["Etiocholanolone fever"?].
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Biomedical subjects
Publications and source records attributed to G Winckelmann.
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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.
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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.
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A diagnosis of low-grade idiopathic fever was made in 85 women and 15 men, examined for subfebrile temperature of unknown origin, after organic disease had been excluded. Compared with 100 healthy control subjects these patients had inadequate movement-dependent temperature elevations with a usually pronounced discrepancy between the rectal temperature, predominantly more than 38 degrees C, and a normal or only slightly raised axillary temperature recorded after bodily movement. Other characteristics were that the elevated temperature was uninfluenced by antipyretic drugs. Almost all patients initially complained about general lassitude as well as frequently about atypical functional complaints and psychological symptoms. These observations indicate that low-grade fever is a functional syndrome due to a harmless faulty regulation of body temperature. In addition to a special constitutional reactivity, psychological factors and possibly previous febrile infections are likely to be involved as precipitating causes.
31 patients with the diagnosis or presumed diagnosis of von Willebrand's disease were reinvestigated by means of Ristocetin cofactor-activity and factor VIII-associated antigen. In addition a family with a variant of von Willebrand's disease is described. Ristocetin cofactor-activity was found the most reliable test, its value for the diagnosis of mild forms and of variants of von Willebrand's disease is further established by these results.
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