Radiometric temperature measurement with Si and InGaAs single-photon avalanche photodiode.

We experimentally demonstrate the use of single-photon avalanche photodiode (SPAD) for radiometric temperature measurement. The low dark count rate CMOS SPAD and a commercial InGaAs/InP SPAD can detect the thermal radiation from a blackbody down to the temperatures of 510 and 405 K, respectively. Our work shows that current SPADs are cost-effective thermal sensors for various applications.

Computer-assisted quantitative upper airway analysis following modified uvulopalatal flap and lateral pharyngoplasty for obstructive sleep apnoea: a prospective case-controlled study.

OBJECTIVES: The study aims to perform static and dynamic quantitative assessment of the anatomical changes of the upper airway before and after modified uvulopalatal flap and lateral pharyngoplasty and comparison of the improvement in airway dimensions, collapsibility and extent of normalisation to that of control patients. DESIGN: Prospective case-controlled study. SETTING: Computer-assisted quantitative measurement is used to compare upper airway parameters before and after modified uvulopalatal flap and lateral pharyngoplasty in patients with obstructive sleep apnoea (OSA). PARTICIPANTS: Patients with obstructive sleep apnoea diagnosed on sleep study and failed positive airway pressure therapy. MAIN OUTCOME MEASURES: Sleep study results, upper airway parameters and symptom score following surgery and its comparison to normal patients to assess the degree and extent of normalisation. RESULTS: Thirty-five study and 32 control subjects were recruited and completed the study. All the retropalatal airway dimensions like area, transverse diameter, longitudinal diameter and collapsibility showed statistically significant improvement following surgery. The success rate of this surgery is 43% (15 of 35) overall, 58% (14 of 24) for patients with isolated palatal obstruction and only 9% (1 of 11) for patients with multi-level obstruction. Comparing obstructive sleep apnoea to the control subjects, there are obvious and logical differences in their biostatistics, sleep study parameters and airway dimensions. The postoperative obstructive sleep apnoea retropalatal longitudinal diameter has a higher tendency of normalising to be comparable to those of control patients. CONCLUSIONS: Modified uvulopalatal flap and lateral pharyngoplasty is an effective surgical technique for the treatment of obstructive sleep apnoea. The surgery increases the resting retropalatal dimensions and reduces the retropalatal collapsibility.

Impact of tinnitus as measured by the Tinnitus Handicap Inventory among tinnitus sufferers in Singapore.

INTRODUCTION: The effects of tinnitus on quality of life (QOL) have never been extensively studied in Singapore. We describe the characteristics of tinnitus and its impact on QOL as measured by the Tinnitus Handicap Inventory (THI) in a series of ear, nose and throat clinic patients. METHODS: A total of 327 patients who attended a tinnitus counselling clinic completed the THI questionnaire, a self-report measure with 25 items grouped into functional, emotional and catastrophic subscales. RESULTS: The mean age of the 134 female and 193 male patients was 48.9 years. 36.7 percent of these patients had bilateral tinnitus and 64.6 percent had symptoms for less than one year. 270 patients had hearing loss, 74 percent of whom presented with bilateral high frequency hearing loss. Most patients (84.1 percent) perceived only one type of sound. The total THI score distribution was: 107 (33 percent) patients had THI less than 16, 100 (31 percent) had THI 18 to 36, 59 (18 percent) had THI 38 to 56, and 61 (19 percent) had THI more than 58. There were no differences in the overall THI and subscale scores between the patients' gender, those with or without hearing loss, and those with unilateral or bilateral tinnitus. However, significantly higher total THI and all subscale scores were found among patients who were hearing more than one type of tinnitus sound. The areas of concern that were commonly reported by the patients in this series were a lack of control over tinnitus, frustration and stress. CONCLUSION: Tinnitus patients who hear multiple sounds tend to have a higher THI and subscale scores. The management of tinnitus should address common areas of concern, and may include counselling. The THI is a potential screening tool to determine if patients require counselling. A series of THI assessments can be used to chart the progress of treatment.

Clinical predictors in obstructive sleep apnoea patients with calibrated cephalometric analysis--a new approach.

