[Hyperuricemia--does modern therapy improve life expectancy?]. / Hyperurikämie--wird durch moderne Therapie die Lebenserwartung verbessert?

Today hyperuricaemia and gout are likewise seen in every population of the western industrial world and have been increasing since the fifties. As known from number of studies hyperuricaemia often occurs in connection with hyperlipoproteinaemia, obesity, diabetes mellitus, arterial hypertension and atherosclerosis. Up to now it was not clear whether one disease caused the other. In 1988 Abbot could prove that among men, those afflicted by gout as compared to those without gout experienced a 60% excess of coronary heart disease. Therefore, patients with gout should receive a regular thorough cardiovascular evaluation. Furthermore risk factor levels which predispose to coronary heart disease, arterial hypertension and gout should be reduced. There is a significant positive correlation between the plasma uric acid levels and the prevalence of attacks of gouty arthritis and nephrolithiasis. It is possible to avoid gouty arthritis, tophi and nephrolithiasis with a consequent diet and medical treatment. Unfortunately, many patients interrupt therapy during intervals free of pain. The consequence is that even today the complications of hyperuricaemia cause days of inability to work and to earn one's living, despite of modern therapy. Hyperuricaemia not sufficiently treated reduces the quality of life through attacks of gout, chronic gout and nephrolithiasis as well as life expectancy caused by nephropathy, arterial hypertension and atherosclerosis. This is of special importance because of the frequency of gout and hyperuricaemia in our population. An early diagnosis, a consistent therapy and a thorough monitoring could stop an increase of this disease and prolong life expectancy for those who have gout and the other attendant diseases.

Allopurinol and oxypurinol in human breast milk.

To pregnant or breast feeding women drugs should be given with caution. We report the case of a 5-week-old breast-fed infant whose mother was taking 300mg allopurinol/day for 4 weeks. Allopurinol and oxypurinol were detected by HPLC in maternal plasma and breast milk with a method first described here. In infant's plasma taken 2 h after breast feeding oxypurinol was found; allopurinol was below the limit of detection. The milk/plasma ratio in the mother 2 h (4 h) after drug ingestion was 0.9 (1.4) for allopurinol and 3.9 (2.4) for oxypurinol. The average daily dose for the baby of allopurinol was 0.14-0.20 mg/kg and that of oxypurinol 7.2-8.0 mg/kg by ingestion of breast milk after oral intake of allopurinol by the mother.

[Blastocystis hominis as a rare arthritogenic pathogen. A case report]. / Blastocystis hominis als seltener arthritogener Erreger. Ein Fallbericht.

Blastocysts hominis, a protozoon considered to be a nonpathogen intestinal commensal, is now discussed to be a cause of intestinal infection under certain circumstances, e.g., immunosuppression. There are two published cases of Blastocysts infection complicated by arthritis which was classified as "reactive" in one case, "infectious" in the other. We report a third case: A 46-year-old female patient developed a chronic diarrhea and oligoarthritis some days after returning from a trip to Senegal. Arthritis was refractory against treatment with NSAID and corticosteroids. Finally, a 3-week course of treatment with metronidazole resulted in a complete remission of arthritis, gastrointestinal symptoms, and inflammation signs (ESR, CRP). The course in our case, as well as the detection of Blastocysts hominis in synovial fluid in another case, implicate an infectious rather than a reactive etiology of arthritis.

Pharmacokinetics and pharmacodynamics of different doses of Irtemazole in repeated application.

Irtemazole, a new uricosuric substance, was tested in 12 normouricemic subjects in doses between 6.25-37.5 mg applied twice daily for 7 days per os. The plasma uric acid level decreased in all subjects, to a constant level within 1-2 days with application of the higher doses, and within 2-3 days with application of the lower doses, and was maintained as long as irtemazole was given. The average decrease of plasma uric acid was 20.4% at a dose of 6.25 mg irtemazole, 22.7% at 12.5 mg, 42.0% at 25 mg, and 45.7% at 37.5 mg. The renal uric acid excretion and the uric acid clearance increased to a constant level within 1 day of irtemazole application. The initial levels of plasma uric acid, uric acid excretion, and uric acid clearance were reached after 1-2 days after cessation of irtemazole. Within 1 to 2 days after ingestion of irtemazole a constant plasma irtemazole level and renal irtemazole excretion were observed in all doses throughout the application period. One to 2 days after discontinuation of irtemazole it was no longer detectable in plasma and urine. No side effects were found.

Pleural effusions in acute mononucleosis.

A case of acute infectious mononucleosis with pleural effusions as rare complication is reported. This complication is detectable by ultrasonographic examination, often performed in the follow-up of affections of liver and spleen in infectious mononucleosis. It should also be regarded in the differential diagnosis of pleural effusions.

Relapsing polychondritis presenting as cutaneous polyarteritis nodosa.

Relapsing polychondritis is an infrequently diagnosed, though not necessarily uncommon, systemic disorder characterized by recurrent and potentially destructive inflammation of cartilaginous structures, the eye, and the audiovestibular and cardiovascular systems. Although dermal involvement occurs in approximately 25% of patients with relapsing polychondritis, in only few cases has a skin biopsy been obtained revealing lesions such as leukocytoclastic vasculitis, livedo reticularis, erythema nodosum or keratodermia blenorrhagicum. We describe a patient with relapsing polychondritis in whom a cutaneous polyarteritis nodosa preceded cartilage inflammation by 6 months. Cutaneous polyarteritis nodosa is a rare form of vasculitis that appears to be limited primarily to the skin, muscles, and joints. In contrast to the systemic form of the disease it is characterized by the absence of visceral lesions and a relapsing but benign course. The present case and the fact that vasculitis is a concomitant feature in approximately 30% of patients with relapsing polychondritis [21] demonstrates that this condition may not represent a distinct clinical entity.

