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PubMed1991

[A bibliographic discussion on the obstruction of arteries and the air passage in hanging].

Since conjunctival petechial haemorrhage and froth can occur when the cervical arteries and air passage are not obstructed or incompletely obstructed, it is useful to know whether they are closed or not in a suspended body when we estimate the cause of its death being due to hanging or being a disguise after killed by strangulation. We discussed their obstruction in hanging after references, as summarized in tables. Arterial obstruction: Classical data on the arterial obstruction (Brouardel, 1897; Schwarzacher, 1928) have not been cited with a definite description that the data were obtained in experiments on typical hanging. In typical hanging, carotid arteries are directly closed with the compression by a ligature. There are three hypotheses on the mechanism of the obstruction of vertebral arteries: They are due to (1) the compression on the posterior and inferior region of the mastoid processes ("posterior compression"), (2) the backward and upward compression at the same time on the thyrohyoid membrane ("anterior compression") and (3) the vertical traction on the neck ("indirect obstruction"). In atypical hanging, carotid arteries can be indirectly closed in certain head positions. Vertebral arteries are not closed by the horizontal compression (hanging in a prone position). The "posterior compression" is effective. The "indirect obstruction" seems to be in existence. In the cases where ligatures do not run on the front of the necks but on the faces, it is advisable to consult the figures prepared by Rauschke (1957) and Brinkmann et al. (1981).(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Obstruction↗

PubMed1997

Effect of patient position on the consistency of placing the rearfoot at subtalar neutral.

The ability of foot care specialists to place a rearfoot at the subtalar neutral position is important for the care of patients who require foot orthosis prescription, fabrication, and management. Although some clinicians perform this procedure with the patient in the prone position, others prefer a seated or standing approach. This study examined whether patient position and preferred patient position influence the ability of clinicians to place a subject's rearfoot at the subtalar neutral position. The results suggest the following: a clinician's ability to find the subtalar neutral position is better with a seated subject; clinicians do not necessarily perform better assessments on a subject in a position corresponding to their patient position preference; and clinicians who prefer their patients prone generally have more flexible and reproducible observations. In addition, the findings suggest that the nature and relative importance of the tactile and visual cues used by clinicians to place a rearfoot at the subtalar neutral position warrant further exploration.

Adult↗

PubMed2000

Sudden infant death syndrome in South Australia 1968-97. Part I: changes over time.

OBJECTIVE: To compare the epidemiology of sudden infant death syndrome (SIDS) over three consecutive decades. METHODOLOGY: The birth history, infant's developmental and health history, infant care practices for the infant, death scene investigation and autopsy findings for all infants dying suddenly and unexpectedly in South Australia (SA) between January 1968 and December 1997 were studied. RESULTS: The incidence of SIDS in SA rose through the 1970s and early 1980s with the highest incidence being in infants born in 1986 at 2.4 per 1000 live births (LB). Two factors felt to be dangerous for some infants were identified being left unobserved in the prone position and having the head covered by bed clothes. Publicity about the risk of prone sleeping has been accompanied by a fall in SIDS deaths, to an incidence of 0.5 per 1000 LB in 1997. The incidence in Aboriginal infants, and infants living in lower socio-economic conditions has always been high, but the over-representation of these groups has increased in the last 5 years. CONCLUSION: It no infant under 8 months of age was placed prone or was able to get to prone unobserved before the age when they can easily get back to supine, and no infant was able to get the head completely covered while unobserved, the incidence of SIDS in SA should fall below 0.2 per 1000 LB.

Humans↗

PubMed1986

Contributions of aeromedical research to flight and biomedical science.

Pilot and plane capabilities to withstand high-Gz combat maneuvers are tactically important. Sustained 10-15 Gz capabilities of current and future planes outstrip safe physiologic limits in spite of the combined use of World War II-vintage straining maneuvers and relatively ineffective anti-G suits to prevent losses of vision and consciousness. However, the extreme arterial pressure increases needed to maintain cerebral blood flow (e.g. 400 mm Hg at heart level during exposures to 13.5 G when sitting upright) carry risks of anatomic damage to the circulatory system and rupture of air-containing, essentially unprotectable, lungs. These could be minimized, and incapacitating losses of consciousness avoided, by use of horizontal positions designed to eliminate heart-to-head hydrostatic gradients. Development of a prone-position cockpit with a counterweighted, forward-looking head support plus optical-electronically aided all-directional visibility is the most physiologic, safest, and surest way to achieve this goal.

