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01 December 2013, Volume 33 Issue 12 Previous Issue    Next Issue

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Immunoglobulin G4 related autoimmune pancreatitis. YU Hang，YANG Ai-ming. 2013, 33(12): 913-915.  Abstract ( )   PDF (963KB) ( )   Abstract：Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis which belongs to the spectrum of IgG4 related diseases.AIP is characterized by lymphoplasmacytic infiltration，storiform fibrosis，obliterative phlebitis，and increasing of IgG4+ plasma cells.Patients with AIP presented clinically with recurrent pancreatitis and obstructive jaundice，usually with symptoms involving bile duct and salivary glands and so on.Serum IgG4 level is often elevated.The main imaging appearance of AIP is a “sausage-shaped pancreas” and multiple stricture of the main pancreatic duct.AIP responds dramatically to glucocorticosteroid but relapses easily.In relapsed cases，re-administration of steroid or in combination with immunosuppressant is effective.

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Immunoglobulin G4 related sclerosing cholangitis. HAN Ying，ZHU Jiang-yi. 2013, 33(12): 916-918.  Abstract ( )   PDF (961KB) ( )   Abstract：Immunoglobulin G4 (IgG4) related sclerosing cholangitis (IgG4-SC)is a kind of cholestatic liver disease characterized by elevated serum IgG4 level，IgG4+ plasma cell infiltration，fibrosis and obliterative phlebitis.The pathogenesis is still not clear and its clinical diagnosis requires a combination of imaging，histology，serology，and performance of involved organs，as well as response to steroid therapy.IgG4-SC patients often respond well to corticosteroid and other immunosuppressive drugs，so early diagnosis and treatment are very important in order to avoid over treatment and unnecessary operation.

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Immunoglobulin G4 related retroperitoneal fibrosis. ZHAO Li-dan，SHI Qun，ZHANG Xuan. 2013, 33(12): 919-922.  Abstract ( )   PDF (975KB) ( )   Abstract：Retroperitoneal fibrosis (RPF) is a chronic inflammatory process that can entrap the retroperitoneal structures，resulting in obstructions，most usually the ureteral obstruction induced by outside pressure，which can lead to hydronephrosis.According to the presence or absence of etiology，RPF can be classified as idiopathic and secondary type.Idiopathic RPF in some cases is related to Immunoglobulin G4 (IgG4)，with the corresponding histopathologic features including elevated serum IgG4 level，storiform fibrosis，obliterative phlebitis and infiltration of IgG4-positive plasma cell.Further investigation is needed to elucidate its pathogenesis and clinical characteristics，as well as to differentiate it from non-IgG4 related RPF.

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Immunoglobulin G4 related lung diseases. SHI Ju-hong. 2013, 33(12): 923-925.  Abstract ( )   PDF (1619KB) ( )   Abstract：Immunoglobulin G4(IgG4) related diseases are a group of clinicopathological systemic entities，and the etiology remains unclear.IgG4 related lung disease is histopathologically characterized by infiltration of IgG4-positive plasma cells and lymphocytes in lung tissues along with fibrous interstitial hyperplasia.Under the condition that no other systemic organs are involved，it is difficult to differentiate these diseases from non-specific interstitial pneumonia (NSIP) and lung tumors according to the imaging features.Therefore，final diagnosis may depend on pathological manifestations.IgG4 related diseases have good responses to glucocorticoid treatment.

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Emphasizing differential diagnosis of immunoglobulin G4 related diseases. ZHANG Wen. 2013, 33(12): 925-927.  Abstract ( )   PDF (961KB) ( )   Abstract：Immunoglobulin G4 related disease (IgG4-RD) is a kind of chronic auto-inflammatory and fibrosing disease recognized in recent years.It is a systemic disease with multiple organ involvement，characterized by elevated serum IgG4 concentration，IgG4-positive plasma cell infiltration and soft tissue fibrosclerosis.Serum IgG4 increasing and/or tissue infiltration of IgG4-positive plasma cells could sometimes be observed in other diseases such as tumor，autoimmune disease and infectious disease，so it is important to distinguish.In this forum，we emphasize some important points in differential diagnosis of IgG4-RD.

