GASTROINTESTINAL DORSAL ROOT VISCEROTOMES IN THE CAT

Subdiaphragmatic phrenic nerve supply: A systematic review

OBJECTIVE

The aim of this systematic review is to study the subdiaphragmatic anatomy of the phrenic nerve.

MATERIALS AND METHODS

A computerised systematic search of the Web of Science database was conducted. The key terms used were phrenic nerve, subdiaphragmat*, esophag*, liver, stomach, pancre*, duoden*, intestin*, bowel, gangli*, biliar*, Oddi, gallbladder, peritone*, spleen, splenic, hepat*, Glisson, falciform, coronary ligament, kidney, suprarenal, and adrenal. The 'cited-by' articles were also reviewed to ensure that all appropriate studies were included.

RESULTS

A total of one thousand three hundred and thirty articles were found, of which eighteen met the inclusion and exclusion criteria. The Quality Appraisal for Cadaveric Studies scale revealed substantial to excellent methodological quality of human studies, while a modified version of the Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias Tool denoted poor methodological quality of animal studies. According to human studies, phrenic supply has been demonstrated for the gastro-esophageal junction, stomach, celiac ganglia, liver and its coronary ligament, inferior vena cava, gallbladder and adrenal glands, with half of the human samples studied presenting phrenic nerve connections with any subdiaphragmatic structure.

CONCLUSIONS

This review provides the first systematic evidence of subdiaphragmatic phrenic nerve supply and connections. This is of interest to professionals who care for people suffering from neck and shoulder pain, as well as patients with peridiaphragmatic disorders or hiccups. However, there are controversies about the autonomic or sensory nature of this supply.

Chronic Abdominal Discomfort Syndrome (CADS): Defining and Discussing a Novel Diagnosis

In this article, we propose a new diagnostic paradigm known as Chronic Abdominal Discomfort Syndrome (CADS). Patient's presentation centers around chronic abdominal pain not explained by acute pathology with or without accompanying dyspepsia, bloating, nausea and vomiting among other symptoms. The pathophysiology is noted to be neurogenic, possibly stemming from visceral sympathetic nerves or abdominal wall afferent nerves. Diagnosis is supported by signs or symptoms traversing clinical, diagnostic and functional criteria. Included is a tool which can assist clinicians in diagnosing patients with CADS per those domains. We hope to facilitate primary care physicians' and gastroenterologists' utilization of our criteria to provide guidance for selecting which patients may benefit from further interventions or evaluation by a pain physician. The pain physician may then offer interventions to provide the patient with relief.

Extradural anaesthesia-analgesia in dogs undergoing cholecystectomy: A single centre retrospective study

Objectives

To assess the effects of extradural anaesthesia-analgesia (EAA) in dogs undergoing cholecystectomy.

Materials and methods

Medical records of dogs undergoing cholecystectomy between 2011 and 2019 were retrieved and allocated to two groups depending if analgesia was provided systemically (group SA) or extradurally (EAA). Preoperative data, intraoperative antinociceptive medications, postoperative analgesia, perioperative complications, and food intake were compared.

Results

Overall 41 medical records were included in the study: 19 and 22 dogs were allocated to groups SA and EAA, respectively. In group EAA, an extradural catheter was placed preoperatively in 8 dogs; in the remaining, it was placed postoperatively but an extradural injection was performed preoperatively. The extradural catheter tip was between the 4th lumbar and the 10th thoracic vertebrae. Intraoperatively, nociception was more likely to occur in group SA [OR 55.42 (2.97–1,035.06)]. During the first 24 and 48 h postoperatively, more dogs in group SA required methadone [OR 24 (2.81–268.4) and OR 11.56 (2.37–45.06), respectively] and additional analgesic drugs [OR 25 (3.47–281.9) and OR 35.29 (1.86–668.2), respectively] compared to group EAA. Voluntary postoperative food intake was also significantly higher in group EAA.

Clinical significance

Compared to systemic analgesia, the use of extradural anaesthesia-analgesia reduced perioperative analgesic requirement and promoted postoperative food intake in dogs undergoing cholecystectomy.

