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1.
Medicine (Baltimore) ; 99(29): e20900, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702831

RESUMO

Cerebral venous sinus thrombosis (CVST) is a cause of secondary headache with substantial morbimortality. Headache dominates the clinical presentation, but no typical phenotype has been described. We aim to evaluate the presence of red flags in headache in patients with confirmed CVST at the moment of emergency department (ED) presentation.Retrospective STROBE compliant cohort study including patients with confirmed CVST that consulted because of headache at the ED. We analyzed presence and type of red flags at the moment of consult. We evaluated whether CVST was suspected at the moment of imaging request and analyzed delay in the diagnosis.Nineteen patients fulfilled inclusion and exclusion criteria. Mean age was 48.5 years, 47.4% were female. All the studied patients exhibited at least 1 red flag, being abnormal neurological examination the most frequent (79%), followed by the presence of other neurological symptoms (68%), alarm data related with headache phenotype (63%), or risk factors concerning prior medical history (47%). Temporal pattern of the headache was acute in 42.1%, thunderclap in 31.6%, and subacute in 26.3%. In none patient CVST was the specific suspicion when imaging was requested. Median time since headache onset and ED presentation was 84 hours, being different in patients with associated symptoms (48 hours) when compared with isolated headache patients (168 hours). Time since ED presentation and the diagnosis also differed between the 2 groups, being more prolonged in patients with an isolated headache at presentation.Headache attributed with CVST did not exhibit any distinctive phenotype, but all the patients presented some red flag, being abnormal neurological examination the most frequent.


Assuntos
Cefaleia/etiologia , Trombose dos Seios Intracranianos/diagnóstico , Afasia/etiologia , Comportamento , Estudos de Coortes , Transtornos da Consciência/etiologia , Serviço Hospitalar de Emergência , Feminino , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Motores/etiologia , Paresia/etiologia , Estudos Retrospectivos , Medição de Risco , Convulsões/etiologia , Transtornos das Sensações/etiologia , Distúrbios da Fala/etiologia , Manobra de Valsalva
2.
Am J Otolaryngol ; 41(4): 102499, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32354482

RESUMO

PURPOSE: To determine the usefulness of 'computed tomography (CT) with Valsalva maneuver (VM)' (Valsalva CT) for localizing lesions of the eustachian tube (ET) and identifying characteristics of ET dysfunction (ETD). MATERIALS AND METHODS: In this case-control study, 12, 17, and 25 patients with obstructive ETD (OETD), patulous eustachian tube (PET), and conductive hearing loss (control), respectively, underwent Valsalva CT in the supine position. The visualized length to total length ratio of the cartilaginous ET (VTRET) with and without VM were compared in the three groups. In the OETD group, obstructed areas of the ET were identified on multiplanar reconstructed images. RESULTS: VTRET without VM in the PET group was significantly higher than that in the control and OETD groups (p-values, 0.003 and 0.007, respectively). However, there was no significant difference between the control and OETD groups (p = 0.053). VTRET with VM in the PET group was significantly higher than that in the other two groups (p < 0.001), whereas that in the control group was significantly higher than that in the OETD group (p < 0.001). In the OETD group, the obstructed area was clearly identified, and there were one, one, six, and eight patients in the isthmus; bony portion and isthmus; bony portion, isthmus, and cartilaginous portion; and isthmus and cartilaginous portion subgroups, respectively. CONCLUSION: Valsalva CT is particularly valuable as a visualization assessment tool for identifying obstructed areas in the OETD. It may help future research of disease-specific mechanical characteristics of the ET on controlling pressure variables.


Assuntos
Otopatias/diagnóstico por imagem , Tuba Auditiva/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Manobra de Valsalva , Estudos de Casos e Controles , Humanos , Estudos Prospectivos
3.
Am J Cardiol ; 125(11): 1688-1693, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32279840

