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Results for “Prone Position”

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At least 1,405 records · Page 78Linked to original sources

PubMed1999

Total body irradiation before bone marrow transplantation. Technique and acute toxicity.

PURPOSE: To evaluate the total body irradiation methods in the National Institute of Oncology between January 1984 and February 1998. PATIENTS AND METHODS: One hundred and twenty-four patients underwent total body irradiation prior to bone marrow transplantation in the last 15 years. A special cobalt unit has been used, the dose rate was 6 to 8 cGy/min in the midline of the abdomen. The source-midline distance (SMD) was 340 cm and the field size was 80 x 200 cm. The dose calculation was done on the basis of a tissue-phantom ratio curve measured in total body irradiation conditions and effective tissue thickness (ETT). Between 1984 and 1992 the beam direction was horizontal, the patients laid in lateral position. In 11 cases the total dose to the abdominal midline was 10 Gy in 1 fraction. From 1986 the fractionation changed to 4 x 3 Gy in 4 days. Within individual lung shielding the average lung dose was 8.5 Gy. In 44/124 cases the order of conditioning treatment was chemo-radiotherapy. Since 1992 vertical beams were used, and the patients (80/124) laid in prone/supine position. The fractionation remained the same but radio-chemotherapy regime has been used. RESULTS: The irradiation in prone position proved to be safer than lateral because of smaller patient motion and it resulted in a more accurate positioning of lung shielding too. In all cases, the acute side effects (headache, nausea, vomiting) were moderate. Using radio-chemotherapy the acute side effects during the total body irradiation were uncommon and well tolerable. CONCLUSION: Our technique with the large source-midline distance, vertical beam direction and the supine/prone position is stable, convenient and safe to produce homogeneous dose distribution and ensures accurate and reproducible lung shielding.

Bone Marrow Transplantation↗

PubMed2005

One-stage correction of intermediate imperforate anus in males.

This prospective study was designed to assess the safety, cost-effectiveness, and advantages of performing posterior sagittal anorectoplasty (PSARP) without colostomy on males with intermediate imperforate anus in a developing country. Fifteen consecutive males with intermediate imperforate anus were entered into the study. Chest and abdominal x-rays, skeletal surveys, renal ultrasound scans, and invertograms were done. Patients were resuscitated and Pena's PSARP done in prone positions. A 2-ml syringe vent was inserted into the new anus for 10 days. Babies were nursed prone postoperatively. Cephalosporin and metronidazole were given as perioperative antibiotics. All patients had intermediate anomalies. There were no other major associated congenital anomalies. A urethral catheter could not be inserted in one patient, and one patient who presented with septicemia and jaundice was deemed too ill to withstand a major operation; these two patients therefore had diverting colostomies. There were no problems with PSARP in the other 13 patients. One patient's father discharged him against medical advice on the 5th postoperative day; the mother had had postpartum hemorrhage, so they opted for traditional treatment because they could not provide blood donors. The skin wounds of 10 patients healed completely with removal of stitches; two boys had superficial wound infection. Parents who lived far from the hospital were taught how to dilate the anus. Follow-up has ranged between 3 months and 2 years. This prospective study shows that it is feasible for males with intermediate imperforate anus to have safe PSARP without colostomy. The advantages of one instead of three major operations are many, especially in developing countries. If this result can be reproduced in cases of high anomalies, colostomy may be unnecessary in many cases of anorectal malformations, with many benefits to these children and their families.

Anus, Imperforate↗

PubMed1988

Treatment of lower ureteral calculi with extracorporeal shock wave lithotripsy.

A group of 70 patients presenting with stones in the lower third of the ureter was treated with extracorporeal shock wave lithotripsy using a Dornier HM3 lithotriptor. For adequate radiological stone visualization a sitting position was used in 68 patients, while 2 with calculi overlying the sacroiliac joint required placement in the prone position. All but 1 patient had additional endoscopic maneuvers before treatment, consisting of the passage of a Zeiss sling around the stone in 40 and, when this was not possible, a ureteral stent in 29. The over-all success rate was 94.2 per cent (66 of 70 patients) with 3 patients having retained fragments and 1 requiring an open operation. The combination of new positioning techniques and relatively simple endoscopic maneuvers makes treatment of lower ureteral stones feasible and safe with the Dornier lithotriptor.

Adult↗

PubMed2001

Comparison of EMG activity of medial and lateral hamstrings during isometric contractions at various cuff weight loads.

