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At least 325 records · Page 18Linked to original sources
PubMed1990

Presurgical evaluation for partial epilepsy: relative contributions of chronic depth-electrode recordings versus FDG-PET and scalp-sphenoidal ictal EEG.

One hundred fifty-three patients with medically refractory partial epilepsy underwent chronic stereotactic depth-electrode EEG (SEEG) evaluations after being studied by positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) and scalp-sphenoidal EEG telemetry. We carried out retrospective standardized reviews of local cerebral metabolism and scalp-sphenoidal ictal onsets to determine when SEEG recordings revealed additional useful information. FDG-PET localization was misleading in only 3 patients with temporal lobe SEEG ictal onsets for whom extratemporal or contralateral hypometabolism could be attributed to obvious nonepileptic structural defects. Two patients with predominantly temporal hypometabolism may have had frontal epileptogenic regions, but ultimate localization remains uncertain. Scalp-sphenoidal ictal onsets were misleading in 5 patients. For 37 patients with congruent focal scalp-sphenoidal ictal onsets and temporal hypometabolic zones, SEEG recordings never demonstrated extratemporal or contralateral epileptogenic regions; however, 3 of these patients had nondiagnostic SEEG evaluations. The results of subsequent subdural grid recordings indicated that at least 1 of these patients may have been denied beneficial surgery as a result of an equivocal SEEG evaluation. Weighing risks and benefits, it is concluded that anterior temporal lobectomy is justified without chronic intracranial recording when specific criteria for focal scalp-sphenoidal ictal EEG onsets are met, localized hypometabolism predominantly involves the same temporal lobe, and no other conflicting information has been obtained from additional tests of focal functional deficit, structural imaging, or seizure semiology.

Adolescent↗
PubMed2004

Fetal scalp pH and ST analysis of the fetal ECG as an adjunct to CTG. A multi-center, observational study.

OBJECTIVE: To evaluate the relationships between scalp-pH and CTG plus ST waveform analysis of the fetal ECG (STAN) clinical guidelines as indicators of intrapartum hypoxia in term fetuses born with cord artery acidemia. STUDY DESIGN: Data from 6999 term deliveries monitored by the STAN (R) S 21 as part of an EU multi-center study on clinical implementation of the STAN methodology for intrapartum fetal surveillance were analyzed. We identified 911 cases where a scalp-pH was obtained, including 53 cases with cord artery acidemia (pH < 7.06). Lag times between ST events and scalp-pH and time to delivery were related to cord artery metabolic and respiratory acidosis and neonatal outcome. RESULTS: 43 fetuses were identified by CTG plus ST as being in need of intervention 31 (25-46) minutes before delivery (median, 95% Cl). In five, no indications were given and in another five there were inadequate data. Fifteen cases with metabolic acidosis required special neonatal care, all 14 cases adequately monitored on STAN had indications to intervene for 19 minutes or more. In 30 adequately recorded cases, fetal blood sampling (FBS) was obtained within the last hour of labor. In 22 cases, FBS was obtained 13 (7-24) minutes after STAN guidelines had indicated abnormality and in eight no ST changes had occurred at time of FBS. The corresponding FBS data were pH 7.10 (7.01-7.15) and pH 7.21 (7.08-7.31), respectively, P = 0.01. In cases of metabolic acidosis, scalp-pH fell 0.01 units per minute after a baseline T/QRS rise was recorded during the second stage of labor. Apart from one newborn that died at 2 h from E. Coli septicemia, none of the neonates were affected neurologically. CONCLUSION: Cardiotocography plus ST analysis provides accurate information about intrapartum hypoxia similar to that obtained by scalp-pH.

Acidosis↗
PubMed2004

Spontaneous scalp arteriovenous fistula in a child with hartnup disease.

