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At least 667 records · Page 37Linked to original sources
PubMed1998

Blood loss in total hip arthroplasty. Lateral position combined with preservation of the capsule versus supine position combined with capsulectomy.

The intraoperative blood loss of 40 uncomplicated primary total hip arthroplasties was studied in a retrospective, matched pair analysis. Half of them were implanted in the supine position after complete excision of the capsule and the other half in the lateral position with preservation of the capsule. The patients were matched for mono- or bilateral procedure. Only one surgeon carried out the operations using the same operative technique and identical prosthesis in both groups. The intraoperative blood loss associated with the lateral position and preservation of the capsule averaged 830 ml and was significantly lower (P = 0.01) than 1165 ml with the supine position and complete capsulectomy. Thus, the intraoperative blood loss can be significantly reduced in primary total hip arthroplasty by choosing the lateral position and preserving the capsule.

Adult↗
PubMed1991

Comparative study on the cardio-respiratory change during prostaglandin E1-induced hypotension in the patients in the supine and prone position.

Prostaglandin E(1)-induced hypotension (25% reduction from the preadministration level in mean arterial pressure) was applied to thirteen patients. Eight patients among them were operated in the supine position (group I) and other five in the prone position (group II). The maintenance dose of PGE(1) was considerably lower in group II than in group I (0.067 micro g.kg(-1).min(-1) vs. 0.119 micro g.kg(-1).min(-1)). In group I, there was a significant increase in CI, with a significant decrease in SVRI and PVRI during PGE(1)-induced hypotension. Such a high dose of PGE(1) (0.119 micro g.kg(-1).min(-1)) was considered to have a direct dilating action on the systemic resistance bed as well as on the pulmonary vasculature. It was considered that the suppression of hypoxic pulmonary vasoconstriction could be a mechanism to increase venous admixture during PGE(1)-induced hypotension. In group II, there was no significant increase in CI, and no significant decrease in SVRI and PVRI. PGE(1)-induced hypotension can be safely applied to the anesthetized patients, but we should be careful to apply it to the patients in the prone position, because lower dose of PGE(1) can induce severe hypotension, which is not accompanied by the increase in CI as occurres in the patients in the supine position.

Journal Article↗
PubMed1982

Reproducibility of equilibrium radionuclide ventriculography in patients with coronary artery disease: response of left ventricular ejection fraction and regional wall motion to supine bicycle exercise.

To evaluate the reproducibility of ejection fraction (EF) and regional wall motion (RWM) analyses by rest and exercise equilibrium radionuclide ventriculography (RNV) in the presence of coronary artery disease (CAD), 18 patients underwent two maximum, multistage supine bicycle exercise studies separated by an interval of 2 weeks. There were no significant differences in EF between the two studies, both at rest (56.0 +/- 13.8% vs 58.2 +/- 11.7%, p = NS) and with exercise (51.1 +/- 17.6% vs 54.3 +/- 17.6%, p = NS) and a highly significant correlation was shown between the two groups of values (rest r = 0.90, exercise r = 0.93, p less than 0.001). There was no significant difference in the change from rest to exercise (-4.9 +/- 12.0% vs -3.8 +/- 11.5%, p = NS) between the two studies and the correlation was highly significant (r = 0.69, p less than 0.01). The interstudy variabilities were 2.2 +/- 6.1% and 1.2 +/- 7.3% for rest and exercise, respectively, and 2.0 +/- 9.2% for the change from rest to exercise. Ninety-four percent of both rest and exercise regions had similar RWM. Eighty-one percent of the abnormally contracting regions were common to both exercise studies. Utilizing conventional criteria for the diagnosis of CAD, 11 patients had abnormal EF response and nine had abnormal RWM response to exercise on both studies. Combining EF and RWM criteria resulted in the diagnosis of CAD in 15 patients in both studies. We conclude that: (1) there were no significant differences in rest and exercise radionuclide EF and RWM between two supine bicycle exercise studies performed 2 weeks apart in patients with stable CAD and there were significant correlations between the two studies; (2) despite these correlations, the interstudy variabilities emphasize the need for the inclusion of reproducibility studies in all evaluations of interventions by exercise radionuclide ventriculography; and (3) the variations in EF and RWM response to exercise result in lack of uniformity between the two studies regarding the diagnosis of CAD based on conventional RNV criteria.

