Burnout Among General Surgeons in Turkey

Aim: Burnout is a syndrome that is very common among surgeons. It is defined by emotional exhaustion (EE), depersonalization (DP), and decreased personal success. This study aimed to investigate burnout in general surgeons in Turkey and to determine the risk factors for burnout. Method: Of the total of 4,395 general surgeons in Turkey, 630 were included in this study. Each participant was asked to complete the Sociodemographic Data Form, Maslach Burnout Inventory, and Minnesota Satisfaction Questionnaire (MSQ) either by face-to-face interview or via electronic questionnaire. Results: Of the 630 participants included in this study, 53 (8.4%) and 577 (91.6%) was female and male, respectively. The highest participation rate was from the Marmara region (36%), while the lowest participation rate was from the Eastern Anatolia region (3.13%). Attending physicians comprised the largest number of participants (72%). Those who perceived themselves as successful, with more work experience and higher academic Mtitles, had decreased EE, personal accomplishment, and DP as well as increased general, external, and internal satisfaction. Conclusion: We observed that most of the general surgeons in Turkey experienced burnout syndrome. To address this, we suggest that health systems and working conditions in Turkey should be reviewed and that the working standards and rights of the healthcare workers should be revised

The evaluation of morbidity in gastrointestinal tumor patients underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC)

Objective: In this study, we aimed to determine the postoperative morbidity rate and identify demographic, clinical, and treatment-related variables that may be potential risk factors for morbidity in gastrointestinal tumor patients undergoing hyperthermic intraperitoneal chemotherapy (HIPEC) with or without cytoreductive surgery (CRS). Material and Methods: In this retrospective study, 60 patients who had undergone HIPEC due to gastrointestinal tumor between October 2017 and December 2019 were included. Systemic toxicities were graded and evaluated according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 criteria. Results: Mean age of the patients was 60.43 +/- 12.83. Primary tumor localization was the stomach in 33 patients (55%), colon in 21 (35%), rectum in five (8.3%), and appendix in one patient (1.7%). PCI mean value was 9.51 +/- 10.92. CC-0 was applied in 37 (61.7%) patients, CC-1 in 11 (18.3%), CC-2 in 6 (10%), and CC-3 in six patients (10%). Morbidity was observed in 50 (83.33%) of the 60 patients participating in the study according to NCI-CTCAE v3.0 classification. Mild morbidity rate was 46.6%, severe morbidity rate was 36.6%, and mortality rate was 11.66%. Enteric diversion application, length of stay in the ICU, and length of hospital stay were shown to have a statistically significant effect on the NCI-CTCAE morbidity score (p= 0.046, p= 0.004, p< 0.001). Conclusion: With proven beneficial effects on survival in patients with locally advanced gastrointestinal tumors, CRC and HIPEC are acceptable in these patients despite their increased morbidity and mortality rate. With new studies on this subject, morbidity and mortality rates may be reduced

Comparison of sirolimus and colchicine treatment on the development of peritoneal fibrozis in rats having peritoneal dialysis

Background: Continuous ambulatory peritoneal dialysis is a successful treatment modality for patients with end-stage renal disease. Peritoneal fibrosis (PF) is the most critical complication of long-term peritoneal di- alysis (PD). Aims: In our study, we aimed to compare the effects of colchicine and sirolimus on PF induced by hypertonic peritoneal dialysis solutions in rats. Study Design: Animal experiment. Methods: Twenty-four rats were randomly divided into three groups. The control group received an intraperitoneal injection (ip) of saline. The sirolimus group received the PD solution, plus 1.0 mg/kg/day Rapamune&reg;. The colchicine group received the PD solution ip plus 1.0 mg/kg/day of colchicine. Blood sam- ples were taken to measure the serum levels of VEGF, TGF-&amp;#946;, and TNF-&amp;#945;. Peritoneal tissue samples were taken for histopathological evaluation. Results: TGF-&amp;#946; and TNF-&amp;#945; values in the sirolimus group were found to be statistically significantly lower than in the control and colchicine groups, but the differences between the control and colchicine groups were not statistically significant. No statistically significant differences were found between the groups regarding the VEGF values. Vascular neogenesis and peritoneal thickness were compared; the values in the sirolimus group were statistically reduced compared to the values in the control group. Mild fibrosis developed in 75% of all animals in the sirolimus group; there was no moderate or severe fibrosis observed. Fibrosis developed to varying degrees in 100% of the animals in the control and colchicine groups. Conclusion: The present study demonstrates that sirolimus might be beneficial for preventing or delaying the progression of PF and neoangiogenesis. These alterations in the peritoneal membrane may be connected with reduced TNF-&amp;#945; and TGF-&amp;#946; levels

