Estenosis de la anastomosis ureteroileal en derivaciones urinarias realizadas mediante abordaje abierto, laparoscópico y robótico. Incidencia y manejo en un centro de tercer nivel / Ureteroileal anastomosis stricture after urinary diversions performed by open, laparoscopic and robotic approaches. Incidence and management in a tertiary care center

Introducción Las estenosis de anastomosis ureteroileal son complicaciones frecuentes en conductos ileales y neovejigas ortotópicas. Analizamos su incidencia en función del tipo de derivación urinaria y del abordaje quirúrgico (abierto, laparoscópico o robótico). Describimos su manejo y los resultados obtenidos.Material y métodos Estudio retrospectivo descriptivo durante 6 años en pacientes con derivación urinaria empleando íleon (conducto ileal o neovejiga ileal). Se recogen datos demográficos, comorbilidades, datos quirúrgicos (abordaje, complicaciones) y resultados. Seguimiento mínimo de un año. Comparación entre grupos, mediante test de la chi al cuadrado en variables dicotómicas. Variables cuantitativas comparadas empleando la prueba de la t Student para grupos independientes o la prueba de Mann-Whitney. Consideramos significación estadística p<0,05.Resultados Incluimos a 182 pacientes (84% varones y 16% mujeres). Edad media 68 años. Abordaje de cistectomía: laparoscópica (67/37%), robótica (63/35%), abierta (43/24%). Tipo de derivación: conducto ileal (138/76%) y neovejiga ileal ortotópica (44/24%). Tipo de reimplante: Bricker (108/59%) y Wallace (47/26%). Estenosis de anastomosis ureteroileal (50/27%): bilateral (26), izquierda (16) y derecha (8). Estenosis según abordaje de cistectomía: laparoscópica (23/46%), robótica (16/32%), abierta (9/18%). Tratamiento de estenosis (33/18%): reimplante ureteroileal (13), nefrostomía permanente (13), dilatación endoscópica (4), nefroureterectomía (2), endoureterotomía (1). Abordaje del reimplante: laparoscópico (5/38%), robótico (6/46%) y abierto (2/15%). Resultados tras reimplantes: reestenosis (0/0%), reintervención (3/23%), estenosis ureteroileal contralateral posterior (1/8%).ConclusiónEl tipo de abordaje empleado en la cistectomía no parece influir en la aparición de estenosis ureteroileales. Abordajes laparoscópicos y robóticos permiten su reparación con resultados

Introduction Ureteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes.Material and methodsDescriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student's t test for independent groups or Mann-Whitney test. Statistical significance if P<.05.Results The study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Ureteric reimplantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%).Conclusion Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates (AU)

Ureteroileal anastomosis stricture after urinary diversions performed by open, laparoscopic and robotic approaches. Incidence and management in a tertiary care center.

INTRODUCTION: Ureteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes. MATERIAL AND METHODS: Descriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student's t-test for independent groups or Mann-Whitney test. Statistical significance if P < .05. RESULTS: The study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Uretericre implantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%). CONCLUSION: Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates.

Ureteroileal anastomosis stricture after urinary diversions performed by open, laparoscopic and robotic approaches. Incidence and management in a tertiary care center. / Estenosis de la anastomosis ureteroileal en derivaciones urinarias realizadas mediante abordaje abierto, laparoscópico y robótico. Incidencia y manejo en un centro de tercer nivel.

