Search PubMed⌕ Search

Biomedical subjects

M Morello

Publications and source records attributed to M Morello.

At least 55 records · Page 3Linked to original sources
PubMed1995

Isolated congenital left ventricular diverticulum.

Two cases of isolated left ventricular diverticulum are presented. A 12-year-old boy and a 7-year-old girl, both asymptomatic, were admitted to our Department for evaluation of an abnormal electrocardiogram and an abnormal cardiac silhouette, respectively. Both patients had the diagnosis confirmed by cardiac catheterization and angiography and underwent successful surgical correction of the abnormality. We discuss the diagnosis, prognosis, and surgical treatment of this entity and we advocate early surgical treatment for all diagnosed ventricular diverticula, even if asymptomatic.

Angiocardiography↗
PubMed1995

[Conservative surgical treatment of rheumatic mitral stenosis].

We prospectively evaluated 50 patients with mitral stenosis (43 women and 7 men; mean age 45 years) to assess the results of surgical reconstruction of the mitral valve. All patients underwent a complete echocardiographic examination before and after operation. Surgical reconstruction was extensive, and included commissurotomy, thinning of the valvular leaflets, calcification removal, splitting of subvalvular apparatus, and posterior annuloplasty. Surgical reconstruction resulted in increasing mitral functional area from 0.89 +/- 0.23 to 2.07 +/- 0.42 cm2. NYHA functional class decreased from 2.76 +/- 0.55 to 1.52 +/- 0.71. Before discharging, 10% of patients had moderate mitral insufficiency. All patients were followed at 6-month intervals in our clinic. Mean follow-up was 37 +/- 18 months. During follow-up 5 patients (10%) developed severe mitral incompetence, which required mitral valve replacement. Chi-square and Student t-test were used to analyze the correlation between variables and outcome. The occurrence of severe mitral incompetence was correlated with: the degree of enlarged left atrium; chronic atrial fibrillation; postoperative more than mild mitral regurgitation. No correlation was found with anatomical parameters detected by echocardiography, or intraoperative anatomy. In conclusion, surgical reconstruction of mitral stenosis provides satisfactory short-term results. We believe that the low mortality rate and the low incidence of complications justify an effort to save the native mitral valve before considering prosthetic replacement. More attention to the development of residual mitral incompetence with intraoperative control may improve long-term results.

Adult↗
PubMed1995

[Clinical usefulness of the immunophenotypic study of circulating lymphocytes in leukemic lymphoproliferative diseases].

The immunophenotypes (IF) on peripheral lymphocytes of 24 B-CLL in different stage, 2 PLL and 14 leukemic B-non Hodgkin lymphomas were investigated. As regard to B-CLL and PLL, the results are similar to those reported so far. In stage A and B of B-CLL the IF appear less variable than in advanced stages where a decrease of CD21+ and an increase of both CD25+ and CD38+ lymphocytes were observed. In the lymphocytic, small cleaved cell lymphomas and splenic lymphomas, the peripheral IF correspond to the theoretical ones of respective lymphoma tissues. On the contrary they disagree in three cases of large cells, mixed small and cleaved cell, immunoblastic lymphomas. These features are discussed.

Antigens, CD↗
PubMed1995

Complicated removal of a hydatid cyst of the interventricular septum.

In a 27-year-old woman with a large hydatid cyst of the liver, an asymptomatic cardiac cyst located in the interventricular septum was discovered as well. The diagnosis was based upon echocardiography, computerized axial tomography and nuclear magnetic resonance. There was no evidence of damage to the atrioventricular conduction system or to the cardiac valves. At operation, however, the left posterior papillary muscle and chordae were firmly adherent to the cyst. Patch closure of the resulting ventricular septal defect, and mitral valve and chordae repair were necessary. The patient is alive and well 6 months after the operation, with mild residual mitral regurgitation. Precise anatomical delineation of the hydatid cyst localization within the heart, particularly in the interventricular septum, and its relations with the various cardiac structures is a difficult task, in spite of all the imaging techniques available. The surgical approach therefore has to be very careful and mindful of the potential complications.

Adult↗
PubMed1994

Nitric oxide inhibition aggravates ischemic damage of hippocampal but not of NADPH neurons in gerbils.

