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The embryology of the normal esophagus and trachea is controversial. There are two main opinions regarding the role played by the tracheoesophageal (TE) septum. Similar controversy exists in explaining the embryology of anomalous TE development, mainly due to a lack of embryos demonstrating these anomalies at critical stages during development. Proposed theories can be divided into four main groups: intraembryonic pressure; epithelial occlusion; differential growth; and vascular occlusion. More recently, a new theory has been described based on analysis of anomalous TE development in adriamycin (doxorubicin)-exposed rat embryos. Impaired tracheal development, with the foregut developing into the trachea rather than the esophagus and associated with development of a dorsal pouch from the upper part of the foregut, gave rise to esophageal atresia with distal TE fistula. On the other hand, development of a ventral upper foregut pouch led to tracheal atresia. A laryngotracheo-esophageal cleft may result if no upper foregut pouches develop, with differentiation of the ventral half of the foregut into trachea and the dorsal half into esophagus. This review describes the basic theories of normal and abnormal TE development in mammalian embryos and presents new data related to this abnormality.

The use of pressure dressing to cover the sutured surgical wound is usually considered a routine conclusion to the repair of umbilical hernias in children. The wound is usually left dressed for a minimum of 5-7 days. The main purpose of pressure dressing is prevention of a hematoma formation. The aim of this study was to compare the surgical outcome after umbilical hernia repair in children when the wounds were covered using pressure dressing or left exposed without dressing after the completion of wound closure. Ninety-six patients with umbilical hernia repair were prospectively randomized to receive pressure dressing (n=52) or have their wounds left exposed without any dressing (n=44) after the completion of wound closure. None of the hernias were huge umbilical hernia and none required an umbilicoplasty. In the group who received pressure dressing, one patient developed wound infection 1.9% while no patients developed wound infection in the group who had their wounds exposed without any dressing. In children, there was no significant difference in terms of wound infection, hematoma or seroma formation and recurrence rate after applying pressure dressing or leaving the surgical wounds exposed without any dressing after completion of wound closure. Pressure dressing after umbilical hernia repair may be unnecessary.

A spectrum of congenital anomalies have been described in an adriamycin-treated model with common features to the human pattern. Multiple intestinal atresias was part of this spectrum occurring in 25% of full-term experimental rat fetuses. The aim of this study was to examine the underlying developmental mechanism that results in intestinal atresia. Virgin timed-pregnant Sprague-Dawley rats were injected with Adriamycin i.p. at a dose of 2 mg/kg on days 6-9 of gestation. Embryos were removed on different gestational days during organogenesis and serial transverse histologic sections were examined and compared with control specimens. In experimental embryos, hindgut atresia was seen in day 12 embryos. Attachment of the intestine with the notochord was obvious observation resulting in abnormal position of the intestine. In some specimens the atretic intestine was splitting the dorsal aorta or even located behind the dorsal aorta. It is concluded that in the adriamycin-animal model, notochord-intestinal failure of detachment resulted in intestinal atresia during the beginning of organogenesis period. The possible underlying mechanisms are pinching of some endodermal cells as well as interference with normal intestinal circulation resulting in ischemic necrosis.

AbstractObjectiveTo systematically document the patterns of war related injuries in Gaza, Palestine.DesignSurvey study of international healthcare workers, August 2024 to February 2025.SettingGaza, Palestine.Participants78 international healthcare workers deployed to Gaza.Main outcome measuresThe main outcome was the type of injuries observed by international healthcare workers during the conflict in Gaza. A Delphi informed survey was distributed through non-governmental organisation rosters and secure WhatsApp and email groups. Respondents completed the survey using contemporaneous logbooks and shift records.ResultsThe survey collected data on 12 anatomical regions, mechanisms of trauma, and general medical conditions. 78 healthcare workers reported 23 726 trauma related injuries and 6960 injuries related to weapons. The most common traumatic injuries were burns (n=4348, 18.3%), lower limb injuries (n=4258, 17.9%), and upper limb injuries (n=3534, 14.9%). Explosive injuries accounted for most of the weapon related trauma (n=4635, 66.6%), predominantly affecting the head (n=1289, 27.8%), whereas firearm injuries disproportionately affected the lower limbs (n=526, 22.6%). Healthcare workers reported 4188 people with chronic disease across 11 domains requiring long term treatment.ConclusionHealthcare workers deployed to Gaza reported an injury phenotype defined by extensive polytrauma (≥2 anatomical regions), complex blast injuries from high yield explosives, firearm related injuries to upper and lower limbs, and severe disruption to primary care and the treatment of chronic diseases. The results provide actionable insights to tailor humanitarian response and highlight the urgent need for structured, resilient clinical surveillance systems.Editor’s noteThis paper is based on research from an active war zone, where conventional research methods may be impossible to apply.

It was proposed that the pathogenesis of multiple intestinal atresias (MIA) in human fetuses is a consequence of malformative processes of the gastrointestinal tract rather than an ischemic process. Recently, MIA has been described in adriamycin-exposed rat fetuses. The aim of this study was to describe the embryogenesis of hindgut atresia (HA) in the adriamycin animal model. Timed-pregnant Sprague-Dawley rats were injected with adriamycin on days 6-9 of gestation. Embryos were removed on different gestational days during organogenesis and histologic sections were examined and compared with control specimens. In experimental embryos, HA was seen on day 13; however, the lumen was patent on day 12. HA was associated with abnormal vascular anatomy that was obvious on days 12 and 13. It is concluded that HA in adriamycin-exposed embryos occurs at the beginning of organogenesis. Although it was associated with an obvious vascular anomaly, further studies are required to find out whether it is ischemic in origin.

Vertebral and radial anomalies are prominent features of VATER vertebral defects, anorectal anomaly, tacheoesophageal fistula with esophageal atresia, and radial dysplasia association. It has been shown that exposure of the rat fetus to adriamycin produces a spectrum of anomalies, including esophageal atresia and other features of VATER association. We aimed to document the skeletal defects found in rats exposed to teratogenic doses of adriamycin in utero. Vertebral, rib. and limb anomalies were found in 54, 54, and 35% of these examined fetuses, respectively. The range of bone lesions seen in this animal model was similar to the range of lesions seen in infants born with VATER association.