Joan Martí-Ragué
University of Barcelona
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Featured researches published by Joan Martí-Ragué.
Diseases of The Colon & Rectum | 2004
Sebastiano Biondo; David Parés; Ricardo Frago; Joan Martí-Ragué; Esther Kreisler; Javier de Oca; Eduardo Jaurrieta
PURPOSEThe aims of this study were to assess the prognostic value for mortality of several factors in patients with colonic obstruction and to study the differences between proximal and distal obstruction.METHODSTwo-hundred and thirty-four consecutive patients who underwent emergency surgery for colonic obstruction were studied. Patients with an obstructive lesion distal to the splenic flexure were assessed as having a distal colonic obstruction. Resection and primary anastomosis was the operation of choice in selected patients. Alternative procedures were Hartmann’s procedure in high-risk patients, subtotal colectomy in cases of associated proximal colonic damage, and colostomy or intestinal bypass in the presence of irresectable lesions. Obstruction was considered proximal when the tumor was situated at the splenic flexure or proximally and a right or extended right colectomy was performed. A range of factors were investigated to estimate the probability of death: gender, age, American Society of Anesthesiologists score, nature of obstruction (benign vs. malign), location of the lesion (proximal vs. distal), associated proximal colonic damage and/or peritonitis, preoperative transfusion, preoperative renal failure, and laboratory data (hematocrit ≤30 percent, hemoglobin ≤10 g/dl, and leukocyte count >15,000/mm3). Univariate and multivariate forward steptwise logistic regression analysis was used to study the prognostic value of each significant variable in terms of mortality.RESULTSOne or more complications were detected in 109 patients (46.5 percent). Death occurred in 44 patients (18.8 percent). No differences were observed between proximal and distal obstruction. Age (>70 years), American Society of Anesthesiologists III–IV score, preoperative renal failure, and the presence of proximal colon damage with or without peritonitis were significantly associated with postoperative mortality in the univariate analysis. Only American Society of Anesthesiologists score, presence of proximal colon damage, and preoperative renal failure were significant predictors of outcome in multivariate logistic regression.CONCLUSIONLarge bowel obstruction still has a high of mortality rate. An accurate preoperative evaluation of severity factors might allow stratification of patients in terms of their mortality risk and help in the decision-making process for treatment. Such an evaluation would also enable better comparison between studies performed by different authors. Principles and stratification similar to those of distal lesions should be considered in patients with proximal colonic obstruction.
Diseases of The Colon & Rectum | 2011
Yolanda Ribas; Esther Saldaña; Joan Martí-Ragué; Pere Clavé
BACKGROUND: Specific treatment of functional bowel disorders requires precise diagnosis. However, prevalence and subtypes of functional constipation among women are not completely understood. OBJECTIVE: Our aim was to assess the prevalence of functional constipation and investigate the subtypes of dyssynergic defecation and slow transit constipation among Spanish women. DESIGN: We performed a prospective epidemiological study in healthy young women and retrospective pathophysiological studies in 2 patient cohorts of women with functional constipation according to Rome II criteria. SETTINGS: Referral centers at Clínica Sagrada Familia, Barcelona, Spain, and Hospital de Mataró, Mataró, Spain. PATIENTS: The epidemiological study included 600 healthy young women, aged 37.1 (SD, 8.2) years. Patient cohort 1 comprised 172 women with functional constipation without symptoms of pelvic floor dysfunction, ranging in age from 18 to 45 years. Patient cohort 2 comprised 106 women with functional constipation and symptoms of dyssynergic defecation, ranging in age from 45 to 65 years. MAIN OUTCOME MEASURES: In healthy women, a questionnaire was used to determine rates of functional constipation, dyssynergic defecation, and slow transit constipation. In patients, results of anorectal manometry, EMG, and colonic transit studies were reviewed to assess subtypes of functional constipation; in addition, results of dynamic videoproctography were reviewed in cohort 2 to assess the role of structural pelvic floor disorders. RESULTS: The prevalence of functional constipation in healthy young women was 28.8%; symptoms of dyssynergic defecation were found in 8.2%, those of isolated slow transit in only 0.17%. In patient cohort 1, a total of 143 patients (83.1%) showed dyssynergic defecation: 117 patients (68.0%) had paradoxical external anal sphincter contraction and 26 (15.1%) had impaired internal anal sphincter relaxation). Slow transit constipation without dyssynergia was observed in 15 (8.7%). Up to 40.2% of patients with dyssynergia also had delayed colonic transit. In the cohort of 106 women with dyssynergic defecation, videoproctography showed impaired puborectal relaxation in 64 patients (60.4%), anterior rectocele in 65 (61.3%), and rectal prolapse in 13 (12.3%). LIMITATIONS: We could not estimate the prevalence and subtypes of irritable bowel syndrome in the epidemiological study. CONCLUSIONS: Functional constipation is extremely prevalent among young, healthy, Spanish women, dyssynergic defecation being the most prevalent subtype. Slow transit constipation without dyssynergic defecation is uncommon. Structural pelvic floor disorders are highly prevalent in middle-aged women with dyssynergic defecation.
