Elbow Crease Research Articles

#865 Autologous cephalic vein transposition in the placement of forearm arteriovenous fistulas

Abstract Background and Aims The autologous vein transposition was commonly used for hemodialysis vascular access (VA) in selected patient. The saphenous vein was used as a vascular graft; while, the contralateral cephalic vein was used as a bridge. We describe a new technique of autologous cephalic vein transposition to create a native AVF in hemodialysis patients. Method Patients referred to our hospital for a vascular access placement. US vascular mapping of upper extremities revealed small arteries, but adequate forearm veins in all patients. Specifically, the radial artery luminal diameter was < 1.4 mm and < 1.6 mm, respectively at wrist and at middle-arm. While, at bend of the elbow, the ulnar artery diameter (>2.5 mm) in one case, and the brachial artery diameter (>3.5 mm) in two cases, were deemed adequate as feeding arteries of a possible AVFs. Furthermore, the diameter of the forearm cephalic vein ranged from 2.0 to 2.4 mm; in the upper arm the veins were obstructed or stenotic in one of the two arms. The basilic vein was patent in both arms of the patients; the internal diameter varied from 2.5 to 2.7 mm. Due to difficulty to create a traditional fistula, and higher risk of primary failure, it was decided to transpose the cephalic vein, from the forearm not suitable for the AVF, to the contralateral arm chosen for the AVF placement. Results With local anesthesia, an approximately 10-cm stretch of cephalic vein was harvested from the arm contralateral to the site chosen for AVF. Then, the transposed veins, reversed in their cranio-caudal position, were tunneled subcutaneously and anastomosed, in an end-to-end fashion, with cephalic vein at wrist region, and subsequently in a side-artery to end-vein at the elbow crease. The transposed AVFs were created in three patients with ESKD (2M/1F), mean age 47± 3.6 years, (two in the non-dominant arm), without complications. After 4 weeks, all the AVF were patent and the access flow was 660±120 ml/min. All the three AVF was deemed mature and usable for hemodialysis. Conclusion In selected cases, autologous transposition of the cephalic vein can be used to create an AVF, providing a long segment for cannulation. This type of AVF can be an alternative to prosthetic fistula, sparing the central venous catheter.

A New Equation to Estimate Peripherally Inserted Central Catheter Length.

Background and Objectives: Peripherally inserted central catheter (PICC) placement plays an important role in clinical practice. This study aimed to provide an equation for the proper estimation of catheter length in cases of PICC placement without imaging guidance in relation to patient height, weight, sex, and age. Materials and Methods: For 1137 PICC placement cases in both arm veins of 954 patients at a single center, the elbow crease to the cavoatrial junction length (ECL) was calculated as follows: ECL = (PICC length) + (distance from the elbow crease to the puncture site). We analyzed the relationship between ECL and patient characteristics and suggested a new equation for ECL based on height, weight, sex, and age. Results: The average ECL was 48.0 ± 2.4 cm in the right side and 51.0 ± 3.0 cm in the left side. ECL in the right arm was significantly correlated with patient height, sex, and age, whereas the ECL in the left arm was additionally significantly correlated with patient weight. The ECL (cm) prediction model was as follows: right ECL = 26.32 + 1.33 × (female = 1, male = 2) - 0.02 × age (years) + 0.13 × height (cm); left ECL = 22.09 + 1.28 × (female = 1, male = 2) + 0.02 × age (years) + 0.14 × height (cm) + 0.042 × weight (kg). Conclusions: The appropriate PICC length was predicted based on the patient's height, weight, sex, and age. The equations in our study can help predict the optimal catheter length and can be automatically calculated using computerized patient information for bedside procedures in PICC.

Beyond Tradition: "Figure of 8" Casting for Gartland Type 1 and Type 2A Pediatric Supracondylar Fractures of Humerus: Video Technique.

