Upright Position (upright + position)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Doxycycline-induced pill esophagitis

A. Kadayifci
SUMMARY., Pill-induced esophagitis is a complication seen in patients who use certain medications such as tetracycline and non-steroidal anti-inflammatory drugs. In this short report, we described five cases of doxycycline-induced esophagitis with endoscopic images. All of the patients were young or middle-aged women. Dysphagia or odynophagia with retrosternal pain were the main presenting symptoms in all cases. The observed injuries were at the middle third of esophagus with a normal surrounding mucosa. All patients had a history of swallowing the capsule with a small amount of water or in a recumbent position. Two patients with dysphagia were managed by intravenous fluid support and parenteral acid suppression. The symptoms were improved in 2,7 days after the ceasing of the drug and control endoscopies were completely normal in all cases after 3,4 weeks of admission. The drug-induced esophagitis is not rare with certain drugs and should be suspected in all patients presenting with chest pain and dysphagia. Physicians must warn the patients to take the pills and capsules with enough liquid and in the upright position. [source]

The Effect of Hemodialysis on Left Ventricular Outflow Tract Gradient

Pawel 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]

The effect of whole-body tilt on sound lateralization

Jörg Lewald
Abstract The effect of passive whole-body tilt in the frontal plane on the lateralization of dichotic sound was investigated in human subjects. Pure-tone pulses (1 kHz, 100 ms duration) with various interaural time differences were presented via headphones while the subject was in an upright position or tilted 45° or 90° to the left or right. Subjects made two-alternative forced-choice (left/right) judgements on the intracranial sound image. During body tilt, the auditory median plane of the head, computed from the resulting psychometric functions, was always shifted to the upward ear, indicating a shift of the auditory percept to the downward ear, that is, in the direction of gravitational linear acceleration. The mean maximum magnitude of the auditory shift obtained with 90° body tilt was 25 µs. On the one hand, these findings suggest a certain influence of the otolith information about body position relative to the direction of gravity on the representation of auditory space. However, in partial contradiction to previous work, which had assumed existence of a significant ,audiogravic illusion', the very slight magnitude of the present effect rather reflects the excellent stability in the neural processing of auditory spatial cues in humans. Thus, it might be misleading to use the term ,illusion' for this quite marginal effect. [source]

Risk of perineal damage is not a reason to discourage a sitting birthing position: a secondary analysis

A. De Jonge
Summary Aim:, To examine the association between semi-sitting and sitting position at the time of birth and perineal damage amongst low-risk women in primary care. Background:, Evidence on the association between birthing positions and perineal trauma is not conclusive. Most studies did not distinguish between positions during the second stage of labour and position at the time of birth. Therefore, although birthing positions do not seem to affect the overall perineal trauma rate, an increase in trauma with upright position for birthing cannot be ruled out. Methods:, Secondary analysis was performed on data from a large trial. This trial was conducted amongst primary care midwifery practices in the Netherlands. A total of 1646 women were included who had a spontaneous, vaginal delivery. Perineal outcomes were compared between women in recumbent, semi-sitting and sitting position. Logistic regression analysis was used to examine the effects of these positions after controlling for other factors. Findings:, No significant differences were found in intact perineum rates between the position groups. Women in sitting position were less likely to have an episiotomy and more likely to have a perineal tear than women in recumbent position. After controlling for other factors, the odds ratios (OR) were 0.29 [95% confidence interval (CI): 0.16,0.54] and 1.83 (95% CI: 1.22,2.73) respectively. Women in semi-sitting position were more likely to have a labial tear than women in recumbent position (OR: 1.43, 95% CI: 1.00,2.04). Conclusion:, A semi-sitting or sitting birthing position does not need to be discouraged to prevent perineal damage. Women should be encouraged to use positions that are most comfortable to them. [source]

Perineal Trauma and Postpartum Perineal Morbidity in Asian and Non-Asian Primiparous Women Giving Birth in Australia

