ROUND: This study aimed to evaluate the effects of silibinin, a compound with demonstrated therapeutic effects in various liver diseases, on liver healing in a rat model of blunt liver trauma.
METHODS: Twenty-four Wistar albino rats weighing 250–300 g were randomly assigned to three equal groups. Group I served as the control group (CG) and received standard nutrition without trauma induction. Under general anesthesia, rats in Groups II and III underwent a blunt trauma procedure applied to the right upper abdominal quadrant. Group II, designated as the trauma group (TG), received standard nutrition only. Group III, designated as the trauma-silibinin group (T-SG), received silibinin at a dose of 100 mg/kg/day via gastric gavage for five days in addition to standard nutrition. Following the five-day observation period, blood samples were collected from inferior vena cava. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were measured in the collected blood specimens. Histopathological examination of liver tissue was performed to assess the degree of inflammation.
RESULTS: Mean AST and ALT levels differed significantly among the groups (p<0.001). Although no statistically significant difference was observed in inflammation scores between the TG and T-SG groups (p=0.115), inflammation scores tended to be higher in the TG, with a moderate effect size (r=0.41). Furthermore, the risk of a high injury score was 11.7 times greater in the TG than in the T-SG.
CONCLUSION: To our knowledge, this is the priority study to evaluate the effects of silibinin in a rat model of blunt liver trauma. Silibinin may represent a promising therapeutic agent for reducing inflammation following liver trauma and promoting liver healing.

BACKGROUND: Skeletal muscle ischemia–reperfusion (I/R) injury is a complex pathological process characterized by excessive reactive oxygen species production, activation of inflammatory cascades, and apoptosis, ultimately resulting in substantial structural and functional tissue damage. Hydroxytyrosol (HT), a naturally occurring phenolic compound predominantly in olive-derived products, exhibits potent antioxidant and anti-inflammatory properties. This study aimed to comprehensively evaluate the potential protective effects of HT against lower-extremity skeletal muscle I/R injury in an experimental rat model.
METHODS: Twenty-four adult Wistar albino rats were randomly assigned to four experimental groups: Sham, HT-Control, I/R, and HT+I/R. Hind-limb ischemia was induced for two hours, followed by two hours of reperfusion. In the treatment group, HT (10 mg/kg, intraperitoneally) was administered 30 minutes before ischemia induction. Serum oxidative stress parameters, including total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI), were measured. Skeletal muscle tissues were evaluated histopathologically, and interleukin-1β (IL-1β) levels, caspase-3 expression, and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL)-positive apoptotic cells were assessed.
RESULTS: Compared with the Sham group, the untreated I/R group exhibited significantly higher TOS and OSI levels, increased histopathological injury scores, marked inflammatory cell infiltration, and enhanced apoptotic activity (p<0.05). HT administration significantly attenuated oxidative stress, reduced inflammatory responses, decreased tissue injury severity, and lowered apoptotic indices compared with the I/R group (p<0.05).
CONCLUSION: Hydroxytyrosol exerted significant protective effects against skeletal muscle I/R injury by attenuating oxidative stress, suppressing inflammatory mediators, and reducing apoptosis. These findings highlight the therapeutic potential of HT as a promising adjunctive strategy in the prevention and management of ischemia–reperfusion-induced tissue damage.

BACKGROUND: Burns are a leading cause of accident-related mortality, following motor vehicle accidents and drowning. Burn wound healing is influenced by several factors, including the degree, depth, and cause of the burn. This study aimed to compare and evaluate the effects of 1% silver sulfadiazine, 0.2% nitrofurazone, propolis vehicle, 10% water-soluble propolis, and 15% water-soluble propolis on partial-thickness burn wound healing using histopathological assessment.
METHODS: In this randomized controlled experimental study, rats were randomly assigned to six groups: control, silver sulfadiazine, nitrofurazone, propolis vehicle, 10% water-soluble propolis, and 15% water-soluble propolis. The animals were anesthetized before burn induction. Four contact burns were created on each rat, and wound areas were measured and recorded. Tissue samples were collected from the wound sites for histopathological examination.
RESULTS: Rats treated with 15% water-soluble propolis had significantly smaller wound areas on days 7 (p=0.019 and p=0.047), 14 (p=0.01 and p=0.033), and 21 (p=0.00 and p=0.040) compared with the control and propolis vehicle groups, respectively. Histopathological evaluation on day 14 revealed differences favoring the propolis-treated groups in terms of fibroblast proliferation, collagen deposition, fibrosis, and mononuclear cell infiltration (p=0.017).
CONCLUSION: The application of water-soluble propolis to burn wounds in rats appears to promote wound healing.

