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PubMed1995

Effects of tomographic table attenuation on prone and supine cardiac imaging.

UNLABELLED: The purpose of this study was to determine the attenuation characteristics of tomographic imaging tables and to evaluate these effects on prone and supine imaging of the heart, using a cardiac phantom. METHODS: Table attenuation as a function of imaging angle was measured in seven different types of tomographic imaging tables, by imaging 99mTc and 201TI line sources placed at various distances above the center-line of the table. Three imaging tables exhibiting low, medium and high attenuation were further studied using a cardiac phantom filled with 201TI to see the effects of attenuation on myocardial image quality. Studies were performed under three conditions: no table, table above phantom (prone imaging) and table beneath phantom (supine imaging). Circumferential count profiles were generated from short-axis slices of the myocardium. RESULTS: Most SPECT tables attenuated only 5%-10% (99mTc) and 8%-12% (201TI) at an angle of 180 degrees (face of detector parallel to table). At angles of 90 degrees and 270 degrees, however, table attenuation was highly dependent on the tables' design and material content. From the cardiac phantom studies, short-axis circumferential count profiles showed no significant difference for low-attenuation tables and a slight difference (< 5%) in the septal region for medium-attenuation tables. In prone imaging, high-attenuation tables caused a reduction in counts in the antero-lateral wall (> 10%) and in the septum (> 5%). CONCLUSION: Table attenuation characteristics should be considered when comparing studies from different systems and in establishing a normal database for 201TI polar maps. High-attenuation tables should be used with caution in cardiac studies.

Heart↗
PubMedDate not supplied

Forearm pronation and supination: reliability of absolute torques and nondominant/dominant ratios.

This study examined the reliability of pronation and supination measurements expressed in absolute units (newton-meters [Nm]) and nondominant/dominant ratios (%), and determined isometrically using the BTE (WS20) and the Cybex (340) dynamometers. Twenty-one healthy men and 22 healthy women were tested twice on each machine, within 14 days. Twelve of 16 reliability coefficients for absolute torques were considered acceptable (> 0.75) when determined as the reliability of two repetitions on one occasion, while 14 of 16 coefficients were acceptable when determined as the reliability of two repetitions on each of two occasions. However, reliability coefficients for the nondominant/dominant ratios were not acceptable on one (0 of 8 coefficients > 0.75) or two (2 of 8 coefficients > 0.75) occasions. Ratio data were also characterized by larger standard errors of measurement (SEMs) and wider 95% confidence intervals, relative to the sample mean and standard deviation. Overall, reliability coefficients, SEMs, and 95% confidence intervals were similar for men and women, pronation and supination movements, and the BTE and Cybex dynamometers. The authors suggest that absolute scores be used when possible, as these data tend to provide more reliable measurements--especially when the clinician has only limited test occasions to establish baseline scores.

Bias↗
PubMedDate not supplied

Interface pressure measurements of support surfaces with subjects in the supine and 45-degree Fowler positions.

In the past 20 years there has been a dramatic increase in different types of support surfaces to reduce the incidence of pressure ulcers. The purpose of this study was to determine the effect of static air overlays (Sof-Care and Tendercloud), replacement mattresses (Dermarest and Therarest), and a standard hospital mattress on tissue interface pressures in healthy subjects. A convenience sample of 25 subjects had tissue interface measurements obtained under the sacrum and heel bony prominences on the five support surfaces in the supine and 45-degree Fowler's positions. A repeated measures analysis of variance (p < 0.05) indicated that the Dermarest, Therarest, Sof-Care, and Tendercloud support surfaces reduced pressure significantly under the sacral bony prominence compared with the standard hospital mattress. Heel interface pressure measurements were significantly higher than sacral interface pressure measurements. There was no significant difference between supine and 45-degree Fowler's positions with respect to tissue interface pressures.

Adult↗
PubMed1996

[Bicycle exercise echocardiography in the supine position: a simple and effective study method for the detection and localization of myocardial ischemia by the first consulted cardiologist].

