Litiasis masiva de la vía biliar intra y extra hepática. Reporte de 2 casos / Massive intra- and extra-hepatic bile duct lithiasis. Report of 2 cases

Resumen La presencia conjunta y masiva de cálculos biliares de la vía biliar, tanto intra como extra hepática, es una rara entidad dentro de la población occidental. A continuación, se presentan 2 casos, los cuales debutan con cuadro clínico de dolor en hipocondrio derecho y con datos clínicos y de laboratorio de obstrucción de la vía biliar, y que mediante estudio de colangio resonancia, se evidencian múltiples litos endoluminales de la vía biliar de manera global, además se muestra del tratamiento de uno de los casos mediante CPRE con evacuación exitosa de los cálculos biliares.

Abstract The joint and massive presence of gallstones from the bile duct, both intra and extra hepatic, is a rare entity within the western population. Two cases are presented below, which debuted with a clinical picture of pain in the right hypo chondrium and with a clinical picture of pain in the right hypochondrium and with clinical and laboratory data of bile duct obstruction, and that by means of a resonance cholangiography study, multiple endoluminal stones of the bile duct are evidenced. Overall, it also shows the treatment of one of the cases by ERCP with successful evacuation of the gallstones.

Colecistectomía Laparoscópica difícil: tratamiento quirúrgico / The surgical management of difficult LaparoscopicCholecystectomy

Objetivo: Caracterizar el tratamiento laparoscópico de pacientes con colecistitis difícil en el Servicio de Cirugía I del Hospital Universitario de Caracas durante el quinquenio2017-2021. Métodos: Estudio retrospectivo, observacional, descriptivo y de corte transversal. Muestra de tipo no probabilístico por conveniencia, seleccionada de la base de datos del Departamento de Historias Médicas del Hospital Universitario de Caracas. El análisis estadístico se realizó con el programa SPSS en su versión 26. Resultados: se recolectaron61 Historias Clínicas con características de colecistectomías laparoscópicas difíciles, el grupo etario más numeroso con67,19%, fue entre 30-59 años; sexo predominante: el femenino con 85,2%; el 42,62% de los pacientes presentaron a su ingreso: litiasis vesicular simple, el cólico vesicular persistente fue la complicación más frecuente con 31,23%. El 65,57% se ubicó en Grado I según Nassar como hallazgo intraoperatorio más frecuente, y según Parkland el 75,40% en grado I, sin individuos afectados con Grado V. Todos los casos fueron tratados quirúrgicamente (colecistectomía laparoscópica total).Conclusión: el total de los pacientes sometidos a tratamiento quirúrgico con hallazgos de colecistectomía laparoscópica difícil, se completó mediante colecistectomía laparoscópica total(AU)

Objective: To characterize the surgical treatment of difficult cholecystectomy in the Chair of Clinical and Surgical therapeutics "A" / Surgery Service I of the University Hospital of Caracas during the five-year period 2017 -2021.Methods: A retrospective, observational, descriptive and cross-sectional study will be carried out. The sample will be of anon-probabilistic type for convenience, selecting from the listof patients in the database of the Department of Medical Records of the Hospital Universitario de Caracas. The statistical analyzes will be carried out with the SPSS program in its version 26. Results: 61 difficult laparoscopic cholecystectomies were observed, the most frequent age group with 67.19%, was between 30-59 years, the female sex with 85.2% was the predominantone. 42.62% of the admission diagnoses were simple gallstones, followed by persistent gallbladder colic as the most frequent complication with 31.23%. 65.57% represent Grade I accordingto Nassar as the most frequent intraoperative finding and according to Parkland 75.40% represented by grade I, leaving Grade V without affected individuals. 100% of the sample were surgically treated by total laparoscopic cholecystectomy. Conclusion: the total number of patients undergoing surgical treatment with difficult laparoscopic cholecystectomy findingswas completed by total laparoscopic cholecystectomy(AU)

Tratamiento mínimamente invasivo del catéter doble J calcificado

Introducción: La calcificación del catéter doble J puede encontrarse en el 13 % de los colocados y aumenta proporcionalmente al tiempo que permanezca en contacto con la orina. Los investigadores coinciden en que el catéter doble J calcificado es una complicación compleja de resolver. Se realizó una revisión bibliográfica, de 2011 a 2021. Se utilizaron las bases de datos SciELO, EBSCO, Elsevier y PubMed, con los descriptores: litiasis, catéteres, procedimientos quirúrgicos mínimamente invasivos y complicaciones intraoperatorias y posoperatorias. Objetivo: Describir el papel de la cirugía mínimamente invasiva para el tratamiento del catéter doble J calcificado. Desarrollo: Los factores de riesgo relacionados a catéter doble J calcificados son clínico-terapéuticos y sociodemográficos, como la infección urinaria, antecedentes de litiasis, embarazo, enfermedad renal crónica, anomalías metabólicas o congénitas. Los de poliuretano presentan mayores tasas de calcificación. La litotricia extracorpórea por ondas de choque puede emplearse hasta en 70,7 % de los pacientes. Métodos multimodales como ureteroscopía, previa cistolitotricia transuretral, se han aplicado entre 6 % y 17,9 %, la nefrolitotomía percutánea y ureteroscopía, previa cistolitotricia o no, en el 7,7 % al 20 %. Las complicaciones más frecuentes se informan durante el posoperatorio (20 %): fiebre, dolor, vómitos, hematuria, pielonefritis, sepsis, urinoma, migración espontánea del nuevo catéter colocado y daño renal agudo, entre otras. Conclusiones: La cirugía mínimamente invasiva en la actualidad es el pilar fundamental, del tratamiento de los pacientes con catéter doble J calcificado.

