Psicoterapia de grupos e Psicologia Analítica / Group Psychotherapy and Analytical Psychology

Jung e a Psicologia Analítica não contemplaram em profundidade o estudo da psicoterapia de grupos, tendo privilegiado o trabalho clínico individual. O presente artigo tem como objetivo principal fornecer um panorama descritivo das pesquisas sobre como a participação em pequenos grupos psicoterapêuticos pode influenciar no processo de individuação de seus membros, no referencial da Psicologia Analítica, e também, como um objetivo secundário, recapitular e confrontar com o que a literatura da área expõe sobre o tema. Para isso, foi feito num primeiro momento uma revisão estruturada, em bases de dados. Os critérios de seleção do material é que fossem artigos, em português e inglês, que tratassem do desenvolvimento da personalidade no interior de pequenos grupos de desenvolvimento pessoal, na área da psicologia analítica. Na sequência foi feita uma pesquisa não estruturada, levantando artigos frequentemente citados e também através da literatura da área e posteriormente uma revisão integrativa que aponta a dificuldade do tema no campo da psicologia analítica, especialmente pelo receio dos processos de identificação e regressão entre os membros do grupo - que para Jung operariam invariavelmente contra a individuação. Os artigos levantados questionam essa afirmação e apresentam possibilidades de desenvolvimento psíquico no interior desses grupos e correlacionam individuação com vida em sociedade. Eles também propõem métodos de psicoterapia grupal no referencial da psicologia analítica. Considera-se que pequenos grupos fazem parte do contexto de vida de qualquer indivíduo, e seu potencial para favorecer a individuação ainda precisa ser melhor compreendido.(AU)

Jung and Analytical Psychology did not contemplate in depth the study of the psychotherapy of groups, having privileged the individual psychotherapy. The main objective of this article is to provide a descriptive overview of the researches on how the participation in small psychotherapeutic groups can influence the individuation process of its members in the framework of Analytical Psychology and - as a secondary objective - to recapitulate and confront it with what the literature of the area exposes about this subject. In order to do that, a structured review was firstly carried out in the databases. The criteria for selecting the material were them to be articles, in both Portuguese and English, dealing with the development of personality, within small groups of personal development, in analytical psychology field. Secondly, an unstructured research was executed, with the examination of the most cited articles, and also a thorough search through the literature of the matter. Lastly an integrative revision was made and that signalized the difficulty of the subject in the field of analytical psychology, especially because of the fear of the processes of identification and regression between the members of the group - which for Jung would invariably work against individuation. The examined articles question this statement and present possibilities of psychic development within these groups and correlate individuation with life in society. They also propose methods of group psychotherapy in the framework of analytical psychology. Small groups are considered part of the life context of any individual, and their potential for individuation still needs to be better understood.(AU)

Jung y la Psicología Analítica no contemplaron en profundidad el estudio de la psicoterapia de los grupos, habiendo privilegiado trabajo clínico del individuo. El presente artículo tiene como objetivo principal proporcionar un panorama descriptivo de las investigaciones sobre cómo la participación en pequeños grupos psicoterapéuticos puede influir en el proceso de individuación de sus miembros, en el enfoque de la Psicología Analítica, y también, como un objetivo secundario, recapitular y confrontar con lo que la literatura del área expone sobre el tema. Para ello, se hizo en un primer momento una revisión estructurada, en bases de datos. Los criterios de selección de materiales es que fuesen artículos en portugués y inglés, que tratasen del desarrollo de la personalidad dentro de pequeños grupos de desarrollo personal en el campo de la psicología analítica. En la secuencia se realizó una investigación no estructurada, buscando artículos frecuentemente citados y también a través de la literatura del área y posteriormente una revisión integrativa que apunta la dificultad del tema en el campo de la psicología analítica, especialmente por el temor de los procesos de identificación y regresión entre los miembros del grupo - que para Jung operaría invariablemente contra la individuación. Los artículos encontrados cuestionan esa afirmación y presentan posibilidades de desarrollo psíquico en el interior de esos grupos y correlacionan individuación con vida en sociedad. También proponen métodos de psicoterapia grupal en el referencial de la psicología analítica. Se considera que pequeños grupos forman parte del contexto de vida de cualquier individuo, y su potencial para favorecer la individuación aún necesita ser mejor comprendido.(AU)

Anti-TNF-alpha-adalimumab therapy is associated with persistent improvement of endothelial function without progression of carotid intima-media wall thickness in patients with rheumatoid arthritis refractory to conventional therapy.

