Selected parameters of nutritional status in patients with pancreatic head cancer - own experience

Introduction

Around 200,000 new cases of pancreatic cancer are diagnosed yearly worldwide. It is the fourth most common cause of cancer deaths. Pancreatic cancer has a high mortality rate due to unspecific symptoms being responsible for late diagnosis.

Aim

In this study, the authors analysed selected nutritional parameters and the severity of anaemia in patients diagnosed with pancreatic head cancer.

Material and methods

Data were collected upon admission to the 2nd Clinical Department of General, Gastrointestinal, and Oncological Surgery in the University Clinical Hospital in Bialystok, Poland and retrospectively with the help of correctly collected anamnesis.

Results

It has been shown that most patients with pancreatic cancer are malnourished at the time of diagnosis. Body mass index (BMI) is the least valuable parameter primarily. Weight loss has been determined to be the most accurate predictor of the patient's metabolic status, although it should never be the only parameter. Although these factors do not suggest an inflammatory process, serum protein levels and albumin concentration should be considered.

Conclusions

When assessing the nutritional status of patients with pancreatic cancer, many predictive factors should be considered. BMI seems to be the least accurate parameter for assessing nutritional status in patients diagnosed with cancer. However, when combined with weight loss and serum albumin levels, it can be quite useful as a prognostic factor.

Preoperative Glutamine Supplementation in Gastric Cancer-Thrombocyte Phagocytic Activity and Early Postoperative Outcomes

BACKGROUND

The aim of this study was to determine the phagocytic activity of thrombocytes in patients with gastric cancer and to assess the effect of oral and parenteral preoperative glutamine-based immunonutrition on nutritional status, thrombocyte phagocytic activity, and early postoperative outcomes.

METHODS

Patients suffering from invasive gastric cancer had been treated with preoperative immunonutrition with glutamine, and they were compared to patients without nutritional treatment. Nutritional status, percentage of weight loss, and BMI were assessed. Levels of total protein, albumin, cholesterol, triglycerides, platelets, and their phagocytic ability were measured twice. Postsurgical complications were assessed via the Clavien-Dindo classification.

RESULTS

Group I consisted of 20 patients with an oral glutamine-10 g daily. Group II had 38 patients who received intravenous glutamine, 1.5 mL per kg body weight of Dipeptiven. Group III consisted of 25 patients who did not receive preoperative immunonutrition. In total, 47% of patients in Group I, 54% of patients in Group II, and 33% of patients in Group III were malnourished. In Group I, the percentage of phagocytizing platelet (%PhP) was 1.1 preoperatively and 1.2 postoperatively. The phagocytic index (PhI) was 1.0 and 1.1. In Group II, %PhP was 1.1 and 1.2 and PhI was 1.0 and 1.1. In Group III, the %PhP was 1.0 and 1.2 and PhI was 1.0 and 1.1. An increase in triglyceride level was observed in both immunonutrition groups. There was a decline in total protein and albumin level in Group II. In Group III, there was a decline in total protein, albumin, and cholesterol level. The total platelet count and PhI were increased in both immunonutrition groups. There was also a rise in %PhP in Group II. In Group III, there was a rise in blood platelet level, %PhP, and PhI. The complication rates were 53% in Group I, 29% in Group II, and 40% in Group III.

CONCLUSIONS

In invasive gastric cancer, laboratory nutritional parameters are significantly reduced, causing malnutrition in 44.7% of patients. Oral glutamine supplementation inhibited the postoperative decline in protein metabolism parameters; however, this did not affect the reduction in the percentage of postoperative complications. Glutamine used preoperatively significantly reduced the percentage of serious surgical complications, regardless of the way it was supplemented. Patients with invasive gastric cancer have a significant decrease in platelet phagocytic activity. The administered preoperative parenteral nutrition and the surgical procedure itself influenced the improvement of the phagocytic activity of blood platelets. Glutamine did not have this effect, regardless of the route of administration.

Foods for Special Medical Purposes in Home Enteral Nutrition-Clinical Practice Experience. Multicenter Study

Background

Enteral nutrition (EN) with foods for special medical purposes (FSMP) is recommended for most patients on home enteral nutrition (HEN). Although there are disease-specific guidelines for energy, protein, and micronutrient provision, only a few studies are showing real-life experience in the long-term use of FSMP.

