[Assessing the effect of health belief, knowledge, and social support on compliance behaviors in chronic hemodialysis patients]

The purposes of this study were to investigate the effects of hemodialysis patients' health belief, knowledge on uremia, and social support upon their compliance behavior. The convenience sample of 330 hemodialysis (HD) patients was obtained at HD centers in southern Taiwan. With the use of a questionnaire developed by the researcher, all subjects were interviewed during hemodialysis. Data analyses were processed by a personal computer with SPSS/PC. Pearson correlation, ANOVA, chi-square, multiple regression and factor analysis were selected as the analysis methods for this study. The results indicated: (1) The average overall rate of compliance was 72.1% by patient self report for fluid limit, diet restriction and taking PBM. (2) Two factors of subject's health belief were identified by factor analysis. (3) Those who had more positive motivation for compliance with therapeutic regiments, more knowledge on uremia and stronger social support were positively correlated with compliance behaviors. (4) The best predictive variables of compliance behaviors of HD patients included positive motivation, knowledge on uremia, educational level, current daily urine amount and age; these five variables explained 23% of variance in compliance behaviors. (5) The instruments with a satisfactory validity and reliability developed by the researcher could provide a valuable basis for relevant future research. Implications of these findings for nursing practice are also discussed.

Ectopic supernumerary teeth as a predisposing cause in localized periodontitis. Case report

Supernumerary teeth are relatively common in the maxillary incisor and molar areas. However, bilateral ectopic, fully erupted supernumerary mesiodentes are relatively rare. The present case documents a patient with localized periodontitis of the maxillary first and second molars associated with bilaterally erupted supernumerary teeth located in proximity to the buccal embrasure space between the molars. Combined clinical data suggested that these ectopic mesiodentes predisposed or contributed to the development of localized periodontitis.

Pharmacokinetics of ceftibuten in children

The bioavailability and pharmacokinetics of ceftibuten administered as an oral suspension were characterized by several studies in young healthy male adults (19 to 39 years old) and children ranging in age from 6 months to 17 years. Ceftibuten suspension was found to be bioequivalent and thus interchangeable with a standard 400-mg capsule. As with the capsule formulation, food slightly (< 20%) affected the rate and extent of absorption of the suspension. The recommended dose of 9.0 mg/kg was found to produce comparable plasma concentrations in children of all ages (6 months to 17 years). The range of mean values of maximum plasma concentrations (Cmax) was 12 to 16 micrograms/ml at the 9.0-mg/kg dose level. Doses of 4.5, 9.0 and 13.5 mg/kg produced Cmax and area under the plasma concentration-time curve values that were dose-proportional. The half-life (t1/2) was essentially independent of age and dose, ranging from 2 to 3 hours. The apparent clearance (Cl/F), uncorrected for the fraction of drug absorbed (F), is independent of dose but appears to increase with a decrease in age. This also occurs to a lesser degree with the volume of distribution (Vd/F), uncorrected for F. Current evidence suggests that this is more likely to be caused primarily by a decrease in F than an increase in Cl. Ceftibuten rapidly and extensively reaches the middle ear fluid in children with acute otitis media. Within 4 hours concentrations in middle ear fluid are similar to plasma concentrations and can be measured for 12 hours. The ratio of area under the concentration time curve for middle ear fluid relative to plasma was about 70%.(ABSTRACT TRUNCATED AT 250 WORDS)

Mechanical properties and histological evaluation of sintered beta-Ca2P2O7 with Na4P2O7.10H2O addition

