Sudden deafness and virus infection (author's transl)]

A survey of the literature concerning sudden deafness caused by virus infection is followed by a discussion of 46 patients with the history of acute loss of hearing, who were subjected to virological-serological examination. In 9 patients the titre movement of the complement fixation reaction was regarded to imply a viral cause of the acute loss of hearing. This was corroborated in 5 cases by the history of recent viral infection. Pathogenetically, the significance of the viral endolymphatic labyrinthitis was underlined. The success of traditional therapy did not differ from the results in cases of sudden deafness due to factors other than viral disease. In the absence of specific therapy the importance of prophylactic measures is stressed.     

Migraine as a Cause of Sudden Hearing Loss

Sudden heating loss is common, but unexplained in many cases. Although usually attributed to a viral infection of the inner ear in mort patients, the abrupt onset of the hearing loss in many patients argues against a viral etiology. We present 13 cases of unexplained sudden healing loss who meet the diagnostic criteria for migraine. All had the sudden onset of hearing loss and other neurologic phenomena that could be attributed to vasospasm, including vertigo, amaurosis fugax, hemiplegia, facial pain, chest pain, and visual aura. We suggest that vasospasm of the cochlear vasculature was the cause of the sudden hearing loss in these patients. A personal and family history of migraine should be sought in patient; with sudden heating loss and when found, a trial of antispas modic agents should be considered.     

脂联素和Hs-CRP在突发性耳聋中的临床意义

目的探讨突发性耳聋患者血清脂联素和血清高敏c一反应蛋白（Hs-CRP）的含量变化,及其在突发性耳聋发生过程中的作用和意义。方法采用酶联免疫（ELISA）法检测血清脂联素含量,采用免疫比浊法对血清Hs—CRP进行测定;检测102例突发性耳聋患者、35例其他疾病对照组和30例正常健康对照组的血清脂联素和Hs-CRP含量,并比较治疗前后血清脂联素和Hs—CRP的测定结果。结果突发性耳聋患者治疗前血清Hs-CRP含量较两对照组显著升高（P〈0．01）;治疗后恢复组患者Hs-CRP含量明显降低。突发性耳聋患者治疗前血清脂联素含量较两对照组显著降低（P〈0．01）;治疗后恢复组患者脂联素含量明显升高。突发性耳聋患者血清脂联素和Hs—CRP含量之间呈负相关（r=-0．63,P〈0．01）。结论血清脂联素和Hs—CRP水平的变化与突发性耳聋病情严重程度密切相关。     

高压氧综合治疗突发性耳聋的疗效观察

目的：探讨高压氧治疗突发性耳聋的疗效。方法：随机选取单纯以药物包括血管扩张剂、能量合剂、激素、神经营养等药物治疗突发性耳聋137例147耳为对照组,另一组176例185耳则在药物治疗基础上同时进行高压氧治疗为HBO组。结果：对照组有效率为57.1%,HBO组有效率为81.1%,两组比较差异有显著性意义（P〈0.05）;对照组与HBO组均以病程≤10天组疗效较好,有效率分别达到75.9%和92.9%。结论：常规应用药物治疗同时加用高压氧治疗,可提高治疗突发性耳聋的总有效率,其治愈、显效、有效各项指标均明显优于对照组。     

突发性耳聋患者HMGB1和ENA-78含量在治疗前后变化的意义

目的探讨突发性耳聋患者血清高迁移率蛋白-1(HMGB1)和中性粒细胞激活肽-78(ENA-78)的含量变化,及其在突发性耳聋发生过程中的作用和意义。方法采用酶联免疫(ELISA)法检测血清HMGB1和ENA-78含量;检测102例突发性耳聋患者、35例其他疾病对照组和30例健康对照组的血清HMGB1和ENA-78含量,并比较治疗前后血清HMGB1和ENA-78的测定结果。结果突发性耳聋患者治疗前血清HMGB1和ENA-78含量较两对照组显著升高(P<0.01);治疗后患者HMGB1和ENA-78含量明显降低。同时重度组突发性耳聋患者血清HMGB1和ENA-78浓度明显高于中、轻度组,中度组患者明显高于轻度组,且差异有统计学意义(P<0.01)。突发性耳聋患者血清HMGB1和ENA-78含量之间呈正相关(r=0.68,P<0.01)。结论血清HMGB1和ENA-78水平的变化与突发性耳聋病情严重程度密切相关。     

