Correlation between endometriosis-associated dysmenorrhea and the presence of typical or atypical lesions

OBJECTIVE

To evaluate the correlation between the severity of endometriosis-associated dysmenorrhea and the extent of the disease assessed both with a current classification system and with the number and type of endometriosis lesions.

DESIGN

Prospective, blinded study.

SETTING

Tertiary care, university hospital.

PATIENT(S)

Sixty-five consecutive patients with endometriosis diagnosed at laparoscopy performed for pelvic pain, infertility, or adnexal mass.

INTERVENTION(S)

The patients were submitted preoperatively to a questionnaire including the assessment of the severity of dysmenorrhea by means of a 10-point linear analog scale. Evaluation of all visible signs of endometriosis at laparoscopy was performed by a surgeon not aware of the patients' symptoms.

MAIN OUTCOME MEASURE(S)

The correlation between the severity of dysmenorrhea and the total score for endometriosis and the partial scores for superficial, deep, and adhesion disease as assessed with a current classification system was evaluated. The severity of dysmenorrhea was also correlated with the total number of superficial implants and with the number of typical, pigmented versus atypical, nonpigmented lesions.

RESULT(S)

The linear analog score for dysmenorrhea correlated significantly with the total endometriosis score, the partial score for deep endometriosis, and the partial score for adhesions. There was no correlation between the pain score for dysmenorrhea and the partial score for superficial endometriosis, nor with the total number of endometriosis implants, the number of typical implants, or the number of atypical implants.

CONCLUSION(S)

The current classification system for endometriosis, devised primarily to formulate a prognosis in infertile patients, correlates significantly with endometriosis-associated dysmenorrhea. The present study does not support the suggested association between atypical implants and the severity of dysmenorrhea.

[Warthin's tumor]

Cystoadenolymphoma is a rare tumor of salivary glands. The classic clinical picture is described and four cases are presented. Current concepts of etiology, histopathology, treatment and prognosis are discussed. Authors remark the significance of radical treatment and the care must be taken not to damage the facial nerve.

[The treatment of intestinal intussusception in childhood]

Intussusception is one of the most frequent cause of mechanical bowel obstruction in children. On the basis of clinical features and diagnosis operations were conducted on 26 children. In 21, the treatment was manual disinvagination. In 5, pathomorphological changes of the walls of the invaginated portion suggested the intestinal resection. The results of treatment and prognosis are discussed.

Laparoscopically assisted vaginal hysterectomy as an alternative to abdominal hysterectomy. A pilot study

Laparoscopically assisted vaginal hysterectomy (LAVH) allows for conversion of some abdominal hysterectomies to a vaginal route. LAVH may be particularly useful when adnexectomy is indicated. In this study the authors evaluate the results obtained in a series of 21 patients prospectively selected for LAVH. The mean operative time was 96 min (range 58-155), with an estimated blood loss of 218 ml (range 50-510). The mean uterine weight was 320 g (range 105-610). Intraoperative complications were limited to one case of bladder injury which occurred during the vaginal phase of the procedure. No patient required heterologous blood transfusion. No postoperative complications were observed. The average length of hospitalisation was 4.4 days (range 2-9). The authors conclude that LAVH allows for conversion of a significant number of abdominal hysterectomies to a vaginal route and that with respect to the former it is definitely less costly since it allows for earlier hospital discharge and resumal of a normal lifestyle.