RESUMO

Dynamic left ventricular (LV) obstruction has important clinical and therapeutic implications in patients with hypertrophic cardiomyopathy (HC). Although absent at rest, LV obstruction may be elicited using varying stressors. Meal-related hemodynamic changes may favor LV obstruction and support postprandial (PP) symptoms in HC patients. The aim of this study was to evaluate PP-LV obstruction inducibility in HC patients in comparison with fasting Valsalva maneuver and exercise test. Ninety-two HC patients without LV obstruction underwent at-rest Transthoracic Echocardiography (TTE) during Valsalva maneuver and exercise test under fasting condition followed by at-rest re-test PP-TTE 30 to 60 minutes after a standardized midday meal. LV obstruction was noted and classified as being related to systolic anterior motion (SAM) of the mitral valve (SAM-related) and/or non-SAM-related (mid-cavity or apical), and intraventricular gradient was measured. At-rest re-test PP-TTE showed significant intraventricular gradient (>30 mm Hg) in 68 patients (60 SAM-related, 8 non-SAM related, 30 combined) with a higher prevalence (74%) of HC phenotype re-classified as obstructive compared with the fasting Valsalva maneuver (23%) or exercise test (33%) (p < 0.001). At multivariate analysis, a clinical history of PP symptoms and mitral anterior leaflet length and/or LV outflow ratio >2 were independently correlated with PP-TTE obstruction. In conclusion, PP TTE re-test is a simple and effective approach to unmask latent LV dynamic obstruction in daily clinical practice over fasting Valsalva maneuver or exercise test. PP clinical phenotype refinement may be relevant in targeting and evaluating HC therapy.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Ecocardiografia/métodos , Teste de Esforço , Jejum , Período Pós-Prandial , Manobra de Valsalva , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Adulto , Idoso , Cardiomiopatia Hipertrófica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Obstrução do Fluxo Ventricular Externo/fisiopatologia
5.
Am J Cardiol ; 125(6): 916-923, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31928720

RESUMO

The pulse amplitude ratio (PAR), the ratio of pulse pressure at the end of the Valsalva maneuver to before the onset, correlates with cardiac filling pressure. We have developed a handheld device that uses finger photoplethysmography to measure PAR and estimate left ventricular end diastolic pressure (LVEDP). Patients hospitalized with heart failure (HF) performed three 10-second trials of a standardized Valsalva maneuver (at 20 mm Hg measured via pressure transducer), while photoplethysmography waveforms were recorded, at admission and discharge. Combined primary outcome was 30-day HF hospitalization, intravenous diuresis, or death. Fifty-two subjects had discharge PAR testing; 12 met the primary outcome. Median PAR on admission was 0.55 (interquartile range: 0.40 to 0.70, n = 48) and on discharge was 0.50 (interquartile range: 0.36 to 0.69). Mean PAR-estimated LVEDP was significantly higher in subjects that had an event (20.2 vs 16.9 mm Hg, p = 0.043). Subjects with PAR-estimated LVEDP >19.5 mm Hg had an event rate hazard ratio of 4.57 (95% confidence interval 1.37, 15.19, p = 0.013) compared with patients with LVEDP 19.5 mm Hg or below, with significantly lower 30-day event-free survival (log-rank p = 0.006). In conclusion, noninvasively estimated LVEDP using the pulse amplitude response to a Valsalva maneuver in patients hospitalized for HF changes with diuresis and identifies patients at high risk for 30-day HF events. Detection of elevated filling pressures before hospital discharge may be useful in guiding HF management to reduce HF events.


Assuntos
Pressão Sanguínea/fisiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Determinação da Frequência Cardíaca/instrumentação , Hospitalização/estatística & dados numéricos , Fotopletismografia/instrumentação , Manobra de Valsalva/fisiologia , Desenho de Equipamento , Insuficiência Cardíaca/mortalidade , Humanos , Intervalo Livre de Progressão , Modelos de Riscos Proporcionais , Medição de Risco , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia
6.
Pediatr Emerg Care ; 36(1): e8-e9, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895203

RESUMO

Vagal maneuvers can be successful in terminating supraventricular tachycardia in pediatric patients. We present a case of a modified Valsalva maneuver identified in the REVERT trial successfully terminating supraventricular tachycardia in a 9-year-old boy.


Assuntos
Taquicardia Supraventricular/terapia , Manobra de Valsalva , Criança , Eletrocardiografia , Humanos , Masculino , Taquicardia Supraventricular/diagnóstico
7.
BMC Ophthalmol ; 20(1): 5, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900115

