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Burgos J, Curran A, Garcia J, Landolfi S, Hernández-Losa J, Suanzes P, Navarro J, Falcó V. Effectiveness of trichloroacetic acid versus electrocautery for the treatment of anal high-grade squamous intraepithelial lesions in persons with HIV. Infect Dis (Lond) 2024; 56:299-307. [PMID: 38217494 DOI: 10.1080/23744235.2024.2303021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/30/2023] [Indexed: 01/15/2024] Open
Abstract
PURPOSE This study aimed to compare trichloroacetic acid (TCA) versus electrocautery (ECA) for the treatment of anal high-grade squamous intraepithelial lesions (HSIL). METHODS This is an observational, single-center study. All subjects with HIV who had anal HSIL treated with TCA or ECA from 2010 to 2022 were included. Effectiveness was evaluated by on-treatment analysis, defining response as the resolution of HSIL and recurrence as a new diagnosis of HSILs during follow-up. A propensity score analysis was used to adjust for confounding factors. RESULTS In total, 227 and 260 HSIL episodes were treated with ECA and TCA, respectively. Response was observed in 61.7% (95% CI: 55.3-68) of cases treated with ECA and in 73.1% (95% CI: 67.8-78.5) with TCA (p = .004). The effectiveness of TCA was higher in large and multifocal HSILs. Side effects were common with both treatments, but no serious events were described. Tolerability was good in 77.1% and 80.7% of patients treated with ECA and TCA, respectively. At 24 months, recurrent HSIL were observed in 36.3% (95% CI: 27.3-45) and 28% (95% CI: 20.2-35.8) in the ECA and TCA groups (p = .049). A nadir CD4 cell count ≤200 cells/µl was found to be a risk factor for recurrence (OR: 1.77; 95% CI: 1.12-2.78). CONCLUSIONS In this study, treatment with TCA showed high effectiveness, low recurrence and good tolerability. Considering the benefits of TCA, it could be considered one of the first-line treatments for anal HSIL.
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Affiliation(s)
- Joaquin Burgos
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Adrià Curran
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge Garcia
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Stefania Landolfi
- Anatomical Pathology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Hernández-Losa
- Anatomical Pathology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paula Suanzes
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Navarro
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vicenç Falcó
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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Nikkilä R, Tolonen S, Salo T, Carpén T, Pukkala E, Mäkitie A. Occupational Etiology of Oropharyngeal Cancer: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7020. [PMID: 37947576 PMCID: PMC10647348 DOI: 10.3390/ijerph20217020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
While abundant evidence exists linking alcohol, tobacco, and HPV infection to a carcinogenic impact on the oropharynx, the contribution of inhalational workplace hazards remains ill-defined. We aim to determine whether the literature reveals occupational environments at a higher-than-average risk of developing oropharyngeal cancer (OPC) and summarize the available data. To identify studies assessing the relationship between occupational exposure and risk of OPC, a search of the literature through the PubMed-NCBI database was carried out and, ultimately, 15 original articles meeting eligibility criteria were selected. Only original articles in English focusing on the association between occupational exposure and risk or death of specifically OPC were included. The available data are supportive of a potentially increased risk of OPC in waiters, cooks and stewards, artistic workers, poultry and meat workers, mechanics, and World Trade Center responders exposed to dust. However, the available literature on occupation-related OPC is limited. To identify occupational categories at risk, large cohorts with long follow-ups are needed. Identification of causal associations with occupation-related factors would require dose-response analyses adequately adjusted for confounders.
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Affiliation(s)
- Rayan Nikkilä
- Department of Otorhinolaryngology—Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, FI-00029 Helsinki, Finland
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer and Research, FI-00139 Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, FI-00014 Helsinki, Finland
| | - Suvi Tolonen
- Department of Otorhinolaryngology—Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, FI-00029 Helsinki, Finland
| | - Tuula Salo
- Department of Oral and Maxillofacial Diseases, Clinicum, University of Helsinki, FI-00014 Helsinki, Finland
- Translational Immunology Research Program (TRIMM), University of Helsinki, FI-00014 Helsinki, Finland
- Research Unit of Population Health, University of Oulu, FI-90014 Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, FI-90220 Oulu, Finland
- Department of Pathology, HUS Helsinki University Hospital, University of Helsinki, FI-00029 Helsinki, Finland
| | - Timo Carpén
- Department of Otorhinolaryngology—Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, FI-00029 Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, FI-00014 Helsinki, Finland
- Department of Pathology, HUS Helsinki University Hospital, University of Helsinki, FI-00029 Helsinki, Finland
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer and Research, FI-00139 Helsinki, Finland
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology—Head and Neck Surgery, HUS Helsinki University Hospital, University of Helsinki, FI-00029 Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, FI-00014 Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Hospital, Karolinska Institutet, SE-17177 Stockholm, Sweden
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Wagner S, Langer C, Wuerdemann N, Reiser S, Abing H, Pons-Kühnemann J, Prigge ES, von Knebel Doeberitz M, Gattenlöhner S, Waterboer T, Schroeder L, Arens C, Klussmann JP, Wittekindt C. Predictors for Survival of Patients with Squamous Cell Carcinoma of Unknown Primary in the Head and Neck Region. Cancers (Basel) 2023; 15:cancers15072167. [PMID: 37046829 PMCID: PMC10093301 DOI: 10.3390/cancers15072167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/26/2023] [Accepted: 03/17/2023] [Indexed: 04/08/2023] Open
Abstract
Background: Human papillomavirus (HPV) status is the most important predictor of survival in oropharyngeal squamous cell carcinoma (OPSCC). In patients with cervical lymph node metastases of squamous cell carcinoma of unknown origin (CUPHNSCC), much less is known. Methods: We assessed a consecutive cohort of CUPHNSCC diagnosed from 2000–2018 for HPV DNA, mRNA, p16INK4a (p16) expression, and risk factors to identify prognostic classification markers. Results: In 32/103 (31%) CUPHNSCC, p16 was overexpressed, and high-risk HPV DNA was detected in 18/32 (56.3%). This was mostly consistent with mRNA detection. In recursive partitioning analysis, CUPHNSCC patients were classified into three risk groups according to performance status (ECOG) and p16. Principal component analysis suggests a negative correlation of p16, HPV DNA, and gender in relation to ECOG, as well as a correlation between N stage, extranodal extension, and tobacco/alcohol consumption. Conclusions: Despite obvious differences, CUPHNSCC shares similarities in risk profile with OPSCC. However, the detection of p16 alone appears to be more suitable for the classification of CUPHNSCC than for OPSCC and, in combination with ECOG, allows stratification into three risk groups. In the future, additional factors besides p16 and ECOG may become important in larger studies or cases with special risk profiles.
