Mustafa Z. Mahmoud

High-Intensity Focused Ultrasound (HIFU) in Uterine Fibroid Treatment: Review Study

Summary Background High-intensity focused ultrasound (HIFU) is a highly precise medical procedure used locally to heat and destroy diseased tissue through ablation. This study intended to review HIFU in uterine fibroid therapy, to evaluate the role of HIFU in the therapy of leiomyomas as well as to review the actual clinical activities in this field including efficacy and safety measures beside the published clinical literature. Material/Methods An inclusive literature review was carried out in order to review the scientific foundation, and how it resulted in the development of extracorporeal distinct devices. Studies addressing HIFU in leiomyomas were identified from a search of the Internet scientific databases. The analysis of literature was limited to journal articles written in English and published between 2000 and 2013. Results In current gynecologic oncology, HIFU is used clinically in the treatment of leiomyomas. Clinical research on HIFU therapy for leiomyomas began in the 1990s, and the majority of patients with leiomyomas were treated predominantly with HIFUNIT 9000 and prototype single focus ultrasound devices. HIFU is a non-invasive and highly effective standard treatment with a large indication range for all sizes of leiomyomas, associated with high efficacy, low operative morbidity and no systemic side effects. Conclusions Uterine fibroid treatment using HIFU was effective and safe in treating symptomatic uterine fibroids. Few studies are available in the literature regarding uterine artery embolization (UAE). HIFU provides an excellent option to treat uterine fibroids.

High-Intensity Focused Ultrasound (HIFU) in Localized Prostate Cancer Treatment

Summary Background High-intensity focused ultrasound (HIFU) applies high-intensity focused ultrasound energy to locally heat and destroy diseased or damaged tissue through ablation. This study intended to review HIFU to explain the fundamentals of HIFU, evaluate the evidence concerning the role of HIFU in the treatment of prostate cancer (PC), review the technologies used to perform HIFU and the published clinical literature regarding the procedure as a primary treatment for PC. Material/Methods Studies addressing HIFU in localized PC were identified in a search of internet scientific databases. The analysis of outcomes was limited to journal articles written in English and published between 2000 and 2013. Results HIFU is a non-invasive approach that uses a precisely delivered ultrasound energy to achieve tumor cell necrosis without radiation or surgical excision. In current urological oncology, HIFU is used clinically in the treatment of PC. Clinical research on HIFU therapy for localized PC began in the 1990s, and the majority of PC patients were treated with the Ablatherm device. Conclusions HIFU treatment for localized PC can be considered as an alternative minimally invasive therapeutic modality for patients who are not candidates for radical prostatectomy. Patients with lower pre-HIFU PSA level and favourable pathologic Gleason score seem to present better oncologic outcomes. Future advances in technology and safety will undoubtedly expand the HIFU role in this indication as more of patient series are published, with a longer follow-up period.

Study of the Association between the Incidences of Congenital Anomalies and Hydrocephalus in Sudanese Fetuses

This study was designed with an aim to detect the congenital anomalies appear to be linked to and in conjunction with hydrocephalus fetuses in Sudan, when ultrasound is used to exam fetuses in the second and third trimesters of pregnancy. This prospective cohort study was performed from December 2011 to December 2013, in a group consists of 5000 single gestation pregnant Sudanese women. In all cases, maternal ages were 35 years up to 48 years; mean age of 42.5 years. Pelvic; obstetric ultrasound scanning protocol used should meet the standards established by the American Institute of Ultrasound in Medicine (AIUM) for scanning in the second and third trimesters of pregnancy. Statistical Package for the Social Sciences (SPSS) was used to analyze the results. Diagnosed hydrocephalus cases (0.4%) were found to be associated with other fetal anomalies as aqueduct stenosis (45%), spina bifida (30%), Arnold-Chiari malformation (20%) and Dandy-Walker malformation (5%). The incidence of congenital anomalies and hydrocephalus in Sudanese fetuses showed considerable variation among different regions of Sudan. Hydrocephalus is associated with certain congenital anomalies. In agreement with previous studies, hydrocephalus is predominantly in male rather than female fetuses. The prevalence of fetal anomalies and hydrocephalus are within previously reported ranges.

