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Pedro Puechleao - One of the best experts on this subject based on the ideXlab platform.

  • long term efficacy of oxybutynin for palmar and plantar Hyperhidrosis in children younger than 14 years
    Pediatric Dermatology, 2015
    Co-Authors: Nelson Wolosker, Mariana Krutman, Paulo Kauffman, Jose Ribas Milanez De Campos, P Marcelo M D Teivelis, P Rafael M D De Paula, Claudio Schvartsman, Pedro Puechleao
    Abstract:

    Oxybutynin for treating Hyperhidrosis in children has been evaluated only in short-term studies. We aimed to investigate the long-term effects of oxybutynin in treating children with palmar and plantar Hyperhidrosis who had not undergone surgery and who were monitored for at least 6 months (median 19.6 mos). A cohort of 97 patients was evaluated retrospectively, with particular attention to 59 children (ages 4-14 yrs) who were treated for longer than 6 months. Their quality of life (QOL) was evaluated using a validated clinical questionnaire before and after 6 weeks of pharmacologic therapy. A self-assessment of Hyperhidrosis was performed after 6 weeks and after the last consultation. By their final office visit, more than 91% of the children with Hyperhidrosis treated with oxybutynin experienced moderate or great improvement in their level of sweating and 94.9% experienced improvement in QOL. More than 90% of children reported improvement of Hyperhidrosis at other sites. Dry mouth was the most common side effect. Oxybutynin appears to be an effective treatment option for children with Hyperhidrosis, and positive results are maintained over the long term (median 19.6 mos).

  • long term results of oxybutynin use in treating facial Hyperhidrosis
    Anais Brasileiros De Dermatologia, 2014
    Co-Authors: Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Taiz Pereira Dozono De Almeida Campbell, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro Puechleao
    Abstract:

    BACKGROUND: Facial Hyperhidrosis can lead to serious emotional distress. Video-assisted thoracic sympathectomy resolves symptoms effectively, though it may be associated with compensatory Hyperhidrosis, which may be more common in patients undergoing resection of the second thoracic ganglion. Oxybutynin has been used as a pharmacological approach to facial Hyperhidrosis but the long-term results of this treatment are unclear. OBJECTIVE: To evaluate the use of low oxybutynin doses in facial Hyperhidrosis patients for at least six months. METHODS: 61 patients were monitored for over six months and assessed according to the following variables: impact of Hyperhidrosis on quality of life (QOL) before treatment and after six weeks, evolution of facial Hyperhidrosis after six weeks and at the last consultation, complaints of dry mouth after six weeks and on last return visit, and improvement at other Hyperhidrosis sites. RESULTS: Patients were monitored for 6 to 61 months (median=17 months). Thirty-six (59%) were female. Age ranged from 17-74 (median:45). Pre-treatment QOL was poor/very poor in 96.72%. After six weeks, 100% of patients improved QOL. Comparing results after six weeks and on the last visit, 91.8% of patients maintained the same category of improvement in facial Hyperhidrosis, 3.3% worsened and 4.9% improved. Dry mouth complaints were common but not consistent throughout treatment. More than 90% of patients presented moderate/great improvement at other Hyperhidrosis sites. CONCLUSION: Patients who had a good initial response to treatment maintained a good response long-term, did not display tachiphylaxis and experienced improvement on other Hyperhidrosis sites.

  • quality of life before Hyperhidrosis treatment as a predictive factor for oxybutynin treatment outcomes in palmar and axillary Hyperhidrosis
    Annals of Vascular Surgery, 2014
    Co-Authors: Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Taiz Pereira Dozono De Almeida Campbell, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro Puechleao
    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.

  • analysis of oxybutynin treatment for Hyperhidrosis in patients aged over 40 years
    Einstein (São Paulo), 2014
    Co-Authors: Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Paulo Kauffman, Jose Ribas Milanez De Campos, Rafael Pessanha De Paula, Pedro Puechleao
    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.

