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Supine Position (supine + position)
Selected AbstractsScapular Bone Flap Harvests of Patients in a Supine Position,THE LARYNGOSCOPE, Issue 6 2004Toshiro Nishimura MD No abstract is available for this article. [source] A Refined Surgical Treatment Modality for Bromhidrosis: Double W Incision Approach with Tumescent TechniqueDERMATOLOGIC SURGERY, Issue 8 2009HANG LI PHD BACKGROUND Axillary bromhidrosis has a strong negative effect on one's social life. A high success rate and few complications are criteria for an ideal treatment method. OBJECTIVE To evaluate a new surgical treatment modality for bromhidrosis: Double W incision with full-exposure excision under tumescent anesthesia. MATERIALS & METHODS Twenty patients with bromhidrosis were treated. Patients were placed in a supine position with their treated arms abducted to 110°. After injection of 60 mL of tumescent solution into each axilla, two small W incisions were made at the superior and inferior axillary poles of the hair-bearing area. The whole hair-bearing skin was undermined at the level of the superficial fat to obtain adequate skin eversion. The flaps were everted to offer full exposure of the apocrine glands, and meticulous excision of each gland was performed. Finally, the incisions were re-approximated, and bulky compressive dressings were applied to the area for 72 hours. RESULTS Of the 40 axillae (20 patients), 32 (80.0%) showed excellent results, and eight (20.0%) had good results. Malodor was significantly decreased. There were no serious complications. CONCLUSION This technique can produce excellent results with a lower complication rate than most other surgical modalities and can be performed without costly equipment. [source] Impairment of cerebral autoregulation in diabetic patients with cardiovascular autonomic neuropathy and orthostatic hypotensionDIABETIC MEDICINE, Issue 2 2003B. N. Mankovsky Abstract Aims Impaired cerebrovascular reactivity and autoregulation has been previously reported in patients with diabetes mellitus. However, the contribution of cardiovascular diabetic autonomic neuropathy and orthostatic hypotension to the pathogenesis of such disturbances is not known. The purpose of this study was to evaluate cerebral blood flow velocity in response to standing in patients with diabetes and cardiovascular autonomic neuropathy with or without orthostatic hypotension. Methods We studied 27 patients with diabetes,eight had cardiovascular autonomic neuropathy and orthostatic hypotension (age 46.4 ± 13.5 years, diabetes duration 25.0 ± 11.0 years), seven had autonomic neuropathy without hypotension (age 47.3 ± 12.7 years, diabetes duration 26.4 ± 12.1 years), and 12 had no evidence of autonomic neuropathy (age 44.1 ± 13.8 years, diabetes duration 17.1 ± 10.2 years),and 12 control subjects (age 42.6 ± 9.7 years). Flow velocity was recorded in the right middle cerebral artery using transcranial Doppler sonography in the supine position and after active standing. Results Cerebral flow velocity in the supine position was not different between the groups studied. Active standing resulted in a significant drop of mean and diastolic flow velocities in autonomic neuropathy patients with orthostatic hypotension, while there were no such changes in the other groups. The relative changes in mean flow velocity 1 min after standing up were ,22.7 ± 16.25% in patients with neuropathy and orthostatic hypotension, +0.02 ± 9.8% in those with neuropathy without hypotension, ,2.8 ± 14.05% in patients without neuropathy, and ,9.2 ± 15.1% in controls. Conclusions Patients with diabetes and cardiovascular autonomic neuropathy with orthostatic hypotension show instability in cerebral blood flow upon active standing, which suggests impaired cerebral autoregulation. [source] The Effect of Hemodialysis on Left Ventricular Outflow Tract GradientECHOCARDIOGRAPHY, Issue 6 2010Pawel Petkow Dimitrow M.D. Background: The aim of the study was to assess the effect of hemodialysis (HD) on left ventricular outflow tract gradient (LVOTG) measured both in supine and upright position (provocative maneuver to unload LV cavity by rapid preload reduction). Supine/standing echocardiography was performed immediately before and immediately after HD. For additional verification of the hypothesis about preload-dependence of LVOTG, the echocardiograms after long (2-day delay HD due to weekend) versus short (usual 1-day) pause between HDs were compared. Methods: Forty-one patients on chronic HD (mean age 44 ± 11 years) were examined using a portable hand-carried echocardiograph. In accordance with the prestudy assumption the ultrafiltration volume was significantly greater during HD after a long pause in comparison to HD after a short pause (3707 ± 2826 mL vs. 2665 ± 1152 mL P < 0.05). Results: After a long pause, the mean value of LVOTG at the pre-HD was mildly increased in the supine position and remained at a similar level in the upright position (13.1 ± 6.1 vs. 13.6 ± 9.1 mmHg). Mean LVOTG at the post-HD in the supine position was similar to pre-HD, however the orthostatic stress test induced a significant increase of LVOTG (13.9 ± 15.2 vs. 18.2 ± 19.9 mmHg P < 0.05). After a short pause at the pre-HD the LVOTG in the supine position and after the orthostatic provocation was very similar to measurements after long pause (13.3 ± 9.1 vs. 13.3 ± 10.8 mmHg). At the post-HD the mean value of LVOTG increased during upright posture but the differences were of borderline significance (13.2 ± 6.6 vs. 17.9 ± 18.6 mmHg P = 0.052). Conclusions: HD predisposed to standing-provoked LVOTG especially when a long pause (2 days) between HDs induced a greater weight gain and subsequently a larger volume of ultrafiltration was needed to reduce hypervolemia. (Echocardiography 2010;27:603-607) [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] Anaphylaxis: Clinical concepts and research prioritiesEMERGENCY MEDICINE AUSTRALASIA, Issue 2 2006Simon GA Brown Abstract Anaphylaxis is a severe immediate-type hypersensitivity reaction characterized by life-threatening upper airway obstruction bronchospasm and hypotension. Although many episodes are easy to diagnose by the combination of characteristic skin features with other organ effects, this is not always the case and a workable clinical definition of anaphylaxis and useful biomarkers of the condition have been elusive. A recently proposed consensus definition is ready for prospective validation. The cornerstones of management are the supine position, adrenaline and volume resuscitation. An intramuscular dose of