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A new formulation for predicting the perforation of ballistic impacts in concrete
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Lima, Thiago Vicente

; Aguilera, Letícia dos Santos

; Peripolli, Suzana Bottega

; Campos, Jose Brant de

Ambiente Construído

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dec 2024, Volume 24 elocation e132500

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Este trabalho apresenta um modelo para determinar a profundidade da penetração de um projetil baseado sobre a formula RBL para impactos balísticos, validados com corpos de prova de microconcreto feito em cimento Portland, agregados de granitos grossos e basalto. O modelo foi validado com munição FMJ (revestido totalmente de metal) de 7,62 x 51 mm sobre corpos de prova de 5 cm de diâmetro e alturas variando entre 5 a 10 cm. Foi possível determinar que uma das formas de liberação de energia ocorreu a través da energia cinética em calor. Os resultados experimentais mostram que o modelo calculado aqui predisse valores de profundidade de penetração mais próximos aos valores experimentais usados nos modelos atuais, das quais são favoráveis para a segurança. balísticos Portland basalto revestido metal 762 7 62 7,6 1 calor atuais segurança 76 6 7,

Abstract This work presents a model for determining the depth of projectile perforation based on the RBL formula for ballistic impact, validated with microconcrete specimens made with Portland cement and coarse aggregate of granite and basalt. The model was validated with 7.62 x 51 mm FMJ (Full Metal Jacketed) ammunition on specimens with 5 cm of diameter and a height variation of 5.00 - 10.00 cm The transformation of kinetic energy into heat was found to be one of the forms of energy release. Experimental results showed that the calculation model proposed here predicts penetration depth values closer to the experimental values than current models, which is favorable for the safety. impact basalt 762 7 62 7.6 Full Jacketed 500 00 5.0 1000 10 10.0 release models safety 76 6 7. 50 0 5. 100 1 10.

https://doi.org/10.1590/s1678-86212024000100736

Lung nodule localization in hybrid room before minimally invasive thoracic surgery: series of 20 cases and literature review
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Gilberto, Guilherme Moratti

; Falsarella, Priscila Mina

; Andrade, Juliano Ribeiro de

; Schmid, Bruno Pagnin

; Mariotti, Guilherme Cayres

; Terra, Ricardo Mingarini

; Campos, Jose Ribas Milanez de

; Succi, Jose Ernesto

; Garcia, Rodrigo Gobbo

einstein (São Paulo)

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2022, Volume 20 elocation eAO6665

Abstract: En | Text: En | PDF: En

ABSTRACT Objective To describe an experience in the preoperative localization of small pulmonary nodules and ground-glass lesions to guide minimally invasive thoracic surgery; in addition, a literature review was conducted, including the main advantages and disadvantages of the different agents used, and site marking in a hybrid operating room. Methods A retrospective search was conducted in a Interventional Radiology Department database, between March 2015 and May 2019, to identify patients undergoing preoperative percutaneous marking of lung injuries measuring up to 25mm. Results A total of 20 patients were included and submitted to descriptive analysis. All patients were marked in a hybrid room, at the same surgical-anesthetic time. Most often used markers were guidewire, Lipiodol® and microcoils. Despite one case of coil displacement, two cases of pneumothorax, and one case of hypotension after marking, all lesions were identified and resected accordingly from all patients. Conclusion Preoperative percutaneous localization of lung injuries in hybrid room is an effective and a safe technique, which can have decisive impact on surgical resection. The choice of marker and of the operating room scenario should be based on availability and experience of service. Multidisciplinary discussions with surgical teams, pathologists, and interventional radiologists are crucial to improve outcome of patients.

https://doi.org/10.31744/einstein_journal/2022ao6665

A Brazilian randomized study: Robotic-Assisted vs. Video-assisted lung lobectomy Outcomes (BRAVO trial)
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Terra, Ricardo Mingarini

; Araujo, Pedro Henrique Xavier Nabuco de

; Lauricella, Leticia Leone

; Campos, Jose Ribas Milanese de

; Trindade, Juliana Rocha Mol

; Pêgo-Fernandes, Paulo Manuel

Jornal Brasileiro de Pneumologia

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2022, Volume 48 N. 4 elocation e20210464

