Chronic Acalculous Cholecystitis Research Articles

Intrahepatic cholestasis and its correction in patients with chronic acalculous cholecystitis

Functional disorders of the liver in chronic acalculous cholecystitis, manifested by intrahepatic cholestasis, require therapeutic correction. The aim of the study was to assess the functional state of the liver in patients with chronic acalculous cholecystitis and to develop therapeutic approaches to the identified changes. Materials and methods: 123 patients with chronic heart failure were examined on the basis of the gastroenterology department among the patients there were 90 women and 33 men with the duration of the disease from 5 to 10 years. The average age of patients was 43.74±1.26 years. To clarify the effect of cholestasis on the course of chronic acalculous cholecystitis, all examined patients were divided into two groups: patients chronic acalculous cholecystitis with cholestasis and patients chronic acalculous cholecystitis without cholestasis. The group of patients with cholestasis consisted of 84 people, whose average age was 46.46 (32.67; 60.25) years old, 22.62% were men, 77.38% were women. The group of patients without cholestasis consisted of 39 people with an average age of 43, 56 (28.44; 53.68) years, 13 (33.33%) men and 26 (66.66%) women. Results: the clinical course of chronic acalculous cholecystitis is determined by the presence or absence of intrahepatic cholestasis. Dyskinetic disorders of the gastrointestinal tract and the sphincter apparatus of the biliary tract are more common in patients with cholestasis, which in turn is formed against the background of gallbladder abnormalities in the form of various deformities, and leads to intrahepatic bile stagnation, biliary hypertension. Conclusion: the combined use of metronidazole, hemicromone and ademethionine contributes to the resolution of congestion in the intrahepatic bile ducts, normalization of tone and motor function of the gallbladder and sphincter apparatus of the hepatobiliary tract and reduction of clinical manifestations.

Late dumping syndrome preceded by Coxsackievirus B4 infection and cholecystectomy

A 44-year-old female patient presented with weight loss, diarrhea and intermittent episodes of left upper quadrant (LUQ) pain lasting for 3years, accompanied by acute episodes of focal LUQ pain, dizziness, tachycardia, borborygmi and bloating, occurring approximately 60min after meals. The patient developed chronic acalculous cholecystitis and transient exocrine pancreatic insufficiency after infection with Coxsackievirus B4 (CVB4), which resolved following laparoscopic cholecystectomy 2years before the current presentation. Although imaging and functional investigation studies were unremarkable, a gastric transit study revealed rapid clearance of radiolabeled food, and the patient's symptomatology and gastrointestinal studies supported the diagnosis of late dumping syndrome. The patient's symptoms significantly improved with adherence to recommended dietary changes, including an increase in protein intake, abstinence from simple carbohydrates and avoidance of simultaneous consumption of beverages with food, following consultation with a dietitian.

Intrahepatic cholestasis and its correction in patients with chronic acalculous cholecystitis

Functional disorders of the liver in chronic acalculous cholecystitis, manifested by intrahepatic cholestasis, require therapeutic correction. The aim of the study was to assess the functional state of the liver in patients with chronic acalculous cholecystitis and to develop therapeutic approaches to the identified changes. Materials and methods: 123 patients with chronic heart failure were examined on the basis of the gastroenterology department among the patients there were 90 women and 33 men with the duration of the disease from 5 to 10 years. The average age of patients was 43.74±1.26 years. To clarify the effect of cholestasis on the course of chronic acalculous cholecystitis, all examined patients were divided into two groups: patients chronic acalculous cholecystitis with cholestasis and patients chronic acalculous cholecystitis without cholestasis. The group of patients with cholestasis consisted of 84 people, whose average age was 46.46 (32.67; 60.25) years old, 22.62% were men, 77.38% were women. The group of patients without cholestasis consisted of 39 people with an average age of 43, 56 (28.44; 53.68) years, 13 (33.33%) men and 26 (66.66%) women. Results: the clinical course of chronic acalculous cholecystitis is determined by the presence or absence of intrahepatic cholestasis. Dyskinetic disorders of the gastrointestinal tract and the sphincter apparatus of the biliary tract are more common in patients with cholestasis, which in turn is formed against the background of gallbladder abnormalities in the form of various deformities, and leads to intrahepatic bile stagnation, biliary hypertension. Conclusion: the combined use of metronidazole, hemicromone and ademethionine contributes to the resolution of congestion in the intrahepatic bile ducts, normalization of tone and motor function of the gallbladder and sphincter apparatus of the hepatobiliary tract and reduction of clinical manifestations.

