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Query: UMLS:C0018099 (gout)
 5,192 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To understand the content of ambulatory family practice and find effective ways to improve clinical service, education and research in the Department of Family Medicine of Kaohsiung Medical College Hospital, we surveyed 14,064 patients from Jan. 1984 to Feb. 1991 and analysed (a) their basic demographic data including sex, age, insurance type, source and residential district and (b) clinical health problems covering 25,679 diagnoses and 148,994 diagnostic visits. Clinical health problems were recorded by the ICHPPC-2 code system. Results of basic demographic survey were as follow: 49.1% of patients was male and 50.9% female; 58.9% fell in the age group of 16-40 years and 22.4%, 12.0% and 6.7% of patients fell into the age groups of 41-65, under 16 and over 65 years respectively; 62.8% was insured usually by labor insurance and 26.9% had no insurance; the commonest referrals were other patients, colleagues, company personnel, doctors, media ... etc.; 58.8% lived in Kaohsiung City and 19.6% in Kaohsiung county. As for clinical health problems, the data showed that the commonest thirty diagnoses encountered at our clinic accounted for 69.3% of 25,679 diagnoses and the commonest ten diagnoses in descending order were medical health examination, acute URI, abdominal pain, uncomplicated hypertension, prophylactic immunization, hepatitis B carrier, back pain, anxiety disorder, viral hepatitis and irritable bowel syndrome. By calculating the average value of each diagnosis in a sample of 148,994 diagnostic visits to evaluate the habits of practice, we found that the commonest ten diagnostic visits at clinic in descending order were diabetes mellitus, hypertension involving target organ, uncomplicated hypertension, gout, hyperthyroidism, duodenal ulcer, tuberculosis, lipid metabolism disorder, other peptic ulcer and depressive disorders; all were chronic diseases. We concluded it was very important and helpful for the development of family medicine program and primary care unit to understand the content of their own ambulatory practice.
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PMID:[The content of ambulatory family practice in Kaohsiung Medical College Hospital]. 156 Apr 75

The Japanese population in Hawaii has one of the longest life expectancies of any large population subgroup in the U.S. and the world. Cross-sectional data on 1,379 elderly, noninstitutionalized, male Japanese American survivors of a population-based cohort study indicated the most common health problems were hypertension (43%), arthritis (33%), diabetes (13%), and gout (9%). For cancer and hypertension there is a trend toward higher prevalence in older age groups. For coronary heart disease, stroke, and angina the oldest age group (75-81 years) has a higher prevalence than that seen in younger age groups. Other relatively common diseases such as diabetes, gout, peptic ulcer, and arthritis do not have higher prevalence in older age groups. Drugs reported to be used frequently by study participants were for hypertension, gout, CHD, and diabetes. The prevalence rates of major limitations of mobility and of living alone appear to be relatively low in this population. Less than one percent of the current population rate their health status as poor. The prevalence of normal serum cholesterol and smoking are similar to those seen in U.S. White males, while the rates of hypertension appear lower. Prevalence rates for stroke and heart attack also appear to be somewhat lower in these long-lived individuals than those seen in U.S. Whites.
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PMID:Health status and life style in elderly Japanese men with a long life expectancy. 239 21

Overweight and obesity have been examined in 7735 middle-aged men in 24 British towns. Half the men exceeded the body mass index (BMI) range associated with minimum mortality (20-25 kg/m2). Social class differences in BMI were marked and obesity was more marked in manual workers. The association of reduced BMI with cigarette smoking and of increased BMI with stopping smoking was most clearly seen in manual workers. With increasing alcohol intake, BMI increased progressively, but the effect in the heaviest drinkers was probably diminished by concurrent heavy smoking. Mean BMI decreased with increasing levels of physical activity. There was considerable variation in the rate of obesity between the towns, from 11 to 28 per cent, determined to some extent by social class. Positive associations were observed between BMI and the presence of ischaemic heart disease, high blood pressure, gout, arthritis and gallbladder disease but not with diabetes mellitus. Peptic ulcer was inversely related to BMI and bronchitis showed a curvilinear relationship. For these men, overweight or obesity is virtually 'normal', and a considerable health education effort will be needed to produce a leaner, healthier society.
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PMID:Overweight and obesity in middle-aged British men. 338 26

