[Randomized controlled trial of medical and medico-surgical treatment of Hansen's neuritis]. / Essai comparé randomisé du traitement médical et médico-chirurgical des névrites hanséniennes.

The aim of the study was to compare the results of the medical treatment alone and of the medico-surgical treatment on leprous neuritis. The patients were followed-up during 2 years, with regular neurological evaluations. The statistical study was performed using the Tukey test. Ninety-three nerves (ulnar, median, common peroneal and posterior tibial) with a deficit of less than 6 months duration have been studied in 31 leprosy patients. All the patients were treated by steroids but in some of them a nerve surgical decompression was performed. An improvement of the sensitive and motor deficit was observed in both groups. No significant statistical differences appeared between the 2 groups according to the nerve involved, the duration of the deficit, the form of leprosy and the type of antibacillary treatment. However, the medico-surgical treatment had a significant better result on pain and on major but incomplete nervous involvement. This study included a limited number of nerves, thus, it would be useful to perform others randomized assays to better define the indications of surgical decompression in the management of leprous neuritis.

[Treatment of leprotic neuritis. Exclusive medical treatment or combined with decompression]. / Evolution du traitement des nevrites hanséniennes. Traitement médical exclusif ou associé à la décompression.

The authors consider the evolution of the treatment of leprotic neuritis based on homogenous series of numerous observations (a minimum of 250-300). These observations are well registered and documented with some results dimensioned by the classical A. L. E. R. T. tests carried out at intervals of time and verified by comparison between series only medical treatment and series of medico-surgical treatment. Considering some remote results and some comparative series, the indications of the exclusive medical treatment have been well defined, and the ones of the surgical decompression have been reduced. The early case finding of a leprotic neuritis by the mean of easy methods as well as its monitoring during its early specific treatment is essential. By this way we get an important proportion of functional results: satisfactory (50 p.c.) or interesting (20 p.c.). In the case of painful hypertrophia, the complementary decompression secure not only the functional recovery of mortricity, but also the epicritic sensibility.

[Lepromatous leprosy: clinical and electrophysiological arguments in favor of axonal multi-neuritis]. / Lèpre lépromateuse: arguments cliniques et électrophysiologiques en faveur d'une multinévrite axonale.

UNLABELLED: This work was undertaken because there were only few reports on neurological aspects on lepromatous leprosy. We studied 30 patients suffering from lepromatous leprosy who, at their first visit to the Institute had never been treated. The clinical examination included a quantitative evaluation of the neurological status following the method developed by Pearson. Motor and sensory nerve conduction velocities were measured: values of conduction velocity and distal amplitude were analysed and compared to those of a group of 22 healthy subjects. IN CONCLUSION: (a) There is a high frequency of clinical and especially electrophysiological neurological impairment. This impairment can be extremely precocious and may happen shortly after the first cutaneous signs. (b) Nervous impairment is diffuse, bilateral but not homogeneous. These are characteristics of mononeuritis multiplex. Impairement is predominantly sensitive and tactile sensibility is more involved than thermo-algic sensation. (c) The radial superficial nerve is the most frequently involved clinically and electrophysiologically. (d) The electrophysiological results, showing a normal or slightly reduced conduction velocity and a low amplitude of evoked potentiel are in favour of a predominantly axonal damage.

[Remote results of the surgical decompression of the posterior tibial nerve in the neuropathies of Hansen's disease]. / Les résultats éloignés de la décompression chirurgicale du nerf tibial postérieur dans les neuropathies de la maladie de Hansen.

Results are reported of surgery to the posterior tibial nerve affected by leprosy in 50 patients. A total of 90 neurolyses were performed using a similar technique. Study of the effect of surgery on the course of plantar sensitivity showed that 3 groups of nerves can be distinguished. Nerves in group 1 (21 totally paralyzed nerves) responded poorly to surgery (38% useful results) while on the contrary nerves in group 3 (non-paralyzed nerves) represented the ideal indication, surgery being truly prophylactic. In group 2 nerves a useful result was obtained in 82%. Indications for use of this surgical procedure are discussed, and more particularly the parameters affecting the quality of the results: severity of lesion, immunologic type of disease.

[Multi-drug therapy trials for leprosy in Senegal: first observations relative to liver tolerance of multibacillary patients. Therapeutic consequences]. / Essais de polychimiothérapie de la lèpre au Sénégal: premières observations relatives à la tolérance hépatique des maladies multibacillaires--conséquences thérapeutiques.

The authors have studied tolerance of multibacillary patients to 4 MDT regimens. These 4 regimens consist of: One supervised part in which RMP-ETH combination in once-monthly administered; furthermore, in 2 of these regimens, is included one "starter phase" with daily doses of that combination for 2 months. One self-administered part during which CLO is associated either to DDS for new cases, or to ETH for relapses. Clinical Supervision: Out to 310 multibacillary patients, 7 cases of hepatitis with or without icterus, but no death due to the treatment. Interruptions of MDT have been temporary and have been observed in 0.9 to 5.6% of the patients according to the therapeutic regimen. Checking SGOT: The SGOT were abnormally high in 16.3% of the patients before treatment. These pre-existing liver damages do not favour the appearance of intolerance disorders. During MDT, abnormal increases in SGOT are observed in 27% of the patients but there is no exact correlation between the absorbed doses of ETH and the frequency in SGOT increases. The clinical or biological evidence of liver damages occur rather early (1st, 2nd month) in regimens with "starter phase", and later (4th-8th month) in those without "starter phase". But introduction of "Starter phase" does not increase the global frequency of such intolerance accidents. ETH combined with RMP, must be used under steady clinical and biological supervision. Recalling the results of a previous survey, the authors consider that a long duration of MDT is not necessary. For the multibacillary leprosy treatment, they propose a diphasic regimen, more easily applicable in the field than the WHO protocols. In this diphasic regimen, the only part which must be supervised is the initial "starter phase" of 2 month. It consists of daily administration of 3 antibacillary drug among which RMP and ETH. The second phase is a relay treatment using 2 drugs, CLO combined with DDS or ETH, self-administered until smear negativity.

