Chronic Non-calculous Cholecystitis Research Articles

Peculiarities of the formation of exocrine pancreatic insufficiency in patients with primary osteoarthritis under conditions of comorbidity

Summary. The comorbidity of primary OA and diseases of the gastrointestinal tract, which EPI accompanies, is an extremely relevant, complex, and unstudied problem of modern medicine, as it has a number of unsolved problems both in the treatment and rehabilitation of such patients. Common pathogenetic mechanisms of the progression of such comorbidity often have a mutually aggravating effect, which requires further study.
 The aim of the study is to analyze the changes in indicators of exocrine pancreatic insufficiency (EPI) in patients with primary OA under the conditions of comorbidity with diseases of the gastrointestinal tract (GI).
 Research material and methods. 304 patients with primary OA in comorbidity with diseases of the gastrointestinal tract accompanied by non-exacerbation EPI were examined. The comparison group consisted of 30 practically healthy individuals who did not have clinical, anamnestic, and instrumental signs of diseases of the gastrointestinal tract and joints.
 Results and discussion. It was established that in patients with primary OA in comorbidity with diseases that are accompanied by EPI, the levels of EPI indicators were statistically significantly different depending on the etiology of EPI.
 Conclusion. Post hoc analysis established the ranking of the pathology of the gastrointestinal tract, accompanied by EPI, according to the indicators of EPI in primary OA, which was located as follows, starting from the highest: CP ˃ T2DM ˃ chronic non-calculous cholecystitis and functional diseases of the gallbladder and biliary system ˃ chronic gastroduodenitis (p ˂0.05).

The role of phytocomponents in the complex therapy of chronic non-calculous cholecystitis

Non-calculous cholecystitis is a form of cholecystitis caused by dysfunction or hypokinesis of the gallbladder. The polyetiology and multiplicity of the pathogenesis of this disease requires different approaches to its correction. In this situation, phytopreparations containing components of origin provide special attention in combination with the main therapy. Curcumin has a strong protective effect against cholestasis through farnesoid X receptors, resulting in a release of bile acid homeostasis and counteracting inflammatory inflammation and as a manifestation of cholestasis. Several studies show that curcumin requires a contraction of the gallbladder. Despite the presence of many useful properties, the widespread use of curcumin in medical practice was limited by its limited bioavailability. Forms with increased bioavailability have been synthesized, such as kavacarcumin. The use of artichoke leaf extract in gastroenterology is based on its strong antidyspeptic effect, mediated by choleretic activity. As study show, the choleretic effect of the artichoke was more pronounced than that of the reference drug. In the description, there is no direct effect of chamomile phytocomponents on the state of bile compatibility and the function of bile outflow, however, an indirect effect on its work is possible. The results make chamomile flower extract a good addition to therapy. Thus, due to the occurrence of synergistic components, the complex is found in individuals, in patients with chronic diseases of the biliary tract, with functional disorders, the period of treatment in long-term complex therapy, with the prevention of exacerbation and prolongation of remission, as well as in healthy individuals for the prevention of these diseases.

Effective Treatment of the Gastrointestinal System Without Drugs

The mineral water is best remedy for correction of digestive organs functioning. The influence of mineral water "Phlate" have been studied at 80 patients with chronic noncalculous cholecystitis. Ecological pure mineral water "Phlate" supports the recovery of balance of liver, stomach and cardiovascular system destructed functions. The research of mineral water has shown prior importance of using of "Phlate" on patients suffering with chronic cholecystitis which is accompanying with hyperkinetic dyskinesias of biliary tract and hypersecretory gastritis. The high efficiency of mineral water "Phlate", which have been determined in our research, gives the reason of it's using as for prevention, so for treatment of above mentioned diseases.

