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Biomedical subjects

R Uppal

Publications and source records attributed to R Uppal.

At least 19 recordsLinked to original sources
PubMed2004

Telemedicine for multidisciplinary lung cancer meetings.

According to recent UK guidelines on the management of lung cancer, all cases should be reviewed prospectively by a lung cancer multidisciplinary team (MDT) and a thoracic surgeon should be readily available to liaise with the MDT. However, there is a shortage of thoracic surgeons in the UK. Over a one-year period, 28 MDT meetings were held at a district general hospital in Southend, at which 62 patients were presented to a tertiary cardiothoracic centre in London, 80 km away, via ISDN videoconferencing at 384 kbit/s. The annual resection rate increased by 30% following the introduction of the telemedicine MDTmeetings, and the mean time from first being seen in the clinic to surgery was reduced from 69 to 54 days.We estimate that the telemedicine meetings saved over three working weeks of thoracic surgical time during the year.

England↗
PubMed2001

Concomitant off-pump myocardial revascularization and pheochromocytoma resection.

Surgical management of patients with coexisting ischemic heart disease and pheochromocytoma remains challenging. We present one such case in which hybrid myocardial revascularization (angioplasty with stenting and off-pump coronary artery bypass grafting) and resection of pheochromocytoma were undertaken. Unusual features included simultaneous coronary artery surgery and tumor resection and, in particular, coronary artery surgery being performed without cardiopulmonary bypass.

Adrenal Gland Neoplasms↗
PubMed2001

Cleft lip and palate management by U.K. consultant oral and maxillofacial surgeons: a national survey.

OBJECTIVE: Following the report of the Clinical Standards Advisory Group (CSAG), a national survey of U.K. consultant oral and maxillofacial surgeons was performed to determine the current cleft lip and palate practice of this group prior to the implementation of proposed radical changes in the delivery of cleft services. The views of these surgeons regarding the proposed changes was also sought. DESIGN: An anonymous postal questionnaire sent to all 266 consultants in the U.K., which requested information on the practice of cleft surgery during a defined 1-year period (March 1997 through February 1998). It included the numbers and types of procedures performed, the involvement of multidisciplinary care, research and audit activity, and questions regarding the implementation of CSAG. RESULTS: One hundred ninety-one replies (72% response rate). Seventy-three surgeons were actively involved with mainly secondary cleft surgery. A varied number and range of procedures were undertaken, with most surgeons performing less than five of each procedure per year. Audit and research activity was 26%. The majority of both noncleft and cleft surgeons agreed with proposals made by CSAG (except for cleft osteotomy procedures). CONCLUSIONS: In the U.K. at present, there are many oral and maxillofacial surgeons performing mainly secondary cleft surgery; overall, the number of procedures performed by these surgeons per year is small. Intraspecialty referral is suggested to further improve patient outcome.

Alveoloplasty↗
PubMed2001

Do oral flora colonize the nasal floor of patients with oronasal fistulae?

OBJECTIVE: To determine if oral bacteria colonize the cleft nasal floor in patients with unilateral oronasal fistula when compared with the unaffected nasal floor and whether the results obtained would be of benefit in assessing oronasal fistulae in the clinic. DESIGN: Prospective study of 26 patients with cleft palate and unilateral oronasal fistula. Microbiological culture swabs were taken from the mouth and nasal floors of patients. The unaffected nasal floor was used as a control. Bacterial isolates were identified and compared in the laboratory by a senior microbiologist. MAIN OUTCOMES MEASURE: A significant growth of oral bacteria from the cleft nasal floor when compared with the unaffected nasal floor. RESULTS: Four patients were excluded because no growth was found on any culture plate. In the remaining 22 cases, a light growth of oral flora was found in the cleft nasal floor in only 3 patients. No statistical correlation between culture of oral bacteria and the cleft nasal floor could be found (p =.12). CONCLUSIONS: The relative lack of colonization of the cleft nasal floor by oral bacteria may reflect poor transmission of bacteria through the fistula, competition with commensal nasal flora, or an inability of oral bacteria to survive in a saliva-depleted area. The investigation is not helpful in the assessment of oronasal fistulae in the clinic.

Adolescent↗
PubMed2000

Effect of oral magnesium supplementation on blood pressure, platelet aggregation and calcium handling in deoxycorticosterone acetate induced hypertension in rats.

