Lesiones ungueales en la lepra / Nails disorders in Lepra

La Lepra produce importantes invalideces y discapacidades por la afectacion neurologica periferica con alteraciones distales, sensitivas, motoras y troficasen pies y manos y también de las uñas, siendo la anestesia un importante factor, asi como traumatismos, deficit vascular e infecciones oportunistas.Exponemos nuestra experiencia observando alteraciones de la uña en un 48% de los casos sin predominio de sexo, siendo las lesiones mas frecuenteslas distroficas onicorrexis, hiperqueratosis, onicogrifosis, opacidad matriz ungueal, estrias paralelas, fragilidad, difusion de la lunula, sequedad, paroniquiae infeccion ,que son de aparicion lenta y mas frecuentes en las formas multibacilares y paucibacilares avanzadas y no es raro el hallazgo demicobacterias, afectando mas los pies que las manos.A esta onicopatía acompaña progresiva reabsorcion de partes blandas y acroosteolisis de falanges terminales y mutilaciones, siendo los restos unguealeslos últimos en desaparecer.El mejor tratamiento es el diagnóstico precoz y la multiterapia específica antes de que aparezca un compromiso neural irreversible que daria lugar aesta patologia ungueal (AU)

Leprosy produce severe discapacity due the neurological peripheric affectation with sensitive , motor and trophics disorders in hands, feet and toes. Inhands also in nails, being the anesthesia an important factor, as well as traumatisms, vascular changes and opportunist infection .We set out our experience observing alterations in the nails in a 48% of patients, in both sex. The most frequent injuries are the distrophia, onicogriphosis,onicorrexis hiperkeratosis, matrix opacity, parallel groove, fragility, difusse lunula, dryness, paroniquia and infecction. They are a very slow process andmore frequent in advances multibacillary and paucibacillary forms, and it is not rare to find mycobacteria affecting the feet more than the hands.This onicopatia goes with a progressive reabsorption of the fingers and toes with acroosteolisis of terminal phalanges being the ungueal remains thelast to disappear.The best treatment is the early diagnosis and specific multitherapy before the irreversible neural affection appears (AU)

[Infectious nature of leprosy, by Juan de Azúa]. / Contagiosidad de la lepra, por Juan de Azúa.

In this article by Juan de Azua, published in the second issue of Actas Dermosifiliográficas in 1909, the author reports his experience in 139 patients, most of them from Hospital San Juan de Dios, Madrid,Spain, and states he is sure that leprosy is a contagious disease. He discusses the factors related to contagion,which occurs in a closed and family environment, emphasizing socioeconomic factors such as hygiene and promiscuity. He considers direct contact to be important, though also recognizing indirect contact through drinks and food; he totally rejects a hereditary mechanism. Epidemiologically, he draws attention to the higher prevalence of the disease in Andalusia, though not forgetting "La Lepra de Ultramar [leprosy from distant lands]"-32 cases in Spaniards in Cuba and the Philippines. He believes isolation in hospitals or special sanatoriums, such as San Juan de Dios or San Lázaro in Santiago, Granada, and Seville, to be the best prophylaxis, and he considers it would be appropriate to create "Hospitals for poor lepers".

Contagiosidad de la lepra, por Juan de Azúa / Infectious Nature of Leprosy, by Juan de Azúa

En este artículo de Juan de Azúa, publicado en el número 2 de «Actas Dermosifiliográficas» de 1909, el autor se manifiesta totalmente seguro de la contagiosidad de la lepra, exponiendo su experiencia en 139 enfermos, la mayoría de San Juan de Dios. Comenta los factores de contagio que es íntimo y familiar, destacando los factores socioeconómicos como la higiene y la promiscuidad. Considera muy importante el contacto directo aunque sin olvidar el indirecto como las bebidas y alimentos, descartando totalmente la herencia. Epidemiológicamente señala la mayor endemia en Andalucía sin olvidar «La Lepra de Ultramar», 32 casos contraídos por españoles en Cuba y Filipinas. Considera que la mejor profilaxis es el aislamiento en hospitales o en «asilos especiales» como San Juan de Dios, San Lázaro de Santiago, Granada y Sevilla, considerando apropiado la construcción de «Hospitales para Lazarinos pobres» (AU)

