[Changes in PT and APTT When Administrating Rivaroxaban, a Direct Inhibitor of Activated Factor X].

The effects of oral rivaroxaban (RX), a direct inhibitor of activated factor X (Xa), on prothrombin time (PT) and activated partial thromboplastin time (APTT) were examined. PT and APTT before and after administration of 15 mg RX in 10 healthy subjects were measured by using various reagents. In addition, the blood Xa inhibitor concentration was measured and its correlation with PT and APTT, as measured by each reagent, was examined. Furthermore, the relationship (sensitivity) between the prolongation ratio and FX activity was evaluated. Prolongation of both PT and APTT was observed after RX administration, and maximal prolongation was observed four hours after administration for each reagent. The prolongation ratio was different among the reagents used for examination, and the reagent with the highest sensitivity to FX and factor VII showed the largest prolongation ratio. PT and APTT were positively correlated with RX concentration when measured by any reagent. In this study, neither PT, APTT, nor RX concentration returned to the values measured prior to dosing even at 24 hours after administration of RX. Our results suggest that approximate concentration of remaining RX may be estimated by PT (second) when using a reagent showing a larger prolongation ratio.

Validation of homogeneous assays for HDL-cholesterol using fresh samples from healthy and diseased subjects.

BACKGROUND: High-density lipoprotein-cholesterol (HDL-C) is a negative risk factor for cardiovascular events. Although several homogeneous HDL-C assays are available, their accuracy has not been validated, particularly in subjects with disease. We aimed to clarify whether HDL-C concentrations measured by homogeneous assays [HDL-C (H)] agree with those determined by the reference measurement procedures [HDL-C (RMP)] using ultracentrifugation and precipitation with heparin-manganese reagent in fresh clinical samples. METHODS: HDL-C concentrations in samples from 48 healthy subjects and 119 subjects with disease were determined using 12 homogeneous assays and RMPs. RESULTS: All reagents showed excellent intra- and inter-assay CVs (<2.23%) for two pooled sera. Furthermore, the mean bias was within ± 1.0% in nine reagents using samples from healthy subjects and in eight reagents using samples from subjects with disease. In a single HDL-C (H) determination, the total error requirement of the National Cholesterol Education Program (95% of results < 13%) was fulfilled in nine reagents using samples from healthy subjects and six reagents in those from subjects with disease. Error component analysis revealed that only one reagent exceeded ± 10% total error in samples from healthy subjects, whereas four reagents exceeded this error in samples from subjects with disease. Correlations between HDL-C (H) and HDL-C (RMP) revealed that the slopes were within 1.00 ± 0.06 in six reagents in healthy subjects, and eight reagents in subjects with disease. CONCLUSIONS: Except for three reagents, HDL-C (H) agrees well with HDL-C (RMP) in subjects with common disease, but not in those with extremely low HDL-C or abnormal HDL composition.

Usefulness of gram-stained sputum obtained just after administration of antimicrobial agents as the earliest therapeutic indicator for evaluating the effectiveness of empiric therapy in community-acquired pneumonia caused by pneumococcus or Moraxella catarrhalis.

We present here three cases in which morphological changes and/or a decreased number of Streptococcus pneumoniae or Moraxella catarrhalis could be observed in gram-stained sputum obtained just after the first administration of an antimicrobial agent. Case 1 was a 53-year-old man with pneumonia caused by gram-positive diplococcus, identified as S. pneumoniae, who was administered 2 g of ampicillin over a period of 1 h. Gram-stained sputum showed smaller or gram-negative pneumococci at the completion of administration of the agent, a decreased number of cocci at 1 h after administration, and almost no cocci at 12 h after the completion of administration. Case 2 was a 72-year-old woman with pneumonia caused by diplococcus, identified as S. pneumoniae, who was administered 2 g of ampicillin over a period of 1 h. Gram-stained sputum showed weakly stained, small cocci at the completion of administration of the agent and few cocci at 1 h after the completion of administration. Case 3 was a 58-year-old woman with pneumonia caused by a gram-negative diplococcus, identified as Moraxella catarrhalis, who was administered 1 g of cefotaxime over a period of 30 min. Gram-stained sputum showed few extracellular cocci and some intracellular cocci inside neutrophils 1 h after administration and no cocci 2 h after the completion of administration. These three cases showed that gram-stained sputum obtained just after and/or 1 h after administration of the first antimicrobial agent were suitable as the quickest therapeutic indicator of the effectiveness of empiric therapy, with the effectiveness of the agent being shown much earlier than with markers such as the white blood cell count and C-reactive protein level.

