One-staged brachial-basilic vein transposition versus arm straight arteriovenous graft for hemodialysis.

OBJECTIVES: After forearm and arm cephalic veins are no longer available as options, the choices of arm vascular access between one-staged brachial-basilic vein transposition (BBAVF) and arm straight arteriovenous graft (AS-AVG) for hemodialysis are controversial. This study aims to compare outcomes between groups. METHODS: All one-staged BBAVF and AS-AVG from August 2014 to December 2019 were reviewed. In cases of suitable basilic vein of 3 mm or more present from cubital crease to axilla, one-staged BBAVF was preferred. AS-AVG was performed for patients who need timely functioning access or have no suitable basilic vein. RESULTS: Twenty-eight one-staged BBAVF and 74 AS-AVG were included. Baseline characteristics were not significantly different, except AS-AVG had less previous ipsilateral access (9% vs 39%; p < .001). Postoperative complications were not different. With six loss follow-ups (3 in BBAVF and 3 in AS-AVG), 24 (96%) and 64 (90%) matured after one-staged BBAVF and AS-AVG, respectively (p = .676). BBAVF took about 30 days (95% CI: 10, 51) longer time to first successful cannulation. Primary patency was significantly better for one-staged BBAVF (hazard ratio (HR) of 3.0 (95%CI: 1.2, 7.7)), whereas secondary patency was not different. The total access failure (i.e. failure to mature combined with any thrombosis or intervention to maintain patency) significantly favored BBAVF (HR 2.7 (95%CI: 1.1, 6.6)). CONCLUSIONS: Provided a suitable arm basilic vein is available, one-staged BBAVF is preferred over AS-AVG when forearm AVF, forearm AVG, and arm cephalic veins are out. However, it requires a longer time to start cannulating than AS-AVG.

Endometriosis in the Canal of Nuck presenting with suprapubic pain: A case report and literature review.

The endometriosis in the Canal of Nuck is a rare condition. Most patients exhibited groin swelling but this case present with a rare condition which is suprapubic pain for 2 years. This case is a 34-year-old healthy woman had developed chronic intermittent right suprapubic pain for 2 years. Physical examination revealed a 2-cm. Reducible mass at right suprapubic area. MRI was performed and the result showed a 2.7 × 1.3 × 4.9 cm-size multiloculated cystic mass located near the round ligament of the uterus which was consistent with a Nuck's canal cyst. The definitive treatment was done by excision of mass.

Endovenous ablation and surgery in great saphenous vein reflux: a systematic review and network meta-analysis of randomised controlled trials protocol.

INTRODUCTION: Endovenous ablations are the new standard procedures for treatment of great saphenous vein reflux including endovenous laser ablation (EVLA), radio frequency ablation (RFA), endovenous steam ablation (EVSA), mechanochemical ablation (MOCA), cyanoacrylate injection and ultrasound-guided foam sclerotherapy (UGFS). EVLA and RFA have demonstrated similar anatomical success for short-term outcome, but results are controversial for longer term (≥5 years). Additional evidences from randomised controlled trials have been published. This study is, therefore, conducted to, directly and indirectly, compare outcomes among all procedures stratifying by short-term and long-term follow-up. METHODS AND ANALYSIS: Medline and Scopus will be searched from 2000 to September 2018 with predefined search strategy. Interventions of interest are open surgery (ie, saphenofemoral or high ligation (HL) with stripping) and endovenous ablations (ie, EVLA, RFA, EVSA, MOCA, cyanoacrylate injection and UGFS). The primary outcome is anatomical success. Two independent reviewers will select studies, extract data and assess risk of bias. Disagreement will be adjudicated by the third party. Outcomes will be directly pooled if there are at least three studies in that comparison. A fixed-effect model will be used unless heterogeneity is present, in which case a random-effect model will be applied. Sources of heterogeneity will be explored using meta-regression analysis, and sub-group analysis will be done accordingly. Publication bias will be assessed using Egger's test and funnel plot. A network meta-analysis will be applied to indirect compare all interventions including RFA, EVLA, EVLA with HL, UGFS, UGFS with HL and HL with stripping. Probability of being best intervention will be estimated and ranked. Inconsistency assumption will be checked using a design-by-treatment interaction model. ETHICS AND DISSEMINATION: Ethical approval is not required for systematic review and network meta-analysis. The study will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42018096794.

Comparison of superficial surgical site infection between delayed primary and primary wound closures in ruptured appendicitis.

BACKGROUND: Delayed primary (DPC) and primary (PC) wound closures have been applied in ruptured appendicitis, but results were controversial. This study aims at comparing the rate of superficial surgical site infection (SSI) in ruptured appendicitis between DPC and PC. METHODS: A retrospective cohort of ruptured appendicitis was conducted between October 2006 and November 2009. Demographic, operative findings and postoperative infection data were retrieved. The superficial SSI rates between groups were compared using an exact test. An odds ratio of SSI was then estimated. RESULTS: One-hundred and twenty eight patients with ruptured appendicitis were eligible and their data were retrieved; 115 (90%) patients had received DPC and 13 (10%) patients had received PC. The SSI rate was much lower in PC patients than in DPC patients, i.e., 7.7% [95% confidence interval (CI): 0.02, 36.0] versus 27.8% (95% CI: 19.9, 37.0), respectively. There was an approximately 72% lower risk of SSI in the PC group than in the DPC group, but this did not reach statistical significance (p = 0.18). CONCLUSION: Our study suggested that PC does not increase risk of SSI in low SSI risk patients with ruptured appendicitis. DPC should not be routinely done.