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At least 1,207 records · Page 67Linked to original sources
PubMed1991

Treatment of syndromic and nonsyndromic bilateral coronal synostosis in infancy and childhood.

The treatment of nonsyndromic and syndromic bilateral coronal synostosis has been outlined. Essential features of this individualized approach include technique modification in bone remodeling and fixation according to the age of the patient as well as additional emphasis on elongating the anterior cranial base or periorbital segment in patients with syndrome-associated bilateral coronal synostosis. Common to the treatment of all patients with turribrachycephaly related to bilateral coronal synostosis is an emphasis on holistic reshaping of the skull afforded by the positioning of the patient in the modified prone position, which gives simultaneous access to the anterior and posterior skull for optimal reshaping of hypoplastic and compensatory abnormalities.

Age Factors↗
PubMed1975

[Isotope diagnostic findigs in nephroptoses].

Radiorenography, serial scans and clearance determinations using 131-I-Iodohippurate and 51-CPr-EDTA were performed on a total of 106 patients with unilateral nephroptosis. In 45 of them with pathological findings in the upright position the examination was repeated in the prone position. 19 patients underwent nephropexy and were reexamined 2 to 6 weeks there after. The results suggest that the combination of different radioisotope methods provides a valuable and sensitive means to detect posture-dependent impairment of kidney and urinary tract function and yields an additional objective basis for the selection of patients for nephropexy.

Adult↗
PubMedDate not supplied

Load-induced inflexion of the surface electromyographic signal during isometric fatiguing activity of normal human paraspinal muscle.

In twelve normal subjects (aged 21-57 years) changes in surface electromyographic (EMG) activity of the paraspinal muscles were examined during "unloaded" and "weight-loaded" fatigue tests. These comprised 60 second isometric holds against gravity with the upper body unsupported in a horizontal and prone position while the lower body was firmly secured to a couch. During one of the tests sand bags, representing 10% of subjects' body weight, were placed between the scapulae. Integrated EMG (IEMG) and the frequency power spectrum were monitored throughout each test. During both tests IEMG activity initially increased and then plateaued in the unloaded test but decreased in the loaded test. Since frequency changes in the power spectrum were similar during both fatigue tests, IEMG reductions in the loaded test appeared due to reductions in motor unit recruitment. Despite these IEMG reductions the horizontal position was maintained, suggesting the operation of intrinsic peripheral fatigue resistance mechanisms which were utilised to a greater extent during the loaded test.

Adult↗
PubMedDate not supplied

Patient restraint positions in a psychiatric inpatient service.

AIM: The use of physical intervention on psychiatric inpatient units continues to be a source of debate and controversy. Some studies and national clinical guidelines have identified particular restraint positions as both dangerous and undesirable. The following study attempts to identify clinical variables that may make physical restraint in a particular position more likely. METHOD: A cross-sectional survey design was adopted and data was obtained from a violence and aggression audit form used by the trust. This form has 122 items to be completed by staff within 72 hours of an episode of patient aggression or self-harm. Ten variables were selected for scrutiny on the basis of their potential clinical importance. RESULTS: The survey found that prone restraint was significantly associated with others reporting the patient's imminent violence and high-intensity observation after the incident. Supine restraint was significantly associated with the patient being withdrawn and/or refusing to communicate prior to the episode and with a high severity incident rating after the incident. CONCLUSION: If we work on the premise that restraint in the prone position is less desirable than interventions undertaken with the patient in the supine position, this study clearly suggests that we have an opportunity to influence the nature of intervention through quite minimal changes to training programmes. It is important that any change in emphasis around intervention does not create a sense that controlled descent to the floor is inevitable. The principle of its use as a 'last resort in the event of loss of control on the feet' has to be maintained.

Aggression↗
PubMed1995

Accidental death or sudden infant death syndrome?

