Publications by authors named "Antonio José Maria Cataneo"

42 Publications

Thoracic sympathectomy for the treatment of primary axillary hyperhidrosis: systematic review and proportional meta-analysis.

Ann Med 2021 12;53(1):1216-1226

Department of Surgery, Division of Thoracic Surgery, Botucatu School of Medicine, São Paulo State University, UNESP, São Paulo, Brazil.

Introduction: Primary hyperhidrosis is a disorder that involves excessive sweat production, which has a negative impact on the quality of life.

Objective: To evaluate the effectiveness and safety of video-assisted thoracoscopic sympathectomy (VATS) for treating primary axillary hyperhidrosis (PAH) and determine which level of ganglion resection offers the best outcome.

Method: This was a systematic review and proportional meta-analysis of observational studies. The result was evaluated for satisfaction, control of symptoms, compensatory sweating and complications. A subgroup analysis was performed to compare the sympathetic trunk resection at high and low levels.

Results: Thirteen studies were selected with a total of 1463 patients. The satisfaction rate was 92% (95% CI = 88-95%, =47.5%), the symptom control rate was 96% (95% CI = 93-99%, =48.2%), and the presence of compensatory sweating could not be assessed because of high heterogeneity among studies. The complications were rare.

Conclusion: This review demonstrated that thoracic sympathectomy by VATS is a viable and safe option for the treatment of PAH. There was no difference between high and lower levels of resection. However, the estimation of the effect is quite uncertain because the quality of evidence was extremely low.Key messagePure axillary hyperhidrosis has great potential to compromise quality of life.Surgery should be indicated only when clinical treatment fails.Thoracic sympathectomy by video-assisted thoracoscopy is a viable and safe option for the treatment of primary axillary hyperhidrosis.
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http://dx.doi.org/10.1080/07853890.2021.1953126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293952PMC
December 2021

Telomere-associated genes and telomeric lncRNAs are biomarker candidates in lung squamous cell carcinoma (LUSC).

Exp Mol Pathol 2020 02 16;112:104354. Epub 2019 Dec 16.

Genetics Dept., Biosciences Institute, Sao Paulo State University (UNESP), Botucatu, SP, Brazil. Electronic address:

In the past decade, research efforts were made to identify molecular biomarkers useful as therapeutic targets in Non-Small Cell Lung Cancer (NSCLC), the most frequent type of lung carcinoma. NSCLC presents different histological subtypes being the most prevalent LUSC (Lung Squamous Cell Cancer) and LUAD (Lung Adenocarcinoma), and only a subset of LUAD patients' present tumors expressing known targetable genetic alterations. Telomeres and its components, including telomerase, the enzyme that replenishes telomeres, have been considered potential cancer biomarkers due to their crucial role in cell proliferation and genome stability. Our study aims to quantify expression changes affecting telomere-associated genes and ncRNAs associated with telomere regulation and maintenance in NSCLC. We first assessed the transcriptome (RNA-Seq) data of NSCLC patients from The Cancer Genome Atlas (TCGA) and then we tested the expression of telomere-associated genes and telomeric ncRNAs (TERC, telomerase RNA component, and TERRA, telomere repeat-containing RNA) in Brazilian NCSLC patient samples by quantitative RT-PCR, using matched normal adjacent tissue samples as the control. We also estimated the mean size of terminal restriction fragments (TRF) of some Brazilian NSCLC patients using telomeric Southern blot. The TCGA analysis identified alterations in the expression profile of TERT and telomere damage repair genes, mainly in the LUSC subtype. The study of Brazilian NSCLC samples by RT-qPCR showed that LUSC and LUAD express high amounts of TERT and that although the mean TRF size of tumor samples was shorter compared to normal cells, telomeres in NSCLC are probably maintained by telomerase. Also, the expression analysis of Brazilian NSCLC samples identified statistically significant alterations in the expression of genes involved with telomere damage repair, as well as in TERC and TERRA, mainly in the LUSC subtype. We, therefore, concluded that telomere maintenance genes are significantly deregulated in NSCLC, representing potential biomarkers in the LUSC subtype.
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http://dx.doi.org/10.1016/j.yexmp.2019.104354DOI Listing
February 2020

Success of endoscopic dacryocystorhinostomy with or without stents: systematic review and meta-analysis.

Orbit 2020 Aug 29;39(4):258-265. Epub 2019 Oct 29.

Faculdade de Medicina - Campus de Botucatu, Universidade Estadual Paulista Julio de Mesquita Filho (UNESP) , Botucatu, Brazil.

Purpose: To evaluate the effect of stents on the success of endoscopic dacryocystorhinostomy (DCR-EN) for treating primary acquired nasolacrimal duct obstruction (NLDO).

Method: A systematic review of randomized clinical trials of DCR-EN for NLDO comparing outcomes of surgeries performed with and without the use of bicanalicular stents and the complications associated with each procedure. Two authors independently searched six databases (Scopus, PubMed, EMBASE, Google Scholar, Cochrane Central Register of Controlled Trials, and Web of Science) up to May 2019. Statistical analysis and meta-analysis were performed using RevMan 5.3 software provided by the Cochrane Collaboration.

Results: Twelve studies involving 997 surgeries were included in this systematic review. The meta-analysis using a fixed-effects model showed a 94% success rate with stents versus 90.6% without stent. Although stent use favors greater success of DCR-EN, the confidence interval (CI) was wide and very close to nullity line (1.01), decreasing the strength of the recommendation for stent (odds ratio: 1.62, 95% CI: 1.01-2.59,  = 0%). Meta-analysis of the adverse effects was not possible. A descriptive analysis was performed of the general complications related to the stents.

Conclusions: There is evidence that the use of bicanalicular stents slightly improves the success rate of DCR-EN, but the quality of evidence is low. Future prospective, randomized trials enrolling larger sample sizes may provide stronger evidence to determine whether the stent use influences the success of primary acquired DCR-EN.
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http://dx.doi.org/10.1080/01676830.2019.1677726DOI Listing
August 2020

Radiofrequency in the treatment of primary hyperhidrosis: systematic review and meta-analysis.

Clin Auton Res 2020 04 24;30(2):111-120. Epub 2019 Sep 24.

Division of Thoracic Surgery, Botucatu School of Medicine, São Paulo State University-UNESP, Botucatu, SP, CEP 18618-970, Brazil.

Purpose: To evaluate, via a systematic review, the effectiveness of radiofrequency (RF) for treatment of primary hyperhidrosis (PH).

Methods: Experimental or observational studies were included where RF treatment (ablation or microneedling) was performed, comparing the periods before and after treatment.

