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PubMed1993

Skin surface pH, moisture, and pruritus in haemodialysis patients.

Pruritus is one of the most common complaints of haemodialysed patients. However, its pathogenesis remains unclear. Dryness of the skin and the effects of pH changes on the nerve endings in the skin have been suggested as related factors. In the present study we measured skin pH using a skin pH meter and skin moisture using a corneometer at four different sites in 41 haemodialysis patients, before and after dialysis, and in 40 healthy controls. Thirty patients (73%) complained of pruritus, six severe constant, 12 moderate and 12 mild. Skin surface pH was higher in patients than in controls in the upper back (5.54 +/- 0.14 versus 5.22 +/- 0.08, P < 0.02), forearm (5.5 +/- 0.1 versus 5.13 +/- 0.1, P < 0.01) and forehead (5.35 +/- 0.08 versus 5.04 +/- 0.07, P < 0.004), whereas there was no difference in the axilla. Haemodialysis had no effect on skin pH, and there was no correlation with blood pH, blood bicarbonate and serum electrolytes. There was no correlation between skin surface pH and pruritus. Skin moisture was lower in haemodialysis patients than in controls in the forehead and axilla. There was no correlation with pruritus. Skin surface pH is higher in haemodialysed patients than in healthy controls in most areas of the body, despite the fact that these patients have a decreased blood pH. Thus, the skin pH is not related to systemic acid-base balance. It is possible that the uraemic state affects the ability of the dermal cells to secrete acid, making the skin more susceptible to bacterial and fungal infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Craniofrontonasal dysplasia in two male sibs.

Craniofrontonasal dysplasia (CFND) was diagnosed in a male child who had bilateral coronal craniosynostosis, midline facial clefting with cleft lip and palate, a broad and high forehead, and hypertelorism. The parents were normal and there was no family history suggestive of CFND. A small recurrence risk was counselled and prenatal ultrasound was recommended in the next pregnancy. At 23 weeks, the ultrasound scan detected a number of dysmorphic features and the pregnancy was terminated. Autopsy of the aborted male foetus showed the following features: High arched palate, a sloping forehead, flattened nose and receding chin, multiple joint contractures, particularly of the mid phalangeal joints, elbows and ankles. This report highlights the occurrence of CFND in two male siblings born to normal parents, and therefore the need to perform prenatal ultrasound in a subsequent pregnancy, even if CFND is diagnosed in an isolated case.

Abnormalities, Multiple↗
PubMed1993

[Relative accuracy and precision of two non-invasive thermometry systems].

The relative accuracy and precision of the two non-invasive thermometry systems, FirstTemp (Intelligent Medical Systems, USA), an infrared tympanic thermometer, and CTM-205 (Terumo, Japan), a newly developed deep body thermometry system, were evaluated in 32 patients undergoing various surgeries under general anesthesia using esophageal temperature as the reference value. The "limits of agreement (mean difference +/- 2SD)" of the "core" temperature measured by FirstTemp and esophageal temperature was 0.4 +/- 0.5 degrees C, and was larger (P < 0.01) than those between rectal temperature and esophageal temperature (0.2 +/- 0.7 degrees C), between tympanic membrane temperature and esophageal temperature (-0.1 +/- 0.4 degrees C), and between "forehead deep body temperature" measured by CTM-205 and esophageal temperature (-0.2 +/- 0.7 degrees C). The "limits of agreement" between "forehead deep body temperature" and esophageal temperature did not differ from that between tympanic membrane temperature and esophageal temperature. The repeatability of the measurement by FirstTemp was good; the difference between paired measurement values was 0 +/- 0.2 degrees C (mean +/- 2SD). We conclude that the relative accuracy and precision of the two systems are still not sufficient for monitoring body temperature during general anesthesia.

Aged↗
PubMedDate not supplied

The clinical application of transcutaneous bilirubinometry in full-term Chinese infants.

