Study of risk factors for delayed gastric emptying after partial pancretoduodenectomy.

INTRODUCTION: Delayed gastric emptying is one of the most frequent complications after pancreatoduodenectomy. METHODS: We performed an analysis of risk factors for delayed gastric emptying on a prospective database of 390 patients operated on between 2013 and 2021. A comparative retrospective study was carried out between patients with and without delayed gastric emptying and subsequently a study of risk factors for delayed gastric emptying using univariate and multivariate logistic regression models. RESULTS: The incidence of delayed gastric emptying in the overall series was 28%. The morbidity of the group was 63%, and postoperative mortality was 3.1%. Focusing on delayed gastric emptying, the median age (73 years vs 68 years, P < 0.001) and preoperative creatinine (75 vs 65.5, P < 0.001) were higher in the group with this complication. The study of risk factors showed that age over 60 years (P = 0.002) and pancreatic fistula (P < 0.001) were risk factors for delayed gastric emptying. CONCLUSION: The presence of pancreatic fistula is confirmed as a risk factor for slow gastric emptying after pancreaticoduodenectomy. In addition, age over 60 years is shown to be a risk factor for slow gastric emptying.

Delayed gastric emptying after classical Whipple or pylorus-preserving pancreatoduodenectomy: a randomized clinical trial (QUANUPAD).

PURPOSE: Pylorus-preserving pancreatoduodenectomy (PPPD) has been the gold standard for pancreatic head lesion resection for several years. Some studies have noted that it involves more delayed gastric emptying (DGE) than classical Whipple (i.e., pancreatoduodenectomy with antrectomy). Our working hypothesis was that the classical Whipple has a lower incidence of DGE. We aimed to compare the incidence of DGE among pancreatoduodenectomy techniques. METHODS: This pragmatic, randomized, open-label, single-center clinical trial involved patients who underwent classical Whipple (study group) or PPPD (control group). Gastric emptying was clinically evaluated using scintigraphy. DGE was defined according to the International Study Group of Pancreatic Surgery (ISGPS) criteria. The secondary endpoints were postoperative morbidity, length of hospital stay, anthropometric measurements, and nutritional status. RESULTS: A total of 84 patients were randomized (42 per group). DGE incidence was 50% (20/40, 95% confidence interval (95% CI): 35-65%) in the study group and 62% (24/39, 95% CI: 46-75%) in the control group (p = 0.260). No differences were observed between both groups regarding postoperative morbidity or length of hospital stay. Anthropometric measurements at 6 months post-surgery: triceps fold measurements were 12 mm and 16 mm (p = 0.021). At 5 weeks post-surgery, triceps fold measurements were 13 mm and 16 mm (p = 0.020) and upper arm circumferences were 26 cm and 28 cm (p = 0.030). No significant differences were observed in nutritional status. CONCLUSION: DGE incidence and severity did not differ between classical Whipple and PPPD. Some anthropometric measurements may indicate a better recovery with PPPD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03984734.

Effectiveness and safety of perampanel as early add-on treatment in patients with epilepsy and focal seizures in the routine clinical practice: Spain prospective study (PERADON).

OBJECTIVE: Perampanel (PER) has been shown to be effective as an adjunctive therapy for controlling refractory focal-onset seizures (FOS). However, the information as early add-on for the treatment of FOS in the clinical practice is still scarce and must be further assessed. METHODS: An observational prospective study was conducted to evaluate the effectiveness of early add-on PER, assessed as 50% responders (seizure frequency reduced by at least 50% during the last 3 months as compared with baseline) rate at 6 and 12 months, in patients with FOS in the routine clinical practice of Spain. RESULTS: One hundred and thirteen patients (mean age: 40.3 years, 51.3% male) with FOS received PER as early add-on (1st add-on: 37.2% and 2nd: 62.8%) for a mean exposure of 11 months (mean PER dose: 6.3 mg/day at month 12). At 6 months, 50.4% and 20.4% of the patients were responders and seizure-free (respectively) relative to baseline (3 months prior to PER initiation), and at 12 months, 68.1% and 26.5% of the patients were responders and seizure-free (respectively), relative to baseline (3 months prior to PER initiation). The retention rate at 6 and 12 months was 83.2% and 80.5%, respectively. The percentage of seizure-free patients at 12 months was significantly (p = 0.033) higher when PER was added as first vs. second add-on. The number of concomitant antiepileptic drugs (AEDs) was significantly reduced from baseline to 6 and 12 months (p = 0.001). Treatment was simplified in 23.9% of patients at the end of the observation period. Drug-related adverse events (AEs), most mild or moderate, were reported in 30.1% of patients, with irritability (8%) and dizziness (7.1%) as the most frequent ones. CONCLUSIONS: This is the first observational, prospective study to evaluate efficacy and safety of early adjunctive treatment with PER in patients with focal epilepsy at 12 months. Perampanel demonstrated a good efficacy and safety profile when used at a median dose of 6 mg/day, regardless of the combination with other AEDs. Adverse events were mild or moderate, with dizziness being the most frequent one.

