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At least 1,639 records · Page 91Linked to original sources
PubMed2001

[Changes in chest wall and lung compliance during laparoscopic cholecystectomy].

INTRODUCTION: The performance of laparoscopic cholecystectomy leads to hemodynamic and gasometric changes as well as to mechanical changes in respiration. The last phenomenon has been less studied in spite of its impact on the patient during surgery. OBJECTIVE: To study changes in chest wall compliance (Ccw) and lung compliance (CL) during laparoscopic cholecystectomy. Material and methods. Nine patients scheduled for laparoscopic cholecystectomy were enrolled. Tidal volume, plateau pressure (Pt) and esophageal (Pes) were measured and the data were used to calculate respiratory system compliance (Crs), Ccw and CL. Measurements were taken at three moments: T1, with the patients in supine decubitus position; T2, in anti-Trendelenburg position with pneumoperitoneum; T3, after withdrawal of pneumoperitoneum with the patient in supine decubitus position. RESULTS: Pt was seen to increase 57%, with a 100% increase in Pes when the patient was placed in anti-Trendelenburg position and pneumoperitoneum was established. Crs changed 44%, with a greater increase taking place in Ccw (52%) than in CL (32%). Baseline values for both pressure and compliance were recovered by T3. CONCLUSIONS: Reduced respiratory compliance occurs during laparoscopic cholecystectomy mainly at the chest wall, with much less reduction taking place in the lung. Thus, intrathoracic pressure increases will be greater than transpulmonary pressure increases.

Adolescent↗
PubMed2001

[Skin care and pressure ulcer. Hyperoxygenated fatty acids in the prevention of pressure ulcers and treatment of stage I lesions].

UNLABELLED: Skin care in general and, more specifically, the use of hyper-oxygenated fatty acids to protect zones at risk, constitute a very useful method in the prevention of dedubitus ulcers and to reverse stage one lesions. PATIENTS AND METHODS: Retrospective evaluation on the systematic use of hyper-oxygenated fatty acids inside the parameters accepted for the prevention and care of decubitus ulcers at the Clinical University Hospital Puerta de Hierro in Madrid in its Internal Medicine Nursing Unit during 1999 and 2000. RESULTS: 853 patients were studied, of whom 524 entered the hospital without any bedsore. Of these 524 patients who entered without a bedsore, 5, or 1% of these cases, developed new lesions. Of the 163 patients suffering a stage one decubitus ulcer upon entering the hospital, 131 or 80% saw their status reserve to not being a bedsore. COMMENTARY: The use of hyper-oxygenated fatty acids is an effective measure in the prevention of bedsores and in the reversal of stage one lesions.

Aged↗
PubMed1975

[Electromyocartography of the thigh. Attempt at a functional analysis of the locking of the knee against resistance].

Electromyocartographic analysis of the extension of the leg in different positions has shown that: - on the whole energy developped by all superficial muscles of the thigh is more important in the position of dorsal decubitus than in a seated position; - functionnal activity of the rectus femoris muscle varies according to different subjects. Its activity is lower in the seated position, compared to dorsal decubitus, a classic notion; - in contradiction to classic notions, the most active muscle electrically is the vastus lateralis muscle. The vastus medialis muscle is however also very active; - from these results, it is possible to obtain a smaller variability owing to their relative quantification. One observes a hierarchy of electric activity levels of different surfaces, that constitutes the basis of functionnal and clinical study.

Electromyography↗
PubMed2002

Lateral positioning technique for the treatment of far-lateral targets with the Leksell gamma knife: technical note.

OBJECTIVE: To describe a procedure for Leksell gamma knife (LGK) radiosurgery in a lateral position, for treatment of far-lateral intracranial lesions. METHODS: Positioning of the patient in the lateral decubitus position during LGK treatment switches the x and y axis coordinates. This increases the range of the x axis from 52 to 148 mm to 40 to 160 mm (i.e., 12 mm in each direction). RESULTS: Conversion of the coordinates of the isocenters is easily performed with simple mathematical algorithms and does not impair the precision of target positioning at the isocenters during LGK radiosurgery. CONCLUSION: LGK treatment in the lateral decubitus position is a simple accurate procedure for the treatment of far-lateral lesions that cannot be reached with normal supine positioning.

Humans↗
PubMed1999

Predictors of in-hospital mortality following operative management of hip fractures.