Characterization of T9-T10 spinal neurons with duodenal input and modulation by gastric electrical stimulation in rats

Gastric electrical stimulation (GES) has been suggested as a therapy for patients with gastric motility disorders or morbid obesity. However, it is unclear whether GES also affects intestinal sensory and motor functions. Furthermore, little is known about intraspinal visceroreceptive transmission and processing for duodenal afferent information. The aims of this study were to characterize responses of thoracic spinal neurons to duodenal distension, to determine the afferent pathway and to examine the effects of GES on activity of these neurons. Extracellular potentials of single T9-T10 spinal neurons were recorded in pentobarbital anesthetized, paralyzed, ventilated male rats (n=19). Graded duodenal distension (DD, 0.2-0.6 ml, 20 s) was produced by water inflation of a latex balloon surgically placed into the duodenum. One pair of platinum electrodes (1.0-1.5 cm apart) was sutured onto the serosal surface of the lesser curvature of the stomach. GES with four sets of parameters was applied for one minute: GES-A (6 mA, 0.3 ms, 40 Hz, 2 s on, 3 s off), GES-B (6 mA, 0.3 ms, 14 Hz, 0.1 s on, 5 s off), GES-C (6 mA, 3 ms, 40 Hz, 2 s on, 3 s off) and GES-D (6 mA, 200 ms, 12 pulses/min). Results showed that 33/117 (28%) spinal neurons responded to noxious DD (0.4 ml, 20 s). Of these, 7 (6%) neurons had low-threshold responses to DD (<or=0.2 ml) and 26 (22%) had high-threshold responses to DD (>or=0.4 ml). DD-responsive spinal neurons were encountered more frequently in deeper (depth: 0.3-1.2 mm) than in superficial laminae (depth: <0.3 mm) of the dorsal horn (24/67 vs. 9/50, P<0.05). DD excited all 9 superficial neurons. In contrast, 20 deeper neurons were excited and 4 neurons were inhibited by DD. Activity of DD-responsive neurons was affected more frequently with GES-C (13/15, 87%) than GES-A (6/16, 38%), -B (3/15, 20%) and -D (5/14, 36%) (P<0.01). Bilateral cervical vagotomy did not significantly alter the effects of DD and GES on 5/5 neurons. Resiniferatoxin (2.0 microg/kg, i.v.), an ultrapotent agonist of transient receptor potential vanilloid receptor-1 (TRPV1), abolished DD responses and GES effects on all neurons examined in vagotomized rats. Additionally, 29/33 (88%) DD-responsive neurons received inputs from somatic receptive fields on the back, flank and medial/lateral abdominal areas. It was concluded that GES mainly exerted an excitatory effect on T9-T10 spinal neurons with duodenal input transmitted by sympathetic afferent fibers expressing TRPV1; spinal neuronal responses to GES were strengthened with an increased pulse width and/or frequency of stimulation; T9-T10 spinal neurons processed input from the duodenum and might mediate effects of GES on duodenal sensation and motility.

The origin and development of the vagal and spinal innervation of the external muscle of the mouse esophagus

Retrograde and anterograde tracing and immunohistochemical techniques were used to examine the origin of the extrinsic innervation, and the development of the vagal innervation to the mouse esophagus. Cholinergic nerve terminals were localised using an antiserum to the vesicular acetylcholine transporter and cholinergic cell bodies were localised using an antiserum to choline acetyltransferase. Cholinergic nerve terminals, which also contained calcitonin gene-related peptide, were present at the motor end plates in the external (striated) muscle of the esophagus. Following injection of Fast Blue into subdiaphragmatic or cervical levels of the esophagus, the only retrogradely-labelled cholinergic nerve cell bodies that also contained calcitonin gene-related peptide were found in the nucleus ambiguus. Neurons in the dorsal motor nucleus of the vagus, the nodose ganglia and dorsal root ganglia gave rise to a number of different types of nerve terminals within the myenteric plexus. Retrogradely-labelled neurons in the dorsal motor nucleus of vagus contained cholinergic markers only, nitric oxide synthase only or cholinergic markers plus nitric oxide synthase, retrogradely-labelled neurons in the dorsal root ganglia contained calcitonin gene-related peptide only, and a small number of retrogradely-labelled neurons in the nodose ganglia contained tyrosine hydroxylase. The development of the vagal innervation to the esophagus was examined following application of DiI to the vagus nerve of fixed mouse embryos. Anterogradely-labelled nerve fibres, which arose from both nodose ganglia and the medulla, were already present in the esophagus of embryonic day 12 (E12) mice. Some of the DiI-labelled vagal nerve fibres were present in among the smooth muscle cells of the external muscle layer prior to their transdifferentiation to striated muscle. We conclude that the neurons in the nucleus ambiguus that project to the esophagus differ from other extrinsic neurons in their chemistry as well as their targets within the esophagus. The development of the extrinsic innervation precedes the transdifferentiation of the external muscle to striated muscle, raising the possibility that, during development, smooth muscle of the esophagus is innervated transiently by vagal neurons.