RESUMO

BACKGROUND: The Valsalva maneuver (VM) is widely used in daily life, and has been reported to cause high intraocular pressure (IOP). This study aimed to assess changes in IOP, the Schlemm's canal (SC), autonomic nervous system activity, and iridocorneal angle morphology in healthy individuals during different phases of the VM. METHODS: The high frequency (HF) of heart rate (HR) variability, the ratio of low frequency power (LF) and HF (LF/HF), heart rate (HR), IOP, systolic (SBP) and diastolic blood pressure (DBP), the area of SC (SCAR), pupil diameter (PD), and some iridocorneal angle parameters (AOD500, ARA750, TIA500 and TISA500) were measured in 29 young healthy individuals at baseline, phase 2, and phase 4 of the VM. SBP and DBP were measured to calculate mean arterial pressure (MAP) and mean ocular perfusion pressure (MOPP). HF and the LF/HF ratio were recorded using Kubios HR variability premium software to evaluate autonomic nervous system activity. The profiles of the anterior chamber were captured by a Spectralis optical coherence tomography device (anterior segment module). RESULTS: Compared with baseline values, in phase 2 of the VM, HR, LF/HF, IOP (15.1 ± 2.7 vs. 18.8 ± 3.5 mmHg, P < 0.001), SCAR (mean) (7712.112 ± 2992.14 vs. 8921.12 ± 4482.79 µm2, P = 0.039), and PD increased significantly, whereas MOPP, AOD500, TIA500, and TISA500 decreased significantly. In phase 4, DBP, MAP, AOD500, ARA750, TIA500and TISA500 were significantly lower than baseline value, while PD and HF were remarkably larger than baseline. The comparison between phase 2 and phase 4 showed that HR, IOP (18.8 ± 3.5 vs. 14.7 ± 2.9 mmHg, P < 0.001) and PD decreased significantly from phase 2 to phase 4, but there were no significant differences in other parameters. CONCLUSIONS: The expansion and collapse of the SC in different phases of the VM may arise from changes in autonomic nervous system activity. Further, the effects of the VM on IOP may be attributed to changes in blood flow and ocular anatomy. TRIAL REGISTRATION: This observational study was approved by the ethics committee of Tongji Hospital (Registration Number: ChiCTR-OON-16007850, Date: 01.28.2016).


Assuntos
Sistema Nervoso Autônomo/fisiologia , Pressão Intraocular/fisiologia , Esclera/fisiologia , Manobra de Valsalva/fisiologia , Adulto , Câmara Anterior/anatomia & histologia , Córnea/anatomia & histologia , Feminino , Frequência Cardíaca/fisiologia , Humanos , Iris/anatomia & histologia , Masculino , Fluxo Sanguíneo Regional/fisiologia , Esclera/anatomia & histologia , Adulto Jovem
8.
Am J Obstet Gynecol ; 222(1): 77.e1-77.e11, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310750

RESUMO

BACKGROUND: Although consensus guidelines on the management of cardiovascular disease in pregnancy reserve cesarean delivery for obstetric indications, there is a paucity of data to support this approach. OBJECTIVE: The objective of the study was to compare cardiovascular and obstetric morbidity in women with cardiovascular disease according to the plan for vaginal birth or cesarean delivery. STUDY DESIGN: We assembled a prospective cohort of women delivering at an academic tertiary care center with a protocolized multidisciplinary approach to management of cardiovascular disease between September 2011 and December 2016. Our practice is to encourage vaginal birth in women with cardiovascular disease unless there is an obstetric indication for cesarean delivery. We allow women attempting vaginal birth a trial of Valsalva in the second stage with the ability to provide operative vaginal delivery if pushing leads to changes in hemodynamics or symptoms. Women were classified according to planned mode of delivery: either vaginal birth or cesarean delivery. We then used univariate analysis to compare adverse outcomes according to planned mode of delivery. The primary composite cardiac outcome of interest included sustained arrhythmia, heart failure, cardiac arrest, cerebral vascular accident, need for cardiac surgery or intervention, or death. Secondary obstetric and neonatal outcomes were also considered. RESULTS: We included 276 consenting women with congenital heart disease (68.5%), arrhythmias (11.2%), connective tissue disease (9.1%), cardiomyopathy (8.0%), valvular disease (1.4%), or vascular heart disease (1.8%) at or beyond 24 weeks' gestation. Seventy-six percent (n = 210) planned vaginal birth and 24% (n = 66) planned cesarean delivery. Women planning vaginal birth had lower rates of left ventricular outflow tract obstruction, multiparity, and preterm delivery. All women attempting vaginal birth were allowed Valsalva. Among planned vaginal deliveries 86.2% (n = 181) were successful, with a 9.5% operative vaginal delivery rate. Five women underwent operative vaginal delivery for the indication of cardiovascular disease without another obstetric indication at the discretion of the delivering provider. Four of these patients tolerated trials of Valsalva ranging from 15 to 75 minutes prior to delivery. Adverse cardiac outcomes were similar between planned vaginal birth and cesarean delivery groups (4.3% vs 3.0%, P = 1.00). Rates of postpartum hemorrhage (1.9% vs 10.6%, P < .01) and transfusion (1.9% vs 9.1%, P = .01) were lower in the planned vaginal birth group. There were no differences in adverse cardiac, obstetric, or neonatal outcomes in the cohort overall or the subset of women with high-risk cardiovascular disease or a high burden of obstetric comorbidity. CONCLUSION: These findings suggest that cesarean delivery does not reduce adverse cardiovascular outcomes and lend support to a planned vaginal birth for the majority of women with cardiovascular disease including those with high-risk disease.


