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Fulltext The efficacy and tolerability of scalp cooling in preventing chemotherapy-induced alopecia in patients with breast cancer receiving anthracycline and taxane-based chemotherapy in an Asian setting

Saad M, Chong FLT, Bustam AZ, Ho GF, Malik RA, Ishak WZW, et al.

Indian J Cancer, 2019 1 4;55(2):157-161.
PMID: 30604728 DOI: 10.4103/ijc.IJC_581_17

BACKGROUND: Scalp cooling has been shown in several studies to be an effective method in preventing chemotherapy-induced alopecia (CIA). Data on the use of scalp cooling in Asian countries are limited, and evidence for its use and efficacy among our patients are not available.
OBJECTIVE: The aim of this study was to assess the effectiveness and tolerability of scalp cooling among breast cancer patients in our study population.
METHODS: Consecutive breast cancer patients receiving FE75C, FE100C, FE100C-D, docetaxel75 or docetaxel, and cyclophosphamide (TC) at our treatment center were recruited and allocated to the treatment (scalp cooling, DigniCapTM system) or control group in this prospective nonrandomized controlled study. The assessment of alopecia was carried out using the World Health Organization grading system and clinical photographs.
RESULTS: Seventy patients were recruited, but only 25 completed the study and were evaluable for analysis. Five of 12 patients (42%) in the scalp cooling group managed to preserve hair. Two of three patients who received FE75C and TC regimens had minimal hair loss. All patients treated with FE100C had severe hair loss. Half of all patients who received scalp cooling throughout chemotherapy rated the treatment as reasonably well tolerated. The most common reason for discontinuing scalp cooling was intolerance to its side effects.
CONCLUSION: Scalp cooling is potentially effective in reducing CIA caused by docetaxel, TC, and FE75C chemotherapy regimen. However, it was not well tolerated by our study population. The dropout rate was high, and this needs to be taken into consideration when pursuing further trials in a similar setting.

Matched MeSH terms: Scalp/blood supply*
Recurrent occipital dermatofibrosarcoma protuberans tackled with wide local excision: A case report and current management

Kho JPY, Ng BHK, John R

Med J Malaysia, 2019 02;74(1):82-84.
PMID: 30846668

Dermatofibrosarcoma protuberans (DFSP) is a slowgrowing, locally invasive tumour of the dermis. It commonly presents in the trunks and proximal extremities but is seen to a lesser extent in the head and neck regions. We present a case report of a recurrent DFSP in a 48-year-old Iban woman at the occipital region. The patient underwent wide local excision and removal of outer table of cranium, dressing followed by split thickness skin graft. Histopathological examination confirmed dermatofibrosarcoma protuberans with clear lateral surgical margins and a deep margin of 0.5mm. She is currently undergoing radiotherapy and is planned for 50Grey 25cycles.

Matched MeSH terms: Scalp/surgery*
Comparison of the effect of scalp block analgesia bupivacaine 0.25% and clonidine 2 μg/kg with bupivacaine 0.25% and dexamethasone 8 mg on cortisol levels and Numeric Rating Scale in craniotomy tumour

