Micro-lymphatic bypass in the treatment of obstructive lymphoedema of the arm: case report of a new technique

A report is presented of a case of secondary lymphoedema of the upper limb successfully treated by microlymphatic bypass with a composite graft containing three lymphocollectors from the lower limb to bypass the ablated portion of the pathway. To ensure success the surgery must be carried out before the peripheral lymphatics have been damaged or destroyed by increasing pressure and recurrent infection. Pre-operative lymphangiography is mandatory to assess suitability for the bypass procedure. Other methods of treatment are reviewed.     

Harrington-Bobechko instrumentation in the treatment of scoliosis: a preliminary report

A dual hook system devised by Bobechko for use with Harrington and Moe distraction rods to eliminate postoperative orthotic support was employed in the surgical treatment of 57 patients with progressive scoliosis. Mean follow-up time was 33 months (range 15 to 56 months). Average correction was 51%, with an average loss of correction of 8 degrees. Five patients required reinstrumentation, two of whom had dislodgement of both upper hooks during the first postoperative week; the other three had rod breakage which occurred 3 to 20 months after surgery. The results indicate that the dual hook system provides greater security of fixation than a single hook construct, but has the disadvantage of bulkiness, making it prominent in thin patients. Postoperative protection with bracing for 6-9 months continues to be recommended to guard against instrument failure.     

Microsurgical treatment of chyluria: a preliminary report

We treated 80 patients with recurrent chyluria (68 men and 12 women) by a microsurgical technique since 1978. Transinguinal spermatic lymphangiovenous anastomosis was performed in 64 patients and inguinal lymph node-saphenous vein anastomosis was performed in 16. Followup was 6 months to 11 years in 50 of the former and 12 of the latter patients. Chyluria disappeared completely in 30 (60%) and 8 (66.7%) patients, respectively. In 6 of the former patients (12%) chyluria had disappeared immediately after the operation but it recurred within 1.5 to 3 years. The procedure has the advantage of a superficial operative field, and is simple and less traumatic.