Pathologic changes in striated muscles in leprosy

Eighteen muscle biopsies from male adult patients of lepromatous and borderline lepromatous leprosy were studied. BI in the biopsies ranged from 1 + to 3+. There was conspicuous absence of granuloma except for a collection of foamy histiocytes in intermysial region and on two occasions in the intermysial nerve endings in LL patients. At places solid staining bacilli were seen in normal looking muscles. None of the biopsies showed loss of muscle striations, fatty change, sarcolemmal changes, fibrosis and necrosis. Hyaline change was seen in two specimens only. Details of these are discussed in this paper.

Chronic airways obstruction in pulmonary sarcoidosis: its poor response to bronchodilators

Emphysema, chronic bronchitis, asthma, and cystic fibrosis are often cited as examples of chronic airways obstruction, while sarcoidosis is typically restrictive. Approximately 15 percent of sarcoidosis patients, however, have airways obstruction clinically characterized by wheezing with granulomatous involvement of airways. Since the majority have Stage IV disease by chest radiograph, their lungs usually have honey-combining with pulmonary fibrosis, adhesions, cavities, and mediastinal distortion.Patients had a mixed ventilatory defect, but obstruction of large airways was present as shown by decreased specific airways conductances. Small airways obstruction was also present as shown by low instantaneous flows at the terminal portion of the maximum expiratory flow-volume curve and diminished helium response of this curve. The closing volume, however, was not very sensitive. Radioactive xenon washout from ventilation lung scans and N2 washout from the lungs were prolonged in patients with worse disease.The authors conclude that the obstructive type of physiologic pattern is more frequent than recognized in sarcoidosis, which like that of cystic fibrosis has some restrictive element and is characterized by poor reversibility to bronchodilators. A trial period of beclomethasone dipropionate aerosol was not helpful in two patients. Relief of this distressing airways obstruction continues to pose a challenging problem in management.

Choice of skin slit smears for study of bacterial and morphological indices

Skin slit smears of 46 patients of lepromatous leprosy (16 untreated, 30 long treated) were studied from ear lobules, fingers, elbows and knees. In untreated patients ear lobules gave highest BI, as compared to other sites. MI from ear lobules was higher than elbows and knees but slightly lower than that from fingers. In treated patients sites other than ear lobules yielded solid staining bacilli more frequently. Multiple sites and especially peripheral sites are recommended for study of skin slit smears to discover persistent bacilli.

Assessment of diluted Dharmendra lepromin

Twenty-one patients of lepromatous and tuberculoid type were tested with standard, 1:2 and 1:4 diluted Dharmendra lepromin. It was found that correlation exists between the degree of induration and the number of bacilli in the lepromin. Uniform and reproducible results were obtained with Dharmendra antigen containing 40 million bacilli/ml. This is of special significance in enhancing the present meagre supplies of lepromin.

Jaundice occurring as a complication of erythema nodosum leprosum (a report of two cases)

Two patients of lepromatous leprosy who developed jaundice during the erythema nodosum leprosum are reported here. There was slight enlargement of the liver and transient change in liver functions during the acute phase, which subsided after subsidence of reaction. Histopathology and other details are described.

Cutaneous responses to antigens and irritants in patients of leprosy

Forty seven patients of various types of leprosy were skin tested with PPD, Dharmendra lepromin, DNCB, Coccidiodin, histamine and croton oil. Twenty five age matched normal controls were also included in the study. All types of leprosy patients reacted in smaller numbers and with decreased response to all antigens and irritants as compared to normal controls. Depression of response being minimum in tuberculoid and maximum in lepromatous group. None of the patients or controls reacted to coccidiodin. Details are given.

Serum lipids in leprosy

Sera of 58 patients of various types of leprosy were tested for total fat, phospholipids, cholesterol and alpha and beta lipoproteins. Total fat and both fractions of lipoproteins were found to have values comparable to normals in all types of leprosy. Serum phospholipid levels were significantly reduced in LL type of leprosy as compared to normals and TT group of patients. Similarly cholesterol levels were found to have significantly no value in LL group compared to that of the controls.

Acro-osteolysis (report of two cases and brief review of literature

Two siblings suffering from acro-osteolysis, a rare disorder, are discussed. Although three distinct types of acro-osteolysis, namely familial, idiopathic, and due to vinyl-chloride, are clearly defined, these patients did not fit into any category. They had intact nails, preserved tactile and sensory system, plantar ulceration and so sensory deficit. Nerve conduction studies showed prolongation of motor distal latencies in median, ulnar, posterior tibial and lateral popliteal nerves. Nerve biopsies from both patients showed severe loss of myelinated fibres of all sizes, but more so of small ones.

Nocardia Mycetoma At Unusual Site

A case of nocardial mycetoma is presented occurring at upper back. Clinical and laboratory studies established the diagnosis. Excellent therapeutic response was obtained with sulphadiazine alone within five months of therapy.

T and B lymphocytes and blastogenesis in leprosy

T and B cell percentages and their blastogenic response to PPD and lepromin have been studied in 107 patients of various types of leprosy. T cell counts and their blastogenic response were found to be considerably lower in all types of leprosy as compared to the normal. The counts and stimulation were the lowest for lepromatous leprosy. B cell counts were unaltered in all types of leprosy.

Histopathologic study of clinically normal appearing skin in lepromatous leprosy

Skin biopsies from clinically normal skin of the scalp, axillary and groin regions in 20 lepromatous leprosy patients revealed significant histopathological findings in upto 25 percent of the patients. The positive findings could, perhaps, be enhanced by studying larger skin materials from these body areas. Indeed, no skin area appears to be immune from invasion by Myco. leprae.