A multicenter study on the precision and accuracy of homogeneous assays for LDL-cholesterol: comparison with a beta-quantification method using fresh serum obtained from non-diseased and diseased subjects.

BACKGROUND: Homogeneous assays for low-density lipoprotein-cholesterol (LDL-C) have good precision and are pretreatment-free procedures. However, their accuracies have been questioned, especially in diseased subjects. In this study, we aimed to verify whether LDL-C levels determined by homogeneous assays [LDL-C (H)] agree with those determined by a beta-quantification method [LDL-C (BQ)] in fresh clinical samples. METHODS: We determined LDL-C levels in 49 non-diseased and 124 diseased subjects whose triglyceride (TG) levels were less than 11.29 mmol/L (1000 mg/dL) using 12 homogeneous assays and a BQ method simultaneously. RESULTS: In total, 30.6% of non-diseased subjects and 46.0% of diseased subjects were in the postprandial state. The maximum inter- and intra-assay CVs were 1.8% and 1.5%, and 8 reagents had a CV of 1.0% or less. The mean bias ranged from -0.5% to 1.8% for non-diseased subjects and from -0.7% to 1.6% for diseased subjects. For non-diseased subjects, all but one reagent achieved the National Cholesterol Education Program (NCEP) total error requirement in more than 90% of samples. However, for diseased subjects, the number of reagents that met this requirement was low. With some reagents, LDL-C (H) was higher than LDL-C (BQ), especially in subjects with hypertriglyceridemia. While for other reagents, the difference between the two methods was not associated with hypertriglyceridemia except for type I (n = 2) and type III hyperlipidemia (n = 1). Postprandial sampling was not the main factor for discordant results. CONCLUSIONS: LDL-C (H) agrees with LDL-C (BQ) in non-diseased subjects, but exhibits positive bias for subjects with hypertriglyceridemia in diseased subjects for some reagents.

Case of Mycobacterium tuberculosis meningitis: Gram staining as a useful initial diagnostic clue for tuberculous meningitis.

A 32-year-old man was admitted to our hospital because of fever, headache, and loss of consciousness. Four days before admission, he had had difficulty speaking. On the day of admission, his colleague had found him to be unconscious and lying on his back. He was admitted to our hospital. The temperature at the eardrum was 35.2°C. Neurologic evaluation was negative. Computed tomography (CT) scan of the brain showed slight ventricular enlargement bilaterally. An X-ray film of the chest showed no abnormality. On the second hospital day, neck stiffness was noted. The cerebrospinal fluid (CSF) contained 870 white cells/µl, most of which were neutrophils; the glucose level in the CSF was 10 mg/dl, and the protein level was 140 mg/dl. Stained smears of the CSF, including Gram staining and India-ink preparations, disclosed no microorganisms. Capsular antigen tests for several bacteria were negative. Antimicrobial agents were started. However, by changing the microscope focus slightly while viewing Gram stains of the CSF, we could see brightened and Gram-positive bacilli that had been phagocytosed by neutrophils. This finding suggested the presence of Mycobacterium tuberculosis. Ziehl-Neelsen staining of the CSF and gastric juice revealed anti-acid bacilli. Polymerase chain reaction for M. tuberculosis in the gastric juice was positive. This case showed that Gram staining could be useful as an initial adjunct for the diagnosis of tuberculous meningitis, particularly when the CSF shows predominantly neutrocytic pleocytosis, but no other evidence of bacterial meningitis.

[Consider the advantages and disadvantages of microbial examinations in a hospital, and ideal microbial laboratory].

The main benefit of carrying out microbial examinations in a hospital is that it rapidly yields information on infectious diseases. Microbiology technicians can easily communicate with the physicians and can carry out precise analyses. The disadvantages are the high costs of microbiological examinations, and the need for long training times for microbial laboratory technicians because of the highly technical nature of their duties. In-hospital microbial inspections will lead to: 1)improved rapid diagnostic tests for infectious diseases and evaluation of antibiotic treatment in the early stages of disease; 2) detection of the precise origin of microbes and confirmation of etiological factors; 3) antibiotic susceptibility testing and evaluation of combined effects of antibiotics against multiple drug-resistant bacteria; and 4)genetic analysis and epidemiological statistical analysis for the purpose of infection control in a hospital and surrounding areas.

