Sudden sensorineural hearing loss during pregnancy safe,lipoflavonoid plus 100 caplets means,tenis nike mercurial en honduras wikipedia - Test Out

01.09.2014
Sudden sensorineural hearing loss (SSNHL) constitutes a considerable diagnostic challenge because it may be caused by many diverse conditions that may be difficult to recognize. Disturbances of microcirculation, autoimmune pathology, and viral infection are among the most likely causes of SSNHL. The therapeutic approaches normally used for this pathological condition include the systemic and local administration of cortisone, vasoactive agents, anticoagulants, vitamin complexes, and plasmapheresis. Group B patients received conventional therapy (cortisone, vasoactive agents, and vitamin complexes) administered intravenously in a physiological solution (100 ml) twice daily for 10 days. At discharge, seven patients (70%) treated with sodium enoxaparin and VVHF (group A) presented with a subjective abatement of tinnitus. In group A, four patients (40%) showed a complete auditory recovery after the first VVHF, and these patients had no particular characteristic that would segregate them as a subgroup. In group B, hearing improved in eight patients (80%); six of these presented blood immune parameter alterations at the beginning of the protocol. In all the patients (group A and group B) with hearing improvement, the evoked otoacoustic emissions revealed an improvement from "fail" to "pass," and otoacoustic distortion products, which were previously absent, were evoked at frequencies of the tonal field normally examined. SSNHL is still a diagnostic and therapeutic dilemma, and predicting recovery from it is very difficult. The various modalities of extracorporeal plasma therapy have found widespread use and acceptance over the last decade; VVHF selectively eliminates fibrinogen, low-density lipoprotein, cholesterol, triglycerides, and complement from the blood plasma by means of extracorporeal circulation. The pathogenesis of SSNHL is probably multifactorial: Immune mechanisms may be the primary and triggering stimuli, whereas such risk factors as hyperlipoproteinemia or lipoprotein elevation may accelerate the progression of the disease. The possibility that viral infections may be associated with viral cochleitis and SSNHL should be recognized. Heparin-induced extracorporeal LDL precipitation (HELP) apheresis is among the most widely used LDL apheresis methods. The contemporary use of LMWH considerably improves the rate of hearing improvement in SSNHL patients without such potential risk as unfractionated heparins (see Table 1). VVHF may be beneficial as an adjunctive therapy for maintaining hearing in patients with SSNHL, and our data highlight the possibility of long-term hearing benefits from VVHF in presumed immune-mediated innerear disease.
Sodium Enoxaparin and Venovenous Hemofiltration in Treating Sudden Sensorineural Hearing Loss and Tinnitus.
No definitive treatment for SSNHL is universally accepted; the goal of this study was to evaluate the efficacy of sodium enoxaparin associated with venovenous hemofiltration in a therapeutic regimen. Hypercholesterolemia, hyperfibrinogenemia, and increased platelet aggregation are frequently observed in patients with SSNHL.