Since both the medial head (MH) and lateral head (LH) of the hamstring muscles contribute to knee flexion, this study investigated whether the relative electrical activity of these heads remained constant with respect to each other or changed during isometric contractions at five different resistance levels. The relative electrical activity of these two heads was determined by comparing their integrated EMG (iEMG). Forty-two volunteers with no history of right lower extremity injury or disease, between the ages of 18 and 35, were studied. Following motor point location, surface electrodes were placed over the MH and LH. Subjects, positioned prone, flexed the knee to 45 degrees using a sawhorse as a tactile cue to help maintain this position. Three recordings, 8 s in length, were taken at each subject's maximum isometric contraction and then using cuff weights of 1, 3, 5, and 7% of their body weight. The average of the three recordings was used in the analysis. During maximum isometric contraction (at 45 degrees of knee flexion), the LH contributes a significantly greater percent of the total iEMG (63.4%) than the MH (P < 0.0001). Furthermore, within the four submaximal levels tested, the LH's contribution was significantly greater than the MH (P < 0.01). During submaximal isometric contractions, the LH percent contribution to total iEMG was less than its contribution during maximal isometric contraction, all P values < 0.005. As a result, during these same submaximal isometric contractions, the MH contribution to total iEMG was greater than its contribution during maximal isometric contraction, all P values < 0.005).

Adolescent↗

PubMed2000

Is a standard protocol necessary for oscillometric blood pressure measurement in term newborns?

OBJECTIVE: The necessity of taking only one randomized blood pressure measurement or averaging three repeated measurements and, the effects of various stages of the restful state and body position on blood pressure measurements obtained with the oscillometric technique were investigated in 138 healthy term newborns. METHODS: The Athena oscillometer was used to measure blood pressure. Three successive measurements with a 5-min interval were made in each of two positions, prone and supine, in random order 30 min after the last feeding if newborns were in very quiet or quiet sleep. During routine recording of vital signs, another (single) measurement was obtained before feeding the infant regardless of the body position of the newborn, provided that they were not struggling, crying or moving. RESULTS: For all systolic, diastolic and mean blood pressures measured, there were no significant differences among either prone, supine and single measurements or among three successive measurements in each position. CONCLUSIONS: We conclude that, in the routine care of term newborns, blood pressure measurements with the oscillometric technique may be made without the need of a special position or sleep state, provided that the measurements are made with an appropriate sized cuff in the absence of struggling, crying and movement of the newborn. Taking only one randomized measurement under these conditions would be enough and practical in daily newborn care practice instead of repeating and averaging many measurements.

Blood Pressure Determination↗

PubMed1995

Therapeutic optimization including inhaled nitric oxide in adult respiratory distress syndrome in a polyvalent intensive care unit.

OBJECTIVE: To investigate the effects of inhaled nitric oxide (NO) in adult respiratory distress syndrome (ARDS) associated with a therapeutic optimization strategy on oxygen parameters, barotrauma, and evolution in a medical and surgical intensive care unit. DESIGN: Prospective study. MATERIALS AND METHODS: Twenty consecutive patients with ARDS were studied (Murray score 3.6 +/- 0.2). Eleven were surgical patients and nine were medical patients. All fulfilled the extracorporeal membrane oxygenation entry criteria. The APACHE II score predicted mortality was 39%. All were ventilated with FiO2 1 with positive end-expiratory pressure (PEEP) of 11 +/- 1 cm H2O. Therapeutic optimization included permissive hypercapnia, tracheal gas insufflation, prone position, continuous hemofiltration, treatment of infection, and pleural drainage. We used NO continuously inhaled at a concentration ranging from 5 to 10 ppm. MEASUREMENTS AND MAIN RESULTS: After 1 hour, inhaled NO improved PaO2 in all patients except one (78 +/- 11 to 130 +/- 25 mm Hg) (p < 0.05), allowing a reduction of FiO2 and PEEP. After 24 hours, mean pulmonary arterial pressure decreased from 31 +/- 3 to 25 +/- 2 mm Hg (p < 0.05). Systemic hemodynamics were unaffected. Oxygen delivery increased from 531 +/- 135 to 603 +/- 125 mL/minute/m-2 (p < 0.05). Barotraumatic lesions were present in only one patient. Reversal of ARDS was obtained in 16 patients, of whom 14 (70%) were discharged. CONCLUSIONS: This study was shorter to demonstrate an improvement in the survival rate. Nevertheless, these preliminary results are encouraging. Because of its safety, effectiveness, and easy use, inhaled NO should be used as a part of a therapeutic optimization protocol before considering more invasive and expensive procedures, such as extracorporeal respiratory support or intravascular oxygenation.

