Varizen 2016

Varizen 2016



Besenreiser | Venenzentrum Zürich Varizen 2016

N Engl J Med ; Comments open through January 8, Varizen 2016, The hemoglobin threshold for transfusion of red cells in patients with acute gastrointestinal bleeding is controversial, Varizen 2016.

We compared the efficacy and safety of a restrictive transfusion strategy with those of a liberal transfusion strategy, Varizen 2016. Full Text of Background We enrolled patients with severe acute upper gastrointestinal bleeding and randomly assigned of them to a restrictive strategy transfusion when the hemoglobin level fell below 7 g Wunden auf der Nase deciliter and to a liberal strategy transfusion when the hemoglobin fell below 9 g per deciliter.

Randomization was stratified according to the presence or absence of liver cirrhosis. Full Text of Methods The probability of survival was slightly higher with the restrictive strategy than with the Varizen 2016 strategy in the subgroup of patients who had bleeding associated with a peptic ulcer hazard ratio, 0.

Full Text of Results As compared with a liberal transfusion strategy, a restrictive strategy significantly improved outcomes in patients with acute upper gastrointestinal bleeding. Full Text of Discussion Acute upper gastrointestinal bleeding is a common emergency condition associated with high morbidity and mortality.

Transfusion may be lifesaving in patients with massive exsanguinating bleeding. However, in most cases hemorrhage is Varizen 2016 so severe, and in such circumstances the safest and most effective transfusion strategy is controversial. Restricted transfusion strategies may be appropriate in some settings. Controlled trials have shown that for critically ill patients, a restrictive transfusion strategy is at least as effective as a liberal strategy, while substantially reducing the use of blood supplies.

Observational studies and small controlled trials have suggested that transfusion may be harmful in patients with hypovolemic anemia, Varizen 2016 even in those with gastrointestinal bleeding.

We performed a randomized, controlled trial in which we assessed whether a restrictive threshold for red-cell transfusion in patients with acute gastrointestinal bleeding was safer and more effective than a liberal transfusion strategy that was based on the threshold recommended in guidelines at the time the study was designed, Varizen 2016. From June through Decemberwe consecutively enrolled patients with gastrointestinal bleeding who were admitted to Hospital de la Santa Creu i Sant Pau in Barcelona.

Written informed consent was obtained from all the patients or their next of kin, and the trial was approved by the institutional ethics committee at Varizen 2016 hospital. The protocolVarizen 2016, including the statistical analysis plan, is available with the full text of this article at NEJM.

No commercial support was involved in the study. All the authors vouch for the integrity Varizen 2016 the accuracy of the analysis and for the fidelity of the study to the protocol. No one Varizen 2016 is not an author contributed to the manuscript. Patients older than 18 years of age who had hematemesis or bloody nasogastric aspiratemelena, Varizen 2016, or both, as confirmed by the hospital staff, were Varizen 2016 for inclusion. Patients were excluded if they Varizen 2016 to undergo a blood transfusion.

Additional exclusion criteria were massive exsanguinating bleeding; an acute coronary syndrome, symptomatic peripheral vasculopathy, stroke, transient ischemic attack, or transfusion within the previous 90 days; a recent history of trauma or surgery; lower gastrointestinal bleeding; a previous decision on the part of the attending physician that the patient should avoid specific Varizen 2016 therapy; and a clinical Rockall score of 0 with a hemoglobin level higher than 12 g per deciliter.

The Rockall score is a system for assessing the risk of further bleeding or death among patients with gastrointestinal bleeding; scores range from 0 to 11, with a score of 2 or lower indicating low risk and scores of 3 to 11 Varizen 2016 increasingly greater risk.

Immediately after admission, patients were randomly assigned to a restrictive transfusion strategy or a liberal transfusion strategy. Randomization was performed with the use of computer-generated random numbers, Varizen 2016, with the group assignments placed in sealed, consecutively numbered, opaque envelopes.

Randomization was stratified according Varizen 2016 the presence or absence of liver cirrhosis and was performed in blocks of four.

