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Biomedical subjects

M Morino

Publications and source records attributed to M Morino.

At least 55 records · Page 3Linked to original sources
PubMed1998

Occlusion of the sigmoid sinus after surgery via the presigmoidal-transpetrosal approach.

OBJECT: In this paper the authors report on sigmoid sinus occlusion as a surgical complication in seven of 143 operations in which a presigmoidal-transpetrosal approach was used. METHODS: Five patients (Cases 1-5) developed occlusion within 40 days after surgery, and in the remaining two (Cases 6 and 7) occlusion was detected 5.4 and 6.4 years postsurgery by means of cerebral venography, which was performed in 40 of the remaining 138 patients. Of the two patients with occlusion of the hypoplastic transverse sinus, one (Case 1) did not develop symptoms and the other (Case 2) developed brain edema with transient aphasia. Of the three patients suffering from occlusion of the dominant sigmoid sinus, one (Case 3) developed severe intracerebral hemorrhages and had a poor prognosis; one (Case 4) developed profuse supra- and infratentorial brain edema with consciousness disturbance; and the other (Case 5) developed hemorrhagic infarction in the temporal lobe accompanied by aphasia. Two patients whose sinus occlusion was detected later (Cases 6 and 7) did not develop symptoms and displayed well-communicated transverse sinuses. In Case 7, a dural arteriovenous malformation formed at the site of the sinus occlusion. Laceration of the sigmoid sinus was suspected as the cause of occlusion in Cases 2, 3, and 7; compression of the sinus in Cases 5 and 6, sinus laceration and postoperative dehydration in Case 4; and laceration and compression of the sinus in Case 1. CONCLUSIONS: Differences in the clinical course among these patients were attributed to anatomical variations in the venous system. Occlusion of the sigmoid sinus should be weighed as a potential complication when selecting candidates for the presigmoidal-transpetrosal approach.

Adolescent↗
PubMed1998

[Transient immunosuppression after abdominal surgical intervention].

Transient immunodepression appears a few hours after surgery and usually regresses spontaneously within 15-20 days. In this study, cellular and humoral immunity parameter values were compared prior to and 24 h, 7 days and 14 days after laparotomic and laparoscopic cholecystectomy (12 patients and 25 patients respectively) operated at the University of Turin's First Surgical Clinic, to look for differences in the immunological effects of these two types of surgery. The following parameters were determined: IgG, IgA, IgM, C3, C4, granulocytes (CD11c), lymphocytes, B lymphocytes (CD19, CD19-CD15), T lymphocytes (CD3), T helper cells (CD3-CD4), T suppressor cells (CD3-CD8), CD4/CD8 ratio, NK cells (CD16), monocytes (CD14, CD11c-CD14), IL-2 receptor expression (CD25), HLA-DR expression (total HLA-DR, HLA-CD3), total cytotoxic activity (CD57), T cell cytotoxic activity (CD8-CD57), and NK cell cytotoxic activity (CD16-CD57). Granulocytes increased significantly (p < 0.05) in both groups. The increase was more marked in the laparotomy group and still evident on the 7th and 14th days. Total T cells, T helpers and NK cells fell after 24 h (p < 0.05) in this group only. These results suggest that laparoscopy is associated with less substantial immunological changes than laparotomy.

Adult↗
PubMed1997

Manual and automatic extraction and high-performance liquid chromatographic determination of a spicamycin derivative, KRN5500, in rat plasma.

A sensitive reliable method for the extraction, separation and quantitation of KRN5500 (I), a spicamycin derivative, from rat plasma was developed. It involves solid-phase extraction of the drug using a Bond Elut C18 cartridge and reversed-phase HPLC on a YMC-Pack ODS column with an ultraviolet detector. The intra- and inter-assay coefficients of variation by manual (n=10) and automatic (n=5) extraction were less than 9 and 13% and 6 and 8%, respectively. The limit of quantitation of each extraction procedure was 2 ng potency/ml. This extraction method may thus be considered useful for monitoring I in animals following its administration.

Animals↗
PubMed1997

Preoperative pneumatic dilatation represents a risk factor for laparoscopic Heller myotomy.

