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PubMed1989

Lung function in the supine and lateral decubitus positions in anaesthetized infants and children.

We have measured dynamic lung compliance or static lung thorax compliance, functional residual capacity (FRC), and two indices of pulmonary gas mixing (pulmonary clearance delay (PCD) and single breath alveolar mixing efficiency (SBAME)) in 25 children in the supine and lateral decubitus position during nitrous oxide-halothane anaesthesia. Fifteen children (5 month-8 yr) breathed spontaneously and 10 (4 month-9 yr) underwent mechanical ventilation. Tidal volume and rate of ventilation were, respectively, 3.5-6.6 ml kg-1 and 22-46 b.p.m. in spontaneously breathing supine children, and 8.3-15 ml kg-1 and 20-30 b.p.m. in mechanically ventilated supine children, and did not differ significantly in the lateral position. There was no significant change in compliance when the child was turned to the lateral position, but FRC increased from 22 (SD7) to 25 (8) ml kg-1 (P less than 0.01) in the spontaneously breathing group and from 19 (6) to 24 (8) ml kg-1 (P less than 0.01) in the other group. In spontaneously breathing children, PCD and SBAME indicated a somewhat impaired pulmonary gas mixing (P less than 0.05) after the child had been turned to the lateral position, but no change occurred in the other group. These findings suggest that the distribution of ventilation in anaesthetized children in the lateral position is similar to that reported previously in anaesthetized adults.

Anesthesia↗
PubMed1995

Anatomical configuration of the spinal column in the supine position. II. Comparison of pregnant and non-pregnant women.

To assess the changes in the curvature of the spinal column in the supine position during pregnancy, we studied seven pregnant (32-37 weeks of pregnancy) and seven non-pregnant women using magnetic resonance imaging. T1-weighted sagittal midline magnetic resonance images of the spinal column were obtained with subjects in the supine position with left tilt. There was no significant difference in the maximum angle of decline of the lumbar spinal canal between the pregnant (mean 12.4 (SD 3.3) degrees) and non-pregnant (13.4 (3.9) degrees) groups. The maximum angle of incline of the upper thoracic spinal canal was smaller in the pregnant (15.8 (2.9) degrees) than in the non-pregnant (22.7 (6.0) degrees) group. The highest point of the lumbar spinal canal was located at a lower lumbar region in the pregnant (median L4-5 (range L4 to L4-5)) than in the non-pregnant (L4 (L3-4 to L4)) group. The lowest point of the thoracic spinal canal was located at a higher thoracic region in the pregnant (T6-7 (T6 to T7-8)) than in the non-pregnant (T8 (T6-7 to T9)) group. This study revealed that the apex of lumbar lordosis was caudad and thoracic kyphosis was reduced in the supine position in the later stages of pregnancy. These changes in the curvature of the spinal column may explain, in part, the enhanced cephalad spread of subarachnoid hyperbaric anaesthetic solutions in the later stages of pregnancy.

Adult↗
PubMed1996

Anatomical configuration of the spinal column in the supine position. III. Comparison of adolescent and adult volunteers.

To clarify the anatomical configuration of the spinal column in the adolescent in the supine position, we have studied 10 adolescent (13-17 yr) and 10 adult (26-38 yr) volunteers using magnetic resonance imaging. T1-weighted sagittal midline magnetic resonance images of the spinal column were obtained with subjects in the supine position. The maximum angles of decline of the lumbar spinal canal did not differ between the adolescent (mean 13.6 (SD 3.3) degrees) and adult (12.4 (3.8) degrees) groups. The maximum angles of incline of the upper thoracic spinal canal were smaller in the adolescent group (15.9 (4.7) degrees) than in the adult group (26.4 (5.8) degrees). The median highest point of the lumbar spinal canal was located at L4 (range L3-4 to L4-5) in both groups. The lowest points of the thoracic spinal canal in the adolescent and adult groups were located at T8-9 (T7 to T9) and T8 (T6-7 to T9), respectively. This study showed that thoracic kyphotic curvature in adolescents was reduced significantly in the supine position compared with that in adults. This minimized thoracic kyphosis may explain, in part, the enhanced cephalad spread of subarachnoid hyperbaric anaesthetic solutions in adolescents.

