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Results for “Prone Position”

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At least 1,693 records · Page 94Linked to original sources

PubMed2005

Management of posttraumatic kyphosis: surgical technique to facilitate a combined approach.

This report describes a variation of the "posterior-anterior-posterior" surgical techniques to correct posttraumatic kyphosis of the thoracic and lumbar spine with the USS internal fixator. This modification is based on the use of "temporary screws" to mark the entrance of the pedicles in the first stage of the operation (posterior approach, with the patient in prone position). Approaching both columns of the spine simultaneously facilitates correction of the kyphotic defect and permits 360 reconstruction of the spine.

Accidental Falls↗

PubMed2006

Spinal muscle evaluation using the Sorensen test: a critical appraisal of the literature.

The first test for evaluating the isometric endurance of trunk extensor muscles was described by Hansen in 1964. In 1984, following a study by Biering-Sorensen, this test became known as the "Sorensen test" and gained considerable popularity as a tool reported to predict low back pain within the next year in males. The test consists in measuring the amount of time a person can hold the unsupported upper body in a horizontal prone position with the lower body fixed to the examining table. This test has been used in many studies, either in its original version or as variants. Although its discriminative validity, reproducibility, and safety seem good, debate continues to surround its ability to predict low back pain; in addition, the gender-related difference in position-holding time remains unexplained and the influence of body weight unclear. A contribution of the hip extensor muscles to position holding has been established, but its magnitude remains unknown. The influence of personal factors such as motivation complicates the interpretation of the results. Despite these drawbacks, the Sorensen test has become the tool of reference for evaluating muscle performance in patients with low back pain, most notably before and after rehabilitation programs.

Exercise Test↗

PubMed2026

Interventions with a significant mortality difference in acute respiratory distress syndrome: A systematic review and comparison with Guidelines.

INTRODUCTION: Acute respiratory distress syndrome (ARDS) has a high mortality rate. European Society of Intensive Care Medicine (ESICM) and American Thoracic Society (ATS) Guidelines are the worldwide reference for clinicians in management of ARDS. Mortality represents one of the most important outcomes in intensive care practice and randomized controlled trials (RCTs) the highest level of evidence. We compared Guidelines recommendations with RCT results to highlight differences and find potential new therapeutic opportunities. METHODS: We performed a systematic review of all RCTs reporting a statistically significant mortality difference in ARDS and a subsequent comparison with ESICM and ATS Guidelines recommendations. RESULTS: We identified 33 RCTs and 23 interventions with mortality difference in ARDS patients. Seven interventions relate to invasive ventilation strategies, two to noninvasive ventilation strategies, one to extracorporeal membrane oxygenation (ECMO), 12 to drugs and one to nutritional support. In 25/33 (76%) RCTs the intervention was associated with mortality reduction and in 8/33 with mortality increase (24%). Multicenter studies were 24/33 (73%) while blinding was adopted in 19/33 (58%) studies. Guidelines recommendations supported by RCTs with mortality impact include: the use of low tidal volume ventilation, prone positioning, venovenous ECMO, steroids and the avoidance of high frequency oscillatory ventilation. Eight of the interventions identified were not mentioned by Guidelines but demonstrated reduced mortality, and five further interventions demonstrated increased mortality. CONCLUSIONS: This systematic review highlights potential gaps between RCTs results and Guidelines that could be used to plan future research or highlight topics to be discussed in future Guidelines.

Humans↗

PubMedDate not supplied

Digitized infrared segmental thermometry: time requirements for stable recordings.

