BACKGROUND: To date, no study has evaluated the effects of calcium dobesilate on regenerative capacity after partial hepatectomy. Within the scope of this research, we aimed to elucidate the effects of calcium dobesilate (CD) on liver regeneration capacity and antioxidant pathways after partial hepatectomy.
METHODS: Thirty-six Sprague Dawley male rats weighing between 250-350 grams were used in the study. All animals underwent partial hepatectomy. The rats were randomly divided into four groups, each consisting of nine rats, as control groups (Groups 1 and 2) and study groups (Groups 3 and 4). Regeneration rate, histopathological parameters, immunohistochemical examination, and the apoptotic index (AI) were measured.
RESULTS: Tissue superoxide dismutase (SOD) levels were statistically significantly higher in the calcium dobesilate study groups compared to controls (p=0.03). Malondialdehyde (MDA) levels were statistically significantly higher in the study groups than in the control groups on both the second and seventh days (p=0.001). The regeneration rate (RR) was higher in the study group compared to the control group on the second day, and this difference was statistically significant (p<0.001). RR was also significantly higher in the study group on the second day compared to the seventh day (p<0.001). According to the Suzuki Scoring System, vacuolization and necrosis were not observed in the study groups (p<0.001 vs. p=0.034, respectively). The apoptotic index was significantly higher in the control groups compared to the study groups (p<0.001), and AI was statistically significantly lower on the seventh day (p=0.006). Ki-67 expression was statistically significantly higher in the groups receiving CD treatment on both the second and seventh days. In the control groups, Ki-67 expression was statistically significantly higher on the seventh day compared to the second day (p=0.006).
CONCLUSION: This research indicated the effects of calcium dobesilate on improving oxidative damage and liver regeneration in rats undergoing partial hepatectomy. The results of the present study showed that (preoperative-postoperative) CD improves oxidative stress and increases liver regeneration capacity after partial hepatectomy.

BACKGROUND: This study aimed to evaluate the neuroprotective potential of pregabalin (PB) and methylprednisolone (MP) in a rat model of spinal cord injury (SCI) by assessing serum and spinal cord levels of superoxide dismutase (SOD) and glutathione peroxidase (GPx), markers of oxidative stress, and neurological recovery outcomes.
METHODS: Forty-four rats were randomized into six groups: sham, PB control (40 mg/kg), SCI alone, MP-treated SCI (30 mg/kg), and PB-treated SCI (40 and 80 mg/kg). SCI was induced at the T10 level using the Allen weight-drop method. PB and MP were administered intraperitoneally for three days post-injury. Neurological recovery was assessed using the Tarlov scale and inclined plane test. Although 44 rats were initially allocated, mortality and technical loss resulted in a final cohort of 35 animals; however, post hoc power remained >90% for key biochemical outcomes.
RESULTS: SOD levels were significantly reduced in the MP+SCI group compared with the sham (p=0.006), SCI (p=0.015), 40 PB (p=0.004), and 80 PB+SCI (p=0.028) groups. Additionally, the SCI group exhibited lower SOD activity than the 40 PB group (p=0.007). Serum glutathione peroxidase levels were significantly lower in both the SCI (p=0.018) and 80 PB+SCI (p=0.009) groups compared with the sham group, whereas the 40 PB group showed higher GPx activity than the SCI (p=0.010) and 80 PB+SCI (p=0.006) groups. In spinal cord tissue, SOD activity in the 40 PB+SCI group was significantly lower than in the SCI group (p=0.007). Additionally, SOD activity in the SCI group was significantly higher than in the 40 PB group (p=0.007). Spinal cord GPx levels were significantly elevated in the SCI group compared with the sham (p=0.007), MP+SCI (p=0.010), 40 PB (p=0.003), 40 PB+SCI (p=0.003), and 80 PB+SCI (p=0.028) groups. Furthermore, the MP+SCI group demonstrated higher GPx activity than the sham group (p=0.045). Pregabalin improved inclined-plane performance but did not produce significant changes in Tarlov motor scores, indicating selective enhancement of postural stability rather than full locomotor recovery. Histopathological analysis revealed no significant differences between the trauma groups.
CONCLUSION: Pregabalin mitigated oxidative stress and partially improved functional stability in experimental spinal cord injury, suggesting possible clinical applicability pending further validation.

