Surgical smoke: a matter of hygiene, toxicology, and occupational health.

The use of devices for tissue dissection and hemostasis during surgery is almost unavoidable. Electrically powered devices such as electrocautery, ultrasonic and laser units produce surgical smoke containing more than a thousand different products of combustion. These include large amounts of carcinogenic, mutagenic and potentially teratogenic noxae. The smoke contains particles that range widely in size, even as small as 0.007 µm. Most of the particles (90%) in electrocautery smoke are ≤6.27 µm in size, but surgical masks cannot filter particles smaller than 5 µm. In this situation, 95% of the smoke particles which pass through the mask reach deep into the respiratory tract and frequently cause various symptoms, such as headache, dizziness, nausea, eye and respiratory tract irritation, weakness, and abdominal pain in the acute period. The smoke can transport bacteria and viruses that are mostly between 0.02 µm and 3 µm in size and there is a risk of contamination. Among these viruses, SARS-CoV-2, influenza virus, HIV, HPV, HBV must be considered. The smoke may also carry malignant cells. The long-term effects of the surgical smoke are always ignored, because causality can hardly be clarified in individual cases. The quantity of the smoke changes with the technique of the surgeon, the room ventilation system, the characteristics of the power device used, the energy level at which it is set, and the characteristics of the tissue processed. The surgical team is highly exposed to the smoke, with the surgeon experiencing the highest exposure. However, the severity of exposure differs according to certain factors, e.g., ventilation by laminar or turbulent mixed airflow or smoke evacuation system. In any case, the surgical smoke must be removed from the operation area. The most effective method is to collect the smoke from the source through an aspiration system and to evacuate it outside. Awareness and legal regulations in terms of hygiene, toxicology, as well as occupational health and safety should increase.

Existence of advanced glycation / lipoxidation end-products in parenteral nutrition solutions and effects of infusion conditions on their levels

Abstract Infusion solutions must be stable from the production stage until the infusion stage. Some infusion fluids contain degradation products, known as advanced glycation end products (AGEs); however, it is unknown whether AGEs exist in parenteral nutrition solutions. We aimed to investigate this question and test the effect of infusion conditions on AGE formation in parenteral nutrition solution. Nine parenteral nutrition solutions were supplied by the pharmacy with which we collaborated. To simulate the infusion conditions, the solutions were held in a patient room with standard lighting and temperature for 24 hours. Samples were taken at the beginning (group A) and the end (24th hour, group B) of the infusion period. The degradation products were 3-deoxyglucosone, pentosidine, N-carboxymethyl lysine, and 4-hydroxynonenal, which we investigated by high-performance liquid chromatography-mass spectrometry (LC-MS) and Q-TOF LC/MS methods. Two of four degradation products, 4-hydroxynonenal and N-carboxymethyl lysine, were detected in all samples, and Group B had higher levels of both compounds compared to Group A, who showed that the quantities of these compounds increased in room conditions over time. The increase was significant for 4-hydroxynonenal (p=0.03), but not for N-carboxymethyl lysine (p=0.23). Moreover, we detected in the parenteral nutrition solutions a compound that could have been 4-hydroxy-2-butynal or furanone

Effects of Lycopene in Intestinal Ischemia Reperfusion Injury via Intestinal Immunoglobulin A.

BACKGROUND: Intestinal ischemia causes an inflammatory response that may become intense by reperfusion and result in bacterial translocation. Intestinal immunoglobulin A is known to be a barrier against bacterial translocation. Lycopene is a compound with antioxidant and anti-inflammatory properties. We hypothesized that lycopene has positive effects in ischemia-reperfusion of the intestine through the intestinal IgA. MATERIAL AND METHODS: Twenty-eight Wistar albino rats were separated into four groups: sham, control, lycopene-administered-before-ischemia (L-pre), and lycopene-administered-after-reperfusion groups. Histopathologic changes, intestinal immunoglobulin A levels, and bacterial translocation were evaluated after the ischemia-reperfusion period of 0.5-12 h. RESULTS: Histopathologic changes, intestinal immunoglobulin A, and bacterial translocation levels in the L-pre group were similar to those in the sham group. Administration of the lycopene after reperfusion showed just a slight protective effect. However, the L-pre group had significantly fewer histopathologic changes when compared with changes in the control (P = 0.011). Intestinal immunoglobulin A level in the L-pre group was found to be higher than that in the control group (P = 0.014). Bacterial translocation levels in the blood and mesenteric lymph nodes, in the L-pre group, were lower than those in the control group (P = 0.0027 and P = 0.0097, respectively). CONCLUSIONS: Lycopene limited intestinal damage, reduced loss of intestinal immunoglobulin A and decreased bacterial translocation when administered before the ischemia-reperfusion injury.

