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

Interest in the prevalence of patent foramen ovale(PFO) and its relation to embolic stroke has increased with the sophistication of methods for noninvasive cardiac assessment. The effect of foramen ovale closure on the risk for subsequent strokes is promised. A 22-year old woman was presented with sudden onset of cerebral infarct. She had a patent formen ovale, and right to left shunt during the Valsalva maneuver, which was diagnosed by transesophageal contrast echocardiography. Transcatheter closure of PFO was performed with Rashkind PDA umbrella under the guidance of transesophageal echocardiography. Transcatheter closure of PFO can be accomplised with little morbidity and may reduce the risk of embolic episode.
Echocardiography ; Echocardiography, Transesophageal* ; Female ; Foramen Ovale ; Foramen Ovale, Patent* ; Humans ; Prevalence ; Stroke* ; Valsalva Maneuver ; Young Adult

The occurrences of pneumothorax and pneumomediastinum are rare, but considered to be potentially life-threatening conditions in patients undergoing functional endoscopic sinus surgery under general anesthesia. Tracheobronchial rupture may results in serious complications, such as pneumothorax and pneumomediastinum. It may occur accidentally by endotracheal tube when the patient's neck is flexed or extended. We report the case of a 48-year-old female patient who developed massive subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumoperitoneum seven hours after functional endoscopic sinus surgery under general anesthesia.
Anesthesia, General ; Female ; Humans ; Mediastinal Emphysema ; Neck ; Pneumoperitoneum ; Pneumothorax ; Rupture ; Subcutaneous Emphysema ; Valsalva Maneuver

BACKGROUND: Patent foramen ovale (PFO) is increasingly being recognized in stroke patients. The capability of transcranial Doppler (TCD) to detect a PFO has been established. We studied the frequency of PFO in patients with ischemic stroke. METHODS: Eighty-nine patients with ischemic stroke (62 men, mean age: 56.5) consecutively underwent a contrast-enhanced TCD with monitoring of the bilateral middle cerebral arteries (MCA). The contrast solution, which consisted of 8 ml of normal saline, 1 ml of air, and 0.2 ml of patient's blood, was injected twice during normal breathing and the Valsalva maneuver. High intensity transient signals (HITS) were counted for 30 seconds after the injection. RESULTS: Patent foramen ovale was detected in 19 patients (21%). The mean age was similar in those with (55 years) and those without (57 years) PFO. Patent foramen ovale was more frequent among men (26%) than women (11%). There were no differences in the frequency of PFO among stroke subtypes (large artery atherosclerosis, 18%; small artery occlusion, 27%; cardioembolic, 27%; undetermined cause, 11%). CONCLUSIONS: Patent foramen ovale is common in patients with ischemic stroke of all subtypes.
Arteries ; Atherosclerosis ; Female ; Foramen Ovale, Patent* ; Humans ; Incidence* ; Male ; Middle Cerebral Artery ; Respiration ; Stroke* ; Valsalva Maneuver

PURPOSE: To report one case of recurrent Valsalva retinopathy presented as subretinal hemorrhage associated with exercising a barbell in a healthy man. METHODS: A 47-year-old healthy man visited our hospital complaining of a pericentral blind-spot in the right visual field. At first visit, visual acuity was 20/20 without correction. Anterior segment examination was unremarkable and dilated fundus examination revealed a subretinal hemorrhage in the inferior area of the macula. We followed up the visual acuity, anterior segment exam, fundus examination, and fluorescein angiography for several weeks. RESULTS: Three weeks after the first visit, the size of subretinal hemorrhage decreased, but recurrent subretinal hemorrhage presented after exercising a barbell at the existing hemorrhagic part and its inferior area. Six weeks after the recurrent hemorrhage, the hemorrhage was resolved completely and the pericentral blind-spot was recovered. CONCLUSIONS: Valsalva hemorrhagic retinopathy is characterised by retinal hemorrhage occurring in healthy individuals due to a rapid rise in intrathoracic or intra-abdominal pressure. In this case, there was recurrent subretinal hemorrhage after repeatedly exercising a barbell. So, it is very important to educate patients about the restriction of excessive Valsalva maneuver to prevent recurrent Valsalva retinopathy.
Fluorescein Angiography ; Hemorrhage ; Humans ; Middle Aged ; Retinal Hemorrhage ; Valsalva Maneuver ; Visual Acuity ; Visual Fields

