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

The sequence of events that may initiate the inflammatory reaction in acute gout has been investigated with specific reference to phagocytosis of urate crystals by polymorphonuclear leucocytes and the results have shown (1) that neutrophil leucocytes avidly ingest microcrystals of sodium monourate, (2) that this causes the rapid degranulation and disintegration of the leucocytes, (3) that fresh leucocytes ingest the debris and crystals liberated by the dead cells, and in their turn degranulate and die, thus possibly establishing a vicious circle in the system.
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PMID:Observations on phagocytosis of urate crystals by polymorphonuclear leucocytes. 4 39

Weight reduction is almost always successful in cases of essential hypertension if and when the weight loss is accompanied by a drastic sodium reduction. (2) Weight normalization is of remarkable help in complete reversal of abnormal glucose tolerance, decrease in insulin requirement in manifest diabetes mellitus, and - in many patients with mild diabetes - discontinuation of oral hypoglycemic agents. (3) Weight loss will occasionally relieve gout patients of their symptoms. The majority of hyperuricemic patients will benefit with a lowering of serum uric acid levels. (4) An unresolved issue is the influence of weight reduction on the cholesterol metabolism - short- and long-term results are by no means predictable. Whereas the triglycerides in obese patients almost always return to lower serum concentrations, and with them the hyperlipoproteinemias of type IIB, III and IV, the type IIA is only rarely seen in association with obesity. Therefore, information on this lipid abnormality is very limited regarding the effect of weight loss.
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PMID:The workinghman's diet. II. Effect of weight reduction in obese patients with hypertension, diabetes, hyperuricemia and hyperlipidemia. 63 8

During observation of 250 patients with gout in the Institute of Rheumatology in Warsaw in the years 1962-1975 several patterns of joint destruction stages in gouty arthropathy have been recognized on the basis of serial roentgenograms. Histological examination of joints and bones suggests with a considerable probability that the progression of arthropathy depends on the extension of sodium urate deposits in articular tissues. Histological documentation of consecutive stages of joint distruction corresponding to the above mentioned patterns of radiological changes is presented.
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PMID:Consecutive stages of arthropathy progression in patients with gout. 86 Jun 4

After World War II the incidence of urolithiasis increased consistently among the general population in this country. Nearly 25% of all examined renal calculi contain uric acid, sodium acid urate or ammonium acid urate as constituents. There are two peaks in lifespan of occurring urate stones: in the adolescence and in the age between 40 and 60 years. The following conditions are due to the formation of uric acid-containing stones: 1. Gout and primary hyperuricemia; 2. secondary hyperuricemia; 3. idiopathic cases with normal renal excretion of uric acid and normouricemia, but with a higher degree of acidity of the urine than normal considering the total renal excretion of acid products; 4. iatrogenic hyperuricemia during insufficient uricosuric therapy. Up to more than 30% of all the patients with recurrent formation of oxalate stones show a clear association with hyperuricemia, hyperuricosuria and increased renal excretion of calcium. In the presence of sodium urate a considerable promotion of precipitation of crystals consisting of calcium oxalate from a meta-stable solution may occur (so-called epitaxy). Frequently the existence of uric acid stones is without any symptoms. Modern views with regard to prophylactic procedures, diet, general and specific medical management including surgical intervention are presented.
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PMID:[Urate nephrolithiasis. Cause of consequence?]. 95 52

In this account the authors have attempted to provide an introductory overview of the mechanisms of crystal-induced inflammation. More specific studies are given in other papers in this symposium. Like clinical gout itself, study of the sodium urate crystal has turned out to have a venerable heritage. Specific crystal identification has proved clinically useful.
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PMID:An overview of cellular and molecular mechanisms in cyrstal-induced inflammation. 120 Nov 20

The effects of low-mineral content water (Adelholzener Primus-Quelle) in 62 patients were studied of which 14 were hypertonic. Changes of blood sodium, potassium, chloride and bicarbonate were not observed in either group. In the hypertonic patients, blood pressure decreased from a mean systolic value of 168 to 140 mmHg and mean distolic pressure from 105 to 88 mmHg. Observations to date suggest the following indications for a low-mineral content water diet: 1. hypertension, 2. renal insufficiency in stages of compensated and decompensated retention, especially in cases with high serum potassium levels, 3. in the initial therapy of diabetes, gout and obesity; patients with a high water demand should be treated with low-mineral content water until the optimal intake of electrolytes is established.
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PMID:[Effects of water with a low mineral content on serum electrolytes and blood pressure]. 122 36