Adolescent↗
PubMed1997

Effects of the pregnant uterus on the extradural venous plexus in the supine and lateral positions, as determined by magnetic resonance imaging.

To clarify the effects of the pregnant uterus on the extradural venous plexus in the supine and lateral positions, we studied magnetic resonance (MR) images of the lumbar spine in three parturients. T2-weighted axial MR images were obtained with the parturient in the supine and lateral positions. On each slice level in the same subject, the MR images were compared with the control MR images obtained before pregnancy. When the parturient lay supine, the pregnant uterus compressed the inferior vena cava and almost totally obstructed it; the extradural venous plexus was engorged. On turning the parturient into the lateral position, the inferior vena cava was free from compression, and the engorged extradural venous plexus was found to shrink to the level of the non-pregnant state.

Adult↗
PubMed1994

An exploratory study of righting reactions from a supine to a standing position in adults with Down syndrome.

BACKGROUND AND PURPOSE: Standing from a supine position is important for physical independence. The purpose of this study was to determine the developmental level of movement in this righting task of adults with Down syndrome. SUBJECTS: Fifteen subjects (mean age = 37.6 years, SD = 18, range = 22-65) with a diagnosis of Down syndrome and mild to moderate mental retardation participated in this study. METHODS: Subjects were videotaped rising from a supine to a standing position during 10 repeated trials. The video record was analyzed to categorize the standing movements according to VanSant's descriptions. RESULTS: Sixty-four percent of the upper-extremity movements, 14.6% of the axial component movements, and 33.8% of the lower-extremity movements could not be categorized according to VanSant's descriptions. Additionally, developmentally less advanced movements dominated those movements that could be categorized. CONCLUSION AND DISCUSSION: The great variety of movements demonstrated by these subjects in the task of standing from a supine position suggests greater motor maturity than is apparent from the movement sequences described by VanSant. Identifying appropriate standing movements in persons with Down syndrome will require weighing numerous intrinsic factors (eg, physiological and anthropometric) other than motor maturity.

Adult↗
PubMed1998

Comparison of supine and lateral positioning on various clinically used support surfaces.

In this study, interface pressures, transcutaneous oxygen tension (TcPO2), and blood flow were compared with the classic pressure ulcer-prone areas in the supine and lateral position on six different high- and low-air-loss support surfaces. Interface pressures were substantially higher in the lateral decubitus than in the supine position. Consistent with this, mean TcPO2 and blood flow readings over the trochanter in the lateral position were lower than over the sacrum and ischium in the supine position. With weighting, the average TcPO2 readings decreased from 78.6 mmHg to 11.9 mmHg on the trochanter and from 65.4 mmHg to 45.7 mmHg on the sacrum and ischium. In parallel, average laser Doppler readings decreased from 2.3 to 0.7 laser Doppler flow units over the trochanter, but did not change significantly over the sacrum and ischium. These data support the clinical suggestion that the lateral decubitus position should not be maintained for long periods of time, not even on many special support surfaces.

Adult↗
PubMedDate not supplied

Correlation of motor control in the supine position and assistive device used for ambulation in chronic incomplete spinal cord-injured persons.

