Transcranial Doppler Study Among Children with Sickle Cell Anaemia Vs Normal Children.

Introduction: Role of transcranial Doppler in prevention of stroke in sickle cell children has been well appreciated. Studies are being done to develop the protocol in children. Since we don’t find stroke very commonly in this part of the world, this study was done in order to see the prevalence of abnormal flow velocity in sickle children attending sickle cell clinic. The aims of this study were to measure mean flow velocity in different vessels in homozygous sickle cell patients using transcranial Doppler study, to compare the mean velocity in sickle children with age and sex matched controls and to correlate mean velocity with headache or stroke if any and also to correlate mean velocity with number of transfusions. Materials and Methods: The study was done in Paediatric wards. It was a prospective crosssectional comparative study. Twenty six children below 14yrs of age with homozygous sickle cell disease attending the Sickle cell clinic were selected as the cases. Forty cases of similar age and sex were recruited as normal control group. Transcranial Doppler was done in six different vessels in both the groups and mean flow velocity was measured. Mean flow velocity was correlated with symptoms and number of transfusions. Velocity was classified as normal (<170cm/sec), conditional (170-199cm/sec) or abnormal (>200cm/sec). Statistical analysis was done using SPSS 10 software. Results: In normal age and sex matched controls mean blood flow velocity was 50cm/sec where as in the cases of sickle cell disease was 180cm/sec. Maximum mean velocity was observed in middle and posterior cerebral artery. In two Sickle cell cases (8%) blood flow velocity was abnormal, these children had headache though received 5-10 transfusions/year. In only 4% sickle cell children flow velocity was normal and rest had conditional velocity. Among these children 39% received less than 5 and rest received 5-9 transfusions /yr and had no symptoms of stroke. Conclusions: Flow velocity measured by Transcranial Doppler is highest in middle cerebral artery and Posterior cerebral artery which appear to be the best arteries for this test in this region. Flow velocity was significantly high in children with sickle cell disease as compared to normal children. Prevalence of abnormal flow velocity in our children was 8% and children with abnormal mean flow velocity presented with headache.

Three-dimensional CT angiography in the evaluation of cerebral arteries in acute hemorrhage.

OBJECTIVE: We conducted this study to demonstrate the value of non-invasive three-dimensional CT angiography (3D CTA) in the detection of a cerebral aneurysm. MATERIAL AND METHODS: A helical CT acquisition was obtained using non-ionic contrast media in 50 patients with 1 mm per second table speed, 1 mm collimation, and pitch 1:1. Axial source images were transferred into a workstation console (Advantage windows GE) and CTA was obtained using MIP (Maximum Intensity Projection) reconstruction. Fourteen patients underwent conventional digital subtraction angiography (DSA) after 3D CTA prior to surgery. RESULTS: A total of 39 aneurysms were detected in 50 patients. All patients with an aneurysm were operated and the presence of aneurysms was confirmed. 3D CTA detected 38 of these 39 aneurysms. In 37 aneurysms, the origin of the aneurysm and aneurysm neck was adequately visualized. 3D CTA was found to be 100% specific and 97.2% sensitive in picking up cerebral aneurysms. 3D CTA was 97% specific in demonstrating the exact origin and showing the neck of the aneurysm. CONCLUSIONS: CT angiography is a simple, quick, and non-invasive technique and can replace DSA in most patients with acute subarachnoid hemorrhage aneurysm for the detection and characterization of aneurysms of the circle of Willis. The relation of the aneurysm with bony landmarks was clearly depicted.

Lateral sacral lipomyelomeningocele : a rare anomaly.

Lateral sacral lipomyelomeningocele is a rare spinal developmental anomaly. In the case under report, the fat attached to the neural placode was blending with the gluteal fat externally. The cord was tethered at this level. Multiple bony anomalies and diastematomyelia were associated findings. A case of lateral sacral lipomyelomeningocele with excellent imaging detail provided by the multiplanar magnetic resonance (MR) scan is reported.

Cervico-dorsal spinal enterogenous cyst.

A case of a histologically proven ventrally situated spinal enterogenous cyst of cervico-dorsal region is reported with magnetic resonance (MR) imaging features. A brief review of literature on the subject is discussed.

Orbital granulocytic sarcoma in acute myelogenous leukemia.

A five year old boy presented with progressively increasing proptosis of the left eye. CT scan showed bilateral extra-conal homogeneously enhancing soft tissue masses, larger on the left side. A possibility of granulocytic sarcoma of the orbit was considered. Diagnosis was confirmed by peripheral smear and bone marrow aspiration. Patient responded to chemotherapy.

Bilateral pulmonary aneurysm in Behçet's disease (a case report).

While investigating a chest opacity in Behcet's disease possibility of pulmonary aneurysm should be considered. Contrast enhanced CT is a safe diagnostic method which is useful in confirming or excluding the presence of an aneurysm in such cases. We report here the first case of bilateral pulmonary aneurysms in Behcet's disease.

Hamartoma--a benign intraluminal tumor of the oesophagus (a case report).

Benign tumours of the oesophagus are rare, representing less than 1% of all oesophageal neoplasms. Most of them are intramural leiomyomas while the other benign tumours are encountered only infrequently; among these pedunculated intraluminal hamartomas form a particularly rare group. We present here one such case.

Pulmonary pseudoaneurysm.

A case of pseudoaneurysm with erosion of both pulmonary and bronchial vessels is reported. The diagnosis was confirmed by computed tomography followed by intravenous digital subtraction angiography. It was removed surgically.

Adreno cortical carcinoma in children--a case report of three cases.

Three cases of adrenal carcinomas are reported with emphasis on different radiological imaging techniques. It is felt that sonography and C.T. both have an important role in diagnosing masses of suprarenal region.

Primary mediastinal embryonal cell carcinoma.

It is now widely accepted that germinal cell tumors can arise primarily in the mediastinum. Primary extragenital seminoma has been documented arising in the mediastinum but very few reports are available about primary mediastinal embryonal cell carcinoma. We report a case of this rare condition with radiological and CT features.