Tophi Research Articles

The appropriate processing of tophi for microscopy.

The appropriate processing of tophi for microscopy.

The rise and fall of disease

C hanges in frequency, severity and geographic distribution of many common diseases, although superimposed on a substrate of diseases and major causes of death such as trauma and starvation which have not changed during recorded history, suggest a pattern that is of continuing importance. Viewed over the long term, the frequency and distribution of diseases rise and fall suggesting that many diseases have their own natural history in addition to the natural history of the disease in the individual patient. Striking examples have occurred in recent decades: the incidence of rheumatic fever and rheumatic heart disease has become much less frequent: coronary heart disease, uncommon before the 1920’s, became the leading cause of death, but this epidemic is subsiding. Cancer has moved into second place on the mortality list, but the incidence of cancer of some previously common sites has decreased remarkably. Identifiable Ancient Diseases. Clearly there are diseases which have persisted since ancient times. Bacteria and parasitism date back 2.5 million years, to paleozoic times. Ancient human remains such as Egyptian mummies show evidence of schistosomiasis [l], spinal abscesses characteristic of tuberculosis, gouty tophi and osteoarthritis (but no evidence of rheumatoid arthritis] [2,3]. Seneb, a sixth dynasty Pharaoh, is depicted as having had achondroplasia; Ruma, an 18th dynasty priest, had an atrophic leg and foot drop characteristic of poliomyelitis. Hippocrates clearly described epilepsy, mumps with orchitis, intestinal worms, fevers suggestive of malaria, cholecystitis, bladder stones, fractures, dislocations and abscesses. However, relatively few of the cases he described in beautiful detail are recognizable in terms of today’s diseases [1,4,5].

Crystal deposition diseases of the joints

HISTORICAL INTRODUCTION A crystal deposition disease may be defined as a pathological process associated with the presence of microcrystals, and in which the crystals are contributing to tissue damage. Gout is the best known joint disease of this type. The ancient Greeks suffered from gout, and the clinical descriptions and aphorisms of Hippocrates and his colleagues remain as valid today as they were in 420 B.C. Galan (138 201 A.D.) was able to fit gout into his concept of all disease being due to abnormal humours; the acute inflammation in the toes and other extremities, and the exuding, chalky, gouty tophi were thought by Galan to be good examples of the body trying to rid itself of evil, noxious subntances. This view was accepted until the 19th Century, and although clinical descriptions of gout continued to be improved upon by physicians all through the ages, many of whom suffered from the disease themselves, it was-not until the work of Sir Alfred Baring Garrod (1819-1907) that advances were made in the understanding of gout. It was Garrod, following on from the Swedish chemist Scheele, who confirmed that gout.9 tophi were salts of uric acid, and who showed that the blood of gouty sufferers precipitated uric acid salts particularly easily. Garrod postulated that gout was caused by the precipitation of the crystals, which then set the inflammatory process going. This was the origin of the concept of a crystal deposition disease.

Extradural spinal involvement by gout

A case of extradural gouty tophus in the lumbar region in a teen-age girl is presented as an addition to the differential diagnosis of erosive lesions of the spinal canal.

Nasal Gouty Tophus

<h3>To the Editor.—</h3> While collections of irritating, autologous, serum uric acid in unusual locations have been reported before, a case of symptomatic gouty tophus of the nose has not been annotated previously to our knowledge. <h3>Report of a Case.—</h3> A 66-year-old man has been in good health all of his life except for hyperlipoproteinemia and gout. Having known that he had gouty arthritis, he has been receiving probenecid since it was first released for medical use. His practitioner attempted to convert his therapy to allopurinol, but it stirred up his gout so much that the patient refused ever to try the medication again. Gradually over a three-year period the patient noticed that the bridge of his nose had become enlarged and that his eyeglasses no longer fit, causing diplopia (Fig 1). Because of this problem and its interference with the patient's driving, the tophus was removed surgically (Fig 2). Roentgenograms