Randomized trial of two types of gastrojejunostomy after pancreatoduodenectomy and risk of delayed gastric emptying (PAUDA trial).

BACKGROUND: Delayed gastric emptying (DGE) is the most important cause of an extended hospital stay after pancreatoduodenectomy. Reports suggest that a Roux-en-Y gastroenteric anastomosis may have lower incidence of DGE than a Billroth II reconstruction. The primary aim of this RCT was to compare Billroth II (single loop) and Roux-en-Y (double loop) after pancreatoduodenectomy to determine whether Roux-en-Y reconstruction is associated with a lower incidence of DGE. Secondary endpoints were postoperative complications. METHODS: This was a randomized unblinded single-centre trial without masked evaluation of the main outcome. Patients undergoing pancreatoduodenectomy between 2013 and 2015 were randomized to undergo one of two types of gastroenteric anastomosis for reconstruction. RESULTS: A total of 80 patients were randomized, 40 in each group. The incidence of DGE was the same in patients undergoing Billroth II or Roux-en-Y gastroenteric anastomosis (both 18 of 40 patients; P = 1·000). The grade of DGE was also similar in the Billroth II and Roux-en-Y groups (grade A, both 10 of 40; grade B, 5 of 40 versus 6 of 40; grade C, 3 of 40 versus 2 of 40; P = 0·962). The mortality rate was 3 per cent, with no significant difference between the two groups. There were no differences in the overall rate of postoperative morbidity, relaparotomy rate or duration of hospital stay. CONCLUSION: The incidence and severity of DGE does not differ between single- or double-loop gastroenteric anastomosis performed after pancreatoduodenectomy. Registration number: NCT00915863 (http://www.clinicaltrials.gov).

[Adherence and fidelity in patients treated with intragastric balloon]. / Adherencia y fidelidad en el paciente tratado con balon intragastrico.

A correct treatment of obesity needs a program of habits modification regardless of the selected technique, especially if it is minimally invasive as the intragastric balloon (BIG). The adherence of the obese patients with regard to recommended drugs measures to medium- and long-term is less than 50%. Given that the results obtained using the technique of gastric balloon must be seen influenced by adherence to the modification of habits program and its fulfillment, we reviewed series published in attention to the program proposed with the BIG. The series published to date provide few details about the used Therapeutic Programs as well as the adherence of patients to them, and even less concerning the Monitoring Plan and the loyalty of the patient can be seen. We conclude the convenience to agree on a follow-up strategy, at least the 6 months during which the BIG remain in the stomach.

Adherencia y fidelidad en el paciente tratado con balón intragástrico / Adherence and fidelity in patients treated with intragastric balloon

Un tratamiento correcto de la obesidad ha de comporta un programa de modificación de hábitos independientemente de la técnica que se indique, en especial si es mínimamente invasiva como el Balón Intragástrico (BIG).Se cifra la adherencia terapéutica de los pacientes obesos en menos del 50% a medio largo y plazo respecto a las medidas higiénico-dietéticas aconsejadas. Dado que los resultados obtenidos mediante la técnica de Balón Intragástrico han de verse influidos por la adherencia al programa de modificación de hábitos, revisamos las series publicadas en atención al programa propuesto junto al BIG y a su cumplimiento. Se observa que las series publicadas hasta la fecha ofrecen pocos detalles sobre los Programas Terapéuticos utilizados así como la adherencia de los pacientes a los mismos, y menos aún respecto al Plan de Seguimiento y la fidelidad del paciente. Concluimos la conveniencia de consensuar una estrategia de seguimiento, al menos durante los 6 meses que permanece colocado el BIG (AU)

A correct treatment of obesity needs a program of habits modification regardless of the selected technique, especially if it is minimally invasive as the intragastric balloon (BIG).The adherence of the obese patients with regard to recommended drugs measures to medium- and long-term is less than 50%.Given that the results obtained using the technique of gastric balloon must be seen influenced by adherence to the modification of habits program and its fulfillment, were viewed series published in attention to the program proposed with the BIG. The series published to date provide few details about the used Therapeutic Programs as well as the adherence of patients to them, and even less concerning the Monitoring Plan and the loyalty of the patient can be seen. We conclude the convenience to agree on a follow-up strategy, at least the 6 months during which the BIG remain in the stomach (AU)

Drosophila Eye Nuclei Segmentation Based on Graph Cut and Convex Shape Prior.

