Isolated intraosseous gout in hallux sesamoid mimicking a bone tumor in a teenaged patient

We are reporting an unusual case of isolated intraosseous tophus in medial hallux sesamoid presenting as tumor-like lesion in a teenage patient without prior history of gouty attack and underlying systemic disorders. The lesion manifested isointensity to surrounding muscles with internal low signal on spin echo (SE) T1-weighted images, and heterogeneous low signal intensity on fast spin echo (FSE) T2-weighted images. Computed tomography (CT) scan disclosed expansion and diffusely increased attenuation of the medial hallux sesamoid with focal cortical erosion and extraosseous extension of high attenuation content. The subsequent resection and pathology revealed intraosseous tophus deposition, which is particularly rare at this site and at this age. Imaging studies revealed some characteristic imaging features which can retrospectively be attributed to gouty tophus. When an expansile osteolytic lesion manifesting low signal intensity on T2-weighted image and internal calcifications on CT scan is encountered, the possibility of intraosseous tophus should be included in the list of differential diagnoses, even in a teenage patient without prior history of gout.     

痛风的影像学表现(附37例分析)

本文报告37例痛风影像学表现并进行文献复习。30例多个关节受累,24例呈两侧对称性侵犯。提出骨关节损害X线表现有11种,特别是囊性膨胀性破坏、骨内钙化点、蜂窝状破坏、恶性肿瘤样溶骨性破坏、指骨皮质不规则增厚,丰富了痛风的X线诊断学知识。尿酸盐沉积在肾脏、心脏,造成超声图像上显示强光点,声影不明显,具有一定的特异性,文献上未见记载。我们称为“痛风肾”、“痛风心脏”的超声学表现。     

痛风性关节炎28例误诊分析

本文报导１９７０～１９９２年间门诊所见３０例原发性痛风性关节炎的诊断问题。其中首诊正确率仅６．６％（２例）。误诊为风湿或类风湿性关节炎２１例（７０％）；误诊为姆趾滑囊炎７例（２３．３％）。如此误诊情况为过去文献中少见。对误诊原因进行了讨论，认为对本病认识不足和检查病人不仔细是误诊的主要原因。作者指出，早期诊断痛风性关节炎的关键是：典型的发病过程；高尿酸盐血症和秋水仙硷试验阳性。     

Bone infarction in gout

A retrospective analysis of 28 consecutive cases of gout revealed nine (32%) with radiographic evidence of bone infarction. The radiographic manifestations of bone ischemia and the possible mechanism of infarction in gout are discussed.     

Purine synthesis de novo in cultured lymphoblast cells derived from patients with gout

Summary Rates of de novo purine synthesis in lymphoblast cell cultures derived from ten patients with gout were compared with those from control individuals. Since the rate of de novo purine synthesis was dependent on the growth rate of the culture, an assay procedure was developed to account for the variation in lymphoblast growth rates and to permit valid quantitative comparison between purine synthesis in each cell line. Clear differences were demonstrated between the rates of purine synthesis in cells from normal control subjects and those from patients with a deficiency of hypoxanthine-guanine phosphoribosyltransferase activity (HPRT-deficient). Lymphoblasts from the gouty patients showed purine synthesis either within the normal range or intermediate between this and the HPRT-deficient cells. In patients having normal renal function, de novo purine synthesis of lymphoblast cells correlated with the degree of urate production as reflected by the urinary excretion of urate over a 24 h period. Three patients, with demonstrable excessive production of urate in vivo, exhibited increased purine synthesis in lymphoblasts. This increased synthesis did not appear to result from any of the enzyme mutations currently recognized as responsible for abnormal purine metabolism.     

