Akram M. Asbeutah

Reproducibility of duplex ultrasonography and air plethysmography used for the evaluation of chronic venous insufficiency.

The purpose of this study was to determine the reproducibility of measurements on duplex ultrasonography (DU) and air plethysmography (APG) in subjects with post‐thrombotic syndrome.

Transcranial doppler and brain MRI in children with sickle cell disease and high hemoglobin F levels

While overt stroke and silent brain infarcts (SBI) are uncommon among Kuwaiti patients with sickle cell disease (SCD), there have been no previous transcranial Doppler (TCD) studies in this population. The main objective of this study is to determine TCD velocities in a group of Kuwaiti children with SCD and correlate same with brain magnetic resonance imaging (MRI) and angiography (MRA) findings.

Changes in the Diameter and Valve Closure Time of Leg Veins Across the Menstrual Cycle

The purpose of this study was to determine the changes (if any) in the diameter and valve closure time of the lower limb veins in healthy young nulliparous women at different phases of the menstrual cycle.

Subject body mass index affects Doppler waveform in celiac artery by duplex ultrasound.

Objective: The aim of this study is to evaluate the effect of body mass index (BMI) on peak systolic velocity (PSV) recording in the celiac artery (CA). Subjects & Methods: Forty male participants were entered prospectively into the study. The subjects were divided into two groups according to their body mass index. Group A included subjects with BMI ≤25 Kg/m2 and those in group B with BMI >25 Kg/m2. The diameter and PSV at the origin of CA of subjects in both groups were recorded while the subject positioned in supine and during expiration phase and fasted for 4 hours using duplex ultrasound. Both groups were matched for age and sex. Independent Student’s t-test was used to test if there is any statistical significance between diameter and PSV in both groups. Results: Group A’s, average age (year, ±SD) was 29.35±1.35 and average BMI (Kg/m2, ±SD) was 23.1±1.60. Group B’s, average age was 30±2.1 and their average BMI was 31±5.1. The average diameter (cm, ±SD) of CA in group A was 0.66±0.076 and in group B was 0.80±0.066. However, the average PSV (cm/s, ±SD) was 117±28.1 in group A and 102±12.4 in group B. Independent student t-test showed statistical significance between both groups for the diameter (p=0.005) and just reached statistical significance for PSV (p=0.049). Conclusion: Subjects with higher BMI showed reduced PSV due to a larger CA diameter and probably due to more fatty tissue accumulation around the CA origin.

Changes in the diameter and valve closure time of leg veins in primigravida women during pregnancy

OBJECTIVE The aim of this study was to monitor the changes that develop in leg veins of primigravida women during pregnancy. METHODS Sixty primigravida women volunteered to undergo clinical evaluation and duplex ultrasound examination of both lower limb veins to monitor changes in vein diameter and valve closure time (VCT) during pregnancy and 3 months postpartum by duplex ultrasound. A total of four readings were taken for each subject, one reading for each trimester and the last reading at 3 months postpartum. RESULTS The mean (± standard deviation) age of participants was 26.82 ± 2.47 years; 39 limbs (32.5%) and 65 limbs (54.2%) developed C1-C3 venous changes during the second and third trimesters, respectively. Three months post partum, 36 limbs (30%) continued to have C1-C2 changes. Only four limbs in four subjects developed varicose veins along the great saphenous vein, and their VCT was more than 1 second. These subjects were found to have a family history of varicose veins. Duplex examinations showed that there was a gradual increase in the diameter and VCT from the second trimester through the third trimester of pregnancy in all examined venous segments. These changes were statistically significant by Friedman and related-samples Wilcoxon signed rank tests within the same legs (P = .001) but not between legs in the same subject (P > .05), even with adjustment for body mass index (P = .001-.049). CONCLUSIONS In primigravida women, lower limb veins showed gradual increase in vein diameter and in VCT starting from the second trimester. These changes reverted to baseline in most cases 3 months after delivery.

To establish whether McKenzie lumbar flexion and extension mobility exercises performed in lying affect central as well as systemic hemodynamics: A crossover experimental study

OBJECTIVE Examine systemic and central hemodynamic responses following McKenzie lumbar flexion and extension mobility exercises performed in lying (FIL and EIL). DESIGN Crossover experimental study. SETTING Clinical laboratory. PARTICIPANTS Healthy male volunteers (n=25) (mean(SD) age: 28(3)years; range 21 to 34). INTERVENTIONS Based on alternating assignment of either FIL or EIL to participants, three sets of the first exercise (10, 15, 20 repetitions) were performed with 5-minute rest between sets; after 15-minute rest, the protocol was repeated for the other exercise. MAIN OUTCOME MEASURES Systemic hemodynamic parameters included heart rate (HR), and systolic and diastolic blood pressures (SBP, DBP). Central hemodynamic parameters included abdominal aortic diameter (AD), peak systolic velocity (PSV/AD), end diastolic velocity (EDV/AD) and resistive index (RI). Measures recorded after each exercise set. RESULTS FIL RPP at baseline was 9.1 (1.4), after 20 repetitions 18.3 (2.5), mean difference 8.9 (95% confidence interval (CI) 7.9 to 9.8) compared to EIL at baseline 9.1 (1.5), after 20 repetitions 13.0 (3.1), mean difference 4.1 (95% CI 3.3 to 5.0). FIL RI at baseline was 0.78 (0.03), after 20 repetitions 0.87 (0.03), mean difference 0.08 (95% CI 0.06 to 0.10) compared to EIL at baseline 0.78 (0.03), after 20 repetitions 0.83 (0.03), mean difference 0.05 (95% CI 0.04 to 0.07). CONCLUSIONS Although 10 repetitions of FIL and EIL may be regarded as safe, our findings support screening patients with lifestyle risk factors, and cautioning about adhering to recommended repetition number given associated increased work of the heart. The extent of AD mechanical perturbation remains unclear.