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Comparar a morbidade em 90 dias de pacientes submetidos à lobectomia pulmonar por robotic-assisted thoracic surgery (RATS, cirurgia torácica robótica) ou por video-assisted thoracic surgery (VATS, cirurgia torácica videoassistida). Complicações intraoperatórias, tempo de drenagem, tempo de internação hospitalar, dor pós-operatória, qualidade de vida pós-operatória e reinternações em 90 dias também foram comparados. Métodos: Ensaio clínico randomizado, com dois braços, incluindo pacientes com lesões pulmonares (câncer de pulmão primário ou metástase pulmonar) candidatos à lobectomia pulmonar. Foram excluídos pacientes com comorbidades que impossibilitassem o tratamento cirúrgico. Todos os pacientes seguiram o mesmo protocolo pós-operatório. Resultados: A amostra total foi composta por 76 pacientes (39 no grupo VATS e 37 no grupo RATS). Os dois grupos foram semelhantes quanto a sexo, idade, IMC, VEF1 em % do previsto e comorbidades. Complicações pós-operatórias em 90 dias tenderam a ser mais frequentes no grupo VATS do que no grupo RATS, mas a diferença não foi significativa (p = 0,12). No entanto, quando analisadas apenas as complicações maiores, essa tendência desapareceu (p = 0,58). Quanto aos desfechos pós-operatórios, o grupo VATS apresentou um número significativamente maior de reinternações em 90 dias do que o grupo RATS (p = 0,029). Não foram encontradas diferenças significativas quanto a complicações intraoperatórias, tempo de drenagem, tempo de internação hospitalar, dor pós-operatória e qualidade de vida pós-operatória. Conclusões: A lobectomia por RATS e a lobectomia por VATS apresentaram desfechos em 90 dias semelhantes. No entanto, a lobectomia por RATS foi associada a uma redução significativa na taxa de reinternação hospitalar em 90 dias. Estudos maiores são necessários para confirmar esse achado. (Identificador ClinicalTrials.gov: NCT02292914 [http://www.clinicaltrials.gov/])

ABSTRACT Objective: To compare 90-day morbidity in patients undergoing lung lobectomy performed by either robotic-assisted thoracic surgery (RATS) or video-assisted thoracic surgery (VATS). Intraoperative complications, drainage time, length of hospital stay, postoperative pain, postoperative quality of life, and readmissions within 90 days were also compared. Methods: This was a two-arm randomized clinical trial including patients with lung lesions (primary lung cancer or lung metastasis) who were candidates for lung lobectomy. Patients with comorbidities that precluded surgical treatment were excluded. All patients followed the same postoperative protocol. Results: The overall sample comprised 76 patients (39 in the VATS group and 37 in the RATS group). The two groups were similar regarding gender, age, BMI, FEV1 in % of predicted, and comorbidities. Postoperative complications within 90 days tended to be more common in the VATS group than in the RATS group, but the difference was not significant (p = 0.12). However, when only major complications were analyzed, this tendency disappeared (p = 0.58). Regarding postoperative outcomes, the VATS group had a significantly higher number of readmissions within 90 days than did the RATS group (p = 0.029). No significant differences were found regarding intraoperative complications, drainage time, length of hospital stay, postoperative pain, and postoperative quality of life. Conclusions: RATS and VATS lobectomy had similar 90-day outcomes. However, RATS lobectomy was associated with a significant reduction in the 90-day hospital readmission rate. Larger studies are necessary to confirm such a finding. (ClinicalTrials.gov identifier: NCT02292914 [http://www.clinicaltrials.gov/])

https://doi.org/10.36416/1806-3756/e20210464

Back to the future: a case series of minimally invasive repair of pectus excavatum with regular instruments
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Tedde, Miguel Lia

; Togoro, Silvia Yukari

; Eisinger, Robert Stephen

; Okumura, Erica Mie

; Fernandes, Angelo

; Pêgo-Fernandes, Paulo Manuel

; Campos, Jose Ribas Milanez de

Jornal Brasileiro de Pneumologia

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2019, Volume 45 N. 1 elocation e20170373

