Infectious papillomavirus in the vapor of warts treated with carbon dioxide laser or electrocoagulation: Detection and protection

Sawchuk, William S.; Weber, Paul J.; Lowy, Douglas R.; Dzubow, Leonard M.

doi:10.1016/s0190-9622(89)70146-8

Cited by 339 publications

(196 citation statements)

References 31 publications

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“…9,10 In addition, infectious virions have been isolated from electrocautery smoke. 11 Previous reports have shown that Harmonic Scalpels generate particles 350 to 650 nm in diameter at approximately a quarter of the particle concentration seen with electrocautery. 12 The bimodal distribution of particles produced by surgical instruments has been described previously.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Surgical Smoke Produced by Various Energy-Based Instruments and Effect on Laparoscopic Visibility

Weld

Dryer

Ames

et al. 2007

Journal of Endourology

100

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,"Analysis of surgical smoke produced by various energy-based instruments and effect on laparoscopic visibility." Journal of Endourology.21,3. 347-351. (2007 ABSTRACT Purpose:We analyzed the smoke plume produced by various energy-based laparoscopic instruments and determined its effect on laparoscopic visibility. Materials and Methods:The Bipolar Macroforceps, Harmonic Scalpel, Floating Ball, and Monopolar Shears were applied in vitro to porcine psoas muscle. An Aerodynamic Particle Sizer and Electrostatic Classifier provided a size distribution of the plume for particles Ͼ500 nm and Ͻ500 nm, and a geometric mean particle size was calculated. A Condensation Particle Counter provided the total particle-number concentration. Electron microscopy was used to characterize particle size and shape further. Visibility was calculated using the measured-size distribution data and the Rayleigh and Mie light-scattering theories.Results: The real-time instruments were successful in measuring aerosolized particle size distributions in two size ranges. Electron microscopy revealed smaller, homogeneous, spherical particles and larger, irregular particles consistent with cellular components Conclusions: Surgical smoke is composed of two distinct particle populations caused by the nucleation of vapors as they cool (the small particles) and the entrainment of tissue secondary to mechanical aspects (the large particles). High concentrations of small particles are most responsible for the deterioration in laparoscopic vision. Bipolar and ultrasonic instruments generate a surgical plume that causes the least deterioration of visibility among the instruments tested.

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Section: Discussionmentioning

confidence: 99%

Analysis of Surgical Smoke Produced by Various Energy-Based Instruments and Effect on Laparoscopic Visibility

Weld

Dryer

Ames

et al. 2007

Journal of Endourology

100

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“…HPV DNA has been demonstrated in CO2 laser vapor, as well as in the vapors from electrocoagulation. [121][122][123][124][125] Erbium:Yttrium/Aluminum/Garnet (Er:YAG) Laser The Er:YAG laser emits a shorter wavelength infrared radiation (2940 nm) that is absorbed 12 to 18 times more efficiently by water-containing superficial cutaneous tissues than is the 10,600 nm wavelengths emitted by the CO2 laser. 126 The Er:YAG laser has a smaller zone of thermal damage, thereby allowing more precise thermal ablation with minimal scarring.…”

Section: Carbon Dioxide (Co2) Lasermentioning

confidence: 99%

An Armamentarium of Wart Treatments

Lipke¹

2006

Clinical Medicine & Research

287

295

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Patients and clinicians experience the frustration of cutaneous viral warts caused by infection with the human papilloma virus (HPV).Warts appear in various forms on different sites of the body and include common warts (verruca vulgaris), plane or flat warts, myrmecia, plantar warts, coalesced mosaic warts, filiform warts, periungual warts, anogenital warts (venereal or condyloma acuminata), oral warts and respiratory papillomas. Cervical infection with HPV is now known to cause cervical cancer if untreated. A review of the medical literature reveals a huge armamentarium of wart monotherapies and combination therapies. Official evidence-based guidelines exist for the treatment of warts, but very few of the reported treatments have been tested by rigorous blinded, randomized controlled trials.Therefore, official recommendations do not often include treatments with reportedly high success rates, but they should not be ignored when considering treatment options. It is the purpose of this review to provide a comprehensive overview of the wart treatment literature to expand awareness of the options available to practitioners faced with patients presenting with problematic warts. Warts of the genital tract carry a much more ominous and pernicious threat for women in particular. It has been estimated that up to 70% of sexually active women become infected during their lifetime with human papillomavirus (HPV), the infective agent that causes warts. 3-5 A causal role for HPV infections in cervical cancer has been documented beyond reasonable doubt. HPV DNA is present in virtually all cervical cancer cases worldwide, with it being detected in 99.7% of an international series of cervical cancers by genetic amplification techniques and in 100% of cases as confirmed by histological review. 6,7 Cervical cancer is the most frequent common cancer in developing countries and the second most common cancer in women worldwide. 3 The association between HPV infection and cervical cancer is so strong that HPV is now considered the first positive cause of any human cancer ever identified. 3This raises the level of concerns over HPV prevention, screening and treatment from that of a nuisance condition to that of a major public health concern. Attention is beginning to focus on the viral factors that determine persistence and neoplastic progression to cancer and the possible role of HPV in other nongenital cancers (e.g., skin, upper aerodigestive tract). [8][9][10][11][12][13][14][15][16][17] Patients with warts seek advice from general practitioners, pharmacists, naturopaths, allied health professionals, family or friends, dermatologists, gynecologists, obstetricians and pediatricians for treatment and may present with recalcitrant warts that have been previously treated with anything from folk remedies to hypnosis to over-the-counter medications to more aggressive clinic-based treatments. Unfortunately, even with years of medical literature on this subject, high-quality, level I evidence for the efficacy of almost all treatments is no...

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“…[3][4][5] However, laser-and ESU-generated smoke contain the same constituents and thus can be considered to have identical hazard profiles. [4][5][6][7] Research into plume generated by both modalities was included in this review.…”

Section: Discussionmentioning

confidence: 99%

Current Attitudes and Practices Towards Diathermy Smoke

Spearman

Tsavellas

Nichols

2007

annals

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INTRODUCTION The hazards of surgical smoke are well documented and electrosurgical units (ESUs) are an integral part of surgical practice. The aim of this study was to gauge the opinions of general surgical consultants, specialist registrars and senior theatre nurses in the Wessex Region towards the hazards of ESU smoke.MATERIALS AND METHODS A literature search was carried out using Ovid Medline. A questionnaire was sent to 169 consultants, SpRs and nurses in the 14 hospitals across the Wessex Region, exploring current practices, perceived hazards and whether adequate precautions were currently in use. RESULTS Only 3 of 98 surgeons used dedicated smoke extractors, despite the fact the majority (72%) felt that, currently, inadequate precautions were taken to protect staff and patients from surgical smoke. There was also uncertainty about the hazards amongst the respondents.CONCLUSIONS The use of smoke extraction equipment is very limited. Greater awareness of the hazards and available technology to extract fumes from the theatre environment might lead to greater uptake.

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Infectious papillomavirus in the vapor of warts treated with carbon dioxide laser or electrocoagulation: Detection and protection

Cited by 339 publications

References 31 publications

Analysis of Surgical Smoke Produced by Various Energy-Based Instruments and Effect on Laparoscopic Visibility

Analysis of Surgical Smoke Produced by Various Energy-Based Instruments and Effect on Laparoscopic Visibility

An Armamentarium of Wart Treatments

Current Attitudes and Practices Towards Diathermy Smoke

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