A Carreres

Publications (9)28.83 Total impact

• Article: [Clinical analysis of unsuspected pulmonary thromboembolism at the emergency department].

  P Tudela, E Davant, M Monreal, A Segura, J Valencia, A Carreres
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  ABSTRACT: Evaluate the degree of suspicion of pulmonary embolism (PE) in the emergency department (ED). We analyzed the cases of patients with TEP diagnosed during two years and compared group A (PE suspected) with group B (PE was not initially suspected). 57 cases of PE were admitted from ED. In 14 (25%) of them the PE was not suspected. There were statistically significant differences in the signs of deep venous thrombosis (more prevalent in group A), heart failure, and pleural effusion (more frequent in group B). The alternative diagnosis were mostly heart failure and pneumonia. The patients with unsuspected PE do not have a different clinical profile. The PE is most of the times confused with heart failure and pneumonia.
  Medicina Clínica 04/2000; 114(8):292-3. · 1.38 Impact Factor
• Article: [Detection of bacteremia in patients discharged from an emergency unit: study of 61 cases].

  P Tudela, C Queralt, M Giménez, A Carreres, J Tor, N Sopena, J Valencia
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  ABSTRACT: To know the prevalence, the clinical and microbiological characteristics of bacteremia episodes detected on discharged patients at the emergency unit, as well as the accordance of diagnostics and the predicting factors. We analysed the cases with bacteria detected on discharged patients during 2 years (1995-1996) in an university hospital. We reported: age, sex isolated organism in blood cultures, bacteremia source, leukocytes count, presence of underlying conditions, and accordance between initial and final diagnosis. We compared the characteristics of the groups with bacteremia without apparent origin and the ones with evident clinical source. We detected 61 cases, the mean age was 55 years (SD = 21), and 54% were males. The most commonly isolated agent was E. coli (50%). The leukocytes count was higher 10 x 10(9)/l in 15%. The source of bacteremia was: urinary tract infection (54%) no clinical focus (31%), respiratory tract (11%) and biliary duct (3%). The 90% of urinary tract and the 71% of respiratory infections were correctly diagnosed. However only the 5% of bacteremias without apparent source was correctly diagnosed. We found these differences statistically a significant (p < 0.001 and p = 0.002). Underlying conditions were detected in the 84% of cases in bacteremia without apparently source: AIDS (22%), cirrhosis (22%), parenteral drugs addiction (17%) and venous catheter (17%). Comparing both groups, with apparent focus and without it, we found that the presence of underlying condition is the only independent factor which predispose to bacteremia (p = 0.000; RR = 4.6; IC 95% = 1.9-11.8). The prevalence of bacteremia detected in discharged patients at the emergency unit seems acceptable. However those results suggest that we could decrease the number of patients with bacteremia without apparently source, because this group shows up to be the less successful in diagnosis. In patients with fever and no clinical focus in the emergency unit, it is useful to consider the presence of underlying factors to decide its management.
  Medicina Clínica 09/1998; 111(6):201-4. · 1.38 Impact Factor
• Source

  Available from: bmj.com

  Article: Electron microscopic microanalysis of bronchoalveolar lavage: a way to identify exposure to silica and silicate dust.

  E Monsó, A Carreres, J M Tura, J Ruiz, J Fiz, C Xaus, M Llatjós, J Morera
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  ABSTRACT: The diagnostic implications of finding non-fibrous inorganic particles in bronchoalveolar lavage (BAL) fluid has not been fully assessed. The aim of this study has been to measure the silica and non-fibrous silicates in BAL fluid from populations with different exposures to inorganic dust, and to find whether such measurement is useful for diagnostic purposes. BAL samples from 19 subjects with only environmental exposure to inorganic dust (group A, mean (SD) age 50.7 (15.2)), 23 subjects with normal chest x ray films exposed to silica or silicates at work (group B, mean (SD) age 52.0 (12.4)), and 15 subjects with a previous diagnosis of silicosis (group C, mean (SD) age 68.0 (6.5)) were studied. Absolute and relative cell counts were found, and the samples were prepared for microanalysis by electron microscopy (EM). Firstly, semiquantitative x ray microanalysis was performed to find the level of silicon (Si) (peak/background Si) and this was followed by microanalysis of individual particles by EM. Variables related to the level of Si detected were assessed with multivariate analysis. Detected levels were higher in group B (2.09, 95% confidence interval (95% CI) 1.56 to 2.82) and C (1.50, 95% CI 1.07 to 2.12) than in group A (0.87, 95% CI 0.66 to 1.16) (P < 0.05, Dunett t test). A first multivariate analysis showed that exposure to silica or silicates was the only determinant of the level of Si expressed as log peak/background Si, when adjusted for age, sex, smoking habit, and cell count. A second multivariate analysis with microanalysis of individual particles as an independent variable showed the silica count to be the main predictor of detected concentration of Si. Silica and non-aluminium silicates together explain 55.5% (R2) of the variation in detected levels of Si. Detected levels of Si in BAL fluid depend on silica count and are higher in subjects with exposure to inorganic dust at work, but will not discriminate between exposed subjects with and without silicosis. Because semiquantitative x ray microanalysis does not accurately define exposure to non-silica inorganic particles, this measurement must be followed by EM microanalysis of individual particles in most cases, especially when exposure to silicates or metal dust is suspected.
  Occupational and Environmental Medicine 08/1997; 54(8):560-5. · 3.02 Impact Factor
• Article: [Bacteremia detected among patients discharged from the emergency service].

  P Tudela, C Queralt, M Giménez, A Carreres
  Medicina Clínica 11/1996; 107(13):519. · 1.38 Impact Factor
• Source

  Available from: chestpubs.org

  Article: Bronchial stump aspergillosis four years after lobectomy.

