Intestinal Mucosal and Serosal Microcirculation at the Planned Anastomosis during Abdominal Surgery

2019 ◽  
Vol 60 (5-6) ◽  
pp. 248-256 ◽  
Author(s):  
Arthur L.M. Tavy ◽  
Anton F.J. de Bruin ◽  
Anke B. Smits ◽  
E. Christiaan Boerma ◽  
Can Ince ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Dark Field ◽  
Vessel Density ◽  
Flow Index ◽  
Dark Field Imaging ◽  
Key Factor ◽  
Observational Cohort ◽  
Incident Dark Field Imaging ◽  
Field Imaging ◽  
Total Vessel Density

Introduction: Intestinal blood flow is often named as a key factor in the pathophysiology of anastomotic leakage. The distribution between mucosal and serosal microperfusion during surgery remains to be elucidated. Objective: The aim of this study was to assess if the mucosal microcirculation of the intestine is more vulnerable to a surgical hit than the serosal microcirculation during surgery. Methods: In an observational cohort study (n = 9 patients), the microcirculation of the bowel serosa and mucosa was visualized with incident dark-field imaging during surgery. At the planned anastomosis, the following microcirculatory parameters were determined: microvascular flow index (MFI), percentage of perfused vessels (PPV), perfused vessel density (PVD), and total vessel density (TVD). Data are presented as median (interquartile range [IQR]). Results: Perfusion parameters and vessel density were significantly higher for the mucosa than the serosal microcirculation at the planned site for anastomosis or stoma. Mucosal MFI was 3.00 (IQR 3.00–3.00) compared to a serosal MFI of 2.75 (IQR 2.21–2.94), p = 0.03. The PPV was 99% (IQR 98–100) versus 92% (IQR 66–94), p = 0.01. The TVD was 16.77 mm/mm2 (IQR 13.04–18.01) versus 10.42 mm/mm2 (IQR 9.36–11.81), p = 0.01, and the PVD was 15.44 mm/mm2 (IQR 13.04–17.78) versus 9.02 mm/mm2 (IQR 6.43–9.43), p = 0.01. Conclusions: The mucosal microcirculation was preserved, while lower perfusion of the serosa was found at the planned anastomosis or stoma during surgery. Further research is needed to link our observations to the clinically relevant endpoint of anastomotic leakage.

scholarly journals Noninvasive, in vivo assessment of the cervical microcirculation using incident dark field imaging

2021 ◽  
Vol 135 ◽  
pp. 104145
Author(s):  
Yani P. Latul ◽  
Arnoud W. Kastelein ◽  
Patricia W.T. Beemster ◽  
Nienke E. van Trommel ◽  
Can Ince ◽  
...  
Keyword(s):  
Dark Field ◽  
Dark Field Imaging ◽  
Incident Dark Field Imaging ◽  
Field Imaging ◽  
In Vivo Assessment

VS03.01: QUANTITATIVE IMAGING OF CHANGE IN MICROCIRCULATION BY SIDESTREAM DARK FIELD MICROSCOPY (SDF) AFTER ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 47-48
Author(s):  
Sanne Jansen ◽  
Daniel De Bruin ◽  
Mark I Van Berge Henegouwen ◽  
Ton Van Leeuwen ◽  
Suzanne Gisbertz
Keyword(s):  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Average Velocity ◽  
Venous Return ◽  
Conflicts Of Interest ◽  
Dark Field ◽  
Vessel Density ◽  
Flow Index ◽  
High Morbidity ◽  
Sidestream Dark Field

Abstract Description Anastomotic leakage is one of the most severe complications after esophageal resection with gastric tube reconstruction. Impaired perfusion of the gastric fundus is seen as the main contributing factor for this complication. Transection of the left gastric and gastro-epiploic artery and veins results in compromised perfusion in the fundus area which can result in anastomotic dehiscence (5–20%), relating to high morbidity and mortality (3–4%). The main objective of this observational study is to evaluation gastric tube microcirculation with Sidestream Darkfield Microscopy (SDF). Method This study included 22 patients (October 2015 - June 2016). Intra-operative microscopic images of gastric tube microcirculation were obtained with SDF directly after reconstruction. Using software (AVA2.0), the following parameters were evaluated: average velocity (μm/sec), Microvascular Flow Index (MFI), Total Vessel Density (TVD), Perfusion Vessel Density (PVD), Proportion of Perfused Vessels (PPV) and the De Backer Score (DBS), to assess change in perfusion. Results SDF accurately visualized and evaluated microcirculation in all patients. A SDF-stabilizer was used to create stable images. The average velocity decreased significantly towards the fundus (P = 0.001). Also, MFI, PVD and PPV were significantly lower towards the fundus, compared to the base of the gastric tube (P = 0.0002). No differences in TVD and DBS were observed, which was associated to the observed vessel dilation in the fundus-area. This vessel dilation proposes that compromised venous return may play an important role in the development of necrosis and leakage. Three patients developed anastomotic leakage. Conclusion This is the first study presenting quantitative microcirculation imaging with SDF of the gastric tube. Velocity, MFI, TVD and PPV were accurate parameters to observe change in perfusion after reconstruction. Also, vessel dilation in the fundus suggests a role for venous return in the development of ischemia. Quantitative microcirculation with SDF could allow for intra-operative early risk stratification, and, potentially, can result in a reduction of anastomotic leakage. Disclosure All authors have declared no conflicts of interest.

