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PubMedDate not supplied

PET for diagnosis of malignant lymphoma of the scalp: comparison of [11C]methyl-L-methionine and [18F]fluoro-2-deoxyglucose.

A 43-year-old woman was admitted with a tumor mass in her forehead. Two months previously, a lump in her breast had been diagnosed as mastopathy. Palpation revealed an elastically hard immobile tumor mass in her forehead. MRI detected a tumoral lesion of generally uniform contrast involving frontal subcutaneous, cranial, and intracranial regions. PET demonstrated more intensive and wider accumulation of [11C]methyl-L-methionine (Met) than of [18F]fluoro-2-deoxyglucose (FDG). Biopsy of the forehead mass was performed, which was diagnosed as B-cell-type malignant lymphoma. The tumor mass in the forehead then shrank spontaneously, as confirmed by palpation and MRI. The tumor mass in the left breast was totally extirpated and histologically diagnosed as B-cell-type malignant lymphoma, like the tumor mass in the forehead. Postoperatively, chemotherapy (VEPA) was performed. Although FDG accumulation had not been detected, postchemotherapy PET demonstrated slight Met accumulation, suggesting the presence of a residual tumor. PET served well to detect the lesion and evaluate therapeutic efficacy in malignant lymphoma. Met-PET was more sensitive to malignant lymphoma than FDG-PET.

Adult↗
PubMed2007

Effects of bone oscillator coupling method, placement location, and occlusion on bone-conduction auditory steady-state responses in infants.

OBJECTIVE: The aim of these experiments was to investigate procedures used when estimating bone-conduction thresholds in infants. The objectives were: (i) to investigate the variability in force applied using two common bone-oscillator coupling methods and to determine whether coupling method affects threshold estimation, (ii) to examine effects of bone-oscillator placement on bone-conduction ASSR thresholds, and (iii) to determine whether the occlusion effect is present in infants by comparing bone-conduction ASSR thresholds for unoccluded and occluded ears. DESIGN: Experiment 1A: The variability in the amount of force applied to the bone oscillator by trained assistants (n = 4) for elastic-band and hand-held coupling methods was measured. Experiment 1B: Bone-conduction behavioral thresholds in 10 adults were compared for two coupling methods. Experiment 1C: ASSR thresholds and amplitudes to multiple bone-conduction stimuli were compared in 10 infants (mean age: 17 wk) using two coupling methods. Experiment 2: Bone-conduction ASSR thresholds and amplitudes were compared for temporal, mastoid and forehead oscillator placements in 15 preterm infants (mean age: 35 wk postconceptual age (PCA)). Experiment 3: Bone-conduction ASSR thresholds, amplitudes and phase delays were compared in 13 infants (mean age: 15 wk) for an unoccluded and occluded test ear. All infants that participated had passed a hearing screening test. RESULTS: Experiment 1A: Coupling method did not significantly affect the variability in force applied to the oscillator. Experiment 1B: There were no differences in adult bone-conduction behavioural thresholds between coupling methods. Experiment 1C: There was no significant difference between oscillator coupling method or significant frequency x coupling method interaction for ASSR thresholds or amplitudes in the young infants tested. However, there was a nonsignificant 9-dB better threshold at 4000 Hz for the elastic-band method. Experiment 2: Mean bone-conduction ASSR thresholds for the preterm infants were not significantly different for the temporal and mastoid placements. Mean ASSR thresholds for the forehead placement were significantly higher compared to the other two placements (12-18 dB higher on average). Mean ASSR amplitudes were significantly larger for the temporal and mastoid placements compared to the forehead placement. Experiment 3: There was no difference in mean ASSR thresholds, amplitudes or phase delays for the unoccluded versus occluded conditions. CONCLUSIONS: Trained assistants can apply an appropriate amount of force to the bone oscillator using either the elastic-band or hand-held method. Coupling method has no significant effect on estimation of bone-conduction thresholds; therefore, either may be used clinically provided assistants are appropriately trained. For preterm infants, there are no differences in ASSRs when the oscillator is positioned at the temporal or mastoid placement. However, thresholds are higher and amplitudes are smaller for the forehead placement, consequently, a forehead placement should be avoided for clinical testing. There does not appear to be a significant occlusion effect in young infants; therefore, it may be possible to do bone-conduction testing with ears unoccluded or occluded without applying a correction factor, although further research is needed to confirm this finding.

