Antecubital Fossa Research Articles

Prevalence of peripheral intravenous catheters and policy adherence: A point prevalence in a tertiary care university hospital.

To determine prevalence and policy adherence for peripheral intravenous catheters (PIVC) in adult inpatients at a tertiary care university hospital (with about 83,000 inpatient admissions annually). Up to 80% of hospitalised patients receive intravenous therapy, most commonly via PIVCs. However, these devices are not risk-free. Studies indicate that PIVC management standards in clinical practice are inadequate despite established policies promoting best practice. This leads to premature failure resulting in treatment delays, extended length of stay and potential compromised venous access for subsequent IV therapy. Observational point prevalence study. Study undertaken on all adult acute care medical, surgical and oncology wards. Data were collected by senior registered nurses working in pairs on a single day. Descriptive statistics used to analyse data. SQUIRE 2.0 checklist for quality improvement reporting used. There were 449 adult inpatients in 19 wards on survey day. One hundred and ninety-seven had one or more PIVCs in situ. The total number of PIVCs in-situ was 212. PIVC Prevalence was 47%. PIVCs were inserted in points of flexion such as antecubital fossa, back of hand or wrist in 52% of patients. Only 19% of cases had documented assessment of 8-hourly visual infusion phlebitis (VIP) score. Patients had local signs of phlebitis in 14.4% of cases. Patients were not aware of the reason/need for their PIVC in 44% of cases. Discrepancies between evidence-based guidelines and local policy in clinical practice were identified including high rates of PIVC insertion in points of flexion and poor documentation. These quality problems increase likelihood of adverse patient outcomes especially when associated with limited patient awareness of the reason for their PIVC. Poor adherence to best practice standards is 'accepted but unacceptable'. PIVC failure is costly to both patients and health systems. A strong focus on improvement in PIVC care and management is needed.

Pseudoaneurism of the brachial artery mimicking a soft tissue sarcoma: Case report

The current case is one of the rare clinical presentations of the brachial artery pseudo aneurysm presentation in children Pseudo-aneurism is one of the late complications of a missed or untreated arterial injury. The diagnosis is suggested in the presence of clinical signs such as: an expending, ill-defined mass with or without pulsation; bruit, pain, paresthesia, or paralysis due to nerve compression. Although plain X-Rays may show a nonspecific soft tissue mass, arteriography is essential in defining differentiating pseudo aneurisms from other soft masses. We report a case of a 10years old boy with a history of a stab injury in a well vascularized left cubital fossa region. The physical examination revealed a soft tissue mass with eroded skin. Ultrasound and MRI findings were respectively of an infected soft tissue mass and probable malignant soft tissue mass. Open biopsy was planned but surgical finding revealed a pseudo aneurism of the left brachial artery before its bifurcation. Brachial arterial lesion was repaired blood flow reestablished with clinical improvement.

Dermatitis in Sun-Exposed Areas in a 4-year-old Boy

Dermatitis in Sun-Exposed Areas in a 4-year-old Boy

The prevalence of Rheumatoid arthritis on female patients of child-bearing age at University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

Rheumatoid arthritis (RA) is the most commonly diagnosed systemic inflammatory disease that can affect multiple joints of the body. RA affects women 2-3 times more than men. Pregnancy has been reported to have an ameliorating effect on the course of existing RA and the flare-up of disease activity in the postpartum period. This study was carried out on two hundred and forty (240) female patients of child bearing age after obtaining an ethical approval from the Ethical Committee of University of Port Harcourt Teaching Hospital. 5ml of blood samples were drawn from the ante-cubital fossa of each woman with 5ml syringe and needle, between 8am to 11am each day. The samples were sent to the laboratory for analysis. The Latex Slide Test kit used for the serological analysis contains both the positive and negative control. The result obtained was compared with both the positive and negative control. Twelve (12) of the samples tested positive for the Rheumatoid Factor during the qualitative analysis, while the remaining two hundred and twenty-eight (228) tested negative. All positive results from the qualitative analysis tested positive when the test control was carried out, likewise the negative results which were all negative for the test control. The prevalence of rheumatoid arthritis in female patients of child bearing age for this study was calculated to be 5% which was 4% higher than the world prevalence, estimated to be 1%. The relevance of this study was to ascertain the occurrence of rheumatoid arthritis in female patients of child bearing age, which would serve as a useful tool in other rheumatoid arthritis prevalence studies that could be directed towards a better understanding of the flare of the disease and for the development of a more effective preventive and curative therapy.

Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices

BackgroundUnused ('idle') peripheral intravenous catheters (PIVC) are those not used within 24 hours of insertion. There is little data on cannulation practices and idle PIVC rates in emergency settings, especially the pre-hospital environment.MethodsThis was an observational cohort study set in south-east Queensland, Australia using data from a large tertiary level emergency department (ED) and the local statutory ambulance service. Demographic, clinical and PIVC data were collected over two periods; 9 February–18 March 2017 and 5 January–4 February 2018. Adult patients were included if they were allocated an Australasian triage scale (ATS) category between 2 and 5, and had a PIVC inserted in the pre-hospital setting or ED. PIVC use was defined as idle if no fluids, medications or contrast were administered intravenously within 24 hours of insertion. Comparisons between pre-hospital and ED practice and idle PIVC status were undertaken using descriptive statistics and logistic regression.ResultsA total of 1249 patients with a PIVC (372 pre-hospital; 877 ED) were included. Overall, 366 PIVCs (29.3%; 95% CI 26.9%–31.9%) remained idle at 24 hours. In the pre-hospital group, 147 (39.5%) PIVCs inserted were not used pre-hospital, and 74 (19.9%) remained idle. In comparison, 292 (33.3%) PIVCs placed in the ED remained idle. ED staff more frequently inserted PIVCs in the antecubital fossa than paramedics (65.5% vs. 49.7%), where forearm PIVC insertion was more common pre-hospital than in ED (13.7% vs. 7.4%). Nursing staff inserted idle PIVCs at a rate of (35.1%) compared to doctors (29.6%) and paramedics (19.9%). Having a PIVC inserted in the ED was the only factor significantly (p ≤ .001) predicting an idle outcome (Odds Ratio: 2.4; 95% CI 1.7–3.3).ConclusionOne-third of PIVCs inserted within the emergency setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent if inserted in the ED than pre-hospital and with greater use of antecubital insertion. Reasons for these differences are not well understood and requires more targeted research.

Dermatologic ultrasound in the management of childhood linear morphea

Linear morphea is the most common subtype of localized scleroderma in the pediatric population. This condition can be quite disabling, with complications such as growth defects and painful flexion contractures. Assessment of disease progression and early intervention are key to minimize morbidity. We report linear morphea in a previously healthy 12-year-old girl. The patient presented with a one-year history of a linear plaque crossing her left antecubital fossa, measuring 7x3cm. The diagnosis was confirmed by biopsy, in which deep tissue involvement was noted. Subsequent management and evaluation of the disease activity was done by ultrasound, which allowed precise guidance of pharmacotherapy. The patient improved both clinically and sonographically with a methotrexate course. Sonographic changes accurately described the disease activity on follow up assessments. Features suggestive of an active phase include a thickened and hypoechoic dermis contrasting hyperechoic subcutaneous tissue. The atrophic stage is characterized by a thinned-out dermis and subcutaneous area. Typical vascular traits of each disease phase can also contribute to the assessment. Ultrasound is a grossly underused tool in the field of dermatology. It can provide accurate and sensitive information about disease activity in linear morphea, allowing for more timely intervention and optimal patient management.

28144 Cobblestoned skin on neck: The differential

Pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-like PDE) is a benign cutaneous condition that mimics pseudoxanthoma elasticum (PXE). PXE is a hereditary distortion and calcification of elastic fibers, not only in cutaneous tissue, but in cardiac and ocular tissues. Histopathology is an important diagnostic tool to distinguish between the two and can save the patient from an extensive work-up if misdiagnosed as PXE. We present, herein, a 62-year-old healthy female of with an asymptomatic papular rash on her neck for 8 months. She wears a hijab, and reports frequent heat and sweat. The patient failed topical steroid creams given by her primary care provider. Exam showed multiple skin-colored to yellow smooth papules on the bilateral and posterior neck, and bilateral antecubital fossae. Biopsy from her left neck showed abrupt loss of elastic fibers in the papillary dermis with a Verhoeff-van Gieson stain. A von Kossa stain did not demonstrate calcium deposition, ruling out PXE. PXE-LPDE is likely an underdiagnosed acquired condition that occurs most commonly in women after the sixth decade of life and has overlapping clinical and histopathologic features with white fibrous papulosis, another benign condition that can be argued is the same entity. We favored PXE-LPDE in our patient due to the band-like loss of elastic fibers in the papillary dermis. Although chronic sun exposure has been implicated in its pathogenesis, our patient has been sun protected for most of her life. Unfortunately, no specific therapy has been shown to be successful in the treatment of PXE-like PDE.

