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Results for “Prone Position”

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At least 973 records · Page 54Linked to original sources

PubMed2005

Comparison of the belly board device method and the distended bladder method for reducing irradiated small bowel volumes in preoperative radiotherapy of rectal cancer patients.

PURPOSE: To determine the most effective method to reduce the irradiated small bowel volume when using a belly board device (BBD), a distended bladder (DB), or both in patients with rectal cancer undergoing preoperative pelvic radiotherapy (RT). METHODS AND MATERIALS: The study involved 20 patients with rectal cancer who were scheduled to receive preoperative pelvic RT. Patients were asked to empty their bladders and then drink 300 mL of water 2 h before the treatment planning computed tomographic (CT) scan. To identify the small bowel, an oral contrast solution (450 mL) was given 1 h before the CT scan. Two sets of transverse images were taken at 1-cm-thickness intervals with patients in the prone position with or without the BBD. After voiding, two additional sets of CT scans were obtained in prone positions with or without BBD. The conventional three-field treatment plan, composed of a 6-MV photon posterior-anterior field and 15-MV photon opposed lateral fields with wedges of 45 degrees, was made using a three-dimensional treatment planning system. The beam weights of the three-field plan were equal. The volume of irradiated small bowel was calculated for doses between 10% and 100% of the prescribed dose at 10% intervals. For each 10% dose increment, the effect of the BBD and the DB on the irradiated volume was analyzed using Kruskal-Wallis, Wilcoxon signed rank, and Wilcoxon rank-sum tests. RESULTS: All patients underwent four sets of CT scan under the conditions of four different methods as follows: Group I = empty bladder without the use of belly board; Group II = empty bladder with the use of belly board; Group III = distended bladder without the use of belly board; Group IV = distended bladder with the use of belly board. We found that the volume of irradiated small bowel decreased in the order of Group I, Group II, Group III, and Group IV at all dose levels (p < 0.05). Compared with Group I, the mean volume reduction rate (reduced volume) of irradiated small bowel in Group II varied between 14.5% and 65.4% (15.5-80.4 cm(3)), in Group III it varied between 48.1% and 82.0% (21.6-163.1 cm(3)), and in Group IV between 51.4% and 96.4% (28.6-167.1 cm(3)). CONCLUSIONS: The DB was more effective than the BBD for reducing the volume of irradiated small bowel in rectal cancer patients receiving pelvic RT. The combination of the BBD and DB showed an additive effect and was the most effective method for reducing the irradiated small bowel volume.

Adult↗

PubMedDate not supplied

Difference in quick phases induced by horizontal and vertical vestibular stimulations: role of the otolithic input.

Quick phases (QPs) induced by horizontal and vertical sinusoidal vestibular stimulations were studied in rabbits, cats, and humans. In all the animals, large and frequent horizontal QPs were observed following yaw stimulation in prone position. By contrast, QPs were almost absent during roll stimulation in rabbits, and they were small and oblique during pitch stimulation in cats and humans. As a result of these differences, the range of gaze displacement induced by vestibular stimulations was greater in the horizontal plane than in the vertical one. We also found that the trajectory of the QPs in rabbits was kept horizontal even when the yaw rotation was off vertical axis of +/- 45 degrees in the sagittal plane. Moreover, in the rabbit, the rare horizontal QPs induced by roll stimulation did not change their orientation at various pitch angles of roll stimulation axis. The QPs were also analyzed following roll stimulation of the rabbit in supine position. In this condition, in which the otolithic receptors were activated in the opposite way compared to prone position, large vertical QPs were elicited. We concluded that these results provide evidence that the otolithic signal plays a role in controlling occurrence and trajectory orientation of the QPs.

Adult↗

PubMed2001

Posterior approach for simultaneous access to the popliteal and anterior tibial arteries: applications to distal arterial bypass.

