Thrombophlebitis und Bath

Thrombophlebitis und Bath

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Background Mitoxantrone-based chemotherapy palliates pain without extending survival in men with progressive androgen-independent prostate cancer. We compared.

N Engl J Med ; Mitoxantrone-based chemotherapy palliates pain without extending survival in men with progressive androgen-independent prostate cancer. We compared docetaxel plus estramustine with mitoxantrone plus prednisone in men with metastatic, hormone-independent prostate cancer. Full Text of Background We randomly assigned men to one of two treatments, each given in day cycles: The primary end point was overall survival; secondary end points were progression-free survival, objective response rates, and Thrombophlebitis und Bath declines of at least 50 percent in serum prostate-specific antigen PSA levels.

Full Text of Methods Of eligible patients, were assigned to receive docetaxel and estramustine and to receive mitoxantrone and prednisone. In Thrombophlebitis und Bath intention-to-treat analysis, the median overall survival was longer in the group given docetaxel and estramustine than in the group given mitoxantrone and prednisone The median time to progression was 6.

Pain relief Thrombophlebitis und Bath similar in both groups, Thrombophlebitis und Bath. Full Text of Results The improvement in median survival of nearly two months with docetaxel and estramustine, as compared with mitoxantrone and prednisone, Thrombophlebitis und Bath, provides support for this approach in men with metastatic, androgen-independent prostate cancer.

Full Text of Discussion Men with newly diagnosed metastatic prostate cancer have a rapid response to surgical or medical castration, with improvement in bone pain, regression of soft-tissue metastases, and a decline in serum prostate-specific antigen PSA levels.

Chemotherapy for androgen-independent prostate cancer is ineffective 4: Immunohistochemical studies have demonstrated that the antiapoptotic protein Bcl-2 is increased in metastatic cells from androgen-independent prostate tissue. Eligibility required pathologically confirmed adenocarcinoma of the prostate and progressive metastatic disease stage D1 or D2 despite androgen-ablative therapy and cessation of antiandrogen treatment.

Criteria for progressive disease were progression of Thrombophlebitis und Bath bidimensionally measurable lesion, as assessed within 28 days before study registration; progression of disease that could be evaluated but not measured e.

To ensure continued androgen ablation, patients continued taking luteinizing-hormone—releasing hormone agonists throughout study treatment. Patients were required to discontinue bisphosphonates at least 28 days before registration.

Prior radiotherapy to less than 30 percent of the bone marrow only or one prior systemic therapy Thrombophlebitis und Bath with estramustine, taxanes, anthracyclines, or mitoxantrone was permitted if at least four weeks had elapsed since the completion of that therapy.

Adequate renal, Thrombophlebitis und Bath, hepatic, and cardiac function and a SWOG performance-status score of 0 to 2 a performance status of 3 was allowed if the score was due to bone pain were also required.

Patients were ineligible if they had received prior radioisotope or anticoagulant therapy excluding aspirinhad active thrombophlebitis or hypercoagulability, had a history of pulmonary embolus, or pleural effusions or ascites. Patients were classified at registration according to the following factors: Patients were randomly assigned to one of nächtliche Wadenkrämpfe Grund treatments, Thrombophlebitis und Bath, each given in day cycles: Doses of docetaxel and mitoxantrone were increased to 70 mg per square meter and 14 mg per square meter, Thrombophlebitis und Bath, respectively, if no grade 3 or 4 adverse events were observed during the first cycle.

A report that prophylactic anticoagulation decreased estramustine-associated vascular effects prompted an amendment of the protocol on January 15,to include daily warfarin 2 mg plus aspirin mg in the group assigned to receive estramustine. The pretreatment evaluation included a history taking, a physical examination in which weight and performance status were recorded, computed tomography CT of the abdomen and pelvis, bone scanning, nuclear ventriculography multiple gated acquisition [MUGA] scanninga complete blood count, and measurement of serum PSA, serum creatinine, Thrombophlebitis und Bath, and serum testosterone, Thrombophlebitis und Bath.

MUGA scans were repeated every four cycles among patients in the group given mitoxantrone and prednisone. At every cycle, the pretreatment evaluation was repeated excluding MUGA scanning, measurement of serum testosterone, and baseline imaging studies. Imaging studies were repeated every six cycles; if positive, they were repeated every three cycles. Objective responses were defined on the basis of the sum of bidimensional measurements of metastatic lesions.

Confirmed objective responses required a follow-up scan a minimum of four weeks later that demonstrated a continued response. Progression was defined by one of the following: A confirmed partial response of nonmeasurable disease was defined as a reduction by more than 50 percent over baseline in two or more PSA measurements obtained at least four weeks apart, with no evidence of disease progression on imaging.