OBJECTIVE: To identify predictors of in-hospital mortality and hospital stay following hip fractures. DESIGN: Retrospective cohort study of 185 consecutive patients. SETTING: Tertiary Care University Hospital. PARTICIPANTS: Individuals requiring operative treatment of a proximal femoral fracture excluding those individuals < 50 years old, with femoral head or subtrochanteric fractures, and significant co-morbidity. OUTCOMES: In-hospital mortality and length of hospital stay (days). RESULTS: 116 patients met the inclusion criteria. Predictors of in-hospital mortality from logistic regression analysis included male gender (odds ratio with 95% CI: 5.5, 1.5-20.5), admission from a long term care facility (5.5, 1.4-22.6), age greater than 90 years (4.5, 0.9-22.1), and living at home with support (0.2, 0.03-0.9). Predictors of hospital stay from multivariate regression analysis in order of magnitude included presence of a post-operative complication (odds ratio with 95% CI: 14.1, 4.7-44), living at home with support (3.4, 1.3-8.9) and older age (> 85 years) (2.7, 1.0-7.3). Moreover, confusion, urinary tract infections and decubitus ulcers accounted for greater than 50% of all complications encountered. A trend between the number of positive predictors and length of hospital stay was observed. CONCLUSIONS: Elderly individuals admitted from a long term care facility are at high risk of mortality following operative fixation of hip fractures. Early recognition and aggressive management of post-operative complications such as confusion, urinary tract infections and decubitus ulcers through careful patient monitoring may decrease hospital stays in those that survive.

Aged↗
PubMed2003

[Anesthetic management of a patient with squeezed heart by huge sternal tumor].

We experienced perioperative management for excision of a huge sternal chondrosarcoma squeezing the heart. A 46-year-old woman could not sleep due to dyspnea for 6 months. Dyspnea increased in the right decubitus and disappeared in the left decubitus. This suggested that the heart was squeezing the tumor. MRI and echocardiography revealed no invasion to the heart. Surgical removal was proposed. Anesthesia was induced with propofol and fentanyl. As this tumor composed of bone-like tissue and was tightly connected with thoracic cage, we thought that the use of muscle relaxant at the induction of anesthesia would not cause cardiovascular collapse and ventilation insufficiency even if the tumor was huge. Vecuronium was administered to facilitate endotracheal intubation. Hemodynamic variables were stable and mask ventilation was uneventful. Anesthesia was maintained with propofol, sevoflurane, supplemental dose of fentanyl and epidural anesthesia. The tumor had invaded the myocardium and was successfully flaked off from the myocardium without using any assisted devices. The tumor was excised including thoracic wall (sternum and parts of 3rd to 12th ribs, 20 cm in diameter). Thoracoplasty was performed using Marlex Mesh. Muscle relaxant was reversed after the end of the operation. Respiration was stable without flail chest. Endotracheal tube was successfully removed in the operation room. The postoperative course was uneventful.

Anesthesia, Epidural↗
PubMed2003

The influence of moisture wound healing on the incidence of bacterial infection and histological changes in healthy human skin after treatment of interactive dressings.

In this article the authors discuss the problem faced by physicians when trying to use moisture-retentive dressing in pressure sores (decubitus ulcers). First, they report the results of an in vitro study using a new model of experimental wound (radio-isotopic investigation) that assesses the release of Ringer's solution from interactive dressings continually during fourteen hours. Second, they perform an animal experiment that assesses the incidence of wound infection in defects treated conventionally or using interactive dressings. The defects treated with interactive pads had lower incidence of wound infection, and the process of wound healing was rapid. Finally, the authors discuss their experience in four paraplegic patients with decubitus ulcers where they used moisture-retentive dressing on ulcers and on the surrounding intact skin before surgical procedure to detect the possibility of maceration of healthy skin. Histological evaluation was performed in order to find microscopically changes after moisture healing. The changes of healthy skin were not significant after treatment of moisture-retentive dressings.

Aged↗
PubMedDate not supplied

Rigid rectosigmoidoscopy: still a well-tolerated diagnostic tool.

BACKGROUND: Although rigid rectosigmoidoscopy has been gradually replaced by the use of flexible rectosigmoidoscopy in recent years, it remains an effective, economic and widely available diagnostic tool. The aim of this study was to determine the type and magnitude of symptoms during rigid rectosigmodoscopy. METHODS: Prospective evaluation of patients who underwent diagnostic rigid rectosigmoidoscopy. The main complaints were recorded, and their magnitude quantified using a visual analogue scale. RESULTS: A total of 134 patients (mean age = 48 years) were examined. The prone jackknife position was used in 54% of them and left lateral decubitus in 46%. A complete (full length) examination was achieved in 68%. There were no complications. Sixty percent of patients referred complaints: pain (33%), discomfort by rectal preparation (13%), uncomfortable defecation desire (8%), and discomfort by the position (4%). Median values determined by visual analogue scale for pain, discomfort by rectal preparation, uncomfortable positioning and overall discomfort were graded as 3.3, 3.3, 2.1 and 2, respectively. There was an association between higher magnitude of pain and overall discomfort with female gender, left lateral decubitus position, and full-length exploration (p < 0.05). CONCLUSION: A high percentage of patients have symptoms during rigid rectosigmoidoscopy but the study is usually well tolerated due the low magnitude of pain and discomfort and remains a very cost-effective study.

