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At least 973 records · Page 54Linked to original sources
PubMed2003

Cardiovascular physiology during supine cycle ergometry and dobutamine stress.

PURPOSE: This study compared cardiac hemodynamics during supine cycle ergometry and dobutamine stress. METHODS: Thirty-two healthy volunteers (19 female, 13 male, 23.5 +/- 3.5 yr old) completed respective tests on separate days and in random order. Heart rate, blood pressure, and cardiac output were recorded at baseline and peak stress. Echocardiographic measures included left ventricular end-diastolic dimension, fractional shortening, heart rate corrected velocity of circumferential fiber shortening, end-systolic wall stress, and the difference between measured and predicted fiber shortening for measured wall stress. RESULTS: Compared with peak exercise, dobutamine infusion resulted in lower cardiac output (12 +/- 2 vs 16 +/- 4 l x min(-1), P < 0.0001), heart rates (163 +/- 7 vs 175 +/- 12 beats x min(-1), P < 0.0001), and systolic blood pressure (160 +/- 22 vs 185 +/- 20 mm Hg, P < or = 0.0001). Echocardiography demonstrated smaller left ventricular end-diastolic dimension (4.2 +/- 0.7 vs 4.5 +/- 0.7 cm, P = 0.013), higher fractional shortening (0.55 +/- 0.07 vs 0.50 +/- 0.06%, P < 0.001), higher VCFc (2.07 +/- 0.36 vs 1.54 +/- 0.20 circs x s(-1), P < 0.001) higher VCFdiff (0.94 +/- 0.35 vs 0.48 +/- 0.20 circs x s(-1), P < 0.001), and lower end-systolic wall stress (25 +/- 11 vs 42 +/- 16 g x cm(-2), P < 0.001). The stress-velocity relationship during dobutamine demonstrated higher y-intercept and steeper slope, indicating greater load-independent contractility. CONCLUSION: The cardiovascular adaptation to exercise and dobutamine stress differ significantly. Cardiac output during peak exercise is greater than during peak dobutamine secondary to increased heart rate and stroke volume. Despite a greater increase in contractility and decrease in afterload, a smaller increase in cardiac output during dobutamine stress may be secondary to limited ventricular preload.

Adaptation, Physiological↗
PubMed1985

Left ventricular responses to supine bicycle exercise assessed by radionuclide angiocardiography and a Swan-Ganz catheter.

Left ventricular responses to supine bicycle ergometer exercise were studied by gated radionuclide angiocardiography (RNA), in 12 normal subjects (group A), 11 coronary patients without effort angina (group B) and 17 coronary patients with effort angina (group C). In the serial measurement of global ejection fraction (EF) there was a significant increase during peak exercise (PEx) in group A and B. In group C, global EF during mild exercise (MEx) did not increase, but decreased significantly during PEx. These results suggest the necessity of achieving adequate exercise loading in the diagnosis of exercise-induced ischemia, and also, that the serial measurement of global EF during exercise appears to be highly valuable. In the assessment of regional wall motion on the basis of regional EF, abnormal responses to exercise were highly inducible in the anteroseptal region in coronary patients with left anterior descending artery involvement. Abnormal wall motion in the other regions was less indicative for right coronary or left circumflex artery dysfunction. We examined hemodynamic responses to exercise by a Swan-Ganz catheter during RNA study in 5 patients of group A, 5 of group B, and 9 of group C. There was a large increase in left ventricular stroke work index (LVSWI) with a small rise in pulmonary capillary wedge pressure (PCWP) in group A. In group B LVSWI increased with a moderate rise in PCWP during PEx. In group C there was a negligible increase of LVSWI despite a marked rise in PCWP. A similar relationship was present between the LVSWI and the end-diastolic count (EDC) in the left ventricular region of interest. In MEx, however, the rise in PCWP in group C was more prominent than the increase in EDC. Thus, the present data indicate that the left ventricle in group C operates on a steeper portion of the diastolic pressure-volume curve than that in group A or B.