The pattern of jaundice in Chinese full-term newborns has seldom been explored. This study was to 1) investigate the correlation between transcutaneous bilirubin indices (TcB) and serum bilirubin levels; 2) use TcB to follow the pattern of jaundice in Chinese full-term newborns; and 3) compare the sensitivity and specificity of TcB measured from the forehead (TcB1), and mid-sternum (TcB2) by receiver operating characteristic curves (ROC curves). From April 1 to August 31, 1989, a total of 3217 TcB were obtained from 305 inborn full-term newborns (male 175, female 130) during their first 6 days of life. The correlation between serum bilirubin levels and TcB measured from the forehead (TcB1) and from the mid-sternum (TcB2) was good (r = 0.82 and 0.86 respectively). For formula-fed infants, both TcB1 (16.3 +/- 3.0) and TcB2 (16.6 +/- 2.7) reached peak levels at 78-84 hours of age, while in mixed-fed infants, peak levels were noted at 54-60 and 84-90 hours for TcB1 (17.2 +/- 2.2) and TcB2 (16.6 +/- 2.6) respectively. The incidence of hyperbilirubinemia was 5.9 per cent. There were no differences in peak TcB levels between formula-fed and mixed-fed infants. The ROC curves suggested that TcB2 is better than TcB1 in sensitivity and specificity. It is concluded that TcB is a reliable device for monitoring jaundice in Chinese full-term newborns. Peak level of jaundice occurred at the third to fourth day of age. The incidence of hyperbilirubinemia in Chinese infants has decreased, for reasons which need further investigation.

Bilirubin↗
PubMed1993

[Changes in 3 different kinds of body temperature during CPR for DOA patients].

We monitored 3 different kinds of temperature (the tracheal, forehead deep and rectal) during CPR for 8 DOA patients. The forehead deep temperature rose slowly from room temperature, and gradually reached the tracheal temperature. The rectal temperature, except for 2 cases, almost immediately exhibited a temperature close to the tracheal temperature. In 2 exceptions, the rectal temperature exhibited a much lower value than the other temperature monitors. On the other hand, the tracheal temperature seemed to represent the core temperature in all cases during CPR. In conclusion, the tracheal temperature is useful for the monitoring of the patient's temperature during CPR because it represents the core temperature and endotracheal intubation is essential for CPR.

Adult↗
PubMed1996

Xenogeneic expression of human stem cell factor in transgenic mice mimics codominant c-kit mutations.

Mutations of c-kit, which encodes a transmembrane receptor tyrosine kinase, have been identified in mice by abnormal coat color, anemia, and germ cell defects. Mice heterozygous for mutations of c-kit have a white forehead blaze and a white ventral spot, leading these mutants to be termed dominant White spotting (W). We have previously demonstrated that the membrane-associated isoform of human stem cell factor (hSCF220, the ligand for c-kit) is inefficiently processed in murine stromal cell transfectants. Thus, in murine cell lines analyzed in vitro, hSCF220 transfectants present SCF as a membrane restricted protein in contrast to the murine SCF220 cDNA protein product, which is slowly cleaved and secreted. We show here that transgenic mice expressing the human SCF220 isoform in vivo display a phenotype indistinguishable from some alleles of W. Specifically, hSCF220-expressing transgenic mice display a prominent forehead blaze and a white ventral spot. Generations of doubly heterozygous animals that carry both a mutated c-kit allele and the hSCF220 transgene display a more severe coat color abnormality. This phenotype appears to be due to occupancy of murine c-kit by human SCF and diminished cell surface expression of endogenous murine SCF. Normal signaling events that lead to cell survival or proliferation appear to be disrupted in vivo in these transgenic mice.

Alleles↗
PubMedDate not supplied

[Reconstructive techniques in cutaneous defects of the nasal tip].

