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Synthetic D(-)penicillamine in rheumatoid arthritis. Double-blind controlled study of a high and low dosage regimen.

Doses of 600 mg and 1200 mg of D(-)penicillamine daily were superior to a standard regimen of therapy in rheumatoid arthritis. The higher dose did not produce significantly greater therapeutic benefit in the group of patients so treated, although individual patients sometimes improved more. The frequency of rashes, blood dyscrasias, and withdrawals from the trial increased withe dosage. It is concluded that D(-)penicillamine is a useful treatment that the daily dose should be as low as possible, and that it should be increased at infrequent intervals only, with due regard to the likelihood of further improvement in relation to an increased risk of adverse reactions.

Acetaminophen↗

Eye pain with nifedipine and disturbance of taste with captopril: a mutually controlled study showing a method of postmarketing surveillance.

Several notifications of eye pain and blurred vision associated with treatment with nifedipine were received by New Zealand's Intensive Medicines Monitoring Programme. A questionnaire survey of patients taking nifedipine was undertaken to test the importance of these associations, with disturbance of taste associated with captopril taken as a methodological control. Altogether 961 patients taking nifedipine and 368 taking captopril were sent a questionnaire that asked whether any eye problems and changes in the sense of taste had occurred while they were taking the drug and whether these had resolved after treatment was stopped. Compliance was high: of 922 and 343 questionnaires that were assumed to have been delivered to patients taking nifedipine and captopril, respectively, 770 (84%) and 295 (86%) were returned satisfactorily completed. The distribution of sex was comparable in the two groups; patients taking captopril were slightly younger. Eye symptoms were reported in both groups, but eye pain was significantly more common in patients taking nifedipine (107 (14%) compared with 26 (9%) patients taking captopril). This is a new finding and may be related to ocular vasodilatation. Theoretically, glaucoma is a possible adverse reaction. Loss of taste was significantly associated with captopril, but no other disturbances of taste showed significant associations. Loss of taste persisted in 27 out of 35 patients who continued to take captopril and in three out of eight patients when the drug was withdrawn. This study showed a method of assessing early signs of adverse drug reactions, which has been used once before and identified previously unrecognised reactions.

Adolescent↗

Taste and smell.

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Aged↗

Concurrent Bell's palsy and diabetes mellitus: a diabetic mononeuropathy?

In a series of 126 patients with Bell's palsy, chemical or overt diabetes mellitus was found in 39% of the cases. A high frequency of disturbances of taste was found in the patients who had no diabetes (83%), as compared to only 14% of diabetic patients whose taste was affected (p less than 0 .001). Thus, the usual site of facial nerve lesion in diabetics appears to be distal to the chorda tympani, while in patients whose glucose tolerance is normal, no such selectivity exists. This may only be explained by a diabetes-related pathogenesis and a vascular rather than a generalised "metabolic" impairment is postulated, leading to a localised facial nerve ischaemia in the distal part of the Fallopian canal. Thus, some cases of Bell's palsy may in fact be a diabetic mononeuropathy.

Diabetic Neuropathies↗

Abnormalities in taste preference in hypothyroid rats.

Rats made hypothyroid by administration of radioactive iodine and age-matched controls were individually caged and offered a choice between either water or varying concentraions of sweet (sucrose), bitter (quinine sulfate), salty (NaCl) or sour HCl solutions to drink ad libitum for 48 h periods. Comparative measurements were made of the volume of test solution consumed to that of total volume consumed and were expressed as taste preferences. Throughout a wide range of concentrations, taste preferences for sucrose were significantly lower (P less than 0.001) and those for quinine sulfate and NaCl significantly higher (P less than 0.001) in hypothyroid animals than in controls. Taste preferences for HCl were generally similar in both groups. Daily intraperitoneal injections of thyroxine, 10 mug/100 g body wt. to hypothyroid rats for 18-24 days eliminated completely the difference between hypothyroid and control rats in taste preference for quinine sulfate. These studies show that significant and reversible changes in taste preferences occur in rats rendered hypothyroid with radioactive iodine.

