BACKGROUND: Fire-related deaths are a significant global public health concern. Although most cases are accidental, some may involve suicide or homicide, making forensic autopsy essential for determining the cause of death. Variations in mortality rates between countries, along with the presence of soot residues and heat-related artifacts, can complicate postmortem interpretation. The classic cherry-pink skin discoloration is not consistently observed; therefore, detection of soot in the upper respiratory tract provides important evidence. This study aimed to evaluate the demographic, forensic, and pathological characteristics of fire-related deaths. METHODS: This retrospective study analyzed fire-related deaths subjected to autopsy at the Morgue Specialization Department of the Erzurum Group Presidency of the Forensic Medicine Institution between 2018 and 2024. Parameters assessed included age, sex, origin of the incident, seasonal distribution, location of the event, degree of burns, and indicators of vitality. RESULTS: The majority of fire-related deaths were accidental and occurred predominantly in adult males. Most incidents took place in residential settings, with a higher frequency observed during the fall and winter seasons. Autopsy findings commonly revealed third-and fourth-degree burns, as well as soot deposition in the respiratory tract and associated pulmonary pathologies. In cases involving prolonged hospitalization, complications emerged as a major contributing factor to mortality. CONCLUSION: Fire-related mortality is influenced not only by the extent and severity of burns but also by associated complications and characteristics of vulnerable populations. From a forensic medicine perspective, there is a need to develop fire safety policies and comprehensive strategies to reduce fire-related deaths.
BACKGROUND:Trauma is a major global health concern due to its potential to affect multiple organ systems and its association with high rates of morbidity and mortality. This study aimed to comparatively evaluate the accuracy of various trauma scoring systems in predicting morbidity and mortality among patients with blunt thoracic trauma across different age groups. METHODS:A retrospective analysis was conducted on 210 patients treated for thoracic trauma at the Department of Thoracic Surgery, Kayseri City Hospital, between October 2022 and January 2024. Patients were categorized into three age groups: 18-44 years, 45-64 years, and ≥65 years. Data collected included demographic characteristics, comorbidities, anticoagulant use, mechanism of injury, thoracic and extrathoracic injuries, and histories of intensive care unit (ICU) admission and intubation. The predictive performance of the Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Chest Trauma Score (CTS), Injury Severity Score (ISS), and Trauma and Injury Severity Score (TRISS) for mortality, intubation, and ICU admission was assessed using receiver operating characteristic (ROC) analysis. RESULTS:The mean age of the patients was 53.43 years, with a predominance of males. Traffic accidents were the most common cause of trauma. The prevalence of comorbidities and anticoagulant use increased with age. The ICU admission rate was 32.38%, and the overall mortality rate was 4.28%. ROC analysis demonstrated that ISS and TRISS had strong predictive performance for mortality, need for intubation, and ICU admission across all age groups. CONCLUSION:Thoracic trauma is a severe form of injury associated with high rates of morbidity and mortality. The findings suggest that ISS and TRISS are reliable predictors of trauma severity regardless of age. Incorporating these scoring systems into hospital triage and clinical decision-making may facilitate early diagnosis and support timely, effective management.
BACKGROUND:Acute tendinous mallet finger (Doyle type I) is commonly treated with continuous immobilization of the distal interphalangeal (DIP) joint; however, treatment success largely depends on patient compliance. Percutaneous intramedullary (IM) Kirschner wire DIP joint transfixation represents a minimally invasive surgical alternative, although the clinical relevance of different pin configurations remains unclear. This study compared conservative and surgical treatment methods and evaluated the impact of different pin configurations on clinical outcomes. METHODS:This retrospective cohort study included 93 adult patients with acute tendinous mallet finger who presented within 7 days of injury and were followed for at least 12 months. Patients were allocated into three groups: conservative treatment with a tape-reinforced Stack splint (n=33), percutaneous IM Kirschner wire DIP joint transfixation with the pin left exposed (n=30), and IM transfixation with the pin buried within the fingertip pulp (n=30). The primary outcome was residual DIP joint extension lag at final follow-up. Secondary outcomes included functional results according to the Crawford criteria and treatment-related complications. RESULTS:Baseline DIP extension lag did not differ significantly among the groups (p=0.801). At final follow-up, residual extension lag was significantly greater in the conservative group (median 4°) compared with the surgical groups (0.5° and 1°, respectively; p<0.001). Multicategorical analysis of Crawford grades showed no significant intergroup difference (p=0.095); however, dichotomous analysis (excellent + good outcomes) demonstrated significantly higher success rates in the surgically treated groups compared with the con-servative group (p=0.014). Skin maceration was more frequent in the conservative group (p<0.001), whereas pin-site irritation was significantly more common in the exposed pin group (p=0.006). No significant differences were observed among the groups regarding superficial infection. CONCLUSION:In patients with acute tendinous mallet finger, percutaneous IM Kirschner wire DIP joint transfixation provides superior extension control and higher functional success rates compared with conservative treatment. Although pin configuration does not significantly influence functional outcomes, it affects patient comfort and the complication profile. Treatment decisions should therefore be individualized based on patient compliance and functional expectations.
