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PubMed2002

Method to plan, administer, and verify supine craniospinal irradiation.

Craniospinal irradiation remains an important technique in the management of malignancies of the central nervous system. It is technically demanding, with potential for treatment field overlap or gaps to yield unacceptable dosimetric heterogeneity. A method to accurately simulate and verify the three-field junction is described. We use a comfortable supine position to minimize patient movement. The supine position provides airway access by anesthesiology in patients requiring sedation or anesthesia. Virtual simulation is performed with a dedicated computed tomography (CT) simulator. Multiplanar sagittal and coronal CT reconstructions allow visual confirmation of three-field matching at the cervical region. The placement of isocenters for each field, table position, and collimator angles are determined by calculation of field sizes accommodating for beam divergence. At treatment, exact matching of the three fields is assured using the record and verify confirmation of beam collimator settings and rotation, digital couch readouts, and gantry parameters. Mini-verification silver halide (Kodak XV) films (6x6 cm) are placed behind the patient's neck and are exposed by all treatment fields (posterior flash from the lateral cranial fields and entrance from the PA spine field). These films assess field placement accuracy at the junction of these three fields. Finally, placement of radio-opaque markers at the junction is visualized in each clinical portal radiograph. Patients readily accept the supine position as their treatment setup is eased. Field placement using digital couch settings is efficient and accurate. Daily mini-verification films are simple, inexpensive, and allow verification of each treatment field matching. Field placement errors of greater than 1 mm can be readily identified and corrected at subsequent treatment sessions. Virtual simulation and direct junction verification with mini-verification films allow for simple and quantitative evaluation of the junction associated with the three-field craniospinal irradiation technique. The supine patient position does not present any difficulties in field matching or verification.

Cranial Irradiation↗
PubMed1988

Effect of supine posture on peak expiratory flow rates in asthma.

In order to determine the effect of supine posture alone on the peak expiratory flow rate (PEFR) in children with asthma, 22 children with asthma of varying severity had PEFR readings taken in the standing position and subsequently at 30 minute intervals in the supine position for a period of up to four hours. In order to minimise any stress factors no other procedures--for example, taking of blood specimens--were performed during the duration of the tests, which were carried out in a relatively dust free room with no curtains and minimal furniture. Fifteen non-asthmatic children acted as controls. The results showed a significant drop in the PEFR readings in the supine position in asthmatic children compared with the controls; this reverted back to baseline levels on assuming an upright posture at the end of the test without any medication. It is concluded that airflow obstruction can be induced by supine posture per se in asthmatic children; this may be a major factor contributing to nocturnal wheeze or cough.

Asthma↗
PubMed2003

Comparison of supine and prone scanning separately and in combination at CT colonography.

PURPOSE: To compare colonic distention, adequacy of colonic preparation, and colorectal polyp detection as assessed with supine and prone scanning separately and in combination at computed tomographic (CT) colonography. MATERIALS AND METHODS: CT colonography and colonoscopy were performed in 182 patients. Distention and preparation of eight colonic segments were rated separately on a scale of 1-4 (1, segment completely distended or no residual material; 4, segment collapsed or large amounts of residual material). The distention, preparation, and polyp detection data were compared with regard to each position alone and then in combination. CT findings were correlated with colonoscopic findings. RESULTS: The percentage of colonic segments with grade 1 distention and preparation was 93.7% (1,364 of 1,456) and 66.6% (969 of 1,456), respectively, with combined scanning; 86.4% (1,258 of 1,456) and 52.1% (759 of 1,456), respectively, with supine scanning alone; and 85.6% (1,246 of 1,456) and 57.1% (831 of 1,456), respectively, with prone scanning alone. The sensitivity for detection of colorectal polyps 10 mm or larger, 5.0-9.9 mm, and smaller than 5 mm and polyps of all sizes was 92.7%, 79.8%, 60.3%, and 69.9%, respectively, with combined scanning. Sensitivity was 58.5%, 47.2%, 36.3%, and 42.1%, respectively, with supine scanning and 51.2%, 41.6%, 30.2%, and 36.3%, respectively, with prone scanning. The improved sensitivities for use of combined versus individual scanning positions were highly significant (P <.001) for polyps in all size categories. CONCLUSION: Colonic distention and preparation at CT colonography were significantly improved by using supine and prone scanning in combination, and results correlated directly with improved sensitivity of polyp detection.

