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PubMedDate not supplied

One-year treatment with recombinant human growth hormone of children with meningomyelocele and growth hormone deficiency: a comparison of supine length and arm span.

Growth retardation and precocious puberty are frequently found in children with meningomyelocele (MMC). Lower limb contractions, spasticity and kyphoscoliosis may lead to disproportionate short stature. Most of these patients have structural brain defects or hydrocephalus which can cause growth hormone deficiency. In this study, 19 children aged between 3.5 and 12.8 years with MMC and growth hormone (GH) deficiency were treated with recombinant human GH for a period of 12 months. Supine length, arm span and growth velocity were compared before, and after 6 and 12 months of treatment with rhGH (daily dose 2.0 IU/m2 BSA s.c.). Mean supine length standard deviation score (SDS) increased by +0.8 SDS after 6 months and +1.2 SDS after 12 months of therapy. Mean arm span standard deviation score increased by +0.9 SDS and +1.3 SDS. Growth velocity increased in supine length from 3.3 cm/yr (-2.1 SDS) to 8.4 cm/yr (+2.4 SDS) and in arm span from 4.8 cm/yr (-1.3 SDS) to 8.6 cm/yr (+3.1 SDS) in the first 6 months and was 8.1 cm/yr (+2.4 SDS) and 8.3 cm/yr (+2.6 SDS) after 12 months of therapy. Linear correlation between SDS growth velocity supine length and SDS growth velocity arm span during one year of treatment was excellent (r = 0.65, p < 0.0025). We surmise that body proportions do not deteriorate when growth velocity is stimulated in MMC patients. Both supine length and arm span measurements are necessary to document growth in children with spinal dysraphism.

Age Determination by Skeleton↗
PubMed1999

More awakenings and heart rate variability during supine sleep in preterm infants.

OBJECTIVE: The Task Force of The American Academy of Pediatrics (1996) recommends the nonprone sleeping position for asymptomatic preterm infants to prevent sudden infant death syndrome. The mechanism by which the nonprone sleeping position reduces the rate of sudden infant death syndrome is unclear for full-term infants and the precise effect of sleeping position on sleep and cardiorespiratory characteristics has never been addressed in preterm infants. The purpose of the present study was to clarify the effect of sleeping position on sleep and cardiorespiratory characteristics in preterm infants at an age when they are ready for discharge. STUDY DESIGN: Sixteen asymptomatic preterm infants were studied in both supine and prone sleeping positions at 36.5 +/- 0.6 weeks' postconceptional age using videosomnography. Sleep, respiratory, and heart rate characteristics were compared between the two positions using each infant as his/her own control. RESULTS: More awakenings (ie, arousals >/=60 seconds) were seen during all sleep states in the supine sleeping position but overall the total sleep and percent sleep state were not affected by sleeping position. After each feeding, the first quiet sleep was significantly shorter, with more heart rate variability and awakenings in the supine position. There were no significant differences in the occurrence of arousals (<60 seconds) or the incidence or severity of apnea and periodic breathing. No clinically significant apnea (>/=15 seconds), bradycardia, or oxygen desaturations were seen. CONCLUSION: In 36-week-postconceptional age preterm infants, the supine sleeping position had less quiet sleep and was associated with greater heart rate variability during the first sleep cycle after the feeding. More awakenings were seen during all sleep states in the supine position. These data support the American Academy of Pediatrics recommendation for "Back to Sleep" for asymptomatic preterm infants because more awakenings and lower threshold for arousal may provide some benefit for the infant responding to a life-threatening event. However, further studies are needed to address positional effect on the physiologic measures in preterm infants at older ages (later stages of development). Precisely what constitutes the most healthy or advantageous sleep for newborn infants remains an important question.

Arousal↗
PubMed1996

The effects of an occupationally embedded exercise on bilaterally assisted supination in persons with hemiplegia.