Neurocontrol of movement after spinal cord injury (SCI) is often spared, but few studies have investigated the chronic incomplete SCI patient. Multichannel surface electromyography (SEMG) can describe characteristics of neurocontrol during a series of volitional and reflex events. The relationship of these neurocontrol characteristics to clinical function is incompletely described. This study, retrospectively, evaluated the relationship between neurocontrol patterns evoked by lower limb movement in the supine position and the assistive device used for ambulation in chronic, incomplete SCI persons. The records of 15 neurologically healthy (9 male, 6 female) and 36 incomplete SCI persons (27 male, 9 female) (C2-T10) were used. SEMG was recorded from both quadriceps, adductors, hamstrings, anterior tibialis and triceps surae muscles and displayed on a stripchart for analysis. SEMG patterns of activity recorded in the supine position during volitional, unilateral, multijoint (hip and knee flexion and extension) movement attempts were characterized, divided into seven groups and compared with the subjects' self-selected ambulation device (independent, cane, crutches, walker or nonambulatory). The neurocontrol patterns recorded in the supine position correlated well with the SCI subjects ambulatory assistive device. Marked decreases in motor unit output and/or loss of motor organization were found in the nonambulatory group. Coactivation of proximal muscles, poor timing of muscle activity and radiation of activity into contralateral muscles were also noted in subjects who required a walker or crutches. To a lesser degree, abnormal motor patterns were also noted in subjects who ambulated with a cane or independently.

Adult↗
PubMedDate not supplied

Electrodiagnostic examination of the supinator--a more dorsal approach: a brief report.

Examination of the supinator muscle of the forearm may be useful in suspected lesions of the 5th and 6th cervical nerve roots, the upper trunk of the brachial plexus, or the radial nerve. It is critical in localizing the level of involvement in a patient with possible posterior interosseous nerve injury. The traditional techniques in the electrodiagnostic examination of this muscle have approached the muscle from the volar aspect, just radial to the insertion of the biceps tendon, medial to the brachioradialis, through the extensor carpi radialis longus/brevis, between the radial wrist extensors and extensor digitorum communis, or through the extensor digitorum communis. These approaches have the inherent risk of piercing vessels and/or nerves. After reviewing the pertinent anatomy in standard textbooks, magnetic resonance imaging, and a cadaver, we developed a more dorsal approach in the examination of the supinator. Examination of 20 patients by staff, fellows, and residents at our institution resulted in consistent, accurate needle placement, with no complications. We describe a more dorsal approach in the examination of the supinator muscle in the forearm.

Cadaver↗
PubMed1996

Comparison of supine versus prone tomographic myocardial imaging. Effect on false-positive rate.

As in most other nuclear medicine facilities, tomographic myocardial imaging was started here with the patients in the supine position. However, previous planar imaging experience indicated a high number of false-positive results using the supine position for left lateral views of the myocardium. Evaluating the accuracy of supine position SPECT imaging was considered necessary. In 1991, 228 myocardial imaging procedures were performed during a period of 3 months. Coronary arteriography followed within 3 months in 67 of these patients, permitting evaluation of the accuracy of the imaging procedure interpretations. These correlations revealed the accuracy of myocardial imaging to be only 73%. This was caused mainly by a rather large number of false-positive results (24%) occurring mostly in the inferior-posterior wall. A similar comparison was performed in 1992 after a change to prone position for routine tomographic myocardial imaging with 63 of 295 patients undergoing coronary arteriography. These data revealed an increase in the overall accuracy to 81% and a decrease in the false-positive results to 16%. The improvements were almost entirely in the inferior-posterior regions with no significant change in the false-positive results in the anterior wall. These findings provide convincing evidence that the prone position should be selected for tomographic myocardial imaging.

Adult↗
PubMed1992

Effect of prone versus supine patient positioning on pelvic magnetic resonance image quality.

RATIONALE AND OBJECTIVES: Magnetic resonance imaging (MRI) of the pelvis in the prone position has been proposed as a means of reducing motion-related image blurring. The authors performed a randomized controlled trial to determine if patient positioning affects image quality. METHODS: All women undergoing pelvic MRI during a 7-month period, who could lie both prone and supine, were randomized to the supine or prone position. The quality of axial T2-weighted spin-echo images was rated by two radiologists using a 1-to-4 scale (1 = marked blurring to 4 = sharp definition of pelvic structures). RESULTS: Of 78 eligible women, 61 were randomized. Two patients could not complete the examination. The mean image quality rating of 2.8 for the 32 patients imaged prone was not significantly different from the mean rating of 2.9 for the 27 patients imaged supine (P = .5, Mann-Whitney U test). CONCLUSION: Patient positioning did not significantly affect pelvic MRI quality. The choice of patient position should be based on other considerations, such as patient comfort or ease of patient positioning.