Іmmunological disorders and colonic dysbiosis inpatients with biliary lesions in type 2 diabetes mellitus and obesity

Background. The microbiome plays a crucial role in maintaining homeostasis. The purpose of the research was to study the peculiarities of changes in immunological status and their relationship with colonic dysbiosis in patients with biliary lesions on the background of type 2 diabetes mellitus (DM) and obesity. Materials and methods. The study included 54 patients with type 2 DM and obesity of varying severity, who underwent a comprehensive examination. Two groups of those examined for type 2 DM and obesity were formed, depending on the type of lesion of the biliary system. Thus, group I included 24 patients with chronic acalculous cholecystitis, and group II consisted of 30 patients with gallstone disease. Results. The results of the analysis of the quantitative and qualitative composition of the colonic microflora indicate dysbiotic changes in patients with type2 DM, obesity, and lesions of the biliary system. More pronounced disorders in the quantitative and qualitative composition of colonic microflora were diagnosed in patients of group II (with type 2 DM and obesity in combination with gallstone disease). The patients of group II significantly more often developed an increase in the number of Enterobacter (14.2%; p<0.05), Citrobacter (31.8%; p<0.01), Staphylococcus (16.7%; p<0.05), and Clostridium (11.8%; p<0.05) compared with the data of group I. More pronounced increase in all immunoglobulin parameters was found in patients with gallstone disease associated with type 2 DM and obesity. At the same time, the increase in IgA and IgG levels, which is indisputable evidence of activation of the humoral part of the body’s immunocompetent system, was found in patients with biliary lesions and type 2 DM and obesity. Conclusions. In patients with type2 DM and obesity in combination with lesions of the biliary system (mainly gallstone disease), changes in the quantitative and qualitative composition of the colonic microflora (a decrease in the number of Bifidobacterium and Lactobacillus and an increase in the concentration of Clostridium, Staphylococci, Proteus, and Klebsiella) were detected. Impairment of immunological status in patients with type 2 DM and obesity in combination with lesions of the biliary tract was diagnosed, which manifested in increased levels of IgA, IgG, IgM, IgG and a decrease in serum C3 and C4 in patients with gallstone disease. The increase in IgA and IgG directly depends on the change in the number of Bifidobacterium and Lactobacillus, Staphylococcus, Clostridium, Proteus in the microbiological examination of feces in patients with type 2 DM and obesity in combination with the biliary system (mainly gallstone disease).

S1726 Eosinophilic Infiltration Causing Biliary Tree Obstruction Without Stricture

Introduction: We present an exceedingly rare case of eosinophilic cholangitis (EC) without stricture. Of the 40 cases of EC reported in the literature, fewer than 10 cases did not involve a stricture. Case Description/Methods: A 60-year-old female with no significant past medical history presented with symptoms of biliary colic for 2 days. Laboratory results were significant for elevated hepatobiliary enzymes including alkaline phosphatase of 300 IU/L and total bilirubin of 3.8 mg/dL. A hepatobiliary iminodiacetic acid scan was performed with an absence of radiotracer excretion into the biliary tract. However, a magnetic resonance cholangiopancreatography showed no obstructing stone, stricture, or lesion. A broad workup including hepatitis and autoimmune serologies was negative. The patient underwent an uncomplicated laparoscopic cholecystectomy, and direct inspection of the gallbladder confirmed significant edema. Histopathology of the gallbladder showed acute and chronic acalculous cholecystitis with eosinophilic rich infiltrates. Notably, the patient had an absolute eosinophil count of 1.2 cells/µL. She was diagnosed with eosinophilic cholangitis and treated with corticosteroids. At her one-month follow-up, her symptoms had resolved. Discussion: Eosinophilic cholangitis is a rare, self-limiting condition featuring eosinophilic invasion of the biliary tree. Laboratory values in EC reflect an obstructive process, but diagnosis is frequently delayed as both symptoms and imaging mimic multiple other biliary conditions including malignancy, primary strictures, primary sclerosing cholangitis, amongst others. Endoscopic dilation of strictures often provides a surprising diagnosis when pathology demonstrates dense infiltration of eosinophils. Although a majority of EC is associated with stricture, EC may also present with obstructive features in the absence of stricture. Likewise, peripheral eosinophilia may or may not be present. Risk factors for EC have not been established. Literature suggests that patients with pre-existing eosinophilic processes such as eosinophilic esophagitis and asthma are more likely to develop EC than the general population. There is no standard treatment, but corticosteroids have demonstrated empiric efficacy, similar to the other eosinophilic processes mentioned. Increased physician awareness of eosinophilic cholangitis will help prevent delays in diagnosis and initiation of effective medical therapy.

