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Search Results: 1 - 10 of 432 matches for " Manel Armengol "
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Non-Axillary Sentinel Node in Breast Cancer. Are we Staging Correctly? A Multicenter Study  [PDF]
Javier Encinas Méndez, Joan Francesc Julián Ibá?ez, Manel Cremades Pérez, Jordi Navinés, Josep Verge Schulte-Eversum, Manel Fraile López-Amor, Manel Armengol Carrasco
Advances in Breast Cancer Research (ABCR) , 2014, DOI: 10.4236/abcr.2014.34019
Abstract: Purpose: The study of the sentinel lymph node is the best technique to stage, have a prognosis and decide the adequate treatment in breast cancer. The usual technique implies studding the axillary lymph node. Our work tries to identify affected nodes in other regions apart from the axilla and its possible impact in staging and treatment. Methods: The sentinel lymph node technique was performed on 1660 patients included in an observational and multicentric study designed to observe the presence of metastatic cells in axillary and non-axillary lymph nodes. Results: In 19% of the patients the sentinel lymph node was detected in non-axillary regions. In these cases metastatic cells were more frequent which could suppose a change in the stage and/or treatment. As protective factor against non-axillary nodes involvement we found the localization of the cancer in external quadrants while youth and injecting the tracer inside the tumor were found to be risk factors. Conclusions: Detecting and studding non-axillary lymph nodes in breast cancer leads to a more precise staging of the disease which could imply a change in the optimal treatment.
Postthyroidectomy Horner’s Syndrome
Ramon Vilallonga,José Manuel Fort,Alejandro Mazarro,Oscar Gonzalez,Enric Caubet,Giancarlo Romero,Manel Armengol
Case Reports in Medicine , 2012, DOI: 10.1155/2012/316984
Abstract: Horner’s syndrome (HSd) results from an injury along the cervical sympathetic chain, producing ipsilateral miosis, ptosis, enophthalmos, and facial anhydrosis. Although more commonly associated to malignant tumors affecting the preganglionar segment of the sympathetic chain (especially in the lung apex), HSd has been described as a rare complication of thyroid surgery. We herein report a case of HSd after completing total thyroidectomy.
The Initial Learning Curve for Robot-Assisted Sleeve Gastrectomy: A Surgeon’s Experience While Introducing the Robotic Technology in a Bariatric Surgery Department
Ramon Vilallonga,José Manuel Fort,Oscar Gonzalez,Enric Caubet,Angeles Boleko,Karl John Neff,Manel Armengol
Minimally Invasive Surgery , 2012, DOI: 10.1155/2012/347131
Abstract: Objective. Robot-assisted sleeve gastrectomy has the potential to treat patients with obesity and its comorbidities. To evaluate the learning curve for this procedure before undergoing Roux en-Y gastric bypass is the objective of this paper. Materials and Methods. Robot-assisted sleeve gastrectomy was attempted in 32 consecutive patients. A survey was performed in order to identify performance variables during completion of the learning curve. Total operative time (OT), docking time (DT), complications, and length of hospital stay were compared among patients divided into two cohorts according to the surgical experience. Scattergrams and continuous curves were plotted to develop a robotic sleeve gastrectomy learning curve. Results. Overall OT time decreased from 89.8 minutes in cohort 1 to 70.1 minutes in cohort 2, with less than 5% change in OT after case 19. Time from incision to docking decreased from 9.5 minutes in cohort 1 to 7.6 minutes in cohort 2. The time required to dock the robotic system also decreased. The complication rate was the same in the two cohorts. Conclusion. Our survey indicates that technique and outcomes for robot-assisted sleeve gastrectomy gradually improve with experience. We found that the learning curve for performing a sleeve gastrectomy using the da Vinci system is completed after about 20 cases. 1. Introduction The sleeve gastrectomy (SG) is the first part of the duodenal switch operation and leaves a lesser curvature tube after excising the fundus and greater curvature portion of the stomach. This surgery has become more and more popular as the first stage in the treatment of obesity [1, 2]. Minimally invasive surgery is being incorporated into general surgical practice. During the last decade, the advent of the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) has enabled many complex procedures to be performed with minimally invasive techniques in bariatric surgery [3]. Roux en Y gastric bypass remains one of the most challenging procedures performed by bariatric and general surgeons [4]. Sleeve gastrectomies are a less technically demanding procedure, and for this reason, we used them to gain dissection and suturing experience using the da Vinci system. This initial experience was used to determine the learning curve in performing the robot-assisted sleeve gastrectomy. 2. Materials and Methods Between February 2010 and April 2011, a trained surgeon in advanced laparoscopic surgery (RV and JMF) performed 32 consecutive robotic sleeve gastrectomies (RSGs) for the treatment of morbid obesity. Patients
