Echocardiographic reference ranges for sedated healthy cynomolgus monkeys (Macaca fascicularis).

Echocardiographic imaging has become the primary tool to evaluate cardiac structure and function in human and veterinary medicine. The cynomolgus monkey (Macaca fascicularis) is a nonhuman primate species frequently used in biomedical research, particularly for the study of human cardiovascular disease and toxicology, yet echocardiographic reference ranges are not available for this species. Using standard 2-dimensional and M-mode imaging, we performed echocardiographic evaluation of 118 female and 119 male cynomolgus monkeys under sedation with either ketamine hydrochloride (10 mg/ kg IM) alone or with a combination of tiletamine hydrochloride and zolazepam (4.0 mg/kg IM) and atropine sulfate (0.015 mg/kg IM). Reference ranges were developed (tolerance interval methodology) separately for each gender for heart rate, left ventricular (LV) size (interventricular septum in diastole, LV internal diameter in diastole and systole, LV free wall in diastole), left atrial diameter, and aortic diameter. LV functional parameters (fractional shortening, aortic peak flow velocity, LV ejection time, and LV preejection period) and mitral valve E point to septal separation were also measured. After normalization for body weight (1.7 to 6.3 kg), the data were analyzed for gender- and sedation-associated differences. Using a large number of healthy subjects (118 of each gender), we have developed gender-specific echocardiographic reference ranges for cynomolgus monkeys.     

Idiopathic new bone formation in the femoral shafts of a cynomolgus monkey (Macaca fascicularis).

A 6.5-y-old cynomolgus monkey was referred to the Veterinary Medical Teaching Hospital at Chungnam National University for suspected bone fracture. The monkey had been reared singly in a cage at a laboratory facility. An animal caretaker incidentally found a bone fragment protruding through the skin of the right leg. Radiographic examination revealed 2 new bone fragments clearly distinguishable from the original femurs; the fragments seemed to be inserted into both femurs. One of the new bone fragments was easily separated surgically from the right femur. Although the bone fragment consisted of a medullary cavity and bone cortex, the periosteal structure was incomplete. New bone formation in nonhuman primates, as manifested in this case, has been reported previously. However, growth of an additional long bone from the original, penetrating the skin without motional disturbance, has not been reported previously.     

Multidetector computed tomographic morphology of ovaries in cynomolgus macaques (Macaca fascicularis).

Macaques are important models for menopause and associated diseases in women. A sensitive, noninvasive technique for quantifying changes in ovarian morphology would facilitate longitudinal studies focused on the health-related sequelae of naturally occurring or experimentally induced alterations in ovarian structure and function. Multidetector computed tomography (MDCT) is a fast, non-invasive imaging technique that uses X-rays, multiple rows of detectors, and computers to generate detailed slice images of structures. The purpose of this study was to describe the utility of MDCT for reliably characterizing ovarian morphology in macaques. Five macaques were scanned using contrast-enhanced MDCT. The following characteristics were described: 1) appearance of ovaries and adjacent landmarks, 2) effects of varying technical protocols on ovarian image quality, 3) radiation doses delivered to the pelvic region during scanning, and 4) MDCT estimates of ovarian volume and antral follicle counts versus those measured directly in ovarian tissue. Ovaries were distinguishable in all MDCT scans and exhibited heterogeneous contrast enhancement. Antral follicles appeared as focal areas of nonenhancement. Ovarian image quality with 5 pediatric scanning protocols was sufficient for discriminating ovarian margins. Pelvic region radiation doses ranged from 0.5 to 0.7 rad. Antral follicles counted using MDCT ranged from 3 to 5 compared with 3 to 4 counted using histology. Ovarian volumes measured using MDCT ranged from 0.41 to 0.67 ml compared with 0.40 to 0.65 ml by water displacement. MDCT is a promising technique for measuring longitudinal changes in macaque ovarian morphology reliably and noninvasively.     

Ischemic brain damage after ketamine and xylazine treatment in a young laboratory monkey (Macaca fascicularis).

