73.7 Tb/s (96 x 3 x 256-Gb/s) mode-division-multiplexed DP-16QAM transmission with inline MM-EDFA.

Transmission of a 73.7 Tb/s (96 x 3 x 256-Gb/s) DP-16QAM mode-division-multiplexed signal over 119 km of few-mode fiber transmission line incorporating an inline multi mode EDFA and a phase plate based mode (de-)multiplexer is demonstrated. Data-aided 6 x 6 MIMO digital signal processing was used to demodulate the signal. The total demonstrated net capacity, taking into account 20% of FEC-overhead and 7.5% additional overhead (Ethernet and training sequences), is 57.6 Tb/s, corresponding to a spectral efficiency of 12 bits/s/Hz.

Peritoneocele and enterocele. Formation and transformation during rectal evacuation as studied by means of defaeco-peritoneography.

PURPOSE: To study, by means of defaeco-peritoneography, the formation and transformation of the peritoneocele, with and without an enterocele, during rectal evacuation. MATERIAL AND METHODS: Forty-six patients with a peritoneocele at defaeco-peritoneography were selected for the study, and examined at three different stages: 1) at the start with a contrast-filled rectum; 2) at maximum straining; and 3) at rest after rectal evacuation. RESULTS: Fourteen patients had a peritoneocele at the start. These peritoneoceles were largest at maximum straining and were all still present at rest after rectal evacuation. In 32 patients defaeco-peritoneography was regarded as normal at the start. At maximum straining these patients developed a peritoneocele and 20 of these were still present after rectal evacuation. No enterocele was seen at the start. At maximum straining 21 patients developed an enterocele and 15 of these were still present after rectal evacuation. Liquid in varying amounts was found in the peritoneoceles. CONCLUSION: The present study demonstrated that peritoneoceles were present at different stages of the defaeco-peritoneographic investigations. Peritoneoceles were most frequent and largest at maximum straining. An enterocele was present in half of the peritoneoceles at maximum straining, but never at the start. Liquid was often present in the peritoneoceles.

Defaeco-peritoneography in the diagnosis of rectal intussusception and rectal prolapse.

PURPOSE: The aim of the present study was to evaluate the use of defaeco-peritoneography in diagnosing rectal intussusception as distinct from mucosal folds in the rectum, and rectal prolapse as distinct from mucosal prolapse. MATERIAL AND METHODS: Fifty-seven patients with defaecation disorders were examined by means of defaeco-peritoneography. RESULTS: Twenty-three patients had rectal intussusception and 7 patients had rectal prolapse at defaeco-peritoneography. All these patients had a rectal peritoneocele in the serosal ring-pocket of the rectal intussusception or in the rectal prolapse. Twenty-seven patients had neither rectal intussusception nor rectal prolapse and none of these patients had a rectal peritoneocele. CONCLUSION: The present study demonstrated that only patients with a rectal intussusception or rectal prolapse have a rectal peritoneocele. Defaeco-peritoneography therefore offers correct diagnosis of rectal intussusception as distinct from mucosal folds in the rectum, and of rectal prolapse as distinct from mucosal prolapse.

Peritoneocele: visualization with defecography and peritoneography performed simultaneously.

PURPOSE: To evaluate the use of simultaneous defecography and peritoneography (defecoperitoneography) in patients with an unexplained widening of the rectovaginal space noted at defecography. MATERIALS AND METHODS: Twenty-two patients with unexplained widening of the rectovaginal space noted at defecography were studied with defecoperitoneography. Defecoperitoneography was a combination of defecography and peritoneography with water-soluble contrast medium administered intraperitoneally. RESULTS: The outline and movements of the peritoneum and alterations in the pelvic peritoneal cavity could be visualized with defecoperitoneography during the dynamic act of defecation. Unexplained widening of the rectovaginal space was completely due to a peritoneocele in 14 patients and partially due to a peritoneocele in six patients. In two patients, there was no peritoneocele. Only nine of 22 patients had bowel in the unexplained widening (enterocele). Three patients had a rectal peritoneocele; six, a septal peritoneocele; one, a vaginal peritoneocele; and 10, a combination of these findings. CONCLUSION: Visualization of the pelvic floor with defecoperitoneography is improved compared with visualization with defecography alone.

Pelvic anatomy and pathology is influenced by distention of the rectum: defecoperitoneography before and after rectal filling with contrast medium.

PURPOSE: The aim of the present study was to evaluate how distention of the rectum with contrast medium at defecoperitoneography affected pelvic anatomy, i.e., position, form, and size, of organs and pouch of Douglas. PATIENTS AND METHODS: Twenty-six female patients with a peritoneocele at defecoperitoneography were selected for the present study. Radiographs taken at the start, before, and after filling the rectum with contrast medium were compared. RESULTS: There was an obvious change in the position of the organs in the pelvis when the rectum was distended with contrast medium. The peritoneocele disappeared completely in 19 of the patients and was reduced in size in the remaining 7 patients, and the enterocele disappeared completely in 13 patients. The small bowel and vaginal portion of the uterus moved cranially. CONCLUSIONS: A distended rectum may conceal existing pathology, such as peritoneocele and enterocele, at defecoperitoneography. Defecoperitoneography should, therefore, include a radiograph before the rectum is filled. This radiograph shows the habitual anatomy of the patient in the sitting position and may demonstrate pathologic findings.

