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At least 883 records · Page 49Linked to original sources

Intracranial ictal onset zone in nonlesional lateral temporal lobe epilepsy on scalp ictal EEG.

OBJECTIVE: To determine the ictal focus and the role of seizure characteristics, fluorodeoxyglucose (FDG) PET, and subtraction ictal SPECT in patients diagnosed as having nonlesional lateral temporal lobe epilepsy by long-term scalp video-EEG monitoring. METHODS: The authors studied 33 consecutive patients with nonlesional neocortical epilepsy who had a scalp ictal onset zone localized in the temporal lobe and good surgical outcome after focal neocortical resection. All patients were evaluated using intracranial recordings prior to resection. Semiology, FDG-PET, and ictal-interictal subtraction SPECT were used to verify the diagnostic role of these methods in the localization of epileptic foci. RESULTS: The ictal onset zones, confirmed by intracranial study, were the lateral temporal (22 patients), parietal (5), frontal (3), temporoparietal (2), and occipital (1) areas. FDG-PET analyzed by statistical parametric mapping correctly localized the epileptogenic lobe in 18 of 33 patients and subtraction ictal SPECT correctly localized it in 13 of 25 patients. However, in patients with extratemporal ictal onset zones, FDG-PET and ictal SPECT in combination correctly localized the epileptogenic lobe in only 3 of 11 cases. CONCLUSIONS: An extratemporal ictal onset zone was encountered in patients with nonlesional lateral temporal lobe seizures based on scalp video-EEG monitoring. FDG-PET and subtraction SPECT had localizing value in no more than half of patients.

Adult↗

Congenital arteriovenous malformation of the scalp--case report.

A case of congenital arteriovenous malformation (AVM) of the scalp containing a complex vascular network is described. The AVM was totally removed, together with its feeding artery and draining veins. Congenital AVM of the scalp is rare; only 21 other cases have been reported since 1973. All involved complex vascular networks, and about one half of the patients had red or purple birthmarks. These clinical features clearly differ from those of traumatic arteriovenous fistulae of the scalp. Although many treatment approaches have been tried, total excision appears to be the most appropriate.

Adult↗

[Reconstruction of the large defects of the scalp with local fastiocutan flaps].

No depending on the reason the large defects of the scalp, denuded from periost calvaria or without calvaria are difficult problem for reconstruction. There are several methods for reconstruction: local, distant pedicled and free flaps. Local fastiocutan flaps should be consider as a first step when planning scalp reconstruction. They are stable coverage and prepared by single technique with minimal functional loss and rapid patien recovery. In this paper we present 14 cases of this technique and discuss the advantage of the local fastiocutaneus scalp flaps.

Adolescent↗

Scalp and intracerebral P300 in surgery for temporal lobe epilepsy.

We have studied the scalp and intracerebral recordings of 12 patients with intractable temporal lobe epilepsy. The intracerebral P300 provides useful diagnostic information regarding the epileptogenicity of a temporal lobe. The scalp P300, by nature of its bilateral scalp distribution, is unable to be used diagnostically in assessing candidates for possible anterior temporal lobectomy.

Acoustic Stimulation↗

[Treatment of scalping wounds of the fingers].

An experience with the treatment of 63 patients with scalped one or several fingers is analyzed. A classification of such traumas is proposed. Plasty with an "acute" Filatow graft, pocket skin plasty, free skin plasty with a splitted transplant were used for completely scalped fingers. In cases with incompletely scalped fingers the decompression of tissues was performed which prevented circulatory alterations. Long-term results within 1-12 years were studied. Indications for each method are analyzed.

Adult↗

Physiopathological role of bald-scalp cytosolic proteins.

