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Vaginoplasty with colon is a common technique for vaginal replacement in patients with cloaca. Malignancy in the neovagina is a rare outcome and typically presents decades after reconstruction. We present a case of an adolescent female with history of cloaca, ulcerative colitis, and high-grade dysplasia of the sigmoid neovagina.

The association of gynecological anomalies in all anorectal malformations (ARM) is firmly established. Our goal is to study this pathology in our patients to focus attention to this important issue. Retrospective study of female patients operated for ARM and who underwent magnetic resonance imaging in our center. The type of malformation, the presence and type of vaginal, uterine, tubaric and urological anomalies were studied. 63 patients were included: 34.9% cloaca, 28.6% vestibular and 12.7% perineal. Half of patients had some type of mullerian anomaly; 19 vaginal, most frequent being the longitudinal vaginal septum (66.7%); 30 had uterine alterations, most frequent being the uterus didelphys (60%). Eighty percent of patients with complex ARM (cloaca, exstrophy) presented some type of gynecological malformation compared to 21.8% found in simple ARM (stenosis, perineal, vestibular) (p

Eine der haufigsten Missbildungen der Harnwege ist die einfache Ektopie der Niere, bei der das Organ im kleinen Becken liegt. Bei der etwas selteneren gekreuzten Ektopie liegt die Niere auf der kontralateralen Seite in Bezug zur Uretermundung in die Harnblase, d. h., ihr Ureter kreuzt die Mittellinie des Korpers. Die Ursache dafur ist das Ausbleiben des Aszensus, des Aufstiegs der ursprunglichen Niere aus dem Becken in die orthotope Lage. Ein beschleunigter Aszensus fuhrt hingegen zur intrathorakalen Nierenektopie. Ektope Ureteren munden auserhalb des Trigonum vesicae. Bei Storungen in der Organogenese kann deren Orificium sowohl in Blasenhals und Urethra als auch im Bereich der Geschlechtsorgane liegen. Die Blasenekstrophie ist ein fehlender Verschluss der vorderen Bauchwand, sodass die Blasenschleimhaut in die umgebende Haut ubergeht. Bei der kloakalen Ekstrophie ist die Harnblase gespalten, dazwischen liegt der ileozokale Anteil des Darms. Als Hodenektopie bezeichnet man die Lage des Organs auserhalb der Deszensuswege. Bei der Ektopie der Prostata handelt sich nicht um eine Fehllagerung des gesamten Organs, sondern um versprengte Prostatadrusen, die vor allem in der Blasenwand und in der Urethra zu finden sind. Einige Falle wurden aber auch in der Darmwand, im Anus, im perikolischen Fettgewebe, Milz, Samenblase, Hoden sowie in der Cervix uteri und Vagina beschrieben. Die Penis- und Skrotumektopie und die penoskrotale Transposition sind die seltensten Missbildungen der mannlichen Geschlechtsorgane uberhaupt. Die seltenste Form ist die gemeinsame Verlagerung von Penis und Skrotum ins Perineum. Bei der Transposition liegt hingegen der Penis unter dem Skrotum oder zwischen beiden Hoden in einer Furche des gespaltenen Hodensacks.

We studied the ultrastructure of the digestive system in late doliolaria, pentactula, and 1-month-old juvenile of the holothurian Apostichopus japonicus. In late doliolaria and pentactula, the digestive system is divided into three segments: pharynx, gut, and cloaca. Pharynx and the posterior part of cloaca are lined by cuticular epithelium and apparently of ectodermal origin. The anterior part of cloaca and the entire gut is not differentiated histologically and is lined by a single type of digestive cells, vesicular enterocytes I. These cells are characterized by large secretory granules, containing an acidic substance, found in cytoplasm. As the anterior part of the cloaca is lined by cells typical of the endodermal segment of digestive tube (vesicular enterocytes I), we suggest this part to be of endodermal origin and probably formed from the larval stomach. In 1-month-old juveniles, the structure of the digestive system grows more complicated. In addition to vesicular enterocytes I, three more types of enterocytes appear in luminal epithelium. The specific distribution of the four types of digestive cells divides the intestine into three parts, each probably performing its own function. All enterocytes develop long microvilli, which indicate the intensification of the extracellular digestion processes and an increased absorption of dissolved nutrients.