Simultaneous defecography and peritoneography in defecation disorders.

UNLABELLED: A number of physiologic and radiologic investigations are used in investigating defecation disorders. Defecography is one important part of these investigations. However, a correct diagnosis of an enterocele is sometimes difficult despite use of contrast media in the rectum, vagina, and small bowel. PURPOSE: This study was undertaken to ascertain if it was technically possible to perform simultaneous defecography and peritoneography in an effort to improve the diagnostic possibilities in patients with defecation disorders. METHODS: Twelve patients with defecation disorders and an unexplained widening of the rectovaginal space at defecography were investigated. Contrast medium was introduced intraperitoneally, after which conventional defecography was performed. RESULTS: All investigations were carried out without complications and demonstrated the peritoneal outline in all patients. Simultaneous defecography and peritoneography differentiated between an enterocele and a pathologically deep pouch of Douglas--a peritoneocele. Three types of peritoneocele were visualized: vaginal peritoneocele, septal peritoneocele, and rectal peritoneocele with or without enterocele. Combinations of the three types were also found. Eight of the 12 patients had rectal intussusception or rectal prolapse. All of these eight patients had a rectal peritoneocele. CONCLUSIONS: Simultaneous defecography and peritoneography can be performed without technical difficulties or complications. Peritoneal outlines and pouches can, therefore, be studied directly during the act of defecation. An unexplained widening of the rectovaginal space at defecography can be clarified as a peritoneocele, with or without an enterocele. Peritoneocele can be of three different types: rectal, septal, or vaginal.

Defecography. Results of investigations in 2,816 patients.

PURPOSE: This study was designed to analyze the frequency of different findings at defecography in patients with defecation disorders and see in what way the evaluation could be improved. METHODS: The reports of investigations in 2,816 patients were analyzed. RESULTS: Twenty-three percent of the investigations were considered normal. Thirty-one percent of the patients had rectal intussusception, 13 percent had rectal prolapse, 27 percent had rectocele, and 19 percent had enterocele. Twenty-one percent of the patients had a combination of two or three of these diagnoses. The combination of rectocele and enterocele was rare. The majority of patients with enterocele had other concomitant findings. Patients with or without abnormal perineal descent had similar frequencies of rectal prolapse, rectal intussusception, and enterocele. Rectocele was more common in patients with abnormal perineal descent. CONCLUSIONS: Defecography is valuable when investigating patients with defecation disorders. Pathologic findings were found in 77 percent of the patients. A standardized protocol should ensure a complete evaluation of defecography.

Radiocolloid uptake in spontaneous osteonecrosis of the knee. A case report.

Bone marrow scintigraphy, including radionuclide angiography in a 66-year-old woman with spontaneous osteonecrosis of the medial femoral condyle, showed a marked increase in radiocolloid uptake in the affected condyle. Radiocolloid uptake (reflecting phagocytic activity at the osteonecrotic lesion) was correlated with findings on roentgenography, three-phase bone scintigraphy, and magnetic resonance imaging.

Colloid scintigraphy showing red bone marrow extension in patients with prostatic carcinoma.

In 25 of 30 patients with bone metastases from prostatic carcinoma, red bone marrow extension was observed by scintigraphy of the reticuloendothelial system (RES). The degree of bone marrow extension in the lower extremities increased with increasing number of bone metastases. In 8 patients, 15 peripheral metastases were detected, all located in areas with extended red bone marrow. The distal level of bone marrow extension coincided with that of the most distal metastases. This is of importance for the detection of peripheral metastases at risk for fracture. Bone marrow extension was also seen in 5 of 8 patients with prostatic carcinoma without bone metastases and was interpreted as a paramalignant activation of RES.

Bone marrow scintigraphy in Paget's disease of bone.

Sixteen patients with 20 lesions of Paget's disease of bone were studied with bone marrow scintigraphy (colloid), bone tissue scintigraphy and radiography. Bone marrow scintigraphy showed normal or increased colloid uptake in 15 of 20 pagetic lesions, and decreased uptake in 4. Bone tissue scintigraphy showed increased metabolic activity in all lesions and was useful in detecting polyostotic disease as well as the extent of the lesions. Conventional radiography most often showed the typical appearance of Paget's disease, but the changes observed were sometimes difficult to differentiate from malignant disease. However, a preserved or increased reticuloendothelial function in the pagetic lesion contradicts metastatic disease as a differential diagnosis. Bone marrow scintigraphy with radiocolloid is a valuable method in the analysis of Paget's disease of bone.

Generalized increase of arterial blood flow to the liver observed at visceral radiocolloid angiography.

