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Articles 
Linda E. Lévesque, James M. Brophy, and Bin Zhang This observational cohort study provides evidence that elderly people who currently use rofecoxib have a dose-related increased risk for acute myocardial infarction. Other nonsteroidal anti-inflammatory drugs, including celecoxib, were not associated with increased risk.
Clive Kearon, Jeffrey S. Ginsberg, James Douketis, Mark A. Crowther, Alexander G. Turpie, Shannon M. Bates, Agnes Lee, Patrick Brill-Edwards, Terri Finch, and Michael Gent This randomized study compared two diagnostic strategies for suspected deep venous thrombosis. The starting point is a normal result on ultrasonography of the proximal leg veins. A strategy based on D-dimer testing followed by no further testing if the results were negative and venography if the results were positive identified substantially more cases than a strategy of repeated ultrasonography in 1 week. The rates of late venous thromboembolism were the same, however.
Mark J. Sarnak, Ronit Katz, Catherine O. Stehman-Breen, Linda F. Fried, Nancy Swords Jenny, Bruce M. Psaty, Anne B. Newman, David Siscovick, Michael G. Shlipak and the Cardiovascular Health Study* Cystatin C, a cysteine proteinase inhibitor produced by all nucleated cells, is a new and promising marker of kidney dysfunction. Its serum concentration is an independent risk factor for onset of heart failure in older adults and provides a better measure of risk than serum creatinine.
Neil A. Goldenberg, Linda Jacobson, and Marilyn J. Manco-Johnson This study evaluated platelet function in 11 healthy volunteers for 24 hours following completion of a 7-day course of 600 mg of ibuprofen every 8 hours. Platelet function was normal in all patients by 24 hours. The results suggest that it is safe to continue ibuprofen until 24 hours before surgery.
Reviews
Jan O. Friedrich, Neill Adhikari, Margaret S. Herridge, and Joseph Beyene Surveys show that physicians continue to prescribe low-dose dopamine for acute renal dysfunction, even though neither evidence nor editorials and reviews support its use. This meta-analysis found that low-dose dopamine has no benefit for acute renal dysfunction.
Position Papers
Lois Snyder, Cathy Leffler for the Ethics and Human Rights Committee, American College of Physicians* The fifth edition of the American College of Physicians' Ethics Manual covers emerging issues in medical ethics and revisits old ones. It reflects on many of the ethical tensions faced by internists and their patients and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, the Manual may help physicians avert future problems.
Clinical Guidelines
Vincenza Snow, Patricia Barry, Nick Fitterman, Amir Qaseem, Kevin Weiss for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians* This guideline provides recommendations for the pharmacologic and surgical treatment of obesity. The target audience is all clinicians caring for patients with a body mass index of 30 kg/m2 or greater.
Zhaoping Li, Margaret Maglione, Wenli Tu, Walter Mojica, David Arterburn, Lisa R. Shugarman, Lara Hilton, Marika Suttorp, Vanessa Solomon, Paul G. Shekelle, and Sally C. Morton This meta-analysis of studies of pharmacologic treatment of obesity supports the American College of Physicians' clinical guideline in this issue. Sibutramine, orlistat, phentermine, bupropion, and topiramate—and probably fluoxetine and diethylpropion—promote modest weight loss when given along with recommendations for diet.
Melinda A. Maggard, Lisa R. Shugarman, Marika Suttorp, Margaret Maglione, Harvey J. Sugerman, Edward H. Livingston, Ninh T. Nguyen, Zhaoping Li, Walter A. Mojica, Lara Hilton, Shannon Rhodes, Sally C. Morton, and Paul G. Shekelle This meta-analysis on surgical treatment of obesity supports the American College of Physicians' clinical guideline in this issue. Surgery is more effective than nonsurgical treatment for weight loss and control of some comorbid conditions in patients with a body mass index of 40 kg/m2 or greater. The advantage of surgery for milder forms of obesity is not clear.
Editorials
Russell D. Hull The article in this issue by Kearon and colleagues compares two strategies for being sure that patients with suspected deep venous thrombosis are successfully diagnosed and treated. One of them involves contrast venography, a seldom-used test that offers a complete one-visit diagnostic strategy but also a small added risk.
Adeera Levin In this issue, Sarnak and colleagues underscore what we know about the association between chronic kidney disease and cardiovascular disease, what we need to know (the mechanisms by which chronic kidney disease affects cardiovascular disease), and what we can do with what we currently know (improve the accuracy of chronic kidney disease measures and use cystatin C as a novel prognostic indicator for heart failure).
Letters Angiotensin-Converting Enzyme Inhibitors in Black Patients
Computed Tomography versus Endoscopic Ultrasonography for Staging of Pancreatic Cancer
The Physiologic Basis of High-Altitude Diseases
Correction: Plasma Level of a Triggering Receptor Expressed on Myeloid Cells-1
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