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Suboesophageal neurons involved in head movements and feeding in locusts.

The projections of nerves 6 and 7 of the locust suboesophageal ganglion (SOG) were stained by axonal filling with cobalt chloride. Nerve 6 contains two motoneurons which innervate neck muscles 50 and 51. Sensory neurons innervating hairs on the dorso-occipital region of the head also enter the ganglion through nerve 6 and terminate in a small bilateral plexus. The projections of the head hairs in nerve 6 do not overlap the arborizations of the motoneurons or the neurons of nerve 7, but lie in the same area as descending sensory neurons from wind-sensitive hairs of the front of the head. One branch of nerve 7 (7B) contains two fibres which innervate the salivary gland. These 'salivary' neurons (labelled SN1 and SN2) have their cell bodies in the ganglion. The second branch, 7A, contains sensory neurons from the submentum of the labium, which form four sensory plexuses, two dorsal and two ventral. The sensory plexuses from the submentum have specific regions of overlap with the salivary neurons and with the neck muscle motoneurons. We interpret these as indicating a flow of information from labial receptors signalling head and mouthpart movement to neurons involved in salivation and head movement. We further postulate that the anatomical separation of the various sensory plexuses is indicative of functional localization within the ganglion.

Animals↗

An optimization model for mastication and swallowing in mammals.

Mammalian mastication is a process combining simultaneous food comminution and lubrication. The initiation of swallowing, which is voluntary, has been thought to depend on separate thresholds for food particle size and for particle lubrication. Instead of this duality, we suggest that swallowing is initiated when it is sensed that a batch of food particles is binding together under viscous forces so as to form a bolus. Bolus formation ensures that when the food mass is swallowed, it will pass the pharyngeal region safely without risk of inhaling small particles into the lower respiratory tract. Crucial for bolus formation is food particle size reduction by mastication. This allows the tongue to pack particles together tightly by pressure against the hard palate. A major function of salivation is to fill the gradually reducing spaces between particles, so increasing viscous cohesion and promoting bolus formation. If swallowing is delayed, excessive saliva floods the bolus, separating particles and reducing cohesion. Swallowing then becomes more precarious. Our model suggests that there is an optimum moment for a mammal to swallow, defined in terms of a peak cohesive force between food particles. The model is tested on human mastication with two foods, brazil nut and raw carrot, which have very different particle size breakdown rates. The peak cohesive force is much greater with brazil nuts but both foods are predicted to be swallowed after similar numbers of chews despite the very different food particle size reductions achieved at that stage. The predicted number of chews to swallow is in broad agreement with published data.

Animals↗

Outcome expectations drive learned behaviour in larval Drosophila.

Why does Pavlov's dog salivate? In response to the tone, or in expectation of food? While in vertebrates behaviour can be driven by expected outcomes, it is unknown whether this is true for non-vertebrates as well. We find that, in the Drosophila larva, odour memories are expressed behaviourally only if animals can expect a positive outcome from doing so. The expected outcome of tracking down an odour is determined by comparing the value of the current situation with the value of the memory for that odour. Memory is expressed behaviourally only if the expected outcome is positive. This uncovers a hitherto unrecognized evaluative processing step between an activated memory trace and behaviour control, and argues that learned behaviour reflects the pursuit of its expected outcome. Shown in a system with a simple brain, an apparently cognitive process like representing the expected outcome of behaviour seems to be a basic feature of behaviour control.

Animals↗

Experimental infection of monkeys with Herpesvirus suis (Aujeszky's-disease virus).

Monkeys were infected intranasally with Herpesvirus suis. After an incubation period of 7 to 13 days the animals became acutely ill and rapidly died. Clinical signs included salivation, incoordination, ataxia and epileptiform convulsions, but not pruritus. Histopathological changes were confined to the central nervous system, and consisted of destruction of neurones with the formation of intranuclear inclusion bodies, gliosis and perivascular cuffing. Virus was isolated from the brain and spinal cord in the later stages of the illness but neutralising antibodies were not detected in serum. The distribution of lesions indicated direct spread of virus from the inoculation site along cranial nerves to the brain.

Animals↗

Poisoning with brown fly agaric, Amanita regalis.

Three patients ate different amounts of a common northern mushroom, brown fly agaric, Amanita regalis. All of them believed they had eaten delicious parasol mushrooms, Macrolepiota procera. The symptoms of poisoning began 1--2 hours after ingestion of the mushrooms. All the patients had marked gastrointestinal symptoms: nausea and heavy vomiting. Two had central nervous system manifestations and cholinergic symptoms: hallucinations, confusion, or loss of consciousness as well as copious salivation, or sweating. All patients recovered within 4--24 hours without any damage to liver, kidneys or central nervous system. It seems that cooking the mushrooms does not completely neutralize the toxic agents of Amanita regalis. The analysis of fried mushrooms shows that it may be possible to identify mushrooms reliably from the remains of a meal.