Results: Nine studies were considered eligible and included for analysis. In seven of nine studies, patients were subjected to RF only, and in two of nine studies RF was compared to video-assisted thoracoscopic sympathectomy (VATS). There was a reduction in the severity of PH in microneedling (three studies, mean difference -1.24, 95% CI -1.44 to -1.03). In a study that performed sympathetic RF ablation there was a greater reduction in PH severity compared to studies that performed microneedling (-2.42, 95% CI -2.55 to -2.29). There was improvement in the quality of life (QoL) after sympathetic RF ablation (two studies, mean difference -15.92, 95% CI -17.61 to -14.24). Regarding the microneedling procedure, there was a lower improvement in QoL, (two studies, -9.0, 95% CI -9.15 to -8.85). One study comparing sympathetic RF ablation with VATS applied the QoL questionnaire, and the VATS showed superior results. One of the two studies comparing compensatory sweating in RF ablation with VATS showed that compensatory hyperhidrosis was higher in VATS; however, the other study did not observe this difference. One study compared the recurrence of symptoms between VATS and RF ablation; symptom recurrence was shown to be higher in RF.

Conclusions: RF is effective for PH treatment, with superior results obtained with sympathetic ablation compared to microneedling.
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http://dx.doi.org/10.1007/s10286-019-00640-wDOI Listing
April 2020

Clinical usefulness of prethymectomy plasmapheresis in patients with myasthenia gravis: a systematic review and meta-analysis.

Interact Cardiovasc Thorac Surg 2019 12;29(6):867-875

Department of Surgery, Botucatu School of Medicine, São Paulo State University, UNESP, São Paulo, Brazil.

Objectives: Our goal was to evaluate, through a systematic review, the efficacy of plasmapheresis in the preoperative preparation of the patient for a thymectomy for the treatment of myasthenia gravis.

Methods: MEDLINE, Embase, LILACS, Scopus and CENTRAL databases were searched. The following outcomes were evaluated: myasthenic crisis, mortality, pneumonia, bleeding, use of mechanical ventilation, length of hospital stay and intensive care unit (ICU) stay. RevMan 5.3 software provided by the Cochrane Collaboration was used for the meta-analysis.

Results: The total number of patients evaluated in the 7 included studies was 360. Plasmapheresis during the preoperative period did not decrease the myasthenic crisis [risk ratio (RR) 0.36, 95% confidence interval (CI) 0.08-1.66; I2 = 44%; 5 studies, 243 patients]. There was also no change in the mortality rate (RR 0.7, 95% CI 0.11-4.62; I2 = 0%; 3 studies, 172 patients) or pneumonia cases (RR 0.28, 95% CI 0.07-1.09; I2 = 27%; 5 studies, 272 patients). Bleeding was greater in patients who underwent plasmapheresis (mean difference 34.34 ml; 95% CI 24.93-43.75; I2 = 0%). We evaluated the following outcomes: need for mechanical ventilation, hospital stay, ICU stay and mechanical ventilation, but these outcomes were not adequate to perform the meta-analysis due to the high heterogeneity among the studies. Subgroup analysis showed that plasmapheresis performed during the preoperative period in patients with severe disease (Osserman III and IV) decreased the myasthenic crisis postoperatively (RR 0.12, 95% CI 0.02-0.65; I2 = 63%).

Conclusions: Plasmapheresis may reduce the myasthenic crisis during the postoperative period in patients with severe disease but may produce little or no difference in patients with mild clinical expression of the disease.
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http://dx.doi.org/10.1093/icvts/ivz186DOI Listing
December 2019

Mitomycin C in the endoscopic treatment of tracheal stenosis: a prospective cohort study.

J Bras Pneumol 2018 Nov-Dec;44(6):486-490

. Departamento de Cirurgia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil.

Objective: To evaluate the efficacy of mitomycin C (MMC) in the endoscopic treatment of tracheal stenosis.

Methods: Patients with laryngotracheal, tracheal, or tracheobronchial stenosis were treated with dilation and topical MMC. The inclusion criteria were as follows: being ineligible for surgery (for medical reasons) at the time of evaluation; membranous stenosis responding well to dilation; and postoperative stenosis at the anastomosis site. Etiology of stenosis and indication for treatment with MMC, as well as site, length, and percentage of stenosis, together with presence of tracheostomy and duration of follow-up, were analyzed. The outcomes evaluated were symptom-free interval ≥ 12 months, number of dilations with topical application of MMC, and complications.

Results: Twenty-two patients (15 men and 7 women) were treated between 2003 and 2010. Stenosis was due to endotracheal intubation in 15 patients and surgery in 8. Pure tracheal stenosis was encountered in 13 patients, subglottic stenosis was encountered in 4, tracheobronchial stenosis was encountered in 3, and complex stenosis was encountered in 2. The length of stenosis ranged from 0.5 cm to 2.5 cm, and the percentage of stenosis ranged from 40% to 100%. Nine patients had undergone tracheostomy and had a Montgomery T-tube in situ. Treatment was successful in 14 patients, who remained free of symptoms for at least 12 months. The number of topical applications of MMC ranged from 1 to 5, and complications included fungal infection, keloid scarring, granuloma, and mediastinal emphysema.

Conclusions: MMC appears to be effective in the endoscopic treatment of tracheal stenosis.
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http://dx.doi.org/10.1590/S1806-37562017000000423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459742PMC
March 2019

Barium Enema Revisited in the Workup for the Diagnosis of Hirschsprung's Disease.

J Pediatr Gastroenterol Nutr 2019 04;68(4):e62-e66

Department of Radiology, Mega Imagem Clinic, Santos, São Paulo, Brazil.

Objective: To analyse the diagnostic capacity of barium enema (BE) in the diagnostic investigation for Hirschsprung's disease (HD) was analyzed for transition zone (TZ) identification and rectosigmoid index (RSI) ≤1.0 determination.

Patients And Methods: BE images were analyzed retrospectively by 2 examiners and the results were compared with the histopathology of rectal biopsies.

Results: TZ identification and RSI ≤1.0 were assessed separately and combined in 43 patients. Twelve (27.9%) patients had the diagnosis of HD based on rectal biopsies. TZ identification presented better diagnostic capacity for the 2 examiners than RSI ≤1.0. However, interexaminer agreement was higher for RSI ≤1.0 than for TZ identification. The combination of TZ identification and RSI ≤1.0 increased the sensitivity (83.3%-92.3%) and the negative predictive value (90.4%-92.3%).