Maharani ND, Fuadi A, Halimi RA

Med J Malaysia, 2023 Nov;78(6):808-814.
PMID: 38031225

INTRODUCTION: Craniotomy tumour is brain surgery that can induce a stress response. The stress response can be measured using haemodynamic parameters and plasma cortisol concentration. The stress response that occurs can affect an increase in sympathetic response, such as blood pressure and heart rate, which can lead to an increase in intracranial pressure. Scalp block can reduce the stress response to surgery and post-operative craniotomy tumour pain. The local anaesthetic drug bupivacaine 0.25% is effective in reducing post-operative pain and stress in the form of reducing plasma cortisol levels. The adjuvant addition of clonidine 2 μg/kg or dexamethasone may be beneficial.
MATERIALS AND METHODS: A randomised control clinical trial was conducted at the Central Surgery Installation and Hasan Sadikin General Hospital Bandung and Dr. Mohammad Husein Hospital Palembang from December 2022 to June 2023. A total of 40 participants were divided into two groups using block randomisation. Group I receives bupivacaine 0.25% and clonidine 2 μg/kg, and group II receives bupivacaine 0.25% and dexamethasone 8 mg. The plasma cortisol levels of the patient will be assessed at (T0, T1 and T2). All the patient were intubated under general anesthaesia and received the drug for scalp block based on the group being randomised. Haemodynamic monitoring was carried out.
RESULTS: There was a significant difference in administering bupivacaine 0.25% and clonidine 2μg/kg compared to administering bupivacaine 0.25% and dexamethasone 8 mg/kg as analgesia for scalp block in tumour craniotomy patients on cortisol levels at 12 hours post-operatively (T1) (p=0.048) and 24 hours post-surgery (T2) (p=0.027), while post-intubation cortisol levels (T0) found no significant difference (p=0.756). There is a significant difference in Numeric Rating Scale (NRS) at post-intubation (T0) (p=0.003), 12 hours post-operatively (T1) (p=0.002) and 24 hours post-surgery (T2) (p=0.004), There were no postprocedure scalp block side effects in both groups.
CONCLUSION: The study found that scalp block with 0.25% bupivacaine and 2μg/kg clonidine is more effective in reducing NRS scores and cortisol levels compared bupivacaine 0.25% and dexamethasone 8mg in tumour craniotomy patients.

Matched MeSH terms: Scalp/surgery
Correlation of Arsenic Levels in Smokeless Tobacco Products and Biological Samples of Oral Cancer Patients and Control Consumers

Arain SS, Kazi TG, Afridi HI, Talpur FN, Kazi AG, Brahman KD, et al.

Biol Trace Elem Res, 2015 Dec;168(2):287-95.
PMID: 25975948 DOI: 10.1007/s12011-015-0355-y

It has been extensively reported that chewing of smokeless tobacco (SLT) can lead to cancers of oral cavity. In present study, the relationship between arsenic (As) exposure via chewing/inhaling different SLT products in oral cancer patients have or/not consumed SLT products was studied. The As in different types of SLT products (gutkha, mainpuri, and snuff) and biological (scalp hair and blood) samples of different types of oral cancer patients and controls were analyzed. Both controls and oral cancer patients have same age group (ranged 30-60 years), socio-economic status, localities, and dietary habits. The concentrations of As in SLT products and biological samples were measured by electrothermal atomic absorption spectrophotometer after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked by certified reference materials. The resulted data of present study indicates that the concentration of As was significantly higher in scalp hair and blood samples of oral cancer patients than those of controls (p<0.001). It was also observed that the values of As were two- to threefolds higher in biological samples of controls subjects, consuming SLT products as compared to those have none of these habits (p>0.01). The intake of As via consuming different SLT may have synergistic effects, in addition to other risk factors associated with oral cancer.

Matched MeSH terms: Scalp/drug effects
Fulltext Posterior intraorbital metallic foreign body: a case discussion

Vinodh VP, Sellamuthu P, Harun RH, Zenian MS

Med J Malaysia, 2014 Apr;69(2):89-91.
PMID: 25241819 MyJurnal

Intraorbital foreign body (IOFB) has been a rare phenomenon in the cases of gunshot wounds and always represents a dilemma in medical management. In Sabah, this scenario is becoming common as there is still certain population in the interiors who owns self made guns for hunting. They either present with self inflicted gunshot injuries or after being mistakenly shot while hunting. There are very few articles on this topic especially when it is located posteriorly in the orbit and occurs without visual impairment. This case reports the challenges faced in the management of the patient with a posteriorly located metallic IOFB. The appropriate management of the patient is discussed based on several international literatures. Author describes a 37 years old male farmer, who was referred from a nearby district hospital after he sustained gunshot injuries to his face and scalp. Urgent computed tomography (CT) scan showed that bullet pellets were at the left orbital floor, the left mandible and the left frontal bone. All bullet pellets were located extracranially only without intracranial involvement. Patient clinically does not have any neurologic deficit and without any visual impairment, thus he refused any surgical intervention. As there is no proper guideline in managing such cases, decision was made based on evidences from international literatures. It was concluded that metallic IOFB located in the posterior orbit may be conservatively managed with observation and regular follow-ups as they are well-tolerated and does not cause much impact on visual deterioration unless inflammation, infection, optic neuropathy or functional deficit occurs. This avoids unnecessary surgery and prevents risk of iatrogenic injury to the eye.

