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PubMed2005

Herpes zoster following cryosurgery.

A 56-year-old man developed reactivation of herpes zoster infection on his right forehead after treatment of several solar keratoses with cryosurgery. The rash was blistering and painful. Treatment with oral aciclovir was instituted and the lesions healed within 2 weeks. Known risk factors for reactivation include age and decreased immunity. Previous case reports have indicated trauma may be a risk factor in herpes zoster. We report a case of herpes zoster as a complication of cryosurgery.

Cryosurgery↗
PubMed1994

Desmoplastic malignant melanoma presenting with orbital involvement.

Desmoplastic malignant melanoma (DMM) is a rare variant of spindle cell melanoma. We report a case of DMM on the forehead secondarily involving the orbit. The diagnosis was based on light microscopic features, including prominent peripheral cell nest formation and spindle cell fascicles in densely collagenous stroma. Immunohistochemical studies showed strong uniform staining for S100 antigen throughout the tumour. It was negative for HMB 45, smooth muscle actin, desmin, cytokeratins and Type IV collagen. Electron microscopy showed neither melanosomes nor myelin figures. The clinical and histological characteristics of desmoplastic malignant melanoma, and its differential diagnosis of malignant schwannoma, are discussed. DMM has a poor prognosis, since it tends to invade deeply, recur locally and metastasize readily.

Aged↗
PubMed2005

Near-infrared spectroscopic cerebral oxygenation reading in neonates and infants is associated with central venous oxygen saturation.

BACKGROUND: The aim of the study was to elucidate easily determinable laboratory and vital parameters in clinical practice to explain variability of near-infrared spectroscopic cerebral oxygenation readings in critically ill newborns and infants using the NIRO 300 spectrometer. METHODS: Near-infrared spectroscopy (NIRS) cerebral tissue oxygenation index (cTOI) was measured on the forehead of critically ill neonates and infants with existing arterial and/or central venous access. We recorded patient characteristics and simultaneously determined sedation state, hemodynamic, respiratory and laboratory data, such as arterial blood gas analysis, electrolytes, hemoglobin and arterial lactate concentration, blood glucose and central venous oxygen saturation. Data were compared using linear, multiple and forward stepwise regression analysis (P < 0.05). RESULTS: A total of 155 neonates and infants aged from 0 to 365 days (median 12 days) were studied. cerebral tissue oxygenation index (cTOI) values ranged from 32.1 to 91.0% (60.5 +/- 11.5%). Simple linear regression analysis revealed significant associations between cTOI and arterial oxygen saturation (r = 0.254, P = 0.001), transcutaneously measured arterial oxygen saturation (r = 0.320, P < or = 0.0001), central venous oxygen saturation (r = 0.489, P < 0.0001), arteriovenous oxygen extraction (r = 0.445, P < 0.0001) and presence of a cardiac shunt (r = 0.250, P = 0.024). Multiple regression analysis and forward stepwise regression revealed two independent, significant predictors for cTOI, namely SvO2 (P < 0.0001) and presence or absence of a cardiac shunt (P = 0.003). SvO2 alone explained 23.9% of the variability of cTOI. The addition of the variable 'cardiac shunt' improved the model to 33%. CONCLUSIONS: Based on our study results cerebral tissue oxygenation readings by the NIRO 300 near-infrared spectrometer is influenced by central venous oxygen saturation, which partially explains intersubject variability of NIRS cerebral oxygenation readings.

Blood Gas Analysis↗
PubMed1983

Chiseling of exposed bone to stimulate granulation tissue after Mohs surgery.

Extensive Mohs surgery for carcinomas of the forehead and scalp occasionally requires the removal of periosteum. The exposed bone presents a wound management problem. One method, if healing by secondary intention is a viable option, is to chisel bone to stimulate granulation tissue and promote healing. A case is presented that describes this procedure in an elderly patient.

Aged↗
PubMed1990

The face lift and ancillary procedures.