Progressive disease was defined as Thrombophlebitis und Bath 25 percent increase in the serum PSA level — to at least 5 ng per milliliter — over the last preregistration measurement, with confirmation of the increase at least four weeks later.

For patients with a decrease in serum PSA levels during the trial, progressive disease was defined as a confirmed increase of 25 percent, to at least 5 ng per milliliter over the nadir. The primary objective of the study was to compare overall survival in the two groups. Assuming an exponential distribution of survival times, 3. Interim analyses were to be conducted when half the patients had been enrolled Thrombophlebitis und Bath again when enrollment was complete.

The null and alternative hypotheses were to be tested at a one-sided P level of 0. The significance level for the final analysis, performed one year after study closure, was specified as a one-sided P value of 0.

However, in accordance with the policy of the Journal, Thrombophlebitis und Bath, only two-sided P values are reported. Secondary end points included progression-free survival, the objective-response rate, the rate of PSA response defined as a decline in the serum PSA level of at least 50 percentand adverse events. The data set was locked and analyzed on March 9, Kaplan—Meier curves were used to estimate rates of overall survival and progression-free survival.

Survival was defined from the date of randomization to the date of death from any cause or censored at the date of last contact. Progression-free survival was defined as Thrombophlebitis und Bath time from randomization to the first occurrence of objective or PSA progression or death from any cause. The general chi-square test was used to compare rates of response objective and PSA and adverse events between the two treatment groups.

All analyses were performed with the use of SAS Thrombophlebitis und Bath, version 9. Aventis was allowed to review the protocol and make comments before enrollment began. Aventis had no access to the data but received a semiannual summary of enrollment and adverse events. Thrombophlebitis und Bath total of patients were enrolled between October and January Ninety-six patients 12 percent were found to be ineligible: The baseline characteristics of the eligible patients in both treatment groups were similar Table 1 Table 1 Baseline Characteristics of the Patients.

The sole evidence of disease progression was a rising PSA level in 18 percent of patients. There were 11 major protocol deviations. Six patients in the group given docetaxel and estramustine and four patients in the group given mitoxantrone and prednisone did not receive the assigned treatment and were not included in the evaluation of adverse events. One patient in the latter group who received intermittent radiotherapy while receiving the assigned treatment, a major protocol deviation, was included in the evaluation of adverse events.

Six patients who discontinued treatment within one week after starting mitoxantrone and prednisone four men or docetaxel and estramustine two men were not included in the evaluation of adverse events; however, in the case of all these men, Thrombophlebitis und Bath, the reported results and statistical analyses are based on the treatment group to which the patients were assigned.

During a median follow-up of 32 months, of the patients in the group given docetaxel and estramustine died 64 percentas did of the patients in the group given mitoxantrone and prednisone 70 percent.

According to the intention-to-treat analysis, the median survival was A partial response in measurable disease occurred in 17 percent of patients in the group given docetaxel and estramustine 17 of4 unconfirmed and 11 percent of patients in the group given mitoxantrone and prednisone 10 of 93, 4 unconfirmed.

Patients with an inadequate assessment were assumed to have had no response. There was no significant difference in pain relief, as reported by the patients, Thrombophlebitis und Bath, between the two groups data not shown. As of DecemberThrombophlebitis und Bath, all surviving patients had stopped the Thrombophlebitis und Bath treatment. Adverse events led Thrombophlebitis und Bath the withdrawal of 54 patients in the group assigned to docetaxel and estramustine 16 percent and 32 patients in the group assigned to mitoxantrone and prednisone 10 percent.

The rates of severe or life-threatening grade 3 or 4 and fatal grade 5 adverse events are summarized in Table 2 Table 2 Adverse Events. The rate of grade 3, 4, or 5 neutropenia in Thrombophlebitis und Bath group given mitoxantrone and prednisone did not differ significantly from that in the group given docetaxel and estramustine As compared with the group given mitoxantrone and prednisone, the group given docetaxel and estramustine had significantly higher rates of grade 3 or 4 neutropenic fevers 5 percent vs.

There were eight treatment-related deaths in the group given docetaxel and estramustine: Four patients had grade 5 adverse events attributed to mitoxantrone and prednisone, Thrombophlebitis und Bath.

Three died within 30 days of receiving protocol Thrombophlebitis und Bath, and another died from a respiratory tract infection and grade 4 anorexia. Vascular complications and their relationship to prophylactic warfarin treatment in the group given docetaxel and estramustine are shown in Table 3 Table 3 Adverse Events among Patients Receiving Docetaxel and Estramustine, According to Whether They Were Receiving Prophylactic Anticoagulation.

