Ulnar neurolysis in 279 cases of leprosy was performed with objectives of relief in neuritic pain and impending/ existing sensory motor loss of varying extent. Of the above, 193 could be followed between 3-10 years. Neuritic pain was first to disappear. 48.7% of the 193 cases showed sensory recovery. Motor power gain and/or further fall in muscle power was prevented as a result of preventive neurolysis in 173 (89.6%) cases. In this series benefits of appropriate and timely surgical intervention have been observed.

Adolescent↗

PubMed1997

Rifampicin and isoniazid in the treatment of leprous nerve abscesses.

Thirty nine cases of borderline tuberculoid leprosy having nerve abscesses (15 with sinuses) were treated with daily dose of rifampicin and isoniazid for six months along with standard multidrug therapy. The patients were followed up for three to five years. No recurrence of abscess or sinus was observed. Observations indicate that medical approach is required at times to supplement surgical intervention for management of these cases.

Abscess↗

PubMed1997

Evaluation of results of surgical decompression of median nerve in leprosy in relation to sensory--motor functions.

Median nerve decompression was performed in 29 leprosy patients of which 20 were followed up for varying periods. It has been observed that the decompression was beneficial, sensory recovery was seen in 90% cases and in 45% cases the muscle strength improved and the process of deterioration was arrested in another 25% cases.

Adolescent↗

PubMed1996

Extensor indicis opposition transfer in the ulnar and median palsied thumb in leprosy.

Twenty seven opponensplasties for ulnar and median paralysis in 25 leprosy patients were performed using extensor indicis proprius. An additional transfer of the radial half of flexor pollicis longus to extensor pollicis longus was done to stabilize the metacarpophalangeal joint of the thumb. The biomechanical aspects of extensor indicis proprius tendon transfer were studied and results evaluated using various anatomical and functional parameters. Extensor indicis proprius provides adequate strength to position the thumb. However, sometimes it does not reach its new insertion. There is no significant deficit at the donor site but in a few cases the index finger may lose its capability for independent extension and sometimes a proximal interphalangeal joint contracture may develop.

Adolescent↗

PubMed1996

Evaluation of the results of opponensplasty.

A comprehensive evaluation system for opponensplasties has been described taking into consideration several variables. Each variable has been assigned a score depending upon its significance in the normal hand. The total score of the hand is used for grading the results as good, fair and poor.

Hand Strength↗

PubMed1996

Calcification of peripheral nerves in leprosy.

A study conducted in 74 TT/TB patients, with gross thickening of nerves together with nerve abscess, showed calcification in 8 patients. Calcification was most common in the ulnar nerve followed by the lateral popliteal nerve. All eight patients were males with significantly longer duration of illness before start of treatment. Patients with late onset of nerve abscess were found to be more prone to calcium deposition in the nerves. Caseous pus of the abscess had high lipid content with raised cholesterol and cholesterol ester ratio to total lipids suggesting a dystrophic nature of calcification.

Abscess↗

PubMed1996

Single tendon--two insertion versus two tendon transfers for reablement of ulnar-median palsied thumb in leprosy.

Twenty-three opponensplasties for ulnar median paralysis in 20 leprosy patients were performed by two different procedures i.e. extensor indicis proprius and flexor digitorum superficialis transfers using standard techniques. The results were evaluated using various objective and subjective, anatomical and functional parameters. Two tendon transfers appeared to be superior to single tendon two insertion transfers. It was concluded that if situation permits, two tendon transfers should be performed for combined ulnar median paralysis.

Adolescent↗

PubMed1995

Towards restoring sensibility in anaesthetic extremities of leprosy patients.

In leprosy patients, the problems arising due to anaesthesia in the extremities have been outlined. The available modalities, some of them still experimental, for overcoming the handicap have been discussed.

Extremities↗

PubMed1995

Neuritic leprosy: further progression and significance.

