Pharmacokinetic profile of alniditan nasal spray during and outside migraine attacks.
AIMS: To compare the pharmacokinetic profile of intranasal alniditan during and outside migraine attacks, and to investigate the relationship between initial rise of alniditan plasma concentration, and headache improvement. METHODS: Twenty-seven migraine patients (age: 18-65 years) were randomized to receive alniditan 2 mg or 4 mg, and investigated both during and outside a migraine attack. Maximal plasma concentrations (Cmax), time to Cmax (tmax), and the area under the curve over 2 h (AUC(0,2 h)), were calculated from the individual plasma concentration-time profile, obtained from 10 blood samples in each patient, during each of the two administrations. RESULTS: Alniditan was rapidly absorbed into the systemic circulation (tmax=11 min). All investigated pharmacokinetic parameters (Cmax, tmax, AUC(0,2 h)) were similar during and outside migraine attacks, both in the 2 mg (n = 13) and the 4 mg group (n = 14). In the 4 mg group, during attacks, mean plasma alniditan concentration at 5 min after administration (Ct=5) in responders (21+/-16 ng ml(-1); n=10) was significantly higher than the Ct=5 in nonresponders (3+/-3 ng ml(-1); P=0.01; n=4). However, the Cmax and AUC(0,2 h) in responders (33+/-18 ng ml(-1) and 12+/-6 ng ml(-1) h) were also significantly higher than the Cmax and AUC(0,2 h) in nonresponders (13+/-9 ng ml(-1); P=0.048 and 5+/-3 ng ml(-1) h; P=0.03). CONCLUSIONS: Absorption of alniditan nasal spray was not affected by migraine attacks, although 95% confidence intervals were wide. Early rise of plasma concentrations and the amount of drug in the circulation were related to headache improvement in the higher dose group. (+info)
Long-term effects on the olfactory system of exposure to hydrogen sulphide.
OBJECTIVE: To study chronic effects of hydrogen sulphide (H2S) on cranial nerve I (nervi olfactorii), which have been only minimally described. METHODS: Chemosensations (smell and taste) were evaluated in eight men who complained of continuing dysfunction 2-3 years after the start of occupational exposure to H2S. Various bilateral (both nostrils) and unilateral (one nostril at a time) odour threshold tests with standard odorants as well as the Chicago smell test, a three odour detection and identification test and the University of Pennsylvania smell identification test, a series of 40 scratch and sniff odour identification tests were administered. RESULTS: Six of the eight patients showed deficits of various degrees. Two had normal scores on objective tests, but thought that they continued to have problems. H2S apparently can cause continuing, sometimes unrecognised olfactory deficits. CONCLUSION: Further exploration into the extent of such problems among workers exposed to H2S is warranted. (+info)
Smell and taste disorders: a primary care approach.
Smell and taste disorders are common in the general population, with loss of smell occurring more frequently. Although these disorders can have a substantial impact on quality of life and may represent significant underlying disease, they are often overlooked by the medical community. Patients may have difficulty recognizing smell versus taste dysfunction and frequently confuse the concepts of "flavor" and "taste." While the most common causes of smell disturbance are nasal and sinus disease, upper respiratory infection and head trauma, frequent causes of taste disturbance include oral infections, oral appliances (e.g., dentures), dental procedures and Bell's palsy. Medications can interfere with smell and taste, and should be reviewed in all patients with reported dysfunction. In addition, advancing age has been associated with a natural impairment of smell and taste ability. A focused history and a physical examination of the nose and mouth are usually sufficient to screen for underlying pathology. Computed tomographic scanning or magnetic resonance imaging of affected areas, as well as commercially available standardized tests, may be useful in selected patients. The causes of olfactory dysfunction that are most amenable to treatment include obstructing polyps or other masses (treated by excision) and inflammation (treated with steroids). Enhancement of food flavor and appearance can improve quality of life in patients with irreversible dysfunction. (+info)
A 70-year-old man with isolated weight loss and a pellagra-like syndrome due to celiac disease.
An elderly man was diagnosed with celiac disease, which presented with three notable features: first, presentation at the age of 70 with no prior gastrointestinal symptomatology or positive family history; second, triggering of all symptoms following recent myocardial infarction and infective endocarditis; third, presentation with marked (more than 20 percent) weight loss and pellagra-like skin lesions despite nearly normal examination and laboratory tests. Thus, celiac disease may present as a pellagra-like syndrome in the elderly with predominant weight loss that is enhanced by the related taste disturbances. (+info)
Clinical bitterness masking test for phantogeusia.
