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.

Peripheral arteriographic studies in leprosy.

There is a considerable controversy regarding the frequency and significance of vascular lesions in leprosy. Twenty-six cases of leprosy below the age of 40 years, without any local or systemic arterial disease and normal looking hands were subjected to brachial arteriography. One patient had posterior tibial arteriography also. The diagnosis of leprosy was confirmed by histology or bacteriological staining techniques. Biopsy material was studied from the involved areas and similar material was obtained from nine matched control subjects at autopsy. Skin thermometry and reflex vasodilatation was studied in eight cases. Arteriographic abnormalities such as occlusion, narrowing, tortuosity, dilatation, irregularity and incomplete filling were seen in more than two vessels in the hand in 50%, and in the digits in 75% of the cases. The ulnar artery was more frequently involved than the radial. Superficial and deep palmar arches were equally affected. Marked increase in arcuate vessels was noticed in nearly three-quarters of the patients, and in some, arcuate vessles were serving as collaterals. Histologically all sizes of vessles, including the capillaries, showed changes in nearly half the cases. Reflex vasodilation was lost in three cases of dimorphous leprosy and impaired or absent in three out of five cases of lepromatous leprosy. There was no predilection for any form of leprosy to show arterial changes more than the other. This study clearly demonstrates that the arterial involvement in leprosy is very frequent and must be playing an important role in causing mutilation and deformities of hands and feet.

Peripheral vascular deficit in leprosy.

There is considerable controversy regarding the frequency and significance of vascular lesions in leprosy. Thirty-five patients of leprosy under 40 years of age, without any local and systemic arterial disease, with normal looking hands and feet, were subjected to brachial arteriography. One patient also had posterior tibial arteriography. Diagnosis of leprosy was confirmed by bacteriologic and histopathologic technics. Biopsy material was studied from the area of radiographic abnormality, similar material was obtained from nine matched control subjects at autopsy. Skin thermometry and reflex vasodilatation were studied in eight cases. Various fractions of serum lipids and cholesterol were estimated in all patients and found to be within normal range. Arteriographic abnormalities such as occlusion, narrowing, tortuosity, dilatation, poststenotic dilatation, irregularity and incomplete filling of the lumen by radio-opaque material, were seen in more than two vessels in 50% of the arteriograms in wrist and palm; digital vessels showed abnormality in 75% to 94% of cases. The ulnar artery was more frequently involved (74%) than the radial (50%). Superficial and deep palmar arches were equally affected. Increased vascularity in hypothenar eminence area was seen in three arteriograms. Marked increase in arcuate vessels was noted in 60% of patients. Some arcuate vessels were serving as collaterals. Histologically, all grades of vessels including capilaries showed changes in nearly half of the patients. Reflex vasodilatation was lost in three patients of dimorphous leprosy, and impaired or absent in three of five patients of lepromatous leprosy. There was no predilection for any form of leprosy to show arterial changes more than others. This study clearly demonstrates that the vascular involvement in leprosy is very frequent and must be playing an important role in causing mutilations and deformities of hands and feet.