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PubMed2005

Sex- and menstrual cycle-related differences in sweating and cutaneous blood flow in response to passive heat exposure.

To examine sex- and menstrual cycle-related differences in thermoregulatory responses to heat exposure, ten young women and six young men were heated passively by immersing their legs in water heated to 42 degrees C for 60 min (in ambient conditions of 30 degrees C and 45% relative humidity). The women underwent heat exposure during the mid-follicular (F) and mid-luteal (L) phases of the menstrual cycle, which were confirmed by assaying plasma female reproductive hormones. The rectal and mean body (T(b)) temperatures of women in the L phase were significantly greater than those of women in the F phase and of men during a pre-heating equilibration period (28 degrees C) and during heat exposure. During heat exposure, the local sweat rates (m(sw)) on the forehead, chest, back, and forearm of women in either phase were significantly lower than those of men, but the thigh (m(sw)) was similar to that of men. The m(sw) did not change at any site during the different phases of the menstrual cycle. The cutaneous blood flow (%LDF) was significantly greater on the thigh for women in either phase compared with men, but no difference was found at any other site (forehead, chest, back, and forearm). The %LDF on the back was significantly greater for women in the L phase than in the F phase, but those at other sites were similar in both phases. We conclude that, compared with men, heat loss from women depends more on cutaneous vasodilation (especially on the thigh) than on sweating, irrespective of the phase of the menstrual cycle. This phenomenon was due to peripheral mechanisms, as reflected in the greater slope of the relationship between %LDF and T(b) lower slope of the relationship between m(sw)) and frequency of sweat expulsion, and lower sweat output per gland. The menstrual cycle modified the T(b) threshold for vasodilation and sweat onset in women. Therefore, the sex difference in the T(b) threshold was more marked for women during the L phase than during the F phase. Moreover, the menstrual cycle modified the slope of the relationship between %LDF on the back and T(b).

Adult↗
PubMed2000

Continuous monitoring of haemodynamic parameters in humans during the early phase of simulated diving with and without breathholding.

This study examined the integrative changes of blood pressure (BP) and stroke volume (SV) leading to the initial biphasic heart rate (fc) response (first 15 s) in simulated diving manoeuvres with and without breathholding (BH). Simulated diving was studied in ten young healthy volunteers by application of a gel-filled pack at 0 degree C and 18 degrees C on the forehead with and without BH. Beat-by-beat and second-to-second fc, BP, SV, and total peripheral vascular resistance (TPR) were followed by continuous non-invasive monitoring. In all conditions (BH with forehead cooling at 0 degree and 18 degrees C) there was an early rise in BP triggering the first tachycardial response (fc acceleration) which was immediately counteracted by the concurrent further increase of SV leading to the second phase of early bradycardic response (fc deceleration). Furthermore, the continuous beat-by-beat and second-to-second monitoring allowed the documentation of a highly significant increase of TPR within the first few seconds of the manoeuvres. Our data further indicated that the differences in haemodynamics observed during the stimuli at different temperatures was overruled by BH. Detailed comparisons of the beat-by-beat and second-to-second analyses were unable to show that one method was better than the other. Using continuous non-invasive monitoring of haemodynamic variables during simulated diving manoeuvres it was possible to provide better insights into the physiological principles and meaning of the diving reflex in humans.

Adult↗
PubMed2000

Maternal uniparental disomy 7--review and further delineation of the phenotype.

