Malignant transformation in trophic ulcers in leprosy: a study of 12 cases.

Twelve cases of carcinomata arising in Trophic ulcers of Leprosy are presented. Out of these, 10 were on the plantar surface more commonly on the proximal part of foot, one on lower leg and dorsum of foot, and one in an ulcer over the lateral malleolus. Almost all presented with infected growths and regional lymphadenopathy. Three cases presented with advanced disease with fungating inguinal nodes and were fatal. Nine cases underwent below knee amputation under antibiotic cover as a definitive treatment and the lymph nodes were kept under observation. Histologically, all were low grade squamous cell carcinomas. In most cases lymph nodes regressed after removal of primary and in one case lymph nodes were positive for malignancy. This study was conducted at Dr. Bandorawalla Leprosy Hospital, Kondhawa, Pune 22 from the year 1981 to 1987.

Management of tarsal disintegration (T.D.) in leprosy.

Tarsal Disintegration (T.D.) is a known entity occurring exclusively in neuropathic foot of Leprosy and being influenced by several factors among which the disease itself and altered biomechanics constitute the main. In this study done on more than fifty cases at the Dr. Bandorawalla Leprosy Hospital, Kondhawa these factors have been studied in detail and it has been found that the increased and abnormal shearing forces constitute one of the major factors both in occurrence and progression of T.D. Treatment based mainly on the conservative lines is thus aimed at minimizing these forces which occur during the heel-toe pattern gait. Depending upon the severity of the case immobilization, periodic check x-rays, graded weight bearing and suitable modified footwear appliance is recommended. A Fixed Ankle Brace (FAB) serves well controlling the ankle movements by its rocker action and ultimately reducing the forces occurring during the normal heel-toe pattern. It has also been found that if the case is detected early and treated promptly the process can be controlled satisfactorily. Careful screening in high risk group is stressed and health education emphasized.

Effect of clofazimine and dapsone on rifampicin (Lositril) pharmacokinetics in multibacillary and paucibacillary leprosy cases.

A comparative pharmacokinetic study of Lositril (rifampicin) was carried out in six multibacillary and twelve paucibacillary leprosy cases. The type of leprosy had no significant effect on rifampicin pharmacokinetics. The effect of dapsone and clofazimine when given separately and in combination was studied on rifampicin pharmacokinetics in each group of six patients. Within group comparison revealed that clofazimine reduced rifampicin absorption significantly (P less than 0.01) and prolonged the time to reach the peak serum concentration (P less than 0.01). Since MCR and Ke were also reduced significantly in RC group, as compared with RDC group (P less than 0.02 and P less than 0.05 respectively), no significant alteration was seen in overall Auc and Cmax, although t0.05 was increased significantly (P less than 0.02) in RC Group. Dapsone alone did not produce any significant alteration in rifampicin pharmacokinetics parameters, while dapsone with clofazimine reduced rifampicin 1h serum levels (P less than 0.05) and Auc (P less than 0.05) significantly. Of the three groups, except RC group, both RDC and RD groups were homogeneous Ka, avd, Cmax and Auc/t0.5 ratio of RC group were significantly different from those in RD group. While Ka and avd were significantly less (P less than 0.05 and less than 0.001 respectively) and Cmax and Auc/t0.5 ratio were significantly more (P less than 0.01) in RC group. Since clofazimine reduced rifampicin absorption, the difference in Ka and tp became more significant in the post-regimen phase (P less than 0.01).