The Cell

Background: A surgical approach preserving functional adrenal tissue allows biochemical cure while avoiding the need for lifelong steroid replacement. The aim of this experimental study was to evaluate the impact of intraoperative imaging during bilateral partial adrenalectomy on remnant perfusion and function. Methods: Five pigs underwent bilateral posterior retroperitoneoscopic central adrenal gland division (9 divided glands, 1 undivided). Intraoperative perfusion assessment included computer-assisted quantitative fluorescence imaging, contrast-enhanced CT, confocal laser endomicroscopy (CLE) and local lactate sampling. Specimen analysis after completion adrenalectomy (10 adrenal glands) comprised mitochondrial activity and electron microscopy. Results: Fluorescence signal intensity evolution over time was significantly lower in the cranial segment of each adrenal gland (mean(s.d.) 0⋅052(0⋅057) versus 0⋅133(0⋅057) change in intensity per s for cranial versus caudal parts respectively; P = 0⋅020). Concordantly, intraoperative CT in the portal phase demonstrated significantly lower contrast uptake in cranial segments (P = 0⋅031). In CLE, fluorescein contrast was observed in all caudal segments, but in only four of nine cranial segments (P = 0⋅035). Imaging findings favouring caudal perfusion were congruent, with significantly lower local capillary lactate levels caudally (mean(s.d.) 5⋅66(5⋅79) versus 11⋅58(6⋅53) mmol/l for caudal versus cranial parts respectively; P = 0⋅008). Electron microscopy showed more necrotic cells cranially (P = 0⋅031). There was no disparity in mitochondrial activity (respiratory rates, reactive oxygen species and hydrogen peroxide production) between the different segments. Conclusion: In a model of bilateral partial adrenalectomy, three intraoperative imaging modalities consistently discriminated between regular and reduced adrenal remnant perfusion. By avoiding circumferential dissection, mitochondrial function was preserved in each segment of the adrenal glands.

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“…S3 , supporting information). Many arterioles form a capsular plexus and irrigate the adrenal cortex 15 .…”

Section: Discussionmentioning

confidence: 99%

“…The ultrastructural analysis focused on the zona fasciculata, which forms up to 75 per cent of the adrenal cortex and is the principal source of glucocorticoid hormone synthesis that is essential for life 15 . Semithin sections were examined using an optical microscope, and ultrathin sections using an electron microscope.…”

Section: Methodsmentioning

confidence: 99%

Intraoperative imaging for remnant viability assessment in bilateral posterior retroperitoneoscopic partial adrenalectomy in an experimental model

Seeliger

Alesina

Walz

et al. 2020

British Journal of Surgery

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“…Microfluidic flows must coalesce to create bulk transport of mucus through the conductive airways of the lungs, which range in size from sub 1 mm diameter bronchioles to the ~2 cm diameter trachea [1,28], or through the oviduct, for example, which can be ~10 cm long [29]. Although flow is still low Reynolds number, given the larger size scale of movement, we refer to this anatomic clearance of fluid (Fig.…”

Section: An Overview Of Ciliary Physiologymentioning

confidence: 99%

Microscale imaging of cilia-driven fluid flow

Huang

Choma

2014

Cell. Mol. Life Sci.

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Cilia-driven fluid flow is important for multiple processes in the body, including respiratory mucus clearance, gamete transport in the oviduct, right-left patterning in the embryonic node, and cerebrospinal fluid circulation. Multiple imaging techniques have been applied towards quantifying ciliary flow. Here we review common velocimetry methods of quantifying fluid flow. We then discuss four important optical modalities, including light microscopy, epifluorescence, confocal microscopy, and optical coherence tomography, that have been used to investigate cilia-driven flow.

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“…They originate from megakaryocytes located mainly in the bone marrow, found in circulating blood and stored in spleen (2). Platelets don't contain a nuclei and during their inactive state they have a discoid morphology with a diameter of 2-4 micrometer (3,4). But whenever they are active they can change their morphology very rapidly to an irregular branched spread form (5).…”

Section: Plateletsmentioning

confidence: 99%