Vascularized bone graft from the index metacarpal for Kienböck's disease: a case report.

A vascularized bone graft from the head and neck of the index metacarpal bone was used for the treatment of stage IIIA Kienböck's disease in a 20-year-old woman. Three months after surgery pain had disappeared and wrist range of motion improved. Postoperative radiographs and magnetic resonance imaging revealed revascularization and fracture healing of the lunate bone. This technique has not been used in the treatment of Kienböck's disease; it may be useful in selected cases.

Vascularized bone graft from the second metacarpal to the thumb: a case report.

Bony pedicled grafts arising from the second metacarpal have been described, mainly for the treatment of recurrent pseudarthrosis of the scaphoid. The clinical use of this graft has been extended for the management of nonunion of the proximal phalanx of the thumb.

Giant congenital melanocytic nevi, neurocutaneous melanosis and neurological alterations.

BACKGROUND: Magnetic resonance imaging (MRI) findings suggestive of neurocutaneous melanosis (NCM) have been reported in asymptomatic patients with giant congenital melanocytic nevi (GCMN). OBJECTIVE: To investigate the presence of NCM and the clinical neurologic status of patients with GCMN involving the head an neck. METHODS: Thirteen patients with GCMN involving the head and neck were clinically examined by pediatric specialists in dermatology, ophthalmology and neurology. Electroencephalograms, noncontrasted and contrasted computerized tomography (CT) scans and MRI were performed. RESULTS: Eleven of 13 patients with GCMN of the head and neck previously considered asymptomatic were found to present mild but evident neurologic alterations. No signs of NCM were found in the CT scans or in the MRI. CONCLUSIONS: Patients with GCMN of the head and neck may have associated neurologic alterations not related to the presence of neurocutaneous melanosis.

[Biochemical profile of primary hyperparathyroidism. Comparative study with hypercalciuric renal lithiasis]. / Perfil bioquímico del hiperparatiroidismo primario. Estudio comparativo con la litiasis renal hipercalciúrica.

Primary hyperparathyroidism (PH) is now considered a common condition. Its frequency and the deleterious long-term effects of hypercalcemia make a correct diagnosis mandatory. We attempted to evaluate the usefulness of the indexes of parathyroid function and hormone measurements more commonly used in the diagnosis of PH. To this end we studied 64 patients, distributed in three groups: group with PH, group with hypercalciuric renal lithiasis (HRL) and control group (CG). The results were evaluated with a test of comparison of means and a stepwise discriminating regression analysis. The 8 most useful measurements to differentiate PH from HRL and CG were serum calcium, corrected serum calcium, serum phosphorus, fasting calcium excretion (FCE), maximal tubular calcium reabsorption (MTCR), maximal tubular phosphate reabsorption (MTPR), osteocalcin, PTH half molecule (PTH-HM) and 1,25-dihydroxyvitamin D. The 3-variable and 4-variable groups with a highest discriminating ability were: serum calcium, FCE and PTH-HM, and serum calcium, FCE, PTH-HM and MTPR. We think that the measurement of these four variables is the most adequate strategy for the diagnosis of PH.

Experimental oxalosis in rats: an electron microscopic study.

The ultrastructural change in rat kidneys was analyzed after intraperitoneal injection of oxalic acid. This study demonstrates fundamental alterations in the epithelial cells of the proximal convoluted tubules (PCT). At 8 h (group IV), cytoplasmic prolongations (CP) begin to be observed, which fill the lumens of PCT at 20 h (group VII) and 24 h (group VIII). Unusual mechanism of cytoplasmic secretion is suggested to this fact. Calcium salts were found on CP and in group VIII. At 16 h (group IV), intracitoplasmic membranous structures (MS) appear, which can emigrate across the microvilli into the lumens of PCT. At 24 h (group VIII), MS are also shown in basal zone and in basement membrane. We considered that CP, which can fragment, and MS are the ultrastructural substratum of the matrix of the calculis, corresponding probably to the substance A.