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Biomedical subjects

F M Crotti

Publications and source records attributed to F M Crotti.

10 recordsLinked to original sources
PubMed2005

Entrapment of crural branches of the common peroneal nerve.

Failed back surgery syndrome (FBSS) occurs in 30% of operated patients and represents a heavy problem both regarding disability and costs in first world countries. Among FBSS we found the possibility of a double crush syndrome: a disco-radicular conflict and a peripheral nerve entrapment. The latter, disguised by root compression symptoms, becomes evident only after spinal surgery. Clinical features are the same as for the restless leg syndrome. We found peroneal nerve crural branches entrapped where they crossed the fascia to reach the subcutaneous layer. Venous stasis during immobility caused presentation of symptoms. Neurolysis was performed, all cases were successful. Most of the patients were found to have myofascial pain syndrome (MPS). MPS patients "feel" entrapments more frequently than others not because of their specific pain tolerance but because they are more prone to develop them.

Crush Syndrome↗
PubMed2005

TOS pathophysiology and clinical features.

The authors present 280 patients operated on for thoracic outlet syndrome (TOS). In a first group of patients anatomical variants were the striking findings. The underlying factor for TOS development is therefore a well defined structural condition and its pathogenetic mechanism is known to be a nerve fibre compression. In a second group there was no specific salient finding but a postural deviation. The unique pathological features were adhesions of the brachial plexus to the scalenus muscle. Consequently its pathogenetic mechanism is generally recognized as nerve fibre distraction. In all patients neurological, vascular and myofascial pain symptoms were observed before the operation. Neurological and vascular pain disappeared after surgery, while the myofascial pain remained. The authors believe that especially in the second, larger group of patients enhancement of the pain-immobility-fibrosis loop is the central pathogenetic factor on which surgical therapy is successful, and that myofascial hemisyndrome--probably arising from a long-standing postural deviation--is not a TOS dependent symptom. In TOS, therefore, there is a pain loop that cannot be resolved by surgical therapy alone. The connection between myofascial pain syndrome and TOS might explain the many controversial opinions regarding frequency, results and surgical possibilities of this lesion.

Activities of Daily Living↗
PubMed2005

Post-traumatic thoracic outlet syndrome (TOS).

TOS is a compressive non-tumorous syndrome of the brachial plexus. It is possible, however, to consider as TOS the irritative and lesional plexus syndrome following trauma as long as compression (or traction) on the nerves is triggered by long-lasting pathological changes of the area after trauma. Overload work of judges and lawyers after traffic accidents does not help to remind the real victim's problem, that is stretching of the neck soft tissues during head acceleration-extension. This movement is due to a forward acceleration. Both the car and the victim's trunk are violently pushed forward while the head does not move fast enough so that it is actually pushed backwards. The mandibula is even slower than the head and this leads to an opening of the mouth with possible temporomandibular joint (TMJ) dislocation. If there is nothing stopping the neck extension, like an appropriate headrest, the momentum is only resisted by cervical soft tissue stretching. Prolonged antalgic contracture and motor neglect may contribute to connective tissue changes and development of microadherences. Final result is fibrosis of paraneurium. The pain-immobility-fibrosis loop is of basic importance in the development of this syndrome.

Brachial Plexus↗
PubMed2003

Neuroendoscopy: one year of experience--personal results, observations and limits.

After reading reports of successful neuroendoscopic treatment of hydrocephalus, colloid cysts and arachnoid cysts as well as tumor biopsy, we started using endoscopic procedures in our Department, one year ago. One surgeon (E.S.) skilled in the Decq Endoscope, performed a series of sixteen procedures, from January 2001 to March 2002 (in patients aged 28 to 69 years). The most common pathology was obstructive hydrocephalus (14 cases), one was colloid cyst, and the last case was tumor biopsy. The surgical treatment consisted of third ventriculostomy, cyst opening and shrinking and tumor biopsy. In fourteen patients treated for hydrocephalus with third ventriculostomy (ETV), one required a definitive shunt. Complication occurred in one case with chronic subdural collection. We further report one case of aqueductal restoration after third ventriculostomy. Our results, with no neurological deficits or deaths, confirmed our opinion that neuroendoscopy is a safe surgical technique in well-selected patients and we believe it is the ideal treatment in obstructive hydrocephalus.

Aged↗
PubMed2003

Overdrainage after endoscopic third ventriculostomy: an unusual case of chronic subdural hematoma--case report and review of the literature.

Endoscopic third ventriculostomy is considered a safe technique for the treatment of obstructive hydrocephalus. However, the literature contains several reports of complications related to this procedure. We describe a case of chronic subdural hematoma (CSDH) after ETV, which required surgical evacuation, in a 69-year-old male patient completely asymptomatic up to the control MRI four weeks after the operation. We believe this unusual complication could result from the ICP changes caused by ETV. In our opinion, successful ETV gives a boost to CSF absorption, and overdrainage may evolve also in endoscopic treatment of obstructive hydrocephalus. This situation could be the starting point of the subdural collection. We review the literature and discuss the causes that may lead to CSDH after ETV procedure.

Aged↗
PubMedDate not supplied

Cranial defects repair by replacing bone flaps.

The Authors, after few historical remarks, discuss the indications and the contra-indications for cranioplasty. Although, in the last 30 years, various materials and techniques have been investigated and proposed, the Authors suggest, as method of choice, the reimplantation to each patient of his own volet, when possible, to repair skulls defects. This technique in fact permits to restore an almost normal physiological condition of the cranial vault functions. In the light of the recent researches on the "bone induction principle" and on the possibility of storing at a temperature of -30 degrees C in a freezer the bone flap in ideal condition before the reimplantation, this method is proposed again. The Authors report their experience on 15 patients, 13 of whom have been successful; a perfect aseptic storage, a rational choice of the patients who should be treated and a correct surgical approach are underlined as mandatory for the successful use of the technique. The mean follow up for the 13 successful patients is 15 months. In the paper the 2 unfavourable cases are discussed too: the hypothetical causes which lead to reject of the reimplants are suggested and debated.

Adult↗