Assessment of Atrial Fibrillation and Ventricular Arrhythmia Risk after Bariatric Surgery by P Wave/QT Interval Dispersion.

BACKGROUND: The association of obesity with atrial fibrillation (AF) and with ventricular arrhythmias is well documented. OBJECTIVE: The aim of this study was to investigate whether weight reduction by a laparoscopic sleeve gastrectomy has any effect on P wave dispersion (PWD), a predictor of AF, and corrected QT interval dispersion (CQTD), a marker of ventricular arrhythmias, in obese individuals. METHODS: In a prospective study, a total of 114 patients (79 females, 35 males) who underwent laparoscopic sleeve gastrectomy were examined. The patients were followed 1 year. PWD and CQTD values before and 3rd, 6th, and 12th months after the surgery were calculated and compared. RESULTS: There was a statistically significant decline in body mass index (BMI), PWD, and CQTD values among baseline, 3rd, 6th, and 12th months (p < 0.001 for all comparisons). Correlation analysis showed a statistically significant correlation between ΔPWD and ΔBMI (r = 0.719, p < 0.001), ΔPWD and Δleft ventricular end-diastolic diameter (LVEDD) (r = 0.291, p = 0.002), ΔPWD and Δleft atrial diameter (LAD) (r = 0.65, p < 0.001), ΔCQTD and ΔBMI (r = 0.266, p = 0.004), ΔCQTD and ΔLVEDD (r = 0.35, p < 0.001), ΔCQTD and ΔLAD (r = 0.289, p = 0.002). In multiple linear regression analysis, there was a statistically significant relationship between ΔPWD and ΔBMI (ß = 0.713, p < 0.001), ΔPWD and ΔLVEDD (ß = 0.174, p = 0.016), ΔPWD and ΔLAD (ß = 0.619, p < 0.001), ΔCQTD and ΔBMI (ß = 0.247, p = 0.011), ΔCQTD and ΔLVEDD (ß = 0.304, p < 0.001), ΔCQTD and ΔLAD (ß = 0.235, p = 0.009). CONCLUSION: PWD and CQTD values of patients were shown to be attenuated after bariatric surgery. These results indirectly offer that there may be a reduction in risk of AF, ventricular arrhythmia, and sudden cardiac death after obesity surgery.

Is the Routine Use of Impedance Analysis for the Diagnosis of Gastro-Esophageal Reflux Disease More Expensive than Conventional pH Monitoring? Cost Analysis of Two Procedures.

Conventional 24-h pH monitoring is the gold standard for the diagnosis of non-erosive, non-acidic gastro-esophageal reflux disease. Multichannel Intraluminal Impedance (MII) analysis markedly improves diagnostic accuracy of non-erosive, non-acidic gastro-esophageal reflux disease. However, MII catheters are more expensive than standard catheters. This study aimed to determine the rates of acid or non-acid reflux and by making a retrospective projection, to predict the costs of two algorithms. We retrospectively reviewed the medical data of 102 patients who presented to our hospital with suspected non-erosive GERD and underwent 24 h impedance/pH-monitoring. Demographic characteristics, Demeester scores, number of reflux episodes, and results of impedance analysis were recorded. According to these data, cost was calculated either for the scenario in which impedance measurement was performed solely or following a negative conventional pH monitoring. Thirty-seven of all 102 patients (36.3 %) had a Demeester score greater than 14.7. These patients were assigned as group 1 (acid reflux). The impedance analysis of the remaining 65 patients detected 34 patients (33.3 %) to have more than 50 reflux episodes over a period of 24 h and assigned as Group 2, and 31 patients (30.4 %) had no reflux (group 3). The cost of the single- step algorithm using MII catheter was calculated as $15,300, while the total cost of two-step scenario would have been predicted as $16,890. Our study showed that an initial conventional pH monitoring can make the diagnosis of GERD in only one third of the patients with suspected non-erosive GERD. In nearly two-thirds of patients, however, repeated procedures and use of impedance catheters are needed. It is clear that this algorithm has certain drawbacks with regard to cost, patient comfort, and workforce loss.

The type of specimen retrieval in laparoscopic appendectomy affects wound infection.

