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Hedonic hot spots in the brain.

Hedonic "liking" for sensory pleasures is an important aspect of reward, and excessive 'liking' of particular rewards might contribute to excessive consumption and to disorders such as obesity. The present review aims to summarize recent advances in the identification of brain substrates for food 'liking' with a focus on opioid hot spots in the nucleus accumbens and ventral pallidum. Drug microinjection studies have shown that opioids in both areas amplify the 'liking' of sweet taste rewards. Modern neuroscience tools such as Fos plume mapping have further identified hedonic hot spots within the accumbens and pallidum, where opioids are especially tuned to magnify 'liking' of food rewards. Hedonic hot spots in different brain structures may interact with each other within the larger functional circuitry that interconnects them. Better understanding of how brain hedonic hot spots increase the positive affective impact of natural sensory pleasures will help characterize the neural mechanisms potentially involved in 'liking' for many rewards.

Animals↗

Amitriptyline absorption in a patient with short bowel syndrome.

Oral drug therapy in patients with short bowel syndrome can be quite challenging. We report the case of a 40-yr-old woman with short bowel syndrome and depression requiring antidepressant drug therapy. After buccal administration of amitriptyline, therapeutic serum antidepressant concentrations were attained despite the patient having only 18 inches of proximal small bowel. Clinical improvement in mood was seen, with the only drug side effects being dry mouth and bitter drug taste. Buccal absorption likely is playing a major role in attaining therapeutic serum tricyclic antidepressants drug concentrations.

Administration, Oral↗

[Use of Aloglutamol in uremic patients on dialysis (author's transl].

The authors experimented Aloglutamol (an organic salt of aluminium) in uremic patients on dialysis to detect its phosphate-binding properties and study its use in the treatment of uremic osteodystropy. They report good results: predialysis Ca increased; serum PO4 and alcaline phosphatase levels decreased; Ca X PO4 was normalized; itch, muscular weakness and constipation decreased; no side-effects appeared, and the drug has a good taste. Therefore it is considered to be most useful in the treatment of hyperphosphatemia in uremia.

Adult↗

Hydrogen sulfide exposure without loss of consciousness: chronic effects in four cases.

Adverse effects of acute exposure to hydrogen sulfide (H2S) are well documented, but long-term effects of occupational exposure to low levels of the gas are not. To evaluate effects of such exposure we performed physical, neurologic, psychiatric, and chemosensory (smell and taste) examinations of four workers who were present but did not lose consciousness when the gas was accidentally released at a construction site. None of the four workers tested positive for functional problems, but all met diagnostic criteria for at least three, and up to eight, H2S-induced neuropsychiatric clinical disorders and from zero to two subclinical disorders. All four had abnormal P300 evoked responses (electrical neurophysiologic tests of brain waves). Our data indicate that exposures to even relatively low concentrations of H2S are hazardous. A rigorous epidemiologic investigation of persons who work with H2S is warranted.

Accidents, Occupational↗

Sjögren's syndrome.

Saliva is an essential body fluid. It is important in maintaining oral health, taste acuity, mastication, deglutition and digestion, oral flora regulation, oral cleansing, voice acuity, and speech articulation. Saliva is composed largely of water but also contains minerals, electrolytes, buffers, enzymes, growth factors, cytokines, immunoglobulins, proteins, and metabolic waste products, with the concentrations and compositions of these components varying by individual. Many systemic disorders can affect salivary function, greatly compromising oral health. One such disorder is Sjögren's Syndrome (SS), an autoimmune exocrinopathy characterized by oral and ocular dryness with or without impairment of other organ systems. SS can cause substantial serologic autoimmune reactivity and in some instances is associated with other connective-tissue autoimmune disorders, such as rheumatoid arthritis, scleroderma, or systemic lupus erythematosus. SS increases the risk for developing malignant non-Hodgkin's lymphoma. Treatment of this syndrome consists of a combination of multiple agents, depending on the degree of symptomatology: cholinergic agonists, artificial salivary substitutes, nonsteroidal anti-inflammatory agents, antirheumatic drugs, and biologic agents. This article describes saliva and salivary function, the pathogenesis of SS, the current treatment of xerostomia, and quality of life issues related to salivary dysfunction.

Cholinergic Agonists↗

A double-blind comparative study of zolpidem versus zopiclone in the treatment of chronic primary insomnia.

