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PubMed1994

Rewarming and sweating during cardiopulmonary bypass.

The hypothesis was tested that facial sweating at the end of cardiopulmonary bypass (CPB) is a thermoregulatory phenomenon. Twenty-two patients undergoing cardiac surgery with fentanyl anesthesia were studied. Nasopharyngeal temperature, nasal skin temperature, rectal temperature, and mean skin temperature were monitored for 90 minutes after the start of rewarming on CPB. Calf-toe and forehead-nose skin temperature gradients were followed as a measure of peripheral and facial thermoregulatory vasoactive responses. Facial sweating was defined as grade 1 (noticeable) or grade 2 (obvious droplets). Fourteen patients (64%) sweated during rewarming at the end of CPB. In 11 cases the onset of sweating was preceded by a dramatic increase in nasal skin temperature (mean +/- SEM, 4.6 +/- 0.3 degrees C in 5 min), suggesting facial vasodilation. The maximum rate of increase (degree C/5 min) in nasal skin temperature was significantly greater in patients who sweated than in those who did not, 4.1 +/- 0.4 degrees C versus 2.6 +/- 0.3 degrees C (P < 0.015). There was no difference in the age, weight, or BSA between patients who sweated during CPB and those who did not. The nasopharyngeal temperature threshold for the onset of sweating was not elevated (grade 1, 36.4 +/- 0.5 degrees C; grade 2, 37.6 +/- 0.4 degrees C), but there was a 5 to 6 degrees C interpatient variation. It was concluded that facial sweating during rewarming on CPB is typical of a thermoregulatory response. Absence of sweating in one third of patients may be due to pharmacokinetic or pharmacodynamic differences in the response to anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

The fate of an amputated nose after replantation.

Traumatic amputation of the nose is a challenging management problem. We describe the case of a 69-year-old woman who had a dog-bite nasal amputation. The avulsed piece, including the lobule, and approximately half of the columella and alae, was replanted within 2 hours of the trauma. Hyperbaric oxygen therapy was administered for 12 daily sessions. Skin gradually necrosed, and the eschar was tangentially excised. Almost all of the mucosa and of the cartilage layers survived and the final defect was smaller than the original. A 3-stage repair was performed by a paramedian forehead flap to replace cover. Lining was by approximation of native tissues, whereas framework was reinforced by conchal and septal cartilage grafts. The outcome was functionally and aesthetically satisfactory. Our case confirms that replantation of an amputated nose as a composite graft is worthwhile. Although the skin necrosed and required reconstruction, most of the lining and of the cartilage support survived, greatly improving the ease of reconstruction, as well as nasal function.

Aged↗

PubMed2005

Interpolation flaps.

Interpolation flaps provide an excellent method for reconstruction of large or deep defects where adjacent local tissue cannot supply sufficient donor tissue for repair. These flaps use tissue imported from nonadjacent sites with an inherent blood supply (vascular pedicle) to support the flap while attached to the recipient defect until neovascularization has been ensured between the flap and recipient bed. Hence, they can supply the thickness or bulk needed for large or deep defects and can survive on exposed bone or cartilage. The main disadvantage of these flaps is that they require two stages to complete because the delayed second stage releases the pedicle after inosculation and neovascularization render the tissue independent of the pedicle. This article describes three major interpolation flaps useful in repair of the nose and ear. The forehead, melolabial, and postauricular interpolation flaps are excellent methods that will add to the dermatologic surgeon's reconstructive armamentarium for the repair of large or deep defects.

Ear, External↗

PubMed2004

Beta-lactam antibiotic-induced pseudoporphyria.

A case of beta-lactam antibiotic-induced pseudoporphyria is presented. A 24-year-old African American woman with systemic lupus erythematosus and end-stage renal disease on hemodialysis developed tense bullae on her forehead and cheeks after exposure to ampicillin-sulbactam and cefepime. Histologically, the lesions were similar to porphyria cutanea tarda, but without the associated porphyrin abnormalities. The lesions resolved spontaneously on cessation of the antibiotics.

Abdominal Abscess↗

PubMed2007

Keratosis lichenoides chronica in pediatric patients: a different disease?

