BACKGROUND: Despite several studies indicating the efficacy of different molecules in preventing ischemia/reperfusion (I/R) damage, the most effective treatment remains unknown.
METHODS: This study included 28 male Sprague rats, which were randomly assigned to four equal groups, with seven rats in each group: Group S (Sham), Group C (Control), Group E (Ethanol), and Group T (Triazole). The superior mesenteric arteries of rats in all groups except Group S were exposed and closed with a vascular clamp, and ischemia was induced for one hour. Oxidative stress parameters, ischemia markers, and biochemical tests indicating organ function were examined.
RESULTS: The mean total antioxidant status (TAS) value of Group T was significantly higher than those of Groups C and E, while being significantly lower than that of Group S (p=0.001). The mean total oxidant status (TOS) value of Group T was significantly lower than those of Groups C and E and significantly higher than that of Group S (p<0.001). Although the mean oxidative stress index (OSI) value of Group T was markedly lower than those of Groups C and E, no statistically significant difference was observed compared to Group S (p=0.002, p<0.001, and p=0.721, respectively). The mean ischemia-modified albumin (IMA) value of Group T was significantly lower than those of Groups C and E and significantly higher than that of Group S (p<0.001). The mean malondialdehyde (MDA) value of Group T was significantly lower than those of Groups C and E and significantly higher than that of Group S (p<0.001).
CONCLUSION: This study represents the first investigation into the effect of a 1,2,3-triazole compound derived from salicylalde-hyde on ischemia/reperfusion injury. The findings provide strong evidence that the 1,2,3-triazole compound significantly enhances the prevention or treatment of experimental I/R injury. We conclude that this triazole derivative may represent a viable therapeutic option for the treatment and prevention of I/R injury, supported by further experimental and clinical research. The triazole is expected to exhibit enhanced protective properties, particularly when solubilized using alternative methods.

BACKGROUND: Ischemia-reperfusion (IR) injury significantly reduces erythrocyte deformability, leading to increased oxidative stress, inflammation, and impaired microvascular perfusion. This study aimed to examine the protective effects of hydroxytyrosol (HT), a powerful antioxidant derived from olives, on erythrocyte deformability and related oxidative stress markers in a rat model of hind limb ischemia-reperfusion injury.
METHODS: Twenty-four rats were randomly divided into four groups: Sham, HT-Sham, ischemia-reperfusion (IR), and IR treated with HT (IR-HT). HT was administered intraperitoneally at a dose of 10 mg/kg prior to ischemia induction. Following reperfusion, biochemical parameters, including malondialdehyde (MDA), superoxide dismutase (SOD), endothelial nitric oxide synthase (eNOS), erythrocyte deformability, and morphology, were evaluated.
RESULTS: HT administration significantly improved erythrocyte deformability, decreased MDA levels, increased SOD activity, and moderated eNOS expression in the IR-HT group compared to the untreated IR group (p<0.001). Morphological analysis demonstrated substantial preservation of erythrocyte integrity, with fewer pathological changes such as echinocytes and dacrocytes.
CONCLUSION: This study provides preliminary insights into the protective mechanisms of HT, highlighting its therapeutic potential in reducing erythrocyte dysfunction and oxidative damage during ischemia-reperfusion events. Further research exploring comprehensive signaling pathways and long-term clinical outcomes is advisable..

