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At least 253 records · Page 14Linked to original sources
PubMed2006

[Establishment of composite facial and scalp allograft transplantation model in canine].

OBJECTIVE: To develop an experimental model of composite facial and scalp allograft in canine in order to investigate technical and immunological aspects and functional recovery of facial muscles of this new approach to facial reconstruction. METHODS: (1) Anatomic study: Four mongrel dogs were used for anatomical dissection of the head and neck region and for harvesting flap experiment. (2) Autologous transplantation (group I): Three types composite facial and scalp autologous transplantation were performed in five mongrel dogs. Type I composite tissue flap (group I a n = 2) included bilateral external ear and orbicularis oculi muscle. Type II (group I b n = 1) included single-lateral external ear, orbicularis oculi muscle, external nose upper and lower lip. Type III (group I c n = 2) included single - lateral external ear and orbicularis oculi muscle. (3) Allograft transplantation (group II): In group II a (n = 2), two allograft transplantation were performed with type III composite facial and scalp . In group II b (n = 4), four allograft transplantation were performed with the modified type III composite facial and scalp which included single - lateral external ear, orbicularis oculi muscle and one third of inferior tarsal plate and palpebral conjunctiva. To prevent allograft rejection, Cyclosporin A (CsA) and Methylprednisolone (MP) or Prednisone (PS ) were combined used as immunosuppressive protocol . Dose of CsA was adjusted depending on its blood drug level. Electromyogram (EMG) of orbicularis oculi muscle was carried out at 4 weeks, 6 weeks, 12 weeks and 6 months postoperation. RESULTS: (1) The facial anatomic characteristic of dog is similar to that of human being, external carotid artery and external jugular vein afford good blood supply to composite facial and scalp. (2) The dogs in group I c were long-term surviving with leakage of salivary juice. (3) In group II a (n = 2), one dog presented rejection reaction at 28th day postoperation, the reversal of rejection was achieved by increasing the dose of CsA and prednisone and with topical clobetasol for 2 weeks, the dog survived indefinitely( > 309 days). In group II b (n = 4), there were three dogs survived indefinitely ( > 159 days, > 129 days, > 108 days) without complication, EMG showed the function of orbicularis oculi muscle was gradually improving. CONCLUSION: The modified type III composite facial and scalp allograft transplantation model is an ideal model for facial allograft transplantation study.

Animals↗
PubMed2007

[Scalp necrosis in temporal arteritis].

BACKGROUND: Temporal arteritis is a systemic granulomatous vasculitis affecting large and medium sized arteries. Scalp necrosis is a rare complication that can appear before, during and after treatment. MATERIAL AND METHODS: A patient with temporal arteritis and scalp necrosis is presented and relevant literature reviewed. RESULTS: Scalp necrosis is seen in a few patients with temporal arteritis. The skin manifestations are most often bilaterally distributed and localised to the frontal, parietal and temporal parts of the scalp. Scalp necrosis often signifies a severe and extensive vasculitis, and is therefore associated with a high incidence of other disease-related complications, among them visual disturbances and blindness. CONCLUSION: Awareness of scalp necrosis as a complication of temporal arteritis could reduce unnecessary time-consuming assessments and lead to a more rapid diagnosis and start of treatment.

Aged↗
PubMed1994

Scalp involvement in dermatomyositis. Often overlooked or misdiagnosed.

OBJECTIVE: To characterize scalp involvement in patients with dermatomyositis. DESIGN: Case series. PATIENTS: All patients with dermatomyositis seen in our office between 1988 and mid 1993. Patient inclusion in this study required fulfillment of three or more of Bohan and Peter's criteria for dermatomyositis. RESULTS: Of 17 patients with the diagnosis of dermatomyositis, scalp involvement was present in 14. Five of the 14 patients with scalp involvement were diagnosed as having scalp psoriasis or seborrheic dermatitis before progression of their disease or tissue examination revealed the diagnosis of dermatomyositis. In all patients, the scalp involvement was manifested as atrophic, erythematous, scaly plaques. In addition, alopecia was noted in six of the 14 patients. Treatment of cutaneous involvement included sun avoidance, topical corticosteroids and/or antimalarials, and/or methotrexate. CONCLUSIONS: Recognition of this process is important because scalp involvement is often overlooked, may be misdiagnosed initially, and can be the presenting complaint in some patients with dermatomyositis.

