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

Calcium hydroxyapatite crystals deposit in periarticular soft tissues usually translates itself clinically through pain and mobility limitation of affected joint. Compromise of small joints in feet is infrequent, less than 1% of all cases. Recently pseudopodagra crises have been described due to the deposit of this material in soft tissues adjacent to metatarsal or phalangeal first joint. Its clinical expression is practically undistinguishable from gout crises. Three new cases of pseudopodagra due to hidroxyamatite are presented and some considerations are made concerning this clinical entity and its differential diagnosis in relation to gout.
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PMID:[Pseudopodagra caused by hydroxyapatite. Report of 3 cases]. 838 43

The EDTA (calcium disodium edetate) lead mobilization test revealed lead as the probable cause of renal disease in industrial lead workers and in patients with gout or essential hypertension. The data reviewed here demonstrate persistence of lead nephropathy in the contemporary scene despite the introduction of modern industrial and environmental exposure standards. Renal function and biopsy studies showed that lead nephropathy is a chronic tubulointerstitial renal disease with modest proteinuria which frequently presents with hyperuricemia, gout and hypertension. Only evaluation of body lead stores by either the EDTA lead mobilization test or by x-ray fluorescence is helpful in diagnosing lead nephropathy. While chelation therapy is safe and helpful in reversing early lead nephropathy, the best treatment is prevention. These studies further raise the possibility that chronic environmental lead poisoning and associated renal disease and hypertension may be a more widespread problem than suspected. Assessment of the true extent of chronic lead poisoning requires large scale epidemiological studies.
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PMID:Lead nephropathy, gout, and hypertension. 847 50

We reviewed 5477 patients with urinary calculi who presented during the years from 1975 to 1993. During this time the percentage of calcium stones has remained at approximately 86%. However over the same period the rate of urinary calculi composed of uric acid has increased and is now about 7.2%. The number of uric acid stones has increased 3.5 times compared to 1975. 355 of 394 (90.1%) with uric acid stones are male. We believe that the increase in the numbers of patients seen with gout, hyperurisemia of a high alcohol intake.
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PMID:[An epidemiologic study on pathogenesis of uric acid urolithiasis]. 859 56

The most common crystal-related arthropathies-gout, calcium pyrophosphate dihydrate disease or "pseudogout," and calcific periarthritis/tendinitis-may be appropriately diagnosed and managed by the primary care physician. Definitive diagnosis via synovial tap is recommended, as the clinical picture may not identify some cases. The acute pain and swelling of attacks, regardless of etiology, generally respond to treatment with nonsteroidal anti-inflammatory drugs and local or occasionally systemic corticosteroids. Once a causative crystal has been identified and a diagnosis established, a plan for long-term management and prevention of recurrences may be devised. Thus, uric-acid-lowering therapy may be indicated in a patient who has experienced recurrent attacks of gout, whereas control of serum phosphate levels might be effective in some individuals with hyperphosphatemia and hydroxyapatite-associated periarthritis or arthritis. Crystal deposits in joints can be destructive as well as painful. Treatment, therefore, has two objectives: To relieve the pain of the acute attack, thus restoring normal function, and to prevent the accumulation of crystals that can lead to degenerative disease. Identification and subsequent treatment of preventable or correctable underlying disorders may be one of the most gratifying aspects of managing crystal-induced arthropathies.
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PMID:Crystal-induced arthritis: an overview. 860 27

Among 4620 synovial fluid specimens examined in our laboratory from 1989 through 1992, 18.3% contained crystals (calcium pyrophosphate dihydrate, 55.7%; monosodium urate, 42%). Both calcium pyrophosphate dihydrate and monosodium urate crystals were found in 17 patients, usually in specimens obtained from the knee. Only five of these 17 patients had a known history of gout. Among the patients with a mixed crystal composition, the females had a higher mean age (78.5 years) than the males (53.2 years), in keeping with the fact that gout is exceedingly rare in premenopausal women. The two youngest men (40 and 45 years) had a history of meniscectomy, which is a known risk factor for early chondrocalcinosis.
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PMID:Mixed monosodium urate and calcium pyrophosphate crystal-induced arthropathy. A review of seventeen cases. 878 78