Hymecromone Administration in Real Clinical Practice: Results of the Prospective Multicentre Observational Study in the Republic of Kazakhstan

Introduction. This multicentre prospective non-interventional observational study was conducted to obtain additional data about Odeston efficacy and safety in routine clinical practice. The objectives of the study included collection of clinical characteristics of patients, evaluation of Odeston effects in treatment of biliary pain and changes in the gallbladder emptying, evaluation of compliance to therapy, and treatment effect satisfaction.Materials and methods. The study was conducted from July 2020 to April 2021 at the premises of 60 study sites in 4 cities of the Republic of Kazakhstan. Patients having indications for Odeston administration according to the patient leaflet were enrolled. The study included 2 patient visits and an intermediate telephone contact. A visual analogue scale and RAPID questionnaire were used to characterise biliary pain; severity of associated symptoms, bowel habit and a quality of life according the SF-12 were also assessed. A rate of a ≥50 % reduction in symptom severity was used as a primary efficacy criterion; a rate of a ≥10 improvement in the SF-12 quality of life score was used as a secondary efficacy criterion. Compliance to treatment was evaluated using a number of days on Odeston. Treatment satisfaction was assessed using 5 grades.Results. 877 patients, 68.2 % of females and 31.8 % of males, were included in the study; the mean age was 46.0 ± 14.9 years. Primary functional biliary disorder was diagnosed in 65.3 % of patients, chronic non-calculous cholecystitis — 51.4 %, uncomplicated gallbladder disease — in 8.9 %, biliary sludge — 38.4 %, sphincter of Oddi functional disorder — 5.3 % of patients. A dose of Odeston was prescribed at the discretion of the physician. Group A patients received 600 mg (n = 89), group B received 1200 mg of Odeston a day (n = 788). In group B, an incidence of pronounced pain interference with daily living activities was higher. In both groups, the mean VAS scores were reduced to 1 point on treatment, a primary efficacy criterion was achieved in 77.3 % of patients in group A and in 79.8 % of patients in group B, р < 0.05. In both groups, a reduction in the incidence of constipation and diarrhea (р < 0,001) and an increase in the mean scores of physical and mental functioning were noted (р < 0.001, though a secondary efficacy criterion was not achieved (a ≥10 change in the SF-12 score). A prevalence of ultrasonographic sings of biliary sludge was reduced, and an increased gallbladder emptying was observed (p < 0.001). 77.4 % of patients in a total group of patients reported about drug administration for 21 days. A number of patients who were completely satisfied with treatment was higher in group B (p = 0.027).Conclusions. It was found that biliary pain interfered with daily living activities and commonly accompanied by other symptoms of gastrointestinal dysmotility. Odeston effectively reduces the severity of biliary pain, corrects dyspeptic disorders and normalizes stool pattern in patients with functional and organic diseases of the biliary system. Treatment satisfaction was higher with a dose of 1200 mg a day, particularly in more pronounced interference of pain with daily living activities.

Possibilities of life quality correction of patients with chronic pancreatitis in postoperative hypothyroidis

Aim: to study the quality of life and the emotional state of patients with chronic pancreatitis on the background of postoperative hypothyroidism and the possibility of effective rehabilitation.Materials and methods. 270 patients with chronic pancreatitis were examined, among which 40 patients with primary postoperative hypothyroidism, who made up group 1, group 2 included 30 patients without thyroid pathology. Patients underwent a blood test according to the main biochemical parameters, hormonal blood count, ultrasound of the thyroid gland, hepatobiliary and duodenal zone. The study of quality of life and psychoemotional state by tests.Results In patients with chronic pacreatitis in combination with postoperative hypothyroidism among diseases of the hepatoduodenal zone, chronic non-calculous cholecystitis and non-alcoholic fatty liver disease were identified that are clinically characterized by abdominal pain syndrome according to the GSRS questionnaire. Patients revealed mild depressive state, high levels of personal and situational anxiety. The quality of life of patients was reduced both in physical and in psychological components, due to indicators of role-playing physical and emotional functioning. Against the background of treatment with a combination of succinate-containing drugs, the severity of depression, situational and personal anxiety decreased, and role functioning due to physical and emotional state, social functioning increased.Conclusions: The use of combination therapy with sodium levothyroxine and ethylmethylhydroxypyridine succinate in patients with comorbid pathology during postoperative hypothyroidism improves the clinical picture, psychoemotional balance and quality of life.

