text:
Web hosting for Panoramas
Expand Messages
- I'm at a stage where i have a heap of panoramas I want to be able to share with you guys and anyone else who might be interested. So I'm wanting to get a domain hosted where I can do that easily. I do have a couple of question hopefully some of you may be able to answer for me in regards to this.
1) Are there any free hosting services that would be sufficient for this purpose?
2) What file sizes are typical or appropriate for high quality full screen QTVRs?
Any other useful information on this topic would be most welcome, as I have not done this before and would like to do it right. I appreciate your help.
----- Original Message -----
From: Hans Nyberg
To: email@example.com
Sent: Saturday, August 25, 2007 3:40 PM
Subject: [PanoToolsNG] Re: HDMI, or 1920 by 1080 or even now 2560 by 1600 - wow
--- In email@example.com, "robert_harshman" <image360@...> wrote:
> I asked a question on this a while back, got zero response. perhaps
> this will be the same.
> My question is, given the advent of digital HD TV and the world of
> VR's, does any one have a recommendation for optimum cubic tile size,
> etc. for viewing on these monster screens? Note, I've given up caring
> about file sizes quite a while ago, my girlfriend refers to this
> as "dial up losers." And it's true, if you're on anything short of DSL
> your losing out on a very large part of the modern world.
> We are quicky moving to screen sizes as big as you want it and can
> afford it. Along with that is the rapid blurring of content sizing for
> TV or computers. 4:3 format is history, 16:9 is the future and who
> knows what is coming next, perhaps a 360:180 :)
Remember that using fast broadband/DSL does not always mean fast connection every
where in the world.
First of all you server has to be fast,
second the connections to the viewer passes through a lot of downgrading cables on the
I have a 6 megabit connection and I usually get full 5200 kbps from most Europe,
However from Turkey I often get less than 1000.
Most overseas connections to Australia and Asia also usually give me from 500-2000.
US is usually 1500-3000
And if you as most people do are using a wireless router in your home you have to be very
Even if they claim 30 m is the range it does not mean the speed is the same.
If I go 5 m into my living room and get a wall between me and the router speed falls from
5000 to 500.
Everything between you and the router lowers speed.
Regarding HDMI the resolution is not larger than most monitors today.
Viewing a pano on a 40" screen with 1920 by 1080 is not different than the same
resolution on my MacBook 17" which I currently use.
And 1600x1600 cubefaces is fine for that resolution. Most people never use the zoom
function anyway so unless you have some very interesting subjects that benefit from
zooming in there is no reason to use higher resolution than the one that gives you optimal
at your default FOV.
If you make the resolution larger than you are going to see it you get worse quality
actually. The flimmering effect we all know from QTVR is the same for the new Flash
viewers. And it increases when you see the pano in a resolution which is smaller than the
image is.
[Non-text portions of this message have been removed]
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text:
Monkey Bookend - Art Object
$ 55.00
A gorgeously detailed monkey bookend with a thoughtful expression.
This heavy weight bookend, which is most likely a bronzed brass could be used in a library or office or as an interesting art object.
Approximately 6 7/8" high, 3 1/2" base
Weight: Nearly 3 1/2 pounds
Excellent vintage condition. Gorgeous patina, some minor wear and scratches appropriate for the age. Black felt pad still present at base.
Note: Color may vary depending on your monitor settings.

subset: commoncrawl


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- Dimensions: 14" w x 4.5" h


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text:
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Those wishing to add new topics leave a comment on the program, where the program is characterized by constant updating of information via the Internet.
Very good


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text: Thank you so much for visiting our registry. The best gift we can receive is to spend time with all of you on our wedding day. If you would like to contribute a gift, please consider helping us start our life together. Because we live in a small apartment and have all the bare necessities, we prefer monetary donations to physical gifts. We can't wait to spend our special day with you!


text:
MSHIPCO's prototype ship, Stiletto, has launched more unmanned systems than any other ship in the US Navy and continues to demonstrate the value of a small dedicated platform to support drones. In its latest demonstration, the United Kingdom's Defense Science and Technology Laboratory (DSTL) in partnership with the Department of Defense (DOD)'s Stiletto Maritime Demonstration Program conducted a second set of maritime unmanned air system (UAS) evaluation aboard the Stiletto during the first half of November 2014, focused on UAS Intelligence, Surveillance & Reconnaissance (ISR) payloads.
Anticipating this change, MSHIPCO has designed the first naval ship developed specifically for supporting unmanned systems and engineered to fit on the MLP or Amphibious Assault Ship. Called the Stiletto Maritime Operations Center (MOC), it's based on the prototype and leverages operational experiences in the Pacific, Atlantic and Caribbean over the last five years.
The Stiletto MOC is a low cost, high-speed, shallow-draft, wide platform that uses M-hull® Technology to easily launch unmanned air, surface and underwater vehicles while preserving its stealthy, high-performance capabilities.
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MSHIPCO is an award-winning naval design firm specializing in research and development of maritime platforms for the military and commercial markets. MSHIP team is uniquely qualified to support the growing use of unmanned system in the marine environment. The team includes former military operators and engineers with extensive "real-world" experience, as well as industry specialists in the areas of design, research, testing and operations.
For more information about the Stiletto MOC, a mothership for unmanned systems; please click here:


text:
U.S. patent law Edit
File wrapper estoppel (also called prosecution history estoppel) occurs when an inventor amends its patent application by narrowing the claims during the course of patent prosecution to overcome a rejection. In such a situation, the inventor is precluded or estopped from asserting a broader interpretation after the patent has issued.
This type of estoppel clearly exists in the face of a prior art rejection, but can also exist when the inventor makes representations in a writing that would cause the patent examiner to rely on those representations when it grants a patent based on the application.
Under current law, while file wrapper estoppel does not preclude the use of the doctrine of equivalents, it does substantially limit the scope and application of that doctrine.


text:
I am focusing on Education.
I understand the importance of a quality education for our children and for our adults. I want to be a strong supporter of improving our schools, keeping them open, and ensuring that schools and our kids have the right resources like computers and up-to-date books.
Source: http://www.repderricksmith.com/


text:
Many websites have gone dark today in protest of SOPA, the Stop Online Piracy Act, and PIPA, Protect IP. These two dangerous bills in congress could lead to censorship on the internet. To summarize the legislation as simply as possible, these two bills are meant to stop companies from copying, or "pirating" content or software from others and reselling it. However, the verbiage is so broad that websites like Wikipedia, Reddit, social networking sites like Facebook and Twitter, and even your … [Read more...]
12 Reasons Why the iPad is Useless
I'm typically a fan of Apple, having been a loyal consumer of their iPod for six years, impressed by their Mac Books, and amazed by their marketing skills. But then they came out with this iPad thing. People won't stop talking about it. It's all over Twitter. And to be honest, Mashable has flooded their social media blog with iPad posts (talk about off topic). Frankly, I don't get it. Sure, it's pretty. And yeah, it's a kinda cool device. Kinda. But does it really deserve the hype it's been … [Read more...]
Introducing the New Google Search Results Page
Google had been randomly releasing test pages for its upcoming three-column search results page. There isn't too much buzz about it yet because many of you probably haven't seen it. But my boyfriend has just randomly been bestowed the honor of testing out this new page by the Google Gods. Or some random algorithm. Yeah, I'm pretty jealous. Here is a screenshot of this new Google search results page: … [Read more...]


