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PubMed1999

Paclitaxel in the treatment of patients with angiosarcoma of the scalp or face.

BACKGROUND: Angiosarcomas are rare tumors. Based on a complete response observed in a patient with angiosarcoma of the scalp treated with paclitaxel in a Phase II trial, the authors treated a cohort of patients with angiosarcoma of the scalp or face with paclitaxel as single agent. METHODS: The authors identified nine patients with angiosarcoma of the scalp or face treated at Memorial Sloan-Kettering Cancer Center with paclitaxel between January 1992 and December 1998. Various paclitaxel schedules were used over 1, 3, and 24 hours. RESULTS: Of the 9 patients, 8 had major responses (4 partial responses and 4 clinical complete responses) and 1 had a minor response, for a major response rate of 89%. The median duration of response was 5 months (range, 2-13 months). Neutropenia and peripheral neuropathy were the most frequent dose-limiting toxicities. No deaths were attributed to therapy. CONCLUSIONS: Paclitaxel as a single agent has substantial activity against angiosarcoma of the scalp or face, even in patients previously treated with chemotherapy or radiation therapy. Further investigation is warranted to define the optimal treatment dose and schedule.

Aged↗

PubMed2000

[A case of a scalp arteriovenous fistula associated with Rendu-Osler-Weber disease treated by direct percutaneous embolization].

We present a case of Rendu-Osler-Weber disease (hereditary hemorrhagic telangiectasia) accompanied by a scalp arteriovenous fistula, which was successfully treated by direct percutaneous embolization. A 51-year-old man, who had multiple vascular telangiectases and pulmonary arteriovenous fistulae, developed an enlarging pulsatile mass of the scalp anterior to the site of the previous craniotomy for a brain abscess in the right occipital lobe. Angiography demonstrated a high-flow arteriovenous fistula between the right superficial temporal artery and a varix. Percutaneous injection of pure ethyl alcohol was planned but seemed risky because of the major drainage being into the bilateral cavernous sinuses through the superior ophthalmic veins. A 24-gauge plastic needle was placed in the right superficial temporal artery just proximal to the fistula, and 0.7 ml of a mixture consisting of n-butyl cyanoacrylate and lipiodol in a ratio of 1:1 was injected. Then, the varix was directly punctured, and retention of the contrast medium was confirmed under manual compression by the placement of a circular ring. Embolization of the varix using 1.0 ml of 70% glucose solution and a subsequent 1.0 ml of pure ethyl alcohol was performed with compression, resulting in total occlusion of the fistula. The scalp mass resolved gradually and there was no evidence of recanalization. We conclude that direct percutaneous embolization is the first therapeutic choice for a scalp arteriovenous fistula with multiple shuntings associated with Rendu-Osler-Weber disease. Dangerous venous drainage should be eliminated before performing embolization with ethyl alcohol.

Arteriovenous Fistula↗

PubMed2001

Scalp replantation: a case report of long ischemic time.

A totally avulsed scalp was treated successfully by microvascular replantation in 1975 (1). Since then, scalp replantation has become the treatment of choice in scalp injuries and should always be considered even in cases of severe damage or prolonged ischemic time. Usually, every attempt is made to establish as many vascular anastomoses as possible. We report one case of total scalp avulsion with a 24-hour ischemic time, which was successfully replanted via one arterial and one venous anastomose.

Accidents, Occupational↗

PubMed2002

Death from hypovolemic shock caused by perforation of duodenal ulcer in a patient with angiosarcoma of the scalp.

We report a case of an 86-year-old woman with angiosarcoma on the scalp, who died from hypovolemic shock caused by perforation of a duodenal ulcer. A purple-red macule was first noticed on her left temporal scalp, and over a 1-month period this macule rapidly grew to a 6 cm purple-red indurated plaque with hematomas. The diagnosis of angiosarcoma was made based on the clinical features and histopathological finding of the lesional skin. Perilesional injections of recombinant interleukin 2 (rIL-2) were followed by surgical resection of the lesion and graft repair. However, 5 months later, new hematomas appeared and increased in number and size to cover her cheek, left temporal scalp and around the grafted area. Electron-beam radiotherapy showed only a temporary effect and the skin lesions with spontaneous severe bleeding extended rapidly again toward a wide region of the left half of the scalp and cheek. The patient died of hypovolemic shock after acute abdominal pain with intestinal hemorrhage. The surgical pathology revealed the presence of a perforated duodenal ulcer which might have been the direct cause of hypovolemic shock.

