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PubMed1994

Alcohol ingestion lowers supine blood pressure, causes splanchnic vasodilatation and worsens postural hypotension in primary autonomic failure.

Patients with pure autonomic failure (PAF) and multiple system atrophy (MSA) may complain of feeling light-headed after alcohol ingestion particularly on assumption of the upright posture. The reasons for this have not been investigated. We therefore studied the effects of oral alcohol (40% vodka in sugar-free orange juice) and placebo (juice only) on the systemic and regional (including superior mesenteric artery, SMA) blood flow in nine patients with PAF and six patients with MSA. After alcohol, there was a fall in supine blood pressure (BP) and vasodilatation in the SMA but no change in cardiac output, or forearm muscle and cutaneous blood flow in either PAF or MSA; BP fell further during head-up tilt with no changes in levels of plasma catecholamines. After placebo, there were no changes while supine. We conclude that alcohol lowers supine BP and dilates the SMA with no change in muscle or cutaneous blood flow. Alcohol also enhances the fall in BP during head-up tilt. This may explain the symptoms experienced by PAF and MSA patients after alcohol.

Adult↗
PubMed1981

Hemodynamic abnormalities in response to supine exercise in patients after operative correction of tetrad of Fallot after early childhood.

The exercise hemodynamic values in two groups of patients with repaired tetrad of Fallot (eight patients with some residual pulmonary insufficiency and seven patients without insufficiency) were compared with values in seven patients with trivial pulmonary stenosis who had not been operated on. The patients with tetrad of Fallot underwent surgery after age 8 years and all had a good hemodynamic repair (no shunts and a right ventricular systolic pressure at rest of less than 60 mm Hg). Exercise increased the right ventricular outflow tract gradient by the same magnitude in all three groups of patients. However, both surgically treated groups experienced impaired cardiac pump function on supine exercise (that is, a lower than anticipated cardiac index for the amount of oxygen consumed and a significant decrease in stroke index). Exercise also caused both groups with repair to have a decrease in stroke index and a concomitant increase in right ventricular end-diastolic and pulmonary wedge pressures; in contrast, the patients with pulmonary arterial stenosis had an increase in stroke index and a concomitant decrease in right ventricular end-diastolic and pulmonary wedge pressures. These findings indicate that an impaired cardiac response to supine exercise can occur in patients in whom intracardiac repair of tetrad of Fallot was performed after early childhood, even though they have had a good hemodynamic repair. In addition, the impaired cardiac response to supine exercise in these patients was probably due largely to an altered myocardial compliance rather than to either residual pulmonary stenosis or pulmonary insufficiency.

Adolescent↗
PubMed1987

Anatomic and functional significance of a hypotensive response during supine exercise radionuclide ventriculography.

The significance of a decline in systolic blood pressure (BP) during supine exercise was examined in 820 patients who underwent both supine exercise gated equilibrium radionuclide ventriculography and coronary angiography. Twenty-seven patients, 3% of the study population, had a decrease in systolic BP at peak exercise of more than 10 mm Hg from the systolic BP at rest. Other indicators of ischemia--angina, ST-segment depression, a decrease in ejection fraction and wall motion abnormality during exercise--were present frequently but not uniformly in these patients. Although most patients had a decline in ejection fraction and a new wall motion abnormality with exercise, 4 patients had an increase in ejection fraction with exercise without any regional wall motion abnormalities. Coronary angiography in the 27 patients with systolic hypotension demonstrated severe coronary artery disease (CAD). Twenty-two patients (81%) had 3-vessel or left main CAD. Twenty of these 22 patients with 3-vessel CAD had at least 2 arteries with 90% or more diameter stenoses. Systolic hypotension during supine exercise radionuclide angiography is infrequent, usually associated with evidence of global and regional left ventricular dysfunction, and a marker of very severe CAD.

Aged↗
PubMed1981

Vertical distribution of perfusion and inspired gas in supine man.

