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題 名 | Tophaceous Gout with Sacroiliac Involvement: A Case Report and Literature Review=薦腸骨關節痛風,一病例報告及文獻探討 |
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作 者 | 林仙明; | 書刊名 | 中華民國風濕病雜誌 |
卷 期 | 14:3/4 民86.11 |
頁 次 | 頁51-57 |
分類號 | 415.954 |
關鍵詞 | 薦腸骨關節痛風; Tophaceous gout; Sacroiliac joint; Computed tomography; |
語 文 | 英文(English) |
中文摘要 | 尿酸鹽結晶常沉積在四肢關節及關節週圍組織。至於沉積在薦腸骨關節則非常少見。本文描述一位41歲男性病人,有12年痛風病史。在最近一個月因四肢有多發性及對稱性關節炎,且無法自由行動而住院治療。最近六年,在四肢關節出現大少不等痛風石,但病人並未接受有效降尿酸藥物治療。最近一年,有間歇性下背痛出現。最近九個月,左側下肢跛行。骨盆X光檢查發現左側股骨頭部截斷,右側薦腸關節有糜爛。骨盆的電腦斷層造影發現薦腸骨關節內的腸骨側關節面有明顯骨內糜爛,且有硬化邊緣,但在薦骨面卻無明顯破壞。此放射線造影特徵提示右側薦腸骨關節及左髖關節結石性痛風。經細針抽取右側薦腸骨關節液,在偏光顯微鏡下檢查發現尿酸鹽結晶沉積。經每天服用Voltaren 200 mg一週後,關節炎症狀好轉。本文提出薦腸骨關節痛風難於早期發現, 主因症狀不明顯、普通X光變化為非特異性、以及臨床上要有高度警覺性。 |
英文摘要 | Papillary serous carcinoma of the peritoneum (PSCP) is a primary peritoneal carcinoma in women and histologically resembles papillary serous carcinoma of the ovary (PSOC). Since Swerdlow reported the first case in 1959 under the name mesothelioma, PSCP has become an established entity through clinicopathologic studies. PSCP is now believed to be derived from extraovarian mesothelium with mullerian potential, in which peritoneal carcinomatosis, usually of serous type, is found in the lower abdomen, pelvis and sometimes on the surface of the ovaries, has been documented as representing up to 7-21% of the cases of ovarian cancer undergoing laparotomy. From Jan. 1992 to Dec. 1997, there were 7 cases of PSCP treated at Taipei Vecterans General Hospital. This report discusses a rare case of PSCP presented as a thoracic tumor. elatively normal. Computed tomography of the pelvis showed intraosseous bony erosion with sclerotic margin at the right posterior iliac bone and severe bony erosion over the left acetabular articular surface with massive effusion. These radiologic findings were comaptible with involvement of the right SI joint and left hip. Polarizing microscopy of needle aspirates from the right SI joint showed monsodium urate crystals. He was treated with voltaran 200 mg/day orally for 1 week and joint pain subsided. Early diagnosis of SI tophaceous gout is difficult because of the relatively asymptomatic nature of the condition and nonspecific roentgenographic findings. |
本系統中英文摘要資訊取自各篇刊載內容。