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Results for “Prone Position”

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PubMed1987

Low viscosity liquid fluorochemicals in vitreous surgery.

Low viscosity liquid fluorocarbons have physical properties potentially useful as intraoperative adjuncts during vitreous surgery for complicated retinal detachments. These substances are optically clear, have specific gravity greater than that of water, and interfacila tension properties similar to those of silicone oil. In four patients who had complicated retinal detachments I used perfluorotributylamine and perfluorodecalin during vitreous surgery. Two giant retinal tears were flattened intraoperatively without turning the patient into the prone position. In two patients with severe proliferative vitreoretinopathy, perfluorotributylamine allowed adequate retinal tamponade and avoided a posterior retinotomy for internal drainage of subretinal fluid. Endophotocoagulation was applied.

Adolescent↗

PubMed1995

Superior mesenteric artery syndrome in traumatic brain injury: two cases.

One of the many causes of enteral feeding (EF) intolerance after traumatic brain injury (TBI) is superior mesenteric artery syndrome (SMAS). Although it is reported in pediatric brain injury, few cases are noted in adults. To increase awareness of this medically treatable condition, we present two patients who developed SMAS after sustaining severe brain injury. SMAS results from compression of the duodenum by the SMA against the aorta and risk factors include acute weight loss, prolonged recumbency, and spasticity--all frequently encountered in severe TBI. After gastric decompression, symptoms often resolve with weight gain achieved by conservative treatment; including feeding in the left lateral or prone position, hyperalimentation, or extension of a feeding tube beyond the obstruction. SMAS should be considered in the presence of EF intolerance in severe adult TBI because multiple risk factors may be present.

Adult↗

PubMed1977

Pseudocysts: diagnosis in the adult by total body opacification.

Recent use of higher doses of contrast material for excretory urography in adults has made differentiation between cystic and solid masses feasible in adults just as it has been in children. The first two adults to have the cystic nature of their pseudocysts ascertained by total body opacification are presented. In one case, the mass was not palpable because the abdomen was markedly tender, suggesting that total body opacification may be helpful in the examination of the acute abdomen. The second case suggests the importance of the prone position.

Adolescent↗

PubMed1988

The value of high definition, narrow section computed tomography in fibrosing alveolitis.

Fibrosing alveolitis was studied by high definition, narrow section computed tomography (CT) in 50 patients, 30 of whom were suffering from systemic sclerosis and 20 from cryptogenic fibrosing alveolitis (CFA). Apart from changes in the mid and lower zones, abnormalities were also observed anteriorly in the upper lobes and in the pleura. Scanning in the prone position was important in seeking evidence of minimal pathological change. In systemic sclerosis CT was 24% more accurate than high kilovoltage radiography in demonstrating minimal evidence of fibrosing alveolitis; this had a characteristic distribution as a peripheral crescent of high attenuation in the lower lobes before any changes were visible on standard radiographs. The CT appearances in CFA were also characteristic, particularly when the disease appeared to be early or limited. We believe that high definition CT may be of value in suggesting the diagnosis of CFA in patients with non-specific abnormalities on the chest radiograph.

Humans↗

PubMedDate not supplied

Delayed biliary drainage is common in asymptomatic post-cholecystectomy volunteers.

A commonly used diagnostic criterion for sphincter of Oddi dysfunction is delayed drainage of contrast media from the bile ducts at endoscopic retrograde cholangiography (ERC), which is defined as the persistence of contrast greater than 45 min after injection. We performed ERC in 11 asymptomatic post-cholecystectomy volunteers for the purpose of evaluating biliary drainage time. In an attempt to more accurately quantify emptying, concomitant scintigraphy was performed at the time of ERC and contrast drainage. Sufficient contrast mixed with technetium-99m sulfur colloid to completely fill out the intra-hepatic tree was injected (mean volume, 9 ml) and the volunteers remained in the prone position during imaging. The length of time from cholecystectomy, bile duct size, volume of contrast injected, and scintigraphic T1/2s did not correlate with drainage time at ERC. At 45 min after injection the degree of residual contrast filling was scored as: empty in three volunteers, almost empty in one, one-fourth full in 5, and one-half full in two. Therefore, 7 of the 11 asymptomatic volunteers (63%) had delayed drainage. Even if more stringent criteria for delayed drainage were used (ducts one-half filled), 2 of the 11 (18%) had abnormal drainage. The frequent occurrence of delayed drainage in these asymptomatic post-cholecystectomy volunteers challenges the validity of the 45-min delayed drainage criterion for sphincter of Oddi dysfunction.

