Complete Recovery Group Research Articles

Factors related to changes in visual symptoms after successful photodynamic therapy in central serous chorioretinopathy.

To investigate biomarkers related to visual symptom and best corrected visual acuity (BCVA) improvement after photodynamic therapy (PDT) for central serous chorioretinopathy. This retrospective cross-sectional study involved 42 consecutive eyes, from 42 patients who underwent successful PDT, divided into two groups according to improvement in subjective visual complaints: complete (20 eyes) and incomplete recovery (22 eyes). The clinical characteristics of each group, including central foveal thickness (CFT), foveal avascular zone (FAZ) area, and degree of change in signal voiding of the choriocapillaris on optical coherence tomography angiography, were compared. Correlations between best-corrected visual acuity (BCVA) and baseline clinical features were investigated. At baseline, CFT and FAZ areas showed significant differences between the two groups (all p < 0.05). Multiple binary logistic regression analysis revealed that greater CFT predicted complete recovery from visual complaints (p = 0.002). Reduction or disappearance of signal voiding in the choriocapillaris 6 months post-PDT occurred more frequently in the complete recovery group (p < 0.05). FAZ area before PDT correlated with BCVA before and 6 months after PDT and BCVA improvement during the study period (all p < 0.05). CFT and FAZ area before PDT correlated with completeness of visual symptom recovery after PDT. Smaller FAZ area before PDT correlated with better BCVA before and after treatment.

A novel treatment workflow of idiopathic hypereosinophilic syndrome: a single-center retrospective cohort study.

A novel treatment workflow of idiopathic hypereosinophilic syndrome: a single-center retrospective cohort study.

Reoperation for Misplaced Pedicle Screws: A Multicenter Retrospective Study.

A multicenter retrospective analysis. This study aims to investigate reoperation of misplaced pedicle screws (MPSs) after posterior spinal fusion (PSF), focusing on neurological complications. The management strategy for MPSs and the clinical results after reoperation are poorly defined. Subjects were 10,754 patients (73,777 pedicle screws) who underwent PSF at 11 hospitals over 15 years. The total number of reoperations for MPS and patient clinical data were obtained from medical records at each hospital. The rate of reoperation for screw misplacement per screw was 0.17%. A total of 69 patients (mean age, 67.4±16.5yr) underwent reoperation because of 82 MPS. Reasons for reoperation were neurological symptoms (58 patients), contact with vessels (5), suboptimal bone purchase (4), and misplacement recognized during operation (2). Neurological symptoms were the major reason for reoperation in cervical (5/5 screws, 100%) and lumbo-sacral (60/67 screws, 89.6%) regions. Contact with vessels was the major reason for reoperation in the thoracic spine (6/10 screws, 60.0%). We further evaluated 60 MPSs in the lumbo-sacrum necessitating reoperation because of neurological symptoms. The majority of MPSs necessitating reoperation were placed in the lower lumbar spine (43/60 screws, 71.7%). The mean pedicle breach tended to be larger in the incomplete recovery group than in the complete recovery group (6.8±2.4 vs . 5.9±2.2mm, P =0.146), and the cutoff value resulting in incomplete resolution was 5.0mm. Multivariate analysis revealed that medial-caudal breaches ( vs . medial breach, odds ratio: 25.8, 95% confidence interval: 2.58-258, P =0.0057) and sensory and motor disturbances ( vs . sensory only, odds ratio: 8.57, 95% confidence interval: 1.30-56.6, P =0.026) were significant factors for incomplete resolution of neurological symptoms. After reoperation, 70.1% of the patients achieved complete resolution of neurological symptoms. Factors associated with residual neurological symptoms included sensory and motor disturbance, medial-caudal breach, and larger pedicle breach (>5 mm).

Early recovery status and outcomes after sepsis-associated acute kidney injury in critically ill patients.

