Patients and experiences from the first Danish flavour clinic.

INTRODUCTION: Chemosensory dysfunction is common. Although patients complain of taste loss, the most common cause of a diminished taste experience is olfactory dysfunction. METHODS: Since January 2017, patients with complaints about smell and/or taste loss have been referred to the Flavour Clinic by ear, nose and throat (ENT) practitioners. Prior to referral, CT, endoscopy of the nasal cavity and allergy testing were required. Patients underwent full olfactory and gustatory testing, complete ENT and neurological examination and review of medicine and medical history. Patients also completed different questionnaires such as the Mini Mental Status Examination, the Sino-Nasal Outcome Test and the Major Depression Inventory. RESULTS: Among 515 patients, 97% complained of olfactory loss and 82% complained of taste loss. While 89% had a measurable olfactory deficit, only 22% were found to have a gustatory deficit. CONCLUSIONS: An accurate distinction between smell and taste requires application of validated chemosensory tests and specialised knowledge. As this is not readily available in all ENT clinics, sensory loss without a clear aetiology should be referred to a more specialisedcentre. FUNDING: none. TRIAL REGISTRATION: not relevant.

Small unrepaired atrial septal defects display impaired exercise capacity compared with healthy peers.

OBJECTIVE: Adult patients with small, unrepaired atrial septal defects have an increased risk of pneumonia, atrial fibrillation, and stroke. Furthermore, they have higher late mortality than the background population. The functional capacity is unknown in these patients. Therefore, our objective was to determine exercise capacity in adult patients diagnosed with an unrepaired atrial septal defect compared to healthy controls. DESIGN: A cross-sectional study. PATIENTS: Adult patients with small, unrepaired atrial septal defects, aged 18-65, diagnosed between 1953 and 2011. INTERVENTIONS: Cardiopulmonary exercise test was performed using an incremental bicycle test and gas exchange was measured using breath-by-breath technique. OUTCOME MEASURES: Primary outcome was peak oxygen uptake, secondary outcome was maximal workload and ventilatory anaerobic threshold. RESULTS: We included 32 patients previously diagnosed with a small, unrepaired atrial septal defect and 16 healthy, age- and gender-matched controls (age 36.3 ± 13 years). Patients were divided into two groups based on whether the atrial septal defect was open (age 36.3 ± 11 years) or spontaneously closed (age 36.8 ± 14 years) since time of diagnosis. No differences in demographic characteristics or weekly exercise levels were found. Both patient groups reached lower peak oxygen uptake (open: 31.7 ± 11 mL/kg/min; spontaneously closed: 29.7 ± 6.9 mL/kg/min) compared with controls (42.6 ± 6.1 mL/kg/min; P = .0001). Workload (open: 2.6 ± 1.0 watt/kg; spontaneously closed: 2.5 ± 0.6 watt/kg) and aerobic capacity (open: 21.4 ± 8.7 mL/kg/min; spontaneously closed: 22.5 ± 6.5 mL/kg/min) was also poorer in patients compared to controls (workload: 3.5 ± 0.5 watt/kg; P = .0006, aerobic capacity: 31.3 ± 6.8 mL/kg/min; P = .0007). CONCLUSION: Adult patients with a diagnosis of small, unrepaired atrial septal defect have significantly impaired exercise capacity when compared to healthy controls. The impairment was present even if, by the time of assessment, the defect had closed spontaneously. The pathophysiological mechanisms behind the impaired exercise capacity demonstrated in these patients remain unexplained and will be a target for future work.

Computed tomography fistulography of the sternum. A case report on interprofessional collaboration between radiologist and surgeon.

INTRODUCTION: Trans sternal fistula can occur after sternotomy/heart surgery. Diagnosing this can be difficult. PRESENTATION OF CASE: In this report, we present a unique case of a patient with infection of an ascending aortic prosthetic graft. This patient was oozing from the wound despite several revisions. Many fistulographies were performed before fistulography with surgeon and radiologist revealed a trans sternal fistula. DISCUSSION: Infection with Propionibacterium acnes is often difficult to diagnose. This is in line with the present case, where a surgeon guided fistulography had to be performed followed by appropriate redo surgery with succesful subsequent sternal wound healing. CONCLUSION: Our case demonstrates the importance of performing a fistulography with the presence of a surgeon, to obtain the best possible result.