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ABSTRACT Objective To assess knowledge on sudden infant death syndrome (SIDS) prevention among postpartum women who received prenatal care in public and private services in Rio Grande, Rio Grande do Sul, Brazil, in 2019. Methods A cross-sectional study was conducted with postpartum women who gave birth in that municipality in 2019; the outcome was the indication of incorrect sleeping position (side/supine position) to prevent SIDS; the chi-square test was used to compare proportions between those who underwent prenatal care in public and private services. Results Among all 2,195 postpartum women, 67.7% (95%CI 65.7;69.6) were unaware of the position that prevents SIDS, 71.6% were public care service users; 77.8% of them feared choking/suffocation; 1.9% were informed about SIDS during prenatal care; doctors/nurses (70.5%) and grandmothers (65.1%) were influential regarding the baby's sleeping position. Conclusion Most postpartum women were unaware of the sleeping position that prevents SIDS, especially those receiving care in the public sector; in general, this subject is not discussed in prenatal care.
RESUMEN Objetivo Evaluar el conocimiento sobre la prevención del síndrome de muerte súbita del lactante (SMSL) entre puérperas que realizaron prenatal en servicios públicos y privados en Rio Grande, Rio Grande do Sul, Brasil, en 2019. Métodos Estudio transversal, con puérperas que dieron a luz en Rio Grande, en 2019; el resultado consistió en la indicación de posición incorrecta para dormir (lado/supino) para prevenir el SMSL; utilizando chi-cuadrado, se compararon las proporciones entre mujeres que recibieron atención prenatal en servicios públicos y privados. Resultados Entre las 2.195 puérperas, 67,7% (IC95% 65,7;69,6) desconocían como se previene el SMSL, estando el 71,6%, en la red pública; 77,8% temía asfixiarse/ahogarse; el 1,9% fue informado sobre el SMSL durante el prenatal; los médicos(as)/enfermeros(as) (70,5%) y los abuelos (65,1%) influyeron en la posición para dormir del bebé. Conclusión La mayoría de las puérperas desconocían la posición que previene el SMSL, especialmente en la red pública; en general, este tema no está cubierto en la atención prenatal.
RESUMO Objetivo Avaliar o conhecimento sobre prevenção da síndrome da morte súbita do lactente (SMSL) entre puérperas com pré-natal realizado nos serviços público e privado de Rio Grande, Rio Grande do Sul, Brasil, 2019. Métodos Estudo transversal, com puérperas do município; seu desfecho constituiuse da indicação de posição incorreta para dormir (decúbito lateral ou dorsal), visando prevenir a SMSL; utilizou-se o teste qui-quadrado para comparar proporções do desfecho e de exposição entre puérperas que realizaram pré-natal nos serviços público e privado. Resultados De 2.195 puérperas, 67,7% (IC95% 65,7;69,6), majoritariamente atendidas na rede pública (71,6%), desconheciam a posição preventiva da SMSL; 77,8% temiam engasgo/afogamento; 1,9% foram informadas sobre SMSL no pré-natal; médicos(as)/enfermeiros(as) (70,5%) e avós (65,1%) mostraram-se influentes na decisão sobre como posicionar o bebê adormecido. Conclusão A maioria das puérperas, especialmente as atendidas na rede pública, desconhecia a posição que previne SMSL; geralmente, o tema não é abordado no pré-natal.
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Prone positioning in percutaneous nephrolithotomy is more and more being replaced by supine positioning now a days for its various benefits. This is a prospective study which does Comparative study on percutaneous nephrolithotomy in supine versus prone position and their various outcomes were analysed. There were totally 100 patients included in the study with 50 patients each group (supine versus prone). 57 were male and 43 female patients. Age ranging from 18 to 70 years. Right side stones were 58 and left side was 42. Age, gender and side of stones were similar between two groups. Stone burden were 2.6cm and 2.9cm for supine and prone group respectively. But average operating time were 63.5 minutes ( 35 to 120 minutes) for supine group versus 80 minutes ( 45 to 160 minutes) for prone group. fluoroscopy time was 18.9 minutes for supine group versus 29.4 minutes for prone group. Clearance rate in our study were pretty good in both groups around 90% in both groups (90% vs 88%). five had complications in form of sepsis and bleeding requiring blood transfusion in both groups. Five in supine group and six in prone group required second procedures. Thus Supine percutaneous nephrolithotomy group had significant advantage in terms of less operative duration and less fluoroscopy time than prone percutaneous nephrolithotomy . The stone clearance and complication rates were similar in both the groups.
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@#A 47-year-old male complained of anuria for 2 days with elevated creatinine of 14 mg/dL on admission. Patient underwent emergent hemodialysis. Non-contrast CT showed a solitary ectopic pelvic kidney with a 2 cm. pelvolithiasis and a 1 cm upper pole calyceal stone with obstructive hydronephrosis. He therefore underwent ultrasound-guided nephrostomy tube placement. Once clinically stable, the patient underwent a multi-tract supine PCNL. Intraoperatively, the authors noted tense abdominal distention accompanied by hypotension during the procedure. A diagnosis of compartment syndrome secondary to hydroperitoneum was considered. An indwelling stent and a nephrostomy tube were placed. An abdominal pigtail drain was placed removing three liters of fluid. The patient remained intubated for 3 days. He underwent blood transfusion. He required two 2 sessions of hemodialysis postoperatively. The patient was discharged in stable condition on postoperative day 22. Hydroperitoneum is a potential complication of PCNL in ectopic pelvic kidneys. Its prompt recognition, followed by immediate aspiration of intraabdominal fluid and drain placement is life-saving.
