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Results for “Prone Position”

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At least 1,189 records · Page 66Linked to original sources

PubMed2001

Attenuation of somatosensory evoked potentials during positioning in a patient undergoing suboccipital craniectomy for Chiari I malformation with syringomyelia.

Intraoperative electrophysiologic monitoring can diminish the risk of neurologic injury by enabling the detection of injury at a time when it can be reversed or minimized. This report describes a 14-year-old girl with a Chiari's malformation type I and syringomyelia who underwent a suboccipital decompression and dural patch grafting with concurrent somatosensory evoked potentials. When the patient was turned into the prone position and the neck was flexed, the left-sided somatosensory evoked potential deteriorated. After the patient's neck was repositioned, the left median nerve potential improved but did not return to baseline. Postoperatively, the patient had decreased proprioception of her left arm, which completely resolved at 2-week follow-up. This single case report does not establish the need for routine somatosensory evoked potential monitoring. Nevertheless, deterioration of the potential in this case led directly to a change in the surgical positioning, which may have significantly reduced the chances of a permanent neurologic injury.

Adolescent↗

PubMed1996

Patient evaluation of prone carts used in spinal cord injury.

Prone carts are used for mobility by individuals with spinal cord injury who cannot use a wheelchair due to the risk of aggravating existing pressure ulcers. A prone cart is a flat/horizontal cart with a fixed height, propelled by the user while laying in a prone position. Patients reported that prolonged use of a prone cart resulted in chronic neck, shoulder and back pain. Additionally the existing prone carts lack user accessible angle adjustability, chest support area, as well as a storage, eating or working area. An interdisciplinary research team collaborated to address these concerns. Three prone carts were evaluated: E&J, Gendron, and a newly developed prototype, MIAD/PVA. Questionnaires were administered to caregivers and patients regarding usage and effectiveness of the prone carts as well as the features of an ideal cart. This data led to the design and refinement of a prototype prone cart which was tested on 20 patients and 19 caregivers at the SCI Centers of the Milwaukee and Tampa VAMC's from 1994-1995. The new prone cart enables the user to lie at an angle rather than laying flat. This position has been found to relieve back and neck pressure. With an hydraulic system, the the user can adjust both the front and rear angles of the cart to achieve desired comfort. In addition, a front deck provides an eating and working area. This study resulted in research-based information and criteria for the design of new prone carts. Findings of this pilot study will be incorporated in a development merit review proposal to the VA Rehabilitation Research & Development service for the design of a new manual and motorized prone cart. The researchers are collaborating with Ortho-Kinetics Inc. to promote ease in manufacturing.

Activities of Daily Living↗

PubMed2006

[Thoracic outlet syndrome: an unusual postoperative complication].

UNLABELLED: Introduction. Neurogenic Thoracic Outlet Syndrome (NTOS) is a chronic lower trunk brachial plexus entrapment caused by a cervical rib or a fibrous band. True NTOS is rare and progresses usually slowly. Case report. A 12-year-old girl complained of numbness and weakness of the right upper limb immediately after an orthopedic surgical procedure for scoliosis. Neurological and neurophysiological features were both consistent with a neurogenic thoracic outlet syndrome (NTOS). CONCLUSION: This observation illustrates the risk of NTOS after certain surgical procedures, especially when a prolonged prone position with abducted shoulders is required.

Adult↗

PubMedDate not supplied

Posterior subpleural nodules in patients with underlying malignancies: value of prone computed tomography.

