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PubMed1976

Differences between supine and sitting Frank-lead electrocardiograms.

Frank-lead electrocardiograms (ECGs) were recorded from 59 adult males with suspected coronary artery disease. Three records were recorded consecutively on frequency modulated tape for each patient in (1) supine position, (2) sitting position with arms relaxed, and (3) sitting position on bicycle with arms on bicycle handles. Electrodes were applied at the level of the fifth intercostal space with patients in the sitting position. Computer measurements of electrocardiographic amplitudes were averaged over ten seconds of each record with these results: (1) QRS spatial amplitudes and R amplitudes in lead z were significantly higher and R amplitudes in lead y lower for sitting than for supine positions. (2) Except for slightly higher R and S amplitudes in lead x for sitting with arms on bicycle, no significant differences were observed between the two sitting positions. (3) These postural differences are significantly greater than those resulting from day-to-day variability of electrode locations. It is hypothesized that electrode level shifts with postural changes are responsible for the observed x- and z-lead changes. For the y-lead changes, it is hypothesized that shifting blood volumes with postural changes are the cause. It is concluded that reference electrocardiographic measurements for stress testing should be obtained from resting ECGs with the patient in the same postural position as that maintained during exercise.

Electrocardiography↗
PubMed1980

Biceps tendon rerouting and percutaneous osteoclasis in the treatment of supination deformity in obstetrical palsy.

Paralytic supination deformity of the forearm, secondary to obstetrical palsy, was treated by biceps tendon rerouting in 11 children. In two patients additional pronation was obtained by subsequent percutaneous osteoclasis and rotation of the radius and ulna. Correction of the supination deformity resulted in improvement of single-handed as well as two-handed activities in all patients.

Child↗
PubMed1984

Primary dysfunction of the afferent limb of the arterial baroreceptor reflex system in a patient with severe supine hypertension and orthostatic hypotension.

A 33 year old man with a history of recurrent episodes of orthostatic dizziness since adolescence was noted to have a supine blood pressure of 200/120 mm Hg and a standing blood pressure of 90/60 mm Hg. Results of extensive laboratory studies for secondary hypertension were negative. Studies of the autonomic nervous system function revealed normal plasma catecholamines, cold pressor test and response to 4 minute 30% of maximal static handgrip contraction and an appropriate increase in heart rate on intravenous injection of atropine. In contrast, the heart rate response to phenylephrine and sodium nitroprusside infusion, carotid massage and graded neck suction with an airtight chamber was very abnormal, indicating marked dysfunction of the afferent limb of the arterial baroreceptor reflex system. Methyldopa decreased the supine hypertension and increased the standing blood pressure.

Adult↗
PubMed1985

Ejection fraction response to supine exercise in asymptomatic aortic regurgitation: relation to simultaneous hemodynamic measurements.

The change in ejection fraction during exercise is frequently employed as a measure of left ventricular functional reserve in patients with aortic regurgitation. However, little information is available about its relation to invasive measurements of cardiac performance. Therefore, simultaneous hemodynamic measurements and supine exercise blood pool scintigraphy were performed in 14 patients with severe, asymptomatic or minimally symptomatic aortic regurgitation associated with cardiomegaly but preserved left ventricular function at rest. Their hemodynamic measurements at rest were normal and their exercise capacity was excellent. When the patients were categorized into those patients whose ejection fraction increased or did not decrease by more than 0.05 (Group 1) and those whose ejection fraction decreased by more than 0.05 (Group 2), important differences were apparent. Echocardiographic, radionuclide and hemodynamic measurements at rest in the two patient groups were similar, but Group 1 exhibited a greater increase in cardiac index during supine exercise (2.8 +/- 0.4 to 10.0 +/- 1.8 versus 2.7 +/- 0.5 to 6.9 +/- 1.0 liters/min per m2; p less than 0.005) and a lesser increase in pulmonary capillary wedge pressure (13 +/- 4 to 19 +/- 7 versus 12 +/- 4 to 31 +/- 8 mm Hg; p less than 0.01). The severity of regurgitation decreased during exercise in all patients, but end-diastolic volume decreased and end-systolic volume decreased or was unchanged in Group 1, whereas end-diastolic volume was unchanged and end-systolic volume increased in Group 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Supine bicycle stress echocardiography versus tomographic thallium-201 exercise imaging for the detection of coronary artery disease.