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Affiliation(s)
- Steffen Wagner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
| | - Christine Langer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
| | - Nora Wuerdemann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, 50937 Cologne, Germany
| | - Susanne Reiser
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
| | - Helen Abing
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, 50937 Cologne, Germany
| | - Jörn Pons-Kühnemann
- Medical Statistics, Institute of Medical Informatics, University of Giessen, 35392 Giessen, Germany
| | - Elena-Sophie Prigge
- Department of Applied Tumor Biology, Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Magnus von Knebel Doeberitz
- Department of Applied Tumor Biology, Institute of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Applied Tumor Biology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | | | - Tim Waterboer
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Lea Schroeder
- Infections and Cancer Epidemiology, Infection, Inflammation and Cancer Program, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, 50937 Cologne, Germany
| | - Claus Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Giessen, 35392 Giessen, Germany
- Department of Otorhinolaryngology, Klinikum Dortmund gGmbH, University Hospital Witten/Herdecke, 44137 Dortmund, Germany
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Boitano TK, Ketch PW, Scarinci IC, Huh WK. An Update on Human Papillomavirus Vaccination in the United States. Obstet Gynecol 2023; 141:324-330. [PMID: 36649341 PMCID: PMC9858349 DOI: 10.1097/aog.0000000000005056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/01/2022] [Indexed: 01/18/2023]
Abstract
Cervical cancer remains a significant disease in the United States. Although the human papillomavirus (HPV) vaccine has been approved for those aged 9-26 years and for some individuals up to age 45 years, there are many circumstances in which health care professionals may not know whether the vaccine should be recommended, such as for patients with previous infection, health care workers, and those older than age 26 years. This article highlights the evidence that the HPV vaccine is a safe and highly effective way to prevent cervical cancer, with the strongest predictor of vaccine uptake being practitioner recommendation.
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Affiliation(s)
- Teresa K.L. Boitano
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Peter W. Ketch
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Alabama
| | - Isabel C. Scarinci
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Warner K. Huh
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama
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Comparison of surgical smoke between two approaches for endoscopic thyroidectomy and open thyroidectomy. BMC Surg 2022; 22:420. [PMID: 36482383 PMCID: PMC9733340 DOI: 10.1186/s12893-022-01870-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Surgical smoke has been recognized as a potential health risk by an increasing number of researchers. Moreover, the counts of surgical smoke produced during different surgical approaches are different. This study aimed to measure and compare the particulate matter (PM) of surgical smoke generated during open thyroidectomy and two endoscopic approaches for thyroidectomy to provide guidance for safe clinical practices. METHODS Forty-eight patients with thyroid cancer admitted to our hospital from June 2020 to December 2021 and treated with different surgical approaches were enrolled in this study. The total and peak counts of PM, dynamic changes, and other characteristics of surgical smoke produced during surgery were recorded. PM was classified as PM2.5 (size ≤ 2.5 μm) and PM10 (size ≤ 10 μm). RESULTS In a single cut, both the peak and total counts of PM2.5 and PM10 of surgical smoke in the open thyroidectomy group (n = 15) were significantly higher than those in the breast approach endoscopic thyroidectomy with CO2 insufflation group (n = 15) and the gasless transaxillary endoscopic thyroidectomy group (n = 18) (p < 0.001). Moreover, the latter two groups showed no significant differences in the peak and total counts of PM2.5 and PM10 (p > 0.05). CONCLUSION In thyroid surgery, more surgical smoke is produced during open thyroidectomy than during endoscopic thyroidectomy, while different endoscopic approaches showed no significant difference in surgical smoke production. Thus, endoscopic approaches outperform the open thyroidectomy approach with regard to surgical smoke production.
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Yilmaz HE, Yilmaz M, Tangirala VA, Spring K. Awareness of surgical smoke risks and assessment of safety practices during the Covid-19 pandemic. THE NATIONAL MEDICAL JOURNAL OF INDIA 2022; 35:189-190. [DOI: 10.25259/nmji-35-3-189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Huriye Erbak Yilmaz
- Department of Biochemistry, University of Katip Celebi University Ataturk Education and Research Hospital, Turkey
- Izmir Biomedicine and Genome Centre, University of Dokuz Eylul, Turkey
| | - Murat Yilmaz
- Department of Neurosurgery, University of Dokuz Eylul, School of Medicine Izmir, Turkey
| | | | - Kevin Spring
- Department of Medical Oncology, Ingham Institute for Applied Medical Research, School of Medicine, Western Sydney University and SWS Clinical School, UNSW, Sydney, NSW, Australia
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Stetkevich SA, Burkhart CG. The dangers of human papillomavirus (HPV) laser plume and best safety practices. Int J Dermatol 2021; 62:32-34. [PMID: 34636418 DOI: 10.1111/ijd.15936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
Human papillomavirus (HPV) remains to be one of the most common viruses that afflicts the skin and mucosa. Direct contact with cutaneous lesions facilitates a majority of viral transmission. However, the development of laser therapy as treatment for HPV brought to attention the concern of infectious laser plume and the risk it poses to those inhaling it. We conducted a literature review using English articles in PubMed to validate this risk and propose the best safety practices dermatologists can apply when using laser therapy as treatment for HPV. Our investigation identified smoke evacuators as primary modes of mitigation, and we suggest further studies will aid in the refinement of best practice recommendations.
