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PubMedDate not supplied

Sensitivity to antibacterials of Staphylococcus aureus isolated from different types of skin infections.

We examined the antibacterial susceptibility of Staphylococcus aureus isolated from several types of skin infections, which were classified into four groups: (i) impetigo, (ii) folliculitis, (iii) atopic dermatitis and eczema and (iv) ulcers and decubitus. The 50% minimal inhibitory concentration (MIC50) of the antibacterial agents was 3.13 micrograms/ml or lower, except that of gentamicin with isolates from the impetigo groups (25 micrograms/ml). The MIC90 of gentamicin was 50 micrograms/ml or more for isolates from all four groups. The isolates from the ulcers and decubitus group showed multiple resistance against antibacterial agents. The frequency of methicillin-resistant S. aureus was low, but was highest, at 25%, in the isolates from the ulcers and decubitus group. Few isolates from the atopic dermatitis and eczema group were resistant, and there was little difference in antibacterial resistance between isolates from atopic dermatitis and eczema.

Anti-Bacterial Agents↗

PubMed2006

Usefulness of a nutrition assessment system for parenteral/enteral nutrition therapy.

Since a nutrition support team (NST) began to work in our hospital in March, 2003, we constructed our original nutrition assessment system that supports the prescription formulation of total parenteral nutrition (TPN). However, in daily NST activities, the re-evaluation of this system became necessary because of a high incidence of enteral nutrition (EN) and marked revisions in the dietary reference intakes in Japanese (7th revision). Therefore, we improved this system and added a prescription formulation support function that is also applicable to EN, and also added a function that automatically calculates the necessary doses of nutrients that tend to become deficient in patients with decubituses. This new system allowed the selection/evaluation of EN solutions in a short time with consideration of the 7th revision, and readily identified deficient nutrients and their levels in decubitus patients. We used this system in patients with high-level malnutrition complicated by decubituses and observed certain treatment effects.

Enteral Nutrition↗

PubMed1986

Effect of sleep position on sleep apnea and parafunctional activity.

Parafunctional activity (toothgrinding, toothclenching and bruxism) is a common problem which may lead to masticatory muscle and temporomandibular joint pain, and may result from sleep arousal or disturbances. Sleep apnea is another common sleep disorder which results in disrupted sleep architecture and frequent arousals. Because sleep apnea leads to sleep arousals, and because sleep arousals are thought to result in increased parafunctional activity, we undertook the present study to determine the relationship between sleep apnea and parafunctional activity. We were also interested in assessing the effects of sleep posture on sleep disordered breathing and parafunctional activity. We prospectively studied 24 patients who were referred to the clinical sleep apnea laboratory for study. They underwent standard nocturnal polysomnographic examination; in addition, masticatory activity was measured with a masseter electromyogram. Patients slept in the supine and lateral decubitus positions. Nocturnal clenching was slightly higher in patients with sleep apnea than those without (12.2 vs 7.6 clenches/hr, p = 0.18), and there was a correlation between the clench index (CI) and apnea plus hypopnea index (A + HI) by linear regression (r = 0.49, p less than 0.05). There were significant falls in both the A + HI (64.4 +/- 28.8 vs 36.5 +/- 36.7, p = 0.02) and CI (12.5 +/- 12.1 vs 7.0 +/- 8.6, p = 0.04) in the lateral decubitus vs supine sleeping positions. We conclude that there is an association between obstructive sleep apnea and parafunctional activity, that sleep position affects the incidence of both sleep disordered breathing and parafunctional activity, and that analysis of apneas and hypopneas in both supine and lateral decubitus sleeping positions may be helpful.

Adolescent↗

PubMed2001

Significant reduction of methicillin-resistant Staphylococcus aureus bacteremia in geriatric wards after introduction of infection control measures against nosocomial infections.

