Colon perforation following percutaneous nephrolithotomy.

Between February 1984 and 1986, 285 patients underwent percutaneous nephrostomy placement followed by track dilation and calculi removal. Although percutaneous colonic perforation is rare, we report a case consequent to this procedure. The patient had a good outcome after surgical management of the damaged colon. This report considers the anatomic aspects for percutaneous nephrostomy placement as well as the auxiliary methods used in diagnosis of lesions of the colon.

Extracorporeal shock-wave lithotripsy with Lithostar lithotriptor.

Initial experience of extracorporeal shock-wave lithotripsy (ESWL) using the Lithostar lithotriptor is reported; 193 patients underwent 248 treatments for 210 stones. A total of 139 renal calculi (126 patients) and 71 ureteral stones (67 patients) were analyzed. Treatments were performed without anesthesia in 65 calculi (27.6%), with intravenous sedation in 91 (42.5%), and under epidural anesthesia in 34 calculi (29.9%). A three-month follow-up showed a success rate of 88.0 percent for renal calculi and 95.5 percent for ureteral calculi treated in situ. Renal stone fragmentation was achieved with a mean of 4,890 shocks at 17.4 kV and ureteral calculi were fragmented with a mean number of 4,798 shocks at a mean of 18.3 kV. Auxiliary procedures after ESWL were required in 2 patients with renal stones and in 1 with ureteral calculi. A comparison between stone size and number of shock waves required to achieve stone fragmentation revealed a linear relationship. Hospitalization was not necessary in 84.4 percent of renal calculi and 89.6 percent of ureteral calculi. Retreatments were necessary in 22 (15.8%) of the renal calculi (18 had 2 sessions, 3 had 3 sessions, and 1 had 4 sessions). Of the ureteral calculi, 8 (11.3%) underwent retreatment (6 had 2 sessions, 1 had 3 sessions, and 1 had 4 sessions). The low morbidity with a large number of patients treated on an outpatient basis, minimizing the need for anesthesia, demonstrated a favorable initial successful experience with the Lithostar.

Lumbar ureteric stones: which is the best treatment?

We reviewed retrospectively 145 patients presenting ureteral calculi above the iliac crest. According to the treatment three groups were established. Group 1 was represented by 24 patients submitted to posterior ureterolithotomy; group 2, 100 patients treated by endourologic procedures; and group 3, 21 patients treated by extracorporeal shock-wave lithotripsy (ESWL). Success rate considered as complete removal of all calculous material was 100 percent in the posterior ureterolithotomy group, 92 percent in the endourologic group, and 94.7 percent in the ESWL group. Hospitalization, anesthesia, and complication rates were minimal in patients submitted to ESWL. One may conclude that ESWL is the treatment of choice for lumbar ureteric calculi.

Urologic aspects associated with isolated hypogastric artery aneurysm.

The isolated hypogastric artery aneurysm may give rise to urologic symptoms. This occurs as a consequence of extrinsic compression exerted by the aneurysm itself to the urinary tract or the involvement of the urinary tract by the perianeurysmatic fibrosis. We report 2 cases of isolated hypogastric artery aneurysm. One of the patients had unilateral ureteral obstruction while the other revealed a mass on rectal examination. In both cases surgery was performed and the urologic manifestations were relieved completely.

Congenital diverticulum of male urethra.

Congenital diverticulum of the male urethra is an uncommon condition. Urinary tract infection, urethral obstruction, and disturbances in micturition are the most common symptoms. Six cases of congenital diverticulum of the male urethra were studied with regard to diagnosis and treatment. Four patients underwent endoscopic treatment of the diverticulum. The procedure is simple and rapid, with low incidence of complications and high rates of success.

A comparative study of electrosurgical vs. cold urethrotomy in the treatment of urethral strictures.

Thirty-one patients with urethral stricture were subjected to internal urethrotomy under visual control. The patients were divided into two groups according to the surgical procedure: electrosurgical or cold resection. A modification of the Sachse knife was introduced in order to permit its use with the American Cystoscope Makers Inc. instruments. The success rate with cold resection was 81.81% and with the electrosurgical procedure 40%. Internal urethrotomy with cold resection is a simple and harmless operation, being a first choice in the treatment of urethral stricture.

