Direct observation of multiple reactive sites in the zeolite HZSM-5, a member of the MFI family of zeolite structures, contradicts the traditional view of only one type of active protonic species in industrially important zeolites. In addition to the well-known Brönsted acid site proton, two other protonic species undergo room-temperature hydrogen-deuterium exchange with an alkane hydrocarbon reagent, including one zeolite moiety characterized by a broad H chemical shift at ca. 12-15 ppm that is reported here for the first time. Although the ca. 13 ppm chemical shift value is consistent with computational predictions from the literature for a surface-stabilized hydroxonium ion in a zeolite, data suggest that the signal does not arise from hydroxonium species but rather from hydroxyls on extra-lattice aluminol species proximate to Brönsted lattice sites, i.e., a small population of highly deshielded acid sites. Double-resonance experiments show that this species is proximate to Al atoms, similar to the Brönsted acid site proton. These sites can be removed by appropriate postsynthesis chemical treatment, yielding a catalyst with reduced activity for isotopic H/D exchange reactions. Additionally, other extra-lattice aluminum hydroxyl groups previously discussed in the literature but whose protons were considered unreactive are also shown for the first time to react with hydrocarbon probe molecules. Two-dimensional exchange NMR reveals direct proton exchange between the Brönsted site and these two types of extra-lattice Al-OH species, and it also reveals unexpected proton exchange between extra-lattice Al-OH species and an alkane reagent.

Doppler ultrasonography of the hepatic vasculature is an integral part of evaluating precirrhotic and cirrhotic patients. While the reversal of the portal venous flow is a well-recognized phenomenon, other flow patterns, although not as easily understood, may play an important role in assessing the disease status. This article discusses the different characteristic flow patterns observed from the portal vein, hepatic artery, and hepatic vein in patients with liver cirrhosis or related complications and procedures. Knowledge of these different flow patterns provides additional information that may reinforce the diagnosis of cirrhosis, help in staging, and offer prognostic information for determining the direction of therapy. Doppler ultrasonography is invaluable when liver transplantation is being considered and aids in the diagnosis of cirrhosis and portal hypertension.

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Mucinous adenocarcinoma of the appendix is a rare form of lower gastrointestinal (GI) tract cancer. These cancers have a high tendency to progress towards peritoneal metastasis and their response to systemic treatment is typically low. Together, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have become an established form of therapy used to prolong the survival of patients with this disease. Repeat CRS and HIPEC have been shown to be feasible in selected patients with GI peritoneal carcinomatosis (PC), among which those with appendix cancer receive the greatest benefit. The peritoneal cancer index (PCI) and completeness of cytoreduction have been shown to be important predictors of outcomes. However, repeat cytoreduction in patients with a high-volume peritoneal tumor burden (peritoneal cancer index (PCI) > 30) is not typically performed due to concerns regarding morbidity and mortality. Herein, we describe a case of repeat CRS and HIPEC for extensive appendiceal mucinous peritoneal carcinomatosis after initial incomplete cytoreduction and durable remission of 28 months without adjuvant chemotherapy. In appendiceal mucinous cancers, repeat CRS can achieve a durable response despite an initial failed CRS and high-volume disease.

Mild to moderate soft tissue stranding with increased attenuation around the hepatic artery and celiac axis is a common finding after pancreaticoduodenectomy that may persist for years after surgery. Such haziness alone has low specificity for tumor recurrence and should not be regarded as an indicator of malignancy.