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Solitary Kidney , Compartment SyndromesABSTRACT
Objective:To explore the effect of intermittent angle traction on the supine position combined with acupoint application on the changes of cervical radiculopathy related biological parameters.Methods:Randomized controlled trial. A total of 100 patients with radiculopathy cervical spondylosis treated in the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from February 2019 to February 2021 were selected and randomly divided into observation group ( n=50) and control group ( n=50). Patients in the control group were given conventional treatment with western medicine, and patients in the observation group were given acupoint application combined with supine intermittent angle traction combined with treatment. Both groups were treated for 3 months. The Japanese Orthopaedic Association Spinal Cord Function (JOA), Cervical Disability Index (NDI), Pain Visual Analogue Score (VAS) and the changes in intervertebral foramen volume of two groups were compared before and after treatment. The difference in clinical efficacy between the two groups after treatment was observed. We took a thin spiral CT film of the patient's cervical spine, established a three-dimensional finite element model of the cervical spine, and compared the differences in related indicators between the two groups before and after treatment. Results:The total effective rate was 94.0% (47/50) in the observation group and 70.0% (35/50) in the control group, and there was a significant difference between the two groups ( χ2=9.76, P=0.002). After treatment, the JOA score in the observation group was significantly higher than that of the control group ( t=6.23, P<0.01), the NDI score, VAS score were significantly lower than those in the control group ( t values were 5.17,9.13, P<0.01), the intervertebral foraminal volume [(8.45±1.27)mm 3vs. (7.18±1.38)mm 3, t=4.79] was significantly higher than that of the control group ( P<0.01), and C 4-7 cervical vertebra flexion [(7.15±0.87)° vs.(5.64±0.78)°, t=9.14], retroflexion [(8.53±0.73)° vs. (7.15±0.68)°, t=9.78], sidebend [(6.57±0.71)° vs. (5.28±0.67)°, t=9.34], rotated [(7.89±0.52)° vs. (6.54±0.48)°, t=13.49] were significantly higher than those in the control group ( P<0.01); C 4-7 disc flexion [(1.41±0.09) kPa vs. (2.01±0.12) kPa, t=28.28], retroflexion [(1.54±0.07) kPa vs. (2.01±0.08) kPa, t=31.26], sidebend [(1.24±0.07) kPa vs. (1.89±0.13) kPa, t=31.13], rotated [(1.23±0.06)kPa vs. (1.85±0.11)kPa, t=34.99] were significantly lower than those in the control group ( P<0.01). Conclusion:The supine intermittent Angle traction combined with acupoint application in the treatment of cervical spondylotic radiculopathy can relieve the neck pain, improve the neck function, restore the physiological curvature of the cervical spine, and promote the recovery of cervical biomechanics.
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【Objective】 To compare the clinical safety and effectiveness of super-mini-percutaneous nephroscope (SMP) combined with flexible ureteroscopic lithotripsy (FURL) in oblique supine lithotomy position and FURL alone in the treatment of 2.0-3.0 cm renal calculi. 【Methods】 Clinical data of 55 patients treated during Jan.2018 and May 2021 were retrospectively analyzed, including 47 cases complicated renal calculi, and 14 cases of lower calyceal calculi with infundibulopelvic angle ≤30°. SMP combined with FURL was performed in 23 cases (combined group), and FURL alone was performed in 32 cases (FURL group). The operation time, hemoglobin reduction, postoperative hospital stay, hospitalization expenses, stone-clearance rate and complications were compared. 【Results】 All operations were successful. Compared with the FRUL group, the combined group had significantly more hemoglobin reduction [(16.30±10.17) g/L vs. (6.94±6.61) g/L], longer postoperative hospital stay [(5.35±1.61) d vs. (3.19±1.26) d], and higher hospitalization expenses [(22 481±2 234) yuan vs. (18 209±2 584) yuan] (P0.05]. One month after surgery, CT results showed that the combined group had higher stone-clearance rate (91.30% vs. 65.63%, P=0.027). There was no difference in the complication rate (21.74% vs. 21.88%, P>0.05). One case (4.35%) in the combined group and 5 cases (15.63%) in the FURL group received retreatment (P>0.05). 【Conclusion】 SMP combined with FURL in oblique supine lithotomy position is safe and effective in the treatment of 2.0-3.0 cm renal calculi, with high stone-clearance rate and low complication rate.