Introduction: The calcification of the double J catheter can be found in 13% of those placed and increases proportionally to the time it remains in contact with urine. The researchers agree that the calcified double J catheter is a complex complication to resolve. A bibliographic review was carried out, from 2011 to 2021. The resources of the SciELO, EBSCO, Elsevier and PubMed databases were used in relation to the descriptors lithiasis, catheters, minimally invasive surgical procedures and intraoperative and postoperative complications. Objective: To describe the role of minimally invasive surgery for the treatment of calcified double J catheter. Development: The risk factors related to calcified double J are clinical-therapeutic and sociodemographic, such as urinary tract infection, history of lithiasis, pregnancy, chronic kidney disease, metabolic or congenital anomalies. Those made of polyurethane have higher rates of calcification. Extracorporeal shock wave lithotripsy can be used in up to 70.7% of patients. Multimodal methods such as ureteroscopy prior to transurethral cystolithotripsy have been applied between 6-17.9%, percutaneous nephrolithotomy and ureteroscopy prior cystolithotripsy or not in 7.7%-20%. The most frequent complications are reported during the postoperative period (20%): fever, pain, vomiting, hematuria, pyelonephritis, sepsis, urinoma, spontaneous migration of the newly placed catheter, and acute kidney injury, among others. Conclusions: Minimally invasive surgery is currently the cornerstone of treatment for patients with calcified double-J catheters.

Prise en charge des lithiases submandibulaires bilatérales au service de stomatologie et chirurgie maxillo-faciale du CHU de Treichville à propos d'un cas management / Bilateral submandibular lithiasis in the department of stomatology and maxillofacial surgery at Treichville University Hospital: A Case Report

Introduction : La lithiase est la plus courante des affections salivaires chez l'adulte. Elle touche principalement la glande submandibulaire. L'atteinte isolée d'une glande est habituelle. Cependant, la lithiase simultanée des deux glandes submandibulaires est moins fréquente. L'objectif était de décrire à partir de l'observation d'un cas, les caractéristiques physiopathologiques, diagnostiques et thérapeutiques de la lithiase submandibulaire bilatérale. Observation : Une patiente de 53 ans, commerçante a consulté en Mars 2022 au Service de Stomatologie et Chirurgie Maxillo-faciale du CHU de Treichville pour une tuméfaction submandibulaire bilatérale. Cette tuméfaction évoluait depuis un an et augmentait de volume au cours des repas. Les antécédents familiaux ont mis en évidence une lithiase submandibulaire bilatérale chez une tante. L'examen clinique a retrouvé une tumeur submandibulaire droite et gauche. L'échographie submandibulaire était en faveur d'une lithiase submandibulaire bilatérale. Une submandibulectomie bilatérale a été réalisée. Aucune complication post opératoire n'a été observée et la patiente est sortie de l'hôpital après deux jours d'hospitalisation. Discussion : Les antécédents familiaux de sialolithiase suggèrent la recherche d'une origine génétique ou familiale de la lithiase bilatérale des glandes submandibulaires, s'il n'existe pas une étiologie évidente ou probable. Conclusion : La lithiase submandibulaire bilatérale est un fait clinique rare mais qu'il faut savoir rechercher même en cas de lithiase submandibulaire isolée.

Introduction: Lithiasis is the most common salivary disease in adults. It mainly affects the submandibular gland. Isolated involvement of one gland is common. However, simultaneous lithiasis of both submandibular glands is less frequent. The objective was to describe, from the observation of a case, the physio-pathological, diagnostic, and therapeutic characteristics of bilateral submandibular lithiasis. Observation: A shopkeeper of 53 years old, consulted a doctor for bilateral submandibular swelling in March 2022 at the Stomatology and Maxillofacial Surgery at Treichville University Hospital. That swelling has been developing for a year. The family history revealed bilateral submandibular lithiasis in an aunt. Clinical examination showed a right and left submandibular tumor that gained volume during meals. The submandibular ultrasound showed bilateral submandibular lithiasis. A bilateral sub-mandibulectomy was performed. No postoperative complications were observed, and the patient was discharged after a two-day hospital stay. Discussion: In the absence of an obvious or probable etiology, a family history of sialolithiasis suggests a genetic or familial origin for bilateral submandibular gland lithiasis. Conclusion: Bilateral submandibular lithiasis is a rare clinical finding but should be investigated even in cases of isolated submandibular lithiasis

Litiasis vesicular: prevalencia y evolución post operatoria en una población pediátrica hospitalaria

Introducción: La litiasis vesicular en la infancia no es frecuente, pero ha ido en aumento, por causas diversas, como un mayor índice de sospecha por parte del médico, la identificación de factores de riesgo, mayor supervivencia de niños con enfermedades que predisponen a la litiasis biliar entre otros. Objetivo: Describir la prevalencia, características clínicas y evolución post operatoria de lalitiasis vesicular en los pacientes de 0 a 18 años en un hospital pediátrico. Materiales y Métodos: Estudio descriptivo retrospectivo de corte transversal. Pacientes con edad de 0 a 18 años de edad con diagnóstico de litiasis vesicular, que acudieron al Hospital Pediátrico Niños de Acosta Ñu, en el periodo 2015-2020 fueron incluidos. Variables estudiadas edad, sexo, procedencia, factores de riesgo, tiempo de evolución, IMC, tiempo de internación, síntomas, método de diagnóstico, tratamiento, complicaciones. Los datos se analizaron en SPSS utilizando estadística descriptiva. El protocolo fue aprobado por el comité de ética. Resultados: Ingresaron 81 pacientes, con edad de 12.4± 4 años. El 61.7% era de sexo femenino. El 52% de las mujeres presentaron factores de riesgo, así como el 70.9% de varones (p=0.14). Presentó dolor abdominal el 87.6%. La ecografía abdominal fue el método de diagnóstico. El tratamiento más frecuente fue quirúrgico, por cirugía vía laparoscópica en el 95.1%. El período de internación de los pacientes fue de 4 ± 13 días y posterior a la cirugía fue de 1 ± 1.3 días. Conclusión: La prevalencia de litiasis vesicular en la población pediátrica fue de 0.6%, con predominio del sexo femenino. La mayoría de los pacientes tenían algún factor de riesgo, siendo predominante la obesidad. El diagnóstico fue realizado mediante la ecografía abdominal. El tratamiento más frecuente fue el quirúrgico, vía laparoscópica, con buenos resultados obtenidos.

