RESUMEN

Cytological signs of the synovial imprint preparation have been correlated with findings of systemic, histomorphologic and arthroscopic inflammatory symptoms in 123 patients with rheumatic arthropathies. Out of the observed cellular and non-cellular structures of the synovial imprint cytology, fibrin, fibrinous necroses and relations of neutrophil polymorphs, as well as synovial phagocytes, reflect the acute inflammatory activity of the joint examined. The content in synovial imprint preparation of cells and cell groups are manners of expression both of the acute and proliferative activity as well as basic activity, respectively, of the synovial membrane. The synovial imprint cytogram's number of giant cells correlates with the histomorphologic degree of severity of the local proliferative inflammatory activity. Correlations between the level of the 1-h-value of the erythrocyte sedimentation rate (ESR) and the imprintocytological finding cellular distribution density, as well as relations between synoviocytes and neutrophil polymorphs, had to be demonstrated statistically. No correlations, however, were found between cytologic structures of inflammatory activities of the synovial imprint cytogram and the differential cell picture of the associated serosynovitis.

Asunto(s)

RESUMEN

By means of a catamnestic study diagnostic evidence, number of complications and examination-conditioned stress of the patient caused by needle biopsy of the synovial membrane were tested. 4-11 years after a blind biopsy of the synovial membrane carried out on account of rheumatological indication 80 patients (48 males, 32 females) were examined and the results of the preliminary examination and the secondary examination were compared with the findings of the needle biopsy of the synovial membrane. While the needle biopsy of the synovial membrane in rheumatoid arthritis has a high diagnostic value in comparison to clinical and paraclinical findings, in the histomorphological ascertainment of the uric arthritis the catamnestic study shows the limits of the method due to place-depending differences of the findings of the crystalline deposit in the synovial membrane. The number of complications of the investigation technique was insignificant and had no influence on the duration of the inability to work. As a highly specialised diagnostic method the blind biopsy of the synovial membrane may contribute to the clarification of problem cases in institutions with rheumatological profile without possibility of arthroscopy.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Disturbances of the renal function, urolithiasis and hypertension are observed in a high percentage already in the asymptomatic stage of the primary hyperuricaemia. They determine above all the fate of the patient with gout. In primary uric arthritis over-accidentally frequently obesity, steatosis hepatis, hyperlipoproteinaemias, manifest diabetes mellitus and premature arteriosclerosis are found, without up to now proving a causal connection. Also these diseases often coin the clinical picture and demand particular attention in the diagnostics of patients with gout.

Asunto(s)

RESUMEN

To the most important prophylactic measures for the prevention of a disturbance of the purine metabolism belong the normalisation of the body-weight, a mixed diet without protein carriers containing much purine, a regular physical activity, a life without hectic conditions as well as without an excess of conflict situations and a moderate taking of alcohol. These recommendations are of particular importance for patients endangered by gout. In patients with hyperuricaemia they form the basic treatment for the prevention of a uric arthritis, a urate nephrolithiasis and a gouty nephropathy. The clinical and paraclinical results of the directives must be continuously tested with regard to the effectiveness. To the comprehensive prophylaxis also belong the preventive measures against an associated disturbance of an associated disturbance of metabolism or concomitant disease. An additional medicamentous therapy is necessary, when the success of the basic therapy is insufficient and there are already organ manifestations of a disturbance of the purine metabolism. The application of antihyperuraemic drugs corresponding to types should be performed by uricostatic drugs, uricosuric drugs and citric acid-citrate mixtures. The approach according to a 3-step-programme is most useful. In the treatment of the concomitant diseases certain preventive measures are to be taken into consideration. The therapy of an acute attack of gout is at present without any essential problems. Patients with disturbances of the purine metabolism need a permanent care by the physician.

Asunto(s)

RESUMEN

The articular chondrocalcinosis--conditioned by the formation of crystals of calcium pyrophosphate dihydrate in the joint cartilage--increasingly gains clinical interest. The symptomatology is multivariant: mono-, oligo- and polyarticular with simultaneous localisation in the discs. Characteristic, but not proving, is the calcification demonstrated in the X-ray picture. Apart from the familial forms increasingly are observed spontaneous, solitary cases in persons older than 50 years (in 3% of all postmortem examinations). The chondrocalcinosis gains differential-diagnostic importance as to primary osteoarthroses, attacks of gout, rheumatoid arthritis and other diseases of bones and joints. It appears symptomatically in hyperparathyroidism and hemochromatosis. The present paper gives as survey on the modern state of knowledge concerning clinic, heredity, diagnostics and pathogenesis.