  • effectiveness of oxybutynin for treatment of Hyperhidrosis in overweight and obese patients
    Revista Da Associacao Medica Brasileira, 2013
    Co-Authors: Nelson Wolosker, Mariana Krutman, Paulo Kauffman, Jose Ribas Milanez De Campos, Rafael Pessanha De Paula, Pedro Puechleao
    Abstract:

    OBJECTIVE: Until the present moment, the lack of efficient therapeutic options available for Hyperhidrosis treatment in obese patients has left this population without prospect of clinical or quality of life (QOL) improvements. Outcomes of oxybutynin treatment for overweight and obese patients with Hyperhidrosis are unknown. This study aims to investigate the results related to clinical and QOL improvements in this specific population, submitted to a 12-week protocol treatment with oxybutynin. METHODS: 559 patients with palmar and axillary Hyperhidrosis, routinely followed in this service, were divided into the groups, according to their body mass index (BMI) ( 30 kg/m2). Improvements in QOL and in the level of Hyperhidrosis were analyzed after 12 weeks of protocol treatment with oxybutynin. These parameters were investigated using a scoring system based on a scientifically validated clinical questionnaire, applied before and after treatment. RESULTS: 67.8% of the overweight sample group and 63% of the obese patients presented "partial" or "great" improvement in the level of Hyperhidrosis. Over 65% of patients demonstrated improvement in QOL ("much better" or "slightly better") for all three groups, with no statistical difference between them. The only adverse event associated with oxybutynin was dry mouth, observed in 63.0% of the patients. CONCLUSION: Overweight and obese patients with palmar or axillary Hyperhidrosis present significant improvement in QOL after treatment with oxybutynin, and the results are comparable to those of normal weight individuals.

Nelson Wolosker - One of the best experts on this subject based on the ideXlab platform.

  • the relation between age and outcomes of thoracic sympathectomy for Hyperhidrosis the older the better
    The Journal of Thoracic and Cardiovascular Surgery, 2018
    Co-Authors: Dafne Braga Diamante Leiderman, Marcelo Passos Teivelis, Paulo Kauffman, Jose Ribas Milanez De Campos, Guilherme Yazbek, Miguel Lia Tedde, Nelson Wolosker
    Abstract:

    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.

  • long term efficacy of oxybutynin for palmar and plantar Hyperhidrosis in children younger than 14 years
    Pediatric Dermatology, 2015
    Co-Authors: Nelson Wolosker, Mariana Krutman, Paulo Kauffman, Jose Ribas Milanez De Campos, P Marcelo M D Teivelis, P Rafael M D De Paula, Claudio Schvartsman, Pedro Puechleao
    Abstract:

    Oxybutynin for treating Hyperhidrosis in children has been evaluated only in short-term studies. We aimed to investigate the long-term effects of oxybutynin in treating children with palmar and plantar Hyperhidrosis who had not undergone surgery and who were monitored for at least 6 months (median 19.6 mos). A cohort of 97 patients was evaluated retrospectively, with particular attention to 59 children (ages 4-14 yrs) who were treated for longer than 6 months. Their quality of life (QOL) was evaluated using a validated clinical questionnaire before and after 6 weeks of pharmacologic therapy. A self-assessment of Hyperhidrosis was performed after 6 weeks and after the last consultation. By their final office visit, more than 91% of the children with Hyperhidrosis treated with oxybutynin experienced moderate or great improvement in their level of sweating and 94.9% experienced improvement in QOL. More than 90% of children reported improvement of Hyperhidrosis at other sites. Dry mouth was the most common side effect. Oxybutynin appears to be an effective treatment option for children with Hyperhidrosis, and positive results are maintained over the long term (median 19.6 mos).

