Olfaction in pregnancy: systematic review and meta-analysis.

Little attention has been paid to olfactory changes during pregnancy with contemporary studies limited in number and sample size. We examined whether pregnancy is associated with differences in olfactory performance and if there were any specific gestational ages at which these differences occur through a comprehensive systematic review and meta-analysis of the current literature. An initial electronic database search identified 234 citations, which were screened at the abstract level. Twenty-three citations were germane for full-text review, and 13 met criteria for inclusion. Our review assessed 5 olfactory measures of interest: odor identification (n = 11 articles), threshold (n = 8), discrimination (n = 5), hedonics (n = 6), and intensity (n = 5). Nine of these 13 studies contained sufficient data for meta-analysis, and these studies included a total of 523 pregnant women and 365 non-pregnant controls. Despite previous subjective and objective reports of odor intolerances and odor hypersensitivity, we did not find any significant differences between pregnant and non-pregnant women in odor discrimination, thresholds, or hedonics. However, meta-analysis of 506 cases and 333 controls showed worse odor identification in pregnant women compared to controls in a random-effects model. Thus, we demonstrate worse performance at odor identification during pregnancy. In this review, we discuss the current evidence (and lack thereof) regarding olfaction in pregnancy as well as highlight current knowledge gaps in this field.

Reduction in deep vein reflux after concomitant subfascial endoscopic perforating vein surgery and superficial vein ablation in advanced primary chronic venous insufficiency.

BACKGROUND: Subfascial endoscopic perforating vein surgery (SEPS) and superficial vein surgery (SVS) have been the recommended treatment for advanced chronic venous insufficiency (CVI), despite a high prevalence of deep vein reflux in these patients. The anatomic and hemodynamic results of these procedures, however, remain uncertain. It is hypothesized that concomitant SEPS and SVS would result in a reduction of deep vein reflux in patients with advanced primary CVI. We investigated the effect of concomitant SEPS and SVS on deep vein reflux as well as the associated hemodynamic and clinical changes after surgery in a cohort of patients with advanced primary CVI. METHODS: We prospectively evaluated 53 consecutive SEPSs with concomitant SVS procedures in 47 patients with advanced primary CVI. There were 25 men and 22 women with a mean age of 58 years at operation. Thirty-four procedures (64%) were performed for limbs with active venous ulcers (class 6), and the other 19 procedures were performed for 15 class 5 limbs, one class 4a limb, and three class 4b limbs, respectively. Duplex scan and air plethysmography were performed before operation, at 1 month, and at 1 year after operation. The patients were followed up regularly with clinical assessment, and the ulcer healing and recurrence rates were documented. RESULTS: The proportion of limbs with common femoral vein incompetence decreased from 68% to 28% at 1 month and to 32% at 1 year after operation. The proportion of limbs with deep vein incompetence at more than one site also decreased from 42% to 15% at 1 month and to 12% at 1 year after concomitant SEPS and SVS. Venous hemodynamics as measured by air plethysmography improved significantly after operation. The cumulative ulcer healing was 85% at 3 months and 97% at 6 months. With a mean follow-up of 31 +/- 16 months, all ulcers healed. Only three recurrent ulcers (6%) were detected during the follow-up period. CONCLUSION: Concomitant SEPS and SVS are effective in reducing deep vein reflux and results in hemodynamic and clinical improvements in patients with advanced primary CVI. Deep vein reconstruction procedures may not be necessary in these patients.

Accelerated progression of carotid stenosis in patients with previous external neck irradiation.

