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Transverse vaginal septum is a residual vaginal plate composed of the Müllerian duct and urogenital sinus. Imperforate hymen results from failure of perforation of the membrane between the urogenital sinus and vaginal cavity. We report a rare case of concurrence of these two conditions. A 16-year-old girl had been treated with puncture several times for hematometra and hematocolpos from 13 years of age because of monthly occurrence of lower abdominal pain without menstrual bleeding and was referred to our hospital. Magnetic resonance imaging demonstrated hematometra, hematocolpos and expansion of the vaginal fornix. The imperforate hymen was incised and a slight adhesion at the lower vaginal cavity was detached. After that, a complete transverse vaginal septum, which was 5 mm thick, was identified. It was excised after ultrasonography-guided puncture. Although two cycles of menstrual bleeding took place, molimina recurred. Re-operation was performed 6 months after the first operation, and recurrence of adhesion in the lower vaginal cavity was identified. A silicon dilator was inserted, but she could not use it at home and instead used a tampon. Cyclic menstrual bleeding is observed 4 months after the second operation., (© 2015 The Authors. Journal of Obstetrics and Gynaecology Research © 2015 Japan Society of Obstetrics and Gynecology.)

Background and Aim: Colonoscopy has the disadvantage of pain and discomfort for patients. It has been shown in randomized controlled trials that carbon dioxide (CO(2) ) insufflations significantly reduce pain and discomfort in patients undergoing colonoscopy. However, there have been no studies in which CO(2) insufflation in colonoscopy of patients with irritable bowel syndrome (IBS) was investigated., Methods: Randomized double-blind controlled study was conducted to assess the suffering from colonoscopy in patients with IBS and the efficacy of CO(2) insufflation in colonoscopy for patients with IBS. Patients with IBS and controls who received colonoscopy were randomized into an air or CO(2) insufflation group. Patients' symptoms such as distension and pain were compared using a 10-cm visual analog scale (VAS)., Results: There were 18 patients in the IBS/air group, 19 patients in the IBS/CO(2) group, 25 patients in the control/air group and 26 patients in the control/CO(2) group. The mean value of severity of distension after colonoscopy and the mean value of severity of pain from during examination to one hour after the examination were higher in the IBS group than in the control group. The severity of these symptoms was reduced earlier in the CO(2) group. CO(2) insufflation in colonoscopy was more effective in the IBS group than in the control group from 15 min to one hour after the examination., Conclusion: Regarding colonoscopy-related suffering, IBS patients showed significant differences from non-IBS patients. CO(2) insufflation in colonoscopy is effective for IBS patients, particularly for patients who commence activities after colonscopy., (© 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.)

Objective: To compare the efficacy and safety of dienogest (DNG) with intranasal buserelin acetate (BA) in patients with endometriosis., Design: Phase III, randomized, double-blind, multicenter, controlled trial., Setting: Twenty-four study centers in Japan., Patient(s): Two hundred seventy-one patients with endometriosis., Intervention(s): Dienogest (2 mg/day, orally) or BA (900 microg/day, intranasally) for 24 weeks., Main Outcome Measure(s): The pre- to posttreatment changes in the scores of five subjective symptoms during nonmenstruation (lower abdominal pain, lumbago, defecation pain, dyspareunia, and pain on internal examination) and two objective findings (induration in the pouch of Douglas and limited uterine mobility)., Result(s): Dienogest reduced the scores of all symptoms and findings at the end of treatment, and the mean changes in the scores of all symptoms and findings except induration in the pouch of Douglas were comparable to those obtained with BA. Compared with BA, DNG was associated with irregular genital bleeding more frequently and with fewer hot flushes. The reduction in bone mineral density (BMD) during DNG treatment was significantly lower than that during BA treatment., Conclusion(s): DNG is as effective as intranasal BA in alleviating endometriosis, and causes less BMD loss.