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At least 811 records · Page 45Linked to original sources
PubMed2001

Contact pressure distribution in the supine position in low-birth weight infants analyzed by a photoelastic method.

BACKGROUND: Contact pressure distribution patterns in the supine position in low-birth weight (LBW) neonates were analyzed by the use of a photoelastic method. METHODS: A total of 61 subjects (LBW neonates, mature (bodyweight > 2,500 g at birth) neonates, normal infants and Down syndrome (DS) infants) were selected for the study. Infants were placed on a photoelastic measuring table. Photoelastic images generated in the contact regions of the body were photographed with a camera and printed on monochrome paper. The coefficient of variation in the pressure distribution value (PcV) and the top and bottom ratio (mu) of the trunk at the center of pressure were calculated. RESULTS: The Pcv value was significantly lower in DS than LBW (P < 0.001), mature (P < 0.002) and normal infants (P < 0.01). The mu value in LBW and mature neonates was 48.9 and 50.2%, respectively. Normal infants had a mu value of 44.0%, which was significantly lower than that in LBW neonates. However, there was no significant difference between LBW and DS infants. CONCLUSIONS: Neurological impairment specifically affects the data obtained by photoelastic analysis.

Body Weight↗
PubMedDate not supplied

Cerclage wire and lag screw fixation of the lateral malleolus in supination and external rotation fractures of the ankle.

Wound dehiscence and exposed lateral hardware can occur after open reduction internal fixation of lateral malleolus. The bulk of a lateral plate and the minimum soft tissue over the lateral malleolus may contribute to this situation. The objective of this study was to evaluate a series of patients with lateral malleolar fractures treated with operative reduction using minimal hardware. We wanted to observe whether there was any loss of reduction and whether there were any incidences of soft tissue disruption. Fifty-two patients with long spiral fracture of the lateral malleolus in a supination-external rotation injury were treated with two or three 3.5-mm lag screws inserted 1 cm apart and 1 or 2 circlage wires. Less rigid fixation was supplemented with a below-the-knee plaster cast. All patients were followed up until clinical and radiological evidence of fracture healing at 6, 10, and 14 weeks postoperatively. By 10 weeks, all patients were full weight bearing, although most patients still limped. At 14 weeks' follow-up, there were no infections or wound dehiscences. All patients were able to return to their activities of daily living. All the fractures had united without loss of original position. Two fractures of the posterior bone spikes seen during surgery united uneventfully. Long spiral fractures of the lateral malleolus of the ankle can be treated successfully with 2 or 3 lag screws and circlage wires without compromising the outcome of the fracture healing.

Adult↗
PubMed2000

Video-assisted thoracoscopic surgery for bilateral spontaneous pneumothorax in supine position: the use of a pillow beneath the back for intercostal space widening.

We performed a single stage video-assisted thoracoscopic surgery for bilateral spontaneous pneumothorax in the supine position with both arms abduced and the back slightly elevated using a pillow. While intercostal spaces were not open enough to insert a trocar, this procedure, not requiring the trouble of placing patients in the lateral decubitus position, is beneficial for the single treatment of bilateral thoracic discase.

Adult↗
PubMed1994

[The value of the supine chest x-ray with digital luminescence radiography in relation to the experience of the observer. A ROC analysis in CT-validated cases].

The aim of the present study was to evaluate supine chest radiographs obtained by DLR for the diagnosis of pleural and parenchymatous changes and to compare the accuracy of observers in relation to their experience. 50 examinations, which had been checked by CT, were chosen. The images were examined by 7 doctors (2 non-radiologists, 5 radiologists). Our experience indicates that DLR has high specificity but low sensitivity for the diagnosis of a pneumothorax but relatively high sensitivity and low specificity for other changes (pleural effusions, atelectases and other intrapulmonary opacities). The area under the ROC curve averaged over the 7 rater was similar for these 4 entities. There were marked differences between the observers; the radiologists were considerably better than the non-radiologists. Altogether, the diagnostic value of single DLR examinations was relatively low. In indeterminate cases, additional diagnostic methods should, therefore, be used.

