Jennifer Wan

Current practices in determining amnionicity and chorionicity in multiple gestations

To evaluate the accuracy of amnionicity and chorionicity (A/C) diagnosis of referral physicians and a tertiary care center as compared to histopathologic diagnosis.

Refining Resuscitation Strategies Using Tissue Oxygen and Perfusion Monitoring in Critical Organ Beds

BACKGROUND Muscle tissue oxygen monitoring (PmO2) holds promise as a continuous guide to resuscitation after hemorrhagic shock, but the relationship of muscle tissue oxygen to perfusion has not been described previously. On the other hand, brain tissue oxygen PbrO2 and perfusion as measured by cerebral blood flow (CBF) are already used clinically, especially as guides to vasopressor use in cerebral perfusion targeted therapy in patients with traumatic brain injury. This laboratory study was undertaken to describe the relative contributions of muscle perfusion and arterial oxygen tension (PaO2) to muscle tissue oxygen (PmO2) levels. Second, we wanted to compare the relationship between muscle oxygen and muscle blood flow (MBF) with simultaneously measured brain tissue oxygen and perfusion during the administration of a vasopressor and during experimental hemorrhagic shock. We hypothesized that muscle perfusion would be an important contributor to PmO2, thus underscoring the need for optimal fluid resuscitation after shock. We further hypothesized that PmO2 would decrease even as PbrO2 increased when vasopressor therapy was used. METHODS Eight pigs were anesthetized, intubated, underwent splenectomies, and were instrumented to monitor PmO2, MBF, PbrO2, and CBF. Oxygen challenges were performed by increasing PaO2 from 100 to 500 mm Hg during three different experimental phases: baseline, vasopressor administration, and hemorrhage. Mean PmO2 and MBF were compared at the beginning and end of each experimental phase and correlations between PmO2, MBF, PbrO2, CBF, and traditional endpoints of resuscitation were investigated. RESULTS During oxygen challenges in all phases, PmO2 increased (31.2 +/- 16.6 mm Hg to 56.6 +/- 34.1 mm Hg; p < 0.01), whereas MBF did not change significantly (16.4 +/- 11.3 mL/100 g/min to 15.4 +/- 11.9 mL/100 g/min). On administration of vasopressors, MBF decreased (18 +/- 8.8 mL/100 g/min to 5.3 +/- 3 mL/100 g/min; p = 0.03), but no change in PmO2 was detected. During hemorrhage, both PmO2 and MBF declined (PmO2: 40 +/- 8.8 mm Hg to 7.7 +/- 9.6 mm Hg; p = 0.002; MBF: 9.8 +/- 5.8 mL/100 g/min to 3.3 +/- 2.4 mL/100 g/min; p = 0.046). Both PmO2 and MBF showed strong relationships with measurements of resuscitation, base deficit (PmO2 and MBF: p < 0.01), and mean arterial pressure (PmO2: p < 0.01, MBF: p = 0.02). Like PmO2 and MBF, PbrO2 and CBF decreased uniformly during hemorrhage. However, on vasopressor administration, CBF and PbrO2 increased significantly, whereas MBF decreased. CONCLUSION PmO2 and MBF can be monitored simultaneously and continuously and correlate well with measurements of resuscitation. PmO2 values reflect both local perfusion and arterial oxygen tension. The clinical application of PmO2 as a continuous endpoint of resuscitation and its relationship to muscle perfusion warrants further study in critically injured patients and these investigations may help to refine resuscitation strategies.

Anal sphincter complex muscles defects and dysfunction in asymptomatic parous women.

Introduction and hypothesisWe aimed to determine anatomy and function of anal sphincter complex using three-dimensional ultrasound (3D-US) and manometry in asymptomatic parous women.Methods3D-US of puborectalis muscle (PRM), external (EAS), and internal anal sphincters (IAS) anatomy was performed in 45 women without pelvic floor dysfunction. To assess function, rest and squeeze vaginal and anal pressures were measured. Based on 3D-US, subjects were divided into injured and uninjured groups.ResultsForty-four of 45 subjects had adequate PRM images. The injured PRM (N = 14) group had significantly lower vaginal pressures as compared with uninjured PRM group (N = 30; p = 0.001). Four of 45 subjects with IAS and EAS defects had lower resting and squeeze anal canal pressure. Muscle injury to IAS, EAS and PRM in the same individual was uncommon.ConclusionsIn asymptomatic parous women, PRM defects were more common than the EAS/IAS defects but defects in more than one muscle were infrequent. Subjects with injured PRM had low vaginal pressure than the ones without.

