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Aim: To investigate the psychoemotional and autonomic states of patients with biliary system diseases and to determine their significance in the development of cholelithiasis., Subjects and Methods: A total of 396 patients with stage 1 cholelithiasis were examined. The results of hepatobiliary ultrasonography, multifractional duodenal probing, followed by macroscopic, microscopic, and biochemical examinations of bile (the total concentration of bile acids and cholesterol, by subsequently calculating the cholate-cholesterol ratio) were used to verify the diagnosis. The functional state of the hepatobiliary system was evaluated by dynamic echocholecystography and dynamic hepatobiliscintigraphy. To characterize the emotional state, the investigators applied indicators of the motivational sphere and orientation of an individual and his/her mental state, such as reactive anxiety, personal anxiety, the levels of depression and neuroticism, and intra-, extraversion. The autonomic state was determined from autonomic tone, autonomic reactivity, and autonomic support., Results: Biliary lithogenesis was found to be related to psychoemotional and autonomic states. In cholelithiasis, there was an increase in reactive and personal anxiety and a predominance of diminished parasympathetic and perverted sympathetic autonomic reactivity. The signs of emotional instability and autonomic dystonia were shown to increase with age and the degree of an autonomic response depended on the severity of mental and emotional disorders., Conclusion: The results of these comprehensive studies can reveal new pathophysiological patterns of lithogenic bile formation and enhance our understanding of the pathogenesis of cholelithiasis.

Aim: To comprehensively study of the function of digestive organs in cholelithiasis (CL)., Subjects and Methods: Three hundred and seventeen patients with the early (prestone) stage of CL were examined. The latter was verified by ultrasonography (USG) and biochemical bile tests. The patients underwent pH metry and esophagogastroduodenoscopy, followed by histological examination of gastroduodenal mucosa (GDM) biopsy specimens. Manometry was used to evaluate duodenal function. The serum levels of pepsinogen-1 (PG-1), pepsinogen-2 (PG-2), cholecystokinin (CCK), gastrin, cyclic nucleotides (cAMP and cGMP), α1-antitrypsin, insulin, and C-peptide were analyzed by an enzyme immunoassay. Small intestinal function was examined using a set of diagnostic tests., Results: Gallbladder USG revealed biliary sludge in 273 (86.1%) patients. Biochemical examination of bile established a lower cholatocholesterol coefficient in its cystic as well as hepatic portions, suggesting enhanced bile lithogenicity. Manometry of the duodenum showed its hypertension, hypotension, and normotension in 57.6, 24.8, and 17.6% of the CL patients, respectively. There were significant increases in basal gastric body pH and PG-1 and PG-2 levels as compared to the control group. Morphological examination of GDM biopsy specimens revealed chronic superficial gastritis in 61.8% of the patients, chronic atrophic gastritis in 17.4%, and moderate diffuse duodenitis in 18.3%. In 148 (46.7%) patients with CL, the latter was burdened by pancreatic comorbidity. Stress tests using water-soluble starch, sucrose, and glucose demonstrated impairments in various stages of digestion; substantially decreased levels of CCK, gastrin and cyclic nucleotides were observed in the patients with CL compared to the controls., Conclusion: Most patients with CL were detected to have digestive organ structural and functional disorders. Moreover, CL may be regarded as a possible manifestation of systemic digestive diseases.

Purpose: The aim of the work was to improve the organization and conduct of clinical examination of patients with gallstone disease (GSD)., Materials and Methods: An integrated study of 396 patients with different pathologies of the hepatobiliary system and the medical check-up for three years for 101 patients., Results: Built logistic model to predict the likelihood of developing gallstone disease and developed a predictive scoring table it possible to distinguish patients at risk of developing gall stones. The result of follow-up of the proposed method was prevented economic losses due to the lack of need for a cholecystectomy, which is made up of one patient 6766.22 rubles., The entire group of 1,004,966.63 rubles., Conclusion: Obtained to diagnose cholelithiasis at an early stage dokamennoy. Developed a screening questionnaire, predictive scoring table, the scheme of follow-up also improves clinical examination of patients with cholelithiasis dokamennoy stage.

The Aim: The studying of physical-chemical qualities of liver bile and lipid exchange before and after cholecystectomy., Materials and Methods: We spent the complex investigation of physical-chemical qualities of bile and lipid levels in 210 patients with cholelithiasis stage I (pre-stone) and in 90 patients with cholelithiasis stage II and III (with gallstones) after cholecystectomy., The Results: In all examined patients we revealed disturbances of physical-chemical qualities of bile and lipid exchange. With correlation analysis it was found that bile lithogenity increases in high bile density, in progressing of inflammation process in bile ducts, in increasing of aterogene fractions of blood cholesterol., Conclusion: After cholecystectomy in liver-cells dyscholia the ability to stones formation preserves. It means that patients after cholecystectomy need in following-up with using of prophylactic measures to restoring of bile-formation.

The aim of our investigation was to study the changes of bile morphology and possibilities of its using in early diagnostic stage of cholelithiasis. We spent the complex investigation of biochemical and crystal-optic qualities of bile in 207 patients with cholelithiasis stage I with different disease duration. The revealed crystal-optic morphotypes have selective morphology due to the bile lithogene level that allows to determine the disease duration and the bile instability to make in-time adequate profilactic.

Aim: to study factors contributing to gallstone formation and to elucidate their relationship., Subjects and Methods: The examination of 230 patients with various hepatobiliary abnormalities used dynamic ultrasonic cholecystography, multifractional duodenal intubation, followed by a microscopic study and determination of the physicochemical properties of bile. Enzyme immunoassay was employed to measure the peripheral blood levels of gastrin, insulin, T3, T4, thyroid-stimulating hormone, cortisol, and growth hormone., Results: All the patients were found to have signs of an early (gallstone pre-formation) stage of cholelithiasis. Decreased emptying of the gallbladder and its hypotonia and altered bile physicochemical properties were ascertained to be poor predictors of possible gallstone formation., Conclusion: Correlation analysis has shown the important role of hormonal factors in the formation of lithogenic bile.

We spent the complex investigation of therapeutic efectiveness of ursosan and afobasol in 125 patients with gallstone disease on early stage (before stones). After the course of treatment we revealed positive changes of clinical symptoms and improvement of biochemical bile compound. Besides we found the positive changes in hormone levels correlated with decreasing of bile lithogenity.

The group of 50 patients with the fatty hepatosis and an accompanying cholecystitis in the age from 22 till 60 years were examined alongside by clinical and some modern laboratory ultrasonic, biochemical researches. In portions "B" and "C" of the bile the level of cholic acids and cholesterol were investigated with the subsequent account of the cholate-cholesterol coefficient. It was shown that in the most of the patients with fatty hepatosis and an accompanying cholecystitis observes infringement of physical and chemical bile properties what correspond to 1st stage of the disease. The use of Essentiale with Cholagogue in the complex therapy at the pathology of hepato-biliary system renders the expressed therapeutic effect. Thus, alongside with the positive dynamic of clinical disease symptoms the bile lithogenic features are lowering.

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.