Introduction: Gallbladder lithiasis in childhood is not frequent, but the diagnosis frequency has been increasing, some of the reasons for this include a higher index of suspicion on the physician's part, identification of risk factors for the condition, higher survival rates of children with diseases that predispose to gallstones. Objective: To describe the prevalence, clinical characteristics and postoperative course of gallbladder lithiasis in patients from 0 to 18 years of age in a pediatric hospital. Materials and Methods: This was a retrospective, cross-sectional, descriptive study. Patients aged 0 to 18 years with a diagnosis of gallbladder lithiasis, who presented to the Acosta Ñu Children's Hospital, during 2015-2020 were included. Variables studied: age, sex, place of residence, risk factors, evolution time, BMI, hospitalization stay, symptoms, diagnostic method, treatment and complications. Data were analyzed in SPSS using descriptive statistics. The protocol was approved by the hospital ethics committee. Results: 81 patients were included, with an average age of 12.4 ± 4 years. 61.7% were female. 52% of females had risk factors, as well as 70.9% of males (p=0.14). 87.6% presented abdominal pain. Abdominal ultrasound was the most frequent diagnostic method used. The most frequent treatment was laparoscopic surgery, in 95.1%. The average hospitalization duration of the patients was 4 ± 13 days and the average postoperative period was 1 ± 1.3 days. Conclusions: The prevalence of gallbladder lithiasis in the pediatric population was 0.6%, with a predominance of females. Most of the patients had some risk factor, obesity being the most predominant. The diagnosis was made by abdominal ultrasound. The most frequent treatment was laparoscopic surgery, with good results obtained.

Composición de las urolitiasis y trastornos metabólicos renales en adultos cubanos

Introducción: La litiasis urinaria es una enfermedad común, cuya prevalencia se incrementa a escala nacional y planetaria. Objetivos: Conocer la composición de las urolitiasis en pacientes adultos cubanos y su relación con los trastornos metabólicos renales. Métodos: Estudio descriptivo, transversal. Universo constituido por los pacientes cubanos de 19 años y más de edad, que se realizaron estudio de composición de urolitiasis en el Instituto de Nefrología "Dr. Abelardo Buch", de La Habana, Cuba, en el período comprendido de 2011-2020. De ellos 443 se habían realizado estudio metabólico renal. Los datos fueron recogidos de los informes de resultados, de composición de litiasis y de estudio metabólico. Se utilizó análisis de distribución de frecuencias, y para identificar las relaciones, el test independencia. Resultados: En cuanto a la composición química, predominaron las litiasis de oxalato de calcio. Los trastornos metabólicos más frecuentes fueron excreción de sodio aumentada (46,7 %) y volumen urinario bajo (29,3 %). La frecuencia de pacientes con litiasis cálcicas, fue superior en los que tuvieron excreción de sodio aumentada (78,3 %), y en los que presentaron hipercalciuria (83,3 %), en contraste con las frecuencias de este tipo de litiasis, en los que no presentaron dichos trastornos (p=0,03 en ambos casos). Conclusiones: Las urolitiasis más comunes en adultos cubanos son las cálcicas, especialmente las de oxalato de calcio. Los trastornos metabólicos más frecuentes son: excreción urinaria aumentada de sodio, volumen urinario bajo y pH urinario ácido. La presencia de litiasis cálcicas se relaciona con excreción urinaria aumentada de sodio y con hipercalciuria.

Introduction: Urinary lithiasis is a common disease, whose prevalence is increasing on a national and planetary scale. Objectives: To know the composition of urolithiasis in Cuban adult patients and its relationship with renal metabolic disorders. Methods: Descriptive, cross-sectional study. Universe constituted by Cuban patients aged 19 and over, who underwent a composition study of urolithiasis at the "Dr. Abelardo Buch" Institute of Nephrology, in Havana, Cuba, in the period 2011-2020. In 443 of them, a renal metabolic study had also been carried out. The data were collected from the results reports of stone composition and metabolic study. Frequency distribution analysis was used, and the independence test was used to identify relationships. Results: Regarding chemical composition, calcium oxalate stones predominated. The most frequent metabolic disorders were increased sodium excretion (46.7%) and low urine volume (29.3%). The frequency of patients with calcium stones was higher in those with increased sodium excretion (78.3%) and in those with hypercalciuria (83.3%), in contrast with the frequencies of this type of lithiasis, in those who did not present these disorders (p=0.03 in both cases). Conclusions: The most common urolithiasis in Cuban adults are calcium ones, especially those of calcium oxalate. The most common metabolic disorders are: increased urinary sodium excretion, low urinary volume and acid urinary pH. The presence of calcium lithiasis is related to increased urinary sodium excretion and hypercalciuria.