Adult↗
PubMed2002

Effects of supine, prone, and lateral positions on cardiovascular and renal variables in humans.

The hypothesis was tested that changing the direction of the transverse gravitational stress in horizontal humans modulates cardiovascular and renal variables. On different study days, 14 healthy males were placed for 6 h in either the horizontal supine or prone position following 3 h of being supine. Eight of the subjects were in addition investigated in the horizontal left lateral position. Compared with supine, the prone position slightly increased free water clearance (349 +/- 38 vs. 447 +/- 39 ml/6 h, P = 0.05) and urine output (1,387 +/- 55 vs. 1,533 +/- 52 ml/6 h, P = 0.06) with no statistically significant effect on renal sodium excretion (69 +/- 3 vs. 76 +/- 5 mmol/6 h, P = 0.21). Mean arterial pressure and left atrial diameter were similar comparing effects of supine with prone. The prone position induced an increase in heart rate (54 +/- 2 to 58 +/- 2 beats/min, P < 0.05), total peripheral vascular resistance (13 +/- 1 to 16 +/- 1 mmHg. min(-1). l(-1), P < 0.05), forearm venous plasma concentration of norepinephrine (97 +/- 9 to 123 +/- 16 pg/ml, P < 0.05), and atrial natriuretic peptide (49 +/- 4 to 79 +/- 12 pg/ml, P < 0.05), whereas stroke volume decreased (122 +/- 5 to 102 +/- 3 ml, P < 0.05, n = 6). The left lateral position had no effect on renal variables, whereas left atrial diameter increased (32 +/- 1 to 35 +/- 1 mm, P < 0.05) and mean arterial pressure decreased (90 +/- 2 to mean value of 85 +/- 2 mmHg, P < 0.05). In conclusion, the prone position reduced stroke volume and increased sympathetic nervous activity, possibly because of mechanical compression of the thorax with slight impediment of arterial filling. The mechanisms of the slightly augmented urine output in prone position require further experimentation.

Adult↗
PubMed2002

Similar ventilation distribution in normal subjects prone and supine during tidal breathing.

Multiple-breath washout (MBW) tests, with end-expiratory lung volume at functional residual capacity (FRC) and 90% O(2), 5% He, and 5% SF(6) as an inspired gas mixture, were performed in healthy volunteers in supine and prone postures. The semilog plot of MBW N(2) concentrations was evaluated in terms of its curvilinearity. The MBW N(2) normalized slope analysis yielded indexes of acinar and conductive ventilation heterogeneity (Verbanck S, Schuermans D, Van Muylem A, Paiva M, Noppen M, and Vincken W. J App Physiol 83: 1907-1916, 1997). Also, the difference between SF(6) and He normalized phase III slopes was computed in the first MBW expiration. Only MBW tests with similar FRC in the prone and supine postures (P > 0.1; n = 8) were considered. Prone and supine postures did not reveal any significant differences in curvilinearity, N(2) normalized slope-derived indexes of conductive or acinar ventilation heterogeneity, nor SF(6)-He normalized phase III slope difference in the first MBW expiration (P > 0.1 for all). The absence of significant changes in any of the MBW indexes suggests that ventilation heterogeneity is similar in the supine and prone postures of normal subjects breathing near FRC.

Adult↗
PubMed2006

Clonidine for the treatment of supine hypertension and pressure natriuresis in autonomic failure.

