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Results for “Prone Position”

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At least 1,225 records · Page 68Linked to original sources

PubMed2004

Adopting 540-degree fusion to correct cervical kyphosis.

BACKGROUND: Two cases of severe cervical spine kyphotic deformity resulting from late effects of infection were successfully corrected by combined anterior and posterior instrumentations in a single operative sitting. CASE DESCRIPTION: Case 1 is a 43-year-old man who developed severe cervical kyphosis from C5-6 discitis over a few months despite long-term antibiotic therapy. He was neurologically intact except for severe neck pain and obvious deformity. Case 2 is a 40-year-old woman who had a previous wound infection five years before presentation. There was gradual worsening of swan neck deformity at the C2-3 and C5-6 levels with some spinal cord compression worsening her baseline myelopathy. The patients were placed and maintained in cervical traction on the Stryker frame for the duration of the procedure. Both cases required anterior approach initially to achieve some release of dense scar tissue using a high-speed drill. The wounds were then closed and patients were rotated to the prone position for further release of fused bony elements, including the facets. Lateral mass screws and plates were placed. In Case 2, additional instrument to the occipital was performed to stabilize the C2 using a U-shaped cervical rod. Once adequate reduction had been achieved, the patients were rotated back to supine position for further corpectomy and fibular construct fusion with plates. CONCLUSION: In cases of severe kyphotic deformity complicating infectious vertebral destruction, the spinal alignment can be achieved safely by a multi-step technique combining the anterior as well as posterior surgical approaches.

Adult↗

PubMed1997

Effects of ventilation in ventral decubitus position on respiratory mechanics in adult respiratory distress syndrome.

OBJECTIVE: To assess the potential benefits of a period of ventilation in ventral decubitus (VD) on oxygenation and respiratory mechanics in the adult respiratory distress syndrome (ARDS). DESIGN: In a stable condition during baseline ventilation in dorsal decubitus (DD), after 15 min of ventilation in VD and after 10 min of restored DD, the following parameters were studied: arterial blood gas tension, haemodynamics and static respiratory compliance (Crs), evaluated with the rapid airway occlusion technique. SETTING: The study was completed in the intensive care units of university hospitals as part of the management of the patients studied. PATIENTS: Twelve patients (7 males, 5 females, mean age 51.8 +/- 16.6 years) suffering from ARDS of different aetiologies. INTERVENTIONS: Before and during each evaluation, the patients were kept under stable haemodynamic and metabolic conditions. The ventilatory setting was kept constant. All the patients were sedated, paralysed and mechanically ventilated. RESULTS: A statistically significant increase in the ratio between the arterial partial pressure of oxygen and fractional inspired oxygen (p < 0.01) was observed between the baseline conditions (mean 123.9 +/- 22.6) and VD (mean 153.0 +/- 16.9), while no statistical significant was noted between baseline conditions and after 10 min of restored DD (mean 141.1 +/- 19.7). A significant increase in Crs (p < 0.001) was observed between baseline conditions (mean 42 +/- 10.1) and VD (mean 48.8 +/- 9.6) and between baseline conditions and restored DD (mean 44.7 +/- 10.6). Two patients were considered nonresponders. All the patients were haemodynamically stable. No side effects were noted. CONCLUSIONS: We observed an increase in oxygenation and Crs when the patients were turned from the supine to the prone position with the upper thorax and pelvis supported.

Adult↗

PubMed1993

[Sciatic nerve block in the popliteal fossa].

A technique of sciatic nerve block in the popliteal fossa, for operations on the foot and the ankle is described. It is obtained in the patient in prone position with a 12 cm long and insulated 22 G needle, connected to a nerve stimulator. The latter increases the rate of success and acceptance by the patient. This technique was used in 1000 patients between 16 and 88 years of age without any significant complication.

Adolescent↗

PubMedDate not supplied

Traumatic masturbatory syndrome.

This article describes a previously unreported pattern of atypical masturbatory behavior, which presents as either an erectile or orgasmic disorder in men. Four case histories are described of men who masturbated in an idiosyncratic manner. The distinguishing features of the masturbatory style include a prone position and daily masturbation over a period of years. It is suggested that the primary care physician or specialist (urologist or neurologist) screen for this problematic style when presented with male sexual dysfunction. Further, and more controversially, it is suggested that a primary prevention model would argue for masturbatory instruction in the home, classroom, or pediatric clinical setting.

Adult↗

PubMed2006

Adjuncts to mechanical ventilation in ARDS.