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Affiliation(s)
- Samuel A Stetkevich
- Divison of Dermatology, Department of Medicine, University of Toledo College of Medicine, Toledo, OH, USA
| | - Craig G Burkhart
- University of Toledo College of Medicine, Toledo, OH, USA.,Ohio University College of Osteopathic Medicine, Athens, OH, USA
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Vaghef Davari F, Sharifi A. Transmission Possibility of COVID-19 via Surgical Smoke Generated by the Use of Laparoscopic Approaches: A Subject of Debate During the Pandemic. J Laparoendosc Adv Surg Tech A 2021; 31:1106-1113. [PMID: 34534021 DOI: 10.1089/lap.2021.0498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: The smoke created by energy-based devices during surgery may have the potential to transmit viral components to operating room staff. The COVID-19 pandemic has changed staff safety regulations. However, it is not clearly understood whether it can be transmitted via surgical smoke. Laparoscopic approaches have become the standard surgical procedure in many cases, but some of previous investigations have advised to pretermit these approaches due to high risk of COVID-19 transmission. Materials and Methods: We reviewed the English literature that were indexed in the PubMed, Google Scholar, and Scopus databases by using key words including Virus, viral transmission, surgical smoke, surgical plum, laparoscopy, and COVID-19 both solely and in two-word combination. A total of 87 articles were found relevant, and after reviewing the abstract, 33 articles were shortlisted and summarized. Results: Previous studies have focused on different surgical instruments that generate smoke, methods to collect and analyze the smoke and to understand the implications of its exposure after an analysis. A total of 9 out of 11 studies on the potential transmission of human papilloma virus through surgical smoke found evidence in favor of transmission. There were studies on the possible transmission of HIV, hepatitis B virus, and Sabin poliomyelitis vaccine virus 2. Conclusion: We do not believe that laparoscopic procedures may have extra risk for COVID-19 transmission compared with the open procedures, but it is always advised that the operating room staff adhere to the safety instructions during the COVID-19 pandemic.
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Affiliation(s)
- Farzad Vaghef Davari
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirsina Sharifi
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Colorectal Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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9
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Jalisi S, Chen AD, Gomez E, Chigurupati R, Cauley R, Olbricht S, Lee BT, Lin SJ. A Multidisciplinary Approach and Review of Safety Recommendations for Plastic Surgeons during the COVID-19 Pandemic: Are N95 Masks Enough? Plast Reconstr Surg 2021; 148:467-474. [PMID: 34398101 PMCID: PMC8312336 DOI: 10.1097/prs.0000000000008177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 02/24/2021] [Indexed: 01/08/2023]
Abstract
SUMMARY The novel coronavirus disease of 2019 pandemic presents a unique challenge to the field of plastic and reconstructive surgery. Although plastic surgeons may be postponing elective operations, there are still a number of emergent or urgent procedures that may need to be performed, and surgeons may be facing the reality of returning to a new normalcy of operating with coronavirus disease of 2019. These procedures, consisting of those such as head and neck reconstruction or maxillofacial trauma, largely require a multidisciplinary approach and may be considered of higher risk to health care workers because of the involvement of areas of the body identified as sources for viral transmission. Moreover, viral transmission may potentially extend beyond respiratory secretions, which has been the main focus of most safety precautions. The authors aim to present the scope of these procedures and the means of viral transmission, and to provide safety precaution recommendations for plastic surgery and its related disciplines.
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Affiliation(s)
- Scharukh Jalisi
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Austin D. Chen
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Ernest Gomez
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Radhika Chigurupati
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Ryan Cauley
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Suzanne Olbricht
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Bernard T. Lee
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
| | - Samuel J. Lin
- From the Divisions of Otolaryngology–Head and Neck Surgery and Plastic Surgery, and the Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School; and the Department of Oral Maxillofacial Surgery, Boston University School of Dental Medicine
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Robertson-More C, Wu T. A knowledge gap unmasked: viral transmission in surgical smoke: a systematic review. Surg Endosc 2021; 35:2428-2439. [PMID: 33495880 PMCID: PMC7833447 DOI: 10.1007/s00464-020-08261-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/22/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Concerns regarding the aerosolized transmission of SARS-CoV-2 via SS have caused significant apprehension among surgeons related to the use of minimally invasive surgery (MIS) during the COVID19 pandemic. While a limited number of studies have previously demonstrated the presence of viral material in SS, no comprehensive systematic review exists on the subject of viral transmission in SS. Methods A systematic review of the literature was conducted as per PRISMA guidelines. MEDLINE, EMBASE, and CENTRAL databases were searched for publications reporting the primary outcome of the presence of viral particles in SS and secondary outcomes of indices suggesting transmission of viable virus particles in SS producing clinically important infection. All human, animal, and in vitro studies which used accepted analytic techniques for viral detection were included. A meta-analysis was not complete due to methodologic heterogeneity and inconsistent reporting of outcomes of interest. RESULTS 23 publications addressed the presence of viral components in SS, and 19 (83%) found the presence of viral particles in SS. 21 publications additionally studied the ability of SS to induce clinically relevant infection in host cells, with 9 (43%) demonstrating potential for viral transmission. CONCLUSION Evidence exists for viral transmission via SS. However, HPV remains the only virus with documented transmission to humans via SS. While meaningful translation into practical guidelines during the COVID pandemic remains challenging, no evidence exists to suggest increased risk in MIS.
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Affiliation(s)
- Connal Robertson-More
- Department of Surgery, North Island Hospital, Vancouver Island Health Authority, 375 2 Ave, Campbell River, BC, V9W 3V1, Canada.
| | - Ted Wu
- Department of Surgery, University of British Columbia, 2775 Laurel Street, 11th Floor, Vancouver, BC, V5Z 1M9, Canada
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Qaderi K, Geranmayeh M, Farnam F, Sheikh Hasani S, Mirmolaei ST. Understanding HPV-positive women's needs and experiences in relation to patient-provider communication issues: a qualitative study. BMC Health Serv Res 2021; 21:286. [PMID: 33784992 PMCID: PMC8011207 DOI: 10.1186/s12913-021-06283-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background HPV testing has been integrated in cervical cancer screening program. Patient-providers relationship is extremely important to improve cervical cancer screening outcomes. This qualitative study aims to understand HPV-positive women’s needs and preferences about HCPs and patient-provider communication based on their experiences of accessing primary and specialized care. Methods We conducted 40 semi-structured interviews with HPV-positive women. Recorded interviews transcribed and analyzed using conventional content analysis approach. Results The analysis of the data led to the extraction of three main categories, including: provider’s communication and counseling skills, commitment to professional principles, and knowledgeable and competent provider. Women needed understandable discussion about HPV, emotional support and acceptance, receiving HPV-related guidance and advice, and some considerations during clinical appointments. Women needed HCPs to treat them respectfully, gently and with non-judgmental attitude. “Precancerous” and “high-risk” words and watching colposcopy monitor during procedure had made women anxious. Weak referral system and limited interactions among gynecologists and other HCPs highlighted by participants. Conclusion The results of this study, based on the experiences and perceptions of HPV women receiving health care, contain messages and practical tips to healthcare providers at the primary and specialized levels of care to facilitate patient-provider communication around HPV. Providers need to approach the discussion of HPV with sensitivity and take individual needs and preferences into account to improve the HPV-positive women’s healthcare experience. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06283-w.