Aged↗

PubMed2002

Vitamin D and scalp psoriasis.

Calcipotriene has been shown to be safe and effective for the treatment of psoriasis. For scalp psoriasis, the safety advantage of this nonsteroid agent is as important as its efficacy. Even though monotherapy with calcipotriene solution may not always be efficacious for severe scalp psoriasis, many patients are managed effectively with a sequential therapy regimen consisting of 3 phases. In phase 1 (clearing), patients apply clobetasol solution or gel in the morning and calcipotriene solution in the evening daily for 2 weeks. After the scalp psoriasis improves, clobetasol is reduced to weekends and calcipotriene solution is applied on weekdays (phase 2, transitional). Phase 3 is maintenance on calcipotriene solution alone to prevent recurrence. For patients with recalcitrant scalp psoriasis-where only a clobetasol-strength, superpotent topical corticosteroid is effective-a flip-flop therapy regimen has been proposed that allows for the safe, prolonged use of clobetasol solution by limiting its treatment to twice a day for 2-week periods with the use of calcipotriene solution twice a day for a minimum of 2 weeks during the corticosteroid-free in-between periods.

Administration, Topical↗

PubMed1976

Continuous Fetal Scalp and Carotid Artery Oxygen Tension Monitoring in the Sheep.

Fetal scalp and carotid PO2 were recorded continuously by polargraphic oxygen electrodes at several levels of maternal oxygenation. The results were compared to measurements obtained by intermittent blood samples using the radiometer blood gas analyzer. There was a good correlation between the PO2 values measured by the implanted oxygen electrodes and by conventional analyses of blood samples collected anaerobically. Electrode measurements differed from the control radiometer values by a mean of +/- 1.2 mmHg; 2 SD= +/- 2.50. Scalp PO2 recordings were lower but paralleled the carotid recordings under varying degrees of maternally inspired O2 concentrations. Thus scalp PO2 levels reflect closely those in the central fetal circulation. Administration of 95% O2 to the mother resulted in a 27% increase of scalp PO2 and a 29% increase in the carotid artery PO2 when compare to room air.

Animals↗

PubMed2003

Hemodynamic response to skull pins application in children: effect of lignocaine infiltration of scalp.

BACKGROUND: Skull pins application following local anesthetic infiltration of scalp obtunds hemodynamic changes in adults. No such study is available in children. METHODS: 30 children undergoing elective suboccipital craniectomy with skull pins fixation, were randomly allocated either to control group I, or lignocaine group II. Whereas in group I, pins were applied without any scalp infiltration. In group II, pins were applied 1 min. after scalp infiltration with 0.5% lignocaine (plain) at each pin site. RESULTS: Mean arterial pressure and heart rate were recorded during pinning (peak increase),1,4,7 and 10 min later, and were compared with the baseline (parameters recorded approximately 20 min. after intubation). Mean arterial pressure in group I peaked from 77.0 +/- 9.19 to 113.87 +/- 13.7mmHg (P<0.001) and remained significantly high throughout the study period. In Group II peak increase in mean arterial pressure was from 91.64 +/- 16.39 to 101.85 +/- 15.87 mmHg (P<0.01) and remained high till 1 min. only. Pins placement resulted in significant increase in heart rate only during pinning (peak increase) and up to 1 min. in both the groups (P<0.01). CONCLUSIONS: In children, skull pins placement 1 min. after scalp infiltration with 0.5% lignocaine plain fails to prevent the hemodynamic changes arising during pins placement (peak change) and up to 1 min. after pins placement. However, the technique successfully blocks these changes beyond 1 min. post skull pins fixation.