Many techniques are used for repairing nasal tip defects. Our own guidelines are reviewed: Small defects often can be closed directly. Lesions of the nasal tip over 0.5 cm in diameter usually require a skin graft or flap. Postauricular, preauricular, and nasolabial full-thickness skin grafts may produce noticeable color or contour differences. The type of local skin flap used depends on defect size: Local rotation-transposition flaps or the nasalis myocutaneous sliding flap described by Rybka are used for defects 2 cm or less in diameter. Rieger and de Marchac frontonasal flaps are used for defects 2-3.5 cm in diameter. Forehead flaps are used for defects of 3.5 cm or more. We prefer Rybka's flap for nasal tip defects less of 2 cm because it has cosmetic advantages: incisions do not deform natural cutaneous crease lines and chronic edema and "dog ears" secondary to rotation-transposition pedicle flaps are avoided. For more extensive defects, we prefer frontonasal or forehead flaps.

Carcinoma↗
PubMed1996

[Lack of ossification of the skull after surgery for craniosynostosis. A study of risk factors apropos of 592 cases].

The Center for Craniofacial Anomalies of Necker-Enfants-Malades Hospital presents a retrospective study of the outcome of 592 patients who were operated for craniosynostosis between 1976 and 1991. The quality of ossification one year after operation is reported with a focus on influencing factors. The lack of ossification rate is 5% (30/592). Three parameters are identified as increasing the risk of poor osseous wound healing: local postoperative infection, forehead advancement especially when accomplished with resorbable osteosynthesis, and brachycephaly. On the contrary, repaired tears of the dura mater do not seem to pose a risk. Seventy five per cent of patients with local infection and 12.4% of forehead advancement presented a lack of ossification which is statistically significant (p < 0.001). Lack of ossification can compromise aesthetic and functional results. Decreasing postoperative infection and stable fixation may help to avoid it.

Child, Preschool↗
PubMed1996

Young children's cardiovascular stress responses predict resting cardiovascular functioning 2 1/2 years later.

BACKGROUND: Since the pathogenesis of coronary heart disease (CHD) has its origins in childhood, researchers have increasingly evaluated CHD risk factors in youth. In this study we examined the hypothesized behavioral risk factor of cardiovascular responsivity as a predictor of very young children's resting cardiovascular functioning 2 1/2 years later. SUBJECTS AND METHODS: During an initial visit to the laboratory, 97 children (30 blacks and 67 whites, 45 boys and 52 girls) aged 6-7 years completed three laboratory stressor tests (forehead cold pressor, postural change, and treadmill exercise). A comprehensive cardiovascular assessment was conducted during the tests. Resting cardiovascular activity (baseline values) was also assessed. Follow-up resting cardiovascular parameters were measured in the laboratory 2 1/2 years later. RESULTS: Cardiovascular stress responses were predictive of cardiovascular follow-up resting levels 2 1/2 years later. Multiple regression was used to evaluate the independent predictive power of stress responses after controlling for traditional risk factors. Follow-up resting systolic blood pressure (SBP) was predicted by the SBP response to postural change and treadmill exercise. Follow-up resting diastolic blood pressure (DBP) was predicted by the DBP response during treadmill exercise, particularly for blacks. The follow-up resting heart rate was predicted by the heart rate response to the forehead cold pressor and treadmill exercise. CONCLUSION: These results show that in very young children, stress responses are predictive of resting cardiovascular functioning 2 1/2 years later. Further developmental and longitudinal investigations will determine whether such responses are predictive of later preclinical manifestations of cardiovascular disease. If so, incorporation of stress testing in a standardized risk identification protocol might aid the design and practice of cardiovascular preventive medicine.

Analysis of Variance↗
PubMedDate not supplied

Coronal suture transplantation to correct fronto-orbital constriction in metopic synostosis.