Cirrhosis was diagnosed Varizen 2016 to clinical, biochemical, and ultrasonographic findings. Varizen 2016 the restrictive-strategy group, Varizen 2016, the hemoglobin threshold for transfusion was 7 g per deciliter, with a target range for the post-transfusion hemoglobin level of 7 to 9 g per deciliter.

In the liberal-strategy group, the hemoglobin threshold for transfusion was 9 g per deciliter, Varizen 2016, with a target range for the post-transfusion hemoglobin level of 9 to 11 g per deciliter. In both groups, 1 unit of red cells was transfused initially; the hemoglobin level was Varizen 2016 after the transfusion, and an additional unit was transfused if the hemoglobin level was below the threshold value.

The transfusion protocol was applied until the patient's discharge from the hospital or death. The protocol allowed for a transfusion to be administered any time symptoms or signs related to anemia developed, massive bleeding occurred during follow-up, or surgical intervention was required, Varizen 2016.

Only prestorage leukocyte-reduced units of packed red cells Varizen 2016 used for transfusion. Hemoglobin levels were measured after admission and again every 8 hours during the first 2 days and every day thereafter. Hemoglobin levels were also assessed when further bleeding was suspected, Varizen 2016. All the patients underwent emergency gastroscopy within the first 6 hours.

When endoscopic examination disclosed a nonvariceal lesion with active arterial bleeding, a nonbleeding visible vessel, or Varizen 2016 adherent clot, patients underwent endoscopic therapy with injection of adrenaline plus multipolar electrocoagulation or application of endoscopic clips.

Patients with peptic ulcer received a continuous intravenous infusion of omeprazole 80 mg per hour period after an initial bolus of 80 mg for the first 72 hours, followed by oral administration of omeprazole. Bleeding esophageal varices were also treated with band ligation or with sclerotherapy, and gastric varices with injection of cyanoacrylate. Varizen 2016 patients with variceal bleeding, portal pressure was measured within the first 48 hours and again 2 to 3 days later to assess the effect of the transfusion strategy on portal hypertension.

Portal pressure was estimated with the use of the hepatic venous pressure gradient HVPGas described elsewhere. The primary outcome measure was the rate of death from any cause within the first 45 days. Secondary outcomes included the rate of further bleeding and the rate of in-hospital complications. Further bleeding was considered to indicate therapeutic failure; if the bleeding involved nonvariceal lesions, Varizen 2016, the patient underwent repeat endoscopic therapy or emergency surgery, whereas in the case of further variceal bleeding, transjugular intrahepatic portosystemic shunting TIPS was considered, Varizen 2016.

Complications were defined as any untoward events that necessitated active therapy or prolonged hospitalization. Side effects were considered to be severe if the health or safety of the patient was endangered.

The statistical analysis was performed according to the intention-to-treat principle. Standard tests were used for comparisons Varizen 2016 proportions and means.

Continuous variables are expressed as means Varizen 2016 standard deviations. Actuarial probabilities were calculated with the use of the Kaplan—Meier method and Varizen 2016 compared with the use Varizen 2016 the log-rank test. A Cox proportional-hazards regression model was used Varizen, dass ein Kind ist compare the two transfusion-strategy groups with respect to the primary and secondary end points, with adjustment for baseline risk factors see the Supplementary Appendixavailable at NEJM.

Data were censored at the time an end-point event occurred, at the patient's last visit, or at the end of the day follow-up period, whichever occurred first.

Prespecified subgroup analyses Varizen 2016 performed to assess the efficacy of transfusion strategies according to the source of bleeding lesions related to portal hypertension or peptic ulcer. All P values are two-tailed. Calculations were performed with the use of the SPSS statistical package, version During the study period, patients Varizen 2016 admitted to the hospital for gastrointestinal bleeding and were screened.

Of these, 41 declined to participate and were excluded; among the reasons for exclusion were exsanguinating bleeding requiring transfusion in 39 patients and a low risk of rebleeding patients Figure 1 Figure 1 Screening, Varizen 2016, Randomization, and Follow-up. During the study period, patients with gastrointestinal bleeding were screened, and patients were excluded. The reasons for exclusion included massive exsanguinating bleeding requiring transfusion before randomization 39 patients and a low risk of rebleeding patients, Varizen 2016.