Sudden Cardiac Death in a Young Athlete: Imaging Techniques to Evaluate the Etiology

Anomalous aortic origin of the coronary artery (AAOCA) is a rare form of congenital heart disease with varying implications. Although most of the population with this congenital heart defect may remain completely asymptomatic and never know of the diagnosis, the risk of sudden cardiac death among healthy children and young adults during or just after exercise is significant. A previously healthy adolescent female athlete presented to the pediatric intensive care unit after sudden cardiac arrest on the playing field. She was successfully resuscitated, and further imaging revealed a diagnosis of AAOCA. She underwent surgical correction of her defect without complications. AAOCA remains a rare and often undetected form of congenital heart disease based on the asymptomatic nature of the defect; however, with proper imaging, a diagnosis can be made to allow for correct treatment.     

Audiological characteristics and exploratory treatment of a rare condition of acute-otitis-media-associated sudden sensorineural hearing loss

BACKGROUNDAcute otitis media (AOM) is a common disease that is more prevalent in children. Most studies concerning AOM-associated sudden sensorineural hearing loss are case reports and retrospective in nature, hence the etiology of AOM-associated sudden hearing loss has not been fully established.AIMTo analyze audiological characteristics of AOM-associated sudden hearing loss and evaluate efficacy of combined tympanostomy tube placement (TTP) and intratympanic methylprednisolone.METHODSEight adult patients who were diagnosed with AOM-associated sudden hearing loss and ineffectively treated by conventional medical therapy were enrolled in this study. Basic data were collected, and pure tone audiometry was performed to assess the audiological characteristics. Combination therapy with TTP and intratympanic methylprednisolone injection was given to the patients.RESULTSMixed or sensorineural hearing loss was observed at high frequencies (2–4 kHz). All the cases in this study were cured after TTP and intratympanic methylprednisolone. After treatment, the average hearing threshold at affected frequencies was significantly lower than those in the pretreatment group (P < 0.05) and was similar to that in the healthy ears (P > 0.05).CONCLUSIONAOM rarely induces sudden sensorineural hearing loss. Combination therapy with TTP and intratympanic methylprednisolone injection may be effective after failure of conventional medical treatment.     

针刺"内听宫"穴对突发性耳聋患者脑干听觉诱发电位的影响

目的观察突发性耳聋患者和正常耳针刺内听宫穴脑干听觉诱发电位( ABR)的变化,以确定该穴位治疗耳聋的作用. 方法 19例( 21耳)突聋患者 ,使用丹迪公司 2000型诱发电位仪 ,在铜网屏蔽状态下进行听觉脑干诱发电位检测,针刺内听宫穴 15 min,拔针后休息 5 min,再行 ABR检测,比较针刺前后 ABR的变化. 结果针刺正常耳"内听宫"穴,针刺前后 ABR的Ⅰ ,Ⅴ波潜伏期以及Ⅰ-Ⅴ波间期无显著性变化( P >0.05). 21耳突聋中 15耳针刺内听宫穴耳鸣减轻,甚至消失.耳闷减轻,听力提高.其中 5耳针刺前 ABR波形分化差,Ⅰ波或Ⅲ波消失,重复性差,针刺后其 ABR波形分化明显清晰,Ⅰ,Ⅲ,Ⅴ波均出现,且重复性好. 16耳突聋针刺前 ABR的Ⅰ波潜伏期( 2.00± 0.34) ms,Ⅴ波潜伏期 (6.04± 0.59)ms,ⅠⅤ波间期 (4.04± 0.57)ms,针刺后 ABR的Ⅰ波潜伏期 (1.77± 0.27)ms,Ⅴ波潜伏期 (5.79± 0.63)ms,ⅠⅤ波间期 (3.98± 0.58)ms,Ⅰ ,Ⅴ波潜伏期针刺前后比较差异有显著性意义( t=2.406,2.463,P< 0.05). 结论针刺内听宫穴能提高突聋患者耳蜗听神经以及外侧丘系桥脑的兴奋性和传导性.但对正常耳无影响,针刺该穴位可作为治疗突聋的方法之一.     