Acute kidney injury (AKI) is one of the common complications in critically ill septic patients, which is associated with increased risks of death, cardiovascular events, and chronic renal dysfunction. The duration of AKI and the renal function recovery status after AKI onset can affect the patient prognosis. Nevertheless, it remains controversial whether early recovery status after AKI is closely related to the prognosis in patients with sepsis-associated AKI (SA-AKI). In addition, early prediction of renal function recovery after AKI is beneficial to individualized treatment decision-making and prevention of severe complications, thus improving the prognosis. At present, there is limited clinical information on how to identify SA-AKI patients at high risk of unrecovered renal function at an early stage. The study aims to investigate the association between early recovery status after SA-AKI, identify risk factors for unrecovered renal function, and to improve patients' quality of life. We retrospectively analyzed clinical data of septic patients who were admitted to the intensive care unit (ICU) and developed AKI within the first 48 hours after ICU admission in the Second Xiangya Hospital and the Third Xiangya Hospital of Central South University from January 2015 to March 2017. Sepsis was defined based on the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). AKI was diagnosed and staged according to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guideline. SA-AKI patients were assigned into 3 groups including a complete recovery group, a partial recovery group, and an unrecovered group based on recovery status at Day 7 after the diagnosis of AKI. Patients' baseline characteristics were collected, including demographics, comorbidities, clinical and laboratory examination information at ICU admission, and treatment within the first 24 hours. The primary outcome of the study was the composite of death and chronic dialysis at 90 days, and secondary outcomes included length of stay in the ICU, length of stay in the hospital, and persistent renal dysfunction. Multivariate regression analysis was performed to evaluate the prognostic value of early recovery status after AKI and to determine the risk factors for unrecovered renal function after AKI. Sensitivity analysis was conducted in patients who still stayed in hospital on Day 7 after AKI diagnosis, patients without premorbid chronic kidney disease, and patients with AKI Stage 2 to 3. A total of 553 SA-AKI patients were enrolled, of whom 251 (45.4%), 73 (13.2%), and 229 (41.4%) were categorized as the complete recovery group, the partial recovery group, and the unrecovered group, respectively. Compared with the complete or partial recovery group, the unrecovered group had a higher incidence of 90-day mortality (unrecovered vs partial recovery or complete recovery: 64.2% vs 26.0% or 22.7%; P<0.001) and 90-day composite outcome (unrecovered vs partial recovery or complete recovery: 65.1% vs 27.4% or 22.7%; P<0.001). The unrecovered group also had a shorter length of stay in the hospital and a larger proportion of progression into persistent renal dysfunction than the other 2 groups. After adjustment for potential confounders, patients in the unrecovered group were at an increased risk of 90-day mortality (HR=3.50, 95% CI 2.47 to 4.96, P<0.001) and 90-day composite outcome (OR=5.55, 95% CI 3.43 to 8.98, P<0.001) when compared with patients in the complete recovery group, but patients in the partial recovery group had no significant difference (P>0.05). Male sex, congestive heart failure, pneumonia, respiratory rate >20 beats per minute, anemia, hyperbilirubinemia, need for mechanical ventilation, and AKI Stage 3 were identified as independent risk factors for unrecovered renal function after AKI. The sensitivity analysis further supported that unrecovered renal function after AKI remained an independent predictor for 90-day mortality and composite outcome in the subgroups. The early recovery status after AKI is closely associated with poor prognosis in critically ill patients with SA-AKI. Unrecovered renal function within the first 7 days after AKI diagnosis is an independent predictor for 90-day mortality and composite outcome. Male sex, congestive heart failure, pneumonia, tachypnea, anemia, hyperbilirubinemia, respiratory failure, and severe AKI are risk factors for unrecovered renal function after AKI. Therefore, timely assessment for the renal function in the early phase after AKI diagnosis is essential for SA-AKI patients. Furthermore, patients with unrecovered renal function after AKI need additional management in the hospital, including rigorous monitoring, avoidance of nephrotoxin, and continuous assessment for the renal function, and after discharge, including more frequent follow-up, regular outpatient consultation, and prevention of long-term adverse events.

