Search

Reflux and aspiration in people cause and exacerbate respiratory diseases in the absence of gastrointestinal signs. Protein biomarkers in humans detect extraesophageal reflux (EER) from oropharyngeal (OP) and bronchoalveloar lavage samples. Reflux likely contributes to respiratory disease in dogs. The objectives of this study were to analyze the canine gastric fluid (GF) proteome and compare this to the OP proteome in normal, vomiting/regurgitating, and coughing dogs to identify biomarkers for EER/aspiration. Twenty-three client-owned dogs were enrolled. Canine GF samples (n = 5) and OP swabs in normal (n = 6), vomiting/regurgitating (n = 7), and coughing (n = 5) dogs were within 2 weeks of sample collection. Protein digests were analyzed by liquid chromatography–mass spectrometry. Differential abundance (DA) of proteins between groups was evaluated by Fisher's exact test with p < 0.0004 significance level after correction for multiple comparisons. DA was found between all groups (p < 0.0001): GF vs. normal (n = 130 proteins), coughing vs. normal (n = 22 proteins), and vomiting/regurgitating vs. normal (n = 20 proteins). Protein abundance was highly variable between dogs. Gastrointestinal-specific proteins were found in OP swabs from vomiting/regurgitating and coughing dogs but not from healthy dogs. In conclusion, the proteomic composition of the OP varies between health and disease. The presence of gastrointestinal-specific proteins in OP of coughing dogs may suggest reflux and/or aspiration as contributing factors. The variable protein abundance warrants investigation into biomarker panels.

Study Design:A literature review.Objective:To summarize the implant removal rate, common bacterial organisms found, time of onset, ratio of superficial to deep infection, and regurgitating the prevalence among all the retrospective and prospective studies on management and characterization of surgical site infections (SSIs).Methods:PubMed was searched for articles published between 2000 and 2018 on the management or characterization of SSIs after spinal surgery. Only prospective and retrospective studies were included.Results:A total of 49 articles were found relevant to the objective. These studies highlighted the importance of implant removal to avoid recurrence of SSI. The common organisms detected were methicillin-resistant Staphylococcus aureus, methicillin-resistant Staphylococcus epidermis, Staphylococcus epidermis, Staphylococcus aureus, and Propionibacterium acnes, with prevalence of 1% to 15%. A major proportion of all were deep SSI, with minority reporting on late-onset SSI.Conclusion:Long-term antibiotics administration, and continuous irrigation and debridement were common suggestion among the authors; however, the key measure undertaken or implied by most authors to avoid risk of recurrence was removal or replacement of implants for late-onset SSI.

Vascular ring anomalies present in young patients and will inhibit growth and development. Therefore it is essential that these patients have the anomaly corrected as soon as clinically stable enough to undergo surgical correction. In particular the congenital malformation of the persistent right aortic arch (PRAA) is uncommon in practice to see, but does require good knowledge and understanding by the veterinary team to provide a successful outcome.

Anatomic pathologies such as stenosed or regurgitating heart valves and artificial organs such as heart assist devices or heart valve prostheses are associated with non-physiological flow. This regime is associated with regions of spatially high-velocity gradients, high-velocity and/or pressure fluctuations as well as neighbouring regions with stagnant flow associated with high residence time. These hemodynamic conditions cause destruction and/or activation of blood components and their accumulation in regions with high residence time. The development of next-generation artificial organs, which allow long-term patient care by reducing adverse events and improve quality of life, requires the development of blood damage models serving as a cost function for device optimization. We summarized the studies underlining the key findings with subsequent elaboration of the requirements for blood damage models as well as a decision tree based on the classification of existing blood damage models. The four major classes are Lagrangian or Eulerian approaches with stress- or strain-based blood damage. Key challenges were identified and future steps towards the translation of blood damage models into the device development pipeline were formulated. The integration of blood damage caused by turbulence into models as well as in vitro and in vivo validation of models remain the major challenges for future developments. Both require the development of novel experimental setups to provide reliable and well-documented experimental data.

