NELSON WOLOSKER
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/02 - Laboratório de Anatomia Médico-Cirúrgica, Hospital das Clínicas, Faculdade de Medicina - Líder
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article 38 Citação(ões) na Scopus The use of oxybutynin for treating facial hyperhidrosis(2011) WOLOSKER, Nelson; CAMPOS, Jose Ribas Milanez de; KAUFFMAN, Paulo; MUNIA, Marco Antonio; NEVES, Samantha; JATENE, Fabio Biscegli; PUECH-LEAO, PedroBACKGROUND: Facial hyperhidrosis is a disease that may lead patients to serious emotional disturbances. Video-assisted thoracic sympathectomy provides excellent resolution of facial hyperhidrosis, but is associated with certain complications. The most frequent and important complication is compensatory hyperhidrosis. Especially in patients who have undergone resection of the second thoracic ganglion, the risk of severe compensatory hyperhidrosis is higher, which may cause dissatisfaction with the procedure. OBJECTIVE: The aim of this study was to evaluate the efficacy of the use of low doses of oxybutynin in treating facial hyperhidrosis as well as the level of patient satisfaction with its use. METHODS: 25 patients with facial hyperhidrosis were treated with oxybutynin. The patients underwent 2 evaluations: before and after treatment. These evaluations were used to assess the patients' clinical improvement and quality of life. RESULTS: We observed that more than 75% of the patients evolved with an improvement in facial hyperhidrosis, and 52% of them presented a great improvement. CONCLUSION: Treatment of facial hyperhidrosis with oxybutynin is a good alternative to sympathectomy, since it presents good results and improves quality of life, in addition to not exposing patients to the risk of experiencing the side effects of sympathectomy.- Impact of Endovascular Technique in Vascular Surgery Training at a Large University Hospital in Brazil(2011) PUECH-LEAO, Pedro; WOLOSKER, Nelson; ZERATI, Antonio E.; NASCIRNENTO, Luciano D.OBJECTIVES: The aim of this study was to determine the impact of endovascular surgery versus open vascular technique training in a Brazilian teaching service. DESIGN: Cross-sectional study. SETTING: Hospital das Clinicas-Faculty of Medicine University of Sao Paulo, a tertiary institutional hospital Brazil. PARTICIPANTS: We reviewed 1,040 arterial operations performed during 2 distinct time periods: January 1995 to December 1996, and January 2006 to December 2007. Based on the disease treated, the procedures were classified into the following 5 groups: abdominal aortic aneurysms (AAA), aorto-iliac obstructive disease (Al), obstructive disease of the femoropoplitealtibial segment (FP), carotid disease (C), and others (0). The operations were also divided into an endovascular surgery (ES) group and an open surgery (OS) group. We compared the number of open and endovascular procedures for each arterial disease group during both periods. RESULTS: During the 2006-2007 period, 654 patients were treated surgically, whereas over the 1995-1996 period, 386 arterial operations were performed. A. significant increase in endovascular procedures (p < 0.001) was found from the 1995-1996 period to the 2006-201)7 period (35 vs 351, respectively) in all groups, whereas open surgery showed a slight increase in the number of procedures in the AAA and 0 groups only. In the 1995-1996 period, OS was the primary surgical method for all groups, but in the 2006-2007 time frame, OS was performed more frequently than ES only in the AAA and 0 groups. Considering all vascular disease groups, OS was the technique used in 90.9% (351 of 386) of the operations during 1995-1996, whereas in 2006-2007, OS was performed in only 46.3% (303 of 654) of the procedures. CONCLUSIONS: The increase in the number of ES observed over the past decade has had little impact on OS procedures performed at our medical center, not bringing harm to open surgical training. (J Surg 68:19-23.
- Effects of walking and strength training on resting and exercise cardiovascular responses in patients with intermittent claudication(2011) CUCATO, G. Grizzo; FORJAZ, C. L. de Moraes; KANEGUSUKU, H.; CHEHUEN, M. da Rocha; COSTA, L. A. Riani; WOLOSKER, N.; KALIL FILHO, R.; MARUCCI, M. de Fatima Nunes; RITTI-DIAS, R. MendesBackground: Exercise training is recommended as the first-line therapy for intermittent claudication patients. However, the effects of exercise therapy on cardiovascular function of these patients have been poorly studied. The aim of this study is to compare the effects of walking and strength training on cardiovascular responses assessed at rest and during exercise in patients with intermittent claudication. Patients and methods: Thirty-four patients with stable symptoms of intermittent claudication were randomized into two groups: strength training (ST) consisting of eight exercises, three sets of 10 repetitions, intensity of 11 - 13 on 15-grade Borg scale, 2-min interval between sets; and walking training (WT) consisting of walking on a treadmill, 15 bouts of 2-min, intensity of 11 - 13 on 15-grade Borg scale, with a 2-min interval between bouts. Before and after 12 weeks, blood pressure, heart rate and rate pressure product were measured at rest and during a progressive treadmill test until maximal claudication pain. Results: Fifteen patients in each group completed the training program. After the training programs, resting systolic blood pressure (ST:-6 +/- 13 mmHg and WT:-3 +/- 18 mmHg, P = .04), heart rate (ST: -6 +/- 10 bpm and WT:-2 +/- 9 bpm, P = .03), and rate pressure product (ST:-1485 +/- 1442 mmHg(star)bpm and WT:-605 +/- 2145 mmHg(star)bpm, P = .01) decreased significantly and similarly in both groups. Submaximal systolic blood pressure (ST: -14 +/- 23 mmHg and WT:-6 +/- 23 mmHg, P = .02), and rate pressure product (ST:-1579 +/- 3444 mmHg(star)bpm and WT: -1264 +/- 3005 mmHg(star)bpm, P = .04) decreased significantly and similarly in both groups. There were no changes in submaximal heart rate after ST and WT. Maximal systolic blood pressure, heart rate, and rate pressure product did not change in either group, although maximal exercise time increased similarly in the ST and WT groups (+31 +/- 19%, and +31 +/- 32%, respectively, P < .01). Conclusions: Strength and walking trainings promoted similar increases in walking capacity and decreases in resting and submaximal exercise cardiovascular load.
