OBJECTIVES: The aims of this study were to investigate the feasibility of isosorbide delivery into perilymph through the round window membrane (RWM), and to compare the intracochlear isosorbide concentration in perilymph after oral administration (PO) versus that after round window perfusion (RWP). METHODS: Sixteen male guinea pigs (32 ears) were used. Isosorbide, an osmotic diuretic, was administered via RWP or PO. First, to investigate the optimal perfusion time, perilymph sampling of scala tympani from the RWM was performed after RWP for 15, 30, or 60 minutes. Second, to compare the drug concentration after RWP versus that after PO, perilymph was aspirated at 3 and 6 hours after administration. Intracochlear concentration of isosorbide was analyzed by high-performance liquid chromatography coupled to refractive index detection. RESULTS: Isosorbide passed through the RWM into perilymph after RWP. After RWP for 15, 30, and 60 minutes, mean isosorbide concentrations in perilymph were 116.27+/-44.65, 245.48+/-112.84, and 279.78+/-186.32 mM, respectively. The intracochlear concentration after RWP for 30 minutes was higher than that after RWP for 15 minutes (P=0.043). At 3 and 6 hours after PO, isosorbide concentrations in perilymph were 28.88+/-4.69 and 12.67+/-2.28 mM, respectively. In contrast, the corresponding concentrations after RWP were 117.91+/-17.70 and 75.03+/-14.82 mM at 3 and 6 hours, respectively. Isosorbide concentrations in perilymph following RWP were significantly higher than those following PO at both 3 and 6 hours (P=0.025 and P=0.034, respectively). CONCLUSION: Isosorbide can rapidly pass through the RWM after RWP in guinea pigs, and 30 minutes of perfusion is considered to be appropriate. In addition, over a 6-hour period, RWP can deliver higher concentrations of isosorbide into perilymph than those achieved with PO.
Administration, Oral* ; Animals ; Chromatography, Liquid ; Diuretics, Osmotic ; Guinea Pigs* ; Humans ; Isosorbide* ; Male ; Membranes ; Meniere Disease ; Perfusion* ; Perilymph* ; Refractometry ; Scala Tympani

Osmotic diuretics are used in neurosurgical patient to decrease intracranial pressure. Mannitol produces diuresis because it is filtered by the glomeruli and not reabsorbed from the renal tubule, leading to increased osmolarity of renal tubular fluid and associated excretion of water. There are some controversies about the effect of mannitol induced diuresis on the change of serum electrolytes. But these controversies are related to the mannitol dosage and infusion speed. We studied the effect of mannitol on serum and urine e1ectrolyte change in 10 patients undergoing operation of cerebral tumor or aneurysm. Every patient was free from cardiac and renal disease. We started infusion of 20% mannitol of which dosage is 0.6-0.9gm/kg for 5 to 10 min after cranium was opened and then injected furosemide O.l mg/kg for acceleration of diuresis. We measured serum electrolyte, urine volume and urine electrolyte before and after 30, 60 and 120 min of mannitol infusion. The results were as follows. 1) Seurm sodium and chloride level decreased significantly from 133 and 102 to l30 and 100 mEq/1 respectively after 30 min, but there was no statistic significance after 60 and 120 min of mannitol infusion. 2) Serum potassium level increased slightly from 4.2 to 4.5 mEq/1 after mannitol infusion but there was no statistic significance. 3) Urine volume increased abruptly from 57 to 477 ml/hr as soon as infusion of mannitol but the degree decreased slowly following times. 4) Urine electrolytes concentration increased abruptly as soon as infusion of mannitol but the degree decrease slowly following times. With the above results, we can conclude that intraoperative mannitol and furosemide infusion in healthy patient can cause only transient change in serum electrolyte and the magnitude of change was too small to have significant clinical effect.
Acceleration ; Aneurysm ; Diuresis ; Diuretics, Osmotic ; Electrolytes ; Furosemide ; Humans ; Intracranial Pressure ; Mannitol* ; Neurosurgery ; Osmolar Concentration ; Potassium ; Skull ; Sodium