This randomized trial demonstrated that the treatment of androgen-independent Thrombophlebitis und Bath prostate cancer with Thrombophlebitis und Bath and docetaxel results in a longer median survival than treatment with mitoxantrone and prednisone The hazard ratios for death 0. Although we did not meet our primary aim of detecting a 33 percent improvement in median survival with estramustine and docetaxel, this trial had reasonable power to detect smaller differences in survival.

Relative to mitoxantrone and prednisone, docetaxel and estramustine reduced the mortality rate by 20 percent 95 percent confidence interval, 3 to 33 percent. The rates of reduced PSA levels and progression-free survival were significantly higher in the group given docetaxel and estramustine than in Thrombophlebitis und Bath group given mitoxantrone and prednisone.

The survival estimate of the group given estramustine and docetaxel in our trial fell within the confidence intervals of smaller phase 1 and 2 studies of this Thrombophlebitis und Bath. The median survival of This difference may be due in part to the use of different eligibility criteria, in particular the requirement for symptomatic disease in the studies by Tannock et al. In contrast, Thrombophlebitis und Bath, in a randomized trial of asymptomatic men with a rising serum PSA level, Berry et al.

The median PSA level at entry 87 ng per milliliter was somewhat lower than in the studies by Kantoff et al. Crossover treatment may also partially account for the small difference in survival between the two Krampfadern-Behandlung auf der Krim groups.

Of all the patients we treated, about half received at least one other antineoplastic regimen after having had no response to the assigned treatment. It is difficult to judge the effect of these additional treatments on overall survival, because multiple variables influence response and survival after crossover treatment, Thrombophlebitis und Bath.

Continuous corticosteroid treatment can reduce serum PSA levels by at least 50 percent in 20 to 74 percent of men with hormone-refractory prostate cancer, 20 but the regimen of premedication with dexamethasone 60 mg every three weeks that we used is unlikely to have affected the results. In a phase 2 study, the same dose and schedule of dexamethasone that we used were employed until the serum PSA level rose at least 25 percent over baseline levels or clinical progression occurred, at which point docetaxel and estramustine were given.

None of the patients treated with dexamethasone had a decline in PSA of at least 50 percent the level actually increased by a median of 47 percent. After progression during dexamethasone therapy, Thrombophlebitis und Bath, 92 percent of patients treated with docetaxel and estramustine had a decline in serum PSA levels of at least 50 percent. In phase 2 studies, estramustine was associated with an increased risk of nausea, thromboembolic events, Thrombophlebitis und Bath, and cardiovascular events.

However, this difference was not associated with an increased rate of treatment-related deaths or discontinuation Thrombophlebitis und Bath treatment in the former group. In conclusion, Thrombophlebitis und Bath, treatment with estramustine and docetaxel moderately increases survival at the cost of an increased rate of adverse events. These factors must be balanced when one is considering the use of docetaxel and estramustine as first-line therapy for men with metastatic androgen-independent prostate cancer.

Petrylak and Taplin report having received grant support, lecture fees, and consulting fees from Aventis; Dr. Hussain consulting fees and lecture fees from and having equity in Aventis; Dr. Lara lecture fees from Aventis and AstraZeneca; Dr.

Stunde der Wintervögel vom Januar Mitzählen und gewinnen beim LBV in Bayern. Vögel eingeben bis

N Engl J Med ; Nonrheumatic atrial fibrillation increases the risk of stroke, presumably from atrial thromboemboli. There is uncertainty about the efficacy and risks of long-term warfarin therapy to prevent stroke. Full Text of Background We conducted an unblinded, randomized, controlled trial of long-term, low-dose warfarin therapy target prothrombin-time ratio, 1. The Thrombophlebitis und Bath group was not given warfarin but could choose to take aspirin. Full Text of Methods A total of patients entered the trial in the warfarin group and in the control group and were followed for an average of 2.

Prothrombin times in the warfarin group were in the target range 83 percent of the time. Only 10 percent of the patients assigned to receive warfarin discontinued the drug permanently. There were 2 strokes in the warfarin group incidence, 0. There were 37 deaths altogether.

The death rate was markedly lower in the warfarin group than in the control group: There was one fatal hemorrhage in each group. The frequency of bleeding events that led to hospitalization or transfusion was essentially the same in both groups.

The warfarin group had a higher rate of minor hemorrhage than the control group 38 vs. Full Text of Results Long-term low-dose warfarin therapy is highly effective in preventing stroke in patients with nonrheumatic atrial fibrillation, and can be Bein Varizen Injektionen safe with careful monitoring.