Assuntos
Cesárea/métodos , Parto Obstétrico/métodos , Cardiopatias , Complicações Cardiovasculares na Gravidez , Adulto , Arritmias Cardíacas , Cardiomiopatias , Doenças do Tecido Conjuntivo , Doença da Artéria Coronariana , Gerenciamento Clínico , Extração Obstétrica/métodos , Feminino , Cardiopatias Congênitas , Doenças das Valvas Cardíacas , Humanos , Hemorragia Pós-Parto/epidemiologia , Gravidez , Estudos Prospectivos , Manobra de Valsalva
9.
Am J Otolaryngol ; 41(2): 102384, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31883755

RESUMO

PURPOSE: There is currently no gold standard for the diagnosis of eustachian tube (ET) dysfunction. To provide an objective basis for the clinical diagnosis of ET dysfunction, we explored the characteristics of sonotubometry, impedance, tubo-tympano-aerography (TTAG), and tubomanometry (TMM) in volunteers with healthy ETs. MATERIALS AND METHODS: Sonotubometry, impedance, TTAG, and TMM tests were performed in 110 healthy ears of 55 volunteers, and the characteristics of each ET test were compared and discussed. RESULTS: 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). CONCLUSIONS: Sonotubometry, impedance, TTAG, and TMM have their own advantages and disadvantages. In clinical practice, the appropriate ET function test should be chosen on the basis of the patient's specific condition.


Assuntos
Técnicas de Diagnóstico Otológico , Tuba Auditiva/fisiopatologia , Adulto , Deglutição , Meato Acústico Externo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nasofaringe/fisiopatologia , Pressão , Manobra de Valsalva , Adulto Jovem
10.
Eur Neurol ; 82(4-6): 113-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31846963

RESUMO

Valsalva maneuver (VM) precedes frequently transient global amnesia (TGA) and up to 84% of the patients with TGA present hippocampal diffusion-weighted imaging-positive (DWI+) lesions on brain magnetic resonance imaging (MRI). We studied 20 patients with TGA and hippocampal DWI+ lesions. Median age (range) of the patients was 67 (57-80) years and 55% were women. TGA had been preceded by a VM-associated activity in 14 patients (70%), and brain MRI had been performed at a median (range) of 47.5 (42-79) h after TGA. These patients underwent a second MRI after a controlled-induced VM at least 3 months after TGA. This MRI was performed at a median (range) of 46.8 (41-138) h after the controlled-induced VM. None of the patients who reproduced TGA symptoms presented new DWI+ lesions on the second MRI. In patients with a previous episode of TGA, VM cannot elicit TGA in isolation and the interplay of other simultaneous factors is needed.


Assuntos
Amnésia Global Transitória/etiologia , Amnésia Global Transitória/patologia , Hipocampo/patologia , Manobra de Valsalva/fisiologia , Adulto , Idoso , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Tunis Med ; 97(4): 595-598, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31729711

RESUMO

PURPOSE: To report a case of patient who presented with valsalva retinopathy after genral anesthesia for the treatment of ruptured intracranial aneurysm. OBSERVATION: A forty year-old man presented, after a general anesthesia for treatment of a ruptured intracranial aneurysm, with a severe decrease of the visual acuity in the left eye. Ophthalmic examination, performed one month after surgery showed a retrohyaloid macular hemorhage. After failure of laser Nd-YAG hyaloidotomy, vitrectomy allowed drainage of the hematoma with good visual outcome. CONCLUSION: Valsalva retinopathy is a rare complication that can occur after genral anesthesia. Vitrectomy may be needed if Nd-Yag laser hyaloidotomy fails.


