High dorsal column cordotomy plus subdiaphragmatic vagotomy prevents acute ionizing radiation sickness in cats

Brain areas essential or non-essential for emesis

This study was undertaken to better delineate those brain regions that are either essential or non-essential for vomiting. Fictive vomiting, identified by a characteristic pattern of respiratory nerve discharge, was induced by a combination of emetic drugs and electrical stimulation of abdominal vagal afferents in decerebrate, paralyzed cats. Regions non-essential for coordinating vomiting included the entire cerebellum, structures rostral to the medullary retrofacial nucleus, and spinal cord. Fictive coughing was also elicited following cerebellar removal but was not studied after other procedures. The respiratory-related components of fictive vomiting were abolished by large lesions or kainic acid injections in the lateral medulla at the level of the retrofacial nucleus, where respiratory pre-motor and motor neurons are known to exist. Electrical stimulation of this region of the brainstem failed to evoke vomiting. The results of the present study are consistent with our previous electrical stimulation [Brain Res., 270 (1983) 154-158] and c-fos [J. Neurosci., 14 (1994) 871-888] studies and the hypothesis that emesis is coordinated not by a unique, well-defined 'vomiting center' but rather by a distributed control system located in the medulla between the levels of the obex and the retrofacial nucleus.

Ondansetron. Therapeutic use as an antiemetic

Ondansetron (GR 38032F) is a highly selective 5-HT3 receptor antagonist, one of a new class of compounds which may have several therapeutic applications. Animal and clinical studies show that ondansetron reduces the 24-hour incidence and severity of nausea and vomiting induced by cytotoxic drugs, including cisplatin, and by single exposure, high dose radiation. Ondansetron is more effective than high dose metoclopramide in the 24 hours following chemotherapy, and preliminary clinical evidence suggests that it is equally effective in the following 4 days. It is also more effective than the 'moderate' doses of metoclopramide used to suppress emesis following radiotherapy. The antiemetic efficacy of ondansetron is enhanced by dexamethasone in cisplatin-treated patients. Importantly, extrapyramidal effects have not been reported with ondansetron. Further comparisons are required with standard combination antiemetic therapy to complement the data presently available. Thus, ondansetron is a promising new agent for prophylaxis against nausea and vomiting in chemotherapy and radiotherapy. It may be particularly useful in young and elderly patients who are more susceptible to extrapyramidal symptoms induced by high dose metoclopramide. With its improved tolerability and clinical response profiles, ondansetron represents an important advance in a difficult area of therapeutics.