Liver diseases at new coronavirus infection in pregnant women of Samara region

The new coronavirus infection (COVID-19) is a life-threatening condition. The features of the treatment of COVID-19 in pregnant women are not sufficiently studied and contradictory, therefore, research in this area is relevant.Objective. Assess the presence of liver disease in pregnant women with COVID-19 infection during pregnancy and after childbirth, taking into account the treatment.Methods. A retrospective analysis of medical records of 43 pregnant women aged 19 to 39 years (mean age 29.1 ± 5.4 years) who were hospitalized with laboratory-confirmed COVID-19 infection was performed. The selection was carried out by the method of continuous sampling.Results. 17 women (39.5%) had an acute respiratory viral disease, 26 people (60.5%) were diagnosed with bilateral polysegmental pneumonia with pulmonary tissue damage from 5 to 25%. In the structure of extragenital pathology, 46.5% of women had anemia and 23.3% of diseases of the hepatobiliary system, including chronic non-calculous cholecystitis (4.7%), biliary dysfunction (7%), chronic viral hepatitis B (2.3%) and chronic viral hepatitis C (9.3%). 6.9% were diagnosed with cholestatic hepatosis of pregnant women before admission to the hospital. An increase in the level of transaminases above the upper normal values was noted in 69.8% of cases, alkaline phosphatase – in 76.7%. In the structure of pregnancy complications in women with COVID-19 infection, fetal hypoxia prevailed in 15 women (34.9%). In second place is premature rupture of amniotic fluid (16.3%) and fetal malnutrition (16.3%).Conclusions. Pregnant women with diseases of the hepatobiliary system and anemia are most susceptible to new coronavirus infection. They have an increase in the level of transaminases and alkaline phosphatase, which can be caused by liver damage due to the increased tropism of the virus to cholangiocytes and hepatocytes, as well as hepatotoxic drugs. The most common complications of pregnancy in women with a new infection are premature birth, fetal hypoxia, and antenatal death.

Асоціація окремих показників ендотеліальної функції з T894G поліморфізмом гена ендотеліальної синтази монооксиду азоту у хворих на гіпотиреоз і супутній хронічний холецистит

Досліджено асоціацію T894G поліморфізму гена eNOS з окремими показниками ендотеліальної функції у хворих на гіпотиреоз і супутній хронічний некалькульозний холецистит. У пацієнтів із Т-алеллю відзначено вірогідне зростання на 33,1 % (P = 0,01) кількості десквамованих ендотеліоцитів у крові порівняно з такою в обстежених носіїв GG-генотипу. Також встановлено на 10,4 % (P = 0,04) вищу концентрацію загальних стабільних метаболітів монооксиду азоту та на 10,8 % (P = 0,02) більший рівень нітрат-аніонів у крові щодо групи порівняння. У хворих на гіпотиреоз із супутнім хронічним холециститом вміст судинного ендотеліального фактора росту в носіїв T-алелі на 27,7 % (P = 0,03) переважав такий у пацієнтів із GG-генотипом.

Manifestation of oxidative stress during pregnancy in women with chronic diseases of hepatobiliary system against the background of reproductive losses

In the early stages of gestation the changes in the lipid peroxidation can lead to violations of regulatory and protective functions of biomembranes in pregnant women. The objective: to study the changes in the concentration of intermediate and final products of LPO during the first trimester of gestation in patients with early miscarriage against the background of chronic diseases of the hepatobiliary system. Materials and methods. 118 pregnant women in the first trimester of gestation (7-10 weeks), aged 22 - 39 y. o. (mean age 29.4 ± 2.7 years) have been examined.64 women (54.2%) were diagnosed with a risk of miscarriage, and 17 patients were diagnosed with involuntary miscarriage within 10-12 days. All women were diagnosed with non-viral and non-alcoholic chronic HBS paathology: hepatic steatosis had 38 patients (32.2%), 80 patients (67.8%) had non-alcoholic steatohepatitis; in 97 patients (82.2%) chronic non-calculous cholecystitis was diagnosed. The state of lipid peroxidation was assessed by the content of malonic dialdehyde spectrophotometrically, as well as diene conjugates in the blood The indicator of erythrocyte peroxide hemolysis was examined by the level of erythrocyte peroxide resistance. Results. A significant increase in intermediate and final products of lipid peroxidation in pregnant women with an unfavorable premorbid background in the form of chronic diseases of the hepatobiliary system and a history of reproductive losses. A significant increase of MDA and DC concentration was found at the risk of premature termination of pregnancy. The degree of PLO processes activation makes these parameters integrative criteria for the detection of systemic metabolic disorders during gestation in women with GBS extragenital pathology. Conclusion. During physiological pregnancy there is an accumulation of metabolites of lipid peroxidation, which is associated with an increase in basic metabolism in women and an increase in oxygen consumption from the blood.