Matched MeSH terms: Scalp
The Two-Brains Hypothesis: Towards a guide for brain-brain and brain-machine interfaces

Goodman G, Poznanski RR, Cacha L, Bercovich D

J Integr Neurosci, 2015 Sep;14(3):281-93.
PMID: 26477360 DOI: 10.1142/S0219635215500235

Great advances have been made in signaling information on brain activity in individuals, or passing between an individual and a computer or robot. These include recording of natural activity using implants under the scalp or by external means or the reverse feeding of such data into the brain. In one recent example, noninvasive transcranial magnetic stimulation (TMS) allowed feeding of digitalized information into the central nervous system (CNS). Thus, noninvasive electroencephalography (EEG) recordings of motor signals at the scalp, representing specific motor intention of hand moving in individual humans, were fed as repetitive transcranial magnetic stimulation (rTMS) at a maximum intensity of 2.0[Formula: see text]T through a circular magnetic coil placed flush on each of the heads of subjects present at a different location. The TMS was said to induce an electric current influencing axons of the motor cortex causing the intended hand movement: the first example of the transfer of motor intention and its expression, between the brains of two remote humans. However, to date the mechanisms involved, not least that relating to the participation of magnetic induction, remain unclear. In general, in animal biology, magnetic fields are usually the poor relation of neuronal current: generally "unseen" and if apparent, disregarded or just given a nod. Niels Bohr searched for a biological parallel to complementary phenomena of physics. Pertinently, the two-brains hypothesis (TBH) proposed recently that advanced animals, especially man, have two brains i.e., the animal CNS evolved as two fundamentally different though interdependent, complementary organs: one electro-ionic (tangible, known and accessible), and the other, electromagnetic (intangible and difficult to access) - a stable, structured and functional 3D compendium of variously induced interacting electro-magnetic (EM) fields. Research on the CNS in health and disease progresses including that on brain-brain, brain-computer and brain-robot engineering. As they grow even closer, these disciplines involve their own unique complexities, including direction by the laws of inductive physics. So the novel TBH hypothesis has wide fundamental implications, including those related to TMS. These require rethinking and renewed research engaging the fully complementary equivalence of mutual magnetic and electric field induction in the CNS and, within this context, a new mathematics of the brain to decipher higher cognitive operations not possible with current brain-brain and brain-machine interfaces. Bohr may now rest.

Matched MeSH terms: Scalp
Fetal and maternal lactate increase during active second stage of labour

Nordström L, Achanna S, Naka K, Arulkumaran S

BJOG, 2001 Mar;108(3):263-8.
PMID: 11281466

To determine longitudinally fetal and maternal blood lactate concentrations during the second stage of labour.

Matched MeSH terms: Scalp
Epidemiology and control of human head louse in Malaysia

Sinniah B, Sinniah D, Rajeswari B

Trop Geogr Med, 1983 Dec;35(4):337-42.
PMID: 6670116

A survey of 4.112 primary school children living in and around Kuala Lumpur, Malaysia, revealed that 12.9% of the children were infested with Pediculus humanus capitis. Indians (28.3%) and Malays (18.9%) have a higher prevalence than Chinese (4.6%). The higher prevalence among Indians and Malays correlates well with their lower socio-economic status in the community; long hair also contributes to the higher rates of pediculosis among them. The prevalence rate was found to be related to socio-economic status, length of hair, family size, age, crowding and personal hygiene. Treatment with 0.2% and 0.5% malathion in coconut oil gave cure rates of 93% and 100%. Treatment with gammexane and actellic at 0.5% concentration gave a cure rate of 100% against adults and nymphs of Pediculus humanus capitis.

