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Abstract
The objective of this blinded randomized trial was to compare five sets of bipolar forceps, both single use and reusable, and discuss their potential role in postoperative complications. An animal tissue experiment was set up with standardized parameters. Results indicate larger tips give larger burns. We also found that some forceps gave suboptimal burns.
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Affiliation(s)
- S K Nadig
- Department of ENT, York District Hospital, Wigginton Road, York, UK.
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52
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Uppal S, Nadig S, Smith L, Coatesworth AP. A cost-effectiveness analysis of conventional and nurse-led telephone follow-up after nasal septal surgery. Ann R Coll Surg Engl 2004; 86:243-6. [PMID: 15239863 PMCID: PMC1964214 DOI: 10.1308/147870804515] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The need to bring down costs while maintaining a high standard of care has led to the expansion in the role of nurses in recent years. METHODS We present results of cost-effectiveness analysis of conventional and nurse-led telephone follow-up after nasal septal surgery. RESULTS AND CONCLUSIONS Our results indicate that the substitution of nurse-led telephone follow-up for conventional out-patient follow-up has the potential for substantial cost reduction and decreased out-patient access times in the NHS.
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Affiliation(s)
- S Uppal
- Department of Otolaryngology, Head and Neck Surgery, York Hospital, Wigginton, York YO31 8HE, UK
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53
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Uppal S, Nadig S, Jones C, Nicolaides AR, Coatesworth AP. A prospective single-blind randomized-controlled trial comparing two surgical techniques for the treatment of snoring: laser palatoplasty versus uvulectomy with punctate palatal diathermy. ACTA ACUST UNITED AC 2004; 29:254-63. [PMID: 15142071 DOI: 10.1111/j.1365-2273.2004.00810.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The aim of this study was to compare laser palatoplasty with uvulectomy with punctate palatal diathermy as treatment modalities for snoring. The study design was a prospective, single-blind, randomized-controlled trial. Eighty-three patients entered the trial. After a mean follow-up period of more than 18 months there was no statistically significant difference between the two groups regarding the patient perception of benefit from surgery or the subjective improvement in snoring. However, there was a statistically significant difference in the degree of pain in the immediate postoperative period (mean difference = 22.14, 95% CI = 7.98-36.31, P = 0.003), with the pain being worse in the laser palatoplasty group. Relative risk of complications for laser palatoplasty was 1.42 (95% CI = 0.93-2.17). The snoring scores and Glasgow Benefit Inventory scores decreased with time in both the groups but there was no statistically significant difference between the two groups.
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Affiliation(s)
- S Uppal
- Department of Otolaryngology, Head and Neck Surgery, York Hospital, York, UK.
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54
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Abstract
We describe a rare case of benign inflammatory pseudotumour of the parotid gland. The literature concerning this condition is discussed.
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Affiliation(s)
- M W Mielcarek
- Department of Otolaryngology, York District Hospital, Wigginton Road, York, UK
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55
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Kocienski P, Bell R, Bourque E, Christopher JA, Cooksey J, Gunn A, Kuhl A, Li Y, Uppal S, Yuen J. Synthetic applications of planar chiral cationic η3-allylmolybdenum complexes. PURE APPL CHEM 2004. [DOI: 10.1351/pac200476030477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The synthesis of planar chiral η3-allylmolybdenum complexes is described together with some examples of the nucleophilic addition of organocopper(I) reagents.