Adult↗
PubMed1986

Hemodynamic effects of moricizine at rest and during supine bicycle exercise: results in patients with ventricular tachycardia and left ventricular dysfunction.

To evaluate the hemodynamic effects of moricizine, 20 patients with frequent nonsustained ventricular tachycardia (VT) with a mean left ventricular ejection fraction (EF) of 39 +/- 14% were enrolled in a prospective single-blind, placebo-controlled study. Hemodynamic measurements were performed at rest and during supine bicycle exercise on placebo and moricizine therapy (10 mg/kg/day). Although 16 of 19 patients experienced no rest or exercise deterioration in hemodynamic parameters during drug dosing, three patients had acute deterioration of pulmonary capillary wedge pressure and cardiac index (CI) on moricizine. During follow-up of 6 +/- 3 months, two subgroups were identified: 10 of 19 patients had effective long-term reduction in VT, whereas 9 of 19 patients had poor control of ventricular arrhythmia or congestive heart failure and were discontinued from the trial. Baseline EF and hemodynamic parameters at rest were similar in both patient subgroups. However, protocol dropouts had a hemodynamic response to exercise on moricizine that was significantly depressed as compared to patients with a favorable antiarrhythmic outcome (p less than 0.02). The following hemodynamic profile characterizes patients unlikely to have an antiarrhythmic response to moricizine: an increase in CI of less than 1.0 L/min/m2 and no increase in left ventricular stroke work index during supine exercise.

Exercise Test↗
PubMed1987

The influence of age and gender on left ventricular response to supine exercise in asymptomatic normal subjects.

The performance of normal subjects during radionuclide ventriculography has been related to age, but the combined effects of age and sex on exercise ventricular function are not well described. We studied 55 normal volunteers, 27 men (age = 30 +/- 10 years) and 28 women (age = 33 +/- 14 years), free of chest pain syndromes, during supine rest/exercise radionuclide ventriculography performed to fatigue. Resting left ventricular ejection fraction did not differ between male and female subjects (64 +/- 5.4 vs 64 +/- 6.1; p = NS). Both the peak left ventricular ejection fraction (78 +/- 4.4 vs 72 +/- 9.2; p less than 0.001) and the change in ejection fraction with exercise (14 +/- 4.0 vs 7.9 +/- 7.0; p less than 0.001) were significantly greater in men compared to respective values in women. Regression analysis showed that sex (r = 0.51; p less than 0.001) but not age (r = -0.18; p = 0.19) was a significant predictor of change in ejection fraction with exercise. Data on left ventricular volume response to exercise, available in 43 subjects, revealed that men had a greater percentage of decline in end-systolic volume with exercise than women (-47 +/- 15 vs -24 +/- 26; p less than 0.001). It is concluded that sex exerts a significant influence on normal left ventricular response to fatigue-limited supine exercise and that the gender difference is mediated, in part, by left ventricular end-systolic volume response to exercise.

Adolescent↗
PubMed1983

Incremental value of clinical assessment, supine exercise electrocardiography, and biplane exercise radionuclide ventriculography in the prediction of coronary artery disease in men with chest pain.

The incremental value of clinical assessment, exercise electrocardiography (ECG) and biplane radionuclide ventriculography (RVG) in the prediction of coronary artery disease (CAD) was assessed in 105 men without myocardial infarction who were undergoing coronary angiography for investigation of chest pain. Independent clinical assessment of chest pain was made prospectively by 2 physicians. Graded supine bicycle exercise testing was symptom-limited. Right anterior oblique ECG-gated first-pass RVG and left anterior oblique ECG-gated equilibrium RVG were performed at rest and exercise. Regional wall motion abnormalities were defined by agreement of 2 of 3 blinded observers. A combined strongly positive exercise ECG response was defined as greater than or equal to 2 mm ST depression or 1.0 to 1.9 mm ST depression with exercise-induced chest pain. A multivariate logistic regression model for the preexercise prediction of CAD was derived from the clinical data and selected 2 variables: chest pain class and cholesterol level. A second model assessed the incremental value of the exercise test in prediction of CAD and found 2 exercise variables that improved prediction: RVG wall motion abnormalities, and a combined strongly positive ECG response. Applying the derived predictive models, 37 of the 58 patients (64%) with preexercise probabilities of 10 to 90% crossed either below the 10% probability threshold or above the 90% threshold and 28 (48%) also moved across the 5 and 95% thresholds. Supine exercise testing with ECG and biplane RVG together, but neither test alone, effectively adds to clinical prediction of CAD. It is most useful in men with atypical chest pain and when the ECG and RVG results are concordant.