PURPOSE: To report the endovascular treatment of a spontaneous scalp arteriovenous fistula (AVF) in a child with Hartnup disease. CASE REPORT: A 6-year-old girl with Hartnup disease presented with recurrent attacks of intense, migraine-like, right-sided headache; a tender, pulsatile small mass was observed in the scalp. Selective digital subtraction angiography revealed a high-flow scalp AVF fed by the frontal branch of the right superficial temporal artery draining via the scalp veins. Endovascular treatment was performed by direct puncture of the distal feeding artery and injection of 2 mL of a 50% mixture of N-butyl-cyanoacrylate and Lipiodol. Serial arteriograms performed 6 months and 2 years later documented complete resolution of the lesion. The patient has had no recurrence of clinical symptoms or local signs for recanalization. CONCLUSIONS: Scalp AVFs may progress in size, causing significantly disabling symptoms, particularly in children. We recommend endovascular treatment at the earliest possible stage.

Angiography↗
PubMedDate not supplied

Scalp closure without fracture elevation does not reduce the risk of infection in patients with compound depressed skull fractures.

We conducted this study in order to determine whether suturing the scalp wound prior to referral for definitive surgery reduces the rate of wound infection in patients with compound depressed skull fracture and to propose guidelines for the initial management of the wound. We conducted a retrospective analysis of 79 patients with compound depressed skull fractures treated surgically in our unit between January, 1987 and August, 1998 and compared the rate of infection in patients who presented with open wounds with the rate in patients whose scalps were sutured prior to presentation to us. Adults and children were nearly equally represented in this study group. The male to female ratio was 3.6:1. Majority (49/79) of the fractures resulted from vehicular accidents. A total of 27 wounds were infected giving a rate of infection of 34%. Nine of the infections were present pre-operatively while the remaining 18 occurred post-operatively. Of the 52 patients with open wounds (OW) at presentation, 15 had wound infection. In the remaining 27 patients in whom the scalp had been sutured prior to referral (SW), there were 12 wound infections. There was no significant difference in the proportions of infected wounds between the two groups (X2 = 1.92, P > 0.5). In compound depressed skull fractures, suturing the scalp laceration alone prior to referral for definitive surgery did not reduce the rate of infection of the cranial wound. We recommend haemostasis, thorough irrigation of the scalp wound and application of sterile dressings prior to transfer for definitive management, in patients who do not have immediate access to neurosurgical care. Prospective studies are required to validate these findings.

Accidents, Traffic↗
PubMed2002

Cardiovascular responses to scalp infiltration with reduced concentration of adrenaline.

A prospective randomized controlled study was carried out in 41 adult neurosurgical patients to find out the hemodynamic effects following scalp infiltration with 0.5% lignocaine with or without adrenaline. The patients were divided randomly into two groups. Group I patients (n=21) received 0.5% lignocaine with adrenaline (1:8,00,000) for scalp infiltration and group II patients (n=20) received 0.5% lignocaine without adrenaline. Continuous monitoring of ECG, heart rate and arterial blood pressure was carried out every minute for 20 minutes following scalp infiltration. Blood loss while raising the scalp flap was assessed by the neurosurgeon who was unaware of the study. No significant hemodynamic disturbances were observed in either group. However, Group I patients had significantly (p=0.001) less bleeding on incision. From this study, we conclude that 0.5% lignocaine with adrenaline (1:8,00,000) does not give rise to any cardiovascular disturbances during and following scalp infiltration. Rather, it minimises blood loss while raising the craniotomy flap.

Adult↗
PubMed2005

Subcutaneous granuloma annulare of the scalp: a case report and case review.

Subcutaneous granuloma annulare (SGA) is a benign inflammatory disorder that may be alarming in its presentation because of its rapid growth and extensive differential diagnosis. The purpose of our study was to improve the appropriate evaluation and management of pediatric patients with subcutaneous scalp nodules. This article presents the clinical presentation, histopathologic data, evaluation, and management of a patient with subcutaneous scalp nodules diagnosed as SGA. Additionally, the clinical data of all other cases of SGA diagnosed at our institution over a 9-year period were reviewed. The majority (72%) of SGA patients encountered at our facility were children. Most of the SGA lesions were located on the extremities; however, all of the lesions located on the scalp were in children. This article reviews the differential diagnosis and workup of scalp nodules. In evaluating the patient with subcutaneous scalp nodules, we conclude that SGA should be added to the differential diagnosis.

Adult↗
PubMed1990

[Rapid expansion of the scalp using a soft tissue expander].

