[Adenomyomatosis of the gallbladder the analysis of 328 operating cases].

UNLABELLED: Adenomyomatosis (AMM) is related to the group of hyperplastic cholecystosis. Despite a long history of studying the problem, many questions concerning the etiology, pathogenesis, prevalence, tactics, management and treatment remain unsolved. OBJECTIVE: To set the frequency of the AMM, its types, nature of pathological changes in the wall and lumen of gallbladder on the base of analizing the gallbladders after surgical removal. MATERIAL AND METHODS: ultrasound examination, macro--and microscopic evaluation of 328 cases of the AMM gallbladders. RESULTS: According to ultrasound examination detection rate of AMM was 16.6%, and aacording to the study of surgical material--33%. The average age of patients 53 years old, male to female ratio--1:3,7. In 193 cases, the AMM was combined with concrements in gallbladder, in 70 cases the AMM was combined with polyps, among them in 40 patients the polyps were combined with concrements. In 175 patients we visualy analyzed the compaund of stones in gallbladder, in 112 cases there were the cholesterol stones (64%), in 51 cases--pigment stones (29.1%), in 12 patients (6.9%)--mixed. In some cases, was mentioned a combination of different AMM forms: adenomyoma on the background of diffuse adenomiomatosis--3.3%, diffuse form of AMM with more emphasized segmental lesions in one of the parts of gallbladder--6.1%, adenomyoma in one part combined with segmental lesions of another part of the gallbladder in 1.2% cases. In 64.9% cases, the AMM was combined with lipomatosis, in 56.7% cases--with the cholesterosis. CONCLUSION: The AMM is not a rare disease of gallbladder, and according to the histological examination of surgical material is detected in 31% of cases, and is oftenly combined with other types of hyperplastic cholecystosis.

[10 years of cholelithiasis classification (Central Scientific Research Institute of Gastroenterology): highlights of scientific and practical applications].

Clinical classification of cholelithiasisis presented, which includes 4 stages: stage without calculi, stage of formed gallstones, chronic calculous cholecystitis and complications. Sonographic description of main versions of biliary sludge, its causes and therapy efficacy are also given.

[Forced resection of the liver right lobe in the patient with cholelithiasis].

There is a case of cholelithic illness complicated by cholangiolithiasis, the treatment of which resulted in resection of the right hepatic lobe.

[The combination of cholelithiasis, adenomyomatosis and xanthogranulomatous cholecystitis increases risk of gallbladder cancer].

The article presents a case of 18-year follow-up of 59 y. o. patient with cholecystolithiasis and adenomiomatosis, with the development of complications of rapidly progressing xanthogranulomatous cholecystitis with malignancy.

[Rationale for the allocation of clinical variants of the postcholecystectomical syndrome associated with bacterial overgrowth in the small intestine].

The article presents the literature data concerning the pathogenesis and clinical manifestations as postcholecystectomical syndrome and syndrome of bacterial overgrowth in the small intestine (ARIS). Was provided information on the microflora of the small intestine and factors affecting its formation. It is shown that the main clinical manifestations of ARIS influenced by intestinal motility disorders, the processes of intestinal digestion and absorption. Are also given own results, which allowed to justify the selection of a clinical variant postcholecystectomical syndrome associated with bacterial overgrowth in the small intestine.

[Cytoprotective effect of ursodeoxycholic acid on the gastroduodenal zone mucous membrane at elderly patients with a combination of gallstone disease and duodenal ulcer].

Was made a clinical-morphological study of elderly patients with a combination of cholelithiasis and duodenal ulcer. Was shown that prolonged ursoterapiya does not adversely affect the clinical course of duodenal ulcer, does not cause exacerbations of her elderly patients. These histological study of gastroesophageal and duodenobioptatov during treatment showed a positive effect of the ursodeoxycholic acid (UDCA) on the mucous membrane of the stomach and duodenum with the partial restoration of its structure, due to its cytoprotective effect.

[Rifaximin application in the overgrowth bacterial syndrome in the small intestine in patients after cholecystectomy].

