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PubMed1986

Pedoscope studies on neonatal activity and center of gravity after delivery.

Seventeen normal term infants delivered at the Jikei University School of Medicine were placed daily on a pedoscope in the supine and prone position after birth, and the movement of the gravity center and changes in the activities of the extremities were assessed. The results indicated that both the activity of the extremities and the movement of the gravity center were sluggish after birth, that both increased to reach peaks within 1 to 3 days, and that then temporary decreases occurred before they increased again. The probable reason for the temporary decrease in activity may be habituation or a decrement in the infant, and it is also presumed that the increase in activity after the transitory decrease reflects natural development.

Extremities↗

PubMed2000

11-gauge vacuum assisted directional biopsy of breast calcifications, using upright stereotactic guidance.

To assess the use of a prototype vacuum assisted biopsy device on a standard upright mammography unit, using a slightly modified digital stereotactic add-on component. A group comprised of 42 sequential patients, who had been recalled from an asymptomatic mammographic screening programme, were studied. All 42 were recalled for assessment of small clusters of microcalcification, graded as indeterminate. Group 1 (21 patients) were biopsied using 14-gauge automated large core needle biopsy. Group 2 (21 patients) were biopsied using 11-gauge vacuum assisted biopsy. Both groups had mammographic guidance on the same upright mammographic unit (Siemens 3000), with Opdima Digital Stereotactic add-on. A total of 86% of specimen radiographs in Group 2 patients (vacuum assisted biopsy) showed successful sampling of the calcifications, compared to 62% of Group 1 patients (14-gauge automated large core biopsies). This study shows that vacuum assisted biopsy is possible using upright stereotactic mammography units. The technique shows promise as a biopsy tool, offering larger cores compared to 14-gauge automated large core biopsy, while requiring less space and lower purchase price compared to dedicated prone biopsy tables. The technique also offers access to biopsy in patients with posterior lesions and for patients who cannot tolerate prone positioning.

Biopsy, Needle↗

PubMed1994

The posterior approach to popliteal-crural bypass.

PURPOSE: An evaluation of the posterior approach to popliteal-crural bypass was performed to assess the feasibility and results of this technique. METHODS: A posterior approach to the popliteal and crural vessels was performed in 21 patients in the prone position over a 24-month period, with use of lesser saphenous vein and a novel exposure of the crural arteries through the vein harvest incision. RESULTS: Diabetes mellitus was present in 17 (81%) patients, and all had limb-threatening ischemia with rest pain (15 patients, 71%), ulceration (7 patients, 33%), and gangrene (8 patients, 38%). The inflow site was the supragenicular popliteal artery in four patients (19%) and the infragenicular popliteal artery in 17 patients (81%). The outflow sites were the tibioperoneal trunk in six patients (29%), the peroneal artery in nine patients (43%), the posterior tibial artery in four patients (19%), and the anterior tibial artery in two patients (10%). The distal anastomosis was performed in the proximal one third of the crural artery in 16 (76%) of the patients, with a mean lesser saphenous vein graft length of 11.2 +/- 1.7 cm. The toe-brachial pressure indexes rose from 0.20 +/- 0.07 to 0.77 +/- 0.16 (p = 0.001), all wounds healed without complication, and 19 patients (90%) were discharged with open bypass grafts and salvaged extremities. The 6-, 12-, and 18-month primary graft patency rates were 88%, 88%, and 83%, respectively (Kaplan-Meier methods). CONCLUSIONS: Thus the posterior approach to infragenicular occlusive disease represents a durable alternative to traditional approaches; sparing the greater saphenous vein, facilitating exposure of the proximal crural arteries, and minimizing the wound healing problems commonly experienced with standard techniques.

Aged↗

PubMed1997

Popliteal artery compression and force of active plantar flexion in young healthy volunteers.

PURPOSE: To define the prevalence of popliteal artery occlusion during active plantar flexion in normally active and highly trained young volunteers by measuring plantar flexion force and to assess the force level associated with popliteal artery occlusion. METHODS: Eighty-four limbs of 42 healthy subjects were studied. Eighteen subjects were highly trained athletes, and 24 were normally active persons. Plantar flexion was progressively performed in prone position against a scale. Plantar flexion force was measured in kilograms. After determination of the maximum strength (Pmax) of plantar flexion force, the level necessary to occlude the popliteal artery (Poccl) was assessed by continuously monitoring that vessel using color duplex sonography. RESULTS: Occlusion of the popliteal artery during plantar flexion was observed in 88.1% of the subjects and 77.4% of the limbs. No significant differences in prevalence were found between athletes and normally active subjects. The popliteal artery occluded at a mean plantar flexion force of 45.1 +/- 11.5 kg, which corresponded with 70.1% +/- 16.8% of the maximum force exerted during the provocation test. Poccl was not significantly different between lower limbs of athletes and nonathletes. Although in lower limbs of athletes the popliteal artery occluded at a significantly lower relative force as compared with normally active subjects (65.6% +/- 17.4% vs 74.5% +/- 17.4% of Pmax; p < 0.02), the difference was a result of two extremely low values found in a female athlete. CONCLUSION: Positional occlusion of the popliteal artery during active plantar flexion is commonly found in young healthy volunteers. Prevalence of the phenomenon depends on the force level exerted during active plantar flexion. Popliteal artery occlusion during active plantar flexion is not more frequent in athletes and occurs at a similar force level than in normally active subjects.

