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PubMed2002

A new transcutaneous bilirubinometer, BiliCheck, used in the neonatal intensive care unit and the maternity ward.

UNLABELLED: Transcutaneous bilirubin (TcB) was measured with a new bilirubinometer, BiliCheck, in 261 jaundiced infants in the neonatal intensive care unit (NICU) [gestational age (GA) 25-43 wk] (group 1) and in 227 healthy jaundiced term and near-term infants (GA 35-43 wk) (group 2). Imprecision of a single determination of TcB measured on the forehead [TcB(h)], expressed as 1 standard deviation, was 15-18 micromol l(-1). No statistically significant difference between intraoperator and interoperator imprecision was found. There was a good correlation between TcB(h) and total serum bilirubin (TSB) in both groups of infants, although TcB(h) was on average lower than TSB. In the NICU infants, TcB(h), other things being equal, was lower in males than in females, and decreased with increasing postnatal age, for the same TSB level. In the infants in both groups who had a GA > or = 35 wk, sick infants had a higher TcB(h) than healthy infants for the same TSB level. The differences were statistically significant, but small and of minor clinical significance. Blood haemoglobin concentration, GA and ethnic origin were not found to influence TcB(h), i.e. BiliCheck corrects sufficiently for these factors. In all 488 infants, TcB was measured at four different body sites. Measurements on the forehead and sternum [TcB(s)] correlated well with TSB, while measurements on the knee and foot correlated less well. In the NICU infants TcB(h) predicted TSB statistically significantly better than TcB(s), while in the healthy term and near-term infants TcB(h) and TcB(s) predicted TSB equally well. Therefore, the preferable body site for measurement of TcB under routine conditions is the forehead. By retrospective analysis of the data, a screening model is presented whereby TcB(h) can be used to screen infants who require phototherapy. We found that using screening limits for TcB(h), which are 70% of the currently used phototherapy limits for TSB, 80% of blood samples in healthy term and near-term infants, and 42% of NICU infants with GA > or = 32 wk, could be avoided. CONCLUSION: BiliCheck is suitable for screening both NICU and healthy newborn infants with jaundice, with regard to the need for phototherapy. The authors recommend using a TcB(h) limit which is 70% of the currently recommended TSB limits for phototherapy, to decide whether TSB needs to be measured.

Bilirubin↗
PubMed1993

Relationship between family environment and children's hemodynamic responses to stress: a longitudinal evaluation.

Because interpersonal relationships may have an impact on the risk of developing cardiovascular disease, the authors examined the prospective relationship of family functioning upon hemodynamic stress responses in 87 6- to 8-year-old children. The parents completed the cohesion, conflict, expressiveness, and control subscales of the Family Environment Scale; 2 years later, the authors assessed the children's hemodynamic responses to postural change, forehead cold stimulation, and treadmill exercise. Maternal reports of greater cohesion and expressiveness were related to less increases in systolic pressure and systemic vascular resistance in response to the forehead cold. Mothers' reports of expressiveness were related to lower systolic pressure and cardiac index reactivity to postural change. Fathers' reports of greater control were associated with greater diastolic pressure and vascular resistance increases to forehead cold and to greater vascular resistance responses to exercise. Paternal reports of greater conflict were associated with greater systemic vascular resistance increases and with lower cardiac index increases to exercise. Results suggest family functioning may predict later hemodynamic reactivity to stress. The findings are discussed in terms of previous research on parent-child interaction patterns and children's cardiovascular health.

Arousal↗
PubMed1993

Determinants of left ventricular mass in normotensive children.