INTRODUCTION: Ureteroileal anastomosis stricture is a frequent complication after radical cystectomy and ileal conduit or orthotopic neobladder formation. We analyze their incidence based on the technique for urinary diversion and on the surgical approach (open, laparoscopic or robot-assisted). Stricture management is described, along with surgical outcomes. MATERIAL AND METHODS: Descriptive retrospective study over 6 years in patients who underwent urinary diversion using ileum (ileal conduit or orthotopic neobladder). Demographic data, comorbidities, surgical approach, complications, and outcomes were collected. Minimum follow-up of 1 year. Comparison between groups using Chi-square test for dichotomous variables. Quantitative variables were compared using the Student's t test for independent groups or Mann-Whitney test. Statistical significance if P<.05. RESULTS: The study included 182 patients (84% males and 16% females). Mean age 68 years. Cystectomy approach: laparoscopic (67/37%), robot-assisted (63/35%), open (43/24%). Urinary diversion: ileal conduit (138/76%) and orthotopic ileal neobladder (44/24%). Ureteric reimplantation technique: Bricker (108/59%) and Wallace (47/26%). Ureteroileal anastomosis strictures (50/27%): bilateral (26), left (16) and right (8). Strictures according to cystectomy approach: laparoscopic (23/46%), robot-assisted (16/32%), open (9/18%). Treatment of strictures (33/18%): ureteric reimplantation (13), indwelling nephrostomy (13), endoscopic dilatation (4), nephroureterectomy (2), endoureterotomy (1). Ureteroileal reimplantation approach: laparoscopic (5/38%), robot-assisted (6/46%), open (2/15%). Outcomes after reimplantation: restenosis (0/0%), reintervention (3/23%), contralateral ureteroileal stricture (1/8%). CONCLUSION: Surgical approach in cystectomy does not influence future development of ureteroileal strictures. Laparoscopic and robot-assisted ureteroileal reimplantation achieves high success rates.

Radiofrecuencia percutánea en el tratamiento de masas renales pequeñas: análisis de resultados y complicaciones tras diez años de experiencia / Percutaneous radiofrequency for the treatment of small renal masses: Analysis of outcomes and complications after 10 years of experience

Introducción y objetivo: El manejo de tumoraciones renales ≤ 4 cm en población anciana o con comorbilidades supone un reto, constituyendo las terapias ablativas una alternativa interesante. El objetivo es evaluar la radiofrecuencia percutánea en el tratamiento de masas renales pequeñas en nuestro centro, las complicaciones asociadas y los resultados obtenidos.Material y métodosEvaluación retrospectiva de las radiofrecuencias realizadas entre abril de 2010 y abril de 2020 en nuestro centro. Se revisaron datos demográficos, comorbilidades asociadas, características tumorales, complicaciones y resultados oncológicos y funcionales.ResultadosSe trataron 57 tumores en 53 pacientes. Seguimiento medio de 48,2 meses. Se obtuvo un 89,5% de ablaciones completas. Hubo un 19,3% de complicaciones. Fueron catalogadas como mayores un 3,5% y un 5,3% según Clavien-Dindo y SIR. Se encontró asociación estadísticamente significativa entre el resultado inicial de la ablación y la edad (p = 0,047), el score RENAL modificado (RENAL-m) (p = 0,044), la presencia de componente quístico (p = 0,049) y el tamaño tumoral (p = 0,01). El punto de corte de tamaño quedó establecido en 25 mm (p = 0,012). En el análisis multivariante, únicamente el tamaño permaneció como predictor de resultado inicial de ablación (p = 0,01; OR 1,183; IC 95% 1,041-1,345). La supervivencia cáncer específica y supervivencia libre de recurrencia a cinco años fueron del 98,1% y del 89,5% respectivamente.Se observó una disminución media del MDRD-4 de 6,59 mL/min (p = 0,005) en los seis primeros meses tras radiofrecuencia (RFA).ConclusionesDados los excelentes resultados oncológicos y funcionales demostrados, la radiofrecuencia percutánea guiada por ecografía es una terapia eficaz y segura en el tratamiento de masas renales pequeñas en pacientes seleccionados. (AU)

Introduction and objective: The management of renal tumors ≤ 4 cm in elderly population or patients with comorbidities is a challenge, for which ablative therapies are an interesting alternative. The objective is to evaluate in our center the role of percutaneous radiofrequency in the treatment of small renal masses, the associated complications and the results obtained.Material and methodsRetrospective evaluation of the radiofrequency treatments carried out between April 2010 and April 2020 in our center. Demographic data, associated comorbidities, tumor characteristics, complications and oncological and functional outcomes were reviewed.ResultsFifty-seven tumors were treated in 53 patients. Mean follow-up of 48.2 months. The percentage of complete ablations obtained was of 89.5%. There were 19.3% of complications. According to Clavien-Dindo and SIR classification systems, 3.5% and 5.3% were major complications. A statistically significant association was found between the initial result of ablation and age (p = 0.047), RENAL-m (p = 0.044), the presence of cystic component (p = 0.049) and tumor size (p = 0.01). The cut-off point for size was established at 25 mm (p = 0.012). In multivariate analysis, only size remained as a predictor of initial ablation result (p = 0.01; OR 1.183; CI 95% 1.041-1.345). Cancer-specific survival and 5-year recurrence-free survival were 98.1% and 89.5%, respectively.A mean decrease of MDRD-4 of 6.59 mL/min (p = 0.005) was observed in the first six months after RFA.ConclusionsGiven the excellent oncological and functional results demonstrated, ultrasound-guided percutaneous radiofrequency ablation is an effective and safe treatment for small renal masses in selected patients. (AU)

