This case report describes the different presentations of three women with bulimia nervosa, all of whom demonstrated purging behaviour. Two of the patients also had hypokalaemia, whereas the third exhibited Russell's sign--that is, calluses on the dorsum of each hand. Drug treatment and psychosocial intervention improved the condition of all three patients. The report emphasises the need for both health care professionals and the public to recognise this potentially dangerous but treatable disorder.

We report on nine patients with multiple sclerosis who had received interferon beta-1a treatment for 6 months or more. Seven patients were Chinese and two were Caucasian. Seven patients had the relapsing-remitting type of multiple sclerosis, one had the primary-progressive type, and one had the progressive-relapsing type. Among the six compliant patients with the relapsing-remitting type of disease, four had less frequent relapses after treatment. This study could not show whether or not the use of interferon beta-1a was beneficial to non-compliant patients, or patients with other types of multiple sclerosis.

We report on a 52-year-old woman who presented with polycystic disease. Both of her kidneys had been removed and she had undergone one failed kidney transplantation. She had severe symptoms from the polycystic liver. The diseased liver and kidney were both treated successfully by performing a combined liver and kidney transplantation.

We report on two cases of pneumococcal infection caused by strains demonstrating high-level cefotaxime resistance (minimal inhibitory concentration, 4 microg/mL). One patient had acute community-acquired meningitis with bacteraemia and the other had bacteraemia probably as a result of nosocomial pneumonia. Both patients died despite treatment with third generation cephalosporins. This is the first report from Hong Kong of infection with Streptococcus pneumoniae with high-level cefotaxime resistance that resulted in death. The emergence of high-level resistance to third-generation cephalosporins will result in treatment failure when these agents or penicillin are used alone, especially in cases of severe infection, such as meningitis, in which drug penetration of the blood-brain barrier is critical. The treatment of severe infections due to these isolates is problematic. Indiscriminate use of life-saving third-generation cephalosporins as out-patient treatment of minor infections or as first-line therapy for uncomplicated community-acquired infections in the hospital and in the community should be discouraged.

Vertebral artery dissection used to be an uncommon diagnosis but it is now being diagnosed more frequently owing to the use of magnetic resonance imaging. We report on three patients with vertebral artery dissection to illustrate the importance of establishing this diagnosis by using magnetic resonance imaging in patients who present with cerebrovascular accident that involves the posterior territory. Treatment with heparin can help prevent recurrent embolic events and should be given in the absence of subarachnoid haemorrhage or other contra-indications.