Patients with autonomic failure are disabled by orthostatic hypotension, which can be worsened by the nighttime pressure natriuresis induced by associated supine hypertension. Several pharmacological agents are available that effectively reduce nighttime hypertension, but none of them prevent pressure natriuresis. Because hypertension of autonomic failure can be driven by residual sympathetic tone, we hypothesized that clonidine would be effective in reducing blood pressure (BP) and nocturnal natriuresis. Therefore, we determined the effect of placebo, 0.1 mg clonidine, and 0.1-mg/h nitroglycerin transdermal patch on supine BP, orthostatic hypotension, and pressure natriuresis in 23 patients with primary autonomic failure and supine hypertension. Medications were given at 8:00 PM, and BP was recorded every 2 hours for 12 hours. The maximal decrease in BP was seen 6 to 8 hours after drug administration and was similar to clonidine and nitroglycerin (-29+/-9 and -30+/-10 mm Hg, respectively), as was the average fall in BP throughout the night. However, only clonidine effectively reduced nocturnal natriuresis (-0.09 mmol/mg Cr; 95% CI, -0.13 to -0.04; P=0.004), but this was not associated with improvement in morning orthostatic hypotension because of a residual hypotensive effect. The decrease in BP induced by clonidine was modestly but significantly correlated with the magnitude of residual sympathetic tone determined in 10 subjects by the fall in BP induced by ganglionic blockade (r=0.66; P=0.043). These results are consistent with residual sympathetic tone contributing to supine hypertension in autonomic failure, which can be targeted with clonidine to decrease BP and nocturnal natriuresis.

Aged↗
PubMed1998

Appraising pulmonary edema using supine chest roentgenograms in ventilated patients.

The role of portable, anteroposterior, supine chest X-rays (CXRs) in distinguishing hydrostatic pulmonary edema (HPE) from permeability pulmonary edema (PPE) in mechanically ventilated patients is controversial. We prospectively obtained and evaluated such CXRs in 33 supine, mechanically ventilated intensive-care-unit patients with pulmonary artery catheters. Three chest radiologists independently reviewed CXRs without clinical information and recorded the cardiothoracic (CT) ratio, vascular pedicle width (VPW), and other radiographic features commonly used to evaluate pulmonary edema. Hydrostatic pulmonary edema was associated with a larger CT ratio (p < 0.001), subjective impressions of cardiomegaly (p < 0.01), and increased VPW (p = 0.02). There was a significant correlation between the pulmonary artery occlusion pressure and the VPW (r = 0.45, p = 0.0076) and CT ratio (r = 0.52, p = 0.0016), as well as between the VPW and CT ratio (r = 0.49, p = 0.0032). Despite this detailed evaluation of the CXRs, the mean accuracy of the radiologists' clinical diagnosis of HPE versus PPE was 41%, and 15 of 19 (79%) of PPE patients showed one or more roentgenographic signs of volume overload. Receiver-operating-characteristic curves were constructed to determine optimum cut-off values of VPW and CT ratio associated with HPE. Hydrostatic pulmonary edema was found to correlate best using a VPW > 63 mm coupled to a CT ratio > 0.52 (p = 0.027). With this combination of objective criteria, radiologists' diagnostic accuracy could have been increased to 73%. We therefore conclude that measurements of CT ratio and VPW correlate with pulmonary artery occlusion pressure in supine, mechanically ventilated patients. Distinction of hydrostatic from permeability pulmonary edema is difficult using portable, supine CXRs, but readily assessed radiologic signs may contribute to the correct diagnosis.

Adult↗
PubMedDate not supplied

Gastroesophageal reflux in intubated patients receiving enteral nutrition: effect of supine and semirecumbent positions.

The incidence of gastroesophageal reflux (GER) in critically ill patients as well as the effect of a nasogastric tube (NGT) and body position as risk factors for GER were determined. Seventy patients with orotracheal intubation receiving enteral nutrition through a NGT for more than 48 hours were prospectively studied with two randomly assigned body positions: supine or semirecumbent. Detection of GER was achieved by scintigraphy after labeling gastric contents with 500 microCi of technetium-99m sulfur colloid administered through the NGT. In 50 patients scintigraphy was performed after subjects had remained in the randomized position for 2 hours with the NGT pinched. Twenty additional patients were studied after the NGT had been removed. In 50 patients with NGT, GER was present in 74% (37 of 50) and was higher in the supine position (81%, 21 of 26) than in the semirecumbent position (67%, 16 of 24), but this difference was not statistically significant (p = .26). In 20 patients without NGT, the incidence of GER was 35% (7 of 20) and it was also higher in the supine (50%, 6 of 12) than in the semirecumbent position (12%, 1 of 8, p = .16). There was a statistically significant difference between GER in patients with and without NGT (74% vs 35%, p = .0002). These data show that there is a high incidence of GER in patients with orotracheal intubation and NGT. The presence of a NGT is a risk factor for GER. Semirecumbency does not prevent GER, but there is less incidence than in the supine position.