Adolescent↗
PubMed1997

The influence of gloves during maximum volitional torque exertion of supination.

This study focuses on the influence of friction between gloves and handle surface during maximum volitional torque exertion of supination (S-MVTE) and under both friction-controlled and regular friction conditions. Forty student subjects (20 males and 20 females) participated in this study. Five types of gloves (surgical, single cotton, double cotton, leather, and rubber), seven handle sizes (25.4, 31.8, 38.1, 44.5, 50.8, 57.2, and 63.5 mm in diameter) and two handle shapes (cylindrical and hexagonal) were evaluated to determine their combined influences on S-MVTE. The barehanded condition was also included for comparison. The results indicate that all the main effects were significant (P < 0.001). Under friction-controlled conditions (oiled surface handle), the S-MVTEs with gloves were found to be greater than the S-MVTEs of the gloveless, and the thicker the gloves, the greater the S-MVTE. On the other hand, under regular (unoiled) conditions, the S-MVTE was mainly affected by the friction between handle surface and gloves, although the interaction between gloves and handle shape was also a minor influence. A hexagonal handle produced, in all handle diameters, greater S-MVTE than a cylindrical handle. The mean S-MVTE under oiled conditions was about 53% of that of unoiled conditions. The mean S-MVTE of females was about 61% of that of males.

Adolescent↗
PubMed1994

Tracheal intubation in a manikin: comparison of supine and left lateral positions.

Tracheal intubation in the left lateral position may be necessary in some circumstances. Using a manikin we demonstrated that anaesthetic trainees found tracheal intubation in the left lateral position was more difficult and took longer than in the supine position. However, the time to successful tracheal intubation decreased with practice, indicating the presence of a learning curve. We suggest that tracheal intubation in the left lateral position should become part of training in the management of the difficult airway.

Anesthesiology↗
PubMed2000

Tension pneumocephalus after neurosurgery in the supine position.

Tension pneumocephalus has been reported most frequently after posterior fossa surgery performed in the sitting position. We present a paediatric patient who developed tension pneumocephalus in the postoperative period after decompression of a craniopharyngioma performed with the patient in the supine position.

Child↗
PubMed1988

Serial pulmonary blood volume changes with supine exercise in normal subjects and in coronary artery disease patients.

Relative changes in pulmonary blood volume (PBV) were assessed serially at first stage, peak and post-supine exercise in 13 young normal volunteers and 33 coronary artery disease (CAD) patients. Gated blood pool imaging was used with time corrected count calculation of a region over the lung and comparison to the rest image. In normal subjects, the PBV ratio did not change with exercise but dropped significantly immediately post-exercise. In CAD patients, the PBV ratio increased in the first exercise stage, increased further at peak exercise, and fell significantly following exercise cessation. In the three stages studied, significantly higher PBV ratios were demonstrated in the CAD patients compared to normal subjects, but with significant overlap between the two groups. No significant relation was found between PBV changes and the number of diseased vessels, severity score (Gensini), left ventricular end-diastolic pressure, exercise-limiting symptoms, and left and right ventricular ejection fraction at rest and with exercise. Despite the different response of the PBV ratio to exercise between normals and CAD patients, a significant overlap limits the value of this ratio as a discriminator of the presence, severity or location of CAD.

Adult↗
PubMed2001

Effects of a titratable oral appliance on supine airway size in awake non-apneic individuals.

