We report on an 80-year-old man who presented with non-hemispheric cerebrovascular symptoms in the form of daily multiple syncope. The left common carotid artery, its two main divisions, and the right vertebral artery were completely occluded. There was high-grade stenosis in the right carotid artery (82%) and left vertebral artery (60%). After excluding other causes of syncope such as postural hypotension, hypoglycaemia, cardiac arrhythymia, and epileptic seizure, a diagnosis of global ischaemia was made. The patient subsequently underwent carotid endarterectomy and the symptoms were relieved. This case represents an unusual indication for carotid endarterectomy.

We report on two patients with spastic quadriplegia and three patients with spastic diplegia who underwent selective posterior rhizotomy. The mean period of follow-up was 15 months (range, 12-21 months). The patients were assessed preoperatively and at 2 weeks, 3 months, 6 months, and 1 year after surgery. Tests included those for muscle tone (using a modified Ashworth scale), range of passive movement, functional status, and gait pattern. Muscle tone was reduced substantially after the procedure, and the range of passive movement was increased. Both the dependent and independent ambulators showed an increment in their walking velocity and stride length. There were no postoperative complications apart from mild fever and the treatment was well tolerated by both patients and parents. There was no return of spasticity in any of the patients during follow-up. The reduced spasticity resulted in better motor performance, and patients felt more comfortable with their daily activities. We conclude that selective posterior rhizotomy should be considered for those patients who have cerebral palsy and are disabled by spasticity.

Myopathy and neuropathy that have been induced by colchicine have been described only occasionally, although colchicine is a widely used drug. We describe a case of colchicine-induced myopathy and neuropathy in an 84-year-old woman who had renal impairment. Results from a muscle biopsy showed characteristic vacuolar myopathy and autophagic vacuoles. The cessation of medication resulted in a marked improvement of myopathy.

We report on a 71-year-old man who presented to the medical department of Our Lady of Maryknoll Hospital with progressive cholestatic hepatitis. Tests for hepatitis viral markers gave negative results and ultrasonography revealed no dilated bile ducts. Endoscopic retrograde cholangiopancreatography showed a normal biliary tree. The patient had completed a 5-month course of methimazole to treat thyrotoxicosis a few weeks before the onset of the jaundice. Methimazole was suspected to be the cause of the cholestatic hepatitis; this diagnosis was supported by the results from a liver biopsy. The presentation of the patient was unusual by virtue of the delayed onset and prolonged course of cholestasis.

Non-obstructive azoospermia used to be considered an untreatable cause of infertility. By the microinjection technique, however, sperm that has been surgically extracted from the testis can be injected into the oocyte cytoplasm. The injected eggs can be transferred to the uterus or fallopian tubes to initiate a pregnancy. A healthy baby boy conceived by using this method was delivered in November 1997. This micromanipulation technique offers couples in which the man has non-obstructive azoospermia the chance of having their own offspring. The methodology used and a brief discussion of its merits are presented.