Female↗
PubMed1992

[Fibrinolysis, interleukins and coronary atherosclerosis].

The study of the fibrinolytic system and the activity of interleukin 1 and 2 in 75 patients with various cardial manifestations of atherosclerosis (angina of effort, angina decubitus, arrhythmia, symptomatic hypertension) revealed a decrease in the activity of plasminogen--a blood activator--in patients with angina of effort, angina decubitus and cardiac arrhythmias. In those with atherosclerotic hypertension the activatory activity was in the normal limits. A decrease in the activity of interleukin 1 and 2 was noted in all those examined.

Aged↗
PubMed2004

[The effects of rilmenidine on cardiac autonomic function in healthy volunteers].

INTRODUCTION AND OBJECTIVES: Rilmenidine is an antihypertensive drug whose antihypertensive effect occurs via a sympatholytic action on the central nervous system. However, the effects of rilmenidine on autonomic cardiovascular function are not clear. The aim of this study was to evaluate the acute effect of rilmenidine on autonomic cardiac function by measuring heart rate variability. SUBJECTS AND METHOD: A total of 20 healthy men (mean age, 263 years) were included in the study; 1 mg of rilmenidine or placebo was given to participants on different days in a double-blind crossover randomized study protocol. After drug administration, time domain and frequency domain parameters of heart rate variability were determined before and after 2 h with the patient in supine decubitus and during the handgrip exercise with 5-min electrocardiographic recordings. RESULTS: Rilmenidine caused an increase in mean RR values after administration when compared to pre-drug administration recordings with the patient in supine decubitus (929 ms vs 860 ms, P<.05), but this effect was not found in the placebo group. However, there were no differences in other time domain parameters or in any of the frequency domain parameters (normalized low frequency unit, normalized high frequency unit and low frequency/high frequency ratio) with the participant in supine position in either group. In addition, neither rilmenidine nor placebo modified heart rate variability parameters during the handgrip exercise. CONCLUSION: Administration of a single dose of rilmenidine increased vagal tone without affecting vagal modulation in the supine position. The absence of vagal tone increase during the handgrip exercise suggests that this effect of rilmenidine is minimal.

Adult↗
PubMed2004

[The Morel-Lavallée lesion: a conservative approach to closed degloving injuries].

OBJECTIVES: We evaluated the results of conservative treatment for closed degloving injuries (Morel-Lavallée lesion) of the pelvic girdle and lower extremities. METHODS: The Morel-Lavallée lesion developed in five male patients (mean age 25.6 years; range 6 to 40 years) due to crush under a vehicle (n=3) and traffic accidents (n=2). The lesions were localized in the pelvic girdle in three cases (2 lumbosacral, 1 lateral lumbar) and gluteal and trochanteric regions in two cases. Treatment was performed with compressive elastic bandages or corsets in all the patients, three of whom also underwent surgery due to accompanying pelvic fractures. Healing was defined as the loss of fluctuation and elicitation of the normal mobility of the injured skin on manual examination. The mean follow-up period was 23.6 months (range 10 to 41 months). RESULTS: Sacral decubitus ulcer developed in a patient in whom the detection of the lesion was obscured because of an associated femoral fracture and a perianal deep soft tissue lesion. Another patient with a wide fluctuating lesion in the gluteal-trochanteric region required aspiration, which yielded a negative culture. However, the lesion recurred early. Except for the patient with a sacral decubitus ulcer, all the lesions healed within a mean of six weeks (range 4 to 12 weeks) without any infections or necrosis. No recurrences were detected during the follow-up period. CONCLUSION: Closed degloving lesions in the pelvic and gluteal regions can be managed conservatively when the overlying skin is intact and the fluid accumulation is not excessive.

Accidents, Traffic↗
PubMed2005

[Society and chronic wounds. Thoughts to stop invisibility].