Surgical correction of non-syndromatic trigonocephaly is generally considered to be ideally performed at the age of 3 to 6 months. Conventional procedures include flattening of the forehead and straightening of the supraorbital bar by multiple osteotomies. Hypotelorbitism is generally not addressed. Long-term follow-up studies have shown that the orbital configuration does not improve spontaneously. Recently, some centres have proposed simultaneous correction of hypotelorbitism by a median widening osteotomy in the supraorbital bar. In our opinion, these procedures are indicated for patients over the age of 2 years, since further transverse growth is restricted by the plates and bone grafts in the glabella region. A procedure is presented by which both the initial and presumably the long-term correction of the transverse constriction in the forehead, glabella and orbital region is safeguarded by midline transplantation of a suitable piece of coronal sutural area.

Constriction, Pathologic↗
PubMedDate not supplied

Facial rejuvenation: a combined conventional and endoscopic assisted lift.

This article describes our personal approach for facial rejuvenation combining conventional and endoscopic procedures. For a forehead lift we use an endoscopic assisted technique. However, for the face and neck we still prefer the conventional lift. Good candidates for subperiosteal endoscopic midface lifts without skin resection are young or middle-age patients with midface ptosis and pronounced nasolabial/nasoyugal folds, without significant skin excess. Ptosis of the temporo-malar or facial area is also a good indication for subcutaneous endoscopic assisted lift. Aesthetic improvement of the forehead is evaluated with objective data of preoperative and postoperative measurements. We find this minimally invasive technique less traumatic and time consuming. It allows a greater range of possibilities for individual needs because it limits the incision and dissection to the required areas and has a higher level of acceptance by the patients. It is also a good complement to a conventional face lift.

Adult↗
PubMed1997

Contribution to the origin of progeny in middle European Habsburgs: skeletal roentgencephalometric analysis of the Habsburgs buried in Prague.

From comparisons of roentgencraniometric findings in the first Habsburgs on the Bohemian throne (1526-1612) reduction of the length of the anterior cranial base is obvious and is also consistent with reduction of the depth of the maxilla. The findings are consistent with the small cranium and skull capacity of these Habsburgs. The maxilla is therefore not retrusive, even in Rudolf II where it is affected by a pathological process. The body of the mandible is not reduced which causes a disproportion due to the short anterior base and the maxilla. The disproportion in Ferdinand I and Maxmilian II is compensated by posterior rotation of the mandible. In Rudolf II the body of the mandible is markedly prolonged, the lower jaw is displaced forward and the finding can be described as true progenia. It is evidenced by the shorter anterior base and maxilla of the emperor. Habsburg progenia is thus evident in Central European Habsburgs only in Rudolf II, probably due to the traits of his mother from the Spanish branch of the Habsburgs. The parameters of the lower jaw of father Maxmilian II and grandfather Ferdinand I, however, do not exclude a certain predisposition to progeny in the Central European Habsburg family. The cranium of the first Habsburg on the Czech throne, Ferdinand I, is typical in the high maxillary portion of the face with a markedly posterior rotation of the mandible and a steep position of the upper and lower incisors. The cranium of his wife Anna Jagellonska, on the other hand, is typical in bimaxillary protrusion. In the son Maxmilian II, as a trait from the maternal side, the face is not prolonged, the incisors procline well and the occlusion is normal. In Rudolf II the face is shorter due to the overclosure of the mandible and the pathological process of the maxilla. Anthropological examination of all three generations of emperors revealed increasing brachycrania, a narrow highly vaulted forehead with a non-indented nasal root, poorly developed supraciliary arches, traces of the obliterated suture on the forehead and poorly developed sexual signs. In Rudolf II we can assume incomprehensible speech, In Maxmilian II a 7 cm long styloid process on the right may have caused neuralgia of the trigeminal and glossopharyngeal nerve.

Anthropometry↗
PubMed1997

[Implant size and soft tissue behavior in different facial areas. An experimental study].