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Affiliation(s)
- Kowsar Qaderi
- Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat st. Tohid sq, Tehran, 141973317, Iran
| | - Mehrnaz Geranmayeh
- Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat st. Tohid sq, Tehran, 141973317, Iran
| | - Farnaz Farnam
- Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat st. Tohid sq, Tehran, 141973317, Iran
| | - Shahrzad Sheikh Hasani
- Gynecology Oncology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Seyedeh Tahereh Mirmolaei
- Reproductive Health Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Eastern Nosrat st. Tohid sq, Tehran, 141973317, Iran.
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Henning MAS, Jemec GB, Ibler KS. Occupational Skin Disease in Physicians: A Review of the Literature. Ann Work Expo Health 2021; 65:11-25. [PMID: 33009561 DOI: 10.1093/annweh/wxaa091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/29/2020] [Accepted: 08/13/2020] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Occupational skin disease (OSD) arises from work-related activity. However, there is a paucity of literature on OSD in physicians. The aim of the this review was therefore to examine and summarize what types of symptomatic OSD physicians experience. METHODS We conducted a systematic literature search on Cochrane Library, Embase, and Pubmed. RESULTS Contact dermatitis from formaldehyde and glutaraldehyde were found in 11.5 and 13.5% of cases, respectively. In total 2.4-14.9% had latex allergy. The reported standardized incidence ratio of squamous cell carcinoma and melanoma was up to 2.15 [95% confidence interval (CI) 1.57-1.95] and 3.2 (95% CI 1.38-6.31). Transmission of human papilloma virus (HPV) particles during carbon dioxide laser wart ablation were found in 70% of samples collected from protective gloves and in 52% of samples from vapors. CONCLUSIONS The most frequently reported OSD in physicians is contact dermatitis from allergens in disinfectants and rubber gloves. There is also a risk of cutaneous reactions to latex. The incidence of skin cancer was higher in physicians than in the general population, and the reason for this remains unexplained and potentially biased. There are no reports of transmission of patient HPV to surgeons during wart ablation, possibly because of proper use of protective equipment.
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Affiliation(s)
- Mattias A S Henning
- Department of Dermatology, Zealand University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
| | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
| | - Kristina S Ibler
- Department of Dermatology, Zealand University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Roskilde, Denmark
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Abstract
BACKGROUND Laser procedures are becoming more prevalent across multiple medical specialties for a variety of indications. The plumes created by these lasers have raised concern for the dissemination of an infectious material. OBJECTIVE To review and summarize the information on viral dissemination in laser plumes available in the literature. MATERIALS AND METHODS Data Sources A systematic review was performed on English and non-English articles using the PubMed and the Cochrane databases. A manual search of bibliographies from relevant articles was also performed to collect additional studies. STUDY SELECTION Only articles in the English language with full texts available that pertained to viral particles in laser plumes were included. Data Extraction Two authors performed independent article selections using predefined inclusion and exclusion criteria. RESULTS There have been case reports of possible transmission of human papillomavirus (HPV) by inhalation of laser-produced aerosols. Multiple investigators have attempted to recreate this scenario in the laboratory to qualify this risk. Others have conducted clinical experiments to determine the presence of HPV in laser plumes. CONCLUSION The current body of the literature suggests that laser surgeons are at a risk for HPV exposure by inhalation of laser-derived aerosols. We offer best practice recommendations for laser operators.
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Palma S, Gnambs T, Crevenna R, Jordakieva G. Airborne human papillomavirus (HPV) transmission risk during ablation procedures: A systematic review and meta-analysis. ENVIRONMENTAL RESEARCH 2021; 192:110437. [PMID: 33181134 DOI: 10.1016/j.envres.2020.110437] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 09/28/2020] [Accepted: 11/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Human Papillomavirus (HPV) is associated with development of oropharyngeal cancer. Aim of this review was to assess airborne transmission risk of infectious particles from HPV lesions to airway mucosa of medical staff during established ablation procedures. METHODS A systematic review of human and animal studies, published before 09/2020, relevant to airborne HPV transmission. Controlled studies reporting prevalence of HPV-associated upper airway (nasal/oral/pharyngeal) disease in staff performing ablation procedures (laser, loop electrosurgical excision [LEEP], cryosurgery) on HPV lesions were included in meta-analysis. Additionally, we aimed for a comprehensive systematic overview of studies regarding occupational risk of airborne HPV transmission and safety measures during ablation procedures. RESULTS A total of n = 30 original studies report outcomes related to HPV transmission risk in medical staff conducting ablation procedures. HPV DNA detection in ablation smoke (n = 7), matching HPV genotypes on ablated HPV lesions and face/airways of medical staff after ablation (n = 2), and evidence for infectivity of papillomavirus in ablation smoke (n = 3, animal models only) were reported. Three case reports describe occupational HPV disease of upper airway mucosa. Three controlled studies assessed warts (in CO2 laser-users only); when pooling all controls (general population, non-laser users), nasal/oral/pharyngeal lesion sites were more common amongst laser-users (OR = 5.75; 95%CI[1.55, 21.38]; p < .001). DISCUSSION Airborne HPV dispersal with matching "high-risk" HPV-genotypes in airways of medical staff after ablations (LEEP and CO2-laser) and cases of HPV-associated upper airways neoplasms based on exposure to laser and LEEP smoke are documented. Upper airway mucosa is a more common anatomical site for warts in CO2 laser users compared to controls. Simple safety measures greatly reduce HPV contamination and transmission risk.
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Affiliation(s)
- Stefano Palma
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Timo Gnambs
- Leibniz Institute for Educational Trajectories, Wilhelmsplatz 3, 96047, Bamberg, Germany; Institute for Education and Psychology, Johannes Kepler University of Linz, Altenbergerstrasse 69, A-4040, Linz, Austria
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria
| | - Galateja Jordakieva
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Vienna, Austria.
