Tribulus terrestris: preliminary study of its diuretic and contractile effects and comparison with Zea mays.

OBJECTIVES: Tribulus terrestris L. (Zygophyllaceae) which is called Al-Gutub (in Iraqi dialect) or Quti;ba (in classical Arabic medicine), and Zea mays were both used alone or in combination by Iraqi herbalists to propel urinary stones. We studied the aqueous extract of the leaves and fruits of T. terrestris and the hair of Z. mays, to determine their diuretic activity and the contractile effect of T. terrestris. METHODS: The aqueous extract was filtered and the solvent was evaporated to produce a dry crude extract. The dry extract was then dissolved in physiological saline to make the required concentrations. Wistar male rats were used for the diuresis test and strips of isolated Guinea pig ileum were used for the contractility test. RESULTS: The aqueous extract of T. terrestris, in oral dose of 5g/kg elicited a positive diuresis, which was slightly more than that of furosemide. Z. mays aqueous extract did not result in significant diuresis when given alone in oral dose of 5g/kg, while combination of Z. mays and T. terrestris extracts produced the same extent of diuresis as that produced by T. terrestris alone. Na(+), K(+) and Cl(+) concentrations in the urine had also much increased. In addition to its diuretic activity T. terrestris had evoked a contractile activity on Guinea pig ileum. CONCLUSION: T. terrestris has long been used empirically to propel urinary stones. The diuretic and contractile effects of T. terrestris indicate that it has the potential of propelling urinary stones and merits further pharmacological studies.

Surgically treated transitional cell carcinomas of the bladder. The role of radical surgery.

OBJECTIVE: To assess the treatment outcome and differentiate between the individual behavior of the tumor stages that were studied (Ta, T1, and T2a) with special reference to T2a tumors. METHODS: This study was carried out at Al-Rasheed Military Hospital, Baghdad, Iraq, during a 12 year period. Fifty-six patients with Ta, T1, and T2a (superficial invasion of muscularis propria) transitional cell carcinomas of the bladder, have been retrospectively analyzed. They were treated surgically with either transurethral of the bladder tumor (N=45) or radical surgery (N=11). Tumors with frequent recurrences or mulifocal or extending to the ureter or vesical outlet were treated with radical surgery. No adjuvant intraveiscal chemotherapy or bacillus calmette-guerin therapy was practiced. RESULTS: All Ta tumors were controlled by transurethral of the bladder tumor treatment. Seventy-five percent of T1 tumors were controlled by transurethral of the bladder treatment and 25% qualified for radical surgery according to our criteria. Sixty percent of T2a tumors were controlled by transurethral of the bladder treatment and 40% warranted radical surgery. No stage progression occurred in Ta and T1 lesions, but 27% of T2a lesions (superficial invasion of muscularis propria) progressed to T2b (deep invasion of muscularis propria). All grade 2a lesions of all stages under study were controlled by transurethral of the bladder treatment. Of 6 patients with T2a grades 2b and 3 tumors, 5 patients (83%) qualified for radical surgery. No distant metastasis occurred during the observation period, which ranged from 4 months to 12 years (mean 51 months). Seventy-five percent of all patients, 78% of the transurethral of the bladder treatment group and 64% of the radical surgery group are alive and free of disease for 5 years or more. CONCLUSION: Radical surgery is indicated for T1 and T2a bladder carcinomas if they were multifocal, or extending to the ureter or the vesical outlet or frequently recurring within the first year, specially if they were T1 tumors of grade 3 or T2a tumors of grades 2b and 3. Transurethral resection is justifiable for grades 1 and 2a, low risk T2a tumors.