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R J Gené

Publications and source records attributed to R J Gené.

7 recordsLinked to original sources
PubMed2002

[Rendu-Osler-Weber syndrome. Pulmonary arteriovenous fistulas. A report of three cases].

Hereditary hemorrhagic telangiectasia (HHT), or Rendu-Osler-Weber syndrome, is a rare disorder that is closely linked to the development of pulmonary arteriovenous malformations (PAVM). Diagnosis can be based on clinical signs such as upper respiratory tract changes or recurrent hemorrhagic events. Nevertheless, pulmonary involvement, a prognostic factor, may remain undetected. In the three HTT cases with PAVM we report, the following diagnostic information was obtained non-invasively: shunt fraction measurements (breathing 100% oxygen), echocardiographic contrast studies, and three-dimensional helical computed tomographs. Arteriography demonstrated a single PAVM in one case and the patient underwent successful coil embolization, with clinical and functional improvement.

Adult↗
PubMed2001

Effects of supplemental oxygen during activity in patients with advanced COPD without severe resting hypoxemia.

STUDY OBJECTIVES: To assess oxygen desaturation during activities and to evaluate the short-term effects of supplemental O(2) use in patients with severe COPD who do not qualify for long-term O(2) therapy. DESIGN: A double-blind, randomized, placebo-controlled trial. SETTING: Outpatients from the pulmonary diseases division of a tertiary-care university hospital. PATIENTS: Twenty patients with stable COPD with FEV(1)/FVC ratios of < 50%, FEV(1) levels < 55% of the predicted normal value, and PaO(2) levels of > 60 mm Hg when resting. INTERVENTIONS: Patients were initially evaluated with pulmonary function tests, blood gas analysis, and Doppler echocardiography, and they underwent the following three 6-min walking tests (WTs) in a random sequence: basal WT (BWT); WT while breathing compressed air (CAWT); and WT while breathing O(2) (O(2)WT). MEASUREMENTS AND RESULTS: The distance walked was recorded in meters. Dyspnea was measured by Borg scale measurement before and after the tests, and arterial oxygen saturation measured by pulse oximetry (SpO(2)) was continuously monitored. Results were analyzed by grouping patients in the following manner: desaturators (DSs) (ie, patients with a drop in SpO(2) of at least 5% and < 90% during the WT) vs nondesaturators (NDSs); and O(2) responders (ie, patients with an increase of at least 10% in the distance walked and/or a decrease of at least 3 points in Borg index score) vs nonresponders. During the BWT, 11 of 20 patients (55%) were defined as desaturators. During the O(2)WT, the SpO(2) remained at > 90% in every patient. The distance walked increased by 22% (p < 0.02), and dyspnea decreased 36% (p < 0.01) in DS patients. In NDS patients, O(2) administration reduced dyspnea by 47% (p < 0.001), but the distance walked did not improve. Responses were markedly different from one patient to another. No significant differences were noticed between the results of the BWT and CAWT in any of the groups. Thirteen O(2) responders did not differ from 7 nonresponders either in basal data or in desaturation measure during the BWT, except that all walking responders (five patients) were above the median of basal left ventricle performance. CONCLUSIONS: Most of the studied COPD patients desaturated during the BWT. O(2) administration avoided desaturation and could increase the distance walked and reduce dyspnea, but these effects were not related to walking desaturation in individual cases. Improvements were not a placebo effect. The therapeutic role of O(2) during activities in some patients with severe COPD needs to be individually assessed.

Aged↗
PubMed2000

Community-acquired pneumonia: etiology, epidemiology, and outcome at a teaching hospital in Argentina.

OBJECTIVE: To survey the etiology and epidemiology of community-acquired pneumonia (CAP) in relation to age, comorbidity, and severity and to investigate prognostic factors. DESIGN: Prospective epidemiologic study, single center. SETTING: University hospital at Buenos Aires, Argentina. PATIENTS: Outpatients and inpatients fulfilling clinical criteria of CAP. INTERVENTIONS: Systematic laboratory evaluation for determining the etiology, and clinical evaluation stratifying patients into mild, moderate, and severe CAP (groups 1 to 3), a clinical rule used for hospitalization. RESULTS: During a 12-month period, 343 patients (mean age, 64.4 years; range, 18 to 102 years) were evaluated. We found 167 microorganisms in 144 cases (yield, 42%). Streptococcus pneumoniae, the most common pathogen, was isolated in 35 cases (24%). Mycoplasma pneumoniae, present in 19 (13%), was second in frequency in group 1; Haemophilus influenzae, present in 17 cases (12%), was second in group 2; and Chlamydia pneumoniae, present in 12 cases (8%), was second in group 3. Etiology could not be determined on the basis of clinical presentation; identifying the etiology had no impact on mortality. Some findings were associated with specific causative organisms and outcome. A significantly lower number of nonsurvivors received adequate therapy (50% vs 77%). CONCLUSIONS: Age, comorbidities, alcohol abuse, and smoking were related with distinct etiologies. PaO(2) to fraction of inspired oxygen ratio < 250, aerobic Gram-negative pathogen, chronic renal failure, Glasgow score < 15, malignant neoplasm, and aspirative pneumonia were associated with mortality by multivariate analysis. Local microbiologic data could be of help in tailoring therapeutic guidelines to the microbiologic reality at different settings. The stratification schema and the clinical rule used for hospitalization were useful.

Adolescent↗
PubMed1999

[Use of trovafloxacin therapy in community-acquired pneumonia].

In community-acquired pneumonia (CAP) the pathogenic microorganism is unknown at the time of diagnosis. For that reason the antimicrobial therapy is empirical, based in the clinical picture and the presumptive causal microorganisms. Hospitalization is one of the most important decisions in patients with CAP. Clinical criteria appropriate to identifying those patients requiring hospital admission for antimicrobial administration and clinical control must be defined. The stratification of patients according to the presence of risk factors such as age and co-morbidities permit to predict which are the potential pathogenic microorganisms and their adequate therapy. Trovafloxacin covers all the presumed bacterial spectrum, pharmacokinetics, easiness to be administered and to pass to the oral route, advantageous for all the groups under consideration. Patients older than 65 years of age or with co-morbidities and those that need to be hospitalized receive clear benefits from this antibiotic.

Adult↗
PubMed1997

[Community-acquired pneumonia in adults. Clinical practice guideline for Argentina. Study Group on Community Acquired Pneumonia].

Community-acquired pneumonia (CAP) affects approximately 1% of the population annually. Initial antimicrobial therapy is most often empirical. Guidelines designed in other countries for the empirical management of CAP are not recommended for use in Argentina. Studies from other countries were considered together with unpublished local data to define the potential etiologic microorganisms and their antimicrobial susceptibility. Recommended diagnostic tests, groups of patients for different therapies and hospitalization criteria were defined. Severe CAP requiring intensive care was distinguished from the rest because of its distinct spectrum of etiologic agents and its high mortality, requiring a more focused therapy. Age, coexisting conditions and severity of illness were taken into account in the election of therapy.

Argentina↗