BACKGROUND: The Achilles tendon is the most commonly injured and ruptured tendon in the body and typically occurs during participation in sports or recreational activities in men between 30 and 50 years of age. Treatment options for Achilles tendon rupture include conservative and surgical approaches. Conservative treatment is associated with a higher risk of rerupture, while surgical treatment carries a risk of wound site complications. Generally, both methods result in a prolonged tendon healing time. Studies are ongoing to identify biomolecules that aid tendon repair. The main objective of our study is to investigate the effects of zinc sulfate (ZnSO4) mineral supplementation on Achilles tendon healing in rats.
METHODS: Forty-eight female Sprague-Dawley rats were divided into four equal groups (C-15, C-30, ZnSO4-15, and ZnSO4-30) after standard Achilles tendon repair surgery. The ZnSO4-15 and ZnSO4-30 groups received an oral zinc sulfate monohydrate solution (50 mg/kg/day) for 15 and 30 days, respectively. The C-15 and C-30 groups were given 1 mL of distilled water per day orally during the experimental periods. Rats were sacrificed on the 15th and 30th day depending on their groups, and the healing of the operated tendons was evaluated using Movin and Bonar histopathologic scoring. For biomechanical analyses, the operated and intact Achilles tendons of all groups were removed, and tensile tests were performed to determine the tensile strength and toughness values for each tendon.
RESULTS: Movin and Bonar scores were significantly lower in the ZnSO4-15 group than in the C-15 group and in the ZnSO4-30 group than in the C-30 group (p<0.05). Although we did not find the biomechanical results statistically significant, the intact tendons of the ZnSO4-15 group exhibited higher toughness than those of the C-15 group, and the tensile strength and toughness values of the operated and intact tendons of the ZnSO4-30 group were also higher than those of the C-30 group.
CONCLUSION: Zinc sulfate monohydrate mineral supplementation had histopathologically positive effects on the proliferation and remodeling stages of Achilles tendon healing and may biomechanically benefit both operated and intact tendons.

BACKGROUND: This experimental study aimed to evaluate the potential protective effects of lidocaine on ischemia-reperfusion injury resulting from testicular torsion/detorsion in rats.
METHODS: A total of 18 male rats were randomized into three groups. Group 1 served as the control group. Group 2 was designed to evaluate testicular ischemia-reperfusion injury using a torsion/detorsion model. In Group 3, the treatment group, a similar ischemia-reperfusion model was used as in Group 2. Additionally, lidocaine at a dose of 15 mg/kg was administered intraperitoneally five minutes before reperfusion. Blood biochemical analyses and testicular histopathological evaluations were conducted.
RESULTS: Blood biochemical analysis showed that malondialdehyde (MDA) and protein carbonyl (PC) levels were significantly higher in Group 2 compared to the other groups (p<0.001 and p=0.008, respectively). Proinflammatory cytokine levels, including interleu-kin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha), were lower in Group 3 than in Group 2 (p<0.001, p=0.007, and p=0.026, respectively). Antioxidant enzyme activities, including glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD), were higher in Group 3 compared to Group 2 (p=0.005 and p=0.025, respectively). Histopathological evaluations revealed significant improvements in all testicular damage scores, including hemorrhage, edema, vasocongestion, and inflammation in Group 3 compared to Group 2 (p=0.015, p=0.035, p=0.015, and p=0.034, respectively). Additionally, there was a notable improvement in the Johnsen score in Group 3 compared to Group 2 (p=0.034).
CONCLUSION: Lidocaine, an effective local anesthetic, significantly alleviates the effects of testicular ischemia-reperfusion injury.