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【Objective】 To explore the safety and efficacy of a modified one-piece posterior laparoscopic total nephroureterectomy with cystic sleeve resection in the treatment of upper urinary tract uroepithelial carcinoma (UTUC). 【Methods】 A total of 24 patients treated during Jan. and Jun. 2022 were involved, including 16 males and 8 females, aged 62 to 90 (average 73) years. The UTUC was in the left side in 15 cases, and in the right side in 9 cases. There were 10 cases of renal pelvis tumor, 6 cases of upper ureteral tumor and 8 cases of lower ureteral tumor. 【Results】 All operations were successful without conversion to open surgery. The operation time ranged from 60 to 100 minutes, average (71.25±9.80) minutes. The intraoperative bleeding volume was 20 to 200 mL, average (30.03±8.13) mL. No significant intraoperative or postoperative complications occurred. The postoperative hospital stay was 4 to 7 days, average (5.83±1.44) days. Bladder perfusion chemotherapy was performed after surgery. 【Conclusion】 The modified one-piece posterior laparoscopic total nephroureterectomy plus cystic sleeve resection for UTUC is an effective and feasible procedure with satisfactory tumor control, which is worth further promotion in clinical practice.
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【Objective】 To evaluate the efficacy and safety of percutaneous nephrolithotomy in Galdakao-modified supine Valdivia (GMSV) position and prone position in the treatment of renal calculi. 【Methods】 PubMed, Embase and Cochrane Library databases were searched systematically to identify all eligible studies. Literature collected were screened and data were extracted by three authors independently. RevMan5.4 software was used for Meta-analysis. 【Results】 A total of 9 articles were enrolled, including 7 randomized controlled studies and 2 case-control studies, with a total of 1 690 patients. The results of Meta-analysis showed that compared with the prone position group, the GMSV group had shorter hospital stay (WMD:-9.04, 95%CI:-16.85--1.22, P=0.02), shorter intraoperative radiation exposure (WMD:-1.23, 95%CI:-1.98--0.48, P=0.001), lower rate of complications (RR:0.72, 95%CI:0.59-0.88, P=0.001), but there were no significant differences in operation time, primary stone clearance rate, postoperative hemoglobin loss, blood transfusion rate, fever rate and non-tubulization rate. 【Conclusion】 Compared with percutaneous nephrolithotomy in prone position, percutaneous nephrolithotomy in GMSV position has the comparable stone clearance rate, but has significant advantages in hospital stay, intraoperative radiation time, and overall complications. It is safe for the treatment of renal stones and upper ureteral stones.
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Abstract Background The efficacy and safety profiles of prone ventilation among intubated Coronavirus Disease 2019 (COVID-19) patients remain unclear. The primary objective was to examine the effect of prone ventilation on the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) in intubated COVID-19 patients. Methods Databases of MEDLINE, EMBASE and CENTRAL were systematically searched from inception until March 2021. Case reports and case series were excluded. Results Eleven studies (n = 606 patients) were eligible. Prone ventilation significantly improved PaO2/FiO2 ratio (studies: 8, n = 579, mean difference 46.75, 95% CI 33.35‒60.15, p < 0.00001; evidence: very low) and peripheral oxygen saturation (SpO2) (studies: 3, n = 432, mean difference 1.67, 95% CI 1.08‒2.26, p < 0.00001; evidence: ow), but not the arterial partial pressure of carbon dioxide (PaCO2) (studies: 5, n = 396, mean difference 2.45, 95% CI 2.39‒7.30, p= 0.32; evidence: very low), mortality rate (studies: 1, n = 215, Odds Ratio 0.66, 95% CI 0.32‒1.33, p= 0.24; evidence: very low), or number of patients discharged alive (studies: 1, n = 43, Odds Ratio 1.49, 95% CI 0.72‒3.08, p= 0.28; evidence: very low). Conclusion Prone ventilation improved PaO2/FiO2 ratio and SpO2 in intubated COVID-19 patients. Given the substantial heterogeneity and low level of evidence, more randomized- controlled trials are warranted to improve the certainty of evidence, and to examine the adverse events of prone ventilation.
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Humans , Respiratory Distress Syndrome, Newborn , COVID-19/therapy , Oxygen , Respiration, Artificial , Prone PositionABSTRACT
SUMMARY OBJECTIVE: The aim of this study was to evaluate the predictive factors for success following percutaneous nephrolithotomy in the supine position. METHODS: Patients who underwent percutaneous nephrolithotomy in the supine position from June 2011 to October 2018 were evaluated. Age, sex, body mass index, the American Society of Anesthesiologists physical status classification, hemoglobin level, number of previous surgeries, stone size, and the Guy's Stone Score were analyzed. Success was considered if no fragments were observed on the computed tomography scan on the first postoperative day. Univariate and multivariate analyses were performed to determine significant parameters. RESULTS: We evaluated 961 patients; of them, 483 (50.2%) underwent previous stone-related surgery, and 499 (51.9%) had Guy's Stone Score 3 or 4. The overall success rate in a single procedure was 40.7%, and complication rate was 13.7%. The univariate analysis showed that the maximum diameter of the stone (25.10±10 mm; p<0.001), previous percutaneous nephrolithotomy (OR 0.52; p<0.001), number of previous percutaneous nephrolithotomy (OR 0.15; p<0.001), the Guy's Stone Score (OR 0.28; p<0.001), and the number of tracts (OR 0.32; p<0.001) were significant. In the multivariate analysis, the number of previous percutaneous nephrolithotomy (OR 0.54; p<0.001) and the Guy's Stone Score (OR 0.25; p<0.001) were statically significant. CONCLUSIONS: Guy's Stone Score and the number of previous percutaneous nephrolithotomy are predictors of success with the supine position. Complex cases and with previous percutaneous interventions may require technical improvements to achieve higher stone-free rates.