BACKGROUND:Acute appendicitis is one of the most common emergency surgical conditions and may progress to perforation, sepsis, and mortality if not treated promptly. This study aimed to evaluate the effectiveness of the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score and the Modified Alvarado Scoring System (MASS) in identifying perforated acute appendicitis. METHODS:This study included 164 patients admitted to the General Surgery Department between June 2023 and December 2023 with a preliminary diagnosis of acute appendicitis. MASS and RIPASA scores, along with demographic data, were obtained from the Hospital Information Management System (HIMS) at the time of diagnosis. RESULTS:A total of 153 patients were included in the final analysis. The mean age was 35.2±14.1 years (range: 18-82 years). Perforation was identified in 15.8% of cases evaluated by ultrasonography (USG) and 6.1% of those assessed by computed tomography (CT). A RIPASA score >7 demonstrated a sensitivity of 71.1% and a specificity of 54.7% for detecting perforation. Patients with perforation had significantly higher RIPASA and MASS scores (both p<0.001) and longer hospital stays (p<0.001). CONCLUSION:Compared with the MASS scoring system, the RIPASA score demonstrates higher sensitivity and specificity and is associated with greater inflammation when elevated. Its incorporation into routine clinical practice may facilitate faster, more efficient, and cost-effective management in emergency and general surgical settings.
BACKGROUND: The pathophysiology of testicular ischemia-reperfusion is characterized by a marked increase in reactive oxygen species. Oxidative damage caused by reactive oxygen species to cellular components, including DNA, proteins and lipids, leads to injury of spermatogenic cells. Maslinic acid, a bioactive compound found in Olea europaea, hawthorn, and other medicinal plants, exhibits antioxidant properties. This study aimed to determine whether maslinic acid protects testicular sperm production following ischemia-reperfusion injury in a rat model. METHODS: Male rats were randomly assigned to three groups: a control group (Group 1), an ischemia-reperfusion group (Group 2), and an ischemia-reperfusion + maslinic acid group (Group 3). Ischemia was induced in the left testis by two-hour torsion, followed by reperfusion via surgical detorsion. The treatment group received intraperitoneal administration of maslinic acid at the onset of detorsion procedure. Following detorsion, left orchiectomy was performed at either four hours or three months. To comprehensively assess testicular oxidative stress and function, we measured key indicators: malondialdehyde concentration (reflecting reactive oxygen species levels); activities of superoxide dismutase and catalase, representing components of the cellular antioxidant system; and overall spermatogenic efficiency. These parameters were evaluated using biochemical assays and histological analysis with hematoxylin-eosin staining. RESULTS: Testicular ischemia-reperfusion significantly increased malondialdehyde levels while suppressing key antioxidant defenses (superoxide dismutase and catalase) and impairing spermatogenic function (p<0.001). Despite testicular damage induced by ischemia-reperfusion, maslinic acid treatment produced a partial restoration of these markers (p<0.01). CONCLUSION: In summary, maslinic acid mitigates ischemia-reperfusion-induced testicular injury by enhancing superoxide dismutase and catalase activities while reducing reactive oxygen species.
