Prognostic evaluation of endoscopic sclerotherapy on bleeding esophageal varices

From November 1981 to March 1984, 100 patients with esophageal varices bleeding were treated by endoscopic sclerotherapy.

The combined peri and intravasal method was applied, using Äthoxysclerol as a sclerosant.

The 79 cases were followed after sclerotherapy over a period ranging from 3 months to 26 months.

The amount of transfused blood on presclerotherapy was 4–5 pints and in 2/3 cases 1–2 pints were needed on postsclerotherapy.

Seven cases (8.1 per cent) had complications; 2 cases developed esophageal stenosis, 3 cases aspiration pneumonia, and 2 cases mediastinitis.

Fortunately, all 7 cases recovered. Rebleeding occurred in 15 cases (19.0 per cent); namely 3 cases (3.8 per cent) within 6 months, 5 cases (6.3 per cent) in the period from 6 months to 12 months and 7 cases (8.9 per cent) after 12 months.

During the follow up period, 14 cases died. Their causes of death were as follows: 6 cases died of hepatic failure, 5 cases died of hepatoma, and 3 cases expired from uncontrollable bleeding.

Based on data, it appears to be possible to control the bleeding in 97 per cent of the esophageal varices bleeding on their (first) bleeding.

Flexion reflex elicited by ventral root afferents in the cat

To investigate the physiological role of ventral root afferent fibers, the ventral root was stimulated in spinal cats in an attempt to elicit the flexion reflex, a common nociceptive spinal reflex. The flexion reflex was elicited by stimulating the distal stump of the cut L7 or S1 ventral root and recorded from the proximal stump of the cut S1 ventral root. In 12 of the 14 cats studied, the flexion reflex was recorded as a compound action potential. The finding was confirmed by recording single-unit activity from 5 units in two cats. These results suggest that the ventral root afferent fibers exert a variety of physiological effects that include eliciting such spinal reflexes as the flexion reflex. The responsible fibers in the ventral root travel distally towards the dorsal root ganglion to enter the spinal cord through the dorsal root.

Funicular trajectories of brainstem neurons projecting to the lumbar spinal cord in the monkey (Macaca fascicularis): a retrograde labeling study

Brainstem nuclei projecting to the lumbar spinal cord in the monkey were identified by using horseradish peroxidase and the fluorescent dye granular blue. These retrogradely transported tracers were used in fluid and/or gel forms to determine the funicular trajectories of the brainstem-spinal projections. The major descending components of the dorsal funiculus arose from the n. gracilis, n. cuneatus, and the n. of the solitary tract. Major components of the dorsolateral funiculus (DLF) came from the raphe complex, medullary and pontine reticular formation, locus coeruleus, Edinger-Westphal n., and red n. Other nuclei giving rise to minor contributions to the DLF included n. gracilis, n. cuneatus, n. of the solitary tract, medial and spinal vestibular n., subcoeruleus, periaqueductal gray, interstitial n. of Cajal, n. of Darkschewitsch, and the anteromedian n. The major components of ventral cord paths (ventrolateral and ventral funiculi) arose from the raphe complex, the medullary and pontine reticular formation, lateral and spinal vestibular n., and the coerulean complex. Minor contributions to the ventral paths descended from the dorsal motor n. of X, n. of the solitary tract, medial vestibular n., paralemniscal reticular formation, dorsal parabrachial n., n. cuneiformis, periaqueductal gray, Kölliker-Fuse n., and red n. The possible functional implications of the funicular distribution of these descending pathways are discussed from the perspective of descending inhibition and pain modulation.

