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PubMed1999

[Supination trauma. A classic case].

Sprains in the lateral ligaments of the ankle produce the most common ligamentous injuries of the human body. The mechanism of injury is complex, while supination represents the main component of foot movement. Classifying lateral ankle ligament injuries, many authors use a system of three degrees, which includes mild, moderate and severe sprains. Despite this scientific categories, in our opinion is the differentiation between elongation and complete ruptures of practical relevance. Under a biomechanical point of view, ligamentous trauma of the lateral ligaments lead to acute antero-lateral rotational instability (ALRI). Following the retrospective clinical study of Zwipp with 1,235 patients, in 70% of complete disruptions, the anterior talo-naviculare and fibulocalcanear ligaments are involved together. Syndesmotic injuries have been reported at a rate up to 10% of ankle sprains with deltoid ligaments at 2.5%. Rarely, the classic ankle sprain leads to injuries which affect the foot on a so called "supination fracture line". A rate of 7.4% is reported for these accompanying injuries. Therefore, clinical examination of ankle sprains should not only address on the distal tip of the fibula. Critical bony and ligamentous structures like the fifth metatarsal base, the calcaneo-cuboideal ligament, the ligaments of the anterior calcaneal process, the talus and syndesmotic ligaments have to be screened for pain and swelling. In our opinion, careful clinical examination and plain radiographs in two plains are sufficient for diagnosing ankle sprains and functional therapy.

Acute Disease↗
PubMed2004

Improvement in obstructive sleep apnea in the supine knees-up position.

We report a 38-year-old man with obstructive sleep apnea whose sleep-disordered breathing was substantially reduced by sleep in the supine, "knees-up" position, relative to his sleep in the customary supine, "knees-down" position. No obvious anatomic or pathophysiologic alterations explained this phenomenon. The effect was reproducible in the patient 4 years later. Potential mechanisms underlying such improvement, including alterations in upper airway/lung volume dependence and venous supply to upper airway vasculature, are discussed. This manipulation could be an important adjunctive treatment for a subset of obstructive sleep apnea patients demonstrating such an effect.

Adult↗
PubMed2006

Effect of supine knee position on obstructive sleep apnea.

We previously reported a case of a middle-aged man whose obstructive sleep apnea (OSA) was virtually eliminated when he slept in the supine "knees up" position. In this study, we attempt to replicate this phenomenon in a group of volunteers with previously diagnosed OSA. Results indicated no significant improvement in OSA when sleeping supine knees up. Examination of distribution of within subjects' change [calculated as Respiratory Disturbance Index (RDI) in the "knees down" position vs RDI in the knees up position] indicated a trend for improvement in the latter (p=0.12, two-tailed probability). These results suggest that knee position is unlikely to be a robust intervention for OSA though they allow for the possibility that some patients may have a moderation of their condition by such a manipulation.

Female↗
PubMed1991

Capabilities of supine exercise electrocardiography versus exercise radionuclide angiography in predicting coronary events.

The ability of supine exercise electrocardiography and exercise radionuclide angiography to predict time to subsequent cardiac events (cardiac death, nonfatal myocardial infarction or late coronary bypass grafting or angioplasty) were compared in 265 patients with normal resting electrocardiograms who were not taking digoxin. All patients had undergone coronary catheterization and were initially treated medically. Follow-up study was performed at a median of 51 months. Separate logistic regression models, which had been previously developed to predict 3-vessel or left main coronary artery disease (CAD), were compared using a Cox regression analysis to predict time to a subsequent cardiac event. The exercise electrocardiography model, consisting of the magnitude of ST depression, exercise heart rate and patient gender, was a powerful predictor (chi-square = 30.8, p less than 0.0001) of subsequent events. The exercise radionuclide angiography model, which included the exercise response of the pressure-volume ratio in addition to the exercise electrocardiography variables, had similar prognostic power (chi-square = 31.8, p less than 0.0001). In a separate analysis considering only cardiac death and nonfatal myocardial infarction, the exercise electrocardiography model remained a significant predictor of events (chi-square = 12.2, p less than 0.001). None of the radionuclide angiography variables added significantly to the prognostic power of the exercise electrocardiography model. Thus, in patients with a normal resting electrocardiogram who are not taking digoxin, the supine exercise electrocardiography model that predicts 3-vessel or left main CAD also predicts future cardiac events. Exercise radionuclide angiography does not provide any additional prognostic information in such patients.