Assuntos
Anestesia Geral/efeitos adversos , Posicionamento do Paciente/efeitos adversos , Hemorragia Retiniana/etiologia , Manobra de Valsalva , Adulto , Humanos , Lasers de Estado Sólido/uso terapêutico , Masculino , Hemorragia Retiniana/terapia , Vitrectomia
12.
Niger J Clin Pract ; 22(10): 1430-1434, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607735

RESUMO

Objective: To demonstrate whether there is an association between jugular venous reflux and nonpulsatile subjective tinnitus (NST) using real-time four-dimensional magnetic resonance imaging (MRI) angiography. Materials and Methods: Patients with unilateral NST who underwent contrast-enhanced MRI with a special protocol were included in the study. Thick slab dynamic maximum intensity projection images were obtained including interleaved stochastic trajectories (TWIST)-MRI examination. All patients were requested to perform Valsalva maneuver during the sequence. Jugular venous reflux grading was performed as follows: absence of reflux or if reflux does not reach the base of the skull: grade 0; if reflux reaches the jugular bulb, but no intracranial contrast is observed: grade 1; and if reflux extends into the intracranial cortical veins and/or the cavernous sinus above the jugular bulb: Grade 2. Results: A total number of 30 patients, 23 male and 7 female, were included in the study. Jugular venous reflux was not identified (Grade 0) in 20 patients. Grade 1 reflux was determined in 7 cases and Grade 2 reflux was observed in 3 cases. Notably, only patients with Grade 2 reflux described worsening of their tinnitus symptoms during the examination and their daily activities as well. Conclusions: NST might also be associated with hemodynamic problems of the venous system and the MRI protocol starting with TWIST accompanied with Valsalva maneuver is not well-known, yet seems to be a feasible and beneficial method to detect potential jugular venous reflux in NST patients.


Assuntos
Encéfalo/irrigação sanguínea , Veias Jugulares/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Zumbido/etiologia , Insuficiência Venosa/fisiopatologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Veias Jugulares/patologia , Masculino , Pessoa de Meia-Idade , Zumbido/fisiopatologia , Manobra de Valsalva , Insuficiência Venosa/complicações , Adulto Jovem
13.
Zhonghua Yi Xue Za Zhi ; 99(29): 2315-2318, 2019 Aug 06.
Artigo em Chinês | MEDLINE | ID: mdl-31434410

RESUMO

Objective: To investigate the value of the area of levator hiatusin diagnosis of uterine prolapse. Methods: From September 2017 to December 2018, 80 patients diagnosed with uterine prolapse by Department of Gynecology, Xiangya Hospital of Central South University were selected as the case group, and 80 cases of normal women in the same period were selected as the control group. All subjects in both groups were examined by transperineal three-dimensional ultrasound. The anteroposterior and transverse diameters and the area of levator hiatus were measured at rest and during maximum Valsalva maneuver respectively. The ROC curve was drawn to determine the cut-off value of area of levator hiatus in diagnosis of uterine prolapse and to evaluate its diagnostic value. Results: At rest and during maximum Valsalva maneuver, the anteroposterior and transverse diameters and the area of levator hiatus in study group were larger than those in control group, the difference was statistically significant (P<0.05). During maximum Valsalva maneuver, the above values in both groups were greater than those of the same group at rest state, but there was no significant difference between the two groups (P>0.05). During maximum Valsalva maneuver, the best cut-off value of area of levator hiatus for the diagnosis of uterine prolapse was 22.09 cm(2), the area under curve was 0.893. The sensitivity, specificity and accuracy were 90.0%, 95.0% and 92.5%, respectively. Conclusion: Transperineal three-dimensional ultrasound can evaluate the morphological changes of levator hiatus in patients with uterine prolapse, and the area of levator hiatus has high diagnostic value for uterine prolapse.


