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Arteriovenous fistulas (AVF) are the preferred access for hemodialysis in patient with end stage renal disease. Usually, distal vessels of upper limb are preferred. There are situations in which the upper limb cannot be a site for AVFs or graft as in cases of bilateral central venous stenosis or with exhausted sites in upper limb. In these cases, lower limb AVF can be considered. Tibial-saphanous (ankle) fistula should be the preferred site over femoral AVF/graft following the principle of distal to proximal. Also, femoral AVFs are associated with more ischemic and infective complications. The present report describes successful hemodialysis in two patients with tibial-saphanous fistula a site rarely used as an option for HD access. Hemodialysis for over 1 year in one patient and 6 months in the other portrays the success of this approach.
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http://dx.doi.org/10.1177/11297298211001164 | DOI Listing |
Pain Med Case Rep
October 2023
Adena Medical Center, Chilicothe, OH.
Background: Peripheral nerve stimulation has been available for many years, yet there is relatively little information available regarding stimulation of many of the large sensory and mixed nerves.
Case Report: A 42-year-old woman presented to the clinic for a 10-year history of intractable left upper extremity and forearm pain following a motor vehicle accident requiring skin grafting. Based on the patient's failure of more conservative therapy, a shared decision was made to pursue opioid sparing interventional modalities.
Ann Acad Med Singap
July 2025
Department of Orthopaedic Surgery, Woodlands Health, Singapore.
Disabil Rehabil
September 2025
Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Purpose: Children with incomplete recovery from Brachial Plexus Birth Injury (BPBI) experience varying degrees of upper limb impairment, and 20-30% require interventions to optimize function. A psychometrically validated measure of upper limb activity capacity is essential to guide shared clinical decisions for surgical and rehabilitation interventions.
Materials And Methods: Following the Joanna Briggs Institute Manual for Evidence Synthesis, this systematic review included studies on the measurement properties of the Brachial Plexus Outcome Measure (BPOM) - Activity Scale, a performance-based outcome measure of upper limb activity capacity in children with BPBI.
A A Pract
September 2025
From the Department of Anesthesiology and Critical Care Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium.
A 48-year-old man with a superior labral tear and medical history including hemidiaphragmatic paresis, obstructive sleep apnea, vocal cord paresis, and glottic narrowing, underwent arthroscopic biceps tenodesis. Reduction in respiratory function presented anesthetic management challenges with general anesthesia or an interscalene brachial plexus block. Instead, ultrasound guidance was used to deliver a selective upper-trunk block with 1 % lidocaine and an axillary nerve block with 0.
View Article and Find Full Text PDFAnn Surg
September 2025
Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Objective: We hypothesized that anatomic location of metastatic melanoma is associated with the degree of therapeutic response to TVEC.
Summary: TVEC is the first FDA-approved injectable oncolytic virus to treat unresectable stage IIIB-IV metastatic melanoma patients. Previously published real-world outcomes demonstrated a 39% complete response (CR) rate to TVEC.