In this article, face lift, forehead lift, and blepharoplasty procedures are addressed. Special emphasis is made on anatomical and surgical guidelines. Some results and complications of the different procedures are presented.

Eyelids↗
PubMed1995

Freehand technique to harvest partial-thickness skin to repair superficial facial defects.

BACKGROUND: The freehand-scalpel technique to harvest skin for grafting is a forgotten surgical art. Modern facial surgeons prefer to use local skin flaps or Wolfe-type full grafts to repair facial defects. OBJECTIVE: To determine the relative merits and cosmetic results of freehand skin grafts to cover facial defects following Mohs surgery. METHODS: We used the freehand-scalpel technique to harvest skin from the periauricular region of the neck and cheek, and other sites. After a local anesthetic is injected the number 15 or 10 blade is used to harvest skin by sequential tangential incisions. The average dermal thickness was about 1.0 mm. To improve cosmetic appearance, the overall shape and thickness of the graft was contoured during harvesting to fit cosmetic unit or facial line. RESULTS: For more than 5 years we have used the freehand technique to repair superficial facial defects of the nose, ear, scalp, temple, forehead, and other nonhead sites. A total of 65 freehand procedures were performed to repair facial defects. The distribution of the anatomic sites and sizes are presented. The size ranged from less than 1 cm to greater than 5 cm in diameter. Three typical cases are presented to illustrate the gratifying results that can be obtained with this technique. CONCLUSIONS: In selected sites and patients, the freehand graft is a rapid and convenient method of harvesting skin. When harvested from the preauricular cheek and subauricular neck, the graft is a good match to cover sun-exposed defects of the nose and ear. The major advantages of the freehand technique are that: 1) it expands the number of potential donor sites from which to select the most compatible skin to cover facial defects; 2) it allows the surgeon to efficiently configure the graft to the desired shape and depth to conform to the cosmetic unit or defect that is being reconstructed; 3) it does not require a dermatome or other specialized instrument to perform; and 4) it achieves wound repair with good appearance and function. The freehand partial-thickness skin graft has become our preferred method of grafting superficial facial defects.

Ear↗
PubMed1997

Skin resurfacing with the erbium:YAG laser.

BACKGROUND: Recent studies have shown that pulsed char-free carbon dioxide lasers are effective in the treatment of rhytids. However, these lasers produce thermal damage with the potential for prolonged wound healing. OBJECTIVE: In this study, we evaluated the role of the erbium (Er):YAG laser in the treatment of rhytids. This laser, with a wavelength of 2940 nm, produces little thermal damage. METHODS: Twenty patients were treated with the Er:YAG laser. Perioral, periorbital, and forehead rhytids were treated. Pulsed of energy varying between 400 and 800 mJ were used; spot sizes between 2.5 and 5 mm were chosen. Patients were evaluated at 2 days, 1 month, and 2 months for erythema, time of healing, degree of improvement, and pigmentary charges. RESULTS: All 20 patients showed improvement of their rhytids. Reepitheliation occurred between 4 and 10 days. Postoperative of eythema resolved in less than 2 weeks. Clinical improvement occurred between 3 and 8 weeks after laser treatment. CONCLUSION: The Er:YAG laser plays a role in the treatment of superficial rhytids.

Adult↗
PubMed2006

Bindi dermatitis to 'chandan' bindi.

Bindi (meaning dot in Sanskrit) is a mark worn by most Indian women on their forehead for religious and social purposes. Traditionally it was worn by only Hindu women to signify their marital status. Nowadays, it is a huge fashion accessory, being worn in different sizes, shapes, designs and colours. The variety includes sequined designs, motifs dusted with gold and silver powder, studded with beads, or even surrounded by glittering gems. Stick-on and liquid ranges are both equally in demand. We report a case of bindi dermatitis with 'chandan' (sandalwood) bindi. To our knowledge this is the first report of contact allergic dermatitis to 'chandan' (sandalwood) bindi.

Aged↗
PubMed2004

Ultrasonographic subepidermal low-echogenic band, dependence of age and body site.