Comparison between percutaneous nephrolithotomy and open stone procedures.

A total of 205 patients have undergone stone extraction surgery. Three groups were studied: in 70 patients the stones were removed by flank incision, in 20 patients by posterior incision and 80 patients were treated by percutaneous nephrolithotomy. Patients submitted to percutaneous nephrolithotomy had a shorter hospitalization, operative time and a significantly reduced period of recuperation, allowing earlier return to work and decreased disability. Narcotic drugs were demanded in a lower amount in the percutaneous nephrolithotomy group.

Evaluation of the impairment of spermatogenesis in varicocele through semen analysis and testicular biopsy.

Twenty-four patients with varicocele and 26 normal men were analysed according to the seminal ejaculate and testicular biopsy. Patients were divided into two groups based on the criteria of sperm normality and abnormality, respectively. Hypospermatogenesis with both normal and abnormal seminal fluid occurred in the varicocele patients, but no statistical differences could be established when compared with each other. We concluded that testicular biopsy is not useful in the evaluation of patients with varicocele.

Triagem fitoquímica e atividade antioxidante de Costus spicatus (Jacq. ) S. w / Phytochemical screening and antioxidant activity of Costus spicatus (Jacq. ) Sw

O objetivo do trabalho foi avaliar o perfil fitoquímico e a atividade antioxidante comparando-se os resultados obtidos entre diferentes órgãos da Costus spicatus. Foram utilizados caules, folhas e flores da Costus spicatus, colhidos na Universidade Estadual do Norte Fluminense Darcy Ribeiro, no município de Campos dos Goytacazes, RJ. Os diferentes órgãos foram avaliados quanto ao perfil fitoquímico e atividade antioxidante nas frações hexânica, acetato de etila e butanólica. Os resultados obtidos comprovaram a presença de Triterpenos e Esteróides (Lieberman-Burchard), Flavonóides (Shinoda), Saponinas (Índice de espuma), Alcalóides (Drangendorff) e Taninos (Cloreto Férrico). Foi demonstrada a atividade antioxidante potencial. Concluiu-se que a Costus spicatus apresentou todas as classes de metabólitos pesquisadas, dentre as quais, algumas possuem atividade biológica já conhecida, fazendo-se necessária a realização de estudos quantitativos e pesquisas que demonstrem seus efeitos farmacológicos, contribuindo para o desenvolvimento de novos fármacos.

The objective of this work was to evaluate the phytochemical profile and the antioxidant activity comparing the results between different organs of Costus spicatus. We used the stems, leaves and flowers of Costus spicatus harvested at the State University of Norte Fluminense "Darcy Ribeiro" in the city of Campos dos Goytacazes, Rio de Janeiro, Brazil. The different organs were evaluated for antioxidant activity and phytochemical profile in the hexane, ethyl acetate and butanol fractions. The results obtained proved the presence of triterpenes and steroids (Liebermann-Burchard), flavonoids (Shinoda), saponins (foaming index), alkaloids (Dragendorff) and tannins (ferric chloride). We demonstrated the potential antioxidant activity. We concluded that Costus spicatus presented all classes of metabolites studied, among which some already have their biological activity known by the literature, being necessary the performance of quantitative and research studies that demonstrate their pharmacological effects, thus contributing to the development of new drugs.

Controle de plantas invasoras em cultivo orgânico e convencional de capim-limão (Cymbopogon citratus (DC) Stapf. ) / Weed control in organic and conventional crops of lemongrass

O cultivo orgânico é preconizado para o capim-limão (Cymbopogon citratus (DC) Stapf.) como planta medicinal promissora ao desenvolvimento de fármacos no Brasil. Objetivou-se avaliar técnicas de controle de plantas invasoras sobre componentes de produção de capim limão em cultivos orgânico e convencional. Dois experimentos foram instalados sob delineamento inteiramente casualizado, com quatro repetições, em esquema fatorial 2x2x3, considerando-se duas áreas (orgânico e convencional) e os tratamentos combinando cobertura morta (presente e ausente) e técnicas de controle de plantas invasoras (capina manual, roçada e nenhuma). Altura, perfilhamento, teor e rendimento total de óleo essencial de capim-limão no cultivo orgânico foram superiores ao convencional, mas a produtividade de biomassa aérea seca não diferiu entre ambos. A capina, com ou sem cobertura morta, favoreceu o rendimento de óleo no cultivo orgânico.