BACKGROUND: The development of minimally invasive surgery has renewed interest in the surgical therapy of achalasia. METHODS: 21 patients with esophageal achalasia underwent Heller's laparoscopic myotomy with anterior fundoplication between August 1991 and March 1996. RESULTS: There were two intraoperative perforations of the mucosa sutured laparoscopically with no postoperative sequelae; both complications occurred in patients previously treated with pneumatic dilatation; no perforations occurred in the 14 patients who had not been submitted to pneumatic dilatation (28% vs 0%). There were no surgical mortalities and no postoperative morbidities. Complete relief of dysphagia and modifications of radiological and manometric patterns were achieved in all patients. All patients remain asymptomatic at follow-ups ranging from 3 to 55 months after surgery. CONCLUSIONS: Laparoscopic Heller's myotomy is as effective as traditional surgery in treating symptoms and has all the advantages of pneumatic dilatation in terms of short hospital stay, quick recovery, and low cost; preoperative pneumatic dilatation is a risk factor for intraoperative mucosal perforation.

Adult↗
PubMed1997

Extended lymph node dissection for gastric cancer: results of a prospective, multi-centre analysis of morbidity and mortality in 118 consecutive cases.

This study reports interim data on post-operative morbidity, hospital mortality and duration of hospital stay of Italian patients undergoing extended lymph-node dissection combined with a pancreas-preserving technique for gastric cancer. Of the 218 patients admitted to one of eight general and/or university hospitals in North Italy, 118 were enrolled in the trial. Eligible patients presented with proven primary adenocarcinoma of the stomach without clinical evidence of distant, peritoneal and/or liver metastasis, or metastasis in para-aortic and retropancreatic nodes at intraoperative biopsy. Patients underwent the extended procedure as described by the Japanese Research Society for the Study of Gastric Cancer, following the Maruyama pancreas-preserving technique. A strict quality control system was used to ensure the performance of a standard surgical treatment. A surgeon of the reference centre (M.D.), who stayed at the National Cancer Center Hospital in Tokyo to learn the D2 technique from a specialist Japanese surgeon, became the trial supervisor and assisted each surgeon in all the Italian participating centres. The patients were staged according both to the TNM system and to the General Rules for the Gastric Cancer Study in Surgery and Pathology. Post-operative surgical complications developed in 21 patients (17.8%). The non-surgical complication rate was 2.5%. Reoperation was necessary in six patients (5%), all of whom survived. The 30-day mortality rate for the eligible group was 2.5%. The overall hospital mortality was the same. Total gastrectomy was associated with a slightly higher operative mortality (4.5% vs 1.3%). Only one patient died from an anastomotic leak. The rate of leakages was higher after total than after distal gastrectomy (15.9 vs 5.4%); the association of splenectomy and pancreatectomy worsened the morbidity rate. D2 lymphadenectomy with pancreas-preserving technique, when performed at experienced centres, seems a feasible and safe technique for the radical treatment of gastric cancer in selected Western patients.

Adenocarcinoma↗
PubMed1997

A biorbitofrontobasal interhemispheric approach for suprasellar lesions.

Suprasellar tumors including pituitary adenomas and craniopharyngiomas, in the case of normofixed or postfixed chiasma and ruptured anterior communicating artery aneurysms in the acute stage, can be approached with minimum brain retraction, increased exposure, and safe manipulation in the shortest possible distance via biorbitofrontobasal interhemispheric approach. Fourteen patients with pituitary adenomas, 3 with craniopharyngiomas, 7 with meningiomas, 2 with mucoceles, 1 with osteoma, and 3 with ruptured anterior communicating aneurysms in the acute stage were operated on, using this approach with excellent results. The operative technique and its results are detailed.

Brain Neoplasms↗
PubMed1996

Laparoscopic colorectal resection. A multicenter Italian study.

