We report on a 14-year-old girl who presented with a 2-year history of simple and complex partial seizures with secondary generalisation. Monotherapy using carbamazepine and combination therapy using carbamazepine and gabapentin had been tried within the 2 years before presentation. Seizure control, however, was poor. Magnetic resonance imaging showed structural abnormalities over the right occipital and temporal lobes. Continuous scalp video electroencephalography was performed over 4 days, during which six clinical seizures were associated with electroencephalography changes at the right occipital and temporal lobes. Invasive intracranial video electroencephalography identified a focus at the right occipital lobe, a focus at the right temporal lobe that spread rapidly to the right parietal lobe, and an irritative zone over the posterior part of the right frontal lobe. Functional mapping delineated the motor and sensory cortices. Right temporal lobectomy, right occipitoparietal cortical excision, and multiple subpial transections of the posterior part of the right frontal lobe were performed. For 16 months after the surgery, the patient has been seizure-free while receiving drug treatment, and the only complication reported has been a segmental loss of the left visual field.

We report on a newborn boy, who was delivered at 26 weeks' gestation by emergency caesarean section because of a prolapsed cord and breech presentation. Grade IV hyaline membrane disease subsequently developed, for which a surfactant was given. On day 8, there were frequent apnoeic attacks, and on day 30, marked irritability developed, as did intermittent stiffening of all four limbs. The anterior fontanelle was bulging and tense, and the cerebrospinal fluid was found to be turbid. Gram staining of the cerebrospinal fluid and blood revealed Gram-positive bacilli. Subsequent culturing yielded Bacillus cereus, which was sensitive to amikacin and vancomycin. Severe cerebral oedema developed, however, and computed tomography of the brain showed bright cortical sulci, suggestive of meningitis. The baby died on day 37, and post-mortem histological examination of the brain showed extensive liquefactive necrosis with abundant neutrophilic infiltration. Since infection with Bacillus cereus is rapidly fatal, early recognition of infection by this organism is important.

We report on an abdominal pregnancy that presented as a missed abortion at 16 weeks' gestation and review the literature on the management of abdominal pregnancy. The clinical presentation of abdominal pregnancy varies, and the diagnosis depends on a high index of suspicion. Ultrasonography is useful for early diagnosis of the condition. The management depends on the gestation at presentation; for advanced abdominal pregnancy, surgical intervention is recommended. The treatment of the placenta is a matter of controversy. In general, expectant management is suggested. When the placenta is left behind, the use of prophylactic methrotrexate is not advocated. An awareness of abdominal pregnancy is very important for reducing associated morbidity and mortality.

Malignant phaeochromocytoma is defined as the presence of tumour deposits at sites that are normally devoid of chromaffin cells. We report on a 63-year-old man who had a giant malignant phaeochromocytoma of the right adrenal gland that encased the inferior vena cava. The urinary excretion rates of catecholamines and their metabolites were normal, except for normetanephrine, which was excreted at a higher rate than normal. The tumour was surgically unresectable by laparotomy. Postoperatively, the patient was given a 4-month trial of subcutaneous octreotide and intravenous meta-iodobenzylguanidine I 131. Occult lung secondary tumours were first detected by meta-iodobenzylguanidine scintigraphy after 2 years, and the patient died of bone and lung metastases 1 year later. Because phaeochromocytoma is rare, local experience in managing this disease is limited. This report alerts physicians of the methods of diagnosing and managing surgically unresectable malignant phaeochromocytoma.

Long and pointed foreign objects in the stomach are difficult to remove by endoscopy, and they can cause complications such as perforation and impaction. The endoscopic removal of long and pointed objects involves the following principles: (1) presenting the blunt end cephalad to prevent perforation or impaction during extraction; (2) orienting the long axis of the object in the line of extraction; and (3) applying traction to the foreign body without losing grip. Currently practised methods of extraction, which use a protector hood or an overtube, do not address these three principles. We report on a case in which an ingested metal dinner fork was removed from the stomach by using a double wire-loop snare technique. This method uses two snares to hold the object and allows the endoscopist to change the presentation, orient the axis, and maintain traction to allow the safe removal of long and pointed objects.