STUDY OBJECTIVES: To define morphological changes in the upper airway and its surrounding structures after the insertion of a titratable mandibular repositioner. DESIGN: Ten non-apneic adult males participated in this study. A set of supine lateral cephalograms was taken for each subject at the end of expiration with a titratable oral appliance in place in four mandibular positions: most retruded (RP), maximum protrusion (MAX), 33% of MAX (MAX33), and 67% of MAX (MAX67). Changes in the anteroposterior width of the upper airway, positions of the hyoid bone and the third cervical vertebra were compared between the four mandibular positions. An ANOVA was used to test for statistical significance. SETTING: N/A. PATIENTS OR PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The anteroposterior width of the velopharynx significantly increased when the mandible was advanced from RP to MAX67 and MAX. However, there were no significant changes in the anteroposterior width of the oropharynx. Significant forward displacement of the hyoid bone and third cervical vertebra together with the mandible was found in MAX67 and MAX compared to RP. CONCLUSION: Especially in MAX67 and MAX, the titratable oral appliance significantly enlarges upper airway size in the velopharynx and results in a forward displacement of the hyoid bone and the third cervical vertebra.

Adult↗
PubMed2003

Effects of mandibular advancement on supine airway size in normal subjects during sleep.

STUDY OBJECTIVES: To examine changes in the upper-airway dimension and its surrounding structures induced by mandibular advancement during sleep. DESIGN: Eleven nonapneic adult males participated in the study. A set of supine lateral cephalograms was taken for each subject at the end of expiration during stage 1 and 2 non-rapid-eye-movement sleep with and without a Klearway appliance (Great Lakes Orthodontics, NY, USA), which was adjusted to 67% of the maximum protrusion position. The Wilcoxon signed-rank test was used to compare changes in the anteroposterior width of the upper airway and the positions of the hyoid bone and third cervical vertebra with and without the appliance. SETTING: N/A. PATIENTS OR PARTICIPANTS: N/A. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The amount of jaw opening was significantly increased by wearing the titratable oral appliance, and the mandibular symphysis moved backward. The sagittal dimension of the superior pharyngeal airway was significantly increased; however, no significant changes were found in the middle and inferior pharyngeal airway. Significant posterior displacement of the hyoid bone and third cervical vertebra was seen. Moreover, significant inferior displacement of the hyoid bone was also seen. The relationship among the mandibular symphysis, the hyoid bone, and the third cervical vertebra remained constant. CONCLUSIONS: Mandibular advancement significantly increases the size of the upper airway in the velopharynx and results in posteroinferior displacement of the hyoid bone and posterior displacement of the third cervical vertebra during sleep.

Adult↗
PubMed2002

Supine hypertension during general anesthesia in a patient taking midodrine.

IMPLICATIONS: Midodrine, a drug used to treat symptomatic orthostatic hypotension, may cause or exacerbate supine hypertension. We describe a case of a patient taking midodrine who exhibited severe hypertension during general anesthesia. Possible preventive measures to avoid this complication are discussed.

Adult↗
PubMed1996

An increase in infant cranial deformity with supine sleeping position.

Abnormalities of the occipital cranial suture in infancy can cause significant posterior cranial asymmetry, malposition of the ears, distortion of the cranial base, deformation of the forehead, and facial asymmetry. Over the past 2 years, we have noted a dramatic increase in the incidence of deformation of the occipital skull in our tertiary referral center. Our patient referral base has not changed appreciably over the past 5 years and patients have been referred from the same primary practitioner base. The timing of this increase correlates closely with the acceptance in our area of recommended changes in sleeping position to supine or side positioning for infants because of the fear of sudden infant death syndrome (SIDS). A total of 51 infants with occipital cranial deformity, with a mean age of 5.5 months at presentation, have been evaluated and treated by a single craniofacial surgeon in the 16-month period from September 1993 to December 1994. Older infants were treated with continuous positioning by the parent keeping the infant off the involved side. Younger infants and those with poor head control were treated with a soft-shell helmet. Mean timing of initial diagnosis and start of treatment was 5.5 months. Mean duration of helmet for positional treatment was 3.8 months. To date, only 3 of 51 patients have required surgical intervention, and other patients demonstrated spontaneous improvement of all measured parameters. Follow up has ranged from 8 to 24 months. We believe that most occipital plagiocephaly deformities are deformations rather than true cranio-synostoses. Despite varying amounts of suture abnormality evidenced on computed tomographic scans, most deformities can be corrected without surgery. In cases where progression of the cranial deformity occurs, despite conservative therapy, surgical intervention should be undertaken at approximately 1 year of age. The almost universal acceptance in the State of North Carolina of positioning neonates on their backs to avoid SIDS, may well increase the incidence of these deformities in the future.