Cirugia Espanola | 2006
Esther Kreisler; Sebastiano Biondo; Joan Martí-Ragué
Resumen El cancer colorrectal (CCR) sigue manteniendo un importante impacto social, y en un elevado porcentaje de casos en el momento del diagnostico se manifiesta en un estadio avanzado. Un tercio de los pacientes con cancer de colon se presentara de manera urgente con un tumor complicado, una situacion de alta mortalidad que implica, ademas, un peor pronostico a largo plazo. La oclusion y la perforacion son las formas mas frecuentes de complicacion, y la hemorragia masiva es rara. La capacidad de curacion de una intervencion, urgente o electiva, depende, entre otros factores, de la radicalidad de la reseccion realizada. En la bibliografia que estudia el tratamiento de la enfermedad urgente de colon, son muy escasas las referencias a los criterios oncologicos de la reseccion. La incertidumbre acerca del tratamiento optimo de una enfermedad se traduce en una amplia variacion en el tratamiento de la afeccion urgente del colon. El objetivo del presente articulo es realizar un analisis critico de las controversias que existen a proposito del papel de la cirugia y de su impacto en el cancer de colon complicado.
Diseases of The Colon & Rectum | 2009
Alvaro Opazo; Begoña Lecea; Carme Admella; Maria José Fantova; Marcel Jiménez; Joan Martí-Ragué; Pere Clavé
PURPOSE: This study aims to compare the physiology of the longitudinal muscle of the anal canal with the internal anal sphincter in pigs. METHODS: Histology and in vitro studies were performed to compare the effect of neural responses induced by electric stimulation and through nicotinic, purinergic, and serotoninergic receptors. RESULTS: The longitudinal muscle and the internal anal sphincter are constituted exclusively by smooth muscle. Strips from the internal anal sphincter a) developed myogenic tone; b) responded to electric stimulation with an “on” relaxation antagonized by nitric oxide synthase inhibitors and purinergic P2Y1 antagonists, and with an “off” contraction antagonized by atropine and phentolamine; and c) responded to stimulation of nicotinic receptors with a relaxation antagonized by nitrergic and purinergic P2Y1 antagonists, responded to stimulation of serotoninergic 5-hydroxytryptamine 3 receptors with a contraction, and relaxed to carbachol and purinergic P2X agonists. Strips from the longitudinal muscle a) did not develop tone, b) responded to electric stimulation with an “on” contraction antagonized by atropine, and c) did not respond to stimulation of nicotinic or serotoninergic 5-hydroxytryptamine 3 receptors, and carbachol and purinergic P2X agonists induced a contraction. CONCLUSIONS: The motility of the internal anal sphincter includes myogenic tone, relaxation mediated by nitric oxide and purinergic P2Y1 receptors, and contraction mediated by cholinergic motor neurons and sympathetic fibers. The motility of the longitudinal muscle is limited to a contraction mediated by cholinergic neurons, suggesting that longitudinal muscle contracts during relaxation of the internal sphincter, shortening the anal canal. Nicotinic, muscarinic, and serotoninergic receptors might be therapeutic targets for anal motor disorders.
Cirugia Espanola | 2005
Joan Martí-Ragué
Resumen El suelo pelvico es una de las estructuras mas complejas del cuerpo humano. Historicamente, el abordaje de sus enfermedades ha sido «vertical», con el compartimiento anterior abordado por urologos, el medio por ginecologos con frecuentes incursions en el compartimiento anterior femenino, y el posterior reservado a los cirujanos. Durante los ultimos anos se ha producido un cambio en la filosofia del manejo de estas enfermedades gracias la aparicion de un concepto integrador «transversal» que afecta a la fisiologia, la fisiopatologia y la propia definicion de estas enfermedades como una estructura integrada, en la que se incluyen la incontinencia urinaria, la incontinencia fecal, el prolapso de organos pelvicos, las alteraciones de la percepcion y del vaciamiento del tracto urinario, el estrenimiento cronico, las disfunciones sexuales y varios sindromes de dolor cronico del area perineal. Creemos que se deberian aunar los esfuerzos de los diferentes profesionales relacionados con el tratamiento de estas enfermedades y crear unidades de suelo pelvico. Parece importante que se establezca un concepto de multidisciplinariedad, ya que las habilidades y los conocimientos necesarios para el abordaje de los problemas de las pacientes requieren equipos formados por multiples dominios profesionales.