A postal survey among 2% of men in Leeds showed that the prevalence of urinary stone disease is 3.8%. The prevalence of upper urinary tract and spontaneously passed stones increases progressively from 0.7% in social class 5 to 5.0% in social class 1 but that of bladder stones (0.7% in the group as a whole) is independent of social class. There is an initial peak of upper urinary tract and spontaneously passed stones commencing at age 20 and having a projected prevalence at age 90 of 5.7% and a second peak of bladder stones, commencing about age 50, with a projected prevalence of 1.9%. The prevalence of stone disease increases according to the order: single less than divorced/separated less than married less than widowed men. A family history of stones tends to be higher amongst relatives of stone-formers than amongst the corresponding relatives of control subjects, the male/female ratio being 2:1. The occurrence of urinary stones is significantly associated with that of gallstones, high blood pressure, backache, arthritis and gout but not with that of peptic ulcer, diabetes, thyroid disease or bronchitis.
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PMID:Studies on the prevalence and epidemiology of urinary stone disease in men in Leeds. 622 82

Traffice Noise and Hypertension. First communication: the question whether traffic noise could be a risk factor of essential hypertension was studied by means of interviews. In Bonn 931 inhabitants between 20 and 59 years of age, who lived either in streets with high (minimum: 9062 cars/day) or low (maximum: 1182 cars/day) traffic volumes were interviewed. While no differences were found in the frequencies of treatment of diabetes mellitus, gout, asthma and peptic ulcer, there was a difference in response to treatment of hypertension (p = 0.002); in the noisy area 22.8% and in the quiet area 14.6% of respondents stated that they were treated. Also in both male and females aged 29-39 years, there was a connection between hypertensive treatment and the duration of stay in the noisy area (p less than 0.05).
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PMID:[Traffic noise and the risk of hypertension. 1]. 677 26

A series of 38 cases of primary hyperparathyroidism seen at a single hospital within a four a half year period is reported. The importance of hypercalcemia in the diagnosis of this syndrome and its screening in cases of arterial hypertension, gout, osteoporosis, and families with type I multiple endocrine neoplasia are underlined. The patients in the present series had a florid clinical history with a mean duration of 14 years. Main symptoms were urolithiasis (52%), arterial hypertension (28.9%), bone involvement and pain (23.7%), and peptic ulcer (18.4%). There were a high proportion of patients with hyperuricemia (26.3%), some with classical symptoms of gout. One patient presented simultaneous pituitary and pancreatic involvement. Surgical therapy was undertaken in 25 patients, of whom 24 (96%) were cured, one of them after reoperation. There were no cases of relapse, hypoparathyroidism, or postoperative death. Surgery is the only rational and definitive form of treatment of hyperparathyroidism; both experienced surgeons and pathologists are necessary to deal with the anatomic and histologic subtleties of this interesting endocrine disorder.
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PMID:[Comments on a series of 38 cases of primary hyperparathyroidism (author's transl)]. 724 69

Acute gout is a well known complication of the commencement of allopurinol therapy. Prophylaxis is needed for some months, even after serum urate levels have returned to normal. Colchicine is usually preferable to NSAIDs for this purpose, being cheaper, and better tolerated, especially in patients with peptic ulcer, gastrointestinal bleeding or dyspepsia or who are taking anticoagulants.
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PMID:Preventing acute gout when starting allopurinol therapy. Colchicine or NSAIDs? 826 82

