[in Japanese]

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This paper report the progress and impact of MDT implementation to leprosy control in Thailand since 1984 until 1994. By ten years of MDT implementation, number of registered cases dropped from 44, 406 in 1984 to only 4, 878 cases in 1994. Which made prevalence rate declined 90% from 8.8 to 0.83 per 10, 000 population, the detection rate of new case declined from 6.2 to 1.97 per 100, 000 population. Total 39, 372 cases have been completely covered by MDT and 22, 821 cases are under post MDT surveilance with the low relapse rate only 1.46%, other indicators showing natural decline of leprosy were increasing in proportion of mutibacilary leprosy and mean age at onset of new case of leprosy together with decreasing in proportion of children among new case. Other impact of MDT showing increasing trend of proportion of new case of patient who voluntarily attend treatment centers. However, there were still no satisfactory impact on decreasing in proportion of deformity and duration since onset to the first detection of new case of leprosy.

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We studied dermal connective tissue of leprosy patients (Pa) in inactive condition. The dermal thickness (D) and the volumes of collagene and elastic fibers were measured utilizing automated computerized image analizer. The length of each elastic fibers (E) in lower legs were also measured. The E in upper dermis of forearms were observed microscopically. All these were compared with age-matched control (Co). We got the following results accordingly.
There was a relative increase of E in Pa's limb skin in spite of greatly decreased dermal thickness and fibrous components. The influence of sun exposure could not be recognized in this result. Each elastic fibers of Pa were longer than that of Co. The increased E in upper dermis was evident in Co's forearms, but not in Pa's. From our results, it is conceivable that the Pa's E either outlast or are overproduced exceedingly the collagen fibers. The factors that may account for these results are remained to be clarified.

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We examined 24 dermatologically cured leprosy patients with ongoing uveitis(UV + ) and 22 age and type matched controls(UV - ) to study the late phase leprous UV. All patients have been skin smear negative for more than 10 years. The history of chemotherapy, 5 years before and after a accomp-lishing bacterial negativity, was evaluated and represented by "SCORE". It was found that anti-PGL-I and anti-LAM-B antibodies were significantly higher in UV + group compared to the controls. The mean SCORE of chemotherapy in UV + group was signifi-cantly lower than in the controls. Iris pearls were seen in 10 cases or 42% out of 24 UV+ patients. No iris pearls were seen in control group. These results suggest that in-sufficient chemotherapy and consequent incomplete elimination of bacilli are the risk factors for leprous UV in the quiescent stage of the disease

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A 67-year-old patienthashad exanthema in the lower right limb since 51 years ago(16 years old at onset), which underwentrepeated remission and recurrence. At present, he has bilateralsymmetrical widespread infiltrating exanthema and asymmetrical marked neuralhypertrophy, and has been diagnosed typical LLs (His father had the same disease). The exanthema recurred severalyears ago, and the patient is being treated for Hansen's disease. He had hada dark brown flat elevation with a roughsurf ace and the size of a small finger tip in his right abdominal skin for approximately 20 years. A biopsy was performed, and the specimenwas fixed in 10% formalin and paraffin sections wereprepared for histopathologic examination. A part of the specimen was processed f orscanning electron microscopic examination. Seborrheic keratosis was diagnosed by H & E staining. Acid-fast (FITE) staining, immunohistochemical staining (keratin, S-100 protein, anti-PGL antibody and antiBCG antibody) and scanning electron micro scopy revealed the presence of bacteria (M. leprae) in the dermal foam cells, the matri with a banded structure and the squamous epithelial cells which normally lack phagocytosis function. Compared to the basal cells of normal epidermis, the basal cells located adjacent to the dermis affected with seborrheic keratosisshowed increased proliferatin and more marked characteristics of a germinative cell. The degree of differentiation of the basal cells appeared regressed, and they probably possessed augmented hagocytic activity. The phagocytosed bacteria were probably carried by the epidermal cell cycle toward the surface layer. However, bacteria could not be found in the stratum corneum, probably due to an associationwith the lysosome.

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