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: O minimally invasive repair of pectus excavatum (MIRPE, reparo minimamente invasivo do pectus excavatum) é um tratamento cirúrgico do PE. Durante o procedimento, utiliza-se um introdutor específico a fim de criar um túnel mediastinal para a colocação toracoscópica de uma barra metálica. Já houve casos relatados de perfuração cardíaca durante essa etapa arriscada. O introdutor grande pode ser uma perigosa alavanca em mãos inábeis. Propusemo-nos a determinar a segurança e viabilidade do uso de instrumentos comuns (isto é, sem contar com dispositivos ou ferramentas especiais) para criar o túnel retroesternal durante o MIRPE. Métodos: Estudo preliminar sobre o MIRPE with regular instruments (MIRPERI, MIRPE com instrumentos comuns), envolvendo 28 pacientes com PE. Foram registrados dados demográficos básicos dos pacientes, medições torácicas e detalhes cirúrgicos, bem como complicações intra e pós-operatórias. Resultados: Os pacientes submetidos ao MIRPERI apresentavam índice de Haller entre 2,58 e 5,56. Não ocorreram complicações intraoperatórias. As complicações pós-operatórias incluíram náusea/vômito em 8 pacientes, prurido em 2 e tontura em 2, bem como atelectasia, pneumotórax com drenagem torácica, derrame pleural e dispneia em 1 paciente cada. Conclusões: Neste estudo preliminar, a taxa de complicações associadas ao MIRPERI foi comparável à relatada na literatura para o MIRPE. A abordagem de MIRPERI tem o potencial de melhorar a segurança do reparo do PE, particularmente para cirurgiões que não têm acesso a certos instrumentos especiais ou não foram treinados para utilizá-los.

ABSTRACT Objective: Minimally invasive repair of pectus excavatum (MIRPE) is a surgical treatment for PE. During the procedure, a specialized introducer is used to tunnel across the mediastinum for thoracoscopic insertion of a metal bar. There have been reported cases of cardiac perforation during this risky step. The large introducer can be a dangerous lever in unskilled hands. We set out to determine the safety and feasibility of using regular instruments (i.e., not relying on special devices or tools) to create the retrosternal tunnel during MIRPE. Methods: This was a preliminary study of MIRPE with regular instruments (MIRPERI), involving 28 patients with PE. We recorded basic patient demographics, chest measurements, and surgical details, as well as intraoperative and postoperative complications. Results: Patients undergoing MIRPERI had Haller index values ranging from 2.58 to 5.56. No intraoperative complications occurred. Postoperative complications included nausea/vomiting in 8 patients, pruritus in 2, and dizziness in 2, as well as atelectasis, pneumothorax with thoracic drainage, pleural effusion, and dyspnea in 1 patient each. Conclusions: In this preliminary study, the rate of complications associated with MIRPERI was comparable to that reported in the literature for MIRPE. The MIRPERI approach has the potential to improve the safety of PE repair, particularly for surgeons that do not have access to certain special instruments or have not been trained in their use.

https://doi.org/10.1590/1806-3713/e20170373 1803 downloads

Overactive bladder – 18 years – part I
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Truzzi, Jose Carlos

; Gomes, Cristiano Mendes

; Bezerra, Carlos A.

; Plata, Ivan Mauricio

; Campos, Jose

; Garrido, Gustavo Luis

; Almeida, Fernando G.

; Averbeck, Marcio Augusto

; Fornari, Alexandre

; Salazar, Anibal

; Dell'Oro, Arturo

; Cintra, Caio

; Sacomani, Carlos Alberto Ricetto

; Tapia, Juan Pablo

; Brambila, Eduardo

; Longo, Emilio Miguel

; Rocha, Flavio Trigo

; Coutinho, Francisco

; Favre, Gabriel

; Garcia, José Antonio

; Castaño, Juan

; Reyes, Miguel

; Leyton, Rodrigo Eugenio

; Ferreira, Ruiter Silva

; Duran, Sergio

; López, Vanda

; Reges, Ricardo

International braz j urol

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apr 2016, Volume 42 N. 2 Pages 188 - 198

Abstract: En | Text: En | PDF: En

ABSTRACT Abstract: Overactive bladder syndrome is one of the lower urinary tract dysfunctions with the highest number of scientific publications over the past two decades. This shows the growing interest in better understanding this syndrome, which gathers symptoms of urinary urgency and increased daytime and nighttime voiding frequency, with or without urinary incontinence and results in a negative impact on the quality of life of approximately one out of six individuals – including both genders and almost all age groups. The possibility of establishing the diagnosis just from clinical data made patients' access to specialized care easier. Physiotherapy resources have been incorporated into the urological daily practice. A number of more selective antimuscarinic drugs with consequent lower adverse event rates were released. Recently, a new class of oral drugs, beta-adrenergic agonists has become part of the armamentarium for Overactive Bladder. Botulinum toxin injections in the bladder and sacral neuromodulation are routine modalities of treatment for refractory cases. During the 1st Latin-American Consultation on Overactive Bladder, a comprehensive review of the literature related to the evolution of the concept, epidemiology, diagnosis, and management was conducted. This text corresponds to the first part of the review Overactive Bladder 18-years.

https://doi.org/10.1590/S1677-5538.IBJU.2015.0365 3261 downloads

Overactive bladder – 18 years – Part II
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Truzzi, Jose Carlos

; Gomes, Cristiano Mendes

; Bezerra, Carlos A.

