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At least 1,099 records · Page 61Linked to original sources
PubMed1998

Airway protection in sleeping infants in response to pharyngeal fluid stimulation in the supine position.

This study was designed to evaluate upper airway protective mechanisms in response to pharyngeal fluid stimulation in healthy term and preterm infants at term equivalent age. Five term and seven preterm infants were studied and the following recorded: sleep state, cardiorespiratory function, and swallowing. Infusions of 0.9% saline and sterile water of volumes of 0.04, 0.2, and 0.35 mL were made during active (AS) and quiet sleep (QS). The effect of these variables on apnea (> or = 2 and > or = 5 s), swallowing, and arousal was examined. After pharyngeal infusion, apnea of > or = 2 and > or = 5 s did not change from spontaneous rates for both term and preterm infants. The most common response to pharyngeal infusion was swallowing. In AS, swallowing occurred after 65 and 73% and in QS after 40 and 64% of infusions in term and preterm infants, respectively. Swallowing was volume-related and occurred significantly more often in term infants after larger infusions of 0.35 and 0.2 mL (83 and 67%) compared with the 0.04 mL (19%) and after 0.2 mL compared with 0.04 mL for preterm infants (94 and 44%). At 0.2 mL, this was significantly higher in preterm compared with term infants (p < 0.01) and was the only significant difference between these infants. In response to pharyngeal fluid stimulation, airway defense in both full-term and preterm infants is maintained primarily by swallowing with no evidence of apnea.

Deglutition↗
PubMed1989

Clinical significance of symptomatic and silent myocardial ischemia during exercise test in patients with effort angina pectoris--investigation of hemodynamic responses during supine ergometer exercise test.

Thirty one patients with stable effort angina who had no prior myocardial infarctions underwent symptom-limited ergometer exercise test. Hemodynamic responses during exercise were assessed to determine whether or not the limiting symptoms were related to the severity of exercise-induced myocardial ischemia. Twenty-two subjects (Group I) were limited by angina and nine (Group II) were limited by other symptoms. There were no differences in age, sex distribution, prevalence of diabetes mellitus, and left ventricular ejection fraction between the two groups. Multivessel coronary artery diseases, however, were more frequent in group I (16/22 vs 3/9: p less than 0.05). Maximal work load (46.6 +/- 16.0 vs 62.5 +/- 13.4 W: p less than 0.05), exercise duration (4.7 +/- 2.0 vs 7.2 +/- 1.4 min: p less than 0.005), and maximal oxygen consumption (12.4 +/- 4.1 vs 19.3 +/- 3.3 ml/kg/min: p less than 0.005) were significantly lower in group I. The magnitude of ST depression was not different between the two groups (2.0 +/- 0.8 vs 1.8 +/- 0.7 mm: NS). At maximal exercise, heart rate, mean blood pressure, cardiac index, and stroke work index (SWI) were significantly lower in group I (p less than 0.05) and pulmonary capillary wedge pressure was significantly higher in group I (31.1 +/- 6.1 vs 25.1 +/- 5.6 mmHg: p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1997

Clinical application of cardiac output during ramp exercise calculated using the Fick equation--comparison with the 2-stage bicycle ergometer exercise protocol in the supine position.

The purpose of this study was to clarify whether the direct Fick method is applicable to the measurement of cardiac output (Q) during ramp exercise. Twelve patients with chronic health failure underwent both a ramp exercise test and a steady-state exercise test. Oxygen intake (VO2), arterial oxygen saturation and mixed venous oxygen saturation were continuously measured using a pulse oximeter and a fiberoptic catheter, and the arteriovenous oxygen difference (a-v O2 diff) and Q were calculated. Both VO2 and a-v O2 diff were significantly lower in the ramp protocol than in the steady-state protocol when they were compared at the same workload. However, the VO2 vs Q relationship and the VO2 vs a-v O2 diff relationship were very similar in the 2 protocols. The difference between Q measured during steady-state exercise and Q calculated at the matched VO2 during ramp exercise was small (3.7 +/- 7.0% and 5.6 +/- 6.6%). The results indicate that, clinically, Q measured by the direct Fick method with simultaneous measurement of VO2 and a-v O2 diff during ramp exercise is a good substitute for the true Q measured by the steady-state protocol. We conclude that Fick Q is applicable to ramp exercise.