Cranial Sutures↗
PubMed2000

Influence of different supine body positions on blood pressure: consequences for night blood pressure/dipper-status.

OBJECTIVES: To investigate the influence of different supine body positions on blood pressure measured by an ambulatory device. DESIGN AND METHODS: Twenty hypertensive and 20 normotensive subjects of a tertiary hospital outpatient clinic participated. Blood pressure was measured with an ambulatory blood pressure device while lying in the back, left side, right side and abdominal positions. The distance between the antecubital fossa and sternum was measured in all four body positions. An expected blood pressure difference between the arm of measurement and the right atrium (i.e. the midsternum) was calculated for the different body positions. RESULTS: When blood pressure was measured in side position at the left arm in hypertensive subjects, the mean systolic and diastolic blood pressure differences (+/- SD) between the left arm in the lower position and in back position at the same arm were +5/+4 (8/6) mmHg. These differences were -14/-17 (6/4) mmHg for the left arm lying above heart level in side position. Values of the right arm in hypertensives and the measurement at both arms in normotensive subjects yielded similar differences. CONCLUSIONS: Body and arm position can both significantly influence the ambulatory blood pressure and therefore the day-night difference. This comprises one of the main reasons for the moderate individual reproducibility of the blood pressure fall at night.

Adult↗
PubMed2005

Sudden drooling and supine gagging: an important emergency?

We describe a case of an eupnoeic patient complaining of a foreign body sensation in his mouth and throat, with sudden drooling and supine gagging. This condition was caused by an isolated uvular angioedema (Quincke's oedema). As this uvular hydrops did not decrease with initial standard therapy for angioedema, epinephrin was applied directly on the swollen uvula, causing it to shrink very rapidly. Isolated uvular oedema is a potentially life-threatening condition with risk of sudden upper airway obstruction, and should therefore be recognized and treated as soon as possible. As described in this case, its initial presentation can consist of gagging and drooling without dyspnoea, thus causing a real challenge for triage and diagnosis.

Adult↗
PubMed2004

Accuracy of automated auscultatory blood pressure measurement during supine exercise and treadmill stress electrocardiogram-testing.

OBJECTIVES: Monitoring of brachial blood pressure during exercise-electrocardiogram (ECG) testing is mandatory and changes in blood pressure (BP) can provide critical management evidence. Patient movement, mechanical vibration, artifactual sounds and observer variability make standard manual techniques problematic. This was an investigator-initiated study to assess an automated auscultatory technique of BP assessment [Tango exercise blood pressure monitor (SunTech Medical Instruments, NC, USA)] to adequately measure BP during stress-ECG testing. METHODS: Initially five fit young male volunteers underwent invasive right brachial artery BP recording using a low-compliance fluid-filled catheter with simultaneous manual and automated assessment. Secondarily, during exercise-ECG testing, the system was assessed against beat-to-beat brachial blood pressures obtained from a catheter-tip solid-state pressure manometer positioned in the ipsilateral brachial artery. RESULTS: In the supine study overall mean difference (+/-SEM) between invasive and manual blood pressures was 3.26 (1.53) and 3.89 (1.90) mmHg for diastolic BP (DBP) and systolic BP (SBP) respectively. Corresponding differences between invasive and automated results, and manual and automated were 3.68 (0.84) and -7.31 (1.83) mmHg, and -0.64 (+/-1.43) and -11.42 (+/-1.59) mmHg. During treadmill exercise-ECG testing the combined mean difference (+/-SEM) between invasive and automated SBP and DBP was 4.79 (+/-0.14) and 6.33 (+/-0.10) mmHg, respectively. CONCLUSION: Automated BP assessment during exercise-ECG testing is feasible with the use of appropriate automatic devices likely to be at least as accurate as manual BP registration. The Tango device is tolerant to exercise and provides reliable automatic BP assessment with absolute differences within an acceptable clinical range.