In mammalian urorectal development, the urorectal septum (urs) descends from the ventral body wall to the cloaca membrane (cm) to partition the cloaca into urogenital sinus and rectum. Defective urs growth results in human congenital anorectal malformations (ARMs), and their pathogenic mechanisms are unclear. Recent studies only focused on the importance of urs mesenchyme proliferation, which is induced by endoderm-derived Sonic Hedgehog (Shh). Here, we showed that the programmed cell death of the apical urs and proximal cm endoderm is particularly crucial for the growth of urs during septation. The apoptotic endoderm was closely associated with the tempo-spatial expression of Wnt inhibitory factor 1 (Wif1), which is an inhibitor of Wnt-β-catenin signaling. In Wif1(lacZ/lacZ) mutant mice and cultured urorectum with exogenous Wif1, cloaca septation was defective with undescended urs and hypospadias-like phenotypes, and such septation defects were also observed in Shh(-/-) mutants and in endodermal β-catenin gain-of-function (GOF) mutants. In addition, Wif1 and Shh were expressed in a complementary manner in the cloaca endoderm, and Wif1 was ectopically expressed in the urs and cm associated with excessive endodermal apoptosis and septation defects in Shh(-/-) mutants. Furthermore, apoptotic cells were markedly reduced in the endodermal β-catenin GOF mutant embryos, which counteracted the inhibitory effects of Wif1. Taken altogether, these data suggest that regulated expression of Wif1 is critical for the growth of the urs during cloaca septation. Hence, Wif1 governs cell apoptosis of urs endoderm by repressing β-catenin signal, which may facilitate the protrusion of the underlying proliferating mesenchymal cells towards the cm for cloaca septation. Dysregulation of this endodermal Shh-Wif1-β-catenin signaling axis contributes to ARM pathogenesis.

The nephron is the functional unit of the kidney and is divided into distinct proximal and distal segments. The factors determining nephron segment size are not fully understood. In zebrafish, the embryonic kidney has long been thought to differentiate in situ into two proximal tubule segments and two distal tubule segments (distal early; DE, and distal late; DL) with little involvement of cell movement. Here, we overturn this notion by performing lineage-labelling experiments that reveal extensive caudal movement of the proximal and DE segments and a concomitant compaction of the DL segment as it fuses with the cloaca. Laser-mediated severing of the tubule, such that the DE and DL are disconnected or that the DL and cloaca do not fuse, results in a reduction in tubule cell proliferation and significantly shortens the DE segment while the caudal movement of the DL is unaffected. These results suggest that the DL mechanically pulls the more proximal segments, thereby driving both their caudal extension and their proliferation. Together, these data provide new insights into early nephron morphogenesis and demonstrate the importance of cell movement and proliferation in determining initial nephron segment size.

Soft tissue expansion is a technique useful in reconstruction when a shortage of tissue exists. This study presents an investigation on using chronic balloon expansion in the urethral and vaginal reconstruction of high persistent cloaca. The common channel was expanded by a balloon, which was progressively inflated over 3–4 weeks at a pressure of 30–50 mmHg until an adequate amount of tissue was obtained. The expanded channel was longitudinally split into anterior and posterior segments: the former was approximated to form a neourethra in continuity with the reconstructed bladder neck and the latter was tubularized to form a vagina. Twenty-one patients underwent primary posterior sagittal urethro-vaginoplasty using the expanded urogenital sinus. Histologic examination demonstrated that the expanded tissue consisted of a dense fibrous wall lined with a stratified squamous non-cornified epithelium, which was characterized by active cell mitosis and angiogenesis. The patients were followed-up for 0.6–9 year (mean 5.69 ± 2.43 years). All reconstructed urethras, vaginas, and vulvas were satisfactory in color, texture match, and sensation. Urinary continence (grades I and II) was observed in all patients without intermittent catheterization. Two complications were encountered in our study. One patient showed a distal urethral dehiscence and a secondary urethroplasty was performed 6 months after the operation. Another patient developed a redundant urethra upon reaching puberty and urethroplasty was needed. Chronic balloon expansion allows the formation of adequate tissue similar in appearance and type to the vagina and urethra. It also provides a valuable surgical alternative for the management of high persistent cloaca.