Exercise echocardiography is increasingly used as an investigative technique, now that dynamic images can be captured digitally. Its equivalent reliability compared to scintigraphic methods has been demonstrated in a hospital setting. This study is an attempt to analyse its impact in daily practise. Standardized progressive stress was provided by bicycle ergometry in a supine position. Echocardiographic images of complete cardiac cycles were obtained in standard apical and parasternal short axial views before, during and after maximum effort and digitized for simultaneous analysis of synchronized images at rest and during exercise. 279 patients were studied (231 men, 48 women, mean age 61 +/- 10 years). Image quality was suboptimal in four cases. In the remaining 275 cases, ischemia was detected in 125 cases, the test was negative in 141 cases and doubtful in nine cases. Control by selective coronary angiography, as motivated by the clinical situation, was performed in 72 cases. In this particular group, exercise echocardiography showed 89% sensitivity, which is significantly higher than the figure of 63% recorded for conventional exercise testing (p < 0.0001). Exercise echocardiography by bicycle ergometer in a supine position is a valid, noninvasive investigative technique which can be used in an outpatient situation (feasibility 95%), since it is available on the spot. Its value appears greatest in cases where exercise ECG was not conclusive. A negative result enables the first consulted cardiologist to reassure the patient immediately, the favourable prognostic value of such a result having been demonstrated in the literature.

Adult↗
PubMed1997

Unwillingness to lie supine? a sign of pericardial tamponade.

The stable patient with an occult cardiac injury can represent a diagnostic dilemma. The trauma surgeon must maintain a high index of suspicion for cardiac injury with precordial penetrating trauma. Herein are reported two cases of stable patients with penetrating precordial trauma who refused to lie supine because of difficulty breathing, preferring to sit upright, who eventually had positive pericardial windows and sternotomies for repair of cardiac injuries. The presence of this clinical finding, unwillingness to lie supine, should make the trauma surgeon highly suspicious of a cardiac injury and to proceed quickly to echocardiography or, preferably, to subxiphoid pericardial window to rule out cardiac injury.

Adolescent↗
PubMed1997

[Echography of the shoulder with the patient supine in the diagnosis of rotator cuff rupture].

We report a new method for shoulder sonography (US): the patient lies supine and his/her arm is positioned so as to optimize tendon depiction. The supraspinatus tendon, which is the most frequently involved structure in rotator cuff tears, is studied with the patient's arm dropped, elbow extended and forearm prone. Our series consisted of 49 surgical patients (arthroscopy in 16 and open surgery in 33 patients): US sensitivity in tear depiction was 84.8%, specificity 100% and accuracy 89.8%. Medium-small tears appeared as transonic areas within tendon substance and/or tendon focal thinning. Large tears appeared as: (a) missed or markedly thinned rotator cuff, with deltoid muscle approximation to the humeral head surface, (b) plenty of fluid collected around bulky tear margins. The US images of 36 patients were then reviewed and the details discussed. A new sign was observed in medium-small tears, that is a sharp hyperechoic band encircling the humeral cartilage (the compass sign). In conclusion, we believe that US performed with the patient in supine recumbency is easier to perform and provides a bigger field of view of the supraspinatus tendon; it also permits to keep stretched rotator cuff, with consequent image quality improvement.

Adult↗
PubMed2001

Telemetered electromyography of the supinators and pronators of the forearm in gibbons and chimpanzees: implications for the fundamental positional adaptation of hominoids.

Extant apes are similar to one another, and different from monkeys, in features granting them greater range of forearm rotation and greater size of the muscles that produce this motion. Although these traits may have been independently acquired by the various apes, the possibility arises that such features reflect adaptation to the stem behavior of the hominoid lineage. Anticipating that knowledge of forearm rotatory muscle recruitment during brachiation, vertical climbing, arm-hanging during feeding, and voluntary reaching might point to this stem behavior, we undertook telemetered electromyographic experiments on the supinator, pronator quadratus, ulnar head of pronator teres, and a variety of other upper limb muscles in two gibbons and four chimpanzees. The primary rotator muscles of the hominoid forearm were recruited at high levels in a variety of behaviors. As had been suspected by previous researchers, the supinator is usually active during the support phase of armswinging, but we observed numerous instances of this behavior during which the muscle was inactive. No other muscle took over its role. Kinetic analyses are required to determine how apes can execute body rotation of armswinging without active muscular effort. The one behavior that is common to most extant apes, is rare in monkeys, and which places a consistently great demand on the primary forearm rotatory muscles, is hang-feeding. The muscles of the supporting limb are essential to properly position the body; those of the free limb are essential for grasping food. Since the greater range of forearm rotation characterizing apes is also best explained by adaptation to this behavior, we join previous authors who assert that it lies at the very origin of the Hominoidea.