The ultimate goal of implantation of biomaterials in the skeleton is to reach full integration of the non-living implant with the living bone. The biomaterial can be used much as a bone graft, resorbing or dissolving as bone growth occurs, and the end result is a new remoulded bone. Calcium pyrophosphate, Ca2P2O7, is one of the intermediate products of bone mineralization. beta-Dicalcium pyrophosphate (beta-DCP) doped with certain amounts of Na4P2O7.10H2O was prepared as the developed material. Na4P2O7.10H2O was used as a liquid-phase additive to improve the sintering process and promote physiological bioresorbability. Compressive strength and four-point bending strength were measured by the Bionix test system 858. The mechanical strength of the sintered beta-DCP increased with the addition of Na4P2O7.10H2O up to 5 wt%, but thereafter decreased. The microstructure and crystal structure were analysed by the techniques of SEM, EPMA, TEM and XRD. The relationship between the mechanical strength of the sintered bioceramics and the Na4P2O7.10H2O dopant was examined in terms of the presence of NaCa(PO3)3, grain growth and abnormal grain coalescence while the dopant increased. Preliminary in vivo evaluation was studied by rabbit femur condyle implantation. There was no inflammation or any toxic sign during the experimental period. The histological section of intraosseous implantation revealed that the new bone deposited directly on the surface of the material in the fourth week after operation. The implant gradually decreased in volume and was replaced by the surrounding regenerated bone in the rabbit condyle in vivo environment. The results led us to conclude that the developed material has great potential as a biodegradable bone substitute.

Radical scavenger and antihepatotoxic activity of Ganoderma formosanum, Ganoderma lucidum and Ganoderma neo-japonicum

The free radical scavenging and antihepatotoxic activity from Ganoderma lucidum, Ganoderma formosanum and Ganoderma neo-japonicum were studied. Treatment with the water extract of Ganoderma lucidum, Ganoderma formosanum and Ganoderma neo-japonicum caused a marked decrease in the CCl4-induced toxicity in rat liver, made evident by their effect on the levels of glutamic oxaloacetic transaminase (GOT) and lactic dehydrogenase (LDH) in the serum. The scavenging potency of the water extracts of the crude drugs was evaluated in terms of their ability to reduce the peaks of spin adducts using electron spin resonance (ESR) spin-trapping techniques. The results indicated that Ganoderma formosanum showed the greatest antihepatotoxic activity and the greatest free radical scavenging activity.

Scavenging effects of Mallotus repandus on active oxygen species

The active oxygen species scavenging potencies of Mallotus repandus (Willd.) Muell.-Arg. extracts were evaluated by the electron spin resonance (ESR) spin-trapping technique. Superoxide radical (O2.-) and hydroxyl radical (OH.) were supplied enzymatically from hypoxanthine-xanthine oxidase (HPX-XOD) reaction and hydrogen peroxide-ferrous sulfate (Fenton reaction), respectively, to the assay system. The ethyl acetate fraction of Mallotus repandus (stem) showed the greatest superoxide radical scavenger activity and the n-hexane fraction of Mallotus repandus (stem as well as root) the greatest hydroxyl radical scavenger activity.

Pharmacokinetics of isepamicin in paediatric patients

The pharmacokinetics of isepamicin were evaluated in 50 paediatric patients ranging from newborn to 13 years old. Children with subdivided according to age: Group I (6-13 years); Group II (4 months to 6 years); Group III (16 days to 4 months); and Group IV (newborn to 16 days). All patients received isepamicin 7.5 mg/kg every 12 hours except those in Group IV who received 7.5 mg/kg once daily. Isepamicin was administered initially as an intravenous 30-minute infusion and then either intravenously or intramuscularly for between 4 and 12 days. Plasma samples were obtained after the first or second dose on day 1 at 0, 0.5, 1, 4, 6, 8 and 12 hours after the initiation of dosing and at 0.5 and 12 hours on other dosing days. Additional samples were collected in the Group IV patients at 18, 20 and 24 hours. Isepamicin showed a similar plasma concentration-time profile in Groups I, II and III (children from 16 days to 13 years), and in these groups the profile was generally similar to that observed in adults. Neonates up to the age of 16 days (Group IV) showed a distinctly different pharmacokinetic profile: a significantly larger AUC, longer half-life, lower Cmax and lower total body clearance. Isepamicin 7.5 mg/kg administered once daily to children less than 16 days old and twice daily to children aged 16 days to 13 years appears to be pharmacokinetically appropriate. The drug was very well tolerated by children of all age groups.