Adolescent↗
PubMed1994

Surgical management of radiated scalp in patients with recurrent glioma.

Patients with malignant brain tumors requiring multiple craniotomies and external beam radiotherapy are at risk of scalp wound breakdown secondary to fibrosis and radiation damage. We present three cases to illustrate the nature of the problem and the surgical approaches to scalp repair. When a bicoronal incision has been used for the initial craniotomy, the plastic repair can be performed with a bipedicle visor scalp flap and split-thickness skin graft to cover the pericranium at the donor site. When a curvilinear (U-shaped or horseshoe) flap has been used for the initial craniotomy, a single-pedicle flap may be rotated to achieve closure without tension. In anticipation of the risk of scalp wound breakdown in patients with malignant brain tumors, the planning of the operative incision for the first craniotomy needs to take into account the long-term viability of the scalp. We recommend linear scalp incisions parallel to the arterial distribution instead of the traditional curvilinear (U-shaped or horseshoe) flaps; linear incisions are less likely to break down, and in the event of breakdown, linear wounds offer better therapeutic surgical options for plastic repair.

Adult↗
PubMed1995

Comparing fetal pulse oximetry with scalp pH.

OBJECTIVE: To determine whether pulse oximetry has the potential to replace scalp blood pH sampling in infants with abnormal cardiotocographs. STUDY DESIGN: The average scalp oximetry reading in labor recorded with an experimental N400 system was compared with fetal scalp blood pH. RESULTS: The average oximetry readings were unrelated to the pH of aerobically sampled fetal scalp blood. There was no subgroup of acidemic infants with a low oximetry reading. CONCLUSION: Pulse oximetry readings with present technology do not reflect scalp pH. The equipment is improving, but at this time pulse oximetry is not a simple alternative for scalp capillary blood sampling.

Blood Gas Analysis↗
PubMed1987

Central motor tract propagation in man: studies with non-invasive, unifocal, scalp stimulation.

Motor-evoked potentials (MEPs) to unifocal, anodal scalp stimulation have been recorded in 45 healthy volunteers from proximal and distal upper limb muscles. Optimal responses were obtained through a pericranial cathode consisting of 6 or more regularly spaced, interconnected plaques whose impedance was carefully balanced with that of a 0.8-cm2 stimulating anode on the scalp. Individual rectangular pulses with threshold intensity (70-86 mA) 100-200 microseconds in duration, with rise-decay times shorter than 50 microseconds resulted more efficient in eliciting individual MEPs in the target muscle. The foci of maximal response for hand and shoulder muscles were localized. The scalp-to-cervical cord conduction time along the motor tracts governing the hand muscles was 5.21 +/- 0.42 ms. This index was highly correlated with the subject's height and stable in time when repeatedly tested. Collision between orthodromically and antidromically propagated motor impulses was obtained by simultaneous stimulation of scalp and median nerve at wrist. Response facilitation was achieved by means of prestimulus voluntary contraction of the target muscle, continuous vibration of its tendon or scalp stimulation with paired shocks. Facilitation of MEPs was obtained by prestimulating the ipsilateral motor cortex 8-24 ms before the stimulation of the one contralateral to the target muscle. This was considered at least in part mediated by transcallosal connections. An efferent volley secondary to scalp stimulation was recorded for the nerve trunk with the near-nerve technique. Segmental and suprasegmental mechanisms underlying MEP facilitation provoked by phasic and tonic contractions of the target muscle have been investigated.