The effects of ankaferd blood stopper on the recovery process in an experimental oesophageal perforation model.

BACKGROUND: Oesophageal perforation is a life-threatening pathology that is generally treated conservatively; however, surgical procedures are frequently performed. A topical haemostatic agent, Ankaferd Blood Stopper (ABS), also has beneficial wound-healing effects. AIMS: This study aimed to determine the effects of ABS following experimental oesophageal perforations. STUDY DESIGN: Animal experiment. METHODS: The experimental rats were classified into 6 groups (with 7 rats in each group). Pairs of groups (primary repair alone and primary repair + ABS) were terminated in the 1(st), 2(nd), and 3(rd) weeks following injury. The oesophageal perforations, which were 8-10 mm in length, were created using a nasogastric tube. The perforation sites were repaired with a 6-0 polyglactine thread in the primary repair groups. Additionally, ABS was sprayed over the perforation site in the treatment groups. Each oesophagus was evaluated histopathologically. RESULTS: There were fewer microabscesses and areas of necrosis in the ABS groups compared with the primary repair groups. The histopathological evaluation revealed that the ABS groups had less inflammation and more re-epithelisation compared to the primary repair groups (p=0.002 and p=0.003, respectively). Fibrosis in the ABS groups was moderate in the 2(nd) week and mild in the 3(rd) week. Comparing the groups with respect to the time intervals, only the 1(st) week groups showed a significant difference in terms of re-epithelialisation (p=0.044). CONCLUSION: Topical ABS application on the repaired experimental oesophageal perforation regions led to positive wound-healing effects compared with the rats that were administered the primary repair alone.

The effect of erythropoietin to pulmonary injury and mast cells secondary to acute pancreatitis.

BACKGROUND: Acute pancreatitis is a life-threatening necroinflammatory disease that is characterized by systemic inflammatory response syndrome and acute lung injury even in its very first days. Erythropoietin (EPO) is a hormone considered as an antiapoptotic and cytoprotective with observed receptors of anti-inflammatory effect on organs apart from the liver and the kidneys. In this study, the effects of EPO on pulmonary mast cells and on secondary injury caused by acute pancreatitis are investigated. METHODS: Twenty one Wistar Albino rats were divided into three groups--sham, control, and EPO groups-with 7 rats per group. Pancreatitis was induced by administering 4.5% sodium taurocholate into the pancreatic duct. A 1000 U/kg/day dosage (three times) of EPO was administered to the EPO group. Blood urea nitrogen (BUN), creatinine, amylase, and troponin I in the serum were studied; and lung, kidney, brain, and heart tissues were examined histopathologically. RESULTS: There were no histopathological changes in the other organ tissues except for the lung tissue. Compared to the control group, the EPO group showed significantly reduced alveolar hemorrhage, septal neutrophil infiltration, lung wall thickness score, and mast cell count in the lung tissue. CONCLUSIONS: Administration of EPO reduces the mast cell count and lung wall thickness, and it reduces the alveolar hemorrhage and septal infiltration induced by acute pancreatitis.

A combination of plasma DAO and citrulline levels as a potential marker for acute mesenteric ischemia.

INTRODUCTION: There is no valid and reliable diagnostic test for early diagnosis of acute mesenteric ischemia (AMI). The aim of this study was to measure the plasma levels of diamine oxidase (DAO) and citrulline in AMI to gain insight into its early diagnosis. MATERIAL AND METHODS: A total of 21 Wistar albino rats were divided into three groups, that is, control group, short-term ischemia group, and prolonged ischemia group. The superior mesenteric artery was occluded for 15 min in the short-term ischemia group and for 12 h in the prolonged ischemia group. Twelve hours later, the experiment was terminated and plasma DAO and citrulline levels were measured. Intestinal tissue was evaluated for the histopathological changes. RESULTS: Compared to the control group, the short-term and prolonged ischemia groups showed significant increases in the plasma levels of DAO, whereas the plasma citrulline levels decreased significantly. Prolonged ischemia caused a larger increase in the plasma DAO levels and a larger decrease in the plasma citrulline levels compared to the short-term ischemia (p=0.011 and p=0.021, respectively). Intestinal damage was shown to develop more in the prolonged ischemia group (p=0.001). CONCLUSION: In the early period of AMI, the plasma DAO levels increase while citrulline levels decrease, and the extent of these changes depends on the duration of ischemia.