OBJECTIVES: Digitized infrared segmental thermometry (DIST) is a method for measuring and recording skin surface body temperatures. The project evaluated the required length of time for patients to acclimatize their core body temperature to ambient conditions to obtain stable DIST readings. METHODS: Seventeen subjects were allowed a 20-minute acclimatizing period in a temperature-controlled room. The bilateral DIST temperature was measured with thermistors in combination with infrared cameras (IRCs) at the C4 and L4 levels. All IRC temperatures were recorded after a 20-minute stabilization period. The room temperature and relative humidity were recorded throughout all trials. The acclimatization trend was computed from the 20- to 24-minute period for the IRCs, and the acclimatization trend was computed continuously for a total of 30 minutes (at 2-minute intervals) for 5 days. RESULTS: We discovered a stabilization trend in the early trial stages, with the thermistor recordings between 8 and 16 minutes. The IRC trend was also conclusive for the core temperature requirements. CONCLUSIONS: This study determined a core body temperature acclimatization trend tested among patients using thermistor recordings in a controlled environment. Based on these findings, we recommend acclimatization in a temperature- and humidity-controlled environment for a minimum 8-minute period, followed by an 8-minute maximum recording period with the patient in a prone position to obtain accurate DIST recordings.

Acclimatization↗

PubMed2004

Laparoscopic ligation of the median sacral artery before resection of a sacrococcygeal teratoma.

To minimize the risk of exsanguinating hemorrhage, the authors describe a technique of laparoscopic ligation of the median sacral artery before posterior sagittal resection of type I sacrococcygeal teratoma (SCT). Two female infants with antenatally diagnosed SCT underwent postnatal evaluation and preoperative imaging and were taken to the operating room. In both patients, pneumoperitoneum was established via an epigastic 5-mm trocar. Two additional trocars were inserted in the right and left lower quadrants. The peritoneal reflection was opened to the right of the sigmoid colon, and the presacral space was explored. A large median sacral artery was identified easily, isolated, and divided. The children then were placed in a prone position, and the tumors underwent en bloc resection via a Chevron incision with minimal blood loss. The laparoscopic portion of the procedure was performed in an average of 15 minutes. This is the first report of laparoscopic ligation of the median sacral artery before posterior resection of a sacrococcygeal tumor in an infant. This technique can be performed easily with minimal morbidity. Division of this artery is a logical preventative measure and may reduce the risk of hemorrhage during operative resection.

Blood Loss, Surgical↗

PubMed2004

Case of the missing penny: thoracoscopic removal of a mediastinal coin.

Complications of coin ingestion in children, although rare, include esophageal perforation, tracheoesophageal fistula, esophago-aortic fistula, and death. The authors describe thoracoscopic removal of a mediastinal coin that migrated extraluminally from the esophagus in a 23-month-old girl. Right-sided thoracoscopic exploration using a 3-trocar technique in a modified prone position was used. Coin location was assisted by manipulation of a transorally placed Foley catheter and intraoperative fluoroscopy. The coin was retrieved successfully with no intraoperative or postoperative complications and minimal postoperative pain. This is the first report of successful thoracoscopic removal of a mediastinal coin. Thoracoscopy may be a valuable approach for mediastinal foreign body removal in children.

Female↗

PubMed2004

Surfactant abnormalities after single lung transplantation in dogs: impact of bronchoscopic surfactant administration.

OBJECTIVE: Disturbances of the alveolar surfactant system have been implicated in the pathogenesis of reperfusion injury. The aim of this study was to evaluate the influence of exogenous surfactant administration on surfactant properties in a model of single lung transplantation. METHODS: We performed heterologous, left lung transplantation (+4 degrees C ischemia; 24 hours, Euro-Collins solution) in 6 foxhounds (untreated) and in 6 animals that received calf lung surfactant extract (Alveofact) prior to explantation (only donor lung; 50 mg/kg body weight) and immediately after onset of reperfusion (both lungs, 200 mg/kg body weight). Separate but synchronized ventilation of each lung was performed, in a volume-controlled, pressure-limited mode, with animals in prone position. Bronchoalveolar lavage fluids were collected in pretransplantation lungs (control), after 24 hours of ischemia prior to transplantation (0 hours) and 6 and 12 hours after reperfusion in both the grafts and the recipient native lungs. RESULTS: Ischemic storage per se did not provoke any changes of the surfactant system; however, severe alterations occurred within 6 hours of reperfusion, resulting in a severe loss of surface activity, including a decrease in the percentage of the large surfactant aggregate fraction, reduction of the surfactant apoproteins SP-B and SP-C, the dipalmitoyl molecular species of phosphatidylcholine and phosphatidylglycerol within the large surfactant aggregate fraction. These abnormalities were restricted to the graft, with virtually normal surfactant function and composition being found in the recipient native lung. Surfactant administration fully normalized the biochemical and largely improved the biophysical surfactant properties, alongside maintenance of lung gas exchange properties. CONCLUSIONS: Severe surfactant abnormalities occur exclusively in the graft when performing separate, synchronized ventilation of each lung to attenuate ventilator-induced lung injury. Bronchoscopic surfactant administration provides protection against these abnormalities and may be a therapeutic strategy in lung transplantation.