In this article by Juan de Azua, published in the second issue of Actas Dermosifiliográficas in 1909, the author reports his experience in 139 patients, most of them from Hospital San Juan de Dios, Madrid, Spain, and states he is sure that leprosy is a contagious disease. He discusses the factors related to contagion, which occurs in a closed and family environment, emphasizing socioeconomic factors such as hygiene and promiscuity. He considers direct contact to be important, though also recognizing indirect contact through drinks and food; he totally rejects a hereditary mechanism. Epidemiologically, he draws attention to the higher prevalence of the disease in Andalusia, though not forgetting «La Lepra de Ultramar [leprosy from distantlands]»—32 cases in Spaniards in Cuba and the Philippines. He believes isolation in hospitals or special sanatoriums, such as San Juan de Dios or San Lázaro in Santiago, Granada, and Seville, to be the best prophylaxis, and he considers it would be appropriate to create «Hospitals for poor lepers» (AU)

Centenario del sanatorio de Fontilles / Centenary of the fontilles sanitorium

Con motivo del Centenario de Fontilles, se exponen las circunstancias históricas de su fundación por los numerosos enfermos sin asistencia en la región valenciana, sobre todo en Alicante. La primera difícil etapa de 1909 hasta 1932 (año en que se produce la incautación por el gobierno de la República), la Guerra Civil y la devolución en 1941 a su propietario, el Patronato, encargando la administración a la Compañía de Jesús y el aspecto sanitario a la Dirección General de Sanidad, coexistencia que no funcionó y en 1943 vuelve a hacerse cargo el Patronato. Se comenta la evolución de la Colonia-Sanatorio hacia un hospital con función asistencial, investigadora y de formación, la aplicación de las sulfonas y posteriormente otros fármacos eficaces para la curación, el importante papel en la eliminación de la lepra en España, el ingreso en la Federación Internacional de Asociaciones de Lucha Contra la Lepra (ILEP) en 1969, los proyectos en países endémicos y la meta final de conseguir un mundo sin lepra (AU)

In recognition of the centenary of the Fontilles Sanitorium, we present some details of its history. The article discusses the foundation of the sanitorium by some of the numerous lepers with no health coverage in the region of Valencia, and Alicante in particular. After a difficult period between 1909 and 1932, the sanitorium was seized by the Republican government. After the civil war, it was returned to the board of trustees, who entrusted administrative tasks to the Compañía de Jesús while health care was overseen by the National Health Board. This coexistence was uneasy, and the board of trustees took over again in 1943. We comment on the transition from a sanitorium and colony into a hospital providing health care, research and training, and treatment with sulfones and subsequently other effective drugs. Also discussed are its role in the elimination of leprosy from Spain, admission to the International Federation of Antilepros y Associations in 1969, and its projects in endemic countries, with the ultimate goal of achieving a world free of leprosy (AU)

[Centenary of the Fontilles Sanitorium]. / Centenario del sanatorio de Fontilles.

In recognition of the centenary of the Fontilles Sanitorium, we present some details of its history. The article discusses the foundation of the sanitorium by some of the numerous lepers with no health coverage in the region of Valencia, and Alicante in particular. After a difficult period between 1909 and 1932, the sanitorium was seized by the Republican government. After the civil war, it was returned to the board of trustees, who entrusted administrative tasks to the Compañía de Jesús while health care was overseen by the National Health Board. This coexistence was uneasy, and the board of trustees took over again in 1943. We comment on the transition from a sanitorium and colony into a hospital providing health care, research and training, and treatment with sulfones and subsequently other effective drugs. Also discussed are its role in the elimination of leprosy from Spain, admission to the International Federation of Antileprosy Associations in 1969, and its projects in endemic countries, with the ultimate goal of achieving a world free of leprosy.

[Brainstem injury diagnosed by MRI. An epidemiologic and prognostic reappraisal]. / Lesión traumática del tronco cerebral diagnosticada por resonancia magnética. Reconsideración epidemiológica y pronóstica.

