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We report a case of a 41-year-old man presenting with persisting fevers over 2 weeks. The patient had spent 4 weeks in Central America. He was in control of a stable stage II sarcoidosis. Laboratory and various microbiological tests as well as chest radiography led to no diagnosis. Activated sarcoidosis was hypothesized as the most likely diagnosis. However, we considered an infectious process as a differential diagnosis, in detail, the travel history imposed histoplasmosis. Chest-CT documented localized interstitial consolidations. Bronchoscopy with bronchoalveolar lavage (BAL) and biopsy was performed. Results of BAL fluid, biopsy, distinct sarcoidosis serum markers and a borderline positive histoplasmosis-serology yielded in a diagnostic dilemma as no distinct diagnosis was drawable. After the patient was already started on a prednisolone trial, the final diagnosis - pulmonary histoplasmosis - could be achieved via positive culture and PCR out of the BAL fluid. This case shows the difficult differentiation between an acute exacerbation of a chronic pulmonary disease and a concomitant infection, which was especially aggravated in this case as the histoplasmosis masqueraded an acute picture of sarcoidosis. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented related to problems in standard procedure of publication based Doctorate.

OBJECTIVE. Bronchoscopic lung volume reduction promises to become an effective treatment option in severe chronic obstructive pulmonary disease. Several techniques are currently being investigated, including implantation of devices into the lung and instillation of hot water vapor or polymer. This article reviews the spectrum of radiologic manifestations on chest radiography and CT that occur after the intervention. CONCLUSION. Familiarity with the intended effects and adverse events will aid the radiologist in supporting bronchoscopic lung volume reduction.

Background: One quality parameter of medical theses is the number of articles published by the doctoral candidates. Over the course of the past decade the Charité-Universitätsmedizin Berlin has taken steps to improve the quality of the theses completed by its doctoral students in medicine and increase their publication activity. This study was designed to verify the efficacy of these measures and to detect general trends., Method: Medical theses completed in 1998, 2004 and 2008 (sample size >250 for each year) were retrospectively analyzed with regard to associated publications within a 7-year period (from 5 years before completion to 2 years thereafter). Quality and quantity were recorded. Publications found in the PubMed database were evaluated; the impact factor of the publishing journal was used as quality parameter., Results: The sample sizes were 264 for 1998, 316 for 2004, and 316 for 2008. The number of publications per doctoral student increased from 0.78 to 1.39 over the course of the study period, and the average impact factor rose from 2.42 to 3.62. Analysis using the current impact factors of the publishing journals showed an increase from 3.13 to 3.85. The proportion of case reports fell from 12.7% to 8%. The proportion of first authorships remained about the same., Conclusion: The past decade has seen an increase in the number of publications by doctoral students at the Charité and a rise in the average impact factor of the journals concerned.