AIM: To evaluate the role of laparoscopy in appendicitis and importance of wound protection in this sense. MATERIALS AND METHODS: Data of 506 patients operated on by either open or laparoscopic appendectomy within the last four years were evaluated retrospectively for wound infection rates. Those had laparoscopic surgery were also subgrouped and analyzed in terms of retrieval type of the specimen. RESULTS: Wound infection rate was 5.7% for open appendectomy and zero for laparoscopic appendectomy in minimal or non-inflamed cases. For suppurative appendicitis and gangrenous or perforated cases wound infection rates were 9.1% versus 17.6% for open appendectomy versus laparoscopy. Laparoscopy without wound protection increased these rates to 17.9% versus 50%, where as wound protection reduced both to zero. DISCUSSION: Laparoscopy itself was protective for wound infection in non-inflamed or minimally inflamed appendectomy cases with respect to open surgery. However, for suppurative, gangrenous or perforated appendicitis, laparoscopy protects from wound infection only when contact of the specimen with incisions was avoided. CONCLUSION: Laparoscopy reduces wound infection rates in appendectomy. This advantage is prominent especially wound contamination with the specimen is prevented anywise. Using a glove finger, as a tissue bag for the retrieval of the specimen has been our favorite method that we defined as "reverse cover-up technique". KEY WORDS: Glove bag, Glove finger, Laparoscopic appendectomy, Specimen retrieval, Tissue bag, Wound protection.

Isolated jejunal metastasis in a patient with cervical cancer: A case report.

BACKGROUND: In approximately 8% of cervical carcinoma patients, gastrointestinal tract is involved, most commonly the rectosigmoid portion, because of local extension. Isolated metastases to small bowel are exceedingly rare. CASE REPORT: We present a case of a 63-year-old woman with cervical cancer who developed isolated jejunal metastasis 8 months after postoperative chemoradiotherapy. The patient was alive with no evidence of disease 6 months after resection of metastasis. Very few cases have been reported concerning squamous cell carcinoma of the cervix with documented metastases to the small bowel. There is only one published case report of cervical cancer with multiple metastases to the small intestine and jejunum. To our knowledge, this is the first case of cervical cancer with isolated jejunal metastasis, which was initially demonstrated with positron emission tomography and confirmed histopathologically. CONCLUSION: Although the exact mechanism underlying the isolated metastasis is unknown, hematogenous spread or tumor seeding during surgery may play a role.

Mattress sutures for the modification of end-to-end dunking pancreaticojejunostomy.

Despite the improvement of surgical techniques, the rate of anastomotic failure of pancreaticojejunostomy remains high (30%-50%). Here we describe the use of vertical mattress sutures in the modification of dunking pancreaticojejunal anastomosis. In 7 patients who used this technique, neither anastomotic failure nor any major postsurgical complication developed. This technique is an easy, safe, and promising for the performance of pancreaticojejunostomy.

Surgical management of endoscopic retrograde cholangiopancreatography related injuries.

BACKGROUND/AIMS: The aim of this study was to determine timing and outcomes of surgical treatment options of endoscopic retrograde cholangiopancreatography (ERCP) related injuries. METHODOLOGY: Nine patients with ERCP related injury were underwent surgical treatment at our institution. Data about these patients and outcomes of the treatment options used were retrospectively analyzed. RESULTS: Out of 9 patients, 5 were female and mean age of 68.2 years (36-92 years). Out of 5 patients with duodenal injury (55.6%), 4 patients were treated with simple repair and 1 patient was treated with duodenostomy. Six patients were treated with pyloric closure and gastrojejunostomy. A T tube was placed in 5 patients with choledochal calculus and 1 patient with biliary fistula. One patient with a tumor in the periampullary region underwent pancreaticoduodenectomy. A total of 4 patients died (44.4%). Out of 5 patients followed, 5 (60%) had postoperative problems such as sepsis, wound infection and abdominal abscess. The mean hospital stay was 22.6±7.9 days. CONCLUSION: Duodenal injuries should be treated with surgery immediately. Findings from physical examination and computed tomography should guide in making decisions about surgery. ERCP indications, type of injuries and abdominal inflammation should be kept in mind in decisions for the type of surgical treatment.

Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study.

