Positive MRA with a positive TCD in an asymptomatic patient in long-term follow-up suggests a trend for developing clinical stroke. A 4- to 8-year follow-up of nine patients with positive TCD, positive MRI, but not positive MRA did not show development of clinical stroke. Nine Doppler findings are significant in screening for clinically symptomatic vascular disease in sickle cell patients. It is recommended that children with sickle cell disease be screened for cerebrovascular disease with TCD. If one or two indicators of abnormality are present, MRA is recommended. If the MRA is positive, the patient may be considered for transfusion therapy or other treatment for prevention of stroke.
Intestinal perforation is a common and serious complication of NEC in neonates. Plain film evidence often is absent in patients with surgically proved perforation. Some patients with NEC develop a distended, gasless abdomen suitable for sonographic evaluation. Five neonates with gasless abdominal distention and clinical decline were studied with ultrasonography. Four patients demonstrated intraperitoneal fluid-debris levels and ascites; all had surgical proof of perforation. The fifth patient did not demonstrate these findings and subsequently recovered. The sonographic findings of ascites and intraperitoneal fluid-debris levels in patients with NEC are suggestive of perforation.
Transcranial Doppler US scanning has great potential as an inexpensive, easily performed screening procedure for cerebrovascular disease in patients with SCD.
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