A 6-week-old full-term male is brought into the emergency room with vomiting. The mother reports that he began regurgitating breast milk one week ago. Although intermittent at first, vomiting now occurs after every feeding and has become progressively more forceful with increased volume. His appetite remains vigorous, even immediately after vomiting. He is the mother’s first child and his delivery was uneventful. His blood pressure is normal and he is afebrile but tachycardic. On physical examination, he is irritable and has a sunken fontanelle. A small, firm mass is palpated in the right upper quadrant.

The gastrointestinal tract is commonly involved in many avian diseases, and vomiting and/or regurgitation is a common presentation. This chapter provides information to facilitate rapid definitive diagnosis, effective treatment protocol and supportive care, which will often result in successful case resolution of vomiting or regurgitating patients. Case examples: Regurgitating/vomiting Umbrella Cockatoo; Blue and Gold Macaw with zinc toxicosis; Budgerigars with Macrorhadbus ornithogaster.

Fibrovascular polyp (FVP) is a benign tumor of the upper esophagus which can remain silent for a long period of time until it becomes large enough to cause symptoms such as: vomiting and air way obstruction. In the following article, we present a 54 years old female complaining from (FVP) regurgitating from her mouth upon coughing. Upon surgery, the findings was consistent with fibrotic tissue isolating areas of adipose tissue.

Gallstone ileus is an uncommon type of little gut hindrance brought about by an impaction of gallstone inside the lumen of small digestive system. The regular side effects are sickness, regurgitating, clogging, stomach agony and distension. Starting administration includes liquid revival and conceivably nasogastric suctioning. Since gallstone ileus is a mechanical little entrail deterrent, it tends to be a careful crisis and requires open or laproscopic medical procedure to evacuate an affected stone. We present an instance of Gallstone ileus in a 75-year-old female who had a 2-day history of intense spewing which bothered after sustenance consumption. Patient was determined to have intestinal hindrance. Enterotomy was finished. The stone was found and recovered. The post-usable stage was uneventful.

Fibrovascular polyps occur most commonly in the cervical esophagus and are extremely rare in the hypopharynx. In this paper, we report a case of fibrovascular polyp of a 52-year-old female, who presented with progressive dysphagia and weight loss and regurgitating a mass from her mouth. By the endoscopic examination, a polyp covered by normal mucosa with a wide stalk was detected at the hypopharynx. The pedicle of the mass was identified under general anesthesia and the 13 × 3 × 2 cm mass was completely resected perorally. Histopathological examination of the tumor showed oedematous subepithelial fibrous stroma, surrounded by squamous epithelium and containing many congested vascular structures. No recurrence was detected over one year of follow-up. This case highlights the need for clinicians to be aware of this rare entity and to develop the best approach to patient management.

A 28-year-old female complaining of epigastric discomfort was informed to have an esophageal mass at her local hospital and came to our hospital for further evaluation and treatment. Chest CT showed a 20 mm A— 4 mm lesion with adipose density similar to cutaneous fat tissue in the upper esophageal lumen. Subsequent endoscopy demonstrated a fleshy, sausage like elongated lesion that originated immediately inferior to the piriform recess and extended into the distal esophagus. The surface of lesion appeared blue after regurgitating to the oral cavity when the patient vomited. Endoscopist explained the difficulties and risks about endoscopic sub-mucosal resection owing to the upper location of the neoplastic stalk, and the patient’s relatives declined endoscopic management and turned to surgery. A complete removal of the mass was achieved via a trans-cervical approach with the esophagotomy. Histopathological outcome was consistent with esophageal hamartoma.

Tonsilloliths are rare dystrophic calcification formed as a result of chronic inflammation of the tonsils. Tonsilloliths tend to occur more commonly with increasing age and are relatively rare in children. We report a case of unilateral tonsilloliths in an eight-year-old boy, who presented with earaches and history of regurgitating tiny yellowish-white foul smelling pellets. The tonsilloliths were successfully removed under local anaesthesia following which the symptoms subsided.

In the dilemma discussed in the June issue of In Practice, David Williams described a scenario where you are performing a caesarean section on a boxer and four of the six puppies have significant cleft lip and palate. Two of the puppies are regurgitating milk and struggling to breathe. You telephone the owner, a well-known breeder, advising her that the kindest thing for these puppies would be euthanasia. She tells you that successful corrective surgery is documented in the USA and says that, as they are legally hers, the bitch and puppies should be cared for until she arrives to take them home. If you cannot perform the corrective surgery, she will find a referral clinic that will (IP, June 2018, vol 40, pp 214-215). What do you do?

