OBJECTIVES Our primary objective was to describe emergency department (ED) presentation, treatment, and outcomes for children after hematopoietic cell transplantation (HCT). Our secondary objective was to identify factors associated with serious infection in this population. METHODS This is a retrospective review of HCT patients who presented to our university children’s hospital ED from January 1, 2011, to June 30, 2013. Emergency department presentation, treatment, and outcomes were described. Descriptive statistics were used to compare children with definite serious infection with those without serious infection. Multiple binary logistic regression was performed for risk factors associated with definite serious infection. RESULTS Fifty-four HCT patients (132 encounters) presented to our ED. Most were transplanted for a malignant (46%) or metabolic (36%) diagnosis and were recipients of bone marrow (51%) or umbilical cord blood (45%). Fever was the most common complaint (25%). Emergency department laboratory (64%) or imaging (58%) studies were frequently obtained. Admission was common (n = 70/132, 53%), with 79% (n = 55) of admissions to intensive care or bone marrow transplant units. Thirty-five encounters had definite serious infection, 5 had probable serious infection, and 92 had no serious infection. Fever (P less then 0.001) and high-risk white blood cell (WBC) count of less than 5 or greater than 15 k/μL (P less then 0.001) were associated with definite serious infection. Fever (odds ratio = 8.84, 95% confidence interval = 2.92-26.73) and high-risk WBC (odds ratio = 6.67, 95% confidence interval = 2.24-19.89) remained significantly associated with definite serious infection in our regression model. selleck inhibitor CONCLUSIONS Children presenting to the ED after HCT require extensive support and resources, with more than half requiring admission. Fever and high-risk WBC are associated with serious infection.OBJECTIVES The rate of negative appendectomy in children is 7%. The value of imaging depends on the institution. In addition, imaging errors can lead to an appendectomy in children who do not have appendicitis. It is the hypothesis that children with short onset of symptoms who undergo negative appendectomy often have erroneous imaging findings. METHODS A retrospective study of patients’ records over a 30-month period was carried out. A search by histologic diagnosis in the department of pathology was used to identify the cases of all patients who did not have a diseased appendix with the preoperative diagnosis of appendicitis. In addition, the imaging report was reviewed for the radiologic diagnosis of each patient, and the operative note was reviewed to document the clinical indication for surgery. RESULTS A total of 1377 patients who underwent appendectomy with the preoperative diagnosis of appendicitis were reviewed. Sixty-eight of these children did not have an abnormal pathologic diagnosis; hence, there was a negative appendectomy rate of 4.8%. All 68 had imaging before surgery consistent with appendicitis. Thirty-six of these patients had symptoms less than 3 days. In 30 (84%) of these 36 patients, the note identifies imaging as the indication for surgery. CONCLUSIONS Children who had an appendectomy and found to have a normal appendix shared 2 characteristics. (1) Their symptoms were less than 3 days, and (2) the imaging was considered the indication by the surgical team. In the situation of an unclear diagnosis and a short onset of symptoms, observation or further evaluation should be considered.OBJECTIVES Solitary rectal ulcer syndrome (SRUS) is said to be rare in children (largest series so-far; 55 in children, 116 in adults). We analysed our experience to look at its clinical presentations, endoscopic appearance and treatment outcome in a large cohort of children. METHODS Clinical and endoscopic data were collected between 2000 to 2018. Children (≤18 years) diagnosed to have SRUS on colonoscopy and confirmed by histopathology were included. All children with SRUS were treated with behavioural modification, bulk laxative. Most with ulcer received steroid enema and some sulfasalazine or sucralfate enema. RESULTS The median age of 140 children was 12 (IQR 10-14) years, 79% were males. The median symptom duration was 21 (IQR 9-36) months. Rectal bleeding was the presenting feature in 131(93.6%), constipation in 38 (27%); and small, frequent stools in 79 (56%). Most children had features of dyssynergic defecation such as prolonged sitting in the toilet (131, 93.6%), excessive straining (138, 98.6%), a feeling of incomplete evacuation (130, 92.8%) and rectal digitation (71, 50.7%). Rectal prolapse was noted in 24 (17%) cases. Colonoscopy documented rectal ulcer in 101 (72%) [Single 84]. Over a median follow-up of 6 (IQR 4-18) months, 27 patients were lost to follow-up and of the remaining 113 cases, 71 (62.8%) showed clinical improvement (healing of ulcer documented in 36/82, 44%). CONCLUSIONS The majority of cases of SRUS presented in second decade with rectal bleeding and features of dyssynergic defecation. Ulcer was noted in three-fourths of cases. The outcome of medical treatment with behavioural modification and local therapy was modest.OBJECTIVES Assessment of adherence to gluten-free-diet (GFD) in celiac disease (CD) is generally recommended. Few data are available about consequences of transition from the referral center to the general pediatrician (GP) once remission is achieved. METHODS Adherence was assessed in patients referred to the GP for an annual basis follow-up, called back for re-evaluation. IgA anti-tTG antibodies and the Biagi Score (BS) were determined at last follow-up at the referral Center (V1), and at re-evaluation (V2). Patients were classified as adherent (BS 3-4, IgA anti-tTG  = 7). Scores of adherence were correlated with personal and clinical data. RESULTS We evaluated 200 patients. Overall, we found good adherence rates in 94,95% of patients at V1 and 83,5% at V2. IgA anti-tTG were negative in 100% at V1 and 96,97% at V2. BS is 3-4 in 94,5% at V1 and 84% at V2. Adherence at V2 was significantly worse than V1 (p  less then  0.001). No significant associations were found between scores of adherence and sex, symptoms and age at diagnosis, family history of CD, comorbidity, diagnosis by endoscopy.