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At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

Aesthetic reconstruction of large scalp defects by sequential tissue expansion without interval.

Tissue expansion is indicated in the reconstruction of various scalp defects when there is inadequate adjacent tissue to allow either primary closure of the defect or repair with a local flap. It is the most important armamentarium for aesthetic hair-bearing scalp reconstruction in cases of congenital or required defects. This technique was used sequentially without interval to achieve scalp reconstruction for 12 patients with a defect ranging from 30% to 75% of the scalp (average, 55%). For 12 patients, 32 expansion treatments were undertaken between September 1997 and January 2002. The 12 patients included 3 women, 4 men, and 5 children with a mean age of 20 years (range, 45 days to 36 years). All patients had more than one period of treatment. The most common conditions treated were burns (n=7), trauma (n=1), congenital naevi (n=2), and male pattern baldness (n=2). Reconstruction of 12 large scalp defects has been performed with a 3.1% rate of major complications. Results show that tissue expansion is a safe and efficient but time-consuming technique for aesthetic scalp reconstruction, especially in the case of "sideburn" scenario or large defects. There was no significant alteration in ratio of complications although tissue expansions were made sequentially.

Adolescent↗
PubMedDate not supplied

Aesthetic reconstruction of burn alopecia by using expanded hair-bearing scalp flaps.

Tissue expansion is one of the most important armamentaria for aesthetic scalp reconstruction after burn; however, the proper way to employ this technique for the scalp reconstruction usually presents a challenge to the plastic surgeon, especially in the case of a "sideburn" scenario or a large lesion, as with, for example, hemiscalp alopecia. In this article, 11 patients, with different degrees of hair-bearing scalp loss as a result of burn, and including four patients with hemiscalp alopecia were successfully treated by using tissue expansion. The results show that tissue expansion is a simple, safe, and efficient technique for aesthetic scalp reconstruction. Versatile design of the expanded scalp flap can distribute the expanded hair-bearing scalp properly in the reconstructed recipient site.

Adolescent↗
PubMed1985

Intrapartum fetal surveillance: the role of fetal scalp blood sampling.

Continuous electronic fetal heart rate monitoring and fetal scalp blood sampling have traditionally played a complementary role in intrapartum fetal surveillance. Nevertheless, biochemical assessment of fetal blood pH, with the use of scalp or umbilical cord blood, is often viewed as the "gold standard" against which biophysical indicators of fetal distress must be judged. In actual clinical practice, however, fetal scalp blood sampling is only rarely used. In addition, there is a growing body of evidence to suggest that, when properly interpreted, fetal heart rate assessment may be equal or superior to measurement of fetal blood pH in the prediction of both good and bad fetal outcomes. Under certain circumstances, fetal scalp blood sampling remains a valuable clinical tool; however, we recommend a deemphasis of fetal scalp blood sampling in general clinical practice. Both theoretical and practical considerations suggest that the properly trained clinician may pursue an approach for the detection of fetal distress that does not include scalp blood sampling without either compromising his ability to detect fetal distress or significantly increasing the cesarean section rate.

Apgar Score↗
PubMedDate not supplied

Comparative effects of age on limbic and scalp P3.

We studied the effects of age on the limbic and scalp P3 in 45 patients with intracranial electrodes implanted for pre-surgical investigation of focal seizures. Scalp P3 data from a reference group of 24 healthy control subjects were also analyzed for comparison. An auditory oddball paradigm with infrequent stimuli being presented with a probability of 0.20 was used. In normals P3 latency increased by 1.34 msec/year (r = 0.60, P less than 0.01). In the patients limbic and scalp P3 latency increased linearly as a function of increasing age at a rates of 3.85 msec/year (r = 0.58, P less than 0.001) and 2.71 msec/year (r = 0.56, P less than 0.01), respectively. The rate of increase of P3 latency with age was significantly lower in the normal controls, as compared to both the patient scalp (t = 1.79, P less than 0.05) and depth (t = 2.25, P less than 0.005) ERP data. There was no significant difference between the slopes of the patient P3 latency versus age scalp and depth data (t = 1.09, P greater than 0.1). Unlike for normal controls, there was no relationship between age and limbic P3 amplitude (r = 0.02, P greater than 0.1) or age and scalp P3 amplitude (r = 0.17, P greater than 0.1). The differences between controls and patients could be due to: (i) effects of chronic seizures; (ii) long-term effects of anticonvulsant use; (iii) the use of a relatively long inter-stimulus interval which may have selectively affected the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Acoustic Stimulation↗
PubMed1995

Origin and distribution of P13 and P14 far-field potentials after median nerve stimulation. Scalp, nasopharyngeal and neck recording in healthy subjects and in patients with cervical and cervico-medullary lesions.