BACKGROUND: Acute appendicitis is the most common diagnosis considered in patients presenting to the emergency department with right lower quadrant pain. However, atypical presentations often lead to unnecessary surgeries and increased healthcare costs. This study aimed to improve diagnostic accuracy in acute appendicitis using a hybrid machine learning (ML) model.
METHODS: A retrospective analysis was performed on 395 patients who underwent appendectomy for suspected acute appendicitis between 2020 and 2024 at Ankara University Faculty of Medicine, Department of General Surgery. Demographic, clinical, laboratory, and radiological variables were collected. ML algorithms, including NaiveBayes, MultilayerPerceptron, IBk, AdaBoost, RandomForest, and a hybrid model combining NaiveBayes, AdaBoost, and RandomForest, were applied. The dataset was evaluated using 10-fold cross-validation, repeated 1,000 times. Accuracy, F-measure, Matthews Correlation Coefficient (MCC), receiver operating characteristic (ROC) area, and precision-recall curve (PRC) area were used as performance criteria.
RESULTS: Among the 395 patients, 52.9% were male, with a mean age of 37.3±15.6 years. Histopathological examination confirmed acute appendicitis in 341 (86.3%) patients and negative appendectomy in 54 (13.7%) patients. The diagnostic accuracy of the Alvarado score at a cut-off value of ≥6 was 79.0%. Among the ML algorithms, the hybrid model achieved the best performance, with 92.9% accuracy, 93% F-measure, 70.4% MCC, 90.8% ROC area, and 93.4% PRC area. This model correctly predicted 95.6% of acute appendicitis cases and 75.9% of negative appendectomy cases.
CONCLUSION: The hybrid ML model demonstrated superior diagnostic accuracy compared to the Alvarado score for acute appendicitis. Integration of such models into clinical practice could reduce negative appendectomy rates and enhance patient management by enabling faster and more reliable diagnosis.

BACKGROUND: Acute calculous cholecystitis (ACC) is one of the most common conditions encountered in emergency medicine and surgical practice. Delayed recognition of severe cases can lead to complications such as empyema, gangrene, or perforation, resulting in high morbidity and mortality. While the Tokyo Guidelines provide standardized diagnostic and severity grading criteria, the availability and reliability of imaging may be limited in certain settings. Therefore, there is growing interest in simple and cost-effective biomarkers. This study aimed to evaluate the diagnostic and prognostic value of complete blood count-derived (CBC-derived) systemic inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte × platelet ratio (NLPR), systemic immune-inflammation index (SII), and multiple inflammatory index (MII), in predicting disease severity in patients with ACC.
METHODS: A total of 160 patients diagnosed with ACC in the emergency department between January 2020 and May 2024 were retrospectively analyzed. Patients with acalculous cholecystitis, cholangitis, choledocholithiasis, incomplete data, or age younger than 18 years were excluded. Demographic, clinical, and laboratory findings were reviewed. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values.
RESULTS: The strongest predictive performance was observed for MII (cut-off=250,011; sensitivity 76.9%; specificity 78.9%; area under the curve [AUC]=0.770). NLR (cut-off=8.45) showed 76.9% sensitivity and 68.0% specificity (AUC=0.755). NLPR (cut-off=0.027) had 76.9% sensitivity and 54.4% specificity, while SII (cut-off=2414) achieved 69.2% sensitivity and 72.1% specificity (all p<0.05). All indices were significant predictors of severe ACC.
CONCLUSION: CBC-derived systemic inflammatory indices, particularly MII and NLR, are effective, accessible, and inexpensive markers for predicting the severity of ACC. These parameters may complement clinical assessment and assist in decision-making, especially in situations where imaging is unavailable or inconclusive.

BACKGROUND: To assess the diagnostic value of the C-reactive protein to lymphocyte ratio (CLR) and other inflammatory markers in distinguishing complicated from uncomplicated acute appendicitis (AA) to support timely surgical intervention.
METHODS: This retrospective study included 682 patients who underwent appendectomy between January 2018 and January 2021. Based on the histopathological American Association for the Surgery of Trauma (AAST) AA grading system, patients were classified as complicated AA (grades 3–5; n=144) or uncomplicated AA (grades 1–2; n=538). Preoperative laboratory values—white blood cell (WBC) count, neutrophil count, C-reactive protein (CRP), sodium (Na), CLR, neutrophil-to-lymphocyte ratio (NLR), and CRP/Na—were analyzed. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis.
RESULTS: Complicated AA cases were significantly older (37.5±17.6 vs. 30.0±12.8 years; p<0.001). CRP (7.17±6.78 vs. 2.98±4.52 mg/dL), WBC, neutrophils, and CLR (5.66±9.13 vs. 1.89±3.94) were significantly elevated in the complicated group (p<0.001). CLR showed moderate diagnostic accuracy (AUC=0.712), with a cutoff of ≥2.82 yielding 53.5% sensitivity and 82.7% specificity (OR=5.49, 95% CI: 3.69–8.16). Hyponatremia and elevated NLR/PLR also correlated with complications.
CONCLUSION: CLR is a moderately accurate, highly specific, and accessible biomarker for identifying complicated AA. Its integration with clinical evaluation may enhance preoperative risk stratification, especially in resource-limited settings.