Activation of dorsal horn cells by ventral root stimulation in the cat

Responses of dorsal horn cells to ventral root stimulation were determined for the L7 and S1 levels of the spinal cord of 14 anesthetized cats. Forty-six dorsal horn cells were found that were excited by stimulation of the distal stump of the cut ventral root. For maximum excitation it was necessary to use a train of stimuli. For the 34 dorsal horn cells whose peripheral receptive-field properties could be characterized, 14 were wide dynamic range cells and 19 were high-threshold cells. The other cell responded exclusively to stimulation of deep tissue. None of the cells responded exclusively to innocuous stimuli, and all responded more vigorously to noxious than to innocuous stimuli. Some cells also responded to noxious heat applied to the skin of the receptive field. Locations of 10 of the activated dorsal horn cells were identified. They were distributed throughout the dorsal horn, but most were found in laminae V and VI. In four animals, both the proximal and distal stumps of the cut S1 ventral root were stimulated while searching for dorsal horn cells. Ten dorsal horn cells were found that were excited by stimulation of the distal stump of the ventral root. No cells were found that responded to proximal stump stimulation. To prevent current spread by stimulation of the ventral root, an extra ground electrode was placed distal to the stimulating electrodes. When the ground electrode was removed, distinctive signs of current spread appeared in that a cord dorsum potential could be recorded and the dorsal horn neuronal responses changed. Dorsal horn neurons could also be excited by nonelectrical stimuli such as crushing the ventral root. If the ventral root was crushed distal to the stimulating electrodes, however, the initially excited cell could no longer be activated by ventral root stimulation. Activation of dorsal horn cells by stimulation of the distal stump of a cut ventral root was abolished when the dorsal root of the same segment was sectioned. Conduction velocities of the fibers in the ventral root that excited dorsal horn cells ranged between 0.25 and 1.78 m/s with a mean of 0.91 +/- 0.47 (SD) m/s. These results show that there are unmyelinated afferent fibers in the ventral root that enter the spinal cord through the dorsal root and excite dorsal horn cells.(ABSTRACT TRUNCATED AT 400 WORDS)

Electrophysiological evidence for the presence of fibers in continuity between dorsal and ventral roots in the cat

Action potentials were recorded from the L7 or S1 dorsal root of the cat following stimulation of the peripheral end of the cut ventral root of the same segment. Conversely, action potentials were also recorded from the ventral root while stimulating the peripheral end of the cut dorsal root. Based on the conduction velocities of 52 single fibers, one-third were A delta-fibers and the remaining two-thirds belonged to the C-fiber category. These results suggest that there are both A- and C-fibers in continuity between the dorsal and the ventral root.

Effects of capsaicin applied to a peripheral nerve on the responses of primate spinothalamic tract cells

Capsaicin is a neurotoxin that appears to affect unmyelinated nociceptive sensory fibers selectively. We examined the effects of capsaicin applied topically to the sural nerve on peripheral nerve volleys and on the responses of neurons belonging to the spinothalamic tract (STT) in the monkey. The responses examined included those following electrical stimulation of the sural nerve and also those produced by more natural forms of noxious and innocuous stimuli applied to the skin. Capsaicin (1% solution) applied onto the sural nerve for 15 min resulted in a reduction of the sizes of A delta- and C-fiber afferent volleys. These changes paralleled the reduction of A- and C-fiber responses of the STT cells elicited by electrical stimulation of the sural nerve. During capsaicin application onto the sural nerve, the background activity of STT cells increased for 5-10 min. After capsaicin treatment, the responses of STT cells to innocuous mechanical stimuli applied to the cutaneous receptive field were increased, whereas the responses to noxious mechanical stimuli were decreased. However, topical capsaicin application almost eliminated the responses of STT cells to noxious heat stimuli. The results of the present study suggest that topical capsaicin application onto a peripheral nerve produces a transient nociceptive response followed by a decrease in sensitivity to noxious stimuli, particularly to noxious heat. These changes are due to conduction block of the nerve fibers at the site of capsaicin application.

