- Volume 70 , Number 4
- Page: 3–372
Abstracts of Congress for Papers and Posters
PPOD 40
EXAME OFTALMOLÓGICO EM HANSENÍASE: COMPARAÇÃO DAS ALTERAÇÕES ENTRE CASOS PAUCIBACILARES E MULTIBACILARES
Costa. M.S.; Gallo. M.E.N.;Nery. J.A.C.; Padoin, E; Benchimol, E.
Centro de Referência em Infecção Oftalmológica -CPqHEC-FIOCRUZ-RJ.
Centro Colaborador Nacional em Hanseníase - IOC -FIOCRUZ-RJ.
Estudo descritivo dos achados oftalmológicos realizados no momento do diagnóstico entre casos paucibacilares e multibacilares. Foram examinados 107 casos no momento diagnóstico e o exame realizado por oftalmologista utilizando padronização (OMS). Do total de 107 pacientes, 77 foram classificados como multibacilares, sendo 75.4% do sexo masculino e 24,6% do sexo feminino. E entre o total de casos paucibacilares (30) 54,5% eram do sexo masculino e 45.5% do feminino. A média de idade dos pacientes foi semelhante entre os grupos 36.0: 41.0 As queixas oculares foram relatadas em percentual significativamente maior entre os pacientes paucibacilares (67.5%) em comparação com os multibacilares (36,3%). O percentual das alterações encontradas no exame oftalmológico foi semelhante entre os casos paucibacilares (60%) e multibacilares (55,8%). A ceratite de exposição, nódulo iriano e a atrofia de íris só foram observadas nos casos multibacilares. o que sugere, serem essas alterações, características dessa forma da hanseníase. A presença dessas alterações oculares deve ser diagnosticada e tratada precocemente para prevenir seqüelas irreversíveis. Assim sendo, o exame oftalmológico deve ser priorizado para todos os casos de hanseníase, independente da forma clínica.
PPOD41
FASCIA AND APONEUROSIS RELEASE FOR LONG FLEXOR CONTRACTURE IN CLAW HAND
Anil Shah
Honorary Professor of Plaslie Surgery. Grant Medical College and Sir .1 J Group of Hospitals. Byculla, Mumbai 400 008. India
In the long standing cases of the claw hand one often come across the long flexor contracture. The clinical test of MP flexion and IP extension often demonstrate that tendon contracture exist. Springing back of finger in flexion after passive stretching demonstrate that the 'tendon' contracture needs to be released. While release of deep fascia may help to a certain extent it is necessary to explore the deeper roots of the origin. The author's technique is carried out through a longitudinal "S" shaped incision anteriorly in front of elbow to avoid veins. The deep fascial envelope of about an inch is excised from the middle of the forearm to the ulnar border. The fingers are moved passively and tightness in the long flexors is noted. With careful dissection the aponeurotic fibres of the long flexors is incised till the tension in the passive stretch on the table is decreased substantially. The entire procedure is in the forearm and muscles are not slided as opposed to muscle slide operation. The plaster cast with lingers in extension completes the operation. The technique and results will be presented.
PPOD 42
FOLLOW UP OF LEPROSY PATIENTS AFTER RECONSTRUCTIVE SURGERY
Jacob Mathew; Vijayakumaran, P.; Krishnamurthy, P.
Damien Foundation India Trust, 27, Venugopal Avenue. Spurtank Road. Chennai 600 031 India. Email: damienin@vsnl.com
Long term follow up of patients who have been helped by surgical correction of their deformities is not well documented. We have made an attempt at this in a study.
The number of surgeries done was 169 from December 1996 to the end of 2001. The follow up was done at intervals of 3. 6, 12 months and then every year, thereafter. This was done by Physiotechnicians from projects from where the patients were referred. For those patients coming from outside the project areas, follow up was done by Physiotechnicians attached to the surgical centres. The parameters assessed include appearance, function, possible social and economic effects on the patients after the operations.
Over 90f/f of patients had restoration of the original appearance and function on the operated limbs.
Further details will be discussed.
PPOD 43
GRAU DE INCAPACIDADE DOS PACIENTES DE HANSENÍASE NA ALTA POR CURA ACOMPANHADOS NO HRAN NO PERÍODO DE 2000/2001
Nancy Pereira Moreira
Hospital Regional da Asa Norte - Secretaría de Saúde do Distrito Federal.