Adaptation, Physiological↗
PubMed1979

The effect of supine rotation on left ventricular dimensions in man: a study using radio-opaque epicardial markers.

It has been reported that patient rotation into the left lateral decubitus position (30 degrees rao) produces significant changes in the regression equations used for left ventricular volume determination and that normal values for echocardiographic left ventricular dimensions obtained from supine patients differ from those obtained after rotation. The purpose of this study was to establish whether patient rotation is associated with changes in left ventricular size and systolic function. The distances between left ventricular epicardial markers attached at the time of cardiac surgery were measured using biplane cineradiography in 14 patients in order to determine left ventricular dimensions before and after rotation. Supine epicardial left ventricular dimensions were not significantly different from those obtained with the patient rotated 30 degrees rao. These results suggest that reported changes in invasive and noninvasive measurements of left ventricular function associated with patient rotation are not primarily due to changes in left ventricular size.

Adult↗
PubMed1984

Superiority of supine bicycle over isometric handgrip exercise in the assessment of ischemic heart disease: an evaluation of left ventricular ejection fraction response using radionuclide angiography.

Left ventricular ejection fraction (LVEF) response to supine bicycle and isometric handgrip exercise was evaluated in 15 patients with documented coronary artery disease (CAD) and stress-induced ischemia using radionuclide angiography. For purposes of analysis, the patients were divided into two groups: group I (n = 7) with single-vessel disease and group II (n = 8) with multiple-vessel disease including 3 with left main artery disease. The studies were repeated 18 days later at similar external workloads to assess reproducibility of both tests. LVEF response to bicycle exercise was different for the two groups. The change in LVEF from rest to peak exercise was +0.04 +/- 0.02 for group I and -0.07 +/- 0.04 for group II (p less than .001). LVEP response to isometric handgrip exercise was not different between the two groups. The change from rest to end of handgrip exercise was -0.02 + 0.02 for group I and -0.05 +/- 0.02 for group II. The reproducibility of LVEF response to bicycle exercise at similar workloads on day 1 and day 19 was good (r = 0.85) while it was poor for isometric handgrip testing (r = 0.67). Our data demonstrate that radionuclide angiographic measurement of LVEF response to supine bicycle exercise testing is superior to LVEF response to isometric handgrip testing in the evaluation of patients with CAD.

Adult↗
PubMed1987

Adaptation of human left ventricular volumes to the onset of supine exercise.

UNLABELLED: The purpose of this study was to measure the changes and rates of adaptation of left ventricular volumes at the onset of exercise. Eight asymptomatic subjects, in whom intramyocardial markers had been implanted 3-6 years previously during aortocoronary bypass surgery, exercised in the supine position at a constant workload of 73.6 W for 5 min. Six also exercised first at 16.4 W, and then against a workload which progressively increased by 8.2 W every 15 s. Cardiac volumes were measured by computer assisted analysis of the motion of the implanted markers. In the constant workload test, cardiac output increased rapidly from 5.7 +/- 1 min-1 to 10.3 +/- 1.9 1 min-1 by 2 min and then increased more slowly to 10.8 +/- 2.0 1 min-1 by 5 min. The cardiac output increase was mainly due to an increase in heart rate from 68 +/- 12 beats min-1 to 120 +/- 16 beats min-1 with minimal changes in stroke volume. The time constant for the early increase in cardiac output was 45s and for heart rate, 35s. With progressively increasing workloads, there was an almost linear increase of heart rate and cardiac output, but these increased at a slower rate than during the early phase of the constant load exercise test. IN CONCLUSION: rapid changes in cardiac output during supine exercise were produced by changes in heart rate; changes in stroke volume provided minor adjustments to cardiac output; the end-diastolic volume was almost constant.

