DEVELOPMENTS IN THE USE OF THERMOLUMINESCENCE AND OPTICALLY STIMULATED LUMINESCENCE FROM MOBILE PHONES IN EMERGENCY DOSIMETRY.

Proposed physical dosimetry methods for emergency dosimetry in radiological, mass-casualty incidents include both thermoluminescence (TL) and optically stimulated luminescence (OSL). Potential materials that could feasibly be used for TL and OSL dosimetry include clothing, shoes and personal accessories. However, the most popular target of study has been personal electronics, especially different components from smartphones. Smartphones have been a focus because they are widely available and, in principle, may be viewed as surrogates for commercial TL or OSL dosimeters. The components of smartphones that have been studied include surface mount devices (such as resistors, capacitors and inductors) and glass materials, including front protective glass, display glass and (with more modern devices) back protective glass. This paper reviews the most recent developments in the use of TL and OSL with these materials and guides the way to future, and urgently needed, research.

A COMPARATIVE STUDY OF EPR AND TL SIGNALS IN GORILLA® GLASS.

Electron Paramagnetic Resonance (EPR) and Thermoluminescence (TL) signals have been studied in samples of Gorilla® Glass (GG) from different smartphones as well as some online stores and vendors. Background, radiation-induced and ultraviolet-induced signals were compared between the samples. Significant variability of both EPR and TL signals (in shape and intensity) was observed between samples from different screens as well as over the surface of the same screen, from the same phone. Both the EPR and TL background signals appear to be due to UV exposure during phone manufacture; some phones have higher EPR and TL signals around the edge of the screen, indicating more UV exposure at the edge than in the center. EPR and TL signals in the same GG samples appear correlated: they decayed over the same temperature region; and both hole- and electron-related EPR and TL signals were made up of stable and unstable components (at room temperature).

Pulse oximeter plethysmograph variation and its relationship to the arterial waveform in mechanically ventilated children.

The variations induced by mechanical ventilation in the arterial pulse pressure and pulse oximeter plethysmograph waveforms have been shown to correlate closely and be effective in adults as markers of volume responsiveness. The aims of our study were to investigate: (1) the feasibility of recording plethysmograph indices; and (2) the relationship between pulse pressure variation (ΔPP), plethysmograph variation (ΔPOP) and plethysmograph variability index (PVI) in a diverse group of mechanically ventilated children. A prospective, observational study was performed. Mechanically ventilated children less than 11 years of age, with arterial catheters, were enrolled during the course of their clinical care in the operating room or in the pediatric intensive care unit. Real time monitor waveforms and trend data were recorded. ΔPP and ΔPOP were manually calculated and the relationships between ΔPP, ΔPOP and PVI were compared using Bland-Altman analysis and Pearson correlations. Forty-nine children were recruited; four (8%) subjects were excluded due to poor quality of the plethysmograph waveforms. ΔPP and ΔPOP demonstrated a strong correlation (r = 0.8439, P < 0.0001) and close agreement (Bias = 1.44 ± 6.4%). PVI was found to correlate strongly with ΔPP (r = 0.7049, P < 0.0001) and ΔPOP (r = 0.715, P < 0.0001). This study demonstrates the feasibility of obtaining plethysmographic variability indices in children under various physiological stresses. These data show a similarly strong correlation to that described in adults, between the variations induced by mechanical ventilation in arterial pulse pressure and the pulse oximeter plethysmograph.

IL-1 gene polymorphisms, secretion in gingival crevicular fluid, and speed of human orthodontic tooth movement.

OBJECTIVES: To investigate genetic, biologic, and mechanical factors that affect speed of human tooth movement. Setting and Sample Population - Sixty-six maxillary canines in 33 subjects were translated distally for 84 days. MATERIAL AND METHODS: Distal compressive stresses of 4, 13, 26, 52, or 78 kPa were applied to maxillary canines via segmental mechanics. Dental casts and gingival crevicular fluid (GCF) samples were collected nine to 10 times/subject over 84 days at 1- to 14-day intervals. Three-dimensional tooth movements were measured using a microscope and each subject's series of dental casts. GCF samples were analyzed for total protein, interleukin-1beta (IL-1beta), and interleukin-1 receptor antagonist (IL-1RA). Cheek-wipe samples from 18 subjects were typed for IL-1 gene cluster polymorphisms. RESULTS: Average speeds of distal translation were 0.028 +/- 0.012, 0.043 +/- 0.019, 0.057 +/- 0.024, 0.062 +/- 0.015, and 0.067 +/- 0.024 mm/day for 4, 13, 26, 52, and 78 kPa, respectively. Most teeth moved showed no lag phase (63/66). Three factors significantly affected speed (p = 0.0391) and provided the best predictive model (R(2) = 0.691): Activity index [AI = experimental (IL-1beta/IL-1RA)/control (IL-1beta/IL-1RA)], IL-1RA in GCF, and genotype at IL-1B. CONCLUSIONS: Increased AI and decreased IL-1RA in GCF plus having > or =1 copy of allele 2 at IL-1B(+3954) were associated with faster tooth movement in humans.

