Left anterior cerebral artery arising from a right internal carotid artery: a rare case of carotid-anterior cerebral artery anastomosis.

Carotid-anterior cerebral artery anastomosis (carotid-ACA anastomosis) is described as infrequent vascular connections between the pre-ophthalmic segment of the internal carotid artery (ICA) and the A1 segment of the anterior cerebral artery (ACA). The embryological origin of these variant is still unclear and they are often associated to other vascular anomalies of the circle of Willis, as well as to the presence of aneurysms. Carotid-ACA anastomosis is often right-sided although left and bilateral cases have also been described. We report a rare case by MR angiography of a carotid-ACA anastomosis in which the abnormal vessel arises from the right ICA and takes an infraoptic course to join the A2 segment of the contralateral ACA, making this vascular anomaly function as a 'left ACA with an origin at the right ICA'. The A1 segment of the left ACA is absent and both A2 segments of the ACAs present fenestration. To our knowledge, no similar cases have been reported in English literature so far.

Salidas laborales de los residentes de Pediatría. Datos del periodo 2014-2017 / Employment outcomes of residents of Paediatrics, 2014-2017 period

Introducción: dada la escasez de pediatras de nuestro sistema de salud y la necesidad de estos en Atención Primaria, donde cerca del 25% de las plazas están ocupadas por no especialistas en Pediatría, se quiso conocer el destino laboral inicial de los residentes que habían finalizado su periodo de formación en los últimos cuatro años. Metodología: se han recogido las salidas laborales de los residentes que han finalizado su periodo de rotación durante los años 2014-2017 en los hospitales españoles. La recogida se ha realizado por medio de los representantes de residentes de las comunidades autónomas y los vocales autonómicos de la Asociación de Pediatría de Atención Primaria. Resultados: se han recogido datos de las salidas laborales del 75,7% de los residentes, lo que supone conocer el destino laboral de 1263 residentes de los últimos cuatro años. La elección de Atención Primaria en el transcurso de estos años ha disminuido del 30,77 al 24,5%; igualmente han disminuido los trabajos en hospitalización o consultas hospitalarias que han descendido de un 43,8 a un 32,85%, mientras que la realización de guardias o cobertura de Urgencias ha aumentado y también ha subido el porcentaje de los que se dedican a la medicina privada. Conclusiones: el porcentaje de residentes que acude a Atención Primaria es insuficiente. El trabajo del pediatra está siendo de peor calidad, con aumento de los contratos de guardias y Urgencias. Está aumentando el porcentaje de residentes que se dirigen hacia la sanidad privada

Introduction: given the shortage of paediatricians in the Spanish health care system and the high demand for them in primary care, where approximately 25% of positions are filled by non-specialists in paediatrics, we wanted to know the initial employment destination of residents who had finished his training period in the last 4 years. Methodology: the work exits of residents who have completed their rotation period during the years 2014-2017 in Spanish hospitals have been collected. The collection was made through the representatives of residents of autonomous communities and auton mous members of the Primary Care Pediatric Association. Results: data were collected on the work exits of 75.7% of the residents, which means knowing the employment destination of 1263 residents of the last 4 years. The choice of primary care during these years has decreased from 30.77 to 24.5%, while hospitalization or hospital consultations have decreased from 43.8 to 32.85%, while the realization of guards or emergency coverage has increased and the percentage of those who dedicate themselves to private medicine has also increased. Conclusions: the percentage of residents who attend primary care is insufficient. The work of pediatrician is being of worse quality, with increased contracts of guards and emergencies. The percentage of residents heading towards private healthcare is increasing

Persistent trigeminal artery: a cross-sectional study based on over 3 years conventional angiography, CT angiography and MR angiography images.

PURPOSE: The trigeminal artery is one of the four primitive anastomosis established between the internal carotid artery and the vertebrobasilar system that regresses at the sixth week of embryonic development. Its persistence in adult life (PTA) is usually found incidentally. The aim of this study is to determine its prevalence, main characteristics and clinical significance. METHODS: A cross-sectional study was performed over the last 3 years, 2012-2014, to analyze images performed on conventional angiography, CT angiography and MR angiography of patients who attended the Neuroradiology Department of the Hospital Universitario Doce de Octubre in Madrid, Spain, to control their underlying pathology. RESULTS: Nine cases of PTA were found (prevalence 0.37 %, two men, seven women; three right, six left; age range 13-88 years). Eight PTA emerged from the cavernous ICA and one from the petrous segment. Six cases were lateral or petrosal type and one was medial or sphenoidal type. The whole PTAs anastomosed the BA, six at the middle third and three at the distal third. Weon et al.'s type 3 was predominant. CVD incidence was 55.6 % and aneurysm incidence was 22 %. CONCLUSIONS: PTA prevalence was similar to those previously reported, being commonly left-sided, Salas et al.'s lateral or petrosal type, Weon et al.'s type 3 and with no gender predominance. CVD and aneurysms incidence in the presence of a PTA were higher than in general population. Its anatomical relations make it essential to consider its presence and directional blood flow when planning endovascular and neurosurgical treatments.

Thomas Willis, a pioneer in translational research in anatomy (on the 350th anniversary of Cerebri anatome).

The year 2014 marked the 350th anniversary of the publication in London of Cerebri anatome, a ground-breaking work of neuroscience heavily influenced by the political and cultural context of Baroque Europe and mid-17th century England. This article aims to review the work of the English physician and anatomist Thomas Willis, specifically with regard to the contents of his Cerebri anatome. Willis's academic and professional career was influenced by the turbulent period of the English Civil War during which he studied medicine. Willis went from chemistry to dissection arguably because of his need to justify the body-brain-soul relationship. As a result, he became a fellow of a select club of eminent experimentalists, and afterward was a Fellow of the Royal Society. Later on, he went to London, leaving the academic life to dedicate himself fully to the profession of medicine. As a physician, Willis did not base his practice on aphorisms but on a 'bench to bedside' approach to medicine, while studying neuroanatomy--covering embryology, comparative anatomy and pathological anatomy--as a basis for the comprehension of neurological pathology. He developed innovative anatomical methods for the preservation and dissection of the brain, injection of coloured substances and illustration of his findings. In Cerebri anatome, Willis recognized the cerebral cortex as the substrate of cognition. He also claimed that the painful stimuli came from the meninges, but not from the brain itself. He explained for the first time the pathological and functional meaning of the brain's circular arterial anastomosis, which is named after him. He also specified some features of the cranial origin of the sympathetic nerves and coined the term 'neurologie'. Cerebri anatome marked the transition between the mediaeval and modern notions of brain function, and thus it is considered a cornerstone of clinical and comparative anatomy of the nervous system. The new contributions and methods employed by Willis justify his place as a father of neurology and a pioneer of translational research.