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PubMed2002

The effect of posture and a mandibular protruding device on pharyngeal dimensions: a cephalometric study.

The objectives were to evaluate the impact of body posture on cephalometric measures and the level and the extent to which treatment with a mandibular protruding device (MPD) affects pharyngeal width. The study was composed of 77 patients: 50 were diagnosed with obstructive sleep apnea (OSA) and 27 snored. After each patient underwent a baseline medical (including a somnographic registration), dental and stomatognathic examination, an MPD that would protrude the mandible 75% of the maximal protrusion range was fabricated. In a radiographic examination, four cephalograms were taken: two in the upright position with and without the MPD and two in the supine position with and without the MPD. The cephalometric measures focused on the pharyngeal structures. MPD treatment significantly increased the relative pharyngeal area (at the level of the oropharynx and the hypopharynx) by a mean of +89.6 mm2 (P < 0.01) in the upright posture. The relative pharyngeal area, however, was reduced by more than 50% in the supine position compared with the upright position, independent of MPD treatment. In the supine position, compared with upright, most pharyngeal measures decreased significantly; the hyoid was significantly lower and displaced posteriorly, and the area of the velum increased by a mean of +201.2 mm2 (P < 0.001). We conclude that the MPD significantly increased most pharyngeal measures except the linear distance between the hyoid bone and the third vertebra and decreased the area of the velum.

Adult↗

PubMed1995

Measurement of lung water content and pleural pressure gradient with magnetic resonance imaging.

The aim of this study was to develop a magnetic resonance (MR) sequence capable of measuring water content and the gravity-dependent gradient in lung density in normal lung. First, the MR signal from excised normal pig lung was characterized using a 2.1 T nuclear magnetic resonance (NMR) spectrometer. A multiecho sequence was then developed on a 0.15 T Picker MR scanner. This sequence was validated in excised normal pig lung by comparison with gravimetric lung water content. Finally, this sequence was used in five normal volunteers in the prone and supine positions during quiet breathing and in the supine position at total lung capacity (TLC). The ratio of lung water measured by MR and gravimetric techniques was 0.95 +/- 0.03. There was no significant difference in average lung density in the prone (0.21 +/- 0.03 g/ml) and in the supine (0.20 +/- 0.03 g/ml) positions. Lung density decreased at TLC (0.12 +/- 0.01 g/ml) (p < 0.01). Gradients in lung density were visible in all prone and supine scans at functional residual capacity (FRC), and on average the gradients were decreased by 90% at TLC. The average estimated pleural pressure gradient in the prone position was 0.13 +/- 0.08 cm H2O/cm lung and in the supine position was 0.38 +/- 0.23 cm H2O/cm lung. MRI allows measurement of lung water content and pleural pressure gradient.

Adult↗

PubMed1991

Respiratory function and ribcage contribution to ventilation in body positions commonly used during anesthesia.

Lung function tests are normally performed in the upright position, whereas anesthesia is usually administered with the patient in the supine position, and occasionally in other postures. We therefore compared forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), functional residual capacity (FRC), and ribcage contribution to ventilation by respiratory inductive plethysmography in 13 conscious healthy male volunteers, sitting and in four horizontal positions used during anesthesia. Forced vital capacity and FEV1 were similar in all positions, except for a significant mean increase in FVC of 300 mL (SD 213) when sitting compared with when supine (P less than 0.001). The mean decrease in FRC was 806 mL (SD 293) between the sitting and supine positions (P less than 0.001). A significant increase in FRC occurred (252 mL, SD 329, P less than 0.01) when supine subjects raised their arms above their heads as required for computed tomography. Functional residual capacity in the prone and lateral positions was significantly larger than in the supine position (mean change 350 mL, P less than 0.001), but was still some 450 mL less than in the sitting position. Mean ribcage contribution was similar in all horizontal positions (32%-36%), whereas supine values were significantly different from those of the sitting position (mean 70%, SD 11, P less than 0.001). In conclusion, the various horizontal postures studied have no effect on FVC, FEV1, or ribcage contribution to ventilation. However, FRC in the prone, lateral, and arms-up positions is on average 250 mL larger than in the supine position, an observation that may affect gas exchange during anesthesia in these positions.