Location of sensory nerve cells that provide calbindin-containing laminar nerve endings in myenteric ganglia of the rat esophagus

To determine the origin of the calbindin-containing laminar nerve endings in the myenteric ganglia of the rat esophagus, retrograde tracing experiments combined with immunohistochemistry using an antibody for calbindin were carried out. After Fast blue was injected into the cervical portion of the esophagus, labeled neurons were found bilaterally in the nodose ganglion and dorsal root ganglia of C1 to T3. 80% of the total neurons in the nodose ganglion and 20% of those in the dorsal root ganglia showed calbindin immunoreactivity. Moreover, 79% of Fast-blue-labeled neurons found in the nodose ganglion and 18% of those in the dorsal root ganglia were immunoreactive for calbindin. These results suggest that the calbindin antibody we used is useful as a marker for identifying esophageal vagal afferents derived from the nodose ganglion. The calbindin-immunoreactive nerve fibers forming the laminar endings in the myenteric ganglia of the rat cervical esophagus are mainly derived from sensory neurons in the nodose ganglion and partly derived from those in the cervical and upper thoracic dorsal root ganglia. Calbindin-containing laminar nerve endings may be related to mechanoreceptors in the esophagus.

Morphological relationships of choleragenoid horseradish peroxidase-labeled spinal primary afferents with myenteric ganglia and mucosal associated lymphoid tissue in the cat esophagogastric junction

The goal of the present study was to gain insight into the environmental factors influencing the activity of primary spinal afferent fibers in the different layers of the esophagogastric junction of the cat and, thus, to analyze the relationships of these afferents with various cellular components. Spinal primary afferent fibers were selectively labeled by anterogradely transported choleragenoid horseradish peroxidase conjugate (B-HRP). B-HRP was injected into the thoracic dorsal root ganglion at the T8-T13 levels. 6-Hydroxydopamine-induced sympathectomy was performed prior to B-HRP injection in order to prevent otherwise unavoidable labeling of sympathetic fibers in the gut wall. Numerous labeled fibers ran between, around, and within the myenteric ganglia. Others crossed the muscle layers directly and entered the mucosa, where some ran near granulocytes and around or through solitary lymphoid follicles. Labeled fibers were observed in the squamous esophageal epithelium but not in the fundic glandular epithelium. The fibers in the myenteric area are probably connected to the muscular tension receptors that have been detected by electrophysiologic techniques. This assumption is based on the observation that only a few fibers appear to terminate in muscle layers and on the fact that the myenteric area is very narrow and subject to powerful forces. Fibers in the myenteric ganglia could be involved in local efferent functions. Fibers in the mucosa could act as nociceptors and might be involved in local immunological responses.

The distribution of spinal and vagal sensory neurons that innervate the esophagus of the cat

The distribution of spinal and vagal neurons that convey sensory information from the distal smooth muscle esophagus is poorly documented. Therefore, sensory cell bodies were retrogradely labeled by injecting fast blue into the striated and smooth muscle of the esophageal body and into the lower esophageal sphincter of the cat. The maximum distribution of spinal sensory neuron labeling was found in the following dorsal root ganglia: C1-T8 (striated muscle); C5-L2 (smooth muscle), and T1-L3 (lower esophageal sphincter). Vagal sensory neurons in the nodose ganglion were found to have a crude topographic layout. The total number of vagal sensory neurons labeled by injection into the three esophageal areas was greater than the number of spinal neurons labeled (809.7 +/- 166.1 vs. 328.9 +/- 53.4; mean +/- SEM; n = 12; P less than 0.005). It is concluded that spinal sensory neurons of the esophagus are segmentally arranged. Accordingly, each level of the esophagus has a distinct but overlapping sensory projection to the spinal cord, and afferents from all parts of the esophagus overlap the known spinal distribution of cardiac afferents.

