ancer is a major risk factors for thrombotic pulmonary embolism (PE), [1][2][3][4] and thrombotic PE associated with cancer is known as Trousseau's syndrome. Cancer induces not only thrombotic PE but also tumor PE and tumor invasion into large veins. However, there is lack of epidemiological data from the general population to compare the incidence of thrombotic PE, tumor PE and tumor invasion to large veins according to the histopathology and the site of the cancer. Clinicians have given more attention to the prevention of venous thromboembolism (VTE) with chemotherapeutic and surgical treatment of cancer patients, but it is important to evaluate the risk of the development of VTE according to the histopathology and primary site of the cancer.The goal of this study was to investigate variations in the incidence of thrombotic PE, tumor PE and tumor invasion into large veins according to tumor histopathology and tumor site. MethodsA total of 65,181 cancer patients (66.0%) were identified from 98,736 postmortem examinations. [5][6][7] The incidence of PE, as well as the tumor site and the histopathology, was recorded for each case. PE was defined as critical (critical PE) when it was the primary cause of death or main diagnosis, and "total PE" was used to indicate the total number of thrombotic PEs, tumor PEs, bacterial PEs, mycotic PEs and other emboli (eg, fat, amniotic fluid etc). The type of emboli was determined by the pathologist performing the autopsy. Cases with 2 different types of emboli were counted twice. All cases were also reviewed for the presence of tumor invasion into a large vein. Within each PE group, the incidence of PE was compared between specific tumor types (adenocarcinoma, mucinous carcinoma, transi- Takeshi Nakano, MD*; Kunio Shirato, MDBackground The specific incidence of thrombotic pulmonary embolism (PE), tumor PE and tumor invasion into large veins according to tumor type and tumor site remains unclear. Methods and Results A total of 65,181 cancer patients were identified from 98,736 postmortem examinations. Thrombotic PE occurred in 2.32% of all cancer patients and comprised 88.6% of the total number of all PE events. The incidence of thrombotic PE was high in those with adenocarcinoma, leukemia and large cell carcinoma, and was low in those with hepatic cell carcinoma. The incidence of PE was high when tumor was present in hematogenous tissue, lungs, ovaries, pancreas and the biliary system, and was low when tumor was present in the liver. The incidence of tumor PE was high with large cell carcinoma, hepatic cell carcinoma and adenocarcinoma, and was also high when tumor was present in the lungs, ovaries, kidneys and liver. There was a significant correlation between the incidence of tumor PE and the incidence of tumor invasion into large veins. Conclusion The incidence of thrombotic PE, tumor PE and tumor invasion into large veins varies significantly according to tumor histopathology and tumor site. (Circ J 2006; 70: 744 -749)

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.

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.

No abstract

he number of deaths from pulmonary embolism (PE) has been increasing in Japan, 1 and the incidence of PE in autopsy cases is also reported to have increased from 1958 to 1986. 2,3 Population-based analysis shows that deaths from PE are increasing in older age groups but PE is often misdiagnosed. 4,5 There are no reports on the incidence of PE in autopsy cases after 1986 in Japan and the following remain to be solved: (1) to what degree does PE contribute to death in different ages and genders and (2) what factor (s) contributes to diagnosis of PE before death. Therefore, our aims in the present study were to examine the incidence of PE in autopsy cases after 1986, and to clarify these 2 unsolved questions. MethodsThe subjects of the present study included PE cases confirmed by autopsy in Japan between 1987 and 1998. 6-17 We excluded cases of pulmonary microembolism with disseminated intravascular coagulation from our analysis. Circulation Journal Vol.71, November 2007PE was defined as critical (critical PE) when it was the primary cause of death or the main diagnosis and it includes all types of PE. The term "all PE" was used to indicate the total number of thrombotic PEs, tumor PEs, bacterial PEs, mycotic PEs and other emboli (eg, fat, amniotic fluid, etc). 18 To make it possible to compare our data with those reported by Mieno et al, 3 we analyzed our PE cases according to Mieno's criteria in which cases less than 1 year old and those with non-thrombotic PE were excluded. Statistical AnalysisStatistical analysis was performed using SPSS 13.0 (SPSS Inc, Chicago, IL, USA). Non-ordinal categorical data using the chi-square test. The results of the logistic regression models and Poisson regression analysis 19 are presented as estimated odds ratios (ORs) with the corresponding 95% confidence intervals (CIs).Circ J 2007; 71: 1765 -1770 (Received April 18, 2007 revised manuscript received July 9, 2007; accepted July 24, 2007