The rapid advance in three-dimensional (3D) confocal imaging technologies is rapidly increasing the availability of 3D cellular images. However, the lack of robust automated methods for the extraction of cell or organelle shapes from the images is hindering researchers ability to take full advantage of the increase in experimental output. The lack of appropriate methods is particularly significant when the density of the features of interest in high, such as in the developing eye of the fruit fly. Here, we present a novel and efficient nuclei segmentation algorithm based on the combination of graph cut and convex shape prior. The main characteristic of the algorithm is that it segments nuclei foreground using a graph cut algorithm and splits overlapping or touching cell nuclei by simple convex and concavity analysis, using a convex shape assumption for nuclei contour. We evaluate the performance of our method by applying it to a library of publicly-available two-dimensional (2D) images that were hand-labeled by experts. Our algorithm yields a substantial quantitative improvement over other methods for this benchmark. For example, our method achieves a decrease of 3.2 in the Hausdorff distance and an decrease of 1.8 per slice in the merged nuclei error.

[Minimally invasive emergent techniques in obesity treatment]. / Técnicas mínimamente invasivas emergentes en el tratamiento de la obesidad.

INTRODUCTION: Obesity is a chronic disease for which several modalities of treatment are investigated today. One of them is the set of minimally aggressive techniques that have been added to the intragastric balloon. OBJECTIVE: To review the minimally invasive techniques described in the last years for the treatment of obesity. MATERIAL AND METHOD: It consisted in reviewing the bibliography through the habitual finders, in addition to the obtained data of the companies. They are classified in restrictive and malabsortive, and the restrictive are divides in mechanical or functional restriction. RESULT: Between mechanical restrictive the classified as we included in the restrictive emergent techniques the adjustable intragastric balloon, the intragastric prosthesis, the vertical endoluminal gastroplasty and the transoral gastroplasty. In order to obtain a functional restriction, we have the gastric pacemaker and the botulinic toxin. And finally, the endoluminal duodenojejunal bypass is described as a malabsortive technique. DISCUSSION: With less than 10 years of existence, it seems that the described techniques compensate their smaller effectiveness compared to the surgical techniques, with the absence of substantial modifications in the anatomy of the alimentary tract. None of these techniques is free of risks and complications.

Técnicas mínimamente invasivas emergentes en el tratamiento de la obesidad / Minimally invasive emergent techniques in obesity treatment

Introducción: La obesidad es una enfermedad crónica para la que se investigan hoy múltiples caminos terapéuticos. Uno de ellos es el conjunto de técnicas poco agresivas que se han sumado al balón intragástrico. Objetivo: Revisar las técnicas mínimamente invasivas descritas en los últimos años para el tratamiento de la obesidad. Material y método: Se procede a revisar toda la bibliografía asequible a través de los buscadores habituales, además de la información obtenida de las casas comerciales. Se clasifican en restrictivas y malabsortivas, y las primeras en restricción mecánica o funcional. Resultado: Entre las técnicas emergentes clasificadas como restrictivas mecánicas incluimos el balón intragástrico ajustable, la prótesis intragástrica, la gastroplastia vertical endoluminal y la gastroplastia transoral. Para obtener una restricción funcional, tenemos el marcapaso gástrico y la toxina botulínica. Y por último, se describe el by-pass duodenoyeyunal endoluminal que sería una técnica malabsortiva. Discusión: Con menos de 10 años de existencia, parece que las técnicas descritas compensan su menor eficacia frente a las técnicas quirúrgicas, con la ausencia de modificaciones sustanciales en la anatomía del tubo digestivo. Ninguna de estas técnicas está exenta de riesgos y complicaciones. Conclusión: Tal como ya manifestó la SAGES en 2009, estas técnicas parecen tener un futuro prometedor, pero la escasez de datos actuales no nos permiten aún confirmar su utilidad en el tratamiento de la obesidad (AU)