Right-sided diaphragmatic rupture after blunt trauma. An unusual entity
Ramon Vilallonga, Vicente Pastor, Laura Alvarez, Ramon Charco, Manel Armengol, Salvador Navarro
World Journal of Emergency Surgery , 2011, DOI: 10.1186/1749-7922-6-3
Abstract: Traumatic injuries of the diaphragm remain an entity of difficult diagnosis despite having been recognised early in the history of surgery. Sennertus, in 1541, performed an autopsy in one patient who had died from herniation and strangulation of the colon through a diaphragmatic gap secondary to a gunshot wound received seven months earlier [1]. However, these cases remain rare, and difficult to diagnose and care for. This has highlighted some of the aspects related to these lesions, especially when they are caused by blunt trauma and injuries of the right diaphragm [1,2].We report the case of a man of 36 years of age, thrown from a height of 12 meters and was referred to our centre. The patient arrived conscious and oriented, and we began manoeuvring the management of the patient with multiple injuries according to the guidelines of the ATLS (Advanced Trauma Life Support) recommended by the American College of Surgeons. The patient had an unstable pelvic fracture (type B2) with hemodynamic instability and respiratory failure. Patient's Injury Severity Score (ISS) was 38. Pelvis and chest X-rays were performed which confirmed the pelvic fracture and pathological elevation of the right hemidiaphragm was observed (Figure 1). We proceeded to stabilise the pelvic fracture and replace fluids, improving hemodynamic status. The patient continued with respiratory failure. For this reason, a chest tube was placed and Computerised Tomography (CT) was performed (Figure 2), showing a ruptured right hemidiaphragm, including chest drain in the right hepatic lobe and occupation of the lesser sac by blood. The patient underwent surgery, finding a right hemidiaphragm transverse rupture with a hepatothorax and an intrahepatic thoracic tube. We performed the suture of the diaphragm and liver packing, moved the patient to the intensive care unit, and after 48 hours, the liver packing was removed without problems. The patient evolved favourably.Currently, traumatic injuries of the diaph
Postthyroidectomy Horner’s Syndrome
Ramon Vilallonga,José Manuel Fort,Alejandro Mazarro,Oscar Gonzalez,Enric Caubet,Giancarlo Romero,Manel Armengol
Case Reports in Medicine , 2012, DOI: 10.1155/2012/316984
Abstract: Horner’s syndrome (HSd) results from an injury along the cervical sympathetic chain, producing ipsilateral miosis, ptosis, enophthalmos, and facial anhydrosis. Although more commonly associated to malignant tumors affecting the preganglionar segment of the sympathetic chain (especially in the lung apex), HSd has been described as a rare complication of thyroid surgery. We herein report a case of HSd after completing total thyroidectomy. 1. Introduction Described by Bernard (1853) and Horner (1869), Horner’s syndrome (HSd) consists of a tetrad defined by unilateral miosis, ptosis, enophtalmos, and facial anhydrosis. It results from an injury along the ipsilateral cervical sympathetic chain, usually in the preganglionic portion. The most frequent cause of HSd is neoplasms, being the malignant ones more common than the benign ones. However, when secondary to thyroid pathology, and against the general belief, HSd is more often due to benign thyroid pathology [1]. 2. Case Presentation A 79-year-old woman presented with a right cervical mass. She had undergone a subtotal thyroidectomy in 1986 for multinodular goiter, and the results of the histopathological studies revealed no malignancy. Twenty-four years after surgery, the patient complained about mass, pain, and swallowing difficulty. The only biochemical remaining sequela was subclinical hypothyroidism. Imaging studies that were performed (ultrasound—Figure 1—and CT scan—Figure 2) revealed an enlarged right thyroid lobe and a right paratracheal mass displacing (but not invading) the carotid artery, the esophagus, and the trachea. A fine needle aspiration cytology (FNAC) was performed but no conclusion could be given according to the cytology found. Figure 1: Hypoechogenic and avascular mass compatible with thyroidal remains. Figure 2: CT scan showing the mass pushing the trachea and occluding its lumen. Surgery was performed, finding a thyroid gland strongly adhered to the carotid sheath and invading the posterolateral side of the esophagus. The recurrent laryngeal nerve was identified and respected. During the surgery, the patient suffered from bradycardia secondary to carotid manipulation, being reverted with atropine. The first postoperative day, the physical exploration revealed right ptosis and miosis, being diagnosed with Horner’s syndrome. Hematoma and seroma were ruled out as a cause after a careful exploration, and HSd was attributed to damage to the communication between the cervical sympathetic chain and the recurrent laryngeal nerve, associated to palsy of the right vocal cord (Figure 2).
