Plantas medicinais no controle de urolitíase / Using medicinal plants in the control of urolithiasis

Plantas medicinais têm sido utilizadas mundialmente para o controle de urolitíases na medicina humana. A ocorrência desta afecção tem aumentado em humanos, ruminantes, cães e gatos. Nos animais, fatores patofisiológicos adquiridos, congênitos ou familiares podem estar envolvidos, havendo similaridade ao que se observa em seres humanos. Porém, apesar dos avanços nas pesquisas, o emprego de plantas medicinais na medicina veterinária, ainda é pouco utilizado. Dessa forma, objetivou-se apresentar uma revisão bibliográfica dos resultados do uso de plantas medicinais no controle de urolitíase. As plantas utilizadas são: Ammi visnaga, Bergenia ligulata, Cynodon dactylon, Herniaria hirsuta e Phyllanthus niruri. A atividade antilitogênica foi relacionada às alterações da composição iônica da urina, atividade diurética, inibição de cristalização e agregação de cristais. Destaca-se o uso de Phyllanthus niruri, pela eficácia na prevenção dos urólitos. Extratos de Phyllanthus niruri normalizaram níveis altos de cálcio urinário, desfavorecendo os estágios iniciais de formação dos urólitos. Adicionalmente, foram associados à elevação da filtração glomerular e excreção urinária de ácido úrico sugerindo utilização potencial não só como efeito lítico e preventivo das calculoses, mas também em pacientes hiperuricêmicos e portadores de insuficiência renal. A partir dos resultados relatados, pode-se concluir que os trabalhos apresentados pela literatura atual são capazes de comprovar os efeitos benéficos do uso de plantas medicinais no controle de urolitíase. Entretanto, ainda são escassos os estudos realizados em animais domésticos, predominando ensaios desenvolvidos em roedores.

Medicinal plants have been used worldwide in the prevention of urolithiasis. The occurrence of this disease has increased in men, ruminants, dogs and cats. With regard to animals, acquired (congenital or hereditary) pathophysiological factors may be involved, a fact that bears similarity to what has been observed in humans. Yet, despite advances in research, the use of medicinal plants in veterinary medicine remains still underutilized. Thus, the purpose of this study is to conduct a literature review on the use of medicinal plants in the control of urolithiasis. The plants used are: Ammi visnaga, Bergenia ligulata, Cynodon dactylon, Herniaria hirsute and Phyllanthus niruri. Antilithogenic activity was related to changes in the ionic composition of urine, diuretic activity and inhibition of crystallization and aggregation of crystals. It is worth highlighting the use of Phyllanthus niruri due to its efficiency in the prevention of uroliths. Phyllanthus niruri extracts normalized high levels of urinary calcium, inhibiting the formation of uroliths in the initial stages. Additionally, they were associated with a higher glomerular filtration and higher urinary excretion of uric acid. These results suggest a potential use due to its lytic and preventive effect, as well as due to its application to hyperuricemic patients having renal insufficiency. We can conclude that the studies that pertain to the current literature can demonstrate the beneficial effects of using medicinal herbs to control urolithiasis. However, studies conducted in domestic animals remain scant, while tests developed in rodents still predominate.

Influence of the echocardiographic score and not of the previous surgical mitral commissurotomy on the outcome of percutaneous mitral balloon valvuloplasty.

OBJECTIVE: To evaluate prior mitral surgical commissurotomy and echocardiographic score influence on the outcomes and complications of percutaneous mitral balloon valvuloplasty. METHODS: We performed 459 complete mitral valvuloplasty procedures. Four hundred thirteen were primary valvuloplasty and 46 were in patients who had undergone prior surgical commissurotomy. The prior commissurotomy group was older, had higher echo scores, and a tendency toward a higher percentage of atrial fibrillation. RESULTS: When the groups were compared with each other, no differences were found in pre- and postprocedure mean pulmonary artery pressure, mean mitral gradient, mitral valve area, and mitral regurgitation. Because we found no significant differences, we subdivided the entire group based on echo scores, those with echo scores < or =8 and those with echo scores >8 the mitral valve area being higher in the < or =8 echo score group 2.06+/-0.42 versus 1.90+/-0.40 cm2 (p=0.0090) in the >8 echo score group. CONCLUSION: Dividing the groups based on echo score revealed that the higher echo score group had smaller mitral valve areas postvalvuloplasty.

