Endovascular Treatment of Cavernous Sinus Dural Arteriovenous Fistula via Radial Artery and Median Cubital Vein

Cavernous sinus dural arteriovenous fistula (CS-DAVF) is an arteriovenous shunt where there is fistulous blood flow from the dural arteries from the internal or external carotid artery into the cavernous sinus. The current mainstay of therapy is endovascular treatment. We present a case of restrictive type of CS-DAVF in a 75-year-old male who presented with right eye symptoms. He was treated with embolisation using trans-radial artery access for angiographic runs and a median cubital vein access navigating into the cavernous sinus for coil deployment. This technique completely avoids the conventional technique of a femoral approach and confines all access to the arm. Therefore, there are less risks and complications associated with an arm access, improves patients’ comfort and mobility post procedure. Transradial artery and cubital vein access allows for a safe and convenient alternative technique using the arm as compared with conventional transfemoral approach for treatment of CS-DAVF.

Peripheral Intravenous Line Access

A peripheral intravenous catheter is used to access a peripheral vein. To start a peripheral intravenous line, identify the site, place a tourniquet, clean the skin, stabilize the vein, and insert the catheter. When a “flash” is obtained, thread off the catheter, connect it to the tubing, and secure. This chapter describes tips for finding common intravenous access sites in children, which are the metacarpal, saphenous, cephalic, median, and scalp veins. These veins vary in size, depth, and difficulty. Metacarpal/dorsal hand veins are on the dorsal aspect of the hand and typically arise from adjacent digital veins and form a network that usually provides several targets for access, although there is significant variation. These veins form the cephalic vein (radial side) and basilic vein (ulnar side) as they converge. The cephalic vein arises from the lateral (radial) side of the dorsal venous network before curving around the wrist to run along the anterolateral forearm, where it is frequently easily accessed. It continues on this course up the arm, but more proximally it is less superficial. The median cubital vein runs from the cephalic vein medially toward the basilic vein diagonally across the antecubital fossa and is reliably present if not always visible. The greater saphenous vein is formed on the foot from the dorsal vein of the great toe and the dorsal venous arch of the foot. It ascends anteriorly to the medial malleolus and superiorly up the medial calf.

Mega Fistulae! A case series

A mega fistula can be defined as generalized aneurysmal dilatation of arteriovenous fistula. Mega fistulae can lead to complications like high output cardiac failure, steal syndrome, skin ulceration and rupture. We describe a series of ten patients who were referred to our interventional nephrology practice for evaluation of mega fistula which had not been in use for a long time. Nine out of ten patients were post-transplant while one was pre dialysis. Five patients had Radiocephalic while four had Brachiocephalic and one had Brachial artery to Median Cubital vein fistula. All except one patient had severe outflow stenosis. The most common site of stenosis in Radiocepahlic and Brachiocepahlic fistula was cephalic vein at the elbow and cephalic arch respectively. Half of the patients had chronic total occlusion of the outflow vein. Successful angioplasty was done in only two patients. Seven patients underwent ligation while one had spontaneous thrombosis of the fistula. None of the patients had regular surveillance of their access for a long time as they were not on dialysis. Unrecognized and uncorrected outflow stenosis over a long time period can lead to creation of mega fistula. Once a mega fistula develops there are not many treatment options other than ligation. This leads to loss of the access which might be needed in future. Continuous access surveillance in patients who are not on dialysis is important to prevent complications like mega fistula.

