Navigating Cultural Challenges in Transplant Surgery: Insights from Turkish Surgeons.

To achieve expertise, transplant surgeons in Turkiye undergo rigorous training, including medical school, residency, compulsory service, and extensive training in transplant surgery. Despite their high academic and clinical knowledge level, success in transplant surgery heavily depends on cultural competency. Through semi-structured interviews with 21 transplant surgeons specializing in kidney and liver transplants in Ankara, this study reveals how health illiteracy, culture, and folklore create significant barriers. Surgeons navigate these challenges while enduring harsh working conditions. This research highlights the critical role of cultural competency in transplant surgery, emphasizing the necessity for surgeons to understand and address the diverse cultural needs of their patients. Key findings indicate that surgeons must balance medical expertise with cultural sensitivity to deliver effective care. This study identifies four main cultural barriers: spiritual trust, family politics, health illiteracy, and subcultural incompetency. Effective transplant surgery requires a combination of theoretical proficiency and cultural awareness to meet a patient's needs and improve surgical outcomes.

Percutaneous cholecystostomy as a bridge therapy in the geriatric age group with acute cholecystitis.

OBJECTIVE: The aim of this study was to investigate the efficacy of percutaneous cholecystostomy (PC) in the geriatric patients with acute cholecystitis. MATERIALS AND METHODS: The records of geriatric patients with high surgical risk who underwent percutaneous cholecystostomy for acute cholecystitis were reviewed retrospectively. RESULTS: The median age of 134 patients who underwent percutaneous cholecystostomy was 77 (65-98) years and 63.4% were women. The mean length of hospital stay was 5 (4-18) days, and the follow-up period until the procedure was 2 (1-6) days. Murphy's sign was positive in 79.1% of patients on physical examination, and the remaining patients (20.9%) had only tenderness on examination. As USG findings, 59.0% of the patients had a gall bladder wall thickness (> 4 mm) with pericholecystic fluid. Additional imaging method, abdominal CT, was performed in 29 patients (21.6%), MRCP was performed in three patients (2.2%), and ERCP was performed in one patient (0.7%). Bacterial growth was detected in 27.6% of the bile cultures performed. During the follow-up period, laparoscopic cholecystectomy was performed in 60.4% of the patients and open cholecystectomy was performed in 5.2% of the patients electively. 34.3% of the patients did not undergo any surgery. Bile leakage was detected in two patients (1.5%) as a procedure-related complication, and no mortality was observed. CONCLUSION: Abdominal ultrasonography-guided PC is a safe and effective method in the management of acute cholecystitis in high-risk patients in the geriatric age group.

Comparison of intraoperative biliary anastomosis stenting technique in living-donor liver transplantation: Review of 41 patients.

BACKGROUND: Biliary fistula is one of the most important complications in liver transplantation. Complications can vary from simple local peritonitis to death, and various techniques have been described to prevent them. In this study, we compared two different stenting methods used in biliary tract anastomosis in living-donor liver transplantation. METHODS: We retrospectively analyzed data from 41 living-donor liver transplantations that were performed due to endstage liver failure between August 2019 and November 2020. Patients were grouped according to the stenting technique used in biliary anastomosis. Postoperative biliary tract complications were investigated. RESULTS: Biliary fistulas were observed in 2 (7.4%) patients in the internal stent group, while 4 (28.5) fistulas were observed in the external stent group. Biliary tract stricture was observed in 2 (7.4%) patients in the internal stent group, but there was no statistical difference in complications. The preoperative MELD score (p = 0.038*) was found to be statistically significant in regard to developing complications. DISCUSSION: Our study did not show the effect of stenting methods used during biliary anastomosis on the development of complications. However, larger randomized controlled studies are needed.

Effect of Extractum cepae, heparin sodium and allantoin combination (ContractubexTM) on adhesion and fibrosis after neck surgery (thyroidectomy) in rats.