Adult↗

PubMed2002

The frictional properties at the thoracic skin-fascia interface: implications in spine manipulation.

OBJECTIVE: To assess the friction at the thoracic skin-fascia interface to determine the potential reaction force vectors during thoracic manual therapy. DESIGN: A basic in vivo study of human subjects, documenting the frictional properties at the interface between the thoracic skin and underlying fascia. BACKGROUND: Chiropractors, and other spine manipulative therapists, during thoracic manipulation have been attempting to apply force vectors to spine tissues in specific directions in addition to those applied normal to the skin. For obliquely applied forces to be directly transmitted to the underlying vertebrae, either friction is required at the skin-fascia interface or the applied force must "hook" on a bony process. METHODS: Subjects were placed in the prone position with the thoracic skin exposed. The posterior thoracic region was loaded with normal forces, incrementally from 125.3 to 392.9 N. The interface between the load and the skin was either a plexiglass plate or modelled hands. A force was then applied to either apparatus in the cephalad direction. The applied forces and corresponding displacements were measured using a load cell and an optoelectronic camera system, respectively. Chiropractors then performed actual thoracic manipulation to determine if they could maintain their location of contacts (spinous process/transverse process) on the underlying vertebra. RESULTS: Each of the subjects exhibited negligible friction between the thoracic skin and underlying fascia for both the plexiglass and modelled hand contacts. Furthermore, in each case, the apparatus travelled a distance greater than that between two transverse or spinous processes without showing an abrupt change in the slope of the force-displacement curves. The hands of chiropractors performing thoracic manipulation travelled a similar distance during the dynamic thrust. CONCLUSIONS: The skin-fascia interface over the thoracic spine exhibits negligible friction. Therefore, the reaction force from a thoracic vertebra will be normal to the overlying skin. Furthermore, the data show that the ability to "hook" either a thoracic transverse or spinous process in the superior-inferior direction during a manipulative thrust may be greatly over-rated. RELEVANCE: During thoracic spinal manipulation, one cannot direct a force vector to a thoracic vertebra at a given angle by simply directing their thrust in that direction.

Adult↗

PubMed1990

Idiopathic gastric volvulus in infancy and childhood.

Gastric volvulus is a rare condition in childhood. Most of the reported cases have been acute and secondary in type with predisposing factors. Between 1965 and 1988, 49 patients were treated at this institution for chronic idiopathic gastric volvulus. Patients were divided further into two groups according to age at admission. The main symptom was vomiting in the neonatal and infantile group, whereas it was abdominal distension, vomiting, weight loss, or constipation in the older age group. This clinical feature was different from that of acute gastric volvulus in which the symptoms resulted from gastric obstruction. Plain film of the abdomen showed no characteristic findings. Contrast study of upper gastrointestinal series showed findings similar to those of the acute volvulus, but the extent or degree was less significant. Conservative treatment was successfully undertaken for the patients in the neonatal and infantile group just by keeping them in prone position. The rationale for this method was demonstrated by the clinical and radiological improvement. Fundic gastropexy was performed in all of 18 patients of the older age group and in one of 31 patients of the neonatal and infantile group. The operative results were satisfactory except for one patient with mental retardation. In Japan, neonates or infants are customarily nursed in the supine position. This is presumed to be a reason why the chronic idiopathic gastric volvulus is frequently noticed.

Acute Disease↗

PubMed1980

Twenty-four hour exophageal pH monitoring in gastroesophageal reflux.

Twenty-four hour pH esophageal monitoring has been studied in 123 children with gastroesophageal reflux (GER) with ages ranging between 6 mo to 6 yr. The technique is described and the scoring system modified to evaluate gastroesophageal reflux in these patients. For the first time the normal patterns are presented in pediatrics (n = 20). The results obtained in 103 patients are presented, divided into pre- and post-nonoperative and surgically treated groups. The test is more objective, has greater precision, sensitivity, and reliability than contrast studies, endoscopy, acid perfusion or acid reflux tests. The study seems to indicate that esophagitis depends more on the duration of the reflux than on the number, for which the concept of esophageal acid clearance is of paramount importance. The prone position generally lessens the number of refluxes but in this position the esophageal acid clearance is altered. With a greater knowledge and more experience in this technique, we would be able to identify children at risk to develop severe complications, control them and aid in the selection of those patients requiring surgical intervention.