[Comparison of portable apnea monitors in the detection of apnea episode during daytime rest].

Although polysomnography (PSG) is the golden standard for the diagnosis of sleep apnea syndrome (SAS), access to this procedure is limited because it requires special institution and trained technicians. Therefore, many portable recording devices have been developed for detection of SAS including home monitoring. The present study evaluated the usefulness of four portable devices in detecting apneic events. The four devices are, (1) FM-500 thermister sensor type III device, (2) LS-300 pressure sensor type III device, (3) Morpheus pressure sensor type III device, and (4) SD-101, a sheet-type type IV device that detects chest wall movement. This study included 1,114 patients who underwent a daytime rest session during a routine clinic visit. The subjects were asked to remain quiet and in a supine position in a dark room. We compared the respiratory disturbance index (RDI) and number of oxygen desaturation events (OD) measured by the four portable devices in each patient. The RDI and number of OD measured by the device using the thermister sensor were significantly lower than those measured by the three other devices. These findings suggest that when using a portable recording device to screen for SAS, the characteristics of the device should be taken into account.

The usefulness of changing focus during examination using Gram staining as initial diagnostic clue for infective tuberculosis.

Gram staining is a useful technique for detecting bacteria but is highly questionable in detecting Mycobacterium tuberculosis. Its detection generally requires special staining, such as Ziehl-Neelsen staining. We experienced three cases in which tuberculosis was first suggested by Gram staining of sputum or pus, confirmed by Ziehl-Neelsen staining, and diagnosed by polymerase chain reaction or culture. To find colorless tubercle bacilli in clinical samples with various organisms, varying the focus to slightly longer and shorter during study of the slides is indispensable. We present criteria for detecting infective pulmonary tuberculosis in Gram staining. First, in the ordinary focus, weakly stained, thin, gram-positive bacilli are found; second, with a slightly longer focus distance, the thin, cord-like, conspicuous gram-positive bacilli can be observed; and third, with a shorter focus distance, the gram-positive bacilli have changed into the brightened, colorless, or ghost ones. Four laboratory technologists each evaluated 20 Gram-stained samples after being lectured on the criteria, with no prior information about the sample. They accurately evaluated the presence of the bacilli in Gram-stained preparations in more than 90% of samples containing 3+ bacilli on Ziehl-Neelsen staining. Gram staining is available as an easy and rapid initial clue to recognize highly infective tuberculosis.

[Utilization of panic values in our institution: hematological testing].

A panic value is defined as an abnormal value indicating a life-threatening situation. Hematological examination results are sensitive to changes in treatment, and are likely to be influenced by blood collection techniques. Panic values may directly influence the diagnosis in many cases because they are treated as clinical evidence. Therefore, the reported results should be carefully evaluated considering the pathologic condition of the patient. In our institution, panic values are determined based on the following concept: "Panic values are established to determine when to ask the opinion of the physician in charge of the patient regarding the validity or confirmation of the clinical condition when an abnormal value is observed." This report describes our approaches for the utilization of panic values and associated problems. Values were determined by referring to those reported previously in the literature and considering differences between the former panic values and clinical conditions and the prescription history of the patients. The reports were made to the doctors in charge in each of the departments directly by telephone or pager. Clinical technologists obtained clinical information, such as on the diagnosis, infusion solutions, and medications, and asked for approval to conduct additional examinations accordingly. The numbers of reports on each item for six months from March to August in 2008 were summed. As the results, a total of four items (SFMC + TAT + D-d + FDP) accounted for 28%, hemoglobin 15%, platelets 10%, INR 9%, APTT 8%, two or more items of CBC 8%, PT+APTT 7%, differential WBC 6%, CBC + differential WBC 5%, WBC 3%, fibrinogen 0.9%, and AT 0.1%. The number of reports as a percentage of the total orders was 0.14% for CBC-related and 0.49% for hemostasis-related items. Regarding diseases and clinical conditions, blood collection-related events accounted for 11.9%, poor management of warfarin administration 9.3%, leukemia and malignant lymphoma 7.7% and chemotherapy 7.4%, and then under-administration of heparin, DIC, the perinatal period, gastrointestinal hemorrhage, severe hepatic disorder, EBV, and acute virus infection, in order of decreasing frequency. This method enabled the quick and accurate reporting of panic values to clinical sites. Furthermore, clinical technologists could be motivated to increase their awareness of the value of examinations, medications, and treatments and to be more involved in medical practice. However, there were some problems, such as intervening in the clinical practice of physicians in charge, individual variations in the performance level of clinical technologists, and insufficient uniformity of management and calculation of panic values. The provision of clinically useful information will be made possible by constructing systems to send panic values to the mobile terminals of physicians in charge and being able to refer to the results and manage medical records on the system when electronic medical charts begin to be used next year.

