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P300: the similarities and differences in the scalp distribution of visual and auditory modality.

PURPOSE: To examine the topographic relationship of P3(00) between the visual and auditory modalities, especially to examine whether there are any modality-specific hemispheric differences of P3 in normal adults. METHODS: The P3s were recorded from the same 41 normal right-handed males between the ages of 20 and 33 in both a typical auditory oddball task and a visual oddball paradigm with novel stimuli, with an extensive set of 61 scalp electrodes. In addition to the visual comparison and quantitative assessment of current source density (CSD) maps between the two modalities, canonical correlation analyses on the P3 raw amplitudes and examination of interaction effects of modality x location on both raw and normalized P3 data were performed. RESULTS: The canonical correlation between modalities was generally high, especially at the left parietal brain region. There were no significant hemispheric effects in anterior brain but significant left-greater-than-right hemispheric effects in posterior brain regions in both modalities; modality-specific hemispheric effect was observed only at the parietal region. Strong surface current density activities were observed in the midline parietal-occipital area, and left and right boundary areas of temporal and inferior frontal region. CONCLUSIONS: The topographic similarities between P3s recorded in the visual and auditory modality outnumber the differences. Combining data from CSD assessments and profile analysis of P3 topography support the hypothesis of multiple generators of P3 that are differentially active in processing stimuli from different sensory modalities and are not symmetrically distributed between the two hemispheres.

Acoustic Stimulation↗

Monophasic sarcomatoid carcinoma of the scalp: a case mimicking inflammatory myofibroblastic tumor and a review of cutaneous spindle cell tumors with myofibroblastic differentiation.

BACKGROUND: The evaluation of malignant cutaneous spindle cell tumors is challenged by a diagnostic differential that comprises neoplasms of diverse histogenesis, and a broad immunohistochemical panel may confound the diagnosis when the results suggest multiple lines of differentiation, such as with a combined myofibroblastic and epithelial phenotype. METHODS: We report the case of a solitary scalp nodule that quickly became locally metastatic. A comprehensive panel of immunohistochemistry markers and electron microscopy was evaluated to determine the differentiation of the spindle cells. RESULTS: The tumor, consisting of wavy and slender spindle cells with predominantly bland nuclei, showed immunoreactivity to vimentin, smooth muscle actin, and muscle-specific actin. AE1/AE3, CK5/6, and MNF-116 antibodies were weakly positive in rare cells. However, 34betaE12 showed diffuse positivity in the spindle cell population, thus supporting the diagnosis of a sarcomatoid carcinoma with myofibroblastic differentiation. CONCLUSIONS: The use of 34betaE12 is essential for the evaluation of myofibroblastic spindle cell tumors with rare cytokeratin reactivity. However, even with immunohistochemical and electron microscopic studies, the diagnosis of spindle cell tumors can be confounded by the multiplicity of nosologic equivalents, such as carcinosarcoma, spindle cell carcinoma, and metaplastic carcinoma. The nomenclature of these spindle cell tumors is discussed.

Actin Cytoskeleton↗

Oestrogen receptor beta is the predominant oestrogen receptor in human scalp skin.

Oestrogens play a major role in non-classic target tissues in both sexes, yet there have been few studies on estrogens and skin. Recently a second oestrogen receptor (ERbeta) has been discovered. Therefore, we have compared the expression of oestrogen receptor alpha (ERalpha), beta (ERbeta), the androgen receptor (AR) and a cell proliferation marker in male and female non-balding scalp skin. ERbeta was the major steroid receptor expressed in human skin. It was highly expressed in epidermis, blood vessels and dermal fibroblasts, in contrast to ERalpha and AR. In the hair follicle, ERbeta expression was localized to nuclei of outer root sheath, epithelial matrix and dermal papilla cells, in contrast to ERalpha, and the AR, which was only expressed in dermal papilla cells. Serial sections also showed strong nuclear expression of ERbeta in the cells of the bulge, while neither ERalpha nor AR was expressed. In the sebaceous gland, ERbeta was expressed in both basal and partially differentiated sebocytes. ERalpha exhibited a similar pattern of expression, while the AR was expressed in the basal and very early differentiated sebocytes. There was no obvious difference in the expression of either oestrogen receptor in male or female skin. The wide distribution of ERbeta in human skin suggests that oestrogens may play an important role in the maintenance of skin and in the regulation of the pilosebaceous unit, and provides further evidence for oestrogen action in non-classic target tissues. The differential expression of ERalpha, ERbeta and AR in human skin suggests that the mechanisms by which steroid hormones mediate their effects may be more complex than previously thought.

Aged↗

Measuring reversal of hair miniaturization in androgenetic alopecia by follicular counts in horizontal sections of serial scalp biopsies: results of finasteride 1 mg treatment of men and postmenopausal women.