BACKGROUND: This study aims to evaluate the predictive value of the blood urea nitrogen (BUN)/albumin ratio for in-hospital mortality in pediatric burn patients with a total body surface area (TBSA) of 20% or greater and to compare its performance with established scoring systems, namely the Abbreviated Burn Severity Index (ABSI) and the Pediatric Baux Score (P-Baux).
METHODS: Patients hospitalized with burns involving 20% or greater TBSA in our pediatric burn unit between 2018 and 2023 were reviewed retrospectively. Patients were analyzed for demographic information, basic clinical data, cause of burn, operative interventions, ABSI and P-Baux scores and the follow-up period. The BUN/albumin ratio was calculated using BUN and albumin values measured at the time of index hospital admission. Data were evaluated for in-hospital mortality.
RESULTS: A total of 212 patients were included in the study. Patients were divided into two groups: survivors and non-survivors. The non-survivor group had significantly higher TBSA involvement, full-thickness burns, inhalation injuries, and operative requirements (p<0.001). The overall mortality rate was 4.5%. Receiver operating characteristic (ROC) analysis demonstrated that the BUN/albumin ratio is a strong predictor of in-hospital mortality, with predictive power similar to that of the ABSI and P-Baux scores. The cut-off value for mortality prediction using the BUN/albumin ratio was >5.24.
CONCLUSION: The BUN/albumin ratio is a simple and easily accessible marker that demonstrates strong statistical value in predicting in-hospital mortality in pediatric patients with burns covering 20% or more of the body. Given its availability from routine blood tests, we believe it may serve as a practical and helpful tool for clinicians caring for pediatric burn patients.

BACKGROUND: Traumatic brain injury (TBI) is a major cause of trauma-related morbidity and mortality worldwide. Early identification of patients at risk of clinical deterioration is essential for optimizing emergency management. The Modified Early Warning Score (MEWS) and the reverse Shock Index multiplied by the Glasgow Coma Scale (rSIG) are simple, rapidly calculable tools that may assist clinicians in early prognostic assessment. This study aimed to evaluate the prognostic performance of MEWS and rSIG in predicting poor outcomes among patients with isolated head trauma.
METHODS: This retrospective observational study included patients presenting to the emergency department of Manisa Celal Bayar University Hospital between June 2021 and June 2024 with isolated head trauma. Demographic, clinical, and laboratory data were retrieved from the hospital information system. MEWS, Shock Index (SI), reverse Shock Index (rSI), and rSIG values were calculated for each patient. Group comparisons were performed using nonparametric tests. Correlations were analyzed using Spearman coefficients. Receiver operating characteristic (ROC) curves were constructed to assess discriminative power, and binary logistic regression was used to identify independent predictors of poor outcomes, defined as intensive care unit admission and/or in-hospital mortality.
RESULTS: A total of 705 patients (65.7% male; mean age 37.2±27.0 years) were analyzed. Pathological cranial CT findings were present in 24.7%, and the overall mortality rate was 2.7%. Patients with poor outcomes exhibited significantly higher MEWS and SI values, whereas GCS, rSI, and rSIG were markedly lower (all p <0.001). ROC analysis showed moderate predictive ability for rSIG (AUC=0.701) and limited discriminative power for MEWS (AUC=0.610), with optimal cut-offs of ≤21.35 and ≥0.5, respectively. In multivariate analyses, MEWS and rSIG demonstrated independent prognostic significance for poor outcomes in separate models, with rSIG remaining significant in models excluding GCS. MEWS correlated positively with hospital stay (r=0.385, p<0.001), while rSIG showed a negative correlation (r=–0.252, p<0.001).
CONCLUSION: MEWS and rSIG are practical bedside tools that may support early risk stratification in patients with isolated head trauma. MEWS reflects early physiological deterioration, while rSIG provides complementary hemodynamic–neurological information and should be interpreted as an adjunct rather than a standalone triage instrument. Routine use of these scores may support early clinical decision-making and patient monitoring in the emergency setting when interpreted as adjuncts to standard clinical assessment.