CHANGES IN THE INTENSITY OF FREE RADICAL LIPID OXIDATION IN PATIENTS WITH BRONCHIAL ASTHMA WITH CONCOMITANT CHRONIC NON-CALCULOUS CHOLECYSTITIS

INTRODUCTION: The incidence rate of chronic non-calculous cholecystitis (CNCC) in the population is 35-38%, and in elderly patients it reaches to 65-72%. Free radical lipid oxidation (FRLO) plays a significant role in the development and progression of bronchial asthma (BA). The initiators of FRLO excessive activation can be the following: hypoxia, inflammation, immune damage to membranes and the imperfection of the antioxidant defense.
 OBJECTIVE: To compare the intensity of FRLO processes in patients with BA and comorbid CNCC, and patients with BA and CNCC each without any comorbidities..
 METHODS: The study was performed on 92 patients: 30 patients with BA (group 1), 30 patients with BA and comorbid CNCC (group 2), and 32 patients with CNCC (group 3). The control group consisted of 30 practically healthy persons (PHP). The number of compounds with isolated double bonds (IDB), diene conjugates (DC), ketodienes and conjugated trienes (K/CT), and malonic aldehyde (MA) in erythrocytes and blood plasma were determined.
 RESULTS: In groups 1, 2, and 3, the content of IDB was higher in comparison with PHP by 1.4, 1.7, and 1.6 times respectively. In group 1, plasma K/CT was 12.0% higher, and DC was 1.5 times higher compared to the PHP group. In group 2, DC and K/CT were higher by 1.7 times and by 21.7% as compared with PHP. In group 1, plasma MA and red blood cell MA were higher by 18.0% and 29.8%. The highest content of plasma MA and red blood cell MA in group 2 of patients was 69.8% and 54.3% respectively. In group 3, plasma MA was 34.7% higher, and red blood cell MA was 44.4% higher compared to the normal values.
 CONCLUSIONS: Intensification of FRLO processes leads to disruption of microcirculation and metabolic processes in the bronchial epithelium, supports local inflammatory process in the gallbladder and bronchi and promotes inhibition of tissue respiration with increased tissue hypoxia, which, in turn, leads to the progression of broncho-obstruction.

Аналіз сучасних засобів фізичної терапії при хронічному некалькульозному холециститі

Purpose: to characterize the use of physical therapy in chronic noncalculous cholecystitis. Material and methods: theoretical analysis and generalization of modern scientific literature in the use of rehabilitation means in chronic noncalculous cholecystitis. Results: modern means of physical therapy for chronic non-calculous cholecystitis were considered. Conclusions: with chronic noncalculous cholecystitis, complex physical rehabilitation is the most effective, the component of which is a rational movement regime, therapeutic nutrition, natural physical factors, therapeutic exercise, therapeutic massage, and physiotherapy treatment.

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.

Interrelation of fibroblast growth factor 19 with the bile acids’ levels and lipid profile parameters in patients with chronic non-calculous cholecystitis with and without type 2 diabetes mellitus