Methods

In a multicenter study, the influence of the FSMP composition and administration technique (bolus vs. continuous) on protein and energy provision in HEN was analyzed. Provision of vitamins and minerals was compared to recommended daily allowance (RDA) and upper tolerable limit (UL).

Results

Approximately, 772 patients on HEN, mostly (88.6%) with oncological and neurological diseases, were enrolled. The patients on standard FSMP received less protein and energy than those on hypercaloric and protein enriched despite receiving higher volumes of EN (p < 0.05). No differences were observed in jejunal feeding with oligomeric vs. polymeric FSMP in terms of energy, protein, and volume. Continuous gastric feeding provided more protein, energy, and volume vs. bolus feeding (p < 0.05). Significant number of patients received less than 100% RDA of vitamin D (50.5%), vitamin B3 (49%), vitamin K (21.8%), vitamin B5 (64.3%), vitamin B9 (60%). Majority of the patients received less than 100% RDA of sodium (80.2%), potassium (99%), chloride (98%), calcium (67%), magnesium (87%), fluoride (99%), and iodine (43%). Approximately, 43.63% of cancer and 49.9% of neurological patients received less than 1 g/kg/day of protein and 51.7% of cancer and 55.5% of neurological patients received less than 25 kcal/kg/day.

Conclusion

Awareness of the available compositions of FSMP and advantageous profiles of specific diets may lead to the implementation of recommendations for EN. HEN professionals need to analyze all the patient's needs and requirements to provide more tailored matching of nutritional support.

Body composition of patients suffering from pancreatic cancer

Pancreatic cancer, despite significant progress in diagnosis and treatment still has poor prognosis. Surgical treatment remains the only cure option. Unfortunately, the percentage of patients in whom radical tumor removal is possible is less than 20%. Resection procedures are burdened with a high degree of difficulty, as well as a high complication rate. One of the important factors contributing to the high morbidity of the perioperative period is malnutrition, and rapidly progressing malnutrition which occurs in about 85% of pancreatic cancer patients. Abnormal nutritional status is closely related to a change in the composition in the body.The aim of the study was to determine the changes in the body composition of patients with pancreatic cancer and their consequences based on the results of the current research.The available reports have shown that the body composition of a patient with pancreatic cancer undoubtedly changes and is dependent on the stage, location and type of cancer. Furthermore, the fact if antitumor treatment is applied or not, also plays a significant role.It appears that in patients with pancreatic cancer, weight loss with a decline in parameters such as body fat and skeletal muscle mass appears early and worsens as the tumor grows and the disease progresses. The above data suggest that knowing the patient&apos;s body composition and observing its changes may be a prognostic factor for survival and the occurrence of complications. Additionally, there are reports that dosing chemotherapy based on body composition rather than conventional measures can help reduce the toxicity of the treatment. Therefore, knowing the patient&apos;s body composition seems to be an important aspect.

Laparoscopic organ-sparing surgery for cystic lesions of the spleen – own observations

<b>Introduction:</b> Splenic cysts are quite rare. In this publication, authors focus on presenting their own observations related to the management of patients with such lesions. </br></br> <b> Aim:</b> To evaluate the effectiveness of laparoscopic procedures in the case of patients with splenic cysts. </br></br> <b>Material and methods:</b> The study included patients treated surgically for cystic lesions located in the spleen at the 2^nd Department of General, Gastroenterological and Oncological Surgery of the Medical University of Bialystok over the years 2017–01.2020. </br></br> <b>Results:</b> All patients were referred for elective excision of the spleen lesion (the size of the lesions ranged from 7 to 15 cm – based on CT examination). In all cases, excision of the anterior wall of the cyst was performed with the help of advanced surgical tools. The duration of the procedure ranged between 65 and 100 minutes. No significant blood loss was observed. No postoperative complications were found. </br></br> <b>Conclusions:</b> In conclusion, sparing laparoscopic surgery for cystic lesions of the spleen seem to be safe and rarely associated with complications or relapses. Extending the scope of the procedure to total splenectomy should also not pose a major problem.

Organizational issues of home parenteral nutrition during COVID-19 pandemic: Results from multicenter, nationwide study

Objectives

Patients on home parenteral nutrition (HPN) are prone to severe complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The pandemic requires adaptation of the health care standards, including epidemiologic surveillance, logistics of home supply, and monitoring. Potential lack of medical professionals may worsen the standard of care. The aim of this study was to evaluate the medical staff resources in HPN units.