BACKGROUND:Middle meningeal artery (MMA) embolization has emerged as a promising therapeutic option in the management of chronic subdural hematoma (cSDH). However, data specifically focusing on trauma-related cSDH remain limited. This study aimed to evaluate the safety and clinical outcomes of MMA embolization in patients with trauma-related cSDH and to investigate radiological predictors of treatment success. METHODS:This retrospective study included patients with trauma-related cSDH who underwent MMA embolization at our institution between 2024 and 2025. Demographic, clinical, and radiological data-including midline shift (MLS) and hematoma thickness-were systematically collected. Functional outcomes were assessed using the modified Rankin Scale (mRS). Recurrence, need for surgical intervention, procedural complications, and mortality were recorded. Receiver operating characteristic (ROC) analysis was performed to evaluate the predictive value of midline shift for treatment failure. RESULTS:A total of 52 patients with a documented history of trauma were included. Embolization alone was performed in 43 patients (82.7%), whereas nine patients (17.3%) underwent combined embolization and surgical treatment. Preprocedural MLS was significantly greater in the embolization-plus-surgery group than in the embolization-only group (7.6±3.9 mm vs. 4.5±3.8 mm, p=0.03). No significant between-group differences were observed in residual hematoma thickness or MLS at 6 weeks (p>0.05). Functional out-comes improved at 90 days compared with baseline. An MLS threshold of 4.5 mm demonstrated the highest predictive accuracy for treatment failure, with a sensitivity of 78% and a specificity of 56%. CONCLUSION:MMA embolization appears to be a safe and clinically feasible treatment option for trauma-related cSDH. In carefully selected patients, it may serve as both an adjunct and an alternative to surgery. MLS may represent a practical and readily accessible parameter for risk stratification and patient selection. Prospective controlled studies are warranted to further validate these findings.
BACKGROUND:Burns resulting from pressure cooker explosions are preventable domestic injuries that occur during routine kitchen use; however, they are underrepresented in the medical literature despite their potential severity. This study aimed to evaluate the clinical and demographic characteristics, treatment approaches, and outcomes of patients with pressure cooker-related burns. METHODS:In this retrospective study, medical records of patients who presented to a tertiary burn center with pressure cooker-related burns between 2016 and 2024 were reviewed. Collected data included demographic characteristics, burn location and depth, total body surface area (TBSA), time to hospital admission, treatment modalities, and clinical outcomes. RESULTS:A total of 41 patients were included in the study. The vast majority were female (97.6%), with a mean age of 36.2±13.5 years. Most injuries were second-degree burns (92.7%). The most commonly affected anatomical regions were the head and neck (65.9%) and the anterior chest (61%). Escharotomy was performed in 29.3% of patients, and 2.4% required skin grafting. Delayed hospital presentation was significantly associated with an increased need for surgical intervention (p=0.001). CONCLUSION:Pressure cooker-related burns predominantly affect women and frequently involve cosmetically and functionally important anatomical regions. Although the total burn surface area is often limited, the depth and location of these injuries may lead to significant complications. These findings highlight the importance of increasing public awareness regarding the safe use of pressure cookers and emphasize the need for prompt medical evaluation to reduce morbidity. Overall, the results underscore the seriousness of domestic burn injuries and the importance of preventive public health measures.
BACKGROUND:Pediatric femoral neck fractures are rare but carry a high risk of complications such as avascular necrosis (AVN), premature physeal closure, and coxa vara. Although stable internal fixation is essential, the optimal number of cannulated screws remains controversial. This study compares the clinical and radiological outcomes of two- versus three-screw fixation in a homogeneous cohort of Delbet type II fractures. METHODS:Thirty-six children treated within three days of injury and followed for at least five years were retrospectively analyzed. All fractures were fixed using either two or three cannulated screws. Surgical variables included reduction quality, screw number, physeal penetration, screw-to-neck area ratio, and the presence of cortical comminution. Patients were stratified into two age groups (<10 and ≥10 years). Complications-AVN, premature physeal closure, and coxa vara-were assessed radiographically and classified using established criteria. Statistical comparisons were performed using appropriate parametric and nonparametric tests. RESULTS:Older children (≥10 years) showed higher rates of total complications, AVN, and physeal closure; however, the differences were not statistically significant. Medial or posterior cortical comminution significantly increased complication rates. Physeal penetration markedly elevated the risk of premature physeal closure (p=0.045). Reduction quality strongly correlated with outcomes, with unacceptable reductions associated with significantly higher rates of AVN and physeal closure. The number of screws did not significantly influence overall complications or specific adverse outcomes. The screw-to-neck area ratio showed a nonsignificant trend toward higher values in patients with complications. CONCLUSION:Anatomical reduction and avoidance of physeal penetration are the primary determinants of postoperative outcomes in pediatric Delbet type II femoral neck fractures. When reduction is adequate and biological structures are preserved, the use of two or three screws yields comparable long-term results.