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Objective:To investigate the optimal lengths of supine position after first lumber puncture for school-aged children with acute leukemia.Methods:From January 2020 to December 2021, a total of 152 children with acute leukemia who underwent first lumbar puncture were randomly divided into 1h group, 2 h group, 3 h group and 4 h group, there were 38 cases in each group. The lengths of supine position after lumber puncture were 1 h, 2 h, 3 h and 4 h in the 1h group, 2 h group, 3 h group and 4 h group, respectively. The effects of different lengths of supine position on headache, low back pain, comfort and postoperative complications were observed.Results:Finally, 38 cases were enrolled in the 1 h group, 36 cases in the 2 h group, 38cases in the 3 h group and 34 cases in the 4 h group. The scores of low back pain, sleep comfort, lying position comfort, emotional comfort as well as the incidence of limb numbness in the 1 h group were (1.71 ± 0.56), (1.95 ± 0.87), (2.74 ± 1.06), (2.63 ± 0.79), 5.3%(2/38), in the 2 h group were (1.61 ± 0.27), (2.08 ± 0.81), (2.92 ± 1.34), (2.86 ± 0.80), 2.8%(1/36), which were significant lower than those of in the 3 h group (2.32 ± 1.12), (2.92 ± 1.34), (3.71 ± 1.11), (3.55 ± 1.25), 21.1%(8/38) and 4 h group(2.74 ± 1.42), (3.06 ± 1.37), (3.85 ± 1.50), (3.88 ± 0.81), 23.5%(8/34), F=6.81 to 14.06, χ2=10.84, all P<0.05. The amount of cerebrospinal fluid exudation in 1 h group was (0.33±0.09) g, which was significantly higher than that in 2 h group(0.27±0.08) g, 3 h group (0.27±0.10) g and 4 h group (0.24±0.09) g, the difference was significant ( F=5.82, P<0.05). The incidence of pressure injury in 1 h group, 2 h group and 3 h group were 0, 2.0%(1/36), 7.9%(3/38), which were significantly lower than that in the 4 h group 23.5%(8/34), χ2=15.39, P<0.05. There was no significant difference in pain scores among the 4 groups ( P>0.05). Conclusion:Two hours for supine position after first lumber puncture does not increase cerebrospinal fluid exudation in children with acute leukemia, and effectively alleviate low back pain, improve the comfort degree.
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Percutaneous nephrolithotomy (PCNL) in children has becomemore widely used due to its high efficacy and safety and to the development of miniaturized instruments. A supine approach is promising due to advantages such as better ventilation, reproducibility, and ergonomics. The purpose of the present study is to describe our surgical technique with special considerations in the pediatric population. We used an oblique supine position supported by one silicone gel positioning pad under the hip and another under the ipsilateral flank. The anatomical landmarks used to guide the puncture were the 11th and 12th ribs, the posterior axillary line, and the iliac crest. Initially, a ureteral catheter was introduced endoscopically. A retrograde pyelography was performed to guide the puncture, which was performed using a biplanar technique. A hydrophilic guide wire was then advanced through the needle. Dilation was performed with Alken telescopic dilators until 14 Ch. Fragmentation was performed either with a 13 Ch semirigid cystoscope or a flexible ureteroscope using a holmium: yttrium aluminum garnet (Ho:Yag) laser.We left a double J catheter. Supine PCNL in the pediatric population has comparable efficacy in terms of stone free rate to that of the prone approach as well as less complications. Certain considerations in children are careful padding and placement of the patient close to the edge of the table. Puncture should be guided by ultrasound to reduce radiation exposure. Miniaturized equipment is not widely available, so adaptation of adult equipment for the pediatric population is sometimes necessary.
La nefrolitotomía percutánea en niños se ha vuelto ampliamente utilizada por su alta efectividad, seguridad, y por la miniaturización de los instrumentos endoscópicos. El abordaje en supino es prometedor por sus ventajas, como mejor ventilación, reproducibilidad, y ergonomía. El propósito es describir nuestra técnica quirúrgica con las consideraciones especiales a tener en cuenta en la población pediátrica. Todos nuestros pacientes han sido intervenidos bajo la siguiente técnica quirúrgica: en una posición oblicua en supino, utilizando soportes de silicona ubicados debajo de la cadera y del flanco ipsilateral, se marcan los reparos anatómicos: las costillas once y doce, la línea axilar posterior y la cresta ilíaca. Inicialmente se introduce un cateter ureteral por vía endoscópica, con el cual se realiza una pielografía retrógrada para guiar la punción con una técnica biplanar. Se avanza una guía hidrofílica y, sobre esta, los dilatadores telescopados de Alken hasta un tracto de 14 Ch. Se realiza la fragmentación con un cistoscopio semirígido de 13 Ch o con un ureteroscopio flexible utilizando el láser Ho:Yag. Se deja un cateter JJ. La nefrolitotomía percutánea en la población pediátrica es comparable en términos de tasa libre de cálculos al abordaje en prono, con menos complicaciones. Una consideración importante en niños es una adecuada posición, cerca al eje de la mesa. La punción debe ser guiada por ultrasonido para disminuir la exposición a radiación. La disponibilidad de equipos miniaturizados es limitada, por lo cual usualmente es necesario adaptar los equipos de adultos.