These drugs can be effective in reversing such hearing loss, although at the cost of occasionally severe side effects [6,7].
Group A patients underwent a therapeutic protocol of hemofiltration performed on the first and last days of the protocol and, beginning on the second day of the protocol, sodium enoxaparin administered subcutaneously at a dose of 4,000 IU once a day for 10 days.
We performed blood tests and instrumental examinations preceding the first treatment, after the first day of the protocol, on the day of discharge, and 1 month after the end of treatment. Five patients (50%) had hearing improvement at the end of therapy; these patients presented with blood immune parameter alterations at the beginning of the treatment. Hearing was unchanged in two patients (20%), and these patients had no particular blood tests results that would qualify them as a subgroup. The reduction of these macromolecules immediately improves the hemorheologic situation and leads to a significant decrease of plasma viscosity and red cell transmission time, which correlates to the deformation of red blood cells.
In immune-mediated hearing loss, the hyperviscosity is determined by the development of immune complexes; such complexes are usually caused by binding of polyclonal IgG to monoclonal IgM. In this apheresis, the low-density lipoprotein precipitation works on the principle of specific precipitation of LDL cholesterol, lipoprotein α, and fibrinogen at an acidic pH in the presence of heparin (heparin-induced extracorporeal LDL precipitation = HELP procedure).
The incidence of adverse effects (catheter dysfunction, local or systemic infection, and thrombosis) directly attributable to VVHF does not exceed 1-2%: the use of sodium enoxaparin appears useful in reducing these risks. Many potential causes can trigger SSNHL but, despite extensive evaluation, the majority of cases elude definitive diagnosis and therefore remain idiopathic. Several authors highlighted the acute reduction of plasma fibrinogen and serum low-density lipoproteins as positively influencing hemorheology and endothelial function, and this finding might thus lead to an effective therapy for SSNHL [1-5]. This study aimed to assess the effect of sodium enoxaparin associated with an extracorporeal procedure of venovenous hemofiltration (VVHF) on the recovery of hearing in patients affected by SSNHL. After the first hemofiltration, all the patients with complete auditory recovery were discharged without receiving the treatment with sodium enoxaparin [8,9].
Hearing was unchanged in only one patient, this patient having no particular blood tests results that warranted consideration as a subgroup. This study aimed to evaluate possible hearing benefits of sodium enoxaparin and VVHF in the treatment of SSNHL. Reestablishment of vascular endothelial function and improved blood rheology may be the underlying cause of better results in patients treated with VVHF (see Table 1) [12,13]. The significant reduction of C3, C4, IgG, and IgM blood levels leads to a significant improvement of capillary blood flow and to a drop in the rheumatoid factors.
In group A patients, the final lower complement, immunoglobulin, CRP, and ERS levels highlight the effectiveness of the association between sodium enoxaparin and VVHF.


Double filtration is necessary to avoid possible rebound effects of the blood parameters in the case of immune-mediated hearing loss [7,12]. Nonetheless, the overall success rate and individual patient results warrant further study of VVHF in the treatment of SSNHL.
Heparin-induced extracorporeal low-density lipoprotein precipitation apheresis: A new therapeutic concept in the treatment of sudden hearing loss.
Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Selective hemapheresis, an effective new approach in the therapeutic management of disorders associated with rheological impairment: Mode of action and possible clinical indications.
Highly effective reduction of C-reactive protein in patients with coronary heart disease by extracorporeal low density lipoprotein apheresis.
Group A patients underwent this therapeutic protocol: Hemofiltration was performed at the first and last day of the protocol while, beginning on the second day of the protocol, sodium enoxaparin was administered subcutaneously at a dose of 4,000 IU once a day for 10 days. Sodium enoxaparin is a particular kind of heparin with a low molecular weight (LMWH) and is endowed with a high antithrombotic activity. In agreement with those from other authors, our results suggest that the removal of immune complexes may be remarkably enhanced using VVHF with an appropriate filter and show that VVHF may be beneficial as adjunctive therapy for maintaining hearing in some patients with immune-mediated hearing loss (see Table 1 ) [14]. Because many cytokines, growth factors, and complements are known to interact with LMWH, the reduction of inflammatory responses by sodium enoxaparin is likely to depend on this heparin-binding nature of the inflammatory cytokines [12,14,15]. After the first hemofiltration, all the patients with complete auditory recovery were discharged without receiving the treatment with sodium enoxaparin.
The drug exerts its effects essentially on capillary blood viscosity, erythrocyte deformability, thrombocyte aggregation, and antiphospholipid antibody activity and shows an antiinflammatory action in subcutaneous administration [11]. Group B patients received conventional therapy (cortisone, vasoactive agents, and vitamin complexes) administered in physiological solution intravenously twice daily for 10 days. In our randomized, controlled trial, treated patients in group A showed more improvement than did those in group B.



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