342 results on '"Marcelo Passos"'
Search Results
102. Surgical outcomes of vascular reconstruction in soft tissue sarcomas of the lower extremities
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Nishinari, Kenji, Krutman, Mariana, Junior, Samuel Aguiar, Pignataro, Bruno Soriano, Yazbek, Guilherme, Zottele Bomfim, Guilherme Andre, Teivelis, Marcelo Passos, and Wolosker, Nelson
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- 2015
- Full Text
- View/download PDF
103. Signs of impending rupture in abdominal aortic and iliac artery aneurysms by computed tomography: Outcomes in 41 patients
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Cynthia de Almeida Mendes, Lucas Lembrança, Marcela Juliano Silva, Adriano Tachibana, Marcelo Passos Teivelis, Nelson Wolosker, and Bruno Fabricio Feio Antunes
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medicine.medical_specialty ,Medicine (General) ,Ruptured Aneurysm ,Computed Tomography Angiography ,030204 cardiovascular system & hematology ,Single Center ,Asymptomatic ,Iliac Artery ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Aneurysm ,R5-920 ,medicine ,Crescent sign ,Humans ,Abdominal ,030212 general & internal medicine ,Iliac Aneurysm ,Computed tomography angiography ,Retrospective Studies ,Rupture ,medicine.diagnostic_test ,business.industry ,Retrospective cohort study ,General Medicine ,medicine.disease ,Aortic Aneurysm ,Original Article ,Radiology ,medicine.symptom ,business ,Tomography, X-Ray Computed ,Aortic Aneurysm, Abdominal - Abstract
OBJECTIVES: This study aimed to determine the prevalence of signs of impending rupture (SIR) in asymptomatic patients with abdominal aortic and iliac artery aneurysms, and to evaluate whether these signs were associated with rupture in asymptomatic patients. METHODS: This was a retrospective study of patients with abdominal aortic and iliac artery aneurysms identified on computed tomography (CT) over a 10-year period in a single center. The CT scans were reviewed by two reviewers, and patients with SIR were assigned to one of three groups: (1) early symptomatic (ES), (2) late symptomatic (LS), and (3) always asymptomatic (AA). The four main SIR described in the literature were investigated: 1) crescent sign, 2) focal wall discontinuity of circumferential calcifications, 3) aortic bulges or blebs, and 4) aortic draping. RESULTS: From a total of 759 aortic and iliac aneurysm reports on 2226 CT scans, we identified 41 patients with at least one SIR, and a prevalence of 4.14% in asymptomatic patients. Focal wall discontinuity of circumferential calcifications was the most common sign, and it was present in 46.3% of these patients (19/41); among these, 26 were repaired (ES: 9, LS: 2, AA: 15). Eleven asymptomatic patients underwent follow-up CT. The aneurysm increased in size in 6 of the 11 (54.5%) patients, and three ruptured (all with discontinuity of calcifications), one of which had no increase in diameter. CONCLUSIONS: The presence of focal wall discontinuity of circumferential calcifications was the most common SIR. There was a prevalence of all signs in less than 5% of asymptomatic patients. In unrepaired patients, the signs could be observed on follow-up CT scans with an increase in aneurysm size, indicating that the presence of SIR alone in the absence of other clinical factors or aneurysm characteristics is an insufficient indication for surgery.
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- 2021
104. EXPANDED LEVEL OF SYMPATHECTOMY AND INCIDENCE OR SEVERITY OF COMPENSATORY HYPERHIDROSIS
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Teivelis, Marcelo Passos, Varella, Andrea Yasbek, and Wolosker, Nelson
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- 2014
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- View/download PDF
105. Anxiety and depression scores in patients subjected to aortic and iliac aneurysm repair procedures
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Mendes, Cynthia de Almeida, primary, Wolosker, Nelson, additional, Fioranelli, Alexandre, additional, Mello, Ricardo Abreu Feijó de, additional, Portugal, Maria Fernanda Cassino, additional, Silva, Marcelo Fiorelli Alexandrino da, additional, Caffaro, Roberto Augusto, additional, Pinheiro, Lucas Lembrança, additional, and Teivelis, Marcelo Passos, additional
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- 2021
- Full Text
- View/download PDF
106. Anxiety and Depression Scores in Patients Subjected to Arterial Revascularization for Critical Limb Ischemia
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Teivelis, Marcelo Passos
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DOENÇAS CARDIOVASCULARES - Published
- 2021
107. Uso de CO2 na tomada de decisão terapêutica de endoleak: relato de caso
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Megale,Adalberto Batalha, Mendes,Cynthia de Almeida, Teivelis,Marcelo Passos, Faustino,Carolina Brito, Souza,Kauê Polizel, and Wolosker,Nelson
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endovascular procedure ,angiografia ,aneurism ,endoleak ,carbon dioxide ,angiography ,procedimento endovascular ,aneurisma ,dióxido de carbono - Abstract
Endovascular aneurysm repair is currently the most frequently treatment modality for infrarenal aortic aneurysms. Endoleaks are the most common cause of reintervention after endovascular aneurysm repair. It is often unclear which type of endoleak is the correct diagnose, making the treatment decision difficult. We report the case of a 72-year-old man with an endoleak two years after endovascular aneurysm repair. Images suggested a type III endoleak, but this was not confirmed by contrast aortography. We proceeded with the investigation using aortography with carbon dioxide and observed a type IA endoleak. This was successfully treated by implantation of a proximal cuff. A review of the literature shows that the role of carbon dioxide in endoleak management is still unclear. We present a case in which carbon dioxide was essential to both diagnosis and therapeutic decision-making in a type IA endoleak. Resumo O tratamento endovascular dos aneurismas de aorta abdominal é atualmente a modalidade de tratamento mais comum. Os endoleaks representam a causa mais frequente de reintervenção após o tratamento endovascular. O diagnóstico do tipo de endoleak frequentemente é incerto, tornando o tratamento desafiador. Apresentamos o caso de um paciente de 72 anos, com endoleak após 2 anos de tratamento endovascular de aneurisma de aorta abdominal. Os exames de imagem pré-operatórios sugeriam um endoleak tipo III; entretanto, durante aortografia com contraste iodado, não foi possível identificá-lo. Optamos por realizar aortografia com dióxido de carbono (CO2), sendo, então, identificado um endoleak tipo IA, que foi tratado com sucesso com o uso de uma extensão (cuff) proximal. O papel do CO2 no diagnóstico de endoleaks ainda não está claro. Relatamos um caso em que o uso do CO2 foi essencial para o diagnóstico e para a decisão de tratamento do endoleak tipo IA.
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- 2020
108. Epidemiological Analysis of 37,424 Carotid Artery Stenosis Intervention Procedures During 11 Years in the Public Health System in Brazil: Stenting has Been More Common Than Endarterectomy
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Maria Fernanda Cassino Portugal, Rodrigo Massaud, Edson Amaro, Claudia Szlejf Jerussalmy, Marcelo Fiorelli Alexandrino da Silva, Nelson Wolosker, and Marcelo Passos Teivelis
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medicine.medical_specialty ,Time Factors ,Public Health Systems Research ,medicine.medical_treatment ,Cost-Benefit Analysis ,Population ,Carotid endarterectomy ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Cost Savings ,Angioplasty ,Carotid artery disease ,medicine ,Humans ,Carotid Stenosis ,Hospital Mortality ,Hospital Costs ,Practice Patterns, Physicians' ,education ,Stroke ,Cause of death ,Endarterectomy ,Retrospective Studies ,education.field_of_study ,Endarterectomy, Carotid ,business.industry ,Mortality rate ,Endovascular Procedures ,General Medicine ,medicine.disease ,Treatment Outcome ,Emergency medicine ,Surgery ,Stents ,Public Health ,Cardiology and Cardiovascular Medicine ,business ,Brazil - Abstract
Background Stroke is a leading cause of death worldwide, with carotid atherosclerosis accounting for 10–20% of cases. In Brazil, the Public Health System provides care for roughly two-thirds of the population. No studies, however, have analysed large–scale results of carotid bifurcation surgery in Brazil. Methods This study aimed to describe rates of carotid artery stenting (CAS) and carotid endarterectomy (CEA) performed between 2008 and 2019 in the country through web scraping of publicly available databases. Results Between 2008 and 2019, 37,424 carotid bifurcation revascularization procedures were performed, of which 22,578 were CAS (60.34%) and 14,846 (39.66%) were CEA. There were 620 in-hospital deaths (1.66%), 336 after CAS (1.48%) and 284 after CEA (1.92%) (P = 0.032). Governmental reimbursement was US$ 77,216,298.85 (79.31% of all reimbursement) for CAS procedures and US$ 20,143,009.63 (20.69%) for CEA procedures. The average cost per procedure for CAS (US$ 3,062.98) was higher than that for CEA (US$ 1,430.33) (P = 0.008). Conclusions In Brazil, the frequency of CAS largely surpassed that of CEA. In-hospital mortality rates of CAS were significantly lower than those of CEA, although both had mortality rates within the acceptable rates as dictated by literature. The cost of CAS, however, was significantly higher. This is a pioneering analysis of carotid artery disease management in Brazil that provides, for the first time, preliminary insight into the fact that the low adoption of CEA in the country is in opposition to countries where utilization rates are higher for CEA than for CAS.
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- 2020
109. Anxiety and Depression Scores in Patients Subjected to Arterial Revascularization for Critical Limb Ischemia
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Ricardo Abreu Feijó de Mello, Marcelo Passos Teivelis, Maria Fernanda Cassino Portugal, Lucas Lembrança Pinheiro, Roberto Augusto Caffaro, Nelson Wolosker, Dafne Braga Diamante Leiderman, Cynthia de Almeida Mendes, and Alexandre Fioranelli
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Adult ,Male ,Time Factors ,medicine.medical_treatment ,Critical Illness ,030204 cardiovascular system & hematology ,Anxiety ,Risk Assessment ,Severity of Illness Index ,Amputation, Surgical ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Peripheral Arterial Disease ,0302 clinical medicine ,Psychiatric history ,Ischemia ,Risk Factors ,medicine ,Humans ,Prospective Studies ,Depression (differential diagnoses) ,Aged ,Gangrene ,Aged, 80 and over ,business.industry ,Depression ,Incidence (epidemiology) ,Incidence ,General Medicine ,Critical limb ischemia ,Perioperative ,Middle Aged ,medicine.disease ,Mental Health ,Treatment Outcome ,Amputation ,Anesthesia ,Surgery ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures ,Brazil - Abstract
This study aims to examine the changes in anxiety and depression scores in 138 patients with critical limb ischemia (rest pain or gangrene) who had no previous psychiatric history, at 30 days and 6 months after surgical revascularization.Patients were submitted to a questionnaire-based evaluation using the Beck Anxiety and Depression Inventories before surgery (no more than three days before surgery) ("Pre-Op"), 30 days after surgical revascularization ("Early PO") and at least 6 months after surgical revascularization ("Late PO"). The cut-off scores for depression were (1)10, no depression or minimal depression; (2) 10‒18, mild to moderate depression; (3) 19‒29, moderate to severe depression; and (4) 30‒63, severe depression. The cut-off scores for anxiety were (1)8, no anxiety or minimal anxiety; (2) 8‒15, mild anxiety; (3) 16‒25, moderate anxiety; and (4) 26‒63, severe anxiety.No perioperative mortality was observed 30 days after surgical revascularization. Thirty-nine (28.2%) patients underwent major (above-ankle) amputation within 30 days. Mean anxiety and depression scores, respectively, declined from 12.48 ± 9.74 (mean ± SD) and 16.92 ± 12.48 preoperatively to 4.89 ± 7.04 and 6.52 ± 9.36 postoperatively (P0.001, both). Anxiety and depression scores were not significantly affected by preoperative comorbidities (systemic arterial hypertension, diabetes mellitus, previous stroke, and smoking), affected arterial territory (aortoiliac, femoropopliteal, or infrapopliteal), or surgical technique (open surgery vs endovascular therapy). Only patients undergoing amputation within 30 days showed no improvement in depressive symptoms.Patients with critical limb ischemia have a high incidence of anxiety and depressive symptoms, which improve considerably after successful surgical revascularization. Major amputation was associated with a lack of improvement in depression scores. A formal psychiatric evaluation may be beneficial in patients who show no improvement in depressive symptoms.