Animals↗

PubMed2003

[Brachial plexus palsy in adults with radicular lesions, general concepts, diagnostic approach and results ].

In post-traumatic brachial plexus lesions in adults, early repair will necessitate a variety of nerve grafting and nerve transfer procedures. In complete palsies, a graft is performed from a radicular stump, using intercostal nerve transfers, partial cross C7 transfer, and the distal spinal accessory nerve. This will provide elbow flexion and extension in 75% of cases, and shoulder abduction or rotation in 50% of cases. In the upper type palsies, ulnar-biceps transfer is the standard procedure. Grafting from a ruptured cervical root, when available, is performed to reanimate the shoulder. In C5 C6 and C7 palsies, extension of the wrist and fingers is provided by tendon transfers. In chronic palsies, elbow flexion and extension loss is treated by means of free muscle transfers, (latissimus dorsi or gracilis) combined with nerve transfers (intercostals or spinal accessory). Secondary procedures are routinely necessary following recovery of elbow flexion. For the shoulder-humeral shaft osteotomy or fusion, for the hand-cosmetic fusion of the wrist and distal radio-ulnar joint in the prone position, or palliative treatment in case of partial recovery. For such weak "plexic hands", we have developed a specific hierarchical functional scale, useful for surgical decisions.

Brachial Plexus Neuropathies↗

PubMed2005

Sudden infant death syndrome: the colon connection.

The etiology of sudden infant death syndrome (SIDS) is not known. Various maternal and infant risk factors have been identified. Adoption of the non-prone position has reduced the incidence of SIDS but has not eliminated the problem. Some sulfate reducing bacteria in the colon produce hydrogen sulfide (H2S) which is as toxic as hydrogen cyanide. Normally, the colonic mechanism for metabolizing and detoxifying H2S is very effective and no H2S appears in the exhaled breath although small amounts are present in the flatus. We are putting forth the hypothesis that in some cases of SIDS colonocytic mechanism for detoxifying H2S may not have matured by the age of 3 months and H2S may be absorbed resulting in SIDS. The hypothesis can be tested by in vitro evaluation of colonic tissue from SIDS cases for its ability to detoxify H2S.

Colon↗

PubMed2004

A simple method for short-term controlled anesthesia in newborn mice.

In this study, we describe a simple and inexpensive method for inducing short-term anesthesia and rapid recovery in newborn mice. Litters of Swiss mice pups were randomly allocated to testing on postnatal days 2, 5, and 8. Anesthesia was induced by placing the pup in a syringe and adding a volume of isoflurane-saturated gas that produced an estimated level of 32% isoflurane. Exposure to isoflurane lasted 30 s. All the pups survived the anesthesia. At all study ages, this method abolished the nociceptive response to tail clamp without inducing mortality, thus showing effective anesthesia. Recovery from anesthesia was assessed immediately after isoflurane exposure, based on two nonnoxious behavioral tests: the defensive response to a drop of water (10 tests, 1 min apart) and 10 min later the righting reflex, i.e., the time to recovery of the prone position (five tests, 10 min apart). The water drop test scores increased during the recovery phase toward the control values in all age groups. Treatment and time had no significant effect on righting reflex scores. The initial volume in the syringe, the volume of added isoflurane-saturated gas, and the duration of exposure may be adjusted according to postnatal age and specific strains or species (e.g., rats). This method is well suited to behavioral or physiological phenotype studies in developing mice, in which noxious procedures must precede functional testing, making rapid recovery from anesthesia a key requirement.