The authors presented a conference at the 5th National Symposium on Bedsores, or Decubitus Ulcers, and Chronic Injuries which dealt with all the dimensions related to this problem: epidemiological data, economic costs, social repercussions and possible alternative treatments; their goal was to raise the consciousness of nursing professionals so that they realize decubitus ulcers are a public health problem for which a solution exists if nursing professionals so desire.

Chronic Disease↗
PubMed1992

Common infections in the elderly.

Symptoms of infection in the elderly may be absent, vague or atypical. Infection should be suspected when an elderly patient presents with a decline in well-being or with non-specific symptoms such as falls, dizziness, confusion, anorexia or weakness. Common infections include bacterial pneumonia, urinary tract infection, intra-abdominal infections, gram-negative bacteremia and infection of decubitus ulcers. Antibiotic therapy is not recommended for asymptomatic bacteriuria or locally infected decubitus ulcers. Drug dosages should be adjusted for the age-associated decline in renal function and for hepatic or renal insufficiency. The trend in antibiotic therapy is evolving toward the use of third-generation cephalosporins instead of aminoglycosides to avoid the side effects of nephrotoxicity and ototoxicity. Pneumococcal, influenza and tetanus/diphtheria immunizations help prevent morbidity and mortality.

Age Factors↗
PubMed2005

Stress echocardiography in the evaluation of exercise physiology in patients with severe arterial pulmonary hypertension. New methodology.

INTRODUCTION: Doppler echocardiography is usually performed when assessing a patient with severe pulmonary hypertension (PHT), since it enables accurate determination of the severity of the hypertension through evaluation of several morphologic and hemodynamic variables. Echocardiograms are usually performed in left lateral decubitus (LLD). However, symptoms often arise only in a standing position and particularly during exercise. OBJECTIVE: To evaluate a group of patients with severe PHT using Doppler echocardiography during treadmill exercise testing. METHODS: We studied 8 patients (group A), mean age 43.88 +/- 14 years, 7 women; three had idiopathic pulmonary hypertension, 2 pulmonary thromboembolic disease, 2 Eisenmenger syndrome, and one pulmonary hypertension associated with celiac disease. We also studied an 8-patient control group (group B) with similar demographic characteristics, who had tricuspid regurgitation but no known cardiac disease, including pulmonary hypertension (excluded by echocardiogram). In addition to the ergometric variables of stress test duration using the modified Bruce protocol, resting heart rate, peak heart rate (PHR), resting systolic blood pressure (RSBP) and peak systolic blood pressure (PSBP), we evaluated the following echocardiographic variables: pressure gradient between right ventricle and right atrium (RV/RAg) and systolic volume (SV) in left lateral decubitus, in a standing position (SP) and at peak workload (PW). Stress testing was stopped in cases of fatigue and/or dyspnea. RESULTS: In group A, the RV/RAg in LLD was 100 +/- 20 mmHg, 98 +/- 20 mmHg in SP (p = NS) and 129 +/- 27 mmHg at PW (p = 0.003 vs. SP). In group B, the RV/RAg in LLD was 19.8 +/- 3.5 mmHg, 14.6 +/- 2.1 mmHg in SP (p = 0.0005) and 29.5 +/- 3.3 mmHg at PW (p < 0.0001 vs. SP). In group A, SV was 38 +/- 11 ml in LLD, 35 +/- 10 ml in SP and 32 +/- 9 ml at PW (p = NS); in group B, it was 63 +/- 5 ml in LLD, 55 +/- 5 ml in SP and 64 +/- 7 ml at PW (p < 0.0001). PHR was 114 +/- 10 bpm in group A and 145 +/- 8 (p < 0.0001) in group B. RSBP was 113 +/- 13 mmHg and PSBP 112 +/- 21 mmHg (p = NS) in group A, and 116 +/- 18 mmHg and 161 +/- 25 mmHg respectively (p < 0.0001) in group B. In four patients from group A, symptomatic falls in systolic blood pressure and SV occurred at PW. During a mean follow-up of 27 months (between 6 and 44 months), two of these four patients died and one is awaiting lung transplantation. CONCLUSIONS: 1. RV/RAg did not diminish in the standing position and rose significantly with orthostatic isotonic exercise during exercise testing in patients with severe PHT, with pulmonary artery systolic pressure reaching suprasystemic values. 2. Systolic volume and systolic blood pressure did not rise during exercise in patients with severe PHT, and patients with a decrease in systolic volume had worse clinical evolution. 3. Patients with severe PHT appeared to have chronotropic incompetence during exercise compared to the control group.

Adult↗
PubMed1991

Differential expression of markers for endothelial cells, pericytes, and basal lamina in the microvasculature of tumors and granulation tissue.