BACKGROUND: Intestinal ischemia requiring bowel resection is a serious complication of mechanical intestinal obstruction, and early identification of patients with irreversible ischemic injury remains challenging. Albumin-based immunonutritional indices, including the C-reactive protein–albumin–lymphocyte (CALLY) index, Prognostic Nutritional Index (PNI), and modified Glasgow Prognostic Score (mGPS), may reflect systemic inflammation, nutritional reserve, and immune status. This study aimed to evaluate the prognostic value of these indices for predicting bowel resection due to irreversible ischemic injury in patients undergoing surgery for non-malignant mechanical intestinal obstruction.
METHODS: We retrospectively analyzed data from 680 adult patients admitted with mechanical intestinal obstruction between January 2017 and July 2025. After excluding patients with malignancy-related obstruction, 464 patients with non-malignant mechanical intestinal obstruction were included in the final analysis. Patients were categorized according to bowel resection status. Demographic characteristics, laboratory parameters, inflammatory and immunonutritional indices, and clinical outcomes were recorded. Separate preoperative multivariate logistic regression models were constructed to avoid mathematical overlap and multicollinearity among related indices. Diagnostic performance was assessed using receiver operating characteristic curve analysis.
RESULTS: The final cohort comprised 300 patients who did not undergo bowel resection and 164 who required bowel resection. Patients in the resection group exhibited higher inflammatory marker levels and lower nutritional and immune-related indices. In the conventional preoperative model, C-reactive protein (CRP) was positively associated with bowel resection, whereas albumin level and lymphocyte count were inversely associated with this outcome. In separate index-based models, a CALLY index ≤2.77, lower PNI values, and an mGPS of 2 were independently associated with bowel resection. The CALLY index demonstrated moderate discriminatory performance with an area under the curve (AUC) of 0.744. However, pairwise AUC comparisons revealed no significant discriminatory advantage of the CALLY index over PNI or the C-reactive protein–albumin ratio (CAR).
CONCLUSION: Preoperative inflammatory and immunonutritional markers were associated with bowel resection due to irreversible ischemic injury in patients with non-malignant mechanical intestinal obstruction. The CALLY index was independently associated with bowel resection and demonstrated moderate discriminatory performance; however, it was not superior to PNI or CAR. These indices may serve as adjunctive tools within a broader preoperative risk assessment framework rather than as standalone decisionmaking tools. Prospective multicenter studies are needed to externally validate the proposed cutoff values and the performance of these markers.

BACKGROUND: This study aimed to compare the diagnostic performance of inflammatory biomarkers derived from routine blood parameters in patients with acute cholecystitis, based on the hypothesis that these biomarkers can predict gangrenous cholecystitis independently of imaging before surgery.
METHODS: Data from 187 consecutive adult patients who underwent laparoscopic cholecystectomy for acute cholecystitis during the same hospitalization were retrospectively analyzed in an observational cohort. After the exclusion of 7 cases, 180 patients constituted the analytic cohort. Gangrenous cholecystitis was defined as intraoperative or pathological verification. C-reactive protein (CRP) and six prespecified haemogram-derived indices – the neutrophil-, platelet- and monocyte-to-lymphocyte ratios (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], monocyte-to-lymphocyte ratio [MLR]) and three composite indices (systemic immune-inflammation index, systemic inflammation response index [SIRI], aggregate index of systemic inflammation) – were evaluated; diagnostic accuracy was assessed using receiver operating characteristic-area under the curve (ROC-AUC), cutoff points were determined using the Youden index, and an age- and sex-adjusted logistic regression model was established.
RESULTS: Gangrenous cholecystitis was confirmed in 33 of the 180 analyzed patients (18.3%). CRP was 163.00 mg/L (interquartile range [IQR] 39.00–224.00) in the gangrenous group and 15.00 mg/L (IQR 4.02–55.89) in the non-gangrenous group. Among hemogram-derived indices, SIRI (7.10 [4.09–10.03] vs. 2.48 [1.03–4.89]) and MLR (0.62 [0.40–0.79] vs. 0.31 [0.19–0.50]) were significantly higher in gangrenous cases (both p<0.001); NLR was 8.00 (5.32–12.90) vs. 4.00 (2.35–6.66) (p<0.001). In the ROC analysis, CRP showed the highest discriminatory power (AUC 0.81; 95% confidence interval 0.71–0.89); at a cutoff point of 61.0 mg/L, the sensitivity and specificity were 0.73 and 0.78, respectively. Among the derived indices, the highest AUCs were observed for SIRI and AISI. In the model including CRP and SIRI adjusted for age and sex, only CRP remained an independent predictor; each 10 mg/L increase in CRP was associated with a 14% increase in the odds of gangrenous cholecystitis.
CONCLUSION: CRP provides the highest discrimination for pre-operative prediction of gangrenous cholecystitis and was the only independent predictor in multivariable analysis. The hemogram-derived indices showed moderate univariable discrimination, but their additional value beyond CRP remains uncertain and requires further evaluation in larger, prospective cohorts.