PURPOSE: The aim of this study was to investigate the value of prone computed tomography (CT) in patients with underlying malignancies and posterior subpleural nodule(s) on a supine CT scan. METHOD: A prospective study was performed on 26 patients who had an underlying malignancy and posterior subpleural nodule(s) on a chest CT scan. Helical CT scanning with a 3-mm collimation was done in both the supine and prone positions at an interval of 1-50 days (mean, 9 days). The size, shape, and location of the nodule(s) as well as the associated dependent ground-glass opacity on an initial CT scan and the change in the nodule(s) on follow-up supine and prone CT scans were analyzed. RESULTS: The nodules were single in 10 patients and multiple in 16. In 25 of 26 patients, the nodules were located in the lower lobes. Most had an oval shape, forming an obtuse angle with the adjacent pleura. The size ranged from 5 mm x 2 mm to 12 mm x 4 mm (mean, 7 mm x 3 mm). An associated dependent ground-glass opacity was found in 11 patients. At the follow-up examinations, the posterior subpleural nodules had disappeared in 10 patients on the supine scan and in 21 patients on the prone scan. The persistent nodules on the prone CT scan were granulomas in 2 patients and metastases in 3 patients. CONCLUSION: Posterior subpleural nodules may be reversible, and the nodular atelectasis can be differentiated from true nodules without using invasive procedures by employing prone CT scanning.

Adult↗

PubMed1994

The Glenn Face Down Pillow: an aid to performance of prone radiologic procedures.

The ease of performing computed tomography (CT)-guided radiologic procedures with the patient in the prone position can be compromised by patient discomfort. This is especially true during transthoracic needle aspiration biopsy when sedation or analgesia may interfere with the patient's ability to cooperate. The Glenn Face Down Pillow, a foam cushion with air vents that allows unimpeded respiration with the patient entirely prone, was tested in 34 such biopsies over a 1-year period. Patient compliance was better than with conventional cushions and padding, and procedural problems related to motion from cramping and stiffness were reduced.

Biopsy, Needle↗

PubMed2003

A randomized trial evaluating rigid immobilization for pelvic irradiation.

BACKGROUND: Accuracy and reproducibility of the patient's position is fundamental to the successful delivery of radiation therapy. In recent years, a number of pelvic immobilization techniques have been developed. Few have been evaluated in randomized trials, and many of these studies have produced contradictory and inconclusive results. PURPOSE: To assess whether the use of rigid immobilization devices improve the accuracy and reproducibility of prostate irradiation to a clinically useful degree. METHODS AND MATERIALS: A total of 100 patients receiving radical irradiation for either prostate or bladder cancer were randomized to be treated with or without the use of rigid immobilization (RI) devices. Of these, 96 patients were suitable for analysis. The control group consisted of the patients being simulated and treated in the prone position with no immobilization devices. Patients randomized to the immobilized arm were simulated and treated prone using a customized Uvex cast of the pelvis as well as ankle- and shoulder-stabilizing devices. Weekly orthogonal port films (PFs) were obtained for each patient. Using previously specified bone landmarks, we measured variations in the isocenter position on each PF compared with the simulation film. The assessors were unaware of the treatment assignment. Patient comfort, skin toxicity, and treatment times were recorded. RESULTS: The average simulation-to-treatment deviation of the isocenter position was 8.5 mm in the control group and 6.2 mm in the immobilization group (p < 0.001). In the control arm, 30.9% of port films had isocenter deviations >10 mm compared with 10.6% in the immobilized arm (p = 0.001). For the control group, average deviations in the anteroposterior, right-left, and superior-inferior directions were 5.2 mm, 3.2 mm, and 4.3 mm, respectively, compared with 2.9 mm, 2.1 mm, and 3.9 mm for the immobilized group (p = <0.001, p < 0.001, p = 0.55). The RTOG skin reaction was greater with in patients with a cast (28% having Grade 2 toxicity vs. 10% in the control arm), although this was not statistically significant (p = 0.68). Patients in both groups found the treatment position comfortable: 90% in the immobilized group and 87% in the control group scored the treatment position either reasonably or very comfortable. Treatment times were very similar between the two groups: the average treatment time was 15.5 min in the control group vs. 16.1 min in the immobilized group (p = 0.82). CONCLUSIONS: The use of rigid immobilization improves the accuracy of treatment delivery for the prone position, especially in the anteroposterior direction. Of clinical importance, the number of major deviations >10 mm (that is, that would result in a geographic miss) was reduced from 31% to 11%.

Aged↗

PubMed2003

Craniospinal treatment with the patient supine.

