Week Of Embryonic Life Research Articles

A Rare Case of Bilobed Gallbladder with Two Cystic Ducts

Bilobed or duplicate gallbladders are the rare anomalies of the biliary system occurring between the 5th and 6th weeks of embryonic life, of which Type 2 ductular variant is the commonest. Patients may be asymptomatic or symptomatic, with majority of the cases being detected intraoperatively or during re-operation. Once suspected a detailed preoperative evaluation is a must to avoid both intraoperative and postoperative complications. We report a case of a 34-year-old female who presented with acute onset of abdominal pain and was detected with symptomatic bilobed gallbladder (H Type) with cholelithiasis, with a resolution of symptoms after a successful laparoscopic cholecystectomy. The case emphasizes the importance of detailed preoperative evaluation in the form of ultrasound and magnetic resonance cholangiopancreatography to be considered during the management of biliary pathologies to avoid any intra- and post-operative complications.

Epidermoid cyst of the brain: A common cystic lesion in rare location

Epidermoid cysts are common benign tumors comprising around 1% and 2% of all intracranial tumors. Their usual locations include the parasellar region and cerebellopontine angle, and less commonly, the Sylvian fissure, suprasellar region, cerebral, and cerebellar hemispheres. Epidermoid cysts located in the brain stem are rare. These epidermoid cysts are similar to epidermoids arising in the skin which contain cheesy and flaky-white soft pultaceous material. Epidermoid cysts are very slow-growing tumors having a similar growth pattern of the epidermal cells of the skin and develop from the remnants of epidermal elements during the closure of the neural groove and disjunction of the surface ectoderm with neural ectoderm between the 3rd and 5th weeks of embryonic life. The ideal treatment of choice is the removal of cystic components with the complete resection of the capsule. We are presenting an interesting case of an epidermoid cyst in the frontal lobe in a 42-year-old male along with radiological investigations.

Early Stages of Human Embryology: A Quasi-experimental Study from South Kerala, India

Introduction: Physical models are being used in embryology lectures along with PowerPoint presentations to improve the spatial orientation of students. But the demonstration of the sequence of changes is not possible with commercial models due to nonavailability and high expenses. The latest audio-visual aids including three-dimensional projections like simulation-based screens, or virtual reality enhance the visual-spatial ability of the students but are very costly and not affordable for all institutions. Aim: To compare the effectiveness of hand-made physical models with the PowerPoint presentation mode of teaching in understanding the 3D concept of embryology, among first-year MBBS students and to assess the students’ perception of this model-based teaching. Materials and Methods: The study was conducted using a quasi-experimental study design, on 218 phase 1 medical students of Government Medical College, Thiruvananthapuram, Kerala, India, from February 2020 to August 2020. The students were divided into two equal groups. Group B was taught the topic “Second week of embryonic life” with a PowerPoint lecture session (n=109) and the Group A had in addition a demonstration with the handmade models (n=109). Pretest and post-test were conducted with an internally validated questionnaire. Feedback on the student’s acceptance of teaching/ learning with models were also collected. The improvement of the test scores was analysed using paired t-tests in both the test and control groups. Results: Statistically significant improvement in knowledge score was obtained while comparing the post-test scores of the intervention group (mean score was 4.83±2) with that of the non intervention group (mean score was 3.99±2.06) (student’s t-test, p-value <0.05). It was observed, 99.1% of students were satisfied with this model-assisted teaching, especially with the series of models demonstrating the sequence of events. A 93.1% of students said that they needed such model-assisted lectures in other subjects also. Conclusion: Series of models pertaining to a particular event is beneficial and effective for learning complex concepts of embryology. Also, it’s a long-lasting, innovative mode of teaching which can be done cost-effectively

PARADUODENAL HERNIA: A HIDDEN CULPRIT

Paraduodenal hernia is a congenital anomaly of developmental defects which occurs due to malrotation of gut in 12th week of embryonic life. This current study represents a case of left paraduodenal hernia with radiological imaging and intra-operative ndings. A 37 years old male presented in surgery OPD, RIMS, Ranchi with complains of recurrent abdominal pain on left side of abdomen since 2 months. CT Scan whole abdomen and pelvis was suggestive of left paraduodenal hernia so patient underwent pre-anaesthetic check up and exploratory laparotomy with hernia repair was done.

Anatomical Variation in the Fissurization of Lung with Embryological and Clinical correlations- A Case Report

Lungs are paired conical organs present in the thoracic cavity, which are responsible for gaseous exchange for oxygenation of blood. Both the lungs are divided into lobes by fissures. The right lung is divided into upper, middle and lower lobes by two fissures. The fissures are horizontal and oblique fissure whereas the left lung is divided into upper and lower lobes by oblique fissure. The left lung is divided into upper and lower lobe by oblique fissure. Both the lungs have ten bronchopulmonary segments (structurally separate and functionally independent units). Embryological evidence showed that the lungs developed from the endodermal counterpart of the foregut. Around 22 days of embryonic period, diverticulum are develop, then between 26-28 days lung buds develop. The right bronchial buds and left bronchial buds are branched into secondary and tertiary buds at 5th and 6th week of embryonic life consecutively. During routine anatomy dissection and demonstration in the Department of Anatomy, a 50 year old male cadaver showed anatomical variation in the right lung. The present study observed that the right lung showed partial horizontal fissure. The reason for partial or incomplete fissure formation is due to incomplete or absence of obliteration of prenatal fissure which indicates partial fusion of lobes, generally fissures separating the broncho-pulmonary segments in prenatal life. The reports says that incomplete fissures of the lung may lead to spread of infection like pneumonia to adjacent lobe and collapse in endobronchial lesions and gradation of the fissures of the lungs are very important for lung surgeries. The present study concludes that the knowledge of anatomical variation of lung is of utmost important in the field of pulmonary medicine.

English

Posterior high cervical spinal cord cleft has been rarely reported in association with Klippel - Feil syndrome (KFS). Its presence may have prognostic value in long term neurological outcome. If there is segmentation anomaly of two or more vertebrae during embryonic life mainly involving the cervical vertebrae, it can result in Klippel - Feil syndrome. It is a rare anomaly and is present with the incidence of 1 : 42000 births.1 During 2nd to 8th week of embryonic life, the segmentation of the mesodermal somites of the spine in the cervical region fails and leads to cervical spine synostosis which is also known as KFS. Although most commonly the KFS patients present with the symptoms of short length of the neck, hairline posteriorly is low and the mobility in the upper part of the spine is restricted. It is also sometimes associated with other congenital anomalies like Sprengel’s deformity, hemivertebra, basilar impression, cleft palate, and many more rare anomalies.2 Most commonly the patients having this syndrome show restriction of the motion in the neck region.3

Laparoskopska holecistektomija kod situs inversus totalis anomalije - prikaz slučaja

Situs inversus totalis represents a rare autosomal recessive morphological anomaly of the internal viscera, equally affecting both genders. The genetic defect occurs in the 2nd week of embryonic life, when a 270-degree clockwise rotation of the primitive digestive tube occurs. The incidence of calculosis of gallbladder in patients with situs inversus is the same as in the general population. A 61-year-old female patient with a history of four episodes of colicky, left hypochondrium and epigastric pain, without fever and jaundice, was admitted for elective laparoscopic cholecystectomy. CT of abdomen confirmed situs inversus totalis that was previously known to the patient. The patient was positioned in supine position and a mirror image configuration of the operating room was obtained, with surgeon and scrub nurse on the right side and assistant on the left side of the patient. Four trocars were introduced mirroring the standard position of the 5 mm trocars. During the dissection, second assistant was introduced for the laparoscope, due to the surgeon's limited motor skills in his left hand for delicate dissection, rendering him inapt to perform precise and safe dissection. The total operating time amounted to 110 minutes, which is three times longer than the standard operating time at our institution. The most critical point of the operation in constellation of situs inversus totalis is applying the clips, which requires precision and strength in the same moment. In the available literature, 40 open cholecystectomies before introduction of laparoscopy and 92 laparoscopic cholecystectomies were reported. To our knowledge, this is the first and the only reported laparoscopic cholecystectomy for situs inversus in North Macedonia.