Diagnosis and treatment of the short-arm type posterior semicircular canal BPPV / Diagnóstico e tratamento da VPPB de braço curto do canal semicircular posterior

Abstract Introduction The Epley maneuver is useful for the otoconia to return from the long arm of the posterior semicircular canal into the utricle. To move otoconia out of the posterior semicircular canal short arm and into the utricle, we need different maneuvers. Objective To diagnose the short-arm type BPPV of the posterior semicircular canal and treat them with bow-and-yaw maneuver. Methods 171 cases were diagnosed as BPPV of the posterior semicircular canal based on a positive Dix-Hallpike maneuver. We first attempted to treat patients with the bow-and-yaw maneuver and then performed the Dix-Hallpike maneuver again. If the repeated Dix-Hallpike maneuver gave negative results, we diagnosed the patient with the short-arm type of BPPV of the posterior semicircular canal and considered the patient to have been cured by the bow-and-yaw maneuver; otherwise, probably the long-arm type BPPV of the posterior semicircular canal existed and we treated the patient with the Epley maneuver. Results Approximately 40% of the cases were cured by the bow-and-yaw maneuver, giving negative results on repeated Dix-Hallpike maneuvers, and were diagnosed with short-arm lithiasis. Conclusion The short-arm type posterior semicircular canal BPPV can be diagnosed and treated in a convenient and comfortable manner.

Resumo Introdução A manobra de Epley é útil para o retorno da otocônia do braço longo do canal semicircular posterior para o utrículo. Diferentes manobras são necessárias para mover a otocônia para fora do braço curto do canal semicircular posterior e para dentro do utrículo. Objetivo Diagnosticar a VPPB do tipo braço curto do canal semicircular posterior e tratá-la com a manobra de incline and balance. Método Foram diagnosticados 171 casos como VPPB de canal semicircular posterior com base na manobra de Dix-Hallpike positiva. Primeiro tentamos tratar os pacientes com a manobra de incline and balance e, em seguida, executamos a manobra de Dix-Hallpike novamente. Se a repetição da manobra de Dix-Hallpike desse resultados negativos, diagnosticávamos o paciente como VPPB do canal semicircular posterior do tipo braço curto e considerávamos que ele ou ela havia sido curado pela manobra de incline and balance; caso contrário, provavelmente o paciente apresentava VPPB do canal semicircular posterior do tipo braço longo e tratávamos o paciente com a manobra de Epley. Resultados Aproximadamente 40% dos casos foram curados pela manobra de incline and balance, com resultados negativos nas manobras de Dix-Hallpike repetidas, e foram diagnosticados com litíase de braço curto. Conclusão A VPPB de canal semicircular posterior do tipo braço curto pode ser diagnosticada e tratada de maneira conveniente e confortável.

Primer reporte nacional de técnica de puestow modificada para el tratamiento de la pancreatitis aguda recidivante en pediatría / First national report of modified puestow technique for the treatment of recurrent acute pancreatitis in pediatrics / Primeiro relatório nacional de técnica puestow modificada para o tratamento de pancreatite aguda recorrente em pediatria

Se comunica el primer reporte nacional del tratamiento de pancreatitis aguda recidivante mediante derivación Wirsung-yeyunal en pediatría. Se trata de un paciente con múltiples ingresos hospitalarios por episodios de pancreatitis, con complicaciones evolutivas de pseudoquistes pancreáticos, estenosis y litiasis del conducto de Wirsung. Se realiza derivación Wirsung-yeyunal por vía convencional con buena evolución posterior.

The first national report of the treatment of recurrent acute pancreatitis by means of Wirsung-jejunal diversion in pediatrics is communicated. This is a patient with multiple hospital admissions for episodes of pancreatitis, with evolutionary complications of pancreatic pseudocysts, stenosis, and Wirsung duct lithiasis. Wirsung-jejunal bypass was performed by conventional route with good subsequent evolution.

O primeiro relato nacional do tratamento de pancreatite aguda recorrente por derivação Wirsung-jejunal em pediatria é relatado. Trata-se de um paciente com múltiplas internações hospitalares por episódios de pancreatite, com complicações progressivas de pseudocistos pancreáticos, estenose e cálculos do ducto de Wirsung. A derivação Wirsung-jejunal foi realizada por via convencional com boa evolução posterior.

Multiple Biliary Stones: a Rare Long-term Complication after Whipple Procedure / Múltiplos cálculos biliares: uma complicação rara a longo prazo após o procedimento de Whipple

A hypertensive, diabetic woman underwent a successful Whipple procedure at the age of 84 due to carcinoma of the ampulla of Vater. She presented an extremely rare complication 24 months after the surgery, consisting of acute cholangitis due to multiple biliary lithiases associated with a bilioenteric anastomotic stricture. The diagnosis was confirmed with computed tomography, magnetic resonance cholangiopancreatography, and cholangiography. The patient was successfully treated with multiple percutaneous transhepatic cholangioplasties (AU)

Uma mulher hipertensa e diabética foi submetida a um procedimento bem-sucedido de Whipple aos 84 anos devido a um carcinoma da ampola de Vater e apresentou uma complicação extremamente rara 24 meses após da cirurgia, consistindo em colangite aguda devido à presença de litíase biliar múltipla associada com estenose da anastomose bilio-entérica. O diagnóstico foi confirmado com tomografia computadorizada, colangiopancreatografia por ressonância mag-nética e colangiografia.O paciente foi tratado com sucesso com múltiplas colangioplastias transhepáticas percutâneas (AU)