  • long term results of oxybutynin use in treating facial Hyperhidrosis
    Anais Brasileiros De Dermatologia, 2014
    Co-Authors: Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Taiz Pereira Dozono De Almeida Campbell, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro Puechleao
    Abstract:

    BACKGROUND: Facial Hyperhidrosis can lead to serious emotional distress. Video-assisted thoracic sympathectomy resolves symptoms effectively, though it may be associated with compensatory Hyperhidrosis, which may be more common in patients undergoing resection of the second thoracic ganglion. Oxybutynin has been used as a pharmacological approach to facial Hyperhidrosis but the long-term results of this treatment are unclear. OBJECTIVE: To evaluate the use of low oxybutynin doses in facial Hyperhidrosis patients for at least six months. METHODS: 61 patients were monitored for over six months and assessed according to the following variables: impact of Hyperhidrosis on quality of life (QOL) before treatment and after six weeks, evolution of facial Hyperhidrosis after six weeks and at the last consultation, complaints of dry mouth after six weeks and on last return visit, and improvement at other Hyperhidrosis sites. RESULTS: Patients were monitored for 6 to 61 months (median=17 months). Thirty-six (59%) were female. Age ranged from 17-74 (median:45). Pre-treatment QOL was poor/very poor in 96.72%. After six weeks, 100% of patients improved QOL. Comparing results after six weeks and on the last visit, 91.8% of patients maintained the same category of improvement in facial Hyperhidrosis, 3.3% worsened and 4.9% improved. Dry mouth complaints were common but not consistent throughout treatment. More than 90% of patients presented moderate/great improvement at other Hyperhidrosis sites. CONCLUSION: Patients who had a good initial response to treatment maintained a good response long-term, did not display tachiphylaxis and experienced improvement on other Hyperhidrosis sites.

  • quality of life before Hyperhidrosis treatment as a predictive factor for oxybutynin treatment outcomes in palmar and axillary Hyperhidrosis
    Annals of Vascular Surgery, 2014
    Co-Authors: Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Taiz Pereira Dozono De Almeida Campbell, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro Puechleao
    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.

  • analysis of oxybutynin treatment for Hyperhidrosis in patients aged over 40 years
    Einstein (São Paulo), 2014
    Co-Authors: Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Paulo Kauffman, Jose Ribas Milanez De Campos, Rafael Pessanha De Paula, Pedro Puechleao
    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.

Jose Ribas Milanez De Campos - One of the best experts on this subject based on the ideXlab platform.

  • the relation between age and outcomes of thoracic sympathectomy for Hyperhidrosis the older the better
    The Journal of Thoracic and Cardiovascular Surgery, 2018
    Co-Authors: Dafne Braga Diamante Leiderman, Marcelo Passos Teivelis, Paulo Kauffman, Jose Ribas Milanez De Campos, Guilherme Yazbek, Miguel Lia Tedde, Nelson Wolosker
    Abstract:

    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.

  • long term efficacy of oxybutynin for palmar and plantar Hyperhidrosis in children younger than 14 years
    Pediatric Dermatology, 2015
    Co-Authors: Nelson Wolosker, Mariana Krutman, Paulo Kauffman, Jose Ribas Milanez De Campos, P Marcelo M D Teivelis, P Rafael M D De Paula, Claudio Schvartsman, Pedro Puechleao
    Abstract:

    Oxybutynin for treating Hyperhidrosis in children has been evaluated only in short-term studies. We aimed to investigate the long-term effects of oxybutynin in treating children with palmar and plantar Hyperhidrosis who had not undergone surgery and who were monitored for at least 6 months (median 19.6 mos). A cohort of 97 patients was evaluated retrospectively, with particular attention to 59 children (ages 4-14 yrs) who were treated for longer than 6 months. Their quality of life (QOL) was evaluated using a validated clinical questionnaire before and after 6 weeks of pharmacologic therapy. A self-assessment of Hyperhidrosis was performed after 6 weeks and after the last consultation. By their final office visit, more than 91% of the children with Hyperhidrosis treated with oxybutynin experienced moderate or great improvement in their level of sweating and 94.9% experienced improvement in QOL. More than 90% of children reported improvement of Hyperhidrosis at other sites. Dry mouth was the most common side effect. Oxybutynin appears to be an effective treatment option for children with Hyperhidrosis, and positive results are maintained over the long term (median 19.6 mos).

