[The development of medical technologies for the spa and resort rehabilitation of patients presenting with pathology of the biliary system taking into consideration circumannual biorhythms].

This study included 188 patients presenting with pathology of the biliary system, such as dyskinesia of bile ducts, chronic non-calculous cholecystitis (CCC), and dysfunction of the bile system. The objective of the work was to develop complexes of intensive non-medicamental rehabilitative treatment for the correction of the adaptive potential of the organism in the springtime (March-May). It was shown that the efficacy of therapy during this period can be improved by modulation of the complex structure. New treatment modalities were proposed taking into consideration specific changes of clinical characteristics in different phases of the circumannual cycle and curative effects of various therapeutic factors that increase the adaptive potential of the organism. These complexes allowed both the efficiency and the tolerability of the treatment to be improved. It is concluded that the use of corrected complexes of intensive therapy in springtime (March-May) permits to reduce the duration of therapy by 5-6 days from the usual 21-24 days using the traditional approach.

[Physical exercise in combined outpatient rehabilitation of patients with ischemic heart disease associated with biliary dysfunction].

AIM: To study prevalence of gastrointestinal symptoms (GIS) including gall-bladder dysfunction (GBD) in coronary patients after acute coronary event (ACE) and effects of early physical exercise (PE) of moderate intensity in coronary patients with GBD on efficacy of outpatient rehabilitation. MATERIAL AND METHODS: A two-stage trial was conducted. Stage 1: 237 coronary patients responded to questionnaire detecting incidence of GIS including GBD 8 weeks after ACE. Stage 2: 85 coronary patients with verified GBD were examined for efficacy of rehabilitation. Of them, 43 patients entered PE group while 42 patients entered a control group. The latter received standard therapy without PE. The efficacy of the treatment was evaluated by clinical, device and biochemical findings at baseline and 12 months later. RESULTS: Of 237 coronary patients 217 (91.7%) patients 2 months after ACE had symptoms of coronary insufficiency, 192 (81.3%) had GIS, 78.9% had GBD. Patients from PE group significantly improved exercise tolerance (bicycle exercise test reached 79.3 +/- 15 and 121.3 +/- 14.5 bt (p < 0.05), respectively. These patients demonstrated improvement of gall-bladder contraction, a decrease in the level of total cholesterol from 6.12 +/- 0.4 to 4.7 +/- 0.2 mmol/l (p < 0.05), of LDLP cholesterol from 3.85 +/- 0.21 to 2.86 +/- 0.32 mmol/l (p < 0.05), thioldisulphide coefficient from 13 +/- 0.3 to 2.7 +/- 0.4 (p < 0.01). The intergroup analysis 12 months after the study revealed significant differences in favor of the PE group. A weekly number of anginal attacks reduced from 5.1 +/- 1.5 to 1.3 +/- 1.4 (p < 0.01). CONCLUSION: The exercise program is rather effective and can be practiced outpatiently in coronary patients after ACE associated with GBD. It can be also used for secondary prophylaxis of cholestasis in coronary patients with biliary problems.

Trauma del Hígado y de la Vía Biliar

El traumatismo hepático se observa frecuentemente en el paciente con trauma abdominal y su mortalidad alcanza el 10 por ciento; los tipos de lesión qu se presenta son laceración, hematoma, lesión vascular según la clasificación de Moore y Shackford. Los principios del manejo quirúrgico inlcuyen medidas hemostáticas básicas como la aplicación de presión y electrocauterio. Sin embargo, la evolución tecnológica de la tomografía permitió el resurgimiento del manejo no operatorio y su predicción como terapia de manejo en este tipo de pacientes; su éxito se basa en la identificación adecuada de los mismos y en el seguimiento estricto de un protocolo preestablecido. La baja incidencia de complicaciones y mortalidad refleja la efectividad de esta terapia. Las lesiones de la vía biliar ocurren con baja frecuencia en el paciente traumatizado y la mayoría son el resultado de mecanismos penetrantes; son de difícil diagnóstico y llevan consigo una alta morbilidad