Adult↗

PubMed2001

Feasibility of continuous transthoracic cardiac imaging using a novel ultrasound transducer.

BACKGROUND: The feasibility of hands-free transthoracic continuous ultrasonic cardiac imaging has not been demonstrated previously. We developed a 2.5-MHZ spherical transducer mounted in an external housing to permit steering in 360 degrees (CONTISON). The external housing was attached to the chest wall using an adhesive patch. METHODS AND RESULTS: The transducer was placed in the third or fourth interspace at the left sternal border to permit imaging of the left ventricle (LV) in its short axis and attached to the chest wall. The transducer then was attached to an ultrasound machine. Ten normal subjects and 20 patients with previous myocardial infarction were studied. The following maneuvers were performed at the beginning of the study: (1) The patient was rotated from the supine position (0 degrees ) in 20 degrees increments to the left lateral decubitus position (90 degrees ). The echocardiogram was displayed continuously and was recorded on videotape (parasternal short-axis view) at 0 degrees, 20 degrees, 40 degrees, 60 degrees, 80 degrees, and 90 degrees. (2) The patient was returned to the supine position and an echocardiogram was obtained. The patient was then seated up 20 degrees, 40 degrees, 60 degrees, 80 degrees, and 90 degrees by using the controls on the bed. (3) The patient then was returned to the supine position and the echocardiogram was displayed continuously on the monitor. The echocardiogram was recorded every 15 minutes for a period of 4 hours. All segments of the LV were visualized in the supine position and during lateral rotation (0 degrees -90 degrees ). Thus, body position did not affect the image. All segments of the LV were visualized during sitting up (0 degrees -90 degrees ), and all segments were visualized during the 4 hours of imaging. The patients were able to move around without distortion of the image. CONCLUSION: The CONTISON transducer permitted continuous imaging of LV wall motion. Body position did not affect interpretation of wall motion. This device has potential applicability in monitoring LV function in the intensive care setting.

Adult↗

PubMed2004

Continuous telemetric monitoring of fetal oxygen partial pressure during labor.

INTRODUCTION: Upright or ambulatory birth positions are favorable for fetal oxygenation. Studies of fetal oxygenation with regard to maternal position require free maternal mobility. Therefore, telemetry for a fetal sensor for such investigations is a pre-requisite. Telemetry-if technically feasible-could enable monitoring of fetal oxygen partial pressure using an existing sensor without restricting the mobility of the parturient woman. We have developed a telemetry system for use with a fetal transcutaneous partial oxygen pressure sensor (ttcpO(2)) and have studied effects of maternal position and position changes during normal labor. MATERIALS AND METHODS: The monitoring system consists of three parts: the telemetry unit with the ttcpO(2) sensor to transmit the tcpO(2) and the heating output telemetrically, a modified CTG monitor and a personal computer storing the measurements. All data were plotted on the CTG recording paper and fed into a new purpose-designed software, displaying fetal heart rate, the uterine contraction intensity, ttcpO(2) and the heating output. Three laboring women, randomly and successively adopting "classical birth positions" (supine or side positions), sitting or vertical or walking position, were studied. RESULTS: Fetal heart rate, uterine contractions, ttcpO(2) and heating output are influenced by the birth positions and by changes of the birth position. In the classical supine and side position there seemed to be lower fetal oxygenation. Sitting, standing and especially walking were more favorable. DISCUSSION: Telemetry is useful to study a possible clinical benefit of individual birth positions.

Equipment Design↗

PubMed1990

[Effects of body posture on cochlear performance].

