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The development of transillumination of the paranasal sinuses is reviewed. A technique of transillumination with a fibre-optic source is described. In acute sinusitis there was a very significant correlation between radiography and transilluminometry.
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UV-transilluminators use ultraviolet radiation (UVR) to visualize proteins, DNA, RNA, and their precursors in a gel electrophoresis procedure. This study was initiated to evaluate workers' exposure to UVR during their use of UV-transilluminators. The levels of irradiance of UV-A, UV-B, and UV-C were determined for 29 UV-transilluminators at arbitrary measuring locations of 6, 25, 62, and 125 cm from the center of the UV-transilluminator's filter surface in the direction of the operator's head. The operators (faculty, research staff, and graduate students) worked within 62 cm of the transilluminators, with most subjects commonly working at < or =25 cm from the UV-transilluminator's filter surface. Daily exposure time ranged from 1 to 60 min. Actinic hazard (effective irradiance level of UVR) was also determined for three representative UV-transilluminators at arbitrary measuring locations of 2.5, 5, 10, 15, 20, 30, 40, and 50 cm from these sets' filter surface in the direction of the operator's head. The allowable exposure time for these instruments was less than 20 sec within 15 cm, less than 35 sec within 25 cm, and less than 2 min within 50 cm from the UV-transilluminators' filter surface. The results of this study suggest that the use of UV-transilluminators exposes operators to levels of UVR in excess of exposure guidelines. It is recommended that special safety training be provided for the affected employees and that exposure should be controlled by one or the combination of automation, substitution, isolation, posted warning signs, shielding, and/or personal protective equipment.
The excitation spectra of Nile red and SYPRO red, two currently used dyes for the fluorescent staining of protein bands in sodium dodecyl sulfate (SDS)-polyacrylamide gels, show an excitation peak in the UV region and another in the visible region (maximum at about 550 nm). Ethidium bromide and other intercalating dyes, e.g. propidium iodide, ethidium dimers, and benzoxazolium-4-quinolinium dimer-3 (YOYO), used for the fluorescent staining of DNA bands in agarose gels also show an excitation peak in the same region of the visible spectrum. We have designed and constructed a green-light transilluminator with an emission maximum at 542 nm. This visible transilluminator allows the detection of protein bands stained with Nile red and SYPRO red with the same sensitivity obtained with a 300 nm UV transilluminator. The green-light transilluminator also allows the detection of about 2 ng of DNA per band in gels stained with ethidium bromide and the other intercalating dyes indicated above. In contrast to the UV transilluminators, the green-light transilluminator does not produce photodamage of DNA even after long exposures (10 min). This makes this transilluminator very useful for preparative work. Furthermore, the green-light transilluminator does not require UV safety equipment and, consequently, it can be very convenient for teaching laboratories.
The reliability of transillumination versus roentgenogram to diagnose maxillary and frontal paranasal sinus disease was assessed in 52 subjects with rhinitis and/or asthma. Two different otolaryngologists transilluminated the sinuses while the roentgenograms were evaluated by a radiologist and a third otolaryngologist. Patients filled in questionnaires of symptoms. There was excellent agreement (p < 0.001) between otolaryngologists regarding transillumination of the frontal sinuses but not the maxillary sinuses. Similarly, transillumination of the frontal sinuses correlated well with the roentgenograms. This was not true for transillumination of the maxillary sinuses. Although pain in the upper teeth related well to the presence of frontal disease, sinus headache was a frequent complaint but not useful as a predictor of sinus disease. Even though transillumination of the frontal paranasal sinus has some predictive value, the technique of transillumination has limited usefulness as a diagnostic tool and is not an adequate substitute for roentgenogram.
The dilemma of diagnosing and possibly treating dentinal cracks continues to present a challenge in endodontics. The purpose of this in vitro study was to compare the effectiveness of transillumination and dyes in identifying root-end dentinal cracks. Fifty maxillary central incisors were decoronated, and the canals were instrumented to an ISO size 50 at the working length. The apical 3 mm of the roots was resected, and cracks were artificially created in the apical dentin. Four independent examiners evaluated the root ends at x8 magnification with a surgical operating microscope using transillumination (group 1), sodium fluorescein dye (group 2), caries detect dye (group 3), methylene blue dye (group 4), and methylene blue plus transillumination (group 5). The examiners' ability to identify root ends correctly with and without cracks was analyzed by comparing the data with the predetermined standard (cracked and noncracked) using logistic regression analysis. All techniques used were shown to be more effective than random chance at diagnosing cracks. The areas under the curve of the different techniques were as follows: transillumination, 0.81 (95% confidence interval [CI], 0.69-0.93); sodium fluorescein, 0.72 (95% CI, 0.58-0.86); caries detector, 0.76 (95% CI, 0.63-0.89); methylene blue, 0.70 (95% CI, 0.55-0.84); and methylene blue plus transillumination, 0.82 (95% CI, 0.70-0.94). Thus, the crack assessment techniques that gave the best discrimination between cracked and noncracked specimens, regardless of rater, was methylene blue plus transillumination. This study emphasizes the usefulness of transillumination along with magnification in detecting dentinal cracks.
