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Dr Charles Sorbie is Professor of Surgery at Queen’s University and a member of the Attending Staff at the General and Hotel Dieu Hospitals in Kingston, Ontario.

A former chairman of the Department of Surgery at Queen’s University, Dr Sorbie has been President of the Canadian Orthopaedic Research Society, the Canadian Ortho paedic Association, and the Societé Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT).

Blue Notes Editor: Charles Sorbie, MB, ChB, FRCS(E), FRCS(C)

Hand No Handicap for DjangoThe name Django Reinhardt (1910-1953) is well known to gui-

tar players and lovers of jazz. He was a Romani gypsy born in a “roulotte” or caravan in Pont-a-Celles close to Liberchies, in Belgium. Like many Romanis, he was musically gifted and quick-ly learned to play the violin. His real name was Jean-Baptiste, but “Django” sounds like a plucked guitar string, and it was the guitar that made his music and his style famous. He married at age 18. His wife, Florine Mayer, sold, to eke out their income, imitation fl owers made from celluloid and paper. One night Django knocked over a lit candle in the roulotte. He was engulfed in fl ames as the fl owers, which fi lled their roulotte, quickly caught fi re. He had extensive fi rst and second degree burns, which included his left hand. His hand burns seriously damaged skin and tendons. He spent a painful month in hospital where amputation of his burned left leg was considered.

Django recovered but was left with contracted tendons in his left hand. Despite crooked fi ngers, he adapted his guitar playing to a form that allowed him to span the strings on the frets with 2 normal long fi ngers and 2, the ring and little fi ngers, that were severely contracted (BMJ. 2009; 339:1427-1428).

In 1934, he, his brother, and 3 others formed the Quintette du Hot Club de France in Paris, which featured sensational jazz. Django became well known in America and played with Louis Armstrong, Duke Ellington, and Dizzy Gillespie.

One night in 1953, while walking home after a concert in Fontaine-bleau where he had played 2 of his best loved scores, “Nuages” and “Manoir de Mes Reves,” he suffered a fatal cerebral hemorrhage.

Django Reinhardt’s musical style was infl uenced by classical composers and reached from fl amenco to swing. His music is still played all over the world and his style universally copied.

doi: 10.3928/01477447-20100225-02

What’s New With Gout?

Not much – except a better understanding, a new drug, and a concern about rising incidence.

“The king of diseases and the disease of kings” has been around for just under 3000 years, at least in Egypt. Known to Hippocrates, it was well described by Thomas Sydenham, an English physi-cian in 1683. He detailed the signs and symptoms of gout and even managed to die of it. When alive, Sydenham introduced quinine for the treatment of malaria and iron for defi ciency anemia. It was not until 1961, however, that McCarty and Hollander fi rst showed that the crystals in joints of patients with gout were monosodium urate. Gout got its name from “gutta,” a Latin word for “drop,” sug-gesting fl owing or dropping down of humors to the feet.

Gout is becoming more frequently diagnosed. In the United States, the rate has risen from 2.1% of the population in 1990 to 4.1% in 1999. The upward trend has been particularly noticeable in men older than 75 years. It is the most prevalent infl ammatory arthritis in developed countries. Although more common in men, it can affect post-menopausal women whose depleted estrogen pro-duction reduces their rate of excretion of uric acid by the kidneys.

An old proverb holds that “you get gout from drinking wine and you get it from not drinking wine.” This is not true, but it is close to the truth. Pascal Richette and Thomas Bardin re-ported (Lancet. 2010; 375[9711]:318-328) that high consumption of meat, seafood, fructose, and spirits are associated with gout, but vegetables, even with high purine content and moderate wine consumption, have no effect. A benefi cial effect is obtained from milk products, vitamin C, and coffee, with or without caffeine.

Failed renal mechanisms are responsible for hyperuricemia in approximately 90% of individuals. Impaired excretion of renal uric acid is the main mechanism underlying the rise in the urate pool. Urate crystals in joints are mopped up by monocytes with the re-lease of the pro-infl ammatory mediators interleukin 1�, interleukin 8 and TNF-�. While joint cartilage eventually is affected, typical punched-out bone erosions develop in the long axis of bones.

Allopurinol, in the long-term treatment of gout, inhibits uric acid conversion from hypoxanthine, but a new “drug on the block” is Febuxostat, released in Europe, which more impor-tantly blocks the production of xanthine. Renal reabsorption of uric acid is also a good target for drugs.

The authors continue to advocate nonsteroidal anti-infl am-matory drugs and low-dose colchicine to treat acute attacks, but oral corticosteroids also work very well.

Living like a king may have its disadvantages. doi: 10.3928/01477447-20100225-03

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