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Biomedical subjects

E Cirino

Publications and source records attributed to E Cirino.

At least 37 records · Page 2Linked to original sources

[Current views concerning the etiopathogenesis of reflux esophagitis in children].

Esophagitis is caused by a gastro-esophageal reflux sometimes reflecting anatomical inadequacy of structures that secure the relationships between the cardia and the diaphragm, fundus of the stomach, and other surrounding viscera, but more often due to functional deficiency of lower esophageal sphincter (LES), this representing the main factor for maintenance of the mechanism of cardial continence. Manometric studies of intraluminal pressures in the esophagus have revealed the presence of a high-pressure segment in the distal esophagus, where a mean pressure of 12-13 mm Hg obtains over a length of 3 or 4 cm. In the first two weeks of extrauterine life the LES is between 0.5 and 1 cm long, with a pressure of 3 mm Hg; pressure values in the LES equal adult values at about one month of age, showing that neuromuscular control of the sphincter has been achieved. Gastro-esophageal reflux, however, is very common in the newborn and not enough by itself to cause peptic disease of the esophagus; this requires the concomitance of morphological defects of the esophageal mucosa and/or dynamic-functional disturbances. This, according to the authors, is why esophagitis actually occurs in only about 60% of patients with radiologically and pHmetrically demonstrated gastro-esophageal reflux.

Age Factors↗

[Clinical picture and diagnosis of reflux esophagitis in children].

Whereas a burning retrosternal pain irradiating upward is the main symptom of reflux esophagitis in the adult, this symptom is usually not extant in children. Rather, the child will show unaccountable vomiting, stunted growth, anemia of unknown etiology, and respiratory disturbances. The pathologic condition more often associated with reflux esophagitis is hypertrophic stenosis of the pylorus, which is in fact regarded as one of the causes of the esophageal disorder. Reflux esophagitis may lead to ulceration and hemorrhage, and may evolve into cicatricial retraction and esophageal stenosis, the latter sometimes quite tight. The condition is diagnosed in light of radiological examination and endoscopy. Whit older children, one may add the Bernstein test and pressure and pH readings. The paper concludes by pointing out the different diagnostic approach in the newborn and small baby on the one hand and in older children on the other.

Child, Preschool↗

[Current trends in the treatment of reflux esophagitis in childhood].

A problem of some complexity is the management of pathological gastro-esophageal reflux due to the presence of cardio-hiatal malformation, malposition of the cardia and gastric tuberosity, a congenitally short esophagus, and the like. Sometimes, however, there is no demonstrable morphological aleration and the condition, characterized by primitive hypotonia of the LES, goes under the name of infant chalasia of the esophagus. The general policy is to try first a conservative treatment consisting of dietary and postural measures and the administration of metoclopramide and d;ugs that protect the esophageal mucosa; this stage, however, should not be prolonged beyond 6 weeks. The presence of gastro-esophageal reflux associated with hiatal hernia; the presence of severe esophagitis or peptic stenosis of the esophagus and the persistence of symptoms after an adequate period of conservative therapy constitute as many indications for surgical correction. Good results can be obtained by restoring or strengthening the failing function of the LES, as is done quite successfully with funduplication after Nissen or with method of Belsey-Mark IV.

Antacids↗

[Glucagon in the treatment of acute pancreatitis (clinical contribution)].

16 patients suffering from acute pancreatitis were treated by intramuscular or intravenous administration of glucagon, with control of the amylasemia and amylasuria values at the start of treatment, the 12th hour and the 36th hour. By the 12th hour from the start of therapy they already observed a reduction in amylasemia and amylasuria to normal values, with disappearance of the symptomatology (pains, vomiting, shock) and complete cure of the patients in 94% of cases. On the basis of their own and others' experience, the Authors therefore believe that glucagon can advantageously be used in this disease, which is characterised by much higher mortality if treated with the traditional therapeutic means.

Acute Disease↗

[Pseudocysts of the pancreas. (Personal cases)].

After reviewing all the various procedures for surgical treatment of pseudocysts of the pancreas, the Authors, analysing the advantages and disadvantages of each method, present a set of nineteen personal cases treated by simple cystogastrostomy, simple cystojejunostomy and cystojejunostomy combined with entero-entero-anastomosis according to Braun, or cystojejunostomy on defunctionalised loop according to Roux. After stading the overall criteria for selection of the technique to be applied individually, the Authors conclude by stressing the advantages that cystojejunostomy on defunctionalised loop according to Roux offers as compared with all the other procedures.

Aged↗