text:
Canon 6D vs Nikon D600 (for travel use)
(Slightly altered repost since it seems to be inapproprate in the News Forum)
I plan to buy the camera, but I'm a bit unsure which one to get. It should definitly be a FF, since the image quality especially in low light conditions such as astrophotography is way better... Also, I belive the price will drop even more for those systems.
I like shooting landscapes, timelaps and stars and I travel fairly often with my DSLR camera.
Currently, I'm a Nikon D90 User, bought the GPS GP-1 and have 3 lenses. After 4 years, my remote shutter plug is broken (repair would be about 300$), my GPS is broken (the guidance rails for the hot shoe are broken).
One reason I plan to buy Canon is because one can do exposore ramps (with Nikon you can't do that, because theire minimal step width is 1/3 stops, which leads to flickr, at least with my D90). Beside that, I (still) think Canon is more inovative when it is about new features and new lenses (e.g. they try DO lenses).
The advantage of Nikon would be that I can reuse my lenses...
The advantage of the 6D would be the built-in GPS, since I plan to buy one anyway. I don't have to buy one extra (price advantage) and also don't have to care about it, since it's built-in). The camera is a bit lighter.
The advantage of the D600 would be the better overall specs and the built-in Flash, but most of my shootings don't need a flash, so it's a minor advantage.
So I'm in between, what would you recommend...? I'm prepared to switch, since my lenses are fairly cheep (except of one). I plan to buy faster lenses anyway. But once I bought some expensive, fast lenses, it will be hard to switch... So for me, in point of switch, it's a "now or never"!
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|Sep 17, 2012
|Sep 17, 2012
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|Sep 20, 2012


text: Now, these awards speak to the high standards of service we deliver across the breadth of our platform from branch banking to phone to online banking and other direct channels. In addition, our investment advice business performed extremely well in the latest J.D. Power and Associates customer survey.I am as proud of this recognition as I am of our strong financial results. It is a testament to our employees' enduring commitment to TD service and convenience model. Along with this positive news, we are very pleased to declare our $0.05 dividend increase today as well as an increase in our target payout ratio to 40% to 50% of adjusted earnings. Latter brings us into line with our Canadian peers. We have maintained a cautious stance on this front through a period of unprecedented economic upheaval. We have heard though from investors loud and clear the growing importance of dividend income in today's low interest rate environment. When our board considered this, together with our strong balance sheet, our stable earnings base, our superior ability to generate capital and the fact that the transition to Basel III is almost complete, they determined that the timing was right to make this change in our payout ratio. Today's dividend increase is our second this year, which is consistent with the pattern of increases declared by the board since 2003, except for a brief pause during the financial crisis. Earnings growth permitting, the board has indicated that they would like to continue increasing our dividend twice a year as we progress towards a mid-point of our new higher payout range. This can reasonably be expected to result in dividend growth outpacing adjusted EPS growth. Collectively, these decisions single the board's confidence in the resilience of our retail focused franchise banking model and our ability to continue to deliver sustainable long term earnings growth despite a challenging operating environment. So let me talk a little bit about that environment and what it means for our outlook. Read the rest of this transcript for free on seekingalpha.com


text:
Police in a small New Jersey town say the theft of an elderly woman from a mausoleum may have been part of a cult ritual, WMGM-TV reports.
The body of Pauline Spinelli, who was 98 when she died in 1996, was taken by thieves who smashed the door of a mausoleum in Greenwood Cemetery, The Press of Atlantic City reports. The mausoleum held six bodies, the newspaper says.
WMGM-TV quotes Pleasantville police Capt. Rocky Melendez as saying the thieves apparently were not looking to steal jewelry.
"It could have been a cult," he says. "Obviously these are rituals or whatever the cult rituals entail."
Melendez tells The Press that research indicates that towns in northern New Jersey have experienced similar incidents in the past.
"It's incredible," he tells the newspaper. "This is the first time I've experienced anything like this in 23 years working here in the city. This is very bizarre."
The deceased woman's grandson, Rocky Spinelli, is quoted by WMGM as saying he was stunned by the news.
"I don't know how they picked grandmom," he says.
Doug is an unrepentant news junkie who loves breaking news and has been known to watch C-SPAN even on vacation. He has covered a wide range of domestic and international news stories, from prison riots in Oklahoma to the Moscow coup against Mikhail Gorbachev. Doug previously served as foreign editor at USA TODAY. More about Doug
Michael Winter has been a daily contributor to On Deadline since its debut in January 2006. His journalism career began in the prehistoric Ink Era, and he was an early adapter at the dawn of the Digital Age. His varied experience includes editing at the San Jose Mercury News and The Philadelphia Inquirer.
Also: Follow On Deadline on Twitter


text:
Campus Summer Festival
Campus invites you and all your friends to our summer Festival!
Schedule is online now! www.buildcampus.com/festival
Stay up to date with our Facebook event: http://on.fb.me/1of7g7Y
A one day event that brings people together to co-create a variety of gatherings, all in a Campus house. Have fun, meet new friends, and learn cool things!
We believe in community building through sharing passions, creating together, and bonding over unique and fun experiences. We happen to have awesome houses in which we can host these experiences. The Festival is a chance for us to share our Campus community ethos and practice with everyone in the Bay Area!
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Tech: Bike mechanics, project stories
Performance: story slam, open mic night
Health: yoga, meditation, fitness training, cooking classes
Fun: potluck dinner, board games
About Campus: Campus is a new startup focused on community building through co-living. See www.buildcampus.com to learn more.
**Note: By attending the Campus Festival you are automatically agreeing to be featured in photos and video created by Campus for purposes of marketing the company's products and services
Campus is a startup in San Francisco creating a network of communities.
Join millions of people on Eventbrite.
In order to purchase these tickets in installments, you'll need an Eventbrite account. Log in or sign up for a free account to continue.


text:
Setonaikai: The Inland Sea
The Inland Sea, Japan's most beautiful body of water, is not landlocked, as its name suggests, but seems almost so with its serene waters and over 3,000 pine-studded islands.
Donald Richie, in his classic travelogue The Inland Sea (1971), sets the scene of a boat journey westward through the narrow defiles of water: "On the left are first the sharp and Chinese-looking mountains of the island of Shikoku, so different that it appears another land, and then the flat coasts of Kyushu.
This shallow sea is a valley among these mountainous islands." You can cycle along a path Y Y that stretches from Onomichi to Imabari. Bridges, local ferries, and cruise boats provide access to the 750 or so inhabited islands. The remote fishing villages on these islands, with their saltweathered wooden houses and black ceramic-tiled roofs, seem to hail from a different era. Among the most visited are Awaji, the largest island, Setoda, Omi, and Shodo, a beautiful island that, with its olive and orange groves, seems to belong more to the Mediterranean than the Orient.


text:
Refreshing Apple Tapioca Pudding
Recipe by Boomette
This recipe comes from a magazine from Quebec. It's healthy. In the cooking time, I included the 2 hours in the fridge. I tried it last week and liked it a lot. I used homemade applesauce (unsweetened). I used more cinnamon and omitted the nutmeg. I guess splenda would be great instead of brown sugar to make it healthier. And I used 1% fat milk.
Top Review by Shuzbud
An absolute 5 star dessert! I love tapioca and this is a great way to make it healthier! I haven't been having many desserts since starting weight watchers but this is going to become a regular! I used Splenda brown sugar blend and loved the cinnamon and nutmeg so added more than a pinch. I also served it warm and loved it that way. Thanks Boomie!
See Discussion:12 Reviews
Ingredients Nutrition
- 1⁄4 cup quick-cooking tapioca
- 1⁄4 cup brown sugar
- 1 pinch salt
- 2 cups milk
- 1 pinch cinnamon
- 1 pinch nutmeg
- 1 cup applesauce
Directions See How It's Made
- Put the 6 first ingredients in a casserole.
- Cook at medium heat, stirring constantly, about 15 minutes or until it thickens.
- Let cool to room temperature.
- Add the applesauce and whisk.
- Put in indivudual dessert dishes and put in the fridge at least 2 hours.
- Serve cold, with a slice of apple as a garnish.
- It's important to stir constantly if you don't want your tapioca to stick together.