We studied median nerve SEPs in 10 healthy subjects, by means of simultaneous recording over the scalp, around the neck and near the ventral surface of the medulla using a nasopharyngeal (NP) electrode. This recording technique enabled us to clearly differentiate P13 and P14 potentials. The former was always found in NP records, while the latter was more evident in scalp traces. The same technique was used to study 9 patients with various lesions of the cervical cord or cervico-medullary junction. Patients with high cervical lesions demonstrated abnormalities of both P13 and P14 potentials, while patients with lesions of the cervico-medullary junction demonstrated a clear dissociation between normal P13 in scalp and NP traces, and abnormal scalp P14. Patients with lower cervical lesions, selectively involving the central grey matter, showed normal P13 and P14 potentials, in spite of abnormal N13 cervical responses. Our findings strongly suggest that both scalp and NP P13 have the same generators in higher segments of the cervical cord, and that NP more than scalp records are effective in analyzing the P13 response. We suggest that the selective recording of the P13 potential could be useful in the assessment of focal lesions of the higher cervical cord or of the cervico-medullary junction.

Adult↗
PubMed1994

Scalp cooling has no place in the prevention of alopecia in adjuvant chemotherapy for breast cancer.

35 patients were studied to determine the effectiveness of scalp hypothermia in the prevention of alopecia caused by adjuvant chemotherapy for breast cancer. Scalp hypothermia was induced by the newly developed Theracool cooling machine. The chemotherapeutic regimen consisted of one perioperative course of doxorubicin 50 mg/m2, cyclophosphamide 600 mg/m2 and 5-fluorouracil 600 mg/m2 (EORTC protocol 10854). Only 4 (11%) patients showed acceptable hair preservation (no or minor alopecia). 12 patients (34%) had moderate alopecia, all requiring a wig. 19 patients (54%) had complete alopecia. No scalp metastases were observed after scalp cooling. These results and a review of the literature suggest that scalp hypothermia to prevent alopecia may only be effective in a cytotoxic regimen containing an anthracycline as the sole alopecia-inducing agent. With current adjuvant chemotherapy for breast cancer, in which a combination of cyclophosphamide and an anthracycline is often used, there is no place for scalp hypothermia.

Adult↗
PubMed2005

Treatment of extensive scalp lesions with segmental intensity-modulated photon therapy.

PURPOSE: To compare static electron therapy, electron arc therapy, and photon intensity-modulated radiation therapy (IMRT) for treatment of extensive scalp lesions and to examine the dosimetric accuracy of the techniques. METHODS AND MATERIALS: A retrospective treatment-planning study was performed to evaluate the relative merits of static electron fields, arcing electron fields, and five-field photon IMRT. Thermoluminescent dosimeters (TLD) were used to verify the accuracy of the techniques. The required thickness of bolus was investigated, and an anthropomorphic phantom was also used to examine the effects of air gaps between the wax bolus used for the IMRT technique and the patient's scalp. RESULTS: Neither static nor arcing electron techniques were able to provide a reliable coverage of the planning target volume (PTV), owing to obliquity of the fields in relation to the scalp. The IMRT technique considerably improved PTV dose uniformity, though it irradiated a larger volume of brain. Either 0.5 cm or 1.0 cm of wax bolus was found to be suitable. Air gaps of up to 1 cm between the bolus and the patient's scalp were correctly handled by the treatment-planning system and had negligible influence on the dose to the scalp. CONCLUSIONS: Photon IMRT provides a feasible alternative to electron techniques for treatment of large scalp lesions, resulting in improved homogeneity of dose to the PTV but with a moderate increase in dose to the brain.

Aged↗
PubMed1997

Vacuum extraction: does duration predict scalp injury?

