Biomedical subjects

Amin R Javer

Publications and source records attributed to Amin R Javer.

4 recordsLinked to original sources

PubMed2003

Choosing a computer-assisted surgical system for sinus surgery.

OBJECTIVES: Choosing the correct computer-assisted system for sinus surgery can be a formidable task for surgeons and their institutions. A formal trial of an electromagnetic (InstaTrak, Visualization Technologies Incorporated, Woburn, MA) and an optical (LandmarX by Medtronic-Xomed, Jacksonville, FL) system was conducted over a 10-month period at the St. Paul's Sinus Centre in Vancouver, BC. An objective and subjective evaluation method was used to select the system for use at our institution. METHODS: Thirty-nine patients were operated on by the senior author (A.R.J.) using the InstaTrak (23 patients) or the LandmarX (16 patients). The two groups were balanced in terms of age, gender, number of previous surgeries, and extent of surgery. Estimated blood loss, surgical time, and surgical complications were compared between the groups, with all other variables constant. Nursing and radiology personnel as well as the three surgeons who used both systems at the centre were surveyed on patient safety, ease of use, storage, and accessories. RESULTS: There was no statistical difference in objective surgical data. There was a more pronounced learning curve using the LandmarX as defined by a greater decrease in the duration of surgical time by the end of the trial period. The operating room personnel found the InstaTrak easier to use, whereas the computed tomography technologists preferred the LandmarX. The surgeons found the two systems acceptable in terms of navigational accuracy; however, the InstaTrak was felt to be more user friendly. CONCLUSIONS: The InstaTrak system was chosen for our institution mainly because of its ease of use by the operating room staff and the sinus surgeons.

Adult↗

PubMedDate not supplied

Effectiveness of intraoperative mitomycin C in maintaining the patency of a frontal sinusotomy: a preliminary report of a double-blind randomized placebo-controlled trial.

BACKGROUND: Postoperative scarring in the frontal recess is the most common cause of iatrogenic frontal sinusitis. Topical mitomycin-C (MMC) is an antifibroblastic agent that has been shown to reduce clinical scarring. This is a preliminary report of a double-blind, randomized, placebo-controlled trial using MMC to determine its effectiveness in reducing frontal recess stenosis after frontal sinusotomy. METHODS: All patients with chronic rhinosinusitis undergoing primary or revision bilateral image-guided endoscopic sinus surgery were enrolled. Patients requiring frontal sinus stents and those with allergic fungal sinusitis were excluded. After completion of the frontal sinusotomy, dimensions of the frontal recess were measured using curved Frazer suction diameters. A neuropattie soaked in 0.5 mg/mL of MMC was then placed into one frontal recess for 4 minutes in a randomized manner. A saline control was used for the other side. The primary surgeon was blinded to the medicated side intraoperatively and throughout the follow-up period. Measurements of the frontal recess were repeated at 1, 3, and 6 months. RESULTS: There was no difference in the degree of frontal recess stenosis between the MMC and control sides at 1, 3, and 6 months postoperatively for both primary and revision cases. CONCLUSION: One-time intraoperative topical MMC is not effective in reducing postoperative frontal recess stenosis in both primary and revision cases.

Adolescent↗

PubMedDate not supplied

Low-grade fibrosarcoma of the anterior skull base: endoscopic resection and repair.

BACKGROUND: Fibrosarcomas of the paranasal sinuses and skull base are uncommon tumors. Traditionally, "open approach" surgery remains the mainstay for treatment of choice for these tumors. METHODS: A 49-year-old man underwent resection of a right anterior skull base fibrosarcoma using the endoscopic approach. RESULTS: Close follow-up using both endoscopic and imaging methods over a period of four years has revealed a well-healed skull base with no evidence of recurrence. CONCLUSION: Significant resistance exists at present for such a technique to deal with malignant diseases of the head and neck but results from advanced centers continue to prove that this may be a technique worth mastering and improving on.

Bone Transplantation↗

PubMedDate not supplied

A preliminary report on the effects of paclitaxel-impregnated stents on sheep nasal mucosa.

INTRODUCTION: Traditional frontal sinus stents serve only as mechanical devices. It has been proposed that stents also may serve as drug-delivery systems for the topical application of drugs that minimize postoperative scarring. Paclitaxel (Taxol), which has recognized antiscarring effects, may be incorporated via a polymeric formulation into standard rubber stents. The impact of topically applied paclitaxel on the morphology of the nasal mucosa is unknown. METHODS: An adult sheep model was used for this study. A modified rubber T-tube stent (incorporating paclitaxel at varying dosages) was secured to each side of the septum in four animals (eight sides). An unmodified T-tube was placed on each side of one animal, a T-tube with the drug carrier (but no paclitaxel) was placed on each side of the second animal, and T-tubes with varying paclitaxel were placed on each side of the final two animals. After 4 weeks, animals were killed and the nasal mucosa was harvested. The nasal mucosa was sectioned and stained with hematoxylin and eosin. A pathologist then assessed the nasal mucosa for vascular congestion, glandular atrophy, chronic inflammation, mucosal metaplasia, and mucosal ulceration. RESULTS: No consistent histopathological differences were noted in the specimens. All specimens showed varying degrees of vascular congestion, glandular atrophy, chronic inflammation, and mucosal metaplasia; the paclitaxel-impregnated stents were not consistently associated with more severe mucosal injury. Finally, mucosal ulceration was noted to be very rare in all specimens. CONCLUSION: This preliminary report describes the impact of paclitaxel-impregnated stents on sheep nasal mucosa, which tolerated these stents very well. Because paclitaxel minimizes scarring reactions at very low concentrations, paclitaxel-impregnated stents may prove useful in clinical situations in which frontal sinus stenting is deemed necessary. Additional investigations with animal models, as well as clinical trials, may be warranted.

Animals↗