In the treatment of paediatric supracondylar humerus fractures (SCHFs), Gartland Type 1 fractures are traditionally managed with in situ above elbow casting, while Type 2A fractures are treated with closed reduction and above elbow casting. This technical note introduces a novel "figure of 8" cast technique for Type I and 2A fractures. The technique aims to maintain fracture reduction while reducing the risk of compartment syndrome by avoiding placement of cast material in the anterior elbow crease. This innovative casting method has the potential to enhance the management of these fractures in children, providing a alternative to conventional approaches. "Figure of 8" cast technique presents a unique, easy-to-implement, and effective approach for treating Type 1 and 2A SCHFs in children, maintaining fracture reduction in 100-110° elbow flexion and minimizing the risk of compartment syndrome.

Computer-Assisted Surgical Anatomical Mapping of the Antebrachial Cutaneous Nerves: An Anatomical Study with a Proposition for Alternative, Cutaneous Nerve-Sparing Anterior Elbow Incisions.

The lateral antebrachial cutaneous nerve (LABCN) and medial antebrachial cutaneous nerve (MABCN) were identified in the coronal plane around the elbow joint in 10 fresh-frozen human arm specimens. Marked photographs of the specimens were analyzed using computer-assisted surgical anatomical mapping (CASAM). Common anterior surgical approaches to the elbow joint and the distal humerus were then compared with merged images, and nerve-sparing alternatives are proposed. The arm was divided longitudinally, from medial to lateral in the coronal plane, into 4 quarters. The LABCN crossed the central-lateral quarter of the interepicondylar line (i.e., was somewhat lateral to the midline at the level of the elbow crease) in 9 of 10 specimens. The MABCN ran medial to the basilic vein and crossed the most medial quarter of the interepicondylar line. Thus, 2 of the quarters were either free of cutaneous nerves (the most lateral quarter) or contained a distal cutaneous branch in only 1 of 10 specimens (the central-medial quarter). The Boyd-Anderson approach, which is often used to access anteromedial structures of the elbow, should be placed slightly further medially than traditionally advised. The distal part of the Henry approach should deviate laterally, so that it runs over the mobile wad. In distal biceps tendon surgery, the risk of cutaneous nerve injury may be reduced if a single distal incision is placed slightly more laterally (in the most lateral quarter), as in the modified Henry approach. If proximal extension is required, LABCN injury may be prevented by using the modified Boyd-Anderson incision, which runs in the central-medial quarter. Cutaneous nerve injury may be prevented by slightly altering the commonly used skin incisions around the elbow on the basis of the safe zones that were identified by depicting the cumulative course of the MABCN and LABCN using CASAM.

ДИАГНОСТИКА И ЛЕЧЕНИЕ СВЕЖИХ РАЗРЫВОВ ДИСТАЛЬ-НОГО СУХОЖИЛИЯ ДВУГЛАВОЙ МЫШЦЫ ПЛЕЧА

Distal biceps ruptures occur mostly in 40–60 y. o. men during rapid elbow flexion against significant external force. Clinical examination remains the mainstay of the diagnostics of the distal biceps tendon rupture (“Popeye” deformity, ecchymosis, and hook-test), ultra-sound and MR investigations may be used in doubtful cases. Non-operative treatment leads to the decrease of flexion and external rota-tion forces, thus surgical treatment is preferable in most cases. The choice of surgical approach depends on the fixation method. Transos-seous fixation with bone tunnels and two-incision technique is valid and pro-vides low level of re-ruptures with more anatomic restoration of the insertion point, but is associated with higher rate of heterotopic ossification. Newer methods of fixation (buttons, anchors, interferential screws) may allow the sin-gle approach, but not always provide anatomic reinsertion and may lead to higher rate of complications at the site of surgical approach in the elbow crease. Functional post-operative care in majority of cases leads to the restoration of range of movements at 6 weeks, and muscle forces at 12 weeks. This usually allows full restoration of the physical activity at 3 to 6 months after the sur-gery.