BACKGROUND: Traumatic posterior meniscal root tears disrupt normal load transmission, resulting in meniscal extrusion and accelerated osteoarthritis. Although transtibial pull-out repair is widely used, creation of a 4.5-mm tibial tunnel at the joint surface may cause iatrogenic chondral and subchondral bone damage at the root footprint. This study aimed to compare the clinical and radiological outcomes of a modified aperture-preserving pinhole technique, designed to avoid reaming at the tibial joint surface, with those of the standard transtibial pull-out repair. METHODS: A total of 60 patients with symptomatic posterior meniscal root tears treated between December 2021 and December 2024 were retrospectively analyzed. Patients were divided into two groups according to the surgical technique used. The standard pull-out group (n=30) underwent transtibial repair using a 4.5-mm tibial tunnel created by reaming at the joint surface for suture passage. The modified pinhole group (n=30) was treated with an aperture-preserving technique in which fixation was achieved through a narrow pinhole channel without reaming or drilling at the tibial articular surface, thereby preserving the subchondral bone at the root footprint. In both groups, final fixation was performed using a cortical post-fixation screw. Clinical evaluations were performed preoperatively and at 6 and 12 months postoperatively using the Lysholm Knee Score, International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Visual Analog Scale (VAS) for pain. Radiological assessment was conducted using magnetic resonance imaging to evaluate meniscal extrusion and healing status, classified as complete healing, partial (loose) healing, or failed healing. RESULTS: Both groups demonstrated significant improvement in all functional outcome scores compared with preoperative values (p<0.001). At the 12-month follow-up, the modified pinhole group showed significantly higher Lysholm, IKDC, and KOOS scores than the standard pull-out group, whereas improvements in VAS pain scores were comparable between groups. Meniscal extrusion decreased postoperatively in both groups, with a significantly greater reduction observed in the modified pinhole group. Complete healing was observed in 80% of patients in the modified pinhole group and 60% in the standard pull-out group. No major complications were recorded during the follow-up period. CONCLUSION: Both surgical techniques resulted in satisfactory clinical and radiological outcomes for posterior meniscal root repair. However, the aperture-preserving modified pinhole technique was associated with superior functional outcomes, reduced progression of meniscal extrusion, and a higher rate of complete healing. Preservation of the subchondral bone and minimization of iatrogenic joint surface damage may positively contribute to meniscal root healing.
BACKGROUND:This study aimed to evaluate the advantages of using double fluoroscopy during closed reduction and internal fixation of femoral neck fractures. METHODS:In this prospective randomized study, 42 patients with femoral neck fractures treated between January 2021 and Sep-tember 2022 were included. Patients were randomly assigned to one of two groups: double fluoroscopy (Group A, n=20) or single fluoroscopy (Group B, n=22). The groups were compared in terms of preparation time, operative time, preparatory radiation time, and intraoperative radiation time. RESULTS:Baseline characteristics were comparable between the groups. There were no significant differences in age, sex, fracture side, fracture classification (Garden and Pauwels), mechanism of injury, anesthesia method, time to surgery, or duration of follow-up. The mean operative times were 73.1±7.25 minutes and 85.59±9.94 minutes for the double and single fluoroscopy groups, respectively (p<0.001). Total radiation times were 92.2±8.4 seconds and 113.27±18.1 seconds, respectively (p<0.001). Both operative and radiation times were significantly shorter in the double C-arm fluoroscopy group compared to the single C-arm fluoroscopy group. CONCLUSION:The use of a double fluoroscopy technique was associated with a significant reduction in operative time and radiation exposure overall in patients.
BACKGROUND:This study aimed to compare the clinical effectiveness of negative pressure wound therapy (NPWT) with traditional wet-to-dry dressings in patients undergoing fasciotomy for acute compartment syndrome of the lower extremities following the February 6, 2023 earthquakes in Kahramanmaraş, Türkiye. METHODS:This retrospective cohort study included 28 patients (15 males, 13 females) admitted to our hospital between February 6 and March 6, 2023, who underwent fasciotomy for lower extremity acute compartment syndrome. A total of 109 fasciotomy incisions were performed across 60 extremities. Of these, 78 wounds were managed with NPWT and 31 with wet-to-dry dressings. Group allocation was determined by NPWT device availability during the disaster period. All patients were managed using a standardized wound closure protocol, including serial debridement followed by primary closure or split-thickness skin grafting when indicated. Outcomes compared between groups included number of debridements, infection rate, primary wound closure, graft requirement, dressing-related complications, and length of hospital stay. RESULTS:The NPWT group required significantly fewer debridements (p<0.05). Dressing-related complications and the need for additional dressing interventions were significantly higher in the wet-to-dry group (p<0.05). No significant differences were observed between groups in infection rate, primary wound closure, graft requirement, or length of hospital stay (p>0.05). Among pediatric patients, infection rates were lower than in adults, whereas unplanned dressing changes were significantly more frequent (p<0.05). CONCLUSION:NPWT is an effective wound management modality in fasciotomy patients, even under disaster conditions. It significantly reduced the need for debridement and dressing-related complications compared to traditional methods, despite similar outcomes in infection and wound closure. These findings support the preferential use of NPWT in mass-casualty settings, where healthcare personnel and resources may be limited. In addition to its clinical benefits, NPWT offers logistical advantages by simplifying wound care and reducing healthcare workload. Future prospective, randomized, multicenter studies are needed to confirm these findings and evaluate the broader applicability and cost-effectiveness of NPWT in both disaster and routine clinical settings.