Age Factors↗

PubMed2005

Reproductive and developmental toxicity screening test of basic rubber accelerator, 1,3-di-o-tolylguanidine, in rats.

Twelve male and female rats per group were exposed to the rubber accelerator 1,3-di-o-tolylguanidine (DTG) by gavage at 0, 8, 20 or 50 mg/kg bw/day. Males were dosed for a total of 49 days beginning 14 days before mating. Females were dosed for a total of 40-49 days beginning 14 days before mating to day 3 of lactation throughout the mating and gestation period. At 50 mg/kg bw/day, deaths were observed in two males and three females. Lowered body weight gain and food consumption were noted in males at 50 mg/kg bw/day and females at 20 and 50 mg/kg bw/day. Mydriasis, decreased locomotor activity, bradypnea, prone position, tremor and/or salivation were observed in males and females at 20 and 50 mg/kg bw/day. No effects of DTG were found on the estrous cyclicity, precoital interval, copulation, fertility and gestational indices, numbers of corpora lutea and implantations, or gestation length. A significant decrease in the number, body weight and viability of offspring and increase in the incidence of fetuses with external malformations were found at 50 mg/kg bw/day. Oligodactyly, anal atresia and tail anomalies were observed. These data suggest that DTG may be teratogenic. The NOAELs of DTG for general and developmental toxicity in rats are 8 and 20 mg/kg bw/day, respectively.

Abnormalities, Drug-Induced↗

PubMed2006

Prenatal developmental toxicity study of the basic rubber accelerator, 1,3-di-o-tolylguanidine, in rats.

Pregnant rats were given 1,3-di-o-tolylguanidine (DTG) by gavage at 0, 10, 20 or 40 mg/kg bw/day on days 6-19 of pregnancy and the pregnancy outcome was determined on day 20 of pregnancy. At 40 mg/kg bw/day, deaths were observed in four out of 24 females. The incidences of females showing mydriasis at 20 and 40 mg/kg bw/day and showing decreased locomotor activity at 40 mg/kg bw/day were significantly increased. Alopecia, bradypnea, prone position and tremor were also observed at mg/kg bw/day. The maternal body weight gain at 20 and 40 mg/kg bw/day and food consumption at 40 mg/kg bw/day were significantly reduced. A significantly decreased weight of the gravid uterus, increased incidence of postimplantation loss, decreased number of live fetuses, and lowered weights of fetuses and placentae were found at 40 mg/kg bw/day. The incidences of the total number of fetuses with external malformations at 40 mg/kg bw/day and with skeletal malformations at 20 and 40 mg/kg bw/day were significantly increased. Significantly higher incidences of fetuses with brachydactyly and short tail and defects of caudal vertebrae, phalanges and metacarpals were observed at 40 mg/kg bw/day. Delayed ossification was also noted at 40 mg/kg bw/day. The data indicate that DTG is teratogenic at maternal toxic doses and the NOAELs of DTG for maternal and developmental toxicity are 10 mg/kg bw/day in rats.

Abnormalities, Drug-Induced↗

PubMed2006

Sudden unexpected death in epilepsy patients: Risk factors. A systematic review.

INTRODUCTION: Several risk factors for sudden unexplained death in epilepsy patients (SUDEP) have been proposed, but subsequent work has yielded conflicting data. The relative importance of various risk factors for SUDEP was never explored. The aim of this study is to review systematically risk factors for SUDEP and also to determine their relevance for SUDEP by calculating relative risk factor ratios. METHODS AND MATERIALS: Authors performed a literature-search on "SUDEP" in Medline, the Cochrane Library and EMBASE. Studies with unknown number of SUDEP cases or with less than five SUDEP cases and reviews were excluded from further analysis. The value of each paper was assessed, based on the quality of the study and the reliability of the diagnosis of SUDEP. This value ranged from 1 (low quality) to 10 (high quality). Papers with a value below 7 were eliminated for further analysis. For each analysed factor, a risk factor ratio was determined, with a higher ratio for a stronger risk factor. RESULTS: A number of strong risk factors for SUDEP: young age, early onset of seizures, the presence of generalized tonic clonic seizures, male sex and being in bed. Weak risk factors for SUDEP: prone position, one or more subtherapeutic bloodlevels, being in the bedroom, a strucural brain lesion and sleeping. CONCLUSIONS: In this study, authors have designed a quality scale to select papers. The relative importance of risk factors for SUDEP is demonstrated.