Adult↗

PubMed2002

Inhaled nitric oxide in ARDS.

The role of nitric oxide (NO) in numerous physiologic systems only recently has been discovered. When used as a gas, inhaled NO (iNO) has many unique properties that cause immediate improvements in pulmonary hemodynamics and oxygenation. Acute benefits in physiologic parameters have been demonstrated in numerous studies of iNO in acute respiratory distress syndrome (ARDS), but recent randomized controlled trials have failed to show improvement in outcome. The addition of other treatments that prolong or enhance the affect of iNO or its use with other ventilator modalities such as prone positioning or high-frequency ventilation offer hope that iNO may be beneficial in select groups of patients.

Administration, Inhalation↗

PubMed2003

[Cardiac arrest and secondary pulmonary oedema following accidental intramucosal injection of naphazoline in an adult].

During neurosurgery for hypophysary adenoma under general anaesthesia in a prone position, a 34 year-old-women received accidental 6 ml intramucosal injection of lidocaine with naphazoline. The patient presented a severe bradycardia associated with a major increase in arterial blood pression followed by a brief cardiac arrest. She also presented a prolonged awakening and a pulmonary oedema, which lead to mechanical ventilation. The patient rapidly recovered a normal clinical state.

Adenoma↗

PubMed1985

[An original intubation technic in a child with Pierre Robin syndrome].

Infants with Pierre Robin syndrome often present the anaesthesiologist with the challenge of upper airway obstruction and difficult tracheal intubation. An unconventional method for solving this problem was used in a 2 week old 2.2 kg term male infant who presented with severe micrognathia, a widely cleft palate and extreme glossoptosis. Hyperextension of the head in the prone position distracted the epiglottis from the glottis. Blind nasotracheal intubation was then used. The curve of the nasotracheal tube made it pass behind the epiglottis into the larynx.

Anesthesia, General↗

PubMed1988

[Respiratory obstruction during anesthesia in children with malignant mediastinal lymphoma].

In children with a malignant mediastinal lymphoma, acute respiratory occlusion can be a life-threatening complication during general anaesthesia. 26 cases have been reported since 1973, with five deaths. There were 23 boys for 3 girls, aged between 13 months and 18 years. The hazards of anaesthesia in these children are described. The risk of airway obstruction should be assessed preoperatively. General anaesthesia, carried out with the patient half-sitting, should be aimed at maintaining spontaneous breathing, and therefore muscle relaxants should be avoided. The anaesthetist should also be prepared to change the patient rapidly to a lateral or prone position; a rigid bronchoscope should always be at hand. Preoperative awareness of the risk of respiratory occlusion in these patients is essential so that the correct anaesthetic technique can be chosen and the postoperative course prepared.

Adolescent↗

PubMed2005

[Workshop to teach elderly patients how to get up from the ground: pilot prospective assessment in a hospital department of internal medicine].

BACKGROUND: Falls occur frequently among the elderly and often lead to hospitalization. Even if uninjured, some of them cannot get up again, and prolonged time on the floor and failed efforts to get up can cause complications. Training methods and exercises for getting up from the floor exist but have not been evaluated. METHODS: We set up a training course to teach elderly patients to get up from the ground and assessed it over the short term by a prospective observational study of 29 patients over 3 months. Each week, a group training session took place, followed 2-9 days later by an individual assessment conducted according to a written protocol. RESULTS: Of the 29 patients (16% of those older than 65 years admitted to our internal medicine department during this period) who received the training, 24 (80%) underwent the subsequent evaluation. Training was effective: before training, only 2 of 29 assessable patients were able to get up on their own, while at the reassessment, 11 of 24 succeeded (p=0.003). Significant improvement was observed for the first two-and most difficult-steps of the maneuver: rolling over from a supine to a prone position (p=0.003), and then moving up into a quadrupedal position (getting up onto all four limbs) (p=0.006). The only variable that appeared to predict a poor result was a Mini Mental Status (MMS) score lower than 26/30. CONCLUSION: Teaching elderly patients how to get up from the floor can be accomplished in an inpatient internal medicine department and appears to be effective in the short term. Although further studies involving more patients followed for a longer period are required to confirm and assess the actual benefits, this training is safe and can be recommended.