BACKGROUND: Ischemia-reperfusion (I/R) injury of the lower limbs is a significant clinical challenge that can arise due to surgical procedures, thrombotic events, embolism, or traumatic vascular damage. This study aimed to evaluate the antioxidative and histo-pathological protective effects of quercetin, a potent flavonoid antioxidant, on skeletal muscle subjected to I/R injury.
METHODS: Eighteen Wistar Albino rats were randomly assigned into three groups: Control (sham laparotomy), Ischemia-Reperfusion (IR) group (2 hours of ischemia followed by 2 hours of reperfusion), and Ischemia-Reperfusion plus quercetin treatment (IR-Q) group, receiving 20 mg/kg quercetin intraperitoneally 30 minutes before ischemia induction. After the experimental protocols, skeletal muscle samples were collected for biochemical assays measuring malondialdehyde (MDA) levels and superoxide dismutase (SOD) activity, as well as for histopathological examination.
RESULTS: The IR group demonstrated a significant increase in MDA concentration compared to controls (p<0.0001), whereas administration of quercetin in the IR-Q group significantly attenuated MDA levels relative to the untreated IR group (p=0.012). SOD activity was markedly diminished in the IR group (p<0.0001) but was significantly restored in the IR-Q group compared to IR alone (p=0.012). Histological analyses revealed pronounced muscle atrophy, degeneration, leukocyte infiltration, and fiber fragmentation/hyalinization in the IR group, which were significantly alleviated by quercetin treatment (p<0.05).
CONCLUSION: These findings indicate that quercetin exerts a protective effect against oxidative stress and structural damage induced by ischemia-reperfusion in skeletal muscle, potentially through enhancement of endogenous antioxidant defenses. Quercetin thus holds promise as a therapeutic agent in mitigating I/R injury; however, further studies are needed to elucidate its precise mechanisms and clinical applicability.

BACKGROUND: The objective of this study was to evaluate the diagnostic value of serum pro-adrenomedullin (pro-ADM) levels in diagnosing acute appendicitis (AA) in patients presenting to the emergency department (ED) with abdominal pain.
METHODS: This prospective clinical study included patients over the age of 18 who presented to the ED with abdominal pain and were initially suspected of having appendicitis. A venous blood sample was collected from each patient upon presentation, and serum pro-ADM levels were measured. Based on laboratory and radiological evaluations, patients were categorized into two groups: those diagnosed with AA and those without AA. The AA group was further subdivided into simple and complicated AA. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) for Windows, version 21.0 (SPSS Inc., Chicago, IL, USA). A p-value of <0.05 was considered statistically significant.
RESULTS: This study included 83 adult patients with abdominal pain, of whom 44 were male (53.0%) and 39 were female (47.0%). The mean age of the patients was 32.28±16.10 years. Serum pro-ADM levels were higher in patients with appendicitis than in those without. Setting the cut-off value for pro-ADM at 3.375 pg/mL to identify patients with appendicitis revealed a statistically significant difference between patients with and without appendicitis (p=0.002). Additionally, there was a statistically significant difference in serum pro-ADM levels when comparing the duration of ED presentation among patients with appendicitis (p<0.001).
CONCLUSION: Serum pro-ADM levels are elevated in patients with appendicitis; however, pro-ADM is less effective in distinguishing between simple and complicated appendicitis. Serum pro-ADM levels in patients who present to the ED within the first 24 hours of abdominal pain onset may be useful for early diagnosis.

