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PubMed1980

Decreased intervillous and unchanged myometrial blood flow in supine recumbency.

The supine position in late pregnancy is associated with many hemodynamic changes caused by compression of the inferior vena cava and a resulting fall in cardiac output. To investigate the effect of this position on uteroplacental blood flow, 22 women with normal (N = 12) or hypertensive (N = 10) pregnancy were investigated using the intravenous 133Xe washout method, in both the supine and left-tilted (45-degree) lateral positions. The intervillous blood flow (113 +/- 48 ml/min/dl) was lower in the supine position than in the left-tilted position (141 +/- 48 ml/min/dl) (P less than 0.01), while the myometrial blood flow was similar in both (9.0 +/- 3.3 ml/min/100 g in supine and 8.7 +/- 2.7 ml/min/100 g in left-tilted position). The results suggest that the autoregulation system for uteroplacental circulation is operative only in the nonplacental component of the pregnant uterus.

Adolescent↗
PubMedDate not supplied

Functional bracing of Colles' fractures: a prospective study of immobilization in supination vs. pronation.

In a prospective study, 156 Colles' fractures were treated with a functional Orthoplast brace. Approximately one-half were braced in pronation and one-half in supination. One hundred and four were available for follow-up. Results were analyzed by type of fracture and position of immobilization (pronation versus supination). In evaluating the results, we found that: (1) displaced Colles' fractures without articular involvement (Type II) braced in supination yielded superior anatomic results when compared with those treated in pronation; (2) Type IV (displaced intra-articular) fractures braced in supination obtained a significantly higher percentage of excellent functional and anatomic results than those braced in pronation. In general, treatment with functional bracing yielded 90% excellent or good functional results.

Adolescent↗
PubMed1980

Postural blood pressure differences in pregnancy. A prospective study of blood pressure differences between supine and left lateral position as measured by ultrasound.

Differences in blood pressure between the supine and left lateral positions were studied in pregnant subjects under standardized conditions with an automated ultrasound device. Cross-sectional studies were performed in 125 nulliparous pregnant women after the twenty-eighth week of amenorrhea and in 42 nonpregnant controls. Arterial blood pressure in the left lateral position was lower than in the supine position. This difference was due largely to differences in hydrostatic pressure. Large errors in measurement and regression to the mean contributed to wide spread in measured values. Neither hypertension nor pregnancy alone gave an enhanced postural difference in blood pressure. Hypertension in pregnancy was associated with a significantly larger positional change in diastolic blood pressure (D) than in systolic blood pressure (S). This study pleads for a standardized procedure for the measurement of blood pressure in gravidas in the supine position, for the detection of peripheral vasoconstriction in the supine position, and to compare clinical blood pressure studies in different institutions.

Blood Pressure↗
PubMed1996

Effect of positioning on pulmonary function of newborns: comparison of supine and prone position.

The effect of positioning on pulmonary function has been previously evaluated, and the prone position has been reported to be preferable for neonates with various respiratory diseases. Studies in healthy neonates have yielded conflicting results. Using a crying pulmonary function test, we examined the effect of positioning on pulmonary function in healthy full-term neonates. Thirty-nine infants with a mean birthweight (+/- SD) of 3,140 +/- 379 g and a mean gestational age (+/- SD) of 39.8 +/- 1.6 weeks were investigated during the first 6 hours of life. Measurements were obtained in both supine and prone positions using a computerized volume-flow system. There were statistically significant decreases in crying vital capacity (CVC) and peak expiratory flow rate (PEF) in the prone compared with the supine position. However, there were no significant differences in forced expiratory flow rate at 75% (V(75)), 50% (V(55)), and 25% (V(25)) of vital capacity between the two positions. These results suggest that prone positioning decreases lung volume and increases resistance of upper airways. We conclude that healthy neonates should be in the supine posture for optimal ventilation.

Humans↗
PubMed1993

Supine and standing sympathovagal balance in athletes and controls.

