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.…

Statins and Muscles – worse than we think

March 15, 2018,  Dr Chee L Khoo

“Doc, my muscles feels tired every time I try to exercise”. Are these patients just unfit or is it the statin or is that just another excuse? Between 7-29% of patients on statins report muscle complaints (depending on who reports them). Often these symptoms are exacerbated with physical activity and exercises. Muscle soreness, muscle pains and muscle tenderness are probably relatively easier to quantify in patients but non-specific muscle fatigue are much harder to pin down.…

Metformin during pregnancy – Goldilocks principle strikes again!

March 15, 2018 Dr Chee L Khoo

Hyperglycaemia during pregnancy has significant metabolic consequences for the mother, the pregnancy as well as for the offspring’s future health. It is tempting to assume that keeping the glucose lower during pregnancy must be beneficial for both parties. Metformin has been used in women with PCOS, GDM and obesity during pregnancy in an attempt to improve pregnancy and foetal outcomes but this practice is not based on solid scientific evidence.…

INTERIM OPIOID TREATMENT ACCREDITATION COURSE

March 15, 2018
Dr Jenny James
General Practice Drug and Alcohol Advice and Support Service

The Opioid Treatment Accreditation Course is currently being restructured by the University of Sydney, Discipline of Addiction Medicine. The new format training is expected to commence by 1 June 2018.

As a measure to manage the waiting list for accreditation training,  an interim course is being be offered.…

VLCD may cause initial reduction in cardiac function

March 2018, Dr Chee L Khoo

Several meta-analyses of randomised clinical trials showed that ketogenic diets induce a long-term significant improvement in body weight, diastolic blood pressure, triglycerides and HDL-cholesterol, when compared to low fat diets. However, rapid weight loss may cause a transient rise in plasma triglycerides which can contribute to impairment in cardiac function in the short term.

The heart has a very high energy demand, which is met almost entirely by the mitochondrial oxidation of fatty acids and carbohydrates.…

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.…

D-dimer – how to use it correctly in general practice

March 2018, Dr Chee L Khoo

We all know a bit about d-dimer. We all know that it can be a useful marker for the diagnosis of venous thromboembolism (VTE). It can be used to guide the optimal duration of anti-coagulation in VTE. It is also useful in assessing the risk of recurrence in patients who already had a VTE event especially in patients with cancer.…

How to get lounge access when flying economy

March 2018, Dr Chee L Khoo

If you earn more than $76,000 per annum and you would like lounge access when flying economy overseas on the cheap, read on. I don’t know about you but I can only afford economy class when flying overseas. I can’t really justify spending 4 times the economy fare to be pampered. Really, I just need lounge access.…

Congenital Hip Dysplasia – how useful is the “click”?

February 2018, Dr Chee L Khoo

Congenital hip dysplasia (CDH)  is a common fear when we examine newborns. A clicky hip is a common reason for further investigations. CDH is actually not very common but how often does a clicky hip lead to a diagnosis of CDH? In other words, how useful is the “click”?

A 20-year prospective, longitudinal, observational study was undertaken to assess the relationship between the presence of a neonatal clicky hip and pathological CDH.…

To err is human… actually, it’s now manslaughter!

February 2018, Dr Chee L Khoo

I am sure you have read about Dr Bawa-Garba who was “thrown under the bus” by the system for her treatment of a 6 year old child with Down’s syndrome who died of sepsis while being treated in hospital. . There have been many discussions in UK and internationally about the ramifications of the court and tribunal’s decisions  but what can GPs in Australia learn from this case?…