It is difficult to determine the reason why a patient complains of a bitter taste when their mouth is empty. We examined a new diagnostic test using a bitterness masking substance. The bitterness masking substance, 'Benecoat BMI-60' (hereafter BMI-60), is a masking substance specific to the taste cells' bitterness receptors. After patients gargled with BMI-60 solutions, the phantom sensation of bitterness was masked in some patients, but was not masked in others. Bitter substances in saliva seemed to be masked by BMI-60, but bitterness did not seem to be masked when the locus of the phantom sensation was within the peripheral nerve and/or the brain. The bitterness masking test is useful for diagnosis of the phantom sensation of bitter taste. (+info)
Changes in taste intensity perception following anterior temporal lobe removal in humans.
To investigate the role of the anterior temporal lobe in taste perception, we compared taste intensity estimations made by patients who had removal from either the left or the right anterior temporal lobe for the treatment of intractable epilepsy with a group of healthy control subjects. Estimations were made for five concentrations of each of four different tastes, as well as for five cards of varying saturations of gray, which served as a control task. A cross-modal magnitude estimation procedure was employed in which subjects used distance on a measuring tape to reflect intensity estimation. Distances were then transformed into logs, and the slope and the correlation with stimulus concentration or saturation was calculated. Correlation was taken as a measure of accuracy of estimation and slope was taken as a measure of perceived intensity. As predicted, repeated measures analysis of variance (ANOVA) revealed a significant difference between the control group and both patient groups in taste intensity estimations, but not for grayness, reflecting the importance of the anterior temporal lobe in low-level gustatory but not visual perception. Additionally, repeated measures ANOVA for slopes indicated that subjects in the right temporal group rated the bitter taste as more intense than did subjects in other groups, possibly reflecting increased intensity perception of the unpleasant bitter taste. (+info)
Taste confusions following chlorhexidine treatment.
Chlorhexidine, a bitter bis-biguanide antiseptic, is the only known blocker of the human salty taste. In order to characterize the effects of chlorhexidine on stimulus identification, taste confusion matrix (TCM) performance was measured for subjects treated with 1.34 mM chlorhexidine gluconate (n = 9) and water controls (n = 9). Ten stimuli [water, 0.1 M NaCl, 0.1 M KCl, 0.1 mM quinine-HCl (QHCl), 0.1 M monosodium glutamate (MSG), 3 mM citric acid, 0.3 M sucrose and mixtures of NaCl, QHCl and citric acid with sucrose] were presented in 10 replicates for identification from a list of 10 stimulus names. T(10), a measure of performance consistency from information theory, was lower for chlorhexidine-treated subjects (2.02 +/- 0.11 bits) than controls (2.73 +/- 0.11 bits) (P < 0.0001). T(2), an indirect measure of pairwise stimulus discrimination, approached chance levels (0.40 bit) in chlorhexidine-treated subjects for all possible pairs of NaCl, KCl, QHCl and water, as well as pairs composed of sucrose and the NaCl-sucrose and quinine-sucrose mixtures. In controls T(2) values approached perfect scores (1.00 bit) for all stimulus pairs except NaCl-KCl and NaCl-MSG. The results demonstrate a decreased ability to identify taste stimuli that is consistent with alterations in the ability of stimuli to elicit salty and bitter taste perceptions. As a selective, effective, persistent and reversible blocker of taste perceptions, chlorhexidine should prove useful in defining taste mechanisms in humans. (+info)
Management of smell and taste problems.
Lost or impaired smell or taste should be taken seriously, as it puts a person at higher risk for toxic exposures, such as gas leaks, smoke, and rotting food, and it also takes away the enjoyment of some of life's pleasures, such as the fragrance of flowers or the taste of good food or fine wine. In many patients, the loss follows a viral upper respiratory tract infection, and the only real treatment is to reassure patients that the problem may resolve if the damaged sensory cells regenerate. In other patients, the loss has more subtle causes and deserves a careful investigation and appropriate treatment. This article reviews the proper steps to take when investigating and treating chemosensory difficulties. (+info)