The Clinicopathologic Spectrum of IgG4-Related Disease

Immunoglobulin G4-related disease is a fibroinflammatory systemic disease that is characterized by focal or diffuse organ infiltration by immunoglobulin G4-bearing plasma cells. Immunoglobulin G4-related disease may affect any organ, and a high index of suspicion is necessary for early detection to avoid irreversible fibrosis, organ dysfunction, and death. Tumor-forming lesions are common radiological features of immunoglobulin G4-related disease that need to be differentiated from malignancies. The diagnostic approach requires the integration of clinical, biochemical, and radiographic manifestations with classic histopathologic features, which remain crucial to diagnosis. The histology of immunoglobulin G4-related disease is determined by a dense lymphoplasmacytic infiltrate, storiform fibrosis, and obliterative phlebitis in the presence of increased immunoglobulin G4-positve plasma cells. Although immunoglobulin G4-related disease forms a distinct, clinically independent disease category, many questions and problems remain unanswered, especially on its pathogenesis and the role of immunoglobulin G4. Advances in the understanding of immunoglobulin G4-related disease are likely to change the diagnostic approach in the future and create potential targets for therapeutic purposes. Here we describe the concept of immunoglobulin G4-related disease and the most recent knowledge in the clinico-pathological characteristics on this emerging disease. This study can guide clinicians in early diagnosis and prevent unnecessary surgical resections.

Síndrome metabólico y trastorno afectivo bipolar: una revisión de la literatura / Metabolic Syndrome and Bipolar Affective Disorder: A Review of the Literature

Resumen El trastorno afectivo bipolar (TAB) es un trastorno psiquiátrico crónico que se encuentra entre las primeras diez causas de incapacidad y mortalidad prematura en el mundo. El síndrome metabólico (SM) es una constelación de factores de riesgo (FR) que predisponen a enfermedad cardiovascular (ECV), diabetes mellitus y mortalidad precoz. Ambas enfermedades generan grandes costos para el sistema de salud. Importantes estudios han demostrado que el SM tiene mayor prevalencia en los pacientes con enfermedad mental que en la población general. El SM en el TAB es multifactorial y se debe a causas iatrogénicas, genéticas, económicas, psicológicas, comportamentales y relacionadas con el sistema de salud. El FR más común es el aumento de la circunferencia abdominal, y el riesgo de padecer esta enfermedad es mayor en las mujeres y los hispanos. Acerca del incremento en los FR de sufrir una ECV en los pacientes con TAB, se han postulado múltiples explicaciones basadas en los comportamientos de riesgo comunes entre estos individuos, como el consumo de tabaco, la inactividad física y el exceso de calorías en la dieta. Una explicación adicional es la visión del TAB como una enfermedad inflamatoria multisistémica, sustentada en la explicación de la inflamación como elemento crucial en la aterosclerosis, la disfunción endotelial, la rotura de placa y la trombosis. La fisiopatología del SM en el TAB incluye factores como disfunciones adrenal, tiroidea y del sistema nervioso simpático, malos hábitos de vida y alteraciones secundarias a medicamentos comunes entre estos pacientes. Este artículo pretende dar una visión general de la información publicada hasta la fecha sobre la relación entre TAB y SM.

Abstract Bipolar disorder (BD) is a chronic psychiatric disorder that is found within the first ten causes of disability and premature mortality. The metabolic syndrome (MS) is a group of risk factors (RF) that predispose to cardiovascular disease (CV), diabetes and early mortality. Both diseases generate high costs to the health system. Major studies have shown that MS has a higher prevalence in patients with mental disorders compared to the general population. The incidence of MS in BD is multifactorial, and due to iatrogenic, genetic, economic, psychological, and behavioral causes related to the health system. The most common RF found is these patients was an increased abdominal circumference, and it was found that the risk of suffering this disease was greater in women and Hispanic patients. As regards the increase in RF to develop a CV in patients with BD, there have been several explanations based on the risky behavior of patients with mental illness, included tobacco abuse, physical inactivity and high calorie diets. An additional explanation described in literature is the view of BD as a multisystemic inflammatory illness, supported by the explanation that inflammation is a crucial element in atherosclerosis, endothelial dysfunction, platelet rupture, and thrombosis. The pathophysiology of MS and BD include factors such as adrenal, thyroid and sympathetic nervous system dysfunction, as well as poor lifestyle and medication common in these patients. This article attempts to give the reader an overall view of the information published in literature to date, as regards the association between BD and MS.