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HISTORY AND ADMISSION FINDINGS A 34-year-old man with chronic inflammation of both tear glands for 10 years was admitted because of severe upper abdominal pain and jaundice. INVESTIGATIONS Transaminase and cholestasis parameters were raised, as were gamma-globulins on electrophoresis. Ultrasound revealed an echo-poor diffusely enlarged pancreas with hypervascularity on colour-Doppler. Endoscopic retrograde cholangiopancreatography (ERCP) indicated chronically changed pancreatic ducts of varying diameter and stenosis, as well as a filiform distal stenosis of the common bile duct. A pancreatic biopsy showed chronic sclerosing pancreatitis with broad periductal lymphocytic infiltration. TREATMENT AND COURSE ERCP and a guide-wire papillotomy were performed, followed by placement of a nasobiliary catheter. All findings markedly improved on oral prednisone. CONCLUSION This case supports the supposition that in idiopathic chronic pancreatitis autoimmune processes may be responsible for the changes in the pancreatic ducts. Immunosuppressive treatment is thus recommended in these cases.

AIM Between cytology of pleural effusion and thorascopy there is a gap for another non invasive biopsy method to diagnose pleural diseases, especially since Adam's and Ramel's blind pleural biopsy is uncommon. Therefore it is suggestive to test feasibility and usefulness of pleural forceps biopsy. METHOD It is possible to take biopsies under ultrasound guidance with the help of a biopsy-forceps from the diaphragmatic pleura or pleural appositions through a 2.5 mm canula with a stop cock and a rubber vent. The specimen can be used for histological or immunohistochemical examinations. The procedure is coducted in a closed system to avoid pneumothorax. The puncture was done in 12 patients with a puncturable pleural effusion. RESULTS In 11 of 12 patients it was possible to get the final diagnosis. In one of three cases of mesotheliomas a rebiopsy was necessary. In 9 cases a malign tumor was diagnosed, effusion cytology was negative in 4 of 7 tumors. In 5 patients with a history of a former tumor pleural carcinosis was related three times correctly to the former cancer and twice to a secondary cancer. In one case a fibrous plaque was found. There were two patients with pleuritis, in one case a pulmonary tuberculosis was found 8 weeks later. In one patient with a mesothelioma inoculated metastasis were present in the sites of the punctures. In all pleural forceps punctures we got enough biopsy material for histological and immunohistochemical diagnosis. CONCLUSION The ultrasound guided forceps biopsy of the pleura is a very promising less invasive method to diagnose pleural tumors. Additional improvements of the equipment are possible. Definitive evaluation of the procedure especially in infectious pleural diseases requires a higher number of cases.

Pertussis, also known as whooping cough, is a classical childhood disease. After a vaccine became available, the number of notified cases fell dramatically (1), leading to the removal of pertussis from the list of notifiable diseases in West Germany in 1963. In many industrialized nations, however, the number of pertussis notifications has increased substantially in recent years, especially among school-age children, adolescents, and adults – a trend that has also been observed in former East Germany (2). In the present study, we performed a systematic search of clinically relevant international literature and reviewed national and international recommendations for treatment and vaccination (box 1). Box 1 Search Strategy Data sources: PubMed, Cochrane Database, Robert Koch Institute databases, vaccination and treatment recommendations in Germany and the US Publication dates: 1998-2008 Search terms: "pertussis" and "disease," "clinical," "complication," "hospitalisation," "death," "reinfection," "epidemiology," "newborn," "infant," "children," "adolescents," "adults," "culture," "PCR," "serology," "vaccination," "acellular," "cost" Filter: The clinical relevance of the identified publications was evaluated based on their abstracts. Relevant review articles are cited whenever possible.