Experience with chemodissolution of uric acid stones in 30 patients is presented. Chemodissolution was achieved either with infusion of 0.16 M i.v. lactate or oral sodium bicarbonate, in addition to liberal fluid intake and allopurinol wherever indicated. In some cases direct chemodissolution by in situ irrigation with sodium bicarbonate solution was done after an initial percutaneous nephrostomy. Seven patients presented with acute obstructive anuria. In this group, 5 of them had bilateral obstructive calculi, while 2 had unilateral obstruction in a solitary kidney. The latter 2 had complete recovery following intravenous lactate therapy. Of the 5 presenting with bilateral obstruction, 2 patients had complete response to chemodissolution, whereas the remaining 3 had only a partial response requiring surgery for ultimate salvage. In this group I, 6 patients are doing well with a normal serum creatinine at 3 months to 4 years follow-up, while 1 patient has a serum creatinine, stabilised at 3.2 mg%. In the second group, 23 patients presented with non-obstructing urinary stones. Flank pain was the commonest complaint and a concomitant history of gout was present in 6 patients. Hyperuricaemia was detected in 12 and hyperuricosuria in 19. All cases were managed by high fluid intake and oral sodium bicarbonate, with self-monitoring of urine pH, which was kept between 6.5 and 7.0. Allopurinol was administered in cases having hyperuricaemia and/or hyperuricosuria. Systemic alkali therapy in the form of intravenous molar lactate or sodium bicarbonate is effective and safe both in obstructive anuria and non-obstructive urinary uric acid stones.
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PMID:Chemodissolution of urinary uric acid stones by alkali therapy. 131 80

1. A commercial 62-week-old layer flock experienced an acute drop in egg production and an increase in shell-less egg production within 2 days of consuming feed erroneously formulated to contain over 30 g/kg instead of 3 g/kg sodium bicarbonate (NaHCO3). Other symptoms included increased water consumption, diarrhoea and increased mortality associated with visceral gout. 2. An experiment was conducted to assess the responses of hens under controlled conditions. Twenty Dekalb XL Single Comb White Leghorn hens (50 weeks old) were placed in individual cages, having ad libitum access to water from trough waterers. Ten hens were fed the TEST (High NaHCO3) feed for one week (Test group), and ten hens remained on normal commercial layer ration (Control group). 3. Hens in the Test group had high water consumption and watery droppings, but egg production and mortality were not affected. Physiological evaluations indicated the Test feed caused metabolic alkalosis. Plasma sodium, urine pH and urinary sodium excretion were increased, and glomerular filtration rates were decreased in the Test group. 4. These physiological effects are consistent with known responses to excess sodium intake in domestic fowl. The reduced egg production and increased mortality caused by the Test feed under commercial conditions may be related to more severe dehydration experienced by hens in multi-bird cages supplied by cup-type watering systems.
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PMID:Excess sodium bicarbonate in the diet and its effect on Leghorn chickens. 132 26

General prophylaxis of renal stone formation consists of 1. high fluid intake and 2. modest consumption of protein-rich foods. Specific prophylactic measures are based on pathophysiologic mechanisms of stone formation. In infection-induced renal stones, combined treatment with culture specific antibiotics and complete stone removal is of utmost importance. In all cases where stone fragments cannot be removed completely and/or partial obstruction remains, long-term antibiotics in combination with urine acidification by methionine (urine pH 5.6 to 6.2) are most appropriate. Prophylaxis of uric acid stones primarily consists of reducing purine intake and alkalizing the urine by potassium citrate. Only if this regimen failed or gout occurred, allopurinol should be administered. In patients with cystine stones, urine volume should be increased to greater than 3000 ml/die. Alkalizing the urine to a pH greater than 7.5 rises cystine solubility, whereas cystine excretion may be reduced by a diet low in sodium and/or low in methionine/cysteine. Thiols form mixed thiol-cysteine disulfides that are many times more soluble than cystine in urine; because of their high rate of adverse side-effects, however, these compounds are of lowest priority in the treatment of cystine stones. There is no convincing evidence for the efficacy of high dose ascorbic acid treatment in cystinuria.
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PMID:[Preventive measures in stones due to infection, uric acid and cystine]. 173 1

Monosodium urate monohydrate (MSUM) crystals derived from a tophus surgically removed from patients suffering from gout and MSUM prepared from a supersaturated solution of sodium urate were studied and compared with respect to their ability to: (1) stimulate chemiluminescence (CL) production by human polymorphonuclear (PMN) cells, (2) induce hemolysis of the human red blood cells and (3) induce inflammation when injected in the rat paw and knee joint. Human MSUM crystals were considerably more active in stimulating CL production by PMN cells and in inducing synovial inflammation. Both serum and papain pretreatment of human MSUM crystals caused inhibition of their enhancing effect on CL production by PMN cells. Papain pretreatment only reduced their phlogogenic activity. Uncoated and, to a much lesser extent, serum-coated human MSUM crystals induced secretion by mononuclear cells (MNC) of the factor(s) that considerably enhanced CL production by PMN cells. Both tophus-derived and synthetic crystals appeared to be weak hemolytic agents. Serum pretreatment of synthetic MSUM crystals reduced their hemolytic activity. These results suggest that surface coating, destroyed by papain treatment, was probably responsible for cell activation induced by human MSUM crystals.
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PMID:Tophus-derived monosodium urate monohydrate crystals are biologically much more active than synthetic counterpart. 204 78


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