[Cholelithiasis and cholesterosis of a gallbladder: a comparison of pheno-genetypic characteristics of patients].

A study was and comparison was carried out of the phenotypical and genotypical features in 115 patients with cholelythiasis and 97 patients with cholesterosis of the gallbladder. The received data proves that cholelythiasis is characterized by the domination of (prevalence) of type O I blood type, decrease of blood types B III and AB IV in comparison to the control group and to the group with cholesterosis of the gallbladder (p < 0.05), increase of the frequency of gene O decrease of frequency of gene B, decrease of heterozygosis. Patients with cholesterosis of the gallbladder are characterized by the increase of frequency of gene A, decrease of ratio of patients with blood type B III and increase of patients with AB IV blood type (p < 0.05). The received data (results) show the presence of different and multidirectional phenotypical and genotypical characteristics in patients with cholelythiasis and cholesterosis of the gallbladder, and therefore differ genotypically.

[Innovations in the diagnosis and treatment of cholelithiasis].

AIM: To determine the density of densitometric gallstones and biliary sludge in order to clarify the possibility of lithotherapy in patients with gallstone disease (GSD). MATERIALS AND METHODS: 70 patients were carried out a comprehensive clinical examination with determination of densitometric density of gallstones and/or biliary sludge by means of computer tomography (CT), ultrasound of the abdomen, biochemical blood analysis. Assigned to the complex lithotherapy (Ursofalk and Kholit) in standard dosages, the results were evaluated in a year. RESULT: It was found that the density of bile in patients with GSD was ranging from +4 to +10 HU, sludge - +17,5 HU, gall stones - over +20 HU. The main factor of the exoediency of conservative therapy of GSD is to determine the density of gallstone by CT, which should not exceed +54 HU (+29,6 +/- 3,4 HU). Visualization of stones on CT is much higher (30%) than in Rg (10%), and its density is observed at more than +75,0 HU. Sludge particle less than 2.0 mm, but having a density more than +20,0 HU, should be viewed as a gallstone. Kholit, a herbal medicine, improves functional and structural indicators of biliary tract, digestive processes of cavity, and may be recommended as a monotherapy in stage I of GSD, as well as a component of combination therapy of cholelithiasis.

[Quality of life of patients with gallstone disease and gallbladder cholesterosis in the conservative and surgical treatment].

OBJECTIVE: to investigate the quality of life of patients with gallstone disease and gall bladder cholesterosis on a background of conservative therapy and after surgery. MATERIALS AND METHODS: the study involved 60 patients with GSD and GBC treated conservatively, 75 patients with GSD and GBC treated surgically, the control group - 35 men aged of 20,6 +/- 1,2. A survey using questionnaires GIC, SF-36, ultrasound, radiography, CT of the abdomen, cholecystography, examined the range of blood lipids. RESULTS: reduction in QOL in the CL was detected in 92.8% of patients on all scales, progressing during the exacerbation of the disease (58.3%). The overall QOL score was reduced (up to 92,5 +/- 7,0) when compared with CG (346,7 +/- 8,2, p <0,001) and the maximum score (410.0). Conservative therapy improves the QOL of patients with gallstone disease in 50.7% of cases at all scales. The overall score increased to 155,9 +/- 5,6, p < 0,001, but remained lower than in the CG. When GBC reduced QOL was found in 75.8% of patients on all scales, progressing during the exacerbation of the disease (40.8%). Contact of worsening QOL with the duration of relapse stable disease (p < 0,001). Conservative therapy improves the QOL of patients with GBC in 54.1% of cases at all scales. The overall score has increased from 51,9 +/- 5,5 to 135,1 +/- 2,6 (p< 0.001), but remained lower than in the CG. QOL of patients with GSD and GBC reduced by all indicators, the GSD to a greater extent. In patients with GSD main factors reducing the QOL are pain (34.5% and 100% in the period of exacerbation of the disease) and non-use of previously familiar food (62.0%) because of fear of pain attack at GBC - emotional quotient (66.9% - thought about the inevitability of surgery and the possibility of malignancy). When GSD QOL of patients before CE decreased (93.6%) to a greater extent than in patients prior to conservative treatment due to the pain factor (65.4%), total score amounted to 86,4 +/- 5,1 and 92,5 +/- 7,0, respectively, p <0.05. The main factors of nuclear explosion-QOL differences were pain attacks (65.4% and 35.7%) and emotional quotient. The factors of higher-QOL after the CE (59.1%) are the elimination of pain attack (100%), normalization of stool. The total score improved from 86,4 +/- 5,1 to 128,4 +/- 6,3, p <0,001, but remained lower than in the CG (p <0,001) and a comparison with the highest scores (p < 0,001). When GBC quality of life of patients before CE decreased (95.1%) to a greater extent than in patients prior to conservative treatment (75.8%) due to emotional factors: the thought of the possibility of malignancy. The total score was 40,2 +/- 5,3 and 51,9 +/- 5,5, respectively, p<0.05. Surgical treatment improves QOL of patients with GBC (61.8%) in all major scales. The total score improved from 40,2 +/- 5,3 to 122,6 +/- 6,0, p < 0,001, but remained lower than in the CG (p < 0,001) and a comparison with the highest scores (p < 0,001). CONCLUSION: the results allow us to recommend a conservative therapy for cholelithiasis patients as a method of choice in the presence of indications for its place-of. The determining factor is the density of lithotherapy concrement, as measured by CT. In case of impossibility of conservative therapy should prompt surgical treatment of cholelithiasis before the development of irreversible changes in the organs of hepato-pancreatoduodenal system.

