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Decreased parotid saliva gustin/carbonic anhydrase VI secretion: an enzyme disorder manifested by gustatory and olfactory dysfunction.

BACKGROUND: Taste and smell dysfunction has been reported to occur in patients with a variety of clinical problems. We wanted to investigate a specific group of patients in whom taste and smell dysfunction occurred putatively related to a specific biochemical abnormality in a salivary growth factor [gustin/carbonic anhydrase (CA) VI] considered responsible for maintenance of taste bud function. METHODS: Eighteen patients developed loss and/or distortion of taste and smell after an acute influenza-type illness. They were evaluated clinically, by psychophysical tests of taste and smell function, by measurement of parotid salivary gustin/CAVI by a radioimmunoassay and by measurement of serum, urine, and salivary zinc. Biopsies of circumvallate papillae were obtained in 6 patients and examined by transmission electron microscopy. Similar studies were performed in 55 asymptomatic volunteers with biopsies of circumvallate papillae performed in 4. RESULTS: Taste and smell acuity were impaired in patients compared with healthy volunteers and parotid gustin/CAVI, salivary, and serum zinc concentrations were lower in patients than in healthy volunteers. Taste buds in circumvallate papillae of patients exhibited severe vacuolization, cellular degeneration, and absence of dense extracellular material. CONCLUSIONS: These results describe a clinical disorder formulated as a syndrome of hyposmia (decreased smell acuity), hypogeusia (decreased taste acuity), dysosmia (distorted smell function), dysgeusia (distorted taste function), and decreased secretion of parotid saliva gustin/CAVI with associated pathological changes in taste bud anatomy. Because gustin/CAVI is found in humans only in parotid saliva and has been associated with taste bud growth and development these results suggest that inhibition of synthesis of gustin/CAVI is associated with development of taste bud abnormalities and thereby loss of taste function.

Adult↗

Taste and olfactory disturbances after upper and middle third facial fractures: a preliminary study.

To estimate smell and taste after traumatic disturbances, the authors questioned a sample of 92 patients who underwent surgical treatment for upper third and/or middle third facial fractures between January 1, 1988, and May 31, 1996, at the Department of Maxillofacial Surgery, University of Rome "La Sapienza," Italy. A total of 86 patients included in the study had a facial fracture sustained during a motor vehicle accident. Twenty-nine patients reported smell and/or taste after the traumatic disturbance. Of these 29 patients, 8 patients had hyposmia and/or anosmia without taste deficit, 10 patients had taste disturbances without smell loss, and 11 patients noted disturbance in both smell and taste. The authors encountered posttraumatic smell disturbances in 19 patients in their sample. Nasozygomatic-Le Fort fractures, fronto-orbital fractures, and pure Le Fort fractures were found to determine posttraumatic smell disturbances in these 19 patients. Nasal fractures, nasoorbital-ethmoidal fractures, ethmoidal fractures, frontal-Le Fort fractures, and nasal-Le Fort fractures did not determine any olfactory dysfunction. Posttraumatic hypogeusia and ageusia were found in 21 patients and was caused by nasozygomatic-Le Fort fractures, fronto-orbital fractures, and pure Le Fort fractures. The authors did not find any taste deficits after patients sustained other kinds of facial fractures. In the 11 patients observed, disturbances in both smell and taste were noted. Nasozygomatic-Le Fort fracture was the most common in these 11 patients. At 5 years' of follow-up, the results indicate that hypogeusia and hyposmia are connected with the etiology of fracture, the violence of the trauma, and the involvement of specific facial bone regions.

Accidents, Traffic↗

Olfaction and social drive in schizophrenia.

