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Biomedical subjects

A Al-Kutoubi

Publications and source records attributed to A Al-Kutoubi.

At least 19 recordsLinked to original sources
PubMed2003

Incidence of metopism in the Lebanese population.

This study was carried out on 968 skull X-rays to determine the incidence of the metopic suture in the Lebanese population. Complete and incomplete metopism was present in 0.82% and 0.93% of cases, respectively, leading to an overall incidence of 1.75%. In both categories, the incidence was relatively higher in males (1.84%) than in females (1.62%). Persons living in rural areas had a higher incidence of complete and incomplete metopism compared to persons living in urban areas, with ratios of 4:1 and 4:2, respectively. Other findings included an absence of frontal sinuses in all but one skull with complete metopism, accessory ossicles in the majority of cases of complete metopism (7/8), and hydrocephalus in one case. Medical records did not reveal any other associated diseases or abnormalities. Despite the low incidence of metopic suture in the Lebanese population, in X-ray diagnosis of fractures of the frontal bone, metopic suture must not be ruled out.

Adolescent↗
PubMed2001

Recurrent venous thrombosis in Behçet's disease: successful endovascular treatment with thrombolysis and stent.

We report the case of a patient with Behçet's disease (BD) and recurrent venous thrombosis in the right subclavian vein, successfully treated with balloon dilatation and the insertion of a Wallstent. Subsequent follow up at 6 months showed no evidence of reocclusion. Endovascular stents should be considered as a possible interventional modality in BD patients with aneurysms or recurrent venous or arterial thrombosis.

Adult↗
PubMed2001

Inferior vena cava obstruction in Budd-Chiari syndrome: successful treatment by radiological stenting followed by a portosystemic shunt.

Surgical decompression by a portosystemic shunt in Budd-Chiari syndrome depends on the caval state. Obstruction of the inferior vena cava (IVC) precludes such an operation due to the risk of reduced blood flow across the shunt and subsequent thrombosis. Similar risks are encountered in more complicated operations such as mesoatrial shunt. We report a patient with Budd-Chiari syndrome in whom obstruction of the intrahepatic IVC by a hypertrophied caudate lobe of the liver precluded the construction of a standard portocaval shunt. A two-step procedure with preoperative radiological stenting of the narrowed IVC followed by a portocaval shunt was successfully performed. This is the fifth case reported in the literature of such an approach.

Adult↗
PubMed2000

Common bile duct obstruction secondary to a balloon separated from a Fogarty vascular embolectomy catheter during laparoscopic cholecystectomy.

Laparoscopic instrumentation of the common bile duct (CBD) via the transcystic route or through direct choledochotomy seems to be safe, but in rare cases, complications such as pancreatitis, bile duct damage, and hemorrhage from cystic artery may occur. We report an unusual complication with this approach. A 62-year-old man with gallbladder stones presented with obstructive jaundice, mild pancreatitis, and a dilated CBD. He underwent laparoscopic cholecystectomy with an intraoperative cholangiogram through the cystic duct. A small stone seen in the CBD was removed using a 6-Fr vascular Fogarty catheter. Two days later, he became jaundiced again with a rising bilirubin. An endoscopic retrograde cholangiogram showed a 1.5-cm round filling defect floating in a dilated CBD. A sphincterotomy was performed, and a balloon catheter was inflated proximally and pulled down. To our surprise, the filling defect was a crystal clear object, which we finally realized was a fully inflated Fogarty catheter balloon. The balloon spontaneously deflated while being caught with a basket. Surgeons should be aware of this possible complication, and every effort should be made to verify that the balloon still is in place after removal of the embolectomy catheter. Whether vascular embolectomy catheter balloons are appropriate for stone removal or more rigid balloons should be used needs further evaluation.

Catheterization↗
PubMed1999

The role of duplex scanning in the diagnosis of lower limb arterial disease.

Color flow duplex imaging of the iliac and femoropopliteal arteries was performed in patients undergoing angiography. The aim of the study was to determine: (1) in what percentage of patients could the iliac arteries be adequately visualized to enable a diagnosis, (2) the overall accuracy of duplex scanning in the diagnosis of arterial disease, and (3) whether there is a useful duplex criterion for the selection of patients for angioplasty. One hundred and twenty patients (79 males, 41 females; mean age 64.4 years) had duplex scans prior to angiography (2-7 days) and the results were compared. The duplex criteria of an increase in the peak systolic velocity ratio (PSVR) >2 and lesions <5 cm were used to signify hemodynamically significant stenosis (>50% narrowing), the presence of plaque and calcification in the arterial wall with alteration of PSVR and lesions >5 cm, diffuse disease, and the absence of flow on color/Doppler interrogation, occlusion. The results show that duplex scanning is a useful screening tool and may be effectively used to diagnose iliac and femoropopliteal disease in nearly 80% of patients. Angiography will be needed in those in whom duplex scanning is inconclusive, or, prior to intervention in those with disease suitable for surgical reconstruction or angioplasty, diagnosed on the basis of duplex scans.

Angiography↗
PubMed1999

The role of duplex scanning in decision making for patients with claudication.

