[Psychoemotional and autonomic states in patients with cholelithiasis]. / Psikhoémotsional'noe sostoianie i vegetativnyi status bol'nykh pri zhelchnokamennoi bolezni.

AIM: To investigate the psychoemotional and autonomic states of patients with biliary system diseases and to determine their significance in the development of cholelithiasis. SUBJECTS AND METHODS: A total of 396 patients with stage 1 cholelithiasis were examined. The results of hepatobiliary ultrasonography, multifractional duodenal probing, followed by macroscopic, microscopic, and biochemical examinations of bile (the total concentration of bile acids and cholesterol, by subsequently calculating the cholate-cholesterol ratio) were used to verify the diagnosis. The functional state of the hepatobiliary system was evaluated by dynamic echocholecystography and dynamic hepatobiliscintigraphy. To characterize the emotional state, the investigators applied indicators of the motivational sphere and orientation of an individual and his/her mental state, such as reactive anxiety, personal anxiety, the levels of depression and neuroticism, and intra-, extraversion. The autonomic state was determined from autonomic tone, autonomic reactivity, and autonomic support. RESULTS: Biliary lithogenesis was found to be related to psychoemotional and autonomic states. In cholelithiasis, there was an increase in reactive and personal anxiety and a predominance of diminished parasympathetic and perverted sympathetic autonomic reactivity. The signs of emotional instability and autonomic dystonia were shown to increase with age and the degree of an autonomic response depended on the severity of mental and emotional disorders. CONCLUSION: The results of these comprehensive studies can reveal new pathophysiological patterns of lithogenic bile formation and enhance our understanding of the pathogenesis of cholelithiasis.

[THE REMOTE RESULTS OF SIMULTANEOUS LAPAROSCOPIC CORRECTION OF CHRONIC DUODENAL OBSTRICTION AND CHOLECYSTECTOMY IN CHOLELITHIASIS].

The aim of the research was to investigate the remote results of surgical treatment of 75 patients with cholelithiasis combined with chronic duodenal obstruction. Control group was composed of 40 patients who underwent laparoscopic cholecystectomy. Compensated stage of cholelithiasis with chronic duodenal obstruction was detected in 16 (21.3%) patients, subcompensated in 37 (49.3%) and decompensated stage in 17 (22.7%) patients. In 14 patients (18.7%) with cholelithiasis combined with chronic duodenal obstruction laparoscopic cholecystectomy was conducted due to the positive results of preoperative conservative treatment. In the long-term quality of life after surgery in the main group of patients were average 35.4% higher than in the control group; in the main group postcholecystectomical syndrome was diagnosed in one case (2,1%) and in 13 (32,2%) cases in the control group.

[The relationship between the effectiveness and specific features of the early postoperative rehabilitation of the patients presenting with cholelithiasis].

The objective of the early postoperative rehabilitation of the patients presenting with cholelithiasis is to prevent the further progression of the disease and reduce the risk of development of post-cholecystectomy disorders. The combined treatment including the use of low-mineralized mineral waters, magnetic, laser, and EHF-therapy makes it possible to significantly improve the parameters of interest due to the marked improve mentor normalization of the clinical and laboratory characteristics, the increase of adaptive capabilities, and the correction of the psycho-emotional and vegetative status of the patients. Taken together, the peculiarities of the combined rehabilitative treatment of the patients with cholelithiasis during the early postoperative period account for its high clinical effectiveness amounting to 94.7%. The results of the study give reason to recommend the application of the proposed technology for the rehabilitative treatment of the patients presenting with cholelithiasis.

The risk of depression in patients with cholelithiasis before and after cholecystectomy: a population-based cohort study.