Age Factors↗

PubMed2005

External-beam partial-breast irradiation.

Although most studies treating patients with partial-breast irradiation have used brachytherapy, giving such treatment with external-beam techniques has many potential advantages. However, there is only limited published experience using this approach. These include a randomized trial of partial-breast and whole-breast irradiation performed at the Christie Hospital in Manchester, England, and pilot studies (using much more rigorous selection criteria and sophisticated treatment planning) from groups at the University of Southern California, New York University (using prone positioning of patients), and the William Beaumont Hospital (using the supine position). A multi-institutional pilot trial based on the latter technique has been completed, which was designed to test the feasibility of using this approach in the cooperative oncology group setting. The unprecedented rapidity with which the study completed its target accrual indicates the degree of interest in this approach. This review focuses on the rationale and the reported studies of external-beam partial-breast radiation and identifies some specific issues and remaining problems associated with this approach.

Breast Neoplasms↗

PubMed2006

Posterior retroperitoneoscopic adrenalectomy--results of 560 procedures in 520 patients.

BACKGROUND: The posterior retroperitoneoscopic adrenalectomy is less popular than the laparoscopic transabdominal method. Due to the direct approach to the adrenal glands, however, the posterior retroperitoneal access is easy to use and may offer advantages not available with other endoscopic procedures for adrenalectomy. METHODS: Between July 1994 and March 2006, we performed 560 adrenalectomies (right side: n = 258; left side: n = 302) by the posterior retroperitoneoscopic approach in 520 patients (200 male, 320 female; age, 10 to 83 years). Of the 520 patients, 21 suffered from Cushing's disease, 499 patients had adrenal tumors (157 Conn's adenomas, 120 pheochromocytomas [13 bilateral], 110 Cushing's adenomas [6 bilateral], and 112 other tumors). Tumor size ranged from 0.5 to 10 cm (mean, 2.9 +/- 1.7 cm). The procedures were performed with the patients in the prone position usually with 3 trocars. RESULTS: Mortality was zero. Conversions to open or laparoscopic lateral surgery were necessary in 9 patients (1.7%). Major complications occurred in 1.3% of patients, minor complications in 14.4%. Mean operating time was 67 +/- 40 min and declined significantly (P < .001) from the early procedures (106 +/- 46 min) to the later operations (40 +/- 15 min). CONCLUSIONS: The posterior retroperitoneoscopic adrenalectomy is a safe and fast procedure. In experienced hands, this method represents the ideal approach in adrenal surgery.

Adolescent↗

PubMed2005

Appropriate cutoff for treatment of distal ureteral stones by single session in situ extracorporeal shock wave lithotripsy.

OBJECTIVES: To determine an appropriate cutoff for treatment by single session in situ extracorporeal shock wave lithotripsy for a prevesical stone by determining the differences in the efficiency quotient (EQ). METHODS: This was a review of a series of patients who underwent shock wave lithotripsy for a primary, single, prevesical stone from January 1995 to June 2003. All 153 patients were treated using a Dornier MPL 9000 lithotripter in the prone position under intravenous sedation. The stone size was measured in two dimensions (parallel and perpendicular to the long axis of the ureter). The EQ was calculated using a standard formula. RESULTS: Of the 153 patients, 141 (92.2%) were stone free within a mean period of 12.2 +/- 12.2 days (EQ 68.8). No significant complications occurred, and none of the patients required admission. The treatment failed in 10 patients (6.5%), who subsequently required an ancillary procedure (ureteroscopy). Statistically, we found 7 mm to be an appropriate cutoff for treatment using in situ shock wave lithotripsy. The EQ for stones greater than 7 mm and those 7 mm or smaller was 58 and 81, with a stone-free period of 13.6 +/- 12.9 and 10.9 +/- 11.6 days, respectively. CONCLUSIONS: Ultrasound-guided shock wave lithotripsy is an efficient and safe modality for the treatment of prevesical stones 7 mm or less. Using an echo-guided lithotripter, the treatment was a radiation-free, day care procedure performed under intravenous sedation. Only 11% of our patients required repeat treatment.