Protective Effect of Curcumin on Liver Damage Induced by Biliary Obstruction in Rats

Objective: The aim of this study is to evaluate the possible protective effects of curcumin against cholestatic oxidative stress and liver damage in common bile duct ligated rats. Material and Methods: A total of 18 male Wistar albino rats were divided into three groups: control, common bile duct ligation (BDL) and BDL+curcumin. Each group contained 6 animals. The rats in the curcumin treated group were given curcumin (100 mg/kg) once a day orally for 14 days, starting 3 days prior to BDL operation. Following 14 days of treatment, all the animals were decapitated and liver tissue samples were obtained for histopathological investigation. Results: The changes demonstrating the bile duct proliferation and fibrosis in expanded portal tracts, including the extension of proliferated bile ducts into lobules, mononuclear cells, and neutrophil infiltration into the widened portal areas, were observed in BDL group. Treatment of BDL with curcumin attenuated liver damage. Both the elevated alpha smooth muscle actin (alpha-SMA), and the activity of TUNEL in the BDL were observed to be reduced with the curcumin treatment. Conclusion: Our data indicate that curcumin reduced BDL-induced cholestatic liver injury, bile duct proliferation, fibrosis

Combined Effects of Tauroursodeoxycholic Acid and Glutamine on Bacterial Translocation in Obstructive Jaundiced Rats:

Background: Bacterial Translocation is believed to be an important factor on mortality and morbidity in Obstructive Jaundiced. .Aims: We investigated the probable or estimated positive effects of tauroursodeoxycholic acid, which has antibacterial and regulatory effects on intestinal flora, together with glutamine on BT in an experimental obstructive jaundiced rat model. Study Design:Animal experimentation.Methods: Forty adult, male, Sprague Dawley rats were used in this study. Animals were randomised and divided into five groups of eight each: sham (Sh); control (common bile duct ligation, CBDL); and supplementation groups administered tauroursodeoxycholic acid (CBDL+T), glutamine (CBDL+G), or tauroursodeoxycholic acid plus glutamine (CBDL+TG). Blood and liver, spleen, MLN, and ileal samples were taken via laparotomy under sterile conditions for investigation of bacterial translocation and intestinal mucosal integrity and hepatic function tests on the tenth postoperative day. Results: There were statistically significant differences in BT rates in all samples except the spleen of the CBDL+TG group compared with the CBDL group (p=0.041, p=0.026, and p=0.041, respectively). Conclusion: It is essential to protect hepatic functions besides maintaining intestinal mucosal integrity in the active struggle against BT occurring in obstructive jaundice. The positive effect on intestinal mucosal integrity can be increased if glutamine is used with tauroursodeoxycholic acid, which also has hepatoprotective and immunomodulatory features

Surgical Treatment of Patients with Tracheal Rupture Following Endotracheal Intubation

Objective: We aimed to present clinical features and treatment outcomes of patients who had tracheal rupture following intubation due to surgical interventions.Material and Methods: Five patients (M/F, 1/4; Mean age, 53.8±10.9 years) who were diagnosed as having tracheal rupture during or soon after surgery were included in the study and evaluated retrospectively. History, clinical features, patient characteristics, and localizations of rupture, diagnostic modalities, and treatment outcomes were reported.Results: Two of the patients were intubated with a single-lumen tube, whereas 3 patients were intubated by using a double-lumen tube. The most common symptom that led to diagnosis was subcutaneous emphysema. One patient was diagnosed during stump control before the occurrence of symptoms. It is considered that using a stylet during intubation might be a risk factor, as four of our patients were intubated with the help of a stylet. Only one patient had a difficult intubation. Conclusion: Close postoperative monitorization of patients intubated due to surgical interventions, may enable us to determine tracheal ruptute cases in the early period before symptoms occur. The most common symptom was subcutaneous emphysema in the present case series. Thus, it is considered as the most effective warning symptom. In the light of the above findings, it is suggested that difficult intubation may not add to the risk of tracheal rupture