Conclusion: Therefore, the high diagnostic sensitivity of TZ identification combined to RSI ≤1.0 reinforces the usefulness of these BE parameters in the screening for Hirschsprung's disease.
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http://dx.doi.org/10.1097/MPG.0000000000002242DOI Listing
April 2019

Hyperhidrosis: prevalence and impact on quality of life.

J Bras Pneumol 2018 Jul-Aug;44(4):292-298. Epub 2018 Jul 30.

. Serviço de Cirurgia Torácica, Departamento de Cirurgia e Ortopedia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista - UNESP - Botucatu (SP) Brasil.

Objective: To determine the prevalence of primary hyperhidrosis in the city of Botucatu, Brazil, and to evaluate how this disorder affects the quality of life in those suffering from it.

Methods: A population survey was conducted in order to identify cases of hyperhidrosis among residents in the urban area of the city, selected by systematic cluster sampling. In accordance with the census maps of the city, the sample size should be at least 4,033 participants. Ten interviewers applied a questionnaire that evaluated the presence of excessive sweating and invited the subjects who reported hyperhidrosis to be evaluated by a physician in order to confirm the diagnosis.

Results: A total of 4,133 residents, in 1,351 households, were surveyed. Excessive sweating was reported by 85 residents (prevalence = 2.07%), of whom 51 (60%) were female. Of those 85 respondents, 51 (60%) agreed to undergo medical evaluation to confirm the diagnosis and only 23 (45%) were diagnosed with primary hyperhidrosis (prevalence = 0.93%). Of the 23 subjects diagnosed with primary hyperhidrosis, 11 (48%) reported poor or very poor quality of life.

Conclusions: Although the prevalence of self-reported excessive sweating was greater than 2%, the actual prevalence of primary hyperhidrosis in our sample was 0.93% and nearly 50% of the respondents with primary hyperhidrosis reported impaired quality of life.
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http://dx.doi.org/10.1590/S1806-37562017000000379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326708PMC
March 2019

Outcome of Percutaneous Radiofrequency Thoracic Sympathectomy for Palmar Hyperhidrosis.

Semin Thorac Cardiovasc Surg 2018 Autumn;30(3):362-366. Epub 2018 Jul 11.

Division of Thoracic Surgery. Botucatu School of Medicine, São Paulo State University - UNESP, Brazil.

The impact of upper thoracic percutaneous sympathectomy with radiofrequency on the quality of life (QOL) of patients with palmar hyperhidrosis was evaluated. Thirty-six patients with palmar hyperhidrosis were selected for a prospective observational study. Treatment consisted of percutaneous radiofrequency thoracic sympathectomy of T3 and T4 ganglions in all cases. QOL questionnaires were applied preoperatively, on the 1st postoperative (PO) day, and on the 30th, 90th, 180th, and 360th PO days. Furthermore, compensatory hyperhidrosis (HDSSc) scale measures were used simultaneously, in order to evaluate the rate and frequency of this side effect. The QOL questionnaire evaluation showed preoperative values of 83.94 ± 4.74 (meaning poor quality of life), decreasing to 24.61 ± 2.86 on the 1st PO day, 25.14 ± 3.12 on the 30th PO day, 31.28 ± 4.42 on the 90th PO day, 32.97 ± 4.54 on the 180th PO day, and 33.94 ± 4.6 on the 360th PO day (all postoperative results with values below 35 were considered optimal). Compensatory hyperhidrosis (HDSSc) scale values were 1.14 ± 0.35 on the 1st PO day, 1.42 ± 0.55 on the 30th PO day, 1.83 ± 0.85 on the 90th PO day, 1.92 ± 0.91 on the 180th PO day, and 1.92 ± 0.91 on the 360th PO day (meaning that hyperhidrosis was mainly unnoticed). Patients' subjective satisfaction was considered very good and the majority of patients would recommend the treatment procedure. Percutaneous radiofrequency thoracic sympathectomy had a positive impact on the quality of life of patients with palmar hyperhidrosis, compared to the surgical treatment, with a low rate and intensity of HDSSc and without other complications.
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http://dx.doi.org/10.1053/j.semtcvs.2018.06.003DOI Listing
January 2019

Treatment of post-intubation laryngeal granulomas: systematic review and proportional meta-analysis.

Braz J Otorhinolaryngol 2018 Nov - Dec;84(6):781-789. Epub 2018 Apr 14.

Universidade Estadual Paulista (Unesp), Faculdade de Medicina de Botucatu, Departamento de Cirurgia, Botucatu, SP, Brazil.

Introduction: Laryngeal granulomas post intubation are benign but recurrent lesions. There is no consensus for its treatment.

Objective: To describe the effectiveness of different treatment modalities for primary or recurrent laryngeal granulomas resulting from endotracheal intubation.

Methods: Systematic review and proportional meta-analysis. Eligibility criteria - experimental or observational studies with at least five subjects. Outcomes studied - granuloma resolution, recurrence, and time for resolution. Databases used - Pubmed, Embase, Lilacs, and Cochrane. The Stats Direct 3.0.121 program was used.

Results: Six studies were selected, with 85 patients. The treatments registered were: antireflux therapy, speech therapy, anti-inflammatory drugs, steroids, antibiotics, zinc sulfate and surgery. 85 patients from six studies had primary treatment: surgery±associations (41 patients), resolution chance 75% (95% CI: 0.3-100%, I=90%), absolute relapse risk 25% (95% CI: 0.2-71%); medical treatment (44 patients), resolution chance 86% (95% CI: 67-97%); and absolute relapse risk 14% (95% CI: 3-33%). There was no significant difference between groups. Three studies, encompassing 19 patients, analyzed secondary treatment (failure or recurrence after primary treatment); three subjects presented new recurrence. The time needed to resolve the lesions varied from immediate, after surgery, to 23 months, for inhaled steroid.

Conclusion: There is no evidence of high quality that proves the efficacy of any treatment for laryngeal granulomas resulting from endotracheal intubation.
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http://dx.doi.org/10.1016/j.bjorl.2018.03.003DOI Listing
December 2018

Thoracotomy compared to laparotomy in the traumatic diaphragmatic hernia. Systematic review and proportional methanalysis.

Acta Cir Bras 2018 Jan;33(1):49-66

Chairman, Head, Department of Surgery, Botucatu School of Medicine, UNESP, Botucatu-SP, Brazil. Conception and design of the study, acquisition of data, manuscript writing.

Purpose: To evaluate the most used approach to treat traumatic diaphragmatic ruptures, and in which one the requirement to assess the second cavity is more frequent.

