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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.

In a food-limited system, parents may have to allocate resources in ways that do not benefit all their offspring equally. We investigated food allocation and parent and chick behaviours in Magellanic penguins at their colony in Punta Tombo, Argentina, by observing feedings in one- and two-chick broods after the chicks were more than 20 days of age. Feeds lasted 21 min on average, and the length of a feed was not correlated either with the number of chicks in a brood, or with the amount of food the parents gave. Parents with two-chick broods distributed food evenly to both chicks. Although single chicks were fed more than chicks with siblings, as a proportion of a chick's start weight, both single chicks and lighter chicks in two-chick broods received significantly more food than heavier chicks. Chicks continued begging after the last feed in nearly half of the two-chick broods, suggesting they were not sated and so are food-limited. In linear mixed-effects models that considered, respectively, the absolute amount of food a chick received and the amount of food it received as a proportion of its start weight, chick begging was the most significant predictor of how much it was fed. Jostling behaviours between the chicks did not correlate with the amount of food either one received. Parental nonfeeding behaviours in two-chick broods (e.g. bending towards a chick and opening the bill but not regurgitating food) were more frequently directed at the lighter chick, but did not correlate with the amount of food a chick received. These results suggest (1) parents are motived to feed their chicks quickly, (2) parents try to allocate food equally to chicks of this age and (3) chicks devote most of their energy trying to get fed by the parent, rather than competing antagonistically with one another.

Nursing students struggle to learn medications that their patients have been prescribed, often regurgitating information found in a drug book or on a drug card. Watching students do this led to the development of the Critical Thinking Medication Storytelling assignment. The assignment was designed to bring information to life in a creative and meaningful way, enabling students to see how specific medications interrelate with the patient's condition. Qualitative results from students revealed that students embraced this teaching strategy; the strategy was effective for acquiring drug knowledge.

Foraging animals must balance benefits of food acquisition with costs induced by a post-prandial reduction in performance. Eating to satiation can lead to a reduction in locomotor and escape performance, which increases risk should a threat subsequently arises, but limiting feeding behaviour may be maladaptive if food intake is unnecessarily reduced in the prediction of threats that do not arise. The efficacy of the trade-off between continued and interrupted feeding therefore relies on information about the future risk, which is imperfect. Here, we find that black carp (Mylopharyngodon piceus) can balance this trade-off using ana posterioristrategy; by eating to satiation but regurgitating already ingested food when a threat arises. While degrees of satiation (DS) equal to or greater than 60% reduce elements of escape performance (turning angle, angular velocity, distance moved, linear velocity), at 40% DS or lower, performance in these tasks approaches levels comparable to that at 0% satiation. After experiencing a chasing event, we find that fish are able to regurgitate already ingested food, thereby changing the amount of food in their gastrointestinal tract to consistent levels that maintain high escape performance. Remarkably, regurgitation results in degrees of satiation between 40 and 60% DS, regardless of whether they had previously fed to 40, 60 or 100% DS. Using this response, fish are able to maximize food intake, but regurgitate extra food to maintain escape performance when they encounter a threat. This novel strategy may be effective for continual grazers and species with imperfect information about the level of threat in their environment.

This case study explored the experience of learning portfolio practice and whether learning portfolio practice facilitated the development of critical thinking skills among online distance students...

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.

Plastic pollution has been the subject of much research in the last decade. Seabirds can mistake plastic fragments for prey, which can perforate or block the digestive tract and cause ulcers. Most commonly, seabirds accumulate this indigestible matter in their stomachs, obtaining no nutrition and may die from starvation. Certain species of seabirds however, have the ability of regurgitating indigestible matter in the form of pellets. This study aimed to investigate the ingestion of plastics by live seabirds through the examination of regurgitated pellets (n=92) from a Great Cormorant (Phalacrocorax carbo) breeding colony and a winter roost in Ireland. Plastic prevalence was consistently 3.2% at both sites. The presence of plastic litter highlights the fact that all species of seabird are susceptible to interact with marine litter regardless of feeding habits, although at different rates. More research is needed to understand the driving factors involved in plastic ingestion among different species.

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.

Recommended Citation: Denis Ribouillault, “Regurgitating Nature: On a Celebrated Anecdote by Karel van Mander about Pieter Bruegel the Elder,” JHNA 8:1 (Winter 2016) DOI: 10.5092/jhna.2016.8.1.4 Available at http://www.jhna.org/index.php/vol-8-1-2016/328-denis-ribouillault-2 Published by Historians of Netherlandish Art: http://www.hnanews.org/ Terms of Use: http://www.jhna.org/index.php/terms-of-use Notes: This PDF is provided for reference purposes only and may not contain all the functionality or features of the original, online publication. This PDF provides paragraph numbers as well as page numbers for citation purposes. ISSN: 1949-9833 Journal of Historians of Netherlandish Art

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?

