[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.

[Progression towards dislocations of foot bone lesions in leprosy]. / De l'évolution vers la dislocation des lésions osseuses du pied du lépreux.

From a series of 211 tarsal, medio-tarsal and metatarso-phalangeal dislocations, the authors, after having recalled the lesion mechanism, adopted a classification and gave a place to preventive conservative surgery in 52 cases. The early forms can have early limited arthrodesia. The developed lesions present indications of arthrodesia--isolated reconstruction or associated to spongy or cortico-spongy bone grafts. The late forms impose amputation even when the forefoot seems of good bone quality because the metatarsal-phalangial stiffness is the cause for the failure of the Wladimiroff-Mickulicz interventions.

[Course of bone lesions of leprosic feet towards dislocation of the tarsus and metatarsus]. / Evolution des lésions osseuses du pied lépreux vers la dislocation du tarse et du métatarse.

The authors have observed 135 dislocations of the tarsus in leprosic feet. They recall the mechanism of the lesion and propose a classification. 42 cases were operated on to prevent further deformities. When early treated limited arthrodeses may be beneficial in some cases. In more severe cases rebuilding arthrodesis alone or associated to cancellous bone grafting is indicated. In very severe cases amputation is only indicated because the Wladimiroff-Mickulicz technique as well as grafts lead to failures related to the metatarsophalangeal joints stiffness.

[Ischemic retraction of the intrinsic muscles of the hand in leprosy (a trial of physiopathologic and therapeutic re-evaluation)]. / Rétraction ischémique des muscles intrinsèques de la main dans la lépre (essai de réévaluation physiopathologique et thérapeutique).

An attempt of reevaluation of the ischemic contracture of intrinsic muscles is presented, study of a mechanism identical to the Volkman Syndrome (forearm muscles), etiopathogenic treatment (excision of infarcts) in the first stage and efficient palliative methods for the Swan neck fingers and deformity of the thumb.

[Osteoarticular lesions in leprosy (experience 1960-1982)]. / Lésions ostéo-articulaires dans la lèpre (expérience 1960-1982).

Bone changes are frequent in leprosy involving small distal bones of the limbs and, in advanced cases, some cranial bones. The various kinds of osteitis and their radiologic features are described as well as the arthritis to which they can give way. These changes may result directly from the infection by M. leprae indirectly through nerve damage and also by pyogenic infections. The therapeutic tactic is discussed according to this approach of the various types of bones and joint damage.

[Surgical decompression of neuritis of Hansen's disease]. / Décompression chirurgicale des névrites de la maladie de Hansen.

The recent progress were focused on: the identification of the general immunological mechanism of the hansenian neuritis, demonstrated by endoneural biopsies; the different pathology of the two categories of neuritis; the pathophysiologic derangements, inducing hypoxia or anoxia in the truncular involved segment. The adjuvant role of the canals is important; the clinical differences of the two categories of neuritis and the cases we shall treat by emergency; the importance of antireactionnal treatment and of the notation by tests for the study of the results. The goals are the hemodynamic decompression, useful in the first stage of ENL neuritis, the mechanical decompression of neural fasciculus and the urgent exeresis of necroses or evacuation of febrile abscess. Three technics a re studied: Extraneural and epineural decompression fascicular endoneural necrosis, neurolysis and complex neurolysis for evaluated ENL neuritis and for endoneural necrosis. The different indication according to the two categories: medico-surgical treatment for ENL neuritis, and according the precocity and the delay of the antireactional treatment, and also the absolute emergency of the necrosis and febrile abscess. The results of the treatment of 258 cases of recent neuritis are presented.