Ramon Vilallonga
Autonomous University of Barcelona
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Featured researches published by Ramon Vilallonga.
Annals of the New York Academy of Sciences | 2008
José M. Ponseti; Josep Gamez; Jamal Azem; Manuel López-Cano; Ramon Vilallonga; Manuel Armengol
Tacrolimus is a macrolide T cell immunomodulator that is used in myasthenia gravis (MG) patients to affect muscle contraction (ryanodine receptor by modulating intracellular calcium‐release channels and increasing muscular strength), glucocorticoid receptors (increasing intracellular concentration of steroids and blocking the steroid export mechanism), and an increase in T cell apoptosis. In this study, we report the results of low‐dose tacrolimus (0.1 mg/kg/day) treatment in 212 MG patients. There were 110 thymectomized, cyclosporine‐ and prednisone‐dependent patients; 68 thymectomized patients who started tacrolimus early postoperatively (24 h after operation); and 34 patients over 60 years old with nonthymomatous generalized MG or in whom thymectomy was contraindicated. The mean follow‐up time was 49.3 ± 18.1 months. Muscular strength showed an increase of 23% after 1 month of treatment and 29% at the end of the study. The acetylcholine receptor antibodies decreased significantly from a mean of 33.5 nmol/L at base line to 7.8 nmol/L at the final visit. In the thymectomy group with combined prednisone and tacrolimus stratified by histology of the thymus, the mean probability to attain complete stable remission at 5 years was 80.8% in patients with hyperplasia, 48.1% in thymic involution, and 9.3% in patients with thymoma. In 4.9% of patients, tacrolimus was withdrawn because of major adverse effects. Our results suggest that a low dose of tacrolimus is effective for MG and could be included to the armamentarium for this autoimmune disease. The present results should be interpreted considering the limitations of a retrospective clinical study. Confirmation of these results in randomized studies is desirable.
Surgery for Obesity and Related Diseases | 2016
Gustavo A. Arman; Jacques Himpens; Jeroen Dhaenens; Thierry Ballet; Ramon Vilallonga; Guido Leman
BACKGROUND More than 10 years of outcomes for sleeve gastrectomy (LSG) have not yet been documented. OBJECTIVES Analysis of>11 years of outcomes of isolated LSG in terms of progression of weight, patient satisfaction, and evolution of co-morbidities and gastroesophageal reflux disease (GERD) treatment. SETTING Two European private hospitals. METHODS Chart review and personal interview in consecutive patients who underwent primary isolated LSG (2001-2003). RESULTS Of the 110 consecutive patients, complete follow-up data was available in 65 (59.1%). Mean follow-up was 11.7±.4 years. Two patients had died of non-procedure-related causes. Twenty (31.7%) patients required 21 reoperations: 14 conversions (10 duodenal switch (DS), 4 Roux-en-Y gastric bypass (RYGB), and 3 resleeve procedures) for weight issues and 2 conversions (RYGB), and 2 hiatoplasties for gastroesophageal reflux disease (GERD). For the 47 (74.6%) individuals who thus kept the simple sleeve construction, percentage of excess body mass index loss (%EBMIL) at 11+years was 62.5%, versus 81.7% (P = .015) for the 16 patients who underwent conversion to another construction. Mean %EBMIL for the entire cohort was 67.4%. At 11+years postoperatively, 30 patients versus 28 preoperatively required treatment for co-morbidities. None of the 7 patients preoperatively suffering from GERD were cured by the LSG procedure. Nine additional patients developed de novo GERD. Overall satisfaction rate was 8 (interquartile range 2) on a scale of 0-10. CONCLUSION Isolated LSG provides a long-term %EBMIL of 62.5%. Conversion to another construction, required in 25% of the cases, provides a %EBMIL of 81.7% (P = .015). Patient satisfaction score remains good despite unfavorable GERD outcomes.
