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: 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: The aim of this study is to assess effects of testicular volume difference and retrograde venous flow of pampiniform plexus measured by Duplex Doppler Ultrasonograpy (DDU) in patients with adolescent varicocele. MATERIALS AND METHODS: Physical examinations and DDU were performed to assess varicocele in fifty five patients with left sided adolescent varicocele. During both normal respiration and the Valsalva's maneuver, the maximum venous diameter (MVD), maximal velocity of reflux and the peak retrograde flow volume (RFV) was measured by DDU. The percentage testicular volume difference (%) between the right and left testicle was calculated as (right testicular volume-left testicular volume)x100/right testicular volume and divided into 3 group; below 10%, 10~20%, >20%. Grade of varicocele, MVD and peak RFV were analyzed as possible determinants of testicular hypotrophy in adolescent varicocele. RESULTS: A total of 55 patients (mean age 17.8 years, range 12 to 20) were included in this study. Of these, physical examination reviewed that 7 (12.7%), 18 (32.7%), 30 (54.6%) patients had grade I, II or III varicoceles on the left side respectively. The mean MVD was significantly higher according to grade of varicocele. The mean maximal velocity of reflux was significantly higher in the patients grade II and III than grade I, but was not significant between grade II and III. The mean peak RFV was significantly higher according to grade of varicocele. RFV was the only significant parameter of predictive value for percentage testicular volume difference. CONCLUSIONS: Patients with peak RFV >35ml minutes showed significant reduction of testicular volume. Measurement of RFV is recommended as predictive tools for assessing the percentage testicular volume difference in patients with adolescent varicocele.
Adolescent ; Humans ; Organophosphorus Compounds ; Physical Examination ; Respiration ; Testis ; Triazoles ; 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

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

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

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

PURPOSE: To evaluate the hemodynamic status of varicocele, 99m Tc-RBC venography was performed in 29 varicocele patients and 10 normal controls from January to July 1996. MATERIALS AND METHODS: The mean age of varicocele patients was 23 years old and of normal controls was 27 years old. Among 29 varicocele patients, 26 had varicocele in left side and 3 had in both side. In unilateral varicocele group. 2 cases had grade I, 8 cases had grade II and 16 cases had grade III varicocele. In bilateral varicocele group, all had grade III in le% side and grade II varicocele in right side. RESULTS: The mean+/-SD of left to right radionuclide uptake ratio in pampiniform plexus during resting and Valsalva maneuver state was 1.01 +/-0.04:1 and 1.05+/-0.05:1 in normal control, 1.05+/-0.02:1 and 1.10:1 in varicocle grade I, 1.21+/-0.19:1 and 1.21 +/-0.12:1 in varicocele glade II, 1.60+/-0.63:1 and 1.27+/-0.18:1 in varicocele grade III, 1 18+/-0.06:1 and 1.26 in bilateral varicocele. As varicocele grade be higher, the mean left to right radionuclide uptake ratio be larger during resting and Valsalva maneuver state. CONCLUSIONS: 99mTc-RBC venography can quantify the hemodynamic state of varicocele so we suggest that it is useful as a method of diagnosis and follow up in varicocele patient.
Adult ; Diagnosis ; Follow-Up Studies ; Hemodynamics* ; Humans ; Phlebography* ; Valsalva Maneuver ; Varicocele* ; Young Adult