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Valsalva Maneuver

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161. Comparison of sonotubometry, impedance, tubo-tympano-aerography, and tubomanometry to test eustachian tube function. (Abstract)

healthy ears of 55 volunteers, and the characteristics of each ET test were compared and discussed.The ET opening rate was compared between sonotubometry with dry swallowing, impedance with the Valsalva maneuver, TTAG with the Valsalva maneuver, and TMM with a nasopharyngeal pressure of 50 mbar in 100 (90.9%), 102 (92.7%), 99 (90.0%), and 104 (94.5%) ears, respectively; there was no significant difference among the four methods (P = 0.575). In sonotubometry, both dry swallowing and the Valsalva (...) maneuver were superior to wet swallowing in terms of detecting ET opening (P = 0.000). In TMM, both the opening rate and the external auditory canal pressure were positively correlated with the nasopharyngeal pressure. Specifically, the opening rate and external auditory canal pressure increased with an increase in the nasopharyngeal pressure (r = 0.271, P = 0.000; r = 0.315, P = 0.000, respectively).Sonotubometry, impedance, TTAG, and TMM have their own advantages and disadvantages. In clinical

2020 American Journal of Otolaryngology

162. CRACKCast E010 – Pediatric Resuscitation

) adenosine 0.1 mg/kg rapid IV push, max 6mg, second dose 0.2 mg/kg rapid IV push, max 12mg 4b) amiodarone 5mg/kg IV/IO over 20-50 minutes OR procainamide 15mg/kg IV/IO over 30-60 minutes 5) narrow complex – probable SVT 5a) consider vagal maneuvers – ice bath, carotid sinus massage, or any Valsalva (REVERT trial?) 5b) adenosine as above or synchronized DCCV if no vascular access 6) If probable sinus tachycardia: search for and treat the cause NOT the HR 3) Describe the PALS septic shock algorithm Rosen’s

2016 CandiEM

163. The Brain?s Effect on the Heart After a Stroke

them to age-matched controls on a variety of autonomic function tests (including Ewing’s battery autonomic function, heart rate variability in response to Valsalva, deep-breathing, and the sit-to-stand maneuver). The study revealed autonomic dysfunction in 82% of patients with large-artery and 63% of patients with small-artery strokes, as compared to only 21% of controls. Patients with large artery infarcts demonstrated decreased function of all parasympathetic tests performed (p<0.05

2016 Clinical Correlations

164. Evaluation and Management of Constipation

prolapse, and fissures. Digital rectal examination can reveal the presence of anal hypertonia, poor incremental squeeze, paradoxical puborectalis contraction, rectocele, anorectal masses, stricture, or fecal impaction that can be associated with constipation. in particular, a Valsalva maneuver should be done to diagnose a rectocele, prolapse, pelvic floor TABLE 1. The GRADE system: grading recommendations No. Description Benefit vs risk and burdens Methodologic quality of supporting evidence (...) motility and the defecation process. t he Rome iii criteria for functional constipation include at least 2 of the fol- lowing symptoms during =25% of defecations: straining, lumpy or hard stools, sensation of incomplete evacuation, sensation of anorectal obstruction or blockage, relying on manual maneuvers to promote defecation, and having less than 3 unassisted bowel movements per week. 7,8 t hese cri- teria include constipation related to the 3 common sub- types: colonic inertia or slow transit

2016 American Society of Colon and Rectal Surgeons

165. A Pivotal Randomized Clinical Trial Evaluating the Safety and Effectiveness of a Novel Hydrogel Dural Sealant as an Adjunct to Dural Repair. (Abstract)

, randomized clinical trial designed as a noninferiority, single-blinded study, 124 patients received Adherus Dural Sealant (test sealant) and 126 received DuraSeal (control). The primary composite endpoint was the proportion of patients who were free of any intraoperative CSF leakage during Valsalva maneuver after dural repair, CSF leak/pseudomeningocele, and unplanned retreatment of the surgical site. Each component was then analyzed individually as a secondary endpoint. Patients were followed for 4 mo

2017 Operative neurosurgery (Hagerstown, Md.) Controlled trial quality: uncertain

166. A cardiac risk score based on sudomotor function to evaluate cardiovascular autonomic neuropathy in asymptomatic Chinese patients with diabetes mellitus. Full Text available with Trip Pro

tests and cardiac autonomic reflex tests, including heart rate variability due to Valsalva maneuver, heart rate response due to deep breathing and heart rate response due to standing up. Presenting 2 abnormal results was defined as cardiac autonomic neuropathy.Subjects with cardiac autonomic neuropathy has significantly higher cardiac autonomic neuropathy risk score (32.88±1.60 vs 27.64±1.24,P = 0.010). Cardiac autonomic neuropathy risk score was correlated significantly with the heart rate response