To compare the accuracy of supine bicycle stress echocardiography (SBSE), a new technique for evaluating coronary disease during peak exercise, with tomographic thallium-201 exercise imaging (SPECT), 71 patients were evaluated by SBSE, SPECT, and coronary arteriography. Twenty patients had normal coronary vessels; 22 had single-vessel, 14 had double-vessel, and 15 had triple-vessel disease. There were no differences in sensitivity (90% vs 92%), specificity (80% vs 65%), and accuracy (87% vs 85%) between SBSE and SPECT for the group of 71 patients. The results were similar in patients with and without prior myocardial infarction and with single-, double-, or triple-vessel disease. There were no differences between SBSE and SPECT for disease detection for the group of 213 individual vessels in sensitivity (88% vs 80%), specificity (87% vs 84%), and accuracy (88% vs 82%), but SBSE was more sensitive for the left anterior descending artery (97% vs 82%, p < 0.005) and for arteries involved in triple-vessel disease (93% vs 69%, p < 0.01) and more specific for the right coronary artery (88% vs 66%, p < 0.01). Supine bicycle exercise was associated with significantly lower maximal heart rates than treadmill exercise but with significantly higher systolic and diastolic blood pressures. There were no differences in heart rate x systolic blood pressure. We conclude that SBSE and SPECT are equally reliable for coronary disease detection in patients and for evaluation of disease in specific arteries with the exception of SBSE's higher sensitivity for the left anterior descending artery and arteries involved in triple-vessel disease and higher specificity for the right coronary artery.

Coronary Disease↗
PubMed2000

Elbow extension and flexion-supination deformities in tetraplegia.

This paper demonstrates the flexion-supination and extension deformities of the elbows in complete tetraplegics and describes the outcome of simple treatments. The principal conclusion is that these two deformities are easily corrected by very simple methods. After treatment the patients could fully extend and flex their elbows and fully supinate and pronate their forearms. One of 11 patients, whose bilateral deformities kept recurring, was a failure.

Adolescent↗
PubMed2002

Surgical correction of supination deformity in children with obstetric brachial plexus palsy.

We present a series of 40 children who were operated on for supination contracture following severe obstetric brachial plexus palsy. Surgery was done at an average age of 7 years and the mean postoperative follow-up was 4 years. In the 23 cases treated by an open or closed radial osteotomy, the mean intraoperative derotation was 78 degrees, the immediate postoperative position was 29 degrees pronation and it stabilized at follow-up at 17 degrees pronation. Biceps rerouting was performed in 17 cases without any recurrence of supination deformity and the final position was 22 degrees pronation. Some active forearm rotation was obtained in a few cases. These surgical corrections are part of an overall treatment plan and allow the "begging hand" to be corrected to a more functional and less noticeable position.

Adolescent↗
PubMed1999

[Compression syndrome of the radial nerve in the area of the supinator groove. Experiences with 110 patients].

Both radial tunnel syndrome and posterior interosseous nerve (PIN) compression syndrome are caused by compression of the posterior interosseous nerve. There is a controversy about certain features of PIN compression especially with regard to diagnostic criteria and therapy as well as differentiation from tennis elbow. From 1992 to 1997, we operated 110 patients because of PIN compression. Diagnosis was based on clinical examination only. As a rule, we decompressed the PIN directly using an anterior approach. With regard to radial tunnel syndrome, we could review 69 from 103 operations with an average follow-up of 41 months. Using the criteria originally proposed by Roles and Maudsley, only 60% showed excellent or good results. The mean DASH score was 32. Recompression of the PIN by scarring was found in as much as 17% of patients and proved to be a serious complication of direct decompression of the PIN. Furthermore, 52% of our patients operated on because of PIN compression suffered from tennis elbow as well. We therefore believe that radial tunnel syndrome is a specific form of tennis elbow. From an anatomical point of view, the inseparable origin of the radial wrist extensors and supinator muscle seems to link tennis elbow and radial tunnel syndrome. To avoid recompression of the PIN by scarring, we have abandoned direct decompression and now routinely use Wilhelm's denervation procedure for the treatment of tennis elbow as well as radial tunnel syndrome. This procedure indirectly decompresses the PIN by cutting the superficial origin of the supinator muscle with consecutive relaxation of Frohse's arcade. Preliminary results are promising and show improvement of preoperative neurologic status by indirect decompression.

Adolescent↗
PubMedDate not supplied

[Decompensation of a supinator syndrome in submuscular lipoma. A rare differential diagnosis of elbow pain].

Important differential diagnoses to epicondylitis humeri radialis are the nerve compression syndromes of the elbow. After a long period of conservative treatment, paresis of the motor branch of nervus radialis in this case led to the diagnosis and surgical treatment showing an unknown submuscular lipoma as the cause of a supinator syndrome with paresis of the finger extensors. In cases of therapy-resistant pain of the elbow, especially resistant to the conservative therapy of an epicondylitis humeri radialis, a nontraumatic supinator syndrome should be considered as a differential diagnosis. A tumor as the cause of a compression syndrome of the motor branch of the nervus radialis is very rare.

