Reduction in total serum protein content, medullary erythroid hypoplasia, anaemia and abnormal excretion of amino acids and their catabolites are frequent complications of marasmus and kwashiorkor (Foy
SUMMARY
An erythroid hypoplasia characterized by falls in red cell precursors, haemoglobin, packed cell volume, reticulocytes and sometimes platelets, resembling that which occurs in marasmus and kwashiorkor, has been produced experimentally in baboons on a synthetic riboflavin‐deficient diet. The red cell uptake of59Fe on the 8th and 12th days was 40 per cent lower in the riboflavin‐deprived animals and thus agreed with the low marrow activity estimated cytologically. The haematological abnormalities were accompanied by gross skin changes, falls in serum folate, and sometimes intramuscular and intestinal haemorrhages. Striking macroscopic and histological abnormalities were also present in the adrenals. All the abnormalities disappeared when riboflavin was given, and re‐appeared when it was again omitted from the diet. When prednisone was given to the deprived animals instead of riboflavin, only the erythroid hypoplasia disappeared. Since the diet was adequate in all respects and contained 20 per cent of its kilocalories in the form of animal protein, the abnormalities cannot have been due to protein deficiency. The pair‐fed controls on a similar diet but with added riboflavin developed no abnormalities. It is suggested that as riboflavin is an important co‐enzyme in many vital metabolic processes, its absence may affect marrow activity directly or by disturbing corticosteroid metabolism, as well as being associated with serum protein changes.
BMMSC 725 demonstrated on a phonocardiogram when atrial systole occurs in the middle of ventricular systole in complete heart block.3 Under these circumstances the atrioventricular valves are closed and ventricular filling is obviously impossible. A presystolic gallop in an abnormal heart does not therefore, as stated in your annotation, result from the increased intensity of the low-pitched vibrations seen on a phonocardiogram of normal subjects, but is due to a different vibration which moves away from the first sound into a presystolic position.3-8 Finally, you have referred to the third heart sound gallop which " may be heard in heart failure, in mitral incompetence, or in constrictive pericarditis." Admittedly the diastolic sound in these instances may result from the same basic mechanism (in this respect the recent work of Nixon,9 who disputes the common belief that a third heart sound is produced by a vibration of the ventricular muscle, is noteworthy), but, since the sound associated with constrictive pericarditis usually occurs earlier and is higher pitched10 than a third heart sound gallop, should it not be regarded separately and be referred to as the early diastolic sound of constriction ?-I am, etc.,
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