Chinese Treatments for Gout
This decree of destiny was engraved by a crowd of maladies, which originated in the social system. The result is that the most intense pleasure one can imagine, cannot atone for certain pains, such as the gout, the tooth ache, etc., acute rheumatisms, strictures, and many other diseases we might mention.
The oxidative damage detected in human spermatozoa may originate from several potential sources. Firstly, the leucocytes that contaminate every human semen sample are largely comprised of neutrophils that are commonly in an activated state. Thus the levels of spontaneous luminol-dependent chemiluminescence recorded in (unfrac-tionated) human semen samples are highly correlated with the levels of leucocyte contamination (Aitken et al., 1995a Fig. 7.5). The presence of free-radical generating leucocytes in human ejaculates might therefore create a degree of oxidative stress. Much depends on the types of leucocytes that are present, their state of activation and their origin (Aitken and Baker, 1995). If the leucocytes originate in secondary sexual organs, such as the prostate and seminal vesicles, then their ability to cause oxidative damage to the spermatozoa will be counteracted by the powerful antioxidant properties of human seminal plasma. These antioxidants include small molecular...
The initial diagnosis, based on the history and initial laboratory data, was anemia of chronic disease (ACD). This is a large group of conditions second only to iron deficiency as a cause of anemia. This class of anemias can be due to chronic infectious or inflammatory conditions, carcinoma, autoimmunity, or chronic renal disease.1 Patients with ACD typically have a mild, normocytic anemia and inappropriately low reticulocyte response. Cytokines, including interleukin-1 (IL-1), interferon gamma (IF-g), and tumor necrosis factor a (TNF-a), produced in response to chronic inflammatory states, such as gout, cause anemia through multiple mechanisms, including direct suppression of erythropoi-esis, blunted renal production of erythropoietin (EPO) in response to anemia, and increased uptake and sequestration of iron within macrophages. A key effecter of iron sequestration is hepcidin, a peptide synthesized by hepatocytes in response to IL-6 and Indirect measurements of iron stores can be...
At one end of the spectrum of public opinion is the view that any explicit manipulation of human biology is undesirable. Whether or not this philosophy has merit, it is operationally moot. For millennia, humans intentionally have altered our external and internal bodily environments in ways that influence health. In the medicinal arena, for example, metabolism-altering compounds have been employed for all manner of ailments, from gout to gonorrhea. Some of the first languages uttered by primitive peoples probably included words describing particular plants and animals perceived to be sources of desirable medicinal products. Modern pharmacology has continued this tradition, deriving many of its prophylactic and therapeutic drugs from natural sources. In this sense, the outcomes envisioned under many applications of gene therapy represent nothing fundamentally new. The production and delivery of metabolism-altering drugs will merely be shifted to engineered genes. So, many of the...
Gout represents a group of diseases in which prolonged hyperuricemia leads to deposition of urate salts in and around joints and other tissues. At physiological pH, most uric acid exists as monosodium urate. Saturation of serum occurs at a urate concentration of mg dL. Above this value the potential for precipitation of monosodium urate crystals exists, although plasma proteins allow stable supersaturated solutions in which the serum urate value may rise considerably higher. The epidemiological definition of normouricemia (mean serum urate value plus or minus two standard deviations in a healthy population) varies depending on the analytic method and the population. Most laboratories now use a uricase assay in which uric acid is cleaved to produce allantoin and hydrogen peroxide. Oxygen consumption is directly proportional to uric acid in the sample. More commonly, the hydrogen peroxide produced reacts with a second reagent of known optical density that is then quantitated by...
Colchicine, a drug used to prevent and treat attacks of gout, can damage nerves and muscles. This is a rare side effect even in people who have taken an overdose of colchicine or taken it for many years. The first symptoms are usually weakness of the thigh, shoulder, and ankle muscles. Levels of muscle enzymes are usually increased. Muscle weakness is often accompanied by evidence of nerve damage such as loss of sensation in the feet and absent ankle reflexes. Muscle symptoms resolve soon after colchicine treatment is stopped, but neurological symptoms recover more slowly.
Arguments were subsequently reinforced by Jerome Nriagu of the National Water Research Institute of Canada. Nriagu, writing in the New England Journal of Medicine (Vol. 308, p. 660, 1983), estimated that a typical aristocrat would be absorbing 250 g day, while ordinary Roman citizens would get around 35 and slaves only 15, most of which would come from wine in the case of the first two groups. Nriagu has even linked the medical complaints and bizarre behaviour of the Roman emperors to their high lead intake. Many of them suffered from gout as a result. Claudius who reigned from 41 to 54 displayed many of the symptoms of lead poisoning, including recurrent attacks of colic. Nriagu expanded on the theory in a scholarly but controversial book, Lead and Lead Poisoning in Antiquity, published in 1983.
Masterpiece may well have been written while Handel was suffering from lead poisoning although the only way this affected him was to give him gout, and clearly it did little to hamper his creative spirit. The lead undoubtedly came from his drink and he was particularly partial to port wine. On one of Handel's manuscripts he jotted a reminder to order 12 gallons of port from his wine merchant, and doubtless this drink was the cause of his gout, but there is no indication that Handel was affected in any other way by lead.
Lead in the inorganic form, as in lead salts, causes a range of effects depending on the amount. General effects on the gastrointestinal tract lead to pain (colic), constipation, and diarrhoea vomiting can also occur. There are sometimes pains in the joints (gout), and weakness in the arms or legs or hands (hence 'wrist drop') resulting from effects on the nerves. Headache and blindness are sometimes symptoms, as well as mental disturbances which in severe cases can reach insanity. Chronic exposure will cause damage and dysfunction of the kidney, leading to nephritis and possible kidney failure.