In order to predict augmentation results reliably in facial contour improvement, the thickness of the soft tissue and its deformation was reliably determined in 15 fresh cadavers after subperiostal insertion of self-made silicon implants ranging from 2 to 14 mm in diameter. Direct percutaneous measurements were made on the forehead, dorsum of the nose, malar bone, angle of the mandible, and the chin. Each region was subdivided into three zones. In 50 normal-weight subjects, the thickness of the facial soft tissues was also recorded sonographically with the aforementioned measuring points. The soft-tissue diameters decreased in the following order: malar region (8-14 mm), chin angle of the mandible-forehead dorsum of the nose (1-2 mm). In the malar region, the angle of the mandible and chin, there was a step-wise, significant compression of the soft tissues, which reduced the augmentation effect by up to 20% after subperiostal insertion of implants of up to 8 mm in diameter. Larger implant diameters (10-14 mm) no longer increased the compression effect. The thickness of the facial soft tissues at the implantation site was of decisive importance, since it defines the degree of buffer capacity. Preoperative sonographic measurement of soft-tissue thickness could therefore help to predict the augmentation result better; in the presence of a thick soft-tissue mantle (from 10 mm), we recommend selecting a 20% greater implant thickness in order to equalize the buffer effect and to avoid subcontouring.

Adult↗
PubMed1998

Morphometric study of skin grooves of the head and neck.

The skin surface contains furrows called wrinkles, Langer's lines, and skin grooves that are characteristic ultrastructures of the skin. When a skin incision line is determined, these features should be considered. Many studies have examined skin wrinkles, the number of which increases with age. Langer's lines have also been studied extensively in cadavers. However, these studies may not consistently reflect Langer's lines in living individuals. Most of the studies of skin grooves have examined dermatoglyphics such as fingerprinting, palm printing, and sole printing. Very few studies have examined skin grooves in other areas or quantified their characteristics. The present study analyzed skin grooves of the head and neck in relationship to age, sex, and region. Subjects consisted of 50 nursery school children aged 6 years, 50 college students aged 20 years, and 50 adults aged over 60 years. Impressions were obtained from: 1) forehead, 2) root of the nose, 3) lateral ocular angle, 4) cheek, and 5) neck. The samples were cut into cubes (5.0 x 5.0 x 1.0 mm) and ion-coated with Au-Pdin by a cool sputter coater. Then scanning electron micrographs (x 50) were taken and analyzed by computer morphometry CB-TASPER. Densities of skin grooves and the specific length representing the complexity of grooves per unit area were analyzed using computer morphometry CB-TASPER software. The density of skin grooves differed according to the area, especially among samples taken from the forehead, root of the nose, and the neck. Females had more grooves than males, particularly in the neck region. Skin grooves decreased with age; they appear to change and be absorbed by increasing wrinkles, thus becoming indistinct.

Adult↗
PubMed1998

[Body temperature changes during combined inhalational and epidural anesthesia].

We investigated the effects of combined inhalational and lumbar epidural anesthesia on body temperature in 8 women for long-lasting lower abdominal surgery. Probes for forehead deep temperature and skin-surface temperatures were placed on the forehead, forearm, fingertip and toe tip on patients' arrival at the operating room. Tympanic membrane temperature was also measured. Lumbar epidural block was established with 2% lidocaine 10 ml. Twenty minutes later, general anesthesia was induced and maintained with nitrous oxide-oxygen-isoflurane. Epidural anesthesia was maintained with intermittent dose of 1% mepivacaine. Before the end of surgery, isoflurane concentration was increased from about 0.5% to 2% and was maintained at this level for 20 minutes, after which it was reduced. With the establishment of epidural blockade, toe tip temperature increased and fingertip temperature decreased, while core temperature remained unchanged. After induction of general anesthesia, fingertip temperature increased, while core temperature decreased. The core temperature drop during the anesthetic induction was significantly affected by the increase in toe tip temperature. Before the end of surgery, core temperature remained at a reduced but constant level, while fingertip temperature continued to decrease. With the application of 2% isoflurane, fingertip temperature increased, while core temperature decreased. The core temperature drop was significantly affected by the increase in fingertip temperature. After the reduction of isoflurane concentration, these temperature changes were reversed fully. At the end of surgery, fingertip temperature decreased, while core temperature increased. During mild hypothermia, isoflurane depressed thermoregulatory vasoconstriction dose-dependently until its concentration reached 0.6-0.7%. In conclusion, anesthetics-induced redistribution of body heat significantly affects the core temperature throughout anesthesia. Peripheral hypothermia results in core temperature drop when the redistribution is induced by anesthetics. Thermoregulatory vasoconstriction may not only suppress heat loss but also increase core temperature through centralization of body heat.