OBJECTIVES: Mèniére's disease is one of the most common causes of episodic vestibular syndrome that shows symptom complexes of recurrent vertigo, hearing loss, tinnitus and ear fullness. Isosorbide (Isobide) is a osmotic diuretics which has been used for Meniere's disease to reduce the endolymphatic pressure. The purpose of this study was to evaluate the efficacy of isosorbide in the treatment of Mèniére's disease by comparing the combined therapy of isosorbide and betahistine (Meniace) to betahistine only. METHODS: Among 220 patients enrolled with Mèniére's disease from 9 centers, 187 patients completed this clinical study. Patients were randomly subjected either to betahistine alone therapy at dose of 6 mg three times a day (n=97) or to combined therapy with isosorbide (dose of 30 mL three times a day) and betahistine (n=90) for 12 weeks. Two groups were compared at 4 and 12 weeks after treatment on frequency of vertigo, hearing level (pure tone audiometry, speech audiometry), electocochleography (ECoG), tinnitus (Tinnitus Handicap Inventory, THI) and quality of life (Korean functional level scale, Korean dizziness handicap inventory). RESULTS: During first 4 weeks after treatment, the frequency of vertigo was not reduced in either betahistine alone therapy group or combined therapy group. However, between 8 and 12 weeks, the frequency of vertigo was significantly reduced in either group, and in the combined group frequency of vertigo was more significantly reduced than in the betahistine alone therapy group (p=0.041). The hearing level, ECoG, tinnitus and quality of life was not significantly different between two groups. CONCLUSION: Isosorbide and betahistine combined therapy were more effective for vertigo control than betahistine alone therapy. Isosorbide is an effective diuretic in vertigo control in definite Mèniére's disease.
Audiometry, Speech ; Betahistine ; Clinical Study ; Diuretics, Osmotic ; Dizziness ; Ear ; Hearing ; Hearing Loss ; Humans ; Isosorbide ; Meniere Disease ; Quality of Life ; Tinnitus ; Vertigo

OBJECTIVE: Subarachnoid hemorrhage(SAH) is commonly associated with polyuria (solute diuresis or water diuresis). The authors investigate the incidence and clinical characteristics of polyuria with special reference to the administration of osmotic diuretics. METHODS: One hundred and forty eight patients with high urine output (> 200ml/hr) after ruptured cerebral aneurysm operated early from Jan 1998 to Jun 2003 were selected. Water diuresis (diabetes insipidus, DI) was differentiated from solute diuresis by lower urine specific gravity ( < 1.005) and higher plasma osmolality. The incidence and mode of onset of polyuria were compared between two types of diuresis. Additionally, the relationships between development of polyuria and clinical features including aneurysm location, clinical grade, Fisher grade, and outcome were analyzed. Osmotic diuretics were not routinely used in patients with Hunt-Hess grade I-III since July 2001. RESULTS: Annual incidence of polyuria decreased markedly since July 2001: 45.2% in 1998, 34.5% in 2001, 11.9% in 2003. Postoperative DI occurred in 2.4~11.1%. DI developed mainly from ruptured anterior communicating artery aneurysm. The mean interval between the last SAH and the onset of DI was 7.1 days (range 1~27 days) and lasted mean 4.6 days. When compared with solute diuresis, the development of DI was significantly delayed. Other clinical features were not closely related to polyuria. CONCLUSION: Uncontrolled polyuria may lead to cerebral ischemia and electrolyte imbalance because SAH patients are already predisposed to hypovolemia, and will risk precipitating the opposite situation with overhydration. We can decrease the development of polyuria without routine use of osmotic diuretics, by avoiding the increased intracranial pressure such as the intraoperative ventriculostomy and gentle brain retraction in good grade patients.
Aneurysm ; Brain ; Brain Ischemia ; Diuresis ; Diuretics, Osmotic* ; Humans ; Hypovolemia ; Incidence ; Intracranial Aneurysm* ; Intracranial Pressure ; Osmolar Concentration ; Plasma ; Polyuria* ; Specific Gravity ; Subarachnoid Hemorrhage ; Ventriculostomy ; Water

We used near-infrared spectroscopy technology to monitor and assess the treatment effect of dehydrating agent in injured rat brain in real time style. We employed the brain edema model in rats resulting from Feeney' s freefall damage, then treated with different doses of mannitol, and collected reduced scattering coefficient (p',) and intracranial pressure (ICP) values after the injury and during the treatment. The results showed that brain edema happened 1 h after the injury in rats' brain tissue, peaked around 72 h after injury, and then began to decrease gradually. The reduced scattering coefficient and ICP values of the treatment group injected with mannitol all decreased after administration. Compared with the effect of low-dose mannitol treatment, that of high-dose mannitol treatment was much better. The duration of the plateau was longer and most experiments results declined significantly. From this we conclude that the reduced scattering coefficient and ICP are consistent with the trend changes, and the reduced scattering coefficient could be used as an indicator for monitoring cerebral edema.
Animals ; Brain Edema ; diagnosis ; Brain Injuries ; therapy ; Dehydration ; Diuretics, Osmotic ; therapeutic use ; Intracranial Pressure ; Male ; Mannitol ; therapeutic use ; Monitoring, Physiologic ; Rats ; Spectroscopy, Near-Infrared

