Summary Squamous cell carcinoma (SeC) 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 see, all of whom presented with locally advanced tumours and lymph node metastasis.Leprosy is a chronic infectious disease caused by My cobacterium leprae which pre dominantly affects skin and peripheral nerves. Damage to peripheral nerves occurs as a result of host immunity (reversal reaction, i.e. delayed-type hypersensitivity) to the presence of bacteria in nerves or as a result of fibrosis due to chronic inflammation in peripheral nerves.This results in sensory, motor and autonomic loss in the affected limbs. As a result of paralysis of the dorsiflexors (damage to the common peroneal nerve) of the fo ot the forefoot is subjected to more pressure than usual with each step. Damage to the posterior tibial nerve results in anaesthesia of the plantar surface and some loss of cushioning in the fo ot due to wasting of the fo ot intrinsic muscles. Patients with insensitive fe et are prone to recurrent wounds which often become secondarily infected. Secondary infec tion can lead to the absorption of digits. A proportion of patients with chronic ulcers (usually those present for more than 10 years 3 -5 ) develop see ' which is usually of low grade malignancy.
A comparison was made of the results produced by the circumtibial and interosseous routes of transfer of tibialis posterior for the correction of foot drop due to leprosy neuritis. The findings in 69 feet, of which 63 also had elongation of tendo Achillis, showed that the interosseous route gave a much lower incidence of recurrent inversion deformity of the foot. The results, in terms of improvement in gait and prevention of trophic changes, were satisfactory.
Summary This study was carried out to assess the role PGL-l antibodies may have to play in assisting with early diagnosis in close contacts of leprosy patients. Blood samples were collected from patients and contacts. It was found that 6·9% of index cases and 1 % of healthy contacts were positive for PGL-l antibody. None of the healthy contacts developed clinical leprosy and all had become seronegative at fo llow-up. We conclude that screening for PGL-l antibodies has a limited role in the screening of healthy contacts and may not be of use in low endemic areas.
Summary This paper describes the use of a neonatal sphygmomanometer cuff as a simple, inexpensive pinch meter. Normal values for key pinch, pulp pinch and side pinch in the dominant hand of healthy Nepali people are provided.The pinch meter was also used to test pinch strength in hands affected by leprosy and normal hands. Some patients with leprosy who have no objective weakness on voluntary muscle testing (VMT) have less pinch strength than people without leprosy. The pinch meter is a useful tool for the early detection of motor fu nction loss.Part of the routine assessment of patients with leprosy is an assessment of muscle power in the hand. There are many methods of testing hand function. Voluntary muscle testing (VMT) as described by the Medical Research Council l is a detailed and accurate method of assessing hand muscle function.However even amongst well-trained observers there is significant interobserver variation. 2 Another problem in assessment is that the scale 0-5 is not, in practice, linear, i.e. there is a much greater loss of strength between grade 5-3 than between 3-1. Staff usually modify the VMT scale for testing the intrinsic muscles of the hand as they are not significantly affected by gravity. Thus Grade 3 = full range of movement,Grade 2 = partial range of movement, and Grade 1 = muscle flicker but no movement. Finger dynamometry is an accurate, reproducible method of testing strength in key and pulp pinches. However pinch meters are expensive and way beyond the budgets of most third world hospital.At Anandaban Leprosy Hospital, Nepal we designed our own pinch meter using a disposable neonatal sphygmomanometer cuff which we received in a box of donated medical supplies. We tested it on normal, healthy hands of people who presented to our nonleprosy outpatients department as well as on hands of people affected by leprosy.
SummaryIn the correction of fo otdrop due to leprosy neuritis the tibialis posterior muscle is re-routed and used to provide dorsiflexion of the fo ot. This study of tibialis posterior transfer was carried out to compare the results of the circumtibial and interosseous routes. There is no significant difference in the range of motion between either route though the range of the interosseous route is more functional (better dorsiflexion). The interosseous route is prefer able as this results in a significantly lower incidence of recurrent inversion deformity of the foot at long-term fo llow-up when compared with the circum tibial route.Footdrop due to the paralysis of the anterior tibial and peroneal muscles is found in 2-5 % 1 0,1 6 of newly diagnosed leprosy patients as a result of leprosy neuritis.Leprosy neuritis affects nerves where they are close to the skin and pass through a narrow fibro-osseous canal. In the lower limb this involves the lateral popliteal nerve around the neck of the fibula (leading to fo otdrop) and the posterior tibial nerve at the tarsal tunnel (leading to anaesthesia of the plantar surface). When both these nerves are damaged then the main impact during walking falls on the anaesthetic fo refoot rather than the heel, with plantar trophic ulceration being the almost inevitable result. This study assesses the outcome of tibialis posterior transfer (TPT) in the correction of fo otdrop due to leprosy and specifically compares the circumtibial (CT) with the interosseous (10) route. MethodsOne hundred and ten fo otdrop corrections in 95 patients (83 male and 12 female) on a total of 105 fe et were followed-up. These were performed in the years 1987-93. Ten patients had bilateral corrections. Nine operations were redone when the earlier operation had fa iled, i.e. the patient developed recurrent inversion or fo otdrop 0305-7518/95/066229 +06 $1.00 © Lepra 229
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