Retrospective analysis of kidney transplanted patients

Kidney transplantation has become one of the best treatment methods for significantly improving the quality of life for patients suffering from kidney disease. This study aimed to provide a retrospective evaluation of kidney transplantation cases between the years 2004 and 2007.Initially, the following data was collected: number of annual cases, age, gender, hepatitis serology, hypertension, and cardiovascular illness, number of cadaver and living donors, kinship, and duration of hospital stay, post-operational complications, mortality and graft loss. 39% of the patients were female whilst 61% were male. 3.8% of the patients were positive for hepatitis serology. 28.8% of the patients were hypertensive. 61% of the patients received their kidneys from live donors. 60.6% of the live donors were the mothers of the patients and 18.2% were the fathers. The average length of hospital stay was 48 days. 21.4% of the patients were identified as having developed major complications including sepsis, heart failure, pulmonary emboli, respiratory insufficiency and rejection. 5.4% of the patients developing major complications ended with mortality and 1.8% with graft loss. Even though the total number of annual cases is constantly rising, we think that this figure is much lower that it should be considering the number of patients dependent on dialysis machines. Kidney transplantation is the most appropriate treatment in terms of cost-effectiveness and thus increasing the ratio of kidney transplantations would be beneficial to both the patient’s health and to the national economy

Deneysel sıçan modeli mezenterik iskemi ve reperfüzyon hasarında apelinin etkileri

Amaç: Barsak iskemi-reperfüzyon (I/R) hasarı yüksek morbidite ve mortalite oranları ile seyreder. Etkili koruyucu veya tedavi edici ajanlar bulmak için sürekli araştırmalar yapılmaktadır. Barsak İ/R hasarının sıçan modelinde apelin 13 (AP)’ün etkilerini araştırmayı amaçladık. Çalışma Planı: 6-8 haftalık ve 280±20 g ağırlığında 24 adet erkek Sprague Dawley sıçan eşit olarak üç gruba ayrıldı (Kontrol, I/R ve I/R+AP). Kontrol grubuna klemp uygulanmadan süperiyor mezenterik arter (SMA) ayrıldı. I/R ve I/R+AP gruplarında atravmatik mikrovazküler bulldog klemp SMA nın aortadan çıkış noktasına yerleştirildi. 60 dk iskemiden sonra, klempler alınarak 3 saat reperfüzyon uygulandı. 3 saat Reperfüzyondan sonra, biyokimyasal incelemeler (malondialdehit (MDA) ve glutatyon (GSH) düzeyleri) ve histopatolojikal incelemeler için doku örnekleri alındı. Bulgular: Kontrol grubu ile karşılaştırıldığında MDA düzeyleri I/R grubunda anlamlı düzeyde yüksekti. MDA düzeyleri I/R grubu ile karşılaştırıldığında I/R+AP grubunda düşük olmasına rağmen, farklılık anlamlı değildi. I/R ile I/R+AP grupları arasında GSH düzeyleri arasında anlamlı farklılık yoktu. I/R+AP grubu histopatolojik medyan değerlendirmeleri I/R grubu ile karşılaştırıldığında anlamlı düzeyde düşüktü (p=0.001). Sonuç: Apelinin oksidatif hasarı üzerinde olumlu etkisi olduğu görüldü, bu istatistiksel olarak anlamlı değildi. Bu yüzden insanlardan kullanılmadan önce, apelinin barsak iskemisinin başlangıç tedavisi ile ilgili bulgular üzerindeki rolü için daha büyük ölçekli hayvan çalışmalarına ihtiyaç vardır.Objective: Intestinal ischemia-reperfusion (I/R) injury is associated with high morbidity and mortality rates. There is ongoing research to find an effective preventive or treatment agent. We aimed to evaluate the effects of apelin 13 (AP) on intestinal I/R injury in a rat model. Material and Methods: Twenty-four male Sprague-Dawley rats aged 6-8 weeks and weighing 280&plusmn;20 g were equally divided into three groups (control, I/R and I/R+AP). The control group underwent superior mesenteric artery (SMA) mobilization alone without any clamping. In the I/R and I/R+AP groups, an atraumatic microvascular bulldog clamp was placed across the SMA at its point of origin from the aorta. In the I/R+AP group, 2 &amp;#956;g/kg/d apelin was administered intraperitoneally. After 60 minutes of ischemia, relaparotomy was performed to remove the microvascular clamp on the SMA for 3 hours of reperfusion. After 3 hours, tissue samples were obtained for biochemical [malondialdehyde (MDA) and glutathione (GSH) levels] and histopathological analyses. Results: MDA levels were significantly higher in the I/R group compared to the control group. Although MDA levels were lower in the I/R+AP group compared tothe I/R group, the difference was not statistically significant. There was also no significant difference between the I/R+AP and I/R groups regarding GSH levels. The median histopathological grade was significantly lower in the I/R+AP group compared to the I/R group (p=0.001). Conclusion: Apelin appeared to have a positive effect on oxidative injury; this did not reach statistical significance. Thus, the role of apelin and associated findings in the initial treatment of intestinal ischemia needs further large-scale animal studies before human use

