INTRODUCTION: Cardiac and pulmonary involvement affects morbidity and mortality after lung resections. Studies have shown that patients have increased pulmonary artery pressure (PAP) and right ventricular (RV) dilatation after resection. Myocardial performance index (MPI) is a numerical value obtained using cardiac time intervals. It has a prognostic importance independent of heart rate changes in different clinical situations. The main purpose of this study is to show the prognostic value of MPI in predicting mortality and morbidity.
METHODS: This prospective study included 44 patients who applied to the thoracic surgery department between October 2014, April 2015 underwent lung resection. In the early post-operative period, pulmonary, cardiac functions of the patients were evaluated using non-invasive methods.
RESULTS: The mean age was 59.1±6.3 years, (39male- 5female). Lobectomy was performed in 37 patients and pneumonectomy was performed in 7 patients. Prolonged air leak, atrial fibrillation, pneumonia, hemorrhage requiring re-thoracotomy, bronchovascular fistula, cerebrovascular infarction were recorded as postoperative complications. Average hospital stay was 8.8±3.6 days. When the effects of gender, age, echocardiography reports on morbidity and mortality were examined, mortality was found to be significantly higher in patients with a change of MPI in the first week more than 0.11 (p=0.022).
DISCUSSION AND CONCLUSION: In our study, the amount of change in MPI in the early period after lung resection was found to be an important and independent variable in predicting mortality and probability of cardiovascular events of patients. Future studies are needed to test these results in larger populations.

INTRODUCTION: Anastomotic leakage after colorectal surgery is a serious complication associated with high mortality. Dextran has been reported to reduce blood viscosity and increase microcirculation. This study was conducted to investigate whether postoperative dextran infusion contributes to anastomotic durability.
METHODS: A total of 40 Wistar Albino rats were used in the study. There are two experimental groups that received Dextran for 3 and 7 days after colon anastomosis and two control groups that did not receive any treatment. Anastomotic burst pressure score was calculated. Anastomosis healing parameters were evaluated histopathologically.
RESULTS: The median bursting pressure observed with the inflammatory phase experiment group was significantly higher than the inflammatory phase control group (p=0.001). Mucosal re-epithelialization was higher than the control groups in both the inflammatory phase (p=0.005) and the proliferative phase (p=0.007).
DISCUSSION AND CONCLUSION: Dextran could be considered as a potential treatment for anastomosis protection due to its positive effect on mucosal re-epithelialization and especially its increase in premature burst pressure.

INTRODUCTION: Hip fractures in the elderly represent a major public health concern, associated with significant short-term mortality and functional decline. Early risk stratification upon admission is essential to guide clinical management. The stress index (SI), defined as the glucose-to-potassium ratio, has emerged as a potential prognostic biomarker in various acute medical conditions. However, its role in predicting mortality in patients with traumatic hip fractures remains underexplored.
METHODS: This retrospective study included patients aged ≥18 years who presented to the emergency department of a teratiary care hospital with traumatic hip fractures between January 1, 2022, and January 1, 2024. Data were obtained from electronic health records, including demographic information, laboratory values at admission, vital signs, comorbidities, and 30-day mortality outcomes. The SI was calculated as the glucose-to-potassium ratio. The primary outcome was 30-day all-cause mortality. Predictive performance was assessed using receiver operating characteristic (ROC) analysis, and model calibration was evaluated using the Hosmer–Lemeshow test and Brier score.
RESULTS: A total of 440 patients were included, with a 30-day mortality rate of 9.3% (n=41). The stress index was significantly higher among non-survivors (40.5 [IQR 33.6–47.5]) compared to survivors (32.4 [IQR 27.2–37.2], p<0.001). ROC analysis yielded an area under the curve of 0.794 (95% CI 0.726–0.860). The optimal cutoff value (Youden index) was 35.9, with 73.2% sensitivity and 76.4% specificity. Calibration metrics indicated good model fit and prediction accuracy.
DISCUSSION AND CONCLUSION: The admission SI is independently associated with 30-day mortality in elderly patients with traumatic hip fractures. As a rapid and accessible marker, it may enhance early risk stratification and inform clinical decision-making in emergency care settings.

