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Tinea capitis with granuloma formation in the scalp of an adult that was caused by Tr. tonsurans infection is presented. The lack of symptomatic findings emphasizes the occasional difficulty in making a clinical diagnosis of this condition. Moreover, the possibility of beauty parlors being the source of scalp infection in adults, as well as children, must be considered.
Though tumours of the scalp and skull are not very common certain severe and extensive forms are associated frequently with intracranial propagation and therefore their reconstruction represents often a major problem requiring the use of a series of surgical methods. Their treatment requires the use of expanders, local flaps, pedicled cutaneous and musculocutaneous flaps, as well as free flaps. This report deals with 10 patients with localized extensive tumours larger than 120 cm2 within the region of the scalp and skull subjected to various reconstruction procedures. The applied surgical techniques are discussed and attention is devoted also to the involvement of bone in the above mentioned localization as well as to the problems associated with these lesions.
A simple, economic stainless steel wire fetal scalp electrode is described. Its uneventful use over a 5-year period is reported in the light of several reports of complications arising from the application of both clip and spiral electrodes. The performance of 100 electrodes prepared under controlled conditions was analyzed in terms of both the quality of the rate trace produced and of problems experienced during application. Six electrodes were wasted during preliminary handling but of the 94 used in an attempted application to a fetal scalp, 88.3% were considered successful.
A case of cutaneous angiosarcoma occurring in a 51-year-old male renal transplant patient is reported. Multiple violaceous nodules surrounded by poorly demarcated red to purple discoloration were found on his scalp. Immunosuppressants consisting of azathioprine and prednisolone had been administered during the 12-year period since the renal transplantation. We diagnosed the lesion clinically as a cutaneous angiosarcoma and performed a wide surgical excision. The histopathological findings confirmed the diagnosis and showed tumour cells in the peripheral margin. Postoperatively, the patient started immunotherapy with systemic administration of recombinant interleukin-2 (rIL-2), but he refused to continue it because of the acute rejection of the transplanted kidney induced by the rIL-2. Instead he received radiation therapy (total 7000 rad) of the scalp. Although no recurrence was noticed for 15 months after the completion of radiation, he died due to lung metastasis from angiosarcoma. We review the seven cases, including ours, of angiosarcoma after renal transplantation that are reported in detail in the literature.
Reconstruction of forehead and scalp defects are challenging. A thorough understanding of the anatomy and dissection planes of the scalp is essential. The ability to use a variety of techniques allows the facial plastic surgeon to maximize functional and aesthetic results. Techniques such as tissue expansion, free tissue transfer, and flaps used for covering exposed bone are useful adjuncts for optimal results.
The authors present a case report of a traumatic defect of the scalp involving all layers including galea and periost measuring 10 x 14 cm. The surgical repair of the scalp avulsion was obtained in 3 weeks using Continuous Skin Extension procedure with Kirschner pins threaded through the wound margins, held together with elastic bands. Traction forces were modified twice a week in our patient basis. No undermining was necessary. The authors analyse the benefits of this technic and describe the alternative surgical procedure. This technique is easy to handle, cheap, safe, and requires a single surgical step. Furthermore, it quickly allows the patient to proceed with his work.
An interesting case of plasmacytoma of the scalp is described. Extramedullary plasmocytoma of scalp is rarely reported. This patient was treated with external radiotherapy dose of which was 40 Gy/20 fraction. Disease responded very well to radiotherapy.
The authors report an extremely rare case of cranio-facial anomaly, which, to our knowledge has previously been reported only once (1993, Chakraborty and al.). This male infant presented with a giant congenital bone defect of the skull in the vertex region (10 x 20 cm) with no scalp deficiency. Minimal turricephaly and moderate telorbitism were associated with minor limb anomalies, but psychometric assessment appeared normal. Non-surgical follow-up was initially decided, but spontaneous reossification was so moderate that skull reconstruction was decided at 28 months of age, because of traumatological risks. A full-size resin cephalic skeletal reconstruction was obtained by 3D computerized tomography utilizing stereolithography techniques. A titanium plate was customized on the resin model for ideal adaptation to the convex skull defect (8 x 16 cm). Surgery was simply performed, consisting of preliminary undermining between the dura mater and scalp, and screwing of the custom titanium plate. The initial follow-up was uneventful.