Anthropometry and lipoproteins-related characteristics of young adult males in Taiwan

OBJECTIVES

To investigate the prevalence of obesity and the lipoprotein-related characteristics among young male adults in the Taiwan area.

DESIGN AND SUBJECTS

After cluster sampling, a cross-sectional survey with a total of 936 males (mean age 20, 18-24) were enrolled.

MAIN OUTCOME MEASURES

The distribution of anthropometric and lipoprotein-related variables and their correlations in young male adults were measured. The prevalence of obesity by different criterion and the lipoprotein characteristics of obese and non-obese were analyzed separately.

RESULTS

The prevalence of obesity was 9.6% by the criterion of body weight greater than 20% of ideal body weight, or 12.6% by the criterion of body mass index (BMI) greater than 25. The obese subjects had significantly higher serum total cholesterol (CHOL), triglyceride (TG) and apo-lipoprotein B (apo B) and lower higher density lipoprotein-cholesterol (HDL-C) levels than the non-obese. The apo A1 levels were 141.3 and 141.9 mg/dl and the lipoprotein [a] (Lp[a]) were 17.4 and 17.1 mg/dl in obese and non-obese respectively, the difference being not statistically significant. Pearson correlation coefficients of body weight, body height, BMI, waist circumference, hip circumference and waist-hip ratio (WHR) to lipoprotein variables showed that both BMI and WHR are positively correlated with CHOL, TG and apo B, but negatively correlated with HDL-C. Furthermore the lipoprotein variables were better correlated with BMI than WHR in lean subjects (BMI < 25). However, this phenomenon was quite different in obese (BMI > 25) subjects, where the WHR was more highly correlated with lipoprotein variables than with BMI.

CONCLUSION

The prevalence of obesity is slightly higher than reported in previous studies in Taiwan. The obese subjects had various abnormal lipoprotein metabolic characteristics, such as higher CHOL, TG, and apo B and lower HDL-C levels than non-obese subjects. The BMI was more highly correlated with lipoprotein variables than was WHR in lean subjects, but the WHR was more highly correlated with lipoprotein variables than was BMI in obese subjects.

Pharmacokinetics of isepamicin

Isepamicin is a new aminoglycoside that has activity against many bacteria resistant to other aminoglycosides. The pharmacokinetics of isepamicin have been characterized in neonatal, pediatric, adult, elderly and renally impaired human populations as well as in clinical trials using the techniques of population pharmacokinetics. The pharmacokinetics of isepamicin are uncomplicated and generally similar to those of other aminoglycosides, although there is some evidence that it may have less tissue accumulation. The drug is completely absorbed following intramuscular administration. The drug is not metabolized and unchanged isepamicin accounts for all of the drug substance in plasma and urine. It is completely eliminated via the renal route; consequently dosing in patients with renal insufficiency has to be adjusted according to the degree of renal impairment. The pharmacokinetics of isepamicin are generally linear. Thus peak plasma concentrations and area under the plasma concentration curve (AUC) values are proportional to the administered dose while clearance (1.1-1.3 mL/min/kg), volume of distribution at steady state (0.23-0.29 L/kg) and half-life (2-2.5 h) are independent of dose. There is no significant accumulation of drug in the plasma with once- or twice-daily dosing. The isepamicin plasma concentration curve following a 1 g intravenous dose to healthy volunteers can be best characterized by a tri-exponential curve corresponding to a t1/2 alpha of 0.17 h, a t1/2 beta of 2.1 h, and a gamma-phase of 34 h. The t1/2 beta represents the elimination phase and changes with age and renal functions, while the gamma-phase represents the return of drug to plasma from a deep compartment including binding in renal tissue. The gamma-phase represents less than 3% of the total AUC and does not change with age. Isepamicin readily distributes to extracellular fluid and pulmonary tissue. In conclusion, isepamicin demonstrates predictable linear kinetics and is similar pharmacokinetically to other aminoglycosides. Preliminary indications of decreased tissue accumulation implied from pharmacokinetic and pharmacodynamic characteristics of isepamicin favour once-daily dosing.