OBJECTIVE: To describe the reasons why it is difficult to decide whether to attribute some infant deaths to accidents or to SIDS. METHODOLOGY: To extract from infant deaths data in South Australia those where the cause of death is debatable. RESULTS: The risks associated with rocking cradles, bed sharing, bedclothes, couch sleeping, unsafe cots or beds and the prone position are presented. CONCLUSIONS: Uniform worldwide death scene investigations for all infant deaths should help identify unsafe sleeping conditions for infants.

Accidents, Home↗
PubMed2006

The effects of mechanical ventilation on the gut and abdomen.

PURPOSE OF REVIEW: Mechanical ventilation generates an increase in airway pressure and, therefore, in intrathoracic pressure, which may decrease systemic and intraabdominal organ perfusion. Critically ill patients rarely die of hypoxia and/or hypercarbia but commonly develop a systemic inflammatory response that culminates in multiple-organ dysfunction syndrome and death. In the pathogeneses of this syndrome the gastrointestinal tract and liver have received considerable attention. RECENT FINDINGS: Mechanical ventilation with high positive end-expiratory pressure has been found to decrease splanchnic perfusion. Hepatic arterial buffer response is preserved and an increased hepatic arterial blood flow will compensate the decrease in portal blood flow. Despite an increased cardiac output with an acute moderate increase in arterial PCO2 during protective ventilation it cannot be expected that splanchnic and gut perfusion is improved. In the absence of a significant rise in intraabdominal pressure without impairment in cardiovascular function, splanchnic and gastrointestinal function remained unchanged during short periods of prone positioning. Spontaneous breathing during ventilator support improves systemic blood flow and gastrointestinal and splanchnic perfusion. SUMMARY: In critically ill patients mechanical ventilation should be adjusted to avoid conditions known to be associated with decreased gastrointestinal and splanchnic perfusion.

Abdomen↗
PubMed2001

Single-breath washouts in a rotating stretcher.

Vital capacity single-breath washouts using 90% O2-5% He-5% SF6 as a test gas mixture were performed with subjects sitting on a stool (upright) or recumbent on a stretcher (prone, supine, lateral left, lateral right, with or without rotation at end of inhalation). On the basis of the combinations of supine and prone maneuvers, gravity-dependent contributions to N2 phase III slope and N2 phase IV height in the supine posture were estimated at 18% and 68%, respectively. Whereas both He and SF6 slope decreased from supine to prone, the SF6-He slope difference actually increased (P = 0.015). N2 phase III slopes, phase IV heights, and cardiogenic oscillations were smallest in the prone posture, and we observed similarities between the modifications of He and SF6 slopes from upright to prone and from upright to short-term microgravity. These results suggest that phase III slope is partially due to emptying patterns of small units with different ventilation-to-volume ratios, corresponding to acini or groups of acini. Of all body postures under study, the prone position most reduces the inhomogeneities of ventilation during a vital capacity maneuver at both inter- and intraregional levels.

Adult↗
PubMed2004

Reproducibility of patient positioning for fractionated extracranial stereotactic radiotherapy using a double-vacuum technique.

BACKGROUND AND PURPOSE: Precise reproducible patient positioning is a prerequisite for conformal fractionated radiotherapy. A fixation system based on double-vacuum technology is presented which can be used for conventional as well as hypofractionated stereotactic extracranial radiotherapy. MATERIAL AND METHODS: To form the actual vacuum mattress, the patient is pressed into the mattress with a vacuum foil which can also be used for daily repositioning and fixation. A stereotactic frame can be positioned over the region of interest on an indexed base plate. Repositioning accuracy was determined by comparing daily, pretreatment, orthogonal portal images to the respective digitally reconstructed radiographs (DRRs) in ten patients with abdominal and pelvic lesions receiving extracranial fractionated (stereotactic) radiotherapy. The three-dimensional (3-D) vectors and 95% confidence intervals (CI) were calculated from the respective deviations in the three axes. Time required for initial mold production and daily repositioning was also determined. RESULTS: The mean 3-D repositioning error (187 fractions) was 2.5 +/- 1.1 mm. The largest single deviation (10 mm) was observed in a patient treated in prone position. Mold production took an average of 15 min (10-30 min). Repositioning times are not necessarily longer than using no positioning aid at all. CONCLUSION: The presented fixation system allows reliable, flexible and efficient patient positioning for extracranial stereotactic radiotherapy.