The aim of the study was to determine the spatiotemporal expression of Wnt5a during hindgut and anorectum development in human embryos and to explore the possible role of Wnt5a during the morphogenesis of the human hindgut and anorectum. The embryos (n = 107) were sectioned serially and sagittally, using Wnt5a immunohistochemical staining on the caudal midline from the 4th–9th weeks of gestation. From the 4th–7th week of gestation, the Wnt5a-positive cells were mainly located on the epithelium of the apical urorectal septum, hindgut, and cloacal membrane. After the anorectum and the urogenital sinus (UGS) opened to the amniotic cavity during the 7th week, the Wnt5a-positive cells disappeared and remained negative up to the 9th week on the epithelium of the anal canal. The expression of Wnt5a was constantly active during human hindgut and anorectum development and disappeared after the anus formed, suggesting that Wnt5a plays an important role in human hindgut and anorectal morphogenesis.

The first morphological and ultrastructural description of testis, Wolffian duct, spermatophore, and spermatozoon of Lissotriton italicus is provided. The male reproductive system of this species consists of a pair of monolobed testes, fat bodies, efferent ductules, paired Wolffian duct, and the cloaca. The Wolffian duct is pseudostratified, consisting of an epithelium composed of an alternation of ciliated cells and non-ciliated secretory cells, with scattered basal cells. Melanocytes are found in the basal lamina of the Wolffian duct. Spermiogenesis is of the discontinuous type. In the early spermatid nuclear elongation, flagellar extrusion and development of a large acrosomal vesicle occur. Soon the perforatorium develops and the flagellum elongates. In the late spermatid gradual chromatin condensation and nuclear elongation is noticeable. At the end of spermiogenesis the flagellum develops marginal filament and undulating membrane. The mature sperm of L. italicus consists of a distinct head (acrosome, perforatorium, nucleus and nuclear ridge, plus the apical acrosomal barb) and a tail with axoneme, undulating membrane, and axial fiber. Nuclear ridge and apical acrosomal barb are two autapomorphic characters found in the Urodela. Several apomorphic characters for Salamandroidea are also present: elongation of the connecting piece, an apically modified acrosome vesicle, trifoliate axial fiber within the principal piece, elongate annulus, elongate midpiece, and the gentle merging of the axial fiber/principal piece into the endpiece. The spermatophore of L. italicus is formed by a cap consisting of randomly distributed spermatozoa surmounting a short pedicel. A membranelike structure involving the spermatophore is absent.

The intrinsic innervation of the developing chick cloaca originates in the vagal and sacral regions of the neural tube. Its major inhibitory neurotransmitters are nitric oxide (NO) and vasoactive intestinal peptide (VIP). It has previously been shown that the majority of neurons in the chick embryo cloaca are derived from vagal neural crest cells. This study aimed to identify the phenotype of these vagal-derived neurons using quail-chick chimeras. Chicken embryos were incubated until the 10–12 somite stage. The vagal neural tube was then microsurgically ablated in ovo and replaced with the vagal neural tube from age-matched quail embryos. Quail-chick chimera embryos were harvested at E12, and E14, and fixed and embedded in paraffin wax, and serially sectioned. Immunohistochemistry was performed using human natural killer-1 (HNK-1), quail-cell-specific perinuclear (QCPN), NOS and VIP antibodies. Expression of NOS and VIP neurons in the developing chick embryo cloaca was also further analysed using immunohistochemistry. HNK-1 labelled all ganglia in the myenteric and submucosal plexuses of the cloaca, whilst the quail-specific QCPN antibody labelled all ganglia derived from the transplanted quail vagal neural tube. NOS- and VIP-immunoreactive neurons appeared to make up a large proportion of the quail-derived vagal neural crest cells. Both NOS and VIP expression was seen to increase throughout development. This data suggests for the first time that the inhibitory neurons in the chick cloaca primarily originate in the vagal neural crest, thus providing new insights into the developmental origin of the intrinsic innervation of the developing cloaca.