A study of elbow crease and some dental anomalies in patients with downs’ syndrome

متلازمة داون هي مرض وراثي ناتج عن التثلث الصبغي 21 كروموسوم. كان هذا أول شذوذ في الكروموسومات اكتشف في البشر وقد لوحظ أيضًا في الرئيسيات الأخرى. المريض والطرق: تجعد الكوع المرتبط بتشوهات المينا في الأسنان تمت دراسة 44 ذكور و 16 إناث مرضى داون متلازمة في مؤسسات المتخلفين عقليا الذين تتراوح أعمارهم بين 8-10 سنوات في مدينة بغداد. الهدف من الدراسة: الهدف من هذه الدراسة هو معرفة وتيرة أشكال وجود أو غياب هذا التجعد: بالإضافة إلى معرفة العلاقة بين تجعد الكوع وتشوهات المينا في المرحلة الابتدائية والأسنان الدائمة من الناحية الجينية.

Een vergelijking tussen spierechografie, impedantieanalyse en handknijpkracht bij gezonde personen

A comparison between muscle ultrasound, impedancemetry and hand grip strength in healthy individuals The pathophysiology of sarcopenia remains incompletely understood, but a muscle ultrasound gains interest as a potential diagnostic tool. The goal of this study was to compare the age- and gender-related effects on muscle parameters derived from an ultrasound, bioelectrical impedancemetry (BIA) and hand grip strength (HGS) in order to gather information about sarcopenia and to strengthen the position of the muscle ultrasound. Healthy subjects were included. Ultrasonographic measurements of muscle thickness (MT), cross-sectional area (CSA) and muscle stiffness (EG) were taken at 75% of the distance between the acromioclavicular joint and the elbow crease, distally. BIA was performed to measure muscle mass (MM), fat mass (FM) and phase angle (PhA). HGS was measured using a Jamar® dynamometer. Associations, age- and gender-related effects were investigated by a Pearson correlation and simple, linear regression analysis. 123 Caucasian individuals (51 men and 72 women) between the ages of 18 and 69 were included. Age showed significant correlations with FM, PhA and HGS. HGS declined with increasing age in both men and women. Only men showed a declining MT. PhA declined with increasing age in both men and women, and FM increased. Analysis of gender- and age-related effects suggests an important role for qualitative parameters in age-related decline of HGS. The absence of significant correlations with respect to a muscle ultrasound is probably a consequence of the limited study population.

Literature review: Preventive actions on contrast media extravasion in patients [Revisión literaria: Acciones preventivas sobre extravasación por medio de contraste en pacientes

Objective: To analyze scientific evidence on prevention measures related to contrast media extravasation in patients. Methodology: A literature review was conducted using 4 databases SciELO, Pubmed, Scopus and Google Scholar in the last ten years, including studies in English, Spanish and Portuguese published in full text indexed journals, carrying a critical analysis of each selected article, reflecting a matrix to sort and categorize. Results: of the 15 scientific articles of the results found show the need to provide the identification of the risk scale (low. mild moderate and high) The affected areas usually present benign lesions characterized by hypervolemia and localized erythema that tend to heal spontaneously without sequelae. However, severe lesions, such as compartment syndrome, can also occur. For these reasons, it is necessary to know the patients at risk, technical characteristics, early diagnosis and timely management of this complication. These are the basic skills that every specialist nursing professional should possess. Conclusions: Extravasation considered an indicator of quality-of-care service in nursing care, with which preventive, corrective and educational measures should be taken in the area where venous accesses are manipulated, an adequate choice of injection site, puncturing thick veins from the elbow crease towards proximal avoiding future complications to reduce the incidence as a zero objective.

Optimization of Piezoresistive Strain Sensors Based on Gold Nanoparticle Deposits on PDMS Substrates for Highly Sensitive Human Pulse Sensing

In this study, highly-sensitive piezoresistive strain sensors based on gold nanoparticle thin films deposited on a stretchable PDMS substrate by centrifugation were developed to measure arterial pulse waveform. By controlling carbon chain length of surfactants, pH value and particle density of the colloidal solutions, the gauge factors of nanoparticle thin film sensors can be optimized up to 677 in tensile mode and 338 in compressive mode, and the pressure sensitivity up to 350. Low pH and thin nanoparticle films produce positive influences to superior gauge factors. It has been demonstrated that nanoparticle thin film sensors on PDMS substrates were successfully applied to sense arterial pulses in different body positions, including wrist, elbow crease, neck, and chest.

