Knee-elbow Position Research Articles

Визначення психологічного профілю вагітних, які бажають обрати альтернативний варіант розродження

One of the main indicators of the country's development is the health of women and children. Today in Ukraine, there is a significant decrease in the level of physical and moral health among young people, which negatively affects the course of pregnancy and childbirth. At the same time, the term “childbirth experience” is spreading in the obstetric community, which reflects the peculiarities of a woman's own feeling of the process of giving birth to a child, along with the spread of “non-traditional” methods of childbirth, such as vertical childbirth, childbirth in the knee-elbow position, childbirth in water, which aimed precisely at obtaining a positive birth experience. However, in the literature reviewed by us, we found only isolated information about the criteria for selecting patients to be involved in the attempt of alternative birth options. Aim - determine the psychological profile of pregnant women who wish to choose an alternative option for childbirth. Materials and methods. Surveyed 274 pregnant women at 11-12 and 36-37 weeks of pregnancy using a Google form containing 16 questions to determine the psycho-emotional state, mood, plans and fears about future childbirth. Results. The obtained results at 11-12 weeks outlined the psychological profile of pregnant women as a state of pleasure combined with insufficient knowledge about the course of childbirth. The results of the questionnaire at 36-37 weeks show a change in the psychological state in the direction of the development of fatigue with a significant increase in the number of women who are worried about the course of the upcoming childbirth, the pain associated with it, and want to involve close relatives/husband or an outside helper in childbirth. The majority of women have been found to have fear and uncertainty about their own condition during and after childbirth, which is the basis for an in-depth study of the psycho-emotional sphere. It was found that significantly more women want to try an alternative method of childbirth - water birth - 122 (44.5%). Conclusions. The psychological profile of pregnant women who wish to choose an alternative method of childbirth, including water birth, is characterized by a feeling of fear and anxiety before the upcoming birth, fears about the use of pharmacological methods of analgesia, as well as about possible aggression on the part of medical stuff. No conflict of interests was declared by the authors.

Flutter of the atria ("Vorhofsflattern)

In September 1920, a patient was admitted to the therapeutic department of the Clinical Institute with symptoms of severe shortness of breath, chest pains, insomnia, and large swelling of the legs, especially the face. Often takes a forced knee-elbow position. In childhood, smallpox, measles. 20 years old syphilis, in 1919 typhus.

Prospective study of different postures during the second stage of labour and their outcome

Background: For centuries, there has been controversy around whether being upright (sitting, birthing stools, chairs, squatting) or lying down have advantages for women delivering their babies. To assess the benefits and risks of the use of different positions during the second stage of labour (i.e. from full dilatation of the cervix).Aim of the study: To study the effect of various postures during the second stage of labour. To compare the duration of the second stage of labour, maternal and fetal outcome in different postures. Materials and Methods: 400 women in labour are studied as to the labour pattern and delivery in different postures. All subjects are matched according to age and parity.Study Design: Prospective Study. Results and Conclusion: Women in squatting position and sitting position had number so intact perineum and no one had episiotomy especially multigravida. Pain perception using the visual analog scale was found to be more in supine, knee elbow position. Overall satisfaction was found better in squatting position than sitting, knee-elbow position in decreasing order. Age group preferred equally position between 26 – 30 years. Multigravida patients preferred squatting posture than any other postures, due to their previous birth experience in the supine position. Primigravida patients preferred the supine position mostly. Blood loss in each posture compared by using under buttock drape. No one presented with postpartum haemorrhage. More comfortable posture during the second stage of labour can be chosen by a mothers by using this study. Because the preference of birthing posture is a basic right of the patient. Duration of the second stage of labour is reduced in squatting and sitting position.

Death due to knee-elbow position in a restricted area: positional - traumatic asphyxia? case report

Positional asphyxia which evolves out of a bodyÂ’s staying in an unusual posture, is a kind of hypoxia and anoxia that occurs as a result of -partially or completely- narrowing of respiratory passage. Crime scene investigation provides significant evidences and clues to enlighten on positional asphyxial deaths. This study aims to discuss the cause of death for the case which was found stuck in knee-elbow position in a restricted area due to external factor exposure. The victim was a 37-year-old male worker. It was thought that he had left on the slaughter house at the end of the shift in the evening but he was found in the following morning as restricted in a cattle knocking box. In the examination of the case, there was no traumatic or pathologic findings to explain the cause of death, except for the apparent finding of asphyxia. It was considered that the death in the case occurred due to positional asphyxia caused by external factor exposure related to restriction in knee-elbow position. As a conclusion, in order to elucidate the death reason and the manner of death, in addition to the findings of internal and external medical examination, evaluation of crime scene investigation and history are also important.