BACKGROUND: Erythrocyte deformability refers to the ability of erythrocytes to bend and twist as they pass through capillaries, which is crucial for tissue perfusion. This study aims to investigate the effects of Thymoquinone treatment on erythrocyte deformability in rats subjected to lower extremity ischemia-reperfusion injury.
METHODS: The study was conducted on Wistar albino rats weighing 400-450 g. The rats were randomly divided into five groups: the control group (C), in which no treatment was applied; the group that received dimethyl sulfoxide (DMSO) as a solvent; the group subjected to 90 minutes of ischemia followed by 90 minutes of reperfusion in the main femoral artery of the lower extremity (IR); the Thymoquinone control group (TQ-C), in which the effects of Thymoquinone alone were examined; and the group that received intraperitoneal Thymoquinone one hour before the ischemia-reperfusion procedure (IR+TQ). At the end of the procedure, intracardiac blood was collected from the rats, and May-Grunwald and Giemsa (MGG) staining, endothelial nitric oxide synthase (eNOS), and erythrocyte deformability indexes were measured.
RESULTS: The study results showed significant differences. Erythrocyte deformability was statistically significantly improved in the group that received Thymoquinone before ischemia-reperfusion compared to the group subjected to ischemia-reperfusion only. Mor-phological changes in erythrocytes were also statistically significantly better in the IR+TQ group than in the IR group. Immunohisto-chemical eNOS staining revealed that eNOS activity in the IR group was lower than in the IR+TQ group.
CONCLUSION: Our study demonstrates that Thymoquinone treatment administered before ischemia exerts protective effects against erythrocyte deformation and morphological deterioration by increasing eNOS activity.

BACKGROUND: Acute appendicitis is a common cause of acute abdominal pain necessitating surgical intervention. While the traditional treatment has been urgent appendectomy, recent studies suggest that an antibiotics-first approach can be safe for uncomplicated cases. Classifying appendicitis into uncomplicated and complicated categories is crucial for guiding treatment decisions and predicting patient outcomes. This study aims to evaluate the distinct imaging findings associated with uncomplicated appendicitis and its complicated subtypes-phlegmonous, gangrenous, and perforated appendicitis—to aid in differential diagnosis.
METHODS: This retrospective observational study was conducted from January 2014 to December 2023 and included 1,250 patients (492 women, 758 men) who underwent an appendectomy with available pathology results. After excluding 56 patients with normal pathology, 52 with non-appendicitis pathologies, and 48 with inaccessible computed tomography (CT) images, 1,094 patients were analyzed. CT images were evaluated for appendiceal diameter, wall thickness, cecal wall thickness, periappendiceal fat stranding, effusion, lymphadenopathy, intraluminal and free periappendiceal air, mucosal hyperenhancement, and the presence of appendicolith.
RESULTS: The diameter of the appendix, along with the presence of periappendiceal air, effusion, and intraluminal appendicolith, were significantly higher in the perforated appendicitis group compared to other groups (p<0.05). Periappendiceal fat stranding, evaluated as a binary variable, did not show significant differences among the groups. Appendiceal wall thickness was higher in the perforated group and lower in the non-perforated gangrenous group compared to the uncomplicated group (p<0.05). No significant correlation was found for mucosal hyperenhancement between the appendicitis subgroups. Intraluminal air, though normal in a healthy appendix, was a specific predictor of complicated appendicitis when combined with other findings.
CONCLUSION: This study provides a detailed analysis of distinct imaging findings associated with uncomplicated and complicated appendicitis. Key differentiators such as appendiceal diameter, periappendiceal air, effusion, and intraluminal appendicolith are crucial for accurate diagnosis. The findings highlight the importance of these parameters in distinguishing various types of appendicitis, offering valuable insights for clinical practice. Future prospective studies and advanced imaging techniques are needed to validate these findings and enhance the diagnosis and management of acute appendicitis and its complications.