After a 4-year-old female laboratory cynomolgus monkey manifested neurological abnormalities, including tetanic spasm, after intramuscular injection of 20 mg/kg ketamine, we administered 2 mg/kg xylazine in an attempt to control the seizure. However, the animal continued to display opisthotonus, nystagmus, and symptomatic epilepsia. Analysis of blood chemistry revealed a dramatically increased creatine phosphokinase level. Abnormal histopathological findings included acute neuronal necrosis or glial reaction or both in the cerebral cortex, nucleus lentiformis, hippocampus, cerebellar cortex and nucleus, and medulla oblongata; severe myocardial hemorrhagic necrosis; and hepatic subcapsular hematoma. Although the mechanism of this neuronal damage has not been clarified, it may be attributable to an ischemic condition in the brain, probably due to temporal cardiac arrest or hemorrhagic change in the liver and heart, with subsequent decreased blood pressure, after ketamine and/or xylazine treatment. Because both drugs often are used as general anesthetics in veterinary medicine, attention should be paid to this rare case with neural damage.     

镜面右位心室间隔缺损合并肺动脉高压超声表现1例

正患者女,14岁,因发热、咳嗽2 d就诊。诉6岁时外院体检偶然发现"先天性心脏病",未做处理。今因受凉后出现发热伴咳嗽,无呕吐、腹泻等症。体格检查:精神稍差,口唇发绀,双肺呼吸音粗,可闻及湿啰音。心尖搏动在胸骨右缘三四肋间,胸骨右缘第二肋间闻及收缩期隆隆样杂音,心律不齐。实验室检查:白细胞计数8.2×10~9/L,中性粒细胞百分比45.6%,红细胞计     

胎儿期肺动脉闭锁合并室间隔缺损的超声心动图特征

肺动脉闭锁合并室间隔缺损(pulmonary atresia with ventricularseptal defect,PA-VSD)是一种少见的复杂性先天性心脏病,其发病率在出生的活婴中约为十万分之4[1]。产前超声检查对PA-VSD的筛查及优生优育具有重要意义。本组回顾分析经尸体解剖证实的3例PA-VS胎儿的超声心动图特征,旨在探讨产前超声在筛查胎儿期PA-VSD中的价值。     

产前超声心动图诊断胎儿室间隔缺损

目的 观察产前超声心动图检查诊断胎儿室间隔缺损（VSD）的价值。方法 对3 826胎胎儿行产前超声心动图检查,并与产后复查超声心动图检查及引产后尸体解剖结果进行对照,计算产前超声心动图诊断VSD的正确率、误诊率及漏诊率。结果 产前超声心动图诊断61胎（61/3 826,1.59%）VSD,其中单纯性VSD 36胎（36/3 826,0.94%）,VSD合并其他心脏畸形25胎（25/3 826,0.65%）;经产后复查超声或引产后尸体解剖,最终共确诊76例（76/3 826,1.99%）VSD,包括51例（51/3 826,1.33%）单纯性VSD、25例（25/3 826,0.65%）VSD合并心脏其他畸形。产前超声心动图诊断单纯性VSD的准确率为58.82%（30/51）,漏诊率为41.18%（21/51）,误诊率为1.06‰（4/3 775）;诊断VSD合并其他心脏畸形的准确率为96.00%（24/25）,漏诊率为4.00%（1/25）,误诊率为0.26‰（1/3 801）。结论 超声心动图在产前诊断胎儿VSD中具有重要临床价值,可为选择治疗方案、评估预后等提供重要参考依据。     

胎儿室间隔缺损的产前超声诊断分析

目的探讨超声检查胎儿室间隔缺损（VSD）的超声表现及操作技巧,以提高超声对VSD的产前检出率。方法对11300例孕19～37周的胎儿进行产前系统超声检查,在胎儿四腔心切面十字交叉处顺时针和逆时针旋转作重点扫查,观察室间隔上部有无连续中断;同时配合彩色多普勒观察有无穿隔血流。结果产前超声正确诊断VSD20例,单纯VSDt0例,VSD合并其他心脏畸形10例,VSD合并心外畸形7例。结论胎儿VSD声像图具有一定特征性,应用胎儿四腔心切面十字交叉处顺时针和逆时针旋转,对胎儿VSD的显示清晰、快捷;产后证实,超声诊断VSD准确性高,有一定的临床推广价值。     

胎儿超声心动图诊断单纯性室间隔缺损

目的 探讨胎儿超声心动图检查对胎儿单纯性室间隔缺损的诊断价值.方法 追踪随访我院建卡生产的37 253名孕妇,采用不同切面和手段检查胎儿单纯性室间隔缺损,并进行统计学分析.结果 我院胎儿超声心动图检查对单纯性室间隔缺损诊断敏感度为73.44%(94/128),特异度为99.87%(37 076/37 125),阳性预测值为65.73%(94/143),阴性预测值为99.91%(37 076/37 110);不同检查切面的诊断效能两两比较差异均有统计学意义(P均 <0.05);二维超声显示回声中断/失落与彩色多普勒超声显示心室水平分流比较,差异无统计学意义(P >0.05).结论 胎儿超声心动图检查诊断单纯性室间隔缺损具有较高敏感度,不同检查切面对该病诊断的意义不同.     