Decompression, Surgical↗
PubMed1994

Early leg blood flow adjustment during dynamic foot plantarflexions in upright and supine body position.

The time courses of leg blood flow, systolic peak velocity, heart rate and blood pressure have been studied in nine health volunteers during dynamic exercise in upright sitting and in a tilted sitting body position. In both positions the subjects performed single and repeated foot plantarflexions against light and moderate forces corresponding to 5%-10% and 25%-30% of maximal voluntary contraction. The following measurement techniques were used: Doppler ultrasound method (blood flow parameters), FINAPRES device (arterial blood pressure) and standard ECG chest leads (heart rate). At rest the supine blood flow parameters measured in the arteria femoralis were significantly higher than in the upright sitting position. In both positions, even one single plantarflexion at the light exercise intensity caused significant increases in blood flow for almost 20s. The major part of the blood flow response to repeated contractions always occurred within the first 10s at virtually unchanged blood pressures. During this initial phase upright leg blood flow increased by factors of 2.5 (light exercise) and 3.1 (moderate exercise). The corresponding values in the tilted sitting posture were 1.7 and 1.9, respectively. The initial increases in the upright position were too large to be attributed only to the increase of the perfusion pressure caused by the withdrawal of the hydrostatic pressure on the venous side ("muscle pump"). Additional, fast decreases in local resistance have to be considered. In the supine posture effects on local resistance have to be taken into account for the early increases in blood flow since hydrostatic effects on arterio-venous pressure differences are too small. The present findings indicate that the effects of repeated contraction-relaxation cycles on the early adjustment of muscle blood flow are not sufficiently described by a "muscle pump" that induces only venous volume shifts and hydrostatic pressure changes. Additional fast effects on local resistance have to be taken into account.

Adult↗
PubMed2006

Stop SIDS--sleeping solitary supine, sucking soother, stopping smoking substitutes.

UNLABELLED: The recognition of prone sleeping and maternal smoking as modifiable risk factors for sudden infant death syndrome (SIDS), has drastically decreased SIDS incidence. However, during the last years other factors have become necessary to consider to further reduce the risk of SIDS. Side sleeping implies a greater risk than supine sleeping but is still common. Bed sharing may increase the risk of SIDS, while use of a pacifier seems to be protective. Replacement of maternal smoking with nicotine substitutes is not harmless. CONCLUSION: To further reduce the risk of SIDS, exclusive supine sleeping should be encouraged and side sleeping discouraged. When the breast-feeding is established, a pacifier can very well be used at bedtime. Bed sharing can increase the risk of SIDS if the infant is below 2-3 months of age, especially if the mother is a smoker. Any nicotine use should be avoided during pregnancy and breast-feeding.

Humans↗
PubMed2000

Does hypertension or a previous myocardial infarction influence the blood pressure and heart rate responses to changes in body position? Results from a study with serial measurements in the supine and standing positions in 60-year-old men.

An age-related attenuation of the normal increase in diastolic blood pressure and heart rate upon standing has previously been observed in man. Whether this is due to ageing as such, or a consequence of a higher prevalence of cardiovascular disease in older compared to younger subjects, is unclear. This population-based study was conducted to address this question. It was carried out in three groups of 60-year-old men: (i) with hypertension (n = 75), (ii) with a previous myocardial infarction (n = 39), and (iii) without any of these diseases, thus constituting a control group (n = 41). Blood pressure and heart rate were assessed during three 7-min periods (supine-standing-supine), using an unbiased non-invasive method. The cardiovascular responses were both qualitatively and quantitatively similar in all three groups, i.e. the increases in diastolic blood pressure and heart rate upon standing, and decreases upon laying down, were of a similar magnitude. In conclusion, 60-year-old men with hypertension or a previous myocardial infarction had blood pressure and heart rate responses similar to those of men of the same age who did not have these diseases. This indicates that the attenuated response previously reported in older compared to younger people is not explained by the higher prevalence of these cardiovascular diseases in the elderly, but is merely an age-dependent characteristic.

Age Factors↗
PubMed2003

Erect and supine radiographs to assess effectiveness of SWL for stones in a caliceal diverticulum or dilated calix.

