Chemosensory function in Wegener's granulomatosis: a preliminary report

Despite the fact that Wegener's granulomatosis affects the nasal and paranasal cavities and the cranial nerves regularly, chemosensory impairments have not been reported. The objective of this study is to test the three chemosensory systems, olfaction, taste, and intranasal trigeminal function in Wegener disease patients. We tested olfactory, gustatory, and intranasal trigeminal function in nine patients (5 women, 4 men, mean age 57years) with confirmed Wegener's granulomatosis. Olfaction was tested with the Sniffin'Sticks, gustatory function with the "Taste strips” and intranasal trigeminal function with a lateralization task. One patient had anosmia (11%), four patients had hyposmia (44%) and four patients were normosmic (45%). Gustatory testing function showed pathological taste strip results in five patients (55%) and normal results in three patients (33%). One patient did not undergo taste testing. Intranasal trigeminal function was lowered in five patients (56%) and normal in four patients (44%). Neither previous nasal surgery status nor endoscopic status was associated to a higher frequency in pathological scores for any of the three chemical senses. In conclusion, these preliminary results suggest a consistent affection in chemosensory functions in Wegener's granulomatosis patient

Structural Correlates of Taste and Smell Loss in Encephalitis Disseminata

BACKGROUND: Olfactory dysfunction in MS patients is reported in the literature. MRI of the olfactory bulb (OB) is discussed as a promising new testing method for measuring olfactory function (OF). Aim of this study was to explore reasons for and optimize the detection of olfactory dysfunction in MS patients with MRI. MATERIALS AND METHODS: OB and olfactory brain volume was assessed within 34 MS patients by manual segmentation. Olfactory function was tested using the Threshold-Discrimination-Identification-Test (TDI), gustatory function was tested using Taste Strips (TST). RESULTS: 41% of the MS patients displayed olfactory dysfunction (8% of the control group), 16% displayed gustatory dysfunction (5% of the control group). There was a correlation between the OB volume and the number and volume of MS lesions in the olfactory brain. Olfactory brain volume correlated with the volume of lesions in the olfactory brain and the EDSS score. The TST score correlated with the number and volume of lesions in the olfactory brain. CONCLUSION: The correlation between a higher number and volume of MS lesions with a decreased OB and olfactory brain volume could help to explain olfactory dysfunction

Quality Standards of Large Clinical Trials After Renal Transplantation

Titelblatt und Inhaltsverzeichnis Kurzfassung Einleitung und Zielstellung Methoden Ergebnisse Diskussion Referenzen AnhangDas Ziel dieser Arbeit war es, die Qualität großer randomisierter Studien aus dem Bereich der klinischen Nierentransplantation systematisch zu überprüfen. Mit Hilfe eines dreigeteilten Instrumentariums (Jadad-Skala, CONSORT- Checkliste, 4-Grad-Skala) wurden Studienqualität, Publikationsqualität und die Verfügbarkeit der Resultate systematisch bestimmt. Weiterhin analysierten wir die Präsentation und Definition akuter Rejektionsraten im Detail. Unter Zuhilfenahme potentieller Einflussfaktoren wurden systematische Unterschiede wissenschaftlicher Kulturen (Amerika, Europa) evaluiert. Wesentliche Ergebnisse: Nur 14/63 (22,2%) der evaluierbaren Publikationen erreichten eine signifikante Studienqualität (Jadad-Punktwert >3). Diese Studien erlangten gleichzeitig auch eine höhere Publikationsqualität (77,2% versus 66,7%, p=0,04). Die Publikationen erfüllten im Mittel 69,1% der CONSORT- Qualitätskriterien für Publikationsqualität (Streubreite 33% 100%). Der Qualitätsfaktor der Fachzeitschriften korrelierte signifikant mit der Studien- (p=0,012, r=0,32) und Publikationsqualität (p=0,031, r=0,27). Nur 8/41 (19,5%) Publikationen, die über Rejek-tionsraten berichteten, definierten die Diagnose akute Rejektion . In der Mehrzahl der Studien (28/41, 68,3%) wurden biopsie- gesicherte akute Rejektionen in Kombination mit behandelten (n=4), klinischen (n=7), vermuteten (n=8), akuten (n=8) oder mit klinischen und vermuteten Rejektionen (n=1) bestimmt. Die errechnete Inzidenz nicht- biopsie-gesicherter akuter Rejektionen betrug 6,5% (Streubreite 0% 16,9%). Generell wurden Studien, die mehr als eine Diagnose der Rejektion analysierten, in Fachzeitschriften mit einem signifikant höheren Qualitätsfaktor veröffentlicht. In europäischen Publikationen wurde signifikant häufiger über mehr als eine Diagnose der Rejektion berichtet. Fazit: Die Diagnose akute Rejektion ist ein akzeptiertes kurzfristiges Merkmal zur Beurteilung des Transplantatüberlebens. Zur Vergleichbarkeit klinischer Studien ist eine einheitliche Definition dieses Begriffes wesentlich. Die Autoren fordern deshalb, dass über biopsie-gesicherte und nicht-biopsie-gesicherte akute Rejektionen berichtet werden muss. Drei wesentliche Bereiche für eine zukünftige Verbesserung der Datenqualität wurden mittels unserer systematischen Qualitätsüberprüfung evaluiert, nämlich die Publikationsqualität, die Verblindung und die Dauer der Nachbeobachtung. Die Autoren lieferten Richtlinien, um die Publikationsqualität bereits vor Vorlage des Manuskripts bei einem Verlag zu verbessern. Als Konsequenz unserer Analyse hat die Fachzeitschrift Transplantation ein allen zugängliches Register eingerichtet, in dem regelmäßig alle publizierten, randomisierten Studien auf ihre Qualität überprüft und bewertet werden.It was the intention of this work to systematically assess the scientific quality of large randomised controlled trials in kidney transplantation. By means of a tripartite instrument (Jadad-Scale, CONSORT-Checklist, 4-Degree- Scale) study and reporting quality as well as the availability of results were determined. Secondary we analysed the presentation and definition of acute rejection in detail. With the aid of potential influencing factors systematic differences between scientific cultures (America, Europe) were evaluated. Important results: Only 14/63 (22,2%) of evaluable study reports met a high study quality (Jadad-score >3). This reports also achieved a significant superior reporting quality (77,2% vs 66,7%, p=0,04). On average the study reports met 69,1% of the CONSORT-criterions of publication quality (range 33% 100%). The impact factor of the publishing journal significantly correlated with study- (p=0,012, r=0,32) and reporting quality (p=0,031, r=0,27). Only 8/41 (19,5%) of study reports on acute rejection provided a sufficient definition of the diagnosis acute rejection. The majority of reports (28/41, 68,3%) provided biopsy-proven acute rejection rates in combination with treated (n=4), clinical (n=7), presumed (n=8), acute (n=8) or clinical and presumed rejection (n=1). The calculated incidence of non- biopsy-proven acute rejection was 6,5% (range 0% 16,9%). In general, study reports on more than one diagnosis of rejection were published by high-impact journals. European study reports significantly more often reported on more than one diagnosis of rejection. Conclusion: The diagnosis acute rejection still is an accepted short-term marker for the definite endpoint graft- survival. To reliable achieve the findings of a clinical trial, the uniform definition of this term is essential. Thus the authors claim to report on biopsy-proven along with non-biopsy-proven acute rejection rates. Three essential items to improve the scientific quality in future were identified, namely reporting quality, allocation concealment and the duration of follow- up. The authors provided guidelines in order to improving reporting quality already before submission of a manuscript. According to our results the journal Transplantation established a registry of studies including all recently published randomised controlled trials in the field of transplantation to regularly provide the aim and the scientific quality of these trials