冠心病猝死的相关因素分析

目的探讨冠心病猝死的相关因素,为预防冠心病发生猝死以及提高抢救成功率提供帮助。方法对2002～2006年合江镇中心卫生院收治的冠心病发生猝死患者78例的临床资料进行收集整理,包括患病的诱因、心电图、超声心动图、24h心电图、胸片、心电监护、电解质等。结果冠心病患者发生猝死与电解质紊乱、Lown3～5级室性早博、高度房室传导阻滞、束支传导阻滞、心室扩大、左室肥厚、心功能不全、持续心肌缺血等可以触发致命性心律失常的的高危因素有关。猝死时起始心电图的类型及其演变过程、结局有相关性。结论早期预防、避免诱发因素、及时处理是预防以及提高冠心病猝死抢救成功率的关键。     

Ticrynafen and probenecid in hyperuricemic, hypertensive men.

In a double-blind crossover study of ticrynafen (TCN) and probenecid (PBC), 9 hypertensive, hyperuricemic men completed 12-wk courses of each drug. With a TCN dose of 125 mg daily, the fall in serum uric acid was prompt, dramatic, and lasting; it was equal to that after PBC, 500 or 1,000 mg daily. There was a small but significant early weight loss (diuresis) after TCN but no antihypertensive effect. Twelve days after resuming TCN for a proposed additional extension study 1 patient suffered acute, reversible bilateral ureteral obstruction, probably caused by sudden urinary uric acid precipitation.     

Hormone replacement therapy (HRT) for hyperlipidemia after menopause

Women are about 10 years older than men to suffer from ischemic heart disease(IHD) and they often experience a sudden rise in cholesterol after menopause. These phenomena are thought to be caused by the production of estrogen in women during normal menstruation cycle and its loss after menopause. Hormone replacement therapy(HRT) has been shown to reduce IHD by nearly 50 per cent. This is caused in part by effects of estrogen on lipid metabolism; it reduces LDL and Lp(a), and increases HDL. Although the first large prospective trial of HRT for secondary prevention of IHD failed to demonstrate estrogen's protective effects, HRT was effective in women with high Lp(a). Thus, selection of patients and HRT regimen seems important.     

Heparin-Induced extracorporeal low-density lipoprotein precipitation apheresis: a new therapeutic concept in the treatment of sudden hearing loss.

Vascular events, immunological processes, and viral infections have to be considered as pathomechanisms for most cases of sudden hearing loss (SHL). In order to clarify predisposing conditions for vascular events. hemorheological parameters have been studied in 53 patients suffering from SHL within 5 days of onset, along with a control group. The striking result was a significantly elevated level of plasma fibrinogen leading to a significantly increased erythrocyte aggregation and plasma viscosity. No significant difference could be found in all other parameters of clinical chemistry, hematology, and hemostasis. These results encouraged us to use heparin-induced extracorporeal low-density lipoprotein (LDL) precipitation (HELP) apheresis, which acutely and drastically reduces LDL. fibrinogen, and lipoprotein (a) in the treatment of patients suffering from sudden hearing loss and hyperfibrinogenemia or hypercholesterolemia. In a pilot study including 30 patients, we found a better recovery of hearing in the patients treated with a single HELP apheresis when compared to conventional treatment for 10 days with prednisolone and dextranes. Currently, we verify these results in a larger multicenter trial in patients regardless of their fibrinogen or LDL levels. In the future, there will be different specific treatments of sudden hearing loss based on the different pathomechanisms. The clinical impression and first controlled data make it likely that HELP apheresis is useful in the therapy of sudden hearing loss with suspected vascular origin.     

