[Abdominal pain syndrome and quality of life in patients with cholelithiasis after cholecystectomy during a 10-year follow-up]. / Abdominal'nyi bolevoi sindrom i kachestvo zhizni u bol'nykh zhelchnokamennoi bolezn'yu posle kholetsistektomii pri 10-letnem nablyudenii.

AIM: To estimate the incidence of abdominal pain syndrome (APS) and to assess quality of life (QOL) in patients within 10 years after cholecystectomy (CE). SUBJECTS AND METHODS: This investigation is part of a long-term prospective follow-up study of patients after CE for cholelithiasis (CL). It enrolled 145 people: 30 (21.5%) patients with baseline asymptomatic CL and 115 (80.7%) with its clinical manifestations. The time course of changes in APS and QOL were analyzed. RESULTS: Over 10 years, all the patients showed a decrease in the incidence of APS from 84.1% (n=95) to 66.4% (n=75; p=0.004). In Group 1 (n=89), APS was at baseline detected in all the patients; 10 years later, its incidence declined to 67.4% (n=60; p < 0.001). Biliary pains were predominant; these had been identified significantly less frequently over the 10-year period in 47 (52.8%) patients; p<0.001). In Group 2 (n=24), pre-CE APS was generally detected in 6 (25%) patients; following 10 years, the incidence rates of pain significantly increased to 62.5% (n=15; p=0.035), among which there were predominant biliary pains (in 54.2%; p<0.001) and dyspepsia from 33.3% (n=8) up to 66.7% (n=16; p=0.039). QOL in the physical and mental health domains was found to decrease in both groups. CONCLUSION: Ten years after CE, the group with the baseline clinical manifestations of CL and poorer QOL showed a lower incidence of APS mainly due to the reduced incidence of biliary pains and the baseline asymptomatic group exhibited a rise in the incidence of APS due to the appearance of biliary pains and dyspepsia.

THE FREQUENCY OF DYSPEPTIC DISORDERS FOLLOWING CHOLECYSTECTOMY PATIENTS ACCORDING TO THE 10-YEAR STUDY.

AIM: To evaluate gastrointestinal symptoms during 10 years after cholecystectomy in patients with symptomatic and asymptomatic gallstone disease and to identify predictors of them. MATERIALS AND METHODS: The work is the part of a prospective long-term monitoring of patients with symptomatic (1) and asymptomatic (2) gallstone disease after cholecystectomy (CE). The study included 145 patients: 115 (80.7%) with initially symptomatic disease (1) and 30(21.5%) asymptomatic (2) disease. RESULTS: The frequency of heartburn increased from 15.9% to 63.7% during 10 years (p = 0.015) after CE especially in the group (1) (from 2.24% to 68.53% (p 0.037). The frequency of "bitter taste in the mouth" raised from 46.9% before the CE to 69.02% after CE (p < 0.001). The frequency of diarrhea increased from 0.88% to 38.2% in both groups. (p = 0.046). CONCLUSION: The frequency of heartburn, "bitter taste in the mouth", diarrhea increased in patients after 10 years in patients with symptomatic and asymptomatic gallstone disease after CE. A common risk factors are presence symptomps at baseline and the presence of these symptoms at the 6rst years after CE.

HEPATIC SARCOIDOSIS.

Sarcoidosis is a multisystemic disease of unknown origin characterized by the formation of non caseating granulomas. Thoracic involvement is the most common presentation; however, sarcoidosis can involve almost any other organ. Liver is one of the most frequently affected organs after lungs and lymph nodes. Microscopic hepatic involvement is common in these patients but is mostly clinically silent. specific symptoms include jaundice and pruritus, mostly from chronic cholestasis. In a significant portion of these patients, macroscopic findings can be detected by ultrasound examination ,abdominal CT or magnetic resonance imaging and these findings may easily be confused with other benign and malignant conditions of the liver. Liver biopsy is usually required to confirm the diagnosis. Not all cases of hepatic sarcoidosis require treatment. For symptomatic patients, the first line treatment includes corticosteroids or ursodeoxycholic acid.

FULMINANT PARACETAMOL HEPATITIS.

This article describes a clinical case of fulminant paracetamoly hepatitis a young woman of 33 years. Fulminant hepatitis has developed as a consequence of uncontrolled reception paracetamol-containing medicines for acute viral infection. Paracetamol poisoning conlirmed at autopsy.

[Long-term dynamics of gastrointestinal symptoms after cholecystectomy for the treatment of cholelithiasis].

The aim of the work was to analyse dynamics of gastrointestinal symptoms and risk factors at different periods after cholecystectomy (CCE) in patients with cholelithiasis (CL). It was a prospective open cohort observational study with interviewing the patients before, 6 and 36 months after cholecystectomy for the treatment of CL. The pain symptom of CL persisted in 65.9% of the patients till the 6th month after CCE and in 57.3% of the patients till the 36th month. The logistic univariant analysis showed high probability of persistence and/or appearance of biliary pain within 6 months after surgery in patients suffering biliary colic before it (OR = 5.3, p = 0.01) and having hereditary aggravation of CL (OR = 2.7, p = 0.38). The relationship between biliary pain and planned surgical intervention for the treatment of CL was documented 3 years after the operation (OR = 2.6, p = 0.018). Similar relationship was revealed after 6 and 36 months (OR = 3.8, p = 0.002). Biliary pain within 6 months after CL was an independent prognostic factor of its development within the next 3 years. Other increasingly severe gastrointestinal symptoms were heartburn, intolerance of greasy food, and disturbed intestinal passage as a result of biliary insufficiency or disordered intestinal motility. The above relationships between gastrointestinal symptoms may be used to predict their appearance within 6 months after CL.

[Cystatin C: a biological role and impaired secretion in viral hepatitis c and hepatic cirrhosis].

Cystatin C is a non-glycated cationic protein with a molecular weight of 13.3 kD, which belongs to the superfamily of cystatins; its basic function is to inhibit and regulate the activity of cysteine proteinase. In apparently healthy individuals, the extracellular concentration of cystatin C is shown to be substantially higher in serum than in urine and bile. The increased serum concentration of cystatin C has been found in the development of chronic viral hepatitis C, and hepatic cirrhosis in particular, which reflects the development of an inflammatory process and, evidently, the higher secretion of cystatin C by stimulated macrophages.

[Biliary tract in patients with chronic viral hepatitides].

AIM: To characterize motor-kinetic and inflammatory changes in extrahepatic biliary tracts and gallbladder in patients with chronic viral hepatitis (CVH). To ascertain whether there is a pathogenetic correlation between affection of the biliary system and viral infection. MATERIAL AND METHODS: The condition of the biliary tract was examined in 183 patients with CVH using fractionated duodenal tubing with biochemical tests and bacteriological investigation of bile, dynamic ultrasonic investigation. RESULTS: 69.9% patients were diagnosed to have dysfunction of the Oddi's sphyncter caused by its hypertonicity, 4.4% patients had hypotonic sphyncter. Hyper- and hypotonicity of the gallbladder were observed in 45.8 and 20.8% patients, respectively. Biliary dysfunction was associated with the process activity but not with a nosological form of the disease. Chronic acalculous cholecystitis was verified in 21.2% patients. CONCLUSION: Chronic HBV and HCV infections are accompanied with biliary dysfunctions associated with activity of inflammation in the liver. Oddi's sphincter dysfunction in CVH is a risk factor of gallbladder inflammation.