The growth factor, 'Glial cell line-Derived Neurotrophic Factor' (GDNF), is involved in the development of enteric ganglia, using the tyrosine kinase receptor 'REarranged during Transfection' (RET) to stimulate the proliferation and differentiation of neural crest-derived precursor cells. To date, the presence of these signalling molecules have not been studied in the developing cloaca, thus the aim of this study was to investigate the distribution of RET and GDNF, and analyse their co-localisation in vagal-derived neurons of the cloaca using quail-chick chimera embryos.Chicken embryos were incubated until the 10-12 somite stage. The vagal neural tube was microsurgically ablated in ovo and replaced with the vagal neural tube from age-matched quail embryos. Quail-chick chimera embryos were harvested at E12, fixed and embedded in paraffin wax, and serially sectioned. Immunohistochemistry was performed using human natural killer-1 (HNK-1), quail-cell-specific perinuclear (QCPN), GDNF and RET antibodies.HNK-1 labelled all ganglia in the myenteric and submucosal plexuses of the cloaca, while the quail-specific QCPN antibody labelled all ganglia derived from the transplanted quail vagal neural tube (Fig. 1, a, b). RET and GDNF were found both co-localised and expressed in separate ganglia in the cloaca (Fig. 1, c, d). The majority of QCPN-labelled vagal-derived neurons also expressed RET and GDNF. Fig. 1 HNK-1 (a), QCPN (b), GDNF (c) and RET (d) immunoreactivity in the chick cloaca at E12. Arrows show ganglia displaying co-immunoreactivity for all four antibodiesResults show that GDNF and RET signalling play a major role in ENS development in the chick embryo cloaca. We have shown, for the first time, that the majority of vagal neural crest-derived neurons co-express RET and GDNF, thus highlighting the importance of these signalling factors in cloacal development.

The spectrum of anorectal malformations (ARM) comprises anal stenosis, ectopic anus, recto-urogenital fistula, persistent cloaca, multisystem VACTERL (VATER associations including cardiac and limb anomalies) associations, and exstrophy of the cloaca (CE). The latter also constitutes the most severe form of the bladder exstrophy epispadias complex. Since recent data revealed that fibroblast growth factor 10 (fgf-10) invalidation in mice resulted in a genetically reproducible urorectal defect, we considered FGF10 a suitable candidate gene for ARM and CE, as the protein seems to be involved in the development of this primary developmental field. A total of 20 patients (ten with ARM and VACTERL association, respectively, and ten with CE) were analysed for genomic mutations in the coding regions and exon-intron boundaries of FGF10. Aside from a common FGF10 variant no deviation from the wild-type sequence could be detected and data obtained is not supportive of FGF10 as a genetic cause of ARMs or CE in the patients investigated. Nonetheless, mutations in possibly further upstream located promoter regions and/or unknown regulatory sequences or non-coding regions cannot be excluded. Furthermore, it cannot be ruled out that other genes involved in the signalling pathway of FGF10 may contribute to the formation of these congenital malformations.

Clinicians caring for newborns with persistent cloaca face significant challenges in the newborn period. Avoiding key pitfalls during this time can have dramatic implications. We reviewed the medical records of 361 patients with cloaca operated on at our institution and analyzed sequelae that resulted from incorrect management in the newborn period. Of 361 patients, 282 underwent primary operations at our institution, and 79 patients were referred to us after a failed repair at other institutions. Pitfalls in management during the newborn period included the following: (1) Failure to recognize and manage hydrocolpos, which occurred in 46 patients. Of these, three patients developed pyocolpos (two progressed to vaginal perforation), and 43 suffered from persistent bilateral hydronephrosis, megaureters, recurrent urinary tract infections, persistent acidosis, or failure to thrive due to undrained hydrocolpos. They underwent unnecessary urinary drainage procedures (nephrostomy, ureterostomy, cystostomy, or vesicostomy) in the newborn period. When the vagina was finally decompressed, all of these symptoms disappeared. (2) Colostomy or vesicostomy problems, which occurred in 50 patients. These included incorrect placement of the colostomy (too distal, which interfered with the pull-through) in 24 and colostomy prolapse in 23. Incompletely diverting loop colostomies led to urinary tract infections in 49 patients. Vesicostomy prolapse occurred in three patients. (3) Clinical misdiagnosis, which occurred in 42 patients. Six were incorrectly diagnosed as "intersex" and 36 as "rectovaginal fistula." In this group only the rectum was repaired, and the patients were left with a urogenital sinus that required reoperation. Proper management of a newborn with cloaca includes drainage of a hydrocolpos, which avoids unnecessary urinary diversions and pyocolpos. Our preferred colostomy is one with separated stomas, adequate distal bowel for the pull-through, and use of a proper technique to avoid prolapse. Correct clinical diagnosis of cloaca avoids problems during the definitive repair.

