As a clinical tool to evaluate autonomic dysfunction, "Valsalva ratio" was measured in 36 Parkinson's disease patients (15 men, 21 women) and 10 control subjects (4 men, 6 women). In this study, the Valsalva ratio was defined as the ratio of peak to nadir heart rate during Valsalva maneuver, namely voluntary and transient breathholding in maximal inspiration state with subsequent release by the subject. EKG was monitored throughout the whole process to observe the moment to moment change of heart rate. The subject group with Parkinson's disease was subdivided by clinical variables including sex, are, Hoehn and Yahr clinical stage, duration of symptoms, and duration of therapy with L-dopa containing drugs. The Valsalva ratio of the subject group as a whole was less than that of the control group (P<0.05). But the differences of Valsalva ratio between the subgroups graded by above clinical variables of Parkinson's disease were not statistically significant. The clinical applicability of "Valsalva ratio" measurement described in this study was discussed.
Electrocardiography ; Heart Rate ; Humans ; Levodopa ; Male ; Parkinson Disease* ; Valsalva Maneuver

PURPOSE: Orbital varices, which can lead to proptosis or globe displacement, are caused by Valsalva's maneuver or bending forward. Most of the orbital varices are treated conservatively, but surgical treatment is necessary for severe cosmetic or functional problems. We report a case of orbital organizing hematoma accompanied by an orbital varix which was successfully removed surgically without complications such as intraoperative bleeding. CASE SUMMARY: A 78-year-old female presented with the complaint of 4 mm proptosis and hyperglobus of left eye. Orbit magnetic resonance imaging (MRI) showed a well demarcated extraconal mass in the inferior orbit which appeared to be an orbital varix. Initially, we decided to monitor the patient without surgery because proptosis was reduced to 1 mm within a week. However, after 5 months, the symptoms suddenly worsened, specifically, 4 mm of proptosis with severe hyperglobus and pain. MRI showed a 29.7 x 21.2 x 23.7 mm mass compressing the globe upward. Six weeks of conservative care did not improve the symptoms and we eventually performed an anterior orbitotomy through the inferior conjunctiva. There was a minor bleeding during the surgery. Based on the histological test, the mass was determined to be an organizing hematoma covered by a membrane. At 8 months postoperatively, symptoms had not recurred. CONCLUSIONS: Orbital varices are usually treated conservatively since its surgical removal is known to have risks. Nonetheless, if an MRI shows an orbital organizing hematoma, it can be surgically debulked successfully without complications when a chronic hemorrhage from orbital varix causes serious proptosis and globe deviation.
Aged ; Conjunctiva ; Exophthalmos ; Female ; Hematoma* ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Membranes ; Orbit* ; Valsalva Maneuver ; Varicose Veins*

Dot-like hippocampal hyperintensities on diffusion-weighted magnetic resonance imaging (MRI) have been reported as an interesting imaging finding of transient global amnesia (TGA). We report three patients with such dot-like hippocampal hyperintensities who did not present with anterograde amnesia. Episodes associated with the Valsalva maneuver such as nausea or vomiting might have produced the dot-like hippocampal hyperintensities in these patients. However, depending on the individual susceptibility to hippocampal lesions, clinical symptoms of TGA might not be present even when hippocampal lesions are present.
Amnesia, Anterograde ; Amnesia, Transient Global* ; Hippocampus ; Humans ; Magnetic Resonance Imaging* ; Nausea ; Valsalva Maneuver ; Vomiting

PURPOSE: The study purpose was to evaluate the clinical and ultrasound characteristics of women with urinary stress incontinence (USI) with or without genital prolapse (GP). MATERIALS AND METHODS: A total of 268 patients who underwent ultrasound perineal evaluation were divided into two groups: isolated USI (n=132) and USIGP (n=136) with USI/GP stage I/II. The latter group was additionally divided into two subgroups: USIGP(A) (n=78) with USI/GP stage I and USIGP(B) (n=58) with USI/GP stage II. RESULTS: Point Aa (pelvic organ prolapse quantification system), which is the projection of the bladder neck (BN) on the anterior vaginal wall, was situated higher in the rest position (RP) but moved lower during a Valsalva maneuver (VM) in the USI group than in the USIGP group (p<0.05). The ultrasound parameters alpha-angle and the distance Sy-BN (symphisis-bladder neck) decreased, whereas distance H increased, in the USIGP group during VM. The ultrasound parameters that gave the best insight into the range of BN movements were as follows: distance R-->V and angle of rotation (rho), which were significantly higher in the USI group than in the USIGP group during VM. CONCLUSIONS: According to the clinical and ultrasound findings, we can conclude that the BN is situated higher during the RP but moved lower during a VM in patients with isolated USI compared with those with concomitant USI/GP, which could be explained by the cystocele-immobilizing effect on the BN during the VM in the latter group but also by the deteriorated pubo-urethral ligaments in the former group.
Female ; Humans ; Ligaments ; Neck ; Prolapse ; Urinary Bladder ; Urinary Incontinence, Stress ; Valsalva Maneuver