Adult↗
PubMed1984

Event-related potentials recorded from the scalp and nasopharynx. II. N2, P3 and slow wave.

Scalp and nasopharyngeal recordings of the N2, P3 and slow wave components were compared in a target-detection task. The effects of probability, interstimulus interval, intensity, discrimination difficulty, attention, stimulus omission and modality were evaluated. Waves of opposite polarity to the scalp N2 and P3 components were recorded in the nasopharynx. The scalp and nasopharyngeal N2 components showed different patterns of variation across experimental conditions. These findings indicate that there are two different cerebral processes occurring at the latency of the scalp N2. The scalp and nasopharyngeal P3 components consistently covaried across conditions, suggesting a single underlying process. The slow wave was observed only in the scalp recordings.

Attention↗
PubMed1986

Comparison in man of short latency averaged evoked potentials recorded in thalamic and scalp hand zones of representation.

Recordings were performed in the thalamus of 13 patients suffering from either abnormal movements or intractable pain, with the aim of delimiting the region to be destroyed or stimulated in order to diminish the syndrome. In 11 of these patients averaged evoked potentials were recorded simultaneously from the scalp and specific thalamus (VP) hand area levels following median nerve stimulation. These recordings were done during the operation or afterwards when an electrode was left in place for a program of stimulation. The latencies of onsets and peaks on the scalp 'P15' were compared with those of the VP wave; a clear correspondence was found. Moreover, when increased stimulation was used, both waves began to develop in parallel. Thus in the contralateral 'P15' a component exists due to the field produced by the thalamic response. To explain the presence of an ipsilateral scalp 'P15' wave, we propose that a second wave having the same latency and a slightly shorter peak exists on the scalp due to a field produced by a brain-stem response. This double origin of 'P15' is also shown by the different changes which the ipsilateral and contralateral waves present during changes in alertness. The scalp 'N18-N20' is also composed of at least 2 components. The first peak appears on the scalp with a latency shorter than that of the negativity which develops in the thalamus. The N wave, moreover, increases in latency with rapid stimulus repetition. We propose with others that 'N18' is a cortical event reflecting the arrival of the thalamo-cortical volley. The second component, 'N20,' has a peak latency closely correlated to that of the thalamic negativity. This component was present alone in 'N' when rapid stimulation (greater than 4/sec) was used, which did not change the thalamic response. It must be a field produced by the thalamic negativity.

Electrodes↗
PubMed2003

Interictal epileptic spiking during sleep and wakefulness in mesial temporal lobe epilepsy: a comparative study of scalp and foramen ovale electrodes.

PURPOSE: To assess distribution of temporal lobe spikes across different states of sleep and wakefulness in simultaneous scalp and foramen ovale (Fo) recordings. METHODS: The study included 12 patients with mesial temporal lobe epilepsy (MTLE). As part of their presurgical evaluation, patients underwent long-term video-EEG monitoring with combined scalp and foramen ovale electrodes (FoEs). In addition to traditional sleep scoring, waking was subdivided into eyes-opened and eyes-closed states, and rapid-eye-movement (REM) sleep was divided into phasic and tonic states. Spike counts were carried out visually for scalp and FoEs, and spiking rates were determined for each state. A ratio between FoE and scalp spiking rates also was calculated for each state. RESULTS: Scalp spiking showed a significant increase during NREM3,4, whereas FoE spiking increased during NREM2. The scalp/FoE ratio significantly increased during NREM3,4. A significant difference in spiking rate also was found between phasic and tonic REM states as well as between waking with eyes opened and closed in FoE recordings. CONCLUSIONS: Our data provide evidence of a discrepancy in spike distribution across different states of sleep and waking monitored by scalp and FoE recordings. We suggest that these discrepancies may reflect differences in archicortical and neocortical spike synchronization.