26414 An uncommon presentation of Sweet syndrome

Sweet syndrome (SS) is a neutrophilic dermatosis characterized by an abrupt onset of painful erythematous skin lesions in association to fever, leukocytosis and occasionally, pathergy. Giant cellulitis-like SS is a rare variant characterized by large painful erythematous plaques resembling cellulitis. A 42-year-old female with acute myeloid leukemia (AML) presented with fever and two erythematous tender plaques localized to the left antecubital fossa and the left proximal medial thigh. Histopathologic evaluation of a biopsy from the left thigh lesion demonstrated findings suggestive of erythema nodosum.

Frequent Eczematous Dermatitis in Unrelated Cord Blood Hematopoietic Cell Transplant Recipients Compared With Other Donor Types

We have consistently noticed in our clinical practice eczematous dermatitis (EcD) without other pathologic findings of graft-versus-host disease (GVHD) in recipients of unrelated cord blood transplantation (CBT). We hypothesized that the incidence of EcD was higher in CBT compared with other donor types, and our objective in this study was to compare the frequency, clinical course, and response to therapy of EcD between CBT and non-CBT recipients. We conducted a retrospective study of 720 consecutive adult recipients of allogeneic hematopoietic cell transplants from 2010 to 2016 from any donor type and with follow-up for at least 1 year after transplantation. After using keyword-based automated scanning to identify "eczema," "dermatitis," or "spongiosis" terms in medical records, we retrieved 217 cases for manual record review. We identified 23 EcD cases (12 in CBT recipients and 11 in patients with other types of donors) with a median onset at 8 months after transplantation. The 2-year cumulative incidence of EcD was 20% (95% confidence interval [CI], 11.2% to 31.5%) after CBT and 1.7% (95% CI, .90% to 2.90%) with other types of donors (P < .0001). Fifteen cases had a skin biopsy without distinctive pathologic features of GVHD. The most common EcD-involved sites in CBT recipients were face (75%), neck (50%), and antecubital fossae (50%). Compared with patients with other types of donors, EcD after CBT was more likely to involve three or more sites (10 of 12 vs. 2 of 10; P=.008) and had a more protracted course (lasting >6 months in 6 of 58 vs. 1 of 661; P < .0001). In both groups, EcD responded to topical therapy, and only a few cases required systemic therapy. EcD is a relatively frequent skin condition among recipients of unrelated CBT. Irrespective of donor type, most cases of EcD can be successfully managed with only topical therapy. These findings will help providers recognize EcD, avoid potentially harmful systemic therapy, and better counsel transplant recipients.

Assessment of Peripheral Intravenous Catheter Site in Oncologic Patients Receiving Chemotherapy: Delphi Technique

Background: A peripheral intravenous catheterization is performed for injecting therapeutic agents into the blood stream. However, it is not easily done in most cancer patients due to the abnormalities of blood vessels because of the repetition of intravenous insertion as well as toxicity of the chemotherapeutic agents. Objective: To study the proper venipuncture sites for chemotherapy in cancer patients. Materials and Methods: Using the Delphi technique, nine of the ten experts, with more than seven years of experience, volunteered to respond to the Likert rating questionnaires. Results: All participants accomplished the study without procedure-related problems. Items concerning peripheral intravenous assessment on the dorsum of hand, forearm, antecubital fossa, and upper arm on the first, second, and third round were 58.3%, 58.3%, 58.3% and 48.3%; 71.6%, 71.6%, 73.3%, and 60.0%; 78.3%, 75.0%, 76.6%, and 65.0%, respectively. Discussion: Veins located on the dorsum of hand were preferred in the first rank due to the facility to identify as well as to care, clean and control infection. This was followed by antecubital veins for its larger size, small risks of thrombophlebitis, and less irritation during chemotherapy, and veins at the forearm for its facilitating self-care management, as well as preventing dislodgement and occlusion. Conclusion: The dorsum of hand followed by the antecubital fossa, forearm and upper arm of the non-dominant hand were the favorable sites of venipuncture for all cancer patients. Keywords: Delphi Technique; Venipuncture sites; Chemotherapy

A Case of Brachial Artery Infected Aneurysm Secondary to Infective Endocarditis from Intramuscular Steroid Use