Inhibition of primate spinothalamic tract cells by TENS

Transcutaneous electrical nerve stimulation (TENS) was applied in an experimental animal model to investigate the underlying mechanisms of this treatment. Recordings were made from identified spinothalamic tract (STT) neurons in the lumbosacral spinal cords of seven anesthetized monkeys. The STT cells were activated by stimulating the common peroneal nerve at a suprathreshold intensity for C-fibers. Evoked responses of C-fibers were compared before, during, and after application of TENS for 5 minutes from a commercially available TENS unit. The current delivered by the TENS unit was monitored. In 14 STT cells, some degree of inhibition of C-fiber evoked responses occurred only when the intensity of TENS exceeded the threshold of A delta fibers. At a given stimulus intensity, bursts of pulses repeated at a low rate were more effective than high-rate pulses. When TENS was applied to an area of the skin within a cell's receptive field, it was more effective than when it was applied outside the receptive field. The C-fiber volley recorded from a peripheral nerve was not reduced in size, and there were no substantial changes in its latency due to TENS. The inhibition of the activity of STT cells was not altered appreciably after intravenous injection of naloxone hydrochloride. These results suggest that TENS produces central nervous system inhibition by activating A delta afferent fibers. The inhibitory effects of TENS on STT cells appear to be due to a mechanism that does not involve release of endogenous opioid substances.

Segmental distribution of dorsal root ganglion cells with axons in the inferior cardiac nerve

The segmental distribution of visceral afferent neurons with axons in the cardiac nerve was studied in cats with the horseradish peroxidase (HRP) technique. After HRP was introduced into the left inferior cardiac nerve, labeled dorsal root ganglion cells were found in the ganglia from the C7 to T7 spinal levels, with a wide variation in distribution among the individual animals. An average of 93 cells was labeled per animal. The data indicate that the afferent nerve fibers in the inferior cardiac nerve project to a much wider range of segments of the spinal cord than previously believed.

The effects of small doses of barbiturate on the activity of primate nociceptive tract cells

The activity of neurons identified as or similar to spinothalamic tract cells was compared in anesthetized, intact monkeys and in unanesthetized, decerebrate or spinalized animals. Background activity and responses to A- and C-fiber volleys were smaller in decerebrate than in the other preparations, suggesting the presence of a tonic descending inhibition of nociceptive tract cells in the decerebrate state. Injections of small doses of sodium pentobarbital caused a slight increase in sensitivity of peripheral receptive fields to mechanical stimuli in some cells, and an increase in responses to squeezing the skin with forceps and to C-fiber volleys. Larger doses of pentobarbital reduced the responses to A- and C-fiber volleys. These observations suggest that the activity of nociceptive tract cells is well preserved in the presence of the doses of pentobarbital we routinely use and are consistent with the hyperalgesic state reported to be produced by small doses of barbiturate.

Prolonged inhibition of primate spinothalamic tract cells by peripheral nerve stimulation

Inhibition of spinothalamic tract (STT) cells was produced by repetitive peripheral nerve conditioning stimulation with high intensity and low frequency pulses. Identified STT cells were recorded from the lumbosacral spinal cord of intact, anesthetized monkeys. In addition, presumed STT cells were recorded from both unanesthetized, decerebrated and decerebrated, spinalized monkeys. These cells were identified by antidromically activating them from the contralateral ventral lateral funiculus of the cervical spinal cord. Both C fiber activity evoked by electrical stimulation of the sural nerve and activity evoked by noxious heat were greatly inhibited by repetitive conditioning stimuli applied either to the common peroneal or tibial nerve with a strong enough intensity for activation of C fibers at 2 Hz for 15 min. The inhibition was maintained during the period of conditioning stimulation and often outlasted stimulation by 20-30 min. The inhibition of cells produced by peripheral nerve stimulation was observed in decerebrate and spinalized animals as well as in intact anesthetized monkeys, although the mean recovery time in the decerebrate group was faster. This indicates that anesthetics did not interfere with the inhibitory mechanism. Furthermore, the presence of inhibition in spinalized animals means the inhibition must depend in part on spinal cord neuronal circuitry. Intravenous injection of naloxone produced a significant but small reduction of the recovery phase of the inhibition. No pharmacological agent was found that substantially interfered with the powerful inhibition produced during peripheral conditioning stimuli. The experimental animal model used in these experiments seems appropriate for studying the mechanisms of analgesia produced by peripheral nerve stimulation.