Screening method for severe sleep-disordered breathing in hypertensive patients without daytime sleepiness.

The high prevalence of sleep-disordered breathing (SDB) in hypertensive patients has been well studied. However, regular screening of SDB in these patients is not performed routinely as the diagnostic procedures are both time-consuming and labour-intensive. Overnight portable device screening is useful, but is sometimes not acceptable for asymptomatic SDB patients. We evaluated the usefulness of daytime 30-min recording with a portable recording device during pulse wave velocity (PWV) measurement sessions as a screening method for detection of asymptomatic SDB in hypertensive patients. Eighty-one hypertensive patients underwent 30-min daytime screening session using a Type III portable recording device during PWV measurement. Each screening session was followed by full overnight Level I polysomnography (PSG). The screening session included recordings of airflow (mouth-nose), chest movement, oximetry, and electrocardiography. The correlation coefficient between respiratory disturbance index (RDI) by screening session and apnea-hypopnea index (AHI) by PSG was 0.64. Using AHI ≥ 30 as diagnostic of severe SDB, 47 of 80 patients had the disorder based on PSG results. Using an RDI cut-off value of 22, the sensitivity and specificity for detection of severe SDB were 86.1% and 64.5%, respectively. Daytime 30-min recording with a portable device for apnea detection during PWV recording is useful for screening of asymptomatic severe SDB in hypertensive patients.

A rapid and quantitative D-Dimer assay in whole blood and plasma on the point-of-care PATHFAST analyzer.

The objective of this study was to evaluate the accuracy indices of the new rapid and quantitative PATHFAST D-Dimer assay in patients with clinically suspected deep-vein thrombosis (DVT). Eighty two consecutive patients (34% DVT, 66% non-DVT) with suspected DVT of a lower limb were tested with the D-Dimer assay with a PATHFAST analyzer. The diagnostic value of the PATHFAST D-Dimer assay (which is based on the principle of a chemiluminescent enzyme immunoassay) for DVT was evaluated with pre-test clinical probability, compression ultrasonography (CUS). Furthermore, each patient underwent contrast venography and computed tomography, if necessary. The sensitivity and specificity of the D-Dimer assay using 0.570 mug/mL FEU as a clinical cut-off value was found to be 100% and 63.2%, respectively, for the diagnosis of DVT, with a positive predictive value (PPV) and negative predictive value (NPV) of 66.7% and 100%, respectively. The correlation between the results of PATHFAST D-Dimer and VIDAS D-Dimer was acceptable (y=1.134x+0.003, r=0.902). The test reproducibility was good (CV%: from 4.0% to 5.0% for plasma and from 7.1% to 7.5% for whole blood) and the total imprecision was very good (CV%: 3.6-5.7%). Whole blood as well as plasma can be used as samples in this assay (y=1.013x-0.010, r=0.971 for heparinized specimens; y=1.068x+0.003, r=0.989 for citrated specimens). Because of its high sensitivity and NPV PATHFAST D-Dimer assay can be useful for the rapid rule out of DVT in patients admitted with suspected thrombosis.

[Progress in assays for and new developments in autoimmune pathophysioirmen's introductory remarks].

We examined the influence of a revision of health insurance in 2004 in Teikyo University Hospital in comparison with 2003. Out to the returns of most hematological tests, especially HbA1c and TK, being included in the treatment charges of outpatients, gross laboratory test sales decreased more than expected. Increased income from judgment charges and management charges could not make up for the deficit in test sales. Therefore, total laboratory test revenues decreased substantially. In 2006, the new revision of health insurance will worsen the revenues further. Hospital laboratory test departments should take appropriate and aggressive management steps in response to these revisions in health insurance.

Regional variation in the prevalence of extended-spectrum beta-lactamase-producing clinical isolates in the Asia-Pacific region (SENTRY 1998-2002).