Anesthetics, Local↗

PubMed2004

Topical melagenine for repigmentation in twenty-two child patients with vitiligo on the scalp.

BACKGROUND: The purpose of this study was to evaluate the efficacy of topical melagenine for repigmentation in child patients with vitiligo on the scalp. METHODS: Twenty-two child patients with vitiligo on the scalp were treated with 1.2 mg/ml aqueous melagenine in combination with 20 minutes of infrared exposure twice daily. RESULTS: In 4 patients (18.2%), melagenine treatment in combination with infrared exposure led to complete recovery; in 6 patients (27.3%), treatment was shown to be effective; in 8 patients (36.3%), treatment led to improvements in patient condition; and only 4 patients (18.2%) showed no response after 1 - 2 treatment sessions. The general effective rate of melagenine-infrared combination treatment was 45.5% for the children with vitiligo on the scalp, and treatment was accompanied by minimal side effects. CONCLUSION: Melagenine may be efficacious and a safe treatment option for childhood vitiligo affecting the scalp.

Administration, Topical↗

PubMedDate not supplied

Clobetasol propionate shampoo 0.05%: a new option to treat patients with moderate to severe scalp psoriasis.

Psoriasis is a chronic, papulosquamous condition that affects up to 2% of the U.S. population. Approximately 50% of patients with psoriasis have involvement of the scalp. This was a multicentre, randomized, vehicle-controlled, double-masked and parallel-group study. The aim was to evaluate the efficacy and safety of clobetasol propionate shampoo, 0.05% versus its corresponding vehicle in subjects aged 12 years and older with moderate to severe scalp psoriasis over a treatment period of 4 weeks. Recurrence of scalp psoriasis was assessed during a two week follow-up period. A total of 142 subjects were treated. Results after 4 weeks demonstrated that clobetasol propionate shampoo, 0.05% was with a similar safety profile significantly more effective than its vehicle. The novel short contact shampoo formulation of clobetasol propionate is convenient and efficacious and minimizes systemic exposure while being efficient, safe and well-tolerated in the treatment of moderate to severe scalp psoriasis.

Administration, Topical↗

PubMed1979

Dermatoses of the scalp.

By judicious consideration of the clinical appearance, by direct examination with magnification, and by culture results, skin biopsy, and other laboratory results, the clinician is able to diagnose most pathological conditions of the scalp. The scalp participates in many systemic disorders and frequently is the chief site of involvement. Similarly, many generalized disorders limited to the skin exhibit their most typical manifestations in the scalp. Whenever a diagnosis eludes the investigator, more than likely he or she has not considered all of the etiological possibilities or has not pursued an adequate laboratory investigation. A few scalp diseases initially present nonspecific clinical pictures. By utilizing follow-up examinations at appropriate intervals, the diagnosis can eventually be made. Once a diagnosis is made, appropriate treatment will generally produce satisfactory improvement or cure. Nevertheless, a few generally rare conditions will defy the physician's most enlightened and aggressive therapy.

Acne Keloid↗

PubMed1992

Comparison of EEG between nasopharyngeal and scalp leads with the aid of an automatic EEG analysis system.

We analyzed the EEG quantitatively with an automatic EEG analysis system, and introduced this system for investigation the relationship between the scalp EEG and nasopharyngeal EEG. The EEG was recorded from healthy volunteers by photic stimulation. We found that components of slow waves like delta and theta were more rich but alpha component was less in the nasopharyngeal EEG than in the scalp EEG. In the analysis of the rate of the appearance of each EEG wave using photic stimulus, a decrease of alpha 1 and an increase of theta 1 are observed in the scalp EEG while there are no specific changes of them in the nasopharyngeal and scalp EEGs. The nasopharyngeal EEG obtained from the vicinity of the base of the brain was thought to originate from the vicinity of the brain stem.

Adult↗

PubMed1991

[Use of a topographic analysis of the myoclonic activity recorded from the scalp for detection of functional disorders of the serotoninergic systems].

