GP Voice

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Morton’s Neuroma – is it a neuroma?

1st September, 2018, Dr Chee L Khoo

It would seem to me that just about every doctor who graduated from Australian medical schools know about Morton’s neuroma. It’s part of the long list of differential diagnoses of forefoot pain but either I have missed many or it’s not that common. I’m also not sure what else to do once diagnosed apart from referring to an orthopaedic surgeon.…

Lynch Syndrome – what GPs need to know

1st August, 2018, Dr Chee L Khoo

Although one third of patients with colorectal cancer (CRC) have a family history of cancer, only 5% of all patients with CRC have an identifiable cause to their cancer predisposition. Most of these identifiable predispositions are inherited mutations in genes that regulate growth processes in colonic stem cells and/or genome caretakers which ensure the only good clean DNA is passed on to the next generation. …

Tamsulosin for renal calculi – does it help?

July 15th 2018, Dr Chee L Khoo

Have you noticed that an increasing number of patients with renal stones discharged from emergency department are prescribed tamsulosin. It makes perfect sense, doesn’t it? Tamsulosin is an alpha blocker and by inhibiting the smooth muscles in the ureter, it facilitates the passage of stone into the bladder. Does it really? It’s logical but is there evidence that it works?…

Interventional Radiology – so many places you can stick a needle at!

July 1st, 2018, Spectrum Radiology

It’s absolutely amazing where and what they can inject or biopsy these days. The list is just mind boggling. Ok, not everyone is equipped and experienced to do those procedures. And the outcome does depend on the expertise of the operator. Have a look at the list of interventional procedures possible here.

Dr. Glen Schlaphoff and Associates, in collaboration with Spectrum Medical Imaging have established an integrated clinical service for interventional radiology. …

Tonsillectomy – do they affect future immunity?

July 1st, 2018, Dr Chee L Khoo

I am sure you have been asked by parents of young patients about to undergo tonsillectomy +/- adenoidectomy whether the removal of the tonsils will affect future immunity since the tonsils and adenoids are integral to the body’s immune response. I have had those questions asked of me and the answer used to be “Of course not.…

Smart intraocular pressure sensors – coming to a centre near you

June 1, 2018, Dr Chee L Khoo

Source: SENSIMED

We are all familiar with 24-hour BP monitor. We are also familiar with 24-hour Holter monitor and continuous glucose monitoring. We now have 24-hour intraocular pressure monitor. It doesn’t actually monitor intraocular pressure but the effects of it (a bit later). A recent study has now confirmed the association between the intraocular pressure monitoring and progression of glaucoma in older adults.…

Opioids or codeine not recommended? What do we do with patients with severe back and leg pains?

May 1, 2018 Dr Chee L Khoo

Chronic, persistent low back, lower extremity pain, and radicular pain may be secondary to disc herniation, disc disruption, disc degeneration, facet joint disease, spinal stenosis, or post lumbar surgery syndrome resulting in disc-related pain with or without radiculitis. The specificity and sensitivity of the symptoms and signs are low and therefore, not as reliable as we think in getting to the precise diagnosis.…

Smoking, alcohol, hot tea and oesophageal cancer – how are they related?

May1, 2018, Dr Chee L Khoo

We all know that smoking and alcohol are associated with increased risk of oesophageal cancer. A recent large study from China looked at 456,155 people and found 1731 esophageal cancers over 9.2 years. They noticed that there was an interaction of hot tea with smoking. Smokers who drank burning hot tea daily had double the risk of oesophageal cancer compared with non-smokers who only occasionally drank tea.…

Prostate Cancer – to screen or not to screen

April 15, 2018, Dr Chee L Khoo

Last fortnight we review the PI-RADS score in relation to prostate MRI and i thought we might go through a real case study and how it relates to general practice. Otherwise well 42 year old gentleman with no family history of prostate cancer or any other hormone related cancers presented for general check-up in 2011  in addition to the usual coughs and colds.…

Prostate MRI – A case study

A 60 year old man presents with a rising PSA despite several previously negative transrectal prostate biopsies. A prostate MRI demonstrates a circumscribed small region of low T2 signal intensity within the left lateral peripheral zone at the gland base. This region demonstrates moderately restricted water diffusion and avid early enhancement after intravenous contrast. This appearance is consistent with a region of high grade prostate cancer.…

A GP guide to understanding prostate MRI – the PI-RADS scoring system

April 2018, Dr Chee L Khoo

Forget about whether PSA screening saves lives or not. What is the next step when a PSA level comes back elevated. Obviously if the PSA is >10 or much higher, they need referral to a urologist for biopsies. What if it is trending high or is significantly higher than the age related reference range? Patients are increasingly having prostate MRIs performed the results are reported as PI-RADS scores.…

Glucocorticoid injection for spinal stenosis – who might benefit?

March 2018, Dr Chee L Khoo

Sometimes conclusions from a landmark scientific trial may be different from what we see in our own practice. The LESS trial (2014) found that epidural injection of glucocorticoids plus lignocaine offered minimal or no short-term (6 weeks) benefit as compared with epidural injection of lignocaine alone in the treatment of lumbar spinal stenosis (LSS). Yet, we all have some patients that have responded well to spinal injections.…

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