Change laws of water absorption in Chinese herbal pieces and prediction model of relative density for Chinese medicine decoction / 中国中药杂志

This study aims to explore the change laws of water absorption in Chinese herbal pieces and establish the prediction model of relative density for Chinese medicine compound decoction. Firstly, fitted equations of water absorption and decocting time was established by observing the change laws of water absorption in 36 kinds of Chinese herbal pieces in 12 groups(according to the drug-parts) with decocting time. The r value of the mineral group and other type group was 0.691 2 and 0.663 3, respectively. The r value of the remaining 10 groups was 0.802 2-0.925 4. All P values were less than 0.05(n=21). The formula of the amount of water added was optimized by combining the fitted equations with determined water absorption, and the liquid yield could be controlled in a range of 100%±10%. Secondly, it was determined that the liquid density tester could be used for the rapid determination of relative density of Chinese medicine decoction after methodological study and comparison with the pycnometer method. The linear regression equation between the corrected relative density(y) and extraction ratio(%, x) was built by measuring and analyzing the related parameters such as liquid yield, relative density and extraction ratio in 46 kinds of Chinese herbal pieces. The established equation was y=0.041 3x+1.003 7, r=0.930 9(P <0.01, n=46), with linear range of 1.94%-65.75%. Based on this, the prototype model for predicting relative density of Chinese medicine decoction was established, and the relative densities of 8 Chinese medicine decoctions were within the prediction interval of this model in verification. This study lays a foundation for database construction of Chinese medicine decoction, implementation of personalized decocting mode and rapid quality control of Chinese medicine decoction.

Development of objective indicators for quantitative analysis of sodium intake: the sodium to potassium ratio of second-void urine is correlated with 24-hour urinary sodium excretion

Sub-morbid dehydration-associated glomerular hyperfiltration: An emerging reality?

BACKGROUND: Severe dehydration decreases renal perfusion. However, it is unclear whether sub-morbid dehydration affects kidney function similarly. Although there have been numerous animal and human studies that have suggested mild dehydration is associated with glomerular hyperfiltration, it has not been confirmed on a large-scale in the general population. Therefore, we aimed to identify the relationship between hydration status and kidney function. METHODS: We reviewed the data of 28,342 adults who participated in the Korea National Health and Nutrition Examination Surveys. Urine specific gravity unit (SGU) was the primary variable that indicated hydration status, and the estimated glomerular filtration rate (eGFR) was used as the primary outcome. RESULTS: Multivariate linear regression analysis showed urine SGU was positively associated with eGFR, which was J-shaped in the multivariate generalized additive model plot. In the penalized spline curve analysis, the odds ratio for high eGFR was steadily increased. Although increased urine SGU was associated with decreased blood pressure and pulse rate, it had no effect on increased fasting glucose and total cholesterol, suggesting conflicting cardio-metabolic dehydration effects. CONCLUSION: Dehydration, presumably sub-morbid in an ambulatory community-dwelling general population, is associated with higher kidney function. The clinical significance of sub-morbid dehydration-associated glomerular hyperfiltration needs further investigation.

Progress in Automated Urinalysis

New technological advances have paved the way for significant progress in automated urinalysis. Quantitative reading of urinary test strips using reflectometry has become possible, while complementary metal oxide semiconductor (CMOS) technology has enhanced analytical sensitivity and shown promise in microalbuminuria testing. Microscopy-based urine particle analysis has greatly progressed over the past decades, enabling high throughput in clinical laboratories. Urinary flow cytometry is an alternative for automated microscopy, and more thorough analysis of flow cytometric data has enabled rapid differentiation of urinary microorganisms. Integration of dilution parameters (e.g., creatinine, specific gravity, and conductivity) in urine test strip readers and urine particle flow cytometers enables correction for urinary dilution, which improves result interpretation. Automated urinalysis can be used for urinary tract screening and for diagnosing and monitoring a broad variety of nephrological and urological conditions; newer applications show promising results for early detection of urothelial cancer. Concomitantly, the introduction of matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS) has enabled fast identification of urinary pathogens. Automation and workflow simplification have led to mechanical integration of test strip readers and particle analysis in urinalysis. As the information obtained by urinalysis is complex, the introduction of expert systems may further reduce analytical errors and improve the quality of sediment and test strip analysis. With the introduction of laboratory-on-a-chip approaches and the use of microfluidics, new affordable applications for quantitative urinalysis and readout on cell phones may become available. In this review, we present the main recent developments in automated urinalysis and future perspectives.