To determine whether treatment with the anti-TNF-alpha blocker adalimumab yields persistent improvement of endothelial function and prevents from morphological progression of subclinical atherosclerosis in patients with rheumatoid arthritis (RA) refractory to conventional therapy, a series of 34 consecutive RA patients, attending hospital outpatient clinics and who were switched from disease modifying antirheumatic drug therapy to anti-TNF-alpha-adalimumab treatment because of severe disease, were assessed by ultrasonography techniques before the onset of adalimumab therapy (at day 0) and then at day 14 and at month 12. Values of flow-mediated endothelium-dependent vasodilatation at day 14 and at month 12 were significantly higher (mean ± standard deviation (SD): 6.1 ± 3.9%; median: 5.7% at day 14, and mean ± SD: 7.4 ± 2.8%; median: 6.9% at month 12) than those obtained at day 0 (mean: 4.5 ± 4.0%; median: 3.6%; P = 0.03 and P < 0.001, resp.). Endothelium-independent vasodilatation results did not significantly change compared with those obtained at day 0. No significant differences were observed when carotid artery intima-media wall thickness values obtained at month 12 (mean ± SD: 0.69 ± 0.21 mm) were compared with those found at day 0 (0.65 ± 0.16 mm) (P = 0.3). In conclusion, anti-TNF-alpha-adalimumab therapy has beneficial effects on the development of the subclinical atherosclerosis disease in RA.

O caminho do meio: a integração dos opostos como uma alternativa para o enfraquecimento do narcisismo / Path of the middle: integration of opposites as an alternative to the weakening of narcissism

Esse artigo utiliza-se de uma metáfora para expor o problema do narcisismo. O narcisista pode ser visto como alguém que age baseado em seu ego e não faz contato com o self. Identifica-se com sua imagem e a partir daí nega quaisquer que sejam as características que não vão ao encontro deste personagem criado, geralmente em busca de aceitação e admiração do mundo externo. Perde em seu inconsciente grande parte de si, parte essa rejeitada, que frequentemente é projetada, não dando ao narcisista a oportunidade nem de se conhecer e nem de conhecer o outro(AU)

Intravenous iron sucrose does not impair sonographic brachial vasodilation in peritoneal dialysis patients.

Serious concerns have been raised with respect to intravenous (i.v.) iron as a potential oxidative stress inducer in chronic kidney disease patients. Oxidative stress has been linked to uremia-related inflammation and endothelial dysfunction. Because i.v. iron promotes oxidative stress and because uremic patients have numerous defects of antioxidant defense unrelated to iron, we hypothesized that i.v. iron administration might increment oxidative stress and consequently endothelial dysfunction. We undertook a pilot study of 8 patients from our peritoneal dialysis (PD) program who were in stable clinical condition. We measured high-sensitivity C-reactive protein (hsCRP), von Willebrand factor antigen (vWFa), and fibrinogen in serum, and several sonographic parameters: left ventricular ejection fraction, left ventricular mass index, carotid intima media thickness, and the presence of carotid plaques. We also used a sonographic methodology to measure endothelium-dependent vasodilation (EDV) and endothelium-independent vasodilation (EIV) in the brachial artery. Three hours after i.v. administration of 200 mg iron sucrose, we repeated the biochemical measurements and the sonographic vasodilation parameter measurements in the brachial artery. None of the biochemical parameters were modified after administration of i.v. iron sucrose [hsCRP: < 0.5 mg/L (range: < 0.5 - 48 mg/L) vs. < 0.5 mg/L (range: < 0.5 - 37 mg/L), p = 0.46; vWFa: 192% +/- 39% vs. 189% +/- 32%; p = 0.40; fibrinogen: 449 +/- 127 mg/dL vs. 445 +/- 128 mg/dL, p = 0.80). Furthermore, i.v. iron stimulus did not affect either EDV (5.8% +/- 2.7% vs. 7.8% +/- 1.9%, p = 0.09) or EIV (15.3% +/- 2.9% vs. 21.4% +/- 2.2%, p = 0.11). Our data do not support an acute impact of i.v. iron in our PD patients with regard to endothelial-related biochemical parameters or sonographic vasodilation of the brachial artery.

Endothelial dysfunction in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors.

