Biomedical subjects
Publications and source records attributed to G Sandhu.
Whitehead's varnish is a little known but excellent nasal packing agent. We review available literature on the historical aspects and clinical use of Whitehead's varnish. Our personal experience with Whitehead's varnish is described, and we strongly recommend its use.
Sialorrhoea can be a significant problem in both adults and children and can cause both physical and psychosocial problems. Botulinum toxin has enjoyed an emergence in the treatment of sialorrhoea, a systematic review of the evidence for botulinum toxin reveals two randomised controlled trials (RCTs) and four other trials that fulfilled our inclusion criteria. Both RCTs demonstrate the effectiveness of botulinum toxin in the management of sialorrhoea. There was no clear evidence for one antigenic type of botulinum toxin over another and minimal evidence for the optimal dose of botulinum toxin for each antigenic type. No advantage is conferred in using ultrasound guidance in injecting the glands. None of the RCTs or other studies directly compared submandibular versus parotid injection or directly compared botulinum toxin against surgery. Minor side effects were reported in one of the RCTs but overall botulinum toxin is a safe, minimally invasive and effective means in the treatment of sialorrhoea with the potential to become the treatment of choice. Our review demonstrates that further randomised controlled trials are required to more fully evaluate this new modality of treatment.
INTRODUCTION: Septal surgery has been identified as suitable for day-surgery, but is not widely performed as such. Guidelines for day-surgery state that the unexpected admission rate should be 2-3%. Previous audits have not achieved this figure and septoplasty is not universally considered suitable for day-surgery. We have reviewed practice over 4 years in our institution to identify surgical and patient factors associated with unexpected admission following septoplasty. PATIENTS AND METHODS: A retrospective case note based audit of day-case septoplasty procedures reviewed at the end of each year between October 1998 and October 2002. RESULTS: A total of 432 septal surgery procedures were performed, comprising 378 septoplasties and 54 submucous resections. Thirty-eight patients were admitted, overwhelmingly because of haemorrhage in the immediate postoperative period, giving an overall admission rate of 8.8% within the first 24 h. Factors associated strongly with re-admission were the use of intranasal splints, the performance of revision surgery, submucous resection (as opposed to septoplasty) and, less so, the performance of additional procedures and the peri-operative administration of diclofenac. There was no correlation between unexpected admission and grade of surgeon, surgical technique or any of the patient factors analysed. CONCLUSIONS: The unexpected admission rate of septal surgery performed at our unit is above that recommended for day-case procedures, but is within the range previously published. Patient satisfaction with day-case septoplasty has been shown to be high. We believe that septoplasty should be performed in this setting but there is a significant chance that patients may need admission, and a pathway should be in place for this to occur with minimal disruption to the patient.
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Practices vary across the UK on the use of topical preparation prior to flexible fibreoptic nasendoscopy. In this double-blind study, we randomised 98 patients to receive cophenylcaine or placebo nasal spray before flexible nasendoscopy. A visual analogue scale (1-100) was used to record pain, unpleasantness of taste and overall discomfort experienced. Overall, the procedure was associated with minimal pain and discomfort in both groups. There was no significant difference in pain or overall discomfort experienced between the two groups; however, the sensation of bad taste was significantly worse in the cophenylcaine group. In linear regression, factors that predicted the overall unpleasantness of the experience were primarily pain experienced and secondarily unpleasantness of taste. We conclude that the routine use of cophenylcaine for nasal preparation is not justified before flexible nasendoscopy.
We review the evidence that activation of the cerebral cortex can lead to movements of the vocal folds and possibly to cough. Electrical stimulation of the motor cortex can cause movements of the vocal folds and vocalizatioin, but cough has not been reported. The motor pathways are via the nucleus ambiguous and possibly the nucleus retroambuigualis in the brainstem. In humans, activation of the cerebral cortex by transcranial magnetic stimulation can cause motor potentials in the intrinsic laryngeal muscles and corresponding surface potentials. The relationships between the cortical sensation related to cough, the voluntary control of cough and the involvement of reflex pathways remain to be clarified.