  • long term results of oxybutynin use in treating facial Hyperhidrosis
    Anais Brasileiros De Dermatologia, 2014
    Co-Authors: Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Taiz Pereira Dozono De Almeida Campbell, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro Puechleao
    Abstract:

    BACKGROUND: Facial Hyperhidrosis can lead to serious emotional distress. Video-assisted thoracic sympathectomy resolves symptoms effectively, though it may be associated with compensatory Hyperhidrosis, which may be more common in patients undergoing resection of the second thoracic ganglion. Oxybutynin has been used as a pharmacological approach to facial Hyperhidrosis but the long-term results of this treatment are unclear. OBJECTIVE: To evaluate the use of low oxybutynin doses in facial Hyperhidrosis patients for at least six months. METHODS: 61 patients were monitored for over six months and assessed according to the following variables: impact of Hyperhidrosis on quality of life (QOL) before treatment and after six weeks, evolution of facial Hyperhidrosis after six weeks and at the last consultation, complaints of dry mouth after six weeks and on last return visit, and improvement at other Hyperhidrosis sites. RESULTS: Patients were monitored for 6 to 61 months (median=17 months). Thirty-six (59%) were female. Age ranged from 17-74 (median:45). Pre-treatment QOL was poor/very poor in 96.72%. After six weeks, 100% of patients improved QOL. Comparing results after six weeks and on the last visit, 91.8% of patients maintained the same category of improvement in facial Hyperhidrosis, 3.3% worsened and 4.9% improved. Dry mouth complaints were common but not consistent throughout treatment. More than 90% of patients presented moderate/great improvement at other Hyperhidrosis sites. CONCLUSION: Patients who had a good initial response to treatment maintained a good response long-term, did not display tachiphylaxis and experienced improvement on other Hyperhidrosis sites.

  • quality of life before Hyperhidrosis treatment as a predictive factor for oxybutynin treatment outcomes in palmar and axillary Hyperhidrosis
    Annals of Vascular Surgery, 2014
    Co-Authors: Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Taiz Pereira Dozono De Almeida Campbell, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro Puechleao
    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.

  • analysis of oxybutynin treatment for Hyperhidrosis in patients aged over 40 years
    Einstein (São Paulo), 2014
    Co-Authors: Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Paulo Kauffman, Jose Ribas Milanez De Campos, Rafael Pessanha De Paula, Pedro Puechleao
    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.

Paulo Kauffman - One of the best experts on this subject based on the ideXlab platform.

  • the relation between age and outcomes of thoracic sympathectomy for Hyperhidrosis the older the better
    The Journal of Thoracic and Cardiovascular Surgery, 2018
    Co-Authors: Dafne Braga Diamante Leiderman, Marcelo Passos Teivelis, Paulo Kauffman, Jose Ribas Milanez De Campos, Guilherme Yazbek, Miguel Lia Tedde, Nelson Wolosker
    Abstract:

    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.

  • long term efficacy of oxybutynin for palmar and plantar Hyperhidrosis in children younger than 14 years
    Pediatric Dermatology, 2015
    Co-Authors: Nelson Wolosker, Mariana Krutman, Paulo Kauffman, Jose Ribas Milanez De Campos, P Marcelo M D Teivelis, P Rafael M D De Paula, Claudio Schvartsman, Pedro Puechleao
    Abstract:

    Oxybutynin for treating Hyperhidrosis in children has been evaluated only in short-term studies. We aimed to investigate the long-term effects of oxybutynin in treating children with palmar and plantar Hyperhidrosis who had not undergone surgery and who were monitored for at least 6 months (median 19.6 mos). A cohort of 97 patients was evaluated retrospectively, with particular attention to 59 children (ages 4-14 yrs) who were treated for longer than 6 months. Their quality of life (QOL) was evaluated using a validated clinical questionnaire before and after 6 weeks of pharmacologic therapy. A self-assessment of Hyperhidrosis was performed after 6 weeks and after the last consultation. By their final office visit, more than 91% of the children with Hyperhidrosis treated with oxybutynin experienced moderate or great improvement in their level of sweating and 94.9% experienced improvement in QOL. More than 90% of children reported improvement of Hyperhidrosis at other sites. Dry mouth was the most common side effect. Oxybutynin appears to be an effective treatment option for children with Hyperhidrosis, and positive results are maintained over the long term (median 19.6 mos).