; Plata, Ivan Mauricio

; Campos, Jose

; Garrido, Gustavo Luis

; Almeida, Fernando G.

; Averbeck, Marcio Augusto

; Fornari, Alexandre

; Salazar, Anibal

; Dell’Oro, Arturo

; Cintra, Caio

; Sacomani, Carlos Alberto Ricetto

; Tapia, Juan Pablo

; Brambila, Eduardo

; Longo, Emilio Miguel

; Rocha, Flavio Trigo

; Coutinho, Francisco

; Favre, Gabriel

; Garcia, José Antonio

; Castaño, Juan

; Reyes, Miguel

; Leyton, Rodrigo Eugenio

; Ferreira, Ruiter Silva

; Duran, Sergio

; López, Vanda

; Reges, Ricardo

International braz j urol

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apr 2016, Volume 42 N. 2 Pages 199 - 214

Abstract: En | Text: En | PDF: En

ABSTRACT Traditionally, the treatment of overactive bladder syndrome has been based on the use of oral medications with the purpose of reestablishing the detrusor stability. The recent better understanding of the urothelial physiology fostered conceptual changes, and the oral anticholinergics – pillars of the overactive bladder pharmacotherapy – started to be not only recognized for their properties of inhibiting the detrusor contractile activity, but also their action on the bladder afference, and therefore, on the reduction of the symptoms that constitute the syndrome. Beta-adrenergic agonists, which were recently added to the list of drugs for the treatment of overactive bladder, still wait for a definitive positioning – as either a second-line therapy or an adjuvant to oral anticholinergics. Conservative treatment failure, whether due to unsatisfactory results or the presence of adverse side effects, define it as refractory overactive bladder. In this context, the intravesical injection of botulinum toxin type A emerged as an effective option for the existing gap between the primary measures and more complex procedures such as bladder augmentation. Sacral neuromodulation, described three decades ago, had its indication reinforced in this overactive bladder era. Likewise, the electric stimulation of the tibial nerve is now a minimally invasive alternative to treat those with refractory overactive bladder. The results of the systematic literature review on the oral pharmacological treatment and the treatment of refractory overactive bladder gave rise to this second part of the review article Overactive Bladder – 18 years, prepared during the 1st Latin-American Consultation on Overactive Bladder.

https://doi.org/10.1590/S1677-5538.IBJU.2015.0367 2297 downloads

The use of soft silicone solid implant molded intraoperatively for pectus excavatum surgical repair
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Anger, Jaime

; Alcalde, Raphael Francisco Vesterman

; Campos, Jose Ribas Milanez de

einstein (São Paulo)

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jun 2014, Volume 12 N. 2 Pages 186 - 190

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

ObjetivoDescrever a técnica para reparação de pectus excavatumcom o uso de bloco de silicone sólido de baixa dureza, que possibilita a adequação de suas dimensões no intraoperatório para melhor resultado estético.MétodosEntre maio de 1994 e fevereiro de 2013, pacientes do gênero masculino, portadores de pectus excavatum, foram submetidos à correção cirúrgica com bloco de silicone sólido de baixa dureza, de 10 a 30 Shore A, pré-fabricado em forma de paralelepípedo, com as dimensões da altura e da base coincidentes com as da falha óssea. Durante o ato cirúrgico, esse bloco foi esculpido até adequar-se ao formato do espaço dissecado. Os pacientes foram acompanhados por um mínimo de 120 dias de pós-operatório.ResultadosTrinta e quatro pacientes foram operados. Destes, 28 foram de tratamento primário e 6 secundário a outras técnicas cirúrgicas, ósseas ou de uso de implantes. As complicações foram dois casos de hematoma e oito de seroma. Foi necessária a retirada do implante em um dos casos devido à dor. Em outro caso, foi a realizada revisão cirúrgica das dimensões da prótese. Dois pacientes foram submetidos a enxerto de gordura, para melhorar o contorno da parede torácica. Não ocorreu nenhum caso de infecção. O resultado foi considerado satisfatório em 33 pacientes.ConclusãoO procedimento mostrou-se rápido e efetivo. Os resultados dos contornos obtidos foram considerados mais efetivos quando comparados aos obtidos com a utilização de próteses pré-moldadas.