A prospective non-randomized study was designed to investigate the effects of Celon radio-frequency thermo-ablation (RFTA) of the soft palate in patients with snoring/mild obstructive sleep apnoea. Ten patients, fulfilling various inclusion/exclusion criteria, underwent single operator sub-mucosal RFTA palatoplasty as an office procedure. Two separate procedures six weeks apart involved each patient receiving six distinct sub-mucosal lesions on each visit. Questionnaires including visual analogue scales (VAS) were used to evaluate post-operative pain and subjective snoring (scored by patient/partner). Polysomnography (PSG) was performed pre-operation and three months following the second procedure. Using non-parametric statistical analysis, a significant reduction in VAS snoring was noted from initial levels to those scored at six and 16 weeks in nine of 10 patients (p = 0.013 and p = 0.007 respectively). (Five of these nine showed a greater than 50 per cent reduction in score). Objectively, six of 10 patients had a reduction in the apnoea-hypopnea Index between the two PSGs, (four of these six showed a greater than 50 per cent reduction) however, this was not statistically significant. Subjective assessment of the PSG snoring signal by the senior author showed eight of 10 patients had either a reduced or much reduced signal at four months. VAS pain confirmed both procedures are well tolerated with minimal analgesia requirements. Minor complaints of transient mild palatal swelling, dry throat, catarrh and referred otalgia were noted and one patient developed mucosal ulceration following both procedures that healed within three weeks. Swallowing and speech were unaffected. These results confirm similar findings using the Somnus Unit, although the Celon device provides additional advantages including inherent safety in a bipolar electrode tip, auto-stop energy application and reduced procedure time.
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In the following study we examined the combined effect of chronic alcohol administration and anti-hypertensive drug treatment in spontaneously hypertensive rats (SHR). SHR were fed alcohol for six weeks while taking the angiotensin converting enzyme (ACE) inhibitor lisinopril. After six weeks, protein synthesis rates, contractile protein levels and protease activities were examined in control; alcohol; control+lisinopril; alcohol+lisinopril groups. Lisinopril treatment significantly reduced left ventricular mass, protein content and contractile proteins in control rats, but these effects were not as pronounced in alcohol+lisinopril rats. Protein synthesis rates in both mixed and myofibrillar fractions were not significantly different in any of the 4 groups. The enzyme activities of the proteases cathepsin D and dipeptidyl aminopepetidase I increased in control+lisinopril rats, however, this effect was not evident in alcohol+lisinopril rats. Contractile proteins identified by one-dimensional electrophoresis showed that lisinopril treatment reduced all contractile proteins in control rats. However, in alcohol+ lisinopril rats, myosin heavy chain was higher than in control+lisinopril rats. In summary, alcohol ingestion impairs the regression of the hypertrophic myocardium in SHR on ACE-inhibitor treatment, which was reflected by altered protein metabolism. This study suggests that successful anti-hypertensive treatment may not be achieved if alcohol misuse is evident.
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We investigated whether the imposition of chronic alcohol in hypertension leads to greater biochemical and cellular abnormalities of the myocardium than those arising in normotension. Fifteen-week-old spontaneously hypertensive rats (SHR) and Wistar Kyoto (WKY) rats were fed ethanol-containing diets for six weeks. Particular attention was focused on the composition of contractile proteins identified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), fractional rate of protein synthesis, and synthesis rates relative to RNA (RNA activity) or DNA (cellular efficiency). In addition, myocardial enzymes and adenine nucleotides were measured. In both SHR and WKY rats chronic ethanol caused a general decrease in the contents of all nine contractile proteins with myosin heavy chain predominantly affected. Fractional rates of mixed (i.e., total) and myofibrillary proteins remained unaltered in both WKY rats and SHR, as were cellular efficiencies. The RNA activity was significantly reduced in ethanol-treated SHR but not in WKY rats. In ethanol-treated SHR, cardiac creatine kinase (CK) and malate dehydrogenase (MDH) activities were increased, AMP levels were elevated, whilst ATP levels and the energy charge were reduced. In WKY rats, the only significant change related to increased aspartate aminotransferase activities in response to alcohol feeding. Although there were only subtle differences between the response of the normotensive and hypertensive rats due to ethanol dosage, the reduced ATP levels and increased CK and MDH activities in SHR may reflect a greater susceptibility to ischaemic damage. Reduced contractile protein content, particularly myosin heavy chain, may contribute to contractile defects, a common feature of subclinical and clinical alcoholic cardiomyopathy.
