No abstract

We conclude that any survival advantage associated with obesity among chronic dialysis patients is significantly less likely for peritoneal dialysis patients, compared to hemodialysis patients.

The Multicenter Diltiazem Postinfarction Trial (MDPIT) reported no consistent diltiazem effect on new or worsened congestive heart failure (CHF) during 12-52 months' follow-up after acute myocardial infarction. This was puzzling in light of the observation that patients with findings suggesting left ventricular dysfunction (LVD) at baseline on diltiazem had more cardiac events (cardiac mortality or recurrent nonfatal infarction) than such patients on placebo. We hypothesized that diltiazem increased the frequency of late CHF as well as of cardiac events, but only in patients predisposed by LVD. Using the same characterizing variables as the primary MDPIT analysis, we found that patients with pulmonary congestion, anterolateral Q wave infarction, or reduced ejection fraction (EF) at baseline were more likely to have CHF during follow-up than those without these markers of LVD. CHF was particularly frequent in the patients with LVI) who were randomized to diltiazem. Among those with a baseline EF of less than 0.40, late CHF appeared in 12% (39/326) receiving placebo and 21% (61/297) receiving diltiazem (p=0.004). Life table analysis in patients with an EF of less than 0.40 confirmed more frequent late CHF in those taking diltiazem (p=0.0017). In addition, the diltiazem-associated rise in the frequency of late CHF was progressively greater with increasingly severe decrements in baseline EF. This diltiazem effect was absent in patients with pulmonary congestion at baseline but an EF of 0.40 or more, suggesting a unique association between diltiazem-related late CHF and systolic LVD. Diltiazemassociated enhancement of CHF in patients with an EF of less than 0.40 was evident among those who took concomitant ,B-blockers and among those who did not. We conclude that postinfarction patients with reduced EF are at particular risk for subsequent CHF when treated with diltiazem. This problem, along with the greater occurrence of cardiac events in patients with LVD, indicates a need for caution when giving diltiazem to patients with postinfarction LVD. (Circulation 1991;83:52-60) D iltiazem is effective in suppressing myocardial ischemia in patients with coronary artery disease.1-4 However, diltiazem and other calcium channel blockers can augment hemodynamic abnormalities in patients with congestive heart failure (CHF).5-9 These contrary actions would explain the findings of the Multicenter Diltiazem

Obese patients on the renal transplant waiting list had a significantly lower risk of mortality after renal transplantation compared with those remaining on dialysis.

Imaging studies accurately reflect the nodularity and septation seen grossly to distinguish biliary cystadenoma and cystadenocarcinoma but do not allow distinction of the presence or absence of ovarian stroma.