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Laboratory and pathologic characteristics of immunoglobulin G4 related diseases and notes on its diagnosis. DONG Ling-li. 2013, 33(12): 928-930.  Abstract ( )   PDF (963KB) ( )   Abstract：Immunoglobulin G4 related disease (IgG4-RD)，a novel disease entity，was initially described at the beginning of the 21st century，and has now become a focusing research field.Because of its complicated and diversified clinical manifestation，laboratory examination of elevated serum IgG4 level is a very important criterion for diagnosis of IgG4-RD.In addition，high levels of serum IgE and eosinophilia can be observed in some patients with IgG4-RD.The characteristic histopathological finding is increased infiltration ofIgG4+ plasma cells with fibrosis in the involved organs，which is another key diagnostic criterion.Combination of the clinical manifestations，laboratory examination，pathologic and imaging findings is recommended in diagnosis of IgG4-RD，while other disorders such as malignancy should be excluded to make a final diagnosis.

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Research advances in immunoglobulin G4 related sclerosing diseases. HAN Ying,ZHU Jiang-yi. 2013, 33(12): 931-933.  Abstract ( )   PDF (963KB) ( )   Abstract：IgG4 related sclerosing disease，as a newly recognized disease，is characterized by multi-focal fibrosclerosing change，elevated serum IgG4 level and infiltration of a large number of IgG4 positive plasma cells in tissue.The pathogenesis of this disease is not clear and there is no uniform diagnostic criterion yet.Its final clinical diagnosis depends on a comprehensive judgment.Clear diagnosis is helpful in guiding treatment to avoid unnecessary operation.Treatments with corticosteroid and other immunosuppressive drugs are effective and the prognosis is favorable.

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Diagnosis and treatment research development of severe alcoholic hepatitis. ZHU Jiang-yi，YANG Cai-feng，HAN Ying. 2013, 33(12): 934-938.  Abstract ( )   PDF (988KB) ( )   Alcoholic hepatitis (AH) is the one of the common life-threatening diseases lead to liver failure，especially severe alcoholic hepatitis (SAH).For early detection of high-risk，poor prognosis of the patients in clinical practice，we should flexibly use various prognostic scoring systems to guide or adjust our treatment strategy.Alcohol abstinence，nutrition support and symptomatic treatment can win the time for follow-up treatment of patients with SAH.Glucocorticoid (CS) therapy can improve the mortality of SAH patients，but it should be assessed the severity of disease reasonably and grasped the indications and individualized therapy.Pentoxifylline (PTX) has been recommend by many guidelines to be the first-line treatment if there is CS treatment taboo (especially with hepato-renal syndrome).Application of antioxidant therapy，molecular adsorbent recycling system and granulocyte separation technology also need to carry out clinical research further.For patients with poor prognosis or drug treatment non response，early liver transplantation can increase the survival rate.

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Interpretation of Chinese Society of Endocrinology consensus statement on hyperglycemia management target in adult inpatients in China. LVQing-guo，TONG Nan-wei. 2013, 33(12): 939-941.  Abstract ( )   PDF (970KB) ( )   Abstract：Hyperglycemia of inpatients will increase the incidence of complications，mortality and medical cost，meanwhile prolong the hospitalized course.A consensus on hyperglycemia management target in adult inpatients is proposed by experts of Chinese Society of Endocrinology in order to control hyperglycemia of inpatients safely and effectively.Individualization is emphasized in this consensus.Different stratified glycemic targets should be established according to different patients and conditions.Target blood glucose control is unnecessary for the patients with diabetes during hospital stay.Glycemic decrease should generally not be quick.Hypoglycemia and weight gain for overweight and obesity individuals should be avoided as much as possible.At the same time，the risk of infection and hyperglycemic crisis must also be avoided due to loose glycemic control.