MyMedR

Fulltext Chylous leakage post mastectomy and axillary clearance: clinical aspect, causes and review of literature

Chan AC, Sarojah A

Med J Malaysia, 2013 Jun;68(3):262-3.

Chylous leakage after mastectomy & axillary clearance is a rare complication. The incidence is less than 0.5%. Anatomical variations in the termination of thoracic duct can occur, rendering it susceptible to injury during axillary dissection. Most chyle leaks in the axilla are managed through conservative measures. Surgical intervention is required in high output chylous leaks. We encountered a case of chylous leak post mastectomy with axillary clearance, which was successfully treated conservatively.

Fulltext Non-recurrent laryngeal nerve in thyroid surgery

Hisham AN, Sarojah A, Alvin A

Med J Malaysia, 2001 Dec;56(4):500-2.

PMID: 12014772

A case of non-recurrent laryngeal nerve is reported. The non-recurrent laryngeal nerve was found on the right side and was not associated with any vascular abnormalities. The anatomy and surgical implication of this rare condition is discussed

Fulltext Novel calcium infusion regimen after parathyroidectomy for renal hyperparathyroidism

Tan JH, Tan HC, Loke SC, Arulanantham SA

Nephrology (Carlton), 2017 Apr;22(4):308-315.

PMID: 26952689 DOI: 10.1111/nep.12761

AIM: Calcium infusion is used after parathyroid surgery for renal hyperparathyroidism to treat postoperative hypocalcaemia. We compared a new infusion regimen to one commonly used in Malaysia based on 2003 K/DOQI guidelines.

METHODS: Retrospective data on serum calcium and infusion rates was collected from 2011-2015. The relationship between peak calcium efflux (PER) and time was determined using a scatterplot and linear regression. A comparison between regimens was made based on treatment efficacy (hypocalcaemia duration, total infusion amount and time) and calcium excursions (outside target range, peak and trough calcium) using bar charts and an unpaired t-test.

RESULTS: Fifty-one and 34 patients on the original and new regimens respectively were included. Mean PER was lower (2.16 vs 2.56 mmol/h; P = 0.03) and occurred earlier (17.6 vs 23.2 h; P = 0.13) for the new regimen. Both scatterplot and regression showed a large correlation between PER and time (R-square 0.64, SE 1.53, P

Fulltext Large adrenocortical carcinoma extending into the inferior vena cava and right atrium

Hisham AN, Sarojah A, Zanariah H

Asian J Surg, 2003 Jan;26(1):40-2.

PMID: 12527494

A case of large adrenocortical carcinoma extending into the inferior vena cava and right atrium is reported. Computed tomography showed a large mass displacing the left kidney inferiorly with an intravascular tumour thrombus extending into the inferior vena cava and right atrium. Radical surgery under hypothermia and cardiopulmonary bypass was performed and the tumour mass, together with the tumour thrombus, was successfully removed. The presence of intravascular tumour extension alone should not be a contraindication to radical surgical therapy, as it is the best hope for prolonged survival.

Fulltext Prevertebral soft tissue measurements in thyroid enlargement: the value of lateral neck radiographs

Hisham AN, Sarojah A, Mastura T, Lim TO

Asian J Surg, 2004 Jul;27(3):172-5.

PMID: 15564155

Measurement of prevertebral soft tissue is commonly used to assess prevertebral abnormalities, such as retropharyngeal abscess or injury to the cervical spine. In the presence of goitres, the widened prevertebral tissue seen on plain lateral neck radiograph may be diagnostic of an enlarged tubercle of Zuckerkandl (ZT), which may be responsible for most pressure symptoms. The aim of this study was to substantiate the value of plain lateral neck radiographs in preoperative demonstration of enlarged ZT.

Total thyroidectomy: the procedure of choice for multinodular goitre

Hisham AN, Azlina AF, Aina EN, Sarojah A

Eur J Surg, 2001 Jun;167(6):403-5.

PMID: 11471662 DOI: 10.1080/110241501750243725

OBJECTIVE: To review our experience of total thyroidectomy for bilateral multinodular goitre.
DESIGN: Prospective open study.
SETTING: Teaching hospital, Malaysia.
SUBJECTS: 98 consecutive patients whose bilateral multinodular goitres were treated by total thyroidectomy, January 1998-November 1999.
INTERVENTION: A revised technique of total thyroidectomy in which more attention than is customary was paid to the exposure and safety of the laryngeal nerves and the parathyroid glands. All patients had at least 1 parathyroid gland autotransplanted.
MAIN OUTCOME MEASURES: Morbidity and mortality
RESULTS: There were no injuries to the recurrent laryngeal nerves and no patient developed persistent hypocalcaemia; 27/98 developed transient hypocalcaemia, but this had settled by 6 months postoperatively. 59 patients had persistent symptoms of pressure preoperatively, and these all resolved by 3 months postoperatively. 6 patients had occult malignant disease discovered on histological examination, and 3 developed minor wound infections.
CONCLUSIONS: Total thyroidectomy is the procedure of choice for bilateral multinodular goitres, provided that sufficient attention is paid to the preservation of the laryngeal nerves and the parathyroid glands.

Large adrenal leiomyoma presented as adrenal incidentaloma in an AIDS patient: A rare entity

Huei TJ, Lip HT, Rahman MS, Sarojah A

Med J Malaysia, 2017 02;72(1):65-67.

PMID: 28255146 MyJurnal

The literature on adrenal gland tumour in HIV-infected patients is scarce. We report a 46-year-old Malay man with HIV and Hepatitis C infection presenting with a large nonfunctioning adrenal tumour. Computed tomography showed a large right adrenal tumour with heterogeneous enhancement and central necrosis. A high index of suspicion of a malignant tumour or pheochromocytoma led us to surgical removal of the adrenal gland. In this case report, we highlight important features to look for during pre-op evaluation of a large adrenal mass. Appropriate action should be taken when there is a suspicion of a pheochromocytoma or malignancy.

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