AIM: Utilization of a new method to accurately quantify differences in cephalometric parameters between obstructive sleep apnoea (OSA) and normal patients, and to identify good predictors for OSA. To illustrate the ethnic differences in cephalometry. METHOD: This prospective study involves 106 South-east Asians. A calibrated catheter is inserted into the upper airway during standard cephalometry to obtain the precise magnification and allow exact measurement of anatomical parameters of cephalometry in both erect and supine positions. RESULTS: The OSA patients have longer lower-facial length, narrower skull base, shorter and receding mandible, smaller posterior airway space (PAS), narrower retropalatal space, longer and thicker soft palate, smaller hard and soft palate angles longer tongue length and more inferiorly displaced hyoid. For the palatal level, retropalatal distance of 11.2 mm cut-off/predictive value for male (receiver operating characteristics (ROC) = 0.8414 with PPV = 77.46, NPV = 90.00) and 5.5 mm for female (ROC = 0.9180 with PPV = 100.00, NPV = 84.21) at erect position were selected. For retrolingual level, erect PAS of 10.1 mm cut-off/predictive value for male (ROC = 0.7000 with PPV = 78.38, NPV = 37.78), 5.3 mm for female (ROC = 0.7227 with PPV = 75.00, NPV = 75.00) were selected. Our study showed that South-east Asians have different cephalometric values compared with White people, Black people and Hispanics. CONCLUSION: This new method of cephalometry using a calibrated catheter provides an accurate and simple method of obtaining precise cephalometric measurements. There is no cephalometric data on OSA from South-east Asia available. These results suggested that surgeons managing OSA patients and using cephalometry as a diagnostic method should have a set of normative and OSA cephalometric values that apply to their local populations.

10th Yahya Cohen Memorial Lecture: Clinical predictors in obstructive sleep apnoea patients with computer-assisted quantitative videoendoscopic upper airway analysis.

AIM: To identify the clinical predictors and assist surgeons in their clinical management of obstructive sleep apnoea (OSA) - a prospective study with a new approach to analyse the static and dynamic upper airway morphology between patients with OSA and normal subjects. To introduce a new method of assessment for surgical outcome. MATERIALS AND METHODS: Quantitative computer-assisted videoendoscopy (validated with upper airway magnetic resonance imaging) was performed in 49 (43 males, 6 females) patients with OSA and compared with 39 (22 males, 17 females) controls (apnoea-hypopnoea index <5). Absolute cross-sectional areas, transverse and longitudinal diameters at the retro-palatal and retro-lingual levels were measured during end of quiet respiration and during Mueller's manoeuvre in the erect and supine positions, allowing us to study static and dynamic morphology (collapsibility) of the upper airway. We analysed 3744 parameters. RESULTS: In males, retro-palatal and retro-lingual areas during Mueller's manoeuvre in the supine position of 0.7981 cm2 [receiver operating characteristics (ROC) = 0.9284, positive predictive value (PPV) = 86.05%, negative predictive value (NPV) = 84.62%] and 2.0648 cm2 (ROC = 0.8183, PPV = 76%, NPV = 83.33%), respectively, were found to be good predictors/ cut-off values for OSA. Retro-palatal area measured in the supine position during Mueller's manoeuvre (AS1M) and collapsibility of retro-palatal area in the supine position calculated (CAS1) were found to have significant correlations with severity of OSA. In females, areas measured during Mueller's manoeuvre in the supine position of 0.522 cm2 at retropalatal level (ROC = 1, 100% PPV and NPV) and transverse diameter at retro-lingual level during erect Mueller's manoeuvre of 1.1843 cm (ROC = 0.9056, PPV = 100%, NPV = 83.33%) were found to be predictive. All measurements at the retro-palatal level and in the supine position had higher predictability. Area measurements obtained during Muller's manoeuvre were more predictive (ROC >0.9910) than resting measurements (ROC >0.8371). Several gender and anatomical-site specific formulas with excellent predictability (ROC close or equal to 1) were also devised. Examples of surgical outcome assessment were introduced. CONCLUSION: Upper airway Mueller's studies are predictive and useful (independent samples t-test/Mann Whitney U test, ROC) in identifying patients with OSA. With these gender and anatomical-site specific OSA predictors/formulas and this innovative clinical method, we hope to assist other surgeons with quantitative clinical diagnosis, assessment, surgical planning and outcome assessment tools for OSA patients.

Crystallization and preliminary X-ray diffraction analysis of spermidine synthase from Helicobacter pylori.

Polyamines, such as putrescine, spermidine and spermine, are essential for the regulation of cell proliferation and differentiation in most organisms. Spermidine synthase catalyzes the transfer of the aminopropyl group from decarboxylated S-adenosylmethionine to putrescine in the biosynthesis of spermidine. In this study, spermidine synthase of Helicobacter pylori has been overexpressed in Escherichia coli and purified. Two kinds of spermidine synthase crystals were obtained. One belongs to the monoclinic P2(1) space group, with unit-cell parameters a = 62.78, b = 58.24, c = 74.28 A, beta = 90.9 degrees , and the other belongs to the orthorhombic C222(1) space group, with unit-cell parameters a = 100.43, b = 128.55, c = 143.60 A.

