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PubMed1988

Response of peripheral venous pressure and plasma catecholamine concentration to supine leg exercise--a study in patients with mild congestive heart failure.

We measured the peripheral venous pressure (VP) in supine leg exercise in 25 "normal" subjects and 122 patients with primarily left-sided heart diseases (NYHA class I = 68, class II = 54 cases) to determine whether or not plasma catecholamine concentration would increase in patients with mild congestive heart failure, in response to dynamic exercise. Cardiac patients (n = 122) were divided into 2 groups on the basis of VP increment (delta VP): Group N had 60 patients with delta VP less than 35 mmH2O, and Group H had 62 patients with delta VP in excess of 35 mmH2O. Plasma concentrations of noradrenaline (NA) and adrenaline (A) were measured before and during leg exercise. The relation between delta VP, NA and A, and the relation between delta VP and increments of NA (delta NA) and of A (delta A) by leg exercise were studied in both the cardiac patients and the "normal" subjects (Group C). (1) NA at rest was 0.225 +/- 0.016 ng/ml (mean +/- SE) in Group C and 0.216 +/- 0.009 ng/ml in Group N. It was 0.468 +/- 0.026 ng/ml in Group H, which was significantly higher than in Group C (p less than 0.001), or Group N (p less than 0.001). (2) delta NA was 0.051 +/- 0.009 ng/ml (mean +/- SE) in Group C, 0.067 +/- 0.007 ng/ml in Group N, and 0.249 +/- 0.019 ng/ml in Group H. There was a statistically significant difference in delta NA between Groups C and H (p less than 0.001) and between Groups N and H (p less than 0.001). (3) There was no significant difference between the three groups in A at rest, or in delta A. (4) There was a correlation between delta VP and NA at rest (r = 0.614, p less than 0.001) and between delta VP and delta NA (r = 0.708, p less than 0.001). These data suggest that sympathetic nervous activity increased in the patients with high delta VP but without overt heart failure, and that the constriction of the capacitance vessels caused by an increase in NA could be at least one of the mechanisms involved in raising the delta VP in those patients.

Adolescent↗
PubMed1993

Abnormal postexercise systolic blood pressure response is a good indicator of impaired left ventricular filling during supine cycle ergometer exercise in patients with coronary artery disease.

To determine whether the postexercise systolic blood pressure (SBP) response is a useful marker of left ventricular filling abnormalities, supine leg exercise testing was conducted in 14 control subjects and 70 patients with coronary artery disease (CAD). An abnormal postexercise SBP response (the ratio of SBP after 3 min of recovery to the peak exercise SBP) was defined as 0.85 or more, which represented the cutoff point with the highest sensitivity and specificity for prediction of pulmonary artery wedge pressure (PAWP) of at least 20 mmHg at peak exercise in CAD patients. There was a significant difference between the SBP ratios of the two groups (Control, 0.72 +/- 0.05; CAD, 0.86 +/- 0.13; p < 0.01). There was no significant difference between the PAWP of the two groups at rest, but the PAWP at peak exercise was significantly higher in the CAD group (20.2 +/- 8.9 mmHg) than in the control group (11.5 +/- 4.0 mmHg)(p < 0.01). PAWP at peak exercise was > or = 20 mmHg in 35 (50%) of the 70 CAD subjects. The SBP ratio was significantly correlated with PAWP at peak exercise (r = 0.67, p < 0.01) in the CAD group, but not in the control group. An SBP ratio of > or = 0.85 showed a sensitivity of 80% and a specificity of 80% for predicting a peak exercise PAWP of > or = 20 mmHg in CAD patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2001

Systolic dysfunction and blood pressure responses to supine exercise in patients with hypertrophic cardiomyopathy.

Left ventricular function and blood pressure responses were evaluated in 56 patients with non-obstructive hypertrophic cardiomyopathy (HCM) and 12 control subjects by using a radionuclide ventricular function monitor during supine ergometer exercise. Patients with HCM were divided into 2 groups: (i) group A had no decrease in ejection fraction (EF) during exercise; and (ii) group B had a decrease in EF during exercise. During exercise, the change in end-diastolic volume did not differ between the 3 groups. In contrast, the change in end-systolic volume differed between the 3 groups (p<0.0001). The change in systolic blood pressure (SBP) also differed significantly between the 3 groups. The change in SBP in group B was smaller than that in the control group and group A, and changes in the EF and changes in the SBP between rest and peak exercise showed a significant correlation (p<0.005). These results suggest that exercise-induced systolic dysfunction in patients with non-obstructive HCM may contribute to abnormal blood pressure response in those patients.