Annual Report of the Korean Association of External Quality Assessment Service on Urinalysis and Fecal Occult Blood Testing (2018)

In 2018, external quality assessment trials for urinalysis and fecal occult blood (FOB) were performed using 1,590 participants. Urine chemistry tests were performed thrice while urine sediment and FOB tests twice. Urine chemistry tests comprised of pH, protein, glucose, ketone body, bilirubin, blood, urobilinogen, nitrite, leukocyte, and specific gravity analyses. The results of urine chemistry and specific gravity tests showed accuracy rates >95%, except for the pH test. The accuracy rate of urine sediments was low, especially for atypical calcium oxalate crystal and red blood cell cast. In the FOB quality test, reagents showed accuracy rates >90%, except for SD and GC Genedia FOB reagents. In the FOB quantitative test, Alfresa NS-Plus C instrument showed falsely high values in the FOB negative specimens.

Evaluation des facteurs de gravité d'une péritonite aigue dans les vingt-quatre premières heures en réanimation des urgences CHU-Joseph Ravoahangy Andrianavalona

Introduction : La péritonite aigue est une urgence diagnostique et thérapeutique. Des scores de gravité élaborés permettent de déterminer sa gravité. L'objectif de notre étude est de déterminer les facteurs de gravité de cette pathologie afin d'établir un score adapté à notre situation. Méthode : C'est une étude prospective, descriptive et analytique, réalisée au sein de l'Unité Réanimation des Urgences du CHU-JRA, durant une période de trois mois, sur tous les patients en péritonite aigue âgés de plus de 15ans, évalués pendant 24 heures. Résultats : Quarante-quatre patients colligés avec un sex ratio de 2,7, un âge moyen de 36,7 ans et une majorité d'ASA I (68,2%). Un sepsis est notée dans 50% des cas ; sévère et associé à une défaillance rénale dans près de 25% des cas. La péritonite est secondaire dans la totalité des cas à une lésion digestive (65,9%) et généralisée dans 77,4% des cas. Le délai d'admission est de moins de 12heures dans 40,9% des cas. L'Apport hydro électrolytique moyen est de 1700 ml et la tri-antibiothérapie est administrée dans 93,2% des cas. La chirurgie est réalisée dans un délai de moins de 6 heures dans 75% des cas. Le transfert en Réanimation chirurgicale est de 45,4%. L'ASA, la FR, la FC, La PAM, le GCS, la présence de pneumopéritoine à l'ASP et le délai d'admission sont les facteurs prédictifs de gravité à H24 des patients présentant une péritonite aigue. Conclusion : Un score de gravité des premières 24 heures basé sur des facteurs cliniques est à établir dans un protocole de prise en charge des péritonites aigues en Réanimation

Heartwood and sapwood in eucalyptus trees: non-conventional approach to wood quality

ABSTRACT This study evaluated the quality of heartwood and sapwood from mature trees of three species of Eucalyptus, by means of the qualification of their proportion, determination of basic and apparent density using non-destructive attenuation of gamma radiation technique and calculation of the density uniformity index. Six trees of each species (Eucalyptus grandis - 18 years old, Eucalyptus tereticornis - 35 years old and Corymbia citriodora - 28 years old) were used in the experimental program. The heartwood and sapwood were delimited by macroscopic analysis and the calculation of areas and percentage of heartwood and sapwood were performed using digital image. The uniformity index was calculated following methodology which numerically quantifies the dispersion of punctual density values of the wood around the mean density along the radius. The percentage of the heartwood was higher than the sapwood in all species studied. The density results showed no statistical difference between heartwood and sapwood. Differently from the density results, in all species studied there was statistical differences between uniformity indexes for heartwood and sapwood regions, making justifiable the inclusion of the density uniformity index as a quality parameter for Eucalyptus wood.

Annual Report on the External Quality Assessment Scheme for Urinalysis and Fecal Occult Blood Testing in Korea (2017)

In 2017, external quality assessment trials for urinalysis and fecal occult blood (FOB) were performed with 1,544 participants. Urine chemistry tests were performed three times and urine sediment and FOB tests were evaluated 2 times. Urine chemistry tests consisted of pH, protein, glucose, ketone, bilirubin, blood, urobilinogen, nitrite, leukocyte, and specific gravity analyses. The results of the urine chemistry and specific gravity tests showed accuracy rates >95%. The accuracy rate of urine sediments was low, especially for fat droplets and atypical uric acid crystals. In the FOB quality test, all reagents showed accuracy rates >82%, which suggested the persistent improvement of false-positive reactions. In the FOB quantitative test, discrepant results depending on the instrument used were observed. To compensate for the result differences caused by the amounts of stool samples, the results should be reported using another unit (µg/g of stool).