Adult↗
PubMed1984

Radionuclide ventriculographic responses to graded supine and upright exercise: critical role of the Frank-Starling mechanism at submaximal exercise.

To assess the influence of work load and posture on the response to exercise, 25 patients with coronary artery disease (CAD) and 17 normal subjects underwent graded supine and upright exercise radionuclide ventriculography. In both groups, end-diastolic counts increased with supine exercise (p less than 0.001). The ejection fraction and peak systolic pressure-end-systolic volume relation increased in normal subjects (p less than 0.02), but not in patients with CAD. At upright rest, end-diastolic counts decreased in both groups (p less than 0.001) and then increased with exercise (p less than 0.001). The increase in end-diastolic counts was most pronounced on the transition from upright rest to the 150-kpm work load and resulted in a significant increase in stroke counts (p less than 0.05) for both patients with CAD and normal subjects, without a measurable change in the ejection fraction or the peak systolic pressure-end-systolic volume relation. Later in exercise, end-diastolic counts plateaued, and the ejection fraction and the peak systolic pressure, end-systolic volume relation increased only among normal subjects. Thus, low-level upright exercise is highly dependent on the Starling mechanism in both normal subjects and patients with CAD, with enhanced contractility apparent only during more vigorous exercise in normal subjects.

Blood Pressure↗
PubMed1985

Different recovery process of ST depression on postexercise electrocardiograms in women in standing and supine positions.

False-positive exercise test responses are frequently observed in women. To differentiate a false-positive from a true-positive test response, the effect of postures for recording a postexercise electrocardiogram to the recovery process of ST depression was investigated in 26 women with nonischemic ST depression and in 14 patients with typical angina pectoris. Exercise tests were performed twice, and the postexercise electrocardiogram was recorded while standing during the first test and in the supine position during the second test. In the false-positive test, maximal ST depression occurred immediately after exercise and showed a rapid recovery process in the early recovery phase. However, ST depression persisted without complete recovery, or increased in the late recovery phase as long as subjects were kept standing. In contrast, ST depression returned to the control level when subjects changed to the supine position after exercising. This discrepant pattern in the recovery process of ST depression by changing postures was not observed in the true-positive test results. Changing postures for recording postexercise electrocardiograms could be helpful in differentiating a false-positive response from a true ischemic response.

Adult↗
PubMed1977

Is the supine pressor test an adequate means of predicting acute hypertension in pregnancy?

The supine pressor test was performed on 207 nulliparous young women between the twenty-eighth and thirty-second weeks of gestation. The supine pressor test predicted pregnancy-induced hypertension in 78 per cent of those women who subsequently developed the condition. Ninety-six per cent of the women who failed to demonstrate a rise in diastolic pressure on position change remained normotensive throughout the remainder of the pregnancy.

Acute Disease↗
PubMed1978

Use of supine pressor test to prevent gestational hypertension in primigravid women.

The supine pressor (roll-over) test was performed on 62 nulliparous patients under 20 years of age at conception. The 28 patients (45%) with positive tests were treated to prevent the development of gestational hypertension. Four of those with a positive test and two of those with a negative test developed gestational hypertension. Compared with a composite of other reported studies of this test in which the patients were not treated, our results indicated a statistically significant reduction in the incidence of gestational hypertension. The supine pressor test appears to be useful clinically in young nulliparous women.