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Affiliation(s)
- P. Kocienski
- 1Department of Chemistry, Leeds University, Leeds LS2 9JT, UK; Department of Chemistry, Glasgow University, Glasgow G12 8QQ, UK; GlaxoSmithKline Research and Development, Medicines Research Centre, Stevenage, Hertfordshire SG1 2NY, UK
| | - Richard Bell
- 1Department of Chemistry, Leeds University, Leeds LS2 9JT, UK; Department of Chemistry, Glasgow University, Glasgow G12 8QQ, UK; GlaxoSmithKline Research and Development, Medicines Research Centre, Stevenage, Hertfordshire SG1 2NY, UK
| | - Elyse Bourque
- 1Department of Chemistry, Leeds University, Leeds LS2 9JT, UK; Department of Chemistry, Glasgow University, Glasgow G12 8QQ, UK; GlaxoSmithKline Research and Development, Medicines Research Centre, Stevenage, Hertfordshire SG1 2NY, UK
| | - J. A. Christopher
- 1Department of Chemistry, Leeds University, Leeds LS2 9JT, UK; Department of Chemistry, Glasgow University, Glasgow G12 8QQ, UK; GlaxoSmithKline Research and Development, Medicines Research Centre, Stevenage, Hertfordshire SG1 2NY, UK
| | - John Cooksey
- 1Department of Chemistry, Leeds University, Leeds LS2 9JT, UK; Department of Chemistry, Glasgow University, Glasgow G12 8QQ, UK; GlaxoSmithKline Research and Development, Medicines Research Centre, Stevenage, Hertfordshire SG1 2NY, UK
| | - Andrew Gunn
- 1Department of Chemistry, Leeds University, Leeds LS2 9JT, UK; Department of Chemistry, Glasgow University, Glasgow G12 8QQ, UK; GlaxoSmithKline Research and Development, Medicines Research Centre, Stevenage, Hertfordshire SG1 2NY, UK
| | - Alexander Kuhl
- 1Department of Chemistry, Leeds University, Leeds LS2 9JT, UK; Department of Chemistry, Glasgow University, Glasgow G12 8QQ, UK; GlaxoSmithKline Research and Development, Medicines Research Centre, Stevenage, Hertfordshire SG1 2NY, UK
| | - Y. Li
- 1Department of Chemistry, Leeds University, Leeds LS2 9JT, UK; Department of Chemistry, Glasgow University, Glasgow G12 8QQ, UK; GlaxoSmithKline Research and Development, Medicines Research Centre, Stevenage, Hertfordshire SG1 2NY, UK
| | - S. Uppal
- 1Department of Chemistry, Leeds University, Leeds LS2 9JT, UK; Department of Chemistry, Glasgow University, Glasgow G12 8QQ, UK; GlaxoSmithKline Research and Development, Medicines Research Centre, Stevenage, Hertfordshire SG1 2NY, UK
| | - Josephine Yuen
- 1Department of Chemistry, Leeds University, Leeds LS2 9JT, UK; Department of Chemistry, Glasgow University, Glasgow G12 8QQ, UK; GlaxoSmithKline Research and Development, Medicines Research Centre, Stevenage, Hertfordshire SG1 2NY, UK
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56
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Uppal S, Nadig S, Mielcarek MW, Smith L, Jose J, Coatesworth AP. Patient satisfaction with conventional and nurse-led telephone follow-up after nasal septal surgery. Int J Clin Pract 2003; 57:835-9. [PMID: 14686576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
The need to bring down costs while maintaining a high standard of care has led to the expansion in the role of nurses in recent years. We present results of an audit of patient satisfaction with conventional and nurse-led telephone follow-up after nasal septal surgery. Our results indicate that patient satisfaction with nurse-led telephone follow-up is significantly higher than conventional follow-up (p=0.001, two-tailed). More patients in the conventional follow-up group felt that a follow-up appointment with an ENT doctor was essential compared with the patients in the nurse-led telephone follow-up group (p<0.001, two-tailed). We conclude that nurse-led telephone follow-up avoids unnecessary outpatient appointments, while identifying patients who require further care. It makes more appointment slots available for patients with pressing clinical problems and has the potential to reduce outpatient access times in the NHS.
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Affiliation(s)
- S Uppal
- Department of Otolaryngology, Head and Neck Surgery, York Hospital, York, UK
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57
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Uppal S, Coatesworth AP. Neurofibromatosis type 2. Int J Clin Pract 2003; 57:698-703. [PMID: 14627181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Neurofibromatosis type 2 (NF2) is often not recognised as a distinct entity from peripheral neurofibromatosis. NF2 is a predominantly intracranial condition whose hallmark is bilateral vestibular schwannomas. NF2 results from a mutation in the gene named merlin, located on chromosome 22. The disease has a variable presentation, with the severe subtype having an early and rapid progression and the milder type having a later onset and a less aggressive course. The diagnosis and management of these patients present a unique challenge. There are also implications for the family members as half the cases are inherited. We discuss the genetic characteristics, clinical presentation, natural history, diagnostic criteria, investigations, screening and management of this condition.