The syndrome caused by lead poisoning was known as Saturnine gout (gout can be one of the symptoms of lead poisoning). It is similar in cause and effects to so-called Devonshire colic in eighteenth-century England and Colic Pictonium in late medieval France. These were due to lead dissolved by acids in cider and wine respectively. An English doctor showed that it was the lead used to line the apple presses that was the cause of the colic. More recently, those making and drinking 'moonshine' whisky during Prohibition may have fallen foul of lead poisoning by using
The hemolytic anemia of Wilson's disease is often episodic, probably owing to intermittent release of free copper from the liver that affects red blood cell membranes. An intravascular hemolytic anemia often accompanies fulminant hepatic failure and should strongly suggest Wilson's disease as the cause of the liver failure. Renal involvement can be significant with a Fanconi-like syndrome characterized by aminoaciduria, glyco-suria, phosphaturia, hypercalciuria, and high uric acid excretion with low serum urate levels (as occurred in the case presented). It is probably this chronic renal involvement that leads to the osteomalacia sometimes seen.
Nitrogen recycling refers to the microbial consumption of nitrogenous waste products of insects and the synthesis of compounds (e.g., essential amino acids) of nutritional value to the insect, which are then translocated back to the animal. Microbial utilization of insect-derived uric acid or ammonia has been demonstrated in several systems, including cockroaches, planthoppers, aphids, and termites. For example, various bacteria, including Streptococcus, Bacteroides, and Citrobacter species, in the hindgut of the termite Reticulotermes flavipes degrade uric acid anaerobically to ammonia, carbon dioxide, and acetic acid. Experiments using 14C and 15N-labeled uric acid confirmed that uric acid is degraded by the hindgut microbiota in the insect and nitrogen is subsequently assimilated by the insect tissues, in the insect.
Treatment and Outcome Most people with DISH do not have symptoms and do not need any treatment. Those with spinal stiffness need to understand what the problem is and use occasional painkillers as needed. A very few may need surgical removal of a spur or decompression of the spine or nerve root. injection of a small amount of corticosteroids around a painful heel spur may be very helpful. Those who are overweight should lose weight and exercise more, but it has not been shown that this will beneficially affect the DISH. More importantly, in these patients the diagnosis of DISH may prove the trigger for them and their physician to recognize that they have the metabolic syndrome. These patients often have high insulin levels, insulin resistance, obesity, hypertension, gout, and high lipid levels as well as a high risk of coronary artery disease.
Combinations in diabetic patients are limited (Table 7). In a small study, 37 diabetic patients who failed captopril monotherapy were randomized to HCTZ or nifedipine and the study continued for 4 months 84 . There was a statistically insignificant trend which showed that captopril plus HCTZ was more effective in controlling BP than captopril plus nifedipine without changes in plasma glucose, cholesterol, triglycerides, HDL-cholesterol, or uric acid 84 . In a diuretic-based study, 25 type 2 diabetics who remained hypertensive after TD therapy were randomized in a crossover design, in which atenolol or slow-release nifedipine or captopril was added 81 . All three combinations were more effective than thiazide alone and there was no significant difference in BP controls 15 hours after administration of the evening dosage. The combination of ACE inhibitors and CCBs has been advocated for BP control in diabetic patients because of its potentially better antiproteinuric efficacy 86...
There are now in this city at least three hundred rich men, capitalists and financiers, retained at home by gout, colds, and doctors. They are always busy to ascertain what will revive them and send their valets out on voyages of discovery. Some one of them will remark this asparagus, and it will be bought. It may be, some pretty woman will pass with her lover, and say, 'what fine asparagus. How well my servant dresses it.' The lover then does not hesitate, and I will tell you a secret, that dear things are sold more easily than cheap ones.
Gout was not the only affliction of the middle and upper classes in the eighteenth and nineteenth centuries. People often complained of feeling unwell and of suffering from ill-defined maladies, which we now suspect was mild lead poisoning, and they were often advised by their doctors to 'take the waters' at one of the fashionable spa towns, of which Bath in England's West Country was the most famous. It was there that those afflicted by 'gout, rheumatics, agues, lethargies, apoplexies, forgetfulness, shakings, and weakness of any member' were taken to be subjected to sitting three hours at a time up to their necks in warm water, several times a week for up to six months, while also drinking copious quantities of the local spring water. The cure generally worked and indeed research in the 1980s by Drs J. P. O'Hare and Audrey Heywood, of the Royal Infirmary in Bristol showed that such a regime would increase the flow of urine and remove significant amounts of lead from the body.
GOUT was once a common malady that immobilized many of the upper class males of ancient Rome and imperial Britain. Both societies blamed it on too much rich food and wine, and they may have been right. The Roman writers, Seneca, Virgil, Juvenal, and Ovid all poked fun at the sufferers of gout, as did the London cartoonists the popular belief was that it was a just punishment for over-indulgence. Physicians knew of the pain it caused and discovered that it was due to sharp crystals of uric acid between the joints of the bones but what caused these to form Among those affected by gout were Benjamin Franklin, one of the founding fathers of the United States of America, British Prime Minister William Pitt, poet Alfred Lord Tennyson, biologist Charles Darwin, and the founder of Methodism, John Wesley. It has been suggested that Alexander the Great, Kubla Khan, Christopher Columbus, Martin Luther, John Milton, and Isaac Newton also suffered its agonies. In the last century, it was found...
Alloxan (2,4,5,6-tetraoxyprimidine 5,6-dioxyuracil), a uric acid derivative, was isolated in 1818 as the first pyrimidine derivative and was named by Wohler and Liebig who described its synthesis by uric acid oxidation.119 The diabetogenic action of alloxan was shown by Dunn and coworkers in 1943,120 who demonstrated its selective islet cell necrosis in rabbits.
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