Prophylaxis of hookworm anemia-deficiency disease

1. In individuals severely infested with Ancylostoma or Necator, it is possible tomaintain the normality of blood value by the administration of a sufficient dose ofan iron salt.

2. The minimum dose necessary to maintain normality of the blood in an individual weighing 45 kilograms, with 1051 helminths, was 0.2. Gm. daily of ferrous sulfate, administered in mixture with manioc flour.

3. The patient observed became clinically normal two weeks after the beginningof blood regeneration up to the end of the trial period one year later. In this period,with the various doses of iron tried, hemoglobin varied from 8.0 to 11.0 per 100ml. of blood.

Note: ACKNOWLEDGMENTWe owe thanks to the kindness of our colleague, Dr. Genard Nobrega, for the case report and electrocardiographic study of the patient.

     

Acute thrombocytopenia induced in dogs by administration of urethane (ethylcarbamate)

1. Dogs treated for one to two weeks with daily injections of urethane (ethylcarbamate) subcutaneously, in doses of 0.4 Gm. per Kg. of body weight, presenteda typical picture of thrombocytopenic purpura.

2. The pathologic changes consisted in numerous purpuric lesions in the smallintestine and a smaller number on the skin, heart, lung, cortical zone of the kidney,epiploon, and, rarely, on the stomach and large intestine.

3. The hematologic changes occurred in the following sequence: leukocytosis,leukopenia and thrombocytopenia, and finally acute anemia coinciding withsevere intestinal hemorrhage. In the final phase, the coagulation time was normaland the bleeding time very much increased.

     

Ruptured mitral chordae tendineae may be a frequent and insignificant complication in the mitral valve prolapse syndrome

In this study, we performed 512 echocardiographic studies on264 consecutive, unselected patients with the idiopathic mitralvalve prolapse syndrome. Twenty-eight patients (10.6%) had evidenceof ruptured chordae tendineae of the mitral valve on M-modeexamination and in 24 the diagnosis was confirmed by two-dimensionalechocardiography. Mild to severe mitral insufficiency was provenin all of them by left ventriculography during cardiac catheterization.Eight patients underwent surgery to relieve symptomatic severemitral regurgitation. At operation all had myxomatous degenerationof the mitral valve, two patients were found to have ruptureof anterior mitral chordae, and six had rupture of posteriormitral chordae. Twenty (71%) patients with chordal rupture hadeither mild symptoms or were completely asymptomatic. It isconcluded that chordal rupture in patients with the mitral valveprolapse syndrome may be present in asymptomatic patients andgo undetected clinically in a substantial number of patientsunless a high index of suspicion is maintained. Serial M-modeand two-dimensional echocardiographic studies are of importancein identifying the progression of prolapse findings and mayreveal the natural history of this pathologic condition in asymptomaticpatients.     

15The effect of Lower Esophageal Sphincter (LES) electrical stimulation on LES pressure

Background: Electrical stimulation (ES) of the stomach has been shown to modulate LESP. Electrical stimulation, using neural high frequency stimulation (NGES) can induce contractions of the smooth muscle of the gut. The purpose of this study was to determine if electrical stimulation of the LES can affect LESP. Methods: Four female hound dogs, weight: 20–25 kg, underwent an esophagostomy that allowed the introduction of a sleeve manometry catheter into the esophagus. They were also implanted with a pair of electrodes along the longitudinal axis of the LES. After 3 weeks of recovery, they underwent esophageal manometry recording during control and ES, performed randomly on separate days, using 4 different stimulations: 1‐Low frequency: freq: 6 cycles/min, pulse: 350 milisec, amp: 5 mAmp; 2 High‐frequency: freq: 50 Hz, pulse: 1 milisec, amp: 5 mAmp; 3‐ NGES: freq: 50 Hz, pulse:20 milisec, amp:10 volts; 4‐ High‐frequency, circular: freq: 20 Hz, pulse:1 milisec, amp:5 mAmp. All recordings were performed 1 hour after consumption of 3 ounces of canned dog food, to prevent fluctuations in LESP and under mild sedation (acepromazine 0.5 mg kg^­1). Tests consisted, during ES days, of 3 periods of 20 minutes each: control , stimulation and post stimulation. The effect of NGES was also tested under anesthesia and following administration of L‐NAME 50 mg kg^­1 IV. and also atropine 0.05 mg kg^­1 IV. Analysis: area under the curve (AUC) and pressure were compared among the 3 periods. Data shown as mean ± SD, ANOVA and t‐test, p < 0.05. Results: Sustained increase in LESP was observed during low frequency stimulation, 32.1 ± 12.8 vs. 42.4 ± 18.0 vs. 50.1 ± 23.6, control vs. stimulation vs. post stimulation respectively, p = 0.013. AUC also significantly increased during and after stimulation, 39,320.3 ± 15,722 vs. 51,294 ± 21,826 vs. 59,823.6 ± 28,198.4 mmHgxsec, control vs. stimulation vs. post stimulation respectively, p = 0.01. There was no significant change with other types of ES. NGES induced an initial rise in LESP followed within few seconds by relaxation with slow resumption of pressure over a 1 minute period. L‐NAME increased LESP and augmented the initial rise in LESP following NGES but markedly diminished or abolished the relaxation phase. Atropine lowered LESP and abolished the initial rise in LESP induced by NGES. Conclusions: Low frequency ES of the LES increases LESP in conscious dogs. NGES has dual effect on LESP: an initial stimulation, cholinergically mediated, followed by relaxation mediated by nitric oxide.