Methods: Systematic review, observational studies. Outcomes: moment of approach, most commonly via addressed and the requirement to open the other cavity. Bases searched: Lilacs, Pubmed, Embase, Clinicaltrials.gov and Web of Science. Statistical analysis: StatsDirect 3.0.121 software.

Results: Sixty eight studies (2023 participants) were included. Approach in acute phase was performed four times more than in chronic phase. Approach: abdominal 65% (IC 95% 63-67%), thoracic 23% (IC 95% 21-24%), abdominal in the acute phase 75% (IC 95% 71-78%), and chronic 24% (IC 95% 19-29%), thoracic in the acute phase 12% (IC 95% 10-14%) and chronic 69% (IC 95% 63-74%). Thorax opening in the abdominal approach: 10% (95% CI 8-14%). Abdomen opening in the thoracic approach: 15% (95% CI 7-24%).

Conclusions: The most common approach was the abdominal. The approach in the acute phase was more common. In the acute phase the abdominal approach is more frequent than the thoracic approach. In the chronic phase the thoracic approach is more frequent than the abdominal one. The requirement to open the second cavity was similar in both approaches.
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http://dx.doi.org/10.1590/s0102-865020180010000006DOI Listing
January 2018

Strategies to optimize MEDLINE and EMBASE search strategies for anesthesiology systematic reviews. An experimental study.

Sao Paulo Med J 2018 Mar-Apr;136(2):103-108. Epub 2018 Jan 15.

MSc, PhD. Assistant Professor, Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu (SP), Brazil; Assistant Professor, Department of Biosciences and Oral Diagnosis, Institute of Science and Technology, Universidade Estadual Paulista (UNESP), São José dos Campos (SP), Brazil; and Research Collaborator, Institute of Urology, McMaster University, Hamilton, Ontario, Canada.

Background: A high-quality electronic search is essential for ensuring accuracy and comprehensiveness among the records retrieved when conducting systematic reviews. Therefore, we aimed to identify the most efficient method for searching in both MEDLINE (through PubMed) and EMBASE, covering search terms with variant spellings, direct and indirect orders, and associations with MeSH and EMTREE terms (or lack thereof).

Design And Setting: Experimental study. UNESP, Brazil.

Methods: We selected and analyzed 37 search strategies that had specifically been developed for the field of anesthesiology. These search strategies were adapted in order to cover all potentially relevant search terms, with regard to variant spellings and direct and indirect orders, in the most efficient manner.

Results: When the strategies included variant spellings and direct and indirect orders, these adapted versions of the search strategies selected retrieved the same number of search results in MEDLINE (mean of 61.3%) and a higher number in EMBASE (mean of 63.9%) in the sample analyzed. The numbers of results retrieved through the searches analyzed here were not identical with and without associated use of MeSH and EMTREE terms. However, association of these terms from both controlled vocabularies retrieved a larger number of records than did the use of either one of them.

Conclusions: In view of these results, we recommend that the search terms used should include both preferred and non-preferred terms (i.e. variant spellings and direct/indirect order of the same term) and associated MeSH and EMTREE terms, in order to develop highly-sensitive search strategies for systematic reviews.
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http://dx.doi.org/10.1590/1516-3180.2017.0277100917DOI Listing
June 2018

Endobronchial solitary fibrous tumor.

Autops Case Rep 2016 Oct-Dec;6(4):35-40. Epub 2016 Dec 30.

Department of Pathology - Botucatu School of Medicine - Universidade Estadual Paulista "Julio de Mesquista Filho", Botucatu/SP - Brazil .

Solitary fibrous tumor (SFT) is a mesenchymal neoplasm that appears primarily in the pleura and rarely in intrapulmonary or endobronchial topography. The authors report the case of a 47-year-old woman who presented obstructive respiratory symptoms for 4 years. The chest computed tomography and bronchoscopy showed an obstructive polypoid lesion located between the trachea and the left main bronchus associated with distal atelectasis of the left lung. A resection of the lesion was performed and, macroscopically, the mass was oval, encapsulated, and firm, measuring 2.3 × 1.7 × 1.5 cm. Histology revealed low-grade mesenchymal spindle cell neoplasm, with alternating cellularity, myxoid areas, and mature adipose tissue outbreaks, as well as blood vessels with irregular walls. The immunohistochemical study was positive for CD34, CD99, and BCL2. The diagnosis was SFT in an unusual topography. The patient's symptoms remitted after tumor excision, and no systemic problems were evident. SFTs primarily affect adults and often follow a benign course; however, their behavior is unpredictable. The presence of necrosis and mitotic activity may portend a poor prognosis. Endobronchial SFTs are rare but should be evaluated and monitored similar to SFTs at other sites, with a long-term follow-up.
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http://dx.doi.org/10.4322/acr.2016.053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304560PMC
December 2016

Myelolipoma of the posterior mediastinum in a patient with chronic dyserythropoietic anemia.

Autops Case Rep 2016 Jul-Sep;6(3):35-39. Epub 2016 Sep 30.

Department of Pathology - Botucatu School of Medicine - Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Botucatu/SP - Brazil .

Myelolipoma (ML) is an uncommon benign mesenchymal neoplasia composed of mature adipose and hematopoietic tissues of uncertain etiology. Less than 3% of MLs occur in the mediastinal topography. The main differential diagnosis involves extramedullary hematopoiesis; therefore, pathological evaluation is essential for the definitive diagnosis. The authors report the case of a 50-year-old man diagnosed with congenital dyserythropoiesis and secondary hemosiderosis, who presented a posterior mediastinal tumor. The tumor was resected. It was macroscopically characterized by mature fat tissue with fibrous areas and soft consistency, which was yellowish at the cut surface. Histology revealed a well-defined nodule composed of adipocytes and hematopoietic tissue represented by erythroid, granulocytic, and megakaryocytic series, which was consistent with the diagnosis of ML located in the posterior mediastinum. There was no recurrence of the lesion during the 3-year follow-up. The aim of this report is to show the diagnosis of an unusual mediastinal lesion in the context of a chronic hematologic disease.
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http://dx.doi.org/10.4322/acr.2016.047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5087982PMC
September 2016

Surgical versus nonsurgical interventions for flail chest.

Cochrane Database Syst Rev 2015 Jul 29(7):CD009919. Epub 2015 Jul 29.

Department of Surgery & Orthopedics, São Paulo State University, Distrito de Rubião Júnior, s/n, São Paulo, Brazil, 18618-970.

