We report a case of a forty-year-old lady presenting with an ulceroproliferative lesion over lower part of left chest wall after having 5 previous operations on breast including mastectomy followed by chemotherapy and radiotherapy. MRI thorax revealed chest wall and muscle involvement with indentation of ribs, without any distant metastasis. Incision biopsy found malignant cystosarcoma phyllodes. WLE of the mass including resection of ribs followed by chest wall reconstruction was performed. In spite of resection margins being found negative on HPE, there has been local recurrence 1 year following last operation. The rarity of the diagnosis along with several discrepancies in HPE reports and repeated recurrences make this case an intriguing one.
Patients with the end-stage renal disease require renal replacement therapy in renal transplant, peritoneal dialysis, and intermittent hemodialysis. Hemodialysis remains the primary modality for renal replacement therapy. Excellent vascular access is a mainstay for performing hemodialysis. Here we present a brief review of the various surgical aspects of AV fistula creation. Preoperative physical examination and judicious use of the imaging modalities to define the artery and venous mapping provide a good outcome of the fistula formation. Surgical creation of RC-AVF is preferred for the end-stage renal disease patient. The end-to-side anastomosis between the radial artery and cephalic vein has shown very good results.
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