No abstract

The rumination syndrome is defined as a process in which a person chews regurgitated gastric contents and then either partially ejects or swallows them. We report 12 cases of rumination in which the clinical diagnosis was supported by esophageal and gastrointestinal motility studies. These patients showed a characteristic pressure spike-wave pattern that was associated with regurgitation and was recorded simultaneously at all manometric sites. These spike waves increased significantly in frequency (p less than 0.001) and amplitude (p less than 0.04) during the postprandial period. The underlying gastrointestinal motility was normal except for a small decrease in postprandial antral motility index, with mean (+/- SE) values of 13.2 +/- 0.3 for patients compared with 14.2 +/- 0.3 for eight healthy adult controls (p less than 0.03). Nine patients had significant personality disturbances, including six whose scores on the Minnesota Multiphasic Personality Inventory for hypochondriasis and depression were significantly above the reference population (p less than 0.02). The rumination syndrome should be considered in adult patients with long-standing postprandial vomiting. The manometric pattern is characteristic.

Previous studies have shown that duodenal motility patterns differ in preterm and term infants, but antral motor activities were not compared. Using a validated, low-compliance, continuous-perfusion, neonatal manometric system, antral and duodenal motility was studied in 19 preterm and nine term infants. Antral motility consisted of isolated single contractions and clustered phasic contractions in term and preterm infants. There were no differences in the occurrence or amplitude of antral activity between the two groups of infants. Thus, there was no change of antral motor activity with advancing gestational age. As has been shown in other previous studies, however, intestinal motor characteristics were more immature in preterm than term infants; clustered phasic contractions occurred more frequently (P less than 0.02) and were of shorter duration (P less than 0.02) and lower amplitude (P less than 0.005). Duodenal clusters were significantly less common, while their amplitudes were significantly increased with increasing gestational age. The proportion of antral clusters that were temporally associated with duodenal activity was significantly lower in preterm infants than in term infants (P less than 0.001). Moreover, the degree of association of antral and duodenal activity increased significantly with gestational age (r = 0.5, P = 0.006). These data show that fasting antral motor activity per se is comparable in preterm and term infants; they also suggest that the temporal association of antral and duodenal activity develops in association with progressive changes in duodenal motor activity in the preterm infant.

Perfusion manometry was used to study the maturation of small intestinal motility in 15 preterm and term infants before the initiation of enteral feeding (study 1); seven of the 11 preterm infants were restudied after 3 weeks or more of enteral feeding (study 2). During study 1, the interdigestive motility of the four term infants exhibited cycles of quiescence and rhythmic activity, compatible with migrating motor complexes observed regularly in adults; in response to feeding, motility changed to irregular, phasic activity. Preterm infants, however, showed only unorganized clusters of phasic activity during fasting, and there was no consistent pattern of motor response to feeding. After 3 or more weeks of enteral feeding, interdigestive cycles with migratory motor complexes and a consistent, obvious motor response to feeding were present. Preterm infants as young as 32 weeks' gestation showed “mature” motor patterns in study 2, results suggesting that intestinal motility matures with postconceptual age.

Restoration of the joint line of the knee is an important technical goal of a total knee arthroplasty. Failure to restore the joint line of the knee to anatomical position can lead to mid-flexion instability, a reduction in range of motion, impingement of the patellar tendon against the tibial tray, and gap imbalance. The presence and integrity of bone and soft tissue landmarks makes restoration of the joint line Successful. Restoration of the joint line both difficult and unreliable especially in revision TKA, where the necessary landmarks are often missing or obscured. Numerous methods, ranging from relative references, to absolute distances have been described for joint line restoration, yet a lack of consensus remains. The aim this study was to determine a reproducible, quantitative relationship between position of joint line and identifiable anatomical landmarks in Indian population after studying randomly selected Indian population. Results of our study indicate that Femoral diameters are statistically different for Sexes while Tibial diameters are not, IMD is 1.75 times LFJL,CTD is 2.7 times PTFJL, PCO is more important in predicting range of motion in TKA. PCJL:FD and IED:LEJL are also significant.