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PubMed2001

Quantitative culture of Malassezia species from different body sites of individuals with or without dermatoses.

Quantitative cultures were obtained using contact plates to determine whether the quantity and composition of Malassezia species at a given anatomic site in normal individuals differs from that of patients with various cutaneous dermatoses. The sample included 20 clinically healthy individuals (without any dermatosis) and 110 patients with dermatoses (including 31 with atopic dermatitis [AD], 28 with psoriasis [PS], 28 with seborrheic dermatitis [SD] and 23 with pityriasis versicolor [PV]). Contact plates filled with special culture medium were used to obtain a quantitative culture from five body sites (scalp, forehead, arm, trunk and leg) of every individual. The number of cfu were recorded for every plate that grew Malassezia yeasts, and 3-5 colonies were isolated for identification to species level using microscopic, physiological and molecular characteristics. The mean cfu counts observed among patients with AD, PS and SD was significantly lower than normal control subjects (P < 0.05). The mean cfu counts from PV patients was not different from that of healthy control subjects. Overall, for all conditions considered together, the mean cfu counts in lesional sites were significantly lower than in non-lesional sites (P <0.05). Furthermore, the mean cfu counts from lesional sites in patients with AD and PS were significantly lower than the corresponding value in patients with PV (P <0.05). Six Malassezia species were recovered from the different dermatoses. Malassezia sympodialis was the most common species associated with AD and PV patients and healthy control subjects, while M. globosa was most frequently isolated from PS and SD patients. More than one Malassezia species was recovered at any given anatomic site from both controls as well as individuals with dermatoses. M. globosa was equally likely to be recovered from scalp, forehead and trunk, but less likely to derive from arms and legs. M. restricta and M. slooffiae were recovered more frequently from the upper body (scalp and forehead) than from the lower body. Among normal individuals and for patients with AD and PV, M. sympodialis was significantly more likely to affect the forehead than the legs.

Adult↗
PubMed2006

Effects of a color filter used in auriculomedicine on ultraweak photon emission of the human body.

CONTEXT: The human body emits ultraweak photons. It has been demonstrated that feedback regulation of ultraweak photon emission from the hand is detectable utilizing gelatin color filters in complete darkness. Color filters are commonly utilized in auriculomedicine diagnostic procedures based on the radial artery vascular autonomic signal. OBJECTIVE: To evaluate the possibility of an effect by a dark-adapted red filter on (1) local ultraweak human photon emission using different anatomic locations, and (2) on systemic photon emission using one location for red filter exposure and another for photon emission recording. DESIGN: Photon emission of abdomen, forehead, palm, and dorsum of the hand was recorded before and after the presence of a red filter. In addition, photon emission of forehead and dorsum of the hand was recorded before, during, and after the presence of the red filter close to the palm. In both instances, the filter was dark-adapted and placed in close proximity to, but not touching the skin of the dark-adapted subject. A low-noise, end window photomultiplier for recording ultraviolet and visible (200-650 nm) photon emission (with a very low background count rate) and designed for manipulation in three directions was situated in a dark room. The technology was utilized to record spontaneous photon emission of the abdomen, forehead, palm, and dorsum of the hand of one human male subject. RESULTS: Data demonstrate that a dark-adapted subject responds in the total absence of light with a temporary increase in photon emission from the anatomic locations that had been exposed for 200 s at a distance of 3 cm to a dark-adapted red filter. Data from sequential time series suggest red filter initiation of a refractory emission reaction. Exposure of the palm to the red filter also evokes photon emission from the dorsum of the same hand and from the forehead. This response could be registered immediately after the beginning of the exposure. The stimulated emission is followed by a slow decrease of emission in the period after exposure to the filter. CONCLUSION: Data suggest that red filter-stimulated photon emission response is systemic and rapid. Data imply an exchange of information vis-à-vis light from both hand and red filter. The mechanism of such interaction is currently speculation only.

Abdomen↗
PubMed1987

Facial flushing and sweating mediated by the sympathetic nervous system.

Sweating and flushing of the forehead and cheeks in response to body heating, embarrassment and strong gustatory stimulation were investigated in 23 patients with a unilateral lesion in the sympathetic pathway to the face. A lesion anywhere along this pathway impaired thermoregulatory sweating and flushing on the denervated side of the forehead in most patients and also of the cheek in some cases. Emotional sweating was also diminished on the denervated side of the forehead irrespective of the site of lesion, but impairment of emotional vasodilatation was noted only with peripheral (second or third neuron) lesions. These findings suggest that sympathetic vasodilator fibres accompany vasoconstrictor and sudomotor fibres through conventional sympathetic pathways to the face. Gustatory sweating and flushing were symmetrical in most patients but flushing was more marked on the denervated side in three cases. Gustatory sweating was accompanied by flushing on the denervated side of the forehead in one patient following section of the T2 and T3 roots. It is concluded that the cervical sympathetic outflow is the main pathway for thermoregulatory flushing and emotional blushing and that diminution or absence of such vasodilator reactions is a usual component of Horner's syndrome unless the responsible lesion is confined to the first thoracic root. Gustatory vasodilatation and sweating is preserved and becomes exaggerated in some instances.