OBJECTIVES: Occupationally embedded exercise is a central idea in the profession of occupational therapy. This experiment compared the effect of an occupationally embedded exercise involving a simple dice game with a rote exercise in persons with stroke with pronator spasticity. Both exercise conditions involved bilaterally assisted supination, consistent with the neurodevelopmental model of practice. METHODS: The sample consisted of 14 men and 12 women post-cerebrovascular accident with a mean age of 68.4 years (SD = 11.2) at six clinical sites in California, Texas, and Michigan. Subjects had pronator spasticity, full passive range for supination after a brief warm-up, and no functional supination. After random assignment for experimental condition, the subjects engaged in two sets of 10 repetitions of bilaterally assisted supination in either the occupationally embedded condition (dice game) or the rote condition (no game). A pen recorder electronically documented degrees of rotation of the handle that was grasped during the exercise. RESULTS: The occupationally embedded exercise resulted in significantly more handle rotation (requiring more supination) than the rote exercise, t (24) = 2.28, p (one tailed) < .05. The effect size was large. CONCLUSION: This study advances the experimental analysis of therapeutic occupation in the area of occupationally embedded exercise. Clinicians are urged to consider the multidimensional nature of occupationally embedded exercise.

Aged↗
PubMed1992

Efficacy of supine versus prone biliary lithotripsy: an in vitro study.

Clinical extracorporeal shock wave lithotripsy (ESWL) results have shown that the smaller the gallstone fragments following ESWL, the faster the patient will become stone-free. At ESWL, an attempt is made to produce sand-like fragments that will easily pass through the cystic and common bile ducts. Sixteen pairs of gallstones of equal shape, size, and composition were harvested from cholecystectomy specimens and then fragmented on the Dornier MPL-9000 lithotripter (Dornier Medical Systems, Inc.), individually, in a phantom oriented to duplicate either supine or prone patient positions. The number and size of remaining fragments were compared following the supine versus prone treatments. The 32 stones, ranging from 5-15 mm in diameter, received 1,500 shock waves at 21 kV. Fragments with a maximal diameter of greater than or equal to 4 mm were measured and counted after 750 and 1,500 shock waves. Fragments greater than or equal to 4 mm were found in four out of 16 stones treated supine (25%) and 16 out of 16 stones treated prone (100%). The largest residual fragment regardless of size for each stone pair occurred in the prone group in 14 out of 16 cases (88%). Biliary lithotripsy performed with supine positioning results in more efficacious gallstone fragmentation in this in vitro model; these findings suggest that supine positioning for patients could improve fragmentation and treatment success.

Cholelithiasis↗
PubMed1999

Pronation and supination of the scaphoid.

The objective of this study was to identify and classify longitudinal rotations of the scaphoid on clinical radiographs of normal wrists. The concept of scaphoid recumbency was defined in terms of the orientation of the palmar tubercle. Pronation and supination of the scaphoid were identified in a set of 130 posteroanterior films of structurally normal wrists in neutral position. Normal variations in scaphoid recumbency and lunate posture were classified. It was found that the scaphoid is in neutral recumbency in 62%, pronation in 32%, and supination in 7% of structurally normal wrists. Neutral scaphoid recumbency and neutral lunate posture occur together in 45% of normal wrists. Rarely, scaphoid supination and lunate flexion occurred together, simulating a collapse pattern often seen in inflammatory arthritis. Scaphoid supination and lunate extension did not occur together. An anatomic basis for this incompatibility of scaphoid recumbency and lunate posture is suggested. We conclude that longitudinal rotation of the scaphoid (ie, pronation and supination) may be seen on clinical radiographs of structurally normal wrists. These rotations are exaggerated in certain types of carpal instability.

Carpal Bones↗
PubMed1998

[Restoration of supination of forearm by flexor carpi radialis transfer].

The dysfunction of supination of forearm following injury of brachial plexus or poliomyelitis always affects the function of hand. To find the dynamic muscle for restoration of the supination, the flexor carpi radialis was investigated on fifty male cadavers. The blood supply of the muscle was polygenic, mainly derived from the humoral and radial arteries. The movement of the muscle was innervated by median nerve. If the proximal 1/3 belly of the muscle was reserved, the blood supply and innervation of the complete muscle was reserved. According to the anatomic data, the operative procedure was designed as following: transfer the distal 2/3 of flexor carpi radialis over the ulnar aspect of the forearm to the dorsal-radial side, the tendon was fixed on the radius shaft 6 to 10 cm proximal to the styloid process with forearm in full supination. Four patients were treated and after followed up for 3.2 years average, the supination restored. It was discussed that in case of paralysis of the flexor carpi ulnaris and pronator teres, the optimal choice to restore the supination would be flexor carpi radialis.