OBJECTIVES: (1) To investigate the efficacy of infection control measures against methicillin-resistant Staphylococcus aureus (MRSA) bacteremias in geriatric wards. (2) To identify predisposing risk factors for MRSA bacteremia. METHODS: Cases with nosocomial bacteremias were retrospectively analyzed between January 1991 and March 1995. The study period was divided into four annual periods and the period 1, January to December 1991, was applied as the control. MATERIALS: We investigated patients with nosocomial bacteremias in geriatric wards (190 beds) of AINO Memorial Hospital, affiliated with Nagasaki University. RESULTS: A significant reduction in cases with MRSA-induced nosocomial bacteremia was observed after the introduction of a stringent infection control and prevention program (period 1 vs. periods 2, 3, and 4: p<0.00833, p<0.00167, and p<0.00167, respectively). The major source of bacteremia included urinary tract infections, intravenous catheter-related infections, and infected decubitus ulcers. Improvement of decubitus ulcer was associated with a significant reduction in MRSA bacteremia (period 1 vs. periods 2 and 3: p<0.00017 and p<0.00833). CONCLUSION: Stringent infection control programs, including prevention and treatment of decubitus ulcers, are necessary in geriatric wards to reduce and prevent MRSA bacteremia.

Aged↗

PubMed1998

Improved sonographic visualization of the fetal spine with the mother seated.

OBJECTIVE: Evaluation of the fetal spine is an essential part of obstetric sonography; however, many technical factors may limit this examination. The purpose of our study was to determine if having the mother seated during sonography could significantly improve visualization of the fetal spine when sonography in routine supine and decubitus positions had failed. SUBJECTS AND METHODS: A prospective study was performed on 526 consecutive fetal spines of obstetric patients. The estimated gestational age of the fetuses was 16 weeks or more. Sonography of the spine was considered satisfactory if the spine was seen in its entirety in the posterior sagittal and axial projections. If the spine was not entirely seen, a short (< 3 min) sonogram was obtained with the mother seated to see the remaining spinal segments. Sonograms were assessed for improved visualization of the spine and whether the entire spine could be seen on the routine and seated studies. Hard-copy images of the sonograms were also analyzed independently by two radiologists. Intraobserver agreement (in the prospective and retrospective analyses) and interobserver agreement of the reviewers (in the retrospective analysis) were assessed using Cohen's kappa coefficient. RESULTS: Of the 526 fetal spines initially insonated in the supine or decubitus position, 68 spines (13%) were not satisfactorily seen and required the seated technique. This technique improved the sonographic visualization of the spine in 43 (63%) of 68 cases. The seated technique allowed the previously nonvisualized spinal segments to be completely seen in 37 cases (54%). However, in six cases (9%), improved visualization of the fetal spine fell short of complete visualization. Retrospective analysis showed a high degree of interobserver and intraobserver agreement, with kappa values of .97 and .94, respectively. CONCLUSION: Sonography performed with the seated technique is simple and can significantly improve visualization of the fetal spine when the spine is not satisfactorily seen in routine supine or decubitus positions.

Adult↗

PubMed1999

[Mechanical ventilation during thoracic anesthesia].

Aim of the study was to test individual mechanical and functional responses to open chest lateral decubitus during one lung ventilation. We measured dependent lung pressure volume (P-V) curves of 19 patients during supine and lateral decubitus. We found that patients characterized by high FEV1 developed greater changes in P-V curve shape than those characterized by low FEV1. Based on these results we decided to test a ventilation strategy characterized by the use of ZEEP or PEEP = 10 cm H2O applied to the dependent lung. In a preliminary set of patients stratified by FEV1 we found that PEEP deteriorated PaO2/FiO2 in patients with low FEV1, while there was a trend towards improvement in patients with high FEV1. It is possible that dependent lung PEEP counteracts atelectasias in normal lungs, while it may divert blood flow or create dead space in patients with sick and stiff lungs. We conclude that during one lung ventilation in open chest lateral decubitus, ventilatory setting need to be individually tailored.

Aged↗

PubMed1999

[Methicillin-resistant Staphylococcus aureus subdural abscess in an elderly patient with dementia].

