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Valsalva Maneuver

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161. Sensitivity of contrast-enhanced transthoracic echocardiography for the detection of residual shunts after percutaneous patent foramen ovale closure. (PubMed)

patients with PFO who had experienced migraines underwent percutaneous PFO closure. c-TTE, TEE, and contrast-enhanced transcranial Doppler (c-TCD) at resting and Valsalva maneuver were performed during the 3-month follow-up after the closure.The closure devices were successfully implanted in all patients without complications. Three months after closure, TEE did not detect residual Valsalva shunts in any of the 57 patients; residual valsalva shunts were found via c-TTE in 15 of the 57 patients and were

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2019 Medicine

162. Effort Thrombosis Provoked by Saxophone Performance. (PubMed)

effort thrombosis of the internal jugular vein. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: To our knowledge, this is the first documented case of PSS resulting from venous stasis with prolonged Valsalva maneuver and vascular trauma with activity of playing the saxophone. The significance of this case is the unusual etiology of a rare presentation and the ability to diagnose this condition quickly and accurately with POCUS.Copyright © 2018 Elsevier Inc. All rights reserved.

2019 Journal of Emergency Medicine

163. Heritability of the dimensions, compliance and distensibility of the human internal jugular vein wall. (PubMed)

and mediolateral diameters of the IJV were measured bilaterally by ultrasonography. Measurements were made both in the sitting and supine positions, with or without Valsalva maneuver. Univariate quantitative genetic modeling was performed.Genetic factors are responsible for 30-70% of the measured properties of IJV at higher venous pressure even after adjustment for age and gender. The highest level of inheritance was found in the supine position regarding compliance (62%) and venous diameter during Valsalva

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2018 PLoS ONE

164. Buteyko breathing technique for obstructive Eustachian tube dysfunction: Preliminary results from a randomized controlled trial. (PubMed)

) symptom scores, tympanogram, positive Valsalva maneuver were evaluated at baseline, 6-week and 12-week follow-up.Normalization of ETDQ-7 symptom scores at 6-week follow-up was observed in 30.0% (12/40) of the Buteyko breathing group versus 16.2% (6/37) of the controls (P > 0.05). At 12-week follow-up, the ratio rose to 50.0% (20/40) in the Buteyko breathing group and 24.3% (9/37) in the controls (P < 0.05). Tympanogram normalization at 12-week follow-up was observed in 53.6% (15/28) of the Buteyko (...) breathing group versus 26.9% (7/26) of the controls (P < 0.05). The Buteyko breathing group showed slight improvement in positive Valsalva maneuver at 6- and 12-week follow-up (P > 0.05).Our study shows that Buteyko breathing technique might be an effective adjunctive intervention in treatment of obstructive ETD, especially for those patients who are refractory to medical treatment and cannot afford Eustachian tube balloon dilation surgery.Copyright © 2019 Elsevier Inc. All rights reserved.

2019 American Journal of Otolaryngology

165. Vagal and Sympathetic Function in Neuropathic Postural Tachycardia Syndrome. (PubMed)

. We compared them to 10 healthy subjects. We assessed hemodynamics, heart rate and blood pressure variability, baroreflex sensitivity, raw and integrated muscle sympathetic nerve activity, and blood volume. To understand the vagal/sympathetic control, we dissected the phase 2 of Valsalva maneuver (VM) into early (VM2e) and late (VM2l). POTS' upright heart rate increased 43±3 bpm. Patients had normal plasma volume but reduced red blood cell volume (1.29 L versus predicted normal values 1.58 L; P

2019 Hypertension

166. Long-term Outcomes of Balloon Dilation for Persistent Eustachian Tube Dysfunction. (PubMed)

was observed by 93.6% (44/47) participants. The revision dilation rate was 2.1% (1/47). Among participants with abnormal baseline middle ear assessments, 76.0% had normalized tympanic membrane position (p < 0.0001), 62.5% had normalization of tympanogram type (p < 0.001), and 66.7% had positive Valsalva maneuvers (p < 0.0001). Participant satisfaction was 83.0% at long-term follow-up.Balloon dilation results in durable improvements in symptoms and middle ear assessments for patients with persistent