The clinical significance of cytoplasmic inclusions(CPI) in synovial fluid(SF) examination was evaluated. We examined SF specimens collected from major rheumatology clinics in the Philadelphia area during the period of January to December 1995. Among 759 patients in the initial study group, 419 cases with established diagnoses and full synovial analyses were included. Their diagnoses and SF analysis results including leukocyte counts, differential counts and wet preparations were collected and analysed. Ninety seven of the 419 SF specimens were found to have CPI. CPI were found in SF from almost all rheumatic diseases. They were most likely to be found in inflammatory arthropathy including rheumatoid arthritis(RA, 46%), juvenile rheumatoid arthritis(JRA, 78%) and psoriatic arthritis(55%). On the contrary, CPI were least common in crystal-induced arthropathy among the inflammatory arthropathy. CPI were found 8 out of 98 gout cases(8%) and 2 among 53 calcium pyrophosphate dihydrate(CPPD) deposition disease(4%). In noninflammatory arthropathy, CPI were found in only 6 cases(6%) out of the 103 osteoarthritis(OA). In RA cases with non-inflammatory SF, 4 of the 20 SF(20%) had CPI while only 6% of OA SF had CPI. OA SF with CPI were all noninflammatory SF. In summary, CPI were a common finding on SF examination. CPI were more likely to be found in inflammatory arthropathy than noninflammatory. Among inflammatory arthropathy, CPI can favor non-crystal arthropathy than crystal arthropathy. Awareness of the presence of CPI is suggested as an addendum to routine SF analysis. Renewed investigation of the several types of CPI may add further to the understanding of joint disease.
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PMID:The clinical significance of cytoplasmic inclusions(CPI) in synovial fluid examination. 887 1

Lead intoxication in human beings has been documented since the second century B.C. Renal disease, hypertension, and gout have all been linked to lead by strong circumstantial evidence. Both acute and chronic nephropathy can occur as a result of lead poisoning. Acute renal failure develops following acute lead intoxication and is often associated with gastrointestinal, neurologic, and hematologic disorders. Both blood and urinary laboratory abnormalities are associated with acute intoxication and are often diagnostic. Chronic lead nephropathy, a chronic tubulointerstitial nephritis on biopsy, occurs in the setting of long-term lead exposure and is often associated with hypertension and gout. Diagnosis of chronic lead nephropathy is more difficult since the laboratory abnormalities seen with acute lead intoxication are not present with chronic lead exposure. The typical clinical picture and the exclusion of other causes of renal disease allow the diagnosis of chronic lead nephropathy to be made. Evaluation of lead stores by either the calcium disodium edetate (EDTA) mobilization test or K-x-ray fluorescence are helpful in clinching the diagnosis. Treatment with EDTA lead mobilization is effective for acute lead poisoning while avoidance of further lead exposure prevents recurrence of lead intoxication. Treatment of chronic lead nephropathy with EDTA lead mobilization is useful if renal failure is modest; however, EDTA mobilization is of no benefit in patients with more severe renal insufficiency.
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PMID:Lead and the kidney: nephropathy, hypertension, and gout. 890 77

Primary gout is characterized by increased plasma and decreased urinary concentrations of hypoxanthine, xanthine and uric acid. To examine whether lead could explain the disturbance of purine metabolism in gout, we determined hypoxanthine, xanthine and uric acid metabolism and 5-day cumulative urinary lead excretion rates after an EDTA (calcium disodium edetate) test in 27 patients with primary gout and reduced creatinine clearance (C(cr)) and in 50 patients with gout and normal C(cr). The results were compared to those obtained in 26 normal subjects matched for age. All gout patients evidenced a marked renal underexcretion of hypoxanthine, xanthine and uric acid relative to their increased plasma levels. Purine metabolism was remarkably similar in both gout groups except for a significantly lower uric acid excretion in patients with reduced C(cr). Blood lead levels and cumulative lead excretion rates were significantly higher in gout patients with renal failure as compared to patients with normal C(cr). Fourteen patients (52%) with renal insufficiency and 6 (12%) with normal C(cr) showed increased lead excretion rates (95% Cl for the difference, 29-51%, p < 0.001). Mobilizable lead was not significantly correlated with serum or urinary purine concentrations. Hypoxanthine, xanthine and uric acid underexcretion was similar in gout patients with increased or normal cumulative lead excretion rates. The prevalence of atheromatosis and arterial hypertension together was significantly higher in gout patients with renal failure than in patients with normal C(cr) (81 vs. 60%, 95% Cl for the difference, 11-31%, p < 0.005). These results indicate that lead is not a significant contributor to the renal underexcretion of purines in gout. An increased mobilizable lead is not by itself evidence that lead is the cause of the renal insufficiency in patients with primary gout. Atheromatous nephropathy and/or nephroangiosclerosis may explain impaired renal function in patients with primary gout.
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PMID:Purine metabolism in patients with gout: the role of lead. 906 56