BACKGROUND: Major abdominal surgery is associated with a high incidence of postoperative complications, morbidity, and mortality. The Systemic Immune-Inflammation Index (SII), calculated from neutrophil, platelet, and lymphocyte counts, reflects both inflammatory and immune status and has been shown to predict outcomes in various diseases. This study aimed to retrospectively evaluate the outcomes of patients admitted to the intensive care unit (ICU) after urgent or elective major abdominal surgery and to investigate the association between postoperative SII and ICU mortality.
METHODS: We retrospectively analyzed patients admitted to the surgical ICU after major abdominal surgery between November 2022 and November 2023. Patients who died within the first 24 hours of ICU admission, were admitted to the ICU for less than 48 hours, and were younger than 18 years were excluded.
RESULTS: During the study period, 360 patients were admitted to the surgical ICU, of whom 102 underwent major abdominal surgery. One patient was excluded because of death within the first 24 hours of ICU admission, leaving 101 patients for analysis. Fifty-nine patients (58.4%) were women, and the mean age was 70.1±15.2 years. Urgent abdominal surgery was performed in 42 patients (41.6%). ICU mortality was higher among patients who underwent urgent surgery (23.8%) than among those who underwent elective surgery (5.1%) (p=0.013). Receiver operating characteristic (ROC) curve analysis identified a postoperative SII cutoff value of 998.26. A low postoperative SII was independently associated with mortality after major abdominal surgery, with a sensitivity of 82.9% and a specificity of 69.2% (95% confidence interval: 0.0579–0.913, p=0.004).
CONCLUSION: Postoperative SII may be a useful prognostic marker for predicting clinical outcomes and mortality in patients undergoing major abdominal surgery.

BACKGROUND: This study aimed to evaluate patients who presented to the emergency department with non-traumatic back or lumbar pain, without new-onset neurological deficits or cauda equina syndrome. Because of inadequate response to medical treatment, patients underwent imaging of the affected region and subsequently required emergency neurosurgical intervention.
METHODS: We included patients aged ≥18 years who presented to the emergency department with back or lumbar pain, experienced no pain relief despite analgesic treatment, underwent imaging of the affected region, and were referred for emergency surgical treatment by the neurosurgery department based on imaging findings. Patients presenting with trauma, new-onset neurological defi-cits, or a history of prior spinal surgery were excluded.
RESULTS: The study included 35 patients with a mean age of 65.51 years (range: 42–82). Among them, 11.4% (n=4) had chronic kidney disease, 37.14% (n=13) had diabetes mellitus, 22.8% (n=8) had a history of cancer, and 22.8% (n=8) had a family history of cancer. No red flag findings other than cancer-related risk factors were identified. The primary clinical indicator of underlying pathology was persistent pain despite analgesic treatment. Advanced diagnostic evaluation revealed pathological fractures in 77.1% of patients (n=27), spinal abscesses in 14.2% (n=5), and spondylodiscitis in 8.5% (n=3); all patients underwent emergency surgical treatment. Among patients with pathological fractures, histopathological examination demonstrated osteoporotic fractures in 59.2% (n=16) and metastatic fractures in 40.8% (n=11). Notably, all spinal metastases led to the initial diagnosis of cancer, and only two of these patients presented with red flag symptoms.
CONCLUSION: Patients without spinal emergencies or red flag symptoms may still require emergency surgical intervention. Therefore, diagnostic and evaluation algorithms should be developed for this patient population. We believe that pain severity scores may play an important role in such algorithms.

