Der Internist
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In the investigation of hypercalcemia of an 81-year-old female patient, the typical laboratory value constellation of primary hyperparathyroidism (pHPT) emerged. The staged imaging diagnostics with sonography of the neck, sestamibi parathyroid gland scintigraphy and C‑11-methionine positron emission tomography-computed tomography (PET CT) resulted in negative or inconspicuous findings for all procedures. The exploratory surgical resection of two hyperplastic epithelial bodies led to a normalization of calcium levels. Inconspicuous imaging findings do not exclude the diagnosis of pHPT.
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Atrial fibrillation is frequent and has severe sequelae, such as stroke, cardiovascular death and cardiac insufficiency. These sequelae can be effectively reduced by anticoagulants, a meticulous recognition and treatment of cardiovascular comorbidities and an early rhythm-preserving treatment. Catheter ablation leads to a better preservation of the sinus rhythm and in symptomatic patients to a better quality of life in comparison to treatment with antiarrhythmic agents. This should be included in the planning of early rhythm-maintaining treatment.
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In the European Union a disease is classified as rare if it affects no more than 5 out of 10,000 people. Currently, there are more than 6000 rare diseases, consisting of a large and heterogeneous number of different diseases that are complex in their symptomatology, multidimensional and therefore difficult to classify in everyday medical practice. ⋯ It also provides an overview of all German centers for rare diseases, which are a contact point for patients with an unclear diagnosis. The se-atlas serves as a compass through the heterogeneous amount of information on care facilities for rare diseases and provides low-threshold information for a broad user group, from affected persons to members of the medical care team.
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Acute pancreatitis is characterized by the autodigestion of the pancreas by its own digestive enzymes. The pathophysiological onset of the disease occurs in the acinar cells. The normally inactive precursors of secreted proteases are prematurely activated and as a result digest the cells from within. ⋯ The consequence of this pronounced SIRS in the later course of the disease is a strong immunological counter-regulation, the so-called compensatory anti-inflammatory reaction syndrome (CARS). In the course of this immunosuppression commensal bacteria from the intestines can colonize the pancreatic necrosis. The outcome of the SIRS/CARS balance is decisive for the course and the prognosis of the patient.
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The cardinal symptom of chronic pancreatitis is severe belt-like upper abdominal pain, which requires immediate and adequate treatment. Furthermore, advanced stage chronic pancreatitis is often associated with complications, such as pancreatic pseudocysts, pancreatic duct stones and stenosis as well as biliary stenosis. The various endoscopic and surgical treatment options for chronic pancreatitis patients have been controversially discussed for decades. ⋯ In contrast, pancreatic pseudocysts, solitary proximally situated pancreatic duct stones and benign biliary strictures (except in calcifying pancreatitis) can nowadays generally be managed endoscopically. For distal pancreatic duct stones and symptomatic pancreatic duct stenosis surgical treatment is again the method of choice. This review article discusses these indication-related procedures in detail and explains them in relation to the recently published S3 guidelines on pancreatitis of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS).