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PubMed1997

Systemic and regional (including superior mesenteric) haemodynamic responses during supine exercise while fasted and fed in normal man.

The systemic and regional (including superior mesenteric artery, SMA) responses to exercise in the fasting and fed state were studied in ten normal subjects before, during and after 9 min of graded supine bicycle exercise on two separate occasions, when fasted and after a liquid meal. During exercise, blood pressure (BP) and cardiac index rose similarly in both states. Resting SMA blood flow was higher when fed (519 (282-619) versus 240 (133-255) ml/min, p < 0.01). SMA blood flow fell during exercise in both states, to 98 (63-154) ml/min, p < 0.01 when fasted and to 55 (42-149) ml/min, p < 0.01 when fed. SMA vascular resistance rose during exercise in both states, but rose less when fasted by 36 (6-57)% versus 143 (36-240)% (NS). Resting forearm and leg blood flow (FBF and LBF) and vascular resistance (FVR and LVR) were similar fasted and fed. FBF and FVR did not change after exercise in either state. LBF rose and LVR fell similarly in both states. We conclude that in normal subjects, although splanchnic oxygen demand is likely to be greater after food, during light to moderate exercise splanchnic vasoconstriction contributes to maintenance of BP.

Aged↗
PubMed1996

Neurohumoral, peptidergic and biochemical responses to supine exercise in two groups with primary autonomic failure: Shy-Drager syndrome/multiple system atrophy and pure autonomic failure.

The neurohumoral, peptidergic and biochemical responses to supine leg exercise were studied in two groups with primary autonomic failure: Shy-Drager syndrome (SDS, n = 15) and pure autonomic failure (PAF, n = 15), to determine if these accounted for exercise-induced hypotension and the greater blood pressure (BP) fall in PAF. Responses were compared to normal subjects (controls, n = 15), in whom BP rose with exercise. Resting plasma noradrenaline (NA) was higher in controls than SDS, and was lowest in PAF. With exercise, NA increased in controls, with a small rise in SDS, but no change in PAF. Resting plasma adrenaline (A) was higher in controls and SDS than PAF, with no change during exercise. Plasma dopamine was unrecordable at all stages in all groups. Resting plasma renin activity (PRA) was higher in controls than SDS and PAF, and was unchanged with exercise in all groups. Plasma insulin, C-peptide and serum growth hormone (GH) were similar at rest and with exercise in the three groups. Plasma glucose was higher at rest in SDS and PAF, and increased with exercise in all three groups. In conclusion, neither exercise-induced hypotension, nor the differences between SDS and PAF could be related to abnormalities in the release of A, PRA, insulin, glucose or GH. The abnormal NA response to exercise was consistent with the BP fall being due to inadequate compensatory sympathetic activity. In SDS, the small NA increase, in the presence of supersensitivity, may have reduced their BP fall as compared to PAF. These results suggest that impaired sympathetic neural activity is a key factor in exercise-induced hypotension.

Autonomic Nervous System Diseases↗
PubMed2003

Venous air embolism during awake craniotomy in a supine patient.

PURPOSE: To report a non-fatal case of intraoperative venous air embolism (VAE) during an awake craniotomy. VAE presented with unusual clinical features. CLINICAL FEATURES: VAE during an awake craniotomy has not been reported frequently. The patient we describe presented with persistent coughing followed by tachypnea, hypoxia and reduction in end-tidal CO(2) during dural opening while undergoing an awake craniotomy in the supine position. Cardiovascular variables were stable during the episode except for transient hypertension. Having ruled out airway obstruction and low cardiac output, we concluded that air embolism was the cause. The patient responded immediately to the standard treatment of air embolism and recovered without any complication. CONCLUSION: This case illustrates a VAE during an awake craniotomy and emphasizes the importance of early diagnosis in the management.

Brain Neoplasms↗
PubMed2000

Angiotensin II formation and endothelin clearance in ARDS patients in supine and prone positions.

