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A case of congenital defect of the scalp and skull, treated conservatively with success, is reported. The defect of the scalp healed rapidly and the underlying osseous defect closed within eight months. The course of obliteration of the osseous defect was followed using radiological methods.
A randomised double-blind placebo-controlled study showed improvement of scalp psoriasis with oral ketoconazole, although the study had to be stopped before completion because of the possibility of drug toxicity. The common appearance of psoriasis in the scalp and certain other sites may be due to pityrosporal colonisation that also causes seborrhoeic dermatitis and dandruff.
Dermabrasion of the scalp was safely and effectively performed on five patients as a treatment for actinic damage. This surgical modality can be an important part of the management of solar keratoses of the scalp in patients with alopecia.
Basal cell carcinoma (BCC), the most common skin cancer in the United States, is locally invasive but has a low risk of metastasis. BCC is rare in black patients but, regardless of racial origin, most BCC occurs on sun-exposed areas. We describe a 67-year-old black man with a large BCC on the hairy scalp, a relatively sun-protected area, that metastasized to the spine. To our knowledge, this is the first description of a black patient with development of metastatic BCC on an otherwise normal scalp.
BACKGROUND: Transverse sections of human scalp biopsy specimens can provide both qualitative and quantitative information about follicular histopathology not readily available in vertically sectioned specimens. OBJECTIVE: We propose a method for making the processing and interpretation of such specimens easier. METHODS: All scalp biopsy specimens obtained during the past 18 months in our institution for the evaluation of alopecia were processed for transverse sections by means of a technique employing trisection or quadrisection (rather than the standard bisection), and maintaining all sections in the same anatomic orientation (deep to superficial) in all tissue pieces on microscopic slides. RESULTS: More than 120 transversely sectioned specimens from more than 75 patients have been processed with this technique. The typical number of slides cut per specimen decreased from between 12 and 20 to between 1 and 4, with no loss of clinical information. CONCLUSION: This technique allows transverse sections for evaluation of alopecia to be processed in a more cost-effective manner and compares favorably with previously published techniques in providing diagnostic information.
Scalp incisions of an elective nature are commonly used as an approach in upper cranial maxillofacial surgery. Similarly, isolated linear parietal incisions are occasionally used to harvest outer table calvarial bone grafts. Although morbidity from these incisions is generally minimal, there is a tendency, particularly when a scar is widened, for it to be more visible if it is of a linear nature. In this review we will present our results with 16 consecutive patients in which a geometric pattern incision was used instead of a straight incision in hopes of improving the ultimate appearance of this scar. We have found that, in general, incisions made in a geometric fashion are less noticeable than traditional linear elective scalp incisions. This is particularly true when there was widening of the scar.
A rare extensive malignant melanoma involving the upper lip and maxillary alveolar mucosa was removed by en bloc resection after chemotherapy and radiotherapy. Simultaneous immediate reconstruction of the entire upper lip defect was carried out with a bitemporal pedicle flap which included the scalp and forehead after applying lyophilized porcine skin to the wound where the alveolar bone had been resected, and the bilateral scalp-forehead and thigh donor sites. A partial denture was inserted six months postoperatively. Now, one and a half years after operation, the patient is quite satisfied with his cosmetic appearance and masticatory recovery.
The correlation dimension of monopolar electroencephalogram (EEG) recordings (reference Cz) and EEGs obtained by applying the Laplacian operator to monopolar recordings, were compared in 11 healthy subjects at P3 and P4 electrode positions of the international 10-20 system. Values of correlation dimension averaged over ten 16-s epochs (8192 samples, 512 Hz) were estimated for each subject. Laplacian derivations demonstrated lower values of correlation dimension in comparison with monopolar EEG. Tests for non-linearity with phase-randomized surrogate signals did not reveal differences between both types of derivations. These data suggest that human scalp-recorded EEG may be a result of activity of weakly-coupled subsystems and are consistent with the view that the correlation dimension can be related to the number of active neuron groups contributing to the scalp-recorded EEG.
PURPOSE: Total scalp radiotherapy is required in a variety of clinical situations. We compared conventional lateral photon-electron (LPE) technique with tomotherapy (intensity-modulated radiotherapy [IMRT]). METHODS AND MATERIALS: A patient with Merkel cell carcinoma was treated at our institution using conventional treatment techniques. Treatment plans were conducted using conventional three-dimensional treatment planning and IMRT. The clinical target volume included the entire scalp tissue volumes to the surface of underlying cranial bone, as well as superficial and deep neck nodes in the bilateral neck. To provide a consistent comparison between the IMRT and three-dimensional conventional treatment plans, the dose distributions were normalized such that 90% of the target volumes received the prescription dose. RESULTS: Examination of our results revealed an acceptable dose-volume histogram and adequate coverage of the clinical target volume using the conventional LPE technique. The IMRT plan provided a more homogeneous dose to the target volume; however, critical structure doses were uniformly higher than for the conventional treatment plan. CONCLUSIONS: The IMRT plan resulted in a substantial dose to the lens, brain, and orbit, making it clinically unacceptable compared with the LPE technique. Overall, the LPE technique was superior.