Adult↗
PubMedDate not supplied

Hepatodiaphragmatic interposition of the colon in the upright and supine position.

OBJECTIVE: Hepatodiaphragmatic interposition of the colon (HDIC) has been previously evaluated with chest radiography (CR) of patients examined in an erect position. In this work the presence of HDIC was assessed in patients who underwent CT in the supine position. MATERIALS AND METHODS: In 1,440 patients, 806 men and 634 women, 19-83 years old subjected to CR and abdominal CT for various indications, HDIC was retrospectively evaluated. RESULTS: In 2.4% of the patients HDIC was found using CT in the supine position but in only 0.3% on CR. The variation appeared more frequently in men than in women and in older adults and individuals with an increased amount of intraabdominal fat. This latter finding may represent an additional factor favoring malposition of the colon. CONCLUSION: The results of this study indicate that HDIC has a significantly greater incidence in the supine position of patients, and it can not be excluded on the basis of negative CR.

Adipose Tissue↗
PubMed1995

Variability in lesion depth on prone and supine CT scans of the chest: implications for the accuracy of transthoracic needle aspiration biopsy.

Transthoracic needle biopsy of the lung is often performed fluoroscopically in the prone position; nodule depth measurements are made from accompanying computed tomographic (CT) scans performed supine. We evaluated the effect of prone and supine positioning on the effect of nodule depth as measured from the skin surface. Twenty consecutive patients having CT-guided biopsy performed in the prone position were assessed. Nodule depth from posterior skin surface to nodule was compared with prebiopsy supine CT scan. Nodules above the carina showed minimal change in depth. Those below the carina showed considerable variability, with depth changes < or = 4.0 cm. Awareness of the magnitude of the potential effect of patient position on lesion depth should be helpful in reducing the likelihood of false negative results in fluoroscopically guided biopsy.

Biopsy, Needle↗
PubMed2003

The effect of pronation and supination on the minimally displaced scaphoid fracture.

The amount of rotation that occurs at the scaphoid waist fracture site with pronation and supination of the forearm is studied in 10 upper extremities from cadavers. Two colinear metal markers were placed in the osteotomized scaphoid and a below-the-elbow cast was applied. Spiral volumetric computed tomography scanning of the scaphoid was done with multiplanar reformation to evaluate displacement of the metal markers. Four of the 10 specimens also were studied without any immobilization. The total magnitude of motion from pronation to supination averaged 0.2 mm in the specimens with a below-the-elbow thumb spica cast, and 2.4 mm in specimens without immobilization. The current study showed no significant rotation at the minimally displaced scaphoid waist fracture site during pronation and supination in a below-the-elbow cast. Furthermore, there is unacceptable rotation at the fracture site in the absence of a cast. Based on this study, a below-the-elbow thumb spica cast seems adequate for fracture immobilization; however, clinical correlation is needed.

Cadaver↗
PubMed2005

"Supine-prone" dynamic X-ray examination: new method to evaluate low-grade lumbar spondylolisthesis.

Lumbar instability often causes clinical symptoms, and spondylolisthesis is a main factor of the low back pain. Segmental lumbar instability generally is due to a degenerative or listhesic process of the lumbar spine and radiological imaging is essential to diagnose it. Lumbar spine segmental mobility has commonly been studied by dyanamic radiographic methods. Dynamic X-rays, with maximal extension and flexion of the lumbar tract, represents the most widely used technique and a valid method to estimate sagittal segmental lumbar motion. Between 1998 and 2002 we treated 75 patients for low-grade spondylolisthesis. All patients underwent a preoperative dynamic X-rays examinination, to evaluate the degree of the lumbar mobility. We report a supine-prone position as new method to clearly estimate the slipping of lumbar vertebrae. The patients had a standard lateral X-rays film in the supine position, and then in the "prone" position. We compared the two methods and we found a higher degree of listhesis in 19 cases (14 I grade, 5 I-II grade), while there was no difference in 56 cases. The higher degree of listhesis was in the prone position. We believe that the supine-prone position is an economic method and should be mandatory performing a dynamic X-rays examination.