Arterial surgery to salvage the lower limb tends to make use of the great saphenous vein, harvested with the subject in the supine position. If this is not possible the small saphenous vein is used, harvested with the subject in the prone position, however this requires a perioperative modification of the procedure. A bypass between the popliteal and anterior tibial arteries can be performed using either a lateral or a medial and lateral approach with the patient supine. In the event of trophic disorders of the lateral compartment of the leg, these approaches are not applicable. In such cases we propose a single posterior approach. The single posterior approach was used on 10 lower limbs from 5 cadavers in the prone position. Approach to the lower part of the popliteal artery was undertaken posteriorly between the two heads of gastrocnemius. The small saphenous vein was entirely dissected 10 cm above the lateral malleolus, the Achilles tendon and short fibular vessels were retracted medially to expose the interossous fascia, which was divided over 10 cm. Medial rotation of the limb by 30 degrees exposed the anterior tibial artery. For 3 of the lower limbs an 8 cm fibular resection was necessary, whereas on the remaining 7 medial rotation enabled excellent exposure of the anterior tibial artery. The single posterior approach to the anterior tibial artery can be applied in cases requiring distal bypass, using the small saphenous vein, between the inferior part of the popliteal artery and the anterior tibial artery.

Anastomosis, Surgical↗

PubMedDate not supplied

Examination techniques for endosonography of the anal canal.

BACKGROUND: To determine whether patient position or sphincter contraction influences sphincter thickness or defect assessment. METHODS: Anal endosonography was performed on 35 consecutive patients (30 women, five men). Twenty-five were scanned in the left lateral and prone positions, and the internal sphincter thickness was measured. In 10 patients, the internal sphincter, longitudinal muscle, external sphincter, and length of any defect were measured at rest and during anal squeeze. RESULTS: There was no significant difference in internal sphincter thickness measured in the prone and left lateral positions (95% limits of agreement, -0.12 to 0.06). The thickness of the internal sphincter, longitudinal muscle, and external sphincter at rest did not change significantly during straining (95% limits of agreement, -0.44 to 0.3, -0.28 to 0.24, and 0.33 to 0.71, respectively). The squeeze maneuver did not influence defect appearance or length (95% limits of agreement, -2.845 to 2. 379). Greater symmetry of the anterior part of the external sphincter and improved visualization of perineum was achieved in the prone position. CONCLUSION: Examination in the prone position is preferred. Squeeze maneuvers are of no diagnostic benefit.

Adult↗

PubMedDate not supplied

Changes in sleep position during infancy: a prospective longitudinal assessment.

CONTEXT: Prone sleeping by infants has been associated with an increased risk of sudden infant death syndrome. OBJECTIVE: To document the prevalence of and identify risk factors for prone sleeping during the first 6 months of life. DESIGN: Prospective cohort study. SETTING: Eastern Massachusetts and northwest Ohio. STUDY PARTICIPANTS: A total of 7796 mothers of infants weighing 2500 g or more at birth. MAIN OUTCOME MEASURES: Maternal and infant characteristics related to prone sleeping at 1 month and 3 months of age. RESULTS: Between 1 month and 3 months of age, prone sleeping increased from 18% to 29%. At 1 month, prone sleeping was associated with the following maternal characteristics: non-Hispanic black or Hispanic race/ethnicity, younger age, less education, and higher parity. At 3 months, switching from nonprone to prone position was associated with mother's race/ethnicity of non-Hispanic black (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2-2.3) or Hispanic (OR, 1.5; 95% CI, 1.1-2.2); younger maternal age (compared with mothers >34 years: 18-24 years, OR, 1.6; 95% CI, 1.2-2.2; <18 years, OR, 2.2; 95% CI, 1.2-4.3); increasing parity (compared with 1 child: 2 children, OR, 1.5; 95% CI, 1.2-1.8; > or =3 children, OR, 1.7; 95% CI, 1.4-2.2); and infant sex (male sex, OR, 1.4; 95% CI, 1.2-1.7). CONCLUSIONS: If infant sleeping practices in the study communities are representative of practices throughout the United States, a substantial number of infants who slept nonprone at 1 month sleep prone at 3 months.

Adult↗

PubMed2001

Bladder tumor detection at virtual cystoscopy.