We examined the prevalence of extended-spectrum beta-lactamase (ESBL)-producing strains of Klebsiella pneumoniae, Klebsiella oxytoca, Escherichia coli, Proteus mirabilis, Citrobacter koseri, and Salmonella spp. that were isolated as part of the SENTRY Asia-Pacific Surveillance Program between 1998 and 2002. During the study period, a total of 6,388 strains were gathered from 17 medical centers in 7 countries and examined for ESBL production and hyperproduction of K. oxytoca chromosomal K1 beta-lactamase enzyme. High rates of confirmed ESBL-producing isolates were found in K. pneumoniae strains from Singapore (35.6%), followed by those from mainland China (30.7%), South Africa (28.1%), and the Philippines (21.9%), whereas the rates were less than 10% in Japan and Australia. ESBL-producing E. coli strains were also prominent in mainland China (24.5%), Hong Kong (14.3%), and Singapore (11.3%). ESBL-producing K. oxytoca were common in the Philippines (38.5%), Singapore (33.3%), and China (30.0%). Hyperproduction of K. oxytoca chromosomal K1 beta-lactamase enzyme was common in Australia and Japan. P. mirabilis strains from Singapore produced ESBL (17.9%) despite the low prevalence (0-8.1%) in other countries. Few ESBL-producing C. koseri and Salmonella spp. strains were found in Japan, Singapore, Taiwan, and South Africa. Although there was variation among countries in substrate preference, ceftazidime was more likely to detect presumptive ESBL phenotype in K. pneumoniae and aztreonam more likely in E. coli, whereas ceftriaxone was the best substrate for the confirmation of ESBL production. ESBL-producing strains showed high levels of co-resistance to aminoglycosides, tetracycline, trimethoprim-sulfamethoxazole, and ciprofloxacin. Imipenem retained activity against all ESBL-producing strains. Organisms expressing ESBLs are widely distributed in the Asia-Pacific region, although prevalence rates vary significantly.

Opsonic activity assessment of human intravenous immunoglobulin preparations against drug-resistant bacteria.

We have used the ability of opsonized bacteria to stimulate luminol-enhanced chemiluminescence (CL) of human polymorphonuclear leukocytes (PMN) to examine the opsonic capabilities of commercially available human intravenous immunoglobulin (i.v.Ig) preparations. The method was tested against 14 strains of drug-resistant gram-positive bacteria (including methicillin-resistant Staphylococcus aureus, hetero-vancomycin-resistant S. aureus, vancomycin-resistant enterococci, penicillin-resistant Streptococcus pneumoniae), and 23 strains of gram-negative bacteria (including extended-spectrum beta-lactamase-producing bacteria, metallo-beta-lactamase-producing bacteria, beta-lactamase-negative ampicillin-resistant Haemophilus influenzae). An Fc-intact i.v.Ig preparation treated with polyethylene glycol (PEG) was evaluated for opsonization effectiveness against these bacteria in vitro. The opsonization of these organisms was enhanced by an Fc-intact i.v.Ig, and the opsonic activity was dose dependent. A pepsin-treated i.v.Ig preparation exhibited poor opsonic activity for all bacteria tested. These results suggest that Fc-intact i.v.Ig, which augments opsonic activity against various drug-resistant bacteria, will be a useful addition to the treatment of severe bacterial infections in immunocompromised patients with impaired serum opsonic capacity.

Evaluation of the contemporary occurrence rates of metallo-beta-lactamases in multidrug-resistant Gram-negative bacilli in Japan: report from the SENTRY Antimicrobial Surveillance Program (1998-2002).