Five cardio-thoracic vascular anomalies were detected in a German shepherd puppy. The patent ductus arteriosus (PDA) was detected on physical examination (5/6 continuous murmur) and confirmed by echocardiogram. The persistent right aortic arch (PRAA) was suspected by the signalment and history of the patient, and confirmed by survey thoracic radiographs (leftward deviation of the trachea cranial to the heart on the ventrodorsal projection). The ventrally deviated trachea cranial to the heart on the right lateral thoracic radiograph was suggestive of a persistent retroesophageal left subclavian artery and confirmed at surgery. The persistent left cranial vena cava and the left azygous vein were detected at surgery. This case report gives a thorough description of the clinical signs, diagnostics and treatments required for the detection and successful resolution of PRAA. The report describes the importance of having experienced surgeons who can recognize vascular anomalies associated with PRAA in order to successfully alleviate the arch and the coinciding oesophageal stricture without compromising vital blood supplies.

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 …

International audience; We investigated allofeeding (feeding of offspring by adults other than their own parents) in the king penguin, Aptenodytes patagonicus, a long-lived pelagic bird that faces severe food shortages during its reproduction and in which parents leave their fasting chick in dense cre`ches. A 1-year monitoring of 103 breeding pairs and 70 chicks was carried out in a colony in the Crozet Archipelago.We examined whether allofeeding was common enough to alter survival costs or benefits for both the allofed chicks and the allofeeders. Twenty-two per cent of marked adults allofed more than 65% of all the chicks without repeatedly feeding the same chick. Allofeeding in king penguins benefited allofed chicks by increasing their survival, yet little or no fitness cost was detected among allofeeders. We identified proximal factors affecting allofeeding: (1) the breeding conditions of the population were not unusual; (2) allofeeding occurred mostly when parental provisioning was low; (3) alloparents did not respond to increased begging by regurgitating more meals; (4) allofeeders were mostly failed breeders, although successful breeders occasionally allofed; (5) when the colony was no longer organized into breeder territories, allofeeders preferentially fed chicks that had been reared by close neighbours at the time of brooding.

On my computer, the name of this list serve, Her Baldness's own privately maintained and preciously guarded list serve, is FOCL'SRB. You'll figure it out. It started small—just the people I could squeeze into the phrase “friends and family.” Her Baldness added to the list, from time to time, in return for acts of kindness that happened as the news traveled—a call, a postcard, a book propped by her front door, an email. Her Baldness also subtracted. She got mad at people for not being there, or not being there as much as she wanted, or not giving her feedback, much as she loathed the word, or giving her feedback, regurgitating what she didn't want to see and never wanted to hear about.

The digestive tract of Oreochromis niloticus is described, in order to resolve discrepancies found between previous accounts. Two types of goblet cells were found in the oesophagus, which differed in size, and in staining characteristics with periodic acid-Schiff and alcian blue. A region with tubular glands consisting of large mucous cells was continuous from the entry of the oesophagus, across the anterior part of the stomach to the pyloric valve, essentially providing a bypass circumventing the sac-like portion of the stomach. This region, which is lined with striated muscle, may be a means of disposing of unwanted material, either by regurgitating it, or by passing it rapidly along to the intestine. Large mucus cells in the tubular glands and the neck cells of the gastric glands probably protect the mucosa from the very acid contents of the stomach. An ileorectal valve was present. There is therefore a separate intestine and rectum in O. niloticus, as in most teleosts.

Regurgitation by birds feeding on pesticide-treated seed was quantified in two experiments, and its role in reducing the risk of acute poisoning from an organophosphorus pesticide was assessed. Captive feral pigeons (Columba livia) were offered fonofos-treated seed ad libitum on a test day after a 6-d period in which one group was given free access to untreated seed and another group was given no food in one experiment or 15% of normal intake in the other. Avoidance of treated seed reduced intake substantially, preventing the ingestion of lethal doses for all birds fed ad libitum and some but not all of the food-restricted birds. Some of the latter regurgitated most of the seed taken in (>60%), reducing by ∼50% the dose of pesticide assimilated and lowering the dose from above to below lethal levels. Regurgitation was the most likely explanation for the survival of at least 12 and 50% of the food-restricted birds in these experiments. Regurgitation reduced but did not prevent mortality, because some birds died without regurgitating and others despite doing so. This study provides the first clear evidence that regurgitation can directly reduce mortality of birds exposed to pesticides in their food. Implications for the risk of poisoning wild birds and avian toxicity testing are discussed.

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.

Regurgitation from adult females towards juveniles is a well known phenomenon in social spiders. However, occasional observations in Anelosimus cf. studiosus from Uruguay showed the occurrence of food transfer also between large juveniles. We experimentally tested if well fed penultimate females were capable of regurgitating fluids to starved males, and if well fed penultimate males were capable of regurgitating fluids to starved females. Other isolated and starved penultimate males and females were used as controls. Starved males and females of the experimental groups significantly increased their body weight, whereas body weight decreased in controls. Males increased their weight more than females. We conclude that both well fed penultimate males and females can feed other starved subadults, but when given access to members of the opposite sex, males benefit than females. This bias in the regurgitation exchange among subadults could contribute to accelerate the maturation of males.