INTRODUCTION AND OBJECTIVES: CT-scan allows emergency surgical evaluation of head injury lesions, but does not offer a comprehensive diagnosis of the resulting brain injuries. Magnetic Resonance Imaging (MRI) can complete the evaluation of head injury, particularly in the brain stem. We attempted to estimate the frequency of traumatic primary brain stem injuries MATERIAL AND METHODS: Thirty patients with moderate or severe head injury (GCS < or = 13) underwent a MRI study during the first two weeks after trauma. In order to exclude old patients with previous ischemic lesions unrelated to the head trauma, only young patients (16-40 years-old) were included. Patients with cranial surgery were also eliminated from the study. Based on previous studies, the FLAIR (8000/120/T. Inversion 2200mseg) sequence was selected. RESULTS: Brain stem injuries were detected in 26.6% of the patients; this was confirmed by two independent radiologists. Six patients had hyperintense lesions compatible with diffuse axonal damage, and two others showed hemorrhagic lesions. These findings were directly related to a specific neurological deficit in four patients; while in the remaining, unspecific consciousness disturbances were noted. CONCLUSIONS: We believe that the FLAIR sequence demonstrate a type of traumatic brain stem injury (probably corresponding to diffuse axonal injury) that is more frequent and less severe in terms of prognosis than those classically described in previous CT scan studies.

Lesión traumática del tronco cerebral diagnosticada por resonancia magnética. Reconsideración epidemiológica y pronóstica / Brainstem injury diagnosed by MRI. An epidemiologic and prognostic reappraisal

Introducción y Objetivos. La TAC craneal permite la evaluación quirúrgica urgente de un TCE, pero no supone una evaluación completa de las lesiones encefálicas producidas. La resonancia magnética (RM) puede complementar la evaluación del TCE, especialmente a nivel de tronco cerebral. Utilizando la secuencia FLAIR pretendemos obtener una estimación de la frecuencia de lesión primaria traumática de tronco cerebral. Material y métodos. Se presenta una serie prospectiva de 30 casos con TCE moderado o grave (GCS<=13) a los que se les realizó RM en un intervalo menor a dos semanas tras el traumatismo. En la serie se incluyeron exclusivamente pacientes jóvenes (entre 16 y 40 años), con objeto de excluir lesiones previas de tipo isquémico no relacionadas con el traumatismo. Quedaron fuera los pacientes con cirugía craneal para excluir lesiones yatrogénicas. En base a estudios previos, se utilizó la secuencia FLAIR (Fluid Attenuated Inversion Recovery 8000/ 120/ T. Inversion 2200mseg) para la detección óptima de lesiones de tronco cerebral. Resultados. En un 26,6% de los casos se apreciaron lesiones en tronco cerebral confirmadas por dos radiólogos independientes. De ellas, seis casos correspondían a lesiones hiperintensas compatibles con lesión axonal difusa y dos casos a lesión hemorrágica. La supervivencia de la serie fue del 100%, si bien este dato está sesgado por la selección exclusiva de pacientes que en un plazo inferior a dos semanas habían salido de cuidados intensivos. En cuatro casos pudo establecerse una relación directa entre lesión y focalidad neurológica. En el resto, la lesión fue relacionada con trastornos inespecíficos del nivel de consciencia. Conclusiones. Consideramos que la RM en secuencia FLAIR nos permite visualizar un tipo de lesión traumática de tronco cerebral (posiblemente lesión axonal) que presenta mayor frecuencia y menor gravedad pronóstica que aquellas otras descritas clásicamente en estudios realizados mediante TAC