OBJECTIVE: Radiotherapy to the head and neck often results in carotid stenosis, but the course of disease is unknown. We investigated the natural history and progression of asymptomatic carotid stenosis induced by external irradiation. Patients and methods The study included 130 carotid arteries in 95 patients who had received external radiation therapy to the head and neck area and who had asymptomatic, mild internal carotid artery or common carotid artery stenosis. Stenosis of 15% to 49% on duplex ultrasound (US) scans defined mild (<50%) disease. Another 95 arteries in 74 patients with matched degree of carotid artery stenosis but who had not received radiation therapy were used as control. Both groups were followed up prospectively with serial duplex US scanning, and degree of carotid artery stenosis was categorized as 15% to 49%, 50% to 69%, 70% to 99%, and occlusion. Progression of carotid artery stenosis was defined as increase in stenosis from less than 50% to 50% or greater at ultrasonography. Secondary end points included progression to higher disease category, new cerebrovascular symptoms, and death. Data from irradiated arteries was compared with control data with the life table method. A Cox regression model was used to analyze disease progression, adjusted for covariates of sex, age, smoking, diabetes, and hypertension. RESULTS: Mean follow-up was 36 months. Adjusted freedom from progression rates at 3 years were 65% for irradiated arteries and 87% for control arteries at life-table analysis (P =.035; odds ratio, 3.1). The annualized progression rate from less than 50% to 50% or greater in irradiated arteries was 15.4%, compared with 4.8% in nonirradiated arteries. A long history of cervical irradiation (>6 years) was the only significant risk factor for disease progression. There was no difference between the two groups regarding development of new symptoms or mortality. CONCLUSIONS: Carotid stenosis associated with external irradiation progresses more rapidly compared with nonirradiated atherosclerotic arteries. Aggressive surveillance is recommended.

Ultrasonic analysis of plaque characteristics and intimal-medial thickness in radiation-induced atherosclerotic carotid arteries.

OBJECTIVES: to investigate the effect of external irradiation on the morphology of atherosclerotic plaques and the intimal-medial thickness of the carotid artery. METHODS: a group of 46 patients (16 symptomatic) who had received external irradiation to the head and neck area more than five years previously and developed carotid stenosis exceeding 50%, were evaluated by duplex ultrasound. The carotid artery lumen, intimal-medial complex, and the plaque echogenicity was determined using computer digital image processing methods. Forty-six age and sex matched patients with similar degrees of non-radiation associated carotid stenosis were used as controls. RESULTS: irradiated stenotic carotid arteries had a greater intimal-medial thickness (0.96 mm vs 0.80 mm, p=0.008) and a narrower lumen (5.5 mm vs 6.6 mm, p<0.001) than the controls. The carotid plaque characteristics (gray-scale median (GSM) and heterogeneity) of the irradiated and control groups did not differ significantly. Symptomatic patients who had received external radiotherapy to the head and neck have a more echolucent plaque (mean GSM of 98) than their asymptomatic counterparts (mean GSM 114, p=0.03). Intimal-medial thickness and carotid lumen was not related to the occurrence of symptoms. CONCLUSIONS: external irradiation to the head and neck area leads to significantly increased thickness of the carotid wall and a corresponding narrowing of the lumen. There seems to be no difference in the plaque characteristics between irradiation-induced and spontaneous carotid atherosclerosis.

Early and late outcomes in Hong Kong Chinese patients undergoing carotid endarterectomy.

OBJECTIVE: To determine the benefit of carotid endarterectomy (CEA) for stroke prevention by reviewing the early and late outcomes of Hong Kong Chinese patients undergoing CEA who have a high reported incidence of intracranial atherosclerotic disease (IAD). METHODS: Fifty-nine Chinese patients underwent 62 CEA. There were 48 males and 11 females, with a mean age of 70 +/- 7 years (range: 52 - 86 years). Twenty-one CEA (34%) were performed for asymptomatic disease. Duplex scan was the primary tool of evaluation prior to surgery. Preoperative angiography was done in 36 instances (58%). All CEA were performed under general anaesthesia with routine intraoperative shunting. The arteriotomy was closed primarily in all patients except three. Patients were followed up regularly with six-monthly Duplex scan surveillance. RESULTS: There were 2 perioperative neurological events consisting of one transient ischemic attack and one minor stroke. There was no operative mortality or major morbidity such as bleeding or cranial nerve injury. Mean hospital stay was 6.5 +/- 4 days (range: 3 - 26 days). The patients were followed up for a mean interval of 24 +/- 17 months (range: 1 - 57 months). Seven patients died during follow-up and subsequent neurological events occurred in 5 patients, including 2 fatal strokes. The 3-year survival, freedom from stroke and stroke free survival were 86%, 87% and 83%, respectively. One recurrent stenosis of 80% was detected on follow-up Duplex scan. CONCLUSIONS: Despite a high incidence of IAD, CEA in Hong Kong Chinese patients is associated with acceptable perioperative morbidity and mortality with satisfactory long-term efficacy in stroke prevention.