Systemic lupus erythematosus is a multi-system inflammatory disease. The clinical manifestations are diverse. Hepatic manifestation is a rarely seen complication of systemic lupus erythematosus. We report a case of complication of systemic lupus erythematosus presenting as cholestatic hepatitis in a 56-year-old Chinese woman. The cholestatic hepatitis progressed as part of the lupus activity and responded to steroid therapy

Colonic leiomyoma is a rare condition. Smooth muscle tumours arising from the colon constitute only 3% of gastrointestinal leiomyomas. Complete endoscopic removal of the tumour is a problem because it is often submucosal in origin. We report a patient with a 5 mm leiomyoma of the colon that was successfully removed by conventional colonoscopic snare electrocauterisation, without complications.

From August 1994 to September 1995, 12 silastic medialization procedures were performed for the treatment of vocal fold palsy. The causes included tuberculous fibrosis, carcinoma of the bronchus, post-oesophagectomy for carcinoma of the oesophagus and idiopathy. Early operation was performed in cases due to malignant conditions to relieve symptoms. In those with benign conditions, operation was performed if conservative treatment failed to control the symptoms in six months. The efficacy of silastic medialization for the treatment of dysphonia was evaluated by both subjective and objective voice assessment. The results indicate that the procedure is effective in the relief of dysphonia in unilateral vocal fold palsy. Only one patient in the study required a revision operation due to unsatisfactory voice quality. The procedure has the advantages of being tunable, reversible, and suitable for old and debilitated patients. The long term benefits of the procedure require further study.

The incidence of complications associated with cerebrospinal fluid shunt procedures varies from low to high in different series and depending on the duration of follow up. We report an unusual case of four-month-old male infant with hydrocephalus who developed bilateral hydroceles soon after ventriculoperitioneal shunting. The possible aetiology is hypothesised and suggestions are made as to how this may be avoided in other infants undergoing shunt procedures.

A 33-year-old woman presented with jaundice, tiredness, nausea, and vomiting of three days' duration after taking two glasses of gin and tonic together with 13 tablets of 500 mg paracetamol. Blood investigation results inferred a toxic hepatitis due to paracetamol overdose. She made an uneventful recovery. The case illustrates that if paracetamol is taken together with alcohol, even a relatively small dose of paracetamol can cause liver damage. Current studies of paracetamol poisoning are also discussed.