Blood-pressure drugs seem to help prevent kidney disease.
* THE QUESTION An increase of albumin in the urine of people with Type 2 diabetes is considered an early sign of kidney disease. Might blood-pressure drugs -- such as ACE inhibitors and calcium channel blockers -- help prevent this condition, known as microalbuminuria?
* THIS STUDY involved 1,204 adults with Type 2 diabetes and high blood pressure but normal levels of urinary albumin. They were randomly assigned to one of four treatments: an ACE inhibitor (trandolapril), a calcium channel blocker (verapamil), a combination of the two or a placebo. After 31/2 years, microalbuminuria had developed in 6 percent of those who had taken the combination or the ACE inhibitor alone, compared with 12 percent of those who had taken channel blockers and 10 percent of the placebo group.
* WHO MAY BE AFFECTED BY THESE FINDINGS? People with Type 2 diabetes, which affects more than 170 million people worldwide. An estimated one-third of them will develop kidney disease.
* CAVEATS Twelve participants died during the study, including five from cardiovascular disease (one was taking the ACE inhibitor; one, the channel blocker; and three, the placebo). The study was funded in part by Abbott, which markets the drugs used in the study.
* BOTTOM LINE People with Type 2 diabetes may want to talk with their doctor about taking an ACE inhibitor or a combination ACE inhibitor/channel blocker.
* FIND THIS STUDY Nov. 4 issue of the New England Journal of Medicine; abstract available online at www.nejm.org.
* LEARN MORE ABOUT diabetic kidney disease at www.kidney.org and www.diabetes.org.
Marrow transplants may be less risky than blood cell donations.
* THE QUESTION For adults with leukemia, transplanting stem cells obtained from a donor's blood has become more common than using stem cells from a donor's bone marrow. In both instances, the cells replace cancerous bone marrow, but using cells from blood allows donors to avoid hospitalization, anesthesia and surgery. Is this treatment also preferable for children with leukemia?
* THIS STUDY compared the results of 143 peripheral blood stem cell transplants with 630 bone marrow transplants done in young people with leukemia. All donors were siblings; recipients were 8 to 20 years old. After an average of four years, recurrence rates were similar for the two groups, but 26 percent of the youths who had received blood cells had died from causes attributed to the transplant, compared with 14 percent who had received bone marrow. In the blood cell group, 20 percent of the recipients had developed graft-vs.-host disease, in which the transplanted cells attack the recipient's cells, compared with 5 percent of the bone marrow group.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Children with leukemia, the most common cancer in children and teens.
* CAVEATS Because the study was not randomized, it could not be determined whether factors such as the aggressiveness of each person's cancer affected the outcome.
* BOTTOM LINE Parents of a child with leukemia may want to talk with an oncologist about the risks associated with peripheral blood stem cell transplantation.
* FIND THIS STUDY Nov. 1 issue of the Journal of Clinical Oncology; abstract available online at www.jco.org.
* LEARN MORE ABOUT childhood leukemia at www.kidshealth.org and at www.cancer.org.
Eyedrops every day may be no better than less frequently.
* THE QUESTION Sometimes a child's vision deteriorates in an otherwise healthy eye, a condition known as amblyopia. Administering eyedrops daily to temporarily blur the vision of the "good" eye can strengthen the so-called lazy eye. Would the drops work as well if given less often?
* THIS STUDY randomly assigned 168 children with amblyopia to be given atropine eyedrops either daily or only on Saturdays and Sundays. All children were younger than 7 and had been diagnosed with a moderately lazy eye (meaning 20/40 to 20/80 vision). After four months, improvement was similar in both groups: Normal vision had returned to 47 percent of the children given the drops daily and 53 percent of those treated only on weekends.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Children with lazy eye, the most frequent cause of vision impairment in children and young adults.
* CAVEATS About 16 percent of the children treated daily and 29 percent of the weekend group complained of sensitivity to light when using the drops.
* BOTTOM LINE Parents of a child being treated for amblyopia may want to talk with an ophthalmologist about how often eyedrops need to be administered.
* FIND THIS STUDY November issue of Ophthalmology; abstract available online at www.aaojournal.org.
* LEARN MORE ABOUT amblyopia at www.nei.nih.gov and www.aao.org.
-- Linda Searing