Experimental research has demonstrated that changes in body position influence auditory function and, specifically, supine position produces a sensorineural hearing loss at low frequencies. The hypotheses to interpret these phenomena are principally referred to an increase of hydrostatic pressure of labyrinthine fluids. In order to evaluate the effects of head position on the cochlear performance a modern test battery has been performed to study cochlear function in 11 normal subjects ranged in age from 22 to 34 years. The tests (Remote Masking:RM; Brief Tone Audiometry:BTA; Critical Ratio:RC) have been evaluated in two positions: sitting upright and supine with the head at a 20 backward angle. The results of our research have shown that in all the cases, the supine position produces a significant shift of the auditory threshold at 250 and 500 Hz, and a decrease of RM values in about all of the cases. We have estimated non statistically significant differences for the RC and BTA values, in more than half of the ears tested. On the basis of the significance given to RM, BTA, RC: we can deduce that the modifications of the auditory performance related to an increase in perilymphatic hydrostatic pressure, induced by the head position are produced by an increase in rigidity of the mechanical vibratory structures of the cochlea rather than the expression of sensorineural damage.

Adult↗

PubMed2004

[How to choose the duration of prone-position ventilation in patients with acute respiratory distress syndrome caused by pulmonary or extrapulmonary diseases?].

OBJECTIVE: To determine the different effect of prone-position ventilation (PPV) in patients with acute respiratory distress syndrome (ARDS) resulting from a pulmonary cause (ARDSp) and that from an extrapulmonary cause (ARDSexp) on oxygenation, respiratory mechanics and hemodynamics. To determine an appropriate duration of ventilation in the prone position in the two groups. METHODS: Nine ARDSp patients and seven ARDSexp patients within 3 days of onset of ARDS were included in this study which were classified as two groups. The patients were placed in prone position for 2 h. The effect of different time (pre-PPV, PPV 0.5 h, PPV 2 h) on oxygenation, respiratory mechanics and hemodynamics were observed. Lung computerized tomography (CT) was obtained in both the supine position and 10 min after prone position. RESULTS: Compared with pre-PPV, in ARDSp, partial pressure of oxygen in artery (PaO(2))/inhaled oxygen concentration (FiO(2)) was not increased after 0.5 h, and increased only after 2 h in the prone position (130.6 +/- 36.2 to 165.1 +/- 72.3, P < 0.05). But in ARDSexp, PaO(2)/FiO(2) was significantly increased after 0.5 h and 2 h in the prone position (116.5 +/- 55.0 to 163.2 +/- 46.4 and 182.7 +/- 87.7, P < 0.05). After 0.5 h in the prone position the responding ratio of ARDSexp was higher than ARDSp (7/7 vs 1/9, P = 0.0007). After 2 h, no significant difference of responding ratio was found between the two groups (6/7 vs 6/9, P = 0.392). The changes of the PaO(2) were similar to the PaO(2)/FiO(2). The PaCO(2) and the static respiratory system compliance (Cstrs) did not differ significantly between the prone position and the supine position in the two groups. In ARDSp, the airway resistance was (10.8 +/- 1.4) cm H2O.s(-1).L(-1) in the supine position, and it was significantly decreased after 2 h in the prone position (8.4 +/- 1.8) cm H2O.s(-1).L(-1) (P < 0.05). Chest CT scans of ARDSp and ARDSexp patients showed marked difference. CONCLUSIONS: PPV could be used to improve severe hypoxemia of ARDS. It improved the PaO(2)/FiO(2) ratio rapidly in ARDSexp, but in ARDSp the improvement took a longer time.

Aged↗

PubMed1998

[Relationship between lung function and nocturnal hypoxemia in patients with obstructive sleep apnea syndrome].