Mechanisms of esophageal pain

Esophageal pain is transmitted via the sympathetic nervous system to the spinal cord, in which pain from visceral and somatic sources ascends to higher centers in the brain. Primary afferent neurons are bipolar, with the peripheral end specialized to be a sensory receptor. Nociceptors of somatosensory afferents are free nerve endings that can be activated by mechanical, thermal, or chemical stimuli. Esophageal nociceptive neurons have not been specifically identified but probably are also free nerve endings. Most esophageal spinal mechanoreceptors have been shown to be nociceptive. Some esophageal mechanonociceptors have a wide dynamic range and respond to physiologic and painful stimuli, while others have a high threshold of stimulation and are solely nociceptive. Esophageal spinal afferents have their cell bodies in the dorsal root ganglia and contain substance P and calcitonin gene-related peptide. These putative neurotransmitters are transported in both the peripheral and central directions of bipolar afferent neurons. Primary afferent neurons are likely to also contain an excitatory amino acid neurotransmitter such as glutamate. Centrally, nociceptive primary afferents terminate on neurons in specific layers of the dorsal horn of the spinal cord. Convergence of multiple visceral afferents with somatic afferents onto the same dorsal horn neurons may explain referred pain. A patient's inability to distinguish esophageal from cardiac pain may be due to convergence of pain pathways. Second-order neurons in the dorsal horn project in the anterolateral system to the brain. Within the anterolateral system, nociception ascends in the spinothalamic, spinoreticular, and spinomesencephalic tracts. The thalamus relays fast pain to the postcentral areas of the parietal lobe of the cortex. Pathways to the reticular formation are slow and may mediate the increased arousal that occurs in response to pain. The spinomesencephalic tract projects to midbrain sites including the periaqueductal gray. Organ-specific pathways in the brain have yet to be defined, but neuroanatomic tracing techniques employing neurotropic viruses are being developed. The perception of pain can be influenced at multiple levels, such as the receptor in the esophagus, the synapses in the dorsal horn of the spinal cord or thalamus, or the cortex. A fundamental mechanism of modulating nociception is descending inhibition.(ABSTRACT TRUNCATED AT 400 WORDS)

Sensory innervation of the canine esophagus, stomach, and duodenum

The sensory innervation of the postpharyngeal foregut was investigated by injecting the enzyme horseradish peroxidase (HRP) into the walls of the esophagus, stomach, or duodenum. The transported HRP was identified histochemically, labeled neurons in the spinal and vagal ganglia were counted, and the results were plotted using an SAS statistical program. The spinal sensory fields of each viscus were defined using three determinations: craniocaudal extent, principal innervation field, and peak innervation field. The data revealed that innervation fields are craniocaudally extensive, the sensory field of each viscus overlaps significantly with its neighbor, yet each viscus can be characterized by a field of peak innervation density. Craniocaudal innervation of the esophagus spans as many as 22-23 paired spinal ganglia (C1-L2). There are two peak innervation fields for the cervical (C2-C6 and T2-T4) and for the thoracic (T2-T4 and T8-T12) sectors of the esophagus. The sensory innervation of the stomach extends craniocaudally over as many as 25 paired spinal ganglia (C2-L5). The peak innervation field of the stomach spans a large area comprising the cranial, middle, and the immediately adjoining caudal thoracic ganglia (T2-T10). The duodenum is innervated craniocaudally by as many as 15 paired thoracolumbar ganglia (T2-L3). Peak innervation originates in the middle and caudal thoracic ganglia and cranial lumbar (T6-L1) ganglia. There is a recognizable viscerotopic organization in the sensory innervation of the postpharyngeal foregut; successively more caudal sectors of this region of the alimentary canal are supplied with sensory fibers from successively more caudal spinal dorsal root ganglia. Vagal afferent innervation of the esophagus, stomach, and duodenum is bilateral and originates predominantly, but not exclusively, from vast numbers of neurons in the nodose (distal) ganglia. The esophagus is innervated bilaterally and more abundantly by jugular (proximal) ganglia neurons than is either the stomach or duodenum. The physiological significance of the findings are discussed in relation to the phenomena of visceral pain and referred pain.

Afferent innervation of the gallbladder in the cat, studied by the horseradish peroxidase method

Following injection of horseradish peroxidase (HRP) into the wall of the gallbladder of cats, HRP-positive cells were found bilaterally in dorsal root ganglia T2-L3 (T2-L2, and T3-L2/L3 also observed in a few cats) and nodose ganglia. In about 33% of animals labelled cells were also distributed in cervical dorsal root ganglia C5-C7. Labelled cells were more frequently localized on the right side than the left. There was no apparent change in numbers of labelled cells in the nodose ganglion (NG) on either side following greater and lesser splanchnicotomy or section of the right phrenic nerve or removal of the celiac ganglion. After severing both the greater and lesser splanchnic nerves unilaterally, numbers of labelled afferent cells from the gallbladder in dorsal root ganglia (DRGs) significantly decreased on the ipsilateral side but there was no change in the pattern of distribution contralaterally. After section of the right phrenic nerve, labelled cells were not found in ipsilateral cervical ganglia. That some afferent fibers from the gallbladder travel via the phrenic nerves, particularly on the right side, may be a supplementary mechanism in the generation of referred pain in gallbladder disease. The splanchnic nerves are the main, but not the only pathway for afferent fibers from the gallbladder.