Фенотипическая трансформация гладких миоцитов стенки желчного пузыря при развитии некалькулезного холецистита

The aim of the study was to analyse ultrastructural changes in the smooth muscle tissue of different gallbladder sections during the development of experimental acalculous cholecystitis. Materials and methods. The research was performed on 20 guinea pigs. The duration of the experiment ranged from 4 to 15 days. Each experimental and control group included 5 animals. A standard model of chronic acalculous cholecystitis was used, in which ligation of the proximal part of the common bile duct is accompanied by inflammation and impaired gallbladder motility. Results. In guinea pigs with cholecystitis, on day 15 of the experiment using electron microscopic examination we revealed cells in the smooth muscle tissue that retain a well-structured contractile apparatus, represented by separate thin bundles of myofilaments, and a developed synthetic apparatus. The ultrastructural organization of this type of cells is quite characteristic of myofibroblasts. Studying the modulation of gallbladder smooth muscle cells in an experiment, we need to take into account that in the conditions of inflammation and impaired gallbladder motility, during the restructuring of the intercellular matrix, myofibroblasts can appear, causing the development of sclerotic processes in the organ wall due to their ability to express high levels of collagen and glycosaminoglycans, as well as numerous other extracellular matrix molecules and fibrogenic cytokines. The research showed that adenomyomatous hyperplasia of the gallbladder wall is accompanied by proliferation of myofibroblasts and smooth muscle cells. Thus, impaired stromal-epithelial interactions can be assumed to underlie the pathology in adenomyomatous hyperplasia of the gallbladder.

VP010 INTRA-ABDOMINAL HERNIA AS A CAUSE OF ACUTE SMALL INTESTINE OBSTRUCTION. LAPAROSCOPIC EMERGENCY TREATMENT - SMALL INTESTINE OBSTRUCTION DUE TO INTERNAL HERNIA WITH CONCOMITANT ACALCULOUS CHOLECYSTITIS

Abstract Aim Nowadays, in vast majority of emergency patients with gastrointestinal obstruction laparoscopy is not the treatment of choice. In our department laparoscopy is routinely used in emergency admitted patients, also those with abovementioned condition, sometimes yielding unexpected and thrilling results. The aim of this work is to present a laparoscopic internal hernia repair with simultaneous “Phrygian-cap-type” gallbladder excision, performed on a patient with small intestine obstruction and chronic acalculous cholecystitis. Material and Methods A 57-year-old patient was admitted to our department as an emergency, with a one week history of symptomatic cholecystitis accompanied by gastrointestinal obstruction. CT revealed atypical suprahepatic displacement of the small intestine. An attempt of conservative treatment failed after the re-initiation of oral nutrition. The patient was qualified for laparoscopy. Results An anatomical variant of the liver ligaments was visualized with two defects in the anteriorly displaced coronary ligament and shortening of the falciform ligament. Those defects formed the hernia ring entrapping a small intestine of a total length of about 1.5 m. The falciform ligament was dissected. To avoid re-entrapment of the intestine, most of the coronary ligament was severed. Consecutively the inflamed gallbladder was removed. The unusual anatomical variation of its structure, the so-called “Phrygian cap”, was an additional difficulty. The postoperative course was uneventful. Conclusions The presented material demonstrates the possibility of immediate treatment of intestinal obstruction, even in a complicated cases, with laparoscopic manner, without the need of conversion to the open method.