Quantitative computer-assisted digital-imaging upper airway analysis for obstructive sleep apnoea.

This was a prospective study of a new objective method which quantitatively analyses the upper airways in patients with obstructive sleep apnoea (OSA). Video-nasopharyngoscopic examinations of the upper airways of 45 patients were carried out with an endoscopic calibrator. Images of the upper airway during quiet respiration and Mueller's manoeuvre in erect and supine positions were digitized by computer to generate the actual dimensions of obstructive sites. Measurements by the new method were validated by comparing 90 pairs of videoendoscopic images with upper airway magnetic resonance imaging (MRI) measurements at two identical levels. Quantitative precision is 100% for the retropalatal level and 95.6% for the retrolingual level with a tolerance of 0.5 cm(2) between the two methods. The absolute mean of the difference between the two methods of measurement is 0.08 cm(2) at the retropalatal level and 0.18 cm(2) at the retrolingual level. The agreement between the digital-imaging videoendoscopic and MRI measurements was 93.3% for the retropalatal level and 95.6% for the retrolingual level. Quantitative computer-assisted digital imaging is a reliable, cost-effective clinical method of upper airway evaluation in OSA patients. This method allows us to examine the dynamic and static morphology objectively, measure surgical outcomes of upper airway, opening up new avenues for OSA management.

Microbiology of chronic suppurative otitis media in Singapore.

The objective of the study was to study the microflora and the antibiograms of patients with chronic suppurative otitis media (CSOM) in Singapore. Ninety patients with CSOM were prospectively studied. They had chronic ear discharge and had not received antibiotics for the previous five days. Swabs were taken, and cultured for bacteria. Antibiotic testing was done using modified Kirby Bauer disk diffusion method. In addition to the usual antibiotics, the three most common topically available antibiotics (chloramphenicol, gentamicin and neomycin) were tested. There were 135 positive cultures for organisms from the 90 patients. The most common causal organisms isolated were Pseudomonas aeruginosa (33.3%) and Staphylococcus aureus (33.3%) followed by coagulase negative Staphylococcus (21.1%). Fungi accounted for 8.8% of isolates while 6.6% were anaerobes. Of the three antibiotics commonly available as topical eardrops, gentamicin has the highest susceptibility rate (82.6%), followed by neomycin (67.8%) and chloramphenicol (62.8%).

Migrating oesophageal foreign body--an unusual case.

Ingested foreign bodies which migrate extraluminally are rare occurrences. If untreated, they may result in life threatening complications. Exploration of the neck via an external approach to remove the foreign body is the recommended treatment. The CT Scan utilising fine cuts is invaluable in localising the foreign body for exploration. The case of a patient with a metallic foreign body in the oesophagus which migrated extraluminally is presented. Hemithyroidectomy was required to gain access for removal of the foreign body. A discussion on the management of such a case follows.

Metastasic oesophageal carcinoma to the paranasal sinuses--a case report.

Metastasis to the paranasal sinuses is rare. We report a case of a patient with metastasis to the paranasal sinuses from carcinoma of the oesophagus. Our patient presented with symptoms mimicking the more common acute sinusitis. Although rare, metastatic disease of the paranasal sinuses should be considered especially in patients with a known primary carcinoma elsewhere presenting with sinu-nasal symptoms.

The incidence and management of post-tonsillectomy haemorrhage: a Singaporean experience.

AIM OF STUDY: To audit the incidence and management of post-tonsillectomy haemorrhage in the Singaporean context. METHODS: Three hundred and sixty-six consecutive tonsillectomies done over a 2-year period were retrospectively studied. Demographic details and indication for operation were evaluated in conjunction with the incidence and management of post-operative haemorrhage. RESULTS: 84.4% of the patients were adults while 58.7% were males. Chronic tonsillitis was the most common indication for operation (84.5%). The incidence of primary and secondary haemorrhage was 0.6% and 7.1% respectively. 3.8% of the patients had to return to the operation theatre to secure haemostasis. The use of post-operative antibiotics did not significantly affect the incidence of haemorrhage. There was no mortality from this complication. The haemorrhage rate was significantly higher among the adults (p = 0.048) and males (p = 0.019) in this study. CONCLUSION: Our overall post-tonsillectomy haemorrhage rate was higher than that reported in most of the Western publications because adults rather than children predominated in our series. We report a low incidence of primary haemorrhage which is in keeping with the results of studies on electrodissection tonsillectomies. Our findings indicate that tonsillectomy is a safe procedure which can be performed on a day surgery basis if the patients are carefully selected.