In order to specify if a closing volume greater than expiratory reserve volume could influence the distribution of perfusion (Qr), we measured vertical Qr in 6 supine subjects before and after inhalation of an oxygen enriched gas mixture. In addition, we studied Qr and inhaled gas (V alv.) at different lung volumes. We observed a preferential perfusion of non-dependent zones of the supine lung during tidal breathing from FRC correlated to the amount of airway closure represented by the difference between FRC and closing capacity. After oxygen breathing, the distribution of perfusion is reversed and flow is preferentially distributed in the dependent zones of the supine lung. This O2 sensitive effect was time and/or volume history dependent since Qr distribution at FRC after a breath to total lung capacity was similar to that after 3 min of tidal breathing with oxygen mixture. At FRC, the ventilation was preferentially distributed to the non-dependent lung zones. The vertical gradient of both Qr and V alv. increased progressively at higher lung volumes and Va/Q ratios were usually greater in non-dependent zones.

Adult↗
PubMed1985

The effect of a 'containing' position in a hammock versus the supine position on the cutaneous oxygen level in premature and term babies.

We evaluated the influence of positioning, and particularly a containing position in a hammock compared with the supine position, on the respiration of the newborn. Recordings of the transcutaneous oxygen level of 40 preterm babies and 10 full-term babies placed in their incubators alternately in the two positions have been analyzed. We found no significant differences between the means of the oxymetric indexes in the hammock and in the supine position, even when the babies had different gestational ages and birth weights. The advantages of the containing position for the neuromotor and relational development of the newborn in the first year of life in comparison with the effects of supine placement, which should be avoided as much as possible in the premature, are pointed out.

Female↗
PubMed1990

Comparison of hemodynamic responses during dynamic exercise in the upright and supine postures after orthotopic cardiac transplantation.

Abnormal hemodynamic responses during supine exercise have been well documented in orthotopic cardiac transplant recipients. To determine the effect of posture, central hemodynamics were studied in 20 patients during a change from supine to sitting and during graded upright bicycle exercise (group U) and were compared with those of 20 patients matched for age, gender and time from transplantation who were studied after passive leg elevation and during exercise in the supine posture (group S). Passive leg elevation resulted in a 9% increase in stroke index (34 +/- 6 to 37 +/- 6 ml/m2, p less than 0.001) and a 10% increase in cardiac index (3.1 +/- 0.4 to 3.4 +/- 0.5 liters/min per m2, p less than 0.001) in group S patients compared with a 15% reduction in stroke index (34 +/- 7 to 29 +/- 6 ml/m2, p less than 0.001) and a 9% decrease in cardiac index (3.2 +/- 0.6 to 2.9 +/- 0.5 liters/min per m2, p less than 0.001) in group U patients on assuming the sitting posture. Likewise, both the pulmonary capillary wedge pressure and right atrial pressure increased significantly (13 +/- 4 to 17 +/- 8 mm Hg, p less than 0.001 and 5 +/- 3 to 7 +/- 3 mm Hg, p less than 0.001) with passive leg elevation in group S and decreased on sitting (12 +/- 6 to 8 +/- 5 mm Hg, p less than 0.001 and 5 +/- 3 to 3 +/- 2, p less than 0.001) in group U.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Effects of supine and lateral recumbent positions on pulmonary venous flow in healthy subjects evaluated by transesophageal Doppler echocardiography.