Залежність літогенності жовчі від показників вуглеводного та ліпідного обмінів у хворих на цукровий діабет типу 2 із хронічним некалькульозним холециститом

Мета дослідження: виявити особливості зміни гомеостазу жовчі та основні каменеутворюючі субстрати при хронічному некалькульозному холециститі та цукровому діабеті (ЦД) типу 2. Матеріали та методи. Клінічне обстеження проведено в 60 осіб, хворих на ЦД типу 2 та хронічний некалькульозний холецистит, у 60 осіб, хворих на ізольований хронічний некалькульозний холецистит, та 20 практично здорових осіб. Проведено ретельне обстеження з використанням загальноприйнятих клінічних, лабораторних, біохімічних, інструментальних досліджень. Усім пацієнтам здійснено багатомоментне дуоденальне зондування. Визначено ліпідні спектри крові та міхурової порції жовчі. Результати. У хворих на хронічний некалькульозний холецистит, що перебігає на тлі ЦД типу 2, спостерігалися підвищення рівнів загальних ліпідів (у 1,61 раза в крові), холестеролу (у 2,04 раза у крові та 1,62 раза в жовчі), жовчних кислот (у 4,4 раза в крові) та зниження їх у жовчі (у 1,34 раза), тріацилгліцеролів (у 3,09 раза в крові), ліпопротеїнів низької щільності (у 1,2 раза в крові) і зниження вмісту ліпопротеїнів високої щільності (у 1,98 раза в крові) та фосфоліпідів (у 1,38 раза в крові та в 1,48 раза в жовчі), а також зниження двокомпонентних співвідношень «фосфоліпіди/холестерол» (у 1,8 раза) та «жовчні кислоти/холестерол» (у 1,9 раза), підвищення трикомпонентного індексу Ісаксона (у 1,85 раза), що свідчить про істотний дисбаланс ліпідного обміну як предиктора формування жовчних конкрементів у даної категорії хворих (р < 0,05). Висновки. У хворих на хронічний некалькульозний холецистит на тлі ЦД типу 2 спостерігаються вірогідно підвищені рівні загальних ліпідів, холестеролу, жовчних кислот, тріацилгліцеролів, ліпопротеїнів низької щільності на тлі зниження ліпопротеїнів високої щільності та фосфоліпідів у сироватці крові та жовчі. Встановлені кореляційні зв’язки між ліпідними спектрами сироватки крові та жовчі дають більш повну та детальну інформацію про порушення гомеостазу жовчі в різних групах пацієнтів. Основним каменеутворюючим субстратом в осіб першої групи виступав холестерол, а в осіб другої групи — знижений рівень ліпопротеїнів високої щільності.

Prevention of structural changes in liver in patients with chronic acalculous cholecystitis

Chronic acalculous cholecystitis is the cause of violations of the functional state of the liver in the form of stagnation in the intrahepatic bile ducts and a decrease in the activity of hepatocytes and is considered within the framework of a single pathology of the hepatobiliary tract. Complex therapy with the inclusion of the drug ademetionine, which in addition to the hepatoprotective effect affects the outflow of intrahepatic bile, contributes to the restoration of the detected violations.

ЗМІНИ ХОЛЕЦИСТОКІНІНУ-ПАНКРЕОЗИМІНУ У ХВОРИХ НА ХРОНІЧНИЙ НЕКАМЕНЕВИЙ ХОЛЕЦИСТИТ У ПОЄДНАННІ З НЕАЛКОГОЛЬНОЮ ЖИРОВОЮ ХВОРОБОЮ ПЕЧІНКИ І СТАБІЛЬНОЮ ІШЕМІЧНОЮ ХВОРОБОЮ СЕРЦЯ