adrenaline is generally recommended to initiate treatment. If additional adrenaline is required, then a controlled intravenous infusion might be more efficacious and safer than intravenous bolus administration. Additional bronchodilator treatment with continuous salbutamol and corticosteroids are used for severe and/or refractory bronchospasm. Aggressive volume resuscitation, selective vasopressors, atropine (for bradycardia), inotropes that bypass the ,-adrenoreceptor and bedside echocardiographic assessment should be considered for hypotension that is refractory to treatment. Management guidelines continue to be opinion- and consensus-based, with retrospective studies accounting for the vast majority of clinical research papers on the topic. The clinical spectrum of anaphylaxis including major disease subgroups requires clarification, and validated scoring systems and outcome measures are needed to enable good-quality prospective observational studies and randomized controlled trials. A systematic approach with multicentre collaboration is required to improve our understanding and management of this disease. [source] Combined Oral Contraceptives do not Influence Post-Exercise Hypotension in WomenEXPERIMENTAL PHYSIOLOGY, Issue 5 2002Karen Birch The aim of the present study was to examine the pattern of cardiovascular recovery from exercise in 15 women (age, 20.3 ± 1.4 years; body mass, 61.5 ± 4.3 kg) across two phases of oral contraceptive (OC) use: 21 days of consumption and 7 days of withdrawal. Cardiovascular recovery was measured in the supine position for 60 min following 30 min of exercise at 60% maximal rate of oxygen consumption (V,O2,max). Central and peripheral haemodynamics were assessed during consumption and withdrawal of the OC pill using occlusion plethysmography, Doppler flowmetry and echocardiography. Significant hypotension occurred following exercise (P < 0.05), returning to baseline values after 60 min. The peak hypotension occurred 5 min into recovery. Cardiac output and heart rate were elevated for 60 min following exercise (P < 0.05), whilst stroke volume remained at baseline values. Heart rate was greater throughout recovery during consumption compared to withdrawal (P < 0.05); however, although there was a trend for greater responses during consumption, phase of OC use did not affect the other central cardiovascular variables (P > 0.05). Post-exercise blood flow parameters were not significantly affected by exercise or OC phase; however, calf blood flow was greater, and resistance to flow lower during consumption (P > 0.05). The pattern of post-exercise fluctuations in cardiovascular parameters may differ from those seen in men, whilst oestrogen variation may influence research findings. [source] Body Position and Cardiac Dynamic and Chronotropic Responses to Steady-State Isocapnic Hypoxaemia in HumansEXPERIMENTAL PHYSIOLOGY, Issue 2 2000S. Deborah Lucy Neural mediation of the human cardiac response to isocapnic (IC) steady-state hypoxaemia was investigated using coarse-graining spectral analysis of heart rate variability (HRV). Six young adults were exposed in random order to a hypoxia or control protocol, in supine and sitting postures, while end-tidal PCO2 (PET,CO2) was clamped at resting eucapnic levels. An initial 11 min period of euoxia (PET,O2 100 mmHg; 13.3 kPa) was followed by a 22 min exposure to hypoxia (PET,O2 55 mmHg; 7.3 kPa), or continued euoxia (control). Harmonic and fractal powers of HRV were determined for the terminal 400 heart beats in each time period. Ventilation was stimulated (P < 0.05) and cardiac dynamics altered only by exposure to hypoxia. The cardiac interpulse interval was shortened (P < 0.001) similarly during hypoxia in both body positions. Vagally mediated high-frequency harmonic power (Ph) of HRV was decreased by hypoxia only in the supine position, while the fractal dimension, also linked to cardiac vagal control, was decreased in the sitting position (P < 0.05). However, low-frequency harmonic power (Pl) and the HRV indicator of sympathetic activity (Pl/Ph) were not altered by hypoxia in either position. These results suggest that, in humans, tachycardia induced by moderate IC hypoxaemia (arterial O2 saturation Sa,O2, 85%) was mediated by vagal withdrawal, irrespective of body position and resting autonomic balance, while associated changes in HRV were positionally dependent. [source] Sympathetic control of short-term heart rate variability and its pharmacological modulationFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 4 2007Jean-Luc Elghozi Abstract The static relationship between heart rate (HR) and the activity of either vagal or sympathetic nerves is roughly linear within the physiological range of HR variations. The dynamic control of HR by autonomic nerves is characterized by a fixed time delay between the onset of changes in nerve activity and the onset of changes in HR. This delay is much longer for sympathetically than for vagally mediated changes in HR. In addition, the kinetics of the HR responses shows the properties of a low-pass filter with short (vagal) and long (sympathetic) time constants. These differences might be secondary to differences in nervous conduction times, width of synaptic cleft, kinetics of receptor activation and post-receptor events. Because of the accentuated low-pass filter characteristics of the HR response to sympathetic modulation, sympathetic influences are almost restricted to the very-low-frequency component of HR variability, but the chronotropic effects of vagal stimulation usually predominate over those of sympathetic stimulation in this frequency band. Oscillations in cardiac sympathetic nerve activity are not involved in respiratory sinus arrhythmia (high-frequency component) and make a minor contribution to HR oscillations of approximately 10-s period (low-frequency component of approximately 0.1 Hz), at least in the supine position. In the latter case, HR oscillations are derived mainly from a baroreflex, vagally mediated response to blood pressure Mayer waves. Beta-blockers and centrally acting sympathoinhibitory drugs share the ability to improve the baroreflex control of HR, possibly through vagal facilitation, which might be beneficial in several cardiovascular diseases. [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] On the accuracy of estimating living stature from skeletal length in the grave and by linear regressionINTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY, Issue 2 2005H. C. Petersen Abstract This study evaluates a method for obtaining stature estimates for populations represented by