Despite the advances in our understanding of venous thromboembolic disease, the prevalence of pulmonary thromboembolism (PTE) at autopsy has not changed over 3 decades. When patients survive long enough to have a diagnosis of massive PTE and start receiving treatment, the outlook is considered to be moderately good. However, the diagnosis is often difficult to obtain and is frequently missed. We hypothesize that mortality of acute PTE is reduced by early diagnosis. Eighty-five patients with acute PTE with circulatory failure who survived 1 h after the onset were divided into two groups: the early Dx group consisted of the patients whose disease was diagnosed as acute PTE within 24 h of the onset, and the Late Dx group included patients whose disease was not diagnosed within 24 h of onset, or died without clinical diagnosis between 1 and 24 h after the onset. Overall mortality was significantly low in the Early Dx group compared with that of the Late Dx group (21.6% vs 67.6%, P < 0.0001). Multiple logistic regression analysis demonstrated that a reduction in in-hospital mortality was associated with early diagnosis (odds ratio for in-hospital death, 0.094; 95% confidence interval, 0.03-0.33). The results of our study suggested that early diagnosis might favorably affect the in-hospital clinical outcome of hemodynamically unstable patients with acute PTE.

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We enrolled 196 patients with hypertension who were already being treated with free-drug combinations of angiotensin-II receptor blocker (ARB) and amlodipine. The free-drug combinations of ARB and amlodipine were replaced with the same dose of the fixed-dose combinations. The average home blood pressure (BP) in all patients receiving fixed-dose combinations was significantly lower than those receiving free-drug combinations (131 ± 10/75 ± 8 vs. 136 ± 11/77 ± 9 mm Hg, P < .01) accompanied with increasing drug adherence. After lowering BP by fixed-dose combinations, the costs for medications decreased by 31% over the 3 months.

1 Endothelin-1 (ET-1) caused a concentration-dependent contraction of helical strips from rat thoracic aorta in the absence of extracellular Ca2+. The Ca2+-depleted muscle strips, prepared by three repeated applications of 10-2M caffeine or 10-6M noradrenaline in Ca2`-free buffer, were contracted by 10-8MET-1 in the same manner as non-treated strips. 2 In the absence of extracellular Ca2 10 -7M phorbol 12-myristate 13-acetate (PMA), an activator of protein kinase C, induced a small but sustained contraction of the rat thoracic aorta strips within 60min.Preincubation of the strips with 10-7M PMA for 60min in Ca2'-free buffer, did not affect the 10-8M ET-1-induced contraction, but decreased the 5 x 10-8M phorbol 12,13-dibutyrate (PDB)-, or the 10-7M PMA-induced contraction, and potentiated the contraction induced by 10-8M urotensin II. Preincubation with 10-8M ET-1 (which induced maximum contraction) for 25min in Ca2+-free buffer did not change the subsequent contraction induced by PMA (10-7M) or urotensin II (10-8M) but gave a somewhat lower maximum tension than in non-treated strips. 3 Calyculin-A, a potent inhibitor of phosphatase, also induced a contraction of the Ca2+-depleted muscle strips in Ca2 '-free buffer. Preincubation of the strips with ET-1 (10-8M) or PMA (10-7M) decreased the calyculin-A (3 x 10 8 minduced contraction. 4 These results suggest that ET-1 may induce

Objective In this prospective, non-controlled observational study, we evaluated the middle-to long-term results of placement of inferior vena cava (IVC) filter devices in Japanese patients.Methods and results In 42 Japanese patients with deep vein thrombosis (DVT) or pulmonary thromboembolism (PTE) who underwent percutaneous insertion of IVC filters, follow-up examinations at fixed intervals of 2 years were performed, and the data was evaluated including complications. There were no fatal complications during IVC filter implantation. About 5 %of patients with an inserted IVC filter developed symptomatic PTE, another 5 %devel-oped asymptomatic PTE. The trapped thrombus was demonstrated in about 22%of the inserted IVC filters. Lower rates of PTEdevelopment, occlusion of IVC, and captured thrombuswere found in the cases whereconcurrent use of anticoagulation therapy with filters was used. Trapped thrombi were found in half of IVC filters inserted prophylactically for proximal femoral venous thrombosis.Conclusion These experiences with IVCfilters suggest that they are safe and effective for the prevention of PTEin the Japanese population.