JOSE RIBAS MILANEZ DE CAMPOS

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Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina

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  • article 22 Citação(ões) na Scopus
    Translation and validation of Hyperhidrosis Disease Severity Scale
    (2016) VARELLA, ANDREA YASBEK MONTEIRO; FUKUDA, JULIANA MARIA; TEIVELIS, MARCELO PASSOS; CAMPOS, JOSÉ RIBAS MILANEZ DE; KAUFFMAN, PAULO; CUCATO, GABRIEL GRIZZO; PUECH-LEÃO, PEDRO; WOLOSKER, NELSON
    SUMMARY Introduction The evaluation of patients with hyperhidrosis (HH) can be accomplished, among other ways, through questionnaires and scales. The Hyperhidrosis Disease Severity Scale (HDSS) has been used as a simple and quick tool to perform this evaluation. Although HDSS has been well established in several languages, it has not been translated into Portuguese, restricting its specific use for Brazilian patients. The aim of this study was to translate HDSS into Portuguese and validate it in a sample of Brazilian subjects. Method 290 Brazilian patients (69% women, with a mean age of 28.7±9.6 years and BMI 22.4±3.9 kg/m2) diagnosed with HH were evaluated using HDSS, Quality of Life Questionnaire (QLQ) and Sweating Evolution Questionnaire (SEQ) before and after a five-week oxybutynin treatment. Regarding validation, an association between HDSS results and two other questionnaires was performed. To analyze HDSS sensitivity, evaluation of effects pre- and post-treatment with oxybutynin was conducted. Furthermore, HDSS reproducibility was analyzed in a subsample in which the scale was applied again after 7 days of the first follow-up appointment. Results There was statistical correlation between HDSS and QLQ and between HDSS and SEQ before treatment and after 5 weeks. Additionally, HDSS was reproducible and sensitive to clinical changes after the treatment period. Conclusion The Portuguese version of HDSS has been validated and shown to be reproducible in a Brazilian sample. Therefore it can be used as a tool to improve medical assistance in patients with HH.
  • article 35 Citação(ões) na Scopus
    Long-term Results of the Use of Oxybutynin for the Treatment of Axillary Hyperhidrosis
    (2014) WOLOSKER, Nelson; TEIVELIS, Marcelo Passos; KRUTMAN, Mariana; PAULA, Rafael Pessanha de; KAUFFMAN, Paulo; CAMPOS, Jose Ribas M. de; PUECH-LEAO, Pedro
    Background: Axillary hyperhidrosis (AH) is a common disease, with a significant impact on quality of life (QOL). Good short-term results are reported with oxybutynin, but longer follow-up data are lacking. We evaluated its effectiveness in a large series of patients who were not surgically treated and who had at least 6 months of follow-up. Methods: From September 2007 to September 2013, 431 consecutive patients were enrolled in ""pharmacological first"" protocol for treatment of AH with oxybutynin. Thirty-four patients were lost to follow-up, and data are available for 397 patients treated for at least 6 weeks. Data at the start of the protocol, 6 weeks after beginning treatment, and at final visit were analyzed. Results: One hundred fourteen patients (28.7%) did not improve and were referred for surgery (sympathectomy). Eight patients (2.01%) presented significant side effects (e.g. dry mouth) and discontinued therapy. Twenty-six patients. (9.4%) preferred surgery over pharmacologic treatment. Sixty-two patients have not yet been under treatment for 6 months. The 181 patients with more than 6 months of follow-up (median: 17 months, range: 6-72) were analyzed as follows: 82.9% of patients presented moderate or great improvement in AH and 89% of patients presented improvement in other sites of hyperhidrosis after a median of 17 months. Conclusions: In patients with good initial response to oxybutynin, >80% presented moderate or great improvement in axillary and in other sites of excessive sweating. Results were particularly better in women and those who presented better QOL after 6 weeks.
  • 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, Pedro
    BACKGROUND: 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.