skeletal material, with individuals buried in a supine position. During the excavation of a Danish mediaeval cemetery, in situ skeletal length in the grave was measured from a point above the cranial point farthest from the body to the most distal point of the talus. The measurement was made with a folding rule placed on the sagittal midline of the skeleton, allowed to follow any curvature of the skeleton in situ. In the laboratory, stature was reconstructed anatomically, and this stature was regarded as an accurate estimate of living stature. Stature was also reconstructed from femur length by two linear regression procedures: 1) by sample and sex specific formulae, employing a leave-one-out approach, and 2) by sex wise formulae for Euro-Americans from Trotter & Gleser (1952, American Journal of Physical Anthropology10: 463,514). Skeletal length in the grave and the two stature estimates based on linear regression were compared to anatomically reconstructed stature. Skeletal length in the grave estimated anatomically reconstructed stature with practically no bias (95% CI: ,1.3,1.5,cm). Sample specific regression formulae estimated anatomically reconstructed stature also with no bias (95% CI: ,1.2,1.1,cm). In contrast, statures calculated from Trotter & Gleser's regression formulae estimated anatomically reconstructed stature with a bias of about 4,cm (95% CI: 3.3,5.0,cm). Estimates of stature variance were biased for all three estimation procedures. However, for samples of adults, an adjusted variance estimate can be obtained by subtracting 8.7,cm2 from the variance obtained from skeletal lengths in the grave. It is recommended to measure skeletal length in the grave whenever possible, and use this measurement for estimating statures for prehistoric and early historic populations. Copyright © 2005 John Wiley & Sons, Ltd. [source] Body positions and esophageal sphincter pressures in obese patients during anesthesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010A. DE LEON Background: The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) play a central role in preventing regurgitation and aspiration. The aim of the present study was to evaluate the UES, LES and barrier pressures (BP) in obese patients before and during anesthesia in different body positions. Methods: Using high-resolution solid-state manometry, we studied 17 patients (27,63 years) with a BMI,35 kg/m2 who were undergoing a laparoscopic bariatric surgery before and after anesthesia induction. Before anesthesia, the subjects were placed in the supine position, in the reverse Trendelenburg position (+20°) and in the Trendelenburg position (,20°). Thereafter, anesthesia was induced with remifentanil and propofol and maintained with remifentanil and sevoflurane, and the recordings in the different positions were repeated. Results: Before anesthesia, there were no differences in UES pressure in the different positions but compared with the other positions, it increased during the reverse Trendelenburg during anesthesia. LES pressure decreased in all body positions during anesthesia. The LES pressure increased during the Trendelenburg position before but not during anesthesia. The BP remained positive in all body positions both before and during anesthesia. Conclusion: LES pressure increased during the Trendelenburg position before anesthesia. This effect was abolished during anesthesia. LES and BPs decreased during anesthesia but remained positive in all patients regardless of the body position. [source] Ultrasonographic changes of the female bladder neck during developmentINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2002KIMIO SUGAYA Abstract Background: Our previous study showed that the anteroposterior vesical wall angle (APVA) at the bladder neck on transabdominal ultrasonography varied widely between women. The present study examines whether the APVA changes during development in girls with a normal bladder. Methods: Seventy-four females aged 0,29 years with normal bladders were examined by transabdominal ultrasonography. They were divided into six age groups and their APVA was measured in the supine position by sagittal ultrasonography. Intravenous urography was conducted to examine bladder neck descent and bladder neck opening. Results: The APVA ranged from 85 to 200°. The mean APVA in girls aged 0,4 years was 129 ± 30° (±SD) and the mean APVA in girls aged 5,9 years was 135 ± 25°. The mean APVA at ages 10,14 years was 161 ± 26°; at 15,19 years, 164 ± 33°; at 20,24 years, 164 ± 18°; and at 25,29 years, 163 ± 16°. The APVA values of these four groups were significantly larger (P < 0.05) than those of the two younger groups. No bladder abnormalities were found on intravenous urography. Conclusion: The APVA was small in some girls under 10 years of age, but the APVA of girls aged over 10 years was similar to that in young adults. The APVA may reflect bladder base plate tone and be partially related to hormonal changes in females during development. [source] Iloprost inhalation redistributes pulmonary perfusion and decreases arterial oxygenation in healthy volunteersACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009D. RIMEIKA Background: Previous studies have shown that ventilation,perfusion matching is improved in the prone as compared with that in the supine position. Regional differences in the regulation of vascular tone may explain this. We have recently demonstrated higher production of nitric oxide in dorsal compared with ventral human lung tissue. The purpose of the present study was to investigate regional differences in actions by another vasoactive mediator, namely prostacyclin. The effects on gas exchange and regional pulmonary perfusion in different body positions were investigated at increased prostacyclin levels by inhalation of a synthetic prostacyclin analogue and decreased prostacyclin levels by unselective cyclooxygenase (COX) inhibition. Methods: In 19 volunteers, regional pulmonary perfusion in the prone and supine position was assessed by single photon emission computed tomography using 99mTc macro-aggregated albumin before and after inhalation of iloprost, a stable prostacyclin analogue, or an intravenous infusion of a non-selective COX inhibitor, diclofenac. In addition, gas distribution was assessed in seven subjects using 99mTc-labelled ultra-fine carbon particles before and after iloprost inhalation in the supine position. Results: Iloprost inhalation decreased arterial PaO2 in both prone (from 14.2±0.5 to 11.7±1.7 kPa, P<0.01) and supine (from 13.7±1.4 to 10.9±2.1 kPa, P<0.01) positions. Iloprost inhalation