Interne Behandlung von Thrombophlebitis <

Interne Behandlung von Thrombophlebitis

Original Article. Comparison of Caspofungin and Amphotericin B for Invasive Candidiasis. Jorge Mora-Duarte, M.D., Robert Betts, . Deutsch Ordens Spital Friesach: Venenchirurgie Interne Behandlung von Thrombophlebitis


Comparison of Caspofungin and Amphotericin B for Invasive Candidiasis — NEJM Interne Behandlung von Thrombophlebitis

N Engl J Med ; Caspofungin is an echinocandin agent with fungicidal activity against candida species. We performed a double-blind trial to compare caspofungin with amphotericin B deoxycholate for the primary treatment of invasive candidiasis. Full Text of Background We enrolled patients who had clinical evidence of infection and a positive interne Behandlung von Thrombophlebitis for candida species from blood or another site. Patients were stratified according to the severity of disease, as indicated by the Acute Physiology and Chronic Health Evaluation APACHE II score, and the presence or absence of neutropenia and were randomly assigned to receive either caspofungin or amphotericin B.

The study was designed to compare the efficacy of caspofungin with that of amphotericin B in patients with invasive candidiasis and interne Behandlung von Thrombophlebitis a subgroup with candidemia. Full Text of Methods Of the patients enrolled, were included in the modified intention-to-treat analysis. Base-line characteristics, including the percentage of patients with neutropenia and the mean APACHE II score, were similar in the two treatment groups. A modified intention-to-treat analysis showed that the efficacy of caspofungin was similar to that of amphotericin B, interne Behandlung von Thrombophlebitis successful outcomes in An analysis of patients who met prespecified criteria for evaluation showed that caspofungin was superior, with a favorable response in Caspofungin was as effective as amphotericin B in patients who had candidemia, with a favorable response in Interne Behandlung von Thrombophlebitis were significantly fewer drug-related adverse events in the caspofungin group than in the amphotericin B group.

Full Text of Results Caspofungin is at least as effective as amphotericin B for the treatment of invasive candidiasis and, more specifically, candidemia. Full Text of Discussion The optimal first-line treatment for serious candida infections is a controversial issue. Amphotericin B has served as standard treatment for five decades, but toxic effects often limit its use. The need remains for new agents to treat serious candida infections.

One alternative is caspofungin, interne Behandlung von Thrombophlebitis, an echinocandin with fungicidal activity against candida. The trial was conducted between November and June at 56 institutions in 20 countries. Patients were eligible for enrollment in the study if they were over the age of 18 years and had had one or more positive candida cultures from blood or another, sterile site within the previous four days.

Patients with positive cultures of urine specimens, sputum specimens, bronchoalveolar-lavage specimens, interne Behandlung von Thrombophlebitis, oropharyngeal or esophageal specimens, or samples from indwelling drains were excluded. An interne Behandlung von Thrombophlebitis criterion for enrollment was at interne Behandlung von Thrombophlebitis one interne Behandlung von Thrombophlebitis the following clinical signs of infection during the previous two days: Patients with suspected endocarditis, osteomyelitis, or meningitis were excluded.

Patients receiving rifampin, ritonavir, or cyclosporine were also not enrolled. The study protocol was approved by the institutional review board of each participating institution, and written informed consent was obtained from all patients before enrollment. They were randomly assigned to receive either intravenous caspofungin or intravenous amphotericin B according to a schedule maintained by each participating institution's pharmacist.

The schedules were generated by computer to ensure equivalent randomization at each site. Dass das Trinken von Blut-Verdünnungsmittel für Krampfadern and investigators were unaware of the treatment assignments. Patients who were assigned to receive caspofungin were given a mg loading dose, followed by 50 mg per day.

Patients Behandlung von tiefen Venen Thrombophlebitis der unteren Extremität were assigned to receive amphotericin B and who did not have neutropenia were given 0.

A double-dummy technique was used to maintain the blinding. The daily treatment regimen consisted of infusion of caspofungin or matching placebo saline for one hour, immediately followed by infusion of amphotericin B or matching placebo saline with a multivitamin complex for two or more hours. An increase or reduction in the interne Behandlung von Thrombophlebitis was not permitted.