Adult↗
PubMed2002

Localization of epileptogenic zone in temporal lobe epilepsy by ictal scalp EEG.

Our aim was to evaluate the ability to localize the epileptogenic zone in temporal lobe epilepsy (TLE) by ictal scalp electroencephalogram (EEG). Using simultaneous video recording, we analysed scalp EEG activity during ictal periods in 38 patients (30 patients with medial TLE (MTLE) and eight with lateral TLE (LTLE)). In 14 patients, intracranial ictal EEGs were recorded with depth electrodes, and simultaneous recordings of scalp and intracranial EEG were performed in 11 patients. Scalp EEG showed that, in all 30 patients with MTLE (71 of 72 seizures), an attenuation of background activity was observed before the appearance of ictal activity. Ictal discharges first appeared in the scalp EEG when the ictal discharges reached the lateral part of the temporal lobe on the intracranial EEG. While, in all eight patients with LTLE (25 of 25 seizures), the attenuation of background activity did not occur before the appearance of ictal activity. When the ictal discharges started in the lateral temporal lobe on intracranial EEG, ictal discharges appeared on the scalp. MTLE and LTLE could be diagnosed by the presence or absence of attenuation of background activity with clinical ictal signs before the appearance of ictal discharges.

Adolescent↗
PubMed1995

Scalp distribution of electrical fields related to blink reflex.

In 20 subjects the supraorbital nerve was stimulated and R1 recorded from electrodes placed over the ipsilateral orbicularis oculi muscle and from locations Fz, F8, F7, Cz, C6, C5, Pz, T4, and T3 on the scalp. The latter were referred either to an extracranial electrode or to Fz. In five subjects an artificial dipole was set at three different positions on the eyebrow and records were taken from the same derivations on the scalp to study the distribution of fields of known intensity originating from known locations. It was found that R1 could be easily detected from all scalp locations. According to its scalp distribution, three patterns were identified, which matched those of the artificial dipole. Conversely from what had been believed by previous authors, the amplitude of R1 could be larger on the contralateral scalp, according to the reference used or to the location of its origin. Therefore, it is remarked that larger amplitude contralateral to the stimulus cannot anymore be considered an exclusive feature of responses arising from the cortex. The evidence we have provided recommends a highly cautious approach in interpreting results describing trigeminal scalp responses in the latency range of R1.

Adult↗
PubMed1989

Short-latency sinusoidal wavelets to bright flashed stimuli: studies with corneal lens, nasopharyngeal, retrobulbar and scalp recordings.

Short-latency flash visual evoked potentials (VEPs) and electroretinograms (ERGs) were recorded in 30 healthy volunteers and 14 patients (7 with retrobulbar neuritis and 7 with retinitis pigmentosa). Simultaneous recordings were performed by corneal, scalp, nasopharyngeal and retrobulbar (5 patients) electrodes. In 18 out of 30 healthy controls a brief sequence of oscillating wavelets was recorded between 15 and 40 ms on the scalp sites behind the vertex. In retrobulbar neuritis (RBN) patients normal responses were recorded by lens, retrobulbar, nasopharyngeal and frontal scalp electrodes. On the contrary none of these patients displayed short-latency activity behind the Cz scalp position. In 5 out of the 7 patients with retinitis pigmentosa, corneal, nasopharyngeal and scalp electrodes failed to detect any reliable waveform time-locked to the flash onset. In the remaining 2, a small lens ERG was recorded, while all other electrodes recorded a sequence of low-volted wavelets initiating 30 ms after the stimulus onset. In these patients an occipital VEP reduced in amplitude and with prolonged latency was also recorded. It is concluded that in presence of a normal corneal ERG because of the presence of volume spread oscillating retinal activity, it is hard to define while part of the scalp recorded, short latency, oscillating potentials is generated in subcortical visual structures.

Adolescent↗
PubMed2005

The role of sebaceous gland activity and scalp microfloral metabolism in the etiology of seborrheic dermatitis and dandruff.