Morphologic Evaluation of the Flexor Carpi Radialis Muscle Using Ultrasonography for Accurate and Safe Needle Electromyography

Objective This study aimed to determine the proper and safe needle insertion point in the flexor carpi radialis (FCR) muscle under ultrasonography guidance. Methods We identified the center point (CP) of the FCR as the optimal needle insertion point using ultrasonography. The location of the CP was analyzed using ratios and distances from other landmarks. The vertical distance (CP-VD) was measured by drawing an imaginary vertical line from the CP to the elbow crease. We measured the horizontal distance from the point where the imaginary vertical line from the CP meets the elbow crease to the biceps tendon at the elbow crease level (CP-HD). We presented the ratio of CP-HD to forearm circumference (HD ratio) and the ratio of CP-VD to forearm length (VD ratio) as percentages. Results The mean values of CP-HD and CP-VD were 2.0 ± 1.0 cm and 8.2 ± 1.1 cm, respectively. The mean HD and VD ratios were 8.4% ± 4.2% and 32.0% ± 3.1%, respectively. Conclusion When performing electromyography (EMG) of the FCR muscle, it is recommended to perform EMG at the point about 2 cm medial from the biceps tendon at the elbow crease level, to nearly the proximal one-third of forearm length. Keywords: Flexor carpi radialis; Ultrasonography; Electromyography

Upper limb sensory evaluations and ultrasonographic skin measurements in breast cancer-related lymphedema receiving complex decongestive physiotherapy.

PurposeThe aims of this study were to investigate if/how the presence of lymphedema affects the sensation of the upper limb and to assess whether complex decongestive physiotherapy (CDP) has a favorable impact on sensory testing.MethodsA total of 27 patients with unilateral stage 2 breast cancer–related lymphedema (BCRL) were included in the study. Bilateral circumferential measurements were taken with a tape measure at different levels. Based on these measurements, limb volumes were determined by summing segment volumes derived from the truncated cone formula. Circumferential measurements and ultrasonographic evaluations (epidermis, dermis, and subcutaneous fat thicknesses) were performed at 10 cm distal to the elbow crease. The Semmes–Weinstein monofilament (SWM), static and moving two-point discrimination, pressure pain threshold (PPT), and tactile localization tests were also applied at the same site. After an initial evaluation, all patients underwent CDP phase 1 program. All the evaluations were repeated at the end of the treatment period.ResultsBefore CDP, affected sides had significantly higher values than the unaffected sides in terms of SWM (p < 0.001), static (p = 0.002) and moving (p = 0.011) two-point discrimination, PPT (p = 0.001), and tactile localization (p < 0.001) values. After CDP, SWM (p = 0.002), static (p = 0.009) and moving (p = 0.024) two-point discrimination, PPT (p = 0.014), and tactile localization (p < 0.001) values decreased significantly on the affected sides.ConclusionBCRL seems to reduce light touch, static and moving two-point discrimination, PPT, and tactile localization sensations, whereas CDP seems to improve these sensory perceptions in women with BCRL. Ultrasonographic measurements also appear to be promising for prompt and convenient follow-up in the management of BCRL.Trial registrationClinical Trial Registration Number: NCT04296929 (date of registration: March 5, 2020)

MIPO helical pre-contoured plates in diaphyseal humeral fractures with proximal extension. Surgical technique and results

