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The aim of the research was to investigate the remote results of surgical treatment of 75 patients with cholelithiasis combined with chronic duodenal obstruction. Control group was composed of 40 patients who underwent laparoscopic cholecystectomy. Compensated stage of cholelithiasis with chronic duodenal obstruction was detected in 16 (21.3%) patients, subcompensated in 37 (49.3%) and decompensated stage in 17 (22.7%) patients. In 14 patients (18.7%) with cholelithiasis combined with chronic duodenal obstruction laparoscopic cholecystectomy was conducted due to the positive results of preoperative conservative treatment. In the long-term quality of life after surgery in the main group of patients were average 35.4% higher than in the control group; in the main group postcholecystectomical syndrome was diagnosed in one case (2,1%) and in 13 (32,2%) cases in the control group.

To date, the factors significantly reduces the tolerance of the liver against the development of NAFLD and GSD. At the stage of biliary sludge cholelithiasis is found in more than half of the patients suffering from NAFLD. BS violates jelchnokamennouu and releaxation activity of hepatocytes, thereby slowing the passage of bile through the intrahepatic and extrahepatic bile ducts that aggravate the course of NAFLD. The reasons for the formation of sludge is not completely understood. To date there are no accepted tactics of conducting and treatment of patients with HB in the background of NAFLD. In our work we demonstrate one possible way to tackle this important problem.

The objective of the early postoperative rehabilitation of the patients presenting with cholelithiasis is to prevent the further progression of the disease and reduce the risk of development of post-cholecystectomy disorders. The combined treatment including the use of low-mineralized mineral waters, magnetic, laser, and EHF-therapy makes it possible to significantly improve the parameters of interest due to the marked improve mentor normalization of the clinical and laboratory characteristics, the increase of adaptive capabilities, and the correction of the psycho-emotional and vegetative status of the patients. Taken together, the peculiarities of the combined rehabilitative treatment of the patients with cholelithiasis during the early postoperative period account for its high clinical effectiveness amounting to 94.7%. The results of the study give reason to recommend the application of the proposed technology for the rehabilitative treatment of the patients presenting with cholelithiasis.

The article is devoted to actual issues of diagnostics of the initial stage of cholelithiasis in children. Special attention is paid to the role of functional disorders of the biliary tract as factors in the pathogenesis of metabolic pathology of the hepatobiliary system. According to the results of the study highlighted the predominant types of functional disorders of the gallbladder and biliary tract stone disease in children. Highlighted the role of diagnostics of the initial manifestations ECB in the prevention of progression and formation of calculous stage of the disease.

Results of cholecystectomy performance were analyzed in 99 patients with a biliary calculous disease, the course of which have become complicated by cholecystitis occurrence, in 49 of them professional diseases of respiratory organs, including silicosis, antracosis, were registered. Estimating results of laparoscopic and open cholecystectomy, we have established, that carboperitoneum in laparoscopic cholecystectomy impacts negatively the course of early postoperative period, what manifests with hemodynamic and respiratory disorders. The level of fibronectin and endotelin--1 in the blood plasm directly depends on the respiratory disorders severity and may be applied as a test for respiratory dysfunction. The method of cholecystectomy in patients, suffering professional diseases of respiratory organs, must be selected, depending on severity of functional disorders of respiratory organs.

Aim: To study the specific features of the clinical course of gastroesophageal reflux disease (GERD) associated with duodenogastroesophageal reflux (DGER) in patients with chronic acalculous cholecystitis (CAC) and cholelithiasis (CL), as well as qualitative and quantitative characteristics., Subjects and Methods: The clinical, morphological, motor tonic characteristics of the esophagogastroduodenal area, mucosal microbial biocenosis in the esophagus, stomach, and duodenum were studied in detail in 83 patients with GERD that was associated with DGER and ran concurrently with CAC or CL., Results: Impaired duodenal propulsive activity as a concomitance of the signs of gastrostasis and duodenal dyskinesia with dyscoordination of both anthroduodenal and duodenojejunal propulsion and with the development of duodenogastric reflux and DGER, which in turn determine esophageal and gastric pH values is shown to be of importance in CAC and CL, which match GERD. Abnormal microbiocenosis in the upper digestive tract is characterized by the higher quantitative and qualitative content of the mucous microflora. Opportunistic microorganisms exhibit cytotoxic, hemolytic, lecithinase, caseinolytic, urease, and RNAase activities., Conclusion: The found specific features of the course of GERD associated with DGER in patients with biliary tract abnormalities lead us to search for novel therapeutic approaches based on the correction of digestive motor tonic disorders and abnormal microbiocenoses of the mucous flora in the esophagus, stomach, and duodenum.

