[Diagnostic difficulties and remission criteria of autoimmune pancreatitis].

The paper describes a clinical case in a 56-year-old female patient who has been suffering from chronic autoimmune pancreatitis, chronic recurrent cholangitis for 3 years. It demonstrates diagnostic difficulties at the early stage of the disease, the specific features of its course, the sequence of treatment in the patient, and problems in choosing a therapy option to achieve a remission.

[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.

[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.

[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.

[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.

[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.

[Features of diagnosis and clinics of gallbladder cholesterosis in children].

UNLABELLED: Cholesterosis in childhood--this is a new poorly studied disease, which only begins to highlight in current literature. According to this our work was to study the clinical characteristics and to develop diagnostic criteria of gall bladder cholesterosis in children. MATERIALS AND METHODS: 66 children with cholesterosis gall bladder at the age of 1 year to 15 years were under the supervision. There were 30 girls and 36 boys. The diagnosis was confirmed in the performance of transabdominal ultrasound examination and endoscopic (transesophageal) ultrasonography, magnetic resonance tomography. The cholesterosis of the gall bladder was confirmed by histological examination of the gall bladder wall at 41 children. This article describes the clinical course of gall bladder cholesterosis in children. It was shown an importance of laboratory and instrumental methods of investigation. It was presented an algorithm of children diagnostics and monitoring with gallbladder cholesterosis.

[Endosonography in the diagnostics of non-epithelial tumors of the esophagus, stomach and duodenum].

Non-epithelial tumors account for 5% of all neoplasms of the gastrointestinal (GI) tract, most often have no clinical manifestations and they are finding during the endoscopy. Visual inspection and standard method for gable biopsy doesn't let to verify the kind of education. Endoscopic ultrasonography (EUS) significantly expands the possible differential diagnosis of submucosal formations on the basis of their ultrasound characteristics. The article presents the literature and personal experience of differential diagnosis of non-epithelial tumors, and benign formations of the esophagus, stomach and duodenum wall.

[Lymphoplasmocytic (IGG4-associated) cholecystitis developed in a case of prolonged gallbladder adenomyomatosis].

The article presented a rare clinical observation of 55 years old patient, long-suffering from gall bladder adenomiomatosis, for which the subsequent development was complicated by lymphocytoplasmocytic cholecystitis.

[Quantitative analysis of morphological manifestations of cholesterosis and concomitant pathology of the gall bladder]. / Kolichestvennyi analiz morfologicheskikh proiavlenii kholesteroza i soputstvuiushchei patologii zhelchnogo puzyria.

Morphological study of 345 cholecytectomies revealed gall bladder cholesterosis in 173 cases. Network form of cholesterosis was most frequent (73.8%), polyposis-network was in 18.5% and only 8.7% polypoid form of cholesterosis was found. The frequency was similar in males and females, the polypoid form prevailed in males, reticular form in females. Main site of cholesterosis was the gall bladder body. Combination of cholesterosis with cholelithiasis was in 151 cases (87.3%), adenomyomatosis occurred in 33 patients (19%). Cholesterol polyps were found in 47 patients, in 30 of them they were multiple. The size of cholesterol polyps varied from 2 to 17 mm. For the first time mixed glandual-cholesterol polyps are described. Morphological picture of xanthogranulomatous cholecystitis was in 7 patients. The morphological difference between foam and xanthome cells is presented.

[Efficacy of ursodeoxycholic acid in gallbladder cholesterosis accompanied by cholecystolithiasis]. / Effektivnost' ursodezoksikholevoi kisloty pri kholeseroze zhelchnogo pyzyria, sochetaiushchemsia s kholetsitolitiazom.

23 patients with gall-bladder cholesterosis associated with cholesterol gallstones were treated with ursodeoxycholic acid preparations. A regression of cholesterol polyps was recorded in 56.5% against the background of treatment, and complete or partial dissolution of gallstones was observed in 87%. The efficiency of dissolution of cholesterol polyps and stones in the gall-bladder went up along with the extension of the therapy terms, reaching its maximum by 7-9 months of treatment. The dissolution rates were higher for gallstones than for cholesterol polyps. The volume of bile being secreted increased, and the gall-bladder contractile function improved in the course of treatment.

[Effectiveness of ursodeoxycholic acid in cholesterosis of the gallbladder]. / Effektivnost' ursodeoksikholevoi kisloty pri kholesteroze zhelchnogo puzyria.

AIM: To study efficacy of ursodesoxycholic acid (UA) drugs in the treatment of polypous and polyporeticular cholesterosis of the gallbladder (CGB), including combination with biliary sludge, with reference to terms of the treatment. MATERIAL AND METHODS: A contraction function of the gallbladder was studied ultrasonically in 74 CGB patients treated with UA drugs. The treatment lasted from 1 month to 1.5 years. A response (complete or partial dilution of cholesterol polyps) was recorded in 71.6% patients. Therapy was less effective if the gallbladder contained biliary sludge, heterogeneous bile and suspension, dense bile. The lytic therapy effect improved with treatment duration. Complete dissolving of cholesterol polyps was achieved after at least 10-month treatment. The treatment also brought about a marked choleretic effect and an increased ejection fraction of the gallbladder. CONCLUSION: UA drugs can be used in the treatment of CGB.

[Causes of biliary sludge]. / O prichinakh vozniknoveniia biliarnogo "sladzha".

AIM: To specify characteristics of biochemical bile composition contributing to destabilization of colloid properties of bile in patients with biliary "sludge". MATERIAL AND METHODS: 37 patients with "sludge" in the gallbladder (GB), 10 patients with cholelithiasis and 10 patients with intact GB participating in the study were examined for bile portion B bile acids (BA), cholesterol and phospholipids (PL); lipid and lipoprotein blood composition. RESULTS: Three types of biochemical composition of bile in GB "sludge" patients were identified. 22 patients had elevated levels of cholesterol and PL in subnormal content of BA (group 1); 9 patients had normal FA and cholesterol, low content of biliary PL (group 2); 6 patients had normal concentrations of the three components (group 3). Blood lipids were characterized by elevated levels of total cholesterol and LDLP cholesterol in group 1; low HDLP cholesterol and triglycerides in group 2 and almost normal values in group 3. Basing on these data, causes of "sludge" formation in the GB are suggested. CONCLUSION: Biliary "sludge" may form because of excessive cholesterol in bile, low phospholipid levels or in normal proportion of the studied substances.

[Cholesterosis of the gallbladder: review of literature]. / Kholesteroz zhelchnogo puzyria: obzor literatury.

The article presents the latest literature data related to the problems of epidemiology, etiology, pathogenesis, morphological changes, diagnostics, classification, clinical coarse and treatment of gallbladder cholesterosis.