RESUMO
Background: Gout is a chronic disorder caused by the deposition of monosodium urate crystals in soft tissues. Tophi are granulomatous inflammatory responses to the deposited crystals and manifest as subcutaneous nodules, typically in the first metatarsophalangeal joint but also in the olecranon bursa, Achilles tendon, ears, and finger pulps. Case Report: A 56-year-old male presented to an outpatient clinic with an 8-month history of an expanding scrotal lesion. The patient had no significant family history but had a history of high blood pressure and gout, diagnosed at age 24 years, without current treatment. Excisional biopsy from the ulcerated area of the scrotum was performed for confirmatory diagnosis, and pathology reported gouty tophus. Conclusion: To our knowledge, this case is the first report of a scrotal manifestation of gouty tophus and the second of genital involvement. Awareness of the possibility of genital manifestations of this disease is important because although gouty tophi are rare, they can present in patients with long-term uncontrolled gout.
RESUMO
INTRODUCTION AND HYPOTHESIS: The objective was to determine the mean morphometric characteristics of the rectovaginal septum (RVS) and its variations in correlation with the number of pregnancies, method of delivery, parity, and estrogenic exposure. METHODS: An observational, cross-sectional, retrospective, descriptive, and comparative study was carried out. Pelvic MRI of Hispanic women (≥15 years of age) from the northeast of Mexico were obtained. Age and obstetric and gynecological history were registered and the sample women were categorized by their variables. Length and thickness measurements were standardized. RESULTS: A total of 102 MRI studies were included, with a mean age of 41; 24.5% were nulligravida, the rest primi- or multigravida. Vaginal delivery was the most common type (49.35%), 16.88% had a cesarean section, and 31.17% had mixed delivery. 74.5% of the women were premenopausal. The mean RVS length was 73.2 ± 15.3 mm, with a thickness of 2.8 ± 1.7, 2.2 ± 1.2, and 2.5 ± 1.3 mm for the upper, middle, and lower thirds respectively. There were tendencies to increase the length of the RVS, and the thickness of the upper and middle thirds in the non-pregnancy and the at-least-one-pregnancy groups; to increase the length and middle-third thickness in those with mixed delivery, and increased upper- and lower-third thickness in those with only a cesarean section. Multiparous women with vaginal delivery had significantly longer and thicker RVS than primiparous. Premenopausal women had significantly longer RVS with a tendency to lose thickness toward postmenopause. CONCLUSIONS: The morphology of RVS can be modified by different factors such as age, number of pregnancies, number of births, and estrogenic exposure. This structure should be evaluated and taken into account in preoperative management and surgical technique planning.