Autochthonous lepromatous leprosy in a Spanish woman with burns on both feet and skin lesions.

The incidence of leprosy is decreasing worldwide and it is considered a rare disease in developed countries. In Spain, leprosy is mainly an imported disease with only few autochthonous cases seen. The diagnosis is difficult because of a low index of suspicion and the absence of visualisation of fast-acid bacilli in the lesions. Here, we report an autochthonous case of leprosy diagnosed after 4 years of evolution of skin lesions. Mechanical rupture of the biopsy helped finally to make the correct diagnosis of the disease.

Exotic pathology of the hand and foot. A pictorial review.

In this article, the imaging findings of the most frequently encountered import pathology of the hand and foot are reviewed, including leprosy, loiasis, snake bites or penetration of spines of sea urchins in the hand and foot. Our objective is to familiarize the radiologist of the Western countries with these diseases, which are still prevalent in developing areas. Due to the rising traveling to foreign countries and continuous immigration, it is important that these disorders be considered in the differential diagnosis in a specific population of asylum-seekers, economic refugees and any other group of persons traveling around the globe. Imaging findings on conventional radiography will be emphasized.

Proyecto de prevención de discapacidades y rehabilitación física para enfermos de lepra. Provincia de Jiangxi, china / No disponible

La Asociación Fontilles, miembro de la Federación Internacional de Asociaciones de Lucha contra la Lepra (ILEP), inicia su trabajo en China colaborando con otros miembros de dicha Federación, y con el Centro Nacional para el Control de Enfermedades de Transmisión Sexual y Lepra de Nanjing en el tercer estadio del Proyecto nacional de Prevención de Discapacidades (PDD) y Rehabilitación Física en la República Popular China. La Asociación Fontilles ha trabajado en esta provincia durante cinco años del 2000 al 2004. El artículo pretende describir las actividades básicas relacionadas con el Proyecto y los resultados obtenidos tras llevarlas a cabo

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[Injuries of the tibialis posterior tendon: diagnosis and therapy]. / Verletzungen der Sehne des M. tibialis posterior. Diagnostik und Therapie.

Complete traumatic rupture of the tibialis posterior tendon is absolutely rare. From the scarce case reports in the medical literature a extreme pronation-abduction or pronation-external rotation mechanism according to the Lauge-Hansen classification can be presumed, leading to a malleolar fracture because of forced pronation, external rotation and dorsiflexion of the foot. With primary suture the prognosis is favorable. Traumatic dislocations, mostly with luxatio pedis sub talo, are treated by atraumatic reduction and refixation of the retinaculum. Again, the prognosis is favorable. Incomplete traumatic rupture of the tibialis posterior tendon with development of posttraumatic pes plano valgus, according to case reports and our own experience result from severe pronation-external rotation-soft tissue injuries as well as with pronation-abduction or pronation-external rotation-type ankle fractures. In these cases no macroscopic rupture of the tendon is evident, however occult interstitial micro-ruptures can occur because of excessive stretching, which can be determined histologically. If conservative measures fail, a modified Evans osteotomy to lengthen the lateral foot column is indicated. Degenerative complete and incomplete ruptures of the tibialis posterior tendon are predominantly seen in women more than 42 years old. Staging of this entity can be achieved with clinical tests (muscular force, external rotation), ultrasound, weight-bearing x-rays, CT and MRT. According to the degree of decompensation of tendon function, treatment consists of augmentation, modified Evans procedure or triple arthrodesis of the hind-foot.

Malignant melanoma over the trophic ulcer.

One case having trophic ulcer over the heel which on histological examination showed malignant melanoma is reported because of malignant melanoma occurring over the trophic ulcer.

Epiphyseal injuries of the foot and ankle.

A thorough knowledge of functional growth plate anatomy and physiology is essential to proper management of epiphyseal foot and ankle injuries. The ability to classify foot and ankle fractures according to the Salter-Harris anatomic and radiographic classification provides useful prognostic information that may affect treatment. The Dias-Tachdjian mechanistic classification system for pediatric ankle fractures provides useful information about the extent of osseous and soft tissue injury and the best method of closed reduction and correlates well with the Lauge-Hansen system, which is widely used for adult ankle fractures. Most epiphyseal foot fractures involve the metatarsals or phalanges and can usually be managed with closed reduction. Considerable spontaneous correction of deformity can be expected in the younger child (under age 10 years), but one should be aware that sagittal plane and rotational malalignment of the metatarsal heads may cause significant problems. Salter-Harris type I and II fractures of the ankle can usually be managed with closed reduction. Salter-Harris type III and IV ankle fractures with greater than 2 mm of displacement require open reduction and internal fixation. One must also have a high index of suspicion for juvenile Tillaux and triplane transitional fractures that may not be obvious on plain radiographs. Although these fractures usually do not produce significant limb-length discrepancies, they are intra-articular fractures and ankle joint arthritis can result. Finally, younger children (under age 10 years) have a better prognosis for spontaneous correction of nongrowth arrest-induced deformities but a much poorer prognosis with growth arrest injuries than do older children, in whom growth arrest does not usually cause a significant problem. All children with growth plate injuries should be followed at regular intervals for at least 2 years or to skeletal maturity in the case of physeal disturbance. Treatment of epiphyseal fractures of the foot and ankle must be individualized but should always be based upon a thorough knowledge of anatomy, bone growth physiology, classification, potential pitfalls, and prognosis.