The Effects of Apelin on Mesenteric Ischemia and Reperfusion Damage in an Experimental Rat Model

Objective: Intestinal ischemia-reperfusion (I/R) injury is associated with high morbidity and mortality rates. There is ongoing research to find an effective preventive or treatment agent. We aimed to evaluate the effects of apelin 13 (AP) on intestinal I/R injury in a rat model. Material and Methods: Twenty-four male Sprague-Dawley rats aged 6-8 weeks and weighing 280±20 g were equally divided into three groups (control, I/R and I/R+AP). The control group underwent superior mesenteric artery (SMA) mobilization alone without any clamping. In the I/R and I/R+AP groups, an atraumatic microvascular bulldog clamp was placed across the SMA at its point of origin from the aorta. In the I/R+AP group, 2 µg/kg/d apelin was administered intraperitoneally. After 60 minutes of ischemia, relaparotomy was performed to remove the microvascular clamp on the SMA for 3 hours of reperfusion. After 3 hours, tissue samples were obtained for biochemical [malondialdehyde (MDA) and glutathione (GSH) levels] and histopathological analyses.Results: MDA levels were significantly higher in the I/R group compared to the control group. Although MDA levels were lower in the I/R+AP group compared tothe I/R group, the difference was not statistically significant. There was also no significant difference between the I/R+AP and I/R groups regarding GSH levels. The median histopathological grade was significantly lower in the I/R+AP group compared to the I/R group (p=0.001).Conclusion: Apelin appeared to have a positive effect on oxidative injury; this did not reach statistical significance. Thus, the role of apelin and associated findings in the initial treatment of intestinal ischemia needs further large-scale animal studies before human use

Protective Effect of Curcumin on Liver Damage Induced by Biliary Obstruction in Rats

Objective: The aim of this study is to evaluate the possible protective effects of curcumin against cholestatic oxidative stress and liver damage in common bile duct ligated rats.Material and Methods: A total of 18 male Wistar albino rats were divided into three groups: control, common bile duct ligation (BDL) and BDL+curcumin.Each group contained 6 animals. The rats in the curcumin treated group were given curcumin (100 mg/kg) once a day orally for 14 days, starting 3 days prior to BDL operation. Following 14 days of treatment, all the animals were decapitated and liver tissue samples were obtained for histopathological investigation.Results: The changes demonstrating the bile duct proliferation and fibrosis in expanded portal tracts, including the extension of proliferated bile ducts into lobules, mononuclear cells, and neutrophil infiltration into the widened portal areas, were observed in BDL group. Treatment of BDL with curcumin attenuated liver damage. Both the elevated alpha smooth muscle actin (α-SMA), and the activity of TUNEL in the BDL were observed to be reduced with the curcumin treatment. Conclusion: Our data indicate that curcumin reduced BDL-induced cholestatic liver injury, bile duct proliferation, fibrosis