A scanning electron microscopic (SEM) study of the digital long flexors of the human hand has provided a greater magnification and an increased resolution that facilitated the study of the architecture and the correlation of their structure to their functional activity. The observations are comparable to reports based on gross anatomic and light microscopic studies previously reported by others.

Isolated fracture of the capitate bone is rare, but an isolated pathological fracture due to leprosy has not been previously reported. Although varying degrees of trauma is implied to be associated with fractures, this case illustrates a pathological fracture of the capitate apparently due solely to a specific disease. Fracture has occurred without a history of trauma and there has been no displacement of the fragments on x-rays over a period exceeding ten years even though it has been subjected to unrestricted activities by the patient who has clinically inactive disease.

A LEPROSY CONTROL PROGRAM consisting mainly of the surveillance of the contacts of persons in the United States with leprosy apparently has been reasonably successful in achieving its goal of expeditious treatment for those few contacts who become infected. Cases in the U.S. native-born have decreased; in the foreign-born, however, they have increased. In this paper, we explore the implications and significance of the increased number of cases in the foreign-born and compare the data on leprosy for 1967-76 with those for 1947-68 (1). The staffs of the Leprosy Register and the Clinical Branch of the Public Health Service Hospital at Carville, La., conduct the control program.

This study compares the effectiveness of the Verhoeff and Puchtler-Sweat resorcin fuschin methods of staining the elastic tissue of palmar and dorsal skin specimens of the human hand. The resorcin fuschin stain demonstrates the “oxytalan” fibres of the elastic tissue system in the dermal papillary layer of the palmar skin. Oxytalan fibres are not generally demonstrated by the Verhoeff method and are not demonstrated in the dorsal skin specimens. These studies substantiate the existence of a system of elastic tissue fibres in the skin of the hand. The inter-relationship of the elastic and collagenous fibres appears to complement each of their functions; namely, in anchoring the dermo-epidermal junction, absorbing the stresses of stretch and compressive forces and return the tissues to their original state of tension, and providing protection to the dermal appendages in addition to lending a gradient mobility transmitted through the dermis to the subcutaneous layer to give suppleness and mobility to the skin.

A case report of an adenoid basal cell epithelioma, a relatively rare condition in the hand, illustrating the need for early diagnosis by biopsy.

We have herewith examined the characteristics of circadian rhythms in patients with lepromatous leprosy, active or inactive, allowing a comparison with corresponding properties of rhythms in healthy subjects mapped earlier. Group results were illustrated by cosinor plots, produced directly on microfilm by computer. Eventually such reference standards in the form of cosinors, among other displays, notably of waveform, may be individualized and carried on a person's health record. Such a quantitative assessment of an individual's rhythms in health may serve for rigorous comparison with any changes accompanying increased susceptibility or occult or overt disease.

✓ Neurolysis of the ulnar nerve is an accepted surgical procedure for the treatment of leprous neuritis. The indications for this procedure in leprosy differ from those in other conditions; the basis for performing the specific steps are explained, and the general results discussed.

To investigate the question of whether dapsone (DDS) resistance in leprosy patients is related to the metabolic disposition of DDS, we studied a group of 22 patients who had relapsed with DDS-resistant disease after approximately 19 years of sulfone therapy. Tests for acetylator phenotype with sulfamethazine (SMZ) showed that this group of patients contained a lower percentage of slow and a higher percentage of intermediate and rapid acetylators than had been observed previously in other populations. Acetylation of SMZ and DDS were directly related. In addition, plasma clearance of DDS for the DDS-resistant group was significantly faster than that found previously in any other population. These observations suggest that the emergence of DDS resistance may be associated with the rapid or intermediate acetylator phenotype and an ability to clear DDS from the circulation at a fast rate. Combining the two parameters into a multirisk factor yielded a significantly higher mean value in DDS-resistant patients than that of any other group studied previously. The implications of these findings for the large-scale treatment of leprosy patients are discussed.

The degree of infiltration of human tissues by Mycobacterium /eprae is considered by many to be temperature related , in which instances derma l lesions occur in relatively cool areas and specific segments of peripheral nerve trunks become involved at leve ls where the deep temperature is lower than core body temperature (6. II . 13. 14. 16). Reported temperature studies along the course of the ulnar nerve revealed a difference greater than 2°e betwee n three selected sites: (a) proximal to the medial epicondyle of the humerus, (b) the proximal end of the cubital groove, and (c) proximal to the flexor crease of the wrist and medial to the fle xor carpi ulnaris tendon, from a deeper site in the prox imal third of the forearm (14). The position and relationship of the ulnar nerve in the distal arm are anatomically comparable with the course of the nerve at the carpal level. In both areas the nerve lies subcutaneously before entering the cubital groove a t the elbow and the pisohamate tunnel at the wrist. This temperature study was done to lend clarification to certain issues. A lower temperature of the ulnar nerve in the distal arm a nd elbow is incriminated as one of several features that a ppear to promote the development of leprous neuritis at that site which is causative for the claw deformity of the hand . An equivalent low temperature affects the ulnar nerve in its subcutaneous course in the distal forearm proxima l to its passi ng into the pi so ham a te tunnel. It is recognized tha t this is a seco nd site of predilection for leprous infiltration of the ulna r nerve, yet very little attention has been directed to the latter process as possi bly representing a simila r situation to

Adult guinea pigs were carefully standardized for at least seven days prior to each experiment; this included an artificial light-dark cycle with light extending from 0600 to 1800. On three experimental days, eight animals were injected subcutaneously with 300 μg of histamine at six-hour intervals over a 24-hour period; each animal received four injections during one day. The size of the erythema produced each time was measured. In all three experiments a prominent group rhythm was demonstrated with maximum response occurring during the dark phase; minimum response always occurred during the latter part of the light phase. Such results indicate a strong synchronization among the animals of the group. Two additional, similar studies were performed on animals standardized in one case for 21 days and in the second for 35 days under continuous illumination. The group rhythms of histamine response under these conditions, when compared to the light-dark adapted group rhythm, were greatly modified in phasing and profile. The circadian rhythm in response to histamine persisted in each individual animal. The change in the phasing and profile of the group rhythm was due to a partial desynchronization among the individual animals subjected to continuous illumination.

Temperature determinations and thermograms have been obtained of normal and deformed paralysed hands of leprosy using the AGA Thermovision.

Characteristic bone lesions in leprosy affect the small bones of the face, hands, and feet. They are due directly to leprous infection and indirectly to injurious effects of trauma and infection imposed upon denervated tissues. The manifestations of leprous bone infection vary from the presence of bacilli in the bone to actual destruction. Distal absorption involves fingers and toes with the loss of digits. Combined absorption of length and width of bone often affects the metatarsophalangeal joints. Tarsal absorption patterns are determined by abnormal weight-bearing forces and infection.