OBJECTIVE: To study the effect of oral magnesium supplementation on blood pressure, platelet aggregation and platelet calcium handling in deoxycorticosterone acetate (DOCA)-induced hypertension in rats. DESIGN AND METHODS: Rats were divided into four groups of 20 each. Drug treatments were given for a 6-week period. Control rats were vehicle treated. In the second group, DOCA, 15 mg/kg, was injected subcutaneously twice weekly with 1% NaCl used instead of drinking water. The third group was given magnesium oxide (MgO), 1 g/kg daily, orally by gavage. The fourth group was given MgO along with DOCA and 1% NaCl. Blood pressure and heart rate were measured weekly. Platelet aggregation, intracellular calcium, calcium uptake and calcium efflux studies were performed at the end of sixth week. Serum magnesium concentration, plasma levels of reactive nitrogen intermediates (RNI) and citrulline were also measured RESULTS: There was a significant rise in blood pressure in the DOCA-treated rats. Magnesium prevented the gradual rise in blood pressure when given along with DOCA, but had no effect in normotensive rats. Heart rate did not show any significant change. Platelet aggregation was significantly reduced in all the treatment groups compared to the control group. DOCA treatment produced a significant increase in the intracellular calcium concentration as well as the calcium uptake compared to the control group. Magnesium supplementation inhibited the increased intracellular calcium concentration and calcium uptake in DOCA-treated rats. RNI and citrulline levels were elevated in all the treatment groups. Serum magnesium levels were significantly higher in the magnesium-treated and DOCA plus magnesium-treated rats. CONCLUSIONS: Magnesium supplementation prevents blood pressure elevation in DOCA hypertensive rats. These effects are associated with inhibition of platelet calcium uptake and decreased intracellular free calcium concentration.

Administration, Oral↗
PubMed1999

Partial cardiomyectomy--an animal model of gastro-oesophageal reflux.

Various procedures have been adopted to provide experimental models of gastro-oesophageal reflux. Although some procedures have produced better results than others, previous literature does not assert that experimental gastro-oesophageal reflux can be produced reliably in all animals. This study attempts to compare two procedures to produce a working model of gastro-oesophageal reflux in the rabbit: (i) cardiomyotomy and (ii) cardiomyectomy. The animals underwent intraoesophageal pH monitoring one week before and one week following surgery. The mean changes in % reflux time from preoperative to one week postoperative were compared. The cardiomyotomy group did not demonstrate significant gastro-oesophageal reflux (p > 0.2, p < 0.5), the mean change in % reflux time was 10.5 +/- 14.11%, whereas the cardiomyectomy group did demonstrate significant reflux (p < 0.001) with a mean change in % reflux time of 22.35 +/- 3.05%. A further study investigated the cardiomyectomy procedure in ten rabbits. Animals underwent preoperative, one-week and four-week postoperative intraoesophageal manometry and pH studies. The mean change in values from preoperative to four weeks postoperative were compared. There was a significant increase in mean % reflux time from a preoperative value of 3.05 +/- 2.29% to 42.08 +/- 12.05% at four weeks after surgery (p < 0.001). There was also a significant decrease in mean basal LOS pressure from a preoperative value of 15.00 +/- 5.49 mmHg to 4.45 +/- 1.90 mmHg four weeks following surgery (p < 0.001). This study showed that cardiomyectomy alone produces effective gastro-oesophageal reflux in the rabbit, and thus provides an experimental model to test the effectiveness of antireflux procedures.

Animals↗
PubMed1998

Adverse drug reactions to fluoroquinolones at a tertiary care hospital in northern India.

Use of fluoroquinolones has increased considerably in the last 5-6 years in our hospitals. With a view to ascertain their safety and the type of adverse drug reactions (ADRs) in our population, spontaneous reports were collected and analysed to ciprofloxacin (the most prescribed fluoroquinolone in our hospital) over a period of three and a half years. The pattern of reactions were rash in 18, severe reactions like Steven Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in 4, gastritis and diarrhoea in 3, shivering and rigors in 2, hemorrhagic purpuric spots in 2 and oedema of eye and lids with topical application in 1 patient. Most cases recovered on stoppage of the drug and symptomatic treatment. However, one case of SJS and one of TEN proved fatal. Care needs to be exercised in their use and they do not appear to be innocuous to severe and disturbing ADRs.

Adolescent↗
PubMed1997

Re-do cardiac surgery in patients over 70 years old.

