RESUMEN
Autoimmune pancreatitis is an entity that has recently been included in the differential diagnosis of chronic pancreatitis-pancreatic mass. The presence of diffuse, irregular Wirsung's duct stenosis, together with high levels of IgG4, the existence of certain autoantibodies and lymphoplasmacytic infiltration of the pancreas are key factors in the diagnosis. An early diagnostic suspicion and multidisciplinary collaboration are vital in these cases to avoid unnecessary surgery as the differential diagnosis is established with such entities as pancreas cancer, chronic pancreatitis, primary biliary cirrhosis or primary sclerosing cholangitis. Autoimmune pancreatitis has an excellent response to steroid therapy, with complete resolution of clinical, analytical and radiological parameters, as occurred in our patient. The very few cases reported so far suggest the need for the elaboration of long-term follow-up studies to determine the prognosis and frequency of its association with other diseases.
Asunto(s)
Enfermedades Autoinmunes , Pancreatitis/inmunología , Adulto , Enfermedades Autoinmunes/diagnóstico , Femenino , Humanos , Pancreatitis/diagnósticoRESUMEN
OBJECTIVES: To describe the characteristics of patients admitted in hospitals with soft tissue infections, and analyse the variables whose died, in order to define risk groups. METHOD: retrospective analysis of medical reports of all patient admitted during 2002 year for soft tissue infections in public malacitans hospitals. We excluded the patient with soft tissue infections associated with burns, surgery, pressure ulcers, and orbit cellulitis. We analysed clinical, biochemical variables and indications for yields and imaging tests, so the empiric antibiotic treatment established and its correlations with practice guidelines. RESULTS: We analysed 391 admissions of 374 patients. Cellulitis was the most frequent diagnosis (69.3%). We did imaging tests in 51.6%. In 94.3% of cases were treated with empirics antibiotics. The most prescribed drug was amoxiciline plus clavulanate (39%). 27 patients died, 40.7% of them for septic cause. All deceased patients had chronic diseases. The only biochemical parameters associated with mortality were serum proteins and albumina (55 +/- 9 g/L vs. 63 +/- 8 g/L; p = 0.0231) and (22 +/- 7 g/L vs. 29 +/- 7 g/L; p = 0.0125) respectively. CONCLUSIONS: Cellullitis are the most frequent soft tissue infections that requires admissions in hospitals. We overuse imaging test and don t follow the practice guidelines recommendations in antibiotic therapy. Primary soft issue infection s mortality is low and it s restricted to people with chronic illness, deep infections and bad nutritional status.