An 88-year-old woman with an undiagnosed chronic subdural haematoma underwent emergency repair of a femora hernia under spinal anaesthesia. The patient complained of headache postoperatively, and a subsequent computed tomography brain scan showed an acute-on-chronic subdural haematoma, with midline shift and impending coning. The patient recovered completely after surgical decompression. The difficulty in diagnosing chronic subdural haematoma in the elderly patient with no history of trauma is discussed, along with the differential diagnosis of headache following spinal anaesthetic in this age-group.

A 36-year-old Chinese man presented to the Queen Mary Hospital in August 1999 with a 2-week history of jaundice due to propylthiouracil treatment for thyrotoxicosis. He had previously received carbimazole but had developed an urticarial skin rash after 2 weeks of treatment. The patient developed liver failure and fulminant pneumonitis shortly after hospital admission. Despite receiving treatment with broad-spectrum antibiotics and intravenous immunoglobulin, he died 11 days after the onset of the respiratory symptoms. Postmortem examination using electron microscopy showed typical glycogen bodies within the cytoplasm of the hepatocytes, which corresponded to eosinophilic cytoplasmic inclusion bodies visible under light microscopy. Immunohistochemical studies of the inclusion bodies were positive for carcinoembryonic antigen and albumin, and negative for fibrinogen, complement protein C3, immunoglobulins G, M, and A, alpha-fetoprotein, and alpha-1-antitrypsin. This is the first report of a patient who received two sequential antithyroid drugs and developed predominate cholestasis with unique histological features. Extreme caution should be taken when a patient develops allergy to one type of antithyroid drug, because cross reactivity may develop to the other type.

Sialocele is an uncommon complication of parotidectomy. Most cases resolve after conservative therapy consisting of repeated aspiration and pressure dressing. The condition is, however, occasionally resistant to such therapy. We report on a 52-year-old Chinese man who had a 10-year history of right parotid swelling. Following fine-needle aspiration cytology, Warthin’s tumour was diagnosed, but after elective parotidectomy, a swelling developed and parotid sialocele was diagnosed. Botulinum toxin type A was given after the sialocele had persisted for almost 3 weeks after surgery, and after conservative management had been tried; the sialocele disappeared after two doses of treatment. Botulinum toxin therapy was thus an effective method of treating persistent sialocele.

Phaeochromocytoma may present as acute abdomen. This report is of a patient with spontaneous rupture of phaeochromocytoma who presented with abdominal pain and a tender abdominal mass. Ruptured phaeochromocytoma is a rare surgical emergency, with only 30 cases reported in the literature. The classical clinical triad of signs is intense vasoconstriction, tachycardia, and labile blood pressure. Computed tomography scanning of

A complicated case of ipsilateral fractures of the left femur and tibia after a road traffic accident is reported. The patient presented with numbness of the first web of his left foot and contracture of the extensor hallucis longus muscle, with fixed length deformity after intramedullary nailing of the femur and tibia. The extensor digitorum longus and tibialis anterior muscles were spared. Tinel’s sign could be elicited at the mid-portion of the anterior compartment of the injured leg. This indicated that the distal half of the anterior tibial nerve (deep peroneal nerve), together with the extensor hallucis muscle of the anterior compartment of the leg, had been damaged. The subsequent management of this patient is described.