Sickle Children Vs Normal Children: A Transcranial and Extracranial Doppler Study.

A prospective hospital based study was carried out to evaluate the role of transcranial Doppler in sickle cell anemia for period of 2 yrs (July 2009- August 2011). A total of 100 children, 50 normal individuals in control group and 50 diagnosed sickle cell disease patients in sickle group were evaluated in the age group .Children were from Newborn to15 years of age, of which 62% were males and 38% were females. Common Carotid Artery (CCA), External Carotid Artery (ECA), Internal Carotid Artery (ICA), Vertebral Artery,Middle Carotid Artery (MCA), Anterior Carotid Artery (ACA), Posterior Carotid Artery (PCA) was evaluated by Transcranial and Extracranial Doppler on both sides in sickle cell patient. The mean velocities in all the vessels were higher in sickle group patient as compared to normal group patients. Evaluation of Extracranial carotid vessels has not been done in previous published studies. Our study can act as benchmark in extracranial Doppler studies of sickle cell patients. We have not followed the patients of sickle cell disease till stroke, but we can say with certainty that increased values of velocity >200 cm/sec is an absolute indication for blood transfusion to prevent stroke, which was observed in 10% of sickle cell patient in our study where velocities reduced by 20-25 cm/sec after blood transfusion.

A Rare Case of Prolapsed Omphalomesenteric duct with ruptured Umbilical Hernia.

Strangulated ileal intussusceptions into the Meckel’s diverticulum (which is caused by an incomplete obliteration of omphalomesentric duct) and coming out through ruptured umbilical hernia is an extremely rare presentation. A 3- months- old male child presented with low grade fever, refusal to feed and episodes of discomfort often alternating with long period of sleepiness and lethargy. On abdominal examination loops of intestine were seen at the site of ruptured umbilical hernia. The abdomen was opened under general anaesthesia by transverse incision. Proximal ileal intussusception into the Meckel’s diverticulum, which was gangrenous, was noted. A resection with end to end ileo-ileal anastomosis was undertaken. The prolapsed bowel was replaced back and double breasting of umbilical defect was done with vicryl 2-0. The patient was completely asymptomatic and healthy.