PURPOSE: To assess the performance of contrast-enhanced three-dimensional(3-D) magnetic resonance venography (MRV) of the pelvis and lower extremities in patients with varicose veins. MATERIALS AND METHODS: Ascending and MR venography were performed in seven legs of seven patients, and duplex Doppler sonography and MR venography in 15 legs of 12 patients, all referred for evaluation of varicose veins. For analysis, the venous system as revealed by ascending and MR venographic images was divided into 13 segments. For detection of reflux to the great saphenous vein, duplex Doppler sonography and MRV were performed. RESULTS: In ascending venography and MRV, 91 venous segments were potentially visible; both modalities depicted 78 of these, but failed to detect four. Ascending venography and MRV detected 17 and 19 varices, respectively. When two tourniquets were placed around the ankle and knee using the Valsalva maneuver, MRV and duplex Doppler sonography detected reflux in 8 of 11 and 13 of 15 legs, respectively. CONCLUSION: Contrast-enhanced 3-D MRV comprehensively displays the venous system of the lower extremities and permits assessment of varicose veins. MRV using the Valsalva maneuver allows assessment of reflux to the great saphenous vein.
Ankle ; Humans ; Knee ; Leg ; Lower Extremity* ; Pelvis ; Phlebography* ; Saphenous Vein ; Tourniquets ; Valsalva Maneuver ; Varicose Veins*

Purpura is discoloration of the skin and mucous membranes due to extravasation of red blood cells and may be due to a variety of factors, but it is sometimes difficult to identify the exact cause. Some forms of purpura can frighten the patient and puzzle the physician. Mask phenomenon is an unusual purpura of the relatively loose tissues of the face and neck occuring after prolonged coughing, vigorous vomiting, valsalva's maneuver, parturition, or any other exertion that raises intrathoracic or abdominal pressure. This occurs with acute onset and fades within twenty-four to seventy-two hours spontaneously. A work-up for a coagulation or platelet defect is usually not required. We herein describe five cases of mask phenomenon(unusual facial purpura).
Blood Platelets ; Cough ; Erythrocytes ; Humans ; Masks* ; Mucous Membrane ; Neck ; Parturition ; Purpura* ; Skin ; Valsalva Maneuver ; Vomiting

Purpura is discoloration of the skin and mucous membranes due to extravasation of red blood cells and may be due to a variety of factors, but it is sometimes difficult to identify the exact cause. Some forms of purpura can frighten the patient and puzzle the physician. Mask phenomenon is an unusual purpura of the relatively loose tissues of the face and neck occuring after prolonged coughing, vigorous vomiting, valsalva's maneuver, parturition, or any other exertion that raises intrathoracic or abdominal pressure. This occurs with acute onset and fades within twenty-four to seventy-two hours spontaneously. A work-up for a coagulation or platelet defect is usually not required. We herein describe five cases of mask phenomenon(unusual facial purpura).
Blood Platelets ; Cough ; Erythrocytes ; Humans ; Masks* ; Mucous Membrane ; Neck ; Parturition ; Purpura* ; Skin ; Valsalva Maneuver ; Vomiting

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

A 48-year-old man presented with acute right flank pain. A computed tomography scan revealed right renal infarction. Because he had no thrombosis in the renal vessels and no clear embolic source, a further examination was performed to find the cause of the renal infarction. On transesophageal echocardiography, a right-to-left shunt during the Valsalva maneuver established a diagnosis of patent foramen ovale. This is a case of paradoxical embolism through a PFO leading to renal infarction.
Echocardiography, Transesophageal ; Embolism, Paradoxical ; Flank Pain ; Foramen Ovale, Patent ; Humans ; Infarction ; Middle Aged ; Thrombosis ; Valsalva Maneuver