The authors present an analysis of treatment results in 14 patients with hepatolithiasis. An influence of chronic opisthorchosis invasion on the frequency was determined. Hepatolithiasis was detected in 8 (0.14%) out of 5757 patients, who underwent the operation for cholelithiasis and its complications. The disease was found out in 6 (0.31%) patients out of 1965, who had cholelithiasis and accompanying chronic opisthorchosis. It was 2,2 times more frequent due to proliferative sclerotic changes of biliary system. The trasdermal teanshepatic cholangiography was contraindicated for opisthorchiasis injuries, because of the danger of subcapsular cholangioectates damage. The endoscopic retrograde cholangiopancreatography and the endopapillosphincterotomy were complicated due to extensive structures of the large duodenal papilla and distal section of the general bile duct. The patients were treated by using the cholecystectomy, extraction of stones from ducts, reconstruction of liver passage. Choledochoduodenostomy was performed with compulsory external drainage for ducts sanation from infections and helminthes in the case of the opisthorchiasis. Interportal infusions were carried out. The surgical, conservative and endoscopic treatment was required for multiple colangiolithiasis. The lethality consisted of 7.1%.

Unlabelled: The aim of the present study was a comprehensive study of the features autonomic nervous system in cholelithiasis before and after cholecystectomy., Materials and Methods: 88 patients aged 40 to 60 years. 55 patients with cholelithiasis before and after laparoscopic cholecystectomy (CE). Control group consisted of 33 patients of similar age and gender. To investigate the function of the autonomic nervous system were evaluated themes complaint history, physical examination data, and used less Tod mathematical analysis of cardiac rhythm by Baevsky RM using the author's computer-related programs "Korveg" with the definition of heart rate variability and table--Solovevoj Wayne., Results and Conclusions: The study of autonomic provision in rest and during exercise were increased sympathetic activity, exceeding those in the control group. Studies indicate a tendency to sympathicotonia patients with gall stones before and after cholecystectomy, which is enhanced adaptive compensatory mechanisms to maintain homeostasis in the body. Identify logical connections between clinical and autonomic indicators will predict flow pattern cholelithiasis before and after cholecystectomy, as well as pick individual therapy for each patient taking into account the autonomic features that can be widely used in practical medicine--not.

Obesity is non-infectious pandemic. Its association with cardiovascular pathology is especially widely discussed, but an overweight patient is actually polymorbid. An increase of body mass provides a pathogenetic basis for many diseases including those of digestive system This review deals with pathogenesis, clinical features, and treatment of gastroesophageal reflux disease, cholelithiasis and non-alcoholic fatty liver disease in obese patients. This pathology and its aggravation result from such pathophysiological processes as a rise in intra-abdominal pressure, excess adipokine, cholesterol and free fatty acid synthesis, activation of lipid peroxidation. Gastroesophageal reflux disease in obese patients has an atypical clinical course characterized by discrepancy between clinical, endoscopic and morphological features in oesophagus and frequent formation of Barrett's oesophagus. Cholelethiasis in obesity is fraught with further progress of the disease after prescription of low-fat diet. The risk of calculi formation can be reduced by prescription of ursodeoxycholic acid that produces both litholytic and hypolipidemic effects. Treatment of non-alcoholic fatty liver disease requires combined therapy with statins, insulin sensitizers, hepatoprotectors and adequate physical activity. Sustained remission of diseases of digestive organs is impossible without correction of body mass and their pharmacotherapy requires increasing doses of medicines and duration of their administration.

A comparative clinical study of 136 female patients with uncomplicated chronic calculous cholecystitis, including 106 patients examined in the pre- and postoperative periods of endoscopic cholecystectomy, revealed the effect of chronic illness and surgery on the neurological status and cognition which was more pronounced in adulthood. We investigated anxiety feelings before and after surgery. Our findings should be taken into consideration in the preoperative preparation of patients and their care in the postoperative period.

The key task of the district physician is staged diagnostic search and clinical detection of functional disorders--conduction of laboratory tests and device investigations (in cholelithiasis patients--ultramicroscopic investigation of bile, x-ray methods, ultrasonography) to initiate prophylactic-therapeutic measures (medico-social, pharmacological and therapeutic-dietary).

