BACKGROUND: This study investigated the protective effect of red ginseng (RG) on oxidative stress and pathological changes in an experimental liver ischemia-reperfusion injury (IRI) model, using both biochemical and histopathological evaluations.
METHODS: Fifty female Wistar-Albino rats were used, with body weights ranging from 174 g to 232 g. The animals were randomly divided into five groups, each consisting of 10 rats. After laparotomy in Group I, the hepatic pedicle was mobilized, no further procedures were performed, and tissue and blood samples were collected. In Group II, ischemia was induced by clamping the hepatic artery and portal vein for 60 minutes following laparotomy. Tissue and blood samples were collected via reoperation at 90 minutes after reperfusion, without any drug administration. In Group III, ischemia was similarly induced by clamping the hepatic artery and portal vein for 60 minutes after laparotomy. Tissue and blood samples were collected via reoperation at the 48th hour after reperfusion, again without any drug administration. In Group IV, RG was administered to the rats at a dose of 5 mg/kg/day via orogastric tube for three days preoperatively. This was followed by laparotomy and induction of ischemia through clamping of the hepatic artery and portal vein for 60 minutes. Tissue and blood samples were collected via reoperation at 90 minutes after reperfusion, with no drug administered postoperatively. In Group V, RG was administered at a dose of 5 mg/kg/day via orogastric tube for three days preoperatively, followed by laparotomy and induction of ischemia by clamping the hepatic artery and portal vein for 60 minutes. After reperfusion, the rats received RG at the same dose for two days postoperatively via orogastric tube, and tissue and blood samples were collected via re-operation at the 48th hour.
RESULTS: Red ginseng did not show a significant histopathological effect; however, differences were observed in biochemical parameters.
CONCLUSION: Red ginseng may have protective effects against ischemia-reperfusion injury.

BACKGROUND: Acute mesenteric ischemia (AMI) is a potentially fatal vascular emergency that results in tissue damage due to ischemia-reperfusion injury (IRI) and is difficult to diagnose and treat in its early stages. Monoacylglycerol lipase inhibitors have demonstrated protective effects against ischemia-reperfusion injury due to their antioxidant and anti-inflammatory properties. This study aimed to evaluate the effects of KML29, a potent and selective monoacylglycerol lipase inhibitor, on intestinal IRI.
METHODS: Thirty-two female Wistar albino rats were divided into four groups: Group 1 – Sham; Group 2 – Ischemia/Reperfusion (IR); Group 3 – IR + KML29 (2 mg/kg); and Group 4 – IR + KML29 (10 mg/kg). Intestinal ischemia-reperfusion was induced by occluding the superior mesenteric artery for 45 minutes, followed by 60 minutes of reperfusion. KML29 was administered intraperitoneally to Groups 3 and 4 at doses of 2 mg/kg and 10 mg/kg, respectively, 30 minutes prior to surgery. Intestinal IRI was evaluated using histopathological and biochemical parameters.
RESULTS: Treatment with 10 mg/kg KML29 was associated with improved histopathological findings in the IR group (p=0.0001). Elevated levels of nuclear factor kappa B (NF-kB), tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), and transforming growth factor-beta 1 (TGF-β1) observed in the IR group were significantly reduced following administration of 10 mg/kg KML29 (p=0.0001). Additionally, treatment with both 2 mg/kg and 10 mg/kg doses of KML29 significantly reduced the number of apoptotic cells in the IR group (p=0.0001).
CONCLUSION: In conclusion, this study demonstrated that treatment with both doses of KML29 (2.5 mg/kg and 10 mg/kg) significantly reduced the number of apoptotic cells and inflammatory markers, and improved histopathological findings in the intestinal tissues of rats subjected to IR. With its anti-inflammatory and anti-apoptotic properties, KML29 may represent a novel therapeutic option for the treatment of mesenteric ischemia.