BACKGROUND:This retrospective study aimed to evaluate anesthesia management, intraoperative support strategies, and 60-day clinical outcomes in patients requiring surgical intervention, including fasciotomy and/or amputation, due to crush and compartment syndrome following the February 6, 2023, Kahramanmaraş earthquakes. The study also sought to identify predictors of mortality and contribute to the field of disaster medicine. METHODS:This single-center study reviewed the data of 64 patients who underwent emergency surgery between February 6 and April 6, 2023. Retrospectively collected and analyzed data included patient demographics, ASA (American Society of Anesthesiologists) physical status classification, anesthesia techniques used, intraoperative support provided, and 60-day follow-up clinical outcomes, including mortality, renal function, and muscle necrosis markers. RESULTS:Most patients (93.8%) underwent surgery under general anesthesia due to systemic instability. This finding highlights the critical role of the systemic effects of traumatic injuries and crush syndrome in the choice of anesthesia. The 60-day mortality rate was 11.1%. Significant decreases in muscle necrosis markers, such as CK, AST, and ALT, were observed after fasciotomy. This finding suggests that even delayed fasciotomy may be effective in reducing the systemic toxic load. A key finding was that the preoperative albumin/lactate ratio was identified as a strong and independent predictor of mortality. This ratio may serve as a practical biomarker for patient risk stratification and prognosis. CONCLUSION:In cases of crush and compartment syndrome following an earthquake, general anesthesia was widely preferred over regional techniques because of patients' severe systemic instability. The data show that surgical interventions, such as fasciotomy, can successfully reduce the systemic toxic load and improve patient outcomes. Furthermore, a simple biomarker, such as the preoperative albumin/lactate ratio, could be a critical tool for predicting patient risk and mortality, especially in resource-limited settings following a disaster. This study provides important information for planning anesthesia and surgical management strategies in similar disaster situations.
BACKGROUND:Fournier's gangrene is a rapidly progressive, life-threatening necrotizing infection of the perineal and genital re-gions, associated with persistently high mortality despite advances in surgical and intensive care. Early and reliable prognostic assess-ment is essential for improving patient outcomes. This study aimed to evaluate the prognostic performance of the Shock Index (SI) in predicting mortality in patients with Fournier's gangrene and to compare its discriminatory ability with established scoring systems. METHODS:This retrospective cohort study included adult patients diagnosed with Fournier's gangrene who presented to the emergency department of a tertiary university hospital and underwent surgical debridement between January 2015 and December 2024. Demographic, clinical, and laboratory data were extracted from institutional and national electronic health records. Survivors and non-survivors were compared using appropriate statistical tests. Variables associated with mortality were assessed using logistic regression analysis. Receiver operating characteristic (ROC) analysis was performed to evaluate the predictive performance of SI and conventional scoring systems, and the optimal SI cut-off for mortality prediction was determined using Youden's index. RESULTS:A total of 158 patients (mean age 62.3±13.4 years; 86.1% male) were included, with an overall mortality rate of 17.1%. Non-survivors were significantly older (p<0.001), and comorbidities including coronary artery disease, chronic heart failure, and chronic renal failure were significantly associated with mortality. At admission, non-survivors had higher heart and respiratory rates and lower systolic blood pressure. ROC analysis demonstrated that the Shock Index had the highest discriminatory performance for mortality prediction (area under the curve=0.952; 95% confidence interval 0.918-0.986; p<0.001), outperforming the Fournier Gan-grene Severity Index, Uludağ Fournier Gangrene Severity Index, Laboratory Risk Indicator for Necrotizing Fasciitis, and quick Sequen-tial Organ Failure Assessment. An optimal SI threshold of 0.866 yielded 92.6% sensitivity and 83.2% specificity. CONCLUSION:The Shock Index demonstrated superior prognostic accuracy compared with conventional scoring systems in patients with Fournier's gangrene. Given its simplicity and reliance on two readily available hemodynamic parameters, SI represents a practical tool for early risk stratification. Prospective, multicenter studies are needed to further validate its clinical utility.