Visceral radiocolloid angiography was performed in 1230 consecutive patients studied with scintigraphy of the reticuloendothelial system (RES). The hepatic arterial flow was considered increased if an early and obviously increased accumulation of the radiocolloid occurred in the liver during the visceral radionuclide angiography, i.e. that the early part of the liver time-activity curve coincided with the early parts of the kidney and spleen time-activity curves with respect to time and steepness. A generalized increase of arterial blood flow to the liver was found in 70 patients, of whom 54 per cent had alcoholic liver disease. 20 per cent metastatic liver disease, 19 per cent had various diagnoses, and in 7 per cent no certain diagnosis was found. Generalized increase of arterial blood flow to the liver gives a typical appearance in radiocolloid angiography and the corresponding time-activity curves. It may be a sign of severe disease, most often localized in the liver, but in some cases it may be of extrahepatic origin. In 27 per cent it was the only obvious pathologic finding. It was in a few cases a reversible condition. Generalized increase of arterial blood flow to the liver is a clinically important finding that could escape detection if radionuclide angiography is not included in the RES scintigraphy.

Radionuclide angiography and scintigraphy in hepatocellular carcinoma.

Among 1 257 patients subjected to liver-spleen (RES) scintigraphy and radionuclide angiography (RNA), there were 13 cases of histologically confirmed hepatocellular carcinoma (1%). All 13 patients had scintigraphic findings indicating cirrhosis. Histologically, cirrhosis was present in only 9 out of 11 cases in which liver parenchyma was available for examination. One patient had hemochromatosis without evidence of cirrhosis. In 11 cases, the tumor was clearly demonstrated as a defect in the static scintigram. However, in 2 cases with cirrhosis and poorly differentiated hepatocellular carcinoma, the tumor nodules were hardly discernible. In RNA, the tumor displayed high activity in the arterial phase and decreasing activity during the portal phase, ending up as a defect. At RNA, the lesion was clearly outlined in 12 cases, including the 2 patients in whom the scintigraphic findings were inconclusive; in one case with severe cirrhosis and a well differentiated hepatocellular carcinoma, the tumor was barely detectable. We conclude that a combination of RNA and scintigraphy is a valuable screening which usually provides a correct diagnosis in hepatocellular carcinoma.

Recording of bone marrow activity in liver-spleen (RES) scintigraphy.

The bone marrow activity in the liver-spleen (RES) scintigraphy has been difficult to estimate correctly. If the activity of the bone marrow is to be decided as counts/time unit it is of importance that structures with a high activity as the liver and spleen are excluded from the registration. A dorsal registration of the pelvis during 180 s will give a rather correct information of bone marrow activity and besides an image of the pelvic bone marrow is obtained. Using 270 to 280 MBq 99Tcm-Albures all 45 normal cases had values below 150 KCNT (1 KCNT = 1 000 counts). All cases with cirrhosis (n = 15) or metastases in the liver (n = 14) had values over 150 KCNT. Values over 150 KCNT were also found in 29 of 34 patients with an increase in ASAT and ALAT (GOT, GPT) as the only pathologic finding and in 12 of 21 patients with a carcinoma but without metastases in the liver.

Angiography with epinephrine and beta receptor blocker in diagnosis of sigmoid lesions.

Various sigmoid lesions, seen on barium enema of 39 patients, were investigated with angiography of the inferior mesenteric artery using three series. The first was performed with contrast medium only, the second after use of epinephrine, and the third after a beta-blocking agent (propranolol) combined with epinephrine. The patients were followed for more than three years. Eleven carcinomas were detected, all diagnosed angiographically. Carcinoma, radiation fibrosis, and diverticulitis with fibrosis may appear similar on pharmacoangiography, but the inflammatory reaction seen, for example in diverticulitis, is different. These findings are important because they can have an influence on the indications and selection of the most suitable operation to be performed.

Influence on symptoms and transit-time of Vi-SiblinR in diverticular disease.

Nine patients complaining of constipation and with diverticuli of the colon on barium-enema were examined with regard to transit-time, bowel movements and subjective symptoms. They were treated with placebo and Vi-SiblinR, using a doubleblind cross-over technique. The transit-time remained normal during the Vi-SiblinR treatment. The feces became softer and increased in weight and the subjective symptoms were significantly reduced (p less than 0,05).

Effect of somatostatin on regional splanchnic blood flows in man. Angiographic studies.

The effect of somatostatin (1 microgram/kg b.w. i.v. over one minute) on regional splanchnic blood flows was studied in nine patients subjected to diagnostic angiography of the coeliac artery, the superior mesenteric artery or the aorta. Following somatostatin there was a prolongation of the circulation times and a marked constriction of the hepatic and splenic vascular beds corresponding to a 50% decrease in blood flow. Blood flow in the gastroduodenal, pancreatic, superior mesenteric and renal arteries was also decreased, but to a lesser extent. There was no effect on the lumbar arterial flow. The time for maximum filling of the portal vein was delayed and the contrasting effect in this vessel was decreased, indicating a decrease in portal flow. It is concluded that somatostatin reduces splanchnic blood flow in unanaesthetized man, while there is no decrease in skeletal muscle blood flow. It is suggested that this effect of somatostatin is due to a direct action on vascular receptor sites.