[Gallstone disease and gallbladder cholesterosis: miscellaneous diseases or various manifestations of a single process].

OBJECTIVE: analysis of literature on the pathogenesis of GSD and GBC. RESULTS: It is suggested that the GSD and GBC are clinical subfenotypes the same disease, the common factor in the pathogenesis of which are metabolic disorders LP low densities, due to polymorphism of the apoB. The main function of the LP is transport into the cells of the NLC, and PUFA, which perform different functions in the body and transported in different ways. NLC are energy substrate, and are delivered to the cells of liver TG in the CM with the participation of apoB-48 BLK. PUFA determine the functional specificity of biological membranes, transport forms are PL and EHS. APOE determines the transport of the NLC at the stage of enterocytes--CM--hepatocytes--VLDL--BOB. Extension of its already active transport of fatty acids to the cells in the LDL. Consequently, the level of cholesterol in the blood reflects the degree of deficiency in the cells of PUFA. Investigation of polymorphism of apoE suggests that in GSD and GBC identified metabolic disorders as NLC (allele epsilon2) and PUFA (allele epsilon4), but the GBC--more polyunsaturated (with the increase and structural changes in LDL), and at GSD--saturated fatty acids (with an increase VLDL). This fact explains why, in the GSD is often formed cholesterosis, and for GBC--stones.

[Disorders of lipid metabolism in patients with cholelithiasis and gallbladder cholesterosis depending on apolipoprotein E genotype].

The work was aimed to study blood lipid spectrum in 133 patients with cholelithiasis (CL) and 159 with gallbladder cholesterosis (GC) as well as apoE genotypes (based on restriction fragment polymorphism) in 49 and 36 respectively. Lipid composition was shown to significantly differ in the two conditions. LDL cholesterol was increased in GC and TG in CL. A rise in LDL cholesterol in both groups was apparent before the age of 30 yr (34.6 +/- 8.4 and 52.6 +/- 12.9% respectively), that in TG and VLDL after 40 yr. E3/3 genotype (norm) was identified in 75.5 +/- 6.2% of the patients with CL and in 83.4 +/- 6.2% in those with GC (p < 0.05). e4 allele (mutation) equally frequently occurred in 10.2 +/- 4.3 and 8.1 +/- 4.5% of patients with CL and GC (p > 0.5), e2 allele in 14.5 +/- 5.0 and 8.1 +/- 4.5% (p < 0.05). These data suggest that patients of both groups equally frequently suffered disturbances in metabolism of saturated (e2 allele) and polyunsaturated (e4 allele) fatty acids predisposing for hypercholesterolemia and hyperlipidemia. They explain why CL is frequently associated with cholesterosis and GC with the formation of caliculi. However, the absence of significant correlation between CL, GC and alleles e2, e4 suggests participation of other factors in pathogenesis of these diseases (LP(a), LDL heterogeneity).

[Possibility of correction of the lipid disorders in patients with cholelithiasis and gallbladder cholesterosis].