E-flow超声成像技术诊断胎儿室间隔缺损的意义

目的探讨E-flow超声成像技术诊断胎儿室间隔缺损的价值。方法分析19例在我院经产前超声诊断为室间隔缺损胎儿的超声资料。对受检胎儿在四腔心切面、左心室长轴切面、右心室流出道及肺动脉长轴等切面观察有无室间隔回声中断,结合E-flow显像技术观察室间隔穿隔血流信号,并观察室间隔缺损的位置及大小。结果 19例胎儿中,1例经尸检证实、18例产后超声均证实为室间隔缺损。其中10例为单纯性室间隔缺损,9例为合并室间隔缺损的复合心脏畸形,包含法洛四联症、心内膜垫缺损、大动脉转位、永存动脉干。CDFI结合二维超声诊断出室间隔缺损13例,6例未检出,E-flow诊断出室间隔缺损19例。结论 E-flow超声成像技术能对胎儿室间隔缺损作出产前诊断,对进一步诊断及治疗方案的选择有重要的临床价值。     

Prenatal diagnosis of pulmonary atresia with ventricular septal defect

Pulmonary atresia with ventricular septal defect (PA-VSD) is a rare complex congenital heart defect. Major artery-pulmonary collateral arteries (MAPCAs) are characteristic of PA-VSD. Prenatal diagnosis can be achieved in most cases of PA-VSD with recent advances in echocardiography. However, it is extremely rare that all MAPCAs can be observed on the echocardiograph. Here, we report a case of prenatally diagnosed type C PA-VSD in which all the MAPCAs could be seen on the echocardiograph, with the diagnosis supported by autopsy evidence.     

MSCT诊断肺动脉闭锁伴室间隔缺损

目的 探讨MSCT诊断肺动脉闭锁伴室间隔缺损（PA/VSD）的价值。方法 回顾性分析81例PA/VSD患者的临床及影像资料。将患者术前经胸超声心动图（TTE）、MSCT检查结果与手术结果对比。结果 PA/VSD A1型23例,A2型17例,B型34例,C型7例。MSCT诊断PA/VSD分型的准确率为93.82%（76/81）,高于TTE[59.26%（48/81）;χ²=26.95,P<0.01];MSCT诊断粗大主动脉及肺侧支循环动脉（MAPCAs）来源准确率为100%（93/93）,高于TTE[51.84%（51/93）;χ²=54.25,P<0.01]。MSCT检出心内畸形50处（50/53,94.34%）,TTE检出53处（53/53,100%）,二者差异无统计学意义（χ²=1.37,P=0.24）;MSCT检出心脏-大血管连接异常66处（66/66,100%）,TTE检出65处（65/66,98.48%）,二者差异无统计学意义（P>0.05）;MSCT检出心外大血管异常106处（106/106,100%）,高于TTE[82.08%（87/106）;χ²=20.87,P<0.01]。MSCT测量McGoon比值、肺动脉指数、全部新的肺动脉指数与手术所见比较差异均无统计学意义（P均>0.05）。结论 MSCT可准确诊断PA/VSD分型及肺血管发育情况,为临床诊疗提供指导。     

Elimination of chronically consumed caffeine in the pregnant monkey (Macaca fascicularis)

Characterization of alterations in caffeine elimination during pregnancy is essential in assessing the potential exposure of the fetus to caffeine and its metabolites. Female monkeys (Macaca fascicularis) were exposed to caffeine in their drinking water 7 days/week before, during and after pregnancy. The low exposure (0.15 mg/ml) corresponded to a level sometimes consumed by pregnant women (10-15 mg/kg/day) whereas the high exposure (0.35 mg/ml) was above average human consumption (25-30 mg/kg/day). Blood samples and 24-hr urine samples were collected every 2 weeks throughout dosing. Caffeine and metabolite concentrations in serum and urine were determined by high-performance liquid chromatography. Before pregnancy, geometric mean serum caffeine concentrations were approximately 1.6 and 4.9 micrograms/ml and serum theophylline concentrations were 6.6 and 13.3 micrograms/ml for the low and high dose groups, respectively. During pregnancy, serum caffeine concentrations increased by approximately 100% for both dose groups and, after parturition, declined to prepregnancy concentrations. Serum theophylline concentrations were usually greater than serum caffeine concentrations and did not change during pregnancy. The amount of caffeine and theophylline excreted in the urine over 24 hr increased during pregnancy and returned to prepregnancy levels after parturition. The results of this study indicate that pregnancy decreased caffeine elimination, resulting in a significant increase in serum caffeine levels. The changes in caffeine elimination may be related to alterations in serum estrogen and progesterone levels.     