BACKGROUND: The neurobiology of social dysfunction in schizophrenia is unknown, but smell identification deficits (SIDs) exist in schizophrenia, and olfaction is related to social affiliation in other mammals. The SIDs have been linked with negative symptoms and the deficit syndrome, but any specificity of SIDs for social dysfunction is unstudied. Low intelligence might explain this relationship, if it is associated with both negative symptoms and SIDs. We examined whether SIDs in schizophrenia were related broadly to negative symptoms, as are a number of other neuropsychological measures, or whether they might show a more specific relationship with social drive. METHODS: Smell Identification Test scores, Wechsler Adult Intelligence Scale-Revised IQ, symptomatology assessed with the Positive and Negative Syndrome Scale, and the deficit syndrome were determined in 70 patients with DSM-IV schizophrenia. RESULTS: The SIDs were related to negative symptoms and the deficit syndrome, but the association of SIDs with diminished social drive explained both relationships. Smell identification was also related to Wechsler Adult Intelligence Scale-Revised IQ, but intelligence was independent of the relationship of SID and social drive. The worse Smell Identification Test scores in male patients were attributable to a greater preponderance of men with the deficit syndrome. CONCLUSIONS: These analyses demonstrated independent relationships of Smell Identification Test scores to social drive and intelligence that together accounted for almost 50% of the variance in Smell Identification Test scores. There may be common neural substrates for the low social drive and SIDs in schizophrenia.

Drive↗

[Evaluation of olfactory stimuli by depressed patients].

Anhedonia, a cardinal sign of depression, is discussed to originate from a transmitter dysbalance in the central dopaminergic reward system. This system involves neuroanatomically many structures of the olfactory system. Hence the question arises whether anhedonia can be quantified when depressive patients judge smells hedonically. Sensory evaluation of olfactory stimuli by 16 depressive patients was compared that of an age-matched control group. In the group comparison, mono- and birhinal sensory thresholds as well as judgment of intensity were not significantly different. For four of the eight smells, the hedonic judgements were found to be identical between the group of depressives and controls, with the remaining smells not significantly different. There were no differences in the consistency of ranking of smells. In a longitudinal (test-retest) assessment there were again no differences in intensity, familiarity, and hedonic quality of the smells. The findings suggest that changes in the dopaminergic transmitter balance during the state of depression causing anhedonia affect neither olfactory perception nor the hedonic judgement of smells. Contrary to the clinical picture, anhedonia thus seems not to arise at the level of sensory perception yet but should be considered a more complex construct of disturbed central processing.

Adult↗

A pooled analysis of seven randomized crossover studies of the palatability of cefdinir oral suspension versus amoxicillin/clavulanate potassium, cefprozil, azithromycin, and amoxicillin in children aged 4 to 8 years.

OBJECTIVE: This analysis of the results of 7 trials compared the taste and smell acceptability scores of cefdinir oral suspension and 4 other pediatric antibiotic oral suspensions--amoxicillin/clavulanate potassium, cefprozil, azithromycin, or generic amoxicillin--using a visual smile-face scale. METHODS: Data from 7 randomized, single-blind, cross-over trials were pooled and analyzed. In each study, children aged 4 to 8 years were asked to taste and smell 2 different antibiotic suspensions and assign preference using a visual smile-face scale. Ratings were converted to a numeric score ranging from 5 (really good) to 1 (really bad). RESULTS: A total of 1011 healthy subjects were randomly assigned to 1 of 2 treatment-order groups; 965 were evaluable for the taste and smell analyses. Baseline demographics of evaluable subjects were similar among test groups. Approximately even proportions of participants were female or male (50.1 % vs 49.9%), most (84.1%) were white, and slightly more participants were aged 7 or 8 years rather than younger (age 4 years, 16.0%; age 5 years, 17.4%; age 6 years, 18.7%; age 7 years, 23.2%; age 8 years, 24.8%). Of the 965 children who tasted both antibiotic suspensions and determined their preference, 798 (82.7%) rated the taste of cefdinir as really good or good (the highest possible ratings); 712 (73.8%) assigned the same ratings to amoxicillin/clavulanate potassium, cefprozil, azithromycin, or generic amoxicillin (P < or = 0.001). With regard to smell, 671 (69.5%) rated the smell of cefdinir as really good or good; 636 (65.9%) assigned these same ratings to the comparator agents (P = NS). CONCLUSION: In this pooled analysis of data from 7 randomized, single-blind, crossover trials, children between the ages of 4 and 8 years preferred the taste of cefdinir oral suspension to that of other pediatric antibiotic suspensions. Based on smile-face scores, subjects found the smell of cefdinir oral suspension to be at least as good as that of the comparators.

