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 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*

PURPOSE: To investigate the change in intraocular pressure (IOP) of normal healthy eyes at different positions while performing sit-ups. METHODS: Twenty normal healthy eyes of 20 subjects were studied. IOP was measured while in the 'sitting upright', 'supine', and 'head-down' position to determine postural effect on IOP when executing a sit-up. Measurements were taken after the performance of a sit-up and during the performance of a sit-up, in both the head up and head down positions to test the effect of the exercise on the IOP. In addition, the IOP after an 'isometric exercise with Valsalva's maneuver in the supine or head-down position' was measured to determine the actual IOP during a sit-up. RESULTS: The postural change from sitting upright to tilting the head in a downward position caused the IOP to increase. After the performance of a sit-up, the IOP decreased in both the upright and supine positions, though IOP increased in the head-down position. After the isometric exercise with Valsalva's maneuver, IOP increased significantly regardless of position. CONCLUSIONS: IOP increased significantly during sit-ups, but decreased afterward. Future studies should be performed to evaluate the long-term effects of IOP change during and after sit-ups with respect to the prognosis of glaucoma.
Exercise ; Eye ; Glaucoma ; Head ; Intraocular Pressure ; Posture ; Prognosis ; Supine Position ; Valsalva Maneuver

PURPOSE: To measure intraocular pressure (IOP) as a function of positional changes of the head during heavy weight lifting. METHODS: The subjects of this study were 30 healthy adult males in their twenties to forties. This study investigated their ophthalmic examinations, BMI (body mass index), and 1RM (one repetition maximum) according to the three bench press positions. RESULTS: Before exercising, the IOP was higher in the lowered head position in the decline bench press (18.20+/-2.89 mmHg) than in the incline bench press (14.38+/-2.32 mmHg) (p<0.001). The IOP increased significantly during the bench press exercise, relative to during the pre-exercise (p<0.001). Upon lift down, IOP increased by 3.72+/-1.85 mmHg greater than upon lift up, and mean IOP increased by 2.61+/-1.63 mmHg (p<0.001). In our experiments, IOP increased to a maximum of 22.10+/-2.79 mmHg, measured during lift down in the decline bench press configuration. The BMI and the IOP before exercise showed significant correlation (p<0.05). CONCLUSIONS: IOP increased more during exercise involving a lower head position. Further study is needed to know the extent to which this result is relevant for glaucoma patients and which activities and head positions during exercise may worsen glaucoma. In the meantime, patients with severe glaucoma may need to avoid lifting heavy objects with a lowered head position.
Adult ; Glaucoma ; Head ; Humans ; Intraocular Pressure ; Lifting ; Male ; Valsalva Maneuver ; Weight Lifting

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

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

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

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

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