Estudo retrospectivo e descritivo dos oitenta e quatro (84) pacientes que obtiveram alta por cura do Serviço de Hanseníase do Hospital Regional da Asa Norte (HRAN). Brasília - DF, Brasil, entre 2000/2001.
Tem como principal objetivo estudar comparativamente o grau ile incapacidade física (0. 1 e II). no inicio e final do tratamento de hanseníase. discutindo as condições de alta dos pacientes, traçando um perfil da qualidade da assistência prestada pelo Serviço.
Analisam-se também, algumas variáveis tais como episódios reacionais e classificação operacional que interferem na evolução das incapacidades durante o tratamento.
Utiliza indicadores epidemiológicos e operacionais preconizados pelo Ministério da Saúde para avaliação do Serviço.
PPOD 44
HANSENÍASE: CIRURGIA DF PREVENÇÃO E REABIL1TAÇÃO/ HUCFF/UFR)
Gomes. Mk.; Knackfuss, I.;, Adeodato, S.; Cabral, E.; Saad, L.M.; Oliveira. E.r; Santos. R.; Ferreira, A; Oliiveira, Mlw.
Faculdade de Medicina/Ufrj-Serviço de Dermatologia/Hucff 5º Andar Av. Brigadeiro Trompowski S/N, Ilha Do Fundão/Rj.
Desde 1992 o HUCFF tem se solidificado como referência para a região metropolitana do Rio de Janeiro, na assistência ao paciente portador de hanseníase. Enquanto órgão formador de recursos humanos, tem se organizado no sentido de integrar uma solicitação da demanda (o Brasil é o segundo país em número de casos), com a responsabilidade de formar profissionais aptos ao diagnóstico e tratamento da endemia.
Cumprindo o objetivo de treinar profissionais das áreas cirúrgicas e de reabilitação, o HUCFF realizou, no período de 30/11/98 a 04/12/98. o primeiro seminário de prevenção e reabilitação cirúrgica em hanseníase. envolvendo os serviços de dermatologia, ortopedia, serviço social e medicina física, bem como a Secretaria Municipal de Saúde/RJ.
Ao longo deste período de 3 anos foram realizadas 47 cirurgias, em pacientes submetidos ao pré e pós-operatório.no serviço de medicina física, após seleção no ambulatório de dermatologia.
Os autores apresentam a metodologia utilizada no primeiro seminario (foram realizadas 18 cirurgias em 5 dias), o processo de seleção dos pacientes, criterios utilizados, a implantação das cirurgias-lluxo na rotina do hospital, os resultados das cirurgias do ponto de vista funcional para o paciente e equipe, com ampla discussão do processo de pré e pós-operalório fisioterápico, da técnica cirúrgica utilizada, motivação inicial do paciente e suas expectativas quanto à cirurgia.
PPOD 45
HELPING DISABLED LEPROSY PATIENTS WITH ADL - ASSESSMENT
Joy Manchcril; Hemant P.N.; Ebenezer J.; A.A. Samy
ALERT-lndia; Association for Leprosy Education, Rehabilitation & Treatment - India. B-9 Mira Mansion, Sion (West), Mumbai -400 022. India.
Leprosy cured persons with deformity or disabilities due to leprosy look forward to a "normal" day-to-day living. It is a known fact that 'misuse' and 'disuse' of insensitive and paralytic limbs are the main cause for deterioration of deformities and disabilities. The activities of daily life and the occupation of the patient are greatly altered by the type and gravity of their deformity and disability. The study examines the relationship between the ADL and the type and severity of deformity.
Specifically the study examines 209 leprosy patients with Grade-II deformities on the basis of International Classification of Impairments, Activities and Participation (ICIDH - 2 - WHO 1997). It outlines the ADL (Activities of Daily Life) of the patient-, in terms of self care, work and leisure activities and relative impact on the deformities and disabilities. Further, the study analyses the role and the impact of the socio-economic factors on their daily life. It suggests deformity related remedial steps for their ADL - to prevent further deterioration of their condition
PPOD 46
HOW TO ORGANISE REHABILITATION SERVICES
Abdulbhai k. Chauhan; Dr. P.V. Dave
District Panchayat, Bharuch. Helth Department. Government of Gujarat - India.