Neurology | 2005
José M. Ponseti; Jamal Azem; José Manuel Fort; Manuel López-Cano; Ramon Vilallonga; M. Buera; C. Cervera; Manuel Armengol
To the Editor: Utilizing the Mood Disorder Questionnaire (MDQ), Ettinger et al.1 observed a high incidence of bipolar symptoms in patients selfreported as epileptic. Half the subjects with bipolar symptoms by MDQ claimed a previous diagnosis of bipolar disorder. The authors suggest that antiepileptic drug (AED) therapy may be effective considering the relationship between altered brain physiology and mood. I submitted a related observation to the American Psychiatric Association’s 159th annual meeting. Forty-two referred patients (24 women, mean age 37 years) with a history of bipolar I or II (Diagnostic and Statistical Manual of Mental Disorders–IV criteria) underwent a behavioral neurologic assessment including EEG.2 None of these patients received prior AED treatment. Eighteen (45%) had EEG abnormalities classified as a focal dysrhythmia grade III (Mayo Clinic classification) and 12 had dysrhythmia grade II (28%). In 21 of the 30 patients with EEG abnormalities (70%), AED therapy that included lamotrigine, levetiracetam, topiramate, or oxcarbazepine proved effective in stabilizing mood without serious adverse event in 18 (85%) over 6 to 60 months (mean 36).3 Because none of these patients had a prior history of epilepsy, a diagnosis of interictal dysthymic disorder was excluded.4 These observations confirm those of Ettinger et al.’s that physiologic assessment in behavioral disorders and behavioral assessment in epilepsy should be further investigated.Seventy-nine patients with cyclosporine- and prednisone-dependent myasthenia gravis (MG) after thymectomy received tacrolimus for a mean of 2.5 +/- 0.8 years. Prednisone was withdrawn in all but two patients. Anti-acetylcholine antibodies and MG score for disease severity decreased significantly and muscular strength increased by 39%. Complete stable remission was achieved in 5% of patients and pharmacologic remission in 87.3%. All patients resumed full activities of daily living.
Surgical Endoscopy and Other Interventional Techniques | 2015
Amir Szold; Roberto Bergamaschi; Ivo A. M. J. Broeders; Jenny Dankelman; Antonello Forgione; Thomas Langø; Andreas Melzer; Yoav Mintz; Salvador Morales-Conde; Michael Rhodes; Richard M. Satava; Chung Ngai Tang; Ramon Vilallonga
Following an extensive literature search and a consensus conference with subject matter experts the following conclusions can be drawn: 1. Robotic surgery is still at its infancy, and there is a great potential in sophisticated electromechanical systems to perform complex surgical tasks when these systems evolve. 2. To date, in the vast majority of clinical settings, there is little or no advantage in using robotic systems in general surgery in terms of clinical outcome. Dedicated parameters should be addressed, and high quality research should focus on quality of care instead of routine parameters, where a clear advantage is not to be expected. 3. Preliminary data demonstrates that robotic system have a clinical benefit in performing complex procedures in confined spaces, especially in those that are located in unfavorable anatomical locations. 4. There is a severe lack of high quality data on robotic surgery, and there is a great need for rigorously controlled, unbiased clinical trials. These trials should be urged to address the cost-effectiveness issues as well. 5. Specific areas of research should include complex hepatobiliary surgery, surgery for gastric and esophageal cancer, revisional surgery in bariatric and upper GI surgery, surgery for large adrenal masses, and rectal surgery. All these fields show some potential for a true benefit of using current robotic systems. 6. Robotic surgery requires a specific set of skills, and needs to be trained using a dedicated, structured training program that addresses the specific knowledge, safety issues and skills essential to perform this type of surgery safely and with good outcomes. It is the responsibility of the corresponding professional organizations, not the industry, to define the training and credentialing of robotic basic skills and specific procedures. 7. Due to the special economic environment in which robotic surgery is currently employed special care should be taken in the decision making process when deciding on the purchase, use and training of robotic systems in general surgery. 8. Professional organizations in the sub-specialties of general surgery should review these statements and issue detailed, specialty-specific guidelines on the use of specific robotic surgery procedures in addition to outlining the advanced robotic surgery training required to safely perform such procedures.
Minimally Invasive Surgery | 2012
Ramon Vilallonga; José Manuel Fort; Oscar Gonzalez; Enric Caubet; Ángeles Boleko; Karl J. Neff; Manel Armengol
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.
