2624 Private vs. Public: How Insurance Type Affects No-Show Rates and Time to Surgery (2023)

McCune-Albright syndrome (MAS), due to a somatic mutationGNAS1gene, usually starts in girls with peripheral precocious puberty. Ovarian autonomy may persist into adulthood with acyclic hyperestrogenemia, infertility and a potential risk of estrogen-dependent cancers.

A 22-year-old woman with MAS was referred for infertility with a left macropolycystic ovary, hyperestrogenemia and chronic anovulation who was unsuccessfully treated with controlled hyperstimulation. This was once confirmed by puncture of the ovarian cysts and cDNA analysisGNAS1the mutation was confined to the left ovary, a unilateral oophorectomy was performed. She improved the function of the right ovary, made pregnancy possible through in vitro fertilization, but discovered an unexpected borderline epithelial tumor of the ovary.

Several breast cancers have already been reported in young patients with MAS, but no borderline ovarian epithelial tumours. In this context, we recommend the correction of persistent hyperestrogenemia in adults and the implementation of gynecological monitoring of the breasts, ovaries and endometrium.

Observational data and the results of post-hoc analyzes in clinical trials suggest that direct oral factor Xa inhibitors may increase the intensity of menstrual bleeding in women of childbearing potential, but the magnitude of this effect is unknown. Our aim was to investigate the treatment and outcomes of complications of vaginal bleeding during direct oral factor Xa inhibitor therapy in a case series of women of reproductive age.

To identify individuals for inclusion in this case series, we searched two sources of prospectively collected data from women of childbearing age treated with direct oral factor Xa inhibitors: the non-interventional Dresden NOAC Registry (NCT01588119), located in the administrative district of Dresden (Saxony, Germany), and all locally archived data from phase 3 direct oral factor Xa inhibitor studies conducted at the Carl Gustav Carus University Hospital Dresden. Vaginal bleeding was defined as all patient-reported complications of vaginal bleeding. We collected data on the type and dose of anticoagulants; suspected or confirmed bleeding, hospitalizations and death; and the pattern and treatment of vaginal bleeding. For all bleeding events identified, we reviewed all available source data to identify study findings suggestive of possible underlying anatomical causes of bleeding.

We identified 178 women of reproductive age who received direct oral factor Xa inhibitor therapy, 57 of whom experienced vaginal bleeding, including 50 who received rivaroxaban, six who received apixaban, and one who received edoxaban. Those 57 women had 72 cases of vaginal bleeding, including 59 cases of heavy menstrual bleeding and 13 cases of bleeding unrelated to the menstrual cycle. 51 (86%) of these major menstrual bleeds (two major bleeds, 17 clinically relevant minor bleeds, 32 minor bleeds) were treated conservatively (e.g., change or reduction of oral hormone therapy, temporary cessation or discontinuation of a direct oral factor Xa inhibitor ), and the remaining eight (14%) cases (three major bleeds and five clinically relevant minor bleeds) required elective surgical or interventional treatment (hysterectomy, curettage, ovarian excision, or ovarian cyst excision). Of the 57 women, 13 (23%) had a second bleed and two (4%) had a third. Nine patients had underlying anatomical abnormalities; compared to patients without abnormalities, these patients had more intense bleeding, had more recurrent bleeding (five [56%] of nine patients with abnormalitiesregardingeight [17%] of 48 patients without abnormalities), and more required surgical treatment of bleeding (eight [89%] of nineregardingzero out of 48).

Vaginal bleeding, particularly heavy menstrual bleeding, is a common complication in women of childbearing age undergoing direct oral therapy with factor Xa inhibitors. Most cases can be managed conservatively, but patients with severe or recurrent complications of vaginal bleeding should be evaluated for underlying anatomical abnormalities, which may require surgical or interventional treatment. Additional data are needed to advise on the prevention and treatment of vaginal bleeding complications in this patient population.

Nee.

To assess the outcome of assisted reproductive technology (ART) after proximal tubal occlusion (PTO) or salpingectomy in patients with hydrosalpinx undergoing in vitro fertilization - embryo transfer (IVF-ET).

Randomized controlled trial (Canadian Task Force I classification).

All India Institute of Medical Sciences, New Delhi, India.

A total of 165 patients were randomized and then assigned to the PTO group (n=83) or the salpingectomy group (n=82).

PTO in salpingectomy.

After surgery, the salpingectomy group, compared to the PTO group, showed a significant decrease in parameters of the serum ovarian reserve of anti-Müller hormone (AMH; 3.7 ng/ml vs. 2.6 ng/ml; p ˂ 0.001) and the number of antral follicles (AFC; 10.6 vs. 8.6; p ˂ 0.001). The salpingectomy group also required a significantly higher dose of gonadotropins (3901 vs. 3260; p ˂ 0.001) and more stimulation days (11.3 vs. 10.2; p ˂ 0.001) compared to the PTO group. The salpingectomy group had a significantly lower conception rate (0.74 vs. 0.83; p ˂ 0.001) and a lower number of stage 1 embryos (4.1 vs. 5.6; p = 0.02); however, there was no significant difference between the 2 groups in implantation rate (22.8% vs. 23.7%; p=0.87), clinical pregnancy (26.3% vs. 33.7%, p=0.25 ), live births (27.5% vs. 32.5%; p=0.42), and abortion (4.7% vs. 3.5%; p=0.90)

PTO is superior to salpingectomy for the surgical treatment of hydrosalpinx patients undergoing IVF-ET in terms of ovarian reserve. However, the 2 surgical techniques are associated with similar pregnancy rates.

Left ventricular diastolic dysfunction (LVDD) is common in patients on peritoneal dialysis (PD). Elevated levels of inflammatory biomarkers, such as highly sensitive C-reactive protein, predict the development of LVDD.

We hypothesized that PD patients with elevated levels of highly sensitive C-reactive protein might benefit from statin treatment for LVDD and designed a randomized clinical trial to prove this hypothesis.

We screened 213 PD patients and randomly assigned 32 men and women with low-density lipoprotein cholesterol levels <130 mg/dL, high-sensitivity C-reactive protein levels ≥1.5 mg/L, and LVDD, diagnosed by conventional and tissue Doppler (TDI) echocardiography, until treatment with atorvastatin, 40 mg daily or without. The primary endpoints were changes in diastolic TDI parameters or diastolic parameters of the global stress pattern.

Atorvastatin reduced low-density lipoprotein cholesterol by 43% and high-sensitivity C-reactive protein by 45% (bothP<.001). Control TDI showed a significant improvement in early mitral flow rates divided by early diastolic peak mitral annular velocities at the medial and lateral sites (nominal change for E/E_medial: -5.01 ± 6.36 versus 1.80 ± 6.59 for atorvastatin or control,P=.02). There was also a significant improvement in the representation of general distress following atorvastatin treatment (general distress rate, -17.12 ± 1.42 vs. -14.61 ± 1.78 for atorvastatin and control,P=.002 I E/SR_IVR, 462,35 ± 110,54 versus 634,09 ± 116,81,P=.003).

In this study of PD patients without hyperlipidaemia but with elevated levels of highly sensitive C-reactive protein and LVDD, atorvastatin significantly improved cardiac diastolic function (ClinicalTrials.govnumber,NCT01503671).