Erythrocyte adenosine kinase activity in gout

1. 1. Erythrocyte adenosine kinase (AK) (EC 2.7.1.20) and guanosine monophosphate (GMP) reductase (EC 1.6.6.8) were measured in healthy male controls and primary gouty subjects. Adenosine kinase activity in 19 controls and 26 gouty subjects was 0.717 ± 0.176 and 0.615 ± 0.128 nmol/mg protein/h, respectively. The difference was statistically significant ( P < 0.05). GMP reductase activity in 39 controls and 46 gouty subjects was 30.90 ± 6.28 and 33.43 ± 7.97 μmol/mg protein/h, respectively, without statistically significant difference. 2. 2. When gouty patients were divided into two groups according to gouty heredity and/or tophus formation, a group with such clinical traits had a lower adenosine kinase activity when compared with another group having none of these clinical features ( P < 0.10). Adenosine kinase activity had negative correlations to serum urate level ( r = −0.433, P < 0.05) and to erythrocyte adenosine deaminase (ADA) activity ( r = −0.689, P < 0.05). The possible biochemical role of adenosine kinase activity in purine metabolism and in the pathogenesis of primary gout is discussed.

Gouty tophus of the true vocal cord.

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Tophectomy and Bone-Grafting for Extensive Tophi of the Feet

Tophectomy and Bone-Grafting for Extensive Tophi of the Feet

Pseudoxanthomatous Rheumatoid Nodules

Two cases of patients with an unusual form of rheumatoid nodules closely resembling tendon xanthomas are reported. The disease process was mistakenly diagnosed by numerous physicians as xanthomatosis in one case and as gouty tophi in the second case. The differential diagnosis of rheumatoid nodules rests on clinical and laboratory findings plus histologic confirmation. Occasionally, the onset of nodule formation antedates the onset of arthritis, adding to diagnostic confusion. This is to be distinguished from the entity, pseudorheumatoid nodules, which has been proposed to explain those rare cases where clinically and pathologically typical nodules persist over many years without the development of associated signs of rheumatoid arthritis. The development of x-ray demonstrable "punched out" bony radiolucencies in association with subcutaneous rheumatoid nodules is stressed.

When an Ear Nodule Hurts

A nodule on the ear rarely escapes attention. Discovery is usually made by the patient, who is worried about cancer, or by the physician, who can use the nodule to identify another disease. The chalky urate deposits in the gouty tophus (Figure,<i>left</i>), and the subcutaneous nodule of rheumatic fever (Figure,<i>center</i>) reflect visible evidence of generalized disease well known to all physicians. Microscopic examination will provide a diagnosis in questionable cases, as well as identify carcinoma when suspected. Pain is notably absent from all nodules of the ear, except one.<i>Painful nodule of the ear</i>, formerly called nodular chondrodermatitis (Figure,<i>right</i>), is an uncommon disorder which is characterized by exquisite tenderness far out of proportion to its insignificant appearance. The nodule is located in the skin, and cartilage is only secondarily affected, if at all. A compromised blood supply is probably responsible for the lesion, but the exact nature

Preliminary observations on local pH in gouty tophi and synovial fluid.

Preliminary observations on local pH in gouty tophi and synovial fluid.

Experimental investigations into the origin of gouty tophi

Experimental investigations into the origin of gouty tophi

EXPERIMENTAL INVESTIGATIONS INTO THE ORIGIN OF GOUTY TOPHI.

EXPERIMENTAL INVESTIGATIONS INTO THE ORIGIN OF GOUTY TOPHI.

"STUDIES ON THE NATURE OF GOUTY TOPHI" BY MAX FREUDWEILER, 1899. (AN INFLAMMATORY RESPONSE TO INJECTED SODIUM URATE, 1899). AN ABRIDGED TRANSLATION, WITH COMMENTS.

Excerpt INTRODUCTION Recently a rapid, simple technique using polarized light microscopy for urate crystal identification in synovial fluid was developed by McCarty and Hollander.*Acute gouty attac...

Acute gout associated with chronic myelogenous leukemia.