Introduction: Obesity is a chronic disease for which several modalities of treatment are investigated today. One of them is the set of minimally aggressive techniques that have been added to the intragastric balloon. Objective: To review the minimally invasive techniques described in the last years for the treatment of obesity. Material and method: It consisted in reviewing the bibliography through the habitual finders, in addition to the obtained data of the companies. They are classified in restrictive and malabsortive, and the restrictive are divides in mechanical or functional restriction. Result: Between mechanical restrictive the classified as we included in the restrictive emergent techniques the adjustable intragastric balloon, the intragastric prosthesis, the vertical endoluminal gastroplasty and the transoral gastroplasty. In order to obtain a functional restriction, we have the gastric pacemaker and the botulinic toxin. And finally, the endoluminal duodenojejunal bypass is described as a malabsortive technique. Discussion: With less than 10 years of existence, it seems that the described techniques compensate their smaller effectiveness compared to the surgical techniques, with the absence of substantial modifications in the anatomy of the alimentary tract. None of these techniques is free of risks and complications (AU)

[Informed consent in the intragastric balloon supported by SENPE, SEEDO, SEN and SECO: legal aspects]. / Consentimiento informado en el balón intragástrico avalado por SENPE, SEEDO, SEN y SECO: aspectos médico-legales.

INTRODUCTION: Intra-gastric balloon (IGB) is an invasive, temporary, non-surgical technique for the treatment of obesity. Its outcomes mainly depend on the patient's collaboration. OBJECTIVE: The aim was to adapt the informed consent used for bariatric surgery to a method that has especial characteristics. MATERIALS AND METHODS: We used the informed consent proposed by ASAC for bariatric surgery and 8 statements related to IGB included in the WESTLAW ES database. RESULTS: The review of the statements defines the IGB treatment as a curative-intended and non-satisfactive therapy with an obligation of the means used, but not the outcomes, by the treating physician. Moreover, the obligations of providing a correct and complete information -which includes the dietary regime- should be observed, as well as the possible therapeutic alternatives and finally, the proceeding used should be in written. CONCLUSIONS: The informed consent is a medico-legal document which content should consider the latest jurisprudence on the minimally invasive techniques for the treatment of obesity.

Consentimiento informado en el balón intragástrico avalado por SENPE, SEEDO, SEN y SECO; aspectos médico-legales / Informed consent in the intragastric balloon supported by SENPE, SEEDO, SEN and SECO; legal aspects

Introducción: El Balón Intragástrico (BIG) es una técnica invasiva, no quirúrgica, de carácter temporal, para el tratamiento de la obesidad, cuyos resultados dependen en gran medida de la colaboración del paciente. Objetivo: El objetivo es adaptar el Consentimiento Informado propio de la cirugía bariátrica, a un método que reviste las características especiales descritas. Material y método: Se utiliza el Consentimiento Informado propuesto por la ASAC para cirugía bariátrica, así como 8 sentencias relacionadas con el BIG tal como se hallan en la base de datos WESTLAW ES. Resultado: La revisión de las sentencias define el tratamiento mediante BIB como tratamiento con intención curativa y no satisfactiva, con obligación de medios aunque no de resultados, por parte del médico tratante. Se han de respetar además las obligaciones de una información correcta y completa -incluyendo las pautas dietéticas a seguir-, así como de las alternativas terapéuticas posibles, y por fin, de una constancia del proceso por escrito. Conclusiones: El Consentimiento Informado es un importante documento médico-legal cuyo contenido debe tener en cuenta la jurisprudencia recientemente aparecida en el campo de las técnicas mínimamente invasivas para el tratamiento de la obesidad (AU)

Introduction: Intra-gastric balloon (IGB) is an invasive, temporary, non-surgical technique for the treatment of obesity. Its outcomes mainly depend on the patient's collaboration. Objective: The aim was to adapt the informed consent used for bariatric surgery to a method that has especial characteristics. Materials and methods: We used the informed consent proposed by ASAC for bariatric surgery and 8 statements related to IGB included in the WESTLAW ES database. Results: The review of the statements defines the IGB treatment as a curative-intended and non-satisfactive therapy with an obligation of the means used, but not the outcomes, by the treating physician. Moreover, the obligations of providing a correct and complete information -which includes the dietary regime- should be observed, as well as the possible therapeutic alternatives and finally, the proceeding used should be in written. Conclusions: The informed consent is a medico-legal document which content should consider the latest jurisprudence on the minimally invasive techniques for the treatment of obesity (AU)