Reconstruction of large scalp defects depends on the ability to cover them with hair-bearing tissue. Using expanded tissue provides sufficient skin with characteristics suitable for covering large scalp defects. We used this technique in a 2-year-old boy to reconstruct a scalp defect caused by birth trauma. Rapid expansion of the scalp, using an expander introduced under normal scalp and an external valve, is recommended whenever dealing with children.

Child, Preschool↗
PubMed1990

Microsurgical replantation of two totally avulsed scalps.

We describe our experience with two patients in whom total avulsion of the scalp occurred. Successful replantation was carried out by microvascular surgery, with 90 and 95% survival of the scalp. Normal hair regrowth and ability to raise the eyebrows was achieved in both cases. A single superficial temporal artery was anastomosed, providing excellent perfusion of the entire scalp. Microvascular replantation should be attempted with all scalp avulsions, regardless of appearance and mechanism of injury. The patient must be transferred to a medical center with comprehensive microvascular surgery capabilities. The avulsed scalp should be cooled to 4 degrees C immediately, but prolonged ischemia time does not preclude a successful result.

Adolescent↗
PubMed1989

[Tonsure reduction. Principles and innovation: scalp lift].

Amongst the surgical procedures for the treatment of baldness, tonsure reduction occupies a very important place due to the quality and the rapidity of the results obtained and the safety of the technique. However, the first descriptions of this technique are only recent, which may seem surprising in view of the fact that the principle of repeated reduction in general and the closure of skin defects by extensive detachment have been known for a very long time. Although the first techniques described were easy to perform, the results obtained were relatively minor and sometimes negligible in the case of poor elasticity of the scalp. Since 1976, techniques have been described using extensive detachment of the scalp. These techniques principally use the cutaneous elasticity of the cervical scalp region situated above the occipital protuberance. They therefore imply the sacrifice of occipital vessels and nerves and survival of the detached scalp depends on the superficial temporal arteries alone. Lastly, to palliate the only disadvantage of this technique, inability to cover the frontal region, we propose the simultaneous combination of the giant reduction technique or scalp lift with an anterior temporal vertical flap with a superior pedicle which, after rotation through 90 degrees, will cover the bald frontal region.

Alopecia↗
PubMed1989

Non melanoma skin cancer of the scalp. On the etiology.

In order to evaluate the relative significance of previous grenz-ray treatment for human non melanoma skin carcinogenesis, the files were studied of all patients treated for non melanoma skin cancer of the scalp (n = 82, male/female ratio 1.1) at the Department of Dermatology, the Finsen Institute, from 1976 to 1985. Fourteen patients, with a male/female ratio of 3.7, were treated for squamous cell cancer (SCC). Sixty-five patients, with a male/female ratio of 0.9, were treated for basal cell cancer (BCC). Twelve patients (15%, 11 with BCCs, 1 SCC), of which eight with psoriasis, were previously treated with grenz rays on the scalp, and two of them had not been exposed to additional skin carcinogens. Comparably, malignant conversion in sebaceous and verrucous nevi accounted for 9 cases or 11%. Characteristically, scalp cancers associated with previous grenz-ray treatment were BCCs, the male/female ratio were less than 0.1 and two-thirds occurred in patients with multiple skin cancer. That grenz-ray related scalp cancers more often develop in females than in males was further confirmed by comparison to the sex distribution among patients treated on the scalp with grenz rays in the years 1950, 1960 and 1970 (p less than 0.01). (Accepted August 10, 1988.)

Adult↗
PubMed1989

[Planning of a local flap of expanded scalp for repair of alopecia cicatrisata].

Tissue expansion of scalp opens a new way for the treatment of alopecia cicatrisata. From May 1986 to April 1988, 56 cases of alopecia cicatrisata and skull outcrop had been repaired by Chinese tissue expander in our department. All cases got good results. Of them, the area of alopecia was over 120 cm2 and the greatest one (320 cm2) consisting of two third of the total scalp in 21 cases. There were 49 cases repaired by one expansion and other 7 cases followed by a secondary expansion. The characteristics of the expanded scalp and the common types of local flap design had been discussed. It was applicable for all kinds of alopecia cicatrisata and both for children (over 3 yrs) and adults. The results of scalp expansion in children revealed superior than that in adults. We considered that the repairing of alopecia cicatrisata by scalp expansion had more advantages than other methods.