Exploratory Study of the Prevalence of Major Chronic Disease According to Daily Water Intake and Physiological Parameters related to Dehydration in Korean Elderly: Based on the Sixth Korea National Health and Nutrition Examination Survey (2015)

PURPOSE: The aim of this study was to explore the prevalence of major chronic diseases related to daily oral water intake and to identify the physiological parameters related to dehydration in Korean elderly. METHODS: The data were collected from the sixth Korea Health and Nutrition Examination Survey (KHANES), which was a nationwide and cross-sectional survey in 2015. We analyzed 1,392 participants using t-test and logistic regression. All participants were divided into the adequate water intake (AWI) group and the non-adequate water intake (NAWI) group based on the dietary reference intakes for Koreans. RESULTS: There was a significant difference in the water intake between the AWI (6.8 cups in a day) and NAWI (2.8 cups) groups (p < .001). There was no statistically significant association between the level of water intake and any of the major chronic diseases. Blood urea nitrogen (BUN) and BUN/Creatinine (Cr) ratio were significantly higher in the NAWI group. Especially, BUN/Cr ratio shows that the NAWI group reached dehydration status. Older age (adjusted odd ratio, OR=1.07, 95% confidence interval, CI [1.04–1.10]), female gender (adjusted OR=1.56, 95% CI [1.05–2.33]), lower body mass index (BMI) (adjusted OR=1.00, 95% CI [0.92–1.00]), higher BUN (adjusted OR=1.04, 95% CI [1.01–1.08]), and higher urine specific gravity (USG) (adjusted OR=1.56, 95% CI [1.19–2.05]) were factors associated with the NAWI group. CONCLUSION: The findings suggest that the level of water intake needs to be considered in relation to age, gender, BMI, BUN, and USG. These are sensitive physiological parameters used for predicting dehydration of the elderly according to their daily oral water intake. It would be helpful to develop strategies to prevent dehydration in elderly individuals and enhance their water intake.

Analysis of the Absorbance Pattern of Postmortem Blood Sample Using Spectrometer / 대한법의학회지

The diagnosis of cause of death (COD) or estimation of postmortem interval (PMI) is hard to perform using postmortem blood or other bodily fluids due to various biochemical changes that occur during the agonal phase or after death. To solve these problems, new paradigms and new analytical methods are needed. In this study, postmortem blood was fractionated with specific gravity 1.021, 1.029, 1.038, and 1.045, and the absorbance patterns of each sample of the 131 total cases (12 kinds of COD) were analyzed using a spectrometer. The absorbance was grouped into 9 patterns (ABS pattern 1 to 9) according to the wave length and the signal intensity. These patterns of postmortem blood were found to be distinctly different from the absorbance pattern of fresh blood. The analysis of ABS patterns is useful for the diagnosis of deaths due to acute or rapid bleeding, fire death, drowning and, in some cases, poisoning, but is not useful for the estimation of PMI.

Annual Report on the External Quality Assessment Scheme for Urinalysis and Faecal Occult Blood Testing in Korea (2016)

In 2016, external quality assessment trials for urinalysis and faecal occult blood (FOB) were performed with 1,487 participants in Korea. Urine chemistry and FOB tests were performed three and two times, respectively, whereas urine sediment was evaluated once using photography. Urine chemistry tests consisted of pH, protein, glucose, ketone, bilirubin, blood, urobilinogen, and nitrite levels; leukocyte count; specific gravity. The results of the urine chemistry and specific gravity tests showed accuracy rates of >95%. The accuracy rate of urine sediments was low, especially that for transitional epithelial cells and atypical crystals. In the FOB quality test, all reagents showed accuracy rates of >90%, which suggested the improvement of false-positive reaction. In the FOB quantitative test, discrepant results depending on the instrument used was observed. To compensate for the result differences caused by the stool samples, the results should be reported using another unit (µg/g of stool).