Visceral pain: a review of experimental studies

This paper reviews clinical and basic science research reports and is directed toward an understanding of visceral pain, with emphasis on studies related to spinal processing. Four main types of visceral stimuli have been employed in experimental studies of visceral nociception: (1) electrical, (2) mechanical, (3) ischemic, and (4) chemical. Studies of visceral pain are discussed in relation to the use and 'adequacy' of these stimuli and the responses produced (e.g., behavioral, pseudoaffective, neuronal, etc.). We propose a definition of an adequate noxious visceral stimulus and speculate on spinal mechanisms of visceral pain.

Central neural control of esophageal motility: a review

We review recent studies on the central neural control of esophageal motility, emphasizing the anatomy and chemical coding of esophageal pathways in the spinal cord and medulla. Sympathetic innervation of the proximal esophagus is derived primarily from cervical and upper thoracic paravertebral ganglia, whereas that of the lower esophageal sphincter and proximal stomach is derived from the celiac ganglion. In addition to noradrenaline, many sympathetic fibers in the esophagus contain neuropeptide Y (NPY), and both noradrenaline and NPY appear to decrease blood flow and motility. Preganglionic neurons innervating the cervical and upper thoracic ganglia are located at lower cervical and upper thoracic spinal levels. The preganglionic innervation of the celiac ganglion arises from lower thoracic spinal levels. Both acetylcholine (ACh) and enkephalin (ENK) have been localized in sympathetic preganglionic neurons, and it has been suggested that ENK acts to pre-synaptically inhibit ganglionic transmission. Spinal afferents from the esophagus are few, but have been described in lower cervical and thoracic dorsal root ganglia. A significant percentage contain calcitonin gene-related peptide (CGRP) and substance P (SP). The central distribution of spinal afferents, as well as their subsequent processing within the spinal cord, have not been addressed. Medullary afferents arise from the nodose ganglion and terminate peripherally both in myenteric ganglia, where they have been postulated to act as tension receptors, and, to a lesser extent, in more superficial layers. Centrally, these afferents appear to end in a discrete part of the nucleus of the solitary tract (NTS) termed the central subnucleus. The transmitter specificity of the majority of these afferents remains unknown. The central subnucleus, in turn, sends a dense and topographically discrete projection to esophageal motor neurons in the rostral portion of the nucleus ambiguous (NA). Both somatostatin-(SS) and ENK-related peptides have been localized in this pathway. Finally, motor neurons from the rostral NA innervate striated portions of the esophagus. In addition to ACh, these esophageal motor neurons contain CGRP, galanin (GAL), N-acetylaspartylglutamate (NAAG), and brain natriuretic peptide (BNP). The physiological effect of these peptides on esophageal motility remains unclear. Medullary control of smooth muscle portions of the esophagus have not been thoroughly investigated.

Distribution of cell bodies for primary afferent fibers from the stomach of the cat

The distribution of primary afferent cell bodies supplying the stomach of the cat was localized using lectin-conjugated horseradish peroxidase. Labelled cells were found in the nodose ganglia and dorsal root ganglia T4-L2 or T4-L1. The spinal entry levels of the stomach afferents do not overlap extensively with those of the cardiac afferents.

An electrophysiological and anatomical study of intestinal afferent fibres in the rat

1. The afferent innervation of the distal ileum has been examined in normal rats and in rats treated at birth with capsaicin. Electrophysiological recordings were made using an in vitro preparation of distal ileum and its associated mesenteric nerves. The fibre composition of the mesenteric nerves was examined by electron microscopy and the numbers of primary afferent fibres innervating a segment of distal ileum was estimated using retrograde tracing. 2. Recordings were made from 120 single afferent units all of which showed some degree of background activity. The conduction velocities of sixty-seven afferent units were estimated, and all were found to be in the C-fibre range (less than 2 m/s). Eighty-two units were sufficiently studied to allow their classification according to whether they responded to mechanical stimuli (M units), chemical stimuli (Ch units) or both mechanical and chemical stimuli (MCh units). In control rats 85.5% were classified as MCh units, 11.9% as M units and 2.6% as Ch units. In capsaicin-treated rats six single and three multi-units were MCh and one multi-unit was classified as an M recording. 3. The effects of intraluminal distension were investigated in sixty-seven units which were classified according to whether or not they adapted during the distension. About half the total units were classified as rapidly adapting, the other half were slowly adapting. This distribution was similar for the MCh-units, but of the eight M units tested, seven adapted during distension. The distension thresholds were tested in thirty units, of which twenty-eight responded at thresholds below 18 mmHg. There were no differences in the thresholds of units from control and capsaicin-treated rats. 4. The chemosensitivity of units was tested in response to acetylcholine (ACh), bradykinin and substance P. Most units tested responded to ACh (78% of MCh units tested) and bradykinin (80% of MCh units), but fewer units responded to substance P (about 50% of MCh units). ACh produced an increased tension which outlasted the increase in afferent activity. Bradykinin gave long-lasting afferent responses which were not always accompanied by increases in tension. The increases in afferent activity produced by substance P were often seen after an increase in tension. 5. The fluorescent dye True Blue injected into the wall of the ileum labelled cell bodies in the spinal and nodose ganglia, predominantly on the left side of an animal. The mean number of labelled cells per animal was eighty-seven, of which the majority was in the T10-T13 spinal ganglia.(ABSTRACT TRUNCATED AT 400 WORDS)

