all things surgical
12th November 2018, Dr Chee L Khoo
Intraoperative floppy iris syndrome (IFIS) was first described by Chang and Campbell. It is characterised by floppiness of the iris, miosis and ultimately, iris prolapse through the surgical wounds. It can occur during surgery for cataract and if not anticipated, it increases the risk of posterior capsule rupture, vitreous loss, retained nuclear fragments, post op intraocular pressure spikes, irido-dialysis, hyphema and corneal endothelial loss.…
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.…
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. …
July 15th 2018, Dr Chee L Khoo
Have you noticed that an increasing n
umber 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?…
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. …
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.…
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.…
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.…
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.…
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.…
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.…
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.…