A 41-year-old man was referred to the emergency department for transient atypical chest pain. Six years before presentation, he underwent concomitant aortic and mitral mechanical valve replacement for a bicuspid aortic valve regurgitation and a regurgitating mitral valve prolapse. A significant paravalvular leak of the 21 mm …

Aim: Infant regurgitation and distress are common but are a major cause of parental anxiousness. The efficacy of dietary management is contradictory. Material and Methods: Twelve exclusively formula fed infants crying for more than 3 hours/day since at least 3 weeks and regurgitating several times after each feeding were enrolled in a double blinded cross-over intervention trial with two innovative formulas ("G1" and "G3"), both developed by Novalac. Prior to inclusion, all infants had been put on at least three different commercialized AR-formulae and/or formulae for digestive comfort and at least one extensive hydrolysate without improvement. All infants had been treated unsuccessfully with prokinetics (domperidone or cisapride) and acid- blocking drug medication (Hreceptor antagonists and/or generic omeprazole and/or alginates). Results: One formula ("G3") scored significantly better than the other, resulting in a significant decrease in regurgitation and crying, an overall subjective well-being amelioration of the baby and enhanced gastric emptying. All 12 mothers pre- ferred the same test formula, despite the cross-over and blinded design. Stool patterns and aspect with "G3" was compa- rable to defecation in breast fed infants. Conclusion: Although the number of infants is limited, one of the test formulas, G3, combining a specific partial whey hydrolysate with a combination of thickeners (bean gum and specially processed tapioca starch) was a) effective in alleviating the symptoms where other thickened and extensively hydrolyzed formulas as well as prokinetics and acid blocking drugs had failed and b) more effective than the other tested formula combining 2 thickeners (locust bean and starch) widely used in anti-regurgitation formulas, G1.

A 25-year-old man presented with a history of breathlessness for the past 2 years. He had a history of operation for Tetralogy of Fallot at the age of 5 years and history suggestive of Rheumatic fever at the age of 7 years. On echocardiographic examination, all his heart valves were severely regurgitating. Morphologically, all the valves were irreparable. The ejection fraction was 35%. He underwent quadruple valve replacement. The aortic and mitral valves were replaced by metallic valve and the tricuspid and pulmonary by tissue valve.

The clinical evaluation of blood flow regurgitation through a heart valve or stenotic lesion is an unresolved problem. The proximal flowfield region has been the study focus in the last few years; however, investigators have failed to identify an accurate and reliable calculation scheme due to lack of geometric information about the shape and size of the regurgitating or stenotic orifice. Presented here is a superior method of calculation, by using three-dimensional (3-D) echocardiography combined with Doppler velocimetry. The geometric structure of the orifice in a regurgitating porcine prosthetic valve in vitro was formulated by 3-D image construction of sequentially obtained 2-D images. The velocity flowfield was accessed by color Doppler flow mapping (CD) and continuous-wave Doppler (CW). Two accurate methods of calculation of regurgitant variables were developed. The first method calculated peak regurgitant flow rate from CD and the second method calculated regurgitant flow volume from CW. Both methods showed excellent correlation with the corresponding true values from an electromagnetic flowmeter. The promising preliminary results in such a realistic porcine model indicate the possibility of establishing a routine procedure to be tested in the clinical setting. The clinical evaluation of blood flow regurgitation through a heart valve or stenotic lesion is an unresolved problem. The proximal flowfield region has been the study focus in the last few years; however, investigators have failed to identify an accurate and reliable calculation scheme due to lack of geometric information about the shape and size of the regurgitating or stenotic orifice. Presented here is a superior method of calculation, by using three-dimensional (3-D) echocardiography combined with Doppler velocimetry. The geometric structure of the orifice in a regurgitating porcine prosthetic valve in vitro was formulated by 3-D image construction of sequentially obtained 2-D images. The velocity flowfield was accessed by color Doppler flow mapping (CD) and continuous-wave Doppler (CW). Two accurate methods of calculation of regurgitant variables were developed. The first method calculated peak regurgitant flow rate from CD and the second method calculated regurgitant flow volume from CW. Both methods showed excellent correlation with the corresponding true values from an electromagnetic flowmeter. The promising preliminary results in such a realistic porcine model indicate the possibility of establishing a routine procedure to be tested in the clinical setting.