Metallo-beta-lactamases (M beta L) were initially characterized in Japan, usually of the IMP-type, and found in Pseudomonas aeruginosa (PSA), Acinetobacter spp. (ACB), or Serratia marcescens (SM). The number of M beta L types has increased worldwide, but geographic dissemination within Japan has appeared limited. This study compares baseline levels of M beta L resistance from two 22-center studies (1996-1997) to the longitudinal sample (3 sites) of Japanese isolates from the SENTRY Antimicrobial Surveillance Program (1998-2002). All minimal inhibitory concentration results were determined by reference methods. A total of 26.8% PSA, 3.4% ACB, and 3.1% Enterobacteriaceae (enterobacters and SM) with resistance to monitored carbapenems (CARB) (minimal inhibitory concentration, > or =8 microg/mL) were screened for M beta L production by disk approximation tests (EDTA and 2-MPA inhibitors), CARB hydrolysis by enzyme extracts, and selected PCR primers for known M beta L types. All M beta L-positive strains (10) were sequenced to determine enzyme identification. Clonality in each center was determined by automated ribotyping and PFGE. The CARB susceptibility rates in PSA decreased (80.7% to 62.0%) over the monitored interval (1998-2002), but varied by medical center location. Among CARB-resistant isolates, 10.8% were attributed to M beta L strains (1.1% of all PSA tested). M beta L identification showed the following: five PSA (three IMP-1, two IMP-2), four SM (one IMP-1, two IMP-1 + OXA-1, and one IMP-11). Also a single ACB had an IMP-1. Eight of 10 M beta L isolations occurred between 2000 and 2002; four occurred in 2002. BRL42715, an AMP-C inhibitor, confirmed AMP-C-mediated resistance in 87.3% of PSA, and outer membrane protein changes were also discovered by membrane studies. Prior results (22 sites, 1997-1998) showed CARB resistance at 22.4-25.6% and 0.5-0.9% M beta Ls (IMP-1) overall; it was slightly elevated in this SENTRY Program sample. In conclusion, M beta L-producing strains from several species persist in Japan, but represent a distinct minority of all CARB-resistant strains (1998-2002). Although M beta L rates appear generally stable in Japan, continued surveillance for these mechanisms seems to be a prudent practice, because of the mobility of the genetic determinants and the emergence of novel enzyme types, especially among the Enterobacteriaceae.

[Basic and clinical evaluation of the new rapid diagnostic kit for detecting group A streptococci with the immunochromatographical method].

Basic and clinical performance of a new diagnostic kit that detects Group A Streptococci by an immunochromatographical method, QuickVue Dipstick Strep A (Quidel Corporation; San Diego, CA) were evaluated. In basic specificity study, the QuickVue Dipstick Strep A showed positive reaction only to group A Streptococci strains among 34 strains of 10 species of bacteria. In detection limit study, the QuickVue Dipstick Strep A had a capacity to detect Group A Streptococci in 1.0 x 10(4); cfu/ml (1.0 x 10(3) cfu/test). This sensitivity was about 6 times higher than that of the existing similar immunochromatographical test, STREP A TESTPACK Plus (TESTPACK, Abbott Japan, Tokyo). In clinical study compared with bacterial culture test using 100 patients' throat swab specimens, the QuickVue Dipstick Strep A showed a sensitivity of 94.4% (34/36), a specificity of 100% (64/64) and an accuracy of 98% (98/100). Furthermore in correlation study with the reference test, TESTPACK, the QuickVue Dipstick Strep A showed 100% agreement (34 positive and 66 negative specimens). As the QuickVue Dipstick Strep A has several advantages as not only simple operation, rapid reaction and good performance but also easy storage (under room temperature), compact size and minimum waste products, we conclude that this new test is useful as Point-of-Care Testing kit and plays a peripheral role in the diagnosis of Group A Streptococci infection and pertinent medical treatment by antibacterial agents.

[Studies on the prognostic factors of idiopathic acute sensorineural deafness].

Acute sensorineural deafness(ASD) presents with various hearing types, and dizziness and tinnitus are accompanied in some cases. The purpose of this study was to estimate the influence of risk factors, including dizziness and tinnitus, on the recovery of hearing acuity. Eighty-three patients who visited our hospital within 1 month from its onset and who were diagnosed with ASD between October 1998 and September 1999 were retrospectively reviewed. The patients whose etiology was defined, or whose symptoms shifted to inconsistent deafness were excluded. There were 35 males(ages ranged from 22 to 71 years; average 49 years) and 48 females(ages ranged from 17 to 79 years; average 46 years). The improvement rates were analysed using the following factors such as levels and hearing types at initial examination, interval between its onset and treatment, and presence or absence of dizziness and tinnitus. Concerning hearing types at initial examination, tan type or low sound disturbance type resulted in favorable prognosis. The patients whose treatment was started by the 7th day from its onset had significantly better prognosis than those whose treatment begun after 15 days. The patients who were complicated with tinnitus, especially accompanied with dizziness, indicated a significantly worse prognosis than those without tinnitus. Tan type or low sound disturbance type is a favorable factor, and tinnitus is an unfavorable factor for ASD prognosis. Though tinnitus generally is a significant factor for poor prognosis, this study remains to suggest that it alone causes the poor prognosis. The sooner treatment is provided indicates the better outcome.