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.

Epidermotropic metastatic melanoma. Are the current histologic criteria adequate to differentiate primary from metastatic melanoma?

A case is reported of a patient with a lentiginous acral melanoma of the heel that was excised and recurred 3 years later at the margin of the previous scar. After another 3 years, a group of five small lesions appeared in the thigh that were considered to be junctional and epidermotropic metastases. The authors question the current histologic criteria for differentiating junctional and epidermotropic metastases of previous melanomas from multiple primary melanomas. It is concluded that the clinical history is of primary importance in reaching a correct diagnosis; histologic studies are not sufficient.

[Early gastric and superficial muscle gastric cancer. Contribution of morphology to prognosis]. / Cáncer gástrico precoz y muscular superficial. Aportación de la morfología al pronóstico.

The purpose of the study was to correlate the depth of invasion in the gastric wall with survival in gastric cancer. In order to do so, we reviewed 48 patients harboring 58 gastric adenocarcinomas that did not exceed the superficial half of the muscularis propia. The patients were followed for up to a period of a least 5 years after surgery. The depth of invasion of the tumour in the gastric wall was found to correlate significantly with the invasion of lymphatic capillaries (p < 0.001) and with the finding of lymph node metastasis (mucous cancer 9%, submucous cancer 36% and superficial muscularis propia cancer 40%; p < 0.05). The size of the tumour was directly related with the depth of the cancerous invasion. Survival after 5 years varies significantly according to size of tumour (< 2 cm = 100%, 2-5 cm = 86% and > 5 cm = 33%; p < 0.0001), invasion of lymphatic capillaries (p < 0.01) and depth of the cancerous invasion (mucous cancer 94%, submucous cancer 84% and superficial muscularis propia cancer 67%; p < 0.05). The Lauren diffuse type or the multicentric cancer had a worse prognosis. The depth of invasion in the gastric wall appears to be the most important prognostic factor, since both the size of the tumor and the lymphatic involvement are related to it. When the tumour is limited to the muscularis propia, the survival rate is intermediate between early gastric cancer and advanced cancer.