Adolescent↗
PubMed2005

The resisted supination external rotation test: a new test for the diagnosis of superior labral anterior posterior lesions.

PURPOSE: To evaluate a new clinical test, the resisted supination external rotation test, for the diagnosis of superior labral anterior posterior lesions of the shoulder. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Forty athletes (average age, 23.9 years) with activity-related shoulder pain were enrolled in the study. The patients underwent 3 different tests designed specifically to detect superior labral anterior posterior lesions (the resisted supination external rotation test, the crank test, and the active compression test); the tests were performed in a random order on the affected shoulder. The results of the tests were compared with arthroscopic findings. RESULTS: Out of 40 athletes, 29 (72.5%) had superior labral anterior posterior tears. The resisted supination external rotation test had the highest sensitivity (82.8%), specificity (81.8%), positive predictive value (92.3%), negative predictive value (64.3%), and diagnostic accuracy (82.5%) of all tests performed. CONCLUSION: By re-creating the peel-back mechanism, the resisted supination external rotation test is more accurate than 2 other commonly used physical examination tests designed to diagnose superior labral anterior posterior tears in overhead-throwing athletes. By using this test in the context of a thorough clinical history and physical examination, lesions of the superior labrum can be more reliably diagnosed.

Acromioclavicular Joint↗
PubMed1989

Kinematics of the ankle/foot complex--Part 2: Pronation and supination.

The influence of pronation and supination of the foot on the joints of the ankle/foot complex was analyzed three dimensionally by roetgen stereophotogrammetry in eight healthy volunteers. Radiopaque markers were introduced into the tibia, talus, calcaneus, navicular, medial cuneiform, and first metatarsal bones. The subjects stood on a platform that was tilted in 10 degree-steps from 20 degrees of pronation to 20 degrees of supination. Pairs of x-ray exposure were made in each position. Calculation of resulting joint deviations from the neutral position showed that the largest amounts of motion occurred in the talonavicular joint followed by the talocalcaneal joint, in the latter case mainly in supination. The joints proximal and distal to the medial cunriform also participated substantially in the total motion registered. The tibia showed an average of 0.2 degrees of external rotation for each degree of supination of the foot.

Ankle Joint↗
PubMed2003

Effect of changing patient position from supine to prone on the accuracy of a Brown-Roberts-Wells stereotactic head frame system.

OBJECTIVE: Despite the growing popularity of frameless image-guided surgery systems, stereotactic frame systems are widely accepted by neurosurgeons and are commonly used to perform biopsies, functional procedures, and stereotactic radiosurgery. We investigated the accuracy of the Brown-Roberts-Wells stereotactic frame system when the mechanical load on the frame changes between preoperative imaging and the intervention because of different patient position: supine during imaging, prone during intervention. METHODS: We analyzed computed tomographic images acquired from 14 patients who underwent stereotactic biopsy, deep brain stimulator implantation, or radiosurgery. Two images were acquired for each patient, one with the patient in the supine position and one in the prone position. The prone images were registered to the respective supine images by use of an intensity-based registration algorithm, once using only the frame and once using only the head. The difference between the transformations produced by these two registrations describes the movement of the patient's head with respect to the frame. RESULTS: The maximum frame-based registration error between the supine and prone positions was 2.8 mm; it was more than 2 mm in two patients and more than 1.5 mm in six patients. Anteroposterior translation is the dominant component of the difference transformation for most patients. In general, the magnitude of the movement increased with brain volume, which is an index of head weight. CONCLUSION: To minimize frame-based registration error caused by a change in the mechanical load on the frame, stereotactic procedures should be performed with the patient in the identical position during imaging and intervention.

