[ASYMPTOMATIC INTRAHEPATIC CHOLANGIOCARCINOMA].

Objective: To analyze the cases of intrahepatic cholangiocarcinoma posthumous diagnosis in patients with concomitant atherosclerotic lesions of the femoral arteries. Key points: The present report describes the clinical observation of a rare tumor - intrahepatic cholangiocarcinoma. Difficulties of its early diagnosis is a combination of symptoms of tumor progression with pain in the lumbar spine, the latter in the presence of concomitant femoral arteries of atherosclerotic lesions, characterized by pain similar localization has led to delay cancer research. Conclusion: Upgrading differential diagnostic procedures with a combination of pain in the lumbar spine with symptoms of tumor progression through the use of a computer and / or positron emission tomography study of plasma levels onkomarkёra CA-19-9, magnetic resonance contrast holangiopankreatikografii, would in this clinical case in a timely manner to make the correct diagnosis.

THE DIFFICULTIES OF DIFFERENTIAL DIAGNOSIS OF EDEMATOUS AND ANEMIC SYNDROMES IN AN EDERLY PATIENT WITH ATYPICAL COURSE OF COELIAC DISEASE.

OBJECTIVE: Analysis of the complexities of diagnosis of atypical celiac disease in elderly patients. KEY POINTS: A clinical observation of the patient 63 years with atypical form of celiac disease, have flowed mainly from edematous and anemic syndrome. High titers of antibodies to gliadin, tissue transglutaminase, histological changes of the mucous membrane of the small intestine (Marsh II), the presence DQA1*0501 of the alleles have confirmed diagnosis. Against the background of strict gluten-free diet and a half years I have come persistent clinical remission with normalization of serum indicators. CONCLUSION: Inclusion in the plan of diagnostic screening for celiac disease in patients \'vith edematous and anemic syndrome possible to establish the correct diagnosis and to reduce the risk of complications (including malignancies) in this patient.

[The role of psycho-autonomic status and the serotonergic system in patients with gastroesophageal reflux disease].

OBJECTIVE: Identify the differences of the autonomic nervous system (ANS), serotonin levels, cognitive, behavioral and emotsinalnoy areas in groups of patients with reflux esophagitis (RE) and non-erosive reflux disease (NERD) and assess the impact on the disease. MATERIALS AND METHODS: The study included 71 patients rith gastroesophageal reflux disease (GERD), including 29 patients with ER, 42--NERD. Diagnosis was based on anamnesis, clinical research, fibrogastrocopy, pH-metry. Tested with a scale situational and personal anxiety Spielberg Hanina, diagnostic techniques and forms of aggression indicators A. Bass and A. Dark, the Toronto aleksitimicheskoy scale method for investigating the level of subjective control, clinical questionnaire for the identification and evaluation of neurotic states, personality questionnaire Bekhterevsky Institute, cardiointervalography, orthoklinostatik and cold test, determined the level of serotonin in the blood. RESULTS: Compared with the group of patients suffering from ER patients with NERD determined by the displacement in the direction of internality measure locus of control personality, and patients with ER, in contrast, had lower locus of control personality, a high level of situational anxiety, irritability, anxiety type of attitude to the situation of the disease associated with impaired autonomic software ANS activity. CONCLUSION: Patients with ER are more pronounced changes in cognitive-emotional sphere may have an impact on the course of disease and requiring psychological, medical correction.