Deutsche medizinische Wochenschrift
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Biliary tract cancer (BTC) is a rare disease with a heterogeneous nomenclature. Carcinomas of the intra- and extrahepatic biliary tract as well as gallbladder cancer are oftentimes combined in clinical research and treatment algorithms. However, these different cancer types vary not only in their anatomical features, but also in the underlying molecular alterations. ⋯ For second-line treatment, the combination of 5-FU, folinic acid and oxaliplatin (FOLFOX) is a treatment option based on preliminary data from a randomized phase 3 study. Potential targeted therapies showing efficacy in prospective clinical studies are, for example, IDH-, BRAF-/MEK- and FGFR-inhibitors as well as immunotherapy. Therefore, in the era of personalized medicine, molecular testing should be offered to all patients with advanced disease and indication for systemic treatment.
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Dtsch. Med. Wochenschr. · Apr 2020
Case Reports[Acute exacerbation of reactivated chronic hepatitis-b after stopping antiviral medication followed by loss of HBsAg].
A 66-year-old women with chronic hepatitis-b and antiviral therapy was presented with icterus and sickness 2 weeks after cold symptoms. The treatment was stopped by patient 6 month before. The liver was enlarged, the abdomen and further body status unsuspicious. ⋯ Acute exacerbation of chronic hepatitis-b followed stopping antiviral treatment can lead to healing by loss of HBsAg.
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The term metabolic surgery describes the surgical therapy of metabolic diseases, which not only aims at weight reduction but more importantly on improving hyperglycemia. Following the current S3-Guidelines, metabolic surgery should be recommended to treat T2 D in patients with a BMI ≥ 40 kg/m2 and in those with BMI 35.0-39.9 kg/m2 when individual hyperglycemia treatment targets are not achieved by optimal medical therapy. Benefits of metabolic surgery. ⋯ For the majority of individuals with T2 D, metabolic surgery will not be the first treatment choice, because modern pharmacotherapies provide an effective and safe long-term treatment of diabetes. However, there are patients with T2 D which may benefit from metabolic surgery. Treatment decisions need to be based on an individual risk-benefit evaluation by a multidisciplinary team.
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The refeeding-syndrome is a potentially life-threatening metabolic complication that may occur after the initiation of a nutritional therapy in malnourished patients. The syndrome is not well known and probably frequently unrecognized and untreated. The pathophysiology is characterized by a progressive depletion in potassium, sodium and phosphate, despite mostly normal serum levels. ⋯ The refeeding-syndrome typically develops within a few days after the start of a nutritional therapy. If serum-electrolytes, including magnesium and phosphate are monitored and supplemented tightly, the syndrome can be prevented or treated at an early stage. In addition, the measurement and supplementation of thiamine and the particularly slow increase of energy intake are fundamental for the prevention and treatment of the syndrome.