Anatomical and cellular heterogeneity in the mouse oviduct-its potential roles in reproduction and preimplantation development†.

The oviduct/fallopian tube is a tube-like structure that extends from the uterus to the ovary. It is an essential reproductive organ that provides an environment for internal fertilization and preimplantation development. However, our knowledge of its regional and cellular heterogeneity is still limited. Here, we examined the anatomical complexity of mouse oviducts using modern imaging techniques and fluorescence reporter lines. We found that there are consistent coiling patterns and turning points in the coiled mouse oviduct that serve as reliable landmarks for luminal morphological regionalities. We also found previously unrecognized anatomical structures in the isthmus and uterotubal junction, which likely play roles in reproduction. Furthermore, we demarcated the ampulla-isthmus junction as a distinct region. Taken together, the oviduct mucosal epithelium has highly diverse structures with distinct epithelial cell populations, reflecting its complex functions in reproduction.

Diagnosis and Management of Ménétrier Disease in Children: A Case Series Review.

PURPOSE: Ménétrier disease (MD) was first described in 1888, and 50 cases have been reported until now. We aimed to discuss the etiology, diagnostics, and management of MD in children. METHODS: We searched for case reports published from 2014 till 2019 in English using PubMed. Articles were selected using subject headings and key words of interest to the topic. Interesting references of the included articles were also included. RESULTS: The pathophysiology of MD is still uncertain. However, overexpression of transforming growth factor alpha with transformation of the gastric mucosa has been observed, which may be mediated by genetics and provoked by an infectious trigger. Clinically, MD is diagnosed by abdominal pain, vomiting, anorexia, and edema secondary to hypoalbuminemia. A gastroscopy with biopsy is the gold standard for the diagnosis of MD. In children, the disease is self-limiting and only requires supportive treatment. In general, children have a good prognosis and recover spontaneously within a few weeks. CONCLUSION: Few pediatric cases of MD have been described in recent years, and with all different etiology. Endoscopy with biopsy remains the golden standard for the diagnosis of MD, and in children, the disease is self-limiting.

Mrmc Neo Surgical Ventilating Port and Neo Attic Malleo-Incudal Complex in Endoscopic Management of Limited Attico-Antral Cholesteatoma.

To study functional outcome of the endoscopic management of limited attico-antral cholesteatoma in terms of visualization of sac, cholesteatoma disease clearance, ABG closure improvement, preservation of residual anatomy and recurrence of disease. It is a prospective study done during Feb 2016 to March 2017 done on 20 pts with limited attico-antral cholesteatoma with CT confirmation. Endoscopic management of limited attico-antral cholesteatoma with complete removal of sac, infected discharge and granulations along with creation of MRMC Neo surgical ventilating port (joining Anterior & posterior isthmuses) done in cases where residual attic anatomy was present to establish physiological attic ventilation and drainage. Whereas in cases of attic and ossicular erosion, ossiculoplasty along with neo attic malleo-incudal complex (with composite tragal cartilage with perichondrium graft) for lateral attic wall reconstruction was done to prevent attic retraction. Patients had mean pre op ABG of 36.29 ± 6.29 and mean post op ABG closure of 16.33 ± 6.50 with no recurrence of cholesteatoma at 6 months of follow up. Patient showed significant (55%) improvement in hearing with all having graft uptake in which four cases having mild pars tensa retraction which recovered later without any intervention. Thus creation of new MRMC Neo surgical ventilating port or neo attic malleo-incudal complex with endoscopic approach allows better visual access to clear the limited attico-antral disease with sparing of normal residual attic anatomy along with physiological ventilation and drainage having better hearing results and outcome.

Lymphatic lacunae of the mucosal folds of human uterine tubes - A rediscovery of forgotten structures and their possible role in reproduction.

The mucosa of uterine tube forms multiple and branched longitudinal mucosal folds and takes part in many reproduction events, such as oocyte pick-up, gamete transport, sperm capacitation, fertilization, and early embryonic development. In the habilitation thesis of German physician Paul Kroemer (1904) was the first to describe the lymphatic lacunae inside the tubal folds (by injection of Indian ink), which the author named the öLymphbahnen" (ölymphatic channels"). Despite the fact that this first description has existed for 110 years, there is no mention of these lacunae in most of the current literature. In this article we present a rediscovery of completely overlooked morphological structures of uterine tubes - the lymphatic lacunae in their mucosal folds. The specimens from the uterine tubes were taken from 72 women (mean age 46.25 years) who underwent transabdominal or laparoscopic salpingectomy. The tissue samples from anatomically different parts of the uterine tubes were used for hematoxylin and eosin staining and for immunohistochemistry. Primary antibodies were used to label and detect podoplanin D2-40, a selective marker of lymphatic endothelia, CD34 antigen, and von Willebrand factor (Factor VIII). In the histological slides of the uterine tubes, there were noticeable slits or gaps within the loose connective tissue of the lamina propria of the mucosal folds. They were lined with one layer of squamous endothelial cells. These öempty spaces" were most prominent in the fimbriae, but were still well recognizable in mucosal folds of the ampulla. They always run through the central part of the fold. As a results of immunohistochemistry, we confirmed that in the centre of every mucosal fold, as well as in the fimbriae of the uterine tubes, dilated lymphatic spaces were situated and were lined with a simple layer of lymphatic endothelial cells (positive for podoplanin and CD34, and negative for Factor VIII). As there is no mention on them in the current Terminologia Histologica, we proposed the term ölymphatic lacunae of tubal mucosal folds and fimbriae" in English and ölacunae lymphaticae plicae mucosae et fimbriae" in Latin. According to our hypothesis, these lymphatic lacunae may be responsible for the thickening of the fimbriae during the oocyte pick-up and the maintenance of the tubal fluid.

Anatomical variants of tympanic compartments and their aeration pathways involved in the pathogenesis of middle ear inflammatory disease.

AIM: The aim of this article is to review the anatomy of middle ear compartments and folds and to demonstrate through anatomical evidence their presence at birth. Additionally, their role in the obstructions of middle ear ventilatory pathway is highlighted. METHODS: Ninety-eight adult temporal bones, with no history of auricular disease and fifteen newborn temporal bones were studied by micro dissection. Documentation was done by color photography using the operation microscope. RESULTS: Our micro-dissections have showed that mucosal folds from the middle ear are steadily present since birth, given that they were found in all newborn temporal bones. The mucosal folds in our normal adult material, showed some variations including membrane defects but they were constantly present. Our micro dissections showed that the epitympanic diaphragm consisted, in addition to malleal ligamental folds and ossicles, of only two constantly present folds: the tensor tympani fold and the incudomalleal fold. When the tensor fold is complete the only ventilation pathway to the anterior epitympanic space is through the isthmus, whereas its absence creates an efficient additional aeration route from the Eustachian tube to the epitympanum. CONCLUSIONS: The goal of surgery in the chronic pathology of the middle ear should be restoration of normal ventilation of the attical-mastoid area. This is possible by removing the tensor fold and restoring the functionality of the isthmus tympani.