Extraction and quantification of oxalic acid in leaves of plant species used in the treatment of chronic non-communicable diseases / Extracción y cuantificación de ácido oxálico en hojas de especies vegetales utilizadas en el tratamiento de enfermedades crónicas no transmisibles / Extração e quantificação de ácido oxálico em folhas de espécies vegetais utilizadas no tratamento de doenças crônicas nã transmissíveis

RESUMEN Introducción: Las enfermedades crónicas no transmisibles (ECNT) tienen las tasas de mortalidad y morbilidad más altas del mundo. El uso de plantas medicinales en la terapia de estas enfermedades es una realidad muy extendida. Sin embargo, la mayoría de las especies vegetales contienen cristales de oxalato cálcico, producto del metabolismo vegetal y su ingesta se correlaciona con la aparición de problemas renales como la litiasis urinaria, especialmente en personas predispuestas a estas afecciones. Objetivo: Determinar la cantidad de ácido oxálico en especies vegetales que se utilizan en el tratamiento de las ECNT. Metodología: Se obtuvieron extractos acuosos y ácidos de 0,5 g del fármaco vegetal de la especie y, posteriormente, se tituló con una solución estandarizada de permanganato de potasio 0,02 mol.L-1con las concentraciones de ácido oxálico expresadas en g/100g de fármaco vegetal seco. Resultados: La concentración de ácido oxálico osciló entre 4,58 ± 0,09 g/100 g a 17,21 ± 0,07 g/100 g en especies de plantas y la extracción de ácido fue más eficiente. Se realizó una optimización metodológica para las especies que presentaron los mejores resultados, Psidiumguajava y Artocarpus heterophyllus. Conclusión: Los datos obtenidos pueden servir de base para decisiones médicas y para profesionales que prescriben plantas medicinales.

SUMMARY Introduction: Chronic non-communicable diseases (CNCDs) are a group of diseases characterized by having the highest mortality and morbidity rates in the world. Despite the increase in new drug technologies, the use of medicinal plants as an aid in therapy for these diseases is a widespread reality. However, most plant species contain inorganic crystals of calcium oxalate, a product of plant metabolism, which has several functions in plant tissues. For the human species, its ingestion is associated with the arising of kidney problems such as urinary lithiasis, especially in people who have a predisposition to these conditions. Aim: To determine the amount of oxalic acid in plant species, which are used in the treatment of CNCDs. Methodology: After collection and characterization the plant species, aqueous and acidic extracts were obtained from 0.5 g of the plant drug of each species and, subsequently, were titrated with a standardized 0.02 mol.L-1 potassium permanganate solution and the concentrations of oxalic acid were expressed in g/100 g of dry vegetable drug. Result: The data obtained from the concentration of oxalic acid ranged from 4.58 ± 0.09 g/100 g to 17.21 ± 0.07 g/100 g and demonstrated that the concentrations from acid extraction are higher compared to the aqueous extraction, for all vegetables species analyzed. Methodological optimization was performed for the species that showed the highest results, Psidium guajava and Artocarpus hetero phyllus. Conclusion: The data obtained can serve as input for medical decisions and for professionals who prescribe medicinal plants.

RESUMO Introdução: As doenças crônicas não transmissíveis (DCNT) são um grupo de doenças caracterizadas por apresentar as maiores taxas de mortalidade e morbidade do mundo. Apesar do aumento de novas tecnologias medicamentosas, o uso de plantas medicinais como auxiliar na terapia dessas doenças é uma realidade bastante difundida. No entanto, a maioria das espécies vegetais contém cristais inorgânicos de oxalato de cálcio, um produto do metabolismo vegetal, que possui diversas funções nos tecidos vegetais. Para a espécie humana, sua ingestão está associada ao surgimento de problemas renais como a litíase urinária, principalmente em pessoas com predisposição a essas condições. Objetivo: Determinar a quantidade de ácido oxálico em espécies vegetais, que são utilizadas no tratamento de DCNT. Metodologia: Após a coleta e caracterização das espécies vegetais, extratos aquosos e ácidos foram obtidos a partir de 0,5 g da droga vegetal de cada espécie e, posteriormente, titulados com solução padronizada de permanganato de potássio 0,02 mol.L-1 e as concentrações de ácido oxálico foram expressos em g/100 g de fármaco vegetal seco. Resultado: Os dados obtidos da concentração de ácido oxálico variaram de 4,58 ± 0,09 g/100 g a 17,21 ± 0,07 g/100 g e demonstraram que as concentrações da extração ácida são maiores em relação à extração aquosa, para todas as espécies vegetais analisadas. A otimização metodológica foi realizada para as espécies que apresentaram os maiores resultados, Psidiumguajava e Artocarpus heterophyllus. Conclusão: Os dados obtidos podem servir de subsídio para decisões médicas e para profissionais que prescrevem plantas medicinais.

Calcified intrarenal aneurysm simulating urinary lithiasis

ABSTRACT We describe the case of a female patient with calcification in renal topography, initially diagnosed as lithiasis in the left kidney, and later attributed to calcification of intrarenal vascular aneurysm. Next, we discuss the relevance of considering such an entity in the differential diagnoses of intrarenal calcifications before choosing any form of specific interventional treatment.

Comparing public interest on stone disease between developed and underdeveloped nations: are search patterns on google trends similar?