Case Reports1 May 1958ACUTE GOUT ASSOCIATED WITH CHRONIC MYELOGENOUS LEUKEMIAFRANK M. BLANTON, M.D.FRANK M. BLANTON, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-48-5-1118 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptMyelogenous leukemia and gout, two distinct diseases of unknown etiology, have in common a disorder of uric acid metabolism which is manifested clinically by an elevation of the blood uric acid. The simultaneous occurrence of these two otherwise unrelated diseases is of interest and is illustrated by the following case report.CASE REPORTA 72 year old Negro male was admitted to the Medical College of Virginia Hospital in March, 1952. He gave a two-week history of chest pain, cough, fever, chills, dyspnea and hemoptysis. On examination the temperature was 100.8° F.; pulse, 88; respiration, 20; blood pressure, 160/80 mm....Bibliography1. ThornEmerson GWK: Gout, in Principles of internal medicine, edited by T. R. Harrison, 1951, The Blakiston Co., Philadelphia, p. 697. Google Scholar2. BarrickMiller LEJR: Gout, a review, Quart. Bull., Northwestern Univ. M. School 17: 133, 1943. Google Scholar3. Forkner CE: Leukemia and allied disorders, 1938, Macmillan Co., New York. CrossrefGoogle Scholar4. Wintrobe MM: Clinical hematology, 3d Ed., 1951, Lea and Febiger, Philadelphia. Google Scholar5. Shorvon LM: Gout in leukemia, report of a case, Lancet 2: 378, 1946. CrossrefMedlineGoogle Scholar6. McEwan T: Chronic myeloid leukemia associated with gouty tophi: report of a case, Glascow M. J. 30: 185, 1950. Google Scholar7. TinneyPolleyHallGiffin WSHFBEHZ: Polycythemia vera and gout: report of eight cases, Proc. Staff Meet., Mayo Clin. 20: 49, 1945. Google Scholar8. Hickling RA: Gout, leukemia, and polycythemia, Lancet 1: 57, 1953. CrossrefMedlineGoogle Scholar9. BronskyBernstein DA: Acute gout secondary to multiple myeloma: a case report, Ann. Int. Med. 41: 820, 1954. LinkGoogle Scholar10. KravitzDiamondCraven SCHDLF: Uremia complicating leukemia in chemotherapy, J. A. M. A. 140: 1595, 1951. CrossrefGoogle Scholar11. SandbergCartwrightWintrobe AAGEMM: Studies on leukemia. I. Uric acid excretion, Blood 11: 154, 1956. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Richmond, Virginia*Received for publication October 12, 1956.From the Blood and Spleen Clinic, Outpatient Department, Medical College of Virginia Hospital.Requests for reprints should be addressed to Frank M. Blanton, M.D., 828 West Franklin Street, Richmond 20, Virginia. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byAn Analysis of Medical Problems In CancerRHEUMATISM AND ARTHRITIS: REVIEW OF AMERICAN AND ENGLISH LITERATURE OF RECENT YEARS (THIRTEENTH RHEUMATISM REVIEW)*CHARLEY J. SMYTH, M.D., F.A.C.P., ROGER L. BLACK, M.D., FELIX E. DEMARTINI, M.D., IVAN F. DUFF, M.D., F.A.C.P., EPHRAIM P. ENGLEMAN, M.D., F.A.C.P., DONALD C. GRAHAM, M.D., F.R.C.P.(C), MAX M. MONTGOMERY, M.D., F.A.C.P., HOWARD F. POLLEY, M.D., F.A.C.P., EDWARD F. ROSENBERG, M.D., F.A.C.P., CARLOS F. SACASA, M.D., F.A.C.P., OTTO STEINBROCKER, M.D., HANS WAINE, M.D., GEORGE M. WILSON JR., M.D.Moderne Gichtprobleme Ätiologie, Pathogenese, Klinik 1 May 1958Volume 48, Issue 5Page: 1118-1121KeywordsArthritisBloodChronic myelogenous leukemiaGoutOutpatient clinicsPolycythemiaRespirationSpleenTemperatureUric acid ePublished: 1 December 2008 Issue Published: 1 May 1958 PDF downloadLoading ...

Conjunctival tophi associated with gout.

Conjunctival tophi associated with gout.