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Pavan N, Crestani A, Abrate A, De Nunzio C, Esperto F, Giannarini G, Galfano A, Gregori A, Liguori G, Bartoletti R, Porpiglia F, Simonato A, Trombetta C, Tubaro A, Ficarra V, Novara G. Risk of Virus Contamination Through Surgical Smoke During Minimally Invasive Surgery: A Systematic Review of the Literature on a Neglected Issue Revived in the COVID-19 Pandemic Era. Eur Urol Focus 2020; 6:1058-1069. [PMID: 32527624 PMCID: PMC7274598 DOI: 10.1016/j.euf.2020.05.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/29/2020] [Indexed: 01/01/2023]
Abstract
CONTEXT The coronavirus disease 2019 (COVID-19) pandemic raised concerns about the safety of laparoscopy due to the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diffusion in surgical smoke. Although no case of SARS-CoV-2 contagion related to surgical smoke has been reported, several international surgical societies recommended caution or even discouraged the use of a laparoscopic approach. OBJECTIVE To evaluate the risk of virus spread due to surgical smoke during surgical procedures. EVIDENCE ACQUISITION We searched PubMed and Scopus for eligible studies, including clinical and preclinical studies assessing the presence of any virus in the surgical smoke from any surgical procedure or experimental model. EVIDENCE SYNTHESIS We identified 24 studies. No study was found investigating SARS-CoV-2 or any other coronavirus. About other viruses, hepatitis B virus was identified in the surgical smoke collected during different laparoscopic surgeries (colorectal resections, gastrectomies, and hepatic wedge resections). Other clinical studies suggested a consistent risk of transmission for human papillomavirus (HPV) in the surgical treatments of HPV-related disease (mainly genital warts, laryngeal papillomas, or cutaneous lesions). Preclinical studies showed conflicting results, but HPV was shown to have a high risk of transmission. CONCLUSIONS Although all the available data come from different viruses, considering that the SARS-CoV-2 virus has been shown in blood and stools, the theoretical risk of virus diffusion through surgical smoke cannot be excluded. Specific clinical studies are needed to understand the effective presence of the virus in the surgical smoke of different surgical procedures and its concentration. Meanwhile, adoption of all the required protective strategies, including preoperative patient nasopharyngeal swab for COVID-19, seems mandatory. PATIENT SUMMARY In this systematic review, we looked at the risk of virus spread from surgical smoke exposure during surgery. Although no study was found investigating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or any other coronavirus, we found that the theoretical risk of virus diffusion through surgical smoke cannot be excluded.
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Affiliation(s)
- Nicola Pavan
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | | | - Alberto Abrate
- Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy
| | - Francesco Esperto
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre Hospital 'Santa Maria della Misericordia', Udine, Italy
| | | | | | - Giovanni Liguori
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, Urologic Unit, University of Pisa, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy
| | - Alchiede Simonato
- Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Urology Unit, Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy
| | - Carlo Trombetta
- Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
| | - Giacomo Novara
- Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Padova, Italy.
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16
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Harrison R, Huh W. Occupational Exposure to Human Papillomavirus and Vaccination for Health Care Workers. Obstet Gynecol 2020; 136:663-665. [DOI: 10.1097/aog.0000000000004021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Gallo O, Locatello LG. Laser-assisted head and neck surgery in the COVID-19 pandemic: Controversial evidence and precautions. Head Neck 2020; 42:1533-1534. [PMID: 32437030 PMCID: PMC7280591 DOI: 10.1002/hed.26271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
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18
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Fox-Lewis A, Allum C, Vokes D, Roberts S. Human papillomavirus and surgical smoke: a systematic review. Occup Environ Med 2020; 77:809-817. [DOI: 10.1136/oemed-2019-106333] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 01/01/2023]
Abstract
ObjectiveTo evaluate what is currently known about the risk to surgeons and other operating theatre (OT) staff of human papillomavirus (HPV) transmission and HPV-related disease following surgical smoke exposure.MethodsA systematic literature search of Embase and Ovid-MEDLINE was undertaken for primary studies relevant to the presence of HPV in surgical smoke, contamination of OT staff with HPV after performing or attending smoke-generating surgical procedures, and the presence of HPV or HPV-related disease in OT staff following occupational surgical smoke exposure. Additional articles were identified by searching the reference lists of relevant published papers.ResultsTwenty-one relevant articles were identified. These demonstrate that surgical smoke from the treatment of HPV-related lesions can contain HPV DNA, and that this can contaminate the upper airways of OT staff. Whether this corresponds to infectious virus is not known. Increased prevalence of HPV infection or HPV-related disease in OT staff following occupational exposure to surgical smoke has not been convincingly shown.ConclusionsWhile HPV transmission to OT staff from surgical smoke remains unproven, it would be safest to treat surgical smoke as potentially infectious. Necessary precautions should be taken when performing smoke-generating procedures, consisting of: (1) local exhaust ventilation, (2) general room ventilation and (3) full personal protective equipment including a fit tested particulate respirator of at least N95 grade. There is currently insufficient evidence to recommend HPV vaccination for OT staff or to state that the above precautions, when used properly, would not be effective at preventing HPV transmission from surgical smoke.
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19
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Mowbray NG, Ansell J, Horwood J, Cornish J, Rizkallah P, Parker A, Wall P, Spinelli A, Torkington J. Safe management of surgical smoke in the age of COVID-19. Br J Surg 2020; 107:1406-1413. [PMID: 32363596 PMCID: PMC7267397 DOI: 10.1002/bjs.11679] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 12/21/2022]
Abstract
Background The COVID-19 global pandemic has resulted in a plethora of guidance and opinion from surgical societies. A controversial area concerns the safety of surgically created smoke and the perceived potential higher risk in laparoscopic surgery. Methods The limited published evidence was analysed in combination with expert opinion. A review was undertaken of the novel coronavirus with regards to its hazards within surgical smoke and the procedures that could mitigate the potential risks to healthcare staff. Results Using existing knowledge of surgical smoke, a theoretical risk of virus transmission exists. Best practice should consider the operating room set-up, patient movement and operating theatre equipment when producing a COVID-19 operating protocol. The choice of energy device can affect the smoke produced, and surgeons should manage the pneumoperitoneum meticulously during laparoscopic surgery. Devices to remove surgical smoke, including extractors, filters and non-filter devices, are discussed in detail. Conclusion There is not enough evidence to quantify the risks of COVID-19 transmission in surgical smoke. However, steps can be undertaken to manage the potential hazards. The advantages of minimally invasive surgery may not need to be sacrificed in the current crisis.