The Yolk Sac: An Interesting Small Structure of the Human Embryonic Stage

The yolk sac is a small extraembryonic structure that plays a crucial role during the first trimester of pregnancy. It provides nutrients and performs endocrine, metabolic, and hematopoietic functions during embryogenesis, reaching its peak of functionality between the fourth and seventh weeks of embryonic life [1]. The size of the yolk sac ranges between 2 mm and 5 mm, and it continues to grow up to the 10th week of gestation. Abnormalities of the yolk sac are correlated with poor pregnancy outcomes [2,3].

Spinal Epidermoid Cyst in a Child- An Experience with a Rare Case

Epidermoid cysts are rare benign neoplasm accounting for less than 1% of all intra-spinal tumors. Congenital epidermis cysts are frequently found with syringomyelia, dermal sinus and spina bifida. Most common etiology for an acquired cyst is repeated lumbar puncture. Congenital epidermoid cysts, often associated with other spinal dysraphisms, are caused by the anomalous implantation of ectodermalcells during closure of the neural tube between the third and fifth week of embryonic life. This is a very rare case. With all these characteristics and literature review, we report this case for its rarity and unique characteristics in this part of world (Nepal). These patients commonly present late to the hospital.

Is Stem Cell Therapy an Answer to Heart Failure: A Literature Search.

The heart is one of the most industrious organs in the human body. It starts beating in the first few weeks of embryonic life and keeps pumping blood till death. This organ can host a range of diseases as well. Some can hamper the vasculature, while others can affect its electrical activity, the heart valves, etc. All these conditions can lead to end-stage failure where it can no longer meet the requirements of the body’s milieu. This imbalance between supply and demand leads to an array of symptoms. Medical management can reduce these clinical effects and possibly prolong the life expectancy in such patients. However, prescription medications can also have their own adverse effects. This necessitates that each line of treatment should be assessed on a risk vs benefit basis. The conventional approach has been to try and slow down the progression of heart failure (HF). However, the inception of stem cells in the management of HF has the potential for reversal of this pathology. Keeping this in view, many studies and trials are under process. To turn the clock back on the HF, before complications set in or get out of control, is the main focus of the time. This article attempts to evaluate various studies about stem cell therapy (SCT) and highlight the important aspects of this novel modality in changing patients' lives.

Anomalies of the branchial arch apparatus in children: case series and review of literature

<p>Branchial apparatus develop between the 3rd and 7th weeks of embryonic life. There are five mesodermal arches separated by invaginations of ectoderm and endoderm. Branchial anomalies are result of aberrant embryonic development and are rarely seen in clinical practice. The objective of this article is to present few cases of branchial arch anomalies and to discuss the clinical presentation, diagnosis and surgical approach of such lesions in pediatric age group.</p>

Second branchial arch anomaly: case series of two

<p>Branchial apparatus develop between the 3<sup>rd</sup> and 7<sup>th</sup> weeks of embryonic life. There are 5 mesodermal arches separated by invaginations of ectoderm and endoderm. During development the second arch grows caudally to cover the third and fourth arches and the second, third, and fourth pharyngeal clefts eventually fusing with the lower neck. The enclosed II, III, and IV clefts are called as the cervical sinus. If this process does not occur for some reason then it gives rise to branchial cyst, sinus or fistula. We are presenting two cases of second branchial arch anomaly. In first case there was bilateral branchial fistula with right side fistula associated with branchial cyst. In second case there was unilateral right side branchial fistula. We operated both the cases by giving step ladder incision. In second case we find fistulous track opening in the tonsillar bed. Both the patients recovered well with no recurrence since 1 year. Brachial cleft cyst is a common cause of soft tissue swelling in the neck of a young adult. They generally occur unilaterally and are typically seen in the lateral aspect of the neck. It is clinically apparent in late childhood or early adulthood. In older adults with this presentation, it is important to exclude metastatic lymphadenopathy, lymphoma or tuberculosis.</p>

Brainstem epidermoid cyst: An update.

