Objectives: The aim of this study is to identify the predictive indexes for post-traumatic coma prognosis, which is important to better direct acute and subacute treatments and rehabilitation efforts. The pattern of sleep organization is a potential prognostic marker, but its role has not been established yet in the context of modern critical care. In the present study, we used a new protocol to evaluate the prognostic value of the different levels of sleep–wake organization recorded at the subacute stage of post-traumatic coma.Methods: Twenty-four head-injured comatose patients were monitored with 24 h polysomnographic recordings. The predictivity of the different levels of sleep–wake organization on polysomnography was compared with other possible prognostic indexes (i.e. neuroradiological findings, age and Glasgow Coma Scores (GCS)). Main outcome measures were survival and the degree of disability after recovery from coma.Results: The presence of organized sleep patterns, but not GCS, was highly predictive of better outcome (odds ratio=10.78, P=0.01), even after correction for potentially confounding variables with multivariate analysis.Conclusions: Our study demonstrates that the sleep–wake organization pattern based on 24 h polysomnographic recordings at the subacute stages of post-traumatic coma is a reliable prognostic marker, both for survival and for functional recovery.

Thymoma has been associated with a variety of autoimmune disorders. We report a case of myasthenia gravis and pancytopenia in a 53-year-old man with lymphoepithelial thymoma and interstitial lung disease. Preoperative examination revealed neither hematologic abnormality nor myasthenia gravis. The patient had enteritis prior to thymomectomy, sternal infection in the first month of operation, and urinary infection at the third month. About three months after thymomectomy, he required mechanical ventilation support due to myasthenia gravis-related respiratory failure. One month later, a rapidly progressing pancytopenia developed. The patient died within two weeks of overwhelming septicemia unresponsive to treatment with antibiotics and steroids. The possible onset of myasthenia gravis or pancytopenia after thymomectomy should be kept in mind during follow-up. Recurrent infections in the early stages of thymomectomy may suggest a lethal onset of pancytopenia.

A retrospective study was carried out using patient files from January 2004 to December 2005 at the Ministry of Health Goztepe Teaching Hospital Neonatology Unit, Istanbul, Turkey. Enrolment criteria included breast-fed term neonates admitted with clinical manifestations of hypernatraemic dehydration (serum sodium level ⩾150 mmol/l). In all, 29 cases of hypernatraemic dehydration were identified. Tables 1 and 2 show the demographic data, clinical variables and laboratory values. View this table: Table 1  Demographic data, clinical variables and laboratory values in breast-fed infants View this table: Table 2  Demographic data, clinical variables and laboratory values in breast-fed …