Factors influencing peripheral nerve stimulation produced inhibition of primate spinothalamic tract cells

Several factors that influence the inhibition of primate spinothalamic tract (STT) cells produced by repetitive peripheral conditioning stimulation have been studied. Identified STT cells were recorded from the lumbosacral spinal cord in intact, anesthetized monkeys. In addition, presumed STT cells were recorded from unanesthetized, decerebrate or decerebrate, spinalized monkeys; these cells were identified by antidromic activation from the contralateral ventral lateral funiculus of the upper cervical spinal cord. Activity of the STT cells was evoked by electrically stimulating the sural nerve with pulses having an intensity strong enough to activate C fibers. The C fiber evoked STT cell activity was compared before, during and after repetitive conditioning stimuli applied to the tibial nerve for 5 min. By applying repetitive strengths of conditioning stimuli, it was found that the A delta fiber group is the most important for producing inhibition of STT cells, although significant additional effects were also produced by the A alpha beta and C fiber groups. Conditioning stimuli with fixed intensity at different frequencies showed that the higher the frequency the more powerful the inhibition within the range we tested (0.5-20 Hz). The inhibition produced by peripheral nerve stimulation was segmentally organized, so the most effective nerve in producing inhibition amongst those tested was the ipsilateral tibial nerve. The contralateral sciatic nerve, the ipsilateral median nerve and the contralateral median nerve were less effective in that order. The results of the present experiments suggest that the most effective way to produce analgesia by peripheral nerve stimulation would be by high frequency stimulation of a nerve innervating the area from which pain originates with an intensity at least strong enough to activate A delta fibers.

Effects of iontophoretically released amino acids and amines on primate spinothalamic tract cells

The effects of glutamate (Glu), gamma-aminobutyric acid (GABA), glycine (Gly), serotonin (5-HT), norepinephrine (NE), dopamine (DA), and acetylcholine (ACh) were examined in this study by iontophoretic application onto primate spinothalamic tract (STT) neurons identified antidromically by stimulation in the contralateral thalamus. Drugs were tested for effects on background activity, Glu-induced firing, and activity evoked by pinching of the skin. Whereas Glu excited STT cells and was thus used for tests of the other compounds, the amino acids GABA and Gly inhibited Glu- and pinch-induced activity in all STT cells examined. STT cells were also inhibited by 5-HT, NE, and DA. Only two cases of excitation by 5-HT were seen (of 58 cells tested). ACh also had inhibitory actions on STT cells, although 3 of 21 cells exhibited some enhancement of activity. The effects of these compounds on identified STT cells resemble previous demonstrations of the effects of these drugs on dorsal horn interneurons. The results suggest that GABA, Gly, 5-HT, NE, and DA may be inhibitory neurotransmitters on nociceptive STT cells.

Effects of iontophoretically released peptides on primate spinothalamic tract cells

The peptides substance P (SP), methionine-enkephalin (M-ENK), leucine-enkephalin (L-ENK), and cholecystokinin (CCK) were released iontophoretically near spinothalamic tract (STT) cells in anesthetized monkeys and STT-like cells in decorticate, spinalized monkeys. Peptide effects were observed on background discharges, firing induced by release of glutamate, and activity evoked by pinching the skin. SP could have any of several actions on STT cells, including excitation, inhibition, or biphasic effects. Multiple effects often resulted while recording from an individual cell when the dose or the electrode position was changed. M-ENK and L-ENK generally inhibited STT cells, and in some cases it was possible to demonstrate a reversal of the inhibition by naloxone. CCK also caused an inhibition that was additive with that produced by L-ENK. The multiple actions of SP on STT cells suggests the possibility that there may be more than one type of SP receptor on STT cells, although alternative explanations should be considered. Inhibition of STT cells by M- and L-ENK is consistent with the known analgesic action of opiates through spinal cord mechanisms. CCK has an action on STT cells similar to that of the enkephalins.

Activation of central neurons by ventral root afferents

It is a fundamental principle of vertebrate neuronal organization that sensory fibers are restricted to dorsal roots and motor fibers to ventral roots. Recent evidence, however, indicates that there are many sensory fibers in ventral roots. The present report shows that stimulation of these fibers activates neurons in the dorsal horn. This provides evidence at the single-cell level for the importance of ventral root afferents and provides an explanation for the clinical phenomenon of recurrent sensibility.