- Published
- 2020
110. Arm mobilization provokes deformity of long-term indwelling ports implanted via the jugular vein
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Carlos Eduardo Tomé Binatti, Dafne Braga Diamante Leiderman, Cynthia de Almeida Mendes, Carolina Faustino Brito, Nelson Wolosker, Dânae Braga Diamante Leiderman, Kauê Polizel Souza, and Marcelo Passos Teivelis
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Adult ,Male ,medicine.medical_specialty ,Catheterization, Central Venous ,Movement ,Vascular access ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Catheters, Indwelling ,Risk Factors ,Jugular vein ,medicine ,Deformity ,Fluoroscopy ,Central Venous Catheters ,Humans ,Displacement (orthopedic surgery) ,030212 general & internal medicine ,Prospective Studies ,High body mass index ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Middle Aged ,Surgery ,Catheter ,Arm ,Equipment Failure ,Female ,medicine.symptom ,Jugular Veins ,Cardiology and Cardiovascular Medicine ,business ,Complication - Abstract
Background The incidence of totally implantable catheter fracture ranges from 0.48% to 5.00%, and these fractures represent a potentially fatal complication. The fracture mechanism of catheters implanted via the jugular vein is unclear, and whether extreme arm movements represent an additional risk factor for repetitive stress of the material remains unknown. The aim of this study was to demonstrate and classify catheter deformations caused by extreme arm mobilization and associations with changes in catheter function and displacement. Methods We analyzed the fluoroscopy images of 60 consecutive patients undergoing long-term indwelling port implantation via the jugular vein. Three images were taken: arm in maximal abduction, maximal frontal elevation, and maximal adduction. The images were compared with an image of the remainder of the arm. We analyzed three catheter regions to classify the deformity: A, connection between catheter and reservoir; B, the catheter's subcutaneous tunnel; and C, the catheter's entrance in the jugular vein. The deformations were classified in comparative manner as follows: 0 (no changes), 1 (minor changes, new slightly curvatures with an angle of >90°), and 2 (major changes, new severe curvatures with angles of ≤90°). In each position, catheter function (injection and aspiration) and displacement of the reservoir and tip were analyzed. Results Only 15% of patients did not show a deformity; 33.3% had a deformity in only one position, 47.7% in two positions, and 10% in three positions. Minor deformities were observed in 70% of patients and major deformities in 40%. Moreover, 25% of patients presented both major and minor deformities. Major deformities were observed in 25.0% of patients on maximal frontal elevation, in 23.3% on maximal adduction and in none on maximal abduction. Region B was the most affected, with 57.8% of all minor deformities and 78.1% of all major deformities. No change in function was noted in 91.7% of the catheters. Maximal arm adduction resulted in greater vertical and horizontal displacement of the catheter tip and horizontal displacement of the reservoir. Higher body mass index values were associated with major deformities. Conclusions Maximal frontal elevation and maximal adduction were associated with major catheter deformities, and the subcutaneous tunnel region was the most deformed catheter region. An association between major catheter deformity and high body mass index was noted; in contrast, no association between the severity of catheter deformity, tip or reservoir displacement, or worsened functioning was observed.
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- 2020
111. Lower Limb Revascularization for Peripheral Arterial Disease in 10,951 Procedures over 11 years in a Public Health System: A Descriptive Analysis of the Largest Brazilian City
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Dafne Braga Diamante Leiderman, Marcelo Fiorelli Alexandrino da Silva, Nickolas Stabellini, Edson Amaro, Wellington Araujo Nogueira, Nelson Wolosker, Marcelo Passos Teivelis, and Claudia Szlejf
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Male ,medicine.medical_specialty ,Financing, Government ,Time Factors ,Public Health Systems Research ,medicine.medical_treatment ,Critical Illness ,Disease ,030204 cardiovascular system & hematology ,Revascularization ,030218 nuclear medicine & medical imaging ,law.invention ,03 medical and health sciences ,Peripheral Arterial Disease ,0302 clinical medicine ,law ,Ischemia ,Urban Health Services ,Medicine ,Humans ,Hospital Mortality ,Aged ,Descriptive statistics ,business.industry ,Mortality rate ,Public health ,Endovascular Procedures ,General Medicine ,Perioperative ,Health Care Costs ,Intermittent Claudication ,Length of Stay ,Middle Aged ,Intensive care unit ,Intensive Care Units ,Treatment Outcome ,Lower Extremity ,Emergency medicine ,Surgery ,Residence ,Female ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures ,Brazil - Abstract
Background Worldwide, peripheral arterial disease (PAD) is a disease with high morbidity, affecting more than 200 million people. Our objective was to analyze the surgical treatment for PAD performed in the Unified Health System of the city of Sao Paulo during the last 11 years based on publicly available data. Methods The study was conducted with data analysis available on the TabNet platform, belonging to the DATASUS. Public data (government health system) from procedures performed in Sao Paulo between 2008 and 2018 were extracted. Sex, age, municipality of residence, operative technique, number of surgeries (total and per hospital), mortality during hospitalization, mean length of stay in the intensive care unit and amount paid by the government system were analyzed. Results A total of 10,951 procedures were analyzed (either for claudicants or critical ischemia—proportion unknown); 55.4% of the procedures were performed on males, and in 50.60%, the patient was older than 65 years. Approximately two-thirds of the patients undergoing these procedures had residential addresses in Sao Paulo. There were 363 in-hospital deaths (mortality of 3.31%). The hospital with the highest number of surgeries (n = 2,777) had lower in-hospital mortality (1.51%) than the other hospitals. A total of $20,655,272.70 was paid for all revascularizations. Conclusions Revascularization for PAD treatment has cost the government system more than $20 million over 11 years. Endovascular surgeries were performed more often than open surgeries and resulted in shorter hospital stays and lower perioperative mortality rates.
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- 2020
112. Initial experience with Duplex scan combined with contrast-enhanced ultrasound for follow-up of endovascular abdominal aortic aneurysm repair
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Carolina Brito, Faustino, Carlos, Ventura, Maria Fernanda Cassino, Portugal, André, Brunheroto, Marcelo Passos, Teivelis, and Nelson, Wolosker
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Microbubble contrast enhanced ultrasound (CEUS) is an accurate diagnostic method for follow-up after endovascular abdominal aortic aneurysm repair (EVAR) that has been well-established in international studies. However, there are no Brazilian studies that focus on this follow-up method.The objective of this study was to report initial experience with CEUS at a tertiary hospital, comparing the findings of CEUS with those of conventional Doppler ultrasound (DUS), with the aim of determining whether addition of contrast to the standard ultrasonographic control protocol resulted in different findings.From 2015 to 2017, 21 patients in follow-up after EVAR underwent DUS followed by CEUS. The findings of these examinations were analyzed in terms of identification of complications and their capacity to identify the origin of endoleaks.There was evidence of complications in 10 of the 21 cases examined: seven patients exhibited endoleaks (33.3%); two patients exhibited stenosis of a branch of the endograft (9.52%); and one patient exhibited a dissection involving the external iliac artery (4.76%). In the 21 patients assessed, combined use of both methods identified 10 cases of post-EVAR complications. In six of the seven cases of endoleaks (85.71%), use of the methods in combination was capable of identifying the origin of endoleakage. DUS alone failed to identify endoleaks in two cases (28.5%) and identified doubtful findings in another two cases (28.5%), in which diagnostic definition was achieved after employing CEUS.CEUS is a technique that is easy to perform and provides additional support for follow-up of infrarenal EVAR.
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- 2020
113. Inferior Vena Cava Filter in Cancer Patients: On Whom Should We Be Placing Them?
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Guilherme Centofanti, Rafael Cavalcante, Kenji Nishinari, Igor Yoshio Imagawa Fonseca, Guilherme Yazbek, Guilherme Andre Zottele Bomfim, Marcelo Passos Teivelis, Isabela Hohlenwerger Schettini, Mariana Krutman, and Bruno Soriano Pignataro
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Adult ,Male ,medicine.medical_specialty ,Palliative care ,Time Factors ,Vena Cava Filters ,Clinical Decision-Making ,Inferior vena cava filter ,Context (language use) ,030204 cardiovascular system & hematology ,Risk Assessment ,030218 nuclear medicine & medical imaging ,Prosthesis Implantation ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Risk Factors ,Neoplasms ,medicine ,Humans ,Device Removal ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Standard treatment ,Patient Selection ,Contraindications, Drug ,Cancer ,Anticoagulants ,General Medicine ,Perioperative ,Venous Thromboembolism ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Filter (video) ,Female ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Background Standard treatment for venous thromboembolism is anticoagulation; vena cava filter placement is an alternative in special situations. We aimed to evaluate the outcomes in patients with cancer undergoing filter placement in a cancer center during a 10-year period and assess which preoperatory variables were associated with poorer survival. Methods Retrospective unicenter analysis during a 10-year period was carried out in patients with cancer who had undergone placement of vena cava filter. Early deaths were those that occurred less than 30 days after the filter placement or that occurred during the same hospital stay of the placement. Results About 250 patients were analyzed. About 51.6% were females; 77.2% had proximal lower limb deep vein thrombosis; 34.8% had contraindications to anticoagulation; 32.8% presented bleeding after the onset of anticoagulation; and 18.4% had the filter implanted because they were going to undergo surgery and could not be anticoagulated immediately after. About 51.2% of the filters were removable. However, only 2 had the filter removed. About 59.2% had metastatic disease at the time of filter placement. About 31.2% fulfilled criteria for early death. Of those, 34 patients were put in palliative care after filter insertion (median, 13.5 days). Body mass index >18 kg/m2, the absence of metastatic disease, and filter placement during the same anesthesia of another surgery (especially if elective and curative) were associated with a higher chance of survival. Conclusions Multidisciplinary evaluation (and possibly consideration for palliation) should take place before the decision to insert a vena cava filter in severe oncologic cases depending on overall status. Patients with a greater chance of survival at a 3 or 5 years interval seem to be those whose filters were placed in the perioperative context of other surgeries (specially elective and curative), who were not undernourished, and whose disease was not metastatic at that time. For patients who survived, an active investigation protocol for filter removal should be implemented.