[Single balloon versus Inoue balloon in percutaneous mitral balloon valvuloplasty. Short-term results and complications]. / Balãco Unico versus balão de Inoue na valvoplastia mitral percutânea por balão. Resultados imediatos e complicações.

PURPOSE: To assess short-term results and complications of percutaneous mitral balloon valvuloplasty (PMBV) performed with Inoue balloon (IB) and single low profile balloon (SB). METHODS: We performed 390 PMBV procedures, 29 with IB and 337 with SB. There were no differences in age, sex, echocardiographic score distribution and echocardiographic mitral valve area (MVA). RESULTS: We performed 29 complete procedures with IB and 330 of 337 in SB group. Comparing IB and pre and pos-PMBV data we obtained: mean pulmonary artery pressure (MPAP) 36 +/- 15 and 39 +/- 14 mmHg, p = 0.2033, mean mitral gradient 17 +/- 6 and 20 +/- 77 mmHg, p = 0.0396 and MVA 0.9 +/- 0.2 and 0.9 +/- 0.2 cm2, p = 0.8043 and pos-PMBV:MPAP 25 +/- 8 and 28 +/- 10 mmHg, p = 0.2881, gradient 5 +/- 3 and 5 +/- 4 mmHg, p = 0.2778 and MVA 2.2 +/- 0.2 and 2.0 +/- 0.4 cm2, p = 0.0362. Mitral valve (MV) was competent in 26 patients in IB and in 280 in SB group and we had +/4 mitral regurgitation in 3 patients in IB and in 57 in SB group (p = 0.3591) pre-PMBV respectively and pos-PMBV there was also no difference in MV competence (p = 0.7439). CONCLUSION: Both techniques were effective. Hemodynamic data were also similar although MVA was greater in IB group after PMBV.

[Percutaneous mitral valvuloplasty with the single balloon technique. Short-term results, complications and in-hospital follow-up]. / Valvoplastia mitral percutânea com a técnica do balão único. Resultados imediatos, complicações e evolução intra-hospitalar.

PURPOSE: To study the short-term results, complication and in-hospital follow-up of 268 percutaneous mitral balloon valvuloplasty (PMBV) procedures performed with the low-profile monofoil balloon (LPMB) technique from 1990 to 1995. METHODS: A single 30mm balloon diameter was used in 247 (92.9%) procedures, a single 25mm balloon diameter in 9 (3.3%), a single 25mm balloon followed by a single 30mm balloon diameter in 7 (2.6%) and in 5 procedures a balloon was not used. The mean age group was 36 +/- 12 years. Two hundred nineteen (81.7%) procedures were performed in women (mean age 36 +/- 12 years) and 49 (18.3%) in men (mean age, 35 +/- 14 years) (p = 0.78). Patients were in functional class II (NYHA) in 39 (14.5%), class III in 198 (73.9%) and class IV in 31 (11.6%). Patients were in sinus rhythm in 228 (85.1%) procedures and in atrial fibrillation in 40 (14.9%). The echocardiographic score ranged from 4 to 14 (mean 7.2 +/- 1.5). RESULTS: There were 256 complete procedures, 249 of which were successful (mitral valve area (MVA) > or = 1.5cm2 after PMBV). Echocardiographic calculated MVA before PMBV was 0.9 +/- 0.2cm2. Hemodynamic calculated MVA before PMBV was 0.9 +/- 0.2cm2 and after was 2.0 +/- 0.4cm2 (p < 0.000001). Mean pulmonary artery pressure decreased from 40 +/- 15mmHg to 28 +/- 10mmHg (p < 0.000001) and mitral mean gradient from 20 +/- 7mmHg to 5 +/- 4mmHg (p < 0.000001). In the 256 complete procedures mitral valve (MV) was competent in 214 and there was 1+ mitral regurgitation (MR) in 42. After PMBV, MV was competent in 166 and there was 1+ MR in 68, 2+ in 16, 3+ in 5 and 4+ MR in 1. There were complications in 14 (5.2%) procedures, severe MR in 6 (3 or 4+), stroke in 2 and cardiac tamponade in 6. Two patients died during emergency cardiac surgery after left ventricular perforation and 1 after stroke. CONCLUSION: PMBV with the LPMB was an effective procedure with a high success rate and a low rate of complications as the more usual double-balloon and Inoue balloon techniques.