BACKGROUND:Hip fractures are a major public health problem associated with substantial mortality and morbidity, particularly among older adults. More than 90% of hip fractures occur in individuals aged 50 years and older, and the incidence increases with age because of osteoporosis and declining bone quality. This study aimed to examine the association between surgical treatment method and short- and long-term mortality after hip fracture, with an emphasis on age-stratified outcomes. METHODS:This retrospective cohort study included patients aged 65 years and older who underwent surgery for hip fracture at a tertiary care center. Age and time to surgery were analyzed as continuous variables, whereas sex, surgical method, comorbidities, and follow-up status were analyzed as categorical variables. Baseline characteristics were compared between surgical treatment groups using the independent samples t-test or Mann-Whitney U test for continuous variables and the chi-square test for categorical variables, as appropriate. Cumulative mortality at predefined time points was assessed descriptively, and overall survival was evaluated using Kaplan-Meier survival analysis with comparisons performed using the log-rank test. RESULTS:A total of 885 patients met the inclusion criteria; 509 patients (57.5%) underwent hemiarthroplasty and 376 patients (42.5%) underwent osteosynthesis. There was no significant difference in one-year cumulative mortality between the groups (p=0.984). At five years, cumulative mortality was higher in the hemiarthroplasty group than in the osteosynthesis group (68.1% vs. 58.5%, p=0.003). Among patients with a Charlson Comorbidity Index ≤5, five-year cumulative mortality was also higher following hemiarthroplasty (61.1% vs. 50.1%, p=0.010). Kaplan-Meier analysis demonstrated significant differences in overall survival between the surgical treatment groups. CONCLUSION:Higher long-term mortality following hemiarthroplasty was more evident among younger elderly patients and those with a lower comorbidity burden, whereas differences were less pronounced in older patients or those with greater comorbidity.
BACKGROUND:Acute appendicitis during pregnancy is the most common indication for non-obstetric emergency surgery. However, physiological changes associated with pregnancy can reduce the sensitivity of its clinical signs and symptoms. This study aimed to compare the diagnostic performance of the Alvarado, Appendicitis Inflammatory Response (AIR), Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA), and Tzanakis scoring systems in pregnant patients, as well as to evaluate surgical outcomes. METHODS:A total of 39 pregnant patients who underwent surgery for acute appendicitis between January 2017 and January 2025 were retrospectively analyzed. Demographic characteristics, gestational age, clinical presentation, laboratory parameters (white blood cell count [WBC], C-reactive protein [CRP]), ultrasonography findings, surgical approach (open vs. laparoscopic), histopathological results, and maternal and fetal outcomes were recorded. Alvarado, AIR, RIPASA, and Tzanakis scores were calculated for each patient. Patients were stratified into risk categories based on established cut-off values from the literature, and diagnostic performance was assessed against histopathological findings. RESULTS:The mean age was 26.0±5.3 years, and the mean gestational age was 19.6±7.9 weeks; 53.8% of patients were in the second trimester. Open appendectomy was performed in 61.5% of cases, while 38.5% underwent laparoscopic appendectomy. High-risk classification rates were 66.7% for Alvarado, 69.2% for AIR, and 79.5% for both RIPASA and Tzanakis scores. Histopathology confirmed acute appendicitis in 66.7% of patients, perforated appendicitis in 15.4%, and a normal appendix in 17.9%. WBC and CRP levels were significantly higher in patients with confirmed appendicitis (p<0.05). The highest sensitivity and specificity were observed with the RIPASA (93.7% and 85.7%, respectively) and Tzanakis (90.6% and 71.4%) scoring systems. Laparoscopic surgery was associated with a shorter hospital stay compared to open surgery (p<0.001), with comparable maternal and fetal safety outcomes. CONCLUSION:Clinical scoring systems are effective and reliable tools for diagnosing acute appendicitis in pregnant patients, with the RIPASA score demonstrating the highest diagnostic accuracy. Elevated CRP levels and leukocytosis may further support diagnosis. Laparoscopic appendectomy is a safe option associated with a shorter hospital stay compared with open surgery. These findings support the safe use of both clinical scoring systems and laparoscopic surgery in pregnant patients.