Administration, Oral↗

Psychophysical evaluation of responses to pleasant and mal-odour stimulation in human subjects; adaptation, dose response and gender differences.

A psychophysical detection test was used to measure the response of human subjects to 'good' and 'bad' smells. Different intensities and frequencies of odour stimulation were delivered by an olfactometer and the responses to a group of malodours (valeric acid, skatol, butyric acid) and pleasant smells (amyl acetate, cis-3-hexenol, linalool) were compared. A mathematical model, a power equation, was used to fit the three-dimensional data plots (dose vs. stimulus frequency vs. response). The model was able to distinguish between malodours and pleasant odours on the basis of the values of parameters describing dose-response and adaptation/habituation. We show that the olfactory system adapts/habituates more rapidly to malodours than to pleasant smells, but is much more sensitive to changes in stimulation by malodours than pleasant odours. The degree of adaptation is inversely proportional to stimulus strength. The response profile for women was different to that of men for certain odours, in particular valeric acid, skatol and cis-3-hexenol. The difference lay in their sensitivity and the slope and range of the dose response. Thus, we have shown for the first time that the olfactory system adapts more readily to 'bad' smells than 'good' smells, and that it has a broader range of adaptation for bad smells. As a consequence, the olfactory system is specially responsive to changes in potential olfactory warning signals.

Adaptation, Physiological↗

Impaired sensory functioning in elders: the relation with its potential determinants and nutritional intake.

This study assessed the relation of an impaired taste and smell perception with (a) potential determinants and (b) nutritional intake and status in elderly people. Determinants examined were age, gender, functional category (institutionalized vs independently living), dental state, illnesses, smoking behavior, drug usage, and saliva excretion and composition. Nutritional intake and status were measured by an "appetite and hunger" questionnaire, a food frequency questionnaire, and body mass index (BMI). In order to have access to a large heterogeneous group, two different categories of elderly people were studied. We enrolled independently living elders (n=89) assumed to have a relatively good taste and smell perception, and institutionalized elders (n=67) with a potential poorer taste and smell perception. Scores at the smell identification (range: 0-10) and taste perception (range: 0-4) test were, respectively, 5.7 (independently living) versus 3.5 (institutionalized); p < .0001 and 3.3 versus 3.0; p < .05. Correlation between smell test scores and outcomes of the "appetite and hunger" questionnaire ranged from r: .19 to .50; p values < .05. There was, however, no clear correlation of any sensory outcome with energy and food intake, nor with BMI. Regression analyses revealed that age and the functional category were the most important determinants of the scores on the taste perception and smell identification tests. It is concluded that a poor performance on sensory tests is related to a poor appetite but not necessarily to low energy intake or low BMI. Age-related factors and smoking are important determinants of impaired sensory functioning.

Aged↗

Increased brain activation in response to odors in patients with hyposmia after theophylline treatment demonstrated by fMRI.