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Humans , Child , Nephrolithotomy, Percutaneous , Urography , Cystoscopes , Ureteroscopes , Urinary Catheters , MiniaturizationABSTRACT
Abstract Objective: The aim of this study was to analyze the relationship between body adiposity and physical fitness with performance in the Supine-to-Stand test (STS-test) in sedentary adolescents. Methods: Sixty-two adolescents, of both sexes, between 10 and 16 years old, participated in the study. Body mass (BM), height, waist circumference (WC), fat mass (FM), fat-free mass (FFM), right and left handgrip strength (HGS-right, HGS-left), abdominal resistance (ABDO), flexibility (FLEX), and cardiorespiratory fitness (VO2peak) were measured. Body mass index (BMI), z-score BMI (BMI-z), tri-ponderal mass index (TMI) and waist-to-height ratio (WHtR) were calculated. The STS-test was applied to evaluate the STS-MC by the movement patterns in the execution of the test. The STS-time in seconds (s) was categorized into terciles: fast (FG < 2.0 s), intermediate (IG = 2.0-2.6 s) and slow (SG > 2.6 s). One-way ANOVA, Chi-square, Spearman's correlation coefficient as well as non-parametric tests were used, with significance p 0.05. Results: The SG presented higher BMI, BMI-z, TMI, WHtR, FM, %FM, as well as lower averages for %FFM, HGS-right, HGS-left, FLEX, ABDO, VO2peak, VO2peak relative to BM (VO2peakBM) in relation to GF. The BMI, BMI-z, TMI, WC, WHtR and FM showed moderate and direct correlations with STS-time and inverse with STS-MC (p < 0.01). HGS-right, HGS-left, ABDO, and VO2peakBM showed moderate and an inverse correlation with STS-time (p < 0.05). The VO2peakBM was moderate and with direct correlations to STS-MC (p < 0.01). Conclusion: It is concluded that excess fat and low physical fitness hamper STS-test performance. Therefore, the STS-test can be used for screening students to assess MC.
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Humans , Male , Female , Child , Adolescent , Hand Strength , Adiposity , Body Mass Index , Physical Fitness , Cross-Sectional Studies , Waist CircumferenceABSTRACT
Objective:To explore the clinical value of ultrasonic inferior vena cava parameters in predicting supine hypotension syndrome after subarachnoid block.Methods:80 cases of cesarean section under subarachnoid block in singleton pregnancy treated in Beijing Maternity Hospital from August 2019 to March 2020 were selected retrospectively. According to the occurrence of supine hypotension syndrome after anesthesia, they were divided into two groups (group A had supine hypotension syndrome and group B did not), with 40 cases in each group. The changes of related parameters of inferior vena cava in supine position and left 30 ° lying position were compared between the two groups. The correlation between the maximum end expiratory diameter (IVCe), the minimum end inspiratory diameter (IVCi) and the collapse index (IVC-CI) of inferior vena cava and the changes of systolic blood pressure in supine hypotension syndrome were analyzed, and the value of IVCe, IVCi and IVC-CI in predicting supine hypotension syndrome were compared.Results:Under the condition of supine position and left 30 ° lying position, the levels of IVCe and IVCi in group A were significantly lower than those in group B ( P<0.05), and the levels of IVC-CI were higher than those in group B ( P<0.05). Spearman analysis showed that the levels of IVCe and IVCi were positively correlated with the changes of systolic blood pressure in the occurrence of supine hypotension syndrome ( P<0.05), and the levels of IVC-CI were negatively correlated with the changes of systolic blood pressure in the occurrence of supine hypotension syndrome ( P<0.05). IVC-CI had the highest yoden index and the highest sensitivity in predicting the occurrence of supine hypotension syndrome, and IVCe had the highest specificity in predicting the occurrence of supine hypotension syndrome. Conclusions:Cava collapse index has high sensitivity to predict supine hypotension syndrome, while the maximum end-expiratory diameter of inferior vena cava has high specificity to predict supine hypotension syndrome.