BACKGROUND: Gallstone ileus (GSI) is a rare surgical emergency. Its diagnosis is challenging and frequently delayed. Moreover, there is no consensus regarding the optimal surgical approach. The primary point of debate is whether cholecystectomy and fistula repair should be performed and, if so, when. Several studies have suggested that omitting cholecystectomy and fistula repair may increase the risk of cholangitis, gallbladder cancer, and recurrent gallstone ileus. However, most of these data originate from studies conducted in the previous century and have not been supported by contemporary evidence. This study aimed to present our clinical experience with gallstone ileus, discuss diagnostic and therapeutic strategies, and review the relevant literature.
METHODS: Medical records of 13 patients who underwent surgery for GSI between 2017 and 2022 at the Department of General Surgery, Kartal Dr. Lütfi Kirdar City Hospital, were retrospectively reviewed.
RESULTS: Of the patients, 69% were diagnosed with gallstone ileus at the time of admission, whereas 30.7% experienced a delayed diagnosis. The median time to surgery was 6 hours, and the median length of hospital stay was 6.5 days among patients diagnosed at admission. In contrast, patients with a delayed diagnosis had a median time to surgery of 126 hours and a median hospital stay of 14.5 days. Failure to establish the diagnosis at admission was associated with preoperative delays and prolonged hospitalization (p<0.05). Eleven patients underwent surgery aimed solely at relieving bowel obstruction, with fistula repair omitted. Two patients underwent additional cholecystectomy and fistula repair. During a mean follow-up period of 39.7 months, no cases of recurrent gallstone ileus, gallbladder cancer, or cholangitis were observed, despite omission of fistula repair in most patients.
CONCLUSION: GSI is a rare surgical emergency that is frequently associated with delayed diagnosis. Accurate diagnosis at presentation reduces preoperative delay and shortens hospital stay. Current evidence is insufficient to support routine cholecystectomy and fistula repair in all patients with GSI. The relationship between GSI and malignancy remains unclear. Surgical management should be individualized, and cholecystectomy with fistula repair should be considered when additional gallstones are present in the gallbladder.

BACKGROUND: In many contemporary studies, individuals aged 65 years and older are defined as older adults. Owing to population aging, the number of older adults worldwide is steadily increasing. Age-related physical and cognitive decline, together with social changes, may increase vulnerability to violence in this population. This study aimed to present and discuss data on older adults aged 65 years and over who were victims of violence and underwent medicolegal evaluation, to draw attention to measures that may help prevent violence against older adults, and to propose potential strategies for prevention and intervention.
METHODS: A total of 275 case files and forensic reports pertaining to individuals aged 65 years and older who underwent medicolegal assessment at the Department of Forensic Medicine, Dokuz Eylul University Faculty of Medicine, between January 1, 2016 and January 1, 2025, were retrospectively reviewed. Sociodemographic characteristics, location of the violent incident, perpetrator characteristics, type of violence, injury site, wound type, presence of a psychiatric diagnosis related to the incident, type of psychiatric diagnosis, and the forensic medical severity of injuries were evaluated. Statistical analyses were performed using IBM SPSS version 29.0.
RESULTS: Among the 275 cases of violence, 97 (35.3%) involved women and 178 (64.7%) involved men. The mean age was 71.53±6.2 years. The most common perpetrators were unknown or unrelated individuals (n=105, 38.2%), followed by friends or neighbors (n=90, 32.7%). Violence most frequently occurred in the home or its immediate surroundings (n=143, 52%), followed by streets, parks, and other public outdoor areas (n=69, 25.1%). Domestic violence accounted for 21.5% of cases. Neglect was identified in 19 cases (6.9%). Isolated physical violence was the most common form of violence (n=238, 86.5%). The injuries were life-threatening in 21 cases (7.6%), while bone fractures were documented in 78 cases (28.4%).
CONCLUSION: Specific legal regulations should be implemented to better protect older adults and support their participation in social life. Additionally, comprehensive strategies should be developed to address violence against older adults both within and outside the family setting. A multilevel, integrated approach is needed to improve prevention and intervention efforts through the identification of individuals at risk of perpetrating or experiencing violence.