Adult↗
PubMed1987

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

The present study examined the effects of phentolamine (PH) on the increments in peripheral venous pressure (delta VP), and of plasma noradrenaline (delta NA) and adrenaline (delta A) concentration, in response to supine leg exercise. Peripheral venous pressure and plasma catecholamine concentrations were measured at rest and during exercise, before and after intravenous injection of PH (0.1 mg/kg) in 10 healthy volunteers (Group C), and in 42 patients with primarily left-sided heart diseases but without apparent right-sided or left-sided heart failure (NYHA class I, II). These cardiac patients were divided into 2 groups on the basis of delta VP. Those with delta VP below 35 mmH2O comprised the normal group (Group N), and those with delta VP more than 35 mmH2O the abnormally high group (Group H). 1) In Group C, delta VP changed only slightly from 11.1 +/- 2.8 (mean +/- SE) to 4.9 +/- 1.7 mmH2O with an intravenous injection of PH. On the other hand, PH caused a significant decrease in delta VP from 22.2 +/- 2.3 to 10.4 +/- 2.3 mmH2O in Group N (p less than 0.001), and from 52.7 +/- 3.4 to 17.0 +/- 12.4 mmH2O in Group H (p less than 0.001). It was suggested that PH blocked the alpha-receptors of the systemic capacitance vessels, thereby inhibiting the constriction of these vessels. 2) Both NA at rest and delta NA before PH were significantly higher in Group H than those in Groups C or N. delta NA increased significantly after the PH injection in all 3 groups, i.e., from 0.038 +/- 0.013 (mean +/- SE) to 0.282 +/- 0.051 ng/ml in Group C, from 0.056 +/- 0.013 to 0.279 +/- 0.034 ng/ml in Group N and from 0.279 +/- 0.034 to 0.839 +/- 0.103 ng/ml in Group H. The increase in delta NA after PH was especially marked in Group H. It was suggested that the "sympathetic nervous activity" was increased in the patients with an impaired left ventricular pumping function. 3) PH caused a slight increase in delta A in all groups, but there was no significant difference in delta A before and after PH in the 3 groups.

Adult↗
PubMed1984

Ventilation perfusion ratios of the normal supine lung using emission tomography.

Ventilation perfusion imaging using single photon emission tomography was carried out in the supine position on four subjects, three normal volunteers and one patient, all free from evidence of respiratory disease. Ventilation imaging was by means of the steady-state inhalation of krypton 81m, perfusion imaging utilised technetium 99m labelled macroaggregates. In the three normal volunteers, perfusion studies were repeated using steady state infusion of 81Krm in solution. Ventilation perfusion ratios were calculated for the anterior, middle and posterior regions of the lung using axial slices from apex to base. The results using 99Tcm for perfusion showed a gradient of ventilation perfusion ratios from front to back of 1.27 anteriorly and 0.93 posteriorly for the right lung, 1.06 anteriorly and 0.77 posteriorly for the left lung. Using 81Krm for perfusion a small gradient of 0.94 to 0.82 was observed.

Adult↗
PubMed1982

The normal right ventricular response to supine exercise.

Nine normal, healthy young males performed graded, maximal supine bicycle exercise with monitoring of hemodynamic and gated blood pool parameters. Right ventricular ejection fraction (RVEF) was greater than 0.45 in all acquisitions at rest (mean +/- SD = 0.53 +/- 0.05) and increased greater than 0.05 in all subjects with maximal exercise (mean +/- SD = 0.69 +/- 0.06 at stage 4). There was a very close correspondence between RV and LV stroke counts from the radionuclide angiograms at rest and all exercise levels in all patients. Cardiac output changes by radionuclide data from the RV correlated closely with those obtained by the Fick technique. Multivariate analysis of RVEF vs pulmonary artery pressure, total pulmonary resistance, and heart rate showed that RVEF was inversely related to total pulmonary resistance in these patients (n = 43 acquisitions, r = 0.61, RVEF = 0.75 -- 0.001 TPR in dynes-sec/cm5 Sy.x = 0.07) and positively related to heart rate (n = 43, 4 = 0.78, RVEF = 0.34 + 0.0025 x HR Sy.x = 0.05). RVEF was not significantly related to the other hemodynamic parameters. These results suggest that in normal subjects RV systolic function is afterload-dependent and that total pulmonary resistance may be a suitable afterload index. The results emphasize that heart rate must be considered when comparing RVEF changes.