In article the data on interrelation between gallbladder contractility and a level of hormones of a thyroid gland (threeiodethyronine, thyroxine, thyrotropin hormone (TTH) and antibodies to thyreoperoxidase (AT to TPO)) in plasma of blood at 470 healthy persons and 540 patients with gallstone disease are submitted. The contractility function of a gallbladder on ultrasonic at persons with gallstone disease is authentic less, than at healthy persons. Dysfunction of a thyroid gland is found out in women with gallstone disease: increase TTH and AT to TPO. Among men hormonal shifts are not revealed. Contact chemical litholysis with methyl tert butyl ether of cholesterol stones in gallbladder except for their dissolution, improves its contractility activity.

Treatment results of 1048 elderly patients, operated on the cholelithiasis, were analyzed. The group of minilaparotomic access cholecystectomy numbered 488 (46,6%) patients; the second group consisted of 560 (53,4%) patients, who had the traditional operation. All patients were operated on in a single hospital during 1998-2008 yy. The cholecystectomy from minilaparotomic access proved to be less traumatic and preferable for elderly patients. The rate of postoperative morbidity was 5,7%, mortality - 0,2%. The procedure, though, is subjected to the experienced surgeons.

This article describes the current status of the issue of biliary tract disease in children. There were shown current differences according to age-appropriate. Was presented a new structure of the bile-excreting system diseases, among them dysfunction of the gallbladder and Oddi's sphincter, bile duct abnormalities, biliary sludge, cholelithiasis; cholesterosis of the gall bladder isn't casuistry. Was established necessity of modern intrascope research methods for the differential diagnosis of these diseases. Were identified promising areas of study of biliary tract diseases in childhood.

Material and Methods: We examined the resultants of treatment of 268 old patients. RESULTATES: The global demographic transition to an older population effects developing as well as developed coutries. Cganges in mitochondria with age, in body composition, in biliary tract gives to start for many diseases such as cholelitiasis. It has recommended the special surgic tactict of treatment such situations.

It was made an organized study of the functional condition of hepato-biliary system beside 200 patients with fatty hepatosis and fatty hepatosis with concomitant sugar diabetes. In verification of the diagnosis were used results of the biochemical blood's study, ultrasonography study, computer and MR tomography. All patients were conducted with duodenal tubing with following biochemical bile study. Breach of the functional condition liver was revealled beside majority sick fatty hepatosis, moreover degree of the breaches becomes above under accompanying sugar diabetes. Unidirectional change in biochemical bile characteristic wasn't noted beside patient fatty hepatosis and fatty hepatosis with accompanying sugar diabetes, corresponding to I stage cholelithiasis.

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.

The aim of the study was to determine the clinical significance of intestinal functional and structural alterations in biliary pathology. Clinical, endoscopic, morphological, and morphometric methods were used. The subjects of the study were 62 patients with functional gall bladder disorder, 90 patients with chronic calculous cholecystitis, and 90 patients who had undergone cholecystectomy for cholelithiasis. The study found that biliary lithogenesis was associated with intestinal dysbiosis, changes in the qualitative density of erythrocytes immunopositive to motilin and substance P, and inflammatory changes in the intestines. After cholecystectomy, changes in intestinal microecology progressed, inflammatory and atrophic changes in the intestinal mucosa appeared or deepened, the qualitative density of erythrocytes immunopositive to motilin and substance P decreased, and colon polyps appeared more frequently.

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.

The subjects of the study were 164 patients, divided into two groups. Group I included 76 patients at the physicochemical stage of cholelithiasis, and 38 patients after cholecystectomy, who underwent endoscopic papillosphincterotomy (EPST). Group II (control) included 30 patients at the physicochemical stage of cholelithiasis, and 20 patients after cholecystectomy, who did not undergo EPST. Endoscopic retrograde pancreatocholangiography revealed type II Oddi's sphincter dysfunction in all the patients. Evaluation of the chemical composition of bile in Group I, performed 6, 12, 18, and 24 months after EPST, revealed its graduate stabilization. In Group II the dynamics of bile composition was negative--in 8 patients bile became more lithogenic. Long-term observations showed that 6 years after EPST bile was lithogenic only in 4 Group I patients, while at the same moment in 25 Group I patients bile lithogenicity did not disappear, but even worsened. Biliferous tract ultrasonography, performed long after EPST, found biliary sludge in 4 Group I patients. 6-year observation of Group Il patients, including ultrasonography, demonstrated that during the 4th year of observation biliary sludge occurred in as many as 28 patients, in 15 of whom small concrements on the bottom of the gall bladder were found during the 5-6th year of observation, and in 3 of whom a solitary concrement of 4 to 5 mm in diameter was found in the choledoch. The results demonstrate that it is appropriate to perform EPST as early as at the physicochemical stage of cholelithiasis, because this procedure results in stabilization of biliary colloid balance and thus prevents biliary sludge and forming of gall bladder concrements. At the same time, 36% of patients with cholelithiasis at various stages who did not undergo EPST, formed gall bladder concrements. EPST is also appropriate in some patients after cholecystectomy, in order to prevent repeating gall bladder concrement formation.