Objective To describe a new surgical technique to treat pectus excavatumutilizing low hardness solid silicone block that can be carved during the intraoperative period promoting a better aesthetic result.Methods Between May 1994 and February 2013, 34 male patients presentingpectus excavatum were submitted to surgical repair with the use of low hardness solid silicone block, 10 to 30 Shore A. A block-shaped parallelepiped was used with height and base size coinciding with those of the bone defect. The block was carved intraoperatively according to the shape of the dissected space. The patients were followed for a minimum of 120 days postoperatively. The results and the complications were recorded.Results From the 34 patients operated on, 28 were primary surgeries and 6 were secondary treatment, using other surgical techniques, bone or implant procedures. Postoperative complications included two case of hematomas and eight of seromas. It was necessary to remove the implant in one patient due to pain, and review surgery was performed in another to check prothesis dimensions. Two patients were submitted to fat grafting to improve the chest wall contour. The result was considered satisfactory in 33 patients.Conclusion The procedure proved to be fast and effective. The results of carved silicone block were more effective for allowing a more refined contour as compared to custom made implants.

https://doi.org/10.1590/S1679-45082014AO2919 9733 downloads

Analysis of oxybutynin treatment for hyperhidrosis in patients aged over 40 years
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Wolosker, Nelson

; Krutman, Mariana

; Teivelis, Marcelo Passos

; Paula, Rafael Pessanha de

; Kauffman, Paulo

; Campos, Jose Ribas Milanez de

; Puech-Leão, Pedro

einstein (São Paulo)

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mar 2014, Volume 12 N. 1 Pages 42 - 47

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Objetivo : Analisar a efetividade da oxibutinina para tratamento da hiperidrose em pacientes com mais de 40 anos. Métodos : Oitenta e sete pacientes com idade superior a 40 anos foram divididos em dois grupos: o primeiro com 48 pacientes (55,2%), com idades entre 40 e 49 anos. O segundo com 39 pacientes (44,8%), com mais de 50 anos (intervalo: 50 a 74 anos). Uma análise comparativa da Qualidade de Vida e do nível de hiperidrose entre os grupos foi realizada 6 semanas após o início do tratamento com oxibutinina. Para isso, foi utilizado um questionário validado para Qualidade de Vida. Resultados : No grupo mais jovem, 75% dos pacientes referiram melhora “parcial” ou “ótima” no nível de hiperidrose após o tratamento. Esse número foi particularmente impressionante em pacientes acima de 50 anos, sendo que 87,2% apresentaram níveis similares de melhora. Mais de 77% dos pacientes, em ambos os grupos, demonstraram melhora na Qualidade de Vida. Desfechos excelentes foram observados em pacientes mais idosos, dentre os quais 87,1% dos pacientes apresentaram melhora “pouco melhor” (41%) ou “muito melhor” (46,1%). Conclusão : Os pacientes acima de 40 anos com hiperidrose tiveram excelentes resultados com o tratamento com oxibutinina. Esses desfechos foram particularmente importantes nos pacientes com mais de 50 anos, nos quais a maioria apresentou melhora da Qualidade de Vida e da hiperidrose.

Objective : Our aim was to analyze the effectiveness of oxybutynin for hyperhidrosis treatment in patients over 40 years. Methods : Eighty-seven patients aged over 40 years were divided into two groups. One group consisted of 48 (55.2%) patients aged between 40 and 49 years, and another was composed of 39 (44.8%) patients aged over 50 years (50 to 74 years). A comparative analysis of Quality of Life and level of hyperhidrosis between the groups was carried out 6 weeks after a protocol treatment with oxybutynin. A validated clinical questionnaire was used for evaluation. Results : In the younger age group, 75% of patients referred a “partial” or “great” improvement in level of hyperhidrosis after treatment. This number was particularly impressive in patients over 50 years, in which 87.2% of the cases demonstrated similar levels of improvement. Over 77% of patients in both groups demonstrated improvement in Quality of Life. Excellent outcomes were observed in older patients, in which 87.1% of patients presented “slightly better” (41%) or “much better” (46.1%) improvement. Conclusion : Patients aged over 40 years with hyperhidrosis presented excellent results after oxybutynin treatment. These outcomes were particularly impressive in the age group over 50 years, in which most patients had significant improvement in Quality of Life and in level of hyperhidrosis.