The physiopathological role of androgen binding proteins in male pattern baldness (MPB) has been studied by using tritiated dihydrotestosterone (DHT) and methyltrienolone (R 1881) as ligands. DHT binding in bald scalp from subjects suffering from MPB is high (53 +/- 12 fmol/mg protein) in cytosol obtained from bald areas, being undetectable in hairy areas from the same subject. Since methyltrienolone does not bind in bald scalp cytosol, there must be no specific DHT receptor in this material. Several kinetic and molecular parameters of DHT binding in bald scalp cytosol and serum were similar in both samples. Only the association rate constant (k+1) was significantly higher in serum (8.8 X 10(6) M-1 min-1) than in cytosol (3.08 X 10(6) M-1 min-1). DHT binding in serum as well as the evaluation of plasma contamination in the skin samples (by nephelometric analysis) strongly suggests that DHT binding in skin cytosol is merely due to the presence of contaminating SHBG but it does not explain the lack of DHT binding in non bald areas. Thus, the possibility arises of there being a specific mechanism for the uptake of the plasmatic testosterone SHBG-complex taking place only in the hypertrophic sebaceous gland as well as the existence of active T metabolites other than DHT, probably 3 beta-androstanediol.

Alopecia↗

Locoid vs betnovate lotion in the treatment of seborrhoeic and atopic dermatitis of the scalp.

In a randomised, double-blind clinical trial, the relative efficacy of Locoid scalp lotion and Betnovate scalp application was assessed in the treatment of 30 patients, 15 in each treatment group, suffering from seborrhoeic or atopic dermatitis of the scalp. Both therapies produced a statistically significant improvement and clearance of the lesions by the end of the four weeks of treatment. Slight differences were observed in favour of Betnovate with respect to global efficacy but this difference was not statistically significant. Side-effects were not spontaneously complained of by any of the 30 patients but six admitted experiencing a stinging or burning sensation (four with Locoid and two with Betnovate) when asked specifically as to the occurrence of these side-effects.

Adolescent↗

Ineffectiveness of scalp hypothermia in the prevention of alopecia in patients treated with doxorubicin and cisplatin combinations.

Eleven patients were studied to determine the effectiveness of scalp hypothermia in the prevention of chemotherapy-induced hair loss. Scalp hypothermia was induced by the Kold Kap. The cytotoxic regimen used consisted of either cisplatin, doxorubicin, and cyclophosphamide or cisplatin, doxorubicin, and methotrexate given at monthly intervals. All 11 patients required a wig by the end of the fifth course of chemotherapy because of severe hair loss. Ten of the 11 patients (91%) had severe hair loss by the end of the second course of chemotherapy. These results suggest that scalp hypothermia as used in this study is ineffective in preventing chemotherapy-induced alopecia in patients treated with cisplatin and doxorubicin drug combinations in doses commonly used for treatment of gynecologic malignancies.

Alopecia↗

SEM/EDX analysis of inorganic elements in human scalp hairs with special reference to the variation with different locations on the head.

In order to obtain additional data for individualizing hair samples collected from the scene of crime, the authors attempted to analyze the inorganic elements in scalp hairs such as sodium, phosphorus, potassium and calcium by a SEM/EDX method. For the purpose of detecting such elements from scalp hairs efficiently, the samples were ashed on a carbon specimen mount for 60 minutes by an oxygen plasma microincineration technique. The characteristic X-ray counts of the elements were investigated as functions of hair location, viz., the frontal, the vertex, the nape, the left and the right lateral, on the head of the same person. The oxygen plasma microincineration method was very efficient in detecting sodium, phosphorus, potassium and calcium from scalp hairs. The characteristic X-ray counts of the elements, especially potassium and calcium, varied from person to person. Within the same location, the variation of X-ray counts was relatively low, with a standard deviation of less than 20%. It was observed that hairs from the frontal and the vertex locations, in general, showed lower X-ray counts for potassium than did those from the nape, the left and the right lateral locations. The calcium X-ray counts varied considerably from person to person but generally tended to give the highest value at the vertex location. The EDX spectrum pattern associated with such elements could be helpful in individualizing hair samples collected as forensic evidence.

Adult↗

Immunofluorescence findings in rapid whitening of scalp hair.

Rapid whitening of scalp hair developed during a three-month period along with a diffuse, subtotal alopecia in a patient. Immunofluorescence microscopy of biopsy material showed prominent deposits of IgG and IgM in a granular pattern in the epithelium of the lower portions of hair follicles. Some return of the color and amount of scalp hair occurred within a year, but occasional bouts of hair loss continued to occur. It is theorized that the rapid graying was caused by a selective loss of pigmented hair, which was perhaps caused by an immunologic mechanism. Some of the findings suggest that the cause of this patient's loss of hair color may be different from those of patients who have been previously described as having rapid whitening of scalp hair because of alopecia areata or vitiligo.