OBJECTIVE: In patients with acute respiratory distress syndrome (ARDS), the prone position may enhance oxygenation by changing ventilation/perfusion ratio. In this study, we investigated whether the prone position affects the net balance between pulmonary endothelin (ET-1) and angiotensin II (Ang II) production and clearance, two metabolic functions of lung endothelial cells. SETTING: Anaesthesiological intensive care unit of a university hospital. PATIENTS: Ten ARDS patients (Murray score > 2.5) were studied in both the supine position (SP) and the prone position (PP). MEASUREMENTS AND DESIGN: Blood samples were taken simultaneously from the patient in SP for assessment of mixed venous and arterial ET-1 and Ang II concentrations, and plasma renin concentration (PRC). This was repeated after 60 min in SP, immediately after turning the patient into PP, and 60 min thereafter. Net arterial/mixed venous ET-1 clearances and net Ang II formations were calculated. RESULTS: arterial oxygen tension increased from SP to PP by an average of 60 mmHg, about 20%. Arterial ET-1 concentrations of ARDS patients were 1.57 +/- 1.1 pg/ml (mean +/- SD) and within the range of healthy persons. Net ET-1 clearances were negative in SP, indicating pulmonary release of ET-1, and did not change in PP. Arterial Ang II concentrations (73 +/- 56 pg/ml) as well as PRC (126 +/- 85 pg/ml) were markedly elevated. Net transpulmonary Ang II formation did not change. CONCLUSION: Acute changes of oxygenation in ARDS patients by positioning do not induce any short-term effects on pulmonary ET-1 net clearance or Ang II net formation.

Adult↗
PubMed2004

Further characterization of the supine empty stress test for predicting low valsalva leak point pressures.

The aim of this study is to determine if the diagnostic accuracy of the supine empty stress test (SEST) differs depending on the volume of residual urine. We performed a review of all patients who were diagnosed with stress urinary incontinence (SUI) via multi-channel urodynamics including valsalva leak point determinations (VLPP). A SEST was performed and the residual urine recorded via catheterization. The test-specific indices of the SEST for the prediction of low VLPP (defined as <60 cm H(2)0) were determined for varying residual volumes. Ninety-nine patients were included. Regardless of residual volume, low sensitivities, specificities and positive predictive values were demonstrated. Sensitivity and positive predictive values were further reduced and negative predictive values were improved slightly with higher residual volume. The highest negative predictive value was 89% at a residual volume of greater than 10 mL. Residual urine volume has minimal impact on the utility of the SEST.

Female↗
PubMed2000

Torsional vestibulo-ocular reflex during whole-body oscillation in the upright and the supine position. I. Responses in healthy human subjects.

In rhesus monkeys, the dynamic properties of the torsional vestibulo-ocular reflex (VOR) are modified by otolith input: compared with torsional oscillations about an earth-vertical axis (canal-only stimulation), the phase lead observed at frequencies below 0.1 Hz is cancelled when the animals are rotated about an earth-horizontal axis (canal-and-otolith stimulation); the gains of the torsional VOR, however, are nearly identical in both conditions. To test whether or not canal-otolith interaction in humans is similar to that in rhesus monkeys, we examined ten healthy human subjects on a three-axis servo-controlled motor-driven turntable. The subjects were oscillated in upright or supine position in complete darkness over a similarly wide range of frequencies (0.05-1.0 Hz) with peak velocities <40 degrees/s. Eye movements were recorded using the three-dimensional search coil technique. Compared with the torsional vestibulo-ocular gains during canal-stimulation only (earth-vertical axis), the gains obtained during combined canal-otolith-stimulation (earth-horizontal axis) were significantly higher throughout the entire frequency range (P<0.05). The gain increased by 0.100+/-0.074 (SD), independent of frequency. During the earth-horizontal axis stimulation, the phase remained always around zero, which is in contrast to the canal-stimulation only, during which one finds an increasing phase lead as frequency decreases. We conclude that, in healthy humans as in rhesus monkeys, the phase lead from the canal signals at low frequencies is effectively cancelled by the otolith input. In contrast to rhesus monkeys, however, otolith signals in healthy humans increase the gain of the torsional VOR at frequencies from 0.05 to 1.0 Hz. This normal database is crucial for the interpretation of results obtained in patients with vestibular disorders.

Adult↗
PubMed1999

Control of grasp stability during pronation and supination movements.