Success of endoscopic injection therapy in correlation with maximal one-day transfusion requirement

BACKGROUND AND STUDY AIMS

The rate of blood transfusion is related to blood flow and the diameter of the bleeding vessel. Therapeutic endoscopy is less effective in larger vessels. To determine the effect of therapeutic endoscopy with pure ethanol injection in massive peptic ulcer bleeding, we conducted a retrospective study using the maximal one-day blood requirement as an indicator of the required blood transfusion.

PATIENTS AND METHODS

The maximal one-day blood requirement was defined as the total amount of blood transfusion needed within a day to keep hemodynamics stable and hemoglobin above 8.0 g% before therapeutic endoscopy. From January 1986 to May 1993, 283 patients with high-risk signs of the stigmata of hemorrhage on endoscopy, who received pure ethanol injection therapy, were included in this study. There were 214 men and 69 women with a mean age of 58.4 years (ranging from 16 to 93 years). One hundred forty-three had gastric ulcers; 125 had duodenal ulcers; and 15 had stomal ulcers. Patients whose maximal one-day blood requirement was less than 1000 ml were assigned to Group I. Patients without, and patients with, major organ diseases whose maximal one-day blood requirement was more than 1000 ml were assigned to Group IIa and Group IIb, respectively.

RESULTS

In Group I, 87.1% attained permanent hemostasis; 51.3% in Group IIa; and 49.4% in Group IIb. Temporary hemostasis and failure rates were 8.9% and 4.8% in Group I; 14.5% and 33.8% in Group IIa; and 21.2% and 29.4% in Group IIb. The rate of permanent hemostasis was significantly lower in patients with massive bleeding (p < 0.001) but did not differ between patients with and without major organ diseases (p > 0.05).

CONCLUSION

The success rate for pure ethanol injection therapy was lower in patients with a large maximal one-day blood transfusion requirement.

Pulmonary carcinoid tumor--tumorlet type: a case report

A rare case of bronchiectasis with carcinoid tumor, tumorlet type, is reported. The patient was a 53-year-old female who underwent lobectomy of the right middle and lower lobes for severe hemorrhage secondary to bronchiectasis. No tumor was seen on chest X-ray or by gross examination of the lung. Microscopically, there were multiple tumorlets in the pulmonary parenchyma surrounding the bronchiole and small bronchus. The tumor cells stained positive for neuron-specific enolase, keratin and chromogranin stain. The morphology, and staining properties suggested that the pulmonary tumorlets were carcinoid tumor. No tumor cells were identified in the four peribronchial lymph nodes. The patient is disease-free after four years of follow-up.

Obstructive sleep apnea syndrome and bronchial hyperreactivity

This study was designed to investigate the prevalence of bronchial hyperreactivity (BH) in patients with obstructive sleep apnea syndrome (OSAS), heavy snorers, and light snorers; its correlation with OSAS severity; and its response to nasal CPAP therapy. Forty-eight age- and sex-matched subjects were selected on the basis of preentry sleep studies: Group I consisted of 16 patients with OSAS (hypopnea-apnea index (HAI) = 35 +/- 9); group II consisted of 16 cases of heavy snorers without OSAS; and group III, a control group, consisted of 16 subjects with only mild snoring. All 48 patients had normal pulmonary function (simple spirometry) prior to study entry and had no history of asthma or allergies. The prevalence of BH was prospectively assessed by giving each subject a methacholine challenge test (MCT). Patients with a positive MCT were treated with 2-3 months of nasal CPAP treatment, after which they had a second MCT. Four of 16 patients in group I had BH on MCT (PD20 = 88, 103, 109, 162 D.U.), whereas none of the group II or III subjects demonstrated BH. There was no correlation between BH and the severity of the OSAS. The 4 patients with BH in group I showed an increase in PD20M after 2-3 months of nasal CPAP treatment. In conclusion, BH may occur in patients with OSAS. It is unrelated to the severity of the OSAS, and nasal constant positive airway pressure (CPAP) therapy can decrease the hyperreactivity to methacholine in these patients.

