Maeda M, Narita M
National Leprosarium Tama Zensho-En, Tokyo, Japan.
Nihon Rai Gakkai Zasshi. 1993 Nov;62(3):89-98. doi: 10.5025/hansen1977.62.89.
A roentgenographic examination was made for the limbs of leprosy patients with calcinosis in whom atrophic cutaneous sclerosis and subcutaneous induration or infiltration were observed. The observation results are summarized as follows. 1. Atrophic cutaneous sclerosis was one of a sequela in lepromatous lesion, especially in case of ENL, and it was observed to occur frequently at the extended sides of 1/3distal part from the forearm and the crus mainly. The atrophied cutaneous surface was tinged with lustrous red. It was able to observe calcium deposition directly just under the skin and/or in the shallow subcutaneous region from the roentgenogram of the site. The roentgenographic patterns were demonstrated as if many granules were scattered, and also the dendric and reticular platy-expansions were detected in some cases. The enucleated parts seemed to be similar to the cancellous bone. It might be said that dystrophic calcinosis cutis developed by inducing histological disorder is one of the origin of such a calcinosis, because the skin in these regions is deficient in the mobility and tends to provoke the circulatory disorder in case of chronic inflammation as discerned in lepromatous lesion. 2. An induration in subcutaneous tissue is lipid lump being as it was when chaulmoogra oil was injected and not undergo absorption of the oil. The lipid lumps enveloped in the tunic were observed in the site of lateral upperarm and the front of femur. They seemed to be remained almost all as it was. It was observed that the lipid lumps, as such, were adjacent to the outer layer of fascia, but not in the muscle. And there are some cases where the oil flowed from the injection site through the hypodermis and got the lipid lumps formed in the forearm and/or the crus. Roentgenogram of that showed the existence of calcinosis regardless of size which transmissivity of X-ray had an irregular pattern. The enucleated lipid lumps were easily cut to pieces by scalpel. 3. It may be said that the calcinosis observed in atrophic cutaneous sclerosis due to lepromatous lesion or lipid lump of unabsorbed chaulmoogra oil makes it necessary for its healing to be 10-20 years. 4. Roentgenogram at that time revealed no abnormality as to serum calcium, phosphorous and/or alkaline phosphatase values.
对出现钙质沉着、皮肤萎缩性硬化以及皮下硬结或浸润的麻风病患者的四肢进行了X线检查。观察结果总结如下:1. 皮肤萎缩性硬化是麻风性病变的后遗症之一,尤其是在结节性红斑型麻风(ENL)患者中,主要在前臂和小腿距远端1/3处的伸展侧频繁出现。萎缩的皮肤表面呈亮红色。从该部位的X线片可以直接观察到皮肤下方和/或浅皮下区域有钙沉积。X线表现为好像有许多颗粒散布,在某些情况下还检测到树枝状和网状板状扩张。去核部分似乎类似于松质骨。可以说,由于组织学紊乱导致的营养不良性皮肤钙质沉着是这种钙质沉着的起源之一,因为这些部位的皮肤活动度不足,在麻风性病变中如慢性炎症时容易引发循环障碍。2. 皮下组织的硬结是注入大风子油后原样存在且未被吸收的脂质块。在左上臂外侧和股骨前部观察到包裹在膜内的脂质块。它们似乎几乎原样保留。观察到这样的脂质块与筋膜外层相邻,但不在肌肉中。并且有一些病例,油从注射部位通过皮下组织流动,在前臂和/或小腿形成脂质块。其X线片显示无论大小,均存在钙质沉着,X线透射率呈不规则模式。取出的脂质块很容易被手术刀切成碎片。3. 可以说,麻风性病变导致的皮肤萎缩性硬化或未吸收的大风子油脂质块中观察到的钙质沉着使其愈合需要10至20年。4. 当时的X线片显示血清钙、磷和/或碱性磷酸酶值无异常。