BACKGROUND: A paradoxical embolism through the patent foramen ovale has been suggested as a possible cause of ischemic cerebrovascular disease in young patients without other cardiovascular risk factors, however, the transesophageal contrast echocardiographic examination is proved to be sensitive and accurate to detect the patent foramen ovale in vivo by demonstration a right-to-left shunting of microbubbles at the interatrial septum. METHODS: Transesophageal contrast echocardiographic examinations were performed in 16 young patients(32+/-6 years, 19~39) with ischemic cerebrovascular diseases without other cardiovascular risk factors. Contrast agents were injected twice in each patients, one with Valsalva maneuver and the other with coughing and the presence of the patent foramen ovale was confirmed by demonstrating echogenic contrast crossing the interatrial septum. RESULTS: The patent foramen ovale was demonstrated in five of sixteen patients(31.2%) during transesophageal contrast echocardiographic examination. Although the prevalence of the patent foramen ovale in normal population has not been examined in this study, the prevalence in patient group appears to be significantly higher than that of normal population. CONCLUSIONS: Taken together, a paradoxical embolism through the patent foramen oval appears to be one of the causative factors and a transesophageal contrast echocardiography is recommended especially in young ischemic cerebrovascular disease patients who have normal transesophageal echocardiographic findings and no known risk factors.
Contrast Media ; Cough ; Echocardiography* ; Embolism, Paradoxical ; Foramen Ovale, Patent* ; Humans ; Microbubbles ; Prevalence* ; Risk Factors ; Valsalva Maneuver

PURPOSE: To evaluate the dynamic patency of the frontonasal duct(FND) on PNS CT scan after administration ofan iso-osmolar contrast agent (lsovist) into the nasal cavity. MATERIALS AND METHODS: Coronal PNS CT scans from ten normal and 30 patients with symptoms of chronic sinusitis were obtained after administration of lsovist intothe nasal cavity, followed by Valsalva maneuver for the even distribution of the agent into the FND and sinuses. Atotal of 80 FNDs were evaluated for dynamic patency by examining the presence of the contrast agent in ducts. RESULTS: The contrast agent was visualized in 34/37 FNDs(91.9%) without ipsilateral frontal sinus it is and was visualized in 18/43 FNDs(41.9%) in cases of ipsilateral frontal sinusitis. In addition, the contrast agent within the ipsilateral frontal sinus was visualized in 8/18 FNDs(44.4%). The major causes of ductal obstruction were mucoperiosteal thickening and polypoid lesions secondary to inflammation. CONCLUSION: PNS CT scan together with the administration of lsovist, which caused minimal irritation, was useful for the evaluation of the relationship between the dynamic patency of the FND and frontal sinusitis, In addition, this study can provide the rhinologist with accurate anatomical and pathological information concerning the FND before a choice is made between endoscopic sinus surgery or medical treatment.
Frontal Sinus ; Frontal Sinusitis ; Humans ; Inflammation ; Nasal Cavity* ; Sinusitis ; Tomography, X-Ray Computed* ; Valsalva Maneuver

The clinical symptom complex characterized by syncopal attacks and sudden death in patients with electrocardiographic anomalies, especially a prolonged Q-T interval is known as the Romano-Ward syndrome. When a similar symptom complex is accompanied by congenital deafness, it is called Jervell and Lange-Nieisen syndrome. This study was undertaken to investigate the investigate the incidence of the latter syndrome in the Seoul area. A total of 1,013 children with congenital deafness who attend schools for the deaf were studied by analyzing their electrocardiograms. A corrected Q-T interval of> or =0.44 seconds was defined as a prolonged Q-T interval. The overall incidence of long Q-T syndrome observed in the deaf in the Seoul area was 0.49% as compared to 0.25% reported from elsewhere in the world. The mean age of patients with long Q-T syndrome was 11.3+/-5.9 years and the first syncopal attacks was 4.6+/-1.1 per patient. A valsalva maneuver and exercise tests in the test group were associated with significant changes in T wave configuration and prolonged Q-T intervals while similar changes were not observed in the control group. A larger survey is needed to derive more statistically significant conclusions.
Child* ; Deafness* ; Death, Sudden ; Electrocardiography ; Exercise Test ; Humans ; Incidence ; Romano-Ward Syndrome ; Seoul ; Valsalva Maneuver

