Symptomatic OMD remnants in children most commonly presented with GIT obstruction, acute abdomen and umbilical anomalies. Rectal bleeding was not a predominant finding in the present series. Surgery is curative and can safely be done either by way of wedge resection or ileal segmentary resection. Ectopic tissue is detected in approximately one third of symptomatic remnants.

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In total, 74 pediatric oncology patients with hematologic malignancies (n=56) or solid tumors (n=18) and a median age of 78.5 months were included in this prospective study. The aims were to assess malnutrition risks and nutritional status over a 6-month treatment period measured at regular intervals. The rate of patients with high risk for malnutrition at diagnosis was 28.4% by Screening Tool for Risk of Impaired Nutritional Status and Growth tool and 36.5% by Pediatric Yorkhill Malnutrition Score. Body mass index (BMI) z-scores at diagnosis showed 12.3% undernutrition (<−2 SD) and 6.8% overnutrition (>2 SD), which changed to 6.7% and 11.1% at the sixth month, respectively. Malnutrition (BMI<5th age percentile) was detected in 13.7% at diagnosis. Despite an initial deterioration noted in BMI, BMI for age percentile, and z-scores at month 1 in all malignancy subgroups (at month 3 for acute lymphoblastic leukemia), the scores improved later on. There was an increase in weight from baseline in 88.2% of patients over 6 months. This study revealed a decrease in the prevalence of undernutrition and malnutrition over a 6-month treatment period with improved anthropometrics despite an initial deterioration in all malignancy subgroups and even in patients with high risk for malnutrition at baseline screening. Solid tumors and acute lymphoblastic leukemia seem to be associated with higher likelihood of undernutrition and overnutrition, respectively, during treatment.

IntroductionSpleen produces specific antibodies and filters out encapsulated organisms and, therefore, is important in protecting the body against infection. On the other hand, splenectomy is a widely used therapeutic modality in the management of a variety of hematological disorders. The current surgical options for this purpose include not only the novel modalities like partial splenectomy, splenic embolization, or laparoscopic splenectomy but also the traditional open splenectomy [1,2]. However, most of the information about the traditional open splenectomy in children, regarding especially the long-term outcome, is based on old publications. The aim of the present study is to retrospectively review the outcome data on efficacy and safety of open splenectomy performed in a single center on a considerably large group of children with hematological diseases. Patients and methodsA retrospective review of the 119 consecutive children who had undergone elective splenectomy for various hematological diseases at our institution between 1993 and 2004 was performed. Operations indicated for reasons other than hematological diseases, like trauma or cysts, were excluded. The cases were identified using the logs of the operating theatre and the records of the Department of Pediatric Hematology. Information was gathered determining age, sex, indication for the procedure, procedural details, morbidity and mortality and whether the primary aim of the surgery was achieved.The indications for splenectomy are shown in Table 1. Routine preoperative abdominal ultrasonography was employed in all of them. Prophylactic antibiotics were used preoperatively and long-term penicillin prophylaxis was established. Polyvalent pneumococcal and Hemophilus influenza vaccines were routinely employed 2-4 weeks prior to surgery. Booster injections were given 1 and 5 years later.Operations were done through a left subcostal or a left upper transverse incision. Standard splenectomy was performed by ligating the splenic artery first. A thorough search was done for the presence of accessory splenic tissue and the gallbladder was palpated for the presence of stones in patients with hemolytic anemia for confirming the ultrasonography findings. The abdomen was closed without drainage for the splenic bed and nasogastric drainage was employed during the early postoperative period.Response to therapy was defined in terms of the disease process toward which therapy was directed. The mean of the hematological parameters recorded at

ERCP in the pediatric population has a high success rate, both as a diagnostic tool and for therapeutic interventions, provided it is performed by experienced endoscopists. The delicate delineation of the anatomy by ERCP and its therapeutic potential make it absolutely superior to other less invasive tools such as magnetic resonance cholangiopancreatography.