Adult↗
PubMed1983

Mechanical properties of a single equivalent muscle producing forearm supination.

Muscles involved in forearm supination in man were analyzed in terms of a two component muscle model. The properties of the contractile component and series elastic component were determined by a series of dynamic contractions at four levels of perceived exerted effort. Generally characteristics were found to be highly non-linear, however at submaximal effort levels mechanical relationships contained long linear segments. This was interpreted as an attempt to make muscle behaviour more linear and thus more predictable. The outlined method is not limited to forearm supination, and allows description not only of muscle properties, but also of strategies employed in the use of muscles. When determined muscle characteristics were used in a validated muscle model, accurate prediction of contractions for individual subjects was possible.

Biomechanical Phenomena↗
PubMed1988

Changes in abdominal muscle length during breathing in supine dogs.

To assess the mechanical function of the abdominal muscles during eupnea in the dog, we have measured the electrical activity and the respiratory changes in length of the rectus abdominis, external oblique, and transversus abdominis muscles in eight supine, lightly anesthetized, spontaneously breathing animals. Seven animals had phasic expiratory electromyographic (EMG) activity in the transversus and showed expiratory shortening of the muscle below its in situ relaxation length (Lr). In contrast, only three animals had expiratory EMG activity and expiratory shortening of the external oblique, and no animal had expiratory EMG activity in the rectus. Seven animals, however, showed shortening of the rectus muscle during expiration. The amount of transversus expiratory shortening in the eight animals averaged (mean +/- SE) - 7.61 +/- 1.72% Lr and was significantly larger (P less than 0.005) than the amount of external oblique (-0.11 +/- 0.10% Lr) or rectus (-0.90 +/- 0.39% Lr) expiratory shortening. Hyperoxic hypercapnia amplified these differences. These data thus indicate that in supine anesthetized dogs (1) the transversus is, in real mechanical terms, the primary abdominal muscle of expiration; and (2) the abdominal compartment of the chest wall during eupnea moves both below and above its neutral position, and not exclusively above it.

Abdominal Muscles↗
PubMed1986

Increases in serum lipid and lipoprotein levels with movement from the supine to standing position in adult men and women.

The effect of movement from the supine to the standing position on the magnitude of change in serum lipid and lipoprotein levels and its impact on the prediction of risk for coronary heart disease was investigated in 23 male and 18 female subjects. The mean age and body weight of the men was 34 years and 93 kg, respectively, while those of women were 36 years and 71 kg. Thirty minutes of standing following thirty minutes in the supine position was associated with hemoconcentration and a significant (P less than 0.05) plasma volume reduction of -13.8% for men and women combined. Posture-related increases in serum lipids and lipoproteins were similar among both men and women and averaged +12% for triglycerides, +9.3% for total cholesterol, +9.0% for low-density lipoprotein + very low-density lipoprotein cholesterol, and +10.4% for high-density lipoprotein cholesterol. Among men, the latter increased from 41.4 to 45.6 mg X dl-1 while among women, the increase was from 58.0 to 64.3 mg X dl-1. The total cholesterol/high-density lipoprotein cholesterol ratio was unaffected by the change in body position, thus strengthening the reliability of this ratio as a coronary heart disease risk measure. Our findings indicate that body position at time of blood withdrawal significantly influences lipid and lipoprotein levels, and, depending on the absolute concentration values of total or high-density lipoprotein cholesterol, can alter the predictive risk for coronary heart disease. Heart disease. Heart disease risk based on the Framingham probability tables and the multiplier for high-density lipoprotein cholesterol is unaffected by the change in body position.

Blood Proteins↗
PubMed1986

Coordination of arm muscles during flexion and supination: application of the tensor analysis approach.