Acoustic Stimulation↗
PubMed1996

Effects of topical erythromycin on ecology of aerobic cutaneous bacterial flora.

We have demonstrated previously that application of topical erythromycin, an antibiotic commonly used for the treatment of acne, results in an increased density of cutaneous erythromycin-resistant (Emr) coagulase-negative staphylococci; however, it is unknown if this increase results in an overall higher density of total cutaneous staphylococci or if upon cessation of erythromycin use, Emr coagulase-negative staphylococci remain at an increased density compared with the pretreatment density. To investigate this, 2% erythromycin or vehicle was applied to each subject's forehead (n = 225) twice a day by laboratory personnel for a period of 6 weeks. Samples were obtained for culture from the forehead, anterior nares, and back of the subjects at baseline and at weeks 6, 9, and 12 of the study. Cultures were performed on differential media. Plates into which erythromycin was incorporated (8 micrograms/ml) were used to identify Emr coagulase-negative staphylococci. The species of all Emr coagulase-negative staphylococci were determined, and an antibiogram for 16 antibiotics was obtained. The baseline prevalence of Emr coagulase-negative staphylococci on the forehead and nose was about 80% at the two study sites, whereas that on the back was 50%. The baseline density of Emr coagulase-negative staphylococci on the forehead, nose, and back was approximately 20% of the total flora. Following 6 weeks of erythromycin treatment, the prevalence of Emr coagulase-negative staphylococci on the forehead and nose was nearly 100% and the densities were 73 and 62%, respectively; the prevalence and density for the back were 78 and 42%, respectively. The most prevalent erythromycin resistance gene expressed by the Emr coagulase-negative staphylococci was ermC. There was no increase in the numbers of Staphylococcus aureus, gram-negative rods, or yeasts, nor was there increased resistance to any other antibiotic except clindamycin. The density of total aerobic organisms also remained static. There were no changes in the prevalence or density of Emr coagulase-negative staphylococci in the vehicle group. A statistically significant decrease in the prevalence and density of Emr coagulase-negative staphylococci in the erythromycin group was observed within 3 weeks posttreatment and by 6 weeks posttreatment, the prevalence and density returned to baseline values. These data demonstrate that the increased prevalence and density of Emr coagulase-negative staphylococci as a result of topical 2% erythromycin use are transient on both population and individual levels.

Administration, Topical↗
PubMed2004

Climatic and temporal effects on the expression of secondary sexual characters: genetic and environmental components.

Despite great interest in sexual selection, relatively little is known in detail about the genetic and environmental determinants of secondary sexual characters in natural populations. Such information is important for determining the way in which populations may respond to sexual selection. We report analyses of genetic and large-scale environmental components of phenotypic variation of two secondary sexual plumage characters (forehead and wing patch size) in the collared flycatcher Ficedula albicollis over a 22-year period. We found significant heritability for both characters but little genetic covariance between the two. We found a positive association between forehead patch size and a large-scale climatic index, the North Atlantic Oscillation (NAO) index, but not for wing patch. This pattern was observed in both cross-sectional and longitudinal data suggesting that the population response to NAO index can be explained as the result of phenotypic plasticity. Heritability of forehead patch size for old males, calculated under favorable conditions (NAO index > or = median), was greater than that under unfavorable conditions (NAO index < median). These changes occurred because there were opposing changes in additive genetic variance (VA) and residual variance (VR) under favorable and unfavorable conditions, with VA increasing and VR decreasing in good environments. However, no such effect was detected for young birds, or for wing patch size in either age class. In addition to these environmental effects on both phenotypic and genetic variances, we found evidence for a significant decrease of forehead patch size over time in older birds. This change appears to be caused by a change in the sign of viability selection on forehead patch size, which is associated with a decline in the breeding value of multiple breeders. Our data thus reveal complex patterns of environmental influence on the expression of secondary sexual characters, which may have important implications for understanding selection and evolution of these characters.

