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Biomedical subjects

G Fortuny

Publications and source records attributed to G Fortuny.

13 recordsLinked to original sources

[Evaluation of the system of direct purchase and distribution of urinary incontinence pads in primary care centers].

OBJECTIVE: To evaluate the impact of the pilot experience of direct purchase and distribution of incontinence diapers in primary health care centres of the Balearic Islands after 10 months of implementation. DESIGN: Comparison of diapers's public expenditures and use during 10 months of pilot experience (9/1/1994-6/30/1995: POSTC) to a same length period prior to pilot experience implementation (11/1/1993-8/31/1994: PREC). SETTING: Primary health care centres of the Balearic Islands (Spain). MEASUREMENTS AND RESULTS: Monthly mean of packages used in the PREC period was 3,246 packages/month, whereas monthly mean of packages used in POSTC period was 4,541 packages/month. It means an increase of 1,295 packages/month. The mean price per package got by public tender was 4,426 ptas., nearly half of mean unit price per package paid through the usual dispensing system of medical prescription (8,583 ptas.), thus producing a saving of 4,157 ptas. per package. A decreasing trend to the monthly mean of diapers use of the PREC period was observed in the last months of the experience. The monthly expenditures in diapers was 27,790 milions ptas. in the PREC period and 21,024 milions ptas. during the POSTC period. CONCLUSIONS: The expected increase in diapers use during the first year of implementation of this measure was 34.86%. Of this increase, 70.5% is attributed to development of stock in centres and the undergoing trend of diapers demand increase observed throughout the country.

Costs and Cost Analysis↗

Effect of cyclosporin A on proteinuria in patients with Alport's syndrome.

Eight patients with Alport's syndrome and massive proteinuria (129 +/- 60.57 mg/m2 per hour) were treated with cyclosporin A (CyA) for 8 months. The average dose of CyA administered to all patients was 4.21 +/- 0.26 mg/kg per day and blood CyA levels of 63.4 +/- 4.1 ng/ml were attained. In five patients, proteinuria abated during the 3rd week of treatment. In the remaining three, all of whom had low creatinine clearance (82.0, 46.0 and 43.2 ml/min per 1.73 m2 respectively), proteinuria persisted but at levels lower than before treatment: 32.5 +/- 15.9 mg/m2 per hour versus 183.3 +/- 29.7 mg/m2 per hour. No permanent decrease in creatinine clearance was observed in any of these patients throughout treatment. In those patients in whom proteinuria abated, it reappeared 2 weeks after discontinuation of CyA treatment. We observed no significant increases in angiotensin II plasma levels in our patients during CyA administration. Although we have shown that CyA will reduce massive proteinuria in patients with Alport's syndrome, we cannot yet recommend its use as a therapeutic measure.

Adolescent↗

[Tubular handling of potassium in cystinosis].

Seven patients with cystinosis (Ccr between 30 and 90 ml/m/1.73 m2), were studied attempting to delineate renal tubular handling of potassium. Ks, Ck/Ccr X 100, Aldou and UAldo V/Ks were determined in basal conditions; tubular handling of water and sodium, and clearance of potassium were studied during hypotonic saline diuresis. Results obtained in cystinosis were compared with normal values and with values found in renal insufficiencies in the same range of GFR. Studies performed indicate that in cystinosis Ks is lower and Ck/Ccr X 100 and UAldo V/Ks higher than in normal children. During hypotonic saline diuresis, patients with cystinosis presented higher fractional water, sodium and potassium clearances than control children with the same range of GFR.

Adolescent↗

Hepatitis B virus infection and vaccination in children undergoing hemodialysis.

Among 54 patients, between 2 and 18 years of age, submitted to hemodialysis due to severe chronic renal failure, the prevalence of hepatitis B virus markers was 66.7% and that of HBsAg was 13.0%. Eighteen children, with no evidence of hepatitis B virus infection, were vaccinated. Following three vaccine injections, only 2 patients did not respond and a third one developed low anti-HBs titers. The vaccine was well tolerated. No relationship was observed between the intensity of the humoral immune response and age, sex, type of renal disease and time on dialysis. Seroconversion rates (87.5%) and geometric means of anti-HBs titers (greater than 4 000 Ausab Units) of these patients are similar to those observed following vaccination of healthy adults.

Adolescent↗

[Bartter's syndrome. Pathophysiology in three cases (author's transl)].

The primary pathologic defect in Bartter's syndrome is unknown. Three patients have been studied. In two of them, with normal intra-erythrocite sodium concentration, authors prove the existence of an impaired proximal tubular sodium reabsorption. In the last case, with a high intra-erythrocite sodium concentration, this impaired sodium reabsorption was localized in the proximal and distal tubular portions.

Adult↗

Studies on the site of renal sodium loss in two patients with cystinosis. Effects of hydrochlorothiazide on tubular sodium reabsorptive mechanisms.

The purpose of this study was to examine the effect of hypotonic saline diuresis on two patients with cystinosis, trying to localize the site of renal sodium loss. At the same time, we have performed the same hypotonic saline infusion under hydrochlorothiazide administration. Results seem to prove the proximal tubular localization of the salt-wasting syndrome in cystinotic patients. On the other hand, these results suggest that hydrochlorothiazide effect can be related to the hypovolemia due to the distal tubular action of hydrochlorothiazide that could inhibit the 'third' natriuretic factor, thus increasing the proximal tubular sodium reabsorption.

Absorption↗

[Review of 15 cases of hypervitaminosis D].

In our experience, hypervitaminosis D, which at present should only be a historic remembrance in pediatrics, is still a frequent cause of hipercalcemia in childhood. It is easy understand that its appearance should turn out to be a complication in the treatment of hypoparathyroidisms or in vitamin D resistant rickets, but its persistance as a purely iatrogenic diseases is at present inexplicable. The frequency with which we have seen it has led us to review 15 cases where erroneous administration of high doses of vitamin D has resulted in serious clinical, biological and anatomical problems.

Child, Preschool↗

[Physiopathological study in 2 cases of Bartter's syndrome].

Batter's syndrome is characterized by retardation in growth pitressin-resistant hypostenuria, hypokalemic alkalosis, high activity of the jux angiotensin-renine-aldosterone system with normal blood pressure; vascular insensibility to angiotensin and hypertrophy and hyperplasia of the juxtaglomerular apparatus. In both patients we studied, we found negative balance of sodium and potassium conditioned to a renal loss of them.

Bartter Syndrome↗