Adult↗
PubMedDate not supplied

Successful treatment of disseminated facial verrucae with contact immunotherapy.

Disseminated flat warts are a common therapeutic problem in immunocompromised patients. However, disseminated infection on the face is, even in the immunocompetent host, a challenge. We report on a 14-year-old girl who had suffered from increasing eruptions of multiple disseminated verrucae planae et filiformes of the face for 18 months. As an alternative to silk-touch CO2-laser, contact cryotherapy or systemic immune enhancer we administered topical immunotherapy with diphenylcyclopropenone (DCP). The initial challenge with DCP 2% was performed on the forehead and the challenge was repeated weekly with DCP 0.01%. After four applications, the girl reported peeling of single warts on the forehead but more importantly at distant sites which had not received DCP. After eight weeks the patient's face was free of lesions. So far, the patient has remained free from relapse. This is the first case report of successful topical immunotherapy with DCP in disseminated facial verrucae planae and should be regarded as an effective therapeutic tool in this indication, emphasizing the great advantage of prevention of scarring of the skin induced by other therapeutic modalities.

Administration, Topical↗
PubMed1998

Quantifying air-conducted acoustic radiation from the bone-conduction vibrator.

Sound pressure levels in the external auditory canals of 50 subjects were measured at 2000 and 4000 Hz with a bone-conduction vibrator on the forehead, the mastoid ipsilateral to the probe microphone, and the mastoid contralateral to the probe microphone. A plug was placed in the external auditory canal to minimize sound pressure levels in the external auditory canal produced by the osseotympanic mode of bone conduction. Results suggest that clinically significant false air-bone gaps (greater than 10 dB) due to acoustic radiation into the concha from the bone-conduction vibrator are most likely to occur at 4000 Hz when the bone-conduction vibrator is placed on the mastoid of the test ear. To minimize the possible confounding effects of acoustic radiation, the bone-conduction vibrator may be placed on the forehead or the mastoid contralateral to the test ear while masking the nontest ear.

Acoustics↗
PubMedDate not supplied

Evaluation of pericranial skull adherence during healing in the rabbit model.

BACKGROUND: The endoscopic brow-lift is a popular technique for rejuvenation of the aging brow and forehead. Long-lasting results depend on readherence of the pericranium to the underlying skull in the newly elevated position. Determination of the time required for pericranial readherence to occur is important when considering optimal brow fixation time postoperatively; however, few studies of pericranial healing exist in the literature. OBJECTIVE: To quantify the time required for pericranial adherence after pericranial elevation in a rabbit model. DESIGN: Anesthetized New Zealand white rabbits underwent elevation of a pericranial flap on day 0. The flap was then repositioned and the skin sutured. One unoperated-on group served as a control. A tensiometer was used to measure the force required to separate the pericranial flap from the skull of the control animals and of test animals killed on postoperative days 3, 5, 8, 10, 13, 17, 20, 25, and 28. Statistical analysis was performed to determine the effect of healing time on the strength of pericranial readherence. RESULTS: There was a statistically significant decrease in the force required for pericranial separation at 3 and 5 days after surgery compared with the control group. By 8 days postoperatively and throughout the subsequent times examined, no statistically significant differences from the control group were observed. CONCLUSION: In this rabbit model, pericranial adherence (as measured by tensile strength) is decreased postoperatively and does not return to baseline levels until postoperative day 8.

Animals↗