Occupational Heat Stress Impacts on Health and Productivity in a Steel Industry in Southern India

BACKGROUND: Workers laboring in steel industries in tropical settings with high ambient temperatures are subjected to thermally stressful environments that can create well-known risks of heat-related illnesses and limit workers’ productivity. METHODS: A cross-sectional study undertaken in a steel industry in a city nicknamed “Steel City” in Southern India assessed thermal stress by wet bulb globe temperature (WBGT) and level of dehydration from urine color and urine specific gravity. A structured questionnaire captured self-reported heat-related health symptoms of workers. RESULTS: Some 90% WBGT measurements were higher than recommended threshold limit values (27.2–41.7°C) for heavy and moderate workloads and radiational heat from processes were very high in blooming-mill/coke-oven (67.6°C globe temperature). Widespread heat-related health concerns were prevalent among workers, including excessive sweating, fatigue, and tiredness reported by 50% workers. Productivity loss was significantly reported high in workers with direct heat exposures compared to those with indirect heat exposures (χ2 = 26.1258, degrees of freedom = 1, p < 0.001). Change in urine color was 7.4 times higher among workers exposed to WBGTs above threshold limit values (TLVs). CONCLUSION: Preliminary evidence shows that high heat exposures and heavy workload adversely affect the workers’ health and reduce their work capacities. Health and productivity risks in developing tropical country work settings can be further aggravated by the predicted temperature rise due to climate change, without appropriate interventions. Apart from industries enhancing welfare facilities and designing control interventions, further physiological studies with a seasonal approach and interventional studies are needed to strengthen evidence for developing comprehensive policies to protect workers employed in high heat industries.

The Efficacy of Fibroblast Growth Factor for the Treatment of Chronic Vocal Fold Scarring: From Animal Model to Clinical Application

OBJECTIVES: This study assessed the regenerative efficacy of basic fibroblast growth factor (FGF) in a rabbit model of chronic vocal fold scarring and then confirmed its utility and safety in a prospective trial of patients with this condition. METHODS: FGF was injected three times, at 1-week intervals, into a chronic vocal fold scar created in a rabbit model. After 1 month, mRNA level of procollagen I, hyaluronic acid synthetase 2 (HAS 2), and matrix metalloproteinase 2 (MMP 2) were analyzed by real-time polymerase chain reaction. The relative densities of hyaluronic acid (HA) and collagen were examined 3 months post-injection. From April 2012 to September 2014, a prospective clinical trial was conducted at a tertiary hospital in Korea. FGF was injected into the mild vocal fold scar of 17 consecutive patients with a small glottic gap. The patients underwent perceptual, stroboscopic, acoustic aerodynamic test, and Voice Handicap Index (VHI) survey prior to and 3, 6, and 12 months after FGF injection. RESULTS: FGF injection of the vocal fold scar decreased the density of collagen and increased mRNA level of HAS 2 and MMP 2 expression significantly compared to the control group injected with phosphate buffered solution in a rabbit model (P < 0.05). In the clinical trial, significant improvements in the majority of the subjective and objective voice parameters were registered 3 months after FGF injection and were maintained at 12 months. Complications associated with the FGF injections, such as granuloma, were not observed during the follow-up period. CONCLUSION: Based on the animal model and the prospective clinical trial, vocal fold injections of FGF in patients with mild chronic vocal fold scarring can significantly improve voice quality for as long as 1 year and without side effects. Our results recommend the use of FGF vocal fold injection as an alternative treatment modality for mild chronic vocal fold scarring.

Factors Associated with Postoperative Diabetes Insipidus after Pituitary Surgery

BACKGROUND: Determining risk factors for diabetes insipidus (DI) after pituitary surgery is important in improving patient care. Our objective is to determine the factors associated with DI after pituitary surgery. METHODS: We reviewed records of patients who underwent pituitary surgery from 2011 to 2015 at Philippine General Hospital. Patients with preoperative DI were excluded. Multiple logistic regression analysis was performed and a predictive model was generated. The discrimination abilities of the predictive model and individual variables were assessed using the receiving operator characteristic curve. RESULTS: A total of 230 patients were included. The rate of postoperative DI was 27.8%. Percent change in serum Na (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.15 to 1.69); preoperative serum Na (OR, 1.19; 95% CI, 1.02 to 1.40); and performance of craniotomy (OR, 5.48; 95% CI, 1.60 to 18.80) remained significantly associated with an increased incidence of postoperative DI, while percent change in urine specific gravity (USG) (OR, 0.53; 95% CI, 0.33 to 0.87) and meningioma on histopathology (OR, 0.05; 95% CI, 0.04 to 0.70) were significantly associated with a decreased incidence. The predictive model generated has good diagnostic accuracy in predicting postoperative DI with an area under curve of 0.83. CONCLUSION: Greater percent change in serum Na, preoperative serum Na, and performance of craniotomy significantly increased the likelihood of postoperative DI while percent change in USG and meningioma on histopathology were significantly associated with a decreased incidence. The predictive model can be used to generate a scoring system in estimating the risk of postoperative DI.