In order to obtain a good understanding of the coordination of the motor system several problems have to be solved. Two major issues are: (1) that muscles do not form an orthogonal coordinate system, and (2) that the number of muscles that may contribute to a movement in general exceeds the number of degrees of freedom of the movement. The latter allows the movement to be executed by an infinite variety of muscle activations. A theoretical solution to these problems has been elaborated by Pellionisz and Llinás. However, convincing experimental support for this theory is still lacking. In this paper the theory has been applied to the activation of arm muscles which contribute to flexion/extension and supination/pronation of the arm. Motor unit activity was recorded with fine wire electrodes. As reported in previous papers, the recruitment threshold of motor units in arm muscles during isometric contraction depends on a combination of forces in flexion and supination directions. This dependence is characteristic for motor units in a single muscle, but is very different for motor units in different muscles. The theoretical results are in good agreement with the behavior of the recruitment threshold for flexion, which decreases (such as m. biceps brachii), or increases (such as for m. brachialis and m. brachioradialis) with force in supination direction. The theory also correctly predicts how the recruitment threshold for motor units changes as a function of the angle between forearm and upper arm. These results give firm support to the hypothesis that the central nervous system uses a tensorial approach for the activation of the motor system, as originally proposed by Pellionisz and Llinás.

Arm↗
PubMed1983

Irradiation of true pelvis for bladder and prostatic carcinoma in supine, prone or Trendelenburg position.

Small bowel transit was performed in 50 patients with bladder or prostatic carcinoma. The patients were all examined in supine and prone positions; some were also studied in 25 degrees Trendelenburg position and 25 degrees inclined procubitus to investigate the effect of the various positions on the displacement of the small bowel loops out of the true pelvis. The prone position proved to be superior to the supine position in 78% of patients. A mean displacement of 0.9 cm was obtained. Greatest shifts generally were found in the Trendelenburg position and inclined procubitus, with a mean displacement of 1.9 and 2.0 cm, respectively. The patients' height, weight, maximal abdominal circumference and Quetelet's index were analyzed with regard to the shifts of bowel loops under the various conditions. Only weight and Quetelet's index were correlated with the shifts in the Trendelenburg and inclined procubitus positions. The shifts were generally larger in case of heavier patients. We conclude that pelvic irradiation should preferably be done in the Trendelenburg or inclined procubitus position, especially in case of obesity.

Body Height↗
PubMed1994

Truly silent ischemia and the relationship of chest pain and ST segment changes to the amount of ischemic myocardium: evaluation by supine bicycle stress echocardiography.

OBJECTIVES: The objectives of this study were 1) to determine the relationship between the amount of exercise-induced ischemic myocardium and the presence or absence of chest pain and ST segment depression, and 2) to define the incidence and characteristics of "truly silent ischemia," that is, ischemia that is not manifested by symptoms or electrocardiographic (ECG) findings. BACKGROUND: There are no prior data relating ischemia to chest pain and ST depression. Thallium-201 imaging studies have evaluated perfusion but not ischemia. In contrast, supine bicycle stress echocardiography demonstrates exercise-induced ischemic dysfunction. METHODS: Supine bicycle stress echocardiography and arteriography were performed in 130 patients and the severity and geographic extent of ischemic myocardium were compared in three groups. On exercise, Group I patients had both chest pain and ST segment depression (symptomatic ischemia), Group II patients ST depression without chest pain (asymptomatic ischemia) and Group III patients had neither chest pain nor ST depression (truly silent ischemia). RESULTS: There were no differences among groups in arteriographic characteristics. The incidence of "truly silent ischemia" was 43%. The number of abnormally contracting ischemic segments, average score per segment and sum of scores were virtually identical in Groups I and II and significantly greater than in Group III for the patients (p < 0.01 to < 0.0001), for the vessels as a group (p < 0.01 to < 0.0001) and for the left anterior descending (p < 0.01 to < 0.0001) and right (p < 0.05) coronary arteries. By multivariate analysis, positive findings on the stress ECG was the single most significant variable in relation to the amount of ischemia (p < 0.001); exercise chest pain had no significant relationship. CONCLUSIONS: Exercise-induced ST segment depression is the single most significant variable in relation to the amount of ischemic myocardium; exercise-induced chest pain is not related to the amount of ischemia. Patients with "truly silent ischemia" constitute almost 50% of patients with coronary artery disease and have less ischemia than do patients with ECG indications of ischemia, with or without chest pain.

Coronary Angiography↗
PubMed2006

Vertebral morphometry by DXA: a comparison of supine lateral and decubitus lateral densitometers.