The subjects of the study were 267 patients with chronic calculous cholecystitis (CCC), in 132 of whom it was accompanied by postinfarction cardiosclerosis. The researchers studied the influence of various clinical forms of CCC on cardiovascular system (CVS) functioning, and established cardiovascular criteria to determine when a surgery for CCC can be performed without serious cardiogenic postoperative complications. With this aim they performed echoCG and tredmill test (TMT) before and 2 months after the surgery. The results show that important factors of early prediction of pre- and postoperative cardiovascular complications in patients with CCC are initial central types of hemodynamics, age, and inflammatory processes in the gall-bladder and biliferous tract. Comparison of the clinical forms of CCC to the condition of system hemodynamics and physical activity tolerance, evaluated by means of TMT, suggests that the main factor of the impairment of CVS functioning is CCC severity, which is also evidenced by the fact that exercise performance improves, and the initial central types of hemodynamics transform in the early postoperative period.

Aim: To study heterogenic forms of LDLP and LP(a) in blood serum of patients with cholelithiasis (CL) and gallbladder cholesterosis (GBC)., Material and Methods: Native gradient (3-12%) electrophoresis in polyacrylamide gel, rocket immunoelectrophoresis with antibodies to apo(a) were made in 20 patients with CL and 20 with GBC, 13 controls without gastrointestinal disease. Correlation of retardation factor (Rf) of LDLP and LP(a) with blood lipids, cholesterol (C) and triglycerides (TG) levels, body mass index (BMI) and age was studied. CL and GBC risk factors were analysed basing on a retrospective assessment in random representative samples of patients (100 CL and 100 GBC patients)., Results: There was a shift of the main peak in LDLP spectrum in the direction of smaller particles in GBC (Rf = 0.171 +/- 0.003) which was significant in comparison with CL group (Rf = 0.146 +/- 0.004, p < 0.001) and control (Rf = 0.114 +/- 0.013, p < 0.05). The analysis of LDLP Rf distribution in patients with different C levels has shown that LDLP small particles can occur in a normal C level: 75% in GBC and 50% in CL groups. Prevalence of small dense LDLP was recorded in both groups (87.5% cases) in hypercholesterolemia. Compared to control, LP(a) concentration was significantly elevated both in GBC (23.7 +/- 4.9 mg/dl) and CL (15.7 +/- 4.4 mg/dl) patients (control--7.5 +/- 1.4 mg/dl, p < 0.01), p > 0.5 in comparison between the groups. The correlation analysis found no correlations between LP9(a), other lipids, BMI and age in both study groups while Rf of LDLP correlated with C and TG levels (r = 0.596 and r = 0.226, respectively, p < 0.05), age and BMI (r = 0. 533 and r = 0.363, respectively, p < 0.05) in CL and did not correlate in GBC., Conclusion: A C level in CL changes with age and BMI while in GBC high LDLP C level was caused by other factors. No correlation of LP(a), LDLP Rf with age, body mass and blood lipids indicates that the above factors are independent in development of GBC.

The purpose of the study was to evaluate efficacy of poliphepan and hepabene as components of complex therapy in patients with chronic cholecystitis (CC). The subjects were 33 CC patients with biliary tract (BT) dyskinesia and biliar sludge. Application of the drugs led to significant improvement of clinical symptoms and the parameters of BT functional condition, as well as to decrease of bile lithogenicity and improvement of life quality.