Hannah Dahlen
ABSTRACT Objectives: To describe the postpartum perineal morbidity of primiparous women who had a vaginal birth and compare outcomes between Asian and non-Asian women in the first 2 days following the birth and at 6 and 12 weeks postpartum. Design: Data from a randomized clinical trial of a perineal management technique (perineal warm packs) were used to address the study objective. Setting: Two maternity hospitals in Sydney, Australia. Participants: Primiparous women who had a vaginal birth in the trial were included (n=697). One third of the women were identified as "Asian." Results: Compared with non-Asian women, Asian women were significantly more likely to have an episiotomy; require perineal suturing; sustain a third- or fourth-degree perineal tear; and report their perineal pain as being moderate to severe on day 1 following the birth. Asian women were less likely to give birth in an upright position or to resume sexual intercourse by 6 or 12 weeks following the birth. Conclusion: More research is needed into methods that could reduce the high rates of perineal trauma experienced by Asian women, and midwives need to be able to offer appropriate support for Asian women. [source]

The Frequency Of Arterial Hypertension Versus Orthostatic Hypotension In Diabetic Patients

C Ionescu-Tîrgoviste
Aim: The aim of this study was to assess the relationship between supine high blood pressure and orthostatic hypotension both in Type 1 (T1DM) and Type 2 (T2DM) diabetic patients. Patients and Methods: Our study included 321 T2DM patients (153 M/168 F; mean age 62.3 (14.2 yr; duration of disease 12.1 (7.6 yr) and 116 T1DM patients (65 M/51 F; mean age 39.7 (9.2 yr; duration of diabetes 11.9 (8.1 yr). Patients with orthostatic hypotension were divided into 3 groups: A , without symptoms; B , mild/moderate symptoms (short and tolerable dizziness when standing); C , severe symptoms (persistent and disabling dizziness or even fainting in upright position). Results: Arterial hypertension was registered in 67.6% of T2DM patients (217 from 321 cases) and in 50.0% of T1DM patients (58 from 116 cases). Orthostatic hypotension (defined as a decrease in systolic blood pressure (30 mm Hg)) was encountered in 64.5% in T2DM patients (207 out of 321 cases) and in 60.3% of T1DM patients (70 out of 116 cases). From 207 T2DM patients with orthostatic hypotension, 105 were in Group A (50.7%), 89 in Group B (42.99%) and 13 in Group C (6.28%), while from 70 T1DM patients with orthostatic hypotension 14 were in Group A (20.0%), 51 in Group B (72.8%) and 5 in Group C (7.14%). An association of supine arterial hypertension with orthostatic hypotension was registered in 96 (29.9%) T2DM patients (68 of them receiving antihypertensive treatment) and in 25 (21.5%) T1DM patients (19 of which were on antihypertensive treatment). From the 18 patients with severe orthostatic hypotension (13 T2DM and 5 T1DM), supine arterial hypertension was registered in 5 cases (3 T2DM and 2 T1DM). In 4 of these 5 cases, patients were receiving antihypertensive treatment. Discontinuation of this treatment led to a decrease in the intensity of clinical signs of orthostatic hypotension in 4 out of 5 cases. An improvement of clinical symptoms of orthostatic hypotension was recorded in about 1/3 of hypertensive patients after discontinuation or just lowering of the dose of antihypertensive drugs (26 out of 87 cases). Conclusion: An association between hypertension and orthostatic hypotension is frequent both in T1DM and in T2DM, rising in difficulties for treatment. The treatment of hypertension in diabetic patients should take into account the possible orthostatic hypotension induced by some of the antihypertensive drugs. [source]

Development and Experimental Identification of a Biomechanical Model of the Trunk for Functional Electrical Stimulation Control in Paraplegia

Ingenieur Michele Vanoncini
ABSTRACT Objectives., Theoretic modeling and experimental studies suggest that functional electrical stimulation (FES) can improve trunk balance in spinal cord injured subjects. This can have a positive impact on daily life, increasing the volume of bimanual workspace, improving sitting posture, and wheelchair propulsion. A closed loop controller for the stimulation is desirable, as it can potentially decrease muscle fatigue and offer better rejection to disturbances. This paper proposes a biomechanical model of the human trunk, and a procedure for its identification, to be used for the future development of FES controllers. The advantage over previous models resides in the simplicity of the solution proposed, which makes it possible to identify the model just before a stimulation session (taking into account the variability of the muscle response to the FES). Materials and Methods., The structure of the model is based on previous research on FES and muscle physiology. Some details could not be inferred from previous studies, and were determined from experimental data. Experiments with a paraplegic volunteer were conducted in order to measure the moments exerted by the trunk-passive tissues and artificially stimulated muscles. Data for model identification and validation also were collected. Results., Using the proposed structure and identification procedure, the model could adequately reproduce the moments exerted during the experiments. The study reveals that the stimulated trunk extensors can exert maximal moment when the trunk is in the upright position. In contrast, previous studies show that able-bodied subjects can exert maximal trunk extension when flexed forward. Conclusions., The proposed model and identification procedure are a successful first step toward the development of a model-based controller for trunk FES. The model also gives information on the trunk in unique conditions, normally not observable in able-bodied subjects (ie, subject only to extensor muscles contraction). [source]

Carotid Sinus Hypersensitivity is Common in Patients Presenting with Hip Fracture and Unexplained Falls

Background:We tried to determine the prevalence of carotid sinus hypersensitivity (CSH) in patients with hip fractures with and without a clear history of an accidental fall. Methods:We studied 51 patients hospitalized for a hip fracture and 51 matched controls from our outpatients department. All patients were subjected to a carotid sinus massage in the supine and upright position. Patients were categorized in accidental (Group A) and unexplained (Group B) fallers. Results:Six of 33 (18.2%) patients in Group A and 12 of 18 (66.7%) patients in Group B (P < 0.001) had a positive response to the carotid sinus massage. Nine controls (17.6%) also demonstrated CSH. Patients in Group B were older (A: 75.5 ± 8.5 years vs B: 80.1 ± 5.9 years, P =0.029) and were more likely to have a history of unexplained falls or syncope in the past (A: 0% vs B: 66.7%, P < 0.0001) than individuals in group A. Vasodepressor/mixed forms accounted for the majority of CSH responses in Group B (75%). When compared with the control group, CSH was still more common in Group B (B: 66.7% vs control: 17.6%, P < 0.0001) but not in Group A (A: 18.2% vs control: 17.6%, P =1.000). Conclusions:The prevalence of CSH is increased in elderly patients with hip fractures, only in those who present with an unexplained fall and report a history of syncope or unexplained falls in the past. The vasodepressor/mixed forms account for the majority of CSH responses in the group of unexplained fallers. [source]

Successful Treatment of Severe Orthostatic Hypotension with Cardiac Tachypacing in Dual Chamber Pacemakers

Orthostatic hypotension is an evolving and disabling disease usually observed in elderly patients with dramatic consequences on morbidity, mortality, and impairing the quality of life. We studied the effects of the pacing rate and AV interval on the blood pressure drop in the upright position in two patients with previously implanted pacemakers for sinus node dysfunction. Although the AV interval did not affect the blood pressure drop in the upright position, tachypacing at 100 paces/min improved it dramatically and prevented syncope. Cardiac tachypacing is a useful therapeutic option in severe refractory Orthostatic hypotensive patients, especially those with chronotropic incompetence. [source]

The Use of Cerebral Oximetry as a Monitor of the Adequacy of Cerebral Perfusion in a Patient Undergoing Shoulder Surgery in the Beach Chair Position

PAIN PRACTICE, Issue 4 2009
Gregory W. Fischer MD
Abstract Four cases of ischemic injury have been reported in patients undergoing orthopedic surgery in the upright position. We describe the use of cerebral oximetry as a monitor of the adequacy of cerebral perfusion in a 63-year-old woman who underwent arthroscopic rotator cuff surgery in a beach chair under general anesthesia. During positioning, a decrease in blood pressure was accompanied by a decrease in cerebral oxygen saturation (SctO2) and was treated with phenylephrine. When spontaneous ventilation resumed, an increase in end-tidal carbon dioxide was accompanied by an increase in SctO2. Cerebral oximetry may prove useful as a guide monitor and manage nonsupine patients. [source]

No cerebrocervical venous congestion in patients with multiple sclerosis,

Florian Doepp MD
Objective: Multiple sclerosis (MS) is characterized by demyelination centered around cerebral veins. Recent studies suggested this topographic pattern may be caused by venous congestion, a condition termed chronic cerebrospinal venous insufficiency (CCSVI). Published sonographic criteria of CCSVI include reflux in the deep cerebral veins and/or the internal jugular and vertebral veins (IJVs and VVs), stenosis of the IJVs, missing flow in IJVs and VVs, and inverse postural response of the cerebral venous drainage. Methods: We performed an extended extra- and transcranial color-coded sonography study including analysis of extracranial venous blood volume flow (BVF), cross-sectional areas, IJV flow analysis during Valsalva maneuver (VM), and CCSVI criteria. Fifty-six MS patients and 20 controls were studied. Results: Except for 1 patient, blood flow direction in the IJVs and VVs was normal in all subjects. In none of the subjects was IJV stenosis detected. IJV and VV BVF in both groups was equal in the supine body position. The decrease of total jugular BVF on turning into the upright position was less pronounced in patients (173 ± 235 vs 362 ± 150ml/min, p < 0.001), leading to higher BVF in the latter position (318ml/min ± 242 vs 123 ± 109ml/min; p < 0.001). No differences between groups were seen in intracranial veins and during VM. None of the subjects investigated in this study fulfilled >1 criterion for CCSVI. Interpretation: Our results challenge the hypothesis that cerebral venous congestion plays a significant role in the pathogenesis of MS. Future studies should elucidate the difference between patients and healthy subjects in BVF regulation. ANN NEUROL 2010;68:173,183 [source]