Keratosis lichenoides chronica (KLC) is a rare acquired disease of adulthood, of unknown etiology, characterized by keratotic parallel linear lesions, retiform plaques, and keratotic, often follicular papules, chronicity and lichenoid histopathologic features. KLC of pediatric onset is considered extremely rare. Its features and relationship to adult onset KLC are unknown. We studied 8 cases of pediatric-onset KLC in the literature and 6 personal cases and compared them with 40 reported adult-onset KLC patients. The following features characterize pediatric-onset KLC: familial occurrence; probable autosomal recessive inheritance; early or congenital onset with facial erythemato-purpuric macules; forehead, eyebrow, and eyelash alopecia; pruritus; and a low frequency of other cutaneous and systemic abnormalities. Pediatric-onset KLC may represent a different disease or a subset of adult-onset KLC, with special genetic and clinical characteristics. Determining its precise nosology will have prognostic and therapeutic implications.

Adolescent↗

PubMed2006

Analysis of RNA recovery and gene expression in the epidermis using non-invasive tape stripping.

BACKGROUND: The recovery of RNA from the upper epidermis by tape stripping yields variable RNA mass but has not been evaluated for its dependence on anatomical location. Gene expression at different body locations and the origin of RNA recovered by tape stripping have not been investigated. OBJECTIVES: To characterize the recovery of RNA from different anatomical locations by tape stripping; to correlate the recovery of RNA and removal of barrier by tape stripping, as assayed by transepidermal water loss; and to investigate gene expression in the upper epidermis at different body locations. METHODS: Twelve subjects were tape stripped at 15 body locations. RNA mass was evaluated and gene expression assayed. Subjects were tape stripped 4, 8 and 12 times on the upper back and transepidermal water loss and RNA recovery assayed. RESULTS: Ranked by median RNA recovery, the following order was observed: mastoid>forehead>chest>upper back>mid back>cheek>lower back>deltoid>forearm>abdomen>ventral thigh>inner arm>shin>dorsal thigh>lower leg. Expression of the housekeeping gene mRNAs is found to be uniform and reproducible while IL-8 and TNFalpha mRNAs are expressed in different quantities both at different body sites within an individual and between individuals at a specific anatomical site. Data show a significant and high correlation between the number of tapes used to strip a site and transepidermal water loss but no strong correlation between transepidermal water loss and RNA recovery or number of tapes used to strip a site and RNA recovery. CONCLUSIONS: Subjects and anatomical location are shown to be significantly different for the ability to recover RNA by tape stripping. We hypothesize that RNA recovered by tape strip is not derived from corneocytes but from cells associated with the stratum corneum.

Abdomen↗

PubMed2005

A human experimental capsaicin model for trigeminal sensitization. Gender-specific differences.

Migraine is much more common in women (18%) than in men (6%). Menstrual migraine in female migraineurs also varies from 7 to 19%. The main goals of the present study were (1) to investigate gender specific differences in an experimental capsaicin model of trigeminal sensitization (a proposed mechanism of migraine) and (2) to explore the influence of menstrual cycle phases. Twenty-eight healthy female and male volunteers were studied. Capsaicin (100 microg/0.1 ml) was injected intradermally to the forehead. Pain intensity and distribution together with the visual flare and allodynic area (central sensitization) were assessed for females (during their menstrual and luteal phases) and for males. Pain area significantly changed across the menstrual cycle with 19.2+/-2.0 cm x min at menstrual and 16.4+/-0.9 cm x min at luteal phase (P<0.001). The area was significantly larger in both phases for females compared to males (14.2+/-1.3 cm x min, P<0.0001). Flare area at menstrual phase (69.2+/-4.2 cm(2)) was significantly (P<0.0001) larger than luteal phase (58.6+/-2.1 cm(2)). Females, in both phases, showed larger flare area compared to males (44.9+/-3.6 cm(2), P<0.0001). Area of brush-evoked allodynia was also larger at the menstrual phase compared to the luteal phase (P<0.0001) and males (P<0.0001). A significant difference was found in the capsaicin-evoked pain distribution with a greater response in menstrual phase compared to the luteal phase (P<0.01) and men (P<0.0001). Capsaicin induced trigeminal sensitization and evoked gender specific sensory and vaso-motor responses, with menstruating females generally showing the strongest manifestations. The model may be further applied to explore mechanisms of human trigeminal sensitization.

Capsaicin↗

PubMed2006

Pain related recall predicts future pain report.