Acceleration↗

PubMed2002

The impact of patient positioning on the adequate coverage of the uterus in the primary irradiation of cervical carcinoma: a prospective analysis using magnetic resonance imaging.

BACKGROUND AND PURPOSE: The intention of this prospective study is to assess the influence of different patient positionings and the use of belly boards on the coverage of the uterus by standard radiation fields. MATERIAL AND METHODS: In 21 women with carcinoma of the uterine cervix magnetic resonance imaging (MRI) scans in prone patient position with and without belly board and computed tomography (CT) scans in supine position were analysed after superimposing standard pelvic box fields. Further, all patients underwent a second MRI field control in prone position with belly board to detect intraindividual variations in the uterus position during treatment. RESULTS: Standard portals did not completely cover the uterus in supine position in 7/21 (33%), in prone position with belly board in 7/21 (33%) and without belly board in 5/21 (24%). Insufficient uterine coverage was found only in the anteroposterior direction. The mean distance (+/- standard deviation) between the field borders of the lateral portals and the uterus was in supine position anteriorly 3.4 cm (+/-2.2 cm) and posteriorly 1.8 cm (+/-1.3 cm), in prone position with belly board anteriorly 2.2 cm (+/-2.7 cm) and posteriorly 2.6 cm (+/-1.6 cm), prone without belly board anteriorly 3.3 cm (+/-2.4 cm) and posteriorly 1.9 cm (+/-1.1 cm). The difference was statistically significant between supine and prone position with belly board and between prone position with and without belly board. Repeated MRI controls during therapy showed no significant changes compared to the MRIs at the beginning of therapy. CONCLUSIONS: The use of standard radiation fields results in a high percentage of geographical misfits. Three-dimensional treatment planning is a prerequisite for adequate uterus coverage.

Adult↗

PubMed2003

Reconstruction of the iliofemoral ligament with an artificial ligament for recurrent anterior dislocation of total hip arthroplasty.

An 86-year-old woman underwent 4 revisions of hip arthroplasty and showed good position of both acetabular and femoral components. This was confirmed by roentgenographic measurements in the prone position. However, poor anterior acetabular covering after posterior inclination of the pelvis associated with lumbar kyphosis was observed in the standing position. Therefore, we reconstructed the iliofemoral ligament using a Leeds-Keio ligament to prevent anterior dislocation. At the 12-month follow-up evaluation, hip stability was confirmed, and the hip showed no further dislocation.

Aged↗

PubMed2002

[Anesthesia for a severe ankylosing spondylitis patient whose posture had been restricted to only sitting for over 20 years].

A 42-year-old woman with an Arnold-Chiari abnormality was scheduled for cervical spine surgery. She had severe ankylosing spondylitis, and all her joints from ankles to occipitocervical joint were fixed except hip joints, which had been replaced with artificial joints 20 years before. She could bend her upper body only in a range from -20 to 70 degree from the sitting position. Her posture had been restricted to only sitting for over 20 years, and she complained vertigo when positioned in supine position. The trachea was intubated with an aid of bronchofiberscopy under sedation in sitting position, and then anesthesia was induced with propofol and fentanyl. When she was turned to prone position, nasal bleeding was noticed and the surgery was performed in a modified sitting position. The intra- and post-operative course was uneventful. The present case indicates that long-term restriction only to sitting position modulates circulatory control in response to changing postures, and that preoperative evaluation for appropriate posture for surgery is mandatory.

Adult↗

PubMed1995

Abnormal tympanography after supine bottle feeding.

OBJECTIVE: To determine whether bottle feeding with the infant in the supine position is related to entry of milk into the middle ear, thereby predisposing the infant to otitis media. STUDY DESIGN: Ninety children, aged 7 to 24 months, who were free of respiratory infection and had normal tympanograms initially, were bottle fed in either the supine or the semiupright position, and tympanography was repeated immediately afterward. RESULTS: Thirty-four (59.6%) of the 57 infants fed in the supine position had abnormal postfeeding tympanographic results compared with only five (15%) of the 33 infants fed in the semiupright position (p < 0.005). In addition, when the infants with abnormal tympanograms were placed in semiupright or prone positions for 15 minutes after feeding, the majority of tympanograms returned to normal. CONCLUSION: These data suggest that supine bottle feeding has a significant effect on middle-ear pressure dynamics, probably caused by the aspiration of milk into the ear. The results also suggest that repositioning infants after feeding may mitigate the effects of supine feeding, at least in healthy children. Although this study did not demonstrate that tympanographic abnormality definitely predisposes to otitis media, it provides more evidence to encourage the practice of feeding infants in a semiupright position.