UNLABELLED: Uniparental disomy (UPD) is defined as the inheritance of both homologous chromosomes from only one parent. So far, maternal UPD 7 has been described in 28 cases. Here, we report 4 new cases, present clinical information of 5 cases previously reported by us, and review the clinical and molecular findings of all 32 cases. We found a phenotype characterized by pre- and postnatal growth retardation, occipitofrontal head circumference in the lower normal range, a triangular face, and retarded bone maturation. Findings of the facial gestalt included a high and broad forehead and a pointed chin. A broad mouth with down-turned corners, prominent ears, café-au-lait spots, hemihypotrophy, or clinodactyly were rarely present. Psychomotor development was delayed in 6 cases. The clinical findings strikingly resemble the phenotype of the heterogeneous Silver-Russell syndrome (SRS). Other anomalies were less frequently found than in SRS. Molecular investigations revealed 11 cases with isodisomy and 17 cases with heterodisomy. In 4 cases this information was not available. From the allelic distribution of the microsatellites investigated, 9 cases might be the consequence of an error at maternal meiosis I, and 6 cases might be due to non-disjunction at maternal meiosis II. Three of the 17 heterodisomic cases had trisomy 7 in chorionic villi, in the remaining cases no prenatal diagnosis through chorionic villus sampling was reported. CONCLUSION: Maternal UPD 7 should investigated in children with pre- and postnatal growth retardation anda facial gestalt characterized by a high and broad forehead and a pointed chin, as well as in cofined placental mosaicism for trisomy 7.

Abnormalities, Multiple↗
PubMed1999

Complications associated with transvenous embolisation of cavernous dural arteriovenous fistula.

Results are presented of transvenous embolisation, via either the inferior petrosal sinus (IPS) or the superior ophthalmic vein (SOV), for 19 patients with cavernous dural arteriovenous fistula with special emphasis on complications. In 17 patients (89%) there was complete angiographic elimination of the shunts and resolution of the symptoms. The remaining two patients also improved clinically, regardless of the minimal residual shunts. Complications included forehead dysaesthesia in one patient, blepharoptosis in two, and transient abducens nerve palsy in three. Injury of the supra-orbital nerve and levator muscle occurred in association with the exposure of the SOV in the patient with dysaesthesia of the forehead and in those with blepharoptosis, respectively. In two patients, abducens nerve palsy resulted from coil over-packing in the cavernous sinus and from dissection of the clival dura during guidewire penetration of the thrombosed IPS in one patient. We found that the complication rate decreased with time, because we became better with this procedure. We believe that transvenous embolisation is the best available treatment modality if one pays careful attention to avoid complications related to the procedure.

Aged↗
PubMed2003

[Typical features of craniofacial growth of the FGFR3-associated coronal synostosis syndrome (so-called Muenke craniosynostosis)].

BACKGROUND: The FGFR3-associated coronal synostosis syndrome (Muenke craniosynostosis) is caused by a point mutation (C749G) on the FGFR3 gene resulting in a Pro250Arg substitution. METHODS: To characterize this malformation, the neuro- and viscerocranium were analyzed by axial CT scans of the skull and cephalometric radiographs of up to 13 affected children before and in part after fronto-orbital advancement. RESULTS: Preoperative analysis of the intracranial volume of four patients showed a mean decrease of 3.6%, indicating a compensatory growth pattern of the skull in cases of coronal synostosis. The typical brachycephaly could be verified by the significant shortening of the skull length of 13.2% on average and by the significant reduction of the anterior cranial base length of maximal 5.9% on average. The anterior part of the skull was characterized by a significant mean increase of the intercoronal distance of 8.6%, which indicates a compensatory transversal growth in this malformation. The widened bilateral interorbital and anterior interorbital distances were increased by 7.3 or 9.0%, respectively, confirming a hypertelorism typical for this syndrome. The "frontal bossing" frequently found in brachycephaly was characterized by the preoperatively increased sagittal extension of the forehead (about 112.9% above the norm) and by the increased height of the frontal prominence (about 47.8% above the norm). Following surgery, both variables defining the morphology of the forehead were reduced and appeared to be constant throughout the follow-up. Hypoplasia of the midface described by Muenke et al. (1997) was confirmed in the present study only by the significant reduction of the sagittal length of the maxillary base, which was decreased by 6.8%. CONCLUSION: In accordance with the current literature, the skull configuration described for Muenke craniosynostosis shows similarities with the Saethre-Chotzen syndrome.

Amino Acid Substitution↗
PubMed1999

Distribution of Acinetobacter species on skin of healthy humans.

