Background: Insomnia and sleep disturbances are common but often neglected symptoms in patients with carpal tunnel syndrome (CTS). In this study, generalized estimating equations (GEEs) were used to investigate temporal trends in insomnia severity and functional recovery following unilateral carpal tunnel release (CTR) and to explore differences in outcomes with respect to CTS laterality. Material and Methods: A prospective cohort of 39 patients with electrodiagnostically confirmed CTS underwent unilateral CTR. Functional status and symptom severity were assessed with the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ). Sleep quality and insomnia severity were measured with the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). Assessments were performed preoperatively and at 2, 6, and 12 weeks postoperatively. Time effects, group differences (unilateral vs bilateral CTS), and interaction effects were analyzed with GEEs adjusted for age, sex, BMI, disease severity, and surgical side. Results: BCTSQ symptom, functional, and total scores ( P < .001); ISI scores (median decline from 10 to 4; P < .001); and PSQI global scores ( P = .004) and domain scores for subjective sleep quality, sleep disturbances, and daytime dysfunction all improved significantly postoperatively. GEE analysis revealed significant time effects across all functional and sleep-related outcomes but no significant group-by-time interaction for PSQI or ISI scores, suggesting similar temporal trajectories between unilateral and bilateral CTS groups. However, significantly greater improvement in BCTSQ symptom severity was observed for patients with bilateral compared with unilateral CTS ( P = .047). Additionally, BCTSQ total scores and CTS severity were independently associated with ISI scores ( P < .05). Conclusions: Unilateral CTR leads to rapid, substantial improvements in sleep disturbance and hand function, even among patients with bilateral CTS. These findings support the use of CTR targeting the more symptomatic side and underscore a need to integrate structured sleep assessments into CTS management. They further indicate that GEE modeling offers a powerful approach to capturing recovery trajectories beyond simple preoperative and postoperative comparisons.

Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms that are commonly benign but may occasionally exhibit a malignant behavior. Herein, we describe a 57-year-old male patient with a previously benign SFT originating from the left zygomatic scalp that subsequently underwent malignant transformation with invasion into the left temporal lobe and metastases to the right 5 th rib and left femur. Although the patient underwent multiple surgical resections and received adjuvant radiotherapy and systemic chemotherapy, complete disease remission was not achieved. This case showed that SFTs have a malignant potential, encompassing both direct intracranial extension from adjacent soft tissues and the exceedingly rare occurrence of distant cerebral metastasis. Further, it emphasizes the considerable diagnostic and therapeutic complexities inherent in the management of such highly aggressive disease phenotypes.

Background: This study aimed to compare homemade and commercialized single-access port devices in terms of short-term surgical outcomes and medical costs. Materials and Methods: Consecutive patients with acute appendicitis who underwent emergency single-incision laparoscopic appendectomy at two regional hospitals between August 2013 and July 2024 were retrospectively included. Patient groups using two different port devices were compared in terms of surgical results and postoperative convalescence. Multivariate regression analysis was performed to evaluate the significance of selected port devices in terms of operation time, complications, time to resume a soft diet, postoperative length of stay, and medical costs. Results: Among 182 patients, 129 patients used homemade port devices and 53 patients used commercialized port devices. The clinical and surgical outcomes were similar between the two patient groups. Multivariate regression analysis showed that the homemade port device was associated with a longer operation time ( β = 8.277, 95% confidence interval: 2.137–14.418, P = 0.009). Conclusions: The outcomes of the homemade port device were similar to those of commercialized port devices except for longer operation time. The advantages of less expensive equipment costs of homemade port devices would lower the economic burden for patients undergoing single-incision laparoscopic appendectomy in low-resource environments.

Tuberculosis surgical site infections (TB SSIs) represent a rare but significant complication in diverse surgical contexts, accounting for less than 1% of all TB cases. They present unique diagnostic and management challenges due to their insidious clinical course, which differs markedly from typical bacterial infections. TB SSIs arise either through direct inoculation of mycobacteria into surgical wounds or reactivation of latent TB at sites of surgical trauma. Risk factors include immunosuppression, malnutrition, and the presence of surgical implants. Clinical presentation is characterized by chronic, nonhealing wounds with minimal acute inflammation, often weeks to months after surgery. Diagnostic approaches include microbiological testing (acid-fast bacilli smear, mycobacterial culture, molecular tests), histopathological examination revealing granulomas, and supportive imaging. Intraoperative findings typically include granulomatous tissue, caseous necrosis, and well-formed sinus tracts. Management requires extended antitubercular therapy (9–12 months) combined with adequate surgical debridement and often removal of infected implants. With appropriate treatment, outcomes are generally favorable, with most patients achieving complete wound healing and infection resolution. Prevention strategies include preoperative TB screening in high-risk patients, rigorous sterilization protocols, careful allograft screening, and surveillance for unusual SSI patterns. Recent outbreaks linked to contaminated bone grafts highlight the importance of vigilance and robust tissue banking protocols. Early recognition and multidisciplinary management are essential for optimizing outcomes in these challenging infections.

