[Olfactory evoked potentials and contingent negative variation in expert assessment of disordered sense of smell]. / Olfaktorisch evozierte Potentiale (OEP) und Contingent Negative Variation (CNV) bei der Begutachtung von Riechstörungen.

Normally, the sense of smell is assessed by means of traditional subjective tests (sniff test, gustatory smell test, and trigeminus test). When results are inconclusive, an objective smell test is indicated. Simultaneously registering olfactory evoked potentials (OEP) and contingent negative variation (CNV) permits evaluation of both odor perception and odor discrimination. We can even objectively assess the false olfactory sensations in parosmia patients who are unable to discriminate between different odors. In this study, the results of 59 patients with olfactory disorders are presented. Head trauma and upper respiratory infections were the most common causes of the patients' complaints. In twelve cases, lack of cooperation and patient unrest prevented us from evaluating the data. In anosmia, the objective results agreed completely with the patient's subjective assessment. In hyposmia and parosmia, the results agreed with the patient's subjective assessment in most cases; here we were able to arrive at a more specific diagnosis in several cases. The objective smell test can be used to supplement subjective methods and thus provide more reliable assessment of olfactory disorders.

Diagnostic efficiency of troponin T measurements in acute myocardial infarction.

BACKGROUND: The present study was designed to evaluate the efficiency of a newly developed troponin T enzyme immunoassay for the detection of acute myocardial infarction. METHODS AND RESULTS: The study comprised 388 patients admitted with chest pain and suspected myocardial infarction and 101 patients with skeletal muscle damage and additional suspected myocardial cell damage. Troponin T was elevated to more than twice the analytical sensitivity of the assay (0.5 microgram/l) in all patients with non-Q wave (range, 1.2-5 micrograms/l) and Q wave infarction (range, 3-220 micrograms/l). Troponin T appeared in serum as early as 3 hours after onset of pain in 50% of the patients and remained elevated in all patients for more than 130 hours, revealing release kinetics of both free cytosolic and structurally bound molecules. The diagnostic efficiency of troponin T was superior to that of creatine kinase-MB (98% versus 97%) and remained at 98% until 5.5 days after admission, if patients with unstable angina were excluded from analysis. In the 79 patients with unstable angina, troponin T was elevated (range, 0.55-3.1 micrograms/l) in at least one blood sample from each of 37 patients (56%). Circulating troponin T was correlated to the presence of reversible ST segment or T wave changes on the electrocardiogram (p less than 0.005) and to the frequency of in-hospital complications. In the 101 patients with skeletal muscle damage and suspected additional cardiac muscle damage, troponin T was the most useful test; its efficiency was 89% or 94% (depending on the discriminator value used) as compared with 63% for creatine kinase-MB. CONCLUSIONS: Thus, the data of the study indicate that the newly developed troponin T test improves the efficiency of serodiagnostic tools for the detection of myocardial cell necrosis as compared with conventionally used cardiac enzymes.