BACKGROUND: The timing of extubation after general anesthesia (GA) in patients with acute ischemic stroke treated with mechanical thrombectomy (MT) is a significant issue. Prolonged duration of mechanical ventilation is considered to be an independent risk factor that negatively affects functional survival in patients receiving neurocritical care. This study evaluated the effect of time to extubation and the development of pneumonia on clinical prognosis after MT performed under GA.
METHODS: This retrospective, single-center, observational study included patients ≥18 years of age who underwent MT under GA for acute ischemic stroke between January 2023 and May 2025. Patient data were retrospectively obtained from hospital records and supplemented, when necessary, with information from patients’ relatives. Demographic data, lengths of intensive care unit and hospital stay, additional complications, neurological functional status (modified Rankin Scale [mRS]) at discharge, and mortality were examined. Patients were evaluated according to extubation timing, pneumonia, discharge mRS score (0–2, favorable; 3–6, unfavorable), and 30-day mortality using multivariate logistic regression analysis.
RESULTS: Data from 119 patients (mean age, 70.3±13.6 years) were analyzed. Patients in whom time to extubation was >24 h were older (p=0.003), exhibited a lower pre-procedural Glasgow Coma Scale (GCS) score (p<0.001), and higher pneumonia and mortality rates (p<0.001). Logistic regression analyses revealed that time to extubation >24 h significantly increased the likelihood of an unfavorable mRS score and mortality (p<0.001). Lower pre-procedural GCS (odds ratio [OR] 0.64; p<0.001) and higher American Society of Anesthesiologists Physical Status (ASA-PS) classification (OR 27.966; p<0.002) scores significantly affected time to extubation. A high ASA-PS score was found to increase the probability of pneumonia by tenfold (95% confidence interval 1.1–100.9). Patients with pneumonia exhibited significantly higher mRS scores (p<0.001).
CONCLUSION: Although the time to extubation had a significant impact on poor neurological prognosis and mortality in patients undergoing MT for acute stroke, the development of pneumonia appeared to be associated with unfavorable early neurological functional outcomes.

BACKGROUND: Acute appendicitis remains one of the most common causes of acute abdomen and the leading indication for emergency abdominal surgery worldwide. Despite advances in imaging and clinical scoring systems, predicting disease severity and postoperative outcomes at the time of admission remains challenging. Early identification of patients at risk for complicated appendicitis or prolonged hospitalization may improve treatment planning and optimize resource utilization. This study evaluated the predictive value of routinely available inflammatory markers for complicated appendicitis and prolonged hospital length of stay.
METHODS: This retrospective study included adult patients who underwent emergency appendectomy for acute appendicitis between May 2024 and April 2025. Demographic characteristics, hospital length of stay, surgical and pathological findings, and admission laboratory parameters were analyzed. Total white blood cell count (WBC-T), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and left shift (LS) were assessed. Disease severity was classified according to the American Association for the Surgery of Trauma (AAST) grading system and categorized as uncomplicated or complicated. Hospital stay was classified as regular (≤2 days) or prolonged (>2 days). Independent predictors were identified using univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) analysis and the Youden index were used to determine optimal cut-off values.
RESULTS: A total of 387 patients were included; 24.8% experienced a prolonged hospital stay, and 15.0% had complicated appendicitis. CRP, NLR, and LS were significantly higher in patients with prolonged hospitalization, whereas WBC-T was not. Multivariate analysis identified elevated CRP as the only independent predictor of prolonged hospital stay (odds ratio [OR]: 1.014, 95% confidence interval [CI]: 1.010–1.019; p<0.001). A CRP cut-off value of 43.05 mg/L predicted prolonged hospitalization with 59.4% sensitivity and 79.4% specificity (area under the curve [AUC]: 0.728). For complicated appendicitis, elevated CRP (OR: 1.008, 95% CI: 1.005–1.012; p<0.001) and increased LS (OR: 1.049, 95% CI: 1.012–1.087; p=0.008) were independent predictors. A CRP cut-off of 27.46 mg/L predicted complicated appendicitis with 69% sensitivity and 67% specificity (AUC: 0.74), whereas an LS cut-off of 77.61% demonstrated high sensitivity but limited specificity.
CONCLUSION: Admission CRP is a practical and reliable biomarker for predicting both prolonged hospitalization and complicated appendicitis. Combined assessment of CRP and left shift may further improve preoperative risk stratification and support clinical decision-making.