text:
Thanks for helping us sort this video!
Thanks for helping us associate the correct Pornstars to this video!
Помогите нам: эти порнозвезды присутствуют в этом видео?
Pornstar Name:
Sofia I sure would like to have walked in on you when you were spread on your desk. I would have buried my tongue in your pussy and asshole. I would like to slip my dick in place of where she has her Bic.
I'd gladly would receive a stockinged footjob and would submit to her shoes for feet worship.
Some errors occurred, please try again later


text:
Killzone: Shadow Fall has arrived alongside the PS4 and it's easily the best looking of the system's launch games. The graphics may be great, but does Shadow Fall's gameplay and story live up to the previous Killzone games?
Check out the critical response below and let us know your thoughts in the comments section!
Liked It
"I like Killzone: Shadow Fall for its change of direction from previous series games, as well as its change of pace over other first-person shooters. Guerrilla has tried a few new things this time around, and should be commended as such. I welcome the almost sandbox-ish level approach, and the stealth segments did a nice job of breaking up the standard shooting action."
"Sure, its characters may not be all that convincing, and its multiplayer is more a well-crafted distraction than a long-term destination, but the game as a whole contains plenty of unexpected surprises that make it worth your time."
"Its single-player campaign suffers from some AI issues and dabbling in non-shooter gameplay it's just not good at, but it's still an enjoyable romp that challenges you to really think about how you're approaching each fight. And then there's multiplayer, as hardcore as ever but with a level of accessibility that will allow Killzone's online community to grow and flourish for some time to come."
Thought It Was OK
"Killzone: Shadow Fall loses its sheen at times, usually when pursuing moments that are cinematic but not sensible. As a shooter, it's better at thriving on eye-catching environments and supportive combat abilities that don't just come for free."
"There's a lack of confidence here that contrasts starkly with Guerrilla's dazzling, sure-footed command of the new hardware. It's a game that any new PlayStation 4 owner will be proud to show off - but it won't be one they remember by the time PS5 rolls around."
"Like its predecessors, Killzone: Shadow Fall is likely to be described through a technical lens, and the game certainly deserves praise for how many polygons it packs into its most expansive landscapes. [...]More wonderful, however, is the art the software's ones and zeroes convey. Shadow Fall brings the ongoing conflict between the series' warring races to planet Vekta, which provides a stark contrast to the hazy Helghan environs we explored in the previous two games."
"That absence of meaningful evolution might be Killzone: Shadow Fall's biggest sin. For all the next-gen bluster of its visuals and the repeated blunt-force attempts to ram a message home, Guerrilla's first shot on the PS4 retreads shooter cliches, and poorly. In a launch lineup crowded with shooters, Killzone: Shadow Fall sits at the bottom."
Hated It
Killzone: Shadow Fall has received no negative reviews as of yet.
Wikia Reviews
Will you be purchasing Killzone: Shadow Fall?


text:
Lee's Hamburgers
1507 Metairie Rd. (Codifer Ave.) Send to Phone
504-837-8990 | Make Restaurant Reservations | Menu
OpenBreakfast, Lunch & Dinner daily
- Parking lot
- Dress code: Casual
- Kid-friendly
- Take-out available
- Wheelchair accessible
* Click here for rating key
Lee's Hamburgers Restaurant Review: What Lee's Hamburgers lacks in ambience (and it definitely does) it makes up for with the juicy goodness of its burgers. Founded in the Central Business District of New Orleans in 1901, this place is a local burger institution that has expanded to the 'burbs with franchisees. Beef ground fresh daily still composes the ample two-handers at all Lee's locations; it's embedded with chopped onions and the meat and onions caramelize as the burger cooks slowly, melding flavors. A number of burger restaurants have opened in the city over the past few years, but many locals stay loyal to this one. Breakfast is served until 10 a.m.
Find out which restaurants and chefs top the list of GAYOT's 2016 Annual Restaurant Awards.


text:
Scene Pictures
Yearly membership lowered in price! Click for details on the join page
Antonio Miracle is at Alpha Males pounding the ass of colleague Jason Domino, who is more than happy to take his co-worker's big dick up his shooter. Antonio is a rugged handsome fella, while Jason is more of your skinhead sleaze bag. They fuck in the workshop after some 69ing. The smell of sweat and masculine musk the studio describes from the scene is almost smellable when you watch this video.
See more at Alpha Male Fuckers


text:
Tibbo Reveals New-gen Intelligent Device Management Platform
Use this security logo:
Buy AggreGate Network Manager for $800.00.
Tutorial not found. Let know us about any useful video tutorial.
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Major changes in release 5.0: browser version of AggreGate Client, Modeling engine, Geographical maps, GIS integration, Statistics-based prediction of SLA breach dates, VoIP and IP SLA monitoring, NetFlow/xFlow-based traffic decomposition.
This product can be freely distributed through the Internet. To publish it on a CD, please contact email@example.com.


text:
Stratophase is University of Southampton spin-out. Its SpectroSens technology is an optical microchip sensor which measures chemical processes and detects biological targets. This core optical measurement technology can be realised in a vast array of sensing heads, offering a wide variety of system configurations applicable to a broad spectrum of industries including chemical and biochemical production as well as biological detection.
Read more Stratophase news below:


text:
We help you search for a Llanfyllin piccolo teacher. Piccolo tuition are a brilliant method to begin an entertaining new hobby, pick up a new talent and attain confidence with piccolo. Try our service to find Llanfyllin piccolo tutors and choose which best matches your requirements so you can begin your piccolo lessons in Llanfyllin today!
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text: ZTE tests distributed MIMO technology for cell-edge data gain17 Nov 2015 12:33 PM Distributed multiple input multiple output technology is capable of increasing data rate nine times at cell-edge to optimise wireless network performanceZTE is claiming a breakthrough in research on next-generation radio access networks by completing a pre-commercial test of distributed multiple input and multiple output (D-MIMO) technology. The field test conducted jointly by ZTE and a partner, demonstrated an up-to-9 times increase in data rate at the cell edge through the use of D-MIMO technology based on ZTE's proprietary Cloud Radio solution.The outdoor portion of the test covered single-user and multiple-user scenarios in an environment with multiple overlapping base stations, and used commercially-available mobile device terminals. The coherent joint-transmission (JT) technology used in ZTE's new D-MIMO system ensures full phase synchronisation among base stations, the resulting jointly transmitted signal is amplified to the maximum level as it arrives at the antenna of a user terminal, minimising interference with other terminals.Compared with legacy non-coherent JT technology, coherent JT provides 3 dB of additional gain at the antenna of a target user terminal and forms null steering at the antennas of other user terminals to minimise signal interference, achieving multi-user joint transmission (MU-JT). As a mobile communications system typically contains many base stations, interference causes degraded signalling at the cell edge, affecting user experience. D-MIMO technology can effectively improve the data rate at the cell edge through coordinated transmission among base stations, resolving a major challenge facing operators. The indoor D-MIMO test result shows that the MU-JT technology can form null steering toward multiple users to guarantee effective multi-user joint transmission in an enclosed and small space.The service data rate of a single testing cell has been at least quadrupled in an ideal non-interference situation, and a number of testing cells have enhanced their resistance to interference by more than a hundred times. This month, ZTE announced the opening of a new research and development (R&D) centre in Tokyo, to further strengthen the company's research on 5G and other next-generation network technologies.James Atkinson EditorLinkedIn |Google + |Email Leave a CommentPlease write code to prove you're humanMore on... 5GSK Telecom, Ericsson and BMW clock up fastest 5G speed for connected carMWC 2017: Zinwave to unveil new in-building wireless solutionsMore on... ZTEZTE offers Pre5G FDD Massive MIMO solution ZTE and MediaTek test integrated Wi-Fi and LTE architecture for IoT


