Improving functions in leprotic hands.

PURPOSE: In the developed countries there is a shift in the rehabilitation strategy from community based services to work site based services for the disabled. Leprosy disabled are more at a disadvantage that many of them have not had the benefit of disability prevention activities and harbour such hand deformities for which the only solution is community based rehabilitation. METHOD/RESULTS: Of the various modalities of rehabilitation the authors consider one for this article suitable for work site based rehabilitation as the Modulan grip-aids. CONCLUSION: Essential components of the material and its uses are described with examples.

Bacterial culture and sensitivity in pemphigus.

Infection is the commonest cause of death in pemphigus and the commonest infection is Staphylococcus aureus bacteremia. In present study bacterial culture and sensitivity from the lesion was done in 25 patients of pemphigus vulgaris and accordingly antibiotics were given along with other treatment of pemphigus i.e. steroid, immunosuppressive drug etc. Most common pathogenic bacteria isolated was Staphylococcus aureus and it was sensitive to cloxacillin, erythromycin, cefotaxime and lincomycin.

Langerhans cell histiocytosis.

A case of Langerhans Cell Histiocytosis (LCH) is reported in 1½ years old boy. He had seborrhoeic dermatitis like condition of scalp, papular lesions with purpura typical of Letterer-Siwe disease associated with constitutional symptoms, hepatosplenomegaly, jaundice, anaemia and thrombocytopenia. Peripheral blood film and bone marrow examination showed presence of LCH cells.

Bilateral pigmented hairy epidermal naevus.

A 15-year-old boy developed bilateral Becker's naevus over scapular region without any associated abnormality.

Serodiagnostic efficiency of phospholipid associated protein of Mycobacterium tuberculosis H37Rv.

The phospholipid-associated protein (55-67 kDa) fraction of Mycobacterium tuberculosis H37Rv was purified as the DE-V protein fraction. This DE-V fraction was used for diagnosis of tuberculosis by enzyme-linked immunosorbent assay (ELISA), detecting IgG antibody in sera collected from different categories of tuberculosis patients, i.e. with acid fast bacilli (AFB) culture-positive pulmonary tuberculosis, with AFB culture-negative, but radiologically suspected, pulmonary tuberculosis, extrapulmonary tuberculosis, and control groups of patients suffering from diseases other than tuberculosis (asthma and/or rhinitis, lepromatous leprosy) as well as from healthy volunteers. Encouraging operational ELISA validity could be achieved with 93% sensitivity, 100% specificity, 97% efficiency, 100% positive predictivity and 95% negative predictability even among the extrapulmonary and suspected pulmonary tuberculosis patients. The above assay was insensitive but with 100% specificity among control group of patients suffering from diseases other than tuberculosis. The DE-V protein fraction was associated with phosphatidyl inositol and phosphatidyl inositol mannosides. The dissociation of phospholipid-protein complex decreased ELISA specificity. ELISA reactivity of the DE-V fraction appeared to be thermostable; thus, it may have serodiagnostic utility in developing countries.

Modulan grip-aids for leprosy patients.

Made-to-measure Modulan grip-aids were fitted to 755 articles for 155 patients with hand deformities due to leprosy. The acceptance of the grip-aids was, in general, good. No instance of contact dermatitis or skin irritation was reported. These grip-aids facilitated a normal grip with crippled hands, and thus considerably improved the quality of the patient's personal and working life. They increased the patient's self-esteem and self-confidence because he/she could handle everyday objects or tools without the help of others and could do his/her job--an important step toward social and economic rehabilitation.

Rehabilitation in Hansen's disease.

Hansen's disease leads to deformities of the lower and upper extremities. Eventually, these deformities become a serious handicap and limit the functional capabilities of the afflicted. This paper defines the characteristics of individuals suffering from Hansen's disease and demonstrates that disabilities caused by Hansen's disease can be overcome by: (i) use of splints, (ii) reconstructive surgery, (iii) modification of the articles and tools of daily use, and (iv) proper job--worker matching.

One in four flexor digitorum superficialis lasso for correction of the claw deformity.

In continuation of the author's work on 'lasso' principle, flexor digitorum superficialis split in to four tails and looped around A1 pulley has been described in this article to correct the ulnar claw and to correct the total claw hand when used along with opponensplasty as a one stage technique. This operation has the advantage of retaining superficialis tendons of the other fingers for better power grip and the avoiding swan neck deformity.

Evaluation of nerve function deficit. Its improvement by nerve decompression or corticosteroid therapy.

An attempt has been made to use the protocol for evaluation of nerve damage prepared at a "Workshop on Neuritis" held at Schiefflein Leprosy Research and Training Centre, Karigiri in three cases of ulnar nerve decompression, three cases of median nerve decompression and three cases of ulnar neuritis on corticosteroid therapy. The nerve function deficit did show an improvement. The problems and suggestions are presented with a view to encourage the use of the said protocol to enable comparison of data amongst different centres and different therapy.

Post decompression ulnar claw and its recovery.

There are no reports on the ulnar claw hand developing immediately after the nerve decompression although the possibility exists. A case report is presented in which the decompression for ulnar neuritis was complicated by the ulnar claw developing on the next day. Such complication can prove embarrassing to the surgeon and worry some for the patient. However, it improved in six months along with recovery of other modalities of sensation and voluntary motor power.

Multiple superficialis motor for opponens and lumbrical replacement: one stage correction of leprous claw hand.

A new one stage approach for the correction of total claw hand in leprosy has been described using multiple superficialis motor for opponens and lumbrical replacement. Five cases have been operated with good results by this technique. The operative technique is described, advantages and precautions discussed.

Correction of ulnar claw hand by a loop of flexor digitorum superficialis motor for lumbrical replacement.

The current dynamic procedures for correction of ulnar claw hand are extensor carpi radialis longus many tail graft, palmaris longus four finger many tail graft and extensor by pass operation. Each of these procedures takes a minimum of one and a half hours and needs extensive post operative re-education and training. These procedures employ a graft of plantaris tendon, fascia lata or extensor tendon, with the disadvantages of operating at another site and adhesion of grafts. The procedure described in this article obviates these disadvantages. The operation is simple to perform and has given good results even when performed at leprosy camps where no extensive re-education physiotherapy was available. This operation also tends to correct the reversal of transverse arch. The technique and observations are discussed in detail.

Nerve conduction in leprosy: in vivo and in vitro study.

Sensory and mixed nerve conduction studies were performed on the distal segments of the radial, sural, median and ulnar nerves of leprosy patients from the entire spectrum of the disease. The values obtained were compared with those of age matched normal controls. All the clinically involved nerves, and about 30% of the clinically normal patient nerves showed a delayed conduction velocity. The conduction velocity difference was most significant (P less than 0.001) for the cutaneous branch of the radial, and sural nerves as compared to the ulnar and median. Five patients nerves that were clinically normal and showed a normal conduction velocity when tested in vivo, were biopsies and studied in vitro to determine the type of early nerve damage. C and A delta fibre involvement was found in all these nerves. It is concluded that leprosy is a diffuse neuropathy and there is early detectable nerve involvement even in clinically normal nerves of leprosy patients.