The cloaca, the caudal limit of the avian gastrointestinal tract, acts as a collecting chamber into which the gastrointestinal, urinary, and genital tracts discharge. It is intrinsically innervated by the enteric nervous system, which is derived from neural crest emigres that migrate from the vagal and sacral regions of the neural tube. Abnormal cloacal development can cause a number of anorectal anomalies, including persistent cloaca. Ablation of the vagal neural crest has previously been shown to result in an aganglionic hindgut to the extent of the colorectum. The aim of our study was to investigate the effect of vagal neural crest ablation on the cloaca, the limit of the hindgut in the developing chick embryo. Chick embryos were incubated until the 10-12 somite stage. The vagal neural tube corresponding to the level of somites 3-6 was then ablated, and eggs were incubated until harvested on embryonic day 11 (E11). Whole chick embryos were fixed, embedded in paraffin, and sectioned. Immunohistochemistry was then carried out using the HNK-1 monoclonal antibody to label neural crest cells, and results were assessed by light microscopy. Vagal neural crest ablation resulted in a dramatic decrease in the number of neural crest cells colonizing the chick embryo cloaca compared with control embryos. Ablated embryos contained only a small number of HNK-1-positive neural crest cells, which were scattered within the myenteric plexus in a disorganised pattern. Hypoganglionosis was also evident in other regions of the hindgut in ablated embryos. Ablation of the vagal neural crest results in a hypoganglionic cloaca in addition to hypoganglionosis of the hindgut. These results suggest that the cloaca is largely innervated by vagal neural crest emigres. Further studies involving quail-chick chimeras to investigate the exact contribution provided by both vagal and sacral neural crest cells to the cloaca should increase our understanding of the pathophysiology of conditions like persistent cloaca.

In the holothurian Eupentacta fraudatrix,the gut wall exhibits trilaminar organization. It consists of an inner digestive epithelium, a middle layer of connective tissue, and an outer mesothelium (coelomic epithelium). The pharynx, esophagus, and stomach are lined with a cuticular epithelium composed of T-shaped cells. The lining epithelium of the intestine and cloaca lacks a cuticle and consists of columnar vesicular enterocytes. Mucocytes are also encountered in the digestive epithelium. The connective tissue layer is composed of a ground substance, which houses collagen fibers, amoebocytes, morula cells, and fibroblasts. The gut mesothelium is a pseudostratified epithelium, which is dominated by peritoneal and myoepithelial cells and also includes the perikarya and processes of the neurons of the hyponeural plexus and vacuolated cells.

We report a case of a persistent cloaca and pseudoexstrophy associated with congenital pouch colon in a native-born American female child. This unusual anomaly occurs in two clinical settings. It has been reported in India as an isolated anomaly occurring primarily in males. Pouch colon also occurs in female patients with pseudoexstrophy or closed cloacal exstrophy. The typical anatomic features of this anomaly are discussed.

Traumatic cloaca is a disabling condition characterized by disruption of the perineal body, anterior sphincter tears and loss of the distal rectovaginal septum. Anterior overlapping sphincteroplasty is the method of choice to treat faecal incontinence caused by obstetric injury. However, reconstruction of large perineal body defects may be a challenging task for surgeons. Herein we describe the successful use of a modified lotus petal flap following overlapping sphincteroplasty to repair a traumatic cloaca that had occurred during vaginal delivery 20 years earlier. After 3 months of follow-up and ileostomy closure, the patient had a good aesthetic result and only minor faecal incontinence episodes not requiring pads, fully recovered urinary continence and a significant improvement in her quality of life.

