BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b617 (Published 16 February 2009) Cite this as: BMJ 2009;338:b617

Preoperative renal dysfunction affects the outcome of cardiac surgery. An Iranian team used creatinine clearance as an alternative measure to the less reliable serum creatinine, and they detected occult renal insufficiency (serum creatinine ≤1.1 mg/dl and creatinine clearance ≤60 ml/min) in 6% of nearly 12 000 patients. Postoperative mortality, renal failure, atrial fibrillation, prolonged ventilation, and prolonged hospital stay were all increased in those with occult renal insufficiency. The team say preoperative creatinine clearance usefully identifies patients who warrant closer surveillance (Journal of Thoracic and Cardiovascular Surgery 2009;137:304-8, doi:10.1016/j.jtcvs.2008.08.001).

Long bone fractures seem to heal faster after patients are injected with osteoblasts cultured from their own bone marrow, according to a multicentre randomised trial in BMC Musculoskeletal Disorders (2009;10:20, doi:10.1186/1471-2474-10-20). The study, which was done over two years and randomised 64 patients to either treatment or normal healing, confirmed that the procedure is safe. Age made no difference to the outcome. Osteoblast treatment can be done under local anaesthesia and doesn’t require surgery.

The results …

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