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PURPOSE: To determine the magnitude of ocular complications that present in incident cases of relapsed borderline lepromatous (BL) and lepromatous leprosy (LL) patients. METHOD: From 1991 to 1997, all new BL and LL patients who had relapsed from an earlier disease, detected by active case finding in the geographically defined area of Gudiyattam taluk, were invited for ocular examination after their leprosy status was confirmed clinically and histopathologically. RESULTS: Sixty relapsed lepromatous patients, 45 male and 15 females, were examined. Fifty-two patients had relapsed after receiving only dapsone mono-therapy, 4 after receiving paucibacillary multi-drug therapy (PB-MDT) preceded by dapsone mono-therapy and 4 after only PB-MDT. Three (5 per cent) patients had lagophthalmos, 1 (1.6 per cent) patients each had ectropion and trichiasis, 32 (53 per cent) patients had impaired corneal sensation in both eyes, 2 (3.3 per cent) patients each had corneal opacity (associated with reduced vision), corneal nerve beading, punctate keratitis, keratic precipitates, and iris atrophy, 4 (6.6 per cent) patients had cataract associated with decreased vision, 1 (1.6 per cent) patient had blocked naso-lacrimal duct and 13 (21.7 per cent) patients had pterygium. Seven (12 per cent) patients had a visual acuity of 6/18 or less, 4 (6.7 per cent) patients had 6/60 or less and one patients had vision below 3/60. General ocular complications rather than leprosy-related ocular complications were responsible for reduced vision. Lagophthalmos was associated with increased duration of the disease (P = 0.009), Grade II deformity (P = 0.001), punctate keratitis (P < 0.001) and cataract (P < 0.001). Beaded corneal nerves were associated with lepromatous leprosy (P < 0.001) and high mycobacterial infection (P = 0.05). Patients whose initial disease was categorised as BL and LL had greater impairment of vision (P = 0.037), more iris atrophy (P = 0.013), increased keratic precipitates (P = 0.013) and more corneal nerve beading (P = 0.013), when compared with the group comprising Tuberculoid-tuberculoid (TT), Borderline-tuberculoid (BT) and Intermediate (IND). CONCLUSION: This first report on ocular complications in relapsed lepromatous patients demonstrates that general and leprosy-related ocular complications occur in these patients. However, they are not in excess of those reported in other leprosy groups...

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Aim: To describe ocular manifestations in newly diagnosed borderline lepromatous (BL) and lepromatous leprosy (LL) patients in India. METHODS: Ocular complications, at enrolment, occurring in all new borderline lepromatous and lepromatous leprosy patients detected by active case finding within the geographically defined leprosy endemic area of the Gudiyattam Taluk in India from 1991 to 1997 who consented to ocular examinations every 6 months, during and 5 years after treatment with multidrug therapy (MDT), were studied. RESULTS: Orbicularis oculi weakness (4.62 per cent), lagophthalmos (4.20 per cent), ectropion (0.42 per cent), trichiasis (0.84 per cent), blocked nasolacrimal ducts (1.68 per cent), pterygium (11.34 per cent), impaired corneal sensation (53 per cent), corneal opacity (10.5 per cent), corneal nerve beading (1.68 per cent), punctate keratitis (1.26 per cent), keratic precipitates (4.62 per cent), iris atrophy (1.68 per cent), and cataract (12.6 per cent) were ocular complications seen in the 301 lepromatous patients at enrolment. 4.6 per cent had blind eyes. Increasing age was associated with ocular complications. 80 per cent of patients were skin smear acid fast bacilli (AFB) positive. The LL/BL ratio was 1:6.4. 71 per cent had some limb deformity. 44 per cent had only leprosy related ocular complications (LROC), 28 per cent had only general ocular complications (GOC) while 14 per cent had both LROC and GOC. Ocular complications were significantly related to leg deformities. Corneal nerve beading was seen most in LL patients (100 per cent) having high bacterial content. Lagophthalmos and muscle weakness were associated with reversal reactions. CONCLUSIONS: Corneal nerve beading occurs in LL patients with high bacillary count. Patients with reversal reaction are more likely to present with orbicularis oculi weakness and lagophthalmos. Leprosy related ocular complications and general ocular complications are significant problems in newly diagnosed lepromatous patients. Elderly, deformed, skin smear positive, lepromatous patients are associated with increased ocular morbidity and form a group that require acceptable and accessible eye care.