Journal of Minimal Access Surgery | 2012
Ramon Vilallonga; Umut Barbaros; Aziz Sümer; Tugrul Demirel; José Manuel Fort; Oscar Gonzalez; Nivardo Rodriguez; Manuel Armengol Carrasco
INTRODUCTION: A novel single port access (SPA) cholecystectomy approach is described in this study. We have designed a randomised comparative study in order to elucidate any possible differences between the standard treatment and this novel technique. MATERIALS AND METHODS: Between July 2009 and March 2010, 140 adult patients with gallbladder pathologies were enrolled in this multicentre study. Two surgeons (RV and UB) randomised patients to either a standard laparoscopic (SL) approach group or to an SPA cholecystectomy group. Two types of trocars were used for this study: the TriPort™ and the SILS™ Port. Outcomes including blood loss, operative time, complications, length of stay and pain were recorded. RESULTS: There were 69 patients in the SPA group and 71 patients in the SL group. The mean age of the patients was 43.2 (17-77) for the SPA group and 42.6 (19-70) for the SL group. The mean operative time was 63.9 min in the SPA group and 58.4 min in the SL group. For one patient, the SPA procedure was converted to a standard laparoscopic technique and to open approach in the SL group. Complications occurred in eight patients: Five seromas (two in the SPA group) and three hernias (one in the SPA group).The mean hospital stay was 38.5 h in the SPA group and 24.1 h in the SL group. Pain was evaluated and was 2 in the SPA and 2.9 in the SL group, according to the visual analogue scale (VAS) after 24 h (P<0.001). The degree of satisfaction was higher in the SPA group (8.3 versus 6.7). Similar results were found for the aesthetic result (8.8 versus 7.5). (P<0.001). CONCLUSION: Single-port transumbilical laparoscopic cholecystectomy can be feasible and safe. When technical difficulties arise, early conversion to a standard laparoscopic technique is advised to avoid serious complications. The SPA approach can be undertaken without the expense of additional operative time and provides patients with minimal scarring. The cosmetic results and the degree of satisfaction appear to be significant for the SPA approach.
Expert Opinion on Biological Therapy | 2009
José M. Ponseti; Norma Caritg; Josep Gamez; Manuel López-Cano; Ramon Vilallonga; Manuel Armengol
Objective: A single-centre, non-randomized, non-controlled study was designed to compare the long-term post-thymectomy clinical outcome in anti-AChR-positive, anti-AChR-negative and anti-MuSK-positive patients with non-thymomatous myasthenia gravis (MG). Methods: A total of 331 consecutive patients with seropositive MG, 55 with seronegative MG and 10 with anti-MuSK-positive MG underwent extended transsternal thymectomy (T-3b according to Myasthenia Gravis Foundation of America). The primary endpoint was to assess differences in the rate of complete stable remission (CSR) in patients with and without anti-AChR and anti-MuSK antibodies. Results: The mean follow-up was 218.3 (SD 128.1) months in the seropositive MG group, 149.8 (SD 131.1) in the seronegative group and 169.9 (SD 116) in the anti-MuSK-positive group. In the seropositive MG group, the probability of obtaining CSR at 5 years post-thymectomy was 51.1% for the seropositive group compared with 40 for the seronegative group (p = 0.05) and 20 for the anti-MuSK-positive group (p = 0.03). Differences between the seronegative and anti-MuSK-positive groups were not observed. The estimated median follow-up to obtain a CSR was 17.8 months (95% confidence interval [CI] 15.7 – 19.8 months) in seropositive MG patients, 22.1 (95% CI 16.7 – 27.4 months) in seronegative MG patients and 20.6 (95% CI 13.3 – 27.9 months) in anti-MuSK-positive MG patients (long-rank test, p = 0.07). Conclusions: Long-term post- thymectomy clinical outcome was better in patients with conventional anti-AChR antibodies than in those with seronegative disease. In seronegative anti-MuSK-positive MG, thymectomy seems to be less effective than in anti-MuSK-negative MG but this study cannot answer the question of whether thymectomy should be undertaken in anti-MuSK-positive patients.