Since its first description, acute respiratory distress syndrome has been characterized by abnormal physiologic and gas exchange properties of the lungs. Many adjunctive therapies have been developed to reduce the stresses of mechanical ventilation on already damaged lungs. We examined the mechanism of action and the latest clinical trial information of several adjunctive therapies including prone positioning, nitric oxide, extracorporeal membrane oxygenation, arterial venous carbon dioxide removal, and liquid ventilation. While all of these therapies have demonstrated short-term improvements in arterial blood gases and in the limitation of lung injury, none have shown an evidence-based survival benefit.

Carbon Dioxide↗

PubMed2003

[Management of the acute respiratory distress syndrome].

OBJECTIVE: To review the current support and treatment strategies of the acute respiratory distress syndrome. DATA SOURCES: Original data from our research laboratory and from representative scientific articles on acute respiratory distress syndrome and acute lung Injury searched through Medline. SUMMARY OF THE FINDINGS: Despite advances in the understanding of the pathogenesis of acute respiratory distress syndrome, this syndrome still results in significant morbidity and mortality. Mechanical ventilation, the main therapeutic modality for acute respiratory distress syndrome, is no longer considered simply a support modality, but a therapy capable of influencing the course of the disease. New ventilation strategies, such as high-frequency oscillatory ventilation appear to be promising. This text reviews the current knowledge of acute respiratory distress syndrome management, including conventional and non-conventional ventilation, the use of surfactant, nitric oxide, modulators of inflammation, extracorporeal membrane oxygenation and prone position. CONCLUSIONS: The last decade was marked by significant advances, such as the concept of protective ventilation for acute respiratory distress syndrome. The benefit of alternative strategies, such as high-frequency oscillatory ventilation, the use of surfactant and immunomodulators continue to be the target of study.

Adrenal Cortex Hormones↗

PubMed2002

Simulator verification of the accuracy of patient repositioning after virtual simulation. Is physical simulation still needed?

PURPOSE: To evaluate the frequency and amount of displacements after repositioning a patient on the physical simulator following virtual simulation. MATERIAL AND METHODS: After laser marking at the CT scanner and virtual simulation, patients were repositioned on the simulator. The isocenter obtained from the calculated table movements was checked by fluoroscopically measuring the distances to standardized anatomic landmarks and comparing them to the treatment plan. RESULTS: In 86% of patients, displacements were < or = 0.5 cm. There was no significant difference between the supine and prone position, diagnosis categories or CT reconstruction indices. The use of immobilization devices and cranial versus body stem localization did make a significant difference. Rates of exact repositioning were high in brain and head and neck patients and comparatively low in abdominal tumors and breast cancer. CONCLUSIONS: Immobilization devices play an important role for the precision of radiotherapy. Whenever precise positioning is possible (e. g. with a head mask), virtual simulation alone might be sufficient. Patients with abdominal and breast tumors, were repositioning precision is often suboptimal, might profit from an additional physical simulation.

Adult↗

PubMed1982

Ultrasound assessment of normal renal dimensions.

This study confirms the accuracy and reliability of sonographic assessment of renal dimensions when meticulous scanning techniques are employed. Sonographic renal dimensions are smaller than those obtained by radiography, since there is neither the geometric magnification nor the change in size related to an osmotic diuresis from iodinated contrast material. Sonographically, with patients in the prone position, the mean right renal length was 10.74 cm (+/- 1.35 SD) and the mean left renal length was 11.10 cm (+/- 1.15 SD). A prospective sample demonstrated the mean depth (ventral-dorsal dimension) to be approximately 4.5 cm when the transducer was angulated for the lie of the kidney.

Adult↗

PubMed2004

Origin of orientation-dependent asymmetries in vestibulo-ocular reflexes evoked by caloric stimulation.

A caloric stimulus evokes primarily a horizontal vestibulo-ocular reflex (VOR) when subjects are in a supine or prone orientation with the horizontal semicircular canal plane oriented vertically. In both monkeys and humans, the magnitude of VOR eye movements is greater in the supine than in the prone orientation, indicating that some factor or factors, other than the conventionally accepted convective stimulation of the horizontal canals, contributes to the generation of the VOR. We used long-duration caloric irrigations and mathematical models of canal-otolith interactions to investigate factors contributing to the prone/supine asymmetry. Binaural caloric irrigations were applied for 7.5 or 9.5 min with subjects in a null orientation with horizontal canals in the earth-horizontal plane (control trial), or with the subject's pitch orientation periodically changing between null, supine, and prone positions with each orientation held for 30 s (caloric step trial). The control trial responses identified a small response attributable to a direct thermal effect on vestibular afferent activity that accounted for only 15% of the observed prone/supine asymmetry. We show that the gravito-inertial force resolution hypothesis for sensory integration of canal and otolith information predicts that the central processing of canal and otolith information produces an internal estimate of motion that includes both a rotational motion component and a linear acceleration component. These components evoke a horizontal angular VOR and linear VOR, which combine additively in the supine orientation, but subtract in the prone orientation, thus accounting for the majority of the observed prone/supine asymmetry.