Penetrating neck trauma from nail guns.

We report 2 unusual cases of penetrating neck trauma arising from nail guns. Nail guns are commonly used in the building industry. The nails are 8 cm long and are driven in by a small explosive charge. The nails are a low velocity projectile and in close proximity can cause penetrating trauma similar to a low powered handgun. Both cases involve a Zone I penetrating injury to the neck.

An occupational hygiene survey in a Chinese viscose rayon factory.

The retinopathy (microaneurysm/small dot hemorrhage) is an early and specific biological indicator to quantitatively evaluate the CS2 exposure. The appearance of retinal lesions was observed among Yugoslavian, German and American workers exposed to CS2. However, among Finnish CS2 workers a positive result was not obtained. We suggested a different response to CS2 exposure between two ethnic populations. We had an opportunity to do a cross-sectional medical and occupational hygiene survey in a Chinese rayon staple plant. Cross-sectional medical examinations failed to show any chronic CS2 effects on the Chinese workers.

Modified surgical procedure for velopharyngeal closure in adults: a preliminary report.

A surgical approach to effect velopharyngeal closure in adults is presented. The three fundamental principles of the procedure are: the complete release of the palatal flap to allow its attachment to the posterior pharyngeal wall without tension; the coaptation of the pharyngeal flap deep into the posterior margin of the velum, with a short and superior based pharyngeal flap that provides a good base for velopharyngeal contact; and the swallow tail division of the pharyngeal flap to form 3 fissural communications between the nasal and oral cavities to maintain physiologic functions. The approach has been applied to eight patients, seven of whom showed no evidence of relapse.

Effects of occupational lead exposure.

Fifty-three workers in a battery factory, 52 solderers in a television factory, and 50 embroidery workers (a reference group) were studied. The average air lead levels of the three workplaces were 0.578 mg/m3, 0.002 mg/m3, and 0.001 mg/m3, respectively. Adverse effects in terms of clinical manifestations and biochemical criteria were evident among the battery factory workers. A significant dose-response relationship existed between the toxic effects and the air lead levels. The solderers showed no apparent abnormalities in comparison with the embroidery workers. The early clinical manifestations were dysfunction of the central nervous system, indigestion, arthralgia, and myalgia in the extremities. A positive association was observed between the prevalence of fatigue, mild abdominal pain, and arthralgia and the blood lead (PbB), urinary lead (PbU), and zinc protoporphyrin (ZPP) levels. The symptomatic threshold values of PbB, PbU, and ZPP were 30 micrograms/dl (1.5 mumol/l), 0.045 mg/l (0.2 mumol/l), and 40 micrograms/dl (0.7 mumol/l), respectively. The PbB, PbU, free erythrocyte protoporphyrin, and ZPP levels and the blood aminolevulinic dehydratase ratio could be used as indicators of lead exposure, although ZPP is preferred for a preventive monitoring program. The motor and sensory conduction velocities of the median nerve were slower in the exposed groups than in the reference group. No effects on behavioral function were observed among the solderers.

An epidemiological study on carbon disulfide angiopathy in a Chinese viscose rayon factory.

To assess long-term vascular effects of occupational carbon disulfide (CS2) exposure, we examined 376 exposed and 325 unexposed Chinese workers with a medical and work-history questionnaire, a chest-pain questionnaire, blood pressure and blood cholesterol measurements, routine urinary tests, monochromatic fundus photography and other tests. Data from 354 exposed and 177 age- and sex-matched reference workers were evaluated. Personal exposure monitorings were performed simultaneously with a passive dosimeter using gas chromatography. Monochromatic fundus photography revealed no CS2-retinopathy characterized by microaneurysms and/or small dot hemorrhages, and no effects of CS2 on blood pressure and blood cholesterol were found. These negative results may have been due to the low daily exposure averages, which varied between 0.01 and 12.8, with a mean of 1.5 ppm. The present study suggested that the no-effect level of CS2 exposure on the development of retinopathy was around 2 ppm (8-h time weighted average), and the absence of adverse CS2 effects among the workers studied supported the current standard for occupational CS2 exposure of 10 mg m-3 in China.