Resultados analíticos en la población con diabetes del área 3 de Madrid: un análisis de calidad asistencial atendiendo al GRD / Analytical results int he population with diabetes of area 3 of Madrid: an analysis of quality of care in according the DRG

Realizamos un estudio retrospectivo para evaluar los parámetros de control glucémico, lipídico y excreción de albuminuria (EAU) así como el grado de objetivo de control conseguido en pacientes con diabetes del área 3 de la Comunidad de Madrid durante el año 2002, analizando los datos atendiendo al Grupo Relacionado con el Diagnóstico (GRD): 294, DM >= 36 años y 295, DM = 36 años, con una prevalencia ajustada a la edad del 0,25% and 3,1%, respectivamente. El porcentaje de pacientes con >= 2 determinaciones de HbA1c fue de 61 y 25%, realización de perfil lipídico completo 66 y 60%, EAU 72 y 46% de los pacientes con DM = 36 años respectivamente. 29% y 37% de los pacientes tenían HbA1c = 36 años respectivamente. En conclusión, el análisis de las peticiones analíticas en pacientes con diabetes es útil para evaluar la calidad asistencial en esta población. En nuestra área de salud algunos indicadores de resultado intermedio y de proceso son inadecuados, habiendo encontrado diferencias en los pacientes seguidos por médicos de Atención Primaria y endocrinólogos. Se precisa aumentar los esfuerzos y recursos de salud pública para mejorar estos resultados y de este modo contribuir a la reducción de las complicaciones crónicas de esta enfermedad

We conducted a retrospective study to evaluate the adequacy of glycemic, lipid and albumin excretion (EAU) management in reference to target goals for diabetic patients in the area 3 of the community of Madrid during 2002, this data were analysed according the Diagnosis Related Group (DRG): 294, DM >= 36 years and 295, DM = 36 years which reflect an age-adjusted prevalence of 0,25% and 3,1% respectively. The percentages of patients with >= 2 determinations of HbA1c were 61% and 25%, complete lipid profile 66% and 60%, EAU in 72% and 46% in DM = 36 years old respectively. 29% and 37% of patients achieved HbA1c = 36 respectively. In conclusion, analysis of the blood test in diabetic patients is useful to evaluate the quality of care for this population. In our health area some indicators of intermediate outcomes and process of care outcomes were inadequate, and we found differences in the patients followed by primary care physicians and endocrinologists. It is necessary to increase to the efforts and resources of public health to improve these results, contributing to reduction of the chronic complications of this disease

Displasia septoóptica: una causa poco frecuente de hipopituitarismo asociado a fiebre y crisis adrenal recurrente / Septo-optic dysplasia: an unusual cause of hypopituitarism with recurrent fever and adrenal crises

La displasia septoóptica consiste en hipoplasia congénita de nervios ópticos, alteraciones estructurales en la línea media del cerebro, fundamentalmente ausencia de septum pellucidum en un 50% de los casos y disfunción hipotálamo-hipofisaria en un 30-80% de los pacientes. Los déficit endocrinológicos se suelen detectar en los primeros años de vida, y los más frecuentes son: déficit de hormona de crecimiento, hipotiroidismo, hipogonadismo y diabetes insípida, y menos frecuentemente insuficiencia adrenal y pubertad precoz. Presentamos el caso de un varón con displasia septoóptica, diagnosticado a la edad de 15 años de hipotiroidismo e hipocortisolismo, que durante su evolución cursa con cuadros febriles de repetición sin foco infeccioso evidente asociado a crisis adrenal. Se revisa la bibliografía y se discuten las alteraciones en la termorregulación como factores implicados en los cuadros febriles. También se discute sobre la necesidad de un tratamiento urgente de la crisis adrenal durante estos episodios febriles para evitar desenlaces fatales