ABSTRACT Gallstone ileus (GI) is a rare condition characterized by nonspecific clinical symptoms and signs, often leading to delayed diagnosis and treatment. We describe the case of a 71-year-old female patient with a ten-year history of gallstones who was admitted to the hospital with symptoms of cholecystitis. The patient was scheduled to undergo laparoscopic cholecystectomy several days after initiating antibiotic therapy. On the fifth day of treatment, she suddenly experienced severe abdominal pain accompanied by vomiting. The patient exhibited stable vital signs and mild abdominal distension. Abdominal radiography revealed air-fluid levels and a radiopaque mass in the left abdomen. A CT scan indicated bowel obstruction due to an intraluminal mass approximately 3 cm in size, suspected to be a gallstone. The patient was successfully treated with enterolithotomy via laparotomy. Postoperative esophagogastroduodenoscopy revealed a fistula extending from the second to the third portion of the duodenum to the gallbladder. Medical literature emphasizes the importance of the history of gallstones and the role of computed tomography in diagnosing GI. Additionally, enterolithotomy alone is considered a safe and effective management strategy for GI.

Dear Editor, We will describe how different factors affect endoscopic portal vein formation into the tendon sheath during human clinical surgery. The type of anatomical structure involved, the surgeon’s level of experience, and the surgical instruments used are all important factors in determining the approach. Although studies in this field can provide useful insights, it is critical to consider any constraints in the study design. For example, the sample size should be large enough and sufficient to ensure that the findings are representative and applicable to broader clinical practice. Furthermore, the choice of anatomical model must be carefully addressed, as focusing on a specific kind may oversimplify the complications faced in actual surgical settings. Concerns about randomization and bias are also relevant. It is vital to clarify the procedures utilized to divide patients into various groups, as well as the tactics used to reduce researcher bias. Furthermore, parameters including measurement methodology, number of procedures, and patient recovery time should adhere to defined processes to ensure uniform data gathering and reporting. Clear procedures for evaluating surgical outcomes are essential, especially in terms of treatment-related harm. Using a consistent scoring system or an acknowledged classification approach can improve the accuracy of the results. Furthermore, while determining the impact of surgical experience on outcomes, it is critical to clarify what the experience entails and how it is measured. Greater experience or specific surgical procedures can have a major impact on the outcome of a treatment. In this context, we recommend that future research focus on the long-term results of tendon sheath access in living patients rather than relying primarily on cadaveric models. In example, applying knowledge and procedures gained in animal surgery can provide valuable insights that can be applied to human clinical practice. Animal surgery frequently faces similar anatomical and biomechanical obstacles, and novel procedures are developed that may inspire breakthroughs in human surgery. For example, enhanced minimally invasive methods in equine surgery or the use of modern imaging technology in veterinary settings could be used to improve surgical protocols in humans.[1] Integrating these findings with modern imaging techniques and biomechanical analysis could help us better understand the anatomical issues that arise in a diverse patient group, ultimately driving surgical innovation.

Dear Editor, A 21-year-old man presented to the emergency department with acute pain in the penis, which started with a pop-up sound after hitting of the erect penis with the perineum of his partner during sexual intercourse and was associated with immediate detumescence and gross swelling and blackish discoloration of the penis with abnormal bending (Fig. 1). There was no bleeding from the meatus. A single gentle attempt at catheterization was performed, which was successful. He was immediately taken to the operating room on the suspicion of penile fracture based on classic finding of eggplant deformity, and on exploration, approximately 1.5-cm transverse defect was seen on the right lateral aspect of the proximal shaft of the penis, which was repaired in watertight fashion (Fig. 2). On follow-up at 1 month, patient had no erectile dysfunction or abnormal curvature of the penis. Penile fracture occurs when there is a break in the tunica albuginea of the corpora cavernosa, due to sudden bending of the penis while erect, usually during intercourse.[1] It is diagnosed on the basis of classic history and examination findings; however, radiological tests may be required if diagnosis is unclear. The so-called “aubergine sign” or “eggplant deformity” (swelling, blackening, and abnormal S-shaped curvature of the penis) is classic of penile fracture.[2] If Buck’s fascia is also injured, the hematoma may spread beyond the penis into the perineum or the suprapubic region. Immediate surgery is required to prevent erectile dysfunction and maintain penile length and for relief in pain.[1]Figure 1: Eggplant deformity in penile fracture.Figure 2: Tear in tunica albuginea before and after repair.