Disorders in the system of neurohumoral regulation, gastrointestinal peptide hormones, such as cholecystokinin-pancreozymin (CCK-PZ), which also acts as a neurotransmitter, are of great importance in the development of the biliary tract pathology. The influence of CCK-PZ on the gallbladder function in patients with chronic acalculous cholecystitis in combination with non-alcoholic fatty liver disease (NAFLD) and Stable ischemic heart disease (SIHD) remains unexplored.We have examined 60 patients with chronic acalculous cholecystitis, among which patients with concomitant NAFLD and SIHD or without comorbidity were distinguished. The lipid spectrum of the blood was determined for all patients, the level of CCK-PZ in the blood serum was determined by the enzyme immunoassay using reagents made by Peninsula Laboratories Inc (USA). A polypositional ultrasound examination of the gallbladder was performed, as well as a fractional multiple moment duodenal intubation. It was found that the combination of chronic acalculous cholecystitis with NAFLD and SIHD is manifested by a significant violation of lipid metabolism, dyslipidemia, an increase in cholesterol of proatherogenic lipoprotein fractions and a deficiency of high density lipoproteins. A decrease in the level of cholecystokinin-pancreosimin in patients with chronic acalculous cholecystitis leads to a decrease in the contractility of the gallbladder and an increase in the tone of the sphincter of Oddi. An increase in the level of triacylglycerols and total cholesterol leads to an increase in the flow of lipids into the wall of the gallbladder, which is manifested by its thickening and hypotension of the gallbladder.

Chronic acalculous cholecystitis and biliary dysfunction: how does clinical diagnosis affect management?

Similar abdominal pain of biliary type in functional disorders of biliary tract and chronic acalculous cholecystitis causes objective difficulties to differentiate not only between each other, but also with other diseases of gastrointestinal tract. The clinical picture is so homogeneous and difficult to distinguish from cholelithiasis that some patients undergo unreasonable surgical interventions for CAC and FDBT. Individual publications pushing for such an aggressive strategy are sporadic and need to be clarified in larger studies. The first choice drugs for treatment of FDBT are spasmolytics; ursodeoxycholic acid drugs are used as adjuvant agents. In CAC, the initial therapy will be similar, but the treatment regimen can be expanded with targeted etiotropic (if the cause of cholecystitis is identified – giardiasis, opisthorchiasis, etc.) or empirical antimicrobial/antiparasitic therapy. The greatest interest today is caused by hymecromone – a drug with proven by both experimental and controlled studies combined choleretic, selective spasmolytic action, mediated effect of reducing bile lithogenicity and possible anti-inflammatory action. Hymecromone effectively relieves biliary pain without causing gallbladder contractions, which determines the possibility of its wide application both in CAC and FDBT, both in monotherapy and in combination with other agents, primarily with UDCA. In this article the issues of optimization of diagnostic and therapeutic strategy of management of patients with biliary pain to avoid unreasonable cholecystectomies in acalculous diseases of the biliary tract are considered.

Динаміка клінічних симптомів й функціонального стану біліарної системи у хворих на хронічний безкам’яний холецистит на тлі цукрового діабету 2 типу під впливом комплексної терапії

The urgent problem of modern medical science and practice is the rapid increase of comorbid pathology spreading among the population of the whole world. Among the nosological forms, which are quite often combined with each other, there are cardiovascular system, digestive tract and endocrine diseases, namely type 2 diabetes mellitus. Diseases of the biliary tract, in the form of chronic acalculous cholecystitis, occur in patients with type 2 diabetes more often than in its absence. There is no doubt that the combination of diseases of the gallbladder and type 2 diabetes significantly affects the course and prognosis of both diseases, and the development of complications is one of the main causes of disability and mortality in patients. In this regard, the priority areas of health protection are the search for preventive measures to eliminate the development of diseases, their complications and the amendment of therapeutic patterns. The purpose of the study was to evaluate the efficacy of complex therapy with the addition of ursodeoxycholic acid and alpha-lipoic acid in patients with concomitant chronic acalculous cholecystitis and type 2 diabetes on the basis of studying the dynamics of clinical symptoms and the content of bile acids in blood serum, as well as parameters of cholecystosonography (in overview and dynamic versions). Material and methods. In the course of the study, 62 patients with the combined course of chronic hepatitis and diabetes mellitus were examined. The age of the patients ranged from 44 to 75 years old. The duration of type 2 diabetes was from 1 to 19 years. The group was representative in terms of age and number of male and female probands. Upon admission to the hospital, all patients underwent a thorough examination using generally accepted clinical, laboratory and instrumental studies. Results and discussion. The complex treatment included hypoglycemic drugs, medical nutrition, prescription of antispasmodic and antibacterial therapy, ursodeoxycholic acid drugs at a dose of 15 mg / kg / day for 4 weeks, as well as preparations of alpha-lipoic acid 600 I / V drip for 10 days, followed by oral administration in within 12 weeks. In order to assess the effectiveness of therapy, clinical symptoms, serum levels of fatty acids, indicators of survey and dynamic cholecystosonography were evaluated after 3 months in the dynamics of treatment. Conclusion. The study showed that the addition of ursodeoxycholic acid and alpha-lipoic acid to the complex therapy was accompanied by positive effects due to an improvement in the contractility of the gallbladder, a decrease in the serum fatty acid content, improved the motor and cholesecretory functions of the gallbladder and the clinical condition of patients by eliminating abdominal pain and reducing the percentage of patients with chronic acalculous cholecystitis and type 2 diabetes with manifestations of dyspeptic, neuro-vegetative and asthenic syndromes