Adult↗
PubMed1993

Overshoot in mixed venous oxygen saturation during recovery from supine bicycle exercise in patients with recent myocardial infarction.

During recovery from dynamic exercise, systemic oxygen extraction rapidly decreases below the resting level in patients with heart failure, which leads to a subsequent increase in mixed venous oxygen saturation (SvO2) above its resting value (postexercise SvO2 overshoot). To evaluate the pathophysiologic basis of this phenomenon, postexercise SvO2 overshoot was evaluated in relation to hemodynamic, metabolic, and neurohumoral responses during recovery from maximal supine bicycle exercise in 22 patients with recent myocardial infarction. Postexercise SvO2 overshoot closely correlated with increased systemic vascular resistance (r = 0.79, p < 0.001) and reduced cardiac output (r = -0.74, p < 0.001), suggesting that SvO2 overshoot is primarily due to increased peripheral arteriovenous shunting caused by an enhanced peripheral vasoconstriction in the setting of reduced cardiac output. Postexercise SvO2 overshoot and systemic vascular resistance were significantly higher and cardiac output was significantly lower in New York Heart Association functional class 3 and 4 (8 patients) compared with class 1 and 2 (14 patients), whereas systemic arterial blood pressure was maintained at normal levels in both groups. Thus, postexercise SvO2 overshoot and, hence, decreased systemic oxygen extraction during recovery represent a compensatory response of an enhanced peripheral vascular tone that maintains systemic arterial blood pressure in the setting of reduced cardiac output by linking central and peripheral blood flow.

Adult↗
PubMed1999

The sleep supine position has a major effect on optimal nasal continuous positive airway pressure : relationship with rapid eye movements and non-rapid eye movements sleep, body mass index, respiratory disturbance index, and age.

STUDY OBJECTIVES: To evaluate the impact of sleep position on optimal nasal continuous positive airway pressure (nCPAP [op-nCPAP]) in obstructive sleep apnea (OSA) patients and to investigate how rapid eye movements (REM) and Non-REM (NREM) sleep, body mass index (BMI), respiratory disturbance index (RDI), and age are related to this effect. DESIGN: Retrospective analysis. SETTING: Sleep Disorders Unit at Loewenstein Hospital Rehabilitation Center. PATIENTS: Eighty-three consecutive adult OSA patients who underwent a complete nCPAP titration. From this group, 60 patients who spent at least 30 min in both the supine (Sup) and lateral (Lat) positions and 46 patients who had data on both positions during REM and NREM sleep were included in the analysis. RESULTS: In most OSA patients (52; 86.7%), the recommended op-nCPAP was obtained when the patients slept in the Sup posture. The mean op-nCPAP was significantly higher in the Sup posture (10.00 +/- 2.20 cm H(2)O) than it was in the Lat posture (7.61 +/- 2.69 cm H(2)O). The op-nCPAP was significantly higher in the Sup position than it was in the Lat position in both REM and NREM sleep, as well as in the severe BMI group (BMI >/= 30) and in the less obese group (BMI < 30). Similarly, in the severe (RDI >/= 40) and less severe groups (RDI < 40), as well as in both age groups (< and > 60 years of age), the op-nCPAP was significantly higher in the Sup posture than it was in the Lat posture. Irrespective of the four parameters mentioned, the actual differences in op-nCPAP between the two body postures were almost identical, ranging between 2.31 and 2.66 cm H(2)O. CONCLUSIONS: For most OSA patients, the op-nCPAP level is significantly higher in the Sup position than it is in the Lat position. This is true for REM and NREM sleep, for obese and nonobese patients, for patients with different degrees of severity, and for young and old OSA patients. Since the op-nCPAP was highest in the Sup posture during REM sleep, no nCPAP titration should be considered complete without the patient having slept in the Sup posture during REM sleep.

Adult↗
PubMed1990

Optimal interpretation of the supine exercise electrocardiogram in patients with right bundle branch block.

A detailed analysis of the exercise ECG was performed in 82 patients with right bundle branch block who underwent supine exercise equilibrium radionuclide angiography. The sensitivity and specificity of each individual electrocardiographic lead for the detection of a positive radionuclide angiogram was determined. Leads V5 and V6 had a sensitivity of 58 percent and a specificity of 89 percent. The limb leads and lead V4 had a lower sensitivity, but an equivalent specificity. Leads V1 and V3 each had a clearly lower specificity that ranged from 56 to 67 percent. Receiver operating characteristic curve analysis demonstrated that the optimal interpretation of the exercise ECG included the limb leads and V4 to V6, but not V1 to V3. The results of coronary angiography in the subset of 16 patients who underwent this procedure confirmed these findings.

