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This retrospective open study evaluating the efficacy of Sudocrem Antiseptic Healing Cream (SAHC) in infantile nappy rash (NR) was based on real-world evidence collected using an online questionnaire that included Likert scales. Participants who had used SAHC in the past (n=2159) were recruited via social media and email. A total of 1818 respondents who had treated NR in the previous 6 months were asked to take part in the study. Over 50% of respondents saw an improvement in NR on the same day that treatment was started, and within 3 days 94.5% of respondents reported an improvement in NR. Of 1804 subjects who answered the question, 72.5% indicated that the NR had completely healed within 3 days of starting treatment and by the fifth day, 94.7% said that the NR had completely healed. A total of 71% of 1793 respondents said that an episode of NR had either no or minimal impact disrupting their normal lives, but 29% reported a noticeable impact, even though evidence suggests that mild to moderate nappy rash can be treated quickly. Based on this real-world retrospective study, the evidence suggests SAHC is rapidly effective, reduces signs and symptoms of inflammation, and heals NR.

We present a case of acute blunt traumatic bilateral renal artery thrombosis in the setting of multisystem trauma. Catheter-directed thrombolysis with tissue plasminogen activator afforded kidney salvage with return of glomerular filtration rate to normal values at the time of patient discharge. included a small left subdural hematoma, a left hemothorax and lung contusion. Bilateral renal infarctions with traumatic renal vascular thrombosis, and a right renal pelvis tear with minimal contrast extravasation was demonstrated. The remaining abdominal viscera were without acute injury. The right renal infarct was extensive compared to the left and involved the majority of the right kidney (Figure 1). A visceral angiogram confirmed bilateral renal infarctions, greater in the right kidney. The thrombus on the right renal artery was large and extending to several interlobar arteries (Figure 2). A catheter was placed in the right main renal artery for infusion of tissue plasminogen activator (TPA) at 2 mg/hr for four hours after an initial bolus of 8 mg for a total dose of 16 mg. The time from injury to the treatment with TPA was approximately 5 hours. The patient was also placed on systemic heparin drip due to the bilateral nature of the renal artery thrombosis. This decision was made following consultation with a neurosurgeon as the patient also had an acute subdural bleed. A collaborative decision was reached to proceed with

Transesophageal echocardiography (TEE) is an invaluable diagnostic tool, particularly in patients with inadequate transthoracic echocardiographic examinations. In addition, continuous TEE has been used to monitor ventricular and valvular performance in the intensive care unit and the operating room. However, current generation transesophageal probes have limitations in the critical care setting due to their size. Recently, a prototype miniaturized transesophageal probe was developed to overcome these limitations. This probe was used by five medical centers for 194 examinations. A large proportion of these patients were in the intensive care unit (43%), as well as mechanically ventilated (39%). Seventy percent (70%) of the subjects in this study were intubated nasally with the prototype probe, with a success rate of 88.5%. Oral intubation was successful in every case. Subject tolerance was good, and 25% of the patients were intubated for > 1 h. Nasal intubation with the probe was more likely in intensive care patients, ventilated subjects, and patients who were intubated for > 1 hour. TEE with this miniaturized probe is feasible and safe even in multi-instrumented critical care patients. This probe provides adequate diagnostic imaging capabilities and may allow imaging over prolonged periods of time, making it suitable for the serial monitoring of ventricular performance.

The use of direct regional intraarterial low dose fibrinolytic therapy was retrospectively studied in a group of 25 patients with acute lower limb ischemia. Bleeding problems were minimized due to careful monitoring of fibrinogen lev els. However two bleeding complications developed during lytic therapy on pa tients who had undergone recent surgical intervention. Following lysis a surgically correctable lesion was seen in one recently occluded conduit and in four late bypass occlusions. Eighty-three percent of the patients who had some lytic response required surgical intervention. The average time of fibrinolytic infusion was 46.7 hours.

Renal vein thrombosis in children can be a diagnostic and therapeutic dilemma for the clinician. Guided by information obtained by standard intravenous contrast studies as well as serial computerized body tomography, the correct diagnosis was made, and effective conservative management was carried out.

Twenty-five patients with ureteral obstruction caused by malignant or benign obstetrical or gynecological conditions were managed by nonoperative measures using indwelling ureteral stents. Bilateral obstruction was present in 15 patients. Immediate indications for stent placement were azotemia or uremia in 11, pain in 8, and preservation of function in 6. Four patients who failed endoscopie ureteral stent placement had successful percutaneous nephrostomy placement and one of these was converted to internal ureteral diversion through a percutaneous nephrostomy. Indwelling ureteral stents were generally well tolerated. Seven had to be replaced from 4 to 12 weeks after placement because of occlusions of the catheters by debris. The length of stent placement ranged from 1 month to 21 months. Three different types of commercially available stents were used (Gibbons, Cook double pigtail, Finney double J). Local anesthesia was utilized in the majority of cases. Protection and improvement in renal function has allowed radiotherapy and longterm chemotherapy to progress in several patients with Stage IV carcinoma of the cervix. Three are in complete remission and have had successful removal of the ureteral stents. Several other patients have been able to return to normal homemaking for significant periods of time.

• In good-risk patients, abdominal aortic aneurysmectomy can be accomplished with a mortality of 2% to 5%. However, in poor-risk patients, ie, those with severe reduction of cardiac, respiratory, and/or renal function, the mortality of this procedure has been reported to be as high as 60%. Fifteen poor-risk patients with abdominal aortic aneurysms have been treated with acute, induced thrombosis and simultaneous axillobilateral femoral bypass. Each patient had preoperative ultrasound and radionucleide flow studies and the runoff from the aneurysm was determined angiographically. Thrombosis, induced by interruption of the iliac outflow vessels, occurred in 12 patients within 72 hours. Flow persisted in three patients, and thrombosis was induced by transaxiliary catheter deposition of bucrylate in the residual outflow vessels. There were two operative deaths (less than 30 days), both due to myocardial infarctions, and four late deaths, three of which were caused by the problems that initially contraindicated direct graft replacement of the aneurysm. Preliminary experience with this approach indicates that this is a simple and potentially effective method of treatment of abdominal aortic aneurysm where direct graft replacement is contraindicated. ( Arch Surg 114:1402-1408, 1979)