  • article 5 Citação(ões) na Scopus
    Analysis of the Results of Videotoracoscopic Sympathectomy in the Treatment of Hyperhidrosis in Patients 40 Years or Older
    (2020) FAUSTINO, Carolina B.; CAMPOS, Jose Ribas Milanez de; KAUFFMAN, Paulo; LEIDERMAN, Dafne Diamante; TEDDE, Miguel; CUCATO, Gabriel; FERNANDES, Paulo P.; LEAO, Pedro P.; WOLOSKER, Nelson
    Background: Several factors that could influence the efficacy and satisfaction of patients after bilateral thoracic sympathectomy (video-assisted thoracoscopic sympathectomy [VATS]) in the treatment of hyperhidrosis (HH) have been studied, but no studies in the literature have specifically analyzed the effectiveness of treatment and variations in the quality of life of patients aged 40 years or older compared with those of young adult patients (19-40 years). Methods: We retrospectively analyzed 2,431 HH patients who underwent bilateral VATS and divided the patients into the following groups: a group younger than 40 years old (1,760 patients) and a group 40 years and older (142 patients). Variables included quality of life before surgery, improvement in quality of life after surgery, clinical improvement in sweating, the presence of severe compensatory hyperhidrosis (CH), and general satisfaction at 1 month after surgery. Results: We observed that all surgical patients presented with poor or very poor quality of life before surgery, with similar proportions in both groups. In the postoperative period, we observed improvement in quality of life in more than 90% of the patients, with no significant difference noted between the 2 groups of patients. More than 90% of the patients in this series had great clinical improvement in the main HH site, with no significant difference between the 2 groups. Severe CH occurred in 23.8% of the patients in this series, with no significant difference between the 2 groups. Conclusions: Patients 40 years of age or older benefit just as much as younger patients from VATS performed to treat primary HH, presenting excellent significant surgical results.
  • article 90 Citação(ões) na Scopus
    A randomized placebo-controlled trial of oxybutynin for the initial treatment of palmar and axillary hyperhidrosis
    (2012) WOLOSKER, Nelson; CAMPOS, Jose Ribas Milanez de; KAUFFMAN, Paulo; PUECH-LEAO, Pedro
    Introduction: Video-assisted thoracic sympathectomy provides excellent resolution of palmar and axillary hyperhidrosis but is associated with compensatory hyperhidrosis. Low doses of oxybutynin, an anticholinergic medication that competitively antagonizes the muscarinic acetylcholine receptor, can be used to treat palmar hyperhidrosis with fewer side effects. Objective: This study evaluated the effectiveness and patient satisfaction of oral oxybutynin at low doses (5 mg twice daily) compared with placebo for treating palmar hyperhidrosis. Methods: This was prospective, randomized, and controlled study. From December 2010 to February 2011, 50 consecutive patients with palmar hyperhidrosis were treated with oxybutynin or placebo. Data were collected from 50 patients, but 5 (10.0%) were lost to follow-up. During the first week, patients received 2.5 mg of oxybutynin once daily in the evening. From days 8 to 21, they received 2.5 mg twice daily, and from day 22 to the end of week 6, they received 5 mg twice daily. All patients underwent two evaluations, before and after (6 weeks) the oxybutynin treatment, using a clinical questionnaire and a clinical protocol for quality of life. Results: Palmar and axillary hyperhidrosis improved in >70% of the patients, and 47.8% of those presented great improvement. Plantar hyperhidrosis improved in >90% of the patients. Most patients (65.2%) showed improvements in their quality of life. The side effects were minor, with dry mouth being the most frequent (47.8%). Conclusions: Treatment of palmar and axillary hyperhidrosis with oxybutynin is a good initial alternative for treatment given that it presents good results and improves quality of life. (J Vasc Surg 2012;55:1696-700.)
  • article 17 Citação(ões) na Scopus
    Long-term results of the use of oxybutynin for the treatment of plantar hyperhidrosis
    (2015) WOLOSKER, Nelson; TEIVELIS, Marcelo P.; KRUTMAN, Mariana; PAULA, Rafael P. de; KAUFFMAN, Paulo; CAMPOS, Jose R. M. de; PUECH-LEAO, Pedro
    BackgroundPlantar hyperhidrosis is a common illness with significant impact on quality of life. Oxybutynin presents good short-term results, but longer follow-up results are lacking. We evaluated oxybutynin effectiveness in patients who were not surgically treated and who had at least sixmonths of follow-up. MethodsFrom September 2007 to September 2013, 85 consecutive patients were enrolled in our institutional protocol for the pharmacological-first treatment of primary plantar hyperhidrosis with oxybutynin. Eight patients were lost to follow-up, 15 patients have not yet been under treatment for sixmonths, and data were available for 39 patients (all female) treated for at least sixmonths. Data at the start of the protocol, sixweeks after beginning treatment, and at their final visit were analyzed. ResultsTwenty-three of the 77 patients (29.87%) did not improve after pharmacological therapy. From the 39 patients with more than sixmonths of follow-up (median 16.9months, range 9-71), 79.5% reported moderate/great improvement in excessive plantar sweating after sixweeks of treatment, and this rate increased to 84.7% in the last follow-up visit; 82.85% showed improvement in other sites presenting hyperhidrosis. Dry mouth was the most common side effect; 51.6% of patients reported it to be moderate/severe at the last visit. ConclusionIn patients with good initial response to oxybutynin, more than 82% presented moderate or great improvement in plantar and other sites' excessive sweating; dry mouth was the most common side effect but was tolerable and did not lead any patient to interrupt treatment.