Body Temperature Regulation↗
PubMed1992

The mechanism of facial sweating and cutaneous vascular responses to painful stimulation of the eye.

The vascular response in the forehead and cheeks to irritating the eye with soapy water was measured in 15 normal subjects. Electrodermal activity, which reflects sweating, was also measured from both sides of the forehead. The mechanism of the response was studied in 15 patients with a unilateral lesion of the facial nerve blocking parasympathetic outflow. Pulse amplitude usually increased briefly on both sides of the forehead after the soap was placed in the eye; the response persisted for several minutes on the ipsilateral side after the soap had been washed from the eye. A facial nerve lesion blocked the vascular response on the lesioned side to stimulation of either eye. No consistent change in pulse amplitude was recorded from the cheeks, although a response was observed in a few subjects. Electrodermal responses to ocular irritation were generally larger on the ipsilateral than contralateral side of the forehead; in patients with facial palsy, electrodermal responses were greater on the normally innervated side than on the lesioned side. The findings suggest that irritating the eye induces a trigeminal-parasympathetic vasodilator reflex and local sweating. The restricted distribution of the response indicates that separate parasympathetic vasodilator reflexes might operate for each division of the trigeminal nerve.

Adult↗
PubMed1996

Surgery for unilateral coronal synostosis (plagiocephaly): unilateral or bilateral correction?

Debate still exists concerning the extent of frontal reconstruction for the correction of plagiocephaly resulting from unilateral coronal synostosis. Between 1982 and 1994, 38 patients with unilateral coronal synostosis have been treated in our department. Initially, a unilateral frontal craniotomy with advancement of the ipsilateral supraorbital bar was used in 13 patients. An unsatisfactory postoperative appearance of the forehead led to modification of the technique using a bilateral frontal bone flap. This allowed simpler and improved forehead reconstruction. The method was used in 22 patients. Three patients with severe deformity had the complete supraorbital bar advanced in one piece and the forehead reconstructed with a bilateral frontal flap. The late results were analyzed using a clinical scoring system to grade residual deformity. The patients in the two main groups had similar characteristics. The mean age at first operation was 30.8 months for the first group and 20.1 months for the second group. Mean length of follow-up was 7.9 years for the first group and 4.6 years for the second group. No significant operative complications were observed. In two patients, one from each group, recurrent deformity developed, requiring further surgery. Analysis of the mean scores obtained at set intervals during the first 4 postoperative years showed that forehead correction with a bilateral frontal bone segment and unilateral supraorbital bar advancement provides better early cosmetic results in the first postoperative year. After that interval, the results of the two techniques are similar, with overall good final cosmetic appearances. The patients in the third group who had the complete supraorbital bar advancement with bilateral frontal bone remodeling had more pronounced deformity initially and had a less satisfactory late result. These findings confirm the clinical impression that bilateral frontal bone remodeling offers a better immediate surgical result from the cosmetic point of view compared with other techniques.

Adolescent↗
PubMed2005

Video-assisted endoscopic transtemporal multilayer upper midface lift (MUM-Lift).

Minimally invasive surgery has been used successfully recently to improve brow ptosis and forehead rhytids. Because the face tends to age more vertically, rather than obliquely, it makes sense to perform the correction in a more vertical direction. Therefore, the authors introduce a video-assisted endoscopic transtemporal approach to allow a multiplanar (subperiosteal, sub-SMAS, and subcutaneous) vertical upper midface elevation (MUM-Lift) avoiding extensive lateral temporal and preauricular incisions. Between 1996 and 2003, 53 patients (8 males, 45 females; age, 47 +/- 6 years) underwent MUM-Lift. This includes simultaneous forehead lift, blepharoplasties and video-assisted transtemporal sub-SMAS and subcutaneous upper midface tissue release, vertico-lateral repositioning, and fixation. Using the various planes of release in the midface produces less tension on each layer and provides a natural and improved facial rejuvenation of the forehead, as well as of the upper midface. The results confirmed that limited incision forehead-plasty techniques in combination with a transtemporal sub-SMAS and subcutaneous upper midface lift (MUM-Lift) reduces unnecessary vascular compromise on any particular layer and can be safely and predictably performed over the zygomatic muscle. This newly introduced procedure is an exciting feature that has evolved into a useful modality. It provides natural and improved facial rejuvenation.