INTRODUCTION: Many parents seek medical help because of frequent regurgitation and inconsolable crying of their formula-fed infant. OBJECTIVE: We aimed to assess the effectiveness of special formulas in distressed and regurgitating infants. METHODS: We included 12 consecutive infants in a prospective, randomized, single-blinded (parents), cross-over trial (6 infants were started on G1 [80/20 casein/whey, tapioca starch, and locust bean] for 2 weeks and then switched for 2 weeks to G3 [partial whey hydrolysate, tapioca starch, and locust bean]; for the other 6 infants, the order of the formulas was opposite). Infants were exclusively formula fed, were crying for >3 hours/day for at least 3 weeks, and regurgitated several times after each feeding. Before inclusion, all of them had been given ≥3 different commercialized AR formulae, formulae for digestive comfort, and at least 1 extensive hydrolysate without success. All infants had been treated without success with a prokinetic agent (domperidone/cisapride) and an acid-blocking drug (H2-receptor agonist/proton-pump inhibitor). RESULTS: Gastric emptying time, as evaluated with a 13C acetate breath test, was 117.1 ± 18.3 minutes with Novalac-AR (80/20 casein/whey and corn starch), 104.5 ± 15.5 minutes with G1, and 79.2 ± 14.0 minutes with G3 (P < .001 [Friedman test]). The mean number of regurgitations per day was 5.1 ± 1.2 with G1 and 1.8 ± 1.2 with G3 (P = .002). Quality of life, as assessed by the parents in a diary, was 4.20 ± 1.79 with G1 and 2.10 + 0.74 with G3 (P = .005). The mean duration of crying per day was 84.5 ± 50.1 minutes with G1 and 26.7 ± 18.1 minutes with G3 (P = .003). CONCLUSIONS: The cross-over design protected for bias. G3 scored better than G1 for all parameters evaluated and decreased regurgitation and infant distress significantly.

The critical review paper was introduced into the MRCPsych examinations in 1998. The introduction of this paper - to develop the skills to accurately appraise both the scientific and clinical merit of published articles on topics relevant to psychiatry, rather than regurgitating facts from

A ten-week-old Blue-fronted Amazon parrot was presented for respiratory distress and weakness. While hospitalized, it began regurgitating. Microscopic examination of the regurgitated material revealed large numbers of Trichomonas spp. and yeasts. Theparrot responded clinically to treatment with metronidazole but died shortly after treatment was discontinued. Necropsy revealed a large caseous mass distal to the thoracic inlet, which invaded andpartially obstructed the esophagus and trachea. Microscopic examination of touch impressions of the mass revealed granulomatous inflammation and large numbers of trichomonads.

An esophageal stricture was noted in a 10-yr-old chimpanzee who presented with dysphagia, vomiting, and weight loss. After radiographic, esophagoscopic, and histopathologic evaluation of the stricture, antegrade bougienage was performed. The animal began eating solid food again without regurgitating after the third dilation and since that time has been asymptomatic. Additional dilations were performed at 3 and 6 months post-stricture.

With the employment of manometric techniques, the lower esophageal sphincter and the cardioesophageal pressure gradient were studied in normal infants 1 to 2 weeks and 3 to 6 weeks old as well as in regurgitating babies of 1 to 9 months of age. Results of these experiments were compared with similar observations in adults. In normal newborn infants, the sphincteric pressure approximates adult levels rather abruptly between the third and sixth week of life, whereas in regurgitating infants it remains at neonatal levels well beyond this period. In addition to a weak sphincteric tone in regurgitating infants, reflux is enhanced by the normal progression of the cardioesophageal pressure gradient.