Results

The study was conducted by major Polish scientific societies in clinical nutrition. A questionnaire was distributed among all Polish adult HPN centers concerning statistics from the first 3 mo of the pandemic (March through May 2020). Data on medical staff resources and organizational issues of the units were collected. Modifications of the home procedures, SARS-CoV-2 infection rates of HPN patients and health care workers (HCW) were analyzed. Influence of the pandemic on the rates of new qualifications for home artificial nutrition (HAN) was estimated. Fourteen of 17 adult Polish HPN units took part in the study. The point prevalence of HPN in Poland was 30.75/1 million citizens. Of HCWs, 344 were involved in patient care in Polish HPN units; 18.9% were physicians (49% surgeons, 18.46% internal medicine specialists, 15.38% anesthesiologists, 7.69% pediatricians, 1.54% palliative care specialists), 32.27% nurses, 5.23% dietitians, 9.01% pharmacists, 4.94% pharmacy technicians, 3.2% pharmacy assistants, 5.81% administrative workers, 3.49% physiotherapists. HAN patient-to-HCW ratios for physicians, nurses, pharmacists, dietitians were 49.5, 29.15, 111.6, and 181.6, respectively. Medium ages of physicians and nurses were 45.6 and 44.15 y, respectively. Slightly less than half (53.8%) of physicians and 31.53% of nurses worked parallelly in hospital wards. Thirty-one pharmacists overall were working in all HPN units (2.21 per unit) as were 18 dietitians (1.3 per unit). Nine patients had a confirmed COVID-19 infection (four HPN, five home enteral nutrition). All the units introduced telemedicine solutions in the first months of the pandemic. The number of new qualifications for HPN and home enteral nutrition in the units did not significantly decline from March through May in comparison with a similar period in 2019.

Conclusions

A shortage of HPN medical professionals requires attention when planning health care organization, especially during a pandemic. Severe restrictions in public health systems may not reduce the number of new qualifications for the HPN procedure. There is a need for the continuation of data collection during the evolution of the pandemic as it may have a detrimental effect on HPN including serious issues with access to professional HCWs.

Home Enteral Nutrition in Adults-Nationwide Multicenter Survey

Home enteral nutrition (HEN) is an important part of the health care system, with a growing population of patients around the world. The aim of our study was to analyze one of the largest cohorts of HEN patients to provide the most recent data available in European literature. A multicenter, nation-wide survey in the period of 1 January 2018–1 January 2019 was performed in Poland. Data concerning adult patients on HEN in 2018 during 1 year of observation time were analyzed: demographic characteristics, primary disease, technique of enteral feeding, diet formulation and amount of energy provided. A total of 4586 HEN patients (F: 46.7%, M: 53.3%) were included in the study. The primary diseases were: 54.5% neurological (17.4%—neurovascular, 13.7%—neurodegenerative), 33.9% cancer (20.2%—head and neck, 11.7%—gastrointestinal cancer), 2.5%—gastroenterology, 1.5%—inherited diseases. Of new registrations in 2018—cancer patients 46.3%, neurological patients 45.1%. The median age overall was: 64 yr., BMI-20.2 kg/m², NRS 2002 score—4.28. A total of 65% of patients were treated with PEG, 11.6% with surgical gastrostomy, 14.3% with naso-gastric tube and 7% with jejunostomy. Boluses were the most common method of feeding (74.4%). Gravity flow was used in 17.6% and peristaltic pump was used in 8% patients. The median energy provision was 1278 kcal/day and 24 kcal/kg/day. The most commonly used diets were: isocaloric (28.1%), protein-enriched isocaloric (20%) and protein-enriched hypercaloric (12%). The median overall duration of HEN was 354 days, 615 days for neurological and 209 days for cancer patients. A number of new registrations of cancer patients was significant and long duration of HEN in this group is encouraging. A developing spectrum of enteral formulas available enables more specified nutritional interventions.

Home medical nutrition during SARS-CoV-2 pandemic - A position paper

BACKGROUND

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a worldwide rapidly spreading illness, Coronavirus Disease 2019 (COVID-19). Patients fed enterally and parenterally at home are exposed to the same risk of infection as the general population, but more prone to complications than others. Therefore the guidance for care-givers and care-takers of these patients is needed.

