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Imported leishmaniasis is rare in non-endemic countries such as the UK. Visceral leishmaniasis (VL) can be life-threatening and its recognition is imperative for successful clinical management. We present a case of VL in an 11-month-old infant several months after returning from a 1-week holiday trip to the South of Spain. The infant suffered from intermittent fever for 5 weeks, and hepatosplenomegaly and pancytopenia, and was successfully treated with a short course of liposomal amphotericin B. This case of VL is to highlight the possibility of transmission of unusual pathogens when travelling to the Mediterranean and therefore the importance of taking a detailed travel history. VL should be considered in the differential diagnosis in returning travellers presenting with prolonged fever, hepatosplenomegaly and/or pancytopenia.

A 41-year-old woman had a three-year history of multiple painful subcutaneous nodules on the head, neck, and trunk. The pain was present at rest and increased on palpation of the nodules and with activity. The patient described intermittent fever and swelling of the arms and legs. Examination disclosed subcutaneous nodules on the neck and trunk that were tender on palpation. A diagnostic procedure was performed.

Artemisinin is currently used for treating drug-resistant malaria. It is found in Artemisia annua and also in A. apiacea and A. lancea. Artemisia annua and A. apiacea were known to the Chinese in antiquity and, since they were easily confused with each other, both provided plant material for the herbal drug qing hao (blue-green hao). This article shows, however, that since at least the eleventh century Chinese scholars recognized the difference between the two species, and advocated the use of A. apiacea, rather than A. annua for 'treating lingering heat in joints and bones' and 'exhaustion due to heat/fevers'. The article furthermore provides a literal translation of the method of preparing qing hao for treating intermittent fever episodes, as advocated by the eminent physician Ge Hong in the fourth century CE. His recommendation was to soak the fresh plant in cold water, wring it out and ingest the expressed juice in its raw state. Both findings may have important practical implications for current traditional usage of the plant as an antimalarial: rather than using the dried leaves of A. annua in warm infusions, it suggests that fresh juice extraction from A. apiacea may improve efficacy.

Malaria still remains a leading cause of morbidity and mortality in humans despite intensive efforts from government and sanitary bodies to control malaria. Common presentations of malaria include intermittent fever with chills and rigors, jaundice, renal failure, myalgia etc. In endemic regions, malaria can present with unusual features due to development of immunity, indiscriminate use of antimalarial drugs and increasing resistance to antimalarial drugs. Post malaria neurological syndrome has been described in literature as a rare complication of malaria. To our knowledge, bilateral peroneal axonal neuropathy as a post malaria neurological syndrome is an undescribed entity. We report an unusual and a rare presentation of falciparum malaria.

A 26-year-old woman with end-stage renal disease from primary membranoproliferative glomerulonephritis presented with a two-week history of intermittent fever, with temperatures as high as 39°C. She had received her second cadaveric renal transplant 11 months previously.

Undifferentiated embryonal sarcoma (UES) of liver is a rare form of liver tumor in children. It may have an atypical presentation leading to delay in diagnosis. The authors report on 3 consecutive children with this condition, each of them presenting in older children who presented with this condition and an initial diagnostic dilemma. One of them presented initially with a solitary cyst, the second with severe abdominal pain, and the third with intermittent fever. Preoperative chemotherapy was successful in shrinking the tumors in 2 children to allow anatomic liver resection with tumor-free margin. Both remain free of recurrence 2 years after completing treatment.

Periodic fever with aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) is a periodic fever illness found across the world, and is as yet unexplained in its aetiology. This article reports on the diagnosis and management and comments on everyday practice. The incidence of PFAPA in children is documented increasingly, possibly due to misdiagnoses due to poor patient and clinician awareness, or confusion with recurrent tonsillitis justifying tonsillectomy. The diagnosis is important to consider, so that other cyclical fevers are not missed, and parents are offered appropriate counselling and a discussion of conservative, medical, or surgical treatment options.

We discuss a recently resettled African refugee child with acute schistosomiasis, who presented with fever, hepatosplenomegaly and marked eosinophilia. We outline the differential diagnoses of eosinophilia in the recently resettled refugee and returned traveller and outline the epidemiology and clinical spectrum of schistosomal infection, including controversies in management of acute schistosomiasis.

