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
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- Nationwide Cross-sectional Analysis of Endoscopic Thoracic Sympathectomy to Treat Hyperhidrosis Over 12 years in Brazil Epidemiology, Costs, and Mortality(2023) LOUZADA, Andressa Cristina Sposato; SILVA, Marcelo Fiorelli Alexandrino da; PORTUGAL, Maria Fernanda Cassino; TEIVELIS, Marcelo Passos; JERUSSALMY, Claudia Szlejf; AMARO, Edson; CAMPOS, Jose Ribas Milanez de; WOLOSKER, NelsonObjective:To analyze the number of endoscopic thoracic sympathectomies performed to treat hyperhidrosis in the Universal Public Health System of Brazil, the government reimbursements, and the in-hospital mortality rates. Background:Even though endoscopic thoracic sympathectomy has been widely performed for the definitive treatment of hyperhidrosis, no series reported mortality and there are no population-based studies evaluating its costs or its mortality rate. Methods:Data referring to endoscopic thoracic sympathectomy to treat hyperhidrosis between 2008 and 2019 were extracted from the database of the Brazilian Public Health System, which insures more than 160 million inhabitants. Results:Thirteen thousand two hundred one endoscopic thoracic sympathectomies to treat hyperhidrosis were performed from 2008 to 2019, with a rate of 68.44 procedures per 10 million inhabitants per year. There were 6 in-hospital deaths during the whole period, representing a mortality rate of 0.045%. The total expended throughout the years was U$ 6,767,825.14, with an average of U$ 512.68 per patient. Conclusions:We observed a rate of 68.44 thoracoscopic sympathectomies for hyperhidrosis' treatment per 10 million inhabitants per year. The inhospital mortality rate was very low, 0.045%, though not nil. To our knowledge, no published series is larger than ours and we are the first authors to formally report deaths after endoscopic thoracic sympathectomies to treat hyperhidrosis. Moreover, there is no other population-based study addressing costs and mortality rates of every endoscopic thoracic sympathectomy for the treatment of any site of hyperhidrosis in a given period.
- Epidemiological Analysis of 12 Years of Open Thoracoabdominal Aortic Aneurysm Repair in the Brazilian Public Health System(2022) ANACLETO, Alexandre Maiera; MORALES, Marcia Maria; TEIVELIS, Marcelo Passos; SILVA, Marcelo Fiorelli Alexandrino da; PORTUGAL, Maria Fernanda Cassino; SZLEJF, Claudia; AMARO JUNIOR, Edson; WOLOSKER, NelsonIntroduction: Although endovascular correction is a promising perspective, the gold-standard treatment for thoracoabdominal aortic aneurisms and type-B dissections with visceral involvement remains open surgery, particularly due to its well- established long-term durability. This study aims to describe and evaluate public data from patients treated for thoracoabdominal aortic aneurism in the Brazilian public health system in a 12-year interval. Methods: Data from procedures performed between 2008 and 2019 were extracted from the national public database (Departamento de Informatica do Sistema Unico de Saude, or DATASUS) using web scraping techniques. Procedures were evaluated regarding the yearly frequency of elective or urgency surgeries, in-hospital mortality, and governmental costs. All tests were done with a level of significance P<0.05. Results:A total of 812 procedures were analyzed. Of all surgeries,67.98% were elective cases. There were 328 in-hospital deaths (mortality of 40.39%). In-hospital mortality was lower in elective procedures (26.92%) than in urgency procedures (46.74%) (P=0.008). Total governmental expenditure was $3.127.051,56 - an average of $3.774,22 for elective surgery and $3.791,93 for emergency surgery (P=0.999). Conclusion: The proportion of urgency procedures is higher than that recommended by international literature. Mortality was higher for urgent admissions, although governmental costs were equal for elective and urgent procedures; specialized referral centers should be considered by health policy makers.
- Percutaneous Embolization for Management of a Recurrent Popliteal Artery Aneurysm after Failure of Conventional Treatment(2023) PORTELA, Felipe Soares Oliveira; MEGALE, Adalberto Batalha; SOUZA, Kaue Polizel; CASSINO, Maria Fernanda; GILBERTO, Guilherme Moratti; MENDES, Cynthia de Almeida; WOLOSKER, Nelson
- Varicose Vein Stripping in 66,577 patients in 11 years in public hospitals in Sao Paulo(2022) SILVA, Marcelo Fiorelli Alexandrino da; LOUZADA, Andressa Cristina Sposato; TEIVELIS, Marcelo Passos; LEIDERMAN, Dafne Braga Diamante; PORTUGAL, Maria Fernanda Cassino; STABELLINI, Nickolas; AMARO JUNIOR, Edson; WOLOSKER, NelsonOBJECTIVES: The aim of this study was to evaluate the epidemiology of varicose vein stripping in Brazil's largest city, Sao Paulo.METHODS: Open and anonymous data regarding varicose vein surgeries between 2008 and 2018 were evaluated from the TabNet platform of the Municipal Health Secretary of Sao Paulo, Brazil. RESULTS: Most patients were female and adults. A total of 66,577 varicose vein surgeries were performed in public hospitals and outpatient clinics in Sao Paulo, with a statistically significant increase for both unilateral (p=0.003) and bilateral (p<0.001) procedures. Since 2016, unilateral procedures have been performed more frequently than bilateral procedures. Most procedures were associated with same-day (54.8%) or next-day (32%) discharge. The in-hospital mortality rate was 0.0045%. The total amount reimbursed was $20,693,437.94, corresponding to a mean value of $310.82 per procedure.CONCLUSION: Surgeries to treat chronic vein disease totaled 66,577 in 11 years, demanding $20,693,437.94 from the public health system. The majority of treated patients were female, over 40 years of age, and local residents. Procedure rates have increased over the years. The in-hospital mortality rate was very low (0.0045%).
