Evaluation of anastomotic strength and drug safety after short-term sunitinib administration in rabbits

Background

Sunitinib (Sutent) is a Food and Drug Administration–approved receptor tyrosine kinase inhibitor found to reduce postoperative adhesion formation in animal models. The objective of the present study was to evaluate anastomotic healing and potential drug-related toxicities after short-term sunitinib administration in New Zealand White rabbits.

Materials and methods

Under an approved study protocol, 40 rabbits underwent a laparotomy followed by colonic transection and anastomosis. Animals were randomly assigned to treatment with oral sunitinib (10 mg/kg/d) or placebo, received one preoperative dose followed by 10 postoperative doses, and were divided into two groups following the procedure: group I animals were euthanized on completion of drug treatment and group II animals were euthanized 30 d after completion of treatment. Prior to study completion, animals underwent an echocardiogram and laboratory test results were obtained. At necropsy, intestinal bursting strength (in mmHg) was evaluated.

Results

All animals survived until designated euthanasia. There was no evidence of intra-abdominal sepsis or intestinal obstruction. Sunitinib-treated animals were found to have lower intestinal anastomotic strength compared with placebo-treated animals, as measured by bursting pressure at euthanasia, and a greater percentage of bursting at the anastomosis. On echocardiography, all ejection and shortening fractions were within established normal reference values. There were no significant differences in liver enzymes between animals. There were no wound infections, dehiscence, or delayed wound healing in any animal.

Conclusions

These results caution against the administration of sunitinib in cases involving intestinal anastomoses because of the elevated risk of anastomotic leak. No evidence of cardiotoxicity, hepatotoxicity, or detrimental effect on wound healing was found in any animal.     

Score for atrial fibrillation detection in acute stroke and transient ischemic attack patients in a Brazilian population: The acute stroke atrial fibrillation scoring system

OBJECTIVE:

Atrial fibrillation is a common arrhythmia that increases the risk of stroke by four- to five-fold. We aimed to establish a profile of patients with atrial fibrillation from a population of patients admitted with acute ischemic stroke or transient ischemic attack using clinical and echocardiographic findings.

METHODS:

We evaluated patients consecutively admitted to a tertiary hospital with acute ischemic stroke or transient ischemic attack. Subjects were divided into an original set (admissions from May 2009 to October 2010) and a validation set (admissions from November 2010 to April 2013). The study was designed as a cohort, with clinical and echocardiographic findings compared between patients with and without atrial fibrillation. A multivariable model was built, and independent predictive factors were used to produce a predictive grading score for atrial fibrillation (Acute Stroke AF Score-ASAS).

RESULTS:

A total of 257 patients were evaluated from May 2009 to October 2010 and included in the original set. Atrial fibrillation was diagnosed in 17.5% of these patients. Significant predictors of atrial fibrillation in the multivariate analysis included age, National Institutes of Health Stroke Scores, and the presence of left atrial enlargement. These predictors were used in the final logistic model. For this model, the area under the receiver operating characteristic curve was 0.79. The score derived from the logistic regression analysis was The model developed from the original data set was then applied to the validation data set, showing the preserved discriminatory ability of the model (c statistic = 0.76).

CONCLUSIONS:

Our risk score suggests that the individual risk for atrial fibrillation in patients with acute ischemic stroke can be assessed using simple data, including age, National Institutes of Health Stroke Scores at admission, and the presence of left atrial enlargement.     

永久心脏起搏器植入对心脏重塑影响的临床观察(附48例分析)

目的分析植入永久心脏起搏器对心脏重塑的影响。方法本研究入组病例48例,其中植入双腔起搏双腔感知P波/R波抑制型(DDD)起搏器25例,心室起搏心室感知R波抑制型(VVI)起搏器23例。采用PHILIPS7500型二维超声心动图诊断系统,分别测定患者安置永久性心脏起搏器前、安置>半年后心脏各房室大小,并进行数据间的比较分析。结果除植入DDD型起搏器组右心房发生重塑改变(P<0.05)外,DDD型起搏器植入者植入前后二维超声心动图的其余指标对比和VVI型起搏器植入者植入前后二维超声心动图的各项指标对比均未见有统计学意义改变(P>0.05)。结论植入DDD型永久心脏起搏器早期就可对右心房的重塑有影响,植入各型永久性心脏起搏器对心脏重塑的远期影响还有待于进一步的长期临床观察和扩大样本数。     

16层CT在先天性房、室间隔缺损诊断中的应用价值

目的:探讨16层CT血管成像对先天性房、室间隔缺损的CT表现及其诊断应用价值。方法:回顾性分析5例先天性房间隔缺损和8例先天性室间隔缺损患者的16层CT对比增强检查结果,13例均有手术结果及超声心动图结果对照。结果:16层CT能清晰显示先天性房、室间隔缺损,诊断符合率为100%;在诊断先天性房、室间隔缺损程度方面与超声心动图无明显差异。结论:16层CT与超声心动图检查相结合,可大大提高对先天性房、室间隔缺损的诊断准确率,减少有创的心血管造影检查,以指导手术。     

