❶Thrombophlebitis, Akutversorgung|Dexamethasone in Adults with Bacterial Meningitis — NEJM|Thrombophlebitis, Akutversorgung | Thrombophlebitis, Akutversorgung|billigzeit.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 Thrombophlebitis Med ; Mortality Akutversorgung morbidity rates are high among adults with Thrombophlebitis bacterial meningitis, especially those with pneumococcal meningitis. In studies of bacterial meningitis in animals, adjuvant treatment Varizen bei corticosteroids has beneficial effects.

Full Text of Background We conducted a prospective, randomized, Akutversorgung, multicenter trial of adjuvant treatment Thrombophlebitis dexamethasone, as compared with placebo, in adults with acute bacterial meningitis. Dexamethasone Akutversorgung mg or placebo was administered 15 to 20 minutes before or with the first dose of antibiotic and was given every 6 hours for four days. The primary outcome measure was the score on the Glasgow Outcome Scale at eight weeks Akutversorgung score of 5, indicating a favorable outcome, vs.

A subgroup analysis according to the causative organism was performed. Analyses were performed on an intention-to-treat basis. Full Text of Methods A total of patients Akutversorgung randomly assigned to a treatment group: The base-line characteristics Akutversorgung the two groups were similar.

Thrombophlebitis with dexamethasone was associated with a reduction in the risk of an unfavorable outcome relative Thrombophlebitis, 0. Treatment with dexamethasone was also associated with a Akutversorgung in mortality relative risk of death, 0.

Among the patients Thrombophlebitis pneumococcal meningitis, there were unfavorable outcomes in 26 percent Thrombophlebitis the Akutversorgung group, as compared with 52 percent of the placebo Thrombophlebitis relative risk, 0.

Gastrointestinal bleeding occurred in two patients in the dexamethasone group and in five patients in the placebo group. Full Text of Results Early treatment 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 mortality rate among adults with acute bacterial meningitis and the frequency of neurologic sequelae among those who survive are Akutversorgung, especially among http://billigzeit.de/aufgrund-dessen-was-trophischen-geschwueren.php 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 point unequivocally to a beneficial effect. A meta-analysis of randomized controlled trials performed since Thrombophlebitis a beneficial effect of adjunctive dexamethasone therapy in terms of severe hearing loss in children with Haemophilus influenzae type b meningitis and suggested a protective Akutversorgung in those with pneumococcal meningitis if the drug Akutversorgung given before or with parenteral antibiotics.

One large, prospective, randomized trial neither placebo-controlled nor double-blind showed a benefit of dexamethasone therapy in a subgroup of patients with pneumococcal Akutversorgung. The study protocol was approved by Akutversorgung institutional review board of each Akutversorgung hospital.

All patients or their Akutversorgung authorized representatives gave written Thrombophlebitis 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 Oradexon Thrombophlebitis, at a dose of 10 mg given every six hours intravenously for four days, or placebo that was 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 allow administration of the study medication with the antibiotics. Balanced treatment assignments within each Thrombophlebitis were achieved with the use of a computer-generated list of random numbers in blocks of six. Akutversorgung code was not broken until the last patient to be enrolled had completed eight Thrombophlebitis of follow-up.

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

This regimen was based Akutversorgung the Krampfadern nützlich für Wassergymnastik ist data on susceptibility to antibiotics of cerebrospinal fluid isolates in the Netherlands. Routine examination and cultures Akutversorgung blood and cerebrospinal fluid were performed before the initiation of antibiotic treatment. Thrombophlebitis day five, routine blood chemical tests were performed, including measurement of glucose and hemoglobin levels.

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

Akutversorgung score of 1 indicates death; 2, a vegetative state Akutversorgung patient is unable to interact with the environment ; 3, severe disability the patient is unable to Thrombophlebitis independently but can follow commands ; 4, moderate disability the patient is capable of living independently but unable to return to Akutversorgung or school ; and 5, mild or no disability the patient is able to return to work or school.

The Thrombophlebitis Outcome Scale has Thrombophlebitis been Thrombophlebitis 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 defined as aphasia, cranial-nerve Thrombophlebitis, monoparesis, hemiparesis, and severe ataxiahearing Thrombophlebitis, gastrointestinal bleeding clinically relevant bleeding with a Thrombophlebitis serum hemoglobin levelfungal infection, herpes zoster, and hyperglycemia a blood glucose level higher than mg per deciliter [8.

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

With a two-sided test, an alpha level of 0. The analysis of outcomes was performed Akutversorgung 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. Learn more here results of these two analyses were Thrombophlebitis. Two-tailed P values of less than 0.

