[SCLEROUSIS CHOLANGITIS AT THE AUTOIMMUNE PANCREATITIS PATIENT].

The article contains the description of a clinical case of the patient P. of 59 years with autoimmune pancreatitis (AIP) associated with a sclerousis cholangitis (SC), and the analysis of literature on this problem. The patient was operated (cholecystenterostomy, enteroenterostomy) for pancreatic cancer. The pancreatic cancer was excluded. Overlap syndrome (primary biliary cirrhosis/autoimmune hepatitis), pseudotumorosis pancreatitis were excluded during the period of monitoring in hospitals of Moscow. In our clinic the diagnosis AIP is established on the basis of Mayo's criterion (HISORt: Histology, Imaging, Serology, Other organ involvement, Response to corticosteroid therapy). The increased level of immunoglobulin G (IgG) by 3 times (46,2 g/l, norm--6.58-18.37 g/l), IgG4 by 25 times (49.5 g/I, norm--0.33-2.01 g/l) was revealed. MRI of abdominal organs showed diffusion increase pancreas with a peripheral hypointensive rim, local stenosis of the Major pancreatic duct in the head pancreas. Immune histochemical study surgical biopsy of pancreas showed large number of IgG-positive plasma cells. Glucocorticosteroids (GCS, prednisolone 40 mg/d), ursodeoxycholic acid 1000 mg/d, creon 120000 ed/d promoted improvement of clinical picture AIP and decrease IgG4 (to 6.4 g/I). After 12 months IgG4 wasn't defined. Control MRI revealed dilatation small biliary ducts in 8, 5, 4 liver segments and thickening wall common bile duct (to 2 mm) at large distance. The peculiarity of the case--the 15-year follow-up of patients with AlP who had inappropriate surgery. Late diagnosis and delayed treatment GCS adversely affected the course of the disease, which led to the development of secondary biliary cirrhosis.

[Medico-social characteristics of patients with chronic pancreatitis].

AIM OF STUDY: Comparative analysis of the health status of patients with chronic toxic-metabolic pancreatitis (CTMP) and chronic obstructive pancreatitis (COP). The gender and social factors was analysed. THE MATERIALS AND METHODS: 250 patients with chronic pancreatitis examined. On based of the TIGAR-O classification, two groups of patients choosed: the 1-st group included 142 (56.8%) a patient with CTMP, the 2-nd group--108 (43.2%) patients COP. The social characteristics of patients had produced, including assessment of status social (gender, age, educational level, employment, marital status, bad habits). Quality of life was assessed by using the updated questionnaire SF-36. RESULTS: The average age of patients with CP is 53.2 years, male to female ratio is 3:2. At stake is 56.8% of all CTMP patients with CP, the median age is 42.3 years, the male to female ratio is 4:1. The average age of patients with COP is 54.6 years, male to female ratio is 1:4. Do not work, not married, engaged in an anti-social way of life 43% of people working age with CTMP, have a lower education in comparison with patients with COP. CONCLUSION: Patients with CTMP reduced social significance illustrate reduced social significance as personal (reduction in the level of education, an anti-social way of life), and social (lack of employment, deterioration of demographic indicators).