Pseudomelanosis duodeni: association with hypertension and chronic renal failure: case report.

We present the first reported case with typical endoscopic and histological findings from Thailand. An 80-year-old man presented with chronic periumbilical abdominal pain for 3 months and melena for one week. He had had hypertension for 17 years, chronic renal failure for 4 years and gouty arthritis for 3 years. Panendoscopy was done and showed diffusely scattered small black and brown pigmentation over the stomach and duodenum. Tissue biopsies from the black pigmented lesions were taken for further microscopic and histochemical evaluation. Histological finding and special histochemical stains, Fontana stain, revealed mild chronic inflammation with accumulation of hemosiderin pigment in the lamina propria of the stomach and duodenal villi. This condition is called Pseudomelanosis duodeni. The literature of this condition was also reviewed.

Tofo gotoso / Thophaceous gout

Apresentamos um caso clínico de gota com tofos gotosos exuberantes, de localizaçäo habitual e lesöes incomuns do tipo pustulosas nas palmas das mäos que também continham cristais de monourato de sódio. Atualmente estes casos näo säo frequentes devido ao diagnóstico precoce e tratamento eficaz da doença.

Paraparesia por gota / Paraparesis in gout

Os autores apresentavam um caso de bloqueio de canal raquidiano por tofo em paciente de 23 de idade com gota tofácea crônica e artrite gotosa, que desenvolveu paraparesia crural. Submetido a laminectomia, com exérese de acúmulos de cristais junto ao ligamento amarelo, näo houve melhora do déficit motor. A revisäo da literatura mostrou 9 casos previamente relatados

A clinical comparison of females and males with gouty arthritis.

Twenty-two (11.3%) of 194 gouty patients were female. The age at onset was earlier than the 40th year in only 4.5 per cent of the females compared with 19.7 per cent of the males. However, in 54.5 per cent of the female patients compared with 38.4 per cent of the males, the age at onset was 60 years or more. Although the initial manifestation of the disease was acute monoarticular arthritis, with involvement of the ankle joint being more commonly observed in the female patients (63.3%) than in the males (37.2%), and by contrast, with involvement of the first metatarsophalangeal joint (podagra) being more frequently noted in the males (45.9%) than in the females (22.7%). In subsequent attacks, oligoarticular arthritis and arthritis of the ankle joints were predominant features of the disease in both sexes. However, podagra was less frequently evident in the female patients (31.8%) than in the males (68.5%) as were tophi (18.2 and 31.4%, respectively); specifically, in those females with tophi, the tophaceous manifestation developed in all of them within four years of the onset of the disease compared with only 27.8 per cent of the males with tophi. Moreover, although provocative factors and associated diseases were present in both sexes, haematologic malignancy was more common in the females (22.7%) than in the males (2.9%). In conclusion, although the clinical features of gout in females are similar to those in males, gout in females is characterized by later onset of the disease, earlier development of tophi and arthritis of the ankle joint.

Clinical pattern of females with crystal-induced arthritis: gout and pseudogout.

Of the 228 patients with crystal-induced arthritis (194 cases of gouty arthritis, 34 cases of pseudogout) seen between 1976 and 1985 at the Medical Service of Chulalongkorn hospital in Bangkok, 46 of them or 20.2 per cent of the total were female. The females with crystal-induced arthritis included 22 cases of gouty arthritis and 24 cases of pseudogout. Pseudogout was seen more commonly than gouty arthritis during the 10-year period. Both types exhibited a similar pattern with regard to late onset of disease at age 60 or more (75% of the cases with pseudogout and 54% of those with gouty arthritis), monoarticular arthritis as the initial manifestation (83.3% of those with pseudogout and 59.1% of those with gouty arthritis), intermittent pattern (54.2% of those with pseudogout and 86.4% of those with gouty arthritis) and the presence of precipitating factors (37.5% of those with pseudogout and 45.5% of those with gouty arthritis). However, different patterns were observed with regard to the joint of involvement: the knee joint was the most commonly involved joint in pseudogout (75%) but the ankle joint was seen in cases of gouty arthritis (86.4%). Podagra was not observed in cases of pseudogout, although in 22.7% of the patients with gouty arthritis, it was the initial manifestation of the disease. In subsequent attacks of arthritis, monoarticular arthritis (61.5%) and knee joint involvement (75%) were the main features of pseudogout. Oligoarticular arthritis (63.2%) and ankle joint involvement (86.4%) were the main feature of gouty arthritis.(ABSTRACT TRUNCATED AT 250 WORDS)