[Variants of Botkin's biliary-cardiac syndrome in acute cholecystitis]. / Varianty biliarno-kardial'nogo sindroma Botkina pri ostrom kholetsistite.

4 cases of little-known syndromes in acute cholecystitis are described. Cholecystic-pericardial and syncopal-cardiac syndrome are seen in 1.33 and 1.78% cases of acute cholecystitis, respectively, and are the variants of Botkin's biliary-cardiac syndrome. These syndromes disappear after surgery on biliary tract, therefore they must be indications for surgical treatment of cholecystitis.

[Importance of echocardiography in prognosis of surgical outcomes in cholecystitis in elderly patients]. / Znachenie ékhokardiografii v prognoze iskhoda operatsii pri kholetsistite u pozhilykh liudei.

The authors propose to use more often echocardiography (EchoCG) in examination of elderly (over 60 years) of age patients with cholecystitis that permits to increase surgical activity to 92.4%. Left ventricular ejection fraction is the most informative. When this fraction is lower than 45% surgery must be recommended on vital indications only. EchoCG was used in 155 patients with cholecystitis, 131 of them were operated. 2 (1.52%) patients died due to acute cardio-vascular insufficiency and pulmonary artery thromboembolism.

[Cardiac and vascular risk factors in surgery of cholecystitis]. / Serdechno-sosudistye faktory riska v khirurgii kholetsistita.

ON the basis of analysis of 1163 patients with cholecystitis and cardiovascular diseases a classification of indications and contraindications for surgical treatment has been developed and introduced that makes it possible to expand surgical activity to 85-90 %.

[Role of therapist in the surgical treatment of cholecystitis]. / Rol terapevta v khirurgii kholetsistita.

The author emphasises that modern surgical treatment of cholecystitis should be based on a constant close contact between the internist, surgeon, and anesthesiologist. Such joint management of 1156 patients with cholecystitis, among which 871 (75.3%) were operated on, helped in expanding successfully the surgical activity to 85% of the total number of patients admitted to the surgical department, without an increase in the number of unfavorable outcomes despite the presence of concomitant cardiovascular diseases (ischemic heart disease, essential hypertension, etc.).

[Atrial fibrillation as risk factor in surgery of cholecystitis]. / Mertsiatel'naia aritmiia kak faktor riska v khirurgii kholetsistita.

The author examined 1,149 patients with cholecystitis, 90% of them had calculous and the others had non-calculous forms of the disease. Atrial fibrillation (AF) was found in 63 (5.48%) patients, which was combined in most cases with ischemic heart disease (IHD), essential hypertension (EH), and rheumatic heart disease concomitant of cholecystitis. In 12 cases with CF organic changes of the heart were not found. Eight patients has transitory AF for some years. In determining the indications for operations on the biliary tract in individuals with concomitant AF the author assigns importance to graded physical loading. In the group of 63 patients with AF 43 underwent surgical treatment for cholecystitis with a favourable outcome. The author claims that AF in combination with IHD, EH, and rheumatic heart disease is not a contraindication for surgical treatment of cholecystitis. In cases of transient AF the biliary tract should be examined more frequently because AF may be one of the signs of the biliary-cardiac syndrome in such patients. A history of thromboembolic complications and AF which are relieved with difficulty may be contraindications for operations on the biliary tract.

[Evaluation of disorders of the heart conduction system as risk factors in the surgical treatment of cholecystitis]. / Narusheniia v provodiashchei sisteme serdtsa kak faktor riska v khirurgii kholetsistita.

The author examined 1,144 patients with cholecystitis and found that 144 (12.6%) had heart block (HB)--atrioventricular block (AVB) and intraventricular block (IVB) were found in 11 and 133 patients, respectively. In some cases of cholecystitis, HB was combined with hypertensive disease, coronary heart disease, rheumatic heart disease. Patients with cholecystitis and HB underwent an exercise test (stepwise test) which was one of the principal criteria for the decision concerning the possibility of operating on the bile tract. A total of 864 (75.5%) patients with cholecystitis were operated on, 104 of whom had HB. No unfavourable outcomes were seen. Stable Stages I and III AVB (with an implanted cardiac pacemaker) and localized and complete block in the system of the right bundle branch without hemodynamic disorders were considered not to be a reason for rejecting surgery of cholecystitis. Surgery is inadvisable in block of some branches and complete (bilateral branch) block in the system of the left bundle branch, as well as in combination of Stage I AVB with IVB without performance of a graded physical exercise whose power should be at least 60% of the normal exercise, or 123 Wt, 750 kgm/min (the normal exercise being 100%, 176 Wt, and 1080 kgm/min).