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At least 361 records · Page 20Linked to original sources
PubMed2004

The medial sural MEDIAL GASTROCNEMIUS perforator free flap: an 'ideal' prone position skin flap.

The medial sural MEDIAL GASTROCNEMIUS perforator flap is a potentially large, thin cutaneous flap that encompasses the calf skin territory. Its medial sural vascular pedicle has a long leash of large caliber that simplifies microanastomoses when used as a free flap. Because the identification of the requisite perforators and their subsequent intramuscular dissection is facilitated with the patient in a prone position, this can be an "ideal" skin free flap for the posterior aspect of the body. This is especially true for the lower limb where all surgical morbidity could then be restricted to the ipsilateral extremity. This approach has been used in 5 clinical cases, with success except once when the flap was aborted as a result of anatomic anomalies, which is always a concern with muscle perforator flaps.

Foot Injuries↗
PubMed2004

Acute lung injury: effects of prone positioning on cephalocaudal distribution of lung inflation--CT assessment in dogs.

PURPOSE: To quantify cephalocaudal gradient of lung inflation in acute lung injury in a dog model in prone versus supine position. MATERIALS AND METHODS: Experiments were performed in accordance with Guide for the Care and Use of Laboratory Animals, as approved by National Research Council (National Institutes of Health), and were approved by committee on care and use of animals in research at Seoul National University Hospital. After induction of acute lung injury with intravenous injection of oleic acid, dogs were randomized to be ventilated in either prone (n = 6) or supine (n = 6) position. Spiral computed tomography (CT) and hemodynamic measurement were performed sequentially on an hourly basis. Volume and mean attenuation of lung were measured quantitatively by using software to evaluate each CT section. Cephalocaudal gradient of mean lung attenuation, distribution of gas and tissue, and alveolar expansion were assessed. Functional residual capacity and net alveolar expansion of entire lung were measured. Statistical analysis was performed with Friedman, sign, and Mann-Whitney tests. RESULTS: Mean lung attenuation increased gradually from apex to base of lung in supine position. Thus, inflation gradient along cephalocaudal axis was found. Gas was located predominantly in upper lung, whereas tissue was dominant in lower lung in supine position. In supine group, cephalocaudal inflation gradient showed no significant change from baseline up to 4 hours. After prone positioning, cephalocaudal inflation gradient was reduced, and gas and tissue proportions became more uniform along cephalocaudal axis. In prone group, absolute values of cephalocaudal inflation gradient at time points of prone positioning for 1, 2, and 3 hours were significantly lower than baseline values (P < .05) and those in supine group (P < .05). Alveolar expansion occurred in caudal regions, and alveolar contraction occurred in cephalic regions; accordingly, net alveolar volume of entire lung was not altered significantly. Functional residual capacity was unchanged by prone positioning. CONCLUSION: In acute lung injury, prone positioning induced more uniform distribution of gas and tissue along cephalocaudal axis by reducing cephalocaudal inflation gradient.

Animals↗
PubMedDate not supplied

Thin section computed tomography in the prone position for detection of axillary lymph node metastases in breast cancer.

Presence or absence of lymph node metastases is the most accurate prognostic indicator in breast cancer. Clinical examination is unreliable in detecting involved nodes. Formerly, CT (computed tomography) was concluded to be an unreliable predictor of axillary lymph node involvement, primarily because of its low negative predictive value. In our institute, thin section CT (TS-CT) in the prone position was performed in patients with breast cancer to improve the predictability of axillary lymph node involvement. Pre-operative TS-CT examination of the axilla and breast was performed in 71 women with breast cancer. The sensitivity for involved nodes was 93.8%, the specificity 82.1%, and the accuracy 87. 3%. Based on these results, we concluded that TS-CT is an accurate predictor of axillary lymph node involvement. However, the upper limit of accuracy was approximately 85% for the imaging diagnoses, mainly because of the existance of micrometastases.

Adult↗
PubMed1994

[Attenuation effects in 99mTc-MIBI stressed myocardium 360 degree SPECT: a comparison of the supine and prone positions].

Due to the higher photon energy of 99mTc as compared to 201Tl attenuation effects are expected to be less prominent in SPECT imaging using 99mTc-labelled isonitriles. Reduced 99mTc-MIBI uptake has been observed especially in male patients despite low probability of coronary artery disease. 56 patients were investigated in prone and supine position after bicycle exercise. Inclusion criterium was the identical location of the ROI with maximal tracer uptake in prone and supine imaging. In prone position 99mTc-MIBI uptake was significantly higher in the posterior wall as compared to supine imaging (p < .001). The underlying cause of the apparent increase in tracer uptake of the posterior wall was a decrease in count density in the region of maximal uptake (p < .01) while the count densities in the posterior wall were unchanged (p = NS). Relative uptake values in apical and septal regions of the anterior wall significantly decreased in prone imaging. SPECT imaging in prone position is useful in minimizing attenuation artifacts. However, because a deterioration in the anterior wall cannot be excluded, studies that compare the sensitivities and specificities for the different coronary arteries are required before general prone imaging can be recommended.