The distribution of the 19 currently known genospecies of Acinetobacter on human skin, i.e. forehead, forearm and toe webs, was determined. Three selective media were compared for their specificity for all genospecies of Acinetobacter. A minimal-salts agar supplemented with 1% acetate proved to be more efficient than the Leeds medium for the isolation of most genospecies in mixed culture with other bacterial species. Acinetobacter isolates were provisionally identified using biochemical tests and the DNA transformation assay of Juni. Genospecies identification was performed using amplified ribosomal DNA restriction analysis, and duplicate isolates of the same genospecies from individuals were ruled out by random amplified polymorphic DNA analysis. Over 40% of 192 healthy volunteers carried Acinetobacter spp. at one or more body sites, and the frequencies of colonisation were as follows: forearm (51%), forehead (47%) and toe web (34%). Genospecies 8/9 (Acinetobacter lwoffii) was the most common (61%), followed by genospecies 15BJ and 12 (Acinetobacter radioresistens) at 12.5% and 8%, respectively. The Acinetobacter baumannii-Acinetobacter calcoaceticus group (genospecies 1, 2, 3 and 13TU) that predominates in hospital-acquired infections was found in only one individual.

Acinetobacter↗
PubMed2005

Selective reconstructive options for the anterior skull base.

Carcinomas of the ethmoid, frontal, or maxillary sinuses sometimes invade the anterior skull base. It is necessary to perform en-bloc resection for this invasive carcinoma according to the concepts of surgical treatment for head and neck cancer. The anterior skull base consists of two parts, the orbital roof as the lateral portion and the roofs of the frontal sinus, ethmoid sinus, and/or sphenoid sinus as the central portion. Selective reconstructive options for the anterior skull base depend on the size of the defect of the skull base. A dural defect is repaired by a fascia lata or a pericranial flap. After the dura has been tacked up, reconstruction of the anterior skull base is performed simultaneously with augmentation of the defect of extracranial structures. Larger defects that consist of both central and lateral portions with orbitomaxillary structures are reconstructed by a bulky musculocutaneous flap such as a rectus abdominis or latissimus dorsi flap. The bony reconstruction of supraorbital structures is also to be considered esthetically. On the other hand, intraorbital tissues are basically preserved in cases of central defects of the anterior skull base. These defects are reconstructed by a free forearm flap or a local flap such as a de-epithelialized midline forehead flap or a pericranial flap. We have selected and applied these flaps in 37 patients as reconstructive options for the anterior skull base since 1989. Eleven of the 37 patients had larger defects and 26 had central defects. De-epithelialized midline forehead flaps were used in 20 patients and were recognized to be a very useful and reliable reconstructive option for central defects of the anterior skull base.

Child, Preschool↗
PubMed1989

Effect of the venodilated state on sympathetic-induced venoconstriction in normal subjects.

The interaction between venoconstriction induced by application of ice to the forehead and nitroglycerin-induced venodilation was examined in 19 healthy male volunteers, ages 25 +/- 5 years (mean +/- standard deviation). Venous tone was determined by the equilibration technique. Mercury-in-silastic plethysmography was used to measure changes in forearm volume before and after ice application during control conditions, and before and after ice application in the venodilated state (nitroglycerin spray, 0.8 mg). Venous tone and arterial pressure increased significantly after the application of ice to the forehead in both the control and venodilated states, indicating that ice increased sympathetic tone. Nitroglycerin increased venous volume by 0.28 cc/100 cc arm. The venoconstrictive effect of ice after nitroglycerin (a decrease in venous volume of 0.53 cc/100 cc arm) was quantitatively similar to the venoconstrictive effect of ice during control conditions (a decrease in venous volume of 0.54 cc/100 cc arm). These results suggest that sympathetic-induced venoconstriction is not attenuated in the venodilated state.

Adult↗
PubMed1983

Massive craniofacial injury: initial treatment and methods of reconstruction.

A patient with a massive craniofacial injury is presented to illustrate useful flaps that may be used in the reconstruction of this type of injury. Initial management, consisting of basic life support, is indicated, because many patients who appear to be unsalvageable may be successfully restored to an active, productive life. Reconstruction of soft-tissue deficits was accomplished using the forehead and deltopectoral flaps. Although other methods of reconstruction may be used, the forehead and deltopectoral flaps remain among the more reliable flaps to restore thin lining to mucosal and external skin surfaces where bulky tissues are not desired.

