In view of the sparsity of report on normal and abnormal pattern of the major arteries during fetal life, the authors undertook investigation of the aortas, coronary arteries, renal arteries, and the umbilical arteries of 76 korean fetuses, ranging from 21/2 months to full-term, A normal pattern and its evolution of the intima, media, and the adventitia was described. The P. A. S. positive substance was most abundantly found in the media of the umbilical arteries, medium amount in the media and intima of the renal arteries and the aortas, and lesser amount in the media of the coronary arteries. A surprisingly high incidence of the alteration of the internal elastic membrane of the aorta simulating to the early lesions of atherosclerosis in adult and neonatal life was observed. In e1even instances, microcystic degeneration of the inner media of the aorta was observed, and its relationship to the idiopathic cystic medial necrosis and dissecting aneurysm was discussed.
Arteries/*embryology ; Arteriosclerosis/*etiology ; Female ; Histocytochemistry ; Human ; Korea ; Pregnancy

PURPOSE: The purpose of this study is to provide better understanding as to how the "double" vascular arcades, in contrast to other intestinal marginal vessels, develop along the right margin of the pancreatic head. MATERIALS AND METHODS: In human fetuses between 8-30 weeks, we described the topographical anatomy of the vessels, bile duct, duodenum as well as the ventral and dorsal primordia of the pancreatic head with an aid of pancreatic polypeptide immunohisto-chemistry. RESULTS: The contents of the hepatoduodenal ligament crossed the superior side of the pylorus. Moreover, the right hepatic artery originating from the superior mesenteric artery ran along the superior aspect of the pancreatic head. An arterial arcade, corresponding to the posterior pancreaticoduodenal arteries, encircled the superior part of the pancreatic head, whereas another arcade, corresponding to the anterior pancreaticoduodenal arteries, surrounded the inferior part. The dorsal promordium of the pancreas surrounded and/or mixed the ventral primordium at 13-16 weeks. Thus, both arterial arcades were likely to attach to the dorsal primordium. CONCLUSION: The fetal anatomy of the pancreaticoduodenal vascular arcades as well as that of the hepatoduodenal ligament were quite different from adults in topographical relations. Thus, in the stage later than 30 weeks, further rotation of the duodenum along a horizontal axis seemed to be required to move the pylorus posterosuperiorly and to reflect the superior surface of the pancreatic head posteriorly. However, to change the topographical anatomy of the superior and inferior arterial arcades into the final position, re-arrangement of the pancreatic parenchyma might be necessary in the head.
Arteries/*embryology ; Duodenum/anatomy & histology/*blood supply/*embryology ; Female ; Fetus/*blood supply ; Gestational Age ; Humans ; Immunohistochemistry ; Male ; Pancreas/anatomy & histology/*blood supply/*embryology ; Pregnancy

Hypoparathyroidism after thyroidectomy occurs as a result of devascularization or unintentional resection of the parathyroid glands. To preserve parathyroid glands, surgeons have to know well about their embryology and anatomy. The parathyroid glands vary in number, size, shape, and color. Because of more variable migration path in the neck, the inferior parathyroid glands are more widely distributed than the superior glands. The upper parathyroid glands are dorsal and the lower parathyroid glands are ventral to the coronal plane of recurrent laryngeal nerve path. Positional symmetry of superior or inferior parathyroid glands is found in approximately 70-80%. Each parathyroid gland has its own end-artery. Both the superior and inferior parathyroid glands most frequently receive blood supply from the inferior thyroid artery. Parathyroid exploration requires a meticulous and bloodless dissection with help of surgical loupes. During the superior pole dissection, every attempt should be made to dissect the gland posteriorly off the thyroid with preserving the posterior branch of the superior thyroid artery. Dissection of the lateral lobe is best achieved by capsular dissection. The tertiary branches of the inferior thyroid artery lying on the thyroid capsule are individually ligated and divided. The surgeon can also utilize positional symmetry of the parathyroid glands. If the parathyroid gland is clearly devascularized or turns deep black, it should be biopsied, confirmed as normal parathyroid tissue, and reimplanted. It is useful to search for unintentionally resected parathyroid tissue in the surgical specimen for autotransplantation at the end of the operation.
Arteries ; Autografts ; Deception ; Embryology ; Hypoparathyroidism ; Neck ; Parathyroid Glands* ; Recurrent Laryngeal Nerve ; Thyroid Gland* ; Thyroidectomy

Various anomalies for the origin of the middle meningeal artery (MMA) have been described in the literature. However, origin of the MMA from the basilar trunk is an extremely rare variant. We report on a 54-year-old female who presented with frequent headaches; magnetic resonance imaging showed a right parietal meningioma. The abnormal origin of the middle meningeal artery from the basilar artery was diagnosed by angiography performed for preoperative embolization of the tumor. We report on the case with a review of the embryologic basis, possible explanations for this aberrant origin, and its clinical implications.
Anatomic Variation ; Angiography ; Basilar Artery* ; Embryology ; Female ; Headache ; Humans ; Magnetic Resonance Imaging ; Meningeal Arteries* ; Meningioma ; Middle Aged ; Rabeprazole