Adult↗
PubMed1983

Left ventricular size and performance during graded supine exercise in normal subjects.

To investigate left ventricular size and performance during graded submaximal exercise, 14 normal subjects with a mean age of 21 years exercised in a supine position to achieve the target heart rate. Using two-dimensional echocardiography, we recorded and analysed the left ventricular (LV) cross-sectional area and internal dimension at the level of the tips of the mitral valve at rest and during mild, moderate and severe exercise. The heart rate and systolic blood pressure increased substantially from rest to peak exercise (71 +/- 11 to 162 +/- 10 beats/min, 122 +/- 10 to 204 +/- 22 mmHg). The end-diastolic cross-sectional area and internal dimension (EDA & EDD) increased by 1.1-2.2 cm2 (7-13%) and 0.2-0.3 cm (4-7%), respectively, from mild to moderate exercise, (p less than 0.05-0.001). At peak exercise, however, these decreased and showed no statistically significant difference from the values at rest. The end-systolic cross-sectional area and internal dimension (ESA & ESD) decreased by 1.1 to 1.6 cm2 (14-20%) and 0.2-0.3 cm (7-10%), respectively, from moderate to severe exercise (p less than 0.01-0.001). However, the end-systolic values during mild exercise were not significantly different from those at rest. The stroke area (EDA-ESA) and dimension (EDD-ESD) increased by 1.6-2.6 cm2 (19-31%) and 0.2-0.6 cm (25-38%), respectively, during all levels of graded exercise (p less than 0.05-0.001). The percent change of LV cross-sectional area and internal dimension during systole increased gradually from rest to moderate exercise (51.0 +/- 7.1 to 61.9 +/- 4.4%, 35.4 +/- 3.9 to 45.0 +/- 3.7%), respectively, and showed no further increase during peak exercise. The mean circumferential fiber shortening velocity increased sharply from rest to peak exercise (1.27 +/- 0.14 to 2.25 +/- 0.21 circ/sec). These results suggest that the Frank-Starling mechanism operates during mild to moderate exercise, and contractility increases markedly at moderate to severe exercise levels as cardiac performance is augmented during graded submaximal exercise.

Adolescent↗
PubMed2004

Stress examination of supination external rotation-type fibular fractures.

BACKGROUND: Deltoid incompetence in association with an isolated fibular fracture is assumed to be present if there is medial tenderness, ecchymosis, or substantial swelling. We sought to determine whether these soft-tissue indicators predict deltoid incompetence by comparing such findings with the findings on stress radiographs. METHODS: Over a thirty-two-month period, 138 patients who presented acutely with a Weber type-B supination-external rotation (SE) fibular fracture were evaluated for tenderness (in nine locations), ecchymosis, and swelling. Patients who presented with an apparently isolated fibular fracture and an intact ankle mortise (with a medial clear space of < or =4 mm and no talar subluxation) were evaluated with a stress radiograph to determine deltoid competence. Four groups of patients were identified: those who had an SE2 fracture (defined as those who had a stable ankle on the stress radiograph), those who had a stress (+) SE4 fracture (defined as those who had an unstable ankle on the stress radiograph), those who had an SE4 fracture (defined as those who presented with a wide medial clear space), and those who had a bimalleolar fracture. These four groups were compared with regard to tenderness, swelling, and ecchymosis at the time of initial presentation. Patients with SE2 injuries were allowed immediate weight-bearing. RESULTS: Of the ninety-seven patients who presented with an isolated fibular fracture and an intact mortise, sixty-one had a stable SE2 injury and thirty-six had an unstable stress (+) SE4 injury. All stable SE2 injuries healed with an intact mortise. Medial tenderness, ecchymosis, and swelling were not predictive of deltoid incompetence (instability). CONCLUSIONS: Stress radiographs allow for the accurate diagnosis of deltoid incompetence in patients with Weber type-B SE fibular fractures and no other osseous injury. Soft-tissue indicators are not accurate predictors of instability. If medial tenderness, ecchymosis, and swelling are used as operative indications, in some cases surgery may be performed on stable ankles.