OBJECTIVE: To identify variables that increase the chance of neonatal scalp injury during vacuum extraction. METHODS: We conducted a prospective observational study of 134 vacuum extraction-assisted deliveries at Olive View-UCLA Medical Center in 1995. Data collected included parity, gestational age, duration of first and second stages of labor, indication for operative delivery, station and position of fetal head, duration of vacuum application, number of "pop-offs," neonatal weight, and descriptions of scalp marks or injury. Cranial imaging studies were obtained if clinically indicated. RESULTS: There were 28 infants with scalp trauma, including 17 superficial lacerations, six large caputs, and 12 cephalohematomata; one infant had subgaleal, subdural, and subarachnoid hemorrhages. Logistic regression analysis showed duration of vacuum application to be the best predictor of scalp injury, followed by duration of second stage of labor and paramedian cup placement. Duration of vacuum application ranged from 0.5 to 26 minutes, with a median length of 3 minutes. The proportion of injuries was greater for applications exceeding 10 minutes (6 of 9) than for those 10 minutes or shorter (22 of 121, P < .01). We did not encounter any cases of clinically important scalp injury. CONCLUSIONS: Cosmetic scalp trauma occurred in 21% of our newborns delivered by vacuum extraction and was more common after longer vacuum applications, longer second stages, and paramedian cup placement.

Adolescent↗
PubMed2002

Sensitivity of scalp EEG, cortical EGG, and somatosensory evoked responses during surgery for intracranial aneurysms.

BACKGROUND: We estimated the relative sensitivity and reliability of scalp EEG, cortical EEG and somatosensory evoked potentials (SSEPs) to detect significant changes during aneurysm surgery. METHODS: Two observers independently reviewed data from 18 patients who were monitored with scalp EEG, cortical EEG, and SSEPs to determine which if any modality demonstrated significant changes during 25 different episodes of temporary intracranial vascular occlusion. RESULTS: Kappa scores indicating the degree of agreement between the two observers were highest for the cortical strip EEG (kappa = 0.92) and the SSEPs (kappa = 0.82) and much greater than for the scalp EEG data (kappa = -0.07). The cortical strip recordings showed changes more often than either the scalp EEG or SSEP during temporary vascular occlusion. In no case did the scalp EEG change when neither the strip nor SSEP changed. In only 4% of events did the observers feel that the SSEP changed when the strip did not, but in 16% of cases, the strip changed without changes in any of the other modalities. CONCLUSIONS: Recording of EEG from strip electrodes placed on the cortical surface detects changes more frequently than either scalp EEG or SSEPs during vascular occlusion. Different observers were more likely to agree on whether the cortical strip EEG changed during vascular occlusion than the other modalities. This argues for the possible advantages of recording from strip electrodes during aneurysm surgery.

Cerebral Cortex↗
PubMed2003

Reliable and convenient method for the fixation of recording electrodes on nonshaved scalp for intraoperative electrophysiological monitoring: technical note.

BACKGROUND: Difficulties with the intraoperative monitoring of evoked responses sometimes occur because of displacement or dislodgment of the recording electrodes during surgery, especially if placed on nonshaved scalp. METHODS: An alternative fixation method of the recording electrode on the nonshaved scalp was developed. The sterile subdermal needle electrode was attached on the scalp by application of a transparent dressing (Tegaderm) over the electrode followed by fixing with a skin stapler. RESULTS: The needle electrodes were easily, quickly, and firmly positioned even on the nonshaved scalp. The responses of the intraoperative evoked potentials were highly stable and reproducible throughout the operation. CONCLUSION: This fixation method for subdermal needle electrodes on the scalp is safe, reliable, and convenient for intraoperative electrophysiological monitoring of evoked potentials, even if the scalp is not shaved.

Electrodes↗
PubMed1989

Scalp whorls.

Abnormally placed or absent scalp whorls have been associated with abnormal brain development. Defects of bony cranial development are not associated with such patterns. Single and double parietal whorls are examples of normal scalp patterns. Frontal patterns are variable, and scalp whorls associated with a cowlick can be seen at any location along the frontal hair line. A case of triple parietal scalp whorls and a case of a right temporal scalp whorl, both associated with normal development, are described. Current theories of hair whorl development, as well as normal and abnormal scalp whorl patterns, also are discussed.

Hair↗
PubMed2002

Antioxidant enzymes and lipid peroxidation in the scalp of patients with alopecia areata.