超声心动图和冠状动脉造影对冠心病诊断的比较观察

目的：研究超声诊断冠心病的意义及应用价值。方法：对88例临床拟诊为冠心病的患者行超声心动图检查，观察有无节段性室壁运动异常及其部位；对上述病人行冠脉造影检查，观察三支冠脉有无病变，狭窄及狭窄程度，狭窄大于50％则可诊断为冠心病。结果：超声对冠心病的诊断符合率93．1％，定位准确率为82.9％，与冠脉造影相比没有娃著性差异，二者有较好的一致性。超声表现特征为：节段性室壁运动减弱、消失或矛盾运动。结论：对临床怀疑为冠心病的病人，超声心动图是一项首要的无创检查方法。     

Longitudinal observations of left ventricular end-diastolic dimension in children using echocardiography

Previous studies have evaluated left ventricular dimensions in children using two-dimensional echocardiography, but there is little information on gender differences and on the longitudinal development of the dimensions of the left ventricle. Our objective was to asses, by two-dimensional echocardiography, the normal size of the left ventricular end-diastolic dimension (LVDd) in children, its differences by sex, and the rate of its development using height, weight, and body surface area as indices. The study group consisted of 437 patients (264 males, 173 females) with a history of Kawasaki disease but with no coronary artery lesions, as determined by repeated echocardiographic and other examinations. A total of 1595 examinations were done over an average of 6.7 years. The increase in LVDd was significantly more rapid in (1) children below 2 years of age than in older children of either sex and (2) in males who were 11 and 12 years old than in males who were 10 years old. Significant gender differences were observed in the increase in LVDd by all indices (p<0.001).     

Confirmation of a retrosternal mass by echocardiogram

Case report of a 14 year old girl with Hodgkin's disease whose echocardiographic findings showed an anterior mediastinal mass between the right ventricle and the chest wall. The echocardiogram permitted an accurate measurement of the AP diameter of the mass. This technique, in conjunction with chest x ray, provides a means of determining changes in overall mass size as an indication of response to therapy.     

Electrocardiographic and Echocardiographic Features That Distinguish Anomalous Origin of the Left Coronary Artery from Pulmonary Artery from Idiopathic Dilated Cardiomyopathy

Many authors have reported noninvasive means of diagnosing anomalous left coronary artery from pulmonary artery (ALCAPA) and differentiating ALCAPA from idiopathic dilated cardiomyopathy (DCM). Systematic evaluation using these noninvasive diagnostic modalities is not available. To distinguish between ALCAPA and DCM using a systematic approach, we examined 23 patients with ALCAPA (age 1 month to 23 years, median 7 months) and 23 patients with DCM (age 5 days to 16 years, median 6.6 months). Standard 12-lead electrocardiograms (ECG) and 2-dimensional (2-D) and color Doppler echocardiograms were performed. A logistic regression model was applied using ALCAPA diagnosis as the dependent variable and ECG and echocardiographic findings as independent variables. A scoring system was created to establish the ALCAPA diagnosis based on results from the logistic regression. On the logistic regression, the ECG feature of QT pattern in aVL (Q wave ≥ 3 mm deep with an inverted T wave) and echocardiographic features of right coronary artery diameter to aortic annulus ratio ≥ 0.14, increased papillary muscle echogenicity, and Doppler color flow of LCA from aorta or pulmonary artery were the most significant differentiating features between the ALCAPA and DCM groups. A scoring system was developed using the previous five variables and assigning a score of 1 to each variable (−1 to Doppler color flow of LCA from aorta). The scoring system had sensitivity of 100% and specificity of 91% for ALCAPA diagnosis. Compared with previous reported diagnostic features in differentiating ALCAPA and DCM, the scoring system had a much higher specificity and positive predictive value. In conclusion, we selected the most useful ECG and echocardiographic features to differentiate between ALCAPA and DCM and created a scoring system to aid clinical diagnosis. This scoring system may be useful in evaluating children with acute congestive heart failure.     

超声心动图右心室评价指标的应用

右心室由于其复杂的解剖结构,舒张期血流易受呼吸周期的影响,位置靠近胸骨后等因素,目前为止,仍没有一项检测指标能够准确的评价其功能及结构的变化。随着超声心动图技术的不断发展,各种测定右心功能的新方法不断涌现,各有优势。它们弥补了原有检测指标的不足且计算简便,重复性好,使得对于右心功能的认识进一步深入。     

心肌致密化不全临床研究

心肌致密化不全是一种罕见的因胚胎发生时正常的心内膜心肌发育停滞所致的心肌病。临床表现各异,可无症状,也可表现为充血性心力衰竭,心律失常和系统性血栓栓塞等。超声心动图检查是诊断的首选。本病预后不同,早期诊断和治疗有助于延长患者的生命。