Predictors of complete recovery of oculomotor nerve palsy induced by posterior communicating artery aneurysms in patients aged eighteen to sixty

ObjectiveTo explore prognostic factors of complete recovery of oculomotor nerve palsy (ONP) induced by posterior communicating artery aneurysm (PcomAA). MethodPcomAA patients aged 18–60 years combined with ONP who underwent surgical clipping or endovascular embolization at our institution between January 2014 and January 2020 were enrolled. Characteristics included maximum diameter of aneurysm, width of aneurysm, subarachnoid hemorrhage (SAH), duration of ONP, age, sex, ONP type, treatment method were compared. Based on the recovery of ONP, patients were separated into two groups: complete recovery group, partial and no recovery group. Analyzing by univariate and multivariate logistic regressions to identify the independent prognostics for complete ONP recovery. We established a score based on these prognostics. Receiver operating characteristics (ROC) were conducted to under the performance of the predictors and score. ResultsFinally, ONP type (OR 6.457 95% CI 1.664–25.052, p = 0.007), treatment method (OR 5.051, 95% CI 1.332–19.158, p = 0.017), and interval to treatment ≤2 weeks (OR 25.601 95% CI 6.222–105.340, p < 0.001) were independent predictors of complete ONP recovery. The score had an area under the curve (AUC) value of 0.870. We defined that the score higher than 5 points as easier to achieve complete ONP recovery, and the AUC value of this definition was 0.821. ConclusionsFor ONP induced by PcomAA in patients aged 18–60 years, the best prognostic factor for complete ONP recovery was timely treatment. The ONP type and treatment methods were correlated with complete ONP recovery.

Vestibular mapping assessment in idiopathic sudden sensorineural hearing loss.

The aim of this study was to investigate patterns of semicircular canal (SCC) and otolith organ dysfunction by vestibular mapping, and to determine the clinical implications of treatment outcomes in idiopathic sudden sensorineural hearing loss (ISSNHL). We retrospectively reviewed 135 consecutive patients diagnosed with ISSNHL from January 2016 to December 2020. Patients underwent video-head impulse tests (vHIT) for each SCC, cervical vestibular-evoked myogenic potential test for the saccules, ocular vestibular-evoked myogenic potential test for the utricles, and hearing tests. Hearing outcomes were evaluated according to the American Academy of Otolaryngology-Head and Neck Surgery criteria and factors associated with prognosis were assessed. We also conducted vestibular mapping assessments and hierarchical cluster analysis. Overall, utricular impairment (76, 56.3%) was the most frequent diagnosis in the 135 ISSNHL patients, followed by saccular impairment (59, 43.7%) and posterior SCC impairment (30, 22.2%). The mean number of affected end organs was 1.37 ± 1.24, with higher numbers in the complete recovery group than in the partial/no recovery groups. In a multivariate analysis, higher initial hearing level and abnormal vHIT results in the posterior SCC were associated with poor prognosis in ISSNHL. In hierarchical cluster analysis, horizontal SCC and anterior SCC showed the highest similarity but were in different clusters than posterior SCC, and the saccule and utricle were in separate clusters from the three SCCs. The vestibular end organ showed various patterns of dysfunction in patients with ISSNHL. Of the five vestibular end organs, only abnormal posterior SCC was associated with poor prognosis for hearing recovery.

Iron deficiency is associated with poor prognosis in idiopathic sudden sensorineural hearing loss.

The effects of iron deficiency on the prognosis of idiopathic sudden sensorineural hearing loss are unclear. This study aimed to investigate the association between serum iron levels and idiopathic sudden sensorineural hearing loss prognosis and its usefulness as an independent prognostic marker for idiopathic sudden sensorineural hearing loss. The audiological and haematological data, including hearing recovery and serum iron levels, of 103 patients with idiopathic sudden sensorineural hearing loss evaluated between 2015 and 2018 were retrospectively analysed. The overall complete recovery rate was 16.5 per cent. Initial higher hearing threshold was associated with poor idiopathic sudden sensorineural hearing loss prognosis. Serum iron levels were significantly higher in the complete recovery group than in the non-complete recovery group (p < 0.05). The possibility of complete recovery from idiopathic sudden sensorineural hearing loss was significantly lower with lower serum iron levels, suggesting that the serum iron level might be a novel prognostic marker for idiopathic sudden sensorineural hearing loss.

