MAYO CLINIC PROCEEDINGS

New-Onset Hypertension and Sodium Oxybate-Something to Think About
Bala S, Valerio J and Ayas NT
Renal Angiography Serves as a Crucial Diagnostic Tool in Determining Complexity and Treatment Plan of Renal Arteriovenous Malformation
Ge SX, Atwell TD and Jundt MC
Decreasing Fertility Rate in the United States: Demographics, Challenges, and Consequences
Dilmaghani D, Ainsworth AJ, Nath KA and Garovic VD
Retroperitoneal Lymphadenopathy in a Patient With a History of Multiple Primary Malignant Neoplasms
Yang W, Gupta S and Erickson LA
Women Consume Less Oxygen Than Men for Muscular Work: Role of Lean Body Mass
Guo M and Montero D
Post-Pulmonary Embolism Syndrome-A Diagnostic Dilemma and Challenging Management
Shah KP, Lee C, McBane RD, Piazza G, Frantz RP, Houghton DE, Casanegra AI and Henkin S
Historically, research on pulmonary embolism (PE) management has focused on short-term outcomes, such as acute cardiovascular collapse, change in right ventricular function, and in-hospital mortality. However, long-standing functional impairments from acute PE occur in up to half of all patients. This chronic syndrome has been termed the post-PE syndrome, which describes patients who have persistent or worsening symptoms, functional limitations, and cardiorespiratory impairment not explained by a comorbid condition. Diagnosis and management are challenging, and post-PE syndrome remains an underrecognized and undertreated condition. This review seeks to increase awareness of the syndrome that affects a significant portion of PE survivors. The epidemiology, pathophysiology, and clinical features are discussed, followed by a description of imaging findings and management options across the entire spectrum of post-PE syndrome.
Characteristics of an Older Adult Population Without COVID-19 Infection in a Southeast Minnesota Community
Pignolo RJ, King KS, Wi CI, Ryu E, Takahashi PY, Yao JD, Binnicker MJ, Dixon RE, Natoli TL and Juhn YJ
To assess demographic characteristics, public health measures, and health beliefs or behaviors that differentiate participants with a history of the coronavirus disease 2019 (COVID-19) infection from those with no history of COVID-19.
21-Year-Old Man With Fever, Jaundice, and Dark Urine
Ganti A, de Melo JF and Sweetser S
Echocardiography Screening of Consecutive Patients With Portal Hypertension Referred to Mayo Clinic for Liver Transplant Evaluation
Burger CD, Saunders H, Hodge DO, Safford RE, Helgeson SA, Moss JE, DuBrock HM, Cartin-Ceba R, Cajigas HR and Krowka MJ
To determine the prevalence of portopulmonary hypertension in patients referred for liver transplant evaluation.
Cutaneous Clear Cell Hidradenoma
Guo R, Peters MS and Sartori-Valinotti JC
75-Year-Old Man With Dysuria, Urinary Frequency, and Altered Mental Status
Whitfield S, Chetram D and Rosenman D
Sex-Associated Differences in Clinical Outcomes After Septal Reduction Therapies in Hypertrophic Cardiomyopathy
Patel N, Shetty NS, Pampana A, Gaonkar M, Vekariya N, Li P, Owens AT, Semsarian C, Arora G and Arora P
To evaluate sex-associated differences in the short- and long-term outcomes of patients with hypertrophic cardiomyopathy (HCM) undergoing septal myectomy and alcohol septal ablation.
Radiofrequency Ablation of T1N0M0 Papillary Thyroid Cancer: First Experience in the United States
Jeong SY and Baek JH
Acute Basilar Artery Embolus After Cardioversion in a Patient Receiving Apixaban With Prior Roux-en-Y Gastric Bypass Surgery
Sohutskay DO, Suen RM, Wijdicks EFM, Brinjikji W, McBane Ii RD and Chareonthaitawee P
"Metabolic" Type of Hyperuricemia Increases Mortality Mainly by Leading to Premature Death From Cardiovascular Disease
Timsans J, Kerola AM, Rantalaiho VM, Hakkarainen KN, Kautiainen HJ and Kauppi MJ
Agreement of Doppler Flow Velocity Reserve With PET Flow Reserve in Patients With Angina Without Obstructive Coronary Arteries
Ismayl M, Raphael CE, Prasad A, Chareonthaitawee P and Bois JP
Evaluation and Management of Female Stress Urinary Incontinence
Jefferson FA and Linder BJ
Female stress urinary incontinence, the loss of urine with transient increases in abdominal pressure, is a common condition that can profoundly impact a patient's quality of life. The diagnosis is most commonly made via clinical history, including the subjective degree of bother, and physical examination evidence of urinary leakage with cough or Valsalva maneuver. A variety of treatment options exist for stress incontinence, ranging from observation, pelvic floor physical therapy, vaginal inserts, or continence pessaries to procedural interventions. Observation and conservative measures (eg, pads) can be used if the patient is not bothered by their symptoms. Nonsurgical management options include pelvic floor physical therapy, vaginal inserts, or continence pessaries. Procedural interventions include urethral bulking agent injection, synthetic mesh midurethral sling placement, autologous fascial pubovaginal sling placement, or retropubic colposuspension. Each procedure has a unique set of risks and benefits, with the choice of operation depending on a variety of factors including severity of stress incontinence, anatomy, medical and surgical comorbidities, and patient preferences. Ultimately, shared decision-making between the patient and the physician is used to decide the management strategy. This collaborative approach facilitates alignment of the chosen intervention with the patient's unique circumstances and preferences. We review relevant clinical considerations in the evaluation and management of female stress incontinence.
Androgen Society Position Paper on Cardiovascular Risk With Testosterone Therapy
Morgentaler A, Dhindsa S, Dobs AS, Hackett G, Jones TH, Kloner RA, Miner M, Zitzmann M and Traish AM
The Androgen Society is an international, multidisciplinary medical organization committed to advancing research and education in the field of testosterone deficiency and testosterone therapy (TTh). This position paper is written in response to results of the TRAVERSE study, published in June 2023, which reported no increased risk of major adverse cardiovascular events (MACE) in men who received TTh compared with placebo. In 2013-2014, 2 observational studies reported increased cardiovascular (CV) risks with TTh and received wide media attention. Despite strong criticism of those 2 studies, in 2015, the Food and Drug Administration added a CV warning to testosterone product labels and required pharmaceutical companies to perform a CV safety study, which became the TRAVERSE trial. TRAVERSE enrolled 5246 men at high risk for MACE based on existing heart disease or multiple risk factors. Participants were randomized to daily testosterone gel or placebo gel, with a mean follow-up of 33 months. Results revealed no greater risk of MACE (myocardial infarction, stroke, or CV death) or venothrombotic events in men who received TTh compared with placebo. Review of the prior literature reveals near uniformity of studies reporting no increased MACE with TTh. This includes 2 additional large randomized controlled trials, multiple smaller randomized controlled trials, several large observational studies, and 19 meta-analyses. In view of these findings, it is the position of the Androgen Society that it has now been conclusively determined that TTh is not associated with increased risks of heart attack, stroke, or CV death.
37-Year-Old Man With Chest Pain
Farooqui N, Inglis SS and Lopez-Jimenez F
Pemphigus Foliaceus
McLennan AL, Cockerell CJ and Ren VZ
Lutetium 177 Radionuclide Therapy-Induced Proliferative Arrest in a Metastatic High-Grade Rectal Neuroendocrine Tumor
Mesci A, Barron CC and Mete O