Differences in autonomic nerve activity between athletes and controls during supine rest and standing were investigated by recording the cardiac rhythm in 18 professional cyclists and 11 controls. We computed four indexes of autonomic control: the standard deviation (SD) of the interbeat intervals, the coefficient of variance (CV) of the interbeat intervals, the percentage of successive intervals differing by more than 50 ms (pNN50), and the fraction low-frequency (0.07-0.14 Hz) spectral power (LF), and we also measured the mean interbeat interval (MI). Significant differences (Student's t-test, P < 0.005) between the athletes and the controls in the supine position were found for pNN50 [mean 52.6 (SEM 2.5) vs 37.1 (SEM 3.4)%], LF [mean 32.2 (SEM 1.6) vs 40.7 (SEM 2.1) normalized units], and MI [mean 1241 (SEM 20) vs 1021 (SEM 25) ms]. A significant difference between the athletes and the controls in the standing position was found for MI [mean 888 (SEM 13) vs 801 (SEM 23) ms]. These results would suggest that there is a parasympathetic predominance in athletes in the supine, but not in the standing position. The finding that pNN50 and LF, but not SD and CV, differed between the athletes and the controls, would seem to demonstrate that the differences in autonomic control between the athletes and the controls are reflected in the quality (balance between slow and fast heart rate fluctuations) rather than in the quantity of heart rate variability.

Adult↗
PubMed1998

Evaluation by ventilation and perfusion scintigraphy in patients who developed postural hypoxemia in the supine position.

Ventilation and pulmonary perfusion scintigraphy were performed in 7 patients in whom postural change from the sitting position to the supine position decreased partial oxygen pressure in arteries (PaO2) by 15 mmHg or more. Six of these 7 patients were obese. Five patients had organic pulmonary disease or space occupying lesions of the liver. On lateral supine-position images taken by using the continuous inhalation method for 81mKr ventilation scintigraphy, ventilation was reduced in the dorsal area corresponding to a gravity-dependent area, but on pulmonary perfusion scintigrams, there were no marked changes compared to normal adults. The mismatch of ventilation to perfusion may have caused hypoxemia. Reduced ventilation was correlated with reduced PaO2. The distribution of 81mKr bolus gas inhalation suggested closure of the airway in the dorsal area at functional residual capacity (FRC), which means the resting expiratory level, in the supine position.

Adult↗
PubMed2006

Minimally invasive total hip replacement with the patient in the supine position and the contralateral leg elevated.

OBJECTIVE: Supine positioning of the patient taking into account - the demands of anesthesia in an emergency requiring intubation, - minimal time for sterile draping, - patient position can be adjusted by the assistants, - easier implant positioning due to the supine position. Reduction of operative trauma with earlier mobilization and shorter rehabilitation time compared with conventional technique. Application of standard instruments and implants. INDICATIONS: Coxarthroses, necroses of the femoral head. CONTRAINDICATIONS: For the "gynecologic position": - hip joint arthrodesis of the contralateral side. - flexion of the contralateral side < 20 degrees . For minimally invasive total hip replacement: - severe anatomic deformities. - revision operations. POSITIONING AND SURGICAL TECHNIQUE: Supine position of the patient with the contralateral leg held at approximately 30 degrees flexion in a gynecologic footrest attached to the operating table. Leg support that can be lowered for the leg being operated on. Minimally invasive anterolateral approach without dissection of muscles or tendons. Resection of the femoral neck and removal of the femoral head. Preparation of the acetabulum and implantation of the cup. Hyperextension of the leg by lowering the leg support with subsequent adduction and external rotation beneath the elevated contralateral leg. Preparation of the femur and implantation of the stem with subsequent repositioning and wound closure. RESULTS: 185 total hip replacements were performed with this positioning and surgical technique from September 2004 to June 2005. The first 108 minimally invasive procedures were compared with 117 conventional procedures. The patients operated in minimally invasive technique generally did better in terms of operating time, blood loss, use of analgesics, rehabilitation time, and functional outcomes. In seven patients, shaft fissures occurred within the first 3 months due to too abrupt intraoperative dislocation of the leg (learning curve!), but were all treated by application of cerclage and healed uneventfully.

Adult↗
PubMed1999

Craniospinal axis irradiation in children. Treatment in supine position including field verification as a prerequisite for anesthesia without intubation.

