Larynxpapillomatose - erstmalige Anerkennung als Berufskrankheit bei einer OP-Schwester

Calero, Luis; Brusis, Tilman

doi:10.1055/s-2003-44546

Cited by 69 publications

(16 citation statements)

References 5 publications

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“…sexually transmitted) methods in which he could have contacted HPV types 6 and 11 apart from the operating theatre. In another case (published in German), a 28-year-old gynaecological theatre nurse who assisted in laser ablation of anogenital condylomata developed laryngeal papillomatosis [1]. Her case was thoroughly investigated by a prestigious virology institute in Germany and hers was deemed to be a case of occupational disease.…”

Section: Resultsmentioning

confidence: 99%

Virus-Induced Cancers of the Skin and Mucosa: Are We Dealing with “Smoking Guns” or “Smoke and Mirrors” in the Operating Theatre?

Goon

Tan

et al. 2017

Dermatol Ther (Heidelb)

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IntroductionHuman papillomavirus (HPV) alone is thought to cause ~610,000 cases of cancer per year, and is the dominant aetiological agent for ano-genital (esp. cervical) and head and neck cancers (esp. oropharyngeal). Merkel cell polyomavirus (MCV) is a more recently discovered virus which causes Merkel cell carcinoma, a rare but highly aggressive skin malignancy.MethodsWe explored the available published evidence to see if transmission of live HPV or MCV virus in smoke generated by laser or diathermy was feasible, and would pose an infection risk. Long-term infection with such carcinogenic viruses would then pose an increased risk for the development of virus-induced cancers in medical personnel.ResultsThe morphological structures of both HPV and MCV are very similar, and the size, external capsids and genomic structures show striking similarity. Both viruses have a non-enveloped external protein capsid consisting of 72 capsomeres, and a double-stranded DNA core. Sizes of both viruses range from 50 to 60 nm. There are now recent data demonstrating live and infectious HPV in smoke, and that these viruses can be used to infect cells in vitro. Further, anecdotal reports of virus transmission leading to disease causation in the production of respiratory airway viral warts (benign disease), and, finally, reports of HPV-induced oropharyngeal carcinoma (malignant disease) in two gynaecological surgeons as an occupational health hazard have been published recently.ConclusionThere is now sufficient evidence to support the hypotheses that live infectious carcinogenic viruses can be transmitted via smoke generated from surgical procedures, and, in rare instances, actually cause significant disease. Protective measures such as smoke extraction and airway protection should be instituted for all healthcare personnel, particularly those with multiple repeated exposures such as gynaecological surgeons.

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Section: Resultsmentioning

confidence: 99%

Virus-Induced Cancers of the Skin and Mucosa: Are We Dealing with “Smoking Guns” or “Smoke and Mirrors” in the Operating Theatre?

Goon

Tan

et al. 2017

Dermatol Ther (Heidelb)

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“…Two case reports describe HPV infection in two health care professionals regularly exposed to laser plumes in an occupational setting. Both reported no other risk factors or other possible exposures to the virus [3,4]. Furthermore, there is a significantly increased incidence of nasopharyngeal warts in laser surgeons when compared to a control group [5].…”

Section: Discussionmentioning

confidence: 99%

HPV positive tonsillar cancer in two laser surgeons: Case reports

Rioux

Garland

Webster

et al. 2013

Journal of Otolaryngology - Head & Neck Surgery

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A 53 year-old male gynecologist presented with human papillomavirus (HPV) 16 positive tonsillar squamous cell carcinoma. He had no identifiable risk factors with the exception of long term occupational exposure to laser plumes, having performed laser ablations and loop electrosurgical excision procedures (LEEP) on greater than 3000 dysplastic cervical and vulvar lesions over 20 years of practice. The second patient is a 62 year old male gynecologist with a 30 year history of laser ablation and LEEP who subsequently developed HPV 16 positive base of tongue cancer. He also had very few other risk factors for oropharyngeal cancer or HPV infection. HPV is a probable causative agent for oropharyngeal squamous cell carcinoma and has been reported as being transmittable through laser plume. This paper suggests that HPV transmitted through laser plume can result in subsequent squamous cell carcinoma.

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“…The exposure to pyrolysis products is known to increase laryngeal papillomatosis caused by human papilloma virus. 23 Calero et al 24 published the first case of the recognition as an occupational disease in an operating room nurse in Germany in 2003. In our study, attention was paid to 2 of the most critical PAHs: phenanthrene and BaP.…”

Section: Discussionmentioning

confidence: 99%

Electrocautery Devices With Feedback Mode and Teflon-Coated Blades Create Less Surgical Smoke for a Quality Improvement in the Operating Theater

et al. 2015

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Monopolar electrocautery is a fast and elegant cutting option. However, as it creates surgical smoke containing polycyclic aromatic hydrocarbons (PAHs), it may be hazardous to the health of the surgical team. Although new technologies, such as feedback mode (FM) and Teflon-coated blades (TBs), reduce tissue damage, their impact on surgical smoke creation has not yet been elucidated. Therefore, we analyzed the plume at its source.The aim of this study was to evaluate if electrocautery FM and TBs create less surgical smoke.Porcine tissue containing skin was cut in a standardized manner using sharp-edged Teflon-coated blades (SETBs), normal-shaped TBs, or stainless steel blades (SSBs). Experiments were performed using FM and pure-cut mode. Surgical smoke was sucked through filters or adsorption tubes. Subsequently, filters were scanned and analyzed using a spectrophotometer. A high-performance liquid chromatography (HPLC-UV) was performed to detect benzo[a]pyrene (BaP) and phenanthrene as 2 of the most critical PAHs. Temperature changes at the cutting site were measured by an infrared thermometer.In FM, more surgical smoke was created using SSB compared with TBs (P < 0.001). Furthermore, differences between FM and pure-cut mode were found for SSB and TB (P < 0.001), but not for SETB (P = 0.911). Photometric analysis revealed differences in the peak heights of the PAH spectrum. In HLPC-UV, the amount of BaP and phenanthrene detected was lower for TB compared with SSB. Tissue temperature variations increased when SSB was used in FM and pure-cut mode. Furthermore, different modes revealed higher temperature variations with the use of SETB (P = 0.004) and TB (P = 0.005) during cutting, but not SSB (P = 0.789).We found that the use of both TBs and FM was associated with reduced amounts of surgical smoke created during cutting. Thus, the surgical team may benefit from the adoption of such new technologies, which could contribute to the primary prevention of smoke-related diseases.

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Larynxpapillomatose - erstmalige Anerkennung als Berufskrankheit bei einer OP-Schwester

Cited by 69 publications

References 5 publications

Virus-Induced Cancers of the Skin and Mucosa: Are We Dealing with “Smoking Guns” or “Smoke and Mirrors” in the Operating Theatre?

Virus-Induced Cancers of the Skin and Mucosa: Are We Dealing with “Smoking Guns” or “Smoke and Mirrors” in the Operating Theatre?

HPV positive tonsillar cancer in two laser surgeons: Case reports

Electrocautery Devices With Feedback Mode and Teflon-Coated Blades Create Less Surgical Smoke for a Quality Improvement in the Operating Theater

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