Adult↗

Review article: supra-oesophageal manifestations of gastro-oesophageal reflux disease and the role of night-time gastro-oesophageal reflux.

Gastro-oesophageal reflux disease (GERD) has been associated with a variety of supra-oesophageal symptoms, including asthma, laryngitis, hoarseness, chronic cough, frequent throat clearing and globus pharyngeus. GERD may be overlooked as the underlying mechanism for these symptoms because typical GERD symptoms may be absent, despite abnormal oesophageal acid exposure. Two basic mechanisms linking GERD with laryngeal symptoms have been proposed: direct contact of gastric acid with the upper airway, in some cases due to micro-aspiration, and a vagovagal reflex triggered by acidification of the distal portion of the oesophagus. Gastro-oesophageal reflux (GER) during sleep is believed to be an important mechanism for the development of supra-oesophageal complications of GERD, such as asthma and idiopathic pulmonary fibrosis (IPF). Several physiological changes during sleep, including prolonged oesophageal acid contact time, decreased upper oesophageal sphincter pressure, increased gastric acid secretion, decreased salivation, decreased swallowing and a decrease in conscious perception of acid, render an individual more susceptible to reflux-induced injury. Supra-oesophageal symptoms often improve in response to aggressive acid-suppressive therapy. However, many unanswered questions remain regarding the appropriate approach to diagnosis and treatment of patients with GERD-related supra-oesophageal symptoms. In this article we review the relationship between supra-oesophageal symptoms and GERD and, where possible, highlight the evidence supporting the role of night-time reflux as a contributing factor to these symptoms.

Asthma↗

Total intravenous anaesthesia with low dose ketamine and Althesin. Assessment of a technique for minor surgery in difficult situations.

In 38 patients subjected to minor surgery, totally intravenous anaesthesia with low dose ketamine and Althesin produced adequate operating conditions in 92% of patients with minimal cardiorespiratory disturbance. Problems arose from muscular hypertonus, spontaneous movement and occasionally salivation. Initial recovery was quicker and the incidence of side-effects lower, than those reported when ketamine was used as the sole agent. The technique could be useful in difficult situations as an alternative to inhalation anaesthesia or other intravenous techniques.

Adult↗

Interactions of orphenadrine and phenobarbitone with chlorpromazine: plasma concentrations and effects in man.

1 Two studies were carried out on acutely psychotic patients receiving chlorpromazine (100 mg) 8-hourly. 2 In the pilot study on five patients, plasma chlorpromazine concentrations fell over the course of 3 weeks of treatment and parallel changes were noted in the plasma half-life of antipyrine, salivation rate and handwriting length. 3 In the main study involving twelve patients treated for 15 weeks, the above findings were confirmed and were interpreted as indicating that chlorpromazine accelerated its own metabolism by inducing liver microsomal oxidising enzymes. No metabolites of chlorpromazine were detected in plasma. 4 The addition of phenobarbitone (50 mg) 8-hourly for 3 weeks, or orphenadrine (100 mg) 8-hourly for 3 weeks, resulted in a lowering of plasma chlorpromazine concentrations together with a further shortening of plasma antipyrine half-life. 5 Physiological effects of the additional treatments suggested that phenobarbitone lessens the effects of chlorpromazine by lowering body concentrations. However, orphenadrine acts more by virtue of its anticholinergic effects. 6 It was concluded that phenobarbitone and orphenadrine should not be prescribed routinely in patients receiving major tranquillisers. The need for the addition of orphenadrine should be assessed in each individual case.

Adult↗

Clinical pharmacology of sibutramine hydrochloride (BTS 54524), a new antidepressant, in healthy volunteers.

The cardiovascular, anticholinergic and central effects of single doses of 30, 45 and 60 mg of sibutramine hydrochloride (BTS 54524), a new potential antidepressant, were compared with amitriptyline (50 mg) and placebo given at weekly intervals in a randomised design to six healthy male volunteers. Sibutramine was associated with increases in both supine heart rate and systolic blood pressure at 1, 2 and 6 h after 60 mg (P less than 0.05). Amitriptyline caused a significant 50-60% decrease in salivation compared with placebo at 2 and 6 h but there were no changes with sibutramine. No significant changes in pupil size were detected with either drug. Visual analogue rating scales (VARS) revealed significant drowsiness with amitriptyline but neither sedative nor stimulant effects with sibutramine. Impairments of simple auditory and visual reaction times, visual two-choice reaction time, finger tapping and trail making, measured using an automated test battery, occurred with amitriptyline compared with sibutramine. If sibutramine proves to be an effective antidepressant it should be devoid of anticholinergic or central depressant effects. Chronic dosage studies are indicated to evaluate the clinical significance of its cardiovascular effects.