Electrolysis of Unipolar Pacing Leads

A 90-year-oJd man with bradycardia and Stokes-Adams attacks had a unipolar VVI pacemaker implanted. Twice within a short period of time we registered a total Joss of function: the first incident was caused by a "fracture" between lead and electrode, and the second was due to partial dissolving of the lead. Both times a new lead electrode was implanted; the second time we replaced the pulse generator as well. Pacemaker analysis showed a capacitor defect leading to a 50 microampere anodal DC leakage that caused electrolysis of the helical coil conductors. The patient had no clinical symptoms besides those due to loss of pacemaker function. The present case report and others in the literature indicate that when an electrode lead fracture is found, it is necessary to check the pacemaker for DC leakage.     

突发性耳聋患者的焦虑抑郁调查及护理

目的探讨焦虑、抑郁与突发性耳聋的关系。方法对突发性耳聋患者于入院时作状态焦虑量表（S—AJ）、抑郁自评量表（SDS）、一般资料的调查，统计数据采用方差分析和t检验。结果83．3％的患者存在不同程度的焦虑，本科以上与本科以下学历之间有统计学意义（P〈0．05）。不同性别、年龄段、费别的患者焦虑差别无统计学意义。36．7％的患者存在抑郁，不同学历、费别之间有统计学差异（P〈0．05），不同性别、年龄段之间无统计学意义。结论在心理疏导的基础上，针对性进行个体化护理对患者的痊愈起着重要的指导作用。     

突发性耳聋患者的焦虑抑郁调查及护理

目的探讨焦虑、抑郁与突发性耳聋的关系。方法对突发性耳聋患者于入院时作状态焦虑量表(S-AI)、抑郁自评量表(SDS)、一般资料的调查,统计数据采用方差分析和t检验。结果83.3%的患者存在不同程度的焦虑,本科以上与本科以下学历之间有统计学意义(P<0.05)。不同性别、年龄段、费别的患者焦虑差别无统计学意义。36.7%的患者存在抑郁,不同学历、费别之间有统计学差异(P<0.05),不同性别、年龄段之间无统计学意义。结论在心理疏导的基础上,针对性进行个体化护理对患者的痊愈起着重要的指导作用。     

Unilateral sudden sensorineural hearing loss with vertigo as a first symptom of bilateral internal auditory canal metastases: a case report

There have been relatively few reports of bilateral internal auditory canal metastases of asymptomatic primary pulmonary adenocarcinoma presenting as unilateral sudden sensorineural hearing loss and vertigo. We report a case of a 60-year-old male patient who complained of sudden hearing loss in the right ear and vertigo. Upon a physical examination, no definite neurological signs or nystagmus were observed. Pure-tone audiometry showed deafness in the right ear at all frequencies and high-frequency sensorineural hearing loss in the left ear. The video head impulse test suggested bilateral vestibulopathy. Magnetic resonance imaging of the brain (with gadolinium contrast) revealed bilateral internal auditory canal enhancement and a variable-sized nodular and peripheral-enhancing lesion in the cerebrum and the right cerebellum. A computed tomographic and bronchoscopic biopsy identified asymptomatic primary pulmonary adenocarcinoma in the left upper lobe of the lungs. This is a rare report of bilateral internal auditory canal metastases in an asymptomatic patient with primary pulmonary adenocarcinoma who initially presented with symptoms of unilateral sudden sensorineural hearing loss with vertigo.     

Insulin receptor down-regulation is linked to an insulin-induced postreceptor defect in the glucose transport system in rat adipocytes.