Assuntos
Prolapso Uterino , Feminino , Humanos , Imageamento Tridimensional , Diafragma da Pelve , Ultrassonografia , Manobra de Valsalva
14.
Diabetes Res Clin Pract ; 155: 107813, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31408665

RESUMO

AIMS: To assess cardiac autonomic control and its association with submaximal exercise measured using the 6-minute walk test (6MWT) in subjects with type-2 diabetes mellitus (DM2). METHODS: Cardiac autonomic control was assessed using Ewing's tests and heart rate variability (HRV) in DM2 volunteers (DG, n = 22) and sex-, age- and body mass index-matched non-diabetic controls (CG, n = 22) before, during and after 6MWT. RESULTS: Before the 6MWT, DG presented lower HRV represented by reduced SDNN [median 28.9 ms2 (IQR:18.6-35.4) vs. 45.1 (IQR:39.2-62.67), p < 0.001] and Total Power [median 785 ms2 (IQR:256-1264) vs. 1757 ms2 (IQR:1006-2912), p = 0.004]. Exercise capacity was reduced in DG [maximal predicted distance (%) = 88.4 ±â€¯6.4 vs. 95.2 ±â€¯11.0%, p = 0.018]. DG demonstrated lower global HRV during recovery and lower parasympathetic drive, represented by reduced RMSSD, during all phases of the 6MWT. Moreover, supine HR (r = -0.32), HR orthostatism (ρ = -0.40), SDNN pre-6MWT (ρ = 0.39), TP pre-6MWT (ρ = 0.38), Valsalva ratio (ρ = 0.39) and 30:15 ratio (ρ = 0.38) were all correlated with maximal walked distance. CONCLUSIONS: DM2 subjects presented abnormal HRV during and after submaximal exercise. Furthermore, autonomic control impairment in orthostatism, represented by lower global HRV (SDNN, Total power) and lower Ewing's indexes (Valsalva and 30:15 ratios), was associated with lower exercise capacity.


Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Teste de Esforço/métodos , Tolerância ao Exercício/fisiologia , Exercício Físico/fisiologia , Frequência Cardíaca/fisiologia , Manobra de Valsalva/fisiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Neurourol Urodyn ; 38(8): 2264-2272, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31385355

RESUMO

AIMS: Pelvic floor disorders (PFDs) in women are a major public health concern. Current clinical methods for assessing PFDs are either subjective or confounded by interference from intra-abdominal pressure (IAP). This study introduces an intravaginal probe that can determine distributed vaginal pressure during voluntary exercises and measures the degree of vaginal tissue support independent of IAP fluctuations. METHODS: An intravaginal probe was fabricated with 18 independent fiber-optic pressure transducers positioned along its upper and lower blades. Continuous pressure measurement along the anterior and posterior vaginal walls during the automated expansion of the probe enabled the resistance of the tissue to be evaluated as a function of displacement, in a manner reflecting the elastic modulus of the tissue. After validation in a simulated vaginal phantom, in vivo measurements were conducted in the relaxed state and during a series of voluntary exercises to gauge the utility of the device in women. RESULTS: The probe reliably detected variations in the composition of sub-surface material in the vaginal phantom. During in-vivo measurements the probe detected distributed tissue elasticity in the absence of IAP change. In addition, the distribution of pressure along both anterior and posterior vaginal walls during cough, Valsalva and pelvic floor contraction was clearly resolved with a large variation observed between subjects. CONCLUSIONS: Our data highlight the potential for the probe to assess the integrity of the vagina wall and support structures as an integrated functional unit. Further in vivo trials are needed to correlate data with clinical findings to assist in the assessment of PFDs.


Assuntos
Exame Ginecológico/instrumentação , Exame Ginecológico/métodos , Vagina/patologia , Adolescente , Adulto , Idoso , Tosse/fisiopatologia , Elasticidade , Exercício Físico , Feminino , Tecnologia de Fibra Óptica , Humanos , Pessoa de Meia-Idade , Contração Muscular , Diafragma da Pelve , Distúrbios do Assoalho Pélvico/diagnóstico , Distúrbios do Assoalho Pélvico/patologia , Imagens de Fantasmas , Pressão , Transdutores , Manobra de Valsalva , Adulto Jovem
16.
AJR Am J Roentgenol ; 213(5): 1163-1169, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31386571

