Improving drug adherence using fixed combinations caused beneficial treatment outcomes and decreased health-care costs in patients with hypertension.

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.

Bilateral giant coronary aneurysms diagnosed non-invasively by dynamic magnetic resonance imaging.

Giant coronary aneurysms are sometimes misdiagnosed as cardiac tumors when they are filled with thrombus. In this case, dynamic magnetic resonance imaging revealed the coronary artery and cardiac mass, and was the most useful tool for diagnosis of giant coronary aneurysms non-invasively.

[The role of echocardiography and venous ultrasonography in the diagnosis of acute pulmonary thromboembolism].

Patients with pulmonary embolism (PE) are undergoing echocardiography and venous ultrasonography with increasing frequency. Echocardiography is ideal because it is readily available and is useful for the differential diagnosis in hemodynamically unstable patients. Although predominantly employed to characterize RV pressure overload, echocardiography may detect right heart thrombus or may provide alternative diagnosis. Echocardiography also is useful in assessing the prognosis of patients as well as their response to therapy. Right ventricular hypokinesis, a patent foramen ovale, and right heart thrombus are markers identifying patients at risk for death. PE and deep vein thrombosis are different clinical manifestations of a common disease entity. Venous ultrasonography may reduce pulmonary angiography in patients with non-diagnostic lung scan.

Prognostic significance of early diagnosis in acute pulmonary thromboembolism with circulatory failure.

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.