Effects of age and comorbidities on prognosis and mortality in geriatric patient groups in intensive Care.

Backround: Treatment of geriatric intensive care patients is tiring and difficult for intensive care physicians due to comorbidities, accompanying acute illnesses and vulnerabilities. Aim: The aim of our study was to determine other factors affecting mortality and morbidity with age in geriatric intensive care patients. Patients and Methods: A total of 937 geriatric intensive care patients were divided into three groups as young-old (65-74 years), middle-old (75-84 years), and oldest-old (85 years and more). Demographic characteristics such as age, gender, and comorbid diseases (oncological malignancy, chronic renal failure, sepsis, chronic anemia, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, pulmonary embolism) were recorded. The number of patients who needed a mechanical ventilator, developed decubit ulcers, underwent percutaneous tracheostomy, and renal replacement therapy were recorded. In addition, the number of central venous catheter insertions for patients, Acute Physiology and Chronic Health Evaluation II scores (APACHE II), hospitalization days, and mortality rates were recorded and compared. Results: In the comparison between the groups in terms of gender, in the 65-74 years' age group, male gender was higher, while in the age group of 85 years and more, the female gender was found to be statistically higher. Among comorbid diseases, the rate of oncological malignancy was found to be statistically significantly lower in patients aged 85 years and more. Comparing the APACHE II scores of the patients as per the groups, scores were found to be statistically significantly higher in the oldest-old group. APACHE II Score, central venous catheter application, chronic obstructive pulmonary disease, chronic renal failure, sepsis, oncological malignancy, and renal replacement therapy were shown to be statistically significant as factors affecting death. The factors affecting the survival or hospitalization time of the patients of decubit ulcer, mechanical ventilator, percutaneous tracheostomy, chronic obstructive pulmonary disease, Sepsis, APACHE II Score, and age were shown to be statistically significant. Conclusion: Our study showed that not only age has an effect on mortality and morbidity in geriatric intensive care patients but also comorbidities and intensive care treatments of the patients are also effective in this process.

Investigation of the clonal associations in Acinetobacter Baumannii strains isolated from the respiratory samples of patients in a tertiary research hospital.

OBJECTIVE: The blaOXA resistance genes and ISAba1 were examined in 70 samples from lower respiratory tract of hospitalized patients. MATERIALS AND METHODS: Of the 67 isolates obtained, almost half (46.3%) of them were from endotracheal aspirate, and most were collected from the intensive care units of the reanimation (37.3%) and internal medicine (32.8%) units. RESULTS: Three samples from the internal medicine intensive care unit had positive cultures. Of the multidrug resistant (MDR) samples, 70 isolates (>50%) were moderately sensitive, while fewer (10%) were resistant to tigecycline. In contrast, 100% were sensitive to colistin. All strains were found to be positive for blaOXA-23-like and blaOXA-51-like genes, whereas no blaOXA-40-like and blaOXA-58-like genes were detected. The ISAba1 positivity rate was 90.0%. Pattern 5 was mainly identified among the 22 different patterns. Of note, 50% of Pattern 5 was found in the patients of the internal medicine intensive care unit, and a third was associated with ventilator-associated pneumonia. Importantly, the internal medicine unit's equipment was found to be culture positive. CONCLUSION: Findings obtained from this study suggest that isolates can easily spread through the hospital via isolate cross-contamination caused by health personnel. These contaminating isolates may be able to maintain their presence within the hospital for a long time.

Langerhans Cell Histiocytosis: Single Center Experience of 25 Years.

OBJECTIVES: To review a single center outcome of patients with Langerhans Cell Histiocytosis diagnosed at a tertiary referral hospital from Turkey.Methods: The files between 1989 and 2015 of 80 patients with LCH were retrospectively analyzed. RESULTS: During the 25 years, 80 patients were diagnosed with LCH. The median age at diagnosis was 53 months (2-180 months) and the median follow-up time of patients was 10 years and 9 months (24 months-25 years). Bone was the most frequently affected organ (n:60, 75%). Initially, 43 patients (54%) had single system (SS) disease, 20 patients (25%) had multisystem (MS) disease without risk organ involvement (MS-RO-), and 17 patients (21%) had a multisystem disease with risk-organ involvement (MS-RO+). The overall survival (OS) rate was 91%, and event-free survival (EFS) rate was 67% at 10 years. 10-year OS rate was lower for patients with MS-RO+ (65%) when compared to those with, MS-RO-, and SS (100%, 97%, p value=<0.001). The overall survival rate was also lower in patients with lack of response to systemic chemotherapy on 12th week (p=<0.001), younger age (<2 years) at presentation (p=<0.02), skin involvement (<0.001) and lack of bone lesions at presentation (<0.001). DISCUSSION: In the group with MS-RO+, OS is significantly low compared to other groups. Further efforts are warranted to improve survival in MS-RO+ patients.

