The impact of international videoconferencing among older adults and secondary students.

This study explores young adults' emotional affect and attitudes towards ageing, as well as older adults' emotional affect and self-esteem following participation in the intergenerational videoconferencing programme Smile Connect (SC). The sample consisted of 94 participants (46 older Spanish adults living in a care home in Spain and 48 young Italian adults -secondary students- learning Spanish at school in Italy). Each age group was divided into an intervention and control group. SC consists of twelve 30-minute chat sessions conducted via Skype between the target groups over six weeks. Pre and post evaluations were made to assess the affect level in both groups, self-esteem among older people, and the level of negative stereotypes about ageing among young adults. At the end of the SC, the intervention group of older adults recorded significantly improved scores in self-esteem compared to the control group. Young adults recorded a reduction in their negative stereotypes about old age after taking part in the SC programme compared to those who did not. These findings suggest that involvement in the SC programme helps to improve the emotional affect of older adults living in care homes, as well as change the negative stereotypes about ageing among young adults.

Cuidados paliativos / Palliative care

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Evolución de los reactantes de fase aguda y del metabolismo del hierro en artroscopia de rodilla por meniscopatía y en plastias de ligamento cruzado anterior / Acute phase reactants and iron parameters after knee arthroscopy: meniscal resection and anterior cruciate ligament reconstruction

Objetivo y métodos: Se ha llevado a cabo un estudio prospectivo cuyo objetivo primario final ha sido determinar la evolución de los reactantes de fase aguda y parámetros de tierra en el postoperatorio precoz (24-48 horas) y tardío (2 semanas) en las cirugías con evolución postintervención sin complicaciones. Resultados: Se reclutaron 56 sujetos (26 sometidos a resección meniscal – AM - y 30 a reparación de ligamento cruzado anterior –ALCA -). En los sujetos sometidos a intervención por AM, al comparar los parámetros prequirúrgicos con los postquirúrgicos precoces (24 horas), se observó un aumento estadísticamente significativo (p < 0,05) de leucocitos totales (9.350 ± 2.363 vs. 7.386 ± 1.735, p=0,001), neutrófilos totales (7.242 ±2.506 vs. 4.421 ±1.509 , p < 0,000), PCR (4,3 ±3,5 vs 1,9 ±1,4, p= 0,01) y RST (3,1 ±0,6 vs 2,9 ± 0,7, p= 0,03), si bien dentro o próximos a los límites altos de la normalidad. Respecto a los niveles en el periodo postquirúrgico tardío (13,5 ± 8,9 días) del mismo grupo, los valores significativos desde el punto de vista estadístico fueron la VSG (8,9 ±5,9 vs. 6,3 ± 3,3, p = 0,006), PCR (5,6 ±6,9 vs. 1,9 ±1,4, p = 0,08) y ferritina (194,5 ±146,9 vs. 153,7 ±101,7, p = 0,022), de nuevo en el nivel alto del rango de normalidad o discretamente por encima. Respecto a las intervenciones –ALCA- se apreció un aumento estadísticamente significativo de leucocitos totales (9.237 ± 2.153 vs. 7.270 ± 1.691, p<0,000), porcentaje de neutrófilos (70,3 ±6,3 vs. 56,3 ±8,6, p < 0,000) VSG (11,0 ± 10,6 vs. 4,9 ± 3,3, p = 0,002), PCR (42,1 ± 30,0 vs. 1,3 ±1,0, p < 0,000) y ferritina (175,6 ±94,3 vs. 152,0 ± 95,4, p = 0,003) y descensos significativos del hierro (36,6 ± 19,0 vs. 96,2 ± 38,3, p < 0,000) y RST (2,7 ± 0,7 vs. 2,9 ± 0,7, p = 0,003) en el postquirúrgico precoz (1,27 ±0,52 días), resultando con trascendencia clínica las modificaciones en la PCR y hierro. En el perio-do tardío (16 ±6,43 días) hubo modificación estadísticamente significativa de la VSG (18,3 ±21,3 vs. 5,0 ±3,3, p = 0,001), PCR (11,8 ± 18,1 vs. 1,3 ± 1,0, p = 0,004), ferritina (181,6 ± 111,9 vs. 155,0 ± 95,6, p = 0,026) y RST (3,4 ± 0,9 vs. 2,9 ± 0,7, p < 0,000), siendo de relevancia clínica los valores de VSG y PCR. Conclusiones: Tras RM se producen modificaciones mínimas de los parámetros inflamatorios y de la ferritina, permaneciendo dentro del rango de la normalidad o próximos a su valor superior. Tras ALCA existe modificación inicial significativa de la PCR y el hierro y en el período tardío de la VSG y PCR. Tanto la VSG como la PCR están por debajo de 30 mm/h y 20 mg/l respectivamente tras 16 días de ALCA con evolución posterior sin complicaciones