Gender differences in trauma mechanisms, and outcomes in a rural hospital which is not designed as trauma centre.

OBJECTIVES: This study aimed to investigate how trauma characteristics and outcomes differ between genders in a rural hospital. METHODS: Records of trauma patients admitted to a state emergency department (ED) in eastern Turkey, between January 2006 and December 2007 were reviewed and data were analysed based on gender. RESULTS: In total, 5379 (87.0%) men and 806 (13.0%) women, totalling 6185 patients, were assessed. Mean age was 26.5 (1 month - 80 years) years for men and 24.7 (2 month - 81 years) years for women. Men comprised 90.2%, 81.3% and 77.3% of the patients injured by assault, motor vehicle incidents and falls, respectively. Women comprised a significantly larger share of suicide attempts (70.8%) than men. Of the men injured, 90.6% were discharged after treatment in the ED. The per cent of hospitalised women (5.8%) was increased compared with the per cent of hospitalised men (p=0.011). There was a higher frequency of transfer among women (8.6%) when compared with men (p<0.001). Women had a mortality frequency of 1.2%, which was similar to the mortality per cent calculated for men. CONCLUSIONS: Men were at an increased risk for trauma, especially assault. The percentage of women injured and admitted to the ED due to assault was low compared with statistics reported in the literature. However, assault is the most common cause of trauma among women. The high per cent of hospitalisation and transfer among women may indicate that women are exposed to more severe trauma, and therefore experience increased morbidity compared with men.

A new model of reversible obstructive jaundice using rapidly absorbable suture materials.

PURPOSE: Reversible obstructive jaundice models have some limiting features, including the need for a second anaesthesia, re-laparotomy and surgical intervention after common bile duct ligation. The present study investigates the feasibility of a new application that can eliminate these limitations. Rapidly absorbable suture materials were used for ligation; therefore, spontaneous biliary decompression was anticipated by the self release of these rapidly degrading materials. METHODS: Common bile ducts in Wistar Albino rats were ligated with silk, polyglytone 6211, or irradiated polyglactine 910 (n=7 for each group). Rats were grouped according to both the suture materials and the experiments termination date: 5 days (sham, silk5, polyglytone5, polyglactine5) and 21 days (silk21, polyglytone21, polyglactine21) after the ligation. Biochemical and morphologic changes of liver were assessed. RESULTS: The group polyglactine21 showed significantly lower mean ALT, AST, GGT, total and direct bilirubin values when compared with the group polyglactine5 (p=0.004-0.037). Morphologic changes did not correlate with the biochemical amelioration. In the group polyglytone21, not only the biochemical but also the morphologic changes significantly ameliorated when compared with the group polyglytone5 (p=0.003-0.043). No procedure associated mortality was observed. CONCLUSION: Common bile duct ligation with polyglytone offers a new reversible model for prolonged obstructive jaundice which abolishes the need for relaparotomy and a second surgical intervention and significantly reduces mortality.

Effect of beta-glucan in lung damage secondary to experimental obstructive jaundice.

BACKGROUND/AIMS: This study aimed at investigating the protective effects of beta-glucans on the lungs in obstructive jaundice. METHODS: In total, five groups -Sham (1), control (2) and treatment groups (3,4,5)- were established; each comprising randomly selected seven Wistar Albino rats. Beta-glucan was given after choleduct ligation in Group 3 while it was given before and after the choleduct ligation in Group 4. As pre-treatment beta-glucan was given before ligation in Group 5. Beta-glucan was administered in a single dose of 50 mg/kg/day by gavage for a ten-day period. Superoxide dismutase, and myeloperoxidase levels in serum; malondialdehyde, lipid hydroxyperoxidase and glutathione levels in lung tissue; lactate dehydrogenase levels in bronchoalveolar lavage fluid were measured. RESULTS: The blood polymorphonuclear leukocytes level was highest in the control group and lower in the sham and treatment groups. Serum superoxide dismutase and tissue glutathione values were significantly higher in Groups 3 and 4 (p≤0.04) whilst Groups 3 and 4 did not differ from each other. In Groups 3 and 4 malondialdehyde, lipid hydroxyperoxidase, and myeloperoxidase values were significantly lower. However, Groups 3 and 4 did not differ for malondialdehyde or lipid hydroxyperoxidase values. Lactate dehydrogenase level in the bronchoalveolar lavage fluid was significantly lower in all of the treatment groups (Groups 3,4,5) (p≤0.008). When compared to the control group, it was observed that lung damage was much more limited in the treatment groups (p<0.001). CONCLUSION: This study suggests that beta-glucan exhibits protective effect in pulmonary tissue against oxidative damage in obstructive jaundice.