redistributed lung perfusion from non-dependent to dependent lung regions in both prone and supine positions, while ventilation in the supine position was distributed in the opposite direction. No significant effects of non-selective COX inhibition were found in this study. Conclusions: Iloprost inhalation decreases arterial oxygenation and results in a more gravity-dependent pulmonary perfusion in both supine and prone positions in healthy humans. [source] The effect of pneumoperitoneum in the steep Trendelenburg position on cerebral oxygenationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009E. Y. PARK Background: daVinci® robot-assisted laparoscopic radical prostatectomy (RALP) requires pneumoperitoneum in the steep Trendelenburg position, which results in increased intracranial pressure and cerebral blood flow. The aim of this study was to evaluate the effect of pneumoperitoneum in a 30° Trendelenburg position on cerebral oxygenation using regional cerebral oxygen saturation (rSO2). Methods: Thirty-two male patients of ASA I and II physical status without previous episodes of cerebral ischemia or hemorrhage undergoing daVinci® RALP were enrolled. The rSO2 was continuously monitored with near-infrared spectroscopy (INVOS® 5100Ô) during the study period. Measurements were obtained immediately after anesthesia induction (T0; baseline), 5 min after a 30° Trendelenburg position (T1), 5 min after 15 mmHg pneumoperitoneum in a supine position (T2), 30, 60 and 120 min after the pneumoperitoneum in a Trendelenburg position (T3, T4 and T5, respectively) and after desufflation in a supine position (T6). Results: The change in the left and right rSO2 was statistically significant (Left P=0.004 and Right P=0.023). Both the right and the left rSO2 increased significantly during pneumoperitoneum in a Trendelenburg position (from T3 to T5) and at T6 compared with the baseline value at T0. The partial pressure of carbon dioxide (PaCO2) was increased significantly at T2, T3, T5 and T6 compared with the baseline value at T0. Conclusions: During daVinci® RALP, cerebral oxygenation, as assessed by rSO2, increased slightly, which suggests that the procedure did not induce cerebral ischemia. The PaCO2 should be maintained within the normal limit during pneumoperitoneum in a Trendelenburg position in patients undergoing daVinci® RALP because the rSO2 increased in conjunctions with the increase in PaCO2. [source] Doppler ultrasound assessment of posterior tibial artery size in humansJOURNAL OF CLINICAL ULTRASOUND, Issue 5 2006Manning J. Sabatier PhD Abstract Purpose. The difference between structural remodeling and changes in tone of peripheral arteries in the lower extremities has not been evaluated. The purpose of this study was to (1) evaluate the day-to-day reproducibility and interobserver reliability (IOR) of posterior tibial artery (PTA) diameter measurements and (2) evaluate the effect of posture on PTA diameter at rest (Drest), during 10 minutes of proximal cuff occlusion (Dmin), and after the release of cuff occlusion (Dmax), as well as range (Dmax , Dmin) and constriction [(Dmax , Drest)/(Dmax , Dmin) × 100] in vivo. Methods. We used B-mode sonography to image the PTA during each condition. Results. Day-to-day reliability was good for Drest (intraclass correlation coefficient [ICC] 0.95; mean difference 4.2%), Dmin (ICC 0.93; mean difference 5.4%), and Dmax (ICC 0.99; mean difference 2.2%). The coefficient of repeatability for IOR was 70.5 ,m, with a mean interobserver error of 4.7 ,m. The seated position decreased Drest (2.6 ± 0.2 to 2.4 ± 0.3 mm; p = 0.002), increased Dmin (2.1 ± 0.2 to 2.4 ± 0.2 mm; p = 0.001), and decreased Dmax (3.1 ± 0.4 to 2.8 ± 0.3 mm; p < 0.001) compared with the supine position. The seated position also decreased arterial range (Dmax , Dmin) from 0.9 ± 0.2 to 0.5 ± 0.1 mm (p = 0.003) and increased basal arterial constriction from 57 ± 19% to 105 ± 27% (p = 0.007). Conclusions. The system employed for measuring PTA diameter yields unbiased and consistent estimates. Furthermore, lower extremity arterial constriction and range change with posture in a manner consistent with known changes in autonomic activity. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:223,230, 2006 [source] Power Doppler sonography of the kidney: Effect of Valsalva's maneuverJOURNAL OF CLINICAL ULTRASOUND, Issue 7 2001Ryuichi Takano MD Abstract Purpose It has been reported that an intra-abdominal pressure (IAP) above 15 mm Hg may cause oliguria and that an IAP above 25 mm Hg may cause anuria. Because Valsalva's maneuver yields an IAP exceeding 180 mm Hg, it is presumed to affect renal perfusion. We evaluated the ability of power Doppler sonography to depict the changes in renal blood flow during Valsalva's maneuver. Methods Seven healthy men aged 21,24 years and 1 50-year-old man with massive ascites participated in the study. With each healthy subject lying in a supine position, longitudinal power Doppler sonograms of the kidney were obtained and analyzed semiquantitatively during Valsalva's maneuver. Also, in the patient with massive ascites, power Doppler sonography was performed before and after paracentesis. Results Along with an increase in IAP, monitored as expiratory pressure during Valsalva's maneuver, power Doppler signals decreased as indicated by both visual impression and computer scores. In the patient with massive ascites, signal intensity increased after paracentesis. Conclusions Our results demonstrated that an increase in IAP within the physiologic range affects renal perfusion and that power Doppler sonography depicts semiquantitatively the change in renal blood flow. © 2001 John Wiley & Sons, Inc. J Clin Ultra- 29:384,388, 2001. [source] Transabdominal sonography of the normal gastroesophageal junction in childrenJOURNAL OF CLINICAL ULTRASOUND, Issue 6 2001Francesco Esposito MD Abstract Purpose Because sonography identifies abnormalities of the gastroesophageal junction, it is essential to understand the normal sonographic anatomy. The aim of this study was to determine the normal sonographic appearance of the gastroesophageal junction and its variations and to provide measurements of the abdominal esophagus in asymptomatic, healthy children. Methods In this prospective study, 124 healthy children (75 boys and 49 girls), aged 2 days,12 years, underwent abdominal sonography. With the patient in a supine position, the transducer was placed under the xiphoid and the ultrasound beam was directed cephalad through the window of the left lobe of the liver. The length of the abdominal esophagus was measured from the point at