Zolpidem (10 mg/day) and zopiclone (7.5 mg/day), administered at night, were compared in a 14-day, double-blind, equivalence trial on 479 chronic primary insomniacs (zolpidem, 231; zopiclone, 248) throughout Japan, with a 1-week follow-up to assess rebound. The primary endpoint was the investigators' rating of global improvement of sleep disorders. A total of 32 patients in the zolpidem group (13.9%) and 45 patients in the zopiclone group (18.1%) withdrew from the study before the end of the treatment. In the zolpidem group, 67.9% (142/209) of patients were rated at least 'moderately improved' versus 61.6% (135/219) with zopiclone, zolpidem being at least as effective as zopiclone (90% confidence interval: -1.7, 14.3). With zolpidem, sleep onset latency improved in significantly more patients (85.8% versus 77.5%) and significantly fewer patients showed aggravated sleep onset latency relative to baseline at follow-up (4.5% versus 15.4%). Significantly fewer patients receiving zolpidem experienced drug-related adverse events (31.3% versus 45.3%), with bitter taste representing 5.8% (six of 104) of such complaints with zolpidem compared with 39.9% (69/173) with zopiclone. In conclusion, zolpidem was at least as effective as zopiclone, showed significantly less rebound on discontinuation and was better tolerated.

Adult↗

Hedonics of binge eating in women with bulimia nervosa and binge eating disorder.

OBJECTIVE: Potential differences in the hedonics of binge eating between female subjects with bulimia nervosa (BN) and female subjects with binge eating disorder (BED) were examined. METHOD: Women seeking treatment for BN (N = 29) and BED (N = 49) completed the Eating Hedonics Questionnaire. RESULTS: Subjects in both groups reported similar precipitants and levels of distress associated with binge eating. Of interest, BED subjects were more likely to report that they enjoyed the food, the taste of the food, the smell and the texture of the food while binge eating. In addition, the BED group reported more relaxation and less physical discomfort and anxiety as a consequence of binge eating compared to the BN group. DISCUSSION: There are interesting and potentially important differences between individuals with BN and BED in the cognitions and behaviors associated with binge eating.

Adult↗

Changing perspectives of apheresis in India in the twentieth century.

Globally, the last century (20th) has seen many changes in terms of amazing advancements and applications of modern science, medicine, biotechnology and computers. One of the dramatic outcomes of such great inventions and discoveries was that the medical profession got the wonderful tool of immunomodulation and haemapheresis which has changed the outlook of the entire spectrum of immune complex disorders both in terms of the great success in treatment and the rehabilitation from so-called incurable diseases. Additionally this has resulted in a better quality of life and lower morbidity and mortality. Organ transplants have become a reality and immunomodulation plays a pivotal role in their success. India also has tasted this sweet recipe of modern medicine and has imbibed it in its medical culture. India is not only famous for the Taj Mahal and Hawa Mahal (Agra and Jaipur) but also for its brain (of brain drain/otherwise) and betz cells which have brought glories and laurels in the field of medicine, mathematics, engineering, literature, physics and computers, etc. to the native countries and India equally. Apheresis has now invaded the Indian scenario also and there is a growing interest, demand and application for it in the clinical field. But, being a unique country, the problems encountered are also unique. This paper deals with an overview of the changing perspectives of apheresis in India in the 20th century.

Blood Component Removal↗

[Pharmacologic treatment of acute migraine attack in children].

Migraine, according to the criteria of the International Headache Society, occurs in about 5 to 10% of children. Management of acute headache is only one of the parts of the treatment, along with identification of migraine precipitants, adjustments in lifestyle, and when necessary the use of preventive therapy, which can include non pharmacologic (relaxation or biofeedback) or pharmacologic treatment. In the acute migraine attack, a single dose of either ibuprofen 10 mg/kg or paracetamol 15 mg/kg has been shown to be effective, with only a few adverse effects. In severe migraine attacks, dihydroergotamine mesylate administered orally (20 to 40 microg/kg) or intravenously (maximum 1 mg/day) may be helpful, but there have been no large placebo-controlled trials of this treatment. Among the different triptans, it is the sumatriptan nasal spray whose efficacy has been best demonstrated. The most frequent adverse event is transitory unpleasant taste.

Acetaminophen↗

Cerebral processing of food-related stimuli: effects of fasting and gender.