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Affiliation(s)
- S Uppal
- Department of Otolaryngology, Head and Neck Surgery, York Hospital, York, UK
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58
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59
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Mistry H, Uppal S, Nadig S, Coatesworth A, Grace A. Remodeling of the temporal bone after involvement with Langerhans' cell histiocytosis. Acta Radiol 2003. [PMID: 12752013 DOI: 10.1034/j.1600-0455.2003.00077.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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60
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Uppal S, Aviv H, Patterson F, Cohen S, Benevenia J, Aisner S, Hameed M. Alveolar soft part sarcoma--reciprocal translocation between chromosome 17q25 and Xp11. Report of a case with metastases at presentation and review of the literature. Acta Orthop Belg 2003; 69:182-7. [PMID: 12769020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
The molecular pathogenesis of alveolar soft part sarcoma, a rare tumor with uncertain histogenesis, was elucidated recently and was shown to be due to a translocation between chromosome 17q25 and Xp11 resulting in a fusion product between TFE3 (a transcription factor gene) at chromosome Xp11 and a novel gene designated as ASPL at chromosome 17q25. This results in the transcriptional dysregulation in the pathogenesis of this neoplasm. Of the 12 cases reported so far, the translocation was due to non-reciprocal translocation in 11 cases with only one case demonstrating a reciprocal translocation with respective fusion products. We report yet another case with reciprocal translocation between chromosomes 17q25 and Xp11 with TFE3/ASPL fusion product who presented with metastatic disease. A standard cytogenetic analysis of primary tumor cells with G-banding revealed an abnormal karyotype: 46, X, t(X;17)(p11;q25)[15]/46,XX[5]. PCR analysis of the frozen tumor tissue revealed a type 1 fusion product as described in the literature. We demonstrate a rare cytogenetic abnormality in ASPS, namely reciprocal translocation between chromosomes 17q25 and Xp11 with demonstration of molecular fusion product between TFE3 and ASPL in a patient who initially presented with pulmonary metastases.
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Affiliation(s)
- S Uppal
- Department of Pathology, UMDNJ-New Jersey Medical School, UH-E-140, 150 Bergen Street, Newark, New Jersey 07103, USA.
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61
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Affiliation(s)
- S Uppal
- Department of Otorhinolaryngology and Head and Neck Surgery, Medway Maritime Hospital, Gillingham, Kent ME7 5NY
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62
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Ram S, Gupta R, Gaheer M, Uppal S. Prevalence of multidrug resistant organisms in an intensive care burn unit. Indian J Med Res 2000; 111:118-20. [PMID: 10935317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
During January to December, 1998, analysis of an outbreak of infections in the burn intensive care unit (BICU) of the hospital attached to the Dayanand Medical College, Ludhiana was carried out. A total of 868 clinical samples from 290 patients with more than 40 per cent thermal injury were investigated. These samples included 322 wound swabs, 325 blood and 221 urine samples. Bacterial pathogens were isolated from 80, 62 and 48 per cent samples of pus, blood and urine respectively. Among the nine different pathogens isolated, the more common were Pseudomona aeruginosa from pus, Staphylococcus aureus from blood and Escherichia coli from urine samples. Multidrug resistance was observed among these predominant pathogens. Identical drug susceptibility pattern was depicted by large number of isolates of Ps. aeruginosa, Staph. aureus, Esch. coli and Proteus mirabilis. Similar pathogens with identical drug sensitivity pattern were isolated from environmental samples of the BICU. The ongoing outbreak of hospital acquired infection (HAI) was significantly reduced after strictly adhering to the guidelines for control of HAI.
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Affiliation(s)
- S Ram
- Department of Microbiology, Dayanand Medical College & Hospital, Ludhiana
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63
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Uppal S, De PR. Oral presentation of an oesophageal mucosal tear. Postgrad Med J 1999; 75:615-6. [PMID: 10621906 PMCID: PMC1741388 DOI: 10.1136/pgmj.75.888.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Tears of the oesophageal wall following sudden forceful vomiting are well documented in literature. In Boerhaave's syndrome there is transmural rupture associated with complications including pneumothorax, pneumomediastinum, surgical emphysema and shock. In Mallory-Weiss syndrome mucosal tears are associated with haematemesis and shock. In neither of these conditions has intraluminal obstruction been described as an aetiological factor. We present a case with similar pathophysiology where oesophageal obstruction by a meat bolus followed by forceful vomiting led to an oesophageal mucosal tear and presentation of a band of oesophageal mucosa in the oral cavity. The patient did not develop any complications and made an uneventful recovery following conservative management.
