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At least 271 records · Page 15Linked to original sources
PubMed1989

Prone decubitus: a solution to inferior wall attenuation in thallium-201 myocardial tomography.

We propose an efficient method to suppress inferior wall attenuation in 201TI 180 degrees myocardial tomography. We systematically performed redistribution studies in both supine and prone decubitus, assuming that the latter should result in shifting with respect to each other's cardiac structures and diaphragm as well as subphrenic organs possibly responsible for attenuation. The comparison of both studies in 25 normal subjects by visual interpretation and circumferential profiles analysis showed a complete suppression of significant attenuation in the inferior wall in prone studies. In addition and consequently, the standard deviation of activity in this area was markedly reduced and became close to its value in anterior and lateral walls. This simple technique now routinely performed in over 400 patients drastically improves specificity in the evaluation of inferior wall abnormalities by suppressing attenuation artifacts and, incidently, the effect of high individual variability in left phrenic and subphrenic anatomic configuration.

Coronary Disease↗
PubMed1988

[Benzoyl peroxide in the treatment of decubitus ulcers].

We communicate a case of pressure sore (decubitus ulcer) treated with 20% topic benzoyl peroxide in O/W emulsion with very satisfactory results. This substance feeds hyperbaric oxygen. Benzoyl peroxide also has antimicrobial, antipruriginous and antifungal properties all of them contributing to shorten the evolution of the lesions.

Aged↗
PubMed1988

[Decubitus ulcer in paraplegic patients--a comparative clinico-pathologic study].

331 pressure sores of 141 patients with paraplegia were investigated histologically, the results were partly correlated with the roentgenological features. The level of the spinal cord lesion was the segment Th12-L1 in 45%, the decubital ulcers were mostly localized above the os ischiadicum (64%). A pseudocancerosis was diagnosed in 14.2%, one time a cancer in a sacral decubitus has been found. The inflammation was limited to the soft tissue in 56.9%, in 28.5% a chronic osteomyelitis of different severity had developed. In 73.6% of the patients with a histologically proven osteomyelitis this osteomyelitis could be diagnosed roentgenologically too. The high amount and severity of the dermal and bony lesions justifies the radical surgical therapy of the pressure sores, which is practised today. Our investigations of chronic pressure sores did not point out new aspects of aetiology of pathogenesis--this is only possible by experimental models.

Adolescent↗
PubMed1988

Decubitus ulcers: update on new approaches to treatment.

Decubitus ulcers are best treated by eliminating the primary etiology, pressure, while supplementing care with the best available treatment modality. Knowledge of new treatment modalities and appropriate selection will help expedite wound closure. Pressure-relieving devices should not be relied upon to eliminate all pressure from the wound. Pressure relief should be supplemented with choice of appropriate dressings and additional therapy. The use of electrical stimulation, biomaterials, and growth factors may soon become available as additional modalities to expedite closure and facilitate wound repair.

Bandages↗
PubMed1988

[A central mechanism augments ventilation of the dependent lung on the lateral decubitus position].

Spontaneously increased ventilation of the dependent lung on the lateral decubitus position compensates for the gravitational shift of the pulmonary blood flow to this side. The present study indicates that the hemilateral predominant ventilation is centrally controlled, though it has previously been attributed to the peripheral mechanisms with simple changes in the mechanical properties between the two lungs. A series of chest roentgenograms taken at every 0.3 seconds during normal breathing in healthy 6 volunteers showed that the diaphragmatic movement was significantly larger on the dependent side (20.4 +/- 7.5 mm, M +/- SD) than on the other (12.1 +/- 4.4 mm). Thoracic or mediastinal movement was minimal on either side. Expired minute ventilation (VE), peak inspiratory pressure (PIP)and airway occlusion pressure (P0.1) were measured on each of the lungs separated with an endobronchial tube in 14 subjects. At light levels of halothane anesthesia (0.2-0.4% in oxygen). VE of the dependent lung was larger than that of the nondependent lung by 56%. PIP and P0.1 were also larger on the dependent side by 61% and 36%, respectively. At deeper levels of anesthesia (halothane 1.4-2.2%), the predominant ventilation of the dependent lung was absent and VE, PIP or P0.1 no longer differed significantly between the lungs. Augmented P0.1 on the dependent side seemed to be essential to produce larger PIP and VE. It is considered that the more widely stretched diaphragm on the dependent side sends stronger muscle afferent signals to increase excitability of the phrenic neurons producing augmented inspiratory driving force.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Transcutaneous oxygen tension measurement over the sacrum on various anti-decubitus mattresses.