Treating scalp and hair disorders is challenging because of the emotional nature of hair loss and because of unknown pathogenesis. Treating African American patients can add an extra layer of complexity to this treatment if the dermatologist is not familiar with hair care practices. Only the dermatologist who strives to understand hair care practices, the common disease entities of the hair and scalp in African Americans, and the disturbance in quality of life from alopecia will effectively approach treatment in these patients.
A 19-year-old man was diagnosed with a rapidly enlarging arteriovenous malformation of the scalp and a mild degree of cardiomegaly. Operation to excise the large fistula took place under general anesthesia. Both external carotid arteries and their branches were controlled to prevent intraoperative hemorrhage, and dissection took place down to the periosteum. A split skin graft from the thigh was applied to the scalp defect. The patient recovered well with no further evidence of dyspnea or high output cardiac failure.
Terminal hair follicles of the human scalp of all ages showed apoptotic pocket-like structures in the outer root sheath of the bulge area at anagen, but not telogen phase. The occurrence of these hole structures was roughly estimated in 15% of anagen terminal hair follicles of the human scalp. The size of these apoptotic pockets was variable, ranging from pin hole-like spaces to larger structures filled with homogeneous black materials. These unusual variations were often co-localized with apoptotic degenerations and exclusively present in the presumptive bulge of anagen terminal hair follicles where arrector pili muscles were seen in the vicinity. In fact, these vacuolated structures tended to be present on the side where the major part of the arrector pili muscles anchored.
Alopecia is a distressing side-effect of cancer treatment. Taxanes (TX), anthracyclines (ANR) and etoposide (ET) have been consistently associated with significant alopecia. We studied an effective scalp cooling system, the Penguin Cold Cap system, for the prevention of chemotherapy-induced alopecia in 70 patients receiving chemotherapy, including one of the following major alopecia-causing agents: Group A, TX-based regimes (without ANR); Group B, TX+ANR; Group C, ANR-based regimes (without TX); Group D, ET-based regimes. Protection from hair loss was achieved by maintaining scalp temperatures below 15 degrees C before, during and after chemotherapy by frequent changing of the caps. Assessment was carried out using a grading system from 0 to 4. Grades 0-2 were considered as satisfactory hair protection, whilst Grades 3-4 were considered failures. 57 patients were evaluable for assessment. An overall 81% protection was achieved. In groups C and D 11 of 12 patients (92%) had no alopecia, whilst 30 of 34 patients (88%) treated with taxanes had adequate hair protection. In Group B, 4 of 11 patients (36%) had adequate hair protection. The system was well tolerated and is a very effective method for protection from hair loss caused by TX, ANR and ET. Our results are comparable with and, in most cases, better than those reported in other studies using various alopecia preventive methods.
OBJECTIVE: To determine the effect of a scalp reference signal, such as that recorded from the mastoid or ear, on the coherence of referential intracranial electroencephalograms (EEGs). METHODS: The relationship between reference signal power and magnitude squared coherence (MSC) was determined from the theoretical expression of the coherence of referential recordings, obtained under the assumption that the reference signal is not correlated with the signals being studied. The effect of a contaminated reference signal on the coherence of intracranial EEGs was determined by measuring the MSC of both a recording of background EEGs with a simulated contaminated reference signal and a contaminated recording of a seizure. RESULTS: The MSC of referential intracranial EEGs is inflated due to the reference signal. This inflation is a function of the true MSC of the intracranial signals and the power of the reference and intracranial signals. The inflation is limited where reference signal power is smaller than the power of the intracranial signals; maximum inflation <0.1 when reference signal power=0.2xpower of intracranial EEGs and </=0.2 when reference signal power=0.5xpower of intracranial EEGs. A contaminated reference signal may have a considerable effect on MSC, however. The changes to the MSC spectrum that result from a contaminated reference primarily occur in an open-ended high-frequency band and may create an elevated plateau in this part of the MSC spectrum. CONCLUSIONS: The findings presented here suggest a scalp reference signal is suitable, with careful monitoring of the reference signal, for coherence analysis of intracranial EEGs. A reference signal will have a limited effect on the coherence of intracranial EEGs except when it is contaminated. In the event the reference signal is contaminated it should be possible to detect this from the stereotyped features of the coherence spectrum.