OBJECTIVE: Reoperative thyroid surgery is technically difficult process with increased complications due to the adhesions and fibrosis caused by the previous surgery. In this experimental animal model, we planned to investigate the effect of ContracttubexTM, a mixture of Extractum cepae, Heparin sodium and Allantoin, on adhesion and fibrosis after neck surgery (thyroidectomy). METHODS: The current study is an experimental animal model of post-thyroidectomy adhesion. Twelve Wistar-Albino male rats in two groups were used. Under sterile conditions, a midline incision on the neck was made. The anterior thyroid muscles were separated and the thyroid lodge was reached. As a minor interventional procedure, a sponge was applied to the thyroid tissue, and then a combination of 1 g Extractum capae, heparin, sodium, and allantoin was applied to the dissection site in the drug group. Rats in both groups were sacrificed on 30th day. Cervical regions were dissected and evaluated for macroscopic adhesion. Tissue samples were taken for microscopic evaluation for fibrosis and inflammation. RESULTS: In the experimental group in which ContractubexTM was applied, inflammation was not detected in five (83.3%) of six rats while no inflammation was detected in four (66.7%) of six rats in the control group (p=0.505). Considering the fibrosis score, mild or moderate fibrosis was detected in four (66.7%) of six rats in the control group, while fibrosis was found in only two (33.3%) rats in the experimental group (p=0.264). When macroscopic adhesion was evaluated, two (33.3%) rats of the control group subjects were Grade 4, and one (16.7%) was Grade 3. No rats in the experimental group were Grade 4 (p=0.392). CONCLUSION: ContractubexTM seems to be effective in preventing adhesions and fibrosis after thyroidectomy and neck surgery, but further research is needed for use in human studies.

Effects of transcutaneous electrical nerve stimulation on rats with post-operative ileus.

BACKGROUND: Post-operative ileus (POI) is a type of bowel dismotility causing accumulation of gas and fluid. Transcutaneous electrical nerve stimulation (TENS) has been frequently used for medical applications such as pain treatment and nervous stimulation. In this experimental animal model of POI, our aim is to investigate the effects of TENS on POI, and to demonstrate histopathological changes in rat intestine after TENS application. METHODS: The present study is an experimental animal model of POI. Sixteen Wistar-Albino male rats in two groups were used and laparotomy was performed. After colorectum and small intestine were manipulated, activated charcoal and Nile red were ad-ministered by oral gavage. Electrodes were placed to the abdomen skin of the rats and TENS method was used. Rats in two groups were sacrificed on 24 h. The esophagus, stomach, and all intestines of the rats were resected and a direct X-ray and computerized tomography scan, and 'J' images were taken, and the progression of active coals was measured radiologically. Histopathological and microscopic evaluation was performed. RESULTS: The median of activated charcoal measure was 429 mm (178-594) in TENS group, 203 mm (149-313) in the control group, respectively, and these were statistically significant (p=0.004963). There was a significant difference between the two groups in terms of histopathological necrosis (p=0.041). In addition, the amount of Nil Red (550 nm) in the GI track is increased after 8 h of gavage with sequential applications of TENS. CONCLUSION: This study demonstrated the protective and therapeutic efficacy of TENS in POI in a rat model by radiologically and histopathologically. In clinical practice, TENS may be examined on POI. Further studies are warranted to validate and generalize our findings, and to assess the impact of TENS for post-operative pain also.

Effects of 5-fluorouracil released from different prosthetic meshes on post-operative adhesion formation in rats.

OBJECTIVE: Post-operative adhesion is a common problem in abdominal surgery. Especially, foreign materials are strong stimulus for the development of adhesions. The aim of this study was to investigate whether drug release material coated prosthetic mesh decreases intra-abdominal adhesion formation or not. METHODS: 5-Fluorouracil (5-FU) releasing "chitosan gels" were loaded to polypropylene and polyglactin-910 grafts. Polypropylene, polyglactin-910 grafts, chitosan gel, and 5-FU-loaded polyglactin 910, polypropylene grafts were used to cover abdominal defects of rats which were created under sterile conditions (n=84). Each group was divided into two subgroups (n=6). Subgroups were sacrificed on the 7th and 30th days. RESULTS: The 7th day macroscopic examinations were similar. Polypropylene group was most adhesive group on the 30th day. There were less adhesions in chitosan gel and 5-FU-loaded groups. Capsule and capsule margins showed no difference on both the 7th and 30th days. Polypropylene-5-FU group and polypropylene-chitosan gel group showed significantly less macroscopic adhesions than polypropylene control group. Furthermore, polyglactin-910-chitosan gel group was less adhesive than polypropylene control group. CONCLUSION: This study showed that 5-FU decreases the adhesions but the dosage and release kinetics need further investigations.

