Olfactory dysfunction seems to be one of the most frequent symptoms in idiopathic parkinsonian syndrome (IPS). In contrast to the increasing number of studies providing evidence of the usefulness of olfactory tests in the diagnosis of IPS, clinical assessment of olfactory function is rarely performed. This may be due to the lack of an easy-to-use, inexpensive, standardized, and reliable test. In this study, we administered the newly developed "sniffin' sticks" test to a group of 40 nondemented IPS patients and compared the results with 40 healthy controls matched for age, gender, and smoking habits. In all three subtests including odor identification, odor detection threshold, and odor discrimination, the control group scored significantly better than the IPS group, yielding a specificity and sensitivity of 90% each. Our results indicate that olfactory disturbances in IPS can be found at early stages of the disease, appear bilaterally, and do not correlate with the dominant side of parkinsonism. Therefore, we emphasize that olfactory testing may be a useful tool in the diagnosis of IPS.
Although operative treatment of Wilms' tumors has become more straightforward as a result of advances in preoperative treatment and precise diagnosis, vascular involvement by the tumor can cause serious problems at operation. These problems can be more easily managed if they have been identified pre-operatively and the level of the intravascular tumor thrombus has been defined. In this study we propose a classification of intravascular involvement of Wilms' tumors suggesting the clinical consequences and operative strategy. In our series of 84 patients we treated 7 (8.3%) with preoperatively diagnosed intracaval tumor thrombus using ultrasound as the most sensitive non-invasive diagnostic technique. The surgical therapy depends on the stage; stage III and stage IV should be operated in cooperation with the cardiovascular surgeon in deep hypothermic circular arrest.
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