Tas, Hakan Gokalp; Akyol, Fethi; Somunkiran, Mustafa

Background: – The goal of this prospective randomized controlled experiment was comparing the analgesic efficacy, opioid needs, and adverse effect profiles of paravertebral (PVB) block, thoracolumbar interfascial plane (TLIP) block, and retrolaminar (RLB) block in patients undergoing lumbar disc herniation surgery. Methods: – One hundred eighty-five adults (American Society of Anesthesiologists I–III) undergoing elective lumbar disc herniation surgery made up this single-center study. Among the exclusion criteria were coagulation problems, injection site infection, allergy to local anesthetics, and incapacity to provide informed consent. Patients were randomly assigned into 4 groups: control (systemic analgesia only), PVB, TLIP, and RLB (45 patients per group). An expert anesthesiologist supervised the ultrasonography during each block. The visual analog scale was used to measure postoperative pain at 0, 1, 2, 6, 12, and 24 hours after surgery. This was the primary outcome. Motor block incidence, rescue morphine consumption, and quality of recovery-40 scores at 24 hours were secondary objectives. Unfavorable incidents were noted. Analysis of variance and Kruskal–Wallis tests (P < .05) were used to examine the data. Results: – At every time point, the TLIP and RLB groups’ visual analog scale scores were significantly lower than those of the PVB and control groups (P < .001). The TLIP and RLB groups consumed considerably less rescue morphine (P < .001). The TLIP and RLB groups had the highest quality of recovery-40 scores (P < .001). The PVB group had the highest incidence of motor block (26.7%), whereas the RLB group had the lowest rate (8.9%). There were no significant adverse effects noted. Conclusion: – Compared to PVB and control group, TLIP and RLB provide better and longer postoperative analgesia, smaller opioid needs, and higher-quality recovery. Their importance in improved recovery regimens following lumbar disc herniation surgery is supported by their good safety profile.

Doğan, Mücahit; Aydin, Cemil; Ekici, Musa; Çağlayan, Mustafa Serdar; Öztürk, Muhammet İhsan; Baykam, Mehmet Murat

Background: – To prospectively evaluate the effects of rectal cleansing using a povidone-iodine (PI) and PI enhanced rectal enema on procedure-related infectious complications in patients undergoing transrectal prostate biopsy. Methods: – Between September 2023 and March 2024, patients scheduled for their first transrectal ultrasound-guided prostate biopsy due to elevated prostate-specific antigen levels, suspicious multiparametric prostate magnetic resonance imaging findings, or abnormal digital rectal examination were prospectively randomized into 2 groups (n = 60 each). All patients received standard prophylactic measures, including antibiotic prophylaxis starting 1 day prior to the procedure and rectal mucosal cleansing with PI immediately before biopsy. Both groups additionally underwent rectal enema administration. In the intervention group, a PI enhanced rectal enema was administered by adding PI to the sodium phosphate enema solution, whereas the control group received a sodium phosphate enema alone. Post-procedural complications, including hematuria, hematospermia, rectal bleeding, fever, acute urinary retention, hospitalization, sepsis, and urine and blood culture results, were recorded and compared using chi-square tests. Results: – In total of 120 patients were enrolled. The mean age in both groups was 66.6 years (± 7.20). Hospitalization due to febrile urinary tract infection occurred in 6 patients (10%) in the control group versus 2 patients (3.3%) in the study group. Positive urine cultures were found in 6 patients (10%) in the control group, while no positive cultures were detected in the study group, a statistically significant difference (P = .046). No significant differences were observed between the groups in terms of hematuria, hematospermia, rectal bleeding or acute urinary retention. Conclusion: – Rectal cleansing with a PI and PI enhanced rectal enema prior to transrectal prostate biopsy significantly reduced the rate of positive urine cultures. Although the reductions in febrile urinary tract infections and sepsis-related hospitalizations were not statistically significant, the overall trend suggests a potential benefit. Given that infectious complications are the most common adverse events associated with transrectal biopsy, this simple and low-cost intervention may improve patient safety.

