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The clinical records of 889 patients with olfactory disturbance who had been examined at the Olfaction Clinic, Osaka City University Hospital, Japan from January 1982 to December 1996 were studied in order to investigate the relationship between the patients' characteristics and their prognoses. Aetiologically the characteristic variables of “head trauma” and “congenital” had the greatest influence on prognosis, representing poor recovery. The patients with “rhinitis” and “head trauma” showed faster improvement of olfactory disturbance in “females”, “those with short duration of olfactory disorder” and “those with high olfactory acuity before treatment”. None of the characteristic variables influenced prognosis in the patients with “viral infection”. Age did not significantly influence prognosis. Improvement was recognized in most patients within 6 months. Hence, we should treat patients with olfactory disturbance for at least this length of time. [ABSTRACT FROM AUTHOR]

Postviral olfactory disorder develops after infection with the common cold, and is a relatively severe and prolonged disorder without rhino-sinusitis. This epidemiological study aimed to characterize its clinical pathology and determine the causative virus. Postviral olfactory disorder occurs most commonly in middle-aged women and is most prevalent in spring and summer. A comparison of the monthly frequency of the disorder with the incidence of isolation of various viruses suggest that the influenza virus, respiratory syncytial virus, and herpes virus are not causative viruses, while parainfluenza virus type 3 is most likely to be a causative virus. This conclusion is supported by immunological study and analysis of symptoms of the cold. All patients with postviral olfactory disorder had increased serum antibody titre for parainfluenza virus type 3. No prominent or specific symptoms of common cold were identified as a potential trigger of this syndrome in patient questionnaires. [ABSTRACT FROM AUTHOR]

We administered zinc sulfate to patients with sensorineural (post-viral, post-traumatic, or unknown aetiology) olfactory disorder and examined its effects. The patients were divided into three groups by method of treatment: zinc sulfate only, combination of zinc sulfate and the usual therapy, or the usual therapy. For disorders of post-viral and unknown aetiologies, there were no significant differences in improvement among the three groups. However, for post-traumatic olfactory disorder, the zinc sulfate groups had significantly higher improvement rates than did the group that received the usual therapy. The difference between post-traumatic and post-viral olfactory disorders in the effect of zinc sulfate therapy appeared to depend on the pathology of the associated lesions. In cases of post-traumatic olfactory disorder, regenerative capacity is retained in the olfactory epithelium because the blast cells of olfactory receptor cells remain intact. However, for post-viral olfactory disorder, the lack of olfactory receptor cells and blast cells due to viral infection results in loss of regenerative capacity. We also determined pre-treatment serum zinc concentrations in those patients who planned to be treated with zinc sulfate. Pre-treatment serum zinc concentration was not significantly related to improvement rates. [ABSTRACT FROM AUTHOR]

Langerhans cell sarcoma (LCS) is a rare neoplastic proliferation of Langerhans cells with a poor prognosis. Owing to its rarity, standard treatment for LCS has not been established to date. Here, we report a case of LCS occurring in multiple lymph nodes in the right cervix in which remission is maintained by autologous hematopoietic stem cell transplantation (auto-HSCT) after surgical resection. A 58-year-old male presented with enlarged right submandibular lymph nodes. Positron-emission tomography/computed tomography (PET/CT) revealed multiple lymphadenopathies in his right cervix. We performed a lymph node biopsy, and he was diagnosed with LCS. We selected the CHOP regimen as the first-line chemotherapy; however, rapid disease progression was observed soon after the first cycle of the therapy. The neck dissection was performed on day 16 of the CHOP therapy. As the residual tumor was suspected, we started the second-line chemotherapy with a combination of etoposide, cisplatin, ifosfamide, and gemcitabine; complete remission was confirmed by PET/CT. Subsequently, the patient was administered high-dose chemotherapy with auto-HSCT. After 2 years of auto-HSCT, complete remission has been maintained. Although there is no report of auto-HSCT for LCS, it could be an effective therapeutic tool for the disease.

In a taste disorder, an agreement between patients' complaints and gustatory function test results is not necessarily found both at the initial hospital visit and during the course of treatment; therefore, it is difficult to assess treatment responses and review treatment strategies based on the assessed treatment responses. The present study investigated the time course of changes in disc gustometry results and subjective symptom scores measured at 4-week intervals in 44 patients with a taste disorder who were considered eligible for zinc replacement treatment and who received polaprezinc at a dose of 150 mg/day (equivalent to a 34 mg/day dose of zinc) for up to 24 weeks. The study also examined the potential differences in treatment outcomes according to the predictive factors for response such as patient background and assessed disc gustometry results during the course of treatment. Results indicated that disc gustometry results and subjective symptom scores showed different time courses of changes. The response rate as measured by disc gustometry was 47.7% at week 12 of treatment, and showed a subsequent slow increase to 56.8% at week 24. On the other hand, subjective symptom scores showed a time-proportional improvement up to week 24. Among the patients included in the present study, a clear difference was found according to the presence or absence of an improving trend as determined by disc gustometry at week 12 of treatment, although there were no differences in ultimate treatment responses, including categories of taste disorder, according to patient background. Patients showing a trend toward improvement had significantly better treatment responses in terms of both ultimate response rates and subjective symptom scores, whereas patients showing no trend toward improvement were less likely to respond to the subsequent 12-week continued treatment.

Diagnosis and treatment of taste disorders are challenging because the disorder can only be determined by the awareness of the patient. Hence, these disorders still require comprehensive evidence. We conducted a randomized, placebo-controlled double-blind study to investigate the effect of polaprezinc, a zinc-containing agent, in 219 patients with either zinc deficiency-inductive or an idiopathic taste, disorder. As a result, the zinc-treated arm experienced a statistically significant improvement against the placebo-treated arm in the perceptible threshold scores of the filter-paper disk method 8 weeks after the administration of the investigational drug. Moreover, the effect lasted for 4 weeks after discontinuation of the drug. However, the effective ratios based on the initial criteria were 55.6% in the treatment group and 43.2% in the placebo, where no statistical significance was recorded. Sex and degree of depression could be two of the potential factors to explain this discrepancy. Furthermore, the effect was not significant among male patients and patients with a high depression score based on the Self-rating Depression Scale (SDS) test. These results indicate that determining the symptom among such patients remains undisclosed. Whereas, in approximately 77%, or 168 patients with "normal" SDS scores and with completely impaired taste qualities, the ratio of effective cases reached 60.9% in the zinc-treated group, the ratio of the placebo-treated group reached 39.5%, resulting in a statistical significance. This may be partly because of a problem in the adaption of male subjects to the gustatory analyses, especially to the identification of saltiness and sourness. Care must also be taken regarding the depressive state of patients when diagnosing and treating taste disorders. Taste disorders caused by depression may not be cured by zinc supplementation due in part to the fact that the symptom is based on a mental issue, and due in part to the conservative responding bias generated by the depression itself, which may inhibit accurate and precise diagnosis of the disorder. In conclusion, administration of a zinc agent is effective for patients with taste disorders, provided selection of appropriate patients is performed, and that proper examination and evaluation are conducted. The present study also indicated that examining depressiveness based on the SDS scores and investigating disturbance of each taste quality using the filter-paper disk method are recommended for the diagnosis and determination of the treatment effect of a taste disorder.