SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A large defect of the scalp was observed soon after debridement of a high-tension electrical burn of the scalp. Bone scan revealed no uptake of radioactive material to the parietal bone below the necrotic tissue of the scalp. Consecutive bone scans after latissimus dorsi free flap transfer revealed progressive regrowth of the bone.
In a search for an invisible skin donor site and a comfortable dressing for the donor site, a study was designed in which the scalp was used as the donor site and Duoderm was applied as the dressing. The study contained 18 children with minor burns. A Duoderm dressing on scalp donor sites showed a normal healing time. In using the scalp as a donor site the patient can be mobilized very quickly after the operation and the scar is hidden and invisible 1 month postoperation.
Traditional surgical treatment of deep burns of the scalp and skull involve the excision of necrotic bone and soft tissues with trephanation of the bone to permit granulation tissue formation and subsequent grafting. This approach prolongs wound time, adds additional trauma and, even after initial healing, necessitates secondary soft tissue and bone reconstruction. The treatment described here is an alternate and more aggressive one involving early excision of necrotic soft tissue without bone resection followed by immediate coverage with well-vascularized axial flaps from adjacent intact scalp. This method provides an optimal environment for healing and regeneration of areas of destruction to the skull. This surgical method was used in the treatment of 22 patients with deep burns of the scalp with satisfactory clinical results. Bone regeneration was confirmed by roentgenological investigations.
PURPOSE: A technique for treating mycosis fungoides confined to the scalp using a method known as the 4 x 4 technique is presented. METHODS AND MATERIALS: Uniform dose distribution on the scalp and acceptable "hot spots" along five match lines is accomplished by using four sets of four fields (i.e., 4 x 4) on the patient. Precise and reproducible patient and field alignment was accomplished with a solid thermoplastic mask, which is the surface on which match lines are drawn. In-vivo dosimetry (thermoluminescent dosimeters and film) are easily attached to the mask which also provides a portion of the 7 mm bolus used to shift the characteristic 6 MeV electron depth dose toward the skin surface. RESULTS: In-vivo dosimetry demonstrated that single fraction match line doses are within 25% to 30% of central axis dose. Shifting these match lines to four locations reduces these "hot spots" to satisfactory levels (less than 120%). Three patients have been treated with this technique and each patient continues to have a complete clinical response at 14 to 21 months post treatment. In addition, each patient has excellent cosmetic results with no evidence of acute or chronic side effects at the match lines. CONCLUSION: The 4 x 4 technique has proven to be useful in the treatment of mycosis fungoides confined to the scalp.
Laser Doppler flowmetry was used to evaluate the relationship between the changes in scalp blood flow and transcutaneous PO2 (PtcO2) during labour. Laser Doppler flow (LDF) and PtcO2 were measured simultaneously in fourteen women using a combined sensor. Scatter diagrams of LDF and PtcO2 show a hyperbolic curve, i.e. at high flow levels PtcO2 is independent of the flow rate and will reflect the arterial PO2 value, whereas at lower flow levels PtcO2 becomes highly dependent on the blood flow rate. The latter situation occurred in most of the fetuses when labour progressed. An inverse relationship between LDF and PtcO2 was observed in two fetuses in those parts of the recordings which coincided with repetitive severe variable decelerations++ in the FHR tracing (r = -0.59 and -0.65), suggesting a compensatory increase in scalp blood flow during hypoxemia. It is concluded that the PtcO2 signal is considerably influenced by local scalp blood flow in the majority of the patients and thus is a questionable parameter for monitoring fetal carotid arterial PO2.
Dipole source localization promises to enhance knowledge about the structural and functional processes underlying differences in scalp-recorded ERPs observed between normal and patient populations. In this paper the Cuffin and Cohen (1) four-compartment model of volume conduction is used to examine the effects of variations in size of different compartments on scalp-recorded potentials. Using single discrete current dipoles located various distances from the center of the head, the effect of varying the thickness of the superficial extra-sulcal subarachnoid layer of CSF and the thickness of the skull are examined. Changing the thickness of the CSF layer alters amplitude recorded at the scalp and also alters the topographic distribution of the potential; these effects are more pronounced the closer the dipole source is to the surface. Changes in skull thickness have similar, but even greater effects.