We have examined the relationship between insulin-induced receptor downregulation and the induction of a postreceptor defect in the insulin-stimulated glucose transport system in rat adipocytes, and found that downregulation was linked to the expression of the postreceptor defect. When recycling of insulin receptors was inhibited by 20 mM Tris, insulin pretreatment (100 ng/ml) for 4 h at 37 degrees C induced both net loss (65%) of cell-surface receptors and a 63% decrease in maximal insulin responsiveness. In contrast, when cells were treated with insulin alone for 4 h at 37 degrees C so that receptors could recycle, or treated at 16 degrees C with Tris plus insulin to inhibit receptor internalization, neither receptor downregulation nor a postreceptor defect was observed. Induction of the postreceptor defect was specific for insulin under conditions when downregulation would occur, since treatment of cells with Tris and the insulin mimicker spermine did not result in receptor loss or the postreceptor defect. Other experiments revealed that receptor downregulation occurred first without loss of insulin responsiveness, but, once the postreceptor defect appeared, its severity was correlated to the degree of further receptor loss, as a function of insulin dose and exposure time. Tris (20 mM) alone acutely decreased maximally stimulated glucose transport rates slightly (22%), but this effect was rapidly reversible after Tris removal and could not have been directly responsible for the lasting and profound postreceptor defect seen after pretreatment with insulin plus Tris. Taken together, these data suggest that insulin-induced receptor loss is linked to the induction of the postreceptor defect. The postreceptor defect was due to an inability to maximally increase the maximum velocity of glucose transport. Furthermore, the expression of the postreceptor defect depended upon the extent to which the glucose transport system was allowed to deactivate; maintaining the glucose transport system in an activated state prevented its expression. Thus, the mechanism could involve rapid inactivation or sequestration of glucose transporters during deactivation such that they become refractory to the subsequent stimulatory effects of insulin. In conclusion, (a) insulin does not acutely induce a postreceptor defect in the glucose transport system of adipocytes without loss of cell-surface insulin receptors; (b) the defect in stimulated glucose transport has been induced distal to the insulin receptor via a mechanism linked to receptor loss; and (c) the postreceptor lesion is due to decreased number of intrinsic activity of glucose transporters on the cell-surface in the presence of a maximally effective insulin concentration. These data suggest that insulin receptor downregulation and postreceptor defects in insulin action, which frequently co-exist both in vivo and in vitro, may be linked mechanistically.     

突发性聋患者心理状况调查及对护理的提示

目的调查和分析突发性聋患者存在的心理问题,并探讨相关的护理问题。方法对100例突发性聋患者进行症状自评量表(SCL-90)评定,与100例耳鼻喉科其他疾病患者进行比较。结果突发性聋患者症状自评量表中焦虑、恐怖、抑郁、躯体化4因子的得分高于对照组(P相似文献   

Branch retinal artery occlusion: a complication of iron-deficiency anemia in a young adult with a rectal carcinoid

We report a case of branch retinal artery occlusion (BRAO) in a patient with iron-deficiency anemia. Various ophthalmological and laboratory studies were performed. A 32-year-old man had a sudden decrease of vision in his left eye to counting fingers at 30 cm two days ago. The left fundus showed a cherry-red spot and milky-white edema, except for the upper temporal region of the macula, and an optic disc malformation. Fluorescein angiography revealed leakage from the disc and a slightly delayed filling time in the left eye but an arterial filling defect was not noted. The differential diagnosis in this young patient includes polycythemia, hypercoagulopathy, coagulation abnormalities, trauma, hypertension, and autoimmune diseases such as systemic lupus erythematosus. Laboratory examinations revealed no abnormalities except for iron-deficiency anemia. The patient was treated with stellate ganglion block, hyperbaric oxygen, and ferrous sulfate. His visual acuity never recovered to better than 0.08. He had a coincidental rectal carcinoid and the tumor was excised surgically. No metastasis was observed. BRAO can be a complication of anemic retinopathy and can lead to severe visual loss without early medication.