[The role of day hospital in optimization of medical care for patients of a therapeutic department of an outpatient clinic].

Day hospital (DH) provides consultations and treatment for all referred patients according to standards of medical care quality. DH has facilities for therapeutic and gastroenterological patients. Treatment in DH is performed according to current standards which cover basic treatment of the diseases (documented medicines, duration of treatment). Efficacy of DH's use of the Standards of Diagnosis and Therapy of Acid-Dependent Diseases associated with Helicobacter pylori (standards of Moscow consensus) is used as illustration. As a result of treatment in DH 93% outpatients resumed their jobs, improvement occurred in 96.7% patients, a complete response was seen in 23%, 1.9% cases failed treatment. Most DH patients (83%) were satisfied with treatment given in DH and think it a convenient replacement of hospital stay.

[The problem of biliary sludge]. / Problema biliarnogo sladzha.

The authors review current literature on etiology, pathogenesis and classification of biliary sludge (BS); they analyse factors promoting formation of BS and show that ultrasonic investigation is the key diagnostic method, detecting various forms of BS and differentiating BS with parietal new-growths of the gallbladder, evaluating function of the latter and controlling efficacy of conservative therapy. Follow-up results demonstrate that BS can disappear spontaneously, be persistent in a part of patients, form stones in 20% patients. Clinical picture in BS has no specific symptoms but in 33-75% cases it is associated with development of biliary pancreatitis as a results of secondary dysfunction of the Oddi's sphincter. The latest findings on efficacy of litholytic therapy in BS and data on possible use of nonsteroid anti-inflammatory drugs as inhibitors of mucin production to prevent recurrent cholelithiasis are presented.

[Causes of biliary sludge]. / O prichinakh vozniknoveniia biliarnogo "sladzha".

AIM: To specify characteristics of biochemical bile composition contributing to destabilization of colloid properties of bile in patients with biliary "sludge". MATERIAL AND METHODS: 37 patients with "sludge" in the gallbladder (GB), 10 patients with cholelithiasis and 10 patients with intact GB participating in the study were examined for bile portion B bile acids (BA), cholesterol and phospholipids (PL); lipid and lipoprotein blood composition. RESULTS: Three types of biochemical composition of bile in GB "sludge" patients were identified. 22 patients had elevated levels of cholesterol and PL in subnormal content of BA (group 1); 9 patients had normal FA and cholesterol, low content of biliary PL (group 2); 6 patients had normal concentrations of the three components (group 3). Blood lipids were characterized by elevated levels of total cholesterol and LDLP cholesterol in group 1; low HDLP cholesterol and triglycerides in group 2 and almost normal values in group 3. Basing on these data, causes of "sludge" formation in the GB are suggested. CONCLUSION: Biliary "sludge" may form because of excessive cholesterol in bile, low phospholipid levels or in normal proportion of the studied substances.

[Local and common humoral immunity in cholelithiasis and biliary sludge]. / Sostoianie mestnogo i obshchego gumoral'nogo immuniteta pri kholetsistolitiaze i biliarnom "sladzhe".

Analysis of local and systemic humoral immunity in 75 patients with cholelithiasis (36 patients) and biliary "sludge" (39 patients) are presented in this article. The bile of these patients were examined. The sIgA reduce in the bile, that testifies to the suppression of local humoral immunity but IgG and IgM increase due to inflammatory changes of gallbladder were revealed. Increase of all immunoglobulins, especially IgA, was revealed in blood serum. The both groups of the patients had demonstrated the same changes but with different expressiveness. This fact testifies to the similarity of pathological processes in these patients.