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Summary This is a retrospective review of the results at our institution of using multi‐detector CT angiography (CTA) to localise lower gastrointestinal (GI) bleeding. We hypothesised that in our patient population: (i) CTA was unlikely to demonstrate bleeding in patients who were haemodynamically stable; (ii) in haemodynamically unstable patients in whom CTA was undertaken, the results could be used to select patients who would benefit from catheter angiography; and (iii) in haemodynamically unstable patients in whom CTA was undertaken, a subgroup of patients could be identified who would benefit from primary surgical treatment, avoiding invasive angiography completely. A retrospective review was conducted of the clinical records of all patients undergoing CTA for lower GI haemorrhage at our institution between 1 January 2005 and 30 June 2007. Out of the 20 patients examined, 10 had positive CTAs demonstrating the bleeding site. Nine were haemodynamically unstable at the time of the study. Four patients with positive CT angiograms were able to be treated directly with surgery and avoided invasive angiography. Ten patients had negative CTAs. Four of these were haemodynamically unstable, six haemodynamically stable. Only one required intervention to secure haemostasis, the rest stopped spontaneously. No haemodynamically stable patient who had a negative CTA required intervention. CTA is a useful non‐invasive technique for localising the site of lower GI bleeding. In our patient population, in the absence of haemodynamic instability, the diagnostic yield of CTA was low and bleeding was likely to stop spontaneously. In haemodynamically unstable patients, a positive CTA allowed patients to be triaged to surgery or angiography, whereas there was a strong association between a negative CTA and spontaneous cessation of bleeding.

Actinic Prurigo (AP), an uncommon idiopathic photodermatosis, presents a distinct clinical picture and can be severely debilitating. The clinical features, investigation and treatment of AP are reviewed. We report the experience of an Australian photobiology unit with this condition.

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Central venous catheters that have been in place for a long time can become fixed to the vein wall, making them impossible to pull out. Leaving them in situ is undesirable because of the risk that they could act as a nidus for thrombosis. Moreover, inserting new catheters alongside the old ones might compromise flow in the superior vena cava, further predisposing to thrombosis. Surgical removal is likewise undesirable, as this would necessitate thoracotomy with the attendant risks. We describe a novel technique, which we were able to use to remove retained long-term hemodialysis catheters in a patient who needed new catheters and who would have been a high-risk candidate for surgery. The right internal jugular vein was punctured adjacent to the site of insertion and a guide wire was used to form a snare, which was passed around the catheters and used to saw through the fibrous attachments to the vein wall. The midsection of one catheter could not be freed but the snare was used to cut off the proximal and distal ends, which could then be removed, the latter via the femoral vein. New catheters were then inserted via the left internal jugular vein. This technique enabled successful catheter extraction and replacement in a patient who would have been a poor candidate for cardiothoracic surgery.

Objectives: To evaluate conservative management of fetal and neonatal ovarian cysts. Methods: We followed the progress of 11 fetal and 2 neonatal ovarian cysts. Results: Ten fetal cysts were simple at recognition, but 8 silently became complex by birth, with ovarian loss in 6/11 cases (54%). In 2 cases where large simple cysts presented for the first time at birth, serious complications occurred, resulting in the death of 1 newborn. Conclusions: If a fetal ovarian cyst is already complex before birth it can be managed conservatively, albeit with loss of the ipsilateral ovary in the majority of cases. As simple fetal ovarian cysts frequently become complex before birth, intervention may be justifiable to preserve the ovary. But any intervention also has the potential for complications, and may be ineffective. Intervention also requires accurate differentiation of ovarian cysts from other abdominal cysts.

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