OBJECTIVE: To explore the relationship between the changes of lung function resulted from position changes and obesity, and nocturnal hypoxemia in patients with obstructive sleep apnea syndrome. METHOD: 34 patients with obstructive sleep apnea syndrome were detected by polysomnography with lung function and blood gas analysis in sitting and supine positions during wake, and the relationship between results of lung function and blood gas analysis, IBW% to the AI, and < 90% T (percentage of the duration of SaO2 below 90% to total sleep time) was analyzed. RESULT: The mean age of the patients was 44 +/- 13 years. The AI was 36 +/- 22 time.hour-1. On changing from sitting to supine position, PaO2, VC%, ERV, FRC, FRC%, RV%, TLC% decreased significantly, especially ERV and FRC%, which decreased 47% and 29% respectively. AI had positive correlation with VC% (r = 0.477, P < 0.01) and TLC% (r = 0.443, P < 0.01) in supine position, < 90% T had negative correlation with PaO2(r = -0.479, P < 0.01) and ERV (r = -0.416, P < 0.05) in sitting position. The IBW% had negative correlation with VC% in sitting (r = -0.547, P < 0.01) and supine position (r = -0.491, P < 0.01). IBW% also had negative correlation with ERV in sitting (r = -0.523, P < 0.01) and supine (r = -0.413, P < 0.01) position and FRC (r = -0.402, P < 0.05) in sitting position. The IBW% had positive correlation with the < 90% T(r = 0.514, P < 0.01). CONCLUSION: These results suggest that positional changes and obesity have effects on lung function in patients with OSAS, and lead to the deterioration of hypoxemia during apnea.

Adult↗

PubMed2003

Relevance of ineffective oesophageal motility during oesophageal acid clearance.

BACKGROUND: Oesophageal clearance of acid reflux consists of an initial volume clearance followed by neutralisation of the acidified mucosa by swallowed saliva (chemical clearance). Ineffective oesophageal motility (IOM), a frequent finding in patients with gastro-oesophageal reflux disease (GORD), has been claimed to underlie prolonged acid clearance by affecting oesophageal emptying and saliva transport. Intraluminal impedance allows non-radiological monitoring of movement of oesophageal liquids. AIMS: To evaluate the relevance of IOM during oesophageal volume and chemical clearance using combined pH impedance measurements. SUBJECTS: Impedance was validated with fluoroscopy to study volume clearance in three healthy subjects. Acid clearance tests were performed in 10 healthy subjects in the upright and supine positions, before and after oesophageal peristaltic disruption with sildenafil 50 mg. METHODS: After instillation of an acid bolus, simultaneous manometry, pH, and impedance were used to study oesophageal motility, chemical clearance, and volume clearance, respectively. RESULTS: Impedance allowed assessment of volume clearance accurately, showing a strong correlation with fluoroscopy (r(2)=0.89). Sildenafil provoked a graded impairment in oesophageal motility in healthy subjects without affecting saliva secretion. In the upright position, volume clearance was slightly prolonged only with severe IOM (>80% abnormal peristaltic sequences). In the supine position, severe IOM significantly prolonged chemical and volume clearance. Moderate IOM (30-80% abnormal peristalsis) had no effect. With normal peristalsis and moderate IOM, clearance times were similar in the upright and supine positions. Severe IOM however had a greater impact on clearance in the supine than in the upright position. CONCLUSION: Ineffective oesophageal motility has little effect on oesophageal clearance during upright acid reflux. With supine reflux, only severe IOM is associated with prolonged oesophageal clearance.

Acids↗

PubMed1989

Positive end-expiratory pressure in supine and sitting positions: its effects on intrathoracic and intracranial pressures.

The effects of positive end-expiratory pressure (PEEP) on central venous and intracranial (ICP) pressures were evaluated in 10 patients with posterior fossa tumors, in both supine and sitting positions. With patients in the supine position, intrathoracic PEEP-dependent venous hypertension was clearly transmitted to the intracranial compartment but without intracranial hypertension. On the contrary, with patients in the sitting position PEEP had no influence in almost half of our patients. In patients with radiological or clinical signs of increased ICP, however, the combination of head flexion and rotation with institution of PEEP caused a dangerous increase in ICP, even when the patients were in the sitting position. The need for early withdrawal of cerebrospinal fluid in these patients is stressed.