Coronary Disease↗
PubMed1991

Comparison of V'O2 kinetics in upright and supine position.

Oxygen uptake (V'O2) kinetics during exercise depends in particular on muscular aerobic capacity and cardio-vascular parameters. The objective of this study was to investigate the influence of body position on the V'O2 kinetics as determined by means of the PRBS technique. 9 healthy male volunteers performed bicycle ergometer exercise in both upright and supine position. No significant changes were seen in normalized gains and phase shifts of the power-V'O2-relationship. It is concluded that the differences in venous blood volume distribution and cardiac output associated with upright and supine position do not have major effects on power- V'O2-gains.

Cardiac Output↗
PubMed1994

Effects of daily mild supine exercise on physical performance after 20 days bed rest in young persons.

To investigate the effects of daily mild supine exercise on physical performance capacity identified as maximal oxygen uptake rate (VO2max) after 20 days bedrest, 3 male students performed a supine pedaling at 40% intensity of VO2max for one hour every day, while 6 male and 5 female students were control. Before and after the bedrest, muscle mass and strength of exercising leg and cardiovascular responses during -40mmHg lower body negative pressure (LBNP) and moderate upright cycling exercise were measured. Despite the exercise programme VO2max was similarly decreased to the control subjects after bed-rest. The delta VO2max was correlated to delta % left ventricular fractional shortening during LBNP, and also % delta VO2max to % delta stroke volume of the moderate exercise (both p<0.05). The exercise programme should be too weak to maintain cardiovascular functions and thus to present the decrease in VO2max against prolonged bedrest as well as weightlessness stress.

Adult↗
PubMed1989

Gender-related differences in cardiac response to supine exercise assessed by radionuclide angiography.

This study examines the recently reported gender differences in cardiac responses to exercise. The study group consisted of 192 men and 67 women with a low probability of coronary artery disease who underwent supine exercise radionuclide angiography. Men had a lower rest ejection fraction than that of women (0.63 versus 0.66, p = 0.02) and greater increases in ejection fraction with exercise (0.08 versus 0.02, p = 0.0001). The slope relating ejection fraction to metabolic equivalents of exercise (METs) was greater (p = 0.004) for men, even after adjustment for differences in rest ejection fraction and end-diastolic volume index. Compared with men, women had a smaller rest end-diastolic volume index (87 versus 97 ml/m2, p = 0.003) and a greater increase in end-diastolic volume index with exercise (6 versus -2 ml/m2, p = 0.002). The slope relating end-diastolic volume to METs was greater for women, even after adjustment for differences in rest end-diastolic volume index and peak work load. There are clear gender differences in the supine exercise response of ejection fraction and end-diastolic volume that are not explained by differences in exercise capacity.

Adult↗
PubMed1988

Cardiopulmonary effects of one-lung ventilation in supine patients.

The cardiopulmonary effects of one-lung ventilation (OLV), with continuous positive airway pressure (CPAP, 5 cm H2O) to the nonventilated lung, were compared to the effects of two-lung ventilation (TLV) in 12 supine patients undergoing coronary artery bypass grafting (CABG). Monitoring was performed with electrocardiography (ECG), arterial, and pulmonary artery catheters. Measurements of cardiac index (CI), heart rate (HR), systemic (MAP) and pulmonary artery pressures (PAP), pulmonary artery occlusion pressure (PAOP), mixed venous oxygen saturation (SvO2), and arterial blood for pH, PaO2, PaCO2 and HCO3- were performed with stable maintenance of anesthesia during both one- and two-lung ventilation. Mean values for CI, HR, MAP, MPAP, PVR, and SvO2 demonstrated no significant changes between OLV and TLV; systemic vascular resistance (SVR) and pulmonary artery occlusion pressure (PAOP) were statistically (P < 0.05) different, but of minor clinical significance. The data suggest that OLV, accompanied by CPAP (5 cm H2O) to the nonventilated lung, produces minimal changes in cardiopulmonary measurements in supine patients.