Benign intracranial hypertension (BIH) is very rare and its cause is unclear. Raised intracranial pressure in the absence of an intracranial mass or hydrocephalus (BIH or pseudotumor cerebri) has been described in association with many conditions including SLE. Several pathogenic pathways tie BIH with SLE as thrombotic obliteration of cerebral arteriolar and venous systems and immune complex deposition within the arachnoid villi that are responsible for cerebrospinal fluid (CSF) absorption. The diagnosis of BIH was confirmed by increased intracranial pressure in the absence of any abnormal radiological findings of the brain. We report a young woman with SLE and autoimmune thrombocytopenia complicated by BIH which resolved with corticosteroid therapy and osmotic diuretics.
Absorption ; Antigen-Antibody Complex ; Arachnoid ; Brain ; Cerebrospinal Fluid ; Diagnosis ; Diuretics, Osmotic ; Female ; Humans ; Hydrocephalus ; Intracranial Pressure ; Lupus Erythematosus, Systemic* ; Pseudotumor Cerebri* ; Purpura, Thrombocytopenic, Idiopathic

The sinking skin flap syndrome (SSFS) is a rare complication after a large craniectomy. Hemorrhage infarction after a cranioplasty is a very rare complication with only 4 cases to date. We report a case of the patient who underwent an autologous cranioplasty to treat SSFS that developed intracerebral hemorrhage infarction. A 20-year-old male was admitted to our emergency department with stuporous mentality. Emergent decompressive craniectomy (DC) have done. He had suffered from SSFS and fever of unknown origin (FUO) since DC. After 7 months of craniectomy, cranioplasty was done. After 1 day of surgery, acute infarction with hemorrhagic transformation involved left cerebral hemisphere. We controlled increased intracranial pressure by using osmotic diuretics, steroid and antiepileptic drugs. After 14 day of surgery, he improved neurological symptoms and he had not any more hyperthermia. Among several complication of large cranioplasty only 4 cases of intracerebral hemorrhagic infarction due to reperfusion injury has been reported. In this case, unstable autoregulation system made brain hypoxic damage and then reperfusion and recanalization of cerebral vessels resulted in intracerebral hemorrhagic infarction. 7 month long FUO was resolved by cranioplasty.
Anticonvulsants ; Brain ; Cerebral Hemorrhage ; Cerebrum ; Decompressive Craniectomy ; Diuretics, Osmotic ; Emergency Service, Hospital ; Fever ; Fever of Unknown Origin ; Hemorrhage ; Homeostasis ; Humans ; Infarction* ; Intracranial Pressure ; Male ; Reperfusion ; Reperfusion Injury ; Skin* ; Stupor ; Young Adult

PURPOSE: Hypertonic fluids such as mannitol and half-molar sodium lactate are given to treat intracranial hypertension in patients with severe traumatic brain injury (TBI). In this study, sodium lactate was compared to mannitol in patients with TBI to investigate the efficacy in reducing intracranial pressure (ICP). METHODS: This study was a systematic review with literature research on articles published in any year in the databases of PubMed, ScienceDirect, Asian Journal of Neurosurgery, and Cochrane Central Register of Controlled Trials. The keywords were "half-molar sodium lactate", "mannitol", "cerebral edema or brain swelling", and "severe traumatic brain injury". The inclusion criteria were (1) studies published in English, (2) randomized control trials or retrospective/prospective studies on TBI patients, and (3) therapies including half-molar sodium lactate and mannitol and (4) sufficient data such as mean difference (MD) and risk ratio (RR). Data analysis was conducted using Review Manager 5.3. RESULTS: From 1499 studies, a total of 8 studies were eligible. Mannitol group reduced ICP of 0.65 times (MD 0.65; p = 0.64) and improved cerebral perfusion pressure of 0.61 times (MD 0.61; p = 0.88), better than the half-molar group of sodium lactate. But the half-molar group of sodium lactate maintained the mean arterial pressure level of 0.86 times, better than the mannitol group (MD 0.86; p = 0.09). CONCLUSION Half-molar sodium lactate is as effective as mannitol in reducing ICP in the early phase of brain injury, superior over mannitol in an extended period. It is able to prevent intracranial hypertension and give better brain tissue perfusion as well as more stable hemodynamics. Blood osmolarity is a concern as it increases serum sodium.
Brain Edema ; Brain Injuries, Traumatic/drug therapy* ; Diuretics, Osmotic/therapeutic use* ; Humans ; Intracranial Hypertension/etiology* ; Intracranial Pressure ; Mannitol/therapeutic use* ; Prospective Studies ; Retrospective Studies ; Saline Solution, Hypertonic ; Sodium Lactate