PURPOSE: For craniospinal axis irradiation in young children sometimes anesthesia is required. In order to minimize risks from the anesthesist's point of view supine position would be preferable to standard prone position. In case of irradiation in supine position verification of the 3-field junction in the cervical region causes problems, because there is no direct visual control. For such situations the clinical application of a new technique is presented. PATIENTS AND METHODS: For treatment planning a modern 3D planning system was necessary. Patient's positioning was done by using a vacuum-form body immobilizer and an integrated head mask. Radiation fields were placed only by table movements being calculated by the planning system in relation to a reference point at the patient's surface. In addition to common verification films specially prepared small films were used for the 3-field junction in the cervical region. These films were placed close to the patient for the whole time of each radiation session being exposed by every radiation field. RESULTS: Two children (age 3 and 5 years, respectively) were irradiated as described. Twenty-eight of those specially prepared films were exposed. Two films (7%) had to be excluded because of inadequate exposure. An overlap of radiation fields was seen on 1 of the 26 remaining films (4%), whereas an unacceptable gap was not found. Acute skin reactions were comparable to those observed in patients being irradiated in standard prone position. CONCLUSION: The presented technique for craniospinal axis irradiation in supine position including field verification was not only precise and reproducable, but also comfortable and safe for the patient. We suggest it as a new option for craniospinal axis irradiation in children.

Anesthesia, General↗
PubMed1989

Responses of left and right ventricular ejection fractions to aerobic and anaerobic phases of upright and supine exercise in normal subjects.

The effects of aerobic and anaerobic exercise on ventricular performance were studied in 13 normal subjects who underwent simultaneous pulmonary gas exchange evaluation and exercise radionuclide ventriculography in the supine and upright postures. Right and left ventricular ejection fraction was measured serially at 2-minute intervals during exercise. The anaerobic threshold occurred at 74% and 80% of maximum heart rate, respectively, during upright and supine exercise. Left and right ventricular ejection fractions rose from rest to the anaerobic threshold (p less than 0.01, p less than 0.01, respectively) and there was a further increase between the anaerobic threshold and maximum exercise (p less than 0.01, p less than 0.01, respectively). The rate of rise of ejection fraction beyond the anaerobic threshold was slightly blunted compared with the rise prior to attaining the anaerobic threshold. There was no significant difference in ventricular performance between supine and upright exercise. The data demonstrate that ventricular performance increases steadily during exercise and is not limited by the conversion of aerobic to anaerobic metabolism.

Adult↗
PubMed1988

Hemodynamic profiles at rest and during supine exercise after orthotopic cardiac transplantation.

To characterize the spectrum of hemodynamic findings after orthotopic cardiac transplantation, 20 healthy heart transplant recipients with no evidence of cardiac dysfunction by noninvasive testing were studied for 1 to 51 months (mean 15) following surgery. After routine endomyocardial biopsy, right-sided heart pressures and thermodilution cardiac outputs were measured at rest (supine) and during symptom-limited, graded supine exercise. In addition, the effect of respiration on right atrial pressures and waveforms was determined at rest (supine, legs down), and after passive leg raising (volume loading). During exercise, striking increases of pulmonary artery, pulmonary artery wedge and right atrial pressures were seen. The mean pulmonary artery pressure rose 45% during the first stage of exercise (p less than 0.001) and by peak exercise it had increased 87% above resting values. The pulmonary artery wedge pressure increased significantly with passive leg elevation (p less than 0.001) and during the first stage of exercise rose 61% above baseline values. By peak exercise the mean pulmonary artery wedge pressure was more than double the resting value. Similarly, the right atrial mean pressure increased significantly (p less than 0.001) with passive leg elevation and nearly tripled at peak exercise. All values promptly returned to near baseline after exercise. The cardiac output increased 98% during exercise. During early exercise, the rise in cardiac output was mediated primarily by an increase in stroke volume. At rest, there was an abnormal response in right atrial mean pressure during slow deep inspiration in 7 individuals with legs down and in 12 after passive leg elevation (volume loading), including 4 of 10 patients studied beyond 1 year.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

Correcting trunk muscle geometry obtained from MRI and CT scans of supine postures for use in standing postures.

Many studies have reported the geometry of the trunk muscles for use in models to predict spine loads. However, all have reported data collected from subjects positioned in a prone or supine posture which is required by CT or MRI scan techniques. This study compared the abdominal and extensor muscle moment arms obtained with muscles relaxed and activated and in both supine and upright postures. Both internal ultrasound measurements and external anthropometer measurements were collected. The anterior abdominal wall increased its flexor moment arm by approximately 30% when in a standing posture compared to the supine posture. The effect of an upright posture on the moment arm of erector spinae at the level of L3 was much smaller (3% increase in males and 12% increase in females). There was no moment arm change due to activating the muscles when compared to the relaxed condition for either posture. Modelers should be aware of the need to scale muscle moment arms obtained from MRI/CT scans in order to more accurately predict spine loads in upright postures.

Abdominal Muscles↗
PubMedDate not supplied

Maternal and fetal effects of the supine and pelvic tilt positions in late pregnancy.