2018 PLoS ONE

167. Utility of Adjunctive Procedures With Balloon Dilation of the Eustachian Tube Full Text available with Trip Pro

, Valsalva maneuver, and PTA audiometry.67 ETs (48 patients) underwent BDET: 1) 30/67 balloon w/wo myringotomy, w/wo tube, 2) 20/67 plus adjunctive procedure or 3) 17/67 plus guidewire. Follow-up was ranging from 0.4 to 3.4 years (mean 1.3 year, SD = 0.7). Significant improvement occurred in 79%. There was no significant difference in the failure rate comparing balloon dilation with adjunctive procedures 5/20 (25%) or without adjunctive procedures; 4/30 p = 0.45 (13%). Failure rate for BDET plus guide

2017 Laryngoscope investigative otolaryngology

168. Heritability of the dimensions, compliance and distensibility of the human internal jugular vein wall. Full Text available with Trip Pro

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

2018 PLoS ONE

169. Ultrasonography and clinical outcomes following anti-incontinence procedures (Monarc vs MiniArc): A 3-year post-operative review. Full Text available with Trip Pro

incontinence and urodynamic stress incontinence who had undergone MiniArc or Monarc surgery. Data regarding preoperative evaluation, intraoperative complications and post-operative follow-ups were collated. Main outcome is to determine the change in position of the sling through measurement of the x- and y-axis at rest and during Valsalva maneuver using the 3D introital ultrasound.A total of 138 patients were evaluated, 82 belonged to Monarc and 56 to MiniArc. At 3years, objective and subjective cure rates (...) for MiniArc and Monarc were comparable (88%, 91%; p>0.05; 83%, 89%, p>0.05 respectively). Ultrasonographic changes between MiniArc and Monarc from 6 months to 3 years, showed MiniArc to exhibit significant movement in both x- [3.0 ±0.4 mm vs. 2.2 ±0.3 mm (p = 0.02) at rest; 2.6 ±0.3 mm vs. 1.6 ±0.3 mm (p<0.001) during valsalva] and y-axis [3.5 ±0.5 mm vs. 2.0 ±0.3 mm (p<0.001) at rest; 3.3 ±0.5 mm vs. 2.9 ±0.3 mm (p = 0.037) during Valsalva]. The mobility of MiniArc was significantly more than Monarc from

2018 PLoS ONE

171. Guidelines for Laparoscopic Ventral Hernia Repair

recommendation) Diagnosis of a ventral hernia is typically made during the history and physical examination. Imaging studies including ultrasound, provocative ultrasound, computed tomography (CT) with and/or without Valsalva, and magnetic resonance imaging (MRI) can also be used for diagnosis. Imaging studies may be helpful to assess the anatomic details of a ventral hernia, augmenting the physical examination, especially when a hernia cannot be reduced, and therefore the defect cannot be palpated (...) defects, which occur in almost half of cases, thus allowing adequate mesh coverage of all defects and the entire old incision. Enterotomy during LVHR has been reported between 1- 6% and usually occurs during adhesiolysis. Several maneuvers facilitate safe adhesiolysis, including: Traction/counter traction technique Use of angled or flexible laparoscope Moving the scope among ports Improved exposure utilizing outside pressure on the abdominal wall, particularly for adhesions within a hernia sac

2016 Society of American Gastrointestinal and Endoscopic Surgeons

174. 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

175. Supraventricular Tachycardia: Guideline For the Management of Adult Patients With

-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 (SVT) previously published by the ACC, AHA, andHeartRhythmSociety(HRS).Referencesselectedand publishedinthisdocumentarerepresentativeandnotall- inclusive. An independent (...) , NO. 13, 2016 Page et al. APRIL 5, 2016:e27–115 2015 ACC/AHA/HRS SVT Guideline e41Recommendations for Acute Treatment of SVT of Unknown Mechanism COR LOE RECOMMENDATIONS I B-R 1. Vagal maneuvers are recommended for acute treatment in patients with regular SVT (82–84). See Online Data Supplements 2 and 3. For acute conversion of SVT, vagal maneuvers, including Valsalva and carotid sinus massage, can be performed quickly and should be the?rst-line intervention to terminate SVT. These maneuvers should

2015 American College of Cardiology

176. Congenital Heart Disease in the Older Adult Full Text available with Trip Pro

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

2015 American Heart Association

177. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia Full Text available with Trip Pro

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

178. 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

2015 American Heart Association

179. 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

180. 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

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