BACKGROUND: In the evaluation of forensic cases, misinterpretations of radiological imaging can directly affect not only patients’ diagnostic and therapeutic processes but also judicial proceedings. This retrospective study aimed to investigate the impact of radiological re-evaluations on forensic report outcomes.
METHODS: Between July 2023 and March 2025, a total of 365 forensic cases that underwent radiological evaluation were retrospectively reviewed. For radiological examinations performed in the emergency department (plain radiography or computed tomography), interpretations made by our radiology specialist and the corresponding forensic reports were reviewed retrospectively. X-ray images requested in the emergency department that lacked a radiologist report and were evaluated by emergency physicians were subsequently interpreted by our radiology specialist; this cohort was defined as an "X-ray interpretation" group. Computed tomography (CT) images requested in the emergency department that were initially reported via teleradiology were subsequently reinterpreted by our radiology specialist; this cohort was defined as the "CT interpretation" group.
RESULTS: Following interpretations performed by our radiologist, changes in the conclusion section of forensic reports were observed in 35.3% of cases. The rate of changes in forensic report conclusions was statistically significantly higher in the "CT interpretation" group (47.8%) than in the "X-ray interpretation" group (34.2%). The likelihood of modifications in forensic report outcomes was significantly greater in cases involving three or more injury sites. The most frequent cause of error was the misinterpretation of bone fractures (84.5%), predominantly affecting the craniofacial and upper extremity regions. In fracture assessment, false-positive findings were more commonly identified on plain radiographs (73.8%), whereas false-negative findings were more frequently encountered on computed tomography scans (59.5%).
CONCLUSION: These findings demonstrate that radiological misinterpretations, particularly in the assessment of bone fractures, can significantly influence forensic report outcomes and, consequently, judicial processes. This study underscores the necessity of involving trauma-experienced radiologists in forensic imaging and highlights the importance of effective interdisciplinary collaboration between radiology and forensic medicine.

BACKGROUND: The aim of this study was to present our institutional experience with periprocedural management of emergency cesarean section (CS) operations and maternal and fetal cardiac complications in pregnant women with pulmonary hypertension (PH).
METHODS: Thirteen patients who were diagnosed with PH during pregnancy and/or prior to pregnancy according to European Society of Cardiology (ESC) criteria, and who were referred to our hospital with a decision for emergency CS from an external center, were included in the study. For patients who underwent urgent surgery, the following data were recorded: demographic characteristics, time of diagnosis, treatments for pulmonary hypertension used before pregnancy, during pregnancy, and/or after CS, arterial blood gas values, pulmonary and systemic pressure values after induction and at the 12th postoperative hour, extracorporeal membrane oxygenation (ECMO) requirements, time to extubation, length of intensive care stay, and mortality rates.
RESULTS: Eight of the 13 patients were diagnosed with idiopathic pulmonary arterial hypertension (IPAH). The mean systolic systemic arterial pressure (BPs), systolic pulmonary arterial pressure (PAPs), and mean pulmonary arterial pressure were 130±14.2 mmHg, 93±28 mmHg, and 52±17 mmHg, respectively. Six of the 13 patients required ECMO support. The one-month mortality rate was 46%.
CONCLUSION: Pregnancy in women with PH is associated with significant maternal morbidity and mortality. If the underlying etiology is IPAH, the risk of mortality is higher than in other forms of PH. Mechanical circulatory support devices, including ECMO, may serve as a temporary bridge to lung transplantation in selected cases. Therefore, early diagnosis of IPAH, timely referral of patients to specialized centers, and planning of these operations by a multidisciplinary team consisting of cardiologists, gynecologists, and cardiac anesthesiologists are necessary.