BACKGROUND: Hand injuries, particularly tendon injuries, are a common reason for emergency department visits and may significantly impact daily functioning. Traditional diagnostic approaches may fail to detect partial tendon injuries, highlighting the need for alternative imaging techniques. Ultrasonography (USG) has emerged as a rapid, non-invasive, and effective diagnostic tool for tendon injuries, particularly in emergency settings where magnetic resonance imaging (MRI) may not be readily available. This study evaluates the diagnostic effectiveness of ultrasonography in assessing tendon injuries among patients presenting with hand trauma in the emergency department (ED). Ultrasonography findings were compared with clinical evaluations to determine its role in diagnosing tendon injuries and guiding surgical management. This prospective observational study was conducted in the ED of a single tertiary-care hospital over a one-year period and included adult patients presenting with hand injuries. METHODS: Patients who met the inclusion criteria underwent both clinical evaluation and ultrasonographic examination. A total of 68 patients were included in the study. All assessments were performed by an experienced emergency medicine physician using a Philips Affinity S70 ultrasonography system (Philips Healthcare, Bothell, WA, USA). Collected data included patient demographics, injury characteristics, ultrasonographic findings, and the need for surgical intervention. Statistical analyses were performed using the chi-square test and binary logistic regression to compare the diagnostic performance of the two methods. RESULTS: Ultrasonography demonstrated a sensitivity of 82.6% (95% confidence interval [CI]: 0.69-0.91), specificity of 90.9% (95% CI: 0.70-0.98), and an overall accuracy of 85.3% (95% CI: 0.75-0.92) in predicting the need for tendon repair. Clinical evaluation showed slightly lower diagnostic performance, with a sensitivity of 80.4% (95% CI: 0.67-0.89) and an accuracy of 80.9% (95% CI: 0.70-0.89). CONCLUSION: Regression analysis indicated that ultrasonography increased the likelihood of accurately diagnosing tendon injuries by 21.8 times compared to clinical assessment. Together, clinical evaluation and ultrasonography predicted 61% of all cases requiring tendon repair.
BACKGROUND: Liver trauma remains a major contributor to morbidity in patients with abdominal injuries. Although nonoperative management (NOM) is widely accepted in hemodynamically stable patients, the relationship between American Association for the Surgery of Trauma (AAST) injury grade, laboratory parameters, transfusion requirements, and the need for surgical intervention remains unclear. METHODS: This retrospective observational study included 53 patients with radiologically or intraoperatively confirmed liver lacerations treated at a tertiary surgical center between October 2024 and May 2025. Data collected included demographics, vital signs, AAST injury grade, laboratory values, transfusion requirements, imaging use, and clinical outcomes. Statistical analyses were performed using analysis of variance (ANOVA), chi-square/Fisher's exact tests, and logistic regression. RESULTS: The mean age was 41.4 years, with 67.9% of patients being male. The most common mechanism of injury was motor vehicle accidents (56.6%). On admission, 64.2% of patients had AAST grade I-II injuries, while 7.5% had grade IV injuries. NOM was successful in 81.1% of cases, with 18.9% requiring operative intervention. No in-hospital mortality was observed. Changes in hemoglobin and hematocrit levels were not significantly associated with injury grade or the need for surgery. However, transfusion requirements increased with injury severity, including erythrocyte suspension (p=0.006) and fresh frozen plasma (p<0.001). Follow-up imaging (n=25) demonstrated stable or improved findings in 96% of patients. Logistic regression analysis did not identify independent predictors of surgical intervention. CONCLUSION: NOM of liver lacerations is safe and effective, with excellent outcomes and no mortality observed in this cohort. Although AAST injury grade alone did not predict the need for surgery, transfusion requirements correlated with injury severity, highlighting their value as practical indicators in clinical decision-making.
BACKGROUND:In this rat model study, we examined the effects of topical and systemic nintedanib treatment on the development of post-laminectomy epidural fibrosis. METHODS:Thirty-two rats were divided into four equal groups (n=8 per group). An L1-L2 laminectomy was performed using standard microsurgical procedures. The control group underwent laminectomy only; the sterile saline group underwent laminectomy followed by sterile saline irrigation; the topical nintedanib group underwent laminectomy followed by topical nintedanib application; and the systemic nintedanib group underwent laminectomy followed by oral nintedanib administration. The degree of fibrosis was evaluated by histological examination. Plasma levels of matrix metalloproteinase-9 (MMP-9), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF), transforming growth factor beta-1 (TGF-β1), tumor necrosis factor-alpha (TNF-α), hydroxyproline (HYP), and myeloperoxidase (MPO) were compared among the groups. RESULTS:In the control group, two rats developed grade 2 epidural fibrosis, while six animals developed grade 3 fibrosis. The sterile saline group demonstrated a similar degree of fibrosis to the control group. In the topical nintedanib group, three, four, and one rat developed grade 1, grade 2, and grade 3 epidural fibrosis, respectively. In the systemic nintedanib group, five rats had grade 1 epidural fibrosis, whereas three rats had grade 2 fibrosis. Groups 3 and 4 showed significantly decreased plasma levels of MMP-9, IL-6, VEGF, TGF-β1, TNF-α, and HYP compared to Groups 1 and 2 (p<0.05). Plasma levels of these markers were lower in Group 4 than in Group 3; however, the difference was not statistically significant (p>0.05). Plasma MPO activity in the study groups was not altered following nintedanib treatment (p>0.05). CONCLUSION:The histological and biochemical findings of the present study indicate that nintedanib is a promising pharmacological agent for the prevention of post-laminectomy epidural fibrosis. Further studies with larger sample sizes and interval assessments are needed to clarify the effects of different dosages.
