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Gout is a recurrent disease but it may be months or years between each bout.

The diagnosis is usually straightforward in the middle-aged male but may be missed in a woman or in a young man, particularly if some other joint is involved. Usually the level of uric acid in the blood will be high. X-rays may not show any changes in the early stages.

Aspiration of the joint by inserting a needle and withdrawing fluid for examination may reveal the true diagnosis. The crystals of urate can be seen and identified.

This procedure may be necessary to distinguish gout from other conditions where crystals are laid down in joints and cause an acute arthritis.

If untreated, gout attacks may become more frequent. But the concern is for the long-term complications — urate crystals laid down as tophi may disrupt the joints and lead to deformity; kidney damage may occur and lead eventually to failure.

High blood pressure and hardening of the arteries are both associated with the kidney changes.

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Whether the ovaries should be removed at the same time is still a debatable issue.

Some surgeons leave them, believing that normal organs should not be removed. Others remove them, believing that their function ceases following hysterectomy, and leaving them may allow disease, such as cancer or cysts to develop, thus requiring a further operation.

Many surgeons remove one ovary, thus halving the risk of developing cancer and leave the other to go on producing oestrogen so as to make the artificial menopause smoother. In women past the menopause, there is no hesitation about removing both ovaries.

Cancer of the body of the womb, cancer of the neck of the womb or cervix, non-cancerous tumors like fibroids, severe infection and severe bleeding are the usual reasons for operation.

With modern surgical techniques and anaesthesia, this operation is now safe.

Unfortunately nearly 50 per cent of those who have the uterus removed suffer from the post operative side-effects. These are mostly depression or interference in sexual function. Most of these side-effects are preventable.

Sometimes the operation is carried out for symptoms which are due more to nervous factors than to pathology or disease in the uterus. Of course, the operation doesn’t cure these symptoms, but only adds a few more.

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