Histopathological spectrum of gall Bladder diseases in cholecystectomy specimens at a Rural tertiary hospital of Purvanchal in North India-Does it differ from South India?

Gall Bladder (GB) diseases are one of the most common digestive system diseases, the prevalence of which is variable within India and ranges from 2-29%. Cholelithiasis (gallstones) is the commonest lesion and accounts for more than 95% of GB diseases. Gall bladder carcinoma showed regional differences in India with prevalence ranging from 0.52% in southern India and as high as 9.6% in northern India. 1)To identify the morphological spectrum of diseases affecting the gall bladder. 2)To identify the most common histopathological lesion and its correlation with clinical and demographic data of the patient. 3)T o identify the frequency of Gall Bladder Carcinoma (GBC) and its correlation with clinical and demographic data of the patient and pre-existing lesions if any. This study was non-participatory descriptive study carried out retrospectively for a period of one year in the Dept. of Pathology, HIMS,from August 2018 to July 2019. All the specimens received in the study period were included in the study. The gross and microscopic findings on H & E slide were included in the study. The descriptive statistics w as applied to analysed data. Total 86 cholecystectomy specimens were received in the Department of Pathology during one year study period. Non-neoplastic lesions (97.67%) of gall bladder outnumbered the neoplastic lesions (2.33%). Most common histopathological lesion was chronic cholecystitis (95.34%). Varied histopathological spectrum was seen comprising of chronic calculous cholecystitis (73.26%), chronic acalculous cholecystitis (13.95), chronic cholecystitis with cholesterosis (13.95%), Xanthogranulomatous cholecystitis (2.33)%), Acute calculous cholecystitis (1.16%), acute gangrenous GB (1.16%), GBC (2.33%). In non-neoplastic lesions, female predilection (70.24%) was seen over male (29.76%) accounting for F:M ratio of 2.4:1, two cases of GBC exclusively seen in females associated with gall stones. Non-neoplastic lesions were common between the age group of 26-50 years accounting for 67.45% where as neoplastic lesions were common in the age group of >60years. Chronic cholecystitis with pigmented gall stone was the commonest GB disease in the present study. The study also revealed that females have increased preponderance for the development of all the gall bladder diseases including malignancy. Non-neoplastic lesions were more common till 5 decade in the present study whereas females in the 5th and 6th decade of life were prone for malignancy of gall bladder which was associated with gall stones.

Combination of general and local action drugs in treatment of patients with generalized periodontitis on the basis of the pathology of the hepatobilary system

The pathology of the hepatobiliary system significantly affects the state of the organs of the oral cavity. A clinical and index study of the state of periodontal tissues in 122 patients was conducted, which showed the prevalence of periodontal disease in patients with chronic acalculous cholecystitis. The examined patients were divided into groups depending on the treatment method, and the result was evaluated before treatment, directly after treatment and 6 months following treatment. Antidysbiotic hepatoprotector and 2% thiotriazolin ointment were included in the combination therapy. Studies have shown that patients with hepatobiliary pathology have increased likelihood of periodontal diseases, and after treatment, periodontal indicators and the hygiene index are significantly reduced, especially in the group where the proposed scheme was used, and the long-term results were stable for 6 months.