To maintain nutritional homeostasis, external food-related stimuli have to be evaluated in relation to the internal states of hunger or satiety. To examine the neural circuitry responsible for integration of internal and external determinants of human eating behaviour, brain responses to visual and complex gustatory food-related stimuli were measured using functional magnetic resonance imaging in 18 healthy non-smokers (10 women, 8 men). Each individual was studied on two occasions, the order of which was counterbalanced; after eating as usual and after 24 h fasting. Raised plasma free fatty acids and lower insulin and leptin concentrations confirmed that participants fasted as requested. When fasted, participants reported more hunger, nervousness and worse mood and rated the visual (but not gustatory) food-related stimuli as more pleasant. The effect of fasting on hunger was stronger in women than in men. No circuitry was identified as differentially responsive in fasting compared to satiety to both visual and gustatory food-related stimuli. The left insula response to the gustatory stimuli was stronger during fasting. The inferior occipito-temporal response to visual food-related stimuli also tended to be stronger during fasting. The responses in the occipito-temporal cortex to visual and in the insula to gustatory stimuli were stronger in women than in men. There was no interaction between gender and fasting. In conclusion, food reactivity in modality-specific sensory cortical areas is modulated by internal motivational states. The stronger reactivity to external food-related stimuli in women may be explored as a marker of gender-related susceptibility to eating disorders.

Adult↗

The palatability of colloidal bulk forming agents.

The palatability of three bulk additives was studied in volunteers under 40 and over 60 years of age. Women highly significantly preferred Normacol Special (Norgine) to Fybogel (Reckitt & Colman) and Celevac Granules (W.B.P.). On both preference and palatability score Normacol Special was significantly preferred to Celevac Granules, as it was in the under 40's on palatability score and in the over 60's on preference, but in the latter, sex may have accounted for the difference observed. Volunteers under the age of 40 gave Celevac a significantly higher palatability score than Fybogel; the reverse occurred in the over 60's. These results have therapeutic implications in patients with different gastro-intestinal disorders.

Adult↗

Antidepressant-like effects of dopamine agonists in an animal model of depression.

Chronic exposure to mild unpredictable stress (CMS) has previously been found to cause an antidepressant-reversible decrease in the consumption of palatable sweet solutions. There is evidence that the effect of antidepressants in this model is mediated by an increase in transmission at dopamine (DA) synpases. The present study investigated whether another treatment known to increase the functional responsiveness of DA systems, intermittent administration of DA agonists, would have antidepressant-like effects. In three experiments in rats, CMS-induced decreases in sucrose consumption were reversed by three to four twice-weekly injections of quinpirole (100-200 micrograms/kg) or bromocriptine (2.5 mg/kg). The effects lasted for several weeks, and when they waned, could be reinstated by a single additional injection of quinpirole. As with tricyclic antidepressants, the effect of quinpirole was reversed by raclopride, administered acutely immediately prior to a sucrose consumption test; there were no changes in sucrose intake in nonstressed control animals. The results suggest that intermittent administration of DA agonists merits investigation as a novel strategy for the treatment of depression.

Animals↗

Radiation therapy as a treatment for benign lymphoepithelial parotid cysts in patients infected with human immunodeficiency virus-1.

Patients who are infected with the human immunodeficiency virus (HIV) may develop benign lymphoepithelial cysts within the parotid gland that cause severe facial deformity. Standard treatment for this disorder has been superficial parotidectomy, repeated fine-needle aspirations or observation alone. These approaches are unsatisfactory because elective surgery in immunocompromised patients should be avoided, the cysts recur soon after aspiration, and observation alone for a treatable deforming facial process is unacceptable. Radiotherapy's proven effectiveness in treating other benign disorders of the parotid gland led us to evaluate its usefulness as a treatment for this disorder. Eight patients with parotid enlargement, who were seropositive for HIV, received 8-10 Gy to the parotids in 1 week. Five patients had complete response and three patients had partial response. All were very satisfied with the cosmetic result. Treatment-related toxicity was well tolerated and consisted of mild xerostomia and transient taste loss. In all cases, these side effects resolved within 1 month. Radiation therapy thus appears to be an effective and well-tolerated treatment for AIDS-related parotid enlargement.

Adult↗

Linear programming and pediatric dietetics.

The composition of 500 foods has been stored in a computer in order to analyse a child's diet. The methodology of operations research is applied to a very simple problem: a diet with only two foods. The geometrical representation of the 'feasible region' and of the 'objective function' is illustrated. One of the analytical methods employable with many variables (foods) is considered. This method was used in trying to find diets allowing for the preferential use of selected foods while respecting recommended dietary allowances, the tastes of the child and other constraints. The theoretical difficulty of transferring this methodology to pediatric dietetics was examined. We solved a simple case utilizing this procedure.

Child↗

Non-colonic features of irritable bowel syndrome.

