BACKGROUND: At the present time, more than 100 cases of squamous cell carcinoma (SCC) developing in neurotrophic ulcers of leprosy have been reported. But the histopathologic features and the differences between SCC in leprosy and de novo SCC was not described. OBJECTIVE: The purpose of this study was to evaluate the characteristics of SCC in leprosy and to investigate growth dynamics of SCC in ulcers in leprosy. METHODS: We reviewed the clinical features and the degree of histopathologic differentiation of 13 cases of SCC in ulcers of leprosy patients presenting at the KLCA from 1986 to 1998. And immunohistochemical staining with PCNA(proliferating cell nuclear antigen) and TUNEL staining were done in paraffin-embedded tissue sections from 18 sites of 13 cases of SCC in ulcers of leprosy. RESULTS: 1. The average duration of leprosy and of an ulcer prior to diagnosis of SCC was 43 years and 19 years, respectively. 2. Histopathologic grading of 13 cases was performed as follows:10 cases were well-differentiated and 3 cases were moderately-differentiated. 3. The PCNA LI(labelling index) was 47.26+/-7.38% in well-differentiated group and 48.86+/-9.39% in moderately -differentiated group. 4. The apoptotic index(AI) was 45.57+/-8.68% in well- differentiated group and 29.38+/-1.06% in moderately differentiated group. The AI in de novo SCC was 45.09+/-6.18%. CONCLUSION: (1) Malignant change in chronic ulcer in leprosy may be found more often if patients are examined with care. (2) Our leprosy case with SCC is a 63-year-old male with past history of lepromatous leprosy of 43 year duration having ulcer problems for 19 years before presenting with SCC on an average. (3) High-degrees of malignancy in SCC of leprosy patients might be caused by extended cell survival due to decreased apoptosis rather than increased cell proliferation.
Apoptosis ; Carcinoma, Squamous Cell* ; Cell Proliferation ; Cell Survival ; Diagnosis ; Humans ; In Situ Nick-End Labeling ; Leprosy* ; Leprosy, Lepromatous ; Male ; Middle Aged ; Proliferating Cell Nuclear Antigen ; Ulcer*

Internet* ; Leprosy*

To prepare the postelimination phase of Hansen's disease in Korea, it is mandatory to review antileprosy strategies that we have pursued in the past, present and future in medical aspects of the plans. The status of Hansen's disease in Korea has reached beyond the elimination period defined as less than one case per 10000 population. The successful control of Hansen's disease up to postelimination stage totally due to the careful support from governmental level, endless efforts of medical staffs who have been engaging in leprosy works, and cooperations of patients. We can suppose that eradication of Hansen's disease will become a true dream within next 25-50 years. With one hundred percent coverage of MDT(multidrug therapy), gradual decrease of new cases and effective health care systems, no re-emergence of Hansen's disease as seen in 1960's and 1970's is conclusive. However we are in the period of elimination of the disease, new cases will continue to occur in small numbers not more than twenty. Special strategies will have to be developed for postelimination phase in Korea. The strategies for Hansen's disease surveillance system need to be different from the past Hansen's disease control system. It should contain regional core groups which includes surgical and medical rehabilitation experts, and a few research group and one referral center. The budget for the groups will come from contraction between government and scientists in medical schools, and NGOs. For national and regional plan of COT(completion of the treatment), it could be more reasonable to separate MB(multibacillary)cases into two groups depend on their possible reactions and relapse after cessation of MDT. First group contains those patients with high BI(bacterial index) more than 4+ need MDT for 24 months. The second group means those patients with low BI less than 4+ need for 12 months MDT as seen in recommendation of WHO short term regimen. In case of PB(paucibacillary) there is few report of relapse following 6 month MDT. In the past period implementation of MDT was so imperative that the other important things for patients cares like prevention of deformities and rehabilitation surgery are neglected and many of them lost golden opportunities to correct deformities in the field. When it is possible to find changes of nerve functions within 12 months, corresponding deformities could be preventable. The mission of mobile team in the past is focused on detection of new cases, but time changes to find no new cases with mobile works. The mobile teams from KLCA(Korean Leprosy Control Association) and NGOs should reshape their aims for care of foot ulcer and prevention of neurological deformities. Outpatient clinics for Hansen's disease will be integrated gradually to horizontal medical care system as like university affiliated hospitals which was done in Japan during from 1973 to 1983. It will give the patients more better quality of medical service. Though the elimination of leprosy does not mean elimination of leprosy research work, there happened brain drain from leprosy to tuberculosis or other research areas. There has been a sympathetic agreement to get gradual decline for support for leprosy research. This will hamper the development of new technologies which are needed for leprosy elimination and beyond. The priorities for research in leprosy have changed as a result of the success of the MDT. Possible recommended leprosy research priorities in Korea should include development of methods to improve the early detection of reactions and nerve damage, development of more effective methods of treatment for reactions and nerve damage, development of more effective and efficient prevention of disability(POD), development of more effective self-care and footwear for patients with impairment and other research works in leprosy.
Ambulatory Care Facilities ; Brain ; Budgets ; Congenital Abnormalities ; Delivery of Health Care ; Foot Ulcer ; Humans ; Japan ; Korea* ; Leprosy* ; Medical Staff ; Missions and Missionaries ; Recurrence ; Referral and Consultation ; Rehabilitation ; Schools, Medical ; Self Care ; Tuberculosis