Introduction and Objectives. CT-scan allows emergency surgical evaluation of head injury lesions, but does not offer a comprehensive diagnosis of the resulting brain injuries. Magnetic Resonance Imaging (MRI) can complete the evaluation of head injury, particularly in the brain stem. We attempted to estimate the frequency of traumatic primary brain stem injuries by using the FLAIR (Fluid Attenuated Inversion Recovery) sequence. Material and Methods. Thirty patients with moderate or severe head injury (GCS<=13) underwent a MRI study during the first two weeks after trauma. In order to exclude old patients with previous ischemic lesions unrelated to the head trauma, only young patients (16-40 years-old) were included. Patients with cranial surgery were also eliminated from the study. Based on previous studies, the FLAIR (8000/120/T. Inversion 2200mseg) sequence was selected. Results. Brain stem injuries were detected in 26.6% of the patients; this was confirmed by two independent radiologists. Six patients had hyperintense lesions compatible with diffuse axonal damage, and two others showed hemorrhagic lesions. These findings were directly related to a specific neurological deficit in four patients; while in the remaining, unspecific consciousness disturbances were noted. Conclusions. We believe that the FLAIR sequence demonstrate a type of traumatic brain stem injury (probably corresponding to diffuse axonal injury) that is more frequent and less severe in terms of prognosis than those classically described in previous CT scan studies

Factors contributing to the decline of leprosy in Spain in the second half of the twentieth century.

BACKGROUND: Leprosy is a chronic infectious disease that is considered to be declining, though it still remains prevalent in many parts of the world. A study was made to explore the health and socioeconomic factors that most influenced the trend of the disease in a typical Mediterranean country. MATERIALS AND METHODS: An ecological study was conducted, investigating possible social, economic and health factors related to the evolution of leprosy incidence. The time period considered was 50 years--the second half of the twentieth century in Spain. RESULTS: The variables showing the strongest correlation to evolution of the incidence of the disease were employment, the number of physicians, and the gross domestic product (GDP), with negative coefficients--while tuberculosis showed a positive coefficient. However, the GDP showed the highest coefficient (0.5). The model that best explained the evolution of leprosy over the last 50 years comprised a 6-year lag period between the socioeconomic factors and the incidence of leprosy--explaining 57% of the data obtained. The annual decrease in leprosy incidence was 1.6%. CONCLUSIONS: Socioeconomic development, assessed in terms of the GDP, was the most important factor in explaining the evolution of leprosy incidence.

Carcinoma epidermoide sobre anomalíavascular superficial / Epidermoid carcinoma on congenital vascular anormality

Se presenta paciente del sexo femenino con carcinoma epidermoide de labio inferior, sobre extenso angioma plano se hace diagnóstico diferencial y su posible relación con la anomalía vascular. Extirpación quirúrgica (AU)

Zonas cutáneas inmunes en la lepra / Inmune skin zones in lepra

A pesar de la constante afectación de la piel en la lepra, existen zonas cutáneas que excepcionalmente o nunca son afectadas. Es raro observarla en genitales, periné, axilas, región inguinal y uñas y es más frecuente en cuero cabelludo, palmas y plantas, casi siempre en enfermos multibacilares (AU)

Influencia de la infección por VIH en la lepra / Influence of VIH infection on lepra

Se expone la coincidencia entre la infección por el Virus de la Inmunodeficiencia Humana (VIH) y su estado terminal el Síndrome de Inmunodeficiencia Adquirida (SIDA) con la lepra, pues ambas tienen en común un deterioro del sistema inmunitario y una misma ubicación geográfica. Se analiza esta coinfección en diferentes países y su evolución, no siendo más frecuente esta asociación que el VIH en los grupos control. No existe oportunismo del M. leprae en los VIH positivos, siendo la evolución y terapia de la lepra en los afectados la misma que en los Hansenianos no afectados por el VIH. Se concluye proseguir la vigilancia de ambas endemias en la próxima década (AU)

Alopecias en la lepra / Alopecias in lepra

Se expone la clínica de las alopecias en la lepra, siendo la localización más frecuente en cejas, barba, pestañas y resto de la piel, y menos en cuero cabelludo. Se presenta casi siempre en enfermos lepromatosos y son de origen específico y neurotrófico, insistiendo en que la alopecia inicial de la cola de la ceja es un síntoma importante para el diagnóstico precoz (AU)

Historia de la Terapéutica de la Lepra / A history of the management of lepra

La Historia de la Terapéutica de la Lepra se divide en tres períodos: incurabilidad, monoterapia y multiterapia. Se describen las diferentes medicaciones en estos períodos y las últimas novedades así como el tratamiento de las reacciones (AU)

Diagnosis of brain abscess by magnetic resonance spectroscopy. Report of two cases.