[Percutaneous balloon mitral valvoplasty. Immediate results, complications and hospital outcome]. / Valvoplastia mitral percutânea por balão. Resultados imediatos, complicações e evolução hospitalar.

PURPOSE: To study the short-term results, complications and in-hospital follow-up of 223 percutaneous mitral balloon valvuloplasty (PMBV) procedures (proc)in 219 patients. METHODS: It was used a single 20mm balloon diameter in 4 proc, double balloon in 7, Inoue balloon in 4 and low profile balloon in 196. The mean-age group was 37.19 years. One hundred eighty three (82.1%) procedures were performed in women (mean age, 36.99 years) and 40 (17.9%) in men (mean age, 38.10 years) (p = 0.63). Patients were in functional class II, (NYHA) in 25 (11.2%) procedures, class III in 165 (74.0%) and class IV in 33 (14.8%). Patients were in sinus rhythm in 182 procedures (81.6%) and in atrial fibrillation in 41 (18.4%). The echocardiographic score range from 4 to 14 (7.4% +/- 1.7). Among 4 and 11 were 98.2% of patients. RESULTS: We had 203 complete proc and success, mitral valve area (MVA) > or = 1.5cm2 after PMBV in 194 proc. Echocardiographic MVA before PMBV was 0.9 +/- 0.2cm2 and after 1.8 +/- 0.3cm2 (p < 0.01). Hemodynamic measures MVA before PMBV was 0.9 +/- 0.2cm2 and after was 1.9 +/- 0.3cm2 (p < 0.01). Mean pulmonary artery pressure decreased from 39 +/- 14mmHg to 27 +/- 11mmHg (p < 0.01) and mitral mean gradient from 20 +/- 9mmHg to 6 +/- 5mmHg (p < 0.01). In the 203 proc, mitral valve (MV) was competent in 176 and there were 1+ mitral regurgitation (MR) in 27. After PMBV, MV was competent in 126, and there were 1+ MR in 60, 2+ in 10.3+ in 6 and 4+ MR in 1. There was complication in 15 proc, severe MR in 7 (3 or 4+), stroke in 3 and cardiac tamponade in 5. Two patients died during emergency cardiac surgery after left ventricular perforation and one by stroke. CONCLUSION: PMBV was an effective procedure with a high grade of success and low rate of complication.

Valvoplastia mitral percutânea por baläo, resultados imediatos e complicaçöes / Percutaneous mitral balloon valvuloplasty. Immediate results and complications

Foram estudados os resultados obtidos em 156 procedimentos de valvoplastia mitral percutânea por baläo (VMPB) realizados em 153 pacientes, no período de 6 de julho de 1987 a 31 de maio de 1993. A idade do grupo foi de 37,62 +/_ 13,76 anos. Foram 126 procedimentos (80,8 por cento) em mulheres (idade média 37,30 +/_ 13,00 anos) e 30 procedimentos (19,2 por cento) em homens (idade média de 38,93 +/_ 16,74 anos) p= 0,568181). A classe funcional (CF) de NYHA foi II em 12 procedimentos (7,7 por cento), I em 118(75,6 por cento) e IV EM 26(16,7 por cento). Em 131 procedimentos (84,0 por cento) os pacientes estavam em ritmo sinusial e em 25 (16,0 por cento) estavam em fibrilaçäo atrial. O escore ecocardiográfico variou de 4 a 14 pontos com média 7,7 +/_ 1,7 pontos, entre 4 a 9 pontos situou-se 90,4 por cento dos pacientes. Foram efetivados com dados pré e pós VMPB, 139 procedimentos e houve sucesso, área valvar mitral (AVM) 1,5 centímetros ao quadrado pós VMPB, em 131 procedimentos. Quando medida pela ccardiografia AVM pré VMPB foi de 0,9 +/_ 0,2 cm ao quadrado e após VMPB 1,8 +/_ 0,3 cm ao quadrado (p<0,000001) e quando medida por métodos hemodinâmicos foi de 0,9 +/_ 0,2 cm ao quadrado pós VMPB (p<0,000001). A pressäo pulmonar média caiu de 41 +/_ 15 mmHg 27 +/_ 11 mmHg pós VMPB (p<0,000001) e o gradiente mitral médio caiu de 22 +/_ 7 mmHg para 6 +/_ 5 mmHg (p<0,000001). Foram utilizados baläo único de 20 mm (4 procedimentos), duplo baläo (7 procedimentos), baläo de Inoue (4 procedimentos) e baläo nio de baixo perfil (131 procedimentos). Dos 139 procedimentos pré VMPB, em 121 a valva mitral (VM) era competente e em 18 havia regurgitaçäo mitral (RM) de 1+. Após a VMPB a VM era competente em 91 e havia RM de 1+ em 39, de 3+ em 4 e de 4+ em 1. Houve complicaçäo em 10 procedimentos, sendo insuficiência mitral grave IM em 5 (3 ou 4+), acidente vascular cerebral (AVC) em 3 e tamponamento cardíaco em 2. Dos 10,2 evoluíram para óbito, um após tamponamento cardíaco por perfuraçäo de ventrículo esquerdo e utr por descerebraçäo após AVC. Conclui-se que a VMPB foi um procedimento efetivo, com alto grau de suceso nos procedimentos efetivados e com baixo percentual de complicaçöes.

