MR imaging of neuropathic feet in leprosy patients with suspected osteomyelitis.

This study was undertaken to analyze MRI findings in leprosy patients with neuropathic feet, which are suspected of having osteomyelitis. As far as we know, there is no literature concerning osteomyelitis and MRI in neuropathic leprosy feet at present. Therefore, we have included MRI examination of 18 events of suspected osteomyelitis in 12 leprosy patients. All patients with long-standing neuropathic foot problems were clinically suspected of having osteomyelitis. All patients underwent the MRI protocol with the inclusion of Two Point Dixon Chemical Shift Imaging as a fat-suppression sequence. For the MRI evaluation, we used signs that are described in literature for detecting osteomyelitis in diabetic feet. The primary MRI signs were positive in 17 of 18 patients. The secondary MRI signs were positive in 100% of the patients. Our results show that MRI with the use of Two Point Dixon Chemical Shift Imaging is a promising diagnostic modality to detect osteomyelitis in the presence of neurosteoarthropathic changes in patients with leprosy. Whenever available, MRI could play an important role in detecting osteomyelitis in leprosy patients with long-standing neuropathic feet.

Squamous cell carcinoma of the foot arising in chronic ulcers in leprosy patients.

Squamous cell carcinoma (SCC) of the foot is a rare sequelae of chronic ulceration secondary to leprosy neuropathy. Most of the tumours are relatively slow growing and tend to metastasize late. Survival after local excision is generally good. In this series of 17 patients so far there have been 3 deaths attributable to SCC, all of whom presented with locally advanced tumours and lymph node metastasis.

[Characterization of chronic plantar ulcers in former leprosy patients]. / Cancérisation des plaies chroniques plantaires chez les anciens malades de la lèpre.

Between 1988 and 1992, 21 biopsies for pathological examination were taken from 20 Senegalese leprosy patients suffering from chronic plantar ulcers (CPU) suspected of malignant transformation. The diagnosis of squamous cell carcinoma was effectively made in 13 cases and that of pseudoepitheliomatous hyperplasia in the remaining 8 cases. The mean period of time between the onset of CPU and that of malignant transformation was 10 years (range: 1 to 15 years); the mean annual frequency of the malignant transformation was 2 per 1,000 CPU. In countries where pathological examination is not available, below knee amputation could be considered whenever main clinical signs of malignant transformation are present. In countries where pathological examination is available, the therapeutic decision may differ according to the diagnosis: below knee amputation supplemented with block dissection of inguinal lymph nodes whenever possible in cases of carcinoma; below knee amputation depending on the function status of the foot and on the volume of tumor in case of pseudo-epitheliomatous hyperplasia.

Squamous cell carcinoma in plantar ulcers in leprosy. A case control study.

The objective of this case-control study was to identify factors associated with the development of squamous cell carcinoma (SCC) in plantar ulcers of leprosy patients. We examined 2 matched groups consisting of leprosy patients with and without SCC in a plantar ulcer. No correlations were found between the development of SCC and race, profession, place of origin, duration of leprosy, the type and duration of leprosy chemotherapy, presence of bone involvement and type of ulcer care treatment given. The only statistically valid finding was that the duration of the ulcer was significantly lower in the group with malignant change. In this group there was an apparently higher use of pesticides, the difference being not of statistical significance. It is concluded that factors other than ulcer duration need to be looked for, in order to identify factors influencing malignant change in plantar ulcers of leprosy patients.

Tetanus in patient with lepromatous leprosy (I).

Tetanus in lepromatous leprosy is rare and reported occasionally as case reports only. We present a case of lepromatous leprosy who succumbed to death due to rapidly progressing tetanus. The mechanism of protection from tetanus in leprosy is discussed.

Squamous cell carcinoma in trophic ulcer cases.

Two cases having trophic ulcer over the heel, for long time, later developed squamous cell carcinoma are reported, because of its paucity in literature. Various factors blamed for carcinomatous change are enumerated.

Squamous cell carcinoma developing in trophic ulcer in leprosy--a case report.

Development of malignancy in the trophic ulcer in leprosy is not previously believed rare. In India, less than a dozen cases are reported uptil now. We present a case of squamous cell carcinoma in trophic ulcer in leprosy patient because of its paucity in literature. Aetiopathogenesis of malignancy is discussed briefly.

Anaerobic flora in trophic ulcers in leprosy patients.

Material from 108 trophic ulcers from leprosy cases were studied bacteriologically. 4 cases showed growth of pure anaerobes and 69 showed mixed growth of aerobic and anaerobic bacteria. The predominant anaerobes were Fusobacteria (41), anaerobic cocci (30) and Bacteroides (25). Clostridia were isolated only in 10 cases. Metronidazole, chloramphenicol, penicillin and ampicillin were found effective against anaerobes in in-vitro studies.

Aspectos da assistência de enfermagem na hanseníase: prevençäo da úlcera plantar / Aspects of nursing care in hanseniasis: prevention of plantar ulcer

Foram estudados 206 pacientes hansenianos com anestesia plantar internados em hospital, a fim de verificar as variáveis que influenciam na ocorrência da úlcera plantar. A coleta de dados foi realizada mediante entrevista com preenchimento de formulário específico. Os resultados submetidos a tratamento estatístico, demonstraram que o sexo, a idade, a escolaridade, a ocupaçäo e o tempo de anestesia plantar näo interferem na ocorrência da úlcera plantar. Acreditando-se no real valor preventivo das técnicas simples, fez-se um levantamento do conhecimento e da prática dessas técnicas nos pacientes com ou sem úlcera plantar. Verificou-se que os pacientes hansenianos com pé anestésico sem úlcera plantar, conhecem e praticam mais as técnicas simples de prevençäo do que aqueles que têm úlcera plantar

Malignant degeneration in chronic ulceration of the leg and foot in leprosy patients; two case reports

The development of squamous cell carcinoma in long-established ulcers is described in two patients with leprosy, one on the lower leg in a patient with borderline-tuberculoid (BT) leprosy and the other on the sole of the foot in a patient with lepromatous (LL) leprosy. Although sometimes stated by clinicians to be rare, and infrequently reported in the literature, it is suggested that malignant change in chronic ulcers in leprosy may be found more often if patients are examined with care and the possibility kept in mind.

Surgical decompression of posterior tibial neurovascular complex in treatment of certain chronic plantar ulcers and posterior tibial neuritis in leprosy.

Seventy-one cases of posterior tibial neurovascular surgical decompression in leprosy are analyzed and reviewed. Thirteen had chronic refractory posterior tibial neuritis while 58 had chronic nonhealing plantar ulcers. The plantar ulcers were associated with posterior tibial neuritis and/or vascular insufficiency. The clinical and operative findings together with the results are presented and the physiopathology of neurovascular compression is discussed. The operative procedure is described. The presence of pale granulation tissue in a nonhealing ulcer seems to be a characteristic finding in these cases. Neurovascular compression in the tunnel, behind and also below the malleolus, was present in all. In operative procedures, the importance of incising the inferior calcaneal bands is stressed. The results show that the neuritis was cured in all cases, while in 53 of 58 cases the plantar ulcers healed in a short period after the decompression. This stresses the value of this procedure. The prophylactic potential of this procedure needs to be evaluated.