Ocak, Ali

The anterior mandible is a region that may frequently receive insufficient attention in surgical interventions; however, is crucial to recognize that this area associated with significant complications due to the presence of lingual foramina and the vascular structures passing through it. Notably, these foramina may exhibit variations in both different numbers and locations, necessitating diligent during surgical planning. The objective of this study is to evaluate the location, distribution, and prevalence of the median lingual foramen and lateral lingual foramen (LLF) as identified through cone-beam computed tomography (CBCT) in a sample drawn from the Turkish population. Measurements were taken concerning the frequency, distribution, location, and diameter (Df) of both the median lingual foramen and LLF. Additionally, the vertical distance to the inferior border of the mandible (Hinf) for each foramen, the horizontal distance (Hhor) from the deepest point of the median lingual canal and lateral lingual canal to the buccal cortical plate, as well as the lengths of the canals (Lc) were systematically recorded. The analysis revealed no statistically significant differences in the prevalence of lingual foramina or in the measurements of Df, Hinf, Hhor, and Lc when comparing male and female patients. It was observed that all CBCT scans exhibited the presence of at least 1 lingual foramen in the mandible. Notably, a significantly greater occurrence of LLFs was identified in the mandibular premolar region compared to other anatomical regions. The findings indicate a higher prevalence of mandibular lingual foramina within the Turkish population compared to previous studies. Specifically, the variations in the anatomy of mandibular lingual foramina and canals warrant careful consideration through CBCT imaging prior to surgical interventions in proximity to the inner surface and basis of the mandible, particularly in the anterior and premolar regions, to mitigate the risk of potential complications.

Ates, Irem; Laloglu, Esra; Kara, Salih; Yaman, Tuba; Isik, Bahar

Background: This study compared the effects of ketamine and dexmedetomidine (Dex) on inflammation and pain in liver resection surgery. Methods: Forty-five American Society of Anesthesiologists class III patients aged 18 to 65 scheduled for liver resection surgery were randomized into 3 equal groups. The ketamine group received an intravenous ketamine bolus (0.5 mg/kg) during anesthesia induction and continuous low-dose infusion at 0.25 mg/kg/hour. In the Dex group, intravenous infusion was initiated at a 1 µg/kg bolus for the first 10 minutes, and at 0.5 µg/kg/hour after intubation. The control group patients were infused crystalloid solution at 8 mL/kg/hour from induction. Venous blood was collected at postoperative hours 1 and 12 for pentraxin 3, serum amyloid A, hepcidin, and inflammatory marker analysis. Visual analogue scale (VAS) values were recorded. Results: Pentraxin 3, serum amyloid A, and hepcidin continued to rise at 12 hours in the control group, but began declining in the Dex and ketamine infusion groups (P<.05). VAS levels and fentanyl consumption decreased in the ketamine and Dex groups compared to the control group (P<.05). The decreases in inflammatory parameters, VAS scores, and fentanyl consumption were similar between the ketamine and Dex groups (P>.05). A positive correlation was observed between inflammation levels and pain severity (P<.001). There was no difference in liver function tests between any of the groups (P<.05). Conclusion: Ketamine and Dex infusions were both effective in reducing inflammation and pain following liver resection, with no obvious superiority of one over the other.

Gürsoy, Nurcan; Gürsoy, Ersan

This study aims to compare patient- and physician-generated YouTube videos on multifocal lens surgery experiences, examining how online narratives align with or diverge from professional medical perspectives. A cross-sectional qualitative analysis of 48 Turkish-language YouTube videos related to multifocal lens surgeries was conducted. Inclusion criteria required videos to be longer than 1 minute, have at least 1000 views, maintain suitable visual quality, and exclude direct advertising. The final sample included 38 doctor-produced and 10 patient-produced videos. Transcripts totaling 62,707 words underwent thematic analysis, with 2 researchers independently coding the data. Seven themes emerged: patient satisfaction and managing expectations, night vision problems and dysphotopsia, importance of individualized lens selection, technological advances in lenses, postoperative adaptation and management, ethical issues and patient information, and surgical procedure's practical aspects. Both doctors and patients largely agree that proper preoperative counseling and realistic expectations are key to favorable outcomes. Patients generally confirm good vision and comfort but may experience dissatisfaction when initial hopes are unmet or communication is insufficient. Dysphotopsias and adaptation periods are recognized by both groups as common, albeit temporary. Notably, patient videos attracted higher viewer engagement, suggesting that personal narratives resonate strongly with the audience. Online patient narratives both reinforce and, at times, question the information provided by physicians, highlighting the importance of clear communication, personalized intraocular lens choices, and active expectation management throughout the treatment process. management. For primary care physicians and ophthalmologists, integrating these insights can enhance patient education, improve the referral process, and ensure that evolving IOL technologies better meet patient needs and experiences.