INTRODUCTION: Although flexor tendon injuries are relatively uncommon, they pose significant challenges due to postoperative complications such as adhesion formation and tendon ruptures, potentially resulting in substantial functional impairment. Contemporary research efforts increasingly focus on optimizing surgical outcomes by targeting the biochemical and cellular mechanisms underlying tendon healing. This study aimed to investigate the effects of acellular dermal matrix (ADM) and epidermal growth factor (EGF) on tendon healing, biomechanical strength, and functional recovery in a rat Achilles tendon repair model.
METHODS: Thirty-three male Sprague-Dawley rats were randomly allocated into three groups: Group 1 (primary repair only), Group 2 (repair with ADM wrapping), and Group 3 (repair with ADM wrapping combined with local EGF injection). At six weeks postoperatively, functional recovery was assessed using the modified Achilles Functional Index (AFI), while biomechanical testing evaluated tensile strength. Histopathological analysis was performed to assess vascularization, fibroblast proliferation, inflammatory infiltration, and collagen deposition.
RESULTS: Group 3 exhibited significantly greater tensile strength compared to Group 1 (p<0.008), alongside markedly increased collagen deposition (p=0.007). Functional assessment revealed that AFI scores in Group 3 approximated those of healthy controls, suggesting superior restoration of tendon function. While no significant differences were observed among groups regarding vascularization, inflammatory infiltration or fibroblast activity, ADM usage was associated with enhanced fibroblast proliferation and improved collagen organization.
DISCUSSION AND CONCLUSION: The combination of ADM and EGF significantly improved tendon biomechanical strength and functional recovery in this experimental model. ADM provided a supportive scaffold for cellular integration, whereas EGF augmented collagen synthesis and promoted tissue regeneration. These findings highlight the potential of combined ADM and EGF therapy as a promising approach for enhancing tendon healing.

INTRODUCTION: Trigeminal neuralgia is an excruciating pain in one or more of the fifth cranial nerve’s branches. Our goal in this study was to report the surgical results of microvascular decompression for trigeminal neuralgia at a single center.
METHODS: In our center, we retrospectively analyzed 35 patients who operated with microvascular decompression for trigeminal neuralgia between 2013-2023. The patients had a minimum of 2 years of follow-up.
RESULTS: Twenty-four patients had right-sided, and 11 had left-sided trigeminal neuralgia. Sixteen of them were female, and 19 of them were male. The age interval was between 27-78 years old. The median age of patients was 57 years. Twenty-nine patients reported complete resolution of trigeminal neuralgia after microvascular decompression who did not have previous interventional pain treatment history. These patients did not have any persistent complications.
DISCUSSION AND CONCLUSION: Microvascular decompression for trigeminal neuralgia is a safe and effective treatment modality. Patients with trigeminal neuralgia that are resistant to medical therapy are ideal candidates for microvascular decompression surgery.

INTRODUCTION: The primary objective is to investigate the potential synergistic effects of concurrent metformin administration alongside enzalutamide therapy in patients with metastatic castration-resistant prostate cancer (mCRPC). The study aims to uncover novel mechanisms that could lead to enhanced treatment outcomes, including more durable responses, delayed disease progression, and prolonged survival. This exploration seeks to provide critical insights that could expand the therapeutic options available for mCRPC patients.
METHODS: This retrospective study evaluated the impact of metformin on progression-free survival (PFS) in 92 patients with mCRPC who received second-line enzalutamide. Patients were divided into two groups: 65 Received enzalutamide alone, while 27 were treated with both enzalutamide and metformin. The primary endpoint was PFS. Statistical analyses, including Kaplan-Meier survival analysis and log-rank tests, were used to compare PFS between the two cohorts, aiming to assess the benefits of metformin in this treatment context.
RESULTS: The analysis revealed that the mean survival time for the enzalutamide-only group was 23 months, while the mean for the enzalutamide-plus-metformin group was 18 months. However, the log-rank test showed no statistically significant difference between the two groups, suggesting that these trends may not indicate a true difference in treatment effectiveness. The median survival times were both 12 months for each treatment cohort, further emphasizing the lack of significant improvement in progression-free survival with the addition of metformin.
DISCUSSION AND CONCLUSION: This retrospective study explored the effects of adding metformin to enzalutamide therapy in patients with mCRPC after docetaxel treatment. Although mean survival times suggested a potential benefit for the combination, statistical analysis revealed no significant differences in median survival between the two groups. These findings may be influenced by biases inherent in the retrospective design and the small sample size. Thus,
further research with larger cohorts and longer follow-up is needed to rigorously evaluate the benefits of the metformin-enzalutamide combination in managing mCRPC.