OBJECTIVE: To determine whether endothelial dysfunction was present in a cohort of patients with psoriatic arthritis (PsA) without overt cardiovascular disease or classic cardiovascular risk factors attended to in a community hospital. METHODS: Fifty patients with PsA who fulfilled the Moll and Wright criteria were recruited from Hospital Xeral-Calde (Lugo, Spain). Patients seen during the period of recruitment who had classic cardiovascular risk factors or had experienced cardiovascular or cerebrovascular events were excluded. Fifty healthy matched controls were also studied. In all patients and controls, endothelial function was determined by measuring flow-mediated endothelial dependent vasodilatation (FMD%) and endothelial independent vasodilatation (GTN%) by brachial ultrasonography. RESULTS: FMD% was significantly impaired in patients compared with controls (mean, median [range] 6.3%, 6.1% [0.3-13.4%] versus 8.2%, 8.2% [0.0-21.2%]; P = 0.008). However, no significant difference existed between patients and controls in GTN% or baseline diameter. A significant correlation between C-reactive protein level and erythrocyte sedimentation rate at the time of disease diagnosis and FMD% was found (P < 0.04). No significant FMD% and GTN% differences were observed when patients with PsA with polyarticular pattern were compared with the remaining patients with PsA. CONCLUSION: The present study demonstrates that patients with PsA without cardiovascular risk factors or clinically evident cardiovascular disease also exhibit endothelial dysfunction. These observations provide a basis for the potential association between PsA and atherosclerotic disease.

Lack of echocardiographic and Doppler abnormalities in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors.

OBJECTIVE: To assess the prevalence of echocardiographic and Doppler abnormalities in psoriatic arthritis (PsA) patients without clinically evident cardiovascular manifestations or classic atherosclerosis risk factors. METHODS: Fifty PsA patients were recruited from Hospital Xeral-Calde, Lugo, Spain. Patients seen during the period of recruitment that had classic cardiovascular risk factors or had suffered cardiovascular or cerebrovascular events were excluded. Fifty healthy matched controls were also studied. Echocardiographic and Doppler studies were performed in all cases and controls. RESULTS: In PsA patients the frequency of aortic and tricuspid (10%) and mitral regurgitation (16%) was not different from that seen in matched controls (10, 4, and 12%). Also, the pulmonary artery systolic pressure was normal in the group of PsA patients (23.4+/-3.9 mm Hg). The prevalence of diastolic dysfunction, in all cases due to impaired relaxation, was similar in PsA patients (28%) and controls (24%) (P=0.65). In addition, no significant echocardiographic and Doppler differences were observed when PsA patients with polyarticular pattern were compared with the remaining PsA patients. CONCLUSIONS: The present study shows that actively treated PsA patients without cardiovascular risk factors or clinically evident cardiovascular disease do not exhibit silent subclinical echocardiographic abnormalities.

Austrian syndrome: report of two new cases and literature review.

In April 2004, Rammeloo et al. reported a child-aortic-valve endocarditis following pneumococcal meningitis. Classically, the association of pneumococcal pneumonia along with meningitis and infectious endocarditis (IE) is known as Austrian syndrome. We assessed the incidence, clinical manifestations and follow-up of patients diagnosed with Austrian syndrome in Lugo (Northwest Spain) between 1987 and 2002. A computerized MEDLINE search was also performed for literature review. During the study period 165 Lugo patients met criteria for definite IE. Two of the 3 patients with definite streptococcus pneumoniae IE also met definitions for Austrian syndrome. The incidence of this syndrome in Lugo patients with definite IE was 1.2%. In the literature review 48 cases, including our two patients, were found. Complete clinical information was only available on 16 patients. Alcoholism constituted the most common predisposing factor. Aortic valve involvement and high grade of valve regurgitation leading to cardiac failure and the need of cardiac surgery during the admission were common in these patients. This review confirms that Austrian syndrome is a rare but severe disease. Early recognition of these patients is required to avoid ominous complications.

High-grade C-reactive protein elevation correlates with accelerated atherogenesis in patients with rheumatoid arthritis.