After we started the National Complete Streets Coalition, I spent a lot of time developing a series of focused fact sheets that brought together the best and most specific answers we could find on every topic related to complete streets. The website was soon overflowing with reports and resources on every aspect of the benefits of complete streets. But somehow they were never enough. They never slaked the hunger from people around the country for very specific information about how to answer a challenging question with an indisputable fact. Over time, I realized I was learning how to overcome barriers not by regurgitating facts but by hearing stories about how others had made change happen.1

Diet is an important aspect of the natural history of all animals, but diet can vary through space and time because of variations in prey availability. The diet of the Common Gartersnake (Thamnophis sirtalis) consists mainly of earthworms and frogs, but other prey items might be important when they are locally abundant. I report an observation of a female Eastern Gartersnake (Thamnophis sirtalis sirtalis) regurgitating 2 nestling birds in Ottawa, Ontario, Canada. Birds are seldom present in the diet of the Common Gartersnake. This rare food choice highlights the opportunistic nature of foraging by adult Common Gartersnakes and, further, demonstrates that diet depends not only on prey preference, but also on prey availability.

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.

WehavereadthestudyofLapennaetal.withgreatinterest [1]. We think that these techniques are not compatible with the co-aptation physiology. Our concerns are as follows. If we apply the clover technique to a normal (without regurgitation) tricuspid valve, would this create an insufficiency? Yes, it would. This is because the free edges of the leaflets could not adapt to changes in filling and stroke volumes and ejection fractions after the clover technique. In the changing volume system, do not the leaflet edges change their locations at the annular plane? What kind of strategies did the authors use to prevent this? The tricuspid annulus shrinks from diastole to systole, thus decreasing its area and contributing to co-aptation. Flexible rings change the annular shape and decrease the annular area. (Can the flexible rings you used decrease their circumference?) These changes occur through bulging internally orexternally and inferiorly orsuperiorly.Wouldnot these changes disrupt the co-aptation mechanism? In the de-Vega annuloplasty technique, we could not be sure of co-aptation. This is because we leave the initiative to annular movement and regurgitating volume regarding what part of the annulus would shrink. In rupture of chordae, why did the authors not think to treat this situation without formation of a new chordae?

Spence’s article is one of the first things I turn (electronically) to each Friday morning. So it was disappointing to see him regurgitating the tired old complaints about clinical guidelines—stifling clinical freedom, imposing straitjackets, etc.1 I chair the clinical guidelines committee at one of the largest trusts in the country (and already I sense you smirking in that slightly tired …

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

PaleontologyThe notion of mothering dinosaurs has taken off since paleontologists argued that hatchlings seemed weak in the knees. Unable to walk very well, hatchling survival would depend on doting parents bringing back food, like mother pelicans regurgitating food for their young. But on (p [page 712][1])of this issue, paleobiologists present data on baby dinosaur pelves and leg joints that suggest the creatures hit the ground running—the bones were robust at birth, implying self-sufficient creatures that didn't need hovering parents. Attacks on motherhood usually stir up controversy, however, and this one is no exception. [1]: /lookup/doi/10.1126/science.272.5262.712

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.

Experiments on the virus-vector relationship of the Trinidad cowpea mosaic virus, transmitted by Ceratoma ruficornis, gave the following results: ability to infect decreased with increasing time after ceasing to feed on infected plants, but vectors remained infective for 14 days (much longer than the longevity in vitro of the virus at glasshouse shade temperatures of 23–31°C.); the beetles transmitted more consistently after longer feeding on infected plants, though feeds of under 5 min. made them efficient vectors; the proportion of plants infected increased with the amount of feeding damage on them; fasting the vectors before feeding on infected plants increased voracity but had no effect on their ability to transmit; beetles became infective immediately after feeding on infected plants. Cowpeas were infected by inoculation with macerated infective vectors or with juice regurgitated by vectors. There is no evidence that aphids or other sucking insects can transmit the virus. It seems similar to squash mosaic and turnip yellow mosaic, for vectors of all three viruses probably transmit by regurgitating infective juice during feeding.

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.

Assimilation efficiency (percentage of nutrients absorbed) from diets compounded from dry food meals was investigated using the prawnsPalaemon serratusPennant andPandalus platycerosBrandt. An indirect ratio method using chromic oxide (Cr2O3) as an inert reference material in the diet was employed, but the method was complicated by the prawns' habit of regurgitating part of the indigestible food remains after a meal. Thus quantitative collection of both faeces and the regurgitated, unassimilated food fraction was necessary.

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