Ani İdiyopatik Sensorinöral İşitme Kaybında Sistemik İmmün İnflamasyon İndeksinin Değerlendirilmesi

Objective: This study aimed to investigate the prognostic value of systemic immune inflammation index (SII) in sudden idiopathic sensorineural hearing loss (SISNHL). Methods: Eighty-nine patients diagnosed with SISNHL were included in this study. SII was calculated from the complete blood count when the patients were hospitalised. The patients were treated in accordance with our routine SISNHL protocol. Hearing recovery was evaluated in accordance with Siegel’s criteria, and two main groups were created (complete and incomplete recovery groups). The control group consisted of patients who were admitted to our clinic for hearing examination. SIIs were statistically analysed amongst these three groups (control, complete recovery and incomplete recovery groups). Results: The mean SII of the three groups significantly differed (p= 0.002). The control group significantly differed from the two other groups (complete recovery group: p= 0.023, incomplete recovery group: p= 0.048). The complete recovery group did not significantly differ from the incomplete recovery group (p= 0.950). Conclusion: SII had no prognostic value in patients diagnosed with SISNHL. However, SIIs were significantly higher in the patient groups diagnosed with SISNHL than those in the control group. This finding supports the predictive value of SII in SISNHL. Studies with more participants are needed to demonstrate the predictive value of SII in SISNHL.

Analysis of Clinical Data from the Third, Fourth, or Sixth Cranial Nerve Palsy and Diplopia Patients Treated with Ijintanggagambang in a Korean Medicine Clinic: A Retrospective Observational Study.

Objective: The clinical course of the third, fourth, and sixth cranial nerve palsies varies according to etiology and onset. The effects of Ijintanggagambang in Korean patients with cranial nerve palsy and paralytic diplopia were assessed. Design: This is a retrospective observational study. Settings: The study was conducted in a Korean Medicine clinic in Seoul, Korea. Subjects: Subjects were 569 patients with cranial nerve palsy and diplopia who received Ijintanggagambang in 2009-2018. Interventions: The patients received herbal decoction, Ijintanggagambang, for 4 weeks. Main outcome measures: The baseline characteristics, including onset, etiology, type of paralysis, and deviation angle, were collected. Patients whose diplopia resolved were classified as completely recovered. Potential factors affecting the clinical effectiveness of Ijintanggagambang for this condition were explored. The rate and duration of complete recovery were narratively analyzed and compared with previous reports. Results: Sixth cranial nerve palsy was the most common type of paralysis (n = 311, 55%) and undetermined origin was the most frequent etiology (n = 281, 49%). The complete recovery rate was higher in patients who started treatment within 12 weeks of onset (95%, 503/532) than in those who started treatment later (19%, 7/37). In 532 patients who started treatment within 12 weeks of onset, the complete recovery rate of patients with vascular origin (98%, 122/124), other diseases (97%, 94/97), and undetermined etiology (96%, 252/263) was statistically high compared with those of traumatic origin (73%, 35/48, p < 0.05). The average treatment duration in the complete recovery group (n = 510) was 9.3 weeks. The treatment duration was correlated with the increase of deviation angle in all three types of cranial nerve palsies. Conclusions: Sixth cranial nerve palsy and undetermined etiology were common. There is an association between recovery of diplopia and the administration of Ijintanggagambang when started within 12 weeks of onset. Results of the study need to be interpreted cautiously due to the limited nature of narrative retrospective analysis.

Risk factors for complete recovery of adults after weaning from veno-venous extracorporeal membrane oxygenation for severe acute respiratory failure: an analysis from adult patients in the Extracorporeal Life Support Organization registry