It is frequently necessary for patients to undergo multiple painful medical interventions as part of their diagnosis and care. Predictors of future pain report have yet to be established although initial pain level, affect, and memory of the procedure are often implicated. The purpose of this research was to establish a predictive model of future pain reporting using a standardized experimental pain stimulus. Forty-three healthy subjects completed an initial forehead cold pressor task (Session 1) and an identical task nine months later (Session 2). Subjects also provided retrospective pain evaluations six months after Session 1. Hierarchical regression was used to identify predictors of Session 2 maximum pain intensity. Fifty-six percent of the total variance (p < .01) was accounted when Session 1 maximum pain intensity, Session 1 negative affect, and remembered maximum pain intensity were loaded together in the model. Only 1% of the variance was uniquely accounted by Session 1 maximum pain intensity (p = .38) while remembered maximum pain intensity uniquely accounted for 25% of the variance (p < or = .01) and Session 1 negative affect uniquely accounted for 17% of the variance (p < or = .01). An additional 13% of the variance was shared between Session 1 maximum pain intensity and remembered maximum pain intensity. The level of remembered Session 1 pain was significantly exaggerated from the initial pain report (p < or = .05) but not significantly different from the level of pain reported at Session 2. These findings provide strong evidence for a post-pain modulation phenomenon in which cognitive processes influence both pain recall and future pain reporting.

Adult↗

PubMed2006

Effects of subcutaneous administration of glutamate on pain, sensitization and vasomotor responses in healthy men and women.

The present study aimed to investigate if (1) subcutaneous injection of glutamate induces pain, sensitization and vasomotor responses in humans and (2) if sex differences exist in these responses. Thirty healthy volunteers (men-15 and women-15) were included. Each subject received four subcutaneous injections (0.1ml; glutamate 100, 10, 1mM and isotonic saline 0.9%) into the forehead skin in two sessions separated by one week. Assessments of pain intensity (VAS), quality, distribution; area of pinprick hyperalgesia; pressure pain threshold (PPT) at the injection site; surface skin temperature and local blood flow were performed at predetermined time points. The highest concentration of glutamate evoked the highest pain intensity, the longest duration of pain and the largest pain area under the VAS-time curve (P<0.001) in both men and women, although responses in women were larger than in men (P<0.05). The face-chart pain area was the largest for the highest concentration of glutamate (P<0.001) and women drew a larger pain area than men (P=0.024). The area of pinprick hyperalgesia was the largest for glutamate 100mM (P<0.001) and women indicated a larger area than men (P<0.001). Concentration-dependent local vasomotor responses were found following the subcutaneous injection of glutamate but there was no sex difference in this effect. Glutamate 100mM significantly reduced the PPT values (P<0.001) without sex-related differences. The present study demonstrates for the first time that subcutaneous injection of glutamate evokes pain, vasomotor responses and pinprick hyperalgesia in human volunteers and that there are sex-related differences in some of these responses.

Adult↗

PubMed1980

Metastases from nasopharyngeal carcinoma in an unusual site.

Eight patients with distant metastases from nasopharyngeal carcinoma are presented. In four the first evidence of distant metastases and generalised disease was a deposit in the soft tissue of the forehead. In seven of the eight cases the primary tumour at presentation had been a locally advanced tumour involving bone or cervical lymph nodes, either bilateral or fixed. Seven of the eight patients were under 25 years of age at the time of presentation. The distribution of metastatic carcinoma of the nasopharynx in some other recorded series is discussed.

Adolescent↗

PubMedDate not supplied

Really painful double vision.

A 67-year-old woman with a history of chronic headache and recent removal of two squamous cell lesions from her forehead presented with left facial pain and diplopia. A diagnosis of Tolosa-Hunt syndrome was made based on clinical presentation and imaging studies. When the patient did not respond to steroids, further studies were done, including biopsy, which revealed perineural spread of squamous cell carcinoma.

Aged↗

PubMedDate not supplied

[Multinucleate cells angiohistiocytoma].

INTRODUCTION: Multinucleate cell angiohistiocytoma is a rare entity. We report two unusual cases of this lesion. CASE REPORT: A 39 year-old man had presented since two years an arciform papular eruption of the forehead. A 40 year-old woman had a disseminated maculo-papular eruption since three years. Histological examination of skin samples of the two patients showed a dermal small vessel proliferation, associated with multinucleate cells, and confirmed the diagnosis of multinucleate cell angiohistiocytoma. DISCUSSION: Our cases, typical histologically, have unusual clinical presentation (first case observed in a man, and the second in a disseminated form). Multinucleate cell angiohistiocytoma is a rare benign vascular proliferation individualized in 1985. Clinically, the lesion consists in small circumscribed papules. Acral sites and notably of the dorsum of the hands are the more frequent topography. It generally occurs in women aged over 50 years. Histologically, there is a dermal proliferation of capillaries and venules, and a fibrosis associated with the interstitial mononucleate cells and multinucleate cells.