Adult↗
PubMedDate not supplied

Measurement of vertebral rotation in standing versus supine position in adolescent idiopathic scoliosis.

Thirty-three structural curves of 25 patients with adolescent idiopathic scoliosis were evaluated using computed tomography (CT) scans and plain radiography. The average Cobb angle on standing radiographs was 55.72 degrees and was observed to be corrected spontaneously to 39.42 degrees while the patients were in supine position (29.78% correction). Average apical rotation according to Perdriolle was 22.75 degrees on standing radiographs and 16.78 degrees on supine scanograms. The average rotation according to Aaro and Dahlborn on CT scans was 16.48 degrees. Radiographic measurements were significantly different from axial CT slice or scanogram measurements (p = 0.000), but the two latter measurements, both obtained in the supine position, did not appear to be different (p = 0.495). Deformities on the transverse plane as well as on the coronal plane are influenced by patient positioning. If the patient lies supine, the scoliosis curve corrects spontaneously to some degree on both planes. Measurements obtained from the scanograms by the Perdriolle method in the supine position are very similar to those obtained by CT. Perdriolle's is a simple, convenient, and reliable method to measure rotation on standing radiograms.

Adolescent↗
PubMed2003

Characteristics of human body dynamic responses to landing impact in supine position.

OBJECTIVE: To study the characteristics of human body dynamic responses to landing impact. METHOD: Five healthy young men were exposed to 4-10 G for 50-80 ms half-sine acceleration pulse at 20 degrees supine angle and 10 G for 50 ms impact at 30 degrees to 60 degrees supine angles. The acceleration curves on the dropping platform of the impact tower, the seat, the human head, shoulder, chest and ilium, as well as ECG of the subjects were recorded. RESULT: The peaks of acceleration at the subject head, shoulder, chest, and ilium along chest-back direction rose with the increase of the impact level. The overshoots of acceleration at the subject head along head-ilium direction and chest-back direction were 93% and 102% respectively for 10 G at 20 degrees supine angle. With increase of supine angle, acceleration response at the subject along chest-back direction decreased. Acceleration response at the subject head along head-ilium direction was minimum at 40 degrees supine angle. CONCLUSION: Transfer function of the human body to landing impact demonstrated that human body had a series of resonance frequencies which were 25 Hz, 34 Hz, 39 Hz, 43 Hz, 50 Hz, 64 Hz, and 70 Hz respectively.

Acceleration↗
PubMed2006

Combined supine and prone quantitative myocardial perfusion SPECT: method development and clinical validation in patients with no known coronary artery disease.

UNLABELLED: Acquisition in the prone position has been demonstrated to improve the specificity of visually analyzed myocardial perfusion SPECT (MPS) for detecting coronary artery disease (CAD). However, the diagnostic value of prone imaging alone or combined acquisition has not been previously described using quantitative analysis. METHODS: A total of 649 patients referred for MPS comprised the study population. Separate supine and prone normal limits were derived from 40 males and 40 females with a low likelihood (LLk) of CAD using a 3 average-deviation cutoff for all pixels on the polar map. These limits were applied to the test population of 369 consecutive patients (65% males; age, 65 +/- 13 y; 49% exercise stress) without known CAD who had diagnostic coronary angiography within 3 mo of MPS. Total perfusion deficit (TPD), defined as a product of defect extent and severity scores, was obtained for supine (S-TPD), prone (P-TPD), and combined supine-prone datasets (C-TPD). The angiographic group was randomly divided into 2 groups for deriving and validating optimal diagnostic cutoffs. Normalcy rates were validated in 2 additional groups of consecutive LLk patients: unselected patients (n = 100) and patients with body mass index >30 (n = 100). RESULTS: C-TPD had a larger area under the receiver-operating-characteristic (ROC) curve than S-TPD or P-TPD for identification of stenosis >or=70% (0.86, 0.88, and 0.90 for S-TPD, P-TPD, and C-TPD, respectively; P < 0.05). In the validation group, sensitivity for P-TPD was lower than for S- or C-TPD (P < 0.05). C-TPD yielded higher specificity than S-TPD and a trend toward higher specificity than P-TPD (65%, 83%, and 86% for S-, P-, and C-TPD, respectively, P < 0.001; vs. S-TPD and P = 0.06 vs. P-TPD). Normalcy rates for C-TPD were higher than for S-TPD in obese LLk patients (78% vs. 95%, P < 0.001). CONCLUSION: Combined supine-prone quantification significantly improves the area under the ROC curve and specificity of MPS in the identification of obstructive CAD compared with quantification of supine MPS alone.