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ABSTRACT Objective To evaluate the displacement of nerve structures according to the decubitus position of the patient in a magnetic resonance imaging (MRI) study. Methods MRI was performed at a radiology clinic in 20 patients in dorsal and right lateral decubitus. The measurement considered was the shortest distance between the dura mater and the medial wall of the pedicle. Results The largest measurement was 11.6 mm in left lateral decubitus, 12.2 mm in right lateral decubitus, 10.5 mm in right dorsal decubitus, and 9.2 mm in left dorsal decubitus. In some patients the space between the medial wall of the pedicle and the dura mater was larger when in lateral decubitus, while in others when in dorsal decubitus. The mean displacement of the measurements on the left was 1.14 mm and on the right 1.355 mm. Conclusions The structures moved on average little more than 1 mm in the positions studied. The positioning of the patient for surgery does not change the space to be approached, being the surgeon's choice according to his learning curve. Level of evidence II; Prospective study of lower quality.
RESUMO Objetivo Avaliar o deslocamento das estruturas nervosas conforme o decúbito do paciente em um estudo de Ressonância Nuclear Magnética (RNM). Métodos Foram realizadas RNM em 20 pacientes em uma clínica de radiologia em decúbito dorsal e lateral direito. A medida considerada será a menor distância entre a dura-máter e a parede medial do pedículo. Resultados A maior medida em decúbito lateral esquerdo foi 11,6 mm, em decúbito lateral direito foi 12,2 mm, em decúbito dorsal direito foi 10,5 mm e no esquerdo, 9,2 mm. O espaço entre a parede medial do pedículo é maior em decúbito lateral em alguns pacientes e, em outros, em decúbito dorsal. O deslocamento médio das medidas à esquerda foi 1,14 mm e à direita 1,355 mm. Conclusões As estruturas se deslocaram, em média, pouco mais de 1 mm nas posições estudadas. O posicionamento do paciente na cirurgia não muda o espaço a ser abordado, sendo de escolha do cirurgião, conforme a sua curva de aprendizado. Nível de evidência II; Estudo prospectivo de menor qualidade .
RESUMEN Objetivo Evaluar el desplazamiento de las estructuras nerviosas conforme al decúbito del paciente en un estudio de Resonancia Nuclear Magnética (RNM). Métodos Fueron realizadas RNM en 20 pacientes en una clínica de radiología en decúbito dorsal y lateral derecho. La medida considerada será la menor distancia entre la duramadre y la pared medial del pedículo. Resultados La mayor medida en decúbito lateral izquierdo fue 11,6 mm, en decúbito lateral derecho fue 12,2 mm, en decúbito dorsal derecho fue 10,5 mm y en el izquierdo, 9,2 mm. El espacio entre la pared medial del pedículo es mayor en decúbito lateral en algunos pacientes y, en otros, en decúbito dorsal. El desplazamiento promedio de las medidas a la izquierda fue 1,14 mm y a la derecha de 1,355 mm. Conclusiones Las estructuras se desplazaron, en promedio, poco más de 1 mm en las posiciones estudiadas. El posicionamiento del paciente en la cirugía no cambia el espacio a ser abordado, siendo la elección del cirujano conforme a su curva de aprendizaje. Nivel de evidencia II; Estudio prospectivo de menor calidad.
Subject(s)
Humans , Low Back Pain , Magnetic Resonance Imaging , Supine Position , Patient PositioningABSTRACT
Many individuals prefer using a pillow under their head when they sleep or read or use hand held electronic devices in recumbent position. Changes in position of the head with respect to the neck in supine posture may occur depending on the use of a pillow or height of the pillow used. This alteration of head and neck position might have an effect on pulmonary ventilation. The Peak Expiratory Flow Rate (PEFR) is one of the tests to assess pulmonary functions and PEFR can be performed easily and rapidly with the help of Wright’s Mini Peak Flowmeter. This study was undertaken to see the effect of variations in neck position on peak expiratory flow rate in supine posture in young healthy adults. METHODSA cross sectional study was carried out on 150 apparently healthy medical students of both sexes in the age group of 18 - 21 years. PEFR values were recorded using Wright’s Mini Peak Flow Meter. The subjects were asked to lie down in supine position on a wooden couch and recording of the peak expiratory flow rate was performed, initially by placing the subject’s head directly on the wooden couch and then by keeping the head on a pillow of 5 cm height. RESULTSData was analysed using paired ‘T’ Test and the p value of less than 0.05 was considered as statistically significant. We found that the mean PEFR value obtained using a pillow of 5 cm height under the head was more than the mean PEFR value obtained without using the pillow and the change in mean PEFR values was statistically significant (Table 1). CONCLUSIONSAfter comparing the mean PEFR values in the supine position with and without use of a pillow, we found that mean PEFR value was significantly higher when PEFR test was performed with use of a low height pillow (5 cm) under the head. From the result of this study, we conclude that pulmonary ventilation is better when the head and neck are supported with a low height pillow in supine posture.
