Foot soaks for callosities and fissures.

A study to assess the effect of soap soaks and plain water soaks on the dry anaesthetic sole of 15 leprosy patients bearing multiple fissures and callouses is reported. A callous scraper devised by us was found effective. It is recommended that a hypotonic keratolytic solution such as toilet soap or plain water be used for soaking which has the effect of softening the keratin. It may be better to use soap solution for this purpose.

Effect of epicondylectomy in early ulnar neuritis treated with steroids.

Sixty-two ulnar nerves belonging to 44 patients with early neuritis were studied to assess the benefits offered by medial epicondylectomy and external decompression in addition to steroid therapy. The patients were randomly allocated to the surgical or the medical group. In those cases where there was bilateral involvement, surgery was carried out only on one side. All cases were assessed prior to treatment, and at predetermined intervals following treatment. This study presents the results after a 12-month follow-up. There was statistically significant improvement in both groups following treatment as assessed by improvement in motor and sensory functions and in the reduction of pain and tenderness. The study, however, failed to demonstrate any added benefit with surgical intervention as compared to steroid therapy alone in the treatment of early ulnar neuritis.

DDS-resistant infection among leprosy patients in the population of Gudiyatham Taluk, South India. Part 3. Prevalence, incidence, risk factors, and interpretation of mouse foot pad test results.

At the Schieffelin Leprosy Research and Training Centre, Karigiri, India, a study of the population of Gudiyatham Taluk revealed that the prevalence of dapsone (DDS)-resistant infection among lepromatous (LL) and borderline lepromatous (BL) leprosy patients treated for a minimum of three years was 3.3% (33 per 1000), with an average annual incidence of 0.28% per year. DDS-resistant infection was diagnosed when review of skin smear readings showed a continuing increase in the number of Mycobacterium leprae in successive smears despite adequate DDS treatment. The attainment of smear negativity in an LL or BL patient was found to be a favorable prognostic sign, indicating a reduced risk of DDS-resistant infection. No association was found between the incidence of DDS-resistant infection on the one hand and either the regularity or the initial dosage of DDS treatment on the other. Ninety-five (88.0%) out of 108 successful mouse foot pad tests on patients with a Bacterial Index (BI) greater than or equal to 2+ detected DDS-resistant M. leprae. The mouse test detected bacilli resistant to 0.01% w/w DDS in mouse diet not only among patients deteriorating despite adequate DDS monotherapy, but also among patients improving on DDS monotherapy. Since the mouse test as presently used does not measure the proportion of M. leprae in a sample that are resistant to DDS, the detection of DDS-resistant bacilli in the mouse test may not always indicate that the patient will fail to respond to DDS monotherapy.

The results of lumbrical replacement by extensor to flexor many tail operation--a retrospective study.

A follow-up study was carried out on sixty one (61) leprosy patients who had extensor to Flexor Many tail surgery at Schieffelin Leprosy Research and Training Centre, Karigiri from 1975 to 1976. After analysing the data, it was noticed that the amount of clawing reduced considerably. Secondly the over all assessment was good for 70% of the hands. But the deformities such as intrinsic plus, deviation of fingers, M.P. extension, Limitation, I.P. Flexion Limitation and loss of fingers showed an increase in number post-operatively when compared to the pre-operative deformities. The reasons for these effects are discussed in this paper.

A clinico-pathological study of primary neuritic leprosy.

Normally neural involvement in leprosy is an ascending neuritis from the nerve involvement in the dermal lesions. However, in some cases neural involvement is seen in the absence of any dermal lesions. In some of these pure neuritic cases, dermal lesions appear sometime later. It is, therefore, more appropriate to designate such cases as 'primary neuritic' cases. This study is aimed at diagnosing primary neuritic leprosy among patients presenting with only neuritic symptoms. An attempt is also made to classify primary neuritic leprosy on a clinical and histopathological basis. During the period 1979-80, 30 patients reported to the out patient department of Schieffelin Leprosy Research and Training Centre, Karigiri with complaints of neuritic origin. In addition to clinical examination and routine skin smears, investigations such as skin, nerve and nasal biopsies, nerve conduction velocity and lepromin testing were carried out where feasible. 17 of these patients were diagnosed as primary neuritic leprosy and in 7 patients other neurological conditions were diagnosed. The remaining 6 patients were kept under observation and have not shown evidence of leprosy during a two year period of following-up. It is interesting that 4 of the 17 primary neuritic cases developed patches during follow-up period of two years. In the final analysis 7 patients (41.2%) were classified into the lepromatous group and 10 patients (58.8%) in the non-lepromatous group (Table-6). This classification will have a bearing on duration of treatment and for their subsequent release from control.

An analysis into the trends of reconstructive surgery in Gudiyatham Taluk, a leprosy control area.

The trends in Reconstructive Surgery in Gudiyatham Taluk, an area where an effective Leprosy Control Programme has been in progress since 1963, were analysed. Over the years 1962-79, it is shown that there is a decline in the number of Reconstructive surgical operations in Karigiri, on patients from the Control area, even though the new case detection rate and the total number of operations from both control and non-control areas remained high. The decline in the number of Reconstructive Surgery on patients from a Control area, provides a reliable index to judge the efficacy of a Leprosy Control Programme.

Prevalence of secondary dapsone resistance in Gudiyattam Taluk, the leprosy control area of the Schieffelin Leprosy Research and Training Centre, Karigiri. 1. Preliminary report.

A preliminary study of the prevalence rate of secondary dapsone resistance among leprosy patients in Gudiyattam Taluk, Tamil Nadu, was undertaken. During the period March 1978 to February 1979, there were 1580 lepromatous and borderline lepromatous patients considered to be at risk of developing secondary resistance. Of them, 1431 were examined clinically, and reactivation and/or relapse was found in 114 patients. Of these, 46 had a bacteriological index of 2,000 and more. Skin biopsies were taken from 26 patients for mouse foot pad studies. Resistance to dapsone at the highest drug concentration was found in 22 and partial resistance in two patients. The organisms from two patients were sensitive to dapsone. Twenty patients were not biopsied because they had been absent from treatment for significant periods of time. These patients are now under observation. Prior to this study, nine patients had been confirmed to have dapsone resistance in the control area, and during the present study 24 additional patients with secondary resistance have so far been detected. Thus 33 patients with dapsone resistance among the 1431 patients examined yields a crude prevalence rate of 2.3% in Gudiyattam Taluk.

Segmental necrotizing granulomatous neuritis of leprosy.

In leprosy, the occurrence of necrotizing nodular lesions in peripheral nerves is a relatively uncommon complication. Despite clinical and gross similarities, there are microscopical differences among groups of such cases, indicating that in all probability different pathogenetic mechanisms are operative. Furthermore, the vast majority of such cases are not true abscesses but are characterized by caseous necrosis and granulomatous inflammation. The traditional collective name "nerve abscess" is therefore inappropriate. Presented herein is an analytic study of 30 cases of the commonest variant, which we suggest should be called segmental necrotizing granulomatous neuritis of leprosy (SNGN). This lesion commonly affects the right ulnar nerve just above the elbow and occurs most often in those with the borderline tuberculoid form of leprosy. It appears to represent the result of a hypersensitivity phenomenon marked by a preponderance of epithelioid cells rather than a reaction of immunity in which lymphocytes predominate. Acid fast bacilli were demonstrable in the lesion in 77% of cases.