BACKGROUND: Acute biliary pancreatitis (ABP) is an acute inflammation of the pancreas that can vary in severity, potentially leading to life-threatening complications. Early identification of severe cases is crucial for effective management and improved outcomes. Traditional scoring systems, such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Ranson, are commonly used to assess severity but can be complex and time-consuming. This study aims to assess the reliability of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as accessible biomarkers for predicting ABP severity and to evaluate their relationship with disease severity as determined by the Balthazar grade.
METHODS: This retrospective study analyzed 161 patients diagnosed with acute biliary pancreatitis. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio values were compared with ABP severity as assessed by the Balthazar grade. The correlation between these inflammatory biomarkers and disease severity was examined. The study was approved by the Ümraniye Training and Research Hospital Clinical Research Ethics Committee (approval date: 13.03.2025, approval number: 54) and was conducted in accordance with the Declaration of Helsinki.
RESULTS: Elevated NLR and PLR values were significantly associated with increased ABP severity. Both NLR and PLR demonstrated potential as reliable biomarkers for early risk stratification, particularly in resource-limited settings.
CONCLUSION: NLR and PLR may serve as valuable biomarkers in predicting ABP severity, facilitating early clinical decision-making, particularly in settings where advanced imaging is limited. This study also highlights the clinical relevance of these biomarkers within Türkiye, potentially guiding future updates to pancreatitis management protocols.

BACKGROUND: Necrotizing fasciitis (NF) is a rare but serious surgical emergency that progresses rapidly, requires urgent operative intervention, and carries a high mortality rate. Current prognostic scoring systems may have limited predictive power for mortality across different patient groups. The aim of this study was to identify clinical, laboratory, and radiological factors associated with mortality in patients with necrotizing fasciitis. In addition, the study aimed to provide a foundation for the development of a practical prognostic scoring system that could support early risk stratification in clinical practice.
METHODS: This retrospective cohort study examined data from 65 patients diagnosed with NF between January 2021 and December 2024. A modified scoring system was created by integrating the Charlson Comorbidity Index and the total body surface area ratio (Samsun Charlson Comorbidity Index, SaCCI). Sarcopenia was assessed using the psoas muscle index. Using receiver operating characteristic (ROC) analysis, the mortality predictive performance of the modified scoring system was calculated and compared with existing systems.
RESULTS: The SaCCI score demonstrated higher prognostic accuracy than existing systems in predicting mortality, achieving the highest discriminatory power with an area under the curve (AUC) of 0.885. Higher SaCCI scores were associated with a significantly increased risk of mortality. Sarcopenia and delayed surgical intervention were also associated with mortality.
CONCLUSION: The SaCCI score shows promise as an effective tool for predicting early mortality risk in patients with necrotizing fasciitis. The validity of this scoring system, which may inform clinical decision-making, should be confirmed by further multicenter studies.

BACKGROUND: This study aims to evaluate the impact of traumatic lens injury on visual and anatomical prognosis in open globe injuries (OGI).
METHODS: The medical charts of patients with OGIs treated at a tertiary ocular trauma referral center between November 2016 and January 2025 were retrospectively reviewed. Patients were categorized into two groups: those with lens injury (LI) and those without lens injury (NLI). Primary outcome measures were final best-corrected visual acuity (BCVA), functional visual success (BCVA ≥ 0.1 [decimal]), and globe survival. Multivariate logistic regression analyses were utilized to model independent predictors of functional visual success and globe survival. Predictor variables were selected based on clinical relevance and prior trauma literature: lens injury, Zone 3 involvement, injury type, number of surgeries, and initial retinal detachment.
RESULTS: A total of 98 eyes were included in the study; 73 eyes had LI, while 25 eyes did not. Eyes with LI had significantly poorer initial BCVA (mean logMAR 2.33 vs. 1.76; p=0.003) and more frequently sustained Zone 1 injuries (p<0.001). Final BCVA (logMAR 1.62 vs. 1.00; p=0.022), functional visual success (23.3% vs. 60.0%; p=0.002), and globe survival (63.0% vs. 88.0%; p=0.037) were all significantly lower in the LI group. In the multivariable analysis, lens injury independently reduced the likelihood of functional visual success (adjusted OR 0.40; 95% CI 0.11–0.81; p=0.019), whereas it was not an independent determinant of globe survival. The presence of initial retinal detachment was the strongest adverse factor for both functional visual success (adjusted OR 0.07; 95% CI 0.02-0.44; p<0.001) and globe survival (adjusted OR 0.13; 95% CI 0.04–0.40; p<0.001).
CONCLUSION: Traumatic lens injury independently predicts poorer functional visual success following OGIs. Retinal detachment at presentation remains the most influential determinant of both visual and anatomical prognosis and holds critical importance in trauma management. Incorporation of lens injury into ocular trauma prognostic scoring systems may improve their predictive accuracy.