- Radiological Profile of 18,430 Vascular Anomalies: Incidence and Demographic Distribution in an Adult Population(2023) PORTUGAL, Maria Fernanda C.; TACHIBANA, Adriano; ROCHA, Marcelo A.; NAVES, Erica A.; AMARAL, Lucas T. W.; CAMILO, Luana Perrone; HALLAGE, Bianca; WOLOSKER, Nelson; TEIVELIS, Marcelo PassosBackground: Most studies on focusing on the prevalence of vascular anomalies are either aimed to determine the individual occurrence of a specific type among known bearers of abnor-malities or propose an estimation of prevalence for the general population by extrapolating from the paediatric population. In this scenario, we intended to assess the profile of vascular anom-alies in a group of patients subjected to imaging studies, throughout a long period of time, to evaluate the frequency of abnormal findings in a consecutive, nonselected population. Methods: This is a retrospective review of 996,569 computed tomography and magnetic reso-nance studies between 2009 and 2019. Findings were grouped as vascular tumours (hemangi-omas; vascular tumours), cavernomas, and vascular malformations. Positive findings were evaluated with regard to patients' demographic characteristics and anatomic distribution and the subset of vascular malformations was also evaluated with regard to size, classification in accordance to flow pattern, and Hamburg Classification. Results: Eighteen thousand four hundred thirty positive examinations were evaluated (mean age, 55.82 & PLUSMN; 15.43 years; 8,188 men). Vascular anomalies were present in 18.49 per 1,000 ex-aminations (17.41 hemangiomas; 0.69 cavernomas and 0.39 vascular malformations per 1,000 examinations). Hemangiomas and cavernomas were homogeneous in anatomic location be-tween sexes throughout the age groups. Complex malformations were heterogeneous in anatomic distribution between the sexes in each age group, with intracranial findings decreasing for female patients in older groups. Conclusions: Vascular anomalies were found in 18.49 per 1,000 examinations. Hemangiomas and cavernomas were homogenously distributed, whereas complex malformations displayed a heterogeneous anatomic distribution pattern between sexes in each age group.
- Physiological responses during walking in men and women with intermittent claudication(2023) MIYASATO, Roberto Sanches; FELIX, Alex Jesus; ANDRADE-LIMA, Aluisio; SILVA, Natan Daniel da; RITTI-DIAS, Raphael Mendes; WOLOSKER, Nelson; CORNELISSEN, Veronique; GOESSLER, Karla Fabiana; FORJAZ, Claudia Lucia de MoraesObjective: Peak oxygen consumption (VO2peak), anaerobic threshold, walking economy, and cardiovascular responses during walking are used to guide and monitor walking training in patients with peripheral artery disease and intermittent claudication. Women with peripheral artery disease and intermittent claudication present greater impairments than men, and evaluating training markers according to sex for decisions regarding walking prescription in this population is important. This study aimed to compare VO2peak, walking economy, anaerobic threshold, and cardiovascular responses during walking in men and women with peripheral artery disease and intermittent claudication. Methods: Forty patients (20 men and 20 women with similar baseline characteristics) underwent a cardiopulmonary treadmill test (3.2km/h and 2% increase in slope every 2 minutes until maximal leg pain). The VO2 and rate-pressure product were assessed. Data from men and women were compared using t-tests. Results: There were no significant differences between men and women (VO2peak: 15.0 +/- 4.8 versus 13.9 +/- 2.9mL center dot kg-1 center dot min-1, p=0.38; walking economy: 9.6 +/- 2.7 versus 8.4 +/- 1.6mL center dot kg-1 center dot min-1, p=0.09; anaerobic threshold: 10.5 +/- 3.2 versus 10.5 +/- 2.2mL center dot kg-1 center dot min-1, p=0.98; rate pressure product at 1st stage: 13,465 +/- 2,910 versus 14,445 +/- 4,379bpm center dot mmHg, p=0.41; and rate pressure product at anaerobic threshold:13,673 +/- 3,100 versus 16,390 +/- 5,870bpm center dot mmHg, p=0.08 and rate pressure product at peak exercise: 21,253 +/- 6,141 versus 21,923 +/- 7,414bpm center dot mmHg, p=0.76, respectively). Conclusion: Men and women with peripheral artery disease and similar baseline characteristics presented similar responses to walking, suggesting that decisions regarding walking prescription and monitoring can be made regardless of sex in this specific population.