Acoustic Impedance Tests↗

PubMed2001

[Acute respiratory distress syndrome in children].

The acute respiratory distress syndrome (ARDS) encountered in a child may be either due to a primary lung infection or may be secondary to a systemic inflammatory response of varying origin. Therapy is based on: 1) the mechanical ventilation strategy aimed at maintaining the functional residual capacity by alveolar recruitment using positive end expiratory pressure and to limit secondary pulmonary lesions by using small tidal volumes, 2) prone positioning as soon as sufficient stability is achieved; 3) optimizing tissue oxygen delivery by cardiac support; 4) correction of any other organ dysfunction. If this conventional approach is not sufficient experimental therapies may be tempted given the vital risk. For instance inhaled nitric oxide and high frequency oscillation ventilation may be a valuable support. Newer techniques, such as partial liquid ventilation, are being developed and could become useful therapeutic options. After the acute phase a close medical follow-up is mandatory. Because of the possibility of a chronic respiratory insufficiency with negative consequences on the right ventricular function, these patients may need long term oxygen therapy and diuretics. Cardiac echography helps orientation in maintaining or discontinuing this long term therapy by estimating the arterial pulmonary pressure.

Acute Disease↗

PubMed1975

[About the influence of body posture on the result of acoustical examinations (author's transl)].

Effect of socalled tonic reflexes on central processing of acoustic stimuli was studied by stimulating the patterns of tonic reflexes in 18 adults with normal hearing abilities. The parameters were: hearing threshold level, acoustical stapedius reflex and slow auditory evoked potential. Only in three positions-corresponding to the symmetrical tonic neck reflex (STNR) and tonic labyrinthine reflex in supine and prone position a hearing threshold shift of 1 dB could be observed. The level of the stapedius reflex showed an increase of 5 dB in one of these three positions. In the acoustical evoked slow potential only the amplitude but not the latency was influenced. In some cases we found an increase of amplitude, in others a decrease or even a complete suppression. In using ERA to evaluate possible auditory disturbances in children with cerebral palsy it seems necessary to consider these possible influences on the evoked potential.

Acoustic Stimulation↗

PubMed1992

Superior mesenteric artery syndrome as a complication in hip spica application for immobilization: report of a case.

A 10-year-old girl who had a pelvic and femoral osteotomy for congenital dislocation of her right hip was immobilized with a hip spica. On the 28th postoperative day, she had upper abdominal pain, distention and bilious vomiting. An upper GI series demonstrated complete obstruction of the duodenum at the third portion of the duodenum in a supine position; however, the barium passed the obstruction site slowly when the patient assumed a lateral or prone position. She was successfully treated conservatively with nasogastric decompression, fluid replacement, proper positioning and hyperalimentation. Superior mesenteric artery syndrome is a rare complication in patients immobilized in a body cast or hip spica. Early diagnosis and proper treatment usually leads to an uneventful convalescence.

Barium Sulfate↗

PubMed1999

Head turning and face-down positioning in prone-sleeping premature infants.

BACKGROUND: Term infants may die of sudden infant death syndrome (SIDS) when they assume the face-straight-down or the face-near-straight-down head positions. Preterm infants have a higher SIDS rate, but it is not known how often they assume the face-straight-down and face-near-straight-down positions. OBJECTIVES: To determine the frequency and cardiorespiratory consequences of head turning and face-down head positioning in prone-sleeping premature infants. STUDY DESIGN: Supervised overnight cardiorespiratory and audiovisual recordings were conducted in 15 prone-sleeping preterm infants nearing hospital discharge: birth weight, 1178 101 (SEM) g, postconceptional age, 40 1.0 weeks. RESULTS: The preterm infants, studied at a younger postconceptional age than previously reported term infants, seldom turned their heads during sleep; therefore they rarely assumed the face-straight-down position (6 episodes in 3 infants) or the face-near-straight-down position (30 episodes in 6 infants). CONCLUSIONS: Prematurely born infants, known to be at increased risk of SIDS, rarely assume face-down positions when sleeping prone at approximately 40 weeks' postconceptional age. These results suggest that head turning during sleep is developmentally regulated and may have relevance to understanding the age distribution of SIDS.