Adult↗
PubMed2005

A pitfall of FDG-PET image interpretation: accumulation of FDG in the dependent area of the urinary bladder after bladder irrigation--the usefulness of the prone position.

In F-18 FDG PET studies, retrograde irrigation of the urinary bladder is usually used to reduce the interference with physiological urinary accumulation of F-18 FDG in patients with possible pelvic lesions. A 34-year-old female who had recently been diagnosed with cervical cancer had an F-18 FDG-PET scan performed for whole-body evaluation. The bladder was irrigated with physiological saline and filled with 200 mL of irrigation fluid through a 3-way balloon catheter inserted before the scan. Two areas with high FDG accumulation were noted in the posterior pelvis. Tumor invasion or metastasis could not be ruled out. Additional focal imaging of the pelvis was performed with the patient in the prone position. The lesion on the left side of the patient was still noted, whereas the lesion on the right had disappeared, which proved that it was a false-positive lesion. Great caution is required when assessing imaging results to avoid misdiagnosis in patients after bladder irrigation.

Adult↗
PubMedDate not supplied

The effect of the prone position on venous pressure and blood loss during lumbar laminectomy.

STUDY OBJECTIVE: To determine the effects of three different prone support systems (Andrews spinal surgery frame, Cloward surgical saddle, and longitudinal bolsters) on inferior vena cava (IVC) and superior vena cava (SVC) pressures; the validity of measuring central venous pressure (CVP) for the determination of ideal positioning of the patient; and the relationship among frame type, blood loss, and hemodynamic measurements. DESIGN: Prospective, randomized study of the hemodynamic effects of the prone position. SETTING: Inpatient surgery at a university hospital (regional spinal cord injury treatment center). PATIENTS: Eighteen patients free of significant coexisting disease (ASA physical status I and II) undergoing elective lumbar laminectomy. INTERVENTIONS: Patients were assigned to one of three support frames and measurement of SVC pressure, IVC pressure, and mean arterial pressures (MAP) were obtained supine, prone, and after repositioning. These pressures and measured blood loss were obtained every 15 minutes during the surgical laminectomy portion of the procedure. MEASUREMENTS AND MAIN RESULTS: Patients positioned on the Andrews frame had decreased mean SVC and IVC pressures from 8.7 mmHg and 8.4 mmHg in the supine position to 3.3 mmHg and 1.8 mmHg in the prone position, respectively (p less than 0.001). Prone position CVP also was significantly lower in the Andrews group compared with that in the other two groups (p less than 0.001). Repositioning efforts did not significantly decrease CVP. Blood loss was higher in the Cloward group (1,150 +/- 989 ml) than in the Andrews (245 +/- 283 ml) and bolsters (262 +/- 188 ml) groups (p less than 0.02). CONCLUSIONS: Increased blood loss was not associated with increased SVC or IVC pressure, nor was there any significant correlation between any demographic or hemodynamic variable and blood loss. There was no evidence that CVP is useful in determining the ideal prone position in patients undergoing lumbar laminectomy.

Blood Loss, Surgical↗
PubMed1984

The use of the Mayfield headrest to perform retinal surgery in the prone position.

A Mayfield neurosurgical headrest positioned at the end of a standard operating room table may be utilized to achieve the prone positioning necessary to perform certain types of ophthalmic procedures, such as the unfolding of the inverted flap of a giant retinal break. We describe the technique of employing this readily available headrest.

Eye Injuries↗
PubMedDate not supplied

[Cardiorespiratory evaluation of midazolam and thiopental during their use in patients undergoing translumbar aortography in decubitus prone position and ASA IV].

AIMS: To verify the cardiorespiratory effects of midazolam and thiopental in ASA IV patients undergoing translumbar aortography in the decubitus prone position. METHODS: A prospective double blind study was carried out on 26 patients (mean age, 65.9 yr) allocated randomly to receive either midazolam (0.13 mg/kg) or thiopental (4 mg/kg) i.v. Without being premedicated all the patients had fentanyl 1.5 micrograms/kg i.v. and were preoxygenated with 50% oxygen before induction of anaesthesia. Blood pressure was measured by oscilometry and blood oxygenation by pulseoxymetry. RESULTS: No significant differences were found in the hemodynamic values (blood pressure, heart rate, double product) upon comparison of the two groups. Apnea was more frequent in the thiopental group 61.5% (8 out of 13 patients) than in the midazolam group 15.3% (2 out of 13 patients). Hypoxemia appeared only in the former group (61.5% of the cases). CONCLUSIONS: In patients undergoing translumbar aortography midazolam and thiopental behaved similarly with regard to hemodynamics. Midazolam produced less apnea than thiopental.

Aged↗
PubMed1994

Improved arterial oxygenation in children with the adult respiratory distress syndrome: the prone position.