BackgroundAs extracorporeal membrane oxygenation (ECMO) has been widely used, the patient quality of life following ECMO termination has become an important issue as same as the patient’s survival. To date, the factors affecting complete recovery of adult survivors from ECMO have not been investigated.MethodsData from adult patients in the Extracorporeal Life Support Organization registry who received veno-venous ECMO between 2012 and 2017 were analyzed. Multivariate logistic regression analyses were conducted.ResultsIn total, 6536 patients with 242,183 days of veno-venous ECMO were reviewed. The overall survival to discharge rate after weaning from ECMO was 89.7% (n = 5861), and 10.3% (n = 675) of the patients died during hospitalization. The discharge location varied as follows: 33.7% (n = 1976) returned home, 23.4% (n = 1369) were transferred to a referral hospital, 41.8% (n = 2447) required hospital services, and 0.6% (n = 36) were discharged to other places. The patients were divided into two groups according to the discharge location: a complete recovery group (n = 1976) and a partial recovery group (n = 3885). In the multivariate analyses, age (≥ 65 years) (odds ratio (OR) 0.72, 95% confidence interval (CI) 0.59–0.87, p = 0.001), cardiac arrest before ECMO (OR 0.76, 95% CI 0.60–0.96, p = 0.021), vasopressor use (OR 0.73, 95% CI 0.64–0.83, p < 0.001), renal replacement therapy (OR 0.40, 95% CI 0.28–0.57, p < 0.001), ECMO-related complications (OR 0.76, 95% CI 0.67–0.85, p < 0.001), and long-term ECMO support (≥ 2 weeks) (OR 0.42, 95% CI 0.37–0.48, p < 0.001) were significantly associated with complete recovery.ConclusionComplete recovery after veno-venous ECMO support is associated with the patient’s baseline condition, ECMO duration, and ECMO-related complications. Respiratory ECMO should aim to increase both the survival and the quality of life after weaning from ECMO.

Nerve Integrity Monitor Responses to Direct Facial Nerve Stimulation During Facial Nerve Decompression Surgery Can Predict Postoperative Outcomes.

To test whether the threshold of nerve integrity monitor (NIM) responses during facial nerve decompression surgery can predict the postoperative outcome. Retrospective study. University hospital. Twenty peripheral facial palsy patients who underwent transmastoid decompression surgery. During decompression surgery, thresholds of NIM responses were measured via direct facial nerve stimulation at three sites: the geniculate ganglion (GG), the second genu (2 G), and the stylomastoid foramen. Facial nerve function was evaluated before and 6 months after surgery using the Yanagihara grading score (maximum score = 40 points). Complete recovery was defined as an improvement of the grading score to ≥ 36 points without synkinesis. Variables including age, sex, disease (Bell's palsy or Ramsay Hunt syndrome), time after onset, Yanagihara grading score, and electroneurography before surgery, and the thresholds of NIM responses during surgery were compared in the complete and incomplete recovery groups. NIM responders were defined as those exhibiting a NIM response of < 1.5 mA at any site. Postoperative Yanagihara grading scores in NIM responders and NIM nonresponders were compared. No variables differed significantly in the complete and incomplete recovery groups before surgery. NIM response thresholds in the complete recovery group at the GG and the 2nd G were significantly lower than the corresponding thresholds in the incomplete recovery group. The postoperative Yanagihara grading scores of NIM responders were significantly better than those of NIM nonresponders. NIM responses to intraoperative direct facial nerve stimulation were useful for predicting outcomes after decompression surgery.

Monitoring the Prognosis of Diabetic Foot Ulcers: Predictive Value of Neutrophil-to-Lymphocyte Ratio and Red Blood Cell Distribution Width.

The aim of this study was to investigate the prognostic values of neutrophil-to-lymphocyte ratio and red blood cell distribution width in diabetic foot ulcers treatment. A total of 250 adult patients who were treated in our clinic between 2007 and 2018 for diabetic foot ulcers were evaluated retrospectively. Diabetic foot ulcers were divided into 4 groups: major amputation, minor amputation, chronic wound, and complete healing. The mean age of our study groups was 60 years (range = 55-65 years). The mean follow-up period was 28 ± 4.3 months. Neutrophil-to-lymphocyte ratio and red blood cell distribution width cutoff values were determined as 4.3 and 12.1, respectively, for patients in complete recovery group (C sig. = .995 and .871, respectively; P < .05). Neutrophil-to-lymphocyte ratio and red blood cell distribution width cutoff values for patients in the major amputation group were 6.73 and 13.4 (C sig. = .864 and .951, respectively; P < .05), respectively. According to the χ2 comparison of the groups, major amputation was seen in patients with neutrophil-to-lymphocyte ratio >6.3, and complete recovery was seen in patients with neutrophil-to-lymphocyte ratio <4.3. In patients with red blood cell distribution width >13.4, major amputation was found to be significant (P < .05). According to these results, neutrophil-to-lymphocyte ratio and red blood cell distribution width are inexpensive and easy to access predictive parameters in the diagnosis and follow-up of diabetic foot ulcers.