which it penetrated the diaphragm to the gastroesophageal junction. The thickness was measured on the anterior wall at the midpoint of the abdominal esophagus. Results The gastroesophageal junction was identified by sonography in all of the children. The mean length of the abdominal portion of the esophagus ranged from 18 mm in the newborns to 34 mm in children older than 6 years. The wall thickness ranged from 2.4 mm to 5.7 mm. Conclusions Our results indicate that visualization of the gastroesophageal junction and measurement of the abdominal esophagus are readily achievable with real-time sonography in healthy children. © 2001 John Wiley & Sons, Inc. J Clin Ultrasound 29:326,331, 2001. [source] Hyperpolarized 3He apparent diffusion coefficient MRI of the lung: Reproducibility and volume dependency in healthy volunteers and patients with emphysemaJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2008Sandra Diaz MD Abstract Purpose To measure the apparent diffusion coefficient (ADC) of hyperpolarized (HP) 3He gas using diffusion weighted MRI in healthy volunteers and patients with emphysema and examine the reproducibility and volume dependency. Materials and Methods A total of eight healthy volunteers and 16 patients with emphysema were examined after inhalation of HP 3He gas mixed with nitrogen (N2) during breathhold starting from functional residual capacity (FRC) in supine position. Coronal diffusion-sensitized MR images were acquired. Each subject was imaged on three separate days over a seven-day period and received two different volumes (6% and 15% of total lung capacity [TLC]) of HP 3He each day. ADC maps and histograms were calculated. The mean and standard deviation (SD) of the ADC at different days and volumes were compared. Results The reproducibility of the mean ADC and SD over several days was good in both healthy volunteers and patients (SD range of 0.003,0.013 cm2/second and 0.001,0.009 cm2/second at 6% and 15% of TLC for healthy volunteers, and a SD range of 0.001,0.041 cm2/second and 0.001,0.011 cm2/second, respectively, for patients). A minor but significant increase in mean ADC with increased inhaled gas volume was observed in both groups. Conclusion Mean ADC and SD of HP 3He MRI is reproducible and discriminates well between healthy controls and patients with emphysema at the higher gas volume. This method is robust and may be useful to gain new insights into the pathophysiology and course of emphysema. J. Magn. Reson. Imaging 2008. © 2008 Wiley-Liss, Inc. [source] Mantle planning: Report of the Australasian Radiation Oncology Lymphoma Group film survey and consensus guidelinesJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 4 2000Michael B Barton SUMMARY The purpose of the present paper was to measure the variation in mantle planning in Australia and New Zealand. A chest X-ray (CXR) of a patient in the supine position with a neck node marked by wire was sent to every radiation oncologist in Australia and New Zealand. They were to mark on the CXR the lung blocks that they would use to treat this patient, assuming that the patient had stage IA Hodgkin's disease. These marks were compared with a small sample of radiologists who were asked to define the mediastinum on the same CXR. Radiation oncologists were also asked to complete a short questionnaire about other modifications to their treatment fields and their experience with this technique. One hundred and six films were sent out and 44 radiation oncologists replied. There was a maximum variation in the placement of their lung blocks of 6 cm. Half of the lung blocks were within a 2-cm range. One respondent said they would not use a mantle field to treat this patient. Mediastinal coverage was inadequate in at least 50% of cases. There was a very large variation in mantle field planning practices within Australia and New Zealand. For this reason Australasian Radiation Oncology Lymphoma Group has produced consensus guidelines for mantle block design. These are appended to the present paper. [source] The influence of morphine on the absorption of paracetamol from various formulations in subjects in the supine position, as assessed by TDx measurement of salivary paracetamol concentrationsJOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 10 2003Julia M. Kennedy ABSTRACT The aim of this study was to determine the influence of the type of paracetamol formulation on the rate of absorption when subjects are in the supine position, with or without taking concomitant morphine. Two groups of healthy volunteers were used, who were in the fasting state and remained in the supine position during the study. One group took 1500 mg of paracetamol on three occasions as conventional tablets, dispersible tablets or a suspension in a randomized crossover design. Seventeen saliva samples per subject were obtained (time zero to 360 min post-dose), which were then centrifuged and kept at ,20°C prior to analysis. The second group repeated the study following four doses of morphine syrup (10 mg 4 hourly) in the 12 h preceding paracetamol ingestion. In this phase of the study, paracetamol absorption from suspension was not investigated. A TDx assay was used to determine salivary paracetamol concentrations. The tmax for conventional tablets when taken concomitantly with morphine was 160 (+81) min compared to 51 (+58) min for subjects not taking morphine. For dispersible tablets the tmax in the morphine group was 14 (+9) min compared to 15 (+12) min without morphine. The results suggest that patients who are confined to bed and taking morphine will have an unacceptably long delay between taking conventional paracetamol tablets and the paracetamol reaching therapeutic plasma concentrations. Conversely, there is little effect on the absorption of dispersible paracetamol under the same conditions. [source] Fetal Exposure to Moderate Ethanol Doses: Heightened Operant Responsiveness Elicited by Ethanol-Related ReinforcersALCOHOLISM, Issue 11 2009Samanta M. March Background:, Prenatal exposure to moderate ethanol doses during late gestation modifies postnatal ethanol palatability and ingestion. The use of Pavlovian associative procedures has indicated that these prenatal experiences broaden the range of ethanol doses capable of supporting appetitive conditioning. Recently, a novel operant technique aimed at analyzing neonatal predisposition to gain access to ethanol has been developed. Experiment 1 tested the operant conditioning technique for developing rats described by Arias and colleagues (2007) and Bordner and colleagues (2008). In Experiment 2, we analyzed changes in the