OBJECTIVE: Patients with rheumatoid arthritis (RA) are at greater risk of developing cardiovascular events compared with individuals without RA. Increased risk for cardiovascular disease in these patients is a consequence of atherosclerosis. Case-control studies have shown that increased intima-media thickness (IMT) of the common carotid artery is an indicator of generalized atherosclerosis. Some investigators have suggested that the development of atherosclerosis in RA may be related to the magnitude and chronicity of the systemic inflammation. We examined the relationship between carotid IMT to C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), which are the most commonly assessed markers of inflammatory response in patients with RA. METHODS: Retrospective review of CRP and ESR values in 47 patients with longterm actively treated (at least 5 years) RA without clinically evident atherosclerosis or its complications, who had been studied for carotid IMT with high resolution B-mode ultrasound. RESULTS: No correlation between ESR and carotid IMT was observed. However, a correlation was found between the maximum CRP values and the carotid IMT (p = 0.009). The distribution of patients in 4 quartiles according to the average CRP values showed significant differences in the carotid IMT (p = 0.03). Those exhibiting the highest mean CRP values (quartile 4) had greater carotid IMT. There was no correlation between CRP at the time of disease diagnosis or at the time of the ultrasound study and the carotid IMT. CONCLUSION: Our study confirms that the magnitude and chronicity of the inflammatory response measured by CRP correlates directly with the presence of atherosclerosis in patients with RA.

Persistent left superior vena cava draining into the coronary sinus: report of 10 cases and literature review.

BACKGROUND: Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly. HYPOTHESIS: This study examines the epidemiologic, clinical, and morphologic characteristics of a cohort of patients with PLSVC draining into the coronary sinus. METHODS: We examined the clinical and morphologic characteristics of patients with PLSVC draining into the coronary sinus diagnosed at a single referral hospital for a defined population in northwestern Spain. We designed a prospective study of the case records of all patients diagnosed with PLSVC draining into the coronary sinus at the echocardiography laboratory of the Hospital Xeral-Calde from January 2001 through December 2002. Patients were included if they had a PLSVC diagnosed by transthoracic echocardiogram (TTE) using an echo-contrast enhancement and confirmed by a magnetic resonance (MR) imaging. Ten patients (6 women) fulfilled the inclusion criteria described above. All patients were adults and had associated heart disease, including a congenital heart disease in three cases. RESULTS: Magnetic resonance imaging examination confirmed the presence of PLSVC and the site of drainage into the coronary sinus. Absence of the right superior vena cava was observed only in three patients, in whom the main coronary sinus size was significantly increased. Absence of the left brachiocephalic vein was diagnosed in five patients. CONCLUSION: This study describes 10 new cases of PLSVC and supports the necessity of considering PLSVC draining into the coronary sinus in the diagnosis of patients presenting with dilated coronary sinus diagnosed by TTE. It also underlines the important role of MR imaging in the evaluation of these abnormalities. An associated heart disease must always be excluded in these patients.

Active but transient improvement of endothelial function in rheumatoid arthritis patients undergoing long-term treatment with anti-tumor necrosis factor alpha antibody.

OBJECTIVE: Cardiovascular disease is the major cause of excessive mortality in rheumatoid arthritis (RA). Atherosclerosis and RA share similar inflammatory mechanisms that include involvement of tumor necrosis factor alpha (TNF alpha). Anti-TNF alpha antibody improved endothelial function in RA patients after a 12-week treatment. The aim of the present study was to assess whether improvement of endothelial function is still effective in long-term infliximab-treated RA patients. METHODS: Seven RA patients (5 women; age range 25-73 years) were studied. They had been treated with infliximab for at least 1 year and were currently being treated with this drug every 8 weeks. Endothelial-dependent and independent vasodilatation were measured by brachial ultrasonography. RESULTS: Following infliximab infusion, a rapid increase in the percentage of endothelial-dependent vasodilatation was found in all patients (mean +/- SD 9.4 +/- 5.5% 2 days postinfusion compared with 2.8 +/- 2.5% 2 days before infusion). However, values returned to baseline by 4 weeks after infusion. There were no differences in the percentage of endothelial-independent vasodilatation prior to and after infusion. A decrease in the individual disease activity score for each patient was observed at day 7 postinfusion (P = 0.02). CONCLUSION: Our study confirms an active but transient effect of infliximab on endothelial function in RA patients treated periodically with this drug. It may support long-term use of drugs that block TNF alpha function to reduce the high incidence of cardiovascular complications in RA.

Echocardiographic and Doppler findings in long-term treated rheumatoid arthritis patients without clinically evident cardiovascular disease.