Factors Associated With Fast Recovery of Bell Palsy in Children.

The purpose of this study was to identify the clinical characteristics and factors affecting the prognosis of children with Bell palsy. We retrospectively reviewed the medical records of 53 pediatric patients diagnosed with Bell palsy. After a mean follow-up period of 30 days, 30 patients (56%) were completely recovered, 21 patients (40%) were partially recovered, and 2 patients (4%) had not recovered. The patients in the complete recovery group were significantly younger than those in the partial and nonrecovery groups (8.8 ± 4.2 years vs 12.2 ± 3.0 years, P = .003). Patients <8 years old had a higher complete recovery rate than was found in patients >8 years old (80% vs 47%, P = .031). Sex, affected side, and early or late treatment did not influence the recovery rate. These results suggest that younger age may be a good prognostic factor affecting the fast recovery of children with Bell palsy.

Ocular vestibular evoked myogenic potential testing for the prognosis of Bell’s palsy

Conclusion: oVEMP could be a useful tool for predicting the prognosis of Bell's palsy comparable to ENoG and H–B grade.Objectives: Several previous studies have reported cases of Bell’s palsy with vestibular function disorder. The basic hypothesis behind this effect lies in the close proximity of the vestibular and facial nerves in the internal auditory canal (IAC). Therefore, the aim of this study was to investigate the correlation between Bell’s palsy prognosis and ocular vestibular evoked myogenic potentials (oVEMPs).Methods: Total 104 consecutive patients who were diagnosed with Bell?s palsy from January 2012 to December 2014 were enrolled. Patients were divided into complete recovery group and incomplete recovery group. All of patients underwent oVEMP recordings within 1 week after disease onset. For the evaluation of correlation between H–B grades, ENoG, oVEMP and Recovery of Bell?s palsy, logistic regression analysis was performed.Results: The mean value of ocular vemp asymmetry was significantly higher in the incomplete recovery group than the complete recovery group (p < 0.05). No association was found between the ipsilesional PTA threshold, caloric test, and rate of abnormal EMG and recovery state. However, the initial state of ENoG, initial H–B grade, and oVEMP abnormal findings (Latency & Amplitude symmetry ratio) were significantly correlated with the rate of recovery (p = 0.025, p = 0.013, and p < 0.005, respectively).

Correlations between the pathogenesis and prognosis of sudden sensorineural hearing loss and blood lipid

We aimed to determine whether blood lipid parameters were related to the severity and the prognosis of idiopathic sudden sensorineural hearing loss (ISSNHL) patients. A retrospective cohort study of 258 patients with ISSNHL from December 2013 to February 2015. The distribution characteristics of lipids [total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), Non-high-density lipoprotein cholesterol (Non-HDL-C), et al] in different degree of deafness (mild, moderate, severe, and profound), hearing curve types (low frequency, high frequency, full range frequency, and completely deafness type) and prognosis of recovery (complete, partial, slight, and no recovery) were analyzed by IBM SPSS 22.0 ANOVA analysis, chi square test and multiple regression analysis. TG level in mild hearing loss group was significantly lower than that in severe and profound hearing loss group (P = 0.017 and P = 0.007). There were no correlation between curve types and lipid indexes (P > 0.05). Non-HDL-C level was elevated in no recovery and slight recovery groups (P = 0.026 and 0.021). TC levels in partial recovery group and no recovery group were significantly higher than that in the complete recovery group (P = 0.049 and 0.042), TG was higher in slight recovery group (P = 0.014). TG has significant correlation with the severity of hearing loss. There are negative correlations between hearing recovery and Non-HDL-C, TC and TG levels. Non-HDL-C, TC and TG might be a prognostic factor for treatment outcome in ISSNHL patients.