PURPOSE: To investigate the utility of computed tomographic (CT) virtual cystoscopy in the detection of bladder tumors. MATERIALS AND METHODS: Twenty-six patients suspected or known to have bladder neoplasms underwent CT virtual and conventional cystoscopy. The bladder was insufflated with carbon dioxide through a Foley catheter. Helical CT of the bladder was then performed. The data were downloaded to a workstation for interactive intraluminal navigation. Two radiologists blinded to the results of conventional cystoscopy independently reviewed the transverse and virtual images, with consensus readings for cases with discrepant results. RESULTS: Thirty-six (90%) of 40 bladder lesions proved at conventional cystoscopy were detected with a combination of transverse and virtual images. Four (10%) of 40 bladder lesions, all smaller than 5 mm, were undetected. Transverse and virtual images were complementary, since six polypoid lesions smaller than 5 mm depicted on the virtual images were not seen on the transverse images. In contrast, areas of wall thickening were more readily appreciated on transverse images. CT with patients in both supine and prone positions was necessary, since seven (19%) and five (14%) of 36 lesions were seen only on supine and prone images, respectively. CONCLUSION: CT virtual cystoscopy is a promising technique for use in bladder tumor detection of lesions larger than 5 mm. Optimal evaluation requires adequate bladder distention with the patient in both supine and prone positions and interpretation of both transverse and virtual images.

Adult↗

PubMed2003

Optokinetic stimulation in microgravity: torsional eye movements and subjective visual vertical.

INTRODUCTION: Microgravity provides unique sensory inputs to the vestibular and oculomotor systems. We sought to determine the effects of long-term spaceflight on sensing of spatial orientation. METHODS: Two cosmonauts participated in experiments on human vestibulo-visual interactions during a long-term mission (178 d) in the MIR station in 1995. During circular optokinetic stimulation (OKS) the tonic torsional eye position (torsional beating field, TBF) and the subjective visual vertical (SVV) were recorded on several days of the space mission as well as pre- and post-flight. A reference data set was obtained from healthy subjects on Earth, in whom the TBF was measured in upright and in prone positions. RESULTS: Neither cosmonaut showed changes in the SVV or the TBF values during the first days in microgravity. On flight day 149, cosmonaut A showed an increase of both values, which continued to rise by 4- and 10-fold until the end of the flight (TBF: 8.1 degrees; SVV: 216.8 degrees). This cosmonaut reported that the increase was accompanied by a loss of spatial orientation. In contrast, cosmonaut B's values remained at pre-flight levels (TBF: 1.6 degrees; SVV: 4.4 degrees). Post-flight values of the TBF did not significantly differ from pre-flight values for either cosmonaut. Subjects showed an increase of the TBF by more than a factor of 2 in prone position (range -7.7 degrees to +10.2 degrees) compared with upright position (range -3.7 degrees to +3.4 degrees). CONCLUSIONS: Pre-flight, post-flight and during the first part of the flight, both cosmonauts exhibited values similar to those of normal subjects in an upright position. The increased TBF values of cosmonaut A from flight day 110 on were within the range of the normal subjects in prone (face-down) position, when the gravity vector cannot be used to stabilize the TBF against the rotating stimulus (the axis of rotation is parallel to the gravity vector). The increasing deviations of cosmonaut A's SVV values in-flight suggest the presence of an internal body reference system, which weakened throughout the flight and thus lost its stabilizing effect.

Adaptation, Physiological↗

PubMed1992

[Continuously alternating prone and supine positioning in acute lung failure].

Acute respiratory failure is still one the main problems in surgical intensive care. Unknown pathophysiological mechanisms permit only symptomatic therapy. Today ventilatory strategies by using PEEP und IRV are established to improve gas exchange and FRC by recruiting collapsed alveoli, decreasing intrapulmonary shunting and returning V/Q matching to normal. Furthermore different studies have shown the effects of supine and lateral decubitus posture in patients with acute respiratory failure. There are only rare reports on using the prone position, which doesn't require two-lung ventilation in difference to lateral position. We have studied 16 patients with acute respiratory failure by using continuous changing between prone and supine position under mechanical ventilation. All were male, aged 41.3 years in the middle and showed an average "Injury Severity Score" of 30 (13-50). 15 were trauma patients with blunt chest trauma in 11 cases. We have used prone position on threatening or manifest ARDS. In all patients we observed an increment of PaO2 during prone position on to 48 mmHg so that FiO2 could be reduced on an average of 0.2 within the first 48 h since changing patient's position. Posture changing depends on blood gas analysis, specifically on decreasing PaO2 after previous increment. Patients remained in prone and supine position at a mean of 6.3 (4.5-20) h and posture changing was proceeded over a period of 15.4 (7-32) days. No problems recording to blood pressure or mechanical ventilation appeared during prone position. 11 of 16 patients survived (68.8%), 5 died of cardiac (2) and multi organic failure (3) in connection with sepsis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2003

Effects of body position and time after feeding on gastric residuals in LBW infants.