复方豨莶草胶囊治疗反复性痛风性关节炎的临床疗效观察

目的：观察复方豨莶草胶囊治疗急性痛风性关节炎的临床疗效。方法：将130例急性痛风性关节炎患者随机分为2组，治疗组（65例）采用复方豨莶草胶囊，对照组（65例）采用扶他林和别嘌呤醇治疗，观察治疗前后血尿酸的变化及临床疗效。结果：与对照组相比，治疗组血尿酸变化无统计学差异（P〉0．05）；临床疗效2组间无统计学差异（P〉0．05）；治疗组患者用药期间不良反应少。结论：复方豨莶草胶囊治疗反复性痛风性关节炎疗效确切，不良反应少。     

Cervical Myelopathy due to Gouty Tophi in the Intervertebral Disc Space

Summary.  Gout, like diabetes mellitus, is a common metabolic disorder. Typically affecting the distal joint of the appendicular skeleton, its occurrence in the spine is rare. We report the case of a 68-year-old male with a long history of diabetes mellitus and hyperuricemic gout. Neck pain developed over two weeks with subsequent quadriparesis, with concomitant subcutaneous deposition of gouty tophi in the right elbow. Magnetic resonance image of the cervical spine revealed multiple segmental narrowing of the thecal sac at the C3–6 levels due to hypertrophic spurs and bulging discs. Anterior discectomies of C3–4 and C4–5 were performed, with a chalky-white, granular material noted in the C4–5 disc space. Histological examination of the surgical specimen revealed deposits of needle-like crystals surrounded by histiocytes and multinucleated giant cells, with the appearance compatible with gout. The patient was ambulatory with the assistance of a walking frame six months after the operation. We emphasize that gouty tophi can be deposited in the spine over a relatively short time, subsequently precipitating a variety of symptoms, from pain to cord compression. The regular administration of antihyperuricemia drug treatment for hyperuricemic gout is necessary to prevent this deposition. If neurological defects are found, surgical decompression can provide satisfactory results.     

肾移植术后痛风的预防和高尿酸血症的治疗

目的 探讨肾移植术后高尿酸血症和痛风的防治策略。方法 分析461例肾移植患者的临床资料。结果 发生血尿酸增高者42例，其中痛风2例，移植肾盂或输尿管结石3例，随访1～5年，4例患者血尿酸控制不理想，其余血尿酸均在正常水平。结论 高尿酸血症在肾移植术后较常见，主要与环孢素A的作用有关，肾移植术后痛风的发生率较低，其确切的原因目前尚不清楚。合理饮食、药物治疗可降低高尿酸血症及痛风的发生。     

痛风颗粒治疗痛风性关节炎的实验研究

［摘要］目的观察痛风颗粒对急性发作期痛风性关节炎大鼠的治疗作用，初步探讨其作用机制。方法用痛风颗粒治疗尿酸钠诱导的急性痛风性关节炎模型大鼠，并设有空白对照组、模型对照组、西药对照组，观察治疗前后受试关节周径、关节腔组织和血浆中前列腺素E2（PGE2）含量、关节腔积液中白细胞数量的变化。结果用药后，模型大鼠受试关节周径明显缩小，肿胀率下降（P＜0.05，P＜0.01），关节周围组织和血浆PGE2含量及关节腔积液中白细胞数量下降（P＜0.05，P＜0.01）。结论痛风颗粒可以有效抑制急性痛风性关节炎模型大鼠关节肿胀。其作用机制可能是通过抑制白细胞向炎症局部的聚集和炎症递质PGE2的分泌。     

高尿酸血症患者急性痛风发作的相关因素分析

目的 探讨和分析高尿酸血症患者痛风发作的高危因素,以便及时采取相应对策,降低痛风发作的风险.方法 对1 847例高尿酸血症患者的健康体检资料进行回顾性调查及问卷调查,对痛风高危因素,如年龄、性别、病程、血糖、血脂、血尿酸以及合并症情况进行单因素分析和Logistic回归分析.结果 性别、阳性家族史、体重指数、暴饮暴食以及合并高血压、高脂血症对高尿酸血症患者痛风发作有显著影响(均P＜0.01).结论 医护人员应熟知急性痛风发作的高危因素及其诱发因素,加强对患者的健康教育,制定针对不同高危因素的措施,以减少高尿酸血症患者痛风发作的风险.