Female↗

PubMed1990

Extracorporeal shock-wave lithotripsy in horseshoe kidneys.

Using the Dornier HM-3 lithotriptor, 10 patients (11 renal units) with calculi in horseshoe kidneys were treated with extracorporeal shock-wave lithotripsy (ESWL) and ancillary procedures. Six renal units (55%) underwent pre-ESWL manipulation consisting of a Double J stent, ureteral catheter, or percutaneous nephrostomy. The "blast path" was employed to treat five renal units which could not be positioned at F2. Good initial stone fragmentation was obtained in eight renal units (73%). There were two episodes of post-ESWL obstruction requiring intervention; both occurred in the same patient. A total of seven post-ESWL procedures were performed on two renal units. After all procedures, eight renal units (73%) were rendered stone-free, six (55%) with ESWL alone. The average follow-up interval was twelve months (range 1-28 months). ESWL can be used effectively to treat some patients with calculi in horseshoe kidneys. The ectopic location of these renal units may make it difficult to position calculi at F2, thus necessitating treatment on the blast path or placement of the patient in prone position. Multiple ancillary procedures may be necessary.

Adult↗

PubMed1997

[Positioning trauma in anesthesia and surgical intensive care medicine (2)].

Specific modes of positioning are essential for successful surgery. These are again critically assessed in this final part of our review. Technically correct execution can minimize the risk of damage caused by positioning, although the possibility of damage still exists. First of all, the position on the fracture table is discussed. Great care must be taken concerning the perineal post and leg holder. In the lateral decubitus position, the correct positioning of head and spine as well as that of the lower arm are of great importance. When using the Trendelenburg and reverse Trendelenburg position, the effect on the cardiopulmonary system and the intracranial pressure must to be taken into consideration. Prone position and its modifications (i.e. tuck position) demand diligent care concerning the positioning of the head. There must be absolutely no bulbus compression and the abdominal wall should not be under pressure. While employing the sitting position, the patient should be adequately monitored so that venous air embolism can be recognized and treated as soon as possible. Because of the increased occurrence of grave complications, the sitting position should be used only if this is absolutely necessary.

Humans↗

PubMed1986

A hydrostatic weighing method using total lung capacity and a small tank.

The purpose of this study was to establish the validity and reliability of a hydrostatic weighing method using total lung capacity (measuring vital capacity with a respirometer at the time of weighing) the prone position, and a small oblong tank. The validity of the method was established by comparing the TLC prone (tank) method against three hydrostatic weighing methods administered in a pool. The three methods included residual volume seated, TLC seated and TLC prone. Eighty male and female subjects were underwater weighed using each of the four methods. Validity coefficients for per cent body fat between the TLC prone (tank) method and the RV seated (pool), TLC seated (pool) and TLC prone (pool) methods were .98, .99 and .99, respectively. A randomised complete block ANOVA found significant differences between the RV seated (pool) method and each of the three TLC methods with respect to both body density and per cent body fat. The differences were negligible with respect to HW error. Reliability of the TLC prone (tank) method was established by weighing twenty subjects three different times with ten-minute time intervals between testing. Multiple correlations yielded reliability coefficients for body density and per cent body fat values of .99 and .99, respectively. It was concluded that the TLC prone (tank) method is valid, reliable and a favourable method of hydrostatic weighing.

Adolescent↗

PubMed1984

The inaccuracy of total uterine volume measurements: sources of error and a proposed solution.

