Effects of stimulation of the hypothalamic area on pancreatic exocrine secretion in dogs

Vagal innervation of the rat duodenum

Electrophysiologic and anterograde tract tracing studies have demonstrated that the vagus nerve innervates the duodenum. These studies, however, have provided little information regarding the finer anatomic topography within the vagal complex. In this study, the retrograde neuronal tracers WGA-HRP or DiI, applied to the duodenum, were used to characterize the vagal afferent and efferent innervation of this portion of the gastrointestinal tract. This approach labeled a substantial number of motor neurons in both the medial and lateral columns of the dorsal motor nucleus of the vagus (DMNV). Vagal motor neurons innervating the duodenum were seen across the medial-lateral extent of the DMNV and between 600 microm rostral to obex and 1600 microm caudal to obex. The three branches of the vagus nerve contained efferent fibers to the duodenum. The gastric branch of the vagus nerve was the pathway that connected the majority of DMNV neurons with the duodenum. These neurons were located in the medial and middle thirds of the DMNV. The celiac branch to the duodenum was composed of axons from the majority of lateral column neurons but also contained axons from neurons in the medial column. The hepatic branch of the vagus nerve contained only a small number of cell axons. Some neurons were located medially whereas others were in the lateral third of the duodenum. Although central terminations of vagal primary afferents from the duodenum were not found in previous tract tracing studies, we observed a large number of terminals in the subpostremal/commissural region of the nucleus of the solitary tract. Similar to the motor fibers, most afferent fibers from the duodenum were located in the gastric branch of the vagus nerve, although the hepatic and celiac branches also contained afferent neurons. These results demonstrate that the vagal innervation of the duodenum is unique, being an amalgam of what would be expected following labeling of more proximal and distal portions of the GI tract. The uniqueness of the sensory and motor innervation to the duodenum has implications for hypotheses regarding the organization of vagovagal reflexes controlling gastrointestinal function.

Brainstem dysfunction in chiari malformation presenting as profound hypoglycemia: presentation of four cases, review of the literature, and conjecture as to mechanism

OBJECTIVE

We report four patients whose cases resulted in our observation that profound hypoglycemia resulting from intermittent hyperinsulinism plays a significant role in patients with brainstem dysfunction from Chiari I or II malformations who have intermittent autonomic dysfunction ("blue spells").

METHODS

The records of four children with severe brainstem dysfunction associated with hindbrain herniation (Chiari I or II malformation) were reviewed retrospectively. Each patient had severe lower cranial nerve dysfunction that required tracheotomy and feeding tube placement. After we found that profound hypoglycemia had occurred during a spell of autonomic dysfunction in one patient, the charts of the other three patients were reviewed for evidence of hypoglycemia. Now, whenever one of them has evidence of autonomic dysfunction, prospective studies of glucose and insulin levels are performed. Three of the patients had Chiari II malformation in association with myelomeningocele, and one patient had a Chiari I malformation resulting from Pfeiffer's syndrome.

RESULTS

Hypoglycemia occurred in these patients episodically, and usually when their shunts were functioning. The hypoglycemia was associated with hyperinsulinemia in each patient. The brainstem structures of these children (presumably the dorsal motor nuclei of the vagus) were extremely sensitive to changes in local or regional intracranial pressure. These changes were triggered by intermittent shunt failure, agitation from pain, abdominal distention from constipation, and retention of CO2. In patients with Chiari malformations, even mild increases in intracranial pressure lead to brainstem dysfunction. One possible explanation is that pressure on the deformed Xth cranial nerve nuclei may lead to insulin release and life-threatening hypoglycemia. Continuous-drip feeds are necessary to prevent this complication.

CONCLUSION

Patients with severe intermittent brainstem dysfunction after decompression of Chiari I or Chiari II malformations should have laboratory studies of glucose levels performed at the time of the episodes to rule out hypoglycemia.