Background: Thoracic trauma (TT) is common among people with multiple traumatic injuries. One of the injuries caused by TT is the loss of thoracic stability resulting from multiple fractures of the rib cage, otherwise known as flail chest (FC). A person with FC can be treated conservatively with orotracheal intubation and mechanical ventilation (internal pneumatic stabilization) but may also undergo surgery to fix the costal fractures.

Objectives: To evaluate the effectiveness and safety of surgical stabilization compared with clinical management for people with FC.

Search Methods: We ran the search on the 12 May 2014. We searched the Cochrane Injuries Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (OvidSP), EMBASE Classic and EMBASE (OvidSP), CINAHL Plus (EBSCO), ISI WOS (SCI-EXPANDED, SSCI, CPCI-S, and CPSI-SSH), and clinical trials registers. We also screened reference lists and contacted experts.

Selection Criteria: Randomized controlled trials of surgical versus nonsurgical treatment for people diagnosed with FC.

Data Collection And Analysis: Two review authors selected relevant trials, assessed their risk of bias, and extracted data.

Main Results: We included three studies that involved 123 people. The methods used for blinding the participants and researchers to the treatment group were not reported, but as the comparison is surgical treatment with medical treatment this bias is hard to avoid. There was no description of concealment of the randomization sequence in two studies.All three studies reported on mortality, and deaths occurred in two studies. There was no clear evidence of a difference in mortality between treatment groups (risk ratio (RR) 0.56, 95% confidence interval (CI) 0.13 to 2.42); however, the analysis was underpowered to detect a difference between groups. Out of the 123 people randomized and treated, six people died; the causes of death were pneumonia, pulmonary embolism, mediastinitis, and septic shock.Among people randomized to surgery, there were reductions in pneumonia (RR 0.36, 95% 0.15 to 0.85; three studies, 123 participants), chest deformity (RR 0.13, 95% CI 0.03 to 0.67; two studies, 86 participants), and tracheostomy (RR 0.38, 95% CI 0.14 to 1.02; two studies, 83 participants). Duration of mechanical ventilation, length of intensive care unit stay (ICU), and length of hospital stay were measured in the three studies. Due to differences in reporting, we could not combine the results and have listed them separately. Chest pain, chest tightness, bodily pain, and adverse effects were each measured in one study.

Authors' Conclusions: There was some evidence from three small studies that showed surgical treatment was preferable to nonsurgical management in reducing pneumonia, chest deformity, tracheostomy, duration of mechanical ventilation, and length of ICU stay. Further well-designed studies with a sufficient sample size are required to confirm these results and to detect possible surgical effects on mortality.
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http://dx.doi.org/10.1002/14651858.CD009919.pub2DOI Listing
July 2015

Respiratory immunohistochemical study in rats exposed to cigarette smoke and alcohol.

Acta Cir Bras 2015 Mar;30(3):178-85

Division of Thoracic Surgery, UNESP, Sao Paulo, SP, Brazil.

Purpose: To investigate the effects of exposure to cigarette and alcohol on immunohistochemical disorders caused by these attacks to respiratory system of rats.

Methods: Sixty male Wistar rats in four groups: control, cigarette smoke, alcohol and cigarette smoke + alcohol during 260 days. Immunohistochemistry was performed by researching survivin and protein P53 expressions and apoptotic index in parenchymal lung and trachea using TUNEL technique.

Results: There was body growth impairment in all experimental groups. Both smoker groups animals had higher trachea survivin expression and bronchial higher apoptotic index. The trachea apoptotic index was also higher in the cigarette smoke group as well as in the alveoli in the cigarette smoke + alcohol group. The three experimental groups showed negative immunoexpression for P53.

Conclusions: this model resulted in immunohistochemical changes caused mainly by exposure to cigarette smoke. There was a synergistic action between alcohol and tobacco in the growth impairment in animals as well as in the cellular apoptotic index. The positive immunoexpression for tracheal survivin in animals from both groups exposed to tobacco smoke and associated with a negative P53 immunoexpression suggests that despite the aggression, carcinogenesis has not happened yet. In addition, the bronchial higher apoptotic index in smokers may be responsible for emphysema.
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http://dx.doi.org/10.1590/S0102-865020150030000003DOI Listing
March 2015

Surgical interventions for treating pectus excavatum.

Cochrane Database Syst Rev 2014 Oct 29(10):CD008889. Epub 2014 Oct 29.

Evidence Based Health Actions Department and Thoracic Surgery Department, Marilia Medical School, Avenida Monte Carmelo, 800, Bairro Fragata, Marilia, Sao Paulo, Brazil, 17519-030.

Background: Pectus excavatum is characterized by a depression of the anterior chest wall (sternum and lower costal cartilages) and is the most frequently occurring chest wall deformity. The prevalence ranges from 6.28 to 12 cases per 1000 around the world. Generally pectus excavatum is present at birth or is identified after a few weeks or months; however, sometimes it becomes evident only at puberty. The consequence of the condition on a individual's life is variable, some live a normal life and others have physical and psychological symptoms such as: precordial pain after exercises; impairments of pulmonary and cardiac function; shyness and social isolation. For many years, sub-perichondrial resection of the costal cartilages, with or without transverse cuneiform osteotomy of the sternum and placement of a substernal support, called conventional surgery, was the most accepted option for surgical repair of these patients. From 1997 a new surgical repair called, minimally invasive surgery, became available. This less invasive surgical option consists of the retrosternal placement of a curved metal bar, without resections of the costal cartilages or sternum osteotomy, and is performed by videothoracoscopy. However, many aspects that relate to the benefits and harms of both techniques have not been defined.

Objectives: To evaluate the effectiveness and safety of the conventional surgery compared with minimally invasive surgery for treating people with pectus excavatum.

Search Methods: With the aim of increasing the sensitivity of the search strategy we used only terms related to the individual's condition (pectus excavatum); terms related to the interventions, outcomes and types of studies were not included. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, LILACS, and ICTPR. Additionally we searched yet reference lists of articles and conference proceedings. All searches were done without language restriction.Date of the most recent searches: 14 January 2014.

Selection Criteria: We considered randomized or quasi-randomized controlled trials that compared traditional surgery with minimally invasive surgery for treating pectus excavatum.

Data Collection And Analysis: Two review authors independently assessed the eligibility of the trials identified and agreed trial eligibility after a consensus meeting. The authors also assessed the risk of bias of the eligible trials.

Main Results: Initially we located 4111 trials from the electronic searches and two further trials from other resources. All trials were added into reference management software and the duplicates were excluded, leaving 2517 studies. The titles and abstracts of these 2517 studies were independently analyzed by two authors and finally eight trials were selected for full text analysis, after which they were all excluded, as they did not fulfil the inclusion criteria.