Inaccuracies in total intrauterine volumes calculated using the prolate ellipse equation have been reported. No previous study has examined all the sources of error. In this study, a comprehensive approach was undertaken. Measurements were obtained from scans of the pregnant uterus in the prone position using an automated water-path scanner (Octoson) and in the supine position using standard static B-mode scanners. Several conclusions could be drawn: 1) From the Octoson prone scans, uterine volumes obtained using the prolate ellipse formula were markedly different from the true uterine volumes obtained by the summation of stepped areas. This showed that the prolate ellipse formula was inaccurate. 2) From the static supine scans, many observer inconsistencies were found in uterine volumes obtained from the prolate ellipse formula. This made the prolate ellipse formula unreliable. 3) Previously published graphs calculated from the prolate ellipse equation, comparing fetal age with total intrauterine volume, were found to vary accuracy, presumably as a result of 1 and 2. A more accurate approach is proposed. Using the outer uterine wall as the boundary, the stepped area-to-volume values of transverse scans taken at 3-cm intervals were found to closely approximate true volumes, with an average error of only 3.5 per cent. Since these measurements encompass the intrauterine contents and the myometrium, it is suggested that the term "total uterine volume" be used instead of "total intrauterine volume."

Amniotic Fluid↗

PubMedDate not supplied

[Ultrasonics and deep vein thrombosis. Ilio-caval level and the lower extremities].

All the important abdominal veins and limbs vein can be examined. The veins, in cross-section are rounded in repletion, (maximum normal vein caliber has reached when erect) almost flat in a state of vacuous-ness. The lumen normally echofree is limited by a wall thinner and less echogenic than the wall of adjacent artery. The parietal motions are rythmed by breathing. Venous blood flow can become echogenic, with weak echoes, as snow storm within the lumen. These phenomena are often visible in venous confluent and within the lumen below occlusion where there is sludge. In supine position deep abdominal veins, limbs veins until popliteal veins are easily seen. Below the popliteal fossa in prone position the veins are nearly empty and not visible beyond pathological circumstances. Objective studies demonstrated the inaccuracy of clinical diagnosis of deep venous thrombosis, echotomography (coupled with doppler) is among the non-invasive methods the most interesting, permitting to recognize venous occlusion complete or incomplete by clot but also compression by tumour or ganglion. The compression under the probe collapse the normal vein, but if there is clot inside, the compression become incomplete or impossible. The caliber of the vein is dilated also in supine position. The richest of venous clot in red cells in comparison with arterial thrombus make it more and earlier echogenic and more especially as the investigation is performed with high frequency probe. In the same way if the clot is floating its motions are put in evidence. Echotomography make usually difference between clot and neoplastic thrombus which is again more echogenic and also have special location. Echotomography permit to follow evolution ot venous thrombosis under treatment. The wall vein lesions after thrombosis are analysed showing thickening, destruction of the cups, dilatation of some veins while others are still obstructed.

Humans↗

PubMed1995

Technetium-99m-sestamibi scintimammography of breast lesions: clinical and pathological follow-up.

UNLABELLED: Mammography and physical examination combined have a sensitivity of 85% for the detection of breast carcinoma. Mammography also has a positive predictive value of 15%-30%. The aim of this study was to evaluate the usefulness of scintimammography using 99mTc-sestamibi as a complementary technique to mammography for the detection of breast carcinoma to improve mammography's sensitivity and specificity. METHODS: We studied 100 consecutive patients (mean age 48.3 +/- 10.8 yr) who had 106 lesions warranting biopsy (67 lesions) or fine needle aspiration cytology (FNA) (39 lesions) of the breast. There were 85 palpable and 21 nonpalpable lesions. The size of the lesions on the mammograms were moderate (2.3 +/- 1.8 x 1.9 +/- 1.5 cm). Each patient received 20 mCi 99mTc-sestamibi intravenously. Five and 60 min postinjection, planar breast images in the lateral prone position were obtained. An anterior erect projection was then obtained to visualize the axilla and, if needed, a posterior oblique prone projection. RESULTS: Scintimammography was true-positive in 30 lesions with biopsy-confirmed breast carcinoma; it was true-negative in 65 lesions subsequently proved to be benign. There were nine breast lesions with benign findings in which the scintimammography result was positive (false-positive scintimammography) for cancer. Finally, two lesions with pathologically proven carcinomas demonstrated a negative scintimammographic result. Therefore, in this group, the sensitivity of scintimammography was 93.7% with a specificity of 87.8%; the positive predictive value was 76.9%. The negative predictive value was 97%. CONCLUSION: Scintimammography is a highly sensitive test that improves the specificity of conventional mammography for the detection of breast carcinoma.

Biopsy, Needle↗