BACKGROUND: Occlusal trauma has become a common phenomenon among individuals today. Its primary source is bruxism, which involves unusual activities such as clenching and grinding during the day or sleep. The hypothesis is that with 5% dextrose neuroprolotherapy, both the trigger points and affected nerves will be healed, and the muscle will be relieved by eliminating the pain.
METHODS: This study aimed to compare the short-term ultrasonographic results of patients treated with occlusal splint and 5% dextrose neuroprolotherapy for bruxism. Patients were divided into two groups: the dextrose neuroprolotherapy group and the occlusal splint group. In the first group, patients were administered 5% dextrose three times at one-week intervals using the dextrose neuroprolotherapy method. Impressions for both jaws were made using a high-viscosity irreversible hydrocolloid impression material in the second group. An occlusal splint was tailored to fit the upper jaw. Patients were assessed for masseter muscle thickness and strain ratio using ultrasonography before and 3 months after the treatment.
RESULTS: No statistically significant differences were found between the two groups for all measures. Statistically significant differences were observed in the strain ratio of the left musculus massetericus in the resting position and the thickness of the left musculus massetericus in the contracted position exclusively in the neuroprolotherapy group (p=0.001, p=0.011, respectively). Differences in the strain ratio of both sides of the contracted musculus massetericus were demonstrated in both groups (neuroprolotherapy group: right side p<0.001, left side p=0.007, splint group: right side p=0.005, left side p=0.012).
CONCLUSION: This study demonstrates that 5% dextrose neuroprolotherapy is an effective treatment comparable to an occlusal splint. Objectively visualizing changes in the masseter muscle through ultrasound provides clear results in the context of occlusal trauma and bruxism.

BACKGROUND: Thoracic trauma is a significant cause of mortality, especially among those arriving at hospitals. This study explores the associations between mortality, the shock index (SI), and specific metabolic and biochemical markers in patients with isolated thoracic trauma.
METHODS: This retrospective cross-sectional study included all consecutive adult patients presenting with isolated thoracic trauma to a high-volume emergency department from January 2019 to December 2023. The predictive capability of SI levels and selected biomarkers upon admission for estimating mortality was assessed by determining the areas under the receiver operating characteristic curves (AUCs). Optimal cutoff values were determined using the Youden index method.
RESULTS: The study involved 352 patients, with 285 (81%) being males and an average age of 50.0±17.7 years. The mortality rate was 9.6%. Mortality was significantly associated with higher shock index (odds ratio [OR]: 14.02, [95% confidence interval [CI] 0.847-0.916], AUC=0.885, p=0.001), glucose/potassium ratio (OR: 1.24 [95% CI 1.14-1.35], AUC=0.869, p<0.001), and lactate levels (OR: 4.30 [95% CI 2.29-8.07], AUC=0.832, p<0.001). The optimal cutoff values determined for the shock index, glucose/potassium ratio, ionized calcium, and lactate were 1.02 (sensitivity, 94.1%; specificity 69.5%; positive predictive value [PPV], 24.8; negative predictive value [NPV], 99.1), 36.85 (sensitivity, 76.5%; specificity, 87.7%; PPV, 40.0; NPV, 97.2), 1.23 (sensitivity, 94.1%; specificity, 56.0%; PPV, 18.6; NPV, 98.9), and 1.98 (sensitivity, 70.6%; specificity, 80.5%; PPV, 27.9; NPV, 96.2), respectively.
CONCLUSION: This study demonstrates that higher shock index, glucose/potassium ratio, and lactate levels are significantly associated with increased mortality in patients with isolated thoracic trauma. These findings suggest that these markers can be effective prognostic indicators, potentially guiding clinical decision-making and improving patient outcomes.