A study was made of 36 EEGs chosen in terms of the principle of combination in them of two elements: (1) a focus of paroxysmal activity; (2) electrophysiological correlates of myoclonus whose stem origin was not questioned. The appearance of myoclonic and paroxysmal patterns distribution on the scalp was reproduced with the aid of color pictograms. It has been discovered that the stem myoclonic activity is largely grouped around the paroxysmal one; within the limits of the anterolateral quadrant of the scalp surface, one can see a tendency toward a compact recording of the stem myoclonic and authentic paroxysmal patterns. In cases where the paroxysmal activity is in the anterotemporal focus, the proximity of the points of the recording from the scalp of the stem myoclonic and paroxysmal patterns may appear maximal. As the latter ones get detectable during recording, the myoclonic patterns play the role of their satellites (rather than coincidents). This can serve a prerequisite for ascertaining local deficiency of 5-HT during observation on the EEG of compact-grouping myoclonic phenomena recorded within the limits of one anterolateral quadrant of the scalp surface.

Action Potentials↗

PubMed2006

[Observation on clinical therapeutic effect of scalp acupuncture combined with body acupuncture on apoplectic hemiplegia].

OBJECTIVE: To search for the best method for increasing clinical therapeutic effect on apoplectic hemiplegia. METHODS: One hundred and twenty cases of apoplectic hemiplegia were randomly divided into three groups in order of visiting. Group A (n = 33) were treated by scalp acupuncture combined with consciousness-restoring resuscitation method, group B (n = 60) by scalp acupuncture combined with traditional acupuncture, and group C (n = 27) by traditional acupuncture. The clinical therapeutic effects were evaluated according to the scores of manner, speech, motor function of limbs, and so on. RESULTS: Three cases were basically cured, 20 were markedly effective, 7 were effective, with a total effective rate of 90.9% in the group A; and the corresponding figures were 7, 28, 21 cases and 93.3%, respectively in group B with no significant difference between the group A and B (P > 0.05); and 7 cases were markedly effective, 11 effective with a total effective rate of 66. 7% in the group C with a significant difference as compared with the group A and B (P < 0.05, P < 0.001). CONCLUSION: Scalp acupuncture combined with consciousness-restoring resuscitation method and scalp acupuncture combined with traditional acupuncture have a similar therapeutic effect on apoplectic hemiplegia, which is superior to that of traditional acupuncture.

Acupuncture Therapy↗

PubMed1991

Familial hypotrichosis of the scalp. Autosomal dominant inheritance in four generations.

We describe a Danish family of four generations suffering from hypotrichosis of the scalp. Age at onset was 6-17 years and almost total scalp alopecia was reached by the age of 14-21 years. No associated ectodermal defects were present. Nine of 22 persons covering four generations were affected. Growth of the scalp hair slowly decreased and was accompanied by a gradual, diffuse hair loss without regional variation. A scalp biopsy was performed, revealing a non-scarring alopecia with features of androgenetic alopecia. The pedigree was compatible with autosomal dominant inheritance.

Adult↗

PubMed2006

Multifocal scalp hair loss.

BACKGROUND: Cutaneous metastases from internal cancer are relatively uncommon in clinical practice, but they are very important to recognize. Metastases of skin may be a herald sign in the diagnosis of internal malignancy. Scalp metastasis from breast carcinoma is reported but it is rare. We describe a 42-year-old woman who presented with three foci of alopecia on her scalp resembling alopecia areata. She was a known case of breast carcinoma 10 years prior. Radical mastectomy and total chemotherapy was done 8 years prior. An incision biopsy of an alopecic patch was done revealing metastases of breast carcinoma to the scalp. Her workup failed to find metastatic involvement of other organs. This represents a case of breast carcinoma metastatic to the scalp mimicking alopecia areata, almost 10 years after radical mastectomy, and 8 years after chemotherapy. It is important for dermatologists to be alert for atypical features of alopecia areata, such as induration, and to maintain a low threshold for biopsy in atypical cases.

Adult↗

PubMed2006

[Profile of basal cell carcinomas of the scalp after radiotherapy for tinea capitis (about 63 cases)].