Child↗

PubMed1998

Construction of a female urethra using the vaginal wall and a buttock flap: experience with 40 cases.

METHODS: From 1975 to 1996 a urethra was constructed using tubularized anterior vaginal wall covered with a buttock flap in 40 female patients in whom urinary incontinence was associated with a short or absent urethra. The underlying pathology included bilateral single ectopic ureters, cloacal malformation, urogenital sinus malformation, previous failed surgery of the urethra, severe trauma, myelodysplasia, female hypospadias, ectopic ureterocele with destruction of the urethra, congenital epispadias, bladder exstrophy, and previous hysterectomy and vaginectomy for clear cell carcinoma caused by intrauterine exposure to diethylstilbestrol. Other reconstructive procedures in these patients included bladder neck narrowing from above in 33 patients, ureteral reimplantation in 35, and bladder augmentation in 21. In the prone position, a tube of vaginal wall was used to create a urethra when it was absent or lengthen the urethra if it was too short. The neourethra was extended up to the base of the clitoris, using a multilayered closure of soft tissue over it distally with introital muscle and adjacent mucosa. The proximal neourethra was covered with a buttock flap. RESULTS: All patients were originally wet. Thirty-four are now dry. Four patients have minimal stress incontinence. Two patients have urinary diversions. The majority (n=25) void normally. Fourteen patients self-catheterize to empty their bladders. One patient wears an external appliance on the abdominal wall for collection of urine. Complications included: creating stress incontinence in one patient who had been previously dry by extracting a stone from the bladder, necrosis of a buttock flap from applying a tight perineal dressing, fistula requiring surgical closure in three patients, and slippage of the buttock flap in one patient. CONCLUSION: This operation is a useful method to correct diverse congenital and acquired pathology that causes incontinence in girls.

Adult↗

PubMed1988

Metoclopramide in gastroesophageal reflux of infancy.

This study examined the effect of metoclopramide on lower esophageal sphincter (LES) pressure, and frequency and duration of reflux episodes in 28 children (mean age (+/- SD) 9 +/- 11 months) referred for evaluation of gastroesophageal reflux (GER). Esophageal manometry was performed before and after one intravenous dose of metoclopramide (0.125 mg/kg), and esophageal pH was monitored over a 24-hour baseline period, followed by oral metoclopramide therapy (0.125 mg/kg four times a day, for 24 hours.) During pH monitoring, patients received diet for age and were kept in the prone position with the head elevated 45 degrees while sleeping. Eight patients entered a 6-month double-blind, placebo-controlled trial of metoclopramide. Metoclopramide significantly (P = 0.04) increased end-expiratory LES pressure, from 14.9 +/- 7.5 mm Hg to 18.6 +/- 6.8 mm Hg. However, there was a significant (P less than 0.05) increase in the number of reflux episodes/24 hours, and no significant change in percentage of time pH was less than 4, number of episodes lasting greater than 5 minutes, or the longest episode of reflux between the 24-hour baseline and M periods. LES pressure did not correlate well with any of these measurements (r = 0.2). In the controlled trial, the three patients receiving metoclopramide, but none of those receiving placebo, were withdrawn by their parents because of exacerbation of GER symptoms and marked irritability (P = 0.01). In the placebo group, symptoms improved in four infants, but did not change in one. The use of metoclopramide in the treatment of GER of infancy needs to be reconsidered.

Double-Blind Method↗

PubMed1995

Animal model for evaluating the effect of systemic estrogen deficiency on residual ridge resorption.

