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Medical Digest April May June 2012

Medical Digest April May June 2012

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Medical Digest April May June 2012
Medical Digest April May June 2012

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Categories:Types, Brochures
Published by: Tan Tock Seng Hospital on Oct 19, 2012
Copyright:Attribution Non-commercial

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02/18/2013

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MICA (P) 127/05/2012
 Apr.May.Jun 2012
contents
1 SURGERY FOR FOOT & ANKLE DEFORMITIES11 TO BARE OR NOT TO BARE13 BARRIERS TO HEALTH CARE FACED BY FOREIGN WORKERS17 DABIGATRAN AND RIVAROXABAN: THE EVIDENCE BEHIND THE NEWER ANTICOAGULANTS25 RADIOLOGY QUIZ28 ECG QUIZ
 
Medical
digest
 Apr.May.Jun 2012
From The Editor
Dr Leong Khai Pang
EDITOR
Medical Digest
I stand by what I wrote in this column in the July-September 2005 issueo Medical Digest. I said that the most important quality o a doctor is hisor her ethics and moral character.I shall reveal what I have learnt is the second most important. It isortitude or persistence under adversity. It is seductive to always takethe easy out. We transer the care o dicult patients (either medicallyor temperamentally, or both) to other doctors. We order 20 tests and5 scans to arrive at the diagnosis rather than work through the datarom the history and examination. We resign rom our work when weencounter diculty with our colleagues or administrators. We becomebitter when we are not happy with the prevailing culture, but we donothing to make things better, except being a gadfy.Being a doctor is never easy; being a very good doctor is even harder.Being able to work through diculty, to trust that the solution will revealitsel sooner or later, and to constantly keep our eye on the desiredoutcome is a great personal strength.I think that we must decide rom the outset what we want to achieveas a doctor. This objective may be achieved in public service or privatepractice. Frittering away our time on picayune or constantly working inour job and not on it are good ways to lose sight o our long-term goals.We should not alter course just because we encounter some hardship.Similarly, we should not game the system and turn our back to it ater wehave gained what we wanted.Do we speak up constructively when we see that things are wrong?Do we set an example o strength and consistency or our colleaguesand juniors? Do we require our sta to take on hardship that we willnever bear ourselves? Do we only love patients and colleagues who arelovable? Who will love the ugly and the dicult? When we are old andgray, when we meet ormer colleagues or coee and kaya toast, dowe regret the opportunities wasted, deeds undone or words unsaid?Or do we triumph over disasters averted, wrongs righted or hypocrisyexposed?Make a dierence. Stand up and be prepared to slug it out. Be a gooddoctor.
 ANSWER
The denitive diagnosis is ventricular tachycardia.Let’s look at the telemetry strips. There are usion beats in the top 2 strips(1st, 9th 10th complexes rom the let in the top strip, 3rd, 4th, 14th and 15thcomplexes in the second strip). There is also a capture beat with a P wavepreceding a narrow complex QRS in the third strip (8th complex). These eaturesare consistent with ventricular tachycardia.The patient’s cardiac rhythm reverted to sinus ater direct-current cardioversion(above).
Dr David Foo is the Head of theDepartment of Cardiology, Tan Tock SengHospital.
MEDICAL DIGEST
29:
 
MEDICAL DIGEST
1:
Medical Progress
CASE 1
This is a 52-year-old bus driver who presented with bilateral eet deormity which has been progressively worsening overthe past 3 years (gure 1).
Surgery or Foot
 Ankle Deormities
Deormity correction is a complex yet rewarding surgical challenge. Deormities o the oot and ankle pose aneven greater challenge to the orthopaedic surgeon given the wide-ranging causes and the progressive natureo some o them. An in-depth understanding o the bony, muscular and ligamentous relationships o the oot and ankle is requiredto tackle these deormities. With better knowledge o the conditions causing the deormities and with the advento newer implants, we are now able to achieve very satisactory surgical results.Patients with oot and ankle deormities may present with pain, diculty with ootwear and walking, ulceration orsimply a ‘unny-looking oot’. Given the plethora o conditions that can cause deormities o the oot and ankle,we approach the problem by determining the cause o the deormity through a sound history. This is ollowedby a detailed examination to assess the mobility o the joints, the sot tissue status and the neurovascular statuso the oot.I present a ew cases that illustrate the commoner conditions that present with deormity o the oot and ankle.
Figure 1. Deormity o the eet o a 52-year-old driver.Figure 2. Posterior view o the eet, showing hindoot valgus deormity.

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