OBJECTIVE: To evaluate the possibility of incorporating organic drugs Hepatosan and Entherosan in the complex therapy of patients with gallstone disease and gall bladder cholesterosis (reticulated polypus form) on the basis of literature data and own research. RESULTS: It has been found that the physiological effect of drugs Entherosan and Hepatosan is directed on the improvement cavity and wall digestion processes, that leads to the reduction (disappearance) of dyspeptic symptoms (eliminating discomfort in the epigastrium, bloating, diarrhea) in most of the patients. The main features of Entherosan are: normalization of gastro-intestinal tract motor activity, intestinal microflora, enteroprotective effect of the drug and its influence on intestinal and cellular pools of cholesterol that leads to the activation of cavitary and parietal digestion. The essential point of Hepatosan is to stimulate 7alpha-hydroxylase, resulting in strengthening of cholesterol oxidation and to an increase the pool of LCD in enterohepatic circulation. This factor, coupled with hepatoprotective action of the drug, ensures the deletion of biliary insufficiency. CONCLUSION: The incorporation of drugs Entherosan and Hepatosan in the complex conservative therapy of cholelithiasis and reticulated polypus forms of gall bladder cholesterosis is pathogenetically substantiated.

[Genetic aspects of bile production].

This article represented a modern view of and choleproduction and choleexcretion processes. It was presented secretion and transport of major bile components machineries as well as role of genes that are involved in protein-transporters biosynthesis.

[Heterogeneity of low-density lipoproteins in cholesterolosis of the gallbladder and cholelithiasis]. / Geterogennost' lipoproteidov nizkoi plotnosti pri kholesteroze zhelchnogo puzyria i zhelchno-kammenoi bolezni.

The heterogeneity of serum low-density lipoproteins (LDL) was studied in patients with cholelithiasis (CL) and gallbladder cholesterolosis (GBC). Native gradient (3-12%) polyacrylamide gel electrophoresis was used, followed by densitometric scanning and analysis; a correlation analysis of the levels of cholesterol levels, the body-mass index (BMI), and age was made. Various heterogeneity of LDL was revealed in CL and GBC. In the group of patients with GBC, the subfraction spectrum of LDL was characterized by a predominance of minor dense particles of LDL (Rf = 0.171 +/- 0.003), which significantly differed from that in the patients with CL (Rf = 0.146 +/- 0.004) and the controls (Rf = 0.144 +/- 0.013, p < 0.05). The increased levels of total cholesterol were associated with the changes in the subfraction spectrum of LDL with a moderate correlation (r = 0.596 and r = 0.343, respectively). However, a correlation was found between the variability of LDL, BMI, and age (r = 0.533 and r = 0.363, respectively) whereas in GBC it was absent (r = 0.148 and r = 0.117). The findings suggest that the minor dense subfractions of LDL are a risk factor for GBC irrespective of age and body mass. The modified minor particles of LDL more rapidly penetrate than other LDL fractions into the gallbladder tissue, where the gallbladder wall is intensively captured by macrophages, and participate in the formation of foamy cells. In CL, the increase in total cholesterol levels is not followed by so marked changes in the structure of LDL. The much lower proportion of minor dense particles that are components of LDL is a cause of the low entry of apolipoproteins into the gallbladder wall in CL as compared with GBC.

[Pathogenesis of gallbladder cholesterolemia]. / Patogenez kholesteroza zhelchnogo puzyria.

Disturbances in cholesterol metabolism may be essential in pathogenesis of gallbladder cholesterosis (GBC). HDL cholesterol in the blood is subnormal. Physicochemical changes in the superficial layer of HDL induce impairment of free cholesterol esterification. Blood lipids and their apoprotein component are important for bile cholesterol level. In gallbladder contractile dysfunction but unaffected absorption there is enhanced passive and active cholesterol transport from the supersaturated bile to the cytoplasm of the epithelial cells from the bladder mucosa. Mechanism of intensive absorption of the lipids by macrophages operates primarily via modification of their apoprotein component. Modification of apoprotein occurs both in blood and gallbladder. Modified apoprotein is recognized by the macrophage and is absorbed by it together with transported lipids. In accumulation of great quantities of lipids in the macrophage it becomes big, slow, stays in the mucous or submucous layer of the wall and finally transforms into the foam cell. Moreover, deterioration of HDL cholesterol acception in GBC leads to slow discharge of cholesterol from the bladder wall.

[Immunomorphologic detection of apoprotein B antigenic determinants in the gallbladder wall in cholesterosis and cholelithiasis]. / Immunomorfologicheskoe vyiavlenie otdel'nykh antigennykh determinant apoproteina B v stenke zhelzhnogo puzyria pri kholesteroze i zhelchnokamennoi bolezni.