Identification of vertebral fracture has become increasingly important in the diagnosis and management of osteoporosis. This study compares the morphometric techniques on a fan beam dual-energy X-ray absorptiometry (DXA) GE-Lunar Expert system (Expert) using a supine lateral position and a narrow fan beam GE-Lunar Prodigy system (Prodigy; GE Lunar, Madison, WI) that requires lateral decubitus positioning. Patient acceptability, image quality, observer, and equipment variability were determined. Study subjects were recruited from clinical referrals sent for a routine DXA study that included vertebral morphometry. Twenty-five patients underwent lateral vertebral assessment on both machines and completed a questionnaire on comfort and tolerability. Analysis was undertaken by two trained observers. Vertebral height, anterior/posterior height (A/P) and mid/posterior height (M/P) ratios, image quality, and prevalent fractures were assessed. There were no significant differences in patient comfort or image quality scores. More upper thoracic vertebrae could be assessed on the Expert, and good radiographic positioning was easier to achieve on the Expert. Inter-observer coefficients of variance percentage (CV%) of vertebral height was lower on the Prodigy (3.5% in the lumbar spine rising to 12.8% in the thoracic spine) than the Expert (4.2% to 16.9%). Inter-observer CV% for A/P and M/P ratios varied from 2.5% to 10.5% on the Prodigy compared with 3.5% to 12.3% on the Expert, depending on vertebral level. The variation between instruments was similar to the inter-observer CV% (anterior height: -0.11+/-1.65 mm; mid height: 0.54+/-1.51 mm; posterior height: 0.43+/-1.46 mm). There was good agreement between observers and between the Expert and Prodigy in identifying severe fractures, but lack of agreement in identifying moderate fractures. In conclusion, there was no clinically significant difference in patient comfort and image quality between the Expert and the Prodigy. The inter-observer variations in vertebral height and A/P and M/P ratios are similar to the variations between instruments. In making the change from the supine lateral to the decubitus lateral positioning, measurements of vertebral height are reproducible and patient comfort is not compromised.

Absorptiometry, Photon↗
PubMed1983

Spectrum of global left ventricular responses to supine exercise. Limitation in the use of ejection fraction in identifying patients with coronary artery disease.

Left ventricular function was evaluated with rest and supine bicycle exercise-multigated blood pool scans in 53 patients who had previously undergone coronary angiography for evaluation of a chest pain syndrome. There were 21 normal patients (less than 25% stenosis in any coronary artery, left ventricular end-diastolic pressure less than or equal to 12 mm Hg, and normal left ventriculography) and 32 patients with coronary artery disease (CAD) (greater than 50% narrowing in 1 or more major coronary arteries). Thirty-two (60%) were receiving propranolol at the time of the study. The normal patient group had a significant increase in mean ejection fraction (EF) during exercise (+0.08 +/- 0.09), while the CAD group had no increase (0 +/- 0.11; p less than 0.05). Mean end-systolic volume decreased significantly in the normal group (-5 +/- 8 ml/m2) but demonstrated no significant change in the CAD group (1 +/- 12 ml/m2; p less than 0.05 compared with normal patients). There was no significant change in mean end-diastolic volume in either group. Mean ejection rate, mean peak systolic pressure/end-systolic volume ratio, and mean pulmonary blood volume ratio also differed in the normal versus CAD patients. Despite mean differences, there was considerable overlap in both groups of individual EF responses: 8 of 21 (38%) of the normal group did not have an increase in EF of 0.05 with exercise, while 15 of 32 (47%) of the CAD group did have an increase in EF of 0.05 with exercise. However, the addition of peak systolic pressure/end-systolic volume ratio and pulmonary blood volume (exercise/rest) ratio improved the sensitivity for detecting CAD from 53 to 84% without adversely affecting specificity. Thus, there is a wide spectrum of left ventricular EF responses to supine exercise. In our patient population, EF alone was an insensitive and nonspecific marker of CAD. The addition of other parameters of global left ventricular function, which may be generated using radionuclide angiography, helps distinguish patients with CAD from normal subjects.

Adult↗