Transcutaneous oxygen tension (tcPO2) was measured over the sacrum of 12 healthy, normal-weight volunteers positioned on five different mattresses. TcPO2 was lower (p less than 0.01) in those on a standard hospital mattress (median 0 mmHg), than in those on a sheep skin (median 22 mmHg), water mattress (median 33.5 mmHg), Spenco mattress (median 52.5 mmHg) or ripple air mattress (median 0/62 mmHg). The tcPO2 for the Spenco mattress was higher (p less than 0.01) than for sheep skin and for the water mattress. No significant difference was found in tcPO2 for the latter two named above. TcPO2 for the ripple air mattress alternated between 0, when inflated under the oxygen sensor, to about full oxygenation, when deflated. We believe that the ripple air mattress theoretically is the best mattress to prevent decubitus ulcers, but due to frequent mechanical failure of pump or mattress, the Spenco mattress is perhaps the best for practical use. Clinical comparative studies will be necessary to confirm that.

Adolescent↗
PubMed1986

[Surgical treatment of decubitus ulcers].

In spite of the improved quality of medical care for paraplegic patients, patients with multiple sclerosis or spinal injuries after severe trauma, the incidence of pressure sores has not diminished. Whilst superficial ulcers usually heal with conservative treatment, deep established pressure sores rarely heal satisfactorily without surgical intervention. The various surgical procedures for closure of decubitus ulcers with their classical localisation, i. e. sacral, trochanteric and ischial ulcers, are critically discussed. The myocutaneous flaps offer a wide range of choices for coverage. Sometimes, however, it may be difficult to provide a good quality myocutaneous flap at one operation. In this paper 400 patients with extensive bed sores operated upon during the last 20 years in the Clinic for Plastic Surgery in Cologne, applying the "slide-swing plasty" are reported. Some principles of the slide-swing plasty are to be respected: The flap should be tailored to the size and the shape of the skin defect. Three basic forms of the method can be applied. The flap is placed to exploit the skin reserves surrounding the defect. The flap thickness should extend as far as the muscles. The advantages of this method are as follows: Extensive bed sores can be closed. Sometimes two or three ulcers can be dealt within a single operation. Subsequent recurrences can be closed again using slide-swing plasty.

Humans↗
PubMed1987

[Primary immediate coverage of decubitus ulcers by musculocutaneous flaps and gentamicin PMMA beads].

Myo- or fasciocutaneous flaps for coverage of longstanding pressure sores in para- or quadriplegic patients have been proved superior to cutaneous flaps. Pretreatment with ulcer-debridement and systemic antibiotics for urinary-tract-infection and septicaemia was thought to be necessary for successful closure of these difficult defects. In a prospective, clinical trial 17 patients with 20 pressure sores were treated this way during 1980-1983. From 1983-1985 no local or antibiotic treatment was given to a second group of 20 patients with 28 decubitus ulcers prior to a one-stage-closure of the pressure sores. Only five patients with septicaemia above 39 degrees C received antibiotics intraoperatively. Gentamicin-PMMA-beads were temporarily inserted under the myo- or fasciocutaneous flaps during the procedure. If necessary, urinary-tract-infection was treated after successful coverage. Both groups have been compared historically. There were less wound complications in the second group while a median time-saving of 2 1/2 weeks per patient could be gained, even though they had larger pressure sores, frequent bone involvement, and multiple ulcers in this group.

Adolescent↗
PubMed1987

[Variants in the management of decubitus ulcers].

Decubitus ulcers of the fourth or fifth degree often tend to heal only after years. The result is a bad scar which is unstable and likely to breakdown. It is still surgically correctable, however. The ulcer should be cleaned and after tamponage one should perform excision without opening into the ulcer. Cover can be achieved with either a rotation flap with accompanying muscular padding or a myocutaneous flap. To protect against recurrence, the bone debridement has to be carried out aggressively.

Humans↗
PubMed1987

[Quantitative histological study of the bone mass and cellular activity after 120-days decubitus. Trial of preventive protocols].

Bone biopsies of iliac crests, performed at the beginning and the end of a decubitus period of 120 days, were studied in 20 healthy volunteers men. The purpose of this experiment is to simulate the bony alterations of astronauts. The bony mass of all bed-ridden patients remained constant. In strictly immobilized patients, the rate of bony mineralization is decreased and the osteoclastic resorption activity is stimulated. In bed-ridden patients subjected to preventive physical exercises, the bony formation and resorption are increased. When prevention is administered with the use of a diphosphonate, the osteoid and osteoclastic parameters are decreased. When both types of prevention are administered, the osteoid parameters and the resorption activity are decreased but less markedly than in patients treated with diphosphonate alone.

Adult↗
PubMed1985

Decubitus ulcers: preventive techniques for the elderly patient.

The at-risk older patient must immediately be placed on a supersoft support, with heels protected with sheepskin boots. If reddened skin is found the next morning, the patient must be turned to a 30 degrees-oblique position on alternate sides every 2 hours. Any condition that greatly decreases frequency of involuntary movement or lowers critical arteriolar closing pressure is a risk factor. Without intervention, the probability that immobile patients will develop decubitus ulcers is 100%.