Material and fetal cardiovascular effects of position change were assessed in 20 women in late pregnancy. On changing from the left lateral to the supine position, there was a 45% reduction in leg blood flow, measured by strain guage plethysmography. Arterial resistance, measured with Doppler ultrasound in the femoral, brachial and uterine arteries, remained unchanged, confirming the absence of compensatory vasoconstriction. There was no change in blood pressure (BP) in the leg, indicating no significant aortic compression, but a rise in maternal heart rate in the supine position suggested the presence of inferior vena cava (IVC) compression. Neither the left or the right pelvic-tilt position was associated with a significant change in leg blood flow or maternal heart rate compared to the supine position. A possible 'sluice' effect in the placental circulation was not confirmed, as fetal heart rate and umbilical Doppler resistance did not change in any position. In the absence of active vasoconstriction and significant aortic compression, IVC compression is the likely cause of the decrease in leg blood flow, and also of the previously demonstrated decrease in uterine blood flow. Leg BP and Doppler ultrasound measurements of uterine artery resistance may not be adequate measures of the effect of posture on uteroplacental perfusion.

Analysis of Variance↗
PubMed2005

Region-based supine-prone correspondence for the reduction of false-positive CAD polyp candidates in CT colonography.

RATIONALE AND OBJECTIVES: Radiologists often compare the supine and prone data sets of a patient to confirm potential polyp findings in computed tomographic (CT) colonography (CTC). We developed a new automated method that uses region-based supine-prone correspondence for the reduction of false-positive (FP) polyp candidates in computer-aided detection (CAD) for CTC. MATERIALS AND METHODS: Up to six anatomic landmarks are established by use of the extracted region of the colonic lumen. A region-growing scheme with distance calculations is used to divide the colonic lumen into overlapping segments that match in the supine and prone data sets. Polyp candidates detected by means of a CAD scheme are eliminated in colonic segments that have sufficient diagnostic quality and contain polyp candidates in only one of the data sets of a patient. The method was evaluated with 121 CTC cases, including 42 polyps of 5 mm or greater in 28 patients, obtained by use of single- and multidetector CT scanners with standard pre-colonoscopy cleansing. RESULTS: Complete or partial correspondence was established in 71% of cases. Based on a leave-one-patient-out evaluation, application of the method reduced 19% of FP results reported by our CAD scheme at a 90.5% by-polyp detection sensitivity, without loss of any true-positive results. The resulting CAD scheme yielded 2.4 FP results per patient, on average, with the use of the correspondence method, whereas it yielded 3.0 FP results per patient without the use of the method. CONCLUSION: The correspondence method is potentially useful for improving the specificity of CAD in CTC.

Colonic Polyps↗
PubMed2004

Kinesthetic estimation of the main orientations from the upright and supine positions.

This work investigated the accuracy of the perception of the main orientations (i.e., vertical and horizontal orientations) with the kinesthetic modality--a modality not previously used in this field of research. To further dissociate the influence of the postural and physical verticals, two body positions were explored (supine and upright). Twenty-two blindfolded participants were asked to set, as accurately as possible, a rod to both physical orientations while assuming one of the two body positions. The horizontal was perceived more accurately than the vertical orientation in the upright position but not in the supine position. Essentially, there were no differences in the supine position because the adjustments to the physical vertical were much more accurate than they were in the upright position. The lower accuracy in the estimation of the vertical orientation observed in the upright position might be linked to the dynamics associated with the maintenance of posture.

Adult↗
PubMed2006

In vivo 3D arthrokinematics of the proximal and distal radioulnar joints during active pronation and supination.

BACKGROUND: Pronation and supination of the forearm are important motions with major impact of impairment on daily activities. Despite this, the migration of contact of the articular surfaces of the proximal and distal radioulnar joints during active pronation has not been evaluated in vivo. METHOD: Helical CT-data in elbow positions of full active supination, mid position and full pronation with the elbow in extension were acquired from three female subjects and processed in 3D skeletal reconstructions. From the sets of skeletal landmarks relative radioulnar finite helical axes were estimated. The migration of the articular contact was evaluated in the planes perpendicularly reconstructed on these finite helical axes. FINDINGS: The center of the radial head translated 1.96 (SD 0.24) mm from a posterior location on the ulna in supination to a centered location in mid-position and an anterior location in pronation. For the distal radioulnar joint, the center of rotation remained relatively fixed about the center of the curvature of the articular surface of the ulna. RELEVANCE: The motion of the radial head on the ulnar surface consists of an anterior spinning with anterior gliding which contrasts with the concave-convex rule as used in manual therapy i.e. posterior gliding of the caput radii on the ulna with pronation. As such, the findings have major therapeutic implications for manual therapy.

