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Tophaceous gout causing lumbar stenosis: A case report.

ABSTRACT: Gout in the spine is very rare. The clinical symptoms of the spinal gout are various and lack of specificity. The authors report a case of spinal gout causing lumbar stenosis. We never find such wide-invasive spinal gouty lesion in the published studies.A 68-year-old male had low back pain radiating to bilateral lower limbs, accompanying with intermittent claudication that lasted for 3 months and aggravated 5 days ago.Spinal gout, lumbar stenosis.The patient underwent L2-L4 laminectomy, L2/3 L3/4 an d L4/5 discectomy and transforaminal lumbar interbody fusion with pedicle screw fixation.Dual-energy computed tomography detected extensive tophaceous deposits in L1/2 L2/3 L3/4 and L4/5 lumbar discs as well as the posterior column, especially L2-L3 and L4-L5 facet joints. During the surgery, we found a mass of chalky white material at the posterior column of L3 to L5 vertebral bodies, which also involved the intervertebral discs. Pathological examination confirmed the diagnosis of spinal gout.Although spinal gout is thought to be rare, the diagnosis should be considered if the patient had severe back pain and a history of gout. Dual-energy computed tomography is highly recommended for these patients.

SUBMITTER: Lu H

PROVIDER: S-EPMC5556215 | biostudies-other | 2017 Aug

REPOSITORIES: biostudies-other

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Case report of a Gore-Tex TCPC conduit dissection causing severe stenosis.

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| S-EPMC8567081 | biostudies-literature

Gout of the temporomandibular joint: report of a case.

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Gout and Progression of Aortic Stenosis.

Project description:BackgroundPatients with aortic stenosis are nearly twice as likely to have a diagnosis of gout compared with individuals without aortic valve disease.MethodsThis retrospective study evaluated consecutive adults age ≥65 years with aortic stenosis between December 2012 and November 2016 who underwent at least 2 transthoracic echocardiograms (TTEs) separated by at least 1 year. Severe aortic stenosis was defined as any combination of an aortic valve peak velocity ≥4.0 m/sec, mean gradient ≥40 mm Hg, aortic valve area ≤1 cm2, or decrease in left ventricular ejection fraction as a result of aortic stenosis.ResultsOf the 699 study patients, gout was present in 73 patients (10%) and not found in 626 patients (90%). Median follow-up was 903 days [552-1302] for patients with gout and 915 days [601-1303] for patients without gout (P = 0.60). The presence of severe aortic stenosis on follow-up transthoracic echocardiogram was more frequent in patients with gout compared to those without gout (74% vs 54%, P = 0.001; hazard ratio [HR] 1.45 [1.09-1.93]), even among the 502 patients without severe aortic stenosis at baseline (63% vs 39%, P = 0.003; hazard ratio 1.43 [1.07-1.91]). Gout remained associated with the development of severe aortic stenosis after multivariable adjustment (adjusted hazard ratio [aHR] 1.46 [1.03-2.08], P = 0.03). The annualized reduction in aortic valve area was numerically greater in the group with gout compared with the group without gout (-0.10 cm2/y [-0.18, -0.03] vs -0.08 cm2/y [-0.16, -0.01], P = 0.09); annualized change in peak velocity and mean gradient did not differ between groups.ConclusionsProgression to severe aortic stenosis was more frequent in patients with gout compared with those without gout, supporting the hypothesis that gout is a risk factor for aortic stenosis.

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| S-EPMC6887476 | biostudies-literature

Significant infrarenal aortic stenosis in pregnancy: a case report.

Project description:BackgroundHypertension is common in pregnant women presenting with aortic coarctation or Takayasu's arteritis. Uncontrolled hypertension leads to increased adverse maternal and neonatal events.Case presentationA 36-year-old gravida 2, para 1 Caucasian woman presented at 9 weeks of gestation with headaches but normal blood pressure. She had a past medical history of an in vitro fertilization pregnancy complicated by preeclampsia at 27 weeks of gestation (birth weight 1900 g) and infrarenal aortic stenosis. In the current pregnancy, she received aspirin and calcium as preeclampsia prophylaxis, remained normotensive throughout pregnancy, and was delivered by elective cesarean section at 37 weeks without complications.ConclusionsThis case demonstrates a significant chronic aortopathy in pregnancy with normal fetal growth and uterine blood flow through collateral supply from the internal mammary and epigastric arteries.

| S-EPMC6492387 | biostudies-literature

Functional Defect of Neutrophils Causing Dermatophytosis: Case Report.

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| S-EPMC5531667 | biostudies-other

Giant lumbar pseudomeningocele after revision lumbar laminectomy: a case report and review of the literature.

Project description:IntroductionIncidental durotomy is a relatively common complication of spine surgery. Prevalence ranges from 3 to 5% in primary and 7 to 17% in revision procedures. Despite this relatively common occurrence the subsequent development of pseudomeningoceles following lumbar spine surgery is reported to be between 0.07 and 2%. Giant pseudomeningoceles (GP) are rare and therefore we report our experience with a case.Case presentationWe report a case of an iatrogenic GP post revision lumbar surgery that extended 19?cm in length. The patient underwent revision L3-S1 laminectomy, laminotomy, excision of pseudomeningocele and successful direct dura repair. Postoperatively, a subcutaneous seroma persisted. This was managed with surgical exploration and prolonged drainage. This led to reduction of the seroma and symptomatic improvement for the patient.DiscussionIncidental durotomy is a relatively common complication of spine surgery and if the durotomy is not addressed at the time of an operation a pseudomeningocele may develop. A pragmatic approach for GP is to individualise management based upon symptoms. Although GP are rare, prevention is likely the best approach. We outlined a structured approach to the management of an incidental dural leak that formed the largest reported pseudomeningocele reported to date.

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Intradural Neurocysticercosis of Lumbar Spine: A Case Report.

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