A phase I clinical trial of ruxolitinib in combination with nilotinib in chronic myeloid leukemia patients with molecular evidence of disease.

Purpose: Preclinical evidence indicates that the bone marrow microenvironment provides a protective niche for leukemic stem cells, allowing them to evade the effects of BCR-ABL tyrosine kinase inhibitors (TKIs), but that targeting of the JAK-STAT pathway with the JAK2 inhibitor ruxolitinib increases TKI-induced apoptosis. A phase I clinical trial (NCT01702064) investigated the tolerability and safety of treating chronic-phase chronic myeloid leukemia patients with ruxolitinib in combination with the BCR-ABL TKI nilotinib and explored initial efficacy evidence.

Experimental Design: Eleven patients already treated with single-agent nilotinib (300-400 mg twice daily) commenced combination therapy, and molecular responses were evaluated after 6 months.

Venous thromboembolism in patients hospitalized with nephrotic syndrome.

Purpose: Whether pulmonary embolism in patients with the nephrotic syndrome is caused by deep venous thrombosis or renal vein thrombosis is controversial. To determine which is the likely cause of pulmonary embolism in patients with the nephrotic syndrome, we investigated data from the National Hospital Discharge Survey.

Methods: The number of patients discharged from nonfederal short-stay hospitals in the United States with a diagnostic code of nephrotic syndrome, deep venous thrombosis, renal vein thrombosis, and pulmonary embolism was obtained using ICD-9-M (International Classification of Diseases, Ninth Revision, Clinical Modification) codes.

Spiral computed tomography for the diagnosis of acute pulmonary embolism.

The accuracy of computed tomography (CT) imaging for the diagnosis of acute pulmonary embolism (PE) was reviewed. Single detector CT, based on pooled data, showed a sensitivity of 73% and multidetector CT, mostly 4-slice, showed a sensitivity of 83%. Respective specificities were 87% and 96%.

Catheter-directed thrombolysis (intrathrombus injection) in treatment of deep venous thrombosis: a systematic review.

Methods of delivery of thrombolytic agents for massive or limb threatening deep venous thrombosis (DVT) include a systemic infusion, local-regional administration, and catheter-directed therapy (tip of catheter placed inside the thrombus). We evaluated the effectiveness of catheter-directed therapy and compared the results with randomized clinical trials of systemic and local-regional thrombolytic therapy. Many who used catheter-directed thrombolysis used balloon angioplasty, stents, or thrombectomy in addition.

Multidetector computed tomography for the diagnosis of coronary artery disease: a systematic review.

Purpose: The study's purpose was to determine the sensitivity and specificity of contrast-enhanced multidetector computed tomography (CT) for the detection of coronary artery disease.

Subjects And Methods: A search of the literature in all languages was performed incorporating both electronic and manual components. Manual reference checks of recent reviews and all original investigations supplemented the electronic searches.

Pulmonary embolism as a cause of death in patients who died with cancer.

Little is known about the frequency of death from pulmonary embolism in patients who die with cancer. We investigated this on the basis of data from death certificates, as listed by the United States Bureau of the Census in the period 1980-1998. Among patients with cancer who died over the 19-year period of study, pulmonary embolism was the listed cause of death in 0.

Usefulness of 4-, 8-, and 16-slice computed tomography for detection of graft occlusion or patency after coronary artery bypass grafting.

The sensitivity and specificity of computed tomographic angiography for the evaluation of coronary artery bypass grafts (CABGs) was reviewed. A search of published studies in all languages was performed, incorporating electronic and manual components. A total of 985 patients with 2,200 CABGs participated in investigations with single-detector computed tomography (CT), 441 patients (1,246 CABGs) with 4-slice CT, none with 8-slice CT, and 144 patients (416 grafts) with 16-slice CT.

Mortality from acute pulmonary embolism according to season.

Background: Varying observations have been made on seasonal differences of mortality from acute pulmonary embolism (PE).

Methods: The number of deaths each year from PE, from 1980 through 1998, based on death certificates, was obtained from the US National Center for Health Statistics Multiple Cause-of-Death Files.

Results: Acute PE as the cause of death ranged from 0.

Venous thromboembolism according to age: the impact of an aging population.

Background: With the aging of the US population, there is concern that the rate of venous thromboembolism will increase, thereby increasing the health burden. In this study we sought to determine trends in the diagnosis of deep venous thrombosis (DVT) and pulmonary embolism (PE) in the elderly as well as the use of diagnostic tests.

Methods: Data from the National Hospital Discharge Survey were used.

Incidence of venous thromboembolism in infants and children: data from the National Hospital Discharge Survey.

Pulmonary embolism (PE), deep venous thrombosis (DVT), and the combination were not rare in pediatric patients in the United States from 1979 to 2001. They were more frequent in infants 0 to 1 year of age and in teenagers 15 to 17 years of age than in children 2 to 14 years of age. Pregnancies doubled the rate of DVT in teenage girls.