https://doi.org/10.1590/S1679-45082014AO2841 4330 downloads

Variation of the Anthropometric Index for pectus excavatum relative to age, race, and sex
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Rebeis, Eduardo Baldassari

; Campos, Jose Ribas Milanez de

; Moreira, Luis Felipe Pinho

; Pastorino, Antonio Carlos

; Pego-Fernandes, Paulo Manuel

; Jatene, Fabio Biscegli

Clinics

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sep 2013, Volume 68 N. 9 Pages 1215 - 1219

Abstract: En | Text: En | PDF: En

OBJECTIVES: To determine possible variations in the Anthropometric Index for pectus excavatum relative to age, race, and sex in individuals free of thoracic wall deformities. METHODS: Between 2002 and 2012, 166 individuals with morphologically normal thoracic walls consented to have their chests and the perimeter of the lower third of the thorax measured according to the Anthropometric Index for pectus excavatum. The participant characteristics are presented (114 men and 52 women; 118 Caucasians and 48 people of African descent). RESULTS: Measurements of the Anthropometric Index for pectus excavatum were statistically significantly different between men and women (11-40 years old); however, no significant difference was found between Caucasians and people of African descent. For men, the index measurements were not significantly different across all of the age groups. For women, the index measurements were significantly lower for individuals aged 3 to 10 years old than for individuals aged 11 to 20 years old and 21 to 40 years old; however, no such difference was observed between women aged 11 to 20 years old and those aged 21 to 40 years old. CONCLUSION: In the sample, significant differences were observed between women aged 11 to 40 years old and the other age groups; however, there was no difference between Caucasian and people of African descent.

https://doi.org/10.6061/clinics/2013(09)07 2455 downloads

10.

Transdiaphragmatic intercostal hernia: imaging aspects in three cases
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Macedo, Ana Carolina Sandoval

; Kay, Fernando Uliana

; Terra, Ricardo Mingarini

; Campos, Jose Ribas Milanez de

; Aranha, Andre Galante Alencar

; Funari, Marcelo Buarque de Gusmao

Jornal Brasileiro de Pneumologia

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jun 2013, Volume 39 N. 4 Pages 513 - 517

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Hérnias intercostais transdiafragmáticas são eventos raros e são geralmente relacionadas a traumas abertos ou fechados, com risco de complicações. Relatamos três casos semelhantes, decorrentes de crises de tosse, destacando o aspecto das alterações anatômicas nos exames de imagem obtidos em cada situação (radiografia, ultrassonografia, TC e ressonância magnética)

Transdiaphragmatic intercostal hernia is uncommon and mostly related to blunt or penetrating trauma. We report three similar cases of cough-induced transdiaphragmatic intercostal hernia, highlighting the anatomic findings obtained with different imaging modalities (radiography, ultrasonography, CT, and magnetic resonance) in each of the cases.

https://doi.org/10.1590/S1806-37132013000400016 7962 downloads

11.

Effectiveness of oxybutynin for treatment of hyperhidrosis in overweight and obese patients
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Wolosker, Nelson

; Krutman, Mariana

; Kauffman, Paulo

; Paula, Rafael Pessanha de

; Campos, Jose Ribas M. de

; Puech-Leão, Pedro

Revista da Associação Médica Brasileira

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apr 2013, Volume 59 N. 2 Pages 143 - 147

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: A falta de alternativas terapêuticas para o tratamento de pacientes obesos com Hiperidrose hiperidrose deixa essa população sem perspectiva de melhorar suas condições clínicas e qualidade de vida. Resultados do tratamento com oxibutinina especificamenteempacientes com sobrepeso ou obesidade são desconhecidos até o presente momento. Este estudo tem como objetivo investigar os resultados relacionados à melhora clínica e qualidade de vida dessa população, após um protocolo de tratamento de 12 semanas com oxibutinina. MÉODOS: 559 pacientes com hiperidrose palmar e axilar, foram divididos em três grupos, de acordo com seu índice de massa corporal (IMC) (< 25 kg/m²; 25 < IMC < 30 kg/m², > 30 kg/m²). Dados sobre evolução na qualidade de vida e nível de hiperidrose foram avaliados com base em um questionário validado cientificamente, aplicado antes e após o tratamento com oxibutinina. RESULTADOS: 67.8% dos pacientes com sobrepeso e 63% dos obesos apresentaram melhora clínica "grande" ou "parcial" no nível da hiperidrose. Mais de 65% dos pacientes relataram melhora na qualidade de vida ("muito melhor" ou "um pouco melhor") para os três grupos, sem diferença estatística entre eles. O único efeito colateral observado foi boca seca, presente em 63.0% da amostra. CONCLUSÃO: Pacientes com sobrepeso e obesidade portadores de hiperidrose palmar ou axilar apresentaram melhora significativa na qualidade de vida após o tratamento com oxibutinina, sendo os resultados comparáveis aos de indivíduos com peso normal.