IntroductionThe aim of this study was to determine the feasibility of applying the MIPO technique with a helical-shaped plate in the treatment of humeral shaft fractures with proximal extension. Patients and methodsWe present an observational prospective study of patients with a humeral shaft fracture involving the proximal humerus fixed with a long proximal humerus polyaxial locking plate with an anterior curvature and helical shape (ALPS® Zimmerbiomet, Warsaw, Indianapolis, USA), using a MIPO technique. Between January 2017 and July 2020, 15 patients were treated at our institution. Proximally a 4–5 cm anterolateral transdeltoid approach was made. And distally, a 5–7 cm incision was made 4 cm proximal to the elbow crease. At each follow-up, radiographs were taken to evaluate fracture healing. Funtional scales were applied to evaluate clinical results. ResultsTen women and five men were included, with a mean age of 62 yo (range 26–86). All but one fracture healed uneventfully. The mean time to union was 28 weeks (range 12–48 weeks). Two out of 15 patients presented complications (an atrophic nonunion and a peri‑implant distal fracture). None of the patients had a nerve palsy prior neither after the surgery. No other complications, including infection, were registered during follow-up. Shoulder range of motion showed the following means: abduction of 147° (range 50°-180°), anterior flexion of 144° (range 80°-180°), external rotation of 77,5 ° (range 70°-80°) and internal rotation of 54.5° (range 45°-60°). All patients recovered their pre-fracture elbow range of motion. All patients presented less than 10° of angular deviation in varus/valgus or ante/recurvatum after the surgical procedure. At the end of the follow-up, all final functional scores were “good” or “excellent”: mean Constant-Murley score was 72 ± 13 (range 38–91), ASES score was 73 ± 12 (range 41–88), UCLA shoulder scale was 30 ± 3,5 (range 10–35), and Q-DASH score was 16.5 ± 0,11 (range 4–57). ConclusionWhen applied correctly, the treatment of diaphyseal humeral fractures involving the proximal humerus using a polyaxial locking helical plate with a MIPO technique is a reliable treatment method. It has high union rates with low complications.

Effects of Acupuncture and Moxibustion on Breast Cancer-Related Lymphedema: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objective:The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the effects of acupuncture and moxibustion (AM) in women with breast cancer-related lymphedema (BCRL).Methods:We retrieved RCTs published before January 24, 2021, from the MEDLINE, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (VIP), and Wanfang databases. RCTs that compared acupuncture and/or moxibustion intervention with other treatments were included. A random effects or fixed effects model was used based on the heterogeneity findings. Study quality was evaluated using the Cochrane risk of bias tool.Results:We included 14 RCTs in the analyses, of which 4 RCTs adopted acupuncture, 4 RCTs used moxibustion, and the rest used both. AM significantly reduced arm circumference at the elbow crease compared to routine care (Mean deviation (MD) = −7.26, 95% confidence interval (CI) = −8.30 to −6.21, P < .00001). There was a significant difference between AM and diosmin tablets in the effective index for upper limb lymphedema (MD = 24.68, 95% CI = 24.82-30.53, P < .00001), the range of motion of the shoulder during protraction (MD = 6.77, 95% CI = 2.81-10.73, P = .0008), and adduction (MD = 4.17, 95% CI = 1.02-7.32, P = .01). There was a significant difference between moxibustion and pneumatic circulation (MD = −0.51, 95% CI = −0.85 to −0.17, P = .003) in the visual analog score (VAS) for swelling. Finally, compared to the blank control, acupuncture reduced the VAS for pain (MD = −1.33, 95% CI = −1.52 to −1.15, P < .00001; heterogeneity (I2) = 0%, P = .57).Conclusion:Our results suggest that AM is effective in the treatment of BCRL. AM may reduce arm circumference at the elbow crease (compared to routine care), increase effective index for upper limb lymphedema (compared to oral diosmin tablets), improve the range of motion of the shoulder during protraction and adduction (compared to oral diosmin tablets), and decrease the VAS for both swelling (compared to pneumatic circulation) and pain (compared to blank control).

