Guilherme Yazbek

Purpose: To study the safety and efficacy of rivaroxaban—a direct oral anticoagulant—use in patients with active cancer and venous thromboembolism (VTE). Patients and Methods: Retrospective cohort study of 400 patients with active cancer and associated VTE, defined as deep venous thrombosis and/or pulmonary embolism. This single-center study was carried out from January 2012 to June 2015. The aim of this study was to determine the efficacy and safety, using the incidence of recurrent symptomatic VTE and major bleeding, respectively, throughout the treatment with rivaroxaban. Results: Of the 400 patients enrolled, 223 (55.8%) were female. A total of 362 (90.5%) patients had solid tumors and 244 (61%) had metastatic disease. A total of 302 (75.5%) received initial parenteral therapy with enoxaparin (median: 3, mean: 5.6, standard deviation [SD]: 6.4 days) followed by rivaroxaban. Ninety-eight patients (24.5%) were treated with on label rivaroxaban treatment. Recurrence rates were 3.25% with major bleeding occurring in 5.5% during the anticoagulant therapy (median: 118, mean: 163.9, SD: 159.9 days). Conclusion: Rivaroxaban can be an attractive alternative for the treatment of cancer-associated thrombosis.

Background: To evaluate the effectiveness and patient satisfaction with the use of oxybutynin at low doses for treating plantar hyperhidrosis.Methods: From January 2007 to December 2010, 35 consecutive patients with plantar hyperhidrosis were treated with oxybutynin. Data were collected from 30 patients (five patients were lost to follow‐up). During the first week, patients received 2.5 mg of oxybutynin once a day, 2.5 mg twice a day from the eighth to the 42nd day, and from the 43rd day to the end of the 12th week, 5 mg twice a day. All of the patients underwent two evaluations: before and after the oxybutynin treatment, using a clinical questionnaire, and a clinical protocol for quality of life.Results: More than 70% of patients experienced an improvement in plantar hyperhidrosis. Most of the patients showed improvements in quality of life (66.6%). The side effects were minor, the most frequent being dry mouth (76.7%).Conclusion: Treatment of plantar hyperhidrosis with oxybutynin presents good results and improves quality of life. We believe that this therapeutic alternative is an excellent choice for the initial treatment of plantar hyperhidrosis.

The aim of the present study was to prospectively, randomly, blindly, and objectively investigate how surgery affects plantar sudoresis in patients with palmar and plantar hyperhidrosis over a one-year period using a sudorometer (VapoMeter). From February 2007 to May 2009, 40 consecutive patients with combined palmar hyperhidrosis and plantar hyperhidrosis underwent video-assisted thoracic sympathectomy at the T3 or T4 ganglion level (15 women and 25 men, with a mean age of 25 years). Immediately after the operation and during the one-year follow-up, all of the patients were free from palmar hyperhidrosis episodes. Compensatory hyperhidrosis of varying degrees was observed in 35 (87.5%) patients after one year. Only two (2.5%) patients suffered from severe compensatory hyperhidrosis. There was a large initial improvement in plantar hyperhidrosis in 46.25% of the cases, followed by a progressive regression of that improvement, such that only 30% continued to show this improvement after one year. The proportion of patients whose condition worsened increased progressively (from 21.25% to 47.50%), and the proportion of stable patients decreased (32.5% to 22.50%). This was not related to resection level; however, a lower intensity of plantar hyperhidrosis prior to sympathectomy correlated with worse evolution. Patients with palmar hyperhidrosis and plantar hyperhidrosis who underwent video-assisted thoracic sympathectomy to treat their palmar hyperhidrosis exhibited good initial improvement in plantar hyperhidrosis, which then decreased to lesser degrees of improvement over a one-year period following the surgery. For this reason, video-assisted thoracic sympathectomy should not be performed when only plantar hyperhidrosis is present.