Telford's operation for primary palmar hyperhidrosis.

Bilateral upper dorsal sympathectomy via the supraclavicular approach was performed in 42 patients for palmar hyperhidrosis. In 16 patients (32 extremities) the effect of sympathectomy on digital circulation was evaluated objectively, in comparison with that of 15 control subjects. Mean values of finger temperature and of digital systolic pressure increased by 6.9 degrees C and 36 mmHg respectively after operation, whereas an increase of digital blood flow and a decrease of the time of the clearance of 99mTc by approximately 60% were recorded. Differences between preoperative and postoperative values and those of controls were statistically significant. Clinical results of treatment remain satisfactory after a mean follow-up period of thirty-two months with no case of recurrence. Permanent decrease of plantar hyperhidrosis was recorded by 14 patients. The advantages of Telford's operation over other methods of upper extremity sympathetic denervation are discussed.

Post stenotic aneurysm in popliteal artery entrapment syndrome.

In a retrospective review of 74 cases of Popliteal Entrapment Syndrome collected over a 16 year period, 10 cases of aneurysm were found (13.5%). This represents an incidence of 26% of the 38 cases of popliteal aneurysm of any etiology seen during the same period of time. In contrast to atherosclerotic aneurysms, these aneurysms were seen in a young age group (21-30 years of age) and all were associated with popliteal entrapment. Evidence is presented to support our opinion that these aneurysms are post-stenotic in origin. We feel that young adults with symptoms of leg ischaemia and evidence of an aneurysm of the popliteal artery should be investigated for popliteal entrapment and treated before complications occur. We have found a posterior approach to be the most satisfactory method of exploring the popliteal fossa.

Muscular abnormalities affecting the popliteal vessels.

Forty-five cases in 33 patients of congenital muscular abnormalities causing vascular compression in the popliteal fossa are reported. Three main types of abnormality were distinguished. In the first, one muscle, either the medial head of gastrocnemius or the plantaris, is abnormal. In the second, both these muscles contribute to the problem, whereas in the third type, the semi-membranosus also is abnormal. In some cases an abnormal course of the popliteal vessel(s) is also found. With only a few exceptions, cases reported in the literature fit into this classification. Twelve patients in this series were affected bilaterally but only 5 had the same anatomy in both legs. In only 14 instances, either with thrombosis or with characteristic shifting of the artery, was routine arteriography sufficient for diagnosis; loss of distal pulses during active plantar flexion was necessary in the majority to demonstrate the abnormality. It is suggested that the condition is more common than has been thought.

Subclavian and axillary vein compression of musculoskeletal origin.

Twenty instances of subclavian-axillary vein compression of musculoskeletal origin in 14 patients are reported. In 9 thrombosis had occurred and in the remainder the compression was intermittent. The cause appeared to be extraluminar factors such as the subclavius muscle, the scalenus anterior, the pectoralis minor and a malunited fracture of the clavicle. Ten cases were treated surgically with satisfactory results.

Unilateral Raynaud's phenomenon in the hand and its significance.

Eighty eight cases of unilateral Raynaud's phenomenon of the hand were studied. The condition in most is progressive and should be treated early--before irreversible changes occur.

The medium term results after profundaplasty.

The medium term results of 112 profundaplasties for lower limb ischaemia are reviewed for periods of up to 9 years after operation. Death from cardiovascular causes was found to be more common than subsequent amputation. Though immediate relief from symptoms was not so dramatic as after a femoropopliteal graft, the longer term results showed a much lower late amputation rate. The only resonable operation for failure of a previous femoropopliteal graft appears to be a profundaplasty.