OBJECTIVES: This study attempted to evaluate the effects of supine and lateral recumbent positions on pulmonary venous flow by transesophageal Doppler echocardiography in healthy subjects. BACKGROUND: Although transesophageal echocardiographic examination is usually performed with the patient lying in the left lateral decubitus or supine position, little attention has been paid to the effects of these positions on pulmonary venous flow. METHODS: We performed pulsed Doppler transesophageal echocardiography of the left and right pulmonary veins in 16 normal subjects as they lay in the left and right lateral decubitus and supine positions. RESULTS: Data are reported as mean value +/- SD. Adequate recordings were obtained in 12 subjects (75%). In the left pulmonary vein, peak systolic velocity and time-velocity integral of systolic flow increased significantly in the left compared with the right lateral decubitus position (56 +/- 12 vs. 44 +/- 13 cm/s, p < 0.05, and 15 +/- 4 vs. 9 +/- 4 cm, p < 0.05, respectively). In the right pulmonary vein, peak systolic velocity and time-velocity integral of systolic flow decreased significantly in the left compared with the right lateral decubitus position (38 +/- 10 vs. 48 +/- 9 cm/s, p < 0.05, and 9 +/- 2 vs. 12 +/- 2 cm, p < 0.05, respectively). There were no significant differences between positions in peak diastolic flow velocity, time-velocity integral of diastolic flow or peak velocity of flow reversal at atrial contraction. CONCLUSIONS: Pulmonary venous systolic peak velocities and time-velocity integrals of systolic flow increase when the pulmonary venous recording is from the recumbent subject's lower side. Therefore, the effects of position should be considered in evaluating left ventricular diastolic function by transesophageal Doppler echocardiography.

Adult↗
PubMed2005

Supine MR mammography using VIBE with parallel acquisition technique for the planning of breast-conserving surgery: clinical feasibility.

Volumetric interpolated breath-hold examination (VIBE), which provides both high-spatial and high-temporal resolution images, is a useful sequence for determining the extent of breast cancer. The VIBE sequence in combination with the parallel acquisition technique allows for a single breath-hold evaluation of the breast. We evaluated the clinical feasibility of MR mammography in the supine oblique position (supine MRM) using this technique for planning breast conservation surgery. The accuracy of determination of the tumor extent with a deviation of less than 2 cm in length was 90% (36/40). Two cases showed a positive surgical margin (7.4%). Supine MRM is feasible for the planning of breast-conserving surgery.

Adult↗
PubMed2005

Diastolic stress echocardiography: a novel noninvasive diagnostic test for diastolic dysfunction using supine bicycle exercise Doppler echocardiography.

Left ventricular filling pressures can be estimated reliably by combining mitral inflow early diastolic velocity (E) and annulus velocity (E'). An increased E/E' ratio reflects elevated filling pressures and may be useful in assessing an abnormal increase in filling pressures for patients with diastolic dysfunction. The purpose of this study was to evaluate the feasibility of supine bicycle exercise Doppler echocardiography for assessing left ventricular diastolic pressure during exercise. Mitral inflow and septal mitral annulus velocities were measured at rest and during supine bicycle exercise (25-W 3-minute increments) in 45 patients (19 men; mean age, 59 years) referred for evaluation of exertional dyspnea. None had echocardiographic or electrocardiographic evidence of myocardial ischemia with exercise. Patients were classified according to E/E' ratio at rest: 26 had E/E' < or = 10 at rest (group 1) and 19 had E/E' > 10 (group 2). For group 1, 17 had no increase in E/E' during exercise (group 1A) and 9 did (group 1B). For group 2, E/E' did not increase during exercise. Despite different responses of E/E', there was no significant difference in changes of mitral inflow indices (E, A, E/A, deceleration time) between groups. Although the percentage of dyspnea as a primary reason for stopping exercise was similar for the groups, exercise duration was significantly shorter for groups 1B (7.2 +/- 2.5 minutes) and 2 (7.1 +/- 3.3 minutes) than in group 1A (10.4 +/- 3.7 minutes, P = .0129). Diastolic stress echocardiography using a supine bicycle is technically feasible for demonstrating changes in E/E' (filling pressure) with exercise. Our preliminary results suggest the hemodynamic consequences of exercise-induced increase in diastolic filling pressure can be demonstrated noninvasively with exercise Doppler echocardiography.

Adult↗
PubMed2004

The role of supinator in the pathogenesis of chronic lateral elbow pain: a biomechanical study.