The diagnosis of carcinoid tumor of the appendix is rare; the involvement is often limited to the gastrointestinal tract. Extramural involvement of surrounding structures has been reported; however, direct involvement of the ureter has not been reported. We report a case of carcinoid tumor of appendix involving the ureter and causing obstruction. To our knowledge, this is the first case report of such presentation in available literature. A 23-year-old woman who presented with right loin pain and intermittent fever for 1 week duration and found to have gross hydroureteronephrosis on the right side due to a mass compressing the ureter.

Bochdalek hernia is a congenital diaphragmatic defect that allows abdominal viscera to herniate into the thorax. Intrathoracic kidney is a very rare finding representing less than 5% of all renal ectopias. A 20 year old female presented with complaints of dry cough since 15 days and intermittent fever of 4 days duration. As part of routine investigation chest X-ray was done which showed a left retro-cardiac homogenous opacity, rest of the lung field appeared normal. Abdominal ultrasound showed the right kidney to be normal, left kidney was not visualized. Computed tomography scan demonstrated left-sided Bochdalek hernia with the left kidney within the thorax. An IVP was done to confirm the diagnosis. Many a times intrathoracic kidney is confused with a thoracic mass and the patient undergoes a battery of unnecessary investigations, surgical interventions and image guided biopsies for the same, hence to avoid this we are reporting this case.

Presentation of Case A 37-year-old man was admitted to the hospital because of three weeks of intermittent fever and abdominal and back pain. The patient had been well until about seven months earlier, one month after he had begun a difficult trip by land from his native Peru to the United States. During his trip, which took four months, he ate fruit directly from trees, bathed in and drank water from rivers and other uncertain sources, passed through several tropical rain forests, and received numerous mosquito bites. In Guatemala, about 7 months before admission, he had a fever that lasted . . .

A 12-year-old girl, originally from Gambia, presented with 12 months’ history of pain in her left hip. She described a steady deterioration in mobility, intermittent fever and weight loss following a blunt trauma injury, which triggered the onset of pain. She required crutches to mobilise and had fixed flexion deformity of the left hip. There was atrophy of the left thigh and calf muscles. Swelling was seen over the left sacroiliac joint and she was tender over the left pelvic and inguinal regions. Imaging …

A woman aged 35 years presented with a 6-week history of worsening shortness of breath. She previously had TB in her early 20s, but had no other medical history of note. She had been referred several months earlier due to an abnormal chest X-ray suggestive of an interstitial lung disease but had not attended. She has previously been an intravenous drug user. The patient had intermittent fever and rigors, night sweats, diaphoresis and diarrhoea. At admission, she was cachectic and tachypnoeic, with clubbing and cervical …

A girl aged 4 years presented with a 1-month history of headache, malaise and episodes of unsteady gait. She appeared well with normal observations. She had limited neck extension and lateral rotation with normal neurological examination. A CT head showed no space-occupying lesion and the patient was discharged. She re-presented a week later with neck pain, stiffness and intermittent fever. There were no signs of upper airway obstruction and she continued to eat …

Sarcomatoid renal cell carcinoma (SRCC), an advanced and uncommon form of renal cell carcinoma (RCC), is more likely to manifest as a unilateral condition, especially in the right kidney, in older people. Here, we report a rare case of bilateral SRCC in a young female, aged 30 years - the youngest reported case of SRCC to the best of our knowledge. The patient complained of osphyalgia and intermittent fever which recurred after symptomatic treatment. Detailed examination, including histopathological analysis of biopsies, confirmed bilateral SRCC (RCC IV) with distant metastases. The patient denied receiving any form of the treatment, including surgery, radiotherapy, and chemotherapy and died approximately 6 months after the initial symptoms.

A 11-year-old girl presented to the clinic with intermittent fever, multiple erythematous maculopapular lesions (erythema multiforme (EM) like lesions) of targetoid appearance over face, trunk, and limbs (Fig. 1), and a large palatal ulcer (Fig. 2). She was tested positive for ANA by Hep-2 (speckled pattern) and for anti-Ro, anti-nucleosome, anti-histone, and anti-dsDNA antibodies by immunoblot. She had reduced complement levels (C3, C4) and tested negative for rheumatoid factor and viral markers. Further evaluation has concluded that the patient met the diagnostic criteria for Rowell’s syndrome.

The study presented a case of esophageal cancer presenting as intermittent fever with markedly elevated serum leukocyte and C-reactive protein. The patient's symptoms had not improved with antibiotic treatment. However, after thoracic esophagectomy, the fever faded and leukocyte serum levels rapidly normalized.