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The garment and footwear sector is one of the largest consumer goods sectors in the world. Although it represents an important economic driving force, the tragic collapse of the Rana Plaza factory in 2013 brought global attention to the risks of severe adverse impacts both in manufacturing but also further upstream.
The OECD has developed a Due Diligence Guidance for Responsible Supply Chains in the Garment and Footwear Sector. This Guidance, developed through an intense multi-stakeholder process, supports a common understanding of due diligence and responsible supply chain management in the sector.
How OECD's new due diligence instrument can transform the global garment industry
Launch of the Guidance
The Guidance was released at a launch event in Paris on 8 February 2017, followed by a roundtable to discuss best practices for building responsible garment and footwear supply chains. Download the agenda
For general enquiries, please contact
Past events
2015 Roundtable | 2014 Roundtable
See also
Towards a standardised supplier assessment framework
Netherlands stakeholders reach Agreement on Sustainable Garment and Textile, 2016
Rethinking due diligence practices in the apparel supply chain, 2015
After Rana Plaza: Spotlight on responsible business conduct, OECD Observer, 2014
One Year after Rana Plaza, 2014
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Updates in the pathogenesis, diagnosis and management of ectopic varices
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Ectopic varices (EcV) comprise large portosystemic venous collaterals located anywhere other than the gastro-oesophageal region. No large series or randomized-controlled trials address this subject, and therefore its management is based on available expertise and facilities, and may require a multidisciplinary team approach. EcV are common findings during endoscopy in portal hypertensive patients and their bleeding accounts for only 1–5% of all variceal bleeding. EcV develop secondary to portal hypertension (PHT), surgical procedures, anomalies in venous outflow, or abdominal vascular thrombosis and may be familial in origin. Bleeding EcV may present with anaemia, shock, haematemesis, melaena or haematochezia and should be considered in patients with PHT and gastrointestinal bleeding or anaemia of obscure origin. EcV may be discovered during panendoscopy, enteroscopy, endoscopic ultrasound, wireless capsule endoscopy, diagnostic angiography, multislice helical computed tomography, magnetic resonance angiography, colour Doppler-flow imaging, laparotomy, laparoscopy and occasionally during autopsy. Patients with suspected EcV bleeding need immediate assessment, resuscitation, haemodynamic stabilization and referral to specialist centres. Management of EcV involves medical, endoscopic, interventional radiological and surgical modalities depending on patients' condition, site of varices, available expertise and patients' subsequent management plan.
KeywordsAno-rectal varices Biliary varices Colonic varices Duodenal varices Intra-abdominal varices Isolated gastric varices type 2 Stomal varices
Argon plasma coagulation
Balloon-occluded retrograde transvenous obliteration
Computed tomography
- EcV
Ectopic varices
Endoscopic ultrasound
Extrahepatic portal venous obstruction
Gastric varices
Isolated gastric varices
Oesophageal varices
Portal hypertension
Randomized-controlled trials
Transjugular intrahepatic portosystemic shunt
The term "ectopic varices" (EcV) describes dilated portosystemic collateral veins located in unusual sites other than the gastro-oesophageal (G-O) region including the ectopic isolated gastric varices type 2 (IGV2). This definition has previously been given to any gastrointestinal mucosa-associated abnormally dilated tortuous veins that may lead to gastrointestinal bleeding. In addition, the term has also been given to any portosystemic collateral veins located in the abdominal wall or in the retroperitoneal space.
As no randomized-controlled trials (RCTs) have previously addressed the therapeutic modalities of EcV, most of the available knowledge about this entity is obtained from small case series, case reports and mini-reviews. Awareness of the existence and the therapeutic options of EcV is essential for any physician dealing with patients with gastrointestinal bleeding. This is crucial not only because EcV represent up to 5% of all variceal bleeding episodes [1] but also because of the difficulty in their management and the high mortality secondary to their initial bleeding (up to 40%) [2].
Nowadays, EcV are diagnosed more frequently because of the recent advances in radiological and endoscopic techniques such as double-balloon enteroscopy (DBE) and video capsule endoscopy (PillCam). Indeed, about 8.1% of patients with portal hypertension (PHT) who underwent capsule endoscopy have small-bowel varices [3]. In this review, we present the currently available knowledge relating to the sites, types, pathogenesis, diagnosis and management of EcV.
Recognized sites of EcV
Peristomal area
Biliary tree
Around the falciform ligament
Urinary bladder
Along the splenic ligament
Right diaphragm
Norton et al. [4] reviewed 169 cases of bleeding from EcV. Twenty-six of them were peristomal in origin, 17% in the duodenum, 17% in the jejunum or ileum, 14% in the colon, 8% in the rectum, 9% in the peritoneum, and few were located in other rare sites such as the vagina and the ovary [4]. Another rare site of EcV include the right diaphragm. On rupture, these varices present with acute dyspnoea and right-sided bloody pleural effusion [5]. Trans-anastomotic porto-portal varices are rare. They usually develop in the presence of extrahepatic PHT and presumably arise within the peri-anastomotic inflammatory tissue. Such varices may be difficult to manage and their prognosis is poor if they are bleeding [6].
EcV account for only 1–5% of all variceal bleeding episodes [1, 2, 7]. EcV represent a relatively common finding during endoscopy in patients with PHT. The prevalence of EcV varies according to the modality used for their detection, the patient population studied and the aetiology of PHT. For example, duodenal varices were detected in 40% of patients with intrahepatic PHT undergoing angiography [7], whereas ano-rectal varices have been reported in 10–40% of patients with liver cirrhosis undergoing colonoscopy [8, 9]. Colonic varices were reported in 3.4% of patients with intrahepatic PHT [10]. In addition, a recent study of 37 patients with liver cirrhosis who underwent capsule endoscopy, 3 (8.1%) were found to have small-bowel varices [3].
On upper endoscopy, most patients with duodenal varices have extrahepatic PHT. In fact, most patients with portal or splenic vein thrombosis on angiography are likely to show duodenal varices [4, 11, 12, 13, 14]. Intestinal varices have also been reported in a patient with prehepatic PHT secondary to cavernous malformation of the portal vein (portal cavernoma) and were associated with oesophageal varices (OV) [15]. Varices in other parts of the small bowel (jejunum and ileum) and in the colon are commonly seen in patients with intrahepatic PHT who have previously undergone abdominal surgery [11].
Stomal varices, particularly common in patients with intrahepatic PHT, are caused by primary sclerosing cholangitis [11]. Because of the low prevalence of extrahepatic PHT in the western countries, most cases of bleeding from EcV reported in the West are usually associated with intrahepatic PHT [11, 16]. These varices usually bleed at hepatic venous pressure gradients of 12 mmHg or less [17]. Similar to gastric varices (GV), a possible explanation for the lower portal pressure in patients with EcV could be the development of spontaneous spleno-renal shunts or a reduced portal collateral resistance [18]. The bleeding can be massive enough to cause mortality, and the source in such cases can only be identified at autopsy [19].
Estimated prevalence of EcV in different studies
Diagnostic modality
Patient population
n (% ) EcV
Kinkhabwala et al.
Transhepatic portography
Predominantly IHPHT
25 (5)
De Palma et al.
Capsule endoscopy
3 (8.1)
Small bowel
Stephan and Miething
1 (1.4)
Stephan and Miething
9 (27.3)
McCormack et al.
Predominantly IHPHT
4 (3.6)
Salam et al.
GI bleeders
6 (3)
GIT and GB
Wilson et al.
GI bleeding
5 (1.6)
Itzchak and Glickman
8 (40)
Tripathi et al.
TIPS patients
12 (2.5)
Sarin et al.
IHPHT and EHPHT
53 (4.6)
Aetiology and pathogenesis
Recognized causes of EcV
PHT (intrahepatic and extrahepatic)
Surgical procedures involving abdominal organs and vessels
Anomalies in the venous outflow vessels
Abdominal vascular thromboses
Hepatocellular carcinoma
Secondary to band ligation of O-G junction varices
Most of EcV represent natural portosystemic shunts that develop as a result of high portal pressure anywhere in the gut, around the ovaries, the biliary tree and the bare area of the liver. Under normal circumstances, such collaterals remain collapsed. However, in portal hypertensive patients, the portosystemic collaterals open in a trial to reduce the increased intrahepatic vascular resistance.
Any surgical operation involving apposition of abdominal structures (drained by the systemic veins) to the bowel (drained by the portal tributaries) may result in the formation of collateral vessels at an unusual site. An example is the development of ileostomy varices (stomal varices) in patients with primary sclerosing cholangitis who have undergone colectomy for ulcerative colitis [24]. In addition, bleeding jejunal varices were detected in a case of severe extrahepatic portal vein stenosis secondary to pancreaticoduodenectomy with portal vein resection and intraoperative radiotherapy [25].
Colonic varices may develop in the absence of PHT because of the anomalies in portal venous outflow as in patients with congenital anomalies of portosystemic anastomoses [26], abnormal vessel structure [27], arteriovenous fistulae [28] or they may be familial in origin [21, 27]. In addition, rectal varices may occur secondary to intra-abdominal vascular thrombosis [29].
Because tension in the varix wall is proportional to the radius of the vessel and the transmural pressure across the vessel wall, the major determinants of rupture of EcV are mostly vessel size, portal pressure and varix wall tension [30]. In addition, the prevalence of haemorrhage from rectal varices was shown to be significantly higher in patients with rectal varices of advanced form and/or with a positive "red-colour" sign [31].
Recognized presentations of bleeding from EcV
Overt gastrointestinal bleeding of obscure origin
Occult gastrointestinal bleeding
Accidental finding
Iron-deficiency anaemia
Internal haemorrhage (haemoperitoneum)
Hypovolaemic shock
Haemorrhagic pleural effusion
At autopsy
Patients with duodenal varices may present with haematemesis, or massive lower gastrointestinal bleeding [32]. In addition, EcV located distal to the duodenum present mostly with melaena or haematochezia [33]. Moreover, the presence of EcV should be considered in all patients with PHT and gastrointestinal bleeding if both upper and lower gastrointestinal endoscopies failed to show a definite source of bleeding.
Methods of detection of EcV
Push and DBE
Wireless video capsule endoscopy
Colour Doppler-flow imaging
Multislice helical CT
Contrast-enhanced 3D magnetic resonance angiography
TC-99m red blood cell scintigraphy
Angiography and CT-angiography
During laparotomy or laparoscopy
At autopsy
Varices in the abdominal wall usually rupture externally and can easily be diagnosed, whereas those located around the falciform ligament of the liver, in the diaphragm, in the rectovesical region, or on the splenic ligament may rupture into the peritoneal cavity causing internal bleeding and can be fatal [42, 43]. Diagnosis of cases with internal bleeding needs a high index of clinical suspicion and often presents with rapid accumulation of ascites associated with signs of hypovolaemic shock and a reduction in the haematocrit value. The diagnosis is further indicated by CT scan, which detects retroperitoneal varices and intra-abdominal bleeding or collections, and can be confirmed by the detection of a heavily bloodstained ascitic fluid tap.
Various techniques can be used to reveal the extent of portosystemic collaterals, the direction of flow and the pressure in the portal venous system. These include splenic portography, umbilical vein catheterization, percutaneous transhepatic portography and transjugular transhepatic portography at the time of or after transjugular intrahepatic portosystemic shunt (TIPS) insertion [44, 45, 46]. The last three modalities allow direct and selective access to the main tributaries of the portal vein, including the coronary-azygous collaterals, which represent a dominant mechanism in patients with PHT [47].
Role of capsule endoscopy (PillCam)
About 8.1% of patients with PHT who have undergone capsule endoscopy have small-bowel varices [3]. This number reflects a prevalence that is generally higher than expected and points to the role of capsule endoscopy as a non-invasive tool in the workup of patients with obscure gastrointestinal bleeding, including those with chronic liver diseases. Also, a case report by Fix et al. [48] has shown the significance of PillCam in diagnosing obscure gastrointestinal bleeding from mesenteric varices. It has also been found to be beneficial in detecting small-bowel varices in a patient after Whipple's operation [49]. Furthermore, PillCam as an alternative to upper endoscopy has been tested in 32 patients with liver cirrhosis for the detection of OG varices and portal hypertensive gastropathy [50]. In one patient, PillCam detected small varices that were not seen at endoscopy, and the overall concordance between both modalities was 96.9 and 90.6% for the diagnosis of varices and gastropathy, respectively, without any adverse effects related to PillCam [50]. A large-scale trial is underway to validate and expand these findings.
Role of DBE
At ileocolonoscopy, 18% of patients with liver cirrhosis and PHT have ileal varices [51]. DBE has the potential to visualize the whole small bowel, take biopsy specimens, and perform all necessary endoscopic interventions [52]. Hekmat et al. [53] have recently demonstrated a successful obliteration of a jejunal varix by using N-butyl-2-cyanoacrylate (Histoacryl) in a lesion found ∼240 cm from the ligament of Treitz. This signifies the therapeutic benefit of DBE over capsule endoscopy in small-bowel EcV. The widespread use of this modality in the future would help detect such varices and allow therapeutic intervention, and hence reduce rebleeding, transfusions, and may be mortality.
Management of bleeding EcV
Therapeutic options for EcV
Band ligation
Injection sclerotherapy
Argon plasma coagulation
Medical: β-blockers
Interventional radiology
TIPS ± embolization
Initial management
Similar to acute OG variceal bleeding, clinical assessment, resuscitation, haemodynamic stabilization, antibiotic prophylaxis and referral to specialist centres should be started as soon as possible in patients with suspected EcV bleeding.
The use of vasoactive drugs such as octreotide and terlipressin to reduce splanchnic blood flow and variceal pressure may be of benefit as in patients with bleeding from OG varices [54, 55]. The role of these vasoactive drugs in the control of bleeding from EcV has not been addressed.
All subjects with suspected variceal bleeding should undergo emergency upper endoscopy as a first-line investigation. If it fails to show the source of upper gastrointestinal bleeding, colonoscopy after a rapid colonic purge (3 litres of polyethylene glycol solution delivered via a nasogastric tube) should be the second step of investigation because in a series of 22% of French patients with EcV, bleeding was reported from the colon or rectum [8]. Colonic and rectal varices appear as serpiginous, dilated bluish vessels projecting into the lumen. However, if panendoscopy fails to identify and localize a variceal or a non-variceal source of bleeding, capsule endoscopy, DBE, transfemoral angiography or TC-99m red blood cell scintigraphy or other modalities, as mentioned above, would be the third step of the investigation.
Endoscopic treatment
The use of endoscopic modalities has been reported both in the setting of controlling acute bleeding from EcV and in the secondary prophylaxis. Therefore, depending on the currently available data, primary prophylaxis of EcV bleeding should not be recommended.
