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
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
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- Expression of Acetylcholine and Its Receptor in Human Sympathetic Ganglia in Primary Hyperhidrosis(2013) MOURA JUNIOR, Nabor B. de; DAS-NEVES-PEREIRA, Joao C.; OLIVEIRA, Flavio R. G. de; JATENE, Fabio B.; PARRA, Edwin R.; CAPELOZZI, Vera L.; WOLOSKER, Nelson; CAMPOS, Jose R. M. deBackground. The pathophysiologic characteristics of primary hyperhidrosis are not well understood and seem to be related to a sympathetic nervous system dysfunction. The resection of thoracic sympathetic chain ganglia is the most effective treatment for hyperhidrosis; however sympathetic ganglia function in normal individuals and in patients with hyperhidrosis is unknown. Methods. A cross-sectional study, in which 2 groups of 20 subjects were analyzed: the hyperhidrosis group (HYP), comprised of patients with hyperhidrosis who were eligible for thoracic sympathectomy, and the control group (CON) comprised of brain-dead organ donors without a history of hyperhidrosis. For each subject, the following were performed: resection of the third left sympathetic ganglion, measurement of the ganglion's diameter, and immunohistochemical evaluation by quantification of strong and weak expression areas of primary antibodies against acetylcholine and alpha-7 neuronal nicotinic receptor subunit. Results. The presence of a strong alpha-7 subunit expression area was 4.85% in patients with primary hyperhidrosis and 2.34% in controls (p < 0.001), whereas the presence of a weak expression area was 11.48% in the HYP group and 4.59% in the CON group (p < 0.001). Strong acetylcholine expression was found in 4.95% of the total area in the HYP group and in 1.19% in the CON group (p < 0.001), whereas weak expression was found in 18.55% and 6.77% of the HYP and CON groups, respectively (p < 0.001). Furthermore, diameter of the ganglia was 0.71 cm in the HYP group and 0.53 cm in the CON group (p < 0.001). Conclusions. There is a higher expression of acetylcholine and alpha-7 neuronal nicotinic receptor subunit in the sympathetic ganglia of patients with hyperhidrosis. Furthermore, the diameter of the thoracic sympathetic chain ganglia is larger in such patients. (Ann Thorac Surg 2013;95:465-71) (c) 2013 by The Society of Thoracic Surgeons
- 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, NELSONSUMMARY 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.
- 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, PedroBackground: 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.
- Morphometric Analysis of Thoracic Ganglion Neurons in Subjects with and without Primary Palmar Hyperhidrosis(2014) OLIVEIRA, Flavio Roberto Garbelini de; MOURA JR., Nabor B.; CAMPOS, Jose Ribas M. de; WOLOSKER, Nelson; PARRA, Edwin R.; CAPELOZZI, Vera L.; PEGO-FERNANDES, PauloBackground: Hyperhidrosis (HH) is a disease whose physiopathology remains poorly understood and that adversely affects quality of life. There is no morphologic study that includes an adequate control group that allows for comparison of the ganglion of HH to those of normal individuals. The purpose of study was to analyze morphologic and morphometric characteristics of the ganglion from patients with HH and normal individuals (organ donators). Methods: This was a transversal study. The sympathetic thoracic ganglia were obtained from 2 groups of patients. Group PH (palmar hyperhidrosis), 40 patients with palmar HH submitted to surgery by video-assisted thoracoscopy, and group C (control group), 14 deceased individuals (control group of organ donators) without any history of HH. The third left sympathetic thoracic ganglion was resected in all patients. Results: We observed higher number of cells in the PH group than in the control group (14.25 + 3.81 vs. 10.65 + 4.93) with P = 0.007; the mean percentage of ganglion cells stained by caspases-3 in the PH group was significantly greater than that of the C group (2.37 + 0.79 vs. 0.77 + 0.28) with P < 0.001; the mean value of area of collagen in the PH group was 0.80 IQ (0.08-1.87), and in the control group it was 2.36 IQ (0.49-5.98) with P = 0.061. Conclusions: Subjects with primary palmar HH have a higher number of ganglion cells within the ganglion and a higher number of cells in apoptosis. Also, the subjects of PH group have less collagen in the sympathetic ganglion when compared with the control group, but not statistically significant.