Adult↗
PubMed1998

Incidence and clinical significance of bone bruises after supination injury of the ankle. A double-blind, prospective study.

We used MRI to study a prospective series of 95 patients with inversion injuries of the ankle and no fracture on plain radiographs. We found an incidence of bone bruises of 27%, but these made no difference to the time of return to work, limitation of walking or physical activity, or the clinical outcome scores at three months. We conclude that bone bruises have very little clinical significance after inversion injuries of the ankle.

Absenteeism↗
PubMed2005

In vivo intrarater and interrater precision of measuring apparent bone mineral density in vertebral subregions using supine lateral dual-energy x-ray absorptiometry.

Analysis of apparent bone mineral density (BMD) in the lumbar spine is commonly based on anteroposterior (AP) scanning using dual-energy X-ray absorptiometry (DXA). Although not widely used, clinically important information can also be derived from lateral scanning. Vertebral bone density, and therefore strength, can may vary in different subregions of the vertebral body. Therefore, subregional BMD measurements might be informative about fracture risk. However, the intrarater and interrater precision of in vivo subregional BMD assessments from lateral DXA remains unknown. Ten normal, young (mean: 24 yr) and 10 older (mean: 63 yr) individuals with low BMD were scanned on one occasion using an AP/lateral sequence. Each lateral scan was reanalyzed six times at L2 by three raters to determine the intrarater and interrater precision in selecting seven regions of interest (subregions). Precision was expressed using percentage coefficients of variation (% CV) and intraclass correlation coefficients (ICC). Intrarater precision ranged from ICC(1,1) 0.971 to 0.996 (% CV: 0.50-3.68) for the young cohort and ICC(1,1) 0.934 to 0.993 (% CV: 1.46-5.30) for the older cohort. Interrater precision ranged from ICC(2,1) 0.804 to 0.915 (% CV: 1.11-2.35) for the young cohort and ICC(2,1) 0.912 to 0.984 (% CV: 1.85-4.32) for the older cohort. Scanning a subgroup of participants twice with repositioning was used to assess short-term in vivo precision. At L2, short-term in vivo precision ranged from ICC(1,1) 0.867 to 0.962 (% CV: 3.38-9.61), at L3 from ICC(1,1) 0.961 to 0.988 (% CV: 2.02-5.57) and using an L2/L3 combination from ICC(1,1) 0.942 to 0.980 (% CV: 2.04-4.61). This study demonstrated moderate to high precision for subregional analysis of apparent BMD in the lumbar spine using lateral DXA in vivo.

Absorptiometry, Photon↗
PubMed1994

Radiologic diagnosis of traumatic occipitovertebral dissociation: 2. Comparison of three methods of detecting occipitovertebral relationships on lateral radiographs of supine subjects.