A 74-year-old man was admitted to our hospital because of a fever of 38.2 degrees C and drowsiness. Two months before admission, he was admitted to another hospital with the diagnosis of Alzheimer's disease. One week before admission, he had a fever which was judged to be due to pyelonephritis. Because imipenem cilastatin and minocycline were not effective in relieving symptoms, he was transferred to our hospital. Methicillin-resistant Staphylococcus aureus (MRSA) was cultured from the blood, and vancomycin was started on the 5th hospital day. Because of the persistent fever and signs of inflammation, Gallium-scintigraphy was performed, showing abnormal accumulation in the left fronto-parietal region of the brain and the sacral region. Enhanced brain CT revealed a crescentic low density area and a fine, intense line of enhancement in the left fronto-parietal region. An emergency drainage of abscess was performed via single left fronto-parietal burr hole. A slightly yellowish, bloody, purulent fluid was obtained. The subdural space was irrigated with saline containing antibiotics and a drain was inserted. MRSA was cultured from the obtained fluid. The fever gradually subsided and drowsiness disappeared. He had had decubitus ulcer, stage I on the surface, in the sacral region, which later turned out to have unexpectedly deep undermining lesion reaching to periosteum. MRSA was cultured from this decubitus lesion. MRSA which entered into blood stream from the decubitus site might have been implanted in the subdural hematoma. Thus, subdural abscess should be kept in mind as an active differential diagnosis in elderly patients with fever and drowsiness.

Aged↗

PubMedDate not supplied

[The one-time surgical repair of postintubation esophagotracheal fistulae].

Personal experience in the treatment of the tracheal-esophageal non-neoplastic fistula is reported. In the last years, three cases of FTE, concerning some cannula tracheal-stomachal beare patients from 14, 2, 1 months have been examined. In two cases the patients were in spontaneous ventilation, on the contrary a mechanical ventilation was employed in the third. In two patients the fistular way was located correspondingly of the decubitus point of the tracheal stomachal cannula, on the membranaceous pars, and it was not associated with concomitant tracheal stenosis. The first stage of the treatment was removal of the nasogastric probe, supporting the decubitus phenomenon subtending the establishment and the extension of the FTE, then the preparation of a gastrostomy to assure the drainage of secretions under the fistula and a jejunum anastomosis to allow a suitable feeding and recovery of the patients. In these three cases the restoring operation was accomplished by a cervicotomy with a direct opening of the fistula, a suture of the esophageal wall, a suture of the membranaceous pars on the healthy tissue and then a protection of these sutures by interposition, between trachea and esophagus, of the prethyroid muscles transposed and fixed to the prevertebral band. In two cases the post-operative course did not present complications, while the patients kept in assisted ventilation during the postoperative course showed a relapse of the FTE on the twelfth day and then the progressive establishment of a septic state and the exitus on the twentieth day. It is underlined how the success of the reparation of the fistula is largely conditioned by the respiratory autonomy of the patient that guarantees the recurrence of decubitus and infection phenomena causing the lesion.

Adult↗

PubMedDate not supplied

The effect of free isotonic and maximal isometric contraction exercises of the hip adduction on vastus medialis oblique muscle: an electromyographic study.

The purpose of this study was to analyse the activity of the vastus medialis oblique (VMO) muscle electromyographically during free isotonic and maximal isometric contraction of the hip adduction with knee extension performing exercises at sitting and in decubitus lateralis positions. Using a 8 channels Nicolet Electromyograph and Beckman surface mini electrodes, the activity of the vastus medialis oblique muscle was recorded among 15 healthy subjects, aged 19 to 33 years, (mean = 24.4, SD = 4.1) without prior knee and hip joints pathology. The sign was recorded in root mean square (RMS), expressed in microvolts. The data were statistically calculated employing an analysis of variance (ANOVA) and the Tukey test, at 5% of significance. The results showed that the electromyographic (EMG) activity of the vastus medialis oblique muscle was significantly greater in both exercises of maximal contraction when compared with free isotonic at decubitus lateralis. On the other hand, there was no significant difference of the electromyographic activity of the vastus medialis oblique muscle between the two exercises of maximal isometric contraction. These findings, within the experimental conditions used, suggest that prior stages of patellofemoral dysfunction, the exercises of hip adduction with knee extension could be performed isometrically or isotonically, at sitting and in decubitus lateralis positions, depending on the biological conditions of each patient.