  J Roig, J Ruiz, X Puig, A Carreres, J Morera
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  ABSTRACT: Bronchial stump aspergillosis (BSA) is an unusual entity. We report a case presenting hemoptysis four years after right upper lobe resection because of lung cancer. Simple removal of the silk suture is most likely the treatment of choice. No additional local or systemic antifungal therapy is needed.
  Chest 08/1993; 104(1):295-6. · 5.25 Impact Factor
• Article: Treatment of Legionnaires' disease. Current recommendations.

  J Roig, A Carreres, C Domingo
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  ABSTRACT: Legionnaires' disease is a relatively common cause of community-acquired pneumonia and of some outbreaks of hospital-acquired pneumonia. Moreover, Legionella pneumophila is frequently involved in the aetiology of the subset of pneumonias that is characterised by severe clinical course and high mortality. No sure clinical, radiographical or analytical features are useful in differentiating Legionella infection from other aetiologies of pneumonia. On the basis of these data, a rational initial therapeutic approach to community-acquired pneumonia, as well as to nosocomial pneumonia in certain circumstances, has to include an antimicrobial agent that is clinically effective against Legionella spp. Clinical studies have provided evidence that erythromycin is the first-line treatment. An intravenous dosage of 1g every 6 hours as initial therapy will be effective in most cases. Parenteral treatment may be switched to oral administration only after clinical response is observed. In vitro susceptibilities and preliminary experimental and clinical results suggest that clarithromycin will most likely become the preferred treatment once an intravenous preparation is available worldwide. However, orally administered clarithromycin at the dosage of 500 mg every 12 hours may be recommended in those developing countries in which health systems cannot afford the costs of intravenous therapy. In the case of clinically severe illness or in seriously immunosuppressed hosts with confirmed legionellosis, a combined therapeutic approach is warranted. Rifampicin 600 mg every 12 hours intravenously or orally has to be added to the usual dosage of erythromycin. Other alternative therapies, but with less distinct clinical efficacy, that can be combined with erythromycin are doxycycline 100 mg every 12 hours intravenously or orally, and intravenous ciprofloxacin 200 mg every 6 hours.
  Drugs 08/1993; 46(1):63-79. · 4.23 Impact Factor
• Source

  Available from: bmj.com

  Article: Measurement of maximal expiratory pressure: effect of holding the lips.

  J A Fiz, A Carreres, A Rosell, J M Montserrat, J Ruiz, J M Morera
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  ABSTRACT: Minor differences in technique may account for the wide range of published normal values of maximum expiratory and inspiratory pressures. The effects of holding the lips while the subject performed a maximal expiratory pressure manoeuvre were investigated in this study. Maximum static expiratory pressures (PEmax) obtained with a cylindrical tube by means of lip compression by the subject and technician aided compression were compared in 20 men (mean age 27 years) and 20 women (mean age 28 years). Technician aided lip compression was associated with higher maximum expiratory pressure than compression by the subject in both men (195 v 110 cm H2O) and women (134 v 80 cm H2O). Compression of the lips and corners of the mouth should be performed by a trained technician for maximum expiratory pressure measurements when a cylindrical mouthpiece is used.
  Thorax 12/1992; 47(11):961-3. · 6.84 Impact Factor
• Article: Postural variation of the maximum inspiratory and expiratory pressures in obese patients.

  J A Fiz, X Aguilar, A Carreres, M Barbany, X Formiguera, J Izquierdo, J Morera
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  ABSTRACT: Evaluating whether weight is a factor responsible for the decrease of muscle force in the supine position with respect to the upright and sitting positions, we measured maximum inspiratory and expiratory pressures (PImax and PEmax) in these postures in ten obese patients (age 38.7 +/- 9.1 years; height 168.7 +/- 8.9 cm; and weight 139.3 +/- 28.4 kg) and ten normal control subjects (age 38.4 +/- 8.2 years; height 169.3 +/- 7.9 cm and weight 66.9 +/- 11.9 kg.) In both study groups, PImax and PEmax values decreased in the supine posture with respect to upright and sitting positions. Differences between pressures in the various postures were similar for both groups with the exception of PEmax in obese females. The decrease in PEmax values from the sitting to supine positions was greater in obese than control females. Weight, sex and postural changes can influence the generation of maximal expiratory force.
  International Journal of Obesity 11/1991; 15(10):655-9. · 4.69 Impact Factor
• Article: [Brain stem involvement in eclampsia and HELLP syndrome].

  J M Gutiérrez-García, A Carreres
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  ABSTRACT: Nowadays, eclampsia is a rare complication of pregnancy and the puerperium. However, it is still one of the main causes of maternal morbi-mortality. Systemic findings in eclampsia may sometimes include association with microangiopathic hemolytic anaemia, raised liver enzymes and thrombocytopenia. This clinical combination constitutes the HELLP syndrome (Hemolysis Elevated Liver enzymes Low Platelets). The commonest neurological findings in eclampsia are headache, visual alterations, convulsions and stupor or coma. The presence of clinical symptoms and signs due to brainstem disorders is unusual. We present the case of a thirty year old woman with eclampsia and associated HELLP syndrome, which briefly affected the brain stem. The patient showed progressive general and neurological improvement. Three months afterwards she still had paresia of the sixth right cranial nerve, due to what was presumed to be a right paramedian infarct of the pons. We consider it important not to forget this exceptional association so that suitable treatment may be given to such patients since prognosis is not invariably bad.
  Revista de neurologia 28(12):1162-6. · 0.65 Impact Factor