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: 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

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

Incidences of blowout fractures have increased due to rapid industrialization and rise in violent crimes. However, there have been few studies on the proper follow-up guidelines or protocol after reduction of the orbital wall for patients working in a high atmospheric pressure environment. We have experienced a pilot with an orbital medial wall fracture who underwent reduction through an endoscopic approach. The patient underwent the Valsalva maneuver and scan of paranasal sinuses 8 weeks after reduction. Emphysema did not occur in the orbit even after the Valsalva maneuver and he was able to return to his workplace without any complications. We report this case with a brief review of the literature.
Atmospheric Pressure ; Crime ; Emphysema ; Follow-Up Studies ; Humans ; Incidence ; Orbit ; Paranasal Sinuses ; Valsalva Maneuver ; Industrial Development

PURPOSE: Retrograde flow is the main criterion for the diagnosis of varicocele, and the Duplex Doppler ultrasonographic values for retrograde flows are poorly defined. The purpose of this study is to assess a relationship between the palpated varicocele and pampiniform plexus diameter and the retrograde flow that was investigated with performing Duplex Doppler ultrasonography (DDU). MATERIALS AND METHODS: Physical examinations and DDU were performed to assess varicoceles in forty patients with left-sided varicocele and also in eight men who were without varicocele on their physical examination. During both normal respiration and the Valsalva's maneuver, the maximum diameters of the pampiniform plexus and the presence of the retrograde flow were measured by DDU. RESULTS: The highest mean venous diameter in the patients with clinical grade III varicocele was 2.7mm (2.4-3.6), and this was significantly higher than that in the patients with grade I (1.9mm) or with grade II varicocele (2.1mm) (p<0.05). While the difference of diameters between grade I and grade II was not significant, venous reflux was found in all degrees of the varicocele veins. Venous reflux during the Valsalva maneuver (type II flow pattern) was detected on the right side in one (8%) of 13 patients with grade II varicocele, and in three (21%) of 14 patients with grade III varicocele. The type III flow patterns, indicating augmenting of the reflux with an intra-abdominal pressure increase, were 46.1%, 69.2% and 100% for grade I, II and III, respectively. No venous reflux was found in the control group. CONCLUSIONS: The presence of retrograde flow may provide a more reliable indicator than does the spermatic vein diameter for the diagnosis of varicocele. When the palpability of the pampiniform plexus is questionable, Duplex Doppler ultrasound is indicated.
Diagnosis ; Humans ; Male ; Physical Examination ; Respiration ; Testis ; Ultrasonography ; Ultrasonography, Doppler, Duplex ; Valsalva Maneuver ; Varicocele* ; Veins

PURPOSE: The aim of the study was to evaluate the relationship between Valsalva leak-point pressure (VLPP) and cough leak-point pressure (CLPP) in the patients with stress incontinence and to determine the correlation between maximal urethral closure pressure(MUCP) and leak point pressure. MATERIALS AND METHODS: Thirty women with stress urinary incontinence were included. Two women were excluded from the evaluation because of detrusor instability. At the bladder volume of 200-300ml cough leak-point pressure and Valsalva leak-point pressure were measured in the sitting position by using 8Fr intravesical catheter. RESULTS: Valsalva leak-point pressure was significantly lower than cough leak-point pressure (69.4+/-24.5 versus 86.6+/-28.1cmH2O, p<0.0001). If intrinsic sphincter deficiency was defined as a leak-point pressure of 60cmH2O or less, 21.4% of women fulfilled this criterion using the cough leak-point pressure compared to 42.8% if the Valsalva leak-point pressure is used. Valsalva leak-point pressure and maximal urethral closure pressure were statistically correlated (p<0.05). However, a correlation coefficient of 0.38 demonstrated poor clinical relationship. CONCLUSION: Cough leak-point pressures were significantly higher than Valsalva leak-point pressures. Cough and Valsalva maneuvers seem to result in a different reaction of the pelvic floor. Valsalva leak-point pressure has more statistical correlation to the maximal urethral closure pressure than cough leak-point pressure. So Valsalva leak-point pressure may have a additional benefit for detecting type III stress urinary incontinence. However, variations in Valsalva leak-point pressure measurement must be precisely descibed, standardized, and validated before a technique can be advocated for clinical use.
Catheters ; Cough* ; Female ; Humans ; Pelvic Floor ; Urinary Bladder ; Urinary Incontinence* ; Valsalva Maneuver*

The majority of melanotic neoplasms of central nervous system(CNS) are metastatic in origin and rarely a primary CNS melanomas, and are usually histologically and clinically malignant in nature. The meningeal melanocytomas are benign, primary melanotic neoplasm and are less common than primary CNS melanoma. They usually present in early adult and have a characteristic appearance in light and electron microscope. A 42-year-old male is presented with pain on the neck and suboccipital region which was worse with flexion and Valsalva's maneuver. MRI revealed homogenous high signal intensity on the T 1 weighted image and low signal intensity on the T 2 weighted image. At operation, the tumor was well circumscribed, pigmented lesion and was attached to dura and cord. Microscopically, the tumor was composed of spindled and epithelioid cells with often prominent nucleoli, without evidence of mitosis and necrosis.
Adult ; Epithelioid Cells ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Male ; Melanoma ; Mitosis ; Neck ; Necrosis ; Valsalva Maneuver

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*

PURPOSE: To assess the ability of scrotal Doppler ultrasonography to confirm the diagnosis of clinical varicoceles and detect subclinical varicoceles. MATERIALS AND METHOD: Sixty patients with clinically evident varicocele were examined by scrotal doppler ultrasonography(gray scale: 60 patients, spectral Doppler: 35 patients, color Doppler: 22 patients). A control group of 21 patients with no suspected scrotal pathology also were studied. The age range of the varicocele group was 12-49 years. The normal group consisted of 21 subjects aged 19-23 years. Ultrasonographic measurement of scrotal vein diameter of patients before and during Valsalva maneuver, and scrotal vein blood flow reversal with Valsalva maneuver was compared with the findings of varicocele by physical examination. RESULTS: Significant differences were found in scrotal vein diameter before and during Valsalva maneuver between normal and varicocele testicular units. Cut-off points were selected in an arbitrary fashion on the basis of scattergram. Using this cut-off points and blood flow reversal, we found that 12(23%) of 53 patients with a clinically palpable left unilateral varicocele had an ultrasonographically positive subclinical right varicocele. 8(38%) of 21 patients without a clinical varicocele had a positive scrotal ultrasound. CONCLUSIONS: We suggest that scrotal doppler ultrasonography is a reliable means of confirming the clinical varicocele and screening the subclinical varicoceles.
Diagnosis ; Humans ; Mass Screening ; Pathology ; Physical Examination ; Ultrasonography ; Ultrasonography, Doppler* ; Valsalva Maneuver ; Varicocele* ; Veins