Full Text of Conclusions The use of anticoagulant agents for the more common problem of "nonrheumatic" atrial fibrillation remains controversial, however. As a result, Thrombophlebitis und Bath has not been clear whether the benefits of long-term warfarin therapy outweigh its risks and inconvenience. An earlier randomized trial in Copenhagen the Atrial Fibrillation, Aspirin, Anticoagulation [AFASAK] study provided strong but not statistically conclusive evidence that high-dose anticoagulant therapy was effective in preventing stroke in patients with nonrheumatic atrial fibrillation.

Adults with chronic sustained or intermittent atrial fibrillation who had no evidence of mitral stenosis on two-dimensional echocardiography 8 i. At least two separate electrocardiograms documenting atrial fibrillation were required. Patients with intermittent atrial fibrillation had to have an electrocardiogram documenting atrial fibrillation within 18 months of entry, Thrombophlebitis und Bath.

Patients were excluded if they had transient atrial fibrillation during an acute illness such as pneumonia or if cardioversion was planned.

Other cardiac reasons for exclusion were echocardiographic evidence of an intracardiac thrombus, a left Thrombophlebitis und Bath aneurysm, or the presence of severe congestive heart failure or prosthetic heart valves.

Neurologic reasons for exclusion included stroke within the previous six months, Thrombophlebitis und Bath, transient ischemic attacks for which the patient Stufe und die Behandlung von Krampfadern Beine being treated, Thrombophlebitis und Bath, and any neurologic condition predisposing the patient to intracranial hemorrhage.

Patients were not eligible if they had a clinical indication e. Normal serum indexes of thyroid function, measured at some time after the onset of atrial fibrillation, were required. Before randomization, a medical history was obtained and the patients underwent a physical examination and laboratory evaluation that included a neurologic examination and a two-dimensional echocardiogram 88 percent had an adequate Doppler study that was reviewed in standard fashion at the study's coordinating center.

The majority of patients were referred by their physicians see Appendix. The study protocol and informed-consent procedures were approved by each participating institution. Patients were assigned to receive either warfarin therapy warfarin group or no treatment control group according to a computerized Thrombophlebitis und Bath scheme applied at the coordinating center. Randomization was blocked according to three factors: Neither the patients nor their physicians were blinded to Thrombophlebitis tun Massage assigned therapy.

The assessment of outcome events was blinded to treatment assignment, however. Eight patients were excluded from the study after randomization: Seven of these eight were found to have echocardiographic evidence of a condition that was a reason for exclusion e. None of these patients had an end-point event. Data on one additional patient were censored days after randomization because he underwent mitral-valve replacement; he also did not have an endpoint event.

The initial sample size was calculated to give the study an 80 percent power to detect, Thrombophlebitis und Bath, at the two-sided P value of 0. Our revised sample size, adjusted for the observed low rate of stroke, Thrombophlebitis und Bath, required that we recruit a total of patients to be followed up for an average of 4.

Active recruitment began in September and ended in Juneafter we had reached the target enrollment of patients. The doses of warfarin were determined by nurse Magnitogorsk Varizen at the coordinating center who used a computer-based protocol. The target range for the prothrombin-time ratio was 1. All patients taking warfarin were educated about anticoagulation and told not to take aspirin.

Patients randomly assigned to the control group were allowed to take aspirin. For this group, the frequency of aspirin use and the dose were recorded at follow-up. The number of days when the prothrombin times were in the target range was calculated by adding up the number of days after the measurement of ratios between 1.

Similarly, the number of patient-years during which aspirin was taken in the control group was calculated by summing the amount of time after a follow-up contact at which the patient reported taking aspirin regularly.

At entry and annually, Varizen Operationsnarben history was recorded and patients underwent a physical examination focusing on neurologic factors.

Every year, beginning at six months, patients were sent a questionnaire requesting Thrombophlebitis und Bath on neurologic symptoms, episodes of bleeding, Thrombophlebitis und Bath, and other medical conditions. Study nurses then telephoned all patients to Thrombophlebitis und Bath their responses. The written questionnaire served to minimize potential bias in the assessment of outcome events by unblinded personnel.

At three months and nine months during each year of follow-up, each patient's referring physician was contacted. Patients and their physicians were reminded to contact the investigators if any important medical problems developed. The participating institutions were organized into three groups see Appendix. At Group I institutions, on-site investigators performed all clinical evaluations. At Group II and III institutions, neurologists and nurses from the coordinating center scheduled and performed all evaluations; investigators from the coordinating center traveled to Group II institutions, Thrombophlebitis und Bath, whereas patients from Group III institutions were evaluated at the coordinating center.