In a series of ten patients who had Flint murmurs incidental to aortic regurgitation, a characteristic deformity of the right aortic leaflet was found at necropsy. This consisted of a concave, cup-shaped deficiency of the inner portion of the leaflet, so situated as to divert or “groove” the regurgitating blood toward the lower portion of the anterior mitral curtain. The latter exhibited on its ventricular aspect a variable degree of endocardial thickening which was interpreted as a frictional sclerosis. The posterior aortic leaflet was normal in some cases, and in others was involved in a manner which we believe was insignificant. We do not attempt, on the basis of this small series of patients, to exclude posterior leaflet lesions as occasional factors of importance. Our experience indicates, however, that they are uncommon. The pathologic changes support the original belief of Austin Flint that a functional mitral stenosis, brought about by aortic regurgitation, is the cause of the presystolic apical murmur bearing his name.

Lower esophageal strictures in infants in more than 90% of cases are related to reflux esophagitis, while the remainder are congenital or induced by injuries such as penetrating trauma or corrosion by caustic agents. Among congenital disorders cartilaginous remnants in the esophagus are very rare, but it is a possibility that should always be considered, especially if signs of esophagitis are not seen on esophagoscopy. The first aim, when evaluating the vomiting or regurgitating infant, is to establish whether this is due to an organic disorder. When stricture of the esophagus becomes evident following prolonged vomiting, clinicians tend to attribute this to reflux with peptic injury, and in most of the cases that will be correct (1). Carefully performed investigation will bring forth those rare etiologic factors that can be easily overlooked (2). The investigation has to include radiographic studies, esophagoscopy, pH monitoring, and in selected cases, manometry. Recognition of the correct etiologic factor that caused the stricture will pave the way for adequate management. We report on two patients with congenital stenosis of the lower esophagus due to cartilaginous rings, one of which was diagnosed preoperatively.

In anesthetized dog, acute mitral insufficiency of variable severity results in an increase in coronary blood flow and myocardial oxygen consumption. The increase in oxygen consumption is interpreted as meaning either that the left ventricle expends a significant amount of energy in regurgitating blood into the left atrium during mitral insufficiency, or that mitral insufficiency induces a decrease of the efficiency of the left ventricle or both.

While carcinoma of the esophagus is by no means of infrequent occurrence, the case here described presents a particularly interesting complication. Although statistics vary, it is estimated that from about 5 (von Hacker) to 9 per cent. (McRae) of all cancers are esophageal. Cancer is by far the most important tumor of the esophagus. REPORT OF CASE P. V. H., man, aged 58, admitted to the City and County Hospital, St. Paul, June 13, 1915, complaining of inability to swallow any solid food, stated that about two months before his admission a portion of meat which he had attempted to swallow seemed to lodge in his gullet and would not pass down into the stomach. He attempted to wash it down with a glass of water, but this resulted in both water and meat regurgitating through the nose and mouth. There was no pain present at this time. After this

The author describes an Indian roadside performer who earns his living by swallowing and regurgitating 10 to 15 live snakes and fishes. Clinical photographs, barium meal radiographs, and oesophageal and gastric pressure recordings are published. Voluntary control of regurgitation may be learnt. The author suggests a possible application of this action. Patients suffering from gastric hyperacidity may be able to avoid taking antacids by giving themselves voluntary gastric lavages.

When the lower esophagus is subjected to repeated or continuous exposure to gastric secretions regurgitating up from the stomach, esophagitis with ulceration is likely to develop. With recurring esophagitis and ulceration, healing with scar formation is likely to progress, and if this is extensive enough, it may actually produce stenosis of the esophageal lumen. As the esophageal disease continues and progresses, scarring of the lower esophagus may lead to enough distortion to result in its actual shortening. In some such cases there is also a diaphragmatic hernia—a physical condition which in itself predisposes to regurgitation. When this process occurs in a patient who has an underlying duodenal ulcer diathesis—ie, a basic peptic hypersecretion—the regurgitation is likely to be relentless, and the intensity of the insult may be serious. The dismal fate of patients caught in this vicious cycle is readily envisioned. Early and intense attention to the hypersecretion must be

A brief synopsis of problems with hiatus herniorrhaphy surgery over its 25-year history includes extensive surgery, recurrences, and postoperative swallowing difficulties. A review of the simple central tendon hiatal herniorrhaphy technic and seven-year results include the adoption of a mersilene strip rather than external rectus fascia in anchoring the esophagogastric junction to the central tendon. The same excellent exposure and visibility allowing the lower esophageal segment to be well secured definitely within the abdomen is completely illustrated. Seven-year results in 138 patients operated upon are reviewed including mortality, recurrence rates, postoperative dysphagia, gas-bloat, and loss of regurgitating ability.