BACKGROUND AND PURPOSE: Nitric oxide may influence pathophysiology of brain ischemia in a complex way depending on the sources of its production either from neurons or endothelial cells. We investigated whether inhibition of nitric oxide synthesis affects postischemic neuronal death in hippocampus. Moreover, we evaluated whether the presence of nitric oxide synthase activity in specific neurons protects these against ischemia in the hippocampus, striatum, and sensorimotor cortex. METHODS: To inhibit nitric oxide synthase, several dosing regimens of NG-nitro-L-arginine methyl ester (L-NAME) were used (5 or 50 mg/kg IP, twice a day for 4 days, or 30 mg/kg IV) in gerbils. Control animals received either the isomer NG-nitro-D-arginine methyl ester or the vehicle. The gerbils underwent 10-minute occlusion of carotid arteries under ether anesthesia and controlled body temperature while physiological parameters were monitored. Neuronal damage was assessed 5 days after ischemia using Nissl-stained sections of hippocampus. Nitric oxide synthase neurons were histochemically stained for reduced nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase activity. RESULTS: L-NAME treatments, but not the chronic one at 5 mg/kg, induced elevation of blood pressure (30% to 80% greater than the control level, P < .01), as observed shortly before and after bilateral carotid occlusion. Postischemic neuronal loss in the CA1 through CA4 sectors was worsened by chronic pretreatment with L-NAME at 50 mg/kg (eg, CA1 neuronal counts per 100-microns length: 3.2 +/- 2.74, mean +/- SD; n = 19; P < .01). After the acute (30 mg/kg) or chronic pretreatment at lower dosage (5 mg/kg) with L-NAME, neuronal loss was comparable to that of animals treated with the D-isomer or the vehicle (CA1 counts in vehicle-treated animals: 7.65 +/- 6.51, mean +/- SD; n = 14). None of the L-NAME treatments affected postischemic survival of NADPH diaphorase-positive neurons in hippocampus, striatum, and sensorimotor cortex. CONCLUSIONS: These observations demonstrate that inhibition of endothelial and neuronal nitric oxide synthase activity does not modify resistance of nitric oxide-producing neurons to transient ischemia. The severe inhibition of nitric oxide production aggravates postischemic neuronal death in the hippocampus, whereas the mild inhibition is ineffective.

Amino Acid Oxidoreductases↗
PubMed1994

Extrathoracic ectopia cordis. Case report.

Extrathoracic ectopia cordis is a challenging congenital anomaly: surgical repair is generally unsuccessful because of the magnitude of the deformity and the associated intracardiac anomalies. Our clinical case had additional surgical risk for prematurity. Immediately after birth the mediastinal space was surgically enlarged and the naked heart covered with a prosthetic patch. Complete repair (placement of the heart inside the chest) would have been done later. The newborn infant survived the 1st procedure; unfortunately few hours later he died for not cardiac-related causes. Surgical strategies on this topic are discussed.

Adult↗
PubMed1994

Evaluation of left ventricular diastolic function in insulin dependent diabetic children by M-mode and Doppler echocardiography.

To evaluate the presence of diabetic cardiomyopathy, we measured various parameters of left ventricular systolic and diastolic function by means of M-mode and Doppler echocardiography in 50 IDDM children (mean age 13 +/- 3 years; mean IDDM duration 5.9 +/- 4.1 years) free of cardiovascular symptoms. As compared to age-matched healthy control subjects, diabetic children evidenced a significant increase in mean values of pressure half time (PHT), an index of the early diastolic phase (53.7 +/- 10.2 msec vs 44.5 +/- 9, p < 0.002). When the patients were subdivided on the basis of IDDM duration, metabolic control and the presence of retinal microangiopathic abnormalities, those with longer IDDM duration and poor glycemic balance had higher PHT values. These data indicate that an early diastolic dysfunction, expressed by reduced left ventricular compliance, can be found in children with Type 1 diabetes mellitus of relatively short duration. Doppler echocardiography is a reliable non-invasive means to assess early impairment of cardiac function in IDDM patients.

Adolescent↗
PubMed1994

[Aortic valve replacement in old age. The results and follow-up echo-Doppler study of the prostheses].

