In patients with suspected pulmonary embolism, multidetector CTA-CTV has a higher diagnostic sensitivity than does CTA alone, with similar specificity. The predictive value of either CTA or CTA-CTV is high with a concordant clinical assessment, but additional testing is necessary when the clinical probability is inconsistent with the imaging results.

Reports of racial differences in the incidence of sarcoidosis, a granulomatous disorder of unknown etiology, are primarily based on studies of military and veteran populations. To determine racial differences in sarcoidosis incidence in a metropolitan population the authors conducted a study of newly diagnosed cases that occurred between 1990 and 1994 among members of the Health Alliance Plan health maintenance organization in Detroit, Michigan. The study population was racially heterogeneous, was limited to individuals aged 20-69 years, and comprised about 5% of the Detroit metropolitan area population in that age group. Annual age-adjusted incidence, in number of new cases per 100,000, was highest in African-American females (39.1 cases). The next highest incidence was found in African-American males (29.8 cases), followed by Caucasian females (12.1) and Caucasian males (9.6). African-American females aged 30-39 years were at the greatest risk, with an annual incidence of 107/100,000. Overall, African Americans had about a threefold higher age-adjusted annual incidence (35.5/100,000) compared with Caucasians (10.9/100,000). Additional adjustment for sex, area of residence, and year of study resulted in 3.8-fold greater risk for African Americans compared with Caucasians. This study further confirmed the higher incidence of sarcoidosis in African Americans compared with Caucasians, but the racial difference was lower than previously reported. The results should be more generalizable than previous studies done with select populations and should serve as a useful frame of reference for future epidemiologic research of sarcoidosis.

When properly diagnosed and treated, clinically apparent pulmonary embolism was an uncommon cause of death, and it recurred in only a small minority of patients. Most deaths were due to underlying diseases. Patients with pulmonary embolism who had cancer, congestive heart failure, or chronic lung disease had a higher risk of dying within one year than did other patients with pulmonary embolism.

We forecast that the proportion of care provided by intensivists and pulmonologists in the United States will decrease below current standards in less than 10 years. While current health care reform initiatives and modification of existing practice patterns may temporarily forestall this problem, most anticipated effects are minor in comparison with the growing disease burden created by the aging US population. JAMA. 2000;284:2762-2770.

The angiotensin-converting enzyme (ACE) has been implicated in the pathophysiology of sarcoidosis. Serum ACE levels in normal and sarcoidosis patients are influenced by an insertion (I)/deletion (D) polymorphism in the ACE gene. To elucidate the role of this ACE gene polymorphism in sarcoidosis, we conducted a case-control study in African Americans and Caucasians. The ACE gene (I/D) polymorphism did not differ between 60 Caucasian cases and 48 control subjects (p = 0.577). In contrast, a comparison of 183 African-American cases and 111 control subjects resulted in a marked difference in genotypic distributions (p = 0.005). In African Americans, the risk for sarcoidosis was 1.30 (95% confidence interval [CI] = 0.72 to 2. 36) for ID heterozygotes, and 3.17 (95% CI = 1.50 to 6.71) for deletion/deletion (DD) homozygotes. The risk associated with the DD homozygotes was even greater in African Americans when cases were restricted to those with a positive family history (odds ratio = 4. 83; 95% CI = 1.86 to 12.59). Further analyses of African-American cases showed that the ACE genotype was not associated with disease severity, extrathoracic involvement, or overall radiographic change 2 to 4 yr after diagnosis. We did find a moderate association between the II genotype and radiographic progression (OR = 2.97; 95% CI = 1.01 to 8.76). Our results suggest the ACE genotype may play a more important role in sarcoidosis susceptibility and progression in African Americans than Caucasians.