Background: Features of fever in Infections of Rachides (IR) is understudied in literatures. Methods & Materials: We measured temperature with a mercury thermometer,three time a day,in all of cases and forming that away febrile curve for each of them;defined the type of febril curve based on classification of fever;evidenced the feature of fever in (IR).We also analyzed correlation between type of fever and causative microbic agents. Material: 55 cases with IR,with specified microbic agents,hospitalized in Service of Infectious Disease,UHC,Tirana, Albania,between June 2003 and Septembre 2013. Results: out of 55 cases 51 were febril and only 4 cases(ekinococcus 1,brucella 3) presented without temperature. Classification of cases according by height of fever:afebril 4 cases,subfebril(37.5-38) 4,low grade (38-38.5) 16,moderate(38.5–39C) 15;high(39–39.5C) 14;hiperpireksia (–41) 4,extrem hiperpireksia (>41) no cases;by type of febril curve:febris continuous 15, intermittent 21, remittent 6,recurrent 3,hectica 7 cases. Conclusion: In our study Infectious Rachiditis were presented without fever in 7.27% of cases. We spotted 5 type of fever, febris intermittent dominated with 38.1%,continuous 27.2%, remittent 5.4%,hectica 12.7%. The most frequent fever accoding to hight of temperature was low grade fever with 29.0% followed bymoderate fever 27.2%, high 25.4%,hiperpireksia 7.2%. Intermittent fever was more frecuent in Infectious Rachiditis caused by Brucella with 76.2%.

Trapa bispinosaRoxb. which belongs to the family Trapaceae is a small herb well known for its medicinal properties and is widely used worldwide.Trapa bispinosaorTrapa natansis an important plant of Indian Ayurvedic system of medicine which is used in the problems of stomach, genitourinary system, liver, kidney, and spleen. It is bitter, astringent, stomachic, diuretic, febrifuge, and antiseptic. The whole plant is used in gonorrhea, menorrhagia, and other genital affections. It is useful in diarrhea, dysentery, ophthalmopathy, ulcers, and wounds. These are used in the validated conditions in pitta, burning sensation, dipsia, dyspepsia, hemorrhage, hemoptysis, diarrhea, dysentery, strangely, intermittent fever, leprosy, fatigue, inflammation, urethrorrhea, fractures, erysipelas, lumbago, pharyngitis, bronchitis and general debility, and suppressing stomach and heart burning. Maybe it is due to photochemical content ofTrapa bispinosahaving high quantity of minerals, ions, namely, Ca, K, Na, Zn, and vitamins; saponins, phenols, alkaloids, H-donation, flavonoids are reported in the plants. Nutritional and biochemical analyses of fruits ofTrapa bispinosain 100 g showed 22.30 and 71.55% carbohydrate, protein contents were 4.40% and 10.80%, a percentage of moisture, fiber, ash, and fat contents were 70.35 and 7.30, 2.05 and 6.35, 2.30 and 8.50, and 0.65 and 1.85, mineral contents of the seeds were 32 mg and 102.85 mg calcium, 1.4 and 3.8 mg Iron, and 121 and 325 mg phosphorus in 100 g, and seeds ofTrapa bispinosaproduced 115.52 and 354.85 Kcal of energy, in fresh and dry fruits, respectively. Chemical analysis of the fruit and fresh nuts having considerable water content citric acid and fresh fruit which substantiates its importance as dietary food also reported low crude lipid, and major mineral present with confirming good amount of minerals as an iron and manganese potassium were contained in the fruit. Crude fiber, total protein content of the water chestnut kernel,Trapa bispinosaare reported. In this paper, the recent reports on nutritional, phytochemical, and pharmacological aspects ofTrapa bispinosaRoxb, as a medicinal and nutritional food, are reviewed.

Burkholderia pseudomallei is a common cause of serious, difficult to treat infections in South-East Asia and Northern Australia, but is a rare imported pathogen in the USA and Europe. We report a case of a patient with a mycotic aneurysm caused by B. pseudomallei in a previously healthy returning traveller. The patient presented with 4 weeks of abdominal pain and intermittent fever after a brief vacation in Thailand. The aneurysm was excised and replaced by an autologous deep vein graft, and the patient was treated for 6 months with antibiotics adjusted according to postoperative renal impairment. Twenty-four months after surgery the patient is well and without relapse.