The anatomy of the arterial system supplying blood to the brain can influence the development of arterial disease such as aneurysms, dolichoectasia and atherosclerosis. As the arteries supplying blood to the brain develop during embryogenesis, variation in their anatomy may occur and this variation may influence the development of arterial disease. Angiogenesis, which occurs mainly by sprouting of parent arteries, is the first stage at which variations can occur. At day 24 of embryological life, the internal carotid artery is the first artery to form and it provides all the blood required by the primitive brain. As the occipital region, brain stem and cerebellum enlarge; the internal carotid supply becomes insufficient, triggering the development of the posterior circulation. At this stage, the posterior circulation consists of a primitive mesh of arterial networks that originate from projection of penetrators from the distal carotid artery and more proximally from carotid-vertebrobasilar anastomoses. These anastomoses regress when the basilar artery and the vertebral arteries become independent from the internal carotid artery, but their persistence is not uncommon in adults (e.g., persistent trigeminal artery). Other common remnants of embryological development include fenestration or duplication (most commonly of the basilar artery), hypoplasia (typically of the posterior communicating artery) or agenesis (typically of the anterior communicating artery). Learning more about the hemodynamic consequence that these variants may have on the brain territories they supply may help understand better the underlying physiopathology of cerebral arterial remodeling and stroke in patients with these variants.
Adult ; Aneurysm ; Arteries ; Atherosclerosis ; Basilar Artery ; Brain ; Brain Stem ; Carotid Arteries ; Carotid Artery, Internal ; Cerebellum ; Cerebral Arteries ; Circle of Willis ; Embryology* ; Embryonic Development ; Female ; Hemodynamics ; Humans ; Learning ; Parents ; Pregnancy ; Stroke ; Vertebral Artery

Intracranial and spinal dural arteriovenous fistulas (DAVFs) are vascular pathologies of the dural membrane with arteriovenous shunts. They are abnormal communications between arteries and veins or dural venous sinuses that sit between the two sheets of the dura mater. The dura propria faces the surface of brain, and the osteal dura faces the bone. The location of the shunt points is not distributed homogeneously on the surface of the dural membrane, but there are certain areas susceptible to DAVFs. The dura mater of the olfactory groove, falx cerebri, inferior sagittal sinus, tentorium cerebelli, and falx cerebelli, and the dura mater at the level of the spinal cord are composed only of dura propria, and these areas are derived from neural crest cells. The dura mater of the cavernous sinus, transverse sinus, sigmoid sinus, and anterior condylar confluence surrounding the hypoglossal canal are composed of both dura propria and osteal dura; this group is derived from mesoderm. Although the cause of this heterogeneity has not yet been determined, there are some specific characteristics and tendencies in terms of the embryological features. The possible reasons for the segmental susceptibility to DAVFs are summarized based on the embryology of the dura mater.
Arteries ; Brain ; Cavernous Sinus ; Central Nervous System Vascular Malformations ; Colon, Sigmoid ; Dura Mater ; Embryology ; Membranes ; Mesoderm ; Neural Crest ; Pathology ; Population Characteristics ; Spinal Cord ; Veins

OBJECTIVETo investigate the value of middle cerebral artery (MCA) and umbilical artery (UA) resistance index in predicting fetal hypoxia in fetuses with umbilical cord around the neck in late pregnancy.

METHODSEighty normal fetuses between 38 and 40 weeks of gestation and 88 fetuses with umbilical cord around neck were measured for MCA and UA pulsatility index (PI), resistance index (RI) and the peak-systolic/diastolic ratio (S/D) by means of color Doppler ultrasonography, and the resistance index ratio was calculated. Fetuses with umbilical cord around neck were estimated according to the measured normograms for the presence of fetal hypoxia, and the results were evaluated by diagnostic test.

RESULTSSignificant differences were found in MCA and UA resistance index ratio between the groups (P<0.01). There was no significant difference in the resistance index ratio between the normal group and around the neck (one round) group (P>0.05), but significant difference was found between normal group and around the neck (two rounds and more) group (P<0.01), and between the two arounds and one round groups (P<0.05). The sensitivity and specificity of MCA and UA resistance index and resistance index ratio in predicting fetal hypoxia of fetuses with umbilical cord around neck was 43%, 85%, 92%, 83%, 89%, and 100%, respectively.

CONCLUSIONMCA and UA resistance index ratio is a better indicator than its resistance index in predicting fetal hypoxia of fetuses with umbilical cord around neck, and may help in early detection of fetal hypoxia for a diagnosis before fetal distress.

Adult ; Female ; Fetal Hypoxia ; diagnosis ; etiology ; physiopathology ; Humans ; Middle Cerebral Artery ; diagnostic imaging ; embryology ; physiopathology ; Pregnancy ; Pregnancy Complications ; diagnostic imaging ; Pregnancy Trimester, Third ; Ultrasonography, Doppler ; Ultrasonography, Prenatal ; Umbilical Arteries ; diagnostic imaging ; physiopathology ; Young Adult