The purpose of this study was to investigate the oral health care conditions of patients who have Leprous disease, which is an infectious disease fixed for the third-class by law, to understand oral health care methods and effects of infectious disease patient, and to analyse those methods and effects in order to apply them to the national oral health occupation baseline data for utilizing continuous oral health occupation and to the treatment for handicapped person. he objects for this study were 7,491 patients(male:4,511, female:2,980) treated in the oral health center among Leprous disease patients, residents in the Sorokdo from 1995, May 1st to 1999, April 30th. We divided them into the first, second, third preventive care group according to the year by preventive classification of oral disease, analysed oral health statistics, classification according to the sex, age, practice, and each consultation hours. The subdivided results carrying out continuous oral health care system for four years were as follows: 1. The distribution for the age indicated that the number of 70-79 year-old patients group was the most, 2,169 and that of 60-69 year-old patients group was the second, 2,406. 2. All the number of consultation hours was 13,454. The consultation hours of first preventive care group were 1,359, 10.1% of them (male:812 female:547), the second group 3,942, 29.3%(male:2,103 female:1,839), the third 8,153, 60.6%(male:5,524 female:2,629) 3. The results of oral health care conditions indicated that DMF rate was 99.2% of them, DMFT rate 59.2%, DMF index 18.9, DT rate 2.6%, FT rate 7.4%, MT rate 49.1%, CPITN0 5%, CPITN10%, CPITN2 24%, CPITN3 71%. 4. It was analysed that the number of patients treated with continuous bridgework was 60 and that the number of patients wearing complete denture and partial denture was 290.
Classification ; Communicable Diseases ; Denture, Complete ; Denture, Partial ; Disabled Persons ; DMF Index ; Humans ; Jurisprudence ; Occupations ; Oral Health

Recently, there has been a strong decrease in the number of temporalis muscle transfer(TMT) operations in cases of lagophthalmos. The primary cause of this decline is patient dissatisfaction with drawbacks of eye clinching in concert with mouth closure, ectropion and ptosis. This is mostly true of patients who are now more commonly exposed to urban social environments. In 1997, I discontinued the use of TMT as part of my combination treatment method reported in this journal. Since 1998, I have removed the fascia in 20 TMT cases due to complications in the upper and lower eyelid areas. I then corrected these complications using my combination method. I still use TMT in cases of lower lip drooping. Lagophthalmos patients are treated using my combination method of gold lid loading in the upper eyelid and Alloderm insertion in the lower eyelid through fixation of both ends to the medial and lateral canthal ligaments respectively. Previously, I recommended the use of conchal cartilage but noted the complication of cartilage warping which caused creating new partial ectropion several months later. Alloderm has shown no complications and the results of its use remain most satisfactory.
Cartilage ; Ectropion* ; Eyelids ; Fascia ; Humans ; Leprosy* ; Ligaments ; Lip ; Mouth ; Social Environment

Though the early detection of leprosy is very important, it has been difficult to determine the M. leprae transmission in the community partly due to a lack of easy specific tools to measure it. A development of a seroepidemiological tool based on the phenolic glycolipid I(PGL-I), an M. leprae-specific antigen, made it possible to detect the M. leprae infection or exposure to the organism. In Korea, 11 studies, used it, were reported in the Korean Leprosy Bulletin. For the reduction of bias, we performed the integrated study of past 11 studies. In our study, we tried to find the useful values of the results of PGL-I Antibody IgM ELISA test for the control of leprosy and to know the further study for more valuable results.
Bias (Epidemiology) ; Enzyme-Linked Immunosorbent Assay* ; Immunoglobulin M* ; Korea ; Leprosy* ; Phenol