The rate of resorption of residual ridges after tooth extraction varies among subjects. Despite many human studies, the etiologic factors of severe forms of resorption of residual ridges are unknown and probably multifactorial. To facilitate investigations of resorption of residual ridges, it is preferable to use an animal model with a dentoalveolar component similar to that of human beings. This study developed a rapid, nonhuman primate model in which one could measure resorption of residual ridges at the most critical period, with the least amount of time, minimal operation, and the least interference with normal nutrition. Three female Macaca fascicularis monkeys, 7 to 9 years old, were selected for simple extraction of four maxillary incisors, four mandibular incisors, and two mandibular canines. Lateral cephalographs were taken at weeks 0, 1, 2 to 3, 5 to 6, 8 to 9, 11 to 12, and 26 to 28 after extraction with a newly constructed cephalostat that allowed easy reproducibility of animal placement in the prone position. Height and area measurements were made of maxillary and mandibular anterior residual ridges in the superimposed cephalographs. Sequential mean bone loss data produced bone loss curves similar to those observed in humans. One animal underwent ovariectomy. The plasma levels of both estrogen and progesterone decreased over 25 days and stayed below the detection limits thereafter. Tooth extraction was done 4 weeks after the ovariectomy and the bone resorption pattern was able to be observed longitudinally with the newly established monkey cephalostat. The results indicated that Macaca fascicularis need not be sacrificed when used in longitudinal studies of resorption of residual ridges in a relatively short period of experimental time. This model can provide an excellent opportunity to investigate a causal relationship between the rate of resorption of residual ridges and predisposing systemic factors such as estrogen deficiency.

Alveolar Bone Loss↗

PubMed1995

Elective pneumonectomy for benign lung disease: modern-day mortality and morbidity.

This retrospective study of elective pneumonectomy for complicated inflammatory lung disease was done to define modern-day mortality and morbidity. One hundred twenty-four patients received elective pneumonectomy. Patient ages ranged from 6 months to 71 years. Past, recurrent, or new pulmonary tuberculosis was present in 107 patients (86.3%). Clinical presentation involved recurrent infections or severe suppurative sequelae (abscess, empyema). Forty-seven patients had chronic hemoptysis and 25 patients had past or recent massive hemoptysis (> 600 ml of hemoptysis fluid within 24 hours). Nutritional deficiencies were common. One hundred six patients (85.5%) had end-stage destroyed lungs. Evaluative bronchoscopy showed inflammatory endobronchial changes in 106 patients (85.5%), bronchial strictures in 4, and indolent endobronchial tumor in 2. Lung separation was by double-lumen tube in 96 patients, single lung-single tube in 6, bronchus blocker in 6, and prone posture in 9. Extrapleural pneumonectomy was done in 83 patients (66.9%). Fifty-seven of these procedures were left sided and 26 were right sided. Standard transpleural pneumonectomy was done in 41 patients (33.1%): 30 left sided and 11 right sided. Nine pneumonectomies were conducted with the patient in the prone position. Four patients had completion pneumonectomy. Hospital mortality was three deaths (2.4%). Morbidity included postpneumonectomy empyema in 19 patients (15.3%). Seven postoperative bronchopleural fistulas occurred. Empyema in most patients was managed by open pleural drainage (thoracostoma) and later space closure. Pneumonectomy proved effective therapy with low mortality but postpneumonectomy empyema posed serious morbidity.

Adolescent↗

PubMed1992

Extracorporeal shock wave lithotripsy for ureteral calculi.

Second generation tubless lithotriptors allow for easy prone positioning of patients, resulting in increased use of extracorporeal shock wave lithotripsy (ESWL) for calculi in the ureter, especially in the mid and lower third portions. The 3-month stone-free rate with single stones using a Dornier HM3 and a Medstone STS lithotriptor in the upper ureter was 79% (316 patients) and 81% (188), respectively, while in the mid ureter it was 60% (20 patients) and 81% (32), respectively, and in the lower ureter it was 80% (5 patients) and 85% (26), respectively. The retreatment rate with single stones using the Dornier HM3 and the Medstone STS devices was 5% and 4%, respectively, in the upper ureter, 13% and 12%, respectively, in the mid ureter, and 0% and 5%, respectively, in the lower ureter. The second procedure rate after ESWL with single stones using the Dornier HM3 and the Medstone STS units was 6% and 6%, respectively, in the upper ureter, 15% and 16%, respectively, in the mid ureter, and 0% and 17%, respectively, in the lower ureter. Expectant management is still an acceptable method to treat small ureteral stones, and it is questionable whether ESWL is the appropriate treatment for lower third ureteral stones compared to equally effective and less expensive ureteroscopy.