PURPOSE: To examine the effects of body position and time after feeding on gastric residuals in low birth weight infants(LBW). METHODS: A repeated measures design was conducted. Twenty LBW infants being fed via indwelling nasogastric tubes were randomly assigned to one of 5 different position orderings. In each position, gastric residuals were measured at 30, 60, 90, 120, 150, and 180 minutes after feeding. RESULTS: In comparisons of gastric residuals with position and time, the main effects of position and time were statistically significant (F = 5.038, p = 0.001; F = 429.763, p < 0.001, respectively), but the interaction between position and time was found not to be significant. In pairwise comparisons, the gastric residuals were more reduced in the right anterior oblique and prone positions compared with the left lateral position (p < 0.05) and the differences across time periods were significant (p < 0.001). CONCLUSIONS: The body position after feeding has a significant affect on gastric residuals over time in LBW infants. The right anterior oblique or prone position is recommended rather than left lateral position after feeding. Knowledge of the proper position and the pattern of gastric emptying over time after feeding may lead to the development of evidence-based nursing care.

Clinical Trial↗

PubMed1990

Positional variation in the ultrasound appearance of the renal pelvis.

A retrospective analysis of 100 renal sonograms (200 kidneys) was performed to determine how the appearance of the renal pelvis varies in the supine und prone projections. The renal pelvis had no distention in either projection in 100 kidneys. The prone position produced dilatation of a previously normal pelvis with 60 kidneys or increasing dilatation in 6 kidneys. Other changes in the renal pelvis were also identified. We believe this positional change is due to shifting of urine from the normal sized calyces (when supine) to the distensible renal pelvis (when prone). It is possible that elevation of bladder pressure in the prone position may also impede urine flow and produce the observed changes. However, it is important to recognize that the slight dilatation of the renal pelvis does not indicate pathology.

Adolescent↗

PubMed1994

Infant sleeping position and inspiratory pressures in the upper airways and oesophagus.

Inspiratory pressures were measured at three levels in the upper airways and in the oesophagus in different sleeping positions. Thirty one consecutive healthy infants were examined at the age of 1-3 days, 25 of these at 6 weeks, and 23 at 12 weeks. Oxygen saturation, an electrocardiogram, transthoracic impedance, nasal airflow, and inspiratory pressure in the epipharynx, oropharynx, hypopharynx, and in the intrathoracic part of the oesophagus were measured. There was no significant change in the heart rate, oxygen saturation, or respiratory rate in the four sleeping positions. The peak negative inspiratory pressures obtained from the oesophagus (PES) were significantly lower in the supine head straight compared with the supine head turned and the prone positions. At 6 weeks, the only significant difference was between the supine head straight and the prone positions. The PES is less negative at all ages in the supine head straight than in all other sleeping positions, but this does not reach statistical significance.

Age Factors↗

PubMed1978

Complications with use of the Stryker frame.

Roentgenograms were made of two patients with acute dislocations of the cervical spine who were undergoing treatment on Stryker frames with cervical traction. Losses of reduction were evident when the patients were turned from the supine to the prone position. The pulmonary vital capacity of patients with complete traumatic quadriplegia consistently decreased when they were turned to the prone position. Prolonged supine positioning of patients on the Stryker frame also caused occipital decubitus ulcers.

Humans↗

PubMed1991

Body position changes redistribute lung computed-tomographic density in patients with acute respiratory failure.