Organic farming is recommended for lemongrass as a promising medicinal plant for drug development in Brazil. The purpose of this paper was to evaluate the effect of the techniques to control weed on the plant height, tillering, biomass productivity, content and yield of the essential oil of lemon grass in organic and conventional crops. Two experiments were set in a completely randomized design with four replications, at a 2x2x3 factorial scheme, considering two areas (organic and conventional) and treatments combining mulching (present and absent) and weed control techniques (hoeing, skimming and none). Plant height, tillering, content and yield of the essential oil of lemongrass were better in the organic crop, but the biomass productivity did not differ between both areas. The biomass production was better in the conventional crop as to weed control, with or without mulching, and for organic crop under hoeing or skimming with mulching. Hoeing or skimming with no mulching improved the oil content in organic crops. Hoeing or skimming with mulching was better than any other weed control technique with no mulching, and hoeing was better than skimming, justifying its recommendation as a technique for this crop system.

Bioatividade de extratos hidroalcoólicos de Cymbopogon citratus (DC. ) Stapf. sobre picão-preto (Bidens pilosa L.) e alface (Lactuca sativa L.) / Bioactivity of hydroalcoholic extracts of Cymbopogon citratus (DC. ) Stapf. on germination and early growth of beggartick (Bidens pilosa L.) and lettuce (Lactuca sativa L.)

Este trabalho visou avaliar a bioatividade de extratos hidroalcoólicos de capim-limão sobre germinação e crescimento inicial da planta daninha picão-preto (Bidens pilosa L.) e da planta teste alface (Lactuca sativa L.). A partir de maceração hidroalcoólica de folhas secas e rasuradas (127,46 g) de capim-limão em 1L de álcool de cereais (70%), foram preparados os tratamentos como extratos hidroalcoólicos (HA) pela diluição (v/v) do macerado filtrado em água deionizada na proporção 1:1 (HA1:1) e 1:2 (HA1:2); dos quais foram obtidos os respectivos extratos secos (ES), a partir da evaporação da fase líquida de duas alíquotas de 50 mL de cada extrato HA, que após re-suspendidas em igual volume de água, sendo uma autoclavada (1 atm por 15 minutos), resultando nos extratos secos de HA1:1 e HA1:2 autoclavados (ES1:1A e ES1:2A) e nos extratos secos não autoclavados (ES1:1 e ES1:2); e água (AG) como controle. No primeiro dia dos bioensaios, foram aplicados 2 mL dos tratamentos, em DIC, com cinco repetições. Avaliou-se a porcentagem de germinação (G%), Índice de Velocidade de Germinação (IVG), altura da parte aérea (AA) e comprimento de radícula (CR) de aquênios (25) de picão-preto e de alface distribuídos em placas de Petri e mantidos em câmara de germinação (B.O.D.) por duas semanas. Os extratos HA1:1 e HA1:2 inibiram a G%, AA e CR das duas espécies. Todos os extratos secos reduziram a G%, IVG e o CR da alface. Para o picão preto, apenas o extrato ES1:1 reduziu a G% e o IVG foi reduzido por todos os extratos, a exceção do ES1:1A, mas nenhum extrato influenciou o crescimento inicial desta espécie.

This study aimed to evaluate the bioactivity of hydroalcoholic extract of lemongrass on the germination and early growth of the weed plant beggartick (Bidens pilosa L.) and the test plant lettuce (Lactuca sativa L.). From the hydroalcoholic maceration of dried and cut leaves of lemon grass (127.46 g) in 1 L grain alcohol (70%), the following treatments were prepared, hydro-alcoholic (HA) extracts by diluting (v/v) the macerate in deionized water at 1:1 (HA1:1) and 1:2 (HA1:2) proportions, obtaining the respective dried extracts (DE) from the evaporation of the liquid phase of two 50-mL aliquots of each HA extract; after resuspension in the same water volume, one aliquot was autoclaved (1 atm for 15 minutes) resulting in HA1:1 and HA1:2 dried autoclaved extracts (DE1:1A and DE1:2A) and in dried non-autoclaved extracts (ES1:1 and ES1:2), and water as control. On the first day of bioassays, 2mL of treatments were applied, in completely randomized design, with 5 replicates. Germination percentage (G%), Germination Speed Index (GSI), shoot height (SH) and radicle length (RL) of achenes (25) of beggartick and lettuce were evaluated after having been distributed in Petri dishes and kept in a germination chamber (B.O.D.) for two weeks. HA1:1 and HA1:2 extracts inhibited G%, SH and RL of both species. All dried extracts reduced G%, GSI and CR of lettuce. For beggartick, only ES1:1 extract reduced G% while GSI was reduced in all extracts, except ES1:1A, but no extract influenced the early growth of this species.

