Serum Complement (C3) in Leprosy

Abstract

In troductionThe production of surgical analgesia in the limbs by intravenous injection of a local anaesthetic, was introduced by Bier (1908). The procedure involves exsanguination of the extremity by elevation and compression, and the application of a tourniquet. The anaesthetic solution, which is injected into the vein , diffuses into the tissue and blocks the nerve endings. TechniqueA sphygmomanometer cuff is placed high on the upper arm of the limb to be operated on, and the hand is prepared and draped . A Mitchell's needle is then introduced into a prominent vein on the dorsum of the hand, the arm is elevated for 5 min, and if necessary the extremity is exsanguinated with a sterile Esmarch bandage. The sphygmomanometer cuff is inflated to a pressure of 220 mmHg, and 15 ml of 1 % Xylo caine solution is injected through the needle . We prefer Xylocaine solution to procaine because it seems to diffuse more easily across the endothelium. Some anaesthetists apply two tourniquets on the arm in an attempt to avoid discomfort, since the pressure of the tourniquet is felt by the patient after about 50 min . At the end of the operation the tourniquet is released intermittently in order to allow the drug from the exsanguinated area to enter the sy stemic circulation slowly . Too rapid a release may produce a generalized response resulting from flooding of the tissues with anaesthetic solution.During the past 5 years, of the 1472 operations performed on the hand at this institution, regional anaesthesia was used in 1124 cases; 80% of the operations were for tendon transplantation, and the remainder were for fractures and other injuries. Plantaris tendon required as graft for tendon transplant was removed under Trilene anaesthesia. Four wrist fu sions, and several reductions of fractures of the forearm bones, both open and closed, were also performed under intravenous regional anaesthesia. Since the anaesthesia lasts for about 15 min after the tourniquet is deflated, this was done before th e skin sutures were inserted.With good technique, 100% success rate is achieved ; our failures were due to a leaking tourniquet. Out of this large series, systemic response has occurred on a few occasions only. In one case the patient developed convulsions and

Renal lesions in leprosy amongst north Indian patients

“…Circulating immune complexes and a fall in complement levels have been demonstrated frequently during ENL and occur in lepromatous leprosy even in the absence of ENL though less frequently (Bjorvatn et al, 1976;Date et al, 1977;Iveson et al, 1975;Moran et al, 1972;Shwe, 1972b;Shwe, 1972c;Shwe and Petty, 1972). These observations, coupled with the findings of deposits of immunoglobulins and complement in the glomeruli in some patients (Iveson et aL, 1975;Shwe, 1972a) as also observed in the present study, suggest that the glomerulonephritis is immune complex mediated. However, confirmation of this pathogenetic mechanism would require identification of lepra antigens in the glomeruli and the elution of specific antibody.…”

“…A similar incidence of 29% was reported by Gutman et aL (1973). Although interstitial nephritis has also been described in leprosy by some workers (Bernard and Vazquez, 1973;Gupta et al, 1977;Mittal et al, 1972;Sainani and Rao, 1974;Shwe, 1972a) several others have recorded the total absence of any interstitial lesions (Date et aL, 1977;Gupta et aL, 1981;Johny and Karat, 1971;Peter et al, 1981). The impairment in concentrating ability and acidification is difficult to explain in the absence of any such lesions.…”

“…The few ultra-structural studies done so far have revealed electron dense deposits mainly in a sub-endothelial and intramembranous location and rarely in the sub-epithelial region (Bullock, Callerame and Panner, 1974;Cologlu, 1979;Date and Johny, 1975;Date et aL, 1977). Circulating immune complexes and a fall in complement levels have been demonstrated frequently during ENL and occur in lepromatous leprosy even in the absence of ENL though less frequently (Bjorvatn et al, 1976;Date et al, 1977;Iveson et al, 1975;Moran et al, 1972;Shwe, 1972b;Shwe, 1972c;Shwe and Petty, 1972). These observations, coupled with the findings of deposits of immunoglobulins and complement in the glomeruli in some patients (Iveson et aL, 1975;Shwe, 1972a) as also observed in the present study, suggest that the glomerulonephritis is immune complex mediated.…”

Lepromatous Leprosy and Contact Dermatitis

“…C3 was the only complement fraction that was found to be increased. In other publications, general increase of immunoglobulins and complement are reported to accompany Hansens's disease [4,5].…”

Το Ολικον Συμπληρωμα (Ch50) Και Οι Παραγοντες C3 Και C4 Επι Λεπρας

“…ό τίτλος τοΰ συμπληρώματος είναι χαμηλός. Ή διαπίστωσις εναποθέσεως άνοσοσφαιρινών καί συμπληρώματος άφ' ενός μέν έπί του δέρματος τών πασχόντων έξ οξέος ENL (Wemambu et al 1969) αφ' έτερου δέ έπί τών νεφρικών σωληναρίων πασχόντων έκ LL μετά πρωτεϊνουρίας(Shwe 1972) αποτελεί άπόδειξιν, ότι αντιδράσεις αντιγόνου αντισώματος λαμβάνουν χώραν in vivo έπί λέπρας.…”