The correlation between lipoprotein ratios and hearing outcome in idiopathic sudden sensorineural hearing loss patients.

Recent reports have identified hypercholesterolaemia as a significant risk factor for idiopathic sudden sensorineural hearing loss (ISSNHL). Therefore, we investigated whether lipid profiles and lipoprotein ratios are correlated with the prognosis of hearing recovery in ISSNHL patients. A retrospective cohort study. Patients with ISSNHL were classified into four groups (complete, partial, slight and no recovery) according to their degree of hearing recovery using Siegel's criteria and the Sudden Deafness Research Group (SDRG) criteria developed by the Japanese Ministry of Welfare. All patients' lipid profiles were analysed, including total cholesterol (TC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol and triglycerides. We calculated the ratios of TC/HDL-C and LDL-C/HDL-C and used statistical methods to evaluate correlations between lipid profiles and lipoprotein ratios and ISSNHL prognosis. Hearing recovery was observed in 103 (62.0%) of 166 cases using Siegel's criteria and in 114 (68.7%) of 166 cases using SDRG's criteria. Among the three recovery groups (i.e. excluding the no recovery group), the ratio of LDL-C/HDL-C was found to be associated with recovery outcome by showing the ratio on an upward trend from complete recovery to slight recovery group, and the difference is statistically significant (P = 0.016 by Siegel's criteria, P = 0.041 by SDRG's criteria). Multiple linear regression analysis further revealed a significantly higher LDL-C/HDL-C ratio in slight hearing recovery group compared with complete recovery group (P = 0.007 by Siegel's criteria, P = 0.031 by SDRG's criteria). We suggested that lipoprotein ratio of LDL-C/HDL-C may be a prognostic factor for hearing recovery in ISSNHL patients. Further studies should be conducted to determine whether hearing outcomes in ISSNHL can be improved by changing patients' lipid profiles via antilipidemic treatment.

Neurotological Parameters and Prognosis of Bell's Palsy Patients

Background: To investigate the relationship with prognosis, various neurotological examinations evaluating all four nerves within the internal auditory canal were performed in patients with Bell's palsy. Methods: A total of 69 consecutive patients with Bell's palsy were included. They were treated uniformly with steroid and an antiviral agent and underwent neurotological examinations consisting of electronystagmography, pure-tone audiometry (PTA), electroneurography (ENoG), caloric test, rotatory chair test and cervical vestibular evoked myogenic potentials (cVEMP). According to the final recovery state, patients were divided into two groups: a complete recovery group and an incomplete recovery group. The incidence of abnormal findings in each test was compared between the two groups. Results: Fifty-six patients recovered completely and 13 patients recovered incompletely. No association was observed between the rate of ipsilesional PTA threshold and the rate of abnormal caloric test, function tests and recovery state. However, the initial state of facial palsy, ENoG and the rate of abnormal cVEMP were significantly correlated with the rate of recovery. Conclusion: The results indicate that Bell's palsy may be more comparable to mononeuritis multiplex and that cVEMP could be a useful tool for predicting the prognosis of Bell's palsy.

Acute mesenteric vein thrombosis: factors associated with evolution to chronic mesenteric vein thrombosis.