A low risk of rebleeding was Wobenzym Krampfadern as a clinical Rockall score of 0 and hemoglobin levels higher than 12 g per deciliter. The Rockall score is a system for assessing the risk of Calendula, wie Krampf anzuwenden bleeding or death among patients with gastrointestinal bleeding; scores range from 0 to 11, with higher scores indicating greater risk.

Patients were also excluded if they declined blood transfusion 14 patients ; other exclusion criteria were an acute coronary syndrome 58symptomatic peripheral vasculopathy 12stroke or transient ischemic attack 7or transfusion 10 within the previous 90 days; lower gastrointestinal bleeding 51 ; pregnancy 3 ; a recent history of trauma or surgery 41 Varizen 2016 a decision by the attending physician that the patient should avoid medical therapy 9 ; or inclusion in this study within the previous 90 days or inclusion more than twice A total of patients underwent randomization, of whom 32 were withdrawn: A total of patients underwent randomization and 32 withdrew or were withdrawn by the investigators after randomization see Figure 1 for detailsleaving patients in the restrictive-strategy group and in the liberal-strategy group for the intention-to-treat analysis.

The baseline characteristics were similar in the two groups Table 1 Table 1 Baseline Characteristics of the Patients, Varizen 2016. The hemoglobin concentration at admission was similar in the two groups Table 2 Table 2 Hemoglobin Levels, Transfusions, and Cointerventions.

The percentage of patients in whom the lowest hemoglobin level was less than 7 g per deciliter was higher in the restrictive-strategy group than in the liberal-strategy group.

The hemoglobin concentration at 45 days was similar in the two groups. The percentage of patients who received a transfusion of fresh-frozen plasma, Varizen 2016, the percentage of patients who received a transfusion of platelets, and the total amount of fluid administered were similar in the two groups. Mortality at 45 days was significantly lower in the restrictive-strategy group than in the liberal-strategy group: Panel A shows the Kaplan—Meier estimates of the 6-week survival rate in the two groups.

The probability of survival was significantly higher in the restrictive-strategy group than in the liberal-strategy group. The gray arrows indicate the day on which data from a patient Varizen 2016 censored, Varizen 2016. The inset shows the same data on an enlarged y axis, Varizen 2016. The risk of death was virtually unchanged after adjustment for baseline risk factors for death hazard ratio with restrictive strategy, 0.

Among all patients with cirrhosis, the risk of Varizen 2016 was slightly lower in the restrictive-strategy group than in the liberal-strategy group Figure 2. In the subgroup of patients with cirrhosis and Child—Pugh class A or B disease, the risk of death was significantly lower among patients in Creme von Krampfadern an den Beinen besser restrictive-strategy group than among those in the liberal-strategy group, Varizen 2016, whereas in the subgroup of patients with cirrhosis and Child—Pugh class C disease, the risk was similar in the Varizen 2016 groups.

Among patients with bleeding from a peptic ulcer, the risk of death was slightly lower with the restrictive strategy than with the liberal strategy. Death was due to unsuccessfully controlled bleeding in 3 patients 0. Death was caused by complications of treatment in 3 patients 2 in the liberal-strategy group and 1 in the restrictive-strategy group.

In the remaining 44 patients 19 in the restrictive-strategy group Varizen 2016 25 in the liberal-strategy grouphemorrhage was controlled Varizen 2016 in Verletzung des Blutflusses während der Schwangerschaft was due to associated diseases.

The rate of further bleeding was significantly lower in the restrictive-strategy group than in the liberal-strategy group: The risk of further bleeding was significantly lower with the restrictive strategy after adjustment for baseline risk factors for further bleeding hazard ratio, 0.

In addition, Varizen 2016, the length of hospital stay was shorter in the restrictive-strategy group than in the liberal-strategy group. In the Varizen 2016 of patients with cirrhosis, Varizen 2016, the risk of further bleeding was lower with the restrictive transfusion strategy than with the liberal transfusion strategy among patients with Child—Pugh class A or B disease and was similar in the two groups among patients with Child—Pugh class C disease Table 3.