We analyzed the control of grasp stability during a major manipulative function of the human hand: rotation of a grasped object by pronation and supination movement. We investigated the regulation of grip forces used to stabilize an object held by a precision grip between the thumb and index finger when subjects rotated it around a horizontal axis. Because the center of mass was located distal to the grip axis joining the fingertips, destabilizing torque tangential to the grasp surfaces developed when the grip axis rotated relative to the field of gravity. The torque load was maximal when the grip axis was horizontal and minimal when it was vertical. An instrumented test object, with a mass distribution that resulted in substantial changes in torque load during the rotation task, measured forces and torques applied by the digits. The mass distribution of the object was unpredictably changed between trials. The grip force required to stabilize the object increased directly with increasing torque load. Importantly, the grip force used by the subjects also changed in proportion to the torque load such that subjects always employed adequate safety margins against rotational slips, i.e., some 20-40% of the grip force. Rather than driven by sensory feedback pertaining to the torque load, the changes in grip force were generated as an integral part of the motor commands that accounted for the rotation movement. Subjects changed the grip force in parallel with, or even slightly ahead of, the rotation movement, whereas grip force responses elicited by externally imposed torque load changes were markedly delayed. Moreover, blocking sensory information from the digits did not appreciably change the coordination between movement and grip force. We thus conclude that the grip force was controlled by feedforward rather than by feedback mechanisms. These feedforward mechanisms would thus predict the consequences of the rotation movement in terms of changes in fingertip loads when the orientation of the grip axis changed in the field of gravity. Changes in the object's center of mass between trials resulted in a parametric scaling of the motor commands prior to their execution. This finding suggests that the sensorimotor memories used in manipulation to adapt the motor output for the physical properties of environmental objects also encompass information related to an object's center of mass. This information was obtained by somatosensory cues when subjects initially grasped the object with the grip axis vertical, i. e., during minimum tangential torque load.

Adult↗
PubMed1998

Value of arthrography after supination trauma of the ankle.

OBJECTIVE: To investigate the merits of arthrography after supination trauma of the ankle. DESIGN AND PATIENTS: In a group of 160 consecutive patients operative exploration was performed in cases where arthrography and/or a delayed physical examination showed positive findings. In all patients arthrography was performed within 48 h after trauma. To determine interobserver agreement, all arthrograms were independently evaluated by two radiologists, both ignorant of the first assessment. RESULTS: The prevalence of an ankle ligament lesion was found to be 76%. Of the 122 patients with a rupture of one or more ankle ligaments, 52% had an isolated anterior talofibular ligament lesion, 3% had an isolated calcaneofibular ligament lesion, and 45% had combined lesions. The site of the lesion was predominantly intraligamentous. In the determination of the presence or absence of an ankle ligament lesion, the specificity and sensitivity of the ankle arthrogram were 71% and 96% respectively. Interobserver agreement on the arthrogram was very good (kappa 0.9). In 1% of patients a clear diagnosis was not possible by means of arthrography. CONCLUSION: Arthrography provides information of high diagnostic quality with excellent interobserver agreement and therefore remains the gold standard for early diagnosis (within 48 h) of a lateral ankle ligament rupture.

Adolescent↗
PubMed2006

Prostate biopsy in the supine position in a standard 1.5-T scanner under real time MR-imaging control using a MR-compatible endorectal biopsy device.

Thirty-seven consecutive patients with elevated PSA levels and negative tumor prostate biopsies underwent a MR-guided prostate biopsy in a 1.5-T scanner in the supine position. After localization of suspected tumor areas using an endorectal coil and two body-phased array coils, the biopsy device was positioned without any repositioning of the patient. The biopsy device consisted of a mount, a ball joint, a positioning stage and an insertion stage with a needle guide, which was filled with a MR-visible fluid to control positioning of the needle using a balanced steady-state free precession sequence (TrueFISP) and a high-resolution turbo spin echo (T2-TSE) sequence. Core biopsies were taken manually in the magnet. The biopsy needle could be correctly positioned in all cases. Suspected lesions with a diameter > or =10 mm could be successfully punctured. Four to nine (mean = 6) biopsies were taken per patient. In 14 patients, prostate cancer was confirmed at histology. Twenty-four biopsies positive for cancer were performed in 14 patients. A correct correlation was found between the site of biopsy and histology. MR-guided prostate biopsy can be effective in increasing primary positive tumor biopsy results in patients with a history of negative tumor TRUS-guided prostate biopsies.

Adenocarcinoma↗
PubMed1997

Accuracy of the diagnosis of pleural effusion on supine chest X-ray.

Diagnosis of pleural effusion (PE) on supine chest X-ray (SCXR) is considered difficult. This study aimed at evaluating the accuracy of the diagnosis of PE on SCXR and was performed in two phases. At phase 1, a formula for the sonographic estimation of the volume of PE was established by correlating 24 measurements (in 7 patients in whom complete drainage was achieved) with the drained volumes. At phase two, 112 consecutive SCXRs were supplemented by sonography of the chest. The films were evaluated for the presence of PE and for the presence of different radiologic signs of PE. Sonography showed PE in 41 right and 30 left hemithoraces. The overall accuracy of the diagnosis of PE on SCXR was 82 %. Only one of the undiagnosed PEs had a volume of > 300 ml. The most accurate signs were increased density of the hemithorax, blunted costophrenic angle, and loss of the hemidiaphragm silhouette.