The association between cholelithiasis and depression remains unclear. We examined the risk of depression in patients with cholelithiasis. From the National Health Insurance population claims data of Taiwan, we identified 14071 newly diagnosed cholelithiasis patients (4969 symptomatic and 9102 asymptomatic) from 2000 to 2010. For each cholelithiasis patient, 4 persons without cholelithiasis were randomly selected in the control cohort from the general population frequency matched by age, sex, and diagnosis year. Both cohorts were followed up until the end of 2011 to monitor the occurrence of depression. Adjusted hazard ratios (aHRs) of depression were estimated using the Cox proportional hazards model after controlling for age, sex and comorbidities. The overall incidence rates of depression were 1.87- and 1.83-fold greater in the symptomatic and asymptomatic cholelithiasis subcohorts than in the control cohort (incidence, 10.1 and 9.96 vs 5.43 per 1000 person-years, respectively). The multivariable Cox proportional hazards regression analysis revealed higher variable-specific aHRs in women than in men, in younger patients than in older patients, and in those without comorbidities than in those with any comorbidity. Cholecystectomy reduced the hazard of developing depression with aHRs of 0.79 (95% confidence interval [CI] 0.62-0.99) for symptomatic cholelithiasis patients and 0.76 (95% CI 0.60-0.96) for asymptomatic patients. Patients with cholelithiasis are at a higher risk of developing depression than the general population. Patients could be benefited from cholecystectomy and have the hazard of developing depression significantly reduced.

[An effect of endoscopic cholecystectomy on neurological status, cognitive functions and anxiety feelings in women with chronic calculous cholecystitis].

A comparative clinical study of 136 female patients with uncomplicated chronic calculous cholecystitis, including 106 patients examined in the pre- and postoperative periods of endoscopic cholecystectomy, revealed the effect of chronic illness and surgery on the neurological status and cognition which was more pronounced in adulthood. We investigated anxiety feelings before and after surgery. Our findings should be taken into consideration in the preoperative preparation of patients and their care in the postoperative period.

[The early postoperative rehabilitation of the patients presenting with cholelithiasis and experiencing psychoemotional stress].

Early postoperative rehabilitation of the patients presenting with cholelithiasis and experiencing psychoemotional stress is designed to restore the function of bile secretion, enhance their adaptive capabilities, and normalize the psychovegetative status for the purpose of preventing further progress of the disease and reducing the risk of the development of post-cholecystectomy syndrome. The inclusion of drinking mineral water, magnetic laser therapy, and UHF therapy in the combined rehabilitative treatment of such patients results in the appreciable enhancement of all functional abilities of the body manifest as the significant improvement and normalization of clinical and laboratory characteristics (elimination of clinical symptoms of the disease, improvement of general and biochemycal parameters of peripheral blood). Simultaneously, the adaptive capabilities and the psychovegetative status of the patients improved as apparent from the increased lymphocyte count, normalization of the Kerdo and Hildebrandt indices and indices of stress level, decreased psychoemotional stress, enhancement of physical functioning characteristics. Taken together, these changes account for the high effectiveness of the above procedures of early postoperative rehabilitation of the patients presenting with cholelithiasisand experiencing psychoemotional stress (94.7%).

Postoperative outcomes and quality of life in patients with cystic fibrosis undergoing laparoscopic cholecystectomy: a retrospective study.