Alopecia areata (AA) is an autoimmune inflammatory disease. However, little is known about the alterations in lipid peroxidation and antioxidant enzymes in the scalp of patients with AA. Therefore, the aim of this study was to investigate the status of oxidative stress in the scalp of patients with AA. We measured the levels of thiobarbituric acid reactive substances (TBARS) as lipid peroxidation status, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) as antioxidant enzymes in the scalp of ten patients with AA and ten control subjects. The levels of TBARS in scalp of patients with AA (3654.1+/-621.2 nmol/g tissue) were significantly higher than those of controls (1210.2+/-188.8 nmol/g tissue) (P=0.002). The levels of SOD (134.8+/-23.8 U/g tissue) and GSH-Px (332.7+/-66.2 U/g tissue) in scalp of patients with AA were also significantly higher than those of controls (63.2+/-8.8 U/g tissue, 112.0+/-18.4 U/g tissue, respectively) (P=0.019, P=0.002, respectively). The mean levels of TBARS, SOD and GSH-Px in early phase of disease were increased 2-fold as compared with late phase of the disease. These results indicate that oxidative status is affected in AA. Lipid peroxidation and antioxidant enzymes may be involved in the pathogenesis of AA. Furthermore, we found high SOD and GSH-Px activities in the scalp of patient with AA. These high levels could not protect the patients against the reactive oxygen species, because lipid peroxidation could not be lowered in AA patients.

Adult↗
PubMed2001

Dipole modeling of scalp electroencephalogram epileptic discharges: correlation with intracerebral fields.

OBJECTIVE: In order to evaluate the feasibility of modeling seizures and the reliability of dipole models, we compared source localizations of scalp seizures with the distribution of simultaneous intracerebral electroencephalogram (SEEG). METHODS: In a first session, only scalp electroencephalogram (EEG) was recorded from 15 patients. We averaged the first detectable ictal activity in two consecutive segments of stable topography and morphology. Spatio-temporal dipole sources were estimated for each segment and projected on 3D-magnetic resonance images. In a second session, SEEG was recorded simultaneously with control scalp electrodes, allowing the identification of ictal patterns similar to those submitted to dipole modeling. RESULTS: Ictal discharges could be analyzed in only 6 of 15 patients. In the remaining 9, scalp discharges were undetectable or non-reproducible in 6, and solutions were unstable despite an apparently stable discharge in 3. In the 6 patients successfully modeled, dipoles were found in regions where SEEG discharges were present. However, when intracerebral discharges were very focal, there was no corresponding scalp activity. When intracerebral signals were maximal in the mesial temporal regions at the seizure onset, only lateral neocortical dipoles were found. When discharges reached the frontal lobes, we could identify lateral and mesial frontal sources. CONCLUSIONS: In most seizures, it was not possible to obtain satisfactory dipole models, probably a reflection of the high noise level or widespread generators. When modeling was possible, our results suggested that mesial temporal seizure discharges did not contribute to scalp EEG activity. This activity appears to reflect signals synchronized and distributed over the lateral temporal or frontal neocortex, as well as signals generated in mesial frontal areas.

Cerebral Cortex↗
PubMed2003

Spatial spectra of scalp EEG and EMG from awake humans.

OBJECTIVE: Evaluate spectral scaling properties of scalp electroencephalogram (EEG) and electromyogram (EMG), optimal spacing of electrodes, and strategies for mitigating EMG. METHODS: EEG was recorded referentially from 9 subjects with a 64 channel linear array (electrodes 3mm apart) placed parasagittally or transversely on forehead or occiput, at rest with eyes open or closed, or with deliberate EMG. Temporal (PSD(t)) and spatial (PSD(x)) power spectral densities were calculated with one-dimensional fast Fourier transform (FFT) for comparison with earlier analyses of intracranial EEG. RESULTS: Scaling of PSD(t) from scalp resembled that from pia: near-linear decrease in log power with increasing log frequency (1/f(alpha)). Scalp PSD(x) decreased non-linearly and more rapidly than PSD(x) from pia. Peaks in PSD(t) (especially 4-12Hz) and PSD(x) (especially 0.1-0.4 cycles/cm) revealed departures from 1/f(alpha). EMG power in PSD(t) was more "white" than 1/f(alpha). CONCLUSIONS: Smearing by dura-skull-scalp distorts PSD(x) more than PSD(t) of scalp EEG from 1/f(alpha) scaling at the pia. Spatial spectral peaks suggest that optimal scalp electrode spacing might be approximately 1cm to capture non-local EEG components having the texture of gyri. Mitigation of EMG by filtering is unsatisfactory. A criterion for measuring EMG may support biofeedback for training subjects to reduce their EMG. SIGNIFICANCE: High-density recording and log-log spectral display of EEG provide a foundation for holist studies of global human brain function, as an alternative to network approaches that decompose EEG into localized, modular signals for correlation and coherence.

Brain↗
PubMed1993

Scalp flap--a utility and reconstructive option for head and neck surgeons.