Adult↗
PubMed2003

Supine versus prone injection of Tc-99m MAA: evidence of thoracic compression or fluid shift.

After a cesarean section, a woman had sharp left chest pain that radiated to the arm and was worse with inspiration. A chest radiograph revealed minimal left lung base atelectasis. A total of 5 mCi (185 mBq) Tc-99m macroaggregated albumin (MAA) was injected with the patient supine. A posterior oblique perfusion lung image revealed nearly absent perfusion of the left lung base. The patient was then injected with an equal quantity of Tc-99m MAA while prone. Images now demonstrated perfusion of the left lower lung. This might represent redistribution of fluid obscured by the atelectatic area, or the relief of pressure on pulmonary arteries to the left lower lobe by positional change.

Adult↗
PubMed2004

Left lateral vs. supine, wedged position for development of block after combined spinal-epidural anaesthesia for Caesarean section.

This prospective, randomised controlled trial compared a spinal block developing in the left lateral position (LL), after sitting a combined spinal-epidural for Caesarean section with the woman sitting -- using intrathecal hyperbaric bupivacaine and fentanyl -- with a block developing in the supine, wedged position (SW). The median (IQR) block onset times for loss of cold sensation to T4 bilaterally for LL and SW women were 15 (13-19) and 12 (10.8-14) min, respectively (p = 0.004). Unilateral blocks did not occur in the left lateral group. There were no other significant differences between groups, except the median [range] 1-min Apgar scores, which were 9 [8-10] and 9 [6-9] in the LL and SW groups, respectively (p = 0.04). In summary, the LL position is associated with a relatively slower block onset, but produces a spinal block with similar characteristics to that obtained in the SW position.

Adult↗
PubMed2005

Blood pressure response to transition from supine to standing posture using an orthostatic response algorithm.

Upon standing from a supine position, the normal response is an increase in heart rate to maintain blood pressure (BP). In patients with chronotropic incompetence, heart rate may not increase upon standing, and they may experience orthostatic hypotension (OH). We evaluated a new orthostatic response (OSR) pacing algorithm that uses an accelerometer signal to detect sudden activity following prolonged rest to trigger a 2 minutes increase in pacing rate to 94 bpm. Ten recipients of DDDR pacemakers which contain the OSR compensation algorithm (mean age = 77 +/- 9 years, 8 women) with sick sinus syndrome (n = 6) or atrioventricular block (n = 4) were studied. In all patients BP was measured before and 0.5, 1, 1.5, 2, and 3 minutes after standing at their programmed base rate. A 20 mmHg fall in systolic BP upon standing was observed in five patients (OH patients), while the other five were considered non-OH patients. The measurements were repeated with the OSR algorithm turned on. Mean BP was defined as 1/3 systolic BP + 2/3 diastolic BP. Baseline heart rate was significantly slower in OH patients (62 +/- 2 bpm) than non-OH patients (71 +/- 7 bpm, P < 0.05). In OH patients mean BP increased significantly upon standing (P < 0.05 for all comparisons) with the algorithm ON instead of decreasing with the algorithm OFF, at 1 minute (+3.4 vs -10.3 mmHg), 1.5 minutes (+7.0 vs -4.9 mmHg), 2 minutes (+1.6 vs -6.7 mmHg), and 3 minutes (+2.5 vs -8.5 mmHg). These preliminary results suggest that the OSR algorithm maintains BP upon standing in patients with OH.

Aged↗