[Case of primary biliary cirrhosis combined with GERD and complicated by peptic strictures of the esophagus].

The clinical case of the two diseases combination such as primary biliary cirrhosis and peptic stricture of the esophagus (complicated GERD) in one patient is presented in the article.

[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.

[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.

[Asymptomatic celiac disease in patient with chronic acalculous cholecystitis].

We described a patient 40 years old, admitted to the clinic with periodic attacks of pain in the right upper quadrant. With ultrasound it was confirmed chronic acalculous cholecystitis, and at endoscopy and multiple biopsies revealed atrophy of the mucosa of the duodenum (DM), corresponding to celiac disease (stage III in the Marsh classification). Titer of antibodies to gliadin (AGA) and tissue transglutaminase (AtTG) were higher: 60 and 110 units/ml, respectively, at a rate of 10 units/ml. The patient was assigned a lifetime adherence to a gluten-free diet, serologic test and a control endoscopy with biopsy at 6 months. The important role of the doctor-endoscopist in the diagnosis of latent forms of celiac disease. The significance of DM atrophy in the pathogenesis of patients with chronic cholecystitis.

[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.

[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.

[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.

[Hypereosinophilic syndrome with the esophagus, stomach and small intestine pathology].

In this article the differential diagnostic line of blood hypereosinophilia is analyzed and the complicated clinical case of severe eosinophilic esophagogastroenteritis with recurrent oedema associated with protein loss is represented.

[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.

[Transnasal esophagogastroduodenoscopy: the place in clinical practice, method of the procedure].

UNLABELLED: Improving of the endoscopic techniques and the accumulation of medical experience shouldn't only contribute to improving the quality of endoscopic manipulation, but also reduce the stress reactions of the patient before their implementation. AIM: To evaluate the effectiveness and advantages of transnasal esophagogastroduodenoscopy. MATERIALS AND METHODS: Were analyzed the experience of more than 4000 transnasal esophagogastroduodenoscopy. To perform endoscopy transnasal endoscope used access Fujinon EG-530N (CPU EPX-4400). The level of situational anxiety before endoscopy was studied using the Spielberger-Hanin test in 110 patients. Were analyzed the subjective assessment of patients, as well as view endoscopists who conducted the research. RESULTS OF THE STUDY: According to the results of the study the lowest level of anxiety mounted among patients who underwent endoscopy transnasal access again. According to the subjective assessment of patients, the benefits of transnasal endoscopy were: the minimum expression or complete lack of gag reflex with the introduction of the device in a study, the possibility of dialogue with the doctor during the study, the lack of negative experiences of endoscopy. Was conducted the endoscopy transnasal access doctors said endoscopists improve the quality of visualization and increase the inspection, due to good tolerability study of a patient. CONCLUSION: Transnasal esophagogastroduodenoscopy is a promising screening method of investigation, since it is easier tolerated by patients and does not require sedation.

[Pathogenetic and diagnostic aspects of postcholecystectomy syndrome].

In the review up-to-date information about postcholecystectomy syndrome was adduced. The main underlying pathogenetic links of different functional disturbs and organic pathology were considered. Necessity of this nosologic unit common diagnostic algorithm elaboration was proved by own and literature data analysing.

[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.

[Choledocholithiasis: etiology, pathogenesis, diagnosis]. / Kholedokholitiaz: Etiologiia, patogenez, diagnostika.

Cholelithiasis is one of the basic pathologies of the digestive apparatus. A certain progress in the study of biliary production and excretion processes has been achieved for the past two decades. This contributed to a deeper understanding of causes and factors promoting the formation of the lithogenic bile. Possibilities for cholelithiasis diagnostics (including precholelithiatic stages) have greatly expanded. The ultrasound method, which is quite efficient for diagnostics of cholecystolithiasis, has become a basic method of cholelithiasis diagnostics. Nevertheless, the course of cholelithiasis is not restricted to the formation of gallstones only. In 5-20% of cases cholecystolithiasis is combined with choledocholithiasis. The latest literature data related to problems of choledocholithiasis etiology, pathogenesis and diagnostics are given in this review of literature.

[Dynamics and scientific prognosis of stomach cancer]. / Dinamika i nauchnyi prognoz zabolevaemosti rakom zheludka.

Stomach cancer will remain one of the most prevalent malignant neoplasms on a global scale and in the foreseeable future. Its etiology is considered to comprise many factors including damaging environmental factors, genetic disorders and risk factors of Helicobacter pylori infection.

[Duspatalin in functional disorders of the Oddi's sphincter in patients subjected cholecystectomy]. / Opyt primeneniia diuspatalina pri funktsional'nykh narusheniiakh sfinktera Oddi u bol'nykh, perenesshikh kholetsistéktomiiu.

There was an examination of 20 patients who had cholecystectomy and have dysfunctional disorders of the Oddi's sphincter. All of the patients underwent the monotherapy with Mebeverine Retard in the dosage of 200 mg twice a day. The treatment efficiency was evaluated by the dynamics of clinical symptoms, results of the study of biochemical blood indices, data of the ultrasonic examination, and intragastric pH measurement. A positive dynamics was observed against the background of the preparation administration, and it became apparent from the disappearance or reduction of pains strength, dyspeptic manifestations, normalization or improvement of biochemical blood indices, and reduction of the common bile duct lumen width according to the ultrasonic examination data.