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Affiliation(s)
- N G Mowbray
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - J Ansell
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - J Horwood
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - J Cornish
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - P Rizkallah
- School of Medicine, Cardiff University, Cardiff, UK
| | - A Parker
- School of Medicine, Cardiff University, Cardiff, UK
| | - P Wall
- Isca Healthcare Research, Caerleon, UK
| | - A Spinelli
- Department of General and Minimally Invasive Surgery, Istituto Clinico Humanitas, Rozzano, Italy
| | - J Torkington
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
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20
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Rubin GA, Biviano A, Dizon J, Yarmohammadi H, Ehlert F, Saluja D, Rubin DA, Morrow JP, Waase M, Berman J, Kushnir A, Abrams MP, Garan H, Wan EY. Performance of electrophysiology procedures at an academic medical center amidst the 2020 coronavirus (COVID-19) pandemic. J Cardiovasc Electrophysiol 2020; 31:1249-1254. [PMID: 32281214 PMCID: PMC7262273 DOI: 10.1111/jce.14493] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/26/2022]
Abstract
A global coronavirus (COVID-19) pandemic occurred at the start of 2020 and is already responsible for more than 74 000 deaths worldwide, just over 100 years after the influenza pandemic of 1918. At the center of the crisis is the highly infectious and deadly SARS-CoV-2, which has altered everything from individual daily lives to the global economy and our collective consciousness. Aside from the pulmonary manifestations of disease, there are likely to be several electrophysiologic (EP) sequelae of COVID-19 infection and its treatment, due to consequences of myocarditis and the use of QT-prolonging drugs. Most crucially, the surge in COVID-19 positive patients that have already overwhelmed the New York City hospital system requires conservation of hospital resources including personal protective equipment (PPE), reassignment of personnel, and reorganization of institutions, including the EP laboratory. In this proposal, we detail the specific protocol changes that our EP department has adopted during the COVID-19 pandemic, including performance of only urgent/emergent procedures, after hours/7-day per week laboratory operation, single attending-only cases to preserve PPE, appropriate use of PPE, telemedicine and video chat follow-up appointments, and daily conferences to collectively manage the clinical and ethical dilemmas to come. We discuss also discuss how we perform EP procedures on presumed COVID positive and COVID tested positive patients to highlight issues that others in the EP community may soon face in their own institution as the virus continues to spread nationally and internationally.
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Affiliation(s)
- Geoffrey A Rubin
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jose Dizon
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Frederick Ehlert
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Deepak Saluja
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - David A Rubin
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - John P Morrow
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Marc Waase
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jeremy Berman
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Alexander Kushnir
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Mark P Abrams
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Elaine Y Wan
- Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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21
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Swerdlow BN. Surgical smoke and the anesthesia provider. J Anesth 2020; 34:575-584. [PMID: 32296937 DOI: 10.1007/s00540-020-02775-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/07/2020] [Indexed: 01/19/2023]
Abstract
Surgical smoke generated by use of electrosurgical units (ESUs), lasers, and ultrasonic scalpels constitutes a physical, chemical, and biological hazard for anesthesia personnel. Inhalation of particulate matter with inflammatory consequences, pulmonary injury from products of tissue pyrolysis, exposure to mutagens and carcinogens, and the transmission of human papillomavirus (HPV) and possibly other pathogens represent a spectrum of adverse effects associated with the occupational exposure to surgical plume. While adequate operating room ventilation and use of high filtration-efficiency masks offer some protection from these conditions, the most effective method of safeguarding against surgical smoke involves its removal with a dedicated smoke evacuation device (SED). Despite the fact that many professional and governmental agencies have endorsed widespread usage of SEDs, anesthesia providers have been largely silent on this subject, with few reports within the field of anesthesiology and perioperative medicine regarding these hazards. SED use is relatively infrequent in most surgeries, and this condition reflects surgeons' reluctance to employ these devices, likely resulting from lack of education and less than optimal technology. Anesthesia societies and academic centers can serve critical roles in advocating employment of SEDs in much the same way that they have supported perioperative smoking cessation.
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Affiliation(s)
- Barry N Swerdlow
- Nurse Anesthesia Program, Oregon Health and Science University, SON #521, 3455 SW US Veterans Hospital Rd, Portland, OR, 97239, USA.
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22
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Subbarayan RS, Shew M, Enders J, Bur AM, Thomas SM. Occupational exposure of oropharyngeal human papillomavirus amongst otolaryngologists. Laryngoscope 2019; 130:2366-2371. [PMID: 31710711 DOI: 10.1002/lary.28383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/25/2019] [Accepted: 10/03/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES/HYPOTHESIS Human papillomavirus (HPV) is a DNA virus that causes cancer in multiple sites. Although sexual activity is the primary means of oropharyngeal HPV acquisition, studies suggest HPV transmission through occupational exposure from medical instruments and surgical fumes. We assess if aerosolization of HPV16 DNA via electrocautery places otolaryngologists at risk for exposure. STUDY DESIGN Animal and human laboratory model. METHODS Plasmid (pLXSN16E6E7) expressing HPV p16 E6/E7 genes was transformed into DH5α Escherichia coli cells using the heat shock method. Miniprep and maxiprep purification of transformed DNA with subsequent restriction enzyme double digestion confirmed presence of E6E7 fragment. We injected 2 μg plasmid DNA in 20 μL TE (Tris and ethylenediaminetetraacetic acid) buffer intradermally into freshly severed mouse tail then cauterized for 5 to 10 seconds. Generated fumes were collected through a suction tube fitted with Whatman filter paper. Filter paper was placed in 100 μL TE buffer. Additionally, six patients undergoing transoral robotic surgery for resection of oropharyngeal cancer were identified, three with p16-negative tumors and three with p16-positive tumors. Intraoperatively, Whatman filter paper was exposed to electrocautery fumes, then placed in 100 uL TE buffer. Additional samples were collected from the suction tubing and filter, the surgical mask of the surgeon at head of the bed, and the robot arm. RESULTS Samples were analyzed via polymerase chain reaction with an assay sensitivity of 1.5 ng E6E7 DNA. None of the patient or mouse tail samples yielded detectable HPV16 DNA in the electrocautery fumes. We did not detect HPV16 DNA on the surgical masks, suction apparatus, or robot arm intraoperatively. CONCLUSIONS There is likely minimal risk of occupational exposure to HPV16 via electrocautery fumes. LEVEL OF EVIDENCE NA Laryngoscope, 130:2366-2371, 2020.