Accidental Falls↗

PubMed1998

An approach to the treatment of severe adult respiratory failure.

OBJECTIVES: The purpose of this article is to evaluate outcome in adult patients with severe respiratory failure managed with an approach using (1) limitation of end inspiratory pressure, (2) inverse ratio ventilation, (3) titration of PEEP by SvO2, (4) intermittent prone positioning, (5) limitation of FiO2, (6) diuresis, (7) transfusion, and (8) extracorporeal life support (ECLS) if patients failed to respond. PATIENTS AND METHODS: This study was designed as a retrospective review in the intensive care unit of a tertiary referral hospital. One-hundred forty-one consecutive patients with hypoxic (n = 135) or hypercarbic (n = 6) respiratory failure referred for consideration of ECLS between 1990 and 1996. Overall, initial PaO2/FiO2 (P/F) ratio was 75+/-5 (median = 66). RESULTS: Lung recovery occurred in 67% of patients and 62% survived. Forty-one patients improved without ECLS (83% survived); 100 did not and were supported with ECLS (54% survived). Survival was greater in patients cannulated within 12 hours of arrival (59%) compared with those cannulated after 12 hours (40%, P < .05). Multiple logistic regression identified age, duration of mechanical ventilation before transfer, four or more dysfunctional organs, and the requirement for ECLS as independent predictors of mortality. CONCLUSIONS: An approach that emphasizes lung protection and early implementation of extracorporeal life support is associated with high rates of survival in patients with severe respiratory failure.

Adolescent↗

PubMed1997

Reflexes evoked in human erector spinae muscles by tapping during voluntary activity.

We studied the stretch reflexes, an early R1 and a late R2, by tapping the voluntarily contracted erector spinae muscles and recording from the same spinal level with the subject in the prone position. The onset latencies increased progressively towards the caudal level from 8.8 +/- 0.7 ms at T5-6 to 15.9 +/- 1.1 ms at L4-5 for R1, and from 33.3 +/- 2.7 ms at T5-6 to 49.1 +/- 2.8 ms at L4-5 for R2. The latency changed significantly (P < 0.05) between two adjacent segments from T5-6/T6-7 through L1-2/L2-3 for R1 and T5-6/T6-7 through L3-4/L4-5 for R2. When recorded remote from the stimulus site, R1, considered segmental in origin, showed, as expected, only a small latency change consistent with the time required for the mechanical event to propagate to the recording site. In contrast R2 was shorter in latency with more rostral stimulation irrespective of the distance to the recording sites. This finding implies a centripetal propagation of the afferent impulse along the central pathway, which shortens with more rostral site of stimulation. Of the two components, the more reproducible R1 has a potential diagnostic value for segmental evaluation of thoracic nerve root compression and truncal neuropathies.

Adult↗

PubMedDate not supplied

Evaluation of the efficacy of a forced-air warmer (Bair Hugger) during spinal surgery in children.

STUDY OBJECTIVE: To evaluate the efficacy of a forced-air warmer during spinal surgery for correction of scoliosis in children. DESIGN: Prospective randomized study (group allocation based on the availability of the warming device). SETTING: Children's teaching hospital. PATIENTS: 51 ASA physical status I and II children (mean age, 15 years; mean weight, 45 kg) scheduled for posterior spinal fusion with general anesthesia. INTERVENTIONS: Study group (warmed; n = 26)--legs covered with the forced-air warmer (Bair Hugger, Augustine Medical, Inc., Eden Prairie, MN) after installation of the patient in prone position--versus control group (n = 25)--400W heat lamp placed over the head during surgery as is usually done in our institution. MEASUREMENTS AND MAIN RESULTS: Rectal temperature was taken every 15 minutes during surgery and during the first 2 hours in the recovery room. Time required for the wake-up test, time to extubation, and blood loss also were noted. Temperature profiles were very different in the 2 groups. In the control group, rectal temperature decreased during the first 180 minutes to a minimum of 34.8 degrees C +/- 0.6 degrees C, followed by a slow rewarming phase. In the warmed group, the lowest temperature (35.6 degrees C +/- 0.5 degrees C) was recorded 45 minutes after placement of the forced-air warmer, followed by an effective warming phase. At the end of surgery, temperature was significantly higher in the warmed group than in the control group (36.5 degrees C +/- 0.8 degrees C vs. 35.4 degrees C +/- 0.9 degrees C). However, time required for the wake-up test, time to extubation, and blood loss did not differ between groups. CONCLUSION: The forced-air warmer (Bair Hugger) is effective during spinal surgery, although only about 20% of body surface area can be covered.