MATRA-A: A study on massive transfusion.

BACKGROUND: We use massive transfusion in various clinical conditions and it is associated with high mortality. Although some massive transfusion protocols improve patient outcomes, the clinical circumstances requiring it are not well defined. METHODS: MATRA-A is a multicenter retrospective study. Six University and Training Research Hospitals in Ankara participated in the study. We collected clinical data on patients (>18 years) who received massive transfusions (≥10 units/24 h) from 2017 through 2019. RESULTS: Overall, 167 (0·27% of transfused patients) received a massive transfusion of 2586 units of red blood cells (1·5% of total RBCs transfused). The median interquartile range values for RBCs, fresh frozen plasma (FFP) and platelets were 13 (11-176), 16 (9-33) and 4 (0-11), respectively. Surgical patients received 90% of massive transfusions. The most common clinical indications for massive transfusion were cardiovascular diseases (42·6%), trauma (20·3%) and malignancies (11%). FFP: RBC: Platelets ratio was 1·9:1:0·5. The overall and trauma-related mortality rates were 57·4% and 61·8%, respectively. The hospital mortality rates of trauma patients that received high vs. low ratio (FFP: RBCs > 1:1·5 vs. ≤1:1·5) transfusions were 47·6% and 86·6% and the difference was statistically significant (P = 0·03). CONCLUSION: Cardiovascular diseases and trauma occasion are the most common causes of massive transfusion. It is infrequent in clinical settings and is associated with high mortality rates. Additionally, in massively transfused trauma patients, a high FFP:RBCs ratio seems to be associated with increased survival. Focused prospective studies are required to define the areas that need improvement on a national scale.

New Findings on Autoimmune Etiology of Idiopathic Granulomatous Mastitis: Serum IL-17, IL-22 and IL-23 Levels of Patients.

BACKGROUND: Idiopathic Granulomatous Mastitis (IGM) is a benign chronic inflammatory breast disease that mimics breast cancer, and the etiopathogenesis has not yet been fully evaluated. Autoimmunity has received the most focus as a possible etiology. Our aim in this prospective clinical study was to investigate the possible association between the cytokines, interleukin IL-17, IL-22, IL-23 and IGM. MATERIALS AND METHODS: The current study was conducted in 26 women with histopathologically diagnosed IGM, and 15 control women of reproductive age having no breast disease history. Blood samples were collected, and serum concentrations of IL-17, IL-22, and IL-23 were determined. RESULTS: In the analysis of variables, the patients with IGM and the control group had statistically significant differences between serum IL-22 titers (p = 0.0378) and IL-23 titers (p = 0.0469. No statistically significant difference was found between IGM patients and the control group in serum IL-17 titers (p = 0.9724). CONCLUSION: The results of the current study, especially pertaining to serum IL-22 and IL-23 levels, support the etiopathogenesis of IGM in favor of the autoinflammatory thesis. Nevertheless, this thesis should be supported by a large case number and prospective clinical studies.

Role of Intraoperative Nerve Monitoring in Postoperative Muscle and Nerve Function of Patients Undergoing Modified Radical Mastectomy.

This study aimed to postoperatively evaluate the effects of intraoperative neural monitoring (IONM) on muscles and nerves in patients who underwent modified radical mastectomy (MRM). In the 11 patients included in the study, nerves were determined and protected by nerve monitoring during the axillary dissection (IONM group). In another 11 patients, nerve monitoring was not performed; however, protection of the same nerves was attempted through careful nerve dissection (cautious nerve dissection [CND] group). The control group consisted of 22 healthy subjects. Muscle and nerve functions were blindly evaluated by an experienced physical therapy and rehabilitation specialist using electromyography (EMG) and ultrasonography (US) methods. The EMG values of the pectoralis major muscle were similar in the IONM and control groups (1.97 mV/1.98 mV, p = 0.97) but significantly lower in the CND group (1.57 mV, p < 0.05). Significant differences were found in the US values of the pectoralis major and minor muscles between the IONM and CND groups. No significant difference was found between the IONM and control groups in terms of EMG values of the serratus anterior muscle. This is the first prospective randomized study to objectively evaluate preservation of the nerve through nerve monitoring and its functional results. Monitoring of nerves during MRM is of great importance in terms of demonstrating the positive effects on muscle and nerve functions.