APACHE↗

PubMedDate not supplied

Comparison of motor self-regulatory and stress behaviors of preterm infants across body positions.

Occupational therapists working with infants in neonatal intensive care units (NICUs) make positioning recommendations to optimize self-regulation, with little published data supporting this practice. In this retrospective descriptive study, 15 hospitalized preterm infants (M(gestational age) = 32 weeks) were videotaped during non-caregiving periods in order to record the frequency of specific behaviors in relation to six infant positions (prone nested, prone un-nested, side-lying nested, side-lying un-nested, supine nested, and supine un-nested). Behaviors coded were those that suggest infant stress or motor efforts at self-regulation, as defined for the original study. Mixed effects regressions and post-hoc Tukey Honestly Significant Difference tests were used to analyze the data, after the calculation of a ratio of the number of behaviors in each position. Higher ratio values reflect a greater occurrence of behaviors. The number of motor self-regulatory and stress behaviors were related to infant position, with the highest ratios of behaviors observed in side-lying un-nested and the lowest in prone nested. Behavior ratios did not differ between prone un-nested and prone nested, nor between supine un-nested and supine nested. More self-regulatory and stress behaviors were related to longer periods of fussing and crying. Longer periods of light sleep were related to fewer stress behaviors. Infants performed the fewest stress behaviors in prone nested, prone un-nested, or side-lying nested. These positions may benefit infants in the NICU by reducing the need for motor-based self-regulatory behaviors and potentially conserving energy for growth.

Child Development↗

PubMed1991

Spinal cord decompression via a modified costotransversectomy approach combined with posterior instrumentation for management of metastatic neoplasms of the thoracic spine.

Fifteen patients with thoracic spinal cord compression from metastatic neoplastic processes were managed by spinal canal decompression via a modified costotransversectomy approach. Ten of the patients also underwent sequential posterior stabilization with Luque or Harrington instrumentation based upon proximity of the lesion to the thoracolumbar junction, prognosis for regaining or maintaining ambulatory ability, and additional spinal stability considerations. A modified lateral decubitus position with the scapula falling away from the side of exposure was used for T1-5 segment lesions, and a prone position was used for the (T-6)-(T-12) segment. Adequate decompression of the spinal canal was achieved in all cases. All patients who were ambulating preoperatively maintained ambulatory ability, and pain and/or further neurological improvement as well occurred in 75%.

Adult↗

PubMed1980

Position-related false-positive renal imaging.

A case report of false-positive renal imaging due to anterior displacement of the upper pole of the left kidney with the patient in the prone position is presented. False imaging can be avoided by imaging the kidneys with the patient in the supine position and with the detector behind the patient.

False Positive Reactions↗

PubMed1987

Development of anti-G suits and their limitations.

Initial anti-G suits were based on the belief that decreased venous return was the critical effect of increased weight of blood during acceleration. Cumbersome water filled, pneumatic gradient or pulsatile pressure suits resulted. Subsequent centrifuge studies implicated arterial pressure, rather than venous return, as the major determinant of G tolerance in the sitting position. Consequently, methods of increasing arterial pressure were developed. Findings that the hypertensive, associated anti-blackout and discomfort effects of suit inflation all increase with bladder system pressure up to arterial occlusive levels resulted in the simplified G-suit used in W.W.II to the present. Recent +Gz loss of consciousness crashes indicate current straining maneuvers plus this suit are inadequate. Furthermore, because of very high pressures to maintain cerebral circulation in the sitting position, very high G suit protection is hazardous. If piloting is essential for full use of super performance fighters, the prone position with counter-weighted head support plus omni-directional surveilance is the surest strategem to obtain this advantage.

Acceleration↗

PubMed2001

[Role of computed tomography in pulmonary aspergillosis. 20 cases].