Adult↗
PubMedDate not supplied

Large visible gas bubbles in the internal jugular vein: a common occurrence during supine radical neck surgery?

STUDY OBJECTIVE: To establish the frequency of large visible bubbles or collections of bubbles in the jugular vein during radical neck dissection in the supine position. DESIGN: Prospective observation by at least two investigators of random consecutive patients scheduled for radical neck surgery. SETTING: Operating room suite in a university hospital specializing in head and neck cancer surgery. PATIENTS: Twelve consecutive ASA physical status II and III patients undergoing modified radical dissection for cancer. INTERVENTIONS: General anesthesia with fentanyl, oxygen (O2) 30% to 40%, nitrous oxide (N2O) 60% to 70%, and isoflurane 0.5% to 1.5%, with mechanical ventilation. Table position horizontal. Modified radical neck dissections performed by attending surgeons. Surgical field (jugular vein) carefully observed by the surgeons and an independent anesthesiologist investigator for the presence of bubbles during the dissection. MEASUREMENTS AND MAIN RESULTS: Easily visible bubbles were observed in the jugular veins of 42% (5 of 12) of the consecutive radical neck dissection patients studied. Some of the collections of bubbles were large (greater than 2.5 cm in diameter). In one case, the appearance and subsequent disappearance of bubbles was followed by a transient drop in arterial blood pressure (BP) and in end-tidal carbon dioxide (PETCO2), which was suggestive of a diagnosis of central venous air embolization. CONCLUSIONS: We theorize that some unexplained, undesirable intraoperative events (hypotension, arrhythmia, and hypoxemia) during radical neck dissection could be a result of venous air embolus or paradoxical air embolus. The anesthesia community should be aware of the high frequency of these visible bubbles in the jugular veins during radical neck surgery, even in the supine position. At minimum, this phenomenon is a frequent event of intellectual interest. At worst, these bubbles may be harbingers of significant central air embolism.

Adult↗
PubMed2004

[Interest and feasibility of a modified supine position for posterior cranial fossa surgical procedures].

The sitting position is considered as a gold standard for posterior fossa surgical procedures. However, in order to decrease the incidence rate of cerebral venous air embolisms, we presently described a modified supine position allowing performance of posterior fossa surgical procedures. Such position is easy and quickly performed with light variations of blood pressure: patients are placed supine with paddings inserted under ipsilateral shoulder and buttock, and head turned to other side of surgical site. Dural tension estimated by the surgeon was always considered as good. We performed more than 100 surgical procedures in this position without any complication for 10 years.

Blood Pressure↗
PubMedDate not supplied

Both-bone forearm osteotomy for supination contracture: a cadaver model.

PURPOSE: To quantify the magnitude of rotational correction possible when comparing a single forearm bone osteotomy and fixation with stepwise osteotomy and fixation of both bones in a cadaver model and to determine if the order in which the stepwise osteotomies are performed influences the amount of correction. METHODS: Ten fresh-frozen cadaveric forearms were fixed to a frame positioned in the field of view of a motion-capture system. An experimental supination contracture was induced in full supination. Cadaver forearms were assigned randomly to group I (ulna osteotomy, rotation, plating) or group II (radius osteotomy, rotation, plating). Cadavers in group I were used later in group III (ulna + radius) by completing a radial osteotomy, rotation, and fixation in the forearms with the plated ulna. Similarly the specimens assigned to group II were used later in group IV (radius + ulna) by completing an ulna osteotomy, rotation, and fixation in the forearms with the plated radiuses. Measurements of forearm pronation were made after single-bone (groups I, II) and stepwise both-bone (groups III, IV) rotational osteotomies. RESULTS: Stepwise rotational osteotomy and fixation of the ulna followed by the radius produced significantly more corrective pronation (101 degrees) than rotating the radius followed by the ulna (65 degrees). Rotating the radius gave only moderate correction (58 degrees) and minimal correction was produced by ulna osteotomy alone (15 degrees). CONCLUSIONS: Rotational osteotomy of both forearm bones can create approximately 100 degrees of correction when performed at the proximal ulna followed by the distal radius. If less rotation is needed then the distal radius osteotomy alone can provide approximately 60 degrees of correction.

Biomechanical Phenomena↗
PubMed2004

Brachioradialis re-routing for the restoration of active supination and correction of forearm pronation deformity in cerebral palsy.

