#16
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#17
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#18
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Обьективности ради:
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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Это статья 1996 года, а в 2008 вышла такая:
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#20
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Я не о SIDS ведь, а о таинственных свойствах позвоночника, т.к. в практике приходится иногда следовать:
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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А я как раз про SIDS. Теорий о причине всего в позвоночнике было немало, и этим в СНГ пользуются более, чем многие. А для клиницистов доказательств по-прежнему не набирается.
P.S. В Нельсоне про SIDS есть. |
#22
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Позвольте, все же речь шла совершенно о другом.
Начало: Цитата:
Цитата:
Вы, Doroga, взяли 3 спорных положения, составили из них произвольную "логическую" цепочку и сделали странный вывод. Берем Ваши положения и логически их продолжаем. Во сне мышечный корсет шеи ослабевает - шейный отдел позвоночника в положении "на животе" оказывается скрученным на 90 градусов - В этой ситуации возможно чрезмерное смещение по оси одного позвонка относительного другого с формированием подвывиха - а при сильном ослаблении корсета - вывиха Вывод: спать нельзя, так как это смертельно опасно. И последнее замечание - как Вы думаете, какими средствами можно обеспечить абсолютную уверенность, что ребенок во сне не повернется на живот и не свернет себе слабую шейку?
__________________
Илюхин Евгений Аркадьевич |
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#23
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Однажды лебедь раком шуку... Не можем мы спеться, говоря об одном.....
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#24
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Цитата:
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#25
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Как я жива то до сих пор, спя, в основном, на животе?.. Случайность, счастливая случайность..
А вообще тема уже была такая пару лет назад, и я тоже до сих пор жива. |