The presence and location of apoprotein B (Apo B) antigenic determinants in cholesterosis and cholelithiasis in gall bladder wall were detected for elaboration of modified Apo B role in pathogenesis of these diseases. Macroscopically changed parts of gall bladder (GB) wall of patients with gall bladder cholesterosis (GBC), and also macroscopically unchanged parts of GB wall of patients with cholelithiasis (CL) after cholecystectomy were studied. Macroscopically unchanged parts of GB wall obtained during autopsy of persons without symptoms of GB pathology were used as a control. Apo B location was studied with monoclonal (MAB 5F8 to Apo B) and polyclonal (PAB) antibodies; Apo B modified by malonic dialdehyde and oxidized by Cu2+ (4C11), Apo A with MAB1C5. Antibodies to CD 68 (specific marker of macrophages) was positive control, antibodies to trichinella--negative control. The most intensive accumulation of modified Apo B was revealed in foam cells region with accumulate lipids and form polyps that testifies to connection of apoproteins with lipids and foam cells and suggests their role in pathogenesis of GBC. More intensive staining of GB epithelial cells, particularly on GB peripheral parts by antibodies to apoproteins compared with surrounding tissues shows that bile is the source of detected modified apoproteins. Increase of absorption and accumulation of apoproteins in GB wall were also revealed in CL but these processes are less intensive than in GBS.

[High-density lipoproteins in cholesterosis of the gall bladder]. / Lipoproteidy vysokoi plotnosti pri kholesteroze zhelchnogo puzyria.

The composition of serum high-density lipoproteins (HDL) was studied in 64 patients with polypous cholesterosis (PC). The spectrum of serum lipids in patients with PC was characterized by the lower concentrations of HDL cholesterol (42.0 +/- 2.5 mg/dl; p < 0.05) and higher concentrations of low-density lipoproteins (LDL) cholesterol (169.9 +/- 6.9 mg/dl; p < 0.01) than those in the controls. The decreased HDL cholesterol, or hypoalphacholesterolemia was associated with quantitative changes in HDL phospholipids (PL) (66.48 +/- 3.4; p < 0.01) and with changes in the composition of individual PL by lowering the proportion of lecithin (47.13 +/- 2.19 mg/dl; p < 0.01). It may be suggested that the lower amount of HDL cholesterol is caused by the decreased HDL acception of free cholesterol from the peripheral cell membranes due to the impaired complexation of PL with free cholesterol and associated the altered PL composition of the superficial monolayer of a lipoprotein particle. At the same time the physicochemical changes in Hdl superficial layer are a cause of abnormal free cholesterol esterification and the impaired plunge of esterified cholesterol into the nucleus of a HDL particle, which facilitates the conversion of HDL to LDL and may explain elevated LDL levels in cholesterosis. The findings suggest that serum lipids are involved in the development of cholesterosis.

[Diagnostic possibilities of mathematical analysis in the evaluation of lithogenicity of the bile]. / Diagnosticheskie vozmozhnosti matematicheskogo analiza pri otsenke litogennosti zhelchi.

A simple modification of the triangulation system is suggested for determination of lithogenous potential of bile. Basing on correlation analysis the regression equation is derived for quantitation of total bile acids. This makes time-consuming chromatographic evaluation of bile needless. It is believed sufficient to specify only two parameters (bile acids and cholesterol) as their correlation in a coordinate system allows one to define the zone of cholesterol saturation of bile. A table is presented to simplify calculations.

[Lithogenic properties of bile in cholelithiasis]. / K voprosu o litogennosti zhelchi pri kholelitiaze.

To specify lithogenic properties of bile in cholelithiasis as well as the effect of cholecystectomy on biochemical composition of bile, 168 patients with cholelithiasis have been examined. Fifty patients underwent preoperative investigation, some of them were followed up for 1-2 years after cholecystectomy (group 1). The rest postcholecystectomy patients were followed up for 10 years (group 2). Bile levels of cholesterol were evaluated by absolute and relative lipid concentrations. The conclusion is made on the absence of a direct correlation between bile cholesterol supersaturation and cholelithiasis as the above supersaturation occurs in healthy subjects as well. It is noticed that cholecystectomy does not warrant discontinuation of cholesterol supersaturation of bile.