Band ligation
Only a few reports are available regarding the successful use of band ligation of EcV mainly in the rectum and duodenum [56, 57, 58, 59, 60]. It has also been reported that band ligation, together with balloon-occluded retrograde transvenous obliteration (B-RTO), is beneficial in the management of bleeding duodenal varices [59]. However, if the entire varix cannot be banded, there might be a high risk of developing a wide defect in the varix, especially after sloughing, rendering the banding technique unsafe for large EcV. It has been recommended that banding can be done only if the varix diameter does not exceed the diameter of the endoscope [4].
Injection sclerotherapy
Most EcV are within reach of standard endoscopy [11] or DBE [54]. Several studies have reported successful treatment of duodenal and rectal varices with sclerosant injection [61, 62]. The response to injection sclerotherapy can be unsatisfactory, especially with rectal and colonic varices, probably due to excessive dilution of the sclerosant in large varices beyond a concentration adequate to obliterate the varix. Therefore, a combination of sclerotherapy with banding in such a situation can be attempted [63]. Also, successful control of bleeding from duodenal, jejunal, colonic and rectal varices after injecting with cyanoacrylate, thrombin or any other combination of sclerosants has also been reported [53, 64, 65, 66, 67].
Argon plasma coagulation
The use of argon plasma coagulation (APC) as a supplemental treatment in the eradication and prevention of recurring oesophageal variceal after band ligation has been shown to be both effective and safe, and better than band ligation alone [68, 69, 70]. APC of EcV has been reported to be effective in stopping bleeding and eradicating ileocolonic anastomotic varices in a 65-year-old male patient [71]. The use of APC in preventing recurrence of endoscopically accessible EcV should be tested in more patients after initial eradication with other modalities such as band ligation or sclerotherapy.
Embolization therapy
Embolization, via intervention radiological techniques, of steel coils, thrombin, gel foam, collagen or autologous blood clot [72], either alone or in combination with band ligation or TIPS, is an effective short-term therapy for bleeding OG varices. The goal of this therapy is not to occlude the bleeding site itself but to occlude the feeding vein (i.e., the vein on the portal venous side) to the EcV. Steel coils are the preferred embolic materials because they lead to a permanent focal occlusion and are available in a variety of sizes, and allow occlusion of large veins without difficulty. The rate of bleeding control has been reported to reach 94% [73, 74]. Unfortunately, embolization does not decompress the portal venous system, resulting in high 1-year rebleeding rates [73]. The feeding veins can be reached via percutaneous transhepatic or transjugular routes.
Percutaneous embolization of bleeding EcV has been reported in the literature as case reports or case series [75, 76, 77, 78]. The transhepatic approach is usually preferred, especially in patients with active bleeding, because access to the portal venous system is faster than the transjugular approach. On the other hand, the transhepatic approach may be difficult in patients with portal vein occlusion, but is usually preferred if a subsequent TIPS is planned after variceal embolization [79, 80, 81]. Macedo et al. presented a retrospective review of 14 patients, 12 of whom had an abdominal surgery 2–38 years earlier, who underwent transhepatic embolization of coils into the draining veins for the management of bleeding EcV. Rebleeding occurred within 72 h in two patients, and recurrent bleeding from 23 days to 27 months after initial intervention was identified in nine patients. Therefore, it can be concluded that percutaneous coil embolization is a simple and safe treatment for bleeding EcV; however, recurrent bleeding is frequent and repeated intervention is often required. TIPS usually offers good control of bleeding at the expense of a more complex procedure and increased risk of encephalopathy [72]. Okasaki et al. [82] have recently reported a case of obliteration of bleeding giant rectal varices with the use of modified percutaneous transhepatic obliteration with sclerosant.
Medical treatment
The role of β-blockers in the primary and secondary prophylaxis of bleeding from OG varices is well established. However, no solid data exist regarding the use of β-blockers or nitrates in the long-term management of patients with EcV. Although an earlier study in 1986 had shown that β-blocker therapy was not effective in the management of peristomal varices [22], a recent report of three cases had shown their effectiveness [83]. Another case report suggests that β-blockers can be effective as secondary prophylaxis of duodenal variceal rebleeding, especially after simple oversewing of duodenal variceal veins [84]. It seems logical that this modality could be tried in patients with EcV, especially after the implementation of emergency endoscopic or surgical modalities or when patients cannot undergo a surgical shunt [85].
Surgical treatment
If endoscopic modalities or interventional embolization fail to control bleeding from EcV, creating a TIPS or proceeding with surgery is the optimal option depending on the availability of expertise, liver function and the cause of PHT. Direct surgery or local devascularization of the EcV is a useful minimally invasive procedure that does not take much time, does not involve resection of long segments of the small intestine and can be done even if the portal vein is not patent or if the patient has Child B or C cirrhosis [84, 86].
Surgery is preferred both in patients with Child-Pugh class A cirrhosis and in patients with an EPVO. Other surgical interventions reported to control EcV include simple oversewing of the duodenal varices through a duodenotomy [87], duodenal dearterialization and stapling [79], circumferential-stapled anoplasty [88] and double selective shunting [89].
The non-selective portosystemic shunts, such as mesocaval, portocaval or central splenorenal shunt, adequately decompress the portal circulation, but because they are considered major surgical procedures, they are not commonly used nowadays. Also, non-conventional portosystemic shunts using large collateral vessels may be performed in patients with EPVO, for example, children with extensive thrombosis of the portal venous system [90].
Transjugular intrahepatic portosystemic shunt
Many recent publications have addressed the role of TIPS in the successful control of bleeding EcV caused by intrahepatic PHT unresponsive to conservative or endoscopic management [17, 40, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101, 102]. The largest four series involved 12, 9, 24 and 21 patients who received TIPS for bleeding EcV [40, 100, 101, 103]. Although TIPS offers a highly effective modality for controlling bleed, the long-term survival of patients is mainly dependent on their liver function. The high efficacy of TIPS has to be balanced against the potential for increased encephalopathy and the procedure-related morbidity.
TIPS together with variceal embolization has the advantage of being effective, minimally invasive, can be performed in one session, does not preclude subsequent liver transplantation, and therefore may be used during the acute situation both as a bridge to transplantation and as the definitive therapy in patients unfit for surgery.
Balloon-occluded retrograde transvenous obliteration
B-RTO is a recent therapeutic technique for the management of patients with large GV. The technique is valuable in patients who bleed at lower portal pressures, patients with hepatic encephalopathy, and when the portal vein is not patent. Recently, B-RTO—alone or in combination with transiliocolic obliteration of vein—has also been shown to be effective in controlling bleeding of duodenal varices that failed endoscopic therapy in poor surgical candidates, without complications or recurrence for a period of up to 3 years [104, 105, 106, 107, 108]. However, its use is currently limited because of its low availability and lack of technical expertise, and caution is required in patients with large OV. Most of the available literature addressing this method originates from the Far East, mainly Japan, and the early results are promising. B-RTO might be a difficult procedure, but it works well if the doctors are familiar with the procedure.
Special types of EcV
Intra-abdominal varices
Varices in the abdominal wall usually rupture externally and therefore are easily recognized and treated with local compression and surgical ligation. Many cases of veins around the falciform ligament of the liver that rupture into the peritoneal cavity have been reported and are characterized by a rapid increase in ascites, particularly in the presence of abdominal pain, and associated with a decrease in the haematocrit value. Management of this situation is difficult because transhepatic obliteration of the varices is relatively contraindicated because of the accompanying ascites. Other modes of therapy include transjugular, intrahepatic embolization of the portal venous system, TIPS placement, and emergency surgical ligation of the bleeding varix, but this results in high mortality [109].
Stomal varices
The term "ectopic stomal varices" refers to abnormally dilated veins that have developed in the stomal mucosa. Stomal varices are commonly seen in patients with ileostomies after proctocolectomy for inflammatory bowel disease associated with primary sclerosing cholangitis and PHT [24]. Stomal varices are recognized by the purplish hue around the stoma. As the patient is usually aware of the bleed early in the clinical course, he or she may be taught how to control the bleeding with pressure. Therefore, mortality from bleeding stomal varices is relatively low (3–4%) [92]. A case report from Korea described the use of 2D reformatted and 3D volume rendered images by multidimensional-CT in a patient with an episode of acute bleeding from the colonic stoma [110]. Local measures, such as epinephrine-soaked gauze, pressure dressings, suture ligation, gel foam or refashioning the stoma, have all been applied successfully in controlling the initial bleeding episode [93, 111]. Injection sclerotherapy has also been tried, but it may cause mucosal ulceration, stomal orifice stricture and peristomal skin necrosis [112]. In patients with uncontrolled or recurrent bleeding, a portosystemic procedure should be contemplated. TIPS—alone on in combination with embolization therapy—is preferred to a surgical portosystemic shunt because patients with stomal varices may be candidates for liver transplantation [111, 113, 114, 115, 116].
Biliary tract varices
The development of biliary tract varices is a rare complication of PHT and sometimes is referred to as "pseudocholangiocarcinoma" or "pseudosclerosing cholangitis" or "portal hypertensive bilopathy". In a series of 42 patients with EPVO, gallbladder varices were detected by Doppler ultrasonography in 11 patients and choledochal varices in 9 patients [117]. Another study showed varices around the gallbladder and/or the biliary channels in 30% of patients [118]. Biliary varices are usually asymptomatic, often discovered accidentally, in the absence of other signs of PHT [119], but can lead to silent fatal outcomes [120]. Occurrence of varices around the common bile duct can result in extrahepatic biliary obstruction, cholangitis and haemobilia. The appearances of a biliary tree on endoscopic retrograde cholangiopancreatography may mimic those of primary sclerosing cholangitis [121]. Also, EUS can serve to diagnose biliary varices in patients with EPVO and jaundice. Although biliary varices are mainly asymptomatic, they may cause obstructive jaundice when they are located in the wall of the common bile duct. EUS can also detect unrecognized malignant tumours in patients with EPVO of undetermined origin [39]. Smith et al. [122] reported a case of severe gastrointestinal bleeding due to jejunal-biliary anastomotic varices. The anastomotic site was the location of the pressure gradient, from the high-pressure small-bowel varices to the low-pressure biliary tract. This was successfully treated by disconnection of the anastomosis and bile duct repair. Therapeutic modalities of biliary varices include surgical portosystemic shunt and endoscopic, radiological or even surgical biliary drainage procedures.
Ano-rectal varices
The misdiagnosis of ano-rectal varices as haemorrhoids can sometimes have devastating consequences. Therefore, it is important to differentiate anal varices from haemorrhoids. The former collapse with digital pressure, whereas the latter do not. Rectal varices are enlarged portosystemic collateral veins, which develop in patients with PHT as a pathway for portal venous blood flow from the superior haemorrhoidal veins (portal) to and through the middle and inferior haemorrhoidal veins (systemic). Massive bleeding from ano-rectal varices has been reported, but such reports are infrequent [123, 124, 125]. On the other hand, haemorrhoids represent a common cause of rectal bleeding, but their prevalence in patients with PHT is not higher than the general population [126]. Weinshel et al. [127] have published an excellent review of the differentiation, pathogenesis and management of these two entities.
Ectopic IGV type 2
Classification of GVa
IGV (GV occurring in the absence of OV)
G-OV (GV extending from OV into the stomach)
Type 1 (IGV1)
Type 2 (IGV2)
Type 1 (G-OV1)
Type 2 (G-OV2)
Varices located in the fundus that are often tortuous and complex in shape
EcV in the antrum, corpus and around the pylorus
Varices continuous with OV and extending along the lesser curve for about 2–5 cm below the G-O junction
Often long, tortuous, varices extending from the oesophagus below the G-O junction towards the fundus
IGV2 are present either in the body or on the antrum of the stomach or upper duodenum. Sarin et al. [131] have described the prevalence, natural history and clinical significance of these varices in a prospective study involving 1,128 patients with PHT. Of these patients, 53 (4.7%) had IGV2. These IGV2 were predominantly (84.9%) secondary in origin and located in the antrum (53%), duodenum (32%) or at both sites (11%), and rarely in the corpus or fundus (4%). Bleeding due to IGV2 was seen only in three (5.7%) patients during a mean follow-up of 36.3 ± 12.1 months and could be successfully managed with endoscopic ligation or obliteration [131].
Recommended future research
Because of the low incidence of EcV and the lack of valid reproduced RCTs addressing this complication, we recommend the establishment of an international Web-based EcV case registry through which a more precise epidemiologic, diagnostic, prognostic, prophylactic and therapeutic data can be obtained. Major referral centres should be encouraged to participate and register their cases and subsequently be involved in multicentre RCTs concentrating on the management of such patients. Also, comparative haemodynamic studies between patients with G-O varices and those with EcV are warranted.
Concluding remarks
Most of the available data about EcV are obtained from case reports or short series of cases.
EcV are being recognized more frequently nowadays because of the continuous advances in the endoscopic and imaging techniques.
Ectopic variceal bleeding is reported in patients with internal haemorrhage, hypovolaemic shock, occult gastrointestinal bleeding, anaemia or bleeding from the gut of obscure origin, especially in patients with PHT, following abdominal surgical procedures, in cases with extrahepatic venous obstruction or thrombosis, or anomalies of the portal venous system.
It is difficult to recommend general guidelines for the management of EcV and each case should be dealt with depending on the site and severity of bleeding and according to available expertise and facilities.
Patients with EcV bleeding must be considered difficult, should be managed in specialized canters, and have to be approached with a multidisciplinary team involving intensivists, gastroenterologists, surgeons and interventional radiologists.
Open Access
This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.


