One hundred and seventy-four outpatients attending the skin clinic in Naha or Miyako were surveyed by the same methods as those used for the inpatients in the first report of this series. As the age-distribution of outpatients was significantly deviated from normal distribution, Kolmogorov-Smirnov's test was used for statistical examination of their age, age at onset, years after onset and period of contact with consanguineous patient accrding to the subgroups classified by personal and family histories and clinical findings. The results were shown in Tables 1-5. Average age of the patients at home after the onset was significantly lower than that of the discharged cases, but the latter was also lower than that of inpatients. Average age of outpatients showed signi-ficant difference according to presence or absence of consanguineous patient, classification (form) of leprosy and living place, but not according to the other findings. Average age at onset was also significantly different between two subgroups with or without consanguineous patient, the result being similar to those of inpatients. Average years after onset of outpatients were significantly different according to the form of leprosy and its stage. However, average period of contact with consanguineous patient was not significantly different among the subgroups classified by consanguinity and leprosy form of index case, the fact being discrepant from that of the inpatients.
A correlation between two items or a comparison of two or more percentages among the subgroups was examined by chi-square test, as shown in Tables 6-17. Male patients were more frequently found in Yaeyama and other islands than those in Main Okinawa and Miyako islands. No difference by sex was found in the other subgroups. The outpatients with lepromatous leprosy were more frequently found in the discharged cases than those at home, in Yaeyama and other islands than in Main Okinawa and Miyako islands, and in physical workers than in brain workers. The skin eruption was more fre-quently found in progressive and retrogressive stages than in quiescent and arrested. However, the frequencies of fall of eyebrow and nose involvement were significantly less than those of inpatients and not significantly different among the subgroups classified by sex, form and stage of leprosy of outpatients.
On the other hand, the frequency of the enlargement of peripheral nerve was not significantly different between in- and out-patients but significantly higher in male than in female. The other neural symptoms such as claw hand, drop hand or foot, facial palsy and lagophthalmos were far less frequently found in the outpatients than in the inpatients, but the frequency of these symptoms showed no significant difference among the subgroups of outpatients as described above. The percentage of outpatients under conti-nuous treatment was significantly higher than that of inpatients. Nearly 62% of outpa-tients was bacteriologically negative (BI= 0). This percentage was not significantly different from that of inpatients, but significantly different among the subgroups classified by leprosy form, stage and complication.
Based on these findings, it is concluded that relatively mild cases with leprosy and those at early stage were more frequently found in the outpatients than in the inpatients and that because of this mildness they might be suited to the treatment at a skin clinic. The results also suggest that the appearance of mild leprosy may be more strongly influenced by post-natal and empirical conditions than by genetic and physiologi-cal factors.

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Hybrid nude mice by mating with CD-1(ICR) outbred and IAI inbred strain originating Jcl: ICR strain female and NFS/N inbred or N: NIH (s) outbred nude male mice, they were given excellent results with the development of marked lepromatoid lesions in comparison with that of "resistant" CD-1(ICR) nude mice. In summary, we have established CD-1(ICR)×NFS/N, CD-1(ICR)×NIH(s) and IAI×NFS/N hybrid nude mice at the M1 circle (generation) as a new model for the experimental lepromatous leprosy. The development of marked lepromatoid lesions formation in nude mice may be produced by the genetic background of the Swiss colony except for CD-1(ICR) nude mice.

