Introduction: Bouveret syndrome, a rare and often underdiagnosed variant of gallstone ileus, is characterized by the presence of a large gallstone impacted in the proximal duodenum, resulting in significant gastric outlet obstruction and aerobilia. Early identification of Bouveret syndrome is crucial for developing an appropriate surgical strategy. Case 1: A 76-year-old female underwent a contrast-enhanced abdominal CT scan, which revealed a cholecysto-duodenal fistula with a 3.9 cm × 4.0 cm × 4.0 cm gallstone located in the proximal duodenum, along with a distended, fluid-filled stomach and aerobilia. Intraoperatively, due to chronic inflammation and adhesion between the gallbladder and duodenum, a cholecystectomy and fistula repair were performed. Case 2: A 72-year-old female presented with a gastroduodenal passage obstruction confirmed by imaging, which identified a duodeno-biliary fistula. The radiological examination showed oval filling defects in the duodenal bulb consistent with Bouveret’s syndrome, with the largest stone measuring approximately 6 cm in diameter. An enterotomy was performed for stone extraction and was followed by cholecystectomy and duodenal repair with omentoplasty. Conclusions: Bouveret’s syndrome is a rare but clinically significant condition that should be considered in patients presenting with signs of upper gastrointestinal obstruction, particularly in those with a history of chronic cholelithiasis. Early recognition and prompt surgical intervention are essential for obtaining optimal patient outcomes.

Background: Isolated splenic metastases from endometrial cancer, which is a relatively common malignancy, are extremely rare findings; to date, only 14 cases have been reported in the literature. Case Summary: We report a patient with isolated splenic metastases of endometrial cancer 3 years after radical surgery of the primary tumor. The patient was successfully treated by splenectomy and six cycles of paclitaxel. Fifty months after splenectomy, she was alive and well, and with no evidence of disease. Conclusion: Isolated spleen metastasis of endometrial cancer is very rare. Radical surgery and adjuvant therapy may offer excellent long-term survival.

Background: Extra-abdominal manifestations of fat necrosis, like subcutaneous fat necrosis, polyarthritis, and polyserositis may appear with an occurrence rate of about 0.8%, wherein intraosseous fat necrosis is a more rare complication of pancreatitis, with few reports in English literature. Case report: A 34-year-old male with a 15-year-history of alcohol abuse was hospitalized several times in the last few years because of attacks of relapsed chronic pancreatitis. After the last attack, pancreatitis came in a stable state (“burned out”) with no symptoms and signs of the disease. The patient had been free of symptoms for 28 months since the last admission when he came with sub-febrile temperature, huge pain, swelling, and erythema in the area of the left lateral malleolar region with propagation in the foot. Blood biochemistry was normal. Conventional radiography showed multiple sites of osteolysis in the left calcaneus. Images on multislice computed tomography (MSCT) with 3D reconstruction revealed hypodense focuses that corresponded to osteonecrosis areas and bone marrow edema in the left calcaneus. Conclusions: The possibility of intraosseous fat necrosis should be considered in situations of unexplained polyarthritis or panniculitis, particularly in individuals with alcohol abuse or pancreatic disease.

Purpose of review: Dexmedetomidine has evolved from a sedative adjunct to a multimodal perioperative adjunct with effects extending beyond hypnosis and analgesia. Growing interest has focused on its opioid-sparing properties, modulation of the surgical stress response, hemodynamic stabilization, organ protection, and patient-centered recovery outcomes. This review summarizes the recent clinical and translational evidence relevant to perioperative and critical care use. Recent findings: Contemporary meta-analyses confirm consistent reductions in perioperative opioid requirements and postoperative pain. Dexmedetomidine attenuates neuroendocrine and inflammatory stress responses and provides predictable sympatholytic hemodynamic control. Emerging high-quality evidence suggests renoprotective effects and reduced postoperative acute kidney injury, whereas cardiopulmonary and neuroprotective benefits remain less definitive. Improvements in early recovery profile, including reduced delirium, smoother emergence, and shorter ICU stay, have been described, particularly in high-risk populations. Regional and pediatric applications demonstrate prolonged analgesia and reduced emergence agitation, while ICU studies indicate benefits primarily in delirium prevention and sleep quality rather than mortality. Summary: Current evidence supports dexmedetomidine as a multimodal adjunct that enhances perioperative stability and recovery quality rather than a standalone anesthetic or outcome-modifying therapy. Careful patient selection and dose titration are essential.