Adolescent↗
PubMed1989

[Surgical management of squamous-cell carcinomas arising in burn scar of the scalp].

A series of seven patients with squamous-cell carcinoma that arose in the area of an old scalp burn is presented, and the patient's profiles, surgical procedures and results are reviewed. In six patients, burn scar of the scalp caused by direct exposure to fire in their infancy was a pathogenesis underlying the development of the malignancy, and the time interval was estimated to be an average of 53 years. In five patients there was evidence of intracranial invasion of the carcinoma involving the dura mater and cerebral parenchyma, as revealed by neuroradiological examinations and surgery. All patients were treated by extensive excision of the lesion, and to cover defects of the scalp and cranium, a variety of reconstructive techniques were used involving advancement, transposition or free latissimus dorsi musculocutaneous flaps combined with microvascular anastomosis. Radiochemotherapy was undertaken additionally in some patients either before or after surgery. Complete excision was accomplished in two patients, in whom the carcinoma was found localized within the layer of the scalp or in the depth of the periosteum. The survival time in these patients ranged from 73 to 87 months. In contrast, incomplete resection was performed in the remaining five patients, in whom the dura mater had been invaded with simultaneous involvement of the middle part of the superior sagittal sinus. The outcome resulted in poor prognosis, and all the patients except one died in 9 to 24 months after surgery due to continuous growth of the tumor in the intracranial cavity. Therefore, total resection facilitated by early detection prior to intracranial invasion is mandatory for successful treatment of such scalp carcinomas.

Aged↗
PubMed1978

Scalp infection after fetal monitoring in labour.

Neonatal scalp infection was reviewed over a four year period. The occurrence of such infection was found to be 0.14% of those infants monitored in labour using a spiral scalp electrode and 0.16% of those infants undergoing instrumental delivery. The duration of labour and the membrane-rupture delivery interval did not differ significantly from the total population. Scalp infection after monitoring occurred significantly later (day seven) than after instrumental delivery (day three) and was less often associated with positive bacterial cultures. Scalp damage is probably important in the aetiology of scalp infection, and the course of infection related to the degree of trauma.

Delivery, Obstetric↗
PubMed1985

The effect of grenz rays on psoriasis lesions of the scalp: a double blind bilateral trial.

Sixteen patients with symmetrical psoriasis lesions of the scalp were treated with grenz rays. In a double blind fashion, one side of the scalp was irradiated with 4 Gy of grenz rays applied on 6 occasions at intervals of 1 week, and the other side of the scalp was given placebo treatment. The patients were seen before and after X-ray therapy. A significantly (P less than 0.0001) better therapeutic result was recorded on the side of the scalp which had received active grenz ray therapy. In 14 of the 16 patients there was complete healing on the grenz ray-treated side after 6 wk of treatment. Nine patients were still free of lesions of the scalp 3 months after the start of the grenz ray therapy.

Adult↗
PubMed1995

Comparison of volume-conducted far-field short-latency glossopharyngeal nerve evoked potentials recorded from the scalp with similarly obtained near-field potentials from the solitary nucleus in dogs.

In 11 dogs, potentials recorded from the scalp and from the solitary nucleus after stimulation of the glossopharyngeal nerve were compared. The far-field potentials recorded from the scalp consisted of negativity, with peak latency of 2.10 to 3.45 milliseconds (mean, 2.93 milliseconds), followed by positivity, with peak latency of 3.20 to 5.95 milliseconds (mean, 4.86 milliseconds) and duration of 4.65 to 6.95 milliseconds (mean, 5.70 milliseconds). The near-field potentials recorded from the solitary nucleus consisted of positivity, with peak latency of 2.15 to 2.70 milliseconds (mean, 2.45 milliseconds), followed by negativity, with peak latency of 4.05 to 5.05 milliseconds (mean, 4.39 milliseconds) and duration of 4.45 to 5.80 milliseconds (mean, 5.21 milliseconds). Comparison of the far-field potentials (n = 10) with the near-field potentials (n = 5) indicated that polarity of the waves was reversed and that the first peak's latency was slightly (approx 0.5 milliseconds) longer in the scalp-recorded far-field potentials. Neither the difference in latency of the second peak nor the difference in its duration, measured from the onset of the potentials to the return to the baseline of the activity, was significant. The results strongly suggest that the response in the solitary nucleus evoked by electrical stimulation of the glossopharyngeal nerve is the source of at least part of the scalp-recorded responses to stimulation of the same nerve. The scalp-recorded far-field potentials could, therefore, be characterized as volume conducted from the evoked response in the solitary nucleus.