The incidence of epidermoid tumors is between 1% and 2% of all intracranial tumors. The usual locations of epidermoid tumor are the parasellar region and cerebellopontine angle, and it is less commonly located in sylvian fissure, suprasellar region, cerebral and cerebellar hemispheres, and lateral and fourth ventricles. Epidermoid cysts located in the posterior fossa usually arise in the lateral subarachnoid cisterns, and those located in the brain stem are rare. These epidermoids contain cheesy and flaky white soft putty like contents. Epidermoid cysts are very slow growing tumors having a similar growth pattern of the epidermal cells of the skin and develop from remnants of epidermal elements during closure of the neural groove and disjunction of the surface ectoderm with neural ectoderm between the third and fifth weeks of embryonic life. We are presenting an interesting case of intrinsic brainstem epidermoid cyst containing milky white liquefied material with flakes in a 5-year-old girl. Diffusion-weighted imaging is definitive for the diagnosis. Ideal treatment of choice is removal of cystic components with complete resection of capsule. Although radical resection will prevent recurrence, in view of very thin firmly adherent capsule to brainstem, it is not always possible to do complete resection of capsule without any neurological deficits.

A second branchial cyst, masquerading as lipoma, a mistaken diagnosis supported by radiology and fine needle aspiration cytology: case report

At the fourth week of embryonic life, the development of four branchial clefts result in five branchial arches, which contribute to the formation of various structures in the head and neck. We report a case of second branchial cleft cyst in a 50 years old lady for last 30 years. The cyst did not develop any complication in spite of long duration. The mass had been evaluated in past and she underwent ultrasonography (USG) and fine needle aspiration cytology (FNAC). Again, we evaluated the patient with USG, contrast enhanced computer tomography (CECT) and FNAC. The final diagnosis on both the occasions was lipoma neck. The mass was found to be second branchial cyst on exploration under local anaesthesia and same was confirmed by histopathology. We wish to highlight the limitation of radiology and cytology the diagnosis of branchial cleft cysts. The magnetic resonance imaging (MRI) may have clinched the exact diagnosis, which was not done in this case. The operating surgeons should always keep in mind these limitation and be prepared for surprises in dealing with the neck masses .

Infratentorial arteriovenous malformation associated with persistent primitive hypoglossal artery

Background:We report a case of infratentorial arteriovenous malformation (AVM) associated with persistent primitive hypoglossal artery (PPHA). To our knowledge, this is the second reported case of these combined anomalies in the English literature. We discuss the embryological relationship between these two congenital vascular anomalies.Case Description:An 18-year-old girl, who suddenly developed severe headache and vomiting followed by loss of consciousness, was admitted to our hospital. A computed tomography scan showed intracerebellar hemorrhage with obstructive hydrocephalus. Digital subtraction angiography revealed an AVM in the left cerebellar hemisphere and an ipsilateral PPHA. After the intracranial pressure was stabilized, the AVM was surgically removed. AVMs develop during the 4th to 8th week of embryonic life. In contrast, carotid-basilar anastomoses (CBAs) including primitive hypoglossal arteries appear and close spontaneously by the 6th week of embryonic life. Thus, AVMs precede CBAs, and a large amount of blood flows into the adjoining AVM via ipsilateral CBAs. As a result, spontaneous closure of a CBA may be disturbed.Conclusion:We speculate that coexistence of infratentorial AVMs and ipsilateral CBAs is not incidental but inevitable.