Infected aneurysms are a subset of aneurysms associated with infection. Approximately 10% of infected aneurysms involve the upper extremity. Infected aneurysms present a management challenge as patients are often unwell with concomitant infective endocarditis or septicemia. We present a case of a brachial artery infected aneurysm secondary to mitral valve infective endocarditis likely due to intramuscular anabolic steroid use. A 52-year-old male presented with a 24-h history of lethargy, blurred vision, and ataxia. He had a background history of intramuscular anabolic steroid use for the past 5 years. Swelling of his left arm localized to his cubital fossa was noted. Blood cultures were positive for Cardiobacterium hominis. Transthoracic echocardiography demonstrated a large vegetation on the mitral valve. Magnetic resonance imaging angiography demonstrated a right middle cerebral artery aneurysm. Computed tomography angiography of the left arm demonstrated an abrupt filling defect of the distal 2 cm of the brachial artery, with surrounding fat stranding and aneurysmal degeneration of the artery. Following successful aneurysm coiling, the patient underwent excision and debridement of the infected aneurysm. Histopathology was consistent with infected thromboembolism with aneurysmal degeneration of the artery. The patient underwent mitral valve replacement 10 days later. The brachial artery is the most common site of upper extremity infected aneurysms. Open surgical resection of the infected tissue is accepted as the gold standard. The rich collateral supply of the upper extremity permits ligation and debridement without needing simultaneous revascularization. We present this case to draw attention to an interesting manifestation of a rare pathology.

Traumatic bicipitoradial bursitis masquerading as an aggressive soft tissue neoplasm of the cubital fossa

This case report discusses a sudden forearm swelling in an otherwise healthy elderly female, which was initially thought to be malignant following clinical examination and imaging studies. An incisional biopsy showed native bursal tissue – bicipitoradial bursitis. Diagnosing bicipitoradial bursitis is challenging due to its intrinsic anatomical rarity. Nevertheless, merely performing radiological imaging may not adequately confirm the diagnosis since some of the characteristic changes are similar to other pathologies such as a myotendinous tear, a neoplasm or an infection. A histopathological examination may be necessary to confirm the diagnosis.

Variation of superficial veins of cubital fossa among students of ardabil University of Medical Sciences

IntroductionThere is a wide variation in the superficial veins of the cubital area. These veins are used in many medical procedures and are clinically important. This study aimed to evaluate the variation of the superficial cubital veins in students of the Ardabil University of Medical Sciences. Material and methodsThe volunteers were 150 females and 160 males from students of different disciplines of the Ardabil University of Medical Sciences aged between 18 and 26 years. To observe the superficial veins of the cubital fossa, the tourniquet was fastened 10 cm above the medial epicondyle of the humerus. One to 3 min after fastening the tourniquet, superficial veins were visualized. The patterns of superficial veins in both arms of the participants were recorded using the vein finder (Vein Revealer Garrote (VRG) −115). ResultsSeven patterns of superficial cubital veins were identified. There was no significant difference between the right and left upper limbs among males and females. The most common type or pattern was N-type, which was more reported in males (70.1% in males and 64.7% in females). The I/0 was the second most observed pattern, which was more common in females (56.7% in females and 49.6% in males). M-shape pattern with a frequency of 46% in males and 31.5% in females was the third most patterns in our study. Other patterns make less than 10% of cases. ConclusionIn general, the present study results show that gender and ethnicity may affect the superficial veins pattern. However, despite the significant similarity between patterns obtained in our study and those of other authors, some differences may be observed, probably related to the examined sample (cadaveric material or living sample).

Androgenetic Alopecia as a Marker of Metabolic Syndrome

Background: Alopecia induced by androgens in genetically predisposed individuals is termed as Androgenetic alopecia (AGA). There is proof appearance the relationship between Androgenetic alopecia and metabolic condition.&#x0D; Objective: To determine frequency of metabolic syndrome in Androgenetic alopecia as a biomarker of disease in adult male patients.&#x0D; Materials and methods: It was a Cross Sectional Study conducted at the Department of Dermatology, Liaquat University of Medical and Health Sciences Hospital, Jamshoro/Hyderabad.&#x0D; Total 178 diagnosed male patients of Androgenetic alopecia were included. The grading of male pattern Androgenetic alopecia was done according to modified Norwood-Hamilton classification. Norwood-Hamilton Stage I-III were regarded to be mild to moderate and Stage IV and higher were regarded as severe. Vein was engorged by a tourniquet applied above the cubital fossa. Blood glucose levels were estimated. The level of triglycerides was determined. HDL-Cholesterol was estimated by a pre­cipitant method. Descriptive statistics were calculated using SPSS. Chi square tests were applied to determine the relationship of independent variables with metabolic syndrome.&#x0D; Results: The overall mean age of the patients was 39.08±10.14 years. The mean waist circumference, triglycerides, high-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure and fasting blood glucose were 94.71±12.30 cm, 133.83±13.27 mg/dl, 48.10±7.89 mg/dl,102.94±17.67 mmHg, 76.88±8.56 mmHg, and 93.06±9.78 mg/dl respectively. A total of 10.1% of the patients were found to have metabolic syndrome. There was a significant association between metabolic syndrome and age and family income.&#x0D; Conclusion: Metabolic syndrome was observed in 10.1% of the patients and this was more commonly found in: the age group &gt;40 years, married individuals, low socioeconomic status individuals, and illiterate individuals.