Özdamar, Mustafa Yaşar; Biçer, Şenol

The parent is the most critical link and decision-maker between the patient and the healthcare provider in treating many pediatric diseases. This entity is essential for the management of pediatric breast diseases for which the rate of surgical intervention is known to be very low. Although previous publications have emphasized that pediatric breast diseases may cause alarming anxiety in parents, the demographic factors that influence this anxiety have not been investigated. Even if practitioners complete patient management with appropriate procedures, treatment is incomplete if the questions remain unanswered. In this observational prospective study, we investigated the demographic factors that affect parental anxiety, which should be prioritized to prevent incomplete management. The Beck Anxiety Inventory score (BAS) created by the parents of 409 boys and girls aged 0 to 17 with breast conditions was recorded at the diagnosis, termination of treatment, and final control stages. A 2-stage hierarchical logistic regression model was applied to show how strongly the demographic characteristics of parents and their children predicted the parental BAS. Of the demographic characteristics, there was a significant correlation (P < .05) between the patient’s sex, age, developmental period, Tanner stage, referral status, management method, family’s place of residence, economic distress, and BAS. However, according to the 2-stage hierarchical regression model, only 3 demographic characteristics, the patient’s gender, place of residence, and method used in patient management, significantly predicted BAS (P < .05, ΔR2 = .35). Among the many factors that affect anxiety experienced by parents whose son or daughter has breast problems, the gender of the child, place of residence of the family, and management methods used by the practitioner are demographic characteristics that should be taken into consideration.

Erçen Diken, Özlem; Kaya, Şerife; Bektaş Aksoy, Hayriye; Ekici, Aydanur; Çapraz, Aylin; Tabaru, Ali; Şengören Dikiş, Özlem; Arpaǧ, Hüseyin; Yildiz, Hanifi; Kiliç, Talat

Pulmonology is one of the branches that frequently receive consultation requests from the emergency department. Pulmonology consultation (PC) is requested from almost all clinical branches due to the diagnosis and treatment of any respiratory condition, preoperative evaluation, or postoperative pulmonary problems. The aim of our study was to describe the profile of the pulmonology consultations received from emergency departments in Turkiye. A total of 32 centers from Turkiye (the PuPCEST Study Group) were included to the study. The demographic, clinical, laboratory and radiological data of the consulted cases were examined. The final result of the consultation and the justification of the consultation by the consulting pulmonologist were recorded. We identified 1712 patients, 64% of which applied to the emergency department by themselves and 41.4% were women. Eighty-five percent of the patients had a previously diagnosed disease. Dyspnea was the reason for consultation in 34.7% of the cases. The leading radiological finding was consolidation (13%). Exacerbation of preexisting lung disease was present in 39% of patients. The most commonly established diagnoses by pulmonologists were chronic obstructive pulmonary disease (19%) and pneumonia (12%). While 35% of the patients were discharged, 35% were interned into the chest diseases ward. The majority of patients were hospitalized and treated conservatively. It may be suggested that most of the applications would be evaluated in the pulmonology outpatient clinic which may result in a decrease in emergency department visits/consultations. Thus, improvements in the reorganization of the pulmonology outpatient clinics and follow-up visits may positively contribute emergency admission rates.