Age Factors↗
PubMed2006

Laser-Doppler flowmetry and Horner's syndrome in patients with complete unilateral damage to the parasellar sympathetic fibers during cavernous sinus surgery.

AIM: To determine ocular, sudomotor, and vasomotor components of Horner's syndrome resulting from complete unilateral intraoperative damage to the parasellar sympathetic fibers during cavernous sinus surgery. METHODS: Complete damage to the parasellar sympathetic fibers was found in four patients operated for central skull base lesions. Pupilometry, eyelid fissure measurement, Hertel's exophthalmometry, starch iodine sweat test, and laser-Doppler perfusion assessment of bilaterally symmetrical forehead and cheek areas were performed. RESULTS: Pupil diameter was smaller and the eyelid fissure was >2 mm narrower on the affected side in all four patients. Exophthalmometry after the operation never revealed >1 mm difference. Anhydrosis was localized to the medial forehead in three and to the entire forehead in one patient. Average perfusion did not significantly differ between the affected and opposite side of the forehead or cheek. CONCLUSIONS: The parasellar sympathetic fibers exclusively innervate the orbit and variably innervate the forehead sweat glands. No conclusion regarding their contribution to the facial vasomotor control could be established.

Adrenergic Fibers↗
PubMed1980

[Early treatment of facial-craniostenosis (Crouzon-Apert) (author's transl)].

The possibilities of treatment of the facial deformities related to Apert and Crouzon syndromes were transformed by the total facial advancement osteotomies described by Paul Tessier. These facial osteotomies are possible in children, and there is enough follow-up nom to assure that facial advancement osteotomies in children do not impair significantly the remaining growth possibilities. There are however severe psychological sequalaes in patients operated as children or youngsters, resulting from a deformed appearance during early childhood. We therefore try to give these children an acceptable appearance before entering school, around 3 or 4 years of age. Now in fact, we are trying not only to correct, but to prevent these deformities by early age release of the synostoses. The synostoses are usually involving the coronal suture and the cranial base. The cranial base being out of safe reach, we have started in 1976 to perform a 2 cm advancement of the forehead, including the supra-orbital rim. At first, we were using a lateral tenon-mortise fixation. We have tried the extended coronal craniectomy advocated by McCarthy and Coll., but since July 1977, we are using the original floating forehead principle: the advanced forehead is wired back only to the face, malar bones and root of the nose, leaving behind and extended craniectomy. Thus, the rapidly expanding brain of the infants is able to project anteriorly the forehead and upper part of the face. We have operated on 26 infants with faciocraniostenosis and severe brachycephaly according to these early release principle, the last 11 with the floating forehead approach. The results are very encouraging, the appearance being normal or subnormal after a few months. Even if an upper maxillary osteotomy is necessary later, we feel that an early improvement of these children is of high benefit to them. The improvement can also be functional, the psychological tests and the intracranial pressure measures showing that an early release is benefitial even in the absence of obvious intracranial hypertension.

Child, Preschool↗
PubMed1994

Transcutaneous bilirubinometry in the management of bilirubinemia in term neonates.

One hundred full term babies of both sexes were randomly selected for transcutaneous bilirubin index (TcBI) estimation at the forehead at 12-24 h intervals from the time of appearance of clinical jaundice till the serum bilirubin levels fell within safe limits. TcBI was correlated with serum bilirubin estimated by conventional diazo method. Forty babies required phototherapy, in 20 an area of 2.5 cm2 over the forehead was covered during phototherapy to make an unexposed 'window' for TcBI estimation. The other 20 newborns received phototherapy as such and TcBI was estimated on the forehead. There was a linear relationship between serum bilirubin level and TcBI estimated at the forehead (r = 0.9090; P < 0.001). Further a significant linear correlation between prephototherapy and post-phototherapy (covered and uncovered groups) TcBI and serum bilirubin levels also existed (r = 0.7979; P < 0.001). There was no significant difference between post-phototherapy TcBI estimated at the covered and uncovered areas of forehead. However, post-phototherapy values of TcBI were significantly lower than corresponding prephototherapy values at higher serum bilirubin levels (> 16 mg/dl).

Bilirubin↗
PubMedDate not supplied

Nasal reconstruction in the elderly patient. The case for not letting age determine method.

