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Left Lateral Position (leave + lateral_position)
Selected AbstractsCOLLAPSE-SUBMERGENCE METHOD: SIMPLE COLONOSCOPIC TECHNIQUE COMBINING WATER INFUSION WITH COMPLETE AIR REMOVAL FROM THE RECTOSIGMOID COLONDIGESTIVE ENDOSCOPY, Issue 1 2007Takeshi Mizukami Colonoscopy is a difficult examination to conduct for inexperienced examiners. In an attempt to improve the view, there is often a tendency to overinsufflate air, which causes elongation or acute angulations of the colon and makes passage of the scope difficult. Sakai et al. were the first to describe a simple colonoscopic technique using water infusion instead of air insufflation. We have modified this technique to simplify the procedure further by combining water infusion using disposable syringes with complete air suction from the rectum to the descending colon. With the resultant elimination of the boundary lines between water and air, a good view of the lumen is obtained though the transparent water. With the patient in the left lateral position, this procedure allows the water to flow straight down into the descending colon through the ,collapsed' lumen, and the scope to be easily negotiated through the straightened recto-sigmoid colon and sigmoid-descending colon junction with minimum discomfort. Measurements of the patients' abdominal circumference during colonoscopy showed that colonic distension hardly occurred. Under supervision by the author, six complete novices were allowed to insert the colonoscope within 10 min by this method for one patient per week, as long as the patients did not complain of pain. The average trial number for the first cecal intubation within 10 min was 3.3, and the average success rate during the first 3 months was 58.6%. We believe that this ,collapse-submergence method' is easy to master, even for inexperienced examiners. [source] Close Physical Contact of the Heart with Diaphragm Causes Pseudo-Asynergy of Left Ventricular Inferior Wall in Normal SubjectsECHOCARDIOGRAPHY, Issue 7 2004Susumu Sakurai Ph.D. Paradoxical outward movement of left ventricular (LV) inferior wall in systole is occasionally recognized in normal subjects and clinically important in terms of the differential diagnosis between physiological pseudo-asynergy and pathological asynergy. In this study, the potential mechanisms by which pseudo-asynergy of LV inferior wall (PLI) is observed in normal subjects were investigated. PLI was defined as the outward movement of LV inferior wall observed during more than 50% of systole. The incidence of PLI was evaluated in 7843 consecutive subjects in routine echocardiography. The effects of body position and artificial gravity on the manifestation of PLI were also examined. PLI was observed in 0.11% (9/7842) of subjects on left lateral position. Measurement of the angle formed by LV long-axis and the long-axis of the body on frontal plane revealed that hearts in subjects with PLI were in relatively horizontal position. PLI was observed on sitting position in 43% (40/92) of subjects without PLI on left lateral position. The subjects with sitting position-induced PLI exhibited significantly higher obesity index. PLI was also induced by artificial gravity in 67% (14/21) of healthy volunteers on supine position, and the degree of PLI correlated with the intensity of gravity. Although the incidence of PLI in routine echocardiography is relatively low, PLI can be induced in normal subjects by any condition that causes close contact of LV inferior wall to diaphragm. Thus, PLI should be taken into consideration in the differential diagnosis of abnormal LV inferior wall motion, especially when performing exercise echocardiography. [source] Ulnar neuropathy at the elbow due to unusual sleep positionEUROPEAN JOURNAL OF NEUROLOGY, Issue 1 2000J. Finsterer Abnormal strain of the ulnar nerve over the sulcus due to an unusual sleep position is a rare cause of ulnar neuropathy at the elbow. A 57-year-old patient with Mandelung's deformity developed progressive weakness in the flexion of fingers 4 and 5 and in finger straddling on the left side. Additionally, there was slight wasting of the left hypothenar and the left interossei muscles. Motor and sensory nerve conduction studies of the left ulnar nerve showed delayed conduction velocities over the left ulnar sulcus. He preferred to