RESUMO

OBJECTIVE. The purpose of this study is to determine the value of translabial real-time 3D ultrasound for predicting stress urinary incontinence (SUI). SUBJECTS AND METHODS. From December 2012 to August 2016, women with or without SUI diagnosed by urologists via urodynamics were prospectively recruited. All subjects underwent translabial real-time 3D ultrasound at one institution. Volume data were analyzed offline by a radiologist who was blinded to the diagnosis and who evaluated the bladder neck position on maximal Valsalva maneuver, the levator hiatus area on maximum Valsalva maneuver, bladder neck descent, and the urethral rotation angle. Combinations of two, three, and four parameters were analyzed using Fisher linear discriminant analysis. ROC curves were constructed to determine the optimal cutoff values of the four parameters and all combinations of parameters to predict SUI. RESULTS. A total of 321 women with SUI (mean [± SD] age, 35 ± 11 years) and 90 women without SUI (mean age, 31 ± 8 years) were included. Only 337 women were included in the final study, to eliminate the confounder of age. The cutoff values for the bladder neck position on maximal Valsalva maneuver, the levator hiatus area on maximum Valsalva maneuver, bladder neck descent, and the urethral rotation angle as parameters predicting SUI were 1 mm, 19 cm2, 24 mm, and 45°, respectively. For all combinations of parameters, the negative predictive values were more than 90%, although none of the combinations had a sensitivity higher than 70%. The specificities were approximately 95% when three or four parameters were included. The positive predictive value of the combinations ranged from 49.2% to 84.8%. CONCLUSION. Translabial real-time 3D ultrasound is insufficient for predicting SUI, but it can be used to identify women without the condition.


Assuntos
Imageamento Tridimensional , Ultrassonografia/métodos , Incontinência Urinária por Estresse/diagnóstico por imagem , Adulto , Feminino , Humanos , Valor Preditivo dos Testes , Estudos Prospectivos , Urodinâmica , Manobra de Valsalva
17.
Australas Emerg Care ; 22(4): 249-251, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31451381

RESUMO

We present a novel case of laughter induction that was noted to terminate an episode of supraventricular tachycardia (SVT) in a 10 year old girl who presented to a large metropolitan emergency department. In the initial management of this patient's SVT, traditional vagal maneuvers (including the valsalva maneuver and stimulation of the mammalian divers reflex) were attempted unsuccessfully. While awaiting further treatment, nursing staff presented the patient with an inflated examination glove that had been crafted into the shape of an elephant. This resulted in a fit of laughter that appeared to terminate the child's arrhythmia. Existing studies identified in the literature help to establish a correlation between the thoracic and cardiovascular physiology of laughter and the mechanics of the traditional Valsalva maneuver. Our patient's case highlights the potential positive impact of this physiology when applied in the context of the paediatric patient presenting in SVT. In the context of the available evidence, the case of our 10-year-old patient serves as a thought-provoking example of the real world relationship between laughter and the traditional Valsalva maneuver. The utility of laughter in the management of supraventricular tachycardia is an area that warrants further investigation.


Assuntos
Riso , Taquicardia Supraventricular/terapia , Criança , Emergências/psicologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Relações Enfermeiro-Paciente , Taquicardia Supraventricular/psicologia , Manobra de Valsalva
18.
Adv Emerg Nurs J ; 41(3): 192-197, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31356242

RESUMO

The REVERT trial was a randomized multicenter trial that investigated the efficacy of using a modified Valsalva maneuver for the reversion of stable supraventricular tachycardia back to a sinus rhythm. Although no improvement in discharge to home from the emergency department (ED) or ED length of stay was observed, the REVERT trial demonstrated that the modified Valsalva maneuver was superior to the standard Valsalva maneuver. The modified Valsalva maneuver should be considered first-line treatment for patients who present with a stable supraventricular tachycardia. A case presentation illustrates the methodology for utilizing the modified Valsalva maneuver to treat supraventricular tachycardia in a hemodynamically stable patient who presents to the ED.


Assuntos
Taquicardia Supraventricular/prevenção & controle , Manobra de Valsalva , Adulto , Eletrocardiografia , Serviço Hospitalar de Emergência , Feminino , Humanos
19.
Handb Clin Neurol ; 160: 419-433, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277866

RESUMO

The evaluation of autonomic function requires indirect assessment of neurophysiologic function using specialized equipment that is often available only at tertiary care centers, with few specialists available. However, the evaluation of autonomic function is rooted in basic physiology, and the results can be interpreted by careful consideration of the context of the problem. Many automated devices have become widely available to test autonomic function, but they tend to gather inadequate data leading to frequent misdiagnosis and clinical confusion. We review the details necessary for the neurophysiologist to properly perform, and interpret, autonomic function testing.


Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Sistema Nervoso Autônomo/fisiologia , Reflexo/fisiologia , Sudorese/fisiologia , Manobra de Valsalva/fisiologia , Sistema Nervoso Autônomo/fisiopatologia , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Humanos , Teste da Mesa Inclinada/métodos
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