Left ventricular hypertrophy has been shown to be an independent predictor of cardiovascular morbidity and mortality. Few studies have examined the determinants of left ventricular mass (LVM) in normotensive children. Eight-four healthy children, blacks and whites, girls and boys, between 6 and 18 years of age, all with positive family histories of essential hypertension, participated in the study. Demographic and anthropometric characteristics, physical activity, and hemodynamic responses at rest and in response to the stress of forehead cold stimulation and a challenging video game were related to M-mode echocardiographic determined LVM indexed by two indices of body habitus. Hierarchical stepwise multiple regression analysis indicated that the significant independent correlates of LVM per body surface area were gender (boys were greater), baseline systolic blood pressure and heart rate, a physical activity index (sweat episodes per week) and peak systolic blood pressure responses to the forehead cold stressor (final model r2 = 0.49). For LVM/height2.7 significant independent correlates were adiposity index (weight z score--height z score), gender (boys were greater), age, resting systolic pressure, and systemic vascular resistance reactivity to forehead cold stimulation (final model r2 = 0.42). These findings with normotensive children corroborate other findings that have typically involved hypertensive children, indicating that resting heart rate and systolic pressure, gender, and adiposity are early determinants of LVM indices in children. In addition, the current findings indicate that hemodynamic responses to stress also appear to play a role in the early development of LVM.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

Increased dermal carotenoid levels assessed by noninvasive reflection spectrophotometry correlate with serum levels in women ingesting Betatene.

beta-Carotene is being used as an oral sun protectant, and evidence indicates that carotenoids may protect human skin from light-induced lesions. However, limited information is available on the distribution and accumulation of beta-carotene in skin, especially with respect to various skin regions. With the use of reflection spectroscopy, we investigated the accumulation of total carotenoids in human skin after repeated supplementation of 12 women with beta-carotene from a natural source Betatene, an algal extract. After daily ingestion of 24 mg beta-carotene (in Betatene) for 12 wk, an increase in carotenoid skin levels was observed. Highest basal values were measured in skin of the forehead, palm of the hand and dorsal skin, with lower levels measured in skin of the arm and back of the hand. Upon treatment, increases in carotenoid skin levels were found in all areas as follows: 2.4-fold in forehead, 0.7-fold in dorsal skin, 2.2-fold in the palm of the hand, 17-fold on the back of the hand and 1.7-fold on the inside of the arm. After cessation of treatment, the carotenoid levels decreased in all skin areas. Serum beta-carotene levels were elevated upon treatment and correlated with carotenoid skin levels. Correlations for serum vs. skin from the palm of the hand (r = 0.94) and skin from the forehead (r = 0.89) were calculated, indicating that serum levels appeared to be a suitable indicator for carotenoid accumulation in specific regions of the skin. With doses of approximately 20-25 mg carotenoids/d, it is possible to raise dermal carotenoid levels.

Adult↗
PubMed1987

Bolster dressing to support a full-thickness skin graft.

The patient with a through-and-through defect of the nose suffers from a loss of skin, subcutaneous tissue, cartilage, and nasal lining. Repair of this defect is generally directed toward restoring the components of skin and lining. The forehead flap is a useful substitute for nasal skin. A full-thickness skin graft may be used to substitute for absent nasal mucosa and serve as a lining for the forehead flap, covering its deep surface and retarding wound contracture. In the case presented, firm contact was maintained between the forehead flap and its full-thickness graft lining using a bolster dressing of simple design. We believe this dressing discourages seroma and hematoma formation while maintaining contact between the graft and the vascularized flap bed.

Bandages↗
PubMed1990

Two flag flaps based on the supratrochlear vessels for nasal reconstruction.

A short forehead or a low hairline sometimes precludes the use of a median forehead flap for reconstruction of defects of the lower nose when both lining and cover are needed. Two flag flaps based on the supratrochlear vessels were used in a patient with a full-thickness alar defect and a narrow, short forehead.

Adult↗
PubMed1991

Eyebrow revascularization.

A 41-year-old man suffered from an incompletely avulsed right eyebrow and forehead after a windshield injury in a traffic accident. Microsurgical techniques were used to revascularize the avulsed tissue of the right eyebrow and forehead with anastomosis of one branch of the frontal branch of the right superficial temporal artery. The revascularized eyebrow and forehead remained viable and provided a good cosmetic result. An aggressive microsurgical approach, either by direct arterial anastomosis or bypass with vein graft, should be encouraged in all incompletely avulsed tissue with inadequate blood supply in the face, hand, and foot.