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- 2020
114. Combination of topical agents and oxybutynin as a therapeutic modality for patients with both osmidrosis and hyperhidrosis
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Juliana Maria Fukuda, Nelson Wolosker, Lucas Lembrança Pinheiro, Marcelo Passos Teivelis, José Ribas Milanez de Campos, Andrea Yasbek Monteiro Varella, Cynthia de Almeida Mendes, and Paulo Kauffman
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Male ,Antifungal Agents ,Glândulas Apócrinas ,Administration, Topical ,030207 dermatology & venereal diseases ,0302 clinical medicine ,Axillary region ,Quality of life ,Surveys and Questionnaires ,Sweat Gland Diseases ,Child ,Clinical treatment ,lcsh:R5-920 ,Hyperhidrosis ,Clindamycin ,General Medicine ,Middle Aged ,Anti-Bacterial Agents ,Treatment Outcome ,Apocrine Glands ,Child, Preschool ,030220 oncology & carcinogenesis ,SUOR ,Drug Therapy, Combination ,Female ,medicine.symptom ,Antagonistas Muscarínicos ,lcsh:Medicine (General) ,After treatment ,medicine.drug ,Adult ,medicine.medical_specialty ,Adolescent ,Hiperidrose ,Doenças das Glândulas Sudoríparas ,Sweating ,Muscarinic Antagonists ,Soaps ,Young Adult ,03 medical and health sciences ,Keratolytic Agents ,medicine ,Humans ,In patient ,Oxybutynin ,Retrospective Studies ,business.industry ,Dermatology ,Topical agents ,Odorants ,Quality of Life ,Mandelic Acids ,business - Abstract
Summary Introduction: The association of osmidrosis and hyperhidrosis often causes emotional and social problems that may impair the patients' quality of life. The purpose of our study was to analyze the therapeutic results of oxybutynin and topical agents in 89 patients with both osmidrosis and hyperhidrosis. Method: We conducted an observational study at two specialized centers of hyperhidrosis between April 2007 and August 2013. Eighty-nine (89) patients with both osmidrosis and hyperhidrosis were treated with oxybutynin and topical agents. Patients were evaluated before treatment and at 3 and 6 weeks after treatment started, by using the Quality of Life Questionnaire and the Sweating Evolution Scale. Results: Before treatment, 98% of the patients presented with poor or very poor quality of life. After six weeks of treatment, 70% stated their quality of life as being slightly better or much better (p
- Published
- 2018
115. Comparison between Saline Solution Containing Heparin versus Saline Solution in the Lock of Totally Implantable Catheters
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Bruno Leonardo de Freitas Soares, Paulo Fernandes Saad, Mariana Krutman, Rafael Cavalcante, Guilherme Centofanti, Bruno Soriano Pignataro, Suellen Cristina Dias Emidio, Monica Aparecida Tomé Pereira, Karen Ruggeri Saad, Antonio Rafael de Oliveira Brito, Guilherme Yazbek, Kenji Nishinari, Guilherme Andre Zottele Bomfim, Marcelo Passos Teivelis, and Igor Yoshio Imagawa Fonseca
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Adult ,Catheter Obstruction ,Male ,Catheterization, Central Venous ,medicine.medical_specialty ,medicine.medical_treatment ,Sodium Chloride ,03 medical and health sciences ,Catheters, Indwelling ,0302 clinical medicine ,Occlusion ,medicine ,Humans ,Outpatient clinic ,030212 general & internal medicine ,Infusions, Intravenous ,Saline ,Aged ,Retrospective Studies ,Aged, 80 and over ,Implantable Catheters ,Heparin ,business.industry ,Significant difference ,Reflux ,Anticoagulants ,Retrospective cohort study ,General Medicine ,Middle Aged ,Surgery ,030220 oncology & carcinogenesis ,Female ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background There are only 3 studies comparing the efficacy of 2 different types of lock used in totally implantable catheters regarding occlusion or reflux dysfunction. The present study contains the largest published casuistry (862 patients) and is the only one that analyzes 3 parameters: occlusion, reflux dysfunction, and flow dysfunction. Methods This was a retrospective study of patients operated at a large oncology center and followed up in the outpatient clinic between 2007 and 2015. The patients were divided into 2 groups according to the type of lock: the Hep group (heparine), whose lock was composed of saline solution 0.9% with heparin (100 IU/mL) and the SS group (saline solution), whose lock was composed of saline solution 0.9%. Results The Hep group was composed of 270 patients (31%) and the SS group of 592 patients (69%). Regarding occlusion, there were 8 cases in the Hep group (2.96%) and 8 in the SS group (1.35%; P = 0.11); in relation to reflux dysfunction, there were 8 cases in the Hep group (2.96%) and 8 in the SS group (1.35%; P = 0.11); in relation to flow dysfunction, there was 1 case in the Hep group (0.37%) and 4 cases in the SS group (0.68%; P = 1). Conclusions There was no statistically significant difference between the groups regarding occlusion, reflux dysfunction, and flow dysfunction.
- Published
- 2018
116. Video-Assisted Thoracoscopic Sympathectomy for Facial Hyperhidrosis: The Influence of the Main Site of Complaint
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Lucas Lembrança Pinheiro, Andrea Yasbek Monteiro Varella, Juliana Maria Fukuda, Nelson Wolosker, José Ribas Milanez de Campos, Marcelo Passos Teivelis, and Paulo Kauffman
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,Side effect ,Sweating ,030204 cardiovascular system & hematology ,Thoracoscopic sympathectomy ,Young Adult ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Quality of life ,Refractory ,medicine ,Humans ,Hyperhidrosis ,Sympathectomy ,Child ,Aged ,Retrospective Studies ,Thoracic Surgery, Video-Assisted ,business.industry ,Medical record ,Compensatory hyperhidrosis ,Retrospective cohort study ,General Medicine ,Middle Aged ,Surgery ,Treatment Outcome ,Face ,Anesthesia ,Quality of Life ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction Facial hyperhidrosis (FH) may lead patients to a significantly impaired quality of life (QOL). Video-assisted thoracoscopic sympathectomy (VATS) is reserved for more severe cases refractory to common first-line agents. The aim of this study was to evaluate the efficacy of VATS for FH and to compare the results between patients with facial hyperhidrosis as main complaint (FHMC) and patients with facial hyperhidrosis as nonmain complaint (FHNMC). Methods This was a retrospective study based on medical chart analysis from March 2000 to January 2014: 40 patients with FHMC and 136 patients with FHNMC. Patients underwent VATS at the T2, T3, or T4 level, according to the main site of complaint. We assessed improvement in QOL, improvement in hyperhidrosis, and presence of complications and side effects, notably compensatory hyperhidrosis (CH). Results Patients with FHMC reported greater improvement in FH (97.1% versus 93.6%; P = 0.006) but had lower improvement in QOL (78.2% versus 92.7%; P = 0.024) compared to patients with FHNMC. For patients with FHNMC, any degree of improvement in FH was reported by 100%, almost 95%, and nearly 80% of the patients who underwent VATS at the T2, T3, and T4 level, respectively ( P = 0.039). Pain and CH were reported by more than 61% and 92% of the patients, respectively, with no statistical difference between both groups. Conclusions Patients with FHMC, despite the greater improvement in FH, experienced lower improvement in QOL compared to patients with FHNMC. CH was the most frequent side effect in both groups, affecting more than 92% of the patients.
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- 2018
117. Signs of impending rupture in abdominal aortic and iliac artery aneurysms by computed tomography: Outcomes in 41 patients
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Antunes, Bruno Fabricio Feio, primary, Tachibana, Adriano, additional, Mendes, Cynthia de Almeida, additional, Lembrança, Lucas, additional, Silva, Marcela Juliano, additional, Teivelis, Marcelo Passos, additional, and Wolosker, Nelson, additional
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- 2021
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118. Endovascular correction of isolated descending thoracic aortic disease: a descriptive analysis of 1,344 procedures over 10 years in the public health system of São Paulo
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Portugal, Maria Fernanda Cassino, primary, Teivelis, Marcelo Passos, additional, Silva, Marcelo Fiorelli Alexandrino da, additional, Stabellini, Nickolas, additional, Fioranelli, Alexandre, additional, Szlejf, Claudia, additional, Amaro, Edson, additional, and Wolosker, Nelson, additional
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- 2021
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119. Experiência inicial com ultrassom Doppler com contraste por microbolhas em adição ao ultrassom Doppler convencional para seguimento de correção endovascular de aneurisma de aorta abdominal
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Faustino, Carolina Brito, primary, Ventura, Carlos, additional, Portugal, Maria Fernanda Cassino, additional, Brunheroto, André, additional, Teivelis, Marcelo Passos, additional, and Wolosker, Nelson, additional
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- 2021
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120. Epidemiological Analysis of 5,595 Procedures of Endovascular Correction of Isolated Descending Thoracic Aortic Disease Over 12 Years in the Public Health System in Brazil
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Portugal, Maria Fernanda Cassino, primary, Teivelis, Marcelo Passos, additional, Silva, Marcelo Fiorelli Alexandrino da, additional, Fioranelli, Alexandre, additional, Szlejf, Claudia, additional, Amaro-Júnior, Edson, additional, and Wolosker, Nelson, additional
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- 2021
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121. Thoracic aortic size in Brazilian smokers: measures using low-dose chest computed tomography anatomical and epidemiological assessment
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Lembrança, Lucas, primary, Teivelis, Marcelo Passos, additional, Tachibana, Adriano, additional, dos Santos, Ricardo Sales, additional, Joo, Richard Wonuh, additional, Zippo, Emanuela, additional, and Wolosker, Nelson, additional
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- 2021
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122. Use of carbon dioxide for therapeutic decision-making in endoleaks: a case report
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Megale, Adalberto Batalha, primary, Mendes, Cynthia de Almeida, additional, Teivelis, Marcelo Passos, additional, Faustino, Carolina Brito, additional, Souza, Kauê Polizel, additional, and Wolosker, Nelson, additional
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- 2020
- Full Text
- View/download PDF
123. Evaluation of patients who underwent resympathectomy for treatment of primary hyperhidrosis
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Juliana Maria Fukuda, Paulo Kauffman, Lucas Lembrança, Pedro Puech-Leão, José Ribas Milanez de Campos, Nelson Wolosker, and Marcelo Passos Teivelis
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Male ,Reoperation ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Thoracentesis ,030204 cardiovascular system & hematology ,Preoperative care ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Humans ,Hyperhidrosis ,Medicine ,Sympathectomy ,Oxybutynin ,Retrospective Studies ,Ganglia, Sympathetic ,Thoracic Surgery, Video-Assisted ,business.industry ,Retrospective cohort study ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Quality of Life ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Body mass index ,medicine.drug - Abstract
OBJECTIVES Video thoracoscopic sympathectomy is the recommended surgical treatment for primary hyperhidrosis and has a high success rate. Despite this high success rate, some patients are unresponsive and eventually need a resympathectomy. Few studies have previously analysed exclusively the results of these resympathectomies in patients with primary hyperhidrosis. None of the studies have objectively evaluated the degree of response to surgery or the improvement in quality of life after resympathectomies. METHODS This is a retrospective study, evaluating 15 patients from an initial group of 2300 patients who underwent resympathectomy after failure of the primary surgical treatment. We evaluated sympathectomy levels of resection, technical difficulties, surgical complications preoperative quality of life, response to treatment and quality-of-life improvement 30 days after each surgery. RESULTS Regarding gender, 11 (73.3%) patients were women. The average age was 23.2 with SD of 5.17 years, and the mean body mass index was 20.9 (SD 2.12). Ten patients had major complaints about their hands (66%) and 5 (33%) patients about their forearms. A high degree of response to sympathectomy occurred in 73% of patients. In 11 of these patients, the improvement in quality of life was considered high, 3 showed a mild improvement and 1 did not improve. No major complications occurred; the presence of adhesions was reported in 11 patients and pleural drainage was necessary in 4 patients. CONCLUSIONS Resympathectomy is an effective procedure, and it improves the quality of life in patients with primary hyperhidrosis who failed after the first surgery.
