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The diagnostic value of laparoscopy with biopsy under vision was analysed retrospectively in 70 patients with persisting or recurrent fever of at least six weeks' duration which had remained unexplained despite detailed noninvasive studies. In 42 of these patients an intra-abdominal process had been suspected. The cause of fever was directly or indirectly diagnosed by the laparoscopy in 31 patients (44%), 29 of whom had clinical findings or abnormal biochemical results pointing to an involvement of abdominal organs. The most common laparoscopic diagnosis was granulomatous disease, isolated liver disease or malignant lymphoma. If clinical signs pointing to abdominal involvement are absent, laparoscopy is unlikely to aid in the diagnosis of fever of unknown origin.

Conjunctival oxygen tension and arterial blood gases were measured in 20 patients with acute ischaemic stroke and compared to values obtained in a reference group. The conjunctival capillary bed is perfused by the ophthalmic artery and, thus, reflects the oxygen delivery to the areas supplied by the internal carotid artery. Patients with acute ischaemic stroke showed especially on the ipsilateral side, i.e. the side of the infarction, and to a lesser extent on the other side a lowered conjunctival oxygen tension and a reduced ratio of conjunctival to arterial oxygen tension. These findings indicate disturbances of the blood fluidity, of the cerebrovascular autoregulation and of brain microperfusion. Monitoring of conjunctival oxygen tension is simple and safe. This method allows the assessment of oxygen tension in a tissue bed vascularized by the internal carotid artery. It appears to yield an objective criterion of the effectiveness of therapeutic procedures aiming at an improvement of cerebral perfusion and oxygen supply in patients with acute ischaemic stroke.

A 14-year-old German boy had the characteristic signs and symptoms of familial mediterranean fever with recurrent attacks of fever which ran a uniform course and were self-limiting. Laparoscopy revealed sterile peritonitis and marked humoral inflammatory signs. Each acute phase was confined to three days, alternating with symptom-free intervals which lasted for as long as several months. The boy's father and three other members of the paternal family have had similar disease symptoms. Even in patients who are not members of a predisposed ethnic group familial mediterranean fever should be included in the differential diagnosis as a rare cause of recurrent episodes of fever of unknown aetiology.

In a 47-year-old man presenting with chronic bronchitis since 1978, a weight loss of 11 kg in 9 months and deteriorated general condition, the x-ray film of the thorax revealed numerous pulmonary nodules of up to 4 cm size. Laboratory findings were characterised by enhanced ESR, blood eosinophilia of 7% and a lot of eosinophilic granulocytes in the sputum. The findings could not be clarified despite many additional examinations including bronchoscopy with transbronchial biopsy. Thoracotomy was finally considered imperative. Pulmonary biopsy revealed necrotising vasculitis, eosinophilic infiltration and epithelioid granuloma, characteristic changes of allergic granulomatous vasculitis (Churg-Strauss syndrome). The condition quickly responded to corticosteroid administration.

A 43-year-old man had severe upper abdominal pain and weight loss of 8 kg for over three months. He underwent a laparotomy because, computed tomography having revealed numerous mesenteric and para-aortic lymph nodes, a malignant lymphoma was suspected. Histological examination of a mesenteric lymph node demonstrated exclusively extraintestinal Whipple's disease. The symptoms completely disappeared after the administration of 1.2 mega U penicillin G and 1 g streptomycin daily for 14 days, followed by twice daily 160 mg trimethoprim and 800 mg sulphamethoxazole.

Sonography can rapidly and reliably help to determine the size by the spleen. To standardise the sonographic dimensions of the healthy spleen, we effected sonographic examination of 793 female and male patients aged between 17 and 82 years with a healthy spleen. In 95% of the patients the length of the spleen was less than 11 cm, the breadth below 7 cm and the thickness less than 5 cm. The weight of the spleen as determined via the rotation ellipsoid formula was below 190 g in 95% of the patients. Whether or not a spleen larger than standard signals an acute disease can be clinically assessed only on the basis of a synopsis of all findings.