Acute mesenteric venous thrombosis signs at MDCT are well described, but the literature lacks studies assessing their evolution. We aimed to describe the radiologic evolution of isolated acute mesenteric venous thrombosis and associated prognostic factors. Patients with isolated acute mesenteric venous thrombosis with follow-up for a minimum of 1 month with MDCT were selected. Images at the acute phase and on follow-up were reviewed in consensus reading. For acute mesenteric venous thrombosis, we searched for low-attenuated intraluminal filling defect. For chronic mesenteric venous thrombosis, we searched for vessel stenosis or occlusion associated with collateral mesenteric veins. Treatment, thrombosis risk factor, symptoms, location, and length and diameter of mesenteric venous thrombosis were reported and correlated with evolution over time. Twenty patients (nine women and 11 men; mean age, 52 years) were selected. Four patients recovered without radiologic sequelae, and 16 developed chronic mesenteric venous thrombosis signs. Anticoagulation did not influence recovery (p = 1). Patients with recovery compared with patients with chronic mesenteric venous thrombosis showed more frequent central lesions (p = 0.03). At diagnosis, the thrombosed segment was shorter and larger in the complete radiologic recovery group compared with the chronic mesenteric venous thrombosis signs group: mean length (± SD) 6.25 ± 3.21 cm and 12.81 ± 5.96 cm, respectively (p = 0.01); mean transverse diameter 1.82 ± 0.42 cm and 1.12 ± 0.34 cm, respectively (p = 0.01). Mesenteric fat infiltration at diagnosis was more frequent in the chronic mesenteric venous thrombosis signs group than in the complete recovery group (p = 0.03). Most cases of acute mesenteric venous thrombosis evolve toward the chronic form with vein stenosis or occlusion and development of collateral veins. Location, length of mesenteric venous thrombosis, transverse diameter of the vein, and mesenteric fat infiltration at diagnosis are determinant factors for mesenteric venous thrombosis evolution.

突発性難聴における歪成分耳音響放射出力と聴力予後

We investigated the clinical usefulness of distortion product otoacoustic emissions (DPOAEs) for the prediction of hearing outcomes in idiopathic sudden sensorineural hearing loss (ISSNHL).Thirty-two patients with ISSNHL (time from the onset to the start of treatment≤14 days) were enrolled in the study. They received steroid administration (400mg/day of hydrocortisone sodium succinate followed by tapered doses) combined with hyperbaric oxygen therapy. DPOAEs (f2/f1=1.2, L1=80dBSPL, L2=70dBSPL, geometric mean (GM) of f1 and f2=531-5, 500Hz, every one-third octave) were measured before and after treatment. The degree of hearing recovery was classified into four categories (complete recovery, good recovery, satisfactory recovery, no change) according to the criteria of the Ad Hoc Committee of the Japanese Ministry of Health, Labour and Welfare.The DPOAE output in the high-frequency range (GM of f1 and f2≥2, 781Hz) before treatment was higher in the complete recovery group than in the other three groups. The DPOAE output at 2, 781Hz and 4, 375Hz was significantly higher in the complete recovery than in the satisfactory recovery and no change groups (Student's t-test, p<0.05). However, the improvement of the DPOAE output after treatment did not statistically differ at any frequency among the four groups.These results indicate that the DPOAE output in the high-frequency range before treatment can be a prognostic indicator of hearing outcomes in patients with ISSNHL.

Postoperative Spinal Epidural Hematoma: Risk Factor and Clinical Outcome

We report a series of epidural hematomas which cause neurologic deterioration after spinal surgery, and have taken risk factors and prognostic factors into consideration. We retrospectively reviewed the database of 3720 cases of spine operation in a single institute over 7 years (1998 April-2005 July). Nine patients who demonstrated neurologic deterioration after surgery and required surgical decompression were identified. Factors postulated to increase the postoperative epidural hematoma and to improve neurologic outcome were investigated. The incidence of postoperative epidural hematoma was 0.24%. Operation sites were cervical 3 cases, thoracic 2 cases, and lumbar 4 cases. Their original diagnoses were tumor 3 cases, cervical stenosis 2 cases, lumbar stenosis 3 cases and herniated lumbar disc 1case. The symptoms of epidural hematomas were neurologic deterioration and pain. After decompression, clinical outcome revealed complete recovery in 3 cases (33.3%), incomplete recovery in 5 cases (55.6%) and no change in 1 case (11.1%). Factors increasing the risk of postoperative epidural hematoma were coagulopathy from medical illness or anticoagulation therapy (4 cases, 44.4%) and highly vascularized tumor (3 cases, 33.3%). The time interval to evacuation of complete recovery group (29.3 hours) was shorter than incomplete recovery group (66.3 hours). Patients with coagulopathy and highly vascularized tumor were more vulnerable to spinal epidural hematoma. The postoperative outcome was related to the preoperative neurological deficit and the time interval to the decompression.