ABSTRACT Objective: The big data provided by Google Trends may reveal patterns in health information-seeking behavior on population from Brazil and United States (US). Our objective was to explore and compare patterns of stone disease online information-seeking behaviors in both nations. Materials and Methods: To compare Relative Search Volume (RSV) among different urologic key words we chose "US" and "Brazil" as country and "01/01/2009 - 31/12/2018" as time-range. The final selection included 12 key words in each language. We defined "ureteroscopy" as a reference and compared RSV against it for each term. RSV was adjusted by the reference and normalized in a scale from 0-100. Trend presence was evaluated by Mann Kendall Test and magnitude by Sen's Slope (SS) Estimator. Results: We found an upward trend (p <0.01) in most of the researched terms in both countries. Higher temporal trends were seen for "Kidney Stone" (SS=0.36), "Kidney Pain" (SS=0.39) and "Tamsulosin" (SS=0.21) in the US. Technical treatment terms had little search volumes and no increasing trend. "Kidney Stent" and "Double J" had a significant increase in search trend over time and had a relevant search volume overall in 2018. In Brazil, "Calculo Renal", "Colica Renal", "Dor no Rim" and "Pedra no Rim" had a significant increase in RSV (p <0.001). More common and popular terms as "Kidney Stent" and "Tamsulosin" were highly correlated with "Kidney Pain" and "Kidney Stone" in both countries. Conclusions: In the last decade, there was a significant increase in online search for medical information related to stone-disease. Population from both countries tend to look more for generic terms related to symptoms, the disease, medical management and kidney stent, than for technical treatment vocabulary.

Guía de Práctica Clínica de litiasis vesicular en niños y adolescentes / Clinical Practice Guidelines of Vesicular Lithiasis in Children and Adolescents

La litiasis vesicular en la infancia y adolescencia ha acusado un notable incremento en los últimos años. En países europeos, como Inglaterra, las colecistectomías se han triplicado desde 1997 y en el 2012 en el Hospital Infantil de Santiago de Cuba representó el 96,4 por ciento de todas las operaciones mayores electivas. En el IV Simposio Nacional de Cirugía Pediátrica (Varadero, Matanzas, 1- 3 de julio de 2019) fue presentada, discutida y aprobada esta "Guía de Práctica Clínica de litiasis vesicular en niños y adolescentes" y se recomendó, al concluir dicho evento, compartir dicha guía a través de su publicación, para que los servicios de cirugía pediátrica la empleen como referencia y la apliquen en las instituciones del sistema cubano de salud encargadas de la atención sanitaria de niños y adolescentes(AU)

Vesicular lithiasis in childhood and adolescence has had a marked increase in recent years. In European countries such as England, cholecystectomies have tripled since 1997 and in 2012 at the Children's Hospital in Santiago de Cuba accounted for 96.4 percent of all major elective operations. At the IV National Symposium on Pediatric Surgery (Varadero, Matanzas, July 1-3, 2019) this " Clinical Practice Guidelines of Vesicular Lithiasis in Children and Adolescents" was presented, discussed and approved, and it was recommended, at the conclusion of that event, to share this guidelines through its publication, for pediatric surgery services to use it as a reference and to be applied in the institutions of the Cuban health system which are responsible for the health care of children and adolescents(AU)

Use of ammonium chloride to prevent urolithiasis in sheep / [Utilização do cloreto de amônio na prevenção de urolitíase em ovinos]

Urolithiasis has a high incidence among confined sheep. It is multifactorial and may cause economic damage. Our aim was to determine the capacity of urinary acidification using ammonium chloride in sheep. Twenty-five 3-month-old male sheep were confined and randomly divided into three groups; the G200 and G500 groups received 200mg/kg/GW and 500mg/kg/GW of ammonium chloride daily for 56 consecutive days, respectively, whereas the CG group did not receive ammonium chloride. Sampling times and clinical evaluation were performed weekly, starting from the 14th day of confinement (M1 or immediately before administering ammonium chloride) until the 17th day (M9) of the feedlot. Hemogasometry, biochemical examination of serum urea and creatinine concentration and ultrasound evaluation of the urinary tract were performed. The urinalysis indicated a higher incidence of ammonium magnesium phosphate crystals at the beginning of the study, showing a migration to urate crystal formation, mainly in the G500 group because of urinary acidification. No hemogasometric, serum biochemistry, ruminal fluid, or ultrasonographic changes were observed. Urinary acidification was achieved and maintained after M7 during the administration of ammonium chloride in the G500 group, but not in the other study groups.(AU)

A urolitíase apresenta alta incidência em ovinos confinados, etiologia multifatorial, e pode causar prejuízo econômico. O objetivo do presente estudo foi determinar a capacidade da acidificação urinária mediante o uso de cloreto de amônio em ovinos. Foram utilizados 25 ovinos de três meses de idade, confinados e divididos aleatoriamente em três grupos: grupo CG (controle) não recebeu cloreto de amônio; grupo G200 (200mg/kg/PV) recebeu cloreto de amônio por 56 dias consecutivos; grupo G500 (500mg/kg/PV) recebeu cloreto de amônio por 56 dias consecutivos, administrados diariamente por via oral. Os momentos (M) de colheita de amostras e de avaliação clínica foram realizados com intervalo de sete dias, sendo M1 (imediatamente antes do cloreto de amônio), M2 (sete dias após) até M9, totalizando 70 dias de confinamento. Foram realizadas hemogasometria, concentração sérica de ureia e creatinina e avaliação ultrassonográfica do trato urinário. Na urinálise, houve uma maior incidência de cristais de fosfato amônio magnesiano no início do estudo, com migração para formação de cristais de urato, principalmente no G500, devido à acidificação urinária. Não houve alterações hemogasométricas, na bioquímica sérica, no líquido ruminal, ou alterações ultrassonográficas. A acidificação urinária foi obtida e mantida a partir do M7 durante a administração do cloreto de amônio no grupo G500, não ocorrendo nos outros grupos de estudo.(AU)