The probability of finding nerve branches to the external anal sphincter

Normal defecation is a combination of several elements of reflex and voluntary functions. The issue of external anal sphincter innervation is of theoretical and clinical significance; however, literature on the subject is still scarce. Most study reports discuss the course of the pudendal nerve with no close insight into inferior rectal nerves supply to the external anal sphincter. We have not found any statistical "mapping" of the site of the nerve branches insertion into the external anal sphincter. Thus, the purpose of the present study was to determine the least and most typical location of nerve branches to the external anal sphincter. One hundred and ten pudendal nerve preparations were analysed. Following the dissection of the pudendal nerve and its branches, a beam compass was used to take linear measurements from the apex of the coccygeal bone to the point of nerve branch insertion to the external anal sphincter. The distance between coccygeal bone apex and the central tendon of the perineum was also measured. For the purpose of comparison, results are presented as relative Bi/A values. Computer programmes devised by the author of this paper within Turbo Pascal were then used to determine the probability of finding nerve branches to the external anal sphincter. Based on the analysis of 110 preparations of the pudendal nerve and its branches, one might conclude that the former was the main although not necessarily the only source of external anal sphincter innervation. While analysing the most and the least probable location of nerve branches to the external anal sphincter, the muscle length was expressed as percentage, i.e., 0% of sphincter length = the apex of the coccygeal bone; 100% of sphincter length = the central tendon of the perineum. The length was then divided into 5% intervals with the probability of finding nerve branches determined by programmes written in Pascal. Within 30-85% of external anal sphincter length, the probability of finding nerve branches to the external anal sphincter is greater than 0.3 with peak probability of 0.68 in the interval between 55 and 65%. Sphincter innervation and clinicoanatomical function of anal canal closure apparatus has been discussed with reference to external anal sphincter injury. Transcutaneous electrostimulation of the pudendal nerve and the use of anal canal electrodes have also been mentioned. The most probable location of nerve branches to the external anal sphincter is half way of its length, i.e., at hour 3 or 9 of the knee-elbow position or lithotomy position. The external anal sphincter can also be directly supplied by nerve branches originating from the sacral nerve root S4; the branches then go towards the posterior part of the sphincter.

Effect of total intravenous anaesthesia and balanced anaesthesia on the frequency of coughing during emergence from the anaesthesia

The effects of total intravenous anaesthesia (TIVA) and balanced anaesthesia (BAL) on coughing during emergence from the general anaesthesia have not yet been compared. Fifty patients, aged 18-60 yr, undergoing elective lumbar disk surgery were randomly allocated to undergo TIVA (propofol-remifentanil) or BAL (fentanyl-nitrous oxide-sevoflurane). Extubation was performed in the knee-elbow position, documented on video, and subsequently evaluated by blinded examiners. There was no difference between TIVA and BAL patients with respect to patient characteristics, proportion of smokers, surgical time, or time of emergence. The median number of coughs was significantly lower in the TIVA group (1, range 0-9) than in the BAL group (4, range 0-20, P = 0.007). Mean maximal heart rate and mean maximal arterial pressure measured during emergence were also significantly lower in the TIVA group (P = 0.009 and P = 0.006, respectively). During emergence from anaesthesia in the knee-elbow position, TIVA is associated with significantly less coughing and reduced haemodynamic response when compared with BAL.

RUBBER BANB LIGATION

Objectives: To find out the post-operative complications of rubber band ligation in 2nd and 3rd degree of hemorrhoids. Design: A descriptive study. Place and Duration of study: An eighteen month study with 2 months follow up (from January 2002 to June 2003), conducted in the department of surgery, Allied Hospital Faisalabad. Patients and Methods: 50 patients were selected (from OPD) in this study. We included all patients with uncomplicated, primary 2nd and 3rd degree hemorrhoids, above 12 years of age and having no co morbid disorders like diabetes, hypertension and bleeding disorders. With patient in the knee elbow or left lateral position (depending upon the choice of patient) digital rectal examination (ORE)was carried out after lubricating the finger with xylocaine jelly. Proctoscopy was done with lubricated proctoscope and exact sites of hemorrhoids localized. The hemorrhoids were ligated one by one. We did triple ligation on a single session. Results: Out of 50 patients, 21(42%) patients were suffering from 2nd degree hemorrhoids, while 29(58%) patients were having 3rd degree. 42(84%) patients were fully cured, 3(6%) developed mild pain, 1(2%) developed severe pain and 2(6%) suffered from mild bleeding while 2(6%) patients developed moderate bleeding. Conclusion: Rubber band ligation is an effective method for treating 2nd or 3rd degree hemorrhoids with no significant post-operative complications.