Cephalic Vein Loop Transposition with Proximal Radial Artery Anastomoses for Haemodialysis

Abstract In Romania the prevalence of chronic kidney disease is estimated to be 7% and end-stage renal disease is an increasingly common diagnosis. A long-term, reliable, dependable, and safe method of repeatedly accessing patient’s blood is one of the most difficult challenges for haemodialysis therapy. The best method to date to accomplish vascular access the arterio-venous fistula (AVF). This segment can be accessed with dialysis needles, providing blood for dialysis. We present a case of a 57-year-old man was diagnosed with an end-stage renal disease and occluded distal radial artery. The cephalic vein was transposed and looped in a tunnel created in the volar aspect of the forearm’s subcutaneous tissue with the end to side anastomosis with the proximal radial artery in the antecubital fossa. The fistula matured in 40 days and the flow volume was 1100 mL/min. He continues his dialysis sessions and is included on the national kidney transplant list.

Type A Cubital Venous Pattern among Students of a Dental College: A Descriptive Cross-sectional Study.

Superficial veins in cubital fossa vary frequently in their anatomical pattern. The knowledge of variation of the cubital venous pattern is very essential for medical professionals for venous access during different medical procedures. This study aims to find the prevalence of Type A cubital venous pattern among students of a dental college. This descriptive cross-sectional study was conducted among 133 dental students of age 18 to 25 years in the department of anatomy of a dental college from November 2020 to February 2021. This study was conducted after obtaining ethical clearance from the Institutional Review Committee. Convenience sampling used and data was analyzed using Statistical Package for Social Sciences version 20. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Out of 133 dental students, Type A cubital venous pattern was found in 96 (72.18%) (64.56-79.79 at 95% Confidence Interval). Type A cubital venous pattern was seen in the left arm in 116 (43.61%) and in the right arm of 76 (28.57%) students. This pattern was noticed in 30 (22.55%) male and 103 (77.44%) female students respectively. This study showed higher Type A cubital venous pattern among dental students than other international studies.

MO1021HYPERTENSION IN CHILDHOOD MINIMAL CHANGE DISEASE: IGNORED, MISSED OR UNDER-DIAGNOSED?

Abstract Background and Aims Minimal change disease (MCD) is most common form of primary nephrotic syndrome (76.6% as per ISKDC) in children aged 1 to 10 years. As per current literature, blood pressure (BP) is usually normal in childhood MCD while in adults, 50% MCD cases are hypertensive. We hypothesized that hypertension is prevalent in childhood MCD also and most of cases are missed or under-diagnosed due to lack of BP monitoring, inappropriate BP cuff size (larger cuff will inaccurately show lower BP; cuff should cover 75% to 80% of arm circumference between antecubital fossa and axilla) or lack of knowledge about childhood hypertension criteria (systolic or diastolic BP&amp;gt; 95th percentile for age on ≥2 clinical visits at least 1 week apart). Method This cross-sectional study was performed from March 2018 to December 2020 at a tertiary care centre in India. Newly diagnosed and relapses of primary nephrotic syndrome (presumed MCD) in children aged 1 to 10 years were included in the study. All cases were subjected to careful BP monitoring and charting using appropriate BP cuff, while child is calm and relaxed, in quiet room with comfortable temperature and empty bladder. Three measurements were taken at 1 minute interals and taking average of last 2 measurements. Percentile charts for age and height were followed. Results fifty four cases of childhood MCD were studied. Thirty six cases (66.67%) were male. Mean age was 5.48 years (SD ±2.31). Thirty two cases (59.26%) were found to be hypertensive. Fourteen cases (43.75%) were relapses. Seven cases (21.87%) were steroid resistant nephrotic syndrome while three cases were steroid dependent. Five cases were already on calcineurin inhibitors when diagnosed of hypertension. There was family history of hypertension in 9 cases diagnosed of hypertension (p value 0.77). There was no correlation between occurrence of hypertension and degree of proteinuria, hypoalbuminemia or body mass index. All hypertensives were managed with angiotensin receptor blockers and regularly followed-up. Conclusion Results of our study are contrary to traditional belief that hypertension is not common in childhood MCD. Significant number of cases are hypertensive. Correct BP measurement and interpretation is necessary in each childhood MCD case. Its occurrence is not correlated with family history or degree of proteinuria, hypoalbuminemia or body mass index.