Percutaneous radiofrequency for the treatment of small renal masses: Analysis of outcomes and complications after 10 years of experience. / Radiofrecuencia percutánea en el tratamiento de masas renales pequeñas: análisis de resultados y complicaciones tras diez años de experiencia.

INTRODUCTION AND OBJECTIVE: The management of renal tumors ≤ 4 cm in elderly population or patients with comorbidities is a challenge, for which ablative therapies are an interesting alternative. The objective is to evaluate in our center the role of percutaneous radiofrequency in the treatment of small renal masses, the associated complications and the results obtained. MATERIAL AND METHODS: Retrospective evaluation of the radiofrequency treatments carried out between April 2010 and April 2020 in our center. Demographic data, associated comorbidities, tumor characteristics, complications and oncological and functional outcomes were reviewed. RESULTS: Fifty-seven tumors were treated in 53 patients. Mean follow-up of 48.2 months. The percentage of complete ablations obtained was of 89.5%. There were 19.3% of complications. According to Clavien-Dindo and SIR classification systems, 3.5% and 5.3% were major complications. A statistically significant association was found between the initial result of ablation and age (p = 0.047), RENAL-m (p = 0.044), the presence of cystic component (p = 0.049) and tumor size (p = 0.01). The cut-off point for size was established at 25 mm (p = 0.012). In multivariate analysis, only size remained as a predictor of initial ablation result (p = 0.01; OR 1.183; CI 95% 1.041-1.345). Cancer-specific survival and 5-year recurrence-free survival were 98.1% and 89.5%, respectively. A mean decrease of MDRD-4 of 6.59 mL/min (p = 0.005) was observed in the first six months after RFA. CONCLUSIONS: Given the excellent oncological and functional results demonstrated, ultrasound-guided percutaneous radiofrequency ablation is an effective and safe treatment for small renal masses in selected patients.

Predictive factors of evolution of patients after pT0 radical cystectomy due to bladder cancer.

OBJECTIVES: To analyze the influence of the different pre - cystectomy factors, both clinical and pathological, in the follow up of patients with no residual tumor ( pT0) in the pathological examination of the radical cystectomy specimen as predictors of tumor recurrence. Secondly we intend to compare overall survival, disease free survival and cancer-specific survival with the rest of cystectomy patients in our series. METHODS: Between 1985 and 2010, radical cystectomy was performed in 280 patients with bladder cancer, being 41 pT0 (14.6%). We analyzed potential predictors for overall survival and disease-free survival: age, sex , number of transurethral resections of bladder tumor before cystectomy , tumor type , tumor grade, tumor stage, tumor size, number of tumors, associated Cis and previous instillations. We used univariate analysis of Cox regression. Survival analysis was performed using Kaplan - Meier curves and log-rank test. RESULTS: Mean age was 61.7 years and 37 patients were males (90.2%). Stages before cystectomy were pT1 in eight (19.5%) , pT2 in 31 (75.6%) and Cis in two (4.9 %) with tumor grade III in 37 (90.2%). Cystectomy specimens revealed the presence of papillary transitional cell carcinoma in 38 (92.7%) cases. The median number of pre-cistectomy-TURBT was one. Eleven patients (26.8%) received intravesical instillations. Six patients (14.63 %) had tumor recurrence and 10 (24.4 %) died from causes unrelated to the disease. None of the variables analyzed was statistically significant in the univariate analysis as a predictor of tumor recurrence. With a median follow up of 70 months (3-272) disease-free survival and overall survival at five years were 85.9% and 72.8% respectively. Compared to the non pT0 cystectomies in our series, pT0 had a statistically significant difference for better recurrence-free survival (63.4 % and 36.8%, respectively in pT0 and no-pT0 patients) (p〈0,05). CONCLUSIONS: According to the results, we have found a better outcome for pT0 patients after cystectomy compared to those with residual tumor. We have not found any pre - cystectomy predictive factor related to disease-free survival and overall survival.

