Browsing by Author "Javer, Amin"
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Item Rapid Hemostasis in a Sheep Model Using Particles That Propel Thrombin and Tranexamic Acid(2017) Baylis, James R.; Finkelstein-Kulka, Andrés; Macias-Valle, Luis; Manji, Jamil; Lee, Michael; Levchenko, Elina; Okpaleke, Christopher; Al-Salihi, Salahuddin; Javer, Amin; Kastrup, Christian J.Objectives/Hypothesis: Bleeding during endoscopic sinus surgery and open surgeries can easily obstruct the surgeons’ field of view and increase morbidity and risk of intraoperative complications. Intraoperative bleeding could potentially be addressed by a hemostatic agent that safely disperses itself through the escaping blood. We tested the safety and efficacy of a self-propelling formulation of thrombin and tranexamic acid (SPTT) in stopping bleeding in a paranasal sinus injury and in an open surgical carotid injury sheep model. Study Design: Interventional animal study. Methods: SPTT was tested in the sinonasal space following endoscopic injury to the inferior turbinate of six sheep, and to the common carotid artery following open surgical injury in eight sheep. In the nasal cavity, bleeding time and local inflammation were measured and compared to plain gauze. Following carotid arteriotomy, successful hemostasis and markers of thrombosis and coagulopathy were compared to Floseal. Results: SPTT significantly decreased bleeding times in the sinonasal space compared to plain gauze (mean difference 5 3.8 minutes, P 5 .002). All of the carotid bleeds (100%) were successfully controlled with SPTT after 10 minutes of application under pressure, compared to 25% with Floseal. No adverse events were noted, and there was no evidence of thromboembolism. Conclusions: SPTT significantly reduced bleeding time in a sheep model of surgical sinus bleeding and successfully stopped bleeding following catastrophic carotid artery injury, with no adverse events observed.Item Safety of long-term intranasal budesonide delivered via the mucosal atomization device for chronic rhinosinusitis(John Wiley & Sons, 2017) Manji, Jamil; Singh, Gurkaran; Okpaleke, Christopher; Dadgostar, Anali; Al-Asousi, Fahad; Amanian, Ameen; Macias-Valle, Luis; Finkelstein, Andres; Tacey, Mark; Thamboo, Andrew; Javer, AminBACKGROUND: Although short-term use (≤2 months) of atomized topical nasal steroids has been shown to be safe and effective, the long-term safety has yet to be demonstrated. The aim of this study was to determine the impact of long-term topical budesonide treatment via the mucosal atomization device (MAD) on the hypothalamic-pituitary-adrenal axis (HPAA) and intraocular pressure (IOP). METHODS: A cross-sectional study of patients with chronic rhinosinusitis (CRS), with or without nasal polyposis, managed with daily nasal budesonide via MAD was conducted at a tertiary rhinology center. Patients using systemic steroids within 3 months of assessment were excluded. HPAA impact was assessed using the cosyntropin stimulation test for adrenal function and a survey of relevant symptomatology. Patients also underwent tonometry to assess for elevated IOP potentially related to corticosteroid use. RESULTS: A total of 100 CRS patients were recruited with a mean budesonide treatment duration of 23.5 months (range, 6-37 months). Stimulated cortisol response was diminished in 3 patients (3%). No patients with adrenal suppression had relevant symptomatology. IOP was elevated in 6 patients (6%). CONCLUSION: These findings suggest that there is a risk of adrenal suppression and raised IOP associated with the long-term use of topical nasal budesonide via MAD. Otolaryngologists should consider periodic surveillance for these adverse events in this patient cohort.