BACKGROUND: After successful restoration of limb perfusion following limb ischemia, a series of secondary damage mechanisms, collectively known as reperfusion injury, is triggered. This study investigated the comparative effects of warming, a technique commonly used in clinical settings after extremity revascularization, and cooling, in a rat model of ischemia-reperfusion injury.
METHODS: Sprague Dawley rats aged 12 to 14 weeks and weighing between 250-350 g were used. The study included four experimental groups: Sham, Control, Cold Application, and Warm Application. Ischemia was induced by occluding the femoral artery with an atraumatic vascular clamp for three hours. Cold and warm treatments were applied for two hours by immersing the hind limbs in water at specific temperatures. In the cold application group, water temperature was maintained at 12±2°C using ice cubes to lower the temperature as needed. In the warm application group, the water temperature was kept at 38±2°C by adding hot water when necessary. Twenty-four hours after the injury model was established, the animals underwent a second surgical procedure to obtain tissue samples for analyses of malondialdehyde (MDA), myeloperoxidase (MPO), poly(ADP-ribose) polymerase (PARP), catalase, and superoxide dismutase (SOD).
RESULTS: Compared to the control group, the warm application group showed no statistically significant differences in levels of MDA (p=0.910), MPO (p=0.527), PARP (p=0.192), catalase (p=0.999), or SOD (p=0.987). In contrast, the cold application group exhibited a significant reduction in MDA, MPO, PARP, catalase, and SOD levels (p<0.001 for all).
CONCLUSION: To minimize reperfusion injury following limb ischemia, cold application may provide greater benefits than warming the extremity. Further studies are necessary to explore the clinical relevance and applications of this finding.

Background:
In this experimental colitis model, it is aimed to evaluate effects of enterally administered daidzein on colonic anastomoses of rats.
Methods:
48 male Wistar albino rats, 8-10 weeks old, were used. They were randomly divided into 8 groups, containing 6 rats each. Half of the randomly selected were given water rectally using a catheter and the other half received 2 cc of 4% acetic acid solution by the same way to cause colitis. Five days after the procedure, the rats were operated on and 4 cm long colonic segment, 6 cm proximal to the anal verge, was resected and an end-to-end colonic anastomosis was performed for each. Daidzein was administered orally to predetermined groups. Relaparatomies were performed on the 3rd or 7th postoperative days and the anastomotic colonic segments were resected.
Results:
According to the statistical comparison of the parameters obtained by biochemical, histopathological and physiological measurements of the anastomotic tissue; there was no positive effect of enteral daidzein administration on anastomotic healing in terms of hydroxyproline level and anastomotic burst pressure in groups with or without colitis in the early and late postoperative period. In addition, daidzein was not effective in reducing oxidative stress markers such as antioxidant enzymes, glutathione peroxidase and superoxide dismutase. In the late postoperative period, beneficial effect of daidzein administration was observed on the pathology damage score only in the groups without colitis.
Conclusion:
No positive effects of daidzein on healing of colon anastomosis were observed in both colitis and colitis-free environments.

BACKGROUND: Medical malpractice refers to harm caused to patients during the delivery of healthcare services due to negligence, misapplication, or failure to provide appropriate treatment by healthcare professionals. In recent years, a notable increase in medical malpractice lawsuits has been observed both nationally and internationally. Surgeons, in particular, are more frequently subject to such lawsuits, as complex surgeries carry a higher risk of adverse effects and complications. Thoracic surgery ranks among the specialties with the highest number of malpractice claims. Understanding the causes and distribution of these lawsuits can contribute to the prevention of malpractice in this field.
METHODS: We retrospectively evaluated 118 cases of alleged medical malpractice in thoracic surgery by the Council of Forensic Medicine. Data collected included sociodemographic characteristics, medical records, other healthcare professionals involved, the institutions and departments in question, relevant specialties, and causes of death, where applicable.
RESULTS: Of the 118 cases, 76 (64.4%) involved male patients and 42 (35.6%) female patients, with a mean age of 43.2±20.5 years. Tertiary healthcare institutions accounted for the majority of allegations (58.5%). Non-traumatic conditions were the reason for admission in 61 cases (51.7%), while traffic accidents were the most common trauma-related cause (25 cases, 43.9%). Medical malpractice was confirmed in 11 cases (9.3%), while six were considered assessable. Diagnostic errors were the most common stage at which malpractice occurred, identified in five cases (45.5%). Pneumothorax was the most frequent diagnosis (29 cases, 24.6%), and tube thoracostomy was the most commonly performed surgical procedure (31 cases, 26.2%). Medical malpractice was identified in 3 out of 6 cases (50%) managed in outpatient clinics. Among the three cases involving procedural misconduct, malpractice was confirmed in two (66.6%).
CONCLUSION: This study is the first in the literature to specifically analyze medical malpractice cases related to thoracic surgery. In specialties where complex procedures are common, such as thoracic surgery, malpractice allegations may arise not only from surgical interventions but also from diagnostic and follow-up processes. To reduce the risk of malpractice lawsuits, it is essential to emphasize continuous education on current best practices, ensure thorough documentation, obtain informed consent, promote shared decision-making, and provide ongoing training for thoracic surgeons in both their professional duties and legal responsibilities.