Aged↗
PubMed1983

Decubitus prophylaxis: a prospective trial on the efficiency of alternating-pressure air-mattresses and water-mattresses.

Six hundred patients at risk for pressure sores were randomized in either a control group or one of two experimental groups placed on alternating-pressure air-mattresses and water-mattresses. The groups remained comparable throughout the 10-day study period. Twenty-one patients from the control group developed decubitus ulcers, compared with 7 in each of the other groups. Patient and ward personnel opinions on the acceptability of the three types of mattresses were registered.

Adolescent↗
PubMed1984

[Evaluation of 10 years of surgical treatment for decubitus ulcer].

The authors report a series of 67 patients presenting with 103 decubitus ulcers, treated between 1969 and 1977, and with a follow-up of one year or more. The majority of the patients were paraplegics, other etiologies being present in smaller numbers and raising different problems. They first studied the importance of the pre-and post-operative treatment. This was followed by study of the importance of different surgical techniques for each of the three localizations (sacral, ischial and trochanteric). They demonstrated the absolute need for surgical management, especially with paraplegic patients. Surgery alone allows rapid healing with a high success rate. While it does not, however, preclude any possibility of recurrence (whatever the technique used), it does at least allow the patient to live a normal life. The authors further emphasize the importance of the preoperative treatment, using the nutripump, and the postoperative treatment, using the pulsating air bed (in preference to the water bed). They consider the nutripump to be the most important breakthrough in this field, in recent years. As regards the different localizations, they consider muscle or musculocutaneous flaps to be the treatment of choice for ischial ulcers, but stress the need for wide ischiectomy and the excision of the bursa. In their experience, insufficient excision is a source of failure, even if the flap is good. Similarly, musculocutaneous flaps offer the best solution for trochanteric ulcers, but again, only accompanied by excision of the bursa. Recognition of coxofemoral arthritis is also essential, and no flap will take until this has been remedied. In the case of sacral ulcers, however, they prefer large rotation skin flaps, which allow further advancement in the event of recurrence. The association of two or three ulcers makes surgical management imperative because of the frequently severe undermining of the patient's general state of health. The treatment of two locations in a single stage is always preferable whenever it is feasible.

Adolescent↗
PubMed1983

[Decubitus: efficient prevention due to new pathogenetic knowledge].

Decubitus ulcers are spots of ischemic tissue necrosis caused by any imposed pressure which occludes the venules and arterioles. Therefore, the most important objective is to avoid completely or to lower the imposed skin pressure below the critical arterial occlusion pressure. This can be achieved by positioning the patient in the 30 degrees lateral position and/or by bedding them on a "supersoft" mattress. The efficacy of this method is demonstrated by recording the oxygen tension of compromised skin areas during these preventive measures and by an improving clinical statistics over a period of 5 years.

Aged↗
PubMed1983

Diagnosis of ill-defined pulmonary infiltrates by lateral decubitus chest radiography.

The lateral decubitus chest radiograph is a useful procedure in the evaluation of ill-defined pulmonary densities that may stimulate infiltrates. This procedure, although described previously in the radiologic literature, has not been in frequent use. The procedure assists diagnosis in patients who are not able to take a deep inspiration due to personal limitations and in young children who are not able to cooperate fully.

Adolescent↗
PubMed1982

[Profile projection of the rectosigmoid in left lateral decubitus with vertical rays in the diagnosis of obstruction of the lower colon].

For differential diagnosis between obstruction of the lower organ and paralytic ileus, an additional projection to the customary A.S.P. plates is proposed: profile of the rectosigmoid in left lateral decubitus with vertical rays, designed to back up the differential reasoning behind the presence or absence of a rectosigmoid distended by gas.

Colon, Sigmoid↗
PubMed1982

[Cardiac valvular disease and pregnancy. Haemodynamic aspects and importance of decubitus].

During the 3rd trimester of pregnancy, 26 women with aortic or mitral valve disease (II class NYHA) have undergone bedside right heart catheterization. Total pulmonary resistances (RPT) have been studied in supine (DS) and lateral (DL) decubitus. The results are compared with those of 7 normal women. It is known that the change from the supine to the lateral posture increases venous return (and cardiac output) by removing the compression which the pregnant uterus causes to the inferior vena cava. This is achieved without increasing the mean pulmonary pressure (PPM) and total pulmonary resistances (RPT); women with mitral and aortic stenosis have little or no increase of cardiac output but always a marked increase of PPM and RPT; the response in patients with aortic and mitral incompetence is closer to normal; an intermediate response was observed in patients with a mitral stenosis and insufficiency. The valvular heart diseases with stenosis badly tolerate the increased cardiovascular burden of pregnancy and are unable to accommodate the increased venous return induced by postural changes, which induces marked elevation of pulmonary pressure and resistances.

Adult↗