Risk factors associated with recanalization of incompetent saphenous veins treated with radiofrequency ablation catheter.

PURPOSE: The purpose of this study was to determine the occlusion rate of incompetent great saphenous veins (GSVs) and small saphenous veins (SSVs) treated with radiofrequency ablation (RFA) and individualize variables associated with recanalization. MATERIALS AND METHODS: A retrospective review of 311 veins (256 GSVs and 55 SSVs) in 211 patients [177 women, 34 men; mean age, 45 years±12 (SD) (range: 18-75 years)] with incompetent GSVs and/or SSVs who were treated using new-generation RFA catheters was performed. The clinical results, occlusion rates, and variables associated with recanalization for the incompetent GSVs and SSVs were analyzed. RESULTS: No major complications were observed in the study population. Ten months after RFA, the occlusion rate was 89% (227/256) for GSVs and 91% (50/55) for SSVs. An increased pre-procedure diameter of the incompetent GSVs was associated with a higher rate of recanalization (OR: 0.825; 95% CI: 0.715-0.952) (P<0.05). No significant differences in age, gender, and side of treated veins were found between patients with recanalization of treated veins and those without recanalization. CONCLUSION: Our results show that pre-procedure diameter of the GSV is the single risk factor for recanalization after RFA.

Factors affecting dural penetration and prognosis in patients admitted to emergency department with cranial gunshot wound.

PURPOSE: To explore the effect of admission physical examination findings, anamnesis, and computed tomography on dural penetration and prognosis in patients with cranial gunshot wound (CGW). METHODS: In this study, the medical data of 56 subjects who were admitted to the Emergency Department of Dicle University Hospital with CGWs between January 2011 and December 2013 were retrospectively reviewed. The effects of type of incident (suicidal vs non-suicidal), pupil diameter and light reflex, hemodynamic status, type (bullet or pellet), velocity, trajectory of foreign material, trauma scores, and imaging findings on dural penetration and mortality were explored. RESULTS: The mean age of the study population was 24.8 ± 13.50 years. Thirty (53.6 %) patients had penetrating injuries and 26 (46.4 %) had non-penetrating injuries; 9 (16.1 %) patients died and 47 (83.9 %) survived. Suicidal injury, pupil diameter and light reflex, bullet as foreign material, and high velocity and lateral trajectory of foreign material significantly affected dural penetration and mortality (p < 0.05). In addition, dural penetration, bilobar, multilobar, or bihemispheric involvement of brain parenchyma, presence of intracranial hemorrhage, subarachnoid hemorrhage, ventricular hemorrhage, fracture, shift, edema, and trauma scores significantly affected mortality (p < 0.05). CONCLUSIONS: In CGWs, dural penetration and prognosis can be predicted by physical examination findings and patient characteristics on initial admission.

Prognostic value of preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with epithelial ovarian cancer.

PURPOSE: The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have recently been evaluated in many cancers in prediction of survival outcomes. The purpose of this study was to investigate the impact of NLR and PLR on the prognosis of patients with epithelial ovarian cancer (EOC). MATERIALS AND METHODS: A total of 208 patients with EOC were included in the study. Hematological parameters and clinicopathological data during diagnosis were retrospectively evaluated. The cut-off values were determined by calculating receiver operating characteristic (ROC) curve analysis of the patients. RESULTS: The median over-all survival (OS) of patients with low NLR was 69 months (95% CI, 43.0-94.9) whereas high NLR was 36 months (95% CI, 29.1-42.8). The median OS with low PLR patients was 76 months (95% CI, 46.4-105.5) and high PLR was 35 months (95% CI, 28.5-41.4). In serous tumors (70.7%), the median OS with low NLR and high NLR was 54 months (95% CI, 27.9-80.0) and 34 months (95% CI, 28.2-39.7), and for the median OS with low PLR and high PLR it was 51 months (95% CI, 2 1.2-80.7) and 35 months (95% CI, 27.8-42.1), respectively. CONCLUSION: The present findings showed that the high NLR and high PLR were associated with poor prognosis and these values are significantly remarkable in EOC patients.