超声心动图诊断部分型心内膜垫缺损合并房间隔肿物1例

<正>患者男,60岁,因发作心慌半年余,劳力性气短、胸闷1月余来我院就诊。体格检查:心界稍大,心率70次/min,律齐,P2亢进,胸骨左缘第三四肋间可闻及2～6级收缩期杂音,传导局限。超声心动图检查:于心尖四腔切面见房间隔下部近十字交点连续中断,缺损口大小为1.2 cm,可见自左房向右房血流信号(图1,2)。于房间隔中部卵圆窝处见一大小约1.5 cm×1.1 cm     

超声心动图诊断及随访胎儿单纯室间隔缺损

目的 探讨超声心动图在胎儿单纯室间隔缺损(VSD)的产前诊断及随访中的应用价值。方法 纳入产前超声心动图诊断为VSD的胎儿35胎,分析胎儿超声心动图特征,对其进行宫内及出生后超声随访,观察缺损大小及闭合情况。结果 误诊2胎;非高危胎儿26胎、高危胎儿7胎;肌部缺损18胎(18/33,54.55%)、膜周缺损13胎(13/33,39.39%)、干下缺损1胎(1/33,3.03%)、隔瓣下缺损1胎(1/33,3.03%);失访1胎,宫内缺损闭合2胎,出生后3年内缺损闭合21例,未闭合9例。非高危胎儿缺损闭合率高于高危胎儿(P<0.05),肌部缺损闭合率明显高于膜周及其他部位缺损(P均<0.05),缺损直径≤3.0 mm者缺损闭合率明显高于缺损3.1~5.0 mm和>5.0 mm者(P均<0.05)。结论 超声心动图在胎儿单纯VSD的产前诊断、随访观察及治疗方案的选择等方面具有重要临床价值。     

超声心动图在外科修补术后室间隔残余漏介入封堵治疗中的应用

目的 探讨外科修补术后残余漏介入封堵治疗的超声心动图筛选适应证及价值.方法 应用HP 5500型彩色多普勒诊断仪检查13例拟行封堵术的残余漏患者,术前观测左右室侧残余漏口大小、漏口残端距主动脉瓣和三尖瓣的距离,术中经胸超声心动图监护引导,术后追踪随访.结果 残余漏部位、残余漏左右室侧大小心血管造影检查与超声心动图结果一致,残余漏距主动脉右瓣距离(2.1±1.6) mm(0～6.9 mm),距三尖瓣(2.3±1.8) mm (0～5.4 mm).所有患者均成功置入封堵器,2例封堵术后少量残余分流,1例于术后3个月消失;1例术后1个月仍有分流,现在随访观察中.结论 超声心动图在外科修补术后间隔残余漏介入封堵术前病例筛选、术中监护引导、术后随访有着其他检查不可替代的临床应用价值.     

单纯室间隔缺损的产前及产后超声诊断分析

目的 探讨单纯性室间隔缺损产前及产后超声表现的差异。方法 回顾性分析244例单纯性室间隔缺损患儿超声心动图资料,对患儿随访至出生后1年。与产后结果对比,将产前检查的胎儿分为正确组和错误组,评价室间隔缺损类型、大小及心室水平分流情况并进行统计学分析。结果 244例患儿中,正确组181例,错误组63例;两组缺损类型差异无统计学意义（P=0.061）;两组产后缺损大小和分流速度差异有统计学意义（P均<0.05）,分流方向差异无统计学意义（P=0.408）;正确组产前和产后缺损大小差异有统计学意义（P<0.05）,分流方向差异无统计学意义（P=0.087）。结论 产前超声可检出单纯性室间隔缺损,缺损本身的解剖特点可能影响产前检查结果,同一病变产前产后超声表现差异明显。