BACKGROUND: This study aimed to describe our clinical experience with surgical approaches and patient management for traumatic multiple-level continuous and noncontinuous thoracolumbar spinal fractures.
METHODS: We retrospectively evaluated patients with continuous and noncontinuous multiple-level thoracolumbar fractures who were operated on by the same surgical team from 2019 to 2021. These patients were divided into two groups: Group 1 (n=12, continuous fractures) and Group 2 (n=14, noncontinuous fractures). We assessed the patients’ age, gender, fracture levels, fracture type, classification according to the AO (Arbeitsgemeinschaft für Osteosynthesefragen) Spine Thoracolumbar Fracture Classification, status of posterior ligament damage, presence of additional traumatic pathology, status of decompression via laminectomy, levels of stabilization and fusion, preoperative and postoperative neurological status, presence of cervical trauma, duration of operation, amount of blood loss, duration of hospitalization, and lordosis and kyphosis angles in terms of fusion status and postoperative follow-up over two years. The study excluded patients over the age of 65, those with single-level fractures, and pathological fractures caused by osteoporosis, infection, or spinal tumors.
RESULTS: Gender, age, neurological status, application of laminectomy, surgical complications, status of cervical fracture, duration of operation, amount of blood loss, duration of hospitalization, lordosis, and kyphosis angles were uniformly distributed between the groups. All patients underwent fusions, ranging from three to eight, with a median of two (range 2-4) fracture levels, and a median of five instrumented vertebrae, ranging from four to seven. Significant differences between the two groups were observed in terms of operation duration (p=0.001), blood loss (p=0.010), duration of hospitalization (p=0.003), number of fusions (p<0.001), and instrumented vertebral segments (p=0.011).
CONCLUSION: Thus, a surgical approach involving decompression, vertebral fusion screws, allografts, and bone substitutes can enhance surgical outcomes for patients with continuous and noncontinuous vertebral fractures.

BACKGROUND: Ankle fractures occur due to a rotational mechanism. According to the Lauge-Hansen classification, supination-external rotation (SER) injuries are the most common type. Following osseous fixation, the evaluation and treatment of syndesmotic injuries in these injuries are controversial. This study aimed to evaluate the clinical, functional, and radiological results of trans-syndesmotic fixation using intraoperative tests in SER type 4 ankle injuries.
METHODS: Ankle syndesmosis was intraoperatively evaluated using cotton/hook and manual external rotation stress tests in 64 patients with SER type 4 fracture dislocation injuries. These patients were divided into two groups: those treated with and without trans-syndesmotic fixation in addition to open reduction and internal fixation of the fractures. Ankle range of motion (ROM), American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, and Olerud-Molander Ankle Score (OMAS), tibiofibular overlap, tibiofibular clear space, and joint arthritis based on the Kellgren-Lawrence (K-L) scale were evaluated.
RESULTS: Median values of OMAS (Z=-3.92, p<0.001), AOFAS (Z=-4.31, p<0.001), and ROM (Z=-2.95, p=0.003) were higher in Group 1. There were no differences between the groups regarding tibiofibular overlap median values (Z=-0.59, p=0.0554), tibiofibular clear space (Z=-1.13, p=0.258), and Kellgren-Lawrence arthritis scale. Lack of posterior malleolus fixation was found to increase the risk of arthritis by 18.197 times, despite having trans-syndesmotic fixation, which was statistically significant (Confidence Interval, CI: 2.482-133.417, p=0.004) (Table 4).
CONCLUSION: Median values of OMAS, AOFAS, and ROM in patients without trans-syndesmotic fixation were lower. These results indicate that intraoperative tests may not provide entirely accurate results in SER type 4 injuries. Failure to detect a syndesmotic injury timely can result in instability. Therefore, we think that routine trans-syndesmotic fixation, as well as posterior malleolus fixation in SER type 4 ankle injuries, may improve outcomes.