Adaptation, Physiological↗
PubMed1980

Effect of alteration of pheripheral blood flow on the central circulation in man during supine cycling in different ambient temperatures.

Whether the alteration of peripheral circulation caused by changing ambient temperature (Ta) affects central circulatory changes in man during supine cycling was investigated in four well-trained men, who exercised at two levels (117.7 or 176.6 W). Exercise metabolic rate (VO2) in cold (0 degree C or 10 degrees C) was the same as it was at 20 degrees C, whereas the cardiac output (CO; CO2 rebreathing technique) and heart rate were significantly lower (e.g.,176.6 W at 0 degree C, both p < 0.01). In heat (30 degrees C or 40 degrees C), the VO2 reduced with falling CO and mean arterial blood pressure from those at 20 degrees C (e.g., 176.6 W at 40 degrees C, all cases p < 0.01), whereas the peak post-exercise calf blood (CBFp) increased (p < 0.01). The VO2 and stroke volume (SV) were inversely proportional to the ratio of CBFp to CO/kg body weight (CBFp/CO) (r > -0.78, p < 0.001). Total peripheral resistance (TPR) was related to arteriovenous oxygen difference (A-VO2 difference) (r > 0.78, p < 0.001). The TPR and A-VO2 difference decreased as Ta rose, while CBFp/CO was almost the same. As CBFp/CO had exceeded 50 and further progressed, however, the two parameters elevated until the same level as that at 0 degree C. The present results suggest that during moderately prolonged (16--60 min) supine cycling in different Ta's the central circulatory changes are mainly affected by the altered peripheral blood flow in competing between skin and muscle for blood flow.

Blood Circulation↗
PubMed1978

[Contribution of the biceps brachii and pronator teres muscles to the efforts of pronation or supination. I. Statistical work (author's transl)].

The electrical activity of the biceps brachii and pronator teres muscles is studied through the prono-supination of the forearm in some isometrical conditions (static work) with different loads and joint positions. If the pronator teres is always being active in pronation, this activity is a function of the load and of the wrist and elbow positions. The same phenomena can be observed for the biceps brachii but when in supination. From the curvilinear relationships between the integrated electrical activity and the load--observed on both muscles--some torque-angle relationships can be established for the biceps brachii which show that a bifunctional muscle seems to be characterized by a very and unique force-length relationship.

Arm↗
PubMed1977

Comparison of supine and sitting body position during a triangular exercise test. I. Experiences in healthy subjects.

A comparison of haemodynamic parameters is performed during a triangular exercise test on bicycle ergometer in respect of studying the influence of supine and sitting body position. At the maximal symptom-limited work load reached the heart rate is on the average 9.2% higher, the arterial systolic pressure 16.1% and the cardiac output 17.2% less in the sitting body position (P less than 0.001). On the opposite the pulmonary artery pressure during work is of slightly but not significantly higher level in the sitting position than in the supine. This phenomenon is explained by a prevailing of the beta-adrenergic tonus in our untrained subjects, while total sympathetic stimulation seems to be comparable in both body positions.

Adult↗
PubMed1980

Direct recording of local pressure in the radial tunnel during passive stretch and active contraction of the supinator muscle.

The radial tunnel syndrome is recognized as on cause of lateral elbow pain. This investigation demonstrated pressures of 40--50 mmHg exerted on the posterior interosseus herve by the edge of the superficial supinator muscle during passive stretch of the supinator muscle. During active muscle contraction caused by tetanic nerve stimulation, the pressure was about four times greater. Intermittent nerve compression of this magnitude might well cause nerve injury and thus explain the pain and local nerve tenderness observed in patients with the radial tunnel syndrome.

Adult↗
PubMed1975

Effect of propranolol and prindolol on renin secretion in normal supine man.