BACKGROUND: Motorcycle accidents represent a significant public health and forensic medicine issue due to their high morbidity and mortality rates. This study aimed to evaluate the demographic, clinical, and forensic characteristics of motorcycle accidents.
METHODS: A retrospective analysis was conducted on 2,445 motorcycle accident cases referred to the Department of Forensic Medicine at Eskiþehir Osmangazi University Faculty of Medicine for forensic evaluation between 2020 and 2024. Demographic data, accident characteristics, helmet and alcohol use, injury patterns, Injury Severity Score (ISS) values, and forensic report classifications according to Turkish Penal Code (TCK) No. 5237 were analyzed.
RESULTS: Of these cases, 91.7% were male, with an average age of 31.8 years; the most commonly affected age group was 20–29 years. Most accidents occurred within city limits (68.1%), and the most frequent accident mechanism was collision with another vehicle (59.8%). Helmet use was reported in 36.0% of cases, while 47.0% were not wearing a helmet at the time of the accident. The most common injuries involved the lower (44.4%) and upper extremities (38.7%). Fractures most frequently affected the tibia/fibula, wrist-hand bones, and ribs. The average ISS was 9.1±4.8; injuries were classified as mild in 59.3% of cases, moderate in 30.0%, and severe in 10.7%. According to the TCK, 66.0% of injuries were classified as “treatable with simple medical intervention.”
CONCLUSION: Motorcycle accidents are particularly common among young men, and helmet use remains low. Injuries predominantly affect the extremities, and forensic classification based on the TCK provides a distinctive contribution to forensic medicine practice. Increasing the use of protective equipment, preventing driving under the influence of alcohol, and strengthening traffic safety measures are essential.

BACKGROUND: To investigate the prevalence and anatomical distribution of radiologically detected arterial calcification in the abdominal, iliac, and femoral arteries among patients aged ≥65 years undergoing surgical treatment for hip fracture, and to assess the impact of both the presence and localization of arterial calcification on patient survival.
METHODS: A retrospective analysis was performed on 270 patients who underwent surgical treatment for hip fractures between 2015 and 2024. The presence of arterial calcifications in the abdominal aorta, iliac arteries, and femoral arteries was assessed on plain radiographs, and their association with patient survival outcomes was investigated. In addition, demographic characteristics, fracture type, treatment modality, and intensive care unit admissions were systematically evaluated.
RESULTS: Arterial calcification was identified in 211 patients (78.1%). The mean survival time was significantly shorter in patients with arterial calcification (47.3 months, 95% CI: 40.7–53.8) compared with those without (76.9 months, 95% CI: 67.1–86.7) (Log-rank χ²=17.23, p<0.001). Log-rank analysis further demonstrated statistically significant differences in survival between patients with and without calcification of the abdominal aorta (χ²=21.39, p<0.001), iliac arteries (χ²=18.21, p<0.001), and femoral arteries (χ²=10.91, p=0.001). Cox regression analysis identified abdominal aortic calcification as an independent predictor of mortality in geriatric hip fracture patients (HR=3.43, 95% CI: 1.31–8.96, p=0.013), whereas iliac artery calcification (HR=1.53, p=0.284) and femoral artery calcification (HR=1.05, p=0.859) were not independently associated with survival after adjustment.
CONCLUSION: Iliac and femoral artery calcifications should not be regarded as independent predictors of mortality in geriatric patients with hip fractures. In contrast, abdominal aortic calcification has been identified as an independent prognostic determinant of mortality within this patient population.

BACKGROUND: This study evaluates the clinical and functional outcomes of intramedullary nailing without grafting for the treatment of aseptic humeral shaft nonunion.
METHODS: Between January 2017 and January 2024, 14 patients treated at a single center for humeral shaft fractures diagnosed with nonunion and managed with intramedullary nailing without grafting were retrospectively analyzed. Demographic and clinical characteristics, union status, and preoperative and postoperative range of motion, Visual Analog Scale (VAS), QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand), and Constant-Murley scores were recorded.
RESULTS: The study included 14 patients (nine women, five men) with a mean age of 49.2±17.5 years (range: 26–80). Nonunion types were oligotrophic in 64.3% (n=9), atrophic in 28.6% (n=4), and hypertrophic in 7.1% (n=1) of cases. The union rate after intramedullary nailing without grafting was 78.5% (11/14). Two patients who did not achieve union underwent nail exchange with iliac autografting, resulting in a total union rate of 92.9% (13/14). The mean time to union was 4.3±2.8 months (range: 2–12). The mean preoperative and postoperative QuickDASH scores were 89.4±6.2 and 17.5±13.3, respectively, while the Visual Analog Scale scores were 7.7±1.1 and 1.7±1.1, respectively (p<0.001). Of the three patients who failed to achieve union after initial treatment, two had atrophic nonunion and one had oligotrophic nonunion. A statistically significant association was observed between nonunion type and the need for revision surgery (p<0.01), with atrophic nonunions being significantly more frequent in patients requiring revision. One patient developed adhesive capsulitis, and another patient who underwent revision experienced transient radial nerve palsy with complete functional recovery. Proximal screw loosening was observed in two patients and was recorded as a minor complication.
CONCLUSION: Intramedullary nailing without grafting is an effective and safe treatment option for aseptic humeral shaft nonunion in selected patients, particularly those previously treated conservatively. However, omission of grafting in cases of atrophic nonunion or during nail exchange procedures may negatively affect healing.