Brain Diseases↗
PubMed2005

Detection of amiodarone-induced pulmonary toxicity in supine and prone positions: high-resolution computed tomography study.

BACKGROUND: The aim of the present study was to describe the effectiveness and feasibility of high-resolution computed tomography (HRCT) in patients in supine and prone positions to detect amiodarone-induced pulmonary toxicity (APT). With regard to the possible differential diagnosis, our second goal was to emphasize the clinical value of HRCT with the patients in supine and prone positions compared with other paraclinical tests. METHODS AND RESULTS: Thoracic HRCT taken in both positions for 23 patients who were administrated amiodarone were prospectively evaluated in the current study. High-resolution computed tomography scans obtained with the patient in a prone position were helpful in differentiating dependent opacity from lung disease in 11 out of 23 patients. In another 4 patients, HRCT scans obtained with the patient in a prone position were useful in confirming the presence of subtle ground-glass opacities, considered as APT. Combination of HRCT in supine and prone positions provided a more reproducible method for evaluating the global extent of APT than other paraclinical tests. CONCLUSIONS: High-resolution computed tomography used in prone positions as well as a supine position could be an effective technique for reducing false-positive results in detection of APT and preventing the clinically serious pulmonary adverse effects by amiodanone.

Adult↗
PubMed2002

Spontaneous arousals in supine infants while swaddled and unswaddled during rapid eye movement and quiet sleep.

OBJECTIVE: Supine sleep is recommended for infants to decrease the risk of sudden infant death syndrome, but many parents report that their infants seem uncomfortable supine. Many cultures swaddle infants for sleep in the supine position. Swaddled infants are said to "sleep better"; presumably they sleep longer or with fewer arousals. However, there have been no studies of the effect of swaddling on spontaneous arousals during sleep. Arousal is initiated in brainstem centers and manifests as a sequence of reflexes: from sighs to startles and then to thrashing movements. Such "brainstem arousals" may progress to full arousal, but most do not. METHODS: Twenty-six healthy infants, aged 80 +/- 7 days, were studied during normal nap times. Swaddled (cotton spandex swaddle) and unswaddled trials were alternated for each infant. Sleep state (rapid eye movement [REM] or quiet sleep [QS]) was determined by behavioral criteria (breathing pattern, eye movements) and electroencephalogram/electrooculogram (10 infants). Respitrace, submental and biceps electromyogram, and video recording were used to detect startles and sighs (augmented breaths). Full arousals were classified by eye opening and/or crying. Frequencies of sighs, startles, and full arousals per hour were calculated. Progression of events was calculated as percentages in each sleep state, as was duration of sleep state. RESULTS: Swaddling decreased startles in QS and REM, full arousal in QS, and progression of startle to arousal in QS. It resulted in shorter arousal duration during REM sleep and more REM sleep. CONCLUSIONS: Swaddling has a significant inhibitory effect on progression of arousals from brainstem to full arousals involving the cortex in QS. Swaddling decreases spontaneous arousals in QS and increases the duration of REM sleep, perhaps by helping infants return to sleep spontaneously, which may limit parental intervention. For these reasons, a safe form of swaddling that allows hip flexion/abduction and chest wall excursion may help parents keep their infants in the supine sleep position and thereby prevent the sudden infant death syndrome risks associated with the prone sleep position.

Arousal↗
PubMed1994

Electrophysiological studies of the biceps brachii activities in supination and flexion of the elbow joint.

Activities of the biceps brachii (long head: BiL, short head: BiS) on the elbow joint were studied using an electrical neuromuscular stimulation (ENS) and an electromyography (EMG). In ENS study, ENS to BiL or BiS was performed in seven volunteers. Before ENS, the volunteer relaxed the upper extremity on a table with the elbow extended and the forearm pronated. Then ENS-induced movements of the upper extremity were examined. Movements of elbow flexion and forearm supination were induced simultaneously by ENS to BiS in all volunteer and by ENS to BiL in six volunteers. ENS to BiL of one volunteer resulted in only elbow flexion. In EMG study, averaged EMGs of BiL and BiS during a to-and-fro motion from prone to supine of the forearm with holding a load were analyzed in eight volunteers. The volunteer acted the movements with keeping the elbow joint in different angles. Although an increase and a decrease of EMG activities in BiL and BiS were observed accompanied by the degree of forearm supination, patterns of changes in quantities of EMG activities to changing elbow angles varied from individual to individual. These findings seem to indicate that each human subject has an individual use of the biceps brachii for supination movements, while the action of the muscle on the elbow joint is similar among the subjects.