OBJECTIVE: To assess the frequency of echocardiographic and Doppler abnormalities in long-term treated rheumatoid arthritis (RA) patients without clinically evident cardiovascular manifestations. METHODS: Forty-seven patients with RA were recruited from Hospital Xeral-Calde, Lugo, Spain. Patients were required to have been treated for at least 5 years and to be on treatment with 1 or more disease-modifying antirheumatic drugs. Patients seen during the period of recruitment who had cardiovascular risk factors or had suffered cardiovascular or cerebrovascular events were excluded. Forty-seven healthy matched controls were also studied. Echocardiographic and Doppler studies were performed in all cases and controls. Patients were HLA-DRB1 genotyped by using molecular-based methods. RESULTS: In patients with RA, the prevalence of aortic regurgitation (17%) and tricuspid regurgitation (17%) was not higher than that seen in controls (15% and 6%). The pulmonary artery systolic pressure was higher in patients with RA (30.3 +/- 8.0 mm Hg) than in controls (26.2 +/- 4.8) (P =.004). Incidence of pulmonary artery systolic pressure >35 mm Hg was significantly higher in patients with RA (21% versus 4% in controls; P =.03). Diastolic dysfunction caused by impaired relaxation was also more common in patients with RA (66%) than in controls (43%) (P =.02). It was more frequent in the older patients. Extra-articular manifestations were more common in patients with RA with diastolic dysfunction (P =.05). The HLA-DRB1 genotype was not implicated in the risk of developing diastolic dysfunction. CONCLUSIONS: The present study confirms a high frequency of left ventricular diastolic dysfunction and pulmonary hypertension in patients with RA without evident cardiovascular disease.

Increased prevalence of severe subclinical atherosclerotic findings in long-term treated rheumatoid arthritis patients without clinically evident atherosclerotic disease.

We conducted the current study to search for subclinical atherosclerosis in patients with rheumatoid arthritis (RA) without clinically evident atherosclerosis or its complications who had been treated for a long duration, and to assess whether demographic or clinical factors affect the development of atherosclerotic disease. Forty-seven white patients fulfilling the 1987 American College of Rheumatology classification criteria for RA were recruited from Hospital Xeral-Calde, Lugo, Spain. Patients were required to have been treated for at least 5 years, including current treatment with 1 or more disease-modifying antirheumatic drugs. Patients with diabetes mellitus, renal insufficiency, hypertension, cardiovascular or cerebrovascular disease, and smokers were excluded. Forty-seven matched controls were also studied. Carotid intima-media wall thickness (IMT) and carotid plaques were measured in the right common carotid artery. The study was performed using high-resolution B-mode ultrasound. Patients had greater carotid IMT (0.779 +/- 0.164 mm) than did controls (0.699 +/- 0.129 mm); (p = 0.010). Sixteen (34%) patients showed carotid plaques compared with only 7 (15%) controls (p = 0.031). There was a positive correlation between the age at the time of study and the carotid IMT. Patients with carotid plaques had significantly greater carotid IMT (0.859 +/- 0.116 mm) than those without plaques (0.739 +/- 0.171 mm) (p = 0.014). Also, RA patients with carotid plaques had a significantly longer disease duration (mean, 21.0 yr) and more extraarticular manifestations (63%) than those without plaques (mean, 12.7 yr and 26%, respectively). Age at the time of the study and disease duration were the best predictive factors for the development of severe morphologic expression of atherosclerotic disease. The present study confirms an increased frequency of severe subclinical atherosclerotic findings in long-term actively treated RA patients from northwest Spain.

Infective endocarditis due to Streptococcus bovis in a series of nonaddict patients: clinical and morphological characteristics of 20 cases and review of the literature.

BACKGROUND AND OBJECTIVES: Controversy frequently exists about the actual frequency of Streptococcus bovis infective endocarditis (IE), its incidence of malignancy and its outcome. Consequently, the characteristics of S bovis IE were examined in an unselected population of nondrug-addicted patients. The literature was also reviewed. METHODS: Nondrug-addicted patients with S bovis IE were retrospectively reviewed. Clinically definite IE was diagnosed according to the Duke classification criteria at the single reference hospital for a defined population in northwestern Spain over a 13-year period. The clinical features, need for surgery and mortality rate of these patients were compared with those of other nondrug-addicted patients with IE examined during the same time period. RESULTS: Between 1987 and 1999, S bovis IE was diagnosed in 20 consecutive patients. This pathogen was responsible for 16.8% of the cases of definite IE in nondrug-addicted patients. Underlying conditions and embolic septic events were common. The aortic valve was the most common site of IE. Simultaneous involvement of two cardiac valves and moderate to severe regurgitation were more common in patients with S bovis IE. Colonic neoplasms were observed in 77% of patients. However, in-hospital mortality rate, need for in-hospital surgery and surgery during follow-up did not differ between patients with S bovis IE and the other nondrug-addicted patients with IE. CONCLUSIONS: In unselected patients, the rate of mortality due to S bovis IE is similar to that observed in IE due to other microorganisms. However, colonoscopic evaluation during admission and follow-up is required.