A prospective study of 170 patients with concurrent cardiac pathology, who had underwent the laparoscopic cholecystectomy under the conditions of a tense carboxyperitomium, led to isolating two groups of patients with high-risk of intra- and postoperative unfavorable cardiac-vascular responses: an original high risk degree (III-IV classes according to ASA), a high value of cardiac risk indices according to Goldman (III-IV classes) and according to Detsky (II-III classes), a hypodynamic blood circulation regimen under rest conditions, and ejection fraction (according to echocardiography) amounting below 50%. Such patients are recommended to be operated on by laparolifting or by low-gas laparoscopy with a local lifting, i.e. by using the surgical techniques free of any negative effects produced on the carboxyperitomium hemodynamics, while all positive features of small-invasion surgery remain intact.

Results of examination of patients suffering from cholecystitis combined with duodenal ulcerative disease and accompanying duodenogastric reflux are presented. The comparison of acidifiable gastric function state in patients suffering from cholelithiasis combined with duodenal ulcerative disease and patients with only cholecystitis or duodenal ulcerative disease was performed. Intragastric pH-metry allows not only to study acidifiable gastric function but also to reveal functional disorders like duodenogastric reflux. Expressed and resistant duodenogastric reflux can result in structural modification of gastric mucosa.

Aim: To study hepatic function after cholecystectomy and the role of absorptive-excretory function of the liver and hormonal factors in development of postcholecystectomy syndrome., Materials and Methods: 106 patients long after cholecystectomy for cholelithiasis were examined for absorptive-excretory function of the liver and blood hormones (hydrocortisone, insulin, gastrin, thyroxine, triiodothyronine, thyrotropine). I-131-bengal-rose hepatography, dynamic hepatobiliscintigraphy with brommeside-Tc-99m, radioimmunoassay were employed., Results: Impairment, often subclinical, of hepatic absorption and excretion after cholecystectomy was found in 94% of the patients. External function of the liver after cholecystectomy was disturbed depending on the condition of its absorptive-excretory function. Hepatic dysfunctions and changes in blood hormones correlated., Conclusion: Absorptive-excretory function and hormonal factors are essential in pathogenesis of postcholecystectomy syndrome.

Condition was studied of the microcirculatory bed in 80 patients with chronic noncalculous cholecystitis and 38 patients with calculous cholecystitis with the aid of biomicroscopy of bulbar conjunctiva and histological examination of removed gallbladders. Changes in microcirculation were characterized by enhancement of arteriole-venous shunting, diminution of the number of the functioning capillaries, appearance of signs of venous congestion, lowering of microvessel reactivity in an acute nitroglycerin test, which fact may suggest their systemic character.

Aim: Elucidation of some pathogenetic mechanisms of cholelithiasis in biliary diseases., Materials and Methods: The examination of 45 patients suffering from gall bladder and biliary tracts lesions complicated with cholelithiasis included: measurements of bilirubin, bile acids and cholesterol in bile portions B and C; estimation of the cholatocholesterol coefficient; duodenomanometry; radioimmunoassay of thyroxine, thyrotropine, insulin, hydrocortisone and gastrin in peripheral blood., Results: A correlation was found between cholelithiasis and changes in intraduodenal pressure as well as secretion of hormones (gastrin, insulin, hydrocortisone, thyroxine, thyrotropine). Combined therapy including xenofalk and polyphepan in biliary diseases produced a good therapeutic response. Besides relief of clinical symptoms and improvement of intraduodenal pressure, positive changes were seen in bile lithogenicity., Conclusion: The data obtained contribute to better understanding of cholelithiasis and planning of relevant preventive measures.

Patients with chronic calculous cholecystitis presenting with atherosclerotic affliction of the heart reveal impairement of the mechanism of adaptation. A trigger mechanism in the activation of the hypophysial-adrenal system is, on the hand, a stressful impact on the frontal lobe of hypophysis and as a consequence of this a pain pang on the adrenal cortex accompanied by tissue hypoxia; on the other hand, disorders in the intrahepatic circulation of bile, enzymic disfunction of hepatocytes result, in their turn, in hypercholesterinemia which promotes augmentation of hydrocortisone levels. A quercetin-pectin complex has been proposed combined with SKN-type enterosorbent to correct the above disorders.

The authors studied the cardiac rhythm regulation status in 22 patients with chronic noncalculous cholecystitis, 35 patients with chronic calculous cholecystitis and 31 patients with chronic hepatitis. All the patients showed signs of sympathicotonic type of regulation of cardiac rhythm. Upon receiving propranolol (0.04), 67.8% of patients displayed no vegetative regulation, with 3.2% cases demonstrating a paradoxical trend of vegetative reactions.