Adolescent↗

PubMed2001

An overview of reflux-associated disorders in infants: apnea, laryngospasm, and aspiration.

Problematic airway responses in infants are common. Reflux-induced apnea affects nearly 1% of infants and involves airway closure or laryngospasm. Recurrent or chronic stridor, caused by dynamic or structural airway abnormalities, occurs in up to 1 in 100 babies. It can be difficult to distinguish microaspiration, which may represent inadequate airway protection mechanisms, from reflexive responses to esophageal refluxate, which may represent overeffective airway protection mechanisms. The diagnosis of gastroesophageal reflux (GER) in babies can be facilitated by a careful history in conjunction with esophageal pH probe monitoring, laryngoscopic evaluation, bronchoalveolar lavage, or nuclear medicine scintigraphy. Conservative lifestyle measures for treating supraesophageal manifestations of infantile GER include prone positioning and thickened feedings. Prokinetic and acid-suppressing therapies are widely used, but their efficacy is incompletely established, and none is currently approved by the US Food and Drug Administration for this purpose. Fundoplication is not indicated if nonsurgical management can prevent serious problems during the child's maturation phase when many of these manifestations spontaneously resolve. Much remains to be learned about the developmental aspects of these supraesophageal manifestations of GER. This information not only will provide a greater understanding of developmental pathophysiology, but also will improve the clinical care of large numbers of infants.

Apnea↗

PubMed2001

Pars plana vitrectomy, subretinal injection of tissue plasminogen activator, and fluid-gas exchange for displacement of thick submacular hemorrhage in age-related macular degeneration.

PURPOSE: To evaluate a new procedure for displacement of large, thick submacular hemorrhage in patients with age-related macular degeneration. METHODS: Retrospective review of 11 eyes of 11 patients with age-related macular degeneration and thick submacular hemorrhage (defined as causing retinal elevation detectable on stereo fundus photographs) treated with vitrectomy, subretinal injection of tissue plasminogen activator (25 or 50 microg), and fluid-gas exchange with postoperative prone positioning. Outcome measures included displacement of hemorrhage from the fovea, best postoperative visual acuity, and final postoperative visual acuity. RESULTS: In the 11 affected eyes of 11 patients (seven men and four women; mean age, 76 years), preoperative visual acuity ranged from 20/200 to hand motions. With surgery, subretinal hemorrhage was displaced from the fovea in all 11 cases. Mean postoperative follow-up was 6.5 months (range, 1 to 15 months). Best postoperative visual acuity varied from 20/30 to 5/200, with improvement in nine (82%) cases and no change in two cases. Eight eyes (73%) measured 20/200 or better, with four of these eyes (36%) 20/80 or better. Final postoperative visual acuity ranged from 20/70 to light perception, with improvement in eight (73%) cases, no change in one case, and worsening in two cases. A statistically significant difference was found between preoperative and best postoperative visual acuity (P =.004) but not between preoperative and final visual acuity (P =.16). Hemorrhage recurred in three (27%) eyes, causing severe visual loss in one eye. CONCLUSIONS: This technique displaces submacular hemorrhage from the fovea and can improve vision in patients with age-related macular degeneration. However, recurrence of hemorrhage occurred in 27% of eyes and caused severe visual loss in one eye. A randomized, prospective clinical trial is necessary to determine the efficacy of this technique in comparison with other proposed treatments.

Aged↗