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Auxiliary Heterotopic Rat Liver Transplantation
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
Grafts of 30 to 35% of the liver mass are used. The median, left, and if desired, the gastric lobes are resected by simple ligation and transection. The portal vein is mobilized for a sufficient length, usually from the splenic vein to the hilus. The pancreaticoduodenal vein is ligated. The celiac artery is ligated to prevent excessive bleeding from the pancreatic bed during mobilization of the bile duct. The hepatic artery is ligated. Skeletonization of the supra- and infrahepatic vena cava is carried out, and the left suprarenal vein is ligated (Figure 2B). Ligatures are placed around the suprahepatic vena cava and the vena porta to keep the perfusion cannula in place. Just prior to graft perfusion 250 U heparin is given i.v. The donor preparation is completed, and the graft can be perfused and removed after preparation of the recipient.
Single Best Answer Questions
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
With regard to the adrenal gland (suprarenal gland):The suprarenal vein on each side drains into the corresponding renal veinThe adrenal gland is situated within the same fascial compartment as the kidneyThe zona glomerulosa forms the innermost layer of the adrenal cortexThe anterior surface of the right adrenal gland is overlapped by the inferior vena cavaThe adrenal medulla is derived from embryonic mesoderm
Anatomy
Published in Jonathan M. Fishman, Vivian A. Elwell, Rajat Chowdhury, OSCEs for the MRCS Part B, 2017
Jonathan M. Fishman, Vivian A. Elwell, Rajat Chowdhury
The single main suprarenal vein drains into the nearest available vessel – on the right, it drains into the inferior vena cava and on the left, directly into the renal vein. The right adrenal gland is tucked medially behind the inferior vena cava. In addition, the right suprarenal vein is particularly short and stubby. Both these features make the inferior vena cava vulnerable to damage in a right adrenalectomy.
Adrenal infarction in the immediate postnatal period†
Published in Journal of Obstetrics and Gynaecology, 2019
Thomas Keith Cunningham, Slavyana Maydanovych, Hannah Draper, Georgios Antoniades, Jane Allen
The adrenal gland has a rich blood supply from the superior, middle and inferior suprarenal arteries, together with a direct branch of the abdominal aorta. However, the venous blood is only drained by the suprarenal vein. Thus, the resulting stasis of blood secondary to a thrombus formation in the adrenal vein causes the oedema and necrosis of the adrenal gland as described in the CT report. Anticoagulation following an infarction is necessary to reduce the risk of further thrombotic events. As supported in the literature, a haemorrhage needs to be excluded prior to commencing a low-molecular weight heparin to prevent further bleeding. Magnetic resonance imaging is more sensitive in detecting a haemorrhage secondary to an infarction; however, a CT is a reliable investigation to diagnose a suspected adrenal infarction (Espinosa et al. 2003).
Insufficiency of the zona glomerulosa of the adrenal cortex and progressive kidney insufficiency following unilateral adrenalectomy – case report and discussion
Published in Blood Pressure, 2018
Joanna Kanarek-Kucner, Adrian Stefański, Rufus Barraclough, Tomasz Gorycki, Jacek Wolf, Krzysztof Narkiewicz, Michał Hoffmann
After adequate preparation time, including modification of antihypertensive medication and correction of serum potassium, the patient underwent an intravenous saline suppression test (SST) with 2000 ml of 0.9% NaCl. Prior to the infusion, aldosterone was 42 ng/dl and renin was unmeasurable, plasma renin activity (PRA) was 0.01 ng/ml/h, at the end of the test aldosterone was 36.5 ng/dl (<10 ng/dl), indicating inadequate aldosterone suppression. An abdominal CT scan revealed a 15x16 mm thickening of the right adrenal gland possibly suggesting a low lipid content adenoma, however in this and in previous CT scans the radiological view was not typical for PA. Adrenal venous sampling was performed. An hour before the procedure, a continuous intravenous infusion with a synthetic corticotropin was administered. Following this, the suprarenal veins were catheterised via the right femoral vein. The localisation of the catheter was regularly validated by sampling cortisol from the veins. For further analysis, samples with the highest cortisol-based selective index were chosen from the right and left suprarenal vein (13.9 and 7.2, respectively). Aldosterone and cortisol levels from the venous samples were then used to calculate the lateralization index (26.8) and suppression index (0.17).