Adult↗

PubMedDate not supplied

Comparative post-operative study of prostheses, with and without an anti-reflux valve system, in the palliative treatment of esophageal carcinoma.

BACKGROUND/AIMS: Palliative treatment of advanced esophageal carcinoma by esophageal tunnelization with a prosthesis allows immediate relief of dysphagia. However, the procedure is subject to a high rate of morbidity, including gastroesophageal reflux (GER) present in all patients with a prosthesis positioned through the gastroesophageal junction, resulting in complications (pyrosis, aspiration pneumonias, sleep disorders) and reduced quality of life in these patients who already have a lower rate of survival. In an attempt to reduce GER and its complications, the authors created a surgical prosthesis coupled to an anti-reflux valve system, comparing it to the use of an esophageal prosthesis without an anti-reflux valve mechanism. METHODOLOGY: Twenty-two patients were allocated to 2 tunnelization groups: esophageal prosthesis without an anti-reflux valve mechanism (group 1) and surgical prosthesis coupled to an anti-reflux valve system (group 2). The GER was quantified measuring esophageal-gastric pH, and using fluoroscopy, contrast radiographs and esophageal emptying scintigraphy. Initially, the pH of secretions in S1 (esophagus) and S2 (stomach) was determined using reagent strips after aspirating their contents with different syringes. First with the patient seated at rest in bed, later performing a Valsalva maneuver, deep breathing and forced coughing. The same procedure was performed with the patient in left lateral decubitus, right lateral decubitus, and dorsal decubitus with the head of the bed lowered to 20 degrees. After finishing these maneuvers, 15 ml of 1 molar acetic acid were infused through the catheter positioned in the antrum, and, after 5 min, S1 and S2 material sampling was repeated in the same positions as mentioned above. RESULTS: The pH values between the various positions and maneuvers performed in each group separately were not significantly different, but, if we compare the 2 groups, and the secretions obtained in S1 and S2, there was a significant difference in pH measures in all positions. In the patients in group 1, S1 presented a mean pH ranging from 2.87-3.62 in the initial measures, and between 2.17 and 3.5 after the infusion of 15 ml of 1 molar acetic acid. On the other hand, in group 2, the mean pH of S1 remained between 6.34 and 8.32 in the initial measures and between 4.99 and 7.33 in the presence of acid infusion. At the level of S2, the pH remained unchanged between 2 and 2.7, in both groups. CONCLUSIONS: The authors conclude that the association of an esophageal prosthesis with a valve system significantly reduces GER, as compared with its use alone. Furthermore, it allows marked reduction of the symptoms and resulting complications, and does not interfere clinically with esophageal emptying. It thus significantly improves the quality of life of these patients.

Equipment Failure Analysis↗

PubMed2001

[Strict anteroposterior radiography of the shoulder: value of the assessment of rotator cuff tears].

PURPOSE: To compare the contribution of various radiographic projections in the evaluation of impingement syndrome and rotator cuff tears. Materials and method. We realized a prospective study in 53 patients with suspected rotator cuff tear, evaluated by plain radiographs and arthrography (gold standard). 31 patients were men and 22 were women (mean age 51 years). In all patients, anteroposterior radiograph, strict anteroposterior straight-beam decubitus view and anteroposterior radiograph during Leclercq's maneuver of the affected shoulder were obtained. The population was divided into three groups: group 1: normal arthrography (n=19), group 2: isolated supraspinatus tendon tear (n=23), group 3: rupture of the supraspinatus and infraspinatus tendons (n=11). The acromio-humeral space was measured on all these views and differences between the three groups were statistically analyzed. RESULTS: There is a significant statistical difference between the height of the acromio-humeral space found in patients with isolated tear of the supraspinatus tendon and those with a tear extending to the infraspinatus tendon (p=0.0001). The ROC methodology showed a better accuracy of the strict anteroposterior straight-beam decubitus view in cases of wide ruptures of the rotator cuff, and this for a selected threshold value of 6 mm. CONCLUSION: Strict anteroposterior straight-beam decubitus view, seems to be easy to realize, cheap, reproducible and very powerful in the preoperative assessment of patients with suspected rotator cuff tendon tear. It allows an excellent visualization of the acromioclavicular joint.