Red grain mycetoma of the scalp (Actinomadura pelletieri). A case report from India

A case of red grain mycetoma on the scalp is described. The disease, caused by Actinomadura pelletieri, is extremely rare in this part of the world, and from India this is perhaps the first case with scalp involvement. The lesion showed satisfactory response to partial excision followed by chemotherapy with streptomycin.

Cardiac dysautonomia in leprosy

Responses to various tests of cardiovascular reflexes were studied in 15 patients with leprosy. Heart rate was continuously monitored by electrocardiogram and blood pressure was recorded simultaneously. Three patients showed evidence of cardiac dysautonomia, showing involvement of both the sympathetic and parasympathetic systems. These three patients belonged to the bacilliferous group.

Study of apparently uninvolved skin in leprosy as regards bacillary population at various sites

Slit smears form 16 LL and 4 BL patients were taken from scalp, axilla, inguinal regions and apparently involved skin patch. The bacilli were found in 100% LL and 75% BL patients at all sites. Scalp showed AFB in all LL and 3 out of 4 BL cases. No lesions were seen on the scalp. Bacterial morphology showed no uniform pattern. Contrary to belief, no immune zones were found on the skin as judged by results of bacteriological examination. Our studies do not support the view that the leprosy bacillus has a predilection for sites with relatively low temperature as far as human leprosy is concerned.

Fine needle aspiration of lymph nodes in leprosy. A study of bacteriologic and morphologic indices

Lymph node aspiration was performed from the inguinal group of lymph nodes in 16 patients having lepromatous or borderline leprosy. In the same group of patients impression smears of excised lymph node and slit smears of the skin were also studied. This study made it obvious that the aspiration biopsy technic gave similar information regarding the Bacteriologic (BI) and Morphologic Indices (MI) as the impression smears of excised lymph nodes. The technic of aspiration being simple and nontraumatic is recommended for the follow-up of patients on antileprosy drugs and in reactional phases.

Evaluation of thyroid functions in leprosy. I. Thyroid function tests

Twenty six patients of different types of leprosy were studied for radio active iodine uptake (I131) and serum levels of triiodothyronine (T3), thyroxine (T4) and thyroid stimulating hormone (TSH). None of the patients had clinical evidence of thyroid involvement. No significant difference was found between the values obtained in patients and normals and in different varieties of leprosy.

Fatal proliferative glomerulonephritis in lepromatous leprosy

A patient of lepromatous leprosy with recurrent erythema nodosum leprosum developing acute renal failure proving fatal within 8 weeks is reported. The renal lesion demonstrated acute proliferative glomerulonephritis. Its pathogenesis in relation to ENL is discussed.

Evaluation of thyroid functions in leprosy. II. Histopathology of the thyroid

Open thyroid biopsies from seven patients of bacilliferous leprosy were studied for leprous granuloma or amyloid deposition. None of the patients had clinical evidence of thyroid involvement. Histopathology did not reveal any specific abnormality.

Evaluation of thyroid functions in leprosy. III. Circulating auto-antibodies against thyroid and nuclear components

Sera from twenty six patients of various types of leprosy were tested for the detection of circulating auto-antibodies and nuclear components against thyroid using various methods. Four patients of lepromatous leprosy had higher levels of thyroid auto-antibodies by latex agglutination. Three patients showed the presence of anti-nuclear antibodies, two belonged to the TT and one to the LL group.

The role of Ga-67 citrate imaging and diagnostic ultrasound in patients with suspected abdominal abscesses

Fifty patients with suspected abdominal abscesses were examined by [67Ga[ Gallium citrate imaging and abdominal sonography. Fifteen of the patients had a proven intra-abdominal abscess; Gallium-67 images were positive in 13 (87%), while the sonogram detected the abscess in 11 (73%). Nineteen patients had true-negative radionuclide images and sonography, and one had a false-positive result by both procedures. The remaining 15 patients did not have abdominal abscesses, but did have other abnormalities (e.g., pyelonephritis, extra-abdominal sites of inflammation) which were detected by the nuclide study. Gallium-67 imaging and abdominal ultrasound have similar sensitivity for detection of abdominal abscesses. A significant advantage of Gallium imaging is its ability to detect other inflammatory foci (both within and outside the abdomen).

Significance of delayed 67Ga localization in the kidneys

One hundred and seventy-five 67Ga-citrate scans were performed to detect suspected occult inflammatory processes. None of the patients had a known malignancy. Renal activity was noted in 12 patients (6.8%) on the 48-hr image. These patients had either pyelonephritis, acute tubular necrosis, vasculitis, or a renal abscess. Since delayed 67Ga uptake in the kidneys may be the first evidence of renal disease, further investigation, including either arteriography or biopsy, is necessary. In patients with a known malignancy, tumor involvement must be considered.

Prognostic significance of endometrial extension from primary carcinoma of the uterinecervix

This is a retrospective analysis of 302 patients with histologically confirmed primary carcinoma of the cervix on whom a dilatation and curettage was performed during the initial workup. The prognostic significance of endometrial extension of the tumor was investigated. Four different types of specimen were identified: 1) endometrial extension of cervical carcinoma; 2) cervical carcinoma in the currettings only; 3) a mixture of normal endometrium and and epidermoid carcinoma in the curettings; 4) no cervical carcinoma noted (negative D&C). The patients were staged according to the FIGO classification. Patients with Stage I carcinoma and positive D&Cs showed significantly lower 3-5 year survival rates (50-60 percent), as opposed to those with D&C.