Lancet
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Randomized Controlled Trial Clinical Trial
Effect of aprotinin on need for blood transfusion after repeat open-heart surgery.
Of 22 patients undergoing repeat open-heart surgery through a previous median sternotomy wound 11 were randomised to receive the serine proteinase inhibitor aprotinin in high dosage (about 700 mg intravenously from the start of anaesthesia to the end of operation, depending on the length of the surgical procedure). Their mean blood loss was 286 ml compared with 1509 ml in the 11 control patients (p less than 0.001), and mean haemoglobin losses were 8.3 g and 78 g, respectively (p less than 0.001). Blood transfusion requirements were eightfold higher in the control group than in the aprotinin group, 7 of whom received only the single unit of their own blood taken before cardiopulmonary bypass.
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Case Reports
Interpreting survival rates for the treatment of decompensated diabetes: are we saving too many lives?
Discussion of the case of a patient admitted to hospital with decompensated diabetes revealed a conflict in attitudes to resuscitation of the patient from that disorder and from cardiac arrest. A survey was sent to 200 diabetologists and 200 cardiologists in the United Kingdom, asking about their management of diabetes and their therapeutic approaches to cardiac arrest for 3 elderly patients admitted with severe decompensated diabetes. The response rate was poor (27%) but the answers showed that all 3 patients were more likely to be resuscitated from decompensated diabetes than from cardiac arrest. Possible reasons for a different approach to the two conditions are discussed, and suggestions are put forward for a greater involvement by patients in decisions about future resuscitation.