Thermal analyser and micro FT-IR/DSC system used to determine the protective ability of microencapsulated squid oil

Squid oil was microencapsulated by spray drying method. Gelatin, sodium caseinate, maltodextrin were contained in spray drying formulation with or without lecithin and microcrystalline cellulose (Avicel). The thermal stability of the unencapsulated and encapsulated squid oils was determined by pressure differential scanning calorimetry (PDSC), Fourier transform infrared (FT-IR) microscopic photometer with DSC system and themogravimetric analysis (TGA). The results indicate that the above analytical apparatus is an easy and reliable method to investigate the samples and that the microcapsule prepared by spray-dried formulation with lecithin as an emulsifier and Avicel as a stabilizer exhibits more stable thermal stability and longer shelf-life.

[Comparison of UW solution and UR (a modified Collins) solution for renal preservation in renal transplantation]

For the storage of human transplanted organs, the benefit of "UW solution" has been proven especially in keeping a longer preservation time for the liver and pancrease; however, the value for kidney preservation was still debated. A total of 293 cases of renal transplantation were performed over 12 years in our hospital and 206 cases were cadaveric transplants. The latter ones were further divided into 3 groups, according to the immunosuppressive medication and preservation solution used. In the CsA treated groups, the ATN rates significantly decreased in those preserved with the UW solution than with the UR solution. Although the UW solution did not improve the graft survival in our series, it did save the cost for postoperative hemodialysis and shorten the hospital stay which made it cost effective.

[Clinical experience of laryngeal mask airway in lateral position during anesthesia]

BACKGROUND

The laryngeal mask airway (LMA), inserted blindly into hypopharynx in patients in supine position, has been reported to be successful in the management of the airway and can provide adequate ventilation during anesthesia. In our study, we used LMA to maintain airway during anesthesia in patients in lateral position.

METHODS

Eighty surgical patients, ASA class I-II, undergoing hemorrhoidectomy, were placed in lateral surgical position before induction. The induction agents were propofol (2 mg/kg), fentanyl (2 micrograms/kg) and atracurium (0.5 mg/kg, i.v.). When mouth opening can be done passively, a LMA was inserted into the mouth and advanced blindly over the tongue into the pharynx until resistance was felt. The rim was immediately inflated with air and several manual positive pressure ventilatory breaths were given to the patient to check for leaks in the LMA system. Chest movement was observed and bilateral lung ausculation was performed to confirm the adequacy of ventilation. Once the LMA was in place, enflurane with oxygen was administered until operation was completed. During the anesthetic course, EKG, blood pressure, pulse oximeter, end-tidal CO2 and inspiratory pressure were monitored.

RESULTS

Blind insertion of LMA in lateral position was successful in the first attempt in 70% (56/80) of patients. Twenty (18/80) patients required a second or third trial making the total successful rate of LMA insertion as high as 90% (74/80). In four patients, airway control through LMA was unsatisfactory due to large air leakage during manual ventilation. In two patients the LMA could not be inserted in proper position for maintaining airway. In six cases, the LMA was immediately removed and was substituted by face-mask for anesthesia. Two patients complained of postoperative sore throat. No other specific complications such as cough, laryngospasm and aspiration was noted.

CONCLUSION

We demonstrated that LMA can be easily inserted and can provide effective patency of airway during anesthesia even in lateral position. It can be used as a substitute for face-mask in anesthesia in this position to prevent complications such as pressure injury that a face-mask may cause.

The evaluation of hepatoprotective effects of Taiwan folk medicine 'teng-khia-u'

'Teng-khia-u' is a folk medicine of Taiwan, derived from the entire plants of Elephantopus scaber L., E. mollis H.B.K. and Pseudoelephantopus spicatus (Juss.) Rohr. The hepatoprotective effects of water extracts of these three plants against beta-D-galactosamine (D-GalN)- and acetaminophen (APAP)-induced acute hepatic damage were determined in rats. The results indicated that the serum glutamate-oxalate-transaminase (sGOT) and the serum glutamate-pyruvate-transaminase (sGPT) levels caused by D-GalN and APAP decreased after treatment with crude extracts of 'teng-khia-u' (P < 0.005). The pathological changes of hepatic lesions, caused by D-GalN and APAP, improved following treatment with the drug extracts mentioned above.

