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Study Objective: To correlate tracheal width as measured by ultrasound with width measured by computed tomography (CT), and to evaluate the possible role of ultrasound in the selection of the proper size of left-sided double-lumen endotracheal tubes (LDLTs)., Design: Two independent, prospective, observational clinical studies (Study 1 and Study 2)., Setting: University hospital., Patients: Study 1 included 25 patients and Study 2 included 20 adult thoracic surgery patients who required a LDLT during anesthesia., Interventions and Measurements: In Study 1, CT measurements of tracheal width were made at the coronary plane 0.5 cm above the sternoclavicular joint; CT measurements of the left main bronchus diameter were made 1 cm below the carina. Ultrasound measurement of tracheal width was performed just above the sternoclavicular joint in the transversal section. In Study 2, patients' tracheas were intubated with a LDLT based on ultrasound measurements. The frequencies of incorrect selections of LDLT and unsatisfactory lung collapse were analyzed., Main Results: There was a strong correlation between tracheal width as measured by ultrasound and tracheal width (r=0.882, P<0.001) and left main bronchus width (r=0.832, P<0.001) as measured by CT. In 5 cases (25%), the incorrect LDLT by ultrasound was selected; and one (5%) was found to have an unsatisfactory lung collapse., Conclusion: Measurement of the outer tracheal width by ultrasound can be a useful method for predicting the diameter of left main bronchus and for selecting a LDLT.

There are only a few reported cases of synovial chondromatosis affecting pisotriquetral joint (PT). Osteoarthritis of the PT is also rare and can be as disabling as osteoarthritis of any other joint. We report this to be the unique case of synovial chondromatosis of the PT joint with secondary osteoarthritis.

Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive imaging test with excellent overall sensitivity and specificity for demonstrating the level and presence of biliary obstruction. Selected MRCP sequences allow relatively stagnant fluids, such as bile and pancreatic juice, to have a high-signal intensity compared with the dark signal of adjacent solid organs and circulating blood, without the use of a contrast agent. Its inability to offer therapeutic interventions is a major weakness of MRCP. MR cholangiopancreatography demonstrates biliopancreatic system at the coronal planes similar to direct cholangiography. Due to very high negative predictive value, MRC has a potential to substitute invasive diagnostics in all patients with suspected choledocholithiasis reserving it for the patients that require therapeutic intervention. MR cholangiography may be useful in establishing the resectability of a malignant neoplasm such as hilar cholangiocarcinoma by helping determine the proximal extent of disease where ERCP may not be successful and in distal obstructions in which percutaneous cholangiography may be of limited value.

Background and Aims: Computed tomography (CT), especially contrast-enhanced CT (CECT), provides important information on the severity and prognosis of acute pancreatitis (AP). Magnetic resonance imaging (MRI) has become a useful tool as an alternative to CT in the assessment of AP. The primary aim of our study was to determine the diagnostic value of nonenhanced MRI (NEMRI) to assess severity and predict outcome in patients with AP from the third to fifth day after admission. We also correlated MRI findings with CT and biochemical parameters., Patients and Methods: The study included 101 patients (49 men, 52 women, median age 62 yr, range 20-82) with a diagnosis of AP admitted to our hospital between January 1, 2004 and June 31, 2005. The inclusion criteria consisted of a combination of clinical features, a typical case history, elevation of serum pancreatic enzymes, and diagnosis confirmed by imaging studies. Contrast-enhanced spiral CT exams were performed in all patients from the third to fifth day after admission, and Balthazar grade and CT severity index were calculated. All patients underwent NEMRI, and MR severity index (MRSI) was calculated. We also performed magnetic resonance cholangiopancreatography (MRCP) in all patients to detect bile duct lithiasis., Results: Significant correlation between CECT and NEMRI was found for Balthazar grade (P<0.001) and the assessment of pancreatic necrosis (P<0.001), as well as between the combined severity indices (rho=0.819, P<0.001). MRSI correlated with Ranson score (rho=0.656, P<0.01), C-reactive protein (CRP) levels 48 h after admission (rho=0.502, P<0.01), appearance of systemic complications (rho=0.576, P<0.01), and length of hospital stay (rho=0.484, P<0.01). Considering the Atlanta criteria as the gold standard and the Ranson score, no difference in sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the two methods was observed. Comparing the group of patients with presumed acute pancreatic hemorrhage with the group of patients with severe AP, we found a significantly higher APACHE II score on the first day (P<0.05), that the development of systemic complications was more frequent (P < 0.05), and that the hospital stay and ICU management of patients with MRI signs of pancreatic hemorrhage tended to be longer., Conclusion: NEMRI is comparable to CECT in the early assessment of the severity of AP, and both methods are equally efficient in predicting local and systemic complications of AP. MRI has a potential advantage over CT in detecting bile duct lithiasis and pancreatic hemorrhage.

Strain of the medial head of the gastrocnemius muscle (GM) is a common injury that can be confirmed by ultrasound (US) or magnetic resonance imaging. We report a case of strain injury of the medial head of the GM, with a hematoma between the soleus muscle and the GM. US revealed an enlarged hypoechoic area between the soleus and the GM. By US-guided puncture, only a small amount of old blood was evacuated. Hence we undertook a surgical approach. It was performed under general endotracheal anesthesia, in the prone position. The most superficial area of hematoma was shown by US. A sharp 4-mm trocar was inserted in the posteromedial side of the calf and the hematoma was partially evacuated by suction. The cavity was washed out with saline solution. The arthroscope was then inserted. A second portal was made laterally and a shaver was inserted under optic control. The inflow pressure was not allowed to exceed 45 mm Hg. The shaver was used to remove blood coagula and fibrin septa that divided the cavity. The fibrous cavity membrane was debrided. By the end of the procedure, the circumference of the leg was reduced by 3 cm and the skin was softer on palpation. The patient was discharged the next day. One week after surgery, US examination revealed only a thin hypoechoic area in place of the previous collection. Two weeks after surgery, he was able to walk painlessly, and at 6 weeks he had regained normal walking activity.