Humans↗
PubMed2000

Tibialis anterior tendon transfer for residual dynamic supination deformity in treated club feet.

Twenty-seven previously treated club feet in 25 patients were evaluated retrospectively following tibialis anterior tendon transfer to the dorsum of the foot to correct residual dynamic supination deformity. In 11 feet, the transfer was combined with additional soft tissue and or bony procedures to treat other accompanying deformities. Electrophysiologically demonstrated peroneal weakness causing muscle imbalance contributed to the etiology of this dynamic deformity. At follow-up, none of the patients had dynamic supination deformity during ambulation. All showed active contraction of the transferred tibialis anterior tendon. There was no case of overcorrection. Functional and cosmetic results were assessed by parents and surgeons as being excellent. Tibialis anterior tendon transfer is recommended to correct residual dynamic supination deformity and to restore muscle balance after satisfactory correction of idiopathic club foot contractures.

Child↗
PubMed2002

Supine behaviour predicts the time to death in male Mediterranean fruitflies (Ceratitis capitata).

Over 97% of the 203 male medflies monitored in a lifetime study of their behaviour exhibited what we term supine behaviour (temporary upside-down orientation) starting an average of 16.1 days prior to their death (mean lifespan of 61.7 days). Supine onset increased the mortality risk by 39.5-fold and a unit increase in supine level increased mortality by 26.3%. The discovery that behavioural traits in insects can be used as biomarkers of their health and to predict their time to death has important implications regarding research on morbidity dynamics, behavioural neuroethology and gerontology, and the interpretation of longevity extension in model organisms.

Aging↗
PubMed2005

A prospective, randomised controlled trial comparing the efficacy of pre-oxygenation in the 20 degrees head-up vs supine position.

We investigated whether positioning patients undergoing general anaesthesia for cholecystectomy in a 20 degrees head-up position, as opposed to supine, improved the efficacy of 3 min of standard pre-oxygenation via a circle breathing system. Following pre-oxygenation, patients received a standard induction of anaesthesia and the apnoea time (from administration of rocuronium to the arterial oxygen saturation to fall to 95%) was recorded. Mean (95% CI) apnoea time was 386 (343-429) s in the 20 degrees head-up position (n = 17) vs 283 (243-322) s in the supine position (n = 18; p = 0.002). Pre-oxygenation is significantly more efficacious and by inference more efficient in the 20 degrees head-up position than in the supine position.

Adult↗
PubMed2004

Extraperitoneal laparoscopic retroperitoneal lymph node dissection in supine position after chemotherapy for advanced testicular carcinoma.

AIM: To evaluate the feasibility and usefulness of extraperitoneal laparoscopic retroperitoneal lymph node dissection (RPLND) in the supine position after chemotherapy for advanced testicular carcinoma. METHODS: Three patients with advanced testicular cancer underwent chemotherapy. Although serum markers were decreased compared with the normal range, residual masses requiring surgical resection were recognized by computed tomography scanning. We applied extraperitoneal laparoscopic RPLND. The patients were placed in the supine position and the first trocar was inserted two finger widths medial to the anterior iliac spine. The retroperitoneal space was dilated using a preperitoneal distention balloon. Two more ports were inserted into the retroperitoneal space and surgery proceeded thereafter. RESULTS: The residual tumors were completely resected by laparoscopy. The procedure required 250-310 min and the bleeding volume was below 50 mL. Although the histopathological findings consisted only of necrosis in all of the patients, one patient recurred at the same place. CONCLUSIONS: Extraperitoneal laparoscopic RPLND in the supine position for residual tumors after chemotherapy is technically feasible and useful in terms of postoperative recovery. With regard to cancer control, further evaluation should be necessary.

Adult↗