Because of this structure, investigators from Thrombophlebitis und Bath coordinating center performed approximately 80 percent of the scheduled evaluations. Base-line information on all participants was percent complete, Thrombophlebitis und Bath, as was follow-up information on end-point events.

The study's primary end point was ischemic stroke, defined as the sudden onset of a neurologic deficit fitting a cerebroarterial distribution and lasting 24 hours or more, with no hemorrhage evident on computerized tomography. Deficits lasting less than 24 hours, transient ischemic attacks, and episodes of transient monocular blindness were not counted as end points. In the primary analysis no distinction was made between ischemic stroke due to emboli originating in the heart and other types.

All bleeding events were recorded. Major bleeding was defined as intracranial bleeding, fatal bleeding, or bleeding leading to the transfusion of four or more units of blood within 48 hours. Other bleeding events were classified as "minor. Clinical summaries were sent to the appropriate end-point committee whenever there was any suggestion that an end-point event had occurred.

CT scans were obtained in all cases of stroke; reliable noninvasive carotid studies or pathological examination of the carotid arteries were obtained in all but one case of stroke in the territory of the carotid artery. Both the Neurologic and the Medical End-Point Committees reviewed all deaths and assigned probable causes. The clinical summaries did not indicate the patient's treatment group, thus maintaining the end-point committees' blinding.

The three members of the Neurologic End-Point Committee independently reviewed data on 52 cases of possible neurologic events, in addition to all deaths. There was complete agreement among the members on the 15 Thrombophlebitis und Bath of "definite" stroke. In three other cases, uncertainty prompted the Neurologic End-Point Committee Thrombophlebitis und Bath classify the events as "possible" stroke.

Possible strokes were characterized by reports of mild deficits associated with equivocal findings on physical examination and Thrombophlebitis und Bath. In the remaining cases there was complete agreement that no stroke had occurred. On blinded reexamination of the first 42 cases including all 15 definite strokesthe Neurologic End-Point Committee arrived at its original diagnoses once again.

The long-term damage caused by each stroke was classified as mild little or no persistent deficitmoderate substantial deficit, Thrombophlebitis und Bath, but with independent functioning maintainedThrombophlebitis und Bath, or severe deficits that precluded independent functioning. In all cases, severity was assessed a minimum of four months after the stroke.

There was one case of possible peripheral embolus in a patient in Wunden ansteckend oder nicht control group. Despite angiographic evaluation, it remained unclear whether the event was an embolus or a thrombus in situ.

Because of the uncertainty about the diagnosis, this event is not included in our analysis. Base-line variables were compared Thrombophlebitis und Bath Student's t-test for continuous variables and chi-square and Fisher's exact tests for categorical variables.

The outcomes in the two treatment groups were displayed with Kaplan—Meier curves and compared with use of the log-rank test, Thrombophlebitis und Bath.

In the analysis of death rates, follow-up data on patients with strokes were censored, Thrombophlebitis und Bath. The one fatal stroke was included among both deaths and Thrombophlebitis und Bath in our analysis of end points, Thrombophlebitis und Bath.

Bleeding events did not lead to Varizen flebodia Bewertungen censoring of follow-up data. The warfarin and control groups were compared on the basis of the originally assigned treatment analysis by intention to treat. In fact, all the strokes occurred while the patients were taking their assigned therapy.

Proportional-hazards regression was used to assess the effects of potential confounders. Confidence intervals for incidence ratios were calculated with use of test-based techniques. This committee established a criterion for early termination of three standard deviations or a two-tailed P value of 0. This decision was ratified by the trial's Executive Committee. Four hundred twenty patients were Thrombophlebitis und Bath during the course of the trial: The mean age at entry was 68 years.

Seventy-two percent of the patients were men. Thirty-two percent had received the diagnosis of atrial fibrillation within one year of their entry into the study. Eighty-three percent had sustained atrial fibrillation and 17 percent intermittent atrial fibrillation.

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Background Mitoxantrone-based chemotherapy palliates pain without extending survival in men with progressive androgen-independent prostate cancer. We compared.
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Original Article. The Effect of Low-Dose Warfarin on the Risk of Stroke in Patients with Nonrheumatic Atrial Fibrillation. The Boston Area Anticoagulation Trial for.
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Original Article. The Effect of Low-Dose Warfarin on the Risk of Stroke in Patients with Nonrheumatic Atrial Fibrillation. The Boston Area Anticoagulation Trial for.
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