A rare case of obscure gastrointestinal bleeding: Small bowel varices flowing into the inferior epigastric vein.

Ectopic varices include all varices except esophageal or gastric varices and comprise large portosystemic venous collaterals that occur anywhere in the abdomen. Ectopic varices are relatively rare; however, approximately 5% are related to gastrointestinal bleeding. Ectopic varices usually occur in the rectum, duodenum, or colon, and portal hypertension is the most common cause. Hemodynamic profiles of ectopic varices remain unknown, and extensive bleeding from these structures occurs because diagnosis and treatment are difficult. Here we report a case of obscure gastrointestinal bleeding (GIB) due to ectopic varices in the small intestine that flowed into the inferior epigastric vein. Our observations suggest that when obscure GIB is detected in patients with either cirrhosis or post-surgical history including incisional hernia, it is essential to acquire multilanar reconstruction images and volume-rendered 3-dimensional reconstruction of computed tomography scans to investigate the complex venous supply and optimize decisions for therapy.

CT-Guided Intranodal Lymphangiography for Postoperative Chylous Ascites.

The utility and minimal invasiveness of ultrasound-guided intranodal lymphangiography have already been reported by several researchers. Although ultrasound-guided intranodal lymphangiography is known to be not technically difficult in general, a patient's edematous groin due to hypoalbuminemia resulting from chylous ascites made it too challenging to detect and prick the lymph nodes precisely. This report describes a 71-year-old female with refractory chylous ascites due to an operation for an extrahepatic bile duct cancer, who was successfully treated by computed tomography (CT)-guided intranodal lymphangiography. After switching from ultrasound- to CT-guided lymphangiography, the procedure was successfully performed, and the refractory chylous ascites was treated.

Rheology of disentangled multiwalled carbon nanotubes dispersed in uncured epoxy fluid.

The rheological behaviors of clustered and disentangled multiwalled carbon nanotubes (MWCNTs) dispersed in a stable, non-reactive Newtonian epoxy fluid have been investigated. Suspensions of untreated and chemically oxidized MWCNTs in epoxy show strong rate-dependent behavior and long-time elastic response that is characteristic of a flocculated microstructure. Suspensions of disentangled MWCNTs in epoxy were prepared by a functionalization reaction with nitrobenzene, and show distinct rheological behavior that is attributed to the motion and rotation of the individual nanoparticles. Characteristic features of the disentangled MWCNTs in epoxy are a lack of low-frequency plateau in storage modulus and shear thickening behavior at high shear rate. The rheological behavior is discussed on the basis of continuum-level predictions for the motion of individual, semiflexible fibers under shearing flows. Implications of MWCNT disentanglement on fundamental study and applications of MWCNT-filled systems are discussed.

Acinar cell carcinoma arising from an ectopic pancreas.

We herein report a rare case of ectopic pancreatic acinar cell carcinoma (ACC) which presented as a submucosal tumor of the pylorus. A 73-year-old man came to our hospital presenting with epigastralgia. Esophago-gastroduodenal endoscopy showed no mucosal lesions, but a submucosal tumor was observed around the pylorus. Abdominal computed tomography revealed two round masses. One was located in the pylorus, while the other was found between the portal vein and the inferior vena cava. An examination of a biopsy specimen was inconclusive. We diagnosed a gastrointestinal stromal tumor or malignant lymphoma preoperatively, and decided to perform an operation in order to confirm the diagnosis and select the optimal treatment. Intraoperatively, the mass in the pylorus invaded the pancreatic head, and the lymph node in the hepatoduodenal ligament was swollen. We performed a pancreaticoduodenectomy as a radical excision. The resected specimen showed the 7.6 x 4.9-cm size tumor to mainly originate from the pylorus. Histopathologically, the tumor was identified as pancreatic ACC with lymph node metastasis. The tumor cells were labeled by immunohistochemical staining for alpha1-antitrypsin. Because of the tumor location, we considered the tumor to have originated from the ectopic pancreatic tissue in the stomach. This is only the second case of ACC originating from an ectopic pancreas reported in the literature.