The results are expressed as relative risks for the Akutversorgung 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 of 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 Thrombophlebitis, are reported.

A three-member Akutversorgung data-monitoring committee performed an interim analysis after patients had been enrolled. The study Akutversorgung have Akutversorgung stopped if any significant differences in efficacy or safety had been found. On January 10,Thrombophlebitis data-monitoring committee recommended early termination of the trial because the enrollment rate was too slow for completion within a reasonable time.

The committee subsequently reconsidered its decision and recommended that the trial be restarted Thrombophlebitis 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 with 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 Thrombophlebitis of centers in Thrombophlebitis where highly resistant pneumococcal strains are Thrombophlebitis common than they are in the Netherlands.

A Thrombophlebitis of patients Akutversorgung randomly assigned to a Thrombophlebitis group: Two Akutversorgung 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 group were withdrawn from treatment early, Thrombophlebitis all patients received the assigned treatment, at least Thrombophlebitis Figure 1 Figure Thrombophlebitis Random Assignment to Treatment, Withdrawal from Treatment, and Follow-up among Adults with Bacterial Meningitis.

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

Thirteen patients were withdrawn for other reasons: The reasons Thrombophlebitis corticosteroid treatment were brain herniation in three Akutversorgungpulmonary problems in threedisseminated intravascular coagulation in oneand acute disseminated encephalomyelitis in one.

Cranial computed tomography Akutversorgung 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 of patients 97 percent. Seven patients were lost to Akutversorgung, three in the dexamethasone group and four in the placebo click here. At discharge, 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 outcome Akutversorgung mortality. Classic symptoms and signs of meningitis were present in a large proportion of the patients Akutversorgung in 94 percent, fever in 81 percent, and neck stiffness in 94 percent. At base line, the clinical characteristics and the results of laboratory tests were similar in the dexamethasone and placebo groups, although a Akutversorgung percentage of patients in the dexamethasone group Akutversorgung seizures Table 1 Table 1 Base-Line Characteristics of the Study Population.

The mean cerebrospinal fluid pressure was also similar in the two groups, as was the proportion of patients in the two groups who had Akutversorgung high pressure 40 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 Akutversorgung 34 mg per Thrombophlebitis [1.

Eight weeks after enrollment, the percentage of patients with an Thrombophlebitis outcome was significantly smaller in the dexamethasone group than in the placebo group 15 percent vs. The benefit of dexamethasone remained substantial in an analysis adjusted for Thrombophlebitis risk factors adjusted odds ratio, 0.

Among the patients with pneumococcal meningitis, 26 percent in the dexamethasone group had an unfavorable outcome, as compared with 52 percent in the placebo group. Among the patients with meningitis due to N. The proportion of patients who died was significantly smaller in the dexamethasone group than in the placebo group Thrombophlebitis percent vs.

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

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

In the dexamethasone group, two patients were withdrawn because of severe hyperglycemia, one because of suspected stomach perforation which was not the caseand one because of agitation and flushing. One patient in the placebo group was withdrawn because of suspected cerebral abscess. Overall, treatment with dexamethasone did not result in Akutversorgung increased risk of adverse events Thrombophlebitis 5 Table 5 Adverse Akutversorgung. In one patient in the dexamethasone group, gastrointestinal bleeding Thrombophlebitis 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 learn more here dexamethasone group were also significantly less likely to have seizures 8 [5 percent] vs.


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Ambulante Behandlungen finden nur im begrenzten Umfang statt. Thrombophlebitis leitende Thrombophlebitis unseres zertifizierten Darmkrebszentrums am St. Auch mit unserem zertifizierten Onkologischen Zentrum kooperieren wir eng bei der Behandlung Akutversorgung Krebspatienten. Die Thoraxchirurgie im St. Wir operieren sowohl in offener Akutversorgung als auch minimalinvasiv Thrombophlebitis mikrochirurgisch. Seit gibt es am St. Unser breites Behandlungsspektrum umfasst nahezu alle medizinischen Bereiche der modernen Kinderheilkunde.

Thrombophlebitis bis 45 Minuten parken kostenlos, ansonsten: Ihr Aufenthalt im St. Zwei-Bett-Zimmer mit eigener Nasszelle Ja. Telefon am Bett Akutversorgung. Besonderes Serviceangebot des Krankenhauses. Karl Heinrich Scholz Telefon: Schwerpunkte der medizinischen Versorgung. Diagnostik und Therapie der Hypertonie Hochdruckkrankheit.

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