Sensory conduction of the median nerve at the carpal tunnel for eight consecutive 1 cm segments of the nerve was evaluated in 217 hands of 153 of our patients with carpal tunnel syndrome. Impairment was found to be highly focal and often confined to a single 1 cm segment of the nerve. The section of the nerve at or just distal to the distal margin of the carpal tunnel was affected most frequently, the section within the tunnel was affected less often, and the section proximal to the tunnel at the level of the mid-carpal and radio-carpal joints was affected least. The greatest contrast between frequencies of slowing at adjacent segments occurred at the proximal and distal margins of the carpal tunnel. The distribution of the nerve impairment was similar between the sexes; however, among the men the segment affected most frequently was located 1 cm distal to the segment affected most frequently among the women. The general pattern of slowing which we found does not substantiate some commonly-held opinions about the aetiology of carpal tunnel syndrome.

Adult↗

PubMed1990

Nerve damage, surgery and rehabilitation in leprosy.

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Foot↗

PubMed1989

Do we need trials of agents alleged to improve healing of plantar ulcers?

The assumptions underlying trials of agents claiming to heal plantar ulcers 'faster' and 'better' are shown to be fallacious and it is pointed out that in most cases these ulcers fail to heal for lack of attention and not for want of a specific topical agent. Clinical trials in this area are difficult and are not worth the trouble as they do not add to our knowledge about these ulcers or their management in the clinic or in the field.

Clinical Trials as Topic↗

PubMed1989

Value of thermal sensibility testing in leprosy diagnosis in the field--field trial of a pocket device.

A handy thermal sensibility testing device has been developed and field tested in different centres in Africa and India. The device performed satisfactorily under field conditions and made testing for thermal sensibility in the field practicable and easy. Examination of the results of testing 260 persons, most of them having a few lesions of early leprosy, showed that the expected increase in the rate of diagnosis of sensory impairment in the skin lesions, and so in the diagnosis of leprosy, would be about 15-25% when thermal sensibility testing using this device was added to the other sensibility tests routinely used in the field. Regular use of this device in the field will help to bring more leprosy patients under treatment than at present.

Adolescent↗

PubMed1989

Leprosy diagnosis: a device for testing the thermal sensibility of skin lesions in the field.

A handy device for testing the thermal sensibility of skin lesions has been developed and field tested in various centres in Africa and India. The instrument performed satisfactorily and its use made testing for thermal sensibility in the field practicable and straightforward. Analysis of the results of testing 260 persons, most of whom exhibited a few lesions that were characteristic of early leprosy, showed that the rate of diagnosis of sensory impairment of such skin lesions, and hence the diagnosis of leprosy, would be about 15-25% more if thermal sensibility testing using this device were added to the other tests of sensibility routinely carried out in the field. Regular use of the device in the field would help to bring more leprosy patients under treatment than at present.

Africa↗

PubMed1988

Secondary and primary dapsone resistant leprosy: an analysis of 199 patients from St. Thomas Hospital and leprosy project, Chettupattu, South India.

The occurrence of secondary and primary dapsone resistance in 199 patients in our control area and the influence of certain variables such as age, initial bacteriological and morphological indices, duration of regular dapsone monotherapy, on the emergence of dapsone resistance was investigated. Ninety one of 122 patients and 29 out of 77 showed secondary (SDR) and primary (PDR) resistance to dapsone respectively. Very low BI (BI:2.5) group also showed both SDR (60%) and PDR (40%). Low or high MI group exhibited the same degree of resistance. Multiplication of M. leprae was obtained even when the MI of the inocula was zero. Even in the group who had 1 to 5 years duration of regular dapsone treatment, 85% patients showed SDR. Significance of such results are discussed in relation to chemotherapy. The overall minimum prevalence of SDR was found to be 5.6% and 21% in the case of PDR in our control area.

Age Factors↗

PubMed1988

Antibodies to HIV-1 in sera from patients with mycobacterial infections.