UNLABELLED: The aim of the work was to determine the frequency of the overgrowth bacterial syndrome (OBS) in the small intestine in patients with postcholecystectomical syndrome (PHES) justify the need for correction of the microflora and to assess the effectiveness of rifaximin at a dose of 800 and 1200 mg/day. MATERIALS AND METHODS: With the help of the hydrogen breath test were examined 92 patients with PHES. 40 patients with OBS were treated with rifaximin, 20 of them received the drug at a dose of 800 mg and 20-1200 mg/day for 7 days. Effectiveness was determined by the dynamics of clinical symptoms and indicators of the hydrogen breath test. RESULTS AND DISCUSSION: OBS was detected in 76% of the patients with PHES, which justifies the holding of antibiotic therapy. Lack of acceleration of peristalsis of small intestine as a cause of diarrhea was confirmed by the study of the electromotive activity of the small intestine, which revealed no differences from the norm. In some patients on therapy at a dose of rifaximin 800 mg/day uncropped pain and dyspeptic symptoms and was not accompanied by normalization of the hydrogen breath test. In the treatment of rifaximin at a dose of 1200 mg/day was showed normalization of the hydrogen breath test parameters in 90% of patients and relief of clinical symptoms in most patients. CONCLUSION: Rifaximin at a dose of 1200 mg/day compared with a dose of 800 mg/day in patients with PHES associated with bacterial overgrowth in the small intestine, had a more pronounced clinical effect, as evidenced by positive dynamics in the form of relief of clinical symptoms and normalization of the hydrogen breath test.

[Biliary pathology. Key aspects of the problem].

Based on the clinical experience gained in the Department of Pathology biliary tract, Central Research Institute of Gastroenterology, were reviewed key aspects of biliary pathology on the issues of classification, diagnosis, treatment, and tactics for management of patients with various diseases of the biliary tract.

[Pharmacoeconomic analysis of treatment of certain diseases of the digestive system].

The article provides data of the pharmacoeconomic analysis (cost/effectiveness) of treatment of peptic ulcer, ulcerative colitis, Crohn's disease, gastroesophageal reflux disease, biliary sludge and cholelithiasis. It was shown that the most appropriate treatment scheme is one that characterized by lower costs per unit of effectiveness. Analysis of cost/effectiveness can give an economic assessment of clinical efficacy, compare alternative treatments and help to choose the method by which the efficiency increases faster than the level of costs.

[The substantiation of UDCA usage in functional disorders of biliary tract].

Ursodeoxycholic acid (UDCA) has been widely used in clinical practice, more frequently in liver diseases treatment. Studies have shown that UDCA has choleretic and cholecyst-kinetic effects. In this paper we give pathogenetic substantiation of UDCA use in the gall bladder dysfunction, hypotension, and identified in clinical usage of UDCA in hypokinesia of the gallbladder.

[Efficacy of rifaximine in small intestinal bacterial overgrowth syndrome in patients after cholecystectomy].

AIM: To define frequency of onset of small intestinal bacterial overgrowth syndrome (SIBOGS) in patients with postcholecystectomy syndrome (PCS); to substantiate necessity of microflora correction and assess efficacy of rifaximine in the doses 800 and 1200 mg/day. MATERIAL AND METHODS: A breath hydrogen test (BHT) was made in 82 PCS patients. Rifaximine was given to 40 SIBOGS patients: 20 of them received the drug in a dose 800 mg/day and 20--in a dose 1200 mg/day for 7 days. The efficacy was estimated by attenuation of the clinical symptoms and parameters of BHT. RESULTS: SIBOGS was detected in 73% of PCS patients. This was an indication for antibacterial treatment. Rifaximine in a dose 800 mg/day failed to attenuate pain and to eliminate dyspeptic syndromes in some patients, BHT in them was not normal. Administration of rifaximine in a dose 1200 mg/day normalized BHT in 90% patients and eliminated clinical symptoms in most of the patients. CONCLUSION: Rifaximine in a dose 1200 mg/day vs 800 mg/day in PCS patients with SIBOGS is more effective as it eliminates clinical symptoms and normalizes BHT.

[Biochemical characteristics of operating bile composition in different types of cholecystolithiasis].

With a view to predicting the outcomes of surgical treatment of cholelithiasis, depending on the composition of concretions by high performance liquid chromatography was studied lipid composition and the spectrum of the operating bile acids in 10 patients with bile pigment cholelithiasis, 15--with cholesterol cholelithiasis, 15--with a combination of cholesterol cholelithiasis, and scab forms cholesterosis gallbladder, 6--to polypous-mesh form cholesterosis gallbladder. As a control, use the operating bile 6 patients with adenomatous and fibro-adenomatous polyps of the gallbladder. Based on the results of the study was proved the need for correction of biliary insufficiency in patients operated on for cholesterin associated pathology of the gallbladder. Spectrum of bile acids of operating bile helped justify holding litholytic therapy to prevent aggregation of bile.