Midbrain nuclei projecting to the medial medulla oblongata in the monkey

To identify the midbrain nuclei that project to the medial part of the lower brainstem in the monkey, labeled cells were mapped in the midbrain following the injection of horseradish peroxidase into the medial medulla oblongata. After the general distribution of labeled cells was observed in three animals with large injections, more discrete injections of HRP were made in different locations in six additional animals. The small injections were centered in the nucleus raphe magnus, nucleus reticularis gigantocellularis, or nucleus medullae oblongatae centralis. The five labeled midbrain nuclei were the periaqueductal gray, nucleus cuneiformis, deep layers of the superior colliculus, nucleus of Darkschewitsch, and the interstitial nucleus of Cajal. In addition, the parvocellular division of the red nucleus and the posterior pretectal nucleus contained large numbers of cells when the injection spread into the inferior olive. No major differences in the distribution of labeled cells between different injection sites were found with the exception that the superior colliculus did not contain any labeled cells when the injection was restricted to midline structures. The functional implications of these anatomical findings are discussed in relation to the descending control of pain.

Cells of origin of the spinoreticular tract in the monkey

The distribution of the cells of origin of the primate spinoreticular tract was determined following injections of horseradish peroxidase (HPR) into the pontomedullary reticular formation in Macaca fascicularis. Five animals received large bilateral injections which included the raphe nuclei and seven monkeys received smaller, unilateral injections. Sections sampled were from upper cervical levels, the cervical enlargement, upper and lower thoracic levels, and lumbosacral levels. The laminar distribution of spinoreticular cells in all spinal cord levels was comparable. More than half of the labeled cells were located ventromedially, in laminae VII and VIII. HRP-labeled cells were also found in the dorsal horn, primarily in the lateral reticulated part of lamina V. Some cells were also found in laminae I and X. Spinoreticular cells in the lumbosacral spinal cord mainly projected to the contralateral brainstem. In the cervical enlargement, however, a bilateral distribution of cells was observed following unilateral injections of HRP. Most spinoreticular cells were multipolar neurons with extensive dendritic ramifications. The distribution of spinoreticular cells is similar to the distribution of spinal cord neurons that project to the medial thalamus, but different from that of spinal neurons projecting to the ventrobasal complex. The anatomical organization of the spinoreticular tract is consistent with a role for this pathway in nociception.

Facilitation of the response of primate spinothalamic cells to cold and to tactile stimuli by noxious heating of the skin

Spinothalamic tract cells in anesthetized monkeys were found to respond to noxious cold stimuli (18/19 cells tested), as well as to noxious heat and noxious mechanical stimuli. Responses to repetition of the noxious cold stimuli after a series of noxious heat stimuli were enhanced. However, subtraction of the enhanced background activity that resulted from damage of the skin revealed that the enhanced response to noxious cold stimuli were due to superposition of the original responses upon an enhanced background activity, rather than to sensitization of the responses to noxious cold stimuli per se. Furthermore, the responses to innocuous mechanical stimuli applied either within the area that was damaged or outside this area were enhanced, provided the noxious heat was applied for a long enough time. Thus, damage to a region of skin can result in enhanced responsiveness of spinothalamic cells to stimuli applied in an undamaged region of the receptive field. The possible relationship between these observations and cutaneous hyperalgesia is discussed.

Ascending spinal pathways mediating somato-cardiovascular reflexes

The influence of spinal somatic afferent pathways upon cardiovascular parameters were studied in anesthetized and conscious dogs. Previous studies on anesthetized cats indicated that activation of somatic A afferent fibres results in a depressor response mediated by ascending spinal pathways in the dorsolateral funiculus (DLF). Additional activation of somatic C afferent fibers results in a pressor response mediated by pathways in the region of the dorsolateral sulcus (DLS). In anesthetized dogs sympathetic-mediated cardiovascular responses to somatic afferent stimulation are found to be conducted in the DLS. To test the possibility that these afferent pathways may mediate cardiovascular responses to exercise, dogs instrumented for blood pressure and heart rate monitoring were trained to run on a treadmill on all 4 legs and on their hindlegs only. Lesions on the DLS and a portion of the DLF significantly altered heart rate responses to treadmill running on all 4 legs. These data suggest that somato-autonomic reflexes participate in the cardiovascular adjustments which occur during exercise.