PURPOSE: Our goal was to demonstrate that medical therapy in patients with smell loss (hyposmia) that restored olfactory function toward or to normal could be verified and quantitated by functional MRI (fMRI) of brain and that visual representation of these changes could be used to identify these patients. METHOD: Multislice FLASH MR or echo planar MR brain scans were obtained in four patients with hyposmia in response to three olfactory stimuli both before and after treatment with theophylline. Activation images were derived using correlation analysis, and ratios of brain area activated to total brain area were obtained. RESULTS: Prior to treatment, all patients stated that they could not smell; these losses were confirmed by standard psychophysical tests. At this time, fMRI brain activation in response to odors was significantly less than that measured in normal volunteers and similar to activation measured previously in other patients with a similar type of hyposmia. After treatment, subjective smell function improved in three patients and no improvement occurred in one; results were confirmed by psychophysical tests. In each patient in whom smell acuity improved, brain activation in response to each odor increased in each section and mean activation increased significantly for each odor. Activation increased in all regions previously associated with olfactory stimulation and was particularly apparent in orbitofrontal cortex, frontal lobe component of cingulate gyri, temporal lobe gyri, and hippocampus. There also was consistent activation in superior, middle, and inferior frontal lobe gyri. There were no changes in brain activation after treatment in the patient in whom smell did not improve. CONCLUSION: These results demonstrate that theophylline is an effective therapeutic agent to correct hyposmia in some patients with smell loss. These changes have been documented by fMRI brain scans using olfactory stimuli. This is the first study in which this type of objective improvement following medical treatment has been demonstrated in patients with hyposmia.

Adult↗

Odor identification in young and elderly African-Americans and Caucasians.

Olfactory function is affected by age and gender. However, there are few data on smell function in various racial/cultural groups, in particular, in different-aged African-Americans. Therefore, this study sought to determine if there is a relationship among age, gender, and race for smell identification. Sixty healthy African-Americans and 60 Caucasians between the ages of 20-40 and 60-80 years were administered the University of Pennsylvania Smell Identification Test (UPSIT). Older persons, regardless of race, had lower UPSIT scores, were more likely to be microsmic and anosmic, and had increased chemosensory complaints. Smell performance among females was better compared with males. Overall, African-Americans had lower UPSIT scores and age- and gender-adjusted percentile rank scores compared with Caucasians, but these differences were significant only among younger subjects. In addition, both young and old African-Americans had no smell complaints. The results from this study suggest that age, gender, and race have an influence on smell identification.

Adult↗

Chemosensory function and dysfunction.

Taste and smell are fundamental sensory systems essential in nutrition and food selection, for the hedonic and sensory experience of food, for efficient metabolism, and, in general, for the maintenance of a good quality of life. The gustatory and olfactory systems demonstrate a diversity of transduction mechanisms, and during the last decade, considerable progress has been made toward our understanding of the basic mechanisms of taste and smell. Understanding normal chemosensory function helps clarify the molecular events that underlie taste and smell disorders. At least 2,000,000 Americans suffer from chemosensory disorders--a number that is likely to grow as the aging segment of the population increases. Smell disorders are more frequent than taste disturbances, due to the vulnerability and anatomical distinctiveness of the olfactory system, and because a decline in olfactory function is part of the normal aging process. Common gustatory and olfactory complaints are due to a number of medications, to upper respiratory infections, to nasal and paranasal sinus diseases, and to damage to peripheral nerves supplying taste and smell. Most chemosensory complaints have an identifiable cause. Although diagnosis of taste and smell disorders has improved considerably over the last two decades, treatment of these disorders is still limited to conditions with discernible and reversible causes. Future research is needed for a better understanding of chemosensory mechanisms, establishing improved diagnostic procedures, and disseminating knowledge on chemosensory disorders among practitioners and the general public.

Aging↗

[Study on difference in olfactory response in dysosmia patients].