Matched MeSH terms: Scalp
Pediculosis among rural school children in Kelang, Selangor, Malaysia and their susceptibility to malathion, carbaryl, perigen and kerosene

Sinniah B, Shekhar C, Ramphal L, Senan P

J R Soc Health, 1984 Jun;104(3):114-5, 118.
PMID: 6431096
Matched MeSH terms: Scalp
Mercury in scalp hair of healthy Singapore residents

Foo SC, Ngim CH, Phoon WO, Lee J

Sci Total Environ, 1988 Jun 15;72:113-22.
PMID: 3406725

Two hundred and twenty-five hair samples (150 Chinese, 44 Malays and 31 Indians) from healthy residents not occupationally exposed to mercury were analyzed by cold vapour atomic absorption spectrophotometry to determine their total, inorganic and organic mercury levels. The arithmetic means of total mercury levels in hair were 6.1, 5.2 and 5.4 ppm for the Chinese, Malays and Indians, respectively. Factors contributing to the amount of mercury in hair, including consumption of fish and marine products, use of traditional ethnic medicines, artificial hair waving, age, sex and ethnicity were analyzed. Fish consumption, sex and ethnicity are factors found to contribute significantly (p less than 0.05) to mercury levels in hair.

Matched MeSH terms: Scalp
Fulltext Extensive Forehead Swelling Including the Periorbital Area in a Child: A Rare Manifestation of Acute Lymphoblastic Leukemia

Hanapi MS, Ghani SI, Sonny Teo KS, Wan-Embong WZ, Ariffin N, Wan Hitam WH

Cureus, 2018 Nov 03;10(11):e3539.
PMID: 30648072 DOI: 10.7759/cureus.3539

Acute lymphoblastic leukemia (ALL) manifestations in a child are varied. We report a unique and rare presentation of acute lymphoblastic leukemia in a child who presented with frontal swelling involving bilateral upper lids. A previously healthy one-year-old girl presented with progressively increasing frontal swelling of seven months duration. An examination revealed erythematous, firm, nontender forehead swelling that extended up to the medial part of bilateral upper eye lids. The extraocular muscle movement was normal. The anterior segment and fundus examination were also normal in both eyes. Other systemic examination revealed multiple leukemic cutis on the scalp. The cervical lymph nodes were also palpable with hepatosplenomegaly. A full blood picture (FBP) showed the presence of leucoerythroblastic blood film with 62% blast cells. Flow cytometry and bone marrow aspiration confirmed the diagnosis. Computed tomographic (CT) scan images revealed multiple well-defined hyperdense lesions at the subcutaneous skull with the largest lesion at the anterior glabella. Upon diagnosis, the patient was started on chemotherapy and the swelling resolved after one month post treatment. Extensive forehead swelling is a rare manifestation of acute lymphoblastic leukemia. A high index of suspicion aided with diagnostic investigations could help the doctors arrive at a correct diagnosis and treatment.

Matched MeSH terms: Scalp
The findings of 18F-fluorodeoxyglucose positron emission tomography-computed tomography scan in patients with hidradenitis suppurativa in Malaysia: A multicenter study

Loo CH, Khoo ACH, Tan WC, Khor YH, Tang JJ, Tang MM, et al.

World J Nucl Med, 2020 08 22;20(1):32-37.
PMID: 33850487 DOI: 10.4103/wjnm.WJNM_33_20

Hidradenitis suppurativa (HS) is known to have association with systemic diseases with chronic inflammation such as psoriasis. We aim to describe the concomitant systemic inflammation in patients with HS using 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) scan. This was a case-control study conducted in three tertiary hospitals in Northern Malaysia from January to December 2017, involving HS patients aged 18 years and above. Thirty-two HS patients with age- and sex-matched controls were recruited with a mean age of 31.4 years (range: 18-56). Numerous cutaneous inflammatory foci were detected on FDG-PET/CT scan in clinically unapparent sites (27/32, 84.4%). Approximately 90.6%, 93.8%, and 50.0% of the patients had significantly higher cutaneous uptake over nasal, mandibular, and scalp regions, respectively (P < 0.0001). PET/CT scan did not detect any systemic inflammation unlike those found in psoriasis. Three (9.4%) patients had thyroid nodules with high uptake (maximum standard uptake values ranging from 2.9 to 11.3). Two of them were confirmed to have papillary thyroid carcinoma, while the third patient has inconclusive finding. 18F-FDG PET/CT scan may be useful to map disease burden of HS. Nonlesional inflammatory foci on the skin of the nose, mandibular, and scalp are probably significant. The association of thyroid carcinoma in HS warrants further evaluation.