[Clinical and hemodynamic aspects of non-obstructive coronary lesions. A comparative retrospective study]. / Aspectos clínicos e hemodinâmicos das lesões coronárias não-obstrutivas. Estudo retrospectivo comparativo.

PURPOSE: To study the clinical and hemodynamic aspects of a group of patient presenting non-obstructive coronary lesions. METHODS: We reviewed 963 coronary angiographies performed at a same institution. The 52 patients presenting only stenosis < or = 50% after semi-quantitative measurement composed group I, which was compared with two other groups consisted of 52 patients each: one, with patients presenting univascular lesion > 50% (group II) and the other with normal coronary arteriographies (group III). RESULTS: Mean age was similar in groups I and II (49.4 +/- 6.89 and 51.3 +/- 7.86, p > 0.05) and significantly higher than that of group III (44.8 +/- 6.81, p < 0.05). Risk factors did not discriminate group I (GI) from groups II (GII) and III (GIII). During a follow-up period of 63 months, the number of hospital admissions due to cardiac events and repetitions of coronary arteriography were similar in GI and GII, being significantly less frequent in GIII (p < 0.00001 and 0.001; p < 0.01 and 0.05, respectively). By the end of the follow-up period, though angina and heart failure functional classes had been similar in the three groups, patients in groups I and II were using more medications than those in group III (p < 0.0001 and 0.00001). Mean ejection fractions (%) were lower in GI and GII (67.04 +/- 10.13 and 68.90 +/- 11.32) than in GIII (74.69 +/- 6.40, p < 0.01). Lesions were predominantly proximal in GI when compared with GII (p < 0.05). Length, simmetry, ulceration, thrombus and proximal shoulder showed no difference between GI and GII. CONCLUSION: Patients with non-obstructive coronary lesions were similar to those with univascular lesion > 50% regarding several aspects and were considerably different from those with normal coronary arteries.

As cardiopatias no pessoal da ativa da policia militar do esta do Rio de Janeiro, sua influência na capacidade laborativa e reforma do policial militar / Cardiopathies on active service personal of the military police of the state of Rio de Janeiro. Their influence on working capacity and retirement of the military policeman