Anaesthesia for spinal surgery

Thoracolumbar procedures (excluding corrective surgery), cervical procedures and spinal reconstruction and fusion require pre-, intra- and postoperative care. Thoracolumbar procedures are common and generally patients are healthy and no special preoperative investigations are necessary. Simple lumbar procedures may be carried out under local or regional anaesthesia, but this is seldom done in practice because of medico-legal concerns. A general anaesthetic technique is more usual, and for all posterior spinal procedures the patient is placed in the prone or knee-elbow position. Good postoperative analgesia is important. Careful airway assessment is vital in all patients requiring cervical spine surgery. General anaesthesia with tracheal intubation and ventilation is required. Again, for posterior approaches the patient is prone; however, the seated position is favoured by some surgeons. Extubation may be difficult and is best performed with the patient awake. Postoperatively, airway obstruction may be life-threatening. Spinal reconstruction is indicated for correction of kyphoscoliotic deformities and for stabilization following trauma or infection. Careful preoperative assessment is required and should include a lung-function test. Intubation with a double lumen may be necessary and standard maintenance techniques are applicable. Early extubation is desirable and good postoperative pain relief is essential. Spinal cord damage during surgery, caused by spinal cord perfusion pressure or underlying pathology, for example, can be monitored with the ‘wake up’ test or the more sophisticated method of somatosensory evoked potentials.

Rigid sigmoidoscopy: an evaluation of three parameters regarding diagnostic accuracy.

Rigid sigmoidoscopy is the method employed for examining the rectum and sigmoid colon in most general surgical clinics. Commonly, this is performed without any prior preparation of the bowel and with the patient in the left lateral (Sims') position. This study was designed to assess three factors relating to this method: preparation of the bowel; position of the patient; and the experience of the operator. The study shows that diagnostic accuracy without preparation is adequate in only 50 per cent of cases but, by employing a preliminary disposable (Fletcher's) enema, this can be improved to 80 per cent. Employing the knee-elbow position gave only slight advantage over the usual Sims' position and operator experience did not improve diagnostic accuracy once familiarity with the use of the sigmoidoscope had been achieved. The study underlines the importance of preparation as an essential prelude to sigmoidoscopy.

Intraocular pressure during lumbar disc surgery in the knee‐elbow position

Increased intraocular pressure is often implicated in the aetiology of postoperative visual impairment. Such an increase in intraocular pressure has been demonstrated in the prone position. We investigated intraocular pressure in seven patients undergoing lumbar disc surgery in the knee-elbow position with the head resting on a cushion and turned to the side. Measurements were performed in the supine position before induction of anaesthesia and in the knee-elbow position after surgery with the patient still anaesthetised. After a mean (SD) duration of prone positioning of 121 (18) min, mean (SD) intraocular pressure in the nondependent eye was unchanged when compared to the awake state (17.7 (2.4) mmHg vs 18.9 (5.5) mmHg), whereas the intraocular pressure in the dependent eye had significantly decreased (17.0 (3.6) mmHg vs 8.1 (1.8) mmHg; p < 0.01). These results may be important for choosing the optimal position for spinal surgery when an increase in intraocular pressure should be avoided.

Use of radon-containing rectal suppositories in chronic prostatitis complicated by sexual dysfunctions

The article describes how to apply radon-containing rectal suppositories in patients with chronic prostatitis (CP). Intrarectal insertion of the suppositories is performed in the patients lying in the left lateral or knee-elbow position daily for the first 8 days in a dose 18.5 kBk, for the following 2-4 days in a daily dose 37 kBk 2-3 times a day. So, the course of the treatment takes 10-12 days. Such treatment of CP patients eradicated or alleviated prostatic inflammation and improved sexual function, was effective in 80% patients, prolonged remission to 12-16 months.