INTRODUCTION: This study aims to evaluate the antioxidant and anti-inflammatory effects of genistein in preventing damage caused by ovarian torsion. Ovarian torsion is an emergency condition characterized by the complete or partial rotation of the ovary on its supporting ligaments and can affect women of all age groups. Rapid diagnosis is crucial for preserving ovarian function and preventing associated complications. However, due to the relatively
nonspecific nature of symptoms, making a diagnosis can be challenging.
METHODS: In the study, 21 Sprague-Dawley female rats of about four months old, weighing 200–250 g, were used. The study involved three groups of rats: torsion (T), torsion/detorsion (T/DT), and genistein therapy following torsion/detorsion (T/DT/G). Ovarian ischemia was induced in the T and T/DT groups, with the latter undergoing detorsion after 3 hours. The T/DT/G group received genistein treatment (1 mg/kg/day) for 14 days post-detorsion. After treatment, samples were collected for histological and biochemical analysis, including Enzyme-Linked ImmunoSorbent Assay for serum samples and assessment of tissue damage and blood parameters.
RESULTS: Our study focuses on genistein, a phytoestrogen described as having similar effects to endogenous estrogen and has gained importance and become an area of interest through advancing research.
DISCUSSION AND CONCLUSION: This study demonstrates that genistein could be an effective protective treatment against post-ovarian torsion damage. However, more comprehensive studies are needed to establish the direct effects of genistein on the ovaries. This study presents important findings supporting the potential clinical use of genistein following ovarian torsion.

INTRODUCTION: Lower extremity amputation (LEA) remains a common intervention for diabetic patients with advanced peripheral vascular disease and foot complications. However, reamputation rates remain high, impacting patient morbidity, rehabilitation, and survival. This study aims to identify clinical and laboratory predictors of reamputation in diabetic patients undergoing LEA and to compare characteristics between those requiring a single surgery and
those undergoing additional procedures.
METHODS: A retrospective review was conducted on 650 diabetic patients who underwent LEA at a tertiary care center between 2020 and 2025. Patients were grouped as single-operation (Group 1, n=480) or reamputation (Group 2, n=80). Demographic, surgical, and laboratory data were analyzed. Comparative statistics were performed using t-tests, chi-square, and Mann-Whitney U tests with a significance level of p<0.05.
RESULTS: Reamputation was required in 14.2% of patients. The most common amputation level was transtibial in both groups. Cigarette use was significantly more frequent in Group 2 (40% vs. 20%, p=0.001). Although HbA1C and CRP levels were significantly higher in Group 2 (p=0.021 and p=0.001, respectively), no significant differences were found in WBC or INR values. Albumin and creatinine levels were significantly worse in Group 2 (p=0.005 and p=0.045, respectively). A greater proportion of Group 2 patients had an ASA score ≥3 (62.5% vs. 45%, p=0.011). Amputation side, age, and the frequency of transtibial or transfemoral amputation did not differ significantly between the groups.
DISCUSSION AND CONCLUSION: Reamputation remains a prevalent issue in diabetic LEA patients. High ASA scores were significantly associated with reoperation risk, underscoring the role of systemic disease burden. While HbA1C levels showed statistical differences, their clinical interpretation remains complex and warrants further prospective analysis. Multidisciplinary preoperative assessment is essential for improving outcomes and minimizing reamputation risk

INTRODUCTION: This study aimed to evaluate the colonoscopic and histopathological findings in patients with incidental focal colonic FDG uptake detected on PET/CT and to investigate the correlation between PET/CT findings and colonoscopy results.
METHODS: We retrospectively analyzed 37 patients (22 males, 15 females; mean age 64.2±9.5 years) who underwent colonoscopy within 6 weeks after detection of incidental focal colonic FDG uptake on PET/CT between January 2019 and March 2025. Patient demographics, PET/CT indications, localization of uptake, SUVmax values, and colonoscopy findings were recorded. Colonoscopy findings were classified according to histopathological results.
RESULTS: The most common PET/CT indications were gastrointestinal malignancies (27.0%), lung cancer (24.3%), and gynecological cancer (18.9%). The mean SUVmax value was 10.2±4.9. Colonoscopic evaluation revealed malignant lesions in 9 patients (24.3%), adenomas in 16 patients (43.2%), and normal/benign findings in 12 patients (32.4%). Malignant lesions included adenocarcinoma (18.9%), non-Hodgkin’s lymphoma (2.7%), and neuroendocrine tumor (2.7%). Among adenomas, tubular (18.9%), tubulovillous (13.5%), villous (5.4%), and serrated (5.4%) types were identified. The mean SUVmax value was significantly higher in patients with malignant lesions (13.5±5.1) compared to those with adenomas (8.6±3.5) and normal findings (6.1±2.3) (p<0.001). The correlation between PET/CT localization and colonoscopic findings was 100% for malignant lesions and 81.2% for adenomas.