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- 2017
124. Oral Rivaroxaban for the Treatment of Symptomatic Venous Thromboembolism in 400 Patients With Active Cancer: A Single-Center Experience
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Marcelo Passos Teivelis, Guilherme Yazbek, Bruno Soriano Pignataro, Nelson Wolosker, Solange Moraes Sanches, Kenji Nishinari, Eduardo Ramacciotti, Mariana Krutman, Igor Yoshio Imagawa Fonseca, Guilherme Centofanti, Rafael Cavalcante, and Guilherme Andre Zotelle Bomfim
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Hemorrhage ,030204 cardiovascular system & hematology ,Single Center ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Rivaroxaban ,Recurrence ,Neoplasms ,medicine ,Humans ,030212 general & internal medicine ,Enoxaparin ,Young adult ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Incidence (epidemiology) ,Cancer ,Retrospective cohort study ,Venous Thromboembolism ,Hematology ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Pulmonary embolism ,Venous thrombosis ,Treatment Outcome ,Female ,business ,medicine.drug - Abstract
Purpose: To study the safety and efficacy of rivaroxaban—a direct oral anticoagulant—use in patients with active cancer and venous thromboembolism (VTE). Patients and Methods: Retrospective cohort study of 400 patients with active cancer and associated VTE, defined as deep venous thrombosis and/or pulmonary embolism. This single-center study was carried out from January 2012 to June 2015. The aim of this study was to determine the efficacy and safety, using the incidence of recurrent symptomatic VTE and major bleeding, respectively, throughout the treatment with rivaroxaban. Results: Of the 400 patients enrolled, 223 (55.8%) were female. A total of 362 (90.5%) patients had solid tumors and 244 (61%) had metastatic disease. A total of 302 (75.5%) received initial parenteral therapy with enoxaparin (median: 3, mean: 5.6, standard deviation [SD]: 6.4 days) followed by rivaroxaban. Ninety-eight patients (24.5%) were treated with on label rivaroxaban treatment. Recurrence rates were 3.25% with major bleeding occurring in 5.5% during the anticoagulant therapy (median: 118, mean: 163.9, SD: 159.9 days). Conclusion: Rivaroxaban can be an attractive alternative for the treatment of cancer-associated thrombosis.
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- 2016
125. Late neurological deficit after attempted PICC insertion in the arm
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Marcelo Passos Teivelis, Bruno Ff Antunes, Roberta A Miziara, Nelson Wolosker, Cynthia de Almeida Mendes, Andrea Mn Machado, and Adolfo W Liao
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Parenteral Nutrition ,medicine.medical_specialty ,Time Factors ,Brachial Artery ,030232 urology & nephrology ,030204 cardiovascular system & hematology ,Ultrasonography, Prenatal ,Young Adult ,03 medical and health sciences ,Pseudoaneurysm ,Hyperemesis gravidarum ,0302 clinical medicine ,Pregnancy ,Hyperemesis Gravidarum ,Catheterization, Peripheral ,medicine ,Humans ,Peripheral vessels ,Ultrasonography, Doppler, Color ,Brachial Plexus Neuropathies ,Neurological deficit ,business.industry ,Nerve Compression Syndromes ,Recovery of Function ,Vascular System Injuries ,medicine.disease ,Surgery ,Treatment Outcome ,Parenteral nutrition ,Nephrology ,Female ,business ,Aneurysm, False - Abstract
Introduction: Insertion of central catheters in peripheral vessels is a common procedure performed for a variety of indications, including parenteral nutrition. Hyperemesis gravidarum may require parenteral nutrition in exceptional situations. Although globally safe, insertion of peripherally inserted central catheters (PICCs) can lead to complications. Case Report: We describe a case of a pregnant woman who required parenteral nutrition and underwent an unsuccessful PICC insertion attempt resulting in arterial puncture, and who 34 days later presented with right upper limb paresthesia. A pseudoaneurysm with nerve compression was diagnosed and treated by open surgery, without maternal or fetal complications. Conclusion: We recommend active surveillance ultrasound (e.g. in the first 24–48 h) of unsuccessful PICC insertion attempts, because late complications may occur and require invasive procedures for treatment.
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- 2018
126. Epidemiological Analysis of Carotid Artery Stenosis Intervention during 10 years in the Public Health System in the Largest City in Brazil: Stenting Has Been More Common than Endarterectomy
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Nickolas Stabellini, Edson Amaro, Marcelo Fiorelli Alexandrino da Silva, Marcelo Passos Teivelis, Nelson Wolosker, Wellington Araujo Nogueira, and Dafne Braga Diamante Leiderman
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Male ,medicine.medical_specialty ,Time Factors ,Databases, Factual ,medicine.medical_treatment ,Population ,Carotid endarterectomy ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Epidemiology ,Medicine ,Humans ,Carotid Stenosis ,Hospital Mortality ,Hospital Costs ,education ,Stroke ,Reimbursement ,Endarterectomy ,Cause of death ,Retrospective Studies ,education.field_of_study ,Endarterectomy, Carotid ,business.industry ,Public health ,Endovascular Procedures ,General Medicine ,medicine.disease ,Treatment Outcome ,Emergency medicine ,Surgery ,Female ,Stents ,Public Health ,Cardiology and Cardiovascular Medicine ,business ,Brazil - Abstract
Background Stroke is the second leading cause of death worldwide with approximately 5.7 million cases/year, and carotid atherosclerosis accounts for 10 to 20% of cases. Methods In Brazil, the Unified Health System (Sistema Unico de Saude [SUS]) is a tax-funded public health care system that provides care for roughly half the population. Sao Paulo is the eighth largest city in the world with an estimated population of over 12 million people, of whom more than 5 million rely solely on SUS. This study aimed to describe rates of carotid artery stenting (CAS) and carotid endarterectomy (CEA) performed between 2008 and 2017 in the city of Sao Paulo through web scraping of publicly available databases. Results Three thousand seven hundred and four carotid revascularization procedures were performed between 2008 and 2017, of which 2,432 were CAS (65.7%). Rates of CAS ranged from 59.9% in 2016 to 86% in 2011. There were 57 in-hospital deaths (1.54%), 34 after CAS (1.4%; 34/2,432) and 23 after CEA (1.81%; 23/1,272) (P = 0.562). SUS reimbursements were US $7,862,017.09 (81.44% of all reimbursements) for 2,432 CAS procedures and US $1,792,324.06 (18.56%) for 1,272 CEA procedures. Average SUS reimbursement for CAS (US $3,232.73) was more than double than that for CEA (US $1,409.05). Conclusions In a city whose population exceeds that of some European countries, costs of CAS and CEA to the public health care system totaled more than US$ 9 million over 10 years. Epidemiologically, CAS was performed more commonly than CEA with no difference in in-hospital mortality between CAS and CEA, but reimbursements were 2.29 times higher for CAS. The low adoption of CEA in Sao Paulo is in contrast to countries where utilization rates are higher for CEA than for CAS.
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- 2019
127. Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm Results in Higher Hospital Expenses than Open Surgical Repair: Evidence from a Tertiary Hospital in Brazil
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Nelson Wolosker, Marcelo Bellini Dalio, Daniel Tavares Malheiro, Marcio Hampe, and Marcelo Passos Teivelis
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Adult ,medicine.medical_specialty ,Time Factors ,Cost-Benefit Analysis ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Patient Readmission ,Endovascular aneurysm repair ,Tertiary Care Centers ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Aortic aneurysm ,Postoperative Complications ,0302 clinical medicine ,Cost Savings ,medicine ,Humans ,030212 general & internal medicine ,Hospital Costs ,Aged ,Retrospective Studies ,Aged, 80 and over ,Surgical repair ,business.industry ,Endovascular Procedures ,Retrospective cohort study ,General Medicine ,Length of Stay ,Middle Aged ,medicine.disease ,Abdominal aortic aneurysm ,Blood Vessel Prosthesis ,Surgery ,Perioperative death ,Treatment Outcome ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Lower mortality ,Brazil ,Aortic Aneurysm, Abdominal ,Abdominal surgery - Abstract
Endovascular aneurysm repair (EVAR) has become the preferred approach for the treatment of infrarenal abdominal aortic aneurysm (IRAAA) in detriment of open surgical repair (OSR). EVAR results in lower mortality rates within 30 days, but rates tend to be the same after longer periods. Moreover, reduced use of hospital resources with EVAR does not necessarily offset the costs of the endoprosthesis. We aimed, in this study, to estimate hospital expenses after OSR or EVAR, including early and late readmissions.Retrospective analysis of hospital expenses (2005-2012) with elective IRAAA surgeries performed in a tertiary hospital, including 127 patients divided into 2 groups, EVAR (n = 102) and OSR (n = 25).One perioperative death occurred in each group. EVAR interventions lasted 145 vs. 210 min of OSR (P 0.001). Among OSR patients, 68% required packed red blood cells. Among EVAR patients, this proportion was 7.8% (P 0.001). Median hospitalization time differed significantly for EVAR (4 days) and OSR (8 days; P 0.001, intervals EVAR: 1-17 days, OSR: 2-442 days). The median and mean expenses with EVAR were US $53,080.95 and US $56,289.49, respectively. The median and mean expenses with OSR were US $37,116.04 and US $68,788.54, respectively. Early readmissions reached 11.2%. None of the OSR patients required late reinterventions, but 10 (9.9%) EVAR patients did, one of whom died.EVAR resulted in higher expenses with the exclusion of one outlier. Late reinterventions, with elevated costs, were only required by EVAR patients. Thus, when patients are eligible to undergo either intervention, OSR seems to have lower costs and better long-term results.