2019 Otology and Neurotology

167. Otovent nasal balloon for otitis media with effusion

).mp. or (glue adj ear).tw. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, an, ui] 4. exp middle ear/ 5. (SOM or OME).tw. 6. ((secretory or serous) adj otitis).tw. 7. (middle and ear*).mp. or (eustachian and tube*).tw. [mp=ti, ab, hw, tn, ot, dm, mf, dv, kw, nm, kf, px, rx, an, ui] 8. middle ear ventilation/ 9. aeration/ 10. valsalva maneuver/ 11. (autoinflat* or ((auot or ear* or ME or air) and (inflat* or aerat*))).tw. 12. ((nose or nasal) and balloon).tw. 13. valsalva.tw. 14. (insufflat (...) until it is the size of a grapefruit by blowing through their nose into the nose piece. The procedure, known as the Valsalva manoeuvre, is then repeated with the other nostril. The forced expiration against the closed airway leads to auto-inflation of the middle ear, increasing the pressure in the nasopharynx. This helps to open the Eustachian tube to equalise the air pressure and allow the fluid in the middle ear to drain naturally down the back of the throat. The user may feel increased pressure

2016 National Institute for Health and Clinical Excellence - Advice

168. Panda Eyes

to call it Post Proctoscopic Palpebral Purpura -- when proctoscopes were the thing. said... "almost pathognomonic" is right. I was moonlighting in an ER one night when a guy came in with P4 (see above); onset of periorbital purpura after a sigmoidoscopy. I told him that he probably had amyloidosis. He had no proteinuria. Sent him back to his primary care and of course there was no evidence of amyloid, myeloma, he had normal CBC, basically a normal healthy guy with a vigorous valsalva maneuver

2017 Renal Fellow Network

169. Research and Reviews in the Fastlane 173

. The authors found that ice water and adenosine are both more effective than carotid sinus massage or Valsalva maneuvers. Recommended by: Jeremy Fried Pediatrics Liu Bexkens R el at. Effectiveness of reduction maneuvers in the treatment of nursemaid’s elbow: A systematic review and meta-analysis. The American journal of emergency medicine. 35(1):159-163. 2017. PMID: Clay Smith: This meta-analysis found hyperpronation for nursemaid’s elbow was better than supination/flexion – a lot better. The aggregate

2017 Life in the Fast Lane Blog

170. Early inner retinal thinning and cardiovascular autonomic dysfunction in type 2 diabetes. (PubMed)

were measured by spectral-domain optical coherence tomography. In patients with type 2 diabetes, a cardiovascular autonomic function test (AFT) was performed, which included the heart rate parameter of beat-beat variation-with deep breathing, in response to the Valsalva maneuver, and on postural change from lying to standing. The results of each test were scored as 0 for normal and 1 for abnormal. A total AFT score of 1 was defined as early cardiovascular autonomic neuropathy (CAN), and an AFT

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2017 PLoS ONE

171. Congenital Heart Disease in the Older Adult

of coronary artery anomalies were assessed, the presence of a left coronary artery from the right sinus was thought to be more strongly associated with risk of sudden cardiac death (SCD); however, there is increasing recognition that a dominant right coronary artery from the left sinus of Valsalva with high-risk anatomic features may pose an equal risk. At older ages, several factors must be taken into account when determining the potential level of risk from an anomalous coronary artery and indications

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2015 American Heart Association

172. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

tachycardia, junctional tachycardia, multifocal atrial tachycardia, paroxysmal supraventricular tachycardia, permanent form of junctional reciprocating tachycardia, pre-excitation, pregnancy, quality of life, sinoatrial node, sinus node reentry, sinus tachycardia, supraventricular tachycardia, supraventricular arrhythmia, tachycardia, tachyarrhythmia, vagal maneuvers (Valsalva maneuver ), and Wolff-Parkinson-White syndrome . Additionally, the GWC reviewed documents related to supraventricular tachycardia

2015 American Heart Association

173. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 1: Classification of Sports: Dynamic, Static, and Impact

muscle, which leads to large, sustained changes in blood pressure via the exercise pressor reflex. The larger the muscle mass involved, the greater the intensity of contraction, and the greater the rise in blood pressure ; incorporation of a Valsalva maneuver during contractions will acutely and transiently increase transmural arterial pressure markedly in blood vessels outside of the chest, although left ventricular (LV) afterload does not appear to increase because of a balanced rise (...) JH, Schibye B, Payne FC, Saltin B. Response of arterial blood pressure to static exercise in relation to muscle mass, force development, and electromyographic activity. Circ Res . 1981 ; 48 (pt 2):I70–I75. Haykowsky M, Taylor D, Teo K, Quinney A, Humen D. Left ventricular wall stress during leg-press exercise performed with a brief Valsalva maneuver. Chest . 2001 ; 119 :150–154. Rowell LB. Neural control of muscle blood flow: importance during dynamic exercise. Clin Exp Pharmacol Physiol . 1997