The relative contributions of the forearm extensors to the tensile force at the lateral epicondyle were examined by implanting a force transducer in the common extensor tendon of four soft fixed cadaver elbows and sequentially stretching each muscle arising from the lateral epicondye. Extensor carpi radialis brevis and extensor digitorum communis produced the largest increases while the superficial head of supinator produced a moderate increase in tensile force in the common extensor tendon. Extensor carpi radialis longus and extensor carpi ulnaris had no significant effect. Radial tunnel pressure was measured using a balloon catheter in a separate study of five cadaver elbows. Radial tunnel pressure increased on moving the wrist from neutral to a flexion-pronation position. This positional rise in pressure was reduced by supinator musculotendinous lengthening (77%) while lengthening of the extensor carpi radialis brevis and extensor digitorum communis had no effect. This study demonstrates a biomechanical basis for the superficial head of supinator in the aetiology of both lateral epicondylitis and radial tunnel syndrome.

Analysis of Variance↗
PubMed2005

Calf compression pressure required to achieve venous closure from supine to standing positions.

BACKGROUND: Compression therapy needs to narrow the veins of patients with venous disorders to achieve a hemodynamic effect. This study investigated the external pressure necessary to narrow and occlude leg veins in different body positions. METHODS: In nine healthy volunteers and five patients with incompetent small saphenous veins, the diameter of the small saphenous veins and of one posterior tibial vein was measured at the mid level of the calf by duplex ultrasound scans in sitting, standing, and supine positions. A modified blood pressure cuff with an acetate window that permitted ultrasound visualization of the veins was gradually inflated, and the pressures needed to narrow or occlude the veins were recorded. RESULTS: Initial narrowing occurs with a median pressure of between 30 and 40 mm Hg in the sitting and standing positions. Complete occlusion of superficial and deep leg veins occurs with 20 to 25 mm Hg in the supine position, between 50 and 60 mm Hg in the sitting position, and at about 70 mm Hg in the standing position. The difference between sitting and standing, and between standing and supine, was statistically significant (P < .01 and P < .001, respectively). CONCLUSION: The external pressure has to exceed the hydrostatic pressure in the vein to compress leg veins effectively. Higher external pressures than can be expected to be delivered by elastic compression stockings are required to achieve the collapse of lower-extremity veins in the upright position.

Adult↗
PubMed1977

Hemodynamics at rest and during supine and sitting bicycle exercise in patients with coronary artery disease.

To access left ventricular function and compare pulmonary capillary wedge pressure and left ventricular end-diastolic pressure in the supine and sitting positions, 20 men with angina pectoris secondary to coronary artery disease underwent hemodynamic studies at rest and during exercise in the two positions. At rest the values for cardiac index, stroke index, systolic ejection rate index and left ventricular stroke work index were lower in the sitting position; heart rate, left ventricular end-diastolic pressure and pulmonary capillary wedge pressure were similar in the two positions. All patients experienced angina during both exercise periods. At angina during supine exercise, stroke index, systolic ejection rate index and left ventricular stroke work index did not increase significantly from the resting values. In contrast, during sitting exercise, significant increases in these variables were observed. Comparison of data during exercise revealed higher values for heart rate, mean systemic pressure, cardiac index, systolic ejection rate index, left ventricular stroke work index and rate-pressure product and lower values for mean pulmonary capillary wedge pressure (20 +/- 3 versus 27 +/- 3 [mean +/- standard error of the mean] mm Hg, P is less than 0.001), and left ventricular end-diastolic pressure (24+/- 3 versus 31 +/- 3 mm Hg, P is less than 0.02) in the sitting position; stroke index and S-T segment depression were similar during the two exercise periods. Four patients had insignificant increases in left ventricular filling pressure during both exercise periods. Of the 16 patients with abnormal left ventricular filling pressure during supine exercise, only 10 had a similar response during exercise in the sitting position. There was a good correlation between left ventricular end-diastolic pressure and mean pulmonary capillary wedge pressure at rest and during exercise in the two postures.