Objectives and methods: We performed a prospective study. Our primary objective was to quantify inflammatory and iron parameters 24 to 48 hours and 2 weeks after an uncomplicated knee arthroscopy (meniscal resection – MR - and anterior cruciate ligament reconstruction – ACLR - ). Results: We recruited 57 subjects with a favourable course after surgery (26 MR, 30 ACLR). 24 to 48 hours after a MR subjects had higher levels of leukocytes (9.350 ± 2.363 vs. 7.386 ± 1.735, p=0,001), neutrophils (7.242 ± 2.506 vs. 4.421 ± 1.509, p<0,000), c-reactive protein –CRP- (4,3 ± 3,5 vs 1,9 ± 1,4, p= 0,01) and serum transferrin receptor –CTR- (3,1 ± 0,6 vs 2,9 ± 0,7, p= 0,03), while two weeks later (13,6 ± 8,6 days) individuals had higher levels of erythrocyte sedimentation rate –ESR (8,9 ± 5,9 vs. 6,3 ± 3,3, p = 0,006), CRP (5,6 ± 6,9 vs. 1,9 ± 1,4, p = 0,08) and ferritin (194,5 ± 146,9 vs. 153,7 ± 101,7, p = 0,022), although none of the values where higher than the upper average level. An exception was the 24 hour postsurgery neutrophil percentage and the late CRP which were almost normal. Subjects submitted to ACLR had 24 hour after surgery, higher levels of neutrophils (9.237 ± 2.153 vs. 7.270 ± 1.691, p<0,000), neutrophils percentage (70,3 ± 6,3 vs. 56,3 ± 8,6, p < 0,000), ESR (11,0 ± 10,6 vs. 4,9 ± 3,3, p = 0,002), CRP (42,1 ± 30,0 vs. 1,3 ± 1,0, p < 0,000) and ferritin (175,6 ± 94,3 vs. 152,0 ± 95,4, p = 0,003) and significant lower iron levels (36,6 ± 19,0 vs. 96,2 ± 38,3, p < 0,000) and lower CTR (2,7 ± 0,7 vs. 2,9 ± 0,7, p = 0,003). Sixteen days (16 ± 6,43) after ACLR, there was statistically significant changes in ESR (18,3 ± 21,3 vs. 5,0 ± 3,3, p = 0,001), CRP (11,8 ± 18,1 vs. 1,3 ± 1,0, p = 0,004), ferritin (181,6 ± 111,9 vs. 155,0 ± 95,6, p = 0,026) and CTR (3,4 ± 0,9 vs. 2,9 ± 0,7, p < 0,000). Nevertheless, only iron and CRP in the early postoperative period and ESR and CRP in the late postoperative period were higher than the upper average level, so considered substantially modified. Conclusions: 24 to 48 hours and two weeks after MR, levels of acute phase reactants and iron parameters are beneath or close to the average upper level. In ACLR, CRP and iron experienced significant changes in the early postoperative period, while in the late postoperative period, ESR and CRP were still significantly modified. ESR and CRP are lower than 30 mm/h and 20 mg/l after 16 days of an uncomplicated ACLR

[Ureteral stenosis after kidney transplantation: treatment with a self-expanding metal prosthesis]. / Estenosis ureteral post-transplante renal: tratamiento con prótesis metálica autoexpandible.