Radiotherapy of the craniospinal axis in young children is frequently complicated by the need for access to the patient's airway for sedation and anesthesia delivery or by frequent, unanticipated movement. Positioning the patient supine, instead of in the conventional prone position, allows the use of immobilization facemasks with body molds and more positive patient fixation, and improved airway access. The procedure for establishing the various fields differs from the prone approach. In this paper, we describe the methodology to achieve successful supine positioning.

Age Factors↗

PubMed1993

A sleep position-dependent mechanism for infant death on sheepskins.

OBJECTIVE: To determine whether rebreathing of expired air is a plausible lethal mechanism of sudden death in infants sleeping face down on sheepskins. DESIGN: Case reports of infants who died on sheepskins combined with a controlled study of effects of their respiratory microenvironment at death. SETTING: Research laboratory. MATERIALS: Rabbits used experimentally to assist in simulation of an infant's respiratory microenvironment. Rabbits breathed into sheepskin through the airway of an infant mannequin. INTERVENTION: None. MEASUREMENTS/MAIN RESULTS: Rebreathing of expired air was documented by carbon dioxide analysis of airway gas. Arterial blood gas analysis showed hypoxemia, hypercarbia, and acidosis in all experimental rabbits but not in controls. Rebreathing expired air was lethal for three of four experimental rabbits. CONCLUSIONS: Infants sleeping prone on a sheepskin, with their faces straight down, experience potentially lethal rebreathing of expired air. Avoidance of the prone position would markedly reduce the risk of rebreathing expired air. The pronounced decrease in sudden infant death syndrome in southern New Zealand that followed a campaign to eliminate prone sleeping may have been attributable to reduced fatal rebreathing, as deaths of infants sleeping face down on sheepskins were common before the campaign.

Animals↗

PubMed1994

Protein accumulation in cerebrospinal fluid during -90 degrees head-down tilt in rabbit.

Plasma proteins are only somewhat larger than the intercellular spaces of the cerebral microvessels that constitute the blood-brain barrier or of the choroid plexus villi that elaborate cerebrospinal fluid (CSF). We hypothesized that the integrity of these barriers in anesthetized rabbits might be compromised during head-down tilt (HDT). Plasma protein and osmolality, hematocrit, and CSF protein concentration were compared in rabbits exposed to 1 h of HDT (n = 20) and prone rabbits (n = 10). In addition, the concentration of trypan blue dye, injected intravenously at the end of HDT or the prone position, was measured in brain homogenate. Finally, arterial blood pressure was measured via a catheterized carotid artery. HDT disrupted the barrier between blood and CSF, as indicated by a significantly (P < 0.01) greater brain trypan blue concentration in the HDT rabbits [172.2 +/- 14.4 (SD) micrograms/g dry wt] than in the prone rabbits (29.8 +/- 4.4 micrograms/g dry wt). Moreover CSF protein 5 min after HDT onset was significantly increased compared with control in HDT rabbits (54.6 +/- 1.9 vs. 81.4 +/- 5.2 mg/dl; n = 8) but not in prone rabbits (55.6 +/- 2.7 vs. 57.2 +/- 5.0 mg/dl; n = 6). Changes in the plasma protein-to-hematocrit ratio in the HDT animals, but not in the prone animals, were also compatible with a loss of fluid from the vascular compartment.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

Optimization of techniques in screening CT of the sinuses.

The number of screening examinations of the sinuses performed with CT has markedly increased owing to the widespread and increasing use of endoscopic sinonasal surgery. We reviewed scans from 500 patients who had screening CT examinations of the sinuses for preendoscopic evaluation of inflammatory sinonasal disease to better define an optimal imaging protocol. Three aspects of direct coronal imaging of the paranasal sinuses were investigated: (1) preparation of the patient prior to the examination; (2) technical factors of the CT study, including positioning of the patient, optimal coronal angle, slice thickness, and CT exposure factors; and (3) data display. Our experience indicates that pretreatment of the patient with maximal medical therapy enables the best preendoscopic definition of anatomy, disease pattern, and nonreversible disease component for the treating surgeon. CT technical factors are optimized with scanning in the prone position with thin (3-mm) sections obtained through the anterior paranasal sinuses. This allows optimal visualization of the ostiomeatal unit. The remaining posterior portions of the sinuses are adequately imaged with thicker slices (5 mm). The coronal scan angle used is less critical. Exposure factors (mAs) can be reduced dramatically without image compromise. Data display is optimized when the bone algorithm is used to acquire the data and with image display at intermediate window center and width level. Use of the techniques outlined in this article results in a cost-effective yet diagnostic scan of the sinuses with decreased radiation exposure to the patient.

