Cholestasis in amoebic liver abscess.

Two hundred and thirty six patients with amoebic liver abscess were investigated for cholestasis, its mechanism and the natural course of the disease. Cholestasis was seen in 29% of cases and it presented with some unusual features: it was frequently seen in young men (mean age 38.6 +/- 6.3 years) (87%) with acute onset (69%) and was associated with signs of peritonism, or peritonitis (28%), splenomegaly (12%) and hepatic encephalopathy (coma 13%). Raised diaphragm was seen only in 37% of cases. Alcoholism may have contributed to the cholestasis in 37% of cases. Multiple (43%) and single (32%) large liver abscesses, especially on the inferior surface of the liver (25%), were common in jaundiced patients with amoebic liver abscess, while size and number of abscesses were directly related to the raised serum bilirubin concentrations. Bromsulphalein excretion (BSP) was found to be significantly reduced (p less than 0.01) in patients with jaundice (60%). Retrograde injection of contrast media into the common bile duct during six necropsies showed compression by amoebic liver abscess on the hepatic ducts. The mortality (43%) and the complications were significantly higher (p less than 0.001) in patients with jaundice. The aspiration/surgical drainage of amoebic liver abscess together with a combination of metronidazole and di-iodohydroxyquinoline was more effective than either metronidazole alone, or dehydroemetine with chloroquine.

Gonadal involvement in leprosy--study of gynaecomastia, testicular and epididymal involvement and therapeutic efficacy of indigenous drugs.

Sixty male patients of leprosy (mean age = 27.2 +/- 5.04 years) selected at random, were studied for gonadal involvement and therapeutic efficacy of two indigenous drugs. Of these 34 were married, with the mean duration of illness 4.17 +/- 3.27 years. Only those with lepromatous and dimorphous leprosy developed testicular and epididymal changes. Testicular pain and/or swelling (lepromatous = 62.5%, dimorphous = 30%) was the commonest presenting feature. Altered sexual function was observed in 34 (56.6%) cases, while 11 patients revealed altered sexual hair pattern and nine gynaecomastia. Reduced testicular size associated with soft feel was present in 25% of cases with no testicular sensation in 8 (13.3%) and impaired testicular sensation in 9 (15%) patients. Spermogram revealed azoospermia in 19 (35%) and oligospermia in 16 (26.6%) patients. Histopathological findings of testicle biopsy revealed evidence of leprous pathological irrespective of testicular size, semen picture and clinical manifestations. Histopathological changes had shown marked variation and so did not enable categorising them into vascular, interstitial and obliterative phases. These changes were believed to be due to the altered gonadal state in leprosy. The therapeutic efficacy of the indigenous preparations, Speman and Tentex forte (Himalaya) was evaluated subjectively as well as objectively in 34 patients. 82.3% of cases showed subjective improvement while objective improvement in spermogram was noted in 87.5% cases with oligospermia. The drugs have no side effect and were well tolerated.

Hepato-protective role of indigenous drug Liv-52 in lepromatous leprosy.

The present study incorporates a study of 42 cases of lepromatous leprosy for hepatic involvement and role of indigenous herbal preparation in protecting the liver in leprosy. Liver was enlarged in 32 cases which was tender in 8 patients. Alteration in liver function irrespective of extent and duration of the illness (3 months to 10 years with mean duration of illness = 2 years 5 months) was mainly seen as uniform elevation of serum proteins (6.2-9.2 gms%, mean = 7.5 gms%) with hypoalbuminaemia (2.0-4.4 gms%, mean = 2.9 gms%). Highest level of serum bilirubin of 1.6 mg% was detected in 6 cases, emphasising the presence of leprous hepatitis. Raised level of serum transaminases (SGOT = 65.2 IU, SGPT = 78.7 IU) were proportionate to the liver and muscle involvement. Presence of characteristic granulomata in the liver around the central vein, periportal area and even distribution at various locations in the liver lobules were the most significant changes in 12 out of 15 liver tissues. Acid fast M. leprae were demonstrated in 12 patients. The present work emphasises the detection of hepatic involvement in the early stage of the disease and hepato-protective role of indigenous drug Liv-52 in lepromatous leprosy which usually lead to dreaded mutilated complications in the body.

Diabetic status in leprosy.

The diabetic status of the local Jhansi patients (120 cases) was established before and after antileprosy treatment. Control studies were performed in normal healthy subjects (50 persons) without family history of diabetes mellitus. Random normals showed an incidence of diabetes only 2%, while leprosy patients (94 males and 26 females) had incidence of diabetic status of 14.2%. The highest incidence (19.3%) of diabetes was in lepromatous leprosy and lowest incidence (6.4%) in tuberculoid leprosy patients. Repeated studies in leprosy after treatment showed not only clinical improvement for leprosy but also disappearance of the chemical and latent diabetes mellitus and lowering of blood sugar levels in manifest diabetes mellitus. Incidentally it was noted that 'diabetic status' was worse among males (82.3%) and with advancing age. Association and improvement of diabetic status with specific treatment would tentatively suggest that Mycobacterium leprae lesions are not confined to skin alone but somehow also related to carbohydrate metabolism. A careful management of the chemical and latent diabetes may help in clinical management of leprosy too.

Diabetic status in leprosy

The diabetic status of the local jhansi patients (120 cases) was established before and after antileprosy treatment control studies were performed in normal healthy subjects (50 person) without family history of diabetes mellitus. Random normals showed an incidence of diabetes only 2% while leprosy patients (94 males and 26 females) had incidence of diabetic status of 14.2%. The highest incidence (19.3%) of diabetes was in lepromatous leprosy and lowest incidence (6,4%) in tuberculoid leprosy patients. Repeated studies in leprosy after treatment showed not only clinical improvement for leprosy but also disappearance of the chemical and latent diabetes mellitus and lowering of blood sugar levels in manifest diabetes mellitus

Erythema multiforme bullosum due to rifampicin.

A case of Erythema Multiforme Bullosum in patient of lepromatous leprosy with pulmonary tuberculosis due to Rifampicin is described. It is stressed that ethambutol may act as a trigger factor to the toxic effects of Rifampicin.

The association of leprosy and pulmonary tuberculosis.

The association of leprosy with pulmonary tuberculosis was seen in 20 cases during January 1972 to October 1977. Of these 20 cases, 15 were of lepromatous, 3 of dimorphous and 2 of tuberculoid leprosy. Maximum number of cases were from 3rd decade of life with male to female ratio of 3 : 1. Patients were suffering from the disease for a very long time (8 cases of lepromatous leprosy with duration of illness 10-15 years). The symptoms of leprosy seemed to have preceded to the symptoms of pulmonary tuberculosis. Duration of tuberculosis in most of them was within 6 months (55%). The predominent presenting symptom was cough with expectoration (100%) and fever (80%). Anaemia (75%) and crepitations (60%) were the presenting physical sign mainly. Radiologically bilateral extensive pulmonary lessons were seen in 14 cases (70%). Sputum for acid fast bacilli was positive in 80% of cases. The general condition and nutritional status was poor and death was resulted in 4 cases (3 of lepromatous and 1 of dimorphous leprosy).

Reaction in leprosy complicated by filariasis.

Five cases of reaction in leprosy with filariasis have been presented to emphasise the coexistance of the two conditions in the areas endemic to filariasis and leprosy. One may modify the clinical features of the other. Necessity of recognising filariasis as an important precipitating factor for lepra reaction in tropical countries has been highlighted for proper management of rather protracted and resistant cases.