Esophageal motility disorders

Esophageal motility disorders consist of a complex array of disturbances in normal esophageal function associated with dysphagia, gastroesophageal reflux, and noncardiac chest pain. A thorough knowledge of normal esophageal anatomy and physiology is important to a full understanding of these motility derangements. Through a complicated interaction of neuromuscular and hormonal influences, the voluntary act of swallowing transforms into an automated sequence of peristaltic waves propelling food and liquids into the stomach in concert with coordinated relaxation of the sphincters. Anatomic and physiologic barriers exist within the esophagus protecting against gastroesophageal reflux and aspiration. With improvements in diagnostic tools such as barium contrast radiography, scintigraphy, pH measurements, and esophageal manometrics with provocative testing, motility disorders have become better defined and understood. Primary motility disorders consist of achalasia, diffuse esophageal spasm (DES), "nutcracker esophagus," hypertensive lower esophageal sphincter, and nonspecific esophageal motility dysfunction (NEMD). A host of secondary and miscellaneous motility disorders also affect the esophagus, including scleroderma and other connective tissue diseases, diabetes mellitus, Chagas' disease, chronic idiopathic intestinal pseudo-obstruction, and neuromuscular disorders of striated muscle. Gastroesophageal reflux disease (GERD) may also be promoted by associated motility disturbances. Treatment modalities include surgical myotomy; dilatation; and pharmacologic manipulations, including use of nitrates, calcium-channel blockers, H2-blockers, and psychotropic drugs where appropriate.

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

Our purpose was to determine the effects on acute radiation sickness of interrupting afferent neural pathways that converge upon the medullary vomiting center but which bypass the emetic chemoreceptor trigger zone in the area postrema. A comparison was made of the vomiting response and other signs of sickness in three groups of chronic cats surgically prepared as follows: high spinal cord section of the dorsal columns, subdiaphragmatic vagotomy, and the combination of procedures. Every cat was exposed over the whole body to 45 Gy 60Co gamma-radiation which was effective in evoking emesis in 11 of 12 normal cats. Neither cordotomy alone (8 cats) nor vagotomy alone (2 cats) reliably blocked the vomiting response but they separately delayed its onset. On the other hand, the cordotomy prevented the loss of appetite and behavioral malaise that was invariably caused by the irradiation in normal cats. Finally, the combination of cordotomy and vagotomy protected all of 3 cats against the entire radiation syndrome. These cats then vomited appropriately in response to the injection of deslanoside which induces emesis through an action on the area postrema. Histological examination of the lower medulla revealed no damage of the area postrema resulting from the cordotomies. We conclude that acute radiation sickness in the cat is signaled through afferent neural pathways originating in the abdomen and that the area postrema does not participate in the causation of this syndrome.

Visceral nociception: peripheral and central aspects of visceral nociceptive systems