Bacillus Calmette-Guerin immunotherapy of infiltrating bladder cancer.

Oral administration of bacillus Calmette-Guerin was used to treat 10 patients with muscle invasive transitional cell carcinoma of the bladder. The treatment induced tumor regression in 7 patients (70 per cent), including 1 who died without evidence of recurrent tumor. Skin test reactivity was correlated with response to treatment. Only 1 patient had marked skin test reactivity at the time of tumor recurrence. Our data demonstrated that patients with invasive bladder cancer may derive benefit from immunotherapy.

Percutaneous nephrolithotomy in patients with previous renal surgery.

Although safe and effective, nephrolithotomy sometimes is difficult. 224 patients have undergone percutaneous stone extraction surgery. Two groups were established according to previous open renal surgery. 79 patients had had previous surgery and 145 patients were initially treated by percutaneous nephrolithotomy. Bleeding and operative time, i.e. puncture of the kidney, dilation of the tract and lithotripsy were greater in the group with previous renal surgery. However, no statistical difference was verified. In conclusion, percutaneous lithotripsy is a safe and effective method with minimal morbidity even in patients with previous renal surgery.

A comparison of treatment methods for the prophylaxis of recurrent superficial bladder tumors.

We assigned 55 patients with superficial transitional cell carcinoma of the bladder by rotation to 1 of 3 treatment categories. Group 1 patients were treated by transurethral resection alone, group 2 by transurethral resection followed by topical thiotepa and group 3 by transurethral resection followed by orally administered bacillus Calmette-Guerin. Recurrent bladder tumors developed subsequently in 80 per cent of the patients in group 1, 42.9 per cent in group 2 and 6.2 per cent in group 3.

Varicocele: medical and surgical treatment.

Varicocele is the most frequent finding in male infertility. Thirty percent of infertile male patients requesting treatment present with varicocele. Between December 1971 and December 1984, 151 infertile patients presenting varicocele were treated in this study: 28 underwent medical treatment, 38 surgical treatment, and 23 both medical and surgical treatment. The spermograms of all the patients were studied before and after treatment. The following variables were considered: volume, sperm count, percentages of general motility and of grade III sperm, and of oval forms. There was not a significant statistical difference in the analysis of the spermogram parameters before and after treatment in the three groups. The pregnancy rate for the medical-surgical group was 60.9% and for the surgical group 47.4%--not a statistically significant difference. The purely medically treated group had a pregnancy rate of 25%, which is significantly lower than the other groups.

Staghorn calculi: percutaneous versus anatrophic nephrolithotomy.

In a retrospective analysis percutaneous ultrasonic lithotripsy and anatrophic nephrolithotomy for staghorn stones were compared to evaluate morbidity. In 46 patients treated percutaneously and 29 patients treated by open surgery, the procedure time, success rate, complication rate, length of hospitalization, disability period, and amount of analgesics needed in the postoperative period were analyzed. 5 patients treated during the learning period were not considered for this study, no matter whether they were treated by open or percutaneous surgery. Complete removal of all stone fragments was achieved in 73.8% of the patients treated percutaneously. Calculi were removed successfully in 82.1% of the patients submitted to anatrophic lithotomy. The group treated percutaneously showed shorter procedural time (mean 120 versus 210 min), shorter hospitalization period (5 versus 7 days), less need for analgesics (mean 1.6 versus 4.7 doses per patient), and an earlier return to normal physical activities (9 versus 43 days). Among the patients who underwent open surgery, 14 (50.0%) required additional interventions to treat complications. Although in the percutaneous group 28.5% required more than one percutaneous intervention, the overall complication rate per surgery of 20.0% was significantly lower, with no need for open surgery. Percutaneous nephrolithotomy proved to be of significantly lower morbidity than anatrophic lithotomy.