Adult↗

Transdermal administration of morphine to healthy subjects.

1. Twelve healthy subjects received 10 mg morphine HCl delivered transdermally from an occlusive reservoir applied to a small area of skin, painlessly de-epithelialised by vacuum suction. On a separate occasion, 10 mg morphine HCl was given as an i.v. infusion over 20 min. 2. Venous blood samples were collected serially for 72 h and assayed for morphine, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G) by h.p.l.c. Pupil size, salivation, and central nervous effects (nausea, fatigue, headache, feeling of heaviness and dysphoria/euphoria) were also measured. 3. After transdermal application morphine was absorbed by a first-order process to produce relatively constant plasma drug concentrations over 11 h. The absolute bioavailability of transdermal morphine was 75% (65-85%; 95% CI). The plasma concentrations of both M6G and M3G were lower after transdermal administration than after i.v. infusion, and a considerable delay (of up to 1 h) was observed before the metabolites were detectable. AUC ratios for M3G and M6G relative to morphine were similar after both modes of administration. 4. Non-analgesic effects were less pronounced at the lower plasma drug and metabolite concentrations observed after transdermal delivery than after the i.v. infusion of morphine. 5. Transdermal administration of morphine warrants investigation as an alternative route of morphine delivery.

Administration, Cutaneous↗

Eruptive lingual papillitis with household transmission: a prospective clinical study.

BACKGROUND: Eruptive lingual papillitis with household transmission (ELP) is an acute stomatitis of unknown cause occurring in children, with possible spread to one or several members of the family. OBJECTIVES: To verify clinical features and search for clinical characteristics of ELP. METHODS: A prospective case series, including an analysis of epidemiological and clinical factors, was conducted within private paediatric practices in collaboration with a dermatology department at the University Hospital of Nice, France. RESULTS: Thirty-eight children (21 girls and 17 boys) with clinical criteria of ELP referred from 1 February 2000 to 31 January 2002 were included in the study. Mean age at diagnosis was 3 years and 6 months. Thirty-three children attended day nursery or school. The seasonal distribution of observed cases showed a peak of incidence in spring. The eruption started abruptly. Fever was found in 15 (39%) cases. Difficulties in feeding were observed in all cases; intense salivation in 23 (61%) cases. The glossitis was characterized by inflammatory hypertrophy of the fungiform papillae on the tip and dorsolateral part of the tongue. Enlarged submaxillary or cervical lymph nodes were noted in 16 (42%) cases. Angular cheilitis was observed in four (11%) children. Spontaneous regression of the stomatitis occurred between the second and 15 days of clinical evolution. Mean duration was 7.3 days. Transmission to one or several members of the family was noted in 20 (53%) cases. Recurrence of symptoms was observed in five (13%) children. CONCLUSIONS: This study confirms some clinical characteristics of ELP: localized lesions of the fungiform papillae on the tip and dorsolateral part of the tongue, high frequency of intrafamilial transmission, and possibility of recurrence. This study also showed unsuspected clinical data such as possible occurrence of fever and angular cheilitis. ELP resembles an entity termed 'transient lingual papillitis' or commonly 'lie bumps'. The origin of this eruption remains unknown, but the transmission data could suggest a possible infectious origin.

Age of Onset↗

Terfenadine reduces skin and conjunctival reactivity in grass pollen allergic children.

Terfenadine suspension, 30 mg b.i.d., was compared with placebo in a randomized, double-blind cross-over study in twenty-five children, 6-12 years of age, with grass pollen induced allergic rhinoconjunctivitis. The patients were treated during two 7-day periods separated by a 4-day wash-out period. Efficacy was assessed during a period without provoking pollen in the air. At the end of each treatment period, skin-prick tests were carried out in quadruplicate with three concentrations of grass pollen extracts (identical batches of Pharmalgen) and histamine HCl, 1 and 10 mg/ml, as were conjunctival provocations with the same grass pollen. The mean size of weals caused by allergen and histamine was significantly smaller after terfenadine than after placebo; in fact, terfenadine increased the tolerance to the allergen by a factor of ten. Similarly, the tolerance to conjunctival provocation was significantly increased during terfenadine treatment as compared with placebo. There was no significant difference between the treatments in scores for alertness and salivation. Seasonal symptoms were mild when the children were allowed to use terfenadine in an open follow-up study. Thus, terfenadine reduced specific as well as non-specific reactivity in grass pollen allergic children and caused few side effects.

Benzhydryl Compounds↗

Effect of terfenadine and placebo on symptoms after nasal allergen provocation.

Terfenadine (60 mg b.i.d.) was compared with placebo in a randomized, double-blind, cross-over study in twenty-three patients with birch pollen allergy. The patients were treated during two 7-day periods separated by a 2-week wash-out period during a season free from birch pollen. Nasal provocations with birch pollen extracts were made at study entry and after each treatment period. Blockage (rhinomanometry), secretion (weight) and sneezings (number) were compared between treatments. The results showed a significant inhibitory effect of terfenadine on secretion and sneezing, but no significant difference between treatments with regard to blockage. Terfenadine showed no signs of sedative properties or inhibition of salivation.