The aim of this study was to compare the accuracy of clinical decisions made for patients presenting with claudication on the basis of the ankle/brachial index (ABI) (at rest and postexercise) and duplex scanning with that made on the basis of angiograms. Fifty-six patients presenting with a history suggestive of claudication had the ABI taken at rest. Seven patients could not be exercised but their resting ABI was <0.8. Additional exercise testing was done in 49 patients; two were then excluded as there was no fall in the ABI. Thus, 54 patients were entered into the study and underwent color-flow duplex scans and angiography. A clinical decision was reached independently on the basis of the results of ABI and duplex scans as to a) conservative treatment, b) angioplasty, and c) surgery. This was compared to the decision reached on the basis of angiograms. The results show that the combined use of ABI (as a screening test) and duplex scanning can replace angiography for clinical decision making in nearly 80% of claudicants. Angiography will only be needed when duplex scans are inconclusive.

Adult↗
PubMed1999

Ultrasonic plaque character and outcome after lower limb angioplasty.

PURPOSE: The value of ultrasonic plaque characteristics in identifying patients at "high-risk" of restenosis after percutaneous transluminal angioplasty (PTA) was studied. METHODS: Thirty-one arterial stenoses (6 common iliac, 2 external iliac, 1 profunda femoris, 21 superficial femoral, and 1 popliteal) in 17 patients who underwent angioplasty were studied by means of duplex scanning. With a computer-based program, B-mode images were digitized and normalized using 2 reference points, blood and adventitia. A grey level of 0 to 5 was allocated for the lumen (blood) and 180 to 190 for the adventitia on a linear gray scale of 0 to 255 (0 = absolutely black; 255 = absolutely white), and the overall plaque gray-scale median (GSM) of the pixels of the plaque was used as a measure of plaque echodensity. After PTA, follow-up of stenoses was done on day 1, weekly for 8 weeks, at 3 months, 6 months, and 1 year. The total plaque thickness (sum of anterior and posterior components), minimal luminal diameter (MLD), and peak systolic velocity ratio (PSVR) were measured for all stenoses. An increase of more than 2 in the PSVR was the duplex criterion used to signify restenosis. RESULTS: The GSM of the stenoses before angioplasty ranged from 6 to 71 (mean, 31.3 +/- 17.9); 17 stenoses had a GSM less than 25 (mean, 18.7 +/- 5.3), and 14 had a GSM more than 25 (mean, 46.4 +/- 15.8). When the GSM was less than 25, the absolute reduction in plaque thickness on day 1 post-PTA was 3.3 +/- 1.8 mm, in contrast to 1.8 +/- 1.6 mm when GSM was more than 25 (P <.03). The restenosis rate (PSVR more than 2) was 41% at 6 months and remained unchanged at 1 year. When the GSM was less than 25, restenosis occurred in 11% of lesions, in comparison with 78% when the GSM was more than 25 (P <.001). CONCLUSION: Plaque echodensity can be used to evaluate stenoses before PTA, to predict initial success and identify a subgroup that has a high prevalence of restenosis. The identification of a group at "high-risk" of restenosis can improve the selection of patients for the procedure and also be used in prospective studies on the prevention of restenosis.

Angioplasty, Balloon↗
PubMed1999

Angioplasty of lower limb arterial stenoses under ultrasound guidance: single-center experience.

PURPOSE: To examine the feasibility and utility of ultrasound-guided angioplasty for treating lower limb stenoses. METHODS: Duplex ultrasonography was employed to guide 55 balloon dilation procedures (27 iliac, 26 superficial femoral, 1 profunda, and 1 vein graft) with the help of a special ultrasound catheter (EchoMark). Ultrasound was used to determine balloon size, monitor guidewire passage, direct the dilation, and judge procedural success. Angiography was performed prior to the procedure to confirm preprocedural ultrasound findings and afterward to compare with duplex visual and hemodynamic parameters of success (peak systolic velocity ratio < 2.0). RESULTS: The balloon size determined from duplex measurements correlated in all cases with sizes selected based on the angiographic image. Guidewire visualization was possible in 95% of the cases. Angioplasty using ultrasound alone was feasible in 84%; inability to obtain a satisfactory image owing to vessel tortuosity, calcification, and bowel gas accounted for the failures. Against the duplex success criterion, initial completion angiograms had an accuracy of 76%, sensitivity of 76%, and specificity of 100%. The additional time for ultrasound guidance averaged 42 +/- 12 minutes for all cases. CONCLUSIONS: Our results show that ultrasound guidance is feasible in routine clinical practice. In this series of well-selected cases of arterial stenoses, angioplasty was performed safely using ultrasound guidance alone in over 80% of the cases. Fluoroscopic monitoring is needed when ultrasound visualization is suboptimal.

Aged↗
PubMed1998

Would thyroid and breast shielding be beneficial in CT of the head?

