#16
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#17
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#18
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Îáüåêòèâíîñòè ðàäè:
A new hypothesis for sudden infant death syndrome: the occlusion of vertebral arteries as a major cause Journal of Clinical Forensic Medicine Volume 3, Issue 2, Pages 93-98 ..........The hypothesis explains the reduction of mortality of SIDS in infants in sleeping supine position to those in the prone position. In prone position, the infant's head is rotated 90 degrees which may put stress on atlas and axis thus occlude vertebral arteries by stretching and kinking. Infants under 6 months are unable to change position unaided so duration of obstruction is an aggravating element. These factors are about 50% less in the supine position... |
#19
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Ýòî ñòàòüÿ 1996 ãîäà, à â 2008 âûøëà òàêàÿ:
Öèòàòà:
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#20
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ß íå î SIDS âåäü, à î òàèíñòâåííûõ ñâîéñòâàõ ïîçâîíî÷íèêà, ò.ê. â ïðàêòèêå ïðèõîäèòñÿ èíîãäà ñëåäîâàòü:
Effect of head rotation on vascular anatomy of the neck: an ultrasound study. - Wang R - J Emerg Med - 01-OCT-2006; 31(3): 283-6 "...The patient's head was positioned at 0, 45 and 90 degrees of rotation...." Abstract: Carotid artery injury is a serious complication of landmark-guided internal jugular catheterization. Studies have determined that the internal jugular vein (IJV) frequently overlaps the carotid artery (CA), which has been postulated to increase the rate of arterial injury. The purpose of this study was to define the anatomic relationship of the IJV and CA by describing CA overlap by the more superficial IJV. We also seek to determine the effect of head rotation on the amount of overlap, which may have implications for IJV catheter placement. We prospectively studied the vascular anatomy of the neck in 156 Emergency Department patients. The primary intervention was head rotation to the left, as if the patient was positioned for right IJV catheterization. The patient's head was positioned at 0, 45 and 90 degrees of rotation. Ultrasound images were obtained in a transverse orientation. The percentage overlap of the CA by the IJV was measured. We also measured the distance between the jugular vein and the carotid artery. In neutral position, there was a mean overlap of 29% at the apex of the sternocleidomastoid. As the head was turned, the percent overlap increased. At 90 degrees, there was a mean overlap of 72%. Differences were determined to be significant by analysis of variance (ANOVA) with a p < 0.001. Furthermore, we found a distance of 10 mm between IJV and CA when the head is in neutral position. As the head was turned, the jugular-carotid distance decreased to 1 mm in the far lateral head position. These differences were also found to be significant by ANOVA with a p < 0.001. We concluded that the IJV overlaps the CA in the neutral position to a significant degree. This overlap increases until the head is fully turned, where most of the CA is overlapped by the IJV. This may help explain the mechanism of CA puncture. We propose two modifications to standard IJV line technique: minimize the patients' head rotation; and use ultrasound guidance for IJV catheterization. |
#21
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À ÿ êàê ðàç ïðî SIDS. Òåîðèé î ïðè÷èíå âñåãî â ïîçâîíî÷íèêå áûëî íåìàëî, è ýòèì â ÑÍà ïîëüçóþòñÿ áîëåå, ÷åì ìíîãèå. À äëÿ êëèíèöèñòîâ äîêàçàòåëüñòâ ïî-ïðåæíåìó íå íàáèðàåòñÿ.
P.S. Â Íåëüñîíå ïðî SIDS åñòü. |
#22
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Ïîçâîëüòå, âñå æå ðå÷ü øëà ñîâåðøåííî î äðóãîì.
Íà÷àëî: Öèòàòà:
Öèòàòà:
Âû, Doroga, âçÿëè 3 ñïîðíûõ ïîëîæåíèÿ, ñîñòàâèëè èç íèõ ïðîèçâîëüíóþ "ëîãè÷åñêóþ" öåïî÷êó è ñäåëàëè ñòðàííûé âûâîä. Áåðåì Âàøè ïîëîæåíèÿ è ëîãè÷åñêè èõ ïðîäîëæàåì. Âî ñíå ìûøå÷íûé êîðñåò øåè îñëàáåâàåò - øåéíûé îòäåë ïîçâîíî÷íèêà â ïîëîæåíèè "íà æèâîòå" îêàçûâàåòñÿ ñêðó÷åííûì íà 90 ãðàäóñîâ -  ýòîé ñèòóàöèè âîçìîæíî ÷ðåçìåðíîå ñìåùåíèå ïî îñè îäíîãî ïîçâîíêà îòíîñèòåëüíîãî äðóãîãî ñ ôîðìèðîâàíèåì ïîäâûâèõà - à ïðè ñèëüíîì îñëàáëåíèè êîðñåòà - âûâèõà Âûâîä: ñïàòü íåëüçÿ, òàê êàê ýòî ñìåðòåëüíî îïàñíî. È ïîñëåäíåå çàìå÷àíèå - êàê Âû äóìàåòå, êàêèìè ñðåäñòâàìè ìîæíî îáåñïå÷èòü àáñîëþòíóþ óâåðåííîñòü, ÷òî ðåáåíîê âî ñíå íå ïîâåðíåòñÿ íà æèâîò è íå ñâåðíåò ñåáå ñëàáóþ øåéêó?
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Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
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#23
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Îäíàæäû ëåáåäü ðàêîì øóêó... Íå ìîæåì ìû ñïåòüñÿ, ãîâîðÿ îá îäíîì.....
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#24
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Öèòàòà:
Öèòàòà:
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#25
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Êàê ÿ æèâà òî äî ñèõ ïîð, ñïÿ, â îñíîâíîì, íà æèâîòå?.. Ñëó÷àéíîñòü, ñ÷àñòëèâàÿ ñëó÷àéíîñòü..
À âîîáùå òåìà óæå áûëà òàêàÿ ïàðó ëåò íàçàä, è ÿ òîæå äî ñèõ ïîð æèâà. |