BACKGROUND: The aim of the present study was to evaluate retrospectively the experience of six surgical units currently performing laparoscopic colorectal surgery. METHODS: From November 1991 to January 1994, 200 patients (103 male, 97 female; mean age 62.5 years) were candidates for, and received, laparoscopic colorectal resection for benign (54) or malignant (196) lesions. All the units excluded patients with locally advanced organ tumors and all cases with suspected perforation and ascites. One center submitted to laparoscopic resection only stage I and IV adenocarcinoma. All surgeons considered obesity a relative contraindication. The following data were analyzed: indications, conversion rate to open surgery, operative time, morbidity and mortality, resumption of gastrointestinal function, number of lymph nodes harvested, hospital stay. RESULTS: Twenty-one out of 200 patients were converted to open surgery (10.5%); 37 patients had a complete laparoscopic procedure (17.1%); 137 had an assisted resection (68.5%); and the remaining 5 patients had a facilitated resection. The mean operative time was 208 min (90-480) for assisted resection and 275 min (54-550) for complete laparoscopic resection. The mortality rate was 1.7%; the overall morbidity was 19.6% (major complications 11.2%). All patients quickly became ambulatory and showed a prompt resumption of gastrointestinal functions, and less postoperative pain if compared with converted cases. The average number of lymph nodes was 12.1 (range 1-32). The mean hospital stay was 8.6 days (range 5-14.5). The mean follow-up was 16 months (range 6-24). The recurrence rate 11.7%. CONCLUSIONS: Laparoscopy seems to offer the possibility of minimally invasive treatment, but long-term follow-up is needed to evaluate the efficacy of laparoscopic surgery in the treatment of colorectal cancer.

Adult↗
PubMed1996

EAES ductal stone study. Preliminary findings of multi-center prospective randomized trial comparing two-stage vs single-stage management.

BACKGROUND: The current management of patients with ductal calculi and gallstone disease consists of endoscopic stone extraction (ESE) followed by laparoscopic cholecystectomy (LC). The advent of techniques of laparoscopic ductal stone clearance has introduced an alternative single stage laparoscopic treatment for these patients. The EAES ductal stone trial was set up to compare the relative efficacy and outcome of these two management options. METHODS: The study consists of a prospective randomized controlled clinical trial comparing two management options of patients undergoing LC and suspected of harbouring common duct stones. Patients registered into the trial are randomized to one of two arms: (i) Group A-preoperative ERC with ESE followed by LC during the same hospital admission. (ii) Group B-single stage laparoscopic management consisting of LC and laparoscopic stone extraction either by the trans-cystic duct route or by direct supraduodenal common duct exploration. RESULTS: This preliminary analysis was carried out on 207 randomized patients with comparisons being made on the intention to treat principle. The two groups (A = 106, B = 101) were comparable with respect to clinical features. ASA grade, serum biochemistry and ultrasound findings. CONCLUSIONS: These preliminary findings indicate equivalent success rates and patient morbidity between the two management options but a shorter hospital stay (cost benefit) with the single stage laparoscopic treatment. Trans-cystic duct extraction is a more benign procedure than laparoscopic supraduodenal CBD exploration and is accompanied by a significantly shorter hospital stay. The higher incidence of conversion in the single stage laparoscopic group compared to the two-stage arm is due to the preference for open common duct exploration when the laparoscopic attempt failed by the majority of participating surgeons. The results to-date suggest that in fit patients, single stage laparoscopic treatment is the better option and the role of ESE should change to selective use in those patients in whom laparoscopic ductal stone extraction has failed.

Adolescent↗
PubMed1996

[Laparoscopic treatment of non parasitic liver cysts].

Various surgical treatments have been proposed for highly symptomatic hepatic cysts: enucleation, fenestration, hepatic resection and liver transplantation. The advent of laparoscopic surgery has provided new opportunities but, at the same time, has increased the uncertainties concerning the correct management of these patients. This study evaluates the results and defines the indications for laparoscopic fenestration of symptomatic nonparasitic hepatic cysts, either solitary or diffuse. 31 patients were observed between November 1990 and October 1995: 15 with solitary cysts and 16 with policystic liver disease (PLD). After a careful review of the symptoms, 8 patients (5 with a solitary cyst and 3 with a PLD) were excluded from surgical treatment and 23 were treated by laparoscopic fenestration. There was no mortality. Ten of the 23 patients had a solitary cyst with a median diameter of 11.6 cm (range 6-20 cm). No conversion to laparotomy was necessary. There were no complications and complete regression of symptoms was obtained in all patients. No recurrences were observed. In the PLD group (13 patients), two patients had to be converted to open fenestration (15%). There were no deaths and the surgical morbidity was limited to two cases of postoperative persistent ascites. Symptomatic relief was obtained in 64% of patients, but symptoms recurred in 36%. A subgroup of PLD at high risk for recurrence was identified and a classification of PLD is proposed: PLD type I characterized by large cysts mainly located in the anterior hepatic segments, and PLD type II characterized by numerous small cysts through the liver which do not represent a good indication for laparoscopic fenestration.

