We report on a healthy 34-year-old woman who received an elective myomectomy for uterine fibroid, and postoperatively developed fatal streptococcal toxic shock-like syndrome. We discuss the series of events that led to this life-threatening disease and its pathophysiology, and suggest areas in which management might have been improved.

Hereditary angioedema is characterised by recurrent episodes of peri-orbital and peri-oral swelling which can cause an upper airway obstruction, abdominal pain, vomiting, diarrhoea, and even hypotensive collapse. This potentially fatal condition is frequently misdiagnosed; its early recognition and appropriate treatment are thus important. We report a familial cluster of hereditary angioedema in a Chinese family and describe the clinical course of two patients.

Systemic lupus erythematosus is a multi-system inflammatory disease. The clinical manifestations are diverse. Hepatic manifestation is a rarely seen complication of systemic lupus erythematosus. We report a case of complication of systemic lupus erythematosus presenting as cholestatic hepatitis in a 56-year-old Chinese woman. The cholestatic hepatitis progressed as part of the lupus activity and responded to steroid therapy

Colonic leiomyoma is a rare condition. Smooth muscle tumours arising from the colon constitute only 3% of gastrointestinal leiomyomas. Complete endoscopic removal of the tumour is a problem because it is often submucosal in origin. We report a patient with a 5 mm leiomyoma of the colon that was successfully removed by conventional colonoscopic snare electrocauterisation, without complications.

From August 1994 to September 1995, 12 silastic medialization procedures were performed for the treatment of vocal fold palsy. The causes included tuberculous fibrosis, carcinoma of the bronchus, post-oesophagectomy for carcinoma of the oesophagus and idiopathy. Early operation was performed in cases due to malignant conditions to relieve symptoms. In those with benign conditions, operation was performed if conservative treatment failed to control the symptoms in six months. The efficacy of silastic medialization for the treatment of dysphonia was evaluated by both subjective and objective voice assessment. The results indicate that the procedure is effective in the relief of dysphonia in unilateral vocal fold palsy. Only one patient in the study required a revision operation due to unsatisfactory voice quality. The procedure has the advantages of being tunable, reversible, and suitable for old and debilitated patients. The long term benefits of the procedure require further study.