Pyogenic hepatic abscess: long resolution time despite adequate therapy.

A 50-year-old male patient with a pyogenic hepatic abscess was successfully treated with an antibiotic regimen and percutaneous drainage of the abscess. Although this treatment was successful, it took more than 3 months for the abscess cavity to be completely resolved. A slow resolution of hepatic abscesses is therefore no evidence for the ineffectiveness of treatment.

Uricosuric effect of different doses of irtemazole in normouricaemic subjects.

Irtemazole 12.5 to 50 mg in 6 healthy, normouricaemic subjects caused a maximal decrease in plasma uric acid (after 8 to 12 h) of 46.5%. The uricosuric effect began during the first 60 min after drug administration and it lasted for 7 to 24 h. Renal uric acid excretion returned to its base line value after 8 to 16 h and uric acid clearance after 10.0 to 12.0 h. Doses of irtemazole between 12.5 and 37.5 mg produced a dose-related rise in the uricosuric effect. There was no essential difference between the uricosuric effect of 37.5 mg and 50 mg irtemazole. The D50 dose (that producing a half-maximal effect) was between 16.3 mg and 34.2 mg, (average 24.7 mg). The value of irtemazole in the management of hyperuricaemia and gout remains to be determined.

[Inflammation mediated osteopenia (IMO): therapeutic effect of D-hormone and the role of cytokines]. / Inflammationsmediierte Osteopenie (IMO): Therapeutischer Effekt von D-Hormon und die Rolle der Zytokine.

Inflammation-mediated osteopenia is an animal model for bone mass reduction following chronic inflammation. We found a reduction of calcitriol serum concentrations during the inflammatory process, in addition cytokines are increased. Treatment of the animals with calcitriol is able to prevent bone mass reduction and to preserve bone formation.

[Extraskeletal Ewing sarcoma: differential diagnosis of a soft tissue tumor]. / Extraskeletales Ewing-Sarkom: Differentialdiagnose eines Weichteiltumors.

We report on a 30-year-old man from Vietnam who complained about diffuse pain in the left epigastrium. Using the ultrasound a pleural effusion in the left recessus costodiaphragmaticus was found. The chest X-ray showed a paravertebral soft-tissue tumor at the left side, with CT and NMR a sarcoma was suspected. The patient was treated by local resection of the tumor, histologically an extraosseous Ewing's sarcoma was identified. Due to the following chemotherapy and local radiation therapy no local recurrence and metastases have developed for 32 months.

[Imaging procedures in diagnosis of large solitary highly differentiated hepatocellular cancer--is it useful?]. / Bildgebende Verfahren in der Diagnostik eines grossen solitären hochdifferenzierten hepatozellulären Karzinoms--sinnvoll?

We report on a 62-year-old man from Ethiopia with a large solitary primary hepatocellular carcinoma. In spite of using modern imaging techniques (ultrasound, computed tomography, magnetic resonance imaging, hepatobiliary function scintigraphy) it was not possible to distinguish between hepatocellular carcinoma, focal nodular hyperplasia and adenoma. Surgery with histological examination was necessary to obtain the diagnosis of a hepatocellular carcinoma.

Uricosuric effect of irtemazole in hyperuricemic patients without and with renal insufficiency.

A single oral dose of 50 mg irtemazole exhibited a clear cut uricosuric effect in five patients with hyperuricemia and normal renal function. The average maximal decrease of plasma uric acid was 46.1% compared to the initial value; it was reached between 6 h and 12 h after drug administration. Extent and course of plasma uric acid showed no differences between normouricemic (5) and hyperuricemic subjects. In four patients suffering from hyperuricemia and renal insufficiency only a minor effect of irtemazole was seen. The average maximal decrease of plasma uric acid reached 12.8% compared to the initial value. It occurred between 8 h and 12 h after drug ingestion. In both normouricemic and hyperuricemic subjects irtemazole acts more quickly than benzbromarone and probenecid. The duration of its uricosuric effect is shorter. Like benzbromarone, irtemazole exhibits only a minor effect in patients with reduced creatinine clearance.

[Focal nodular hyperplasia of the liver]. / Fokalnoduläre Hyperplasie der Leber.

For several weeks a 27-year-old man had experienced a pressure sensation and noticed a spherical area of resistance in the epigastrium. On physical examination the firm, elastic tumour seemed most likely to be arising from the liver. Sonography recorded a 7.4 x 10.5 cm echo-poor structure. Computed tomography demonstrated in the tumour a central star-like, hypodense zone which filled with contrast medium, a finding typical of focal nodular hyperplasia. Functional hepatobiliary scintigraphy and histological examination of a fine-needle biopsy from the tumour (slightly enlarged hepatocytes, portal reticular fibrosis, ductular proliferation) confirmed the diagnosis. As there was no danger of rupture and no sign of local compression surgical intervention was not indicated, but regular ultrasound monitoring is planned.

Variation of benzbromarone elimination in man--a population study.

The plasma benzbromarone concentration-time profile in a healthy subject who retained the compound much longer than other individuals is described. The data suggested that determination of the 24 h plasma concentration of the parent drug after a single oral dose of 100 mg benzbromarone would be an appropriate procedure to determine the elimination phenotype. Based on this procedure, 148 of 153 healthy individuals (97%) in a population study were found to eliminate benzbromarone rapidly. In one subject the 24 h benzbromarone plasma concentration was very similar to that observed in the individual who had been more fully characterized. Four participants gave intermediate results. The data are compatible with a bimodal or trimodal distribution of different benzbromarone elimination phenotypes.