BACKGROUND: Acute mesenteric artery ischemia is recognized as a significant cause of mortality and morbidity, with its incidence increasing with age. This study aims to investigate the efficacy of sesamin in mitigating the histological, immunological, and biochemical damage associated with superior mesenteric artery ischemia and reperfusion (SMA I/R) injury in the ileum.
METHODS: Twenty-eight Sprague-Dawley rats were randomly assigned into four equal groups. Group I (Control group): Received no treatment. Group II (SMA I/R group): Carboxymethylcellulose was mixed with distilled water and administered orally via gavage at a dose of 1 mL/kg/dose for three weeks. At the end of the third week, SMA ischemia was induced for 60 minutes followed by 120 minutes of reperfusion. Group III (Sesamin group): Received sesamin orally at a dose of 30 mg/kg via gavage for three weeks. Group IV (Sesamin + SMA I/R group): Received sesamin followed by SMA I/R.
RESULTS: Serum malondialdehyde (MDA) levels were highest in the SMA I/R group, while lower levels were observed in the Sesamin + SMA I/R group (p<0.05). Similarly, total oxidant status (TOS) was significantly reduced in the Sesamin + SMA I/R group compared to the SMA I/R group (p<0.05). Consistent with these findings, Bax expression, a pro-apoptotic marker, was less intense in the Sesamin + SMA I/R group than in the SMA I/R group.
CONCLUSION: Our findings indicate that the administration of sesamin prior to SMA I/R effectively reduces oxidative damage and prevents histological alterations, as demonstrated by histological, immunohistochemical, and biochemical parameters.

BACKGROUND: Erythrocyte deformability, the ability of red blood cells to bend and twist as they pass through capillaries, is es-sential for tissue perfusion. This study investigates the effects and underlying mechanisms of rosmarinic acid treatment on erythrocyte deformability in rats subjected to lower limb 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 with no treatment (C), the group receiving only the solvent dimethyl sulfoxide (DMSO), the ischemia-reperfusion group (IR) subjected to 90 minutes of ischemia followed by 90 minutes of reperfusion in the femoral artery of the lower limb, the rosmarinic acid control group (RA-C) to assess the effects of rosmarinic acid alone, and the group (IR+RA) in which rosmarinic acid was administered intraperitoneally one hour before the ischemia-reperfusion procedure. At the end of the experiment, intracardiac blood samples were collected. Analyses included May-Grünwald-Giemsa (MGG) staining, measurement of endothelial nitric oxide synthase (eNOS), erythrocyte deformability indexes, malondialdehyde (MDA), and superoxide dismutase (SOD) levels.
RESULTS: Significant findings were observed in the study. Erythrocyte deformability was statistically significantly improved in the group that received rosmarinic acid prior to ischemia-reperfusion compared to the group that underwent ischemia-reperfusion alone. Morphological changes of erythrocytes were also significantly better in the IR+RA group than in the IR group. Immunohistochemical analysis of eNOS staining revealed that eNOS activity was higher in the IR group compared to the IR+RA group. Malondialdehyde (MDA) levels were significantly elevated in the IR group compared to all other groups. Analysis of superoxide dismutase levels showed that the SOD levels in the IR+RA group were significantly higher than those in the other groups.
CONCLUSION: Our findings indicate that rosmarinic acid treatment administered prior to ischemia provides protective effects against erythrocyte deformation and morphological deterioration. It is suggested that the improvement in deformability may be mediated by increased SOD activity, which reduces reactive oxygen anions, by-products of nitric oxide (NO) production, thereby exerting an antioxidant effect and enhancing the beneficial actions of NO.

BACKGROUND: This study aimed to determine the diagnostic value of the product of the reverse Shock Index (rSI) and the simplified Motor Score (sMS) (rSIsMS) as a predictor of clinical outcomes in patients with abdominal trauma.
METHODS: Patients who presented with abdominal trauma to the emergency department of a tertiary care hospital between 2023 and 2024 were included in the study. Using the patients’ data, we calculated the Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS). Additionally, the rSIsMS and the product of the rSI and Glasgow Coma Scale (GCS) (rSIG) were calculated.
RESULTS: A total of 270 patients were included in the study. The diagnostic validity of the TRISS, rSIsMS, and rSIG, which had the highest area under the curve (AUC) values for mortality outcomes, was examined; the AUC values were 0.928, 0.908, and 0.886, respectively. The AUC values of the TRISS and rSIsMS concerning intensive care unit (ICU) needs were 0.844 and 0.852, respectively. With regard to surgical intervention needs, the AUC values of the TRISS and rSIsMS were 0.774 and 0.881, respectively. The diagnostic validity of the rSIsMS for surgical intervention needs was significantly higher than that of the TRISS (p<0.001, DeLong test). Concerning massive transfusion protocol (MTP) requirements, the AUC values of the TRISS and rSIsMS were 0.799 and 0.930, respectively. The diagnostic validity of the rSIsMS for MTP requirements was significantly higher than that of the TRISS (p<0.001, DeLong test).
CONCLUSION: The rSIsMS is superior to other trauma scores in predicting MTP and surgical intervention needs in patients with abdominal trauma, and it performs similarly to other trauma scores in predicting mortality and ICU needs. The ease of calculation and its ability to be obtained at the bedside may further enhance the clinical utility of the rSIsMS in the emergency department.

