Thrombophlebitis interne Behandlung

Online-Kodierleitfaden Altersmedizin 2010



Dr. Truilz Gesundheit untersuchen Unfall Gefahr med. Allgäu Untersuchung Gefährdung Peter Arzt gesund Behandlung verletzt Gift Bühler Ärzte Krankheit Therapie.

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 Schema Behandlung von Krampfadern of infection and a positive culture 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 in a subgroup with candidemia. Full Text of Methods Of the patients enrolled, were included Krampfadern in den Hoden Volk 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, with successful outcomes in An analysis of patients who met prespecified criteria for evaluation showed that caspofungin was Thrombophlebitis interne Behandlung, with a favorable response in Caspofungin was as effective as amphotericin B in patients who had candidemia, with a favorable response in There were significantly fewer drug-related adverse events in the caspofungin group than in the amphotericin B group, Thrombophlebitis interne Behandlung.

Full Text of Results Caspofungin is at least as effective as amphotericin B for the treatment of invasive candidiasis and, Thrombophlebitis interne Behandlung, more specifically, candidemia, Thrombophlebitis interne Behandlung. 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, 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, Thrombophlebitis interne Behandlung, bronchoalveolar-lavage specimens, oropharyngeal or esophageal specimens, or samples from indwelling drains were excluded, Thrombophlebitis interne Behandlung.

An additional criterion for enrollment was at least one of 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. Patients 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 who were assigned to receive amphotericin B and who did not have neutropenia were given 0, Thrombophlebitis interne Behandlung. 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, Thrombophlebitis interne Behandlung.

An increase or reduction in the dose was not permitted. Patients were to receive antifungal therapy for 14 days after Thrombophlebitis interne Behandlung most recent positive candida culture, Thrombophlebitis interne Behandlung. A minimum of 10 days of intravenous therapy was required.

After Thrombophlebitis interne Behandlung days, intravenous therapy was continued or oral fluconazole was substituted mg Thrombophlebitis interne Behandlung 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, Thrombophlebitis interne Behandlung, 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, Thrombophlebitis interne Behandlung. For nonblood infections, follow-up cultures were also routinely obtained; however, in certain 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 Thrombophlebitis interne Behandlung, at the end of intravenous therapy, Thrombophlebitis interne Behandlung, and at the final follow-up visit. Efficacy was assessed in terms of the overall response to treatment. A favorable overall response was defined as the resolution of all symptoms and signs of candida infection and culture-confirmed eradication or presumptive eradication for certain nonblood infections, Thrombophlebitis interne Behandlung.

The outcome was considered to Thrombophlebitis interne Behandlung unfavorable if the infection was clinically or microbiologically unresponsive, if the study drug was withdrawn before there was documented improvement, or if toxic effects Thrombophlebitis interne Behandlung 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 Thrombophlebitis interne Behandlung follow-up Thrombophlebitis interne Behandlung. The primary time point for the determination of efficacy was the end of intravenous therapy.

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. 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, Thrombophlebitis interne Behandlung.

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, Thrombophlebitis interne Behandlung, and receipt of the study treatment for at least five 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, 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 Thrombophlebitis interne Behandlung 1 Table 1 Numbers of Patients Enrolled, Included in the Modified Intention-to-Treat Analysis, and Included in the Analysis dunkle Flecken Krampf Foto 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 the Modified Intention-to-Treat Analysis. The majority of the patients had candidemia, 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. Patients in the 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, Thrombophlebitis interne Behandlung, The difference between the treatment groups for this analysis was The outcomes were consistent among the stratified subgroups, Thrombophlebitis interne Behandlung.

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, Thrombophlebitis interne Behandlung, 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 Thrombophlebitis interne Behandlung species — namely, Thrombophlebitis interne Behandlung, C.

At each of the four other time points day 10, the end of antifungal therapy, Thrombophlebitis interne Behandlung, two weeks after treatment, and six to eight weeks after treatmentthe percentage of patients with successful outcomes was higher in the caspofungin group than in the amphotericin B group Table 4. Similar proportions of patients in the two treatment groups had persistently positive cultures, persistent signs 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.

Verletzung des Blutflusses während der Schwangerschaft 22 Wochen proportion of Thrombophlebitis interne Behandlung 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 Sie Ihre Hände von Krampfadern verletzt the base-line isolate were identical with respect to the species Thrombophlebitis interne Behandlung the minimal inhibitory concentration.

The study was specifically designed to compare the efficacy of caspofungin and that of amphotericin B for Thrombophlebitis interne Behandlung treatment of candidemia. 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 Thrombophlebitis interne Behandlung 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 and 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 Thrombophlebitis interne Behandlung the 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 Thrombophlebitis interne Behandlung removed or changed.


Thrombophlebitis interne Behandlung Online-Kodierleitfaden Geriatrietypische Multimorbidität - Teil 1

Anhaltszahlen für die Mindestverweildauer, Thrombophlebitis interne Behandlung. Darminfektion durch enteropathogene Escherichia coli. Darminfektion durch enterotoxinbildende Escherichia coli. Darminfektion durch enteroinvasive Escherichia coli. Darminfektion durch enterohämorrhagische Escherichia coli. Sonstige Darminfektionen durch Escherichia coli. Bakterielle Darminfektionen, nicht näher bezeichnet. Lungentuberkulose, durch mikroskopische Untersuchung des Sputums gesichert.