Ultrasound-guided percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy: a new trial in the treatment of severe acute suppurative cholecystitis

Seven cases of acute suppurative cholecystitis underwent percutaneous transhepatic gallbladder drainage followed by laparoscopic cholecystectomy at the Tainan Municipal Hospital. All the patients had frank septic phenomena clinically, including fever, jaundice, leukocytosis and unstable blood pressure. Organisms were cultured from both blood and bile specimens. Ultrasound-guided transhepatic puncture of the gallbladder was performed for bile drainage, and laparoscopic cholecystectomy was subsequently performed two to five days later after the patients had stabilized. No procedure-related complications from either percutaneous transhepatic gallbladder drainage or laparoscopic cholecystectomy were observed. All patients had early recovery, shortened hospital stay and good cosmetic results. These preliminary results show that laparoscopic cholecystectomy is a safe method and can be employed in those patients with symptomatic gallstone associated with suppurative cholecystitis after preoperative biliary drainage.

Patient-related barriers to cancer pain management in Taiwan

The reluctance of patients with cancer to report pain and to use analgesics hinders the management of their pain. In the United States, this reluctance is related to the patient's misconceptions regarding addiction and tolerance to analgesics and the desire to be a "good patient" who does not complain. Reports in the literature suggest that patients in Taiwan may have these same concerns and misconceptions. This study was designed to explore (a) the concerns of patients in Taiwan about reporting pain and using analgesics and (b) the relationship between these concerns and the adequacy of analgesics used by the patients. Sixty-three patients with cancer completed the Barriers Questionnaire-Taiwan (BTQ) form, a self-report instrument that measures the extent to which patients have eight specific concerns about reporting pain and using analgesics. The responses indicated that patients who were less educated were more likely to have concerns and that patients in general were most worried about tolerance. Patients who were inadequately medicated, as determined by an index of "adequate pain management" constructed for the study, had significantly higher levels of concerns. Open communication between health professionals and patients and educational programs about pain and about the concerns measured in this study could help overcome these concerns and misconceptions and improve pain management.

A specific enzyme immunoassay (EIA) with selective extraction for quantitation of a topical anti-inflammatory agent, SCH 40120, in human plasma

SCH 40120 is a potent anti-inflammatory agent under development for the topical treatment of dermal inflammatory and allergic disorders such as atopic dermatitis, contact dermatitis and psoriasis. We have previously described a sensitive enzyme immunoassay (EIA) for SCH 40120 in unextracted human plasma to support clinical studies. However, severe cross-reaction with unknown metabolites was observed during validation using samples from rats dosed with 14C-SCH 40120. Therefore, a selective extraction procedure was developed to remove the unknown plasma metabolites of SCH 40120 prior to EIA quantitation. The modified EIA using extracted plasma was cross-validated with an LC method using plasma samples from dosed subjects (human and rat), thereby confirming the specificity of the assay. The EIA can reliably quantitate SCH 40120 in plasma samples from 100 pg ml-1 to 10 ng ml-1 with good linearity, accuracy and precision, and is suitable for pharmacokinetic studies in man.

Studies on the agronomic characteristics, yield, and saikosaponin content of two Bupleurum species in Taiwan