Adult↗

Excretion of trypsin-like activity, electrolytes and protein in mixed and parotid saliva of patients with cystic fibrosis of the pancreas.

The esterolytic activity of mixed and parotid saliva in cystic fibrosis (CF) patients and normal subjects was determined using BAEE (alpha-Benzoyl-1-arginine-ethylester) as the substrate. Using soybean-trypsin-inhibitor the trypsin-like activity (TLA) was measured and plotted as a function of parotid flow rate. In addition calcium, protein and pH were determined. Trypsin-like activity in mixed and parotid saliva showed large individual variations in CF and normal children. In parotid saliva we could not find any significant difference, whereas a reduction of TLA in mixed saliva of CF patients was observed. The fact that our normal values fell within the range of heterozygotes reported by Rao et al. (19), makes their hypothesis of a close relationship between reduced TLA and the genetic defect very doubtful. Protein, calcium and pH increased with augmented salivation and no difference between CF patients and normal age matched children could be found except for the pH at a flow rate above 0.75 ml/min per m2 body surface where significantly lower pH values resulted. The relevance of reduced TLA to the pathogenesis of cystic fibrosis is discussed.

Calcium↗

Polycystic disease of the parotid glands: case report of a rare entity and review of the literature.

We report a case of polycystic disease of the parotid glands. This is a rare disorder and we know of only two previous documented cases in the literature. The disease presents with painless enlargement of one or both parotid glands and is not associated with any clinical abnormality of salivation or with any apparent anomaly of the other salivary glands. Histologically, the overall glandular architecture is preserved but the lobules are all markedly distended by epithelial-lined cysts, which appear to be derived from the intercalated ducts. Characteristic congophilic laminated spheroliths are present within the cystic spaces. The condition must be differentiated from cystic neoplasms, particularly papillary cystic adenocarcinoma, and from various non-neoplastic disorders including sialectasia, retention cysts and lymphoepithelial cysts.

Adult↗

Pirenzepine, telenzepine, atropine and metacine as agonists for the muscarinic cholinoreceptors in the denervated human parotid gland.

New anti-ulcer preparations, pirenzepine and telenzepine, are structurally dissimilar to the classical cholinomimetics, atropine and hyoscine (scopolamine). However, they are all capable of provoking paradoxical salivation from the chronically parasympathetically denervated human parotid gland. The rates of the secretory responses to the typical and atypical cholinoblockers are found to be the same. This finding is discussed with respect to the general functional mechanism of the traditional and non-traditional antimuscarinic agents.

Anti-Ulcer Agents↗

Parotid salivary flow rates in two patients during immediate denture treatment.

Parotid salivary flow rates in response to chewing or citric acid stimulation were studied in two patients who had their last maxillary teeth extracted and immediately replaced with complete dentures. The patients were monitored 6 months from the last week before extraction. Parotid salivary flow rate in response to chewing was increased after insertion of the denture. For one of the patients a particularly high output from the parotid gland was found 2 weeks after treatment. Throughout the experiment, parotid salivary flow was higher on the chewing side than on the contralateral side. At the end of the experimental period the dentures were relined. Salivary flow measured immediately after relining was lower than prior to this procedure. An increased salivary response was also observed during citric acid stimulation after transition from the dentate to the denture wearing state. This increase was more marked if the patients had their dentures in situ when the gustatory provocations were performed. It is concluded that parotid salivation increases during masticatory and gustatory stimulation in patients subjected to total extraction and immediate complete denture treatment, and that the presence of a complete denture per se appears to act as an additional mechanical stimulus in the salivary reflexes.

Citrates↗

The relationship between salivary secretion rate and masticatory efficiency.

In order to elucidate the relationship between the salivary secretion rate and masticatory efficiency, experimental hypo- and hyper-salivation were produced by the administration of atropine sulphate presenting an anticholinergic effect and pilocarpine hydrochloride having a muscarine effect orally in 10 healthy fully dentates. To confirm the pharmaceutical effect of these drugs, the unstimulated whole salivary secretion rate during 10 min, and masticatory efficiency using the sieve method were measured before and after medication. The unstimulated whole salivary secretion rate during 10 min decreased significantly by the administration of atropine sulphate (P < 0.05), and increased significantly by pilocarpine hydrochloride (P < 0.01). The masticatory efficiency after atropine sulphate medication was significantly lower than that before (P < 0.01). The increase in salivary secretion by pilocarpine hydrochloride did not lead to a higher masticatory efficiency. The evidence supports the understanding that saliva plays an important role in masticatory function.

Adult↗