Humoral response to nerve glycolipid antigen in sera of leprosy patients.
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Biomedical subjects
Publications and source records attributed to S S Pandya.
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Muscle responses evoked on transcranial stimulation of the motor cortex (corticomotor) and motor roots (spinal) were studied in 20 healthy volunteers using a simplification of Rossini's technique and conventional EMG equipment. Cortical motor responses were consistently obtained from the contralateral upper limb with tolerable stimuli. Lower limb motor responses were inconsistent and sometimes required uncomfortably high stimulus strengths. In the upper limbs, peripheral conduction time (PCT) was estimated by the latency of the response to spinal stimulation. A comparable measure of PCT was obtained for the abductor pollicis brevis (APB) from the F-responses. The difference between the latency of the corticomotor response and the PCT was considered to represent central motor conduction time (CMCT). Corticomotor latencies were: APB 18.51 +/- 1.1 msec, biceps 9.77 +/- 0.46 msec and tibialis anterior 26.5 +/- 2.9 msec. CMCT from cortex to C8/T1 segments (APB) was 4.68 +/- 0.6 msec and between cortex and C5/C6 (biceps) 4.24 +/- 0.42 msec.
We report the clinical features, electrophysiologic findings, and dapsone and isoniazid excretion studies in three young people who ingested excessive amounts (2-4 times the prescribed dose) of dapsone for hypopigmented macules and who developed, subacutely, progressive motor neuropathy a few months later. Pathologic studies on a biopsied motor nerve confirmed the electrophysiologic conclusion of distal motor axonopathy. All made a rapid recovery in a few months after dapsone was stopped, although electrical abnormalities persisted. One patient was a rapid acetylator of isoniazid.
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This paper summarises the experience gained through extensive surveys of school children carried out in Greater Bombay over the past five years. The strikingly high proportion of children of 6 to 14 years age group suffering from leprosy attending the Acworth Leprosy Hospital and its peripheral clinic prompted these surveys. While surveys of 10% of child population attending randomly selected municipal schools revealed a general prevalence rate of 3 per 1000, there existed pockets of endemicity of the order of 10.8 per 1000, in some schools situated in the northern suburbs of the city. Even private schools catering to the not-so-poor sections of the community showed prevalence rates of over 6 per 1000, confirming the hyperendemicity of leprosy in Bombay city, with no socioeconomic or age group immune from exposure. Clinical observations of 1265 leprosy cases identified in the course of the above surveys covering a total population of nearly 1.8 lakhs of school children are presented. 24.7% of the cases had either the potential to develop into progressive forms of leprosy in view of the multiplicity of lesions or were already in an advanced stage of the disease. Polyneuritic leprosy together with intermediate and lepromatous types representing 5.8% of all cases (24 cases were confirmed to be smear positive) belonged to the groups posing therapeutic as well as public health problems. Analysis of 953 cases with single lesions revealed greater frequency of distribution (58.4%) of patches in parts of the body which are generally covered. It is striking that 26.4% of the solitary lesions was found in the gluteal regions and thighs, emphasising the need for thorough examinations of these parts during surveys.
The pattern of extrafusal and intrafusal innervation was studied in muscle biopsies from the flexor carpi ulnaris and biceps brachii muscles, which were clinically unimpaired. Smudginess and enlargement of the motor end plates were the most definitely abnormal feature of the extrafusal innervation pattern; the intrafusal fibers, on the other hand, were either unremarkable or showed increased tortuosity, beading and in more extreme cases of grossly complicated intertwining pattern. Bacilli were frequently found in the spindles, no component being spared. The study emphasizes the significant involvement of striated muscle in leprosy, a fact not revealed by clinical examination alone.