Adolescent↗

PubMed2003

Association between sleep bruxism, swallowing-related laryngeal movement, and sleep positions.

STUDY OBJECTIVE: To describe the relationships of sleep bruxism to swallowing and sleep positions. DESIGN: Controlled descriptive study. SETTING: Polysomnography and audio-video recordings were done in a hospital sleep laboratory. PARTICIPANTS: Nine patients with sleep bruxism and 7 normal subjects were matched for age and sex. INTERVENTIONS: n/a. MEASUREMENTS AND RESULTS: During sleep, patients with sleep bruxism showed a higher frequency of rhythmic masticatory muscle activity episodes (6.8 +/- 1.0 [SEM]/h) than did normals (0.5 +/- 0.1/h, p < 0.01). Swallowing-related laryngeal movements occurred more frequently in sleep of patients with sleep bruxism (6.8 +/- 0.8/h) than in normals (3.7 +/- 0.3/h, p < 0.01). In both groups, during sleep, close to 60% of rhythmic masticatory muscle activity episodes were associated with swallowing. In sleep bruxism patients, 68% of swallowing events occurred during rhythmic masticatory muscle activity episodes, while only 10% of swallowing events were associated with rhythmic masticatory muscle activity in normal subjects. Sleep bruxism patients and normals spent 95.5% and 87.3% of sleeping time in the supine and lateral decubitus positions, respectively. In both groups, up to 96% of rhythmic masticatory muscle activity and swallowing were observed in the supine and lateral decubitus position. In sleep bruxism patients, although sleeping time did not differ between the 2 sleeping body positions, 74% of rhythmic masticatory muscle activity and swallowing events were scored in the supine position compared to 23% in the lateral decubitus position. CONCLUSIONS: During sleep, rhythmic masticatory muscle activity is often associated with swallowing. In sleep bruxism patients, most of these oromotor events are observed in the supine position. The physiologic link between rhythmic masticatory muscle activity and swallowing and the clinical relevance of sleep position in sleep bruxism management need to be investigated.

Adult↗

PubMed2006

Hip arthroscopy by the lateral approach.

Performing hip arthroscopy with the patient in the lateral decubitus position is advantageous in aiding in visualization of the hip joint, in maneuvering instruments in obese patients, and in facilitating entry to the hip joint in patients with spurs on the anterolateral aspect of the acetabulum. The patient is placed in the lateral decubitus position with the hip on which the surgery is being performed on the top. The leg is placed in traction and a well-padded perineal post is applied for countertraction. An image intensifier is placed around the hip to help direct the instruments into the hip joint. Traction is necessary to reach the depths of the hip joint. After traction is applied, two portals are made over the greater trochanter and one directly anterior to the greater trochanter. A capsulotomy is performed at each portal site to maintain the portals and to aid in maneuvering the arthroscope and instruments. Traction is released and the hip is flexed to allow visualization of the intracapsular area around the femoral neck. An additional, ancillary portal (made anterior and distal to the first direct anterior portal) may be required to reach the intracapsular portion around the femoral neck. A regular traction table requires adjustments of the perineal and traction posts to apply traction to the leg of a patient in the lateral decubitus position. Special traction devices make setup easier. The lateral approach to hip arthroscopy provides a safe and consistent method of entering, visualizing, and performing surgical procedures on the hip.

Arthroscopy↗

PubMed1990

Femoral neck fractures in patients receiving long-term dialysis.

The morbidity and mortality of 11 femoral neck fractures were analyzed to compare operative and conservative management of femoral neck fractures in dialysis patients. All fractures occurred in older men with severe cardiac, pulmonary, gastro-intestinal, and neurologic conditions and with advanced renal osteodystrophy. Six of the seven operated patients survived the surgery and achieved varying degrees of ambulation. Stability of the operated hip was excellent in each case. Post-operative complications included transient confusional state related to narcotics, pneumonia, decubitus ulcers, and severe hypoalbuminemia. All four patients who were managed conservatively died from complications of the fracture. Progressive deterioration was noted in each nonoperated patient, with confusion caused by narcotics and analgesics, pneumonia, hepatic coma, decubitus ulcers, severe depression, and severe hypoalbuminemia. Therefore, operative management was superior to conservative management for femoral neck fractures of patients receiving chronic dialysis with multiple medical problems and advanced renal osteodystrophy. Narcotics must be used with great caution, and efforts should be directed toward prevention of malnutrition and decubitus ulcers.

