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PubMed1993

Analyses of serum copper and zinc levels and copper/zinc ratios in skin diseases.

With the objective of comprehending abnormal metabolisms of the essential metals of zinc (Zn) and copper (Cu) in three groups of skin diseases, skin cancer, inflammatory diseases, and non-inflammatory disease, we measured serum levels of Zn and Cu in 151 cases of various cutaneous manifestations and estimated the significance of the ratios between the two metals (Cu/Zn). The serum level of Zn was significantly decreased in cases of bullous pemphigoid, decubitus ulcer, and alopecia areata. The serum level of Cu was elevated in cases of psoriasis, decubitus ulcer, and skin cancer. We observed no elevation of serum Zn level or abnormally depressed serum Cu level. The Cu/Zn ratio showed significantly different values among these three groups of the diseases, suggesting the utility of measuring Cu/Zn ratios for differential diagnosis over that of determining the serum level of Zn or Cu alone. It was also demonstrated that, in each skin disease, the Cu/Zn ratio clearly reflects the severity of the progress.

Adult↗
PubMed2005

An evaluation of the antireflux properties of sodium alginate by means of combined multichannel intraluminal impedance and pH-metry.

BACKGROUND: Alginate-based preparations act as mechanical antireflux barrier, which can reduce both acid and non-acid reflux events and limit the proximal migration of oesophageal refluxate. AIM: To evaluate all the above features with a novel technique, multichannel electrical impedance and pH-metry. METHODS: Ten reflux patients underwent stationary impedancemetry and pH-metry after eating a refluxogenic meal. They were studied 1 h in basal conditions and 1 h after taking 10 mL of Gaviscon Advance. In both sessions, measurements were obtained in right lateral and supine decubitus. RESULTS: Alginate preparation was able to decrease significantly (P < 0.05) the number of acid reflux events and the percentage time pH < 4.0 compared with baseline. There was no effect of the drug on non-acid refluxes. Gaviscon Advance was also significantly effective (P < 0.05) in reducing the height of proximal migration of reflux events compared with baseline in both decubitus positions. CONCLUSIONS: Our findings explain how Gaviscon Advance controls acid reflux episodes, limits the proximal migration of refluxed material and thereby decreases symptoms in clinical practice.

Adult↗
PubMed2004

Epithelial tissue-type plasminogen activator expression, unlike that of urokinase, its receptor, and plasminogen activator inhibitor-1, is increased in chronic venous ulcers.

BACKGROUND: The plasminogen activation system represents a potent mechanism of extracellular proteolysis and is an essential component of normal wound healing. It has also been implicated in the pathogenesis of chronic, nonhealing ulcers. Traditionally, urokinase-type plasminogen activator (uPA) has been associated with pericellular proteolytic activity involved in tissue remodelling processes, and tissue-type plasminogen activator (tPA) mainly with intravascular fibrinolysis. OBJECTIVES: The present study was conducted to characterize the spatial distribution of the various plasminogen activation system components in chronic ulcers and acute, well-granulating wounds. METHODS: The expression of uPA, tPA, urokinase receptor (uPAR), plasminogen activator inhibitor-1 (PAI-1), and vitronectin was investigated by immunohistochemical staining, in addition to uPA, tPA and PAI-1 expression by in-situ hybridization, in samples from eight chronic venous ulcers, five decubitus ulcers, five well-granulating acute wounds and five normal skin samples. RESULTS: In chronic venous leg ulcers tPA mRNA was detected in basal and suprabasal keratinocytes at the leading wound edge, while in well-granulating wounds and in decubitus ulcers tPA mRNA was expressed only in a few keratinocytes. However, tPA was widely expressed in fibroblast- and macrophage-like cells in the stroma of well-granulating wounds, while less tPA was detected in the granulation tissue of chronic ulcers. tPA mRNA and protein were localized in the superficial granular layers in normal skin. Although no qualitative differences in expression of uPA, PAI-1 or uPAR in the wound edge keratinocytes in chronic ulcers vs. normally granulating wounds were found, their expressions were more pronounced in the granulation tissue of well-granulating wounds. CONCLUSIONS: These results suggest that in poorly healing venous leg ulcers, the pattern of tPA expression is altered in keratinocytes at the leading edge of the wound, and the patterns of tPA, uPA and PAI-1 expression are altered in the granulation tissue.

Acute Disease↗
PubMed1984

Lateral positioning with differential lung ventilation and unilateral PEEP following unilateral acid aspiration in the dog.