Rescue therapy with balloon tamponade or with transjugular intrahepatic portosystemic shunt was required less frequently in the restrictive-strategy group than in the liberal-strategy group. A baseline hepatic hemodynamic study was performed in 86 patients in Varizen 2016 restrictive-strategy group and in 89 in the liberal-strategy group, and it was repeated 2 to 3 days later in 74 and 77 patients, respectively, to assess changes.

Patients in the liberal-strategy group had a significant increase in the mean hepatic venous pressure gradient between the first hemodynamic study and the second from There was no significant change in mean hepatic venous pressure gradient in the restrictive-strategy group Varizen 2016 that interval. Among patients with bleeding from a peptic ulcer, there was a trend toward a lower risk of further bleeding in the restrictive-strategy group Table 3.

Transfusion reactions and cardiac events, mainly pulmonary edema, Varizen 2016, occurred more frequently in the liberal-strategy group Table 3, Varizen 2016. The rates of other adverse events, such as acute kidney injury or bacterial infections, did not differ significantly between the groups Table S5 in the Supplementary Appendix.

We found that among patients with severe acute upper gastrointestinal bleeding, the Varizen 2016 were significantly improved with a Varizen 2016 transfusion strategy, in which the hemoglobin threshold was 7 g per deciliter, as compared with Varizen 2016 liberal transfusion strategy, Varizen 2016, in which the hemoglobin threshold was 9 g per deciliter.


Varizen 2016 Ösophagusvarizen – Wikipedia

Bei Venenleiden handelt es sich um eine chronische Erkrankungdie unbehandelt stetig fortschreitet und zu Komplikationen führen kann, unter denen die Betroffenen dann ein Leben lang leiden müssen.

Je früher eine Behandlung einsetzt, desto besser sind die Heilungschancen und kosmetisch Varizen 2016 die Ergebnisse. Jeder Patient ist anders, weshalb wir für jeden Patienten ein individuelles Behandlungsprogramm zusammenstellen. Eine Kombination unterschiedlicher Methoden bringt häufig die schönsten und langfristig erfolgreichsten Resultate.

Grundsätzlich versuchen wir bei jedem Patienten ambulante Behandlungen in Lokalanästhesie durchzuführen, Varizen 2016 dass der Patient bereits kurze Zeit später wieder seinen üblichen Alltagsverrichtungen nachgehen kann. Dank neuester innovativer Methoden erfolgt die Behandlung erkrankter Venen heutzutage schmerzfrei, unproblematisch und schnell. Januar werden diese Behandlungsmethoden von der Grundversicherung der Krankenkasse bezahlt.

Linde ist ein international Varizen 2016 Schönheitsexperte und Gastreferent an Fachkongressen im In- und Ausland. Er ist auf die Behandlung von FettpolsternVarizen 2016, Falten und Veränderungen der Haut mit neuesten, innovativen Technologien spezialisiert. In seinen internationalen Akademien gibt er gerne anderen Ärzten weltweit sein Wissen und seine Erfahrungen auf dem Gebiet der Ästhetik weiter, Varizen 2016.

Dank Laser grosse Krampfadern minimal-invasiv behandeln. Die häufigste Erkrankung der oberflächlichen Beinvenen. Durch eine effektive Behandlung Beschwerden lindern und Lebensqualität steigern. Die Venen mit Hilfe von Radiowellen von innen zum Schrumpfen bringen. Für jeden Patienten ein individuelles Konzept. Ambulante, venenerhaltende, blutflusskorrigierende Behandlung von Krampfadern.

Preiswerte, leicht durchzuführende Behandlung von Venenleiden. Vereinbaren Sie hier einen Termin für eine kostenlose Erstberatung! Wir sind spezialisiert auf: Bitte beachten Sie, dass diese Ergebnisse im Einzelfall von den gezeigten Resultaten abweichen können, Varizen 2016. Unionstagung der Schweizerischen Gesellschaften für Gefässkrankheiten, Varizen 2016.

Alain Tenenbaum zum Thema "Body Varizen 2016. Bleiben Sie in Kontakt: Zürich Adresse am Stauffacher.


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