Discomfort and pain are the sensations most commonly evoked from viscera. Most nociceptive signals that originate from visceral organs reach the central nervous system (c.n.s.) via afferent fibres in sympathetic nerves, whereas parasympathetic nerves contain mainly those visceral afferent fibres concerned with the non-sensory aspects of visceral afferent function. Noxious stimulation of viscera activates a variety of specific and non-specific receptors, the vast majority of which are connected to unmyelinated afferent fibres. Studies on the mechanisms of visceral sensation can thus provide information on the more general functions of unmyelinated afferent fibres. Specific visceral nociceptors have been found in the heart, lungs, testes and biliary system, whereas noxious stimulation of the gastro-intestinal tract appears to be detected mainly by non-specific visceral receptors that use an intensity-encoding mechanism. Visceral nociceptive messages are conveyed to the spinal cord by relatively few visceral afferent fibres which activate many central neurons by extensive functional divergence through polysynaptic pathways. Impulses in visceral afferent fibres excite spinal cord neurons also driven by somatic inputs from the corresponding dermatome (viscero-somatic neurons). Noxious intensities of visceral stimulation are needed to activate viscero-somatic neurons, most of which can also be excited by noxious stimulation of their somatic receptive fields. The visceral input to some viscero-somatic neurons in the spinal cord can be mediated via long supraspinal loops. Pathways of projection of viscero-somatic neurons include the spino-reticular and spino-thalamic tracts. All these findings give experimental support to the 'convergence-projection' theory of referred visceral pain. Visceral pain is the consequence of the diffuse activation of somato-sensory nociceptive systems in a manner that prevents accurate spatial discrimination or localization of the stimuli. Noxious stimulation of visceral receptors triggers general reactions of alertness and arousal and evokes unpleasant and poorly localized sensory experiences. This type of response may be a feature of sensory systems dominated by unmyelinated afferent inputs.

Distribution of somatic and visceral primary afferent fibres within the thoracic spinal cord of the cat

Transport of horseradish peroxidase (HRP) through somatic and visceral nerve fibres was used to study the patterns of termination of somatic and visceral primary afferent fibres within the lower thoracic segments of the cat's spinal cord. A concentrated solution of HRP was applied for at least 5 hours to the central end of the righ greater splanchnic nerve and of the left T9 intercostal nerve of adult cats. Some animals remained under chloralose anaesthesia for the duration of the HRP transport times (up to 53 hours) whereas longer HRP application and transport times (4-5 days) were allowed in animals that recovered from barbiturate anaesthesia. Somatic afferent fibres and varicosities (presumed terminals) were found in laminae I, II, III, IV, and V of the ipsilateral dorsal horn and in the ipsilateral Clarke's column. The density of the somatic projection was particularly high in the superficial dorsal horn. In parasagittal sections of the cord, bundles of somatic fibres were seen joining the dorsal horn from the dorsal roots via the dorsal columns and Lissauer's tract. A medio-lateral somatotopic arrangement of somatic afferent terminations was observed, with afferent fibres from the ventral parts of the dermatome ending in the medial dorsal horn and afferent fibres from the dorsal parts of the dermatome ending in the lateral dorsal horn. The total rostro-caudal extent of the somatic projection through a single spinal nerve was found to be of 2 and 2/3 segments, including the segment of entry, the entire segment rostral to it and two-thirds of the segment caudal to it. A lateral to medial shift in the position of the somatic projection was observed in the rostro-caudal axis of the cord. Visceral afferent fibres and varicosities (presumed terminals) were seen in laminae I and V of the ipsilateral dorsal horn. The density of the visceral projection to the dorsal horn was substantially lower than that of the somatic projection. Visceral afferent fibres reached the dorsal horn via Lissauer's tract and joined a lateral bundle of fine fibres that run along the lateral edge of the dorsal horn. The substantia gelatinosa (lamina II) appeared free of visceral afferent fibres. These results are discussed in relation to the mechanisms of viscero-somatic convergence onto sensory pathways in the thoracic spinal cord.

Somatic and visceral primary afferents in the lower thoracic dorsal root ganglia of the cat

Anterograde transport of horseradish peroxidase (HRP) through somatic and visceral nerves was used to estimate the proportions of somatic and visceral dorsal root ganglion (DRG) cells of the lower thoracic ganglia of the cat. A concentrated solution of HRP was applied for at least 5 hours to the central end of the right greater splanchnic nerve and of the left T9-intercostal nerve of adult cats. Some animals remained under chloralose anaesthesia for the duration of the HRP transport time (up to 53 hours) whereas longer HRP application and transport times (4-5 days) were allowed in animals that recovered from barbiturate anaesthesia. Visceral DRG cells were found in approximately equal numbers in all ganglia examined (T7-T11). Population estimates were obtained for the T8 and T9 ganglia where visceral DRG cells were found to be 6.2% (T8) and 5.2% (T9) of the total cell population. In contrast, somatic DRG cells were found in large numbers in the ganglia examined (T8 and T9) where they amounted to over 90% of the cell population. Measurement of cross-sectional areas and estimates of cell diameters of the DRG cells showed greater proportions of large somatic cells (diameter greater than 40 micron) than of large visceral cells. Similar distributions of cell size were found for both somatic and visceral DRG cells with diameters less than 40 micron. These results show that the proportion of visceral afferent fibres in the dorsal roots that mediate the spinal cord projection of the splanchnic nerve is very small. Since viscerosomatic convergence in the thoracic spinal cord is very extensive, the present results suggest considerable divergence of the visceral afferent input to the central nervous system.