Ultrasound Guided Non Surgical Closure of Post Angiographic Femoral Arteriovenous Fistula (AVF) and Pseudoaneurysm (PSA)

Local complications of femoral arterial catheterization like hematomas, pseudoaneurysm (PSA) and arteriovenous fistula (AVF) are increasing in incidence due to the large number of patients undergoing diagnostic and therapeutic angiographic procedures through this route [1 3] (see figure 1). A PSA refers to a confined collection of thrombus and blood associated with tear of one or more layers of an arterial wall [4]. An iatrogenic AVF occurs when an arterial puncture inadvertently extends to involve an adjacent vein leading to a communication between the two. Color flow Doppler ultrasound is the imaging modality of choice for the diagnosis and assessment of a PSA, with a high sensitivity and specificity [5].

Is a Constant Doppler Angle of Insonation Worthwhile during Carotid Duplex Ultrasound

Background/Aims. —Velocity ratio is a good indication to determine the degree of vessel stenosis. This study was done to determine the effect of Doppler angle in carotid artery velocity ratio measurements. Methods. —Thirty-eight patients who underwent routine carotid duplex ultrasound were asked to participate in this study. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) at distal common carotid artery (CCA) and proximal internal carotid artery (ICA) with constant and different Doppler angles were recorded. The ICA/CCA PSV ratio was calculated. Results. —There were 12 female and 26 male patients; their mean age (year, ±SD) was 50.53 ± 16.4 and their mean body mass index (kg/m2, ±SD) was 29.6 ± 9.53. The mean ± SD. ICA PSV, CCA PSV, and the ICA/CCA PSV ratio with a 60° Doppler angle were 80.40 ± 16.6, 87.90 ± 16.96, and 0.93 ± 0.18, respectively. However, the mean ± SD. ICA PSV, CCA PSV, and the ICA/CCA PSV ratio with a 45° Doppler angle were 63.84 ± 16.18, 70.67 ± 16.19, and 0.91 ± 0.17, respectively. Moreover, the ICA60°/CCA45° PSV ratio was 1.17 ± 0.25 and the ICA45°/CCA60° PSV ratio was 0.73 ± 0.16. Paired Students t-test showed a statistical significance for different Doppler angle of insonation (p = 0.001) but was not statistically significant when the Doppler angle was constant (p = 0.389). Conclusion. —Constant Doppler angle is preferred during carotid ultrasound for a consistent result.

Patient Position and Phase of Respiration Affect the Doppler Waveform in the Celiac Artery

Introduction Multiple factors might affect the velocity recording in the celiac artery (CA), causing a compression syndrome. Reports that focused on the phase of respiration found that the CA is highly compressed during the phase of expiration. Few reports in the literature have focused on body position during Doppler scanning of the CA. The aim of this study was to evaluate the effect of patient position as well as the phase of respiration on velocity recording in the CA. Methods Thirty male subjects were entered prospectively into the study. Peak systolic velocity and vessel diameter at the origin of the CA at different body position and different phases of respiration were recorded by the use of duplex ultrasound while the subject was fasting. Results There were 30 healthy men; their average age was 25.5 ± 5.30 (±SD, years), and their average body mass index was 24.8 ± 3.1 (±SD, kg/m2). The average diameter of CA in supine position and expiration was 0.70 ± 0.10 (±SD, cm), and the average peak systolic velocity was 111.2 ± 29.7 (±SD, cm/s). Moreover, the average diameter of CA in standing position in expiration was 0.75 ± 0.10 (±SD, cm), and the average peak systolic velocity was 96.8 ± 25.2 (±SD, cm/s). Paired Student t test for the effect of body position and phase of respiration in the peak systolic velocities and the diameter of the CA was performed and demonstrated statistical significance (p < 0.05). Conclusion The CA peak systolic velocity varies between 2 positions in healthy young men, which may have implications for disease detection and needs further study.

Effect of finger position on the median nerve area within the carpal tunnel: an ultrasound imaging study

Introduction Finger flexion has been suggested to contribute to the aetiology of carpal tunnel syndrome (CTS). The purpose of this study was to measure the immediate effects of finger flexion on the cross-section area of the median nerve (MNA). Methods Thirty-one healthy volunteers participated in this experimental study. The MNA was measured at the level of hook of hamate using high-resolution ultrasonography during four different finger positions. Results A significant change in MNA during different finger positions was found (F = 24.149, P < 0.001). The biggest difference in MNA was recorded between full finger extension and forceful finger flexion (mean difference = 1.29 mm2, P < 0.001). An inverse correlation between MNA and finger flexion was found (Pearsons r = −0.348, P = 0.002) where the MNA decreased as fingers moved toward flexion. Conclusion Finger flexion resulted in direct decrease in MNA, possibly contributing to median nerve compression. Clinical implications Hand therapists need to consider modifying their conservative treatment of CTS by limiting activities that require finger flexion and restricting the movement of the wrist and fingers to restrict finger flexion, thus limiting pressure increase on the median nerve.