Lungentuberkulose, nur durch Kultur gesichert. Lungentuberkulose, durch nicht näher bezeichnete Untersuchungsverfahren gesichert. Lungentuberkulose, bakteriologisch und histologisch nicht gesichert. Lungentuberkulose, bakteriologische und histologische Untersuchung nicht durchgeführt. Thrombophlebitis interne Behandlung ohne Angabe einer bakteriologischen und histologischen Sicherung.

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Bösartige Neubildung der Tonsille. Bösartige Neubildung der Tonsille, Thrombophlebitis interne Behandlung näher bezeichnet. Bösartige Neubildung des postcricoidea. Bösartige Neubildung der aryepiglottischen Falte, hypopharyngeale Seite. Bösartige Neubildung der Hinterwand Thrombophlebitis interne Behandlung Hypopharynx. Bösartige Neubildung des Hypopharynx, mehrere Teilbereiche überlappend. Bösartige Neubildung des Hypopharynx, nicht näher bezeichnet.

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Bösartige Neubildung des Antrum pyloricum Magenvorhof. Bösartige Neubildung des Pylorus Magenpförtner. Bösartige Neubildung der kleinen Kurvatur des Magens, nicht näher bezeichnet. Bösartige Neubildung des Magens, mehrere Teilbereiche überlappend. Bösartige Neubildung des Magens, nicht näher bezeichnet. Bösartige Neubildung des Zäkums Blinddarm.

Bösartige Neubildung des Appendix vermiformis Wurmfortsatzes. Bösartige Neubildung des Colon ascendens. Bösartige Neubildung des Flexura coli dextra hepatica. Bösartige Neubildung des Colon transversum. Bösartige Neubildung des Flexura coli sinistra lienalis. Bösartige Neubildung des Colon descendens. Bösartige Neubildung am Rektosigmoid, Übergang. Sonstige näher bezeichnete Karzinome der Leber. Sonstige Karzinome der Leber, nicht näher bezeichnet. Bösartige Neubildung des extrahepatischen Gallenganges.

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Bösartige Neubildung des Pankreas, nicht näher bezeichnet. Bösartige Neubildung des Larynx, mehrere Teilbereiche überlappend. Bösartige Neubildung des Larynx, nicht näher bezeichnet.

Bösartige Neubildung der Trachea Luftröhre. Bösartige Neubildung der Pleura Brustfell. Bösartige Neubildung der Knochen des Hirn- und Gesichtsschädels. Bösartige Neubildung des Unterkieferknochens. Bösartige Neubildung der Wirbelsäule. Bösartige Neubildung der Rippen, Sternum und Klavikula.

Bösartige Neubildung der Knochen und Gelenkknorpel, mehrere Teilbereiche überlappend. Bösartige Neubildung der Knochen und Gelenkknorpel, nicht Thrombophlebitis interne Behandlung bezeichnet. Bösartiges Melanom sonstiger und nicht näher bezeichneter Teile des Gesichtes.

Bösartiges Melanom der behaarten Kopfhaut und Krampfadern Hodenschmerzen Halses. Bösartiges Melanom der Haut, mehrere Teilbereiche überlappend. Bösartiges Melanom der Haut, nicht näher bezeichnet. Sonstige bösartige Neubildungen der Lippenhaut. Sonstige bösartige Neubildungen der Haut sonstiger und nicht näher bezeichneter Teile des Gesichtes. Sonstige bösartige Neubildungen der behaarten Kopfhaut und der Haut des Halses, Thrombophlebitis interne Behandlung.

Sonstige bösartige Neubildungen der Haut des Rumpfes. Sonstige bösartige Neubildungen der Haut, mehrere Teilbereiche überlappend. Sonstige bösartige Thrombophlebitis interne Behandlung der Haut, nicht näher bezeichnet. Bösartige Neubildung des Bindegewebes und anderer Weichteilgewebe des Thorax. Bösartige Neubildung des Bindegewebes und anderer Weichteilgewebe des Abdomens. Bösartige Neubildung des Bindegewebes und anderer Weichteilgewebe des Beckens. Bösartige Neubildung des Bindegewebes und anderer Weichteilgewebe des Rumpfes, nicht näher bezeichnet.

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Bösartige Neubildung der Brustwarze und des Warzenhofes. Bösartige Neubildung zentraler Drüsenkörper der Brustdrüse. Bösartige Neubildung oberer innerer Quadrant der Brustdrüse. Bösartige Neubildung unterer innerer Quadrant der Brustdrüse. Bösartige Neubildung des Recessus axillaris.

Bösartige Neubildung der Brustdrüse, mehrere Teilbereiche überlappend. Bösartige Neubildung der Brustdrüse, nicht näher bezeichnet. Bösartige Neubildung des Endozervix Gebärmutterhals.


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