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At least 1,045 records · Page 58Linked to original sources
PubMed1998

Set-up error in supine-positioned patients immobilized with two different modalities during conformal radiotherapy of prostate cancer.

BACKGROUND: Conformal radiotherapy requires reduced margins around the clinical target volume (CTV) with respect to traditional radiotherapy techniques. Therefore, high set-up accuracy and reproducibility are mandatory. PURPOSE: To investigate the effectiveness of two different immobilization techniques during conformal radiotherapy of prostate cancer with small fields. MATERIALS AND METHODS: 52 patients with prostate cancer were treated by conformal three- or four-field techniques with radical or adjuvant intent between November 1996 and March 1998. In total, 539 portal images were collected on a weekly basis for at least the first 4 weeks of the treatment on lateral and anterior 18 MV X-ray fields. The average number of sessions monitored per patient was 5.7 (range 4-10). All patients were immobilized with an alpha-cradle system; 25 of them were immobilized at the pelvis level (group A) and the remaining 27 patients were immobilized in the legs (group B). The shifts with respect to the simulation condition were assessed by measuring the distances between the same bony landmarks and the field edges. The global distributions of cranio-caudal (CC), posterior-anterior (PA) and left-right (LR) shifts were considered; for each patient random and systematic error components were assessed by following the procedure suggested by Bijhold et al. (Bijhold J, Lebesque JV, Hart AAM, Vijlbrief RE. Maximising set-up accuracy using portal images as applied to a conformal boost technique for prostatic cancer. Radiother. Oncol. 1992;24:261-271). For each patient the average isocentre (3D) shift was assessed as the quadratic sum of the average shifts in the three directions. RESULTS: Group B showed a better accuracy and reproducibility than group A for PA shifts (2.6 versus 4.4 mm, 1 SD), LR shifts (2.4 versus 3.6 mm, 1 SD) and CC shifts (2.7 versus 3.3 mm, 1 SD). Furthermore, group B showed a rate of large PA shifts (>5 mm) equal to 4.4% with respect to the 21.6% of group A (P<0.0001). This value was also better than the corresponding value found in a previously investigated group of 21 non-immobilized patients (Italia C, Fiorino C, Ciocca M, et al. Quality control by portal film analysis of the conformal radiotherapy of prostate cancer: comparison between two different institutions and treatment techniques (abstract). Radiother. Oncol. 1997;43(Suppl. 2):S16, 16.8%, P = 0.001). For both groups there was no clear prevalence of one component (systematic or random) with respect to the other. The average isocentre shifts (averaged on all patients) were 3.0 mm (+/-1.4 mm, 1 SD) for group B and 5.0 mm (+/-2.8 mm, 1 SD) for group A against a value of 4.4 mm (+/-2.4 mm, 1 SD) for the previously investigated non-immobilized patient group. CONCLUSIONS: Immobilization of the legs with an alpha-cradle system seems to improve both the accuracy and reproducibility of the positioning of patients treated for prostate cancer with respect to alpha-cradle pelvic-abdomen immobilization. Based on these data, we decided to use the legs immobilization system and to reduce the margin around the CTV (from 10 to 8 mm) in the PA direction.

Humans↗
PubMed1997

Optimization of glottic exposure during intubation of a patient lying supine on the ground.

Two methods of endotracheal intubation of patients lying on the ground were compared for ease and speed of intubation and minimization of complications in a crossover study of prehospital-oriented emergency physicians. Intubation of a mannequin was attempted by the physicians in either a left lateral decubitus (LLD) position or a kneeling (K) position, followed by the alternate position. The LLD position afforded more rapid intubation, better glottic visualization, and less dental trauma. Eighty-seven percent of physicians completely visualized the glottis in the LLD position, versus 33% of the K position group. Intubation times were 10.5 versus 14.6 seconds in the LLD and K positions, respectively (P < .001). The LLD position is a more effective position (in a mannequin model) than the K position for intubation of patients found lying on the ground, a frequent situation in prehospital care.

Cross-Over Studies↗
PubMedDate not supplied

Intrarater reliability of a new method and instrumentation for measuring passive supination and pronation: a preliminary study.

Because of the clinical impression that traditional forearm goniometry has several potential sources of error and is therefore inherently unreliable, a new method using a newly designed goniometer was compared with traditional forearm passive range-of-motion goniometry. The new method utilized an offset face with a plumbline design and a patient-held tubular handle. Thirty orthopedic patients (31 wrists) were measured by three experienced hand therapists in a test-retest protocol to determine the reliability of both the traditional and new methods. Both the intraclass correlation coefficients and standard error of the measure showed improved scores with the new goniometric technique, compared with the traditional one. The differences between methods may not be clinically significant.

Adult↗
PubMed2002

Accuracy of visual estimation of body height and weight in supine paediatric patients.