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Hereditarily asplenic-athymic mice with the background of BALB/c, artificially splene-ctomized congenitally athymic mice of various strains and comparisons of susceptibility to M. leprae were made with control hereditarily athymic mice by inoculations made on the right intra-upper lip and right hind foot. Evidently hereditarily asplenic-athymic mice and artificially splenectomized congenitally athymic mice showed higher susceptibility than the respective control. In addition, difference in the susceptibility to M. leprae was observed among strains of splenectomized congenitally athymic mice, the congenitally athymic mice strains with backgrounds of NFS/N, C3H/HeN+MTV and CBA/N previously reported were found to demonstrate further enhancement of their susceptibility to M. leprae following splenectomy. Multiplication of M. leprae in severely deformed hind foot was not detected with congenitally asplenic mice. But, in the case of hereditarily asplenic-athymic mice which were observed to have highly advanced deformities of the femur and tibia with muscular atrophy, though the macroscopic swelling of the inoculated hind foot appeared to depressed, the proliferation of M. leprae reached to the bone-marrow at the later stage of inoculation. Further, regarding hereditarily asplenic-athymic mice, aside from the individual difference accompanying the difference in the grade of hind limb deformity, tumor formation and aging also influenced the M. leprae susceptibility. In conclusion, this study is suggested that the M. leprae susceptibility would still be enhanced, if new hereditarily asplenic-athymic mice of milder hind limb deformity are produced by mating the congenitally athymic mice of high susceptibility to M. leprae and the hereditarily asplenic mice.

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This article reports that a 60 year-old Korean male patient suffered from the type 1 lepra reaction of which the dominant manifestation was peripheral neuritis accompanied by secondary diabetes mellitus and hypothyroidism.
The patient has been hospitalized in National Leprosarium Oku-Komyoen since 1945, his case being diagnosed as lepromatous leprosy in 1944. As the result of the regular treatment, such as injection of Chaulmoogra oil and the following sulfone therapy, the skin lesions had been clearly absorbed by 1949. The patient, therefore, was regarded as a clinically cured case and the dapsone treatment had been regularly continued afterward till 1987.
About 6 years ago, the patient noticed drop foot which appeared insidiously on his left foot without neuralgia.
In October 1987, the patient began to suffer from left sciatica followed by neuralgia, sensory disorder and motor palsy on bilateral hands and the left of the face.
In January 1987, his blood sugar level went up to 520mg/dl, and it is considered that it resulted from secondary diabetes mellitus. We administrated insulin to him. After three months, blood sugar became normal. But symptoms of hypothyroidism were obse-rved in April; manifesting general fatigue, chill, anorrhexia, loss of body weight, constipation and so on. And besides he presented the ophthalmological symptom of iridocyclitis at the same time. Thyroid hormone was administrated. Symptoms of hypo-thyroidism have almost disappered now (August, 1988), though he has not recovered from his neural palsy yet.
In this case, neuritis, and iridocyclitis are thought to be due to the type 1 reaction, judging from the facts of the positive conversion of lepromin reaction (Mitsuda) and change of MLPA from negative to positive. Secondary diabetes mellitus and hypo-thyroidism subsequent to peripheral neuritis are also thought to be closely related with the immunological response associated with the type 1 lepra reaction, though the me-chanism is still unknown.

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Since all of catalase, peroxidase and cytochromes a and c have not been detected in Mycobacterium leprae, the cultivation of this pathogenic acid-fast strain is presumed to be impossible especially under aerobic condition. In this reason the supplementation of these defected enzymes was planned by introducing DNAs from cultivable acid-fast strains, which have all of these defected enzyme activities. As a model experiment, the introduction of SM resistant DNA into SM sensitive M. smegmatis was examined to verify the transformation. High voltage cell processor, freezing and thawing, and that combined with contusion shock were mutually compared in introducing DNA from cracks becterial cell wall, because the formation of a spheroplast was unsuccessful in M. leprae.
All the experimental results were negative. Many negative results have been seen in transformation of mycobacteria. Still more Mizuguchi also said that no genetic expression was detected in purified DNA transformation, even though positive in bacterial mating system such that arginine and methionine requirement could recover by the mating. Mycobacteria may destroy the purified DNA introduced from outside. There-fore, it was presumed that the purified DNA should be introduced to the recipient ba-cillus after integrated to bacteriophage DNA. Just then, at the 23 th U. S.-Japan Joint Conference Leprosy Panel in 1988 Jacobs reported that kanamycin resistant DNA which was inserted into the DNA of lysogenic bacteriophage L1 was expressed in M. smegmatis 607 strain.

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[in Japanese]

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