OBJECTIVE: To determinate the efficacy in the treatment of ureteral estenoses after renal transplantation with metallic self-expandable stent. MATERIALS AND METHODS: From october of 1995 to april of 2002, 8 ureteral obstruction post renal transplantation have treated by means of implants of a metallic self-expandable stent (6 men and 2 women). The average time of pursuit was of 30 months (rank 2-53 months). In this work the severity and location of the estenosis are analysed, the method of implant of the stent, the permeability of the same one, the levels of creatinine pre and postimplant and the complications derived from the same one. RESULTS: The treatment was effective in the 100% of the patients (8/8), with an average reduction of the creatinine of 36% (rank 13.6%-59.6%). The complications were minimum and the hospital stay was short. CONCLUSIONS: In the patients with: chronic deterioration of the graft with short functional expectation, patient with high surgical risk and reestenosis after ureteral reimplantation by previous ureteral estenosis, the use of a metallic self-expandable stent, constitutes technique of election given its efficacy and low associate morbidity.

Estenosis ureteral post-trasplante renal: tratamiento con prótesis metálica autoexpandible / Ureteral obstruction after renal transplantation: treatment with metallic self-expandable

OBJETIVO: Determinar la eficacia del empleo de prótesis metálicas autoexpandibles en el tratamiento de las estenosis ureterales post-trasplante renal. MATERIAL Y MÉTODOS: Desde octubre de 1995 a abril de 2002, se han tratado 8 estenosis ureterales postTR mediante el implante de una prótesis metálica autoexpandible (6 hombres y 2 mujeres). El tiempo medio de seguimiento fue de 30 meses (rango 2-53 meses). En este trabajo se analizan la severidad y localización de la estenosis, el método de implante de la prótesis, la permeabilidad de la misma, los niveles de creatinina pre y postimplante y las complicaciones derivadas del mismo. RESULTADOS: El tratamiento fue efectivo en el 100 por ciento de los pacientes (8/8), con un descenso medio de la creatinina del 36 por ciento (rango 13,6 por ciento-59,6 por ciento). Las complicaciones fueron mínimas y la estancia hospitalaria fue corta. CONCLUSIONES: En los pacientes con: deterioro crónico del injerto con expectativa funcional corta, pacientes con alto riesgo quirúrgico y reestenosis tras reimplantación ureterovesical por estenosis ureteral previa, el empleo de una prótesis metálica autoexpandible constituye la técnica de elección dada su eficacia y baja morbilidad asociada (AU)

OBJECTIVE: To determinate the efficacy in the treatment of ureteral estenoses after renal transplantation with metallic self-expandable stent. MATERIALS AND METHODS: From october of 1995 to april of 2002, 8 ureteral obstruction post renal transplantation have treated by means of implants of a metallic self-expandable stent (6 men and 2 women). The average time of pursuit was of 30 months (rank 2-53 months). In this work the severity and location of the estenosis are analysed, the method of implant of the stent, the permeability of the same one, the levels of creatinine pre and postimplant and the complications derived from the same one. RESULTS: The treatment was effective in the 100% of the patients (8/8), with an average reduction of the creatinine of 36% (rank 13,6%-59,6%). The complications were minimun and the hospital stay was short. CONCLUSIONS: In the patients with: chronic deterioration of the graft with short functional expectation, patient with high surgical risk and reestenosis after ureteral reimplantation by previous ureteral estenosis, the use of a metallic self-expandable stent, constitutes technique of election given its efficacy and low associate morbidity (AU)

[Treatment of ureteral obstruction with auto-expandable metallic endoprosthesis]. / Tratamiento de la obstrucción ureteral mediante endoprótesis metálicas autoexpandibles.

OBJECTIVE: To evaluate the efficacy of Nitinol (Memotherm) self-expandible metal stents in the treatment of malignant and non-malignant ureteral obstruction in patients who are not eligible for surgery. METHODS: A total of 14 ureteral strictures (5 malignant, 9 non-malignant) in 13 patients were treated by the implantation of a Nitinol endoprosthesis. Eight were implanted by the antegrade and 6 by the retrograde route. A mean of 1.3 stents were implanted per patient. RESULTS: 85% of the stents were patent at a mean follow-up of 10.2 months (range 2-28). Four prostheses developed transient obstruction that was resolved by insertion of a double-J catheter for periods that ranged from 2 to 6 months. One stent required a permanent double-J catheter and another stent showed functional obstruction, although it was morphologically patent. CONCLUSION: The Nitinol self-expandible metal stent is effective in the treatment of malignant and non-malignant ureteral obstructions in patients who are not eligible for surgery due to the tumor stage or high surgical risk.