Knee Imaging Following Anterior Cruciate Ligament Reconstruction: The Surgeon's and Radiologist's Perspectives

Abstract Anterior cruciate ligament (ACL) tears are common injuries that if left untreated can result in chronic instability, cartilage damage, meniscal tears, and ligamentous injuries, eventually leading to early osteoarthritis. ACL reconstruction surgeries are therefore increasingly being performed. Despite the fact that most patients achieve excellent postoperative results, patients can present with recurrent instability and pain. These patients often undergo imaging with radiographs, magnetic resonance imaging, and/or computed tomography. An understanding of the imaging appearance of the normal ACL reconstruction and common causes of failure is therefore essential for the interpreting radiologist. This article reviews surgical techniques for ACL reconstruction, highlighting recent technical advances, the normal imaging appearance after ACL reconstruction, etiologies for reconstruction failure, and the diagnosis of these with the aid of imaging.

Diffuse thyroid metastases and bilateral internal jugular vein tumor thrombus from renal cell cancer

Renal cell cancer rarely metastasizes to the thyroid gland, and it has been reported to present as a solitary mass. We present a case of diffuse thyroid cancer metastases from renal cell cancer. Bilateral internal jugular vein tumor thrombi were also present. To the best of our knowledge, this is the first description of diffuse thyroid metastases from renal cell cancer in the English literature. Renal cell cancer metastases should be considered in the differential of thyroid imaging abnormalities arising in the setting of known renal cell carcinoma, particularly late in the course of disease. This is frequently associated with internal jugular vein thrombi, which should be evaluated with an abnormal thyroid. Thyroglobulin levels are usually normal in such patients.

OP19.06: How accurate are we in determining the placental cord insertion site in multiple gestations?

L. E. Romine1, M. Hwang5, N. Trivedi2, J. Wan4, Y. LaCoursiere2, P. Do4, K. Benirschke3, D. Schrimmer2, D. H. Pretorius1 1Radiology, University of California, San Diego, CA, USA; 2Reproductive Medicine, University of California, San Diego, CA, USA; 3Pathology, University of California, San Diego, CA, USA; 4School of Medicine, University of California, San Diego, CA, USA; 5School of Medicine, Vanderbilt University, Nashville, TN, USA

OP24.02: Pelvic floor muscles anatomy and function in asymptomatic parous women

transvaginal sonography. Evacuation of uterus was performed based on vaginal bleeding, lower abdominal pain and/or sonographic findings of hyperechoic material or endometrial thickness more than 8 mm. Maternal age, gestational age, clinical signs and symptoms, sonographic findings were recorded. Correlation of clinical and sonographic findings with histopathologic reports was made and the sensitivity and specificity of vaginal bleeding, abdominal pain and sonographic appearance of endometrium for detecting products of conception were assessed. Results: Histopathologic analysis confirmed the presence of chorionic villi in 55 cases (60%) and decidua in 36 women. Vaginal bleeding was more frequent in women with RPOC (P < 0.001), whilst lower abdominal pain was more frequent symptom in those with decidua (P = 0.019). The ultrasound finding of hyperechoic material had sensitivity of 78%, specificity of 100% and positive and negative predictive value of 100%. Vaginal bleeding as predictor of RPOC had sensitivity of 93%, specificity, positive and negative predictive value of 50%, 74% and 82%. Combination of hyperechoic material and vaginal bleeding increased sensitivity to 98% and negative predictive value to 95%. There was no significant difference in endometrial thickness between two groups. Conclusions: Ultrasound finding of hyperechoic material is the best predictor for the diagnosing RPOC. In the absence of hyperechoic material and vaginal bleeding, RPOC are extremely unlikely.