Bundle-Branch Block↗
PubMed1996

Motion of the ankle in a simulated supination-external rotation fracture model.

UNLABELLED: An experimental study was undertaken with use of axially loaded, unconstrained cadaver ankles to determine the motion patterns seen with progressive stages of the supination-external rotation type of fracture. As described by Lauge-Hansen, these fractures were modeled by transection of the anterior aspect of the capsule and the anterior tibiofibular ligament (stage I), followed by oblique fibular osteotomy ending at the level of the ankle joint (stage II), transection of the posterior aspect of the capsule (stage III), and sequential sectioning of the superficial and deep fibers of the deltoid ligament (stage IV). Thirteen specimens were tested on an apparatus that allowed for controlled loading while the ankle was passed through a physiological range of dorsiflexion and plantar flexion. The ankles were unconstrained about the axial (internal and external rotation) and coronal (varus and valgus angulation) axes. Measurements were made throughout the range of motion in these axes in order to define the kinematic behavior. In the intact specimens, maximum plantar flexion was associated with a mean (and standard deviation) of 1.9 +/- 4.12 degrees of internal rotation of the talus and maximum dorsiflexion, with a mean of 7.2 +/- 3.88 degrees of external rotation. Varus angulation increased slightly with plantar flexion compared with the value in dorsiflexion (2.4 +/- 2.40 compared with 0.3 +/- 1.96 degrees). Internal and external rotation was not affected by fibular osteotomy or by transection of the superficial fibers of the deltoid ligament. Transection of the deep fibers of the deltoid ligament caused a significant (p < 0.02) increase in external rotation of the talus at maximum plantar flexion; this was corrected incompletely by insertion of an anatomical fibular plate. With the numbers available for study, we could not show that varus or valgus angulation was significantly affected by any combination of sectioning of the deltoid ligament and fibular osteotomy. These experiments were repeated with the addition of fixation of the subtalar joint with a talocalcaneal screw. With the number of specimens available, we could detect no significant difference, with respect to axial rotation, due to fixation of the subtalar joint. However, along the coronal axis, increased valgus angulation (p < 0.02) was seen during plantar flexion when either the deep or the superficial fibers of the deltoid ligament had been cut. CLINICAL SIGNIFICANCE: These results indicate that stability of the loaded ankle is primarily due to the deltoid ligament, which exerts a restraining influence on external rotation of the talus. Complete fibular osteotomy did not cause abnormal motion of the ankle in the absence of a medial injury. In the presence of a complete injury, lateral reconstruction only partially restored the mechanical integrity of the ankle. The results provide justification for the non-operative treatment of isolated fractures of the lateral malleolus. The data also suggest that a lateral fracture associated with a major injury of the deltoid ligament should be treated with anatomical lateral fixation followed by immobilization without early motion, to allow adequate healing of the deltoid ligament at its resting length.

Aged↗
PubMed2006

Quantitative analysis of semi-supine exercise echocardiography--influence of age on myocardial Doppler imaging indices.

OBJECTIVES: This study was performed to evaluate the feasibility of quantitative analysis of exercise echocardiography using pulsed wave Doppler myocardial imaging (DMI) and to examine the relation between age and DMI parameters at rest and during graded exercise in normal subjects. METHODS AND RESULTS: Seventy-two healthy volunteers were divided into three age groups (group I, age < or = 40 years, group II, age 41 - 59 years and group III, age > or = 60 years), and underwent a semi-supine exercise echocardiogram. Peak systolic velocity (SV), time to peak SV (TPV), systolic velocity time integral (VTI) and peak diastolic velocities (VE and VA) were measured off-line. There was a heterogeneity in DMI parameters between different myocardial walls and a gradient was found between basal and mid segments. Both persisted during exercise. Group I had significantly higher TPV than groups II and III. Increase in workload was accompanied by an increase in velocities, while TPV decreased. Differences between groups persisted throughout exercise. CONCLUSIONS: Off-line measurements of DMI parameters are feasible during exercise. SV and E decline as age increases while A increases. SV already increases at low charge exercise and may serve as a quantitative marker for the detection of myocardial viability. Change of the absolute DMI velocity values during exercise may provide a better indicator of ischaemia or viability than the absolute values themselves.

Adult↗
PubMed1996

Changes of atrial natriuretic peptide level in patients with nephrotic syndrome after supine bicycle exercise.