The effect of desflurane on postoperative olfactory memory.

OBJECTIVE: In this study, we investigated the effects of desflurane 6%, on olfactory memory. PATIENTS AND METHODS: This is a prospective clinical study performed with 40 patients aged 18-60 who had elective surgery and American Society of Anesthesiologists (ASA) physical status I-III. The Brief Smell Identification Test (BSIT) was used for evaluating patients' olfactory memories before and after the surgery. Patients received standard general anesthesia protocol and routine monitoring. For induction, 1.5 mg/kg of fentanyl, 2 mg/kg of propofol, and 0.5 mg/kg of rocuronium bromide were administered. Anesthesia was maintained with the inhalational of anesthetic desflurane (6%). The scores are recorded 30 minutes before the surgery and when the Aldrete Recovery Score reached 10 in the postoperative period. Preoperative and postoperative results were compared and p-values <0.05 were considered statistically significant. RESULTS: The patients' mean age was 41.1±12.0. Preoperative total correct answer rate to odorous substances was 92.7%, and postoperative rate was 92.1%. Percentage of the odor substance identification by the patients revealed no statistically significant difference when pre and post-operative rates have been compared (p-value >0.05). CONCLUSIONS: We have observed for the first time in the literature that general anesthesia using desflurane (6%) did not affect short-term olfactory memory. Further studies will be necessary to confirm our findings with larger sample size.

Effect of perioperative inadvertent hypothermia on the ECG parameters in patients undergoing transurethral resection.

OBJECTIVE: Perioperative inadvertent hypothermia (PIH) (core body temperature to < 36 °C) is a common event during surgery. PIH may result from multiple factors. Elderly urology patients are at greater risk than other patients for hypothermia. PIH may cause adverse postoperative cardiac clinical manifestations. Our study aimed to determine the effects of postoperative alteration of core body temperature on the ECG parameters in patients undergoing transurethral resection. PATIENTS AND METHODS: Fifty-nine patients, 40-83 years of age, who were scheduled for elective Transurethral Resection Prostate and/or Bladder (TUR-P and/or TUR-B) were enrolled in the study. Patients with operation times more than 30 minutes were included. Core temperatures were measured and standard 12-lead ECG readings were taken before surgery and immediately upon arrival in the postanesthesia care unit. RESULTS: 59 patients were included this study. Prevalence of PIH (< 36ºC) was (57.6%). The postoperative temperature was found to be significantly lower than the preoperative of all patients (preop 36.46±0.39; postop 35.68±0.59, paired sample t-test, p<0.001). Also in all patients, postoperative QTc dispersions were found to be significantly longer than the preoperative QTc dispersions (preop 59.66±32.69; postop 74.57±37.47 ms, p<0.05). When we divided the patients; hypothermic and normothermic, postoperative QTc dispersions were significantly different between two groups (68.23±33.43 ms, and 83.20±41.50 ms; p=0.009). CONCLUSIONS: The prevalence of inadvertent intraoperative hypothermia in patients undergoing transurethral resection is relatively high. QTc dispersion of mild hypothermic patients was significantly longer than normothermic patients'.

Comparison of the effects of bispectral index-controlled use of remifentanil on propofol consumption and patient comfort in patients undergoing colonoscopy.