BACKGROUND: Approximately 28% of the patients with cystic fibrosis are affected by cholelythiasis. More than 40% of them have a symptomatic disease, which would mandate cholecystectomy. AIM: The aim of this study was to review surgical and respiratory outcomes and quality of life scores of cystic fibrosis patients undergoing laparoscopic cholecystectomy for symptomatic cholelythiasis to verify the hypothesis that cholecystectomy is a low-risk operation by laparoscopy, not affecting unfavorably respiratory function and quality of life. PATIENTS AND METHODS: Study group was consisted of 9 patients with a mean age of 24.8±8.1 years (range, 15 to 38 y), 2 male and 7 female patients, with cystic fibrosis and symptomatic cholelithiasis. Three patients also presented common bile duct stones. All the patients underwent perioperative Positive End-Expiratory Pressure mask sessions and aggressive antibiotic regimens. At the middle of the antibiotics regimen period, a standard laparoscopic cholecystectomy was performed. In the 3 cases with common duct lithiasis, the so-called "rendezvous" technique was carried out. Preoperatively, intraoperatively, and postoperatively, respiratory function was strictly monitored by the evaluation of SO2 and of the forced expiratory volume in 1 second (FEV1). Preoperatively and 6 months after laparoscopic cholecystectomy the Gastro Intestinal Quality of Life Index was evaluated on all patients. RESULTS: All the operations were completed laparoscopically. No mortality was observed. The intraoperative mean SO2 was 89.0%±5.6% (range, 80% to 95%), versus 82.8%±8.5% (range, 66% to 91%) at the extubation (P=0.006). Intraoperative respiratory functions were stable in 6 patients. In 3 patients, a severe bronchospasm occurred determining marked desaturation. Preoperative mean FEV1 was 70.5%±7.0% (range, 55% to 75%) versus 61.8%±13.2% (range, 39% to 80%) 48 hours after the operation (P=0.132). The 3 patients, who experienced intraoperatively severe bronchospasm, reported a 48 hours postoperative FEV1 under 60%. All the patients showed disappearance of postprandial colicky pain and vomiting. Preoperative mean total Gastro Intestinal Quality of Life Index score was 105.2±13.6 versus 117.8±10 at 6-month follow-up (P=0.015). CONCLUSIONS: On the basis of a proper surgical timing and adequate preoperative physiokinesis therapy, laparoscopic cholecystectomy is a safe and indicated procedure in patients with cystic fibrosis and symptomatic cholelithiasis and it is able to significantly improve the quality of life. Quality of life of these patients it not worsened while symptoms and risks of biliary gallstones are removed.

[Effectiveness of combined application of ursosan and anxiolytic 2-mercaptobenzimidazole in early stage of cholelithiasis].

We spent the complex investigation of therapeutic efectiveness of ursosan and afobasol in 125 patients with gallstone disease on early stage (before stones). After the course of treatment we revealed positive changes of clinical symptoms and improvement of biochemical bile compound. Besides we found the positive changes in hormone levels correlated with decreasing of bile lithogenity.

Quality-of-life measures in Taiwanese adults with symptomatic gallstone disease.

PURPOSE: The objective of this study was to investigate the association of quality-of-life status with baseline laboratory findings among Taiwanese adults having symptomatic gallstone disease. METHODS: A prospective quality-of-life survey was administered at a tertiary referral medical center among 102 consecutive adults with symptomatic gallstone disease. Patients underwent regular laboratory testing at admission and were evaluated using the 36-Item Short-Form Health Survey (SF-36) and the Gastrointestinal Quality of Life Index (GIQLI). Correlation and regression models were used to investigate quality-of-life predictors. RESULTS: Compared with the general Taiwanese adult population, patients having symptomatic gallstone disease had significantly poorer performance on all eight SF-36 subscales (P < 0.001). Total GIQLI showed moderate to strong correlation with all eight SF-36 subscale scores (gamma = 0.29 ~ 0.62, P < 0.05). In multivariate analysis, serum levels of direct bilirubin (beta = -32.6, P = 0.001) and alkaline phosphatase (beta = -13.6, P = 0.032) were predictive of worse total GIQLI (adjusted R (2) = 0.183). CONCLUSIONS: Symptomatic gallstone disease may considerably affect patient quality of life in terms of general health status and gastrointestinal-specific measures. Before gallstone surgery, serum levels of direct bilirubin and alkaline phosphatase significantly correlated with quality-of-life measures and can be used to evaluate patient well-being at admission.

Quality of life following colorectal cancer surgery: the role of alexithymia.

BACKGROUND: Alexithymia refers to a set of cognitive and emotional deficits. Its effect on surgical outcome has been demonstrated but no studies have been published on colorectal cancer patients. STUDY DESIGN: A series of 60 consecutive colorectal cancer patients were enrolled in a 3-year prospective study on quality of life by using the SF-36 test and Toronto Alexithymia Scale questionnaires. Patients were investigated pre- and postoperatively (before discharge and then 1 and 3 months thereafter). The control group consisted of patients undergoing laparoscopic cholecystectomy for cholelithiasis. These two groups were divided into two subsets: high-level alexithymia (HA) and low-level alexithymia (LA). The prevalence of HA was 34% in colorectal patients and 35% in cholelithiasis patients. RESULTS: During the postoperative period, in the colorectal group the SF-36 score was significantly higher in HA than in LA subsets. This result was confirmed in the cholelithiasis group. During follow-up, a progressive reduction of the SF-36 score was observed in both HA populations. DISCUSSION: Results emerging from this investigation demonstrate that surgery significantly improves the quality of life in HA patients. These findings suggest that alexithymia might be advantageous in evaluating the adaptation after surgery in the short follow-up period.