Studies on the prevalence of varicocele and the relation of varicocele to scrotal temperature and testicular volume were performed on 986 healthy Korean boys 6 to 15 years of age for 5 months from the May, 1988 to September, 1988. We examined the subjects in standing position with Valsalva maneuver for detecting varicocele and classified the varicocele as grade I, grade II, or grade III according to the system proposed by Dubin and Amelar in 1970. Scrotal temperatures were measured in standing position by contact scrotal thermography using Varicoscreen, a flexible screen covered with thermosensitive liquid crystals reflecting color from brown (at 31.8 degrees C) to blue (at 34.5 degrees C). Testicular volume was measured by indirect method using series of graduated plastic models (Prade orchidometer). Following results were obtained. The overall prevalence rate of varicocele aged 6 to 15 years was 8.8%. No case of varicocele was encountered in 303 boys aged 6 to 8 years, while the incidence in the 683 subjects 9 to 15 years was 12.8% with an increase from 2.9% in 9-year-olds to 18.8% in 14-year-olds. Among 87 varicocele subjects, varicocele accounted for 75.9% in the left side, 5.7% in the right and 18.4% in both sides. And of 103 varicocele testes 51.5% were classified as grade I, 29.1 % as grade II and 19.4% as grade III. The scrotal temperature exceeded 31.8 degrees C in their contralateral normal testes. Varicocele increased scrotal temperatures not only in the affected side, but also in the other side. Scrotal temperature in varicocele testes was revealed significantly higher than that in normal (p<0.01). The degree Of varicocele bears relation to scrotal temperatures (p<0.01). In healthy Korean boys in 6-year-olds, the mean testicular volume was 1.1+/-0.4 ml. The testicular growth rapidly increased in 11-year-olds and in 15 years of age testis was 14 times larger than that of 6-year-olds. There was no volume differential between both testes in normal subjects. In the subjects with unilateral left varicocele, the testicular volume was decreased in both sides than in the normal subjects. Ipsilateral and contralateral testicular volume was most prominently decreased in grade III varicocele.
Adolescent* ; Child* ; Humans ; Incidence ; Liquid Crystals ; Plastics ; Prevalence* ; Testis ; Thermography ; Valsalva Maneuver ; Varicocele*

PURPOSE: The association of varicoceles and subfertility has been well documented. Although varicoceles remain the most common surgically correctable cause of male infertility the subjective diagnosis of varicocele, especially the small ones remains a challenge. MATERIALS AND METHODS: We evaluated 40 young men (16 volunteers, 24 varicocele patients) with scrotal blood pool scan using 99mTc RBC. RESULTS: Complete correlation between physical findings and the scrotal scan was found. The postoperative scans of 12 patients with surgically corrected high grade varicoceles demonstrated symmetrical photon accumulation in the scrotum. The technique which most accurately correlated the clinical grade was the varicocele index using total count at Valsalva maneuver. CONCLUSIONS: We believe that the 99mTc RBC scrotal scan with technical refinement is a useful procedure in the objective diagnosis and followup of varicoceles.
Diagnosis ; Follow-Up Studies ; Humans ; Infertility ; Infertility, Male ; Male ; Scrotum ; Valsalva Maneuver ; Varicocele* ; Volunteers

Internal jugular phlebectasia (IJP) is a fusiform dilatation of the internal jugular vein (IJV), usually presented as a neck mass in children. Accurate diagnosis from carefully directed history, physical examination, and radiological study could result in lifesaving therapy. We performed our study to suggest possible clinical diagnostic criteria for IJP in Korean children. We reviewed three cases of IJP (patients group) and compared the diameter of the internal jugular phlebectasias with diameters of IJVs in ten normal children (control group) using ultrasonography (USG). There were no significant differences in the range of diameters in the resting state between the two groups. The diameters on the right side, compared with those on the left side, showed no statistical significance (p < 0.05). Te range of expanding diameter and average expanding ratios (resting state to Valsalva maneuver X 100%) showed a statistical difference between the two groups (p < 0.05).
Child ; Child, Preschool ; Dilatation, Pathologic/*ultrasonography ; Female ; Human ; Jugular Veins/*ultrasonography ; Korea ; Male ; Valsalva's Maneuver