Ten patients with parenchymal acute respiratory failure (ARF) underwent computed tomography (CT) scans while in the supine and prone positions. At equal levels of positive end-expiratory pressure, the authors measured the changes of CT density in dorsal and ventral basilar lung regions induced by the change of position as well as alterations of gas exchange. The level of venous admixture did not change with body position. The CT scan image of each lung was fractionated into ten levels from dorsal to ventral, each constituting 10% of the lung height. After measuring each lung fraction, the volume, the average CT number, its frequency distribution, and the expected normal value, we computed the lung tissue mass, the excess tissue mass, and the fraction of normally inflated tissue (excess tissue mass = amount of "tissue," which includes edema, cells, and blood in excess of the expected normal value). We also estimated the superimposed hydrostatic pressure on each lung region. We found that the excess lung tissue mass is independent of position. However, in patients in the supine position, lung CT density increased and regional inflation decreased from ventral to dorsal, suggesting progressive deflation of gas-containing alveoli along the gravity gradient. A similar ventral-dorsal deflation pattern occurred within 10 min in patients in the prone position. We conclude that the lung in patients with ARF behaves like an elastic body with a diffusely increased mass; dependent lung regions are compressed by the pressure of overlying structures.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMed1973

The effects of heating and cooling the spinal cord and hypothalamus on thermoregulatory behaviour in the pig.

1. The effects of warming and cooling the spinal cord and hypothalamus on operant thermoregulatory behaviour and posture have been studied in the pig at neutral and cold ambient temperatures.2. Cooling the spinal cord increased and warming decreased the rate of obtaining thermal reinforcement. The response to cooling began with the onset of the stimulus and persisted for up to 5 min followed by a diminution in rate during the remaining 15 min of cooling. The peak of this ;on' response was greater the lower the ambient temperature. The response to heating was a small reduction in rate of reinforcement.3. The ;on' response to cooling the spinal cord was related to changes in temperature of only the cervical region of the cord.4. Cooling the hypothalamus led to an increase in the rate of obtaining heat and this increase was sustained during the 20 min of central cooling. Termination of cooling was followed by a marked depression in rate. Heating the hypothalamus had only a weak inhibitory effect on rate of reinforcement.5. While working for external heat during periods when thermodes over the spine and in the hypothalamus were not being cooled, pigs lay in ;cold defensive' prone positions 25% of the time and lay on their sides 75% of the time. During cooling of the spinal cord the time spent in the prone position was 95% at 5 and 15 degrees C ambients and 71% at a 25 degrees C ambient. During cooling of the hypothalamus the prone posture was adopted 50% of the time.6. When the temperatures of the spinal cord and of the hypothalamus were changed in opposite directions, the operant response was determined by the temperature of the hypothalamus while the postural response was most frequently determined by the temperature of the spinal cord.

Animals↗

PubMed1991

Effect of lung inflation on regional lung expansion in supine and prone rabbits.

At functional residual capacity, lung expansion is more uniform in the prone position than in the supine position. We examined the effect of positive airway pressure (Paw) on this position-dependent difference in lung expansion. In supine and prone rabbits postmortem, we measured alveolar size through dependent and nondependent pleural windows via videomicroscopy at Paw of 0 (functional residual capacity), 7, and 15 cmH2O. After the chest was opened, alveolar size was measured in the isolated lung at several transpulmonary pressures (Ptp) on lung deflation. Alveolar mean linear intercept (Lm) was measured from the video images taken in situ. This was compared with those measured in the isolated lung to determine Ptp in situ. In the supine position, the vertical Ptp gradient increased from 0.52 cmH2O/cm at 0 cmH2O Paw to 0.90 cmH2O/cm at 15 cmH2O Paw, while the vertical gradient in Lm decreased from 2.17 to 0.80 microns/cm. In the prone position, the vertical Ptp gradient increased from 0.06 cmH2O/cm at 0 cmH2O Paw to 0.35 cmH2O/cm at 15 cmH2O Paw, but there was no change in the vertical Lm gradient. In anesthetized paralyzed rabbits in supine and prone positions, we measured pleural liquid pressure directly at 0, 7, and 15 cmH2O Paw with dependent and nondependent rib capsules. Vertical Ptp gradients measured with rib capsules were similar to those estimated from the alveolar size measurements. Lung inflation during mechanical ventilation may reduce the vertical nonuniformities in lung expansion observed in the supine position, thereby improving gas exchange and the distribution of ventilation.

Animals↗

PubMedDate not supplied

Barriers to following the back-to-sleep recommendations: insights from focus groups with inner-city caregivers.

