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We report a 7-year-old boy presenting with an acute upper gastrointestinal (GI) haemorrhage subsequently diagnosed to have a very rare duodenal gastrointestinal stromal tumour (GIST). Endoscopy, pertechnetate and red cell scans were negative. Abdominal US detected a 17-mm mass lesion of the third part of the duodenum. This was confirmed on CT and shown to be hypervascular on selective angiography. At laparotomy, a 20-mm submucosal duodenal lesion was found associated with mucosal ulceration. Immunohistochemical analysis revealed it to be positive for CD117 (c-KIT protein) consistent with a GIST. We emphasize the importance of a thorough abdominal US examination in children with GI haemorrhage and the consideration of GIST in the diagnosis after the common causes have been excluded. [ABSTRACT FROM AUTHOR]

By the year 2050, agriculture will have to provide the food and nutrition requirements of some 9 billion people. Moreover, to maintain that level of productivity indefinitely it must do so using environmentally sustainable production systems. This task will be profoundly complicated by the effects of climate change, increasing competition for water resources and loss of productive lands. Agricultural production methods will also need to recognize and accommodate ongoing rural to urban migration and address a host of economic, ecological and social concerns about the 'high inputs/high outputs' model of present-day industrial agriculture. At the same time, there is a need to confront the unacceptable levels of continuing food and nutrition insecurity, greatest in the emerging economy countries of Africa and Asia where poverty, rapid population growth and climate change present additional challenges and where agriculture is practiced primarily by small-scale farmers. Within this context, we here review science-based evidence arguing that diversification with greater use of highly valuable but presently under-valorised crops and species should be an essential element of any model for sustainable smallholder agriculture. The major points of these development opportunity crops are presented in four sections: agricultural farming systems, health and nutrition, environmental sustainability and prosperity of the populations. For each section, these crops and their associated indigenous knowledge are reported to bring benefits and services when integrated with food systems. In this paper, we conclude that not only a change in policy is needed to influence behaviours and practices but also strong leadership able to synergize the various initiatives and implement an action plan. [ABSTRACT FROM AUTHOR]

Background: Although MRI prognostic features for juvenile osteochondritis dissecans (JOCD) have been determined, the natural history of JOCD on serial MRI has not been fully documented.Objectives: To document the natural history of JOCD on serial MRI and to correlate this with arthroscopy and clinical outcome over a 5-year follow-up.Materials and Methods: Twenty-one knees in 19 patients (15 boys, 4 girls; age range 5-15 years) with JOCD underwent MRI and clinical follow-up over 5 years. Lesions were classified as stable or unstable on MRI and compared with clinical and arthroscopic data.Results: On 5-year follow-up, 17 of 19 patients were asymptomatic and 2 of 19 had minimal pain. Fourteen arthroscopies were performed on 11/21 knees. One of twenty-one had fragment fixation. On initial MRI, eight knees had marked fragmentation, high signal at the fragment/bone interface and incomplete defects in the hyaline cartilage (MRI stage III-stable), but no tear. Of these, five had arthroscopy, all confirming intact cartilage. One of twenty-one knees was unstable (MRI stage IVb) with a detached osteochondral fragment, requiring surgery.Conclusions: Despite extensive subchondral bone changes on MRI, all cases with intact cartilage (95%) improved with conservative treatment. Early MRI allows prompt diagnosis and institution of conservative treatment. This results in healing and avoidance of surgery in most patients. [ABSTRACT FROM AUTHOR]