[HBV as one of the causes for development of cholelithiasis].

The aim of this study was to identify the influence of HBV on gall bladder and to establish necessity and terms of preventive measures. For this reason we have examined 58 patients, passed through cholecystectomy and 142 patients with B hepatitis. Patients of this group were followed up during 18 months. In the first group presence HBsAg in the gall bladder tissue was identified using immunoferment analysis and immunofluorescent testing. In all cases the blood was tested for specific markers (HBsAg, Anti-HB-cor antibodies of G and M classes). In the second group 75 patients were investigated prospectively. Observation using ultrasound was performed to find out the changes of gall bladder and bile. In this group preventive measures against gallstone formation were performed. 67 patients were investigated retrospectively and prevention was not performed among them. In 10 cases of cholecystectomy (17,2%) out of 58, HBsAg in the gall bladder tissue was identified both, with immunoferment analysis and immunofluorescent testing. The ultrasound examination revealed morpho-functional changes of gall bladder and bile in the acute stage of hepatitis B and also in following period. There were no cases of development of gallstones in the group where preventive measures using dietary fiber-rich food "Margi" were conducted, in the second group, where such measures have not been performed, gallstones developed in 5 patients (7,46%) out of 67, during 6-18 months after the acute B hepatitis. This results allow us to conclude, that cholecystopathogenic influence of HBV leads to the morpho-functional changes of gall bladder. This fact must be assessed as a risk factor for development of cholelithiasis and confirms necessity of early longlasting preventive measures.

[Risk-factors of cholelithiasis and chronic cholecystitis during pregnancy].

The peak of cholelithiasis formation in women concurs with reproductive period and physiological pregnancy serves as a starter of pathological processes in bile-excreting system. The aim of investigation was to reveal the risk-factors of cholelithiasis and cholecystitis during pregnancy. Investigation was a case-control type. A main group consisted of 30 cases. 2-4 pregnant patients in control group were corresponding with each case from main group. Basic significant prognostic factors of cholelithiasis and cholecystitis were determined. They are: fat-rich diet (OR=5.00), feeding irregularity (OR=5.78), visceral obesity (OR=2.67), artificial abortion (OR=3.25); among notable abdominal symptoms during pregnancy are heaviness sensation in right lateral region (OR=406.0), dull ache sensation in right lateral region (OR=196.0) and heartburn sensation (OR=14.50). Thus, revealing the anamnestic risk-factors related with pregnancy and delivery on any stage of pregnancy will be very useful for prevention of cholelithiasis and chronic cholecystitis. The results need to be confirmed by further investigations.

[Relationship of cholelithiasis with obesity in pregnancy].

The aim of investigation was to study the influence of obesity on the development of cholelithiasis and chronic cholecystitis in pregnant patients. The type of investigation was case-control study. Inclusion criteria were cholelithiasis and chronic cholecystitis. Exclusion criteria were severe maternal diseases (preeclampsy, eclampsy, haemorrhagia) during pregnancy and in past. The main group consisted of 30 cases. For each case 2-4 pregnant patients served as control. Obesity was assessed by body mass index (BMI), and visceral obesity before pregnancy--by waist circumference (WC, criterium of WC>88 cm). In main group obesity by BMI was observed in 19 cases (63.3%), in control group--in 18 subjects (20.0%); therefore statistically significant odds ratio was OR=6.90 (95%CI--2.80/17.07). In main group obesity by WC was observed in 12 cases (40.0%), in control group--in 18 subjects [20.0%; OR=2.67 (95%CI--1.09/6.52)]. Increment of BMI during pregnancy in main group was 7.5+/-1.6 kg/m2; in control group--4.5+/-1.6 kg/m2 (p<0.001). As for WC increment during pregnancy, in main group it was 23.2+/-1.9 cm; and in control--18.1+/-3.8 cm (p<0.001). BMI, WC values and their increment are significantly increased in patients with diseases of gall bladder during pregnancy. Physiological dyslipidemia during pregnancy is more aggravated, but in patients with diseases of gall bladder lipid characteristics are even greater deteriorated.

[Peculiarities of lipid metabolism during pregnancy].