Aspectos biomoleculares de la prevención de la litogénesis biliar de colesterol / Biomolecular aspects of biliary cholesterol lithogenesis prevention

Introducción: La litogénesis biliar, proceso de sobresaturación de colesterol en la bilis vesicular, es prevenible. Objetivo: Describir las nuevas evidencias biomoleculares de la litogénesis biliar de colesterol como base de la futura terapia preventiva de la litiasis vesicular. Método: Se realizó una revisión sistemática y crítica de las evidencias de impacto sobre la litogénesis biliar. Se consultaron artículos publicados entre 2015-2020 en las bases de datos PubMed, Medline, SciELO, LILACS y Elsevier. Resultados: Se recuperaron evidencias actuales de los mecanismos biomoleculares relacionados con las futuras terapias preventivas de la litiasis vesicular, propuestos como fundamentos teóricos. Conclusiones: La descripción actualizada de la litogénesis biliar de colesterol, con los nuevos conceptos biomoleculares incorporados, aporta a su comprensión el papel de los genes de receptores nucleares, la intervención de estos últimos y de los transportadores de la secreción biliar. Dirigida a médicos generales, cirujanos, gastroenterólogos y fisiólogos, la descripción actualizada de La litogénesis biliar impacta como nuevo paradigma con los conceptos biomoleculares que intervienen en pro de su prevención(AU)

Introduction: Biliary lithogenesis is a preventable process of cholesterol supersaturation in gallbladder bile. Objective: Describe the new biomolecular evidence of biliary cholesterol lithogenesis serving as a basis for future preventive therapy for gallbladder lithiasis. Methods: A systematic critical review was conducted of impact evidence about biliary lithogenesis. The papers consulted were published in the databases PubMed, Medline, SciELO, LILACS and Elsevier from 2015 to 2020. Results: Current evidence was retrieved of biomolecular mechanisms proposed as theoretical foundations for future preventive therapies for gallbladder lithiasis. Conclusions: Intended for general practitioners, surgeons, gastroenterologists and physiologists, the updated description of biliary lithogenesis including the role of nuclear receptors, biliary lipid transporters and the biological value of enterohepatic circulation in the integrity and functioning of the hepatobiliary system as regulators of the cholesterol mechanism, makes an impact as a new paradigm with the biomolecular concepts involved in biliary lithogenesis prevention(AU)

Análisis clínico y terapéutico ante la patología obstructiva crónica de las glándulas salivales / Clinical and therapeutic analysis to the chronic obstructive pathology of the salivary glands

Introducción: gran parte de la población sufre procesos relacionados con las glándulas salivales, que, con los avances técnicos, se tiende cada vez más a tratar de una manera mínimamente invasiva. Objetivos: remarcar las indicaciones y las diferencias entre los abordajes comunes y los mínimamente invasivos, guiados por el sialoendoscopio. Además, describir la presentación clínica y el estudio de dichos pacientes. Diseño: realizamos un estudio descriptivo, observacional, longitudinal y retrospectivo sobre un grupo de 67 pacientes diagnosticados con patología obstructiva crónica no tumoral de las glándulas. Material y métodos: revisamos los datos referentes a la edad, sexo, hábitos tóxicos, enfermedades sistémicas o autoinmunes asociadas, radioterapia o tratamiento con yodo radiactivo (I131), síntomas asociados y resultados del examen físico y radiológico efectuados, así como el tratamiento efectuado. En mayo de 2019 incorporamos la técnica de sialoendoscopia al manejo de esta patología. Resultados: desde la incorporación de la sialoendoscopia, los casos de patología litiásica a nivel del tercio distal del conducto de Wharton se abordaron mediante exéresis de la litiasis sobre el suelo de la boca con ayuda del sialoendoscopio. Realizamos una sialoendoscopia diagnóstico-terapéutica en pacientes con clínica obstructiva crónica no litiásica. Discusión: el abordaje mínimamente invasivo permite una recuperación más temprana con una adecuada función glandular tras la cirugía. No solo es útil en la patología litiásica, sino que también presenta buenos resultados en patología autoinmune. Conclusión: las técnicas mínimamente invasivas han hecho que el manejo haya cambiado, limitando la realización de resecciones glandulares.

Introduction: A large part of the population suffers from processes related to the salivary glands, which with new advances in technology tends to be treated in a minimally invasive way. Goals: To highlight the indications and differences between common and minimally invasive approaches, guided by the sialoendoscope. In addition, to describe the clinical presentation and the study of these patients. Design: We carried out a descriptive, observational, longitudinal and retrospective study on a group of 67 patients diagnosed with non-tumorous chronic obstructive pathology of the glands. Material and methods: We review the data regarding age, sex, toxic habits, associated systemic or autoimmune diseases, radiotherapy or treatment with I131 (radioactive iodine), associated symptoms and results of the physical and radiological examination carried out. As well as the given treatment. In May 2019 we incorporated the sialoendoscopy to the management of this pathology. Results: Since the incorporation of sialoendoscopy, cases of lithiasic pathology at the distal 1/3 of Wharton's duct were approached by excision of the stone on the floor of the mouth using sialoendoscopy. We perform diagnostic-therapeutic sialoendoscopy in patients with non-lithiasic chronic obstructive symptoms. Discussion: The minimally invasive approach allows an earlier recovery with adequate glandular function after surgery. It is not only useful in lithiasic pathology, but it also has good results in autoimmune pathology. Conclusion: Minimally invasive techniques have changed management, limiting the neck open surgeries.