DISCUSSION AND CONCLUSION: Incidental focal colonic FDG uptake on PET/CT warrants colonoscopic evaluation as a significant proportion of these patients have malignant or premalignant lesions. Higher SUVmax values are associated with an increased risk of malignancy.

INTRODUCTION: The aim of this study was to evaluate the clinical and angiographic outcomes of endovascular treatment (EVT) for intracranial aneurysms (IA). The efficacy and safety of coil embolization, flow diverter (FD), and coil + FD combination were examined.
METHODS: Between 2019 and 2022, 110 patients who underwent EVT in two centers were retrospectively analyzed. Demographic data, aneurysm characteristics, treatment modalities, and procedural outcomes were compared. The primary endpoint was complete aneurysm occlusion as assessed by the Raymond-Roy Occlusion Classification (RROC). Secondary endpoints included complication rates, neurologic outcomes, and clinical outcomes at follow-up (modified Rankin Scale (mRS)).
RESULTS: Of the 110 patients included in the study, 84.5% had aneurysms localized in the anterior circulation and 15.5% in the posterior circulation. The rates of RROC 1 were 69.8% in the coil group, 71.8% in the FD group, and 71.4% in the coil+FD group (p=0.231). Thromboembolic complication rates were higher in the FD (20.5%) and coil + FD (21.4%) groups, while intraoperative rupture rates were 10.3% in the FD group. In terms of neurologic outcomes, mRS 0-2 rates were 93.0% in the coil group, 89.7% in the FD group and 85.7% in the coil + FD group (p=0.161).
DISCUSSION AND CONCLUSION: EVT is an effective method in the treatment of IAs. Although the clinical and angiographic results of coil, IA and coil + FD combinations are similar, thromboembolic complications have been shown to be higher in the groups using IA. The need for individualized patient management and long-term follow-up in treatment selection is emphasized.

INTRODUCTION: The aim of this study is to compare the relationship between cerebroplacental ratio (CPR) and adverse perinatal outcomes in pregnant women with preterm premature rupture of membranes (PPROM).
METHODS: This prospective observational study included pregnant women who were at 24−36 weeks’ gestation, had a singleton pregnancy and were diagnosed with PPROM. CPR were analysed in two groups (<1 and >1). Birth indication, delivery method, birth weight and poor perinatal outcomes were recorded. Foetal compromise was used as one of the determinants of the labour decision. Foetal compromise was diagnosed in those with category 3 foetal heart rate trace based on the ACOG guideline.
RESULTS: Fetal compromise was significantly higher in the CPR of <1 group than in the CPR of >1 group (28.6 vs. 6.9%, p=0.006). No significant difference was observed between the low and high CPR groups in terms of birth weight (2140±485.7 vs. 2225±470.1, p=0.390) and 5th min APGAR scores (9 vs. 10, p=0.159). Neonatal intensive care needs were comparable between the two groups (40% vs. 30%, p=0.332).
DISCUSSION AND CONCLUSION: Low CPR in PPROM is associated with foetal compromise. Clinicians might consider to use CPR in determining the foetal status during follow-up of a PPROM pregnancy.

INTRODUCTION: Carpal tunnel syndrome (CTS) is the most common compression neuropathy. Although its etiology is idiopathic, inflammatory processes are frequently implicated. Various inflammatory parameters obtained from complete blood count data are helpful in the diagnosis and prognosis of many inflammatory diseases. However, there is no consensus in the literature regarding the association between CTS and serum inflammatory markers. This study aimed to assess whether there were significant differences in various inflammatory markers between patients with severe CTS and healthy controls.
METHODS: In this retrospective study, we compared 40 patients who had unilateral severe CTS which is diagnosed by clinic symptoms and positive electrodiagnostic tests (EDT) with 42 healthy patients. We investigated serum inflammatory markers such as the monocyte/HDL-cholesterol ratio (MHR), red blood cell distribution width (RDW), mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and monocyte/lymphocyte ratio (MLR) in patients with unilateral severe CTS compared to a control group.
RESULTS: No significant difference was observed between the two groups in WBC, CRP, SED values analysed for the presence of active inflammation. No significant difference was observed between the two groups in the analysed parameters PLT, NEU, LYM, MON, and HDL (p>0.05). When inflammatory parameters were analysed, no difference was observed between the two groups in RDW, MPV, HDL, NLR, PLR, and MLR values (p>0.05).
DISCUSSION AND CONCLUSION: No significant association was found between serum inflammatory markers in the two groups, suggesting that inflammation in CTS may be localized.