Event-related brain potentials (ERPs) were recorded from young (mean age = 24.1), middle-aged (48.7) and older (69.7) adults during a version of the oddball paradigm, in which 48 unique, unexpected novel stimuli were interspersed with equally rare instructed targets. As older relative to younger adults are thought to differ in their ability to inhibit the processing of task irrelevant information, we expected, based on previous work, that novel stimuli would retain their 'novelty' longer in older than in younger adults. To assess this, P3 amplitude and scalp topography elicited by novels and targets were analyzed as a function of stimulus number (n = 6) within the block and as a function of block number (n = 4). The results were in line with the prediction: While the younger adults' P3 scalp distribution shifted from a relatively more frontal to a relatively more posterior focus as a function of novel number within the block, this was not evident in the scalp topographies of the older adults. Coupled with the older adults' elevated false alarm rates to novel stimuli, the data are consistent with a change in frontal lobe function with increases in age.
STUDY OBJECTIVE: We have previously described a prospective, randomized, multicenter, clinical trial comparing the hair apposition technique, a new technique of treating scalp lacerations with tissue adhesives, with standard suturing. We found the hair apposition technique to be a better technique for closing suitable scalp lacerations. In this study, we aim to compare the cost-effectiveness of the hair apposition technique and standard suturing. METHODS: All costs related to each method were calculated, including equipment and staff time. On the basis of the previous randomized controlled trial, differential costs caused by complications were also calculated. The incremental effectiveness of the hair apposition technique was assessed in terms of complications avoided. Expected values of costs and outcomes were obtained through Monte Carlo simulation. RESULTS: The hair apposition technique was dominant over standard suturing in that it was more effective and resulted in a cost savings of USD 28.50 (95% confidence interval USD 16.30 to USD 43.40) per patient compared with standard suturing because of reduced equipment needs, shorter medical staff time required, no need for another visit to remove sutures, and lower complication rates. The probability of the hair apposition technique being both cost saving and more effective was 98.9%. CONCLUSION: The hair apposition technique is more cost-effective compared with standard suturing and could lead to large cost savings, given the common occurrence of scalp lacerations in most health systems.
Conventional follicle harvesting techniques for hair transplantation are limited by the available scalp donor hair. The development of an innovative technique of microsurgical single follicular unit extraction has made it possible to exploit body hair grafts for scalp transplantation. This case study reports on 18 months of follow-up on a patient with extensive scalp scarring who underwent a transplantation procedure using donor chest hair. The photographically documented results show a change in the length of the chest hair measuring an average of 4 cm at transplant to 15 cm by 18 months post-transplant. The transplanted chest grafts provided an excellent cosmetic result for hair replacement.
Fifteen patients with various scalp defects resulting from contact electrical burns to the head, were reconstructed between the periods of January 1989 and October 2004 in our burns unit. The incidence of scalp burns in our patient population was 2.99% for electrical injuries and 0.95% for all burns during the study period. We present here a clinical series of fifteen patients with large, complex scalp defects following contact electrical burns to the head treated successfully by the application of local and free flaps. In this series, four free flaps, one pedicled flap and 10 local flaps were used for the reconstructions with no major postoperative complications seen. The average size of the defect was 89.45 cm2 for cases in whom local flaps were applied, 193 cm2 for free flaps and 143 cm2 for one case treated with distant flap. Four cases required craniectomies because of the delay in reporting to our burns unit. Early surgical attempt to cover the defect with a well-vascularized tissue provides excellent healing, osteogenesis, short hospital staying, low rate of infection and requires no surgical debridement of the bone in the early phase.