We are reporting a case of recurrent Kala azar with recurrent post-Kala-azar anterior uveitis in an 8 year old immune-competent child. Patient presented history of intermittent fever with loss of appetite and lassitude. Diagnosis of Kala azar was made on the basis of clinical examination and bone marrow microscopy. Child was treated with intravenous liposomal Amphotericin B, and was declared cured after 3 weeks. However, after one week of discharge, he presented with both eyes redness and on slit lamp examination bilateral anterior uveitis was detected. Uveitis was treated with topical steroids and cycloplegics. Relapse of Kala azar was noted 5 months after the first attack. He was treated with increased dose of intravenous liposomal Amphotericin B. After completion of treatment, bilateral anterior uveitis was noted. This was more severe than first attack, associated with fibrinous exudates in the left eye. Uveitis was successfully treated with topical steroids and cycloplegics. He presented with second relapse of Kala azar 7 months after the second attack and this time he was treated with intravenous liposomal Amphotericin B along with oral Miltefosine. On the 4th day of treatment, anterior chamber cells were noted bilaterally and this inflammation was controlled with topical steroids and cycloplegics.

Adult-onset Still's disease (AOSD) is a systemic disorder characterized by intermittent fever, evanescent rash, arthralgias or arthritis and predominantly neutrophilic leucocytosis. We report on a 16-year-old woman with Still's disease who developed, in addition to the typical rash, persistent papular lesions on her face, neck and upper and lower back. Although the presence of fixed skin lesions is not a characteristic feature of AOSD, their appearance at the onset of the disease and their evolution suggest that they represent a specific manifestation of the disease.

Inflammatory pseudotumour of the lung (IPT), also termed as plasma cell granuloma is non-neoplastic process due to unregulated growth of inflammatory cells, usually sequelae to old lung infection. These tumours are exceptionally rare, that are usually present as a solitary nodule. Here, we present a case of 25-year-old male complaining of dry cough, dyspnoea and intermittent fever since three years with multiple large, lobulated intraparenchymal mass lesions in mid and lower zones of both lung fields. Transthoracic CT guided biopsy was reported as inflammatory pseudotumour. The imaging features, clinical presentation and differential diagnosis of this seldom encountered entity are discussed which can present also as multiple intraparenchymal masses.

A diagnostic laparotomy was performed on a 41-year old woman who, having suffered from recurrent arthralgias for several years and intermittent fever for many months, was found to have extensive enlargement of abdominal lymph-nodes, raising the suspicion of malignant lymphoma. Frozen-tissue biopsy was highly suspicious of Hodgkin's lymphoma, but light- and electron-microscopy revealed Whipple's disease, confirmed in an endoscopically obtained duodenal mucosal biopsy. The arthralgia quickly responded to antibiotic treatment. This case demonstrates the potential difficulties and errors in the diagnosis of Whipple's disease.

A 65-year-old man came with pain in the right gluteal region which he had for the past five years. This pain was of a burning type with high intermittent fever. His medical reports suggested Hepatosplenomegaly and chronic active inflammation of the liver. A malaria attack 50 years ago which repeated itself ten years later had affected him profoundly. After a symptom-free period, now it was again disturbing his whole system for the last five years. After China officinalis, he had a strong aggravation followed by good improvement, which reminds us of the discovery and principles of homeopathy, which as we know started with Hahnemann's description of China.

Introduction; Methyl bromide has been responsible for deaths that usually occur from its accidental inhalation during fumigation. Case Report; We report an accidental fatality that occurred after methyl bromide seeped through underground conduits from a fumigated building to an adjacent guest house on the same property. The patient developed refractory seizures, intermittent fever, and multiorgan system failure before dying 19 days after exposure. The initial serum bromide was 27 mg/dL. Postmortem analysis detected methyl bromide concentrations of 2.9 mg/dL in the blood, 1.7 mg/dL in the bile, 24 μg/g in the liver, and 28 μg/g in the adipose tissue. Conclusion; Methyl bromide, although applied under acceptable safety standards, led to the inadvertent death of a young woman. Extreme care must be used when fumigating to insure no unsuspected seepage routes exist.

A 42-year-old male nonsmoker presented with recurrent hemoptysis for 12 years requiring two hospitalizations and 11 units of blood transfusion, with occasional low-grade intermittent fever, and cough with scanty expectoration. Examination of lower respiratory system revealed biphasic and coarse crepitations over the left infrascapular area.

