Coping with a chronic disease: the role of the mind and spirit.

This article presents personal experience of surgeons with the rehabilitation of disabled people. Attention is paid to the role of mind and spirit in the rehabilitation with particular attention to people with leprosy. The consequences for patient education, emotional support and attitudes of professionals are described. The influence of hope and faith in the case for disabled people is stressed.

Bone loss in limbs with decreased or absent sensation: ten year follow-up of the hands in leprosy.

Three hundred and sixty-seven patients with insensitive hands have been studied by correlating radiologic findings with occupational and medical history in order to better define causal factors in bone resorption. This study indicates that nonspecific infection and trauma are the reasons for bone resorption in 98% of cases. The role of intermittent pressure seems to be in soft tissue breakdown, which then allows bone to become infected. Bone resorption can be arrested at any stage of the disease by appropriate therapy of splinting and control of infection.

Median nerve function after tendon transfer for ulnar paralysis.

This is a long term follow-up study of the median nerves of 128 leprosy patients who originally had pure ulnar palsy for which they had tendon transfers to correct claw hand. Of the thirty-one cases in which the carpal tunnel was not used as a pathway for tendon grafts, 16% developed median palsy in the subsequent years. Of the ninety-seven cases in which tendon grafts were passed through the carpal tunnel, 7% developed a transient median nerve palsy and 11% developed permanent median palsy. None of the median nerve palsies developed during the weeks or months of post-operative re-education or observation, but were noted at follow-up visits months or years later. It is concluded that the use of the carpal tunnel did not significantly affect the status of those high-risk median nerves in cases of leprosy.

Thermography: an aid in the management of insensitive feet and stumps.

Infrared thermography contributes to the care of insensitive limbs. The inflammatory response of near damaged or damaged tissue presents areas of increased heat on the surface which can be detected and followed. Thermography was found to be a valuable aid to the established management methods used for insensitivity problems including management of healing and freshly healed ulcerations, management of neuropathic bone and joint problems and fitting of prosthetic devices and custom shoes. The most important contribution thermography offered was the detection of irritated tissue prior to frank breakdown often in time to prevent permanent injury if quick and effective management followed.