierda con nacimiento en el seno coronario derecho, en una mujer de 74 años con angina inestable prolongada, en el que la resonancia magnética demostró ser definitiva en la determinación del trayecto exacto de dicha coronaria anómala

The incidence of congenital anomalies of the coronary arteries reported in different series ranges from 0.3 to 1.3%. These anomalies were initially considered to be findings with no clinical significance. Later reports of syncope, angina, acute myocardial infarction and sudden death related to their presence changed this belief. Clinical complications are known to be related to the course of the anomalous coronary artery. We present a case of a congenital anomaly of the left coronary artery arising from the right coronary sinus in a 74-year-old woman with long-standing unstable angina in which magnetic resonance imaging provided the definitive determination of the exact course of this coronary anomaly