Adolescent↗

PubMed1986

Hemodynamics of the varicocele. Part II. Correlation among the results of renocaval pressure measurements, varicocele scintigraphy and phlebography.

Left renal vein compression occurring mainly with the patient in the upright position, and being less severe or absent in the supine position, was considered to be the main cause of varicoceles. We show that left renal vein compression is, indeed, more severe with the patient in the upright than in the supine position and that it produces a left renocaval pressure gradient that is responsible for the retrograde blood flow in the left testicular vein. This pressure gradient, which was determined in the supine and semierect positions in 34 patients, increased from a mean of 3.8 mm. Hg in the supine position to a mean of 7.8 mm. Hg in the semierect position. On the basis of the assumption that the renocaval pressure gradient measured with the patient in the semierect position determines the presence and velocity of a retrograde flow in the left testicular vein, as shown by the dynamic portion of the varicocele scintigram (see part I), these variables were analyzed and the correlation coefficient proved to be good. Therefore, we conclude that the varicocele occurs when the left testicular vein lacks valves or there is a renogonadal bypass, and the severity of the left renal vein compression in the (semi) upright position determines the velocity of the retrograde flow in the left testicular vein and the size of the varicocele.

Blood Pressure↗

PubMed1994

Effects of age and hypertension on autonomic nervous regulation during passive head-up tilt.

To study the effects of age and hypertension on autonomic nervous function with passive postural change, we examined 31 normotensive subjects (25 to 85 years old) and 31 hypertensive patients (21 to 71 years old) without any cardiac disease, diabetes mellitus, or neurological disorders. Subjects were passively placed in a 60 degrees head-up tilting position after 15 minutes in the supine position. Autonomic nervous function was evaluated by frequency domain analysis of heart rate with the autoregressive method. Using low-frequency (0.1 Hz) and high-frequency (0.25 Hz) peaks, the ratio of low- to high-frequency power (L/H) was calculated as an index of sympathetic activity and the ratio of high to total power (%HF) as that of parasympathetic activity. With the patient in the supine position, total power spectral density declined logarithmically with age in normotensive subjects and hypertensive patients, but %HF and L/H showed no changes. In response to passive tilting, L/H was increased and %HF was decreased in the normotensive subjects, and these responses declined with age logarithmically. In contrast, hypertensive patients exhibited less autonomic response to postural change regardless of age. These results suggest that autonomic neural response to tilt is decreased with age; however, attenuation of the response by hypertension is not associated with an increase in age.

Adult↗

PubMed1984

Effect of posture on extradural pressure.

Extradural pressure was measured in the lateral and the supine positions in three groups of patients using the extradural catheter as a manometer. The groups consisted of 20 pregnant patients at or near term, 10 patients in the period after childbirth and 10 male surgical patients. In every patient, the extradural pressure in the supine position was greater than that in the lateral position. The mean extradural pressures in the lateral and the supine positions were similar in the three groups. It is suggested that the difference between the extradural pressures in the lateral and the supine positions is physiological and occurs irrespective of vena caval compression. Extradural pressure changes are probably the result of postural changes in the cerebrospinal fluid (CSF) pressure. The influence of CSF pressure on extradural pressure was confirmed further by measuring the extradural pressure in the prone position in five pregnant patients.

Adolescent↗

PubMed1990

The influence of body position and differential ventilation on lung dimensions and atelectasis formation in anaesthetized man.

