AIM:To evaluate seven patients with non-traumatic splenic rupture (NSR). NSR is an uncommon dramatic abdominal emergency that requires immediate diagnosis and prompt surgical treatment to ensure the patient's survival. METHODS: Within 11 years, seven cases were evaluated for patient characteristics, anamnesis and symptoms, method of diagnosis, findings of laparotomy, and etiology of NSR. RESULTS: There were six (86%) male and one female (14%) patient, whose mean age was 36 ± 12.8 (17-56) years. We report here four cases of Plasmodium vivax malaria (cases Ⅰ-Ⅳ), one case of hemodialysis (case Ⅴ), one case of spontaneous splenic rupture (case Ⅵ), and one case of hairy cell leukemia (case Ⅶ). Splenectomy was performed in all patients. All of them made an uneventful recovery and were discharged in stable condition. CONCLUSION: NSR is a rare entity that needs a high index of suspicion for diagnosis. Using ultrasonography or computer tomography, and peritoneal aspiration of fresh blood may assist in the diagnosis of NSR. Increased awareness of NSR can enhance early diagnosis and effective treatment.

CI = confidence interval; DG = delirious group; HBP = hepatobiliopancreatic diseases; ICU = intensive care unit; LSH = length of stay in hospital; LSICU = length of stay in the ICU; NDG = non-delirious group; OR = odds ratio. AbstractBackground Delirium is a sign of deterioration in the homeostasis and physical status of the patient. The objective of our study was to investigate the predisposing factors for delirium in a surgical intensive care unit (ICU) setting. Method Between January 1996 and 1997, we screened prospectively 818 patients who were consecutive applicants to the general surgery service of Dicle-University Hospital and had been kept in the ICU for delirium. All patients were hospitalized either for elective or emergency services and were treated either with medication and/or surgery. Suspected cases of delirium were identified during daily interviews. The patients who had changes in the status of consciousness (n = 150) were consulted with an experienced consultation-liaison psychiatrist. The diagnosis of delirium was based on Diagnostic and Statistical Manual of Mental Disorders (revised third edition) criteria and established through psychiatric interviews. Patients were divided into two groups: the 'delirious group' (DG) (n = 90) and the 'nondelirious group' (NDG) (n = 728). During delirium, all abnormal findings related to physical conditions, laboratory features, and additional diseases were evaluated as probable risk factors of delirium. Results Of 818 patients, 386 (47.2%) were male and 432 (52.8%) were female. Delirium developed in 90 of 818 patients (11%). The cases of delirium in the DG were more frequent among male patients (63.3%) than female patients (36.7%) (χ 2 = 10.5, P = 0.001). The mean age was 48.9 ± 18.1 and 38.5 ± 13.8 years in the DG and NDG, respectively (t = 6.4, P = 0.000). Frequency of delirium is higher in the patients admitted to the Emergency Department (χ 2 = 43.6, P = 0.000). The rate of postoperative delirium was 10.9%, but there was no statistical difference related to operations between the DG and NDG (χ 2 = 0.13, P = 0.71). The length of stay in the ICU was 10.7 ± 13.9 and 5.6 ± 2.9 days in the DG and NDG, respectively (t = 0.11, P = 0.000). The length of stay in hospital was 15.6 ± 16.5 and 8.1 ± 2.7 days in the DG and NDG, respectively (t = 11.08, P = 0.000). Logistic regression was used to explore the associations between probable risk factors and delirium. Delirium was not correlated with conditions such as hypertension, hypo/hyperpotassemia, hypernatremia, hypoalbuminemia, hypo/hyperglycemia, cardiac disease, emergency admission, age, length of stay in the ICU, length of stay in hospital, and gender. It was determined that conditions such as respiratory diseases (odds ratio [OR] = 30.6, 95% confidence interval [CI] = 9.5-98.4), infections (OR = 18.0, 95% CI = 3.5-90.8), fever (OR = 14.3, 95% CI = 4.1-49.3), anemia (OR = 5.4, 95% CI = 1.6-17.8), hypotension (OR = 19.8,3), hypocalcemia (OR = 30.9, 95% CI = 5.8-163.2), hyponatremia (OR = 8.2, 95% CI = 2.5-26.4)...

The objective of this study is to discuss the effective factors on morbidity and mortality in patients who were operated on for acute mesenteric ischemia. Between 2006 and 2011, 95 patients, who underwent emergent surgery for acute mesenteric ischemia, were analyzed retrospectively. The study group consisted of 56 men (58.9%) and 39 women (41.1%), with an average age of 68.4 ± 14.4 years. Elapsed time between the onset of the symptoms and the surgical operation was less than 24 hours in 47 (49.5%) cases, and more than 24 hours in 48 cases (50.5%) (P , 0.001). Although all of the patients had intestinal necroses, colon involvement was seen in 38 patients, and mortality was higher in this group of patients (P , 0.001). Mortality rate was 42.1%. This was higher in older patients, those with increased leukocyte levels, increased elapsed time to laparotomy, and when the colon was involved.

Treatment of large bladder stones by transurethrally placed nephroscope is a fast and effective treatment modality compared to endoscopic treatment via cystoscope. Nephroscope allows for use of larger forceps and facilitates collection of large stone fragments through its 24F sheath. It also prevents multiple entries to the urethra and hence avoids possible urethral injury. Combined pneumatic/ultrasonic lithotripsy device, with its aspiration quality, enables the surgeon to gain a better endoscopic view during both procedures.

Given the high frequency of antibiotics prescribed for surgical prophylaxis in Turkey, adherence to surgical prophylaxis guidelines is urgently needed.

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We investigated the effects of Antep pistachio on International Index of Erectile Function (IIEF) scores, penile color Doppler ultrasound (PCDU) parameters and serum lipid levels in patients with ED. A total of 17 married male patients with ED for at least 12 months were included in this prospective study. Patients were put on a 100 g pistachio nuts diet for 3 weeks. IIEF and PCDU were evaluated before and after the pistachio diet. In addition, plasma total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride were measured before and after dietary modifications from all subjects. Mean IIEF-15 score was 36±7.5 before the diet and 54.2±4.9 after the diet (P ¼ 0.001). Similarly, an increase in all five domains of IIEF was observed after the diet (Po0.05). Mean peak systolic velocity values before and after the pistachio diet were 35.5 ± 15.2 and 43.3 ± 12.4 cm s -1 , respectively (P ¼ 0.018). After the pistachio diet, TC and LDL levels decreased significantly, whereas HDL level increased (P ¼ 0.008, 0.007 and 0.001, respectively). We demonstrated that a pistachio diet improved IIEF scores and PCDU parameters without any associated side effects in patients with ED. Furthermore, the lipid parameters showed statistically significant improvements after this diet.

This study of elderly patients reveals some novel predictors of post-CABG AF, most notably preoperative renal insufficiency and EuroSCORE. It is important to identify risk factors for post-CABG AF in all patient groups as this knowledge might lead to better prevention of this problem and its potential consequences.