Adult↗
PubMed1995

Surgical management of life-threatening epistaxis in Osler-Weber-Rendu disease.

Hereditary hemorrhagic telangiectasia is a systemic disorder of blood vessels. It often leads to severe epistaxis that is refractory to conventional therapy. Three patients with severe epistaxis caused by hereditary hemorrhagic telangiectasia unresponsive to laser coagulation and to septal dermoplasty and requiring multiple transfusions underwent extirpation of nasal mucosa through a rhinotomy approach, with a median forehead flap and split-thickness skin graft coverage of the mucosal defects over the floor and lateral walls of the nose. All patients had reduced frequency and severity of bleeding without any need for transfusions during follow-up periods of 6 months, 3 years, and 5 years, respectively. Forehead flaps resulted in minimal morbidity. Partial nasal obstruction and a forehead scar were the main complaints. Surgical technique, complications, and alternative therapy are discussed.

Epistaxis↗
PubMed1997

Endoscopically assisted plastic surgical procedures in the pediatric patient.

Endoscopically assisted surgery has gained wide popularity in plastic surgery. Its major uses have been in aesthetic procedures. In this article we demonstrate the safety and utility of these techniques to a pediatric population. All patients younger than 20 years who underwent an endoscopically assisted plastic surgical procedure by one of the authors were pooled and their medical records reviewed. Complications were determined. For those children having an excision of a forehead mass, the duration of the procedure, length of incision, specimen size, and length of hospital stay were determined. Additionally, parents of these children were contacted by telephone after the excisions to determine satisfaction with the procedures. Sixteen patients' records were reviewed. Patients' ages ranged from 6 months to 15 years (mean, 5.8 years). The procedures performed included removal of forehead mass (n = 9), placement of tissue expanders (n = 5), excision of gynecomastia (n = 1), and malar soft tissue elevation (n = 1). All procedures were completed with endoscopic assistance. One procedure had to be converted to an open technique. No hematomas were observed. For forehead mass excisions, the average duration of the procedure was 46.9 min. Incision length was 1.1 cm, and specimen volume was 0.5 cm3. Parent satisfaction with the endoscopic procedures was high, with 100% responding favorably. No significant complications were observed. Many of the procedures were performed as outpatients. Parental acceptance of and satisfaction with the endoscopic techniques was high. Our experience supports the use of endoscopic techniques in the pediatric plastic surgical patient.

Adolescent↗
PubMed2001

Cortical representation of the orbicularis oculi muscle as assessed by transcranial magnetic stimulation (TMS).

OBJECTIVES: To analyze characteristic features and details on motor-evoked potentials (MEPs) of the orbicularis oculi muscle resulting from cortical transcranial magnetic stimulation (TMS) in normal subjects as a basis for further investigations on motorcortical representation in patients presenting with facial nerve diseases. STUDY DESIGN: MEPs of the orbicularis oculi muscle resulting from focal cortical TMS with a figure-8-shaped coil were investigated in 17 healthy subjects with special regard to amplitude and onset latency as a function of the coil position on the head surface along the interaural line and in the anterior-posterior direction. The results were then compared with our data on lower-lip mimetic muscles and on the frontalis muscle obtained in previous studies. RESULTS: Bilateral reproducible responses could be observed at coil positions varying from 1 to 13 cm lateral to the vertex. During moderate muscle activation, maximum responses (mean amplitude 0.75 +/- 0.44 mV contralateral, 0.74 +/- 0.36 mV ipsilateral) were obtained at a mean stimulus position of 8.6 +/- 1.6 cm lateral and 2.0 +/- 2.2 cm anterior to the vertex for contralateral responses, and of 8.6 +/- 2.0 cm lateral and 2.8 +/- 2.4 cm anterior to the vertex for ipsilateral responses, respectively. Voluntary muscle activation by forced eye-closure was associated with a further increase in mean amplitudes. At rest, bilateral responses could be elicited in 15 subjects (88.2%). During moderate muscle activation, the shortest mean onset latencies were obtained at the optimum stimulus position on the interaural line, both for contralateral (10.2 +/- 1.3 ms) and ipsilateral (10.6 +/- 1.5 ms) MEPs. Comparing our data on the orbicularis oculi muscle with those obtained on lower-lip muscles and on the frontalis muscle, there was a considerable overlap of coil positions from which reproducible MEPs could be elicited in all three groups of mimetic muscles, but with the orbicularis oculi area being placed between forehead and lower-lip motorcortical areas. CONCLUSIONS: A statistically significant separation of the cortical representation areas of forehead, orbicularis oris, and lower-lip mimetic muscles is possible by focal cortical TMS reflecting a kind of somatotopic organization of the face-associated motorcortex. Compared with the results on lower-lip and forehead muscles, orbicularis oculi muscle responses show characteristics of both.