Migración de dispositivo intrauterino a vejiga / Intrauterine device migration to bladder

Introducción: La litiasis vesical secundaria se forma en el reservorio vesical y requiere la existencia de condiciones patológicas previas como lo son los cuerpos extraños. Objetivo: Describir dos casos clínicos de litiasis vesical secundaria a migración de un dispositivo intrauterino. Caso clínico: Se presentan dos casos de migración intravesical de dispositivo intrauterino con litiasis vesical secundaria. Se diagnosticaron años después de su inserción, ante la aparición de dolor pélvico, cistitis a repetición y hematuria. La laparoscopia no fue útil para su diagnóstico. En consulta de Urología la ultrasonografía y la radiografía de pelvis fueron herramientas diagnósticas útiles ante la sospecha inicial de esta patología. Presentaron buena evolución y regresión total de los síntomas tras cistolitotomía suprapúbica. Conclusión: Se debe pensar en la posibilidad de migración de un dispositivo intrauterino a vejiga ante la cronicidad de síntomas urinarios irritativos bajos en toda mujer que emplee este método anticonceptivo y desconozca su paradero(AU)

Introduction: Secondary bladder lithiasis is formed in the bladder reservoir and requires the existence of previous pathological conditions such as foreign bodies. Objective: To describe two clinical cases of bladder lithiasis secondary to intrauterine device migration. Clinical case report: Two cases of intravesical migration of an intrauterine device with secondary bladder stones are reported. They were diagnosed years after insertion, due to the appearance of pelvic pain, recurrent cystitis and hematuria. Laparoscopy was not helpful for its diagnosis. In Urology consultation, ultrasound and pelvic radiography were useful diagnostic tools in the event of the initial suspicion of this pathology. They showed good evolution and total regression of symptoms after suprapubic cystolithotomy. Conclusion: The possibility of an intrauterine device migration to the bladder should be considered when chronicity of irritative low urinary symptoms in every woman who uses this contraceptive method and which locations are unknown(AU)

Pielonefritis enfisematosa / Emphysematous pyelonephritis

La pielonefritis enfisematosa es una enfermedad poco frecuente. Esta consiste en una infección necrotizante severa del parénquima renal asociada a formación de gas en el sistema colector, parénquima renal y/o tejidos perirrenales. Se presenta una paciente de 54 años de edad con antecedentes de diabetes mellitus tipo 2 no controlada y litiasis urinaria, atendida en el Cuerpo de Guardia del Hospital Celia Sánchez Manduley, Granma, Cuba. Presentaba náuseas y vómitos, dolor en ambos lados de la región lumbar, y fiebre. La ecografía mostró riñones hiperecogénicos e imágenes ecorefringentes en proyección de las cavidades renales. El cultivo de orina probó la presencia de escherichia coli, y se medicó de forma endovenosa. Por evolución no favorable, se realizó tomografía que evidenció patrón gaseoso en cavidades renales. Se reajustó la antibioticoterapia parenteral y la evolución fue favorable. Se dio alta de consulta, luego de 10 meses de seguimiento asintomática, con diagnóstico de pielonefritis enfisematosa(AU)

Emphysematous pyelonephritis is a rare disease, consisting of severe necrotizing infection of the renal parenchyma associated with gas formation in the collecting system, renal parenchyma and / or peri renal tissues. We report a 54-year-old patient with history of uncontrolled type 2 diabetes mellitus and urinary stones, she was treated in the emergency service at Celia Sánchez Manduley Hospital, Granma, Cuba. She had nausea and vomiting, pain on both sides of her lower back, and fever. Ultrasound showed hyper-echogenic kidneys and echo-refractive images in projection of the renal cavities. The urine culture proved the presence of Escherichia coli, and medications was administered intravenously. Due to the unfavorable evolution, a tomography was performed and it showed a gas pattern in the renal cavities. Parenteral antibiotic therapy was readjusted and the outcome was favorable. After 10 months of asymptomatic follow-up, she was discharged from the clinic with diagnosis of emphysematous pyelonephritis(AU)

Litiasis vesical gigante / Giant bladder lithiasis

RESUMEN Introducción: la litiasis vesical gigante es poco frecuente. Se diagnostica cuando el cálculo sobrepasa los 100 g de peso. Objetivo: comentar a la comunidad médica un nuevo caso de litiasis vesical gigante diagnosticado en un hombre de edad avanzada. Presentación del caso: paciente masculino de 72 años de edad, con antecedentes de infecciones urinarias a repetición, quien consultó por presentar dolor en bajo vientre y síntomas urinarios irritativos. Con el empleo de estudios de imagen se detectó un cálculo vesical de gran tamaño. Se utilizó anestesia regional espinal, se realizó adenomectomía y cistolitotomía convencional. Se extrajo un cálculo gigante con un peso de 460 g. Conclusiones: la litiasis vesical gigante es un padecimiento poco frecuente. Actualmente no representa un problema de salud en el territorio. La cistolitotomía convencional es la técnica de elección para la extracción de cálculos gigantes.

ABSTRACT Introduction: Giant bladder lithiasis is rare. It is diagnosed when the calculus exceeds 100g in weight. Objective: to comment to the medical community a new case of giant bladder lithiasis diagnosed in an elderly man. Case report: a 72-year-old male patient with a history of repeated urinary tract infections consulted for lower abdominal pain and irritative urinary symptoms. With the use of imaging studies a large bladder stone was discovered. Spinal regional anesthesia was applied, adenomectomy and conventional cystolithotomy were performed, and a giant stone weighing 460g was removed. Conclusions: giant bladder lithiasis is a rare entity. At present it does not represent a health problem in the territory. Conventional cystolithotomy is the technique of choice to remove giant stones.