Newborns with anorectal malformations may have associated perineal lipomas. These lesions are rare but may make the repair of the anorectal malformation more complex. Knowledge about the functional consequences of these lesions is scanty. The purpose of this study was to review the experience of anorectal malformations with perineal lipomas in two Scandinavian paediatric surgical centres. Six patients with perineal lipomas and anorectal malformation treated in the two centres from 1991 to 2005 were retrospectively reviewed. Bowel function was evaluated in patients more than 4 years old. Three girls and three boys (age 4 months to 14 years) with anorectal malformations and perineal lipoma were included in the study. The boys all had high anorectal malformations with rectourethral or rectovesical fistulas. Two girls had a rectovestibular fistula and one girl had a cloaca. All patients had perineal lipomas, in one associated with an anterior meningocele. The lipomas were excised at time of anorectal reconstruction. One of the patients still has a colostomy, and two colostomies were recently closed. The bowel function was evaluated in three patients. Two patients have an ACE stoma to control constipation and soiling and one is soiling despite regular washouts. In conclusion, perineal lipomas associated with anorectal malformations are rare but may distort sphincter anatomy. Excision is best performed at time of anorectal reconstruction. Although our experience is limited, bowel function seems to be compromised by these lesions.

A new rajid species,Raja koreana, is described from a single adult female specimen, 735 mm in total length, collected off the southwestern coast of the Korean Peninsula. AlthoughR. koreana is included in the group of species characterized by the scapulocoracoid lacking an anterior bridge and having the postventral fenestra expanded, it is unique among the latter in possessing: pectoral girdle propterygium not extending to snout tip; rostral shaft of neurocranium narrow and thick, unsegmented base with filamentous cartilage; snout fleshy; pores of ampullae of Lorenzini densely distributed over much of ventral surface to behind cloaca; most thorns on tail directed anteriorly; tail short; a pair of longitudinally elongated black blotches on middle of dorsal surface of disc when fresh; a pair of black blotches (grayish at center) posteriorly on pectoral fins; ventral surface of dise uniformly blackish-brown, except for areas around pores.

A neonate with umbilical evagination of the bladder (UEB) and omphalocele minor (OM) is reported. The findings in this case support the origin of the urachus from the upper end of the cloaca rather than the allantois. The frequent occurrence of OM with urachal anomalies, including UEB, suggests an embryological association between the two conditions.

Dunnifilaria meningica from naturally infectedNeotoma micropus in Mexico were studied by scanning electron microscopy (SEM). The anterior end of adults is surrounded by two pairs of buccal and two pairs of cervical papillae. Two amphidial openings lie near the central mouth opening, surrounded by a thick cuticular ring. The cuticular surface of males and females shows fine transversal striations. At the posterior end of the male is a semicircular cloaca, a large preanal central papilla, two pairs of perianal and two pairs of postanal papillae. The short, strong, and almost equal spicules are rolled plates that end in a knobshaped apex, showing a central groove. In the female, the vulva is located 550 μm from the anterior end. The inconspicuous anus is subterminally situated in the right ventrolateral portion of the posterior end. The anterior tip of the sheathed microfilariae is formed by a cap-like cephalic disk. Cuticular annulations were clearly demonstrated across the body.

Es wird uber eine Misbildung der Urogenitalanlage eines 9 mm langen menschlichen Embryos berichtet, die darin besteht, das der rechte Wolffsche Gang keine Kloakenmundung besitzt, wohl aber eine blasig aufgetriebene Ureter-und Nierenbeckenanlage. Auserdem sind die unteren Anteile der rechten Urniere im Sinne einer Hydronephrose verandert.

Bericht uber eine angeborene Spaltbildung des Dammes bei einem Madchen. Aus der klaffenden Perinealregion wolbte sich auserdem ein Tumor vor, dessen Oberflache aus Rectummucosa und dessen Inneres aus Serosa unter Zwischenschaltung einer Muscularisschicht bestand. Die regelrechte Lage des Anus ermoglichte eine Zuordnung zu den als persistierende Kloakenspalte (=Fehlen des Dammes) bekannten Fehlbildungen. Fusend auf den UntersuchungenPolitzers, wird fur den Tumor die Deutung als Uberschusbildung aus den dorsalen Abschnitten des Septum urorectale gegeben. Ein Fehlen des linken Ureterostiums und die Wahrscheinlichkeit einer linksseitigen Nierenaplasie ermoglicht die Vorverlegung des teratogenetischen Terminationspunktes fur diese Misbildung in die Zeit der beginnenden Septum urorectal-Entwicklung und der Aussprossung der Ureterknospe. Der Auffassung einer Uberschusbildung wird auch die als „perinealer Schleimhautstreifen“ beschriebene Fehlbildung zugeordnet. Damit legt die Beschreibung obiger Mis-bildung die Annahme nahe, das es nicht nur Unterentwicklungen (Minusvarianten) des Septum urorectale, sondern auch Uberschusbildungen im Sinne der Plusvarianten gibt.