METHODS

The literature search identified no relevant systematic reviews or studies on the subject. Therefore a panel of 21 experts from 13 home medical nutrition (HMN) centres in Poland was formed. Twenty-three key issues relevant to the management of SARS-CoV-2 infection or COVID-19 in the HMN settings were identified and discussed. Some statements diverge from the available nutrition, surgical or ICU guidelines, some are based on the best available experience. Each topic was discussed and assessed during two Delphi rounds subsequently. Statements were graded strong or weak based on the balance between benefit and harm, resource and cost implications, equity, and feasibility.

RESULTS

the panel issued 23 statements, all of them were graded strong. Two scored 85.71% agreement, eleven 95.23%, and ten 100%. The topics were: infection control, enrolment to HMN, logistics and patient information.

CONCLUSIONS

the position paper present pragmatic statements for HMN to be implemented in places without existing protocols for SARS-CoV-2 pandemic. They represent the state of knowledge available at the moment and may change should new evidence occurs.

A Rare Spontaneous Gastrobiliary Fistula

We report the case of a 69-year-old man with a spontaneous gastrobiliary fistula. Internal biliary fistulas are usually the result of longstanding, untreated choledocholithiasis, cholecystolithiasis, peptic ulcers or rarely neoplasia. This patient’s unspecific clinical picture led to a late diagnosis, which was made during surgery.

How to cite this article: Chwiesko A, Jurkowska G, Kedra B, Okulczyk B, Kamocki Z, Dabrowski A. A Rare Spontaneous Gastrobiliary Fistula. Euroasian J Hepato-Gastroenterol 2014;4(2):101-103.

Platelets and inflammatory markers in patients with gastric cancer

The aim of the study was to assess the contribution of platelets and inflammatory markers in gastric cancer. We studied 50 patients. Taking into consideration the advancement of gastric cancer, patients were divided into 3 groups. Group (E)--13 patients with early gastric cancer, group (A)--18 patients with regionally advanced cancer, and group (M)--19 patients with metastatic cancer. The determinations were performed twice prior to surgery and after surgery. In patients with gastric cancer, there is an increase in IL-6 and IL-23 compared with the healthy group. The highest values of IL-6 were obtained in early cancer (more than 8-fold increase), which seems to confirm the presence of acute inflammation. The lowest value of both of these cytokines was obtained in patients with metastatic cancer. In all patients, regardless of tumor stage, there was an increase in the concentration of CRP. An increase of PLT, higher proportion of the percentage of large platelets (LPLT), and increased mean platelet volume (MPV) were observed in the process of disease development. A positive correlation between MPV and LPLT and the accompanying decrease in the concentration of proinflammatory cytokines indicates the presence of an existing relationship between the platelet morphological parameters and the inflammation process in the development of gastric cancer.

Assessment of platelet activation and phagocytic activity in gastric cancer patients

AIM: To assess the activation of platelets and their phagocytic activity in the course of gastric cancer.

METHODS: Forty-three gastric cancer patients were recruited to the study. The patients were divided into 3 groups depending on tumor stage. Group E included 6 patients with early gastric cancer; group A 18 patients with locally advanced cancer; and group M-19 with metastatic cancer. The investigations were performed twice, prior to surgery and 12-14 d afterwards.

RESULTS: The platelet count and the level of soluble platelet selectin (sP-selectin) were found to increase with the disease progression. The level of sP-selectin was lowest in early cancer and was observed to increase after surgery in all the study patients. Irrespective of tumor stage, a statistically significant decrease was noted in the percentage of phagocytizing platelets and in the phagocytic index in gastric cancer patients as compared to healthy subjects. Despite increased platelet count and stimulation of thrombocytopoiesis, the phagocytic functions of blood platelets were markedly impaired. Tumor development seems to impair metabolic processes.

CONCLUSION: A decreasing phagocytic activity can promote both inflammatory processes and cancer growth.