Adult↗
PubMed1996

[The use of intraoperative topical bupivacaine in the control of postoperative pain following laparoscopic cholecystectomy].

Taking the starting point of a trial conducted on female patients who had undergone laparoscopic gynaecologic operations, which shows a good control of the postoperative pain through intraperitoneal infusion of local anaesthetic during the operation, the authors have proposed to reproduce the study on patients undergoing a laparoscopic cholecystectomy. The trial was conducted on two groups, a 50 patients each, undergoing an intraperitoneal infusion of local anaesthetic (bupivacaine) and placebo (physiologic solution) respectively. The results regarding the rate of patients who had felt postoperative pain (88% in the first group, 96% in the second group) and the different places of it, the pain in the right shoulder particularly (28% in the first group, 22% in the second), the intensity in the time and the different requests of analgesics new recorded. The results don't show statistically significant differences and they are different from the gynaecologic ones. The authors suggest, as reasons for these differences, the various moments of the liquid inoculation (at the beginning of the operation in gynaecology, at the end of it in cholecystectomy) and the Trendelemburg position of patients during the gynaecologic operation, on the contrary of cholecystectomy operations. They suggest, in the end, that the trials esecutions on numerically larger groups could bring more significant results.

Administration, Topical↗
PubMed1995

Survey on Torino courses. The impact of a two-day practical course on apprenticeship and diffusion of laparoscopic cholecystectomy in Italy.

Since March 1991 a monthly course on laparoscopic cholecystectomy has been organized at the Department of Surgery of the University of Turin. To evaluate the impact of this course and to obtain feedback from surgeons in order to improve the teaching of laparoscopic surgery, detailed questionnaires were sent to the participants of the first 20 courses. The outcome of this survey shows that short-residency "hands on" courses do not represent a completely satisfactory training, either for practicing surgeons or for residents, mainly because of the constraints of time and the lack of proctoring and supervision. Besides, the present study shows a significant difference in the diffusion of laparoscopic surgery in different areas of Italy. However, clinical results reported by this group of surgeons are satisfactory and comparable to the best multicentric series: 2,127 laparoscopic cholecystectomies were performed by 48 surgeons with a conversion rate of 6% and a complication rate of 2.4%.

Cholecystectomy, Laparoscopic↗
PubMed1995

Current management of common bile duct stones in northern Italy.

In order to obtain a complete picture of the current management of cholecystocholedocal lithiasis in northern Italy we've conducted the present survey. In the years 1992-1993, among 7,861 cholecystectomies, 665 patients with gallbladder and common bile duct stones were treated in 49 surgical departments. Some 271 (43%) were treated by traditional methods: open surgery or endoscopic sphincterotomy followed by laparotomic cholecystectomy; 313 patients (49%) were treated by endoscopic sphincterotomy followed by laparoscopic cholecystectomy and only 38 (6%) were treated by one-stage laparoscopy, either by a transcystic approach (27) or by laparoscopic choledochotomy (11). Morbidity and mortality were not significantly different in the different groups. We conclude that open surgery and sequential minimal invasive treatment are the standard approaches to cholecystocholedochal lithiasis in this first stage of the laparoscopic era. The laparoscopic management of common bile duct stones is at present confined to surgical departments specially devoted to laparoscopic surgery.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1994

Large postoperative umbilical hernia following laparoscopic cholecystectomy. A case report.

The authors report a case of large postoperative umbilical hernia following laparoscopic cholecystectomy, which occurred in the early postoperative period despite primary suture of the trocar insertion site. Forced dilation of the fascial layer is proposed as the etiological mechanism. This procedure should be avoided and an accurate and aseptic removal of the gallbladder should be performed in order to prevent risk of abdominal wall weakness and visceral herniation.

Cholecystectomy, Laparoscopic↗
PubMed1994

IgA nephropathy and idiopathic thrombocytopenic purpura with splenectomy: a case report.