BACKGROUND: Trauma poses a high risk of mortality and morbidity in the pediatric age group. The preventable nature of a considerable portion of trauma cases in this age group highlights a significant issue. In our study, we aimed to raise awareness about abdominal injuries resulting from trauma, focusing on the period from 2019 to 2022 and the cases admitted to the Pediatric Surgery Department at Karadeniz University. We examined cases based on various factors, such as gender, age, origin, injured organ, presence of multiple traumas, duration of hospital admission, month and year of occurrence, length of hospital stay, physical abuse indicators, presence of genital injuries, psychiatric history, whether the incident was an accident or a preventable situation, the presumed responsible party, case type, indicators suggesting neglect, trauma history, vital threat, the presence of bone fractures, and whether simple medical interventions could address the injuries. Across this examination, we aimed to shed light on the extent and forensic aspects of abdominal injuries resulting from trauma, fostering awareness regarding child abuse issues.
METHODS: The research has a cross-sectional descriptive study design and was conducted by retrospectively examining the files of cases that presented with abdominal trauma to the Pediatric Surgery Department of Karadeniz Technical University Faculty of Medicine Hospital between 2019 and 2022. The examination involved both electronic and physical records.
RESULTS: Out of the 64 cases presenting with abdominal trauma, 47 (73.4%) were male, and 17 (26.6%) were female. When examining the origin distribution, falls from a height were the most common cause, accounting for 25 cases (39.1%); followed by 18 cases (28.1%) involving bicycle falls. Regarding the distribution of injured organs, it was found that 15 cases (23.4%) had injuries to multiple abdominal organs, 15 cases (23.4%) had liver injuries, and 12 cases (18.8%) had intra-abdominal free fluid. It was found that 35 cases (54.7%) were forensic cases. Neglect-indicating signs were identified in 41 cases (64%).
CONCLUSION: Pediatric trauma, including the mechanisms of trauma occurrence and child abuse, is a subject that needs to be addressed from a forensic medical perspective. Preventive measures for trauma in the pediatric age group should be organized and reviewed, and healthcare professionals should not forget their legal reporting obligations in cases of forensic traumatic injuries.

BACKGROUND: Craniofacial nerve injuries are a major source of long-term morbidity following maxillofacial trauma, often resulting in substantial functional impairment and psychosocial burden. This study aimed to perform a trauma-focused bibliometric analysis of the evolving research landscape on craniofacial nerve injuries and to determine whether the literature reflects a shift from trauma-related injury mechanisms toward surgically modifiable risk factors.
METHODS: A bibliometric analysis was conducted using publications indexed in the Web of Science (WoS) Core Collection and Scopus databases. Articles and reviews were retrieved using predefined trauma-related search terms. The search identified 119 records in WoS and 449 records in Scopus. Following database integration, duplicate removal, and PRISMA-guided (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) screening, 118 publications were included in the final analysis. Bibliographic data were evaluated to characterize thematic distribution, temporal trends, and comparative patterns among facial, inferior alveolar, and lingual nerve injuries. Keyword-based thematic clustering was used to identify major research domains.
RESULTS: Three principal trauma-related anatomical clusters were identified: facial nerve, inferior alveolar nerve, and lingual nerve injuries. Facial nerve injury emerged as the dominant research theme and was primarily associated with risks related to surgical approaches and operative management. Inferior alveolar nerve injury was more commonly linked to mandibular fracture patterns and fixation-related complications, whereas lingual nerve injury, although less frequently studied, demonstrated a disproportionately high functional impact. Temporal analysis revealed a gradual shift in research emphasis from fracture-driven inferior alveolar nerve injury toward facial nerve injury as a surgically modifiable risk factor.
CONCLUSION: The findings demonstrate a clear evolution in craniofacial nerve injury research, highlighting the growing importance of anatomical knowledge and surgical decision-making in optimizing long-term neurological and functional outcomes following maxillofacial trauma.