BACKGROUND: Childhood forensic traumatic injuries represent one of the foremost preventable public health concerns. This study aims to evaluate the sociodemographic characteristics, types of trauma, and the legal nature of traumatic injuries in pediatric cases subjected to forensic evaluation.
METHODS: Data from 275 pediatric cases who presented to Çankýrý State Hospital between January 1, 2024 and December 31, 2024, with traumatic injuries requiring forensic notification were retrospectively analyzed.
RESULTS: Of the cases, 72.4% were male and 27.6% were female, with a mean age of 13.01±4.22 years. The most common causes of injury were physical assault (43.3%), in-vehicle traffic accidents (19.6%), and out-of-vehicle traffic accidents (17.8%). The distribution of injuries varied significantly by age and sex; physical violence (73.9%), injuries from sharp or stabbing objects (95%), and firearm injuries (100%) were more frequent among males, whereas blunt trauma was more commonly observed in females (42.9%). Soft tissue trauma was present in 92.4% of the cases, and multiple body region injuries were identified in 39.3%, with the head and neck region being particularly affected in physical assault cases (53.8%). Traffic accidents were associated with multi-region injuries and moderate to severe bone fractures.
CONCLUSION: This study demonstrates that childhood traumatic injuries vary significantly by age and gender. Enhancements in socioeconomic, environmental, and educational interventions are essential for the prevention of pediatric trauma. The findings are considered to offer valuable guidance for improving clinical and legal processes.

BACKGROUND: This study aimed to investigate whether the level of the fracture line relative to the olecranon fossa influences surgical difficulty, complication rates, and radiological outcomes in pediatric supracondylar humerus fractures (PHSF).
METHODS: A retrospective review was conducted of 822 children who underwent surgical treatment for PHSF. Patients were categorized according to the location of the fracture line relative to the apex of the olecranon fossa: high-level (proximal to the fossa, n=163) and low-level (at or distal to the fossa, n=659). High-level fractures were further classified as oblique (n=40) or transverse (n=123), based on the angle between the fracture line and the transepicondylar line. Patient demographics, fracture characteristics, surgical parameters, complications, radiographic findings, and revision rates were analyzed.
RESULTS: There were no significant differences between groups in terms of patient demographics, fracture side, open versus closed fracture status, neurovascular injury, or associated trauma (p>0.1). High-level fractures were significantly more unstable, required longer surgical durations, and showed a greater number of K-wire cortical scars compared to low-level fractures (p<0.05). K-wire configuration, number, and diameter showed no significant differences. Subgroup analysis demonstrated that oblique high-level fractures more often required divergent pin configurations and had significantly higher revision rates compared with transverse high-level fractures (p=0.049 and p=0.004, respectively).
CONCLUSION: Fractures located proximal to the olecranon fossa are more unstable and technically demanding, resulting in longer operation times and more intraoperative pinning attempts. Among high-level fractures, oblique types are especially prone to technical challenges and increased revision rates, highlighting the importance of fracture morphology in surgical planning.

Purpose:
To compare the clinical, cosmetic, and surgical outcomes of medial-first and lateral-first open reduction approaches in the treatment of unstable pediatric supracondylar humerus fractures when closed reduction fails.

Methods:
In this retrospective comparative study, 68 pediatric patients (aged 2–10 years) with Gartland Type III and IV supracondylar humerus fractures requiring open reduction were evaluated. Patients were divided into two groups based on the initial surgical approach: medial-first (n = 31) and lateral-first (n = 37). Demographic characteristics, surgical time, pin configuration, range of motion, Flynn’s functional and cosmetic outcomes, and postoperative complications were compared between groups.