Aged↗

PubMed1989

[Value of measuring transcutaneous oxygen pressure in arterial disease of the legs].

The authors specify the methods used for measuring teh transcutaneous oxygen pressure (TcPO2), then present the four main advantages of the TcPO2. 1. Although the decision to amputate remains controlled by the clinical evaluation, TcPO2 is useful when one has to choose to preserve or not the heel support or the knee joint, when hesitating on the indication of amputation or the nature of the pain of a stump. Two measurements are crucial: a value of TcPO2 in a decubitus position greater than 30 mmHg at the amputation level seems to guarantee a primary healing, while under 10 mmHg, failure is the rule. 2. Correlations between the Fontaine classification and TcPO2 measured on the fore-foot in decubitus position, show that, at stages I and II, the TcPO2 is not significantly decreased in comparison with the control group (54 +/- 12 mmHg at stage I, 49 +/- 11 mmHg at stage II) and that at stages III and IV, TcPO2 is significantly much lower than at stages I and II and the value of 10 mmHg seems a remarkable threshold defining severe ischemias (12 +/- 15 mmHg at stage III, 3 +/- 5 mmHg at stage IV). 3. A prospective study of 66 arterial disease of the lower extremities cases, at stages II and IV, validated by a TcPO2 measured at the fore-foot in decubitus position less than 10 mmHg, and which could all benefit from reconstructive arterial surgery, is presented.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMedDate not supplied

[Does obesity modify surgical technics?].

This paper expounds, according to the author's personal experience, the tactical and technical modalities in varicose surgery on the obese patient. The need to remain safe as well as effective leads in particular to a preference for loco-regional anaesthetic (peridural, spinal anaesthetic) over general anaesthetic, and to avoid wherever possible operations on the patient in the ventral decubitus position. For venous complexes of the popliteal space which have to be operated, an extremely precise anatomical schema has to be drawn up, by dint of a very thorough clinical examination, whose results will be further refined using echography and phlebography; in most cases, it will be possible to tackle them postero-internally, the patient in the dorsal decubitus position, or even in lateral decubitus. Special attention is given here, according to the type of varicosity to be operated, the best location for cutaneous incisions and modalities of reclosing, taking into account cicatrization problems encountered in this region.

Humans↗

PubMed1980

[Radiographic evidence of small amounts of pleural effusion in infant stage individuals. Animal experiments (author's transl)].

The pleural cavity of ten young pigs was punctured and pilled with specific amounts of fluid. Subsequently chest films were obtained in ap and lateral erect and in cross-table lateral decubitus position. Only 2 cases of these pigs radiographed in the erect position (after injection of 80 and even 100 ml of fluid) gave clear evidence of pleural effusion. Indirect signs of pleural effusion (such as blunting of the costophrenic angles; unsharpness, flatting or "elevation" of the diaphragm as a sign of subpulmonic effusion), however, were already noted with only 20 ml of pleural fluid. In contrast to these exams done in the erect position, the radiographs obtained in cross table lateral decubitus position showed as little as 5 ml of fluid. Therefore, the cross table lateral decubitus position is ideal for the work up of suspected pleural effusion.

Animals↗

PubMed1993

[An original method of disarticulation in the hip in paraplegic patients].

The surgical technique of disarticulation in the hip in paraplegic patients with deep decubitus around the trochanter area is presented. The presence of penetrating decubitus calls for early decision of disarticulation, before deteriorating of patients general condition, as it is the only measure to control infection, save patients life and make further rehabilitation possible. Disarticulation and concurrent excision of the decubitus is illustrated by a case of a patient who underwent bilateral procedure.

Adult↗