OBJECTIVES: To review a series of nasal reconstructive procedures in elderly patients, and to discuss management issues related to reconstructing nasal defects in patients 80 years and older. DESIGN: Retrospective review identifying patients 80 years and older undergoing significant nasal reconstructive surgery. SETTING: University and private practice settings. PATIENTS: Patients 80 years and older requiring significant nasal reconstructive surgery, with nasal defect large enough to require a forehead flap for skin resurfacing. Patients whose defects were allowed to granulate or who had skin grafts were excluded. INTERVENTION: Nasal reconstructive surgery using advanced surgical techniques such as forehead flaps and cartilage grafts. MAIN OUTCOME MEASURES: Complications related to surgery or use of anesthesia and whether patients believed the effort and resources required to complete the nasal reconstruction were worth it. RESULTS: Fifteen patients 80 years and older underwent nasal reconstructive surgery using forehead flaps. In addition, 5 patients had intranasal mucosal grafts and 6 had cartilage grafts. There were no instances of anesthetic or perioperative morbidity or mortality. In addition, all flaps completely survived, and results were judged as good to excellent. CONCLUSIONS: Actuarial evidence shows that a 90-year-old American woman has a 40% chance of living to be 95 years old. Presently, with the improved level of functioning of octogenarians and nonagenarians, we are also concerned with their facial appearance, and want to use the optimum reconstructive technique. The decision of what type of reconstructive surgery to perform should not be based simply on a patient's age but must also take into account the patient's mental status and wishes, and medical condition. Our evidence supports the concept that, in the appropriately chosen patient 80 years and older, forehead flaps and cartilage grafting can be performed without significant morbidity.

Aged↗
PubMed1994

Endoscopic facial rejuvenation: endoforehead, the functional lift. Case reports.

Endoscopic techniques have only very recently been applied to aesthetic plastic surgery procedures, especially in carpal tunnel release, in forehead plasties, and in breast augmentation operations. The author briefly outlines his experiences with endoscopic forehead lifts, first reported at surgical conferences in Los Angeles and Buenos Aires in 1992, and now totaling 61 cases performed in the 11 months just prior to the submission of this article. This endoscopic approach to forehead lifting has provided similar and comparable results to conventional coronal forehead lift operations, by means of small incisions made in the scalp area with minimal and fewer complications.

Adult↗
PubMed1981

Is frontalis activity a reliable indicator of the activity in other skeletal muscles?

Multichannel integrated action-potential recordings (called electromyometrograms of EMMGs) from 10 individuals with various functional symptoms and disorders were selected for statistical examination to obtain evidence bearing on the topic in question. Each EMMG recorded the action-potential levels from four regions simultaneously via four channels of integrating differential amplifiers. The subjects sat quietly, awake and alert, with eyes open and head erect. Electrodes were placed over antagonistic muscle groups in the following regions: (1) forehead, (2) jaw-throat, (3) right forearm, (4) left leg. Successive 1-minute action-potential levels from each of these regions were sued to calculate within-subject correlations (r) and predictabilities (r 2 and R2) among the different regions. Mean and median correlations (r) and predictabilities (r 2 and R 2) for each of the following pairs of regions were found to be weak: (1) forehead and jaw-throat, (2) forehead and forearm, (3) forehead and leg, (4) jaw-throat and forearm, (5) jaw-throat and leg, (6) forearm and leg. The findings support the statement that the frontalis or any of the other regions measured are poor indicators of the amount of activity elsewhere in the skeletal musculature of awake and alert individuals. When combined with basic principles of neuroanatomy and neurophysiology, the findings also support the statement that there is probably no portion of the skeletal musculature that can be used to quantify the activity in other portions.

Action Potentials↗
PubMed1997

Comparison of distal oesophageal temperature with "deep" and tracheal temperatures.

