ObjectivesCongestion is associated with worse outcomes in critically ill surgical patients but can be difficult to quantify noninvasively. We hypothesised that plasma volume status (PVS), estimated preoperatively using a validated formula that enumerates percentage change from ideal plasma volume (PV), would provide incremental prognostic utility after coronary artery bypass graft (CABG) surgery.MethodsIn this retrospective cohort study, patients who underwent CABG surgery (1999–2010) were identified from a prospectively collected database. Actual ([1-haematocrit] x [a+(b x weight [kg])]) and ideal (c x weight [kg]) PV were obtained from equations where a, b and c are sex-dependent constants. Calculated PVS was then derived (100% x [(actual−ideal)/ideal]).ResultsIn 1887 patients (mean age 67±10 years; 79% male; median European System for Cardiac Operative Risk Evaluation [EuroSCORE] 4), mean PVS was −8.2±9%. While 8% of subjects had clinical evidence of congestion, a relatively increased PV (PVS >0%) was estimated in 17% and correlated with lower serum sodium, higher EuroSCORE and a diagnosis of diabetes mellitus. A PVS≥5.6% was optimally prognostic and associated with greater mortality (HR: 2.31, p=0.009), independently of, and incremental to, EuroSCORE, New York Heart Association class and serum sodium. A PVS≥5.6% also independently predicted longer intensive care (β: 0.65, p=0.007) and hospital (β: 2.01, p=0.006) stays, and greater postoperative renal (OR: 1.61, p=0.008) and arrhythmic (OR: 1.29, p=0.03) complications.ConclusionsHigher PVS values, calculated simply from weight and haematocrit, are associated with worse inpatient outcomes after CABG. PVS could help refine risk stratification and further investigations are warranted to evaluate the potential clinical utility of PVS-guided management in patients undergoing CABG.

AIm:To raise the awareness of the appropriate management of unusual clinical presentation of cervical disc herniation. mAterIAl and methOds: Seven patients with Brown-Sequard syndrome due to cervical disc herniation presented with Brown-Sequard syndrome had been treated surgically as one of them treated with anterior cervical discectomy and three patients treated by anterior cervical discectomy and fusion while three of them have been treated by posterior laminectomy.results: Patients were 7 three of them were female and four were males and the mean age of our patients is 45.28±16.49 years ranged between 32 and 72 years. History of spinodegenerative disease in the form of chronic neck pain with or without brachialgia was found in 6/7 patients (85.7%) while history of trauma was found in 5/7 patients (71.4%). Most common affected level is C5-C6 disc Outcome after surgical treatment revealed complete recovery in 4/7 patients (57.1%) while incomplete recovery in 2 patients (28.6%) and no improvement in one patient (14.3%).COnClusIOn: Brown-Sequard syndrome is a rare presentation of cervical disc herniation but accurate diagnosis, and early anterior spinal cord decompression lead to complete recovery of these cases. KeywOrds:Cervical disc, Herniation, Brown-Sequard, Management ÖZ AmAÇ: Servikal disk herniasyonunun olağandışı klinik sunumunun uygun takibi konusunda farkındalığı arttırmak. yÖntem ve GereÇler: Servikal disk herniasyonu nedeniyle Brown-Sequard sendromu olan 7 hasta cerrahi olarak tedavi edildi. Bunların biri anterior diskektomi ile, üç hasta anterior servikal diskektomi ve füzyonla ve üç hasta posterior laminektomiyle tedavi edildi.BulGulAr: 7 hastanın üçü kadın ve dördü erkekti ve ortalama yaş 32 ile 72 aralığında olup 45,28±16,49 yıldı. Brakialji ile veya olmadan kronik boyun ağrısı şeklinde spinodejeneratif hastalık öyküsü 6/7 hastada mevcuttu (%85,7) ve travma öyküsü 5/7 hastada bulundu (%71,4). En sık etkilenen seviye C5-C6 diskti. Cerrahi tedaviden sonra 4/7 hastada tam iyileşme (%57,1), 2 hastada tam olmayan iyileşme (%28,6) oldu ve 1 hastada (%14,3) iyileşme olmadı. sOnuÇ: Brown-Sequard sendromu servikal disk herniasyonunun nadir bir sunumudur ama erken tanı ve erken anterior spinal kord dekompresyonu bu olgularda tam iyileşme sağlar.AnAhtAr sÖZCÜKler: Servikal disk, Herniasyon, Brown-Sequard, Takip

No abstract