BACKGROUND: Acute appendicitis (AA) is the most common indication for emergency surgery in general surgery worldwide, with peak incidence occurring in the second and fifth decades of life. The main symptoms include nausea, vomiting, and pain that typically begins around the umbilicus and migrates to the lower right quadrant. While the most frequent cause is fekaloids, intestinal parasites, tumors, and fruit seeds may also rarely contribute to the etiology of appendicitis. The aim of this study was to determine the incidence of parasitic infections in the etiology of AA, along with associated demographic and histopathological findings in adult patients who underwent appendectomy.
METHODS: The records of 10,658 patients over the age of 15 who underwent appendectomy between January 2011 and January 2023 were retrospectively reviewed. Based on histopathological findings, 114 patients who underwent appendectomy due to parasitic infestation were included in the study.
RESULTS: According to the pathology results, a total of 114 patients underwent appendectomy due to parasitic infestation. Of these, 53 (46.5%) were female and 61 (53.5%) were male. Histopathological examination revealed that 70 cases (61.4%) were diagnosed as acute appendicitis, 22 (19.3%) as suppurative, 15 (13.2%) as gangrenous, and seven (6.1%) as perforated appendicitis. In terms of etiology, Taenia saginata was identified in four patients (3.5%), Ascaris lumbricoides in two patients (1.8%), and Enterobius vermicularis (EV) eggs or parasites in 108 patients (94.7%).
CONCLUSION: Parasitic infections, particularly Enterobius vermicularis, may contribute to the development of acute appendicitis, although their exact role in the pathogenesis remains unclear. In our study, Enterobius vermicularis was the most common cause of parasite-related appendicitis.

BACKGROUND: Anastomotic leakage is a significant complication following colorectal surgery, associated with increased morbidity and mortality. Endoluminal vacuum therapy (EVT) has emerged as a promising treatment option for managing such leaks, although stan-dardized guidelines are still lacking. This study aimed to evaluate the efficacy of EVT in managing anastomotic leakage after colorectal surgery, focusing on outcomes and contributing factors.
METHODS: A retrospective analysis was conducted on 25 patients who underwent EVT for anastomotic leakage between 2018 and 2022 at our institution. Data collected included patient demographics, surgical details, timing of EVT initiation, number of EVT sessions, complications, and outcomes such as leak closure and subsequent surgical interventions. Statistical analyses were performed using Python packages.
RESULTS: The study cohort had a mean age of 56.84 years, with 68% being male. All patients received neoadjuvant therapy followed by low anterior resection and diverting ileostomy; 80% underwent open surgery. EVT was initiated for postoperative anastomotic leak-age, with a mean hospital stay of 14.16 days and an average initiation time of 16.16 days post-surgery. Ileostomy closure was performed in 14 patients after endosponge therapy. The overall EVT success rate was 68%, with a mean follow-up period of 30.7 months for those who underwent ileostomy closure. No significant relationship was found between patients' age and the time to first EVT after anastomotic leakage (p=0.52). However, a significant association was observed between the timing of the first EVT and the duration of EVT termination (p=0.0003).
CONCLUSION: EVT is a viable option for managing anastomotic leakage following colorectal surgery, demonstrating high closure rates and low associated morbidity. Early initiation of EVT appears to be crucial for optimizing treatment outcomes. Further pro-spective studies are needed to establish standardized protocols and confirm the long-term benefits of EVT in this challenging clinical context.

BACKGROUND: Proximal femoral nailing is a widely used technique for treating intertrochanteric femur fractures but may result in complications requiring revision surgery. Hemiarthroplasty is a common solution, with the transtrochanteric and posterolateral approaches being two surgical options. This study aimed to compare these approaches in terms of surgical outcomes and complication rates.
METHODS: A retrospective analysis was conducted on 79 patients who underwent revision hemiarthroplasty for complications related to proximal femoral nailing between 2019 and 2022. Patients were divided into two groups based on the surgical approach: transtrochanteric (Group 1, n=36) and posterolateral (Group 2, n=43). Key variables included surgical time, intraoperative blood loss, transfusion requirements, functional outcomes (Harris Hip Score), and complication rates. Statistical significance was set at p<0.05.
RESULTS: Group 1 had a shorter surgical time (49.6±5.69 vs. 64.8±10.29 minutes; p<0.001) and lower intraoperative blood loss (395.8±142.89 vs. 474.2±130.94 mL; p=0.004) compared to Group 2. Transfusion requirements were also lower in Group 1 (0.4±0.71 vs. 1.2±1.014 units; p=0.002). Harris Hip Scores were similar between groups (74.7±7.17 vs. 72.4±7.8; p=0.276). Although overall complication rates did not differ significantly (p=0.744), dislocations occurred only in Group 2 (6.5%, n=2).
CONCLUSION: The findings suggest that the transtrochanteric approach may offer advantages in surgical efficiency and reduced intraoperative challenges. However, both techniques yielded similar functional outcomes and overall complication rates. Further studies are necessary to validate these findings and assess their applicability in varied clinical contexts.