OBJECTIVE: Until the present moment, the lack of efficient therapeutic options available for hyperhidrosis treatment in obese patients has left this population without prospect of clinical or quality of life (QOL) improvements. Outcomes of oxybutynin treatment for overweight and obese patients with hyperhidrosis are unknown. This study aims to investigate the results related to clinical and QOL improvements in this specific population, submitted to a 12-week protocol treatment with oxybutynin. METHODS: 559 patients with palmar and axillary hyperhidrosis, routinely followed in this service, were divided into the groups, according to their body mass index (BMI) (< 25 kg/m²; 25 < bmi < 30 kg/m², > 30 kg/m²). Improvements in QOL and in the level of hyperhidrosis were analyzed after 12 weeks of protocol treatment with oxybutynin. These parameters were investigated using a scoring system based on a scientifically validated clinical questionnaire, applied before and after treatment. RESULTS: 67.8% of the overweight sample group and 63% of the obese patients presented "partial" or "great" improvement in the level of hyperhidrosis. Over 65% of patients demonstrated improvement in QOL ("much better" or "slightly better") for all three groups, with no statistical difference between them. The only adverse event associated with oxybutynin was dry mouth, observed in 63.0% of the patients. CONCLUSION: Overweight and obese patients with palmar or axillary hyperhidrosis present significant improvement in QOL after treatment with oxybutynin, and the results are comparable to those of normal weight individuals.

https://doi.org/10.1016/j.ramb.2012.11.002 2014 downloads Cited 7 times in SciELO

12.

Objective evaluation of plantar hyperhidrosis after sympathectomy
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Wolosker, Nelson

; Ishy, Augusto

; Yazbek, Guilherme

; Campos, Jose Ribas Milanez de

; Kauffman, Paulo

; Puech-Leão, Pedro

; Jatene, Fabio Biscegli

Clinics

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2013, Volume 68 N. 3 Pages 311 - 315

Abstract: En | Text: En | PDF: En

OBJECTIVE: The aim of the present study was to prospectively, randomly, blindly, and objectively investigate how surgery affects plantar sudoresis in patients with palmar and plantar hyperhidrosis over a one-year period using a sudorometer (VapoMeter). METHODS: From February 2007 to May 2009, 40 consecutive patients with combined palmar hyperhidrosis and plantar hyperhidrosis underwent video-assisted thoracic sympathectomy at the T3 or T4 ganglion level (15 women and 25 men, with a mean age of 25 years). RESULTS: Immediately after the operation and during the one-year follow-up, all of the patients were free from palmar hyperhidrosis episodes. Compensatory hyperhidrosis of varying degrees was observed in 35 (87.5%) patients after one year. Only two (2.5%) patients suffered from severe compensatory hyperhidrosis. There was a large initial improvement in plantar hyperhidrosis in 46.25% of the cases, followed by a progressive regression of that improvement, such that only 30% continued to show this improvement after one year. The proportion of patients whose condition worsened increased progressively (from 21.25% to 47.50%), and the proportion of stable patients decreased (32.5% to 22.50%). This was not related to resection level; however, a lower intensity of plantar hyperhidrosis prior to sympathectomy correlated with worse evolution. CONCLUSION: Patients with palmar hyperhidrosis and plantar hyperhidrosis who underwent video-assisted thoracic sympathectomy to treat their palmar hyperhidrosis exhibited good initial improvement in plantar hyperhidrosis, which then decreased to lesser degrees of improvement over a one-year period following the surgery. For this reason, video-assisted thoracic sympathectomy should not be performed when only plantar hyperhidrosis is present.

https://doi.org/10.6061/clinics/2013(03)OA05 1539 downloads

13.