Adult↗
PubMed2005

Doppler tissue imaging during supine and upright exercise in healthy adults.

Doppler tissue imaging variables were measured in 18 healthy men and women during supine bicycle stress exercise and upright exercise treadmill testing. From a color Doppler tissue imaging cineloop, tissue velocities in basal and mid segments of the standard 3 apical views during rest and peak exercise were assessed. Compared segments were adjusted for double product, and peak variables were compared using the paired t test. Peak systolic velocity and strain rate increased with both forms of exercise (P < .03). Time to compression-expansion crossover shortened in all segments with exercise and at peak exercise treadmill testing versus peak supine bicycle stress exercise (P < .03). Of all segments, 81% were analyzable for peak systolic velocity, 79% for strain rate. Doppler tissue imaging is a feasible tool for quantitatively assessing left ventricular response to supine and upright exercise.

Adult↗
PubMed2006

Utility of supine oblique radiographs in detecting cervical spine injury.

A retrospective case-control study was performed to determine if the addition of supine oblique radiographs to the routine cervical spine series results in the detection of patients with cervical spine injuries not identified with standard views alone. The cervical spine radiographs of 82 patients with known cervical spine injuries and 180 hospitalized patients without cervical spine injuries were collected. Radiographs of the two patient groups were randomly combined to form the study sample. The radiographs were reviewed independently by a board-certified radiologist and a board-certified emergency physician. During the first phase, each reviewer was provided with standard views of the cervical spine (lateral, anterior-posterior, open-mouth odontoid, and submental views). During the second phase, each reviewer was provided with the standard views and supine obliques. The reviewers were masked to all clinical information and previous radiologic interpretations. The results showed that in the first phase (standard views only), the two physicians had a sensitivity of 81% (95% confidence interval [CI] 74-87%) and a specificity of 93% (95% CI 90-96%). In the second phase (obliques included), the two physicians had a sensitivity of 76% (95% CI 69-83) and specificity of 90% (95% CI 87-93%). In a subset analysis of patients with posterior element (lamina, facet, and pedicle) fractures, the two physicians had a sensitivity of 88% (95% CI 78-95%) with standard radiographs and 86% (95% CI 76-94%) with the addition of oblique radiographs. In conclusion the addition of supine oblique radiographs to the standard trauma cervical spine series did not increase the readers' sensitivity for detecting patients with cervical spine injuries. Routinely including oblique radiographs in patients undergoing radiographic screening of the cervical spine is not warranted.

Case-Control Studies↗
PubMed2005

A simple technique for craniospinal radiotherapy in the supine position.

PURPOSE: Craniospinal irradiation poses technical difficulties that may be addressed with the use of the newer technologies that have become available over the past decade. The use of CT simulation allows improved target localisation and beam geometry definition while significantly reducing the treatment simulation time. We have developed a CT-based technique for whole CNS irradiation in the supine position that uses fixed field parameters, asymmetric jaws for field matching and drastically reduces simulation and treatment times. METHODS: The patient is CT scanned and treated in the supine position. The clinical target volume and relevant critical structures are outlined on a planning CT scan. Half beam blocked lateral fields with a collimator rotation are used to match the beam divergence from the superior border of the spinal field at the C2 vertebral body. The shielding for the cranial fields is generated automatically, and the dose distribution is calculated using a 3D treatment planning system. Fixed field parameters are used for the planning and treatment. The position of the isocenter of the spine field is always a fixed longitudinal distance from the isocenter of the brain fields. If multiple posterior fields are required, the isocenter of the second spine field is always a fixed longitudinal distance from that of the first and the gap between the fields is determined using virtual simulation and feathered during treatment using the asymmetric jaws of the linear accelerator. All treatment portals are filmed daily during the first week of treatment, and after each junction change thereafter. RESULTS AND CONCLUSION: The supine position provides numerous advantages. Patients are more comfortable, the treatment position is more reproducible, and access to the airway is possible, if necessary, for patient sedation. The use of CT simulation decreases the simulation time, allows for increased planning accuracy, and enables the use of multimodality image registration, and 3D treatment planning. The use of asymmetric jaws allows for junction feathering without changing the patient setup or using a couch angle.

Axis, Cervical Vertebra↗