The skin lesions in the lepromatous leprosy during chemotherapy showed distinct improvement serveral years before acid fast bacilli disappeared from the lesions. Conse-quently an indicator called Bacterial Clearance Time (BCT) was chosen to represent the clinical course and prognosis of each case of lepromatous leprosy. BCT is the period of time from the start of treatment until skin smears from the skin lesions become negative. Negativity of bacilli is defined here as negative skin smears over a twelve month period with no clinical evidence of activity.
This study concerns the 56 patients for whom a diagnosis of lepromatous leprosy was made in our clinic between 1952 and 1964, whose records were relatively complete, and were followed more than 5 years. In addition, 123 lepromatous patients admitted to Tama-Zenshon Leprosarium in Tokyo between 1957 and 1963, were studied to know whether the differnt results in these two institutions were observed.
There was no significant difference in the BCT distribution of lepromatous case in the two institutions. The cummulative ogive of BCT showed the sigmoid curve. A BCT of 4.5 and 7.5 years can be roughly regarded as inflexion points of this sigmoid curve. The following three groups were defined in the relation to the above inflexion points :
(1) Rapid decrease group (RA group) …… BCT _??_4.5(years)
(2) Standard decrease group (ST group) …… 4.5<BCT _??_7.5
(3) Slow decrease group (SL grou) ……7.5<BCT
Four and a half to 7.5 years chemotherapy was necessary to gain the bacterial nega-tivity in standard lepromatous leprosy. In RA group, some were the cases with Acute Infiltration reaction (Tajiri) in their clinical course. Some other cases in this group had a history of previous treatment or showed near lepromatous leprosy. The skin lesions in the RA group were localized type and were not so extensive. One of main causes in the SL group was irregular treatment due to ENL or other reasons.

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The author presented a case of "simple pneumothorax" complicated with a Hansen's patient, and by the way the view on literatures of pneumothorax was herein made in detalils.

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Histopathologic studies of the semilunar (Gasserian) ganglia were conducted in a series of 25 cases of leprosy, 5 with the tuberculoid type and 20 with the lepromatous stype. The tissue specimens examined were bilateral in every case and particularly detailed microscopic examinations made in 14 of the cases, with the results leading to the following conclusions.
1. Proliferation of the interstitial connective tissue was evident in the ganglia with focal round cell infiltration, in both the tuberculoid and lepromatous types.
2. In patients with lepromatous type the nerve cells were noted to show vacuolar degenera-tion as well as atrophy or enlargement, with deformity, necrosis or loss of nuclei. Such alterations of nerve cells were scarcely demonstrable in the tuberculoid type.
3. Leprosy bacilli were consistently demonstrable within the ganglion cells in the majority of the lepromatous cases, whereas in the tuberculoid type, such finding was almost nonexistent.
4. Axonal hypertrophy, sewelling or destruction of nerve fibers were noted with a fair degree of frequency in both types of the disease.
5. Various organs and tissues other than Gasserian ganglia were also examined microscopi-cally to compare the incidence of leprosy bacilli. These viscera included the liver, spleen, adrenals and testes as well as the skin and peripheral nerves. No bacilli were found in any of the organs examined, in the 5 cases of the tuberculoid type. The organiims were demonstrated in the ganglion cells in practically all 12 cases of lepro-matous type showing no significant absorption of cutaneous lesions of nodular infiltra-tion. Leprosy bacilli were also found in other viscera in many of these cases. Of the remaining 8 cases of this type with complete absorption of leprous infiltration and nodules in the skin, 4 were noted to have no evidence of leprosy bacilli in any of the viscera examined while the organisms were still demonstrable in both the peripheral nerves and ganglion cells of 2 other cases.

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This is a report of a case of typical Kaposi's sarcoma with visceral involvement (lungs, stomach, bone marrow, lymphnodes, spleen, thyroid, etc). The first skin lesion was seen in the occipital scalp and the patient died after one year and two months clinical course. The case was a 59 year old male who has had a history of lepromatous leprosy of 33 years duration. The combination of Kaposi's sarcoma and lepromatous leprosy is not considered as accidental. There must be some connection between these diseases through immunosuppresive relation. Electron-microscopic studies were carried out and no virus or virus-like particles were seen in the sections, studied. This, how-ever, is not enough proof to deny the possiblity of a virus cause of this disease.
We considered the case very valuable to help explain the immunosuppresive problem in those who suffer from lepromatous leprosy. Leprosy must have a hypofunction of its immune competent system consisting of lymphocytes, reticuloendothelial cells and mac-rophages.
We also considered the reason for the high frequency of Kaposi's sarcoma seen in Congo and Uganda. There are great differencies in the clinical manifestations between the cases in Uganda and in our country. It is recognized that the cases in equatorial Africa show a great variation in symptoms and signs. Finally, we discussed the problem of the multicentric origin and metastatic lesions of Kaposi's sarcoma.

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