A brachioradialis muscle rerouting procedure was used to restore active supination in five children with cerebral palsy and a pronation deformity. Following release and lengthening of the pronator quadratus and pronator teres muscles, respectively, the brachioradialis tendon was divided as a Z plasty and the distal part of the tendon was passed through the interosseous space in a dorsal to palmar direction, and then sutured to its proximal end. The procedure resulted in a gain of 81 degrees of active supination.

Adolescent↗
PubMed2005

Deformational brachycephaly in supine-sleeping infants.

OBJECTIVES: Medical dictionaries and anthropologic sources define brachycephaly as a cranial index (CI = width divided by length x 100%) greater than 81%. We examine the impact of supine sleeping on CI and compare orthotic treatment with repositioning. STUDY DESIGN: We compared the effect of repositioning versus helmet therapy on CI in 193 infants referred for abnormal head shape. RESULTS: Eighty percent of the infants had a pretreatment CI > 81%. Their initial mean CI at mean age 5.3 months was 89%, and after treatment, their mean CI was 87% (+/-2 SE = 0.9%) at mean age 9.0 months. For 92 infants with an initial CI at or above 90%, their initial mean CI of 96.1% was reduced to a mean of 91.9%. CONCLUSIONS: Post-treatment CI was 86% to 88%, CI in neonates delivered by cesarean section was 80%, and CI in supine-sleeping Asian children was 85% to 91%, versus 78% to 83% for prone-sleeping American children. Repositioning was less effective than cranial orthotic therapy in correcting severe brachycephaly. We recommend varying the head position when putting infants to sleep.

Female↗
PubMed2006

A modified supine position to speed hand assisted retroperitoneoscopic nephroureterectomy: the Johnnie Walker position.

PURPOSE: To minimize the operative time of hand assisted retroperitoneoscopic nephroureterectomy by avoiding position change we report an especially designed surgical position. MATERIALS AND METHODS: A total of 41 patients with upper tract transitional cell carcinoma who underwent hand assisted retroperitoneoscopic nephroureterectomy and bladder cuff resection were enrolled. Patients lay supine, and the flank and hip on the lesion side were elevated 30 degrees. The legs were extended and abducted in the Johnnie Walker position, allowing the operator to stand between them. Operation was completed via a 7 to 8 cm Gibson incision and 2 additional laparoscopic ports. RESULTS: All procedures were successful except 1 open conversion due to bleeding, in which there was no need to reposition the patient. Average patient age was 65.2 years (range 34 to 85), mean operative time was 207.6 minutes (range 130 to 345) and mean estimated blood loss was 166 ml (range 50 to 900). Simultaneous transurethral endoscopic procedures were performed in 11 patients in the same position. Time to oral intake and ambulation was 2.1 and 2.0 days, respectively. Two patients had postoperative complications, including pneumonia and wound hematoma in 1 each. No complication was related to the position. CONCLUSIONS: The Johnnie Walker position minimizes operative time by eliminating the delay caused by patient positioning and draping changes, allowing better coordination for the surgeon and assistant, and permitting more efficient use of the nondominant hand. The retroperitoneal approach prevents bowel interference in the visual field, making laparoscopic surgery in this modified supine position possible. Nephroureterectomy, bladder cuff resection and endoscopic procedures can be done with ease with the patient in this position.

Adult↗
PubMed2005

Association between supine cerebral perfusion and symptomatic orthostatic hypotension.

The goal of this study was to investigate whether the supine resting perfusion of brain tissue in symptomatic patients suffering from orthostatic hypotension (OH) is changed compared to control subjects and whether an association exists between the resting perfusion and the severity of OH. Ten symptomatic OH patients and 8 control subjects were included in this study. One patient was retrospectively excluded because he suffered from multiple system atrophy. Systolic and diastolic blood pressure changes were measured during a tilting bed procedure. Cerebral blood flow, cerebral blood volume and mean transit time were determined by bolus-tracking perfusion MRI and correlated with blood pressure changes. Cerebral blood volume was significantly increased in OH patients compared with control subjects for white matter (P = 0.019) and the mean transit time was significantly increased for gray (P = 0.010) and white matter (P = 0.015). The cerebral blood flow of the gray (r = 0.74, P = 0.022) and white matter (r = 0.75, P = 0.020) was significantly, positively correlated with systolic blood pressure changes. The mean transit time in white matter was significantly, negatively correlated with systolic blood pressure changes (r = -0.68, P = 0.045). This study suggests that in symptomatic patients with OH the cerebral perfusion of the brain in the resting, supine position correlates with the severity of OH as measured by postural changes in blood pressure.