The effects of body position and anaesthesia with mechanical ventilation on thoracic dimensions and atelectasis formation were studied by means of computerized tomography in 14 patients. Induction of anaesthesia in the supine position reduced the cross-sectional area for both lungs and caused atelectasis formation in dependent lung regions in 4/5 patients. Conventional ventilation with positive end-expiratory pressure (PEEP) increased thoracic dimensions and reduced, but did not eliminate, the atelectatic areas. The vertical diameters of both lungs were smaller in the lateral position as compared to the supine position (16.7 vs 10.4 cm in the left lung and 17.3 vs 12.8 cm in the right lung). The lateral positioning also caused a large reduction of the atelectatic area in the non-dependent lung. Differential ventilation with selective PEEP to the dependent lung eliminated (3/8 patients) or reduced (5/8 patients) dependent lung atelectasis. It can be concluded that lung geometry is altered in the lateral position: the shape of the lung makes the vertical diameter of each lung less in the lateral position, compared to the supine position. The atelectatic areas are mainly located in the dependent lung in the lateral position, and these atelectatic areas could be further reduced by selective PEEP to this lung.

Adult↗

PubMed2005

Expiratory flow limitation is associated with orthopnea and reversed by vasodilators and diuretics in left heart failure.

BACKGROUND: In patients with acute left heart failure (LHF), orthopnea has also been related to the occurrence or worsening of expiratory flow limitation (EFL) in the supine position. We wished to assess whether short-term treatment with vasodilators and diuretics was able to abolish supine EFL and whether this could help to control orthopnea in patients with acute LHF. METHODS: In nine nonobese (ie, mean [+/- SD] body mass index, 24 +/- 5 kg/m2), never-smoker patients (two men and seven women; mean age, 77 +/- 7 years) with acute LHF (mean ejection fraction, 43 +/- 15%), we assessed EFL by the negative expiratory pressure method and dyspnea by the Borg scale, with patients in both the seated and supine positions, before and after short-term treatment with vasodilators and diuretics until hospital discharge. Orthopnea was defined as a positive difference in the Borg score between measurements made with the patient in the supine and seated positions. Postural variations in the end-expiratory lung volume were inferred from changes in inspiratory capacity (IC) that were measured under the same circumstances. RESULTS: Before treatment, with the patient in the seated position the mean dyspnea score was 1.5 +/- 0.5, the mean IC was 1.49 +/- 0.38 L, seven patients were non-flow-limited, and two patients were flow-limited. During recumbency, the mean dyspnea score was 2.7 +/- 0.5 (p < 0.01 vs seated position values), the mean IC was 1.66 +/- 0.45 L, and seven patients exhibited EFL. After a mean duration of 17 +/- 8 days of treatment (range, 7 to 28 days), EFL was detected in two patients only in the supine position, IC increased both in the seated position (1.65 +/- 0.34 L; p < 0.01) and the supine position (1.81 +/- 0.41 L; p = 0.07) position, and, although only two patients denied orthopnea, the mean dyspnea score during recumbency actually decreased to 1.9 +/- 1.0 (p < 0.05). CONCLUSIONS: Our results indicate that short-term treatment with vasodilators and diuretics is able to control orthopnea and to remove supine EFL in most patients with acute LHF, suggesting a posture-related increase in bronchial obstruction as the main mechanism of EFL, which appears to play a role in the occurrence and severity of orthopnea in these circumstances.

Aged↗

PubMed1998

Alveolar oxygen uptake and femoral artery blood flow dynamics in upright and supine leg exercise in humans.

We tested the hypothesis that the slower increase in alveolar oxygen uptake (VO2) at the onset of supine, compared with upright, exercise would be accompanied by a slower rate of increase in leg blood flow (LBF). Seven healthy subjects performed transitions from rest to 40-W knee extension exercise in the upright and supine positions. LBF was measured continuously with pulsed and echo Doppler methods, and VO2 was measured breath by breath at the mouth. At rest, a smaller diameter of the femoral artery in the supine position (P < 0. 05) was compensated by a greater mean blood flow velocity (MBV) (P < 0.05) so that LBF was not different in the two positions. At the end of 6 min of exercise, femoral artery diameter was larger in the upright position and there were no differences in VO2, MBV, or LBF between upright and supine positions. The rates of increase of VO2 and LBF in the transition between rest and 40 W exercise, as evaluated by the mean response time (time to 63% of the increase), were slower in the supine [VO2 = 39.7 +/- 3.8 (SE) s, LBF = 27.6 +/- 3.9 s] than in the upright positions (VO2 = 29.3 +/- 3.0 s, LBF = 17.3 +/- 4.0 s; P < 0.05). These data support our hypothesis that slower increases in alveolar VO2 at the onset of exercise in the supine position are accompanied by a slower increase in LBF.