Cost-Benefit Analysis↗

PubMedDate not supplied

Are nurses acting as role models for the prevention of SIDS.

PURPOSE: To examine nurses' knowledge, attitude, and practice in positioning healthy newborns for sleep in the hospital setting. DESIGN AND METHODS: A cross-sectional descriptive design was used to survey a convenience sample of practicing maternal child nurses in 58 Missouri hospitals. A 24-item investigator designed questionnaire was developed with input from SIDS Resources in Missouri. RESULTS: A total of 528 surveys were analyzed. These nurses reported no longer placing infants in the prone position for sleep, but almost 75% of those answering the survey used either the side-lying position or a mixture of side and back positioning, even though 96% of the nurses said they were aware of the AAP Guidelines recommending "back to sleep." Forty-five percent of the nurses thought the infant would be at risk for aspiration if only placed on his/her back. Only 53% of the nurses knew their hospital's policy about newborn positioning; 80% of those who knew about the policy said it included the lateral position as being acceptable practice. CLINICAL IMPLICATIONS: Nurses are the role models for new parents regarding newborn sleep position, and are in a unique position to influence parents' decisions about how to place their infants for sleep at home. Because nurses continue to worry about aspiration when newborns are placed on their backs, it is clear that more education is needed for hospital nurses about newborn sleep position and hospital policies, as well as AAP Guidelines.

Adult↗

PubMed1995

Absolute 99Tcm-DMSA renal uptake in children: a study of 321 kidneys.

Absolute 99Tcm-dimercaptosuccinic acid (DMSA) uptake was measured in 160 children ranging in age from 3 months to 15 years. In total, 108 pairs of kidneys were normal and the mean uptake for the left and right kidneys was 24.0 and 23.4%, respectively. The mean summed uptake for the left and right kidneys was 47.3%. A method of calculation based on the geometric mean of the anterior and posterior views was used to allow for radiation attenuation. DMSA uptake did not vary significantly with the age of the child. The value of the method in the assessment of abnormal kidneys is presented. The effect of using a supine or prone position for the anterior view was also investigated.

Adolescent↗

PubMed2004

[Inhaled nitric oxide for the treatment of ARDS].

Acute respiratory distress syndrome (ARDS) is characterized by perfusion in favor of non-ventilated areas of the lungs as the main cause of intrapulmonary right-to-left shunt and hypoxemia. Therapeutic interventions to selectively influence pulmonary perfusion in ARDS became possible with the introduction of inhaled nitric oxide (iNO), which provided a way not only to reduce pulmonary hypertension, but also to acutely improve ventilation-perfusion mismatch, and thus to treat severe hypoxemia. Clinical studies in ARDS demonstrated that the combination of iNO with other interventions, such as positive end-expiratory pressure (PEEP) and prone positioning, yielded beneficial and additive effects on arterial oxygenation. Although randomized controlled trials of this concept have up to now failed to show an improved outcome, iNO is a valuable option for the treatment of severe refractory hypoxemia in ARDS patients.

Administration, Inhalation↗

PubMed1990

Upbeat nystagmus influenced by posture: report of two cases.

Two cases of vertical gaze nystagmus, which were influenced by posture are reported. In both cases, upbeat nystagmus (UBN) on forward gaze in upright and supine positions changed to downbeat nystagmus (DBN) in prone position. Convergence had no influence on the vertical nystagmus. A CT scan revealed an atrophy of the anterior vermis of the cerebellum in the first case. The UBN of the second case was suspected to be associated with lesions in the brachium conjunctivum. The authors concluded that both UBN and DBN were not completely separate, but they could coexist in cases with certain lesions in the posterior cranial fossa.