BACKGROUND: To evaluate the anatomical and functional outcomes of pars plana vitrectomy (PPV) combined with prophylactic chorioretinectomy (CR) in patients with deadly weapon-related open globe injuries (DWOGIs).
METHODS: Medical records of patients who underwent PPV and prophylactic CR for open globe injuries (OGIs) caused by deadly weapons between November 2016 and October 2024 were retrospectively reviewed. Demographic characteristics, injury type, cause of injury, zone of injury, intraocular foreign body (IOFB) exit/impact site, best-corrected visual acuity (BCVA), proliferative vitreoretinopathy (PVR) rates, anatomical success, and globe survival were evaluated.
RESULTS: Of a total of 283 OGIs, 41 eyes from 35 patients who underwent PPV with prophylactic CR for deadly weapon-related trauma were included in the analysis. The mean age was 30.9±9.4 years, and 88.6% of the patients were male. Perforating injuries were observed in 38 eyes (92.7%), and penetrating injuries associated with an IOFB in 3 eyes (7.3%). The causes of injury included improvised explosive devices in 20 eyes (48.8%), hand grenades in 11 eyes (26.8%), landmines in 8 eyes (19.5%), and rocket-propelled grenades in 2 eyes (4.9%). The IOFB exit/impact site was located in the posterior pole in 38 eyes (92.7%), of which 22 (53.6%) were outside the vascular arcades, 12 (29.3%) within the vascular arcades, and 4 (9.7%) adjacent to the optic disc. The mean initial BCVA was 2.62±0.98 logMAR, with 90.2% of eyes presenting between light perception and counting fingers. PPV was performed at a mean of 5.9±2.7 days after primary repair. Of these eyes, 43.9% had retinal detachment. The mean number of PPV procedures was 2.6±1.1. C3F8 gas endotamponade was used in 51.2% of cases. At a mean follow-up of 32.8±16.6 months, the final BCVA improved significantly to 1.18±1.20 logMAR (p<0.001), with 68.3% achieving ≥20/200 vision. At final follow-up, the rates of PVR, anatomical success, and globe survival were 14.6% (6/41), 85.4% (35/41), and 87.8% (36/41), respectively.
CONCLUSION: Pars plana vitrectomy combined with prophylactic CR appears to be an effective treatment option for DWOGIs, offering prevention of PVR development and achieving high anatomical success, favorable globe survival, and meaningful visual improvement despite severe ocular trauma.

Uncontrolled hemorrhagic shock due to trauma is a life-threatening condition requiring rapid intervention. Every minute in the man-agement of these patients is valuable. In recent years, resuscitative endovascular aortic balloon occlusion (REBOA) has emerged as a valuable tool in emergency and trauma practice, providing additional time for the patient, particularly in cases where surgical hemosta-sis is delayed. A 62-year-old male patient with no known comorbidities was transported to our tertiary trauma center after receiving five minutes of cardiopulmonary resuscitation (CPR) and intubation at an external facility following a high-energy traffic accident. Upon presentation, the patient's blood pressure was 50/20 mmHg and pulse rate was 128 beats/min. He had extensive pelvic trauma, lower extremity trauma, major soft tissue loss, and vascular and bone injuries. He underwent hemostatic resuscitation along with whole-body computed tomography (CT) imaging; however, cardiac arrest recurred after imaging. During CPR, simultaneous imaging studies revealed no trauma or bleeding in the brain or thorax. REBOA was planned for the patient. Temporary return of spontaneous circula-tion (ROSC) was achieved 38 minutes after REBOA. During this period, the patient received a total of six units of packed red blood cells, three units of fresh frozen plasma, two units of cryoprecipitate, and calcium replacement. The REBOA procedure was performed by emergency physicians and cardiovascular surgeons who had received hands-on training using a REBOA simulation model developed by our team. However, despite achieving a temporary hemodynamic response, the patient could not be stabilized for surgical interven-tion and was pronounced deceased. In this case, we share the first REBOA experience of emergency department physicians trained with a locally produced simulation model. We believe that simulation-based training will contribute to physician experience and direct field application in rare or rapidly evolving emergencies.