Contrary to common perception, the advent of third- and fourth-generation scanners has lead to a significant increase in radiation dose to the patient per computed tomography (CT) head scan. With that in mind, a pilot study was designed with the objective of assessing the effectiveness of a dental-style protective bib in reducing the dose to the radiosensitive organs of the neck and thorax. Radiation doses over the thyroid gland and breast were measured with thermoluminenscent dosemeters and an ionization chamber respectively in 110 patients undergoing routine head scans. Half the patients wore the protective bib and collar. With lead protection, the thyroid measurements were reduced by an average of 45 % and the breast measurements by an average of 76 %. Similar results were seen in phantom measurements.

Breast↗
PubMed1998

Peter B. Samuels Award. Restenosis after percutaneous transluminal angioplasty.

BACKGROUND: Determine the feasibility of studying the natural history of the atherosclerotic plaque following percutaneous transluminal angioplasty (PTA), using duplex scanning. METHODS: Twenty-three patients with 40 stenoses (>70% and <5 cm in length) in the iliac and femoro-popliteal segments were studied by duplex scanning before PTA, on day 1, weekly for 8 weeks, and at 3 months, 6 months, and 1 year. The following measurements were made: thickness of the plaque, minimal lumen diameter (MLD), and peak systolic velocity ratio (PSVR). A PSVR >2.0 was used to indicate >50% lumen diameter reduction. RESULTS: Thirty stenoses were available for measurement and analysis. Mean reduction in plaque thickness after angioplasty was greater in echolucent plaques (2.33 +/- 0.9 mm) than echogenic plaques (0.83 +/- 0.6 mm; P < 0.0001). Successful angioplasty (PSVR <2.0) and increase in MLD in echolucent plaques was the result of plaque compression; in echogenic plaques, of wall dilatation. The incidence of restenosis (PSVR >2.0) at 6 months was 12 of 30 (40%) remaining unchanged at 1 year; of the lesions that restenosed, 33% recurred before week 8 and the remainder between weeks 8 and 24, suggesting different mechanisms. During follow-up, all plaques showed "growth"; <2 mm in 17 (57%; group A) and >2 mm in the remaining 13 (43%; group B). The incidence of restenosis (PSVR >2.0) was 4 of 17 (23%) in group A and 8 of 13 (61%) in group B (P <0.05). CONCLUSION: Duplex scanning provides valuable information on both luminal diameter and plaque thickness; it may be used to study the natural history of plaques following angioplasty and also the effects of therapeutic agents aimed at reducing restenosis.

Angioplasty, Balloon↗
PubMed1998

How "gold" is the standard? Interobservers' variation on venograms.

BACKGROUND: The aim of this study was to determine the degree of agreement between radiologists having different levels of experience, in reporting 151 venograms independently. It was also aimed to assess whether the degree of disagreement would have influenced the final outcome of a thromboprophylactic study and the decision to anticoagulate the patients. METHODS: Seventy-eight patients undergoing total hip replacement had bilateral venography on postoperative days 8-12. Patients were allocated to receive either a low molecular weight heparin (enoxaparin) with or without TED stockings or a placebo Each of the 151 venograms obtained has been reported on four times. RESULTS: The overall incidence of deep venous thrombosis was 42% (33 of 78 patients). The range of the Kappa value of each radiologist versus the others was 0.568 to 0.669. There was a significant decrease in the incidence of deep venous thrombosis in the treatment versus the placebo groups. On an intention to treat all diagnosed thrombi, a difference of up to 16% was demonstrated between the report of individual radiologists and the panel. This difference was reduced to 8% when only thrombi proximal to the calf were considered clinically significant. CONCLUSIONS: These differences reflect the radiologist's experience and frequency of reporting on venograms and should be taken into account when studies for thromboprophylaxis are planned.

Aged↗
PubMed1997

Transbrachial coil occlusion of the first intercostal branch of an internal mammary artery bypass graft for angina.

Percutaneous transbrachial insertion of a metallic coil into the first intercostal branch of the left internal mammary artery resulted in resolution of severe angina in a 60-year-old man who had coronary artery bypass surgery 14 years previously. The diagnosis of coronary artery steal was made clinically. This case illustrates the importance of recognising coronary steal in patients who redevelop angina after coronary artery surgery with the use of an incompletely prepared left internal mammary artery as a conduit. The diagnosis can be made clinically and the condition treated without the need for further surgery.

Angina Pectoris↗
PubMed1996

Weight loss.

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Adult↗
PubMed1996

Intracranial imaging.

This article concentrates on the imaging of intracranial structures and outlines some basic imaging strategies for common clinical presentations.

Acute Disease↗
PubMed1989

Clinical diagnosis from digital displays: preliminary findings of the St Mary's Evaluation Project.

Image quality is a fundamental issue in the introduction of picture archiving and communications systems (PACS), and one that has hitherto been eclipsed by other aspects of the considerable technological challenge facing scientists and manufacturers involved in its development. We conducted a formal evaluation of clinical radiological diagnosis from a commercially available PACS viewing station, using subperiosteal resorbtion in renal osteodystrophy as the test pathological diagnosis, with receiver operating characteristic (ROC) analysis of the results. We conclude that the displayed, digitised images were inferior to film using the apparatus tested and believe that careful, objective clinical evaluation of such systems is of paramount important.

Chronic Kidney Disease-Mineral and Bone Disorder↗