Blepharoplasty↗
PubMed1994

Retracted: Influence of volume replacement with different HES-solutions on microcirculatory blood flow in cardiac surgery.

A variety of hydroxyethyl starch HES preparations with different molecular weight average (Mw) and molar substitution (MS) is available for volume replacement during acute normovolemic haemodilution (ANH). Particularly with regard to microcirculation, the ideal solution for volume therapy has not been found. The influence of four different HES preparations on macro- and microcirculation was investigated in 40 patients scheduled for elective aorto-coronary bypass grafting and undergoing ANH (preoperative withdrawn blood: 10 ml.kg-1): 1) 6% HES with Mw of 450,000 dalton and MS of 0.7; 2) 6% HES with Mw of 200,000 dalton and MS of 0.5; 3) 6% HES with Mw of 200,000 dalton and MS of 0.62; 4) 6% HES with Mw of 40,000 dalton and MS of 0.5. A 5th group without ANH served as a control (10 patients in each group). In addition to systemic haemodynamics and various laboratory parameters, skin capillary blood flow was measured by laser Doppler flowmetry. Laser Doppler flow (LDF) was monitored simultaneously at the patient's forehead and forearm. Changes in systemic haemodynamics were similar in all ANH-patients. Systemic vascular resistance (SVR) was lowest after infusion of HES 200/0.5. The most pronounced increase in plasma viscosity was in patients of group 1 (450/0.7) (P < 0.05) and plasma viscosity remained highest during the entire investigation period in these patients. After ANH, skin capillary blood flow measured at the forehead decreased in all patients except in patients of group 2 (200/0.5: max. +18%). Group 3 (200/0.62) showed the highest decrease in forehead-LDF. During CPB, forehead-LDF decreased significantly in groups 3 (200/0.62) and 4 (40/0.5).(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Circulation↗
PubMed1991

Factors affecting transcutaneous bilirubin measurement: effect of daylight.

The purpose of this study was to determine whether daylight might affect the accuracy and reliability of TcB measurement at the forehead and sternum. One hundred and seven full-term newborn infants were divided into two groups. Babies in group I (N = 59) were kept near the window which was sometimes directly exposed to daylight, and babies in group II (N = 48) were kept on the door side of the room which had no direct daylight, during the first week of life. The result indicates that daylight is one of the significant factors affecting TcB measurement at the forehead, contributing to poor correlation between TcB reading at the forehead and serum bilirubin concentrations. We suggest the necessity of obtaining TcB readings at the forehead and sternum, at least, in order to improve the accuracy and reliability of such measurements in infants.

Bilirubin↗
PubMed1993

Patterns and stability of cardiovascular responses to variations of the cold pressor test.

Test-retest reliabilities and patterns of heart rate and blood pressure responses were examined using variations in the cold pressor test in 113 normotensive white college men. Comparisons were made of stimulus site (forehead vs. foot) and bodily posture (seated vs. supine) across four separate groups of men. The stability of cardiovascular responses was examined over a 2-week-test-retest interval. Different cardiovascular response patterns emerged as a function of stimulation site and posture. Systolic and diastolic blood pressure increases were accompanied by bradycardia in the forehead cold pressor task but by tachycardia in the foot cold pressor task. Systolic blood pressure increases were larger for foot than for forehead stimulation. Heart rate increases were larger for supine than for seated men. Effects on response were independent of postural differences at baseline, and there were no stimulation site by posture interactions. The cardiovascular responses to stimulation did not attenuate across sessions in any experimental condition but were more reliable for foot than for forehead stimulation and for supine than for seated posture. Short-term stability for changes to the task approached that for baseline and task and was higher than has been reported elsewhere.

Adolescent↗
PubMed1995

Endoscopic surgical correction of glabellar creases.

BACKGROUND: A number of alternatives exist for the temporary correction of glabellar creases and frown lines. The traditional "open" operative procedure has often involved a large incision to gain access to the depressor muscles that are responsible for the deformity. While useful for patients with multiple or more significant deformities, patients with isolated glabellar creases and frown lines have been reluctant to consider an extensive surgical procedure, with its attendant morbidity, for an isolated problem. OBJECTIVE: The purpose of this report is to describe a new technique of endoscopic corrugator muscle resection, without the need for the traditional lengthy scalp incision. METHODS: Traditional criteria for patient selection was employed. A series of 10 consecutive patients with vertical mid-forehead glabellar-eyebrow frown lines were treated by endoscopic corrugator muscle resection and evaluated. RESULTS: The procedure was efficacious in reducing the frown-muscle complex prominence and rhytids in the mid-forehead area. Circumstances of heavy folds, hyperactive muscle function, or premature furrows in patients with good skin tone appear to be most suitable for this technique. CONCLUSION: With the introduction of a more acceptable, less problematic surgical solution, deformities in the forehead-eyebrow area can be readily addressed surgically. The procedure is a cost-effective alternative to temporary techniques improving aesthetic problems in the forehead-eyebrow area.