Authors' Conclusions: There is no evidence from randomized controlled trials to conclude what is the best surgical option to treat people with pectus excavatum.
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http://dx.doi.org/10.1002/14651858.CD008889.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6885037PMC
October 2014

C-reactive protein and vasospasm after aneurysmal subarachnoid hemorrhage.

Acta Cir Bras 2014 May;29(5):340-5

Botucatu School of Medicine, UNESP, Botucatu, SP, Brazil.

Purpose: To evaluate the relationship between C reactive protein levels and clinical and radiological parameters with delayed ischemic neurological deficits and outcome after aneurysmal subarachnoid hemorrhage.

Methods: One hundred adult patients with aneurismal SAH were prospectively evaluated. Besides the baseline characteristics, daily C-reactive protein levels were prospectively measured until day 10 after subarachnoid hemorrhage. The primary end point was outcome assessed by Glasgow Outcome Scale, the secondary was the occurrence of delayed ischemic neurological deficits (DINDs).

Results: A progressive increase in the CRP levels from the admission to 3rd postictal day was observed, followed by a slow decrease until the 9th day. Hemodynamic changes in TCD were associated with higher serum CRP levels. Patients with lower GCS scores presented with increased CRP levels. Patients with higher Hunt and Hess grades on admission developed significantly higher CRP serum levels. Patients with higher admission Fisher grades showed increased levels of CRP. A statistically significant inverse correlation was established in our series between CRP serum levels and GOS on discharge and CRP levels.

Conclusions: Higher C-reactive protein serum levels are associated with worse clinical outcome and the occurrence of delayed ischemic neurological deficits. Because C-reactive protein levels were significantly elevated in the early phase, they might be a useful parameter to monitor.
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http://dx.doi.org/10.1590/s0102-86502014000500009DOI Listing
May 2014

Congenital lobar emphysema: 30-year case series in two university hospitals.

J Bras Pneumol 2013 Jun-Aug;39(4):418-26

Department of Surgery and Orthopedics, São Paulo State University, Botucatu School of Medicine, Botucatu, Brazil.

Objective: To review the cases of patients with congenital lobar emphysema (CLE) submitted to surgical treatment at two university hospitals over a 30-year period.

Methods: We reviewed the medical records of children with CLE undergoing surgical treatment between 1979 and 2009 at the Botucatu School of Medicine Hospital das Clínicas or the Mogi das Cruzes University Hospital. We analyzed data regarding symptoms, physical examination, radiographic findings, diagnosis, surgical treatment, and postoperative follow-up.

Results: During the period studied, 20 children with CLE underwent surgery. The mean age at the time of surgery was 6.9 months (range, 9 days to 4 years). All of the cases presented with symptoms at birth or during the first months of life. In all cases, chest X-rays were useful in defining the diagnosis. In cases of moderate respiratory distress, chest CT facilitated the diagnosis. One patient with severe respiratory distress was misdiagnosed with hypertensive pneumothorax and underwent chest tube drainage. Only patients with moderate respiratory distress were submitted to bronchoscopy, which revealed no tracheobronchial abnormalities. The surgical approach was lateral muscle-sparing thoracotomy. The left upper and middle lobes were the most often affected, followed by the right upper lobe. Lobectomy was performed in 18 cases, whereas bilobectomy was performed in 2 (together with bronchogenic cyst resection in 1 of those). No postoperative complications were observed. Postoperative follow-up time was at least 24 months (mean, 60 months), and no late complications were observed.

Conclusions: Although CLE is an uncommon, still neglected disease of uncertain etiology, the radiological diagnosis is easily made and surgical treatment is effective.
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http://dx.doi.org/10.1590/S1806-37132013000400004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4075869PMC
May 2014

Surgical risk tests related to cardiopulmonary postoperative complications: comparison between upper abdominal and thoracic surgery.

Acta Cir Bras 2013 Jun;28(6):458-66

Postgraduate Program in General Basis of Surgery. Botucatu School of Medicine, UNESP, Botucatu-SP, Brazil.

Purpose: To investigate if tests used in the preoperative period of upper abdominal or thoracic surgeries are able to differentiate the patients that presented cardiopulmonary postoperative complications.

Methods: Seventy eight patients, 30 submitted to upper abdominal surgery and 48 to thoracic surgery were evaluated. Spirometry, respirometry, manovacuometry, six-minute walk test and stair-climbing test were performed. Complications from immediate postoperative to discharge from hospital were registered.

Results: The postoperative complications rate was 17% in upper abdominal surgery and 10% in thoracic surgery. In the univariate regression, the only variable that kept the correlation with postoperative complications in the upper abdominal surgery was maximal expiratory pressure. In thoracic surgery, the maximal voluntary ventilation, six-minute walk test and time in stair-climbing test presented correlation with postoperative complications. After multiple regression only stair-climbing test continued as an important risk predictor in thoracic surgery.

Conclusion: The respiratory pressure could differentiate patients with complications in upper abdominal surgery, whereas in thoracic surgery, only spirometric values and exercise tests could differentiate them.
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http://dx.doi.org/10.1590/s0102-86502013000600010DOI Listing
June 2013

Efficacy of surgical versus conservative treatment in esophageal perforation: a systematic review of case series studies.

Acta Cir Bras 2013 Apr;28(4):266-71

Postgraduate Program in General Basis of Surgery, Botucatu School of Medicine, UNESP, Brazil.

Purpose: To evaluate the efficacy of surgical treatment for esophageal perforation.

Methods: A systematic review of the literature was performed. We conducted a search strategy in the main electronic databases such as PubMed, Embase and Lilacs to identify all case series.

Results: Thirty three case series met the inclusion criteria with a total of 1417 participants. The predominant etiology was iatrogenic (54.2%) followed by spontaneous cause (20.4%) and in 66.1% the localization was thoracic. In 65.4% and 33.4% surgical and conservative therapy, respectively, was considered the first choice. There was a statistically significance different with regards mortality rate favoring the surgical group (16.3%) versus conservative treatment (21.2%) (p<0.05).

Conclusion: Surgical treatment was more effective and safe than conservative treatment concerning mortality rates, although the possibility of bias due to clinical and methodological heterogeneity among the included studies and the level of evidence that cannot be ruled out.
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April 2013

Proposal to utilize simplified Swensen protocol in diagnosis of isolated pulmonary nodule.

Acta Radiol 2013 Sep 30;54(7):757-64. Epub 2013 Apr 30.