Although laparoscopic cholecystectomy (LC) is considered the gold standard treatment for symptomatic gallstone disease, iatrogenic bile duct injury remains a rare but serious complication. We present a case of a Strasberg type D bile duct injury that was diagnosed intraoperatively and successfully managed with endoscopic retrograde cholangiopancreatography (ERCP) during the same session, and we discuss it in light of the current literature. A 46-year-old female patient underwent LC for a hydropic and edematous gallbladder. During difficult dissection, a bile leak was observed from the posterior wall of the common hepatic duct, consistent with a Strasberg type D injury. The endoscopy team was consulted intraoperatively, and ERCP was performed. Cholangiography confirmed the leak, and a plastic stent was placed from the common hepatic duct to the ampulla. The operation was completed with drainage of the subhe-patic area. Postoperatively, the patient remained clinically stable. At the sixth postoperative week, follow-up ERCP revealed complete healing with no evidence of leakage, and the stent was removed. The patient had an uneventful recovery, with normal biochemical parameters on follow-up. Early recognition of iatrogenic bile duct injury is the most critical factor influencing prognosis. The literature reports intraoperative detection rates between 25% and 32%, whereas delayed diagnosis is associated with higher morbidity, additional surgical interventions, and prolonged hospital stay. Endoscopic management, particularly in Strasberg type C and type D injuries where ductal continuity is preserved, has shown high success rates (89–96%) and represents a reliable alternative to surgery. This case high-lights that multidisciplinary collaboration and intraoperative endoscopic intervention provide a minimally invasive and effective option for the management of bile duct injuries during LC.

Intradural migration of a bullet within the spinal canal represents an exceptionally uncommon clinical scenario and carries the potential for progressive or delayed neurological decline. Although such fragments may initially remain silent, their subsequent movement within the spinal canal can create significant diagnostic and therapeutic challenges. In this report, we present an unusual and instructive case of cauda equina syndrome that developed secondary to the delayed caudal migration of an intradural bullet fragment. We further provide a detailed discussion of the diagnostic evaluation, surgical management, and clinical decision-making considerations associated with this condition. A 32-year-old male patient sustained a gunshot injury in 2022. Initial imaging demonstrated that the bullet had penetrated the spinal canal and become lodged intradurally at the L1-L2 level, although the patient exhibited no neurological deficits at that time. He was, therefore, managed conservatively with routine follow-up. Approximately 2.5 years later, the patient presented with the sudden onset of bilateral lower extremity weakness, progressive gait impairment, and new-onset urinary incontinence. Computed tomography revealed that the intradural bullet fragment had migrated caudally to the S2 vertebral level, resulting in significant compres-sion of the cauda equina nerve roots. Urgent surgical intervention was undertaken, consisting of a partial bilateral laminectomy at the S1-S2 level and microsurgical extraction of the bullet. Postoperative neurological recovery was substantial, with marked improvement in motor function and complete resolution of urinary symptoms. Although intradural bullet fragments may initially appear clinically insignificant in patients who present without neurological deficits, delayed migration poses a serious risk for the development of cauda equina syndrome and other potentially irreversible complications. This case highlights the importance of maintaining a high index of suspicion and considering early prophylactic surgical extraction when intradural localization is identified, even in neurologically intact individuals. Early intervention may prevent severe late complications such as neurological deterioration, infectious sequelae arising from contaminated missile tracts, and possible lead toxicity related to chronic intradural exposure.