1/5. Acute paraplegia in a patient with spinal tophi: a case report.A 28-year-old man with a 5-year history of gouty arthritis suffered from an acute episode of lower back pain. He visited a rehabilitative clinic and received physical therapy following his examination. Weakness and numbness of both lower legs developed rapidly after physical therapy. He was sent to our hospital with complete paralysis of both lower limbs and complete sensory loss below the umbilicus 3 hours after the physical therapy. No peripheral tophi were found. myelography showed an extrinsic compression of the dura sac at T10. Emergency decompressive laminectomy of T9 to T11 was performed. During the surgery, caseous material was found deposited in the ligamentum flavum and the left T9 to T10 facet joint, with indentation of the dura sac. The pathologic diagnosis was spinal tophi. After surgery, the patient's neurologic function recovered rapidly. It was suspected that inappropriate physical therapy might have aggravated acute inflammation of spinal gout and resulted in a rapid deterioration of neurologic function. Though gout is a chronic medical disease, an acute attack of spinal gout may be disastrous and requires emergency neurosurgical intervention.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Chronic myeloid leukemia presenting as gout.A 53-year-old man presented with gouty arthritis. A physical examination and haematological and biochemical tests showed that he had chronic myeloid leukemia. He was treated with allopurinol, hydroxyurea and analgesics. The arthritis subsided completely within 2 weeks. He continues in haematologic remission (on interferon) with no further recurrence of the gout.- - - - - - - - - - ranking = 3.3137719343649keywords = physical examination, physical (Clic here for more details about this article) |
3/5. An atypical case of primary renal tubular hypokalaemic metabolic alkalosis with chronic tophaceous gout.A 55-year-old woman was referred to our ward for further evaluation of marked hyperuricaemia and suspected tophi. On physical examination, huge subcutaneous nodules were observed on the knee joints as well as a small nodule on the lateral side of the left sole. Blood chemistry showed marked hyperuricaemia (0.85 mmol/l), hypokalaemia (2.7 mmol/l) and a mild degree of renal insufficiency. Arterial blood gas analysis showed signs of metabolic alkalosis. Daily urinary uric acid excretion on a purine non-restricted diet was 8.9 mmol/day. uric acid clearance and fractional uric acid clearance were 0.8 ml/min and 2.6%, respectively. plasma renin activity was 21.8 ng/ml/h, and plasma angiotensin ii and aldosterone concentrations were 61 and 121 pg/ml, respectively. However, pressor response to an intravenous administration of angiotensin ii was normal. The urinary calcium to creatinine molar ratio was 0.069, and serum magnesium concentration was normal to supranormal. A biopsy of the subcutaneous nodule showed a typical appearance of tophus. Based on these findings, the patient was diagnosed with an atypical case of renal tubular hypokalaemic metabolic alkalosis, with marked hyperuricaemia and tophi as the initial manifestations. So far, only four cases of Bartter's syndrome with gout and/or hyperuricaemia have been described in japan. This rare case is presented and its mechanism of hyperuricaemia discussed.- - - - - - - - - - ranking = 3.3137719343649keywords = physical examination, physical (Clic here for more details about this article) |
4/5. gout-induced arthropathy after total knee arthroplasty: a report of two cases.gout, although relatively rare in joint replacements, can present as an acute or chronic painful knee or hip arthroplasty. gout and acute infection of a joint replacement can be difficult to differentiate, with the physical examination and laboratory study results frequently being similar. Both conditions can present with a rapid onset of joint pain, swelling, erythema, and constitutional symptoms, including fevers and malaise. Laboratory findings in both conditions often include an elevated leukocyte count, erythrocyte sedimentation rate, and c-reactive protein level. Negatively birefringent, needle-shaped crystals in the synovial fluid confirm the diagnosis of gout. The mistaken diagnosis of septic arthritis in a joint replacement with crystal-induced synovitis can lead to inappropriate open debridement or component removal. The current study includes a review of the literature and presents two cases of gout after total knee arthroplasty. These cases suggest that in situations of suspected sepsis without synovial fluid crystals, operative intervention is indicated with a presumed diagnosis of septic arthritis. The identification of chalky white or yellow deposits in the synovium or bone is highly suggestive of gout. The definitive diagnosis is made by polarized light histologic evaluation of these tissues. If these deposits are present in the absence of a positive preoperative culture, positive Gram stain for bacteria, or component loosening, component retention is indicated.- - - - - - - - - - ranking = 3.3137719343649keywords = physical examination, physical (Clic here for more details about this article) |
5/5. Septic arthritis and calcium pyrophosphate deposition disease in the setting of chronic gout.Septic arthritis is a medical and surgical emergency that if left untreated may lead to permanent joint disfigurement and loss of function. In the setting of chronic joint disease, the diagnosis, based on history and physical examination, may be difficult. A case is reported of a patient with a history of aspirate-proven gout presenting with symptoms of typical gouty exacerbation but diagnosed as septic arthritis and pseudogout.- - - - - - - - - - ranking = 3.3137719343649keywords = physical examination, physical (Clic here for more details about this article) |