FUNCTIONAL STATE CHANGES OF THE VEGETATIVE NERVOUS SYSTEM IN PATIENTS WITH ACALCULOUS CHOLECYSTITIS DEPENDING ON THE TYPE OF SOMATOFORM VEGETATIVE DYSFUNCTION AND ESSENTIAL HYPERTENSION

Objective: to establish the features of the functional state changes of the autonomicnervous system in patients with chronic noncalculous cholecystitis, depending on the typeof concomitant somatoform autonomic dysfunction and hypertension stage II.Material and methods. 138 patients were examined: 98 of them with chronic acalculouscholecystitis in the exacerbation phase and concomitant somatoform autonomicdysfunction, 40 patients with chronic noncalculous cholecystitis in the phase ofexacerbation with accompanying essential hypertension stage II and 30 practicallyhealthy persons who made up the control group. To characterize the state of theautonomic nervous system we used A.M. Vein vegetative symptoms scale, Ashner-Danyini,Danielopulu (orthoclinostatic) tests.Results. Indices’ analysis of the carried out investigation of the general vegetativesymptoms have shown that the skin color changes during excitement, physical activity inpatients with somatoform autonomic dysfunction according to hypertensive type, cardiacneurosis and hypertension had a negative tendency, that is, the skin was pale, whatreflects an increase of the sympathetic nervous system tone and forms a decrease fromthe state of eutonia in scores by 1.7 times, 1.6 times and 2.0 times respectively (p<0.05).Pulse rate veritably increased (51.6%, 41.9% and 54.8% (p<0.05)) in patients of the 1st,3rd and 4th groups, in patients of the 2nd group it veritably decreased (29.0% (p <0.05))when conducting orthostatic test. During clino-orthostatic test, the pulse rate changed inthe diametrically opposite direction: in patients of the 1st, 3rd and 4th groups it sloweddown (21.9%, 28.1% and 31.3%, respectively (p< 0.05)), in patients of the 2nd groupit probably accelerated (21.9% (p <0.05)). During Ashner’s test in patients of the 1stand 3rd groups the pulse rate paradoxically tended to accelerate (20.0% and 26.7% (p<0.05)); in patients of the 4th group it veritably increased 30.0% (p <0.05), in patients ofthe 2nd group it veritably decreased (52.8%, p <0.05).Conclusions. Thus, an increase in the tone of the sympathetic part of the autonomicnervous system with frequent sympathoadrenal crises is observed in patients withchronic acalculous cholecystitis and concomitant somatoform vegetative dysfunction byhypertension type and cardiac neurosis as well as hypertension type II, and vagotonia witha predominance of the vago-insular crises is peculiar for the patients with concomitantsomatoform vegetative dysfunction according to hypotonic type.

Changes in thyroid hormones in patients with chronic acalculous cholecystitis in the practice of a family doctor

Abstract. Among biliary pathology, chronic acalculous cholecystitis (CAC) occupies one of the central places. The important role of the hormonal system in the regulation of the functioning of the biliary tract has been known for a long time, but the specific mechanisms of these influences remained unclear. Based on the results of a comprehensive clinical, laboratory, biochemical and instrumental examination, all patients with chronic acalculous cholecystitis were divided into three groups depending on the variant of impairment of the motor-kinetic function of the gallbladder. The first group consisted of patients with CAC and hypertensive-hyperkinetic gallbladder dyskinesia (group I) – 17 people; the second – patients with CAC with mixed hypotonic-hyperkinetic gallbladder dyskinesia (group II) – 19 people; the third – patients with САС and hypotonic-hypokinetic dyskinesia of gallbladder (III group) – 29 people. The level of free FT3, FT4, and thyroid-stimulating hormone (TSH) was determined by the immunofluorescence method using BREAHMS test systems (Henning Berlin GMBH). The disproportion between the thyroid hormones and the quantitative predominance of the inactive form made it possible to identify the relative hypothyroid syndrome in group I patients. The disproportion between the biologically inactive and active forms of thyroid hormones with a quantitative predominance of the inactive form made it possible to judge the presence of a relative hypothyroid syndrome in group II patients. In group III patients, a significantly increased TSH level was revealed, which was a response of the hypothalamic-pituitary system to a decrease in the level of FT3.