Adult↗
PubMed1983

Left and right ventricular function at rest and during bicycle exercise in the supine and sitting positions in normal subjects and patients with coronary artery disease. Assessment by radionuclide ventriculography.

To assess the hemodynamic influence of posture during radionuclide cardiac studies, rest and exercise electrocardiographically gated blood pool cardiac scintigraphy was performed in the supine and sitting positions in 22 normal subjects and in 20 patients with coronary artery disease (CAD). In normal subjects, left ventricular ejection fraction was higher in the sitting position both at rest (67 +/- 6% versus 64 +/- 5%, p less than 0.01) and during exercise (79 +/- 9% versus 76 +/- 6%, p less than 0.05). Left ventricular end-diastolic volume in the sitting position was smaller at rest (by 19 +/- 26%, p less than 0.001), but this variable was similar in both positions during exercise (p greater than 0.05). Left ventricular end-systolic volume was smaller in the sitting position both at rest, by 26 +/- 31 percent, and during exercise, by 14 +/- 20% (p less than 0.001). Left ventricular end-diastolic volume increased from rest to exercise, in the sitting position by 31 +/- 23% (p less than 0.001) and in the supine position by 6 +/- 22% (p greater than 0.05). In patients with CAD, similar left ventricular ejection fractions in both postures were found at rest and during exercise. Left ventricular end-diastolic volume in the sitting posture was smaller at rest by 16 +/- 22% (p less than 0.01) and during exercise by 8 +/- 18% (p less than 0.05). Sitting left ventricular end-systolic volume was smaller by 18 +/- 20% (p less than 0.001) at rest and by 14 +/- 21% (p less than 0.01) during exercise. Left ventricular end-diastolic volume increased from rest to exercise, in the sitting position by 45 +/- 36% (p less than 0.001) and in the supine position by 32 +/- 51% (p less than 0.01). Despite significant hemodynamic differences, the value of rest-exercise radionuclide cardiac studies to detect CAD was similar in the 2 positions.

Adult↗
PubMed1985

Rearranged automated keratometer for newborn infants and patients in the supine position.

To measure corneal curvature in newborn infants and patients in the supine position, we rearranged an automated keratometer, dividing it into two parts, the power unit and the measuring system. The measuring unit was mounted on a universal stand. We observed no difference in measured value between the sitting and supine positions and no difference in maneuverability. We also examined the effect of a speculum in normal adult subjects in the supine position, in which both the strong and the weak radii and the axis of astigmatism were slightly affected. However, there was no significant difference in the mean values of the strong and weak radii of corneal curvature in 22 eyes of infants with corrected gestational ages of 37 to 43 weeks. The examination was carried out with ease. The mean value of corneal curvature was 7.05 mm and the range was 6.63 to 7.74 mm.

Adult↗
PubMed1995

The stabilizing mechanism of the distal radioulnar joint during pronation and supination.

A biomechanical cadaver study was performed to determine the roles of the stabilizing structures of the distal radioulnar joint during pronation and supination. Subluxation and dislocation of the radius with respect to the ulna were evaluated in seven cadaver forearms placed in supination, pronation, and neutral forearm rotation. The amount of subluxation was measured with all structures intact, and after sectioning in various sequences the dorsal and palmar radioulnar ligaments, the distal portion of the interosseous membrane including the pronator quadratus, and the entire interosseous membrane. After sectioning two of any four structures, the distal radioulnar joint remained stable. When the interosseous membrane was disrupted first, the dorsal radioulnar ligament was found to be more important than the palmar radioulnar ligament in stabilizing the distal radioulnar joint in pronation, and conversely the palmar radioulnar ligament was more important than the dorsal radioulnar ligament in supination. Dislocation, and frequently diastasis, occurred only with sectioning of all four structures. This suggests that all four structures contribute to stability of the distal radioulnar joint.