Using 1952 dysosmia patients, we studied the difference in olfactory response to 5 types of odorous substances used in the standard olfactory acuity test in Japan--beta-phenyl ethyl alcohol, methyl cyclopentenolone, isovaleric acid, gamma-undecalactone, and scatol. Olfactory dysfunctions included 887 patients with chronic paranasal sinusitis, 255 with allergic rhinitis, 326 with common cold sequela, 77 with complications from head injuries, 28 with drug-induced dysosmia, 39 with congenital dysosmia, 257 with dysosmia of unknown etiology, and 83 miscellaneous. The standard olfactory acuity test before treatment indicated that 82 patients detected only one odor within the detection threshold and 157 within the recognition threshold; 40 responded only to isovaleric acid at the detection threshold and 101 at the recognition threshold. Both figures were significantly greater than those who responded to other odors (p < 0.01). No specific trends were noted in etiologies of dysosmia that allowed smelling of isovaleric acid only either at the detection or recognition threshold. Among those whose olfactory thresholds were judged to be scaled out against all 5 odorous substances, 552 were rated as scaled out at the detection threshold and 630 at the recognition threshold. During post treatment, 33 scaled out at the detection threshold and 32 scaled out at the recognition threshold improved enough to smell 1 type of odor. Of these, 15 scaled out at the detection threshold and 13 scaled out at the recognition threshold became able to smell only isovaleric acid. Those becoming able to smell only isovaleric acid either at the detection or recognition threshold, significantly outnumbered those becoming able to smell other odors (p < 0.01). No outstanding cause of dysosmia was seen in those able to smell isovaleric acid. This data indicates that olfactory function for detecting isovaleric acid is relatively resistant to disease and is most likely to be restored. The difference in olfactory response of patients with olfactory dysfunction such as those above may be due to variations in the number of olfactory receptor proteins for specific odors within olfactory cells or different responses to the type of molecules of odor-emitting substances.

Adolescent↗

Olfaction in patients with nasal polyposis: effects of systemic steroids and radical ethmoidectomy with middle turbinate resection (nasalization).

AIM: In this prospective study the effect of medical and surgical treatment on subjective olfaction was studied in patients with nasal polyposis (NPS). The effects on nasal obstruction, anterior and posterior rhinorrhea, sneezing and itching are reported in another article in this issue. PATIENTS AND METHODS: Protocol 1. Twenty-four patients with NPS who complained about anosmia were treated with a 7-days course of systemic steroids. Their subjective overall sense of smell was determined with a visual analog scale (VAS) before treatment, immediately after treatment, and two months later. Subsequently all patients underwent surgery bilaterally according to the nasalization principles. The sense of smell was re-evaluated at 1, 3, 6, 9, and 12 months postoperatively. Protocol 2. Thirty-two patients with NPS not responding to medical therapy who, for different reasons, did not receive oral steroid treatment, received surgery only and were followed up during one year after nasalization. Of these patients, 25 were anosmic and 7 normosmic. RESULTS: Protocol 1. Following the 7-day treatment with systemic steroids the olfactory score increased significantly. During the waiting time for surgery (64 +/- 39 days) this score deteriorated again in a significant way. One month after nasalization which included a depot injection of triamcinolone 80 mg the day after surgery, the olfactory score ameliorated again and remained stable at 3, 6, 9, and 12 months. None of the patients reported any intake of systemic steroids during the one-year of follow-up. Statistically, there was a trend suggesting that the 12 month post-nasalization score was better than the immediate post-oral steroid score. A good correlation between the improvement of the sense of smell after 7 days of systemic steroids and one year after nasalization was found. Protocol 2 One month after the nasalization protocol, olfaction in patients of the hypo-anosmic group had improved considerably. Scores at 3, 6, 9, and 12 remained very stable. The sense of smell in the normosmic group did not change after surgery and remained stable during the year of follow-up. In total, 49 patients with a severe loss of smell showed a significant improvement at 12 months after surgery. CONCLUSION: The present study shows that 1) long-lasting correction of olfactory dysfunction produced by nasal polyposis can be achieved through the combination of nasalization and low dose of nasal steroids, 2) middle turbinate resection does not alter the possibilities to restore the sense of smell.

Adolescent↗

The effect of topical 0.75% metronidazole gel on malodorous cutaneous ulcers.

The unpleasant smell of infected fungating tumors and benign cutaneous ulcers is a distressing clinical problem, known to be associated with anaerobic infection. Topical metronidazole 0.8% gel has been shown to decrease smell from fungating malodorous tumors. This study was conducted to assess prospectively the subjective and bacteriological response to 0.75% metronidazole gel to decrease smell from these lesions and to assess whether bacterial contamination of the tubes of gel occurs during use. Forty-seven patients with benign or malignant cutaneous lesions associated with a foul smell were assessed for smell, pain, appearance, and bacteriological profile before entry and at 7 and 14 days. Forty-one (95%) of the 43 patients assessed at 14 days reported decreased smell. Anaerobic infection was initially found in 25 (53%) of patients and was eliminated in 21 (84%) of these. At review after 7 days, patients reported less pain from the lesions. Discharge and associated cellulitis were also observed to decrease significantly.