BACKGROUND AND PURPOSE: There are patients who have been treated with shockwave lithotripsy (SWL) for stones in a caliceal diverticulum (CD) or a dilated calix in whom the degree of fragmentation is difficult to assess. The aim of this study was to see if adequate fragmentation could be confirmed by the demonstration of layering of fine fragments on an erect radiograph. PATIENTS AND METHODS: Over a period of 9 months, 13 patients with stones in a CD or a dilated calix with a stenosed infundibulum were studied 2 weeks after SWL with erect and supine radiographs. RESULTS: One of eight patients with a CD cleared all fragments. Two patients showed no change in the appearance of the stone on either the supine or the erect film, and of the remaining five patients, three demonstrated layering of sand at the base of the CD. Five patients with a dilated calix and a narrow infundibulum were also studied: two of these patients became stone free, two demonstrated complete fragmentation with layering of the sand, and in one patient, a 4-mm fragment, hidden within the sand, was revealed only on the erect film. CONCLUSION: There are patients who have been treated with SWL for stones in a CD or a dilated calix in whom adequate fragmentation is difficult to demonstrate. An erect radiograph in these patients may demonstrate layering of the fragments to confirm fragmentation and obviate repeat SWL.

Dilatation, Pathologic↗
PubMed1983

Inaccuracy of oesophageal pressure for pleural pressure estimation in supine anaesthetized subjects.

Oesophageal pressure was measured, using a balloon and catheter system, at three or four positions in the oesophagus of eight supine subjects anaesthetized with 1-1.5% halothane in 67% nitrous oxide. Airway pressure and the difference between airway and oesophageal pressures were recorded during occlusion of inspiration, occlusion of expiration and occlusion of expiration followed by inspiratory occlusion. Lung volume could not change appreciably during these manoeuvres, so the difference between airway and oesophageal pressure should not have changed. The change in oesophageal pressure was less than the change in airway pressure in 86 of 90 measurements. The change in oesophageal pressure was expressed as a fraction of the change in airway pressure: the maximum fraction was obtained in each patient, and the mean of these maximum values was 82%. This suggests that changes in the difference between airway and oesophageal pressures will overestimate the change in transpulmonary pressure during artificial ventilation in supine subjects, and that lung compliance would be underestimated.

Adult↗
PubMed1985

Peridural anesthesia and the distribution of blood in supine humans.

To determine the effects of vasomotor tone on intrathoracic and splanchnic blood volume, the distribution of radioactively (99mTc) labeled erythrocytes was recorded by whole body scintigraphy before and during peridural anesthesia (PDA) in eight supine men. The radioactivity was recorded with a gamma camera and its distribution determined in the thorax, abdomen, and limbs. Arterial and central venous pressure, heart rate, and calf volume and flow also were measured. During PDA with a sensory block up to T4/5, radioactivity increased only in the denervated legs (+ 9.9 +/- 2.3% SE), whereas it decreased in all other regions, i.e., in the thorax (-8.1 +/- 1.2%), the innervated upper limbs (-10.6 +/- 4.0%), and in the splanchnic vasculature (-5 +/- 1.7%). However, in two of the subjects, after an initial decrease, splanchnic blood content increased while intrathoracic blood volume decreased further. The effects of PDA on thoracic and splanchnic filling could be duplicated by the sequestration of about 500-600 ml of blood in both legs. In supine humans high peridural anesthesia evokes the same decrease in intrathoracic blood volume as orthostasis. This seems to be counteracted by a reflex decrease in filling of the denervated muscle and skin areas and also by a constriction of the splanchnic vasculature by an unknown mechanism. Potential circulatory collapse may ensue when the vasoconstrictor response fails in the splanchnic circulation.

Adult↗
PubMed1990

The measurement of blood pressure: sitting or supine, once or twice?

In 166 patients attending a hypertension review clinic, we compared supine and sitting blood pressure measurements and first and second measurements (1 min apart) in each position to determine whether any differences seen might have implications for the routine measurement of blood pressure in these patients, as a group or as individuals. Measurements were made with the Copal UA-251 semi-automated sphygmomanometer. In the group there was no significant difference between the first and the second diastolic measurements. The first systolic measurement was on average 3-4 mmHg higher than the second in both positions. Mean supine systolic pressures were 2-3 mmHg higher and diastolic pressures 2-3 mmHg lower than the corresponding sitting pressures. In individual subjects there were substantial disagreements between successive measurements in both positions and between positions. However, these differences would not have influenced blood pressure management in more than a few instances. We suggest that two measurements should routinely be taken, and the average recorded, particularly when the average exceeds 155/90 mmHg.

Blood Pressure Determination↗
PubMed1983

Comparison of supine, upright, and prone positions for liver scans.

We compared liver scan interpretations based on anterior images obtained in the upright, prone, and supine positions. Receiver-operating-characteristic curves were generated for three well trained observers. Results showed that reading the three different views together was more accurate than the reading of any individual image. Furthermore, interpretations based on either the prone or upright view were superior to those using the supine view alone. The prone and upright views should be used more often in liver scanning.

Humans↗