Cardiovascular dysautonomia in patients with lepromatous leprosy.

Autonomic functions were studied by six standard tests in 65 patients with lepromatous leprosy and 25 healthy controls. Dysautonomia was observed in 22 patients, all having the disease for more than five years. Associated peripheral neuropathy, judged clinically, was present in all, except one patient. Of the 22 dysautonomic patients, 9 each had mild or moderate dysantonomia and 4 had severe dysautonomia as per the scoring schedule devised by us. Syncope, gustatory sweating and impotence were the symptoms suggestive of dysautonomia. But not all affected patients reported these symptoms. Involvement of the sympathetic system was more frequent than that of the parasympathetic system. Statistically significant abnormality was seen with Atropine ratio, standing 30:15 beat ratio, postural hypotension and sustained hand grip test. Sustained hand grip test was the one which consistently gave abnormal results in all the 22 dysautonomic patients.

Electrogustometry in Hansen's disease (study of 225 cases).

An electrogustometric study of 225 cases of Hansen's disease revealed impairment of taste in 55.1% of the cases. It was related to the duration of the disease, and was seen in 74.6% of the cases of lepromatous leprosy, 49.3% of the cases of borderline leprosy, and 41.3% of tuberculoid leprosy cases. Only in lepromatous cases was complete ageusia seen (9.39% of cases). All of the cases having lesions in the oropharynx and those with facial nerve palsy revealed impairment of taste, but it was not related to the type of antileprosy drug used or to the development of ENL reaction.

Olfaction in leprosy.

Olfactory test was carried out in 225 cases of Hansen's disease with 75 cases each of lepromatous leprosy (L.L.), borderline leprosy (B.L.) and tuberculoid leprosy (T). Impairment of olfaction was found in 94(41.7%) cases. It was seen in 69.33% cases of L.L., 33.33% cases of B.L. and 22.6% cases of T. Total anosmia was present in 5(6.61%) cases of L.L. only. Males were more affected than the females. Impairment of olfaction was related to the duration of the disease, severity of the nasal condition, and E.N.L. reaction. It was not related to the type of antileprosy drug used.

Pattern of renal amyloidosis in Indian patients.

Two hundred and thirty-three patients with renal amyloidosis were studied in an attempt to identify the incidence and pattern of the disease in northern India. The incidence of amyloidosis was 1.01% of 6431 post-mortems and 8.4% of 1980 renal biopsies from patients who presented with clinical evidence of glomerular disease. Two hundred and three patients (87.1%) had secondary amyloidosis, 22 (9.4%) had primary amyloid and 8 patients (3.5%) had amyloidosis associated with multiple myeloma. Tuberculosis of various organs was the commonest predisposing disease accounting for 59.1% of secondary amyloidosis, followed by chronic suppurative lung disease in 24.1%. Rheumatoid arthritis, chronic osteomyelitis and lepromatous leprosy were seen in a small percentage of patients (2 to 8%). Proteinuria of varying degree was present in all the 233 patients and 12.9% of them had a daily protein excretion of more than 10 g. Post-mortem examination of 65 patients with renal amyloidosis showed that 75.3% also had amyloid deposit in the spleen, 63% in the liver, and 50.8% in the adrenals. Clinical evidence of disappearance of proteinuria was observed in 3 patients with secondary amyloidosis; in 2 of them, the regression of amyloidosis was confirmed by serial renal biopsy performed 3 and 5 years after the initial diagnosis.