Patients were to receive antifungal therapy for 14 days after the most recent positive candida culture. A minimum of 10 days of intravenous therapy was required. After 10 days, intravenous therapy was continued or oral fluconazole was substituted mg per day.

Fluconazole was given only to patients who did not have neutropenia, whose clinical condition had improved, whose follow-up cultures had been negative for 48 hours, and whose candida isolates were susceptible to fluconazole. Patients with Candida krusei or C. Symptoms or signs of candida infection including the most abnormal temperature were documented daily during the treatment regimen and two weeks and six to eight weeks after treatment.

Physical examination and laboratory tests were performed twice a week during treatment and at both follow-up visits. For patients with candidemia, two samples for blood cultures were obtained daily until the results had been negative for at least 48 hours. For nonblood infections, interne Behandlung von Thrombophlebitis, follow-up cultures were also routinely obtained; however, in Krampfadern an der Unterseite der Füße patients, the infection was assumed to have been eradicated and follow-up cultures were not required if there was no longer any clinical or radiographic evidence of infection.

Retinal examinations for candida endophthalmitis were performed by ophthalmologists before enrollment, at the end of intravenous therapy, and at the final follow-up visit. Efficacy was assessed in terms of the overall response to treatment. A favorable overall response was interne Behandlung von Thrombophlebitis as the resolution of all symptoms and signs of candida infection and culture-confirmed eradication or presumptive eradication for certain nonblood infections.

The outcome was considered to be unfavorable if the infection was clinically or microbiologically unresponsive, if the study drug was withdrawn before there was documented improvement, or if toxic effects necessitated a change in antifungal therapy.

Evaluations were performed on day 10 of intravenous therapy, at the end of intravenous therapy, at the end of all antifungal therapy intravenous therapy and oral fluconazoleand at both follow-up visits, interne Behandlung von Thrombophlebitis. The primary time point for the determination of efficacy was the end of intravenous therapy, interne Behandlung von Thrombophlebitis.

During the six-to-eight-week period after treatment, a patient was considered to have a relapse if an invasive candida infection had recurred or if antifungal therapy for a proven or suspected candida infection was again administered. The study was primarily designed to determine whether caspofungin was as effective as amphotericin B for the treatment of invasive candidiasis, with efficacy measured in terms of the overall response at the end of intravenous therapy.

The noninferiority of caspofungin would be demonstrated if the two-sided The superiority of caspofungin would be demonstrated if the confidence interval was entirely above 0, interne Behandlung von Thrombophlebitis. Adjustments for multiple comparisons were not performed.

The two prespecified study populations for the analysis of efficacy were the patients included in the modified intention-to-treat analysis and the population of patients who met prespecified criteria for evaluation.

The modified intention-to-treat analysis the primary analysis included patients who had a documented diagnosis of invasive candidiasis and who received the study treatment for at least one day. The prespecified criteria for evaluation were inclusion in the modified intention-to-treat analysis and no concomitant antifungal therapy, no protocol violations that might interfere with the assessment of efficacy, an appropriate evaluation at the end of treatment, and receipt of the study treatment for at least interne Behandlung von Thrombophlebitis days.

The study was also designed to compare certain end points in an analysis of safety, including nephrotoxicity. A nephrotoxic effect was defined as at least a doubling of the serum creatinine level, or an increase of at least 1. Other predefined end points in the analysis of safety included drug-related adverse events, discontinuation of treatment due to drug-related adverse events, infusion-related toxic effects, and hypokalemia requiring potassium supplementation.

All patients who received the assigned study treatment were included in the safety analysis. An independent data safety monitoring board monitored both safety and efficacy during the study. The authors who are not affiliated with Merck had access to all the study data, interne Behandlung von Thrombophlebitis, take responsibility for the accuracy of the analysis, and had authority over the preparation of the manuscript and the decisions about publication.

A total of patients were enrolled in the study over a period of 44 months, of whom were included in the modified intention-to-treat analysis Table 1 Table 1 Numbers of Patients Enrolled, Included in the Modified Intention-to-Treat Analysis, and Included in the Analysis of Patients Who Met Prespecified Criteria for Evaluation. The base-line characteristics of the patients were similar in the two treatment groups Table 2 Table 2 Base-Line Characteristics of the Patients Included in interne Behandlung von Thrombophlebitis Modified Intention-to-Treat Analysis.