Administration, Topical↗

Rapid induction of conditioned opiate withdrawal in the rat.

Previous studies of conditioned opiate withdrawal in animals either have suffered from a lack of readily quantifiable data (e.g., measurement of diarrhea and vocalization in rodents) or were very long and costly (e.g., disruption of operant responding in monkeys). In this study, an attempt was made to produce a rapid and quantifiable measure of conditioned opiate withdrawal in the rat. Rats were trained to lever-press for food reinforcement on a fixed-ratio-15 schedule. All rats were then implanted with two subcutaneous 75-mg morphine pellets and allocated into three groups. The paired group received four naloxone injections (0.025 mg/kg SC) in the operant chambers paired with a distinctive tone and smell. The unpaired group was also exposed to the tone and smell in the chambers on four occasions, but received the naloxone injections in the home cage. The saline control animals were never exposed to naloxone or the tone and smell. On the test day, all rats were exposed to the tone and smell and injected with saline. The paired group showed a significant reduction in operant responding in response to the tone and smell when compared either with the other two groups, or to their own response rates on the previous day. In a second experiment, the paired and unpaired groups were again challenged with the tone and smell and a saline injection 1 month after removal of the morphine pellets. Again, the paired group showed a significant disruption of response. These results suggest that the conditioned stimulus acquired significant behavior-disruptive properties manifest even in the absence of opiate receptor occupancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis of Variance↗

Media warnings about environmental pollution facilitate the acquisition of symptoms in response to chemical substances.

OBJECTIVE: Previous studies showed that somatic symptoms can be acquired in response to chemical substances using an associative learning paradigm, but only when the substance was foul smelling and not when it smelled pleasant. In this study, we investigated whether warnings about environmental pollution would facilitate acquiring symptoms, regardless of the pleasantness of the smell. METHOD: One group received prior information framing the study in the context of the rapidly increasing chemical pollution of our environment. Another group received no prior information. Conditional odor stimuli (CS) were diluted ammonia (foul-smelling) and niaouli (neutral-positive smelling); the unconditional stimulus (UCS) was 10% CO2-enriched air. Each subject breathed one odor mixed with CO2 and a control odor mixed with air in 80-sec breathing trials. The type of odor mixed with CO2 was counterbalanced across participants. Next, the same breathing trials were administered without CO2. Breathing behavior was measured during each trial; subjective symptoms were assessed after each trial. RESULTS: Only participants who had been given warnings about environmental pollution reported more symptoms to the odor that had previously been associated with CO2, compared with the control odor. This was so for both the foul- and the pleasant-smelling odor. Symptom learning did not occur in the group that did not receive warnings. The elevated symptom level could not be accounted for by altered respiratory behavior, nor by experimental demand effects. CONCLUSIONS: Raising environmental awareness through warnings about chemical pollution facilitates learning of subjective health symptoms in response to chemical substances.

Administration, Inhalation↗

Olfactory-corporeal reflex: description of a new reflex and its role in the erectile process.

