Effects of indomethacin on prostanoid synthesis and vasomotor responsiveness in endothelium-denuded abdominal and thoracic aortas of Wistar rats.

In endothelium-denuded abdominal (but not thoracic) aortas of rats, the nonselective cyclooxygenase (COX) inhibitor, indomethacin, suppressed contractions evoked by α-adrenergic agonists hypothetically mediated by prostanoids. We aimed to identify these non-endothelial-derived contractile prostanoids released by α-adrenergic receptors activation. Endothelium-denuded abdominal and thoracic aortas of Wistar rats were used for biochemical and functional analyses. Western blot analysis showed that COX-1 and COX-2 protein levels were respectively equivalent in endothelium-denuded abdominal and thoracic aortas. Enzyme immunoassay data supported direct evidence of phenylephrine-stimulated release of prostanoids (PGI2, PGE2, and PGF2α) by thoracic and abdominal aortas without endothelium, and their almost complete inhibition by 1 µM indomethacin. Isometric force measurements established that 10 µM indomethacin-but no lower concentrations-inhibited the contractions evoked by phenylephrine in endothelium-denuded abdominal aorta. In this preparation, 10 µM indomethacin also depressed the contractions provoked by angiotensin II and high K+ (80 mM). In fact, indomethacin (up to 1 mM) caused concentration-dependent reductions in all abovementioned contractile responses. In endothelium-denuded thoracic aortas, however, only 1 mM indomethacin significantly depressed the contractile activity stimulated by either phenylephrine, angiotensin II, or high K+. Hence, there was a clear quantitative difference in response to indomethacin between abdominal and thoracic aortas without endothelium. Altogether, the results indicate that prostanoids induced by phenylephrine in abdominal and thoracic aortas were derived from non-endothelial COX-mediated metabolism; notably, the decrease in prostanoid synthesis could not account for the inhibition of vasoconstrictor responses by indomethacin: Through COX-independent actions, indomethacin inhibited aortic smooth muscle contractility.

Endoscopic Retrograde Cholangiopancreatography in the Elderly.

BACKGROUND: The use of gastrointestinal endoscopy in geriatric patients is rising as an increasing proportion of the population is reaching an advanced age. Most studies of endoscopic retrograde cholangiopancreatography (ERCP) in the elderly have been done in tertiary care or referral centers. METHODS: We analyzed the clinical and endoscopic data on all ERCPs in patients aged 65 years and older in a retrospective review of medical records of patients at the county hospitals in El Paso and Lubbock, Texas between 2004 and 2008. ERCP data in patients aged 75 years and older were compared with those who were 65-74 years. RESULTS: There were 125 ERCPs performed in 89 patients (74 procedures in 54 patients older than 75 years, 51 procedures in 35 patients younger than 75 years). The average age was 76.0 (range: 65-94), 62.4% were female and 79.2% were Hispanic. Indications were similar between groups: jaundice (66.9%), abnormal liver tests (87.2%), abdominal pain (79.2%), cholangitis (24.0%), pancreatitis (32.8%) and stent change (12.9%). Concomitant illnesses were also similar. Lower doses of midazolam and meperidine were used for moderate sedation in the older group (P < 0.01). ERCP findings were similar in both groups: stones (40.8%), stricture (18.4%) and stent placement (30.4%). Complications occurred in 6.4%. CONCLUSIONS: This study of ERCP in elderly predominantly Hispanic patients found similar indications, efficacy and safety in patients 75 years and older compared with those 65-74 years old. Advanced age is not a contraindication to ERCP, but issues related to sedation and the use of antithrombotic therapy need to be addressed in the elderly.

Fluid genetic analyses predict the biological behavior of pancreatic cysts: three-year experience.

CONTEXT: EUS with fine-needle aspiration and cyst fluid analysis is routinely used to evaluate pancreatic cysts; however, the clinical course of these lesions is often not well defined. OBJECTIVE: Our study evaluated whether EUS imaging, cyst fluid CEA, and cytology combined with cyst fluid genetic analyses for allelic imbalance and genetic mutations can be used to better predict the malignant potential of pancreatic cysts. PATIENTS: Seventy-two patients underwent EUS-FNA for evaluation of pancreatic cysts from 2010 to 2013. DESIGN: In addition to routine cytology and fluid CEA, the aspirated cyst fluid was analyzed for the presence of KRAS mutations, GNAS mutations, and allelic imbalance (loss of heterozygosity). Patients were followed up to 3 years. SETTING: Tertiary care center. RESULTS: EUS revealed 39 IPMNs, 17 mucinous cystic neoplasms, and 16 serous cystadenomas. Twenty two of 56 patients with IPMNs or mucinous cystic neoplasms had pancreatic cysts with abnormal genetic fluid analysis. Of those 22 patients, 18 contained a non-benign clinical diagnosis. This is consistent with cyst fluid genetic analysis carrying a sensitivity and specificity of 75% and 88%, respectively, and a positive predictive value of 82%.There was also a significant negative predictive value of 81%. For mucinous cystic neoplasms the negative predictive value was 100%. CONCLUSION: Genetic mutations and allelic imbalance detected in pancreatic mucinous cysts are associated with progression to malignancy and could be helpful as predictors of biological behavior of pancreatic cysts. In our experience, genetic analyses when used in combination with EUS imaging, cytology, and fluid CEA could serve as a guide to clinical decisions regarding cyst surgical resection and follow up.

El sismo de Tecomán, Colima del 21 de enero de 2003 (Me 7.6)

El 21 de enero de 2003, a las 20:06 hora local ocurrió un sismo de magnitud Me=7.6, con epicentro frente a las costas del estado de Colima. En este informe se presentan, de manera resumida las características sismológicas del evento. Se describen las observaciones, hechas durante una visita a la zona afectada, del comportamiento de hospitales, escuelas, viviendas, puentes monumentos históricos y edificios públicos y de uso comercial. Se incluye, también, una evaluación económica del costo de reconstrucción de los daños causados por el sismo. Finalmente, se señalan algunos aspectos que deben atenderse en el campo de la protección civil en México.(AU)

El sismo de Oaxaca del 30 de septiembre de 1999 (Mw=7.5)

El 30 de septiembre de 1999, a las 11:31:00 h (hora local) ocurrió un sismo de magnitud Mw=7.5, con epicentro al noreste de la ciudad de Puerto Escondido, Oaxaca. En este informe se presentan, de manera resuminada las características sismológicas del evento. Se describen la observaciones, hechas durante una visita a la zona afectada, del comportamiento de hospitales, escuelas, viviendas, monumentos históricos y edificios de uso comercial. Se incluye, también, una evaluación económica del costo de reconstrucción de los daños causados por el sismo. Finalmente, se señalan algunos aspectos que deben atenderse en el campos de la protección civil en México. (AU)