When organs collide: A rare cause of gastrointestinal bleeding.

A 72-year-old man was referred to our Emergency Department with a 2-week history of melaena. His medical history was relevant for Atrial Fibrillation and Non-Hodgkin's Lymphoma (NHL) in remission on most recent PET. Our patient responded to resuscitative management and then went on to have upper gastrointestinal endoscopic evaluation to elucidate the cause of bleeding. As seen in the images, endoscopy showed a gross defect in fundal wall with evidence of extrinsic infiltration by a large vascular mass-like structure, suspected to be spleen. Computed tomography (CT) abdomen and pelvis confirmed a gastrosplenic fistula as well as new lymphadenopathy. The findings were in keeping with recurrence of NHL. Discussion at multidisciplinary meeting deemed his gastrosplenic fistula unsuitable for surgical repair. He was managed conservatively, had a nasojejunal (NJ) tube inserted for feeding, and clinically improved on the ward. Our patient expressed a preference not to undergo further chemotherapy, having struggled quite significantly with his initial chemotherapy. He was discharged home 23 days following admission. At this stage, his NJ tube was removed and he was tolerating oral diet. He is currently being managed by the Palliative Care team in the community.

Correlating in-situ process monitoring data with the reduction in load bearing capacity of selective laser melted Ti-6Al-4V porous biomaterials.

Selective Laser Melting allows for the creation of intricate porous structures, that possess favourable biological properties. These structures are known as porous biomaterials. The focus of this paper is to evaluate the use of an in-line photodiode based process monitoring system, for the monitoring of the operational behaviour of the laser, and to correlate this with the resultant parts mechanical performance. In this study the production scale Renishaw 500M was used to produce porous structures, using Ti-6Al-4V feedstock powder. During the process, a co-axial process monitoring system was utilised to generate data relating to both the meltpool and the operational behaviour of the laser. An advanced scanning technique was used to produce the structures, whereby the laser parameters determine the strut dimensions. In this study, the laser input energy was reduced by 33%, 66% and 100%, at specific layers within the structures. Computer Tomography and Scanning Electron Microscopy was utilised to characterise the affected struts within the structures, while quasi-static compression testing was used to determine the structure's mechanical properties. It was demonstrated that as the level of input energy decreased and the number of affected layers increased, a corresponding decrease in the load bearing capacity of the structures occurred. With the structures experiencing a significant loss in strength also exhibiting a change in the failure mode during compression testing. Data generated during the processing of such structures was compared to the data generated during the processing of control structures, with the difference between the two been calculated on a layer-by-layer basis. A clear correlation was demonstrated between the total level of deviation between the two signal sets and a reduction in the load bearing capacity of the structures. This indicates that by comparing build data to a benchmark data set, valuable information relating to the structural integrity of the porous structures can be obtained.