Disabled persons are located through an organized case finding programme and offered rehabilitation service, if unemployed or under employed.
An expert diagnosis is made of their employment needs and of their physical, mental and vocational resources.
Corrective surgery of therapeutic treatment may be provided of secured, if necessary for employment.
Prosthetic devices [ limbs, aid etc.] may be provided or secured, if necessary for employment.
Expect counseling or guidance assist them to decade upon a suitable employment objective.
A plan is prepared outlining the steps or service needed to enable the disabled person to secure suitable employment.
Training carefully planed and supervised, is provided to those, who need such preparation for employment.
Maintenance during training may be provide in case of need.
Other necessary services, incident to the solution of personal of family problems are provided or secured.
The culminating factor and essential step in every case is entry in to suitable remunerative employment such placement in followed up to determine its lasting success or to provide any needed adjustment.
PPOD 47
IDENTIFICAÇÃO DE INCAPACIDADES EM PORTADORES DE HANSENÍASE
Vânia Del'Arco Paschoal; Marilúcia Gonçalves Pinheiro; Margaret Gonçalves dos Santos; Angela Midori Akasaki
Faculdade de Medicina de São José do Rio Preto. Curso de Graduação em Enfermagem. Av. Brigadeiro Faria Lima. 5416 CEP: 15.090-000 Fone: (017) 2275733. São José do Rio Preto, SP, Brasil
A hanseníase é um serio problema de Saúde Pública pelas complicações e deficiências físicas que gera. Este trabalho tem como objetivos levantar áreas de comprometimento em pacientes acometidos pela hanseníase em tratamento no ambulatório de controle e alertar profissionais da área da saúde quanto a necessidade da avaliação de incapacidades. Foram estudados 8 pacientes portadores de hanseníase. em tratamento quimioterapia) no Ambulatório de um Hospital-escola, com idades entre 22 a 66 anos, no período de junho a agosto 2000. Utilizou-se o método descritivo exploratorio de dados referentes a pacientes portadores de hanseníase em tratamento. O instrumento de coleta de dados foi baseado em uni roteiro oferecido pela Secretaria de Estado da Saúde, para identificação das incapacidades, com 53 itens para determinar lesões em órgãos como o nariz, os olhos, as mãos e os pés. Os resultados obtidos mostraram que 87'# dos pacientes faziam tratamento multibacilar, 50% já possuíam algum tipo de lesões em nariz ou mão ou olhos ou nos pés. No nariz as maiores ocorrências foram obstrução e formação de crostas: nos olhos, a diminuição da produção de lágrima e a perda da sensibilidade: nas mãos e nos pés. os nervos foram os mais lesados. Concluiu-se que a prevenção de incapacidades é um fator importante para a avaliação do portador de hanseníase, pois detecta elementos que não aparecem nas suas queixas.
Unitermos: Enfermagem, hanseníase. prevenção de incapacidade.
PPOD 48
IMPLEMENTATION OF COMPUTERIZED HAND SCREEN
John Figarola; James Eoto
National Hansen's Disease Programs. 1770 Physicians Park Drive Baton Rouge. Louisiana 70816. USA.
Along with the efforts that have gone into eradicating HD. surveillance could be improved by the identification of patients who have peripheral nerve changes. Monitoring of peripheral nerves for changes and early treatment is an integral part of the prevention of disability in Hansen's Disease. The Hand Screen has been utilized at the National Hansen's Disease Programs for the hist twenty years to document sensory and motor function in the hand. Data from the screen has been analyzed to establish the level of disability in the United States HD population and to review treatment outcomes. An electronic screen form is in development to allow the direct input of screen data into a database for subsequent analysis. The system utilizes an internationally available software program (Microsoft Access) for the input of information in the simple form of the Hand Screen and for the storage of data. The program allows easy entry of information, printing, and sharing of reports. Data is displayed in tables and can be easily exported for statistical analysis to review treatment outcomes and for surveillance activities. The process of the development of the screen, the input of data as well as the application of stored information will be presented.