Department of Tropical Diseases and Diagnostic Imaging, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Sao Paulo.

Background: The problem of diagnosing whether a solitary pulmonary nodule is benign or malignant is even greater in developing countries due to a higher prevalence of infectious diseases. These infections generate a large number of patients who are generally asymptomatic and with a pulmonary nodule that cannot be accurately defined as having benign or malignant etiology.

Purpose: To verify the percentages of benign versus malignant non-calcified nodules, the length of time after contrast agent injection is spiral computed tomography (CT) most sensitive and specific, and whether three postcontrast phases are necessary.

Material And Methods: We studied 23 patients with solitary pulmonary nodules identified on chest radiographs or CT. Spiral scans were obtained with Swensen protocol, but at 3, 4, and 5 min after contrast injection onset. Nodules were classified as benign or malignant by histopathological examination or by an absence or presence of growth after 2 years of follow-up CT.

Results: Of the 23 patients studied, 18 (78.2%) showed a final diagnosis of benign and five (21.7%) malignant nodules. Despite the small sample size, we obtained results similar to those of Swensen et al., with 80.0% sensitivity, 55.5% specificity, and 60.8% accuracy. Four minutes gave the greatest mean enhancement in both malignant and benign lesions.

Conclusion: Small non-calcified benign nodules were much more frequent than malignant nodules. The best time for dynamic contrast-enhanced CT density analysis was 4 min postcontrast. As well as saving time and money, this simplified Swensen protocol with only precontrast and 4 min postcontrast phases also reduces patient exposure to ionizing radiation.
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http://dx.doi.org/10.1177/0284185113481695DOI Listing
September 2013

Time in the stair-climbing test as a predictor of thoracotomy postoperative complications.

J Thorac Cardiovasc Surg 2013 Apr 23;145(4):1093-1097. Epub 2012 Oct 23.

Division of Thoracic Surgery, Department of Surgery, Botucatu School of Medicine, São Paulo State University, UNESP, São Paulo, Brazil.

Objectives: The stair-climbing test as measured in meters or number of steps has been proposed to predict the risk of postoperative complications. The study objective was to determine whether the stair-climbing time can predict the risk of postoperative complications.

Methods: Patients aged more than 18 years with a recommendation of thoracotomy for lung resection were included in the study. Spirometry was performed according to the criteria by the American Thoracic Society. The stair-climbing test was performed on shaded stairs with a total of 12.16 m in height, and the stair-climbing time in seconds elapsed during the climb of the total height was measured. The accuracy test was applied to obtain stair-climbing time predictive values, and the receiver operating characteristic curve was calculated. Variables were tested for association with postoperative cardiopulmonary complications using the Student t test for independent populations, the Mann-Whitney test, and the chi-square or Fisher exact test. Logistic regression analysis was performed.

Results: Ninety-eight patients were evaluated. Of these, 27 showed postoperative complications. Differences were found between the groups for age and attributes obtained from the stair-climbing test. The cutoff point for stair-climbing time obtained from the receiver operating characteristic curve was 37.5 seconds. No differences were found between the groups for forced expiratory volume in 1 second. In the logistic regression, stair-climbing time was the only variable associated with postoperative complications, suggesting that the risk of postoperative complications increases with increased stair-climbing time.

Conclusions: The only variable showing association with complications, according to multivariate analysis, was stair-climbing time.
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http://dx.doi.org/10.1016/j.jtcvs.2012.09.001DOI Listing
April 2013

Lung morphology and growth of rats exposed to tobacco smoke and alcohol.

Acta Cir Bras 2012 Oct;27(10):687-93

Botucatu School of Medicine, UNESP, Sao Paulo, Brazil.

Purpose: Investigate the morphological effects of chronic exposure to tobacco smoke inhalation and alcohol consumption on the lungs and on the growth of rats.

Methods: Sixty male Wistar rats were divided into four groups: control, tobacco, alcohol, tobacco + alcohol, for a period of study 260 days. Morphological analysis was conducted by optical and electron microscopy. Rat growth was investigated by measuring the snout-anus length, body mass index and body weight.

Results: The three groups exposed to the drugs presented lower growth and lower weight than the control group. The percentages of alveolitis, bronchiolitis and the mean alveolar diameter were greater, particularly in the groups exposed to tobacco smoke, but were not significantly different from the control group. Electron microscopy revealed more intense apoptotic and degenerative lesions in the smoking group, while degenerative lesions in the lamellar bodies were more intense with the association of both drugs.

Conclusions: This experimental model showed morphological alterations observed by electron microscopy, principally due to tobacco smoke exposure. Alcohol and tobacco hindered the growth of rats, such that tobacco showed a greater effect on body length and alcohol on body weight.
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http://dx.doi.org/10.1590/s0102-86502012001000004DOI Listing
October 2012

Systematic reviews showed insufficient evidence for clinical practice in 2004: what about in 2011? The next appeal for the evidence-based medicine age.

J Eval Clin Pract 2013 Aug 3;19(4):633-7. Epub 2012 Jul 3.

Botucatu Medical School (FMB), UNESP - Universidade Estadual Paulista, Botucatu, São Paulo, Brazil.

Rationale And Aim: The aims of the Cochrane systematic reviews are to make readily available and up-to-date information for clinical practice, offering consistent evidence and straightforward recommendations. In 2004, we evaluated the conclusions from Cochrane systematic reviews of randomized controlled trials in terms of their recommendations for clinical practice and found that 47.83% of them had insufficient evidence for use in clinical practice. We proposed to reanalyze the reviews to evaluate whether this percentage had significantly decreased.

Methods: A cross-sectional study of systematic reviews published in the Cochrane Library (Issue 7, 2011) was conducted. We randomly selected reviews across all 52 Cochrane Collaborative Review Groups.

Results: We analyzed 1128 completed systematic reviews. Of these, 45.30% concluded that the interventions studied were likely to be beneficial, of which only 2.04% recommended no further research. In total, 45.04% of the reviews reported that the evidence did not support either benefit or harm, of which 0.8% did not recommend further studies and 44.24% recommended additional studies; the latter has decreased from our previous study with a difference of 3.59%.

Conclusion: Only a small number of the Cochrane collaboration's systematic reviews support clinical interventions with no need for additional research. A larger number of high-quality randomized clinical trials are necessary to change the 'insufficient evidence' scenario for clinical practice illustrated by the Cochrane database. It is recommended that we should produce higher-quality primary studies in active collaboration and consultation with global scholars and societies so that this can represent a major component of methodological advance in this context.
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http://dx.doi.org/10.1111/j.1365-2753.2012.01877.xDOI Listing
August 2013

Surgical treatment of pulmonary aspergilloma.