Coronary Artery Disease↗
PubMed1988

Oxygen saturation in the supine hypotensive syndrome.

This study used recently available, continuous noninvasive monitoring techniques to evaluate positional variations in pulse, blood pressure, and maternal oxygen saturation in 42 women undergoing fetal nonstress testing in the third trimester. Ten nonpregnant women were similarly evaluated with the automatic sphymomanometer and pulse oximeter. Six of 42 pregnant women (14.3%) developed the supine hypotensive syndrome (defined as a mean blood pressure decrease of 15 mmHg and a sustained increase in pulse of 20 beats per minute) when in the supine position. Nine of them (21.4%) met at least one of the criteria, but the majority (27 of 42, 64.3%) met neither criterion. None of the ten nonpregnant subjects had hypotension or tachycardia, although nine demonstrated blood pressure elevation after assuming the supine position. Significant oxygen desaturation did not occur in any patient, although three of six hypotensive patients had a transient 3-5% desaturation after supine rest. This study confirms that a significant percentage of patients in the third trimester are affected to some degree by supine hypotension. However, significant oxygen desaturation does not appear to occur.

Adolescent↗
PubMedDate not supplied

Supine infant sleep: what do family physicians recommend?

BACKGROUND: Sudden infant death syndrome (SIDS) kills more than 6000 infants annually in the United States. Researchers have described prone sleep position as a risk factor for SIDS. A greater than 50 percent reduction in SIDS has been reported in countries where the predominant sleep position changed from prone to supine. In 1992 the American Academy of Pediatrics (AAP) recommended that healthy infants be placed in a supine position at bedtime. Previous studies of pediatric practices reported a 60 percent compliance with the recommendation. This study describes the self-reported compliance with the AAP recommendation by a cohort of family physicians. METHODS: Three hundred members of the Uniformed Services Academy of Family Physicians were mailed a questionnaire about their recommendations regarding infant sleep position. RESULTS: The response rate was 77 percent. Sixty-two percent of the respondents usually or always encourage supine sleep position. Twenty-one percent usually or always discourage the supine sleep position. CONCLUSIONS: This cohort of family physicians encourages the supine sleep position at rates similar to reported cohorts of pediatricians. Reasons for the limited endorsement of the AAP recommendation were not explained by the results of this study.

Adult↗
PubMed1994

Improved assessment of lumbar vertebral body strength using supine lateral dual-energy x-ray absorptiometry.

Clinical and biomechanical investigations indicate that assessment of vertebral body bone mineral density (BMD) by anteroposterior dual-energy x-ray absorptiometry (DXA) is a useful index of vertebral body strength and fracture risk in osteoporosis. However, inclusion of non-force-bearing and small-force-bearing mineralized structures, such as the posterior elements and aortic calcifications, in the measurement of anterior BMD obscures the assessment of vertebral body mass by this technique. Indeed, such interference is particularly severe in the presence of posterior element degeneration or previous spinal surgery. Recent anatomic studies illustrate that the lateral view provides unobstructed visualization of the L3, L4, and possibly L2 vertebral bodies, suggesting that supine lateral BMD may more accurately assess vertebral body fracture risk. We evaluated this hypothesis in a blinded using human cadaver spines to compare the value of supine lateral and anteroposterior BMD in assessing vertebral body fracture force, average compressive stress, maximum stored strain energy, and strain at failure. Both measures of BMD significantly correlate with these biomechanical measures. However, statistical comparison of the methods using multiple and stepwise regression reveals that supine lateral BMD provides a better assessment of the vertebral body fracture properties than anteroposterior BMD. The enhanced predictive value of supine lateral BMD occurs because of the variable contribution of posterior element mineral to the anteroposterior BMD measurement. Evaluation to test the utility of supine lateral BMD for the assessment of fracture risk and a fracture threshold in patients with osteoporosis is therefore recommended.

Absorptiometry, Photon↗
PubMed1987

Relative effects of the supine posture and of immersion on the renin aldosterone system at rest and during exercise.