The CIAO Study ("Complicated Intra-Abdominal infection Observational" Study) is a multicenter investigation performed in 68 medical institutions throughout Europe over the course of a 6-month observational period (January-June 2012).Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.2,152 patients with a mean age of 53.8 years (range: 4-98 years) were enrolled in the study. 46.3% of the patients were women and 53.7% were men. Intraperitoneal specimens were collected from 62.2% of the enrolled patients, and from these samples, a variety of microorganisms were collectively identified.The overall mortality rate was 7.5% (163/2.152).According to multivariate analysis of the compiled data, several criteria were found to be independent variables predictive of patient mortality, including patient age, the presence of an intestinal non-appendicular source of infection (colonic non-diverticular perforation, complicated diverticulitis, small bowel perforation), a delayed initial intervention (a delay exceeding 24 hours), sepsis and septic shock in the immediate post-operative period, and ICU admission.Given the sweeping geographical distribution of the participating medical centers, the CIAO Study gives an accurate description of the epidemiological, clinical, microbiological, and treatment profiles of complicated intra-abdominal infections (IAIs) throughout Europe.

Complicated intra-abdominal infections in Europe: preliminary data from the first three months of the CIAO Study.

The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012).This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period.Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.912 patients with a mean age of 54.4 years (range 4-98) were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified.The overall mortality rate was 6.4% (58/912). According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock) as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality.White Blood Cell counts (WBCs) greater than 12,000 or less than 4,000 and core body temperatures exceeding 38°C or less than 36°C by the third post-operative day were statistically significant indicators of patient mortality.

Clinical outcomes of manual bowel decompression (milking) in the mechanical small bowel obstruction: a prospective randomized clinical trial.

BACKGROUND: The aim of this prospective randomized study was to investigate the effects of manual bowel decompression in patients who were operated on for mechanical small bowel obstruction. METHODS: Between March 2008 and February 2010, 40 consecutive patients with mechanical small bowel obstruction were randomized into 2 clinically comparable groups. The intestinal content of the dilated small bowel was caressed to the stomach (by milking) and aspirated via a nasogastric tube in the milking group (group M, n = 20) and left uncaressed in the control Group (group C, n = 20). Patients' characteristics and general operative outcomes were compared and analyzed. RESULTS: The resumption of a regular diet and postoperative hospital stay (P = .68) were not significantly different in groups M and group C. Similarly, there were no differences between the 2 groups regarding respiratory complications (P = .34), bacterial translocation (P = 1), or wound infection (P = 1). CONCLUSIONS: The findings suggest that routine milking is unnecessary in mechanical small bowel obstruction.

[Use of drainage in surgery for perforated appendicitis: the effect on complications]. / Perfore apandisit ameliyatinda dren kullaniminin komplikasyonlara etkisi.

BACKGROUND: We aimed to investigate the use of drainage in surgery for perforated appendicitis and to determine its effect(s) on complications. METHODS: Two-hundred and eight patients diagnosed with perforated appendicitis between May 1999 and January 2009 were retrospectively evaluated in terms of using drainage with respect to surgical infections and other complications and duration of hospital stay. RESULTS: A total of 208 patients diagnosed with perforated appendicitis underwent surgery. The mean age of the patients was 41.05±16.30 years. Of the 208 patients, 128 (61.5%) were male. The median duration of complaints was 2 days (1-15 days). Drainage was applied in 83 patients (39.9%). The median duration of drainage was 3 days (1-7 days). Surgical infections, wound dehiscence, other complications, and re-hospitalization rates were significantly higher in patients with drainage. The mean time from appearance of complaints to surgery, the duration of hospitalization and antibiotic treatment were also longer in the drainage group (p=0.001 for all). A higher rate of the patients with an accompanying disease (39.8%-19.2%) and midline incision (20.5%-3.2%) and of the elderly patients had drainage. Multivariate analyses showed that using a drain independently affected surgical infections (p<0.001). CONCLUSION: It can be concluded that using a drain after surgery for perforated appendicitis increases surgical infections and in turn the duration of hospital stay.

Incidence of congenital hemolytic anemias in young cholelithiasis patients.