Background: Sepsis is a leading cause of mortality in intensive care units, with liver dysfunction representing a critical determinant of poor outcome, mainly associated with excessive inflammation and oxidative stress. Lycopene, a carotenoid with potent antioxidant and anti-inflammatory properties, has been proposed as a potential therapeutic agent. This study investigated whether lycopene supplementation mitigates lipopolysaccharide-induced oxidative and inflammatory liver injury in rats. Methods: Male Wistar rats, divided into four groups, were exposed to either lipopolysaccharide or a combination of lipopolysaccharide (10 mg/kg) and lycopene (6 mg/kg). In order to assess liver damage induced by lipopolysaccharide, hepatocellular injury markers, oxidative stress indices, nitric oxide metabolism, glutathione redox status, apoptotic enzyme activity, and inflammatory mediators were assessed in serum and liver tissue. Results: Lipopolysaccharide induced marked hepatocellular damage, characterized by elevated serum liver-cell damage parameters, and liver tissue xanthine oxidase, myeloperoxidase, thiobrabituric reactive substances, protein carbonyl content, deoxyribonuclease I/II activity, nuclear factor kappa B, tumor necrosis factor-α, and interleukin-6, alongside depletion of reduced glutathione and reduced glutathione reductase and glutathione peroxidase activities. Lyc pretreatment significantly attenuated liver enzyme leakage, oxidative damage, and cytokine release while restoring reduced glutathione and glutathione reductase activity. In contrast, lycopene had limited effects on glutathione peroxidase activity, nitric oxide/inducible nitric oxide synthase signaling, and nuclear factor erythroid 2-related factor 2 expression. Conclusions: These findings demonstrate that lycopene confers partial hepatoprotection in endotoxemic rats, primarily through suppression of oxidative damage and nuclear factor kappa B-mediated inflammation. Further studies are needed to clarify tissue-specific mechanisms and optimize dosing strategies in order to increase the efficacy of this carotenoid.

Background and Objectives: Postoperative delirium (POD) is a frequent and severe complication following cardiac surgery, particularly in high-risk patients undergoing coronary artery bypass grafting (CABG) and aortic valve replacement (AVR). Despite extensive research, predicting POD remains challenging due to the multifactorial and often non-linear nature of its risk factors. This study aimed to improve POD prediction using an interpretable machine learning approach and to explore the combined effects of clinical, biochemical, and perioperative variables. Materials and Methods: This study included 131 patients who underwent CABG or AVR. POD occurrence was assessed using standard diagnostic criteria. Clinical, biochemical, and perioperative variables were collected, including patient age, sedation type, and mechanical ventilation status. Machine learning analysis was performed using an XGBoost classifier, with model interpretation achieved through SHapley Additive exPlanations (SHAP). Univariate logistic regression was applied to identify significant predictors, while SHAP analysis revealed variable interactions. Results: POD occurred in 34.3% of patients (n = 45). Patients who developed POD were significantly older (67.7 ± 6.5 vs. 64.5 ± 8.7 years, p = 0.020). Sedation with mechanical ventilation and the type of sedative used were strongly associated with POD (both p < 0.001). Sedation during mechanical ventilation showed the strongest association (OR = 2520.0; 95% CI: 80.9–78,506.7; p < 0.00001). XGBoost classifier achieved excellent performance (AUC = 0.998, accuracy = 97.6%, F1 score = 0.976). SHAP analysis identified sedation, mechanical ventilation, and their interactions with fibrinogen, troponin I, leukocyte parameters, and lung infection as key predictors. Conclusions: This study demonstrates that an interpretable machine learning approach can enhance POD prediction, providing insights into the combined impact of multiple clinical, biochemical, and perioperative factors. Integration of such models into perioperative workflows may enable early identification of high-risk patients and support individualized preventive strategies.