Adult↗

PubMed1992

In situ prone ESWL for the treatment of lower ureteral stones: experience with 28 patients.

Twenty-eight patients with lower ureteral stones underwent in situ extracorporeal shock wave lithotripsy (ESWL) in the prone position over the period of 7 months between March 1990 and September 1990. For stone disintegration the spark gap shock wave lithotripter Tripter XI (Direx) was used. Satisfactory disintegration was achieved in 93 per cent of patients. The stone-free rate at 12 weeks was 82 per cent, and 11 per cent had residual fragments less than or equal to 4 mm in diameter. Twenty-one per cent of patients required repeat treatments. For only 2 patients general anaesthesia was required (7 per cent). There were no remarkable complications except for haemospermia which resolved spontaneously 15 days after treatment. It was concluded that in situ prone ESWL is an effective and safe procedure for the treatment of lower ureteral stones.

Adult↗

PubMedDate not supplied

Motor function of infants with spastic hemiplegia.

The motor function of 25 children with spastic hemiplegia was examined retrospectively using videotapes recorded at 2-8 months of age. Many infants showed deficient forward movement of the arm and deficient opening of the hand on the affected side. At 7 and 8 months of age, whether the hand was semiflexed or clenched was correlated with the later upper extremity function. In the prone position, most could support their weight on the flexed arm on the affected side. In the supine position, half of the infants could not extend the knee on the affected side. At 2 months of age, asymmetry of the upper and lower extremity movements was not identified. Persistent primitive reflexes and abnormal truncal muscular tone were not recognized in the hemiplegic infants, and did not seem to be signs predicting hemiplegic cerebral palsy.

Cerebral Palsy↗

PubMedDate not supplied

Microbubble retention and failed macular hole surgery.

This case reports a possible new cause of failed macular hole surgery. Standard macular hole surgery with removal of epiretinal membranes, 16% C3F8, and strict postoperative prone positioning was performed on a patient with stage 4 macular hole. Macular hole surgery failed with retention of a microbubble of C3F8 within the macular hole during the follow-up period. Retention of a microbubble within a macular hole may prevent closure of the hole and be a previously unrecognized cause of failed macular hole surgery.

Epiretinal Membrane↗

PubMed2004

Anatomical and pathological considerations in percutaneous vertebroplasty and kyphoplasty: a reappraisal of the vertebral venous system.

OBJECTIVES: To focus attention of the clinician on the anatomy and (patho)physiology of the vertebral venous system, so as to offer a tool to better understand and anticipate (potential) complications that are related to the application of percutaneous vertebroplasty and kyphoplasty. BACKGROUND: Percutaneous vertebroplasty and kyphoplasty are newly developed, minimally invasive techniques for the relief of pain and for the strengthening of bone in vertebral body lesions. With the clinical implementation of these techniques, a number of serious neurologic and cardiopulmonary complications have been reported in the international medical literature. Most complications appear to be related to the extrusion of bone cement into the vertebral venous system. METHODS: The literature about complications of percutaneous vertebroplasty and kyphoplasty is reviewed, and the anatomic and (patho)physiologic characteristics of the vertebral venous system are reported. Based on what is currently known from the anatomy and physiology of the vertebral venous system, the procedures of percutaneous vertebroplasty and kyphoplasty are analyzed, and suggestions are made to improve the safety of these techniques. CONCLUSIONS: Thorough knowledge of the anatomic and (patho)physiologic characteristics of the vertebral venous system is mandatory for all physicians that participate in percutaneous vertebroplasty and kyphoplasty. To reduce the risk of cement extrusion into the vertebral venous system during injection, vertebral venous pressure should be increased during surgery. This can be achieved by operating the patient in the prone position and by raising intrathoracic venous pressure with the aid of the anesthesiologist during intravertebral instrumentation and cement injection. Intensive theoretical and practical training, critical patient selection, and careful monitoring of the procedures, also taking into account patient positioning and intrathoracic and intra-abdominal pressures, will help to facilitate low morbidity outcomes in these very promising minimally invasive techniques.

Blood Pressure↗

PubMed2006

Severe respiratory failure: advanced treatment options.