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Antoine de Saint Exupéry
Having successfully participated in the Opti 2016 in Munich, makellos.POTSDAM is now ready for the next optical fair.
Embedded in the location of a former metalworking shop from the 19th century, makellos.POTSDAM has now moved into its new showroom.
A new advertising campaign has been created under the supervision of the famous fashion photographer Bert Spangenmacher.


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Stripping Painted Finishes
Exploring the: Stripping Painted Finishes Zone
106 Results for: BlogSort by:
CCAI Awards 2016 Scholarships
CCAI awards scholarships from the CCAI Matt Heuertz Scholarship Fund to students in programs in technical schools, high schools and colleges geared toward coatings and finishing.
Axalta Hosts Annual Latin America Distributor Convention in Cancún
5-day event offered opportunities for distributors and other customers to hear from Axalta management about the latest global developments.
DeFelsko to Host SSPC Training This Fall.
Courses include the Protective Coatings Inspector Program and a workshop on using SSPC PA2 effectively.
CCAI Wisconsin Golf Outing Awards $14K in Scholarships
This event serves as the primary fundraiser for the chapter's James F. Wright scholarship program; he Wisconsin chapter awards scholarships to individuals studying finishing related fields including chemistry, environmental studies, business adminis...
CCAI Honors Chapter, Installs Officers and Board
The CCAI Chapter User and Supplier of the Year awards and the James F. and David J. Wright Lifetime Achievement Award were presented during the Annual Awards Ceremony, also held during the Annual Meeting.
PPG ice-deterrent coating for airplanes highlighted at Farnborough
Unique coating, which is still development, helps to eliminate ice build-up on airplanes for increased fuel efficiency, enhanced safety and less required maintenance.
Products Finishing's Steve Kline Jr. Delivers CCAI PCI Economic Talk
Director of Market Intelligence for parent company Gardner Business Media, spoke at the CCAI PCI annual meeting on the topic "2016 Economic Trends in Finishing."
Spray Equipment and Service Center Acquires FinishLine Technologies
FinishLine designs, building, installs, and services spray paint systems used within the industrial and automotive OEM paint and coating market.
PPG Expands Aerospace Coatings Development, Capabilities at UK Facility
$2 million investment supports installation of advanced-technology equipment for evaluating paint characteristics.
PPG Opens New Liquid Coatings Application Development Center in Wisconsin
Development center houses multiple curing ovens, robotic paint applicators and spray booths with temperature and humidity controls to mimic a wide range of liquid coatings application conditions.