Results:
The medial-first group demonstrated significantly shorter surgical time (55.5 ± 16.0 vs. 72.0 ± 20.2 minutes, p < 0.001) and superior cosmetic outcomes (excellent cosmetic Flynn’s scores in 83.9% vs. 62.2%, p = 0.0408). The need for an additional incision was markedly higher in the lateral-first group (0 vs. 18 patients, p < 0.00001). Functional outcomes and complication rates were comparable between groups.

Conclusion:
The medial-first approach in unstable pediatric supracondylar humerus fractures provides advantages in surgical efficiency and cosmetic outcomes, while minimizing the need for secondary incisions. It represents a safe and effective option for achieving stable fixation when closed reduction is unsuccessful.

BACKGROUND: This study aims to compare the radiological and functional outcomes of long arm casting versus splinting in the nonsurgical treatment of pediatric supracondylar humerus fractures classified as Modified Gartland type I and IIa.
METHODS: Between January 2021 and January 2024, 112 pediatric type I and IIa supracondylar humerus fractures (SCHFs) treated nonoperatively with long arm splinting or casting were evaluated. Baumann angle and lateral capitellohumeral angle (LCHA) were measured pre-reduction, post-reduction, and at weeks 1 and 4. Outcomes were compared using Flynn’s criteria.
RESULTS: Of the 112 patients, 55 had type I (49%) and 57 had type IIa (51%) fractures (mean age: 7.51 years; 69 males, 43 females). Fractures were equally distributed between the right and left sides (n=56 each). Fifty-eight patients were treated with long arm splinting and 54 with long arm casting. Follow-up durations were similar between groups. In the splint group, the mean Baumann angle was 72.1° pre-reduction and 73.2° at week 4; in the cast group, it was 70.7° and 73.4°, respectively. Mean LCHA increased from 43.9° to 50.8° with splinting and from 42.4° to 50.1° with casting. A statistically significant difference was not observed for loss of reduction between the splinting and casting groups (p=0.475). No statistically significant differences were observed in LCHA (p=0.175), Baumann angle values (p=0.485), or Flynn scores (p=0.768) pre- and post-reduction in type I and type IIa SCHFs.
CONCLUSION: Splinting and casting yielded comparable clinical and radiological outcomes in nonsurgically managed Modified Gartland type I and IIa supracondylar humerus fractures. However, splinting stands out as a strong alternative due to its ease of application and lower complication rates.

Blunt abdominal trauma most often results from high-energy mechanisms such as motor vehicle accidents. The spleen and kidneys are the organs most commonly injured in such cases, whereas pancreatic injuries are rare. Concomitant involvement of the pancreas along with splenic and renal injuries is particularly uncommon. We report the successful non-operative management (NOM) of a 24-year-old male patient who sustained grade IV splenic and left renal injuries, a grade II pancreatic injury, and widespread pulmonary contusions following a motorcycle accident. During follow-up, expansion of the retroperitoneal hematoma, perisplenic fluid collection, and left-sided pleural effusion were observed. Interventional radiology procedures, including abdominal and thoracic drainage, were performed. The presence of high levels of amylase and lipase in the abdominal catheter output indicated the development of a pancreatic fistula, for which conservative treatment was initiated. Following catheter repositioning and administration of a somatostatin analogue, the fistula resolved spontaneously. Although left renal atrophy was detected on long-term follow-up, the patient remained clinically stable. This case highlights that even in the presence of multiple high-grade solid organ injuries, favorable outcomes may be achieved without surgical intervention through NOM. Supported by advanced imaging modalities and interventional radiology, NOM represents a safe and effective therapeutic strategy that can minimize surgical complications in hemodynamically stable patients.