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2015 American Heart Association

174. An Unusual Tachycardia

and Scott Weingart for sending this interesting tracing to Dr. Smith for publication in Steve excellent ECG Blog. Very interesting ECG. What about vagal maneuvers as first diagnostic/therapeutic approach? Many thanks Sure, that might work. The modified Valsalva with leg raise has 40% efficacy. I've tried the modified Valsalva three times without success... I may have to read the REVERT trial once more to make sure I'm doing it right.. Nice ECG! It does seem to be BVT at the first glance Anonymous If 1st

2016 Dr Smith's ECG Blog

175. AIUM Practice Parameter for the Performance of Scrotal Ultrasound Examinations

also be scanned to look for testicular ectopia. 16 Relevant extratesticular structures should be evaluated. The head, body, and tail of the epi- didymis should be evaluated when technically feasible. The spermatic cord should be evaluat- ed if there is suspicion for testicular torsion. 20 The scrotal wall, including the overlying skin, should be evaluated. Additional techniques such as the Valsalva maneuver or upright position- ing can be used as needed. Any abnormality should be documented

2015 American Institute of Ultrasound in Medicine

176. AIUM Practice Parameter for the Performance of Peripheral Venous Ultrasound Examinations

should be evaluated. c. Augmentation with squeezing of the calf musculature should generally be used. The Valsalva maneuver may be used at the groin. A cuff inflator may also be used. d. The patient should be situated in the erect position for the detection or exclusion of reflux. The reverse Trendelenburg position can be used if erect scanning is not possi- ble. The examined leg should be in a non–weight-bearing position. The patient should not be studied for reflux in the supine position. e. All (...) /15 3:28 PM Page 52015—AIUM PRACTICE PARAMETER—Peripheral Venous Ultrasound 4 www.aium.org B. Venous Insufficiency: Lower Extremity 1. Technique a. When evaluating for venous insufficiency, the location and duration of reversed blood flow should be determined during the performance of accepted maneuvers. 17,18 b. Duplex interrogation should be performed at as many levels as necessary to ensure a complete examination based on the clinical indications. 18–21 Veins in the superficial and deep systems

2015 American Institute of Ultrasound in Medicine

178. Neuro-urology

Urodynamics 14 3C.7.1 Introduction 14 3C.7.2 Urodynamic tests 15 3C.7.3 Specialist uro-neurophysiological tests 16 3C.7.4 Recommendations for urodynamics and uro-neurophysiology 16 3C.7.5 Typical manifestations of neuro-urological disorders 16 3C.8 Renal function 16 3D DISEASE MANAGEMENT 17 3D.1 Introduction 17 3D.2 Non-invasive conservative treatment 17 3D.2.1 Assisted bladder emptying - Credé manoeuvre, Valsalva manoeuvre, triggered reflex voiding 17 3D.2.2 Lower urinary tract rehabilitation 17 3D.2.2.1 (...) the resulting residual urine [101]. Reduction of the detrusor pressure contributes to urinary continence, and consequently to social rehabilitation and QoL. It is also pivotal in preventing UTI [9, 104]. Complete continence can however not always be obtained. 3D.2 Non-invasive conservative treatment 3D.2.1 Assisted bladder emptying - Credé manoeuvre, Valsalva manoeuvre, triggered reflex voiding Incomplete bladder emptying is a serious risk factor for UTI, high intravesical pressure during the filling phase

2015 European Association of Urology

180. Report on varicocele: a committee opinion

reduced when the patient is recumbent.Whenasuspectedvaricocele is not clearly palpable, the scrotum should be examined while the patient performs a Valsalva maneuver in a standingposition. Onlyclinicallypalpablevaricoceles havebeenclearlyassociatedwithinfer- tility. Varicoceles are typically graded on a scale of 1 to 3, with grade 3 being present on visual inspection of the scrotum, grade 2 being easily palpable, and grade 1 only being palpable with Valsalva maneuver (2). These de?ni- tions (...) for evaluation of an inconclusive physical examination of the scrotum. Although de?nitive evidence-based criteria are lacking, most investigators agree that multiple spermaticveins>2.5–3.0mmindiam- eter (at rest and with Valsalva) tend to correlatewiththepresenceofclinically signi?cant varicoceles (3). Spermatic venography may be useful to demon- strate the anatomic position of re?ux- ing spermatic veins that recur or persistaftervaricocelerepair.Although earlystudiesdidnotdemonstrateadif

2014 Society for Assisted Reproductive Technology

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