[Ulnar nerve palsy in leprosy without skin changes: biopsy of the superficial branch of the ulnar nerve in the hand]. / Paralisia do nervo ulnar na lepra sem alterações cutâneas. Biópsia do ramo superficial do nervo ulnar na mão.

Leprosy is one of the most common diseases of peripheral nerves in the world. In Brazil it is particularly frequent, being a major health problem. In tuberculoid leprosy the ulnar nerve is the most common affected nerve. Sometimes there are no skin changes. In these cases in spite of nerve thickening only the nerve biopsy is capable to make a specific diagnosis. We performed a biopsy in the dorsal sensory branch of the ulnar nerve in the hand in 17 patients with ulnar palsy with thickening of the nerve in the elbow, without skin changes. The pathological findings consisted mainly of: loss of fibers (14 cases), inflammatory infiltration (13), fibrosis (12), demyelination and remyelination (9), presence of granuloma (6) and presence of bacilli (5 cases). We conclude that in case of ulnar nerve palsy in leprosy without skin changes, the biopsy of the dorsal sensory branch of this nerve in the hand is a good procedure for the diagnosis of leprosy.

[Analysis of inter and intrapathologist concordance and discordance in a comparative study of the Madrid and Ridley-Jopling classifications of leprosy]. / Analyse de la concordance et de la discordance interet intrapathologistes dans une étude comparative des classifications de la lèpre de Madrid et de Ridley-Jopling.

Eighty-six patients of leprosy have been examined by three leprologists; they have been classified according to the Madrid classification and their lesions biopsied and sent to two pathologists for independent histopathological examination. The pathologists have not received any information regarding the cases. Firstly the "senior" pathologist (A) utilized the Madrid classification and the "junior" pathologist (B) the Ridley-Jopling classification. In a second phase, the "senior" pathologist utilized the Ridley-Jopling classification and the "junior" pathologist the Madrid classification. Both pathologists did not know their own previous histopathological diagnosis at the second phase. The analysis of concordance and discordance between the histopathological diagnosis of the two pathologists and for the same pathologist, on utilizing the two classifications, have elicited the following conclusions: 1. There has been more concordance between the two pathologists on utilizing the Madrid classification than the Ridley-Jopling classification for the lepromatous, borderline and tuberculoïd in reaction patients. 2. The comparison of the two classifications for each pathologist on "blindly" examination of the material, has shown more concordance for the "senior" pathologist than for the "junior" pathologist. 3. These observations have convoyed to the final conclusion that the Ridley-Jopling classification brings some difficulties to the pathologists with limited experience in leprology and therefore it should be utilized only by experienced pathologists. 4. This preliminary study shows the necessity of performing another one with larger number of patients, in the active phase, with larger number of pathologists, preferably from different countries, and by utilizing the same methodology of "blind" examination of the material.

[Comparative analysis of the clinical diagnosis of hanseniasis and the histopathological examinations performed according to the criteria of the Madrid and Ridley-Jopling classifications]. / Análise comparativa entre o diagnóstico clínico da hanseníase e os exames histopatológicos realizados segundo os critérios da classificação de Madrid e a de Ridley-Jopling.

A comparative study of the Ridley-Jopling's (RJ) and of the Congress of Madrid's (CM) pathological criteria was made in the different clinical types and groups of hanseniasis. A concordance between both criteria was found in the Indeterminate group and in the regressive phases of the Virchowian (V), Tuberculoid (T) and Reactional tuberculoid (RT) types. Clinical RT was confirmed by pathology in 81.2% of the cases according to CM, whereas 46.2% were considered "Borderline" according to RJ. Out of the 48 clinically V patients, 17 (35.4%) were "Borderline" (BL-2, BL-1 and BB), but practically all were also pathologically V according to CM. It is concluded that there is no practical convenience in the establishment of histopathological sub-groups that do not perfectly agree with clinical criteria. The Authors stress the importance of the study of the plasmocytes in the V infiltrates, of the lymphocytes in all granulomas and of the differences in the involvement of the neural ends, specially between the T and V poles. The dyeing of lipids by the Sudan III is useful to perfectly characterize the V pole, recognize residual V structures, separate the sub-groups BT, BB and BL, help in the early diagnosis of V infiltrations and differentiate the edematous, diffuse, non-granular cytoplasmatic vacuolization of RT.