Sera from 478 persons (348 leprosy patients, 33 tuberculosis patients, 29 healthy contacts of leprosy patients, 38 normal healthy Indians, and 30 normal healthy Europeans) were screened for anti-HIV-1 IgG antibodies by ELISA. None was positive. In addition, 132 samples (from 43 leprosy patients, 21 tuberculosis patients, 5 healthy contacts of leprosy patients, 33 normal healthy Indians, and 30 normal healthy Europeans) were also tested by Western blot assay for anti-HIV-1 IgG antibodies. Only 1 of the 63 healthy subjects expressed a prominent p17 band. One or more bands were found in 44 (leprosy patients 33/43, tuberculosis patients 7/21, and leprosy contacts 4/5) of the remaining 69 sera. Antibody to the HIV-1-specific antigen p24 was expressed by 17 of these subjects (14/43 leprosy patients, 1/21 tuberculosis patients, and 2/5 leprosy contacts), either as a single band or in combination with other bands. This raises the possibility of a common antigenic pattern between HIV-1 and mycobacteria, especially Mycobacterium leprae.

Blotting, Western↗

PubMed1987

Measurement of pressure under leprotic feet using a barograph.

This paper describes the measurement of pressure distribution under normal and leprotic feet using a barograph. The barograph consists of a glass plate illuminated at its edges by fluorescent lights. The top surface of the glass plate is covered by a thin sheet of opaque white plastic upon which the subject stands. Greater pressure levels cause more intimate contact between the plastic and the glass, which results in the breakdown of total internal reflections within the glass. When viewed from a 45 degree inclined mirror placed below the glass plate, the areas of contact of the foot can be seen with light intensity related to the applied pressure. The resulting image recorded photographically is scanned for pressure intensity patterns using a microdensitometer. The pressure intensities are calibrated using known weights over specified areas. The method establishes characteristics of pressure distribution under normal feet. It confirms that scars resulting from healed ulcers in leprosy subjects are discrete sites of very high pressures in the range of 90 to 110 N/cm2. This is two to three times the pressure levels under normal feet. Scar regions combined with deformity of the foot increase these pressures to still higher levels and possibly cause ulcers. The quantitative values of pressures determined in this study for leprosy subjects during standing are helpful in identifying problem areas on the soles of the feet.

Foot Deformities, Acquired↗

PubMed1985

Report of Panel on Paralytic Deformities (including leprosy).

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Hand↗

PubMed1985

Dermadesis and flexor pulley advancement: first report on a simple operation for correction of paralytic claw fingers in patients with leprosy.

A simple operation is described for correcting the intrinsic minus finger deformity commonly seen in patients with leprosy. It consists of shortening the palmar skin at the level of the MP joint and flexor pulley advancement. This produces an acceptable flexion contracture of not more than 40 degrees of the MP joint, as in Zancolli's capsuloplasty, and optimizes the balance of forces around the finger joints in favor of improved MP joint flexion and PIP joint extension. A preliminary evaluation of 11 hands of patients with leprosy with ulnar or ulnar and median nerve paralysis who underwent this surgery and were followed for 7 to 17 months after surgery shows that this operation satisfactorily corrects claw deformity and improves intrinsic minus disability. The most important advantages of this procedure are that it is technically simple and does not require postoperative reeducative therapy.

Adult↗

PubMed1984

Models for leprosy. An appraisal of graphic representations of the "spectrum" concept as models and a suggestion for a catastrophe theory model for leprosy.