disposition to gain access to ethanol as a result of moderate prenatal exposure to the drug. Methods:, In Experiment 1, newborn pups were intraorally cannulated and placed in a supine position that allowed access to a touch-sensitive sensor. Paired pups received an intraoral administration of a given reinforcer (milk or quinine) contingent upon physical contact with the sensor. Yoked controls received similar reinforcers only when Paired pups activated the circuit. In Experiment 2, natural reinforcers (water or milk) as well as ethanol (3% or 6% v/v) or an ethanol-related reinforcer (sucrose compounded with quinine) were tested. In this experiment, pups had been exposed to water or ethanol (1 or 2 g/kg) during gestational days 17 to 20. Results:, Experiment 1 confirmed previous results showing that 1-day-old pups rapidly learn an operant task to gain access to milk, but not to gain access to a bitter tastant. Experiment 2 showed that water and milk were highly reinforcing across prenatal treatments. Furthermore, general activity during training was not affected by prenatal exposure to ethanol. Most importantly, prenatal ethanol exposure facilitated conditioning when the reinforcer was 3% v/v ethanol or a psychophysical equivalent of ethanol's gustatory properties (sucrose,quinine). Conclusions:, The present results suggest that late prenatal experience with ethanol changes the predisposition of the newborn to gain access to ethanol-related stimuli. In conjunction with prior literature, this study emphasizes the fact that intrauterine experience with ethanol not only augments ethanol's palatability and ingestion, but also facilitates the acquisition of response,stimulus associations where the drug acts as an intraoral reinforcer. [source] Arterial oxygen tension increase 2,3 h after hyperbaric oxygen therapy: a prospective observational studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2007B. Ratzenhofer-Komenda Background:, Inhalation of hyperbaric oxygen (HBO) has been reported to decrease arterial oxygen tension (PaO2) in the early period after exposure. The current investigation aimed at evaluating whether and to what extent arterial blood gases were affected in mechanically ventilated intensive care patients within 6 h after HBO treatment. Methods:, Arterial blood gases were measured in 11 ventilated subjects [nine males, two females, synchronized intermittent mandatory ventilation (SIMV) mode] undergoing HBO therapy for necrotizing soft tissue infection (seven patients), burn injury (two patients), crush injury (one patient) and major abdominal surgery (one patient). Blood gases were obtained with the patients in the supine position under continuous analgesia and sedation before the hyperbaric session (baseline), during isopression, after decompression, after each transport, and 1, 2, 3 and 6 h after exposure. Heart rates and blood pressures were recorded. Intensive care unit (ICU) ventilator settings remained unchanged. Transport and chamber ventilator settings were adjusted to baseline with maintenance of tidal volumes and positive end-expiratory pressure (PEEP) levels. The hyperbaric protocol consisted of 222.9 kPa (2.2 absolute atmospheres) and a 50-min isopression phase. The paired Wilcoxon's test was used. Results:, Major findings (median values, 25%/75% quantiles) as per cent change of baseline: PaO2 values decreased by 19.7% (7.0/31.7, P < 0.01) after 1 h and were elevated over baseline by 9.3% (1.5/13.7, P < 0.05) after 3 h. SaO2, alveolar-arterial oxygen tension difference and PaO2/FiO2 ratio behaved concomitantly. Acid-base status and carbon dioxide tension were unaffected. Conclusion:, Arterial oxygen tension declines transiently after HBO and subsequently improves over baseline in intensive care patients on volume-controlled mechanical ventilation. The effectiveness of other ventilation modes or a standardized recruitment manoeuvre has yet to be evaluated. [source] Stroke volume of the heart and thoracic fluid content during head-up and head-down tilt in humansACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2005J. J. Van Lieshout Background:, The stroke volume (SV) of the heart depends on the diastolic volume but, for the intact organism, central pressures are applied widely to express the filling of the heart. Methods:, This study evaluates the interdependence of SV and thoracic electrical admittance of thoracic fluid content (TA) vs. the central venous (CVP), mean pulmonary artery (MPAP) and pulmonary artery wedge (PAWP) pressures during head-up (HUT) and head-down (HDT) tilt in nine healthy humans. Results:, From the supine position to 20° HDT, SV [112 ± 18 ml; mean ± standard deviation (SD)], TA (30.8 ± 7.1 mS) and CVP (3.6 ± 0.9 mmHg) did not change significantly, whereas MPAP (from 13.9 ± 2.7 to 16.1 ± 2.5 mmHg) and PAWP (from 8.8 ± 3.4 to 11.3 ± 2.5 mmHg; P < 0.05) increased. Conversely, during 70° HUT, SV (to 65 ± 24 ml) decreased, together with CVP (to 0.9 ± 1.4 mmHg; P < 0.001), MPAP (to 9.3 ± 3.8 mmHg; P < 0.01), PAWP (to 0.7 ± 3.3 mmHg; P < 0.001) and TA (to 26.7 ± 6.8 mS; P < 0.01). However, from 20 to 50 min of HUT, SV decreased further (to 48 ± 21 ml; P < 0.001), whereas the central pressures did not change significantly. Conclusions:, During both HUT and HDT, SV of the heart changed with the thoracic fluid content rather than with the central vascular pressures. These findings confirm that the function of the heart relates to its volume rather than to its so-called filling pressures. [source] Effects of intra-abdominal CO2 -insufflation on normal and impaired myocardial function: an experimental studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2003C. A. Greim Background:, Intra-abdominal pressure (IAP) elevation during CO2 -pneumoperitoneum increases cardiac afterload and may enhance dysfunction of the already compromized heart. This study focused on the effects of acute IAP increases on left and right ventricular loadings and contractility in the heart with impaired global function. Methods:, Impairment of myocardial function (IMF) was pharmacologically induced in 16 pigs by administration of halothane and propranolol, while baseline arterial pressure was maintained by intravenous phenylephrine. Intra-abdominal pressure was gradually increased by 10 mmHg up to 30 mmHg in the supine position (IMF group 1, n = 8) or in a head-down tilted position (IMF group 2, n = 8). In two control groups with normal myocardial function, IAP was also increased in the supine position or the head-down tilted position. Cardiac function in all groups was assessed by epicardial echocardiography, intraventricular