Management of ulcerative colitis.

Ulcerative colitis (UC) in children is increasing. The range of treatments available has also increased too but around 1 in 4 children still require surgery to control their disease. An up-to-date understanding of treatments is essential for all clinicians involved in the care of UC patients to ensure appropriate and timely treatment while minimising the risk of complications and side effects.

River rehabilitation for the delivery of multiple ecosystem services at the river network scale.

This paper presents a conceptual framework and methodology to assist with optimising the outcomes of river rehabilitation in terms of delivery of multiple ecosystem services and the benefits they represent for humans at the river network scale. The approach is applicable globally, but was initially devised in the context of a project critically examining opportunities and constraints on delivery of river rehabilitation in Scotland. The spatial-temporal approach highlighted is river rehabilitation measure, rehabilitation scale, location on the stream network, ecosystem service and timescale specific and could be used as initial scoping in the process of planning rehabilitation at the river network scale. The levels of service delivered are based on an expert-derived scoring system based on understanding how the rehabilitation measure assists in reinstating important geomorphological, hydrological and ecological processes and hence intermediate or primary ecosystem function. The framework permits a "total long-term (>25 years) ecosystem service score" to be calculated which is the cumulative result of the combined effect of the number of and level of ecosystem services delivered over time. Trajectories over time for attaining the long-term ecosystem service score for each river rehabilitation measures are also given. Scores could also be weighted according to societal values and economic valuation. These scores could assist decision making in relation to river rehabilitation at the catchment scale in terms of directing resources towards alternative scenarios. A case study is presented of applying the methodology to the Eddleston Water in Scotland using proposed river rehabilitation options for the catchment to demonstrate the value of the approach. Our overall assertion is that unless sound conceptual frameworks are developed that permit the river network scale ecosystem services of river rehabilitation to be evaluated as part of the process of river basin planning and management, the total benefit of river rehabilitation may well be reduced. River rehabilitation together with a 'vision' and framework within which it can be developed, is fundamental to future success in river basin management.

Histiocytic sarcoma with interdigitating dendritic cell differentiation.

The authors describe a rare tumor with overlapping features of true histiocytic sarcoma and interdigitating dendritic cell sarcoma occurring in infancy. A 3-month-old boy presented with hepatosplenomegaly and abdominal distention. He presented a diagnostic challenge at initial presentation despite extensive investigations. On follow-up at age 16 months he had progressive splenomegaly, thrombocytopenia, and worsening coagulopathy. A diagnosis of histiocytic sarcoma with interdigitating dendritic cell differentiation was established after an open biopsy of liver and spleen. A repeat liver biopsy coupled with splenic biopsy is recommended in young children with unexplained hepatosplenomegaly and thrombocytopenia.