Body position can significantly alter the efficiency of gas exchange following unilateral lung injury. We systematically examined three positions during differential lung ventilation with unilateral positive end-expiratory pressure (PEEP) following unilateral hydrochloric acid aspiration in the dog. Twelve mongrel dogs were intubated with a double-lumen endobronchial tube and mechanically ventilated with a microcomputer-controlled pair of ventilators. A tidal volume of 7.5 ml/kg was delivered to each lung. The PaCO2 was maintained at 4.67 kPa. A unilateral injury was induced with an injection of 0.1 N hydrochloric acid (2.5 ml/kg) into one lumen of the endobronchial tube. 0.984 kPa PEEP was applied to the injured lung and the dogs were placed sequentially in one of three positions (supine, lateral decubitus with injured lung non-dependent, and lateral decubitus with injured lung dependent) for 1 h apiece. There was no significant difference between the three positions with regard to PaO2 (F (2, 10) = 1.60, P = 0.25) of venous admixture (F (2, 10) = 0.49, P = 0.63). Our data indicated that position did not alter oxygenation. This was probably due to the use of differential ventilation with unilateral PEEP which eliminated redistribution of ventilation between the two lungs and minimized position-dependent changes in pulmonary blood flow.

Animals↗
PubMed1994

High-frequency jet ventilation vs continuous positive airway pressure for differential lung ventilation in patients undergoing resection of thoracoabdominal aortic aneurysm.

Twenty patients, scheduled for surgical resection of thoracoabdominal aortic aneurysm were divided into two groups according to the type of differential lung ventilation used during graft replacement of the descending thoracic aorta. In the high-frequency jet ventilation (HFJV) group of ten patients, HFJV was applied to the left lung once collapsed and retracted by the surgeon, the patient lying in the right lateral decubitus and being intubated by a Carlens' tube. In the continuous positive airway pressure (CPAP) group of ten patients, CPAP was applied to the left lung at the same mean airway pressure as HFJV (1 kPa). Before anaesthetic induction, an arterial and a Swan-Ganz catheter were inserted for cardiovascular monitoring. The same anaesthetic technique using fentanyl 6 micrograms.kg-1, flunitrazepam 0.02 mg.kg-1 and pancuronium 0.1 mg.kg-1 was used for each patient. Haemodynamic and respiratory measurements were made; 15 min after positioning the patients in the right lateral decubitus using two-lung ventilation; 15 min after collapse and retraction of the left lung using one-lung ventilation and 15 min after using differential lung ventilation with CPAP or HFJV. Left lung collapse with conventional one-lung ventilation induced a dramatic decrease in arterial oxygenation: PaO2/FIO2 ratio decreased from 43 +/- 6 kPa to 20 +/- 8 kPa, alveolo-arterial oxygen difference increased from 24 +/- 7 kPa to 72 +/- 11 kPa and pulmonary shunt increased from 17 +/- 2% to 37 +/- 3%. Whereas differential lung ventilation with CPAP did not improve any of the respiratory parameters measured, differential lung ventilation with HFJV, significantly increased PaO2/FIO2 ratio to 41 +/- 14 kPa.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Rhabdomyolysis following laparoscopic radical nephrectomy: a case to heighten awareness.

Rhabdomyolysis, myoglobinuria and acute renal failure are rare complication of surgery. Long operative time, increased body mass, lateral decubitus positioning and extracellular volume depletion may predispose to this condition. The authors describe the case of a 70-year-old man with renal cell carcinoma who underwent a laparoscopic right radical nephrectomy in the lateral decubitus position. His postoperative course was complicated by acute renal failure due to rhabdomyolysis. Heightened awareness, early recognition and treatment of this condition are important, particularly as laparoscopic nephrectomy is becoming a common procedure for living donor transplantation.

Aged↗
PubMed1994

Influence of shear on skin oxygen tension.

Since the early studies on decubitus many authors expect significant influence of shear on decubitus risk. In the study described here skin oxygen tension at the sacrum was measured with combined pressure and shear stress on a young healthy population (mean age 25.5 years, SD 3.4 years). Cut-off pressure is defined as the level of external pressure exerted on the skin at which the skin oxygen tension is 1.3 kPa. At this level ischaemia of the skin can be expected (Bar, 1988). A mean cut-off pressure of 11.6 kPa was found when no shear stress was applied vs. a significantly lower mean cut-off pressure of 8.7 kPa with a shear stress of 3.1 kPa. No significant relationship was found between cut-off pressure and systolic blood pressure, diastolic blood pressure, skin thickness at the sacrum, percentage of fat and skin oxygen tension in the unloaded situation.

Adipose Tissue↗
PubMed1992

Historical perspective: the neurotrophic theory of skin ulceration.