Biomechanical Phenomena↗
PubMed1981

Entrapment of the posterior interosseous nerve by a fibrous band in the dorsal edge of the supinator muscle and erosion of a groove in the proximal radius.

An unusual case of transient, reversible entrapment of the PIN has been described. The entrapment was due to a fibrous band at the distal edge of the body of the supinator muscle, not at the level of the arcade of Frohse. The transient paralysis was exacerbated by pronation and alleviated by supination. Release at operation alleviated all symptoms. A radiograph showed erosion in the proximal radius, presumably due to the posterior interosseous nerve. One must consider such an entrapment of the PIN when there is weakness of muscles innervated by the radial nerve distal to its course through the supinator muscle.

Adult↗
PubMed1999

Supine bicycle versus post-treadmill exercise echocardiography in the detection of myocardial ischemia: a randomized single-blind crossover trial.

OBJECTIVES: We sought to determine the comparative accuracy of supine bicycle exercise echocardiography (SBE) and posttreadmill exercise echocardiography (TME) in detecting myocardial ischemia in patients with known or suspected coronary artery disease (CAD). BACKGROUND: Supine bicycle echocardiography and TME have been used for evaluation of CAD. However, the comparative accuracy of these modalities in the detection of ischemia in the same patients is not known. METHODS: Seventy-four patients (age 59 +/- 9 years [mean +/- SD]) referred for evaluation of coronary disease underwent SBE (starting at 25 to 50 W with 25-W increment every 3 min) and post-TME (Bruce protocol) in a random sequence. Digitized images at baseline and maximal exercise were interpreted in a random and blinded fashion. RESULTS: Maximal heart rate was higher during TME, whereas systolic blood pressure was higher during SBE, resulting in a similar double product. At quantitative angiography (n = 67), 57 patients had coronary stenosis (>50%). During SBE, ischemia was detected in 47 patients compared with 38 patients by TME (p < 0.001). Wall motion score index at maximal exercise was higher with SBE than with TME (1.48 +/- 0.51 vs. 1.38 +/- 0.43; p < 0.001). The extent of myocardial ischemia (number of ischemic segments) was higher during SBE compared with TME (3.3 +/- 3.4 vs. 2.3 +/- 2.9 segments; p = 0.004), whereas severity of abnormal wall motion was similar. The sensitivity of SBE and TME for CAD was 82% and 75% with a specificity of 80% and 90%, respectively. Image quality was similar with both techniques. Patients and sonographers favored SBE over TME. CONCLUSIONS: During SBE and TME exercise, patients achieve a similar double product. During SBE, however, the detection of ischemia is more frequent and more extensive which, along with patient and sonographer preference, makes supine bicycle exercise a valuable stress echocardiographic modality.

Adult↗
PubMed1983

Tricyclic antidepressants and supine, standing, and exercise plasma norepinephrine levels.

Fourteen depressed patients were treated for 1 to 8 wk (4.1 +/- 0.6, mean +/- SEM) with imipramine, doxepin, or amitriptyline to study the effects of tricyclic antidepressants (TCAs) on sympathetic nervous system (SNS) function. Eight had chronic but medically stable cardiac disease and six were medically healthy. Supine plasma norepinephrine (NE) and epinephrine (EPI) levels, mean arterial blood pressure (MAP), and heart rate were measured at rest, after standing, and during graded, supine maximal bicycle exercise. Eight nondepressed patients with cardiac disease were studied without drug intervention as controls. There were no baseline differences in any of these measures among the medically healthy depressed subjects, the depressed cardiac patients, and the eight nondepressed patients matched for cardiac disease. After TCAs, NE was increased by 51 +/- 6% of basal values and heart rate rose, but EPI and MAP were unchanged. The supine to 10-min standing increment in NE increased from 309 +/- 51 pg/ml at baseline to 406 +/- 55 pg/ml during TCA treatment. These findings are compatible with an increase in SNS outflow after TCAs.

Adult↗