BACKGROUND: Acute pancreatitis (AP) is a condition frequently encountered by emergency department (ED) physicians, presenting with a spectrum of severity ranging from a mild, uncomplicated form to a severe, potentially fatal one. This study aimed to identify ED admission parameters that could predict a complicated disease course in patients with AP.
METHODS: Patients consecutively diagnosed with AP between 2010 and 2018 were included in the study and categorized into complicated and uncomplicated AP groups based on disease progression. Various clinical and laboratory characteristics at ED admission were compared between the two groups, and independent risk factors for complicated AP were identified. Complicated AP was de-fined as the development of any of the following during hospitalization: death, severe disease, necrosis, late peripancreatic or vascular complications, and pancreatic/peripancreatic or major extrapancreatic infections.
RESULTS: Of the 511 patients included in the study, 74 (14.5%) were classified into the complicated AP group. At ED admission, recurrent AP, alcoholic etiology, pleural effusion, systemic inflammatory response syndrome, and calcium levels were identified as independent risk factors for complicated AP. The area under the curve for the combination of these five predictors for complicated AP was 0.857 (95% confidence interval: 0.810-0.904), significantly higher than that of existing scoring systems.
CONCLUSION: Using five simple parameters, the development of complicated AP was successfully predicted. These parameters should be considered in the development of new scoring systems to identify patients at risk for clinically severe outcomes in AP.

BACKGROUND: Individuals who are not citizens of a country are defined as foreigners, whereas those with citizenship ties are referred to as nationals. In cases where a foreign national dies in our country, a death certificate is issued by the director of the relevant institution if the death occurs in a public health facility, or by the attending physician in a private health institution. In cases of forensic or suspicious deaths, necropsy and autopsy procedures are conducted in accordance with the Code of Criminal Procedure and the circular issued by the High Council of Judges and Prosecutors. Based on the circumstances of the incident, a notification form is forwarded to the relevant consulates and the Ministry of Foreign Affairs. Data on the deaths of foreign nationals are crucial for understanding the demographic characteristics and causes of death within the foreign population. This study aimed to evaluate the deaths of foreign nationals within a geographical and socioeconomic context, to generate scientific data and identify potentially preventable causes of death.
METHODS: This study retrospectively analyzed autopsy reports of foreign nationals who underwent examination at the Morgue Specialization Department of the Erzurum Group Directorate of the Forensic Medicine Institute between 2016 and 2021.
RESULTS: A total of 90 cases were analyzed. Of these, 92% (n=83) were male, and 65.5% (n=59) were in the young to middle-aged group. The mean age was 34.1 years, and 78.8% (n=71) of the individuals were from Central Asia. The causes of death were as follows: diseases in 28.8% (n=26) of cases, traffic accidents in 16.6% (n=15), and hypothermia in 14.4% (n=13). The rate of negative autopsy findings, where no definitive cause of death could be determined due to advanced decomposition, was 5.5% (n=5).
CONCLUSION: The majority of autopsied deaths of foreign nationals were determined to be due to traumatic causes and occurred outside their country of origin, highlighting the fatal consequences of migration-related mobility. In cases involving the deaths of foreign nationals, the provisions of the Vienna Convention on Consular Relations should be observed, death notifications should be properly processed, and biological samples should be preserved for identification purposes.