Adult↗

PubMed1996

The use of botulinum A toxin to ameliorate facial kinetic frown lines.

PURPOSE: External photography and subjective response were used to evaluate the use of botulinum A toxin to diminish glabellar kinetic folds. METHODS: Eleven patients with glabellar folds and midline forehead wrinkling received one to four injections of 0.1 ml of 100 U/1 ml botulinum A toxin. The injections were given into the procerus or corrugator muscles or both. The number of injections corresponded to the wrinkle lines in each patient. The patients were examined and photographed just before the injections and at 7 to 10 days after the injections. Treatment efficacy was judged by photographic evaluation and by the patient's subjective evaluation of the effect of the treatment. RESULTS: Photographic evaluation showed objective improvement in the glabellar wrinkling in 6 of 11 patients in relaxed facial position and in all 11 patients during contraction of the periocular mulscles. Ten of the 11 patients reported satisfaction with their cosmetic results and indicated that they would choose to have the procedure done again. CONCLUSIONS: The results of this study suggest that botulinum A toxin is a safe and effective treatment for glabellar folds.

Adult↗

PubMed2003

Ocular and cutaneous squamous cell carcinoma in an African American man with epidermodysplasia verruciformis resulting in blindness and death.

Epidermodysplasia verruciformis (EV) is a hereditary disease that has served as a model for viral-induced carcinogenesis. Patients with EV have an increased susceptibility to infection with human papillomavirus, which results in the development of benign lesions in childhood. The lesions may resemble tinea versicolor in appearance and distribution, and usually remain benign. However, later in life cutaneous squamous cell carcinoma may develop on sun-exposed areas, such as the forehead. Radiation therapy may not only result in the malignant conversion of EV lesions, but may also increase the risk of metastases. To our knowledge, this is the first report of a patient with EV in whom squamous cell carcinoma of the conjunctiva developed. His clinical course was complicated by ocular invasion causing blindness, metastasis, and eventually death.

Blindness↗

PubMed1982

Eruptive vellus hair cysts--a facial variant.

A 29-year-old man and a 29-year-old woman developed over fifty asymptomatic, slate-colored macules disseminated mainly on the forehead. Histologic study revealed keratinous cysts in the dermis, lined by a few layers of epithelial cells with rudimentary hair bulb-like structures. The cysts' contents were vellus hair fragments and laminated horny material. Ultrastructural studies of the second case disclosed that the keratinization of the cyst wall was similar to that of the infundibular portion of the outer root sheath. It is suggested that our two cases are a type of follicular hamartoma. Similar follicular hamartomas, eruptive vellus hair cysts have been reported previously. The cysts were located in the chest and/or extremities and had a tendency to be eliminated transepidermally. Although these clinical features were different from ours, the characteristic histologic features were the same; therefore, our cases might be a variant of eruptive vellus hair cysts.

Adult↗

PubMed1984

Osteomyelitis complicating Mohs' chemosurgery.

We report a case of osteomyelitis complicating Mohs' surgery for recurrent basal cell carcinoma of the forehead. The need for immediate versus delayed repair after this type of surgery is discussed. It is evident that open, bone-exposed defects allowed to heal by secondary intention require meticulous wound care and follow-up.

Basal Cell Carcinoma↗

PubMed1999

Anetoderma of prematurity in association with electrocardiographic electrodes.

Anetoderma in premature infants is an uncommon lesion that may be associated with the use of various types of monitoring leads. In 2 infants multiple papules of anetoderma occurred on the forehead in association with the use of gel electrocardiographic electrodes. It is postulated that the cause of these papules was a local hypoxemia caused by pressure from the electrodes. Growth-restricted infants may be particularly predisposed to iatrogenic anetoderma.

Biopsy, Needle↗

PubMed1997

Cartilage viability with interpolated skin flaps: an experimental study.

Although composite cartilage grafts are often used in conjunction with a midline forehead flap to repair full-thickness nasal defects, the timing of pedicle division, which optimizes cartilage viability, has yet to be determined. A rabbit animal model was designed to investigate this question. The skin flap pedicle was divided at 0 days, 4 days, 3 weeks, 6 weeks, and 10 weeks in each of five groups of five animals. Although early pedicle division led to partial skin flap necrosis, the cartilage grafts tolerated this ischemic period better. Cartilage viability was approximately 70% and did not differ significantly between the five groups. It is concluded that a larger composite graft and better definition of the skin flap's critical period are needed to determine optimum timing for pedicle division in this animal model.

Analysis of Variance↗