Adult↗
PubMed1996

Interaction between cold and hypoxia on pulmonary circulation in COPD.

This study was designed to investigate the interaction of mild and localized cold exposure and hypoxia on pulmonary hemodynamics in chronic obstructive pulmonary disease (COPD). Nineteen patients with COPD were studied at sea level and seven at an altitude of 2,640 m. For all patients, pulmonary hemodynamic measurements were performed 10 min after insertion of a catheter in a femoral vein and following 10 min of cold exposure. Cold exposure was restricted to the forehead, and subjects breathed air at ambient temperature. Flow and temperature of air (1.5 L.s(-1), 5 degrees C) to the forehead were chosen to cool down the forehead skin to approximately 20 degrees C without discomfort for the subject. For the seven patients studied at high altitude, the same measurements were also performed after 5 min of oxygen supplementation with and without cold exposure. At sea level, an increase in pulmonary vascular resistance (PVR) during cold exposure was inversely related to the initial PaO2. In six severe hypoxic subjects (PaO2 < 50 mm Hg), PVR increased by 24%. At high altitude, PVR was significantly increased by 15%. After O2 supplementation, cold exposure did not induce an increase in PVR. We concluded that mild and localized cold exposure to the forehead only induced an increase in PVR in COPD patients with severe hypoxia. Moreover, in cold exposure responders, O2 supplementation negated the effect of cold exposure on pulmonary hemodynamics.

Cold Temperature↗
PubMed2003

Unusual frontal bone injury.

A 12-year old girl presented 6 months after a forehead injury due to fall from height. She had a deformed forehead with a rectangular bone defect and a rectangular bicortical bone fragment impacted into the lower edge of the defect. There was no obvious skin or dural injury. The deformed forehead was exposed through a bi-coronal scalp flap. The bone fragment was reposited back into the defect. The forehead of the patient healed with a smooth contour.

Accidental Falls↗
PubMed2004

Endoscopically assisted removal of tumors in the frontal region.

BACKGROUND: Advancements in endoscopic surgery, due in part to patient demands and in part to provision of superior medical care by surgeons, have significantly contributed to improvements in patients' quality of life. An endoscopic operation is minimally invasive, associated with faster recovery, and produces less postoperative morbidity. It is a well-accepted procedure in the field of plastic surgery. By applying the principle of endoscopic surgery used in facelift operations, we performed tumor excision in the forehead region. METHODS: Two 1.5-cm slit incisions were made in the anterior hairline. One incision was to allow access for the 4.0-mm, 30 degrees endoscope, and the other was for surgical instrumentation. These incisions, determined by the plane of dissection, were more superficial and below the subgaleal layer for soft tissue tumors and deeper into the subperiosteal layer for bone tumors. With good illumination and magnified monitor viewing, the tumors could clearly be visualized and were completely excised. RESULTS: Seven patients with either dermoid cysts (3), osteomas (2), or lipomas (2) underwent endoscopically assisted procedures. In all cases, tumors were successfully excised with no acute or chronic complications. The average postoperative follow-up period was 7 months. No incidence of tumor recurrence was reported. All patients were satisfied with the resultant forehead contour and surgical scars. CONCLUSIONS: The main advantage of this procedure is the fact that it is minimally invasive, thus reducing the incidence of injury to the neurovascular structures of the forehead as well as minimization of scar visibility. In conclusion, an endoscope-assisted approach is a good alternative method for managing benign soft-tissue and bone tumors in the forehead and brow region.

Adolescent↗
PubMed1980

Comparison of reconstructive methods used following ablative head and neck operations.

To overcome the sometimes crippling effect of extensive ablative surgery for oral cancer, two reconstructive techniques, the forehead flap of McGregor and the deltopectoral flap described by Bakamjian, have been incorporated into the operative procedure making it nearly routine. The records of 77 patients in whom 55 deltopectoral flaps and 30 forehead flaps were used were reviewed retrospectively. The failure rate of deltopectoral flaps was 16.4% and for forehead flaps was 7%. Causes of failure included infection, pressure by bone, prosthesis or teeth, residual cancer, previous irradiation and flap crowding. Functional results were similar with both flaps. The forehead flap is preferred although it has cosmetic disadvantages. Both these flap procedures, which are staged and result in prolonged hospitalization for the patient, may in the future be replaced by myocutaneous and free-flap reconstructions.

