The definition of a pre and postfixed brachial plexus is varied in the literature, which results in inconsistent conclusions for various studies. As anatomical variation is important both during clinical evaluation and surgical procedures of the brachial plexus, a review of this literature was performed. Based on our review, variation in the contribution to the brachial plexus is more the rule than the exception. These variations may lead to deviation from the expected dermatome distribution as well as differences in the motor innervation of muscles of the upper limb. Such variations may predispose patients to certain pathology such as thoracic outlet syndrome and may alter surgical approaches to the brachial plexus.

Originally described over 300 years ago, the clinical scenario of intussusception remains incompletely understood. Intussusception is now one of the conditions that can be, most of the time, preoperatively diagnosed and treated with success. This article reviews the literature regarding this pathological state of the abdomen and discusses what is known regarding the presentation, diagnosis, embryology, and anatomy of intussusception.

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Objectives: There is mounting evidence that delays in appropriate antimicrobial administration are responsible for preventable deaths in patients with sepsis. Herein, we examine the association between potentially modifiable antimicrobial administration delays, measured by the time from the first order to the first administration (antimicrobial lead time), and death among people who present with new onset of sepsis. Design: Observational cohort and case-control study. Setting: The emergency department of an academic, tertiary referral center during a 3.5-year period. Patients: Adult patients with new onset of sepsis or septic shock. Interventions: None. Measurements and Main Results: We enrolled 4,429 consecutive patients who presented to the emergency department with a new diagnosis of sepsis. We defined 0–1 hour as the gold standard antimicrobial lead time for comparison. Fifty percent of patients had an antimicrobial lead time of more than 1.3 hours. For an antimicrobial lead time of 1–2 hours, the adjusted odds ratio of death at 28 days was 1.28 (95% CI, 1.07–1.54; p = 0.007); for an antimicrobial lead time of 2–3 hours was 1.07 (95% CI, 0.85–1.36; p = 0.6); for an antimicrobial lead time of 3–6 hours was 1.57 (95% CI, 1.26–1.95; p < 0.001); for an antimicrobial lead time of 6–12 hours was 1.36 (95% CI, 0.99–1.86; p = 0.06); and for an antimicrobial lead time of more than 12 hours was 1.85 (95% CI, 1.29–2.65; p = 0.001). Conclusions: Delays in the first antimicrobial execution, after the initial clinician assessment and first antimicrobial order, are frequent and detrimental. Biases inherent to the retrospective nature of the study apply. Known biologic mechanisms support these findings, which also demonstrate a dose-response effect. In contrast to the elusive nature of sepsis onset and sepsis onset recognition, antimicrobial lead time is an objective, measurable, and modifiable process.

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