[Gallbladder adenomyomatosis].

THE AIM: to familiarize with the main clinical aspects of the adenomyomatosis gallbladder. Recent literature data show that adenomyomatosis of the gallbladder is not a rare disease and its frequency in cholecystectomy is 2-8.7%. It is more common after the age of 35-40 years and among women. Course of the disease is complicated by cholecystolithiasis, and localization in the bottom of the gall bladder-malignization. The main method of diagnosis is ultrasonography. For the differential diagnosis of cancer of the gall bladder used under the MRIs. Cholecystectomy is indicated for complications of cholecystolithiasis and suspected malignancy in the gallbladder.

[Disorders of bone mineral density in patients with cholelithiasis and postcholecystectomic syndrome].

AIM: to justify the role of biliary insufficiency (BI) in the development of disorders of bone mineral density (BMD) in patients with cholelithiasis and after cholecystectomy, to introduce with main methods of diagnosis, prevention and treatment of osteoporosis and osteopenia in biliary pathology. Recent literature data showed that development of BI in the CL and PS leads to malabsorption of vitamin D and thereby contribute to the development of osteoporosis and osteopenia. The main method of diagnosis of BMD is twoenergic X-ray densitometry.

[Changes in concentration of cholecystokinin-pancreozymin in patients with cholelithiasis before and after cholecystectomy].

The level of cholecystokinin and secretin in 50 patients after cholecystectomy (from 1 to 10 years ago) was analyzed to study connection between cholecystectomy and gastrointestinal hormones concentration. 30 patients with gall bladder stone disease were included into the group of comparison. Cholecystokinin and secretin concentration in the groups of research was compared with indicated hormones concentration in the group of control formed of healthy volunteers. After anamnestical clinical and diagnostical features in every group had been studied we concluded, that cholecystokinin level changes depending on period after operation and outflow of bile conditions.

[Diffuse thickening of the gallbladder wall. Clinical significance].

This article presents an analysis of the causes thickening of the gallbladder wall. It was shown that thickening of the wall of the gallbladder may be primary and secondary. Submitted by illustrations showing the thickening of the wall of the gall bladder in various diseases of the gallbladder.

[Efficacy of rifaksimin in excessive bacterial growth syndrome after cholecystectomy].

UNLABELLED: OBJECTIVE. To determine the frequency of the syndrome of excessive bacterial growth in patients with cholecystectomy and PL, justify the need for correction of intestinal microflora and to assess the effectiveness of rifaksimin decontamination. MATERIAL AND METHODS: The study involved 35 patients with gallstone disease (GSD) (3 men, 32 women, average age--59 +/- 9 years) and 50 patients who underwent cholecystectomy at the cholecystolithiasis (4 men, 46 women, average age--60 +/- 9 years). Inclusion criteria were the complaints that are characteristic for the syndrome of excessive bacterial growth in the small intestine (EBG). All the patients underwent clinical, laboratory and instrumental examinations and hydrogen breath test. In identifying the EBG was a rifaksimin treatment at a dose of 800 mg/day for 7 days. Treatment efficacy was determined by the dynamics of clinical symptoms and indicators of the hydrogen breath test at the 8 th and 30th day of observation. RESULTS AND DISCUSSION: Patients who was underwent cholecystectomy, EBG was detected in 58%, and among patients with gallstone disease--in 28%. The rifaksimin treatment to 8 th day was declining intensity of clinical symptoms correlated with the dynamics of the hydrogen breath test. On day 30 the majority of patients clinical symptoms of EBD disappeared (from 56 to 75% depending on the symptoms), but in some patients it persisted, despite the reduction in their severity. These data also correlated with the dynamics of the hydrogen breath test. CONCLUSION: At cholecystolithiasis and in patients with removal of the gallbladder detected EBG in 28 and 52% respectively, which requires corrective therapy. The rifaksimin therapy have positive dynamics in relieving clinical symptoms and the decline in the hydrogen breath test. However, some patients with therapy at a dose of 800 mg/day uncropped pain and dyspeptic symptoms and hadn't accompanied by normalization of pH test.