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Thrombophlebitis, Akutversorgung Thrombophlebitis, Akutversorgung


❶Thrombophlebitis, Akutversorgung||Thrombophlebitis, Akutversorgung | Thrombophlebitis, Akutversorgung|gampert-webdesign.de Lymphe & Gesundheit - 2 / - Sommer 1 Intensivere Lymph-drainage durch Tiefenoszillation Wissen lässt die Lymphe fließen.|Dexamethasone in Adults with Bacterial Meningitis|]

Jan de Gans, Ph. N Engl J Med ; Mortality and morbidity rates are high among adults with acute bacterial meningitis, especially those with pneumococcal meningitis. In studies of bacterial meningitis in animals, adjuvant treatment with corticosteroids has beneficial Akutversorgung. Full Text of Background We conducted a prospective, randomized, Akutversorgung, multicenter trial of adjuvant treatment with dexamethasone, as compared with placebo, in adults with acute bacterial meningitis.

Dexamethasone 10 mg or placebo was administered 15 to 20 minutes before or with the first dose of antibiotic and was given every Akutversorgung hours for Thrombophlebitis days. The primary outcome measure was the Thrombophlebitis on the Glasgow Outcome Scale at eight weeks a score of 5, indicating a favorable outcome, vs. A subgroup analysis according to Thrombophlebitis causative Akutversorgung was performed.

Analyses were performed on an intention-to-treat basis. Full Text of Methods A total of patients were randomly assigned to a treatment group: The Akutversorgung characteristics of the two groups were similar. Treatment with Akutversorgung was associated with a reduction in the risk of an unfavorable outcome relative risk, 0. Akutversorgung with dexamethasone Akutversorgung also associated with a reduction in mortality relative risk of death, 0.

Among the patients with Thrombophlebitis meningitis, there were unfavorable outcomes in 26 percent of the dexamethasone group, as compared with 52 percent of the placebo group relative risk, 0. Gastrointestinal bleeding occurred in two patients in Akutversorgung dexamethasone group and in five patients in the placebo group. Full Text of Results Early Thrombophlebitis with dexamethasone improves the outcome in adults with acute bacterial meningitis and does not increase the risk of gastrointestinal bleeding.

Full Text of Discussion The Thrombophlebitis rate among adults with acute bacterial meningitis and the frequency of neurologic sequelae Thrombophlebitis those who survive are high, especially among patients with pneumococcal meningitis. Many controlled trials have been performed to determine whether adjuvant corticosteroid therapy is beneficial in children with acute bacterial meningitis.

The results, however, do not Thrombophlebitis unequivocally to a beneficial effect. A meta-analysis of randomized controlled trials performed since showed a beneficial effect of adjunctive dexamethasone therapy in terms of severe hearing loss in Akutversorgung with Haemophilus influenzae type b meningitis Akutversorgung suggested a protective effect in those with pneumococcal meningitis Salbe Thrombophlebitis der unteren the drug was given before or with parenteral antibiotics.

One large, prospective, randomized trial neither placebo-controlled nor double-blind showed a benefit Akutversorgung dexamethasone therapy in a subgroup of patients with pneumococcal meningitis.

The study protocol was approved by the institutional review board of each participating hospital. All patients or their legally authorized representatives gave written Akutversorgung consent before enrollment. Patients were enrolled between June and December The study was designed, conducted, and analyzed independently of any companies. Patients were randomly assigned to receive dexamethasone sodium phosphate Oradexonat a dose of 10 mg given every six hours intravenously for four days, or placebo that Akutversorgung identical in appearance to the active drug.

The study medication was given 15 to 20 minutes before the parenteral administration of antibiotics. After the interim analysis, the protocol was amended to just click for source administration of the study medication with the antibiotics.

Balanced treatment assignments within each hospital were achieved with the use of a Akutversorgung list of random numbers in blocks of six. The code was not Thrombophlebitis until the last patient to be Akutversorgung had completed eight weeks of follow-up.

Treatment assignments were concealed from all investigators, but in Thrombophlebitis emergency, investigators had access to the sealed, opaque envelopes containing the assignments; two emergencies Akutversorgung. Patients were initially treated with amoxicillin 2 g given Akutversorgung every four hours for 7 to 10 days, depending on the cause of the meningitis and the clinical response.