PURPOSE: To compare distal oesophageal (reference) temperature with "deep-sternal," "deep-forehead," and tracheal temperatures, establishing the accuracy and precision of each. METHODS: We studied 20 patients undergoing general anaesthesia for gynaecological surgery. Their lungs were mechanically ventilated with a circle system, at a fresh-gas flow rate of 6 L.min-1 Respiratory gases were not warmed or humidified. Tracheal temperatures were recorded from a Trachelon tube inserted approximately 21 cm. Deep-body temperatures were measured at the sternum and forehead using a Coretemp thermometer. The principle of the method is to null thermal flux through a cutaneous disk, thus obliterating thermal gradients between the sides of the disk, skin surface, and subcutaneous tissues. Distal oesophageal temperatures were measured from thermocouples incorporated into oesophageal stethoscopes. Tracheal and deep-tissue temperatures were compared with oesophageal temperature using regression and Bland and Altman analyses. RESULTS: Tracheal, sternal, and forehead temperatures correlated similarly with distal oesophageal temperature, correlation coefficients (r2) being 0.7 in each case. The offset (oesophageal temperature minus study site) was considerably larger for tracheal temperature (0.7 degree C) than for the other sites (0.2 degree C). However, the precision was only 0.3 degree C at each site. CONCLUSION: Our data suggest that tracheal temperatures may not be an adequate substitute for conventional core-temperature monitoring sites. In contrast, the accuracy and precision of deep-tissue temperature monitoring at the sternum and forehead was sufficient for clinical use.

Anesthesia, General↗
PubMed2006

Kinetics of blood flow after topical application of benzyl nicotinate on different anatomic sites.

Cutaneous characteristics, e.g., thickness of the SC and density of follicles, affect the penetration of topically applied substances. In the present study, the penetration of benzyl nicotinate, causing a vasodilation, was studied on three anatomic sites (forearm, forehead and calf) differing in their skin characteristics. Therefore, the blood flow of the superficial dermal plexus and that of the larger capillaries in the deeper skin layers was simultaneously measured using a laser Doppler flowmeter. In addition, the cutaneous temperature and redness were determined as a function of time. These four biological reactions were measured in turn on a skin area treated with a gel containing benzyl nicotinate and on an untreated control area. The highest basal levels were observed on the forehead. Topical application of benzyl nicotinate resulted in an increase in each biological response. Compared to the other sites, the maximal values were reached earliest on the forehead, which also showed the fastest decrease. No significant differences were obtained comparing the kinetic data of the calf with that of the forearm. The results indicate an additional contribution by the numerous vellus hair follicles of the forehead to the penetration and exposure of the drug.

Administration, Topical↗
PubMed1998

Cutaneous glands of male and female impalas (Aepyceros melampus): seasonal activity changes and secretory mechanisms.

The cutaneous glands of the forehead and the metatarsus were studied by histological and histochemical methods and electron microscopy in adult male and female impalas in various seasons of the year. All glandular areas consist of apocrine and holocrine glands, which, however, occur in different proportions. Our findings in the apocrine gland cells suggest (1) the synthesis and exocytosis of a glycoproteinaceous secretory product stored in secretory granules, (2) typical apocrine secretion of the transformed apical cytoplasm, and (3) transepithelial fluid transport. The Golgi apparatus and apical membrane have binding sites for several lectins (PNA, HPA, RCA I, WGA). Cytokeratins 7, 14 and 19 are expressed at various intracellular localizations, suggesting an active role in the secretory mechanisms. The glands of the male forehead show marked seasonal changes in activity that are correlated with the main phases of the reproductive cycle, with the highest cellular activity occurring during the rut in April/May. The female forehead glands are only moderately developed and do not undergo seasonal changes. The metatarsal glands are of equal size in males and females and show no seasonal changes in activity. This study supports the hypothesis that (1) forehead glands in the male have a signaling role in the rut and (2) the metatarsal glands have a more general, probably social role maintaining and restoring contact between herd members.

Alcian Blue↗
PubMed1986

Cell death organizes the postnatal development of the trigeminal innervation of the cerebral vasculature.