Adult↗

PubMed1992

[Comparison of nicardipine and nifedipine in treatment of Chinese senile hypertension placebo-control, double-blind, randomized and crossover study].

The purpose of this placebo-control, double-blind, randomized and crossover study is to evaluate the effect of nicardipine and nifedipine in Chinese senile hypertension. Among totally 37 senile hypertensive patients enrolled, 26 patients (25 males, 1 female) from 55 to 78 years of age (mean 65) who had finished one part or whole protocol were studied. Totally 18 cases after 6-week treatment of nicardipine (Perdipine) had blood pressure decrease significantly from 152.6 +/- 12.3/99.6 +/- 5.7 to 140.4 +/- 15.6/93.8 +/- 8.1 mmHg in supine position (P < 0.05), and from 153.3 +/- 12.7/98.7 +/- 7.7 to 139.2 +/- 13.5/90.7 +/- 7.6 mmHg in standing position (p < 0.05). Twenty-five cases after 6-week treatment of nifedipine (Towarat) also had significant blood pressure decrease from 155.0 +/- 13.3/99.5 +/- 8.4 to 144.2 +/- 10.0/95.3 +/- 9.2 mmHg in supine position (P < 0.05), and from 151.5 +/- 17.8/100.6 +/- 9.5 to 138.6 +/- 12.8/90.4 +/- 8.3 mmHg in standing position (p < 0.05). Heart rate was unchanged in both groups. Both nicardipine and nifedipine decreased blood pressure and increased heart rate significantly with the first dose of medication in the morning (P < 0.05). There was 6.5% and 9.0% decrease of systolic and diastolic blood pressure with nicardipine in supine position, 10.1% and 11.2% decrease with nifedipine in supine position, 6.3% and 7.2% decrease with nicardipine in standing position, and 9.7% and 10.6% decrease with nifedipine in standing position. The major side-effects were palpitation (20%) and lower abdominal distension (16%) with nicardipine; and nausea or vomiting (22%) and dizziness (15%) with nifedipine.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1990

Forefoot transcutaneous oxygen tension at different leg positions in patients with peripheral vascular disease.

Transcutaneous oxygen tension (TcPo2) was measured on the forefoot of 150 limbs of 128 patients with different stages of peripheral vascular disease (PVD) and on 36 limbs of 18 healthy subjects in the sitting and supine position. The diagnostic value of TcPo2 measurements was tested and compared with indirect toe pressure measurements. TcPo2 measured in the supine position gives the best diagnostic discrimination between healthy controls and patients with PVD and between patients with different degrees of PVD. The median TcPo2 in patients with PVD and rest pain (severe PVD), patients with PVD without rest pain (moderate PVD) and control subjects was 12 mmHg (range 0-61), 50 mmHg (range 0-86), and 60 mmHg (range 35-78), respectively. In the supine position, 95% of the patients with severe PVD had TcPo2 values below 40 mmHg, as opposed to 28% of the patients with moderate PVD and 8% of the control subjects. TcPo2 below 40 mmHg measured on the forefoot in the supine position suggests severe ischaemia. The diagnostic value of TcPo2 measurement is comparable with that of toe systolic pressure measurement. As a diagnostic and quantitative non-invasive method of evaluating patients suspected of PVD, TcPo2 measurement is ideal as it is easy to perform, and does not cause discomfort.

Adult↗