Estudou-se o problema de doença, capacidade laborativa e reforma na Polícia Militar do Estado do Rio de Janeiro (PMERJ) e a aceitaçäo pela corporaçäo de que o policial militar com algum graude doença mas com parte de sua capacidade laborativa preservada continuasse em atividade e ascendesse funcionalmente. Devido ao percentual de acometimento da populaçäo adulta pelas cardiopatias e comprovaçäo anteiror de serem responsáveis por mais da metade das reformas na PMERJ no ano de 1990, optou-se pelo esto das cardiopatias mais frequentes: hipertensäo arterial e coronariopatia. levantaram na Junta de Saúde as reformas e passagens para a reserva remunerada do ano de 1991 (1008 policiais militares) e as licenças para tratamento de saúde ou incapacidade fisica parcial do mês de novembro de 1991 (1664 policiais militares). Através de pesquisa de opiniäo foram ouvidos 168 oficiais policiais militares sobre a utilizaçäo na PMERJ de policiais militares com doença mas com capacidade laborativa preservada em pare Constatou-se ser a hipertensäo arterial responsável por grande parte das reformas (65,26 por cento) e a doneças isquêmica por apenas 1,32 por cento. Na incapacidade física parcial a hipertensäo arterial contribuiu com 19,09 por cento e a doneça isquêmica com 0,99 por cento. Já na licença para tratamento de saúde a hipertensäo arterial contribuiu com 2,50 por cento e a doença isquêmica com 1,32 por cento. A idade média dos policiais militares reformados com hipertensäo arterial foi superior a dos que pssra a reserva remunerada (50,6 +/- 3,1 49, 6 +/- 4,2 anos, respectivamente, com p=0,0001). O tempo de serviço foi similar, näo havendo encurtamento da vida funcional do policial militar portador de hipertensäo arterial. Os oficiais consultados opinaram de forma semelhante, fossem do quadro de oficiais combatentes ou de saúde. Colocaram-se pelo aproveitamento do policial militar com alguma doença mas com parte da capacidade laborativa preservada e pela sua ascensäo funcional através cursose, ainda, pelacriçäo de um programa de reabilitaçäo médica. Concluimos que apesar do percentual elevado de hipertensäo na PMERJ entre o pessoal da ativa, näo houve diminuiçäo do seu tempo funcional e a hipertensäo arterial apenas contribuiu com um percentual elevado de incapacidade física parcial. A doença isquêmica foi encontrada em percentual baixo na populaçäo estudada.

[Percutaneous transluminal renal angioplasty in the treatment of renovascular hypertension]. / Angioplastia renal transluminal percutânea no tratamento da hipertensão renovascular.

PURPOSE: To analyze the effect of percutaneous transluminal renal angioplasty (PTRA) in renovascular hypertension. METHODS: Twenty-three patients with renal artery stenosis and arterial hypertension underwent PTRA. There were 11 male and 12 female, 19 to 78 years old (45.8 +/- 17.41). In 20 lesions the diagnosis was atherosclerosis, in 7 fibromuscular dysplasia and in 1 Takayasu arteritis. Three patients underwent bilateral dilatation and 2 patients repeated the procedure due to restenosis. Two patients presented with acute renal failure and severe bilateral renal artery stenosis. RESULTS: There were 21 technical success in 25 procedures. After 20 satisfactory dilatations, clinical success followed in 17 (100% of cases of fibromuscular dysplasia cases and 77% of atherosclerosis. The fall in diastolic arterial pressure after PTRA was statistical significant (p < 0.001). In two cases acute renal failure the renal function became normal after angioplasty. There were 2 complications and no death attributed to PTRA. CONCLUSION: The method was effective and safe in the management of renovascular hypertension during the short-term follow-up. It was possible in two cases of acute renal failure to normalize renal function.

[Angioplasty of distal aorta and iliac, femoral, popliteal, renal and subclavian arteries. Early and late results]. / Angioplastia de aorta distal e artérias ilíaca, femoral, poplítea, renal e subclávia. Resultados imediatos e tardios.

PURPOSE: To study the late results of peripheral angioplasty. PATIENTS AND METHODS: In the period of 8 years from August, 1981 until August, 1989, 27 patients were submitted to 33 procedures of peripheral angioplasty. RESULTS: There was success in 29 procedures, an insufficient dilatation in 1 and and failure in 3 (2 new attempts were effective). Success rate was 88% of the procedures; clinical and angiographic success was reached in 25 (93%) of the 27 patients. Thirty four obstructions were successful dilated: 12 in renal artery, 12 in common iliac artery, 4 in external iliac artery, 3 in superficial femoral artery, 1 in distal aorta. In the evolution we had a restenosis of a renal artery that was redilated, a precocious occlusion of a common iliac artery (9% of common iliac artery dilatations and 6% of the total of the iliac dilatations) and a popliteal occlusion. Of the 34 dilatations we had a patency of 91% until 2 months. CONCLUSION: Angioplasty showed to be an effective method with good results in the long term follow-up.