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- 2016
128. Twenty years of experience in vascular reconstructions associated with resection of malignant neoplasms in a single cancer center
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Guilherme Centofanti, Guilherme Yazbek, Igor Yoshio Imagawa Fonseca, Kenji Nishinari, Bruno Soriano Pignataro, Rafael Cavalcante, Guilherme Andre Zottele Bomfim, Marcelo Passos Teivelis, and Mariana Krutman
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Thorax ,Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,030204 cardiovascular system & hematology ,Resection ,Arterial patency ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Neoplasms ,medicine ,Humans ,Neoplasm Invasiveness ,030212 general & internal medicine ,Contraindication ,Vascular Patency ,Aged ,Retrospective Studies ,business.industry ,Cancer ,Retrospective cohort study ,Perioperative ,Middle Aged ,Plastic Surgery Procedures ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Abdomen ,Blood Vessels ,Female ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures ,Brazil - Abstract
Objective Vascular invasion is no longer considered to be an absolute contraindication to tumor removal, and complex reconstructions are part of the daily activity of vascular surgeons in specialized cancer centers. Our aim was to report a single-center experience of complex vascular reconstructions involving en bloc resection of tumors and patients' long-term survival and graft patency outcomes. To the best of our knowledge, this is the largest report of vascular reconstructions published to date, with the longest follow-up. Methods Between September 1997 and January 2016, there were 91 patients who underwent 92 arterial and 47 venous reconstruction procedures in this retrospective cohort study. Long-term survival and patency outcomes were analyzed for all study patients and individually assessed in different body segments (head and neck, thorax, upper limbs, abdomen, and lower limbs). Results The estimated mean and median follow-up times were 112.66 and 100 months, respectively. The 24- and 60-month survival estimates for the patients overall were 55.3% and 31.1%, respectively. Survival estimates were significantly lower in the head and neck cases compared with the other body segments. The primary arterial patency rates at 24 and 60 months were 96.7% and 84.9%, respectively, and they were similar in all body segments. The venous patency rates were 71.4% and 64.2% at 24 and 60 months, respectively. Seven cases (7.6%) of arterial vascular complications were observed. Conclusions Vascular reconstruction performed in conjunction with oncologic resection is a feasible treatment option for tumors with vessel involvement. When surgery is performed in specialized centers, low perioperative morbidity and long-term patency rates are expected irrespective of the vascular territory undergoing intervention.
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- 2018
129. The relation between age and outcomes of thoracic sympathectomy for hyperhidrosis: The older the better
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José Ribas Milanez de Campos, Miguel Lia Tedde, Paulo Kauffman, Marcelo Passos Teivelis, Nelson Wolosker, Guilherme Yazbek, and Dafne Braga Diamante Leiderman
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Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,medicine.medical_treatment ,Sweating ,QUALIDADE DE VIDA ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Patient satisfaction ,Quality of life ,Thoracoscopy ,medicine ,Humans ,Hyperhidrosis ,030212 general & internal medicine ,Sympathectomy ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Thoracic Surgery, Video-Assisted ,Compensatory hyperhidrosis ,Age Factors ,Odds ratio ,Middle Aged ,Surgery ,Treatment Outcome ,Patient Satisfaction ,Quality of Life ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Objective Several factors may potentially influence the efficacy and patient satisfaction after bilateral thoracic sympathectomy as the treatment for hyperhidrosis, but few studies have specifically analyzed the impact of age on the efficacy of this treatment, the occurrence of compensatory hyperhidrosis (CH), and variations in the quality of life. Methods We retrospectively analyzed the effect of age, body mass index, surgical techniques, quality of life before surgery, betterment in the quality of life after surgery, clinical improvement in sweating at the main site, and the occurrence and intensity of CH in patients with hyperhidrosis (n = 1633) who underwent bilateral sympathectomy. Results Quality of life improved in more than 90% of patients, and severe CH occurred in 5.4%. Age did not affect these outcomes. The older, the greater reduction in sweating, and CH was linked to other variables (body mass index, craniofacial hyperhidrosis, and level of resection). Conclusions We observed that patients with old age reported an improvement in sweating in the main site of hyperhidrosis. Sympathectomy outcomes in older patients are similar to those observed in younger patients in terms of quality of life improvement and occurrence of CH.
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- 2017
130. Treatment of uncommon sites of focal primary hyperhidrosis: experience with pharmacological therapy using oxybutynin
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Nelson Wolosker, José Ribas Milanez de Campos, Pedro Puech-Leão, Marcelo Passos Teivelis, Paulo Kauffman, and Mariana Krutman
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Side effect ,Adolescent ,Muscarinic Antagonists ,Xerostomia ,Cholinergic Antagonists ,Young Adult ,Quality of life ,Palpitations ,Medicine ,Humans ,Hyperhidrosis ,Oxybutynin ,Aged ,Retrospective Studies ,Pharmacology ,lcsh:R5-920 ,Groin ,business.industry ,Retrospective cohort study ,General Medicine ,Clinical Science ,Middle Aged ,Dry mouth ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Quality of Life ,Mandelic Acids ,Female ,medicine.symptom ,business ,lcsh:Medicine (General) ,medicine.drug ,Follow-Up Studies - Abstract
OBJECTIVES: Primary hyperhidrosis usually affects the hands, armpits, feet and cranio-facial region. Sweating in other areas is common in secondary hyperhidrosis (after surgery or in specific clinical conditions). Oxybutynin has provided good results and is an alternative for treating hyperhidrosis at common sites. Our aim was to evaluate the efficacy of oxybutynin as a treatment for primary sweating at uncommon sites (e.g., the back and groin). METHODS: This retrospective study analyzed 20 patients (10 females) who received oxybutynin for primary focal hyperhidrosis at uncommon sites. The subjects were evaluated to determine quality of life before beginning oxybutynin and six weeks afterward and they were assigned grades (on a scale from 0 to 10) to measure their improvement at each site of excessive sweating after six weeks and at the last consult. RESULTS: The median follow-up time with oxybutynin was 385 days (133-1526 days). The most common sites were the back (n = 7) and groin (n = 5). After six weeks, the quality of life improved in 85% of the subjects. Dry mouth was very common and was reported by 16 patients, 12 of whom reported moderate/severe dry mouth. Five patients stopped treatment (two: unbearable dry mouth, two: excessive somnolence and one: palpitations). At the last visit, 80% of patients presented with moderate/great improvement at the main sites of sweating. CONCLUSION: After six weeks, more than 80% of the patients presented with improvements in their overall quality of life and at the most important site of sweating. Side effects were common (80% reported at least one side effect) and caused 25% of the patients to discontinue treatment. Oxybutynin is effective for treating bothersome hyperhidrosis, even at atypical locations and most patients cope well with the side effects.
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- 2014
131. Carbon dioxide Is a Cost-effective Contrast Medium to Guide Revascularization of TASC A and TASC B Femoropopliteal Occlusive Disease
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Nelson Wolosker, Marcelo Passos Teivelis, Kenji Nishinari, Helio Halpern, Sergio Kuzniec, Alexandre de Arruda Martins, Mariana Krutman, and Cynthia de Almeida Mendes
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Adult ,Male ,medicine.medical_specialty ,Cost-Benefit Analysis ,Concordance ,medicine.medical_treatment ,Contrast Media ,Renal function ,Constriction, Pathologic ,Radiography, Interventional ,Revascularization ,Nephrotoxicity ,Peripheral Arterial Disease ,Predictive Value of Tests ,Angioplasty ,medicine ,Humans ,Ankle Brachial Index ,Popliteal Artery ,Prospective Studies ,Contraindication ,Aged ,Aged, 80 and over ,business.industry ,Endovascular Procedures ,Health Care Costs ,General Medicine ,Gold standard (test) ,Carbon Dioxide ,Middle Aged ,Surgery ,Femoral Artery ,Contrast medium ,Treatment Outcome ,Feasibility Studies ,Female ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Brazil ,Glomerular Filtration Rate - Abstract
Background Iodine contrast medium (ICM) is considered gold standard in endovascular revascularization procedures. However, nephrotoxicity and hypersensitivity to ICM are causes that limit its indiscriminate use. Carbon dioxide (CO 2 ) contrast angiography has been used as an alternative in patients with formal contraindication to ICM. However, no studies to the present date have compared in a randomized and prospective way, outcomes of revascularization procedures performed with either ICM or CO 2 in patients eligible for use of both contrasts. Methods Between April 2012 and April 2013, 35 patients with peripheral arterial disease with arterial lesions classified as Trans-Atlantic Inter-Society Consensus A or B (identified on preoperative angio computed tomography scan) and adequate runoff underwent femoropopliteal revascularization by endovascular technique in a prospective, randomized, and controlled study. Patients were randomized into 2 groups: CO 2 group and ICM group, according to the contrast media selected of the procedure. We evaluated the following outcomes in both groups: feasibility of the procedures, complications, surgical outcomes (ankle-brachial index [ABI]), glomerular filtration rate using the Cockcroft–Gault formula, relationship between the volume of injected iodine and postoperative creatinine clearance, quality of the angiographic images obtained with CO 2 , costs of the endovascular materials, and finally, cost of contrast agents. Results We were able to perform the proposed procedures in all patients treated in this series (ICM group and CO 2 ). There were no CO 2 -related complications. No procedures required conversion to open surgery. Clinical results were satisfactory, with regression of ischemia and increased levels of ABI in both groups. Variations in creatinine clearance levels showed a numerical increase in the CO 2 group and a decrease in ICM group, however, with no statistically significant difference between the delta clearance in each group. All CO 2 arteriograms of the supragenicular arteries were graded as good or fair by both observers with high interobserver image quality concordance. There was no statistical difference between endovascular material costs between the groups, but the contrast cost was significantly lower in CO 2 group ( P Conclusions The use of CO 2 in patients with no restriction for ICM is an alternative that does not limit the feasibility of the procedures. Similar outcomes were observed with CO 2 when compared with the gold standard contrast (ICM) regarding quality of images produced, with no associated changes in creatinine clearance or hypersensitivity reactions and also allows a reduction in contrast-related costs in angioplasty procedures.
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- 2014
132. Long-term Results of the Use of Oxybutynin for the Treatment of Axillary Hyperhidrosis
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Marcelo Passos Teivelis, Rafael Pessanha de Paula, Pedro Puech-Leão, Mariana Krutman, Nelson Wolosker, José Ribas Milanez de Campos, and Paulo Kauffman
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,medicine.medical_treatment ,Sweating ,QUALIDADE DE VIDA ,Muscarinic Antagonists ,Drug Administration Schedule ,Young Adult ,Patient satisfaction ,Quality of life ,medicine ,Humans ,Hyperhidrosis ,Young adult ,Child ,Oxybutynin ,Aged ,Retrospective Studies ,Dose-Response Relationship, Drug ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,Surgery ,Clinical trial ,Treatment Outcome ,Sympathectomy ,Patient Satisfaction ,Child, Preschool ,Anesthesia ,Axilla ,Mandelic Acids ,Patient Compliance ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,medicine.drug - Abstract
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.
