PAULO KAUFFMAN
Índice h a partir de 2011
15
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
4 resultados
Resultados de Busca
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- Technical Difficulties and Complications of Sympathectomy in the Treatment of Hyperhidrosis: An Analysis of 1731 Cases(2013) ANDRADE FILHO, Laert Oliveira de; KUZNIEC, Sergio; WOLOSKER, Nelson; YAZBEK, Guilherme; KAUFFMAN, Paulo; CAMPOS, Jose Ribas Milanez deBackground: The aim of this study was to ascertain the technical difficulties and complications of video-assisted thoracic sympathectomy (VTAS) in the treatment of hyperhidrosis in a large group of patients. Methods: Between October 1995 and February 2008, 1731 patients with palmar, axillary, or craniofacial hyperhidrosis, who were treated using bilateral VTAS, were studied. We assessed the technical difficulties, early and late complications, and the approaches that were used to resolve them. Results: Therapeutic success was achieved in 91% of the cases as evidenced by anhidrosis. The most common and severe technical difficulty during the procedure was pleural adhesions in 116 cases (6.7%); azygos lobes were seen in 7 patients (0.4%) and apical blebs in 3 patients (0.2%). The most frequent postoperative immediate complication was postoperative pain in 1685 (97.4%) patients; pneumothorax with chest drainage was seen in 60 cases (3.5%), neurologic disorders involving the upper limbs in 36 cases (2.1%), Homer's syndrome in 11 cases (0.9%), significant bleeding in 8 cases (0.4%), and 1 patient had extensive subcutaneous emphysema. The most frequent late complication was compensatory hyperhidrosis, which occurred in 1531 cases (88.4%). Although 27.2% of the patients reported severe compensatory hyperhidrosis, only 2.5% expressed regret for undergoing surgery. Gustatory sweating occurred in 334 patients (19.3%). No deaths occurred in this series. Conclusions: VTAS is safe and has shown good results. The major complication is compensatory hyperhidrosis and, when severe, the patient may express regret for undergoing surgery. Improvements in instrumentation, adequate training, and careful patient selection may help to reduce the number of drawbacks associated with VTAS.
- Videothoracoscopic Sympathectomy Results after Oxybutynin Chloride Treatment Failure(2017) LEMBRANCA, Lucas; WOLOSKER, Nelson; CAMPOS, Jose Ribas Milanez de; KAUFFMAN, Paulo; TEIVELIS, Marcelo Passos; PUECH-LEAO, PedroBackground: Videothoracoscopy sympathectomy (VATS) is the only definitive treatment for primary hyperhidrosis (HH). Since 2007, in our institution, patients with HH were initially treated with oxybutynin chloride to avoid VATS and reduce compensatory hyperhidrosis incidence with good results. The aim of this study was to analyze the surgical response of patients suffering from essential hyperhidrosis after failure of oxybutynin chloride treatment. Methods: This was an observational retrospective study that included 737 patients who were diagnosed with palmar or axillary hyperhidrosis and received VATS from January 2007 to January 2014. Patients were selected for 2 different groups: The post-oxybutynin surgery group consisted of 167 patients that were initially treated with oxybutynin chloride for 6 weeks and then received VATS after drug treatment failure. The primary surgery group consisted of a historic control group of 570 patients who were referred directly to surgical treatment. We evaluated the degree of improvement in symptoms 30 days after surgery and quality of life before and after the surgical treatment. Results: All patients showed poor or very poor quality of life before surgery. Most patients showed a response between moderate and high after surgical treatment. However, those in primary surgery group responded better (95.1% vs. 98.2%). In the quality of life after surgery, most of the patients reported improvement, and the primary surgery group had better improvement (92.2% vs. 95.1%). Conclusions: VATS showed good results in patients with palmar or axillary hyperhidrosis regarding surgical response and improvement on quality of life even when the previous oxybutynin chloride treatment failed.
- Video-Assisted Thoracoscopic Sympathectomy for Facial Hyperhidrosis: The Influence of the Main Site of Complaint(2018) FUKUDA, Juliana Maria; VARELLA, Andrea Yasbek Monteiro; TEIVELIS, Marcelo Passos; CAMPOS, Jose Ribas Milanez de; KAUFFMAN, Paulo; PINHEIRO, Lucas Lembranca; WOLOSKER, NelsonIntroduction: Facial hyperhidrosis (FH) may lead patients to a significantly impaired quality of life (QOL). Video-assisted thoracoscopic sympathectomy (VATS) is reserved for more severe cases refractory to common first-line agents. The aim of this study was to evaluate the efficacy of VATS for FH and to compare the results between patients with facial hyperhidrosis as main complaint (FHMC) and patients with facial hyperhidrosis as nonmain complaint (FHNMC). Methods: This was a retrospective study based on medical chart analysis from March 2000 to January 2014: 40 patients with FHMC and 136 patients with FHNMC. Patients underwent VATS at the T2, T3, or T4 level, according to the main site of complaint. We assessed improvement in QOL, improvement in hyperhidrosis, and presence of complications and side effects, notably compensatory hyperhidrosis (CH). Results: Patients with FHMC reported greater improvement in FH (97.1% versus 93.6%; P = 0.006) but had lower improvement in QOL (78.2% versus 92.7%; P = 0.024) compared to patients with FHNMC. For patients with FHNMC, any degree of improvement in FH was reported by 100%, almost 95%, and nearly 80% of the patients who underwent VATS at the T2, T3, and T4 level, respectively (P = 0.039). Pain and CH were reported by more than 61% and 92% of the patients, respectively, with no statistical difference between both groups. Conclusions: Patients with FHMC, despite the greater improvement in FH, experienced lower improvement in QOL compared to patients with FHNMC. CH was the most frequent side effect in both groups, affecting more than 92% of the patients.
- The Use of Oxybutynin for Treating Axillary Hyperhidrosis(2011) WOLOSKER, Nelson; CAMPOS, Jose Ribas Milanez de; KAUFFMAN, Paulo; NEVES, Samantha; MUNIA, Marco Antonio; BISCEGLIJATENE, Fabio; PUECH-LEAO, PedroBackground: To evaluate the effectiveness and patient satisfaction with the use of oxybutynin for treating axillary hyperhidrosis in a large series of patients. Methods: One hundred two patients with axillary hyperhidrosis were treated with oxybutynin. During the first week, patients received 2.5 mg of oxybutynin once a day in the evening. From the 8th to the 42nd day, they received 2.5 mg twice a day, and from the 43rd day to the end of the 12th week, they received 5 mg twice a day. All of the patients underwent two evaluations: before and after (12 weeks) the oxybutynin treatment, using a clinical questionnaire; and a clinical protocol for quality of life (QOL). Results: More than 80% of the patients experienced an improvement in axillary hyperhidrosis; 36.3% of them presented a great improvement, and half of the patients showed improvements at all hyperhidrosis sites. Most of the patients showed improvements in the QOL (67.5%). The patients with very poor QOL before the treatment presented greater satisfaction levels after treatment. The side effects were minor, dry mouth being the most frequent (73.5%). Conclusions: Oxybutynin is a good alternative to sympathectomy. It presents good results and improves QOL without the side effects of sympathectomy.