BACKGROUND/PURPOSE: The presence of an age-dependent subepidermal low-echogenic band (SLEB) is well established at specific body sites. Several studies have also proposed it to be a marker of photoaging, but only few studies have included children in their material, and UVR exposure has predominantly been evaluated as differences between body sites with different UVR exposure. The aim of this study was to further investigate the existence of SLEB and exploring its relation to both age and body site/UVR exposure. METHODS: In all 137 healthy volunteers from 4 to 68 years of age were included. In vivo high-frequency ultrasonography (B-mode, 20 MHz) was obtained from sun-exposed and sun-protected skin in a period with negligible environmental exposure to solar UVR. The SLEB was evaluated both visually and quantitatively. RESULTS: We found a significant correlation between visual scoring of SLEB and dermal echogenicity, which supports the usefulness of SLEB scoring. We found that the grade (existence and development) of SLEB increased significantly with age at both the forehead and at the dorsal aspect of the forearm, where a well-defined SLEB was absent in children and present in over 50% of adults above the age of 40 years. No such age dependence was found either at the buttock or at the shoulder, and remarkably a well-defined SLEB was present in 37% of the adolescents at the buttock. CONCLUSION: These results indicate that the age-related increase in SLEB grade at highly sun-exposed body sites might be attributed to UVR exposure. The presence of SLEB in both the young and at the sun-protected buttock points to a multifactorial etiology, where anatomical differences may play an important role as well as water content. SLEB might not be a very sensitive and specific marker of photoaging.

Adolescent↗
PubMed1990

In-vivo indentation of human skin.

Indentation tests were carried out on the forehead skin of volunteers under loading pressures of 0-5 KPa. The indentation was found to increase asymptomatically with loading pressure. In an attempt to develop a quantitative index for aging of the skin, its response to indentation loading was analyzed in reference to its glycosaminoglycan (GAG) containing ground substance and fibers' network microstructure. An analytic model that considers the skin as an incompressible solid-fluid mixture was developed and utilized to simulate the skin's indentation response. Following parameter fitting, the predicted results are in close agreement with the data. The model can thus serve as a tool for evaluating the effect of changes in the dermis components which accompany aging.

Adult↗
PubMed2002

Ultrasound measurements of overlying soft tissue thickness at four skeletal sites suitable for in vivo x-ray fluorescence.

Due to signal attenuation in overlying soft tissue, development of x-ray fluorescence systems to measure low atomic number elements, such as strontium, in human bone required a search for a skeletal site with thin overlying tissue. This paper reports ultrasound measurements of overlying tissue on 10 subjects, at four anatomical sites. The average tissue thickness at the finger was (2.9+/-0.7) mm. The average tissue thicknesses were (3.6+/-0.7) mm, (4.8+/-2.0) mm, and (8.4+/-1.7) mm at forehead, tibia and heel, respectively. Additionally, both parametric and nonparametric approaches to the relationship between body mass index (BMI) and tissue thickness suggest that there is a significant linear correlation between the subject's BMI and overlying tissue at the finger and heel bone. These correlations might be used as a criterion to perform XRF measurements, however a larger data set is required to address these correlations more clearly.

Adult↗
PubMed1978

Isolation and identification of Peptococcus saccharolyticus from human skin.

Peptococcus saccharolyticus was a numerically important organism on the forehead and the antecubital fossa of the arm of ca. 20% of the subjects studied. It was best detected by prolonged (4- to 7-day) anaerobic incubation on a suitably enriched medium but also appeared in smaller numbers in aerobic primary cultures after 4 to 7 days. Initial screening was based on growth patterns in shake cultures and on the relative amounts of growth on aerobic and anaerobic streak plates. The organism was nonhemolytic and usually catalase positive. It produced acid anaerobically from glucose, fructose, and glycerol, but not from maltose, and did not produce lactic acid from glucose.

Aerobiosis↗
PubMed2004

The direct brow lift: efficacy, complications, and patient satisfaction.

