Faculty Bibliography

The Accreditation Council for Graduate Medical Education recently approved regulations that would prohibit residents from working more than 80 hours per week and more than 24 hours at a stretch. These regulations are scheduled to take effect in all U.S. teaching hospitals on 1 July 2003. Those who approve of the proposed regulations argue that house staff fatigue is responsible for physician error, depression, anger, and a lack of compassion for patients. But critics point to the adverse effects on key goals of house staff training--the development of accountability and responsibility. Can the rigorous discipline of medical education and the long tradition of medicine as a profession be reconciled with the current calls for limiting resident duty hours and on-call schedules? The intensity of patient care in teaching hospitals today is far greater than it was in the past. These changes in medical care make it critical to develop new programs that will reconcile rigorous, scientifically based humanistic medicine with the needs of patients and physicians. This will require imaginative and creative solutions that take a larger view of medical education and medical care than mere manpower calculations and numerical solutions focused simply on compliance with an 80-hour work week

Ranitidine is an H2 blocking agent widely used in the treatment of peptic ulcer disease. Although acute interstitial nephritis has been described in association with a related drug, cimetidine, this complication secondary to ranitidine has been reported only once before. We describe a patient who presented with acute renal failure and features of Fanconi syndrome in association with the use of ranitidine. Renal biopsy showed acute interstitial nephritis. The patient had renal tubular acidosis with alkaline urine, aminoaciduria, renal glycosuria, uricosuria, and phosphaturia. There was a marked disparity between the degree of elevation of urea nitrogen and creatinine concentrations in the serum that was attributable to diminished urea generation, since simultaneous measurement of inulin, creatinine, and urea clearances showed that they were comparably reduced. Urinary nitrogen loss in the form of aminoaciduria contributed significantly to decreased urea generation. Both acute renal failure and Fanconi syndrome resolved after treatment with prednisone

1. The effect of sea water adaptation on renal eicosanoid production in the goldfish (Carassius auratus) was studied. 2. The major AA metabolites, averaging 48 and 41% of recovered radioactivity in fresh water and sea water adapted fish, co- migrated with 12- and 15-hydroxyeicosatetraenoic acid (HETE); PGE2 accounted for only 1.6% of radiolabeled product. 3. Microsomes from freshwater fish synthesized an NADPH-dependent eicosanoid which was not identified in microsomes from sea water adapted fish. This product(s) had a mobility similar to epoxyeicosatrienoic (EET) produced from arachidonate by a cytochrome P-450 epoxygenase. 4. Inhibition of cytochrome P- 450 epoxygenase might account for the marked reduction in GFR and the decrease in free water excretion which attend sea water adaptation

The effects of placebo, propranolol, and clonidine on blood pressure and blood pressure variability were examined in 14 subjects who had moderate essential hypertension. Hydrochlorothiazide was given throughout successive 4- to 5-week periods of placebo, propranolol, and clonidine administration. During each treatment period, subjects were admitted twice to the clinical research unit for 24-hour blood pressure monitoring performed during administration of placebo, propranolol and clonidine and repeated 1 to 2 weeks later during the first 24 hours after the abrupt cessation of placebo or drug administration. Blood pressure was recorded at 15-minute intervals using an automated noninvasive recorder (Arteriosonde, Roche, New Jersey). Systolic and diastolic blood pressure readings were averaged and the standard deviation taken as the measure of long-term variability (LTV). Systolic and diastolic blood pressure in sequential overlapping blocks of seven readings were averaged and the standard deviation calculated. Short-term variability (STV) was estimated as the average of the standard deviations of the running means. During placebo administration and withdrawal, systolic and diastolic blood pressures as well as LTV and STV were unchanged. Systolic and diastolic pressures did not differ during propranolol administration from those during propranolol withdrawal or placebo withdrawal. Systolic and diastolic LTV and STV did not differ during propranolol administration and withdrawal from those observed during placebo administration or withdrawal. After clonidine withdrawal, both systolic and diastolic pressures increased to values significantly greater than during clonidine administration. These values were significantly greater than those observed after placebo withdrawal, thereby indicating rebound hypertension. After clonidine withdrawal, seven of fourteen subjects developed systolic pressure rebound; diastolic pressure rebound was observed in three patients.(ABSTRACT TRUNCATED AT 250 WORDS)