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
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- Current treatment options for craniofacial hyperhidrosis(2020) WOLOSKER, Nelson; FAUSTINO, Carolina Brito; SILVA, Marcelo Fiorelli Alexandrino da; CAMPOS, José Ribas Milanez de; KAUFFMAN, PauloAbstract Hyperhidrosis (HH) is characterized by sweating exceeding the amount necessary to meet the thermal regulation and physiological needs of the body. Approximately 9.41% of individuals with HH have craniofacial hyperhidrosis (FH). The present study aims to review the most current data in the literature regarding craniofacial hyperhidrosis, including pathophysiology, diagnosis and clinical presentation, treatment options (clinical and surgical), and outcomes. VATS (videothoracoscopy sympathectomy) is considered the gold standard for definitive treatment of axillary or palmar hyperhidrosis. Recently, several studies have shown the usefulness of clinical treatment with oxybutynin hydrochloride, leading to clinical improvement of HH in more than 70% of users. Both clinical and surgical treatment of craniofacial hyperhidrosis have good results. However, surgical treatment of FH is associated with more complications. Clinical treatment with oxybutynin hydrochloride yields good results and can be the first therapeutic option. When the patient is not satisfied with this treatment and has good clinical conditions, surgical treatment can be used safely.
- Are cardiovascular function and habitual physical activity levels similar in patients with classic and atypical claudication symptoms? A cross-sectional study(2020) LONGANO, Paulo; KANEGUSUKU, Helcio; CORREIA, Marilia A.; PUECH-LEAO, Pedro; WOLOSKER, Nelson; CUCATO, Gabriel G.; RITTI-DIAS, Raphael M.Objective To analyze the impact of the different types of exertional leg pain on cardiovascular function, functional capacity, and habitual physical activity levels in patients with peripheral arterial disease. Methods In this cross-sectional study, 124 patients with symptomatic peripheral arterial disease were included. Exertional leg pain was evaluated using the San Diego Claudication Questionnaire. Subsequently, patients were categorized into two groups according to their exertional leg pain: atypical leg pain (non-calf pain and atypical calf pain, n = 31) and intermittent claudication (classic intermittent claudication symptoms, n = 93). Cardiovascular function (blood pressure, heart rate, arterial stiffness, and heart rate variability), functional capacity (6-min walk distance, handgrip strength, and short physical performance battery), and habitual physical activity levels were measured. Results Functional capacity and physical activity levels were similar between patients with atypical leg pain and symptoms of intermittent claudication. However, patients with classic intermittent claudication symptoms presented higher central systolic blood pressure (P = 0.028) and arterial stiffness (augmentation index and pulse pressure; P <= 0.001 and 0.019, respectively) compared to patients with atypical leg pain. Conclusion The type of exertional leg pain does not influence functional capacity and habitual physical activity levels in patients with peripheral arterial disease. However, patients with classic intermittent claudication symptoms present impaired cardiovascular function compared to patients with atypical leg pain.
- A prospective controlled randomized multicenter study to evaluate the severity of compensatory sweating after one-stage bilateral thoracic sympathectomy versus unilateral thoracic sympathectomy in the dominant side(2020) HAMILTON, Niura Noro; TEDDE, Miguel Lia; WOLOSKER, Nelson; AGUIAR, Wolfgang William Schmidt; FERREIRA, Hylas Paiva da Costa; OLIVEIRA, Humberto Alves de; LIMA, Alexandre Marcelo Rodrigues; WESTPHAL, Fernando Luiz; OLIVEIRA, Marina Varela Braga de; RIUTO, Fabio de Oliveira; PEREIRA, Sergio Tadeu Lima F.; REZENDE, Guilherme Cancado; VALERO, Caroline Elizabeth Brero; PEGO-FERNANDES, Paulo M.Objective: To evaluate the contribution that unilateral thoracic sympathectomy in dominant side or two-stage bilateral thoracic sympathectomy can have as strategies to reduce the incidence of compensatory sweating after sympathectomy for palmar hyperhidrosis. Methods: This is a prospective, controlled, randomized multicenter trial of 200 participants with palmar hyperhidrosis, which will be randomized into two arms: (a) one-stage bilateral thoracic sympathectomy (control arm); or (b) unilateral thoracic sympathectomy in dominant side (intervention arm). At six months the participants submitted to unilateral procedure can make the contralateral surgery if they wanted it, creating a third group called two-stage bilateral sympathectomy. Participants will be evaluated for the degree of sweating by the Hyperhidrosis Disease Severity Scale (HDSS) and of quality of life questionnaires. Results: 96 participants out of the 200 proposed have been included so far, with 48 participants randomized to each arm. From the sample 61 (63.5%) are female, with a mean age of 24 (20-32) years. There were exclusive palmar hiperhydrosis in 14 cases (14.5%), palmar and plantar hyperhidrosis in 36 (37.5%) cases, palmar and axillar hyperhidrosis in 12 (12,5%) cases and palmar-axillary-plantar hyperhidrosis in 34 (35,4%) cases. The age at the beginning of the disease was childhood (78%), with mean of time of disease 15 (11-22) years. Conclusions: If one or both hypothesis: (a) unilateral sympathectomy in dominant hand is a satisfactory treatment; b) two-stage bilateral sympathectomy causes less compensatory sweating than in one stage are confirmed there is a chance that surgical therapy for palmar hyperhidrosis can be changed for better.