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ABSTRACT Purpose: This study aims to compare the anatomical success rates of vitrectomy and SF6 gas tamponade for macular hole surgery with and without postoperative face-down posturing. Methods: This was an observational, longitudinal, and retrospective case series analysis. The study included 52 eyes from 52 patients who underwent pars plana vitrectomy with trypan blue-assisted internal limiting membrane peeling and 25% SF6 tamponade for stages 2, 3, and 4 macular holes. After surgery, all patients were provided with a postoperative postural regimen: 31 patients were instructed not to maintain face-down posturing, whereas 21 were instructed to maintain face-down posturing for 7 days. The primary outcome measure was the macular hole closure rate. Statistical analysis was performed using Epi Info 7.1. Results: A total of 47 (90.3%) patients achieved hole closure. The nonface-down posturing group and face-down posturing group obtained closure rates of 90.3% and 90.4%, respectively; these rates were not significantly different. Statistical analysis revealed that no significant differences existed in sex, age, hole duration, hole stage, preoperative visual acuity, or postoperative visual acuity between the two groups. Conclusion: Our results suggest that macular hole surgery with the use of short duration gas (SF6) is safe and effective and that maintaining a postural orientation of nonface-down posturing is also safe. However, these recommendations should be assessed further in a prospective and randomized study to comprehensively delineate the associated benefits and risks.
RESUMO Objetivos: Comparar as taxas de sucesso anatômico da vitrectomia e tamponamento de gás SF6 na cirurgia de buraco macular com e sem a postura pronada pós-operatória. Métodos: Foi realizado um estudo observacional, longitudinal e retrospectivo de séries de casos. O estudo incluiu 52 olhos de 52 pacientes submetidos à vitrectomia posterior via pars-plana com peeling de membrana limitante interna auxiliada por azul trypan e tamponamento com gás SF6 a 25% para os estágios 2, 3 e 4 dos buracos maculares. Após a cirurgia, todos os pacientes foram orientados a manter um regime postural pós-operatório: 31 pacientes foram orientados a não realizar posição pronada de cabeça, enquanto 21 foram orientados a manter uma pronada pós-operatória por 7 dias. O objetivo principal foi a análise da taxa de fechamento do buraco macular. A análise estatística foi realizada usando Epi-Info 7.1. Resultados: Um total de 47 (90,3%) pacientes obtiveram fechamento do buraco macular. O grupo de postura não pronada e o grupo de postura pronada obtiveram taxas de fechamento de 90,3%, e 90,4%, respectivamente; essas taxas não foram significativamente diferentes. A análise estatística revelou que não houve diferenças significativas relacionadas ao gênero, idade, duração do buraco macular, estágio do buraco macular, acuidade visual corrigida pré e pós-operatória entre os dois grupos. Conclusão: Nossos resultados sugerem que a cirurgia para buraco macular com o uso de gás de curta duração (SF6) é segura e eficaz e que a manutenção de uma orientação pós-operatória de não-pronada também é segura. No entanto, essas recomendações devem ser avaliadas em um estudo prospectivo e randomizado para delinear de forma abrangente os riscos e benefícios associados.
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Humans , Retinal Perforations , Fluorocarbons , Retinal Perforations/surgery , Vitrectomy , Prospective Studies , Retrospective Studies , Treatment Outcome , Prone PositionABSTRACT
Introduction: The applicability of the Modified Mallampatitest in supine patients is doubtful. We undertook this studyto evaluate the efficacy of acromio-axillo-suprasternal notchindex (AASI) for predicting difficult intubation and tocompare it with modified Mallampati test in supine position(MMT-S).Material and Methods: This prospective observationalstudy included 200 patients of American Society ofAnaesthesiologist (ASA) physical status I and II ofeither gender, aged 18-60 years. Patients with anatomicalabnormalities involving head and neck, pregnant, edentulousand BMI>35Kg/m2 were excluded. AASI and MMT-S wereassessed preoperatively. Direct laryngoscopy was performedby an experienced anaesthesiologist blinded to the result ofairway assessment tests. Cormack Lehane grade (CL grade)and number of attempts to successful intubation were noted.Primary objective was to assess AASI as predictor of difficultvisualisation of larynx (DVL) and secondary objective was tocompare it with MMT-S. Statistical analysis- McNamer testwas used to compare sensitivity and specificity of both themethods. Comparison of Area under Curve(AUC) of both themethods was performed.Results: AASI was 92% sensitive and 97.71% specificin predicting difficult intubation whereas sensitivity andspecificity of MMT-S was 76% and 84.57% respectively. AreaUnder Curve (AUC) of AASI was 0.97 with cut-off value>0.49 as a predictor of difficult intubation.Conclusion: AASI with cut off value >0.49 has highersensitivity and positive predictive value and is better inpredicting difficult airway in supine patients as compared toMMT-S.
