Characteristics of acute groin injuries in the adductor muscles: A detailed MRI study in athletes

Acute adductor injuries account for the majority of acute groin injuries; however, little is known about specific injury characteristics, which could be important for the understanding of etiology and management of these injuries. The study aim was to describe acute adductor injuries in athletes using magnetic resonance imaging (MRI). Male athletes with acute groin pain and an MRI confirmed acute adductor muscle injury were prospectively included. MRI was performed within 7 days of injury using a standardized protocol and a reliable assessment approach. 156 athletes presented with acute groin pain of which 71 athletes were included, median age 27 years (range 18-37). There were 46 isolated muscle injuries and 25 athletes with multiple adductor injuries. In total, 111 acute adductor muscle injuries were recorded; 62 adductor longus, 18 adductor brevis, 17 pectineus, 9 obturator externus, 4 gracilis, and 1 adductor magnus injury. Adductor longus injuries occurred at three main injury locations; proximal insertion (26%), intramuscular musculo-tendinous junction (MTJ) of the proximal tendon (26%) and the MTJ of the distal tendon (37%). Intramuscular tendon injury was seen in one case. At the proximal insertion, 12 of 16 injuries were complete avulsions. This study shows that acute adductor injuries generally occur in isolation from other muscle groups. Adductor longus is the most frequently injured muscle in isolation and in combination with other adductor muscle injuries. Three characteristic adductor longus injury locations were observed on MRI, with avulsion injuries accounting for three-quarters of injuries at the proximal insertion, and intramuscular tendon injury was uncommon.

Cardiovascular involvement in human and experimental leptospirosis: pathologic findings and immunohistochemical detection of leptospiral antigen

Twenty hearts from patients dying of leptospirosis were studied. Interstitial myocarditis was found in 50% of the cases, and a significant statistical correlation was observed between myocarditis and the inflammatory involvement of the conduction tissue. Acute coronary arteritis, affecting the main branches of the coronary arteries, was observed in 70% of the cases, and this finding also correlates significantly with interstitial myocarditis. Aortitis was found in 57.8% of the cases. When serum against L. interrogans serovar icterohaemorrhagiae was used, focal IP antigen deposits were observed in the coronary arteries and in the aorta. Experimental data from 12 guinea-pigs inoculated with L. interrogans serovar icterohaemorrhagiae showed a focal myocarditis involving mainly the subendocardial and pericoronary heart tissue, with IP antigen deposits in the same sites. Leptospirosis might be visualized as a generalized illness resembling other infectious vasculitides. The heart and main vessels are involved during the septicaemic phase of the disease, and bacterial migration, toxin(s), enzymes and/or antigenic products liberated by bacterial lysis might account for the increased endothelial permeability with antigen deposits and inflammation.

Chronic human schistosomiasis mansoni-schistosomal antigen, immunoglobulins and complement C3 detection in the liver

The distribution of schistosomal antigen, immunoglobulins and complement C3 was studied by IF stain in 26 biopsies of human liver from 21 cases of hepatosplenic and five of intestinal schistosomiasis mansoni. Schistosomal antigen and immunoglobulins, chiefly of the IgG class and in a lesser intensity complement C3, were seen focally as scanty deposits in cells of the sinusoidal wall. They probably correspond to antigen-antibody insoluble large aggregates which are being removed by local cells of the mononuclear phagocyte system. Gamma globulin of the IgG class and antigens were also present in the granuloma around S. mansoni eggs and dead worms in the human liver. During the early phase of the granulomatous reaction the structure was not efficient enough to wall off completely the antigen, which is seen in cells at the center of the granuloma. As the granuloma matures, antigen demonstration becomes restricted to the miracidium, and immunoglobulins are observed mainly at the periphery. The kinetics of the granuloma formation with intralesional antibody presence promote a progressive antigen neutralization.