- Magnetic Resonance Imaging Evaluation of Left Common Iliac Vein Compression in Patients With and Without Symptoms of Venous Disease(2020) COSTA, Larissa Maria Giacon; TACHIBANA, Adriano; MAGAO, Fernanda da Silva; WOLOSKER, Nelson; BARONI, Ronaldo HuebBackground: The goal of this study was to assess the degree of the left common iliac vein (LCIV) compression by the right common iliac artery (RCIA) on magnetic resonance imaging (MRI), and verify differences in compression measurements in end-inspiration, end-expiration, supine, and prone decubitus between patients with and without symptoms in the lower limbs. Methods and Results: A total of 82 consecutive participants provided informed consent and underwent pelvic MRI for different clinical indications other than vascular-related disorders. The participants answered a questionnaire about venous disease in the lower limbs and history of previous deep vein thrombosis. This study measured the area and diameter of the LCIV at the site of the crossing with the RCIA and in the uncompressed caudal LCIV segment. Statistical analysis was performed to compare the degree of LCIV compression by the RCIA and verify differences in compression measurements. A total of 71 participants were included; 46.6% were in group A and did not experience signs and symptoms in lower limbs and 53.6% were in group B and answered at least one question with a positive answer. It was observed that there was a statistically significant difference between groups for end-expiration. No statistically significant differences were observed for all other measurements. Conclusions: A substantial percentage of the asymptomatic and symptomatic population showed compression of the LCIV, suggesting there are no clear relationships between stenosis and non-specific symptomatology in the general population.
- Impact of obesity on walking capacity and cardiovascular parameters in patients with peripheral artery disease: A cross-sectional study(2020) KANEGUSUKU, Helcio; CUCATO, Gabriel G.; DOMICIANO, Romulo M.; LONGANO, Paulo; PUECH-LEAO, Pedro; WOLOSKER, Nelson; RITTI-DIAS, Raphael M.; CORREIA, Marilia A.Background: Patients with peripheral artery disease (PAD) present a high prevalence of obesity and metabolic syndrome, as well as diseases related to cardiovascular dysfunction. However, whether obesity influences walking capacity and cardiovascular function in patients with PAD is poorly understood. Objectives: The objective of this study was to analyze the impact of obesity on walking capacity and cardiovascular parameters in patients with PAD. Design: This is a cross-sectional study. Setting: Patients were recruited from public hospitals of Sao Paulo. Methods: One-hundred two patients with PAD and symptoms of intermittent claudication were recruited and divided into 2 groups according to their body mass index: normal weight (<25 kg/m(2)) and overweight/obese ($25 kg/m(2)). Patients were submitted to objective (6-minute walk test) and subjective measurements of walking capacity (Walking Impairment Questionnaire). In addition, cardiovascular parameters (office blood pressure, resting heart rate, arterial stiffness, vascular function, and heart rate variability) were obtained. Results: The speed domain of the Walking Impairment Questionnaire was lower in the overweight/obese group compared to the normal weight group (32 +/- 20 vs 21 +/- 16, respectively, P < .01). Resting heart rate was higher in overweight/obese patients (61 +/- 10 vs 70 +/- 12, respectively, P < .01). However, no other walking capacity or cardiovascular parameter variables were related to obesity in patients with PAD. Conclusion: Obesity influences resting heart rate and walking speed in patients with PAD.
- Long-term results of the treatment of primary hyperhidrosis with oxybutynin: follow-up of 1,658 cases(2020) WOLOSKER, Nelson; KAUFFMAN, Paulo; CAMPOS, Jose R. M. de; FAUSTINO, Carolina B.; SILVA, Marcelo F. A. da; TEIVELIS, Marcelo P.; PUECH-LEAO, PedroBackground Hyperhidrosis (HH) is characterized by exaggerated sweating in a specific region due to hyperfunction of the sweat glands. In the late 2000s, we started treating patients with an anticholinergic, oxybutynin, that was not being used until then. Objectives To present, after 12 years of utilizing this medication in our service, the substantial experience obtained with the use of oxybutynin as an initial treatment of HH in a large series of 1,658 patients. Methods We analyzed 1,658 patients treated with oxybutynin for HH from May 2006 to June 2018. The patients were divided into four groups according to the main site of HH: the plantar group, the axillary group, the facial group, and the palmar group. To measure the degree of satisfaction, a quality of life (QoL) questionnaire was used. Results Pre-treatment QoL was poor or very poor in more than 94% of the cases, and the palmar group had the worst quality of life. After treatment, we observed an improvement in the quality of life in 77% of patients. More than 70% of the patients in all groups present moderate or optimal subjective clinical improvement in sweating after treatment. The group with the best result was the facial group. Intense dry mouth was reported in 24.9% of all patients in all groups. Conclusions This study included a large number of patients followed for a long period and demonstrated the good effectiveness of treatment with oxybutynin for hyperhidrosis in the main sites of sweating.