Platelet activation in patients with advanced gastric cancer

The aim of this study was to evaluate platelet activation in gastric cancer patients with regard to histopathological classification and the presence of distant metastases, by using platelet morphological parameters: MPV, L-PLT, MPC, as well as quantitative evaluation of surface receptor expression: CD41a, CD61, CD42b, CD62P, by flow cytometry at the resting state and after TRAP activation. In gastric cancer patients higher values of MPV and LP, as well as decreased MPC values were determined. Quantitative evaluation of surface antigen expression also revealed higher number of CD41a, CD61 and CD62P molecules, as compared with the platelets in the control group. Significant decrease of CD42b molecules' number after TRAP incubation, and the increased CD41a, CD61 and CD62P expression also point to the retained reactivation capacity of platelets. Good correlation between morphological parameters and the number of CD62P molecules indicates the usefulness of routine tests in evaluation of platelet activation.

[The plasma level of myeloperoxidase (MPO) and total antioxidant status (TAS) in gastric cancer patients after surgery]

The human body is subject to constant effects of reactive oxygen species (ROS). The source of cellular ROS production include activated phagocytes for examples neutrophils and macrophages. ROS at appropriately low level are needed for the proper function of the organism. Uncontrolled increase however is known as oxidative stress and may have serious consequences. The purpose of this investigation was to evaluate in the plasma of gastric carcinoma patients the level of MPO (enzyme of granulocyte) and TAS (total antioxidant status). MPO is a measurement of neutrophils activation and synthesis of ROS. TAS informs about the effect of radicals on neoplastic processes. We tested 28 patients with III and IV stage of gastric carcinoma. Plasma samples were drawn before and 1 and 10 days after surgery operation. The control group consisted of 18 healthy subjects. The plasma level of MPO was measured using a chemiluminescent microparticle immunoassay (CMIA), TAS was measured using colorimetric method. In gastric carcinoma patients before and after operation (1 and 10 day) MPO concentration was 3 times higher in comparison to the control group, but TAS level was decreased. These results suggest the presence of prolonged oxidative stress in malignant disease but it requires long time observation after surgery.

[The effect of surgical and nutritional treatment on activation parameters of peripheral blood T lymphocytes in stomach cancer patients in postoperative period]

Several studies have reported that patients with stomach cancer are frequently affected by malnutrition. Malnourished patients are at risk of postoperative complications. Immune function starts to deteriorate when weight loss exceeds 15%. Early enteral nutrition support reduces postoperative lymphocytopenia. T lymphocytes are central elements of the immune system. CD69, CD25 and HLA-DR molecules are expressed following activation on T lymphocytes surface. THE AIM OF THE STUDY was to assess the effect of surgery and early postoperative enteral nutrition on peripheral blood T lymphocytes activation status in stomach cancer patients.

MATERIAL AND METHODS

Lymphocyte T CD: CD3/CD69, CD3/CD25, CD3/HLA-DR were determined in 30 stomach cancer patients before treatment and 1, 3, 7 and 10 days after gastrectomy. Patients received early enteral nutrition from 20 hours to 7 days after surgery. The obtained results were compared with the results of 30 healthy volunteers.

RESULTS

The significant deficiency of total T lymphocyte number was found in stomach cancer patients before surgery and in postoperative period in comparison with the control group. The populations of CD3+/CD69+, CD3+/CD25+ and CD3+/HLA-DR+ T lymphocytes in patients with stomach cancer were significantly higher in comparison with healthy donors. The significant increase of percentage of activated T lymphocytes was observed, too.

CONCLUSIONS

The obtained data demonstrated significant quantitative defect in T lymphocytes and significant increase of their activation status in stomach cancer patients. Surgical procedure intensified changes that were observed before treatment. The most dynamic changes were observed in CD3+/CD69+ T cells population.

[An assessment of peripheral blood lymphocytes populations and subpopulation in patients with stomach cancer]

AIM

In the present study, we conducted the quantitative analysis of peripheral blood lymphocytes population and subpopulation in patients with stomach cancer, based on flow cytometry immunophenotyping.

MATERIAL AND METHOD

The results were compared with the advancement of the disease (UICC/TNM), histological type (Lauren classification), and grade of differentiation of stomach cancer. Lymphocyte CD: (CD3/CD19, CD3/CD4, CD3/CD8, CD3/CD16, 56) were determined in 50 cancer patients and 30 healthy humans.

RESULTS

The significant deficiency of total lymphocyte number, T and B lymphocytes, as well as CD4+ and CD8+ was found in stomach cancer patients. There was no depletion in NK cells number. In advanced stomach cancer, the number of NK cells decreased, along with further deterioration of lymphocytes T and B populations. In patients with diffuse-type of stomach cancer and III or IV stage, the more pronounced deficiency in T, CD4+ and CD8+ population was noted. The decrease grade of differentiation was correlated with the increase of NK cell population. There was no correlation between the number of B lymphocytes and the histologic type or grade of differentiation of stomach cancer.