BACKGROUND: Ambulatory phlebectomy (AP) for removal of varicose and reticular veins has become a very popular and widely used in-office outpatient technique over the past decade. One of the major obstacles of this or any other surgical vein removal technique is the technical difficulty presented to the surgeon by the disappearance of the veins to be removed when the patient is positioned horizontally on an operative table. Preoperative marking is therefore essential. OBJECTIVE: To investigate whether use of transillumination would facilitate and enhance marking of varicose veins prior to AP, we performed a study in which both traditional marking with the patient standing and transillumination marking with the patient horizontal were performed sequentially. METHODS: One hundred patients were sequentially examined prior to AP. The veins to be removed were mapped by the traditional way utilizing visual inspection and palpation in a standing position. They were then mapped in the supine or prone position utilizing a transillumination device specifically designed to enhance visualization of veins prior to venipuncture. RESULTS: In 100 out of 100 patients the markings performed using transillumination mapping most closely correlated with actual vein position during surgery. In addition, transillumination allowed for gauging of vein depth. CONCLUSIONS: Transillumination mapping significantly enhances the technique of ambulatory phlebectomy by more accurately visualizing the course of a varicose vein prior to extraction. Furthermore, sites for incisions or punctures are more accurately guided. As a result of this experience, it is now our routine practice to perform preoperative mapping for AP by transillumination in the horizontal position.
The aim of this study was to compare the results obtained by transillumination and bitewing radiography in the diagnosis of caries affecting approximal surfaces of molar and premolar teeth for epidemiological surveys. 3960 posterior approximal surfaces on the right side of 330 patients aged 5 to 35 years were examined using a transillumination probe with a 1.5 mm diameters light source (Oralum, Rocky Mountain, Denver, Colorado) and bitewing radiographs using a portable dental apparatus (Elin, Wien, 60kV, 15mA. Transillumination detected 89% of the carious lesions reaching dentine diagnosed on radiographs and no statistically significant differences were observed in the diagnosis yield of the two systems. However, transillumination detected only 45% of these lesions diagnosed from bitewings as being confined to the enamel. Transillumination also made it possible to detect approximal caries into dentine in teeth covered by orthodontic bands. Thus comparative study gives experimental support to the use of transillumination in large epidemiological studies. The transillumination method is however not suitable for epidemiological trials including caries confined to the enamel.
OBJECTIVE: To compare transillumination and histologic slide measurements of choroidal melanomas in 479 eyes randomized to enucleation in the Collaborative Ocular Melanoma Study. DESIGN: Transillumination defects were measured during gross examination of enucleated eyes. Tumor basal diameter and height were measured on histologic slides and each tumor was assigned to 1 of 8 distinct shape categories. Comparison of the transillumination and histologic slide measurements revealed 3 categories of difference: underestimation (transillumination measurement more than 4 mm smaller than the histologic slide measurement), overestimation (transillumination measurement more than 4 mm larger than the histologic slide measurement), and agreement within 4 mm. RESULTS: There was good correlation between transillumination and histologic slide estimates of largest basal diameter, particularly when the basal diameter was 16 mm or less. Measurement discrepancies were related to the shape of the tumors but not to the presence of subretinal fluid or fixation. CONCLUSION: Agreement was high between measurements of transillumination defect and histologic sections.
