Wide Awake Tendon Transfers in Leprosy Patients in India.

Dr Akbar Khan began using the wide awake local anesthesia no tourniquet (WALANT) technique for leprosy tendon transfers in the summer of 2015 at the Damien Foundation Hospital in Nellore, India. This article summarizes his first 18 months of experience and describes 5 of his operations. He found that WALANT provides effective anesthesia with good visibility for leprosy tendon transfers. WALANT permits economically disadvantaged leprosy patients to afford the surgery. All of the leprosy patients who have undergone WALANT tendon transfers in this series would like the same technique for their next tendon transfers.

Dual regulation of muscle glycogen synthase during exercise by activation and compartmentalization.

Glycogen synthase (GS) is considered the rate-limiting enzyme in glycogenesis but still today there is a lack of understanding on its regulation. We have previously shown phosphorylation-dependent GS intracellular redistribution at the start of glycogen re-synthesis in rabbit skeletal muscle (Prats, C., Cadefau, J. A., Cussó, R., Qvortrup, K., Nielsen, J. N., Wojtaszewki, J. F., Wojtaszewki, J. F., Hardie, D. G., Stewart, G., Hansen, B. F., and Ploug, T. (2005) J. Biol. Chem. 280, 23165-23172). In the present study we investigate the regulation of human muscle GS activity by glycogen, exercise, and insulin. Using immunocytochemistry we investigate the existence and relevance of GS intracellular compartmentalization during exercise and during glycogen re-synthesis. The results show that GS intrinsic activity is strongly dependent on glycogen levels and that such regulation involves associated dephosphorylation at sites 2+2a, 3a, and 3a + 3b. Furthermore, we report the existence of several glycogen metabolism regulatory mechanisms based on GS intracellular compartmentalization. After exhausting exercise, epinephrine-induced protein kinase A activation leads to GS site 1b phosphorylation targeting the enzyme to intramyofibrillar glycogen particles, which are preferentially used during muscle contraction. On the other hand, when phosphorylated at sites 2+2a, GS is preferentially associated with subsarcolemmal and intermyofibrillar glycogen particles. Finally, we verify the existence in human vastus lateralis muscle of the previously reported mechanism of glycogen metabolism regulation in rabbit tibialis anterior muscle. After overnight low muscle glycogen level and/or in response to exhausting exercise-induced glycogenolysis, GS is associated with spherical structures at the I-band of sarcomeres.

Circadian and other variation in epinephrine and norepinephrine among several human populations, including healthy blinded and sighted subjects and patients with leprosy.

Urinary levels of epinephrine and norepinephrine were studied in three populations: presumably healthy young men who were studied twice, 8 years apart, and in the same month to avoid seasonal influences; blinded but otherwise healthy males and females; and patients with leprosy. Determinations of epinephrine and norepinephrine were done on urine samples collected at 3-hr intervals for 72 hr from the first two groups and for 10 days from patients with leprosy. The same chemist, method, and protocol were used in all studies. In one study of the group of healthy young men, the effect of meal timing and fasting on the rhythms was investigated. From these studies several generalizations can be made. Highly statistically significant population circadian rhythms characterize both epinephrine and norepinephrine in all three groups. In general, the rhythm in norepinephrine was "noisier" than that in epinephrine; in the blind subjects, both variables were characterized by noisier rhythms than in the sighted. The overall levels of epinephrine were much higher in blind than in sighted subjects. The overall levels of norepinephrine were much higher in blind males than in blind females. In the studies done with the group of healthy young men, the overall levels of epinephrine and norepinephrine increased significantly over a 10-year period. The amplitude of the rhythm also increased significantly with time. The average age of the group was 27 years at the time of the first study and 40 years at the time of the second. The patients with leprosy also showed strong circadian variation in both epinephrine and norepinephrine, but, because many of the subjects were on medication, comparisons with the other groups are questionable. In general the data raise some questions about, but do not refute, the commonly held view that the amplitude and mesor of the circadian rhythm in epinephrine decrease with age. Additional work is needed to resolve this question completely.