Alterations in behavioral responses to stressors following excitotoxin lesions of dorsomedial hypothalamic regions

The dorsomedial hypothalamus is important for regulation of cardiovascular responses associated with emotional arousal. This region has also been identified as a component of neural circuitry involved in fear/anxiety, yet clear evidence as to the effects of lesioning on stress-related behaviors is missing. In this study, we lesioned the dorsomedial hypothalamic region with the neurotoxin, ibotenic acid (IBO; 2.0 micrograms in 0.2 microliter), and studied the impact on spontaneous and unlearned behavioral responses to stressors. In the open field test, we observed non-generalized increases in motility parameters in the IBO rats with the differences occurring in the latter two-thirds of the test. In the elevated plus-maze, the IBO rats displayed a classic anxiolytic response with a greater proportion of entries into (and greater time spent in) the open arms of the maze. In the environment-specific social interaction (SI) test, the IBO rats showed a normal familiar/unfamiliar environment discrimination with respect to Total SI; however, the composition of the behaviors ('curiosity' vs. physical contact) by the IBO rats was markedly altered, with there being a 2-fold increase in non-violent physical interactions. Additionally, the differences in these traditional indices of anxiety were associated with lesioned animals exhibiting greater acoustic startle responsiveness than controls as a function of prepulse intensity. Overall, the results following IBO lesions indicate an altered responsiveness to sudden stressors, particularly as relates to novelty or exploration-oriented behaviors. The hypothalamic lesion may, therefore, have resulted in a disinhibition of normally suppressed responding to innate fear or challenging stimuli. This study contributes to those that have begun to define neural interactions that are essential for integrated stress responses.

Bile evacuation induced by hypothalamic stimulation in dogs

To investigate the role of the central nervous system in the cephalic phase of gallbladder emptying, the effects of electrical stimulation of the hypothalamus on the gallbladder and sphincter of Oddi and on bile flow rate were studied in anesthetized dogs. Stimulation of the anterior hypothalamic area induced gallbladder contraction and simultaneous relaxation of the sphincter without a significant increase in plasma cholecystokinin concentration. The bile flow rate was facilitated by stimulation of the same area. These responses were obtained even in dogs with cervical cord transection and were abolished by cervical vagotomy. The contraction response in the gallbladder was prevented by atropine, but a slight relaxation response in the sphincter remained. On the other hand, stimulation of the posterior hypothalamic area induced gallbladder relaxation and contraction or relaxation in the sphincter. The bile flow rate was decreased by stimulation of the same area. These responses were still obtained after vagotomy. These results indicate that the anterior hypothalamic area and the vagus nerves play an important role in gallbladder emptying in the cephalic phase.

Age differences in the proliferative response of cultured arterial smooth muscle cells induced by sera of hypothalamically-stimulated rats

In an earlier report, it was shown that arterial smooth muscle cells (ASMC) cultured from normal rat aorta, proliferated in response to homologous sera from young rats which had received hypothalamic stimulation (HS), in contrast to the effect of sera from non-stimulated age-matched controls (sham-operated). In the present study, this proliferative response was compared in young and old rats. Isolated target cells were subcultured from primary explants of aortic tissue obtained from young, male, Fischer 344 rats, which were electrode-implanted in the hypothalamus but not stimulated. After an initial quiescence period (growth arrest), target cells were exposed to plasma derived serum (PDS) from 4 experimental groups: young stimulated rats; young sham-operated controls; aged stimulated rats and aged sham-operated controls, at PDS concentrations of 2.5% and 5.0% and counted at days 2 and 5. Proliferative responses of ASMC were found to be influenced by concentration of the PDS, age of the donor animal contributing the serum and the presence of HS. The greatest responses were observed in relation to sera derived from aged stimulated rats, especially at the higher concentration, suggesting an interaction of HS with advanced age. These results are discussed in reference to their possible bearing on the pathogenesis of atherosclerosis.