OBJECTIVE: This study was conducted in order to determine the outcome of cardiac re-operations in patients over the age of 70. METHODS: All patients who underwent 're-do' cardiac surgery at our institution, between January 1987 and October 1995 were identified. The case notes of patients over the age of 70 were reviewed retrospectively and follow-up was by telephone. RESULTS: A total of 687 re-do operations were performed during this 8 years and 9 months period. Operations, 110 (16%) were on patients aged 70 years and over (CABG 54, MVR 32, AVR 9, AVR + MVR 5, MVR + CABG 4, AVR + CABG 3, repair of paraprosthetic leak 2 and closure of VSD 1). Operations, 63 (57%) were elective and 42 (38%) were urgent. The median age was 73 years (range 70-82) and 64 patients (58%) were male. Pre-operatively, 78 patients (72%) were NYHA functional class III/IV and 55 (50%) had angiographically impaired left ventricular function (ejection fraction < 50%). The overall operative mortality was 7% (8/110). Median ITU stay was one night (range 1-21) and hospital stay was 7 days (range 5-35). Major in-hospital complications included resternotomy in five patients (5%), permanent stroke in three (3%), renal failure requiring haemodialysis in two (2%) and heart block requiring permanent pacing in two (2%). At a median follow-up of 34 months (range 2-101), 69 of the 77 patients alive at follow-up (90%) were NYHA functional class I/II. CONCLUSIONS: 'Re-do' cardiac surgery in patients over the age of 70 carries an acceptable operative morbidity and mortality with a good functional improvement at medium term follow-up.

Aged↗
PubMed1997

A surgical approach to coexistent coronary and carotid artery disease.

OBJECTIVE: To assess the early results of combined coronary artery bypass graft surgery and carotid endarterectomy. DESIGN: Retrospective and ongoing analysis of patients who underwent combined coronary artery bypass graft surgery and carotid endarterectomy. SETTING: Cardiothoracic unit in a London teaching hospital. PATIENTS: From June 1987 to March 1995, 64 patients were identified. They were patients who were scheduled to have coronary artery bypass graft surgery or required urgent coronary revascularisation and who were found to have significant coexistent carotid disease. (Unilateral carotid stenosis > 70%, bilateral carotid stenosis > 50%, or unilateral carotid stenosis > 50% with contralateral occlusion.) INTERVENTIONS: Both procedures were performed during one anaesthesia: the carotid endarterectomy was performed first without cardiopulmonary bypass. After completion of carotid endarterectomy, coronary artery bypass graft surgery was performed. MAIN OUTCOME MEASURES: The incidence of stroke, transient ischaemic attack, and myocardial infarction in the early postoperative period was analysed. RESULTS: Myocardial revascularisation was successful in all 64 patients. There were no perioperative infarcts. In three patients (4.7%) a new neurological deficit developed postoperatively: two recovered fully before hospital discharge. CONCLUSIONS: Combined coronary artery bypass graft surgery and carotid endarterectomy were performed safely and with good results.

Aged↗
PubMed1994

Right thoracotomy for reoperative right coronary artery bypass procedures.

The use of a right thoracotomy is a safe alternative approach for reentering the mediastinum for reoperative right coronary artery bypass grafting. This technique was used in 9 patients and allowed minimal dissection, reducing the risks of hemorrhage and injury to previously placed patent grafts. Cardiopulmonary bypass was used in 4 patients in whom myocardial protection was accomplished with systemic hypothermia. Right atrial cannulation provided adequate venous return, with arterial inflow established via the femoral artery (n = 2) or ascending aorta (n = 2). In 5 patients, revascularization was accomplished by temporary coronary artery occlusion without cardiopulmonary support. There were no deaths, and postoperative recovery was not delayed. Postoperative chest drainage (mean +/- standard deviation, 1,076 +/- 718 mL) was significantly less (p < 0.01) than redo median sternotomy (1,352 +/- 602 mL) in a similar population. Eight of 9 patients remain free of angina 29 +/- 24.8 months postoperatively.

Aged↗
PubMed1994

Unifocal Langerhans' cell histiocytosis (eosinophilic granuloma) resembling Ewing's sarcoma.

In a 9 year old boy, a destructive lesion in the diaphysis of the right femur was wrongly diagnosed as a Ewing's sarcoma on the basis of the radiologic findings and fine needle aspiration cytology report. The clinical and radiologic picture was suggestive of Ewing's sarcoma, but an open biopsy of the lesion revealed a histopathological pathological picture of eosinophilic granuloma. A brief review of the literature is given, together with discussion on the differential diagnosis of a mid shaft femoral lesion in young patients.

Bone Diseases↗