An analysis of the initial type of central hemodynamics and the postoperative period in 177 patients aged older than 70 years having calculous cholecystitis has shown that surgical treatment of patients with the normo- and hyperdynamic types of circulation even with concomitant diseases can give positive results. The least favourable regimen of blood circulation proved to be the hypodynamic type characteristic of patients with pronounced disturbances of homeostasis and/or with recent myocardial infarction.

Gallbladder concrements were found in 6.7% of 30,000 persons over 40 years of age during dispensary screening. In 720 (2.4%) of them the clinical and laboratory findings corresponded to those in chronic calculous cholecystitis, whereas in 1,290 persons gallbladder concrements were asymptomatic. Detailed study of 84 records of patients with asymptomatic cholecystolithiasis made in possible to recognize in most of them also chronic inflammatory diseases and dyskinesia of the gastrointestinal tract which could be conducive to the formation of concrements. During a 4-year follow-up period, signs of chronic calculous cholecystitis appeared in only 6% of these patients. The authors conclude that most patients with asymptomatic cholecystolithiasis must be subjected to regular medical examination and only with the development of a clinical picture of chronic calculous cholecystitis only some of them should be treated by surgery.

Cardiac haemodynamics have been studied radiocardiographically in 56 men at the age of 40-60 including 15 healthy persons, 24 patients with chronic coronary disease and 17 patients associating coronary disease with chronic cholecystitis. This association was shown to reduce minute heart volume thus playing the role of a factor compromising cardiac blood circulation in such patients. Neuroreflex influence on the coronary arteries and autoimmune damage of myocardium due to similarity of myocardial and gallbladder antigenic determinants may be probable mechanisms of such an effect.

Results of complex experimental and clinical (146 patients) investigations of the morphofunctional state of the duodeno-intestinal flexure (DIF) are presented. It was established that patients with the pathology of extrahepatic bile ducts had limited mobility of DIF which was responsible for higher intraduodenal pressure and appearance of duodeno-gastric reflux. Mobilization of DIF improves the evacuation of the intestinal contents from the duodenum in patients with the pathology of extrahepatic bile ducts and is thought to be a prophylactic measure against the development of chronic duodenal obstruction after cholecystectomy.

Intraoperative cholangio-manometry with a miniature tensor sensor and graphic recording of the results were conducted to study the function of the major duodenal papilla in 53 patients. A periodical activity of the ampulla of the papilla was revealed, which was characterized by certain values of the peak and basal pressure, and duration of contraction and relaxation periods. The numerical values and the pattern of the pressure curve differed in patients with obstructive cholecystitis, biliary pancreatitis, and a concrement incarcerated in the ampulla of the papilla. The informativeness of the study increases with the use of the glucagon test.

The authors provide the long-term results of cholecysto-digestive + anastomoses in 59 patients operated on for nontumorous diseases. The gallbladder anastomosed with the upper parts of the alimentary tract preserved reservoir and concentration functions, ability for visualization during cholecystocholangiography. The discrete pulse mechanism of bile secretion via the bile diverting anastomoses and their antireflux function eliminated the risk of chronic pancreatitis and terminal cholangitis. The recovery of deranged liver functions and excretory functions of the pancreas were traced during the postoperative period within 2 to 21 years.

The authors proposed a method for the determination of differences in the rate of evacuation of 3 types of test breakfast: boiled semolina, boiled semolina with proteins or fat. Evacuatory function of the gastroduodenal system was investigated in healthy persons and in patients using a gamma-camera. The results obtained have shown that in a majority of healthy persons carbohydrate breakfast was evacuated at the highest rate, breakfast with egg protein was evacuated slower, and breakfast with butter was evacuated even much slower. In duodenal ulcer the rate of evacuation of all 3 types of breakfasts was slowed down, and evacuation was undifferentiated (all 3 types were evacuated at the same slow rate). In patients with liver cirrhosis the evacuation of carbohydrate and protein breakfasts was slow, in calculous cholecystitis these types of breakfasts differed slightly as a result of the slow evacuation of carbohydrate breakfast. The evacuation of breakfast with butter was inhibited almost to the same degree. These results indicate the complex nature of gastric content evacuatory disorders in gastroenterologic patients, and it should be taken into account in differential diagnosis and therapy.