Endoscopes require repeated cleaning and application of anti-mist solution during surgery. A novel, simple and inexpensive method of application of the anti-mist solution is described.
Tonsillectomy is a frequently performed surgical procedure. Problems arising in the early postoperative period will have an important impact on community and hospital resources. We determined the type of problems that occur and the way these problems are managed. We monitored 203 patients undergoing routine tonsillectomy by a postoperative telephone survey and contacted their general practitioners, 164 in all. We found 46% of the patients experienced problems post-discharge which led to early contact with a doctor. Infection was identified in 26% and secondary haemorrhage in 11%. Common symptoms associated with the prescribing of antibiotics were sore throat (74%) and secondary haemorrhage (41%). Each GP saw, on average, 2.4 post-tonsillectomy patients per annum. The diagnosis of post-tonsillectomy infection is difficult. This was reflected in the wide variation of clinical features used to diagnose post-tonsillectomy infection by doctors. The vast majority (95%) of GPs expressed a desire for a framework for treating post-tonsillectomy complications.
A case of acute airway obstruction due to an acute retropharyngeal haematoma secondary to indirect trauma as a first presentation of metastatic prostatic adenocarcinoma is described.
BACKGROUND: There has been no previous work investigating the effects of furred pet ownership and pillow type on the risk of developing rhinitis. Recently, unexpected and unexplained associations of asthma with nonfeather pillows have been reported. OBJECTIVE: We developed a questionnaire-based cross-sectional survey to determine whether the past or present ownership of cats or dogs, or the use of nonfeather pillows contributes to the development of seasonal or perennial rhinitis. METHODS: We surveyed 2555 accompanying friends and relatives of patients attending the outpatients departments at one London hospital in 1996. Individuals with rhinitis were defined as those suffering with three or more symptoms of rhinitis either throughout the year (perennial) or for part of the year (seasonal). Present or childhood ownership of cats or dogs was recorded. RESULTS: A strong association was seen with nonfeather pillow use and both seasonal [odds ratio (OR) 1.85; 95% confidence interval (CI) 1.43-2.5] and perennial (OR 2.63; CI 1.67-5. 0) rhinitis. However, more than one-third of rhinitics had changed their pillow type. After restricting the data to exclude subjects who changed their pillow to avoid allergies, the strong association of nonfeather pillow use with perennial rhinitis remained (OR 2.44; CI 1.25-5.0). Adjusting the data to the extreme situation where all former pillow type was feather changes the apparent risk to 0.99 (CI 0.67-1.43). No associations for either seasonal or perennial rhinitis were seen for feather pillows. A weak association of current dog ownership is demonstrated for seasonal rhinitis (OR 1. 47; CI 1.01-2.14). No associations were seen for childhood dog ownership or cat ownership at any time with either type of rhinitis. CONCLUSIONS: Feather pillow use and the ownership of furred pets appears unlikely to increase the risk of developing perennial or seasonal rhinitis. In fact, in contrast with currently held views, there is evidence that the use of nonfeather pillows may increase the risk.
We have previously described the patterns of stress kinase activation in rat kidney and heart in response to ischemia/reperfusion (Yin et al., 1997, J. Biol. Chem. 272, 19943-19950). During the course of these studies, we observed the activation of a novel kinase capable of phosphorylating c-Jun on serines 63 and 73. The molecular weight of this kinase is approximately 37 kD, significantly below the molecular weight of all previously identified Jun N-terminal kinase (JNK) isoforms. The pattern of activation of this 37 kD kinase in response to ischemia/reperfusion in both kidney and heart is distinct from that of known JNK isoforms. Western analysis of human renal proximal tubular epithelial (RPTE) cells, using a non-isoform specific phospho-JNK antibody, revealed the phosphorylation (activation) of a 37 kD protein in response to hypoxia. The 37 kD protein in RPTE cells is phosphorylated by other stress stimuli capable of activating JNK. Western analysis of tissues, using a non-isoform specific JNK antibody, identifies a cross-reactive 37 kD protein expressed in the liver, thymus and lymph node which is likely to correspond to the 37 kDa stress-activated kinase. The results of this study have led to the identification of a potentially novel kinase closely related to JNK but showing a distinct pattern of activation.