OBJECTIVES: The exact role of atrial natriutetic peptide (ANP) in the pathogenesis of edema in nephrotic syndrome (NS) has not been fully elucidated. We aimed to investigate the possible contribution of ANP to edema formation in NS. METHODS: We subjected 18 nephrotic subjects and 20 healthy volunteers to supine bicycle exercise (SBE), a maneuver that seemed to increase venous return and to enhance the release of ANP. Plasma concentrations of immunoreactive-ANP were measured before and after SBE by radioimmunoassay. RESULTS: There was a significant rise in the plasma concentration of ANP in the controls after SBE (from 31.1 +/- 6.16 to 42.0 +/- 6.01 pg/ml: p < 0.05). Meanwhile, there was no change in plasma concentration of ANP in the patients with NS (from 35.4 +/- 6.04 to 35.1 +/- 5.31 pg/ml). The change in plasma concentration of ANP in controls was significantly different from that in those with NS (p < 0.05). The mean baseline value of ANP in controls was the same as in NS. CONCLUSIONS: These results show that SBE was a simple maneuver to stimulate the release of ANP in healthy controls. In contrast, it failed to stimulate the release of ANP in subjects with NS.

Adolescent↗
PubMed1988

Soft splinting with neoprene: the thumb abduction supinator splint.

Thermoplastics are useful for many types of splints, but most splints made from them position the hand statically and have the disadvantage of limiting the sensory feedback that occurs during normal use and movement. Neoprene is an alternative to thermoplastics when dynamic mobility in splinting is the goal. Neoprene is soft, stretchable, lightweight, durable, nontoxic, machine-washable, and has a good memory. The TASS uses the Bobaths' key point of forearm supination and thumb abduction to position the upper extremity more functionally without the patient having to use effort. Thus sensory feedback can occur while the limb is moving within a prescribed range. The TASS can be used as an extra "hand" during the occupational therapy treatment session, or it can be applied immediately after treatment to continue to facilitate functional positioning of the limb.

Child↗
PubMed1999

A case of thoracoscopic bilateral lung volume reduction surgery in a supine position.

We present a case of thoracoscopic bilateral lung volume reduction surgery performed with the patient in a supine position. By rotating the operative table, bilateral apical resection could be performed without difficulty. The duration of the operation was 160 minutes and the patient's forced expiratory volume in 1 second improved from 0.81 l to 2.49 l.

Endoscopy↗
PubMed2001

Biomechanics of pronation and supination of the forearm.

Pronation-supination, the rotation of the forearm around its longitudinal axis, is an important motion because it allows the hand to be oriented, allowing one to take food and carry it to the mouth, perform personal hygiene, and live autonomously. The motion depends on the integrity of two bones, the radius and the ulna, as well as joints, ligaments, and muscles. In every pathological case, as described in this article, the anatomical features must be restored for normal function.

Biomechanical Phenomena↗
PubMed2001

Dyspnoea exaggerated in the supine position and during exertion--diagnostic challenge.

The case of dyspnoea, exaggerated when in the supine position and during exertion, as a result of severe weakness of the diaphragm is reported. The aim of the study was to present a rare case of idiopathic bilateral diaphragmatic paresis (BDP) and to describe all the diagnostic procedures necessary to perform differential diagnostics. In order to establish the final diagnosis, chest radiography, haemodynamic evaluation of the circulatory system, ultrasonography, ultrasonocardiography, measurement of transdiaphragmatic pressures, scintiscanning of the lungs, spirometry, analysis of arterial blood gases, computed tomography of the thorax and external stimulation of the phrenic nerve were performed. The measurement of transdiaphragmatic pressure was crucial to establish and confirm the diagnosis of BDP, as only a small difference in gastric and oesophageal pressures during tidal breathing and inspiratory efforts was recorded. As no cause of diaphragmatic paresis was found, the case was classified as idiopathic. The final diagnosis of non-trauma related bilateral diaphragmatic weakness was generally delayed. In the case of the described patient, dyspnoea, the main symptom he was suffering from, was supposed to result from his congenital heart defect. We recommend that the suspicion of idiopathic diaphragmatic paresis should always be raised in patients suffering from respiratory failure of unknown origin. It is, however, necessary to perform extensive diagnostics to exclude the other causes of phrenic-diaphragmatic impairment. It's also necessary to consider all infections, injuries and surgical procedures within the thorax as possible causes of diaphragmatic paresis.

Diagnosis, Differential↗
PubMed1999

Importance of somatosensory input for spatial orientation in supine subjects: evaluated by pointing arm movements during linear acceleration.