pressure measurements and pulmonary artery catheterization. Results:, The increase in IAP was accompanied by a transient rise in LV end-systolic wall stress and reduced cardiac output significantly by 16,24% in all groups. In the IMF groups, LV end-diastolic transmural pressure increased by 34,60% to peak values of 24 mmHg, while cross-sectional LV end-diastolic areas remained unchanged. Increases in right ventricular end-diastolic volume and decreases in right ventricular ejection fraction as well as in cardiac output were most pronounced at IAP 20 mmHg and significantly stronger in both IMF groups than in the control groups (P < 0.001). Conclusion:, Following the acute elevation of IAP, the right ventricular volume load shifted more extensively in the IMF groups than in the animals with normal myocardial function. Myocardial function in the impaired heart may worsen during IAP elevation due to right ventricular load alterations rather than a LV afterload increase. [source] Effect of delayed supine positioning after induction of spinal anaesthesia for caesarean sectionACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2002F. Køhler Background: The study tested the hypothesis that the incidence of hypotension during spinal anaesthesia for caesarean section is less in parturients who remain in the sitting position for 3 min compared with parturients who are placed in the modified supine position immediately after induction of spinal anesthesia. Methods: Spinal anaesthesia was induced with the woman in the sitting position using 2.8 ml hyperbaric bupivacaine 0.5% at the L3,4 or L2,3 interspace. Ninety-eight patients scheduled for elective caesarean section under spinal anaesthesia were randomised to assume the supine position on an operating table tilted 10° to the left (modified supine position) immediately after spinal injection (group 0, n=52) or to remain in the sitting position for 3 min before they also assumed the modified supine position (group 3, n=46). Isotonic saline 2,300 ml was given intravenously over 15 min before spinal injection followed by 15 ml/kg over 15,20 min after induction of spinal anaesthesia. If the systolic blood pressure decreased to less than 70% of baseline or to less than 100 mmHg or if there was any complaint of nausea, ephedrine was given in 5 mg boluses intravenously every 2 min. Results: The blood pressure decreased significantly in both groups following spinal injection (P<0.001). Blood pressure variations over time differed significantly between the two groups (P<0.05). However, the incidence of maternal hypotension before delivery was similar in the two groups. The difference was caused by the time to the blood pressure nadir being significantly shorter in group 0 compared with group 3 (9.1±4.5 min vs. 11.7±3.7 min, P<0.01). Similar numbers of patients received rescue with ephedrine before delivery: 35 (67%) in group 0 vs. 26 (57%) in group 3 (NS). The mean total dose of ephedrine before delivery was 10.9 mg in group 0 vs. 9.2 mg in group 3 (NS). There were no differences in neonatal outcome between the two groups. Conclusion: At elective caesarean section, a 3-min delay before supine positioning does not influence the incidence of maternal hypotension after induction of spinal anaesthesia in the sitting position with 2.8 ml of bupivacaine 0.5% with 8% dextrose. [source] Characterization of autonomic dysfunction in patients with irritable bowel syndrome using fingertip blood flowNEUROGASTROENTEROLOGY & MOTILITY, Issue 5 2008T. Tanaka Abstract, Fingertip blood flow (FTBF) as measured by laser Doppler flowmetry (LDF) measurement is considered an indicator of sympathetic nerve function. We evaluated autonomic function in patients with irritable bowel syndrome (IBS) by assessing FTBF with both LDF and continuous-wave (cw) Doppler sonography. Firstly, the two methods were compared in 40 healthy volunteers. Next, 59 patients with IBS as well as 118 healthy volunteer controls were studied. In the supine position, FTBF in the right index finger was measured with cw Doppler sonography, whereas FTBF in the left index finger was assessed with LDF. After baseline measurement for at least 5 min, the volunteers received sympathetic stimulation from cold stress applied without notification in the form of an icebag (0 °C) upon the left forearm for 1 min. The new cw Doppler sonography method can be used in place of the old LDF method for clinical purposes. FTBF velocity before stimulation (Vpre) was significantly lower in the IBS group than that in the healthy volunteers (P < 0.01). In addition, the time required for FTBF to return to Vpre after stimulation was significantly longer in the IBS group than that in the control group. (P = 0.02). Thus, measurement of FTBF with cw Doppler sonography can be useful in the assessment of sympathetic nerve function. The IBS patients showed an abnormal FTBF response suggesting the presence of excess sympathetic activity. [source] Relationship between urinary profile of the endogenous steroids and postmenopausal women with stress urinary incontinenceNEUROUROLOGY AND URODYNAMICS, Issue 3 2003S.W. Bai Abstract Aims The aims of this study were to investigate whether endogenous steroid hormones are (1) related to pathogenesis of stress urinary incontinence after menopause, (2) are related to severity of stress urinary incontinence, and (3) are related to prognostic parameters of stress urinary incontinence. Methods Twenty post-partum women with clinically diagnosed stress urinary incontinence and 20 age-matched postmenopausal women without stress urinary incontinence (control group) were evaluated. We compared urinary profile of the endogenous steroid hormones patients with stress urinary incontinence and controls, and between grade I and grade II of stress urinary incontinence. We also in vestigated the relationship between urinary profile of the endogenous steroid hormones and prognostic parameters of stress urinary incontinence (maximal urethral closure pressure, functional urethral length, Valsalva leak point pressure, cough leak point pressure, posterior urethrovesical angle, bladder neck descent, and stress urethral axis). The ages of the patients and those in the control group were 64.3,±,5.6 and 57.5,±,3.8 years old and the body mass indexes were 24.96,±,3.14 and 22.11,±, 2.73 kg/m2 in patients and in normal subjects, respectively. Nine patients were grade I and 11 were grade II. Estrone and 17,-estradiol only were detected in all subjects, regardless of control or patient group. It is noteworthy that there were no significant differ ences (P,>,0.05) in the