Assessment of cutaneous autonomic nerve functions in leprosy.

31 cases of established leprosy were studied for sweat response to acetylcholine and adrenaline injected intradermally and compared with normal areas of skin on the contralateral side in a total of 40 lesions. Sweating was measured by counting the number of blue dots which appeared on the yellow back ground of a filter paper soaked in 1% Bromophenol blue solution which represented sweat pores, whereas there was decreased, or absent sweat response in 31 lesions, there was an increased response in to acetylcholine in 7 lesions, and normal response in 2 lesions. Sweat response to adrenaline was obtained in 29 lesions. It was increased in 13 lesions all of which were anaesthetic or analgesic. Adrenergic sweating in these cases is probably a result of direct effect of adrenaline on sweat glands. Biopsy sections of 20 cases were reviewed for the histological appearance of the nerves. It was found that out of the cases who showed increased sweat response 1 had partially destroyed nerves while 2 others had intact nerves. Sweat function tests are of limited value in the diagnosis of leprosy and some autonomic function may continue in leprosy despite loss of somatic nerve function.

A study of autonomic functions in leprosy.

The two groups of leprosy patients were compared with normal for the evaluation of the functional status of the autonomic nervous system, with the aid of several established procedures. Our findings reveal that in the leprosy patients the adrenergic system is hypo-functional as compared to the cholinergic. Further, in maculoanaesthetic group, there appears to be a physiological Dale's vasomoter reversal when adrenaline was used.

A study of autonomic functions in leprosy

The two groups of leprosy patients were compared with normal for the evaluation of the functional status of the autonomic nervous system, with the aid of several established procedures. Our findings reveal that in the leprosy patients the adrenergic system is hypo-functional as compared to the cholinergic. Further, in maculoanaesthetic group, there appears to be a physiological Dale's vasomoter reversal when adrenaline was used.

Oxidation of 3,4-dihydroxyphenylalanine by connective tissue constituents. Identification of Mycobacterium leprae not related to phenolase activity.

The oxidation of 3,4-dihydroxyphenylalanine (DOPA) was studied by spectrophotometric methods at pH 6.8. In the presence of L- or D-DOPA, a color development occurred in the presence of the following substances as measured by increase in absorption both at 540 nm and 480 nm: hyaluronic acid, trypsinized human skin and umbilical cord extract, trypsin treated rat tissue from subcutaneous rat leproma, trypsin treated M. lepraemurium isolated from rat lepromata, and trypsinized M. leprae isolated from non-treated lepromatous leprosy cases. Normal human skin and connective tissue extract and nontrypsinized connective tissue of rat leprosy granuloma did not oxidize DOPA. While the trypsin-treated partially purified M. leprae suspension oxidized DOPA at both wave-lengths, the hyaluronidase-treated same suspension of M. leprae failed to oxidize these phenolic compounds. Mushroom tyrosinase oxidized D-DOPA, L-DOPA, epinephrine and norepinephrine at 480 nm. Hyaluronic acid also oxidized epinephrine and norepinephrine at both wave-lengths. Since it is known that M. leprae in the human host is closely associated with the presence of the acid mucopolysaccharides of the skin, and since acid mucopolysaccharides and skin constituents strongly oxidized DOPA, and since the hyaluronidase treated M. leprae failed to oxidize DOPA, it became evident that hyaluronic acid and not M. leprae is responsible for DOPA oxidation, and phenolase activity is not associated with the metabolism of M. leprae. Evidence is presented that DOPA is not a unique characteristic of the human leprosy bacillus. For instance, trypsin-treated murine leprosy bacilli from the rat strongly oxidized DOPA. The reaction of DOPA oxidation, therefore, must be rejected as a test for the identification of M. leprae. The obtained results confirmed the pertinent findings of Skinsnes and his co-workers.