Objective — to study changes in the levels of fibroblast growth factor 19 (FGF‑19), bile acids (BAs) and lipid profile parameters in patients with a combined course of type 2 diabetes mellitus (DM2) and chronic non‑calculous cholecystitis (CNC) and with isolated CNC, as well as to investigate the nature of these relationships between the indicators.Materials and methods. Examinations involved 93 patients with CNC, from them CNC was combined with DM2 in 62 cases (the main group). The comparison group consisted of 31 patients with isolated CNC. The age of patients ranged between 44 and 75 years. The DM2 duration varied 1 to 19 years. The control group consisted of 20 practically healthy age‑ and gender‑matching subjects. The assessments included the lipid metabolism status (total cholesterol, high, low and very low density lipoprotein cholesterol («Dac spectrum med reagent» kits, Moldova), triglycerides («Dac spectrum med reagent» kits, Moldova). «Dialab» reagent kit (Austria) was used to determine the blood serum BAs levels. The FRF‑19 level was studied by the enzyme immune method («BioVendor» reagent kit, Czech Republic).Results. It has been established that RFF‑19 levels in the groups of combined CNC‑DM2 pathology and isolated CNC were significantly lower than in patients from the control group, with more pronounced decrease was masked in patients with comorbid pathology. In patients with CNC‑DM2 comorbidity, the serum BAs level was in 4.8 times higher, and in patients with isolated CNC in 2.6 times higher than in subjects from control group (p &lt; 0.05). The comparison of the studied parameters in patients with comorbidity of type 2 diabetes and CNC and patients with isolated CNC showed differences. In patients with CNC‑DM2 comorbidity vs isolated CNC, the BAs levels were higher by 82 % and FGF‑19 levels were lower by 39.6 % (p &lt; 0.05). The changes in lipid profile vs norm were determined in all investigated patients, the most pronounced they were in case of the CNC and DM2 comorbidity. The levels of total cholesterol, triglycerides and low density lipoproteins levels were higher at CNC and DM2 comorbidity by 46.1 %, in 1.4 times and by 29.8 %, respectively (p &lt; 0.05). The levels of high density lipoproteins were significantly lower at the combined course of CNC and DM2 when compared with patients who had isolated CNC (p &lt; 0.05).Conclusions. In patients with comorbidity of type 2 diabetes mellitus and CNC and with isolated cholecystitis, an increase in the serum BAs levels have been established against the background of the low serum levels of their regulator FRF‑19 along with the changes in lipid profile of atherogenic nature when compared with the control group. Dysregulation of BAs homeostasis and proatherogenic activity of lipid profile markers are more profound in cases with the simultaneous course of DM2 and CNC compared to the cases with isolated CNC.

ASSESSMENT OF HUMORAL IMMUNITY IN PATIENTS WITH CHRONIC VIRAL HEPATITIS B, COMBINED WITH CHRONIC NON-CALCULOUS CHOLECYSTITIS

The article presents data on assessing the state of the humoral immunity in patients with chronic viral hepatitis B, combined with chronic non-calculous cholecystitis, as chronic liver viral lesions are immune-mediated condition, depending on the replicative activity of the virus and the immune system’s responses to this virus. At the same time, there is an increase in the overall level of CIC in serum and an imbalance in the molecular composition of immune complexes, as well as a decrease in the immunological reactivity in such patients.

IMPROVEMENT OF THE TREATMENT OF CHRONIC NONCALCULOUS CHOLECYSTITIS IN PATIENTS WITH DIABETES MELLITUS TYPE 2

The purpose of the work is to improve the medical treatment of chronic noncalculouscholecystitis (CNC) combined with diabetes mellitus type (DM).Material and methods. A detailed clinical examination was conducted in 60 patientswith DM type 2 and CNC. Patients were divided into two identical groups (30 persons inevery group), representative to the signs of gender, age, severity and duration of thedisease. Patients of the 1st group were treated in the traditional way, and the secondgroup - by the proposed method. Treatment of patients of the 1st group (30 pesons) wascarried out by the protocol method: clinical nutrition (diet No. 9/5), chophytol 1 tabletthree times a day, antispasmolitics and antibiotics (if indicated). Patients of the 2ndgroup (30 persons) were prescribed diet No. 9/5, a preparation of -lipoic acidthiogammа turbo and raphacholine C. All patients underwent a thorough examinationusing standard clinical, laboratory, biochemical and instrumental studies.Results. Applying the proposed treatment regimen, manifestations of pain, dyspeptic andastenovegetative syndromes were observed in significantly smaller numbers in patients ofthe 2nd group than in patients of the 1st group. In patients of the 2nd group,normalization of ultrasonographic signs of the gallbladder was observed. Also in patientsof the 2nd group there was a significant decrease in the duration of the I, III, IV and Vphases of multi-stage duodenal sounding with a decrease in the volume of secreted bile.Patients of the 2nd group showed a significant decrease in the levels of total lipids,cholesterol, bile acids, triacylglycerols, low density lipoproteins and an increase in highdensity lipoproteins and serum phospholipids relative to similar indices before treatmentand indices of patients of the 1st group after treatment. The same changes were in thelipid spectrum of bile in patients of both subgroups after the treatment. An increase intwo-component and a decrease in three-component indices of bile lithogenicity inpatients of the 2nd group relative to similar indicators before treatment and in patients ofthe 1st group after treatment were observed.Conclusion. The use of raphacholine C and thiogamma turbo in the complex treatment ofpatients with chronic noncalculous cholecystitis and diabetes mellitus type 2 has apositive effect on the reduction of symptoms of pain, dyspeptic and asthenovegetativesyndromes, the dynamics of biochemical changes in blood and bile.

