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Fulltext Recurrent Chromobacterium violaceum infection in a patient with chronic granulomatous disease

Sureisen M, Choon SK, Tai CC

Med J Malaysia, 2008 Oct;63(4):346-7.
PMID: 19385503 MyJurnal

We report a rare case of recurrent infection of Chromobacterium violaceum in an immunocompromised patient. Despite the high mortality rate associated with this infection as reported in the literature, this patient survived three episodes of recurrent infection. We believe that with high clinical suspicion, prompt treatment and appropriate antimicrobial agents, it is possible for clinicians to treat this infection effectively and reduce the mortality rate.
Fulltext What the mind does not know, the eyes do not see: a rare congenital fusion of the odontoid process to the atlantal hemiarch

Sureisen M, Achannan R, Chong KC, Wong CC

BMJ Case Rep, 2015 Oct 27;2015.
PMID: 26508120 DOI: 10.1136/bcr-2015-212748

Congenital spinal fusion of an odontoid process to an atlantal hemiarch is very rare. The unfamiliarity of the medical fraternity with this congenital malformation can easily be mistaken for an acute fracture, chronic infection or inflammatory disease. We present our experience of managing an adult who presented with neck pain after a motor vehicle accident. Radiological investigation revealed congenital fusion of the odontoid process to the atlantal hemiarch. The prevalence, embryology and clinical significance of this anomaly are discussed. As the natural progression of this anomaly is not well documented, we suggest periodic follow-up to monitor the progression of degenerative changes and instability of the occipitoatlantal junction.
Fulltext A Rare Incidence of Breakage of tip of Micropituitary Forceps during Percutaneous Discectomy - How to Remove it: A Case Report

Sureisen M, Tan BB, Teo YY, Wong CC

Malays Orthop J, 2015 Nov;9(3):58-60.
PMID: 28611913 MyJurnal DOI: 10.5704/MOJ.1511.009

Breakage of the tip of the micropituitary forceps during spine surgery is a rare occurrence. Retrieval of the broken tip could be a challenge in minimally invasive surgeries due to limitation of access and retrieval instruments. We describe our experience in handling such a situation during percutaneous radiofrequency discectomy. The removal was attempted, without converting into open surgery, by utilising percutaneous endoscopic lumbar discectomy working cannula and guided by image intensifier. We were able to remove the fragment without any significant morbidity to the patient. This technique for removal has not been reported previously in the literature.
Fulltext Radiological assessment of cervical lateral mass screw angulations in Asian patients

Sureisen M, Saw LB, Wei Chan CY, Singh DA, Kwan MK

Indian J Orthop, 2011 Nov;45(6):504-7.
PMID: 22144742 DOI: 10.4103/0019-5413.87118

BACKGROUND: Various lateral mass screw fixation methods have been described in the literature with various levels of safety in relation to the anterior neurovascular structures. This study was designed to radiologically determine the minimum lateral angulations of the screw to avoid penetration of the vertebral artery canalusing three of the most common techniques: Roy-Camille, An, and Magerl.
MATERIALS AND METHODS: Sixty normal cervical CT scans were reviewed. A minimum lateral angulation of a 3.5 mm lateral mass screw which was required to avoid penetration of the vertebral artery canal at each level of vertebra were measured.
RESULTS: The mean lateral angulations of the lateral mass screws (with 95% confidence interval) to avoid vertebral artery canal penetration, in relation to the starting point at the midpoint (Roy-Camille), 1 mm medial (An), and 2 mm medial (Magerl) to the midpoint of lateral mass were 6.8° (range, 6.3-7.4°), 10.3° (range, 9.8-10.8°), and 14.1° (range, 13.6-14.6°) at C3 vertebrae; 6.8° (range, 6.2-7.5°), 10.7° (range, 10.0-11.5°), and 14.1° (range, 13.4-14.8°) at C4 vertebrae; 6.6° (range, 6.0-7.2°), 10.1° (range, 9.3-10.8°), and 13.5° (range, 12.8-14.3°) at C5 vertebrae and 7.6° (range, 6.9-8.3°), 10.9° (range, 10.3-11.6°), and 14.3° (range, 13.7-15.0°) at C6 vertebrae. The recommended lateral angulations for Roy-Camille, Magerl, and An are 10°, 25°,and 30°, respectively. Statistically, there is a higher risk of vertebral foramen violation with the Roy-Camille technique at C3, C4 and C6 levels, P < 0.05.
CONCLUSIONS: Magerl and An techniques have a wide margin of safety. Caution should be practised with Roy-Camille's technique at C3, C4, and C6 levels to avoid vertebral vessels injury in Asian population.