Chemosensory function in Wegener's granulomatosis: a preliminary report

Despite the fact that Wegener's granulomatosis affects the nasal and paranasal cavities and the cranial nerves regularly, chemosensory impairments have not been reported. The objective of this study is to test the three chemosensory systems, olfaction, taste, and intranasal trigeminal function in Wegener disease patients. We tested olfactory, gustatory, and intranasal trigeminal function in nine patients (5 women, 4 men, mean age 57 years) with confirmed Wegener's granulomatosis. Olfaction was tested with the Sniffin'Sticks, gustatory function with the "Taste strips" and intranasal trigeminal function with a lateralization task. One patient had anosmia (11%), four patients had hyposmia (44%) and four patients were normosmic (45%). Gustatory testing function showed pathological taste strip results in five patients (55%) and normal results in three patients (33%). One patient did not undergo taste testing. Intranasal trigeminal function was lowered in five patients (56%) and normal in four patients (44%). Neither previous nasal surgery status nor endoscopic status was associated to a higher frequency in pathological scores for any of the three chemical senses. In conclusion, these preliminary results suggest a consistent affection in chemosensory functions in Wegener's granulomatosis patients

Patient data: Results of olfactometry, gustometry and neurological examinations.

<p>Patient data: Results of olfactometry, gustometry and neurological examinations.</p

CISS sequence of OB, axial view.

<p>CISS sequence of OB, axial view.</p

Results of the MRI examination.

<p>Results of the MRI examination.</p

Topical Beclomethasone in the Therapy of Smelling Disorders—A New Application Technique

Systemic corticosteroid is the first-line-treatment for olfactory dysfunction of sinonasal origin but is afflicted with many side-effects. Topic corticosteroid does not reach the same efficacy but has a remarkable safety profile. In this trial we investigated the efficacy of topic therapy with beclomethasone (BDP) –spray. The drug was applied precisely to the olfactory cleft by a special spraying top-part. In addition we determined extinction and volume of a gelaspon sponge placed in the olfactory cleft to show the difference of the topical spray application. 18 patients with anosmia or hyposmia of different genesis and duration applied BDP-spray twice daily for four weeks. The olfactory function was determined using the TDI score (‘Sniffin’-Sticks test battery’). Factors correlated with therapy efficacy were assessed. The median TDI score increased from 13.5 (0–25) at the beginning to 18.5 (1–26) after therapy of four weeks (P = 0.005). The extinction and volume in the moistened sponge was more than two times greater with the top-part than without. The direct application of BDP-spray to the olfactory cleft attained superior therapeutic effects than a usual applied mometasone spray, but did not perform as good as systemic corticosteroid treatment