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Hong Kong Med J 2009;15:249-54

Two methods--bypass surgery and percutaneous transluminal angioplasty (PTA)--should both be used to prevent loss of lower limbs in patients with blocked arterial circulations, a study published in the August edition of the Hong Kong Medical Journal has found.

The study, conducted by a group of Hong Kong surgeons and radiologists assessed the two methods to see which one was the more effective means of correcting the arterial blockage and saving the affected leg.

Their conclusion was that the two methods "are complementary in the treatment of severe peripheral arterial disease" and the timing and the use of each method should be tailored to the individual patient's needs and general health condition. Many patients with this condition are aged and have other serious chronic diseases like diabetes and coronary heart disease.

While percutaneous transluminal angioplasty, a technique where a catheter is threaded into the blocked artery under radiological guidance and used to clear the blockage away, was a good choice for patients unfit for major surgery, the authors concluded bypass surgery--where a new blood vessel is inserted to bypass the blocked one--should be offered first to fitter patients with extensive blockages.

Of course there remains a certain percentage of patients for whom major amputation cannot be avoided and early detection of the problem can help minimise such risk.

Hong Kong Med J 2009;15:280-4

A study of eight patients who underwent limb-lengthening surgery to increase their height has found the procedure can increase bone length by up to 40 percent without causing significant long-term problems.

Nevertheless, warn the authors, from Queen Mary Hospital and the Duchess of Kent Children's Hospital, it is a complex and prolonged procedure with many complications and requires good psychological preparation of and support for both parents and patients.

Most of the patients were young (age range 9-39 years) and suffered from conditions that caused abnormally short stature, such as achondroplasia (3 patients) or hypochondroplasia (2 patients). However, three had severe short stature not caused by any medical condition--known as constitutional short stature.

The limb lengthening surgery involved cutting bone in the femur (thigh bone) and tibia (shin bone) and attaching an external fixator, a device that can be adjusted to gradually widen the gap between the ends of healing bone, thus enabling the bone to grow longer.

The average increase in bone length was 5.2 cm, but to achieve this the patients had to stay in the fixator frame for an average of 8.3 months, making it a long, difficult and, painful process.