CONCLUSION

The obtained data demonstrated significant quantitative defect in defence of stomach cancer patients.

Bactericidal capacity of platelets in gastric cancer patients

The aim of this study was to evaluate bactericidal capacity of platelets in patients suffering from gastric cancer. Number of platelets and their bactericidal activity were measured in 32 cancer patients (divided into 2 groups: I--resectable cancer, II--non-resectable one) and 32 normal donors. In group I the number of platelets was 259.136+/-84.459 x 103/microl. It was increased comparing to the normal donors 193.219+/-55.493 x 103/microl. After the surgery increase in platelet number was observed (472.05+/-111.772 x 103/microl). In group II an increased number of platelets was observed (265.1+/-81.813 x 103/microl) and it was maintained in a post-operative period: 234.2+/-54.141 x 103/microl. In group I bactericidal capacity of platelets was 2.25+/-7.33%, whereas it increased significantly after the surgery--4.7+/-7.46%. In group II, it was 8.6+/-17.61% before and 4.72+/-4.76% after the surgery. In normal donors this ability was 21.66+/-16.66. In gastric cancer patients increased platelet number was observed. Significant increase in platelets number occurred after a radical tumor removal. Decreased bactericidal activity of platelets was noticed in gastric cancer patients. After surgical removal of the tumor, platelets partly reclaimed bactericidal capacity. In patients presenting disseminated gastric cancer, bactericidal capacity of platelets could be permanently impaired.

Lithogenecity of bile in the pathogenesis of cholelithiasis

The authors have made a review of the present literature relating to lithogenic bile as the main pathogenic factor in the creation of cholelithiasis. Lithogenic bile is formed in result of complex biochemical reactions taking place in bile under physiological conditions, as well as in pathology of the liver and the biliary tract. Significant clinical implications result from the analysis.

[Laparoscopic cholecystectomy conversion--causes and surgical procedures]

From September 1993 tol May 1997 360 laparoscopic cholecystectomies have been performed in patients aged 17-74: 318 women (88.3%) and 42 men (11.7%). 19 of them (5.3%) required a conversion to open surgery. In 13 cases (13.6%) conversion was caused by technical difficulties. In the other 6 (1.7%) was caused by intraoperative complications. While converted 15 simple cholecystectomies were performed, 2 with T-tube drainage of bile ducts, 1 with anastomosis choledochoduodenalis and 1 with partial stomach resection (Rydygier method). In all cases adhesions were divided. None of the patients died. Authors believe that LCh can be performed safely on most of the patients with chronic and acute cholecystitis.

Surgical treatment of prolapse of the rectum--evaluation of distant results

In the years 1972-1995 41 patients suffering from prolapse of the rectum were operated according to the Moore method. The method is based on the observations which suggest that the cause of prolapse is intestinal intussusception which can be prevented by translocating the anus under the pubic joint. The observation time is from 1 to 23 years. Two patients were reoperated; one-as a result of a recurrence of rectal prolapse and one due to a post-operative adhesive ileus. One patient died as result of peritonitis following an overlooked microperforation in the rectal wall. In the case of the remaining patients, the treatment was fully successful. Regular defecation cycle as well as incontination of stool and flatus returned and the anal sphincters almost fully regained their tension in comparison to the pre-operative state. Early and distant results of surgery of prolapse of the rectum are satisfactory.

Study of lithogenicity of bile among patients suffering from cholecystolithiasis and among patients not suffering from this disease

On the basis of biochemical and morphological research, the authors decided to attempt to determine the degree of lithogenicity of the bile among patients suffering from cholecystolithiasis (100 patients) and those not suffering from this disease (31 patients). Having analyzed the obtained data, it can be concluded that the degree of lithogenicity of bile is influenced by the concentration of cholesterol, bile acids and phospholipids as well as the damage of the liver and of the wall of the gallbladder as well as its kinetics. Lithogenic bile was noticed in 84% of the patients of group I and in 54% in group II. However, the degree of lithogenicity was significantly higher in patients suffering from cholecystolithiasis. According to the authors, the degree of lithogenicity is the deciding factor in the creation of bile stones.