To investigate the effect of propranolol and prindolol on renin secretion plasma renin activity (PRA) was determined overnight at short-time intervals in 10 sodium-restricted normal supine subjects. 4 of them were on a 4-days medication with propranolol, 3 were rreated with prindolol and 3 were used as control group. In normal controls renin was secreted episodically and showed characteristic night-day variations. Both in propranolol and in prindolol-treated subjects secretory episodes in renin secretion either did not occur or were less frequent than in normal controls. With one exception night-day variations in renin secretion were not observed. Mean PRA values were significantly lower than in the control group (p less than 0.001). Our results show that both propranolol and prindolol lower PRA and eliminate or reduce the frequency of secretory episodes. It is concluded that the sympathetic nervous system plays an important role in regulating night-day variations and short-time fluctuations of renin secretion in normal supine man.

Adult↗
PubMed2004

Stroke volume and systolic time intervals: beat-to-beat comparison between echocardiography and ambulatory impedance cardiography in supine and tilted positions.

The aim of the study was to compare stroke volume (SV), ejection time (ET) and pre-ejection period (PEP) measurements obtained using a central haemodynamics ambulatory monitoring device based on impedance cardiography (ICG), in supine and tilted positions (60 degrees), with pulsed Doppler echocardiography as a non-invasive reference method. The Holter-type ICG device was used for off-line, beat-to-beat, automatic determination of SV, ET and PEP. ICG data were compared with those obtained simultaneously using pulsed Doppler echocardiography in the ascending aorta from a suprasternal projection, 1 min before and 10 min after tilting. The tests were performed in 13 young, healthy subjects (six men and seven women, aged 23-33 years). Linear regression between the measured values obtained for all subjects was described by the following formulas: SVicg= 13.9 + 0.813 x SVecho (r = 0.857, SEE = 9.03, n = 496), ETicg = 16.8 + 0.987 x ETecho (r = 0.841, SEE=21.3, n = 496), PEPicg= 22.8 + 0.890 x PEPecho (r = 0.727, SEE = 14.6, n = 496). The data showed that ambulatory impedance cardiography gives useful absolute values of SV and systolic time intervals measured in supine and tilted positions.

Adult↗
PubMed1992

[Fat pad signs and supinator fat line in cubital trauma].

The fat pad sign and the supinator fat line (SFL) are valuable diagnostic aids in the evaluation of bony cubital injuries. A total of 377 lateral X-rays of the elbow joint-including 121 fractures--were investigated. The supinator fat line exhibited bar-like and bird-like configurations in 55.9% and 41.8% of healthy test subjects, respectively. In the presence of a fracture, a wavy configuration, directed downwards from, or running parallel to, the upper edge of the radius, was seen in 95% of the cases. If in the event of an injury to the elbow a wavy configuration is seen in association with a positive anterior and/or posterior fat pad sign, bony involvement of the joint-forming elements may justifiably be suspected.

Adipose Tissue↗
PubMed1998

Combined hyperextension and supination of the elbow joint induces lateral ligament lesions. An experimental study of the pathoanatomy and kinematics in elbow ligament injuries.

An epidemiological study suggested that the injury mechanism of 'handball goalie's elbow' may be hyperextension. The pathomechanics of hyperextension combined with supination was studied in ten macroscopically normal, male, cadaveric elbow joint specimens. The age of the donors was 28.8 years (range 18-45 years). Extension loading of the elbow was performed in an experimental three-dimensional (3D)-kinematic loading apparatus. The degree of extension increased by 16.7 degrees +/- 8.7 degrees after loading. Hyperextension loads induced significant joint laxity in joint flexion (< 50 degrees) during forced valgus, external and internal rotation, respectively, but not during forced varus. The hyperextension trauma produced three lesions: (1) anterior capsule rupture, (2) avulsion of the proximal insertion of both the medial and the lateral collateral ligaments, and (3) occasional single rupture of the lateral collateral ligament. The lesions indicate that combined hyperextension and supination represent a possible mechanism leading to 'handball goalie's elbow'.

Adolescent↗