Adult↗
PubMed1995

Temperature monitoring during photodynamic therapy of skin tumors with topical 5-aminolevulinic acid application.

Temperature monitoring during photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) cream application was performed on 22 patients with solar keratoses (SK) and basal cell carcinoma (BCC). The lesions were located on the forehead, nose, ear and cheek. Temperature measurements during photoirradiation, with a power density of 100 mW/cm2 from an incoherent light source (light delivery system for PDT), were carried out by noncontact (infrared thermal imaging radiometer) and contact (thermocouple) methods. Thermal imaging analysis revealed nonuniform temperature distribution in the irradiated areas. The temperature gradually increased from the peripheral to the central zone of the area. The results showed that photoirradiation induced heating of the skin tumors to 39.5-42.5 degrees C during the PDT procedure. The temperature of normal skin areas disposed symmetrically to the lesions on the contralateral side at the same conditions of irradiation (without prior ALA application) was about 42-43.5 degrees C. The surface temperature differences (delta T) between the normal and tumor tissues after 10 min of irradiation were 3.3 +/- 0.5 degrees C in the forehead areas, 2.5 +/- 0.4 degrees C in the nose areas and 0.8 +/- 0.3 degrees C in the ear areas.

Aminolevulinic Acid↗
PubMed1990

The cephalocaudal progression of jaundice in newborns in relation to the transfer of bilirubin from plasma to skin.

The cephalocaudal progression of jaundice was studied in 136 mature, clinically well newborns. The yellow colour of the skin was measured with the transcutaneous bilirubinometer. Significant positive correlation was found between the yellow colour of the skin in four regions and the plasma bilirubin concentration (forehead: rho = 0.83, abdomen: rho = 0.89, knee: rho = 0.82, and foot: rho = 0.65, all P less than 0.00001). The values obtained from the forehead were significantly higher than the values obtained from the abdomen (P less than 0.0001), the knee (P less than 0.00001), and the foot (P less than 0.00001). The cephalocaudal progression of jaundice correlated positively with the plasma bilirubin concentration (rho = 0.58, P less than 0.00001) and inversely with the gestational age (rho = -0.28, P less than 0.01). The results support a proposed hypothesis explaining the cephalocaudal progression of jaundice in newborns. According to the hypothesis, the cephalocaudal colour difference may be caused by the presence of young bilirubin-albumin complexes in the blood undergoing conformational changes.

Bilirubin↗
PubMedDate not supplied

Two siblings with partial trisomy 1(q42.3-ter).

Two brothers, aged 6 and 4 years, with an unbalanced chromosome translocation (partial trisomy 1), and their mother, a balanced carrier of the translocation, t(1;3)(q42.3;p26.3), were described. Both patients show minor anomalies; a large head with a prominent forehead, low-set and soaring ears, a high-arched palate, a shallow nasal bridge, hypertelorism, and slender hands and feet. The manifestations in our cases were very mild compared to in the previously reported cases of partial trisomy 1. And our patients exhibit psychomotor retardation and ventricular dilatation on brain CT. We speculated that the amount of extra material reflects the phenotype. Our cases and previous reports indicate that the minimum clinical features of partial trisomy 1 are poor psychomotor development, a prominent forehead, and slender hands and feet. And many cases have macrocephaly with ventricular dilatation or hydrocephalus. So these features may be a key for the diagnosis of very mild partial trisomy 1.

Abnormalities, Multiple↗
PubMed1989

Activation of masked neural determinants in amphibian eggs and embryos and their release from the inducing tissue.