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Affiliation(s)
- Rahul S Subbarayan
- Departments of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Matthew Shew
- Departments of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Jonathan Enders
- Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Andrés M Bur
- Departments of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Sufi M Thomas
- Departments of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, U.S.A.,Cancer Biology, University of Kansas Medical Center, Kansas City, Kansas, U.S.A.,Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, Kansas, U.S.A
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23
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Brief Report: Effectiveness of Trichloroacetic Acid vs. Electrocautery Ablation for the Treatment of Anal High-Grade Squamous Intraepithelial Lesion in HIV-Infected Patients. J Acquir Immune Defic Syndr 2019; 79:612-616. [PMID: 30179983 DOI: 10.1097/qai.0000000000001847] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trichloroacetic acid (TCA) and electrocautery ablation (ECA) are 2 of the main treatment options for anal high-grade squamous intraepithelial lesion (HSIL). Our aim was to compare the efficacy and tolerance of TCA vs. ECA for HSIL. METHODS Retrospective uncontrolled study of HIV-infected men who have sex with men who had an anal HSIL treated with TCA or ECA. On-treatment effectiveness was evaluated at 6-8 weeks after treatment. A complete response was defined as resolution of HSIL, a partial response as regression to low-grade lesion, and recurrence as biopsy-proven HSIL during follow-up. A propensity-score analysis was used to adjust efficacy to potential confounding. RESULTS From May 2009 to March 2018, 182 and 56 cases of anal HSIL were treated with ECA and TCA, respectively. Comparing ECA with TCA, a complete response was observed in 33.5% (95% confidence interval: 25.8 to 41.6) vs. 60.7% (50.0 to 74.8) and a partial response in 28.0% (20.3 to 36.0) vs. 23.2% (12.5 to 37.3), respectively (P < 0.001). These differences were maintained in the propensity-score analyses. Side effects were common in both treatment, but tolerance was reported as good in 80.6% (74.2 to 89.2) and 82.6% (73.9 to 93.9) of cases treated with ECA and TCA, respectively, and no serious events were described. Recurrence cumulative incidence for the first 12 months was 14.6% (9.1 to 23.1) for ECA episodes and 27.6% (11.5 to 57.7) for TCA (P = 0.183). CONCLUSIONS Our study showed a higher efficacy of TCA than ECA with similar rates of side effects. In our opinion, considering the benefits of TCA, it should be considered as a first-line therapy for most anal HSIL management.
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Liu Y, Song Y, Hu X, Yan L, Zhu X. Awareness of surgical smoke hazards and enhancement of surgical smoke prevention among the gynecologists. J Cancer 2019; 10:2788-2799. [PMID: 31258787 PMCID: PMC6584931 DOI: 10.7150/jca.31464] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/29/2019] [Indexed: 12/31/2022] Open
Abstract
Surgical smoke is the gaseous by-product produced by heat generating devices in various surgical operations including laser conization and loop electrosurgical procedures that often are performed by gynecologists. Surgical smoke contains chemicals, blood and tissue particles, bacteria, and viruses, which has been shown to exhibit potential risks for surgeons, nurses, anesthesiologists, and technicians in the operation room due to long term exposure of smoke. In this review, we describe the detailed information of the components of surgical smoke. Moreover, we highlight the effects of surgical smoke on carcinogenesis, mutagenesis, and infection in gynecologists. Furthermore, we discussed how to prevent the surgical smoke via using high-filtration masks and smoke evacuation systems as well as legal guidelines for protection measures among the gynecologists.
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Affiliation(s)
- Yi Liu
- Department of obstetrics and gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yizuo Song
- Department of obstetrics and gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoli Hu
- Department of obstetrics and gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Linzhi Yan
- Department of obstetrics and gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xueqiong Zhu
- Department of obstetrics and gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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25
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Transfer of pathogens to and from patients, healthcare providers, and medical devices during care activity-a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2018; 39:1093-1107. [PMID: 30039774 DOI: 10.1017/ice.2018.156] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The transfer of pathogens may spread antimicrobial resistance and lead to healthcare-acquired infections. We performed a systematic literature review to generate estimates of pathogen transfer in relation to healthcare provider (HCP) activities. METHODS For this systematic review and meta-analysis, Medline/Ovid, EMBASE, and the Cochrane Library were searched for studies published before July 7, 2017. We reviewed the literature, examining transfer of pathogens associated with HCP activities. We included studies that (1) quantified transfer of pathogens from a defined origin to a defined destination surface; (2) reported a microbiological sampling technique; and (3) described the associated activity leading to transfer. For studies reporting transfer frequencies, we extracted data and calculated the estimated proportion using Freeman-Tukey double arcsine transformation and the DerSimonian-Laird random-effects model. RESULTS Of 13,121 identified articles, 32 were included. Most articles (n=27, 84%) examined transfer from patients and their environment to HCP hands, gloves, and gowns, with an estimated proportion for transfer frequency of 33% (95% confidence interval [CI], 12%-57%), 30% (95% CI, 23%-38%) and 10% (95% CI, 6%-14%), respectively. Other articles addressed transfer involving the hospital environment and medical devices. Risk factor analyses in 12 studies suggested higher transfer frequencies after contact with moist body sites (n=7), longer duration of care (n=5), and care of patients with an invasive device (n=3). CONCLUSIONS Recognizing the heterogeneity in study designs, the available evidence suggests that pathogen transfer to HCPs occurs frequently. More systematic research is urgently warranted to support targeted and economic prevention policies and interventions.
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Stanley C, Secter M, Chauvin S, Selk A. HPV vaccination in male physicians: A survey of gynecologists and otolaryngology surgeons' attitudes towards vaccination in themselves and their patients. PAPILLOMAVIRUS RESEARCH (AMSTERDAM, NETHERLANDS) 2018; 5:89-95. [PMID: 29524677 PMCID: PMC5887017 DOI: 10.1016/j.pvr.2018.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/01/2018] [Accepted: 03/04/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Attitudes and barriers towards HPV vaccination were explored in a population of male surgeons in Gynecology and Otolaryngology in Ontario, Canada. MATERIALS/METHODS An internet-based survey was distributed to male residents and physicians affiliated with the departments of Obstetrics and Gynecology, and Otolaryngology at six Ontario universities. The survey consisted of 16 questions (3 demographic, 3 workplace exposure, 6 regarding personal vaccination, and 3 regarding patient vaccination). Subgroup analyses examined differences between residents versus staff physicians and gynecologists versus otolaryngologists. RESULTS Most respondents (51/63, 81.0%) had not been vaccinated against HPV, yet would consider vaccination in the future (41/51, 80.4%). Significantly more residents would consider vaccination compared to staff physicians (p = .03). Personal protection from benign HPV disease was the most common motivating factor (25/59, 42.4%) among participants. A notable barrier to vaccination was "age over recommendations" (9/44, 20.4%). Most participants would recommend the HPV vaccine to both male patients (49/62, 79.0%) and male partners of female patients (47/62, 75.8%). CONCLUSIONS This study demonstrates male gynecologists and otolaryngologists had largely favorable attitudes towards HPV vaccination though few had received vaccination. These findings may be used to increase HPV vaccine uptake among male health care professionals and their patients.