Deriving from positive effects of whey drinking cures in antiquity, the Middle Ages and modern time, a review is given on nutritional significance of whey. The proteins are essential components of whey and belong to the proteins with highest biological value because of their amino acid composition. Besides, they show fundamental functional properties, which enable a varied application in foods, dietetic foods and beverages in form of different whey products (powder, protein concentrates and isolates). Whey proteins have found considerable usage in infant's nutrition as whey predominant formulas as well as whey protein hydrolysates in case of cow's milk protein intolerances. A recent field of research are biological active peptide sequences which become effective during digestion and are of importance for secretion of entero hormones as well as for immune enhancing effects. They may contribute to assess the biological value of whey proteins under enlarged points of view and to develop new application forms and areas. It is pointed to further fields of application (e.g. adipositas, gout, kidney insufficiency). Concerning the quantitatively most dominant lactose in whey, it is dealt with its importance for the healthy development of infants (adaptation to the increased lactose content of mother's milk) as well as with lactose intolerance and galactosaemia. In case of mineral salts of whey it is emphasized the high nutrient density of calcium (prophylaxis for osteoporosis), the beneficial Ca:P and Na:K proportions (antihypertensive in case of the last one), the promotion of absorption of mineral salts by lactose, and the high content of iodine. The whey is rich in B-vitamins, which contribute essentially for their satisfaction or requirement in case of a corresponding consumption. To be emphasized is the vitamin B12 in milk and whey, which is the sole source of this indispensable nutrient for blood-formation and cell division in lacto-ovo-vegetarian nutrition. In conclusion, a summarizing dietetics valuation of whey is performed.
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PMID:[Nutritional physiology of whey and whey components]. 915 93

Plasminogen (Pg) in the synovial fluid of patients with acute inflammatory disease, including rheumatoid arthritis, osteoarthritis, and gout, was purified by affinity chromatography techniques. The Pg isolated from patients with osteoarthritis and gout has affinities for L-lysine Sepharose and structural properties similar to those of normal plasma Pg. However, Pg from rheumatoid synovial fluids is abnormal in that it does not bind to L-lysine Sepharose. Analyses of rheumatoid synovial fluid Pg purified by immunoaffinity chromatography indicate that the molecule has size and folding properties similar to those of normal plasma Pg. However, we detected abnormalities in the molecule using two different criteria. First, isolated kringles 1-3 fragments are unable to bind L-lysine Sepharose. Second, reactivity toward a monoclonal antibody against a region in kringles 1-3 is decreased. In addition, rheumatoid synovial fluid Pg competes with normal plasma Pg for binding to the receptor on rheumatoid synovial fibroblasts but not on normal synovial fibroblasts. We also found that binding and activation of rheumatoid synovial fluid derived Pg on the surface of rheumatoid synovial fibroblasts elicits a rise in the concentration of cytosolic free Ca2+ similar to that of normal plasma Pg. Our data suggest that the inability of rheumatoid synovial fluid Pg to bind to L-lysine Sepharose is due to minor structural changes in kringle 1-3. These changes do not affect the physiological properties or the binding ability of synovial fluid Pg to cellular receptors on cells obtained from rheumatoid synovial tissue.
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PMID:Molecular abnormalities of human plasminogen isolated from synovial fluid of rheumatoid arthritis patients. 918 80


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