Joanne J. L. Chionh
Background: Intra-abdominal pressure (IAP) measurements can be used for the early detection and management of the abdominal compartment syndrome. IAP values are widely thought to be atmospheric or subatmospheric. However, there are no reports that describe normal IAP values using urinary bladder pressure measurements in patients not suspected of having a raised IAP level. This study sought to determine these normal values to aid our interpretation of IAP measurements in post-surgical patients or patients with suspected increased IAP. Methods: Urinary bladder pressure measurements were carried out in 40 men and 18 women awake medical or non-abdominal surgery inpatients with existing indwelling catheters. Measurements were made in the supine, 30° and 45° sitting positions. Comparisons were carried out to determine the effects on urinary bladder pressure of body position, sex and a suspected diagnosis of benign prostatic hypertrophy. Results: Median values for IAP were higher if measured in a more upright position (P < 0.0001). Median values were supine, 9.5 cmH2O (range, 1,18 cmH2O); 30° upright, 11.5 cmH2O (range, 3,19 cmH2O); and at 45° upright, 14.0 cmH2O (range, 4,22 cmH2O). Measurements recorded were neither atmospheric nor subatmospheric. IAP was higher in men compared with women in the supine and 30° positions (P < 0.05) but not in the 45° position (P = 0.083). There was no significant difference between patients with and without suspected benign prostatic hypertrophy. Conclusions: Normal IAP using urinary bladder pressure in awake patients are above atmospheric pressure. As a patient is moved from the supine into the upright position, IAP measurements increase. [source]

Kangaroo Mother Care, home environment and father involvement in the first year of life: a randomized controlled study

R Tessier
Abstract Aims:, This study tested the hypothesis that Kangaroo Mother Care creates a climate in the family, which enhances infants' performance on the developmental quotient scale. Setting:, The largest social security hospital in Colombia with a neonatal intensive care unit. Subjects:, At 12 months of corrected age, 194 families in the Kangaroo Mother Care group and 144 families in the Traditional Care group were available for analysis. Interventions:, Infants were kept 24 h/day in an upright position, in skin-to-skin contact until it was no longer tolerated by the infants. Babies in the Traditional Care were kept in incubators on the Minimal Care Unit until they satisfied the usual discharge criteria. Outcome measures:, The Home Observation for Measurement of the Environment (HOME), Father Involvement and Developmental Quotient (Griffiths) scores. Results:, 1) Kangaroo mothers created a more stimulating context and a better caregiving environment than mothers in the Traditional Care group; 2) this environment was positively correlated to father involvement and 3) the family environment of male infants was most improved by Kangaroo Mother Care. Conclusion:, Kangaroo Mother Care has a positive impact on home environment. The results also suggest, first, that both parents should be involved as direct caregivers in the Kangaroo Mother Care procedure and secondly, that this intervention should be directed more specifically at infants who are more at risk at birth. The Kangaroo Mother Care intervention could be an excellent means to ensure parents' mature involvement in the future of their children. [source]

Decrease in heart rate variability with overtraining: assessment by the Poincaré plot analysis