Matched MeSH terms: Scalp
Fulltext Aggressive scalp and sternal lesion: A presentation of rare case of metastatic eccrine carcinoma

Rownose CS, Mohamad Saupi MS, Sharif SZ, Lah NASN

Ann Med Surg (Lond), 2021 May;65:102322.
PMID: 33996055 DOI: 10.1016/j.amsu.2021.102322

Introduction: Ductal Eccrine carcinoma (DEC) is a rare primary cutaneous tumor that exhibits both squamous and adnexal ductal differentiation. Due to its rarity in clinical practice we present as case of DEC and a literature review on the latest management of this rare disease.
Case presentation: We report a case 41 years old female presented with lesion on the scalp and sternal mass, increasing in size with itchiness and erythematous for 6 months duration. Further CECT scan of brain and neck shows features of malignant left frontal scalp lesion with poor plane with overlying skin and underlying skull bone and CECT of thorax shows a large, irregular heterogeneously enhancing mass with necrotic center noted at right hilar within superior segment of right lower lobe, encasing right middle and lower lobe bronchi. Wedge biopsy of scalp lesion showed an intradermal lesion extensively infiltrating by malignant gland accompanied by desmoplasia and the tumor cells are seen extending into the surgical margins suggestive of ductal eccrine carcinoma.Clinical Discussion:This case highlights the importance and challenges in achieving early diagnosis coupled with the scarcity of information on these leads to difficulty in managing this patient.
Conclusion: In managing Ductal Eccrine Carcinoma tumor, standard method of treatment for has not been established. However, wide surgical excision is the treatment of choice for localized lesions. Regarding prognosis, there is conflicting data published which we describe in this article.

Matched MeSH terms: Scalp
Fulltext Scalp Haematoma in Cerebral Palsy Case due to Unknown Cause - A Rare Case Report

Uthamalingam M, Singh DS

J Clin Diagn Res, 2016 Jun;10(6):PD05-6.
PMID: 27504347 DOI: 10.7860/JCDR/2016/18761.7965

Incidences of cerebral palsy (CP) in children are not quite common even though it is the most common motor disorder in children. Further quality of life in CP cases is not so good in young adult stages and has to face certain problems. However scalp haematoma formation in CP patient without injury to head is rarely been reported. The case is being reported for the first time from Malaysia. We report on a unique case of scalp haematoma in an 18-year-old girl of known CP patient with unknown cause. No history of trauma or fall with any of the focal neurological signs or symptoms was found. Clinical examination showed soft boggy swelling of 8 x 10 cm size, involving most of scalp and upper face. CT - scan showed scalp haematoma with right orbital extraconal lesion. She underwent incision and drainage of scalp lesion; consequently around 100 ml of clotted blood came out. At follow-up she was doing well.

Matched MeSH terms: Scalp
Neural activation patterns and connectivity in visual attention during number and non-number processing: An ERP study using Ishihara pseudoisochromatic plates

Al-Marri F, Reza F, Begum T, Hitam WHW, Jin GK, Xiang J

J Integr Neurosci, 2018 Aug 15;17(3):257-269.
PMID: 30338955 DOI: 10.31083/JIN-170058