Performance Evaluation of the CLINITEK Novus Automated Urine Chemistry Analyzer

BACKGROUND: We aimed to evaluate the performance of the CLINITEK Novus urine chemistry analyzer (Siemens, UK). METHODS: The precision, correlation, and carryover study were performed using two kinds of commercial quality control materials and 40-55 freshly collected patient specimens. We calculated exact and within-1-block agreement, along with kappa agreement, to compare the semi-quantitative results between urine chemistry analyzers. The urine specific gravity taken by a refractometer was compared with the analyzer results. Moreover, we analyzed additional urine specimens for protein to evaluate the agreement of results between those of the CLINITEK Novus and the AU680 analyzers (Beckman Coulter, Japan). RESULTS: The precision study showed acceptable results; within-1-block agreement was 100% in all tested items. The urine chemistry results from the CLNITEK Novus analyzer demonstrated ≥85.1% within-1-block agreements with those of the Uriscan Super, and the kappa test results were ≥0.81. The comparison of specific gravity with manual refractometer showed a good correlation (r=0.991), and the protein comparison with the AU680 analyzer also showed a good correlation (with exact and within-1-block agreements being 75.9% and 100.0%, respectively). The carryover rates were 0% in all tested items, except specific gravity and heavy blood tests. CONCLUSIONS: The CLINITEK Novus analyzer showed good performance in terms of precision, comparison, and carryover in this study. Therefore, the CLINITEK Novus automated urine analysis is expected to be useful for routine urinalysis in a clinical laboratory.

Deficiency of antidiuretic hormone: a rare cause of massive polyuria after kidney transplantation / 소아과

A 15-year-old boy, who was diagnosed with Alport syndrome and end-stage renal disease, received a renal transplant from a living-related donor. On postoperative day 1, his daily urine output was 10,000 mL despite normal graft function. His laboratory findings including urine, serum osmolality, and antidiuretic hormone levels showed signs similar to central diabetes insipidus, so he was administered desmopressin acetate nasal spray. After administering the desmopressin, urine specific gravity and osmolality increased abruptly, and daily urine output declined to the normal range. The desmopressin acetate was tapered gradually and discontinued 3 months later. Graft function was good, and urine output was maintained within the normal range without desmopressin 20 months after the transplantation. We present a case of a massive polyuria due to transient deficiency of antidiuretic hormone with the necessity of desmopressin therapy immediately after kidney transplantation in a pediatric patient.

Annual Report on the External Quality Assessment Scheme for Urinalysis and Faecal Occult Blood Testing in Korea (2015)

In Korea, external quality assessment trials for urinalysis and faecal occult blood (FOB) were performed for 1,250 participants. Urine chemistry and FOB tests were evaluated three times, whereas urine sediment by photography was evaluated twice. Urine chemistry tests consisted those for pH, protein, glucose, ketone, bilirubin, blood, urobilinogen, nitrite, leukocyte, and specific gravity. The results of the urine chemistry and specific gravity tests showed accuracy rates >95%. In the FOB quality test, all reagents showed false-positive results. These reagents showed positive results in stool specimens containing >11 ng/mL haemoglobin. In the FOB quantitative test, the results were significantly different, based on the instrument used for the measurements. The average accuracy rate of urine sediments was 90.8%, whereas those for renal epithelial cells and cholesterol crystals were 83%.

Alteración emocional en atención primaria y urgencias pediátricas. ¿Se enfadan los padres durante la atención pediátrica? / Emotional alteration in Primary Health Care and paediatric emergencies. Do parents get angry during paediatric care?