Two Bupleurum species (Bupleurums spp.), i.e., B. falcatum L. cv. Tainung No. 1 and B. kaoi Liu, Chao, et Chuang, were compared for their differences in seed germination, plant characteristics and root yield, and saikosaponin content. Experimental data showed that the most suitable temperature for seed germination of the two species was 16 degrees C. Two treatments, cold stratification at 4 degrees C for 8 weeks and presoaking by running water for 2 days, resulted in higher germination rates. Tainung No. 1 possessed a higher 1,000-seed weight than B. kaoi. However, field survival rate was higher for B. kaoi than for Tainung No.1. Results from field experiments also revealed that stem diameter, leaf width and fresh weight of various plant parts except the root were superior for Tainung No. 1 to B. kaoi. On the contrary, tiller number and root diameter and weight of B. kaoi were higher than those of Tainung No. 1. Harvest data and elevation had significant effects on the agronomic performance of the two Bupleurum spp. Measurements of most traits of the 6 month-old plants were superior to those of the 3 and 10 month-old plants. Cultivation at higher elevation (850 m) favored the development of leaf weight and root length, while cultivation at lower elevation (85 m) facilitated the development of plant height, root diameter, and root weight. Analysis of saikosaponin concentration in the root tissue revealed that average contents of 3.19 and 3.80 mg/g, respectively, for plants grown at the elevations of 850 m and 85 m. Comparison between the two species showed no significant difference in saikosaponin content, ranging from 3.45 to 3.55 mg/g.

A preliminary report on the correlation of vestibular Meniére's disease with electrocochleography and glycerol test

Objective evaluation of vestibular Meniére's disease has been difficult due to the lack of audiometric findings. Thus inevitably, the existence of vestibular Meniére's disease is constantly being challenged. In recent years, electrocochleography (ECochG) has proved to be a useful tool to verify the presence of endolymphatic hydrops electrophysiologically. To further clarify the nature of this disease, we collected 40 patients prospectively who met the following conditions as diagnostic criteria for clinical vestibular Meniére's disease: i) episodic vertigo, ii) aural fullness, and iii) normal hearing. We implemented the glycerol test and extratympanic ECochG in addition to routine survey in these cases. The diagnosis was confirmed if either test result was positive. A retrospective collection of 24 cases who underwent endolymphatic sac surgery was made to evaluate in retrospect the existence of endolymphatic hydrops indirectly proved by successful surgery. Results showed a positive SP/AP ratio in 25 cases (62.5%) of which 7 had bilateral positive responses. The glycerol test was positive in 5 cases including 3 who also had positive ECochG responses. In the retrospective group, 4 cases exhibited an abnormally large SP/AP amplitude ratio at preoperative baseline conditions after general anesthesia. Twenty cases showed an SP/AP ratio within normal limits. Only 7 cases (29%) showed a decrease in the SP/AP ratio at different surgical steps. Short-term surgical results showed a 96% success rate of relief of vertiginous symptoms. Symptoms of fullness were completely controlled in 22 patients (92%). Hearing was preserved in 18 patients (75%). We conclude that i) the above-listed clinical criteria combined with these objective tests may prove to be very useful in the diagnosis of vestibular Meniére's disease, and ii) a successful control of vertigo and aural fullness after endolymphatic sac surgery indirectly indicates that endolymphatic hydrops is involved in vestibular Meniére's disease, sharing as it does, a pathophysiology that is similar to that of classic Meniére's disease.

A further critical assessment of the efficacy of endolymphatic sac surgery

This paper further assesses the efficacy of two selected techniques of endolymphatic sac surgery (ELS) employing implants for the treatment of classic Meniere's disease and endolymphatic hydrops: the Arenberg inner ear valve implant and the newly developed Huang/Gibson inner ear shunt. Long-term (8-10 years) results for 57 patients given the Arenberg inner ear valve implant show that our demonstrated high success rate in achieving control of symptoms over the short term (1 year) is long-lasting and that although previously reported hearing gains have decreased in some cases, the overall long-term hearing results are better than for other surgical techniques. Preliminary results (less than 1 year) for 10 patients treated with the Huang/Gibson inner ear shunt indicate that it is comparable in efficacy to the Arenberg implant, while 4 out of the 10 patients have shown remarkable hearing gain, as detailed in case reports. These results again illustrate and substantiate the authors' previous conclusion that, in cases where there is a definitive delineation of the endolymphatic sac and its lumen, and where the sac is anatomically suitable, ELS is undoubtedly an effective modality and should be the standard primary choice for intractable Meniere's disease.