Depression↗

Glove perforations and blood contact associated with manipulation of the fetal scalp electrode.

OBJECTIVE: To assess prospectively the frequency of glove injury associated with insertion of the fetal scalp electrode and subsequent examination of the cervix with the electrode in place. METHODS: Over a 7-month period, sterile gloves were collected after use for insertion of the fetal scalp electrode or cervical examination with the electrode in place. Attendants indicated their level of training, time, date and purpose of glove use, and cervical examination. They also noted whether they were aware of a glove perforation or observed blood, amniotic fluid, or genital tract secretions on their hand. Glove patency was assessed by filling the glove with water to 1.5-2.0 times its normal volume and observing for leaks. One hundred unused gloves were tested for patency and served as controls. RESULTS: Five hundred one gloves were evaluated, of which 13 (2.6%, 95% confidence interval [Cl] 1-4%) had perforations. Seven of 277 gloves (2.5%) used only for examinations had perforations, compared with six of 244 (2.5%) used only for insertion of the electrode. Two percent (95% CI 0-5%) of the unused control gloves had perforations. These observed differences were not statistically significant. Nineteen attendants (3.8%, 95% CI 2.1-5.5%) noted blood or genital tract secretions on their hand after insertion of the electrode (N = 4) or subsequent cervical examination (N = 15). Only one point of contract resulted from a glove perforation; the other 18 were on the wrist and apparently resulted from leakage of fluid around the open cuff of the glove. CONCLUSIONS: The risk of glove perforation during insertion of the fetal scalp electrode or subsequent cervical examination is low if proper technique is observed. Blood or fluid contact is more likely to result from leakage of fluid around the open cuff of the glove during a vaginal examination.

Amniotic Fluid↗

Subcutaneous pedicle flaps for scalp defects.

We report the reconstruction of scalp defects by subcutaneous pedicle flaps with transverse pedicles. These flaps are supplied by vascular networks in the upper and lower parts of the epicranial aponeurosis. We have used this technique in 12 cases and have found it to be a useful alternative to other methods of scalp reconstruction.

Adult↗

Multiple palisading granulomas in the scalp of an infant: a case report.

BACKGROUND: We describe an unusual lesion that represents an uncommon but important element in the differential diagnosis of subcutaneous scalp nodules in a child. CASE DESCRIPTION: A 1-year-old boy presented with two clusters of subcutaneous scalp nodules. The lesions increased in size and number. Computed tomography showed no changes in underlying bone. Findings on magnetic resonance imaging were nonspecific. Serologic and clinical evaluation showed no evidence of rheumatic disease. Complete excision of the nodules, together with adjacent fascia and galea, was performed. Histopathologic examination showed the lesions to be palisading granulomas; given the absence of rheumatic disease, these represented deep granuloma annulare, a benign condition. No recurrence has been observed in our patient. CONCLUSION: While we chose total excision because of preoperative concerns about a possible malignant tumor, some other authors have suggested that surgery be limited to confirmatory biopsy when a benign lesion such as palisading granuloma is strongly suspected.

Diagnosis, Differential↗

Subcutaneous nodules of the scalp: preoperative management.

The differential diagnosis of subcutaneous lesions of the scalp is extensive and includes many tumors with intracranial and intraosseous extension. The vast majority of lesions seen by the dermatologist will be benign. However, certain lesional characteristics increase the likelihood of a serious disorder and these must be evaluated preoperatively. We review the important features of subcutaneous scalp lesions and suggest a systematic approach to diagnosis based on patient age, lesion morphology, location, and radiographic findings.

Adult↗

Mutations in the desmoglein 4 gene underlie localized autosomal recessive hypotrichosis with monilethrix hairs and congenital scalp erosions.