Two cases of brain abscess were diagnosed by combining magnetic resonance spectroscopy (MRS) and magnetic resonance (MR) imaging. The resonances observed in vivo were assigned by means of an in vitro MRS study of the exudates extracted during surgical aspiration of the abscesses. The technique of MRS was demonstrated to be very powerful in the differential diagnosis of brain abscesses from other brain pathologies such as neoplasms. Amino acids, probably originating from extracellular proteolysis, and other compounds, such as acetate, arising from bacterial metabolism, were visible in the MRS spectra of the abscess, whereas they are not present in spectra of neoplasms. In this sense, MRS complemented the information provided by MR imaging to achieve a correct diagnosis of brain abscesses and could be added to routine MR examinations with only a small increase in cost and time.

The natural history of arachnoid cysts: endoscopic and cine-mode MRI evidence of a slit-valve mechanism.

Arachnoid cysts are space-occupying lesions filled with CSF-like content and surrounded by a membrane resembling arachnoid matter. They are regarded as a development abnormality of the arachnoid, originating from a splitting or duplication of this membrane. However, precise etiology and natural history remain controversial. Different hypotheses have been developed including agenesis of brain structures, arachnoiditis, active fluid secretion, and pulsatile pump. We present a review of the literature concerning these items and report one case of a suprasellar arachnoid cyst in which a slit-valve mechanism was observed by means of cine-mode MRI preoperatively and confirmed during the endoscopic intervention.

Giant cephalhematoma in a 15-year-old boy. Unilateral amaurosis as the main complication.

BACKGROUND: The term "cephalhematoma" is applied to a collection of blood under the periosteum of a skull bone. It most frequently occurs in the neonatal period and is rare at other times of life. METHODS AND RESULTS: We report on a 15-year-old boy with a subperiosteal hematoma involving the whole cranial surface. Surgical drainage was performed. In the immediate postoperative course, the patient developed a progressive decrease in the right eye visual acuity. An orbital computed tomographic scan revealed the retro-orbital subperiosteal extension of the hematoma. A second surgical procedure was necessary to obtain visual recovery. CONCLUSIONS: The occurrence of cephalhematoma in adults is exceptional. However, it may lead to serious complications. Surgical treatment should be aimed to avoid retro-orbital extension of the hematoma.

Establishing a home care protocol for early discharge of patients with hip and knee arthroplasties.

Joint arthroplasty procedures are significant in number and cost. Discharging hip and knee arthroplasty patients early from the hospital to a transitional home care program has the potential to reduce costs, while maintaining quality. A retrospective review of hospital records of hip and knee arthroplasty patients quantified patient problems during postoperative days 3 through 12 and analyzed them by age, gender, and joint type. The pilot study also allowed the development of a protocol for transitional home care after hip and knee arthroplasty.

[Immunology of leprosy. Review of data from the 1980-1990 time period]. / Immunologie der Lepra. Ubersicht zu Daten des Zeitraumes 1980-1990.

The classification used for leprosy so far distinguishes between two polar forms (pauci-bacillary and multi-bacillary), with different influences on the immune cells. The identification of specific antigens of the germ surface with monoclonal antibodies allows finer differentiation in classification, which now extends to transitional forms of clinical relevance. The current status of knowledge about immunological phenomena triggered by Mycobacterium leprae is complex, and controversy is rife at present. The bacillus is comparable to other mycobacteria in antigenicity. Owing to the complicated composition of the cellular envelope, few epitopes are accessible for immunological reactions. Investigation on the behaviour of T-lymphocytes in combination with analysis of the bacterial surface structures led to the development of a new pathogenetic concept. In spite of different immunological and inflammatory reactions in patients (reflecting the individual pathology), the discrimination between a partial and a total immunological defect is made. So far, no histocompatibility-antigen type has been found that allows recognition of the predisposition to infection. Immunity against the bacteria is achieved after BCG in some cases. All this suggests that the development of a vaccine via biotechnical synthesis of idiotypes and anti-idiotypes may be possible.