JAMA 13 Oct 2010 Vol 304
1559 Cardiac surgery was once considered too bloody even to contemplate: now it is commonplace. But there is still no agreement in practice about how much blood should be transfused following heart surgery - rates of transfusion vary between 8% and 93% in similar units across the USA (p.1586). The Brazilian TRAC trial randomised heart surgery patients to be transfused to achieve a target haemoglobin level of 10.5 g/dl in one group and 9.1 in the other. Outcomes were identical. An accompanying editorial is entitled "Blood Transfusion as a Quality Indicator in Cardiac Surgery." Enough said.
http://jama.ama-assn.org/cgi/content/abstract/304/14/1568http://jama.ama-assn.org/cgi/content/abstract/304/14/1559
Lancet 16 Oct 2010 Vol 376
1303 A nice clear NHS-based study shows that the results of renal transplantation are equally good from kidneys donated after cardiac death as from those donated after brain death. The most important factor is not the mode of death but the cold ischaemia time.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60827-6/abstract
Arch Intern Med 11 Oct 2010 Vol 170
1622 A decade ago, much hope centred on the fact that levels of homocysteine correlate well with cardiovascular risk, and so it followed (we thought) that using B vitamins to lower homocysteine was bound to be a simple and effective way to reduce the population risk. One person talked to years ago about possible primary care studies was Robert Clarke, now principal author of this meta-analysis of 8 big randomised trials. Every trial succeeded in lowering Hcy but utterly failed to make any impact on cardiovascular outcomes, cancer, or all-cause mortality. You can't push some risk curves the other way by known interventions - as we've also found with a wide range of blood sugar.
http://archinte.ama-assn.org/cgi/content/abstract/170/18/1622
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