Adult↗
PubMedDate not supplied

Depressed mood is related to high-frequency heart rate variability during stressors.

OBJECTIVE: The purpose of this study was to examine the relationships between depressed mood and parasympathetic control of the heart in healthy men and women at rest and during two stressors. METHODS: Fifty-three healthy college students completed a laboratory stress protocol that included a baseline resting period, a challenging speech task, and a forehead cold pressor task. Depressed mood was assessed using the Beck Depression Inventory (BDI). Parasympathetic cardiac control was measured as the high-frequency (0.12-0.40 Hz) component (HF) of heart rate variability using power spectrum analysis. Blood pressure, respiration rate, and respiration amplitude were measured simultaneously. RESULTS: Participants were categorized as having a high or low depressed mood on the basis of median splits of their BDI scores. Those in the high depressed mood group had significantly greater reductions in HF during the speech task and significantly smaller increases in HF during the forehead cold pressor task than those in the low depressed mood group. Women had significantly greater reductions in HF during the speech task and smaller increases in HF during the forehead cold pressor task than men. However, gender and depressed mood did not interact to predict changes in HF. CONCLUSIONS: Depressed mood is related to the magnitude of decrease in parasympathetic cardiac control during stressors in healthy men and women. These findings extend those of previous studies, in which a similar phenomenon was observed among patients with cardiac disease. Because the participants in this study were healthy, the relationship between depressed mood and parasympathetic cardiac control does not seem to be secondary to cardiovascular disease.

Adolescent↗
PubMed2003

Influence of patient variables and sensor location on regional cerebral oxygen saturation measured by INVOS 4100 near-infrared spectrophotometers.

Cerebral oximeter based on near-infrared spectroscopy has been used as a continuous, noninvasive monitoring of regional cerebral oxygen saturation (rSO2). Although the absolute rSO2 values have a wide range of variability, the factors affecting a variability of rSO2 values have not been extensively investigated. The authors investigated the influence of patient variables and sensor location on rSO2 measured by the cerebral oximeter INVOS 4100 in 111 patients anesthetized with sevoflurane, fentanyl, and nitrous oxide in oxygen. The sensors for rSO2 measurements were applied on the right forehead (R), 1 cm lateral to R (R1), on the left forehead (L), 1 cm lateral to L (L1), and on the center of the forehead (C). The relationship between the rSO2 values and patient variables were also analyzed. Values of rSO2 at R1 and L1 were significantly lower than those at R and L, respectively. Values of rSO2 at C were significantly higher compared with those at other sites. There were no significant correlations between the rSO2 values and values of weight, height, and head size. Values of rSO2 were similar between males and females. A significant negative correlation between the rSO2 values and age and a positive correlation between the rSO2 values and hemoglobin concentration were observed. These data indicate that patient age, hemoglobin concentration at the measurement, and sensor location can affect rSO2 values.

Adolescent↗
PubMed2003

Significance of House-Brackmann facial nerve grading global score in the setting of differential facial nerve function.

