Clinical and Immunopathologic Profile of Mexican Patients with IgG4 Autoimmune Pancreatitis

Autoimmune pancreatitis is part of the spectrum of IgG4-associated diseases. Its diagnostic criteria and histological subtypes have been formally proposed recently and although based on current data it has been suggested that there are differences in clinical presentation among populations, more research is needed to properly establish if this heterogeneity exists. In this paper, we describe 15 cases of autoimmune pancreatitis diagnosed at a Mexican centre of reference, all of them associated to the lymphoplasmocytic sclerosing pancreatitis variant. The mean age at the onset of symptoms was 47.5 ± 14.4 years, and 53% of patients were male. The main manifestations were weight loss (87%), obstructive jaundice (53%), and acute (27%) and chronic (27%) pancreatitis. Only 20% of patients had high IgG4 serum levels at the time of diagnosis. All patients receiving prednisone responded favourably, both in their pancreatic and extrapancreatic manifestations. Clinical manifestations of Mexican patients showed certain differences with respect to those usually reported

Síndrome de Guillain-Barré en el anciano: un estudio retrospectivo

El síndrome de Guillain-Barré (SGB) es la principal causa de parálisis flácida. Su pronóstico usualmente es bueno pero algunos tienen secuelas neurológicas graves y la mortalidad es del 1 al 3%. Objetivo: reconocer las características clínicas del SGB en el anciano y compararlos con pacientes jóvenes. Material y métodos: se revisaron los expedientes de pacientes con el diagnóstico de SGB de 1995 al 2002. Los enfermos fueron divididos en dos grupos: igual o mayores de 60 años (grupo 1) y menores de 60 años (grupo 2). Comparamos las características sociodemográficas, evolución clínica, resultados de punción lumbar, tratamiento, recaídas y presencia de secuelas. Resultados: la edad promedio del grupo 1 fue de 65.8 años (rango 62-72) y de 35.6 años en el grupo 2 (rango 17-56). No encontramos diferencias relacionadas al sexo, forma de presentación, factores desencadenantes, hallazgos en la punción lumbar, necesidad de ventilación mecánica ni en el tiempo de recuperación. La principal complicación fue neumonía (P=0.704). El 60% de los pacientes del grupo 1 tuvieron recaídas comparado con el 3% del grupo 2 lo que fue significativo (P <0.001). Discusión: el comportamiento clínico del SGB no es diferente entre ambos grupos. Sin embargo, hubo un mayor índice de recaídas en el grupo de ancianos. No hay una explicación clara para ello. Quizá, debido a que el SGB tiene un origen autoinmune, las diferencias se deban a las irregularidades inmunológicas relacionadas a la vejez pero esta propuesta y nuestros resultados deberán confirmarse

Persistent hepatic encephalopathy secondary to portosystemic shunt occluded with Amplatzer device

Hepatic encephalopathy is a frequent complication of cirrhosis, when this event becomes persistent, treatment compliance should be verified and any precipitating factor need to be identified. Also the presence of portosystemic shunts, which are a rare cause of decompensation or persistence hepatic encephalopathy need to be ruled out. In this paper we report the case of a 57 year old man with persistent hepatic encephalopathy secondary to the presence of a porto-onfalo-femoral shunt successfully closed with the placement of an Amplatzer device

Immunotolerance in liver transplantation: a primer for the clinician

The use of immunosuppressive medications for solid organ transplantation is associated with cardiovascular, metabolic, and oncologic complications. On the other hand, the development of graft rejection is associated with increased mortality and graft dysfunction. Liver transplant recipients can withdraw from immunosuppression without developing graft injury while preserving an adequate antimicrobial response - a characteristic known as immunotolerance. Immunotolerance can be spontaneously or pharmacologically achieved. Contrary to the classic dogma, clinical studies have elucidated low rates of true spontaneous immunotolerance (no serologic or histological markers of immune injury) among liver transplant recipients. However, clinical, serologic, and tissue biomarkers can aid in selecting patients in whom immunosuppression can be safely withdrawn. For those who failed an immunosuppression withdrawal trial or are at high risk of rejection, pharmacological interventions for immunotolerance induction are under development.In this review, we provide an overview of the mechanisms of immunotolerance, the clinical studies investigating predictors and biomarkers of spontaneous immunotolerance, as well as the potential pharmacological interventions for inducing it