Pythiosis is a disease caused by Pythium insidiosum, a fungus-like organism. P. insidiosum is pathogenic in mammals, particularly in horses, dogs, and humans. Human pythiosis can be classified into 4 types: (1) cutaneous/subcutaneous, (2) ocular, (3) vascular, and (4) disseminated pythiosis. Vascular pythiosis is a rare disease but a serious limb- and life-threatening infection. We reviewed 22 cases over a 10-year period in Maharaj Nakorn Chiang Mai/Chiang Mai University Hospital. The survival rate was around 63.6% during our follow-up period. The only effective treatment was complete excision of the infected tissue, which was done mainly by major amputation, such as above-knee amputation. This report raises awareness of this disease, which needs preemptive diagnosis and appropriate treatment.

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Aim: Chronic venous disease (CVD) is very common in nurses. Noticeably, operating room (OR) nurses are predicted to have a major prevalence of varicose veins. We investigated whether the prevalence of CVD in OR nurses was more than non-OR nurses. Methods: Study populations were OR nurses and non-OR nurses at the Faculty of Medicine, Chiang Mai University. Information was compiled by questionnaire. Physical examination was operated by examiners for CVD based on clinical finding using Comprehensive Classification System for Chronic Venous Disorders classification. Results: 222 nurses were included. The prevalence of C0-C2 was notably different between the two groups (P < 0.001). The prevalence of C1 in OR nurses and non-OR nurses was 59.6% and 72.1% while the prevalence of C2 in OR nurses and non-OR nurses was 8.1% and 16.4%, respectively. Nevertheless, the quality of life was not remarkably different between the two groups. Conclusion: The results demonstrated that CVD in non-OR nurses appear to be higher than OR nurses.

IntroductionA 42 year old male with Behcet's disease (BD) had endovascular treatment of a symptomatic infrarenal abdominal aortic aneurysm (AAA). Thirteen months later he developed haematemesis and melaena.MethodsComputed tomography (CT) and angiography showed an aorto-enteric fistula with migration and kinking of the stent graft. Explantation of the infected graft and axillobifemoral bypass, aneurysm sac debridement, and jejunal repair with omental interposition was performed on this severely contaminated patient.DiscussionThere are no reports of an aorto-enteric fistula secondary to endovascular repair in the literature and this case describes the potential consequences of endovascular repair of AAA in BD. The aorto-enteric fistula was associated with persistent inflammatory aortitis, stent graft kinking, and infection. Five cases of secondary aorto-enteric fistulas following open AAA repair in BD patients have been reported including this case resulting from endovascular repair.

This study systematically reviewed the evidence and quantified the effectiveness of arm exercise training programs, before and after arteriovenous fistula (AVF) operation on AVF maturation, among people with chronic kidney disease. Scopus, CINAHL, PubMed, Science Direct, Cochrane Library, and reference lists were searched. Experimental studies that investigated the effect of arm exercise before and post-operation on AVF maturations were included. Screened and extracted data were administered by two independent reviewers. Seven studies with preoperative exercise were included in a systematic review, while five studies were analyzed in a meta-analysis. Preoperative exercise significantly increased vessel diameters and grip strength after training. Postoperative exercise had higher clinical and ultrasonographic (US) maturation rates and arterial blood flow than controls (risk ratio [

Patients infected with human immunodeficiency virus (HIV) can present with 4 pathology types: drug-induced vasospasm (ergotism), arterial limb ischemia, critical limb ischemia, and aneurysm. Although these problems are common vascular problems, they result in increased morbidity and mortality in HIV-infected patients, especially aneurysm. Patients with these problems tend to be diagnosed with difficulty because of atypical symptoms and signs. Because of lack of data in treatment outcome literature, our report explores and provides information on HIV infection-related arteriopathy. There were 17 patients in our 5-year review. There was no death in patients except the aneurysm type. The survival of aneurysm patients was significantly lower than from other pathologies (P = .003). Our case series showed good short-term outcome, and patients were not at risk for less beneficial surgical procedures.

Introduction: Physical examination (PE) is used to determine if arteriovenous fistula (AVF) meets criteria for first hemodialysis (HD) cannulation in chronic kidney disease (CKD) with HD patients. Three ultrasound (US) based criteria are adopted to investigate maturation: (i) Rule of Six: blood flow ⩾600 milliliters per minute (mL/min), vein diameter ⩾6 millimeters (mm), vein depth ⩽6 mm); (ii) Rule of Five: blood flow ⩾500 mL/min, vein diameter ⩾5 mm, vein depth ⩽6 mm; and (iii) Rule of Four: blood flow ⩾500 mL/min, vein diameter ⩾4 mm, vein depth ⩽6 mm. In Thai, no study determined optimal US criteria for predicting AVF maturation measured by PE before first cannulation. This study examined the significance of these US criteria on the physical AVF maturation in Thai. Methods: Fifty CKD patients, operated brachiocephalic AVF, were enrolled and examined on the operative day and 6 weeks afterwards. PE was evaluated by an experienced vascular surgeon, and US measurements were obtained by an experienced US technologist. Matching mature number between US criteria and PE was computed using McNemar test. Agreement between US criteria and PE was measured using Kappa. Mature and immature discrimination were evaluated by the Receiver Operator Characteristics (ROC) curve and Youden index. Results: Rule of Six and Rule of Five had higher non-mature matching number than Rule of Four ( p < 0.001 both). Regarding Kappa statistics, Rule of Six and Rule of Five agreed with the PE ( p < 0.01 both). The ROC curve of Rule of Six and Rule of Five were 0.75 and 0.74, respectively ( p <0.01 both). Youden index (maturity and immaturity discriminating performance) of both rules was 0.5 and 0.47, respectively. Conclusion: Rule of Six and Rule of Five agreed with the PE, with the highest performance of the Rule of Six to predict first successful cannulation in Thai.

We report two HIV infected patients with ruptured abdominal aneurysm by using endovascular aneurysm repair (EVAR) technique. A 59-year-old Thai man had a ruptured abdominal aortic aneurysm and a 57-year-old man had a ruptured iliac artery aneurysm. Both patients had a CD4 level below 200 μ/L indicating a low immune status at admission. They were treated by EVAR. Neither patient had any complications in 3 months postoperatively. EVAR may have a role in HIV patients with ruptured abdominal aneurysm together with very low immunity.