Splenic injury following colonoscopy is rare but can be fatal and easily overlooked. A case of colonoscopic splenic injury is presented to highlight its potentially fatal complication. The risk factors, underlying mechanism, possible measures of prevention, diagnosis, and treatment are also discussed.

Spontaneous regression of some tumours is known to occur. We report here on a patient who developed lung and scalp metastases from renal cell carcinoma approximately 1 year after undergoing a radical nephrectomy. The lung metastasis was documented by computed tomography and histological examination. A spontaneous complete regression of the lung and scalp metastases occurred. Shortly after, however, a brain metastasis developed in the absence of any radiographic evidence of recurrence in the primary site or the lung.

Necrotising fasciitis is an uncommon soft tissue infection characterised by the widespread necrosis of subcutaneous tissue and fascia, and secondary necrosis of the overlying skin. Ten patients who had necrotising fasciitis were admitted to the intensive care unit of the Prince of Wales Hospital between June 1994 and August 1997. The necrosis in six patients was caused by marine Vibrionaceae. Because of the rapid onset of necrosis, progression to severe disease, and frequently fatal outcome, the public (especially at-risk individuals), general practitioners, and specialist medical personnel should be made aware of the clinical syndrome of necrotising fasciitis caused by marine Vibrionaceae. The diagnosis is dependent on a high index of suspicion, which should be aroused by the presentation of an immunocompromised patient with an extremity lesion and a history of contact with raw seafood or a warm aquatic environment. Once the disease is suspected, treatment should be a course of a third generation cephalosporin, and fluoroquinolone or tetracycline. Aggressive surgical debridement is recommended.

Cytomegalic inclusion disease is a common complication in recipients of organ transplants. In renal transplant recipients, the disease involves the lungs more often than it does the gastrointestinal tract. We report on a recipient of a cadaveric kidney who had cytomegalic inclusion disease that involved both the upper and lower gastro-intestinal tract, and massive gastro-intestinal bleeding that was caused by a large colonic ulcer. Despite treatment with ganciclovir and cytomegalovirus-specific immunoglobulin, the patient died from subsequent complications.

Extensive tissue loss in a weight-bearing area of the foot almost invariably heralds limb loss. We report on a 74-year-old man with diabetes mellitus who had an ischaemic foot that was affected by prolonged pressure, which resulted in a necrotic heel. After two sessions of debridement, the calcaneum became exposed. Amputation was initially suggested but was refused by the patient. The foot was subsequently salvaged by staged operations. The first operation was a femoro-anterior tibial bypass using an autogenous saphenous vein to revascularise the foot. This was followed by debridement and attachment of a free subscapular flap to cover the defect 2 weeks later by a plastic surgeon. After 85 days of rehabilitation by physiotherapy and education of foot care by a podiatrist, the patient was discharged home and was able to walk with a walking-stick. This multidisciplinary approach avoided an almost certain below-knee amputation.