Laser cordectomy for T1 glottic carcinoma: a 10-year experience and videostroboscopic findings.

Fifty-three patients underwent laser cordectomy for T1 glottic squamous cell carcinoma between January 1980 and December 1989--sixteen after having undergone unsuccessful radiation and thirty-seven who had no previous treatment. There was a 51% five-year cure rate in the irradiated group vs. 62% in the nonirradiated group. Extension of tumor to the anterior commissure resulted in a higher failure rate. Patients experienced an overall 5-year cure rate of 98% after surgical or radiation salvage of unsuccessful laser cordectomies. Six patients had preoperative and postoperative videostrobolaryngoscopy. The most common postoperative problem with voice was a breathiness that did not resolve in any of the patients. All patients had absent or moderately reduced amplitude and mucosal wave patterns and imcomplete glottic closure proportional to the amount of cordal tissue removed. Despite it seemingly poor results in carefully selected patients, laser cordectomy is still indicated without compromising the ultimate oncologic results. Advantages over radiation therapy or conservation laryngeal surgery include a short treatment time, requiring only an outpatient surgical procedure at the time of the initial diagnostic and/or staging laryngoscopy, and the avoidance of potential radiation side effects or surgical complications. However, patients should be advised the possibility of persistent postoperative breathy dysphonia, in addition to the possibility of further treatment to effect a long-term cure.

Malignant external otitis and osteomyelitis of the base of the skull.

If malignant external otitis is not treated properly and until all evidence of infection has disappeared, it is likely to recur either in the external auditory canal and/or in the bone marrow at the base of the skull. Unremitting headache is the only early symptom of the latter and may occur in the absence of any signs of local ear disease. A conductive hearing loss is the most common additional symptom and is caused by fluid in the middle ear. If not diagnosed and treated adequately and properly, the infectious process in the bone marrow involves the soft tissues at the skull base and results in a progressive paralysis of the lower cranial nerves. Treatment must be vigorous and continuous until the gallium scan is normal or shows great improvement (i.e., for a minimum period of 2 months). Intravenous antibiotics with a proven record of success and effectiveness against this organism are recommended, although newer antimicrobial agents give promise of being effective when administered orally.

Transoral excision of lateral parapharyngeal space tumors presenting intraorally.

Six patients with parapharyngeal space tumors presenting intraorally over the past 16 years were managed by transoral excision. All had benign tumors of salivary gland origin (1 monomorphic and 5 pleomorphic adenomas) and 3 of 6 patients were asymptomatic. There were no surgical complications and blood loss was minor in all cases. One patient, who had refused treatment for more than 40 years, presented with dyspnea and dysphagia, and required a tracheotomy for safe induction of anesthesia. Only one patient was hospitalized for more than 3 days and only one tumor recurred--as a malignant pleomorphic adenoma 3 years later.

Osteomyelitis of the base of the skull.

Infection in the marrow of the temporal, occipital, and sphenoid bones is an uncommon, but increasing occurrence. It is usually secondary to infections beginning in the external auditory canal and is caused almost uniformly by the gram negative Pseudomonas aeruginosa bacteria. Technetium and gallium scintigraphy help in the early detection of such infections while CT scans demonstrate dissolution of bone in well-developed cases. Headache is the predominant symptom. Dysphagia, hoarseness, and aspiration herald the inevitable march of cranial nerves. We have diagnosed and treated 17 cases of osteomyelitis of the skull base. Although the total mortality rate is 53%, it is now a curable disease. Six of our last 8 patients remain alive, although 1 is still under treatment. Treatment is medical and requires the long-term concomitant intravenous administration of an aminoglycoside and a broad spectrum semisynthetic penicillin effective against the causative organism.

Surgical obliteration of the tympanomastoid compartment and external auditory canal.

The ideal patient for a radical mastoidectomy with total tympanomastoid cavity obliteration is one with chronic granulomatous otomastoiditis without cholesteatoma, profound sensorineural hearing loss, and a normal ear on the opposite side. A meticulous and thorough classical radical mastoidectomy is required. The resultant cavity is eliminated by filling it with pedicled flaps and/or adipose tissue taken from the abdominal wall. Suturing the skin of the anterior and posterior membranous canal walls completes the procedure. Healing is rapid and requires minimal postoperative care. The absence of a cavity eliminates the necessity of additional otologic care. Swimming, diving, and free participation in all other aquatic sports are important additional benefits. This procedure has been performed in 44 patients, 24 by author HFS and 20 by author JRC.

Nasopharyngeal angiofibromas: staging and management.