Niacin has been used for many years to treat hyperlipidemia. It has been shown to reduce coronary death and non-fatal myocardial infarction and, in a separate analysis of long-term (15-year) follow-up, all cause mortality. It reduces total cholesterol, low density lipoprotein cholesterol (LDL-C) and triglycerides and increases high density lipoprotein cholesterol (HDL-C). Sustained-release niacin may be associated with more dramatic changes in LDL-C and triglyceride, whereas the short acting preparation causes greater increases in HDL-C. The increase of HDL-C occurs at a lower dose (1500 mg/day) than the reduction of LDL-C (> 1500 mg/day). Niacin also favorably influences other lipid parameters including lipoprotein(a) [Lp(a)], alimentary lipemia, familial defective apolipoprotein B-100 and small dense LDL. Combination of niacin with a bile acid sequestrant or a reductase inhibitor represents a powerful lipid-altering regimen. Whereas the reductase inhibitors and bile acid binding resins primarily affect LDL-C, the combined therapy has a synergistic effect to reduce LDL-C and, in addition, the niacin reduces triglycerides and increases HDL-C. The major drawback in the use of niacin is associated side effects (flushing and palpitations) and toxicity (worsening of diabetes control, exacerbation of peptic ulcer disease, gout, hepatitis). Niacin has a long history of use as a lipid lowering agent and has several attractive features. Unfortunately, the side effect profile of this agent warrants its use only in patients with marked dyslipidemia in whom side effects and potential toxicity are closely monitored.
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PMID:New developments in the use of niacin for treatment of hyperlipidemia: new considerations in the use of an old drug. 885 85

Gout in the elderly differs from classical gout found in middle-aged men in several respects: it has a more equal gender distribution, frequent polyarticular presentation with involvement of the joints of the upper extremities, fewer acute gouty episodes, a more indolent chronic clinical course, and an increased incidence of tophi. Long term diuretic use in patients with hypertension or congestive cardiac failure, renal insufficiency, prophylactic low dose aspirin (acetylsalicylic acid), and alcohol (ethanol) abuse (particularly by men) are factors associated with the development of hyperuricaemia and gout in the elderly. Extreme caution is necessary when prescribing nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of acute gouty arthritis in the elderly. NSAIDs with short plasma half-life (such as diclofenac and ketoprofen) are preferred, but these drugs are not recommended in patients with peptic ulcer disease, renal failure, uncontrolled hypertension or cardiac failure. Colchicine is poorly tolerated in the elderly and is best avoided. Intra-articular and systemic corticosteroids are increasingly being used for treating acute gouty flares in aged patients with medical disorders contraindicating NSAID therapy. Urate-lowering drugs are indicated for the treatment of hyperuricaemia and chronic gouty arthritis. Uricosuric drugs are poorly tolerated and the frequent presence of renal impairment in the elderly renders these drugs ineffective. Allopurinol is the urate-lowering drug of choice, but its use in the aged is associated with an increased incidence of both cutaneous and severe hypersensitivity reactions. To minimise this risk, allopurinol dose must be kept low. A starting dose of allopurinal 50 to 100mg on alternate days, to a maximum daily dose of about 100 to 300mg, based upon the patient's creatinine clearance and serum urate level, is recommended. Asymptomatic hyperuricaemia is not an indication for long term urate-lowering therapy; the risks of drug toxicity often outweigh any benefit.
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PMID:Gout in the elderly. Clinical presentation and treatment. 978 27

Gout is an inflammatory response to deposition of monosodium urate crystals in and around joints. It is primarily a disease of adult men. In acute gout, treatment options include non-steroidal anti-inflammatory drugs (NSAIDs), colchicine and corticosteroids, administered either intra-articularly, orally or parenterally. Asymptomatic hyperuricaemia does not require specific treatment, but should prompt screening for atherosclerosis risk factors, and general lifestyle modification to reduce serum urate levels. Gout presents differently in the elderly. Both women and men are affected, attacks are frequently polyarticular and in the upper limbs, and the gout may be associated with diuretic use, hypertension and renal impairment. In patients with peptic ulcer disease, selective COX-2 inhibitors provide another treatment option. In the presence of renal impairment, allopurinol is the treatment of choice for urate lowering therapy, but doses of allopurinol and colchicine must be adjusted. Urate lowering therapy should only be used if recurrent episodes of gout occur despite aggressive attempts to reverse or control the underlying causes. It should not be introduced or discontinued during an acute episode of gout, and gout prophylaxis (NSAIDs or colchicine) should be prescribed during the introduction of urate lowering therapy.
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PMID:Clinical manifestations of gout and their management. 1090 73


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