BACKGROUND: Hip fractures in the elderly represent a major public health concern due to their high incidence, associated morbidity and mortality, and rising healthcare costs. This study investigates the impact of initial serum chloride levels, measured upon emergency department admission, on hospital length of stay, revision surgeries, and in-hospital mortality in elderly patients with hip fractures.
METHODS: Between August 2022 and August 2023, a total of 204 patients over 65 years of age diagnosed with hip fractures in the emergency department were included in the study. Patients were categorized into two groups based on their initial serum chloride levels: normochloremic (96-108 mEq/L) and hyperchloremic (>115 mEq/L). Length of hospital stay and postoperative complications were compared between the groups.
RESULTS: The mean chloride level was 102.1 mEq/L in the normochloremic group and 121.3 mEq/L in the hyperchloremic group. The average hospital length of stay was 9.9 days in the normochloremic group and 15.5 days in the hyperchloremic group, a statistically significant difference (p=0.009). Mortality and revision surgery rates did not show statistically significant differences between the groups. However, all six patients who died during the study had serum chloride levels above 115 mEq/L at admission.
CONCLUSION: This study demonstrates that elevated serum chloride levels at admission are associated with prolonged hospital stays and increased morbidity in elderly patients with hip fractures. While hyperchloremia may not directly predict mortality or the need for revision surgery, it may serve as a prognostic marker for extended hospitalization, indicating a higher risk in this vulnerable population.

BACKGROUND: Fournier's Gangrene (FG) is a rare, life-threatening necrotizing fasciitis of the perineum and genitourinary regions with high morbidity and mortality rates. Despite advancements in healthcare, FG remains a challenge due to its rapid progression and the need for aggressive intervention. This study aims to investigate the factors influencing mortality in FG patients, assess the effectiveness of laboratory parameters and scoring systems, and emphasize the role of blood glucose regulation in improving survival.
METHODS: This retrospective study included 36 patients diagnosed with FG at Bolu Abant Ýzzet Baysal University Medical Faculty Hospital between January 2014 and September 2024. Patients with incomplete data, a history of isolated perineal, gynecological, or perianal surgeries unrelated to FG, and those under 18 years of age were excluded. For all patients, Neutrophil-Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR), Lymphocyte-Monocyte Ratio (LMR), CRP-Albumin Ratio (CAR), and Prognostic Nutritional Index (PNI), Inflammatory Prognostic Index (IPI), Systemic Inflammation Index (SII), Urology and Plastics Index (CUPI), Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), Fournier's Gangrene Severity Index (FGSI), and Uludað Fournier's Gangrene Severity Index (UFGSI) scores were calculated. A comparison was made between the results obtained from laboratory parameters and scoring systems and the effect of blood sugar regulation on survival. Statistical analyses were performed using SPSS 27.
RESULTS: The mean age of the patients was 64.67±13.25 years, with a male-to-female ratio of 3: 1. Diabetes Mellitus (DM) was present in 61.1% of cases and 66.7% of deceased patients. The mortality rate was 16.7%. Elevated blood glucose levels at admission were significantly associated with mortality (p=0.024). The cut-off value of 186.5 mg/dL for glucose predicted mortality with 83.3% sensitivity and specificity. Scoring systems such as LRINEC and CUPI also demonstrated predictive utility, but glucose was found to be a simpler, faster marker. Among inflammatory markers, Neutrophil-Lymphocyte Ratio (NLR) was significant (p=0.016) with a cut-off of 14.04, showing 83.3% sensitivity and 76.7% specificity.
CONCLUSION: FG is a rapidly progressing disease requiring early diagnosis and multidisciplinary management. While scoring systems and inflammatory markers are valuable for predicting mortality, blood glucose level stands out as a simple, rapid, and effective predictor. Ensuring blood sugar regulation can significantly improve prognosis and survival in FG patients, underscoring the need for immediate attention to glucose levels in clinical practice.