Sixteen neuritic cases have been seen developing cutaneous lesions. These cutaneous lesions by and large appear within 4 months after the diagnosis of neuritic leprosy. Leprosy pathology in cutaneous lesions has been found ranging between indeterminate and borderline lepromatous group. Development of cutaneous lesions does not seem to be influenced by age, sex or number of nerves or lepromin status. Neither lesions seem to appear in any particular part of the body. Therapy, duration and type i.e. monodrug or multidrug, also does not seem to influence the development of cutaneous lesions in either way. It appears that neuritic cases with either very early (indeterminate) or with advanced multibacillary neural pathology may develop skin lesions. Skin lesion possibly appear following reversal reaction in skin. Cases with newly developed skin lesions well respond to standard therapy. Development of cutaneous lesions by neuritic cases possibly indicates towards the natural history of the disease, conforming to the hypothesis that leprosy is basically neural in inception and that all other forms emerge from it.

Adult↗

PubMed1995

Membrane attack complex in thickened cutaneous sensory nerves of leprosy patients.

Membrane attack complex (MAC) is a terminal end product produced as a result of complement activation. The deposition of MAC, in tissues, is known to have a local tissue damaging effect in several clinical conditions. Therefore, an attempt was made to demonstrate MAC in peripheral nerve biopsies, collected from leprosy patients. Interestingly, we could demonstrate deposition of MAC in involved cutaneous sensory nerves from most of the lepromatous leprosy patients. Contrary to this, majority of nerve biopsies from tuberculoid leprosy patients did not stain for MAC. Though MAC positive sections showed reactivity for S-protein, our observations support the possibility that MAC, either acting directly or indirectly, may be implicated in nerve damage, at least, in lepromatous leprosy patients.

Antigens, Bacterial↗

PubMed1994

Surgical correction of saddle nose deformity in leprosy--one stage procedure.

In twenty-four leprosy patients having mild to moderate nasal deformity, a corticoperiosteal bone graft obtained from second metatarsal bone was placed in a pocket created between the lining and cover of the nose. The cases were evaluated later, mean follow-up period being 4 1/2 years. The results were satisfactory in 13 patients. Improved shape was reported in 7 and poor in 3. The bone graft got incorporated and consolidated at the recipient site in 16 cases. The main donor site problem was overriding of the donor toe. The operated cases need health education for after-care of nose since nasal mucosa is atrophic.

Adult↗

PubMed1993

Finger dynamography. A complimentary technique for functional evaluation of the hand.

The movements of the MP and PIP joints occur together and enable the fingers to acquire different postures. A graphic record of these movements gives an idea of the working space of the fingers. Normally, the tracing forms the shape of a quadrangle with almost parallel sides. If muscle paralysis occurs or joints are diseased, the shape of the quadrangle--the "working space"--becomes distorted. Different patterns of distortion are seen with different finger problems. "Finger dynamography" is a simple bedside procedure requiring only a goniometer. If supplemented with additional data on pinch and grip strengths and sensibility, it gives a pictorial record which is easy to interpret and can be used for documentation.

Adolescent↗

PubMed1993

Evaluation of methods of claw finger correction using the finger dynamography technique.

Finger dynamography is a bedside technique for evaluation of the moving abilities and working space of the hand. Various operative procedures used for correcting the claw finger deformity restore the functional abilities to a varying extent. The palmaris longus transfer with insertion into A1-A2 pulley appears to be a better procedure than lateral band insertion, extensor diversion or extensor many-tail procedures. The use of palmaris longus as a motor seems to have advantages over flexor digitorum superficialis transfer where removal of FDS as a motor produces local deficits.

Adolescent↗

PubMed1993

Paralysis of occipitofrontalis in a borderline case of leprosy.

A patient with neuritic leprosy developed borderline skin lesions. Later, another skin lesion developed on the left side of the forehead with clinical involvement of the supraorbital branch of the ophthalmic division of the trigeminal nerve. Simultaneously, paralysis of the occipitofrontalis and mild paresis of orbicularis oculi occurred.

Adult↗