Visual cognitive function is important in the construction of executive function in daily life. Perception of visual number form (e.g. Arabic digits) and numerosity (numeric magnitude) is of interest to cognitive neuroscientists. Neural correlates and the functional measurement of number representations are complex events when their semantic categories are assimilated together with concepts of shape and color. Color perception can be processed further to modulate visual cognition. The Ishihara pseudoisochromatic plates are one of the best and most common screening tools for basic red-green color vision testing. However, there has been little study of visual cognitive function assessment using such pseudoisochromatic plates. 25 healthy normal trichromat volunteers were recruited and studied using a 128-sensor net to record event-related electroencephalogram. Subjects were asked to respond by pressing numbered buttons when they saw the number and non-number plates of the Ishihara color vision test. Amplitudes and latencies of N100 and P300 event related potential components were analyzed from 19 electrode sites in the international 10-20 system. A brain topographic map, cortical activation patterns, and Granger causation (effective connectivity) were analyzed from 128 electrode sites. No significant differences between N100 event related potential components for either stimulus indicates early selective attention processing was similar for number and non-number plate stimuli, but non-number plate stimuli evoked significantly higher amplitudes, longer latencies of the P300 event related potential component with a slower reaction time compared to number plate stimuli imply the allocation of attentional load was more in non-number plate processing. A different pattern of the asymmetric scalp voltage map was noticed for P300 components with a higher intensity in the left hemisphere for number plate tasks and higher intensity in the right hemisphere for non-number plate tasks. Asymmetric cortical activation and connectivity patterns revealed that number recognition occurred in the occipital and left frontal areas where as the consequence was limited to the occipital area during the non-number plate processing. Finally, results demonstrated that the visual recognition of numbers dissociates from the recognition of non-numbers at the level of defined neural networks. Number recognition was not only a process of visual perception and attention, but was also related to a higher level of cognitive function, that of language.

Matched MeSH terms: Scalp
Neurofibromatosis Type 2 Presenting with Oculomotor Ophthalmoplegia and Distal Myopathy

Tevaraj JM, Li Min ET, Mohd Noor RA, Yaakub A, Wan Hitam WH

Case Rep Ophthalmol Med, 2016;2016:1701509.
PMID: 27738538

Neurofibromatosis type 2 usually presents with bilateral acoustic schwannomas. We highlight the rare presentation of neurofibromatosis initially involving third nerve. A 23-year-old Malay female presented with left eye drooping of the upper lid and limitation of upward movement for 8 years. It was associated with right-sided body weakness, change in voice, and hearing disturbance in the right ear for the past 2 years. On examination, there was mild ptosis and limitation of movement superiorly in the left eye. Both eyes had posterior subcapsular cataract. Fundoscopy showed generalised optic disc swelling in both eyes. She also had palsy of the right vocal cord, as well as the third and eighth nerve. There was wasting of the distal muscles of her right hand, with right-sided decreased muscle power. Pedunculated cutaneous lesions were noted over her body and scalp. MRI revealed bilateral acoustic and trigeminal schwannomas with multiple extra-axial lesions and intradural extramedullary nodules. Patient was diagnosed with neurofibromatosis type 2 and planned for craniotomy and tumour debulking, but she declined treatment. Neurofibromatosis type 2 may uncommonly present with isolated ophthalmoplegia, so a thorough physical examination and a high index of suspicion are required to avoid missing this condition.

Matched MeSH terms: Scalp
Cephalhematoma infected by Escherichia coli presenting as an extensive scalp abscess

Wong CS, Cheah FC

J Pediatr Surg, 2012 Dec;47(12):2336-40.
PMID: 23217901 DOI: 10.1016/j.jpedsurg.2012.09.029

Cephalhematoma is normally a self-limiting condition affecting 1%-2% of live births, especially following instrumental forceps delivery. The sub-periosteal bleed is characteristically limited by the cranial sutures. Although benign in most instances, this condition may, in a small proportion of cases, be complicated by hyperbilirubinemia or scalp infection. We describe a case of cephalhematoma in a newborn infant infected with Escherichia coli resulting in an extensive deep seated scalp abscess. The infection was also systemic causing E. coli septicemia and initial assessment assumed local extension including bone and meningeal to cause skull osteomyelitis and meningitis respectively. Further investigations and multiple-modality imaging with ultrasound, CT scan and bone scintigraphy outlined the involvement as limited to the scalp, resulting in a shorter antibiotic treatment period and earlier discharge from hospital. The infant recovered well with parenteral antibiotics, saucerization of the abscess and a later skin grafting procedure.

Matched MeSH terms: Scalp*

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