Though nearly forgotten, the neurotrophic theory was very much a part of mainstream medical thinking during the mid-nineteenth century. This theory stated that all bodily organs are maintained by special nutritional factors secreted by the central nervous system. Development of skin ulceration in the face of neurologic injury became a model for the theory, and controversy involved two great neurologists of the time, Jean Martin Charcot and Edouard Brown-Séquard. As the neurotrophic theory fell into disfavor, interest in decubitus ulcers waned as well. Today, pressure sores remain a major epidemiologic problem for the growing population of frail elderly persons in both acute and long-term care settings. Because of the increased mortality, morbidity, and cost associated with these lesions, attention needs to be refocused on research and education concerning the decubitus ulcer.

Animals↗
PubMed1993

Surface area measurement of pressure sores using wound molds and computerized imaging.

OBJECTIVE: To develop a method to measure wound surface area. DESIGN: Validity study. SETTING: Inpatient service. PARTICIPANTS: Four patients with decubitus ulcers. MEASUREMENTS: A new imaging process estimating wound surface area and volume by NMR spectroscopy of a mold of the pressure ulcer and a comparison measurement of volume of the mold by water displacement. Measurements made serially totalled 17. RESULTS: Measurement of the volume of the mold by the computer system correlated strongly with measurement of the volume by water displacement. Surface area of the pressure sore mold correlated strongly with volume of the mold raised to the two-thirds power. CONCLUSIONS: It is possible for the first time to measure surface area of decubitus ulcers. This may provide a way of determining accurately the dose of newly proposed topical treatments.

Colloids↗
PubMed1995

Malnutrition, tube feeding and pressure sores: data are incomplete.

PURPOSE: To review data about the relationship between pressure sores and (1) nutritional status, (2) nutrient intake, and (3) tube feeding. DATA SOURCES: Medline search of terms associated with "decubitus ulcer" combined with terms associated with "pressure sore" from 1985 through August 1994. Hand review of all issues of the journal Decubitus (now Advances in Wound Care) through June 1994 and the Journal of Parenteral and Enteral Nutrition from January 1987 through May-June 1994. Review of bibliography of pertinent articles. A small survey of experts. STUDY SELECTION: Articles where the title, Me SH terms, or abstract suggested an examination of the relationship between nutrition and pressure sores, and those suggested by the experts, were reviewed. DATA EXTRACTION: Study designs were disparate. Results were simply tabulated. RESULTS: In seven studies, low serum albumin was associated with development or presence of pressure sores; in five it was not. Most measures of nutritional status were not associated with pressure sore outcomes. Poor nutritional intake was associated with poor pressure sore outcome in four of seven studies. Tube feeding was positively associated with presence of pressure sores in one study. Special nutrition support was ineffective in improving pressure sore outcome in a second. Two studies showed better healing in patients receiving high-protein formula: in one, all patients were tube fed; in the other, route of feeding was not stated. CONCLUSION: Data about the relationship between malnutrition and pressure sores are incomplete and contradictory. No randomized trials of tube feeding as prevention or treatment of pressure sores has been done. Routine use of tube feeding to prevent or treat pressure sores is not clearly supported by data.

Enteral Nutrition↗
PubMed1997

Effect of the National Resident Assessment Instrument on selected health conditions and problems.

OBJECTIVE: To evaluate the effect of the implementation of the National Resident Assessment Instrument (RAI) system on selected conditions representing outcomes for nursing home residents. DESIGN: Quasi-experimental, pre-/post-design, with assessments at baseline and 6-month follow-up. SAMPLE: Two thousand one hundred twenty-eight residents from 268 nursing homes in 10 states before RAI implementation, and 2,088 from 254 of the same nursing homes after implementation. MEASURES: From the full RAI Minimum Data Set, measures of dehydration, falls, decubitus, vision problems, stasis ulcer, pain, dental status (poor teeth), and malnutrition were examined at baseline and 6 months later. Poor nutrition was evaluated using a body mass index score below 20 and vision using a 4-level scale; other conditions were represented by their presence or absence. Decline and improvement were computed as the changes in level between baseline and follow-up, limiting the sample to those who could manifest each such change. MAIN RESULTS: Of eight health conditions representing poorer health status, dehydration and stasis ulcer had significantly lower prevalence after the implementation of the RAI (1993) compared with 1990. At the same time, there was an increase in the prevalence of daily pain. Fewer residents declined over 6 months in nutrition and vision after implementation. Although for these two conditions there were also significantly reduced rates of improvement, the net was an overall reduction in the 6-month rate of decline for all residents. Pain also demonstrated a decline in the postimplementation rate of improvement. The combined eight conditions showed reductions in the rates of both decline and improvement. CONCLUSIONS: Several outcomes for nursing home residents improved after implementation of the RAI. Of the four conditions for which there are significant declines in prevalence or outcome changes, three are specifically addressed in the care planning guidelines incorporated the RAI system (all except stasis ulcer, although there is a RAP for decubitus ulcer). Pain, the only other condition with a significant result --an increase in baseline prevalence--also has no RAP. Although the changes might be ascribed otherwise, they support the premise that the RAI has directly contributed to improved outcomes for nursing home residents.