  • long term results of oxybutynin use in treating facial Hyperhidrosis
    Anais Brasileiros De Dermatologia, 2014
    Co-Authors: Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Taiz Pereira Dozono De Almeida Campbell, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro Puechleao
    Abstract:

    BACKGROUND: Facial Hyperhidrosis can lead to serious emotional distress. Video-assisted thoracic sympathectomy resolves symptoms effectively, though it may be associated with compensatory Hyperhidrosis, which may be more common in patients undergoing resection of the second thoracic ganglion. Oxybutynin has been used as a pharmacological approach to facial Hyperhidrosis but the long-term results of this treatment are unclear. OBJECTIVE: To evaluate the use of low oxybutynin doses in facial Hyperhidrosis patients for at least six months. METHODS: 61 patients were monitored for over six months and assessed according to the following variables: impact of Hyperhidrosis on quality of life (QOL) before treatment and after six weeks, evolution of facial Hyperhidrosis after six weeks and at the last consultation, complaints of dry mouth after six weeks and on last return visit, and improvement at other Hyperhidrosis sites. RESULTS: Patients were monitored for 6 to 61 months (median=17 months). Thirty-six (59%) were female. Age ranged from 17-74 (median:45). Pre-treatment QOL was poor/very poor in 96.72%. After six weeks, 100% of patients improved QOL. Comparing results after six weeks and on the last visit, 91.8% of patients maintained the same category of improvement in facial Hyperhidrosis, 3.3% worsened and 4.9% improved. Dry mouth complaints were common but not consistent throughout treatment. More than 90% of patients presented moderate/great improvement at other Hyperhidrosis sites. CONCLUSION: Patients who had a good initial response to treatment maintained a good response long-term, did not display tachiphylaxis and experienced improvement on other Hyperhidrosis sites.

  • quality of life before Hyperhidrosis treatment as a predictive factor for oxybutynin treatment outcomes in palmar and axillary Hyperhidrosis
    Annals of Vascular Surgery, 2014
    Co-Authors: Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Taiz Pereira Dozono De Almeida Campbell, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro Puechleao
    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.

  • analysis of oxybutynin treatment for Hyperhidrosis in patients aged over 40 years
    Einstein (São Paulo), 2014
    Co-Authors: Nelson Wolosker, Mariana Krutman, Marcelo Passos Teivelis, Paulo Kauffman, Jose Ribas Milanez De Campos, Rafael Pessanha De Paula, Pedro Puechleao
    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.

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  • quality of life before surgery is a predictive factor for satisfaction among patients undergoing sympathectomy to treat Hyperhidrosis
    Journal of Vascular Surgery, 2010
    Co-Authors: Nelson Wolosker, Paulo Kauffman, Jose Ribas Milanez De Campos, Marco Antonio Munia, Guilherme Yazbek, Fabio Biscegli Jatene, Pedro Puechleao
    Abstract:

    Purpose The objective of this study was to evaluate the postoperative quality of life (QOL) experienced among a group of 1167 patients who underwent video-assisted thoracoscopic sympathectomy (VATS) to treat primary Hyperhidrosis, as compared with the presurgical QOL. Methods Between February 2002 and June 2007, 1167 patients who had undergone VATS were surveyed. The majority had presented with palmar Hyperhidrosis (794 patients; 68%), while 340 (29%) had presented with axillary Hyperhidrosis. Based on data obtained from the QOL protocol applied to all of the patients preoperatively, the patients were divided into two groups according to the level of their QOL: group 1 consisted of 312 patients (27%) with poor QOL and group 2 of 855 patients (73%) with very poor QOL. The same protocol was applied postoperatively, and five different levels of satisfaction were obtained. The same parameters were evaluated for both the palmar and the axillary Hyperhidrosis subgroups. Results The patients with very poor QOL had much better results in terms of improvement in QOL than did those with poor QOL ( P P Conclusion The worse the preoperative QOL among patients undergoing sympathectomy to treat primary Hyperhidrosis is, the better the postoperative improvement in QOL will be.