Endoscopic Management of Drain Inclusion in the Gastric Pouch after Gastrojejunal Leakage after Laparoscopic Roux-en-Y Gastric Bypass for the Treatment of Morbid Obesity (LRYGBP)
Ramon Vilallonga,José Manuel Fort,Oscar Gonzalez,Juan Antonio Baena,Albert Lecube,Josè Salord,Manel Armengol Carrasco,Josep Ramon Armengol-Miró
Diagnostic and Therapeutic Endoscopy , 2010, DOI: 10.1155/2010/891345
Abstract: Background. Drain inclusion inside the gastric pouch is rare and can represent an important source of morbidity and mortality associated with laparocopic Roux-en-Y gastric bypass (LRYGBP). These leaks can become chronic and challenging. Surgical options are often unsuccessful. We present the endoscopic management of four patients with drain inclusion. Patients. All four obese morbidly patients underwent LRYGBP and presented a gastro-jejunal fistula after acute anastomotic leakage. During follow-up endoscopy the drain was found inside the gastric pouch. It was moved into the abdominal cavity. Fistula debit reduced significantly and closed. Results. Gastric leak closure in less than 24 hours was achieved in all, with complete resolution of symptoms. These patients benefited exclusively from endoscopic treatment. Conclusions. Endoscopy is useful and technically feasible in chronic fistulas. This procedure is a less invasive alternative to traditional surgical revision. Other therapeutic strategies can be used such as clips and fibrin glue. Drains should not be placed in contact with the anastomosis or stapled lines. Drain inclusion must be suspected when fistula debit suddenly arises. If so, endoscopy is indicated for diagnostic accuracy. Under endoscopy vision, the drain is gently removed from the gastric reservoir leading to sudden and complete resolution of the fistula. 1. Introduction Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is one of the most frequently performed bariatric procedures worldwide and complications such as postoperative gastrocutaneous fistula (GCF) are infrequent and difficult to treat [1]. Leaks can occur in 0.5% to 4.4% of patients who undergo LRYGBP operations, resulting in significant morbidity with peritonitis, abscess formation, sepsis, multiorgan failure, and eventual death [2–5]. Early detection of leaks is necessary and is proven to reduce morbidity and mortality. Leaks may appear in the gastric remanent either in staple line or in the gastrojejunal anastomosis itself. Some surgeons feel that most leaks can be managed conservatively with total parenteral nutrition and broad-spectrum intravenous antibiotics as long as adequate drainage has been achieved. Operative intervention with large-drain placement and/or surgical repair is, however, necessary when sepsis and/or symptoms of sepsis developed. Though, spontaneous closure of GCF occurs in 90% of cases within 2 weeks, but the mortality rate can reach 85% among patients presenting with sepsis [6]. Because of the surgical difficulty, however, successful primary surgical
Identification of Copy Number Variants Defining Genomic Differences among Major Human Groups
Lluís Armengol, Sergi Villatoro, Juan R. González, Lorena Pantano, Manel García-Aragonés, Raquel Rabionet, Mario Cáceres, Xavier Estivill
PLOS ONE , 2009, DOI: 10.1371/journal.pone.0007230
Abstract: Background Understanding the genetic contribution to phenotype variation of human groups is necessary to elucidate differences in disease predisposition and response to pharmaceutical treatments in different human populations. Methodology/Principal Findings We have investigated the genome-wide profile of structural variation on pooled samples from the three populations studied in the HapMap project by comparative genome hybridization (CGH) in different array platforms. We have identified and experimentally validated 33 genomic loci that show significant copy number differences from one population to the other. Interestingly, we found an enrichment of genes related to environment adaptation (immune response, lipid metabolism and extracellular space) within these regions and the study of expression data revealed that more than half of the copy number variants (CNVs) translate into gene-expression differences among populations, suggesting that they could have functional consequences. In addition, the identification of single nucleotide polymorphisms (SNPs) that are in linkage disequilibrium with the copy number alleles allowed us to detect evidences of population differentiation and recent selection at the nucleotide variation level. Conclusions Overall, our results provide a comprehensive view of relevant copy number changes that might play a role in phenotypic differences among major human populations, and generate a list of interesting candidates for future studies.