Consequences for the teenagers after anogenital sexual contacts

Necessity of research of teenagers after violent actions of sexual character is connected basically with anogenital sexual contacts. Survey of victims by the medicolegal (forensics medicines) expert assumes knowledge of illnesses like anorectal complex, causing anorectal dysfunctions (perianal itch, proctalgia, a crack of anal tract, encopresis). All specified diseases concerned with anorectal rings can be idiopatic (without the established reason) and secondary (locks, violent actions of sexual character, medical manipulations, traumas). On suspicion of anal penetration in children, survey should be carried out after obligatory conversation with the psychologist and with special feeling of a step, taking into account age factors and diseases of mental sphere. Such survey demands a certain algorithm of inspection, whose basic stages consist of the following: 1. Survey of anal areas will be carried out after preliminary conversation and examinations of other sites of a body in knee–elbow position. Whenever possible, the expert should be on floor with surveyed. 2. Hands of the expert should be warm so as not to provoke a pressure of muscles in the anus. 3. The anal reflex is checked by an easy touch, without painful variant, to a superficial part anal apertures (external sphincter is tunicae reduced, back pass is involved). 4. Children, as a rule, do not keep sphincter, a strong-willed pressure and therefore, reduction of a reflex is accompanied by reduction of force as a result of reduction of sphincter and its tone.

Effect of posture on echographic examination for dialysate in patients treated with chronic ambulatory peritoneal dialysis as a model of ascites

We evaluated the effect of posture on echographic examination for dialysate in 15 patients treated with chronic ambulatory peritoneal dialysis as a model of ascites. After gradually infusing 500 1000 and 1500 ml dialysate into their abdominal cavity, we compared echographic findings of infused fluids in dorsal, knee–elbow, and standing positions. The height of fluid in the standing position was largest and the width of fluid in Morison's pouch in the dorsal position was smallest. When calculating the volume of the infused fluid by modeling as an elliptic cone in the standing position or as a segment of a sphere in the knee–elbow position, the correlation coefficients between the calculated volumes and the infused volumes were 0.979 ( P<0.0001) in the knee–elbow position and 0.920 ( P<0.0001) in the standing position, respectively. Patients and examiners were required to endure an unnatural and awkward posture in the knee–elbow position. These findings suggest that echographic examination in the standing position is an easy and accurate method for the diagnostic paracentesis and the measurement of the volume of ascites in this model.

Tenotomy of the ligamentum patellae in spina bifida: management of limited flexion range at the knee

THE JOURNAL OF BONE AND JOINT SURGERY pared for an open procedure. Under general anaesthesia and in the knee-elbow position, a central incision was made over the dislocated joint. There was a local haematoma with minor damage to the periosteum. The coccyx was found to be displaced ventrally and 1 cm proximally. Distal traction alone proved ineffective but reduction was achieved using a raspatory as a lever. The sacrum and coccyx were fixed together using four vicryl sutures as tension bands (Fig. 2). Postoperative radiographs confirmed reduction (Fig. 3). The patient was advised not to sit during the first six weeks after surgery, but rehabilitation was uncomplicated and she had no pain. Radiological examination at six weeks and six months after operation showed normal alignment and at two years she had no complaint. Discussion. We have been unable to find any publication of this type of traumatic dislocation. Yamashita (1988) mentioned the condition but his article was not published in English. Fractures are more common, probably because of the normal strength of the ligaments. The need for surgical reduction may be questioned. Excision of the coccyx is performed for coccydynia (Tilscher et al 1986), but the application of the normal principles of trauma surgery led us to reduce the dislocation with success.

Toxic megacolon: the knee-elbow position relieves bowel distension.

Toxic megacolon complicating inflammatory or infective colitis carries a high morbidity and mortality and surgical intervention is necessary in up to 80% of cases. Perforation complicates toxic megacolon in about 35% of cases. After perforation, the death rate nears 50%. Gaseous distension of the bowel causes considerable discomfort to the patient and increases transmural pressure. The latter is thought to cause a reduction in blood flow and may predispose to perforation. The use of instruments for colonic aspiration is discouraged, because of the high risk of perforation. The successful use of the knee-elbow position to relieve bowel distension in two patients with toxic megacolon is described.