A Cadaveric Study of Radial Nerve Course and its Clinical Implications on Radial Nerve Block at Elbow

Introduction: Upper limb nerve blocks are done commonly by brachial plexus (C5-T1) blocks via supraclavicular, infraclavicular approaches. Sometimes a single peripheral nerve needs additional block with local anaesthetic to achieve adequate block. Peripheral nerve blocks are useful for minor surgical procedures in a single nerve distribution. Aim: To study the course and clinical significance of the radial nerve in 50 cadaveric upper limbs. Materials and Methods: A cross-sectional study was conducted on 50 intact dissected upper limbs. The upper limbs were obtained from the Department of Anatomy, Sri Ramachandra Medical College from August 2020 to December 2020. Radial nerve was exposed by routine dissection in all the upper limbs and its entire course was studied and observed for any variation. The distance from the biceps tendon to the radial nerve at the elbow, distance of the radial nerve in the Lateral Intermuscular Septum (LIS) from the epicondyles at the elbow were measured. The results obtained were statistically analysed using Statistical Package for the Social Sciences (SPSS) version 16.0. Results: In present study, the mean distance of the radial nerve in the LIS to the medial epicondyle was 12.4±0.31 cm and to the lateral epicondyle was 12.1±0.28 cm. The mean distance from the biceps tendon to the radial nerve at the elbow was 1.75±0.22 cm. Conclusion: From the present study, it can be inferred that effective peripheral radial nerve block can be achieved by blocking the nerve 1.75 cm lateral to the biceps tendon at the elbow 3 cm above the elbow crease. This can be made comfortable to the patient and more precise by ultrasound localisation of the radial nerve.

Electronic Moxibustion for Breast Cancer-Related Lymphedema: A Pilot Clinical Trial

This is a preliminary study to investigate the feasibility of electronic moxibustion in breast cancer patients with upper limb lymphedema. As current treatment options for lymphedema are unsatisfactory and time consuming, there have been attempts to manage symptoms using integrative treatments. Electronic moxibustion was developed to compensate for the shortcomings of conventional moxibustion and is widely used in clinical practice. However, there have been no studies on using electronic moxibustion in breast cancer-related lymphedema. To investigate the feasibility of electronic moxibustion in treating breast cancer-related lymphedema, this study included subjects who completed primary cancer treatment at least 6 months ago and had more than 10 mm difference in arm circumference of upper limbs. All subjects were assigned to the treatment group. Subjects were treated with 16 sessions (30 minutes/session) of electronic moxibustion for 8 weeks followed by 4 weeks of follow-up. For outcome measures, upper limb circumferences, shoulder range of motion, bioimpedance analysis, and quality of life questionnaire were assessed. All 10 subjects completed the study. The effective index showed 38.21% reduction after treatment (P = .0098) and 29.35% (P = .0039) after 4 weeks of follow-up compared to the baseline. The reduction of lymphedema was most prominent at 10 cm above the elbow crease, where the mean reduction of circumference difference was 7.5 mm (P = .0430) and continued to improve after treatment (mean reduction of 8.3 mm, P = .0156). There was significant improvement in shoulder range of motion only in flexion and internal rotation at week 9. There were 7 adverse events, and most were irrelevant to the treatment. Only 1 participant had a mild burn on the acupuncture point. Here, we demonstrate for the first time that electronic moxibustion treatment is a feasible treatment for breast cancer-related lymphedema. Electronic moxibustion may reduce differences in upper limb circumference and improve shoulder range of motion. A future comparative clinical trial is needed to confirm the clinical efficacy of this treatment.

Experience on the Vascular Approaches for Hemodialysis in the EL ABBADI Mohamed Saâd Clinic in Casablanca