The structure and function of the tumor microvasculature is of great interest for cancer biology, diagnosis, and therapy. The distribution of endothelial cells, pericytes, and basal lamina in tumors is not well documented. In this study, the authors investigated the distribution of markers for these different components in a series of malignant human tumors and in human granulation tissue, both situations with extensive angiogenesis. Their results show a striking heterogeneity in the expression of markers for pericytes and endothelial cells between different tumors, but also within a single tumor lesion. To be able to distinguish between these two adjacent cell types decisively, all marker studies were carried out both on the light and the electron microscopical level and compared with staining results in granulation tissue of cutaneous wounds in healthy volunteers and of decubitus lesions. In granulation tissue of decubitus lesions, well-defined zones with increasing levels of maturation can be delineated. It was found that antibodies recognizing von Willebrand factor often failed to stain the tumor capillaries. Of the pericyte markers, alpha-smooth muscle actin was only locally expressed by pericytes in the tumor vasculature, whereas the high-molecular-weight melanoma-associated antigen, a chondroitin sulfate proteoglycan, stained the microvasculature broadly. Staining of the basal lamina components collagen type IV and laminin was, within the tumor, not restricted to the microvasculature. From their findings the authors conclude that 1) for the visualization of the tumor vasculature, antibodies recognizing endothelial markers, especially monoclonal antibodies PAL-E and BMA 120, are preferable to those recognizing pericytes or basal lamina; 2) within the microvasculature of tumors and granulation tissue, a heterogeneity of expression of endothelial and pericyte markers is observed; 3) during the formation of granulation tissue, all three microvascular components can be demonstrated already in the histologically earliest stage, suggesting not only an involvement of endothelial cells but also of pericytes and basal lamina in the initial steps of angiogenesis in wound healing.

Adult↗
PubMedDate not supplied

Spinal anesthesia for cesarean delivery with dilute solutions of plain bupivacaine: the relationship between infused volume and spread.

In a prospective open study, 40 women received spinal anesthesia for cesarean delivery induced with 15 mg glucose-free bupivacaine administered in dilutions of 0.5% (3 ml), 0.25% (6 ml), 0.125% (12 ml) and 0.083% (18 ml). The solutions were infused over 30 minutes while the women lay in the right lateral decubitus. No clinical or statistical difference in the final level of block was observed between the groups. All the solutions behaved as if slightly hypobaric with the development of essentially unilateral blocks during the infusion period. At the end of the infusion period when the women were turned from the lateral decubitus to a supine tilted position, there was a sudden rise in the levels of block on both sides of the body such that, by ten minutes after turning, there was no discernible difference between the two sides. The final block levels attained were within the expected range for conventional spinal anesthesia using 2.5-3.0-ml glucose-free 0.5% bupivacaine. The findings suggest that the subarachnoid spread of isobaric/hypobaric spinal anesthetic drugs is a complex process unlikely to be explained by reference to simple models of the spinal curves.

Adult↗
PubMed1990

[Ultrasonic study of the dimensions of the common bile duct in various postures].

To date, the importance of patient position has not been considered in defining the normal range of the internal diameter of the main bile duct. The authors examined 160 patients to verify if significant changes in the internal diameter of the main bile duct take place when changing patient position. In 20/160 cases (12.5%) internal diameter was observed to decrease by greater than 1 mm, in 6/160 cases (3.75%) by greater than 2 mm. These changes were found more often in cholecystectomized patients and were mostly associated with an increase in the max absolute caliber of the main bile duct. Therefore, postural changes (dorsal decubitus, left lateral decubitus, upright position) of the patient are important factors when calculating max internal diameter of the main bile duct. Moreover, postural changes may play an analogous role to functional tests.

Common Bile Duct↗
PubMed1990

Tips of the trade #26. Treatment of amputation residual limb ulcers with a hydroactive dressing and continued weight bearing.

This paper discusses treatment methods for amputation residual limb (stump) ulcers and infected or failed-amputation wounds. Local wound care and abstinence from prosthetic limb use and weight bearing have been found effective in the treatment of decubitus ulcers, as has the use of occlusive hydroactive dressings such as DuoDERM (ConvaTec, Princeton, NJ). DuoDERM application and prosthetic socket modification have been found useful for the treatment of decubitus ulcers in ambulatory patients. The techniques of, and benefits obtained from, DuoDERM therapy are explored; we conclude that the relief of local wound pressure and shear forces obtained with this therapy generally enhances ambulation capacity.

Amputation Stumps↗