Cirugia Espanola | 2005
David Parés; Sebastiano Biondo; Mónica Miró; Domenico Fraccalvieri; David Julià; Ricardo Frago; Amador García-Ruiz; Joan Martí-Ragué
INTRODUCTION The introduction of one-stage procedures in emergency colonic surgery many years ago has relegated the use of the Hartmann procedure to the most seriously-ill patients, which has led to the high morbidity and mortality rates associated with this surgical technique. The aim of our study was to investigate our results using Hartmanns procedure and to evaluate several prognostic factors of postoperative mortality in this group of patients. PATIENTS AND METHODS From January 1995 to December 2000, 79 patients (34 men and 45 women) with a mean age of 71.5 years underwent Hartmanns operation. Almost all the series (91.1%) had comorbidities. In this group of patients, morbidity and mortality were analyzed retrospectively, and a multivariate logistic regression analysis was performed to study prognostic factors of postoperative mortality. RESULTS The indications for surgery were acute peritonitis (77.2%), intestinal obstruction (18.9%), and lower gastrointestinal hemorrhage (3.7%). The most frequent etiology was acute diverticulitis (36 patients), followed by complicated colorectal carcinoma (18 patients). In 70.9% of the patients (56 patients) one or more postoperative complications was observed. Reoperation was performed in 15 patients (18.9%) and overall postoperative mortality was 45.5%. Renal failure (creatinine > or = 120 micromol/l) and high surgical ASA score (III or IV) reached statistical significance as predictive factors of mortality in these patients (p=.001 and p=.005, respectively). CONCLUSION The patients who underwent Hartmanns procedure with high surgical ASA score and/or renal failure were at significantly higher risk of mortality.Resumen Introduccion La introduccion, hace ya muchos anos, de la cirugia colica urgente en un tiempo ha relegado la intervencion de Hartmann para los pacientes mas graves. Este hecho ha conducido a que las tasas de morbimortalidad asociadas a la tecnica de Hartmann sean elevadas. El objetivo de nuestro estudio fue analizar los resultados obtenidos con la intervencion de Hartmann en el periodo de estudio y analizar los factores pronosticos de mortalidad postoperatoria en este grupo de pacientes. Pacientes y metodos Durante el periodo comprendido entre enero de 1995 y diciembre de 2000 se intervino quirurgicamente a 79 pacientes (34 varones y 45 mujeres), con una edad media de 71,5 anos, a los que se les realizo una intervencion de Hartmann. Casi la totalidad de los pacientes (91,1%) tenia una o mas enfermedades asociadas. En este grupo de pacientes se analizaron retrospectivamente los resultados de morbimortalidad y, mediante un estudio de regresion logistica multivariable, los factores pronosticos de mortalidad postoperatoria. Resultados En toda la serie, la indicacion de cirugia fue: peritonitis aguda (77,2%), oclusion intestinal (18,9%) y hemorragia digestiva baja (3,7%). La causa etiologica mas frecuente fue la diverticulitis aguda complicada (36 casos) y el cancer colorrectal complicado (18 casos). El 70,9% de los pacientes (56 casos) presento 1 o mas complicaciones durante el postoperatorio; 15 casos fueron reintervenidos (18,9%), y la mortalidad postoperatoria fue del 45,5%. La insuficiencia renal (creatinina ≥ 120 μmol/l) y el riesgo quirurgico ASA avanzado (III o IV) alcanzaronsignificacion estadistica como factores predictivos de mortalidad en estos pacientes (p = 0,001 y 0,005, respectivamente). Conclusion Los pacientes a los que se les practico una intervencion de Hartmann y que tenian un mayor riesgo quirurgico anestesico (ASA) y/o una alteracion de la funcion renal tuvieron un riesgo de mortalidad significativamente mas elevado.
Cirugia Espanola | 2004
Joan Altet; David Parés; Sebastiano Biondo; Susana Lamas; Raúl Mato; Javier de Oca; Joan Martí-Ragué
Resumen La presencia de bario retenido en diferentes localizaciones anatomicas, dias o semanas despues de la practica de alguna exploracion con contraste, es bien conocida desde hace ya algunos anos, cuando el uso de exploraciones baritadas era mas frecuente que en la actualidad. Algunos autores han postulado que la presencia de bario retenido en el fondo apendicular puede obstruir la luz apendicular o actuar a modo de apendicolito y tener por tanto, un papel clinicamente relevante en la etiopatogenia de la causa mas frecuente de abdomen agudo en nuestro medio: la apendicitis aguda. Otros autores, sin embargo, han considerado esta asociacion puramente anecdotica. En definitiva, la actitud diagnostico-terapeutica ante la presencia de contraste en el apendice ha variado drasticamente en los ultimos anos. Por ello, presentamos un caso de apendicitis aguda en el contexto de bario retenido y, a partir de una revision bibliografica, mostramos la evolucion controvertida en el manejo de esta situacion clinica.
Diseases of The Colon & Rectum | 2007
Juan Figueras; Jaume Torras; Carlos Valls; Laura Lladó; Emilio Ramos; Joan Martí-Ragué; Teresa Serrano; Juan Fabregat
American Journal of Surgery | 2005
Sebastiano Biondo; Joan Martí-Ragué; Esther Kreisler; David Parés; Adán Martín; Matilde Navarro; Laura Pareja; Eduardo Jaurrieta
Cirugia Espanola | 2007
Sebastiano Biondo; Esther Kreisler; Monica Millan; Joan Martí-Ragué; Domenico Fraccalvieri; Thomas Golda; Javier de Oca; Alfonso Osorio; Rosa Fradera; Ramon Salazar; Francisco Rodriguez-Moranta; Xavier Sanjuan