The arteriovenous fistula (AVF) for hemodialysis, consists of surgically creating an anastomosis between an artery and a superficial vein in the arm. This study aims to mark our contribution to the study of arteriovenous fistulas for hemodialysis during our internship in Morocco Methodology: We carried out a six years retrospective study from January 1^st, 1994, to December 31^st, 1999, inclusively. The study involved 1,531 arteriovenous fistulas performed during our studying period on 2,361 consultations. All the adequate files were included in our study. The other inadequate files were excluded. Results: The study involved 833, that is 44.8% of men and 698, or 37.6% of women. Sex ratio 1.19. Thus, we counted right radial FAV 388 cases; Ulnar FAV 5 cases; FAV of the elbow crease 137 cases. In the left upper limb, 1,321 procedures, or 71.1%, distributed as follows: Left radial FAV 1,080 cases Cubital FAV 7 cases Elbow fold AVF 234 cases. According to the Vascular Seats (arteries and veins), the anastomoses were performed between Arteries and radial veins 388 or 20.9% Left radial arteries and veins 1080 cases or 58.1%, Humero-basilica 194 or 10.4%, Humero-cephalic 154 cases or 8.2%. Anastomoses on ulnar and other arteries 2, 5% straight 388 or 20.9% Left radial arteries and veins Conclusion: For patients with end-stage chronic kidney disease, arteriovenous fistulas are the last hope for their survival.

Sterile Parts of Operating Gown during Lower Limb Joint Replacement Surgery.

The prevention of surgical site infection is one of the most concerning issues in operating rooms. Surgical gowns are worn as one of the intraoperative strategies for infection prevention. The present study investigated whether the gowns remained sterile during the surgical procedure. Furthermore, this study examined which parts of the surgical gown were more prone to contamination. The sterility of the gowns was investigated during eight total joint arthroplasties all of which were performed by four surgeons. The samples were taken from the arms and frontal part of the sterile gowns pre- and postoperatively. In the anterior surface of the gown, the sampling was initiated at a strip with 50 cm height from the ground followed by the strips with 15 cm distances from caudal to cephalad. Furthermore, the frontal part of the gown was divided into three parts in relation to the operating room table. Finally, the contamination rate was evaluated in each part. A semiquantitative method was used for the analysis of bacterial culture. Before the operation, there were four samples tested positive for bacterial culture (1.06%). All of these samples were taken from the most proximal strip near the neckline. After the surgery, the rate of contamination in the strips on the frontal part of the gown was reported as 3.1% to 53%. Based on the operating table, the contamination rate was 35.9%, 8.9%, and 47.3% in the distal, middle, and proximal parts of the gown, respectively. The contamination rate at the elbow crease was 23%, and at 5 and 10 cm above the creases were 24% and 36%, respectively. The high rate of gown contamination during the operation is concerning. However, part of the gown that was in contact with the operating room table remained clean most of the time. More safe strategies should be used for infection prevention in operating rooms.

SAT-046 RESULTS OF THE GRACZ FISTULA CONSTRUCTED BY THE NEPHROLOGIST

Gracz arteriovenous fistula (AVF) at the elbow involves an end to side anastomosis between the and of the perforating vein to the median cubital vein to the side of brachial artery (Fig 1). The anastomotic site is below the elbow crease. This analysis was aimed to assess fistula patency, maturation and complication rates in Gracz elbow fistulas constructed by the Nephrologist. At our Nephrology centres, all AVF surgeries are performed by the Interventional Nephrologists (SRB and SSS) independently. Case records and follow up data of all patients undergoing Gracz AVF during the study period of April 2014 to March 2016 was retrieved. AVF outcome was assessed by short term fistula patency (first 24 hrs), medium term patency (upto 3 months), fistula maturation and complications. Gracz AVF was constructed whenever operating Nephrologist observed a suitable perforating vein available for anastomosis. In rest of the patients more conventional elbow AVF (side to side median cubital vein to the brachial artery; end to side median cubital to the brachial artery; end to side cephalic vein to the brachial artery or end to side basilic vein to the brachial artery) were contructed. Short term patency rate was defined as a clinically audible bruit with colour doppler evidence of patent AVF. Medium term patency rate was defined as a clinically audible bruit with colour doppler evidence of > 600 ml/min blood flow in cephalic vein in arm. AVF was considered mature if successfully cannulated by 16 G” AVF needle with blood flow rate of >250 ml/min. Surgical steps in Gracz Fistula at elbow : The perforating vein to the brachial vein is identified and tied Brachial artery identified and arteriotomy is done After successful end of the perforating vein to the side of the artery anastomosis During the study period a total of 53 Gracz elbow AVF were constructed which accounted for 10.9 % of all AVF and 30.4 % of all elbow AVF. Of all Gracz fistulae, left elbow was the site for 77.4 % cases. 51 patients had short term patency (96.2 %). Of these, 2 patients died within 3 months period and 4 were lost to follow up. Out of 47 patients available for follow up 43 patients met medium term patency criteria (91.4%). All but 2 AVFs were successfully cannulated 3 weeks after the surgery. One patient had delayed wound healing and one patient had limb edema during the follow up period. The Gracz elbow fistula has very good success rate. Such surgeries can be performed by the Nephrologists independently