Seven ventilated children with the adult respiratory distress syndrome (ARDS) were studied. While supine and haemodynamically stable, baseline arterial blood-gas analyses and haemodynamic measurements, including cardiac output, were performed. Each child was then turned prone and 30 min later a repeat set of measurements were made. Following this, the children were returned to the supine position and 30 min later a final set of measurements were performed. Ventilation and inotropic support remained unchanged during these positional changes. No significant effect on heart rate, mean systemic arterial blood pressure and cardiac output occurred following these positional changes (p > 0.05; Friedman's ANOVA). Arterial oxygen saturation significantly improved, however, when nursed in the prone position (p < 0.02). Similarly, oxygen delivery significantly increased (p < 0.02). The prone position improves arterial oxygenation and oxygen delivery in children with ARDS. By adopting the prone position, in ventilated children with ARDS, we surmise that realistic gas exchange targets may be reachable with lower levels of inspired oxygen and/or peak airway pressures.

Cardiac Output↗
PubMed1986

Pulmonary resection in the prone position for suppurative lung disease in children.

Lung resection for suppurative inflammatory disease is hazardous in children whose small airway diameter precludes the use of standard methods of bronchial separation. A prospective evaluation of the prone position for thoracotomy in 17 children referred for operation with severe inflammatory disease was done. Bronchography showed whole lung bronchiectasis eight, destroyed lung in three, and lobar bronchiectasis five. Pulmonary resections performed with the child prone included left pneumonectomy (nine), right pneumonectomy (four), lingulectomy with lower lobectomy (two), and other lobectomy (two). No endobronchial or intrapleural spillage occurred. One child required reexploration for bleeding and one child developed a postoperative empyema that ultimately caused death. The remaining 16 children were discharged within 8 days of operation, and follow-up of 1 to 18 months records favorable progress.

Bronchiectasis↗
PubMed1975

Advantages of the prone position for neurosurgical procedures on the upper cervical spine and posterior cranial fossa in children.

The authors have reviewed the charts of 107 patients undergoing 119 surgical procedures in the prone position for posterior fossa or upper cervical lesions. The intraoperative complications encountered include cardiac arrhythmia, respiratory complications, cardiac arrest, hypothermia, air embolus and technical difficulties. In all but three children the problems were minor and easily remedied. The use of controlled ventilation appears to reduce blood loss, permits excellent relaxation of the exposed tissues and had some anesthetic advantages.

Apnea↗
PubMed1999

[Pathophysiology of established urinary incontinence (UI) in the elderly and an ameliorative method for disuse syndrome including UI seen in the bed-ridden elderly--using prone position and its variations].

Multipathology is the physical characteristics of the elderly, and their established urinary incontinence (UI) is usually based on multiple causal diseases and types of UI. Decubitus voiding (urination and defecation) inevitably causes UI and fecal incontinence (FI). Difficulty in controlling UI and FI seen in bed-ridden elderly results in long-term use of diapers and indwelling catheters, which eventually leads to the progression of disuse syndrome and decline of ADL (activity of daily living). Most elderly UI cases have only a few major causal diseases. Arrangement of relationship between the diseases and the existing types of the UI; recognition of gender gap in urination; determination and execution of various kinds of treatment in a methodical way; and the maintenance of the proper medication dosage are the four keys to the effective and safe control of the UI. For bed-ridden elderly, passively provided suitable positions on urination and defeca-tion has become a prerequisite condition. These are not supine or Fowler (semi-reclining) positions, but normal sitting, or prone and its variation forward-tilting positions. The latter two positions, which ameliorate UI and FI in the bed-ridden elderly, have been found to improve all of the pathologies including the disuse syndrome as well. The Seikatsudai (Life rack), which provides a forward-tilting position, not only has such an effect, but also offers the possibility to make the bed-ridden elderly more independent in their lives.

Activities of Daily Living↗
PubMed1990

Left lower lobe ventilation is reduced in patients with cardiomegaly in the supine but not the prone position.

To determine the effect of the heart on regional ventilation, Krypton-81m (81mKr) tomographic (SPECT) ventilation scans were recorded in seven patients with cardiomegaly and four normal subjects in the supine and prone positions. All patients had a cardiothoracic ratio of greater than 0.50 and clear lung fields radiographically. Using standard gamma camera tomographic reconstruction techniques, images of transaxial slices were obtained during a 360 degree rotation around the thorax of the subject breathing the radioactive gas 81mKr. The transaxial images, acquired over 10 min were aligned in each posture at the level of the cardiac apex, mid-heart, and aortic arch and were matched in relation to a radioactive marker on the chest wall and to anatomic landmarks. A horizontal line (gravity independent and parallel to the couch) was drawn on the transaxial section through the dorsal regions of the right and left lung. Counts per resolution element (12 to 15 mm) were plotted along this line and the ratios of the peak values in right and left lung compared. These ratios represent differences in regional ventilation per unit lung volume. In controls the mean left-to-right (L/R) peak count ratio varied from 0.91 to 1.00 at the three levels (range: 0.76 to 1.04); there were no significant differences between supine and prone. In patients with cardiomegaly the mean (+/- SEM) L/R peak count ratio at cardiac apex, mid-heart, and aortic arch was 0.46 (+/- 0.08), 0.55 (+/- 0.07), and 0.89 (+/- 0.08) when supine and 1.04 (+/- 0.07), 1.05 (+/- 0.05), and 1.08 (+/- 0.07) when prone, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