Ankle Injuries↗
PubMed1975

Comparative detection of pancreatic body--tail enlargement using the supine translateral and axial pancreatic views: a prospective statistical study.

A prospective statistical study of 429 patients was undertaken to determine if the axial pancreatic view would improve detection of pancreatic body-tail enlargement. This view is produced by directing a roentgen-ray beam along the axis of the pancreatic body-tail cylinder. On this view and on the supine translateral view, a pancreatic body-tail space can be identified as a subdivision of the retrogastric space. When the pancreatic body-tail enlarges, this space selectively enlarges. The percentage change of this space is particularly impressive on the axial pancreatic view, where 10 of 12 pancreatic body-tail neoplasms were detected with only a 1.8 per cent false positive rate.

Humans↗
PubMed1978

Medial herniation of the parietal pleura: a useful sign of pneumothorax in supine neonates.

In a series of 235 consecutive infants with respiratory distress syndrome, pneumothorax was demonstrated radiographically in 20. On anteroposterior supine chest radiographs of such infants, the intrapleural gas tends to seek an anteromedial position within the involved hemithorax. When the pneumothorax is large, the gas may cause the ipsilateral mediastinal pleura to bulge and herniate across the anterior mediastinum into the contralateral hemithorax. This was seen in 12 or the 14 right pneumothoraces, but only in two of the 10 left ones. The gas-containing sac appeared radiologically as a crescent-shaped lucency medial to the upper thoracic spine which was sharply delineated laterally by the mediastinal pleural layers and the somewhat atelectatic contralateral lung. In some patients treated with a chest tube, the gas disappeared more slowly from the herniated portion of the pleural sac than from elsewhere in the pleural space. Therefore, in addition to being a useful confirmatory sign of pneumothorax, this finding is also important in assessing the completeness of pleural drainage.

Hernia↗
PubMed1980

Prone-supine change in organ position: CT demonstration.

A study of positional variation of anatomic structures in 38 patients undergoing CT in both the supine and prone positions prior to beginning radiotherapy is reported. Within the thorax, turning the patient to the prone position resulted in a ventral shift of hilar structures in 36 of 38 patients. In two patients, pulmonary metastases shifted ventrally and caudally in the prone position. In all cases reviewed, prone positioning produced a ventral shift of the heart and great vessels. Within the abdomen, prone positioning produced ventral as well as caudal shift of both the liver and spleen in 34 of 38 patients. In all of the patients, a ventral shift of the kidneys as well as caudal shift was noted. Little or no variation of position was noted in cervical or pelvic structures with changing body positions.

Digestive System↗
PubMed1999

Whole-body vibration perception thresholds of recumbent subjects--Part 1: Supine posture.

The objective of the present study was to determine perception thresholds for whole-body vibration in the recumbent supine posture in vertical and horizontal directions and to compare the present results with ones obtained at the same laboratory in 1984 and also with ISO frequency weighting curves both in ISO 2631-1 and in ISO 2631-2. The frequency characteristic and thresholds values of the present results are similar to previous results. Weighting curves of ISO, however, show quite different characteristic in both vertical and horizontal directions compared to the present characteristics. It is not suitable to apply weighting curves Wk for the vertical direction, Wd for the horizontal direction and combined curves in ISO to recumbent posture from the results of this present study.

Adult↗
PubMed1980

The effect of repeated supine exercise on exercise tolerance and left ventricular pump function in patients with angina pectoris.