This report details a case of unexpected, severe post-operative cerebral edema following cranioplasty. We discuss the possible pathological mechanisms of this complication. A 50-year-old female was admitted to our department with sudden onset of stuporous consciousness. A brain computed tomography (CT) revealed a subarachnoid hemorrhage with intracranial hemorrhage and subdural hematoma. Emergency decompressive craniectomy and aneurysmal neck clipping were performed. Following recovery, the decision was made to proceed with an autologous cranioplasty. The cranioplasty procedure was free of complications. An epidural drain was placed and connected to a suction system during skin closure to avoid epidural blood accumulation. However, following the procedure, the patient had a seizure in the recovery room. An emergency brain CT scan revealed widespread cerebral edema, and the catheter drain was clamped. The increased intracranial pressure and cerebral edema were controlled with osmotic diuretics, corticosteroids, and antiepileptic drugs. The edema slowly subsided, but new low-density areas were noted in the brain on follow-up CT 1 week later. We speculated that placing the epidural drain on active suction may have caused an acute decrease in intracranial pressure and subsequent rapid expansion of the brain, which impaired autoregulation and led to reperfusion injury.
Adrenal Cortex Hormones ; Aneurysm ; Anticonvulsants ; Brain ; Brain Edema* ; Catheters ; Consciousness ; Decompressive Craniectomy ; Diuretics, Osmotic ; Edema ; Emergencies ; Female ; Follow-Up Studies ; Hematoma, Subdural ; Homeostasis ; Humans ; Intracranial Hemorrhages ; Intracranial Pressure ; Middle Aged ; Neck ; Recovery Room ; Reperfusion Injury ; Seizures ; Skin ; Stupor ; Subarachnoid Hemorrhage ; Suction ; Tomography, X-Ray Computed

OBJECTIVETo observe the therapeutic effect of Xuesaitong soft capsule (XST) and its effect on platelet counts, coagulation factor 1 (CF1) as well as hemorrheologic indexes in treating patients with acute cerebral infarction (ACI).

METHODSTwo hundred and four patients with ACI were assigned into two groups, the control group (n = 96) and the treated group (n = 108). They were all treated with conventional Western medicines, including mannitol, troxerutin, citicoline, piracetam and aspirin, while to the treated group, XST was given additionally through oral intake, twice a day, 2 capsules each time for 8 successive weeks. The clinical efficacy was evaluated according to the nerve function deficits scoring and the changes of platelet count. CF1 and hemorrheological indexes were measured before and after treatment.

RESULTSThe total effective rate was 87.0% in the treated group, and 87.5% in the control group, respectively, showing insignificant difference between them. But the markedly effective rate in the treated group (66.7%) was significantly higher than that in the control group (27.1%, P < 0.01). The count of platelet was not changed significantly in both groups after treatment, while CF1 in them evidently lowered at the end of the 4th and 8th weeks of treatment, but showed insignificant difference between the two groups. The hematocrit, whole blood viscosity and plasma viscosity in both groups were all improved significantly after treatment, but also showed insignificant difference in comparison of the two groups.

CONCLUSIONXST has good efficacy in auxiliary treatment of patients with ACI, though its mechanism remains to be further explored.

Acute Disease ; Adult ; Aged ; Aspirin ; administration & dosage ; Blood Viscosity ; drug effects ; Capsules ; Cerebral Infarction ; drug therapy ; physiopathology ; Cytidine Diphosphate Choline ; administration & dosage ; Diuretics, Osmotic ; administration & dosage ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Hematocrit ; Hemorheology ; Humans ; Male ; Mannitol ; administration & dosage ; Middle Aged ; Nootropic Agents ; administration & dosage ; Piracetam ; administration & dosage ; Platelet Aggregation Inhibitors ; administration & dosage