More than 200 mln women become pregnant every year. In most cases outcome of labor is successful. The hormonal status changes during pregnancy initiate various adaptive mechanisms. Among them is "switch" of the energetic metabolism to lipid metabolism. It undergoes essential changes. The aim of our investigation was to study the peculiarities of lipid metabolism during pregnancy. 30 pregnant patients have been investigated based on 2 stage dynamics: I stage--pregnancy period=13.0+/-1.4 weeks; II stage--pregnancy period=35.7+/-0.5 weeks. Total cholesterol, HDL, LDL, triglycerides, VLDL and Index of atherogenic risk have been measured by biochemical analysis. The parameters of lipid metabolism became significantly impaired, except HDL (40.0+/-5.8 vs. 57.5+/-9.4 mg/dl), which increased significantly. They revealed significant both direct and inverse correlations with sex hormones. Obtained results point to the body's adaptive mechanisms expressed in the increase of antiatherogenic fraction of total cholesterol; and the influence of sex hormones as well. With the increase of period of pregnancy physiological dyslipidemia became worse, which might be metabolic basis for the development of "prestage" of gall-stone--cholestasis of gall-bladder.

[Changes of pH and kinematic viscosity of the contents of gall-bladder at the pre-gallstone stage of cholelithiasis].

The aim of the work was to study the indicators of pH and kinematic viscosity of the contents of the gall-bladder at receiving B-portion and their changes after a 7-hour period according to the biliary sediment of patients and to establish their link to the infection. Total 31 patients aged 25-55 with biliary sediment in lumens of their gall-bladders (a general group) and 5 healthy patients (a control group) were studied by us. In all cases the markers of the virus of Hepatitis B in blood serum were determined and ultrasonic examination of gall-bladder was carried out by us prior to the duodenal intubation. B-portion was subjected to bacteriological research for aerobes and anaerobs, and pH and kinematic viscosity (eta=mm(2)/sec) were determined. The patients from the control as well as from the general group after a 7-hour period were redetermined pH and Kinematic viscosity of B-portion. Kinematic viscosity was determined with a capillary viscosimeter, and pH was fixed by a method of potentiometer. Statistical treatment was undertaken by the method of ANOLA p<0,05. During the duodenal intubation the mean value of pH within the control group was fixed at 6.74, and the mean value of the kinematic viscosity was 1.34, and after a 7-hour period the same indicators constituted 6.87 and 1.35 mm(2)/sec, respectively. The same indicators within the general group during duodenal intubation were the following: 7.26 and 1.99 mm(2)/sec, and after a 7-hour period the same indicators were 7.78 and 2.19 mm(2)/sec, respectively. There was a significant statistical difference between the mean values of pH and kinematic viscosity of the contents of gall-bladder of the patients from the control and general groups. During a 7-hour period, there was also a significant statistical difference between the changes of the same indicators. The difference was even greater in case of infection. Following the above-mentioned we can conclude that in case of sediment in the lumen of gall-bladder, inclination of pH to alkalinity and increase in kinematic viscosity of the contents is one of the most important criteria of lithogenicity of gall-bladder contents, and one of the reasons for such changes is chronic infection of a gall-bladder.

[Correlation of infection with the physical and chemical characteristics of gall bladder contents].

The aim of the study was to investigate pH and viscosity (h) of gall bladder contents during cholelithiasis and establishment of their correlation with bacterial and HBV infections. Seventy-eight patients undergone the planned cholecystectomy were investigated. 5 healthy persons (control group) were also involved into the study. In all cases the markers of HBV (Anti-HB core IgG, Anti-HB core IgM, HBsAg) in blood were detected, also bacteriological analysis of gall bladder tissue was performed. In 78 cases (I group) pH of gall bladder contents was measured, in 29 cases (II group), also viscosity of gall was studied. In the control group pH and viscosity were detected. Statistical analysis was performed using ANOVA method. Bacteriological study revealed presence of bacterial infection in gall bladder tissue in 34 cases (43,6%), in 30 patients Anti-HB core antibodies were found in the blood, in 13 cases (16,7%) coincidence of bacterial and HBV infection was documented. Mean indexes of pH and viscosity appeared to be significantly higher in the operated group (pH--7,30, h 2,1 mm(2)/sec), then in the control group (pH--6,74, h--1,34 mm(2)/sec); this indexes were highest in the infected patients. Thus, according to results of the study, changes of pH and viscosity of gall bladder contents could be considered as the useful indexes of initial stage of cholelithiasis and their values depend on the presence of bacterial or HBV infection of gall bladder.