No abstract

Iatrogenic arteriovenous (AV) fistula is a vascular complication which may result from coronary angiography. Whilst infrequent via transfemoral access, the incidence in transradial angiography is even rarer with mostly case reports in the literature. Most of these had thus far described transradial AV fistula formation as a delayed complication requiring surgical intervention. Here we describe a rare early case of transradial AV fistula complicating coronary intervention which was managed conservatively with mechanical compression. Follow-up imaging confirmed resolution of fistula. We also reviewed the existing literature on management strategies for transradial AV fistula. We support the use of conservative management as the firstline treatment option for transradial AV fistula, with surgical options reserved for cases involving limb vascular compromise and cardiac insufficiency.

A 72-year-old Caucasian man with several medical problems presented with a 1-week history of lower back pain, fever, chills, nausea, anorexia, dysuria and lethargy. His history included congestive heart failure, diabetes, hypertension, coronary artery and peripheral vascular disease. A Dacron aorto-bi-iliac bypass graft had been performed in 1993. A physical examination revealed stable vital signs, a temperature of 37.7uC and a tender 10 cm palpable mass in the right mid-abdomen. Laboratory evaluation showed a white blood cell count of 7000/mL, a haematocrit of 30%, blood urea nitrogen of 0.5 g/L and a creatinine level of 0.19 g/L. Urine analysis showed 0-2 white blood cells and abundant bacteria per high power ®eld. CT without contrast enhancement revealed a massively enlarged right kidney with cortical thinning and marked dilation of the collecting system to the level of the sacrum, where a large cystic collection containing gas and debris was noted, distinct from the bladder (Fig. 1). Similar ®ndings were noted on CT 16 months earlier but the patient had remained asymptomatic, and had been treated conservatively. Because there was no response to antibiotics, a right percutaneous nephrostomy tube was placed and drained a foul-smelling purulent material which grew Enterococcus faecalis and methicillin-resistant Staphylococcus aureus. An antegrade nephrostogram showed the ureter emptying into the large debris-®lled abscess cavity in the pelvis (Fig. 2). The patient subsequently underwent a subcapsular nephrectomy, partial ureterectomy and open drainage of the abscess via an extraperitoneal approach. Within the abscess an aorto-iliac graft was visualized and

Introduction: Maintenance of warm chain and prevention of hypothermia to ensure smooth transitional adaptation of a newborn during early postnatal period is an important component of essential newborn care. Early detection of hypothermia in term normal weight newborns, kept in busy postnatal wards is essential, but is a challenge for healthcare personnels. Empowering the mothers with a simple tool to recognise hypothermia can decrease the burden on the healthcare personnels and also increase awareness among the mother and family members. Aim: The present study aimed at detecting hypothermia in healthy term newborns in the postnatal ward using a hypothermia alert (BEMPU TempWatch) device while simultaneously recording the abdominal skin temperature. Materials and Methods: The pilot study conducted from June 2018 to September 2018, recruited 51 full-term healthy infants in the postnatal ward and monitored them for hypothermia using BEMPU TempWatch on the wrist for 6 hours. Simultaneously, abdominal skin temperature was also recorded for these babies using a portable monitor. The number of hypothermia episodes detected using Bempu TempWatch and simultaneous abdominal skin temperature were recorded and analysed using R i386.3.5.1 and Microsoft Excel ver. 2010. Results: The device beeped when the temperature was <36.5°C; 68 episodes of hypothermia using TempWatch were recorded in 51 infants within 6 hours of transfer to the postnatal ward. The hypothermic incidence was significantly more (p-value 0.006) during the day shift (70%) than during the night shift (30%). Conclusion: The hypothermia alert BEMPU TempWatch was useful to detect hypothermia in healthy term neonates.