The leap to trust: perspective of cholecystectomy patients on informed decision making and consent.

BACKGROUND: Although experts in ethics and law prescribe autonomous decision making as an essential component of informed consent to operative treatment, patients with esophageal cancer told us in a previous study that they preferred to entrust decision making to their caregivers in the context of life-threatening illness. The purpose of this study was to describe the patients' perspective on the process of informed decision making and consent to operative treatment in the context of a less frightening illness and intervention. STUDY DESIGN: Face-to-face interviews with 33 patients recovering from elective cholecystectomy for cholelithiasis were conducted at Toronto General Hospital in Ontario, Canada. The views of patients were analyzed using a qualitative approach. RESULTS: Patients described a spectrum of initial attitudes toward operative treatment ranging from profound distrust to unquestioning faith. Important factors influencing the decision to accept cholecystectomy included increasingly intolerable symptoms and fear of complications of the disease. Patients managed their doubts and fear by various means, without fully resolving them. CONCLUSIONS: In the context of symptomatic chronic cholelithiasis, pathways to consent for operative treatment originated at diverse, culturally determined starting points. Patients work their way through the decision process along many paths. Some rely on gathering information, but eventually all set aside unresolved residual doubts and fears, enabling a leap to trust and a decision to act.

Psychological factors influencing results of cholecystectomy.

BACKGROUND: Cholecystectomy is a surgical gold-standard procedure for gallbladder diseases, among which gallstones are the most frequent. Despite the introduction of minimally invasive surgery and broad access to ultrasound examination there is a group of patients in whom the surgery ailments persist. Those vague ailments can be perceived from a psychological point of view as somatization or even somatoform disorders. METHODS: The aim of the study, designed as a case-control study, was to evaluate psychological characteristics that may accompany the incidence of so-called post-cholecystectomy pain syndrome (PCPS). The study focused on 367 patients treated for gallstones in the Dept. of General, Gastroenterological and Endocrinological Surgery, Medical University of Gdansk, Poland. At about a year after the operation, the patients received a questionnaire that included a structured interview and psychological assessment of social support and rumination. Those who revealed symptoms of PCPS were invited to the department for further medical and psychological evaluations. Psychosocial scores of PCPS and non-PCPS patients were compared. RESULTS: The PCPS patients did not present any dysfunction at the physical examination or in gastroduodenoscopy or sonography. However, they differed from the remaining. asymptomatic group in terms of lacking social support, as well as increased rumination. CONCLUSION: It is concluded that psychological variables may play an important role in the onset of subjective symptoms in at least a subgroup of the PCPS patients as a form of somatization. Psychological supportive and explanatory activities (cognitive and behavioural approach) may provide sufficient help.

Predictors of improvement in health-related quality of life in patients undergoing cholecystectomy.

BACKGROUND: Few studies have assessed health-related quality of life (HRQoL) among patients undergoing cholecystectomy. This study aimed to determine clinical variables that predict changes in HRQoL following cholecystectomy. METHODS: This was a prospective study of consecutive patients undergoing elective cholecystectomy for gallstones in six hospitals. Patients were asked to complete two questionnaires-the Short Form 36 (SF-36) and the Gastrointestinal Quality of Life Index (GIQLI)-before and 3 months after cholecystectomy. Multivariate linear regression models were used to examine factors potentially contributing to changes in HRQoL. RESULTS: Patients with symptomatic cholelithiasis and low surgical risk experienced the highest HRQoL gains in several SF-36 and GIQLI domains, with significant improvements in physical function detected by both instruments, compared with asymptomatic individuals at high surgical risk. Patients with asymptomatic cholelithiasis or high surgical risk experienced least improvement. CONCLUSION: These data indicate that cholecystectomy is appropriate for patients with symptomatic cholelithiasis and low surgical risk. In terms of HRQoL, the risk to benefit ratio seems poor for patients with asymptomatic gallstones.