BACKGROUND AND STUDY AIMS: In endoscopic procedures, propofol can be safely administered either alone or in conjunction with remifentanil. The aim of the study is to compare the effects of the administration of propofol alone and the administration of remifentanil in addition to propofol on patient and endoscopist satisfaction, preoperative hemodynamic response, and propofol consumption. MATERIALS AND METHODS: A totally 60 patients were enrolled in the study. Propofol group (Group 1): A 0.4-mg/kg propofol bolus and 1 mg/kg/h maintenance infusion of propofol until a bispectral Index value of 70-75 was achieved. Propofol + remifentanil group (Group 2) received a 0.4 mg/kg propofol bolus dose and maintained with a 0.5 mg/kg/h infusion of propofol + 0.2 mcg/kg/min infusion of remifentanil. The infusion dose of remifentanil was maintained, and the propofol infusion dose was titrated until a BIS value of 70-75 was achieved. RESULTS: In Group 1 (colonoscopic intervention 1 and 5 min) and Group 2 (colonoscopic intervention 10 min.), main blood pressure (MBP) value has a significant decrease. Hypotension occurred in 6 patients in group 1, while 12 patients in group 2. No significant difference was found between the Patient's endoscopist' satisfaction, MBP and heart rate. Propofol consumption was greater in group 1 than in group 2. When the Ramsay sedation levels of Group 1 and Group 2 were compared, a statistically significant difference was observed. CONCLUSIONS: The addition of remifentanil to propofol may be an alternative to the use of alone propofol for sedation in colonoscopic interventions.

A comparison of the effects of lidocaine or magnesium sulfate on hemodynamic response and QT dispersion related with intubation in patients with hypertension.

BACKGROUND: The aim of this study was to investigate the effect of magnesium administered before induction on the hemodynamic response and QT dispersion (QTd) related with intubation in hypertensive patients and to compare it with lidocaine. METHODS: Patients with essential hypertension who were under ≤ 65 years old, scheduled for elective surgery with a Mallampati score of I-II were included in the study. Patients were randomly divided into three groups; group M (n = 20) received magnesium sulfate, group L was prescribed lidocaine, and group C (control group) received saline. Standard 12-lead ECG readings were taken before the induction of anesthesia and at the first and fifth minutes following intubation. RESULTS: There were no statistically significant differences between the groups in terms of age, sex and demographic characteristics. There was no significant difference in the QT interval values before induction and 5 minutes after intubation in all groups. In group M, QTd values were significantly lower at the first and fifth minutes than before induction. There were no statistically significant differences in QTd values at different times in group L and group C. CONCLUSION: QTd is not increased during tracheal intubation in hypertensive patients so there is no need for magnesium sulfate for these patients. But as QTd has been shown to increase during tracheal intubation for coronary artery disease patients, magnesium sulfate might be useful for those patients although future studies are required to confirm this statement.

Evaluation of inhibitory effects of benzothiazole and 3-amino-benzothiazolium derivatives on DNA topoisomerase II by molecular modeling studies.

There has been considerable interest in DNA topoisomerases over the last decade, as they have been shown to be one of the major cellular targets in anticancer drug development. Previously we synthesized some benzothiazole derivatives and corresponding benzothiazolium forms, and tested their DNA inhibitory activity to develop novel antitumor agents. Among the 12 prepared compounds, compound BM3 (3-aminobenzothiazole-3-ium 4-methylbenzene sulfonate) exhibited extreme topoisomerase II inhibitory activity compared with the reference drug etoposide. We also tried to determine the DNA and enzyme binding abilities of BM3 and found that BM3 acted on topoisomerase II first at low doses, while it had also showed DNA minor groove binding properties at higher doses. In this study the interactions between DNA topoisomerase II and the compounds were examined in detail by molecular modelling studies such as molecular docking and pharmacophore analysis performed using Discovery Studio 3.5. As a result, it was found that benzothiazolium compounds exhibited a totally different mechanism than benzothiazoles by binding to the different amino acids at the active site of the protein molecule. 3-Aminobenzothiazoliums are worthy of carrying onto anticancer studies; BM3 especially would be a good anticancer candidate for preclinical studies.

Pharmacophore generation of 2-substituted benzothiazoles as AdeABC efflux pump inhibitors in A. baumannii.

RND family efflux pumps are important for multidrug resistance in Gram-negative bacteria. To date no efflux pump inhibitors for clinical use have been found, so developing the specific inhibitors of this pump system will be beneficial for the treatment of infections caused by these multidrug-resistant pathogens. A set of BSN-coded 2-substituted benzothiazoles were tested alone and in combination with ciprofloxacin (CIP) against the RND family efflux pump AdeABC overexpressor Acinetobacter baumannii SbMox-2 strain. The results indicated that the BSN compounds did not have antimicrobial activity when tested alone. However, if they were applied in combination with CIP, it was observed that the antibiotic had antimicrobial activity against the tested pathogen, possessing a minimum inhibitory concentration value that could be utilized in clinical treatment. A 3D-common features pharmacophore model was applied by using the HipHop method and the generated pharmacophore hypothesis revealed that the hydrogen bond acceptor property of nitrogen in the thiazole ring and the oxygen of the amide substituted at the second position of the benzothiazole ring system were significant for binding to the target protein. Moreover, three hydrophobic aromatic features were found to be essential for inhibitory activity.