Moxibustion as a Therapy for Breast Cancer-Related Lymphedema in Female Adults: A Preliminary Randomized Controlled Trial.

Objective: To evaluate the effect of moxibustion on relieving breast cancer–related lymphedema. Materials and Methods: A randomized controlled trial was conducted in our institution from March 2016 to March 2017. All patients (N = 48) with cancer-related lymphedema were allocated to 2 groups: a treatment group, in which moxibustion was performed, and a control group, in which pneumatic circulation was performed with compression garments worn every day. Therapeutic efficacy was evaluated by measuring arm circumference (wrist crease, 10 cm proximal to wrist crease, elbow crease, and 10 cm proximal to elbow crease) and determining the Revised Piper Fatigue Scale score and Visual Analog Scale score for swelling before and after treatment. Results: All patients were treated for 4 consecutive weeks. Compared with 0 week after treatment, the affected-side arm circumference after 4 weeks’ treatment decreased in both treatment and control groups; the difference value in the treatment group was superior to that in the control group. Compared with the controls, moxibustion resulted in a lower Visual Analog Scale score. The Revised Piper Fatigue total scores were improved in both the moxibustion and control group, and there was no significant difference between the 2 groups. Moxibustion reduced the behavioral, sensory, emotional, and cognitive Revised Piper Fatigue scores, but only the behavioral and sensory scores improved in the control group. Conclusion: Moxibustion has potential effect on breast cancer–related lymphedema. We present promising preliminary data for larger randomized trials to enable accurate evaluation of moxibustion as a lymphedema treatment.

Bloodletting puncture and cupping as an adjuvant therapy for breast cancer-related lymphedema in female adults: A non-randomized controlled pragmatic trial

Abstract Objective To evaluate the effectiveness of bloodletting puncture and cupping in relieving breast cancer-related lymphedema. Methods We conducted a non-randomized controlled study at the Galactophore Department of the 3rd Affiliated Hospital of Beijing University of Chinese Medicine from March 2013 to December 2014. Seventy-five patients undergoing treatment for breast cancer-related lymphedema were divided into two groups in accordance with the patients’ treatment choices: the treatment group (n = 50) underwent bloodletting puncture and cupping every 5 days for 15 min/session (one session per day) combined with exercise training once a day for 30 minutes; the control group (n = 25) underwent the same exercise training alone. Evaluation indexes were measured before and after treatment; these included arm circumference (at the wrist crease, 10 cm distal to the wrist crease, the elbow crease, and 10 cm distal to the elbow crease) and visual analogue scale (VAS) score for pain. The safety of the treatment was also evaluated. Results The treatment period was 50 days for all 75 patients. At the end of the treatment period, the mean reduction in arm circumference was 1.21 (0.65) cm the treatment group, and 0.58 (0.78) cm in the control group. Compared with the control group, the treatment group had a significantly greater reduction in arm circumference (P = .03) and a significantly lower VAS score for pain (P = .01). No patient in either group experienced any adverse events. Conclusion Bloodletting puncture and cupping effectively reduces arm circumference and relieves upper limb pain in patients with breast cancer-related lymphedema. Our results provide sufficient basis for exploring cupping as long-term therapy for managing breast cancer-related lymphedema.