Sonography of common carotid arteries' intima: Media thickness in the normal adult population in Sudan

Background: Carotid ultrasonography is a useful diagnostic tool for assessing carotid disease. It is highly reliable, has no radiation risk, and has no risks when compared to conventional angiography. Aim: The study was to determine the common carotid artery (CCA) intima–media thickness (IMT) in the normal adult Sudanese so as to create standards for defining abnormalities. Materials and Methods: In 440 participants, the intima–media thickness was obtained sonographically in the supine position at the point of 1 cm section distal to the carotid bulb. Due to ethnic variations, participants were divided into a five ethnic groups according to their geographic distribution in Sudan. Results: The ranges of IMT found in the study were from 0.04 cm to 0.07 cm in carotids. Ethnically, males and females from West and East of Sudan show the highest IMT (0.070 ± 0.00 cm and 0.065 ± 0.01 cm) for CCA while males and females from the South of Sudan show the lowest IMT (0.055 ± 0.01 cm and 0.058 ± 0.004 cm). Conclusion: Mean carotids’ IMT was slightly higher in females compared to males. No significant differences were found between IMT and different ethnics but significance was noted among participants’ age and IMT of both sexes.

Fetal Transverse Cerebellar Diameter Measurement for Prediction of Gestational Age in Pregnant Sudanese Ladies

This study was carried out to evaluate whether Transverse Cerebellar Diameter (TCD) in singleton gestations can serve as a reliable predictor of gestational age (GA) in fetuses in the second and third trimester of pregnancy. A prospective study was carried out with 50 pregnant ladies, GA ranging from 15to37 weeks (estimation of mean GA was 26.8 ± 6.8 weeks), with a single fetus.TCD measurement by ultrasound was used for each fetus. Correlations between fetal TCD and GA were determined for the whole sample. Mean TCD was 28.6 ± 7.5 mm in 15-37 weeks of gestation. Regression analysis indicates a significant relationship between TCD and GA; correlation coefficient (r) = 0.94 and p< 0.001. Fetal TCD by ultrasound could be a predictive biometric parameter of GA in the last two trimesters of a pregnancy. Keywords-Fetal Transverse Cerebellar Diameter (TCD); Gestational age (GA); Ultrasound

Spectral Doppler findings in a rare case of acute compartment syndrome following leg burn

Acute compartment syndrome (ACS) is an orthopedic emergency condition, which is rarely attributed to burns. It occurs when pressure in an enclosed space rises to a point where it reduces blood flow and impairs tissue perfusion. Its consequences often lead to ischemia and possible necrosis within that space. Until now, the use of Doppler assessment to explore different types of compartment syndrome has yielded contradictory findings. Here, we present a significant increase of blood flow velocity in the arteries proximal to the burned area. Thus, the combination of Duplex ultrasound results with clinical findings will help vascular surgeons to make immediate decision to perform fasciotomy.

Duplex ultrasound for evaluation of deep venous blood flow in fractured lower extremities

Purpose Early identification of deep venous thrombosis (DVT) in trauma patients would result in an early initiation of treatment, thereby decreasing the frequency of complications. The aim of the current study was to evaluate the role of duplex ultrasound (DUS) in the evaluation of deep venous blood flow in fractured lower extremities to rule out DVT prior to orthopedic surgery. Material and methods In this prospective study a total of 58 patients (42 males and 16 females; mean age of 51.5 ± 19.5 years) with fractured lower extremities were thoroughly evaluated prior to surgery with respect to medical history, fracture pattern, associated injuries, comorbid conditions, and venous duplex ultrasound (VDUS) findings. Each affected limb was assessed for the presence of DVT using a Sonoline G 60S ultrasound unit. The analysis was performed with the Statistical Package for the Social Sciences (SPSS) version 20. Results DVT was found in 36 (62.1%) patients with single closed fractures, 9 (15.5%) patients with single opened fractures, 10 (17.2%) patients with multiple closed fractures, and in 3 (5.2%) patients with multiple opened fractures. Sensitivity and specificity of the findings of compressibility and phasicity for DVT detection in patients with fractured lower extremities were 81.25% and 87.50% and 100% and 100% respectively. In addition, the absence of compressibility and phasicity had positive predictive value of 100% and 100% and negative predictive value of 93.75% and 95.65% respectively. Conclusions US of DVs in the brightness mode (B-mode) with compression maneuvers should be the first-line imaging modality for suspected DVT in patients with fractured lower extremities.

