Multiple biochemical blood testing as a case-finding tool in ambulatory medical patients.

PURPOSE: The usefulness and costs of multiple biochemical blood tests as a case-finding tool in ambulatory medical patients are not well known. Recommendations are lacking or based upon results of screening asymptomatic persons. We designed a study to determine prospectively the yield, potential disadvantages, and patient charges of routine biochemical testing at our medical outpatient clinic. PATIENTS AND METHODS: Twenty-three biochemical parameters were evaluated in 493 consecutive patients. Parameters not considered indicated for diagnostic or management purposes by the staff physicians at the first visit were classified as routine tests. The main outcome measures were the number and the nature of new diagnoses leading to a new management, the number of additional tests and visits, and patient charges. RESULTS: New diagnoses resulting in new management were found in 25 patients (5%). They were mainly lipid disorders. Seven additional visits and 74 further tests were caused by abnormal results of routine tests. The net charges for the detection of the new diagnoses leading to new management were $12,682. Secondary analysis revealed that the determination of only three routine tests (cholesterol, glucose, alanine aminotransferase) would have detected all clinically important diagnoses and would have reduced the charges by 30%. CONCLUSIONS: Routine biochemical testing is a useful case-finding tool with acceptable costs in middle-aged medical outpatients of a university teaching setting. However, the spectrum of newly detected disorders leading to changes in patient management is small. The results suggest that a reduced routine battery consisting of cholesterol, glucose, and alanine aminotransferase might be preferable because it will detect the clinically important diagnoses and lead to a substantial reduction of patient charges.

Cerebral blood flow is not altered by treatment with nitrendipine in patients with mild to moderate hypertension.

We evaluated the effects of nitrendipine, a calcium antagonist of the dihydropyridine group, on cerebral blood flow (CBF) in nine patients with mild to moderate hypertension. The CBF was determined under placebo, 2 h after the first dose (short term) and after 4 weeks (long term) of regular nitrendipine treatment. The CBF was determined using the xenon-133 method. All patients were on placebo for 2-4 weeks before nitrendipine administration. The mean age was 48 years (range of 35-67 years). Blood pressure fell from 169 +/- 19/110 +/- 16 to 147 +/- 12/94 +/- 11 mm Hg after the first dose and to 140 +/- 12/92 +/- 9 mm Hg after long-term administration (p less than 0.01). The corresponding CBF did not change significantly from 37.5 +/- 4.8 ml/100 g/min before to 38.7 +/- 4.5 ml/100 g/min 2 h after the first dose and 38.1 +/- 6.0 ml/100 g/min after long-term administration of nitrendipine (p = 0.3 and p = 0.8, respectively). In conclusion, nitrendipine did not alter the CBF of mildly to moderately hypertensive patients. Particularly, the CBF was maintained during short-term and long-term administration despite significant blood pressure reduction.

[Asymptomatic microhematuria: follow-up in 39 patients]. / Asymptomatische Mikrohämaturie: Verlaufsbeobachtung bei 39 Patienten.

We have studied 39 patients with asymptomatic microhematuria (AM) over a mean period of 3.7 years (2.6 to 5.3). In 28 patients, the etiology of the AM had remained unknown despite extensive work-up at the time of AM diagnosis. During follow-up, the urine was examined by the dipstick method and a urine sediment was prepared by standard techniques. Erythrocyturia was judged as grade I or grade II (3-9 or less than 9 erythrocytes/hpf) and classified by phase-contrast microscopy as glomerular or non-glomerular (greater than 30% or less than 30% of erythrocytes with glomerular characteristics). The results were as follows. All patients were in good health during the whole follow-up. None developed significant proteinuria or gross hematuria. AM persisted in 28 of the 39 patients (72%) and in 22 of the 28 with AM of unknown etiology (79%). Persistence of AM was independent of grade and morphology of AM. Among the patients with AM of unknown cause, the fifteen who initially showed grade I AM had grade I AM in 92% and grade II AM in 8% of follow-up urinalyses, and the seven with grade II AM at the first examination had grade II AM in 65% and grade I AM in 35% of follow-up urinalyses (p = 0.007). The last morphologic classification of AM corresponded to the first in all patients with grade II AM, but only in 74% of patients with grade I AM. The following conclusions were drawn. (1) Most AM of unknown etiology persists over several years irrespective of grade and morphology of erythrocyturia.(ABSTRACT TRUNCATED AT 250 WORDS)