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Annals of Internal Medicine, Tip Sheet, July 17, 2001

American College of Physicians

Annals of Internal Medicine is published by the American College of Physicians-American Society of Internal Medicine (ACP-ASIM), an organization of more than 115,000 internal medicine physicians and medical students. The following highlights are not intended to substitute for articles as sources of information. For an embargoed fax of an article, call 1-800-523-1546, ext. 2656 or 215-351-2656.

ACE Inhibitors Appear to Slow Kidney Disease Regardless of Cause

A study found that the type of blood pressure medications known as angiotensin-converting enzyme (ACE) inhibitors slowed progression of kidney disease not caused by diabetes (Article, p. 73). The medications were especially beneficial for kidney patients with proteinuria, excess protein in the urine. Researchers combined original patient data of 1,860 people from 11 published, randomized clinical trials using a technique called a patient-level meta-analysis. The authors say that ACE inhibitors should be given to most patients with kidney disease. An editorial says that because the information did not come from a single, large randomized trial, the conclusion could be considered "exciting" but tentative.

Three Studies on Improving Diagnosis of Blood Clots

Three studies in today's issue of Annals look at diagnosing blood clots -- relatively common and potentially fatal conditions. Blood clots can travel to the lung, heart or brain. Diagnosing them is imprecise and can be invasive, complicated and expensive.

One study found that blood clots in deep veins (deep venous thrombosis) can be accurately identified in suspected cases by first assigning a low, medium or high probability category based on physical examination, followed by a D-dimer blood test (Brief Communication, p. 108). This system was 99.4 percent accurate in ruling out deep vein thrombosis and thus reducing need for additional diagnostic testing.

A second study of patients admitted to emergency departments for suspected clots in the lungs (pulmonary emboli) also assigned patients a probability category followed by a D-dimer blood test. The negative D-dimer result ruled out clot formation in 97.3 percent of cases by itself and in 99.5 percent when combined with low pretest probability.

Less encouraging results were found in a study of patients with suspected pulmonary emboli seen in emergency departments and given a special CT scan, helical computed tomography (Article, p. 88). The scans were positive for pulmonary emboli in only 70 percent of patients who actually had the clots and positive for 9 percent who did not have pulmonary emboli.


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