The incidence of extensive full thickness scalp burn involving the calvaria is rare and can be very difficult to reconstruct, as the application of local or free tissue transfer is limited. Although wound closure can be achieved with bone debridement and immediate or delayed split-thickness autografting, the result may be problematic due to unstable skin graft surface. The use of artificial dermis that may provide stable thick coverage in the treatment scalp and skull burn has rarely been reported in literature. We encountered two patients who suffered from severe head burns involving the calvarium. Following debridement including the necrotic bone, the artificial dermis (Integra) was used for immediate wound coverage which was 15 cmx10 cm in one case and 5 cmx6 cm in another. Three weeks later, ultra-thin skin grafting was placed on the neodermis. Compared to split-thickness skin graft, this technique provides a thicker coverage for wound closure. Neither skin breakdown nor ulceration was noted in the 1-year follow-up. This paper reports the successful use of artificial dermis for reconstruction of severe scalp burn with calvarial bone involvement.
OBJECTIVE: To evaluate the usefulness of an adhesive paste named EC2 (Grass-Telefactor) in comparison with collodion, for scalp electrodes placement in patients with drug resistant partial epilepsy monitored by long-term video-EEG. METHODS: A total of 40 patients with drug resistant partial epilepsy participated in the study. In 20 patients, electrode placement on the scalp was made with collodion (group C) whereas in the remaining patients EC2 was used (Group P). After the electrode placement (T1) and after 24 h of recording (T2), the impedance of the electrodes was measured. Moreover, the time required to apply the electrodes and for their daily maintenance was calculated and recorded for all patients who entered the study. RESULTS: At each observation, group C showed mean values of electrode impedance significantly higher that the group P (T1: 16.8 k omega; T2: 6.5 k omega vs T1: 2.4 k omega; T2: 4.0 k omega, respectively) (P < 1 x 10(-5)). The time required to make the montage and to provide its daily maintenance was significantly shorter in group P than in group C [20.8 and 10.5 min vs 44.3 and 19.7 min, respectively (P < 1 x 10(-5))]. CONCLUSIONS: We found that the use of EC2 paste in scalp electrode attachment is less time consuming, with better recording quality as a result of lower electrode impedance values, than the use of collodion. SIGNIFICANCE: EC2 paste may substitute collodion in electrode placement for long-term video-EEG monitoring, with an optimal cost-benefit ratio in terms of recording performance, time consumption, and safety.
Rotation flaps constitute a time-honoured method for repair of small-to-moderate scalp defects, in effect even in the era of microsurgical reconstruction. A case of cicatricial pressure alopecia that was successfully repaired using the Bardach modification of the curved tripod flap confirms the value of this flap in scalp reconstruction. The main advantages of this method are the natural appearance of the final result due to preservation of hair orientation, and the uniform distribution of the wound-closure tension over a wide peripheral area of the scalp, although extensive undermining is generally required.
STUDY OBJECTIVE: To evaluate the effect of 0.25% bupivacaine scalp block on alterations in hemodynamics and plasma catecholamine metabolites during general anesthesia in patients undergoing frontotemporal craniotomy. DESIGN: Prospective, clinical study. SETTING: Operating room of a university hospital. PATIENTS: 16 ASA physical status II and III patients who were scheduled for frontotemporal craniotomy. INTERVENTIONS: Patients were prospectively randomized to receive a saline control (C group) or bupivacaine scalp block (SB group) as an adjuvant to general anesthesia using isoflurane in 50% N(2)O-O(2). MEASUREMENTS: Routine monitoring of electrocardiogram, heart rate (HR), and mean arterial blood pressure (MAP) were recorded at two-minute intervals from the beginning of anesthesia until 10 minutes after incision, followed by 5-minute intervals throughout the remaining course of the surgery. By prospective design, increases in MAP or HR by 20% above the mean baseline values were treated with 2.5 mg/kg of thiopental combined with 2 mug/kg of fentanyl. Arterial blood was sampled at 5 minutes before and after skin incision and at the start of dural opening for measuring serum catecholamine metabolites by high-performance liquid chromatography. MAIN RESULTS: Only two patients in the SB group needed additional anesthetics for stabilizing their hemodynamics during the course of anesthesia. In contrast, all C group patients required supplemental anesthesia for controlling the abrupt rise in hemodynamic parameters. In addition, absolute MAP and HR values were significantly higher in the C group than in the SB group during the surgical period between incision and dural opening. The differences in hemodynamics observed between the two groups were, however, not accompanied with a significant change in plasma catecholamine metabolites at each predetermined time interval measured. CONCLUSIONS: Pretreatment with 0.25% bupivacaine scalp block appeared to be an effective adjuvant treatment for maintaining stable hemodynamics for patients undergoing craniotomy during general anesthesia especially at the time of skin incision and dural opening. This study design was unable to discern any correlation between elevation in hemodynamic parameters and a rise in serum catecholamine levels.