BACKGROUND: The Kahramanmaraþ Earthquake, often referred to as the "disaster of the century," occurred on February 6, 2023. Following the 7.7 magnitude earthquake, extensive destruction and significant loss of life occurred across 10 provinces. This study aims to analyze the outcomes and share the surgical and radiologic algorithm applied to live, trauma-affected pregnant patients who were referred to the obstetrics and gynecology emergency department of our hospital following the earthquake.
METHODS: This is a retrospective observational study. The study included pregnant patients affected by the earthquake who were admitted to and/or referred to the obstetrics and gynecology emergency department of a tertiary hospital between February 6 and March 6, 2023. Demographic data, trauma-related findings, surgical details, and obstetric outcomes were recorded.
RESULTS: A total of 58 pregnant earthquake victims were evaluated. The mean gestational age was 22.24±10.59 weeks. The most common obstetric complaint was pelvic pain or contractions (36.3%). Eleven patients gave birth, two via vaginal delivery and nine via cesarean section. The mean gestational age at delivery was 32.81 weeks. Curettage was performed in three patients, and hysterotomy in one patient. There were six live births and five stillbirths. In patients undergoing cesarean section, a midline incision was made. After delivery, the uterus was sutured, and intra-abdominal organs were evaluated. In cases of pelvic or other fractures, intraoperative scope devices were used. When necessary, patients were consulted by general surgery and orthopedics departments and were transferred to either the ward or the intensive care unit, depending on their clinical condition.
CONCLUSION: Ultrasound has become the primary diagnostic tool for emergency evaluation in pregnant women. For earthquake victims who lack access to radiological assessment and require rapid clinical decisions, the recommended surgical approaches, particularly midline incisions, and intraoperative evaluations (such as the use of intraoperative scope after delivery) can be life-saving for both the baby and the mother.

BACKGROUND: Acute appendicitis (AA) is one of the most common causes of surgical acute abdomen. Currently, laparoscopic appendectomy (LA) is the most frequently preferred surgical approach. As with all laparoscopic procedures, the possibility of conversion to open surgery also exists in LA. This study aims to identify the risk factors associated with conversion to open appendectomy (OA) during the laparoscopic management of AA.
METHODS: This retrospective case-control study included 445 patients who underwent LA for AA between 2018 and 2023. Patients were divided into two groups based on whether conversion to OA was required during the laparoscopic procedure. Preoperative demographic, clinical, and perioperative data were evaluated. Both univariate and multivariate analyses were performed.
RESULTS: The median age of the 445 patients included in the study was 34 years (interquartile range: 25-49). Of these, 58.2% were male. The overall conversion rate to open surgery was 3.8%. In univariate analyses, factors such as age (p=0.002), the American Society of Anesthesiologists (ASA) score (p=0.011), time of arrival at the emergency department (p<0.001), C-reactive protein (CRP) level (p<0.001), amylase level (p=0.012), Malatya Complicated Appendicitis Prediction Score (MCAPS) ≥6 (p<0.001), and presence of complicated appendicitis (p<0.001) were associated with conversion. However, in multivariate analyses, only an MCAPS score of 6 or higher (p=0.034) was identified as an independent risk factor for conversion.
CONCLUSION: Since conversion to OA is sometimes unavoidable in the management of AA, clinicians may benefit from using the easily applicable MCAPS to predict the likelihood of conversion. This scoring system may also assist in considering primary OA when appropriate.

OBJECTIVE: Thoracic level localization in the treatment of thoracic spine problems is more challenging than other spinal regions. The purpose of this study was to prove the reliability of pedicular spinal needle placement under computed tomography guidance before thoracic spine surgery and to reduce the margin of error, surgery time and operating room radiation exposure during thoracic spine and spinal cord surgery.
METHODS: Fourteen patients undergoing posterior aproach to the thoracic spine and/or spinal cord related lesions were investigated. Spinocaths were placed under CT guidance, into the pedicle of the relevant vertebra, at the same day or the night before surgery. The surgical field is prepared as usual, and a spinocath is placed to the relevant thoracic pedicle under CT guidance.
RESULTS: Intraoperative level localization was more reliable and easier in patients undergoing preoperative CT-guided marking in surgeries on the thoracic region performed for various reasons. Shorter preoperative preparation and intraoperative anesthesia times, a decrease in number of fluoroscopic images taken intraoperatively, and no spinal mislocalizations were observed.
CONCLUSION: The results obtained suggest that localising the level with preoperative CT before all types of thoracic surgery is a safe, reliable, and useful method for thoracic spine surgery.

