Placental mesenchymal dysplasia (PMD) is a rare placental vascular anomaly which resembles partial molar pregnancy by 2-D ultrasonography. It is challenging but clinically important to distinguish between them in order to avoid unnecessary termination of pregnancy. A patient was referred to our centre at 13 weeks of gestation and 2-D ultrasound of the placenta showed a widespread vesicular pattern mixed with normal appearing placenta. Amniotic fluid volume was normal, and the fetus appeared to be an appropriate size for gestation without obvious structural abnormalities. 3-D reconstruction imaging of the placenta showed a large multi-cystic area arising from the chorionic plate which was adjacent to normal-appearing placenta. 3-D imaging rendered with 'inversion mode' revealed multiple fluid-filled structures with different sizes and appearances. Her serum hCG level was slightly elevated. All findings taken together, we suspected PMD rather than partial molar pregnancy. Histological examinations of the placenta after termination at 15 weeks confirmed the diagnosis.

No abstract

Cystic adenomyosis, a cystic lesion in the myometrium, is a rare disease that is characterized by intense dysmenorrhea. Here we report a case of a woman diagnosed with adnexa chocolate cyst that was found to be cystic adenomyosis during laparoscopic surgery. The case is of a 37-year-old woman, gravida 0 and para 0. When she was 32 years old, she visited a nearby hospital for dysmenorrhea. She was diagnosed with adnexa chocolate cyst in both sides and was followed up with oral low dose of estrogen-progestin (LEP). Five years later, she was suggested to undergo surgery because of the increasing size of the cysts. During the laparoscopic surgery, we found that the cystic lesion was not typical, and the connection with the uterus was clear. The pathological findings were consistent with the diagnosis of cystic adenomyoma. We suggest that when cystic lesions are identified with severe dysmenorrhea, the connection with the uterus and the possibility of cystic adenomyoma should be considered.

Objective: To identify the risk factors involved in the conversion to laparotomy during total laparoscopic hysterectomy (TLH) for benign diseases. Design: Retrospective comparative studySetting: Kaizuka Municipal Hospital for gynecologic endoscopic surgery.

speckle tracking echocardiography (STE) in various cardiac diseases including reduced LV ejection fraction (EF) and validate eTau by invasive Tau measured by catheterization. Methods: Isovolumic relaxation time (IVRT) was reported to be measured by Doppler echo. Pulmonary capillary wedge pressure (PCWP) was reported to be accurately estimated by STE as 10.8 -12.4 x Log (left atrial active emptying function / minimum left atrial volume index). Tau was reported to be calculated as IVRT / (ln LV end-systolic pressure -ln LA pressure or PCWP). Thus, eTau by echo is noninvasively obtained using the formula: eTau = IVRT / (ln 0.9 x systolic blood pressure -ln ePCWP). Echo parameters including eTau, e', E/e' and LV strain were measured just before catheterization in 115 patients (age 72±8) with various cardiac diseases including coronary artery disease, hypertensive heart disease, congestive heart disease, valvular heart disease and atrial fibrillation. Moreover, the accuracy of this eTau was examined in patients with reduced EF <50% versus those with preserved EF. Results: The ePCWP had a good correlation with LV end diastolic pressure (r=0.66, p<0.001). There was a good correlation between eTau estimated by STE and Tau obtained by cardiac catheterization (r=0.75, n=115, p<0.001) and good correlations were noted in both subgroups (reduced EF, n=15, r=0.77 and preserved EF, n=100, r=0.75, both P<0.001), whereas IVRT, e', E/e' and LV peak longitudinal strain had a poor correlation with Tau (r=0.44, 0.37 and 0.47, respectively, all p<0.01). Using eTau cutoff of 45ms, the sensitivity and specificity to predict prolonged Tau (>47ms) was 76 and 83%, respectively and positive and negative predictive value was 71 and 87% with AUC of 0.86. Multiple regression analysis revealed that eTau was the best independent predictor of Tau measured by catheterization among echo parameters. Bland-Altman analysis revealed a good agreement between eTau and Tau without fixed and proportional bias. Conclusions: This study demonstrated that eTau estimated by our noninvasive method using STE has a good correlation with Tau obtained by cardiac catheterization in various cardiac diseases in both patients with preserved and reduced EF. The eTau as an index of LV relaxation can be noninvasively assessed by echocardiography and may have utility and value in routine clinical practice for diagnosis and treatment in diastolic dysfunction. Background: The existence of diastolic intraventricular pressure gradients was first described by high fidelity catheters. Later, also systolic gradients have been shown invasively. We have developed a new method, Ultrasonic Relative Pressure Imaging (RPI), based on the Navier-Stokes equation applied to velocity fields. RPI visualizes and calculates pressure difference (PD) noninvasively. Purpose: Our purpose was to noninvasively characterize normal and ischemic PD waveforms in the left ventricular (LV) inflow tract by RPI. P4334 | BENCH Methods:In an open-chest dog model (n=7), a Millar catheter was introduced into t...