Dexamethasone added to levobupivacaine in ultrasound-guided tranversus abdominis plain block increased the duration of postoperative analgesia after caesarean section: a randomized, double blind, controlled trial.

OBJECTIVES: When added to local anaesthetics, dexamethasone can prolong the duration of peripheral blocks. Dexamethasone has a long and efficient glucocorticoid structure and presents anti-inflammatory properties. The aim of this study was to determine the effect of dexamethasone on the block duration added to levobupivacaine used for transversus abdominis block (TAP) applied to patients who underwent caesarean section. PATIENTS AND METHODS: Forty-two patients with spinal anaesthesia in an American Society of Anesthesiologists (ASA) I-II risk group were included in the study and divided into two groups. Bilateral 30 ml 0.25% levobupivacaine and 2 ml 0.9% NaCl for the levobupivacaine group and bilateral 30 ml 0.25% levobupivacaine and 2 ml dexamethasone (8 mg) for the dexamethasone group were administered in a TAP block performed with ultrasonography. The time need for the first analgesic in the postoperative period was recorded. The numeric evaluation scale, and the total additional analgesic amounts were recorded. RESULTS: The time before the administration of the first additional analgesic dose was prolonged significantly in the dexamethasone group compared to the levobupivacaine group (p = 0.004). The pain scores were lower in the dexamethasone group for superficial pain. A significant difference for the dexamethasone group was observed in the evaluation of deep pain. The total consumption of tramadol was significantly lower in the dexamethasone group (p = 0.001). CONCLUSIONS: The utilization of dexamethasone, which has a prolonging effect on the transversus abdominis plane block, may be an alternative to epidural opioid analgesia in caesarean section. We observed that dexamethasone added to levobupivacaine in a TAP block applied for analgesia following a caesarean section procedure prolonged the time required for analgesia.

Is there any diagnostic value of serum protease-activated receptor-1 (PAR1) levels on determination of epithelial ovarian carcinoma?

The role of molecular markers in ovarian cancer is still a matter of debate. Protease-activated receptor-1 (PAR1) might be a good marker in some types of malignant tumors and might provide useful information in diagnosis and prognosis. The objective of this study was to evaluate the serum levels of PAR1 in regard to diagnostic, predictive, and prognostic value in epithelial ovarian cancer (EOC) patients. Forty-four EOC patients were enrolled in this study. Serum PAR1 levels were determined by enzyme-linked immunosorbent assay (ELISA) method. Twenty-five age- and sex-matched healthy controls were included in the analysis. The median age of patients was 58 years old, ranging from 22 to 83 years, where most of them had advanced disease (stage III-IV) (n = 40, 91%). The median serum PAR1 values were significantly elevated in patients compared to healthy controls (1.52 ng/ml vs. 1.13 ng/ml) (p = 0.03), whereas any clinical variables including response to chemotherapy did not associate with serum assay (p > 0.05). Progression-free survival (PFS) and overall survival (OS) of patients who did not respond to chemotherapy nor had platinum resistance in relapsed disease were poorer in the analyses. On the other hand, serum PAR1 levels showed no significant adverse effect on either PFS or OS (p = 0.43 and p = 0.49, respectively). These results proved that baseline serum PAR1 levels of patients with EOC were significantly higher than those of healthy people. However, these assays suggested no predictive or prognostic value in this group of patients.

Prognostic factors associated with the response to sunitinib in patients with metastatic renal cell carcinoma.