BACKGROUND: Hip fractures (HFs), which are common in the geriatric population and have a high mortality rate, are among the pathologies frequently encountered in emergency departments (EDs). The aim of this study was to investigate the prognostic value of red cell distribution width (RDW) and modified 5-item frailty index (mFI-5) scores in the prediction of short-term mortality and intensive care unit (ICU) admission in patients with HFs.
METHODS: Patients who presented to the ED due to HF between January 01, 2019, and December 31, 2023, were evaluated. Patients who underwent surgery for femoral neck, intertrochanteric, or subtrochanteric fractures were included in the study. Baseline demographics (age and sex), comorbidities, ICU admission status, and in-hospital and 30-day mortality rates were recorded. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of ICU admission and 30-day mortality.
RESULTS: A total of 413 patients undergoing surgical treatment for HFs were included. The mean age of the patients was 80±11 years, and 271 (65.6%) were female. ICU admission was required for 43 patients (10%), while in-hospital and 30-day mortality rates were 7% (n=30) and 9.9% (n=41), respectively. Multivariable logistic regression analysis identified RDW as an independent predictor of both ICU admission (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.05–1.41; p=0.009) and 30-day mortality (OR 1.20, 95% CI 1.03–1.39; p=0.016). Atrial fibrillation (AF) and Alzheimer’s disease were also identified as independent predictors of ICU admission, while AF and age independently predicted 30-day mortality. The mFI-5 score did not reach statistical significance in univariate analysis for either outcome. A predictive model incorporating RDW and other covariates achieved area under the curve values of 0.74 for ICU admission and 0.70 for 30-day mortality.
CONCLUSION: RDW emerged as an independent predictor of ICU admission and 30-day mortality in surgically managed HF patients, with improved discriminatory performance when integrated into a multiparametric model. Advanced age, Alzheimer’s disease, and AF further contribute to increased risk and should be closely monitored in clinical management. These findings support the incor-poration of RDW into routine emergency risk stratification for this vulnerable population.

An ectopic spleen refers to splenic tissue or lobules located outside the normal anatomical position of the spleen and is most commonly found near the splenic hilum. Ectopic splenic tissue is typically found in characteristic anatomical locations but may rarely occur in atypical sites. Owing to its unusual localization, it can be radiologically mistaken for a variety of tumors. This case is notable because a large retroperitoneal mass requiring emergency laparotomy was ultimately diagnosed as ectopic splenic tissue. A 44-year-old man underwent emergency diagnostic laparotomy for acute abdominal symptoms. Preoperative imaging revealed a heterogeneous lesion medial to the left psoas muscle that was radiologically suggestive of a soft tissue tumor. Intraoperative frozen section examination demonstrated lymphoid tissue suggestive of splenic origin, and the diagnosis was subsequently confirmed on paraffin sections. Histopathological evaluation revealed a well-circumscribed nodular lesion composed of follicle-like lymphoid structures and sinusoidal vascular channels, consistent with ectopic splenic tissue. Unlike most reported cases, which typically occur in women aged 20–40 years and involve lesions measuring 1–3 cm, our patient was male and presented with a retroperitoneal lesion measuring 6.5×3×2.5 cm, an uncommon presentation. The unusual location and relatively large size of the lesion led to its initial radiological interpretation as a soft tissue tumor, highlighting the importance of comprehensive radiologic evaluation and histopathological examination for accurate diagnosis.

Gossypiboma refers to a retained cotton-based, non-absorbable foreign body left in the operative field after surgery. Its detection is often difficult and may lead to significant morbidity and mortality. In this case report, we present a case of biliary stricture caused by gossypiboma in a patient who had undergone laparoscopic cholecystectomy 9 months earlier and presented with jaundice. A 64-year-old male had previously undergone laparoscopic cholecystectomy for cholelithiasis. Postoperatively, he experienced recurrent abdominal pain, nausea, and vomiting. In the 9th post-operative month, jaundice and pruritus developed, and laboratory tests revealed cholestasis (total bilirubin: 11.66 mg/dL; gamma-glutamyl transferase: 930 U/L). Magnetic resonance imaging demonstrated intrahepatic bile duct dilatation and a stricture adjacent to a metallic clip. Endoscopic retrograde cholangiopancreatography and percutaneous cholangiography confirmed the obstruction. During laparotomy, a retained surgical sponge (gossypiboma) was identified and removed, and a Roux-en-Y hepaticojejunostomy was performed. The patient recovered uneventfully and was discharged on post-operative day 13. In accordance with surgical safety protocols, performing a final count at the end of the operation, using radio-opaque materials, and maintaining effective team communication are critical measures for preventing such errors. Delayed diagnosis may result in prolonged asymptomatic periods or misdiagnosis due to non-specific clinical findings. In patients with a history of surgery who present with symptoms such as infection, pain, fistula, or a mass, gossypiboma should be considered, and computed tomography should be the preferred imaging modality. Multidisciplinary awareness and meticulous perioperative protocols may significantly reduce this risk. In conclusion, gossypiboma is a complication that is far easier to prevent than to treat.