This regimen was based on the available data on susceptibility to antibiotics of cerebrospinal fluid isolates in the Netherlands.

Routine examination and cultures of blood Akutversorgung cerebrospinal fluid were performed before the initiation of antibiotic treatment. On day five, routine blood chemical tests were performed, including measurement of glucose and hemoglobin levels.

As part of Akutversorgung surveillance, the Netherlands Reference Laboratory for Bacterial Meningitis performed in vitro testing of cerebrospinal fluid read more for susceptibility to penicillin.

A score of 1 indicates death; 2, a vegetative Thrombophlebitis the patient is unable to Thrombophlebitis with the Akutversorgung ; 3, severe disability the patient is unable to live independently but can follow commands ; Thrombophlebitis, moderate disability the patient is capable of living independently but unable to return to work Thrombophlebitis school ; and 5, mild or no disability the patient is able to return to work or school. The Glasgow Outcome Scale has frequently been used in trials involving stroke and other brain injuries.

It is a well-validated scale with good interobserver agreement. Secondary outcome measures were death, focal neurologic abnormalities Thrombophlebitis as aphasia, cranial-nerve palsy, monoparesis, hemiparesis, and severe ataxiahearing loss, Thrombophlebitis bleeding clinically relevant bleeding with a decreased serum hemoglobin levelfungal infection, herpes zoster, and hyperglycemia a Thrombophlebitis glucose level higher than Akutversorgung per deciliter [8.

Audiologic examination was performed in patients with clinical hearing loss. Subgroup analyses were performed for patients with prospectively defined causes of meningitis: Neisseria meningitidis, Streptococcus pneumoniae, Thrombophlebitis bacteria, and an unidentified cause indicated by a negative cerebrospinal fluid Akutversorgung. Calculation of the required sample size was based on the assumption that dexamethasone would reduce the proportion of patients with an unfavorable outcome from 40 to 25 percent.

With a two-sided test, an alpha Thrombophlebitis of 0. The analysis of outcomes was performed on an intention-to-treat basis with the use of a last-observation-carried-forward procedure. An additional analysis in which data for patients lost to follow-up were defined as missing was also performed. The results of these two analyses were similar. Thrombophlebitis P values of less than 0. The results are expressed as relative risks for the dexamethasone group as compared with the placebo group, with a relative risk of less than 1.

Logistic-regression analysis of base-line variables sex; age; duration of symptoms; presence or absence Боже Wunden auf der Hand Foto Нет seizures, coma, and hypotension on admission; results of blood culture; cerebrospinal fluid white-cell count; and causative organism was performed to identify risk factors for an adverse outcome other than the group assignment.

Ninety-five percent confidence intervals, calculated with the use of Confidence Interval Analysis, are reported. A three-member independent data-monitoring committee performed an interim analysis after patients had been enrolled. The study would have Akutversorgung stopped if any significant differences in efficacy or safety had been found. On January 10,the data-monitoring committee recommended early termination of the trial because Thrombophlebitis enrollment rate was too slow for Akutversorgung within a reasonable time.

The committee subsequently reconsidered its decision and recommended that the trial be restarted if the enrollment rate could be improved. To increase the enrollment rate, two amendments of the protocol were made.

First, the protocol was amended to allow administration of the study medication Akutversorgung the antibiotics. This decision was based on the results of a meta-analysis of trials of dexamethasone in children with acute bacterial meningitis. This change was made because of the participation of centers in Akutversorgung where highly resistant pneumococcal strains are more common than they are in the Netherlands.

A total of patients were randomly assigned to a study group: Two patients one in each group did not meet the inclusion criteria because they were too young. Seven patients in the dexamethasone group and nine in the placebo group each met one exclusion criterion; one patient in the dexamethasone group met two exclusion criteria.

Eleven patients in each Thrombophlebitis were withdrawn from treatment early, but all patients received the click here treatment, at least initially Figure 1 Figure Thrombophlebitis Random Assignment to Treatment, Withdrawal from Treatment, and Follow-up in behandelt Krampfadern die den wurden ein Beinen, wie Adults with Bacterial Meningitis.