Outcome and complications of retrievable inferior vena cava filters.

The results and risks of retrievable inferior vena cava filters were reviewed. Systematic review identified 6 prospective case series with broad ranges of indications for filters. In these case series, 4 different types of retrievable filters were inserted in 284 patients.

Pulmonary thromboembolism in American Indians and Alaskan Natives.

Background: The rate of diagnosis of deep venous thrombosis and/or pulmonary embolism (collectively, venous thromboembolism: VTE) among patients discharged from Indian Health Service hospital care from 1980 through 1996 was considerably lower than rates reported in African Americans or whites. Expansion of the national census in 1990 to include American Indians and Alaskan Natives permits a more in-depth examination of this issue.

Methods: Combined data from the National Hospital Discharge Survey (nonfederal hospitals) and the Indian Health Service (federal hospitals) from 1996 through 2001 were used to evaluate the rate of diagnosis of VTE in American Indians and Alaskan Natives.

Twenty-one-year trends in the use of inferior vena cava filters.

Background: Improved inferior vena cava (IVC) filters have led to liberalization of the indications for insertion. Increased use, however, has been followed with a potential for unwarranted insertion. There are only sparse data on trends in the use of IVC filters in patients with pulmonary embolism (PE), patients with deep venous thrombosis (DVT) alone, and patients at high risk.

Trends in the use of diagnostic imaging in patients hospitalized with acute pulmonary embolism.

From 1979 to 2001, the proportion of imaging tests by computed tomography (CT), ventilation perfusion (VQ) lung scan, pulmonary angiography, and venous ultrasound was assessed in patients with pulmonary embolism (PE) from the National Hospital Discharge Survey. By 2001, there was a higher proportion of imaging tests with CT than VQ scans (36% vs 32%). Even so, in the United States, a large proportion of patients continued to have VQ scans.

Estimated case fatality rate of pulmonary embolism, 1979 to 1998.

Trends in the estimated case fatality rate of pulmonary embolism (PE) in the United States were obtained from the Bureau of the Census Compressed Mortality File and the National Hospital Discharge Survey. The estimated case fatality rate of PE increased from 1979 to 1989, then decreased through 1998. It increased exponentially with age and was higher in African-American than Caucasian patients (rate ratio 1.

Regional differences in rates of diagnosis and mortality of pulmonary thromboembolism.

The rates of diagnosis of deep venous thrombosis, pulmonary embolism (PE), and venous thromboembolism (PE and/or deep venous thrombosis) and the mortality rate of PE in hospitalized patients were evaluated in 4 regions of the United States. Data are from the National Hospital Discharge Survey and the United States Bureau of the Census. The western region of the United States showed a lower rate of diagnosis of deep venous thrombosis and venous thromboembolism and a lower mortality rate of PE than any other region.

Pulmonary thromboembolism in Asians/Pacific Islanders in the United States: analysis of data from the National Hospital Discharge Survey and the United States Bureau of the Census.

Purpose: To assess the rate of diagnosis of deep venous thrombosis, pulmonary embolism, and venous thromboembolism; the incidence in hospitalized patients; and mortality from pulmonary embolism among Asians/Pacific Islanders in the United States.

Methods: The number of patients discharged from hospitals with a diagnostic code for pulmonary embolism or deep venous thrombosis from 1990 through 1999 was obtained from the National Hospital Discharge Survey. Population estimates and deaths from pulmonary embolism from 1990 through 1998 were obtained from the United States Bureau of the Census.

Analysis of occurrence of venous thromboembolic disease in the four seasons.

Reports of seasonal variation of the incidence of pulmonary embolism and deep venous thrombosis are inconsistent as to when or if it occurs. We used data from the National Hospital Discharge Survey and the United States (US) Bureau of the Census to test for circannual variation throughout the entire US and in regions of the US over a period of 21 years. Pulmonary embolism, deep venous thrombosis, or the combination did not show seasonal variation in the US or in any region of the US, including the Southern region, where winters are mild, and the northeastern and midwestern regions, where seasons are sharply defined.

Gadolinium-enhanced magnetic resonance angiography for detection of acute pulmonary embolism: an in-depth review.

Study Objective: To review the published experience with gadolinium-enhanced magnetic resonance angiography (MRA) for the detection of acute pulmonary embolism (PE) in order to test the hypothesis that gadolinium-enhanced MRA may be potentially sensitive and specific enough to include it among diagnostic alternatives in the evaluation of patients with suspected PE.

Methods: Studies were identified by searching MEDLINE for trials that used gadolinium-enhanced MRA to diagnose acute PE based on the visualization of an intraluminal filling defect or a cutoff vessel, using pulmonary angiography as a reference standard.

Results: Twenty-eight investigations were identified in which MRA was used to diagnose PE.