In the adult trigeminal ganglion single cell bodies that innervate the middle cerebral artery (MCA) are different from but situated near to one or more cell bodies that innervate the forehead (O'Connor and Van der Kooy, submitted). Multiple fluorescent retrograde axonal tracing in postnatal day 3-90 rats was employed to describe the development of this adult pattern of trigeminal projections. We found that close to 90% of the cells that innervate the MCA at postnatal day 5 (PND 5) are eliminated by PND 90. Less than 20% of the ganglion cells innervating the forehead die over the same postnatal period. Subpopulations of cells in the ganglion were observed to have a maximal rate of death during different postnatal periods. First, 15-20% of the cells throughout the ophthalmic division die between PND 5 and PND 10. Second, a small population of cells that had early projections to the contralateral MCA die out completely by PND 22. Third, cells with a projection only to the MCA die primarily between PND 10 and PND 54. Fourth, during the first postnatal week there are many cells that project to both the MCA and the forehead; however, 90% of this population dies by PND 90. This elimination is observed latest in the postnatal period, with these cells exhibiting their greatest rate of cell death between PND 22 and PND 90. Thus, cell death is the primary postnatal mechanism that produces this organization in the ophthalmic division of the trigeminal ganglion and retraction of axonal collaterals is a minor mechanism. We suggest that the latest period of death in cells with divergent artery and forehead projections as well as the ultimate persistence of some artery projecting cells beyond PND 90, may be due to the larger peripheral fields of innervation of these trigeminal ganglion cells.

Animals↗
PubMed2006

Influence of digital clubbing on oxygen saturation measurements by pulse-oximetry in cystic fibrosis patients.

OBJECTIVE: To determine the influence of digital clubbing on oxygen saturation by pulse oximetry measurements (SpO2) in Cystic Fibrosis patients. BACKGROUND: Measuring the arterial oxygen saturation at the fingertip by pulse-oximetry is commonly used in the management of CF patients. In these patients, clinical signs of hyperoxia are often observed with oxygen supplies based on digital oximetry readings. This suggests inaccuracies in the digital measurement method, which in its turn may be caused by digital clubbing. In order to study the influence of digital clubbing, measurements between fingertip and forehead sensor were compared in a clubbing and non-clubbing CF-population. The ear sensor measurements are used as a reference variable. METHODS: Two groups were examined. Group 1 consisted of 50 CF patients without digital clubbing (DPD/IPD ratio<1.00). Group 2 consisted of 50 CF patients with digital clubbing (DPD/IPD ratio>1.00). Patients were measured at rest before any treatment and with their daily oxygen supply, if applicable. Saturation was simultaneously measured with three Criticare SpO2 T pulse oximeters, using a fingertip sensor at the right index (transmission oximetry), a forehead sensor at the forehead (reflectance oximetry) and an ear sensor at the right ear. RESULTS: Using the Bland and Altman method no clear difference was found between the saturation measurements of right ear versus forehead sensor in the two groups. When the measurements of right ear versus fingertip sensor are compared there is still no difference for the non-clubbing group. On the contrary, for the clubbing group lower saturation scores were measured by the fingertip probe compared to the right ear measurement. The differences in saturation became greater as the saturation value at fingertip was lower. CONCLUSION: Digital clubbing significantly influences the registrations of the SpO2 measurements by means of a fingertip probe, underestimating the saturation. It can be advised to use the ear sensor as good alternative for these patients.

Adolescent↗
PubMed1998

Perioperative tissue thickness measurement by a new miniature ultrasound device.

INTRODUCTION: A recently developed mini ultrasound device for measurement of peripheral tissue thickness is now available for use in clinical practice. Whether this device allows a better guidance of perioperative fluid therapy has to be investigated. Therefore, it is necessary to get basic data on the parameter tissue thickness in otherwise healthy patients during surgery. The aim of the present study was to evaluate differences in tissue thickness change between patients in supine and head down position with a novel handheld ultrasound device during the perioperative course of healthy surgical patients under a standardized fluid regimen. METHODS: After obtaining ethics committee approval and informed consent we studied 19 ASA 1-2 female patients undergoing gynecological procedures in supine (SUP, n = 11) or in 30 degrees head down position (HD, n = 8) in general anesthesia. Preoperative NPO status was comparable in both groups. Lactated Ringer's solution (LR) was continuously infused at a rate of 8 ml/kg b.w./h over 90 min and tissue thickness (TT) was determined by ultrasound before induction (t0) and in 30 min intervals (t30, t60, t90) at the forehead. Simultaneously plasma viscosity (PV) was evaluated. RESULTS: Group SUP presented at t0 a forehead TT of 5.3 mm (SD +/- 0.5), at t30 TT was unchanged. At t60 mean TT increased significantly to 5.6 mm, (+/- 0.6). At t90 mean TT remained stable at 5.7 mm (+/- 0.5). Group HD presented at t0 a mean TT of 4.6 mm (+/- 0.7), at t30 mean TT was 4.9 mm (+/- 0.7) and at t60 mean TT of the forehead skin was measured as 5.3 mm (+/- 0.6). Significance to t0 was reached at t90 with a mean TT of 5.4 mm (+/- 0.7). Group HD showed a steeper increase and a parallel stabilization phase at the end. Differences between t0 and t90 have been significant. Mean PV in the SUP group at t0 (1.361 mPa*s, SD: +/- 0.045) decreased under the infusion therapy to 1.276 mPa*s (+/- 0.04) at t90. Mean PV in the HD group was determined 1.351 mPa*s (+/- 0.06) at t0 and declined to 1.274 mPa*s (+/- 0.03) at t90. CONCLUSIONS: The findings suggest that fluid replacement after an NPO period and the expected changes of forehead TT due to positioning of the patient are detectable by this new ultrasound device.