The reproducibility of symptoms, exercise tolerance and haemodynamic variables describing left ventricular pump function have been studied at rest and during repeated supine exercise in ten patients with severe angina pectoris. Two exercise periods were performed about 20 min apart and the breaking point was in all cases determined by angina pectoris. The average working capacity was 22.5 W in both exercise periods. Duration of work, time to onset of angina and pain level at breaking point were not different in the two periods. There were no significant differences at rest nor during exercise for oxygen uptake, arterio-venous oxygen difference, heart rate, cardiac output, stroke volume, left ventricular systolic and end-diastolic pressure, pulmonary artery mean pressure, right atrial mean pressure, stroke work index or left ventricular work. Pressure-time index was significantly (P less than 0.01) higher in the second rest period but systolic pressure heart rate product was not significantly different. The high reproducibility with very small variations of the variables studied should permit the use of this protocol to study the acute haemodynamic effects of pharmacological interventions at rest and during exercise in patients with severe effort-induced angina pectoris.

Aged↗
PubMed1984

Supine and standing plasma catecholamines in essential hypertensive patients with different renin levels.

In this study we measured plasma renin activity (PRA), plasma norepinephrine (NE) and epinephrine (E), heart rate (HR) and blood pressure (BP) in 89 supine (sup) essential hypertensive patients (pts), WHO I-II, after 3-5 days of fixed normal sodium and potassium intake; the same measurements were repeated after 30' of active standing (stand) in 44/89 pts. In the whole population NE was directly related to PRA, both in sup and in stand position (p less than 0.01). NE was above the upper limits of normotensive controls in 2/34 (6%) pts with low PRA, in 6/40 (17%) pts with normal PRA and in 6/15 (40%) pts with high PRA. In respect to normal PRA pts, HR was significantly lower in low PRA pts and higher in high PRA pts, both in sup and in stand position (p less than 0.05). Sup and stand NE and E were similar in low and normal PRA pts, while they were significantly higher in high PRA pts (p less than 0.05). These results suggest an increased adrenergic tone at least in some high PRA pts, and blunted responsiveness of renal and cardiac beta adrenergic receptors to adrenergic stimuli in low PRA pts.

Adult↗
PubMed1980

Ankle fractures. Supination-eversion fractures stage II. Primary and late results of operative and non-operative treatment.

Sixty-nine patients with stage II supination-eversion fractures of the ankle, 34 treated by operation and 35 treated conservatively, were seen at follow-up after 3-10 years. There was no statistically significant differnce between the results of the two methods. However, larger series and perhaps a longer observation time are probably needed to decide whether the displacement of the lateral malleolus as a result of non-operative treatment affords the same possibility of unhindered ankle function as union of the lateral malleolus in the anatomical position obtained by operation.

Adolescent↗
PubMed1980

Ankle fractures: supination-eversion fractures of stage IV. Primary and late results of operative and non-operative treatment.

Supination-eversion fractures of stage IV, 60 treated operatively and 29 non-operatively, were seen at follow-up after 3-10 years. This disclosed a statistically significant difference between the results of the two methods. Operation which attempted to re-establish the anatomical position was apparently the better method in the presence of more than minimal displacement or a suspicion of deltoid ligament rupture.

Ankle Injuries↗
PubMed1985

Closed treatment of ankle fractures. Stage II supination-eversion fractures followed for 20 years.

Ninety-four conservatively treated patients with Lauge Hansen Stage II supination-eversion fractures of the ankle were interviewed after 16-25 years. Patients with pain were examined clinically and radiographically. Eighty-nine patients had good and five medium results. Our observations compare well with published reports of open treatment. We conclude that this particular fracture type is so benign that it can be treated closed without reduction.

Adolescent↗
PubMed1982

Death from a snake bite: associated with the supine hypotensive syndrome of pregnancy.

A young pregnant woman, near term, died shortly after being bitten by an immature brown snake (genus Pseudonaja). Analysis of the bitten area suggested that the degree of envenomation was mild, and could not satisfactorily explain her rapid demise. It was concluded that the supine hypotensive syndrome of pregnancy was a contributing factor in her death.

Adult↗