We report our experience with 42 coverage flaps for tissue loss involving the scalp. Malignant tumors of the scalp were the major cause of tissue loss. Repair modalites and outcome are reported. This series included 23 local flaps, one pediculated regional flap, and 18 free flaps associated with three cranioplasties and four dura mater plasties due to invasion of the subjacent tissues. We discuss therapeutic indications and insist on selection criteria which depend on etiology (localization, form depth), local factors (integrity of the pericranium and subjacent structures) and general factors (age, sex, physical and psychological status, socioprofessional context, patient expectations). In all cases, we opted for tissue repair which offers greater safety with minimum function and esthetic morbidity.
A 69-year-old man had reversible generalized thinning of the scalp hair and normal-appearing scalp skin that proved to be secondary to follicular mucinosis. This case illustrates that when mild degrees of follicular degeneration and inflammation occur in this disorder, physical findings other than alopecia may be absent. In rare instances, follicular mucinosis can occur as a chronic diffuse noncicatricial alopecia.
We describe an infant with aplasia cutis congenita of the scalp complicated by sagittal sinus hemorrhage. The defect was successfully managed by primary closure with scalp flaps. The literature on aplasia cutis congenita is reviewed, including etiology, genetic transmission, associated anomalies, and options for management. The potentially fatal outcome highlights the importance of early surgical coverage of the exposed superior sagittal sinus to avoid life-threatening hemorrhage and other complications.
Considerable ambiguity exists about the generators of the scalp recorded P300, despite a vast body of research employing a diverse range of methodologies. Previous investigations employing source localization techniques have been limited largely to equivalent current dipole models, with most studies identifying medial temporal and/or hippocampal sources, but providing little information about the contribution of other cortical regions to the generation of the scalp recorded P3. Event-related potentials (ERPs) were recorded from 5 subjects using a 124-channel sensor array during the performance of a visuo-verbal Oddball task. Cortically constrained, MRI-guided boundary element modeling was used to identify the cortical generators of this target P3 in individual subjects. Cortical generators of the P3 were localized principally to the intraparietal sulcus (IPS) and surrounding superior parietal lobes (SPL) bilaterally in all subjects, though with some variability across subjects. Two subjects also showed activity in the lingual/inferior occipital gyrus and mid-fusiform gyrus. A group cortical surface was calculated by non-linear warping of each subject's segmented cortex followed by averaging and creation of a group mesh. Source activity identified across the group reflected the individual subject activations in the IPS and SPL bilaterally and in the lingual/inferior occipital gyrus primarily on the left. Activation of IPS and SPL is interpreted to reflect the role of this region in working memory and related attention processes and visuo-motor integration. The activity in left lingual/inferior occipital gyrus is taken to reflect activation of regions associated with modality-specific analysis of visual word forms.
The distribution of source densities (the "Laplacean") of event related potentials (ERPs) over the scalp during a goal-directed task has been derived by a novel method which presents seven samples in a hexagonal array, using an economical computing technique that affords much freedom from artefactual contamination. The task had four phases: waiting for a ball to appear, observing its coordinates and estimating action needed to get it through a goal-mouth, acting and awaiting the outcome, and finally evaluating the outcome as success or failure. Different phases of the task were characterized by significantly different distributions of sources. Failures were distinguished from success to consistent features of the last phase of the ERP. All locations within the reference hexagon (spanning a circle of approximately 12 cm diameter on the scalp) showed the latter features. In control experiments, the effects of response mode and of different cognitive interpretations of the input/output situation were studied. A check showed that with monopolar recording involuntary tongue movements can totally vitiate conclusions in such investigations. The Laplacean derivations proved relatively free of such artefactual contamination.
The scalp topography of somatosensory evoked potentials (SEPs) following stimulation of the median and posterior tibial nerve of 39 patients with Down's syndrome was compared with that of age-matched normal controls using significance probability mapping (SPM). The maximal area of each potential in Down's syndrome was similar to that in normal controls, but the scalp distribution was wider. The amplitudes of all components, except the N45 and P59 potentials of the posterior tibial nerve SEPs, were greater in Down's syndrome, and the t values calculated by SPM were significantly greater. However, the difference of SEP maps between Down's patients and aged controls (over 65 years) was much smaller than that between Down's patients and age-matched controls. Therefore, we conclude that the generator sources and generating mechanisms of SEPs in Down's syndrome are not different from those of normal control, however SEP potentials in Down's syndrome are remarkably enhanced, resulting in a wider distribution, probably due to accelerated aging in Down's patients.