The relative influences of the supine posture and of immersion on the renin-aldosterone system (RAS) were studied at rest and during moderate exercise in five healthy men. When supine, resting or immersion to the neck for 20 min in a thermoneutral environment both induced a decrease in plasma renin activity (PRA) when compared with the levels measured after 15 min sitting at rest (resting: -44%, p less than 0.05. Immersion: -45%, p less than 0.05). There was no significant difference in PRA decrease between the two situations. Aldosterone (ALDO) values were lower after supine rest or immersion than those observed after sitting at rest, but the difference was not significant. Two types of exercise at a constant relative work load (40-50% maximal oxygen uptake), namely cycling on an ergocycle in the supine position and free-style swimming, induced increases in PRA and ALDO when compared with the levels measured after 15 min rest when sitting (respectively, PRA = +35%, p less than 0.05, and +45%, p less than 0.05, ALDO = +32%, p less than 0.01 and +35%, p less than 0.05). Increases in PRA and ALDO did not differ between the two exercises. Thus inhibitory effects on RAS of change in external pressure are negligible during water immersion to the neck in the supine position and during swimming at moderate intensity.

Adult↗
PubMed2000

Supine Cephalometric Analyses of an Adjustable Oral Appliance Used in the Treatment of Obstructive Sleep Apnea.

OBJECTIVE: To investigate the effects of the Klearway(TM) appliance on the upper airway in patients with obstructive sleep apnea (OSA) in the supine position. METHODS: Sixteen subjects (12 males and 4 females) were recruited on the basis of baseline polysomnography with a documented Apnea and Hypopnea Index (AHI) >15 per hour. A second overnight sleep study was performed for each subject with the appliance in place. Baseline supine cephalometry was performed for each subject before the initial insertion of the appliance, and follow-up supine cephalometry was undertaken with the appliance in place. RESULTS: The polysomnographic variables improved significantly, and the mean changes in overbite and overjet were 5.15 mm and 6.26 mm after insertion of the Klearway(TM) appliance. The supine sagittal cross-sectional areas of the pharynx and the tongue significantly increased, while the linear distance from the hyoid position to the mandibular plane or the RGN-C3 line significantly decreased after insertion of the appliance. The ratio of the vertical pharyngeal length to the sagittal cross-sectional area of nasopharynx or tongue decreased significantly. When the subjects were evaluated on the basis of the after-insertion AHI, the group with good response (n = 11) was found to be significantly younger than the group with the poor response (n = 5). Similarly, the good responders revealed less prominent chins, larger tongue heights, and an increase in hypopharyngeal sagittal cross-sectional area after insertion of the appliance. There was a significant correlation between the improvement in AHI (%) and the supine middle airway space (r = -0.52, p < 0.05). CONCLUSION: The mechanical effect of the Klearway(TM) appliance on the upper airway and the stabilization of jaw posture may be important determinants of the efficacy of the appliance.

Journal Article↗
PubMed1994

Head-up tilt and hemodynamic changes during orthostatic hypotension in patients with supine hypertension.

OBJECTIVES: This study assessed the mechanism(s) of the decrease in upright blood pressure in patients with supine hypertension by using the tilt test and a hemodynamic approach. BACKGROUND: Orthostatic hypotension in patients with supine hypertension creates a pathophysiologic and therapeutic dilemma. METHODS: We studied 28 consecutive patients with history of orthostatic intolerance amounting to recurrent syncope in 13 of them (15 men, 13 women; mean [SD] age 65 +/- 11 years). They all had supine hypertension (systolic blood pressure > 160 mm Hg) and orthostatic hypotension (found to be a decrease in systolic blood pressure > 30 mm Hg during tilt test). Cardiac output, cardiopulmonary volume and systemic resistance were assessed by radionuclide first-pass technique (technetium-99m red blood cell tagging). Total blood volume was determined by radioiodinated serum albumin, and the ratio of cardiopulmonary to total blood volume was used as an index of venous capacitance. RESULTS: Twenty-one patients had accentuated venous pooling defined as a tilt-induced decrease in cardiopulmonary volume/total blood volume ratio > 15% from baseline or a supine ratio < 14% (normal 16% to 18%), or both. Seven of the 28 patients had autonomic insufficiency; 6 of the 7 also had venous pooling; 1 patient had autonomic insufficiency only. Neither clinical history nor changes during tilt differentiated the subgroups. Plasma catecholamine levels increased during head-up tilt in all subgroups, and differences in their increase were not significant between patients with venous pooling and those with autonomic insufficiency. However, radionuclide hemodynamic variables revealed that patients with venous pooling compensated for the decrease in stroke volume by increasing peripheral resistance, whereas patients with autonomic dysfunction did not. CONCLUSIONS: Orthostatic hypotension in patients with supine hypertension may have multiple etiologies. Hemodynamic assessment with determination of cardiopulmonary volume and systemic vascular resistance differentiated between venous pooling and autonomic insufficiency in these patients; head-up tilt and plasma catecholamine levels did not. These findings may have important therapeutic implications.