Adult↗
PubMed2005

Postoperative visual loss following prone spinal surgery.

Postoperative visual loss is a rare but disastrous complication that has an estimated incidence of 0.01-1% after non-ocular surgery. We report a patient who underwent a prolonged spinal operation in the prone position and complained of blindness in one eye postoperatively. We consider the potential aetiological factors contributing to this unilateral postoperative visual loss and suggest strategies to reduce the incidence of this complication in spinal surgery.

Blindness↗
PubMed1997

Sudden infant death syndrome: a hypothesis.

A study of the strikingly low incidence of sudden infant death syndrome in Eastern countries revealed significant differences in infant handling thought to have an etiological bearing; therefore this writer suggested that adoption of certain Eastern methods of nursing may reduce the incidence of sudden infant death syndrome. A dramatic fall in incidence has resulted from implementing one of the suggestions made by the writer in 1983, namely the abandonment of the prone position, after initial opposition. The present hypothesis sets out to give a scientific explanation for this fall, and is a unified hypothesis explaining certain puzzling and disparate features of sudden infant death syndrome such as the remarkable winter incidence, age incidence, and the occurrence of sudden infant death syndrome during sleep, and is based on a postulated disturbance in thermoregulatory function (a unique hypothermia). Recommendations are made for evolving a test for sudden infant death syndrome-proneness and a possible method of treatment of a fatality within a short time frame.

Adipose Tissue, Brown↗
PubMed2005

Intravitreal tissue plasminogen activator and pneumatic displacement of submacular hemorrhage secondary to retinal artery macroaneurysm.

PURPOSE: To assess the efficacy of treating submacular hemorrhages secondary to retinal arterial macroaneurysm with intravitreous tissue plasminogen activator (tPA) and gas. PATIENTS AND METHODS: Six consecutive patients (6 eyes) with submacular hemorrhage secondary to retinal arterial macroaneurysm were included in this study. Tissue plasminogen activator, at a dose of 50 microg/0.1 mL, was injected through the pars plana into the vitreous cavity. Gas (0.3-0.5 mL of perfluoropropane) instillation followed tPA injection, either immediately after injection or sometime during the next day. RESULTS: Best postoperative visual acuity improved in 5 of 6 eyes (83%) and was unchanged in 1 of 6 (17%) eyes. In 5 of 6 (83%) eyes, the procedure resulted in complete or partial displacement of submacular hemorrhage out of the foveal area. CONCLUSIONS: Intravitreous injection of tPA and gas, followed by prone positioning of the patient, is an effective and simple treatment of submacular hemorrhage secondary to retinal arterial macroaneurysm. No complication occurred in this series.

Aged↗
PubMed2006

Percutaneous nephrolithotomy under conscious sedation in morbidly obese patients.

Two morbidly obese males weighing 159 kg and 184 kg underwent percutaneous nephrolithotomy (PCNL) for large, symptomatic renal stones. To avoid anesthetic complications and cardiorespiratory compromise in the prone position, the procedures were performed under IV sedation with local anesthesia. The risks of PCNL in this patient population are reviewed, and the technique employed to mitigate the risks in these two cases is described.

Anesthesia, Local↗
PubMedDate not supplied

The efficacy of developmentally sensitive interventions and sucrose for relieving procedural pain in very low birth weight neonates.