OBJECTIVE: To determine the clinical significance of the House-Brackmann facial nerve grading scale (HBFNGS) in the setting of differential function along the branches of the facial nerve. STUDY DESIGN: Prospective study of 38 patients with facial palsy who demonstrated differential facial function. SETTING: Tertiary referral center. PATIENTS: Patients with facial nerve dysfunction from any cause. Patients with complete facial nerve paralysis (House-Brackmann Grade 6) were excluded. INTERVENTION: Physicians were provided with printed description of the HBFNGS and asked to report facial nerve function as a traditional global score and as a regional score based on the House-Brackmann scale for the forehead, eye, nose, and mouth. This was reported as F(w) E(x) N(y) M(z), where w, x, y, and z ranged from 1 to 6 based on the HBFNGS. Synkinesis was graded as none, mild, or severe. MAIN OUTCOME MEASURES: The traditional HBFNGS score was compared with a regional grading facial nerve grading system based on the HBFNGS for the forehead, eye, nose, and mouth. Agreement between the traditional global score and the regional scores was analyzed. RESULTS: In patients with variable facial weakness, the single House-Brackmann score did not fully communicate their facial function. Further, the single grade did not always correlate with the best or worst function along the four facial regions. The single House-Brackmann score most strongly correlated with the regional scoring of the eye (61%), followed by the nose/midface (40%), mouth (32%), and forehead (18%). The global score did not correlate with the worst regional score in 30 patients (79%). In 3 of 5 patients with synkinesis and an obligatory Grade 3 or higher in the global House-Brackmann grading system, the regional facial function was Grade 2 or better at one or more areas of the face. CONCLUSIONS: In patients with differential facial function, a single global number is inadequate to describe facial function and primarily reflects the function of the eye. Regional assessment using the HBFNGS and reported as F(w) E(x) N(y) M(z) more fully communicates facial function.

Adolescent↗
PubMed1979

The aerobic growth of Propionibacterium acnes in primary cultures from skin.

Although Propionibacterium acnes ordinarily grows as an anaerobe, this organism was commonly seen on aerobic primary cultures (directly from skin) of the forehead, axilla, deltoid area, and antecubital fossa. On subculture, strains from aerobic primary cultures showed their normal anaerobic state. On repeated tests of the foreheads of 7 subjects over periods of 1 to 4 yr, 24% of all cultures were positive for propionibacteria (P. acnes) on aerobic culture. This phenomenon was equally common in cultures from those with relatively sparse or dense populations of P. acnes on the skin surface. Several different patterns of aerobic growth were observed: satellitism, profuse growth at one dilution and none on the next higher dilution, and proportionate growth in successive dilutions. These different growth patterns indicate that more than one mechanism is operative in stimulating the aerobic growth of propionibacteria. Whether one or more of these mechanisms is operative in vivo, we do not know, but it appears that they do not account for the great individual differences in population density of P. acnes on such sites as the forehead.

Adult↗
PubMed1990

Frictional properties of human skin: relation to age, sex and anatomical region, stratum corneum hydration and transepidermal water loss.

Differences in the dynamic skin friction coefficients (mu) were investigated with respect to age, sex, and anatomical region. A total of 29 volunteers consisting of seven young females, seven old females, seven young males, and eight old males participated in the study. Measurements were obtained from II anatomical regions, namely, the forehead, upper arm, volar and dorsal forearm, postauricular, palm, abdomen, upper and lower back, thigh, and ankle. The friction data were compared with stratum corneum hydration and transepidermal water loss (TEWL). The dynamic friction coefficient did not vary significantly between age and sex groups but varied considerably among the anatomical regions of the body. The forehead and postauricular had the highest mu (0.34 +/- 0.02) while the abdomen had the lowest (0.12 +/- 0.01); the remaining regions had an average mu value of 0.21 +/- 0.01. Similarly, no sex differences were observed for TEWL and stratum corneum hydration. Capacitance was only significantly lower on the palms of the elderly. Regional differences showed a higher state of hydration on the forehead and postauricular as well as the upper arm, upper and lower back when compared with the volar forearm. TEWL was generally lower in the elderly on all anatomical regions except the postauricular and palm. A significant correlation was established between mu and capacitance for most regions. Between mu and TEWL significant correlation was observed only on the palm and thigh. These findings suggest that frictional properties of skin are dependent on more than water content or non-apparent sweating and the role of sebum secretion is suggested as one possible factor.