Adult↗
PubMed2006

Changes of corneal aberrations in sitting and supine positions.

PURPOSE: To examine the effect of posture change on corneal aberrations and corneal curvature. DESIGN: Observational case series. METHODS: The Keratron topographer, improved to measure patients in the supine position, was used to measure the corneal aberrations and the curvature in nine healthy volunteers. The first measurement took place with the subject in the sitting position and the others in the supine position, immediately after assuming the supine position and then 30 minutes later. RESULTS: The total higher-order and spherical-like aberrations were significantly increased from the sitting position to the supine position (P=.011, and P=.044, Scheffé test). CONCLUSIONS: These results suggest that the increase in the higher-order aberration from the sitting to the supine position acts to limit the improvements in visual performance after customized refractive surgery based on wavefront measurement.

Adult↗
PubMed1995

Abnormal tympanography after supine bottle feeding.

OBJECTIVE: To determine whether bottle feeding with the infant in the supine position is related to entry of milk into the middle ear, thereby predisposing the infant to otitis media. STUDY DESIGN: Ninety children, aged 7 to 24 months, who were free of respiratory infection and had normal tympanograms initially, were bottle fed in either the supine or the semiupright position, and tympanography was repeated immediately afterward. RESULTS: Thirty-four (59.6%) of the 57 infants fed in the supine position had abnormal postfeeding tympanographic results compared with only five (15%) of the 33 infants fed in the semiupright position (p < 0.005). In addition, when the infants with abnormal tympanograms were placed in semiupright or prone positions for 15 minutes after feeding, the majority of tympanograms returned to normal. CONCLUSION: These data suggest that supine bottle feeding has a significant effect on middle-ear pressure dynamics, probably caused by the aspiration of milk into the ear. The results also suggest that repositioning infants after feeding may mitigate the effects of supine feeding, at least in healthy children. Although this study did not demonstrate that tympanographic abnormality definitely predisposes to otitis media, it provides more evidence to encourage the practice of feeding infants in a semiupright position.

Acoustic Impedance Tests↗
PubMed1984

Aortic injury: comparison of supine and upright portable chest films to evaluate the widened mediastinum.

Despite many reports of radiologic findings that may be suggestive of aortic injury, most authors believe the recognition of a widened mediastinum on chest film remains the sine qua non. Few studies have confirmed the widely held belief that the supine AP chest film is inaccurate in assessing the width of the mediastinal structures, and that one should use only the upright or sitting chest films. This study was undertaken to assess the accuracy of both upright and supine chest films in the evaluation of mediastinal widening after blunt deceleration chest injury. Both supine and upright sitting chest films were obtained immediately on arrival in the resuscitation areas for 55 patients. Twenty-one (38%) exhibited a mediastinum that appeared wide on supine view but within normal limits on the upright view, as attested by two radiologists. Aortography was not performed on any of these patients. Daily upright chest films, repeated until discharge, failed to demonstrate any change in mediastinal anatomy, and all patients recovered without incident. Twelve patients' films (22%) demonstrated widened mediastinum on both views, and these 12 patients underwent immediate aortography. Aortic rupture was revealed in four (33%). This study clarifies the diagnostic value of the upright chest film in assessing the mediastinum after blunt injury. It confirms the belief that supine films are not accurate, and that they may lead to numerous false positives and unnecessary aortograms. The initial upright or sitting chest film is accurate, and its use is cost-effective and time-saving for patient and physician.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta↗