Adult↗
PubMed1994

Sound pressure in the external auditory canal during bone-conduction testing.

Sound pressure levels (SPLs) were measured in the external auditory canals (EACs) of 16 subjects with normal hearing and normal middle ear immittance. SPLs were the result of bone-conduction (BC) stimulation at 500, 1000, 2000, and 4000 Hz, with the oscillator placed either on the forehead or on the mastoid process. At 1000, 2000, and 4000 Hz, significantly higher SPLs were measured when the head was stimulated from the mastoid than from the forehead. When SPLs were compared between right and left EACs, forehead placement of the oscillator produced no interaural differences, while mastoid placement resulted in significantly greater EAC SPLs ipsilateral to the oscillator at 2000 and 4000 Hz. We conclude that forehead placement of a BC vibrator may help to lessen the (unwanted) contribution of the EAC to measurements of hearing sensitivity by BC.

Audiometry, Pure-Tone↗
PubMed1996

Hemodynamic responses to cold stress in blacks: effect of application site.

Black Americans have been shown to exhibit increased blood pressure responses to a variety of physical stressors. However, few investigators have examined hemodynamic responses to cold stress. Additionally, no studies have compared blood pressure responses to forehead and foot stress in blacks. Therefore, in this study, hemodynamic responses to cold pressor tests were compared in 30 blacks (15 males, 15 females) utilizing two application sites. Baseline comparisons of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), forearm blood flow (FBF) and forearm vascular resistance (FVR) were not different prior to forehead and foot cold stress. Following baseline measurements, ice was applied separately to the forehead and foot for 90 seconds with hemodynamic measurements being recorded at 45 and 90 seconds. During application of ice to the forehead, FVR-90 was significantly higher (P < .002, 97.0 units vs. 66.4 units) compared to the foot. The application of ice to the foot resulted in significantly greater SBP-45 responses (P < .0001, 147 mmHg vs. 139 mmHg), HR-45 responses (P < .0043, 80, b.min-1 vs. 69 b.min-1). HR-90 responses (P < .0001, 78 b.min-1 vs. 64 b.min-1), and FBF-45 responses (P < .05, 2.74 ml.min-1.100ml-1 vs. 1.98 ml.min-1.100ml-1). These findings suggest that blacks exhibit disparate patterns of reactivity in response to cold stress as a function of application site. Therefore, investigators should consider the application site when interpreting studies examining a biracial cohort.

Adult↗
PubMed1997

Rejuvenation of the upper face. A logical gamut of surgical options.

The prime objective of forehead rejuvenation is to correct the factors that accentuate the impression of aging, namely, eyebrow ptosis, glabella frown lines, forehead wrinkles, and asymmetry. Options for forehead rejuvenation are undergoing a renaissance. With the wide variety of choices currently available, accurate analysis of the presenting problem is mandatory so that the appropriate surgical technique can be chosen. The less invasive endoscopic procedures have a low morbidity rate and great patient satisfaction. Not all patients are candidates for these procedures, however. A thorough knowledge of alternative methods, including botulinum injection, fat injection, fat grafting, and subcutaneous approaches to the brow, are necessary if optimal aesthetic results are to be accomplished. Having an armamentarium of forehead rejuvenation techniques is, therefore, the key to individualizing treatment for each patient.

Adipose Tissue↗
PubMedDate not supplied

Modification of the subunit principle for reconstruction of nasal tip and dorsum defects.

This article reports our observations on, and modification of, the subunit principle with regard to reconstruction of nasal tip and dorsum defects. Forty-two patients who underwent reconstruction of a nasal tip and/or dorsum defect with a forehead flap were reviewed. These patients were categorized by how the subunit principle was used in their reconstruction and graded on the aesthetic outcome of the reconstruction. We found that the patients who had both the nasal tip and dorsum replaced obtained better results than those who had just 1 subunit replaced (P = .008). Review of postoperative photographs shows that the reason for this discrepancy in aesthetic outcomes is the line of transition between the forehead skin and remaining nasal skin if only 1 subunit is replaced. With this observation in mind, we feel that patients undergoing reconstruction of the nasal tip and/or dorsum should be evaluated for discrepancies in tissue type between the recipient nasal site and forehead donor site. If the tissues are noted to be significantly disparate, the reconstructive surgeon may consider replacing both subunits with a single forehead flap.

Esthetics↗