Chronic noncalculous cholecystitis and diabetes mellitus type 2: clinical-instrumental features of comorbide pathology

The purpose of the work is to identify the peculiarities of clinical course and instrumental changes by chronic noncalculous cholecystitis (CNC) and diabetes mellitus type 2 (DM).Material and methods. The clinical examination was carried out in 120 persons, patients with diabetes mellitus type 2 and CNC. All patients were divided into 2 groups depending on the presence of CNC and combined pathology: group 1 — persons with DM and CNC, group 2 — persons with isolated CNC. A thorough examination was carried out using clinical, laboratory, biochemical, instrumental methods. All patients have undergone a multi-moment duodenal sensing (DS) and an ultrasound examination (ultrasound) of the abdominal cavity.Results. Pain syndrome was observed in 100% of patients in the 2nd group, and in half of patients in group 1. The probable difference in the intensity of pain was noted. The leading symptoms of dyspeptic syndrome among patients were flatulence and nausea. In patients with a combined pathology, the signs of vagotonia prevailed: emotional lability and thirst. All patients had all the echographic signs of CNC by conducting an ultrasound investigation. Murphy's positive ultrasound symptom was observed only in 87,1% of the 1st group and 100% of the patients in the 2nd group. Taking into account the data of ultrasound and BS, all examined patients revealed hypotonic-hypokinetic dyskinesia of biliary tract, which was more severe in patients with a combined pathology. Conclusions. In patients with chronic noncalculous cholecystitis and diabetes mellitus type 2, pain is present only in a half of the examined patients with its insignificant intensity, while in patients with isolated chronic noncalculous cholecystitis there was a pain syndrome of 100% with moderate intensity and appearance of pain syndrome in 1–1,5 hours after food intake. Patients in the first group were more likely to have constipation and flatulence, which is probably due to diabetic autonomic neuropathy. In the structure of asthenovegetative syndrome in patients of the 1st group, prevailing signs of vagotonia, which indicate a more significant disorders of the homeostasis in persons of this category compared with persons in the 2nd group. There were observed in the patients with chronic noncalculous cholecystitis and diabetes mellitus type 2 by instrumental research methods thickening of walls, inequality and presence of deformations, increase in size of gallbladder, decrease in the threshold of pain sensitivity in the examination of the Murphy ultrasound symptom, and the presence of hypotonic-hypokinetic dyskinesia.

Особливості тиреоїдного статусу у жінок із гіперплазією щитоподібної залози, поєднаною з безкалькульозним холециститом

It was conducted a comprehensive survey of 87 women aged 22-54 years who had chronic noncalculous cholecystitis as the main diagnosis, and hyperplasia of the thyroid gland was firstly established in the conditions of the resort Truskavets, and accordingly, these women did not use drugs for its treatment. It was found that in the presence of thyroid gland hyperplasia and noncalculous cholecystitis, thyroid status in women is characterized by hypofunction of the thyroid gland, and changes in it functioning occur by the type of hypothyroidism. The thyroid status of such patients, according to some features, corresponds to subclinical, in some cases – manifest primary hypothyroidism in addition with the syndrome of "low T3". The values of the parameters that characterize the hormonal status of the patients, in its pure form not meet any of these pathological conditions.

Личностно ориентированная образовательная программа у пациентов с желчевыводящей патологией

Purpose of the study. Show the effectiveness of training for young people with chronic non-calculous cholecystitis on the example of a personality oriented educational program. Materials and methods. A total of 64 patients with chronic non-calculous cholecystitis in the remission phase were examined. They determined the levels of anxiety, indicators of quality of life, types of attitudes towards the disease. The obtained data were compared before and after training in a person-centered program. Results. In the course of dynamic management of patients with biliary pathology, a decrease in high anxiety levels, an increase in persons with a low level of anxiety, an increase in ergopathic, mixed types of attitudes towards the disease, a decrease in anxiety and hypochondriacal types was noted. In terms of quality of life, an increase in self-satisfaction along with a scale of health status was reliably detected. Positive changes in the behavior of patients in terms of adherence to the implementation of the recommendations of the doctor according to the person-oriented program are identified. Individual approach, familiarity of patients with the basics of the disease, risk factors, self-help, mutual aid, non-drug, urgent measures contribute to the primary and secondary prevention of the disease. Conclusion. In the course of this study, positive results were obtained in the psychosomatic status of patients. Due to the development of this trend now, increasing the level of education of certain groups of the population, individual approach to each patient, resolving issues together with the doctor in class, discussing emerging issues, getting advice - all this allows you to increase the patient’s participation in resolving issues of self-, mutual assistance, control the state of the main indicators of the level of health, monitor the levels of anxiety, depression and promptly contact specialists; therefore, this technique is relevant to and Use at the outpatient stage for people of all ages.