The neural-archencephalic (forehead) inducing activity of the microsomes and the high speed supernatant from Xenopus laevis ovaries and eggs was tested on gastrula ectoderm of Triturus alpestris. Both fractions have a very small inducing activity which increases considerably after autolysis or treatment with dissociating agents. A comparison with the inducing activity of the high speed supernatant from gastrulae suggests that neural inducing factors are synthesized in the ovary, stored in a masked form and activated, in part, during gastrulation. When the supernatant proteins from eggs and gastrulae were subjected to size-exclusion HPLC the neural inducing activity was eluted in different size classes, suggesting a limited proteolysis of a precursor during early embryogenesis. Further experiments have shown that treatment of the blastoporal lip from early Triturus gastrulae with actinomycin D or cycloheximide which inhibit the synthesis of RNA and protein respectively, diminishes the neural-archencephalic (forehead) inducing activity of the blastoporal lip. Treatment with actinomycin D or cycloheximide followed by ethanol, which, besides other structures, impairs the plasma membrane, does, however, not reduce the inducing activity. This may suggest that components which are needed for the transport of the neuralizing factor are diminished, when the synthesis of mRNA and protein is inhibited. Such components are probably needed for the release of the neuralizing factor from the blastoporal lip, the inducer tissue.

Animals↗
PubMed2004

Simultaneous and symmetrical reconstruction of heminose and restoration of nasal airway in congenital absence of heminose.

Congenital absence of heminose is an extremely rare anomaly. Reconstruction of full thickness defects of the nose requires lining, support and cover. Reconstruction of congenital absence of heminose has an additional requirement of reconstruction of the nasal airway. Simultaneous reconstruction of the heminose and internal nasal passage has not been reported earlier. In a case of congenital absence of heminose, reconstruction of the heminose and internal nasal passage was done simultaneously by using expanded forehead tissue and a nasolabial flap. The nasolabial flap is robust and supports the alar margin without any need of cartilage support. The bulk of subcutaneous tissue it carries lies on the outerside of nostril and, therefore, it does not obstruct the nasal opening. This was covered by expanded forehead tissue, which got thinned out due to tissue expansion, thus achieving symmetry with other half of nose. Skin of the nasolabial flap lines nasal passage thereby avoiding the need of splintage of nasal airway which is required if nostril is lined by split skin graft.

Adolescent↗
PubMed2004

Vestibular testing by electrical stimulation in patients with unilateral vestibular deafferentation: galvanic evoked myogenic responses testing versus galvanic body sway testing.

OBJECTIVE: To investigate the agreement of a lesion site as indicated by two different vestibular tests with electrical stimulation, galvanic body sway testing (GBST) and galvanic evoked myogenic responses (galvanic vestibular evoked myogenic potential; galvanic VEMP) testing, in patients with unilateral vestibular deafferentation. METHODS: Nineteen patients with unilateral vestibular deafferentation were studied, and the criteria for patient selection were as follows: (1) absence of a caloric response to ice water on the affected side in a supine position, and (2) absence of VEMP to 95 dBnHL clicks on the affected side. We assessed the postural response of the subjects to long duration galvanic stimulation (1 mA, 5 s) by measuring the lateral displacement at the center of foot pressure with a cathode electrode on the forehead, and an anode electrode on the mastoid (GBST). We also recorded the electromyographic (EMG) activities of the sternocleidomastoid muscle (SCM) to short duration galvanic stimulation (3 mA, 1 ms) (galvanic VEMP) with a cathode electrode on the mastoid, and an anode electrode on the forehead. RESULTS: In 18 of the 19 patients, the lesion site indicated by GBST was identical to that indicated by galvanic VEMP. Fourteen patients had abnormal results in both tests while 4 patients had normal results in both tests. One patient with acoustic neuroma had normal results in GBST but abnormal results in galvanic VEMP. CONCLUSIONS: These results suggest that electrical stimulation in these two tests stimulates the same area of the peripheral vestibular afferent system, although the duration of stimulation was different, and that the estimate of the lesion site indicated by these tests in patients with complete or nearly complete unilateral vestibular damages is reliable. SIGNIFICANCE: These results suggest that short-duration galvanic stimulation as well as long-duration galvanic stimulation stimulates the vestibular system at the same level.

Adult↗
PubMed2006

Trigeminal somatosensory evoked magnetic fields to tactile stimulation.

