Outcomes of surgery for gouty tophi in the extremities

Abstract

Gouty tophi occur in appr. 50-60% of patients suffering from gout. Their occurrence is related to severity of the disease and effectiveness of its treatment. They develop more frequently in patients with long lasting and poorly controlled disease. The results of surgical treatment of gouty tophi in the extremities in 14 patients, 13 men and one woman, at a mean age of 51 years are presented. Twelve patients had tophi localized in the upper extremities, whereas 3 had tophi in the lower limbs (one patients had upper and lower extremity involved). Duration of the disease to the operation was a mean of 8 years. Seven patients received excision of a single tophus, and remaining had 3-15 operations performed due to multiply tophi, over a period from 3 months to 2 years. Outcomes of the treatment was assessed at a mean of 3 years (range 2-8) after the last operation in a form of a phone interview. Results. All patients declared satisfaction from the result of the treatment. No case of complication or recurrence of the tumour was noted. The results of this study confirm usefulness of surgical treatment of this form of the gout.

Diagnosing Schwannoma in the Wrist: a Challenging Case of Intraneural Ganglion Cyst Mimicry and a Review of Literature

“…Schwannomas, as mentioned earlier, are the most common benign peripheral nerve tumors. However, their occurrence in the upper extremities is rare compared to other neoplasms [ 1 ]. They grow inside nerves, causing a thickening of the nerve and a visible lump underneath the skin.…”

“…In the early stage, the subcutaneous lesions are usually painless. However, large and long-growing lesions may cause pain, paresthesia, and weakness [ 1 , 2 ]. Unlike benign schwannoma, malignant ones grow faster and cause more pronounced symptoms.…”

“…Unlike benign schwannoma, malignant ones grow faster and cause more pronounced symptoms. Fortunately, they are extremely rare [ 1 ]. Schwannomas are characterized by their slow growth, and they can undergo degeneration such as cyst formation, fibrosis and calcification, in a case report by Valeriu Ardeleanu et al.…”

“…Although they can occur at any age and in any part of the body, they most commonly tend to occur between the third and sixth decades of age and appear in the head and neck areas of the body. Also, there is no sex predisposition that appears to exist for the occurrence of these tumors [ 1 , 2 ]. In clinical practice, Ultrasonography and/or Magnetic Reasoning Imaging (MRI) can help in the diagnosis.…”

“…On MRI, they usually present as a round, hyperintense to fat, homogeneous mass, with a poorly enhanced central part and enhanced peripheral part, which is known as the target sign. However, small schwannomas can present without a distinguishing target sign, which in turn can make them mimic cysts in appearance [ 1 , 3 ]. With that being said, small schwannomas can be misdiagnosed as intraneural ganglion cysts if they are presented in the hand or wrist, which is the most common site for ganglion cysts to occur [ 3 ].…”