Aged↗
PubMed1998

Importance of intrinsic calf vasodilator capacity in determining distribution of skeletal muscle perfusion during supine bicycle exercise in patients with left ventricular dysfunction.

BACKGROUND: Distribution of skeletal muscle perfusion during exercise is an important factor in determining exercise capacity and is markedly impaired in patients with cardiac disease. This study examined the importance of intrinsic calf vasodilator capacity in determining distribution of skeletal muscle perfusion during supine bicycle exercise in patients with left ventricular dysfunction. METHODS: We studied 19 patients with left ventricular dysfunction (left ventricular ejection fraction <45%) after myocardial infarction. All the patients underwent cardiopulmonary exercise testing with measurements of central hemodynamics, leg blood flow (LBF), and the percentage of cardiac output distributed to both legs (%LBF). Calf reactive hyperemic flow (RH) was measured by venous occlusive plethysmography at supine rest. RESULTS: LBF at peak exercise was closely related to peak cardiac output and RH. Furthermore, %LBF at peak exercise had modest correlation with peak cardiac output and good correlation with RH. Although peak cardiac output and RH were independent determinants of LBF at peak exercise by multiple regression analysis, RH had higher correlation with %LBF at peak exercise than peak cardiac output. Despite marked changes in other hemodynamic variables, nonleg blood flow during exercise was constantly maintained at a level identical to resting value. CONCLUSIONS: Calf vasodilator capacity, which was the major determinant of distribution of skeletal muscle perfusion during exercise, may have contributed to maintaining perfusion of important nonexercising regions during exercise in patients with left ventricular dysfunction.

Adult↗
PubMed1998

Autonomic imbalance in preeclampsia: evidence for increased sympathetic tone in response to the supine-pressor test.

OBJECTIVE: To examine whether an increase in sympathetic nervous tone contributes to the augmented response to cardiovascular reflex testing in preeclamptic women. METHODS: Maternal electrocardiograms were recorded from 11 nonpregnant women and 25 normotensive and 15 preeclamptic nulliparous women at term, during periods of quiet respiration in the left-lateral position and after shifting to the supine position. Power spectral analysis was applied to epochs of 512 consecutive beat-to-beat intervals to determine the contribution of sympathetic tone, parasympathetic tone, and respiratory sinus arrhythmia to heart rate variability. RESULTS: Both normotensive and preeclamptic pregnant women showed a significant decrease in respiratory sinus arrhythmia and an increase in sympathetic tone compared with nonpregnant women. In nonpregnant and in normotensive pregnant women, shifting from the left-lateral to the supine position did not cause any change in autonomic characteristics. In contrast, preeclamptic women demonstrated a marked increase in power within the very low-frequency range representing sympathetic tone, from 288 +/- 214 to 556 +/- 322 second2/Hz, in response to the same challenge (P < .05). CONCLUSION: Third-trimester pregnancy is characterized by sympathetic overactivity. When complicated by preeclampsia, sympathetic overreactivity to cardiovascular reflex testing is observed. Our data support the notion that the pathophysiologic phenomena that characterize preeclampsia are mediated not only by circulating or locally acting vasoactive substances, but also, at least in part, by an increase in sympathetic nervous tone.

Adult↗
PubMed1996

Use of the scapular manipulation method to reduce an anterior shoulder dislocation in the supine position.

We report the successful use of the scapular manipulation method to reduce an anterior shoulder dislocation in a multiply traumatized patient in the supine position. We discuss the treatment options for multiply traumatized patients with anterior shoulder dislocations in whom cervical spine injury is a possibility. Although larger patient studies are necessary for confirmation, we show that in this particular case the scapular manipulation technique was safely employed. To our knowledge, this is the first reported case of use of the scapular manipulation method with the patient in the supine position.

Adult↗