Hansenologia internationalis最新文献

There are many difficulties in the use of the Ridley & Jopling classification in daily practice. The author identified the morphologic parameters whose variations permit to distinguish the polar types and borderline groups according to Ridley. If we avoid the inconstant histologic alterations we believe that this distinction depends basically on the following parameters: epithelioid cell, granuloma of epithelioid cells, numbers of lymphocytes and number of bacilli. A critical analysis is performed of each of these parameters and the author concludes that they are scarce, and that there are great difficulties for the identification and interpretation of their variations for classification purposes. These difficulties are even more important during the reactional episodes.

As a continuation of the research line related to the insertion of prevention and treatment of physical disability in programs of leprosy control, we present here results related to specific professional risk for the disease based on data obtained in a recent multicenter investigation at the national level in Brazil. In a survey of 416 professionals and 69 health units, 179 patients with different clinical forms of leprosy were surveyed. Using initial and current patient socioprofessional condition (whether economically active or dependent and the different modalities of the two situations) as an indicator of social mobility, the associations were tested using the chi 2 statistical parameter of Pearson. The results revealed statistical significance at the 5% level among the variables investigated both in the first and the second specific determination.

The efficaciousness evaluation of the polychemotherapics regimens recommended by WHO to the hansenian paucibacillary patients, is carried out mainly by the suitable follow up of patients after therapeutic discharge. The criterion for inclusion of patients as paucibacillary ones is another point of importance. The authors based on the follow up of 66 patients that completed treatment and in the absence of relapses until the moment, advise that together with the clinical classification it should be considered factors like: the Mitsuda test, the number of lesions and the bacilloscopy result.

Some general facts about Hansen's Disease are presented: in the world, in the Americas, in 1986, with the purpose to focalize on the Northern Region of Brazil (Amazon Valley) where an attempt is made to specify, State, the clinical forms in the active registry, the respective coefficients of Prevalence, about the cases detected during the year, by clinical forms and the correspondent Coefficient of Incidence, the age range of less than 15 years, and above 15 years; and to analyze according to the township in the State of Amazonas in a series of 8 years, from 1979 to 1986, the registered cases under control and also without control, the new cases, by clinical form and Coefficient of Incidence, the positive cases among students in the capital and also in the country, and with more details, still by township and by Public Health Registry, in 1986, with the population, new cases, and Coefficient of Incidence, cases of the active registry, cases under control, Coefficient of Incidence, the relationship between patients/inhabitants, cases according to the decreasing intensity as far as the Prevalence and Health Department Regions: all this to give an idea, in detail, inclusive statistics, of the real position of Hansen's Disease in the Northern Region (Amazon Valley), with the highest figures of Prevalence and even of Incidence, in comparison with other Regions of the country, and to stress the grave situation of the endemic proportions of the disease, in Brazil in general and in that Regions, in particular.

Based on a new morphological concept and classification of granulomatous inflammation: the polar granulomas, on the histogenesis of the tuberculoid granuloma of the positive Mitsuda test and on the relationship between the degree of histogenetic differentiation and behaviour of tumors, the Authors concluded that the "benign" or "malignant" behaviour of hanseniasis depends on the degree of tuberculoid differentiation of the lesions. If the lesion is histologically well differentiated toward a polar tuberculoid granuloma (tuberculoid hanseniasis) it will have a "benign" behaviour. On the contrary, if this differentiation is absent (virchowian hanseniasis) or poor (interpolar borderline hanseniasis) the behaviour of the lesion will be "malignant".

A 60-year-old woman was admitted with congestive heart failure, essential hypertension and abdominal distension. Her son reported that she appeared with red spots in the body and that she was under dapsone therapy. Seven months ago there was sudden increase of the skin lesions. In the 11th day after admission she underwent a stroke that progressed to decerebration and she expired on the fourth day. Autopsy confirmed CHF due to chronic myocarditis related to Chagas' disease. Aneurysm of the apical region of the left ventricular chamber was also observed leading to thrombosis and systemic embolism with brain and spleen hemorrhagic infarct. In the encephalous there was edema, uncus herniation and hemorrhagic infarct of the brain stem. The skin lesions were due to reactional tuberculoid hanseniasis (RHT) with focal lesions in axillary lymphnodes, nasopharyngeal mucosa and in the posterior tibial nerve. The pathogenesis of RHT is discussed as well as its differentiation with the BT group of Ridley and Jopling and its probably relationship with the secondary tuberculoid hanseniasis reported by Ridley. The focal lesions are also discussed with END to the involvement of a peripheral nerve trunk what is said to be uncommon in this form of Hansen's disease.

One hundred and twenty Brazilian patients with several forms of hanseniasis were tested with DNCB. The results were the following: 1) the sensitization of patients with hanseniasis to DNCB was lower than that seen in the general population; 2) the sensitization of the borderline and virchowian forms of hanseniasis were lower than that seen in the indeterminate and tuberculoid forms.

The effect of local treatment of nose of lepromatous type of patients with different formulations of rifampicin nasal drops/sprays was investigated in a large number of patients. The preparations were either sprayed or instilled into the nostrils after flushing the nostrils with normal saline at 37 degrees C. It was observed that 10 mg/ml of rifampicin was effective in reducing the BI and MI to zero in nose in seven days in majority of the patients. No untoward effect was seen in any of the patients. It is suggested that nasal sprays/drops may be able to prevent the transmission of hanseniasis, as nose is recognised to be an important portal of exit of M. leprae. Further when rifampicin drops/sprays are used as soon as the diagnosis is made, the nasal deformity may be prevented. It is believed that local treatment along with systemic therapy would go a long way in controlling the transmission of hanseniasis.