Asymmetry is a common phenomenon in higher organisms. In humans, the cortical representation of language exhibits a high degree of asymmetry with a prevalence of about 90% of left hemispheric dominance, the underlying mechanisms of which are largely unknown. Another sign that exhibits a form of lateralization is the scalp hair-whorl direction, which is either clockwise or anti-clockwise. The scalp hair-whorl develops from the same germ layer as the nervous system, the ectoderm, between the 10th and 16th week in utero and has been shown to be associated with various neurodevelopmental disorders. Here, we use an established fMRI paradigm to examine the association of a solely biological marker of asymmetry, hair-whorl direction and language lateralization. We show that the mechanism that influences hair-whorl direction and handedness [Klar, A.J.S., 2003. Human handedness and scalp hair-whorl direction develop from a common genetic mechanism. Genetics 1651, 269-276.] also affects cerebral language dominance.
A 30-year-old female patient lost her scalp in an industrial accident. Surgeons used a microscope to reconnect the arteries and veins in her scalp and to reattach the scalp to the patient's cranium. The patient tolerated the procedure without complications, although she developed venous congestion in her right ear while she was in the neuroscience intensive care unit. After several days of leech therapy, the patient experienced an uneventful postoperative course. One month after discharge from the hospital, the patient's hair was growing back in and her incision lines were fading.
Thirty-five patients with stage I melanoma of the scalp were retrospectively reviewed and compared with similar patients with melanoma of the extremity and trunk. Patients with melanoma of the scalp were predominantly male. The 5-year survival rate was 89 percent. This compared favorably with similar patients with melanoma arising either in the trunk or the extremity. The prognosis of patients with stage I melanoma of the scalp is no worse than that of patients with melanoma arising in the trunk or extremity; therefore, they should be treated in a comparable manner.
Electrical stimulation of upper limb nerves allows one to record two types of scalp responses, that is conventional low-frequency somatosensory evoked potentials (SEPs), and bursts of high-frequency (about 600 Hz) wavelets. To further clarify the functional meaning of both types of responses, we investigated whether changes of GABAergic drive could cause significant modifications of conventional as well as high-frequency SEPs. We recorded median nerve SEPs from six healthy volunteers before and after a single oral administration of lorazepam. In order to explain scalp SEP distribution before and after lorazepam administration, we performed the brain electrical source analysis of raw data. After lorazepam administration, conventional scalp SEPs showed a significant amplitude decrease of all cortical components including the primary N20/P20 response, while the subcortical P14 response remained substantially unchanged. Similarly, dipolar analysis showed a significant strength decrease of all cortical dipoles, whereas the strength of both subcortical dipoles (possibly located at the level of the brainstem and thalamus, respectively) remained unchanged. By contrast, no significant changes of high-frequency SEPs were induced by drug intake. Therefore, our findings suggest that the inhibitory effect induced by lorazepam mainly affects intracortical circuitry. Tonic increase of the inhibitory drive, possibly mediated by GABAA receptors, can account for the reduced activity of first order deep spiny neurons generating the primary N20/P20. Conversely, intrinsic firing properties of the cell population generating high-frequency SEP responses are unaffected by the increase of GABAergic drive. This finding lends further substance to the hypothesis that conventional and high-frequency SEPs are generated by different cell populations.