The pyramidalis-anterior pubic ligament-adductor longus complex (PLAC) and its role with adductor injuries: a new anatomical concept.

PURPOSE: Adductor longus injuries are complex. The conflict between views in the recent literature and various nineteenth-century anatomy books regarding symphyseal and perisymphyseal anatomy can lead to difficulties in MRI interpretation and treatment decisions. The aim of the study is to systematically investigate the pyramidalis muscle and its anatomical connections with adductor longus and rectus abdominis, to elucidate injury patterns occurring with adductor avulsions. METHODS: A layered dissection of the soft tissues of the anterior symphyseal area was performed on seven fresh-frozen male cadavers. The dimensions of the pyramidalis muscle were measured and anatomical connections with adductor longus, rectus abdominis and aponeuroses examined. RESULTS: The pyramidalis is the only abdominal muscle anterior to the pubic bone and was found bilaterally in all specimens. It arises from the pubic crest and anterior pubic ligament and attaches to the linea alba on the medial border. The proximal adductor longus attaches to the pubic crest and anterior pubic ligament. The anterior pubic ligament is also a fascial anchor point connecting the lower anterior abdominal aponeurosis and fascia lata. The rectus abdominis, however, is not attached to the adductor longus; its lateral tendon attaches to the cranial border of the pubis; and its slender internal tendon attaches inferiorly to the symphysis with fascia lata and gracilis. CONCLUSION: The study demonstrates a strong direct connection between the pyramidalis muscle and adductor longus tendon via the anterior pubic ligament, and it introduces the new anatomical concept of the pyramidalis-anterior pubic ligament-adductor longus complex (PLAC). Knowledge of these anatomical relationships should be employed to aid in image interpretation and treatment planning with proximal adductor avulsions. In particular, MRI imaging should be employed for all proximal adductor longus avulsions to assess the integrity of the PLAC

Type I interferon: friend or foe?

Although the role of type I interferon (IFN) in the protection against viral infections has been known and studied for decades, its role in other immunologically relevant scenarios, including bacterial infections, shock, autoimmunity, and cancer, is less well defined and potentially much more complicated

Thrombosis in vasculitis: from pathogenesis to treatment

In recent years, the relationship between inflammation and thrombosis has been deeply investigated and it is now clear that immune and coagulation systems are functionally interconnected. Inflammation-induced thrombosis is by now considered a feature not only of autoimmune rheumatic diseases, but also of systemic vasculitides such as Behçet’s syndrome, ANCA-associated vasculitis or giant cells arteritis, especially during active disease. These findings have important consequences in terms of management and treatment. Indeed, Behçet’syndrome requires immunosuppressive agents for vascular involvement rather than anticoagulation or antiplatelet therapy, and it is conceivable that also in ANCA-associated vasculitis or large vessel-vasculitis an aggressive anti-inflammatory treatment during active disease could reduce the risk of thrombotic events in early stages. In this review we discuss thrombosis in vasculitides, especially in Behçet’s syndrome, ANCA-associated vasculitis and large-vessel vasculitis, and provide pathogenetic and clinical clues for the different specialists involved in the care of these patients

Facial duplication: Case, review, and embryogenesis

The craniofacial anatomy of an infant with facial duplication is described. There were four eyes, two noses, two maxillae, and one mandible. Anterior to the single pituitary the brain was duplicated and there was bilateral arhinencephaly. Portions of the brain were extruded into a large frontal encephalocele. Cases of symmetrical facial duplication reported in the literature range from two complete faces on a single head (diprosopus) to simple nasal duplication. The variety of patterns of duplication suggests that the doubling of facial components arises in several different ways: Forking of the notochord, duplication of the prosencephalon, duplication of the olfactory placodes, and duplication of maxillary and/or mandibular growth centers around the margins of the stomatodeal plate. Among reported cases, the female:male ratio is 2:1.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/38153/1/1420250205_ftp.pd

Le déploiement de la pharmacie clinique au CHU de Martinique : difficultés et opportunités

Introduction : Au CHU de Martinique (CHUM), le déploiement de la pharmacie clinique rencontre des difficultés de mise en place malgré une réelle volonté de la PUI pour la développer. La problématique est donc de savoir comment déployer cette activité au CHUM ?Matériel et méthode : Deux benchmarks ont été réalisé. Le premier entre le CHUM et des CHU des DOM afin de vérifier si le retard pris par le CHUM, dans le déploiement de la pharmacie clinique, est partagé par ces derniers et s’il résulte de problématiques communes aux CHU des DOM. Le second entre le CHUM et des CHU métropolitains afin de connaître la place des internes métropolitains dans les missions de pharmacie clinique. Résultats et discussion : Avec 2.95 ETP pharmacien dédié aux activités de pharmacie clinique (13% de l’effectif pharmacien total), aucunes activités décentralisées dans les services de soins, le retard du CHUM dans le déploiement de la pharmacie clinique est confirmé et partagé par les autres CHU des DOM. Des tâches spécifiques au DOM telles que l’approvisionnement des médicaments et la logistique sont des raisons qui peuvent écarter le CHUM d’un climat favorable à sa mise en œuvre. Le manque d’internes prive également les PUI DOM d’un effectif opérationnel pour les tâches routinières de pharmacie clinique.Conclusion : Ce travail a permis au CHUM de répondre à des problématiques utiles pour qu’il puisse entamer une restructuration. Il a également permis à mesurer le chemin à parcourir, pour atteindre certains niveaux de pharmacie clinique pratiqués aujourd’hui en métropole

Ensayos sobre la anatomía patológica en general, y sobre las transformaciones y producciones orgánicas en particular

T. I (XLVIII, 379, [5] p. -- t. II (441, [5] p.