HLA-DRB1 status affects endothelial function in treated patients with rheumatoid arthritis.

PURPOSE: To examine endothelial function in rheumatoid arthritis patients and to assess whether clinical or genetic factors affect the development of endothelial dysfunction. METHODS: Fifty-five patients fulfilling the 1987 American College of Rheumatology classification criteria for rheumatoid arthritis were recruited from Hospital Xeral-Calde, Lugo, Spain. Patients were required to have been treated for at least 5 years, including current treatment with one or more disease-modifying antirheumatic drugs. Patients with diabetes mellitus, renal insufficiency, or cardiovascular disease were excluded. Thirty-one age-, sex-, and ethnically matched controls were also studied. Endothelium-dependent (postischemia) and -independent (postnitroglycerin) vasodilatation were measured by brachial ultrasonography. Patients were genotyped for human leukocyte antigen (HLA)-DRB1. RESULTS: Patients had decreased endothelium-dependent vasodilatation (mean [+/- SD], 3.8% +/- 4.9%) compared with controls (8.0% +/- 4.5%; P <0.001). There were no differences in endothelium-independent vasodilatation. Clinical features were not associated with endothelial dysfunction. Endothelium-dependent vasodilatation was lower in the 30 rheumatoid arthritis patients with the HLA-DRB1*04 shared epitope alleles (2.4% +/- 4.1%) than in the remaining patients (5.5% +/- 5.3%; P = 0.01). Similar results were seen for patients with the HLA-DRB1*0404 shared epitope allele (-0.4% +/- 2.5%) compared with other patients (4.4% +/- 4.9%; P = 0.01). CONCLUSION: Patients with chronically treated rheumatoid arthritis had evidence of endothelial dysfunction, especially those with certain HLA-DRB1 genotypes. If confirmed, our results suggest that HLA-DRB1 status may be a predictor of cardiovascular risk in these patients.

Anomalías congénitas de las arterias coronarias del adulto descritas en 31 años de estudios coronariográficos en el Principado de Asturias: principales características angiográficas y clínicas / Adult Congenital Anomalies of the Coronary Arteries Described over 31 Years of Angiographic Studies in the Principado de Asturias: Angiographic and Clinical Characteristics

Objetivo. Conocer la incidencia de las anomalías congénitas de las arterias coronarias del adulto en 31 años de estudios coronariográficos, describiendo sus principales características angiográficas y clínicas. Se comparan los resultados con las principales series publicadas. Métodos. Se revisan los informes de las coronariografías diagnósticas realizadas en el Principado de Asturias desde 1968 hasta 1999. En aquellos en los que se diagnosticó una anomalía, se estudiaron la historia clínica y la angiografía. El trayecto inicial de la coronarias anómalas fue definido siguiendo criterios coronariográficos. Resultados. Se revisaron 13.500 informes que describían 75 pacientes con 75 anomalías (0,5 por ciento): circunfleja anómala (n = 24), fístulas (n = 21), origen de ambas coronarias en el seno coronario izquierdo (n = 15), coronarias únicas (n = 6), origen de ambas coronarias en el seno derecho (n = 3), origen separado de la descendente anterior y circunfleja (n = 3), origen de la descendente anterior en el seno derecho (n = 2) y otras (n = 1). La coronariografía se realizó por las siguientes causas: angina (59 por ciento), disnea (25 por ciento), dolor atípico (7 por ciento), síncope (3 por ciento), mareos (3 por ciento) y palpitaciones (3 por ciento). El trayecto inicial fue: retroaórtico en las circunflejas, interarterial en las derechas, retroaórtico, septal y combinado en las izquierdas y anterior en las descendentes anteriores. Conclusiones. Las anomalías congénitas de las arterias coronarias del adulto son poco frecuentes y suelen ser hallazgos casuales en las coronariografías diagnósticas. Las anomalías de la arteria circunfleja son las más frecuentes (AU)