Most common scalp flaking disorders show a strong correlation with sebaceous gland (SG) activity. Early SG activity in the neonate results in microfloral colonization and cradle cap. After maternal hormonal control subsides, there is little SG activity until puberty, when the SG turns on under sex hormone control. When the SG activity increases, the present but low Malassezia population has a new food source and proliferates, resulting in the scalp itching and flaking common to greater than 50% of adults. Dry scalp flaking, dandruff, and seborrheic dermatitis are chronic scalp manifestations of similar etiology differing only in severity. The common etiology is a convergence of three factors: (1) SG secretions, (2) microfloral metabolism, and (3) individual susceptibility. Dandruff and seborrheic dermatitis (D/SD) are more than superficial stratum corneum disorders, including alteration of the epidermis with hyperproliferation, excess lipids, interdigitation of the corneal envelope, and parakeratosis. The pathogenic role of Malassezia in D/SD has recently been elucidated, and is focused on their lipid metabolism. Malassezia restricta and M. globosa require lipids. They degrade sebum, free fatty acids from triglycerides, consume specific saturated fatty acids, and leave behind the unsaturates. Penetration of the modified sebaceous secretions results in inflammation, irritation, and scalp flaking.

Dermatitis, Seborrheic↗
PubMed1999

[Recurrence of erosive pustular scalp dermatosis after a skin graft].

INTRODUCTION: Erosive pustular dermatosis of the scalp is a rare and chronic dermatosis of unknown etiology with non specific histology and without effective treatment. It affects mostly old women. We have observed a 80 year-old male suffering from an erosive pustular dermatosis of the scalp following application of 5 p. 100 fluorouracile cream (Efudex) and his resistance to various treatments including skin graft. OBSERVATION: An 80 year-old man had been suffering, for many years from recurrent episodes of pustules, erosions and crusts of the scalp, following treatment with 5 p. 100 fluorouracile cream for skin lesions diagnosed as actinic keratosis. Different topical and systemic treatments were tried without much improvement. A skin graft of the scalp lesional area was finally done, showing a severe recurrence as a Koebner's reaction. Despite this recurrence, we have observed an easier control with a topical mixture of steroid and antibiotic. CONCLUSION: This recurrence of erosive pustular dermatosis of the scalp following skin graft had never been previously observed before, showing that removing affected skin did not control the disease, suggesting that anti-inflammatory agents probably originating from trauma persist.

Aged↗
PubMedDate not supplied

[Microsporum canis mycetoma of the scalp].

BACKGROUND: Mycetoma is a chronic subcutaneous tumefaction with presence of grains or granules. Etiological agents include bacteria or filamentous fungi. Mycetoma due to dermatophytes is uncommon, mainly occurring in Africa. To our knowledge, no case has been reported in the West Indies. Only two observations of Micosporum canis mycetoma in humans have been reported in the literature. We report a third case of mycetoma of the scalp caused by this fungus. CASE REPORT: A 22-year-old woman from Martinique, French West Indies, presented with an indolent tumefaction of the scalp evolving over five years. She had mental retardation due to congenital adrenal hyperplasia with 21-hydroxylase deficiency. The lesion was extracted surgically. Pathology and mycology examinations showed features of Microsporum canis mycetoma. Two months later, the scalp lesion recurred and the patient was treated with griseofulvin after surgical extraction. DISCUSSION: Mycetoma due to dermatophytes is very uncommon, mainly observed on the scalp and nape of the neck. A history of a skin lesion is frequent, leading to transcutaneous penetration of the fungus and mycetoma formation. Several dermatophyte species have been identified as causal agents (Microsporum ferrugineum, Trichophyton rubrum, Trichophyton verrucosum, Trichophyton mentagrophytes, Microsporum audouinii, Microsporum langeronii). Microsporum canis is rarely demonstrated in humans: two cases in children in Africa and Australia. Our observation was similar to the two cases in the literature: indolent and mobile tumefaction of the scalp, in a child or young adult, suggestive of lipoma or epidermal cyst, with excision leading to diagnosis. Association with tinea capitis and skin or nail involvement can also be observed.