J Bras Pneumol 2010 Nov-Dec;36(6):779-83

Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil.

The objective of this study was to analyze the outcome of surgical treatment of pulmonary aspergilloma. To that end, we evaluated 14 adult patients so treated between 1981 and 2009 at the Botucatu School of Medicine University Hospital, in the city of Botucatu, Brazil. Data were collected from the medical records of the patients. Ten patients (71%) presented with simple pulmonary aspergilloma, and 4 (29%) presented with complex pulmonary aspergilloma. Hemoptysis was the most common symptom, and tuberculosis was the most prevalent preexisting lung disease. Two patients (14%) underwent surgery on more than one occasion. There were no intraoperative deaths. Half of the patients developed postoperative complications, prolonged air leak and empyema being the most common.
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http://dx.doi.org/10.1590/s1806-37132010000600016DOI Listing
August 2011

Comparison between actual and predicted postoperative stair-climbing test, walk test and spirometric values in patients undergoing lung resection.

Acta Cir Bras 2010 Dec;25(6):535-40

UNESP, Botucatu, SP, Brazil.

Purpose: To assess whether the tests - Forced Expiratory Volume at one second (FEV₁), 6-minute walk test (6MWT) and stair-climbing test (SCT) showed proportional changes after the resection of functioning lung.

Methods: Candidates for pulmonary resection were included. Spirometry, 6MWT and SCT were performed preoperatively (pre) and at least 3 months after surgery (pos). SCT was performed on a staircase with a total ascent height of 12.16m. The time taken to climb the total height the fastest possible was defined as stair-climbing time (SCt). Number of functioning segments lost, was used to calculated predicted postoperative (ppo) tests values. Pre, ppo and pos values for each test were compared. Data were analyzed by repeated-measure ANOVA with significance level set at 5%.

Results: A total of 40 patients were enrolled. Pulmonary resection results ranged from gain of 2 functioning segments to loss of 9. Pre, ppo and pos values were the following: preFEV₁ = 2.6±0.8L, ppo FEV₁ =2.3±0.8L, and pos FEV₁=2.3±0.8L, (pre FEV₁ > ppo FEV₁ = pos FEV₁); pre6MWT = 604±63m, ppo6MWT= 529±103m, pos6MWT= 599±74m (pre6MWT = pos6MWT > ppo6MWT); preSCt = 32.9±7.6s, ppoSCt = 37.8±12.1s, posSCt = 33.7±8.5s (preSCt = posSCt < ppoSCt).

Conclusion: In our group of patients, pulmonary resection led to loss of lung function measured by spirometry, but not to exercise capacity measured by stair-climbing and walk tests.
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December 2010

Accuracy of six minute walk test, stair test and spirometry using maximal oxygen uptake as gold standard.

Acta Cir Bras 2010 Apr;25(2):194-200

Thoracic Surgery Division, Department of Surgery, Botucatú School of Medicine, UNESP, Botucatú - São Paulo, Brazil.

Purpose: To assess the accuracy of the variables stair climbing time (SCt), stair climbing power (SCP), six-minute walk test distance (6MWT), and forced expiratory volume in 1 second (FEV1) using maximal oxygen uptake on exercise (VO(2)max) as the gold standard.

Methods: Tests were performed in 51 patients. FEV1 was measured by spirometry and 6MWT was performed in a flat 120-m corridor. Stair climbing test was performed on a 6-flight stairway to obtain SCt and SCP. VO(2)max was measured by ergospirometry, using the Balke protocol. Pearson's linear correlation and p values were calculated between VO2max and the other variables tested. For accuracy calculations, variable cutoff points were obtained through receiver operating characteristic (ROC) curves, dividing individuals into normal or unhealthy. Kappa statistic was used to calculate concordance.

Results: Accuracy was: SCt - 86%, 6MWT - 80%, SCP - 71%, FEV1(L) - 67%, FEV1(%) - 63%. SCt and 6MWT showed 93.5% sensitivity when combined in parallel, and 96.4% specificity in series.

Conclusion: SCt presented the best accuracy. SCt and 6MWT combined showed nearly 100% sensitivity or specificity. Thus, these simple exercise tests should be more routinely used, especially when an ergospirometer is not available to measure VO(2)max.
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April 2010

Chemical lumbar sympathectomy in plantar hyperhidrosis.

Clin Auton Res 2010 Apr 11;20(2):113-5. Epub 2009 Dec 11.

Department of Surgery and Orthopedics, Botucatu School of Medicine, São Paulo State University, Botucatu, SP, Brazil.

Plantar hyperhidrosis can cause great changes to an individual's quality of life. We described a case successfully treated by the minimally invasive method of percutaneous injection of 7.0% phenolic solution into the lumbar sympathetic chains.
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http://dx.doi.org/10.1007/s10286-009-0047-9DOI Listing
April 2010

Active tuberculosis in surgical patients with negative preoperative sputum smear results.

J Bras Pneumol 2009 Sep;35(9):892-8

Faculdade de Medicina de Botucatu, UNESP, Botucatu, SP, Brasil.

Objective: To determine the proportion of negative preoperative sputum smear results among patients presenting active TB, as identified through the evaluation of surgical samples.

Methods: A retrospective study of patients undergoing surgery between 2003 and 2006 at a university hospital and receiving a histopathological diagnosis of active or latent TB. We reviewed patient histories, TB-related clinical aspects, acid-fast bacilli (AFB) test results, type of surgery performed and histopathological findings in surgical samples.

Results: We included 43 patients, 27 of whom were male. The mean age was 44 + or - 19 years. Twenty-eight patients had a history of TB (treated appropriately), and 15 reported no history of the disease. The main reason for seeking treatment was recurrent infection, followed by alterations seen in imaging studies. Of the 43 patients, 35 underwent preoperative AFB testing: 32 tested negative, and 3 tested positive. Among those 35 patients, the histopathological diagnosis was active TB in 26 and latent TB in 9. The 8 patients not submitted to preoperative AFB testing were also diagnosed with latent TB. The proportion of active TB in patients with negative sputum smear results was 72% (23/32), whereas that of negative sputum smear results in patients with active TB was 88% (23/26). Only 11.5% (3/26) of the patients had tested positive for AFB.

Conclusions: Direct sputum smear microscopy has a very low yield. Many previously treated patients can present negative sputum smear results and yet have active TB. Active TB can be mistaken for secondary infections or for cancer.
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September 2009
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