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- 2014
133. Quality of Life before Hyperhidrosis Treatment as a Predictive Factor for Oxybutynin Treatment Outcomes in Palmar and Axillary Hyperhidrosis
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Marcelo Passos Teivelis, Taiz Pereira Dozono de Almeida Campbell, Paulo Kauffman, Pedro Puech-Leão, José Ribas Milanez de Campos, Mariana Krutman, and Nelson Wolosker
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Treatment outcome ,Sweating ,Muscarinic Antagonists ,Thoracoscopic sympathectomy ,Axillary hyperhidrosis ,Young Adult ,Quality of life ,Surveys and Questionnaires ,Humans ,Hyperhidrosis ,Medicine ,Child ,Oxybutynin ,Adverse effect ,Retrospective Studies ,TORACOSCOPIA ,business.industry ,General Medicine ,Middle Aged ,humanities ,Predictive factor ,Treatment Outcome ,Child, Preschool ,Quality of Life ,Physical therapy ,Mandelic Acids ,Female ,Surgery ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background Studies have suggested that quality of life (QOL) evaluation before video-assisted thoracoscopic sympathectomy for patients with hyperhidrosis may serve as a predictive factor for positive postoperative outcomes. Our study aims to analyze if this tendency is also observed in patients treated with oxybutynin for palmar and axillary hyperhidrosis. Methods Five hundred sixty-five patients who submitted to a protocol treatment with oxybutynin were retrospectively analyzed between January 2007 and January 2012 and were divided into 2 groups according to QOL assessment before treatment. The groups consisted of 176 patients with “poor” and 389 patients with “very poor” QOL evaluation before oxybutynin treatment. Outcomes involving improvements in QOL and clinical progression of hyperhidrosis were evaluated using a validated clinical questionnaire that was specifically designed to assess satisfaction in patients with excessive sweating. Results Improvements in hyperhidrosis after oxybutynin were observed in 65.5% of patients with very poor pretreatment QOL scores and in 75% of patients with poor pretreatment QOL scores, and the only adverse event associated with oxybutynin treatment was dry mouth, which was observed with greater intensity in patients with very poor initial QOL evaluation. Conclusion Improvements in hyperhidrosis after oxybutynin treatment were similar in both groups, suggesting that QOL before treatment is not a predictive factor for clinical outcomes, contrasting with surgical results that disclose significantly better results in patients with initially poorer QOL analysis.
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- 2014
134. Análise do tratamento de hiperidrose com oxibutinina em pacientes com mais de 40 anos
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Paulo Kauffman, Pedro Puech-Leão, Rafael Pessanha de Paula, José Ribas Milanez de Campos, Nelson Wolosker, Marcelo Passos Teivelis, and Mariana Krutman
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Adult ,Male ,Toxinas botulínicas/uso terapêutico ,Farmacologia ,medicine.medical_specialty ,Pediatrics ,Time Factors ,lcsh:Medicine ,Muscarinic Antagonists ,Body Mass Index ,Hiperidrose/tratamento ,Sex Factors ,Older patients ,Quality of life ,Surveys and Questionnaires ,medicine ,Humans ,Hyperhidrosis ,In patient ,Oxybutynin ,Retrospective Studies ,Aged ,Pharmacology ,Chi-Square Distribution ,business.industry ,Idoso ,lcsh:R ,Age Factors ,Retrospective cohort study ,General Medicine ,Middle Aged ,Surgery ,Hyperhidrosis/therapy ,Botulinum toxins/therapeutic use ,Treatment Outcome ,Quality of Life ,Mandelic Acids ,Female ,Original Article ,medicine.symptom ,business ,Chi-squared distribution ,Body mass index ,Qualidade de Vida ,medicine.drug - Abstract
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. Objetivo : Analisar a efetividade da oxibutinina para tratamento da hiperidrose em pacientes com mais de 40 anos. Métodos : Oitenta e sete pacientes com idade superior a 40 anos foram divididos em dois grupos: o primeiro com 48 pacientes (55,2%), com idades entre 40 e 49 anos. O segundo com 39 pacientes (44,8%), com mais de 50 anos (intervalo: 50 a 74 anos). Uma análise comparativa da Qualidade de Vida e do nível de hiperidrose entre os grupos foi realizada 6 semanas após o início do tratamento com oxibutinina. Para isso, foi utilizado um questionário validado para Qualidade de Vida. Resultados : No grupo mais jovem, 75% dos pacientes referiram melhora “parcial” ou “ótima” no nível de hiperidrose após o tratamento. Esse número foi particularmente impressionante em pacientes acima de 50 anos, sendo que 87,2% apresentaram níveis similares de melhora. Mais de 77% dos pacientes, em ambos os grupos, demonstraram melhora na Qualidade de Vida. Desfechos excelentes foram observados em pacientes mais idosos, dentre os quais 87,1% dos pacientes apresentaram melhora “pouco melhor” (41%) ou “muito melhor” (46,1%). Conclusão : Os pacientes acima de 40 anos com hiperidrose tiveram excelentes resultados com o tratamento com oxibutinina. Esses desfechos foram particularmente importantes nos pacientes com mais de 50 anos, nos quais a maioria apresentou melhora da Qualidade de Vida e da hiperidrose.
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- 2014
135. Translation and validation of Hyperhidrosis Disease Severity Scale
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Paulo Kauffman, Nelson Wolosker, Juliana Maria Fukuda, Pedro Puech-Leão, Marcelo Passos Teivelis, José Ribas Milanez de Campos, Gabriel Grizzo Cucato, and Andrea Yasbek Monteiro Varella
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Male ,030204 cardiovascular system & hematology ,Severity of Illness Index ,030207 dermatology & venereal diseases ,0302 clinical medicine ,Quality of life ,Surveys and Questionnaires ,Medicine ,hyperhidrosis ,traduções ,lcsh:R5-920 ,Hyperhidrosis ,General Medicine ,Middle Aged ,escalas ,translations ,Treatment period ,Treatment Outcome ,Scale (social sciences) ,Female ,medicine.symptom ,lcsh:Medicine (General) ,Brazil ,medicine.drug ,Adult ,medicine.medical_specialty ,Adolescent ,MEDLINE ,scales ,B100 ,03 medical and health sciences ,Young Adult ,hiperidrose ,Disease severity ,questionários ,Severity of illness ,Humans ,Translations ,Oxybutynin ,validation studies ,business.industry ,Reproducibility of Results ,questionnaires ,C600 ,Physical therapy ,Quality of Life ,Mandelic Acids ,estudos de validação ,business - Abstract
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.
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- 2016
136. Brachial insertion of fully implantable venous catheters for chemotherapy: complications and quality of life assessment in 35 patients
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Igor Yoshio Imagawa Fonseca, Rafael Cavalcante, Guilherme Andre Zottele Bomfim, Marcelo Passos Teivelis, Kenji Nishinari, Guilherme Yazbek, Mariana Krutman, and Nelson Wolosker
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,030232 urology & nephrology ,lcsh:Medicine ,Antineoplastic Agents ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Catheters, Indwelling ,Postoperative Complications ,Catheters, indwelling/adverse effects ,Neoplasms ,Surveys and Questionnaires ,Catheterization, Peripheral ,Segurança do paciente ,medicine ,Humans ,Prospective Studies ,Intraoperative Complications ,Gynecology ,business.industry ,lcsh:R ,Patient satisfaction ,General Medicine ,Middle Aged ,Satisfação do paciente ,Patient safety ,030220 oncology & carcinogenesis ,Chemotherapy complications ,Arm ,Quality of Life ,Feasibility Studies ,Original Article ,Female ,Quimioterapia ,Drug therapy ,business ,Cateteres de demora/efeitos adversos - Abstract
Objective To prospectively evaluate the perioperative safety, early complications and satisfaction of patients who underwent the implantation of central catheters peripherally inserted via basilic vein. Methods Thirty-five consecutive patients with active oncologic disease requiring chemotherapy were prospectively followed up after undergoing peripheral implantation of indwelling venous catheters, between November 2013 and June 2014. The procedures were performed in the operating room by the same team of three vascular surgeons. The primary endpoints assessed were early postoperative complications, occurring within 30 days after implantation. The evaluation of patient satisfaction was based on a specific questionnaire used in previous studies. Results In all cases, ultrasound-guided puncture of the basilic vein was feasible and the procedure successfully completed. Early complications included one case of basilic vein thrombophlebitis and one case of pocket infection that did not require device removal. Out of 35 patients interviewed, 33 (94.3%) would recommend the device to other patients. Conclusion Implanting brachial ports is a feasible option, with low intraoperative risk and similar rates of early postoperative complications when compared to the existing data of the conventional technique. The patients studied were satisfied with the device and would recommend the procedure to others. RESUMO Objetivo Avaliar prospectivamente segurança perioperatória, complicações precoces e grau de satisfação de pacientes submetidos ao implante de cateteres centrais de inserção periférica pela veia basílica. Métodos Foram acompanhados prospectivamente e submetidos ao implante de cateteres de longa permanência de inserção periférica, entre novembro de 2013 e junho de 2014, 35 pacientes consecutivos com doença oncológica ativa necessitando de quimioterapia. Os procedimentos foram realizados em centro cirúrgico por uma mesma equipe composta por três cirurgiões vasculares. Os desfechos primários avaliados foram as complicações pós-operatórias precoces, ocorridas em até 30 dias após o implante. A avaliação do grau de satisfação foi realizada com base na aplicação de um questionário específico já utilizado em estudos prévios. Resultados Em todos os casos, a punção ecoguiada da veia basílica foi possível, e o procedimento foi concluído com sucesso. As complicações precoces observadas incluíram um caso de tromboflebite de basílica e um de infecção de bolsa, ambos tratados clinicamente sem necessidade de retirada do dispositivo. Dos 35 pacientes interrogados, 33 (94,3%) recomendariam o dispositivo para outras pessoas. Conclusão A implantação do port braquial é uma opção factível, com baixo risco intraoperatório e taxas semelhantes de complicações pós-operatórias imediatas quando comparada a dados já existentes da técnica convencional. Os pacientes estudados apresentaram-se satisfeitos com o dispositivo e recomendariam o procedimento para outras pessoas.
