Bullectomy has been shown to be an effective treatment of severe compressive bullous emphysema. However, persistent air leak is a common complication from this procedure. We report a case of a 48-year-old man with severe bilateral bullous emphysema and disabling dyspnoea treated by bilateral staple resection with bovine pericardial buttress through the median sternotomy approach. Despite a post-operative need for ventilatory support, air leak was not a problem and the patient was able to have both chest drains removed shortly after extubation. The patient had a pre-operative forced expiratory volume in 1 second of 0.5 L/sec, forced vital capacity of 1.25 L and peak expiratory flow rate of 100 L/min. These parameters were increased to 1.4 L/sec (180% increase), 1.9 L (52% increase) and 270 L/min (170% increase), respectively, one month later, in association with a marked clinical improvement. We conclude that bilateral bullectomy in carefully selected patients is useful and bovine pericardium buttress is probably helpful in achieving pneumostasis.

Over the past two years, three Hong Kong Chinese individuals have presented to the Social Hygiene Service (Department of Health, Hong Kong) with granuloma-like nodules on their lower extremities. Histopathological examination of the lesions revealed that they were Kaposi's sarcoma, two of which were initially misdiagnosed as pyogenic granuloma. All three patients originated from southern China and had previously been in good health, with no evidence of immunosuppression. All ELISA tests for human immunodeficiency virus antibodies were negative. The course of the disease has been favourable. The lesions in the first patient regressed with radiotherapy. Complete surgical excision of the lesion in the second patient was not followed by recurrence. In the third patient, the lesions were static and did not require active intervention. Awareness of the existence of Kaposi's sarcoma among non-risk groups allows for their prompt recognition.

This case report describes a man with C1-C2 cervical myelopathy due to an os odontoideum. Over a span of 30 years, the patient developed weakness of his left lower limb, which gradually spread to all four limbs. The diagnosis was not made for three decades despite several medical consultations, a myelogram, and a computed tomography scan of the brain. This case illustrates that neurological disease due to spinal chord compression can have a long history, and demonstrates how advances in magnetic resonance neuroimaging contribute to a definite and accurate diagnosis.

The development of intracranial tuberculoma during treatment for tuberculosis have been described previously. A decrease in steroid therapy was thought to be responsible. We report a 30-year-old woman with tuberculous meningitis who developed brainstem tuberculoma while being treated with corticosteroids and anti-tuberculous therapy.

A 36-year-old man with a chronic hepatitis C infection developed hyperthyroidism from a previously normal thyroid status. Laboratory tests showed both elevated serum thyroxine and anti-thyroid antibody titres. The patient's hyperthyroidism was brought into remission by the administration of anti-thyroid medication. Graves' disease is a possible autoimmune manifestation of chronic hepatitis C not associated with interferon therapy. The mechanism may be due to antigen mimicry, epitope modification, or T-cell activation by the hepatitis C virus. New treatment modalities may be more effective than interferon therapy for chronic hepatitis C patients with thyroid disorders.