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Affiliation(s)
- Claire Stanley
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada M5S 1A8
| | - Michael Secter
- Department of Obstetrics and Gynecology, Sunnybrook Health Science Centre, Toronto, Ontario, Canada M4N 3M5
| | - Sarah Chauvin
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada M5S 1A8
| | - Amanda Selk
- Department of Obstetrics and Gynecology, Women's College Hospital, Toronto, Ontario, Canada M5S 1B2; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada M5G 1E2.
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Park IU, Introcaso C, Dunne EF. Human Papillomavirus and Genital Warts: A Review of the Evidence for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. Clin Infect Dis 2016; 61 Suppl 8:S849-55. [PMID: 26602622 DOI: 10.1093/cid/civ813] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
To provide updates for the 2015 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines on human papillomavirus (HPV) and anogenital warts (AGWs), a review of the literature was conducted in key topic areas: (1) epidemiology and burden of disease; (2) transmission and natural history; (3) diagnosis and management of AGWs; (4) occupational exposure of healthcare workers; (5) anal cancer screening among men who have sex with men (MSM); and (6) HPV vaccine recommendations. Most sexually active persons will have detectable HPV at least once in their lifetime; 14 million persons are infected annually, and 79 million persons have prevalent infection. HPV is transmitted frequently between partners; more frequent transmission has been reported from females to males than from males to females. A new formulation of imiquimod (3.75% cream) is recommended for AGW treatment. Appropriate infection control, including performing laser or electrocautery in ventilated rooms using standard precautions, is recommended to prevent possible transmission to healthcare workers who treat anogenital warts, oral warts, and anogenital intraepithelial neoplasias (eg, cervical intraepithelial neoplasia). Data are insufficient to recommend routine anal cancer screening with anal cytology in persons living with human immunodeficiency virus (HIV)/AIDS or HIV-negative MSM. An annual digital anorectal examination may be useful for early detection of anal cancer in these populations. HPV vaccine is recommended routinely for 11- or 12-year-olds, as well as for young men through age 21 years and young women through age 26 years who have not previously been vaccinated. HPV vaccine is also recommended for MSM, people living with HIV/AIDS, and immunocompromised persons through age 26 years.
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Affiliation(s)
- Ina U Park
- Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, California Department of Public Health, Richmond Department of Family and Community Medicine, School of Medicine, University of California, San Francisco
| | - Camille Introcaso
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eileen F Dunne
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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28
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Bowen AJ, Bryson PC. OR Management of Recurrent Respiratory Papilloma. CURRENT OTORHINOLARYNGOLOGY REPORTS 2016. [DOI: 10.1007/s40136-016-0117-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Condyloma acuminata are the most frequent cause of infections in the anal genital area. They are caused by the human papilloma virus (HPV). Risk factors are early onset of sexual activity, multiple sexual partners, a history of sexually transmitted disease, and immunosuppression. The urethra is afflicted in only 20% of cases; of these, 80% of the warts are at the meatus and 20% in the proximal urethra. This article reports on two cases with condyloma acuminata affection of the total urethra. The current diagnostic, different treatment modalities, and prophylaxis are reviewed.
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30
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Lopez R, Lacey SE, Jones RM. Application of a two-zone model to estimate medical laser-generated particulate matter exposures. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2015; 12:309-313. [PMID: 25622045 DOI: 10.1080/15459624.2014.989361] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We estimated particulate matter exposures for two simulated medical laser procedures using a near-field/far-field model. Size-specific mass emission rates obtained from a laboratory-based emission chamber study were used with estimated room size, air exchange rate, and interflow between zones to demonstrate the potential exposure range. Modeled steady-state concentrations for the near-field ranged between 80 and 2140 μg/m(3) and between 40 and 1650 μg/m(3) in the far-field. Results indicate concentrations in the simulated scenarios are similar to those obtained from limited field assessments conducted in hospital operating rooms. Since new medical laser technologies and applications continue to grow, modeled occupational exposures of medical laser-generated particulate matter can be useful in better understanding these exposures in the clinical environment, and to inform control strategies.
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Affiliation(s)
- Ramon Lopez
- a Department of Environmental Health Science , Richard M. Fairbanks School of Public Health, Indiana University , Indianapolis , Indiana
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Malicki J, Golusinski W. Challenges in organizing effective oncology service: inter-European variability in the example of head and neck cancers. Eur Arch Otorhinolaryngol 2014; 271:2343-7. [PMID: 25047398 PMCID: PMC4118027 DOI: 10.1007/s00405-014-3197-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/03/2014] [Indexed: 12/01/2022]
Abstract
The increasing worldwide burden of cancer makes it imperative that every country develop a comprehensive cancer control programme. In the past, cancer control in Central and Eastern Europe was inadequate, particularly when compared to many wealthier Western European countries. We analyse interregional differences in Europe to the approach to comprehensive cancer care, with a focus on head and neck squamous cell carcinoma using the case of Poland as a representative example. Due to national plans major improvements have been achieved in the field of prevention and in radiotherapy delivery having a measurable and positive impact on treatment outcomes. In head and neck cancers a notable move towards multidisciplinary approach has been made, combining surgery, radiotherapy and chemotherapy accompanied by rehabilitation and social support. In Poland and several other Eastern and Central European countries a shortage of physicians in the field of oncology was noted. The main conclusion is that the special plans are needed in Central and Eastern Europe or those existing must be extended for another decade to fulfil the EU requirement of providing all European citizens with equal access to quality cancer care.
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Affiliation(s)
- Julian Malicki
- Department of Electroradiology, University of Medical Sciences, Poznan, Poland
- Department of Medical Physics, Greater Poland Cancer Centre, Poznan, Poland
| | - Wojciech Golusinski
- Department of Head and Neck Surgery, University of Medical Sciences, Poznan, Poland
- Greater Poland Cancer Centre, Poznan, Poland
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