Factores predictivos de la evolución de los pacientes pTo Post-Cistectomía Radical por causa tumoral / Predictive Factors of Evolution of Patients after pT0 Radical Cystectomy Due to Bladder Cancer

OBJETIVOS: Analizar la influencia de los diferentes factores pre-cistectomía tanto clínicos como anatomopatológicos, en el seguimiento de pacientes con estudio anatomopatológico de la pieza de cistectomía radical con ausencia de tumor residual (pT0), como factores predictivos de recurrencia tumoral en estos pacientes. En segundo lugar, pretendemos comparar la supervivencia global, supervivencia libre de enfermedad y la supervivencia cáncer específica con las del resto de pacientes cistectomizados de nuestra serie. MÉTODOS: Entre 1985-2010 se intervinieron 280 pacientes de cistectomía radical por causa tumoral, de los cuales 41 fueron pT0 (14,6%). Se exploraron los potenciales factores predictores para supervivencia global y supervivencia libre de enfermedad: edad, sexo, número de resecciones transuretrales de vejiga previas a la cistectomía, tipo tumoral, grado, estadio, tamaño tumoral, número de tumores, Cis asociado e instilaciones previas usando un análisis univariado de regresión de Cox. El análisis de supervivencia se realizó mediante curvas de Kaplan-Meier y Log-Rank test. RESULTADOS: La edad media fue 61,7 años y 37 (90,2%) de ellos fueron varones. Los estadios previos a la cistectomía fueron pT1 en ocho (19,5%), pT2 en 31 (75,6%), y Cis en dos (4,9%), con un grado tumoral III en 37 (90,2%). La anatomía patológica (AP), reveló la presencia de carcinoma transicional papilar en 38 (92,7%) casos. La mediana de RTU-V previas fue una. Habían recibido instilaciones endovesicales 11 (26,8%) pacientes. Seis pacientes (14,63%) presentaron recidiva tumoral y diez (24,4%) fallecieron por causas ajenas a la enfermedad. Ninguna de las variables analizadas resultó ser estadísticamente significativa en el estudio univariado como predictora de recurrencia tumoral. Con una mediana de seguimiento de 70 meses (3-272), la supervivencia libre de enfermedad y supervivencia global fueron del 85,9% y del 72,8% a los cinco años respectivamente. Comparando con las cistectomías no pT0 de nuestra serie, los pT0 presentaban una diferencia estadísticamente significativa en cuanto a mayor supervivencia libre de recurrencia (63,4% y 36,8% respectivamente en pacientes no pT0) (p<0,05). CONCLUSIONES: En nuestra serie, al análisis encontramos que los resultados clínicos de los pacientes pT0 tras la cistectomía son mejores que los de los pacientes con tumor residual. No habiendo encontrado factores pronósticos pre-cistectomía predictivos para la supervivencia libre de enfermedad

OBJETIVES: To analyze the influence of the different pre-cystectomy factors, both clinical and pathological, in the follow up of patients with no residual tumor ( pT0 ) in the pathological examination of the radical cystectomy specimen as predictors of tumor recurrence. Secondly we intend to compare overall survival, disease free survival and cancer-specific survival with the rest of cystectomy patients in our series. METHODS: Between 1985 and 2010, radical cystectomy was performed in 280 patients with bladder cancer, being 41 pT0 (14.6%). We analyzed potential predictors for overall survival and disease-free survival: age, sex , number of transurethral resections of bladder tumor before cystectomy , tumor type , tumor grade, tumor stage, tumor size, number of tumors, associated Cis and previous instillations. We used univariate analysis of Cox regression. Survival analysis was performed using Kaplan - Meier curves and log-rank test. RESULTS: Mean age was 61.7 years and 37 patients were males (90.2%). Stages before cystectomy were pT1 in eight (19.5%) , pT2 in 31 (75.6%) and Cis in two (4.9 %) with tumor grade III in 37 (90.2%). Cystectomy specimens revealed the presence of papillary transitional cell carcinoma in 38 (92.7%) cases. The median number of pre-cistectomy-TURBT was one. Eleven patients (26.8%) received intravesical instillations. Six patients (14.63 %) had tumor recurrence and 10 (24.4 %) died from causes unrelated to the disease. None of the variables analyzed was statistically significant in the univariate analysis as a predictor of tumor recurrence. With a median follow up of 70 months (3-272) disease-free survival and overall survival at five years were 85.9% and 72.8% respectively. Compared to the non pT0 cystectomies in our series, pT0 had a statistically significant difference for better recurrence-free survival (63.4 % and 36.8%, respectively in pT0 and no-pT0 patients) (p < 0,05) CONCLUSIONS: According to the results, we have found a better outcome for pT0 patients after cystectomy compared to those with residual tumor. We have not found any pre - cystectomy predictive factor related to disease-free survival and overall survival