BACKGROUND: Two major earthquakes struck southeastern Türkiye consecutively on February 6, 2023. On the same day, a Surgical Disaster Response Team was immediately formed at Ankara Etlik City Hospital and deployed to the affected region, where they worked for seven days at Hatay-Reyhanlý State Hospital. The aim of this study was to present the experiences, data, and recommendations of the Ankara Etlik City Hospital Surgical Disaster Response Team following the February 6, 2023 earthquakes.
METHODS: Data were collected from the individual records of the physicians in the Surgical Disaster Response Team. The physicians provided information about the units in which they worked, their roles, the procedures they performed, treatments administered, observations made, experiences encountered, and recommendations for future disaster response efforts.
RESULTS: The anesthesiologists in the team worked in the operating theatres and intensive care units. In addition to performing surgical procedures, the cardiovascular surgeon, general surgeons, and pediatric surgeon also assisted in the emergency department’s red and yellow zones as needed. The orthopedic surgeons performed 96 interventions, the neurosurgeon 11, the cardiovascular surgeon five, the general surgeons four, and the pediatric surgeon four. Of the total procedures, 80% were performed by orthopedic surgeons, while the remaining 20% were carried out by specialists from other surgical branches.
CONCLUSION: Extremity injuries are common among earthquake survivors and usually require orthopedic intervention. In a hospital where the administrative staff are also disaster victims, management should be assumed by the incoming disaster response team. A detailed disaster preparedness plan must outline which regions will provide support, including personnel, transportation, materials, and patient referrals, to specific disaster-affected areas. In addition to surgeons, the disaster response team must include emergency medicine specialists, internal medicine specialists, pediatricians, and gynecologists. The Surgical Disaster Response Team should be a fully integrated unit consisting of doctors, nurses, and auxiliary personnel.

BACKGROUND: On February 6, 2023, two devastating earthquakes struck southeastern Türkiye and northern Syria, significantly affecting 11 provinces in Türkiye and causing widespread destruction. The aim of this study is to investigate the factors influencing mortality among patients who underwent surgical procedures at a regional tertiary care center following the earthquakes.
METHODS: A total of 4,622 earthquake victims were admitted to our hospital. Of these, 637 patients who required surgical interventions were included in the study. Patient records were retrospectively analyzed. Data collected included demographic characteristics, laboratory findings, types of injuries, surgical procedures performed, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, length of stay (LOS) in the intensive care unit (ICU), and mortality outcomes. Extrication time and transport time to the hospital were obtained from prehospital emergency ambulance records.
RESULTS: Among the patients, 159 had been trapped under debris and later extricated. The mean APACHE II score was 29.6 and the overall mortality rate was 3.9%. Crush syndrome and burn injuries were significant predictors of mortality. Factors associated with mortality included the use of hemodynamic support drugs, direct ICU admission upon arrival, male sex, prolonged extrication and transport times, higher APACHE II scores, elevated levels of potassium, phosphorus, creatine kinase, blood urea nitrogen, aspartate aminotransferase, alanine aminotransferase, C-reactive protein, and acidosis on admission. Extrication time demonstrated strong pre-dictive value for mortality (area under the curve [AUC]=0.895). The optimal cut-off point was identified as 21 hours, with a sensitivity of 78.9% and specificity of 86.4%.
CONCLUSION: Extrication time from entrapment under debris is one of the most important factors predicting mortality in earthquake victims. A rescue period of 21 hours is critical for survival. Early rescue from debris and rapid transport to a medical facility are essential for improving survival outcomes in earthquake victims.

BACKGROUND: This study aims to evaluate the accuracy and reliability of Generative Pre-trained Transformer (ChatGPT; OpenAI, San Francisco, California) in answering patient-related questions about trigger finger. This evaluation has the potential to enhance patient education prior to treatment and provides insight into the role of artificial intelligence (AI)-based systems in the patient educa-tion process.
METHODS: The ten most frequently asked questions regarding trigger finger were compiled from patient education websites and a literature review, then posed to ChatGPT. Two orthopedic specialists evaluated the responses using the Journal of the American Medical Association (JAMA) Benchmark criteria and the DISCERN instrument (A Tool for Judging the Quality of Written Consumer Health Information on Treatment Choices). Additionally, the readability of the responses was assessed using the Flesch-Kincaid Grade Level.
RESULTS: The DISCERN scores for ChatGPT's responses to trigger finger questions ranged from 35 to 47, with an average of 42, indicating "moderate" quality. While 60% of the responses were satisfactory, 40% contained deficiencies. According to the JAMA Benchmark criteria, the absence of scientific references was a significant drawback. The average readability level corresponded to the university level, making the information difficult to understand for patients with low health literacy. Improvements are needed to enhance the accessibility and comprehensibility of the content for a broader patient population.
CONCLUSION: To the best of our knowledge, this is the first study to investigate the use of ChatGPT in the context of trigger finger. While ChatGPT shows reasonable effectiveness in providing general information on trigger finger, expert oversight is necessary before it can be relied upon as a primary source for patient education.

