Biomedical subjects

M F Stancić

Publications and source records attributed to M F Stancić.

11 recordsLinked to original sources

PubMed2001

Anterior decompression and fixation versus posterior reposition and semirigid fixation in the treatment of unstable burst thoracolumbar fracture: prospective clinical trial.

AIM: To compare the anterior and posterior surgical approach in the emergency treatment of unstable burst thoracolumbar fracture. METHODS: Twenty-five patients with unstable thoracolumbar fracture underwent either anterior neurodecompression and fixation (n=13) or posterior reposition and semirigid fixation by hook-rod with pedicle screw fixation (n=12), depending on the type of implants available at the time of operation. Neurologically injured patients were operated on within the first 8 hours and neurologically intact patients within the first 2 days after the fracture. Neurological improvement was assessed according to the American Spinal Injury Association grading scale and the Prolo economic/function outcome scale. We also recorded operation time, blood loss, cosmetic outcome, hospital stay and cost, complications, and donor site pain. RESULTS: There were no significant differences between the two groups in either neurological improvement (p=0.86) or favorable economic or function outcome (p=0.54 and p=0.53, respectively). The operation time was shorter in the posterior approach group than in the anterior approach group (median 174 min, range 130-215 vs median 250 min, range 200-295, respectively, p<0.001). The blood loss was smaller in the posterior approach group (median 750 mL, range 500-1,10, vs median 1,362 mL, range 1,150-1,50, in the anterior approach group; p<0.001). The posterior approach group also had better esthetic outcome, lower hospital cost, lower complication rate, and no donor site pain. CONCLUSION: Both surgical techniques were equally effective in neurological improvement and functional outcome. Posterior surgery can be recommended in emergency neurodecompression and fixation of unstable thoracolumbar fractures because of the shorter operation time and smaller blood loss.

Adolescent↗

PubMed2000

Brachial plexus gunshot injury in an infant.

We present the case of an infant with a gunshot lesion in the brachial plexus. Intraoperative nerve action potential recordings suggested posterior cord neurolysis and medial and lateral cord grafting. After 3 years' follow-up complete recovery of motor and sensory function was seen as a result of immense nerve regeneration capability and brain plasticity. According to our knowledge this is the first reported case of such a mechanism of injury in an infant.

Brachial Plexus↗

PubMed2000

Marinacci communication. Case report.

Marinacci or reverse Martin-Gruber communication is a rare anatomical variation. Until now, in all reported cases the branch was diagnosed using electrophysiological studies but not substantiated anatomically. The authors report a case of ulnar-median nerve communication in the distal forearm that was discovered during carpal tunnel release surgery and confirmed postoperatively on electromyographic studies.

Action Potentials↗

PubMed2000

Hook-rod with pedicle screw fixation for unstable spinal fracture. Technical note.

A technique is described in which spinal fracture repositioning, decompression, and stabilization are achieved by a combination of hook-rod and pedicle screw fixation. This straightforward technique is useful for performing acute decompression in patients with partial neurological deficits and multisystem injuries. A laminectomy allows for placement of a stiffer fixation system, and it improves the insufficient canal clearance obtained when performing annulotaxis alone.

Adult↗

PubMed2000

Cerebrospinal fluid seepage through polyglactin 910 dura substitute manifested as spinal extradural collection of fluid.

Following excision of pilocytic astrocytoma, a 12-year-old girl underwent posterior cranial fossa synthetic duraplasty with polyglactin 910 mesh. On the 8th postoperative day, unusual extradural collection was diagnosed by spinal magnetic resonance imaging. On the 14th postoperative day, cerebrospinal fluid leakage in the upper part of the postoperative wound was noticed. Unusual extradural collection detected by spinal magnetic resonance imaging was assumed to be the consequence of cerebrospinal fluid seepage and a warning sign of cerebrospinal fluid leakage following synthetic posterior fossa duraplasty. This case shows that polyglactin 910 mesh may be ineffective when used for posterior cranial fossa duraplasty in children, although it is considered as valuable as autologous tissue.

Astrocytoma↗

PubMed1999

Evaluation of functional nerve recovery shows that allogeneic nerve graft treated with ICAM-1 and LFA-1 mAbs can be good alternative to syngeneic graft.

The objective of the study is to establish recovery results of tibial nerve defects reconstructed using allogeneic and xenogeneic graft, in host immunosuppressed with Intercellular Adhesion Molecule-1 (ICAM-1) and Lymphocyte Function Antigen-1 (LFA-1) monoclonal antibodies (mAbs). A pilot study was conducted in fifteen Fischer rats by forming a 1 cm right tibial nerve gap, then reconstructing it with 1.2 cm long grafts, namely, Wistar allogeneic, Black mouse xenogeneic, and syngeneic (n = 5/group). The main study included forty-eight rats allocated to the following groups (n = 12/group): 1) Allograft without treatment as control group. 2) Allograft with intraperitoneal ICAM-1 and LFA-1 mAbs treatment. 3) Allograft preserved in Belzers' solution including ICAM-1 mAbs plus standard intraperitoneal treatment. 4) Syngraft as benchmark. At 3, 6 and 9 weeks postengraftment walking track analysis was performed and expressed as Tibial Functional Index (TFI). Motor and compound nerve action potential across the graft conduction velocities were measured at week 10. Xenograft did not show any functional recovery and was therefore excluded from main study. However, pilot and main study results showed recovery results in both treated allogeneic groups and were comparable to benchmark syngraft. Therefore, allogeneic nerve graft could be an alternative in peripheral nerve reconstruction and spinal cord grafting.