The effectiveness of the use of anti-dysbiotic hepatoprotector in the complex treatment of patients with periodontal inflammatory diseases on the background of chronic non-calculous cholecystitis

Summary. Inflammatory periodontal diseases continue to be one of the pressing problems of modern dentistry [1]. It is known that there is a close relationship between general-somatic pathology and diseases of the oral cavity [2].&#x0D; The aim of the study – to learn the effectiveness of the use of anti-dysbiotic hepatoprotector in the complex treatment of patients with periodontal inflammatory diseases on the background of chronic non-calculous cholecystitis.&#x0D; Materials and Methods. The main (group 1) group consisted of 106 people who suffered from inflammatory periodontal disease (IPD) with concomitant chronic non-calculous cholecystitis (CNC). The comparison group included 92 patients with IPD without concomitant pathology (group 2). To compare the research results of the patients with IPD, 30 healthy teethed individuals without periodontal pathology and without somatic diseases (group 3 or the control group) were involved. The state of the hepatobiliary system in patients of the main group was assessed by the doctors of the Gastroenterology Department of Zolochiv District Hospital of Lviv region.&#x0D; Results and Discussion. The symptomatic HCG and the presence of solid and soft dental deposits were diagnosed in all patients. The Green-Vermillion’s index was the highest in patients from the main group (1.67±0.01); it was probably (p &lt;0.05) higher than that in the comparison group (1.54±0.04), as well as in the control group (0.44±0.07). The PMA index in the subgroup 1A immediately after treatment decreased by 9.7 (p &lt;0.001) times. The index of bleeding in the subgroup 1A decreased by 10.7 (p &lt;0.001) times. The PMA index in the subgroup 1A immediately after treatment decreased by 10.4 (p &lt;0.001) times. The index of bleeding in the subgroup 1A under the influence of the proposed therapy decreased by 6.5 (p &lt;0.001) times.The difference regarding the data before treatment remained lower by 2.2 times and 2.0 (p &lt;0.001) times, however, the difference between the subgroups 1A and 1B in 3 months and 6 months was already 2.1 times in both cases.&#x0D; Conclusions. It was found that the clinical course of inflammatory periodontal diseases was much more difficult in these patients. The presence of pathology in the hepatobiliary system in patients increases the risk of periodontal disease. Therefore, in order to improve the efficacy of treatment, it is advisable to use this antidysbiotic drug in the complex treatment, and the results obtained in 3 and 6 months after treatment indicate a long-lasting positive effect.

Modern approaches to the diagnosis and management of chronic cholecystitis at the primary level of medical care

The article presents the main etiological factors, diagnostic criteria and tactics for the management of patients with chronic noncalculous cholecystitis under the conditions of the primary care unit. The algorithm of the action of the general practitioner – family medicine in the management of patients with chronic noncalculous cholecystitis is formulated. The main directions of primary and secondary prevention of this pathology by the family doctor are given.

Dynamics of the intestinal biocenosis, indicators of the blood lipid profile, antioxidant system, and energy metabolism in the patients presenting with chronic non-calculous cholecystitis under the influence of the therapeutic physical factors in the combination with probiotics

The present study included 60 patients presenting with chronic non-calculous cholecystitis and intestinal dysbiosis. It has been demonstrated that the application of the 'Nor Narine' probiotic in the combination with 'Djermuk' hydrocarbon sodium sulfate mineral water and the pre-formed physical factors, in the first place the magnetic laser radiation, increases the effectiveness of the rehabilitative treatment of the patients. Such treatment resulted not only in the positive dynamics of the clinical picture of disease but also in the well apparent marked tendency toward normalization of the intestinal biocenosis, the lipid blood spectrum, the antioxidant system, and the energetic exchange.