Simple excision of the trapezium for osteoarthritis of the carpometacarpal joint of the thumb

We have reviewed the results in 34 patients (39 operations) following simple excision of the trapezium for osteoarthritis of the basal joint of the thumb. The average age at operation was 57 years and the average follow-up was 6 years. All the patients were graded clinically and radiologically and were asked their opinion of the procedure. There was dramatic relief of pain following this procedure. Stability of the thumb was not compromised. When compared to the unoperated side, thumb length, thumb abduction and first web span were similar. There was a reduction in pinch strength (operated 8.1 k.p.a., non-operated 9.6 k.p.a.) and grip strength (operated 15.5 k.p.a., non-operated 19.5 k.p.a.) and an increase in MIP extension (operated 5.4 degrees, non-operated 2.9 degrees) following this procedure but the differences were not statistically significant. 11 patients (32%) had scar hyperaesthesia on testing but this was a clinical problem in two patients only (5%). Simple excision of the trapezium is a satisfactory procedure for the majority of patients with this disorder, but has a long post-operative rehabilitation period.

Sporotrichosis in north-west India

Twelve culture proven patients of sporotrichosis were seen over a period of 4 1/2 yr in the north-western region of this country. Most of the patients (75%) were from Himachal Pradesh, with slight female preponderance. The right upper limb was commonly (58.3%) involved; gardeners and housewives being the common sufferers. Localised lymphocutaneous variety was the commonest presentation (91.7%), except in one patient, where after initial involvement of the face, the lesion extended to the right upper limb and trunk. All but one patient responded to oral potassium iodide therapy; this patient with mixed infection of Sporothrix schenckii and Cladosporium species, required in addition, amphotericin B therapy.

Further experience with pemphigus in children

Seven children had pemphigus: six had pemphigus vulgaris and one pemphigus foliaceus. Four who had pemphigus vulgaris were administered dexamethasone pulses. Follow-up from six months to one year was uneventful; the disease was under control and there were no complications due to therapy. Our observations suggest that the clinical features, course, and principles of therapy for pemphigus in children are essentially the same as those in adults.

The modified Liverpool total elbow prosthesis

We present the results of the modified Liverpool total elbow joint replacement. The humeral component of the original prosthesis was modified because of a high incidence of loosening. 19 patients who had total elbow joint replacement for rheumatoid arthritis were reviewed 8 years after surgery. 14 patients had the modified prosthesis implanted. There was dramatic relief of pain and improvement in function following surgery. There was a reduced fixed flexion deformity and an increased range of movement with the modified prosthesis. None of the humeral components of the modified prosthesis have as yet required revision. In selected patients therefore, this operation is a predictably successful procedure. Our follow-up confirms the ability of the modified prosthesis to provide a pain-free, stable and mobile joint.

Some observations on patients from two leprosy colonies in north India attending a city clinic

Fifty-eight patients (26 males - mean age 52.5 years, 32 females - mean age 58.5 years) from two different leprosy colonies (Ambala and Jagadhari) were studied. Maximum number of the patients (48.4%) belonged to Uttar Pradesh. The clinical diagnosis was LLp:41(70.7%), LLs:14(24.2%), LL-burnt-out, BB-BL and BT: one each (1.7%). Mean duration of disabilities/deformities in these patients was 21.5 years. A peculiar myokymic movement of periorbital muscles was observed in 20 patients (34.5%). While dapsone monotherapy was continued in 55 patients, MDT (WHO-multibacillary regimen) was started in three patients. Vocational advice was given to 23 patients; and 35 (60.4%) patients were declared as "destitutes".

Cutaneous sarcoidosis masquerading as relapsed borderline tuberculoid leprosy?

A patient with cutaneous sarcoidosis is presented. The patient was diagnosed initially as borderline tuberculoid leprosy downgrading to borderline lepromatous leprosy and received a full 2 years of World Health Organization multibacillary drug treatment (MDT). Bilateral hilar lymphadenopathy on chest X-ray and cutaneous anergy manifested by negative Mantoux, candidin and trichophytin skin tests suggested the diagnosis of sarcoidosis. Histopathology confirmed this diagnosis. The subcutaneous nodule seen in this patient is a rare type of cutaneous sarcoidosis.