OBJECTIVE: The dog approaches the bitch and smells the vulva. The relationship which seems to exist between a special smell in the bitch and sexual arousal in the male dog was investigated. METHODS: 12 male dogs and 25 bitches were studied. The bitches were divided into five equal groups, each representing 1 of the 5 phases of the estrous cycle. A vaginal swab that soaked in the bitches' vaginal secretions was divided into two pieces: one was sent for estradiol and progesterone determination, and the other was smelt by the male dog. The responses of the intracorporeal pressure (IP) and the electromyographic activity of the bulbo- and ischiocavernosus (BC, IC) muscles of the male dog to the smelling of bitch's vaginal odor were assessed. The pressure response was also determined 10 min and 1 h after either the nasal mucosa or the corporeal tissue was anesthetized. RESULTS: Elevated IP was recorded in 12 of 12, 10 of 12 and 8 of 12 dogs smelling vaginal swabs of bitches in metestrus (p < 0.001), estrus (p < 0.001), and diestrus (p < 0.01), respectively. No pressure response occurred when the vaginal swab was smelt while the nasal mucosa or the corporeal tissue was anesthetized. The BC and IC muscles exhibited no response to smelling of the vaginal swab of bitches in any phase of the estrous cycle. The results were reproducible. CONCLUSIONS: The study showed that the IP increased with smelling of vaginal secretions containing high progesterone levels, whereas estradiol-17 beta did not effect IP elevations. The higher the progesterone level, the greater the IP. The increased IP is not due to BC and IC muscle contraction. It is postulated that a reflex relationship exists between IP elevation and olfactory stimulation. This reflex response was reproducible and was not evoked when the two arms of the reflex were anesthetized. We call this reflex 'olfactory-corporeal reflex'. This reflex seems to prime the male dog for sexual intercourse.

Animals↗

Trimethylamine N-oxidation in Turkish women with bacterial vaginosis.

Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women of child-bearing age. A common symptom of this condition is a fishy-smelling vaginal discharge. Trimethylamine (TMA) is the substance which is primarily responsible for this distinctive odour. The ability to metabolize TMA is polymorphically distributed such that the majority of individuals metabolize a large part of the body burden of TMA to the odourless trimethylamine N-oxide (TMAO) which is excreted in urine with a small amount of TMA. However, in certain individuals, N-oxidation of TMA is impaired which results in the excretion of large amounts of TMA in the urine, breath, sweat and vaginal secretions. In the present study the metabolism of TMA to TMAO was determined in women with clinically diagnosed BV, women with fishy-smelling vaginal discharge but with no other evidence of BV and control women with no evidence of fishy-smelling vaginal discharge. An index of TMA N-oxidation was established for all subjects after analysis of a 24 h urine sample for free TMA and total TMA after reduction of TMAO. We show that, irrespective of diagnosis of BV or not, women with fishy-smelling vaginal discharge excrete significantly more free TMA and have a similarly significantly reduced capacity to N-oxidize TMA when compared to healthy control women. Thus, the results of this study suggest that a woman's ability to metabolize TMA to TMAO is an important factor which predisposes to a fishy-smelling vaginal discharge.

Adolescent↗

A ChemoSensory questionnaire for patients treated for cancer of the head and neck.

OBJECTIVES: To investigate primary chemosensory issues experienced by patients who undergo treatment for cancer of the head and neck and to develop and assess a ChemoSensory Questionnaire (CSQ). DESIGN: Cross sectional survey for questionnaire development and testing. METHODS: Literature, expert opinion, and focus group methodology were used to identify aspects of smell and taste affecting patients before, during, and after therapy for cancer of the head and neck. A draft instrument was compiled, reviewed, and revised. The revised instrument was administered along with a demographic and clinical form, the SF-12, the Performance Status Survey, and the University of Michigan Head and Neck Quality of Life Questionnaire (HRQOL) to a sample of patients. After item and scale analyses and reductions, a final instrument was assembled. Construct validity and test-retest reliability were assessed. RESULTS: Two hundred six patients were included in the study. The final survey instrument consisted of eight items, four on smell and four on taste. Cronbach's alpha was 0.89 for the smell scale and 0.78 for the taste scale. Correlations with other HRQOL scales ranged from 0.20 to 0.64 for the taste scale and from 0.10 to 0.33 for the smell scale. Good construct validity of the CSQ scores was demonstrated. CONCLUSIONS: Treatment for head and neck cancer negatively impacts smell and taste. A survey instrument was developed to evaluate chemosensory function that is simple to administer and is brief. This instrument will be of value in identifying factors that contribute to chemosensory disturbance and may serve as a guide for planning treatment regimens that minimize such disturbance.

Aged↗