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Affiliation(s)
- S Uppal
- Department of Otolaryngology, Queen's Hospital, Burton Hospitals NHS Trust, Burton upon Trent, Staffordshire, UK
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64
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Abstract
Forestier's disease (diffuse idiopathic skeletal hyperostosis) is characterized by extensive spinal osteophyte formation and endo-chondral ossification of paravertebral ligaments and muscles. Dysphagia in the setting of Forestier's disease is a rare and hence often unrecognized entity. The dysphagia is due to mechanical obstruction in the initial stages and later due to inflammation and fibrosis. Most of these patients are treated conservatively in the initial stages and later by excision of osteophytes through a lateral cervical approach. We present a case of dysphagia due to cervical osteophytes in the setting of Forestier's disease causing narrowing of the pharynx. The patient was treated surgically via a peroral-transpharyngeal route with excellent results.
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Affiliation(s)
- S Uppal
- Department of Otolaryngology, Royal Bolton Hospital, Lancashire, UK
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65
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Giri TK, Wali JP, Meena HS, Pande I, Uppal S, Kailash S. Sociodemographic characteristics of HIV infection in northern India. J Commun Dis 1995; 27:1-9. [PMID: 7636144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
134 patients testing positive for HIV antibody during the period 1986-1993 were included in the present study. An in-depth analysis of the subjects revealed that the adult males seemed to have the highest propensity for HIV infection in this part of the country. Marital status had no bearing on incidence and route of seropositivity. This was not so in females. Extramarital heterosexual contact was the mode of HIV acquisition in adults in contrast to blood transfusion in children. Clinically, most of these patients were still asymptomatic. At presentation, oral Candidiasis was common. Pneumocystis carinii pneumonia (PCP) was the leading cause of death.
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Affiliation(s)
- T K Giri
- Department of Medicine, All India Institute of Medical Sciences, New Delhi
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66
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Abstract
In a study of risk factors for cardiovascular disease in 2388 school children aged 9--12 years carried out in Westland, Holland, serum insulin levels at one hour after an oral challenge of 50 g glucose were measured in a systematically selected subsample of 715 children. The distribution and associations of serum insulin in these children are described. The mean insulin values were 24.6 muU/ml for boys and 32.0 muU/ml for girls. The difference between these means was statistically significant and remained so even taking measures of adiposity into account. Insulin values were positively related to levels of plasma sugar and systolic blood pressure in both sexes.
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67
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Florey CV, Uppal S, Lowy C. Relation between blood pressure, weight, and plasma sugar and serum insulin levels in schoolchildren aged 9-12 years in Westland, Holland. Br Med J 1976; 1:1368-71. [PMID: 1276694 PMCID: PMC1640120 DOI: 10.1136/bmj.1.6022.1368] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In 2388 schoolchildren aged 9-12 years who took part in a study of cardiovascular risk factors in Westland, Holland, plasma sugar concentrations were found to be positively correlated with systolic and diastolic blood pressure, independently of weight. Serum cholesterol levels were also related to systolic blood pressure in boys, but much less strongly than plasma sugar levels. The relation between serum insulin and blood pressure, independent of plasma sugar, was weak. The relation between plasma sugar and systolic pressure existed for both sexes and regardless of whether measurements were made in the morning or afternoon; its association with diastolic pressure was weaker, and was not so consistent over all groups. These findings suggest that the relations between risk factors for coronary heart disease that exist in adults are already evident in childhood.
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68
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du V Florey C, Uppal S, Lowy C. Hyperglycaemia; a risk factor for hypertension. Rev Epidemiol Sante Publique 1976; 24:313-9. [PMID: 1005857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The epidemiological evidence for an association between diabetes mellitus and ischaemic heart disease is reviewed briefly. The relationship between blood sugar after challenge and blood pressure is described, with particular reference to studies in populations of U.S. and Jamaican adults and Dutch children.
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