En el presente trabajo nos proponemos estudiar la presencia de ansiedad e ira en atención pediátrica, explorando posibles diferencias entre atención primaria y urgencias pediátricas. Es objetivo adicional determinar cuáles de las variables estudiadas predicen en mayor grado ansiedad en la muestra de progenitores estudiados. En este estudio participaron un total de 1517 progenitores cuyos hijos habían sido atendidos en servicios de pediatría. El método se basa en un estudio descriptivo transversal mediante encuesta, donde los participantes contestaron el Inventario de Expresión de Ira Estado-Rasgo (STAXI-2) y el Inventario de Ansiedad Estado-Rasgo de Spielberger (STAI). Nuestros resultados indican una asociación significativa entre ansiedad y las diferentes dimensiones de ira consideradas, y también con el nivel de gravedad percibido por los padres en el estado de salud del menor. De las dimensiones de ira consideradas, la expresión como sentimiento es la que más predice la presencia de ansiedad en los padres. Las alteraciones emocionales en contextos de atención sanitaria pediátrica deben ser prevenidas, detectadas cuando ocurren y atendidas de manera eficaz para evitar consecuencias negativas de diverso tipo.

A study was conducted in order to determine the presence of anxiety and anger in paediatric health care, exploring possible differences between primary health care and paediatric emergencies. The study also sought to determine which of the variables studied better predict anxiety in the sample of parents studied. A total of 1.517 parents whose children had been attended in paediatric department participated in this study. The method was based on a cross-sectional descriptive study using a questionnaire, where all the participants answered the State-Trait Anger Expression Inventory and the Spielberger State-Trait Anxiety Inventory. The results indicate a significant association between anxiety and both the considered dimensions of anger and the level of severity perceived by parents in the child's health status. From the anger dimensions considered, anger as a feeling is the most predictive expression of parental anxiety. Emotional alterations in paediatric health care settings should be prevented, detected when they occur, and effectively treated to avoid different negative consequences.

Predictors of early neurological deterioration in patients with acute ischaemic stroke with special reference to blood urea nitrogen (BUN)/creatinine ratio & urine specific gravity.

Background & objectives: Early neurological deterioration (END) occurs in about 20 to 40 per cent of patients with acute ischaemic stroke and results in increased mortality and functional disability. In recent studies relative dehydration has been found to be associated with END in patients with acute ischaemic stroke. This study was conducted to identify factors useful for predicting END and to assess the role of blood urea nitrogen/creatinine ratio (BUN/creatinine) and urine specific gravity (USG) as predictors of END in patients with acute ischaemic stroke. methods: The present study was an observational prospective study. Various parameters comprising demographic, clinical, laboratory and radiological variables along with stroke severity were assessed and studied as predictors of early neurological deterioration in 114 consecutive patients presenting to the Emergency department during 2012. BUN/creatinine >15 and USG >1.010 were studied as markers of relative dehydration contributing to END. results: of the 114 patients enrolled in the study, END was observed in 25 (21.9%) patients. National Institutes Health Stroke Scale score (NIHSS) ≥ 12 at admission was found to be an independent risk factor for END. Amongst markers of relative dehydration, BUN/creatinine >15 at admission was found to be an independent risk factor for END, as also USG >1.010. Also, cerebral oedema and size of hypodensity >1/3rd of the middle cerebral artery territory on cranial CT were observed to be independent risk factors for END. Interpretation & conclusions: Our study findings highlighted a possible association of relative dehydration, as indicated by BUN/creatinine ratio >15, with END along with other parameters like stroke severity at presentation, extent of hypodensity >1/3rd of the middle cerebral artery (MCA) territory and cerebral oedema. Dehydration being a treatable condition, the use of BUN/creatinine >15 as a marker of relative dehydration, can be helpful in detecting patients with dehydration early and thus play a role in preventing END.

Persistent Positional Vertigo in a Patient with Sudden Sensorineural Hearing Loss: A Case Report

Because inner ear organs are interconnected through the endolymph and surrounding endolymphatic membrane, the patients with sudden sensorineural hearing loss (SSNHL) often complain of vertigo. In this study, we report a patient with SSNHL accompanied by persistent positional vertigo, and serial findings of head-roll tests are described. At acute stage, head-roll test showed persistent geotropic direction-changing positional nystagmus (DCPN), which led to a diagnosis of SSNHL and ipsilateral light cupula. Although vertigo symptom gradually improved, positional vertigo lasted for more than 3 weeks. At this chronic stage, persistent apogeotropic DCPN was observed in a head roll test, which led to a diagnosis of the heavy cupula. Although the mechanism for the conversion of nystagmus direction from geotropic to apogeotropic persistent DCPN is unclear, the change of specific gravity of the endolymph might be one of the plausible hypothetical explanations.