Patients' experiences of laparoscopic cholecystectomy in day surgery.

Previous research has concentrated mainly on surgical aspects and postoperative complication rates after day surgery laparoscopic cholecystectomy (LC), and less on patients' experiences and nursing care aspects. A qualitative study was conducted aimed at investigating patients' experiences of LC in day surgery. Ten women and two men were interviewed. The material was coded, categorized and analysed using qualitative analysis. The findings demonstrate that individuals with gallstone disease experience limitations in their daily life and feelings of socially handicapped. Prior to surgery, the patients felt anxious and expressed a wish for tranquilizers, and to meet the surgeon responsible. At discharge after day surgery, amnesia was experienced and the respondents did not remember important information about the operation given by the surgeon. Experience of postoperative pain varied greatly. Several respondents had a relapse of pain on the third day lasting up to 1 week. The need for additional pain medication and a bloated feeling were reported. Some respondents reported nausea and vomiting, and most had questions about wound care. The need for additional telephone follow-up was mentioned, as was the fact that it was difficult to come home to small children. However, the great majority felt that returning home on the same day as the operation, was positive.

The significance of personality in pain from gallbladder stones.

BACKGROUND: The aim of the study was to investigate the association between personality factors related to coping styles and reported pain due to gallstones. METHODS: Personality trait measures were completed by 28 consecutive gallstone patients to provide estimates of positive coping resources (Life Regard Index, Sense of Coherence Scale, Sense of Humor Questionnaire) and negative coping resources (Eysenck Personality Questionnaire on Neuroticism, Tension, and Effort Stress Inventory). An overall index of gallstone-related complaints (pain) over the past 7 days/6 months was also obtained. Ultrasonography confirmed the gallstone condition. Multiple regression analyses tested the hypothesis that pain would be moderated by positive coping resources and mediated by negative coping resources. RESULTS: Reported pain was less severe with positive coping resources (39% of pain variance explained) and more severe with negative coping resources (45% of pain variance explained). CONCLUSION: The results confirm that mental coping resources have a significant role in pain differences among gallstone patients.

Core mental state in irritable bowel syndrome.

OBJECTIVE: Psychiatric illness is higher among patients with irritable bowel syndrome (IBS) who seek medical care; however, a specific psychopathology that differentiates patients with IBS from patients with other organic gastrointestinal disorders has not been found. In the study described here, we investigated the predominant psychiatric symptoms in women with IBS. METHODS: The criteria of Manning et al., as modified by Thompson et al., were used to make the diagnoses of IBS. Psychiatric assessment was performed by using a structured interview in 64 women, aged 20 to 70 years, 36 with IBS and 28 with chronic cholelithiasis. Diagnosis of chronic cholelithiasis was made by histopathological examination. The final diagnoses were confirmed by interview after 1 year. The diagnostic system based on the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) was used to make the current diagnoses. The Present State Examination (PSE)-Index of Definition (ID) computer program (CATEGO) was used to define total psychopathology (total PSE score), current clinical severity (ID), and clusters of psychiatric symptoms. RESULTS: No difference in the specific DSM-IV diagnostic categories was found, but there were more total depressive disorders in the IBS group. The ID and total PSE score were high among patients with IBS. Multiple logistic regression analysis showed that duration of gastrointestinal pain, and the symptoms of general anxiety, and hypochondriasis significantly predicted a diagnosis of IBS. CONCLUSIONS: Female patients with IBS are categorized into the general DSM-IV category of depressive disorder, their current psychiatric severity is high compared with that of women with chronic cholelithiasis, and patients with IBS are characterized by the psychiatric syndromes of general anxiety and hypochondriasis. The implications of these findings and areas for future research are discussed.