Baclofen is a skeletal muscle relaxant used for the relief of chronic severe spasticity resulting from disorders such as multiple sclerosis or traumatic injury to the spinal cord. We report convulsions in a 7 day old girl who had been exposed to baclofen during intrauterine life. A paraplegic mother had been taking baclofen 20 mg four times daily (Lioresal, Novartis, Surrey), oxybutanin 3 mg three times daily, and trimethoprim 100 mg daily, which she continued throughout her pregnancy. The pregnancy was uneventful, but the baby was delivered by ventouse extraction owing to fetal tachycardia. The Apgar score was 10 at one and five minutes (cord pH: arterial 7.33, venous 7.3).Seven days later the baby was admitted with generalised convulsions. In retrospect the mother had noticed abnormal movements from the second day after birth. Investigations included a full septic screen for bacteriology and virology; a full blood count; serum electrolytes; liver function tests; a metabolic screen of blood, urine, and cerebrospinal fluid; urine for toxicology; and cranial ultrasonography. All gave negative results. The convulsions did not respond to phenobarbitone, phenytoin, clonazepam, lignocaine, or pyridoxine, which were tried according to our hospital's guidelines for the management of neonatal seizures. The baby received broad spectrum antibiotics until the cultures gave negative results. Electroencephalography on day 11 showed prolonged episodes of epileptic activity.We thought that the convulsions could be due to withdrawal of baclofen. Baclofen, 1 mg/kg daily in four divided doses, was started. Thirty minutes after the first dose the convulsions stopped. Baclofen was withdrawn slowly over the next two weeks. Magnetic resonance imaging of the brain on day 17 suggested a short hypoxic ischaemic insult during the perinatal period.Because the baby was in good condition at birth and because the convulsions were controlled within 30 minutes of starting baclofen, we concluded that the convulsions had been caused by its withdrawal. The change shown by the magnetic resonance image may have been secondary to the convulsions.In adults the half life of baclofen is 2-6 hours (mean 3.5 hours). A previous report of baclofen overdose showed a secondary increase in baclofen concentrations into the therapeutic range after an initial decrease, probably due to its slow release from the central nervous system and lipid stores.5 This may explain the delay in presentation of our patient.Convulsions after withdrawal of baclofen are well reported in adults.

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Parasitic leiomyoma (PL) is an extremely rare variant of uterine leiomyomas that occurs outside of the uterus and can often present like intra-abdominal tumors. The aim of this study is to report a case of PL and compare it with current literature. We present a rare case of a 45-year-old female who presented with bloating and spasmodic abdominal cramps for a two-month duration. She had a previous laparoscopic myomectomy six years ago. Transvaginal ultrasound (TVUS) showed solid vascular masses in the pelvis, the largest being 6 cm. Computed tomography (CT) of the thorax, abdomen, and pelvis (CTTAP) revealed further peritoneal masses in the left paracolic gutter suggesting peritoneal distant metastasis. Laparoscopy was completed, and biopsy and histopathological examination confirmed the diagnosis of parasitic leiomyoma. The patient opted for a bilateral salpingo-oophorectomy (BSO) creating iatrogenic menopause. One-year follow-up CT showed a reduction in the size of fibroids. PL can present with vague symptoms, typically nonspecific abdominal pain and cramping. It can often be confused with intra-abdominal tumors. It should be suspected in patients with previous uterine procedures. Histopathological examination is crucial for diagnostic and surgical management.

Intestinal obstruction during pregnancy is rare. I present a case in which a woman of 37 years 18 th weeks of twin gestation presented with 4 days intermittent abdominal pain with constipation. She was initially admitted for pain relief and treatment for her constipation and nausea. The patient was reviewed and discharged as she felt her symptoms had improved after passing flatus. She was readmitted a day later with severe cramping abdominal pains, feeling unwell, vomiting, sweaty and unable to pass flatus. The patient's symptoms worsened, and eventually she was diagnosed as caecal volvulus and laparotomy was done. A right hemicolectomy with primary anastomosis was performed. Her ongoing antenatal care was unremarkable. She had a vaginal delivery for the 1 st twin, followed by an emergency caesarean section for the 2 nd twin due to a transverse lie with a cord prolapse.

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