Hydronephrosis during pregnancy: a literature survey

The occurrence of hydronephrosis and hydroureters during pregnancy has been termed physiological, inasmuch as it is seen in more than 80%, most frequently and most pronounced in primigravida. The dilatation develops during the second trimester, and becomes more prominent on the right side, is only seen above the linea terminalis and disappears within a few weeks after birth. The condition is not seen in women whose ureters do not cross the pelvic brim. The extent of the dilatation can be reduced by placing the woman on the side least affected or in the knee-elbow position. After a survey of the literature, the conclusion is reached that today there is every probability that hydronephrosis during pregnancy develops as a result of compression of the ureters between the pregnant uterus and the linea terminalis. It has not been demonstrated that the change in hormonal balance during pregnancy is of importance. The clinical significance of hydronephrosis lies in the association between ureteral obstruction and the high frequency of ascending urinary tract infection during pregnancy and in the understanding of the importance —in the treatment of infection—of improving drainage by means of a change in position. Isotope renographic studies seem to show a possible relationship between bilateral ureteral obstruction and the development of pre-eclampsia. Similarly, it appears that acute hydronephrosis or worsening of an existing hydronephrosis has been somewhat overlooked as a possible cause of uncertain abdominal pain during pregnancy. These conditions should be examined by means of ultrasonography, and an attempt at treatment by a change in position should be made. In cases of continued pain or affected renal function, treatment should consist of the insertion of a ureteral catheter.

The knee--elbow position in lumbar disc surgery: a review of complications.

Follow-up studies were carried out in 1962, 1977, and 1981 on 35% or 943 or our 2690 patients operated upon from 1950 through 1981 for lumbar disc herniation. Seven hundred and twenty-four were done with and 1848 without spinal fusion. There were 11.2% operative, 8.3% postoperative and 18.9% late complications. Sepsis occurred in 2 patients (0.2%). Thrombosis decreased from 10% in the 1950s to 4% in the 1960s and to zero in the late 1970s. Reoperations were performed in 10.8% of the fused and in 23.6% of the nonfused patients. There were no serious vascular injuries and no postoperative deaths. Serious complications from lumbar disc surgery with the patient in the knee--elbow position occur rarely and ought to be avoided. Posterior spinal fusion seems to give better protection against recurrence of pain than simple removal of the herniated disc material.

Recurrent pneumoperitoneum due to jejunal diverticulosis: With a review of the causes of spontaneous pneumoperitoneum

In the absence of abdominal operative procedures, symptomless spontaneous pneumoperitoneum is uncommon. The case is described of a patient with jejunal diverticulosis who developed spontaneous pneumoperitoneum on three occasions and brief details are given of six other cases of jejunal diverticulosis with pneumoperitoneum from the literature. Other causes of symptomless pneumoperitoneum include pneumatosis intestinalis, perforation in tabes dorsalis or coma, stercoral ulceration, physiological pneumoperitoneum in women due to exercise in the knee-elbow position, and vaginal douches with a bulb syringe or effervescent fluid.

Routine Examination With Proctosigmoidoscope

To the Editor:— As far back as 1950 (New York J Med50:89, 1950) the late Garson and I advocated the routine addition of sigmoidoscopy as part of a physical examination, performed by the general practitioner, internist, and general surgeons, of individuals past 40 years of age. I've also stated that in a large number of patients proctosigmoidoscopic examination may be performed successfully without preliminary cleansing enemas. We also stated that the knee-chest or the knee-elbow positions are employed except in the case of debilatated or aged patients when the left lateral Sim's position is used. I wish to stress that the value of the knee-elbow position has been greatly underestimated and in my experience is superior to Sim's position. The virtue of performing endoscopy without preparation has been recognized but not universally accepted. Preliminary preparation is avoided in order to observe the unaltered mucosa and not to wash

SOME RESPIRATORY EFFECTS OF A MODIFIED KNEE-ELBOW POSITION DURING ANAESTHESIA

A modified knee-elbow position which facilitates the repair of vesico-vaginal fistulae is described. Some respiratory effects consequent on the assumption of this position were investigated. In twenty-seven conscious male subjects the vital capacity was reduced by an average of 16.3 per cent on assuming the position. In twelve patients under light anaesthesia with halothane there was no difference in mean values for respiratory rate, minute volume, arterial carbon dioxide tension and oxygen saturation obtained in the modified knee-elbow and in the supine position. It is concluded that the use of this position in patients with healthy lungs does not increase the hazards of the operation if respiratory muscle function is not impaired by deep anaesthesia or the injudicious use of muscle relaxants.