PPOD 49
INSTITUTIONAL STUDY ON NEW IMPAIRMENTS SEEN AMONG PATIENTS WITH ESTABLISHED NERVE FUNCTION LOSS
Victor Parisipogula1,2; Kameswar Rao1,3; Eliazar T. Rose1
1. Hoina Leprosy Research Trust. MUNIGUDA-765 020. Rayagada District. Orissa. India.
2. Physio Therapist, Program Coordinator.
3. Physiotherapist.
Fifty-one patients with leprosy were admitted to LEPRA - HOINA Reconstructive Surgical Unit with nerve function loss during the period 1st Oct' 2000 to 30st Sept' 2001. All these cases were referred from different SET projects of Orissa for correction of their established deformities. Dining our initial assessments it was also found thai these patients had disease involvement impairing other nerves besides those causing their deformities.
All the cases were commenced on steroids as per guidelines of Img/lkg body wt, to the maximum of 40 nig. with an initial trial period of one month. If no improvement was shown then the steroids were tapered off over 6-7 weeks. However with improvement the same dose was continued for a further 2-4 weeks and then tapered to ensure an administration period from 3 to 6 months.
Routine physiotherapy and protective splints were also given. All the patients who were included in the study additionally taught to rigorously care for (heir anaesthetized areas of skin.
At the end of treatment 27 cases were found to have improvement in motor status and 18 cases were shown to have improved sensation. 15 cases showed improvement in both areas. Three cases were given steroids only for tenderness of multiple nerves and till recovered completely without any surgical intervention.
11 patients reported that they had difficulties in daily activities at the time of detection of nerve function loss. Six of these had recovered by the end of treatment.
PPOD 50
INTEGRATED REHABILITATION THROUGH VOCATIONAL TRAINING OF THE DISABLED INCLUDING LEPROSY - AN EXPERIENCE IN BOMBAY
S. Kingsley; Vinchala Bala; V.V. Pai; R. Ganapati
Bombay Leprosy Project, Sion-Chunabhatti, Mumbai -400 022. India
Physical handicap due to disabilities caused by a disease often perpetuate lack of confidence and dependency among the disabled persons including leprosy-affected persons. Regaining self-reliance is a slow process and does not occur spontaneously unless an opportunity is given to acquire technical skills. As literacy levels are admittedly higher among urbanitis, the computer technology is penetrating even into the heart of the slums. Computer literacy as a qualification for job prospects becomes the felt need of normal individuals as well as the physically disabled in-chiding leprosy victims living in the slums. Our initial attempt to rehabilitate the handicapped youths along with leprosy cured in an integrated manner by offering vocational training in computer have enabled them to secure gainful employment and thereby improving the quality of their lives (Ganapati el al, 1998). 42 disabled persons, of whom 13 were disabled due to leprosy, living in the slum has undergone 6 months computer training till January 2002. The training is conducted in collaboration with the local Computer Institutes situated in the slum as well as at the BLP's Vocational Training Centre. The training fees were raised through public donations.
A questionnaire study revealed that out of twenty trainees, nineteen (95%) trainees preferred computer training as it has better scope for jobs than the other vocational trades. Although 6 (30%) trainees secured job in the related field using the acquired skills, all the trainees fell that the training had given them the basic foundation necessary to pursue further career oriented training.
We present our experience on how the NGOs can help the disabled leprosy patients and handicapped persons through computer training, which have enabled them to lead a productive life.
PPOD 51
INTEGRATED. HOLISTIC REHABILITATION ENDEAVOURS IN P.R. OF CHINA
Jean M.Watson; W. Withers; Gemei Lihua
Project Grace International. PO Box 130, Jin HuaPu Yu Dian Suo, Xi Shan Qu, Kunming. Yunnan Province, PR of China 65018.
In this mountainous province of Yunnan in China, the Government reports 15,000-18.000 persons as being disabled as a result of former leprosy. Around 500 new patients are detected each year. 3,500 of the disabled who were treated prior to the introduction of MDT. live in isolated 'leprosy villages', many in mud housing built during the 1960s and little repaired, some lacking clean water and electricity. The remaining persons with nerve impairment were treated by MDT and live at home, most in isolated villages, many facing discrimination. The government has focused attention to new ease finding and cure. With fewer new cases, skin department staff are now busy coping with other skin diseases and giving AIDS education. Thus they are able to give little care to the cured,disabled. The Disabled Persons Federation are giving support by ways of grants for surgery and aids such as some footwear, wheelchairs and walking sticks.