OBJECTIVE: The purpose of this study was to describe a method for recognizing acute traumatic occipitoatlantal dissociation that uses the basion-axial interval and basion-dental interval and to compare the accuracy of this method with the accuracies of two other methods: the Powers ratio and the x-line method. MATERIALS AND METHODS: Lateral radiographs of the cervical spine of 37 patients in whom the diagnosis of occipitoatlantal dissociation had been made on the basis of the relationship of the basion to the tip of the dens, the Powers ratio, and/or the x-line method were reviewed. Retrospectively, the occipitoatlantal junction of each was reassessed by using the the Powers ratio, the x-line, and the basion-axial interval-basion-dental interval methods. Independently, the neurologic findings at admission and the final neurologic diagnosis at discharge were obtained from the hospital records and were compared with the radiologic findings to determine the degree of radiologic-clinical correlation. RESULTS: Three groups of patients were identified by analyzing the basion-axial and basion-dental intervals of the occipitovertebral junction and related clinical findings. Twenty-three patients (group 1) had frank occipitoatlantal dislocation. Eight patients (group 2) had incomplete occipitoatlantal dissociation, which was defined as occipitoatlantal subluxation. The remaining six patients (group 3) had normal radiologic and clinical findings. Four patterns of occipitovertebral dissociation were identified: purely anterior (4/31, 13%), purely distracted (6/31, 19%), concomitantly anterior and distracted (20/31, 65%), and purely posterior (1/31, 3%). Regardless of the magnitude or direction of occipitoatlantal dissociation, the basion-axial interval-basion-dental interval method correctly identified the abnormality and the type of each. Positive clinical correlation was found in 13 (57%) of the 23 patients in group 1 and in 100% of the eight and six patients in groups 2 and 3, respectively. Neither the Powers ratio nor the x-line method could be applied in 17 (46%) of 37 cases, either because the opisthion could not be detected on the radiographs or because fusion of the posterior arch of C1 had not occurred. In the remaining 20 patients in whom the Powers ratio and the x-line method were applicable, the type of occipitoatlantal dissociation was correctly identified by the Powers ratio in 12 (60%) and by the x-line method in four (20%). Neither the Powers ratio nor the x-line method was applicable in three (50%) of the six patients in whom analysis by the basion-axial interval-basion-dental interval method and clinical findings showed no occipitoatlantal abnormality. Normal occipitovertebral anatomy was correctly identified by the Powers ratio in the remaining three patients (50%) and by the x-line method in two (33%). CONCLUSION: Direct measurement of occipitovertebral skeletal relationships altered by occipitoatlantal dissociation using the basion-axial and basion-dental intervals provides the most accurate radiologic assessment of this injury.

Atlanto-Occipital Joint↗
PubMed1992

Isolated fracture of the lateral malleolus requires no treatment. 49 prospective cases of supination-eversion type II ankle fractures.

54 patients with isolated SE II fractures through the lateral malleolus, with 2 mm maximum dislocation, were treated with an elastic bandage and immediate weight bearing. 2 patients suffered dislocation but both should not, on reassessment, have been included in the study. 49 of the remaining patients were assessed after an average of 1.5 years. All but 4 patients had very minor, if any, symptoms. The average sick leave was 6.3 weeks and the patients were back to normal activity in about 4 months. This virtual nontreatment was safe and beneficial to both the patients and the health service.

Adolescent↗
PubMed1990

Supine exercise electrocardiography compared with exercise radionuclide angiography in noninvasive identification of severe coronary artery disease.

STUDY OBJECTIVE: To determine the incremental value of exercise radionuclide angiography for identification of severe coronary artery disease. DESIGN: Retrospective analysis comparing logistic regression models. SETTING: A tertiary care referral center. PATIENTS: Three hundred and ninety-one consecutive patients who had normal resting electrocardiograms (ECGs) and no digoxin therapy within the previous week. MEASUREMENTS AND MAIN RESULTS: The exercise ECG model, consisting of magnitude of ST depression, exercise heart rate, and patient gender, was highly predictive of three vessel or left main coronary artery disease (chi 2 = 100, P less than 0.0001). The model correctly classified 60% of the study group which included 56 patients with and 179 without severe disease. The addition of radionuclide angiographic variables improved the predictive power of the model (chi 2 = 124, P less than 0.0001). However, the exercise radionuclide angiographic variables increased the number of patients who were correctly classified by only 11 and the percentage by 3% (to a total of 63% of the study group). CONCLUSIONS: The modest additional advantage provided by exercise radionuclide angiography for identification of three vessel or left main coronary artery disease in patients with normal resting ECGs would not appear to justify its routine use for this purpose. Before this conclusion is used as a guide for clinical practice, our results should be prospectively confirmed in a separate sample of patients in another institution.

Coronary Angiography↗