In 100 patients with irritable bowel syndrome a wide variety of non-gastrointestinal symptoms were significantly more common than in a group of 100 age, sex, and social class matched controls. Nocturia, frequency and urgency of micturition, incomplete bladder emptying, back pain, an unpleasant taste in the mouth, a constant feeling of tiredness and in women dyspareunia were particularly prominent (p less than 0.001). With reference to non-colonic gastrointestinal symptoms nausea, vomiting, dysphagia and early satiety were very common (p less than 0.0001). This symptom diversity was observed irrespective of whether the patient had a psychiatric disorder or not. Patients smoked more than controls (p = 0.02) drank more caffeine containing drinks (p = 0.03) and 26% had taken at least one week off work in the previous 12 months. Thirty three per cent of patients had a family history of irritable bowel syndrome. Cognisance of these diverse symptoms may prevent referral to the wrong medical specialty and inappropriate investigation. They may also be indicative of a much more diffuse disorder of smooth muscle than has previously been appreciated.

Adolescent↗

Picrorhiza kurroa. Monograph.

Picrorhiza kurroa is a well-known herb in the Ayurvedic system of medicine and has traditionally been used to treat disorders of the liver and upper respiratory tract, reduce fevers, and to treat dyspepsia, chronic diarrhea, and scorpion sting. It is a small perennial herb from the Scrophulariaceae family, found in the Himalayan region growing at elevations of 3,000 - 5,000 meters. Picrorhiza kurroa has a long, creeping rootstock that is bitter in taste, and grows in rock crevices and moist, sandy soil. The leaves of the plant are flat, oval, and sharply serrated. The flowers, which appear June through August, are white or pale purple and borne on a tall spike; manual harvesting of the plant takes place October through December. The active constituents are obtained from the root and rhizomes. The plant is self-regenerating but unregulated over-harvesting has caused it to be threatened to near extinction. Current research on Picrorhiza kurroa has focused on its hepatoprotective, anticholestatic, antioxidant, and immune-modulating activity.

Asthma↗

Taste responses of cortical neurons in freely ingesting rats.

1. Activities of 35 taste-responsive neurons in the cortical gustatory area were recorded with chronically implanted fine wires in freely ingesting Wistar rats. Quantitative analyses were performed on responses to distilled water, food solution, and four taste stimuli: sucrose, NaCl, HCl, and quinine hydrochloride. 2. Taste-responsive neurons were classified into type-1 and type-2 groups according to the response patterns to licking of the six taste stimuli. Type-1 neurons (n = 29) responded in excitatory or inhibitory directions to one or more of the taste stimuli. Type-2 neurons (n = 6) showed responses in different directions depending upon palatability of the liquids to rats: neurons showing excitatory (or inhibitory) responses to palatable stimuli exhibited inhibitory (or excitatory) responses to unpalatable stimuli. 3. Correlation coefficients of responses to pairs of stimuli across neurons suggested that palatable stimuli (water, food solution, sucrose, and NaCl) and unpalatable stimuli (HCl and quinine) elicited reciprocal (excitatory vs. inhibitory) responses in type-2 neurons, whereas type-1 neurons showed positively correlated responses to specific combinations of stimuli such as food solution and NaCl, sucrose and HCl, NaCl and quinine, and HCl and quinine. 4. A tendency toward equalization of effectiveness in eliciting responses among the four basic taste stimuli was detected on the cortex. The ratios of mean evoked responses in 29 type-1 neurons in comparison with spontaneous rate (4.4 spikes/s) were 1.7, 1.9, 1.8, and 1.9 for sucrose, NaCl, HCl, and quinine, respectively. 5. The breadth of responsiveness to the four basic taste stimuli was quantified by means of the entropy measure introduced by Smith and Travers (33). The mean entropy value was 0.540 for 29 type-1 neurons, which was similar to 0.588 previously reported for rat chorda tympani fibers, suggesting that breadth of tuning is not more narrowly tuned in a higher level of the gustatory system in the rat. 6. Convergent inputs of other sensory modalities were detected exclusively in type-1 neurons. Thirteen (45%) of 29 type-1 neurons also responded to cold and/or warm water, but none of 6 type-2 neurons responded to thermal stimuli. Two (7%) of 29 type-1 neurons responded to almond and acetic acid odors, but the 6 type-2 neurons did not. Two (13%) of 16 type-1 neurons responded to interperitoneal injection of LiCl, which is known to induce gastrointestinal disorders, with a latency of approximately 5 min, but 4 type-2 neurons tested were not responsive to this stimulation.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