Acute kidney injury remains a relevant complication of open aortic surgery requiring suprarenal cross-clamping. We describe a simplified extracorporeal shunt configuration for temporary selective renal blood perfusion using devices routinely available in vascular operating rooms. Brachial arterial inflow is connected to a 9F Pruitt-Inahara shunt, whose limbs are positioned within the renal artery ostia. In our initial experience of five consecutive patients, technical success was achieved in all patients, with no postoperative deterioration in renal function or need for renal replacement therapy. This technique provides a practical and reproducible adjunct for select open aortic procedures.

Langerhans cell histiocytosis is a rare histologic disorder that can affect and damage any tissues and organ in the body. A 40-year-old man with multisystem Langerhans cell histiocytosis presented with a painful distal arm mass. Imaging demonstrated a 3.6-cm true distal brachial artery aneurysm and progressive hypermetabolic activity of the affected artery on the retrospective review of serial positron emission tomography/computed tomography scans. The patient underwent aneurysm resection and arterial reconstruction using a reversed great saphenous vein bypass. Histopathology confirmed infiltration of the intima and media by Langerhans cells with destruction of the elastic lamina. Subsequent disease-specific therapy achieved a complete metabolic response, and vascular reconstruction remains patent.

Isometric exercise (IE) has been introduced as an effective non-pharmacological strategy for blood pressure (BP) management; however, the influence of exercise intensity remains unclear during lower-limb IE. This study investigated the acute effects of volume-matched high-intensity (HIIE) and low-intensity IE (LIIE) on cardiovascular function in men with elevated BP. Seventeen men with prehypertension or stage I hypertension completed three randomized crossover conditions, including HIIE (60% of maximal voluntary contraction (MVC)), LIIE (30% of MVC), and a non-exercise control condition (CON). BP, heart rate variability (HRV), brachial-ankle pulse wave velocity (baPWV) were measured at baseline and three different time points during recovery, while flow-mediated dilation (FMD) was measured at baseline and 30-min post-exercise. No significant BP reduction was observed. However, HIIE induced greater autonomic disturbance with elevated heart rate and reduced HRV indices during recovery (p < 0.05). Right baPWV decreased following HIIE (p < 0.05) while FMD increased after both exercise conditions (p < 0.001). Our findings suggest that volume-matched HIIE induces greater acute autonomic and vascular responses than LIIE in men with elevated BP, despite no immediate changes in BP. HIIE may provide a stronger physiological stimulus associated with vascular adaptation.

The interscalene triangle is a key cervicothoracic gateway bounded by the anterior and middle scalene muscles and the first rib. It transmits the roots and trunks of the brachial plexus (C5-T1) and the subclavian artery (SA), while the subclavian vein (SV) courses anterior to the anterior scalene muscle and the phrenic nerve (PN) descends along its anterior surface. Cadaveric dissection highlights these critical topographic relationships, providing an anatomical basis for understanding thoracic outlet syndrome, optimizing ultrasound-guided regional anesthesia, and minimizing the risk of iatrogenic nerve injury during cervicothoracic surgery.

Painful upper extremity injuries frequently require procedures for which procedural sedation may be resource-intensive. This prospective study evaluated the educational impact and clinical feasibility of implementing a structured ultrasound-guided regional anesthesia curriculum as an alternative to procedural sedation for selected upper extremity procedures within a community emergency medicine residency. From January through December 2025, attending emergency physicians participated in a two-hour didactic session and hands-on workshop followed by longitudinal on-shift mentorship. Physician knowledge was assessed using a locally developed pre- and post-intervention cognitive assessment. Seventeen physicians completed the curriculum. Mean assessment scores increased from 8.18±3.05 to 18.41±1.58, with a mean improvement of 10.24 points (95% confidence interval (CI), 9.02-11.45; p<0.001). During clinical implementation, 30 ultrasound-guided brachial plexus blocks were performed. The intended procedure was completed without procedural sedation in 28 (93.3%) cases. In two (6.7%) cases, procedural sedation was subsequently required to complete the planned reduction. No immediate procedure-related complications were observed. A structured ultrasound-guided regional anesthesia curriculum was associated with improved physician knowledge and successful clinical implementation of brachial plexus blocks. These findings support the feasibility of incorporating ultrasound-guided regional anesthesia as an additional analgesic strategy for selected upper extremity procedures in a community emergency medicine setting.