Hair regrowth was evaluated by histologic analysis in men and women treated for androgenetic alopecia, by counting follicles in horizontal sections of scalp biopsies. Serial 4mm punch biopsies were taken at baseline and after 12mo of treatment from the transitional area of hair thinning between normal hair and vertex balding in men, and in an area of frontal/parietal thinning in women. Horizontal sections of reticular and papillary dermis were read by one observer, blinded to patient, treatment, and time. All terminal hair bulbs, terminal anagen and telogen hairs, and vellus and vellus-like miniaturized hairs were counted. Twenty-six men aged 18-41y, comprising 14 on finasteride 1 mg daily and 12 on placebo, and 94 postmenopausal women, aged 41-60y, comprising 44 on finasteride 1 mg daily and 50 on placebo, were evaluated. In the male study, the terminal hairs increased from a mean baseline count of 15.5-20.9 after 12mo of finasteride, versus 17.3-18.3 in the placebo patients. The miniaturized hairs decreased from 26.7 to 23.6 with finasteride versus 21.3-20.3 with placebo. The terminal-to-vellus ratio increased more in the finasteride than in the placebo patients, suggesting some reversal of the miniaturization process with finasteride. In the female study, no significant differences in follicular counts were found between the finasteride and placebo groups after 12mo of treatment. Follicular counts in horizontal sections provide an informative adjunct to noninvasive measures used in hair growth studies. Finasteride appears to be capable of reversing hair miniaturization in androgenetic alopecia in young to middle-aged men, but not in postmenopausal women.

5-alpha Reductase Inhibitors↗

Processing of facial emotional expression: spatio-temporal data as assessed by scalp event-related potentials.

Event-related potentials (ERPs) were recorded in 10 adult volunteers, who were asked to view pictures of faces with different emotional expressions, i.e. fear, happiness, disgust, surprise and neutral expression [Ekman, P. & Friesen, W.V. (1975). Pictures of Facial Affect. Consulting Psychologist Press, Palo Alto, CA]. ERPs were recorded during two different tasks with the same stimuli. Firstly, subjects were instructed to pay attention to the gender of the faces by counting males or females. Secondly, they had to focus on facial expressions by counting faces who looked surprised. The classical scalp 'face-related potentials', i.e. a vertex-positive potential and a bilateral temporal negativity, were recorded 150 ms after the stimulus onset. Significant differences were found, firstly between late-latency ERPs to emotional faces and to neutral faces, between 250 and 550 ms of latency and, secondly, among the ERPs to the different facial expressions between 550 and 750 ms of latency. These differences appeared only during the expression discrimination task, not during the gender discrimination task. Topographic maps of these differences showed a specific right temporal activity related to each emotional expression, some particularities being observed for each expression. This study provides new data concerning the spatio-temporal features of facial expression processing, particularly a late-latency activity related to specific attention to facial expressions.

Adult↗

The size and form of the medulla of human scalp hair is regulated by the hair cycle and cross-sectional size of the hair shaft.

Hairs were sampled from long-haired Caucasian females, and cross-sectional measurements were performed using a rotating profile method at fixed humidity (100%). The effect of the hair cycle on medullation was investigated by examining medulla size and form along the lengths of anagen and telogen terminal hairs and also from a composite model of the entire medulla, as produced from a full cycle's growth, by amalgamating the results from the anagen and telogen hairs. The effect of hair shaft cross-sectional size on medullation has been investigated by controlling any effect of the hair cycle on terminal hairs and by use of the maximal medulla size in short, fine (vellous) hairs from the same subjects. All terminal hairs were medullated for the majority of their lengths. The presence and size of the medulla, in terminal hairs, was profoundly affected by the hair cycle. It was largest early in anagen, where the medulla minor axis, major axis and cross-sectional area represented about 26%, 23% and 7% of the corresponding whole hair shaft parameters (at 100% humidity). The medulla was virtually absent towards the end of anagen. The shape of the medulla cross-section was less elliptical than that of the whole hair shaft and was close to circular. There was no significant change in medulla shape through anagen. The form of the medulla was also affected by the hair cycle; approximately, it was continuous for the first 50% of anagen, discontinuous for the next 25% and virtually absent or absent for the final 25%. The maximal size of the medulla, as occurred in early anagen, was markedly associated with the cross-sectional size of the whole hair shaft, both within terminal hairs and between all scalp hairs. The medulla was large in terminal hairs and small or absent in very small hairs. The proportion of the whole hair shaft occupied by the medulla increased with increase in hair size and reached a maximum in terminal hairs, in which the medulla minor axis represented about 30% of the whole hair shaft minor axis. Furthermore, this proportion was constant in the terminal hairs and was not related to whole hair shaft size. Such maximal proportional medullation might represent a defining feature of terminal hairs. Variation in size of the medulla is not the cause of the previously reported cycle-dependent change in cross-sectional size of the whole hair shaft of terminal hairs.