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- 2016
137. The relation between age and outcomes of thoracic sympathectomy for hyperhidrosis: The older the better
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Leiderman, Dafne Braga Diamante, primary, Milanez de Campos, Jose Ribas, additional, Kauffman, Paulo, additional, Tedde, Miguel Lia, additional, Yazbek, Guilherme, additional, Teivelis, Marcelo Passos, additional, and Wolosker, Nelson, additional
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- 2018
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138. Comparison between Saline Solution Containing Heparin versus Saline Solution in the Lock of Totally Implantable Catheters
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Brito, Antonio Rafael de Oliveira, primary, Nishinari, Kenji, additional, Saad, Paulo Fernandes, additional, Saad, Karen Ruggeri, additional, Pereira, Monica Aparecida Tomé, additional, Emídio, Suellen Cristina Dias, additional, Yazbek, Guilherme, additional, Bomfim, Guilherme Andre Zottele, additional, Cavalcante, Rafael Noronha, additional, Krutman, Mariana, additional, Teivelis, Marcelo Passos, additional, Pignataro, Bruno Soriano, additional, Fonseca, Igor Yoshio Imagawa, additional, Centofanti, Guilherme, additional, and Soares, Bruno Leonardo Freitas, additional
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- 2018
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139. Combination of topical agents and oxybutynin as a therapeutic modality for patients with both osmidrosis and hyperhidrosis
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Varella, Andrea Yasbek Monteiro, primary, Fukuda, Juliana Maria, additional, Teivelis, Marcelo Passos, additional, Pinheiro, Lucas Lembrança, additional, Mendes, Cynthia de Almeida, additional, Kauffman, Paulo, additional, Campos, José Ribas Milanez de, additional, and Wolosker, Nelson, additional
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- 2018
- Full Text
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140. Videothoracoscopic Sympathectomy Results after Oxybutynin Chloride Treatment Failure
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Paulo Kauffman, Pedro Puech-Leão, Lucas Lembrança, Nelson Wolosker, Marcelo Passos Teivelis, and José Ribas Milanez de Campos
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Adult ,Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,medicine.medical_treatment ,Sweating ,Muscarinic Antagonists ,030204 cardiovascular system & hematology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Oxybutynin Chloride ,Quality of life ,Surveys and Questionnaires ,Medicine ,Humans ,Hyperhidrosis ,Treatment Failure ,Sympathectomy ,Retrospective Studies ,business.industry ,Thoracic Surgery, Video-Assisted ,Incidence (epidemiology) ,Compensatory hyperhidrosis ,Retrospective cohort study ,General Medicine ,Surgery ,Anesthesia ,Quality of Life ,Mandelic Acids ,Observational study ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Brazil - Abstract
Background Videothoracoscopy sympathectomy (VATS) is the only definitive treatment for primary hyperhidrosis (HH). Since 2007, in our institution, patients with HH were initially treated with oxybutynin chloride to avoid VATS and reduce compensatory hyperhidrosis incidence with good results. The aim of this study was to analyze the surgical response of patients suffering from essential hyperhidrosis after failure of oxybutynin chloride treatment. Methods This was an observational retrospective study that included 737 patients who were diagnosed with palmar or axillary hyperhidrosis and received VATS from January 2007 to January 2014. Patients were selected for 2 different groups: The post-oxybutynin surgery group consisted of 167 patients that were initially treated with oxybutynin chloride for 6 weeks and then received VATS after drug treatment failure. The primary surgery group consisted of a historic control group of 570 patients who were referred directly to surgical treatment. We evaluated the degree of improvement in symptoms 30 days after surgery and quality of life before and after the surgical treatment. Results All patients showed poor or very poor quality of life before surgery. Most patients showed a response between moderate and high after surgical treatment. However, those in primary surgery group responded better (95.1% vs. 98.2%). In the quality of life after surgery, most of the patients reported improvement, and the primary surgery group had better improvement (92.2% vs. 95.1%). Conclusions VATS showed good results in patients with palmar or axillary hyperhidrosis regarding surgical response and improvement on quality of life even when the previous oxybutynin chloride treatment failed.
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- 2016
141. Endovascular revascularization of TASC C and D femoropopliteal occlusive disease using carbon dioxide as contrast
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Mendes, Cynthia de Almeida, Teivelis, Marcelo Passos, Kuzniec, Sergio, Fukuda, Juliana Maria, and Wolosker, Nelson
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Insuficiência renal ,Dióxido de carbono ,Angioplastia ,Procedimentos endovasculares ,Carbon dioxide ,Endovascular procedures ,Angioplasty ,Peripheral arterial disease ,Renal insufficiency ,Doença arterial periférica - Abstract
Objective To analyze the results of ten angioplasties of TASC C and D femoropopliteal lesions using CO2 as primary contrast in patients with no formal contraindication to iodine, aiming to decrease allergic reactions and potential nephrotoxicity in high-risk patients. Methods We describe the results of ten angioplasties of TASC C and D femoropopliteal lesions using CO2 as primary contrast in patients with high risk for open revascularization and no formal contraindication to iodine. We analyzed feasibility of the procedures, complications, quality of the angiographic images, clinical and surgical outcomes, and costs of C and D lesions treated using CO2 as contrast medium. Results The use of CO2 in C and D lesions needed iodine complementation in most of the cases (nine cases) but decreased the potential nephrotoxicity of iodine contrast medium by the reduction of its volume in this group of high-risk patients. The extension of the arterial lesions was the factor that most contributed to the need for iodine supplementation due to the difficulty to visualize the refill after a long arterial occlusion. Conclusion The use of CO2 as contrast in patients with C and D lesions with no restriction for iodine contrast medium was an alternative that did not dismiss the need of iodine supplementation in most of the cases, but could decrease the potential nephrotoxicity of iodine constrast medium. RESUMO Objetivo Analisar os resultados de dez angioplastias de lesões fêmoro-poplíteas TASC C e D utilizando CO2 como meio de contraste primário em pacientes sem restrição ao meio de contraste iodado com o objetivo de diminuir reações alérgicas e potencial de nefrotoxicidade em pacientes de alto risco. Métodos Descrevemos os resultados de dez angioplastias de lesões fêmoro-poplíteas TASC C e D utilizando CO2 como meio de contraste primário em pacientes de alto risco para revascularização aberta e sem contraindicação formal a iodo. Analisamos possibilidade de execução dos procedimentos, complicações, qualidade das imagens obtidas, desfechos clínicos e cirúrgicos e custos das lesões C e D tratadas com CO2 como meio de contraste. Resultados O uso de CO2 nas lesões C e D necessitou de complementação de iodo na maioria dos casos (nove casos), porém reduziu o potencial de nefrotoxicidade do meio de contraste iodado, diminuindo seu volume nesse grupo de pacientes de alto risco. A extensão das lesões arteriais foi o fator que mais contribuiu para necessidade de suplementação de iodo, devido à dificuldade de visualizar o reenchimento após oclusão arterial longa. Conclusão O uso de CO2 como contraste em pacientes com lesões C e D sem restrição ao meio de contraste iodado foi uma alternativa que não excluiu a necessidade de suplementação com iodo na maioria dos casos, porém pôde diminuir o potencial de nefrotoxicidade do meio de contraste iodado.
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- 2016
142. Endovascular revascularization of TASC C and D femoropopliteal occlusive disease using carbon dioxide as contrast
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Sergio Kuzniec, Juliana Maria Fukuda, Marcelo Passos Teivelis, Cynthia de Almeida Mendes, and Nelson Wolosker
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Male ,Angioplastia ,Procedimentos endovasculares ,Endovascular revascularization ,Contrast Media ,lcsh:Medicine ,Arterial Occlusive Diseases ,030204 cardiovascular system & hematology ,030230 surgery ,Dióxido de carbono ,03 medical and health sciences ,0302 clinical medicine ,Peripheral arterial disease ,Humans ,Medicine ,Popliteal Artery ,Renal insufficiency ,Aged ,Observer Variation ,Insuficiência renal ,business.industry ,Endovascular Procedures ,lcsh:R ,Angioplasty ,Angiography ,General Medicine ,Carbon Dioxide ,Middle Aged ,Femoropopliteal Occlusive Disease ,Femoral Artery ,Carbon dioxide ,Endovascular procedures ,Female ,Original Article ,business ,Nuclear medicine ,Observer variation ,Doença arterial periférica ,Iodine - Abstract
To analyze the results of ten angioplasties of TASC C and D femoropopliteal lesions using CO2 as primary contrast in patients with no formal contraindication to iodine, aiming to decrease allergic reactions and potential nephrotoxicity in high-risk patients.We describe the results of ten angioplasties of TASC C and D femoropopliteal lesions using CO2 as primary contrast in patients with high risk for open revascularization and no formal contraindication to iodine. We analyzed feasibility of the procedures, complications, quality of the angiographic images, clinical and surgical outcomes, and costs of C and D lesions treated using CO2 as contrast medium.The use of CO2 in C and D lesions needed iodine complementation in most of the cases (nine cases) but decreased the potential nephrotoxicity of iodine contrast medium by the reduction of its volume in this group of high-risk patients. The extension of the arterial lesions was the factor that most contributed to the need for iodine supplementation due to the difficulty to visualize the refill after a long arterial occlusion.The use of CO2 as contrast in patients with C and D lesions with no restriction for iodine contrast medium was an alternative that did not dismiss the need of iodine supplementation in most of the cases, but could decrease the potential nephrotoxicity of iodine constrast medium.Analisar os resultados de dez angioplastias de lesões fêmoro-poplíteas TASC C e D utilizando CO2 como meio de contraste primário em pacientes sem restrição ao meio de contraste iodado com o objetivo de diminuir reações alérgicas e potencial de nefrotoxicidade em pacientes de alto risco.Descrevemos os resultados de dez angioplastias de lesões fêmoro-poplíteas TASC C e D utilizando CO2 como meio de contraste primário em pacientes de alto risco para revascularização aberta e sem contraindicação formal a iodo. Analisamos possibilidade de execução dos procedimentos, complicações, qualidade das imagens obtidas, desfechos clínicos e cirúrgicos e custos das lesões C e D tratadas com CO2 como meio de contraste.O uso de CO2 nas lesões C e D necessitou de complementação de iodo na maioria dos casos (nove casos), porém reduziu o potencial de nefrotoxicidade do meio de contraste iodado, diminuindo seu volume nesse grupo de pacientes de alto risco. A extensão das lesões arteriais foi o fator que mais contribuiu para necessidade de suplementação de iodo, devido à dificuldade de visualizar o reenchimento após oclusão arterial longa.O uso de CO2 como contraste em pacientes com lesões C e D sem restrição ao meio de contraste iodado foi uma alternativa que não excluiu a necessidade de suplementação com iodo na maioria dos casos, porém pôde diminuir o potencial de nefrotoxicidade do meio de contraste iodado.