Adult↗
PubMed1991

Physiology of the vellus hair follicle: hair growth and sebum excretion.

The growth of vellus hair and the secretion of sebum from vellus hair follicles were measured on the forehead, cheek, chest, shoulder and back of healthy men and women aged 15-30 years. Hair growth was assessed by computerized image-analysis of photographs and sebum excretion by the use of Sebutape followed by image analysis. The density of vellus hairs and the percentage of growing hairs were higher on the face than on the thorax (439 hairs/cm2 with 49% growing hairs on the forehead compared with 85 hairs/cm2 with 31.5% growing hairs on the back). The rate of growth ranged from 0.03 mm/day on the forehead to 0.13 mm/day on the back. The maximum length of vellus hair significantly decreased with age; otherwise hair growth was not affected by age or sex. Some variations in hair growth and sebum secretion were observed over a period of 3 months, but no consistent rhythms were detected. There was no obvious link between vellus hair growth and sebum excretion.

Adolescent↗
PubMed1993

The vellus hair follicle in acne: hair growth and sebum excretion.

In this study we investigated the activity of the vellus hair follicle in acne. Hair growth and sebum excretion in vellus hair follicles were measured on the forehead and back of men, and on the forehead, cheek, and back of women with acne. Hair growth was assessed by computerized image analysis (phototrichogram), and sebum excretion by computer analysis using Sebutape. In patients with acne, marked differences were revealed when results were compared with recent data from healthy persons. In particular, the mean growth rate of vellus hairs was higher, whereas the percentage of anagen hairs was lower, and the duration of the anagen phase shorter in patients with acne than in healthy individuals. Hair growth and sebum excretion depended significantly (P < 0.01) on the anatomical site (forehead 414 hairs/cm2, 0.053 mm/day, 34%; back 93 hairs/cm2, 0.16 mm/day, 21%). In addition, analysis of hair growth revealed significantly higher values in females than in males for (i) percentage of anagen hairs (P > 0.01), (ii) for vellus hair length (P < 0.05), and (iii) for the duration of the anagen phase (P < 0.01). The present study demonstrates that the activity of the vellus hair follicle is influenced by acne, and vice versa, and therefore its role in the aetiopathogenesis of acne should be reconsidered.

Acne Vulgaris↗
PubMed2004

A case of primary cutaneous anaplastic large cell lymphoma with variant anaplastic lymphoma kinase translocation.

Anaplastic lymphoma kinase (ALK) is frequently observed in systemic anaplastic large cell lymphoma (ALCL), mostly in childhood or adolescence, but only rarely in primary cutaneous cases. We report a case of primary cutaneous ALCL (pcALCL) with cytoplasmic ALK expression. A 54-year-old woman with an ulcerative tumour on her forehead was admitted to our hospital. Histologically, there was an infiltrate consisting of atypical large lymphocytes and small lymphocytes in the dermis and fat tissue. Southern blot analysis showed monoclonal T-cell receptor Cbeta1 gene rearrangement. Atypical large lymphocytes were positive for CD30, CD4 and CD25, and negative for CD3 and CD79a. They were also positive for ALK only in the cytoplasm, and neurophosmin (NPM)-ALK fusion transcript was not detected by reverse transcription-polymerase chain reaction. This suggested that the translocation partner of the ALK gene in this case was different from NPM (variant translocation). The tumour on the forehead resolved in 1 month after biopsy. Nodular lesions recurred on the right knee, and were histologically identical with the forehead lesion. Our case suggests the existence of a subgroup with variant ALK translocation in pcALCL; examining NPM-ALK translocation in each case with ALK expression should be useful to characterize the disease further.

Anaplastic Lymphoma Kinase↗