Asunto(s)

Asunto(s)

RESUMEN

The Lesch-Nyhan syndrome - the complete absence of hypoxanthine-guanine-phosphoribosyl transferase - was also found in some cases in the GDR. On the basis of a literature study considering the reports on 55 cases found in the world literature it can be stated that besides the disturbance of the purine metabolism symptoms of the dysfunction of the extrapyramidal system, especially of the stem ganglia, are never absent. The syndrome shows a multitude of neurological and psychiatric variants which cannot be explained exclusively by the loss of the enzyme activity. In the individual families new mutations of the gene locus are present, the phaenotypology of which can also be explained by variable compensatory activation of other enzymes, by physico-chemical variants of the inactive enzyme protein and by its antigenic effectiveness. The research work about this - also genetically interesting - syndrome has not been completed yet. But it points to the vital importance of the urine re-utilisation, especially in the early phase of brain maturing.

Asunto(s)

RESUMEN

The present paper adopts a definite attitude to the differentiated therapy of the disturbances of the uric acid metabolism. This demands an exacter subdivision of the kind of the metabolic disturbance (types Ia, Ib, IIa, IIb, and III). On the basis of this classification in types an individually adapted therapy is possible. It might form the prerequisite of a still more effective meeting of the nephrogenic complications of the gout and of the reduction of the side effects of the necessary permanent therapy.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

In 31 out of 35 patients with retinal thromboses metabolic disturbances were found. 11 patients showed disturbances of lipid, purine and carbohydrate metabolism and hypertension. In 19 further cases hyperuricaemia was found, usually combined with hypotriglyceridaemia. Two young women with branch vein thrombosis and pathological metabolic values were taking hormonal contraceptives. The possible relationships between vein thromboses and metabolic disturbances are discussed.

Asunto(s)

RESUMEN

The therapy of gout is discussed taking into consideration the concomitant diseases occurring significantly frequently in patients with gout: Hypertension, uric acid-nephrolithiasis, hyperlipoproteinaemia, obesity, premature arteriosclerosis as well as diabetes mellitus. In contrast to other opinions the authors are of the opinion that the dietetic treatment is furthermore of essential importance. It is referred to the still allowed sufficiently great number in the supply of nourishment, in which cases, however, the limitations in the supply of calories, protein or purin bodies, respectively, lipid and carbohydrate do not remain unmentioned. The propositions for the medicamentous treatment essentially correspond to the central therapeutic recommendations. For the acute attack of gout, however, following to the international experiences, the colchicine therapy is more emphasized again. The medicamentous therapy of the asymptomatic hyperuricaemia is to be included into the considerations after full exhaustion of all dietetic and other possibilities in constant increase of the serum-uric acid-level more than 8 mg/dl.

Asunto(s)

RESUMEN

The arthritis urica is defined as a relatively rare, at the same time facultative symptom of different metabolic and other disturbances (primary and secondary gout). As a rule it is observed only several years of the beginning of the hyperuric-anemia nearly exclusively in males and is only one form of manifestation of the wide-spread complex gout syndrome. It is proposed to supplement the criteria for gout or arthritis urica of Rome 1961 and New York 1966 by new knowledge on the uncharacteristic gouty arthropathy. It is particularly referred to method problems of the determination of uric acid in the serum.

Asunto(s)

RESUMEN

Gout may present in such atypical forms as "primary-chronic", "masked", or "asymptomatic gout at all stages affecting almost any joint. These uncharacteristic presentations were found in 22 out of 124 patients observed. The disease of 4 patients is described as casuistics. Important conclusions of practical use for early diagnosis and early treatment are drawn. Every arthropathy in a male where the diagnosis is not certain, must be suspected as being due to gout. The diagnosis can be assured by detecting urate deposits in the tissue. Determinations of the serum uric acid level can only be indicative since they are subject to a variety of influences. In early disease the x-ray appearances may be described as normal; in later disease as "degenerative" in the joints or in the vertebral column. In an acute relapse the colchicine-test is of high specifity, but its interpretation may be difficult in the primary chronic forms. The other clinical manifestations of the gout syndrome are of high value for the selection of patients in whom urate deposits in the tissue must be sought.

Asunto(s)