Effective pain management is a cornerstone in the treatment of patients with multiple rib fractures, as inadequate analgesia can impair ventilation and increase the risk of pulmonary complications. Bilateral rib fractures, in particular, can significantly compromise respira-tory mechanics, leading to hypoventilation, atelectasis, and hypoxemia. Regional analgesic techniques play a crucial role in improving respiratory function while reducing reliance on opioids and their associated adverse effects. We report the case of a patient with multiple bilateral rib fractures following thoracic trauma who presented with severe pain and compromised respiratory function. Initial management with systemic analgesic proved inadequate. Multimodal regional analgesia was therefore initiated with a bilateral erector spinae plane block, resulting in rapid pain relief and improved oxygenation. Given the limited duration of analgesia provided by a single-shot erector spinae plane block, thoracic epidural analgesia was subsequently established via epidural catheter. Continuous low-dose epidural local anesthetic infusion ensured sustained analgesia, prevented pain recurrence, and supported ongoing improvement in respiratory function throughout the clinical course. This case highlights that a multimodal regional analgesic approach, combining an erector spinae plane block followed by thoracic epidural analgesia, may represent an effective and feasible strategy for optimizing pain control and respiratory outcomes in patients with bilateral rib fractures. Such an approach may also reduce the need for systemic opioid therapy while optimizing clinical outcomes and minimizing associated risks.
Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder of the esophagus characterized by dysphagia and food impaction. Although uncommon, spontaneous esophageal perforation may occur, most frequently involving the distal esophagus and the gastroesophageal junction. These perforations are typically managed with surgical or endoscopic interventions. Early diagnosis and prompt initiation of treatment within the first 24 hours significantly reduce morbidity and mortality. The aim of this report is to demonstrate that gastroesophageal junction perforation secondary to eosinophilic esophagitis can be successfully managed conservatively, even in delayed presentations, and to contribute to the understanding of treatment strategies for this rare but potentially life-threatening complication. We report the case of a 35-year-old male with a 12-year history of EoE who presented to the emergency department with retrosternal pain, dyspnea, and hematemesis. Five days prior to presentation, he developed a sore throat and cherry-colored diarrhea after consuming grilled chicken and self-administered ibuprofen for symptom relief. Contrast-enhanced imaging and upper endoscopy revealed a perforation at the gastroesophageal junction. Due to the location of the lesion, endoscopic stenting or clipping was considered inappropriate. In the absence of signs of acute abdomen, mediastinitis, or significant fluid collection, a conservative management strategy was adopted. The patient was admitted to the intensive care unit and initially treated with intravenous ceftriaxone (2 g/day) and metronidazole (1.5 g/day), which were later changed to piperacillin-tazobactam (4.5 g every 6 hours) following infectious disease consultation. The patient remained clinically stable, and oral intake was initiated on day 6. Antibiotic therapy was discontinued on day 10, and the patient was discharged without complications. At the three-month follow-up, the patient reported recurrent and progressively worsening dysphagia. Control endoscopy performed at the previously visited center revealed a distal esophageal stricture preventing passage of the gastroscope; therefore, a 12-cm fully covered self-expandable esophageal stent was placed. The stent was removed 20 days later, and the patient remained asymptomatic during the subsequent six-month follow-up period. Spontaneous esophageal perforation secondary to EoE is a rare but potentially life-threatening complication. This case highlights that conservative management may be a viable alternative to surgical or endoscopic intervention not only in early-detected cases but also in carefully selected delayed presentations managed in a multidisciplinary setting. Long-term follow-up remains essential for the early detection and treatment of late complications, such as stricture formation.