We propose a system for staging nasopharyngeal angiofibromas based on clinical evaluation and computerized tomography. Twenty-three patients with this pathologic diagnosis have been managed at the University of Miami/Jackson Memorial Medical Center in the past two decades. In 13 patients, the clinical diagnosis was confirmed by transnasal biopsy as a minor outpatient procedure. This avoided unnecessary diagnostic studies, shortened the hospital stay, and expedited treatment. Computerized tomography has replaced conventional x-ray studies and routine tomography, although angiography is still necessary for proper evaluation of larger tumors. Stage groupings recommended on the basis of this experience are stage I--tumor confined to nasopharynx; stage II--tumor extending into nasal cavity and/or sphenoid sinus; stage III--tumor extending into one or more of the following: antrum, ethmoid sinus, pterygomaxillary and infratemporal fossae, orbit, and/or cheek; and stage IV--tumor extending into cranial cavity. Surgical excision is recommended for stages I, II, and III. Stage IV tumors require surgical resection and/or radiation therapy with the possible addition of hormonal therapy.

Diagnosis and cure of venous hum tinnitus.

Sounds arising from abnormalities of or abnormal communications between blood vessels in the neck or cranial cavity may result in objective tinnitus. It is audible to patient and examiner alike. Contrary to the usual subjective tinnitus of non-vascular origin, it is low pitched and pulsatile in character. That tinnitus which arises from and within the internal jugular vein is particularly important, as it may be loud enough to interfere with sleep, and result in some loss of hearing. Diagnosis is important as it can be cured by simple ligation of the internal jugular vein. Such a case is reported.

Changing patterns of otosclerosis surgery in teaching institutions.

The rapidly dwindling number of patients with otosclerosis suitable for surgery has made a severe impact on this aspect of training and experience in our medical centers. Results secured in the past and expected in the future are now difficult to achieve. This trend has been analyzed with particular reference to the experience in the last 3 years at the University of Miami--Jackson Memorial Hospital--Veterans Administration Hospital Medical Center. The analysis of results and complications also compared patients operated on by residents vs. faculty. Hearing loss as a consequence of improperly performed stapes surgery or complications thereof can seldom be salvaged. Stapes surgery should be performed in medical centers and community hospitals only by designated "stapes surgeons."

The role of high resolution computerized tomography and standardized ultrasound in the evaluation of orbital cellulitis.

We reviewed the records of 22 patients with orbital cellulitis to determine the value of high resolution computerized tomography (HRCT) and standardized ultrasound (US) in their management. In 13 patients, they demonstrated abscess formation and accurately defined its location and extent. The appearance of an abscess did not necessarily mandate immediate surgery. Three patients responded promptly to intensive antibiotic therapy and resolved despite a presumptive diagnosis of orbital abscess. The remaining 10 patients required surgical intervention and abscess formation was confirmed. In patients presenting with good visual acuity and some globe motion we recommended instituting intensive intravenous antibiotic therapy for 36 hours with close monitoring of visual acuity, avoiding surgery unless some impairment of vision is noted. The decision regarding surgery is then made on the time honored basis of response to therapy. Surgery is no necessary in those patients exhibiting prompt significant improvement in local inflammatory signs.

Rare complications following ethmoidectomies: a report of eleven cases.

Intranasal ethmoidectomy is one of the most difficult operations to teach residents. An accurate knowledge of the regional topographic anatomy is of utmost importance. Friedman and Kerr reported complications of 1000 cases of consecutive intranasal ethmoidectomies performed at the Mayo Clinic from 1957 to 1972. The complication rate was 2.8%. Meningitis, cerebrospinal fluid rhinorrhea, loss of olfaction, and nasolacrimal duct obstruction were reported. No blindness, loss of occular motility, excision of brain tissue or intracranial vessel damage occurred in their series. We are reporting a series of 8 cases of very rare complications following intranasal ethmoidectomies: 1. Optic nerve damage resulting in total blindness (3 cases). 2. Loss of occular motility (2 cases). 3. Cerebrospinal fluid leak resulting in 8 episodes of pseudomonas meningitis and epidural abscess (1 case). 4. Cavernous sinus--internal carotid artery fistula (1 case). 5. Anterior cranial fossa brain damage resulting in death (1 case). These cases, which were either referred to us or came up for our review, are described in detail. A search of the world literature demonstrates a lack of emphasis on such complications. The pitfalls of intranasal ethmoidectomy are considered and ways to avoid such dreadful complications are discussed.

Triple therapy for advanced cancer of the head and neck.

Eighty-two patients with advanced cancer of the head and neck have been treated with sequential administration of methotrexate and cisplatin. Methotrexate was given orally (50 mg/sq m). Cisplatin was given intravenously 24 hours later. Treatment was repeated four times at weekly intervals. This method of administration is based on laboratory evidence, including cell kinetic studies. Forty-three patients were operated on. Those with involved or close surgical margins or with more than one cancerous neck node were also treated with therapeutic postoperative radiation therapy. Twenty-two patients were treated with only radiation therapy. After surgery and/or radiation therapy, patients were randomly selected as to who would receive further chemotherapy or who would be under observation only. Twenty-two patients are still in the early phases of treatment and follow-up, so their conditions could not be evaluated. Early results indicate a 64% response to initial chemotherapy and no increase in operative difficulty, morbidity, or mortality.