Scalp hair samples were obtained every month for three months after administration from healthy male volunteers who participated in the phase I study of a new antimicrobial fluoroquinolone derivative (Q-35). Hairs were cut into 1 cm long pieces successively from the scalp end. Corresponding pieces of 5 hair strands were dissolved in 1 M NaOH and assessed for Q-35 by HPLC. The drug was detectable in the hairs of all subjects taking either a single (400 mg, n = 6) or repeated oral doses of Q-35 (400 mg/day for 6.5 days, total 2600 mg, n = 6). The hair portions containing the drug were shown in most subjects to move outwards along the hair shafts month by month in proportion to the hair growth rate of about 1 cm/month. Q-35 (600 mg/day) was also given to 6 healthy male volunteers for 6.5 days (total 3900 mg) and hair samples were obtained 1 and 3 months after administration. When Q-35 was analyzed along a single hair shaft, the drug was detectable only in 1-2 consecutive 1 cm long pieces, which were also shown to move outwards along the hair shaft with time. A detailed analysis revealed that the drug was contained only in 2-4 consecutive 2.5 mm long pieces of a single hair collected after 3 months, showing that there was no significant axial diffusion of the drug along the hair shaft with time.(ABSTRACT TRUNCATED AT 250 WORDS)
Among 10 patients with squamous cell carcinoma admitted to our hospital, 5 showed intracranial invasion and 4 died with regrowth of intracranial tumour 9 to 24 months after incomplete extirpation of tumour. We reviewed our experience in the management of advanced scalp carcinoma, from neurosurgical and neuroradiological points of view. Dural invasion failed to be removed completely because of involvement of the middle part of the superior sagittal sinus. Therefore, total resection, facilitated by early detection prior to intracranial invasion, is mandatory for successful treatment of these scalp carcinomas.
Event-related brain potentials to tachistoscopically presented events were recorded from adults 24--36 years of age. Subjects counted the number of target events (P = 0.12) randomly interposed in sequences of background events (either P = 0.88 or P = 0.76). In some sequences, slides bearing the letter A were targets and those bearing the letter B were backgrounds; the reverse was true in the other sequences. Also interposed (P = 0.12) in these sequences of targets and backgrounds were one of two types of non-target events: in some sequences non-targets were slides (termed dims) bearing any one of the letters C to Z and having one-tenth the luminance of the target and background slides, while in the others, they were slides bearing 'novel' patterns, each consisting of a different, quasi-random, unrecognizable color pattern. The scalp amplitude distribution of P3 waves to novels were initially frontal, but, with repeated presentations of novel events, they became parietal. The scalp distributions of P3 waves to targets and dims were both initially parietal and did not change with repeated presentations of target and dim events. P3 amplitudes to targets were unaffected by repeated presentations of target events. However, P3 amplitudes to dims and novels were affected. P3 amplitudes to dims decreased linearly at Fz, Cz and Pz with repetition of dims. P3 amplitudes to novels decreased at Fz and increased at Pz with repetition of novels. An abbreviated analysis of possible effects of sequential event probabilities on P3 amplitudes and latencies to novels, dims and targets was performed and no effects were found. It is suggested that P3 waves may be affected by at least 4 factors: the facility with which events may be categorized by subjects, the importance attached to events (via task instructions, subjective assessment of the contents of events, etc.), a priori category probability, and sequential event structure.
The cochlear microphonic response to continuous pure tones has been recorded in the 'far field' from the scalps of anesthetized cats. Previous methods for scalp recording used tone pip transients only. Our experiments show that the observed wave forms are not due to electrical or mechanoelectrical artifacts. Neural responses such as brain stem responses or the frequency-following response have been excluded as major contributors to the observed wave forms, which are virtually identical to the round window cochlear microphonic response with respect to (1) wave shape with non-sinusoidal stimuli, (2) intensity-amplitude functions, (3) response phase, and (4) amplitude changes due to superimposed band-limited white noise. The methods of ruling out significant artifacts are applicable to non-invasive recordings from humans.