[in Japanese]

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The clinical spectrum of leprosy reflects the diverse nature of human immune responses to Mycobacterium leprae. The clinical presentations correlate with the level of cell-mediated immunity against M. leprae. Cell-mediated immunity, as assessed by the Mitsuda reaction, is positive in tuberculoid patients and negative in lepromatous patients. In contrast, humoral immunity, as assessed by anti-M. leprae antibodies is greatest in lepromatous patients. The inverse correlation between cell-mediated immunity can be explained on the basis of the local cytokine pattern.

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In Japan, 90% of inpatients are housed in leprosaria. As of the end of 1994, the overall number of inpatients hospitarized in leproisaria accounts for 5, 811 in Japan, of whom 5, 767 inpatients are hospitalized in national leprosaria.
In recent years, the number of Japanese patients who are newly affected by leprosy in Japan has decreased to within ten. Accordingly, the number of new admission to leprosaria has decreased to as low as zero. The number of readmission, on the other hand, is about 30 a year, and about 15 patients a year return to their social lives. It is estimated that the number of patients hospitalized in leprosaria will decrease to about 4, 000 by the year of 2005, about 2, 000 by the year of 2015, and further to about 700 by the year of 2025, as a result of deaths due to aging of these hospitalized patients.
At the end of 1994, patients who were leprosy bacillus-positive in the skin smear test accounted for only 2% in the overall hospitalized patients, and the counterplan for leprosy is almost terminating in the leprosarium. However, about 40% of the patients hospitalized in leprosaria are in fact still on medication, and the-re still remain a number of problems to be solved by us. That is, to deal with anxiety of recurrence, which is the reason for taking medicine, leprous neuralgia, iritis and glaucoma, leprous acute reaction, and intractable leprosy, treatment at leprosaria is not sufficient, and a joint counterplan on a nationwide scale is necessary.
In the future, it would be necessary to secure medical welfare for "the decrease and aging of hopitalized patients" at leprosaria.

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It was believed in the past that hallux valgus would not become a subject of medical treatment, since it rarely occurred in the Japanese people, although Europeans and Americans suffered from hallux valgus frequently. Recently however, hallux valgus has been observed in as many as about 30% of the Japanese, and waht is more, 80% of these are female. It has been reported that the incidence of hallux valgus in leprosy patients is 32%, but there is no sex difference indicated and no mention that hallux valgus occurs more frequently in females.
In this study, we selected dry photographic plates taken between 1910 and 1951 from materials for medical study stored at Tama Zenshoen, and examined the 38 plates in which feet were photographed (96 feet of 54 patients) for complications of hallux valgus.
The results showed that 7 feet of 6 patients (photographs 1, 2, 7, 8 and 9) gave some indication of having hallux valgus. After excluding cases which seemed to be due to destruction of the capitus ossa metatarsalia I accompanying perforation of the feet (photos 1, 2 and 7), however, ohly 3 feet of 2 patients (photos 7 and 9) remained. Furthermore, the hallux valgus observed in the 3 feet (2 patients) was judged to be slight to moderate and not to require medical treatment.
This large difference in the incidence of complications of hallux valgus between the past and the present is thought to be due to the fact that the primary footwear in the past comprised geta (wooden clops) and zori (Japanese sandals). That is to say, a hanao should be retained between the valgus and the digitis pedis II, which must have the same effect as that of hallux valgus prevention equipment.
The bandaging methods of hte past shown in photos 3, 4 and 5 also seems to have contributed to the prevention of hallux valgus. At any rate, exogenous factors such as footwear are thought to be the principal cause of the occurrence of hallux valgus in leprosy patients, rather than unbalanced muscular strength in the feet destruction of the horizontal arch due to motor paralysis of leprosy.

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In order to investigate the role of immunogenetic factors in the pathogenesis of uveitis in leprosy, HLA antigens were analyzed between the leprotics with and without uveitis. Sixty-five Japanese leprosy patients comprised 32 with uveitis and 33 without uveitis. Controls consisted of 138 healty subjects. A lymphocyte cytotoxicity test was used for typing HLA-A, -B, -C, -DR and -DQ antigens. HLA-DR2 genotyping was performed by the polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) and PCR restriction fragment length polymorphism (RFLP) methods. The frequency of HLA-DR2 antigen was significantly increased in the patients with uveitis as compared with the control subjects (Pc<0.0005), whereas HLA DR53 antigen was significantly decreased (Pc<0.05). At the genomic level the frequency of HLA-DRB1*1501 was significantly increased in the patients with uveitis and without uveitis as compared with that in the controls. The association with DRB1*1501 was even stronger in patients with uveitis (odds ratio =7.1, Pc<0.000005) than in the patients without uveitis (odds ratio =4.1, Pc<0.005). Our results suggestthat HLA-DRB1 * 1501 contribute to the susceptibility to uveitis in the Japanese with leprosy.

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Evidence was presented in the previous paper that the activity of cells of My cobacterium leprae was maintained in the phosphate buffer(pH7) containing fetal calf serum (10%) with /without glycerin (2%) for approximately 4 weeks during incubation of cells at 30°C when the inoculum having more than 3, 000 pg ATP was used.
In the present paper, it is confirmed that the definite inoculum sizes are essential f or obtaining the reproducible results that are described above, by using the inocula containing more and less than 3, 000pg ATP.

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