OBJECTIVE: To record the potentials evoked at the scalp by stimulation through electrodes targeted at the human subthalamic nucleus (STN) and to determine whether the responsible pathways continue to be excited or become blocked with high frequency stimulation. METHODS: We recorded the potentials evoked at the scalp in response to single and multiple stimuli delivered through STN contacts in 6 patients with Parkinson's disease. RESULTS: On 9/11 sides tested, single stimuli elicited a negative potential with latency of approximately 3 ms which was largest over the frontal region. Its short chronaxie (50 micros) and refractory period imply that it arose from the activation of low threshold neural elements, possibly myelinated axons. This potential could follow at 100 Hz. This early potential was sometimes followed by later negative potentials at approximately 5 ms (6/11 sides) and approximately 8 ms (8/11 sides). The responsible neural elements had the same short chronaxie. These potentials were augmented by paired stimuli at separations of 2-7 ms and by trains of stimuli at 200 Hz. CONCLUSIONS: Trains of stimuli delivered to the STN may excite low threshold neural elements which can transmit impulses at frequencies >100 Hz without blocking and which may produce postsynaptic facilitation at the cortex.
OBJECTIVE: To investigate the location of the cerebral generators of the early scalp somatosensory evoked potentials (SEPs) after tibial nerve stimulation. METHODS: Tibial nerve SEPs were recorded in 15 patients, suffering from Parkinson's disease, who underwent implantation of intracerebral (IC) electrodes in the subthalamic nucleus, in the globus pallidum or in the thalamic ventralis intermediate nucleus. SEPs were recorded both from the scalp surface and from the IC leads. RESULTS: The lemniscal P30 response was recorded by all the electrodes. The IC waveforms included a negative N40IC response, followed by a positive (P50IC) and a negative (N60IC) potential. The N40IC, the P50IC and the N60IC potentials did not differ in latency from the P40, the N50 and the P60 responses recorded by the Cz electrode. In 6 patients, in which SEPs were recorded also during the voluntary movement of the stimulated foot (active gating), an amplitude reduction of the SEP components following the P30 potential was observed during movement at the vertex and in the IC traces. Instead, in the contralateral temporal traces the SEP components (N40temp and P50temp) were not modified by active gating, and in the ipsilateral parietal traces only the positive potentials at about 60ms of latency was decreased. CONCLUSIONS: Two differently oriented generators are active in the contralateral hemisphere at both 40 and 50ms of latency after tibial nerve stimulation. One source is oriented perpendicularly to the mesial hemispheric surface and generates the potentials recorded by the contralateral temporal and the ipsilateral parietal leads; the other dipolar source is radial to the hemispheric convexity, and generates the potentials at the vertex and those recorded by the IC electrodes.
BACKGROUND: Major neurological complications of sickle cell disease include cerebral infarction and intracranial hemorrhages. METHODS: We describe the case of a 25-year-old man with sickle cell disease who developed a severe headache of acute onset, located at the vertex. There was associated pitting edema of the scalp. RESULTS: Technetium and gallium bone imaging showed focal decreased uptake of the tracers, consistent with a recent fronto-parietal skull infarction. Management included intravenous hydration and analgesic medication. CONCLUSIONS: In addition to the more common intracranail vaso-occlusive complications, skull infarction should be considered as a cause of newonset headache in patients with sickle cell disease, especially if scalp edema is present.
Hair analysis can be used as a screening tool in the diagnosis of genetic diseases. The scalp hair roots of 67 normal neonates and 39 neonates with glucose-6-phosphate dehydrogenase (G6PD) deficiency were analysed using Fourier transform infrared (FT-IR) microspectroscopy to differentiate the stages of the hair growth cycle and to diagnose the genetic disorder on the basis of spectral differences. We have demonstrated that FT-IR microspectroscopy is a rapid and effective noninvasive diagnostic method to differentiate scalp hair roots of normal neonates into the anagen, catagen or telogen phases of the hair growth cycle, using IR spectral differences within the 3000-2800 cm(-1) region and the IR peak area ratio of 2854 cm(-1)/2873 cm(-1) or 1084 cm(-1)/amide II band (p<0.001). Moreover, G6PD-deficient neonates could be accurately diagnosed from telogen phase hair roots owing to significant differences in IR peak area ratios of 2854 cm(-1)/2873(-1) or 1084 cm(-1)/amide II band compared to normal values in healthy neonates. The result suggests that the application of FT-IR microspectroscopy may be capable not only of differentiating the hair growth cycle into anagen, categen or telogen phases but also of detecting G6PD deficiency. Hair root analysis promises to be a useful complement to serum and urine analysis in the diagnosis of genetic diseases.