Adult↗
PubMed2002

Scalpdex: a quality-of-life instrument for scalp dermatitis.

OBJECTIVE: To develop a scalp dermatitis-specific quality-of-life instrument. METHODS: Based on the results of directed focus sessions with 8 patients with scalp psoriasis or seborrheic dermatitis, we conceptualized 3 major constructs that explain the way scalp dermatoses affect patient quality of life: symptoms, functioning, and emotions. We constructed a 23-item instrument, Scalpdex, and tested its reliability, responsiveness, and validity. RESULTS: Fifty-two dermatology patients completed the study. We demonstrated construct validity by confirming that the factors derived by principal axes factor analyses with orthogonal rotation correlated to our hypothesized scales (r = 0.76-0.84) and that differences in symptom, functioning, and emotion scores differed among the varying levels of self-reported scalp severity more than would be expected by chance (P<.05 by analysis of variance). The instrument demonstrated reliability with internal consistency (Cronbach alpha, 0.62-0.80) and reproducibility (intraclass correlation coefficient, 0.90-0.97). The quality-of-life scores changed in the expected direction in our test for responsiveness (P<or=.05, by paired t test for functioning and emotion for those who improved). We ascertained the discriminant capability of Scalpdex compared with a dermatological generic quality-of-life tool, Skindex, by demonstrating superior responsiveness (P<or=.005 by paired t test in functioning and emotion) and improved overall sensitivity in individual items. CONCLUSIONS: Scalpdex is, to our knowledge, the first quality-of-life instrument specifically for patients with scalp dermatitis that is reliable, valid, and responsive. Clinicians can use the instrument to determine which aspect of the disease most bothers the patient and to evaluate quality of life as one variable of responsiveness to the therapeutic intervention.

Adult↗
PubMedDate not supplied

Reconstruction of complex scalp defects: the "Banana Peel" revisited.

OBJECTIVE: To demonstrate the use of multiple, large, local flaps in the reconstruction of large scalp defects. METHODS: A retrospective review of 4 cases in which the "banana peel" method of scalp reconstruction, originally described by Orticochea, was used as a method for closure of moderately large to extensive scalp defects. RESULTS: In all 4 cases, closure of the scalp defects was accomplished. Major morbidity included hair-bearing skin in the forehead in 1 patient, an inconsequential small flap dehiscence requiring closure in the same patient, and a partial loss of a small skin graft to a donor site defect in 1 patient. CONCLUSIONS: While other techniques may be optimal for the management of most scalp defects, such as 1- to 2-flap rotation-advancement flaps in small to moderate-size defects and microvascular free tissue transfer and secondary tissue expansion for larger defects, we conclude that the multiple-flap reconstruction method as described by Orticochea may be useful in a small subset of patients. The latter includes older, severely debilitated patients who would be optimally treated with microvascular tissue transfer but cannot tolerate lengthy general anesthesia and young patients who will not accept a significant area of alopecia that might exist with other techniques, such as secondary intention, skin grafts, or free flaps.

Adult↗
PubMed1976

Complete scalp avulsion.

Complete scalp avulsion results in serious consequences, including hospitalization, economic loss, devasting disfigurement, and psychological effects on the patient. Three patients suffering complete scalp avulsion are discussed. Each case involved injury from farm tractors and occurred in young girls with long hair. In each of them we successfully employed split thickness skin graft for repair of the extensive scalp loss. Excellent aesthetic results were obtained with the use of a wig. Other reported experiences using replacement of the avulsed scalp have been almost uniformly unsuccessful. With recent advancements in microsurgery, the potential for replantation of a completely avulsed scalp has become a hope for the future.

Adolescent↗