Action Potentials↗

PubMed1999

The anatomy of the Berrettini branch: implications for carpal tunnel release.

OBJECT: Dissections were performed in 100 fresh cadaver palms to determine the frequency with which superficial palmar communication between the median and ulnar nerves occurs and to what extent it might incur iatrogenic injury during endoscopic carpal tunnel release. METHODS: Superficial palmar communication between the median and ulnar nerves was present in 81% of the dissected hands. Superficial palmar communication, also known as the Berrettini branch, has been classified into four distinct types by Ferrari and Gilbert. Twelve hands were classified as Group 1 (communication in an oblique course from the ulnar to the median nerve originating >4 mm above the distal margin of the transverse carpal ligament [TCL]), 16 hands were classified as Group 2 (communication parallel to the distal margin of the TCL), and 53 hands were classified as Group 3 (communication in an oblique course from the ulnar nerve to the third common digital nerve, originating below the distal margin of the TCL). No hand fit the Group 4 classification (atypical communication). CONCLUSIONS: The Berrettini branch can be considered a normal anatomical finding. In 28% of the hands in this study, the branch was proximal to the edge of the distal ligament and, therefore, prone to iatrogenic injury in both one-portal and two-portal endoscopic surgery.

Adult↗

PubMed1998

The value of an operating microscope in peripheral nerve repair. An experimental study using a rat model of tibial nerve grafting.

The aim of this study was to test the hypothesis that the use of an operating microscope improves the results of peripheral nerve repair. Tibial nerve grafting was carried out on 48 Fischer rats divided into 2 groups: in one, a loupe was used, and in the other a surgical microscope. At 5 months after grafting, recovery was evaluated by functional, electromyographic, and morphometric tests. The mean motor nerve conduction velocity was 26.77 +/- 9.37 m/sec in the group where the loupe was used compared with 44.19 +/- 11.36 m/s when the microscope group was used. The soleus muscle weight and the diameter of myelinated fibres also confirmed better regeneration in the microscope group. These results clearly indicate that it is essential to use the microscope for peripheral nerve repair.

Analysis of Variance↗

PubMed1996

Electromyographic evaluation of experimental nerve grafts suggests better recovery with microscope assistance.

Controversy surrounds the value of optic magnification for peripheral nerve surgery. The aim of this study was to compare the loupe magnification with microscope-assisted techniques in a rat tibial nerve graft model. The parameters studied included motor nerve conduction velocity (MNCV), clinical test equivalent (CTE), soleus muscle weight (SMW) and morphometric nerve indices. In the loupe and microscope groups MNCV mean was 26.77 +/- 9.37 m/sec and 44.19 +/- 11.36 m/sec respectively. MNCV results suggest better regeneration in the microscope group, as confirmed by CTE, SMW and myelinated fibre (MF) diameter.

Action Potentials↗

PubMed1996

The role of interfascicular nerve grafting after gunshot wounds. A report of 44 cases.

In this study the authors present the results of 44 patients with 49 interfascicular nerve grafting procedures necessitated by gunshot wounds. The aim was to establish the effectiveness of microsurgical interfascicular nerve grafting for war injuries. The 49 interfascicular nerve grafting procedures were performed between July 1991 and January 1993. All but one were performed within 6 months of injury. Nerve recovery was assessed independently by a neurologist. The M/S scale was used for median, ulnar and radial nerves, and the grading scale recommended by Millesi was used for the sciatic, tibial and peroneal nerves. Follow-up was for between 2.5 and 3.5 years. Patients scoring at least M3/S3+, or Grade 2 on the Millesi scale, were considered to have useful functional recovery which occurred in high median (0 out of 1), low median (4 out of 9), high ulnar (0 out of 2), low ulnar (5 out of 11), high radial (4 out of 6), low radial (2 out of 2), sciatic (5 out of 9), peroneal (4 out of 7), and tibial (2 out of 2). The extent of recovery correlated inversely with the patient's age and the length of the graft, but was independent of the time between injury and surgery and of presumed projectile energy. Our results suggest that microsurgical interfascicular nerve grafting is of value in the management of wartime nerve injuries.

Adolescent↗

PubMed1995

Anatomical variations of the median nerve in the carpal tunnel.

The median nerve was explored in 100 hands and the variations classified by the Lanz system. Only 47.7% of hands showed the standard anatomy described in textbooks. Rare variations were also found. Knowledge of the variable anatomy of the nerve could help to avoid incomplete decompression at operations for carpal tunnel entrapment and injury to the thenar branch of the nerve. The possibility of double thenar innervation must be considered in preoperative evaluation and in the follow up of median nerve injuries.

Carpal Bones↗