OBJECTIVE: We investigated the prognostic clinicopathologic factors associated with overall survival (os) and progression-free survival (pfs) in the once-daily continuous administration of first-line sunitinib in a consecutive cohort of Turkish patients with metastatic renal cell carcinoma (rcc). METHODS: The study enrolled 77 Turkish patients with metastatic rcc who received sunitinib in a continuous once-daily dosing regimen between April 2006 and April 2011. Univariate analyses were performed using the log-rank test. RESULTS: Median follow-up was 18.5 months. In univariate analyses, poor pfs and os were associated with 4 of the 5 factors in the Memorial Sloan-Kettering Cancer Center (mskcc) score: Eastern Cooperative Oncology Group performance status of 2 or higher, low hemoglobin, high corrected serum calcium, and high lactate dehydrogenase. In addition to those factors, hypoalbuminemia, more than 2 metastatic sites, liver metastasis, non-clear cell histology, and the presence of sarcomatoid features on pathology were also associated with poor pfs; and male sex, hypoalbuminemia, prior radiotherapy, more than 2 metastatic sites, lung metastasis, nuclear grade of 3 or 4 for the primary tumour, and the presence of sarcomatoid features were also associated with poorer os. The application of the mskcc model distinctly separated the pfs and os curves (p < 0.001). CONCLUSIONS: Our study identified prognostic factors for pfs and os with the use sunitinib as first-line metastatic rcc therapy and confirmed that the mskcc model still appears to be valid for predicting survival in metastatic rcc in the era of molecular targeted therapy.

Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia.

BACKGROUND: Nausea and vomiting are frequently seen in patients undergoing cesarean section (CS) under regional anesthesia. We aimed to compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the use of each agent alone to decrease the incidence of post-delivery intraoperative nausea and vomiting (IONV) during CS under spinal anesthesia. OBJECTIVE: To compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the single use of each agent to decrease the incidence of postdelivery IONV during CS under spinal anesthesia. METHODS: A randomized, prospective, double blind study was performed on 90 patients undergoing planned CS under spinal anesthesia. Patients received 4mg ondansetron in Group O, 8mg dexamethasone in GroupD, 4mg ondansetron+8mg dexamethasone in Group OD intravenously within 1-2 minutes after the umbilical cord was clamped. Frequency of postdelivery IONV episodes was recorded. RESULTS: A total of 86 eligible patients were included in the study. There were 29 patients in Group O, 29 patients in Group D and 28 patients in Group OD. There were no statistically significant difference between the groups in terms of baseline characteristics and intraoperative managements. Frequency of intraoperative nausea, retching and vomiting experiences were similar between the groups (p>0.05). CONCLUSION: Single dose 4mg ondansetron, 8mg dexamethasone, or combined use of 8mg dexamethasone+4mg ondansetron, given intravenously is all effective agents for the control of postdelivery IONV. Combined use of dexamethasone and ondansetron for the same indication does not seem to increase the antiemetic efficacy.

Impaired coronary flow reserve in metastatic cancer patients treated with sunitinib.

PURPOSE: Hypertension is one of the major side effects of sunitinib, an angiogenesis inhibitor used in the treatment of metastatic renal cell carcinomas (mRCC) and gastrointestinal stromal tumors (GIST). Endothelial dysfunction, an early and reversible event in the pathogenesis of atherosclerosis, is suggested to be one of the possible underlying mechanisms of hypertension caused by angiogenesis inhibitors. Coronary flow reserve (CFR) measurement by trans-thoracic Doppler echocardiography (TTDE) reflects coronary microvascular and endothelial functions, as a cheaper and an easy screening test. We have used TTDE to evaluate endothelial function and coronary microvascular function in mRCC and GIST patients under sunitinib treatment. METHODS: Eighteen metastatic cancer patients (16 mRCC and 2 GIST) on sunitinib treatment and 27 healthy subjects were enrolled in this cross-sectional study. Thyroid stimulating hormone (TSH), lipid profile, creatinine, hemoglobin, glucose, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), anthropometric and physical parameters of patients were recorded. CFR recordings were performed by the Vivid 7 echocardiography device. RESULTS: CFR was significantly lower in patients when compared with controls (1.82±0.4 vs 2.71±0.8, respectively; p < 0.001). Impaired CFR was found in 13 (72%) patients whereas all controls had normal CFR values. CFR was inversely correlated with the duration of sunitinib treatment (r=-0.36, p =0.01), high sensitivite (hs) CRP (r = -0.574, p =0.01) and ESR (r = - 0.5, p = 0.02). CONCLUSION: Our findings indicate that CFR is significantly impaired in cancer patients on sunitinib treatment. There is an inverse correlation between CFR and duration of sunitinib treatment and inflammation markers.