Point-of-care ultrasound leads to a rare incidental diagnosis in a patient with acute kidney injury.

ABSTRACT: Cardiac amyloidosis is a rare disorder with a poor long-term prognosis. Presenting features often mirror those of more commonly encountered diseases, making diagnosis challenging. Clinicians should suspect amyloidosis in patients presenting with symptoms of heart failure and preserved ejection fraction. Diagnostic testing assesses for characteristic ECG, echocardiogram, and cardiovascular MRI findings. Confirmatory testing traditionally is performed with endomyocardial biopsy, but safer, less-invasive options exist. Although overall prognosis is unfavorable, contemporary advances in treatment options have improved short-term patient survival.

Natural history and metabolic consequences of morbid obesity for patients denied coverage for bariatric surgery.

BACKGROUND: Patients satisfying the National Institutes of Health criteria and deemed appropriate candidates often do not undergo bariatric surgery for insurance-related reasons. Our objective was to explore the natural history of these patients compared with that of those who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: The medical records of the patients evaluated for LRYGB from 2001 to 2007 were retrospectively reviewed. The presence of co-morbidities was assessed at the initial evaluation and within a 3-year follow-up period for patients who had undergone LRYGB and those denied surgery. The statistical analysis included chi-square tests. RESULTS: A total of 189 patients were in the denied cohort and 587 in the LRYGB cohort. The age, gender, and body mass index were similar between the 2 cohorts at the initial evaluation. The percentage of patients with a diagnosis of a co-morbidity in the denied and LRYGB cohorts at the initial evaluation was 20% and 25% with diabetes mellitus, 51% and 43% with hypertension, 20% and 22% with obstructive sleep apnea, 34% and 24% with lipid disorders, and 62% and 49% with gastroesophageal reflux disease, respectively. The body mass index at the initial evaluation and during follow-up was 47.3 and 46.8 kg/m(2) in the denied cohort (n = 165, P = .236) and 48.5 and 30.5 kg/m(2) in the LRYGB cohort (n = 544, P <.001), respectively. During the follow-up period, a greater incidence of new-onset diabetes (P <.001), hypertension (P <.001), obstructive sleep apnea (P <.001), gastroesophageal reflux disease (P <.001), and lipid disorders (P <.001) was observed in the denied cohort. CONCLUSION: Patients denied LRYGB had a greater incidence of new co-morbidities diagnosed within a short follow-up period, without a significant change in their body mass index.