Graphic representations of the spectrum concept of leprosy are examined in some detail as models for this disease. This reveals that this concept is somewhat inadequate and that the spectrum metaphor may itself be inappropriate because, by its very linearity of logic, it may not be able to depict the nonlinear behavior of leprosy properly. The assumptions underlying this concept and their logical consequences, brought out by the graphic representations, include an invariable relation between CMI and BI, identity of one type of leprosy with one specific level of CMI, a fixed sequence of types, and the consequent impossibility of skipping the sequence. However, our experience with leprosy does not bear out these assumptions. Further, development and progress of leprosy from a normal (nonleprous) state cannot be represented in these models. A search for alternative conceptual models therefore appears reasonable and even necessary. The catastrophe theory (a branch of topology in mathematics) describes a number of models for explaining how continuous causes could produce sudden or discontinuous changes. Of the various catastrophe theory models available, the relatively simple "cusp" model appears capable of application to leprosy. This model, as applied here, requires two control factors (identified tentatively as the amount of dead bacilli and the amount of living bacilli or their indicators) and one pattern of behavior, identified as progress towards limited or extensive disease. This model suggests under what conditions leprosy will change from one type to another and whether that will happen gradually or suddenly. It also suggests that for certain values of control factors the disease may manifest in one of two forms of borderline leprosy, and that lesions very similar to start with can progress to quite different states under similar conditions of change. The behavior of leprosy agrees more or less with that suggested by this model. The cusp model thus seems to: a) provide an insight into the behavior of leprosy, enabling us to understand the dynamics of the disease; b) explain some of its intriguing manifestations; c) ask meaningful questions; and d) plan new therapeutic approaches. Although this is a highly speculative and probably too simple a model, this attempt shows that it is possible to view leprosy outside the framework of the concepts of spectrum scale and polar types of leprosy, the conceptual models which dominate all of our current thinking about the disease.

Humans↗

PubMed1983

Postural changes in thenar paralysis and their significance.

A comparison of postures in 145 thumbs having paralysis of some, all, or none of the intrinsic muscles showed that the carpometacarpal joint was more hyperextended when only the extrinsic muscles were present. When the opponens and short flexor were also working hyperextension was less apparent. The metacarpophalangeal joint was flexed when only the extrinsic muscles were working and in less flexion when the opponens was also present. The joint was stable in flexion when the extrinsic muscles, opponens and short flexor were all present. The interphalangeal joint was flexed when only the extrinsic muscles were working, in less flexion when the opponens was also present, and stable in extension when the intrinsic muscles, opponens, and flexor pollicis brevis were all present. This study shows that the function of the opponens and short flexor muscles are both necessary to obtain the optimal balance of forces for thumb function.

Adolescent↗

PubMed1983

Universe of finger postures and finger dynamography. A conceptual methodological tool for assessing and recording the motor capacity of the finger.

The sum total of all postures actively possible at a joint constitutes its "universe of postures". This universe can be identified by its limits. The universe of a biarticular system like the finger can be mapped out visually, by identifying the limiting postures, plotting them as points in a graph sheet in which the postures of the MP joint are represented in the horizontal axis and the postures of the PIP joint are represented in the vertical axis, and connecting the points serially. The closed figure thus obtained represents the universe of postures of the finger and shows at a glance the motor deficits of the finger as a whole. It also remains as an objective record of the universe, available for comparison after treatment. This method of evaluation of the finger has been found to be particularly useful in assessing fingers with paralytic problems. Such a visual representation of the universe, called "dynamogram" here, can also be used for kinesiological studies.

Biomechanical Phenomena↗

PubMed1982

Internal stabilization in the thumb.

An analysis of the thumb as an articular chain, with the biarticular tendon displacement used as a model, is presented. Comparison of the extensor pollicis longus/flexor pollicis longus (EPL/FPL) tendon displacement ratios at the three joints, as determined from cadaver studies, shows that the thumb will be unstable, with a persistent tendency to extend at the carpometacarpal (CMC) joint and flex at the interphalangeal (IP) joint when it is under the exclusive control of the EPL and FPL muscles. In addition, according to the model, with stabilization of the CMC joint, the MCP joint will tend to extend and the IP joint will flex. Clinical data from thumbs of leprosy patients with thenar paralyses largely confirm these predictions and the validity of this approach in studying the functional behavior of the thumb.

Biomechanical Phenomena↗