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BACKGROUND: The posterolateral approach is the most commonly used surgical approach for total hip arthroplasty. In recent years, total hip replacement by direct anterior approach has been applied in clinic gradually, and has achieved good treatment outcomes. OBJECTIVE: To compare the clinical efficacy of the direct anterior approach in supine position and the posterolateral approach in supine position for total hip arthroplasty. METHODS: Ninety patients undergoing unilateral primary total hip arthroplasty at Baoding Municipal First Center Hospital from April 2015 to April 2019 were included, including 35 males and 55 females, aged 35-70 years. The patients were divided into direct anterior approach group (n=45) and posterolateral approach group (n=45) by the random number table method. Postoperative follow-up was used to evaluate the Harris hip scores, Visual Analogue Scale scores, initial fixation mass of prosthesis and safe range of the cup. The study was approved by the Ethics Committee of Baoding Municipal First Center Hospital. RESULTS AND CONCLUSION: (1) Ninety patients were followed up for 3-51 months, with an average 14 months. There were 2 cases of intraoperative great trochanteric fracture, 1 case of femoral lateral cutaneous nerve injury, 4 cases of femoral nerve injury, and 20 cases of tensor fascia lata injury. No such complications occurred in the posterolateral approach group. (2) The direct anterior approach group showed significant superior outcomes compared with the posterolateral approach group in the Harris hip scores and Visual Analogue Scale scores at 1 month after surgery (P 0.05). (3) In the direct anterior approach group, the femoral prosthesis of 44 hips was in neutral position, and 1 hip was in varus position. The initial fixation quality of all prosthesis was excellent. In the posterolateral approach group, the femoral prosthesis of 43 hips was in neutral position, 2 hips were in varus position and all prosthesis initial fixation quality was excellent. No significant difference was found between two groups (P > 0.05). (4) The ratio of acetabular cups in the safety range of Lewinnek in the direct anterior approach group was higher than that in the posterolateral approach group (100%, 82%, P < 0.05). (5) These results imply that compared with the posterolateral approach, direct anterior approach in supine position for total hip arthroplasty can significantly reduce postoperative pain, promote postoperative early rapid recovery, obtain more accurate angle of the acetabular prosthesis, and be more conducive to the equalization of both lower limbs. It is a safe and reliable approach. However, direct anterior approach has certain technical difficulty and needs a learning curve. And there are some complications different from other approaches.
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Objective@#To investigate the application of gradient cushion on prevention of supine hypotension syndrome (SHS) undergoing cesarean section.@*Methods@#450 parturients undergoing cesarean section with spinal and epidural anesthesia, aged 20-45 years, ASA Ⅰ, Ⅱor Ⅲ grades, were randomly assigned into three groups: gradient cushion group (group A), sandbag group (group B) and left-leaning-operating table group (group C), 150 cases in each. The posture intervention was alternated after completion of spinal and epidural anesthesia. Recorded the cases of SHS, and collected systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR) and saturation of pulse oximetry (SpO2) before anesthesia, 2 min, 5 min, 10 min after anesthesia and prefetus removal from uterus. And assessed the position comfort with surgical posture comfort scale.@*Results@#The incidence of SHS in group A was 8.0%(12/150), in group B was 20.0% (30/150), and in group C was 21.3% (32/150). The rate of SHS was higher in group A than other groups (χ2 value was 8.970, 10.653, all P<0.01). The score with surgical posture comfort scale was (47.03 ± 3.01), (38.13 ± 4.70), (36.10 ± 4.04), which was higher in group A than group B or group C, and the score with surgical posture comfort scale was higher in group B than group C (t value was 27.413, 30.227, 2.542, P<0.01 or 0.05). SBP and DBP were higher in group A and group B than group C at 2 min, 5 min, 10 min after anesthesia and prefetus removal from uterus, and SBP and DBP were higher in group A than group B at 2 min, 5 min, 10 min after anesthesia and prefetus removal from uterus, HR and RR were higher in group A and group B than group C at 2 min, 5 min, 10 min after anesthesia and prefetus removal from uterus, and HR and RR were higher in group A than group B at 2 min, 5 min, 10 min after anesthesia and prefetus removal from uterus (t value was -15.842-21.117, P<0.05 or 0.01).@*Conclusion@#After spinal and epidural anesthesia, applying the gradient cushion for adjustment of position would be effective to reduce the occurrence of SHS, simple to handle, decreasing to change the position and increasing to comfort after position in cesarean section.
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ABSTRACT Purpose We aimed to compare the outcomes of supine and prone miniaturized percutaneous nephrolithotomy (m-PNL) in the treatment of lower pole, middle pole and renal pelvic stones. Materials and Methods 54 patients who performed supine m-PNL between January 2017 and March 2018 and 498 patients who performed prone m-PNL between April 2015 and January 2018 were included in the study. Of the 498 patients, 108 matching 1: 2 in terms of age, gender, body mass index, American Association of Anesthesiology score, stone size, stone localization and hydronephrosis according to the supine m-PNL group were selected as prone m-PNL group. The patients with solitary kidney, upper pole stone, urinary system anomaly or skeletal malformation and pediatric patients (<18 years old) were excluded from the study. The success was defined as 'complete stone clearance' and was determined according to the 1st month computed tomography. Results The operation time and fluoroscopy time in supine m-PNL was significantly shorter than prone m-PNL group (58.1±45.9 vs. 80.1±40.0 min and 3.0±1.7 min vs. 4.9±4.5 min, p=0.025 and p=0.01, respectively). When post-operative complications were compared according to the modified Clavien-Dindo classification, overall and subgroup complication rates were comparable between groups. There was no significant difference between the groups in terms of the success rates (supine m-PNL; 72.2%, prone m-PNL; 71.3%, p=0.902). Conclusions Supine m-PNL procedure is more advantageous in terms of operation time and fluoroscopy time in the treatment of lower pole, middle pole and renal pelvic stones.