This paper outlines the leprosy work of Project Grace which is an international. Christian umbrella group with teams working in seven areas of the province in cooperation with the Government Poverty Alleviation Department. Their work is varied. Most teams run courses to train village doctors and school teachers. Some organise community development projects, and they have an expanding rehabilitation programme in support of the deaf, of some younger persons disabled by poliomyelitis, of persons with serious burn scars and of persons with below-knee amputation.
This paper describes how the project is now initiating work together with persons disabled or socially isolated as a result of leprosy, integrating that support where feasible with that for the other disabled persons served by the project. Support is holistic and includes measures to minimise physical impairment, to maximise function, to improve income in ways that give minimal risk of injury, to improve social participation, to mend or replace some older, mud housing and in some areas to improve access to safe water. Plans are under way not only to work with village doctors but also to train some leprosy disabled persons ;is village doctors
PPOD 52
IS LEPROSY MORBIDITY LESS? THREE DECADES OF HOSPITAL EXPERIENCE
Arunachalam Subramanian; Fr. M.A. Sebastian; Sr. Linda Roseline
Sacred Heart Leprosy Centre. Karaikal Road. Sakkot-tai — 612 401. Kumbakonam, Tamil Nadu. India.
Though there is low leprosy prevalence all over, the deformities and ulcers is a major concern today. Thirty years of hospital data regarding the number of patients treated in O.P.D.. I.P.D.. deformities status and positive cases was analyzed to evaluate the change in the trend.
On Analysis. New active untreated cases are still present. No reduction in the number of patients with deformity and ulcers. Reaction cases are less. After the closure of Control Units, patients with severe ulcer and deformities attend the hospital despite availability of government treatment centres nearby.
Points to Ponder:
- Strict vigil is needed in the field by skeletal staff to diagnose fresh cases and early nerve involvement.
- Voluntary reporting and self-care practices are re-emphasised.
- Complicated cases need care in specialized centres which are to be supported for sustained work.
- History has taught lesson about hurried closure of programmes (e.g. resurgence of TB and Malaria).
- Consumption of resources is high to restart than to maintain.
PPOD 53
IS THERE A RELATIONSHIP BETWEEN LIGHT TOUCH-PRESSURE SENSATION AND FUNCTIONAL HAND ABILITY?
Hanna Melchior
Israel Leprosy Control Center, Hansen Government Hospital, 17, Marcus St.. Jerusalem 92232. Israel.
Introduction: The Semmes Weinstein Monofilaments are designed to test light touch-pressure sensation. Thresholds measured by this tool have been related to levels of functional sensibility. It is known, that loss of sensation does not influence merely functional sensibility, it has also an impact on motor precision, control of grip force and line coordination. For this reason a correlation between the sensory thresholds measured by Semmes Weinstein Monofilaments and manual function tests would add an important predictive functional value to this tool.
Objective: The purpose of this study was to investigate and compare the level of light touch-pressure sensation as tested with Semmes Weinstein monofilaments with the level of functional hand ability.
Methods: Thirty leprosy patients with some loss of sensation and 30 healthy controls were tested with Semmes Weinstein Monofilaments to determine their sensory threshold on the palms. AH subjects were measured by the Medical Research Counsel muscle grading scale to exclude any motor impairment. Then their functional hand ability was tested via the Functional Dexterity Test and the Jebsen-Taylor Hand Function Test.
RESULTS AND DISCUSSION: Statistical analysis comparing the sensory thresholds and their relationship to the scoring on the manual function tests will be performed. The results will be reported and discussed.
PPOD 54
KUSHTROG KAYAKAEP KARYAKRAM (RECONSTRUCTIVE SURGERY CAMPS) - THREE YEARS EXPERIENCE IN GUJARAT STATE (INDIA)
Dr. Paresh V. Dave; Dr. Kamal Pathak; Dr. Anil Chadha; Dr. Yogesh Bhatt; Mr. Ashok Bhatt
S.S.G. Hospital, Vadodara, Gujarat (India)
Under the banner of Kusthrog Kayakalp Karyakram. Reconstructive Surgery Camp approach was successfully done in Gujarat. India. Three Mega Camps continuously 300 hours non-stop in January 1999. 500 hours non-stop in January 2000 and 300 hours nonstop surgery camp in January 2002 were organized at S.S.G. Hospital. Vadodara. In January 1999, 514 deformed leprosy patients were operated, in January 2000 total 1001 deformed leprosy patients were operated and in January 2002, 467 patients were operated during these mega camps. The eminent surgeons from all over India had attended these camps. The detail results and planning of these camps will be discussed in the Congress.