OBJECTIVE: To characterise the activation of the contra- and ipsilateral primary somatosensory cortex (SI) after tactile stimulation of the face. METHODS: Trigeminal somatosensory evoked magnetic fields (TSEFs) were recorded after tactile stimulation of the lower lip, cheek, chin and forehead in 11 healthy subjects. The responses were determined visually from the waveforms and modelled with equivalent current dipoles (ECDs). RESULTS: Contralateral SI responses were evoked in all subjects after lip stimulation, and in 91% and 64% after right and left cheek, 73% and 82% after chin and 64% and 27% after forehead stimulation. The responses usually showed an early double-peak wave pattern, the underlying sources localising to the SI. In addition, altogether 37 ipsilateral SI responses were evoked in eight subjects. Fourteen of these responses were amenable to ECD modelling and localised to ipsilateral SI. CONCLUSIONS: Tactile stimulation of the lip area reliably activates the contralateral SI in normal subjects, but the success rate for other trigeminal areas is lower. Ipsilateral responses can be present after stimulation of any of the trigeminal branches in normal subjects. SIGNIFICANCE: Recording of TSEFs after tactile stimulation of particularly the lip area provides a non-invasive technique to study the function of the trigeminal nerve.

Adult↗
PubMed2004

Skin reflectance changes in preterm infants with patent ductus arteriosus.

INTRODUCTION: Patent ductus arteriosus (PDA) is a common complication in preterm infants. While two-dimensional echocardiography is the method of choice for diagnosing a PDA, clinical signs are known to be of limited value. STUDY DESIGN: Haemodynamically significant PDA (hs-PDA) was defined as a ductal left-to-right shunt with elevated left atrial/aortic root ratio ( > 1.6:1), a ductal diameter > 2 mm, retrograde diastolic flow exceeding 30% of the anterograde flow and anterograde peak diastolic flow velocity in left pulmonary artery > 50 cm/s. A hs-PDA may affect the cerebral circulation and skin color is known to be related to local perfusion. In this study, we tested the value of a caudal-to-cephalic skin reflectance differential in detecting preterm infants with hs-PDA. The study was blinded and prospective. SUBJECTS: Fifteen infants with a hs-PDA (M: 8, F: 7; gestational age: 28.0 +/- 2.0 weeks, birth weight: 880 +/- 130 g) and 15 gender- and gestational age-matched infants without a haemodynamically significant PDA (M: 8, F: 7; gestational age: 28.2 +/- 2.3 weeks, birth weight: 885 +/- 135 g) participated to the study. OUTCOME MEASURE: Skin reflectance measurements were performed using a reflectance spectrophotometer (CM-2600d/2500d, Minolta, Osaka, Japan). Sole ("postductal" site) to forehead ("preductal" site) skin reflectance ratio (caudal-to-cephalic ratio). RESULTS: hs-PDA infants showed significantly lower forehead light reflectance values on for the whole visible spectrum (p < or = 0.043) with the exception of 580-590 nm (p = 0.058), whereas no statistically significant differences were observed for the sole skin reflectance between the two groups in the examined visible spectrum. Consequently, hs-PDA infants showed a significantly higher caudal to cephalic ratio in the 410-430 nm (p < or = 0.042), 460-530 nm (p < or = 0.027) and 590-700 nm (p < or = 0.011) wavelength ranges. CONCLUSIONS: These findings may provide a previously unrecognised clinical marker for haemodynamically significant PDA in preterm infants, thus predicting those preterm infants who may require intervention for PDA.

Blood Flow Velocity↗
PubMed2005

Subgaleal hematoma in child abuse.

The mother brought her 31/2-year-old son to a paediatric clinic as his forehead was swollen and bluish in appearance. She was unable to give any explanation for this lesion. Clinically it was noted that a very visible and also palpable, doughy swelling was present both in the forehead as well as the hard skull areas. Some hours later, a massive bilateral periocular haematoma appeared. Whilst X-rays were unable to provide any diagnostic help, the sonographic examination of the skull carried out on the same day revealed an extensive subgaleal haematoma. This phenomenon is described in radiological literature as "scalping" and is caused by the use of considerable, blunt violence against the head (shear stresses, e.g. by pulling at the hair). The mother's boyfriend later confessed forceful pulling of the hair.

Child Abuse↗