Female↗

Angiosarcoma of the scalp: absence of vascular endothelial cadherin in primary and metastatic lesions.

A 73-year-old man with angiosarcoma of the scalp died about 1 year after disease onset, despite systemic and topical administration of recombinant interleukin-2. Histopathology showed typical changes of endothelial cells with very sparse lymphocytic infiltration into the tumour. An autopsy revealed that the primary site penetrated cranial bone and invaded vertically into the subarachnoid space. Multiple metastases to lung, chest wall, vertebrae and ribs were also found. On immunofluorescence staining, the expression of vascular endothelial cadherin, which is present in normal endothelium, was absent from both primary and metastatic sites. This may have promoted local invasion and metastasis.

Aged↗

Dissecting folliculitis of the scalp with marginal keratitis.

We describe a young man with dissecting folliculitis of the scalp, who subsequently developed marginal keratitis. We are unaware of any previous reports of this association. The aetiology of dissecting folliculitis is thought to relate to abnormal follicular occlusion with subsequent suppuration, although an infective process has never been established. Marginal keratitis is postulated, but not proven, to be caused by an enhanced immune response to Staphylococcus aureus antigens. We suggest that a similar abnormal response to infection may be important in these two conditions. This case also highlights ocular complications which may occur in patients with dissecting folliculitis.

Administration, Topical↗

A comparative study between AFM and SEM imaging on human scalp hair.

A comparative study of AFM and SEM imaging of the same area of a human scalp hair has been carried out to determine the similarity and the differences between the two techniques. Sample preparation for SEM analysis requires a metallization step and vacuum exposure, both of which could potentially induce modifications to the surface details. By contrast, AFM is a suitable technique to evaluate any effect resulting from sample manipulation because it can be applied without any specific treatment. AFM analysis demonstrates that sample metallization is responsible for modifications to the surface details of hair, mainly comprising an increase in height of scale steps and of root mean square roughness together with variation in scale profiles. Sample treatments for SEM imaging are in general potentially responsible for surface modifications to the samples involved.

Hair↗

Angiosarcoma of the scalp.

An 82-year-old woman was seen at our Dermatology Department for a plaque on the right parietal scalp that had recently increased in size, and bled. The lesion had been present for 3 months. The patient had a previous diagnosis of chronic bronchitis, noninsulin-dependent diabetes mellitus, and hypertension, but no previous history of cancer. Physical examination revealed a 7 x 10 cm plaque, composed of a central necrotic and bleeding surface, surrounded by small purple-red satellite nodules. A biopsy showed an ill-defined infiltrative intradermal mass with a pattern of hypercellular sheets of large cells alternating with areas of dilated, irregular, blood-filled channels, dissecting the collagen bundles. The endothelial cells lining these channels were plump and pleomorphic, surrounded by other spindle-shaped cells with pleomorphic and atypical nuclei. The diagnosis of angiosarcoma was made, and the patient was sent to an oncology center for further evaluation and treatment, where a computed tomography head scan was taken revealing no erosion of the skull. The patient refused surgery, so radiotherapy was proposed. One month later, she developed lymph node enlargement of the left anterior cervical nodes. A needle aspiration biopsy was consistent with sarcoma. Two weeks later, she was started on palliative radiotherapy: a programmed dose of 4500 cGy was proposed of which she only received 3000 cGy because of treatment withdrawal and loss to follow-up. During this time, she showed partial initial response, but despite treatment the disease relentlessly progressed, with hemorrhage and severe pain being the most striking features.

Aged↗

Ulcerated juvenile xanthogranuloma of the scalp.

A 7-month-old girl presented with a single rapidly enlarging thickly crusted lesion on her frontal scalp. Histology was consistent with a juvenile xanthogranuloma (JXG) with ulceration and surface crust formation. Reports of ulcerating, crusted lesions of JXG are rare and the few reports have been confined to giant forms or those involving mucosal sites. This unusual presentation delayed diagnosis. Our report highlights the great variability in clinical presentation of JXG and is a reminder to consider this diagnosis in the differential of any lesion developing in an infant, particularly on the head, neck and upper trunk.

Child↗

Scalp recorded direct current brain potentials during human sleep.