PPOD 55
LAGOPHTHALMOS IN LEPROSY - A CURRENT STATUS REPORT FROM EASTERN INDIA
Swapan K. Samanta; I.S. Roy; Asim K. Dey; Amitava Chattaraj
B.S.Medical College & Gouripore State Leprosy Hospital, Bankura, West Bengal, PIN 722101. India.
Next to Cataract, Lagophthalmos is one of the major ocular complications in leprosy encountered in Eastern India where 8 0% of the Leprosy sufferers are PB patients and 20% are MB variety. But most of these leprosy sufferers remains untreated due to the lack of proper eye health care delivery system for lagophthalmos surgery and patient's apathy towards surgery. In a random rapid epidemiological assessment conducted in this part of the country in the October-November 2001, 125 patients with lagophthalmos in one or both eyes were examined. The associated ocular lesions include corneal exposure in 60%, cataract of different degree in 30%, exposure keratitis in 40%, hyposthetic cornea in 70%, corneal opacity in 56%, panuveitis in 10% and phthisis bulbi in 10% of cases. Lagophthalmos surgery was found to be performed only in 26 patients. With a few exception of Temporalis Muscle Transfer (TMT). the lagophthalmos correction was mostly limited to tarsorrhaphy. The Lagophthalmos Surgical Coverage (No. of operated eyes with lagophthalmos x 100 divided by Total No. of eyes with Lagophthalmos + No. of operated eyes with lagophthalmos) was only 15.7%. So there was an urgent need to provide proper surgical care for these neglected leprosy sufferers with lagophthalmos and high risk eyes. In this respect a special unit of Ocular Leprosy has been developed recently in a Non Government Eye Hospital to conduct screening camps by mobile team of Eye health Care personnel at the different aftercare leprosy colonies and clinics so as to identify and motivate the patients to undergo mass surgery in a camp fashion in the base eye hospital. The encouraging outcome of this model show an average outcome of five to six cases of lagophthalmos surgery per week.
PPOD 56
LEPROSY FOOT DISABILITY IN NEPAL
Sharan Ruchal; Narendra Khadka; Mark Macdonald
Anandaban Leprosy Hospital. PO Box 151. Kathmandu. Nepal. E-mail: anandaban@mail.com.np.
AIM: To document existing foot disability suffered by person affected by leprosy in Nepal, and to highlight factors most likely to endanger their feet.
Methods: Two hundred and fifty seven leprosy patients who received protective footwear were enrolled in this study. Five hundred and fourteen feet were examined and recorded. Data collected included altered fool mechanism, geographical location and occupation.
Results: Of the 257 subjects, 218 (85%) were male and 39 (15%) female. The average age was 42. ranging from 11 to 71. Grade 2 disability (WHO) was found on 75% and 25% had grade 1 disability. More than 2/3 (73%) had fairly normal gait (heel strike, midstance and toe off). Ninety-two (36%) of those examined had either unilateral or bilateral foot drop and 45 of these (49%) had surgical intervention. Almost 30% of feet (146/514) were found to have single or multiple claw toes. The forefoot was observed to be most liable to plantar ulcers: 50% of ulcers were found on the metatarsal head. 267 on toes, with heel (16%) and lateral border (8%) less commonly affected.
Sixty percent of those enrolled were farmers, 7% labourers, and 77 housewives. Sixty four percent lived in the Terrai (plains), while 36% in hilly regions of the country.
Conclusion: This study has sought to document foot disability among Nepali leprosy patients, and lo examine factors which may contribute to foot destruction. A further follow up study on the same subjects after a period of lime is planned, to compare wh ether the state of foot disability remains the same or deteriorates further.
PPOD 57
LEPROSY VILLAGE IN SHANDONG PROVINCE —PAST, PRESENT AND IN FUTURE
Zhang Furen; Chen Shumin; Liu Bing; Liu Dian-chang; Zhang Lin; Yu Xioulu
Shandong Provincial Institute of Dermatology and Vereneology
57 Jiyan Lu, Jinan, Shandong, P.R. China. 250022. E-mail: chenshm@puhlic.jn.sd.cn
In the late phase of leprosy control program in Shandong Province, there are few old and disabled ex-patients affected by leprosy in the 54 leprosy villages/leprosaria. This makes the running of these leprosy village/leprosaria more costly. In this paper, we reviewed history of the development and the roles of leprosy village and leprosarium. And then we analyzed the present situation of leprosy-affected people living in these leprosy villages/leprosaria in Shandong province, using the information collected from a questionnaire-based survey. Finally, we made some suggestions and recommendations for policy makers concerned and leprosy control managers, in order to improve the present situation and belter use of exiting resources.