MO659INITIAL EXPERIENCE OF PERCUTANEOUS ARTERIOVENOUS FISTULA CREATION

Abstract Background Arteriovenous fistulas (AVFs) for hemodialysis are inconstantly used primarily due to problems with maturation and early thrombosis. An endovascular approach -without open surgery- for fistula creation offers another option for establishing a reliable vascular access. By this procedure, a arteriovenous fistula is created in the area of the cubital fossa in the deep vascular system, either between the ulnar artery and the accompanying vein or the radial artery and radial vein and uses the perforating vein at the level of the elbow to transfer blood to the superficial network of the arm. Aim To evaluate the safety, success and maturation rates of percutaneous arteriovenous fistula creation. Materials and Methods From February 2018 to June 2020 (28 months), 30 percutaneous arteriovenous fistulas (pAVF) using the WavelinQ device were created in 30 patients (male: 100%) with end stage kidney disease. Outcome measures were safety, defined as adverse events occurring within the first month of creation, success, defined as the ability to create an anastomosis between the vessels of interest and maturation rates, defined as the ability to perform at least one successful dialysis with the AVF. Secondary outcome measures included procedural complications, secondary procedures, time to cannulation, and AVF survival. Results All cases were performed as day procedures. 23 out of 30 patients (70%) were already on hemodialysis carrying a permanent central venous catheter. Main comorbidities were hypertension (21/30; 70%), diabetes (15/30; 50%) while 11/30 (30.5%) were smokers. Success was 100% (30/30). Mean follow-up was 547 days (range: 14-1071 days). In one case a pseudoaneurysm of the brachial artery was created immediately after sheath removal and in another case, an aneurysm of the AVF anastomosis was observed 17 days post-procedure and AVF was legated with a covered stent placed in the arterial part. In all, 26/30 AVFs (86.6%) were successfully cannulated. Mean time to cannulation was 61.3 days. Another one failed after maturation during the follow-up period. In total, 15 interventions were needed to achieve maturation (15/26; 0.58 procedures per AVF). 5 maintenance endovascular interventions were performed during the follow-up period (5/26; 19.2%). Mean time from cannulation to the end of follow up was 566.2 days (range: 135-1041 days). Conclusion Current analysis suggests that percutaneous AVF creation is safe, successfully performed with high maturation rates. Large scale prospective studies are needed to validate results.

Modified Unipolar Latissimus Transfer to Restore Elbow Flexion in Musculocutaneous Nerve Palsy

Modified Unipolar Latissimus Transfer to Restore Elbow Flexion in Musculocutaneous Nerve Palsy

Cross-sectional area reference values for high-resolution ultrasonography of the upper extremity nerves in healthy Asian adults.

In this study, multiple-site, cross-sectional area (CSA) reference values were established for major peripheral nerves, including small branches, in the upper extremity of a healthy Asian population.This study included 107 prospectively recruited age-matched, healthy subjects with a mean age of 46 years (range, 24–75 years). All subjects underwent standardized nerve conduction studies for the median, ulnar, peroneal, posterior tibial, and sural nerves. CSA was measured unilaterally at 21 sites of the median, ulnar, radial, posterior interosseous, superficial radial sensory, musculocutaneous, lateral antebrachial cutaneous, and medial antebrachial cutaneous nerves.According to their age, the subjects were assigned to the younger group (20–40 years, n = 40), the middle group (40–59 years, n = 40), and the older group (60–80 years, n = 27). The significant differences of CSA values between age groups were found only at certain sites, such as the median (wrist, P = .003), ulnar (medial epicondyle, P = .031; forearm, P = .022), radial (antecubital fossa, P = .037), and superficial radial sensory nerve (P = .028). The CSA significantly correlated with gender, height, weight, and body mass index.This study provides CSA reference values for nerves, including small sensory nerves in the upper extremity, which can be useful in the ultrasonographic investigation of various peripheral neuropathies in the upper extremity.