Bilateral anterior shoulder dislocation (BASD) is a rare condition typically associated with a history of trauma. This case report presents a patient with BASD resulting from trauma and discusses treatment options. A 51-year-old male patient was admitted to the emergency department following a fall from a height. Radiographic examination revealed BASD and a comminuted intra-articular fracture of the distal end of the left radius. The patient did not have any other additional pathologies. After a preoperative evaluation, the patient was urgently taken to the operating room, where both shoulders underwent reduction using the Hippocratic maneuver under sedation anesthesia. Immediately after this procedure, the left wrist was reduced closed, and a penning-type external fixator was inserted under fluoroscopic guidance. Following the reductions, both shoulders were wrapped with a Velpeau bandage and immobilized. An elastic bandage was wrapped around the wrist. By the end of the third week, shoulder mobility exercises were initiated, with a gradual increase in the intensity of the exercises. The wrist fixator was removed in the fifth week after radiographic evaluations, followed by the initiation of passive and then active exercises. Given the rarity of BASD, it is crucial to obtain a detailed clinical history, conduct a comprehensive clinical examination, and perform detailed imaging studies-radiography, computed tomography, and magnetic resonance imaging to avoid overlooking such pathologies in emergency situations. Bilateral anterior shoulder dislocation is a pathology that results from major trauma. It is important to remember that this particular type of pathology may be accompanied by various other pathologies, such as fractures (of the tuberculum majus), rotator cuff injuries, and neurovascular injuries.

Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal system, occurring in approximately 2% of the population. It is rare for MD to be symptomatic or complicated in adulthood. In this case report, we describe a patient who was admitted to the clinic with Meckel's diverticulitis, which had fistulized to the anterior abdominal wall, and was incidentally found to have an ileal inflammatory myofibroblastic tumor (IMT) on radiological imaging. A 46-year-old male patient presented to the emergency department with abdominal pain. Physical examination revealed localized guarding on the right side of the umbilicus. Blood tests showed elevated acute-phase reactants, including a white blood cell count of 13,800/µL, and C-reactive protein (CRP) level of 165 mg/L. Abdominal computed tomography demonstrated Meckel's diverticulitis fistulizing to the anterior abdominal wall and a polypoid structure in the ileum distal to the MD. The patient underwent emergency surgery, during which segmental ileal resection and ileocolic anastomosis were performed. On the fourth postoperative day, the patient developed an anastomotic leak. Relaparotomy, right hemicolectomy with end ileostomy, and mucous fistula creation were subsequently performed. Pathological examination of the resected ileum from the initial surgery revealed a benign IMT distal to the MD. The patient was discharged on the 40th postoperative day after developing a surgical site infection following the second surgery. The end ileostomy was closed six months later. In this case, it appears that the ileal IMT located distal to the MD may have caused intermittent intestinal obstruction, fecal stasis, and the development of Meckel's diverticulitis. Furthermore, a detailed examination of the patient’s history, laboratory results, and radiologic tests may contribute to the detection of incidental pathologies and influence treatment choices.

Evisceration of the small intestine from a perforated rectum is a rare condition, particularly seen in elderly women. We present a case involving an 83-year-old woman with a history of chronic rectal prolapse and no other comorbidities. The patient declined surgical intervention for her rectal prolapse, and one month later, she presented with evisceration of the small intestine from the anus. The intervention was a laparotomy followed by Hartmann’s procedure, which is the most recommended procedure. No small bowel resection was necessary. Although the management of this case was adequate and timely, the patient did not survive. This case underscores that elective repair of rectal prolapse might prevent this very rare but potentially fatal complication of transanal small intestinal evisceration.

Intestinal choriocarcinoma is a very rare phenomenon. This is the first reported case of intestinal choriocarcinoma following an ectopic pregnancy. We report a 24 year-old woman who presented with severe abdominal pain, distension, and vomiting. She had a history of an ectopic pregnancy nine months prior. Emergent laparotomy exploration revealed abscess formation and obstructions at two sites in the small intestine, with unremarkable gynecological organs. The obstructed sections of the intestinal were excised and subsequently diagnosed as intestinal choriocarcinoma in histopathological evaluation. Postoperative positron emission tomography (PET) revealed a non-contrast-enhancing lesion on the small intestinal wall with increased metabolic activity consistent with healing tissue at the anastomosis site. No other primary focus and/or metastatic lesions were detected. Multi-agent chemotherapy was planned for the patient. No residual and/or recurrent tumoral lesions were detected on the PET scan at the one-year follow-up.