OBJECTIVE: Aspergilloma is the most common form of pulmonary aspergillosis. The purpose of this work was to compare computed tomographic findings with features observed on standard radiographs. PATIENTS AND METHODS: We retrospectively reviewed 20 cases of pulmonary aspergilloma. These patients (mean age 36 years) were followed after cure of pulmonary tuberculosis and consulted for hemoptysis. All underwent computed tomography (CT) and standard radiographic explorations. Serology was positive for Aspergillus in 16 cases and clinical and radiographic findings led to the diagnosis in the 4 others. Both supine and prone positions were used for thoracic CT. Slice thickness was 5 mm without contrast injection. RESULTS: In many cases, standard films evidenced the typical mycetoma seen as a rounded mass of soft tissue density filling a portion of a preexisting cavity or as an air crescent sign, but atypical alveolar opacities, aeric images without aspergillosis colonization and parenchymal destruction predominated in certain cases. The CT-scan demonstrated these features even better revealing the typical cavity in 80% of the cases or an air crescent in 20%. Mobility of the fungus ball was demonstrated by comparison of the prone and supine images. The characteristic CT features allowed certain diagnosis of aspergilloma in 6 patients with atypical radiographic or serologic results. DISCUSSION: Computed tomography is highly contributive to the diagnosis of pulmonary aspergillosis, particularly in case of small cavities that may be missed on the standard films. Recognition of the mobility of the fungal ball enables differentiation from a tumor or infectious lesion. CT is also helpful for guiding transparietal treatment. CONCLUSION: A computed tomography series should be obtained in former tuberculosis patients consulting for hemoptisis.

Adult↗

PubMed1995

High-resolution computed tomography sampling for detection of asbestos-related lung disease.

RATIONALE AND OBJECTIVES: We determined whether a limited number of high-resolution computed tomography (HRCT) scans will effectively screen for interstitial lung disease (ILD) in a population of individuals exposed to asbestos. METHODS: We retrospectively reviewed the computed tomography studies of 49 patients exposed to asbestos. HRCT in the supine and prone positions had been performed at specifically preselected levels. Two teams of thoracic radiologists evaluated, on separate occasions: (1) all images, (2) prone images only, and (3) a single prone image through the lung bases for the presence of diffuse ILD. RESULTS: A relatively high level of accuracy was obtained with a single prone scan. However, improvement to 95% or better was found when additional prone images were used. CONCLUSION: A screening study for ILD, in this case patients exposed to asbestos, may be performed by preselected prone HRCT images only. The ease and decreased time of performing the procedure make screening relatively large patient groups for ILD more feasible.

Asbestos↗

PubMedDate not supplied

Ipsilateral decubitus position for percutaneous CT-guided adrenal biopsy.

Positioning the patient on the side to be biopsied elevates and relatively immobilizes the diaphragmatic leaf on the dependent side, allowing percutaneous adrenal needle biopsy by a direct posterior approach without traversing lung tissue. The ipsilateral decubitus position was used successfully for biopsy of four small adrenal lesions in which lung precluded a direct posterior approach in the prone position. In addition, the relative stability of the diaphragmatic leaf further facilitated accurate needle placement.

Adrenal Gland Diseases↗

PubMed1986

Tomography of regional ventilation and perfusion using krypton 81m in normal subjects and asthmatic patients.

Single photon emission computed tomography, a rotating gamma camera, and continuous inhalation or infusion of krypton 81m (half life 13 seconds) were used to measure regional ventilation (V), perfusion (Q), and ventilation-perfusion (V/Q) ratios in five normal subjects in supine, prone, and lateral decubitus postures and in three asthmatic patients (supine posture only) before and after inhalation of 2.5 mg nebulised salbutamol. Vertical and horizontal gradients of V, Q, and V/Q were examined at three levels in each lung in regions of 1.9 cm3 size. In normal subjects V and Q increased along the axis of gravity in all postures and at all levels in the lung except for V in the prone position. Smaller horizontal gradients were found with an increase in V and Q from caudal to cranial--again except in the prone posture, where the gradient was slightly reversed. Constraint to outward motion of the ventral chest and abdominal wall is the most likely explanation for the different behaviour in the prone posture. In chronic asthma the vertical gradients of V and V/Q were the reverse of normal, but the Q gradient was normal. Bronchodilator treatment did not affect the vertical or horizontal gradients significantly, but analysis of individual regions showed that, relatively, V/Q worsened in 42% of them; this was associated in two thirds with an increase in fractional Q. After inhalation of beta agonist local vasodilatation may influence V/Q ratios in some units more than bronchodilatation.

Adult↗

PubMed1998

[Correlation of SPECT myocardial stress scintigraphy with coronary angiography].