Revisión de cistectomías en mujeres por cáncer vesical: complicaciones y calidad de vida según la derivación urinaria / Review of a series of Cystectomies in women for bladder cancer: Complications and quality of life

OBJETIVO: Realizar un análisis de las complicaciones y de la calidad de vida de las cistectomías por causa oncológica realizadas en mujeres en nuestro centro. MÉTODO: Análisis descriptivo de los datos demográficos y de las complicaciones precoces y tardías de las cistectomías y derivación urinaria realizadas en nuestro centro en mujeres. Analizamos la calidad de vida mediante el cuestionario de calidad de vida FACT-BL (Functional Assessment of Cancer Therapy-Bladder Cancer) cuestionario validado para evaluación de la calidad de vida en pacientes con cáncer de vejiga. Se realiza comparación entre grupos de las variables principales. RESULTADOS: De un total de 265 cistectomías, 25 (9.4 %) se realizaron en mujeres. La derivación predominante fue la Ureterosigmoidostomía 60 %, seguido de Ureterostomía Cutánea 16 %, Neovejiga ileal ortotópica tipo Studer 12 % , Conducto Ileal 8 % y 1 Nefrostomía permanente (4 %). La edad media: 55,75 años. Las complicaciones precoces más frecuentes fueron: íleo prolongado (20 %) y fístula urinaria (20 %). Las complicaciones tardías más frecuentes fueron: hidronefrosis (32 %) y pielonefritis (32 %). Los resultados de los cuestionarios fueron similares en los diferentes tipos de derivaciones siendo la puntuación media de 104.5 sobre 156 puntos. CONCLUSIONES: La cistectomía radical es una cirugía de alto riesgo asociada elevado número de complicaciones. En mujeres, la Ureterosigmoidostomía puede ser una buena alternativa como derivación urinaria continente en pacientes seleccionadas, siendo en nuestra serie su calidad de vida similar a la de las otras derivaciones

OBJECTIVES: To analyze the complications and quality of life after cystectomies performed in women with bladder cancer at our hospital. METHODS: Descriptive analysis of demographic data and early/late complications of cystectomies and urinary diversions performed in women at our hospital between 1990-2010. We also assessed quality of life using the Functional Assessment of Cancer Therapy - Bladder Cancer (FACT-BL) questionnaire and a comparison was drawn between groups of clinical variables. RESULTS: Out of 265 cystectomies, 25 (10%) were performed in women. The predominant urinary diversion was ureterosigmoidostomy (60%), followed by cutaneous ureterostomy (16%), orthotopic ileal neo-bladder Studer pouch (12%), ileal conduit (10%) and permanent nephrostomy (4%). Mean age was 55.75 years. The most commonly occurring early complications were prolonged ileus (20%) and urinary fistula (20%). Late complications included hydronephrosis (32%) and pyelonephritis (32%). The results of quality of life questionnaires were very similar for the different types of urinary diversions, with a mean score of 104.5 out of 156 points. CONCLUSIONS: Radical cystectomy is a high-risk procedure associated with many complications. In women, ureterosigmoidostomy may be a good choice for urinary diversion in selected patients, with a quality of life very similar to those with different urinary diversions

[Therapeutic options for renal graft tumors]. / Opciones terapéuticas para tumores en el injerto renal.