Primary afferent axons in the tract of Lissauer in the monkey

The main thrust of the present study was to determine the numbers of primary afferent fibers in the tract of Lissauer in the monkey. The findings are that approximately 40% of the axons in the tract of Lissauer are primary afferent axons from a single segment, and approximately another 40% are primary afferents from segments cranial and caudal to the segment under consideration. Presumably, the remaining 20% are propriospinal axons. There is relatively little difference in the proportions of primary afferents in medial as opposed to lateral parts of the tract, and in this respect the monkey differs somewhat from the rat and cat. Thus in the monkey the tract of Lissauer should probably be regarded as a primary afferent pathway with the propriospinal forming a distinct but relatively minor component of the tract.

Inhibition and excitation of primate spinothalamic tract neurons by stimulation in region of nucleus reticularis gigantocellularis

1. Electrical stimulation in the region of the nucleus reticularis gigantocellularis (NGc) in anesthetized monkeys inhibited or excited spinothalamic tract neurons in the lumbosacral and cervical enlargements. 2. The descending effects were generally more pronounced for activity evoked by cutaneous A-delta-fibers than for activity produced by large myelinated cutaneous afferents. Nevertheless, the responses to all types of natural stimuli used could be inhibited or facilitated. 3. The excitation from repeated brief stimulus trains to the NGc sometimes increased progressively, suggesting the existence of a positive feedback system. Occasionally, repeated stimulation of the NGc produced a progressively greater inhibition. 4. The threshold stimulus strength to elicit the inhibitory and excitatory actions was usually less than 50 microA, and in some cases less than 25 microA. The inhibition and excitation increased as the stimulus intensity was raised above the threshold value, or as the number and/or frequency of pulses in the stimulus train was increased. 5. The strongest inhibition and excitation was produced by stimulation within the NGc on either side of the brain stem. There was no obvious topographic organization of inhibitory and excitatory zones. 6. Dorsolateral tractotomies in the high cervical spinal cord did not prevent the effects of NGc stimulation, indicating that the inhibitory and excitatory pathways descend in the ventral parts of the white matter. 7. It is suggested that the inhibition and excitation are mediated by the medullary reticulospinal system.

The anatomical localization of descending pressor pathways in the cat spinal cord

Functional evidence suggests the location of descending pressor pathways in the bilateral dorsolateral funiculus (DLF). To investigate the anatomical course of these pathways, orthograde degeneration studies were conducted following unilateral lesions of the DLF at the C6-C7 spinal level. Degenerating fiber tracts were localized exclusively in the ipsilateral DLF. Degeneration was also demonstrated in the central portion of the intermediate spinal gray matter, but little or no degeneration in the intermediolateral cell column. This evidence suggests that these descending pathways do not terminate on sympathetic preganglionic cell bodies or their proximal dendrites, but perhaps upon their more distal dendrites or interneurons.

Responses of primate spinothalamic neurons to graded and to repeated noxious heat stimuli