European Journal of Cardio-Thoracic Surgery | 2008
José M. Ponseti; Josep Gamez; Ramon Vilallonga; Carmen Ruiz; Jamal Azem; Manuel López-Cano; Manuel Armengol
OBJECTIVE We determined the effect of detecting ectopic thymic tissue in thymectomy specimens on the long-term outcome of patients with myasthenia gravis. METHODS A total of 83 consecutive patients with generalized seropositive nonthymomatous myasthenia gravis underwent transsternal extended thymectomy (T-3b according to Myasthenia Gravis Foundation of America). Ectopic thymic tissue was only accepted when Hassals corpuscles in the excised cervicomediastinal fat were documented. The primary endpoint was to assess differences in time to obtain complete stable remission (CSR) according to the presence or absence of ectopic thymus. RESULTS Thirty-five patients (42.2%) had ectopic thymic tissue. The mean follow-up was 88.4+/-36.3 months (range 20-144). By the Kaplan-Meier analysis method, the estimated median follow-up to obtain a CSR in the group without ectopic thymic tissue was 32.9 months (95% confidence interval [CI] 21.1-44.8 months) and 117.8 months (95% CI 98.0-137.6 months) for the group with ectopic thymic tissue (log-rank test, p=0.0002). The probability over time of obtaining CSR for the groups without and with ectopic thymic tissue was 65% vs 26% at 5 years. After stratification by hyperplasia or involution of the thymus as well as by post-thymectomy immunomodulating regimen (prednisone and prednisone-tacrolimus), the probability over time of obtaining CSR at 5 years was also significantly higher for patients without ectopic thymic tissue than for those with ectopic thymic tissue. CONCLUSIONS The clinical outcome of patients with nonthymomatous seropositive myasthenia gravis is significantly affected by the presence of ectopic thymic tissue in the mediastinal fat.
Minimally Invasive Surgery | 2012
Ramon Vilallonga; Umut Barbaros; Ahmed Shafik Nada; Aziz Sümer; Tugrul Demirel; José Manuel Fort; Oscar Gonzalez; Manuel Armengol
Introduction. Laparoscopic appendectomy (LA) has been performed in many approaches such as open, laparoscopic and recently Single Port Access (SPAA). In order to elucidate its potential advantages, we compared the two laparoscopic approaches. Methods. 87 patients were included in a multicentric study for suspected appendicitis in order to perform (SPAA) appendectomy or laparoscopic appendectomy (LA). All outcomes, including blood loss, operative time, complications, and length of stay and pain were recorded prospectively. Results. There were 46 patients in the SPAA group and 41 in the LAG with a mean operative time of 40,4 minutes in the SPAA group and 35,0 minutes in the LA group. Only one patient was converted to an open approach. We described only 2 complications. Pain was graded 2,8 in the SPAA group and 2,9 in the LA group, according to the AVS after 24 hours. Patients in the SPAA Group were more satisfied (7,5 versus 6,9) (P < 0.05). Same results were found for the cosmetic result (8,6 versus 7,4) (P < 0.05). Conclusion. Using the single port approach feasible and safe. The true benefit of the technique should be assessed by new randomised controlled trials.
Journal of Cellular and Molecular Medicine | 2009
Jordi Guillen-Marti; Ramon Diaz; Maria T. Quiles; Manuel López-Cano; Ramon Vilallonga; Pere Huguet; Santiago Ramon-y-Cajal; Albert Sanchez-Niubo; Jaume Reventós; Manel Armengol; M.A. Arbós
Background: Incisional hernia is a common and important complication of laparotomies. Epidemiological studies allude to an underlying biological cause, at least in a subset of population. Interest has mainly focused on abnormal collagen metabolism. However, the role played by other determinants of extracellular matrix (ECM) composition is unknown. To date, there are few laboratory studies investigating the importance of biological factors contributing to incisional hernia development. We performed a descriptive tissue‐based analysis to elucidate the possible relevance of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) in association with local cytokine induction in human incisional hernia tissues. The expression profiles of MMPs, TIMPs and pro‐inflammatory cytokine signalling were investigated in aponeurosis and skeletal muscle specimens taken intraoperatively from incisional hernia (n= 10) and control (n= 10) patients. Semiquantitative RT‐PCR, zymography and immunoblotting analyses were done. Incisional hernia samples displayed alterations in the microstructure and loss of ECM, as assessed by histological analyses. Moreover, incisional hernia tissues showed increased MMP/TIMP ratios and de‐regulated inflammatory signalling (tumor necrosis factor [TNFA] and interleukin [IL]‐6 tended to increase, whereas aponeurosis TNFA receptors decreased). The changes were tissue‐specific and were detectable at the mRNA and/or protein level. Statistical analyses showed several associations between individual MMPs, TIMPs, interstitial collagens and inflammatory markers. The increment of MMPs in the absence of a counterbalance by TIMPs, together with an ongoing de‐regulated inflammatory signalling, may contribute in inducing a functional defect of the ECM network by post‐translational mechanisms, which may trigger abdominal wall tissue loss and eventual rupture. The notable TIMP3 protein down‐regulation in incisional hernia fascia may be of pathophysiological significance. We conclude that this study may help to pinpoint novel hypotheses of pathogenesis that can lead to a better understanding of the disease and ultimately to improvement in current therapeutic approaches.