The literature describes transillumination as a means of curing orthodontic light-cured composite adhesive. The literature also recommends a 2 to 3 times increase in light exposure time when light curing using transillumination. The purpose of this study was to determine the transmittance of the curing light through human enamel and the effect of transillumination on the bond strength of orthodontic brackets. One hundred extracted human maxillary incisors were used in this study. Brackets with orthodontic composite adhesive were placed on the labial surface of the incisors and light cured from either the labial or the lingual (transillumination). The control sample was cured from the labial for a total of 40 seconds of light exposure. Experimental samples were cured from the lingual (transillumination) for 20, 30, 40, or 50 seconds. The shear-peel bond strengths were tested at 30 minutes and 24 hours after light application. The results of this study demonstrated no statistically significant difference between 40 seconds of labial curing and most of the lingually cured groups. The only experimental group that differed statistically from the control group was the 40-second lingual cure group tested at 30 minutes after light application. Actual bond strengths, however, were lower for all experimental samples. The samples tested at 24 hours that received 50 seconds of transillumination were nearly the same as the control values. This study demonstrated that transillumination of maxillary incisors is an acceptable method of curing orthodontic adhesive, particularly if the exposure time is increased from 40 to 50 seconds.
Mammographic screening for early detection of breast cancer has proven valuable in improving breast cancer survival. However, breast cancer incidence is still increasing, and thus preventative oncology needs to receive more attention, with the goal of identifying women with increased risk of developing breast cancer in the future and offering them risk reduction interventions. Mammogram derived parenchymal density pattern has been shown by various authors to provide a high odds ratio for breast cancer. Near-infrared optical transillumination spectroscopy was employed to determine physiological properties of the breast tissue to quantify differences in women with low or high breast cancer risk. Specifically in this study, women who had a recent mammogram underwent examination of their breast tissue by optical transillumination spectroscopy. Areas of adipose and glandular tissues which give rise to mammographic density patterns also have characteristic optical transillumination spectra. Correlation between optical transillumination spectroscopy and mammographic density pattern was established using partial least squares analysis. Results show that predicted tissue density based on optical transillumination spectroscopy correlates with mammographic observed tissue density, with a Spearman Rank correlation coefficient of 0.72. This suggests that optical transillumination spectroscopy may be a promising tool to quantify and monitor changes in breast cancer risk.
This prospective study of 1239 women compares the breast cancer detecting abilities of state-of-the-art mammography and transillumination. Mammography was found to be the superior technique, detecting 80 (96%) of the 83 pathologically proven cancers, while transillumination detected only 44 (53%). Among cancers having the best prognosis, transillumination was even less accurate relative to mammography, detecting only 43% of malignancies that had not yet spread to axillary lymph nodes and only 19% of the nonpalpable cancers and cancers smaller than 1 cm, whereas mammography detected over 90% in each of these categories. None of the three cancers missed by mammography were detected by transillumination. Clearly, transillumination is not an acceptable substitute for mammography in the detection and diagnosis of breast cancer. Therefore, the current commercial promotion of transillumination seems to be premature.
The ability of operative endoscopic transillumination of the bowel wall to detect duodenal gastrinoma was evaluated prospectively in 26 patients with the Zollinger-Ellison syndrome. The results were assessed by exploratory laparotomy and compared with the results of other localization techniques. Twelve duodenal gastrinomas were resected from 10 patients. Operative endoscopic transillumination detected 10 of the 12 gastrinomas, a sensitivity of 83%, which was significantly greater (P less than 0.05) than that for either preoperative imaging (25%) or intraoperative ultrasonography and palpation (42%). The sensitivity of operative endoscopic transillumination was a result of the ability to detect focal areas that did not transilluminate on the serosal side of the duodenum, and not the mucosal appearances seen through the endoscope, which were not helpful. Operative endoscopic transillumination detected gastrinomas less than 1 cm in diameter throughout the duodenum. Of the patients in this study, 39% had duodenal gastrinomas, a greater frequency than previously reported. These results indicate that operative endoscopic transillumination is the most sensitive technique yet described for detecting duodenal gastrinomas and should be performed routinely in all patients with the Zollinger-Ellison syndrome who undergo exploratory laparotomy for cure.
Tumor size is an important prognostic factor for deaths due to uveal melanoma. The objectives of this study are: (1) to determine the association between largest tumor diameter assessed by clinical transillumination and largest tumor diameter assessed by measurement of the histologic slide; (2) to predict a clinical transillumination diameter for each enucleation specimen based on the best combination of histologic variables--diameter, height, location, and tumor shape; and (3) to use the predicted transillumination diameter in place of histologic diameter measurement as a prognostic factor for patients treated by enucleation in order to reevaluate previously reported survival outcomes for patients treated by proton beam and enucleation. Comparison of measurements on 40 eyes indicated that transillumination largest diameter measurements were larger than histologic slide measurements (mean difference, 2.87 mm). Multiple linear regression analysis yielded the following equation: transillumination diameter = [4.73 + (0.58 X histologic diameter) + (0.38 X histologic height) + (1.87 X anterior location)]. Using the actual and predicted transillumination measurements, the results of this study support a previously published report on these data: treatment type, tumor size, and location were predictive of melanoma-related deaths, metastases, and all deaths.
