Der Internist
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A 64-year-old woman presented with a history of recurrent hypoglycemia. A prolonged fasting test revealed an increased "amended" insulin-glucose ratio. Transabdominal ultrasound (US), computed tomography (CT) scan, and magnetic resonance imaging (MRI) did not show abnormal results. ⋯ Hypoglycemia did not occur during the postoperative period. The prolonged fasting test is the gold standard for the diagnosis of an insulinoma. Novel imaging procedures, such as contrast-enhanced endoscopic US or (68)gallium-DOTA-exendin-4 PET/CT are valuable additions to the diagnostic workup.
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Drug-resistant tuberculosis (DR-TB) is one of the serious problems in the fight against tuberculosis on a global scale. This review article describes in brief the global epidemiology, diagnostics and treatment of DR-TB. The situation in Germany, Switzerland and Austria is addressed in detail. The article concludes with a presentation of current research topics in the field of resistant TB.
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We report the case of a 29-year-old Turkish woman who was admitted to hospital with a 4-week history of fever up to 39.0 °C, headache, sore throat, fatigue and painful cervical and right-sided axillary lymph node swelling. Computed tomography imaging of the neck, thorax and abdomen identified generalized but in particular bilateral cervical and right-sided axillary lymph node enlargement (up to 2 cm). The histological examination of the axillary lymph node biopsy revealed Kikuchi-Fujimoto disease (KFD), a condition characterized by histiocytic necrotizing lymphadenitis. The patient was treated symptomatically with analgesics and antipyretics and the symptoms and febrile condition slowly improved.
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Practice Guideline
[Diagnosis and treatment of sarcoidosis. Current standards].
Sarcoidosis is a granulomatous disease that mainly affects the lungs and intrathoracic lymph nodes; however, virtually any organ can be affected. As an orphan disease, recommendations are mainly based on observational or small randomized studies as well as experts' opinion. Diagnosing sarcoidosis requires proof of non-necrotizing granulomas in patients with a compatible symptomatic pattern and the exclusion of other granulomatous diseases. ⋯ In case of functional organ impairment, cardial or CNS involvement, or other complications, steroid therapy is necessary with a starting dose of 0.5 mg/kg body weight that should be tapered-off over 6-12 months. Steroid-refractory disease can be treated by adding methotrexate or azathioprine, two drugs long known in sarcoidosis treatment. Monoclonal antibodies against TNF and lung transplantation are further therapeutic options.