Wepresent the diagnostically challenging case of a 51-year-old Japanese male who visited Papua NewGuinea for one month. Approximately a month after returning to Japan, he experienced a high fever. Malaria was suspected and he was admitted to Tsukuba University Hospital. Although the blood smear did not reveal the malarial parasite, a diagnosis of malaria was made using an indirect fluorescent antibody test (IFAT). The patient was treated and discharged but symptomsreturned three months later. This time, the blood smear was positive for malarial parasites. IFATwas useful in this case for the early diagnosis ofPlasmodiumvivax and for ruling out infection by Plasmodium falciparum. (Internal Medicine 34: 32-35, 1995)

Between 1989 and 1991, ultrasonograms (US) and CT films of 13 patients undergoing continuous ambulatory peritoneal dialysis (CAPD) were obtained to evaluate splenomegaly, other abdominal splanchnic systems , distribu tion of CAPD fluid in the abdominal cavity and the condition of the bowel and mesentery. In this group, there were no cases with splenomegaly, while in hemodialyzed patients , splenomegaly is often demonstrated, as has previously been reported by us. Furthermore there was no statistical correlation between splenic index (SI) and duration of CAPD or platelet count in CAPD patients , though these have been recognized in hemodialyzed patients. There is a definite difference between CAPD and hemodialysis with respect to how the machines are used, so it may be concluded that splenomegaly is caused by hypersplenism resulting from blood cell injury due to mechanical stimulation with, for example , the dialyzer. Other organs in the abdominal cavity showed no differences between CAPD patients and hemodialyzed patients. Distribution of CAPD fluid in the abdominal cavity was different in each case , and in addition, the contact surface between it and the bowel or mesentery was localized. Furthermore , measurement of mesentery thickness tended to be affected by peristalsis, and differed according to various sites in the same patient. Therefore, mesentery thickness measured by US as an index of CAPD efficiency must be evaluated cautiously .

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