Goal-directed movements are secured by sensory interactions among visual, vestibular and somatosensory information. Reliable inputs from the visual system have been known, and the contribution of otolithic information demonstrated most clearly by evidence that target-pointing arm movements shifted downward in astronauts with eyes closed under space microgravity (Watt 1997), whereas the direction of shift was the opposite in subjects under centrifuge hypergravity (Bock et al. 1996). Somatosensory contribution has been also supported by many reports. In the present study, we attempted to evaluate the otolithic contribution to spatial orientation by arm-pointing deviation in supine subjects exposed to Z-axis linear acceleration in darkness.

Acceleration↗
PubMed2003

A novel skilled-reaching impairment in paw supination on the "good" side of the hemi-Parkinson rat improved with rehabilitation.

Parkinson's disease is characterized by tremor, rigidity, bradykinesia, and postural abnormalities ascribed to the loss of nigrostriatal dopamine (DA). Symptoms similar to the human condition can be produced in the rat by DA-depleting 6-hydroxydopamine injections made into the nigrostriatal system. After a unilateral lesion, the rat symptoms include sensory and motor impairments and turning biases reflecting motor abnormalities to the contralateral-to-depletion side of the body. In addition, a number of studies on skilled reaching report impairments in the use of the ipsilateral limb. It is suggested that the ipsilateral deficit is secondary to the contralateral motor impairments however. Here we re-examine how rats with unilateral DA depletion use their ipsilateral limb for skilled reaching for food. We provide the first description of an impairment on the ipsilateral-to-depletion side of the body of the rat and the first demonstration of amelioration of the defect using behavioral therapy. Video analysis of rats reaching for single pellets of food with the ipsilateral limb revealed that, although limb advancement and food grasping were normal, paw supination and food release to the mouth were impaired. Consequently, the animals were unable to transport a grasped food pellet to the mouth. Behavioral therapy, consisting of training in a simpler reaching task, strikingly lessened the impairment and improved reaching movements to the point that the rats could transport the food to the mouth. The results are discussed in relation to possible causes of the ipsilateral impairment, its treatment, and to relevant research on human Parkinson patients, indicating that they display bilateral improvements after unilateral treatments.

Animals↗
PubMed2001

Effects of water temperature on cardiac autonomic nervous system modulation during supine floating.

It is well known that heart rate, oxygen uptake and body temperature during exercise in water are affected by water temperature, buoyancy, hydrostatic and so on. It has been reported that the central blood volume during immersion was affected by the increased external hydrostatic pressure and cold-induced peripheral vasoconstriction, and intrathoratic blood volume should be greater during cold than warm water immersion (Epstein, 1992). The purpose of this presentation study was to make clear heart rate, blood pressure, oxygen uptake and cardiac autonomic nervous system modulation during supine floating at water temperatures of 25, 35 and 41 degrees C.

Adult↗
PubMed2003

Hip arthroscopy: the supine position.

Hip arthroscopy performed with the patient in the supine position is an effective, reproducible procedure. Advantages include ease and simplicity of patient positioning, use of a standard fracture table, operating room layout that is user friendly, familiar joint orientation, and optimal access for all portal placements. All technical aspects of performing the procedure are detailed, including necessary equipment, patient positioning, landmarks, portal placement, and arthroscopic anatomy. Effective and safe performance of this procedure is dependent on careful attention to every detail of the operation.

Arthroscopy↗
PubMed2000

[Relaxative effects of supine floating on heart rate, blood pressure and cardiac autonomic nervous [correction of nerveous] system activity].

The purpose of this study was to make clear the relaxative effects of supine floating (SF) on heart rate, blood pressure and cardiac autonomic nervous activity in males. Ten males served as subjects (n=10, mean age: 22.4 yrs). All subjects gave informed consent before participating. Water and room temperature were 30 degrees C. Heart rate and blood pressure were measured during SF or control (C) conditions. Cardiac autonomic nerve activity was estimated with the power spectrum analysis of heart rate variability (HRV) by using the Fast Fourier Transformation (FFT). High frequency (HF; 0.15-0.40 Hz) and the ratio of low frequency (LF; 0.04-0.15 Hz) to HF (LF/HF) were used as an indicator of cardiac vagal activity and sympatho-vagal balance, respectively. Those values were showed logarithmically (LogHF and LogLF/LogHF). LogHF during SF condition was significantly increased, LogLF/LogHF, heart rate and blood pressure were significantly decreased. These data indicate that cardiac vagal activity is enhanced and sympathetic nervous activity is suppressed by reciprocal response.

Adult↗