The direct current (DC) potential recorded from the scalp of awake humans has been considered a reflection of general changes in cortical excitability. This study examined DC potential shifts in humans during a night of continuous sleep. Standard polysomnographic recordings and skin temperature were measured simultaneously. Contrary to expectations, average DC potential level indicated higher negativity during nonrapid eye movement (NREM) sleep than REM sleep and wakefulness. Moreover, a dynamic regulation of the DC potential level was revealed in association with the NREM-REM sleep cycle comprising four successive phases: (i) a steep 'NREM-transition-negative shift' during the initial 10-15 min of the NREM sleep period; (ii) a more subtle 'NREM-positive slope' during the subsequent NREM sleep period; (iii) a steep 'REM-transition-positive shift' starting shortly prior to the REM sleep period, and (iv) a 'REM-negative slope', characterizing the remaining greater part of the REM sleep period. DC potential changes were only weakly related to changes in slow-wave activity (r2 < 0.18). The NREM-negative slope and REM-positive slope could reflect, respectively, gradually increasing and decreasing cortical excitability resulting from widespread changes in the depolarization of apical dendrites. In contrast, the NREM-transition-negative shift and the REM-transition-positive shift may reflect the progression and retrogression, respectively, of a long-lasting hyperpolarization in deeply lying neurons.

Adult↗

Successful treatment of angiosarcoma of the scalp by intralesional cytokine therapy and surface irradiation.

An 88-year-old woman presented to us with angiosarcoma of the scalp that had developed over a 6-month period following previous trauma. Despite explicit information concerning the extremely malignant potential of the tumour the patient refused any surgical intervention. However, she agreed to receive local, intralesional interferon alpha-2b and interleukin-2 therapy. After partial remission of the tumour, the intralesional cytokine injections were combined with surface radiotherapy. This combination therapy led to a 2-year remission of both the tumour and sonographically suspicious cervical lymph nodes. Apart from the typical, moderate side-effects of interferon alpha-2b and interleukin-2 the therapy was well tolerated. In conclusion, in our limited experience intralesional cytokine therapy--alone as well as in combination with surface irradiation--seems to be an alternative therapeutic option for patients who is not a candidate for surgery.

Aged↗

Bacillary angiomatosis of the scalp in a human immunodeficiency virus-negative patient.

Bacillary angiomatosis (BA) is a recently recognized bacterial infectious disease that is mainly seen in patients with the acquired immunodeficiency syndrome. BA has rarely been reported in immunocompetent individuals. A case of BA of the scalp in an immunocompetent patient, who was human immunodeficiency virus seronegative, is reported. The importance of differential diagnosis of this lesion is emphasized.

Aged↗

Multiple agminated superficial arteriovenous haemangioma on the scalp.

We describe a patient with an unusual presentation of multiple arteriovenous haemangioma (AVH) grouped in one area of the scalp. The diagnosis was confirmed by histological, X-ray and ultrasound studies. These lesion represent a rare, benign, acquired vascular hamartomatous formation that arises from the suprapapillary vascular plexus.

Adult↗

Prenatal diagnosis of atypical cystic lesions of the fetal scalp.

Two cases of cystic lesions of the fetal scalp are described. They were initially thought to be meningoceles, but the brain was normal on ultrasound examination and there were no associated abnormalities. In the first case, by 26 weeks' gestation, the original cystic lesion had regressed to a dense tissue mass; in the second case, the cyst remained as a small anechoic mass. Postnatal assessment in the first case revealed a plexiform skin lesion measuring 40 x 15 mm on the left parietal bone. This was mobile and not attached to the underlying structures. The skull showed no obvious defect and a cranial scan was normal. In the second case, an epidermal cyst was diagnosed.

Adult↗

Histologic and cell kinetic studies of hair loss and subsequent recovery process of human scalp hair follicles grafted onto severe combined immunodeficient mice.

To establish a model for studying human scalp hair, individually isolated hair follicles were grafted onto back skin of severe combined immunodeficient mice. Histologic changes and cell kinetics in the hair loss and subsequent recovery process were investigated. In the dystrophic stage (from day 7 to 30), all the hair shafts became dystrophic and were shed. Thickening and corrugation of vitreous membrane, apoptosis, and regression of the lower part were observed in the grafted hair follicles. 5-bromo-2'-deoxy-uridine-labeled cells were not detected in the lower end of the follicles, and keratin 19-positive cells appeared there. At the end of this stage their lower part was maximally retracted, secondary germ remained beneath the bulge, and the vitreous membrane disappeared. In the regeneration stage (from day 30 to 50), the same histologic findings as those at the end of the dystrophic stage were observed. The keratin 19-positive cells in the secondary germ, however, were replaced with keratin 19-negative and 5-bromo-2'-deoxy-uridine-labeled cells. Then, differentiation into an inner root sheath and a hair shaft began, and apoptosis was terminated. In the stable growth stage (from day 40 to at least 150), the grafted follicles were immunohistochemically and light microscopically identical with the normal anagen hair follicles except for the presence of melanin incontinence. These findings suggest that the grafted hair follicles entered into dystrophic catagen, subsequently dystrophic telogen, then returned to normal anagen follicles, and that stem cells or their close progeny in the secondary germ play an important part in the recovery process.

Animals↗