Accidental Falls↗
PubMed2004

Atrial signal amplitude measurements in VDD systems according to body position.

Single lead VDD pacing is an established therapy in patients with AV block. Body position may influence the amplitude of the atrial signal recorded through the floating atrial electrode. This study analyzed the degree of posture related variation in the signal amplitude of floating atrial electrodes in 63 patients (mean age 72 +/- 21 years) implanted with a VDD system. The average atrial amplitude in the supine position was 1.59 +/- 1.15 mV and decreased significantly in the sitting position (1.37 +/- 1.08, P < 0.014), right decubitus (1.33 +/- 0.83, P < 0.007), and the abdominal position (1.24 +/- 0.86, P < 0.001). The left side decubitus showed a nonsignificant increase in atrial amplitude (1.66 +/- 1.02, P < 0.64). Body position significantly affects P wave amplitude and may be the cause of intermittent atrial undersensing. P wave amplitude measurement in different body postures should be performed in cases where suspected atrial undersensing occurs.

Aged↗
PubMed2005

Left ventricular Tei index: comparison between flow and tissue Doppler analyses.

BACKGROUND: It is still unknown whether a correlation exists between left ventricular Tei index obtained by tissue Doppler imaging and that determined by flow Doppler waveforms. This study was conducted to evaluate their relationship and to assess the positional effect on them. METHODS: Twenty-six healthy subjects and 25 patients with essential hypertension were included. On the tissue Doppler images, the time interval from the end to the onset of the mitral annular velocity pattern during diastole and the duration of the S-wave were used to calculate tissue Doppler Tei index. RESULTS: The tissue Doppler Tei index correlated with the flow Doppler Tei index at sitting position (r = 0.406, P = 0.003), but not at left lateral decubitus position. The limits of agreement for the Tei index measured by both methods were -0.26 to 0.62 at left lateral decubitus position and -0.09 to 0.55 at sitting position. Preload reduction associated with sitting position with dangling feet raised the Tei index both in the healthy controls [0.54 (0.14) vs 0.42 (0.12), P < 0.001] and in the hypertensives [0.53 (0.15) vs 0.46 (0.12), P = 0.005]. There was a similar positional effect on the tissue Doppler Tei index in the control subjects [0.75 (0.12) vs 0.53 (0.10), P < 0.001]. CONCLUSIONS: Tissue Doppler Tei index does not seem to be a suitable substitute for flow Doppler Tei index. Flow Doppler Tei index is preload dependent and the loading status should be taken into consideration at the application of Tei index to the evaluation of myocardial performance.

Adult↗
PubMed1999

Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease.

OBJECTIVE: Body position has been shown to influence postprandial and fasting gastroesophageal reflux (GER) in patients and normal volunteers when they are assigned to lie in a prescribed position. No published studies have evaluated the effect of spontaneous sleeping positions on recumbent reflux in patients with GER. METHODS: Ten patients, three female and seven male (mean age 47.6 yr, range 30-67 yr) with abnormal recumbent esophageal pH <4 on 24-h pH-metry participated. A standardized high fat dinner (6 PM) and a bedtime snack (10 PM) were administered to all patients. GER during spontaneous sleep positions was assessed with a single channel pH probe placed 5 cm above the lower esophageal sphincter (LES) and with a position sensor taped to the sternum. Data were recorded with a portable digital data logger (Microdigitrapper-S, Synectics Medical) and analyzed for recumbent percent time pH <4 and esophageal acid clearance time in each of four sleeping positions. Time elapsed between change in sleeping position and GER episodes was also calculated. RESULTS: Right lateral decubitus was associated with greater percent time pH <4 (p < 0.003) and longer esophageal acid clearance (p < 0.05) compared to the left, supine, and prone. GER episodes were more frequent in the supine position (p < 0.04) and occurred within 1 min after change in sleeping position 28% of the time. CONCLUSIONS: The left lateral decubitus position is preferred in patients with nocturnal GER. Measures to aid patients in sleeping in this position should be developed.

Adult↗
PubMed1998

Aerobic and anaerobic microbiology of infections after trauma in children.