Laurent Mourot
Summary Numerous symptoms have been associated with the overtraining syndrome (OT), including changes in autonomic function. Heart rate variability (HRV) provides non-invasive data about the autonomic regulation of heart rate in real-life conditions. The aims of the study were to: (i) characterize the HRV profile of seven athletes (OA) diagnosed as suffering of OT, compared with eight healthy sedentary (C) and eight trained (T) subjects during supine rest and 60° upright, and (ii) compare the traditional time- and frequency-domain analysis assessment of HRV with the non-linear Poincaré plot analysis. In the latter each R-R interval is plotted as a function of the previous one, and the standard deviations of the instantaneous (SD1) and long-term R-R interval variability are calculated. Total power was higher in T than in C and OA both in supine (1158 ± 1137, 6092 ± 3554 and 2970 ± 2947 ms2 for C, T and OA, respectively) and in upright (640 ± 499, 1814 ± 806 and 1092 ± 712 ms2 for C, T and OA, respectively; P<0·05) positions. In supine position, indicators of parasympathetic activity to the sinus node were higher in T compared with C and OA (high-frequency power: 419·1 ± 381·2, 1105·3 ± 781·4 and 463·7 ± 715·8 ms2 for C, T and OA, respectively; P<0·05; SD1: 29·5 ± 18·5, 75·2 ± 17·2 and 37·6 ± 27·5 for C, T and OA, respectively; P<0·05). OA had a marked predominance of sympathetic activity regardless of the position (LF/HF were 0·47 ± 0·35, 0·47 ± 0·50 and 3·96 ± 5·71 in supine position for C, T and OA, respectively, and 2·09 ± 2·17, 7·22 ± 6·82 and 12·04 ± 10·36 in upright position for C, T and OA, respectively). The changes in HRV indexes induced by the upright posture were greater in T than in OA. The shape of the Poincaré plots allowed the distinction between the three groups, with wide and narrow shapes in T and OA, respectively, compared with C. As Poincaré plot parameters are easy to compute and associated with the ,width' of the scatter gram, they corroborate the traditional time- and frequency-domain analysis. We suggest that they could be used to indicate fatigue and/or prevent OT. [source]

Acute Blood Pressure Changes After the Onset of Atrioventricular Nodal Reentrant Tachycardia: A Time-Course Analysis

Introduction: We aimed to characterize blood pressure (BP) response at the beginning of atrioventricular nodal reentrant tachycardia (AVNRT) and its relationship to orthostatic challenge and variable atrioventricular interval. Methods and Results: In this prospective study of 17 consecutive patients with documented AVNRT, mean BP was analyzed in the supine and upright positions during sinus rhythm, AVNRT, and pacing with atrioventricular delay of 150 msec (AV150) and 0 msec (AV0). Mean BPs were compared at 3,5 seconds, 8,10 seconds, and 28,30 seconds after the onset of AVNRT or pacing. BP decreased immediately after AVNRT initiation, with gradual recovery during the first 30 seconds from 71.9 ± 16.5 mmHg to 86 ± 13.8 mmHg, P < 0.01. A similar pattern was observed during AV0, but not during AV150, pacing. While supine, mean BP decrease was more pronounced during AVNRT and AV0 pacing (,26.1% and ,32.1%, respectively) than during AV150 pacing (,8%, P = 0.02 and P = 0.07, respectively). This difference subsided 30 seconds after the onset of AVNRT or pacing. When upright, the mean BP time course was similar, but mean BP recovery during AVNRT was slower, and the difference between mean BP during AVNRT and AV150 persisted at 30 seconds. Conclusions: The initial mean BP decrease during AVNRT recovered gradually within 30 seconds. A short atrioventricular interval is associated with a greater mean BP decrease at the onset of tachycardia. These observations may explain clinical symptoms immediately after the onset of AVNRT. [source]

Observing Position and Movements in Hydrotherapy: A Pilot Study

Mary Ann Stark
ABSTRACT Objective:, To observe and describe the positions and movements women choose while immersed in water during the first stage of labor. Design:, Descriptive, observational pilot study. Setting:, A rural community hospital that provided hydrotherapy in labor. Participants:, Women (N = 7) who intended to use hydrotherapy in labor were recruited prenatally from a midwife-managed practice. Measures:, For 15 minutes of each hour during the first stage of labor, position and movements of the participants were observed and recorded on a laptop computer. The observational tool was developed for this study from a review of the literature and interviews with nursing experts; 435 observations were recorded. Women were free to choose when and how long to use hydrotherapy and had no restriction on their positions and movements. Results:, Only 3 of the 7 participants labored in the tub. Women demonstrated a greater range of positions and movements in the tub than in bed, both throughout labor and during late first-stage labor (7-10 cm of dilatation). Women had more contractions and made more rhythmic movements while in the tub than in bed. Conclusions:, Hydrotherapy may encourage upright positions and movements that facilitate labor progress and coping, helping women avoid unnecessary interventions. [source]