An Adult Man With Acute Dysphagia and Systemic Inflammation

Question: A 45-year-old man was admitted to the hospital with increasing dysphagia and retrosternal pain of 2 weeks' duration. He denied any weight loss or B-symptoms. The patient had no history of alcohol or nicotine consumption. He was afebrile and the blood pressure was 110/60 mmHg. The physical examination of the oropharynx and thyreoidea was unremarkable. Auscultation revealed decreased breath sounds basal on the patient's left side. Laboratory studies showed leukocytosis (15.8 × 103/ μL) and an increased C-reactive protein level of 67.9 mg/L; troponin and heart enzymes were negative. The esophagogastroduodenoscopy showed esophageal obstruction by an impression of the right and anterior wall of the lower third of the esophagus at 30–36 cm ab ore. The mucosal aspect was normal (Figure A). Contrast-enhanced computed tomography (CT) was performed, revealing a paraesophageal mass (5 × 4.5 × 1.5 cm) adjacent to the lower third of the esophagus (asterisk) and a pleural effusion on the left side (Figure B). After a severe coughing attack on the second day after admission there was a short exacerbation of pain and an increase of temperature. The dysphagia improved promptly. Correlating his clinical and imaging findings, what is your diagnosis? Look on page 1166 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. The re-performed esophagogastroduodenoscopy showed a perforation (arrow) at about 32 cm ab ore, with secretion of purulent discharge. The impression of the lower esophagus was no longer detectable (Figure C). Endoscopic ultrasonography showed a paraesophageal cavity with a 3-layer wall (arrow) containing air (arrowhead) and debris, connected with the esophageal lumen by a short fistula tract (Figure D; asterisk = diaphragm). CT showed a paraesophageal mass, consistent with an abscess in a preexisting congenital cyst, which has been emptied intraluminally after spontaneous perforation. The patient was started on an antibiotic therapy. In the paraesophageal cavity and also pleural empyema the same pathogen (Streptococcus intermedius) was detected as a result of bacterial migration. A bronchial fistula could be excluded. The further course of treatment involved the surgical removal of the pleural empyema and the surgical resection of the cystic tumor. Pathologic examination showed a cystic lesion with dual muscular layer and no cartilage or bronchial glands. The inner layer was composed of both squamous (Figure E) and multirowed ciliated epithelium (Figure F). Esophageal duplication cyst is a rare congenital anomaly; few cases have been reported in the literature to date. Up to 80% of esophageal duplication cysts are diagnosed in childhood while investigating for respiratory distress or feeding difficulty. In adults esophageal duplication cysts are often asymptomatic and diagnosed incidentally when a chest radiograph or CT is taken. Esophageal duplication cysts result from an abnormal vacuolization process during the development of the esophageal lumen in the fifth to eighth week of embryonic life.1Lee H.S. Jeon H.J. Song C.W. et al.Esophageal duplication cyst complicated with intramural hematoma—case report.J Korean Med Sci. 1994; 9: 188-196Crossref PubMed Scopus (15) Google Scholar Most are located in the right posterior mediastinum at the level of the distal third of the esophagus.2Procházka V. Kala Z. Novotny I. et al.Laparoscopic management of an infected oesophageal cyst.Rozhl Chir. 2005; 84: 526-528PubMed Google Scholar Cysts may become symptomatic owing to complications such as esophageal stenosis, respiratory system compression, or rupture. Complete operative resection is the standard treatment even if the patient is asymptomatic because of the risk of complications. The traditional approach for resection is via thoracoscopy. Esophageal duplication cysts are lined by squamous, columnar, cuboid, pseudostratified, or ciliated epithelium.3Gilbert-Barness E. Potter's pathology of the fetus infant and child. Amsterdam: Elsevier.Google Scholar To our knowledge, this is the first report of the development of empyema and spontaneous perforation in an adult. The authors thank W. Hofmann for providing the pathologic images and J. Stollfuss for the radiologic images.