• The infant rumination syndrome is an uncommon disorder difficult to differentiate from commoner conditions causing vomiting and weight loss. Its validity has recently been questioned. Its importance is heightened by the availability of newer diagnostic and operative procedures that might be misapplied. An 8-month-old male infant had been regurgitating for two months with increasing inanition. Results of diagnostic tests suggested pylorospasm or gastric pseudo-obstruction syndrome. Medical management failed. A therapeutic trial of special nursing eight hours a day resulted in rapid rehydration, weight gain, and avoidance of surgery. This case exemplifies each of the ten characteristics of the infant rumination syndrome. ( Am J Dis Child 133:266-269, 1979)

To the Editor.— Laetrile (amygdalin), found in the kernels of apricot seeds and other fruits, has recently been legalized in several states for the treatment of cancer. Amygdalin is a cyanogenic glycoside that on hydrolysis yields hydrogen cyanide. Although supporters of laetrile as a cancer remedy maintain it has no toxicity, several reports document its toxic effects (238:482, 1977; 238:1361, 1977; 239:1532,1978). We report yet another case of cyanide poisoning from the ingestion of apricot seeds. Report of a Case.— On June 8, 1978, a 49-year-old woman with nodular lymphoma diagnosed six years earlier ate 20 to 40 apricot pits, which she had purchased in a local health food store. The patient denied using the pits as a cancer treatment or preventive; rather, they were a substitute for her regular lunch. Within half an hour the patient noted headache, weakness, disorientation, and nausea. She vomited once or twice, regurgitating substantial

In rare instances syphilis has been reported as responsible for the origin of the syndrome of acute anterior poliomyelitis. Another case is here added to the list. REPORT OF CASE A white man aged 29 was admitted to the Johns Hopkins Hospital (service of Dr. W. T. Longcope) on March 22, 1942, complaining of inability to swallow and weakness of both legs. The illness began a fortnight earlier with sore throat and temporary double vision. Later he had difficulty in swallowing (fluids regurgitating through the nose) and increasing paralysis of the legs. A lumbar puncture (done at another hospital on the day before admission) revealed a cell count of 100 cells (small mononuclears) per hundred cubic centimeters of fluid and an increase of globulin. It was believed that he had acute anterior poliomyelitis, and he was sent to the isolation ward of the Johns Hopkins Hospital. His earlier history was

HISTORY AND EXAMINATION. S. S., a boy of 3½ years, weighing 29 pounds, was brought to me July 30, 1902. His parents, Jewish people, gave me the following history: He had always been well until seven weeks previously when he was run over by a wagon in the street. They said there was no visible injury excepting bruises about the head, and yet he seemed to be severely hurt. He was carried into a nearby hospital and kept there a week, then brought home. Two weeks after the injury the parents noticed that his abdomen was swollen, bulging out to the left of the median line and half-way between the umbilicus and the ribs. This swelling gradually increased during five weeks until the present distended condition was reached. They said the size of the abdomen varied slightly at different times, which they attributed to the quantity or quality of his food, as he sometimes bloated with gases. They did not think he was larger than two weeks previously. The boy's appetite was poor. He had vomiting spells every few days. They said he swallowed with difficulty, the food or drink sometimes regurgitating.

Some years ago I treated a child, aged 3 years, who suffered from a severe case of anorexia nervosa. She had reached a serious state of depletion and weakness from her self imposed starvation, refusing all food and regurgitating that fed to her by gavage. She finally accepted a banana, with the result that other food was taken in a more or less normal amount within forty-eight hours. There was a complete relapse when the banana was withheld, and food was taken normally only with bananas. This experiment was repeated to test the validity of the observation, always with the same result, until a time came when her appetite was normal whether bananas were included in the diet or not. The action was such as is attributed to a hormone. It was natural, therefore, to test bananas in a case of celiac disease where anorexia was a prominent symptom. Celiac