Septo-optic dysplasia (SOD) consists of congenital hypoplasia of the optic nerves and alterations of mid-line brain structures, specifically the absence of septum pellucidum in 50% of patients, and hypothalamic-pituitary dysfunctions in 30-80%. Usually endocrinological deficiencies are detected in the first few years of life, and the most frequently found abnormalities are growth hormone deficiency, hypothyroidism, hypogonadism and diabetes insipidus, and less frequently adrenal insufficiency and precocious puberty. We report a man with SOD who was diagnosed with hypothyroidism and cortisol deficiency at 15 years and who had recurrent fever without evident infectious origin associated with adrenal crises during the course of this disease. We review the literature and discuss thermoregulatory disturbances as factors involved in the origin of fever. The need for urgent treatment of episodes of fever to avoid fatal outcomes is also discussedSepto-optic dysplasia (SOD) consists of congenital hypoplasia of the optic nerves and alterations of mid-line brain structures, specifically the absence of septum pellucidum in 50% of patients, and hypothalamic-pituitary dysfunctions in 30-80%. Usually endocrinological deficiencies are detected in the first few years of life, and the most frequently found abnormalities are growth hormone deficiency, hypothyroidism, hypogonadism and diabetes insipidus, and less frequently adrenal insufficiency and precocious puberty. We report a man with SOD who was diagnosed with hypothyroidism and cortisol deficiency at 15 years and who had recurrent fever without evident infectious origin associated with adrenal crises during the course of this disease. We review the literature and discuss thermoregulatory disturbances as factors involved in the origin of fever. The need for urgent treatment of episodes of fever to avoid fatal outcomes is also discussed

Amputaciones de miembro inferior en población con diabetes mellitus en el área 3 de la comunidad de Madrid / Amputations of the lower limb in a population with diabetes mellitus in the Madrid community Area 3

Los pacientes con Diabetes Mellitus presenta un riesgo superior de sufrir amputación de miembro inferior (AMI), sin embargo, su incidencia difiere mucho según la población analizada. Conocer la incidencia de AMI en nuestra población es indispensable antes de poner en funcionamiento cualquier medida preventiva. Para ello, estudiamos la incidencia de AMI en la población general en el área 3 de la Comunidad de Madrid durante el período 1997-2000, analizando de forma pormenorizada su incidencia en la población diabética. Durante los 4 años se realizaron 117 AMI, 73 en varones (39 mayores y 34 menores) y 44 en mujeres (36 mayores y 8 menores). La incidencia estandarizada a la edad de las AMI fue de 13,3 por 105 habitantes y año (17,9 para varones y 8,5 para mujeres). 104 AMI fueron no traumática ni tumorales (NTT) y un 73 por ciento se realizaron en diabéticos. La incidencia de AMI de causa NTT fue de 69,3 por 105 diabéticos y año (78,7 en varones y 59,5 en mujeres), 24 veces superior que en no diabéticos. En conclusión en nuestro estudio la incidencia de AMI fue una de las más bajas comunicadas en la literatura y coincide en líneas generales con la hallada en nuestro entorno, sin embargo, este mayor riesgo de AMI en población diabética reflejan que estos resultados no son todo lo óptimo que se quisiera. El diseño de estrategias multidisciplinarias para prevenir y mejorar el manejo del pie de riesgo de amputación podría reducir el número de AMI en nuestra población (AU)

Intracellular and extracellular calcium utilization during hypoxic vasoconstriction of cyclostome aortas.

Hypoxic vasoconstriction (HV) is an intrinsic response of mammalian pulmonary and cyclostome aortic vascular smooth muscle. The present study examined the utilization of calcium during HV in dorsal aortas (DA) from sea lamprey and New Zealand hagfish. HV was temporally correlated with increased free cytosolic calcium (Ca2+c) in lamprey DA. Extracellular calcium (Ca2+o) did not contribute significantly to HV in lamprey DA, but it accounted for 38.1 +/- 5.3% of HV in hagfish DA. Treatment of lamprey DA with ionomycin, ryanodine, or caffeine added to thapsigargin-reduced HV, whereas HV was augmented by BAY K 8644. Methoxyverapamil (D600) in zero Ca2+o did not affect HV in lamprey DA, nor did it prevent further constriction when Ca2+o was restored during hypoxia in hagfish DA. Removal of extracellular sodium (Na+o) caused a constriction in both species. Lamprey DA relaxed to prehypoxic tension following return to normoxia in zero Na+o, whereas relaxation was inhibited in hagfish DA. Relaxation following HV was inhibited in lamprey DA when Na+o and Ca2+o were removed. These results show that HV is correlated with [Ca2+]c in lamprey DA and that Na+/Ca2+ exchange is used during HV in hagfish but not lamprey DA. Multiple receptor types appear to mediate stored intracellular calcium release in lamprey DA, and L-type calcium channels do not contribute significantly to constriction in either cyclostome.