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Surgery of the Hip
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Daud TS Chou, Jonathan Miles, John Skinner
Hip arthrography is uncomfortable. It is recommended that it is performed under at least sedation but a short general anaesthetic is preferred. The supine position is used. The hip is placed in the position of maximum joint volume to aid injection: 10° abduction10° flexion10° internal rotation
Rehabilitation in the intensive care unit
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Piero Ceriana, Nicolino Ambrosino
For many years, based on a ‘conservative’ paradigm, mobilization and physiotherapy of critically ill patients was considered unsafe and was postponed until after discharge from the ICU. Patients were considered too sick for any form of physical activity (PA) and there was also concern that activity might dislodge intracavitary tubes and intravascular lines. Support for the viewpoint came from observations such as: Bed rest requiring a lower muscle oxygen consumption results in more availability to repair vital organs.Lower ventilatory requirements diminish the risk of ventilator-induced lung injury, allowing lower tidal volumes and a lower inspired oxygen fraction.The supine position could facilitate blood flow to the brain, reduce the risk of falls and reduce pain to injured parts of the body.Lower blood pressure and oxygen consumption could mean less cardiac workload and a lower risk of arrhytmias and ischaemia.
Management of osteoporotic extra-articular proximal tibial fractures
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Daniela Sanchez, Amrut Borade, Daniel S. Horwitz
The procedure was performed with the patient in supine position. Under fluoroscopic views, reduction was obtained with longitudinal traction and a pointed reduction clamp. Then a lateral approach to the proximal tibia was performed, the fascia of the anterior compartment incised, and the iliotibial band retracted posteriorly. The fracture was exposed, and after minimal periosteal stripping, the hematoma was evacuated. The fracture was reduced under direct visualization and reduction temporarily maintained with a reduction clamp; at this point, a lag screw was placed across the fracture plane. A 12-hole locking compression plate was inserted over the lateral aspect of the proximal tibia, and its position and the quality of the reduction were assessed under fluoroscopic orthogonal views. Four cortical screws were placed in the distal fragment, six locking screws were placed in the proximal fragment, and finally a kickstand screw was placed for additional support. A small medial incision was then made, and an 8-hole 3.5 mm reconstruction plate was slid using the MIPO technique. Plate position and alignment were checked using the image intensifier, three unicortical locking screws were placed proximally, and two bicortical nonlocked screws were placed in the distal fragment. The final quality of reduction and implant position were assessed using fluoroscopic AP and lateral views, and surgical wounds were irrigated and closed (Figure 26.8c,d). The patient was placed in a bulky splint and was allowed to be toe-touch weight-bearing for the first 6 weeks.
Effects of rTMS combined with rPMS on stroke patients with arm paralysis after contralateral seventh cervical nerve transfer: a case-series
Published in International Journal of Neuroscience, 2023
Ting Yang, Xueping Li, Peng Xia, Xiaoju Wang, Jianqiang Lu, Lin Wang
The protocol of rPMS is outlined in Figure 1(b). The rPMS procedure is utilized to reduce spasticity of the hemiplegic upper limb. The patient is placed in a supine position with the upper extremity naturally positioned at side of the body. Stimulation is prescribed according to Modified Ashworth Scale (MAS) classification [20]. Muscles with a MAS classification ≥ I+ were stimulated at 5 Hz for a total of 750 stimulations, with 15 stimulations per string and 3 s intervals between trains. If the antagonist muscle has a MAS classification ≥ I+, it is then stimulated with similar parameters. Otherwise, it is stimulated at 20 Hz for a total of 5100 stimulations, with 30 stimulations per train and 3 s intervals between trains. The intensity was 100% RMT. The coil was placed on the skin without pressure, which led to stimulation of two groups of muscles, the elbow flexor and extensor groups and wrist extensor and flexor groups, respectively. When stimulating, the therapist held the coil, thus moving each group of muscles from proximal to distal stimulation and moving one time at the rate of the duration of each train [21]. The rPMS was also carried out one time per day for 15 days.
Current and future strategies for diagnostic and management of obstructive sleep apnea
Published in Expert Review of Molecular Diagnostics, 2021
Sartaj Khurana, Narshone Soda, Muhammad J. A. Shiddiky, Ranu Nayak, Sudeep Bose
Obesity has been regarded as one of the most common and potential risk factors for OSA [128]. Food habits such as increased calorie intake especially high in carbohydrates have been seen to be associated with OSA severity [129]. Several studies have demonstrated that weight loss achieved through very low calorie diet intake has been successful in alleviating the symptoms of OSA by improving the BMI and AHI [130]. Very low calorie diet accompanied with active lifestyle not only results in weight loss and OSA tolerance but also improves other existing comorbidities such as hypertension, cardiovascular diseases, and diabetes by improving a range of cardiovascular variables [131]. Mediterranean diets have been observed to be beneficial for weight loss as they promote satiation and encourage adherence to calorie-restricted diets [132]. Moreover, surgically induced weight loss has also been associated with improvements in OSA severity, associated clinical conditions, and overall quality of life [133]. However, in morbidly obese OSA patients, only weight loss cannot completely cure OSA and additional therapies are required. In addition to diet mediated weight loss, changing of sleeping postures has been advised to alleviate the symptoms of OSA. Supine position increases the likelihood of the tongue falling back into the airway as a result of gravity, thereby blocking the airway. Therefore, positional therapy is advised in OSA patients to reduce the apneic events from occurring.
Reinforcement of the abdominal wall with acellular dermal matrix or synthetic mesh after breast reconstruction with the pedicled transverse rectus abdominis musculocutaneous flap. A prospective double-blind randomized study
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Mette Eline Brunbjerg, Thomas Bo Jensen, Peer Christiansen, Jens Overgaard, Tine Engberg Damsgaard
The secondary outcomes were abdominal muscle strength, complications and pain as described. Abdominal muscle strength was measured with fixated hand-held dynamometer before surgery and at 12 and 24 month follow-up. All measurements were performed by investigator in the same standardized way using The PowerTrack IITM (JTech Medical Industries, Salt Lake City, UT) (see Figure, Supplemental Digital Content 1, which illustrates the setup for measuring abdominal muscle strength using the fixed hand-held dynamometer). The patient was placed in a supine position with legs straight and the arms along the body. The dynamometer was placed in a tripod, adjustable with belts, and placed below the xiphoid process. After instruction the patient performed a trial run to familiarize with the dynamometer. The patient was strongly encouraged to perform maximal effort at each trial in a standardized manner. A resting period at 30 s was allowed between each test and the test was repeated until peak was clearly reached and the maximum score was chosen. Immediately after the last test the patient was asked to assess pain during the exercise on a Visual Analogue Scale (VAS) instrument.