BACKGROUND: When it is impossible to measure the weight and height of paediatric patients, these are usually estimated. We undertook this study to see how accurate these estimates are in practice. METHODS: Five observers estimated body height and weight, and subsequently calculated body surface area, in 48 paediatric inpatients who were lying on surgical ward trolleys. RESULTS: Regression analysis of the data revealed that good correlations existed between estimated and actual body size in all the investigators. However, we found large percentage errors in estimation for infants and younger children with small physical size, and a variation in scatter distribution of estimation errors among the five investigators. CONCLUSIONS: These findings suggest the necessity to titrate drug doses for administration in this small paediatric population.

Adjuvants, Anesthesia↗
PubMed1998

[Functional neuroanatomy of the radial nerve in the region of the long wrist and finger joint extensors and the supinator groove].

Basing on electrophysiological data measured by us we studied the course of the radial nerve or its motoric branches with regard to anatomically conditioned bony contractions and their possible significance for pain experienced at the radial epicondyle of humerus, the pain being known under several synonymous designations. To differentiate between the various pathomechanisms discussed in the literature, we performed longitudinal and transversal dissections on a total of 40 cadaveric arms. We found as constant variations to the topographic anatomy published in the standard literature a regularly extended and (in relation to the other muscles we examined) exposed course of the nerve branch proceeding towards the m. extensor carpi radialis brevis. As the only long wrist extensor muscle this is innervated in most cases from the superficial end branch of the radial nerve. The origin of the muscle projected regularly over the common aponeurosis of the extensor tendon and delimitated in most of the preparations the distal end of the tunnel of the deep radial nerve. Since the deep radial branch and the muscular branches parallel to that branch cross this part of the tendon at an obtuse angle we believe that the repeatedly discussed possibility of a dynamic nerve compression without structural influences is the triggering mechanism for the observed nerve damage.

Cadaver↗
PubMed1997

[Diagnosis of pleural effusion in intensive care patients with supine digital thoracic imaging. A study of CT validated cases].

PURPOSE: The significance of the recumbent chest x-ray using digital luminescence radiography was to be assessed in respect of diagnosis of pleural effusions. MATERIAL AND METHODS: Three experienced radiologists evaluated 32 digital recumbent chest x-rays of 32 intensive-care patients. The radiologists were asked to estimate the effusion volume and to assess whether typical x-ray signs of pleural effusions were seen. These evaluations were compared with one another and with the simultaneously produced CTs. RESULTS: Diagnostic accuracy of the digital recumbent chest x-ray is of medium quality in respect of diagnosis of pleural effusions (sensitivity: 69%, specificity: 54%, positive predictive value: 81%, negative predictive value: 34%, rate of accuracy: 65%). Diagnostic safety is the same for right-sided or left-sided pleural effusions, and increases with increasing effusion volume. The ratings by the radiologists are statistically not significantly different, but are significantly different from the CT measurements (Wilcoxon test, p < 0.05). Correlations of the assessments and the measurements were weakly positive (r = 0.24, r = 0.36, r = 0.47). The pleural effusions were on the average underestimated by the radiologists. The median predictive error was 203 ml. CONCLUSIONS: Recumbent chest x-ray with digital luminescence radiography is an imaging method of limited accuracy in respect of diagnosis of pleural effusions. Supplementary diagnostic methods are recommended, as the present results show, especially in such cases where the recumbent chest x-ray does not reveal an effusion or if the volume must be determined accurately. Digital recumbent chest x-ray ranks equal with conventional x-ray in the diagnosis of pleural effusions.

Adolescent↗
PubMed1998

Age-related differences in movement patterns used by toddlers to rise from a supine position to erect stance.

BACKGROUND AND PURPOSE: Rising from the floor to a standing position is an important milestone in the development of children. The purposes of this study were (1) to describe the movement patterns (MPs) toddlers use when rising to a standing position, (2) to determine whether toddlers' MPs differ with age, and (3) to investigate whether MPs that are proposed to occur earliest in the development of this task predominate in toddlers. SUBJECTS AND METHODS: Sixty children aged 15 to 47 months were videotaped performing at least six trials of rising. Data were reduced by classifying movements of the upper extremity (UE), axial region (AX), and lower extremity (LE) into categorical descriptions of the action of these body regions. The incidence of each UE, AX, and LE movement pattern was determined for each 10-month age interval and compared across age groups. RESULTS: Two previously unidentified MPs were described for LE action. The youngest children demonstrated the highest incidence of MPs that have been predicted by other researchers to occur early in development. CONCLUSION AND DISCUSSION: In general, toddlers' UE and AX movements were described using previously developed MP categories. Age differences were found among toddlers in the performance of the rising task. Movement patterns of the UE and AX that have been thought to occur earliest in the developmental sequence for this task predominated in this young group.

Aging↗