BACKGROUND: To analyze the results of aortic valve replacement in elderly patients and to evaluate the hemodynamic performance of valvular prostheses, we have retrospectively studied the patients 70 years of age or older, who consecutively underwent aortic valve replacement in our Center. METHODS: From January 1988 to December 1992, a series of 112 patients aged 70 to 88 years (mean 74.8 +/- 3.8 years) underwent aortic valve replacement; 49.1% of patients were male; aortic valvular lesion was: stenosis in 65.2%, insufficiency in 9.8% and mixed stenosis and insufficiency in 25.0%. In 73.2% isolated valve disease was present; in 25.0% coronary artery disease was associated. Preoperatively 58.9% were in New York Heart Association class III, and 29.5% were in class IV. Concomitant extracardiac diseases were present in 73.2%. The types of valve prostheses employed were: mechanical tilting disc (28 cases), mechanical bileaflet (40 cases), bioprosthesis (44 cases). A significantly favourable relationship between body surface area and size of prostheses was evident. RESULTS: Overall hospital mortality was 8.9% (5.4% for elective isolated aortic valve replacement) with significant difference (p = 0.006) related to criteria for surgical indication (elective 6.4%, urgent 10.0%, emergency 37.5%). Valvular lesion, age, sex, associated coronary artery bypass surgery, the values of peak and mean aortic valve gradient, the relative wall thickness and the presence of extracardiac disease have not been identified as risk factors for hospital mortality. The mean follow-up of the 102 discharged patients is 27.1 +/- 16.5 months (range 2 to 64 months). Eight late deaths (7.8%) occurred; the overall actuarial freedom from all deaths (excluding hospital mortality) was 95.6 +/- 2.2% at 1 year and 88.6 +/- 4.0% at 3 and 5 years. Five non fatal valve related complications occurred: hemorrhage in 4 cases (1.8% pt/yr) and hemolysis in 1 case (0.4% pt/yr). Ninety-seven percent of patients were found to be in NYHA functional class I or II. Comparative echocardiographic evaluation of the prostheses showed significant differences in mean gradient: regarding 21 mm size lower in bileaflet than in tilting disc and regarding 23 mm size lower in bileaflet than in tilting disc or bioprostheses. CONCLUSIONS: Aortic valve replacement has proved to be safe and effective in the elderly population and is considered the procedure of choice for aortic valve disease. Although we consider mandatory to choose the valve substitute matching different physiopathological and psychological attitudes of individual patient, mechanical prostheses and particularly bileaflet type for size < or = 21 mm should be preferred.

Aged↗
PubMed1993

NADPH diaphorase activity is inhibited by EDTA in neurons but not in choroid plexus epithelium.

NADPH diaphorase histochemical staining was investigated in rat brain and choroid plexuses. All epithelial cells of the latter as well as some sparse neurons in striatum and cerebral cortex showed strong NADPH reaction product. While staining was homogeneous in neuronal cytoplasm, it was particulate in epithelial cells. Preincubation with EDTA (0.1 mM, 2h) prevented appearance of NADPH diaphorase reaction in neurons but not in choroid plexuses. These data show that in rat brain two forms of NADPH diaphorase are present; they are specifically localized in neurons and choroidal cells, respectively.

Animals↗
PubMed1993

The effect of pure right ventricular ischemia on right and left ventricular performance in the anesthetized dog.

This study was planned to investigate the effect of ischemic dysfunction of the free wall of the right ventricle on right and left ventricular performance in the presence of a normally contracting interventricular septum. The experiments were performed in 6 anesthetized dogs in which echocardiogram, electrocardiogram, aortic blood pressure and left and right ventricular pressure were recorded. In the dog, the contractility of the septum is not affected by the occlusion of the right coronary artery which does not perfuse this part of the myocardium. Complete occlusion of the major individual ventricular branches and partial occlusion of the main right coronary artery did not impair right ventricular performance. Only complete occlusion of the main artery affected right and left ventricular function as revealed by echocardiogram. Reduced output by the ischemic right ventricle caused a reduction in left ventricular diastolic and systolic dimensions and in left ventricular developed pressure without any effect on left ventricular end-diastolic pressure.

Animals↗
PubMed1992

Late reoperations after repair of tetralogy of Fallot.

Twenty-two patients underwent 23 late reoperations after total correction of tetralogy of Fallot from 1965 to 1990. Indications for reoperation included: isolated ventricular septal defect (VSD) in 9 patients (41%), isolated right ventricular outflow tract (RVOT) obstruction in 3 patients (13.7%), VSD associated with a RVOT obstruction in 7 patients (31.8%), aneurysm of the pericardial RVOT patch in 1 patient (4.5%), aortic insufficiency with a residual VSD in 1 patient (4.5%), and tricuspid regurgitation in 1 patient (4.5%). The reoperation consisted of closure of a residual VSD in 17 patients, relief of a RVOT gradient in 11, insertion of a RVOT valve in 4, tricuspid valve replacement in 1 (reoperated twice), aortic valve replacement in 1, and excision of a RVOT aneurysm in 1. Two patients died in hospital (9%) but there were no early deaths in the 11 patients reoperated upon after 1978. Mean follow-up period was 135 months. There were 2 late deaths. The actuarial 20-year survival was 87%. Of the surviving patients, 16 (89%) were in New York Heart Association class I, 1 (5.5%) was in class II, and one (5.5%) was in class III. One patient required a second reoperation for tricuspid bioprosthesis degeneration and 1 patient had moderate recurrent RVOT gradient due to calcified pulmonary bioprosthesis. This study tends to support the policy of recommending reoperation in the presence of surgically significant residual defects. Reoperation is associated with a low early mortality and good long-term results.

