JOSE RIBAS MILANEZ DE CAMPOS
Projetos de Pesquisa
Unidades Organizacionais
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
- The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis(2011) CERFOLIO, Robert J.; CAMPOS, Jose Ribas Milanez De; BRYANT, Ayesha S.; CONNERY, Cliff P.; MILLER, Daniel L.; DECAMP, Malcolm M.; MCKENNA, Robert J.; KRASNA, Mark J.Significant controversies surround the optimal treatment of primary hyperhidrosis of the hands, axillae, feet, and face. The world's literature on hyperhidrosis from 1991 to 2009 was obtained through PubMed. There were 1,097 published articles, of which 102 were clinical trials. Twelve were randomized clinical trials and 90 were nonrandomized comparative studies. After review and discussion by task force members of The Society of Thoracic Surgeons' General Thoracic Workforce, expert consensus was reached from which specific treatment strategies are suggested. These studies suggest that primary hyperhidrosis of the extremities, axillae or face is best treated by endoscopic thoracic sympathectomy (ETS). Interruption of the sympathetic chain can be achieved either by electrocautery or clipping. An international nomenclature should be adopted that refers to the rib levels (R) instead of the vertebral level at which the nerve is interrupted, and how the chain is interrupted, along with systematic pre and postoperative assessments of sweating pattern, intensity and quality-of-life. The recent body of literature suggests that the highest success rates occur when interruption is performed at the top of R3 or the top of R4 for palmar-only hyperhidrosis. R4 may offer a lower incidence of compensatory hyperhidrosis but moister hands. For palmar and axillary, palmar, axillary and pedal and for axillary-only hyperhidrosis interruptions at R4 and R5 are recommended. The top of R3 is best for craniofacial hyperhidrosis. (Ann Thorac Surg 2011;91:1642-8) (C) 2011 by The Society of Thoracic Surgeons
- Compensatory Hyperhidrosis: Results of Pharmacologic Treatment With Oxybutynin(2014) TEIVELIS, Marcelo Passos; WOLOSKER, Nelson; KRUTMAN, Mariana; CAMPOS, Jose Ribas Milanez de; KAUFFMAN, Paulo; PUECH-LEAO, PedroBackground. Hyperhidrosis may affect nearly 3% of the population, and thoracic/lumbar sympathectomy has been highly effective. Compensatory hyperhidrosis is a risk associated with surgical procedures, and its treatment is both complex and not well defined. Treatment of primary hyperhidrosis with oxybutynin has yielded positive results; however, its use in compensatory hyperhidrosis (CH) has not been described. Methods. Twenty-one patients (11 female patients) received oxybutynin for severe CH at a median of 5 years after sympathectomy. Patients were evaluated to determine quality of life before starting oxybutynin and 6 weeks afterward; they assigned grades to determine improvement after 6 weeks and at their last consult visit for each site at which they complained of symptoms. Results. Six and 15 patients underwent operation for axillary hyperhidrosis and palmar hyperhidrosis, respectively. Median follow-up time with oxybutynin was 377 days (49-1,831 days). Most common CH sites were the back (n = 8) and abdomen (n = 5). After 6 weeks, the quality of life improved in 71.4% of patients. Five patients stopped treatment: 2 because of unbearable dry mouth, 1 because of absence of pharmacologic response, 1 because of excessive somnolence, and 1 because of probable tachyphylaxis. At the last visit, 71.4% of patients presented with moderate to major improvement at the main sites at which sweating was noted. Conclusions. More than 70% of patients presented with improved overall quality of life and improvement at the most prominent site of compensatory sweating. Longterm treatment was ineffective in less than 25% of patients, primarily because of the side effects of dry mouth and somnolence. Oxybutynin appears to be effective in treating bothersome CH. (C) 2014 by The Society of Thoracic Surgeons
- A Simplified Method to Pass the Bar Through the Mediastinum in the Nuss Technique(2015) MESSINEO, Antonio; GHIONZOLI, Marco; PICCOLO, Roberto Lo; CAMPOS, Jose Ribas Milanez DeIn the minimally invasive repair of pectus excavatum, as reported by Nuss, the introducer is inserted into the thoracic cavity, making its way through the mediastinum, and emerges through a left intercostal space. Then, 2 umbilical tapes are tied to the introducer tip as a guide to pass into this tunnel the curved bar with the concave side up. When fat tissue is present in the anterior mediastinum or bars with notched ends are used, passage of the umbilical tape could be challenging and eventually lead to bleeding. In this report, we describe a different and simple technique to allow this passage, from left to right, in a very safe and effective way. (C) 2015 by The Society of Thoracic Surgeons
- Pectus Excavatum: Consensus and Controversies in Clinical Practice(2023) JANSSEN, Nicky; DAEMEN, Jean H. T.; POLEN, Elise J. van; COORENS, Nadine A.; JANSEN, Yanina J. L.; FRANSSEN, Aimee J. P. M.; HULSEWE, Karel W. E.; VISSERS, Yvonne L. J.; HAECKER, Frank -Martin; CAMPOS, Jose R. Milanez de; LOOS, Erik R. de; Chest Wall Int Grp Collaborator GrpBACKGROUND Pectus excavatum is the most common congenital anterior chest wall deformity. Currently, a wide variety of diagnostic protocols and criteria for corrective surgery are being used. Their use is predominantly based on local preferences and experience. To date, no guideline is available, introducing heterogeneity of care as observed in current daily practice. The aim of this study was to evaluate consensus and controversies regarding the diagnostic protocol, indications for surgical correction, and postoperative evaluation of pectus excavatum. METHODS The study consisted of 3 consecutive survey rounds evaluating agreement on different statements regarding pectus excavatum care. Consensus was achieved if at least 70% of participants provided a concurring opinion. RESULTS All 3 rounds were completed by 57 participants (18% response rate). Consensus was achieved on 18 of 62 statements (29%). Regarding the diagnostic protocol, participants agreed to routinely include conventional photog-raphy. In the presence of cardiac impairment, electrocardiography and echocardiography were indicated. Upon sus-picion of pulmonary impairment, spirometry was recommended. In addition, consensus was reached on the indications for corrective surgery, including symptomatic pectus excavatum and progression. Participants moreover agreed that a plain chest radiograph must be acquired directly after surgery, whereas conventional photography and physical ex-amination should both be part of routine postoperative follow-up. CONCLUSIONS Through a multiround survey, international consensus was formed on multiple topics to aid stan-dardization of pectus excavatum care. (Ann Thorac Surg 2023;116:191-9) & COPY; 2023 by The Society of Thoracic Surgeons.
- Have Robots a Future in Sympathetic Operations?(2014) CAMPOS, Jose Ribas M. De; HASHMONAI, Moshe; SCHICK, Christoph H.; BISCHOF, Georg; CAMERON, Alan A. P.; CONNERY, Cliff P.