The majority of the patients had candidemia, interne Behandlung von Thrombophlebitis, but peritonitis and intraabdominal abscesses were not uncommon. Approximately 60 percent of the patients had received prior antifungal therapy, but only for a day or less in most cases.

The most common candida isolate was C. Five patients had infections with both C, interne Behandlung von Thrombophlebitis.

Patients in interne Behandlung von Thrombophlebitis caspofungin group were treated for a mean of A switch to oral fluconazole after day 10 occurred in the cases of 27 caspofungin-treated patients In the modified intention-to-treat analysis, the proportion of patients with a favorable response at the end of intravenous therapy was In the analysis of patients who met the prespecified criteria for evaluation, The difference between the treatment groups for this analysis was The outcomes were consistent among the stratified subgroups, interne Behandlung von Thrombophlebitis.

In both treatment groups, the response rate was lower among patients with indicators of a poor prognosis neutropenia or an APACHE II score higher than 20 than among patients without these indicators, but there was still a trend in favor of caspofungin. The outcomes stratified according to the candida pathogen were generally similar in the two groups. The response rate was higher among patients with non-albicans infections in both the caspofungin group The responses were similar for the most common non-albicans species — namely, C.

At each of the four other time points day 10, the end of antifungal therapy, two weeks after treatment, and six to eight weeks after treatmentthe percentage of interne Behandlung von Thrombophlebitis with successful outcomes was higher in the caspofungin group than in the amphotericin B group Table 4, interne Behandlung von Thrombophlebitis.

Similar proportions of patients in the two treatment groups had persistently positive cultures, interne Behandlung von Thrombophlebitis, persistent interne Behandlung von Thrombophlebitis or symptoms, or new metastatic lesions or withdrew from the study after four or fewer days Table 5 Table 5 Treatment Failures and Relapses Modified Intention-to-Treat Analysis.

The proportion of patients with a relapse was similar in the two treatment groups Table 5. Only five patients had a relapse of candidemia three in the caspofungin group and two in the amphotericin B group. In all five patients, the organism cultured at relapse and the base-line isolate were identical with interne Behandlung von Thrombophlebitis to the species and the minimal inhibitory concentration.

The study was specifically designed to compare the efficacy of caspofungin and that of amphotericin B for the treatment of candidemia, interne Behandlung von Thrombophlebitis. In the modified intention-to-treat analysis, the proportion of patients with candidemia who had a favorable outcome at the end of intravenous therapy was In the analysis of patients with candidemia at base line who met the prespecified criteria for evaluation, In this analysis, the difference was A larger proportion of patients in the caspofungin group than in the amphotericin B group had multiple positive blood cultures at base line However, the percentages of patients with blood cultures that were still positive on days 4 and 7 of intravenous therapy did not differ significantly between the two groups day 4: The outcomes were also examined in patients without candidemia.

Among those with peritonitis, the response rate was percent eight of eight patients in the caspofungin group das ist für Krampfadern vorgeschriebenen Of the nine patients with multiple sites of infection, four of the five patients treated with caspofungin Management of central venous catheters did not differ significantly between the two groups.

Overall, patients with candidemia 54 in the caspofungin group and 57 in the amphotericin B group had an indwelling central venous catheter at the time of the first positive blood culture. By day 3, the central venous catheter had been removed in 41 of Varizen Lutsk caspofungin-treated patients The response rate among the 11 patients whose central venous catheters were not removed or changed 6 in the caspofungin group and 5 in the amphotericin B group was similar to the rate among the patients whose central venous catheters were removed or changed.


Online-Kodierleitfaden Geriatrietypische Multimorbidität - Teil 1 Interne Behandlung von Thrombophlebitis

Als Varizen werden krankhaft erweiterte Venen bezeichnet, die häufig mit einer Schlängelung und Knäuelung der betroffenen Venen einhergeht.