Although pancreaticoduodenal injuries are rare, they represent complex surgical conditions associated with high risks of morbidity and mortality. This case report presents an emergency pancreaticoduodenectomy (Whipple procedure) performed on a 17-year-old male patient who was admitted to the emergency department following a non-vehicular traffic accident. Imaging studies revealed free intraperitoneal air and fluid, as well as multiorgan injury, including right renal perfusion loss. Emergency surgical exploration revealed a Grade V pancreatic head avulsion, distal bile duct injury, duodenal laceration, a laceration in the proximal one-third of the transverse colon, and right renal devascularization. Considering the patient’s intraoperative hemodynamic stability, a Whipple procedure, segmental colectomy with primary anastomosis, and right nephrectomy were performed. On postoperative day 11, a leak developed at the colocolonic anastomosis site, and the patient underwent emergency surgery involving a right hemicolectomy and end ileostomy. During the follow-up period, no additional emergency surgical intervention was required from a general surgery perspective. This case highlights the importance of multidisciplinary team collaboration and individualized surgical decision-making in the management of high-risk trauma based on the patient’s clinical condition. In the presence of complex anatomical injuries, determining appropriate surgical timing, selecting optimal techniques, and managing complications play decisive roles in treatment success. In this context, the surgical approach and timing are discussed in light of the current literature and evaluated in comparison with similar cases.

Aortoesophageal fistula (AEF) is a rare and life-threatening condition that can result from foreign body ingestion, particularly in vulner-able populations with impaired communication, where diagnosis may be delayed. A 26-year-old male with severe autism and limited expressive ability presented to the emergency department with a two-day history of fever and melena. Two hours prior to arrival, hematemesis occurred during an attempt at oral intake. Caregivers reported behavioral changes and a deterioration in his general condition over the preceding 10 days. Diagnostic imaging revealed a large, curved metallic foreign body that had perforated the esophageal wall, traversed the prevertebral space, and appeared to penetrate the thoracic aorta with its tip, leading to mediastinitis and AEF. Despite emergency surgery with cardiopulmonary bypass, the patient succumbed to sepsis and multi-organ failure within 24 hours postoperatively. This case highlights the importance of clinicians considering the possibility of an asymptomatic period following sharp metallic foreign body ingestion, which can lead to severe complications, particularly in patients with communication impairments. The asymptomatic interval can result in significant complications, including luminal erosion, rupture, or the development of a fistula with adjacent structures. Emergency physicians must suspect AEF, especially in patients with a history of foreign body ingestion, when gastrointestinal bleeding is accompanied by signs of severe infection. Timely use of computed tomography (CT) imaging is critical for confirming the diagnosis and determining the need for emergency surgical intervention. This case underscores the necessity of thor-ough evaluation in managing potentially life-threatening foreign body ingestion.

Cardiopulmonary resuscitation (CPR) is a vital life-saving intervention but may result in various traumatic injuries, particularly with vigorous or prolonged efforts. Although visceral injuries are uncommon, they can be fatal. In this report, we present a rare postmortem case demonstrating multiple internal injuries-including pericardial and myocardial lacerations, liver laceration, and renal pelvis and renal vein injury-following CPR. A 70-year-old male was found unresponsive on the roadside and transported to the emergency department, where CPR was initiated due to cardiac arrest. Despite all medical interventions, resuscitation efforts were unsuccessful. Laboratory tests showed elevated cardiac and liver enzymes. A forensic autopsy was performed due to the suspicious nature of the death. External examination revealed no signs of assault; a burn over the sternum was consistent with defibrillator pad contact. CPR-related rib and sternal fractures were observed. A non-transmural myocardial laceration with pericardial injury was noted. Minor intraperitoneal hemorrhage, small hepatic and renal lacerations, and a millimetric tear in the left renal vein were identified. Histopathology revealed severe coronary atherosclerosis with ~80% luminal narrowing. Toxicology detected only therapeutic drug levels. The patient had a history of hypertension without recent cardiac follow-up. Surveillance footage showed the individual clutching his chest before collapsing. In conclusion, this case underscores that multiple internal organ injuries, although uncommon, may arise as complications of CPR. In elderly individuals, reduced tissue resilience may predispose to pericardial, myocardial, hepatic, and renal venous injuries, which should be considered in both clinical management and forensic evaluations.