We report our experience of two cases of refractory cellulitis caused by peripheral micro-arteriovenous fistulas (AVFs) in the lower extremity. The micro-AVFs were so small that they could not be located accurately; further, the patients’ symptoms differed markedly from those previously reported for AVF. AVF is known to cause ischemic symptoms. In contrast, micro-AVF causes congestive symptoms and remains undetected in the majority of patients. Identification of this pathology is crucial to enable effective treatment by the ligation of the incompetent perforator vein that increases venous hypertension, leading to congestive symptoms.
Key words:dialysis, clinical pathway, disaster 〈Abstract〉 The Great East Japan Earthquake (March 11, 2011), which caused unprecedented damage, also greatly affected dialysis facilities in Miyagi Prefecture. In particular, the coastal areas were devastated, affecting numerous chronic dialysis patients. The Supply of electricity and water was unstable, and communication links were paralyzed. The living conditions of the people were miserable. We requested dialysis facilities outside the disaster areas to provide treatment for chronic dialysis patients, because the quality of dialysis could not be maintained under the conditions. In regard to dialysis treatment, requesting the afflicted dialysis facilities to provide usual medical information about chronic dialysis patients does not fit into the basic philosophy of disaster relief. On the other hand, we had to treat many chronic dialysis patients who were admitted to our hospital for the first time. Issues related to the medical treatment of patients who were evacuated from the disaster-afflicted areas were quite different from those in ordinary situations. Therefore, we formulated aclinical pathway for the hospitalization of chronic dialysis patientsas a tool to visualize information and allow it to be shared among different professionals and institutions. The clinical pathway allowed the standardization and understanding of patientśconditions during 村田 弥栄子 東北大学病院血液浄化療法部 〒 980
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