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  1. Operative challenges in a gigantic ganglioneuroma of the posterior mediastinum with mediastinal compression
    Amir MA, Isahak MI, Adnan I, Dimon MZ
    J Surg Case Rep, 2023 Sep;2023(9):rjad524.
    PMID: 37746526 DOI: 10.1093/jscr/rjad524
    Symptomatic giant ganglioneuromas with mediastinal compression are rare, complicating its management with significant morbidity and mortality risks. A meticulous multidisciplinary preoperative planning is pivotal in ensuring success. We describe a case of a 30-year-old man with a giant posterior mediastinal mass with compression and displacement of the mediastinal structures. Biopsy confirmed a ganglioneuroma and patient underwent excision. Surgery was challenging in view of the size and adherence to the local structures. Haemodynamic instabilities were encountered necessitating a pre-emptive femoral-femoral cannulation for CPB. A piece-meal debulking of the tumour was performed, complicated with massive haemorrhage requiring autologous blood transfusion using an intraoperative blood salvage device. The patient recovered and was discharged home well at Day 8. A thorough pre-operative planning involving a multidisciplinary approach, an understanding of the surgical anatomy as well as anticipating impending complications is of paramount importance  in the management of this particular case.
  2. Haemoblock hemostatic substance in reducing seroma formation post axillary lymph node dissection following breast conserving surgery
    Isahak MI, Abdullah MS, Awang RR, Abdul Rashid NF, Md Sikin S, Abdullah Suhaimi SN, et al.
    World J Surg, 2024 May;48(5):1159-1166.
    PMID: 38578243 DOI: 10.1002/wjs.12134
    BACKGROUND: Axillary lymph node dissection (ALND) in breast cancer management, necessitates a nuanced understanding of complications that may impede treatment progression. This study scrutinize the impact of Haemoblock hemostatic solution, evaluation it's potential in reducing seroma complication by controlling lymph flow and obliterating axillary dead space.

    METHOD: A prospective, randomized, double-blinded controlled trial was conducted with 58 patients undergoing breast conserving surgery (BCS) and ALND, stratified into two groups: Group A (ALND + Haemoblock, n = 29) and Group B (ALND + placebo, n = 29). Postoperative drainage charts were monitored, with the primary endpoint being the time to drain removal, Additionally, patients were observed for surgical site infection (SSI).

    RESULTS: Group A exhibited a marginally higher mean total drain output (398 +/- 205 vs. 326 +/- 198) compared to Group B, this difference did not attain statistical significance (p = 0.176). Equally, the mean time to drain removal demonstrated no discernible distinction between the two groups (6 +/- 3.0 vs. 6 +/- 3.0, Group A vs. Group B, p = 0.526). During follow up, nine patients in Group A required seroma aspiration (mean aspiration 31 +/- 73) as compared to Group B, 6 patients required aspiration (mean aspiration 12 +/- 36), p = 0.222). No notable disparity in SSI rates between the groups was identified.

    CONCLUSION: In conclusion, the administration of Haemoblock did not manifest a discernible effect in mitigating seroma production, hastening drain removal, or influencing SSI rates following ALND. The study underscores the intricate and multifactorial nature of seroma formation, suggesting avenues for future research to explore combined interventions and protracted follow-up periods for a more comprehensive understanding.

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