Adult↗
PubMed1994

Rerouting of the biceps brachii for paralytic supination contracture of the forearm in tetraplegia due to trauma.

Six tetraplegic patients (eight forearms) who had a supination contracture were evaluated after lengthening and rerouting of the biceps brachii. Preoperatively, the mean range of supination and pronation of the forearm was 85 and 14 degrees, respectively. Pronation increased a mean of 75 degrees without affecting the strength of flexion or the flexion-extension arc of motion of the elbow. The forearms that had a satisfactory result had a mean active range of supination of 69 degrees, while those that had a poor result had no active supination. The mean duration of follow-up was twenty-seven months (range, twelve to seventy-two months). The result was considered satisfactory for six limbs and unsatisfactory for two. Functional gains were made in the patients' ability to feed and groom themselves, in their ability to tend to personal hygiene, and in writing and typing skills when the dominant extremity was treated. The results were less predictable for the non-dominant extremity. The maximum gain in the range of motion occurred at three months and the maximum functional gain, by six months.

Activities of Daily Living↗
PubMed2001

Comparison and reliability of three goniometric methods for measuring forearm supination and pronation.

Active supination and pronation range of motion of the right forearm by 10 men and 21 women were measured with a goniometer using three methods. For Method One the moveable arm was aligned with a pencil held in the hand; for Method Two the moveable arm was placed over the anterior and posterior surface of the distal forearm for supination and pronation, respectively; and for Method Three the moveable arm was aligned parallel with a visualized line connecting the distal ulna and radius. Supination range of motion was greatest for Method One, followed by Methods Three and Two, respectively. Pronation range for Method One was less than for the two other methods. Intraclass correlation coefficients ranged from .81 to .97 for three trials within the test session and from .86 to .96 between the test and a 1-hr. retest session for both actions using all three methods. Method One was the most reliable but appeared invalid for measuring supination because of movements of the 4th and 5th metacarpal bones. Methods Two and Three appeared appropriate for clinical application but not interchangeable.

Elbow Joint↗
PubMedDate not supplied

The reliability of the manual supination resistance test.

Several decisions need to be made when prescribing foot orthoses for abnormal foot pronation. One of these decisions is how much force is needed from orthoses to supinate the foot. The supination resistance test has been described as one technique to help determine the amount of force needed. The aim of this project was to determine the reliability of the manual supination resistance test. Four clinicians of differing levels of experience performed the test on 44 subjects (88 feet) on 2 separate days. The test had good reliability overall, with an intertester intraclass correlation coefficient of 0.89. For the two more experienced clinicians, the intratester intraclass correlation coefficients were good (0.82 and 0.78), but for the two inexperienced clinicians they were poor (0.56 and 0.62). The supination resistance test may be clinically useful in the prescription of foot orthoses, but more work is needed to determine its validity and its relationship to clinical outcomes.

Adult↗
PubMedDate not supplied

Acid gastro-esophageal reflux in the 10 degrees-reversed-Trendelenburg-position in supine sleeping infants.

Many pediatricians recommend, empirically, the "supine reversed-Trendelenburg sleeping position" in infant regurgitation, although its efficacy has not been validated. Esophageal pH monitoring data from 10 consecutively investigated regurgitating infants show that the acid reflux parameters in all of them were increased in the "supine reversed-Trendelenburg position at 10 degrees" in comparison to the flat supine sleeping position. We conclude that further studies are needed to evaluate the effect of the "supine reversed-Trendelenburg position" on reflux parameters before recommending this position as a possible treatment to decrease esophageal acid exposure.

Female↗