Adolescent↗

PubMed1997

Combined popliteal and posterior cutaneous nerve of the thigh blocks for short saphenous vein stripping in outpatients: an alternative to spinal anesthesia.

STUDY OBJECTIVE: To compare a combination of peripheral nerve blocks with spinal anesthesia in ambulatory patients undergoing short saphenous vein stripping. DESIGN: Prospective, randomized study. SETTING: University hospital. PATIENTS: 28 ASA physical status l and II ambulatory surgery patients undergoing short saphenous vein stripping. INTERVENTIONS: 14 patients received a popliteal block (sciatic nerve block at the popliteal fossa) using 30 ml of alkalinized 3% chloroprocaine and a posterior cutaneous nerve of the thigh block with 10 ml of 1% lidocaine. The 14 patients who were randomized to the spinal anesthesia group received 65 mg of 5% hyperbaric lidocaine. MEASUREMENTS AND MAIN RESULTS: There were no significant differences in age and gender between the two groups (mean age 53 +/- 13 years, 8 men and 20 women). Patients in the peripheral nerve block group recovered significantly faster in phase 1 of the postanesthesia care unit (PACU) (67 +/- 10 min vs. 122 +/- 50 min, p < 0.01) and were discharged home sooner (222 +/- 53 min vs. 294 +/- 69 min, p < 0.01) than the patients in the spinal anesthesia group. CONCLUSIONS: The combination of popliteal and posterior cutaneous nerve of the thigh blocks provided adequate anesthesia and a faster recovery profile with a similar subjective acceptance of both anesthetic techniques in ambulatory patients undergoing short saphenous vein stripping in the prone position.

Ambulatory Surgical Procedures↗

PubMed2002

EMG-angle relationship of the hamstring muscles during maximum knee flexion.

The aim of the present study was to investigate the EMG-joint angle relationship during voluntary contraction with maximum effort and the differences in activity among three hamstring muscles during knee flexion. Ten healthy subjects performed maximum voluntary isometric and isokinetic knee flexion. The isometric tests were performed for 5 s at knee angles of 60 and 90 degrees. The isokinetic test, which consisted of knee flexion from 0 to 120 degrees in the prone position, was performed at an angular velocity of 30 degrees /s (0.523 rad/s). The knee flexion torque was measured using a KIN-COM isokinetic dynamometer. The individual EMG activity of the hamstrings, i.e. the semitendinosus, semimembranosus, long head of the biceps femoris and short head of the biceps femoris muscles, was detected using a bipolar fine wire electrode. With isometric testing, the knee flexion torque at 60 degrees knee flexion was greater than that at 90 degrees. The mean peak isokinetic torque occurred from 15 to 30 degrees knee flexion angle and then the torque decreased as the knee angle increased (p<0.01). The EMG activity of the hamstring muscles varied with the change in knee flexion angle except for the short head of the biceps femoris muscle under isometric condition. With isometric contraction, the integrated EMGs of the semitendinosus and semimembranosus muscles at a knee flexion angle of 60 degrees were significantly lower than that at 90 degrees. During maximum isokinetic contraction, the integrated EMGs of the semitendinosus, semimembranosus and short head of the biceps femoris muscles increased significantly as the knee angle increased from 0 to 105 degrees of knee flexion (p<0.05). On the other hand, the integrated EMG of the long head of the biceps femoris muscle at a knee angle of 60 degrees was significantly greater than that at 90 degrees knee flexion with isometric testing (p<0.01). During maximum isokinetic contraction, the integrated EMG was the greatest at a knee angle between 15 and 30 degrees, and then significantly decreased as the knee angle increased from 30 to 120 degrees (p<0.01). These results demonstrate that the EMG activity of hamstring muscles during maximum isometric and isokinetic knee flexion varies with change in muscle length or joint angle, and that the activity of the long head of the biceps femoris muscle differs considerably from the other three heads of hamstrings.

Adult↗

PubMed2003

Changes in contractile properties and neuromuscular propagation evaluated by simultaneous mechanomyogram and electromyogram during experimentally induced hypothermia.