Comparison of the Stamey bladder neck suspension procedure with a modified endoscopic suspension for the treatment of stress urinary incontinence.

Endoscopic vesicourethral suspension is an acceptable procedure for the treatment of stress urinary incontinence and is associated with a high success rate and little morbidity. Classical endoscopic vesical neck suspension was performed in 93 patients with cure of incontinence in 89 (95.7%). Cost-effectiveness and simplification were introduced to Stamey's technique. Modifications introduced to the Stamey technique were found to be simpler and to provide cost savings with fewer complications. Eighty-six women were operated on by this method, with 84.9% of success. A total of 133 (74.3%) of the patients had previous surgical procedures to correct incontinence, demonstrating the indication of the endoscopic vesicourethral suspension in case of failures with other techniques.

Relation between the vaginal introital and perianal flora in recurrent cystitis in women.

15 patients with urinary infection were selected and analyzed in relation to infection in the vaginal and perianal areas. After treatment, 12 patients with urinary infection were cured, but bacterial organisms persisted in their vaginal and perianal areas. In spite of the persistence of the vaginal and perianal infection, those patients remained free of urinary infection. We can conclude that other factors, besides the persistency of bacterial organisms in the vaginal introitus and perianal regions, may be important in the development of ascending urinary infection.

Endourological management of ureteral strictures.

We reviewed the records of 20 patients (21 ureters) treated during the last 5 years for ureteral stricture disease. The causes of stricture formation included ureterolithotripsy in 47.7% of the patients, open ureterolithotomy in 9.5%, other urological procedures in 23.8%, general surgical and gynecological procedures in 9.5% and miscellaneous factors in 9.5%. A total of 20 patients (21 ureters) underwent endourological treatment with balloon dilation (19) or balloon dilation and internal ureterotomy (2), with good results in 57.1% and a mean followup of 24 months. Of the 9 patients who failed endourological management 3 underwent successful open repair, 3 underwent nephrectomy, and 3 had a relatively large ureteral lumen and became asymptomatic, receiving no further treatment. The interval between injury and treatment was not a decisive factor. The length of ureteral stricture assumes the most significant parameter to predict success in the treatment of ureteral stricture. There were no intraoperative or postoperative complications. The association of balloon dilation and incision by special endoureterotomy scissors is a potentially useful technique.

In situ extracorporeal shock wave lithotripsy for ureteral calculi.

We reviewed our experience with in situ extracorporeal shock wave lithotripsy for ureteral stones in 30 patients. The Siemens Lithostar unit was used for stone disintegration and no attempts were made to manipulate the calculi back into the kidney. During the study period 15 patients presented with upper, 9 with mid and 6 with lower ureteral calculi. The mean stone size was 5 x 12 mm. The success rates in stone removal, hospitalization, anesthesia, average number of shocks and kilovolts used were analyzed. Complete removal of all calculous material was obtained in 86.6% of the patients after 3 months. Followup consisted of a plain film of the kidneys, ureters and bladder, and eventually renal ultrasound 1 day and 1 to 3 months postoperatively. Routinely, patients were treated without hospitalization, while 3 had persistent stone fragments and required hospitalization for auxiliary endourological procedures. The average hospital stay for these patients was 1.6 days. Of the 30 patients 13 (43.4%) were treated without anesthesia, 9 (30.0%) received intravenous sedation and 8 (26.6%) had epidural anesthesia. Patients received 3,000 to 6,000 shock waves per session (median 4,000) at 14.0 to 19.0 kv. (median 18.1 kv.), and in 76.9% the treatment was completed after 1 session. Patients who needed more than 1 session received 3,000 to 4,000 shock waves (median 3,000) at 15.0 to 19.0 kv. (median 17.8 kv.) per additional session. Minor complications, such as hematuria, were observed in 33.3% of the patients for less than 24 hours. A small erythematous area usually was present on the abdominal wall at the shock wave entrance site and temporary ileus was noted in 2 patients. In situ extracorporeal shock wave lithotripsy with the Siemens Lithostar device is an effective method for treatment of ureteral stones in all parts of the ureter due to the ease of patient positioning.