AIM: To clarify the incidence of congenital hemolytic anemias (CHA) in young cholelithiasis patients and to determine a possible screening test based on the results. METHODS: Young cholelithiasis patients (< 35 years) were invited to our outpatient clinic. Participants were asked for comorbidities and family history. The number of gallstones were recorded. Blood samples were obtained to perform a complete blood count, standard Wright-Giemsa staining, reticulocyte count, hemoglobin (Hb) electrophoresis, serum lactate dehydrogenase and bilirubin levels, and lipid profile. RESULTS: Of 3226 cholecystectomy patients, 199 were under 35 years, and 190 with no diagnosis of CHA were invited to take part in the study. Fifty three patients consented to the study. The median age was 29 years (range, 17-35 years), 5 were male and 48 were female. Twelve patients (22.6%) were diagnosed as thalassemia trait and/or iron-deficiency anemia. Hb levels were significantly lower (P = 0.046), and mean corpuscular volume (MCV) and hematocrit levels were slightly lower (P = 0.072 and 0.082, respectively) than normal. There was also a significantly lower number of gallstones with the diagnosis (P = 0.007). CONCLUSION: In endemic regions, for young cholelithiasis patients (age under 35) with 2-5 gallstones, the clinician/surgeon should pay attention to MCV and Hb levels as indicative of CHA.

Prospective randomized controlled trial comparing V-Y advancement flap with primary suture methods in pilonidal disease.

BACKGROUND: An ideal treatment method for the widely prevalent pilonidal sinus disease is not yet available. The most commonly practiced technique is simple closure following resection of the effected tissue. However, high recurrence rates in some series have led to the search for other methods. One of these methods is the V-Y advancement flap (VYAF), which in theory results in the flattening of the natal cleft without tension in the suture line. METHODS: In this prospective randomized controlled study, the VYAF method was compared to 2 simple primary closure techniques. In 238 patients, following resection, in the AL (all layers) group, all layers were closed with polypropylene sutures. In the SS (subcutaneous suture) group, polyglactin subcutaneous sutures were used to approximate the wound edges. Skin was closed separately in the SS group. In addition, demographic variables, past history, physical examination findings, defect dimensions, and wound tension were recorded. RESULTS: Surgical site infection was observed in 23.9%, 17.4%, and 10.2% of the patients in AL, SS, and VYAF groups, respectively (P = .129). Early wound dehiscence without infection was detected in 11.9%, 7.4%, and 10.2% of the patients in groups AL, SS, and VYAF, respectively (P = .665). Mean follow-up was 29.7 +/- 15.6 months. Survival (time without recurrence) was not significantly different between groups (P = .648). In the whole group, independent predictors of recurrence according to logistic regression analysis were younger age, recurrent disease, presence of discharge on physical examination, and development of postoperative surgical site infection. CONCLUSIONS: VYAF is not superior to simple primary closure techniques in terms of postoperative complications, recurrence, and patient satisfaction. For most cases, simple primary closure would suffice. Patients should be informed of the increased risk of recurrence if any of the independent predictors (being a recurrent case, presence of discharge, development of postoperative infection) are present.

[Role of anatomic and physiologic trauma scoring systems in forensic cases]. / Adli olgularda anatomik ve fizyolojik travma skorlama sistemlerinin rolü

BACKGROUND: The Turkish Penalty Law has recently been changed. The novel law asks the practitioner to report if there is any 'Situation Placing a Life in Danger '. Herein, we evaluate the anatomic (ISS, TRISS) and physiologic (RTS) trauma scores assessing mortality. METHODS: Study data were obtained from a retrospective chart screening of cases who were accepted to the emergency department in GATA Faculty of Medicine in 2007 and from archived forensic reports. Demographic features and the time period of admittance were recorded. Trauma scores were calculated. All parameters were evaluated with the reported condition of "life threat" and mortality. RESULTS: Forensic reports were completed for 373 patients and 6.16% of them were noted as being in a life-threatening condition. Mortality rate was 1.34%. A significant rate of trauma patients suffered from firearm injury and stab wounds (p<0.001). There was no statistical difference between ISS, TRISS and RTS with respect to predictive value of a 'life-threatening condition' (Area under curve [AUC] in the receiver operating characteristic [ROC] curve analysis: ISS: 0.968, TRISS: 0.922, RTS: 0.196). There was also no statistical difference between ISS, TRISS and RTS scores regarding mortality prediction (AUC in the ROC analysis: ISS: 0.992, TRISS: 0.0995, RTS: 0.005). CONCLUSION: We assume that there is no difference between physiologic and anatomic scoring systems to predict mortality for deciding a life-threatening condition.

Is the zeolite hemostatic agent beneficial in reducing blood loss during arterial injury?

BACKGROUND: Uncontrolled hemorrhage is the leading cause of fatality. The aim of this study was to evaluate the effect of zeolite mineral (QuikClot - Advanced Clotting Sponge [QC-ACS]) on blood loss and physiological variables in a swine extremity arterial injury model. METHODS: Sixteen swine were used. Oblique groin incision was created and a 5 mm incision was made. The animals were allocated to: control group (n: 6): Pressure dressing was applied with manual pressure over gauze sponge; or QC group (n: 10): QC was directly applied over lacerated femoral artery. Mean arterial pressure, blood loss and physiological parameters were measured during the study period. RESULTS: Application of QC led to a slower drop in blood pressure. The control group had a significantly higher increase in lactate within 60 minutes. The mean prothrombin time in the control group was significantly increased at 60 minutes. The application of QC led to decreased total blood loss. The QC group had significantly higher hematocrit levels. QC application generated a significant heat production. There were mild edematous and vacuolar changes in nerve samples. CONCLUSION: According to the physiological parameters, we observed that zeolite tends to reduce blood loss, however could not stop bleeding completely. We believe that further clinical trials are needed to conclude that zeolite could be used in the routine practice.

Traumatic lumbar hernia: report of a case.

Traumatic lumbar hernias are very rare. Here, we present a case of secondary lumbar hernia. A 44-year-old man sustained a crushing injury. On admission, ecchymotic, fluctuating swelling was present on his left flank with normal vital signs. Subcutaneous intestinal segments were revealed at his left flank on abdominal CT. Emergency laparotomy revealed a 10-cm defect on the left postero-lateral abdominal wall. The splenic flexure was herniated through the defect. Herniated segments was reduced, the defect was repaired with a polypropylene mesh graft. There was also a serosal tear and an ischemic area 3mm wide on the splenic flexure and was repaired primarily. The patient had an uneventful recovery. Most traumatic lumbar hernias are caused by blunt trauma. Trauma that causes abdominal wall disruption also may cause intraabdominal organ injury. Abdominal CT is useful in the diagnosis and allows for diagnosis of coexisting organ injury. Emergency laparotomy should be performed to repair possible coexisting injuries.

Effect of manual bowel decompression (milking) in the obstructed small bowel.

BACKGROUND: Mechanical intestinal obstruction is a frequently encountered problem in general surgery. One of the frequently used techniques for surgical decompression, so-called milking, is to caress the intestinal contents cephalad into the stomach or caudally into the colon. The aim of our study was to examine the functional, morphologic, and microbiologic effects of manual bowel decompression (milking) in the obstructed small bowel. METHODS: Six rats in the milking (M) group (obstructed and decompressed manually), 6 in the control (C) group (obstructed only), and 5 rats in the sham (S) group (laparotomy and evisceration) underwent surgery. Muscle contractility, gastrointestinal dye transmission, histopathologic changes of ileum, and bacterial translocation were analyzed. RESULTS: The contractile response of intestinal segments to acetylcholine was significantly less in group M compared with those of groups C and S (P < .05). The maximal contractile response to acetylcholine also was significantly lower in group M (P < .05). There was no statistically significant difference between the groups regarding the sensitivity of cholinergic receptors. Frequency of peristaltic movements, progression of Evans blue dye, histopathologic variables, and the quantitative evaluation (colony-forming units/gram of tissue) of isolated bacteria were not different among the groups. However, Escherichia coli in group M and Klebsiella spp in group S were the main isolated bacteria. CONCLUSIONS: Although it reduces muscle contractility, a milking procedure in an intestinal obstruction model does not cause peristaltic deterioration, histopathologic or inflammatory changes, or alterations in the degree of bacterial translocation.

Small bowel obstructions secondary to bezoars.