The Effect of Creatine Supplement on The Kidney Function of Dragon Boat Athletes

The consumption of creatine supplement among amateur and professional athletes is increasing. The purpose of this study was to determine the effect of creatine supplementation on the kidney function of dragon boat athletes. 12 dragon boat athletes were divided into 2 groups, including one group that consumed creatine supplement and one group without creatine intake (placebo). Creatine supplement was given at a loading dose of 20gr/day. The frequency of creatine supplement intake was 3-4x a day. In the second week, the dose was reduced into 15 gr/day. Creatine supplements were consumed for 5 weeks. Blood urea and creatinine were taken from the median cubital vein of the arm by using a 3cc syringe. The results showed that creatine supplementation had a significant effect in increasing the level of blood urea and creatinine. Although there were increases in urea and creatinine levels in the blood, the amount was still within normal limits. Therefore, it should be anticipated by taking a sufficient water intake. AbstrakKonsumsi kreatin suplemen di kalangan atlet amatir dan profesional semakin meningkat. Tujuan dari penelitian ini adalah untuk mengetahui pengaruh suplemen kreatin terhadap fungsi ginjal atlet dragon boat. 12 orang atlet dragon boat dibagi menjadi 2 kelompok, satu kelompok yang mengkonsumsi kreatin dan satu kelompok tanpa asupan kreatin (placebo). Suplemen kreatin diberikan dengan dosis loading 20gr/hari, frekuensi pemberian 3-4x sehari. Pada minggu kedua dosis diturunkan menjadi 15 gr/hari. Suplemen kreatin dikonsumsi selama 5 minggu. Kadar ureum dan kreatinin darah diambil dari vena median cubital lengan dengan menggunakan spuit 3cc. Hasil penelitian didapatkan pemberian suplemen kreatin berpengaruh signifikan meningkatkan kadar ureum dan kreatinin dalam darah. Walau terdapat peningkatan kadar ureum dan kreatinin dalam darah namun jumlahnya masih dalam batas normal, sehingga perlu diantisipasi dengan asupan cairan yang memadai.

IgM Anti PGL-1 Antibody Level in Patients with Leprosy: A Comparative Study between Ear Lobes Capillary and Median Cubital Vein Blood Samples

BACKGROUND: To establish the diagnosis of leprosy accurately, additional examination such as serologic examination with ELISA is required. There are considerations about taking a blood sample from the earlobe region.AIM: To determine the differences in IgM anti-PGL-1 antibody levels from earlobe capillary and median cubital vein blood sample in leprosy patients.METHODS: An observational analytic study using a cross-sectional study involving 30 patients with leprosy. ELISA examination of earlobe blood samples with filter paper, and the median cubital vein blood samples with filter paper and conventional methods were performed to determine IgM anti-PGL-1 antibody levels.RESULTS: The mean value of IgM anti PGL-1 antibody levels from earlobe blood samples with filter paper (1476.62 μ/ml) was relatively similar with median cubital vein blood samples with conventional method (1476.77 μ/ml), but the mean value of IgM anti PGL-1 antibody levels from median cubital vein blood samples with filter paper (1210.37 μ/ml) was lower from other methods. However, there was no statistically significant difference between them.CONCLUSION: There are no significant differences between the mean levels of IgM anti-PGL-1 antibody from earlobe and the median cubital vein blood samples.

Comparison of Serum Probrain Natriuretic Peptide (ProBNP) Levels in Migraineurs and Hypertensive Migraineur Patients

Migraine being one of the common and disabling causes of headaches, has been described by World Health Organization as close to quadriplegia and dementia.Among the headache complaint visitors in the emergency department, the most common are those suffering from migraine. (1) Alinear correlationhas been found between rising serum pro BNP levels and Cardiovascular pathologies especially those involving left ventricular dysfunction which may depict a probable association between migraine and CVD. To compare the levels of serum pro Brain natriuretic peptide (pro BNP) between migraineurs and hypertensivemigraineurs. It was a cross sectional comparative study in which serumpro BNP levels were measured in migraine patients and hypertensive patients with migraine. A blood sample of 3 cc was drawn from the median cubital vein after securing aseptic measures. The blood sample was allowed to clot for 30 minutes and serum was separated. The serum was then centrifuged andpro BNP levels were estimated by ELISA using Human pro BNP kit. Patients’ history and recorded blood pressure was documented on a questionnaire. The results were analyzed using SPSS 21. One way ANOVA and Independent sample T test were applied to compare the proBNP levels. A P-value of < 0.05 was taken as significant. Serum pro BNP levels were raised in migraine patients and also in hypertensive patients with migraine (p-value 0.00). Serum pro BNP levels were found to be raised in both migraineurs and hypertensive migraineurs but the increase was not equal.