Adolescent↗
PubMed1989

Effects of dilevalol on rest and supine exercise hemodynamics in mild to moderate systemic hypertension.

Eight mildly to moderately hypertensive subjects free of any antihypertensive medications and on a normal salt diet performed maximal supine arm exercise. Before starting the exercise, a right-sided cardiac catheterization was performed to measure hemodynamic parameters before and during exercise. All patients had normal increases in cardiac output for the level of exercise performed and the peripheral vascular resistance diminished appropriately. An increase in the right atrial and pulmonary artery wedge pressures during exercise could be explained by increased venous return. After the baseline testing, rest and exercise hemodynamics were repeated 2 hours after the administration of 400 mg of dilevalol, a new beta blocker. For the next 2 weeks the patients received 400 mg of the study drug twice a day, with repeat studies obtained thereafter. As with other beta blockers, dilevalol decreases the heart rate and cardiac output on exercise, but, in addition, it induces a decrease in the resting systemic vascular resistance. This action is similar to its isomer, labetalol.

Adrenergic beta-Antagonists↗
PubMed1993

Usefulness of supine bicycle stress echocardiography for detection of restenosis after percutaneous transluminal coronary angioplasty.

The role of supine bicycle stress echocardiography (SBSE) for detecting restenosis after percutaneous transluminal coronary angioplasty (PTCA) was evaluated in 80 patients: 41 (51%) with single and 39 (49%) with multivessel PTCA (total 129 dilated vessels). Total revascularization was performed in 54 (68%) and partial revascularization in 26 (32%) patients. Restenosis was angiographically demonstrated in 60 patients (75%) and in 72 vessels (56%) 6.1 +/- 2.9 months after PTCA. The results for detecting restenosis were: (1) SBSE versus exercise electrocardiographic sensitivity, 87 versus 55% (p < 0.001); (2) specificity, 95 versus 79%; and (3) accuracy, 89 versus 61% (p < 0.001). SBSE was 83% sensitive, 95% specific and 88% accurate for restenosis detection in specific vessels with comparable results for single versus multivessel PTCA and total versus partial revascularization. Sensitivity, specificity and accuracy were: 91, 93 and 91% for the left anterior descending coronary artery; 77, 94 and 85% for the right coronary artery; and 76, 96 and 88% for the left circumflex coronary artery. Ninety-four percent of the nondilated diseased vessels were correctly identified. It is concluded that SBSE is an excellent tool for identifying restenosis after PTCA.

Aged↗
PubMed1993

Derotation osteotomy of the forearm in management of paralytic supination deformity.

Ten children with supination deformity of the forearm due to obstetric paralysis were treated by pronation osteotomy of the radius and ulna. In two patients release of the interosseous membrane was added. The main achievement of the operation was an improved position of rest, which rendered a mechanical advantage for the basic function of the hand in grasping medium-sized objects. Preliminary results of three other patients who recently underwent rerouting of the biceps tendon concurrently or following the osteotomy are encouraging. One patient who had both procedures underwent rerouting of the biceps, which resulted in a gain of 135 degrees of active pronation.

Child↗
PubMed1990

Altered left ventricular volume and ejection fraction responses to supine dynamic exercise in athletes.

Two-dimensional echocardiography was used to determine the responses of left ventricular volumes, ejection fraction and segmental left ventricular motion to supine dynamic exercise in 22 professional athletes, comparing these responses with those in 22 age- and gender-matched healthy untrained individuals. End-systolic volume was significantly greater at rest and during exercise in the athletes (50 +/- 6 versus 29 +/- 4 ml and 40 +/- 5 versus 17 +/- 4 ml, respectively, p less than 0.001 for both). It decreased during exercise in all the untrained subjects, but did not change or increased in nine athletes (41%). End-diastolic volume was greater in the athletes at rest (143 +/- 12 versus 98 +/- 9 ml) and during exercise (157 +/- 14 versus 121 +/- 13 ml, p less than 0.01 for both). It increased in all the untrained subjects, but decreased or did not change in six athletes (27%). Ejection fraction was significantly lower in the athletes at rest and during exercise (65 +/- 4% versus 70 +/- 5% and 73 +/- 5% versus 86 +/- 5%, p less than 0.01 and 0.001, respectively); the values augmented normally in all the untrained subjects, but increased only by less than 5% units, did not change or decreased in nine athletes (41%). Eight athletes (36.5%) failed to demonstrate the expected symmetric hyperkinetic wall motion changes during exercise, which were seen in all the untrained subjects. No correlation was found between atypical responses to exercise and electrocardiographic patterns.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Extension-supination sign in prearthroscopic elbow distension.