- Endovascular treatment for iliac artery pseudoaneurysm with arteriovenous fistula after abdominal aortic aneurysm open repair(2011) FUKUSHIMA, Rodrigo Bono; WOLOSKER, Nelson; BENITTI, Daniel Augusto; PUECH-LEAO, Pedro
- 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.
- Post-resistance exercise hypotension in patients with intermittent claudication(2011) CUCATO, Gabriel Grizzo; RITTI-DIAS, Raphael Mendes; WOLOSKER, Nelson; SANTAREM, Jose Maria; JACOB FILHO, Wilson; FORJAZ, Claudia Lucia de MoraesOBJECTIVE: To verify the acute effects of resistance exercise on post-exercise blood pressure in patients with intermittent claudication. METHODS: Eight patients randomly underwent two experimental sessions: a session of resistance exercise (R: 6 exercises, 3 sets of 12, 10 and 8 reps with a perceived exertion of 11 to 13 on the 15-grade Borg scale) and a control session (C: resting on exercise machines). RESULTS: Before and for 60 min following an intervention, auscultatory blood pressure was measured while subjects rested in a sitting position. After the C session, systolic, diastolic and mean blood pressures did not change from the pre-intervention values, while these values decreased significantly after the R session throughout the entire recovery period (greatest decreases = -14 +/- 5, -6 +/- 5, and -9 +/- 4 mmHg, respectively, P < 0.05). CONCLUSION: After a single bout of resistance exercise patients with intermittent claudication exhibited reduced systolic, diastolic and mean blood pressures, suggesting that acute resistance exercise may decrease cardiovascular load in these patients.
- An alternative to treat palmar hyperhidrosis: use of oxybutynin(2011) WOLOSKER, Nelson; CAMPOS, Jose R. de; KAUFFMAN, Paulo; NEVES, Samantha; YAZBEK, Guilherme; JATENE, Fabio B.; PUECH-LEAO, PedroTo evaluate the effectiveness and patient satisfaction with the use of oxybutynin at low doses for treating palmar hyperhidrosis in a large series of patients. From January 2007 to June 2009, 180 consecutive patients with palmar hyperhidrosis were treated with oxybutynin. Data were collected from 139 patients (41 patients were lost to follow-up). During the first week, patients received 2.5 mg of oxybutynin once per day; from the 8th to the 42nd day, 2.5 mg twice per day; and from the 43rd day to the end of the 12th week, 5 mg, twice per day. All of the patients underwent three evaluations before and after the oxybutynin treatment (at 6 and 12 weeks), using a clinical questionnaire and a clinical protocol for quality of life (QOL). More than 80% of the patients experienced an improvement in palmar hyperhidrosis. Most of the patients showed improvements in their QOL (74.6%). The side effects were minor, with dry mouth being the most frequent (70.5%). The use of oxybutynin is an alternative as the first step in the treatment of palmar hyperhidrosis, given that it presents good results and improves QOL.
- Objective evaluation of patients with palmar hyperhidrosis submitted to two levels of sympathectomy: T3 and T4(2011) ISHY, Augusto; CAMPOS, Jose Ribas Milanez de; WOLOSKER, Nelson; KAUFFMAN, Paulo; TEDDE, Miguel Lia; CHIAVONI, Camila Ribeiro; JATENE, Fabio BiscegliThis study compares the results obtained of video-assisted sympathectomy performed on two distinct ganglion levels (third vs. fourth thoracic ganglion) in the treatment of palmar hyperhidrosis (PH), through a blind randomized clinical trial. All participants were randomized into two groups of 20 patients (G3 and G4) and underwent the operation, and were followed for 12 months. We used an objective method for measuring sweat, checking the transepidermal water loss (TEWL), and evaluated the quality-of-life (QoL) before and after the operation. All patients (n=40) ceased suffering from PH after surgery, with statistical difference when we compared the values of TEWL palmar preoperatively with their respective values at one week, one month, six months and 12 months. The main side effect observed was compensatory hyperhidrosis (CH), which was most frequent in G3 after 12 months of follow-up. There was an improvement in QoL since the first evaluation of the postoperative period with no difference between groups. Both techniques were effective in the treatment of PH, generating objective reduction of TEWL regardless of the ganglion operated. Sympathectomy G3 had a higher incidence of CH, yet the improvement in QoL was similar in both groups.