The transillumination-assisted isolation of segments of seminiferous tubules in defined stages of the wave of the seminiferous epithelium was investigated in Pseudomys australis and Notomys alexis. In P. australis, three different transillumination patterns (pale, spotty and dark) of the seminiferous tubules could be isolated. They corresponded to histological stages 1-2, 3-5 and 6-8 of the wave of the seminiferous epithelium. The dark pattern made up about 40% of the wave, the pale pattern about 31%, and the spotty pattern about 24%. In N. alexis, no such isolation of segments with particular cell associations was possible. In a comparison of P. australis with the laboratory rat, the dark, pale and spotty transillumination patterns of seminiferous tubule segments corresponded to the same cell associations in both species, but the length of the spotty segments in the laboratory rat made it possible to subdivide the spotty region into pale spotty and dark spotty areas and thus to isolate four different transillumination patterns. Further separation into other subgroups to isolate additional types of segments could not be performed repeatedly in any of the studied species because of the gradual change of one subgroup of transillumination pattern into another and the short length of some of the subgroups.
AIM: To assess the efficacy of transillumination of the palm of the hand in establishing venous access in small infants. METHODS: One hundred infants aged 2 to 36 months were considered for venipuncture under transillumination following failure to find an accessible vein or a failed venipuncture attempt. RESULTS: In 40 of the 100 infants, a vein was visible with transillumination. In 22 of these children, previous attempts to achieve a venous line failed (mean number of failed venipunctures 2.11 +/- 0.6) and in 18 infants, no vein could be identified. Using transillumination, venous access was established with just one venipuncture in 39 of the 40 patients. CONCLUSIONS: Transillumination of the palm can aid in establishing venous access in infants. This can be easily carried out using a common otoscope.
PURPOSE: To examine the incidence and pattern of iris transillumination defects in patients with primary open angle glaucoma (POAG) with and without vascular dysregulation, in comparison to controls. METHODS: We prospectively examined 24 patients with POAG (M/F 10:14; mean age 59 +/- 14, range 21-76 years) and 23 controls (M/F 10:13; mean age 52 +/- 15, range 25-86 years). Vascular dysregulation was presumed if patients had a typical medical history of vasospasm and a pathological result in nailfold capillaroscopy. Iris transillumination defects were visualized by video-taped, digitized diaphanoscopy and assessed by two blinded observers. RESULTS: We found significantly more iris transillumination defects in POAG than in controls (54.2% vs. 8.7%; chi2 = 8.85; df = 1; p = 0.002). The defects in POAG showed a characteristic radially-streaked pattern different from those described, for instance, in pigment dispersion syndrome, pseudoexfoliation syndrome, and acute glaucoma. Glaucoma patients with vascular dysregulation had a tendency to a higher incidence of transillumination defects than non-vasospastic patients, though this finding was not significant. CONCLUSIONS: Patients with POAG have a higher incidence of iris transillumination defects than controls. The underlying mechanisms are not yet clear and call for further investigation.
PURPOSE: Difficult intubation is a major problem in anesthesia. In case of limited mouth opening only a few intubating devices are available. Our study was designed to evaluate the effectiveness and safety of a modified transillumination technique for nasotracheal intubation (NTI). METHODS: One hundred twenty-three patients needing NTI were studied, 76 in group A: NTI with no expected intubation difficulty; and 47 in group B: limited mouth opening (<20 mm). All intubations were performed with the Trachlight(TM). Patients in group A were under general anesthesia while deep sedation (maintaining spontaneous breathing) was used in patients in group B. The standard transillumination technique was modified by keeping the metallic stylet in place and personalizing the length and the angle of the short arm of the J shaped endotracheal tube-transillumination lightwand (ETT-TL) assembly. RESULTS: The overall rate of success was 98.4% and 92.6% of intubations were successful on the first attempt. The average duration of intubation was 28 sec +/- 15 sec. Success rate and duration of intubation were similar in both groups. CONCLUSION: Modification of the technique facilitated transillumination and placement of the ETT. The simplicity and high success rate of NTI by transillumination with the TL suggest our modified technique is a valuable alternative for NTI in patients with difficult airway.