Oxybutynin treatment for hyperhidrosis: a comparative analysis between genders
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Wolosker, Nelson

; Krutman, Mariana

; Campdell, Taiz Pereira Donozo Almeida

; Kauffman, Paulo

; Campos, Jose Ribas Milanez de

; Puech-Leão, Pedro

einstein (São Paulo)

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dec 2012, Volume 10 N. 4 Pages 405 - 408

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Avaliar os resultados do tratamento com baixas doses de oxibutinina em homens e mulheres com hiperidrose palmar e axilar. MÉTODOS: Análise retrospectiva de 395 mulheres e 170 homens acompanhados em nosso serviço com queixa de hiperidrose palmar e plantar, submetidos a um protocolo de 12 semanas de tratamento com oxibutinina. Melhora clínica da hiperidrose e da qualidade de vida foram estudadas por meio de um questionário específico, aplicado antes e após o tratamento. RESULTADOS: Dentre os pacientes em ambos os grupos, 70% apresentaram melhoria parcial ou grande no nível de hiperidrose após o tratamento. Os melhores resultados foram obtidos no grupo feminino, no qual 40% classificaram sua evolução como "ótima". Aproximadamente 70% dos pacientes em ambos os grupos melhoraram sua qualidade de vida após a terapia médica e 30% não apresentaram mudança da condição inicial. CONCLUSÃO: Gênero é um fator que não interfere significativamente nos resultados do tratamento com oxibutinina. Os índices de qualidade de vida e o grau de melhora clínica da hiperidrose foram semelhantes em homens e mulheres.

OBJECTIVE: To assess the results of palmar and axillary hyperhidrosis treatment in males and females using low doses of oxybutynin. METHODS: A retrospective analysis was conducted in 395 women and 170 men followed up in our service with complaint of palmar and axillary hyperhidrosis. RESULTS: A total of 70% of patients in both groups presented partial or great improvement in the level of hyperhidrosis after treatment. The best results were obtained in the female group, in which 40% classified their improvement as "great". Approximately 70% of the patients in both groups improved their quality of life after medical therapy and 30% presented no change in condition. CONCLUSION: Gender is not a factor that significantly interferes in oxybutynin treatment results. Quality of life indices and clinical improvement level were similar in men and women.

59312 downloads Cited 6 times in SciELO

14.

The search for stability: bar displacement in three series of pectus excavatum patients treated with the Nuss technique
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Tedde, Miguel Lia

; Campos, Jose Ribas Milanez de

; Das-Neves-Pereira, João-Carlos

; Abrao, Fernando Conrado

; Jatene, Fábio Biscegli

Clinics

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2011, Volume 66 N. 10 Pages 1743 - 1746

Abstract: En | Text: En | PDF: En

OBJECTIVES: To compare bar displacement and complication rates in three retrospective series of patients operated on by the same surgical team. METHOD: A retrospective medical chart analysis of the three patient series was performed. In the first series, the original, unmodified Nuss technique was performed. In the second, we used the ''third point fixation'' technique,and in the last series, the correction was performed with modifications to the stabilizer and stabilizer position. RESULTS: There were no deaths in any of the series. Minor complications occurred in six (4.9%) patients: pneumothorax with spontaneous resolution (2), suture site infection (2), and bar displacement without the reoperation need (2). Major complications were observed in eight (6.5%) patients: pleural effusion requiring drainage (1), foreign body reaction to the bar (1), pneumonia and shock septic (1), cardiac perforation (1), skin erosion/seroma (1), and displacement that necessitated a second operation to remove the bar within the 30 days of implantation (3). All major complications occurred in the first and second series. CONCLUSION: The elimination of fixation wires, the use of shorter bars and redesigned stabilizers placed in a more medial position results in a better outcome for pectus excavatum patients treated with the Nuss technique. With bar displacement and instability no longer significant postoperative risks, the Nuss technique should be considered among the available options for the surgical correction of pectus excavatum in pediatric patients.

3754 downloads Cited 2 times in SciELO

15.

Microsurgical techniques using human placenta
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Romero, Flávio Ramalho

; Fernandes, Sérgio Tadeu

; Chaddad-Neto, Feres

; Ramos, Javier Gonzalez

; Campos, Jose Maria de

; Oliveira, Evandro de

Arquivos de Neuro-Psiquiatria

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dec 2008, Volume 66 N. 4 Pages 876 - 878

Abstract: En | Text: En | PDF: En

3352 downloads Cited 1 time in SciELO

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