The aim of the study was to determine motor and morphological factors, and to assess their impact on specific motor skill performance in rhythmic gymnastics (RG). Experimental training process aimed at learning and improving basic movement structures of rhythmic gymnastics was performed for nine months in a sample of 50 female rhythmic gymnastics novices (mean age 7.1 +/- 0.3 years). Seven dimensions in total were isolated by factorial analysis of 13 motor, 11 morphological, and 20 specific rhythmic gymnastics tests. The factors of flexibility (Beta = 0.26; p < 0.05), explosive strength (Beta = 0.25; p < 0.05) and adipose voluminosity (Beta = -0.42; p < 0.001) explains 41% of the success in performing RG basic body elements--jumps, rotations, balance and flexibility (R = 0.64), while the frequency of movement (Beta = 0.44; p < 0.001) and non-adipose voluminosity (Beta = 0.26; p < 0.05) explains 26% of RG-specific manipulations with the apparatus--club, ribbon and ball wrist manipulation (R = 0.52; p < 0.01). According to study results, the RG-training process intended for rhythmic gymnastics novices should be programmed, with preset objectives for the development of flexibility and explosive strength, speed and peripheral joint strength and adipose tissue reduction.

The effects of six-month athletic training on improving motor abilities in 7-year-old schoolgirls were assessed. Analysis of the results of 12 motor tests showed significant improvement in the study group (n = 38) in comparison with control group (n = 140) subjected to conventional physical education classes only. The improvement referred to the variables of aerobic endurance (3-min run), flexibility (forward bow), explosive strength (ball throwing and 20-m run), keeping balance (bench standing), static strength (bent arm hang), and repetitive strength (sit-ups). These are probably adaptive changes brought up by discriminant functions. The varimax factor and discriminative function correlations indicated that all four factors of changes contributed significantly to the explanation of discriminative function. An almost equally high correlation of varimax factors and discriminative function was obtained on the basis of differences in the third factor responsible for changes in the frequency of movements and in the explosive strength of the jump type; in the second factor responsible for changes in coordination with changes in the repetitive strength of the body; and in the fourth factor responsible for changes in the explosive strength of the throw and sprint types with changes and endurance.

Purpose: The aim of this study was to evaluate kidney length in patients with postoperative acute renal failure (PARF)., Methods: The effect of PARF on renal size was prospectively studied in 76 patients with PARF and 40 healthy volunteers. Sonographic measurements of kidney length and the level of serum creatinine were obtained each day patients stayed in our surgical intensive care unit. These measurements were done once in volunteers. All study subjects were divided into groups on the basis of age, those younger than 65 years and those 65 years or older. Statistical analyses on the relation of renal size, age, and degree of PARF used the kidney length:body height ratio (KBR) and the peak serum creatinine level. Follow-up kidney length and creatinine measurements were done in 24 patients 1-5 years after they recovered from PARF., Results: Regardless of age, mean KBRs were significantly greater in patients than in healthy volunteers (< 65 years, p < 0.001; > or = 65 years, p = 0.008), with a negative correlation between KBR and patient age (r = -0.664; p < 0.001). A positive correlation was found between the KBR and the peak serum creatinine level in patients younger than 65 years (r = 0.543; p < 0.001); an insignificant negative correlation was found between these factors in patients 65 years or older (r = -0.264; p = 0.1). Follow-up on recovered patients showed that their KBRs were significantly lower than the values when patients had PARF (< 65 years, p < 0.001; > or = 65 years, p = 0.027)., Conclusions: PARF produces a sonographically measurable increase in renal size.

The anastomosis between rectal remnant and anal canal with other parts of digestive system, remains a big challenge for surgeons till nowadays. In the years period 173 anastomoses has been done with 21 case (12%) of clinical leaks. According to our experience the technique of continuous extramucosal one layer anastomosis is a good one for high colorectal and ileorectal anastomosis. For low colorectal anastomosis the technique of extramucosal interrupted sutures for posterior and Lembert's suture for anterior wall as single layer have had the lowest incidence of clinical leaks. Low and ultra low anastomoses could be best done with double staptechnique acc. to Knight-Griffen. Our figure of 12% of clinical leaks is rather comparable with published data of others.

Presented are the analysis of 134 single-layer colon anastomosis done between years 1983 and 1993. Essential parameters of those are compared with two-layer colon anastomosis - 65, done at the same period, as well as with wider series done in the world in a last couple of years. Main task of the analysis is to point to contemporary developments of suture technique in the world and at home, which is being simplified in technical terms, characterized by time and material savings without affecting anastomosis quality. Those characteristics have been attained due to good preparation of intestines, improved materials, antibiotics and due to finding out that submucosis and subserosis are carriers of suture firmness. On processed material when single-layer suture was used (134) we had average of 8.2% clinically evident fistulas - single-layer individual (78) 3.8% a single-layer continuous (58) 14%. With two-layer suture technique (65) we had 14% clinically evident fistula. Average mortality with both techniques was 4%.