Effects of gestational hypertension in the pulsatility index of the middle cerebral and umbilical artery, cerebro-placental ratio, and associated adverse perinatal outcomes

Abstract This paper reports the effects of gestational hypertension in the pulsatility index (PI) of umbilical artery (UA) and middle cerebral artery (MCA), cerebro-placental ratio (CPR), and associated adverse perinatal outcomes, after 20 to 40 weeks’ gestation in singleton pregnancy. A total of 280 pregnant women, divided equally into control and gestational hypertension groups, were recruited prospectively. Alpinion Medical System ECUBE 7 ultrasound equipment was used to measure the UA-PI, MCA-PI, and CPR within the two groups. Data were analyzed to correlate the results with the presence of adverse perinatal outcomes. In gestational hypertension group, the UA-PI, MCA-PI, and CPR were associated with adverse perinatal outcomes after adjustment for gestational age. The increase in risk for lower birth weight, higher incidence of elective Cesarean section delivery, and preterm birth were statistically significant for UA-PI, MCA-PI, and CPR. Study of pulsatility indices of placental and fetal circulation in singleton pregnancy developed gestational hypertension can provide important information regarding fetal well-being, yielding an opportunity to improve fetal outcome.

Incidental extraspinal findings in the lumbar spine during magnetic resonance imaging of intervertebral discs

Purpose To calculate the frequencies of incidental extraspinal findings and incidentally detected congenital anomalies or anatomical differences in the lumbar spine on magnetic resonance imaging (MRI) scans of intervertebral discs. Materials and methods A total of 379 lumbar spine MRI cases were prospectively investigated in the period spanning from August 2016 to January 2018. Both 1.5 and 0.35 Tesla MRI units (Toshiba and Siemens Medical Systems) were used to examine patients with clinically suspected intervertebral disc abnormalities at three MRI diagnostic centers in Khartoum State, Sudan. Results Of the 379(100%) patients, 90(23.7%) patients were presented with incidental findings. Among the incidental findings, 39(10.3%) were renal cysts, 10(2.6%) were retroverted uteri, 5(1.3%) were Nabothian cysts, 4(1.1%) were ovarian cysts, 10(2.6%) were uterine fibroids, 3(0.8%) were endometrial thickening, 11(2.9%) were indicative of hydronephrosis, 4(1.1%) were uncovered prostatic enlargement, 2(0.5%) were atrophic kidney, and 1(0.3%) each was of an ectopic kidney and bladder wall thickening, respectively. Conclusions A high percentage of extraspinal pathological findings were detected during MRI lumbar spine scans of intervertebral discs. Thus, it is important to be aware of the high percentage of patients who undergo further evaluation given the presence of unexpected findings, but for whom clinical confirmation of these abnormalities is not obtained.

Use of ophthalmic B-scan ultrasonography in determining the causes of low vision in patients with diabetic retinopathy

Purpose To determine the causes of low vision among Sudanese patients with diabetic retinopathy (DR) by using ophthalmic B-scan ultrasonography. Materials and methods A total of 100 patients with DR at different grades, were recruited prospectively between September 2016 and January 2018. Nidek (Echoscan US-4000) ultrasound unit was used to determine the causes of low vision in diabetic patients according to their glycated haemoglobin (HbA1c) and early treatment of diabetic retinopathy scale (ETDRS) severity levels. Results Vitreous hemorrhage (VH) 42(66.6%), asteroid hyalosis (AH) 12(14.3%), and partial retinal detachment (PRD) 9(19%) were the main cause of low vision in patients presenting with moderately regulated HbA1c and graded with either minimal or mild nonproliferative retinopathy (NPDR). While VH 15(40.5%), total retinal detachment (TRD) 12(32.4%), posterior vitreous detachment (PVD) 7(19%), and choroidal detachment (CD) 3(8.1%), were dominant in patients with poorly regulated HbA1c and graded either as moderate NPDR; severe NPDR; and proliferative retinopathy (PR). Conclusions Ophthalmic B-mode ultrasound is a rapid, noninvasive imaging technique that can be used with minimum discomfort in ophthalmological practice for the detection and evaluation of DR complications that predict the visual outcome.