BACKGROUND: Severe respiratory failure (including acute lung injury and acute respiratory distress syndrome) continues to be associated with significant mortality and morbidity in patients of all ages. OBJECTIVE: To review the laboratory and clinical data in support of and future directions for the advanced treatment of severe respiratory failure. DATA SOURCES: MEDLINE/PubMed search of all relevant primary and review articles. DATA SYNTHESIS: Our understanding of lung pathophysiology and the role of ventilator-induced lung injury through basic science investigation has led to advances in lung protective strategies for the mechanical ventilation support of patients with severe respiratory failure. Specific modalities reviewed include low-tidal volume ventilation, permissive hypercapnia, the open lung approach, recruitment maneuvers, airway pressure release ventilation, high-frequency oscillatory ventilation, prone positioning, and extracorporeal life support. The pharmacologic strategies (including corticosteroids, surfactant, and nitric oxide) investigated for the treatment of severe respiratory failure are also reviewed. CONCLUSION: In patients with severe respiratory failure, an incremental approach to the management of severe hypoxemia requires implementation of the strategies reviewed, with knowledge of the evidence base to support these strategies.

Adrenal Cortex Hormones↗

PubMed2001

MRI of lung parenchyma in rats and mice using a gradient-echo sequence.

Signal of lung parenchymal tissue from the living rat and mouse lung was detected at 4.7 T with a good signal-to-noise ratio and motion-suppressed artifacts using a short TE gradient-echo sequence. Neither cardiac nor respiratory gating were applied, and animals respired freely during data collection. Mean T(2)* relaxation times of parenchyma in the anterior, middle and posterior regions of both lungs ranged between 403 and 657 micros and 397 and 751 micros, respectively for the rat and mouse. For the rat in the prone position, there was a gradient in T(2)* values, from the posterior to the anterior regions of both lungs. In the supine position, however, T(2)* values were larger in the posterior and in the anterior portions. For the mouse in both prone and supine positions, there was a tendential gradient in T(2)* from the anterior to the posterior portions. The robustness of the approach renders it well suited for routine applications, e.g. in pharmacological studies concerning asthma models in small rodents. The method was applied to lung inflammation models involving challenge with ovalbumin or lipopolysaccharide.

Animals↗

PubMed1994

Carbon dioxide concentrations in the environment of sleeping infants.

In 22 infants continuous measurements were made of the concentration of carbon dioxide (CO2) in inspired air during sleep. Evidence was found of CO2 enrichment of inspired air in certain environmental conditions. The levels achieved were not sufficiently high to acutely endanger an infant. Carbon dioxide concentrations as high as 2-3% were observed in the prone position when the infant's head was under a blanket and when the lower face was obscured by bedding. Sleeping prone on a sheepskin also resulted in an increased concentration of CO2 but to a lesser extent than being under a blanket. In awake infants the presence of a pacifier also promoted an excess of CO2 in the inspired air, both in the prone and supine positions. The physiological and clinical implications of these findings, in relation to the Sudden Infant Death Syndrome (SIDS), are unknown and warrant investigation.

Air↗

PubMed1994

Quadriplegia caused by push-up exercises.

This paper describes a case of a 52-year-old male patient with spinal cord injury caused by doing push-up exercises in the prone position. To our knowledge, no previous report has been published describing a case of spinal cord injury caused by push-up exercise. These days, sport is recommended not only to the young but also to older persons. However, to the older, who inevitably have some degenerative disease, moderation should be recommended.

Cervical Vertebrae↗

PubMed2005

The role of gravity in adaptation of the vertical angular vestibulo-ocular reflex.

The gain of the vertical angular vestibulo-ocular reflex (aVOR) was adapted in side-down and prone positions in two monkeys and tested in four planes: left-/right-side down; forward/backward; and two intermediate planes that lie approximately in the planes of the vertical semicircular canal pairs, left anterior/right posterior (LA/RP) and right anterior/left posterior (RA/LP). Gain changes, expressed as a percent of preadapted values, were plotted as a function of head orientation in the planes of tilt, and fitted with sinusoids to obtain the gravity-dependent (amplitude) and gravity-independent (bias) components of adaptation. Gravity-dependent gain changes were always maximal when tested in a plane that included the head orientation in which the aVOR gain had been adapted. Changes were minimal when the head was tilted in a plane orthogonal to the plane of adaptation, and were smaller but still significant when tested in the two intermediate planes. Gravity-independent VOR gain changes were uniform over all planes of head tilt. Thus, the gravity-dependent and gravity-independent components could be separated experimentally. The aVOR gain changes from the head tilts in different directions were utilized to reconstruct the gain changes in three dimensions. They formed a continuous surface, which peaked in and around the position of adaptation. These studies support the postulate that gain adaptation has both gravity-independent and gravity-dependent components, and further show that these gain changes have a three-dimensional structure. These results are similar to those in humans, indicating that the gravity-dependent adaptation of the aVOR is likely to be a common phenomenon across species.

Acclimatization↗