Analysis of trauma patients in a rural hospital in Turkey.

BACKGROUND: There is a grey zone about the epidemiology of trauma in eastern Turkey. The present study was aimed at obtaining data on this subject. METHODS: Trauma patients who applied to the emergency department (ED) between January 2006 and December 2007 were analyzed. RESULTS: There were 6183 patients, of whom 87% were male. The mean age was 26.2 ± 13.6 years. Assault was the most common cause (63.2%). Motor vehicle injury (MVI) and fall were encountered at frequencies of 21.2% and 6.5%, respectively. The most frequently injured body regions were head-neck and extremities. The majority of patients were managed and discharged from the ED (89.8%) with no consultation (81.8%). Interestingly, the discharge rate of assault cases was 98.7%. Patients were hospitalized (4.2%) mostly for MVI (32.6%) and fall (19%); however, hospitalization rates for firearm and piercing/cutting injury (36.1% and 16.7%) were significantly high. Among the transported patients (5.3%), the rates of MVI and fall were high (41.5% and 24.3%, respectively). In groups, for burn and firearm injuries, these were 42.1% and 24.1%, respectively. Forty-eight patients (0.8%) died, mostly from MVI by number, but by self-infliction and firearm by rate (8.3% and 6%). CONCLUSION: Assault cases caused an excessive trauma patient density in the ED, as 98.7% were discharged from the ED. Further studies are needed regarding the high rate of assault cases.

[Effects of beta-glucan on hepatic damage caused by obstructive jaundice]. / Tikanma sariliginda beta glukanin karaciger hasarina etkisi.

BACKGROUND: Beta-glucans are known as macrophage stimulators and antioxidants. This study aimed to investigate the effects of beta-glucans on oxidative damage to the liver during obstructive jaundice. METHODS: Sham, control and treatment groups (7 Wistar Albino rats in each) were designed. In the treatment group, beta-glucan was given through gavages for 10 days after bile duct ligation. All groups were sacrificed on the 11th day. Liver function tests, superoxide dismutase (SOD), myeloperoxidase (MPO), malondialdehyde (MDA), lipid peroxide (LPO), glutathione (GSH), and histopathological examination of the liver were investigated. RESULTS: In the treatment group, the levels of alanine and aspartate aminotransferases (AST, ALT), gamma glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), total and direct bilirubin, MPO in the serum, and the levels of MDA and LPO in the liver tissue were significantly lower when compared with the control group. Moreover, SOD and GSH levels were relevantly high in the treatment group. Histopathological examination of the liver revealed less damage in the treatment group. CONCLUSION: These results show that beta-glucan induced the phagocytic and anti-oxidative effects and also reduced the liver damage and oxidative stress in obstructive jaundice. Advanced studies are required for the clinical use of beta-glucan in obstructive jaundice.

Surgical approach to extensive hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic suppurative disease of skin with high recurrence. OBJECTIVE: To determine factors affecting complications and recurrence of HS in patients who underwent surgery. MATERIALS AND METHODS: We operated on 15 patients with HS at 36 sites between 1999 and 2009. The affected areas were classified as groin, axilla, buttocks, nuchae, perianal, and perineal. All patients were treated using wide surgical excision under general anesthesia. The methods of reconstruction varied depending on the size and location of the defect. RESULTS: The female:male ratio of patients was 4:11. Mean age was 41.8 ± 10.6. Twenty-eight (77%) of the lesions were Stage III according to Hurley's staging system. Mean follow-up was 42 months. Radical excision was performed on all lesions; 20 were reconstructed with primary closure, nine with fasciocutaneous flaps, and five with split-thickness skin grafts. The overall complication rate was 25% (9/36) and complications occurred mostly in perineal, perianal, and buttocks sites. Two (5.5%) recurrences were seen only in buttocks site. CONCLUSION: To prevent complication, avoid recurrence of HS, and improve patients' quality of life, early and wide surgical excision is important and effective. The recurrence and complications are mostly related to the location of the disease. The authors have indicated no significant interest with commercial supporters.