A clinical sign of extension and supination of the elbow is described after prearthroscopic distension with fluid. When elicited, intra-articular fluid placement is indicated, assisting correct location of the arthroscope within the joint.

Arthroscopy↗
PubMed2005

Thinking on your back: solving anagrams faster when supine than when standing.

There is potentially less locus coeruleus-noradrenergic system activity when lying down than when standing, an effect expected to develop via a difference in baroreceptor load. Furthermore, there is evidence implying that locus coeruleus-noradrenergic system activity impairs attempts to solve anagrams. Consistent with these ideas, we found that subjects solved anagrams significantly faster when supine than when standing. With anagrams characterized as insight problems, our finding suggests that insight may be influenced by body posture.

Adolescent↗
PubMed2004

The clinical use of supine left lateral leg cycle ergometry for exercise electrocardiographic testing in women, as used in exercise echocardiography.

BACKGROUND: Two-dimensional exercise echocardiography is commonly performed in the supine (SUP) left lateral posture (SLL) to optimize imaging quality. OBJECTIVES: To assess the clinical use of SLL cycle ergometry, we determined the metabolic, cardiovascular, and hemodynamic responses during graded leg cycle ergometry in women, performed in SLL, commonly used during exercise echocardiography, and compared our findings with those obtained during upright (UP) and SUP leg cycle ergometry. METHODS: A total of 21 apparently healthy women performed leg cycle ergometry in 3 distinct postures (UP, SUP, and SLL). RESULTS: Peak oxygen consumption and peak achieved workload during SLL cycle ergometry were significantly lower compared with UP cycle ergometry, indicating that in SLL physical work capacity would be underestimated compared with that obtained for the UP and SUP postures. The peak heart rate was significantly lower in SLL and the peak systolic blood pressure higher, compared with UP. Maximal rate pressure product was not significantly different among the postures, indicating the equivalent value of SLL with regard to augmenting myocardial oxygen demand during exercise. Stroke volume (calculated from aortic Doppler flow integral) was higher at rest, and increased to a smaller extent during exercise, in the SUP posture and SLL compared with UP. Similar peak values were attained for the 3 postures. CONCLUSIONS: SLL is not a suitable modality for the assessment of functional status or for the derivation of target heart rates for exercise training in UP posture. However, SLL leg cycle ergometry exercise provokes a comparable stimulus for the detection of coronary artery disease, as it will increase myocardial oxygen demand to the same extent as UP leg cycle exercise.

Adult↗
PubMed2005

Prognostic value of supine bicycle exercise stress echocardiography in patients with known or suspected coronary artery disease.

AIMS: To assess the prognostic significance of supine bicycle exercise stress echocardiography (ESE) for cardiac events, and the ESE additional role compared to other traditional clinical and echo variables, in patients with proven or suspected coronary artery disease (CAD). METHODS AND RESULTS: Clinical status and long-term outcome were assessed in 607 patients, for a mean period of 49.9 +/- 12.5 months. ESE was performed for the diagnosis of suspected CAD in 267 patients, and for the risk stratification in 340 patients. At baseline, the mean value of WMSI was 1.22 +/- 0.36, and the mean left ventricular ejection fraction was 58.2 +/- 10.9%. The ESE was positive for ischemia in 210 patients (34.9%), while the ECG was suggestive for ischemia in 157 patients. At peak effort, the mean WMSI was 1.38 +/- 0.46. Low work load was achieved by 158 patients (26.1%). During the follow-up period there were 222 events, including 48 cardiac deaths and 34 acute non-fatal myocardial infarction. By multivariable model, cigarette smoking, peak WMSI, positive ESE for ischemia and low work load were the only independent predictors of cardiac death. The cumulative 5-year mean survival rate according to ESE response was 95.9% in patients with negative ESE, and 81.7% in positive ESE (p < 0.00001). CONCLUSIONS: In patients with known or suspected CAD able to perform a physical stress, bicycle ESE is able to stratify patients at higher risk of cardiac events. The final report of an ESE performed for prognostic purpose should include both the assessment of induced dyssinergy and the evaluation of indexes of the extent and the severity of myocardial ischemia.

Bicycling↗