levels of estrone and 17,-estradiol in the urine of postmenopausal normal subjects compared with in the urine of postmenopausal patients with urinary incontinence. E2/E1 ratio was not different between the two groups (P,>,0.05). Among the objective steroids, DHEA, ,4 -dione, ,5 -diol, Te, DHT, 16,-DHT, 11-keto An, THDOC, and THB were not detected either in the urine of normal subjects and nor in the urine of the patients. After comparing androgen levels between normal subjects and patients, no significant differences (P>0.05) were detected, except for 5,-THB and 5,-THF. Neither 5,-THB or 5,-THF were detected in the patients' urine. Et/An (11,-OH Et/11,-OH An) concentration ratios were not significantly different between the two groups, either (P,>,0.05). There were not significant differences of concentrations (,mol/g creatinine) of urinary steroids between grade I and grade II of stress urinary incontinence. Pregnanediol was significantly related to bladder neck descent in supine and sitting positions (R,=,0.79, P,=,0.01, and R,=,0.73, P,=,0.03, respectively), and pregnanetriol was significantly related to maximal urethral closure pressure and functional urethral length (R,=,0.68, P,=,0.04, and R,=,,0.79, P,=,0.01, respectively). Androsterone was significantly related to bladder neck descent in supine and sitting positions (R,=,0.68, P,=,0.04, and R,=,0.78, P,=,0.01, respectively). 5-AT was significantly related to bladder neck descent in sitting position and stress urethral axis (R,=,0.72, P,=,0.03, and R,=,,0.71, P,=,0.03). 11-Keto Et was significantly related to bladder neck descent in supine and sitting positions and related to stress ure thral axis (R,=,0.82, P,=,0.01, and R,=,0.81, P,=,0.01, R,=,,0.67, P,=,0.04, respectively). THS was signi ficantly related to bladder neck descent in supine and sitting positions and related to stress urethral axis (R,=,0.76, P,=,0.02, and R,=,0.74, P,=,0.02, R,=,,0.68, P,=,0.04, respectively). THE was significantly related to bladder neck descent in sitting position (R,=,0.67, P,=,0.04).,-Tetrahydrocortisol/,-tetrahydrocortisol (,-THF/,-THF) and ,-cortol were significantly related to maximal urethral closure pressure and functional urethral length (R,=,0.74, P,=,0.02, and R,=,,0.92, P,=,0.01; R,=,0.71, P,=,0.36, and R,=,,0.87, P,=,0.000, respectively). 17,-Estradiol (E2) was significantly related to bladder neck descent in supine position (R,=,,0.62, P,=,0.04) and 17,-estradiol/estrone (E2/E1) was significantly related to cough leak point pressure (R,=,0.79, P,=,0.01). In conclusion, the urinary concentrations of endogenous steroid metabolites in postmenopausal patients with stress urinary incontinence were not significantly different from normal patients and were not significantly different between grade I and grade II patients with stress urinary incontinence. Some endogenous steroid metabolites were positively or negatively significantly related to prognostic parameters of stress urinary incontinence. Neurourol. Urodynam. 22:198,205, 2003. © 2003 Wiley-Liss, Inc. [source] Acute Effects of Moxonidine on Cardiac Autonomic ModulationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2010DAYIMI KAYA M.D. Background: Moxonidine, an imidazoline I1 receptor agonist, is a centrally acting antihypertensive agent having sympatholytic effect. However, there are only limited data regarding the effects of this drug on autonomic cardiac functions. Methods and results: In this study we investigated the acute effects of moxonidine on cardiac autonomic modulation by heart rate variability (HRV) analysis. The effects of oral 0.4-mg moxonidine were studied on 11 healthy male volunteers in a randomized, double-blind, placebo controlled, and crossover study. After 15 minutes rest, time and frequency domain parameters of HRV were calculated from 5-minute continue electrocardiography recordings in supine position, during controlled respiration (15 breath/min) and during handgrip exercise before and 1 hour after taking placebo or moxonidine. Baseline parameters before taking placebo and moxonidine were similar (P > 0.05). Moxonidine, but not placebo, caused an increase in heart failure (HF) (119 ± 21 vs 156 ± 23, P = 0.029) and HFnu (39 ± 4 vs 47 ± 4, P = 0.033) and decrease in LFnu (61 ± 4 vs 53 ± 4, P = 0.033) and LF/HF ratio (1.96 ± 0.36 vs 1.12 ± 0.35, P = 0.010) in supine position compared with baseline parameters. However, there was no difference in other time or frequency domain parameters during controlled breathing and handgrip exercise either with moxonidine or placebo administration (P > 0.05). Single dose of moxonidine administration increases cardiovagal tone but parasympathetic and sympathetic autonomic maneuvers attenuated its short term effects on HRV in healthy male subjects. (PACE 2010; 929,933) [source] Outcomes Studies of Epiglottic and Base of Tongue Prolapse in Children,THE LARYNGOSCOPE, Issue 3 2008FACS, Robert F. Yellon MD Abstract Objectives: The purpose of this study was to compare previously reported flexible fiberoptic laryngoscopy (FFL) findings of a grading system for children with epiglottic and base of tongue (EBT) prolapse with findings at follow-up FFL. Surgical outcomes and tracheotomy decannulation are also reported. Study Design: Retrospective medical record review. Methods: Fourteen children with EBT prolapse had transnasal FFL in the supine position on at least two occasions. Findings were graded for initial versus most recent FFL. The previously published EBT prolapse grading system was reapplied. Mean age was 8.7 years at the last evaluation. Mean interval between initial and most recent FFL was 1.9 years. Results: At follow-up FFL, six (43%) children had the same grade of EBT prolapse, five (36%) had a milder grade, and three (21%) had a more severe grade. Five (36%) children were decannulated, and nine (64%) children remain tracheotomy dependant. Of nine children who had surgery, four (44%) were decannulated. Eight (89%) of nine children who were not decannulated have a history of developmental delay (P < .03). Twelve (86%) children had gastroesophageal reflux disease, and six (43%) had abnormal swallowing function. Conclusions: The grading system was successfully reapplied to compare initial with follow-up findings in a cohort of children with EBT prolapse. Gastroesophageal reflux disease and swallowing dysfunction are common in this population. Judicious surgery may have some efficacy for EBT prolapse in selected patients. Many children with EBT prolapse still require tracheotomy, especially those with developmental delay. [source] | |||||||||||||||||||||||||||||||