Adult↗

PubMed1996

Effectiveness of extracorporeal shockwave lithotripsy in the management of stone-bearing horseshoe kidneys.

Although extracorporeal shockwave lithotripsy (SWL) has dramatically changed the management of urinary tract stone disease, the anatomic abnormalities of horseshoe kidneys cause some difficulties in the use of SWL in this disorder. In this study, 18 patients with stone-bearing horseshoe kidneys were investigated retrospectively in order to determine the effectiveness of SWL. Patients received an average of 11,437 + or - 3062 shocks at an average of 18.8 kV with the Siemens Lithostar. Ten patients were treated in the supine position; stones could be localized in the prone position in eight. Catheterization with a double-J stent was the only adjunctive procedure; it was used in four patients prior to SWL. Adequate stone fragmentation (smaller than 5 mm) was achieved in 14 of the 18 patients (78%). Although 5 of them (28%) became stone free within 6 months after the treatment, residual fragments persisted in 9 patients (50%) during the mean follow-up of 55 months. Stones of 4 patients (22%) were not fragmented adequately. We concluded that although adequate fragmentation can be achieved in stone-bearing horseshoe kidneys, the anatomic abnormalities prevent fragment passage in a substantial number of patients.

Adult↗

PubMed2003

Avoiding the sequela associated with deformational plagiocephaly.

Over the last decade, infants with deformities in the craniofacial skeleton have been seen at our craniofacial center, and similar observations have been noted in infants seen for evaluation and management after birth, where there are not any evident pathological findings such as craniosynostosis or another known genetic disorder. The known condition of deformational plagiocephaly has been related to a sequela of the infants being placed on their back for sleep. The change in the position of the infants to sleep on their back was altered from the traditional position, where infants were placed in the prone position for many decades in the past in the Western world. A special study was initiated to compile meaningful data to help those in the field pursue their treatment of affected children in a systematic and comprehensive manner. Avoidance of unnecessary surgery was essential in those children unless the deformational condition persisted and was not resolvable by nonsurgical means and change in the cultural habitat.

Adolescent↗

PubMed1998

[Evaluation of optokinetic afternystagmus (OKAN) induced by cyclo-rotatory optokinetic stimulation (C-OKst)].

It is not known whether the optokinetic afternystagmus (OKAN) can be evoked by cyclo-rotatory optokinetic stimulation (C-OKst) or not. Accordingly, this study was designed to investigate the problem by using a rotating white dome with random dots. Optokinetic nystagmus (OKN) and OKAN in standing upright, supine, and prone positions were recorded and analyzed with an infrared-ray CCD camera and computed picture analyzer. During stimulation, rotatory OKN showed clearly, but there was no slow-rise component. The OKAN was continuously recorded and analyzed. The component of this OKAN was found only in the head-horizontal direction (yaw axis) in all different head positions. It appeared fairly constantly in the prone posture. The velocity storage mechanism (VSM) had to be charged by the C-OKst, but the OKAN (1st phase) appeared only in the yaw axis, not in the roll axis.

Adult↗

PubMed2002

[Medial approaches to the distal humerus for fracture fixation].

PURPOSE OF THE STUDY: We report our experience with the medial and medioposterior approaches to the humeral diaphysis for plate fixation of the proximal humerus. MATERIAL AND METHODS: Fifteen patients were treated for shaft fracture (n=13) or nonunion (n=2) of the distal third of the humerus without radial nerve involvement. The medial approach was performed in the supine position and the medioposterior approach in the prone position. Bone healing was achieved in all cases. Three patients experienced sensorial irritation in the territory of the median nerve after the medial approach; one case did not regress. There were no complications with the medioposterior approach. DISCUSSION: Dissection of the radial nerve can be avoided with these two approaches which also have a cosmetic advantage. The medioposterior approach appears to be preferable because of the comfortable operative position and the absence of risk for the median nerve. Both approaches are however contraindicated if there is preoperative involvement of the radial nerve.

Adolescent↗