BACKGROUND: We aimed to present our experience on computed tomography (CT) findings of small bowel obstruction due to bezoar impaction. METHODS: CT scans of seven patients (3 males, 4 females, age range; 30-93 years) who were diagnosed as small bowel obstruction due to bezoars were reviewed. RESULTS: In each patient, an intraluminal mass with a mottled gas pattern on CT enabled specific preoperative diagnosis of bezoars, and postoperative changes such as anastomotic lines and afferent-efferent loops. CONCLUSION: CT imaging is useful in making the diagnosis of bezoar associated with small bowel obstruction, and greatly helps assessing the detailed abdominal anatomy.

Adhesion molecules as prognostic markers in pancreatic adenocarcinoma.

BACKGROUND AND OBJECTIVES: Pancreatic adenocarcinoma is a highly aggressive cancer with high metastatic potential and therefore, a high mortality rate. Ezrin, radixin, moesin, and E-cadherin are transmembrane glycoproteins that regulate cell motility, migration, and metastasis. In this study, we investigated the relationship of ezrin, moesin, and E-cadherin expression with the clinicopathological features of pancreatic ductal adenocarcinoma. METHODS: Data including demographic features, size and grade of tumor, presence of perineural and lymphovascular invasion, and survival were obtained retrospectively from 46 patient records. RESULTS: No significant correlation was found among ezrin, moesin, and E-cadherin. Significant correlations were found between ezrin and the tomographic size of the tumor (P = 0.034) and resectability (P = 0.052). Moesin-stained tumors were found to have high lymphovascular (P = 0.030) and perineural (P = 0.036) invasion rates and a high histopathologic grade (P = 0.053). E-cadherin staining was correlated with perineural invasion (P = 0.003) but not with lymphovascular invasion (P = 0.334). Only moesin was correlated with survival in resected pancreatic adenocarcinomas and moesin-negative patients had longer survivals compared with moesin-positive patients (P = 0.021). CONCLUSIONS: We could not demonstrate a relation between ezrin and E-cadherin staining with survival. However, we found ezrin to be related to local tumor behavior, and moesin to be a potential prognostic molecule.

Is routine preoperative ultrasonographic mapping for arteriovenous fistula creation necessary in patients with favorable physical examination findings? Results of a randomized controlled trial.

INTRODUCTION: Preoperative ultrasonographic mapping (PUSM) is widely used for arteriovenous fistula creation in end-stage renal disease patients, and some authors even advocate that it be used routinely. To date, however, there are no prospective randomized data to support this suggestion. METHODS: This prospective, randomized, controlled study compared PUSM and physical examination in relation to short-term outcome after AVF creation. Data sets from 70 hemodialysis patients who were deemed eligible for AVF surgery-according to specific physical examination (PE) criteria for vessel anatomy-were analyzed. The patients were randomly divided into two groups. In the PE group, no other investigation was performed, and the patient underwent AVF creation. The other patients (M group) underwent PUSM, and the AVF was created according to the mapping results. Early AVF success was defined as clinical detection of thrill (immediately and on postoperative day 1). Ultrasonographic parameters were recorded on the first postoperative day and at 1 and 6 months postoperatively. The need for intervention and intervention-free AVF survival and cumulative AVF survival were also noted. RESULTS: The PE and M groups showed similar rates of early AVF success: immediate thrill, PE 24/35 (68.6%) vs. M 26/33 (78.8%), P=0.340; postoperative day 1, PE 20/34 (58.8%) vs. M 24/32 (75%), P=0.164. The groups' results for ultrasonographic parameters of AVF function were also similar on postoperative day 1 and at 1 month after surgery. The groups had similar intervention-free AVF survival (P=0.770) and cumulative AVF survival as well (P=0.916). After an average follow-up of 217.7+/-239.7 days, the two groups also had similar proportions of patent AVFs: 23/35 (65.7%) vs. 23/35 (65.7%) for PE vs. M, respectively; P=1.0). CONCLUSIONS: The results indicate that PUSM offers no advantage over PE with regard to AVF function in patients with favorable forearm anatomy. The authors do not advocate routine use of PUSM in patients with favorable PE findings scheduled for forearm AVF creation.