A 75-year-old man developed an incisional hernia over the upper abdomen following a wedge resection of a gastric stromal tumour in 1996. This is the first published report of a successful repair of an incisional hernia via a laparoscopic intraperitoneal on-lay technique using GORE-TEX DualMesh material in Hong Kong. Compared with conventional open repair of incisional hernia, long incisions and wound tension are avoided using the laparoscopic approach. This translates into a reduced risk of wound-related complications and facilitates recovery. In selected cases, minimally invasive surgery is a safe technique for the repair of incisional hernias.

Two cases of subclinical and undiagnosed thyrotoxicosis that presented with unexplained tachycardia during surgery are described. Differential diagnosis and logistics in the management of patients presenting with tachycardia, with or without fever during anaesthesia are discussed. It is emphasised that when encountering unexplained tachycardia during anaesthesia, thyrotoxicosis must be suspected. Investigations for thyrotoxicosis must be carried out in the postoperative period.

Septic metastatic endophthalmitis is a rare but serious disease. Endophthalmitis arising from Klebsiella pneumoniae liver abscess has been reported with diabetes mellitus as a major associated condition, but is rarely seen in patients without diabetes. A non-diabetic patient with liver abscess complained of right eye discomfort and floaters 3 days after admission. Both blood and liver aspirate cultured Klebsiella pneumoniae . The patient was treated initially with systemic and subconjunctival antibiotics followed by intravitreal antibiotics with successful visual salvation. Previous reports from the literature showed poor visual outcome despite treatment and delayed recognition was often the cause. Clinicians should be alert to endophthalmitis whenever a patient with Klebsiella pneumoniae liver abscess complains of ocular symptoms. Urgent ophthalmological assessment should be sought.

A 34-year-old Chinese woman who had lived in the United Kingdom in the 1980s was admitted to hospital in Hong Kong because of a 7-month history of progressive neurological deterioration. Initially, she complained of heartburn and paraesthesia of the hands and feet. She then developed slowness of speech and gait, and was noted to be forgetful and irritable. In January 2001, she was brought back to Hong Kong for treatment. On admission in May she was dysarthric, ataxic, and dystonic. Magnetic resonance imaging showed high signals in both thalami suggestive of variant Creutzfeldt-Jakob disease. Other investigations, including electroencephalogram and lumbar puncture, were unremarkable. A tonsil biopsy showed the presence of prions. This patientÕs presentation is typical of the variant Creutzfeldt-Jakob disease cases that have been reported since 1996. Because of her residential history, we conclude that this is an imported case from the United Kingdom.

Primary human immunodeficiency virus infection is a distinct medical syndrome which is often not diagnosed. The importance of its early recognition lies in the potential for early therapeutic intervention for the individual, with consequent public health benefits for the community at large. Diagnosis requires a high index of suspicion in a person with a history of potential exposure. Early treatment with combination antiretroviral therapy should be considered once the diagnosis has been established. We report a local case of primary human immunodeficiency virus infection in a patient who presented initially with fever, lymphadenopathy, generalised skin rash, dry cough, splenomegaly, and aseptic meningitis.