Mechanoreceptor pathways from the distal colon to the autonomic nervous system in the guinea-pig

Electrophysiological and histological techniques were used to trace sensory pathways for stretch mechanoreceptor fibres from the distal colon to dorsal root ganglia. Extracellular and intracellular recording techniques revealed sensory pathways for mechanoreceptors to the prevertebral sympathetic ganglia but no further centrally. Histological studies involving the retrograde transport of horseradish peroxidase revealed sensory pathways from the distal colon to the spinal cord, mainly to the level of the second lumbar vertebra. Few (less than 2000) fibres were involved; their perikarya were small (ca. 25 micron). Sensory perikarya in spinal ganglia in the guinea-pig could be categorized into two populations, F and H cells, after a previously defined nomenclature for murine spinal ganglion cells. F and H cells were distinguished initially by their times to decay by 50% of the action potential. H cells took three times as long to repolarize. F and H cells were distinguished further by their electrical properties including membrane potential, input resistance and amplitude and duration of the after-potential following the action potential. Both F and H cells showed unusual time-dependent rectification following either depolarizing or hyperpolarizing current pulses. Threshold currents to show rectification were different for F and H cells. When taken in conjunction with conduction velocities, the electrophysiological evidence may assist in identifying sensory neurones. For example, H cells appeared to have slow conducting (C fibre) axons. From the lack of electrophysiological evidence and limited histological support for major central sensory pathways, it is concluded that stretch mechanoreceptor information from the colon of the guinea-pig is referred mainly to the prevertebral ganglia with minimal involvement of the spinal cord.

Afferent innervation of the lower esophageal sphincter of the cat. Pathways and functional characteristics

The sensory vagal and 'sympathetic' innervation of the lower esophageal sphincter (LES) has been investigated in cats using both electrophysiological and histochemical techniques. Histochemical studies produced evidence that 'sympathetic' afferents run in: (i) the splanchnic nerves; (ii) the sympathetic thoracic nerves; and (iii) the sympathetic cardiac branch. Electrophysiological studies allowed us to describe different kinds of LES receptors: (i) mucosal vagal receptors acting as rapidly adapting mechanoreceptors or as slowly adapting chemoreceptors; (ii) vagal and 'sympathetic' endings located in the muscular layers, adapting slowly and mainly activated by LES contractions; and (iii) vagal and 'sympathetic' endings located in the serous membrane behaving as rapidly adapting receptors sensitive to stretching.

Afferent innervation of the lower oesophageal sphincter of the cat. An HRP study

Labeling of afferent neurons by the retrograde axonal transport of horseradish peroxidase (HRP) was performed on anaesthetized cats in order to examine the afferent innervation of the lower oesophageal sphincter (LOS), involving both the vagal and the sympathetic nerves. The labeled cells, whose fibres follow the sympathetic pathways were found in dorsal root ganglia from T1 to L2. Nerve section experiments indicated that the main pathways involved were the splanchnic nerves, as expected from classical data. Additional pathways passing through the sympathetic cardiac branch emerging from the stellate ganglion and the thoracic sympathetic branches were also evidenced. This work corroborated the electrophysiological data showing the richness of the LOS sensory vagal innervation. Nevertheless, in this case the difficulties related to the HRP technique are particularly enhanced since the abdominal sensory vagal fibres can be affected by HRP injections.

Thoracic esophageal mechanoreceptors connected with fibers following sympathetic pathways

The existence of splanchnic mechanoreceptors was demonstrated in the esophagus including the lower esophageal sphincter of anesthetized cats. For this purpose, unitary activities were recorded in T9, T10 and T11 spinal ganglia by means of extracellular glass microelectrodes. Two types of receptors were evidenced according to their location: the muscular and the serosal receptors. The muscular mechanoreceptors usually exhibited a weak spontaneous discharge (0.8-18 imp/sec) and adapted slowly to mechanical stimulations (distension, contraction, digital compression). The potent physiological stimulus resulted in distension for the receptors situated in the thoracic esophagus and contraction for the receptors located in the lower esophageal sphincter. The serosal mechanoreceptors were always silent and belonged to the rapidly adapting type. They responded mainly to touching the serous membrane, but strong distension or stretching was sometimes efficient. A comparison with the vagal receptors already described in this region is drawn, and the role of splanchnic mechanoreceptors is discussed.