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The skin and nasal mucosa of 10 lepromatous leprosy patients who had completed 24 doses of fixed duration multidrug therapy (MDT) but who continued to be skin-smear positive for acid-fast bacilli (AFB) were examined histopathologically. The nasal mucosa showed granuloma fractions that exceeded those seen in the skin specimens, signifying that activity in this region subsides much more gradually than the activity in the skin. Mouse foot pad studies done using T900r mice with an inoculum from the nasal mucosa biopsy specimens of these patients did not demonstrate any growth of Mycobacterium leprae, indicating that these bacilli were not viable. A skin specimen from one patient grew significant amounts of bacteria in the T900r mouse foot pad. These results show that 2 years of treatment with MDT would prevent dissemination of M. leprae from the nasal mucosa and, therefore, should preclude further transmission of the disease. It also indicates that viable bacteria might persist in the skin of patients, especially those with an initial bacterial index of > or = 4+ who have completed 24 doses of regular MDT. Therefore, a more cautious approach to administering only 12 doses of MDT to highly positive multibacillary patients is suggested.

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The use of compressed air-oxygen mixtures to replace nitrous oxide-oxygen in general anaesthesia was investigated in 378 patients. There were neither prolongations of recovery time nor instances of awareness under anaesthesia. The cost of general anaesthesia using compressed air-oxygen was about half that for nitrous oxide-oxygen mixtures.(AU)

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Six infants with coarctation of the aorta underwent percutaneous balloon angioplasty over a 6-month period ending July 1985. These infants had associated cardiac defects including aortic stenosis, ventricular septal defect, and patent ductus arteriosus. Catheters used carried 5 to 10 mm balloons; 4 to 8 atm pressure was applied for 10 to 15 seconds, and the procedure was repeated at least three times. No significant complications were encountered during the procedure. The mean systolic pressure gradient across the coarctation decreased from 44.2 +/- 4.7 mm Hg to 11.7 +/- 9.4 mm Hg (P less than 0.001) after angioplasty, and the diameter of the coarcted segment increased from 2.9 +/- 0.7 mm to 6.3 +/- 1.2 (P less than 0.001). Long-term follow-up indicated excellent results in four patients; the other two infants required additional treatment (repeat angioplasty and surgical resection, respectively). No aneurysm was seen in any infant. Based on this experience and the reported high mortality and high recurrence rate after surgical repair in neonates and young infants, we recommend balloon angioplasty as the therapeutic procedure of choice for relief of severe, previously unoperated coarctation of the aorta in neonates and young infants.

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The purpose of this study was to determine the long-term effects of chronic afterload reduction with oral hydralazine therapy in patients with primary myocardial disease (PMD). Twenty-six children aged 3 to 48 months with the diagnosis confirmed by M-mode and two-dimensional echocardiograms and angiograms were given digitalis and diuretics. Fourteen of these patients also received hydralazine orally in doses up to 4.0 mg/kg/day in four divided doses. Echocardiograms were initially repeated at 1- to 3-month intervals and subsequently at 6-month intervals. Long-term follow-up data were available in 10 patients given hydralazine and eight control patients; the follow-up interval ranged from 3 to 48 months. In the hydralazine group the shortening fraction rose from 14.5 +/- 4.9 to 23.2 +/- 7.5 (P less than 0.01), and the ratio of pre-ejection period to ejection time (0.52 +/- 0.05 to 0.35 +/- 0.06, P less than 0.001) and left ventricular size, normalized to body surface area (116 +/- 7 to 87 +/- 21, P less than 0.01), decreased. Significant improvement was demonstrated by echocardiography after 12 months of hydralazine therapy. There was no significant change in any of these values in the control group. We conclude that hydralazine therapy is a useful adjunct in the management of primary myocardial disease in infancy and childhood.

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The use of compressed air/oxygen mixtures to replace nitrous oxide/oxygen in general anaesthesia is investigated in 378 patients. There was no prolongation of recovery time nor instances of awareness under anaesthesia. The cost of general anaesthesia, using compressed air/oxygen mixtures was BDS$10.05 per patient while the cost of using nitrous oxide/oxygen mixtures was BD$20.11 per patient (AU)

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