PPOD 58
LESÃO DO NERVO FIBULAR EM HANSENÍASE: Resultados OBTIDOS ATRAVÉS DE UMA ABORDAGEM FISIOTERAPÊUTICA
Byanca CG. Ferreira; Danyelle M. Cavalcante; Geísa CP. Campos
Hospital Clementino Fraga, rua Esther B. Bastos, s/n, Jaguaribe, João Pessoa-PB.
A hanseníase é uma doença infecto-conlagiosa. provocada pelo Mycobacterium leprae, de evolução crônica, caracterizada por manifestações dermato-neurológicas. O nervo fibular quando acometido acarretará alterações sensitivas, motoras e autonômicas, dentre as quais a motora é a mais incapacitante, causando o pé caído por paralisia ou paresia da musculatura dorsiflexora e/ou evertora do pé. O fisioterapeuta, profissional integrante da equipe de tratamento atua auxiliando o diagnóstico precoce das neurites, através de uma avaliação específica e traçando um programa cinesiolerapêutico. que associado ao tratamento medicamentoso, promove a recuperação do paciente. Objetiva-se demonstrar as principais características da lesão do nervo libular, devido à hanseníase, bem como a freqüência desta lesão no Hospital Clementino Fraga/PB, enfatizando a importância da fisioterapia neste agravo. Fez-se revisão bibliográfica e análise da incidência dessa lesão nos anos de 2000 e 2001. Oito pacientes apresentaram paresia/paralisia dorsiflexora até o mês de Maio de 2001. estando em fase de estudo o período de Junho a Dezembro do citado ano. A partir disto elaborou-se uma conduta fisioterapêutica baseada em cinesioterapia (exercícios, marcha com uso de órtese e preparação para cirurgia). A hanseníase é uma doença curável, porém suas complicações nem sempre podem ser revertidas totalmente, dependendo da intensidade do dano neural, da precocidade do diagnóstico e de um tratamento eficaz.
PPOD 59
LIPOENXERTO PARA AMIOTROFIA DO 1º ESPAÇO INTERDIGITAL
Dr. Roberto do Couto Pinho; Dr. William John Woods; Dr. Silvano Renzo
Secretaria Estadual de Saúde de Saneamento. Hospital Geral das Clínicas. Avenida Getúlio Vargas s/n. Rio Branco - Acre. E-mail: wwoods@uol.com.hr.
A técnica consiste em retirada do enxerto gorduroso da região para - umbilical com incisão transversal de 5 em de comprimento. Retira-se o lipoenxerto de aproximadamente 10 ml. conforme a necessidade da área receptora. Sutura por planos da área doadora, e faz o preparo do lipoenxerto retirando lodo o tecido conjuntivo. Faz-se uma incisão de 4 em na prega interdigital palmar do 1º espaço entre a pele volar e dorsal (na área de intersecção) e disseca se o espaço cutâneo onde injeta, com uma pinça o lipoenxerto. Sutura se o subcutâneo e a pela. Com 7 anos de follow up não foi observada reabsorvição do enxerto.
PPOD 60
LONG TERM EVALUATION (17 YEARS) OF A PERSONAL TECHNIQUE FOR OPPONENS PLASTY
A. Salalia; G. Chauhan
Vimala Dermatológical Center - Yari Road Versova, Bombay.
Low median nerve palsy is usually accompanied by low Ulnar nerve palsy causing Ulnar and Median Claw and Opponens palsy.
None of the techniques wherein Intrinsic muscles are used pro Opponens can be applied to leprosy because all the Intrinsics are usually paralyzed. In hyper-mobile lingers, the route of the graft and the attachment-as suggested by Bunnel and Brand- may lead to a 'Swan-neck' of thumb (Tsuge) because -we believe-one of the tails presses dorsally over the Metacarpophalangeal (MP) while the hyper-flexion of the distal phalanx is not attended to.