[Analysis of the results of treatment of Hansen's neuritis]. / Analyse de résultats du traitement des névrites hanséniennes.

The authors expose a retrospective study about 133 nervous contingents treated exclusivement by steroid-therapy. The objective is to study the influence on nerve-function recovery of the following parameters: clinic form, function (sensitive or motor) of the nerve, position of the nerve (ulnar, median...), nature of the antibiotherapy. The method is based on the comparison for average progress in relation with the initial score. It appears that tuberculoid nerves recovery is better and faster than the lepromatous one. But lepromatous nerves improvement keeps on the end of the second year. On the other hand, the results are not influenced by the nerve itself or its function. Concerning antibiotherapy, our results show à significant difference, in consideration of a better improvement in PCT-treated nerves. Nevertheless, these results have to be confirmed by a comparative experimentation.

[A trial of polychemotherapy of leprosy in the Dakar region. Initial observations on the acceptability of the protocols used]. / Présentation d'un essai de polychimiothérapie de la lèpre dans la région de Dakar. Premières observations sur l'acceptabilité des protocoles utilisés.

Since 1982, in Dakar, a controlled essay tests the suitability of several short protocols of multidrug therapy (MDT), some of them being close to those advised by the WHO, others showing a starter stage of a two month daily MDT. In three years, 198 paucibacillary and 123 multibacillary patients have been treated. The short duration of these treatments leads to an important decrease in the load of the Department. The total rate of those who have not attended for the treatment is of 15.2% whereas it was of 52% with DDS monotherapy for a similar treatment duration. Those who gave up don't seem to live in Dakar. To judge by the diligence of the patients, the compliance seems excellent even for the protocols requiring a daily dose of ethionamide: 95% of paucibacillary, 76% of multibacillary patients have maximal attendance. The authors think that any MDT program: must be preceded by a retraining of staffs; must give a priority to the health education of the patients; must involve a home patient search for system.

[The value of electromyographic studies in leprosy]. / Intérêt de l'examen électromyographique dans la lèpre.

In Dakar, during a definite period of time, all the new leprosy cases have been subjected to an electromyographic examination before treatment: a total of 37 patients and 518 examined nerves including all clinical forms: NCV: 33% of the examined nerves are found to be affected. The sensory nerves are frequently and early involved. In frequency order: sural (54%), posterior tibial (50%), sensory ulnar (35%), sensory median (29%), motor ulnar (28%), lateral popliteal (17%) and motor median (12%). The study of the SCV seems relatively more reliable than the sensory testing in the case of the ulnar and the median (75 comparisons): concordance in 69% of the cases; SCV only abnormal in 19%; sensory testing only abnormal in 12%. The EMG detection is superior to the motor testing and to the motor nerve conduction for the lateral popliteal (32 comparisons): 41% of concordant examination; 59% of differences among which 44% of anomalies revealed only by detection.

[Correction of the Hansen claw hand using direct Zancolli lasso procedures and 2 of its variations]. / Correction des griffes cubitales hanséniennes par le procédé du "lasso de Zancolli" direct et par deux de ses variantes.

The procedure of the Zancolli "Lasso" or V direct Zancolli uses a flexor superficialis tendon which after a distal section is turned inside out and is fixed on itself after forming a loop around the proximal pulley of the sheath of the flexor. The mode of distal fixation being the same, the authors also study two different methods which resort either to one tendon for two, three or four fingers, or only to one strip of the flexor tendon for one finger. 45 cases of this kind of operation are reported. In the most important series in which the principle procedure has been used, the results are good in 80% of the mobile claws and average in 70% of the stiffened claws. The cases operated according to the two different methods, less numerous, give approximately the same results. The suggested indications are in favour of the changes in the procedure.

[Prevention of perforating plantar ulcers: trial directed by a mobile team]. / Prévention des maux perforants plantaires: essai mené par une équipe mobile.

AIMS: to prevent the appearance of plantar ulcerations and then mutilations, by going in the field in order to: make suitable footwear, educate the patients, train the paramedical staff. Means: 1 fitted lorry, 1 physiotherapist, 1 shoemaker, and 1 educator. RESULTS: In one year, 206 patients have been provided with shoes and followed up. Advice have been taken exactly in the leper villages in which the attendance rate is of 98%; this rate varies between 47 to 70% in the all-purpose dispensaries. Paramedical workers of all-purpose Health Centers did not take great interest in this action. After 6-12 months under observation: 84% of good results for the feet without deformity or slightly deformed; 51% for the deformed feet. The results are quite satisfactory for the feet without plantar ulcer at the beginning, and that whatever the food deformity stage. But for the feet wounded by plantar ulcer at the beginning, 33% of recovery have been reported after wearing these shoes.

[Frequency of the association of perforating plantar leprotic lesions and truncal involvement of the posterior tibial nerve]. / Fréquence de l'association entre les maux perforants plantaires lépreux et l'atteinte tronculaire du nerf tibial postérieur.

This study was performed to determine the electrophysiological status of the posterior tibial nerve and its muscular innervation in patients both with and without plantar ulcers without osteitis. In both cases, motor distal latencies remained normal, but the denervation of the plantar muscles was significantly more important in patients with ulcers. These results show that axonal degeneration is predominant in leprous neuritis affecting the tibial nerves. Neurolysis was performed in twelve patients in the retromalleolar part of the tibial nerve. All patients have recover from their ulcers, but no improvement of their electrophysiological parameters was observed.