ОСОБЛИВОСТІ ЛІКУВАННЯ ХВОРИХ НА ХРОНІЧНИЙ БЕЗКАМ’ЯНИЙ ХОЛЕЦИСТИТ ІЗ СУПУТНЬОЮ ГІПЕРТОНІЧНОЮ ХВОРОБОЮ З УРАХУВАННЯМ ПОРУШЕНЬ В СИСТЕМІ ГОМЕОСТАЗУ

&#x0D; &#x0D; &#x0D; Recovery of chronic acalculous cholecystitis (CAC) in patients with hypetension disease (HD) is shown to be accompanied by inhibition of antioxidant system parameters and significant changes in lipid peroxidaton, which cause elevation of anti-inflammatiry cytokines level. The studied parameters correlate with thecharacterof the inflammatory processand the type of the gallbladder dyskinesia. The use of Choliver and Duspatalin in complex treatment of CAC in patients with HD provides clinical and laboratory remission, which allows to recommend these drugs for treatment of the above persons.&#x0D; &#x0D; &#x0D;

Trends in the epidemiology of pediatric acute and chronic cholecystitis-related admissions in the USA: a nationwide emergency department and inpatient sample study

Acute and chronic cholecystitis can be related to gallstone disease, although in childhood acalculous cholecystitis may be the most frequent form. Chronic acalculous cholecystitis is a subtype of pediatric chronic...

Study of histopathological spectrum of cholecystectomy specimens received in a government hospital

Introduction: Gall bladder analysis for various lesions was conducted. Chronic cholecystitis is was most commonly encountered lesion. Cholelithiasis and incidentally diagnosed carcinoma constitutes more than 95% and 0.5-1.09% of gall bladder lesions respectively. So, every specimen should undergo histopathological examination. Aims and objectives: i) To study various histopathological lesions of gall bladder ii) To evaluate the incidence of incidental gall bladder carcinoma. Materials and Methods: A cross-sectional study of 430 cholecystectomy specimens was conducted at Pathology Department, GMERS Medical College and General Hospital, Sola, Ahmedabad from February 2017 to March 2019 (2 years). Specimens received in 10% Neutral Formalin were processed and Haematoxylin and Eosin sections were studied. Results: We studied 430 cholecystectomy specimens. Females showed predominance (294 cases; 68.5%) with male-female ratio of 1:2.2. Most commonly affected age group was 21-40 years (154 cases, 35.8%), followed by 41-60 years (135 cases, 31.5%). The most common diagnosis was chronic calculous cholecystitis (279 cases, 65%). Others were chronic acalculous cholecystitis (114 cases, 26.4%), acute on chronic cholecystitis (13 cases, 3.1%), cholesterolosis (5 cases,1.2%), acute cholecystitis (4 cases,0.9%), xanthogranulomatous cholecystitis (4 cases,0.9%) and acute suppurative cholecystitis (2 cases,0.4%) with one case of adenomyomatosis (0.2%). Four cases of adenomas (ICPN- Intracholecystic Papillary-Tubular Neoplasms) and four cases of incidentally detected gall bladder carcinoma were obtained. Conclusion: The microscopic examination of cholecystectomy specimens is required to study various lesions and to detect carcinomas which are difficult to diagnose grossly. Thus, histopathological examination is the gold standard diagnostic tool. Keywords: Cholecystectomy, cholecystitis, cholelithiasis, Intracholecystic Papillary-tubular Neoplasms (ICPN), Signet ring adenocarcino

Engilen: from different therapeutic possibilities to effective clinical use

Composition of the Engilen preparation, medicinal properties of plants that make up the preparation, indications for its prescription are analyzed in detail in the article. Particular attention is paid to the advantages of Engilen, such as: optimal doses and ratio of active ingredients, wide range of indications, effectiveness upon combined diseases of the digestive system and with the concomitant pathology of other organs and systems. The results of our own study are presented, showing the effectiveness of Engilen upon chronic acalculous cholecystitis and non-alcoholic steatohepatitis in patients with excessive body mass or obesity. In addition, an effective correction of various types of the gall-bladder dysfunction has been obtained.