Hysteroscopic adhesiolysis for patients with Asherman's syndrome: menstrual and fertility outcomes.

Purpose: Most patients with Asherman's syndrome present with infertility and menstrual problems. In this retrospective clinical study, we analyzed patients with Asherman's syndrome who underwent hysteroscopic adhesiolysis to examine their associated symptoms, disease etiologies, and fertility outcomes. Methods: Twenty-seven patients with Asherman's syndrome that were diagnosed using hysteroscopy were recruited. The chief complaints were infertility, hypomenorrhea, and amenorrhea. Each case of Asherman's syndrome was classified according to the American Fertility Society classification. Hysteroscopic adhesiolysis was performed in all cases and concomitant transabdominal ultrasonography was conducted in cases with extensive and dense adhesions. Results: There were no complications associated with the hysteroscopic procedure. Normal menstrual cycles resumed in all cases. Of the 16 infertile patients, 9 conceived. Three patients achieved term deliveries and one patient is currently pregnant. None of the patients had obstetric complications. Two patients had spontaneous abortions, one had an ectopic pregnancy, one had an abortion at 16 weeks' gestation due to cervical incompetence, and one had a molar pregnancy and required uterine artery embolization for uncontrolled hemorrhaging during a dilatation and curettage procedure. Conclusions: Hysteroscopic adhesiolysis with transabdominal ultrasonography is a suitable treatment method for Asherman's syndrome. Subfertile patients with Asherman's syndrome undergoing adhesiolysis should be appropriately informed about the risk of associated life-threatening complications and preterm delivery.

Prenatal diagnosis of trisomy 16 mosaicism manifested as pulmonary artery stenosis.

Trisomy 16 mosaicism detected at midtrimester amniocentesis is rare and indicative of true fetal mosaicism. We report a case of mosaic trisomy 16 diagnosed by amniocentesis in which the sonographic findings included fetal pulmonary artery stenosis, a single umbilical artery, and early onset fetal growth restriction. The pregnancy was legally terminated. A review of previous reports suggests that abnormalities of outlet tracts are rarely encountered in fetuses with trisomy 16 mosaicism revealed via amniocentesis.

[A case of isolated hepatic malignant lymphoma representing characteristic findings on radiological imaging].

We present an 80-year-old-man who showed characteristic radiological findings of secondary hepatic malignant lymphoma. The patient was first admitted to our hospital 6 months before with left cervical mass, which was diagnosed as malignant lymphoma by biopsy. After complete response to chemotherapy, a large hepatic mass appeared, as the serum value of lactic dehydrogenase elevated. CT/MRI showed a well-demarcated hypovascular mass, which was penetrated by the right hepatic vein. The apparent diffusion coefficient of the mass was 0.70 x 10(-3) mm2/s. The patient was diagnosed as relapse of malignant lymphoma, mainly based on these radiological findings reflecting the mass with high cellularity which grows without destruction of existing vascular structure, and additional chemotherapy was given. The hepatic mass disappeared almost all and the serum value of lactic dehydrogenase decreased with in normal range. The patient was discharged in a good condition 2 months later.

Fulminant type 1 diabetes during pregnancy: A case report and review of the literature.

Fulminant type 1 diabetes, classified as a subtype of nonautoimmune type 1 diabetes, may result in severe complications for both mother and fetus due to the sudden onset of diabetic ketoacidosis. Little is known about the clinical features of pregnancy with fulminant type 1 diabetes. We present a case of fulminant type 1 diabetes during pregnancy, along with a review of the published literature. A 31-year-old Japanese woman presented with sudden onset of nausea and vomiting at 36 weeks' gestation and was provisionally diagnosed with acute gastroenteritis. She was referred to us for investigation of exaggerated general fatigue and intrauterine fetal death. Based on blood and urinary examinations, she was diagnosed with diabetic ketoacidosis, caused by fulminant type 1 diabetes. Although her ketoacidosis was improved, insulin therapy was needed. Awareness of this disease can lead to prompt diagnosis and treatment and consequently, improved maternal and fetal prognosis.