BACKGROUND/AIMS: The direct brow lift operation can be used to treat brow ptosis arising from either involutional changes or facial nerve palsy. The authors reviewed their experience with this operation to establish its efficacy and complication rate in the light of concerns over poor scar cosmesis and forehead paraesthesiae in the postoperative period. METHODS: A retrospective review of patients undergoing direct brow lifting from 1989 to 2002 was conducted, and information gained on patient satisfaction by questionnaire. RESULTS: The direct brow lift operation was found to give a predictable outcome, with high levels of patient satisfaction. With careful wound closure, postoperative scars are rarely cosmetically unacceptable to the patient. Paraesthesiae are a common but well tolerated sequelae. CONCLUSIONS: The direct brow lift was found to be a reliable method for treating brow ptosis arising through involutional change or facial nerve palsy in both men and women. The postoperative scars may be more evident in younger patients so the authors reserve this technique for "rehabilitative" rather than cosmetic brow lifts in patients of middle age and beyond.

Aged↗
PubMed1983

Seborrhoea is not a feature of seborrhoeic dermatitis.

The sebum excretion rate from forehead skin was measured in 44 patients with classic seborrhoeic dermatitis and 200 control subjects. The mean excretion rate was normal in the 29 men with seborrhoeic dermatitis and significantly reduced in the 15 women with the disease. This study showed that seborrhoeic dermatitis is not usually associated with seborrhoea, and therefore "dermatitis of the sebaceous areas" may be a more accurate term.

Adolescent↗
PubMed1977

Pulmonary metastases from basal-cell carcinoma of skin.

Although rodent ulcers are a relatively common malignant condition of the skin, pulmonary metastases arising from them are extremely rare. There have so far been only 29 authenticated reports of this condition. A further case is described of a man who, at the age of 35, developed a rodent ulcer (typical basal-cell carcinoma) on the forehead. Despite local excisions, skin grafting, and radiotherapy, the ulcer continued to recur, although there was no spread to regional lymph nodes. When he was aged 52, he developed widespread bilateral pulmonary lesions and a right pleural effusion. Thoracotomy provided a lung biopsy which showed the typical histological appearance of basal-cell carcinoma. He died aged 54, 19 years after the onset of the rodent ulcer, and necropsy confirmed that the pulmonary lesions were bloodborne metastases of basal-cell carcinoma.

Basal Cell Carcinoma↗
PubMed2000

Measurement of fluid volume shifts during hemodialysis by A-mode ultrasonography.

BACKGROUND: The rate of intercompartmental fluid volume changes during hemodialysis (HD) is a major determinant of dialysis-induced hypotension and lacks direct monitoring. The aim of the study was to evaluate the feasibility of tissue thickness (TT) measurement in monitoring the mobilization of interstitial fluids during HD. METHODS: We studied the intradialytic changes in forehead TT and inferior vena cava diameter (IVCD) in 20 patients. Plasma refilling was calculated from changes in hematocrit (Hct) and ultrafiltration rates. RESULTS: During ultrafiltration of 2,437 +/- 117 ml (mean +/- SEM), Hct increased significantly from 27.9 +/- 0.7 to 30.0 +/- 0.9%. IVCD decreased significantly from 9.7 +/- 0.2 to 6.1 +/- 0.4 mm/m(2). We found a simultaneously pronounced reduction in TT from 4. 46 +/- 0.12 to 3.78 +/- 0.12 mm (> or =15.3%) with a significant correlation to plasma refilling (0.613). CONCLUSION: Volume changes in the peripheral shell tissues during HD can be monitored directly and noninvasively by A-mode ultrasound.

Adult↗
PubMed1999

Linear cutaneous lupus erythematosus in an adult.

We report on a 32-year-old female with a 3-year history of an asymptomatic erythema of the forehead. The lesion had a linear distribution following the lines of Blaschko. Histopathological findings and direct immunofluorescence allowed to establish the diagnosis of cutaneous lupus erythematosus. Treatment with local corticosteroid and antimalarial agents given for 2 months resulted in a complete remission.

Adolescent↗