Animals↗

Altered taste sensitivity in obese, prediabetic OLETF rats lacking CCK-1 receptors.

Otsuka Long-Evans Tokushima fatty (OLETF) rats lack the CCK-1 receptor, are hyperphagic, progressively become obese, and develop type-2 diabetes. We recently demonstrated an increased preference for both real and sham feeding of sucrose in this strain, suggesting altered orosensory sensitivity. To investigate taste functions, we used an automated gustometer with 10-s access to different concentrations of various sapid stimuli. Tests were repeated at 10 and 18 wk of age to assess the early and advanced stages of prediabetes, respectively. Compared with age-matched, nonmutant controls, the OLETF rats showed higher avidity for sucrose at both ages. This difference increased as a function of age and tastant concentration. An exaggerated response also occurred for saccharin, alanine, and fructose, but not for Polycose. Similarly, OLETF rats consumed monosodium-glutamate more at the lower concentrations compared with controls, an effect that age also accentuated. In contrast, there was no statistical strain or age differences in responses to NaCl, MgCl2, citric acid, quinine-HCl, and the trigeminal stimulus capsaicin. These findings demonstrate that compared with controls, OLETF rats differ in their gustatory functions with an overall augmented sensitivity for sweet that progresses during prediabetes. This effect explains their overconsumption of sweet solutions and may contribute to the overall hyperphagia and obesity in this strain.

Animals↗

Satiety effects of cholecystokinin and caerulein in rabbits.

Six adult rabbits were maintained on an 18 h fast, 6 h feeding schedule. At the end of the fast either 0.5-40 Ivy dog units (IDU)/kg cholecystokinin (CCK) or 0.9% NaCl were injected intravenously. Feed intake was then measured for 15 min. Significant depression of intake was found at 1 IDU/kg, a 50% depression of intake after 5.5 IDU/kg, and no intake after 40 IDU/kg. Caerulein in similar experiments gave significant depression of intake at 0.125 microgram/kg, a 50% depression after 0.28 microgram/kg, and no intake after 5.0 microgram/kg. In three of these rabbits subdiaphragmatic vagotomy did not abolish the satiety effects of CCK and caerulein. The synthetic octapeptide of CCK was less potent in causing satiety. After CCK or caerulein the rabbits showed typical postprandial behavior. Taste aversion tests failed to demonstrate a strong aversion to flavors associated with the compounds used. These results indicate that exogenous CCK can act as a satiety agent at levels of the same order as the physiological range.

Animals↗

Comparison of budesonide Turbuhaler with budesonide aqua in the treatment of seasonal allergic rhinitis. Rhinocort Study Group.

OBJECTIVE: To compare the effect of budesonide Turbuhaler 400 microg/day with budesonide aqua 256 microg/day in the treatment of seasonal allergic rhinitis (SAR). Secondarily to ascertain patients' preferences for the two nasal devices and to assess quality of life. DESIGN: Randomized, multicentre, double-blind, double- dummy, parallel groups study. SETTING: Private practices and hospital clinics in Ontario, Quebec and Manitoba. POPULATION: Two hundred and eighty-four out-patients with SAR, who were symptomatic during the ragweed season, volunteered for enrolment (243 randomized). RESULTS: Mean daily nasal symptom scores were significantly reduced with treatment. There were no statistically significant changes from baseline for eye symptoms. Most patients (more than 80%) achieved substantial control of their symptoms with budesonide. The most common nasal and non-nasal adverse events for both groups were epistaxis and headache. Turbuhaler was easier to use and more convenient to carry, had less of an unpleasant taste, and caused less nasal irritation than the aqua spray. More than twice as many patients preferred Turbuhaler to the aqua spray (69% versus 31%). Improvement in quality of life from baseline to clinic visits was statistically significant in both groups. CONCLUSION: Once daily use of 256 mg of budesonide aqua and 400 mg of budesonide Turbuhaler are equally safe and efficacious in the treatment of SAR. Patients preferred the budesonide powder formulation delivered via Turbuhaler two to one over the aqua formulation.

Administration, Topical↗