sleep in a left lateral position with his head lying on a headrest roll, his left forearm being flexed at 110° and his hand lying either under his cheek or placed on the roll. Only three weeks after the patient had been advised to change his sleep position and to sleep without the headrest roll, weakness markedly improved. This case shows that sleeping in a lateral position with the head on a headrest roll and the hand placed on the roll or under the cheek may cause ulnar neuropathy at the elbow. Change of such a habitual sleep position promptly resolves the symptoms. [source] The influence of bladder filling on anorectal functionCOLORECTAL DISEASE, Issue 3 2003J. J. Crosbie Abstract Objective The aim of this study was to develop a technique to simultaneously evaluate bladder and anorectal function. In particular, this study was designed to determine if anal sphincter resting pressure, anal sphincter squeeze pressure and rectal sensation change with bladder filling. Patient and methods A pilot study of ten female patients who presented to the pelvic physiology unit for assessment of urinary symptoms was performed. All patients completed a symptom questionnaire and quality of life assessment form. Following informed consent a baseline urodynamic test was performed with the bladder empty and subsequently followed by an anorectal manometric test. Changes in anal sphincter resting pressure, squeeze pressure and rectal pressure were recorded over a ten-minute period. With the patient lying in the left lateral position, the bladder was then filled with isotonic saline at room temperature at a constant rate of 30ml/min. A continuous assessment of changes in anal sphincter resting pressure during bladder filling was made. Anal sphincter squeeze pressure and rectal sensation were measured at fixed intervals during bladder filling (50, 100, 150 ml etc.) and at fixed intervals relative to bladder capacity (25, 50, 75 and 100% capacity) by stopping bladder filling at the appropriate level. Results , There was no significant change in anal sphincter resting pressure (Mean difference(s.d.) between bladder full and empty = 2.7(5.6) P = 0.92*), squeeze pressure (Mean(s.d.) difference = 9.5(26.3) P = 0.86*) and rectal sensation (Mean difference(s.d.) first sensation 10(15.2) P = 0.958; Mean difference(s.d.) urgency = 10(17.8) P = 0.07*) on bladder filling. Conclusion , Under normal physiological circumstances, bladder filling does not influence anorectal function. *Stastistical analysis: Wilcoxon signed rank sum test. P < 0.05 considered significant. Units = mmHg [source] Gravity is an important determinant of oxygenation during one-lung ventilationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2010L. L. SZEGEDI Background: The role of gravity in the redistribution of pulmonary blood flow during one-lung ventilation (OLV) has been questioned recently. To address this controversial but clinically important issue, we used an experimental approach that allowed us to differentiate the effects of gravity from the effects of hypoxic pulmonary vasoconstriction (HPV) on arterial oxygenation during OLV in patients scheduled for thoracic surgery. Methods: Forty patients with chronic obstructive pulmonary disease scheduled for right lung tumour resection were randomized to undergo dependent (left) one-lung ventilation (D-OLV; n=20) or non-dependent (right) one-lung ventilation (ND-OLV; n=20) in the supine and left lateral positions. Partial pressure of arterial oxygen (PaO2) was measured as a surrogate for ventilation/perfusion matching. Patients were studied before surgery under closed chest conditions. Results: When compared with bilateral lung ventilation, both D-OLV and ND-OLV caused a significant and equal decrease in PaO2 in the supine position. However, D-OLV in the lateral position was associated with a higher PaO2 as compared with the supine position [274.2 (77.6) vs. 181.9 (68.3) mmHg, P<0.01, analysis of variance (ANOVA)]. In contrast, in patients undergoing ND-OLV, PaO2 was always lower in the lateral as compared with the supine position [105.3 (63.2) vs. 187 (63.1) mmHg, P<0.01, ANOVA]. Conclusion: The relative position of the ventilated vs. the non-ventilated lung markedly affects arterial oxygenation during OLV. These data suggest that gravity affects ventilation,perfusion matching independent of HPV. [source] | ||||||||||