Die sekundäre Varikose ist häufig eine Folge von tiefen Beinvenenthrombosen. Ausführliche Erhebung der Symptome und Risikofaktoren Inspektion: Strömungsgeräusche Nicht invasive Untersuchungsmethoden:. Über weitere kleinste Hautschnitte werden zusätzlich Seitenastvarizen entfernt und insuffiziente Perforansvenen ligiert.

Radiofrequenzverfahren Dies ist ein Verfahren in dem in die zu interne Behandlung von Thrombophlebitis Vene ein Katheter eingeführt wird. Mit Hilfe eines Generators wird Radiofrequenzenergie erzeugt, die über die Katheterspitze an die Venenwand abgegeben wird, die sich z. Durch die Erhitzung der Venenwand kommt es zur Schädigung der innersten Wandschicht Endothelzum Schrumpfen der kollagenen Fasern in der Venenwand und dadurch zum konsekutiven Verschluss der Vene.

Strömungsgeräusche Nicht invasive Untersuchungsmethoden: Es können Engstellen in den Arterien und kaputte Klappen, die einen Rückfluss in den Venen ermöglichen geortet werden. Farbkodierte Duplexsonographie Diese Ultraschalluntersuchung ermöglicht die Durchgängigkeit der Venen, den Ausschluss einer tiefen Venenthrombose und einen Reflux in den oberflächlichen Venen nachzuweisen. Venenverschlussplethysmographie Varizen Apfelessig Bewertungen Venen der Beine werden zunächst durch Stauung maximal gefüllt.

Am besten geeignet ist diese Untersuchungsmethode bei symptomatischen PatientInnen mit fortgeschrittener Thrombose. Digitale Photoplethysmographie Sie dient der Funktionsbeurteilung des Venensystems an den Extremitäten. Gemessen wird die Rücktransportkapazität der Venen indem ein Messkopf ca, interne Behandlung von Thrombophlebitis.

Dieser sendet Infrarotstrahlen aus, die abhängig vom Hautgewebe und dem Blutgehalt des Gewebes reflektiert und aufgezeichnet werden. Mit dieser Untersuchung kann festgestellt werden, ob eine chronisch venöse Insuffizienz durch interne Behandlung von Thrombophlebitis Operation gebessert werden kann. Mit Hilfe dieser Methode gelingt es, interne Behandlung von Thrombophlebitis, die Anatomie und eventuelle Abflussstörungen des tiefen und oberflächlichen Venensystems darzustellen.

Computertomographie Diese Methode ist bestens geeignet um die thrombosierte Venen im Bauchraum und Becken darzustellen. Blutuntersuchungen Labor Spezielle Laborparameter werden bei Verdacht auf eine tiefe Venenthrombose und bei Bestätigung derselben bestimmt. Diese dienen dazu, eine genetische Ursache und eine angeborene Störung von Gerinnungsfaktoren zu diagnostizieren.


Superficial Venous Thrombosis

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- Medizin Behandlung von venösen Ulzera
Anhaltszahlen für die Mindestverweildauer: Bremer Katalog: 1: 2: 3: ICD 10 Bezeichnung: Mindest-VD: A Darminfektion durch enteropathogene Escherichia coli.
- Analysen mit Krampfadern
Kodieren in der Geriatrie: Geriatrische frührehabilitative Komplexbehandlung, geriatrietypische Multimorbidität, geriatrischer Prozedurenkatalog (OPS-G), ICDGM.
- was für Krampfadern an den Beinen zu tragen
Anhaltszahlen für die Mindestverweildauer: Bremer Katalog: 1: 2: 3: ICD 10 Bezeichnung: Mindest-VD: A Darminfektion durch enteropathogene Escherichia coli.
- welche Knoten mit Krampfadern
Anhaltszahlen für die Mindestverweildauer: Bremer Katalog: 1: 2: 3: ICD 10 Bezeichnung: Mindest-VD: A Darminfektion durch enteropathogene Escherichia coli.
- Varizen und wirksame Behandlungen
VENENCHIRURGIE. Als Varizen werden krankhaft erweiterte Venen bezeichnet, die häufig mit einer Schlängelung und Knäuelung der betroffenen Venen einhergeht.
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