Congenital partial absence of the pericardium in a young man with atypical chest pain

Pericardial defects are infrequent congenital anomalies due to agenesis caused by premature atrophy of the common cardinal vein or Cuvier duct during the 5(th) or 6(th) week of embryonic life. These congenital defects are rare, typically observed as an incidental finding and usually remain asymptomatic. Nevertheless, the more widespread use of modern imaging techniques has contributed to an increase of its incidence in recent years. There is currently no consensus regarding therapeutic options, all of which are based on small retrospective studies that evaluate the risk of developing a life-threatening complication such as herniation and incarceration of the myocardium. We report on a 22-year-old male who presented with sudden onset of sharp chest pain and dyspnea. Computed tomography and cardiac magnetic resonance scan revealed a pericardial defect adjacent to the lateral free wall of the left atrium with associated herniation of the left atrial appendage. The patient was managed conservatively and had an uneventful clinical progress.

Case Report: An Unusual Osseous Lesion

The intraosseous benign notochordal cell tumor (BNCT) is an intravertebral lesion derived from notochordal tissue. The notochord develops in humans during the third week of embryonic life and persists in adults as the nucleus pulposus of the vertebral disks. The most common locations of such tumors are the saccrococcygeal region and the skull base. Most tumors are asymptomatic and small. Magnetic resonance imaging is useful in their detection and precise localization. Histologically, these lesions consist of sheets of adipocyte-like vacuolated or less vacuolated eosinophilic tumor cells with eccentrically located round nuclei without myxoid matrix. The tumor cells express the epithelial markers, vimentin and S100 protein. Main differential diagnosis is chordoma. Intraosseous BNCT do not require any surgical management and should be recognized by pathologists to prevent unnecessary radical surgery. These lesions should be followed-up with conventional MRI.

Persistent left superior vena cava: implications during central venous cannulation

To the Editor, We read with interest the article by Commandeur et al. entitled ‘‘Ultrasound-guided cannulation of the left subclavian vein in a case of persistent left superior vena cava (PLSVC).’’ The authors did not mention in their article the possibility of having cannulated the left pericardiophrenic vein, which can be mistaken for the PLSVC on an anterior chest radiograph except that it follows the left superior mediastinal border and then curves laterally along the left heart border (whereas a PLSVC curves medially). Normally, a PLSVC drains into the right atrium. Drainage into the left atrium (as was stated in the report) is rare, creating a right-to-left shunt with associated risks of hypoxemia and systemic embolization. Usually, a PLSVC coexists with a right superior vena cava (RSVC); and the two may or may not be connected by a left innominate vein (Figure, lower panel). The authors noted that ‘‘a PLSVC is usually asymptomatic.’’ However, the risk of other congenital anomalies increase if a PLSVC drains into the left atrium or if the RSVC is absent. As the Figure shows, when the RSVC is absent, drainage from the right jugular and subclavian veins passes via the innominate vein into the PLSVC, and passage of a central catheter via the right jugular or the subclavian vein will appear to take an atypical course on a chest radiograph (Figure, lower panel). With regard to the development of a PLSVC (Figure, upper panel), venous drainage of the upper embryo occurs along the right and left anterior cardinal veins. These veins drain via the right and left common cardinal veins into the sinus venosus and, finally, the primitive atrium. By the eighth week of embryonic life, a connecting vessel has developed between the right and left anterior cardinal veins, directing flow from the left to the right side. This connecting vein is destined to become the left innominate vein. Below the connecting vein, the left anterior cardinal vein atrophies into a fibrous cord (becoming the ligament of the left vena cava and extending from the upper part of the left superior intercostal vein to the oblique vein of the left atrium). The oblique vein of the left atrium (a remnant of the left common cardinal vein) drains into the coronary sinus (developed from the left lateral horn of the sinus venosus). Inadequate development or absence of the connecting vein leads to the development of a PLSVC, which normally drains into the right atrium via the oblique vein of the left atrium and the coronary sinus (Figure). In conclusion, embryonic variations in venous anatomy must always be considered when performing central venous cannulation.

Aphalangia possibly linked to unintended use of finasteride during early pregnancy

Aphalangia possibly linked to unintended use of finasteride during early pregnancy