This chapter summarises an earlier study that detailed in chronological order the translation of all the entries on qinghao 青蒿 (and its synonyms caohao 草蒿, chouhao 臭蒿, huanghuahao 黃花蒿, etc.) that Frederic Obringer and I could locate in the premodern Chinese materia medica (bencao 本草) in the time period between 168 BCE and 1596. The aim of that study (Hsu in Plants, health and healing: Berghahn, Oxford, pp 83–130, 2010) was threefold: it aimed to make a contribution to ethnobotany, the history of Chinese medicine and herbal medical practice. It underlined, first and foremost, that ‘herbal’ medications are not to be conceived of as ‘natural’ ‘herbs’ but as cultural artefacts: the entries on qinghao in the Chinese materia medica contained detailed information on the culture-specific transformation of plant parts into the drugs that the patient would then consume. This underlined that the so-called ‘herbal’ medical practice depends not only on plant classifications that are culture specific, but also on practical interventions that treat the plant as a thing. Accordingly, the study of qinghao involved not merely attending to the cultural acquisition of knowledges (epistemologies) but also to the techniques and practices of intervening with perceived realities (ontologies). Second, the study highlighted that the practical recommendations of how to use the plant and its various parts changed over time; it remains, to date, one of the first longitudinal studies on a specific item of the materia medica in the history of Chinese medicine. Finally, it evaluated the identification of qinghao and other hao 蒿 in terms of modern botanical taxonomies (as given in the Zhongyao dacidian 1986).

A 9-year-old Thoroughbred gelding presented with a 97-day history of poor performance and intermittent fever. Clinicopathologic changes included increased serum activity of γ-glutamyltransferase and alkaline phosphatase, mild hyperbilirubinemia, and leukocytosis with neutrophilia and lymphopenia. Abdominal ultrasound revealed hepatomegaly with hyperechoic hepatic parenchyma and biliary distention. Pathologic findings included marked hepatomegaly (liver 3.6% of body weight), firm hepatic consistency with a diffuse enhanced reticular pattern, severe portal bridging and sinusoidal fibrosis, oval cell/bile duct hyperplasia, and bile stasis. The differential diagnoses and diagnostic workup to achieve the diagnosis are briefly discussed.

The first European community in Queensland, the Moreton Bay Penal Settlement, was established in 1824 and continued until 1842 when the area was opened up to free settlers. In the official records of the time there is little mention of the health of children, although the presence of a small number is noted. It is only possible to speculate which diseases were prevalent among the young. Epidemics of ophthalmia, presumably trachoma, dysentery and intermittent fever were recorded in the adult population and, as these conditions were infectious, undoubtedly children would have been included amongst their victims. At the time, one death for twenty-two live births was recorded, a comparatively low infant mortality rate. This may have been because the young population was so small and the children were isolated from the epidemics of childhood disease which occurred in Sydney in the same period.

To the Editor: We report a 65-year-old patient with Schnitzler syndrome evolving over 18 years who developed rheumatoid arthritis (RA) while being successfully treated for 8 years with the interleukin 1 (IL-1) inhibitor anakinra. This observation raises the question of the potential link between persistent IL-1 inhibition and RA. A 65-year-old man had typical Schnitzler syndrome diagnosed 16 years ago on account of a 2-year history of urticarial rash, intermittent fever of up to 40°C, pain in both tibias, and a monoclonal immunoglobulin M (IgM) κ component. Prednisone, ibuprofen, and interferon-α proved ineffective to control his symptoms. In February 2007, treatment with anakinra (100 mg/day) was started. Efficiency was immediate and spectacular. … Address correspondence to Dr. D. Lipsker, 1 place de l’hopital, F-67091 Strasbourg Cedex, France. E-mail: dan.lipsker{at}chru-strasbourg.fr

We report a case of urticarial vasculitis associated with macroglobulinemia in a 50-year-old woman. She suffered from intermittent fever with wheals persisting for more than 24 hours. Skin histology revealed perivascular neutrophilic infiltrates with nuclear dusts. Laboratory study demonstrated leucocytosis and a high serum IgM level (2350 mg/dl) with an M component. No overt lymphoid proliferative disease was found. As far as we know, this is the first report of such a case in Japan. Predonizolone and nonsteroidal anti-inflammatory drugs have proved transiently effective for controlling the urticaria, but not for the IgM gammopathy.

Presentation of Case A 32-year-old man was referred to the hospital because of hyperthermia on exercise. The patient had been well and athletic until 4 1/2 years earlier, when he began to experience intermittent fever provoked by exercise and followed by myalgia and excessive fatigue. When he held an object in his hand it caused the hand to “cramp up,” and holding a heavier weight, such as 15 kg, for a longer period was perceived as holding a weight of 45 kg. At the same time he noticed excessive sweating of the right lower extremity while he was playing basketball, . . .