Regional scalp flaps are invaluable in resurfacing defects resulting from resections in the area of the upper face, orbit and scalp itself. The tissue lies adjacent to the defect, is easy to harvest, and can be termed as a 'durable one-stage' procedure. Scalp defects posterior to the vertex lend themselves to resurfacing by a posterior flap based on the occipital arteriovenous system. Anterior scalp defects including upper face and orbit can be resurfaced by an anterior scalp flap based on the superficial temporal arteriovenous system. While large areas can be resurfaced and the donor site effectively camouflaged, this flap finds less of an acceptance amongst patients with defects in the upper facial region when compared to the scalp defects. We recount our experience with these flaps and describe the high points of the reconstructive procedure and the results obtained in ten consecutive cases carried out over a three year period at the Department of Head and Neck Surgery, Kidwai Memorial Institute of Oncology, Bangalore, India. The short healing time and minimal morbidity make this reconstructive option an attractive one for the practising Head and Neck Surgeon.

Carcinoma, Squamous Cell↗
PubMed2001

Melanocyte-associated T cell epitopes can function as autoantigens for transfer of alopecia areata to human scalp explants on Prkdc(scid) mice.

Alopecia areata is a tissue restricted autoimmune condition affecting the hair follicle, resulting in hair loss. The goal of this study was to test the hypothesis that the autoantigen of alopecia areata is melanocyte associated. Potential autoantigens were tested in the human scalp explant/Prkd(scid) CB-17 mouse transfer system. Scalp T cells from lesional (bald) alopecia areata scalp were cultured with antigen-presenting cells, and antigen, along with interleukin-2. The T cells were then injected into autologous lesional scalp grafts on SCID mice, and hair regrowth was measured. Hair follicle homogenate was used as an autoantigen control. T cells cultured with melanoma homogenate induced statistically significant reduction in hair growth (p <0.01 by ANOVA). HLA-A2-restricted melanocyte peptide epitopes were then tested with lesional scalp T cells from HLA-A2-positive alopecia areata patients. Melanocyte-peptide-activated T cells significantly reduced the number of hairs regrowing in two experiments with six patients (p <0.001 by ANOVA). Injected scalp grafts showed histologic and immunochemical changes of alopecia areata. The most consistent peptide autoantigens were the Gp100-derived G9-209 and G9-280 peptides, as well as MART-1 (27-35). Melanocyte peptide epitopes can function as autoantigens for alopecia areata. Multiple peptides were recognized, suggesting epitope spreading.

Adult↗
PubMed1999

Scalp topography of the auditory evoked K-complex in stage 2 and slow wave sleep.

During NREM sleep a very large amplitude wave-form, known as the K-complex, may be elicited upon presentation of an external stimulus. The present study compared the scalp distribution of a prominent negative wave peaking at about 550 ms and a later positive wave peaking between 900 and 1300 ms in stage 2 and slow wave sleep (SWS). Nine subjects spent a single night in the laboratory. They were presented with an 80 dB SPL 2000 Hz auditory tone pip every 15 s. The EEG was recorded from 29 electrode sites and referenced to the nose. A K-complex was elicited on 34% of trials in stage 2 and on 46% of trials in SWS. A negative wave peaking at 330 ms was larger on trials in which the K-complex was elicited than on trials in which it was not. The large amplitude N550 was readily observable on trials in which the K-complex was elicited but could not be observed on trials in which it was not. The N550 was bilaterally symmetrical and was maximum over fronto-central areas of the scalp in both stage 2 and SWS. It inverted in polarity at the mastoid and inferior parietal regions. The scalp distribution of N550 significantly differed between stage 2 and SWS. It showed a sharper decline in amplitude over parietal and posterior-inferior areas of the scalp in stage 2 compared to SWS. A later P900 was maximum over centro-frontal areas of the scalp and was also bilaterally symmetrical. It showed a significantly sharper decline in amplitude over widespread inferior areas during SWS. Because the scalp maps of the N550 and P900 are different in stage 2 and SWS, their intracranial sources must also be different.

Adolescent↗
PubMed1999

The scalp biopsy: making it more efficient.

BACKGROUND: The scalp biopsy plays an important role in diagnosis and subsequent management of many scalp disorders. This simple diagnostic procedure can be time-consuming and frustrating for most dermatologists. OBJECTIVE: To outline an efficient technique for performing a scalp biopsy. METHODS: The technique of performing a scalp biopsy is reviewed and suggestions are made to make this time-consuming procedure more efficient. RESULTS: Sufficient specimen for histopathologic evaluation in a short perid of time is obtained. CONCLUSION: Attention to specific details in performing a scalp biopsy allows the physician to obtain a quick and histopathologically informative scalp biopsy.

Biopsy↗