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Urinary system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Some patients with end-stage renal failure require haemodialysis. Ideally this is achieved by the surgical creation of an arteriovenous fistula, typically in the patient’s non-dominant arm. Common sites of fistulae include connection of the radial artery with the cephalic vein at the wrist, or the brachial artery with the cephalic vein or basilic vein at the elbow. As the vein receives high pressure blood directly from the artery, it arterialises (‘matures’), enlarging and becoming thicker walled. Flow though the fistula may be clinically noticeable as a palpable ‘thrill’ (a buzz). This large vein provides easier long term access for the large gauge dialysis needles and allows continuous high volumes of blood flow necessary for efficient dialysis. However, over time stenoses may develop, often around the site of the anastomosis or the needling sites; this can cause reduced blood flow, and if untreated can lead to suboptimal dialysis and/or thrombosis of the fistula. Stenoses may be treated by angioplasty, while thrombosis, if diagnosed early enough, may be treated with thrombolysis, mechanical or aspiration thrombectomy or ‘trawling’ the thrombus with an angioplasty balloon. Alternative access for haemodialysis may be provided via a tunnelled central venous catheter. In difficult cases this can be inserted under radiographic control.
Stemless total shoulder arthroplasty in elderly patients with primary osteoarthritis of shoulder – a developing country experience
Published in Expert Review of Medical Devices, 2021
Vishwajeet Singh, Sanjay S Desai
All the patients were operated in beach chair position once regional block was given followed by Sedation or GA (general anesthesia). The incision starts above the coracoid process and terminates above the insertion of the pectoralis major on the shaft of the humerus. The cephalic vein is mobilized laterally with deltoid muscle, and conjoint tendon is protected. A retractor is placed under CA (coracoacromial ligament) to protect it and provide exposure to superior aspect of subscapularis, and the humerus. Subscapularis is cut at 5 mm from insertion over lesser tuberosity and secured using number 2 fiberwire. Capsular release is done at anterior and inferior levels. The axillary nerve is secured and protected. The humerus is gently dislocated from the glenoid. The arm is held in 90° of external rotation, 20° −30° of extension, and adducted against the operating room table.
Restoration of wall shear stress in the cephalic vein during extreme hemodynamics
Published in Journal of Medical Engineering & Technology, 2018
M. E. Boghosian, M. S. Hammes, K. W. Cassel, S. M. J. Akherat, F. Coe
The BCF, located in the mid-arm region, involves surgical connection of the brachial artery and the cephalic vein. The cephalic vein geometry considered in this investigation consists of an approximately 10 cm segment including the curved arch portion as illustrated in Figure 1. The cephalic arch is the final bend in the cephalic vein prior to its junction with the axillary vein. The domain starts downstream (based on flow direction) of the artery–vein junction in a relatively straight segment of the cephalic vein. In this figure, the cephalic arch is on the left side and flow is from right to left. Figure 1(a) shows an example of a normal vein and arch, whereas part b shows the arch for the same patient at a later time with stenosis present.