BAC array CGH in patients with Velocardiofacial syndrome-like features reveals genomic aberrations on chromosome region 1q21.1
Anna Brunet, Lluís Armengol, Damià Heine, Jordi Rosell, Manel García-Aragonés, Elisabeth Gabau, Xavier Estivill, Miriam Guitart
BMC Medical Genetics , 2009, DOI: 10.1186/1471-2350-10-144
Abstract: We analyzed 18 patients with VCFS-like features by comparative genomic hybridisation (aCGH) array and performed a face-to-face slide hybridization with two different arrays: a whole genome and a chromosome 22-specific BAC array. Putative rearrangements were confirmed by FISH and MLPA assays.One patient carried a combination of rearrangements on 1q21.1, consisting in a microduplication of 212 kb and a close microdeletion of 1.15 Mb, previously reported in patients with variable phenotypes, including mental retardation, congenital heart defects (CHD) and schizophrenia. While 326 control samples were negative for both 1q21.1 rearrangements, one of 73 patients carried the same 212-kb microduplication, reciprocal to TAR microdeletion syndrome. Also, we detected four copy number variants (CNVs) inherited from one parent (a 744-kb duplication on 10q11.22; a 160 kb duplication and deletion on 22q11.21 in two cases; and a gain of 140 kb on 22q13.2), not present in control subjects, raising the potential role of these CNVs in the VCFS-like phenotype.Our results confirmed aCGH as a successful strategy in order to characterize additional submicroscopic aberrations in patients with VCF-like features that fail to show alterations in 22q11.2 region. We report a 212-kb microduplication on 1q21.1, detected in two patients, which may contribute to CHD.The hemizygous chromosome 22q11.2 microdeletion occurs in approximately 1:4000-6000 live births [1,2], being the most common genomic aberration among patients clinically diagnosed with velocardiofacial syndrome (VCFS) or DiGeorge syndrome (DGS). Main clinical symptoms include palatal abnormalities, particularly velopharingeal incompetence, with feeding difficulties reported in most (69%) young patients, conotruncal heart defect, characteristic facial features (long face, broad/tubular nose, hooded eyelids, hypertelorism, ear abnormalities and retrognathia), immune deficiency (involving the respiratory tract in up to 77% of cases), motor
Impact environnemental d'une désulfuration poussée des gazoles Environmental Impact of Gaz Oil Desulfurization
Armengol C.
Oil & Gas Science and Technology , 2006, DOI: 10.2516/ogst:1995040
Abstract: En une dizaine d'années, le diesel a connu un développement spectaculaire sur les marchés automobile fran ais et européen et pourrait atteindre, en 1995, la moitié des immatriculations de véhicules particuliers en France et le quart en Europe de l'Ouest. Cette situation n'est évidemment pas sans poser de problèmes. Problèmes environnementaux puisque le moteur diesel est une source plus importante d'émissions d'oxydes d'azote et de particules que le convertisseur essence, mais également au niveau de l'industrie du raffinage qui, en France, n'est plus en mesure de satisfaire la demande en gazole. De plus, à compter du 1er octobre 1996, la teneur en soufre du gazole routier ne devra pas excéder 0,05 %, conformément aux nouvelles spécifications européennes. Cette perspective de production de carburants fortement désulfurés va affecter directement l'équilibre en hydrogène de la raffinerie et donc les autoconsommations et les émissions de CO2. L'objectif de cette étude est de mesurer l'impact sur l'environnement d'une réduction de la teneur en soufre des gazoles de 0,3 à 0,05 %. Le bilan est réalisé sur l'ensemble de la filière énergétique, depuis l'extraction du pétrole jusqu'à la combustion du carburant dans le moteur. Les gains et les pertes en termes de pollution locale ou globale sont évalués suivant la nature de l'hydrogène utilisé (oxydation partielle de résidus sous vide ou de charbon, reformage à la vapeur de gaz naturel ou de naphta électrolyse) et la nature de la charge à traiter (gazole straight run ou light cycle oil) lors de l'hydrodésulfuration. Over the past decade, diesel had made large advances in the French and European automobile markets. In 1995, diesel could account for half of all private vehicle registrations in France, and a quarter in Western Europe. This situation inevitably raises a number of problems : environmental problems, because the diesel engine emits more nitrogen oxides and particulates than the gasoline converter, and also because the French refining industry is no longer able to meet domestic demand. Furthermore, starting 1st October 1996, according to the new European specifications, the sulfur content of road diesel must not exceed 0. 05%. This prospect of the production of highly desulfurized motor fuels will directly affect the hydrogen balance of the refinery, and hence self-consumption and C02 emissions. This study is aimed to assess the environemental impact of the reduction of the diesel sulfur content from 0. 3 to 0. 05 %. The review covers the entire energy cycle, from oil extraction to fuel combustion in the e
El contingut i la metodologia de l'Educació Ambiental. Continuem pensant-hi
Manel Cervera
Temps d'Educació , 1995,
Abstract:
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