In kangaroos, the penis lies posterior to the scrotum. We report an infant born with a similar arrangement initially thought to be penile agenesis. In addition, there was a dysplastic horseshoe kidney: two ureters and the rectum drained into a primitive cloaca which in turn drained externally through an anal canal. Previous reports of “penile agenesis” have consistently described a perineal skin tag immediately anterior to the anus; postmortem dissection of this patient revealed intact corpora extending from the pubis to the perineal appendage into which ran the urethra, suggesting that the patient had concealed posterior ectopia rather than penile agenesis.

In Darm und Kloake von Echidna (Tachyglossus aculeatus) wurden besondere Lymphdrusen festgestellt, die Parallelen mit der Vogel-Bursa Fabricii zeigen.

Vesico-intestinal fissure (extrophy of the cloaca, OEIS complex) is a pattern of multiple malformations including extrophy of the bladder with epispadias, extrophy of the cecum with rudimentary colon and imperforate anus. Other commonly associated anomalies include omphalocele, intestinal duplication, meningomylocele and hydronephrosis. Current pathogenetic theories postulate fusion of genital tubercles caudal to the normal position leading to interruption of migration of the infra-umbilical mesoderm with secondary abdominal wall rupture. Patients with vesico-intestinal fissure have a poor prognosis. Abnormal bowel motility with malabsorption often contribute to death. Histopathologic observation of a visceral myopathy suggestive of an embryologic insult to smooth muscle development in a recent patient with a negative family history for familial visceral myopathy, prompted review of all cases of vesicointestinal fissure since 1966 at this institution. Results suggest abnormal morphogenesis of intestinal smooth muscle may be an important part of the pathogenetic sequence. This is consistent with an early insult to the lateral plate mesoderm from which arise the intra-embryonic splanchopleure and the intra-embryonic somatopleure. These structures form the smooth muscle of the GI tract and the ventral body wall, respectively. Intestinal biopsy and electrophysiologic motility studies may help to define the extent of such defects and contribute to the successful clinical management of these patients.

IN a recent communication Bellerby (1933)1 has shown that injection of acid or alkaline extracts of bovine anterior lobe of the pituitary gland into female South African clawed toads (Xenopus Iœvis) produces extrusion of ova through the cloaca within 18 hours.

The accessory genital glands ofOpsanus tau are large fan-shaped organs lying in the posterior region of the abdominal cavity. Four distinct parts on each side can be recognized grossly and microscopically by virtue of morphology, color, secretion granules, and vascularity. All four parts have separate collecting ducts which drain into the paired spermatic ducts as they course posteriorly to exit into the cloaca via a grooved genital papilla. Seasonal changes in the gross and microscopic anatomy of the accessory glands are described.

The testes ofOpsanus tau are paired, elongated organs lying along the dorsal body wall. They are drained by a series of spermatic ducts which remain separate throughout their length and which empty their contents into the cloaca via a small genital papilla. Spermatogenesis occurs cyclically within cysts which line the testis tubules. Maturation and division occur simultaneously in all of the cells within the cyst. Six distinct stages of spermatogenesis have been recognized and described. With phase microscopy, sperm differentiation was investigated and described. Two tails are characteristic of the sperm of this species.

WILL you pardon me for asking a question which probably I ought to be able to answer myself? Mr. Corfield, in his interesting comparison of the hygienic performances of the ancients and ourselves, mentions the well-known Cloaca Maxima as one of the great glories of the Romans. Can he tell us how they got the sewage into it? I presume the invention of Bramah was not known in those times, and I was a little disappointed in not finding in his able paper a solution of a mystery which has puzzled me since my childhood. What did the Romans want with a Cloaca Maxima, and how did they use it?

YOUR correspondent “Ignoramus” will find some account of the drainage of Rome in Pliny (“Hist. Nat.” xxxvi. 15, s. 24). He will also find further particulars in Livy (i. 38) and in Ulpian (”Dig.” 43, tit. 23, s. I).