1. The responses of primate spinothalamic tract cells innervating the glabrous skin of the foot to noxious thermal stimuli have been examined. 2. Of the 41 cells studied, 98% responded to noxious thermal stimuli. Heating the cutaneous receptive field with a series of stimuli from 35 to 43, 47, and 50 degrees C produced a graded increase in discharge rate. The responses were characterized by an onset, which occurred after the temperature change had either slowed or stopped, an acceleration in the discharge up to a peak, and then an adaptation to a new base-line level. The time constants of adaptation were faster than those reported for C polymodal nociceptors. 3. No systematic differences were found in the responses to noxious thermal stimuli of cells with wide dynamic range receptive fields and of cells with narrow dynamic range, high-threshold receptive fields. There were also no differences in the responses of cells located in the marginal zone and of cells located in the neck of the dorsal horn. 4. The relationship between peak frequency and final skin temperature with a 30 s stimulus duration can best be described by a power function with an exponent of 2.1. An increase in the stimulus duration to 120 s resulted in an increase in the exponent of the power function to 3.2. 5. Repetition of the series of 30-s heat stimuli resulted in an increase in peak frequency, total impulse count, and background activity. Repetition of stimuli having a duration of 120 s produced an increase in the peak frequency at 43 and 45 degrees C, a smaller increase at 47 degrees C, and a decrease at 50 degrees C. Background activity was increased by the lower temperature stimuli, but was decreased following higher temperature stimuli. 6. In six additional cells, the skin was heated with three consecutive presentations at each temperature level (43, 45, 47, and 50 degrees C) for 30 s. No change was observed in the peak frequencies of the responses to successive stimuli of the same intensity. However, the exponent of the power function relating the average peak frequency for the six cells to changes in skin temperature was 3.9. This exponent was larger than that seen when two series of graded heat stimuli of 120 s duration were used, indicating more sensitization despite the fact the total time of exposure to noxious heat was less. 7. A role for both high-threshold and wide dynamic range spinothalamic cells in transmitting nociceptive information to the diencephalon is postulated.

Excitation of primate spinothalamic neurons by cutaneous C-fiber volleys

1. The responses of spinothalamic tract cells in the lumbosacral spinal cords of anesthetized monkeys were examined following electrical stimulation of the sural nerve or the application of noxious thermal and mechanical stimuli to the skin on the lateral aspect of the foot. 2. The spinothalamic tract neurons were classified as wide dynamic range (WDR), high-threshold (HT), or low-threshold (LT) cells on the basis of their responses to mechanical stimuli. 3. All of the WDR and HT spinothalamic tract cells tested responded to volleys in A- and C-fibers. However, strong C-fiber responses were more common in HT than in WDR cells. 4. The responses atributed to C-fibers were graded with the size of the C-fiber volley. The latencies of the responses attributed to C-fibers indicated that the fastest afferents involved had a mean conduction velocity of 0.9 m/s. The responses remained after anodal blockade of conduction in A-fibers. 5. Temporal summation of the responses of spinothalamic tract cells was demonstrated both to brief trains of stimuli at 33 Hz and to single stimuli repeated at 1- to 2-s intervals. The latter phenomenon is often called "windup." 6. The responses of several spinothalamic tract cells to noxious heat pulses could still be elicited during anodal blockade of conduction in A-fibers. Similarly, it was possible to demonstrate an excitatory action of noxious mechanical stimuli despite interference with conduction in A-fibers by anodal current. 7. The cells investigated were located either in the marginal zone or in the layers of the dorsal horn equivalent to Rexed's laminae IV-VI in the cat. The cells were generally activated antidromically from the caudal part of the ventral posterior lateral nucleus of the thalamus.

Ascending spinal pathways for the somatosympathetic A and C reflexes

Sympathetic unit nerve activity was recorded from the cervical sympathetic trunk of anesthetized, vagotomized, and carotid sinus-denervated cats. Single pulses or short trains of pulses with suprathreshold intensity for afferent C fibers were applied to the common peroneal nerve to elicit somatosympathetic A or simultaneous A and C reflexes, respectively. Bilateral lesions of an ascending spinal pathway in the dorsolateral sulcus area (DLS) of the T12 spinal cord eliminated the sympathetic C reflex. The remaining somatosympathetic A reflex was abolished by the subsequent lesion of an ascending spinal pathway in the dorsolateral funiculus (DLF) bilaterally. The duration of the silent period was found to be mainly influenced by an ascending spinal pathway in the DLF. It was concluded that excitation of afferent A fibers activates ascending pathways mainly in the DLF and a smaller contribution in the DLS of the spinal cord. This produces a small reflex excitation (A reflex) followed by a long silent period in the sympathetic nerves resulting in a net decrease of total sympathetic nerve activity. On the other hand, excitation of afferent C fibers activates the ascending spinal pathway in the DLS. This produces a reflex excitation (C reflex) which exceeds the decreased activity due to the silent period resulting in a net increase of total sympathetic nerve activity.