The present study examined, whether or not mechanomyogram (MMG) amplitude and frequency component could reflect the contractile properties of the triceps surae muscles, composed of relatively slow soleus (SOL) and fast medial gastrocnemius (MG), during experimentally induced hypothermia condition. In eight male subjects, lying in prone position, supramaximal single twitch and repetitive electrical stimulations at 10 Hz were applied at the intramuscular temperatures of control (34 degrees C), 15, 20, and 25 degrees C, respectively. The hypothermia induced substantial reduction in muscle contractile properties, e.g. prolonged twitch contraction and half relaxation times, resulted in a highly significant reduction in the fluctuation of force signal during the repetitive stimulations. These changes were almost mirrored by the similar and significant reductions in the MMG amplitude in both SOL and MG. Power spectrum analysis revealed that peak frequency components of MMG and fluctuation of force were almost matched with the applied stimulation frequencies, independent of the temperature condition. These results strongly suggest that MMG analysis could be employed to study muscle contractile properties varying across different physiological conditions.

Adult↗

PubMed1998

Preliminary technique of laparoscopic extraperitoneal infrarenal paraaortic lymphadenectomy in the porcine model.

We developed an extraperitoneal approach to laparoscopic infrarenal paraaortic lymphadenectomy in the porcine model, with the ultimate aim of shortening the long learning curve of this procedure in humans. Surgery was performed on four females pigs with three 10-mm cannulas placed along the midaxillary line in prone position. The first and second pigs underwent subsequent laparotomy to evaluate the adequacy of lymph node dissection and complications. In all four animals, complete infrarenal paraaortic lymphadenectomy was successful, retrieving between 6 and 11 lymph nodes (average 9). Laparotomy in the first two animals confirmed adequate lymphadenectomy. No complications occurred. Operating time was shortened dramatically with each procedure (180, 120, 50, 40 min). In the porcine model this approach provides excellent exposure to the entire paraaortic lymphatic chain, is safe, and has a remarkably short learning curve. Development of a similar technique in humans may have significant advantages, including short learning curve, feasibility in obese patients and those with peritoneal adhesions, decreased adhesion formation, and reduced bowel complications associated with postoperative adjuvant irradiation. Further studies are indicated.

Animals↗

PubMedDate not supplied

Continuous inferior mesenteric ganglion block for the control of abdominal pain.

BACKGROUND AND OBJECTIVES: A 71-year-old woman was referred for control of intractable left-sided abdominal pain and constipation caused by stage 2B rectosigmoid colon cancer. She was treated with an intravenous morphine sulfate infusion at 4 mg/h which made her drowsy and lethargic. Because the distal colon is innervated by the inferior mesenteric sympathetic ganglion, it was hypothesized that a continuous block of this ganglion would provide both pain control and increased intestinal motility. METHODS: The patient was placed in a prone position, and a Tuohy needle was placed at an entry site 7 cm lateral to the L3 spinous process. The needle was advanced 2 cm anterior to the L3 vertebral body with fluoroscopic guidance. An 18-gauge indwelling catheter was placed through the needle and a continuous infusion with 0.1% bupivacaine was maintained for 4 days. RESULTS: The patient obtained immediate pain relief and bowel motility. She remained awake and comfortable throughout the duration of therapy. She was discharged home 3 days after stopping the infusion and required a minimal amount of opioids. CONCLUSION: Continuous inferior mesenteric ganglion block may be an option in providing relief for pain caused by distal colon pathology.

Abdominal Pain↗

PubMed1999

Sleeping environments as risk factors of sudden infant death syndrome in Japan.

For the purpose of assessing the risk factors of the sleeping environment in SIDS, we performed a population-based, case-control study. Index cases comprised 56 SIDS cases which were diagnosed on the basis of autopsies during a period of 11 years at the Department of Legal Medicine, Faculty of Medicine, University of the Ryukyus. Control cases comprised infants who were examined at regional health centers for Infant Health Screening. The incidence of SIDS obtained was 0.25 per 1000 live births, which was comparable to that obtained in other districts having the established medical examiner's system. The proportion of prone sleeping was 81.0% and 38.3% in the SIDS and control groups, respectively, and an odds ratio was calculated as 10.4 (99% confidence interval, 3.9 to 37.6). This indicates that prone sleeping is a risk factor of SIDS, in Japan, as reported in various countries. Various kinds of bedclothes were used in this country, and our survey of bedclothes in the control revealed their improper use for infants to sleep, particularly with the prone position. In addition, the co-sleeping habit, which was not uncommon in Japan, seems to contribute to certain deaths of infants whose causes of death were controversial. In the investigation of SIDS, therefore, the sleeping environments, such as bedclothes and the co-sleeping habit, as well as the sleeping position should be taken into consideration as risk factors.

Journal Article↗