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- 2016
143. Carbon Dioxide as Contrast Medium to Guide Endovascular Aortic Aneurysm Repair
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Cynthia de Almeida Mendes, Sergio Kuzniec, Nelson Wolosker, Alexandre de Arruda Martins, Marcelo Passos Teivelis, and Andrea Yasbek Monteiro Varella
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Male ,medicine.medical_specialty ,Time Factors ,Computed Tomography Angiography ,medicine.medical_treatment ,Iohexol ,Operative Time ,Contrast Media ,030204 cardiovascular system & hematology ,Radiography, Interventional ,Endovascular aneurysm repair ,Aortography ,03 medical and health sciences ,Aortic aneurysm ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,medicine.artery ,medicine ,Humans ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Contraindication ,reproductive and urinary physiology ,Computed tomography angiography ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Endovascular Procedures ,General Medicine ,Carbon Dioxide ,Middle Aged ,medicine.disease ,Internal iliac artery ,Surgery ,Contrast medium ,Treatment Outcome ,embryonic structures ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Brazil ,Abdominal surgery ,Aortic Aneurysm, Abdominal - Abstract
Background Iodine contrast medium (ICM) is considered to be gold standard in endovascular procedures, but its nephrotoxicity and hypersensitivity limit the widespread use. Carbon dioxide (CO 2 ) is considered as an alternative for endovascular procedures in patients with contraindication to ICM. However, no studies have compared the outcomes of endovascular aneurysm repair (EVAR) performed with ICM or CO 2 among patients with no contraindication to ICM. Methods From May 2012 to April 2014, 36 patients with abdominal aortic aneurysms underwent EVAR in a prospective, randomized, and controlled study. Patients were randomized into 2 groups, CO 2 or ICM group. Results We were able to perform the proposed procedures in all patients in this study. There were no conversions to open surgery and no CO 2 -related complications. Endovascular material costs, duration of surgery, and time of fluoroscopy were similar between groups, and the cost of the contrast media was smaller in the CO 2 group than in the ICM group. Among CO 2 group procedures, 62.5% of the patients needed ICM complementary use. Conclusions The use of CO 2 as a contrast medium for EVAR is an alternative in patients with no restriction for ICM, with similar outcomes when compared to ICM, regarding duration of surgery, duration of fluoroscopy, and endovascular material costs. Using CO 2 , there were no changes in creatinine clearance and no risk of hypersensitivity reactions; moreover, there was a reduction in contrast-related costs for EVAR procedures. However, in our study, additional use of ICM to visualize the internal iliac artery was needed in most procedures.
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- 2016
144. Rediscussing Anticoagulation in Distal Deep Venous Thrombosis
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Andrea Yasbek Monteiro Varella, Adriano Tachibana, Sergio Kuzniec, João Carlos de Campos Guerra, Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Eduardo Ramacciotti, and Mira Zlotnik
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Adult ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Lower limb ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Ultrasonography ,Venous Thrombosis ,Leg ,business.industry ,Anticoagulants ,Retrospective cohort study ,Hematology ,General Medicine ,Middle Aged ,medicine.disease ,Thrombosis ,Surgery ,Pulmonary embolism ,Venous thrombosis ,Female ,Radiology ,business ,Pulmonary Embolism - Abstract
Background: Distal deep venous thrombosis (DVT) accounts for approximately half of all the cases of lower limb thrombosis. The impact and management of this condition is still controversial. This study aims to evaluate the incidence of pulmonary embolism (PE) in patients with distal DVT in comparison to proximal DVT and evaluate the correlation between DVT and PE extension. Methods: 100 patients with acute lower limb DVT diagnosed with whole leg Doppler ultrasound from January 2006 to December 2014 were retrospectively analyzed. Active investigation for PE was carried out in all patients using multislice computed tomography angiography. Classification of DVT and PE was based on the proximal extension of the thrombus. Results: The overall incidence of PE in our sample patients was 72%. In the subgroup analysis, incidence of PE was equal in both the proximal and distal DVT groups (77%, p > 0.99). PE was detected in 43% of the patients with isolated calf vein thrombosis (ICVT). No statistical difference was observed between the distribution of lobar, segmental and subsegmental PE in the 3 DVT subgroups (p = 0.665); however, truncular PE was only observed in the proximal DVT group. Conclusion: Distal DVT is associated with a high incidence of PE compared to proximal DVT. Distal DVT and ICVT can provoke PE with involvement of proximal vessels in the pulmonary arterial tree, even in asymptomatic patients. Our study arises discussion in the controversial debate regarding the need for routine anticoagulation in distal DVT.
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- 2016
145. Enoxaparin Treatment Followed by Rivaroxaban for the Treatment of Acute Lower Limb Venous Thromboembolism: Initial Experience in a Single Center
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Juliana M. Fukuda, Eduardo Ramacciotti, Sergio Kuzniec, João Carlos de Campos Guerra, Mariana Krutman, Andrea Yasbek Monteiro Varella, Nelson Wolosker, and Marcelo Passos Teivelis
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Adult ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Single Center ,Lower limb ,03 medical and health sciences ,0302 clinical medicine ,Rivaroxaban ,Medicine ,Humans ,030212 general & internal medicine ,Enoxaparin ,Initial therapy ,Aged ,Aged, 80 and over ,business.industry ,Hematology ,General Medicine ,Venous Thromboembolism ,Middle Aged ,Surgery ,Clinical trial ,Lower Extremity ,Acute Disease ,Oral anticoagulant ,Female ,business ,Venous thromboembolism ,Major bleeding ,medicine.drug - Abstract
Rivaroxaban is a target-specific oral anticoagulant approved for the treatment of venous thromboembolism (VTE). On its major clinical trials, treatment was initiated directly with a 3-week dose of oral 15 mg twice daily followed by 20 mg every day for at least 3 months. We retrospectively evaluated an initial therapy for confirmed VTE with 1 to 18 days of enoxaparin (1 mg/kg twice daily parenteral) followed by oral rivaroxaban 20 mg every day. Of 49 patients, we found no symptomatic recurrence, no major bleeding, and only 1 clinically relevant nonmajor bleeding. We concluded in this pilot study that it is safe and effective to treat patients with enoxaparin course followed directly by a dose of 20 mg of rivaroxaban.
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- 2016
146. Mycotic aneurysm of the tibioperoneal trunk: a first manifestation of an infected endocarditis
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Carlos Alberto de Oliveira, Sergio Quilici Belczak, Igor Rafael Sincos, Marcelo Passos Teivelis, Ricardo Aun, and Hélio Fragoso
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Adult ,Male ,medicine.medical_specialty ,lcsh:Arctic medicine. Tropical medicine ,lcsh:RC955-962 ,Deep vein ,Tibioperoneal trunk ,Review ,Aneurysm ,Edema ,Venous thrombosis ,medicine ,Humans ,Endocarditis ,cardiovascular diseases ,business.industry ,Endocarditis, Bacterial ,General Medicine ,Mycotic aneurysm ,medicine.disease ,Thrombosis ,Surgery ,Infectious Diseases ,medicine.anatomical_structure ,cardiovascular system ,Tibial arteries ,medicine.symptom ,business ,Aneurysm, Infected ,Infected - Abstract
Infrapopliteal mycotic aneurysm resulting from endocarditis is rare, with only a few reported cases. We describe the case of a 28-year-old male patient who was suffering with pain and edema in the right leg. The ultrasound revealed an aneurysm of the right tibioperoneal trunk and a deep vein thrombosis (DVT). The patient was admitted and developed acute congestive heart failure, being diagnosed with possible endocarditis. A pseudo-aneurysm was revealed by arteriography. Aggressive antibiotic treatment was initiated, and open surgery confirmed a mycotic pseudo-aneurysm of the tibioperoneal trunk. To our knowledge, this is the 8th case reported of an infected aneurysm in this particular location. Aneurisma micótico infra-poplíteo resultante de endocardite infecciosa é raro, com apenas alguns casos relatados. Descrevemos o caso de um paciente de 28 anos do sexo masculino que apresentou dor e edema na perna direita. A ultrassonografia demonstrou um aneurisma do tronco tíbio-fibular e trombose venosa profunda do membro inferior direito. O paciente foi internado e desenvolveu falência cardíaca aguda, sendo diagnosticado de endocardite bacteriana. Um pseudo-aneurisma foi evidenciado na arteriografia. Antibioticoterapia agressiva foi iniciada e cirurgia aberta confirmou um pseudo-aneurisma micótico do tronco tibio-fibular. Para o nosso conhecimento, este é o oitavo caso relatado de aneurisma infectado localizado especificamente nesta região.
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- 2012
147. Videothoracoscopic Sympathectomy Results after Oxybutynin Chloride Treatment Failure
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Lembrança, Lucas, primary, Wolosker, Nelson, additional, de Campos, José Ribas Milanez, additional, Kauffman, Paulo, additional, Teivelis, Marcelo Passos, additional, and Puech-Leão, Pedro, additional
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- 2017
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148. Evaluation of patients who underwent resympathectomy for treatment of primary hyperhidrosis
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de Campos, José Ribas Milanez, primary, Lembrança, Lucas, additional, Fukuda, Juliana Maria, additional, Kauffman, Paulo, additional, Teivelis, Marcelo Passos, additional, Puech-Leão, Pedro, additional, and Wolosker, Nelson, additional
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- 2017
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149. Carbon Dioxide as Contrast Medium to Guide Endovascular Aortic Aneurysm Repair
- Author
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de Almeida Mendes, Cynthia, primary, de Arruda Martins, Alexandre, additional, Teivelis, Marcelo Passos, additional, Kuzniec, Sergio, additional, Varella, Andrea Yasbek Monteiro, additional, and Wolosker, Nelson, additional
- Published
- 2017
- Full Text
- View/download PDF
150. Carbon dioxide contrast medium for endovascular treatment of ilio-femoral occlusive disease
- Author
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Andrea Yasbek Monteiro Varella, Cynthia de Almeida Mendes, Sergio Kuzniec, Alexandre Fioranelli, Alexandre de Arruda Martins, Nelson Wolosker, and Marcelo Passos Teivelis
- Subjects
Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Occlusive disease ,Iodine Compounds ,chemistry.chemical_element ,Contrast Media ,Arterial Occlusive Diseases ,Femoral artery ,Iodine ,Iliac Artery ,Statistics, Nonparametric ,chemistry.chemical_compound ,Angioplasty ,medicine.artery ,Medicine ,Humans ,Iliac ,Endovascular treatment ,Aged ,lcsh:R5-920 ,Endovascular ,business.industry ,Endovascular Procedures ,General Medicine ,Clinical Science ,Middle Aged ,Carbon Dioxide ,Surgery ,Femoral Artery ,Contrast medium ,Treatment Outcome ,chemistry ,Carbon dioxide ,Feasibility Studies ,lcsh:Medicine (General) ,business - Abstract
OBJECTIVES: Compare the use of carbon dioxide contrast medium with iodine contrast medium for the endovascular treatment of ilio-femoral occlusive disease in patients without contraindications to iodine. MATERIALS AND METHODS: From August 2012 to August 2014, 21 consecutive patients with ilio-femoral occlusive disease who were eligible for endovascular treatment and lacked contraindications to either iodine contrast or carbon dioxide were randomized into the carbon dioxide or iodine groups and subjected to ilio-femoral angioplasty. We analyzed the feasibility of the procedures, the surgical and clinical outcomes, the procedure lengths, the endovascular material costs, the contrast costs and the quality of the angiographic images in each group. RESULTS: No conversions to open surgery and no contrast media related complications were noted in either group. A post-operative femoral pulse was present in 88.9% of the iodine group and 80% of the carbon dioxide group. No differences in procedure length, endovascular material cost or renal function variation were noted between the groups. Four patients in the carbon dioxide group required iodine supplementation to complete the procedure. Contrast media expenses were reduced in the carbon dioxide group. Regarding angiographic image quality, 82% of the carbon dioxide images were graded as either good or fair by observers. CONCLUSIONS: The use of carbon dioxide contrast medium is a good option for ilio-femoral angioplasty in patients without contraindications to iodine and is not characterized by differences in endovascular material costs, procedure duration and surgical outcomes. In addition, carbon dioxide has lower contrast expenses compared with iodine.
- Published
- 2015
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