scholarly journals Pregnancy at high altitude in the Andes leads to increased total vessel density in healthy newborns

2016 ◽  
Vol 121 (3) ◽  
pp. 709-715 ◽  
Author(s):  
Norina N. Gassmann ◽  
Hugo A. van Elteren ◽  
Tom G. Goos ◽  
Claudia R. Morales ◽  
Maria Rivera-Ch ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
High Altitude ◽  
Sea Level ◽  
Near Infrared ◽  
Arterial Oxygen Saturation ◽  
Dark Field ◽  
Vessel Density ◽  
Arterial Oxygen ◽  
Dark Field Imaging ◽  
Total Vessel Density

The developing human fetus is able to cope with the physiological reduction in oxygen supply occurring in utero. However, it is not known if microvascularization of the fetus is augmented when pregnancy occurs at high altitude. Fifty-three healthy term newborns in Puno, Peru (3,840 m) were compared with sea-level controls. Pre- and postductal arterial oxygen saturation (SpO2) was determined. Cerebral and calf muscle regional tissue oxygenation was measured using near infrared spectroscopy (NIRS). Skin microcirculation was noninvasively measured using incident dark field imaging. Pre- and postductal SpO2 in Peruvian babies was 88.1 and 88.4%, respectively, which was 10.4 and 9.7% lower than in newborns at sea level ( P < 0.001). Cerebral and regional oxygen saturation was significantly lower in the Peruvian newborns (cerebral: 71.0 vs. 74.9%; regional: 68.5 vs. 76.0%, P < 0.001). Transcutaneously measured total vessel density in the Peruvian newborns was 14% higher than that in the newborns born at sea level (29.7 vs. 26.0 mm/mm2; P ≤ 0.001). This study demonstrates that microvascular vessel density in neonates born to mothers living at high altitude is higher than that in neonates born at sea level.

scholarly journals Intraoperative Incident Dark Field Imaging of the Human Peritoneal Microcirculation

2018 ◽  
Vol 55 (3) ◽  
pp. 136-143 ◽  
Author(s):  
Zühre Uz ◽  
Arnoud W. Kastelein ◽  
Dan M.J. Milstein ◽  
Dan Liu ◽  
Fadi Rassam ◽  
...  
Keyword(s):  
Dark Field ◽  
Dark Field Imaging ◽  
Incident Dark Field Imaging ◽  
Field Imaging

Detection of a point defect in a silicon single crystal by high-resolution TEM

1995 ◽  
Vol 53 ◽  
pp. 466-467
Author(s):  
M. Awaji
Keyword(s):  
High Resolution ◽  
Single Crystal ◽  
Point Defect ◽  
Point Defects ◽  
Noise Level ◽  
Dark Field ◽  
Silicon Single Crystal ◽  
High Resolution Image ◽  
Dark Field Imaging ◽  
Field Imaging

It is necessary to improve the resolution, brightness and signal-to-noise ratio(s/n) for the detection and identification of point defects in crystals. In order to observe point defects, multi-beam dark-field imaging is one of the useful methods. Though this method can improve resolution and brightness compared with dark-field imaging by diffuse scattering, the problem of s/n still exists. In order to improve the exposure time due to the low intensity of the dark-field image and the low resolution, we discuss in this paper the bright-field high-resolution image and the corresponding subtracted image with reference to a changing noise level, and examine the possibility for in-situ observation, identification and detection of the movement of a point defect produced in the early stage of damage process by high energy electron bombardment.The high-resolution image contrast of a silicon single crystal in the [10] orientation containing a triple divacancy cluster is calculated using the Cowley-Moodie dynamical theory and for a changing gaussian noise level. This divacancy model was deduced from experimental results obtained by electron spin resonance. The calculation condition was for the lMeV Berkeley ARM operated at 800KeV.

scholarly journals Correlation of image quality parameters with tube voltage in X-ray dark-field chest radiography: a phantom study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Andreas P. Sauter ◽  
Jana Andrejewski ◽  
Manuela Frank ◽  
Konstantin Willer ◽  
Julia Herzen ◽  
...  
Keyword(s):  
Image Quality ◽  
Imaging Modality ◽  
Signal Strength ◽  
Dark Field ◽  
Tube Voltage ◽  
X Ray ◽  
Dose Area Product ◽  
Dark Field Imaging ◽  
Field Imaging

AbstractGrating-based X-ray dark-field imaging is a novel imaging modality with enormous technical progress during the last years. It enables the detection of microstructure impairment as in the healthy lung a strong dark-field signal is present due to the high number of air-tissue interfaces. Using the experience from setups for animal imaging, first studies with a human cadaver could be performed recently. Subsequently, the first dark-field scanner for in-vivo chest imaging of humans was developed. In the current study, the optimal tube voltage for dark-field radiography of the thorax in this setup was examined using an anthropomorphic chest phantom. Tube voltages of 50–125 kVp were used while maintaining a constant dose-area-product. The resulting dark-field and attenuation radiographs were evaluated in a reader study as well as objectively in terms of contrast-to-noise ratio and signal strength. We found that the optimum tube voltage for dark-field imaging is 70 kVp as here the most favorable combination of image quality, signal strength, and sharpness is present. At this voltage, a high image quality was perceived in the reader study also for attenuation radiographs, which should be sufficient for routine imaging. The results of this study are fundamental for upcoming patient studies with living humans.

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