Possibilities of osteopathic methods of diagnosis and correction in gallbladder dyskinesia

Functional disorders of the digestive system (including gallbladder dyskinesia) are widespread among the adult population of the Russian Federation. Their combination in a fairly large percentage of cases with degenerative-dystrophic diseases of the spine, and the probable vertebrogenic causality of a number of the gastrointestinal tract pathological conditions lead to the need using new approaches in diagnosis and treatment, including non-drug methods. This clinical case shows the possibility of osteopathic diagnostics and correction in gallbladder dyskinesia.

How dangerous Gilbert's syndrome is

Gilbert's syndrome is a benign (functional) hyperbilirubinemia, which is based on a hereditary disorder of bilirubin metabolism, as a result of which the concentration of unbound bilirubin can increase several times. Bilirubin, being a breakdown product of hemoglobin, circulates through the bloodstream, combining with albumin molecules. Such bilirubin is called indirect. In the endoplasmic reticulum, it is conjugated; the enzyme glucuronyltransferase is responsible for this process. In Gilbert's syndrome, as a result of insufficient production of this enzyme, the conjugation process is disrupted, and, as a result, the concentration of unconjugated bilirubin increases. According to statistics, this pathological condition is observed in about 5 % of Russians. This syndrome was first described in 1901 by the French physician Augustin Nicolas Gilbert, and was subsequently named after him. The literature also contains references to this syndrome, described as «constitutional hepatic dysfunction», «familial non-hemolytic hyperbilirubinemia», «idiopathic non-conjugated hyperbilirubinemia». Gilbert's syndrome is inherited in an autosomal recessive manner; men get ill 3–4 times more often than women. A number of scientists associate this with a possible inhibitory effect of testosterone on the enzyme UDP-GT1, which breaks down bilirubin. Clinically, Gilbert's syndrome is manifested by episodes of jaundice caused by an increase in the level of unconjugated bilirubin in the blood serum. Against the background of icterus of the sclera and skin, there is increased fatigue, the appearance of a feeling of bitterness in the mouth, loss of appetite, nausea, and sometimes vomiting. The association of Gilbert's syndrome with functional disorders of the biliary tract, in particular, with gallbladder dyskinesia, is often noted.

Diagnostic significance of clinical and para-clinical signs of community-acquired pneumonia in children

Annotation. Respiratory diseases are relevant in pediatric practice, which is associated with its widespread and frequent complications, especially in young children. The aim of the study was to assess the diagnostic value of clinical symptoms, laboratory and ultra-sonographic parameters in pneumonia in children of the first 3 years of life. A retrospective study of medical records of 218 children who were hospitalized in the department for young children diagnosed with pneumonia for the period from 2016 to 2018. The average age of children was 11.67±9.97 months and it was within the range from 1 month to 3 years. The ration of boys and girls was practically identical (51.8% and 48.2% accordingly). The first group included children aged under one year (the average age is 4.57±0.84 months; n=88). The second group included children aged from 1 to 3 years (the average age is 18.2±4.25 months; n=130). To characterize the information content of clinical and laboratory symptoms the study has used objective parameters defined as the operational characteristics of tests. The most important operational characteristics of diagnostic methods included: sensitivity (Se, sensitivity) and specificity (Sp, specificity). To check the statistical hypothesis on differences of absolute and relative frequencies, fractions, and ratios in two independent samples, the criteria of хі-square (χ2) was used. While detailing an anamnesis, the disease was more often related to untimely treatment and outpatient care. Various data were obtained on the absolute and relative risk, as well as the sensitivity and specificity of the localization of pneumonia depending on age. Therefore, the incidence of bilateral pneumonia was considered an indicator of risk. On admission to hospital, the body temperature of patients was 38.2±0.66°С. Most of the complaints were on the unproductive or productive cough. Besides, in some cases, shortness of breath and runny nose were mentioned. Thus, in young children with pneumonia, a diagnostically significant clinical symptom is a bilateral lung impression (82.6%), compared with right-handed (15.1%) and left-handed (2.3%), which is significantly more common in children under 1-th year of life compared with patients 1–3 years; laboratory features are probably higher levels of liver-specific enzymes – ALT and AST in children under 1 year; ultrasonographic indicators associated with the presence of pneumonia in young children include increased liver size, gallbladder deformity, the presence of sediment in the gallbladder, dyskinesia of the biliary tract, thickening of the gallbladder wall; children under 1 year of age have a risk of liver enlargement and biliary dyskinesia.

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

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

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

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

Role of 99mTc-HIDA Scan for Assessment of Gallbladder Dyskinesia and Comparison of Gallbladder Dyskinesia with Various Parameters in Laparoscopic Cholecystectomy Patients

Objectives. Pathogenesis of gallstone includes bile stasis due to defect in the gallbladder muscle contraction. Our aim of the study is to find out the role of 99mTc-HIDA scan in assessment of gallbladder dyskinesia in cholelithiasis patients before laparoscopic cholecystectomy and compare the gallbladder dyskinesia with various parameters like symptoms of patients, diabetic status of patients, gallstones size and number, and cholecystitis features in histopathology report after surgery. Material and Method. This is a prospective observational study conducted at our hospital for three years. Totally 40 patients with gallstone were subjected to 99mTc-HIDA scan, to assess the ejection fraction of gallbladder. For all these patients detailed clinical history, presence of comorbid illness like diabetics, and symptomatology were elicited. For all patients, ultrasonogram of abdomen was done to assess number and size of stones. All parameters were tabulated and correlated. Result. While comparing 99mTc-HIDA scan findings with symptoms of patients, 21.2% were asymptomatic and 78.8% symptomatic patients who had ejection fraction less than 80%. All patients in EF >80% group were symptomatic only. It is not statistically significant. On comparing 99mTc-HIDA scan findings with diabetic status of the patients, 42.4% of diabetic and 57.6 % of nondiabetic patients had ejection fraction less than 80%. It is not statistically significant (0.681). While comparing 99mTc-HIDA scan findings with size of the gallstone in ultrasound, 63.6% patients with size less than 1cm and 36.4% with size more than 1cm had ejection fraction < 80%. It is statistically significant (0.048). On comparing 99mTc-HIDA scan findings with number of stones in ultrasound, 18.2% single gallstone patients and 81.8% multiple gallstone patients had EF less than 80% which is statistically significant (0.001). While comparing the 99mTc-HIDA scan findings with histopathology report after laparoscopic cholecystectomy, 21.2% non-cholecystitis patients and 78.8% cholecystitis patients had EF less than 80%, which is statistically (0.017) significant. Conclusion. 99mTc-HIDA scan can be an accurate method to diagnose the gallbladder dyskinesia. Gallbladder dyskinesia in 99mTc-HIDA scan can be used to predict large size stones and multiple stones before surgery. The sensitivity can be improved by 99mTc-HIDA scan in diagnosing cholecystitis patients.