OBJECTIVE: To review the recovery of aerobic and anaerobic bacteria from infections after trauma in children over a 20 year period. METHODS: Only specimens that were studied for both aerobic and anaerobic bacteria were included in the analysis. They were collected from seven separate centres in which the microbiology laboratories only accepted specimens that were properly collected without contamination and were submitted in appropriate transport media. Anaerobes and aerobic bacteria were cultured and identified using standard techniques. Clinical records were reviewed to identify post-trauma patients. RESULTS: From 1974 to 1994, 175 specimens obtained from 166 children with trauma showed bacterial growth. The trauma included blunt trauma (71), lacerations (48), bites (42), and open fractures (5). Anaerobic bacteria only were isolated in 38 specimens (22%), aerobic bacteria only in 51 (29%), and mixed aerobic-anaerobic flora in 86 (49%); 363 anaerobic (2.1/specimen) and 158 aerobic or facultative isolates (0.9/specimen) were recovered. The predominant anaerobic bacteria included Peptostreptococcus spp (115 isolates), Prevotella spp (68), Fusobacterium spp (52), B fragilis group (42), and Clostridium spp (21). The predominant aerobic bacteria included Staph aureus (51), E coli (13), Ps aeruginosa (12), Str pyogenes (11) and Klebsiella pneumoniae (9). Principal infections were: abscesses (52), bacteraemia (3), pulmonary infections (30, including aspiration pneumonia, tracheostomy associated pneumonia, empyema, and ventilator associated pneumonia), wounds (36, including cellulitis, post-traumatic wounds, decubitus ulcers, myositis, gastrostomy and tracheostomy site wounds, and fasciitis), bites (42, including 23 animal and 19 human), peritonitis (4), osteomyelitis (5), and sinusitis (3). Staph aureus and Str pyogenes were isolated at all sites. However, organisms of the oropharyngeal flora predominated in infections that originated from head and neck wounds and abscesses, and bites, and those from the gastrointestinal tract predominated in infections that originated from peritonitis, abdominal abscesses, and decubitus ulcers. CONCLUSIONS: Many infections that follow trauma in children involve multiple organisms.

Abscess↗
PubMed1984

Recurrent tracheo-esophageal fistula: a protocol for investigation.

Following repair of esophageal atresia and tracheo-esophageal (TE) fistula, the fistula may recur in approximately 10% of patients and is often difficult to diagnose. The authors review the clinical and radiographic findings in 16 cases. Clinical findings are nonspecific; however, recurrent TE fistula may be suspected when the plain radiograph reveals an air esophagram (44% of cases), gas in the abdominal portion of the bowel (50% of those who had abdominal radiographs), or a "beaked" appearance of the anterior wall of the esophagus (50% of negative barium examinations). Oral barium studies resulted in 17 false negatives and 4 true positives, while a right lateral decubitus esophagram with a vertical beam gave 2 false negatives and 2 true positives, and a prone esophagram with a horizontal beam gave 2 true positives and no false negatives. Despite the small number of cases, the authors suggest that a prone view with a horizontal beam, rather than a decubitus examination, is the procedure of choice for recurrent TE fistulas.

Barium Sulfate↗
PubMed1998

Unilateral absence of ureteral jets in the third trimester of pregnancy: pitfall in color Doppler US diagnosis of urinary obstruction.

Among 23 asymptomatic pregnant women with ureteral jets noted at color Doppler ultrasonography, jets were detected at only one ureteral orifice in three (13%) during the third trimester. In each such case, normal jets were detected from the suspicious ureter after the patient turned to the contralateral decubitus position. A unilaterally absent jet noted in the third trimester of pregnancy should not be interpreted as a sign of ureteral obstruction unless the finding persists in the contralateral decubitus position.

Female↗
PubMed1977

Regional intrapulmonary gas distribution in awake and anesthetized-paralyzed man.

Intrapulmonary distribution of ventilation/unit lung volume was studied in 28 volunteers in the sitting, supine, or right lateral decubitus position, either awake or anesthetized-paralyzed and mechanically ventilated. We found significant differences between the awake state and anesthesia-paralysis with mechanical ventilation in 1) intrapulmonary gas distribution, and 2) the vertical gradient of regional functional residual capacities for the subjects in the lateral decubitus position, but not for those in the sitting and supine positions. The effect of increasing the tidal volume on distribution of ventilation was significantly different 1) between the three body positions for a given state, and 2) between the two states for a given body position. The data suggest thoracoabdominal mechanics are different in the three body positions and that anesthesia-paralysis and mechanical ventilation may cause a different pattern of expansion of the respiratory system than spontaneous breathing in the awake state.

Adult↗