Kawasaki disease is a systemic vasculitis of unknown etiology, presenting typically in infants and young children. We report a rare case of incomplete Kawasaki disease in a 15-month-old male infant presenting with symptoms mimicking retropharyngeal abscess and intermittent fever.

Presentation of Case A 50-year-old man was admitted to the hospital because of fever of unknown origin and diarrhea. The patient had been in stable health until three months earlier, when fever and diarrhea developed while he was on a camping trip in Morocco. The fever subsided after five days, recurred one week later, and subsided again in one week after the administration of an unknown antibiotic. Six weeks before entry, intermittent fever recurred, with the temperature rising to 39.4 °C and with chills, malaise, and diarrhea. The fever usually began in the afternoon, worsened at night, and subsided in . . .

A 75-year-old man presented to the ED with a 5-day history of back pain and intermittent fever. He had undergone endovascular aortic repair of a thoracic aortic aneurysm 7 years previously.

In Italy, malaria was an endemic disease that was eradicated by the mid-20th century. This paper evaluates the prophylactic and therapeutic remedies used by folk medicine to cure malaria in Calabria (southern Italy).The data has been collected by analysing works of physicians, ethnographers, folklorists and specialists of the study of Calabrian history between the end of the 19th century and the 20th century. The data collected have allowed us to describe the most common cures used by the Calabrian people to treat malaria and the most evident symptoms of this disease, such as intermittent fever, hepato-spleenomegaly, asthenia and dropsy. This approach uncovered a heterogeneous corpus of empirical, magical and religious remedies, which the authors have investigated as evidences of past "expert medicine" and to verify their real effectiveness in the treatment of malaria.

A 68-year-old woman presented with a five-month history of dry cough and intermittent fever. During the previous month, she had intermittent retrosternal chest pain radiating to her back. Two days before presentation, she had coughed up about 5 mL of blood on two occasions. She had type 2 diabetes

A 77-year-old woman presented to the emergency department with back pain, which began shortly after moving furniture 1 week before presentation. The pain was persistent, did not radiate, limited activities of daily living, and was unrelieved by conservative measures. Although there were no associated neurologic symptoms, the patient described intermittent fever and chills.

This previously healthy 3-year-old girl was admitted following a 3-month history of intermittent fever and abdominal pain. She initially had a 2-week history of intermittent vomiting and fever without diarrhea. Although this resolved, she continued to have 2 weeks of intermittent periumbilical abdominal pain and fever on a daily basis. After 2 weeks, she developed 3 weeks of watery, non-bloody diarrhea with continued intermittent fever. She had been treated with multiple doses of acetaminophen during her illness. She was seen during this time period in several emergency rooms. Over the course of the illness, she had lost 5 pounds. Birth history was unremarkable. The family history was only remarkable because her mother had had a recent illness, which had consisted of vomiting, fever, and diarrhea. Her past medical history was significant for recurrent episodes of otitis media with bilateral myringotomy tube placement at 1 year of age. At home, there is one dog, one old cat, and four kittens. Her mother is a food handler. Evaluation at an outside hospital included normal electrolytes, ALT 116 IU/mL, albumin 3.1 mg/dL, and negative stool culture, rotavirus antigen test, and stool examination for parasites.Key Learning PointsTen percent to 15% of healthy school-age children have functional chronic abdominal pain.Ultrasonography is the best initial test for imaging the biliary tract.Choledochal cysts can be several centimeters in diameter and are sometimes palpable. There’s generally no liver dysfunction until the biliary tract obstruction becomes complete.Asymptomatic small-bowel intussusceptions are seen regularly on computerized tomography scans. They are evanescent, and don’t cause obstruction. No treatment is necessary unless they persist and lead to a small bowel obstruction.The likelihood of lead poisoning is higher in children who ingest coins or other foreign objects.ABOUT THE AUTHORDr. Listernick is Professor of Pediatrics at Feinberg School of Medicine, Northwestern University, and Director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL

Theodore Roosevelt's death at age 60 was probably caused by a pulmonary embolus, but it was preceded by a 2 1/2-month illness described as inflammatory rheumatism. He had intermittent fever and acute arthritis in several joints leading to hospitalization and enforced bed rest for 6 weeks. The details of his illness and its possible etiology are reviewed. Inflammatory rheumatism was a descriptive term within which several modern diagnoses might be included. Although it is not possible to identify Roosevelt's illness with any certainty, it was most compatible with polyarticular gout, although reactive arthritis, rheumatic fever, and several other diagnoses cannot be ruled out.