Localized autosomal recessive hypotrichosis (LAH) is a recently defined disorder characterized by fragile, short, sparse hairs on the scalp, trunk, and extremities. Mutations in desmoglein 4 (DSG4), a novel member of the desmosomal cadherin family that is expressed in the hair follicle as well as the suprabasal epidermis, have been found to underlie LAH. Thus far, the allelic series includes a recurrent intragenic deletion identified in affected Pakastani kindreds and a missense mutation detected in an Iraqi family. We report three siblings of Iraqi and Iranian origin with LAH that presented with congenital scalp erosions and monilethrix-like hairs, features that have not been previously described in this disorder. Follicular hyperkeratotic papules and marked pruritus were also prominent clinical findings. Novel compound heterozygous DSG4 mutations, including a splice-site mutation and a missense mutation that disrupts a conserved calcium-binding site in the extracellular (EC)2-EC3 interface, were found to underlie the disease in this family. These observations broaden the phenotypic and genotypic spectrum of LAH, further illustrating the consequences of DSG4 dysfunction on epidermal and hair shaft integrity.

Amino Acid Sequence↗

Malignant primitive neuroectodermal tumor presenting as a scalp nodule.

We report a case of a 20-year-old woman who presented with a 3-year history of a stable cystic nodule on the scalp. Light microscopy of the excised nodule demonstrated a malignant small round cell undifferentiated neoplasm. Immunohistochemical studies suggested a neural crest origin, while ultrastructural examination revealed characteristics of schwannian differentiation. Both of these special techniques were essential in establishing the diagnosis of a malignant epithelioid schwannoma of superficial tissue (neurotropic melanoma, desmoplastic melanoma). We discuss the differential diagnoses and describe the immunohistochemical and ultrastructural characteristics of this tumor. This case illustrates the difficulty of diagnosing this rare malignant tumor, which masqueraded as a benign-appearing scalp lesion.

Adult↗

Gigantic cutaneous horns of the scalp: lesions with a gross similarity to the horns of animals: a report of four cases.

Gigantic cutaneous horns, grossly similar to the horns seen in animals, are exceedingly rare in humans. After finding one case in practice, we searched our departmental files for similar cases and examined them grossly and microscopically. Four cases were identified. All occurred as solitary lesions in older women on the parietal-occipital region of the scalp. They had a growth history of up to 30 years; the women hid these horns in their hair. Grossly, the horns were yellow-grey, and there were shallow furrows running along the length of the horns. The length ranged from 17 to 25 cm, and the width was up to 2.5 cm. All four lesions showed similar histologic changes. Microscopically, the gigantic horns consisted of a mixture of squamous epithelial cells and tricholemmal keratinized debris. In one case the base of the horn was directly connected with a mass composed of benign tricholemmal cysts of the scalp. Mitoses were common, but atypical mitoses were not observed. The nuclei of the squamous cells were bland without pleomorphism, hyperchromasia, or atypia. Follow-up of all patients was uneventful: all patients were well and without signs of recurrence or metastasis 2-15 years after the surgical excision. Gigantic cutaneous horns are rare and benign. We think that they represent an extremely well-differentiated variant of proliferating tricholemmal tumor with an unusual and remarkable gross pattern.

Aged↗

Quantitative microbiology of the scalp in non-dandruff, dandruff, and seborrheic dermatitis.

The composition of the scalp microflora was assessed quantitatively in normal individuals and in patients with dandruff and seborrheic dermatitis, disorders characterized by increasing scaling. Three organisms were constantly found: (1) Pityrosporum, (2) aerobic cocci, and (3) Corynebacterium acnes. Pityrosporum (mainly Pityrosporum ovale) made up 46% of the total microflora in normals, 74% in dandruff, and 83% in seborvheic dermatitis. The geometric mean number of organisms per cm-2 in non-dandruff subjects was 5.04 times 10-5; 9.22 times 10-5 in dandruff subjects; and 6.45 times 10-5 in those with seborrheic dermatitis. The cocci were dominantly Baird-Parker type SII and no quantitative or qualitative change occurred in the scaling disorders. C. acnes comprised 26% of the flora on the normal scalp, 6% in dandruff, and only 1% in seborrheic dermatitis. These results differ significantly from previous reports which describe a much more complex microflora and suggest an etiologic role for microorganisms in dandruff.

Apicomplexa↗