Our modification: aims at correcting these deformities.
The chosen motor tendon - the Sublimis or the Extensor Indicis Proprius- are routed through a small incision just distal and medial to Pisiform bone and split in 3 tails; the pisohamate ligament will be acting as a pulley. One tail is sutured on the dorsal expansion at the level of Interphalangeal (IP) joint, after plicating the dorsal expansion and thus correcting the hyper-llexion. The other two tails are sutured at the level of MP joint. Of these, one tail is routed dorsally to MP under minimal tension, while the other is passed ven-trally under tension; this will act as a tenodesis of the MP, further will replace -partly- the action of the paralyzed adductor and thus prevent the 'Swan-neck' deformity. In the last 17 years we have operated 595 cases; in 87 cases (prior to 1987) the Brand's technique was used, our technique in all other cases.
The results: 508 casers were operated with our technique: 472 (93%) had excellent functional and aesthetic results; 36 (795) had poor results due mainly to sepsis and not technical errors. We achieve excellent extension of PIP joint and have never had a case of Swan-neck deformity of the thumb following surgery. In order to assess the pre and post operative function of the thumb we use a modified Kapandji scale. Clinical photos and drawings will highlight the mechanical problems leading to opponens palsy and the significance of the proposed corrective steps.
PPOD 61
LONG TERM FOLLOW UP OF PATIENTS WITH MALIGNANT CHANGE IN PLANTAR ULCERS IN LEPROSY
Dr. Mannam Ebenezer; Dr. S. Patheebarajan; Dr. Anil Thomas
Schieffelin Leprosy Research and Training Centre, Karigiri, India.
Malignant change is a known complication of plantar ulcers in leprosy. Often the plantar ulcer is chronic and becomes a cauliflower growth or a flat lesion with everted edges. On clinical suspicion of malignancy a biopsy is done. If the ulcer is found to be malignant, it is usually a well differentiated squamous cell carcinoma of the skin. The treatment of choice is a wide excision providing a 5 ems margin.
In this study, 110 cases who underwent surgery for malignancy in plantar ulcer are studied retrospectively. The age, sex. duration of the ulcer, site and size of the ulcer, histology and the presence or absence of metastasis at the time of diagnosis were analysed. Depending upon the site and size of the ulcer either a wide excision and skin grafting (24%) or a radical procedure was done (76%)
Long term follow up of 90 patients is presented. The duration of the follow up ranged from 10 to 20 years. Four patients died of causes not related lo malignancy of plantar ulcer. Four patients who had poorly differentiated squamous cell carcinoma developed metastasis. 12 patients were lost to follow up.
Adequate wide local excision and skin grafting where possible or local radical excision give good results in treatment of malignancy arising in plantar ulcers.
PPOD 62
LOSS OF DORSAL SENSATION COMPARED TO LOSS OF PALMAR/PLANTAR SENSATION OF LIMBS IN LEPROSY PATIENTS
Hanna Melchior; Ruth Wexler
Israel Leprosy Control Center, Hansen Government Hospital, 17 Marcus St., Jerusalem 92232, Israel.
Introduction: Loss of light touch sensation in the limbs is a frequent consequence of nerve function impairment. In leprosy programs, sensory testing is routinely performed on the palmar/plantar aspect, usually not on the dorsum.
In Israel, dorsal sensation is routinely tested.
Objective: This study compares loss of plantar/palmar sensation to loss of dorsal sensation in hands and feet, and investigates the relationship between them.
Material and Methods: Data was collected from 125 leprosy patients' files.
These patients were tested with SW Monofilaments. The threshold of loss of sensation was defined as a lack of response to 4.31 filament.
Results: Prevalence of loss of dorsal sensation in hands was 63.2% compared to 46% loss of palmar sensation. In feet, the prevalence of loss of dorsal sensation was 70.4'/ compared to 66.8% loss of plantar sensation, heels excluded. In 31.9% of patients with normal palmar sensation, loss of dorsal sensation was present. In feet, loss of dorsal sensation was found in 12.5% of patients with normal plantar sensation.
Conclusion: In hands and feet, loss of light touch sensation on dorsum occurs more frequently than loss of palmar/plantar sensation. Full nerve function assessment will therefore be incomplete if dorsal sensation is not tested, especially in patients with normal palmar/plantar sensation.