The induction of basal cell carcinoma (BCC) of the scalp by X-ray therapy for tinea capitis is well known. The aim of the study was to specify the epidemiological, clinical and histological characteristics of this disease. In a retrospective study, we collected data from the files of 63 patients, with a history of radiotherapy for tinea capitis, followed between January 1995 and December 2004. Fifty one men and 12 women with a total of 108 BCC of the scalp are reported (1.76 lesion per patient and 1.13 cm on average of diameter). The mean age at the occurrence of the BCC was 45.5 years. Thirty seven percent of BCC occurred on the occipital area; 28.7% were in the parietal site. The most frequent clinical aspect was the nodular BCC (51%) and the cicatricial BCC (35%). Histological study showed a nodular aspect in 74 % and pigmentation in 62% of cases. It is concluded that BCC of the scalp following X-ray therapy for tinea capitis have some clinical and histological particularities. It represents the most frequent tumour developing on irradiated scalp.

Adult↗

PubMed1990

Scalp cooling by cold air for the prevention of chemotherapy-induced alopecia.

A new system is described for cooling the scalp with cold air in order to prevent chemotherapy-induced alopecia. Compressed air was cooled by means of a vortex tube built into a hair-drier cap. This system reduced the blood flow in the scalp to 35%, the surface temperature to 14.2 degrees C and the intradermal temperature at hair follicle level to 29.2 degrees C. The low temperature could be kept constant for at least one hour of cooling. By means of comparison, with cryogel packs the lowest epidermal temperature attained was 17.9 degrees C; moreover, once this was reached after 10 min, it rapidly rose again to 20.6 degrees C after 40 min. Forty-eight patients receiving cytostatic treatment for breast cancer were subjected to scalp cooling with the cold air system, starting 15 min before chemotherapy and lasting for 90 min. With the system set at an air temperature of -12 degrees C, the treatment was well tolerated. Of the 13 patients treated with 40 mg/m2 doxorubicin in combination with other cytostatics, 6 had hair loss less than WHO grade 3, in contrast to 1 of 4 patients given cryogel packs. However, patients treated with epirubicin at 75 mg/m2 all showed grade 3 hair loss in spite of air cooling. In view of the possibility of achieving and maintaining low scalp temperatures, the cold air system is to be preferred to cryogel packs. Whether better clinical results may be obtained with cooling for longer periods and/or to lower temperatures remains to be determined.

Alopecia↗

PubMed1988

[Scalp recorded P13 and spinal recorded N13 in short latency somatosensory evoked potentials].

Using non-cephalic reference and by median nerve stimulation, P 13 component and N 13 component are recorded on the scalp (scalp P 13) and the posterior neck (spinal N 13), respectively, in the short latency somatosensory evoked potentials (SSEP). The purpose of this study is to disclose the origin, characteristics and clinical significance of these two components. Ten healthy volunteers served for normal subjects. Ten patients with pontine lesion or brain death were studied. The effect of barbiturate was also studied in additional 5 patients during anesthesia for cranioplastic surgeries. Electrical stimuli of 0.2 msec square wave pulse were used in routine examination. To confirm the effects of stimulation frequency, 3, 6, 9, 12, 15, 18, 21, 24 and 27 Hz were also used in normal subjects. Recording electrodes were placed in the following sites. (1) Scalp electrode at the Shagass' point contralateral to the stimulated side (Par.). (2) Posterior neck electrode on the spinous process of the fifth cervical vertebrae (Cv5), (3) Anterior neck electrode on the thyroidal cartilage (Ant. C). (4) Erb's electrode just above the mid-clavicular point ipsilateral to the stimulation. Erb's electrode contra-lateral side of stimulation was used as a reference. Spinal N 13 on posterior neck reversed its polarity into P 13 (spinal P 13) on the anterior cervical electrode. A study with different stimulus rates revealed that the latency of scalp P 13 significantly prolonged at 24 Hz stimulation. On the other hand, the latency of spinal N 13-P 13 easily prolonged even at 18 Hz. This suggested that spinal N 13-P 13 were generated polysynaptically.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