Because tuberculosis (TB) causes two - three million deaths annually, development of a vaccine to control and eradicate the infection is an important unmet medical need. Analysis of the mechanisms of protective immunity in mouse models has indicated that both MHC class I- and class II-restricted T cells contribute to immunity against TB. MHC class II-restricted CD4+ T cells release lymphokines such as IFN-gamma and tumor necrosis factor-alpha that result in macrophage activation. More importantly, beta(2)-microglobulin (beta(2)m)-deficient mice are unable to develop MHC class I-restricted cytotoxic T lymphocytes (CTL) and rapidly succumb to Mycobacterium tuberculosis (MTB) infection. This pathway of protective immunity appears to involve CD8+ T cells and transporters associated with antigen processing (TAP)-dependent presentation of peptide antigen. Thus, studies of mouse models of tuberculosis (TB) infection have indicated a central role for MHC class I-restricted CD8+ T cells in protective immunity. Furthermore, CD8+ T cells not only are able to lyse MTB infected cells but also can simultaneously kill intracellular bacteria by the release of the antimicrobial peptide granulysin. To define antigens and epitopes of Mycobacterium tuberculosis (MTB) proteins that are presented by infected cells to CD8+ T cells, we screened 40 MTB proteins for HLA class I A(*)0201-binding motifs. Peptides that bound with high affinity to purified HLA molecules were subsequently analyzed for recognition by CD8+ cytotoxic T lymphocytes. We identified three epitopes recognized by CD8+ T cells from patients recovering from TB infection. Those three epitopes were derived from three different antigens: thymidylate synthase (ThyA(30-38)), RNA polymerase beta-subunit (RpoB(127-135)), and a putative phosphate transport system permease protein A-1 (PstA1(75-83)). In addition, CD8+ T cell lines specific for three peptides (ThyA(30-38), PstA1(75-83), and 85B(15-23)) were generated from peripheral blood mononuclear cells of normal HLA-Al(*)0201 donors. These CD8+ T cell lines specifically recognized MTB-infected macrophages, as demonstrated by production of IFN-gamma and lysis of the infected target cells. Finally, CD8+ cytotoxic T lymphocytes reduced the viability of the intracellular MTB, providing evidence that CD8+ T cell recognition of MHC class I-restricted epitopes of these MTB antigens can contribute to effective immunity against tuberculosis. Currently, the frequencies of circulating CD8+ T cells specific for each epitope peptide are being investigated in TB patients, normal PPD+ and PPD- donors in order to evaluate the relationship of epitope-specific CD8+ T cell population to the immune responses to MTB infection.
Animals ; Antigen Presentation ; Bacteria ; Cell Line ; DNA-Directed RNA Polymerases ; Epitopes ; Humans ; Lymphokines ; Macrophage Activation ; Macrophages ; Mice ; Mycobacterium tuberculosis ; Peptides ; T-Lymphocytes ; T-Lymphocytes, Cytotoxic ; Thymidylate Synthase ; Tissue Donors ; Tuberculosis* ; Tumor Necrosis Factor-alpha

The name of St. Lazarus is commonly found in relation with leprosarium throughout the world but the historical background about how it has been used is less well known. Originally Lazarus was the man who was resurrected by Jesus Christ four days after his death caused by an illness. Considering the unique personal history of Lazarus, it is understandable that Lazarus was revered as the patron for patients with serious illnesses in the society of Christianity thereafter. The actual popularity of his name in Europe was from the era of Crusade in Middle Age, when the Order having its name was first founded. The Order contributed greatly for the leprous patients rapidly increased in Europe after the Crusade. Subsequently lazarhouse came to be regarded as leprosarium. At the present time, the Order is still working for the poor countries and human rights.
Christianity ; Europe ; Human Rights ; Humans ; Leprosy* ; Middle Aged

No abstract available.
Asian Continental Ancestry Group* ; Humans ; Leprosy*

Prevalence of Hansen's disease is reduced about 90% all over the world 20 years by the active efforts of World Health Organization and every country government. As a result, Hansen's disease remains as the public-health problem in only 10 countries after 2003. Recently, patients ware converged in 5 countries such as India, Brazil, Mozambique, Nepal, Madagascar, prevalence of these country 83% of all patients in the world, 88% of new patients of the world. Recently the general society-interests about Hansen's disease are fallen because of the reducing the importance in the public health service and the decreasing of the occurrence of the new patients of Hansen's disease. And the special workers about Hansen's disease and the supports from the government and international organization were reduced. So many workers are worried about the reducing of the quality of Hansen programme, delayed diagnosis and possibility of disability. And Hansen's disease is not actually the main concerns of public-health problem all over the world, but recently the Hansen's disease is known as the major cause of neuropathy and blindness among the infectious disease. For the use of the references of decisionmaking of the national Hansen programme I have reviewed and compared the national Hansen programme in some countries.
Blindness ; Brazil ; Communicable Diseases ; Delayed Diagnosis ; Humans ; India ; Leprosy ; Madagascar ; Mozambique ; Nepal ; Prevalence ; United States Public Health Service ; World Health Organization