Animals↗
PubMed1998

[The effect of scalp infiltration with bupivacaine on blood coagulability and fibrinolysis in neurovascular surgery].

We investigated the effect of scalp infiltration with bupivacaine on blood coagulability and fibrinolysis in neurovascular surgery. Patients were randomly divided into two groups: scalp infiltration group (who received scalp infiltration with 0.5% bupivacaine prior to surgical incision, n = 7) and control group (n = 6). The blood coagulability and fibrinolysis were measured before and after surgical incision using a thromboelastogram (Thromboelastograph C-3000, Haemoscope). In the control group, the reaction and coagulation times were significantly shortened (30% and 23%, respectively, P < 0.05) and the maximum amplitude, which reflects coagulability, increased significantly (21%, P < 0.01) compared to each presurgical value. The scalp infiltration prior to the surgical incision prevented these reactions (P < 0.05). The fibrinolytic rate did not change in either group. We conclude that scalp infiltration prior to surgical incision is beneficial for attenuating an increase in blood coagulability, which could induce perioperative complications due to associated systemic diseases (i.e. hypertension, diabetes, ischemic heart disease, etc.).

Aged↗
PubMed1997

[Erosive lichen of the scalp].

BACKGROUND: We report an exceptional clinical presentation of erosive lichen planus of the scalp associated with hepatitis C and idiopathic CD4 lymphocytopenia. CASE REPORT: A 90-year-old woman was hospitalized in May 1995 for erosive dermatosis of the scalp and alopecia, associated with ungual lesions. Histology of the scalp lesions demonstrated lichen and the serology tests were positive for hepatitis C. The patient also had severe CD4 lymphocytopenia (290/mm3). The lesions regressed with clobetasol and occlusion and growth of scalp hair turned. DISCUSSION: Erosive lichen planus of the scalp has, to our knowledge, not been reported previously. The causal effect of drugs taken by this patient (tetrazepam and clorazepam) was not retained. Seropositivity for hepatitis C (with no evidence of active disease) was however probably not fortuitous. The association with CD4 lymphocytopenia merits discussion.

Aged↗
PubMed2002

Mediation of alopecia areata by cooperation between CD4+ and CD8+ T lymphocytes: transfer to human scalp explants on Prkdc(scid) mice.

OBJECTIVE: To determine the role of CD4+ and CD8+ T lymphocytes in the pathogenesis of alopecia areata. DESIGN: Relapse of alopecia areata was induced in autologous human scalp grafts on Prkdc(scid) mice by injection of activated T lymphocytes derived from lesional skin. CD4+ and CD8+ T cells were separated by magnetic beads before injection. SETTING: University-based dermatology practice. PARTICIPANTS: Eleven patients with either alopecia totalis or severe alopecia areata. MAIN OUTCOME MEASURES: Hair regrowth, hair loss, and immunohistochemical findings of scalp explants. INTERVENTION: Transfer of scalp T cells to autologous lesional scalp explants on Prkdc(scid) mice. RESULTS: Injection of unseparated T cells and mixed CD4+ plus CD8+ T cells resulted in significant hair loss (P<.01) in 5 of 5 experiments. However, injection of purified CD4+ or CD8+ T cells alone did not result in reproducible hair loss. CD4+ and CD8+ T cells induced follicular expression of intercellular adhesion molecule 1 (CD54), HLA-DR, and HLA-A, HLA-B, and HLA-C after injection into scalp grafts. CONCLUSIONS: CD4+ and CD8+ T cells have a role in the pathogenesis of alopecia areata. It is hypothesized that CD8+ T cells act as the effector cells, with CD4+ T cell help. It is now necessary to look for HLA-A, HLA-B, and HLA-C associations with alopecia areata. Therapeutic manipulations that interfere with CD8+ activity should be examined.

Adult↗