- Preservation of Alpha-3 Neuronal Nicotinic Acetylcholine Receptor Expression in Sympathetic Ganglia After Brain Death(2012) MOURA JUNIOR, Nabor Bezerra de; DAS-NEVES-PEREIRA, Joao Carlos; CAMPOS, Jose Ribas Milanez de; OLIVEIRA, Flavio Roberto Garbelini de; WOLOSKER, Nelson; PARRA, Edwin Roger; CAPELOZZI, Vera Luiza; JATENE, Fabio BiscegliThe goal of this study was to evaluate if the immunohistochemical expression of alpha-3 neuronal nicotinic acetylcholine receptor subunit in sympathetic ganglia remains stable after brain death, determining the possible use of sympathetic thoracic ganglia from subjects after brain death as study group. The third left sympathetic ganglion was resected from patients divided in two groups: BD-organ donors after brain death and CON-patients submitted to sympathectomy for hyperhidrosis (control group). Immunohistochemical staining for alpha-3 neuronal nicotinic acetylcholine receptor subunit was performed; strong and weak expression areas were quantified in both groups. The BD group showed strong alpha-3 neuronal nicotinic acetylcholine receptor expression in 6.55% of the total area, whereas the CON group showed strong expression in 5.91% (p = 0.78). Weak expression was found in 6.47% of brain-dead subjects and in 7.23% of control subjects (p = 0.31). Brain death did not affect the results of the immunohistochemical analysis of sympathetic ganglia, and its use as study group is feasible.
- 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.
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.- The Nuss procedure made safer: an effective and simple sternal elevation manoeuvre(2012) TEDDE, Miguel L.; CAMPOS, Jose Ribas Milanez de; WIHLM, Jean-Marie; JATENE, Fabio BiscegleThe Nuss procedure requires the creation of a substernal tunnel for bar positioning. This is a manoeuvre that can be dangerous, and cardiac perforation has occurred in a few cases. Our purpose was to describe two technical modifications that enable the prevention of these fatal complications. A series of 25 patients with pectus excavatum were treated with a modification of the Nuss procedure that included the entrance in the left haemithorax first, and the use of the retractor to lift the sternum, with the consequent lowering displacement of the heart. These modified techniques have certain advantages: (i) the narrow anterior mediastinum between the sternum and the pericardial sac is expanded by pulling up the sternum; (ii) the thoracoscopic visualization of the tip of the introducer during tunnel creation is improved; (iii) the rubbing of the introducer against the pericardium is minimized; (iv) the exit path of the introducer can be guided by the surgeon's finger and (v) haemostasis and integrity of the pericardial sac can be more easily confirmed. We observed that with these manoeuvres, the risk of pericardial sac and cardiac injury can be markedly reduced.
- Segmentectomia pulmonar anatômica robótica: aspectos técnicos e desfechos(2019) TERRA, Ricardo Mingarini; LAURICELLA, Leticia Leone; HADDAD, Rui; DE-CAMPOS, José Ribas Milanes; NABUCO-DE-ARAUJO, Pedro Henrique Xavier; LIMA, Carlos Eduardo Teixeira; SANTOS, Felipe Carvalho Braga dos; PEGO-FERNANDES, Paulo ManuelABSTRACT Objective: to report our initial experience with pulmonary robotic segmentectomy, describing the surgical technique, the preferred positioning of portals, initial results and outcomes. Methods: we collected data, from a prospective robotic surgery database, on patients undergoing robotic segmentectomy between January 2017 and December 2018. All patients had lung cancer, primary or secondary, or benign diseases, and were operated on with the Da Vinci system, by the three portals technique plus one utilitarian incision of 3cm. We dissected the hilar structures individually and performed the ligatures of the arterial and venous branches, of the segmental bronchi, as well as a parenchymal transection, with endoscopic staplers. We carried out systematic dissection of mediastinal lymph nodes for non-small cell lung cancer (NSCLC) cases. Results: forty-nine patients, of whom 33 were women, underwent robotic segmentectomy. The average age was of 68 years. Most patients had NSCLC (n=34), followed by metastatic disease (n=11) and benign disease (n=4). There was no conversion to laparoscopic or open surgery, or to lobectomy. The median total operative time was 160 minutes, and the median console time, 117 minutes. Postoperative complications occurred in nine patients (18.3%), of whom seven (14.2%) had prolonged hospitalization (>7 days) due to persistent air fistula (n=4; 8.1%) or abdominal complications (n=2.4%). Conclusion: robotic segmentectomy is a safe and viable procedure, offering a short period of hospitalization and low morbidity.
- 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, NelsonBackground: 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.