BACKGROUND: African American infants have a higher incidence of SIDS and increased risk of being placed in the prone position for sleep. OBJECTIVE: To determine new barriers and more information about previously identified barriers that interfere with adherence to the Back-to-Sleep recommendations among inner-city, primarily African Americans. DESIGN/METHODS: We conducted 9 focus groups with caregivers of infants and young children from women, infants, and children centers and clinics in New Haven and Boston. Themes were identified using standard qualitative techniques. RESULTS: Forty-nine caregivers participated, of whom 86% were African American, 6% were Hispanic, 4% were white, and 4% were other. Four themes were identified: 1) SAFETY: Participants chose the position for their infants based on which position they believed to be the safest. Some participants did not choose to put their infants in the supine position for sleep because they feared their infants would choke; 2) Advice: Participants relied on the advice of more experienced female family members. Health care providers were not uniformly a trusted source of advice; 3) Comfort: Participants made choices about their infants sleeping positions based on their perceptions of whether the infants appeared comfortable. Participants thought that their infants appeared more comfortable in the prone position; 4) Knowledge: Some participants had either limited or erroneous knowledge about the Back-to-Sleep recommendations. CONCLUSIONS: We identified multiple barriers to adherence to recommendations regarding infant sleep position. Data obtained from these focus groups could be used to design educational interventions aimed at improving communication about and adherence to the Back-to-Sleep recommendations.

Adult↗

PubMed2004

The role of body position and gravity in the symptoms and treatment of various medical diseases.

Postural medicine studies the effects of gravity on human body functions and the ability to influence various diseases by changing the body's position. Orthostasis requires numerous cardiovascular and neurohumoral adaptations to prevent hypotension and a resulting decrease in cerebral perfusion. Sitting upright or in a semi-sitting position reduces venous return in patients with heart failure, intracranial pressure in patients with intracranial hypertension, intraocular pressure in glaucoma patients and may decrease gastro-oesophageal reflux. A left recumbent posture also decreases reflux. A right lateral position results in a lower sympathetic tone than lying on the left side and is beneficial in patients with heart failure or after an infarction without bradycardia. A 40 to 70% decreased prevalence of the sudden infant death syndrome has been observed since the recommendation to avoid laying infants to sleep in a prone position. Sleeping in a supine posture increases the severity of sleep apnoea compared to a lateral position. In patients with acute respiratory distress syndrome, a prone position can rapidly improve blood oxygenation. Idiopathic oedema, orthostatic proteinuria, intradiscal pressure and venous circulation in legs are improved in the decubitus position, whereas arterial flow is reduced. Health risks due to microgravity and prolonged bed rest, such as osteoporosis, venous thrombosis or pressure sores, are discussed.

Cardiovascular Diseases↗

PubMed1987

[Application of the RI-counting method in CSF rhinorrhea].

Some diagnostic procedures for CSF rhinorrhea have been reported, but they can not always identify and localize CSF leakage. This method, using intranasal cotton pledgets after the intrathecal injection of radioisotope (111In-DTPA) is thought to be reliable, informative and innocuous for localizing the sites of CSF leakage. This technique was named RI-counting method, and applied in two cases that were difficult to diagnose especially with positional-loading. The patients were first in the supine position, then in the sitting position, after the intrathecal injection of radioisotope and the intranasal insertion of cotton pledgets. After exchanging these pledgets, the patients were set in the prone position. After measuring the radioactivity of these pledgets and of 1 ml of blood, the ratios of the radioactivity of the pledgets to that of the blood were calculated. In case 1 the ratios of the left sphenoethmoid recess and the left middle meatus were significantly higher when the patient took the prone position, but in the supine or sitting position the ratios were in the normal range. In case 2 the ratio of right olfactory cleft was significantly higher in the sitting position or neck flexion. Both cases were operated and demonstrated that the location of the CSF leakage was presumable by using RI-counting method, regarding the anatomical relationship between the intranasal sites of pledgets and the opening of the paranasal sinuses. Positional-loading seemed to be essential. We obtained 72 pledgets of patients without CSF rhinorrhea, and the ratios of radioactivity of these pledgets had a mean value (M) of 0.156 and a standard deviation (SD) of 0.107.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebrospinal Fluid Rhinorrhea↗