A 14-year-old boy who had had a splenectomy at the age of 2 years for idiopathic thrombocytopenic purpura, suffered from IgA nephropathy. Serum IgA and IgE levels were elevated and low levels of circulating immune complexes were detected. Splenectomy may play a role in the pathogenesis or susceptibility to IgA nephropathy by means of decreased clearance of circulating immune complexes or impaired immune regulation, such as increased IgA synthesis.

Adolescent↗
PubMed1994

Effects of microinjection of N-methyl-D-aspartic acid into the nucleus tractus solitarii on cerebral blood flow in anesthetized rats.

N-Methyl-D-aspartic acid (NMDA) (10 pmol in 100 nl of 0.9% sodium chloride solution) was microinjected into the nucleus tractus solitarii (NTS) of urethane-anesthetized, paralyzed and artificially ventilated rats, and cerebral blood flow (CBF) was determined using a combination of labeled microspheres. Moderate hypertension within the upper limit of cerebral autoregulation was induced by blood transfusion in order to measure CBF at normotension. Arterial blood pressure (ABP) was decreased by unilateral microinjection into the NTS in these rats but remained within normotensive range. The CBF in the cerebral cortex ipsilateral to the stimulated NTS significantly (P < 0.01) decreased from 38 +/- 4 (mean +/- S.E.M) to 27 +/- 4 ml.min-1.(100 g)-1(n = 9). The cerebrovascular resistance (CVR) in the cerebral cortex ipsilateral to the stimulated NTS significantly (P < 0.01) increased from 2.6 +/- 0.3 to 4.1 +/- 0.7 mmHg per [ml.min-1.(100 g)-1]. Blockade of NMDA receptors in the NTS with D,L-2-amino-5-phosphonovalerate (AP5, 500 pmol) abolished the CBF decrease and CVR increase responses elicited by microinjection of NMDA into the NTS (n = 9). Blockade of non-NMDA receptors in the NTS with 6,7-dinitro-quinoxaline-2,3-dione (DNQX, 100 pmol) had little effect on the CBF decrease and CVR increase responses elicited by microinjection of NMDA into the NTS (n = 10). Microinjection of the vehicle solution into the NTS had no effects on cerebral circulation (n = 7). Cerebral autoregulation was well maintained at moderate hypertension induced by blood transfusion and at normotension returned from moderate hypertension following controlled hemorrhage (n = 8). These results suggest that the NMDA receptors in the NTS may be involved in the control of cerebral circulation.

2-Amino-5-phosphonovalerate↗
PubMed1994

Laparoscopic management of symptomatic nonparasitic cysts of the liver. Indications and results.

OBJECTIVE: This clinical study evaluated the results of and defined the indications for laparoscopic fenestration of symptomatic nonparasitic hepatic cysts, either solitary or diffuse. SUMMARY BACKGROUND DATA: Different surgical treatments have been proposed for highly symptomatic hepatic cysts: enucleation, fenestration, hepatic resection, and liver transplantation. The advent of laparoscopic surgery has given new opportunities but, at the same time, has increased the uncertainties concerning the proper management of these patients. METHODS: Eight patients with solitary cysts and nine with polycystic liver and kidney disease (PLD) were seen during a period of 2 years. After a careful review of the symptoms, 6 patients were excluded from surgical treatment and 11 (4 solitary cysts and 7 PLD) were treated by laparoscopic fenestration. Postoperative morbidity and mortality rates, hospital stay, and clinical early and late results were evaluated. RESULTS: In the solitary cyst group, there was no surgical morbidity or deaths, and a complete regression of symptoms occurred in all patients. No recurrences were observed. In the PLD group, two patients had to be converted to laparotomic fenestration (28%). There were no deaths, and the surgical morbidity was limited to two cases of postoperative ascites. Symptomatic relief was obtained in 80% of patients, but the symptoms recurred in 60%. A subgroup of PLD at high risk for recurrence was identified. CONCLUSIONS: The best indications for laparoscopic fenestration seem to be solitary cyst and PLD characterized by large cysts mainly located on the liver surface (type 1), whereas PLD characterized by numerous small cysts all over the liver (type 2) should be considered a contraindication to laparoscopic fenestration.

Adult↗