In the past four years, we have encountered three patients in whom malaria parasites were found incidentally in their blood when they were receiving corticosteroid therapy. Although there is little direct evidence that corticosteroid therapy can activate human malaria, animal studies have successfully demonstrated the recrudescence effect of immunosuppression on malaria infection.

We herein report a case of adenocarcinoma of the right main bronchus disseminated to the pons, left cerebal peduncle, and liver. Computed tomography-guided Cosman-Robert-Wells stereotactic aspiration of the cystic pontine lesion was performed through a transoccipital, transtentorial route and a catheter inserted in the cyst cavity that was connected to a subgaleal Ommaya reservoir for further aspiration and decompression. The choice of this approach to the lesion is briefly discussed.

Recurrent hypersomnia is an uncommon clinical problem that can be misdiagnosed and mistreated. I report a case of idiopathic recurrent hypersomnia. The clinical features, differential diagnoses, polysomnographic findings, possible aetiologies, and treatment are discussed.

Endoscopic sclerotherapy is a standard procedure for the treatment of oesphageal varices. It is generally regarded as a safe procedure with low morbidity and mortality. However, there are a number of rare and fatal complications associated with this procedure. We report a case of pericardial effusion developing after oesophageal sclerotherapy. The patient developed cardiac tamponade requiring pericardiocebtesis. This complication is uncommon, but its true incidence may be underestimated. When pericardial effusion is diagnosed early, this potentially fatal complication can be treated without serious sequelae.

Bullectomy has been shown to be an effective treatment of severe compressive bullous emphysema. However, persistent air leak is a common complication from this procedure. We report a case of a 48-year-old man with severe bilateral bullous emphysema and disabling dyspnoea treated by bilateral staple resection with bovine pericardial buttress through the median sternotomy approach. Despite a post-operative need for ventilatory support, air leak was not a problem and the patient was able to have both chest drains removed shortly after extubation. The patient had a pre-operative forced expiratory volume in 1 second of 0.5 L/sec, forced vital capacity of 1.25 L and peak expiratory flow rate of 100 L/min. These parameters were increased to 1.4 L/sec (180% increase), 1.9 L (52% increase) and 270 L/min (170% increase), respectively, one month later, in association with a marked clinical improvement. We conclude that bilateral bullectomy in carefully selected patients is useful and bovine pericardium buttress is probably helpful in achieving pneumostasis.