Renal graft neoplasias are a rare complication,possibly due to the immunosuppressive therapy itself and increased susceptibility to potentially oncogenic viruses. Few case series have been reported in the literature on the treatment of such tumors, so far there is no clear consensus on how to deal with them. We conducted an exhaustive review of the literature to examine the treatment performed by different authors.

Opciones terapeuticas para tumores en el injerto renal / Therapeutic options for renal graft tumors

Las neoplasias en los injertos renales son una complicación poco frecuente. En su desarrollo parecen intervenir tanto la terapia inmunosupresora como una mayor susceptibilidad a padecer virus potencialmente oncogénicos. Escasas series de casos han sido descritos en la literatura sobre el tratamiento de dichos tumores por lo que hasta la fecha no existe un consenso claro de cómo abordar dichas lesiones. Realizamos una exhaustiva revisión de la literatura para examinar la terapéutica desarrollada por los diferentes autores(AU)

Renal graft neoplasias are a rarecomplication,possibly due to the immunosuppressive therapy itself and increased susceptibility to potentially oncogenic viruses. Few case series have been reported in the literature on the treatment of such tumors, so far there is no clear consensus on how to deal with them. We conducted an exhaustive review of the literature to examine the treatment performed by different authors(AU)

Comparación entre la adquisición de la fonología castellana y catalana a partir del AREHA y del AREPA / Comparison between the Spanish and Catalan phonological acquisition through the AREHA and the AREPA

En este trabajo se compara la adquisición de la fonología de la lengua catalana y castellana a partir de dos pruebas de evaluación muy similares, el AREHA y el AREPA. La muestra se compone de niños de habla catalana y castellana de diferentes edades (3, 4, 5 Y 6 años). Los resultados muestran que, en general, en catalán y castellano se adquieren más tardíamente los fonemas y/o las estructuras que son más complejos en cada lengua. De este modo, en catalán se tarda más en adquirir los fonemas fricativos y africados, mientras que en castellano se adquieren más tarde las estructuras de palabras AATA. Sin embargo, hemos observado un efecto de la frecuencia de la lengua en las sílabas CVC, ya que en catalán, donde las codas son más frecuentes y más complejas, estas sílabas se adquieren antes que en castellano, donde las codas son más simples y menos frecuentes

This paper compares phonological acquisition in Catalan and Spanish based on two very similar tests, the AREHA and the AREPA. The sample comprises Catalan and Spanish-speaking children of different ages (3, 4, 5 and 6 years). The results show that, in general, Catalan and Spanish children acquire the more complex structures or phones later. Thus, children spend more time acquiring fricatives and affricatives in Catalan, whereas WWSW word structure is acquired later in Spanish. Furthermore, the effect of language frequency in CVC syllables has been observed, since codas are more frequent and complex in Catalan and are acquired earlier than in Spanish

Restricciones de movilidad física en residencias de personas mayores: actitudes del personal asistencial y directivo hacia su uso / Physical restraints in homes for the elderly: attitudes of management and nursing staff towards their use

Introducción: El uso de las restricciones de movilidad, tales como cintos y barras, en residencias de personas mayores plantea serias cuestiones éticas, legales y asistenciales. Las actitudes del personal directivo y asistencial de las residencias son muy importantes para su eventual reducción. Objetivo: Examinar las actitudes hacia su uso de gestores, médicos, trabajadores sociales, y personal de enfermería de nuestro entorno. Métodos: Estudio cualitativo, con 25 entrevistas en profundidad, con 13 preguntas abiertas múltiples; contrastamos la validez de la transcripción de las respuestas mediante la técnica de jueces ciegos. Resultados: Todos coinciden en que su uso se debe evitar al máximo. El personal de enfermería se muestra más a favor; directores y gestores mencionan problemas éticos. Generalmente su utilización se vive como algo negativo aunque a algunos no les afecta personalmente o acaban acostumbrándose. Existen protocolos o pautas de actuación y la decisión se delega en el personal médico, teniendo en cuenta el bienestar del residente. Algunos residentes se sienten mal, otros más seguros, al estar sujetos. Conclusiones: Es necesario reformar la legislación, realizar protocolos de actuación, informar debidamente al personal e investigar sobre el tema. En la toma de decisiones debe participar el equipo multidisciplinar (AU)