The sensitivity and specificity of a myocardial perfusion single-photon emission tomography (SPECT) for the detection of the coronary artery disease (CAD) was investigated. As a gold standard the coronary angiography was used--the stenosis of the artery by 50% and more was considered as significant for CAD. After performing SPECT studies patients were examined by coronary angiography according to the attending physician's judgement. In the retrospectively created group of 123 subjects (94 males and 29 females, mean age 53 years, range 30-69 years) 55 patients underwent myocardial infarction (MI). The stress was performed using a bicycle ergometer or, in case of patient's inability, an intravenous dipyridamole infusion. Before december 1995 201T1 was used in all patients, after this date only in patients with prior MI with regard to the advantage of this radionuclide for the detection of the ischemic but viable myocardium. Other patients were administered 99mTc-tetrofosmin. In our group of patients we found the high sensitivity of myocardial SPECT of 94.5% 86 (from 91), specificity of 84.4% (27 from 32) corresponding to usually values and the high diagnostic accuracy of 91.9% (113 from 123). Specificity can be impaired by marked attentuation of gamma-rays by overlying soft-tissue structures such as the breast or diaphragm. The artificial imaging of the inferior wall due to the infradiaphragmatic structures represents the most serious problem-there were four false positive findings in our group; further ones in our 99mTc-tetrofosmin studies were avoided by the routine use of the prone position recommended in the literature. The validity of SPECT myocardial perfusion findings should be verified by coronary angiography; however, one must be aware of some questionable points inherent in this comparison.

Adult↗

PubMed2005

A new technique for superior hypogastric plexus block: the posteromedian transdiscal approach.

Superior hypogastric plexus block has been advocated for the treatment of cancer related pelvic pain. Neurolysis is usually established using the classical posterolateral approach in the prone position, in which correct placement of the needle is sometimes difficult due to vertebral anatomy and the patient's inability to lie prone. We describe an alternative posteromedian transdiscal approach under fluoroscopic guidance for the treatment of intractable pelvic pain in three patients, in whom the classical approach was not possible. The L5-S1 interdiscal space was identified with fluoroscopy. The needle was then introduced through the disc and advanced under lateral fluoroscopic control. After verifying correct needle placement, neurolysis was performed with 8 ml of 10% phenol solution. All patients had significant pain relief immediately after the block, lasting from 6 to 12 months, and their pain severity scores and opioid consumption were reduced by more than 50%. There were no complications such as discitis, disc rupture or nerve injury. Since this new posteromedian transdiscal approach provides easy access to the superior hypogastric plexus with a single puncture and with any patient position, it may be an alternative to the classical approach.

Aged↗

PubMed1983

The infant seat as treatment for gastroesophageal reflux.

Positioning in the infant seat ("chalasia chair") for treatment of infants with gastroesophageal reflux is presumed to have a beneficial effect. We undertook a controlled, prospective study of such positioning to evaluate this purported benefit. Nine infants with documented gastroesophageal reflux participated in 18 paired two-hour postprandial trials in an infant seat and in the horizontal prone position. Distal esophageal pH monitoring demonstrated longer exposure to gastroesophageal reflux while infants were in the seat than when they were prone (28.2 +/- 6.4 per cent vs. 12.8 +/- 3.7 per cent of total time with pH less than 4.0, P = 0.023), a difference due largely to more episodes (16.0 +/- 2.4 vs. 10.1 +/- 2.3 per two-hour postprandial period, P = 0.002). We conclude that the infant seat, rather than being therapeutic in gastroesophageal reflux in children under six months of age, is actually detrimental, when compared with simply placing an infant prone.

Clinical Trials as Topic↗

PubMed2000

Ventilatory sensitivity to mild asphyxia: prone versus supine sleep position.

AIMS: To compare the effects of prone and supine sleep position on the main physiological responses to mild asphyxia: increase in ventilation and arousal. METHODS: Ventilatory and arousal responses to mild asphyxia (hypercapnia/hypoxia) were measured in 53 healthy infants at newborn and 3 months of age, during quiet sleep (QS) and active sleep (AS), and in supine and prone sleep positions. The asphyxial test mimicked face down rebreathing by slowly altering the inspired air: CO(2), maximum 5% and O(2), minimum 13.5%. The change in ventilation with inspired CO(2) was measured over 5-6 minutes of the test. The slope of a linear curve fit relating inspired CO(2) to the logarithm of ventilation was taken as a quantitative measure of ventilatory asphyxial sensitivity (VAS). Sleep state and arousal were determined by behavioural criteria. RESULTS: At 3 months of age, prone positioning in AS lowered VAS (0.184 prone v 0.269 supine, p = 0.050). At newborn age, sleep position had no effect on VAS. Infants aged 3 months were twice as likely to arouse to the test than newborns (p = 0.013). Placing infants prone as opposed to supine increased the chances of arousal 1.57-fold (p = 0.035). CONCLUSION: Our findings show 3 month old babies sleeping prone compared to supine have poorer ventilatory responses to mild asphyxia, particularly in AS, but the increased prevalence of arousal is a protective factor.

Arousal↗