Yücetaş, Şeyho Cem; Çakır, Tayfun

Background: This is an immunohistologic study of gene expression between patients and controls. This study aims to evaluate expression of the catalase gene in hypertrophied ligamentum flavum (LF) specimens obtained from patients with lumbar spinal canal stenosis (LSCS). LSCS is one of the most common spinal disorders. It is well known that LF hypertrophy plays an important role in the onset of LSCS. Although degenerative changes, aging, and mechanical stress are all thought to contribute to hypertrophy and fibrosis of the LF, the precise pathogenesis of LF hypertrophy remains unknown. Previous genetic studies have tried to determine the mechanism of LF hypertrophy. However, the association between catalase gene expression and LF hypertrophy has not yet been explored. Methods: LF specimens were surgically obtained from 30 patients with spinal stenosis (LSCS group) and from 30 controls with lumbar disc herniation (LDH group). LF thickness was measured at the thickest point using calipers to an accuracy of 0.01 mm during surgical intervention. The extent of LF elastin degradation and fibrosis were graded (grades 0–4) by hematoxylin and eosin staining and Masson trichrome staining, respectively. The resulting LF measurements, histologic data, and immunohistologic results were then compared between the 2 groups. Results: The average LF thickness was significantly higher in the LSCS group than in the LDH group (5.99 and 2.95 mm, respectively, P = .004). Elastin degradation and fibrosis of the LF were significantly more severe in spinal stenosis samples than in the disc herniation samples (3.04 ± 0.50 vs 0.79 ± 0.60, P = .007; 3.01 ± 0.47 vs 0.66 ± 0.42, P = .009, respectively). Significantly lower expression of catalase was observed in the perivascular area of LF samples obtained from patients with LSCS compared with controls (61.80 ± 31.10 vs 152.80 ± 41.13, respectively, P = .009). Conclusion: Our findings suggest that decreased expression of catalase is associated with LF hypertrophy in patients with LSCS.

Çakir, Tayfun; Çakir, Mürteza; Önder, Hilmiokay; Yolaş, Coşkun; Tanriverdi, Osman; Ömeroǧlu, Muhammed; Arslan, Yusuf Kemal

Background: Low back and leg pain due to lumbar discal hernia (LDH) is an important health issue. Current evidences support surgery in carefully selected patients who have failed conservative treatment and do not exhibit any psychosocial overlay. However, as known, sometimes it may be still very difficult to normalize the life qualities of patients for long times. Now different surgical methods for LDH are in use with new technological materials. One of them is lumbar disc prosthesis. In this study, the radiological and clinical effects of using lumbar disc prosthesis were evaluated with comparing patients underwent simple lumbar microdsicectomy. The purpose of this study is to reveal whether inserting the disc prosthesis into the intervertebral distance after lumbar microdiscectomy is beneficial or not both radiologically and clinically. Methods: A total of 114 patients were analyzed; the first cohort consisted of 57 patients who received a lumbar discectomy at a single level along with the implantation of a disc prosthesis and the second consisted of 57 patients only received a lumbar discectomy at a single level. These 2 groups were studied by comparing the disc space on the level of carried out operations with pain scales, foramen diameters of coming about related roots preoperatively and postoperatively at 3 years. Results: One of the significant results of the implementation of the disc prosthesis is fulfilment of a healthy disc height again after microdiscectomy due to LDH. We concluded that fulfilment of a healthy disc height with lumbar disc prosthesis was clinically beneficial for patients underwent microdiscectomy. Conclusions: Based on the results obtained in this study, it can be concluded that the implantation of a disc prosthesis in appropriate patients is more favorable regarding pain and spinal physiology when compared to simple microdiscectomy.

Karaköse, Oktay; Pülat, Huseyin; Oguz, Serhat; Zihni, Ismail; Özçelik, Kazim Caglar; Yalta, Tulin Deniz; Eken, Huseyin

Introduction: Ancient schwannoma is a rare tumor of the peripheral nerve sheath. As degenerative properties are defined histologically, it can be wrongly interpreted as malignant. Case presentation: The case presented here is of a giant ancient schwannoma with a pelvic retroperitoneal location, which was mimicking an adnexal mass. Conclusion: In the rarely seen cases in the retroperitoneum, it may reach very large dimensions.