INTRODUCTION: Pancreatic cystic neoplasia represents a challenging and complex spectrum of lesions within the pancreas and requires a detailed understanding of their biological behavior and clinical implications. We aimed to examine the demographic characteristics, imaging and histopathological features, and clinical outcomes of patients who underwent pancreatic surgery due to cystic neoplasms. Moreover the impact of sarcopenia and obesity on clinical outcomes was investigated.
METHODS: Patients who underwent pancreatic surgery with the preliminary diagnosis of pancreatic cystic neoplasia at the General Surgery Clinic of Kartal Dr. Lütfi Kýrdar City Hospital between 2010 and 2020 were retrospectively evaluated. The size, morphological features, location, and number of the cystic lesions were recorded. The presence of sarcopenia was determined by measuring the psoas muscle cross-sectional area at the L3 level with
preoperative CT and calculating the psoas muscle index.
RESULTS: The number of patients included in the study was 23 and the average age of these patients was 59.4 (SD: 14.3). 18 (78.3%) of the patients were women. The most common cyst type was mucinous cystic neoplasia (30.4%), followed by an adenoma (26%), ductal adenocarcinoma (26%) and IPMN (17.3%). The most common surgery was the Whipple procedure (56.5%). Sarcopenia was detected in 47.8% of the patients. Postoperative omplications were seen in 6 (26%) patients.
DISCUSSION AND CONCLUSION: This study provides valuable information regarding pancreatic cystic neoplasms’ pathological and clinical consequences. In particular, it is one of the few studies investigating the relationship between sarcopenia, obesity and pancreatic cystic neoplasms in the current literature.

INTRODUCTION: This study aimed to comparatively evaluate the impact of the surgical setting (emergency department vs. operating room) on postoperative complication rates in isolated Zone 2 flexor tendon injuries.
METHODS: Seventy patients who presented with isolated Zone 2 flexor tendon injuries and underwent primary surgical repair between January 2023 and December 2023 were retrospectively reviewed. Patients were divided into two groups according to the surgical setting: emergency department (Group 1, n=35) and operating room (Group 2, n=35). All patients underwent repair using a modified Kessler core suture technique combined with an epitendinous running suture, followed by rehabilitation with a modified Kleinert protocol. Patients were systematically evaluated over a 3-month postoperative period for tendon rupture, adhesion, flexion contracture, and infection.
RESULTS: There was no statistically significant difference between the groups regarding demographic characteristics (p>0.05). The tendon rupture rate in Group 1 (37.1%) was significantly higher compared to Group 2 (11.4%) (p<0.01). No statistically significant differences were observed between the groups regarding adhesion, flexion contracture, or infection rates (p>0.05). Additionally, no significant correlation was found between patient age and
the development of complications.
DISCUSSION AND CONCLUSION: The findings suggest that the surgical environment plays a critical role in post-operative outcomes following isolated Zone 2 flexor tendon repairs. Tendon rupture risk is significantly higher when repairs are performed under emergency department conditions. Therefore, performing flexor tendon repairs under sterile conditions with appropriate surgical equipment and experienced surgical teams in the operating room is strongly recommended.

INTRODUCTION: The development of targeted therapies for primary tumors and early diagnosis enabled by advanced imaging methods have extended survival in cancer patients. This study aims to evaluate the effectiveness of the Modified Bauer and Van der Linden classifications in determining survival in the Turkish population.
METHODS: Retrospective analysis was conducted on 83 patients who presented with spinal metastases at neurosurgery clinic from 2012 to 2020. Demographic characteristics, malignancy origin, metastasis region, and scores Modified Bauer, Vander Linden systems were detailed. Survival was calculated from the date of diagnosis and analyzed using statistical software.
RESULTS: The average age of the 83 patients was 59.6 years; 67 (80.72%) were male, and 16 (19.27%) were female. Primary tumor types included lung cancer (43.37%), urogenital tumors (32.53%), gastrointestinal tumors (14.45%), breast tumors (7.22%), and nasopharyn-geal tumors (2.4%). Thoracic involvement was present in 46.98%, lumbar in 39.75%, cervical in 8.43%, and sacral in 4.81%. In 45.78% of the patients, the diagnosis of a spinal mass led to further investigation to identify the primary tumor. The Modified Bauer score predicted survival accurately in 48.19% of patients, and the Van der Linden score in 46.99%. No significant difference was found between the tumor growth rate and the survival prediction accuracy of the classifications.
DISCUSSION AND CONCLUSION: While prognostic scoring systems provide useful guidance in managing spinal metastases, their predictive accuracy varies. These systems often underestimate survival predictions. Further improvements, including the development of new AI-assisted classifications, could enhance the accuracy of survival predictions and improve treatment strategies.