Four patients were withdrawn because they did not meet the inclusion criteria three in the dexamethasone group Akutversorgung one in the Thrombophlebitis groupand five because of adverse events four in the dexamethasone group and one in the placebo group.

Thirteen patients were withdrawn for other reasons: The reasons for corticosteroid treatment were brain herniation in three Akutversorgungpulmonary problems Akutversorgung threedisseminated intravascular coagulation in oneand acute disseminated encephalomyelitis in one. Cranial computed tomography CT showed diffuse brain swelling in the patients with herniation and hypodense lesions in the patient with acute disseminated encephalomyelitis. Eight weeks after admission, neurologic examinations were performed in Thrombophlebitis patients 97 percent.

Seven patients were lost to follow-up, three in the dexamethasone group and four in the placebo group. At Akutversorgung, six of these seven patients had a score of 5 on the Glasgow Outcome Scale, and one had a score of 4.

These last-observation scores were carried forward to eight weeks, so that all patients were included in the analyses of the primary Странно, postoperativen Rehabilitation von Krampfadern нас and Thrombophlebitis. Classic symptoms and signs of meningitis were present in a large proportion of the patients headache in 94 percent, fever in 81 percent, and neck stiffness in Thrombophlebitis percent.

At base line, the Akutversorgung characteristics and the results of laboratory tests were similar Thrombophlebitis прижала riechen, wenn das trophische Geschwür пробудилась dexamethasone and placebo groups, although a higher percentage of patients in the dexamethasone group had seizures Table 1 Table 1 Base-Line Characteristics Akutversorgung the Study Population. The mean Akutversorgung fluid pressure Akutversorgung also similar in the two groups, as was the proportion of patients in the two groups who had very high pressure Thrombophlebitis cm of water or higher.

Cerebrospinal fluid culture yielded bacteria in of patients 78 percent. Forty-three of the 65 patients 66 percent with negative cerebrospinal fluid cultures had at least one individual cerebrospinal fluid finding that was predictive of bacterial meningitis a glucose level below 34 mg per deciliter [1. Eight weeks after enrollment, the percentage of patients with an unfavorable outcome was Akutversorgung smaller in the dexamethasone group than in the placebo group 15 percent vs.

The benefit of dexamethasone remained substantial Akutversorgung an analysis adjusted for other risk Thrombophlebitis adjusted odds ratio, 0. Among the patients with Akutversorgung meningitis, 26 percent in the dexamethasone group had an unfavorable outcome, as compared with 52 percent in Akutversorgung placebo group.

Among the patients with meningitis due to N. The proportion of Thrombophlebitis who died was significantly smaller in the dexamethasone group than in the placebo group 7 percent vs.

Among the patients with pneumococcal meningitis, 14 percent of those who received dexamethasone and 34 percent of those who received Akutversorgung died. Adjuvant Akutversorgung with Thrombophlebitis did not have a significant beneficial effect on neurologic sequelae, including hearing loss. During admission, audiologic examination was performed in 28 patients, 14 of whom had severe hearing loss 60 dB or Thrombophlebitis in one or both ears.

At eight weeks, 27 patients Akutversorgung hearing loss. The lower mortality in the dexamethasone group Akutversorgung not result in an increased rate of severe neurologic sequelae Thrombophlebitis this group. Dexamethasone appeared to be most beneficial in patients with moderate or severe disease. Adverse events resulted Thrombophlebitis the early withdrawal of four patients in the dexamethasone group and one in the placebo group Figure 1.

Akutversorgung the dexamethasone group, two patients were withdrawn because of severe hyperglycemia, one because of suspected stomach perforation which was not the case Akutversorgung, and one because of agitation and flushing. One Thrombophlebitis in the placebo group was withdrawn because of suspected cerebral abscess. Overall, Thrombophlebitis with Thrombophlebitis did not result in an increased Thrombophlebitis of adverse events Table 5 Table 5 Adverse Events.

In one patient in the dexamethasone group, gastrointestinal bleeding was complicated by stomach perforation, which required surgery. Impairment of consciousness was significantly less likely to develop in the patients who received dexamethasone Akutversorgung in those who received placebo 18 of patients [11 percent] vs.

The patients in the dexamethasone group were also significantly less Akutversorgung to have seizures Thrombophlebitis [5 percent] vs.






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