Cervical gunshot injuries, although rare, carry a significant risk of vertebral artery injuries (VAIs), which can lead to complex neurological and vascular complications. Effective management requires individualized strategies tailored to the clinical presentation and associated injuries. This study presents three cases of civilian cervical gunshot wounds involving VAIs and reviews the literature to highlight optimal management approaches. Three male patients, aged 24, 41, and 44, presented with cervical gunshot wounds and varying degrees of spinal cord and vertebral artery injuries. Two patients were managed conservatively with close monitoring, broad-spectrum antibiotics, and supportive care due to the absence of progressive neurological deficits or active bleeding. The third patient underwent emergency surgical decompression and vertebral artery clipping to control massive hemorrhage and prevent further neurological deterioration. Where feasible, endovascular treatment was prioritized due to its lower complication rates compared to open surgery. Follow-up revealed diverse outcomes, ranging from paraplegia to quadriparesis, highlighting the variable presentations and long-term consequences associated with these injuries. The third patient developed a delayed arteriovenous fistula (AVF) two years post-injury, which was successfully treated with endovascular embolization. Civilian cervical gunshot injuries involving the vertebral artery require individualized treatment plans. Conservative management may be appropriate for clinically stable cases, while surgical or endovascular interventions are crucial for managing vascular instability or progressive neurological deficits. Long-term follow-up is essential to detect and address delayed complications such as pseudoaneurysms or AVFs. This case series underscores the importance of a multidisciplinary approach, involving neurosurgery, vascular surgery, otolaryngology, and interventional radiology, to optimize outcomes and deliver comprehensive care.

Pseudoaneurysms of the extracranial arterial system are rare, largely due to the small size and thin walls of superficial vessels. This report presents a case of a pseudoaneurysm of the superficial temporal artery (STA) following dog bites in a 4-year-old child, an injury sustained three months prior. The lesion was initially misdiagnosed as an abscess, possibly involving an occult foreign body, and was unsuccessfully drained in the Emergency Department (ED). Physical examination revealed a palpable mass measuring 21 × 18 × 12 mm in the left frontotemporal region above the eyebrow. There were no signs of local inflammation or fluctuation. The child’s facial expressions and eyebrow movements were normal, and laboratory tests were within normal limits. Doppler ultrasound demonstrated a partially thrombosed pseudoaneurysm with a well-defined swirl pattern, known as the “yin and yang” sign. The patient was admitted for surgery, and the frontal branch of the superficial temporal artery was dissected to the neck of the pseudoaneurysm after debride-ment and removal of blood clots. A pseudoaneurysm measuring approximately 1 cm in diameter was observed on the deep side of the lesion, extending up to the eyebrow. The affected artery was ligated using a segmental running locking suture and then excised. Postoperatively, the patient was transferred to the clinic in stable condition without complications. Pathological analysis revealed that the tumor wall consisted of a mixed thrombus with signs of organization. The patient experienced no complications during follow-up. It is of utmost importance to obtain a comprehensive clinical history, conduct a meticulous physical examination, and perform detailed imaging studies, including ultrasound, to avoid overlooking critical pathologies in emergency situations. Such measures are essential for early detection and management of underlying medical conditions, thereby preventing further complications and improving the overall prognosis.

Pneumomediastinum is a rare but potentially serious complication characterized by the presence of air within mediastinal structures. Although it is typically associated with thoracic trauma or vigorous coughing, it can also occur following dental procedures involving high-speed air-turbine drills. During these procedures, air can enter the cervical fascial planes and potentially extend to the mediastinum, leading to risks like deep neck infections or mediastinitis.
This report presents the case of a 38-year-old woman who developed cervical emphysema and pneumomediastinum on the same day following endodontic treatment. Computed tomography (CT) imaging demonstrated air densities extending from the submandibular region to the mediastinum. There was no evidence of pneumothorax, pleural effusion, or pericardial effusion. The patient was managed conservatively with oxygen therapy and intravenous antibiotics, resulting in complete recovery within one week.
This case highlights the importance of recognizing pneumomediastinum in patients presenting with neck swelling and subcutaneous crepitus following dental procedures. Since it can be mistaken for postoperative edema, infection, or allergic reactions, early CT imaging is crucial for accurate diagnosis and timely intervention. Awareness of this rare complication among healthcare professionals plays a critical role in ensuring early detection and effective patient management.