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Embryology, Anatomy, and Physiology of the Adrenal Glands
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Rich blood supply estimated at ~6−7 mL/g per minute.Superior adrenal artery arises from the inferior phrenic artery.Middle artery arises from the aorta.Inferior artery arises from the renal artery.Right adrenal vein drains into the IVC.Left vein drains into the left renal vein.
Anatomy & Embryology
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
Which one of the following is TRUE regarding the adrenal glands?The right gland is round in shape and lies lower than the left.The zona fasciculata produces sex hormones.The cortex contains chromaffin cells, which produce catecholamines.The blood supply to the adrenal gland includes the inferior phrenic artery.Postganglionic sympathetic fibres directly innervate the adrenal glands.
Microsurgical Aspects of Rat Liver Transplantation
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
T. S. Lie, K. Jaeger, K. J. Niehaus
In clinical surgery the iatrogenic or traumatic division of the hepatic artery is rather infrequently followed by complications.12,13 A selective ligation of branches or total ligation of hepatic artery with or without subsequent chemotherapy is performed in patients for treatment of primary or metastatic liver tumors.14,15 However, the postoperative mortality within 4 weeks after dearterialization of the liver does not exceed 15%.16 The blood supply of the liver through the collateral circulation, mainly through the inferior phrenic artery, prevents total liver dearterialization.17,18 The concomitant occurrence of shock, septicemia, or other lesions of the liver is decisive for the prognosis.13 The species specificities also play a role in survival after liver dearterialization19,20 Rats can survive total dearterialization (ligature of hepatic artery and collaterals), whereas dogs die after this procedure.19,20 In the highly developed mammals and in man, the recipients of liver transplant die when the hepatic artery becomes thrombosed.22 On the contrary, in rats Lee et al.22 reported that more than 70% of transplant recipients survived over a week without arterial blood supply to the graft.
Acute necrotizing esophagitis presenting with severe lactic acidosis and shock
Published in Baylor University Medical Center Proceedings, 2018
Kenneth Iwuji, Sarah Jaroudi, Arpana Bansal, Ana Marcella Rivas
Although the etiology of acute esophageal necrosis is hypothesized to be multifactorial, vascular compromise seems to be a mainstay.2 The “two-hit” hypothesis describes an initial low flow state due to a vasculopathy or hemodynamic instability that leaves the esophageal mucosal barriers susceptible to gastric acid reflux insults in the setting of gastric outlet obstruction. The esophagus has an intricate vascular supply that is rarely susceptible to ischemia but in the case of the two-hit hypothesis can reveal transient necrosis that will rapidly recover with restoration of flow. The blood supply is distributed among segments of the esophagus, with the distal segment known as a “watershed” area where acute esophageal necrosis tends to be detected. The upper esophagus is supplied by the descending branches of the inferior thyroid arteries. The middle esophagus receives its blood supply from branches off the descending aorta that include the bronchial arteries, right third or fourth intercostal arteries, and esophageal arteries. Lastly, the distal esophagus derives its supply from the branches off the left gastric artery or left inferior phrenic artery. In addition, numerous contributions are derived from surrounding arteries leading to a rich vascular supply.2 This rich arterial connection makes ischemic esophagus necrosis a rare finding.
Preoperative adrenal artery embolization followed by surgical excision of giant hypervascular adrenal masses: report of three cases
Published in Acta Chirurgica Belgica, 2018
Ismail Cem Sormaz, Fatih Tunca, Arzu Poyanlı, Yasemin Giles Şenyürek
The patient underwent DSA 24 h prior to the intervention. Angiography images showed that the right adrenal mass was predominantly fed by inferior phrenic artery. The inferior phrenic artery was selectively catheterized with 2.8 French microcatheter (Figure 3(a)) and embolized with polyzene-F hydrogel microspheres (six boxes of 1300 μm and one box of 1100 μm). At the end of the procedure, test imaging showed almost complete disappearance of tumor blush (Figure 3(b)). The patient was closely monitored at the ICU during the subsequent 24 h and had no symptoms associated with arterial embolization. The patient underwent surgical exploration via extended right subcostal incision and right adrenalectomy was performed. During the operation, we observed marked decrease in the hypervascularity of the tumor. The size of the vessels, especially veins, surrounding the adrenal tumor was found to be decreased when compared to preoperative imaging findings. No major blood loss occurred during the operation. The postoperative period was uneventful and the patient was discharged on the 5th postoperative day. The final histopathologic examination revealed perivascular epithelioid cell tumor (PEComa) and the largest diameter of the tumor was measured as 18 cm.