BACKGROUND: Isolated traumatic spinous process fractures account for a small proportion of diagnosed spinal fractures. Among spinal fractures, the cervical vertebra is the most common site of involvement, often referred to as a Clay-Shoveler’s fracture. This study included patients with isolated spinous process fractures through radiologic examinations over the past five years. The study aimed to investigate the cause of trauma, the presence of spinal ligament injury, and the relationship between these fractures with age and sex.
METHODS: Magnetic resonance imaging (MRI) and computed tomography (CT) scans of the spine, performed for any reason over the past five years at the hospital where the study was conducted, were retrospectively reviewed and re-evaluated. Patients whose examinations were unrelated to trauma, those with imaging artifacts that interfered with evaluation, and those who had undergone spinal vertebral surgery were excluded. The etiology of fractures was classified using the International Classification of Diseases (ICD) diagnoses. Data on age, sex, cause of trauma, and spinal ligament injury were recorded.
RESULTS: A total of 44 patients (36 men and eight women) were included in the study, with a mean age of 43.1 years. Among them, 25 patients were admitted due to traffic accidents and 18 due to falls. Spinous process fractures were observed in 18, 17, and three patients in the cervical, thoracic, and lumbar regions, respectively. Multiple spinous process fractures were found in 15 patients, while six patients had fractures in both the cervical and thoracic regions (Clay-Shoveler’s fracture). In 12 patients, spinal MRI with Short-TI Inversion Recovery (STIR) sequences was performed in addition to CT imaging. All patients with Clay-Shoveler’s fracture fractures underwent both CT and MRI examinations. In all cases where MRI was performed, interspinous ligament damage was detected. However, no intracanal involvement or comorbid pathology was observed.
CONCLUSION: Notably, multiple fractures may occur, particularly at the cervicothoracic junction. Although spinous process fractures associated with trauma are rarely isolated, they are usually managed with medical treatment. Therefore, the vertebrae below the initially detected fracture site should also be evaluated. Additionally, imaging studies such as MRI with STIR sequences should be performed to assess ligament damage and the neural canal, in addition to tests for evaluating bony structures.

BACKGROUND: Medial distal tibial Salter-Harris Type 3 and Type 4 epiphyseal injuries, also known as McFarland fractures, pose significant risks due to their potential to damage the growth plate and cause long-term joint deformities. Surgical treatment is commonly performed to restore joint congruity; however, there is no clear consensus on whether surgical or conservative treatment yields better outcomes. This study aimed to evaluate the mid-term clinical and radiological outcomes of surgical treatment in patients with McFarland fractures.
METHODS: This retrospective study analyzed outcomes of 13 patients, aged 6-17 years, who underwent surgical treatment for McFarland fractures between 2021 and 2023 at a Level 1 Trauma Center. Surgical methods included screw fixation, K-wire fixation, and tension wire fixation. Outcome measures included radiological deformity assessments (lateral distal tibial angle [LDTA], anterior distal tibial angle [ADTA]), range of motion (ROM), Foot and Ankle Ability Measure (FAAM) scores for functional assessment, and Visual Analogue Scale (VAS) scores for pain. Comparisons were made between the operated and non-operated limbs.
RESULTS: LDTA and ADTA values showed minimal differences between the operated and non-operated limbs, indicating successful surgical realignment (p<0.05). Although slight ROM limitations were observed in the operated limb, high FAAM scores and low VAS scores reflected good functional recovery and effective pain management. Correlation analysis revealed a moderate positive correlation (r=0.45) between FAAM scores and ROM, and a weaker correlation (r=0.32) between FAAM scores and radiological alignment.
CONCLUSION: Surgical treatment of McFarland fractures resulted in favorable clinical and radiological outcomes, with minimal limitations in ROM and significant improvements in alignment and functional recovery. However, ongoing follow-up is essential, particularly in younger patients, to monitor and manage the risk of potential growth disturbances.

Pancreatic carcinosarcoma is one of the rare malignant tumors of the pancreas. Although they are aggressive, they can be detected with local or distant organ metastases when detected.
In this article, the surgical procedure applied to pancreatic trophoblastic carcinosarcoma, which showed local invasion in a patient who applied to the emergency department of our hospital with the complaint of bloody vomiting and was operated with a preliminary diagnosis of gastric hemorrhage, the pathology result and the aggressive progression of the disease in a short time were presented. A literature review was conducted for pancreatic trophoblastic carcinosarcoma, which is a rare case, and the findings were presented.