Evaluation Studies as Topic↗

PubMed1989

Technique of pudendal nerve localization for block or stimulation.

A diagnostic technique is described for study of the pudendal nerve via a dorsal rather than perineal approach. The method offers unique advantages for the urodynamic study of sphincteric function. The patient is placed in the prone position with slight flexion of the hips. The position of the ischial spine is identified topographically using the ischial tuberosities, greater trochanter and lower edge of the ischial-tuberous ligament. Local anesthesia and electrical stimulation then are used to position a needle tip adjacent to the pudendal nerve. This approach allows for specific localization of the nerve for accurate temporary or permanent nerve block. It also permits continuous urodynamic monitoring of pelvic floor behavior with stimulation of the pudendal nerve to assess functional integrity of the nerve and the pelvic floor striated muscles.

Anesthesia, Local↗

PubMed1989

Extracorporeal shock wave lithotripsy of stones in the mid ureter.

We treated successfully 16 patients with stones in the mid ureter, that is overlying the pelvic bone, in the prone position with a Dornier HM3 lithotriptor. The lithotriptor was equipped with the original reflector and generator system, and all treatments were performed with only surface anesthesia of the skin and premedication with pethidine chloride and diazepam. Between 1 and 3 sessions were necessary with up to 2,000 shock waves at each session. The generator voltage was varied between 14 and 18 kv. After completion of extracorporeal shock wave lithotripsy all patients became free of stones without ureteroscopy or transureteral manipulation except for a ureteral catheter and fluid irrigation during treatment.

Diazepam↗

PubMed1984

Sheathed catheter system for fluoroscopically guided retrograde catheterization, and brush and forceps biopsy of the upper urinary tract.

A sheathed (coaxial) ureteral catheter has been designed for use in fluoroscopically guided retrograde procedures. Once the catheter has been inserted into the ureter the inner section is removed, leaving a semiflexible sheath as a conduit for biopsy forceps, curved catheters and other instruments. The sheath facilitates ureteral stenting, forceps biopsy of the renal pelvis and brush biopsy of all calices. The sheath also helps in percutaneous stone extraction by allowing retrograde passage and removal of balloon catheters with the patient in the prone position. Cystoscopy is needed initially to insert the catheter but not to pass instruments through the sheath. Thus, procedures can be completed in a standard fluoroscopy room.

Biopsy↗

PubMed1980

Modification for computerized tomographic staging of infiltrative bladder carcinoma.

Technique modifications for computed tomographic staging of infiltrative bladder carcinoma are aimed at maximizing image quality and reducing artifactual problems, particularly those associated with the effects of motion owing to poor patient cooperation. Patients unable to tolerate a lengthy procedure or the prone position have been studied using a low density contrast technique with controlled bladder distension. Although the intravesical tumor component often is not as dramatically demonstrated as with the gas insufflation technique the accuracy of both staging procedures appears to be high. The tendency towards overstaging is common to bladder opacification and gas insufflation techniques but this may be reduced considerably by bowel opacification when necessary and the use of intravenous contrast enhancement techniques.

Aged↗

PubMed1991

A useful technique for measurement of back strength in osteoporotic and elderly patients.

Improvement of back extensor strength (BES) can be used as a therapeutic method for patients with chronic back pain and osteoporosis. The method of evaluation must be reliable and accurate without compromising the condition of the patient. We report the development of a back isometric dynamometer (BID-2000) designed specifically by two of us to address these concerns in elderly patients with osteopenia or osteoporosis. As the demographics of the general population change, increasing numbers of patients will need the type of monitoring that the BID-2000 provides. Aging has been shown to cause a reduction in the number of functional muscle motor units. To examine this effect on BES, we tested 50 normal, healthy women who were 30 to 79 years old. Proper testing of BES in patients with fragile vertebrae should include isometric measurement in the prone position, maneuverability of the device to allow comfortable positioning of the patient, and simplicity of technique to minimize repetitious performance of maximal contraction. The BID-2000 incorporates each of these features and also provides meaningful results inexpensively. The device offers a safe, reliable (coefficient of variation = 2.33%), and valid (P = 0.001) method of evaluation. The results of our study demonstrated moderate, steady reduction of BES with increasing age and with each successive decade.

Adult↗