  • sustained benefit lasting one year from t4 instead of t3 t4 sympathectomy for isolated axillary Hyperhidrosis
    Clinics, 2008
    Co-Authors: Marco Antonio Munia, Nelson Wolosker, Paulo Kaufmann, Jose Ribas Milanes De Campos, Pedro Puechleao
    Abstract:

    INTRODUCTION: Level T4 video-assisted thoracoscopic sympathectomy proved superior to T3-T4 treatment for controlling axillary Hyperhidrosis at the initial and six-month follow-ups of these patients. OBJECTIVE: To compare the results of two levels of sympathectomy (T3-T4 vs. T4) for treating axillary sudoresis over one year of follow-up. METHODS: Sixty-four patients with axillary Hyperhidrosis were randomized to denervation of T3-T4 or T4 alone and followed prospectively. All patients were examined preoperatively and were followed postoperatively for one year. Axillary Hyperhidrosis treatment was evaluated, along with the presence, location, and severity of compensatory Hyperhidrosis and self-reported quality of life. RESULTS: According to patient reports after one year, all cases of axillary Hyperhidrosis were successfully treated by surgery. There were no instances of treatment failure. After six months, compensatory Hyperhidrosis was present in 27 patients of the T3-T4 group (87.1%) and in 16 patients of the T4 group (48.5%). After one year, all T3-T4 patients experienced some degree of compensatory Hyperhidrosis, compared to only 14 patients in the T4 group (42.4%). In addition, compensatory Hyperhidrosis was less severe in the T4 patients (p < 0.01). Quality of life was poor before surgery, and it improved in both groups at six months and one year of follow-up (p = 0.002). There were no cases of mortality, no significant postoperative complications, and no need for conversion to thoracotomy in either group. CONCLUSION: Both techniques were effective for treating axillary Hyperhidrosis, but the T4 group showed milder compensatory Hyperhidrosis and greater patient satisfaction at the one-year follow-up.

  • a randomized trial of t3 t4 versus t4 sympathectomy for isolated axillary Hyperhidrosis
    Journal of Vascular Surgery, 2007
    Co-Authors: Marco Antonio Munia, Nelson Wolosker, Paulo Kauffman, Jose Ribas Milanez De Campos, Pedro Puechleao
    Abstract:

    Introduction Video-assisted thoracic sympathectomy (VATS) is one minimally invasive definitive treatment for axillary Hyperhidrosis. Different techniques exist for controlling axillary sudoresis, but they are temporary and have high cost. This study was conducted to compare the initial results from sympathectomy using two distinct levels for treating axillary sudoresis: T3-T4 vs T4. Methods Sixty-two patients with axillary Hyperhidrosis were prospectively randomized for denervation of T3-T4 or T4 alone. All patients were examined preoperatively and were followed-up at 1 and 6 months postoperatively. Evaluated were the axillary Hyperhidrosis treatment, the presence, location, and severity of compensatory Hyperhidrosis, and the quality of life. Results All the patients said that their axillary Hyperhidrosis was successfully treated by the surgery after 6 months. There was no treatment failure. Compensatory Hyperhidrosis was present in 29 patients (90.6%) of the T3-T4 group and in 17 T4 patients (56.7%) after 1 month. After 6 months, all the T3-T4 patients presented some degree of compensatory Hyperhidrosis vs 13 T4 patients (43.3%). The severity of the compensatory Hyperhidrosis was also lower in the T4 patients (P Conclusion Both techniques are effective for treating axillary Hyperhidrosis, but the T4 group presented milder compensatory Hyperhidrosis and had a greater satisfaction rate.