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I am trying to setup email for the helpdesk module.
Our Internet and Email is provided by another company. All of which use a proxy.
The Exhange server name is : DB2PRD0103.mailbox.outlook.com
Error on outgoing settings: Unexpected response from the Exchange server received. Are you sure you entered the correct address? Error on incoming settings: Unexpected response from the Exchange server received. Are you sure you entered the correct address?
Please if anyone could suggest some ideas that would be great
This topic was created during version 5.0.
The latest version is 7.5.00101.
5 Replies
Nov 5, 2010 at 9:29 UTC
Connexa EDS is an IT service provider.
How do your users connect to the Exchange server. From what I understand Spiceworks offer two options, Exchange connectivity based on AD, and regular POP/IMAP/SMTP connectivity.
Best bet is to use the same method that your users use. Let us know and we should be able to point you in the proper direction.
Nov 5, 2010 at 9:54 UTC
The users have two ways either live.com or use the county portal (which uses live.com)
Nov 5, 2010 at 10:21 UTC
Connexa EDS is an IT service provider.
Hmmm that's a tough one, so they all use webmail? If they use outlook inspect their current setups to how they are configured.
Have you tried using the exchange setup yet? It just may work.
Nov 5, 2010 at 11:07 UTC
We have this (Attached) to configure the outlook 2007 clients. I have tried the server but same error.
Nov 5, 2010 at 11:23 UTC
Connexa EDS is an IT service provider.
Ahh, you're using RPC over HTTPS (tunnels Exchange Calls through HTTPS), I'm almost certain that Spiceworks doesn't support that.
You may be SOL with live.com
You could maybe setup an account and forward that to a gmail account or something. Then use it for your Helpdesk.
You could also setup and outbound only SMTP server. Your helpdesk can send out notifications and such, but the user would have to use the User Portal to submit tickets. If your running Linux just use sendmail and Windows can use hMailServer.
Sorry I couldn't be of more help, just not that familiar with live.com
This discussion has been inactive for over a year.
You may get a better answer to your question by starting a new discussion.


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On Monday, October 24, 2016 this Target Toy Catalog was leaked to us. The catalog contains 80 pages of various coupons and offers on some of the hottest toys of the season. By using Target's Cartwheel, you can save 50% every single day on a different toy. You can also download the Target Kids' Wish List App, and be eligible for an additional 10% off the sale prices. The best part is that all of the toys are eligible for free shipping and free returns. Before shopping, make sure you look at page three for a 20% off coupon for a toys, sporting goods, or kids' arts and crafts purchase.