BACKGROUND: Procedural pain management for very low birth weight (VLBW) neonates has been minimal or nonexistent in most neonatal intensive care units (NICUs). OBJECTIVES: To compare the efficacy of developmentally sensitive behavioral interventions (nonnutritive sucking via a pacifier, positioning) and sucrose for relieving procedural pain in VLBW infants and to determine the influence of contextual factors (gestational age, postnatal age, birth weight, severity of illness, frequency of painful procedures) on pain response. METHOD: In a prospective randomized crossover trial, pain was assessed in 122 VLBW neonates using the Premature Infant Pain Profile following four randomly ordered interventions during consecutive routine heel lance procedures. RESULTS: Significant differences in pain existed among treatment interventions (F = 16.20, p < .0001). The pacifier with sucrose (F = 24.09, p < .0001) and pacifier with sterile water (F = 9.00, p = .003) significantly reduced pain. Prone positioning did not decrease pain (F = 2.24, p = .137). Frequency of painful procedures approached significance in influencing pain response (F = 3.59, p = .01). CONCLUSIONS: The most efficacious interventions for reducing pain from single painful events were the pacifier with sucrose and the pacifier with sterile water. Research on the efficacy and safety of implementing these interventions, alone and in combination, for repeated painful procedures is needed. In addition, research is needed on the influence of implementing these interventions on pain response and clinical outcomes (e.g., health status and neurodevelopmental status) in VLBW neonates in the NICU.

Blood Specimen Collection↗
PubMed2000

Respiratory failure. Conventional and high-tech support.

Although significant progress has been made in the treatment of patients with acute lung failure in the critical care setting, the mortality rate from acute lung injury and ARDS is unacceptably high, given the numbers of patients treated for these syndromes each year. The improved understanding of the pathophysiology of respiratory failure from basic science and clinical research is reflected in improved survival rates over the years. Advances in the mechanical ventilator (through microprocessor technology); biosurface technology; liquid ventilation; and, in some cases, returning to so-called "antiquated" practices of patient care (e.g., prone positioning) seem to have had an impact nonetheless. As refinement continues to occur in these areas, morbidity and mortality from lung failure will have a lesser impact on patients as physicians treat the consequences of organ failure in the ICU.

Adult↗
PubMed1996

Extracorporeal shock wave lithotripsy of middle ureteral calculi: ventral shock wave application.

A total of 150 patients presenting with stone in the middle iliac ureter were treated with extracorporeal shock wave lithotripsy using a Dornier HM-4 lithotriptor. For adequate radiological stone visualization and excellent fragmentation, the prone position was used in all patients. In 45 patients (30%) an ureteral stent was placed before treatment. The overall success rate was 82% (123 of 150 patients). All patients were treated on an outpatient basis without anesthesia.

Adult↗
PubMedDate not supplied

Transient meralgia paresthetica after pediatric posterior spine fusion.

Meralgia paresthetica (MP) rarely occurs during posterior spine surgery. The study goal was to examine risk factors associated with the incidence of MP. A review of 56 consecutive pediatric patients undergoing posterior spine fusion for scoliosis was performed. Patients with abnormal sensation in the lateral thigh preoperatively and prior spine surgery were excluded. All patients were positioned prone on the Jackson (Orthopaedic Systems, Inc., Union City, CA) spinal table with either (1) the lower leg support table and thigh supports or (2) the lower leg suspension sling. Data on patient weight, diagnosis, surgeon, duration of surgery, presence of MP, symptoms, and symptom duration were collected. A logistic regression analysis was performed between independent variables and presence of MP. There were 10/56 patients with MP (18%). Symptoms were anterolateral thigh numbness without pain or weakness. Symptoms in all cases were resolved, on average, before the 6-week postoperative visit (range 2-24 weeks). Patients with MP more often had idiopathic scoliosis (28% vs 7%; P < 0.05) were positioned with the lower leg sling instead of the flat table support (31% vs 13%; P < 0.05) and trended toward longer surgery times (451 vs 388 minutes; NS). Abnormal body mass index, age at surgery, surgeon, and sex did not correlate to MP. MP can occur after pediatric posterior spine surgery. Symptoms were minor, temporary, and did not require treatment. Shorter surgical times and use of thigh pads in conjunction with the lower leg support table may decrease the incidence of MP.

Adolescent↗