Studies of multilayers and thin-foil x-ray mirrors using a soft x-ray diffractometer.

A versatile x-ray diffractometer is described in detail. Two applications to the study of x-ray optical elements are presented. The first is a Bragg reflection study of state-of-the-art multilayers deposited both on conventional Si-wafer substrates and on superpolished substrates such as fused quartz and electroless nickel. These data are compared to data previously obtained at FeKα. The second study is a reflectivity and scattering study of various thin-foil x-ray reflectors proposed for up-coming x-ray satellite missions. All the data have been obtained at MgKα = 1.2536 keV.

Prognostic staging of extraperitoneal rectal cancer.

In 375 patients who had curative resection for cancer of the rectum below the peritoneal reflection, prognosis was evaluated according to four currently used staging systems, i.e., Dukes' system, the modified TNM system described by the American Joint Committee for Cancer Staging, The Australian Clinicopathological Staging System, and The Astler-Coller Staging System. Dukes' Staging System, which originally was described for use in rectal cancer, gives as good a prognostic separation as any of the other staging systems, some of which include serosal involvement as a staging criteria, which cannot be used for cancer of the extraperitoneal part of the rectum. It is furthermore demonstrated that an important prognostic separation can be obtained by dividing the B group of Dukes' Staging System into tumors that reach the surface of the muscularis propria and those with demonstrable invasion of extrarectal structures, the latter having as bad a prognosis as Dukes' C tumors.

Videodefaecography combined with measurement of the anorectal angle and of perineal descent.

Cineradiographic defaecography combined with measurement of the anorectal angle and descent of the pelvic floor is proposed. The method used in 73 women gave valuable information in 48 patients who complained of anal incompetence, rectal tenesmus, and chronic constipation. In these patients, high and low rectal intussusception, rectocele, and pathologic movement of the pelvic floor were detected. Some of these phenomena could only be diagnosed by the radiologic method here described. Quantitations of the anorectal angle and descent of the pelvic floor placed the group with constipation halfway between normal individuals and those with anal incompetence. The value of this finding is discussed. Recent improvements in anorectal surgery often make videodefaecography decisive for the choice of the optimal operative method. Therefore, videodefaecography together with measurement of the anorectal angle and pelvic floor descent is recommended whenever anorectal surgery for correction of functional disturbances is contemplated.

Incidence of fistula-in-ano complicating anorectal sepsis: a prospective study.

The incidence of fistula-in-ano following anorectal abscesses was studied prospectively in 50 consecutive patients. A total of 13 patients (26 per cent; 95 per cent confidence limits: 14-40) had a fistula diagnosed either in the acute phase or during follow-up within 6 months. Half of the fistulas diagnosed at follow-up were unrecognized by the patients and no fistulas developed in patients where culture from the abscess only revealed skin-derived bacterias. X-ray examination was of no value in the diagnosis of anal fistula.

Primary results after resection and anastomosis for mid-rectal cancer with a new stapling instrument. A preliminary report.

Early results after resection with primary anastomosis for cancer of the mid-rectum using a new stapling instrument are reported. 20 patients with an adenocarcinoma 7-12 cm from the anal verge were operated. On patient died postoperatively from respiratory complications but with no sign of anastomotic dehiscence. One patient had a clinically recognizable leakage which closed spontaneously within 2 days. Three patients had roentgenologically demonstrable leakage but no clinical symptoms. On examination, 1-3 months after the operation, all patients were continent for feces as well as for gas and none had more than four bowel movements per day. Resection and anastomosis by means' of the stapling instrument is practicable even at the lowest level, and is far less time consuming and does not require the same degree of training as low anterior resection with conventional suture anastomosis.

Yersinia enterocolitica infection in patients with acute surgical abdominal disease. A prospective study.

The rate of yersiniosis in patients with acute abdominal disease was studied in a 16-month prospective investigation in 1972-1973 of 205 acutely ill patients referred to a surgical clinic of a Copenhagen City hospital with complaints of abdominal pain suggestive of appendicitis. Yersinia enterocolitica, biotype 4, was isolated from 11 patients (5.4%), 8 of whom were children. Yersinia was grown from faeces in 8 cases and from appendix of all 9 patients operated upon. Rising or falling agglutinin titres larger than or equal to 100, indicative of yersiniosis, were found in 22 patients (10.7%) including all bacteriologically verified cases. Eight additional patients (3.9%) had less significant titres larger than or equal to 100, suggestive of recent or present infection. 28 patients (13.7%) had insignificant titres, including 3 with antibodies against serotype 9. In all cases except these 3, antibodies were against Y. enterocolitica, serotype 3. A differential diagnosis between Y. enterocolitica infection and other types of appendicitis could not be made within this highly selected group of patients using available clinical data. All cases were rather mild and self-limiting. It is suggested that in future epidemiological and other studies of yersiniosis, early bacteriological and serological examinations be carried out.