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PORTLAND, Ore. (AP) Bobby McClintock ran for four touchdowns Saturday to lead Portland State to a 31-14 win over Western Oregon.
McClintock, who missed almost all of last season with a knee injury, rushed for 48 yards against the Wolves, mostly in short-yardage situations. Quarterback Drew Hubel came off the bench to complete 28-of-40 passes for 305 yards.
It was the first meeting between Portland State and Western Oregon, a Division II school, since 1977. Despite the loss, Western still holds a 11-9-1 edge in the all-time series.
Hubel relieved starting quarterback Tygue Howland with the Vikings clinging to a 7-0 lead midway through the second quarter. Howland had completed 9-of-21 passes and was intercepted once.
The Vikings padded their lead early in the third quarter, when McClintock scored on a three-yard run one play after Western Oregon quarterback Brady Lovell lost a fumble.
The Wolves quickly responded with a drive highlighted by Ben Kuenzi's 53-yard run. Western scored two plays later on a six-yard pass from Josh Riddell to Demario Ballard.
But Portland State replied with a 66-yard drive capped by McClintock's one-yard run. Danny Urrego's 31-yard field goal extended the lead to 24-7 and McClintock's fourth TD of the afternoon sealed the victory.
Kuenzi led the Wolves with 78 yards rushing, and Riddell was 7 of 14 for 93 yards and two touchdowns.
The Associated Press
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Advanced weapons in the wrong hands
January 9, 2013
The first four words of the second amendment are: "A well ordered militia…" Does anyone seriously believe that any of the over 70 school killings since 1990 were perpetrated by a member of a "well organized militia?" Can we not all agree that technologically advanced weapons should only be in the hands of people we expect to protect us: Armed Forces, National Guard and Police? And that the general non-military population, with it's sprinkling of invisible murderous sociopaths, should have no access to these gadgets?
William Durbrow
Grass Valley
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The Metropolitan Opera: The Merry Widow Encore (NR)
Synopsis: The Met Opera's encore performance of Lehár's The Merry Widow will be shown in select cinemas on Wednesday, January 21 at 6:30 p.m. in all time zones. Please note: not all cinemas showing the live transmission will present an encore showing.
The great Renée Fleming stars as the beguiling woman who captivates all of Paris in Lehár's enchanting operetta, seen in a new staging by Broadway virtuoso director and choreographer Susan Stroman (The Producers, Oklahoma!, Contact). Stroman and her team, set designer Julian Crouch (Satyagraha, The Enchanted Island) and costume designer William Ivey Long (Cinderella, Grey Gardens, Hairspray), have created an art-nouveau setting that climaxes with singing and dancing grisettes at the legendary Maxim's. Nathan Gunn co-stars as Danilo and Kelli O'Hara is Valencienne. Sir Andrew Davis conducts.
Genre: Program
Runtime: 03:00
Starring: Renée Fleming, Kelli O'Hara, Nathan Gunn, Alek Shrader, Thomas Allen
Release Date: January 21st, 2015
* "No passes" indicates that there are no discounts, promotional passes or complimentary passes accepted due to film company restrictions (rain checks are accepted).


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A stranger walks into Caroline's life and calms her nerves about looking after Flora on her own. Saturday, July 22 at 8 PM
On Second Thought is a one-hour, daily news talk show that airs at 9 a.m. ET weekdays.
The unemployment rate is now the lowest it's been in more than a decade.
The GHSA state championships for football are right around the corner. There are 16 teams left on the road to the Georgia Dome and by late Saturday night all eight champions for 2016 will be... MORE
GPB Passport is the new member benefit that provides you with extended access to an on-demand library of quality local and national public television programming, including tens of thousands of hours of your favorite programs.
Fri., February 28, 2014 4:16am
Former Bibb School Superintendent Dallemand Spent $26 Million Without Approval
Romain Dallemand repeatedly violated school board policy by ordering more than $26 million in technology equipment and services without required, prior approval from the board, according to a 2013 audit of the school system.
Full Story
Wed., March 13, 2013 12:10pm
Bibb Superintendent 'Extremely Sad' To Go
GPB has obtained previously unseen footage of former Bibb County schools Superintendent Romain Dallemand discussing his sudden departure last month. Dallemand made international headlines by instituting universal Mandarin Chinese classes, but promptly disappeared from the public eye after negotiating a six figure contract buyout with the school board.
Wed., February 27, 2013 1:55pm
Dallemand Gone, Students Disappointed
Bibb County public school students say they're disappointed by the circumstances that led to Superintendent Romain Dallemand's abrupt departure.
Tue., February 26, 2013 2:56am
Bibb Schools Ousts Dallemand
The Bibb County School Board has voted to buy out Superintendent Romain Dallemand. The board voted 7-1 Monday and agreed to pay Dallemand a lump sum of $350,000.
Tue., December 4, 2012 6:21am
Bibb Schools Retains Dallemand
The Bibb County Board of Education on Monday night extended Superintendent Romain Dallemand's contract. The 5-3 vote means Dallemand's new term will start Jan. 1, 2013, and end Dec. 31, 2015.
Wed., September 19, 2012 12:47am
Bibb Schools Defend Discipline Policies
Bibb County Deputy Superintendent for Student Affairs Ed Judie discusses the on-going controversy over the administration's new discipline policies, and defends the principle that it's better to keep troubled kids in the classroom.
Mon., September 10, 2012 5:16am
Major Discipline Problems At Bibb Schools
The Telegraph finds serious repercussions for disciplinary infractions in Bibb County schools have plummeted.
Fri., March 11, 2011 6:40am
Bibb Schools To Cut 16 Jobs
Bibb County schools superintendent Romain Dallemand has presented a new organizational chart that will eliminate 16 administrative jobs and add six new ones.
Wed., November 10, 2010 10:40am
Bibb Co. Schools Get New Chief
Rochester, Minn superintendent Romain Dallemand has been chosen to lead the school system, replacing Sharon Patterson who was forced out earlier this year.


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Home > Wellness > Health Library > Walking boot or cast
Browse and register for related classes.
Having a walking boot or cast
forces you to rest your foot, which helps relieve your heel pain.
ByHealthwise StaffPrimary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency MedicineE. Gregory Thompson, MD - Internal MedicineAdam Husney, MD - Family MedicineSpecialist Medical ReviewerMartin J. Gabica, MD - Family Medicine
Current as ofMay 23, 2016
Current as of:
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Founded in 1958, Crowe Soberman is one of the premier chartered professional accountant firms in Canada. We serve clients worldwide as an independent member of Crowe Horwath International, one of the largest accounting networks in the world. Our reputation for providing quality professional services is vital to our success.
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"The proof of the quality of Daniel's evidence is the result of the trial – the jury awarded my client compensation for the loss of income (a seven figure sum) that mirrored Daniel's reports and evidence almost to the letter."
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text: United States Natural Gas Fund ( UNG) -1.4% Natural gas prices are tumbling for a third day, leading UNG to carve out yet another all-time low. GAZ is taking a hit as well. However, the premium-laden ETN's losses come as it is in the process of testing previous 2012 highs. GAZ's premium has grown to a staggering size, at over 100%. Buyer beware. All prices as of 2:11 PM EST Written by Don Dion in Williamstown, Mass.


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Need a Chicken Pox Titer in Mason, OH? Simply order online 24/7 and get a fast, affordable Chicken Pox Titer at a lab near you (Find More Locations):
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The Chicken Pox Titer is a blood test used to prove immunity to Chicken Pox. People in Mason, OH get the Chicken Pox Titer for general screening or for credentialing for work or school.
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Facebook is now willing to spy for you!
Basically Facebook will keep the ball in your court to decide if an account in question is an impersonation of you profile. If you believe that the account is a duplicate one, a dedicated team at Facebook will manually review the said account before shutting it down. This way, Facebook will ensure no innocent profiles are being harmed.
As a relief to a lot of users in open societies, not-so-open societies and societies where blasphemy or physical exposure means death, the end of fake or impersonating profiles will come as a big relief. A number of fake profiles are also being used to promote character assassinations, twisting ideologies and deceiving the public and thus deserve a quick demise.
The feature in question has been in testing since November and has been rolled out to 75 per cent of Facebook's global user base till date. In the process, Facebook has interacted with NGOs, activists, social groups and users to get new ideas and feedback on ensuring security and privacy of individual profiles.
Step away from those Facebook quizzes NOW!
"We heard feedback prior to the roundtables and also at the roundtables that this was a point of concern for women. And it's a real point of concern for some women in certain regions of the world where it [impersonation] may have certain cultural or social ramifications," said Antigone Davis, Facebook's Head of Global Safety to Mashable.
Facebook has also been at the forefront of the worldwide defence to state-sponsored legislations and actions that undermine encryption and user privacy. Back in October, Facebook announced that it will warn users if their profiles were snooped on by Government security agencies.
Facebook's Android app can now be accessed using Tor!
"Starting today, we will notify you if we believe your account has been targeted or compromised by an attacker suspected of working on behalf of a nation-state," said Alex Stamos, Chief Security Officer at Facebook.
He further wrote that Facebook will only warn users if it is convinced that agents of the state are trying to snoop on your profile. This will ensure you will know if you're under attack and you won't have to worry about deleting your profile to safeguard your privacy.