  • article 11 Citação(ões) na Scopus
    Analysis of oxybutynin treatment for hyperhidrosis in patients aged over 40 years
    (2014) WOLOSKER, Nelson; KRUTMAN, Mariana; TEIVELIS, Marcelo Passos; PAULA, Rafael Pessanha de; KAUFFMAN, Paulo; CAMPOS, Jose Ribas Milanez de; PUECH-LEÃO, Pedro
    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.
  • article 50 Citação(ões) na Scopus
    Efficacy and Quality of Life Outcomes of Oxybutynin for Treating Palmar Hyperhidrosis in Children Younger than 14 Years Old
    (2014) WOLOSKER, Nelson; SCHVARTSMAN, Claudio; KRUTMAN, Mariana; CAMPBELL, Taiz Pereira Dozono Almeida; KAUFFMAN, Paulo; CAMPOS, Jose Ribas M. de; PUECH-LEAO, Pedro
    The effects of oxybutynin for treating hyperhidrosis in children are still unknown. Therefore the aim of this study was to investigate the effects of oxybutynin on improving symptoms of hyperhidrosis and quality of life (QOL) in children with palmar hyperhidrosis (PH). Forty-five children ages 7-14 years with PH were evaluated 6 weeks after protocol treatment with oxybutynin. QOL was evaluated before and after treatment using a validated clinical questionnaire. More than 85% of the children with PH treated with oxybutynin experienced moderate or greater improvement in the level of sweating and 80% experienced improvement in QOL. Children who initially presented with very poor QOL were those who benefited most from oxybutynin therapy. Side effects occurred in 25 children (55.5%) and were mainly dry mouth. Only one patient had neurologic symptoms, which was reported as drowsiness. Oxybutynin is an effective treatment option for children with PH because it improves clinical symptoms and QOL. Further studies are required to determine the long-term outcomes of treatment with oxybutynin.
  • article 20 Citação(ões) na Scopus
    Long-Term Comparison of Video-Assisted Thoracic Sympathectomy and Clinical Observation for the Treatment of Palmar Hyperhidrosis in Children Younger Than 14
    (2012) NEVES, Samantha; UCHOA, Patricia C.; WOLOSKER, Nelson; MUNIA, Marco A.; KAUFFMAN, Paulo; CAMPOS, Jose Ribas M. de; PUECH-LEAO, Pedro
    The results of video-assisted thoracic sympathectomy (VATS)in children are unknown. To investigate the improvement in quality of life (QOL) of a group of 45 children who did and did not undergo VATS for the treatment of palmar hyperhidrosis (PH) 4 years after the initial evaluation. Forty-five children with PH were initially evaluated. Children were divided into two groups: 30 in the VATS group and 15 in the control group. We studied the evolution of PH, negative effect of hyperhidrosis on the QOL before the treatment, and improvement in QOL after treatment. Twenty-five patients (83.4%) in the VATS group experienced great improvement in PH, and five (16.6%) experienced partial improvement; 12 (80.0%) children from the control group had some type of improvement, and three (20.0%) had partial improvement. Two (13.3%) children in the control group and 23 (76.7%) in the VATS group had great improvement in QOL. For children with PH and poor QOL, VATS is better than no treatment. It produces better results with regard to sweating and greater improvement in QOL.
  • article 12 Citação(ões) na Scopus
    Objective evaluation of plantar hyperhidrosis after sympathectomy
    (2013) WOLOSKER, Nelson; ISHY, Augusto; YAZBEK, Guilherme; CAMPOS, Jose Ribas Milanez de; KAUFFMAN, Paulo; PUECH-LEAO, Pedro; JATENE, Fabio Biscegli
    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.