Adolescent↗
PubMed1991

Aneurysm of an aberrant right subclavian artery. Report of a surgically treated case.

A 53-year-old man was admitted for treatment of an aberrant right subclavian artery aneurysm that had been diagnosed 5 years earlier and had recently begun to enlarge. The aneurysm, which involved the right subclavian artery from its origin, measured 47 mm in diameter and about 10 cm in length. Because of the lesion's size and friability, a 2-stage operation was performed. In the 1st stage, the right subclavian and right vertebral arteries were revascularized with double bypass grafts via a right cervical approach. In the 2nd stage, the patient was repositioned and a left thoracotomy incision was made. With the aid of left-heart bypass, the aorta was cross-clamped proximal and distal to the lesion, and the aneurysmal orifice was closed with a Dacron patch. The patient was discharged from the hospital on the 17th postoperative day and remains asymptomatic 24 months later. We recommend the 2-stage technique for similar cases because it prevents limb ischemia and reduces the risk of hemorrhagic and embolic complications.

Journal Article↗
PubMed1991

Coronary response to transient increases in transmural pressure.

Previous studies have shown that transient increases in aortic blood pressure obtained by occlusion of the descending thoracic aorta, in anesthetized dogs with beta-blockade and vagal section, did not affect coronary vascular resistance apart from a non-significant increase just after release of the constriction. The present study examined whether this response also occurred in the normally innervated heart. Experiments were carried out in six anesthetized dogs, in which pressure in the aortic root and in the left ventricle, as well as flow in the left circumflex coronary artery, were recorded. Coronary vascular resistance was calculated as the ratio of the difference between aortic pressure and left ventricular pressure to coronary circumflex flow during the slow inflow phase. Before occlusion coronary vascular resistance was significantly lower than during the same period in the previous studies using animals with beta-blockade and vagal section. During the occlusion, in contrast with the previous investigation, the increase in aortic pressure caused a significant increase in coronary vascular resistance 10 seconds after the beginning of the occlusion. Coronary vascular resistance was further increased immediately after release of the occlusion, concomitantly with the decrease in aortic pressure, which fell abruptly below the control level. The increase immediately after the release of the constriction was qualitatively similar, but greater in extent, to that observed in the animals with vagal section and beta-blockade. These differences are assumed to depend on a lower vasomotor tone in the normally innervated hearts.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

[Coronary vascular resistance during transitory variations in aortic pressure].

The present study was aimed at studying the interaction between elastic properties and myogenic responses of the coronary wall in regulating coronary vascular resistance (CVR) during and after sudden changes in perfusion pressure. Whilst the effects of transient reductions and recoveries of the aortic blood pressure (ABP) were previously considered, in the present study attention was paid to the changes induced in CVR by the reverse procedure, i.e., by transient increases followed by abrupt decreases of ABP. The experiments were performed in 6 anesthetized dogs after section of the vagi nerves and beta-adrenergic receptor blockade. The increase of ABP was obtained by a 10 or 20 s constriction of the descending thoracic aorta. During the experimental maneuver, coronary flow increased without any significant change in CVR. Only in the late part of the 20 s constriction a reduction of CVR was observed as a likely consequence of increased myocardial metabolism. Immediately after the release of the constriction, the fall of ABP below the control was accompanied by a significant reduction of coronary flow without any significant increase in CVR. About 10 s later, a remarkable increase in flow occurred together with a significant fall of CVR, while ABP was recovering towards the control. In each animal the exact timing of these changes was independent of the duration of the constriction. When, about 20-30 s from the end of the constriction, ABP was back to the control, the hyperemia was completely over.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

[Multidisciplinary approach to the patient with oropharyngeal dysphagia].

The Dysphagia Study Group of the Regional Hospital of Treviso uses a multidisciplinary approach to assess patients with oro-pharyngeal dysphagia. From 1996 to 2000, 208 patients with functional dysphagia were studied by the Group. Dysphagia was due to neurological disease in more than 50% of patients, to surgery in 25% and to a functional disease in 17%. In patients less than 20 years old the aetiology was due to the aftermath of traumas; in patients aged from 20 to 45 years the cause was a functional disease or achalasia, while in the majority of the older patients, aged over 45, had cerebral ischaemic lesions. The majority of patients (78%) were submitted to rehabilitation, 9.5% to medical treatment and 2.8% to surgery. Oro-pharyngeal dysphagia calls for a multidisciplinary approach in qualified centers with specialized facilities.

Adult↗