Adult↗
PubMed2004

The influence of larger subcutaneous blood vessels on pulse oximetry.

OBJECTIVE: Recent studies have renewed interest in reflectance pulse oximetry, specifically for monitoring the patient's forehead. Blood circulation on the forehead immediately above the eyebrow is fed by arteries that branch from the internal carotid artery and lack the vasoconstrictor response present in more peripheral regions. Some investigators question, however, the reliability of monitoring SpO2 on the forehead due to prior reported inaccurate readings with reflectance sensors. The present study evaluates pulse oximetry accuracy when reflectance sensors are placed over potentially pulsing or moving larger arterial vessels, or over more homogeneous microvasculature devoid of larger subcutaneous vessels. METHODS. Ten healthy adult volunteers were fitted with reflectance pulse oximetry sensors and exposed to a controlled desaturation to 70%. Sensors were placed immediately above the left and right eyebrows as well as over the temple. Additionally, numerical modeling was used to simulate light signals and photon migration through a homogeneous tissue bed with an added static or dynamic artery. RESULTS: Sensors placed above the eyebrows tracked one another with significantly better accuracy than when comparing temple with the brow placement (RMS of the Differences = 1.12% vs. 4.24%, respectively). Photon migration simulations indicate that the detected light bypasses the interior of larger vessels, while vessel presence affects the red and IR light pulse amplitudes independent of SaO2. CONCLUSIONS: Placement of reflectance pulse oximetry sensors directly over larger cardio-synchronously pulsing or moving vasculature can significantly degrade SpO2 reading accuracy. Reflectance sensors placed low on the forehead directly over the eyebrow and slightly lateral to the iris appear to avoid such vasculature and provide consistent and accurate estimates of SaO2.

Adult↗
PubMed2003

Botulinum toxin type B (MYOBLOC) versus botulinum toxin type A (BOTOX) frontalis study: rate of onset and radius of diffusion.

BACKGROUND: Botulinum toxin types A and B can improve the appearance of facial wrinkles. Differences in the time until onset and the degree of diffusion have been observed anecdotally, but no direct comparative studies have been done. OBJECTIVE: To compare the rate of onset and the radius of diffusion of botulinum toxin types A and B in the rhytides of the forehead. METHODS: Adults with symmetrical moderate to severe forehead wrinkles at full contracture received botulinum toxin type A (BOTOX; 5 U) on one side of the forehead and type B (MYOBLOC; 500 U) on the other side. Photographs taken at rest and full frontalis contracture were analyzed by computer, and a time-lapse motion picture was created. Radius of diffusion and time until full effect were measured. RESULTS: Botulinum toxin type B had a slightly faster onset of action than type A. All patients responded to type B quickly, whereas some had a delayed response to type A. A greater radius of diffusion was consistently observed with botulinum toxin type B, as measured by the greater area of wrinkle reduction at the doses used. CONCLUSIONS: In this comparative study of patients with symmetrical forehead wrinkles, botulinum toxin type B produced a greater area of diffusion and a more rapid onset of action than type A.

Adult↗