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J Carena

Publications and source records attributed to J Carena.

5 recordsLinked to original sources
PubMed1998

[Rhabdomyolysis associated with disseminated gonococcal infection in an elderly woman].

Disseminated Gonococcal Infection (DGI) is very unusual in elderly patients and its association with Rhabdomyolysis (RML) has not been published for which reason we are presenting a case of RML secondary to DGI in an elderly women. We presume that the muscle damage was directly related with the gonococcal infection through toxin generation and release of endogenous mediators from mononuclear phagocytes and neutrophils and/or with ischemic injury due to altered tissue perfusion evidenced in this case by the presence of hypotension, oliguria and acidosis. We suggest that DGI be added to the RML infectious etiologies and considered in the initial differential diagnosis of all patients with polyarthritis and RML in order to facilitate an optimal treatment.

Aged↗
PubMed1995

[Community-acquired pneumonias. Admission criteria and complicated course indicators].

To evaluate the admission criteria and to select indicators that identify patients for whom hospitalization is not necessary, we studied 75 patients with community acquired pneumonia (CAP) who were admitted to a clinical service. According to Appropriateness Evaluation Protocol (AEP) only 60% of our patients justified their hospitalization (Group A) while 40% did not (Group B). The most frequent hospitalization criteria found in Group A were tachypnea (> 30x min.) (40%), respiratory failure (38%) and encefalopathy (18%). The average age in Group A was 62 versus 47 in Group B (p < 0.001). Comorbid conditions were present in 100% of Group A and 71% had two or more while only 33% of patients in Group B had two or more (p < 0.01). During the evolution, Group A had more organ failure than B (53 vs. 17%) (p < 0.001) and a longer period of hospitalization (14 vs. 9 days) (p < 0.01). The differences between groups A and B is best visualized in the incidence of sepsis (4 vs. 0%), and mortality rates (15% vs. 0%) (p < 0.05). Using the Fine risk criteria for a complicated course, we selected 14 patients from Group B, with one or more criteria (Group C) that were compared with 16 patients without them (Group D). The presence of a poor clinical status at admission was the only difference between Group D and C (79 vs. 0%) (p < 0.001). When three or more risk factors were present the differences were significant (79 vs. 6%) (p < 0.001). We conclude that the utilization of hospitalization criteria together with the risk factors for a complicated course, specifically when two or more factors per patient are present, permit the identification of a population with CAP that needs hospitalization with 71.4% sensitivity and 100% specificity. The presence of two or less risk factors in patients without admission criteria has a highly predictable negative value (100%) and anticipates an uneventful evolution without complications.

Adolescent↗
PubMed1994

[Multiple cerebral hydatid disease].

A case of hydatid cerebral disease with multiple cysts is reported with the purpose of presenting this unusual form of hydatid neurological involvement and to discuss some aspects of the pathogenesis and treatment. In this patient, the liver hydatid cyst surgery two years prior to the development of multiple pulmonary and cerebral cysts suggests a vascular invasion of oncoesphere during the hepatic surgery with hematological dissemination to the lungs and brain. The multiplicity and deep localization of the cerebral cysts prevented the performance of a definitive surgical resection. The multiple percutaneous drainage of the cysts was useful in this case to reduce the endocraneal hypertension and to achieve a neurological improvement. Albendazole has proved of benefit as a chemo-therapeutic agent in these cases and Magnetic Resonance Imaging has proven useful for surgical planning.

Adult↗
PubMed1991

[Rhabdomyolysis associated with an iodinated contrast media].

A case of rhabdomyolysis associated with an iodinated contrast medium (sodium diatrizoate) in a patient with chronic renal failure is presented for the purpose of discussing this association. Clinical manifestations were: diffuse myalgias, proximal muscular weakness and an acute reversible deterioration of the renal function. Muscle biopsy showed the typical pattern found in rhabdomyolysis, that is, cellular necrosis with no inflammation signs and myolytic areas. The temporal association between the rhabdomyolysis and the use of the contrast medium suggests a causal relationship. The present case allows us to postulate that the skeletal muscle injury was secondary to direct toxicity and/or the compromise of muscle blood perfusion by the contrast medium in a susceptible muscle due to previous renal failure. It is suggested that this group of substances should be incorporated to the list of agents capable of causing non traumatic rhabdomyolysis.

Adult↗